Washington D.C., and health care reform

I woke up in Washington D.C today. I'm going to meet my friend Johnson "Spud" Maxey tomorrow to go to the International Spy Museum and to eat some Ethiopian food at his request. Today I wanted to spend the day on the Mall. I ate breakfast near my place at the Club Quarters and it was here that I read that health care reform will be dropped in it's current form by Obama and the Democratic majority in Congress.

I am two blocks away from the White House so I stared at it. After breakfast I started walking and my path took me past a woman in a short black cocktail dress and strappy high heels absolutely yelling into her cell phone. She was pissed at somebody, perhaps her boyfriend, and every other word out of her mouth was f--k this and f--k that and "You better get your f--king ass out here!" etc. She and I were the only ones on the street since it was about 8A and D.C. was sleeping in, or trying to. I took this as a metaphor for...what? I don't know.

Anyway, I was to the White House in a snap. I almost got Lafayette Square to myself. It was only me and the guy with tattoos on his forehead who had been part of a group sitting in front of the White House continuously since 1981 demanding nuclear de-escalation. An issue that has fallen far on the "to do list" of the nation.

Health care is on top and this thing has upset me. While staring at the White House I couldn't help but feel that President Obama and the Congress have not done us a service at this time, that health care for more Americans was within our grasp. In fact, we had it in the boat but it wiggled out. I don't think they should have given up. Since the turn of the previous century there have been two Republicans and a hand-full of Democrats that have tried to get more broad coverage for Americans and all have failed. It appears now that Obama may fail as well and this is especially crushing since he was elected on a health care platform and he came so close. Health care is the holy grail and no President has found it yet.

As a physician I have worked in public hospitals: Hennepin County Medical Center in Minneapolis and Bellevue Hospital in New York City. I have felt, like others, that there is disparity in health care delivery and those without insurance are at a distinct disadvantage. Some could afford it and choose not to buy it, they deserve some knuckle rapping,  but I also think that there are enough that are struggling, or are not sophisticated enough, to figure out a system that follows no reasonable rules of economics and they suffer disproportionately.

The preamble to the constitution addresses ensuring domestic tranquility and promoting the general welfare of Americans. Health care is right down its alley. Yet the Constitution does not state a right to health care, as it doesn't mention a right to a public education, yet we have chosen to offer that to the citizens of our country. Arthur Caplan, at the Penn Center for Bioethics, addressed this at a recent keynote speech at a Critical Care meeting. He invoked our desire as a nation to see equal opportunity for all, as one might evoke with creating public education, and he went on to suggest that more accessible health care may also afford more equality of opportunity. By not having reasonable access to health care there are those with asthma, diabetes, seizure disorders, etc. who may not be able to get reasonable health care and thus they experience disproportionate limitations financially and physically that limit their access to a more level playing field of opportunity through little fault of their own.

As cost has always been an issue let me throw this out. The governor of Colorado told me that his office estimated that each uninsured person in his state costs more than $20,000 a year in E.R. costs alone. The average cost per insured person in Colorado seems to be approximately $7,000 based on government statistics from all fifty states. One could estimate 500,000-1,000,000 uninsured in Colorado alone (40 million in U.S.). If one conservatively thinks that there would be $10,000 a year saved on 500,000 people if they were brought into some insurance pool this would add up to $5 billion dollars of savings in Colorado alone.

My personal feeling is that a lack of reasonable health care access for everyone in a country that claims to be the beacon of truth and justice in the world should leave us embarrassed. Lyndon Johnson tried to limit the Congress into drilling down on the cost of medicare because he thought health care coverage, in some form, for the elderly was a necessity in this country. He likened it to having milk and bread in your kitchen. No matter how much milk and bread cost you would just have to spend the money because you had to. Broad health care access is just such an issue. The cost matters, but it doesn't matter, so why not JUST DO IT. We can adjust the budget deficit, we can afford not to buy the next weapons system, or we can let the grass grow at the campsites of our National Parks, or we could all reap the financial benefit of a more healthy medical sector, but health care is bread and milk for the nation. We need it, be it in single party payer form, with a public option in a privately managed system, or some form of mandate without a public option and it seems extremely disappointing that we can't seem to do this.

The White House just sat there, in its beauty and splendor. I walked around and took pictures of the Washington Monument, saw Whistlers Peacock room, and went to the Air and Space Museum after having a hot dog near a childrens group so large that they reminded me of a school of sardines. Then I went to the National Art Museum and saw a Chekov film in Russian with subtitles.

When all is summed up I feel lucky to have economic stability, wonderful friends and family, and I'm lucky to be in D.C.