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What Are We Afraid Of?

For initiating a massive overhaul of the broken and unjust health care system in this country, Obama’s approval ratings dropped almost 25% from the time the debate began in June of 2009 until he signed the bill in the Oval Office in May of 2010.   For authorizing the execution of a terrorist last week his approval ratings bounced up over ten percent in a matter of days.  Admittedly painted with a broad brush, and without factoring in the drag our dismal economy has on the numbers, these CBS poll numbers depict an interesting message that the American people are apparently giving their president.

The irony, of course, is that most of us have far more to fear in a health care system that fails to meet the needs of the growing number of people priced out of the medical market place than it does from an isolated and obsolete terrorist hiding in Pakistan.  But, the “decapitation” – read bullet through the head of an unarmed man – of the leader of a terrorist organization sounds so seductively simple in its moral and operational dimensions compared to fixing health care with the inevitable implications for changing the way we’re used to doing things.  Hunt down a criminal, locate him, send in the elite troops, kill him and dump him in the ocean to the cheers of real and potential victims.  The simple story line blurs the very real moral questions involved not to mention the potential geopolitical complexities that may yet emerge.  Hit the applause button.

Meanwhile, many other real problems persist, some with the potential to radically erode the moral, physical, and financial health of our nation.  I read an article the other day about an emerging trend in American medical care that could have far more impact on the fabric of our society than a terrorist like bin Laden.  It’s called “concierge medicine.”  Plans vary, but typically involve payments of a “retainer” to a doctor of anywhere from $2,000 to $75,000 a year for special attention from a primary care doctor and fast track access to specialists in an emergency.  The more you pay, the greater the perks – same day appointments, access to a special phone number for your doctor, elaborate annual health screenings not normally covered by insurance, etc.  But the basic principle is that concierge doctors limit their practices to enable them to see fewer patients and concentrate more on each one.  Third party reimbursement, of course, continues, but these doctors don’t have to fool around with the limitations and red tape of Medicare and Medicaid.  Concierge doctors trumpet their ability to give the best possible care to their patients.  More to the point, between the retainer and higher private reimbursement, concierge doctors can earn more income while seeing fewer patients.

Concierge doctors aren’t terrorists.  One group, Guardian 24/7, was founded by former White House doctors offering “medical protection previously available only to the president of the United States.”  Their most elaborate product is a “ready room” installed in your home or private jet or yacht equipped with enough technology to allow a trained physician to respond to almost any crisis remotely for the modest cost of $700,000.  I suppose if you can afford a private jet, you’d want it fitted with a ready room.

Am I the only one who fears for our country if this trend continues?  County hospitals around the country that accept Medicaid patients or the uninsured already give us a glimpse of the gulf between the Rich Man and Lazarus, a gulf likely to widen as more and more doctors restrict their practices to those who can pay a surcharge.  And we don’t need health care reform?

It’s curious to note what citizens fear the most and to observe how leaders will be punished or rewarded for taking on the threats to our commonwealth’s well being.  Both terrorism and health care confront us with grave national challenges that require nuanced, patient solutions and, yes, more than a little sacrifice from all of us.  Meanwhile, it seems to me that a leader ought to get as much credit for trying to solve one problem as he or she does for the other.  But I guess it all comes down to what you’re most afraid of.

John H. Thomas

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