Dr. Thomas L. Fisher, who practices in the emergency room at the University of Chicago Medical Center and serves on the faculty of the University of Chicago’s Department of Medicine, has written a superb riff on our healthcare system, inspired by Michael Moore’s SiCKO.
Fisher provides the following illustration of our broken system:
AT 4 a.m., the ambulance rushed the driver in a single-car accident to the emergency room where I was the attending physician in Chicago. The victim, a man in his late 20s, had been knocked unconscious when his head slammed into the windshield. The paramedics handed me two-thirds of his scalp in a plastic bag…
Human tissue can die in a just few hours if it’s cut off from its blood supply. So to avoid a disfiguring injury, our patient would need the care of a specialist who could reattach his scalp’s blood vessels. Unfortunately, my hospital didn’t have such a surgeon; the closest one worked at a sibling hospital in a more affluent neighborhood 15 miles away … I called and called and called, searching for a physician willing to take care of our patient. But no one would accept him. After 40 minutes, we flew him — and his dying scalp — by helicopter to a hospital 45 minutes away. The patient should have been recuperating after a close call. Instead, by the time he was whisked away from me, he was facing lifelong disfigurement…
The young driver in the car accident essentially had the misfortune of getting hurt in the wrong part of town. I was working in a community hospital system in the Midwest that consisted of two very different hospitals. Hospital A (where the patient started) served a blighted, post-industrial city of about 100,000 residents, about 85 percent of whom are black and largely poor and uninsured. Hospital B (the one we couldn’t get him into) is 15 miles away, in a more affluent community of about 30,000 people, about 70 percent of whom are white.
Although technically the two comprised a single hospital system, physicians were allowed to choose to work at one or both of the locations. Most chose Hospital B, leaving few specialists on call for emergencies at Hospital A. By dumb luck, my patient wound up at the wrong hospital, and that made all the difference.
Why a two-tier structure?… There’s less of a financial incentive to work in communities with many uninsured members.
The doctor’s proposed solution?
Many Americans oppose a single-payer health care system. My support of this initiative has grown from witnessing inequities daily through years in an emergency room. I hear the concern about such a system; people worry that they won’t get what they need, that the government will ration health care. But in fact, that’s exactly what we have right now. It’s just a little more subtle, a form of rationing that’s based on a person’s ability to endure hours of anxiety in the ER, to wait for the next medical appointment, to afford high-quality insurance.
This country has limited resources to devote to health care. But it also is saddled with an inefficient health care system that gives advantages to the privileged and well-off while ignoring preventive care and serving those most in need … All those little choices add up to big society-wide choices and market incentives for drug companies — and produce an America where one man pops his Medicare-covered Viagra pills while another can’t get life-saving cancer medication.
Many Americans do get the Mercedes-Benz of health care. But … you never know what neighborhood you may wind up driving in.
