I am writing this as a representative of the examination room – one who sits facing patients, dealing with our healthcare delivery “system” on a daily basis. I am writing this as one who will bear the brunt of what you accomplish or fail to accomplish in your attempts to reform our “system.” I write this as a primary care doctor who makes a living (or not) by what I earn from that “system.” I write as someone who has seen people not take medicine they need, not get the help they should, and not care for themselves as they should because of our “system.”
I talk to patients every day about what you folks are doing, and let me tell you what they are saying: nobody has any confidence in you whatsoever. Whether conservative or liberal, insured or not, black or white, elderly or young, all of my patients express frustration, disillusionment, and pessimism over your chances at getting it right. Nobody is confident, nobody is all that passionate anymore, and nobody is holding their breath.
Why no passion? Why wouldn’t people be invested in something so vital as our healthcare system? Because it seems to all that what you are doing in Washington is not about people’s health, it’s about politics. It’s not about caring for the frail and elderly, it’s about holding on to your power or regaining the power you lost. The cross-section of people I talk with is convinced that you would sacrifice what’s good for the country to get what’s good for your party. It’s hard to get passionate about your games and power struggles. It is as if the house is burning down and you folks are arguing about what color to paint it.
So what do people want? What is really important to my patients? Here’s what I see:
1. People want things to get simpler – The system is so complicated and so difficult to deal with. Please resist the urge to make more government agencies and more hoops people must jump through. Remove the impediments to care, don’t add more of them.
2. People care about information – Some patients want to have access to their own records, but most would be satisfied if their doctor actually had access to their records. The number of times I must work without hospital discharge summaries, medication changes, lab results, x-ray results, and consultant notes is appalling. My patients are more than frustrated that nobody is communicating; my patients are getting sick and dying because of it.
3. People are very suspicious – Very few people trust the big businesses in healthcare. You should thank the healthcare insurance industry, because they actually have less trust than you do! But whey you pander to their lobbyists, you undermine what little trust people have in you. People want you to represent them, the people who elected them, not those people with the money to finance better commercials for your re-election.
4. People don’t want a system that is secretive – The exchange of money in medicine happens behind closed doors, and when costs are out of control, that makes it look very suspicious. It makes patients mistrust me, and it gives a lot of room for questionable practices on all sides. You would score big points if you made a system in which the payment of doctors and hospitals was not treated as “off limits” to others. People don’t mind paying me for what I do, but the fact that I can’t answer the simple question, “what will this cost?” undermines their trust. Neither I nor they can afford to have that trust undermined.
5. Everyone thinks you are out of touch – People get passionate still when they complain about this. You are passing laws that you are not going to pay for. You are playing with our lives and our money, but you have your own insurance plans and special treatments that shield you from your own bad decisions. Our government is supposed to be “of the people and for the people,” but you are starting to look like an elite ruling-class. We all know that’s not good – it’s what made us rebel against the King in the first place. You need to somehow show you are still part of us and are willing to pay the same price we pay from your own decisions.
This list is not even close to being complete; there are lots of things people want. The details aren’t as important as the idea that you are actually listening. Don’t ignore the fact that one of the big political forces in our country today (right or wrong) is called “Tea Party.” There is an atmosphere of “us against them” that reminds me of the accounts of the colonies before they rebelled against the King. You are looking less and less like you care about us, and more and more like our enemy. This goes for all of you: democrats and republicans, liberals and conservatives. Stop pandering to your parties and start serving us. Stop jockeying for power and start fighting for what’s right.
If you don’t, I think it’s just a matter of time before angry mobs with torches show up at your doorstep, before another shot is heard in a small town in Massachusetts and another revolution is joined.
Don’t be foolish. Listen. You are not smarter than us; you are representing us.
ROB LAMBERTS is a primary care physician practicing somewhere in the southeastern United States. He blogs regularly at Musings of a Distractible Mind, where this post first appeared. For some strange reason, he is often stopped by strangers on the street who mistake him for former Atlanta Braves star John Smoltz and ask “Hey, are you John Smoltz?” He is not John Smoltz. He is not a former major league baseball player. He is a primary care physician.