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.

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64 Responses for “Dear Mr. President”

  1. Nancy says:

    One more line before I become infracted myself, One wonderful group of surgeons in california stepped up, saved my arm, took the risk of helping me, they have my praise forever, they are the saints of my life, along with God my Lord, men who value quality of life, who are truly physicians for their patients most of all, If I could name them one by one, I would, but they do not want the publicity, they do what they do quietly, for they know and see the healthcare mess we are in..and stood above it for me! God Bless Them forever. Bless the hospital out of my area, who helped me, they took 70% less than they should have, who treated me like a very special person,God will shine on them forever. If it was not for our delivery system, malpractice threats, etc..more physicians would step forward..our way of medicine has tied their hands..in a firm grip.

  2. Lorie Detter says:

    My sentiments EXACTLY – No compassion is the total key. You go Mr. Lamberts, but am fearful this is falling on “deaf ears” — My compliments to you for speaking out– I’m certain of the politics being more important than people and for people who have not faced life without insurance, little insurance, no tragedy, no severe illness, not yet elderly, etc. etc. they will not see it differently….. Thanks again for such a very truth full letter to our president.

  3. Rob Lamberts says:

    Margalit: I am not really suggesting a revolution; I am simply drawing attention to the increased frustration people have with their “representatives.” It seems as if the folks in DC (congress, especially) are at the very least giving the impression that re-election is more important than representation. The Republicans don’t want Obama to succeed in this, because his success would help the Democrats (at least that is my impression). The same would happen with Democrats if it was a Republican president. Democracy seems to have devolved into demagoguery. THAT is how this resembles pre-revolutionary America. Our leaders are more interested in maintaining their job in DC than they are helping their constituents. You may not agree, but this certainly is the growing feeling among the people I see every day.
    Peter: I am talking about two different things. Medicare/Medicaid lead the way by paying with out question for things like cardiac stents (which are totally unproven and expensive) and other expensive procedures with even less proof to them. That is the reason for the Comparative Effectiveness Trials, which I absolutely support (as long as they are clearly apolitical). The other insurers do follow suit as well. Why? Because they just pass on the cost to consumers and maintain their profit margins. It’s REALLY bad PR to deny a cardiac stent, and so paying is the lesser of two evils. That’s the reality of medicine in 2010.
    Regarding those who don’t take their meds, it is the Medicare patients (Part D is terrible, and the “donut hole” creates havoc), insured patients with huge copays for drugs, and especially the uninsured.

  4. Our platform costs the same no matter what your existing health is… pricing is transparent, the 125 a month includes five home visits a year. We have a couple of folks working on a grant to provide our platform services in inner city, indigent, even rural india, locations. So as you can see it’s a national health pilot to replace medicaid/medicare as it continues to fail. ( which is very soon)…
    It reduces costs of caring for patients by 80%, period. It eliminates the costs of defensive medicine which are detailed here…
    And enables a whole generation of primary care physicians. Mister Gates and Buffet will be paying for it. And it will be executed while everyone else is still sitting around in meetings talking and arguing… I invite you to take a look at the value proposition for the customer here…

  5. Rob Lamberts says:

    Natalie: as attractive as this seems (and it does), if all primary care physicians embraced this, the system would collapse. Here are my thoughts on this: http://distractible.org/2010/02/09/good-conscience-is-bad-business/

  6. Peter says:

    “We have a couple of folks working on a grant to provide our platform services in inner city, indigent, even rural india, locations.”
    Grant from whom? If it’s so cheap why would people need grant money to afford it? Who pays for drugs etc.? Does the $125 include all office visits and the home visits, in other words you don’t charge anything else but the $125/yr?
    “It reduces costs of caring for patients by 80%,”
    Primary care and/or hospitals?
    “It eliminates the costs of defensive medicine which are detailed here…”
    No they weren’t “detailed” at all. Useless link. How would defensive medicine be eliminated?

  7. Margalit Gur-Arie says:

    Natalie, I don’t understand. It seems that $1500 covers 5 home visits. This is $300 per visit.
    I see from your link that your PCPs will arrange for tests and specialists, but those will be additional expenses for the patient, correct? And so are the prescription drugs, and of course the hospitals, if necessary?
    One other question would be if the insurance plan, which you recommend that people still carry, will recognize the $1500 towards the high deductible.
    I can see how house calls on demand are really nice and high availability of a PCP is very convenient, but it seems to me that just like concierge medicine, this is better suited for relatively healthy and well off people. It is also probably a very good service for large employers, like Microsoft, which I think employs a similar service.
    Rob is right, this is not a model that can replace the current office based model of practice, nor can it replace standard insurance coverage. It’s too limited in scope and too expensive for most people.
    However, I can see how it could be relaxing for a doctor to practice that way, even though taking 1/3 off the top is pretty steep….

  8. inchoate but earnest says:

    Dr Lamberts’ views are interesting; valuable; worth attention. At the same time, a couple of his underlying premises deserve cautionary reflection:
    a) people are people first. Patients are a subset of that 1st population – and not in the majority, despite their accounting for a big portion of GDP. Patients are a health constituency – but not the only one, or arguably the one deserving of most of the attentions of reformers.
    Regroup around health. Persisting in making sickness – “patients” – the focal point of remaking a health system is a race to the bottom, which in the case of this subject is death.
    b) Primary care DOCTORS most certainly have an important role in provision of care, but it is and should be an evolving role, and one which includes a variety of primary care givers.
    Unfortunately, too many very well-meaning primary care docs want, like the most heedless reactionaries, to “go back” to some mythical time when their specific role was more central and/or more effective*.
    The lament about lack of patient accountability is instructive, especially when synthesized with a subsequent poster’s references to behavioral economics; people are ‘non-adherent’, are ‘noncompliant’ to authoritative, rational guidance with respect to a host of behavioral situations. Is it rational to expect them to be different somehow with regard to their medicalization?
    So, what to do? Dear rational healer, you must change your behavior – and change it as a dynamic of your practice – meaning ‘expect to continually amend it’, principally to systematize it, to integrate other primary care inputs.
    (*Also witness AAFP’s very recent decision to retract its already highly qualified support for retail clinics care, a small decision, one that will go almost unnoticed in most circles, that is very little about care, and almost entirely about power, about politics.)

  9. Marty Hermes says:

    I just read this blog about the health care issue, again, after reading about the earthquake in Chili and the impending tsunami predicted to strike today!
    ENOUGH OF THIS POLITICAL grand-standing from Congress and the President. WE,as people of the United States see these bills as positions of power, not for the good of the people. Scrap the ideas, form a panel of American people who have no agendas and begin at the beginning.
    I cannot believe that President Obama can be using strong arming to get this bill passed, just for his own agenda, which appears more and more to be for a power take over, a way to turn this country into a socialist dictatorship….Are we going to let him? He’s NOT listening to us Americans….We need reform of the insurance industry and legal systems that hike the costs for us. I grew up with no insurance available, everyone paid for care out of pocket…..Maybe we should go backward in order to move forward.
    With all the disasters and the breaches in homeland security, our health care packages should be much lower in priority. Come on Mr President, if YOU don’t want to be a one term President, change your ways and LISTEN TO THE PEOPLE!!!!!

  10. Ann says:

    We The People, These words only apply to Senators, Congressmen and President not the AMERICAN PEOPLE. We have no say in our own country. Clinton changed our HEALTH CARE and now Obama. This is his religion not the AMERICAN way of life. Go back to our way, before CLINTON, of going to DOCTORS and not having to go to primary DOCTORS everytime we need to go to a specialist. Also tell them stay the hell out of Social Security every time this country has to bail our COMPANIES and other COUNTRIES. When you make a loan you have to pay back the company and that is with interest so should these companies and the GOVERMENT. Pay back SOCIAL SECURITY that the Goverment owes US and get the people OUT OF SOCIAL SECURITY that is not completely disable and that have not reached the age of 62 and older. THIS COUNTRY IS NOT OF FREEDOM IT IS OF DICTATORSHIP. Where are our RIGHTS AS FREE AMERICANS TO CHOOSE WHAT WE WANT YOU ARE RIGHT IT IS OF POLITICS NOT ANAIN OF THE PEOLPE. STOP GIVING Illegal Immigrant.

  11. Tod says:

    It seems to me that you (Dr. Lamberts) have too much time away from your patients if you sit at your computer and blog about politics! It also seems to me that a lot of the points you directed toward the President should have been in the other direction, at the party who IS for big business and IS beholden to the lobbyists of big business (big insurance and big pharma). So, GROW UP and let’s get behind our leaders who actually want to FIX our “system”. Now, cut off your computer and go HELP your patients!!!

  12. Rob Lamberts says:

    So, Tod, you suggest that doctors not enter the debate about HC reform? Or should it only be our lobbyists and retirees? Why should we care about the process? Is it not GROWING UP to try to be part of the discussion/debate? Don’t I have valuable things to contribute?

  13. Nice detailed articles but if I may suggest, you need to bring some imagery to draw attention better, too much literature makes it hard to focus and grab interest. Just my 2 cents.

  14. Gary Lampman says:

    I agree with Rob on the Majority of this subject matter,. However,Obama is just a puppet on a string !

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