Oh, For Civil Healthcare in America

by Donna Smith –

Ah, we must be more civil. No more taunts. No more tirades. No more gun crosshair targets, no matter how innocently placed on our graphics (though I am not sure gun crosshairs are ever really innocent in placement). We’ll be more civil in our discourse. In light of the tragedy in Tucson. Maybe.

But stand at the front desks in a hospital admissions area or a doctor’s office or at other providers’ offices and civility is the last thing we’ll know. We can be sick – shaking with fever, bending over in pain, bandaged for wounds, chest aching with unknown agony, and the questions and responses will be anything but civil. “What insurance do you have? Where’s your co-payment today? Is that a check, debit or credit card? Do you have a picture ID? Have you signed our legal forms and signed our privacy forms?”

And if you make it through all of that, you may still not receive the kind of care needed to make you feel better or even save your life. You may sit waiting for a doctor who may or may not treat you based on what an external organization or agency says you are entitled to receive. The doctor may be annoyed that you are in his or her care instead of farmed out to another specialist. If you do find yourself referred for a test or another doctors’ visit, you’ll start the process all over again from the beginning. Co-pay paid? Insurance in order? Credit or debit card? Picture ID?

Civility? Hell. No one has even helped with the symptoms that brought you or a loved one in for care.

In my more civil healthcare world, the first questions asked would relate to, well, civil sorts of patient-related questions. “How can I help you today? How are you feeling? Does that hurt? How can I make you more comfortable?” But until we transform this system, those questions are secondary, at best.

Even in our most crass and impersonal financial transactions, some polite interaction is programmed into the dialogue. But not in healthcare in America. It seems every time I seek care or take someone I love for care, I am treated like an annoyance or like the enemy – someone from whom the providers must be protected. The evil, non-cash-bearing patients, we are viewed by many as such.

So long as the motivation for profits and more profits and ever-increasing profits remain the primary motivator for those who dole out our care and our access to that care, I am not likely to see more civility but less. I half expect that within a short bit of time, I will carry with me a card that shows not only my medical history but also my credit score, my bank balance, my credit or debit card information, my next payday linked to a payday loan operation, my current insurance coverage and the status of my deductibles and out-of-pockets yet owing at the time of treatment and so on. It may even have my photo and maybe some biological security device to make sure I am the widget labeled on the card. If at any point in the process, I cannot pass from patient to insured patient to out-of-pocket expense paying patient to finally in the exam room patient, I’ll be let go. And it won’t be civil. All but the most exaggerated gaping and bleeding and gasping will wait until all financial systems are clear.

If we were civil in our healthcare delivery, we’d want what is the right and the best treatment for one another delivered at the most appropriate time in an appropriate way. We finance such a system through shared risk and shared cost-saving, and we’d minimize the wasted administrative expenses and the duplication of services now so costly and so un-civil.

I watch with hope when I see communities rally after tragedy. So why is our healthcare system so different then and why are our sick folks less deserving of our best caring and effort simply because their tragedies unfold more slowly, more methodically, and more quietly?

Bending the healthcare cost curve will only happen when we believe that creating a progressively financed, single-standard of high quality care for all is the most rational, civil course of action and we set about to make it happen. So far, allowing tens of thousands of our fellow citizens to suffer and die in a very uncivilized way while the care they needed was within our grasp has not compelled us to act decisively. Civility has not been the hallmark of healthcare in America.

We’ll watch next week as legislators argue the pros and cons of repealing the newest healthcare bill. They might even attempt to show a calmer tone while doing so. But whether they succeed in the political theatrics of the repeal effort or not, sick and hurting patients will keep standing at those front desks waiting to be cleared for care or sent away in shame. And no one will care much at all right now about the civility of that preventable suffering.

When we see good people harmed in unimaginable acts of violent outrage, I hope we’ll pause to remember those among us for whom quiet acts of unthinkable pain and illness are an on-going assault on any sense of human decency. When we finally have reached the point of shared realization that we’re responsible for one another and for our civil society as manifested not only in acts of occasional violence but also in our everyday ability to uplift one another for the common good, then we’ll be moving toward a sense of civility that will do more than change our words – it will change our lives.

Donna Smith is a community organizer for National Nurses United (the new national arm of the California Nurses Association) and National Co-Chair for the Progressive Democrats of America Healthcare Not Warfare campaign.


  1. Vashti Winterburg on January 18, 2011 at 10:38 pm

    Donna, good column, as always, especially in light of having a nephew almost die this fall from a gangrenous gall bladder because the first emergency room he went to basically refused to see him because it couldn’t establish that he had insurance. Fortunately he went to another hospital, but really, he’s lucky to be alive.
    I also have to wonder how much of the shooting in Tucson is part of our immoral,health care non-system. What if this young man had been able to get mental health care, therapy and medication for free? Yeah, I know, still way too much access to guns, but still….

    Vashti Winterburg

  2. Barbara Larcom on January 25, 2011 at 2:20 pm

    Several years ago, I was feeling pretty sick and visited my family doctor. She was civil, but then her office manager kept me standing up and answering questions about payment – all the while incorrectly accusing me of not having paid a bill which in fact my insurance should have covered. I finally insisted on being given a seat while we finished our discussion. The matter was resolved when my insurance paid the bill.

    A few months later, I was in a horrible house fire and suffered serious smoke inhalation and some carbon monoxide poisoning. I was treated at a Shock Trauma Center and released. I called my family doctor and (still very hoarse) asked for a follow-up appointment. The same office manager told me that in order to be seen, I would have to pay an additional $109 over and above the regular fee for an office visit. When I asked why, he said it was because I hadn’t paid my bills promptly in the past.

    At that point, I said, “Well, guess what? I’m firing my doctor. I’ll ask to have my records sent to the new physician.” The office manager responded that they would charge me for the photocopying, and I said fine.

    I found a new physician who is WONDERFUL and so caring about her patients. The office staff is GREAT too. I just wanted to share this story because it’s such an example of how a little civility goes a long way when people aren’t feeling well. We patients need to stick up for ourselves and insist on civility. Thanks for your article.

  3. Susan Litchfield on January 25, 2011 at 4:36 pm

    Loved the U-Tube musical video – Stop! Don’t hurt my Medicare!
    I am 62 drowining in Florida with a well-package from Blue Cross at $299/month. We need to move to a better national system and a full national choice.

    Great Music! – Send me the words to sing at my next social activity.
    Keep Healthy – Sue

  4. Dusty Putorium on April 3, 2011 at 10:06 am

    Oh, I wish I could live in Vermont and I tried to win that beautiful home on HGTV, but sadly did not? Health care for Vermont citizens and why can’t the rest of this rich USA pay for universal health care and stop the greed as I know from being an RN? See on news yesterday that the hedge fund leaders made over 22 billion WHY or HOW? Why do we no longer have enough jobs to pay for high health care maybe NAFTA so many could make more money? Az now is doing the death squads they said Obama care would bring about and these are Republicans WHY? We have a great clinic here in Pickens cty Ga for 8 years now for those who no longer can pay the high cost per many have lost jobs here locals not all the immigrants we allowed in to the mtns to take away jobs in our chicken and carpet and landscaping and all over WHY? This clinic is volunteer and try to help as they can great doctors daily give their time for nothing? All the other volunteers only one of maybe 30 in this country a rich country? Please no more from these politicians who are being lobbied by the greedy insurance etc companies who say but you can go to the ER wish they would go and give up their free health care that you have one term in office keep forever WHY? Thank you nurses in Calif for fighting for the middle class for all ppl and yes we have to take care of the immigrants too we allowed them to come or why almost 15 years ago did we get dial 1 for Englishand 2 for Spanish because the powers that be wanted this to happen ?