Essay: Where Are We Headed? U.S. Healthcare Questions Are Mounting—with No Answers

Our blogger—an Emergency Room doctor and med-school professor—shares his concerns for the future of our healthcare system. The crystal ball, for now, is foggy. Buckle up as you consider the healthcare questions facing our nation.

Dr. Jim Bregman, MD

James M. Bregman MD is an Emergency Physician at White Plains Hospital in New York. He has been on staff there since 1993 after completing his residency at Montefiore Medical Center, N.Y.

I just left my classroom at Pace University, where I teach PA (Physician Assistant) students in their first year of training. They exude an energy and optimism often seen in those who have youth, health, hope, and plenty of time ahead.

Before these students lies the unscathed landscape of their lives. They will soon confront the successes and failures and all gradations of experience that will come their way. They stand up like a king’s guard in the wake of an oncoming storm, ready to render care and “make the world a better place.” They are the Jedi of their generation’s health providers. They are bright, enthusiastic, and impressive. They will become the providers of compassionate healthcare for baby boomers as we age out.

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The Future of Healthcare: Questions Worth Asking

My students eat up my stories and laugh at my overused anecdotes. They absorb my cynical aura and “burned out,” dark vibe, and recycle it back to me in a life-giving nectar. The process allows me to again face the real world—and with a renewed enthusiasm and a realization that things will work out. It will all work out.

This is what I get from them. This is what I take away when I teach a class, and recall those feelings of wonder and hope that I also had many years ago. Years spent in graduate school, medical school, research labs, and residency. Countless nights sleeping in the hospital’s on-call rooms and coming home late, exhausted and tired but inspired. Those nights and days full of “hair-raising cases” and “fly by the seat of your pants” encounters in a city hospital ER. Nights and days spent running to code blues, intubations, resuscitations, discussions with families, humorous and unbelievable stories, anguish, growth, humor, and death all in one day, one week, years compressed into hours.

This energy still lives in me and can be tapped and teased out like an old Texas oil well alive again after a good fracking. This is what my students give to me. What do I give to them? What do we give to them?

I teach their basic sciences and recite case studies and practical information, which will be useful, but what will our society give back to them? What will the medical landscape of the future look like? Will we invest in the care of our weak, poor, retired, of our bankrupt and less fortunate? Will we invest in the future of these young, optimistic, capable individuals? How will we answer these and myriad other healthcare questions of the day?

healthcare questions

What type of healthcare system will today’s med students graduate into?

After graduating, they will spread out across our nation, staffing hospitals, offices, nursing homes, urgent cares, and clinics. I know they’ll be able to lance abscesses and treat urinary tract infections, and I am confident they’ll be capable of splinting broken wrists and twisted ankles. They will repair cuts, lumps, and bumps and perform countless dressing changes. They will learn and grow, as I did, and suffer the humbling blows of medicines’ unforeseen surprises and “blind-side” events. This is what I give them, but what do we leave them? What will their medical system look like? I am truly uncertain—and deeply concerned.

America’s Concerns for Healthcare: Questions Outweigh Answers

In the wake of the 2016 Presidential election and subsequent inauguration, I have fielded numerous healthcare questions from my students, who—as I have observed during our discussions—are rife with fear, anxiety, and uncertainty.

healthcare questions

Our author, an ER doctor who also serves as a med school professor, finds today’s students to be enthusiastic, energetic, and forward-thinking—but wonders what today’s administration will leave them, besides all kinds of healthcare questions to resolve.

They ask me, “Hey Doc, how will healthcare change if the Affordable Care Act [ACA] is repealed?” They ask, “Will there be a place for us?” “Why would any right-minded politician want to dismantle health coverage?” They ask me if I think that hiring in clinics and reimbursements in health facilities will change.

They also convey a sense of dismay and disappointment in my generation. Why did we let them down? Why did we let us all down? They express to me, “Who on earth would vote so vehemently against their own interests? What is the problem with your generation?”

After the election, their enthusiasm and hope turned, overnight, to anxiety, fear, and frustration, much of it directed at the baby boomers and institutions who were supposed to uphold a higher standard. They now scoff at the foundations of a nation that once claimed to be something different than what it seems to be now.

ACA Repeal: What Does It Mean?

As I write this piece, I just watched on the news that our esteemed POTUS signed an executive order to start the repeal of the Affordable Care Act (a.k.a., Obama Care). I am flabbergasted that some of us thought that caring (i.e., Obamacare) was a bad word. Since when did caring put us at a disadvantage?

The train is now rolling, and it looks like the repeal process is in motion. Is there another plan to provide care and cover our citizens? Not sure. Will there be provisions to keep the aspects of the ACA that all of us actually wanted? Not sure—not even a vague idea, because no definitive plan has been put forth. Will we cover people with pre-existing conditions? Do we get to cover our children on our own plans until they’re age 26?

healthcare questions

In these post-2016-election days, healthcare questions are a major concern for Americans. Repealing the Affordable Care Act (a.k.a. Obama Care) is one thing; replacing it is another, and, as our blogger notes, the new administration hasn’t accompanied its repeal efforts with a replacement.

None of this is known, but what is more frightening is the assumption on the new administration’s part that everything about the ACA is bad, and the only one who can give us a good plan, an affordable plan, a quality plan, is our POTUS—even though he has never put forth any viable plan with any details, and hasn’t shown an understanding of the complexity of a healthcare system.

I don’t want to criticize or disparage those who helped put our current POTUS in office, but I hope they are at least partly aware that health coverage is at risk for a number of people. I hope they realize when they go to their churches and temples and places of worship to reflect on the best of humanity that this incoming administration may be responsible for making some lives more challenging.

An example would be the ACA’s “Black Lung” coverage for coal miners and industrial laborers. The new administration has every intention of cutting this coverage. The most extreme members of Congress look at as an unnecessary expense or even an entitlement program. The administration gives me the impression that it would rather build another destroyer then worry about the pulmonary disease of so many who made the company owners rich.

This attitude by our new leaders to politicize a system (however imperfect) smacks of immoral if not at least deeply cynical. The move to dismantle a system that protects many Americans before elucidating any new plan to take its place is exactly what is happening now.

These are the facts I use to answer the hard questions put to me by my students. I have to explain to them that our generation wants them to perform their best, be their best, and think their best even as we clumsily slash away at the support structure of our own citizens.

We ask these students to rise to a higher standard, but will we continue to take care of the weak and less fortunate? I am ashamed of our generation in this respect, and disappointed that we dishonor the legacy of my father’s generation with what I see as a backward-moving force in ACA repeal. I feel as though we have become what we once feared. In some ways, the hate groups, fear mongers, and terrorists have won the day.

Healthcare Questions May Weigh on Us, But… Don’t Give Up

Our world has seen unbelievable turns in the years since I was starting a medical career. Look at what has gone on during the past few decades. Could we have imagined any of the odd, fantastic, sometimes humorous, often dark events that have dotted the timeline of the late 20th and early 21st centuries?

In the minds of at least half of all Americans, the promise of “hope and change” has been replaced by negativism, suspicion, and pettiness in the highest office in the land. We’re better than that… aren’t we? This is our world and we must make of it what we can—and try to create a world of respect, truth, and fairness.

healthcare questions

The greatest gift we can leave today’s medical students—tomorrow’s healthcare providers—is, as our contributor puts it, “the same optimism and hope” that his students regularly show him in class.

I want to tell this to my students. I want to be able to say that the universal arc does bend positively, and there is no shame in helping the “little guy,” the “different guy,” the “other” or less fortunate (even if there is an economic cost). I want to be able to say these things, but I am not certain that I honestly can, given the current stance of the new government and its cynical characterization of our national condition.

Now is not a time to look inward and embrace suspicion and fear. Now is not a time to look away from science and creativity. We should embrace progressive ideas and help each other move forward in this incredible world with its unlimited possibilities. We should embrace the same optimism and hope that my students impart on me when I teach them. This would be the greatest gift we could give to their generation.


Originally published in February 2017 and updated.

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