Reach Out and Touch Someone

I have a new plan for healthcare reform. Take HMO and pharma executives on mandatory tours of the ER.

How did I come up with this brilliant plan, you ask? Let me talk you through it...

Last night I admitted a 23 year-old woman to the hospital. Let's call her Marisa. Her only medical problem, diagnosed when she was fourteen, was Crohn's disease, which is an inflammatory condition of the bowel that causes unpleasantness like chronic diarrhea, vomiting and abdominal pain.

For many years Marisa's disease was well-controlled with Azathioprine, meaning she had very few of the disagreeable symptoms i just listed. Then a year ago her insurance (which was chosen by the university she attended --- none of that mythical free-market "choice") decided that they weren't going to cover azathioprine, because for most patients cheaper medicines would do the trick just as well.

There's a problem with basing overall policy on how most patients react. I've never met someone named Most Patients. Every real human being is a little bit different than the composite they create from research. It may be true that in a study of 4000 people, the average Diarrhea Symptom Index score (i just made that up) was not significantly different between Azathioprine and another medicine. But what does that matter to Marisa? For her the "average" patient is meaningless. She needs exactly this medicine to treat her disease.

We have a gargantuan, multi-billion dollar profit-making pharmaceutical industry in this country. The industry is constantly pumping out new drugs, each of which does almost exactly the same thing as its predecessor. Most of the time, it doesn't matter which of the ten available drugs is chosen. But in the rare cases where it does matter --- like now, with Marisa lying on a stretcher in front of me --- shouldn't the patient have access to the drug? Why do we have this massive pharmaceutical industry otherwise?

Marisa couldn't get her Azathioprine six months ago, so she was forced to try inferior alternatives, none of which have done the trick. She came to the ER last night because things had gotten so bad she'd begun to experience rectal bleeding. Not just blood in her stool, mind you: this is blood dripping from her rectum at random intervals without her control. She's twenty-three and she has to wear a diaper.

I could almost justify a system of huge profits, shameless marketing, and ridiculous unnecessary drugs, if at least that system gave this one 23 year-old the relief she was crying out to me for.

But it didn't. I had nothing to offer her.

The dinosaurs who believe in free-market healthcare carry around a certain fantasy --- something akin to elementary school civics class. Remember "How a Bill Becomes a Law"? We learned that there are three branches of government, and each branch provides checks and balances to the other two. None of them can get too strong, because the others are watching.

The free-marketeers think the same thing will happen in healthcare. They are deluded into thinking that although the pharmaceutical industry will ply us with expensive new medicines, the HMOs will keep them in line. In turn, consumers will keep the HMOs in line by demanding that they cover the medicines that work. Checks and balances.

But in the case of Marisa, we have an example of how the checks and balances only serve to slam every door and leave the patient out in the cold. The patient has no voice. It's not a coincidence that they call them for-profit entities, not for-patient entities.

You might think I'm naive to expect a giant HMO or pharmaceutical company not to pursue profit. And it's true, I would not expect otherwise. But that's why situations like Marisa's make me want to cry: corporations may be evil, but the human beings inside them aren't. If any of the people working for Aetna or Merck met this poor girl, and heard her story, I know they would do everything they could to get her the medications she needs. They would be touched, they would see her as a human being, and they would act compassionately.

But the people who work for Aetna and Merck haven't met Marisa. They don't know her story. They are are blissfully removed from her life, and from the lives of millions of other people they affect daily. For them, this 23 year-old Crohn's patient exists only as an account payable, a number to be spindled and manipulated and shifted into the proper column. If enough of these faceless numbers move in the right direction, the workers get a healthy year-end bonus. Hey, they're just doing their job. Nothing cruel or heartless about that.

Which is why it's time for the mandatory ER tours. Sign-up sheets will be posted soon.