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September 10, 2009
Ideology and the Heath Care Debate
In October 2009, Physicians Practice will publish the findings of their annual survey. Nearly 1600 physicians were asked this year about what health care reforms they’d like to see. Among the top ten were ‘get the government out of medicine entirely’, ‘institute a single-payer system that has universal coverage’, and ‘cap insurance and pharmaceutical company profits’. The results highlight the ideological divide between those segments that’d prefer to see more government involvement in our health care system, and those that’d prefer to see less—much less! The ideological divide was no less evident in Washington on Wednesday night when President Obama addressed congress to explain some of the details of his plan for health care reform.
The President’s reforms propose to offer more choice, lower costs, and improved security for people who already have health insurance. Under the proposal, insurance companies would not be allowed to drop or dilute coverage. For the uninsured, the new plan proposes affordable coverage for individuals and small business owners. Among other changes, it’d be unlawful for insurance companies to deny an applicant coverage on the basis of a pre-existing condition. Other proposed reforms include pilot studies for changes to medical malpractice laws.
The President made it clear that, while alternative proposals were welcome, he would not lie down easily on a public insurance option, nor his concept of an insurance exchange. In his words, a public insurance option would provide better choice and competition for consumers. Dr Charles Boustany replied on behalf of the Republicans. He told the press that his party opposes a government-operated insurance agency, and argued that competition in the insurance market could be improved by allowing families and small businesses to purchase their insurance across state lines.
One political commentator described the presidential address as ‘vintage Obama’, highlighting what he saw as a veiled contradiction: ‘Complete command of the issue, excellent cadence and pace. The reach out, as expected, to the GOP to join him half way, while standing firm on his beliefs and denouncing what he saw as the "politics" of division’(Rudin 2009). Another agreed that the President failed to exhibit the attitude of compromise he was demanding. William McKenzie of The Dallas Morning News wrote:
[Under Obama’s plan] there's no guarantee you can keep your health plan. If your company stops offering coverage and you end up on a public plan, you could lose your doctor. Look at Medicare. Washington has been tightening up Medicare payments to doctors, so fewer providers are picking up seniors. The same phenomenon could happen under a public plan. If you end up on it, and your doctor chooses not to participate, you're out of luck. The president wants a public option so consumers can have more insurance choices. Well, they could get more options if he supported letting insurers and consumers connect across state lines. That way, we all could get plenty of choices and wouldn't have to worry about the headaches of creating a federal plan.
All this political crossfire overshadows the facts. The US has the most expensive health care system in the world—around 1.5 times more expensive per capita than the average of other developed nations. For every six dollars an American earns, they spend more than one dollar on health care (Gawande 2009). You’d think, therefore, that our nation would be exceptionally healthy. Instead, we’re ranked 42nd in the world for average life expectancy—just above Mexico—and we have the dreadful honor of being the fattest country on the planet (Ohlemacher 2007). Research reveals that 41 percent of working age adults in the US have a medical debt, or have a problem paying medical bills (Gardner 2008). A study published in the American Journal of Medicine found that nearly two-thirds of personal bankruptcies filed in the US in 2007 were caused by illness and medical expenses. More concerning, most of these people had insurance at the start of their illness, were middle class, university-educated, and owned a home (Healy 2009). Meanwhile, insurance companies and their executives are rewarded for the relentless pursuit of profits.
The Democrats and GOP have agreed on a middle ground when it comes to expanding insurance access for people with pre-existing conditions, and providing health care assistance for very low income earners. But the coming months will further tell if our representatives in Washington are able to conceive of the world in shades of gray by building a bridge of compromise between their ideologies—or if they are only capable of confusing and polarizing the constituency. The danger of not compromising on ideology is that we will continue to compromise our health.
Robin Stone, M.D.
Insight Psychiatry
13123 Rosedale Hill Ave.
Huntersville, NC 28078
704-948-3810
References & further reading:
Beckel, A & Michael, S 2009 Ten health reforms docs want, Physicians Practice.
Gardner, A 2008 Medical debt sending many over financial brink, US News & World Report.
Gawande, A 2009 The cost conundrum: what a Texas town can teach us about health care, The New Yorker.
Healy, M 2009 Medical bills led to two-thirds of bankruptcies in 2007, study finds, Los Angeles Times.
McKenzie, W 2009 Obama's health care speech got it right and wrong, National Public Radio.
Rudin, K 2009 The President spoke. What did people hear? What will congress do?, National Public Radio.
September 6, 2009
When Healers Need Healing
In the last 30 years, ‘burnout’ has turned from a vernacular idiom into a prevalent psychosocial syndrome—one that’s particularly relevant in current times as the economic recession impacts on lifestyles. Surveys reveal that job cuts and the threat of redundancy are affecting work/life balance. Many people are working longer hours and seriously worrying about their job security.
Professional burnout has many characteristics, not least of which include emotional exhaustion, cynicism, and a loss of interest in one’s work or personal life—the feeling of “just going through the motions”. Burnout cuts a broad swathe across professions, but is especially prevalent where occupational stressors—such as heavy workload and constant pressure—are accompanied by other job demands that lead a person to perceive a lack of control in their life.
It’s little surprise, then, that medical professionals are particularly prone to burnout, especially so given the current health crisis. When physicians are surveyed, up to 40 percent of them report feelings of stress and burnout, while a concerning 70 percent report feeling pessimistic about the future of the health care system (Gundersen 2001).
Burnout can be especially dangerous in medicine because it carries potential consequences for patients. Some studies suggest that burned out physicians have more trouble relating to patients, and the quality of the care they provide may suffer—let alone that an increasing number of doctors contemplate early retirement and alternative professions.
Due to fear of recrimination (licensure issues, shame and guilt, and social stigmatization), physicians often avoid or postpone mental health treatment, or attempt to treat themselves secretly. As a case in point, about a third of physicians do not have their own doctor. A concerning pattern occurs where medical professionals often delay seeking help until they hit rock bottom.
The good news is that there’s a growing movement that recognizes the importance of physician health—not only for the benefit of members of the medical profession, but for the wider good of the community. Wellness strategies include methods of recharging one’s physical and mental capacity, emotional self-awareness, connecting with social support systems, and seeking help before stress begins affecting work performance. Research demonstrates greatly reduced burnout rates and improved job satisfaction in physicians who practice these coping strategies (Spickard et al 2002).
As a fellow medical professional, I understand the pressures that make physicians reluctant to seek care, which is why my practice is designed to protect the professional sensitivities of my patients. At my office, for example, there are two separated waiting rooms. Patients enter and exit from different doors, and discrete parking is provided at the rear of the building. Privacy is a very valid concern for medical professionals seeking mental health support, but it should not be an insurmountable obstacle. We must remind ourselves that ‘doing no harm’ begins with our own well-being first.
Robin Stone, M.D.
Insight Psychiatry
13123 Rosedale Hill Ave.
Huntersville, NC 28078
704-948-3810
References & further reading:
Gundersen, L. 2001 ‘Physician burnout’, Annals of Internal Medicine, vol. 135, no.2, pp. 145-148.
Spickard, A., Gabbe S., Christensen, J. 2002 , ‘Mid-career burnout in generalist and specialist physicians’, Journal of the American Medical Association, vol. 288. no. 12.
