When Americans head to the polls in November, they’ll be deciding the fate of the Affordable Care Act, what Barack Obama has called “the most important healthcare legislation enacted in the United States since the creation of Medicare and Medicaid in 1965”. Over the past decade, healthcare providers have observed the rollout of Obamacare and its net-positive impact on their patients and their practice of medicine.
But how will they vote? Data reported by the New York Times last week suggests that different kinds of doctors tend to have very different political views. My experiences lead me to believe that this empathy gap can be traced to the mix of patients that clinicians care for. The more doctors get out of their privilege bubble, the more likely they are to support keeping, and strengthening, the ACA.
All doctors bear witness to the lives of others. But whom we meet depends in part on what insurance we accept. Medical specialists including cardiologists and orthopedic surgeons and are less likely to take patients on Medicaid than are primary care doctors, pediatricians and infectious-disease docs.
Poverty, discrimination and other social factors also increase the risk of certain diseases such as HIV, hepatitis, childhood asthma, obesity, high blood pressure and depression. So certain medical specialists, like me, see a higher proportion of patients from backgrounds vastly different from our own. Call it empathy boot camp.
One of my patients has been to the hospital six times in as many months because her asthma flares up every time she smokes crack cocaine. She lives with her elderly mother and can’t move, and it’s hard for her to quit when most of her neighbors smoke crack too. Another of my patients had PCP, a severe pneumonia related to HIV/Aids, which required treatment with multiple medications. She left the hospital against our advice because she doesn’t feel comfortable asking family, friends or neighbors to look after her kids.
I have another patient who bounces around from hospital to hospital looking for safety from her abusive partner. Another patient with advanced Aids refused to go to a nursing home where he would have gotten help taking his dozens of medications, three square meals a day, substance abuse treatment services and physical therapy. He was afraid of losing the apartment he shared with his HIV-uninfected girlfriend, leaving her homeless. He died. This is just a sample of patients I saw in one month.
My patients have shown me it’s nearly impossible to get someone healthy when they don’t have stable housing. I’ve learned that if my goal is to help people get better, I’ve got to be pragmatic. I’ve realized that most people with an opioid addiction will never be opioid-free. But with medication-assisted treatment (using substances like methadone, buprenorphine and naloxone), they can become functioning members of society, return to work and resume their roles as caregivers of children or ageing parents.
I’ve even come to believe in safe injection sites, where people can use heroin and cocaine under the supervision of healthcare workers. Not only are they less likely to overdose, but they’re also channelled into testing and treatment. I used to think it was unfair for transgender women to want their breast implants covered by insurance when equally flat-chested cisgender women have to pay for their own cosmetic surgery. But then I saw the harm that comes from injecting industrial grade silicone.
As doctors, we have the privilege of crossing social divides when most others don’t. With that comes a responsibility to our patients and our country that goes beyond our vote. We know all too well what’s at stake.
Doctors would all support Obamacare if they saw the vast inequality that I do | Celine Gounder
