When We Talk About Health Care, We're Forgetting One Important Group: The Already Insured

By Michael Bader, AlterNet. Posted June 19, 2009.

I intervened and took the daughter and her MRI to a neurosurgeon I knew at a nearby university hospital who saw immediately that there was severe disk disease and that surgery was imperative. He called the chief of neurosurgery at the HMO, who saw the patient the next day and operated on her -- successfully -- two days after that.

Obviously, without the help of someone like me who could pull strings (in another bureaucratic medical system), this girl would have suffered the fate of many other Kaiser patients who spend untold days and weeks in needless suffering because their medical system doesn't relate to them as real people in real need.

I'm sure that there are many patients at this HMO who have found their care to be adequate or even good. We all tend to accept what "is" as the way it's "supposed to be." When the rudiments of medical care are delivered adequately, and we're helped to feel better, we don't naturally judge the process critically. The problem, of course, is that we haven't experienced any alternative and when we do, the problems of the original system become immediately apparent.

Everyone has stories of going to see a specialist or an internist who spent a lot of time with them and, to a person, they leave with an enthusiastic, even ecstatic, view of how great the doctor was -- simply because of the time, interest and sense of personal commitment they experienced. Too many of the stories, unfortunately, are of the opposite.

We all have stories like this. "We" includes folks with insurance, even with decent insurance. Unfortunately, most progressive demands for universal coverage include little obvious direct benefit for us.

Yes, we occasionally hear about demands to reduce waiting times, and slogans like "quality care" might be interpreted to include concerns about time spent with providers. But, in general, all sides of this debate focus primarily on access, availability and affordability. They avoid the "soft side" of the issue primarily because of the implicit assumption that some care, even indifferent care, is better than none, and we have to start with the basics.

Thus, many of us who do have insurance support progressive health care proposals either because we fear losing ours or because we have general liberal proclivities to help those who are disadvantaged.

In my view, this is politically misguided. First, we need to speak to the widest range of needs in people we wish to organize, not just to the more "fundamental" physical and economic ones.

When a movement addresses needs for meaning, relatedness and recognition, that movement is strengthened and its members energized. For a campaign for universal coverage to succeed, it has to have the energetic support of multiple constituencies, including those that might already have decent coverage but who suffer in less-dramatic ways in the course of interacting with their doctors and hospitals. Their suffering, the suffering of bureaucratic indifference, misrecognition, anxious attachment and being shuffled around like a thing in an environment that doesn't see us as people, isn't any less politically important to address than the suffering of people without any coverage.

The suffering I'm describing might not rise to the level of tragedy, but nevertheless it corrodes our spirits, increases our cynicism and contributes to terrible and costly long-term outcomes. And most important, it's suffering that were we to address would expand our political base, reach out across class and party lines and strengthen our chance of success.

In addition, addressing the noneconomic frustrations in the current system of health-care delivery invites alliances with health care providers at all levels who are burned out and alienated in relationships with patients increasingly perceived as demanding, noncompliant and ungrateful.

People don't become doctors and nurses to provide assembly-line service or express indifference but to provide care, and systems that compress that care into 10-minute segments are as oppressive to doctors and nurses as to patients.

We on the left so often find ourselves fighting for the most stripped down and basic elements of social welfare programs. We do so because the present balance of political power makes us do so. We're realistic. We should be. The human cost of not accepting some compromise in the health care debate is too high.

But in this case, we're fortunate because shooting high is eminently practical. Focusing on the relational quality of care is not only economically practical but speaks to the psychic bruising and frustration that is so built into many encounters with the medical system that those enduring them hardly think there is any alternative way of being treated.

Such a focus, however, can bring this frustration to the surface, connecting with the experience of people who might, themselves, not be suffering from problems of availability or cost, but suffer nevertheless. It positions our movement for health care reform as one that speaks to what ails all of us.

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Michael Bader is a psychologist and psychoanalyst in San Francisco. He is the author of Arousal: The Secret Logic of Sexual Fantasies, and Male Sexuality: Why Women Don't Understand It -- and Men Don't Either. He has written extensively about psychology and politics.

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