Crack

Me My life is not fine, I have not seen my kids in quite some time, And I owe it all to this addiction of mine. This addiction makes me numb, This addiction has me acting dumb, But this addiction needs to be done. When I use I can fly, When I use I feel high,  When I use I tend to cry,  When I use I sometimes lie, When I use I just want to die. It does not run, It will not hide, It leaves you feeling so cold and empty inside. I want my life back I need to know how to act I loath the day I ever heard of crack. You Crack may seem like fun, Crack will make you feel numb, But crack will make you so very dumb.  The addiction is strong, The addiction will go on and on, But the addiction is wrong. It is not cool, It does not rule, It will turn you into a fool. You will end up lying, You will end up crying, Most likely you will end up dying. Just say no, Just turn around and go go go, Just so that you can save your soul.  --by Daniel G.

Facing the Real Issue in Health Care

Are we, as Americans, each entitled to at least a basic, minimal standard of medical care? Or should we be denied medical care we clearly need if we are unable to pay for it? We can never even begin a meaningful debate on health care until we confront this fundamental issue with a clear "yes" or "no". The American College of Emergency Physicians has finally given an answer, calling for universal care in the United States, a stand in which I, as a member, take pride.

Many of my colleagues consider the question moot. They think of patients who cannot pay as freeloaders, even though they seldom know the size of their actual bills and have no experience themselves with living on a limited income, being hounded by collection agencies, or having a debt one can never expect to pay off. They firmly believe no one has ever been denied care, since they "can always go to the ER".

The authors of the ACEP editorial know this isn't so, because they work in the ER. Many diseases, from diabetes to cancer, progress imperceptibly from nonemergencies to incurable and fatal conditions without ever going through the dramatic, yet curable stage when the ER can really help. When the patient finally crashes, we make a vain and expensive attempt to help what could easily have been treated a few months or years earlier.

Many US physicians still consider what they call "socialized medicine" to be the ultimate evil, although they're quite willing to take payments from Medicare. They accept severe constraints from private managed care providers, yet believe universal care would impede their freedom to practice medicine. They castigate government as inefficient, although Medicare has a lower administrative cost than our supposedly "efficient" private insurance companies (roughly 5% vs 20%), and the most cost-efficient providers in our state are actually the Veterans Administration and the State Health Department.

Disputes over employer-provided health insurance have led to costly strikes at companies including Ford and Boeing and in today's mobile labor market it frequently forces patients to leave their personal physicians when they change jobs, or simply because their employer changes plans. Laws requiring smaller employers to provide insurance will only force more Americans into "independent contractor" status, where they lack even OSHA protection.

Americans like to be generous, and many of my colleagues put considerable effort into programs that take care of specific groups or individuals they consider to be "in need". While it is personally rewarding to the physician to do a few hours of "charity care" a month, it blithely ignores the scope of the real problem.

Our system has huge costs to which we turn a blind eye. Both auto insurance and business insurance are considerably more expensive in the US than in Britain because here they have to cover medical expenses, as well as the interminable battles over who will pay them.

Moreover, the increasing focus on medicine as a business has led to a subtle change in our perspective of what it means to be a doctor. A British medical student, touring a hospital in Florida recently, noticed a sign saying "This hospital is legally obligated to provide certain services for indigent patients." "That's funny" he remarked. "In my country we would have said we were morally obligated."

Originally published in Forida Today, April 3, 2000.