At the Still Point of the Turning World
Residency is over, NOW what? (While I'm waiting for the answer, I'll get some spinning done....)

Monday, March 10, 2003


This week is Cover the Uninsured Week. Perhaps we can all take a few minutes from each day this week to give some thought--and some action--to the problem of uninsured patients in America. I work at a county hospital so this is a BIG ISSUE among the staff here. A significant number of our patients have no insurance and come to us only when their disease is advanced or when they have developed terrible complications. Many of our diabetic patients, for example, need dialysis or leg amputations by the time they establish care with us. Why wait so long? Because they didn't have insurance, and they didn't want to bankrupt their families merely in order to take care of themselves.

This is a complex political and social issue, I know. Many of us will come to the debate with our own experiences of HMO-driven medicine, with all the criticisms of that system of health care already well spelled-out. Many are concerned about the cost of universal health care during this period of economic turmoil. I'm sure others will want to argue about the philosophical angles of the problem--for example, whether health care is a right, or merely a privilege, of being human. Then there will be discussions of complicating factors, such as the health care of undocumented immigrants, many of whom come to my hospital, and upon whose backs much of the agricultural industry of this region depends. I expect there will be much talk, many heated arguments, some celebrity sound-bites, a few rallys, and--if we're lucky--the beginnings of change.

I am not a politician or philosopher, and I am certainly not a celebrity. I'm a family doctor in training and--irresponsible as it may seem--in my day-to-day life, I'm not interested in the ethics or economics of universal health care. I'm interested instead in how far we can keep going like we are now, before we evolve into a new Medieval age, where the sick lie suffering in the streets or die in fields of pristine salad lettuce, one day to grace the dinner tables of the well-insured few.

I hope there will be no talk of safety-nets for health care, such as the meager Medically Indigent Adult program in my county. What seems to escape the people who blithely use this term is that safety nets are used by trapeeze artists, as they swing and twirl from unnatural heights, and are only there as a thin shield against dying. Hardly adequate protection for those who volunatrily risk their lives, unacceptable for those who only wanted to be well.