CMR: Chief Middle-management Resident (medipol) wrote,
CMR: Chief Middle-management Resident

An awful smell coming from Washington

Liberal America has been overcome by nausea and malaise caused by an awful smell emanating from Washington, DC. I think it's the smell of sausage being made ...

Yes, the health care reform bill stinks. It smells to high heaven right now. It's just plain awful, and everyone near it is holding their nose and breathing through their mouths. Including the health care types, who don't even wince at the blast of a melanic stool or the stench of a gangrenous foot.

It's really bad, that thing they are cooking up in Washington. They've tossed out all of the fresh ingredients like the public option, and thrown in some seriously unhealthy stuff -- like an individual mandate to buy health insurance.

It reeks, indeed, but it's the only meal we're going to get served this year, or even this decade. And we're just going to have to swallow the swill that Joe Lieberman is dishing up if we want to have any hope of making a better health care system.

The Senate bill is undesirable for sure, but the status quo is worse. The status quo allows insurance companies to dump patients the moment they get sick. It allows insurance companies to stop paying out when patients cost them too much (and they get to define what "too much" is). And those are the people who can even get insurance -- those with pre-existing conditions are deemed Untouchables by the insurance industry.

Those are the options we face right now: reform that applies a few more patches around the edges and doesn't do much to fundamentally alter the system, or a status quo that lets 18,000 people die every year because they don't fit into the for-profit business model of insurance.

Pretty grim choices.

On one hand, we have the party that is a herd of cats. And on the other we have the Party of No! But remember, only one side is even offering a choice, even attempting to address the problems. To switch metaphors for a moment, at least the Dems are on their feet and stumbling around (occasionally even in the right direction). The GOP is plain passed out in the gutter. The GOP's hope for coming out ahead on this is that the Dems stumble into the path of an on-coming car. It's hard to describe either image as "leadership", but I'll side with the guy on his feet -- he at least has a chance of getting home.

As a physician, I know that it takes a long time and hard work for patients to take control of their illnesses and move to better health. And through every long change process, there are set backs and moments when it feels like things will never get better.
As doctors, we work with our patients through the hard times, and help them take the small steps that lead to health. We help them through the tough patches, but we don't abandon them when they have set-backs. We are partners with our patients through the whole process.

Our health care system has been seriously ill for a long time. It will take a long time to bring it back to health. We of all people should know that there isn't a magic pill that will cure all ills overnight. Our health care system has a chronic disease, that has to be overcome in small bits, day by day, through a life-long process. There is no magic solution to making our health care system better - only hard work and thoughtful effort.

Right now, we have a key moment to make critical decisions that will make the health care system better. Not every decision will be for the best, but we need to stick with our "patient" to help guide it through the long-term reform process: legislation, regulatory process, state-level responses, etc.
There have certainly been set-backs during this reform process, but we need to stay with the process and help guide the reforms, now and in the future. Our patient will not always make the best decisions - we need recognize that. And while we may not agree with those decisions, now is a critical time for us to be engaged and to continue providing our recommendations.

We need the Senate to pass something (anything!), so that we have a starting point for the debate in the conference committee. "Starting over now" will lead to a certain death - we'd be starting in a weaker place than where we were after Obama's election. This is our chance to any reform in this decade: insurance reforms, coverage expansion, malpractice models and payment reform ... all are necessary and better than than the status quo. We need to make this a victory, and use it as momentum for the next steps. Otherwise, we'll have more of the same: rapid cost increases, less insurance coverage, and more medical bankruptcies.

That smell from DC is foul, rank and nauseating. But it's better than the rotten, spoiled gruel we're eating right now.
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