Lindsey Trella with the Debate Question of the Night

Amidst a discussion of health care in which both candidates rattled off plans for tax credits, debated employment based health care, and praised electronic health records, it was the question from an audience member that really told of one of those “fundamental differences”. 

The question of the night went to Lindsey Trella, “Senator, selling health care coverage in America as the marketable commodity has become a very profitable industry.  Do you believe that health care is a commodity?”

Sen. Obama didn’t answer the question head on, but did give an adqueate reply describing the burden that the middle class faces when it comes to health care.  He spoke well of the “moral committment” to address the crisis. 

McCain’s language clearly demonstrated that to him health care is just another marketplace commodity to be bought and sold.   He spoke of increased efficiency, tax credits, competition across state lines, walk-in clinics.  (Don’t get me started on walk-in clinics.)  Never was McCain’s position on health care more clear than when he said:

Don’t we go across state line when we purchase other things in America?  Of course its OK to go across state line because in Arizona they may offer a better plan that suits you best than they do here in Tennessee…the American people will have increased funds to go out and buy the insurance of their choice and to shop around.

Marketplace commodity, marketplace commodity, marketplace commodity.  Americans might as well comparison shop at Wal-Mart or Costco for health care insurance.

The follow up question by Tom Brokaw hammered home these differences, “Is health care in America a right, a privilege, or a responsiblity?”

McCain casually answered, “I think it’s a responsibility, in this respect, in that we should have available and affordable health care to every American citizen, and every family member…”  Make sure its available and affordable (which no one defines) and let what happens happen.  Let the market play out.

Obama assertively responded, “Well, I think it should be a right for every American.  In a country as wealthy as ours, to have people who are going bankrupt because they can’t pay their medical bills…there’s something fundamentally wrong with that.”

All of the answers to health care flow from these most basic questions–is health care a right?  Is health care a marketplace commodity?  This is what divides the two parties.  When people go into the emergency room they expect to be treated regardless of insurance status.  If someone has appendicitis they expect to have surgery regardless of their ability to pay.  If someone needs a blood transfusion they are not asked to pay for the unit up front.  American values dictate that health care is a right and not a commodity.  Now it it is time to get public policy in line with our values.

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About The Country Doc

Practicing full spectrum family medicine and teaching the next generation of physicians from the heart of logging and farming country in Elma, Washington.
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6 Responses to Lindsey Trella with the Debate Question of the Night

  1. Stuart O'Neill says:

    Well said, CountryDoc. And I would love to get you started on the value or non-value of walk-in clinics. I’ve used one a couple of times. My experience was expensive.What do you think of them from all perspectives?

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  3. Since Stuart has goated me on, studies show that walk-in clinics are less expensive that an ER visit, but more expensive than a primary care office for the same diagnoses.  Cost, however, is only a small part of my bias against this form of care.  The real issue with walk-in clinics, urgent care centers, retail clinics, or any other no appointment necessary model is that the care is by definition episodic and discontinuous.  This is the antithesis of what health care should look like.  Walk-in clinics can treat asthma exacerbations, but not prevent the flare up from starting.  Urgent care can treat a child’s cold, but the discussion with the parents about their need to quit smoking for the child’s sake looks much different coming from a stranger than it does from trusted primary care provider.  But isn’t a cold just a cold?  In ideal primary care settings, every appointment no matter how insignificant can be an opportunity to check in with a patient and see how someone’s weight loss is going, or how is their depression doing.  It is an opportunity to update immunizations, order mammograms, and check cholesterol.  Every visit to an urgent care center robs primary care and patients of these opportunities.Walk in clinics are a symptom of our health care problems and not a sign of a cure.  It is this unappreciation of the value and the power of the continuity of care for the patient and the health care system as a whole that frustrates me so.  When there are more primary care offices opening and urgent care centers are no longer necessary, then I’ll know that we are on the right path.

  4. cadmium says:

    There are good walkin clinics and there are bad walk in clinics — just like there are great primary care practices and sloppy primary care practices.

    A walk – in clinic that is affiliated with a primary care practice — either directly like in the same health center or by affilliation by shared labs, practice priveleges and medical record is a valuable adjunct to a standard primary care practice. Such an integrated walk-in practice handles episodic issues in a way that is coordintated with the primary care practice. When done well walk-in clinics help to relief the burden on the primary care practice while increasing patient access. Not all primary care practices have open access and a good relationship (by electronic medical records, relationships and shared resources) enhances primary care.

    In some other situations — a patient may be more comfortable going to a totally separate provider — like an anonymous STD clinic for instance. When working well different practice styles improve care, but they can become more like the discontiunous problem you describe when there care coordination is ignored.

    Good Walkin clinic = Good service. Stand – a-lone uncoordinated care is a problem

  5. cadmium says:

    I typed to fast in the preceding comment and made lots of typos

    My drift should be clear. Good walkin clinic can be helpful.

  6. Cadium

    The drift is definitely clear.

    P.S. Hope you got my delayed response to your last email.