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Photograph by Patrick Lentz

Dear Mr. President,

I wanted to discuss your plans for making a purchasing decision during your stroke.  If health care is a commodity. The Republicans believe patients are customers and people should have choices in a competitive capitalistic system.  Well, I’m interested in how you are going to make an informed consumer choice during your brain attack.

In a stroke, there is a 3-4 hour window when hospitals might reverse the negative outcome; one of the miracles of modern medical research, which of course is being defunded.  Under the Republican model you are in control. You are the customer. You believe in competition and consumer choice.  So, how does that work?

As you start to lose your vision, will you drag the side that no longer functions to the computer and set up an Excel spreadsheet to compare the costs of local ambulance services?  Will you ask your spouse, before you lose the ability to talk, to research the various neurological services in your area, the customer reviews of various physicians, the quality ratings of your hospital options, and to do a cost-benefit analysis of the various drugs available?

Having made your educated consumer decision, will you then contact your health insurance company to determine if your choices of ambulance service, hospital, and physician are “in network” or “out of network?”  Will you ask for their permission for treatment and a list of the pharmacy formulary determining which stroke drugs are covered by your insurance? Will you sit at home waiting for the 18 year-old who answers the insurance line to call you back to tell you their standard line that “you are not covered?” That’s what insurance companies like to do. Immediate denials often discourage patients from care. Helps the company make money for their investors.  They are, after all, corporations and have to first look after shareholder values – that’s the beauty of capitalism.

Let’s say you’re still alive by the time you have made your consumer choices. When you get to the hospital, there will be so much more to purchase.  Do you want a CT scan or the more expensive MRI?  Do you want the more expensive brand name drug with a 90% efficacy rating (that means effectiveness) to break up a blood clot, or the reverse engineered generic brand with a 75% success rate that your insurance will cover?  Will you have a credit card with you and at each consumer decision point?  They can now swipe purchases on mobile devices.

Well, the truth is, you’d be dead.  I suppose that’s the point.  You will have paid enormous premiums to the insurance company for coverage over your lifetime.  Then when the stroke happens, you are free to make all of your health care decisions.  If you die, the insurance company makes money – they win!  It’s a terrific business model.

Every developed nation in the world has figured out that health care is not a commodity.  It’s not a choice made in the super market aisle between Coke and 7 Up. It’s not a choice between a Ford or a Chevy. It’s not a choice between Trump Tower and the Ritz.  People needing health care are patients – not customers.   The providers of health care should be professional, highly skilled medical staff – not insurance clerks.  Americans deserve to participate in the largest, most diverse patient pool that can be imagined, all of the people of the United States with universal coverage.

We have some smart people in the country.  While the health care system is complex, fixing it is not beyond the reach of our best minds.  After all, we sent people to the moon and back with just the computing power equivalent to the modern toaster.

Of course, it can’t be done if the profit interests of the insurance companies and drug providers trump the welfare of the citizens.  If those representing the welfare of citizens are “bought and paid for” by the industry looking to profit bigly, real reform will never happen.

Mr. President, we can do better than this.  Do something extraordinary that will really shake up the system – universal health care.



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