Doctor, Filmmaker, Commentator, Joe Wright
Joe articulates so effectively the frustrations of so many doctors and patients and loved one and friends, as we weather the many challenges of a healthcare care system in crisis.
Laying the Blame
(aired on All Things Considered in slightly different form on March 21, 2005)
My patient says the pharmacy says her health insurance isn't valid. Like a lot of people in the US, she's got just a little bit too much money to get health insurance for the indigent, but not enough money to buy health insurance on her own.
Advocates for universal healthcare like the slogan "Health care is a right, not a privilege." Put it on a bumper sticker if it sounds good, but unless she has an immediate life-threatening emergency, my patient can't claim a right to healthcare any more than she can claim a right to pizza delivered to her house for free. A right is just a wish if it can't be claimed.
And so my patient asks us to intercede with our blue-state bureaucracies of mercy; we call the bureaucracies of mercy on the phone and beg them to understand; they suggest another phone number for someone who might have actual mercy to offer, and so on. Year after year, doctors who care for the working poor watch their patients fight these battles.
Sometimes, like my teacher who is my patient's real doctor, they try to help. She's arguing with some phone-answerer, and I'm sitting on hold with another, and my anger starts brewing. And the next step from anger is thinking about who I should blame.
I could blame politicians, who know about the increasing number of Americans without health security, and yet do nothing. I could also blame American voters generally: they often tell pollsters that they favor some form of universal healthcare but they don't punish politicians who fail to deliver it.
But looking back on history, I'm angriest about the role of doctors. The most prominent organizations of doctors led the way against most of the twentieth century's proposals for universal coverage. They lost their fight only once, when Medicare and Medicaid were created to care for the elderly, the disabled and the indigent. FDR decided not to make health insurance part of the New Deal because he couldn't afford to add doctors to his list of political enemies. Truman tried to fight what he called the "medical lobby" to get national health insurance. But in that early part of the Cold War, doctors' groups successfully made national health coverage sound like communism. And why did they oppose national health insurance? Two main reasons: They wanted to keep getting paid whatever they wanted to charge. And they didn't want bureaucrats looking over their shoulder making medical decisions for them.
By the time of President Clinton, doctors had lost both of those battles, but to a different enemy. As doctors drove medical costs up and up and up, employers got insurance administrators to control prices and restrict medical decisions. By the time President Clinton proposed a national healthcare plan, it wasn't doctors who really killed it; health insurers were the ones who really profited from the system, and this time, they paid for the campaign to keep the status quo.
So now my generation of doctors works amidst both the heartlessness of the market and the stifling rigidity of bureaucracy. Doctors are waiting on hold in the cubicles in the back of the clinic. Out in front, my patient is staring into some middle distance, wondering how she'll make it through. Past generations of doctors saw medicine as a business. Defending their businesses, they managed to persuade Americans that healthcare is a privilege, not a right.