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The answer probably should be an automatic ‘yes’, but…

I have been struggling recently, well… recently is not true as I have struggled my entire career as a nurse with this topic but more so lately.  The topic of whether people ‘deserve’ healthcare or not has again reared its head forcefully as politicians decide whether to dismantle the Affordable Care Act, which by the way is law. I’ve seen and lived both sides of this argument.  I have seen patients who have health insurance provided for them who take advantage of the system, but I have also seen patients who pay for their health insurance or who have no health insurance who do the same.  I have heard those who pay more for Medicare supplements and medications complain that they are paying more ‘only because they make more money’.  I have seen those who have no supplement struggle to fill daily medications.

After decades in healthcare questions continue to arise. I am looking for honest answers to these questions. They are not meant to be rhetorical in any sense. Please feel free to engage me on any of the following areas.

Discrimination against those who have Medicaid insurance

Have you ever been standing at a nurses’ station and heard from a healthcare professional of any sort make the following statement… “Oh they have Medicaid insurance and thus want us to do (blank) for them” and then either roll their eyes or let out an exasperated sigh? How did we become so jaded or so discriminatory against a group based on some identifying factor such as type of insurance?  Does having Medicaid insurance predispose providers to make judgements or to provide different care? Does the institution of Medicaid itself set up a class-system, in a country where how much wealth you have has always dictated healthcare access, type, etc.?  Is there a contrast for how a practice treats its VIP patients versus its Medicaid patients? Is this good? Should we allow it?

The truth is that being poor, and needing healthcare insurance may co-exist, but they are two entirely different things. Further, the reasons people need one or both is complex. Ranging from profound tragedy and loss of income or ability, to geographic location and opportunity, race, gender, education, or even twists of fate. Does this make persons who are poor, who need Medicaid, or who have no health insurance less human or less deserving of healthcare? Did our oaths and schooling teach us this? Did our culture? Did our parents? Did our religions? Do those of us who have the ability to pay for healthcare or have private health insurance always make the best choices? Which choices or attitudes should automatically exclude people from certain aspects of healthcare or access in its entirety? Should there be levels of deservability (not a word I realize, but one that is called for in this discussion) or access as we seem to now have? Should we continue these?  Should we shrug and say access to an ER or a community health center is enough for those without health insurance? Should we look the other way with a sigh and express that the problem is too big and that attempts to change it thus far have failed so why do it? Would the current levels of access available to those without insurance or with Medicaid suffice for those of us who have private insurance or can pay? Would we work to change the system if all we had was access to the ER and a community health center? Would we want the same for our parents or children?

Do you always “deserve” the level of heathcare access you have? Even when you used that nail gun without safety glasses? Or set off that firework in your hand? Or were texting while you were driving?  Or didn’t show for the last two appointments you had with your specialist? Or didn’t complete that round of antibiotics as directed? The truth is there are many different ways we can chalk up ‘deservability’ of healthcare. Are we going to say financial access and wisdom with which care is used are the way we judge? Is healthcare like car ownership, the more money you have the better yours should be? Those without enough money to own one… well… it’s just their own fault for making poor decisions to get there?

Does not having access to care affect health outcomes? Of course the answer to this question is yes, proven repeatedly in research.  If we know this to be true and we know that the health of people affects their ability to work, to have quality of life, pain control, functional ability, and even life relationships… then why on earth would we say that those who probably need the most assistance in these areas should in fact get none? What do we value as a society?

I fully realize the topic is much more complicated than my seemingly never ending stream of questions and that the currents of business, gross domestic product, jobs, wage earning, shareholder profits, and more is wrapped up in this.  However, this conversation is just for those of us who chose to be healthcare providers.  What does that mean to you? Why did you start? Do you believe in treating all people differently based on anything (Gender, sexuality, religion, criminal history, ability to pay, etc.)?  Resources are finite and we are all clearly human.  In a healthcare culture that is the most expensive, with the poorest health outcomes in the westernized world, we are all going to have to sacrifice something to make things better. What are you willing to sacrifice?  What ethical values and personal principles are at play for you when you treat patients? Would having healthcare access for all fix anything? Would making our population as a whole healthier by treating everyone with the same access do anything for our moral, financial, health, and economic stability as a nation?

I guess the bottom line is… when I contemplate the judgement I have seen and even handout out to others myself over the years for providing healthcare to those that have somehow been deemed less worthy, whether by finances, immigration status, addiction, criminal activity, gender identity, lifestyle choices, or whatever else we choose to identify them as… I then have to look back at myself.  Am I deserving of the healthcare I have? What makes me more worthy than anyone else? What am I willing to do to help change the current state of healthcare access and healthcare outcomes in this country? What can one healthcare provider do? How do I reach my current students to engage them in the same critical discussion? How do I create a new generation of healthcare providers, in a day and age of narcissism, which helps to answer these questions in a more effective way?

How do I look at myself in the mirror every day and then go to work and get paid within an industry that I do not work to make better or change? What one thing can I do each day to improve access, affordability, and equality in healthcare?
Thoughts?
Suggestions?

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