Pickaway News Journal

Thu, Jul 20, 2017

INTERSECTIONS: Debating health care reform

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The following words were my opening remarks at the Ohio State University College of Medicine debate on health care reform held on May 3:

I am Brad Cotton. Decades ago I was a student in this very room. I am honored to have almost 40 years of service in emergency medicine. In the emergency department, we try to care for all those cast aside by our profits-before-care health system. Speaking out today for single payer improved "Medicare for All" to protect my patients is part of that caring.

We are here to debate this most critical of subjects: Is health care a commodity to be sold to the highest bidder on the market, or is it a human right to be guaranteed by a civilized society?

Anthropologist Margaret Mead was once asked what archaeological signs portend that a society has become civilized. Mead answered that finding a healed femur fracture proves both compassion and civilization, as they are one and the same. Someone did the hunting and gathering, the feeding, the caring for this injured proto-human. Even under the Affordable Care Act, this femur-fractured citizen today had better be prepared to be a player in the market, with insurance, deductibles, co-pays. Which society was more compassionate? The tribal community or the avaricious market?

Tim arrived by EMS aphasic and hemiplegic. As is so often true, Tim can say formulaic speech like "hello" and "how are you" well; all other attempts meet with frustrated flailing of his left arm. Tim's right arm is stilled, likely forever. He had used that arm as an auto mechanic to support his wife and two teenage girls. Now he can't even talk to them.

Tim's wife arrived, still in her Bob Evans server uniform. I always tip servers well--they have a hard job. I am a server also, waiting on beds in the ED instead of tables at Bob Evans. Takes the same set of skills.

Tim's wife says, "I'm glad you're our doctor--you were so good with Tim last time." Tim was here three months ago, here for A-Fib with RVR. He had wanted to sign out of the hospital, knowing his insurance had a $10,000 deductible. A good man, he was worried about braces for his girls. Tim's wife had helped me talk him into being admitted that time. Her thankfulness on seeing me is genuine.

Tim has missed the window of opportunity for TPA. The CT perfusion studies show no penumbra--a completed stroke. A good man to his wife and children. Now he is nearly helpless, can't even talk. I think of the pride I take in doing emergency medicine in the third busiest ED in Columbus. How would I deal with that taken away?

Tim's horror has a name, has a cause. It is US profits-first, market-based healthcare--the only civilized nation in the world that trusts corporate board rooms to look after our health. Remember Margaret Mead's definition of civilization as compassion?

Tim's family was financially destroyed by his first hospitalization for A-Fib. Tim could not afford the co-pays for follow-up care, he could not afford the meds that kept his blood from clotting in his fibrillating atria. His heart spit up a big, ugly clot - ugly because it was preventable - that plugged up his middle cerebral artery. Tim's stroke was preventable. Markets, profits, "American Exceptionalism" and our stubborn refusal to learn from other nations that take care of every single one of their citizens for about half the cost took away Tim's speech, his job, his everything.

I see good Americans, our neighbors who fix our cars, wait on us at Walmart, cut our hair, every single shift in the ED. They have nowhere else to go. They suffer from untreated hypertension, diabetes, arthritis, COPD. Untreated even with Medicaid--which conservatives in Ohio are working to extract more cash from those who have none--even with Medicaid, many docs refuse to treat them.

The evidence, data, the numbers are overwhelming, clear and inescapable: US health care is among the worst in the civilized world as measured for outcomes, and repeatedly rated dead last for equity and fairness. The US has the highest financial barriers to care, highest rates inability to afford needed care, meds and follow-up. Sixty percent of all US bankruptcies are due to medical expenses. Prior to the ACA, 50,000 of us died yearly directly as a result of having no health insurance. Properly implemented, which isn't happening as many conservative governors are refusing to expand Medicaid, the ACA cuts the number of uninsured by only about 50 percent.

I have very little tolerance for Ayn Randian armchair theories about the role of free markets and limited government. Neither does Tim, my stroke patient, as well as his suffering wife and family.

I share three favorite quotes:

Martin Luther King: "Of all the forms of inequality, injustice in health care is the most shocking and inhumane."

Marcia Angell, MD, former editor of the New England Journal of Medicine: "We've engaged in a massive and failed experiment in market-based medicine in the US. Rhetoric about the benefits of competition and profit-driven health care can no longer hide the reality: Our health system is in shambles."

Wendell Berry: "Rats and roaches live by competition under the laws of supply and demand; it is the privilege of human beings to live under the laws of justice and mercy."

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