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You Can Always Count on Americans
- Categorized in: Editor in Chief
“You can always count on Americans to do the right thing—after they’ve tried everything else.”
Attributed to Winston Churchill 1874-1965
It is unclear if Winston Churchill actually ever said this, though there are a number of versions (all attributed to him) on the Internet. Nevertheless, as a student of American history the truth of this comment resonates with me. Particularly in light of the recent American healthcare reform bill debate. After years of failed effort, the House finally passed HR 3590 (Patient Protection and Affordable Care Act) into law by a vote of 219 to 212 (without a single consenting Republican vote) on Sunday, March 21, 2010. This historic legislation represents a course change in a healthcare system that has worked well for the insured but leaves few options for the less affluent in our society. This healthcare ‘disconnect’ has plagued presidents as far back as Theodore Roosevelt, the first president to advocate for universal healthcare in the United States.
As with most important decisions within a democracy, there are many opinions regarding, and opponents of, change in our current healthcare system. The debate in Congress and the media has been serious and at times farcical. Fears of government sponsored “death panels,” denial of lifesaving medical treatment, or concerns of universal healthcare ‘socialism’ are just a few of the contentious issues that have inflamed passions and at times even led to violence. As a federal healthcare provider in one of the larger universal healthcare systems on the planet, I feel I have followed the debate dispassionately. For those of you who must know, I am a registered independent voter.
The bill, from my point of view, does appear to be a positive step in the right direction for healthcare in this country. Arguably, the recently passed legislation is not perfect and there will be repercussions and unintended consequences of the bill as it is phased in by 2014. The absolute worst move would have been to do nothing. We already have a ‘socialized’ system of healthcare in the United States, it just happens to be one of the most costly and inefficient systems. A visit to any hospital emergency room will confirm the plight of our millions of uninsured citizens. These patients often put off less expensive preventive health measures until they are too ill to avoid the hospital. They use the nation’s emergency rooms as a substitute for primary care. The uninsured are billed for this care, but often do not have the means to pay, and the cost of this care is eventually shifted to the insured population in higher premiums (sometimes referred to as the ‘hidden’ healthcare tax). This approach is unsustainable.
Some have suggested that universal healthcare in this country will dilute the quality of care that marks the United States as world leader in medicine. Interestingly, countries such as Canada or Great Britain that maintain nationalized health systems that supply universal health coverage, maintain higher satisfaction rates with the availability of healthcare services among their citizens when compared to the United States. When citizens of each country were asked to rate the quality of their medical care, responses were very similar (Gallup, 25 March 2003).
I have always cherished the freedom of practicing medicine within the federal system, insulated from market forces. Perhaps I am naïve, but I do see healthcare as a fundamental human right. Admittedly, I do not consider myself an expert on healthcare reform legislation. I see HR 3590 as the first positive step in a healthcare reform project that is just beginning in this country. Finally, I have an abiding love and enthusiasm for our system of government. Like Churchill, in the end, I believe Americans will do the right thing.
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The opinions expressed here are solely those of the author and not necessarily those of U.S. Medicine, Marathon Medical Communications, Inc. or the United States government and its agencies.
Survey
Does VA have an appropriate number of specialty physicians to meet patient-care needs?
Dr. Buckenmaier,
I particularly liked your “You Can Always Count on Americans” piece in the May issue. I am retired from the Navy after over 30 years of active and reserve service. Plus I have just gone over 20 years with the VA. One of my surgery professors in med school once said that sometimes you just have to do something even if it’s wrong. Another great philosopher, Iggy Pop, sang that Americans are scared to death of failure. I truly believe that. The health care reform battle is not only a sad demonstration of party politics but one of fear of making a mistake. Healthcare has to be fixed. So you don’t get it all right the first time. You fix it down the road. Spending as much time as I have working for the government, I have certainly seen far too much of the operative word being “no”. No to new ideas, “no” to worthwhile initiatives to improving patient care and most frustratingly “no” to actions that would have allowed us to hold on to young bright physicians whom the VA critically needs.
All because we can’t make a decision or go against the grain for fear of being wrong. It’s OK to be wrong. That’s how we learn to be right. Thanks for writing your editorial.
Dr. Gary Harpold - VA
Dr. Harpold,
I appreciate your kind remarks on my U.S. Medicine editorial. I also have been frustrated at the culture of 'no' that seems to permeate the federal health care system. Fortunately, I am always impressed how individuals within our system make it work despite itself. I would be very pleased if you could provide your opinions on topics you would like to see addressed in future issues. Cheers, Trip
Chester 'Trip' Buckenmaier III, MD
COL, MC, USA
Chief, Acute Pain Medicine
Walter Reed Army Medical Center
My mother in law has increasing dementia and has become very frail and weak. Trying to avoid nursing home care, she is being cared for full time by another daughter. Unless there is assistance from someone else in the family, that daughter has to be at home 24/7 and has full responsibility for bathing, toileting, medications, etc. A recent visitor from Australia was amazed that there was no other help available (other than expensive private care nursing). In Australia such a situation is unheard of. There would be in home medical support provided by their national healthcare--at no cost to the patient. I am in hopes that our country will get to such a point eventually.
It is heartening to know that someone else in the healthcare system acknowledges the possibilities that the new healthcare bill offers. While certainly not perfect, it allows the country to try to make healthcare provision in this country more inclusive and more efficient. The current system is difficult to navigate even for health professionals at times and next to impossible for the layman. Even those who are insured privately have limited or insufficient coverage. Medical costs are one of the leading causes of personal bankrupcy in this country. The current system is embarrassing and unacceptable for a nation as rich in resources as we are.
As a physician assistant with the VA, I am thankful that our veterans have the opportunity to receive healthcare. It would be a wonderful thing if their family members and friends had the same opportunity. However many of our patients and staff members complain about the new healthcare bill. Perhaps they fear it will impact their level of service. In reality the hidden costs of covering the uninsured already gravely impacts the healthcare system.
The Constitution and Declaration of Independence both speak to the responsibility of the nation to ensure the welfare and safety of it's citizens and the citizens' rights to "life, liberty, and the pursuit of happiness". That can only be accomplished if the nation's citizens have the ability to try to preserve their health without the threat of onerous debt. We need to unite as a nation and and work to make healthcare reform the success it can be, to improve quality of life for all.