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.