Now the Constitutional Battle Is Over, Let's Embrace a Shared Health System

One physician's sigh of relief at today's ruling. 



I'm one more doctor proud of the fact that the Patient Protection and Affordable Care Act has passed its test of constitutional muster. In this solemn moment, American health care has become a national priority. Every health care worker shares in a refreshed responsibility not just to our patients, but to our country's well being. The act not only offers a health insurance safety net for all, but will start to build the evidence-based infrastructure we need to treat the toughest cases.

I welcome the nation's new found interest in health into my daily worries because I'm the kind of doctor that you truly do not want to see -- at least not until something catastrophic and entirely unexpected has happened to you. A brain injury is never part of anyone's imagined future; people consider it far less a possibility than cancer or a heart attack, but close to ten million Americans are living with disabilities caused by traumatic brain injury (TBI) and stroke. More than 10 percent of this country's population is currently struggling with some form of neurological disability. These are numbers no region can cope with on its own; these are needs that require national standards of care.

If TBI survivors live through the part where they're lying unconscious at the scene, the neurosurgery, and the intensive care unit, they might finally make it to a rehabilitation hospital where many will regain basic functions. But the story of rehab is also the story of becoming rapidly destitute before finally going on public assistance. That's the fate of most of the patients with severe brain injuries that I see, even for the college age kids. The quality of the medical coverage offered is at the whim of the state you live in, which can seem all too cruel on certain state lines (as I've written about before).

Because what comes next, after critical care, is so often an afterthought it's not addressed well by many major insurance plans. Here in one of the wealthiest communities in Massachusetts, I see patients on good private insurance who can't get into the rehab hospital. If your brain injury is particularly severe it's the policy of one major national insurer to send you to a nursing home until it looks like you can "participate" in rehab. Left unsaid is who at that nursing home will make that determination. It's combating private insurance policies like these that makes me thrilled for opportunity to appeal to our nation and its representatives instead of the insurance administrators on the other end of my telephone line. This country as a whole has more heart that any private insurance company. The pursuit of life, liberty and happiness is nowhere to be found in your insurance plan.

Paying for rehabilitation in this country often means church yard sales and the support of friends and neighbors. These kind offerings needn't be so desperate. We've built a structure where those without deep-pocketed churches (or no church at all) and those who don't live in the tony neighborhoods are just out of luck. No the ACA hasn't created a single payer national health system, but it's created something just as good: national standards. Minimums of care that private and public insurers must live up to. With this new reality the people and their health care providers now also have new channels to lobby for better care and proper market regulation.

The next time some insurer is keeping my young TBI patient stuck in a nursing home I'm calling on you, America.