I returned from Palm Desert California on a 6:45 am flight today after attending the Association of Departments of Family Medicine meeting this past week. To say the airport in Palm Springs is congested would be an understatement. To get the airport with plenty of time, I had the “car” arrive at 5 am. At 5 o’clock it is pretty dark and the roads are pretty empty so the driver was in a talkative mood. He was about 40 years old and reminded me of a surfer that had taken one too many waves the wrong direction. This, for some reason, was not odd in the desert. The conversation went something like this:

Driver: So, what do you do?

Me: I teach people to be doctors.

This is a common ploy of mine to avoid the “Doc, doc it hurts when I go like this” moment.

Driver: Oh, you’re here for that medical convention. Tell me, how do you train doctors?

This allowed me to discuss medical students and residency, the differences, what is teachable in lectures (medical information) and what isn’t (values such as integrity).

Driver: Sooo, you’re not a doctor?

Having just been exhorted to exhibit integrity in all I do, I confessed that I was indeed a doctor who not only taught but saw patients. This brought about the next question:

Driver: What do you think about Obamacare?

Me: I think the Affordable Care Act, though not perfect, offers the tools to allow all Americans to have access to affordable health care and includes improvements in the system to allow that to happen.

Driver: You don’t think all that government control is unAmerican?

Me: The ACA is essentially based on a plan based on a Nixon administration idea. I somehow don’t think it is unAmerican.

Driver: I just think we ought to let the market dictate how the health care system works.

Me: The problem is there are a bunch of people who have to spend health care dollars on severe illnesses or are sick due to no fault of their own. If we are going to let the market take over, we need to not let people who access the market ineffectively or make poor decisions seek out health care when their money runs out. In essence, we would have to let them die.

Driver: Yeah, that’s letting the market take over.

Uh oh, this is going  badly. It is still dark. Aren’t we at the airport yet?

Me: No, the real problem is that people need help in accessing the health care system because they don’t have the knowledge to interpret symptoms effectively. The Affordable Care Act puts primary care doctors in a position to help people interpret their problems and decide if they need to see another kind of doctor.

Here’s the turn to the airport, time for my big finish:

Me: In addition, we need to figure out a way to make doctors do the right thing for the right reason. Let me give you an example. Let’s say you could drive your cab around all day and find people who are walking and say to them, “If you say you are tired, I can give you a ride and charge someone else.” Bet you would get a lot of tired folks. We’ve got to find a way to have doctors only provide needed services to folks. The ACA has provisions for this as well.

Driver: Well, I still don’t like the idea of government healthcare.

Personally, I would prefer a single payor but I’ve yet to get my luggage.

Me: This is far from government health care. President Obama has just done a poor job of telling people about it.

Driver, pulling to a stop: Wow, man. Thanks for the didactic ride

Me (to myself): Shaka bro’