Seeking a counterpoint to the talk of markets, budgets, and costs involved with repealing and replacing the Affordable Care Act, regular Race and Beyond columnist Sam Fulwood III asked Taison Bell, a critical care physician, to offer an opinion about the human care elements missing from the contentious debate regarding the imposition of a congressional Republican health care proposal.
When people ask me what kind of physician I am, I simply say, “I’m the kind you hope to never have to meet.” I’m an intensivist, which means I deliver care in a specialized unit to patients who are on the brink of death or have severe injuries. My patients are incredibly diverse, ranging from children to the elderly, healthy to chronically ill, homeless to wealthy, and any other ways you can characterize and categorize people. What links all of these unique individuals is that none of them plan or expect to need my care. Those who survive their illnesses face lives that are often markedly different than before.
I’ve been following the health care debate closely, checking the news in free moments to see the latest comments from legislators, policy experts, and health care organizations. But I do not dwell on headlines because, in the scheme of our complex health care system, my role is relatively simple: If you or your loved one has a life-threatening illness, it’s my job to either try to stop it or to ease suffering if death is inevitable. Discussions about copays, deductibles, and exchanges go out the window when I enter the picture. The immediacy of the moment, when life hangs in the balance, rapidly brings priorities into sharp focus.
But I’ve also seen how the financial aftermath of critical illness shatters any notion that our country’s governance is grounded in a social contract meant to truly take care of patients. How can we say that we’re a caring nation when we tolerate families going into bankruptcy because of medical bills? How can we call ourselves generous when some patients openly wonder if it would have been better to die than to become a financial burden on their family? As a wave of opiate overdoses ravages our nation, why are we wasting time debating the merits of mandated coverage for mental illness and addiction?
The American Health Care Act, or AHCA, is a deplorable piece of legislation. It’s an abomination to human decency. And I have to be blunt about it because there is no nuance to its consequences for my patients. Increasing the number of uninsured Americans by 24 million, under provisions of the bill, means that more people will suffer from devastating strokes, heart attacks, complications from cancer, and other illnesses that could have been prevented or treated earlier with insurance and access to regular health screenings. Unlinking health care subsidies from income level misaligns resources. Cutting Medicaid pulls an already tenuous safety net out from under lower-income Americans.
Rather than protecting the vulnerable, the ACHA attempts to tear away the moral fabric of our society to expose where its supporters’ true loyalties lie: with protecting the wealthy and fortunate at the cost of human lives deemed not worthy of their concern. Nobody in good conscience should be able to support a bill that willingly lets an increased number of people die from preventable causes.
Yet the bill’s existence is not what frustrates me the most, as one can expect bad ideas to emerge from an ineffective and unpopular Congress. Rather, what truly unnerves me is the embarrassing lack of courage on both sides of the aisle to come together and design a health care fix that reflects the attitude and achievements of our prosperous nation. Somehow, it seems that discussing a simple concept such as guaranteeing a basic level of health insurance for everyone—especially the poor, mentally ill and chronically ill—is anathema to being American.
While our lawmakers debate the difference between “access” and “coverage,” they continue to act as if it is reasonable to think that individuals can make well-informed decisions about how to manage their own health risks. As a physician married to a woman with a public health degree, even I cannot comprehensively compare the health plans available to me. I have no idea how to accurately assess my risk of developing a new chronic or catastrophic illness. I don’t know the right amount to contribute to a health savings account. Lucky for me, I at least have options and the income to make a choice. But how does a struggling, seemingly healthy person with competing financial interests objectively gauge the benefits of enrolling in a health plan, especially if that person will be charged extra for re-entering the market? That is not a true choice; it is a burden that should not fall on the individual.
Fixing the coverage gap and the host of other issues plaguing our health care system will not be easy. Whether it’s publicly funded or a partnership between employers and the private market is secondary to the fact that it desperately needs to happen.
We need less partisan politics around protecting the health and wellness of our people. Rather, we need a health care system that reflects the generosity and compassion that we strive for in this country. We need patients like my own to focus their energy on getting better rather than worrying about how much it will cost. We need the families that I counsel and console to know that their only worry should be directed toward their loved one. We need immigrant and unauthorized families to know that our drive to deliver care with compassion will not be compromised.
And for the patients who I do say a final goodbye to, they should be allowed to pass in peace, knowing that their country refused to play politics with their lives and guarded their right to affordable and effective health care.
Taison Bell is a critical care medicine physician in the Washington, D.C., area and a current member of the Leadership Institute at the Center for American Progress.