Over the past decade, health care delivery has deteriorated – under the watchful eye of insurers and legislators – to the point where it can no longer be managed effectively or efficiently without enormous staffs who spend their days negotiating on behalf of patients while working for doctors and hospitals. Insurance premiums have skyrocketed while reimbursements to doctors have decreased.
This will remain true regardless of whether ObamaCare is repealed and replaced or not. But at least the American Health Care Act, no matter what its final iteration, will no longer force you to purchase an insurance product that doesn’t guarantee delivery of the very care it promises you.
Remember, though health insurance is falsely promoted and sold to you as though it is actual health care, it still relies on a business model which makes a greater profit by turning down your requests rather than approving them. I’m reminded of Franz Kafka’s The Castle, where paper pushing bureaucrats sit at desks in endless offices and spent their time keeping you from ever getting to your goal (The Castle) rather than enabling your passage there.
And where is your physician in all of this? These days you can probably find her squinting at a computer screen as she robotically documents your visit.
“Not without my son,” is an enormous debt that a son cannot easily repay, though Tuchman has sought to repay it over 65 years in medical practice by transferring a father’s uncompromised love into a deep commitment to his patients.
Don’t get me wrong, we doctors continue to do our best to commit to the Hippocratic Oath – “Do no Harm” – as well as the more evocative Oath of Maimonides, the 12th century physician, philosopher and Torah scholar.
His oath states, in part, “The eternal providence has appointed me to watch over the life and health of Thy creatures. May the love for my art actuate me at all times; may neither avarice nor miserliness, nor thirst for glory or for a great reputation engage my mind.”
As I struggle to remain a healer beneath a pile of insurance regulations while still aiming to achieve Maimonides’ lofty goals, I am reminded of one of my original mentors, a paradigm for physician-as-caretaker.
His name is Marcel Tuchman, and he is still practicing medicine at the age of 95, though suffering from failing hearing and without having transitioned to electronic prescriptions. But, while others may write prescriptions for him, he remains in practice, still inspirational to me and many others. Back when I was first in practice I was deeply affected by the story of Tuchman rushing out of his office and jumping into a cab to go to a sick patient’s bedside.
Even more affecting is the Holocaust story that is likely the basis of Tuchman’s deep commitment to helping and healing others, a living example of Maimonides’ oath.
He wrote about it in his book, and he recounted it to me in an interview several years ago. He was 19, and standing in line with his father – at Auschwitz, in line to be exterminated – when his father was pulled aside by a friendly German officer who identified him as an engineer and offered him a position working in a tool shop. Knowing instantly what the offer meant, his father looked straight at the man and uttered the fateful words “not without my son.” The officer hesitated, and then agreed to spare the son. Over the next several months they taught the young man to work with tools too.
“Not without my son,” is an enormous debt that a son cannot easily repay, though we all would like to believe that we would do the same for our sons if we were ever in that father’s position. Tuchman has sought to repay it over 65 years in medical practice by transferring a father’s uncompromised love into a deep commitment to his patients. He has watched over their lives and their health in a way that would make Maimonides proud.
No matter what the outcome of the current health insurance debate, no matter how shortsighted the regulations and requirements of health care delivery may remain, we physicians must continue to remember our commitment as healers. Even if we must continue to struggle with cumbersome one-size-fits all insurance policies that fuel false expectations, we must still be there for you in your moments of need. It is an honor and a privilege to gain entrance into your private health world. Dr. Tuchman has always remembered this. We must too.