Considering Medicine ꟷ Please Consider This

T Michael White MD FACP

“As much as we need a prosperous economy,

we also need a prosperity of kindness and decency.” - Caroline Kennedy

Health care in these fine United States is a paradoxical hot mess.  For some, care is breathtakingly perfect.  For many, care is inaccessible.  In my dotage, I have been endeavoring to step forward with a solution ꟷ a fix that will leave my beloved, sacred medicine profession better than I found it.  My journey has been supported by many as alarmed like-minded are abundant and eager to engage.  For a glimpse of territory trekked, please scan webpage: https://www.fixingushealthcare.com/.  

I wish I could report the fix is in; but I cannot.  All I have achieved is a humble recommendation for a band-aid on a mortal health care wound: Universal Access to Affordable Health Care --- The System.  Humility aside, if enacted it would represent an important affordable step forward.  I advocate that you find the energy and time to also give Universal Access to Affordable Health Care --- The System a turn.

Conveying the Status of Health Care 

Today I have a sobering message for you, for me, for our government leadership and, most importantly, for our trailing generations (our progeny) whose short and long-term well-being is in jeopardy.  Complicated, I endeavor to skinny it all down and tell my conclusions plain.  Ah, but with so much to say, how may I best frame my message?  As one whose career regularly assisted young physicians move forward in their careers, I will:

1. Address the question that is often posed to me: should I consider a career in medicine?  And then…   

2. Ask you to generalize the information provided and apply it to your own personal circumstance.

My Experience

Let me begin by sharing my medical career experience.  I grew up as a blue-collar kid (and proud AA caddie) in Schenectady.  In a very foggy high school-thinking kind of way, I perceived that I would go to medical school, do important, meaningful work, make a difference, live in a big house, drive a nice car and play golf on Thursday afternoons.  In between that idea and my quasi retirement much has transpired.  For eight years, living in abject poverty, I worked my way through college and medical school.  Then (still below the poverty level) I completed four years of internship and residency training.  At age 30, I embarked on a wondrous 50-year internal medicine career addressing clinical, academic and administrative responsibilities.  From what I can remember ꟷ chronic sleep deprivation has prevented the manufacturing and storage of many memories ꟷ I have done some important, meaningful work that at times has made a difference and, if given the opportunity, I would, in a New York minute, do it all over again.

Need to Know

For me, a beneficiary of some hard work, good timing and much serendipity, things worked out.  Today, less sanguine for this generation’s prospects, I feel compelled to share that which I wish I didn’t know now that I didn’t know then:

• Reality: in these fine United States access to health care is a commodity to be afforded and purchased.  It is not a right.  When I had the privilege to proudly don my first white coat, I naively perceived medicine far differently ꟷ a humanitarian (not business) undertaking.

• Bad news: as a perpetual student, I could not afford health insurance.  Good news: with no income or assets and only liabilities (massive, ever-expanding educational debt), if illness intervened, I would have qualified for charity care (Medicaid).  Bad news, access to Medicaid is becoming more elusive.

• Young and invincible, I did not think about my health.  If I thought for a moment (mercifully I didn’t), I would have come to a terrifying, paralyzing realization that a significant accident or illness could, mid-journey, collapse my career (and life) like a house of cards.  That recognized, I may have worked daily (diet, exercise, habits, risks, etc. ꟷ all impossibilities for a physician in training) to preserve my health.

• Good news: as a practicing physician, I had a good income.  Bad news: educational debt, taxes and my late start in life would forever relegate me to physician high income/low wealth status.  Nevertheless, as a practicing physician, 1) I had health insurance; and 2) I could afford ever increasing premiums, co-pays, deductibles and co-insurance.

• Bad news: if my hard-working (just getting by paycheck to paycheck) ‘insured’ patients became significantly ill: they could no longer afford their premiums, co-pays, deductibles and co-insurance; they would be making too much for charity care (Medicaid); and ensuing medical debt would collapse their lives like a house of cards and extinguish family, food, health and home security.  In these fine United States, my hard-working ‘insured’ patients, if/when significantly ill and in need of insurance, would become essentially uninsured.

• Really bad news: millions of totally uninsured citizens struggle with only minimal access to health care.  The implications of their complex realities are beyond my imagining. 

• Good news: having aged into Medicare with modest personal savings, I have access to excellent, affordable (for me) health care.  Bad news: Medicare recipients unprotected by modest wealth cannot afford premiums, co-pays, co-insurance and deductibles and significant illness often places their family, food, health and housing securities at risk.

Bottom Line

So, what does this all mean?  What do I make of this?  Let me tell it to you precisely and plain:

• In our fine country, we are each encouraged to pursue life, liberty and happiness.  I now understand these words are only aspirational.  The realization is entirely up to each individual.  No safety nets (for example, access to affordable health care) will be provided.

• In the past, I counseled young people to prudently plan for educations, homes, transportation and retirement.  To that list, I must now add health care insurance protected by wealth as a primary planning consideration.    

• Daily, we must each strive to preserve good health through judicious diet, exercise, habits, risk avoidance and genetics (choosing our ancestors well), and remain cognizant that, despite best efforts, accident and illness may intervene.   

• We must recognize that the concept ‘health insurance’ is misleading.  Those who 1) have health insurance and 2) are protected by sufficient wealth to address premiums, co-pays, deductibles and co-insurance are insured.  Those who 1) have health insurance but 2) cannot afford premiums, co-pays, deductibles and co-insurance become uninsured if  significant deterioration of health intervenes. 

• Being uninsured is an unambiguously perilous circumstance.  It is a frightening status facing increasing numbers of hard-working residents of these fine United States that daily threatens to place family, food, health and housing securities in jeopardy.   

• And, compounding the problem, our fine country’s leaderless and unregulated health care (non-system) is becoming exponentially more expensive and less affordable for all.

Recommendations  

So, what do I advise?  I have recommendations for the individual, for our government, for myself and, most importantly, for your and my trailing generations ꟷ our progeny: 

• I advocate that we each work hard to maintain health:

  • Address our genetics ꟷ our family history.

  • Place our diets, exercise, habits and risks in order;

  • Create and maintain accurate, up-to-date personal medical records and health care desires and wishes (advanced directives).

  • Avoid accessing health care by become adept at using excellent, reliable, free online resources (for example the superb  https://my.clevelandclinic.org/ and https://www.mayoclinic.org/medical information websites). 

  • To the best of our abilities, prioritize personal health insurance and health savings in our financial planning. And…

  • Work closely with a talented a primary care physician to address cost-effective care and prevention (immunizations, cancer detection, etc.) practices. 

• I advocate our fine government’s leadership:

  • Immediately places a band aid on our mortal health care wound by providing imperfect free universal access to basic health care ꟷ computer/telephone access to qualified nurse guidance.  For a humble detailed example, please review: Universal Access to Basic health Care --- The System.  This imperfect, band aid intervention must be funded as infrastructure by the taxpayer supported United States Treasury.

  • And then our fine government’s leadership must roll up their health care sleeves and get down to serious, long-overdue business of:

    • Striving for universal access to affordable, compassionate, safe, timely, effective, efficient, equitable (just), patient-centered care (C-STEEEP).   

    • Defining exactly what basic health care is.  Clearly affordable health care cannot be all things to all people.

    • Standardizing charges for basic health care.

    • Using efficient, effective, award-winning 5-star Medicare Advantage programs as models to pilot systems providing universal access to well-defined basic health care.

    • Fund, through the United States Treasury, affordable, basic health care as tax-payer-supported national infrastructure. 

    • Eliminating (extinguishing) massively expensive inappropriate access, duplication, waste, fraud and abuse.

    • Restructuring malpractice to ensure that individuals legitimately harmed are fairly compensated and inappropriate litigations and awards are eliminated.  And…

    • Allowing individuals to pursue (at their expense) alternative health care above and beyond the basic national infrastructure.

• Then it comes down to me…

  • Having had the privilege of a medical career, I must step up to my personal responsibility.  I must walk my talk.  Seeing something, I must say something:

  • As outlined, I must expend significant energy to efficiently and effectively maximize my personal well-being.

  • I must pay my fair share of taxes in support of national health care infrastructure.

  • I must minimize my unnecessary access of and/or duplication of finite health care services.

  • I must ensure that at the end of my life:

    • My comfort and dignity are preserved; and

    • Precious health care resources are not expended on futile care. 

  • I must become comfortable with reality: 1) it is not good to live too long; and 2) I must not aspire to live forever).

  • I must recognize that this is not all about me.  My behaviors will impact (positively or negatively) my community and trailing generations (my and your progeny).

  • Then there is this: I will actively volunteer my services:

    • To our fine regional free clinic (if they will have me) to: 1) lecture and demonstrate to the many how to place their personal medical records in order; how to articulate their personal health care desires and wishes (their advanced directives); how to efficiently access free, reliable online health information; and how to prepare for unavoidable health care encounters; 2) I will work with individuals and their families to address these considerations (I envision my business card will read: The Doctor is In ꟷ 5

  • As a stretch goal, I will (with the support of many) create and produce a national talk-radio program that will address enhancing access to health care.  Title?  Something like: Dr. Don Quixote Fixes Health Care.       

  • Akin to the Federalist Papers, I will (with the support of many) enhance the efficient and effective distribution of webpage: https://www.fixingushealthcare.com/ and its central message:Universal Access to Affordable Health Care --- The System and Commentary.  And…

  • I will (unceasingly) request that you join me to advance universal access to affordable health care in these fine United States.  In that regard, please today, and forever more, support and proliferate the website; support the radio program; and speak out for universal access to basic health care in these fine United States.

• Finally, and most importantly, our trailing generations (our progeny) must realize:

  • Our United States health care hot mess is their hot mess. 

  • Unless protected by wealth, even if insured, they are essentially uninsured. 

  • Significant accident or illness may, today, immediately jeopardize their education, family, food, health and home securities.

  • Our country’s retired and elderly, protected by Medicare and lifetime savings, are largely satisfied with their health care and will not lead necessary change.  

  • Our country’s leaders, satisfied with their health care and seemingly incentivized to ignore this health care hot mess, are comfortable preserving status quo chaos.  They will not lead necessary change.

  • Therefore, it is for them (our trailing generations ꟷ our progeny), with our encouragement, to consider this message, appreciate its significance and design and implement universal access to affordable, basic health care.

Go for It

Knowing this, do I advocate a career in medicine?  If I could leave college, medical school and training healthy and without massive educational debt, I would dedicate my life in a heartbeat to doing important, meaningful work and make a difference by 1) providing C-STEEEP to  patients entrusted to me; and 2) striving to cure the paradoxical health care hot mess described ꟷ somebody has to do it.  If the challenge feels right for you, go for it.  Our world will be a better place.

Respectfully submitted,

T Michael White MD FACP

            Dr. Mike White is an author who resides in Bellair Florida. In his medical career, he has served as primary care physician, clinical professor of medicine, vice president for medical affairs, vice president for value, quality and safety, chief medical officer, internal medicine department chair,  residency program director and hospital surveyor.  He and his wife, Jackie, reside in Belleair, Florida.