Letter to the Editor
I read with interest Anne Scheck's article, and I couldn't help noticing two glaring contradictions. (“Special Report: EPs a Casualty of Turkish Uprising,” EMN 2014;36:12; bit.ly/1myNcPc.) She purports that the current Turkish government is prosecuting emergency physicians who are treating protesters who have suffered violence directly from their protesting activities. She implies that this is unethical and immoral. She quotes Terry Mulligan, MD, who indicated the Turkish situation requires an international response, implying that American emergency physicians should be part of this response.
The first contradiction became evident here: “The encroachment of politics into emergency medicine could have particularly devastating consequences in the years ahead.” I wonder which country this is about. We don't have to look any further than right here in our own backyard where our health care has been politicized to the extreme. The most restrictive legislation to date is the Affordable Care Act. This law actually makes it illegal for health care consumers and providers to engage voluntarily in commerce without the approval of the state. There have been untold stories, available on the Internet, about patients having their insurance policies canceled to comply with the encroachment of politics into medicine which could have particularly devastating consequences.
But our health care problems in this country started way before the ACA. Medicare and the state, and therefore politics, entered the health care system in 1966. Medicare is a health care policy that has resulted in a fixed priced cartel of health care goods and services. To be specific, I cannot charge patients that come to the emergency department lower prices than what Medicare allows because my doing so would be considered discrimination against Medicare patients. The only way to get around this force-of-government provision is not to participate in Medicare, a task that is all but impossible for the average emergency physician like me.
The second contradiction in the article became evident here: “Control of health care in some countries — through its proffering or denial — has been used to gain control of local populations.” Again, we only need to look in our own backyard to see the obvious. Medicare has more claimant denials than commercial health insurers. (Healthcare Economist blog; http://bit.ly/1py2j91.)
The presence of Medicare de facto makes the delivery of health care a political football full of grandstanding politicians and predatory lobbyists. All of this political health care rationing is taking place before the implementation of the Independent Payment Advisory Board, an entity of 15 unelected bureaucrats claiming to know how to best save on health care expenses for 300 million Americans. It seems too coincidental to me that President Obama will implement this advisory board after the 2014 general election.
Readers of this article should really question the need for an organized international response when the American federal government is busy dropping drones on innocent men, women, and children in Pakistan, Somalia, Sudan, Afghanistan, and who knows where else? What about the health care needs of these victims? What about the health care needs of all the children whose bodies were ripped to shreds by American bombs under the pretense of a humanitarian war in Libya? What about the more than 500,000 children who died in Iraq because of U.S. sanctions? Why is there such a compartmentalization of government activities? Why didn't the EMN article make the obvious connections regarding the interest of individual Americans before spewing out what appears to be nothing more than a propaganda piece for further American interventionism tailored to emergency physicians? I hope we emergency physicians are smarter than EMN assumes we are.
Mirand Sharma, MD