Reverend Bachman’s Brother Deserved Better

  Published in 13 October Herald

As an emergency physician faced daily with the unspeakable sufferings of all those worthy Americans abandoned by our profit-driven  healthcare system.  I thank  Rev. Don Bachman for his courageous column “We Deserve Better” published in the Saturday 26 September Circleville Herald.  Rev. Bachman wrote of his brother, without health insurance, sent home from emergency department after emergency department until his gallbladder problem became so bad he qualified for emergency surgery and admission to the hospital. It was then too late, his brother died.

Rev. Bachman’s brother is one of the 45,000 deaths yearly directly caused by lack of health insurance according to a recent study from the Harvard Medical School, published in the American Journal of Public Health. ( Wilper MD, Woolhander MD, Lasser MD, et. al :“Health Insurance and Mortality in U.S. Adults” 17 September 2009 ) 

I am one of those emergency physicians who would have had no choice but to send the Reverend’s brother home, with papers filled out to obtain a gallbladder ultrasound and follow up with a surgeon. I know that my patient will obtain neither the ultrasound nor surgical care as he has no insurance. I also send home the  uninsured diabetic restaurant server and mother of two, the working father  with high blood pressure but no insurance, knowing that they also will get no further medical care, no primary care Doc will see them, until they develop complications bad enough to bring them back to the emergency department again. They will live sicker, shorter and less productive lives. They deserved better.

What kind of nation are we that we , and we alone,  of all the civilized nations on earth allow 45,000 of us to die yearly because their healthcare is not profitable for the insurance industry? This is barbaric. At a recent healthcare forum in Circleville I was asked “ If  the 50 million without health insurance are given access to physicians by proposed reforms, won’t I have to wait longer to see my Doctor since he will then be busy  seeing all those previously uninsured?”. I answered that our healthcare system is “upside down”, that is we have too many high priced specialists that are accessible only to the well insured and not enough primary care Docs, the family practitioners, the internal medicine Docs, the pediatricians who do so much of the front-line work taking care of us. We need to alter the market incentives, so that more Docs go into primary care, in Canada, for example there are more primary care Docs per capita than in the U.S, and Canadians see their Doc more often than U.S. citizens do. Canadians may have to wait a month or two for a hip replacement, but that wait is of no clinical signifigance , it harms no one. In fact Canada does more hip replacements per capita than does the United States. My questioner was persistent, would he have to wait longer while these 50 million folks now denied access, would he not have to wait longer since these would now be able to get care? I told my questioner that was possible, but that we must start somewhere, but  that  I was bothered by the morality of his question, that he would think only of his own convenience, while denying others life-giving care. I thought of that scene in the movie Titanic, where the steel tycoon, having previously bribed his way onto a lifeboat with a wad of cash, is pushing others off the boat with an oar.

 Economically single payer health care aka “Medicare for All” is a clear winner. Multiple nations using single payer cover everyone at one-half the money we spend. The current reform bills will not cover everyone and will not control costs because they are designed  primarily to protect the profits of the hugely inefficient health insurance and pharmaceutical companies. Twenty percent of every U.S. healthcare dollar is wasted on health insurance industry profit, another 11% is wasted on the thousands of private industry bureaucrats who deny your claims, and all the folks the hospital and your Doctor has to hire to fight back with them.  Government Medicare runs on 3% overhead. Yes, 3%.

Would I vote for the current reform bills? Yes, because they will have some good effects, they will rein in some of the worst insurance company abuses, they will cover some more folks. But they are far, far, far from what we, the people, deserve. We deserve single payer healthcare. The fight for single payer will now move on to the state level. California and Vermont legislatures had previously passed single payer plans. They were vetoed by Republican governors. Join the Ohio Single Payer Action Network at

The uninsured are our neighbors, our friends, the folks beside us at church, my extended family. In Ohio, 50% of the uninsured are working. They are not lazy slackers who refuse to work, as a letter to the editor in the 5 October Columbus Dispatch stated. For many of them work is not available. 45,000 of them are dying yearly. Speak with Rev. Bachman about the value of his brother. Come, if you could, along with me on a shift in the emergency department, and look into the eyes of those our Golden Calf of a private market driven health care system considers not worthy. Explain to them why protection of insurance company profits is more important than their health and life. Who knows, in our economy, you may be the next uninsured person.


Brad Cotton is a full time emergency physician and serves as Convener for the Circleville Friends (Quakers). Dr. Cotton is available to speak to groups on single payer healthcare at