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The contents of this website are for contemplative purposes only. No medical advice will be given, and emails asking for medical advice will be ignored.

Although patient vignettes are based on my experiences with real individuals, I liberally change details to maintain patient confidentiality.

I also reserve the right to change old postings to correct errors, and to delete comments that include obscene language or that I deem abusive to me or other commentators.  If you are looking for a open mind, I suggest you consult a neurosurgeon.

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Sunday
May072017

Jimmy Kimmel and Pre-Existing Conditions

Late night comedian Jimmy Kimmel delivered a powerful and important message last, an argument I have been making for years: There are some people who will never be able to afford their health insurance obligations. They lack the financial resources to pay for their treatment, and they always will. But society at large can afford to pay for these treatments, and should.

This seems self-evident. I don't have to go far on my daily hospital rounds to run into people who have medical problems that will cost more to treat than the patient can ever earn. Many stroke patients and most cancer patients fall into this category. Almost all children born with serious congenital diseases fall into this category as well.

This was Jimmy Kimmel's point. That children with serious medical problems will never be able to pay back their medical bills, and shouldn't be required to. Everyone has a basic right to life -- after all, the Declaration of Independence argued for the basic human rights of "life, liberty, and the pursuit of happiness." I do not think it was accidental, either, that the Founders put life first on the list.

No one can be faulted for wanting to live. Survival and the avoidance of pain, both goals of medical treatment, are the most basic instincts humans have. As a free society, we ought to be all about helping people to live when they want to, since all other freedoms depend on the right to live. After all, a dead person can't have rights. To have other any other right -- speech, religion, or voting -- you have to be alive first.

So, since all human rights flow from life itself, it makes sense to argue that the right to live -- that is, the right to life-saving healthcare access -- should be one of the chief goals of a free society. The fact that it costs a lot to insure everyone doesn't seem like much of an excuse. Defending the country is expensive. Educating children is expensive. Incarcerating millions for the maintenance of civil order is expensive. This hasn't stopped us before.

Critics of Kimmel and of health reform in general have argued that no person should be forced to pay for the health problems of another. That forcing a free individual to pay for another's health is a violation of liberty, just as it would be unfair to force me to buy my neighbor's shoes, or repair his car. In a free society, the argument goes, every individual should be responsible for himself.

This philosophy makes sense in theory. We are, after all, a free country. Why should I be required to pay for someone else's medical problems?

The problem is that the theory breaks down when faced with reality. If I don't pay a police force to protect someone else's home, there will be no police to protect me when my home is threatened. If I don't pay to educate other people's children, who will be educated enough to be my doctor, fix my computer, fly my airplane, educate my own children?

If I don't fund a health care system to take care of others while I am well, what reason do I have to expect it to exist when I get sick? Hospitals don't just pop into existence when we need them, like scenery props in a cheap movie. They need to exist all the time, so they can exist when rich people are in need.

And then there is the problem of consequences, which was also Kimmel's point. It is one thing to stand for the theory that the government shouldn't tax me or force me to buy health insurance, but it is another thing to face the outcome of that decision: A newborn baby with heart disease who must die because his parents can't afford the operation.

Kimmel was speaking out of experience. This is what we need in the health care debate, more people speaking out of experience. More people who have been denied care, who have had their care limited, or who have been frustrated by the shortcomings of the system that we have now. Healthcare reform cannot be about pie-in-the-sky political theories. Healthcare is about what happens to real people, in real situations.

One of the things that attracted me to medicine in the first place was its practicality. Medicine is conducted in the real world and is concerned with real people. No patient cares if an antibiotic will work on her disease in theory. She wants to know when she takes the antibiotic, if it will make her feel better. This is what medicine is all about. It is all medicine has ever been about.

As a doctor, I don't give a flip about constitutional arguments over health insurance. I don't care whether Mr. Jefferson thought it was fair or unfair to tax one person to treat the illness of another, or if Mr. Madision thought health administration should be a federal or a state responsibility. I care only that the system works, and that it works for a price that my patients can afford. My concerns are purely practical. Will it help me to take care of patients, and to help heal sick people?

For this reason, I think it is wrong to deny people insurance because of pre-existing conditions. As a doctor, it is my job to discover medical problems, which means I am in the business of finding pre-existing conditions. It is not acceptable that doctors do what they are trained to do, and in doing so, exclude patients from further care. It is, to say the least, impractical.

There has been a pitched debate over the funding of health care in this country for as long as I have been an adult, and it is ridiculous. American citizens don't want to think about their health insurance any more than they have to think about electricity, or roads, or running water. They just want to have it, and pay a reasonable price for it. When an intersection needs a stoplight, citizens expect government to put one in. When there is a fire, they expect the fire department to show up. What they do not expect when a fire breaks out is for a carload of politicians to drive up and lecture them about the constitution.

This should not be so hard. The only reason it is hard is because the discussion is dominated by people who can afford good doctors and who have adopted the principle that everyone else should be as rich as they are, not matter their age, genetics, or social condition. These people of high priniciples will raise taxes to put the poor in jail, but not a finger to help them with their doctor bills.

This is and always has been about money. About who has to pay what and when. For once in my life, I'd love to see the U.S. government grow up, make a fair estimate of what it would cost to insure everyone, figure out how to pay it, and then move on without further whining. This is not about "us" and "them." There is no "them;" it is all "us." Everyone wants health insurance.

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