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Donna Smith

Donna Smith, American SiCKO, is executive director of the Health Care for All Colorado Foundation

March 14th, 2010 4:34 PM

When Patients Own the System: A Progressively Financed, Single Standard of Care for All

The national legislative healthcare fix that may be passed by the 111th Congress and then signed by President Obama will do little to relieve the stresses felt by most patients in this country. The steady decline most of us have seen in the kind of quality medical services we need is not likely to be mitigated. Insurance companies will grow ever stronger and more deeply ensconced, and the patient voice will fade more quickly from prominence than it has in recent years.

Patients have been props in this discussion. Patients are widgets in an economic system. Patients are an annoyance to insurance companies who worry about the medical losses (claims) as a loss of profit and often even to providers who must carefully screen patients to make sure they come with profit potential via their insurance coverage or very deep pockets full of cash for payment. Pesky patients.

And nothing – nothing – in the current legislation disrupts this process from deepening.

The results are mind boggling and devoid of any ethical grounding which would lead anyone to believe that healthcare is a human right in America.

I know scores of patients – people who need medical care – who tell me about their personal journeys. They are often shuffled from provider to provider getting whatever medical tests or procedures are approved by their insurance companies while not receiving even one stitch of treatment or relief for the issue that brought them to seek care. The money flows; the patient is not treated. Maybe a pill. Maybe.

The practice of medicine has long ago shifted away from being a patient-centered art and science, from the perspective of most patients I know. Most providers spend very little hands on time with patients and even less listening time. Nothing about forcing the purchase of private, for-profit insurance will change that reality. And finding that one or two providers who still care enough to try to provide kind and compassionate patient care is a daunting and long process for most patients I know. Most give up and just get care when they have to and put up with being treated as an annoyance, an irritation in a system that just wants to take more and more profit with less and less contact with the patients who generate that profit.

The costs of that shift form the practice of medicine to the profit-taking of the medical business is enormous both in dollars and cents and in human decency. People spend long days and weeks and months seeking a medical home – somewhere that they can trust to provide the right care at the right time with just a touch of kindness instead of the nasty, condescending atmosphere so many patients endure just trying to make appointments, get test results or God-forbid ask a question over the phone.

I know a seriously ill person who has at least five different providers. Yet this patient is slowly wasting away while begging someone, anyone to take his symptoms seriously. Not one of the providers has an appointment time in anything less than five or six weeks – and all have office staffs that grow angry if questioned about that wait. No one on the other end of the phone wonders what is making the patient feel bad or even suggests a way for some earlier treatment. Not one provider who has made thousands of dollars on this patient’s behalf cares enough to want to find out how they can help. The providers simply have all the revenue streams they need coming through the door so one patient’s life and one patient’s suffering doesn’t matter much in the scheme of things.

Nothing in the reform bill will interrupt this hideous and relentless process for many patients. You simply cannot legislate a system drunk on money and massive profits to care about patients. We, the people, need to control the system – our money, our system, our lives. Nothing but a progressively financed, single standard of high quality care should be allowed. It should be a crime to do less.

The U.S. healthcare system represents more than 16 percent of the gross domestic product. That’s a huge chunk of the economic energy of this nation. That’s going to get bigger and bigger in the years going forward. And as the financial linkages and economic impact of the system grows, the patients’ individual significance will continue to lose ground. It’s simply a numbers game.

My biggest worry is that the diminishment of caring and compassion will accelerate that has escalated in recent years with managed care and for-profit insurance driving medical decisions and therefore medical profits and therefore how providers really treat patients.

We, the people, must own this system or it will own us. Public, progressive financing of a single standard of high quality care is the only way to protect patients from the abuses.

I remember days not so very long ago when patients were treated so very differently. We’re never going back to those days but we’d better stop the trending. Patients need to band together, share information about provider practices and take a stand together – it must be our system. Or the profit-takers will make their fortunes ever larger on our suffering and pain and never look back for an instant.

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