Conservative political and social commentary
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First they came for the communists,
but I was not a communist, so I did not speak out. Then they came for the socialists
and the trade unionists, but I was neither, so I did not speak out. Then they
came for the Jews, but I was not a Jew, so I did not speak out. And when they
came for me, there was no one left to speak out for me.
– Pastor Martin Niemoeller.
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|No Insurance Does Not Mean No Care - Monday, July 30, 2007
No Insurance Does Not Mean No Care
David C. Stolinsky, MD
How many times have the media told us that there are 40 million Americans without health insurance? Granted, the figure is a rough estimate. Granted, the figure includes most of the 10 to 20 million illegal aliens, who would not be entitled to free health care even in a socialist nation. Granted, the figure includes millions of younger Americans who believe they do not need health insurance, and who prefer to spend their money elsewhere.
Still, however inexact the figure may be, it is worrisome to anyone with a heart. Those without insurance are less likely to receive optimum care. The trouble starts when many politicians – even presidential candidates – equate having no health insurance with having no health care. This error insults my intelligence, and it insults my whole professional life. Like millions of other physicians, nurses, paramedics, technicians and others, I devoted most of my career to caring for patients who could not pay for their care.
I spent my early years in a small North Dakota town, where my father practiced 15 years as a country doctor, going out in snowstorms to deliver babies. The county sometimes paid him a minimal fee to care for poor patients, of whom there were many. But most of them at least left a sack of potatoes on our back porch to show their gratitude. That’s the way people were back then – grateful, not entitled.
I attended the University of California School of Medicine in San Francisco. Our third year was spent at the old San Francisco County Hospital. The building was decrepit, the equipment scanty, but almost all of us – from lowly students to professors – were dedicated to caring for indigent patients. When I rotated through the emergency room, I helped care for victims of shootings and stabbings, many of whom were alcoholics, and some of whom were criminals themselves. I recall a black man lying on a gurney, his hands cuffed behind his back. I didn’t know why he had been arrested, but I went out of my way to help him. I was troubled by a grown man unable to care for his bodily needs.
My internship was at the U.C. Hospital. My first month was on the private service, where we helped care for well-to-do patients of the professors. Rather than being sought after, this service was looked down on by calling it the “fig leaf service” – you know, “we cover the privates.” The other 11 months were on clinic services, where we cared for patients with little or no funds. I was proud to have a part of their care, for which I received the magnificent salary of $186 a month, which did not include room and board.
My first year of residency was at Mount Zion Hospital, where most of the patients were private, but there were active clinic services for indigent patients. My second year was back at old San Francisco County. No, the care wasn’t optimum, but we worked night and day to do the best we could. I recall my oldest patient, a lady in her nineties. I spent what little time I could with her, because she had no more family.
And I recall an indigent man who arrived in shock and heart failure from a heart attack. The mortality rate for that combination was close to 90 percent, and it is still very high. To top things off, he had a stroke. I stayed up all night with him, and eventually he walked out of the hospital. His chart was returned to me by my chief with the notation, “Good work.” As the credit-card commercial says, “Priceless.”
I completed my training with a fellowship in medical oncology in the Los Angeles County hospital system. At the time, there was little to be done for most patients with advanced cancer. We were the headquarters of a research group trying new treatments. Most of our patients were indigent or working class, but they also included a newspaper reporter, a successful businessman, the fiancée of a police officer, and the brother of one of my medical-school professors. The all got equal care.
After my fellowship was over, I remained working at Los Angeles County facilities, mainly L.A. County-U.S.C. Medical Center, for 20 years. Our faculty was excellent and included distinguished professors. My first chief went on to become U.S. Surgeon General and then a medical-school dean. I recall an internationally known expert on liver disease, trotting up the stairs late in the evening to see patients – because he had no time to wait for an elevator.
Was everything first class? Of course not. The wards were crowded, the paint drab, and the medical and nursing staffs stretched too thin. Recently the Los Angeles Times reported months-long waiting times for elective surgery such as hernia repair, and for referral to specialists. Of course the Times, which favors lax immigration policies, did not make the connection between overcrowded county facilities and the influx of illegal immigrants. Of course the Times, with its liberal slant, did not compare the waiting times for indigent patients in Los Angeles with the waiting times for all patients in Canada and Great Britain. They are roughly similar.
It is true that drug costs are a burden for the less-than-affluent. Critics condemn the profits made by drug companies. But where do life-saving new drugs come from? Are they delivered by extraterrestrials in flying saucers, and drug companies then make huge profits selling them? No, drug companies use a major share of their profits to gamble that new drugs will be successful. Drug-company profits play a major role in funding development of new drugs.
Take AZT, the first drug useful for AIDS. How was it developed so fast? It was pulled off the shelf by Burroughs Wellcome, a British drug company that developed several cancer drugs. AZT wasn’t useful for cancer, but there it was on the shelf, ready to try on AIDS. Instead of being grateful for this good fortune, activists condemned Burroughs Wellcome for “profiting from AIDS.” This is similar to complaining that General Motors, Ford, Chrysler, Boeing and Lockheed made profits during World War II. Would the critics have preferred that these companies went broke, and Hitler won? Would the critics have preferred that Burroughs Wellcome made no profit, funded no research, and that several years went by before an AIDS drug appeared? Some people hate capitalism more than they hate Nazism or AIDS. Avoid these people.
I believe that in its 74 years of existence, the Soviet Union developed one new drug. But “progressives” want to emulate the Soviets and remove the profit motive from drug development. Roast goose is delicious, but where will we get any more golden eggs?
We have choices. Do we want to continue our excellent system of health care, but add resources to improve care for the indigent? Do we want to reduce the influx of indigent immigrants, who overburden our health-care system? Or do we want everyone’s health care to be some version of the Los Angeles County system? Do we want to raise the floor, or lower the ceiling? These are legitimate questions, with good arguments on both sides.
But what is not legitimate is to claim that the millions without health insurance also are without health care. This is an error at best, and a lie at worst. Even more, it is an insult to all those who devote their lives to caring for those who cannot pay for their care. It is an insult to my father, who went out in snowstorms to treat the indigent for little or no pay. It is an insult to all those − from the gray-haired nurse at Bellevue, to the newly minted intern at Cook County, to the streetwise paramedic in Los Angeles, to the busy private practitioner in Paris, Texas − who care for the least fortunate among us. These caregivers deserve to be assisted and honored, not ignored and devalued.
Dr. Stolinsky writes on political and social issues. He can be contacted at firstname.lastname@example.org.