This I Believe

Sherif - Orange, California
Entered on September 27, 2007

I believe that health care is a fundamental human right that should be guaranteed for every citizen of an affluent society. I am not a liberal. I consider myself a socially conservative Christian. I feel compelled by my faith, as well as my profession, to speak out against what health care has become in America – a commodity bought and sold according to means, and not a service sought and delivered according to need. And it saddens me that many who share my faith and my profession don’t see this moral imperative.

I am a pediatric surgeon. I attend to, and operate on, our most precious resource – children. Some of my patients are a little over a pound in weight, and yet their parents put enough trust in me to take their children away, perform intricate surgeries, and return them to their arms. I am constantly humbled by this experience. I am grateful to God for giving me the gift to heal and I am grateful to my country for giving me the chance to exercise this gift. I have been given much. From those to whom much has been given, much will be expected.

After more than 15 years of being a physician, I, like thousands of my medical colleagues, have come to believe that the American health care delivery system is not only inefficient, expensive, and erratic– it is unjust and unethical. It results in unnecessary human suffering and often adds to the burden of human beings when they are most vulnerable.

Don’t misunderstand me. We have the components of the best health care in the world – skilled and gifted physicians and surgeons, compassionate and well-trained nurses, well equipped and technologically advanced facilities, great medical schools, and cutting edge research. And for that we should all be grateful. But we have not been able to put these components together to create the best health care system in the world. Our health care delivery methods are standing in the way. As I tell my students and residents, none of our medical assets really matter if you cannot apply them fairly and equitably to those in need. And in that we have failed, and failed miserably. We currently have 46 million uninsured Americans, including about 10 million children, and millions more underinsured. Illness is now responsible for half the bankruptcies in America.

But numbers don’t tell the full story. You have to live the human stories that I have lived. You have to see the mother whose teenage son wasted away over many months because he couldn’t swallow. You have to see her on her knees tears flowing and only able to utter one sentence over and over – “Please help us!” And you have to know that she is not an anecdote. You have to know that her story is repeated hundreds, perhaps thousand of times across America, every day.

On September 11, 2001, we lost well over 3000 Americans in one the saddest and most tragic event our homeland has experienced. In the two months after, that we lost another three thousand to lack of health coverage, and in the two months after that another 3000, and 3000 more in the two months following. The Institute of Medicine has informed us that 1500 Americans die every month due to lack of health care. I would argue that it is not publicly funded universal health insurance that is un-American. It is our current system.

How do we move forward? I believe that you cannot build a second floor on a house with a rotten foundation. In addition to the problem of the uninsured, many more problems abound. Private insurers thrive by denying care and injecting tremendous inefficiency into the system. The burden of insuring the riskiest patients – the elderly, the poor, end-stage renal failure patients, native Americans – is shifted to the government. Physicians practice with their hands tied behind their back. I cannot get a simple x-ray or blood test on many of my patients until the test is authorized, and the patient is sent to another facility. Patients are trapped in health care plans that treat them as widgets that can be moved around for financial gain. Choice of physician has become a luxury most patients cannot afford. This in turn has created stagnation among some physicians who consciously or unconsciously feel that they have a trapped audience. Continuity of care is easily disrupted if insurance shifts to a different plan or is lost altogether, the treating physician changes practice, or job changes occur. Resources are poorly utilized due to competition driven by market forces, not quality. While 46 million are uninsured and millions more are not getting the care they need, hospitals are closing under financial stress. Why would we want to take this system, which is already at the breaking point, and expand it to cover everyone?!

Medicare for all! Despite all the criticisms directed at Medicare, it has survived for over 40 years, given our elderly the peace of mind we all deserve, improved the health of its beneficiaries, avoided micromanagement of clinical interventions, preserved patient freedom to choose their physician, and sustained efficiency in claim reimbursement. It has done all that with virtually no shared risk, providing services for almost all its beneficiaries. When we advocate for a single-payer model, our opponents immediately bring up waiting lists in Canada and other industrialized countries. Joint replacement is typically the sentinel operation used to demonstrate inadequate wait times in Canada. Ironically, most joint replacements in the United States are also paid for by a single- payer system, Medicare! Under Medicare, waiting lists are not an issue because spending and system capacity are significantly higher than Canada’s. We should also remember that Canadians spend about half of what we spend per capita on health care and cover everyone.

As someone who has been involved with health care reform since medical school, many expect me to be excited as health care again rises to the top of the national domestic agenda. But I have to admit I am ambivalent. I am happy to see health care once again rise from the tomb of the last 10+ years, and to see that universal coverage is again becoming an acceptable word to use in public. But it saddens me to see emergence of the same broken promises on one side and the same unfounded rhetoric on the other. The Democratic candidates all essentially want to expand a system already at the breaking point. The Republican candidates are using the same buzz words – socialized medicine, government takeover, etc.— to scare us all – physicians and the public – from doing what is in our best interest.

About sixty years ago, Harry Truman wanted to establish a publicly funded universal health care system. He was defeated, and we have been told for the last half century that the free market will solve the problem. It hasn’t and it can’t. Another mid-20th century hero who loved America, Winston Churchill, said that “Americans will always do what is right…….after they’ve tried everything else.” We have tried everything else, and now I believe we have to do what is right!