The "us vs. them" mentality of the healthcare reform debate is playing the power game with the lives of my patients.
The wannabe congressman appeared with his neat hair and pressed suit, a competent yet compassionate expression on his face. “The first thing I am going to do when I get to Congress is to work to repeal Obamacare,” he said, expression growing subtly angry. “I will do everything I can to give you back the care you need from those who think big government is the solution to every problem.”
My wife grabbed my arm, restraining me from throwing the nearest object at the television. I cursed under my breath.
No, it’s not my liberal ideology that made me react this way; I’ve had a similar reaction to ads by Democrats who demonize Republicans as uncaring religious zealots who want corporations to run society. I am a “flaming moderate,” which means that I get to sneer at the lunacy on both sides of the political aisle. I grew up surrounded by conservative ideas — and probably still lean a bit more in that direction than to the left — but my direction has moved to a comfortable place in the middle.
It’s not the ideology that bugs me, it’s the use of the “us and them” approach to problem-solving. If only we could get rid of the bad people, we could make everything work. If only those people weren’t oppressing us. If only those people weren’t so lazy. It’s the radical religious people who are the problem. It’s the liberal atheists. It’s the corporations. It’s the government. All of this makes the problem into something that isn’t the fault of the person making the accusation, conveniently taking the heat off of them to come up with solutions to the problems.
Taken to its logical end, the to concentration camps, the Spanish Inquisition, the Gulag, or McCarthyism. The problems this state of mind creates are much bigger than the ones it is trying to avoid. Hate crimes are committed against people who aren’t like us, while others are demonized for voicing an opinion that go against the “right” way of thinking. Both these reactions are extreme, and both push us further from the solutions.
Us and them-ism is also prominent in medicine. Drug companies are evil, Medicaid patients are scum, doctors are too busy counting their money to care, and patients don’t listen to what their caring doctors say. My conservative patients come in to the office assuming that all the problems in healthcare are obviously caused by Obama, just as the liberals blamed it all on Bush four years ago. They worry about me leaving medicine because of the passage of the Affordable Care Act, not really knowing what kind of impact it actually has on primary-care physicians. Ironically, the one thing both conservatives and liberals agree on is term limits for Congress members, as we all see that the “bad” special interest groups are controlling Congress. Maybe that’s more of the us and them-ism, but I can get anyone to laugh at a joke about a congressman.
“When you don’t have blood going to your head,” I explain, “you pass out so the blood can get to your brain easier. Getting blood to your brain (and your heart) is pretty much essential … unless you are a member of Congress, where having a brain or a heart seems to be a liability.” I’ve gotten laughs from the right and the left on that one.
We unfortunately are soon to experience the pinnacle of us and them-ism: a presidential election. Those who govern us leave governance and embrace pure politics. If Obamacare were the best possible law, the Republicans would demonize it anyway to avoid giving the president the political upper hand. The same would happen if there were a Republican president; this is bipartisan power lust with no apology.
Yet the problems remain in my exam rooms: Care is too expensive; there is more red-tape and less good care; more patients fewer patients have insurance than ever before; and doctors are getting really, really tired of dealing with this mess. Patients die due to poor access to care (far more than most people realize), and many grow rich off a system that pays more attention to shareholders of device manufacturers than to the patients in which the devices are implanted.
The intersection of healthcare and politics is where I lose my temper. Politicians playing the power game with the lives of my patients are my arch nemesis. This is insane. This has to change.
When I was a medical student I did a cardiology rotation. One of my patients had a heart attack and was sent to the floor, seemingly stable. I met her and her family, getting to know the situation as well as could be understood by a student. I heard the overhead page for the code on the ward she was in, so I ran to see if it was her who had suddenly crashed. My heart sank when I came to her room and saw a flurry of activity around her doorway, with her family somberly standing outside while people hurried in and out of the room. Her husband’s eyes were tearful as I came up to the doorway.
“It’s Maria,” he said to me, “She just stopped breathing.”
I gave a weak smile to try to comfort him. “I’ll go and find out how she’s doing.”
She wasn’t doing well. Her heart rhythm was nothing I had ever seen before and her face was ashen. The respiratory therapist was assisting her breathing using a bag-mask and the nurses were attending to her IV.The cardiology fellows I was working with on the rotation were in a corner, far away from the woman, arguing with each other.
“I think it’s a junctional rhythm with PVC’s,” said one with passion.
“No, it’s clearly a left bundle with a-fib,” argued another, with derision in his voice.
As the argument went on between the doctors, the woman grew more pale. She was obviously dying. I thought about her husband, not able to be with his wife as she lay dying in bed, away from him, instead being the subject of an academic debate about heart rhythms.
I felt sick.
The rhetoric on healthcare seems eerily similar. The patient lies on the bed dying while the politicians are vie for the upper hand in the debate. The patients are serving as a tool to smear the other side. Just like I felt when I was a medical student, I feel powerless to do anything while a tragedy unfolds before my eyes.
And who’ll deny that’s what the fightings all about
Get out of the way, it’s a busy day
And I’ve got things on my mind
For want of the price of tea and a slice
The old man died
Rob Lamberts, MD, is an internal medicine-pediatrics physician who blogs at More Musings (of a Distractible Kind).