Why are we here?

By Claudia Fegan, M.D.

[Note: The following remarks were delivered to the participants in this year’s PNHP Leadership Training Institute in Washington, D.C.]

Why are we here?

We are here because every patient deserves to be treated with dignity and respect.

I had a patient who worked as a laborer, not a high-paying job, but a job that allowed him to buy a home and support his family. I met him 10 years ago. I was challenged to control his blood pressure. It was very difficult. I tried numerous combinations of medications.

Over the course of 2-3 years he had frequent visits, allowing me to adjust his meds. We talked a lot. I got to know this man very well. He always came alone. He talked about his children, his wife, his disappointments, his accomplishments and life.

Eventually we got that blood pressure under control and we saw each other less frequently. Five years later he had a massive myocardial infarction, a heart attack. His wife brought him to County Hospital and we admitted him. He was a good candidate for bypass surgery, so he had the procedure, did well and went home weakened, but hopeful.

I remember he told how fortunate he felt because his brother, with poorly controlled diabetes, doesn’t live near County and is unable to get regular care.

Six months after his bypass surgery my patient had a massive gastrointestinal bleed and again his wife brought him to County where he eventually had to have a hemicolectomy. After that his wife brought him to all his appointments with all of his medications. It was clear he was having trouble with his memory and he needed help to manage his complicated regimen.

There were good times and bad, sometimes everything was working and sometimes not.

He developed claustrophobia and could not stand being sent to the Emergency Department at County where there was usually a 12-24 hour wait on a gurney before he got admitted to the floor. Sometimes he yelled and complained and his wife cried, sometimes the three of us had a good laugh about something silly. Life carried on.

Last month in the middle of the night he became short of breath and stopped breathing before the paramedics arrived. Although he was revived it was clear by the time he arrived at the hospital we had lost the man we all knew.

I had that conversation with his wife – that he would not want to be preserved on a ventilator this way indefinitely. She told me she believed that, but wanted to know how I knew.

I told her we had had that conversation early on in our relationship and, although he never returned the advance directives form, despite being given it numerous times, he was clear on his wishes. I don’t think he could read the form and he didn’t want to discuss it with his wife.

Once his brothers and sisters arrived from out of town, life support was discontinued and he died.

His wife called me a week later to thank me for all I had done. I told her it was my job.

Two weeks later his sister called to ask if I would be her doctor.

Why are we here? Because there is no patient in need who doesn’t deserve what my patient got: he was treated with dignity and respect.

Why are we here? This month Wal-Mart, the largest private employer in the United States, decided all future part-time workers who work less than 24 hours a week would no longer be eligible for insurance benefits; new workers who work 24-33 hours a week would no longer able to cover their spouses on their policies; employees with HMO coverage would now have a $5,000 deductible; and all employees would have to pay a larger share of their premium costs, causing more employees to opt out of accepting the company’s health insurance benefit.

We are here because access to health care should be a right and not a privilege based on your ability to pay for it.

Why are we here? We are here because this month the esteemed Institute of Medicine decided the “essential health benefits” under the new health law should be defined as a package that will fall under a pre-defined cost target instead of building a package of essential benefits based on appropriate data and then figuring out what that would cost.

We are here because someone has to say this is wrong.

Why are we here? We are here because a Consumer Reports analysis of National Committee for Quality Assurance rankings noted the five largest national insurers, Aetna, Cigna, Humana, Kaiser Permanente and United Healthcare, plus the mostly state-based Blue Cross Blue Shield plans, account for about 75 percent of the 390 ranked private plans, but only 36 percent of the top 50 in terms of quality.

United Healthcare is the nation’s largest health insurance company, but none of its private plans rank among the top 100, and most occupy the bottom half.

We are here because we know there is a better way to guarantee the public access to quality health care. A single-payer health care system would actually allow us to get a better handle on the quality of care delivered.

Why are we here? We are here because undocumented immigrants represent 1 in 7 of the uninsured. These undocumented immigrants will not be eligible for public insurance or any type of the private coverage obtained through the exchanges created under the Affordable Care Act.

If we had a real single-payer national health program, the financing of the system and the delivery of care would be separated from each other. Everyone would contribute funds to the system based on their ability to pay.

In such a system, everyone, including undocumented immigrants, would receive care. We are here because in a just society we would guarantee access to care to everyone, regardless of their ability to pay or their immigration status.

Archbishop Oscar Romero from El Salvador said, “Do not give in charity what is due in justice.” Archbishop Romero was assassinated one day after a sermon where he called on Salvadoran soldiers, as Christians to obey God’s higher order and to stop carrying out the government’s repression and violations of basic human rights.

I mention Archbishop Romero not because I am a religious person, but because he spoke to a responsibility of people in positions of authority.

As physicians we have a responsibility to those in need, particularly to our nation.

Why are we here? We are here because people are suffering, people are dying and we know the answer. We are here to arm ourselves with the information we need to heal our nation, to save our patients.

Why are we here? We are here because Dr. Quentin Young turned 88 years old this year. He has worked tirelessly in this effort his entire professional career. We owe it to Quentin to carry on this fight and to win it in his lifetime.

Although Quentin’s parents Abe and Sarah each lived to be 98, we should not assume we have 10 more years to win this fight. We know what needs to be done and we know how to frame the discussion.

It is so simple, we need a plan that takes everybody in and leaves nobody out. Come one say it with me, we will feel better for it:

Everybody in, Nobody out!
Everybody in, Nobody out!
Everybody in, Nobody out!

Now let’s go out and change this country for the better.

Claudia Fegan, M.D., F.A.C.P, C.H.C.Q.M., is interim chief medical officer at the Cook County Health and Hospitals System and past president of Physicians for a National Health Program. She is co-author of the book "Universal Health Care: What the United States Can Learn from Canada" and a contributor to another book, "10 Excellent Reasons for National Health Care.”