By RICHARD C. DILLIHUNT, M.D.
The Portland (Maine) Press Herald, Jan. 1, 2011
PORTLAND – Fear is a distressing emotion aroused by an impending danger. This simple four-letter word commands attention in a myriad of daily circumstances in the lives of men. Fear can paralyze any person or nation — thank goodness FDR saw this coming.
Perhaps the first expression of fear in primates is the Moro reflex, in which the infant, when startled, instinctively throws out his arms, spreads his fingers and then grasps for his mother.
Creatures below man rely upon fear for survival; see the spider roll up in a ball, the lobster in reverse gear or the chipmunk disappear into a hole seemingly too small for escape.
In medical practice, fear is a constant visitor to patients, and the allaying of apprehensions assumes a dominant role in the doctor-patient relationship. A hidden, quiet, highly personal part, it’s nonetheless a crucial factor in the strategic approach to management of the medical problem at hand.
As an aside, this is one of several reasons why attempts at involvement of political forces in patient care are unsuccessful — even laughable when brought to bear awkwardly, as we have seen during recent health care debates. As my dad said, “If you want to comment on that, go first to medical school.” So I did.
With the skyrocketing of health care costs continuing, it has become evident that this is contributing deeply to our decrepit economy, and to the overall national health (or lack of it).
Newspaper and magazine articles as well as books are written about this morass, but lurking in the background is a complex element of our situation that hasn’t surfaced as a significant factor.
Yes, it’s fear itself. When this box is opened, a vast seascape is exposed, and one wonders how this subject has remained under cover.
The mechanics and importance of fear in this setting deserve a look.
The insurance industry is afraid of losing its control over Washington by restriction of campaign donations; the pharmaceutical industry fears price control, and the legal profession fears tort reform.
The medical profession is shaking at the thought of losing reimbursement for services rendered and hospitals fear competition among themselves, while politicians fear loss of campaign funding, completing a circle reminding one of buffalo under siege.
More importantly, outside the circle, fear is entrapping a huge category of health care recipients — our vast middle class who have absorbed repeated blows by armies of providers bellying up to the troughs, feasting on a source of great riches that has a decidedly detrimental effect on America’s economy.
Let’s explore this matter to illuminate our health care system — especially how it compares to other countries. Ours is much more expensive, has no price controls, penalizes business the most and allows bankruptcy due to inability to pay.
In a large number of middle-class patients receiving major care, a second fear is manifest under our system.
This is the fear of economic consequences and secondary personal humiliation occurring weeks later when the bills arrive. Insurance coverage, health savings accounts, deductibles and personal savings accounts are inadequate. The bills are so astronomical that fear again appears — and rules.
This is fear of economic consequences with personal humiliation, a situation not seen in nations with universal health care. It’s perhaps best depicted by a fictitious example:
John Recipient, age 50, has a complicated gastrectomy requiring prolonged hospitalization. After health insurance payments he still owes $75,000 to the hospital and physicians. His disability insurance covers only his basic needs.
He borrows from his aged parents and his 401(k), his wife returns to work, his employer suffers from hard times and John has no job. His daughter cancels plans to attend Yale and two family cars go without payment for two months, requiring the sale of one to pay for the other.
Credit cards are maxed out, his mortgage is in arrears with ultimate foreclosure at a huge loss, and his youngest son needs braces.
Along the line a deep-seated throbbing, even palpable fear, has developed, along with loss of self-respect and despair. Bankruptcy is filed, and a middle-American family lies in economic ruin.
This does not happen in Canada or other industrialized countries with universal health care. It happens right here. Nothing Karl Rove can say will make this story go away. No tea party will correct this social injustice. We are struck another blow in trying to emerge from depression.
Hello, Washington, do you hear the people? We are anxious for change. Please, no more tweaks.
Richard C. Dillihunt, M.D., of Portland is a retired surgeon.