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Making Your Own Healthcare Reform

A medical professional speaks out on why insuring everyone won't fix everything.

Right after I caught a quick glance of a website announcing the Supreme Court’s decision on health care reform, I went to see a patient reporting a fever, one of about 20 such cases on my schedule. When I got to this patient’s room, I asked when the fever began and was told it had only started about three hours ago. But this patient said they had “never run a fever,” so the worries of what it could be worried the family.

“So how’s the fever now?” I asked, while looking over the vital signs. As I saw that the nurse had recorded the patient’s temperature as completely normal, the patient told me that “the fever dropped right after I took some Tylenol.”

“And how do you feel now?” I asked.

“Really good. But what do you think caused that fever?”

There’s a saying I learned in medical school: If you hear hoof beats, don’t assume it’s zebras. So I told my patient it was probably just a mild virus that might bring the fever back for a few days, off and on. After the usual exam and some reassuring words, the patient left feeling 100 percent normal.

And I pocketed a government-approved fee of more than $100 for less than ten minutes of work. Thanks, Medicaid.

There’s no denying that the current health care system is broke, but adding more people to the rolls of the insured won’t solve the problem.

Now with the current health care reform, or health care “tax” as Chief Justice Roberts terms it, we’ll have many more deserving, Medicaid-covered individuals able to obtain this valuable commodity we call health care. Add to that the uninsured who will now have mandated coverage from a variety of new, often government-subsidized, plans and, in this day of unemployment woes, my job is secure.

Trying to cure over-spending on health care results in debates featuring dramatic stories of a distant uncle with myasthenia gravis who couldn’t get approved for health insurance and his small business employer had to cancel his insurance for him and the insurance of all the other employees to boot. Then there’s the even sadder stories of the young person debilitated for life by an accident or affliction, financially devastating the family because the child didn’t qualify for insurance. There’s no question health care reform will help solve those tragedies.

These health catastrophes that make headlines will be financially protected by Obamacare, and a goodly portion of the uninsured will have something to cover their health needs. Yet, in my work, I continue day-after-day, hour-by-hour, to meet with people who come to me for small time, garden variety health needs that would, more than likely, be cured by nothing more than a good night’s sleep. And I get to charge an arm and a leg to tell people that. There’s no denying the current health care system is broken, but adding more people to the rolls of the insured won’t solve the problem.

I’m stuck. Our nurses screen the calls of all patients with an illness. The nurse will talk the patient through the symptoms and try to provide reassurance if an office visit isn’t necessary. But people know how to get past that, either by demand or exaggerated claims. And, yes, sometimes, when the office schedule has a dozen unfilled afternoon openings, the nurses will schedule appointments with patients self-declaring their grave illnesses to help cover the business overhead and keep our wages intact. And there are the rare but real calls of a simple-sounding illness which actually winds up being something complicated, if not life-threatening. When that happens, everyone who helped discover the more severe illness gains praise and notoriety, and the story gains an immortal retelling.

And we, the clinical staff, are all reminded to do everything possible to minimize the risk of overlooking a serious diagnosis because we too quickly dismiss a simple fever that began three hours ago and responded to Tylenol.

So, maybe I am at fault. I can’t help it. I feel the responsibility to meet the patient’s needs, making sure I don’t miss a serious illness and keeping our business afloat financially. So I’ll meet with patients who may not need to be met with. It’s my job. But when do we finally admit the majority of health care costs are due to people, often those among the economically-deprived, who come to the door with a sniffle, an ache and a worry? For one hundred dollars and change, I’m happy to give you the reassurance that everything is OK. And more often than not, the government foots the bill.

Health care reform really won’t make a big difference to me. Granted, those of us paying taxes will feel it in our wallets. Our country’s leaders think they know a way to find the money to pay the extra, but that’s not worked well in the past. It might still just come down to each of us making common sense choices about our lifestyles—helping those around us think through when a doctor visit is truly needed, talking more openly about reasonable health concerns, avoiding a race to recount the horror stories of illness, and sticking with that medical school adage about hoof beats.

It’s typically horses. And if not, you’ll see the stripes soon enough.


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