For the Media

Do our politicians understand in a fundamental way what their policy decisions mean for the rank and file of our nation, and if they do, how do they behave? Empathy is a powerful emotion. We depend upon it to make important decisions in our day-to-day interactions with others. It is almost automatic to say, "I know how you feel." It is probably one of the great assets for a politician to know how to connect to others in this visceral way. Bill Clinton is a contemporary politician well known for his ability to connect. George H.W. Bush was famous for his stiffness.

As a physician, my ability to listen to a patient and to understand what they are feeling occurs at several levels. As I have gotten older, though, my understanding and the conviction behind "I know how you feel" has strengthened because truly, I have begun to experience many of the ills that my patients tell me about. I know in a first hand way about sprained ankles and carpal tunnel syndrome, about relatives with severe illnesses, and friends dying young from illness and from violence. So, I have become better informed and perhaps a better physician.

In my last blog entry, I introduced some stark facts regarding healthcare coverage in the United States. Can any of our politicians understand what it means to be without healthcare insurance or the benefits that they derive? Three senators and one governor – all have excellent health coverage for themselves and their loved ones. They have benefited from being employed and being elected (even better). Based upon my understanding, I wanted to make examples of how these four politicians know or benefit from the healthcare system and their health insurance.

John McCain has had federally funded healthcare for his entire life (including veterans benefits for service-related injuries). He needs that continuous coverage and the guarantee of Medicare (for persons 65 years old and older) because if he were a normal Joe with four episodes of melanoma, he would either be excluded as being too high risk or be paying out-of-pocket for surveillance healthcare for this condition.

Barack Obama knows about health. He has smoked cigarettes in the past. This might be an exclusion for life insurance or even higher premiums on health insurance. His mother died of ovarian cancer in her early fifties. There are over twenty thousand new cases and fifteen thousand deaths attributable to this disease in the U.S. every year. Most cases are sporadic, but perhaps up to 10% have an identifiable genetic component. If he is a carrier of the BRCA1 or BRCA2 gene, his children may have this gene as well and be at risk. As they get older, their doctor and they may decide to evaluate this risk. Fortunately, it is covered. If they know that they have it, will anyone be willing to insure them?

Sarah Palin has a baby with special needs, who with luck will live a long and healthy life. However, a baby with Down Syndrome is not just developmentally delayed, it has a very high risk for congenital and chronic healthcare problems. Fortunately for Governor Palin, her baby is eligible for Medicaid and other publicly funded services that will ensure that her baby gets the care that it needs, because we all contribute to that public good. With luck, her baby will outlive her and become the responsibility of her other children and of Society. Governor Palin’s unemployed, unmarried pregnant oldest daughter (and unborn baby) who may no longer be eligible for the Governor’s healthcare insurance once she gets married, will be eligible for Medicaid through the WIC (Women, Infants, and Children) Program.

Joe Biden lost his first wife and two children in a car accident. His two other children from that marriage were critically injured in the accident, but survived. He later nearly died from a brain aneurism. He must appreciate the value of having emergency rooms and emergency trauma services. In a country with so many uninsured, a crisis is brewing as emergency rooms and trauma centers close. The hospital emergency department is where the hospital meets the street curb, and by law, they cannot turn people away, regardless of ability to pay. The only way for a hospital to prevent losses through the emergency department (because their patients are uninsured) is to not have an emergency department.

As we look at the healthcare proposals and attitudes of the parties and their candidates, let’s ask whether their proposals reflect their experiences or hypothetical situations for which we must depend upon their empathy.

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