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What I Remembered On My Birthday

By Dr. Evan Saulino

I had a birthday recently. 

I remembered that I forgot to schedule the preventive health visit I promised I would when it was my birthday last year.  I kept planning to do it next week.

The older I get the more time seems to speed up.  Work and other things pile up, we get going faster and faster on our treadmill, and we can start feeling like a bit like we’re playing Speed Twister.

I blink and summer has passed me by - its almost Thanksgiving – what happened? A year is no time, and when I look back, 5 years seem to have passed in a flash. 

So it’s important on some personally momentous occasion like a birthday – when I have the opportunity to step back, and get perspective about the past year, 5 years, 10 years - to celebrate what has passed, what has been accomplished, and to open my mind to what the future may hold.

The fact is, just five years ago, I was nearly ready to give up on medicine. 

So frustrated with a decaying and insanely organized health care system that seemed to punish my patients, I thought I might do something completely different, away from health care. 

“Maybe I could open a coffee shop,” I thought.

Of course, back 5 years ago almost to the day, I had to sit, essentially idle, and watch “Irene” die.  

“Irene” was a hardworking American in her 40s. She had been married for 20 years and had 3 children.  She had just moved from a job without benefits to a new one, which paid better and offered health insurance after 6 months of employment.  Her future was looking bright.

Then she began to experience symptoms she knew were not normal, but she put off coming to see me – her doctor - because friends had warned her about “pre-existing condition exclusions”.  She was afraid treatment for her problem, whatever it was, would not be covered by insurance if it was discovered before her coverage officially started.

She thought she could wait the 6-month “probation period” at her job and then go to the doctor.

She was wrong.

Her cancer caught her first.

So much has changed in 5 years.

Now we have a law – the Affordable Care Act – that has made pre-existing condition exclusions illegal for those under 19 years old, and will outlaw them for adults – people like “Irene” – beginning in 2 more years. If implemented well, these and other protections should help the insurance market work better for Americans and would make sure stories like “Irene’s” only continue to exist in our history lessons.  

Now we have a strategy to help insure over 30 million more Americans by 2014.

Now we have the ability to limit insurer profits, and to shape the rules of the new insurance marketplaces – state insurance “exchanges” – so they begin to foster improvements in insurance company accountability and efficiency, and the investments in high value primary and preventive care we need. 

Now policymakers have begun to recognize that we don’t have the numbers and kinds of doctors and nurses we need for the 21st century in America. We have made a “down-payment” to start training more.  

Now, instead of the foreseeable future consisting of running faster on the “Relative-Value-Unit” hamster-wheel, policymakers have begun to recognize we should stop paying for quantity rather than quality.  We are now talking about paying more for the value offered by good primary care, and are beginning to foster innovative and well-coordinated, team-based care delivery that can produce better outcomes at lower overall cost.

Now, doctors like me who work on the frontlines of American health care are organizing and amplifying our voices through movements like Doctors for America. 

Five years ago I would not have thought most of these things were possible. Now, I no longer want to leave health care – I’m determined to keep making it better. 

I guess sometimes when there’s such a big hill to climb, it can seem that we’re making no progress.  But sometimes when we stop, rest for a second, and take a step back, it can help to change our perspective.   

I am hopeful that when I look up and realize another 5 years have gone by, I’ll be even more amazed at how far we’ve come.   


“Cuando canto mi cancion quiero inspirar mi gente con una solucion
Cuando desperto en la manana se que tengo el poder para un dia triumfar
Cuando me acuesto en la noche puedo mirar estrellas que me dan esperanza
Cuando sueno en la madrugada ojala que mi trabajo no es temporal
Cuando canto mi cancion.”


“When I sing my song I want to inspire my people with a solution
When I wake up in the morning I know that I have the power for any triumph
When I go to bed at night I can see the stars that give me hope
When I dream in the early morning I hope that my work is not temporary

When I sing my song.”

- “Cuando Canto” by Ozomatli

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