On Health Care “Reform”

I’ve followed health care reform since it started getting a lot of attention from Pres. Obama at the beginning of his presidency, particularly closely since May of 2009, when I made a trip to Washington, D.C. to lobby with the ACP for what I felt to be the most necessary changes to the failings of our current health care systems.

I’ve read the text of the bills as much as possible every time a new bill rose to the forefront, though it became more and more difficult as the length grew and grew.  Every time the health care bill went through compromise and revision, what I felt to be important parts were pulled out and replaced with things that I don’t think address the real problems of healthcare, until there isn’t much of the initially quite promising legislation left.  Some of those things I believe will contribute to making some things worse.

I’m ambivalent at best about what has finally passed.  Some important regulations were placed on the out-of-control private health insurance companies, but some very suspicious (at best) concessions were made as well.   Pharmaceutical companies seem to have escaped unreformed, and while health insurance companies lost some ground to regulation, they gained what may be significantly more ground from requirements for almost all citizens to carry health insurance.

Medical student indebtedness is one of the major obstacles to students choosing to pursue careers in primary care, because it simply isn’t well compensated compared to the rest of the field, and $250,000 of debt (on average, a few years ago) is a staggering amount of debt for anyone to be staring at as he graduates from school, particularly considering that he may be making less per month than the monthly interest accruing on his loans.  If we’re to address the shortage of primary care physicians in this country (and we need to if we are to truly reform health care) we need to address those things that are seen by graduating medical students as barriers to pursuing careers in primary care.  This legislation starts to address that, but I’m not sure it does enough, and I’m not sure everything it does will help.

All that said, we still have, in this country far more freedom than in Cuba, or China.  We still have far more protection of our basic human rights.  We are still far, far, far from the abuses of those countries, and I’m very, very tired of the misplaced comparisons to them.   And even if we were moving closer to such countries in a significant or meaningful way, which I don’t believe we are, there is good to be found in them, as well.  Despite the things we may disapprove of in such governments, I don’t believe it is possible for everything about the countries to be “bad”, and thus becoming more like them in one aspect or another is not innately bad.  The determiner of good or bad must, then, be the change that is made itself, and not who it may or may not bring us closer to resembling.

Considering the cruft that made it into this bill, and the important bits that were removed, you won’t find me celebrating much tonight.  But you won’t find me lamenting the destruction of our freedom, either, because that freedom still thrives, and is (on the whole) in no immediate danger from this bill.

Instead, you’ll find me looking at this as a first step.  One that isn’t in the direction I’d like it to be, but a first step nonetheless, and an opportunity to use the momentum it might create to propel us, with the aid of future legislation to refine our course, to redirect us toward everyone in our country having access to basic health care.  Not necessarily receiving “free” health care, but having access to basic healthcare at a cost they actually have the ability to pay.

I firmly believe access to basic healthcare is necessary for the practice of the most basic of human rights, those considered to be so basic and inalienable that their violation by the government at the time was listed as the impetus for what has become the United States of America in declaring independence from Britain: Life, Liberty and the Pursuit of Happiness.

You’ll find me hoping what I’ve experienced to be true in so many other aspects of my life holds true here: that it is far easier to change the direction that something is moving than it is to get it moving in the first place.

So, here’s to continued change.  And I think this is something that even those of you who cannot find anything redeeming about this legislation can agree with me on: now is not the time to stop pursuing what you feel is right, but rather now is a time more important than any time we’ve ever seen to work to exert our influence in directing the change that has begun toward the ends we feel will be best for our country, and for our fellow citizens.

I hope to see many of your out there, and even if you’re pushing from the other side of one or more of these issues, even if you’re pushing directly against me, I congratulate you for pushing, and hope that perhaps as we steer this thing along its path, we’ll end up pushing side-by-side at some point.

What we cannot do any more is try to keep this change from happening, because it has started.

Change, is now.

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