MCMS Physician Winter 2017 - 5

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who were no longer uninsured conveniently left out the fact
that for many, their insurance didn't kick in until they'd spent
themselves nearly broke, making their newly-purchased
coverage essentially worthless. What had been a promise of
wonders for many had fallen flat.
For others, the ACA has been a lifesaver, providing
coverage for preventative services and complex cancer care
that for the preceding decades had been out of reach. To
them, the thought of having coverage taken away and once
again be subject to discrimination just for being sick is
terrifying. It's a terror I share, and one which we will all one
day face. Whatever our political leanings, we are each mortal,
unalterably subject to illness and death.

So Many Questions. No Clear Answers
So where do we go? What are the answers? A good
place to start is a discussion on the definition of healthcare
itself. Is it a right, or not? If the answer is "no," the question
then becomes "why is it an entitlement?" If the answer is
"yes," we must then ask ourselves, "what kind of right?"
Yes, there is no "right to healthcare" in the U.S.
Constitution, but how relevant is that statement to a practical
debate? Certainly, we treat healthcare as a moral right-the
federal Emergency Medical Treatment and Active Labor Act
(EMTALA for short)-mandates the treatment of anyone
who enters an emergency department, regardless of their
ability to pay. Well then, you might say, it MUST be a right.
But if it is, how far does it go? Where does an individual's
right end and the recognition that resources are finite begin?
We won't deny a destitute man having a heart attack access
to care, but what about the 90-year-old with terminal cancer
whose family insists that everything be done? Or the one
with dementia who keeps ending up in the hospital on a
ventilator because his children refuse to make him DNR
(do not resuscitate)? We've all heard those stories, and for
some, the question of age offers an easy way out. Exceed a
certain age, the thinking goes, and they have to self-pay. But
what about the 40-year-old father of three newly diagnosed
with Stage IV colon cancer? Based on the evidence, the odds
would be against him, but do we deny treatment based solely
on the low-probability of surviving five years?
These are difficult, soul-searching questions. But if
we are truly to discuss the future of American healthcare,
they are foundational themes that must be addressed. To
ignore that fact would lead us to base our decision-making
on a house of cards, and ignore the most serious drivers
behind the issue of cost. For me, it's been a war between two
opposing sides: my head and my heart, my formative years vs.

my experiences as a physician. What we learn as children shapes
who we are, and it is difficult to shake loose long-held beliefs. My
heart says "cover them all," while my head screams "no socialized
medicine!" I'd like to think there is common ground, and that is
as good a place as any to begin this conversation.

All Ears: Let's Talk
With that in mind, I'd like to invite you, our readers, to join
the debate. If we're going to find real solutions, we'll need all
hands on deck. Whatever your background or experience, we
want to hear from you. I'm asking you personally-don't be shy.
Our new "Letter To the Editor" column is ready and waiting-all
it needs is to be given a voice.
That voice is yours. The time is now. Let your thoughts and
feelings be heard. I look forward to the conversation.
Warm regards,
Jay Rothkopf, MD

MCMS PHYSICIAN 5 WINTER 2017
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Table of Contents for the Digital Edition of MCMS Physician Winter 2017
