I’m writing a review-like blog post on Timothy Snyder’s Our Malady: Lessons in Liberty from a Hospital Diary (Crown, 2020), a short book on American health care. To that end, I’m interested in hearing what PoT readers have to say about health care in the US today.
In other words, I’m inviting anyone and everyone–patient, practitioner, support person, clinician, non-clinician, etc.–to sound off in the comments on any or all the following questions, or any others you deem relevant:
- What is your overall verdict on “the American health care system”? Does the United States even have “a health care system”?
- What is your experience of American health care, and how does that contribute to your verdict on it?
- Do you agree with Snyder that we have a right to health care? What does that mean to you?
If you’d prefer to contact me in private (and/or want confidentiality), feel free to write me at khawajaenator at gmail dot com.
I’ve worked in two very different parts of “health care” for about a year now. In that time, I’ve pieced together a scattered patchwork of observations about American health care, but haven’t developed an overarching picture of “the system” as a whole, whether as a matter of diagnosis or prescription. Hence my interest in hearing what other people have to say.
Tell me if you want to be acknowledged by name in the “review.” So far, it’s not a formal review meant for publication, just a longish post meant for this blog.
Policy of Truth 
First, I’ve been a unit clerk on a step down unit. An admission counselor that created the “Expected Admissions List.” And I was a Centralized Scheduler. I also used to work for the New York Psychiatric Institute, but in a non-medical role. I was at the computer service desk.
So to answer your questions:
Yes we do have a healthcare system. My verdict is that our healthcare system is both too complex and too simple. It’s too complex in the sense that there’s always a dance between good patient outcomes vs Press Ganey’s vs appropriate level of care vs what insurance will pay for. (I’ll leave out the uninsured as honestly they’re already left out to be honest. They pay rates that are just not acceptable.)
The too simple part is severe reluctance to computers. Yes, computers are there. Yes some patients are wired up like pincushions. But there’s a general lack of seeing how computers are a necessary part of hospitals and doctor’s offices. Case in point, I was once written up for “sharing” my password so an overnight float Unit Clerk could log into the system. I was one of the few unit clerks that had a “real” network account, mainly because I could do the kind of statistics that my bosses could do, and I could do it fast. But that meant that the unit clerk that came by overnights, didn’t have access to do her job. They seemed fixated on the damage that the person could do, not realizing that every other computer was unprotected. They specifically called out email and how they could have sent some emails as me. (Frankly the night unit clerk wasn’t bright enough to figure that one out. She was very nice, but overworked as she had several floors to look after. And she seemed like her head was in the clouds.)
Additionally, when I was a scheduler, we had to try to get people to read and tell us what their prescription sheet said. A good percentage of the time they didn’t speak English. Thankfully we had at least three on the team who could speak Spanish. Our solution? Fax the script to us. But we couldn’t accept it via email because of HIPAA. Well, why not set up a secure email address or a secure portal to accept a scanned image? Out of the question. It would have saved us a ton of time as most people, even ten years ago, were more likely to have a scanner than a fax machine. (I have both, but that’s besides the point.)
American healthcare has saved my life several times. In terms of an acute appendicitis when I was in my early 20s. To getting a decent sleep study to control my sleep apnea. To having excellent PCPs. (And I say that from my pediatrician and the two doctors I’ve had previously, and now.) I may be forever in their debt to be alive, but at the same time a previous doctor had a sign that read, “If this is your first or second visit we will not write you a prescription for Opioids.” (I of course asked if I could have some Opioids. My Dr. says, you don’t need them. But I said, but I’m an established patient! We’d joke around about that sort of stuff on the regular.)
But the verdict I’d give from a patient perspective is that medicines are way too expensive. And the regulations on them, like controlled substances are stupid. I have no problem getting Adderall (a.k.a. Amphetamines) once a month with no refills. But try and get Provigil? That’s thousands of dollars a month and several calls per year to justify using it. It’s pretty much the only non-amphetamine stimulant. Sold because it has a lower addiction potential. But man they are fastidious about not letting me have it when I needed it.
I do think we have a right to healthcare. Affordable healthcare and reasonable healthcare. It is unreasonable to have al the stops pulled out for someone who is likely to die, and I’d say especially because of their own actions or inactions. (Whatever the case may be.) I don’t like the idea of rationing care, but I do like the idea of palliative care for those who are virulent (pun sort-of intended) anti-vaxxers. And by that I mean, make them comfortable, ease their pain and try to help them get though their fears of dying. But not giving them heroic measures when those, through no fault of their own, are suffering what would normally be a survivable condition.
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Concerning the idea of a right to healthcare, it seems ambiguous. Is it only a right to engage healthcare with some provider? Or is it a right to have a provider? In the latter case, is it a right for fulfillment within a contract? Or is it a right for having a provider paid through coercive squeeze (taxation) of a collective?
Coercive squeezes have a moral presumption against them, and I take it that it is when that presumption has a rationale adequate to overcome it that we say we have a right to something being provided rather than simply it is a right thing for such-and-such to be provided. I can see the sense of saying I have a right to healthcare in the sense that having been forced to pay into SS and Medicare earlier in life, it is by their contractual character that I have a right to those benefits. Similarly, without the earlier coercion, with benefits from my private employer. But to say that simply because I’m a human or simply because I’m a citizen, I have a right to healthcare seems fuzzy talk or false. (When false as a moral right, I’m supposing that being made a human right under positive law, it remains not a human right all the same and should not have been made a legal right.) It is right that I receive healthcare under those simple antecedents of being a human or a citizen, but having a right is more than that, else we don’t need the concept ‘have a right’.
I take it that advances in medicine have no bearing on the question of a right to healthcare. That is, Leibniz and I might suffer from gout (I don’t), yet even though modern medicine can now alleviate the pain and damage, Leibniz had the same rights and not-a-right over healthcare as I even though the care was not so effective in his day. Does anyone have a rationale for the contrary view? That would be interesting to consider. I mean a rationale for the position that a right to healthcare emerges as the effectiveness of healthcare advances beyond some threshold.
The US health care I have received has been splendid overall. My life has been saved by hospitalizations and by advancing pharmaceuticals. One doctor failed for seven years to correctly diagnose the blistering and torment of the skin of a foot after it came out of a cast for a broken leg (with consequent poor venous return and swelling of the foot). But going to another doctor got the whole skin problem cleared up in two weeks, and it was my own fault to not see I should get that second opinion. I’m often asked if I sued. No. I really don’t like that people do that to people purely trying to help you, generally speaking. Though it depends on the case. The famous old case of a hospital taking off the wrong leg of a patient seems worthy of suit.
I once had healthcare in Italy. I never got a bill. I was a tourist in Florence, when I broke my leg. Though it was treated in a more old-fashioned way (just set the bones and use a plaster cast) and though the hospital procedures were different (families of the patient bring the supper and a bottle of wine), it was effective.
I have a mixed impression of healthcare in US federal prisons (through reports of my friend who’s been confined there). The doctors were immigrants from other countries and could not get a license here. There is a big jam when the doctor visits the prison, and each patient is allowed to bring up only two complaints. Nurses are more helpful than doctors there.
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