What Is He Thinking?

Decoding the male psyche.

Who Is Speaking Up for the Insured?

How Progressives Are Missing the Boat by Ignoring the Rest of Us

Progressives today seem to care much more about people without medical coverage than those with it.  And, on the surface, this makes a lot of sense.  The suffering and anxiety of the uninsured is, indeed, a national shame.  Obamacare will, over the next decade, reduce the number of uninsured from 55 to 33 million.  And the Left will continue to fight for universal health care.

But most Americans today have medical insurance; they have it through Medicare, their employers, individual plans, or Medicaid.  Coverage might be inconsistent or, in the case of Medicaid, downright poor, but there is coverage.  The problem is not the coverage but the fact that the care that the coverage provides often sucks, and we’ve gotten so used to its low quality that we don’t even know it.  As a result, we don’t raise a political banner to address the quality of the care we receive. 

Those with decent-enough coverage don’t see anything in health care reform for them. As it’s currently framed, there isn’t--and that’s our fault, not theirs.  Progressives are always appealing to the values of equity and justice, but too often it’s to benefit or rescue “the other guy.”  As a result, we can’t galvanize the numbers of activists and voters we need to reshape a health care system desperately in need of it.

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A friend of mine works in the outpatient department in a large hospital chain.  She’s allotted 30 minutes for new patients, patients who often have problems with multiple systems, and 15 minutes for follow-up appointments.  Then she has extensive charting to do.  She’s paid for 8 hours/day, but usually works 10-11.  She believes her patients are, at best, maintained at their current level.

Another friend, however, who is financially well off, hired a “concierge doctor” who can afford to spend large amounts of time with his patients, made house calls, and, most of all, take time to reflect on what his patients needed.  His patients got better.

This isn’t a news flash.  Everyone knows now—or should know—that when doctors spend more time with their patients, listen to and try to understand them, their patients improve, are more compliant with treatment, and use the “system” less. And haven’t all of us been victimized by this system on a small but personal level when we’ve had to endure long waits in full waiting rooms or had difficulties getting through the front office to speak with our doctors by phone?  And, finally, haven’t most of us had encounters with doctors harried by overwork, distracted by phone calls or other priorities, and seemingly motivated to give a diagnosis, write a prescription and get us out of their office?

We’re so used to this type of care that we think the frustration of our perfectly normal needs for care and empathy is inappropriate and we settle for the status quo and call it “good enough.” 

But it’s not.  The evidence is that when we do encounter doctors or nurses who seems genuinely curious, reflective, caring and attentive, we can’t stop singing their praises.

Doctors and nurses are not the problem—some are even heroes.  And we know about the greed and near-criminality of insurance companies.  Moreover, we’re also up in arms fighting against those political forces that want to stop health care reform for narrow political advantage.  I’m not arguing that we shouldn’t continue to fight to make the system provide less expensive care to those who have it, and basic care to those who don’t.

But we should also fight to create a system that is caring.  Activists trying to help the uninsured should also initiate a conversation about the lousy care that’s offered to people with insurance—not simply the costs or deductibles but the psychological and human costs that we all bear in our everyday interactions with a system that too often treats us with indifference.

Imagine if we made people think about training and reimbursing doctors who were genuinely interested in their patients, were good listeners, offered empathy and support along with medication, and took the time needed to provide comprehensive care?  Many medical and nursing students enter their fields to do just that, but are ground down by debt and external institutional necessities to give up on that ethic. 

I think that if we stood up for caring and not simply more access to care, we might engage the unengaged, and give everyone a stake in creating a better health care system.  We would also be challenging the prevailing cynicism in our culture and within the progressive movement about talking about anything other than equity and economics.  While vitally important, people have a need for caring providers and environments when they’re sick, not just access to a system that treats the body but injures the heart and soul.

Michael Bader, D.M.H.,  is a psychologist and psychoanalyst in San Francisco. He is the author of Male Sexuality: Why Women Don't Understand It—and Men Don't Either.

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