Doctors For America

I just got back from clinic. I got a slap in the face....a wake up call today. I saw a 64 y/o taxi driver who has both HIV and Hepatitis C. He really needs treatment for Hepatitis C but no one is willing to do a liver biopsy we need to outline his treatment plan because....he doesn't have insurance. He is one year too young for medicare and he can't qualify for Medicaid because they say he makes too much money. He makes $900/month. So what is he to do? Wait for treatment for another year when he turns 65? On top of it all, since he has no insurance, the private lab our hospital uses is sending threatening letters to him because he owes thousands of dollars for lab work.....critical lab work we order every visit to ensure he is responding to therapy. I had to order additional labs today but felt embarrassed telling him he needed more lab work knowing that it would only add to his bill. A bill he has no way to a pay. He suspects they will soon begin refusing to service him. It seems criminal to deny care to people who are poor. I am sick about it. Our system is so broken. There must be a better way.

Hello. My name is Suneer Chander, I am an ER doc in Framingham, MA.

Last week I pulled out my medical school application essay. After five years working as an ER physician, I had become so frustrated with my job, I was thinking about moving on to the business world. The essay reminded me that I chose to be a physician because I wanted to dedicate my life in the service of others. I realized that our broken healthcare system has made this very hard to do.

I recently took care of a young contractor who had shredded his hand using a saw and cut right through one of his tendons. This is a serious injury that requires expert attention. After cleaning and closing his wounds to the best of my ability, I referred him to an orthopedic doctor for outpatient surgery. A couple of days later, I called him up to see how he was doing. I was shocked to hear his story: he had called every orthopedic doctor in the area, but no surgeon would see him because he had no health insurance. This man is young, hardworking, and needs the use of his hands to provide for himself and his family, yet his lack of health insurance put his career and family in serious jeopardy.

On the last shift I worked, the paramedics brought in a 95 year old man who was found on the floor. No one knew how long he had been lying there. Our paramedics were horrified by the sight of this man's home. They described a disheveled apartment that hadn't been cleaned in months; no food in the fridge; and no signs of anyone helping. When I went to examine this man, he was covered in urine and stool that was days old. After taking care of him, I decided to call Elder Protective Services to report the situation. I was surprised to find out that they already knew about his situation and "see him regularly." The last time they saw this man was two weeks prior to his visit to our ED. This man has lived a long life and deserves dignity.

This is why I am so frustrated with my job. Our healthcare system does not allow paramedics, nurses, and doctors to take care of the people who need it the most: 1. hard working Americans who are simply trying to provide for their families; and, 2. elderly Americans who have worked so hard to make sure our lives are better than theirs.

In this election year, I believe that solving the healthcare crisis is the most serious issue on the agenda. After reviewing the candidates' plans, I have concluded that the choice is clear: Senator Obama's plan provides a road map to meaningful, realistic reform; Senator McCain's plan will make matters worse.

Under Senator Obama's plan, any American lucky enough to have insurance already will have the choice to stay with the plan they have. But, Obama will also create a new public insurance program available to anyone that will provide benefits similar to those provided to Members of Congress. This program will be affordable and attainable and will not discriminate based on pre-existing conditions. This will allow millions more Americans receive the quality medical care that they need and deserve. Experts predict the opposite effect if McCain's plan were implemented: millions of Americans would lose the health insurance they already have.

Obama's plan also renews our promise to seniors by strengthening Medicare. His Medicare reforms will lower prescription drug costs, eliminate the significant and excessive payments to Medicare Advantage health plans, and emphasize disease management and coordinated care programs for the many elderly with chronic medical conditions. And he will modernize the health care system by making the necessary investments in information technology and important changes to the way health care is paid for.

With this coming election fast approaching, I have been excited at the opportunity our country has to start fixing the health care system. I hope that when Barack Obama is elected our President, health care will be a right rather than a privilege. I believe that Obama's plan will help return our profession to what it should be: noble and dedicated to the service of those who need it most.

I chose to become a doctor after witnessing first hand the devastating health trends in my hometown of Detroit, Michigan. I believed that by becoming the "doctor" I could reduce the incidence of unplanned pregnancy, sexually transmitted infections like HIV/AIDS, intimate partner violence, gang violence, stroke, heart attacks, diabetes, etc.

My grandparents, did not have a doctor of their own. They could not say "Dr. X" is my doctor. Instead, they had and continue to have multiple doctors that change on a monthly basis contingent on who is assigned in the community for the month. Many of these physicians come to the community to get their loans repayed or to dedicate service for the government paying their tuition through medical school. Too often...these docs are not invested in the patients as much as they are invested in loan repayment. Who truly wants to come to an impoverished, health burdened community where patients tend to be noncompliant with their medications, show up late to appointments, mistrust the healthcare system at baseline and have very little comprehension of disease processes? It is much easier to take care of patients that are healthier, show up on time to their appointments and take their medications as prescribed. And did I mention...in these communities (the more compliant ones) the pay checks are sometimes 6 figures higher?

Well...I and some other docs I know want to ensure that people like my grandparents and citizens of communities like Detroit, Michigan have doctors that are invested in them, in their health, in their well being and understand and respect their unique needs.

So...I decided to become that doctor. I wanted people to be able to say "Dr. Anthony is my doctor" and it be a true statement. I wanted to dedicate my life to educating patients, being a contrbuting member of the community improving medical outcomes and reducing what I later learned were racial and ethnic disparities in health care.

So..I went to college at the University of Minnesota, attended medical school on the south side of Chicago at the University of Chicago (Senator Obama was our medical school class graduation speaker and I had the honor of attending meetings moderated by Mrs. Obama). It was at University of Chicago...I learned that public health affords one the opportunity to look at population health and improve outcomes of more than one person at a time.

SO...I went to Harvard and earned a masters of public health. Can you believe it? Harvard! It was the first of such accomplishments in my family and when I walked across the stage at graduation and saw my family rooting it was not only my personal accomplishment but that of my parents, grandparents and community friends.

When I chose a specialty for residency training, I chose women's health, obstetrics and gynecology. It is the one specialty that combines medicine and public health. A nation with healthy women bears a nation of healthy children and healthy men.

As an intern at Vanderbilt University Medical Center in the Ob/Gyn department I worked 80+ hours a week. I can tell you I often left the hospital exhausted. Sometimes physically but more times than not.. mentally. I was filled with a sense of failure and guilt. I'd worked so hard to get to this point in my career only to discover that the population I so desired to help was invisible. I felt guilty because the women who desperately needed our services could not get appointments. Women were sent to other clinics and hospitals with a phone number on a sheet of paper. I met women on my ER rotation who truly needed the care and assistance of our competent Ob/Gyn team but could not get access because they did not have the RIGHT insurance. These women had insurance but not the RIGHT one. Other women who were not insured had very few options.

It was only 8 months into my residency that we were told at Grand Rounds that Vanderbilt would no longer be taking Medicaid/Medicare for GYN services and only 1/2 of Medicaid for Obstetrics. This one decision changed my practice and my life. In one day, I lost 80% of my patient population. Patients I had taken care of majority of their pregnancy. Patients I had come to develop relationships with, saw in local grocery stores, was invited to baby showers, and personally called and checked on. We dropped them without a pipeline or referral. Patients called me desperate and told me no one would take NEW OB patients, especially those in the middle of their pregnancies for malpractice concerns. They were being charged $1.99/page for their medical records to be copied...and these were medicaid patients. So...they fell through the cracks and went without prenatal care for the duration of their pregnancy. When they went into labor they showed up at our hospital and we did not have their routine final trimester lab results because we dropped them from our care.

It required us treating all women with antibiotics because we did not know their GBS status. It required us spending more money to send rapid HIV tests because we did not have that information either. Pregnancy is a finite process (9 months + a 6 week post partum visit). I was bewildered that we did not have a "grandfather/mother clause" for existing patients. That unlike diabetes or heart disease we couldn't find a way to care for the existing patients we had until they delivered. I felt like a failure...like I had failed my patients. Patients that were doing the best they could, had actually sought out prenatal care for the health of their baby, had remarkable life situations. Most importantly these were women who reminded me of my neighbors...these were the women who lived and came from environments in which I was raised and left to become THEIR doctor.

How could I work 80+ hours a week, endure the crazy hours, volunteer not to have a social life and purposely stay awake on call non stop for 24+ hours when 90% of my own family, friends and their parents could not get an appointment to see me if their life depended on it.

I was disgusted and felt sick. I had worked so hard to get to this paramount "Dr. Anthony" point in my life only to learn that the poor and the poorly insured get less than ideal care. That you can indeed work to serve these patient populations but at the tradeoff of earning significantly less and working in hospitals and environments with less resources and specialists. This reality was all confounded by the reality that an MD from the University of Chicago and MPH from Harvard University cost me $217,000 gaining interest daily.

What could I do? I was a resident. My new clinic patients came with birthing plans, did not want their newborn vaccinated and knew about the latest prenatal pills with extra folic acid. They were honorary obstetricians at times. I enjoyed taking care of them but often wondered who was taking care of those less fortunate. I had many competent, compassionate physician colleagues that could deliver outstanding care to this population. I had colleagues who always intended to open private practices to take care of this populations. I realized that many of my colleagues chose medicine because of the science, biology, physiology and surgery. The patient was simply the vector that brought what they loved. I chose medicine because of the patient and the disease, science, surgery just came with the territory.

In addition to no longer taking Medicaid/Medicare we decreased the number of minutes per patient to 10 minutes. How can you see a patients, address their concerns, ensure fetal well being and educate the patient in 10 minutes. I know how...you can't. So...this is why the wait time for patients ends up being significantly longer.

What was I to do? This was not what I signed up for and I wanted to know why we were no longer taking care of sick people but taking care of people with the RIGHT insurance. I spoke with the chair of my department and was informed that it was a hospital decision and not that of the department. That there was nothing we could do.

I started speaking to my mentors and relating my concerns. The more I read the more the compass pointed towards the nations capitol. I had been involved politically in medical school and worked on Obama's Campaign for Senator. I wrote him and Dick Durbin about my concerns about the US Supreme Court Justices and Darfur. I knew there was a problem at a national level that extended beyond prenancy and prenatal care. I knew there were people with more dire situations.

I took inventory of my interests and discovered that my skills may be better suited in public health and policy. So...I left the traditional halls of medicine, hung up my white coat and I accepted an AAAS fellowship in Washington D.C. with the goal of getting acquainted with the national legislative process. To learn how one can translate their passion into action and action into legislation. So...I took my MPH and MD and committment to improving the lives women to Washington D.C. I worked at NIH and the Office of the Surgeon General. I ultimately ended up here...at George Washington University School of Public Health as a professor and researcher. I also consult at NIH and Office on Women's Health at HHS. Most gratifying is my work on the Hill with Congressional leaders to ensure that women and their unique health needs are not left off the political agenda.

I am now able to lay my head on my pillow at night knowing that the work I do impacts the lives of those I initially chose medicine for. A highlight of my career and confirmation of my decision was this past summer where I was honored by the Surgeon General for my service and contributions to the Surgeon General's Conference on the Prevention of Preterm Birth where we developed a national action plan to prevent preterm birth in the US. I can sleep knowing that the work I do somehow, someway directly impacts the health of a nation including those most vulnerable and those living in inner cities like Detroit, Michigan.

I am looking forward to and rooting for an OBAMA administration. I believe his healthcare plan is on the right track to ensuring that all Americans have access to quality health care.

I've learned there are a million ways to be a doctor. I miss seeing patients on a daily basis, bringing life into the world, operating, and having a doctor/patient relationship like no other. (In Ob/Gyn people tell you things they don't tell their spouses or closest friends...it is truly an honor). It is with the greatest hope and expectation that Senator (soon to be) President Obama reform healthcare ensuring all Americans can have access to their own Dr and be treated on the basis of their condition than their ability to pay. Only when healthcare is under reform...can I return with a weight off my shoulders... to the halls of the hospital and slip into my white coat with the embroidered "Dr. Anthony" on the pocket. Only then...can I return home at the end of the day knowing that I am a proud Obstetrician Gynecologist.. taking care of women...not because of their insurance status or ability to pay...but simply because they need the assistance of a physician and desire to be able to have a doctor they call their own. Dr. Renaisa S. Anthony.

Too many times during my training I have come in contact with patients who received inadequate care because of their lack of insurance. I had one patient sent home from another hospital after a heart attack, after being given a list of appropriate coronary artery disease medications that she should go to the county clinic for. After working on getting her county insurance set up, we finally had her able to get a cardiac catheterization, and she went for coronary artery bypass grafting that same day. That this woman was sent out of the hospital in the first place without prescriptions or proper care because of her insurance status is unconscionable.

The one patient that will always haunt me is a young woman in her thirties who developed heart failure presumably because of congenital heart disease and lost her job, lost her car, her home, her insurance. She had to move herself and her three children in with her mother. I remember her saying to me, "I did everything I was supposed to do, I love to work, but I just can't do it." Her heart function was so poor at this point, that she was under evaluation for a heart transplant, and on speaking with her, one of her fears was what was she going to say to her children about her heart failure, and would she be able to see her eldest child graduate from high school. Unfortunately, her transplant workup was postponed while we (myself, my attending, the social workers) had to work to get her set up medicare approval so that a cardiologist would evaluate her.

It is patients like this that make me support the Obama plan because these women would have had access to appropriate care and medications under his plan. Everyone should have access to health care, but when a physician's hands are tied in terms of doing what is best for her patient because of insurance, it is not right. I became a doctor because I wanted to help people, and I'm training to be a cardiologist to help women like the ones I've mentioned.

I am a pediatrician who works in a community health center in the Washington Heights area of Northern Manhattan. I am also an Assistant Professor of Clinical Pediatrics and Population and Family Health at Columbia University.

I recently took care of a little boy with asthma and developmental disabilities who lost his health insurance coverage because his mother who works part-time got "too much" overtime that year and he did not qualify for SCHIP anymore. Yet, his mother does not make enough money to purchase private insurance (she usually does not have that much over-time) and her employer does not offer benefits since she is part-time. This child was not getting needed care and services because of this lack of insurance. This is exactly the child who falls through the cracks in our current system and who Obama's health plan will help.

I have been an inpatient physician working at a county hospital in Ventura, CA for over 10 years. We are the safety net hospital for this county of roughly 1 million people. Approximately 70% of our patients are either uninsured or underinsured and because of this they have no access to regular physician visits, routine health maintenance and frequently can not afford to obtain the chronic medications that they have previously been prescribed. As such, their only interaction with the healthcare system is when they are acutely ill requiring hospitalization.

I have hundereds of stories of patients that I have cared for in the hospital for problems that could have been prevented, or at least minimized, if they had access to regular physician visits and identification or treatment of chronic medical conditions. Because the majority of the patients that I care for in the hospital do not have access to routine preventative healthcare, their chronic medical illnesses (e.g., diabetes, hypertension, chronic kidney disease, cirrhosis, chronic lung disease, asthma, hyperlipidemia, etc.)are not discovered and appropriately cared for and they eventually develop a complication of these chronic illnesses requiring hospitalization. In addition, patients do not obtain their recommended immunizations that protect them against preventable infections and do not receive routine cancer screening (e.g., pap smears, colonoscopies, bimannual exams to assess ovarian sizes, clinical breast exams, mammograms, prostate exams, etc.); as a result, they present with acute infections that could have been prevented or widespread cancer that could have been detected and cured in advance.

Their are hundreds of examples that I could share which illustrate this problem, however I will only share two stories. One story involves a young caucasion woman who was 29 and the single mother of two young kids. She had been working at two part-time jobs to try and keep a shelter over her family's heads and food on the table. Neither of her employers would offer her health insurance and she could not afford to obtain health insurance for her family. She presented to my hospital with a new severe headache and was found to have a brain mass by CT scan of her head. She was also found to have a large breast mass. Pathology of the breast mass and the brain mass both revealed infiltrating ductal breast carcinoma. The patient received whole brain radiation and palliative systemic chemotherapy and died within 6 months of her presentation to our hospital leaving behind two grade school kids.

The second story is a case of a hispanic man who presented to our ER in a comatose state and was found to have a massive intracranial bleed and severe hypertension. It turns out that he had been diagnosed with "alta presion" about 5 years ago. He was a field worker and could not afford his blood pressure medications on his salary. Because he was not able to obtain the medications and regular healthcare that he needed, he presented with a hypertensive intracranial bleed and expired in our ICU within a week despite maximal medical care.

These two cases point out two critical failures of our healthcare system. First, it emphasizes acute care medicine which by nature waits for a tragic event to happen and then tries to fix it. This not only can leave the patient in a chronically impaired state, but is very costly for the taxpayers. It also demonstrates how preventive care could have saved a couple of lives and in the long run would have costed taxpayers less.

Every day I care for somebody who could have benefited from universal healthcare and I yearn for the day when this will become a reality. I trust Barack Obama will carry through with his promise to make this a reality when he is the President of the United States.

Medical Director of a mobile medical and mental health program for children in existence since Hurricane Katrina.

I was seeing a 13 year old young lady just last week who came in for severe headaches, decreasing performance in school, and occassional faiting spells and dizziness. These symptoms have been occurring for four months since a head injury in a river this summer! Her emergency room visit at the time of injury revealed a concussion for which she was to have neurological follow up. Immediately after the accident she returned to the ER four additional days for headaches and nausea. Her MRI did not reveal any bleeding or major concerns. She again was told to follow up with her Dr. and a neurologist. The problem was she had no doctor, no insurance, and no extra cash to pay out of pocket.

She now presents to our clinic (which is part of a Federally Qualified Health Center serving high risk families) for the same complaints with worsening school performance and questionable memory loss. When asked about the neurlogist the family responded that they have no insurance and had no means of paying for a visit. A recent job change in the family has made it more difficult for them to pay the bills that accumulated after the initial injury. There was no primary doctor before the accident which is why there were multiple visits back to the emergency room. Now she needs the neurlogy consult and further testing soon more than ever! Still she sits without insurance. Because mom had never applied for federal support before, she was unfamiliar with the rules requring an original birth certificate ,therefore, her initial application (1 month duration) was denied. She is awaiting the birth certificates for her family which could not be purchased until they had enought money at which time she will have to reapply for the insurance. We could be looking at an additional 2-3months waiting. At this point I can only treat her symptoms and had to be careful about the medication selection because pain medicines can be costly. I have advised her to return to the ER if she becomes suddenly worse. The insidious onset of new symptoms worry me. It is quite frustrating, irritating, and down right wrong that this family was caught in this situation. The mom is upset and feels she is letting her child down by not having the money to care for her properly. Now that my program is involved, we have a social worker who will work fervently to expidite her receipt of insurance and we will watch over her closley, we will call a neurology friend to help me care for her. She is just part of a long list of children who suffer because of a governmental system that does not value health for children, especially one's affected by economics. It is all too often that children are plagued by some unforseen mishap that brings tragedy to the family economically, socially, physically and mentally when the illness is compounded by controllable issues. If every child had insurance regardless, then so many stories like this could be avoided or certainly have better outcomes. I look forward to times like that!

Two years ago this month, I took care of an agent in Los Angeles. He had Crohn's disease, and his health and nutrition had getting worse for over a year. He was seeing doctors at one of our private hospitals, but he lost his insurance, so he couldn't see his doctors anymore. Buying private insurance was impossible - no amount of money could have convinced an insurance company to cover him. He tried the county hospital ER, but the wait was 24 hours. He thought maybe he could manage.

A few months later, when he could barely walk from his bed to the door, he tried the ER again. By then, he had kwashiorkor (the kind of malnutrition that famine-stricken African children get) as a complication of his gut disorder. Every organ system was failing. Even in the hospital, he tried to keep up his work via his Blackberry. We tried to help him, but he rapidly deteriorated and died six days after admission.

I was devastated and talked to many colleagues about what i could have done differently to save my patient. He should have been living his life and being a productive member of society today, but he's dead. We could have saved him if he had been able to come for care sooner. Ultimately, I recognize that he died because the system failed him. In our great country, that is unacceptable.

As a retired military physician, I have had the privilege of caring for America's soldiers and their families. These brave and committed individuals who will make the ultimate sacrifice if required, and as such, they deserve the best medical care this country can offer. The Bush administration support of limiting veterans benefits was reprehensible, abandoning the individuals who are willing to fight and die for this country. .

Having cared for both men and women, I am also convinced that women's reproductive rights must be preserved. Eliminating the right to choose will result in an increase in maternal deaths when women are denied the right to safe pregnancy terminations.

I believe that Barack Obama will ensure that our troops have the medical resources they need when they re-enter civilian life. He will not seek to overturn Roe vs Wade, and he will not appoint judges to the Supreme Court that will destroy a woman's right to choose.

I am a 62 year old black male who has recently retired from US Airforce service after 30 years, and am now serving as chief medical officer for almost 2000 inmates at two state prisons.

I have also recently been diagnosed with state 3 colon cancer and am currently receiving chemotherapy. I had no symptoms. My cancer was picked up on a routine screening exam.

I just received a medical bill for the treatment of my colon cancer for $33,000, and my insurance paid the entire bill. But what if I was one of the 45 million individuals who have no insurance? Well, I would probably have about a year to live and place a great strain on the local medical system in my final days. I know this; I have cared for the poor souls in that situation. My insurance plan costs about $9000. This cost is covered by my employer and me. For people who are unemployed, there is a $6500 gap that is not addressed by plans relying entirely on private, non-governmental coverage [McCainÕs proposal during the 2008 presidential run]

I recently took care of a young contractor who had shredded his hand using a saw and cut right through one of his tendons, a serious injury that requires expert attention. After treating his wounds, I referred him to an orthopedic surgeon. A couple of days later, I called him to see how he was doing. I was shocked to hear that he had called every orthopedic surgeon in the area, but no one would see him because he had no health insurance. This man is young, hardworking, who needs the use of his hands to provide for his family, yet his lack of health insurance put his career and family in serious jeopardy. .

On the last shift I worked, the paramedics brought in a 95 year old man who was found lying on the floor. No one knew how long he had been lying there. Our paramedics told us that his apartment hadnÕt been cleaned in months; there was no food in the fridge, and there were no signs of anyone helping him. I found that he was covered in urine and stool that was days old. After taking care of him, I called Elder Protective Services to report the situation. They told me that they already knew about his situation and Òsee him regularly.Ó The last time they saw this man was two weeks prior to his visit to our ED. This man has lived a long life and deserves dignity.

The people who come to me have been told they may have cancer and theyÕre scared; it breaks my heart to be helpless when I meet a patient with no health insurance. So, if my tax dollars are going to be used to build this country and our middle classes back up, please tax me more. Right now my tax dollars are going towards a war that I didn't want; anything is better than that.

I work in a county health clinic, provider of last resort. We also help train Family Physicians for the University of California.I recently admitted a new, 40 year old patient into my practice. Three years earlier he had been diagnosed with hypertension and mild Congestive Heart Failure. He had been given medication, but when he ran out, he did not have money for medication refills or follow-up visits. In the course of three years, his untreated high blood pressure resulted in severe Congestive Heart Failure. Because he is now disabled, he finally qualifies for health insurance, but his life expectancy is now much decreased. He also takes care of his infirm father. Who will take care of his father if he dies prematurely?

In the course of my training [as a Cardiology Fellow], I have far too often come in contact with patients who received inadequate care because they lack insurance. One patient was sent home from another hospital after a heart attack, having been given a list of coronary artery disease medications that she needed to get from the county hospital. After getting her county insurance set up, she was finally able to get a cardiac catheterization, and she went in for coronary artery bypass grafting that same day. It is unconscionable that this woman was sent out of the original hospital without prescriptions or proper care because of her insurance status

A case that will always haunt me is a young woman in her thirties ho developed heart failure because of congenital heart disease. She lost her job, lost her car, her home, and her insurance. She and her three children moved in with her mother. She said to me, "I did everything I was supposed to do; I love to work, but I just can't do it." Her heart function was so poor that she was under evaluation for a heart transplant. She was scared to talk with her children about her heart failure, and was worried about whether she be able to see her eldest child graduate from high school. Unfortunately, her transplant work-up was postponed while we (myself, my attending, the social workers) got her Medicare approval so that a cardiologist could evaluate her condition.

I support the Obama plan because patients like these women would have had access to appropriate care and medications under his plan. Everyone should have access to health care; it is not right but that a physician's hands are tied because of insurance

As a retired military obstetrician gynecologist, I have had the privilege of providing care to America's soldiers and their families. These brave and committed individuals are expected to make the ultimate sacrifice if required. They deserve the best medical care this country can offer. That is why I found the Bush administration support of limiting veterans benefits so reprehensible. Those that are willing to fight and die for this country should be supported and not abandoned. Unlike the Bush administration I believe Barack Obama will ensure that our troops have the medical resources they need when they re-enter civilian life.

As a physician working with women's health, I know that women's reproductive rights can and must be preserved. Eliminating the right to choose will result in an increase in maternal deaths when women are denied the right to safe pregnancy terminations. Barack Obama will not seek to overturn Roe vs Wade, and he will not appoint judges to the Supreme Court that will destroy a woman's right to choose.

As a physician, a parent, and a healthcare consumer I cannot support the [health care plan presented by Senator McCain during the 2008 Presidential campaign]. We are fortunate that we have a better choice and an opportunity for real change.

I am an Infectious Disease doctor who treats many HIV/AIDS patients. Let me tell you the story of one of my patients, a young African-American with HIV whose insurance covered his HIV medications. His HIV was well controlled - his viral load undetectable and CD4 count excellent. One day his company changed insurance carriers. He was suddenly required to cover over 500 dollars a month in co-payments that he could not afford. He stopped taking his medications and stopped following-up with me. Two years later, he was admitted to the hospital I work with severe pneumonia (PCP) and had to be intubated. His viral load was very high and his CD4 count 20 (very low), essentially advanced AIDS. He stayed in ICU for more than a week. Though he survived, he still does not know how to get his medication. The money spent on his hospital care is a lot more than what he could have spent for his medication. He still is not on any HIV medication though he is still at high risk for HIV-related complications and premature death. He is not getting the quality medical care he deserves as a full-time, active employee and active worker of a company.

I have a unique solo family practice in Waynesboro, Virginia, and I love what I do. I use no staff; I answer all of my own phone calls; I am available to my patients 24/7. My patients can see me when they are sick, and there are no long waits in my office. I file claims and bill insurance myself. I keep my overhead very low so that I can provide the kind of high quality medicine that patients deserve and get the reimbursement that I need.

Many patients in our area are uninsured. Last year, a local business owner approached me with a unique idea. He is unable to provide insurance for his employees because insurance company rules mandate 50% employee participation. He proposed that I take care of his employees, and he would pay me directly for my services. This system has worked wonderfully. His employees are seen promptly, miss fewer days from work, and most importantly, have access to local health care. When they need further care, I work out creative ways for them to get financial assistance for the care that they need. Next week, I will have a flu shot clinic for these employees.

We need to find creative ways to provide care to patients in this country. I trust Barack Obama, with his obvious, incredible intelligence, to work on these very real issues in creative ways so that people in this country get access to the wonderful health care that is available here.

The economy is hitting patients hard. I talked with a woman this weekend who has only $5. She worried about whether the immediate care center would see her if she couldn't pay, and then will probably not be able to afford an antibiotic for her illness. Another patient is refinancing her house, can't afford more medical bills, and quit taking her blood pressure medicine...she's begging for medicine until she can afford to pay for a visit. A third patient, disabled and bedridden, may lose her home.

We need to add humanity to our health and human services. How? Simple: Cover basic preventive services, eliminate pre-existing condition exclusions, pay doctors fairly and eliminate employees who work only to save insurance companies money by denying care. These employees can be re-deployed to support patients in adhering to recommended treatment, diet and exercise plans, etc. or locating local resources to help them cope with chronic illness.

Mr. A is in his late 40's, and has struggled with symptoms of schizophrenia for several decades. He is highly intelligent and sometimes capable of working regularly, but at other times, his paranoia, disordered thought processes, and other symptoms make it impossible to work. He has not held regular employment for about 10 years, and now receives Social Security benefits and Medicaid.

With the help of medications, rehabilitation services based on peer counseling, and a very supportive family, Mr. A. found a job for which he can earn minimum wage. This achievement has been enormously therapeutic for Mr. A, who is strongly motivated to be a productive member of society. His self-esteem has begun to recover, and not surprisingly, his symptoms have been easier to control as the stress of chronic unemployment has eased. The income he is now earning has improved his tenuous financial situation and lowered his risk for homelessness, a worry that has plagued Mr. A and his family for years.

Wonderful success story, right? Of course not Ð this is the United States, not some socialist country in Europe or Asia!Now that Mr. A earns a minimal income, he may lose Medicaid coverage, and subsequently his clinic visits and medication. The medication that has proven most helpful to this patient is a newer medication that is not available in generic form and costs well over $300/month -unaffordable to a person who is working a minimum wage job.

So Mr. A, because he has made such substantial progress in his treatment, and because he wants to work, will now be punished by our healthcare system. My prediction is that he will re-enter the endless cycle of losing his coverage, stopping his medications, relapsing, and if he survives the period of psychotic dysfunction and likely homelessness that will follow, will end up back on disability pay and eventually be able to get Medicaid again.

I am a psychiatrist and genetics researcher. My clinical work is predominantly with adults with developmental disabilities such as autism or severe mental illnesses such as schizophrenia.My two decades of clinical experience with the severely mentally ill population indicate that Mr. A's story is all too typical. The entire medical system is broken in this great nation. The mental health system is worse off than any other sector of the system.

My 33 year old wife was afflicted with a severe progressive deterioration of both hips necessitating total replacements. She wants to be independent and return to work. Our health care providers have been stellar (surgeons, nurses, physical therapists, EMT's etc...), but the insurance company has made the situation difficult. They have double billed us thousands of dollars on a number of occasions. They stopped paying for her physical therapy despite documented progressive improvement towards goals set by the surgeon, physical therapist, and physiatrist. The appeals process has been nearly impossible to penetrate.

Although our story is tragic, I don't understand how elderly, less educated individuals are able to negotiate such a system when she is having trouble despite being young and educated.

I work in the VA system where none of this would have happened. Services are provided when indicated and only terminated when not. These determinations are made by clinicians and patients, not payers. If that's socialized medicine, i don't understand why it would be bad.

The Cambridge Health Alliance (CHA) provides safety net care for uninsured, low income and disenfranchised patients is facing a 40 million dollar reduction in support. CHA provides high quality, low cost community based care with 20 health centers and 3 community hospitals. If CHA is forced to reduce its services by 20% (as would be indicated by the reduced support), the health care system will be adversely affected. In contrast, Partners Health Care has realized an 85 million dollar profit (which corresponds to the deficits realized by Boston Medical Center and CHA). Meanwhile, the waiting time in emergency departments across the city is long; few primary care MDs are accepting new patients.

There are over 1300 insurance companies. What is the cost of all these duplications in service? Are the services for the benefit of the customers or the management? Each community office or the public library should have a health care club to teach and offer nutritional and preventive health care activities to kids and adults. Disease prevention and early diagnosis are the best ways to control the health care cost.

I am writing this from an internet cafe in South India. I come to an ashram here yearly to do volunteer work. I had a fulfilling career as an ObGyn and a physical leader and administrator IN Kaiser Permanente, Northern California. I have been retired for over one year and now practice medicine only on a volunteer basis. I have spent the last week with a Mobile Hospital that visits rural, remote and very poor villages in this part of Andhra Pradesh, India. The program involves a large van that has been converted to contain an X-ray suite and laboratory as well as a multi-specialty team of doctors and dentists who volunteer for 4 days each month. They return monthly to each village and serve not only the village, but people from surrounding villages up to radius of 10 km. They set up clinics in the local school and in peoples homes. They provide service in internal medicine, orthopedics, surgery, ob/gyn, pediatrics, ENT, ophthamology, dentistry, diabetology and a complete pharmacy. They do extensive health education and provide healthy children check ups. All care is free.

I also volunteer in a free women's health clinic in San Francisco. The Women's Community Clinic serves uninsured women and is part of the safety net of health care organizations that thankfully exists in our city. The doctors and nurses who provide care in our clinic as well as the support staff and health educators are volunteers.

Why are these experiences pertinent to my thoughts about health care reform in the US? It is unacceptable to have uninsured people in the wealthiest country in the world. When i am asked about what I think about Obama's election by people in India, I answer that many of the people in my own country find themselves in the same situation as the poor villagers in India, without access to health care (preventative, acute and chronic) and are forced to wait until they are so sick that they go to emergency departments. I tell them about my free clinic in San Francisco so that they know that the people of the U.S., the doctors and other providers, are also trying to fill the need as they are here in India.

Our country's health care policies have gone astray, promoting health care as a profit making business. I answer their questions stating that Obama will change this so all people in my great country will have health care and that the spirit of volunteerism that overflows from the hearts of so many US health care providers will be encouraged and directed towards the developing world bringing all people the access to health care that is a simple human right.

Every "system" is perfectly designed to achieve the results it actually gets. Therefore, the present system of financing and delivering health care needs overhaul by major change rather than twiddling the dials. The primary issues in today's mess are (1) Fee-for-service, which today is inherently inflationary, and (2) The fact that cost control is in the hands of third-party payers, and not the primary physician. And (3) the most practical approach with a new paradigm is through initial pilot programs rather than more broadly instituted reform, since it is difficult to know of the unintended consequences of any reform package (Massachusetts reform, highly touted, has proven far more costly than projected, for example, in part because it considered only one of the three elements of reform, access, while underestimating cost and not considering quality.)

As early as 1983, I voiced an approach to health care reform (New England Journal of Medicine 309:982,1983) In 2002, a colleague, John S. Cook, and I published a detailed proposal (Academic Medicine 77:1069,2002.) Both met with tepid response save from a few thoughtful individuals -- Rep. Barney Frank and health care economist Stuart Altman of Brandeis. A new article has been submitted to Pharos. The problem is that, like some other remedies in medicine, the pill may be bitter, and also there are many constituencies that remain fat and happy with things as they are.

However, things are getting so bad for both patients and physicians, and for medical education in the clinical setting, too, that ideas for major change may soon have a more viable place in a discussion that for the most part thus far has consisted of "reform" efforts that try the same thing over and over yet naively expect different results!

I am a gastroenterologist who trained in South Africa and moved to Binghamton, NY in 1987. I am involved in teaching and research as well as patient care. I host undergraduates from Binghamton University for an internship program as well as teaching medical students and residents. One of my Binghamton University undergraduates has been keeping a tally of insurance problems as they are identified in my interactions with patients. Over 50% of the patient encounters she has witnessed have included some insurance-related issue, from the patient being uninsured to minor issues with an insurance company dictating medication choices. In particular, I have many patients with Hepatitis C who cannot be treated because of the cost. My student and I find is particularly as these patients have so many other psychosocial issues to deal with..

I nearly cried in front of my patient today. In the 20 minute time slot allotted to my 29 year old patient (a mother of 4), I not only had to tell her that she now has severe pulmonary hypertension but that without insurance, she doesn't have access to the best diagnostics and treatments for her disease. So instead of systematically ordering the necessary right heart catheterization that she needs to assess her condition or sending her to a specialist in a hospital right across the street), I have to develop a piecemeal plan for figuring out what's going on with her lungs and how to treat it. It doesn't seem okay that she's already on a payment plan for the echocardiogram that diagnosed this disease (monthly payments for the $2012 test) and will need to pay out of pocket for the next set of diagnostics only if she can afford them. We need to fix this health care system that doesn't allow a 29 year old to prosper. I'll do whatever I can to change the system.

My friend's mother does not have health insurance. She did not need frequent doctor's visits until recently when she started having lower back pain. The pain worsened for months; two weeks ago she was diagnosed with multiple myeloma. Multiple myeloma is a treatable yet incurable disease so her life expectancy will be lowered even if she receives treatment. Right now, there is little I can do besides send care packages and visit often. I believe that her socioeconomic situation determined her health outcome, as socioeconomic status does to so many. See, my friend's mom is a low-income, black single mother living in Long Island. Although she lives in one of the wealthiest places in the world, the United States, and in one of the wealthiest parts of the United States, Long Island, she lives as though she in a developing country with no health care infrastructure, because the health care resources are there, but she cannot access them. I feel that as Americans as well as physicians, we have a responsibility to take care of all our American uninsured and that we should also examine how our healthcare insurance system further fuels health inequities.

I was the product of a teenage pregnancy, and my birth was difficult for my family. I was raised by my grandmother and my uncle, who always believed in me. God favored me with the skills to make it though college and medical school with little financial or emotional support. I took a Health Profession Scholarship and achieved the rank of Major in the United States Army and practice pediatric cardiology. My greatest love has been helping those who truly need medical help. I have have seen some thing in some experience with the insurance world and see access problems that prevent all people from receiving the care that they need. I would like to move away from clinical medicine and work in public health and policy to ensure that no child or family is left without access to care. The practice of medicine is important but people who need it often have other issues. We need to improve access, education and the utilization of a health care programs to include social workers, parent and clinical educators, physical therapists, and exercise physiologists; services must be directed to removing social barriers and educating patients and families about heart disease and prevention. This is a great country and we must have a great health care system that is accessible to all.

I am the one of a dying breed of MD's, running a small FP urban practice. No health care plan can hope to succeed without a vast base of Family Medicine as being the primary source of care for our patients

I'm a family medicine physician on the South Side of Chicago, working in a FQHC (Christian Community Health Center) with all the challenges entailed by my patients' lack of resources and the glaring inequalities and embarrassing waste in our healthcare system.

I have many stories, but one in particular seems to exemplify the strangeness of our system: One of my patients, working full time, had multiple sclerosis, somewhat under control with her medications. Her employer changed insurance carriers, and the new health insurance company would not cover anything that pertained to her MS, including the expensive injections that she could not afford on her own (pre-existing condition). She gradually became enough disabled to qualify for disability, and now we all (taxpayers) pay for her medications, but at the loss of multiple productive years of this woman's life (both to her and to society--taxes, again)

This is a good example of how disability and healthcare need to be separated. I can't tell you how many patients I have with chronic conditions, who are receiving disability and functional, but should they go off disability and lose their medical card, would qualify for disability again rather quickly.

I wanted to practice medicine in a community similar to the one I was raised in order to provide the best care that I was capable of providing. I started practice about the time the bucket really started leaking; however since I was raised poor the fact that I had a satisfying and fulfilling career would be enough. I did not bargain on the fact that 12 years later at 50 years of age, I would be working more hours than I did as a resident and having latchkey children who achieve less than me since I have no time to spend with them them. The reason: skyrocketing malpractice rates, cuts in reimbursements, difficulties in scheduling patients, facing disrespect and insults, and working in an environment which is not conducive to well being.

I am impressed that Doctors for America appreciates the fact that as physicians we should once again be able to provide unrestricted care for our patients instead of constantly arguing w/ clerical workers to provide needed appliances, _RHoGam injections for patients,or D & C for post menopausal patients who are ultimately is diagnosed with uterine carcinoma.

The sad part is that we as physicians are part of the crime. We allow ourselves to be labeled as PROVIDERS; we act as GATEKEEPERS for insurance companies under the guise of medical directorships for a cushy salary; we donÕt look at the big picture, which is that everyone is losing out. The patients have nothing to gain when they lose physicians who are qualified and actually care about the well being of their patients. I hope I affect the struggle in front of us at this time.

3 things cost too much: unnecessary tests, medications and treatments. Patients pay nothing for their care and want everything done. Millions are spent on individual patients in the VA who have no potential for recovery, just to keep them alive because their families (who pay nothing) say so.

"Not for Profit" hospital systems bully and consume private practice physicians groups and purchase their practices under the guise of providing better benefits and less overhead. They then produce factory-style hospitals and office practices that remove doctors from those hospitals, which cranks out more outpatient encounters and increases profits for the system. Physiscians are put on productivity-based salaries to drive the machine, while system administrators make millions in salaries and bonuses and never see a patient. Health care dollars are wasted on plush offices and non-essential perks! The notion that health care costs are driven by high physicians' salaries is ludicrous! These hospital systems must be reigned in!

I am Medical Director of a program for patients with psychological trauma, who often have multi-axial psychiatric, medical, and psycho-social pathologies. We have an inpatient and outpatient program as well as research and postdoctoral training.

America's health system wraps the worst of a private system and a government run system into one package. Private insurers "carve out" mental health care and do not link it with costs for physical health care, despite abundant evidence that psychiatric illnesses are a huge part of primary care and that successful management of psychiatric illness has a positive impact on overall health care costs. Further, the ACE studies from the CDC show that childhood trauma is closely linked to poorer mental, physical, and psychosocial health outcomes.

Despite the overall lack of cost efficacy and negative impact on patients, the managed care system attempts to control costs by limiting patients' access to inpatient and outpatient psychiatric care. The insurers' attempt to force the sickest psychiatric patients into the public system and, as one person put it, de-institutionalize the middle class [who have] insurance. They limit payments for Day Hospital Services, patients and providers are squeezed in every direction. In one estimate, more than 50% of psychiatrist in the Baltimore area no longer accept ANY type of insurance due to the minimal reimbursement provided by insurance payors. Accordingly, patients who can not afford private fees can only go into the public or institutional systems. This is a disastrous, not only because of the mental health impact, but also the impact on overall health outcomes. My internist colleagues tell me that if they spend time counseling patients, and bill accordingly, their bills are DOWN-CODED and thus reimbursed LESS for the coordination, education, and counseling that allows for the best care.

The system is fundamentally broken. The incentives are all backwards and competent care is punished by the managed care system. The Republicans and others decry "rationing". However, WE DO RATION care endemically in our system, so that many services are not available or only partially available to a large number of patients. Since there is no societal appraisal going into this process, as in other countries' systems, those with the most limited resources (and often a broad range of health problems) get the worst, most fragmented, and least effective care. When hospitalized, massive resources are put into heroic treatments that could have been avoided by adequate primary care and/or more careful decision making about how resources should be allocated.

In my hospital work, I am continually forced to review care with managed care doctors, who often, even while professing otherwise, have only one interest: reducing payment for inpatient days. They are rewarded if they can limit costs and are treated negatively if they don't. Further, the managed care reviewers, with few exceptions, have no expertise in the diagnosis and treatment of trauma disorders. They apply review criteria to our patients that do not fit the needs of the population, many of whom require more intensive psychiatric resources and who have high costs in medical utilization. Appropriate, evidence-based care can reduce overall health costs for this population, although this improvement may take several years to be apparent. The current insurance system is devised to obscure this and to devalue psychiatric care/trauma-specific care. The lack of integration of psychiatric and physical health care is disastrous; the devaluation of mental health care, and psychiatric care in particular, compromises health outcomes across the board.

I met a psychiatrist from Sweden who told me, "if the Swedish health system tried to treat psychiatric care differently than medical health care, the population would rise up as one to protest". Not here.

Currently, Medicare reimburses psychiatric hospital care at below cost. However, even though Medicare fees for psychiatric care are too low, they are BETTER than those paid by virtually every commercial insurers. The commercial insurers also use inefficiency to prevent people from being paid for claims. The entry-level call centers make every attempt to stymie patients; they rarely have consistent information or consistent follow-up, and their agents are often low-level, poorly-paid clerks. The goal appears to be to deter people (especially those with mental illnesses who may be easily confused or embarrassed) from pursuing reimbursement. Pursuing claims requires my administrative assistant and I to make multiple calls and request to speak with supervisors (who are always elsewhere). The goal is to make us go away. Or at least hold onto the money longer to support the company's investment income. What a joke that these clowns are crying that reform will cause "the end of civilized life as we know" as if some miraculous wonder will be destroyed. If the current system was so great, why would we have the current problems? Not only do we need a public payor, we need to massively control and regulate the insurance system to prevent these sorts of egregious practices. Follow the money.

Since we worked for the same hospital system, I dropped my Blue Cross insurance and went onto my wife's policy. A few years later, I contracted a rare soft tissue malignancy called gastrointestinal stomal tumor. I started on a medication called Gleevec, which currently costs over $6000 a month but for which Blue Cross paid the vast majority. In early 2008, my wife developed lymphoma that was resistant to all chemotherapy. In 9 months she exceeded the "lifetime cap" of $1M in benefits after an unsuccessful bone marrow transplant. She died early in 2009, leaving me without insurance and with several hundred thousand dollars in health care bills. With the diagnosis of GIST, I am uninsurable, paying a premium for COBRA benefits that will expire before I'm eligible for Medicare. "Harry and Louise" could lose their insurance instantly at no fault of their own.

Private health insurance companies make submitting a claim and getting it approved and paid very complicated, often with multiple submissions of the same item in order to get it finally approved. What a waste of time. Why not have a system where people get care and there is no paperwork? Imagine the savings.

Moreover, there is virtually no way for any given service to understand what is being charged and what paid. There are multiple billings for the same medical event. The paper trail is enormous and very confusing.

I see this both professionally in my practice and with medical issues in my family, and I am supposed to have a good insurance policy.