Remove government from health care

Whenever I read an article about health care reform, I look at the credentials of the writer, posted at the end of the column. Frequently, I see policymakers, politicians, consultants and academics. Occasionally, I see the head of an insurance organization, or a physician who works as the administrator of a large health care system or agency. What I seldom see is the name of a physician fully engaged in the apparently mundane business of treating the sick.

So, here are my qualifications to speak on health care reform. I practice medicine in a medium-sized emergency department. I have done so, if I include my three-year residency, for 19 years of my life. For 19 years, I have seen patients at all hours of the day and night, every day of the week, holidays and weekends included. I have done so on good days, as well as while ill, exhausted and grieving. I have done it while my wife was in labor, and even on the day after my children were born.

Although neither a policymaker nor politician, I have an intimate knowledge of our health care system. I have practiced good, modern medicine and have tried to stay current in my knowledge and skills. I have saved some lives and lost some. I have been covered in blood. I have held the families of the dying and heard mothers scream in loss. I have cared for the abused, the vulnerable, the psychotic, the suicidal, the victims of assault and accidents, the victims of lifestyle and stupidity. I have caught pneumonia and been threatened with death.

I have also learned to love my patients. The drunk have apologized to me. The addicted have hugged me. I have seen, in life and death, the wonder of human life and have been constantly reminded of the intrinsic, divine value of each individual, every person vastly more than a mere bill for government to pay.

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Nineteen years is a long time in emergency medicine. Over the years, I have learned to navigate labyrinthine federal regulations. I have watched as the HIPPA privacy regulations made it harder to do my job, by (among other things) requiring passwords for virtually every activity of my practice. I have seen nurses frustrated as government and other regulatory bodies require more and more charting, with less and less time for patient care.

I have practiced under the federal mandate called EMTALA (the Emergency Medical Treatment and Active Labor Act), which requires me to see everyone, regardless of ability to pay. I have routinely collected 25 percent of my bill. Consequently, I have marveled at the unintended consequences of mandating free care, as emergency rooms and trauma centers in many areas of the country have closed from the combination of overwhelming volume and fiscal insolvency.

I have watched talented specialists develop an understandable and abject hatred for taking call, since they are also required to see patients without pay, and without even the courtesy of protection from litigation under the same federal mandate. I know of many places where specialists simply open their own surgery centers or clinics and refuse to take call at their nearby hospitals, leaving a vacuum in the availability of surgeons, neurosurgeons, obstetricians, otolaryngologists and many other specialties. And why not? How many of our esteemed legislators or think tanks are available at all hours for free, and under the constant threat of disease or lawsuit?

My point is that I have practiced in an area of medicine where government has meddled; where politicians, ever desiring praise for their magnanimity, force facilities and physicians to provide care for free.

But of course, nothing is free. The cost of government involvement is tallied in real lost dollars to real facilities and practitioners and in paradoxically reduced access for the patients who need it most.

Furthermore, federal compulsions have created a mentality of entitlement in which emergency departments constantly struggle with a subset of abusive patients who place zero value on the "free" care they receive. And be assured, the government extracts no accountability from those troublesome patients whatsoever.

I have seen government in action in health care. And it has been consistently inefficient and harmful. Politicians, separated at great distance from the consequences of their actions, only diminish and frustrate the work of those caring for patients. They best thing for our leaders to do is gradually extricate themselves from health care.

At least that's my prescription. You can trust me – I'm actually a doctor.

Edwin Leap, M.D., has been in medical practice in South Carolina since 1993. He writes an op-ed column twice monthly for the Greenville News and writes a monthly column for Emergency Medicine News, a Lippincott publication. Last year, his blog was listed as a notable medical blog by the Los Angeles Times.