It’s time to advocate for our patients to politicians

As a physician, I often forget how much I know.  But there are things that remind me just how different our own experience as doctors is from those who don’t spend their days and nights taking care of the ill.

I do a lot of work for television, helping writers and directors to create medically plausible stories and scenes.  I used to get worried that I might get the dose of a rare medication wrong, or use the wrong instrument when staging a complex operation I don’t normally do myself. Then writers would come to me and ask, “How many lungs do people have?” or “What’s the name of the leg bone?”

Recently, I married a business litigation lawyer.  When I come home and describe a standard, boring day at the office, she gets a look of startled amazement and says, “You did WHAT to a baby?”

It all seems pretty normal, though. Of course, we spend our days seeing people at their most vulnerable — their clothes off, their scars exposed. Of course, I take children from their parents’ arms, put them under general anesthetic, and open them up. Of course, I sometimes have to tell those parents their child didn’t survive, despite our best efforts to save them from any number of traumas. Or that the cancer has spread. Or that their newborn baby will require a lifetime of care. This is what we do. It’s our normal. But to those who do not do it, it’s not just extraordinary; it’s unfathomable.

Now is the time for us to make people fathom, though. Because the Senate is about to pass a bill that will take $800 billion out of Medicaid, which pays for the medical care of almost 50 percent of children. Which pays for prenatal care, childbirth, cancer care, surgery, home nursing, total parenteral nutrition (TPN) — all the things our patients need to survive, and even thrive, with debilitating medical conditions. Twenty-two million patients will lose their insurance, according to the CBO. To us, those patients have names. We’ve looked into their eyes, their family’s eyes. We’ve cared for them, and know them.

To most people, the people we know as our patients are numbers on a page — vague abstractions impossible to really conceive. What is 800 billion? What is 22 million?  What’s an essential benefit? People don’t know what that means. How can they? But they can understand Joey with cerebral palsy, Susie with neuroblastoma, Jorge who got run over by a tractor. These are the real people to whom loss of Medicaid means loss of houses and jobs, desperate GoFundMe drives, bankruptcies and ultimately, in many cases, early death.

We need to explain that without Medicaid funding, small, rural hospitals will close. That large academic safety net hospitals will strain to provide care that people need while not receiving the money necessary to provide that care.  Some conservative politicians, like Senator Ron Johnson (R-WI), think this is a good thing – that making people pay for their own health care will drive down health care costs.  He points to the example of laser surgery for eyes, which got cheaper when it stopped being covered by insurance.  But there’s a critical difference, that we as physicians understand and he does not, between elective surgery to stop wearing glasses, and care for a childhood cancer — care that, even if steeply discounted, would bankrupt all but the wealthiest and most assiduous savers.

We know what that looks like. We know that it’s wrong.  We owe it to our patients to treat them not just in the clinic, the wards, and the operating room, but by advocating for them to politicians who, if they knew what we know, could never do what they’re doing.

Jonathan Kohler is a pediatric surgeon.

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