Published November 09, 2013
I opened the door of my Manhattan apartment to greet my 28-year-old handsome date, who was standing in the hallway holding an umbrella that was dripping wet.
As an underpaid medical resident, he had undoubtedly walked several blocks in the rain to come get me, rather than splurge for a cab.
His black jacket was dampened from the rain, clinging perfectly to his muscular build. He looked well-rested. A thick lock of dark, wavy hair swept down onto his forehead. It was Tuesday night, and this was our second time out together.
I knew then that Michael would be my husband.
Now married for over 16 years, that moment remains one of my first and last impressions of him as a young man.
In the ensuing months, he would become a fully-credentialed, practicing anesthesiologist. It took its toll on him.
In fact, just one year later, I couldn’t figure out what happened to that healthy lock of hair.
A few months after that date, I was making my way out of the city to the beach on the Eastern end of Long Island.
I was usually solo on the weekends, as Mike would have to report to New York University Hospital, formerly known as Bellevue, for a grueling, sleepless weekend at one of the busiest trauma centers in the world.
By the time I was heading back to my job on Wall Street Monday morning, Mike was just getting home from his weekend shift.
And while I was away, cops were attacked by violent criminals, babies were given their first breath, car accident victims were helicoptered to his operating room with head injuries.
A child inhaled a peanut.
The alleged intoxicated cop assailant tried relentlessly to escape the chains that bound him to his hospital bed.
That was Mike’s weekend.
I felt funny chatting about who I ran into at beach that weekend. By Monday, Mike was exhausted, which is why we went out on Tuesdays.
On our fifth or sixth date, I remember explaining to him the difference between a stock and a bond. I was shocked by both his naivety of the subject and the profundity of his questions.
He wasn’t particularly interested in finance, but good doctors ask questions in order to derive understanding. More importantly, they listen to answers.
They have to be good at this, because each human is a unique, complex being.
Medical conditions, treatments and responses vary tremendously from one person to the next. Those who choose the profession are energized by the challenge of finding out what is making a person sick. Only then can they make them well. They are caregivers.
“Come on Mike, let’s save another life today,” a surgeon said to my husband about ten years later, at a small community hospital on Long Island, where he currently works.
That was the attitude with which many hospital-based physicians would go to work.
It was stressful but rewarding. Most physicians were able to pay off their huge education expense and eventually enjoy a comfortable lifestyle.
Medical care costs had gone up, but those with good insurance made up for those with no insurance and doctors were generally happy to take care of everyone.
That’s how the haves took care of the have-nots. People without insurance would be offered the best medical care at any American hospital’s emergency room, whether or not they were U.S. citizens.
Soon I fear that unbeknownst to most Americans, the good, smart, well-rested physicians won’t be there to take care of us.
I decided recently to download a slightly abridged version of The Patient Protection and Affordable Care Act to find out how this new legislation might affect caregivers.
I was shocked that not one word of it addresses the human beings who are providing us with protection and care.
In every chapter, the law just assumes that physicians will continue to practice medicine providing us with protection and care.
In every chapter, the law just assumes that physicians will continue to practice medicine under the new rules.
While the American Medical Association reportedly supported ObamaCare, that group represents less than 15% of American physicians.
Before I set out to write this article, I contacted my brother John, a prominent neurosurgeon practicing in Princeton, New Jersey.
John is one of very few neurosurgeons in the world with expertise in non-invasive or knifeless brain and spine surgery using radiosurgery.
John earned his expertise as a fellow at Stanford University Medical Center, where the life-saving technology using CyberKnife was developed.
What makes my brother’s ability as a healer so valuable, is that CyberKnife targets diseased tissue while leaving healthy tissue intact, thereby greatly enhancing a patient’s quality of life, more so than traditional techniques.
Even Memorial Sloan-Kettering doesn’t have physicians with John's highly-specialized CyberKnife training, although they acknowledge its value by touting “CyberKnife-like” procedures on its website.
Unfortunately, as my brother explained, most health insurance plans, including Medicare, seldom reimburse brain surgeons enough to cover the high costs of providing specialized care.
Consequently, patients often receive alternative treatments such as whole-brain radiation therapy or comfort care, which invariably results in the progression of neurologic disease and loss of function.
ObamaCare will contribute to the increasing number of health plans with poor coverage for high-end neurosurgical procedures.
The result is effectively eliminating the availability of the very life-saving treatments he can provide because insurance companies will no longer pay for them.
It’s simple math, really. Insurance companies have to make money so their stock is valuable to investors. Under ObamaCare, all Americans must be insured.
In order to provide coverage for this new onslaught of enrollees AND maintain profitability, they will have to raise rates (double insurance premiums) and lower costs (cut payments to doctors and hospitals) and eliminate costly complex surgeries, like what John can perform, altogether.
Recently, my brother started a charity called Preserve the Nerve Foundation, to raise money for patients who have health insurance, but whose insurance will not adequately cover advanced brain and spine procedures that would extend and enhance the quality of their lives.
Though he still wants to devote his life to healing, he hopes to make a greater difference by raising awareness of an increasingly large group of insured patients to cutting-edge neurosurgery currently shrouded by the cost-cutting efforts of the health insurance industry.
My husband has also refocused his energy away from delivering care. He’s helped create several businesses that now employ lots of people.
While I’m impressed by his adaptability, his disenchantment with medicine is a big loss to the profession.
The old way was flawed, he says. But this way is disastrous.
Perhaps an expansion of Medicaid to a higher income level of $40,000 per family would have been a better reform. After all, Medicaid and Medicare have been in place for years, and expanding them would have been a much less costly way to provide more coverage.
So what will happen on January 1st, 2014, when most Americans have to renew their current insurance plan at a much higher premium rate they may not be able to afford?
Will healthy Americans opt out of the new expensive, but skimpy coverage and pay the much less expensive fine instead of being insured?
Then what happens when they get sick?
Will there be lines around the block at emergency rooms where large numbers of uninsured patients will go as their only option for care?
I think a Medical Cliff is possible.
Already, I’ve noticed Mike is working much longer hours as patients try to squeeze in procedures before the end of the year, when their insurance coverage runs out.
One of my biggest fears is that a little further down the road, the brightest minds won’t choose medicine as a profession.
Although the desire to save the life of another is honorable and innate, the smartest students won’t want to practice medicine under the limitations established by the new law.
Mike and I now have four children, at least one of whom will want to become a doctor like their father and uncle. But if he or she decides to abandon medicine as a career because of these conditions, then surely that will be the biggest cost to all Americans.