At this point, much has been made of the health care bill the Republican administration has put forth to replace the ACA. We’ve heard the details of the bill, we’ve seen the numbers. We know that the U.S. Congressional Budget Office has forecast that 24 million more people will be uninsured by 2026 if House Representatives replace the ACA with the current bill proposed by the Trump administration. We know that the cost of the Republican plan will fall disproportionately on older Americans, who tend to be sicker and need more health care services than younger people, and we know that the subsidies offered to lower-income Americans in order to defray their health care costs will drop.
We know that there will be an early rise in insurance premiums, even as fewer services are covered. We know that Thursday morning, on the same day that the Republican health care bill was to originally come up for a vote, the House Freedom Caucus was negotiating with the president to eliminate federal requirements that compel health insurance plans to cover basic benefits like maternity care, emergency services, and preventative care. We know this will amount to higher cost, lower-quality health care for patients. For these reasons and more, the list of medical groups opposing this new bill is long and growing, and includes the American Medical Association, the American Nurses Association, the American College of Physicians, the American Academy of Pediatrics, the American Hospital Association, and the AARP.
These are some excellent reasons to oppose the House bill put forth to replace the Affordable Care Act. However, as a doctor, I have a more selfish reason.
I need help doing my job.
Every time we receive a patient in the operating room who waited for days and weeks and months and sometimes even years before seeking medical attention because they lacked health insurance, it makes it much more difficult for me to care for them. Small problems bloom into big ones. A case of appendicitis blooms into a florid pus-filled abdomen in a septic patient. Small curable cancers grow and metastasize and become unresectable. Small blockages in arteries grow to choke off blood flow to the heart. Small flesh wounds progress to gangrene. And when these cumulative insults add up, it makes my work as a doctor much more difficult.
I need help doing my job.
When I get patients for surgery who for months have been off their blood pressure medication, or medication for diabetes, or psychiatric medications, simply because they cannot afford to pay for their prescriptions, that makes my job more difficult. When I get uninsured patients who cannot seek preventative care, electing instead to use the emergency room for all of their health care needs at ten times the inefficiency and ten times the cost, that makes my job more difficult. When I don’t see sick patients at all because they simply cannot access the hospital system due to lack of insurance, high deductibles, lack of coverage for basic health care services, or because we’ve communicated that in this country, you need to have enough money to deserve medical treatment—well, that makes my job impossible.
So please help me. My colleagues and I can’t do this alone. I’m not a politician. I’m just a doctor. And I know when to ask for help.
The Affordable Care Act was never perfect, but we know that the current bill to replace it is worse on every metric that has to do with patient care. So please consider the facts, the numbers, and the toll. But in the end, please, just help me do my job.
Michelle Au is an anesthesiologist and author of This Won’t Hurt A Bit (and other white lies): My Education in Medicine and Motherhood.
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