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Dr Patrick Neustatter, formerly a GP in the UK and now a family doctor in Fredericksburg, Virgina, gives a grassroots perspective on the increasingly rancorous arguments over the future of healthcare

Dr Patrick Neustatter, formerly a GP in the UK and now a family doctor in Fredericksburg, Virgina, gives a grassroots perspective on the increasingly rancorous arguments over the future of healthcare

Imagine a healthcare system where little old ladies have to choose between medicines and food – while the drug companies whose medicines they cannot afford make more than the GDP of some countries.

And health insurance is so expensive and inadequate that 70% of bankruptcies are due to medical bills – while the companies whose insurance patients can't afford award tens of millions in salaries or hundreds of millions in stock options to their CEOs.

These are the symptoms of a broken system that you would think anyone in their right mind would want to change.

An apparently growing and ever more obnoxious faction do not, it would seem.

Though English-raised and trained, I have been a family physician (the American version of a GP) in Virginia for the last 23 years – getting an up-close and personal view of the insanities of the American healthcare system. I have plodded on, a grunt in the trenches through multiple presidential administrations, waiting for the Americans to come to their senses.

Never have I seen the vitriol and the bile that is being unleashed in opposition to the Democrats' relatively modest proposals for health care reform however, personified by the opponents that came to two town hall meetings in my home town of Fredericksburg, last month, held first by Republican senator Rob Wittman, and two nights later by Democrat senator Mark Warner, where they took questions from the floor.


These vociferous and belligerent opponents seem to be a stereotype, with their ‘Guns Save Lives' buttons; harassing an Irish woman friend because she didn't join in reciting the Pledge of Allegiance; a standing ovation for one of the questioners when he announced he was a navy veteran; passionate opposition to public money going to family planning organizations that might have anything to do with abortion, and one woman claiming abortion 'is being used for population control'.

Then an 'I'm alright Jack' selfishness exemplified by one belligerent old geezer in plaid shirt and blue jeans wagging his finger at the audience in opposition to the idea of illegal aliens getting health care coverage, saying 'I didn't do my part so I could give an illegal immigrant part of my Social Security'.

In the nationwide war of words between the pros and the cons, complaints of racism have been raised - by commentators better informed than me. Joe Klein in Time magazine notes that there has been 'not just the steady stream of misinformation about the nature of President Obama's health care proposal, but racism – both overt and opaque'.

I heard evidence of this in a backhanded way from another questioner saying 'if you don't support health care reform, doesn't that mean you are a racist'. Or plain denigration of the country's first African American president that I never heard leveled at any white Democrats, with one strident woman commenting 'for the first time I don't believe the president we have is a patriot'.

It is a health care system rife with absurd insurance company regulations and restrictions - they are able to cancel your policy if you are costing too much, and cherry pick and refuse to insure you if you are sick (and need I point out the tragic irony that it is when you have a preexisting condition that you really need the insurance).

It is massively overpriced and inefficient (with estimates of 30% waste). Those who can afford it get the best in the world, 'Cadillac care', and those that can't get nothing. It call costs far more than any other country (16% of GNP) - but the US is ranked 37th in the world by the WHO (between Costa Rica and Slovenia). The healthcare industry is lobbying for the status quo to the tune of $1.4 million a day for the first quarter of 2009.

You would think even Republicans would balk at such madness.

They seemed to at first, with Senator 'Chuck' Grassley, a 76-year-old soybean and corn farmer from Iowa being the standard bearer. But he seems to have faltered.

All that's left is the misinformation campaign – where discussion of rational use of limited resources is misrepresented as 'Death Squads' that will be 'genocide to the old people of this country', as one meeting attendee put it.

Or claiming 'Government-run healthcare doesn't work', as one emergency room doctor speaker told us – a notion propagated by the right wing media with the British National Health Service being cited as 'Orwellian'. Joining in, it was Grassley himself that claimed Senator Ted Kennedy would not have got adequate care for his brain cancer in England because of his age.

A large and belligerent subset of Americans seem to have a total aversion to the idea of government sticking its oar into any kind of nationalized health scheme – or even Government-run health insurance (the so-called 'public option') to provide some competition to the private insurance companies.

They also seem to be totally unaccepting of the idea, that is the norm in so much of the world, that such a system should be paid for out of taxes.

It's getting near to the showdown time. But opposing views seem to be getting more partisan and more entrenched – which seems to get in the way of any rational or reasonable consideration of what can be done to fix this broken system.

It is unlikely any health care reform plan will be perfect first time round – more a work in progress. But even that is beginning to look in doubt as we fall victim to a mob that, to take an ancient Greek medical perspective when they believed in 'the humors', Hippocrates would have diagnosed as bilious rather than sanguine.

The debate over healthcare in America is becoming increasingly rancorous The debate over healthcare in America is becoming increasingly rancorous

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