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The I and Thou of Health Care

Posted on 19 March 2010

by Julie Penny

I saw one of my doctors a couple months ago, a specialist. He’s not accepting certain insurers anymore. One of them is mine. This allows him to earn more, and to free up time he otherwise wasted on paperwork that insurers use to drown doctors in—the capricious, redundant kind of paperwork meant to delay, undercut, or obstruct patient care. Since he gave up on several insurers he has more time for his patients. But that was his hallmark, he always took time with patients even when accepting all insurers. He always resisted the patient mill to augment insurance payment shortfalls.

I hadn’t seen him in several years and in the interim he’d moved his office further west of here and downsized it. He’s excellent in his field, with a bent for philosophy and is always reading. Appointments always included interesting conversation. This past time, besides evaluating and discussing my immediate ailment, we discussed a famous essay—“I and Thou”—written in 1923 by the Jewish philosopher, Martin Buber, that’s had an enduring impact on students of social psychology and social philosophy. I’d read it as a student; the doctor just recently.  In it, Buber presented two almost opposite concepts on how we experience existence: either by “I and Thou” (I and You) or, “I and It.”

To simplify, I and Thou is a relationship that stresses the mutual, holistic existence between two beings. It can be between two people, an observer and an animal. It’s a concrete encounter, because these beings meet one another in their authentic existence, without any qualifications or objectification of one another. In the I and It relationship, an individual treats other things, people, etc. as objects to be used and experienced. Buber believed the I and It paradigm devalued not only existents, but the meaning of all existence.

I’m glad the doctor brought it up because it brings our current topsy-turvy world of health insurers, Wall Streeters, too-big-to-fail bankers, and other corporate sociopaths into sharp focus: too much “I and It” and not enough “I and Thou” going on in the world.

His comments on the health insurance industry who waste doctors’ time in fighting for patients’ care and who chip away at doctors and hospitals for their own aggrandizement and to post fat profits for Wall Street were bitter. It was also a sad lament. They’d high-jacked the profession he loved for their own selfish purposes. People’s health is nothing to be speculated upon. Money should go back into the system for patient care, not portfolios. Health care should be a “non-profit,” not a “for-profit” system. His comments on America’s healthcare system were no more cynical than comments made by a lot of other doctors and nurses I know and who I read about since I follow this issue closely. I think if they had other professions to turn to, a lot of them are so disgusted they’d walk away from the current landscape. Doctoring is no longer what it was. It’s being drained of nobility and its humanity by forces other than the doctor and patient relationship. Market forces. Doctors are being eaten up, as is the public by these for-profit insurers. The top five insurers made $12 billion in profits last year, 2009, while arbitrarily dropping 2.7 million people who interfered with their bottom line. These days, why would anyone start a profession with hundreds of thousand in debt from medical school and stripped of the authority and means to do what’s in the best interest of a patient’s health?

After my appointment I started thinking of other doctors I know and have known, going back to my first—Dr. R, I’ll call him, the family doctor who delivered me and who, like other doctors back then, made “house calls.” It’s inconceivable to me to imagine such a thing today, making house calls, although they still do it in France. France, which is rated as having the “number one” health care system in the world. It’s also “Single-Payer” with choice of doctors and hospitals. What would Dr. R. make of today’s brutal system? Where insurers dump the sick on any pretext to pad their pockets?

Here was a doctor who would arrive at all hours of the day or night driving down from Westchester Square in the Bronx to our apartment on East 119th Street and the East River Drive. On one such night, he appeared, heeding my mother’s panicked phone call. Both my father and five-year-old sister were terribly sick. After examining them, he paced the red wool carpet in our living room back and forth looking up at the paintings hung on the walls for courage. He didn’t know how to tell my mother and father. My mother could see how conflicted he was. Finally, he told them my sister had pneumonia. My father, ill with fever and flu got out of bed, but Dr. R stopped him “You stay right there or you’ll end up the same way.” He had my mother wrap up my sister in a blanket and off he took them both that bitter cold January night to Parkchester Hospital.

Besides us, Dr. R. ministered to our whole extended family—aunts, uncles, cousins. If it weren’t for his crusty old nurse, Mrs. B., he never even would have billed any of his patients for his services. He knew everyone’s ailments, medical histories and the context in which they lived. We all revered him, and speak of him with enduring love and affection.

Today, family doctors are a dying breed.  Killed off by compartmentalization and specialization. Few are electing to become family practitioners. Killed off by our health care systems. Today’s buzzword is “preventive medicine.” But family physicians were the generalists, par excellence, who intimately knew each of his or her patients and, in effect, practiced “preventive medicine” because they viewed their patients holistically. Today’s health care providers and politicians tout “health teams” while ignoring the value of family practice. Family doctors are rapidly becoming anonymous “team members” in “wellness emporiums.” 

Aetna, Wellpoint, United Healthcare, Cigna and the other health insurers have jacked up premiums to obscene levels, make obscene profits, and continue dropping people from their policies or short-changing them of care, while meanwhile employing vast armies of lobbyists that outnumber members of Congress. They are using money we pay in premiums to do this. We are paying money that is then being used against us by insurers for these well-paid lobbyists and front-groups.

There are many fine doctors who innately view their patients in an “I and Thou” light that I spoke of before. For the oily barkers of the insurance industry, it’s merely “I and it.”  Even reading Martin Buber wouldn’t change the mindsets of these dark souls. Greed trumps all. Humanity seems beyond their comprehension. 

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2 Responses to “The I and Thou of Health Care”

  1. Really says:

    “make obscene profits”

    really 3-4% profit margins are obscene?

    can’t wait to see your article on drug companies and their 15-20% margins…

    how about doctors that make 15-20x the national average wage?

  2. Go to Medical School says:

    Really have you given tought to the Medical school debt and lost opportunity cost of of residency and fellowship. Once you have that type education than you can get paid 15×20 times the national average wage. How much do insurance company executives make? My suggestion is to work at a doctor’s office and deal with the insurance companies directly and find out whose interest they have.

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