Health Reform Was Worth It

From the Huffington Post on Nov 3, 2010.

In the aftermath of the midterm elections, political commentators are saying that Democrats paid a heavy price for overreaching, particularly with healthcare. That is probably true. In our preoccupation with the political fallout, however, let us not lose sight of the real people who will benefit from the new health-reform law. As a physician, I am witness to the struggles of such people. David is one of them.

Several years ago, David went to an emergency room for a minor accident. His X-rays did not show any fractures, and he was cleared to go home. As he was leaving, a doctor informed him that he had high blood pressure. He told David not to worry. All he needed to do was make an appointment with a primary care doctor to get treatment.

David soon realized that there were no primary care doctors willing to see him without health insurance. Although his job as a taxi driver provided enough money to maintain a small apartment and pay the bills, it did not provide health insurance. So he had to forgo treatment as his high blood pressure silently damaged his kidneys.

Five years passed. David began to tire easily. He could not make it across a parking lot without having to stop to catch his breath. A few months later, he would wake up from sleep gasping for air. His breathing was getting worse by the day. One night his sister finally brought him into the emergency room, where I first met him.

I could tell that years of high blood pressure had damaged David's kidneys beyond repair, causing fluid to accumulate inside his lungs and compromise his breathing. After a few days of treatment, David began to feel better. That is when I broke the news to him. To stay alive, he would need to go on dialysis.

David was stunned. "Doctor, will I be able to work?" was his first question. Then he asked me if he could ever visit his parents again. They lived abroad and were too frail to travel. That evening, it became clear that his life would never be the same.

David's life will have to revolve around dialysis. For three days every week, he will make his way to a dialysis center and wait for four hours as his blood is cycled through a large machine. Since missing a single session can be dangerous -- leading to sudden cardiac arrest, for example -- his ability to leave town will be curtailed. It is unlikely that he will ever see his parents again.

Working will also be difficult. In addition to the demands of thrice weekly dialysis, David will have to put up with the weakness, nausea, and cramping that accompanies his condition. There will be the fear of complications. His risk of having a heart attack, for example, has increased by ten fold because of kidney disease.

This could have been prevented. The emergency room doctor who saw him six years ago was right. All David needed was a primary care doctor to regularly check his blood pressure and write a prescription for pills that cost as little as a nickel a day. Yet, he was denied that access because his line of work did not come with health insurance.

Americans are understandably skeptical about the new health reform law. Some fear a larger government role in healthcare. Others wanted the law to go further and include a public insurance option. Many were disturbed by the politics that played out on their television screens, such as the raucous town halls and Senate backroom deals.

Yet, no one can deny that the new law will address a fundamental issue in healthcare -- the unacceptably high number of Americans, like David, who are uninsured.

Politically, it would have made sense for Democrats to put off health reform, at least until the economy had improved. Those without insurance, however, suffer the consequences of waiting. Had this law been enacted five years ago, David would have had a chance at saving his kidneys. Now, it is too late.

The new law will provide coverage for more than thirty million uninsured Americans. Those with insurance will have the peace of mind that they will be protected if they lose their job or fall ill. This matters for a mother unable to obtain a mammogram because she is uninsured or a diabetic who lost his insurance because he was laid off. With all the focus on the political fallout, now is a good time to remind ourselves that their stories matter. Because of them, health reform was worth it.

Healthcare reform: Giving up now is not an option

From a speech given at a health reform rally on February 19, 2010.

This week, President Obama will meet with Congressional leaders to take up the topic of healthcare reform once again. As a physician who works on the front lines, my message for them is simple: giving up now is not an option.

I am fortunate to work with dedicated doctors and nurses, and in them I see the strength of our health care system. Yet, like so many of my colleagues, I also see what is wrong with our healthcare system.

I see the patient with asthma, merely in his twenties, who runs out of inhalers and suddenly can't breath. I see him connected to a breathing machines in our intensive care unit.

I see the small business worker who could never afford insurance, now requiring dialysis because high blood pressure damaged his kidneys beyond repair.

The single mother of two who showed up for her mammograms every year. Then she lost her job and with it her insurance. I see her, three years later, to confirm that indeed that lump on her breast is cancer.

I see this and so much more. And like other physicians, I know that healthcare reform cannot be pushed back any more.

For those of us who support reform, the last few weeks have been difficult. We are so close to passing a bill that, while imperfect, is still a significant step in the right direction. After the election in Massachusetts, however, the media thinks that we cannot pass health reform. Some in Congress are afraid. There is talk of giving up.

This talk reminds me of a conversation I had with another physician a few months back. He was taking call, working all day and then admitting new patients to the hospital that same night. He was on his feet, taking care of patients, responding to pages, talking to families, checking labs, writing notes. Finally at 2:30 in the morning, twenty hours into his shift, there was a lull, a chance for a quick nap. He made his way to the call room in the basement of our hospital. Just as his head touched the pillow, his pager went off again. There was another patient waiting to be admitted.

I asked him, "What keeps you going? You have a wife and kids at home. You could be spending time with them or getting a full night's sleep in your own bed." He looked at me and asked? "You think we have it tough? Our patients are the ones who are going through real struggles. They have to cope with illness and the thought of burdening their loved ones. Yet, they don't give up. So who am I to give up on them?"

It is tempting, when things get difficult, for us to give up. It is tempting, when the political winds change course, for members Congress to give up on those who need healthcare, to move on to something easier.

For us who work in healthcare, we know that giving up won't cure our patients' asthma. It won't make cancer go away. Giving up won't relieve the pain of a lady with a fracture or that of a family that just lost a loved one.

The mother undergoing chemotherapy for breast cancer while also holding down a job is not giving up.

The wife who prays at the bedside of her husband injured in an accident is not giving up.

The alcoholic with cirrhosis, having resisted a drink for four years and now patiently waiting for a liver transplant, is not giving up.

The nurse who eases the pain of a patient with a stroke, the physical therapist who gets him to walk again, the doctor who works to prevent another one -- they are not giving up.

Our patients do not give up. Because of them, we cannot give up. Neither should our elected officials, until every American has access to the affordable and quality healthcare that is their right.

Fixing healthcare: Primary care is job No. 1

"The Senate and House are inching closer to extending health insurance to millions of Americans. Access to insurance, however, does not necessarily mean access to healthcare. What is also needed is a sufficient supply of primary-care doctors. As an internal-medicine physician who works in multiple clinical settings, I repeatedly witness the consequences of patients not having that access."

Read more in the Los Angeles Times.