“We must come to see that the end we seek is a society at peace with itself, a society that can live with its conscience.” Dr. Martin Luther King, Jr.
When I launched my private practice, it was on the eastern shore of Maryland in a small town. I joined a physician who had been in practice for several years. I managed to keep my schedule light for a few weeks so I could study for my Board Examination. I had just finished my residency training but I was no stranger to outpatient practice. After my return from the test which I opted to take in Orlando, I never saw fewer than 20 patients a session. The busiest days saw us seeing 30 or more patients. I admit that many walked in but most were scheduled. This was in 1990 which was the beginning of the rise of HMO’s. My practice was hospital sponsored. In less than 1 year, I had repaid the hospital the loan and started to make a profit. Many of my patients were uninsured but a significant number were Medicaid, Medicare and HMO. I welcomed the Clinton Health Plan and even was interviewed by local newspapers. Sadly, for my community, it never happened.
While I was on the Eastern Shore in the 90’s, it was apparent that many of the residents had no way out of the cycle of poverty and the health problems neglected from being uninsured. The reality played out in the Emergency Room of the local hospital day and night. Being uninsured affected every family. Our community had business owners who were farmers, fisherman, mechanics, contractors and shop owners. Many made too much money for Medicaid but they could not afford the cost of private insurance. Many of them landed in the ER with serious medical conditions they had ignored. Some even called my office and were seen as emergency visits. One particular case was a bit scary. One of my staff called and brought her brother in. He was complaining of chest pain and would not go to the ER. They came to the office and I did an EKG. To my surprise the brother was having an acute myocardial infarction. He was uninsured and was still refusing to go to the ER even as the ambulance arrived. We did get him there. He and I had a tense ambulance ride together to the tertiary care hospital and I handed him off to the cardiologist who greeted us both and whisked him off to the Cardiac Intensive Care Unit. Weeks later, the community came together for a fund-raiser. I attended and was to my surprise honored by everyone for my excellent care. Unfortunately, I had to leave to go to the ER to care for a patient that was not so fortunate.
I had hoped that the HMO’s would make healthcare affordable but that did not happen. The reality for patients then and now is that if you lack insurance, you end up in the ER. I worked with the local health department. My office was ground-zero for many programs. We saw patients enrolled in the Breast and Cervical Cancer Screening Program, Vaccines for Children and participated in every pharmaceutical company sponsored free medication program. We saw patients from the Mental Health programs, Drug treatment programs, and Adult Daycare. My office was such a high utilizer of one Pharmaceutical Company Patient Assistance Programs; one company invited me to give a presentation to a group of providers.
I was part of the steering committee and a board member of the new Federally Qualified Community Health Center (FQHC). It was our answer to tacking the rate of uninsured patients. It was hard work to get the grant written, not by me thankfully but I did read it and had to give input on the clinical operation. I also had to pledge my service which meant clinical sessions, on call coverage and hospital admissions. I was also involved in recruiting the first full-time provider. We were fortunate to be designated a National Health Service Corp (NHSC) site. This allowed us to recruit a NHSC scholar who could use our site and a 3-year commitment to repay medical school loans. The good news is that built into the Affordable Care Act is increased funding for the NHSC. The program is now expanded and will allow an increase in primary care providers in areas where they are needed. We were fortunate to get a brilliant young Family Physician in our community. The CHC is still there but it is now part of a bigger network. Across the US, FQCHC are providing care to uninsured and underinsured patients.
Medicine for me has always been about helping my patients. The Affordable Care Act has changed the delivery of medical care in the US. There is no restriction for preexisting conditions. The Affordable Care Act (ACA) decreased the number of uninsured patients in the US. The dilemma was increasing the number of providers to care for all of the patients. Across the country this has happened. The defeat of the Republican’s health care plan was a victory. I knew it would fail. It was written without the input of anyone with experience in the present health care climate. After 34 years in medicine, I know how complicated health care is. I live the reality everyday as I see patients and teach residents and medical students. The problem is that the history behind all those social programs is not passed on. Medicaid, Medicare and the Children’s Health Insurance Plan have saved lives and provided care to so many Americans of all ages.
I work with my residents in a Health Start Clinic that provides maternity care to uninsured women. They can get emergency Medicaid for prenatal care. The Republican plan would have cut this program. We already have poor perinatal health outcomes for an industrialized nation.
Let’s continue to be vigilant and keep up the fight. We must never fail to uphold our democratic process and institutions and remember what happened when the Germans ignored Adolf Hitler.
“When a man assumes a public trust, he should consider himself as public property.” Thomas Jefferson
“There comes a time when one must take a position that is neither safe, nor politic, nor popular, but he must take it because conscience tells him it is right.” Dr. Martin Luther King, Jr