There is a Chinese proverb that is both a blessing and a curse. The blessing is, “May you live in interesting times,” and the curse is, “May you live in interesting times.” All of us would like things to stabilize into a constant, comfortable and predictable environment for us to live our lives, raise our families and care for our patients. We are entering the most complex and challenging period that medicine has experienced since the 1960s when Medicare was introduced. From now on, everything we have come to know and are comfortable with in our professional lives will change.
Explore this issue:September 2011
Much of this has to do with a law of nature, that of unintended consequences. It states that the desired result of an action, which may have been well intended, well thought out, and justified, may lead to future events that were neither intended nor foreseeable.
The current health care reform bill, the Patient Protection and Affordable Care Act (PPACA), is well intended, has the input of many bright people and was justified because of our failure to provide health care equally to all Americans. Yet it may have the dramatic, unintended consequences of bringing about the demise of private health care as we know it, creating a monumental power struggle and laying the groundwork for a single-payer system.
I would like to explain support of the first element of the premise: that of need, justification and good intentions. The current increase in the cost of health care is unsustainable at 17 percent of gross domestic product (GDP) and growing (Congressional Budget Office. “The Long-Term Outlook for Health Care Spending.” cbo.gov). Something had to be done. According to the U.S. Census Bureau, 30 million citizens did not have insurance or could not obtain it during a two-year period (politifact.com). This statistic implies that they did without health care, but did they? In large metropolitan cities like Memphis, where I practice, the underinsured and uninsured are cared for by the teaching services of the local medical school, county hospitals funded by community taxes or the kind hearts of private physicians. In rural areas and those cities without a medical school, these services are frequently deficient. Those who have lost a job that provided insurance are chronically unemployed or are uninsurable because they suffer from a chronic illness are forced to use Medicaid, Supplemental Security Income or charity services. These patients receive care, though the press suggests that they do not. I know I was part of the safety net system. It worked but was stretched thin and was just not viable for the long term.