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Please begin with an informative title:

As I write this, I'm not really certain how constructive it is to say this, but I know at least that it's the truth, and it's probably a truth that people around here should face at some point.

I hope that Obama will win.  If he does, we are more likely to see Obamacare survive.  If that happens, we will have succeeded in maintaining one of the most expensive, yet least effective health care systems in the world.  If we lose, it will get worse.

I'm in kind of a unique position.  I'm a medical transcriptionist who works from home, processing medical reports all day, while at the same time surviving on about $1000 a month.  I'm also a disabled person who badly needs my medication.  Those three traits combined make me extremely aware of the state of medical care in this country, and when I listen to the political dialogue out there, it becomes very clear to me that most people even at dailykos aren't.


You must enter an Intro for your Diary Entry between 300 and 1150 characters long (that's approximately 50-175 words without any html or formatting markup).

Today, the general practitioner is a position which no doctor wishes to fill, because they are paid less than ever before.  For that reason, we are moving more and more to hospital and emergency room based care than ever before, and Obamacare not only doesn't solve that problem, it actually makes it worse.  The trend of cutting costs essentially gives the message that we think doctors have too much time to see their patients, so we need to force them into seeing even more people in a day.  That of course, means they will spend less time with each patient.

When I process a new medical record, there is something like a 30 percent chance that the person I get speaks English as a second language.  It's a problem for me to understand them, but what is more interesting from a community standpoint is what it says about our health care system.  Specifically, what it says is that increasingly Americans don't want to practice medicine in this country any more, and we have to pull in people educated elsewhere here because they are the only people willing to work for the pay.  Our own doctors want to work as well-paid specialists who only freelance at hospitals.  

I'm constantly told by medical transcriptionists that the records which they see, whether from English speakers are not, are consistently worse as the years go by.  Doctors work faster and cut more corners, and pay less attention to each case they deal with.  We are constantly finding new ways to save a nickle, because Americans aren't willing to pay for health care, and then we lie to ourselves and say that won't result in a higher incidence of doctor mistakes.  Well mistakes are on the rise, and they will get worse under Obamacare specifically because of attempts under that bill to cut costs.

I see people complaining about the attitude the press takes when Romney lies his way through an interview and I can identify with that.  But I wonder if anyone understands just how deep in the hole we really are here?

We've been backed into a corner to the point that we are supporting a plan that will make things only moderately worse, because the alternative is someone who will effectively deny coverage to many millions of people.  We aren't fighting for positive change, we are supporting the part of our two-party system that is relatively sane and won't screw up things too badly.

Sometimes I get a report, and I know the instant I got it that the doctor was barely conscious when he made it.  Sometimes it's because they've been on the floor for days, and are describing a patient's visit that happened a full 24 hours ago.  I wonder if he forgot any details while he was constantly working over that time?

Increasingly, most doctors who see their patients are treating them in the same way they would if they saw them in the Emergency Room.  They can't actually remember their patients details any more, and many of them walk into the room with their chart, ask them a few questions, and come up with a response on the spot.  They don't remember them like individuals or have a coherent idea of what their problems are.  They just respond to what they see on that day, and by the time they see them again they will have forgotten that last appointment.  

Knowing the patient's history is how you catch cancer early; it's how you catch a lot of the hard-to-catch stuff.  That's what doctor's tell me, and some of them have told me that's why they are thinking of quitting.  They are tired of having to push people through their office faster than ever before; they are tired of not being allowed to effectively treat their patients.

And that folks, is one of the main problems of being treated in an Emergency Room, it's one of the reasons why having your own doctor was supposed to be better in the first place.  You wanted a doctor who actually knew you, but even your own doctor probably doesn't really know you any more.

The truth is that the important battles aren't fought come election time, they are fought in the minds of the public over the years.  Today, Americans have only one god, and that is the dollar.  They cut medical costs and insist that it's smart not to regulate anything that's going on because they want a bigger house or a better car.  It never seems to occur to them that when they have a heart attack, they are going to end up seeing the same overworked ER physician that all the poor people see.

The real fight is one that's been lost ever since Reagan got elected, and it happens in the hearts and minds of the public, and it effects the way they all vote.  It's what allows 'independents' to ignore Romney's obvious dishonesty, and vote for him anyway because they have this vague idea that if they vote for the millionaire, the economy will get better.  They know that the poor will get screwed, but on some instinctive level they hope they will be able to make enough money off the decision that it won't matter.  So they ignore forced ultrasounds and 'legitimate rapes,' and statements about how evolution is a lie from the pit of hell.  They hold their nose and vote for the Republican, because they don't really watch debates but they are sure they'll get a 5% raise in the next few years if they do.

That kind of thinking hasn't worked out well for the country, and it's only getting worse.  Sometimes I look at the situation, and I wonder if the answer here isn't the same one as when you watch an alcoholic killing himself.  If you try to help him up, he'll get up and go buy another bottle.  Maybe what needs to happen is the alcoholic needs to nearly kill himself, and when he has that moment where he look into the abyss, he'll finally understand what he's been doing to himself.

I'm in a very dark place in my life right now, and when I see this stuff I try to tell myself that it's just my mood blotting everything out.  But no matter how much I tell myself that, I think there is probably some value in pointing out that our health care system is not being saved.  As screwed up as my own life is, I wish I could look around and find something better in the world around me, but that just isn't what I see.  The part of the system I see is breaking down.  I don't know how much more it can take.

Obamacare was the result of a hundred compromises; and yet, even with all that ground lost it's still under sustained attack.  Americans have no values left; it's all about the money.  From the way they act, you might think you could bring your savings with you after a botched operation.  

Sadly, you cannot.

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