If I ever find an agent and/or publisher for a book I’m working on, this is how it will open: Imagine kicking over a rotting log and finding all manner of centipedes running to escape the sunlight when darkness is their life. This is how I view the healthcare industry we’re living with today.
Photo by Viktor Talashuk
For more than a dozen years, beginning in 1982, I was a sales and marketing executive for several health insurance companies until I too risked becoming just another centipede. Recently I discovered the term Moral Injury. This resonated with what I have been feeling for so many years. It was first used by therapists in veterans’ hospitals and refers to the way people feel after “perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations.”
Just sixty years ago, Americans weren’t filing for bankruptcy from medical bills. We had more than twenty minutes with a doctor and mostly trusted them. Unnecessary tests and procedures weren’t used to boost income streams of hospitals and medical groups. Insurance executives didn’t write us letters suggesting a GoFundMe campaign to pay for life-saving treatments. And, big pharma’s inflated prices weren’t sending us to Canada or Mexico for affordable drugs like insulin. Back then we were patients; now we’re supposed to be consumer-driven shoppers—like buying a car. Automakers only get to kill a certain number of people before a nationwide recall kicks in. It’s not the same in healthcare. We’re driving the Corvair equivalent but without Ralph Nader to lead the charge.
Photo by Jean Kercheval
Recently I’ve read more than my share of books on the general topic of how to fix a broken system. There is no dearth of policy wonks, professors, doctors, and others who are basically talking to each other and have no idea what it’s like to be an actual patient. Too often these authors finish their recommendations with what we, the patients, can do—which is mostly nothing. As they say, it takes an act of Congress. This challenge feels like David vs many Goliaths.
Medicare for All advocates had new reason to decry the U.S. system that ties the healthcare for many to employment after a new study released 8/26/2020 showed an estimated 12 million Americans have lost their employer-sponsored insurance coverage since the Covid-19 pandemic hit earlier this year. And, there are nearly 6 million Americans who have a pre-existing condition—the coronavirus. Do we think insurers raking in billions are going to welcome us back into the fold without charging more? Think again.
I have to wonder how many people working inside the US healthcare system are suffering from Moral Injury. Here’s a short list of those I would nominate and hold in my heart because it’s soul killing to “perpetrate, fail to prevent, or bear witness to acts that transgress deeply held moral beliefs and expectations.”
- Employees – who work for insurance companies and are paid to say No first. This isn’t just clerks in the Claims Department. Medical and mental health providers are advised to question care and/or coverage (often inadequate) whenever possible.
- Doctors – who instead of feeling like heroes are sounding like victims, drowning in a labyrinth of payment schemes, and burned out. Maybe they regret being encouraged to think as much about profits than why they became doctors in the first place.
- Nurses – who do what they can with staffing shortages, cost-cutting measures, and spend more time at a computer than at a patient’s bedside.
- And the American people – whose lives depend on surviving a broken system or worse – going without affordable access. We too suffer moral injury – becoming immune to injustice, grotesque profits, and well-scripted lies. We are told that it’s too costly to fix our broken healthcare system, too complicated, too disruptive. We have to leave it to the experts and politicians (the haves) to decide the fate of the have-nots. We go along—myself included—hoping that the surprise bills and bankruptcies we read about or see on social media don’t happen to our families, to our friends, or to us.
I don’t believe change will come from the top. Whatever improvements to be made will trickle down after all of the pipers that have to be paid are satisfied. I do believe and am committed to do what I can to create change from the bottom up and still hold to what Margaret Mead said:
“Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.”
Barbara, I just had occasion to read the White House Council of Economic Advisors (CEA) statement, The Opportunity Costs of Socialism (2018). Almost half of its 75-page rant is devoted to the “opportunity costs” of expanding access to health care in the US. You, more than most people, can imagine the trashing of the “socialist” proposal of health care for all. I’m reading this CEA stuff in connection with a study group (social distancing practiced!) on Thomas Piketty’s latest, Capital and Ideology. Some years ago Piketty resigned from MIT, denounced US “economics” as a farce, and returned to France where he is now teaching. This CEA statement is a good example of the problems he denounced. Anyway, my point here about the statement is that nowhere in it is a mention of the fact that currently millions of Americans have no access to health care at all. Oh wait, that’s not right. It was W. Bush who reminded us that anybody can go to an emergency room. Only with a medical emergency, of course. I look forward to your book!
Hi and thanks for the cliff notes on the CEA statement. Isn’t it sad that GWB (former war criminal now painter) is the only person who comes to mind? I’ve now read 9 books on the healthcare crisis and not one writer (mostly docs of course) suggest universal hc. And the few that address patients or just people, their suggestions are pathetic. They mostly live in NYC area and spend a lot of time talking about being wise shoppers with choice of where to go, etc. I just read a wonderful novel to take the edge of off depressing reading.
I. Love. Your. Blog. It’s like having you here in my living room. The concept of moral injury is fascinating. Complicit folks in exist everywhere and in every segment of our wonderful culture based, as it is, on winning for oneself rather than collaborating for the good of all. We all fear we might lose our jobs, our acceptance, our friends if we speak up. The biggest sufferers at this moment might be all those senators who know better. BTW, you remind me of Elizabeth Warren in so many ways. Rant on!
Hello you! Thanks for your comments – I’ll take EW reminder but still prefer Bernie even though I feel like I got “dumped.” I watched Michael Moore’s Where to Invade Next again and felt such sadness for the US when I listened to the women of Iceland – should have stayed when I had the chance. They pointed out the difference between our 2 countries – we’re the “me” and they’re the “we” as in eveyone has to count. I’ll try to be more cheerful in October! XO
So well said. I’m continually disheartened by what I see happening and NOT happening in our broken health care system. You make thoughtful and compelling points. Thank you for sharing!
Hi Lorinda,
Thanks for commenting – as a writer you know – does anyone read any of this? Miss you and hope you and yours are doing well.
I look forward to ready that book and seeing the good it will do by uncovering the truths.
Hi Stephanie. About that book – I’m at a place in the manuscript where I believe that unless a demand is made from ordinary people – the under and no insurance and working families – there’s no point in going forward. We are at “me” not a “we” country and would give anything to change that. Thanks for your encouragement.
Beautiful, Barbara! We can identify many separate villains, but, really, at this point, it’s the tragically flawed system itself that must be stopped.
Hi Pete – how great to hear from you and that you are reading my humble blog! I try not to rant but it’s heartbreaking to read “the expert” books on what we should do and not one so far has come around to single payer or some kind of universal system. Not just nibbling around the edges of the ACA but real, all-in change. Hope you are well and think fondly of you as my “neighbor” across the aisle. Thanks again, Barbara