Healthcare in America

'This is how the world ends. Not with a bang, but with a whimper.'' - T.S. Eliot 

We have a healthcare system steadily disincentivizing generations of Americans from pursuing medical studies. Prospective students are wary of careers in the medical field due to the plummeting numbers of self-sufficient doctors. Perhaps the most alarming marker of this crisis is NYU's plan to offer free medical schooling tuition. The expenses of owning your own business in healthcare have corroded the stability of small practices who have forged on for years. Under the workload, financial pressures, and personal strain as family life and external supports are nudged into the periphery, physicians are in the fast lane towards burnout. Inevitably these practices can no longer maintain their overhead.

If you ask any physician about what going into healthcare at a young age meant to them, they don’t speak of the daunting time commitment, financial sacrifice, sleep and food deprivation, but instead of the excitement of being in pursuit of their passion. For many, this dream would culminate in the autonomy of owning their own private practice.

Autonomy, a word that, for many physicians, is so far from their reality that it makes them misty-eyed.

''What do you want to be when you grow up?'' they asked. Doctor always seemed impressive, it came with an entire identity. Most can't imagine the stages of such a career. The deep-dive into stress management in adapting to medical school. The organized chaos of hospital internships and residencies where the margin for error was thinner than a papercut. Getting a Fellowship. After years, to emerge experts in efficiency under pressure and, as a testament to their fervor and perseverance, the day would come when they finally had something of their own.

Flash-forward to the current state of healthcare in America, and the dynastic rule of insurance companies. Specialists in guile and with little consequence to using it, they avoid paying bills in a myriad of ways. They can stall a payment for months. They can pay a fraction of the contracted amount (a percentage which physicians note keeps shrinking every year). They can pay in full, only to revoke the payment long after the fact. Finally, they can refuse a bill outright, using obscure legal smallprint in their defense. Indifference is their tradecraft, the 10 blade they wield it with surgical precision. Doctors are left to eat the costs and no one is the wiser. Suddenly, these professionals in charge of the health of the next generation find themselves pawns in the gamble of insurance payout.

In its simplest form: doctors are paying to work for free.

For all the fuss made over our inadequate healthcare, and the absurd cost of it, very little attention seems to be given to physicians themselves. These aren’t financiers sacrificing long hours for a bank with the expectation of large yearly bonuses and early retirement. These are the people who reattach limbs lost in vehicle accidents, help children fight cancer, spot life-threatening conditions in women in labor, and deliver children. There should be no question of their value. Yet they go unnoticed. Instead you want to fight over your $20 co-pay. Do we really get to demand more from our healthcare system while allowing doctors to continue to receive less and less?

What if people lose the incentive to practice medicine altogether? We take for granted that our every crisis has matching solutions and experts working diligently on them. Terrorism? Safety and security has become the air we breathe, and counterterrorism teams might collectively be the biggest tribe on the planet. Climate change? Evergreen trees, the largest, hardest working carbon sinks we know of. Ocean pollution and habitat obliteration by deforestation? Each have their own armies of workers and thinkers. Even bees have their own rallying forces and research teams. But what to do about the doctor shortage?

What would our lives be like without pediatricians, surgeons, psychiatrists? As we demand lower co-pays, we give little thought to what that money is for. The healthcare of a civilization is surely one of its fundamental supports, if not the keystone, the very reason it remains standing. How unreasonable would it be to predict that our downfall will not be terrorism, nuclear war, or environmental catastrophe, but simply our own neglect of those who mend us in the day-to-day and send us home safely to our loved ones? The hands that fixed your daughter's arm, the eyes and mind that diagnosed your father's cancer before it was too late. The voice that walked your brother out of a year of major depression. Steady guardians of our true well-being, they are the makers of the subtle, rarely examined joy of life simply carrying on.

Established physicians, well into their career, have reached a point where they can barely make payroll, let alone face their student loans. Respected professionals with solid foundations in the medical world are left to wither with hardly a semblance of dignity to grasp on to. Consider the symphony musician who, once performed under the warm red starlight of Carnegie Hall, but who ends up with nothing except their violin in the dank fluorescent midnight of an underground subway station. It is a spiritual execution.

Few have the influence or grit needed to stand against the insurance giants, as they bulldoze their way through the ecosystem of American healthcare. The final destination for physicians is rerouted from plush to pragmatic: employment by hospital groups. Physicians jump ship by the thousands, trading in their freedom for the shelter of hospital employment where they can rest on salaries that actually cover expenses. They have learned the hard way about the Sisyphean nature of striving for independence in a system dominated by profit lust. As we bear witness to this strange diaspora of private practice physicians, it would seem that some fundamental hope in them has been snuffed out.

When we look back and ask how did this happen, we will answer with Hemingway's The Sun Also Rises: “Two ways. Gradually, and then suddenly."