I witnessed one of the most beautiful expressions of love recently. A dear lady whom I have had the privilege of caring for in my practice for many years had slowly declined due to a malignancy that she had fought to the greatest extent that she could. She had recently been told that further chemotherapy would not benefit her and her ability to breath was slowly worsening. Everyone gets to a point of acceptance of their condition at different points along their path and no one should be rushed along in the pace of their travel. Already on oxygen and hoping for anything that would help, she and her family opted to attempt to improve her condition even if it was temporary.
After getting a transfusion and some intravenous fluids, she felt a little better, but it was obvious that it was not enough; she needed to see her critical care physician and would have to be transferred to another hospital. Upon entering the room to discuss the situation with them, the patient’s daughter was curled up in the bed holding her mom close to her in a reversal of roles that the daughter was most likely remembering from years ago when her mother would hold her. The love that this mother had sown over many years was being reaped; what was given was being returned in a very touching way. This was a precious moment not just for this patient and this daughter, but for this physician; it is one that will linger and be treasured for years to come.
As this scene unfolded, I couldn’t help thinking about how this same story will unfold when it plays out later under the control of the Affordable Care Act (“ObamaCare”). It is already becoming apparent that the insurance being offered on the exchanges has restricted networks which will make it very difficult for someone who wants to be able to receive more health care, especially if it is state of the art. Many research hospitals are being shut out of networks across the nation because they typically cost more; the increased cost is understandable since they are typically tertiary care centers and also teaching institutions.
Once people start comparing their limited option policies that they will get on the insurance exchanges with what they thought and heard they were going to have, there will be a lot of unhappy campers out there. They are going to be more than just unhappy if their employers drop insurance coverage for them and tell them to go to the exchange. Be watchful for the picture of someone’s innocent child plastered everywhere in the media as the desperate parents attempt to get their child to a research hospital that is not covered in their network; the picture might also be an elderly mother who is not ready to accept hospice care and is being denied any further treatment.
Less local control and more centralized control always results in a less individualized program that attempts to give everything within the system a one-size-fits-all solution. This march toward federal government control over all of healthcare has been in progress for many years now and the newest major change in law, which may become known alternatively as the Unaffordable Care Act, takes it a leap forward in that direction. Good and effective leaders will not adhere to an ideological agenda which does not work in practice, but will keep their focus on the mission of taking good care of patients by putting good ideas into place no matter who suggests them, whether it comes from one’s political party or not. In the near future, unless some negotiated changes occur, what will linger might be some memories that will not be so precious.
David P. Smith MD is a family physician in private practice.
Photo by The U.S. National Archives