Night Shift

I’ve been staring at my sea bag and field pack in the corner of my office since May when I got notice of my return to active duty. But now it’s time to finally go. Having been to Iraq before doesn’t make it any easier. Oh, it’s a lot safer over there now than before. So many things are better now. But now I worry about what will happen here while I’m gone. The politicians have finally decided to turn their attention to two problems that have been brewing for a decade, energy and health care. I began my medical career with Jimmy Carter in office. We had gas lines that wrapped around the corner, 17% home loan interest rates, and a president who sat fearfully in his chilly office while Americans were being held captive in Iran. I pray that we don’t return to those days.
And if that weren’t enough to cause concern, now they want to completely overhaul my profession. Will I recognize it when I get back? There is no doubt that there are some fundamental flaws in our system. Is there too much bureaucratic overhead from insurance companies? No doubt. But will a government bureaucracy solve that? I doubt it. Do we suffer from over-testing because of a fear of litigation? Most certainly. But will a system run by lawyers change that? Not likely. No, I suspect that the focus for reduction in health care costs will focus on two areas, drug companies and doctors. We are both easy targets. Drug companies are corporations. Strike one. They make money off of sick people. Strike two. And not just a little money, boat loads. Strike three. And doctors? Well, they make too much money, also. The problem is that everyone is looking for a single quick fix.

As much as we would like to vilify lawyers, tort reform is not the quick fix. Undocumented, untraceable aliens are costing the system millions, but they are not the whole problem. Chronic disease due to bad personal choices, such as smoking and obesity, contribute to rising health care costs, but they may not even be the largest contributor. A population that is living longer and expecting to be healthier longer combined with a smaller contributing work force may be the largest single factor.

So what can we do? That’s easy. Cap lawyers’ wages at 500% of the minimum wage. Build a fence on the border. Ban smoking and McDonald’s. And legalize euthanasia. There. We’re done.

Nice try, Adolf. No, this is going to be a problem that requires a lot of thought, debate, and compromise by everyone involved. This is not one of those fights that we can afford to avoid. And it’s not just about protecting our lifestyle. We are in a unique position to understand the system. We can advocate for a balanced, effective, humane system. But it will require that all of us really get down in the weeds and delve into the details. We can’t just leave it to others.

My hat is off to Paul Hochfeld. I may not agree with all of his conclusions, but this EP from Oregon saw problems in health care and set out to do something to stimulate the conversation. (See the documentary Health, Money, and Fear at It’s time to get beyond hand wringing and cynical finger pointing. It’s time to inform ourselves about the details of what is driving our system to bankruptcy and start the difficult process of hard choices and compromise.

As I head to Iraq, the temptation for me is to say “Hey, I’m out of here. You guys solve the problem. I’ll see what you came up with when I get back.” And each of us has a reason for not getting involved. “I’m at the end of my career, leave it to the next generation” or “I’m just getting started in my career. How can I know what is best for the country?” Or even, “I’m in the thick of my career. I don’t have time for this.” The truth is that we all have to get involved. Vote for the presidential candidate who represents your view point, for sure. But do more than that. Educate yourself and your neighbors on the issues. Then advocate for the position that is the best for everyone, both now and in the future.

Nobody gets a pass on health care. Not me. Not you. I’ll be coming back next Spring, and when I do, I hope we will have a system that is on the mend, not on the ropes.

In the last few months I’ve received many emails expressing your thoughts and prayers for my safety during this deployment. Thank you from the bottom of my heart. Many of you have offered to take care of my needs and that of my family. Well, I have only one request. Get involved in this issue. Educate yourself. We at Emergency Physicians Monthly will try to help you. Then move out into the community and use the power of your knowledge and position to advocate for a better, more humane, more cost effective system. This is a historic opportunity for change. So let’s get it right.

Also featuring guest columnist Clint Lowry, MD Reflections from a Newbie


# I can't agree moreabdurrahman 2008-08-05 05:55
I can't agree more mark , we need people like you here , unfortunately we are shifting our resources overseas , and leaving our country in shambles , i don't understand why we self-destroy ourselves , what the point of taking bright professionals like you half the way aroundd the world and our still not fixed yet , i am going to lobby hard in washington to get guys back here , so we can get back on track and move on out of this pity hole.
# Michael Nerenberg MD 2008-08-05 19:28
You are correct in that everybody is going to need to give up something. Drug companies their enormous profits. Insurance companies their enormous profits. AARP their "do everything for every old person forever, no matter what." Trial lawyers their nonsensical theories of injury. Government their expensive and often baseless policies and regs. Doctors their "nobody can do it but us turf issues. The public's "we don't care what it costs, we want everything" attitude. Ethicists' their "cost cannot be a factor when life is at stake" mantra.
Hard choices?: What about the enormous amount spent on extreme preemies. What about the enormous amount spent on end of life care? What about taxing the life style "choices" that contribute so much to health care costs and devoting that money to, oh I don't know, health care?
The problem is, there are large and powerful constituencies out there opposed to every one or another part of this. No one is willing to give up their part. And so, nothing gets done.
Good luck in Iraq. Keep your head down anyway. It's not that damn safe.
Michael Nerenberg MD
# MDJ. Peter Gregoire MD 2008-08-05 19:53
It is essential that what ever the solution to the Health Care issue, it needs to
include personal responsibility built in to the mix.
Probably financial reward/penalty for good/poor health practices and "use/abuse" or resources.
The concept of "my insurance will pay for it" is disastrous, as is
the sense of "entitlement" to have any and all testing, treatments, etc.

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