As the national debate over health care reform rages, we’re asking Schweitzer Fellows and Fellows for Life — who are working directly with the populations whose needs are unmet under our current health care system — to weigh in.
On Sept. 12, 2006-07 Chicago Schweitzer Fellow Eijean Wu — currently an OB/GYN resident at Montefiore Medical Center in the Bronx — will be traveling to Chicago and hosting a skills-based workshop on delivering health care with dignity to women with disabilities. At the workshop, Wu will offer effective and efficient ways of improving quality of care in the face of systemic constraints. Her goal? To support participants in providing dignified care here and now, and to empower them with the tools to do so.
Wu’s commitment to the health of individuals with disabilities is longstanding. As a Schweitzer Fellow, she worked to increase health awareness for people with disabilities and to provide emerging health professionals with skills to understand the medical and social needs of people with disabilities.
Below, Wu weighs in on health care reform — and suggests “a fundamental shift in attitude towards health care.”
Do you think the structure of our health care system needs to be changed, in order to truly address, reduce, and ultimately eliminate health disparities? How so?
I got into a heated discussion with Zeidy, one of my favorite physician assistants on the labor and delivery floor the other day, who essentially insisted that all people in support of health care reform Obama-style were “socialist” and should leave our capitalist system be. In her own words, “If you don’t like the American way, then move to another country.”
Her passion for “capitalism” and the “American way” gets at the core of what I think remains one of the key questions for health care reformers today: Do you think health care is a basic human right?
For people on the extreme of one side of that question, health care is a market good like any other commodity and should be bought, sold, and traded with minimal government involvement. Some of them will point out that Medicaid goes far enough to appease the “communists” among us.
People on the extreme other side see health care as a basic human right and thus want to ensure health care for all people, regardless of personal effort, ingenuity, and resources.
So, for Zeidy, I am that enemy, the “communist” and “socialist” who should “move to another country.” If we are serious about eliminating health disparities, as is the stated goal of Healthy People 2010, we have to adopt a new attitude towards health care. We need to emphasize similarly American principles such as equality and basic rights, ahead of private market economies.
What I am suggesting is a fundamental shift in attitude towards health care. Personally, I believe that equal rights can and should co-exist with capitalistic ideals. Whether or not someone receives necessary care should not be dependent on their wealth or ability to navigate a very convoluted system. Whether or not a patient with cancer receives treatment should not be dependent on whether or not they have a job with an employer well-off enough to offer adequate health insurance. As a society, we need to prioritize health for all, because healthy people leads to healthy economies, not the other way around.
What is the single most important issue meaningful health care reform needs to address?
To me, the single most important issue is access to care. People get sick or get progressively sicker because they are not connected to the health care system.
When I was in graduate school, I remember seeing a venn diagram that illustrated the intersections of quality, cost, and access. For a while after the Institute of Medicine report on medical errors, the media buzzed over quality. Now, people are talking about costs. While I firmly believe that the prize is in finding the sweet spot that accounts for quality, cost, and access.
If it’s poor quality, why should we spend money on it? If it’s unaffordable, clearly we can’t do it. If people can’t get it, what’s the point of quality or low cost? So, we have to find policies that balance cost, quality, and access. I believe it’s possible. Access is what gets lost the most often in my own personal experience. People have to be connected to the system before anything else can matter.
Even in my short 3 years of clinical experience, I have seen too many people come in with end stage disease because they didn’t seek care, [due to having] no insurance earlier. They have kids to think about, bills to pay, etc, and simply could not afford even basic preventive care. A self-employed friend of mine went for her annual gyn exam, self-paid $250 for the visit, paid another $200 for lab work, and then received another $350 “facilities” bill after the fact. How many people can afford a $800 annual visit? We need to get people hooked up the right way.
From your personal experience, is there a certain specific anecdote that best illustrates what’s broken about our health care system?
Many times in my training, I have been asked by attending physicians to admit patients to the hospital for treatment that really could occur outpatient. However, because of no or inadequate insurance and inability to pay, the patient — usually a patient with cancer or requiring major surgery or expensive diagnostic tests — is admitted to the hospital and receives her care under emergency Medicaid provisions or as a charity case.
Of course, here I have offered ammunition to the non-bleeding-hearts among us, and I have to confess that even my bleeding heart recoils at this frequent abuse of the system. Doctors struggle between doing what is best for the individual patient and what is best for the system. In these cases, there is little doubt that what is best for the patient is to get the treatment ASAP.
The question is: how do we do it? If this were my mom/sister/friend, what would I want to see happen? Don’t blame the doctors. Most of us would do the same thing in these situations. The system is what’s broken and needs to be fixed.
Are you encouraged or discouraged by the current political conversations about health care reform? Why?
Encouraged. People are talking about it. That’s the first step. There is so much noise out there that I cherish every bit of attention, that something I live with intimately causes someone to blink twice. Health care is a sensitive topic. I expect and welcome heated discussion. That’s the only way we’ll get to a solution.
What news sources do you follow to stay informed re. discussions about health care reform? Do you feel that news coverage of these discussions is adequate, or are there perspectives out there that aren’t getting heard?
As a resident, I haven’t been able to keep up the same way I did during policy school. I may flip through the New York Times or catch an occasional article in the New Yorker. Ultimately, my opinions are being shaped by the stories I hear and live through at work, in the trenches. I have been at the 30,000 feet level, discussing concepts like adverse selection and moral hazard and severity-adjusted DRGs and capitation. This is my chance to see it from the other side and it has been illuminating.
Click here for details on Wu’s Sept. 12 workshop.