The Emergency Room and Basic Health Care 

CHAIRPERSON’S COLUMN

by Dan O'Brien, PhD

Dan O'Brien is vice president, ethics, Ascension Health, St. Louis.  He can be reached at dobrien@ascensionhealth.org


It wasn’t until I had been reading and re-reading Robert Frost’s poem for many years that it suddenly struck me: the “yellow wood” in his poem referred to the autumn of our lives! What a different insight that gave me, in contrast to the first time I heard the poem many years ago at my own high school commencement when I was embarking on a new path. Now it speaks to me of coming to that point in the autumn of our lives when we stop and decide whether to break from the path we have been taking:

Two roads diverged in a yellow wood,
And sorry I could not travel both
And be one traveler, long I stood
And looked down one as far as I could
To where it bent in the undergrowth . . .

Although the poem continues to disclose truths to me that I am only now discovering, I believe it can also speak to us all about health care today in the United States. It doesn’t take a long look down the current road to where it bends in the undergrowth to see that our current health care system isn’t taking us where we need to go as a nation.

The growing number of uninsured and underinsured is staggering—there are numerous countries in the world whose entire populations don’t even approach the number of uninsured and underinsured in the United States. This is taking a huge toll on individual and community health and on our collective economy. We are less productive and less competitive than we could be in the world market if everyone had access to basic health care, not just to the emergency room.

And isn’t the emergency room an interesting metaphor for our health care system? We are only willing to guarantee each other the care we need in times of crisis, when it is often too late to change the course of an illness or disease.

In the meantime, too many are forced to make unnecessary and unjust tradeoffs between work and basic health care. Too many are risking the well being and security of their families by opting out of insurance programs that have become too costly to bear. Too many are left to fend for themselves and to make terrible choices between basic human goods—between food and medication; between health care and education; between relief of suffering and not being a burden on others. How much more of this will we take before we rise up in moral indignation and outrage and say enough?

There is another way. There is another path we can take—where no one is forced to make a choice between mere survival and real living; where everyone has access to basic health care; where individuals and communities can truly flourish. How long are we going to continue standing at this fork in the road before we take that path less traveled—the path we have been refusing to take for over half a century when it was first presented to us under President Truman?

In January 2006 the Supportive Care Coalition adopted a new vision statement. It is a vision of a society “in which all persons living with or affected by a chronic or life threatening condition receive compassionate, holistic, coordinated care,” where such excellent care will be provided “according to need,” and will assist individuals, families and loved ones “to live fully in community.” It is not just a vision for palliative care. It is a vision for a new system of care and for a new way of caring. This new vision cannot be realized without genuine health care reform. The tradeoffs people are making are driven not simply by bad personal choices but by an inequitable distribution of society’s resources. In fact, there is enough to go around; there is enough for all. We are still the richest country in the world—it seems that we ought to be able to take care of each other. How long will it take?

We stand at a fork in the road. One path leads us on the same course—the path of the emergency room, where we are each on our own except in times of crisis. The other path leads to access for all—the path where we anticipate each other’s needs and respond to each other in community, with solidarity and compassion. As more and more of us enter into the autumn of our lives, my hope is that we will muster up the courage to take the road less traveled. And then perhaps we will share in Robert Frost’s deep sense of satisfaction in knowing that the new path was the right path:

I shall be telling this with a sigh
Somewhere ages and ages hence:
Two roads diverged in a wood, and I—
I took the one less traveled by,
And that has made all the difference.