I have an answer and it's hopefully not going to come off as an excuse. It is quite simple, I believe that after EMTALA was crammed down our throats in 1986 we all saw the writing on the wall and have simply been trying to muddle through to the inevitable.
This betrays a few weaknesses inherent in most physicians which are as follows. We are not lawyers. The legislature as it stands is populated by a huge proportion of lawyers who are schooled in the ways of legislation and politics, and we are not. We are schooled in what works and what does not. We are incredibly impatient as a rule, especially those of us in the ER. Get it done now or go away. When the monstrosity of EMTALA was enshrined the battle against universal health care was lost. How is the argument even made that we do not have universal care now? And how can one argue that there is a problem with access? I have not been able, ever, to turn a patient away from the ER.
You can be a murderer, an illegal alien, or a John Doe, pick up the phone, call 911, and get all your care (up to and including all manner of surgery) right away at the ER and never pay a dime. Why in God's name would we physicians, as a group, have any other belief than that the battle is lost and was lost some time ago.
Also, even though we have swallowed the bitter pill of universal care (without any legislative disincentive to abuse the system having survived scrutiny) our feeble attempts to bring even a small amount of sensibility to our tort system have been crushed in their infancy by the legal community, most often the American Trial Lawyers Association (and their willing accomplices in the congress). This puts us in the position of being forced to give extraordinary care to everyone who comes through the door regardless of their ability to pay AND bear the full legal consequence of any mistake made in their care up to and including 'pain and suffering' damages from 'malpractice'.
Also, we are not allowed to deduct the cost of this free care we give away, conservative estimates place it at $150k per year per Emergency Physician, and we are taxed in the highest bracket. The thanks are few and fleeting and the idea of mounting a legal challenge to universal care will have to repeal or revoke EMTALA which, I believe, to be impossible. It is impossible because the parade of sob stories before congress will succeed in painting us in the most monstrous light... money-grubbers who care not a whit for their patient's suffering, and the common sense response will be laughed out of Washington, namely that health care is not a right, and that everyone needs to be responsible for their own well-being at least to some degree. Obama has declared it a right for goodness sake.
Hell, Obama got elected by a convincing majority by PROMISING to redistribute wealth and who better to take from than the 'rich doctors'. The myth of the 'rich doctor' is easy to refute to those who appreciate logical argument, but there aren't many remaining who have not sold their souls for the sake of reelection. I know those with warrior spirits would not let this list dissuade them from at least trying to work the system to our benefit but here's the other part of how we arrived at this pons asinorum. Academic medicine.
As a general rule, the hard sciences produce more conservative thinkers than the liberal arts. I have no proof of this other than my own experience with attending law school for over a year and then switching to medicine. Out of my L1 class of 220 there were a small minority of conservatives. But in medical school I think we outnumbered the enemy by about 10%. I had found home.
As one progresses through medical training and residency the choice of whether to remain in the academy or go into private practice tends to split down political lines. There are a lot of advantages to remaining in academia. One generally makes a little less than in private practice BUT one has these convenient indentured servants called 'interns' and residents' who do all the 'scut work'. One is allowed, by this arrangement, to concentrate on writing papers and doing research. The life is attractive and I almost went, recently, back to the dark side simply for my own sanity.
However, it became evident in the interviews that, even at the august institution to which I was applying, the medical side of the academy had sold out to socialism. The attitude in the Emergency Medicine department is that our patients are SO incapable and stupid that we MUST do it all for them. The doctrine of personal responsibility is hard to maintain when you are treating the same person for the same thing for the 30th time that calendar year, each time the patient having called 911 to come in for their nonspecific overwhelmosis, and each time having the patient fail to comply with follow up instructions and fail to quit smoking, drinking, whoring, shooting up, or eating eighteen bags of cheetos a day. All of our national associations are run by the academics.
I understand this, but they are wrong. The end result of universal health care is not hard to discern, it is merely a lower quality care for all, and RATIONING of care. How could it be otherwise? The strong emotional desire to provide the best for all is merely a reappearance of the old Utopian dream, doomed to fail, because there is no one to pull the cart.
And this, Hugh, is where most doctors are. Most of us in private practice have given up trying to reason and argue with those who argue for a living. We are simply going to cut back on our hours, downsize our lives, and try to find other outlets for our talents. I admit that this is passive-aggressive in the extreme but it may be the only arrow in our quiver that will have any effect.
Unfortunately for patients, they will learn of their folly too late and there will be many people dying in 2012 who would not have died in 1990. Doctors, already a vanishing breed, will be on the endangered species list soon. Why would one choose to go to medical school now? Dear Mr. President, before you commit us to Universal Care you should ask if we are going to participate. I am not.
Thank you, Mr. Hewitt, for putting the docs front and center this week, and please check out the other conservative doctor's blogs listed on the links page here. We are simply looking for a leader and a command and a bit of hope and we will fight. Perhaps you can champion our cause? In doing so you will be championing the cause of every citizen of this country.