What do Louis Pasteur, Jonas Salk, Sigmund Freud and Barack Obama have in common? They all championed controversial medical revolutions and if not for their bravery in the face of conflict, billions would have died. Sterilize instruments to kill invisible bugs? Inject disease particles to build immunity? Look into our subconscious to explain everyday behavior? Give basic healthcare to everyone? Ludicrous. That is why we named these advances after these men.
As an oncologist who has seen the fatal cost of our patchy, imbalanced and unfair healthcare system, I have to be at very least hopeful about ObamaCare; AKA the Affordable Care Act (ACA). The list of benefits is so vast that whatever glitches happen along the way, I know that cancer patients will be helped:
–No pre-existing condition exclusion: so the 31-year-old programmer with Stage 1 breast cancer can change jobs without losing insurance.
–Healthcare coverage by parents until their child is 26: so families will not lose their homes paying for Hodgkin’ s disease in a 22-year-old.
–Guaranteed payment by insurers for patients entering experimental trials: So, patients with any insurance can be involved in research, and everyone benefits from the latest advances.
–Free healthcare screening: So that my 58-year-old neighbor with a family history of colon cancer gets routine exams and life saving colonoscopies.
–Uniform healthcare insurance standards: So that the 45-year-old man with stomach lymphoma I saw last week, does not have to suffer and die because his employer brought a health policy, which excluded chemotherapy.
–All health insurance must cover at least one drug of each type: So patients do not have to choose which insurance by which drug they are taking, and prey the doctor does not change his mind.
–Emergency room visits do not require preauthorization and they cannot be charged as out-of-network; So that Monday morning my patient with lung cancer does not stumble into and collapse in the office after having a fever all weekend.
–Psychiatric parity: So that the 41-year-old Mom with advanced melanoma, two kids and a mortgage, whose husband just walked out on her, can get counseling and support.
–Insurers must cover hospitalizations without a lifetime cap on health costs; So that more than half a million families each year in America will not go bankrupt paying inpatient bills.
–Guaranteed physical therapy and rehabilitation; So that my patients who are cured of cancer have a real chance to get back to real lives.
–Prenatal care: So that the national disgrace that is a ridiculously high infant mortality rate will stop killing babies and I can hear children playing outside my window instead of tears.
–Health insurance for tens of millions of people: So that they can get care and, hopefully, their caregivers will be paid.
-Finally, and critically, health insurance and policies written not in lawyer-businessman language, but in clear English and every person is guaranteed the right to appeal any coverage decision.
I know that such a massive, complex undertaking, giving medical care to an entire nation, will not go without a hitch. Rumor has it that Pasture kept burning his bands, Salk broke dozens of syringes and Freud, well Freud himself needed therapy. Nevertheless, ObamaCare is a chance. A chance for us toward move toward a compressive, modern, world-class health system, instead of medical chaos, which may hurt as many as it helps.
My physician colleagues are concerned about the affect of the ACA on their relationship with patients. Doctors worry that information system enforced standards, increased volumes and decreased reimbursements may make it difficult to give personal care. These are important issues and protecting the quality of individual care is vital. Still, I find that when I close the door to the exam room, that it is still just me and the patient and I can deal with the demands of a new system if it means that millions do not need to go without hope.
What is happening in Washington baffles me. I cannot imagine any of us want to live in world where decisions already made, have no meaning. For physician’s whose word and honor is the key to our bond to patients, that leaders would fail my patients so badly is horrifying. My patients would be distraught if I told them I was going to order one treatment, but gave them another. They would be desperate if I told them to come for a critical test, but locked the door. Their worlds would collapse if the price for treatment were all their savings before we could even begin. I would be betraying all that I know if I told patients they would live, but planned for them to die.
It is time to move on with this next step in a healthcare revolution, which started 150 years ago. We can change, rebuild, add to or subtract, but for now and future generations we have to try. Simply turning our backs on such an exciting future would be the same as spitting on our hands before operating, inviting polio to return, and treating psychiatric disease with pity. We are smarter than that. We are better than that. We deserve more than that. Let us move forward, not back.