Thursday, September 4, 2008

The Elephant in the Room

I, like many women, and perhaps like physicians in general, am averse to political activism. Medical problems have, or we are taught to think they have, right answers. Controversy and disagreement are uncomfortable to us, implying that our judgment or knowledge is somehow at fault. Even the formal exercise of an M and M conference does not help us recognize and accept legitimate differences; at the end of the disagreement, the pathologist is there to provide the single right answer. And as women, we want to make others feel accepted and comfortable. So I am reluctant to take a political position in this blog. Some of my best friends, etc....

I am not about to rant on either candidate, but I do want to share my dismay at some of the health care issues that are going to be affected by the outcome of the next election. A friend of mine in Hawaii wrote to me that blue cross/blue shield in her state requires women to pay higher premiums than men--and gets away with it! Yes, women have expenses related to reproductive care that men don't, and yes, we live longer. But the whole idea of health insurance is to spread risk fairly through a population. Differential pricing by gender implies that men are the true representatives of the population and women somehow deviant from the norm (despite being an absolute majority). This stands the very edifice of health insurance on its head.

Beyond reproductive health care services like abortion and contraception, adequate insurance for the elderly, including nursing and other support services, are also "women's issues." When insurance fails to cover services, it is typically women--wives and daughters--who pick up the responsibilties of caregiving. When insurance does not pay for services for children, it is mothers who step in fill the vacuum. Now that women are more productive in work outside the home, the economic costs of us having to cut back our own work to become caregivers are huge, and rarely acknowledged.

The underlying problem is one of state/federal conflict, not necessarily Democratic/Republican differences. The regulation of private health insurance is a state rather than a federal function. Many insurance companies have budgets--and therefore political clout--larger than the state governments that regulate them. Only the federal government is large enough and strong enough to rein in the rogue health insurance industry. Personalities and records aside, this mother in medicine is going to vote for the candidate who believes in using the power of government to regulate crucial service institutions directly, not through byzantine manipulations of the tax code. Three guesses as to who that will be.


  1. I spent medical school and residency believing in socialized medicine. I was going to the rallies and speaking w/ my representative about the good that would come about w/ government-backed medicine. I went into primary care so I could better care for the poor and uninsured. Now having spent 3 years working in an inner city clinic w/ all medicaid/medicare patients and the past 10months in a VA clinic (which is completely gov't run), I have made a complete 180 on the idea of the gov't managing any portion of healthcare. Especiallyin the VA system, it is not a matter of unequal or unfair access to healthcare. Instead, it is a complete lack of access to healthcare. The majority of our patient are older w/ a slew of problems. I work at one of the larger clinics outside of the main VA hospitals. We are able to draw blood. That's it. Even that is being threatened to take away. An x-ray of anything is 45min away
    -urine dip - 45 min away
    - CT scan - 45min away
    - MRI - 2hrs away
    - most specialists - 2hrs away
    We are not even supposed to be checking spot glucoses. To get an wrist brace for carpal tunnel, again 45min away. We cannot prescribe anything off-label (i.e. cannot get Lyrica for HAs, even if we know it works). Just recently were able to start prescribing Lantus for our pts w/ overnight glucose lows. And women's care- forget it. I can do a pap, that's it. We're not allowed microscopes or slides to check for anything like BV, fungus, trich, etc. Again, 45min away. And that's just from our clinic. Many of our patients drive 1-2hrs just to get to our clinic.
    Despite our complaints, and our concerns regarding our limitations to appropriately care for our patients, we have more and more taken away from our clinic secondary to "budget cuts", though many times, it's someone on top flexing their muscles.
    Working w/ mostly Medicaid/Medicare patients was only slightly easier. The sheer amt of paperwork involved in trying to get anything ok'ed was staggering. And again, there were barriers to access everywhere.

    Don't get me wrong, I don't think the current system is good, but I think the government taking over would make it unimaginably worse.

  2. Hey, I thought there were no health care problems cuz anyone who needed care could just go to the ER? I see absolutely no huge major gaping problems with THAT solution ;)

  3. Any reforms in our healthcare crisis will need reform of the current malpractice situation. We also need a cultural change that says we need to accept personal responsibility for our own healthcare (care for our own bodies, watch excesses, exercise etc.), and that bringing a lawsuit against someone is not one of the freedoms guaranteed by the constitution.

  4. Responsibility: What is that? If one knows anything about the generation of high school students that is rising up in the U.S., they would literally swim/run/jet to another country. As a former substitute teacher in an urban school district, I had my days of being abused and bullied, and it was my lack to control the classroom. The students got away with everything! Keep in mind, in one classroom I had 3 (THREE) uniformed police officers and 30 students in the classroom, and my cell phone was stolen from my pants pocket. I was informed it my fault, not the students who stole it. Please note the only reason I had it, was my life was in my hands as I had literal death threats. Oh by the way, I have to carry my own health care insurance, and I pay $35.00 more dollars per month, than males my age.

  5. it was my lack to control the classroom. -

    The administration blamed me and stated it was my lack of ability to control the classroom.

  6. Reply from poster: I agree that any health care reform has to include malpractice reform and some effort to consider the cost of medical education and medical debt. We as physicians need to advocate for our own interestes, but it should not be at the cost of opposition to efforts to extend health care to others--we justifiably lose the public's trust if we do not put their interest at least on par with our own. Tax policies that merely encourage individuals to purchase insurance on the open market cannot achieve these multiple, complex ends, which will require much more direct regulation and reform.

  7. Wait...women have higher expenses and you're complaining because they have to pay more for insurance? Wow. Are you also mad at the grocery store for having to pay more for a full cart than the guy next to you with 2 items? Insurance is not socialism. It's risk management by a private company.

    Hey, I don't trust the government to deliver my mail. Dear God, don't let them have any more control over healthcare. They already have way, way too much control.

    That government is best which governs least.


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