With increasing rapidity the years of your life will scurry by. You will experience sentinel quotidian events that will score your memory, alter your reckoning of your personal and professional future and recalibrate your value system. You will be invested with a sense of your own mortality so palpable it has a reality of its own. You will wonder who and how you will be cared for if ill, injured, or aged. I share with you a recent epiphany.
Thursday, May 9, 2013 I awoke from a restful sleep almost completely deaf in my right ear. There were no other symptoms such as vertigo, nystagmus, or dizziness. My hearing has been checked regularly over the years. Mild high-tone loss and tinnitus, the result of childhood hunting and target shooting without ear protection, had been very stable. I was startled at how profound the handicap of unilateral deafness was. I could not hear television, radio, converse properly and driving felt insecure. The sense of isolation was profound. My ability to practice medicine was suddenly jeopardized.
I called a group of ENT physicians and was given a same day appointment. An audiology test and exam confirmed a diagnosis of idiopathic sensorineural hearing loss. I was started on oral steroids and improved for 48 hours. The condition then worsened to complete unilateral deafness. I contacted a nationally-known otologist who was at the time playing in a charity golf tournament. He asked me to meet him at his office where he expertly performed a middle ear injection of decadron, a procedure that significantly improves the likelihood of hearing recovery. Indicating that in unusual circumstances an acoustic neuroma can present in such a manner, he recommended a MRI. He called me at home the evening of the test to inform me the results were normal. A week later, after noting a major improvement in my hearing, he performed a second injection. I have recovered about 85–90% of my loss and further improvement continues.
The events of May 9, 2013, and the period thereafter, have made me profoundly grateful for the highly skilled and specialized care I received. I was able to get a same day urgent appointment with an ENT physician; when things worsened I had access to a fellowship-trained, nationally-known otologist who agreed to see me an emergent basis. He was able to offer a unique treatment that improved the chances of a recovery by over 50%. A high quality MRI was promptly scheduled and expertly read and reported to me all in the same day. These competent and compassionate doctors were all on the insurance plan my physician employers offer their staff. My wife and I are Medicare-eligible but we have so many fears and reservations about Medicare and physician access that we pay more out-of-pocket for commercial insurance.
The events of May 9, 2013 have also left me profoundly fearful for the future of American Medicine and the care my wife and I will receive if forced to be insured under Medicare. Things will be much worse if the Affordable Care Act (ACA), aka “Obama-care,” is fully implemented. Our concern extends to all U.S. citizens and our nation’s present and future physicians. Medicine in the U.S. faces many grave threats.
Many of the drugs, instruments and techniques that are sight/hearing preserving and lifesaving are not available to U.S. physicians due to the ineptitude, uncaring and incomprehensible bureaucracy of the Food and Drug Administration (See “Serious Drug & Device Delay: Thank the FDA,” parts I–IV, March/April and May/June, 2013). The power and predation of U.S. trial lawyers has also stifled medication and device development. U.S. companies are moving testing and early marketing to the rest of the developed world where junk lawsuits and vexatious litigation are proscribed by law. In Missouri, millions of tort kings’ and queens’ dollars have been spent to overturn the highly successful 2005 tort reform law. The thoroughly corrupted “Missouri Plan” for picking judges has denigrated into a conduit into which the trial bar unimpeded invests their advocates and shills onto the seats of the state’s most powerful courts (see “Missouri Compromised,” Sept/Oct 2013).
The high costs of a medical education, equipping and staffing a medical office, coupled with parsimonious Medicare reimbursement (4% increase since 2000, at present reduced to 2% by the sequestration. Same period medical practice expenses have increased over 20%). Commercial insurance payments are only somewhat better. These and other adversities have driven over half of our physicians to become hospital employees. While hospitals are the primary drivers of skyrocketing health care expenditures (See “Bitter Pill,” May/June 2013) they have escaped blame and have preferred reimbursement and taxation benefits. Hospitals are the real winners, perhaps the only winners, under the ACA.
The ACA jeopardizes the type of outstanding care that I received during my recent illness. It jeopardizes the quality of care you and I can render our patients. There is $5 billion to $10 billion over 10 years for the thoroughly discredited IRS administrative (FactCheck. org), yet none for funding medical education and training more physicians. The ACA is so ponderous, expensive and byzantine that it is proving difficult, hopefully impossible, to implement. The false promises this President and his supporters offered Americans, notably not having to change physicians and not losing existing insurance coverage are now causing political allies - notably labor unions - to look askance at ACA implementation.
Given the many scandals and self-inflicted wounds this President and his administration have suffered; the growing dissatisfaction with provisions just surfacing from the 20,000+ pages of regulations; it is my hope that the American people and Congress will push the “reset” button and start over on bi-partisan, affordable, implementable, high quality health care for all Americans.
I like the sound of that!
Biography
John C. Hagan, III, MD, FACS, is a Kansas City ophthalmologist and Missouri Medicine Editor since 2000. Contact: jhagan@bizkc.rr.com
