As Paul Newman, John Russell, in Hombre, the 1967 classic Western, said to Cicero Grimes, played by Richard Boone, "We all die, it's just a matter of when."
Depending on how you look at it, the lucky live long enough to witness every last vestige of their youth and vitality being slowly, surreptitiously stolen from them. It's a stealth that robs one cell at a time until entire systems fail; a knee, a hip . . . the natural bone that began in the womb gets replaced with titanium and the metal screws that hold things in place . . . for a while. It's the prelude to the demise of the organism; you and me, everyone. As John Russell said, " . . . it's just a matter of when."
The neurosurgeon, one of the most highly respected - if not the most highly respected - in the region, knocked on the exam room door, then entered. His well-trimmed beard, flecked with gray, told more about his pressurized schedule than his more youthful chronological age. Although the mirthful sparkle in his eyes didn't convey it, he looked tired; not exhausted, just tired.
This consultation was, he hoped, to be his last patient of the day; the last patient of what was a typically well-stuffed week. But then, you never can tell: auto accidents, gunshot wounds, beatings, falls in a bathtub . . . Any or all of them might set his cell phone humming, summoning him in for an emergency surgery. He genuinely seemed grateful to engage a few moments of just plain repartee. His in-box of reports to write, and films and histories to review, all in preparation of the next week's schedule, were waiting for him. They were always there.
"Do you have any children?"
He had three; two teenagers in high school, and a seven-year-old. In response to a follow-up question, he was fairly certain none would retrace his path into medicine. What they chose, as a career, was entirely up to each of them, of course. But, without a discouraging word ever having been uttered by him, he hoped none would go into medicine.
I had heard that sentiment from other doctors, but, while anticipating an echo, I wanted his reasoning, to add to the portfolio.
I didn't get the echo, the war-stories about the hours-consuming battles many (most?) physicians engage with the insurance "clerks" that our insurance-industry healthcare system foments. (In his neurosurgery specialty, he assured me, what he wants generally generates an immediate pass from the clerks; the ones that "No-government-bureaucrat-should-come-between-the-patient-and-doctor" Republicans conveniently fail to refer to while they're opposing every single-payer proposal.)
In the stead, I was schooled on two other of the professions disincentives. The first one iterated all that composes the "normal" adult life that was necessary to forsake. Seventeen years had elapsed between his high school graduation and the day when he could actually practice his specialty. Without complaining about the disappointments they suffered, the kids understood he couldn't promise to attend every recital or sporting event in which they participated, that indeed, he'd miss almost all of them. Not every cranial or spinal surgery goes by the book; in fact few turn out to be easy text book. It's a jangled mess in there, once you open it up. He might be at dinner, in a movie, or sound asleep when the phone would ring--the "stat" call that would truncate every other intention he might have had and send him suddenly back in to the hospital.
Then, all of a sudden, they weren't kids any longer, and where the hell did those precious, unrepeatable years disappear to? Kids grow up living that, and they most often decide that that sort of life just is not for them.
But it was his second reason that, as someone who is rapidly approaching Medicare age, was a dump truck unloading its tons of bricks on me. "I can't name a single doctor in the region who wants to take Medicare patients. Most who do are trimming back, no longer taking new Medicare patients, and are trying to get their practice out from under the program. This is going to a crisis situation for the baby-boomers."
As to the question why, he said it all came down to money. It takes a lot of it just to fund his specialization's malpractice premiums, let alone the other expenses needed to run an office. Medicare has a fixed sum it will pay for every specific procedure; a sum that is, given the intense slog the practitioner had to persevere, for the expertise required to practice, low - very low. And the component that is within Health and Human Services (HHS) is excruciatingly slow with its payments to doctors. A six-month wait is not unusual. Rather, it's more the norm.
I didn't press him for his position on the ideas circulating through Congress. Where he stood seemed sufficiently discernable that anything he might say would only have been redundant. That the present private insurance company dominated system posted similarly low remuneration rates for their contracted providers, for their computerized list of procedures, wouldn't have advanced the comity of our discussion.
Just as his remarks opened my eyes wider to the breathtaking expanse of the healthcare dilemma, I want to disabuse any and all of whatever simplistic, dogmatic prejudices they may have been harboring. The need for reform is inarguable. This country spends twice as much on a gross and a per capita basis as every country on earth, save for Switzerland (We also outspend Switzerland, just not fully twice as much.), and we get wholly miserable results in the bargain. The solution, however is not at all simple, is not at all straight forward. It's a Rubik's cube with a near infinite number of sides.
Tinkering around the healthcare delivery system edges will work as well as taking your car to the carwash when the pistons, rings, and intake and exhaust valves have seized up, and the battery is shot. But taking the decades-old system our economy has been burdened by to the drive-through auto wash is exactly what the GOP, a handful of conservative Democrats, and the entire health insurance industry have in mind. Hold a ceremony on the East Lawn or in the Rose Garden, snap thousands of pics of Obama smiling broadly and handing out pens, and everyone can go home and tell their constituents how the problem has been licked and that now it's on to the next one! 1 | 2
We'll still have millions of Americans uninsured; counting them, perhaps a hundred million under-insured, and an intact insurance industry that wastes 30% of every premium dollar in admin costs and rakes in another 20% in profit . . . none of which would buy the subscriber a cent in actual medical care! But hey! The insurance industry CEOs, their execs, and the stockholders would be happy. To them, that's what counts. That's all that counts.
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