There is a new book out this year, authored by Otis Webb Brawley, M.D. and Paul Goldberg, which addresses many of the flaws of our current medical care system. This book is a sweeping indictment of the disparity of health care between the insured and the uninsured, of the use of those treatments which will provide the greatest profit for the physician, of the greed of the pharmaceutical companies, of the disdain those pharmaceutical companies have for human suffering if their product gives them great compensation, the misuse of our Emergency Rooms, the compulsive use of futile expensive intensive care treatments, when death with dignity would be much better, and of the lack of common scientific sense, when treatments are given without proven benefit, but with disastrous side effects. All of this is deserved, and certainly should be known by all of us as the possibility of universal health care is debated.
The forces opposed to a universal health care plan which would eliminate the vast majority of these terrible flaws are extremely powerful. The insurance companies do not want to give up their immense profits. The pharmaceutical companies are most unwilling to relinquish their corporate greed. Medical device suppliers, who are in a competitive rush to develop the fanciest and most expensive testing and treating instruments, are highly resistant to losing this bonanza of profit. Conservative senators and congressmen are vehemently vying with one another as to who can claim to be the most conservative, who can claim the most to stand for “American values,” and who can the most vociferously denounce a health care plan that will anger their strongest monetary supporters. Candidates for presidency bray with mulish blind resistance against any medical health care system that will “take away the right of the American citizen to choose.” All of them splutter when asked how they plan to meet the health care needs of the uninsured, a dense problem for which all the rest of us pay dearly. This non sequitur amongst those who would lead our country is deeply disturbing, when we desperately need a system that will serve all our people, and cure these ills.
Having said as much, I disagree significantly with some of Brawley’s long list of complaints, and also take great umbrage at other parts of this diatribe. Brawley is an oncologist, and does not see all of medicine through the eyes of multiple other disciplines. He sees only what he knows through his own specialty. He is opposed, for example, to some recent innovations which, although more expensive, are nevertheless important advances, such as IMRT and robotic surgery. His opposition to these advances and many other things seems intended to only make him appear more righteous and heroic. He casts himself as the only voice of reason against a crowd of others who pursue false doctrines and improper treatments. I take great umbrage at that exclusion of the rest of the medical community. I am offended that he does not appreciate my personal efforts all my life to always do only what is right for my patient, and nothing else, and to recognize that I am only one of a large body of physicians who are just the same as me. The majority of those physicians with whom I have practiced during the last fifty years have been deeply dedicated to giving their patients the best care that they can give. I am sorry that Brawley does not recognize us, and the volunteers of Haiti, the volunteers of the Asian tsunami victims, the volunteers for the African dispossessed, and the volunteers of the inner city clinics which care for the poor. The full picture of our medical care in this country deserves great blame, just as well as it deserves great praise.
Sadly, this is not a lesson I have not painfully known for the last fifty years. When I went to medical school, it was so I could best serve as a missionary. I thought I could do more good as a missionary to underdeveloped regions of the world if I had medical knowledge, which I could give to those in need, and train them to take care of themselves. I thought that all the rest of the students in my class would harbor similar altruistic reasons for going into this field. It was quite a revelation to my closeted mind to find that more than half of them were talking about how much money they planned to make in their chosen careers. That statistic, unfortunately, has not changed a great deal, in my experience. We live in a capitalistic society, in which monetary gain is emphasized more than altruism. We have prospered immensely, as a society, from this emphasis on exploration and gain. We have enjoyed great freedom to develop whatever programs or services will give us profit. We have not been, until recent decades, stultified by oppressive government regulations and programs. We have allowed the market to speak for itself, and for the most aggressive marketer of the best product to win. America is a great country because of this freedom.
But what do you do when capitalism runs amuck? You get what we have now. Those in power are becoming more powerful. Those in control are becoming more controlling. Those who are rich are becoming richer, and those who are poor are becoming poorer. Our middle class, the backbone of our stable society, is disappearing. Watch out, America. Allow these disparities to develop further, and the revolutions are coming. The terrorist attacks will increase. The paralyzing split between our liberal and conservative legislators will increase. We will not be able to defend ourselves abroad, because we will be mired in debt trying to control all other nations as well as solve our domestic problems.
One certain way to help turn our ”Ship of State” around from this disastrous course, away from capsizing storms, and toward calmer and balmier waters, will be to develop Universal Health Care. This is a must. We have to realize that we are all in this together, and unless we take care of all our neighbors, we are not going to survive as a society. The answer is not raw capitalism. The answer is not communism. The answer is somewhere in between, in a society that takes care of its own, with respect and dignity. I detest drug company ads on the television, trumpeting their latest and most expensive medicines. I shudder seeing drug company representatives in our clinic, buying lunches, persuading clinicians to use their latest and most expensive products. I detest politicians who rail against universal health care, when they all have expensive health care. It’s time to take the profit out of medicine. It is time we take care of each other, as all our religious seers have taught us to do. It is time to take their lessons to heart.
We either learn to take care of our own, with full respect for all other humans, or the bad times and the revolutions are coming.