If it ain’t broke, don’t fix it . . .
That phrase is attributed to a Georgia farmer and popularized by Bert Lance (Office of Management and Budget) during the Carter administration. That was just a few years after President Lyndon B Johnson pulled off a big fix to health care. On July 30, 1965, LBJ signed H.R. 6675 in Independence, Missouri, making Medicare law. During the ceremony, Former President Truman was issued the very first Medicare card. Medicaid, the program that is part state and part federal funding which provides health care for the poor and a large part of long term care, was established at the same time. Both Medicare and Medicaid greatly expanded access to needed health care. But if you work in health care or have been a patient you know firsthand that health care is broken today. Too little for some and too much for others. A maldistribution of providers and services with the goal of profit.I finished my Family Medicine residency in the late 1980s and quickly learned the system was broken. I joined the group of doctors advocating for single payer. I gave talks during grand rounds and at continuing medical education meetings, talked at citizen rallies, shared stories from the trenches with legislators, helped write single payer legislation, testified and served on committees. At that time, Minnesota expanded Medicaid, then the Clinton Managed Competition effort rose and fell thanks to insurance company’s effort to sink reform with the Harry and Louise commercials. Since then, the stats have climbed only higher: numbers of un-/under-insured, cost per person in the US, salaries of health care executive CEOs, infant mortality, etc.
I recently met family physician Dr. Michael Fine who has spent most of his career in Rhode Island. He just published Health Care Revolt. At this point, I didn’t think there was much more for me to learn. But Dr. Fine does much more than updating the stats and sharing recent tragic stories of failure. He helps us understand what was right and wrong with Obamacare. He showcases modern success stories. His final diagnosis isn’t far off from mine—Health care is benefiting the health care executives, the pharmaceutical companies and the insurance companies while we spend lots of money on expensive procedures that don’t really keep people healthy. As a result, many of us feel tired out, used up, and heartbroken, because the work lives we have aren’t what we want and we aren’t doing anything like the work we went into the health professions to do. Dr. Fine reminds us that more is at stake: the wealth extraction system that passes for health care in the U.S. is helping to destroy our democracy.He maps out a solution which the title gives away: a revolt. But how cockamamie is this? Nurses at the other health system in my area are getting ready to strike next week. Nurses I talk to are worried about the safety of patients given the staffing ratios and demands on their time. It is not about caring, it is about numbers. Physicians have not unionized, but they should. Dr. Fine calls for a million health professionals march on Washington to demand changes in the laws. And he proposes a unique way of striking: We must never stop patient care. Our strikes must focus on the stupid work that only enriches others.
We can and must refuse to do the preauthorizations and preapprovals and to sign forms that don’t matter.
We need to refuse, together, to use the electronic medical records until they change the software so that those computers free us to look at and listen to patients instead of looking at and listening to computer screens. Until they build us computerized records that support our work.
Not many physicians I know would disagree with those demands.Dr. Fine has written an easy read and a sound call to action. As someone who’s been working for reform for thirty years, I too am weary and losing hope. But Dr. Fine reminds us not to be complacent. And I remind you to get educated, if you’re not. Find your hope. And join others in taking action. As physicians we owe it to our patients. This is about professionalism—fulfilling our duties as physicians and healers. Health care is broke. Help fix it.