It's a Right..........not a Priviledge

It’s a Right……………..not a privilege

Yesterday, between patients, I watched the president’s health summit. When Senator Clyburn state that health care is a right, I was reminded of a presentation I was asked by the St Louis medical society about a small health center that a few of my classmates and I had organized in the Pruitt-Igoe projects. Explaining why we had decided to divert our attention from the library and anatomy lab, I said, “ Health care is a right - not a privilege.

As an pre-med student, studying American history, I fantasized that if our Constitution had been written in mid twentieth century the unalienable Rights “Life, Liberty and the pursuit of Happiness”, promised to ‘all men’ would have meant equal access to health care. I had no idea that claiming that health care, as a right of all citizens would be so controversial.

I can still feel the stirrings and hear the whispers of shock. My intent was not to be provocative. It was what I believed. It was confirmed in the first weeks of my freshman year as I walked to class past rows of long benches of people waiting in the clinic for free care and saw the same people still waiting as I returned from class.

That was 1966. Now more than 40 years later, our country remains divided by those who believe that health is a right and those who believe it should be purchased in the ‘market place’. This was what I took away from the president’s forum.

It was not Republican versus Democrat. It was those who believed that everyone should have access to basic health care and those who believed that health care is a commodity traded in the market place and available to those who can afford to pay. For all citizens to have access, the federal government must be involved as it is for other programs that are made available to everyone. On the other hand, if health care is traded in the market, it should remain in the private sector.

That is the divide. After listening to yesterday’s discussion, this is a bridge too far. One of the unspoken items of the forum was that health care has been in the market place. The market has produced a health system that everyone agrees requires reform. So why would anyone trust the market forces to realign itself to now allow those who have until now been denied or unable to afford access ‘into’ the system? This is was what was the unspoken message from the Blair House.

The problem is that in the past four decades, the ‘market’ has proven itself unable to meet this challenge. Now it is the time to for a new tact an allow government regulation, incentive, and guidelines a chance to create the mechanisms to assure that all Americans can pursue ‘twenty first century happiness’ and benefit from the advances in modern medicine that until now has been only available to those who have been fortunate to be have been blessed by the market.

Ralph B Freidin, MD

http://theunseenpatient.blogspot.com

Lexington, MA

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HELPING

Haiti - What a tragedy. How long will it take to create order out of this disorder? Perhaps 10 -20 years will come and go before we can say job done, and it may be fifty or more before we can think of saying ‘job well done’

It is inspiring to see and hear of the thousands who have left home and jobs to help the victims of this catastrophe. But it puzzles me how quickly suffering beyond our borders is seen while the suffering in front of our noses is rarely seen.

Clearly it is not a reluctance to assist others distant form us. Witness Haiti and the tsunami of 2004. However, we seem reluctant to assist those close to us. Is it because we cannot acknowledge that suffering of similar magnitude occurs within our borders? To do so, we would have to accept that there are two Americas. With just less than twenty percent of our citizens unable to afford health insurance, if we are honest with ourselves, this dichotomy is not deniable.

Having personally seen how ‘my neighbors’ live without health insurance in Arkansas, Missouri, and Connecticut, and having heard how they get by in Texas and Louisiana, I know that there is much suffering here in our country and it is not limited to one area. It is everywhere one cares to look.

As a physician for more than forty years, when I think about those of us who live without the security of health insurance, it is clear that our current system of health care, dominated by private insurance, has deprived them of many of the advances of current medical practice. Could there be a better reason for reform?

There are several ways of responding to this home-grown crisis. One is working at a free clinic (www.freeclinics.us). One can also speak to his/her congress person. If we all call our representatives on February 24^th during the president’s health summit, we be assisting those American citizens who need as much help as the refugees of the Haitian earth quake or the Indian Ocean tsunami.

Ralph B.Freidin,MD Boston,MA

_{CONGRESS BICKERS - SUFFERING CONTINUES}

_{They arrived early at the Connecticut Convention Center as they had before in Little Rock and Kansas City. The line formed long before the doors opened. As a primary care doctor, I had come to help the National Association of Free Clinics run a one-day medical clinic in Hartford, CT to provide care for anyone without health insurance. This was the third time I was volunteering for a one day free clinic}

_{Volunteers, health professionals came from around the country to participate.}

_{I came from Boston where I have practiced primary care medicine for thirty-three years. I was asked to triage the registration line for anyone needing urgent care. As the line grew, I made my way through the crowd.}

_{Most were working. Others had been laid off. None had health insurance. Half had not seen a doctor since 2000. A third did not go anywhere. They did not have insurance. They did not have cash. Those who had been to the doctor could not afford to fill their prescriptions.}

_{A man, with a below knee amputation, rested in his wheel chair.}

_{His medical insurance had denied his prosthesis. He hoped the clinic could assist him in obtaining a prosthetic leg so he could return to work and care for his family.}

_{A woman, grimacing in pain, had cancer treatment two years ago, but without insurance she was unable to continue treatment. No insurance, no physician, no medication.}

_{Another woman wore a trench coat to cover her emaciated frame. She had had three seizures in the past two weeks. A local emergency room told her that the level of her seizure medications was “OK” and discharged her. No follow up was arranged. During her seizures she had bitten the inside of her mouth that she now could barely open. I could not see an intact tooth in her smile. She could not eat. No Insurance, no doctor, no care.}

_{A young man with labored breathing and sweaty brow was given a wheelchair. His weak voice told me five days ago he was in the intensive care unit of a local hospital for leg swelling. He did not understand why his legs had swelled then nor why the swelling had recurred. For a month, he experienced chest pains walking across his living-room. He needed three pillows to avoid awakening from sleep breathless. At discharge, he was handed a list of unaffordable medications that he did not understand. Continuing care was not arranged.}

_{HHe had an unstable heart condition. I wheeled him to the front of the line. An ambulance was called. He was taken back to the emergency room with a possible heart attack. Why was this man’s leg swelling and chest pains not completely evaluated before discharge? Was it because he did not have health insurance? Had there been no free clinic, and his daughter not insisted that he come, he may have died. No insurance, no physician, no continuity.}

_{A young man tried to avoid eye contact. His slouched posture told me he did not want to talk, but had something to say. Later, I learned the suicidal plans of three young people had been averted. Surely he was one. Would they have completed their plans were it not for the free clinic? No insurance, no access, no help.}

_{A woman was leaning against the wall breathless. She was taken out of the line and seen immediately and then transported to the closest emergency room for acute congestive heart failure. No insurance, no doctor, no care.}

_{Diabetes was her problem said a middle aged woman who had not seen a physician for three years. I asked her who was helping her control her diabetes. “Oh, I do” she said. “But where do you get the medicine” I asked. Staring me straight into my eyes she replied unabashedly “I get it from my brother who gets it from his doctor”. No insurance, no doctor, no medication.}

_{Over one thousand patients were seen at each of these one day clinics. More were turned away. From the south through the mid west and into the northeast, all the patients, as if rehearsed, said the same thing: “No insurance, no doctor, no care”.}

_{The day was overwhelming. In each city, I felt I was in a undeveloped country. I had seen patients with this burden of illness, but that was 40 years ago in medical school.}

_{The American Medical Association claims to support health reform, but they were not in Little Rock, Kansas City, or Hartford. Absent was the American Association of Medical Schools planning the education of tomorrow’s physicians remote from the health crisis of today. My profession shames me.}

_{Despite multiple invitations, absent were the politicians, bragging with self-righteousness, that they cannot support a ‘public option’ all giving a multitude of reasons filled with hypocrisies and fictions.}

_{The cost of reform is not the question. We already incur the expense with the loss of manpower and the extraordinary cost emergency, and end of life care. The question is how much it costs not to reform. The question is how much we value our neighbor and fellow citizens. The question is how long our nation will allow the million citizens without health insurance to remain unseen. The question is of how we see ourselves.}

_{No self-respecting, informed person could honestly believe without a public option private insurance companies will write policies to alleviate the suffering I witnessed in Little Rock ARK;, Kansas City,MO: and Hartford,CT. The opportunity was theirs for more than fifty years. They did nothing. It is time for reform.}

_{Ralph B Freidin, MD}

_{Boston, MA}

We Already Have Death Panels

Death panels do exist in American health care, but they are not your grand mother's death panels. Rather they are for those citizens who live without health insurance in our immensely wealthy, but morally wanting,country.

For those of us who cannot afford, or whose job does not provide health insurance, death comes sooner and with more pain.

As a physician, I have witnessed this when I volunteered at the free one-day medical clinics in New Orleans,LA; Little Rock, ARK; and Hartford, CT; and the two-day free clinic in Kansas City, MO. These events were organized by the National Association of Free Clinics and sponsored by funds raised by MSNBC. Each day, we provided medical, mental health and some dental care more than 1000 patients.

There I saw working Americans with untreated hypertension, uncontrolled diabetes, undiagnosed heart disease, crippling arthritis and rotting teeth. We saw patients with impending heart attacks and desperate people with clear suicidal plans.

Yes, Congress, there are death panels. By not including all of our citizens, our system of health care has death panels for the one sixth of our citizens who do not have health insurance. Your job is to pass heath reform and kill these panels, and not our neighbors.

Ralph Freidin, MD

Lexington, Mass.

TESTIMONY OF ONE OF THE MANY PATIENTS CARED FOR AT

THE HARTFORD FREE CLINIC FEB 3 2010

"Hello Nicole. My name is Carol Wichen and I was a patient at the Hartford Clinic on February 3rd. A very short time after arriving I was rushed to the hospital I was in hypertensive crisis and congestive heart failure. I called to thank you guys for being there and also to thank the gentleman- I think he was a doctor -who noticed I was in distress. The prompt care is why I am here today, I got out of the hospital yesterday. I was there in the knick of time, I was there for one week. And I just wanted to thank you guys for being there for us who don't have anyone or anything. God bless you all. You saved my life you are my team of angles."

If it were not for these free clinics who knows what would have happened to this woman and the countless others that we have yet to hear from. Is there any doubt that health reform is necessary.

Ralph Freidin

Lexington Minuteman Feb 4, 2010

Freidin: Suffering continues while reform in D.C. collapses

By Ralph B Freidin, MD

GateHouse News Service

Posted Feb 05, 2010 @ 08:42 AM

Lexington —

The line formed long before the doors opened. As a primary care doctor, I had come to help the National Association of Free Clinics run a two-day medical clinic in Kansas City, MO. Previously, they had had clinics in New Orleans, La. and Little Rock, Ark. All were organized to provide free services to anyone without health insurance.

Volunteers and health professionals came from around the country.

I came from Boston where I have practiced primary care medicine for 33 years. I was asked to triage the registration line for anyone needing urgent care. As the line grew, I made my way through the crowd.

Most were working. Others had been laid off. None had health insurance. Half had not seen a doctor since 2000. A third did not go anywhere. They did not have insurance or cash. Those who had seen a doctor could not fill their prescriptions.

A man with a below knee amputation rested in his wheel chair. His medical insurance had denied his prosthesis. He hoped the clinic could assist him in obtaining a prosthetic leg so he could return to work and care for his family.

A woman grimacing in pain. She had cancer treatment two years ago but without insurance, she was unable to continue treatment. No insurance, no physician, no medication.

A trench coat covered the emaciated frame of another woman. She had had three seizures in the past two weeks. A local emergency room told her that the level of her seizure medications was “OK” and discharged her. No follow up was arranged. During her seizures she had bitten the inside of her mouth. She could barely open it. There was not an intact tooth in her smile. She could not eat.

A young man with labored breathing was given a wheelchair. His weak voice told me five days ago he had been in the intensive care unit of a local hospital for leg swelling. He did not understand why his legs had swelled then or why the swelling had recurred. For a month, he experienced chest pains walking across his living room. He needed three pillows to avoid awakening from sleep breathless. At discharge, he was handed a list of unaffordable medications that he did not understand. Continuing care was not arranged.

He had an unstable heart condition. I wheeled him to the front of the line. An ambulance was called. He was taken back to the emergency room with a possible heart attack. Why was this man’s leg swelling and chest pains not completely evaluated before discharge? Was it because he did not have health insurance? Had there been no free clinic, and his daughter not insisted that he come, he may have died.

A young man avoided eye contact. His slouched posture told me he did not want to talk, but had something to say. Later, I learned the suicidal plans of three people had been averted. Surely he was one. Without a free clinic, would their plans have succeeded?

The day was overwhelming. I knew that I was in Little Rock, but it felt like I was in a remote undeveloped country. I had seen patients with this burden of illness, but that was 40 years ago in medical school.

The American Medical Association claims to support health reform, but they were not in Little Rock. Absent was the American Association of Medical Schools planning the education of tomorrow’s physicians remote from the health crisis of today. My profession shames me.

Absent were the politicians, bragging with self-righteousness, that they cannot support a “public option” giving a multitude of reasons filled with hypocrisies and fictions.

The cost of reform is not the question. We already incur the expense with the loss of manpower and the extraordinary cost of end of life care. The question is how much it costs not to reform. How much do we value our neighbor? How long will our nation allow 43 million citizens to be marginalized without access to medical care?

No informed person could honestly believe that without a public option private insurers will write policies to alleviate the suffering I witnessed in Little Rock. My country embarrasses me.

We squabble over health reform and across the country patients suffer and die daily without proper care. Doing nothing cannot be an option.

Ralph B Freidin, MD lives in Boston but has a practice on Bedford Street in Lexington.

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