An insatiable maw consuming 18% of our GNP;
that it cannot go on screams out like a banshee;
and though we spend twice as much as the very next;
we live not as long and lag behind more than 30 in most respects.
Blame for this state is enough to go around the globe a dozen times;
That it is the fault of another, each special interest quickly chimes;
Patients blame the docs who blame the insurers who blame the feds;
and don’t forget the neocons who claim any fix will make us all Reds.
We can blow up the world more than a thousand times;
We can move an army to destroy a regime for both real or imagined crimes;
We can endlessly debate which path or no leads to heaven;
But we can’t vaccinate all kids or provide simple care for at least 1 in 7.
Suggesting that universal coverage might be a fair start;
Has self-serving pols rattling china on their tea cart;
Some moron can try be be coy by suggesting we must all buy a gun;
A family an illness away from bankruptcy may not be ready to join in his fun;
Legislators are quick with a resonating sound byte;
but sadly they don't really have a dog in this fight;
they pass rules all the time that they don't have to employ;
requiring them to abide by what we get might be a sound ploy.
One things for sure, keep this up and a collapse is near;
Then better hope you need no care for one who is dear;
Tea party nay sayers may celebrate what they claim is for freedom a victory;
but to die from neglect, seems to be for a great nation somewhat contradictory.
As one in medicine’s trenches for a quarter century I know what I speak;
wait much longer and harder will it be to find the care that you seek;
Ignore those who believe the phrase health care reform is a kind of profanity;
To avoid the peril that Einstein reminded defined insanity.
Is there any hope, any direction other than over the edge?
any means to avoid the collapse or a means our bets to hedge?
The answer is yes but the cost will be high, though not in dollars;
The only answer is sure to stir a great chorus of hoots and hollers.
No doubt you have already heard the dire rumors;
We can neither afford nor staff to the levels needed to care for the Boomers;
Not if we persist in our national predilection for acute care late in the game;
Only a shift toward prevention, wellness and early detection will these costs contain.
Bricks and mortar systems are impressive with scanners and the latest high tech toy;
But using robots to cure one while others get nothing, any claim to national greatness must destroy;
The cost of one mechanical heart for a former VP;
could vaccinate thousands of kids from many a working family.
The limits are few on the options for those with means;
but nothing is left to provide the poor with the simplest of health screens;
The rich are told, ‘well here of the list of things that might provide some limited good’;
But to offer the most basic care to the poor a doc must don the cloak of Robin Hood.
Test after test is used to define an insured’s problem in detail;
those without means wait outside an ED to be seen at a pace that would bore a snail;
Clinical judgement and communication has fallen by the wayside on the path to a cure;
Why do one test when three can be had for 10 times the price just to be sure.
Oh yes, a doc will claim that they do too much because they are liable;
but as a real excuse that just isn’t viable;
yes lawyers and suits are a nuisance, that much is sure;
but tort reform isn’t where we’ll find the cure.
The real key to reform is a mindset that must be corrected;
if our rendezvous with disaster is to be deflected;
Less the purview of the doc is the change that is required;
More effort than nothing from the patient is needed lest we remain in red ink mired.
Prevention wellness and optimized care lower cost and improve the quality of care;
But for these the individual not the doc is the one who must the responsibility bear;
The Bard was right when he said that the fault resided in ourselves;
Not as some would claim on a pharmacy’s shelves.
Americans have demanded a system that at ‘goal line D’ gets ever stronger;
So that they can smoke, drink, eat, and veg in front of the TV all the longer;
A life of sloth and neglect requires expensive fixes as is our convention;
Ben Franklin, it turned, out was too conservative by far in the value of prevention.
And it’s not just inattention that has its costs as some choose an alternate who claims to cure with water or prefer some Asian needles;
or crystals or prayer or twists to the spine or the ground carcass of some beetle;
that is your right but should not the failure then be your own?;
not shared with those who prefer the direction that the light of science has shown.
But science is but part for the ability to pour money down a hole with greater precision;
Is not what should drive every health care decision;
It’s more than a question of ‘yes we could’;
But can is not now, nor ever, the same as should.
Everyone dies in the end - a sorry fact from which there can be no buffer;
Medicine blurs the edges between preserving life and extending the time one will suffer;
But for every futile act wasted at the end of one’s time on earth;
solace could come from knowing the savings could help hundreds at the time of their birth.
Why a spiritual nation fears the undiscovered country so much;
is a topic of much interest to those who work closely to death's touch;
for we see every day that there can be far more sinister fates;
than to die whether eternal bliss or the void is what awaits.
We must find a balance far different from what we do today;
more attention to staying well than being rescued is really the only way;
and then we can afford to care for all as befits a great nation;
yet still have enough for acute care just not as our sole fixation.
They say that freedom always comes at a cost and it's socialism we should fear;
but our health care freedom currently runs a tab of two trillion each year;
robbing us of jobs and crippling our industries with insurmountable costs;
but opponents to reform offer nothing but rhetoric while our treasury exhausts.
Should we consider our health as an island that to a greater sphere need not connect?
Or in this was Donne once again correct?
The individual must be responsible for their own destiny as this is the answer not another;
and try to get in the habit of remembering that your clinician is not your mother...