I usually walk from the University of Illinois, campus to Union Station at the end of my workday. But, that day it was raining. So, I hailed a cab. The cab driver was not in a mood to talk so I had time to relax and look around at the traffic. To my right was a recent model Mercedes sedan. I watched it for a moment and then pivoted to peer to the left. An old Toyota Corolla with the rear view mirror attached with duct tape was neck-in-neck slowed on the road with the cab and the Mercedes.
This image struck me; three impressively different cars depicting, perhaps, personal preferences and different opportunities of individuals, despite the differences, were driving on the same road.
So, this piece is about civil rights. Everyone who gets ill deserves the same road to drive on, but presently, some get better, or different roads than others. The “road” in the potentially obscure metaphor is the road that allows every individual the equal and omnipresent rights to information that will allow them to make an informed decision.
Once they decide, then, every person should have the same opportunity and cost for tests, treatments, and paths that assure them equal outcome chances with all others like them. We hear of the shrinking middle class, widening gaps of income, and increasing inequalities daily, but medical care should be one, at least, equalizer for every person who faces illness. In addition, then, every person involved in helping those who are ill must be required and compelled to provide equal benefits and uniform communication about trade-offs of benefit and harm so everyone is on the same medical decision making journey regardless of their personal abilities, preferences, or lots in life.
I admit I approach this theme with trepidation. I have heroes who fought for the rights of others their entire life, and some died for their efforts. Their fight for equality is legendary and worthy of praise. So, when I make my claim, I do not mean to discount any other civil rights issue or minimize the work of others. Here is my claim; the delivery of medical care in this day and age is our most universal, pressing, civil rights debacle. I have heard others draw this link between the practice of medicine and our civil rights, but, perhaps not so forcefully. Why might the word, “debacle” be reasonable? Consider these inequalities: the unequal insurance plans and personal payment amounts based on variable deductibles and co-pays, the inequality in who can get insurance and what kind, the unequal ability of patients to make choices rather than physicians, the unequal benefit and harm balances of interventions levied against an unsuspecting ill person, the inequality in the sites of care delivery, the unequal medication lists, some generic medicines, some not, for the same conditions. These inequalities cut across all races, income strata, types of cars we drive, and intelligence. If I have an illness, I pay next to nothing and can access care anywhere. But, another person with my exact illness cannot get to the same care, and if they do, they pay different amounts. None of this inequality is necessary.
We are searching for ways to improve the care of people who are ill and make sure that care is united and uniformly delivered. But, we are struggling. The new ways we are proposing to provide care are increasing inequality, not decreasing it. I read that republican leaders have broached the idea of covering more ill people with public funds so that private insurers will not have to charge well people more to cover the ill. This is an inequality fostering idea, in my view. I am writing this, partially, to express my amazement that intelligent people are continuing to pile on inequality rather than rally for an ill person’s civil rights. Where is the champion that will take up the banner and pummel the present system with claims of civil abuses?
I hope that re-identifying the connection between unequal delivery of medical care and civil rights’ abuse strikes a cord. We need to be on the same road to best medical care as medical illness is an equal opportunity condition. If we get on the same road, we will find ways to make sure that everyone pays equally and for only the care that benefits in excess of harm. Perhaps, if we are able to achieve this, we will see ways, then, to make the road better, free of potholes, toll ways, and traffic jams. I know that all of us can pay the same without co-pay or deductible if equal rather than unequal care is provided regardless who is the lead, government or private industry.
Some may argue with my metaphor. They may say that we are already equal; each of us that day driving toward Chicago was stuck in the same traffic jam. But, the goal of the care of people is not traffic jams when they are ill. The goal of medical care is the equal rights and opportunities of people to make medical decisions based on knowledge of what is best for them, from their perspective. When this becomes the medical road, we may be on our way to sharing the same ride.
Robert McNutt is an oncologist based in Chicago. Before joining THCB he served as an associate editor of the Journal of the American Medical Association.