Universal health insurance – no wrong answers

Want to see what doctors look like in a food fight? Ask them what they think about universal health insurance and how to achieve that lofty goal; the white coats will come off, the scalpels will come out, and the goose liver pate will start flying.

You might think that if any group of people could agree on the issue of universal health insurance that doctors could, but they are no less divided on the issue than the rest of us. Some doctors oppose universal insurance completely, others support it as a right, and a few probably think universal insurance is about insurance for the universe, including inhabitants of Mars. Some bring their fierce belief in free enterprise to the debate, others think the profit motive is incompatible with quality health care for all.

If doctors cannot agree about universal health insurance it should come as no surprise that legislators in state government cannot agree on it either. In legislatures around the country, legislators are locked in bruising struggles about how to cover the uninsured, especially as soaring state Medicaid costs scuttle state budgets. In Maine much of the political struggle has involved the expansion of Medicaid eligibility and the related Dirigo Health Plan, two cornerstones of Gov. John Baldacci’s universal health insurance plan.

The debate has been rancorous and bitter, leaving hard feelings in all quarters. It has sapped much of the interest in bipartisan politics out of the state legislature at a time when the bipartisan spirit is needed to solve other difficult issues. In Maine those issues include property tax reform, municipal government restructuring, and, of course, whether people should be permitted to bait bears for hunting.

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The lack of consensus about universal insurance among doctors – people who spend their entire professional lives providing health care – should suggest that there is no right way to universal health insurance, and therefore no wrong way either. Take, for example, the seemingly simple issue of whether there should even be universal health insurance. I know health care professionals who argue fervently that if everyone has it many will abuse it, because no one respects anything they are given for free. They regard every patient who shows up in the emergency department for some “stupid” reason as evidence in support of their argument.

When I hear this from them I put my opinion into high gear and my mouth into four-wheel drive, but try as I may to turn their position into social road kill, they have an answer for every argument. I try suggesting they have the brains of a weasel, but that does not work either, because often they are very capable health care professionals who work miracles on patients.

Being a contentious, argumentative SOB there are few health care issues about which I have not argued with some other health care professional. I have done so enough to know that, for everything I believe on issues of health care policy, there are reasoned arguments to be made that I am wrong. Good, smart people who care passionately about health care can have very different opinions about how to achieve it for all Americans. The truth is, there are fewer issues of real right and wrong in health care policy debates than there are differences in approach.

That being the case, universal health insurance may be worth fighting about, but making enemies over it is an unfortunate mistake. Acrimony, sanctimony, and ill will over health care issues are unaffordable luxuries and run contrary to the caring spirit which should imbue debates about the health care of human beings. One is hard- pressed to argue they care much about others if they hate someone with whom they disagree about the care of others. Just as there should be a special place in hell for those who kill in the name of their God, there should be a special procedure in the doctor’s office for those in politics who cast aside legislative colleagues over disagreements about health care policy.

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If the high road in health care debates is unappealing for reasons of principle it should be appealing for reasons of politically expedience. These debates are like mosquitoes in the Maine woods; no matter how many you smack down there is always another one waiting to stick you in the neck. Next week, next year, next session will see other tough issues, and the person you flipped off last week will be the one you need in the debate over next week’s issue. That is especially true in a small state such as Maine, where there are too few political leaders and experts to make any into enemies over issues for which there are usually few unmistakably right answers.

If all of that doesn’t convince those who want to do political open-heart surgery on their political opponents over health care issues, they should come spend a night with me in the emergency department. On a regular basis there something I believed in the abstract of my previous experience gets stood on its head by the reality of the next patient in front of me.

Much of what any of us have assumed about the way things are, or should be in health care policy could be “shake ‘n’ baked” to a crisp in the ED.

At the end of the day, in the ED or in politics, we don’t need people who simply think they are right; the world is full of those. We need politicians who will stand together through thick and thin, through right or wrong, through good fights and bad, and be there at the end of the fray ready to work together as a team for the next debate that is coming through the door.

That team could win the war for universal insurance, which is much more important than the battle of the moment.

Erik Steele, D.O. is a physician in Bangor, an administrator at Eastern Maine Medical Center, and is on the staff of several hospital emergency rooms in the region.