Back in eighth grade I learned from a very wonderful English teacher and debate coach what an ad hominem attack was and that not only was I never to use this gutter tactic when engaged in argument, that I was, in fact, to allow any opponent who used it to speak freely and at length as they would kill their own side. As briefly explained by wikipedia an ad hominem attack... "is most commonly used to refer specifically to the ad hominem abusive, or argumentum ad personam, which consists of criticizing or personally attacking an argument's proponent in an attempt to discredit that argument."
For instance, if I were to begin the rest of this post as follows, you, my friend, would do best to quit reading... "Paul Krugman, "professor" of economics at Princeton, besides looking like a cheap version of Wolfman Jack, is also well known for spitting on babies and stealing pension checks from the elderly while pushing them down flights of stairs. He secretly hates women, puppies, and eskimos and for all the above reasons can not be trusted when he speaks about economics."
Imagine my surprise when this Princeton professor and New York Times columnist began a recent piece on "Universal Health Care" (again, linked above) with the following quote: "OK, it's not news that (President) Bush has no empathy for people less fortunate than himself. But his willful ignorance here is part of a larger picture: by and large, opponents of universal health care paint a glowing portrait of the American system that bears as little resemblance to reality as the scare stories they tell about health care in France, Britain, and Canada."
This guy is a famous economist? A Princeton professor? What follows in his article is a confusing mish-mash of pseudo statistics and anecdotal evidence (he cites a "recent Business Week article based on statistics and anecdotes") that our health care system is terrible because sometimes both the insured and the uninsured have to wait a long time for short term care. This is the best I can do at untangling this guy's logic. It seems he's comparing apples to oranges and complaining that the safety net which IS the Emergency Department is overcrowded and sometimes overcrowded to the point that that uninsured and insured alike must wait for a while to be seen. That's right, it's called triage, and thanks for the news flash professor.
To the extent that I can understand the rest of his piece it's no more than a pitiful attempt to gin-up an issue for the upcoming election cycle and confuse the public into believing that "universal health care" will solve all our ills. As has been detailed extremely well on Panda Bear, MD's site there's about a million reasons that this is a terrible idea. Having worked as an active duty military physician, a physician in the Veteran's Administration system, and in the private sector I can not imagine a worse idea than growing a government bureaucracy to administer a single-payer system. Do you enjoy going to the DMV? Are you a vet now? Do you get your care through the VA? Ever read about Walter Reed Army Hospital?
Krugman and his ilk, and pretty much anyone who comments on the current health care crisis neglect to mention what I believe to be the key factor to solving the majority of our problems. Patients, all patients, need to be made to be responsible for their health care. It is not a RIGHT it is a RESPONSIBILITY. Now there is ABSOLUTELY NO MONETARY INCENTIVE for patients to make healthy choices in their lives, to actually get a primary physician, to take their medicines as prescribed, or to get that operation they were told to get three years ago because THEY CAN, in fact, go to the Emergency Department 24/7/365 and have someone like me arrange it all for them.
The economics is simple. People have chosen to drop their health insurance OR have chosen not to purchase it because it is expensive (for me and my family of five we pay $460 a month) OR simply can't be bothered to open a phone book and call a doctor. Under EMTALA it doesn't matter, Emergency Physicians, Surgeons, and other specialists must see these patients in the Emergency Department regardless of their ability to pay, regardless of whether they are wanted by the police, regardless of whether they are in the country illegally, and regardless of the fact that many of them were seen just the day before for the exact same problem. And, as you know by now, the government that brought us EMTALA does not pay us anything for these donated services nor does it allow us protection from malpractice suits related to cases we treat under EMTALA.
When we make Emergency Department visits more expensive than a visit to the local pediatrician, internist, of family practitioner (and I mean collecting a small co-pay with EVERY VISIT) then the Emergency Medicine crisis will vanish. And no, what I'm proposing is not heartless, I'm not asking to bankrupt our underprivileged, I'm merely asking that they forego something, make some contribution towards their care, give up their 1800 minutes/month cell phone plan and settle on the 1400 minutes/month plan, give up their visit to the movie theater this week, don't get their nails done... you know, pony up $50 or so. It's amazing how behaviour changes when money is involved. I would think a brilliant economist like Professor Krugman would understand this, but then again he's just an ivy-league douche bag.