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Coates: Political Divisions Harm Health

The government shutdown and the disconnect on health care By Andrew D. Coates, M.D., F.A.C.P.

I’d like to offer some thoughts this week about the discussion over health care in Washington. We’re heading into the second week of the federal government shutdown, in which the right wing of Congress has demanded that President Obama step back from his health reform.

This reveals to me the shocking disconnect between the center-stage discussion in Washington and the everyday discussion we have at our kitchen tables, at our jobs, and with our friends.

Back in February 2009, the president hit a note of urgency when it came to health care reform. He said before Congress, “Let there be no doubt, health care reform cannot wait. It must not wait. And it will not wait another year.”

At that time the president tapped in to popular sentiment, because everyone knows that our health care system is broken, that on a world scale it is mediocre and even disgraceful. Too many undignified medical encounters take place simply because money is involved, where it never should be in the first place.

And yet the debate in Washington seems to me to prove the thesis that there’s a 1 percent and a 99 percent.

Because the debate in Washington is among, on the one side, a right wing that believes there should be no government intervention in health care whatsoever. This side believes that some individuals deserve to be sick, even deserve to die – that they deserve to go without health care because of the choices they may have made in their lives.

Meanwhile, on the other side – among the “left” of the 1 percent – there’s an idea that any government intervention could be a good thing, even if it’s government intervention to manipulate a profit- driven health insurance marketplace in a way that recruits more customers for private health insurance companies.

So this debate about where the government should be, and its proper role, becomes intense in Washington. Meanwhile, the government is profoundly involved in the health care system. In fact, a majority of health spending in the United States of America comes from taxpayers. 

A majority of spending already comes from public sources.

And so the debate makes little sense. It reminds me of 2009, when the right wing was yelling “Government takeover!” and the left wing was yelling “Public option!,” and neither the right, nor the left, was talking about something that was included in the president’s Affordable Care Act.

So where will things end up? I believe that this country has great promise as a democracy, and that no modern democracy can afford to neglect the health needs of its population. We have everything it takes for a first-class, outstanding medical system for every person in the United States. We have wonderful nurses. We have excellent and highly trained doctors. We have terrific research and hospitals ready to go.

What we don’t have is public control over the financing. Heath care costs rise, and rise again. Doctors are blamed, technology is blamed, all kinds of excuses are made, but in the final analysis, nobody will say what the real cause, underlying it all, is.

Underneath it all, health care is becoming an industry. It’s becoming a business. And there are myriad new forces within the system, each trying to extract their tiny profit, and this drives all of us crazy. 

But it also drives prices and costs ever upward.

It doesn’t have to be this way, and everybody knows that. So when the discussion takes place in Washington, the disconnect kicks in. The 99 percent of us continue to have those undignified experiences. The consequences, of course, are grave in the short run. But in the long run, I believe that we will together build the kind of health system worthy of us as a people.

Dr. Andrew Coates practices internal medicine in upstate New York.


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