I have been reflecting recently on the many inequities of medical care—both in this country and the world at large. America is supposed to have the most advanced medical care, and it does have some of the top-rated hospitals, but the reality is that whether or not someone receives top medical care depends on geography, income, insurance, race, and gender.
I am only alive today because at one time in my life when I was critically ill, I received medical care that would probably not be available to most people. Let’s start with geography. I live in the San Francisco Bay Area, home of two of the top-rated hospitals in the world—Stanford and University of California Medical School, or UCSF. I also live in one of the country’s most affluent counties—Marin County, just north of San Francisco. Affluent areas attract the best doctors and specialists, since people of means expect to have the best; an average doctor would not be competitive here. Next, I am white; studies have shown that white patients receive better care on the whole than people of color. And at the time of my cancer, at age 35, I had the best insurance, a so-called P.P.O., the kind that allowed me to consult any doctor or specialist anywhere. An H.M.O. restricts you to their own set of doctors, and advanced or experimental treatments are often not approved or paid for.
So let’s just briefly go through the many ways that I survived my cancer in a way that most others would not. My personal physician saw that my blood pressure was going up—a mundane symptom. Most doctors wouldn’t see that as terribly significant, but my doctor had the intuition of a master diagnostician; his antennae went up. He sent me for a kidney ultrasound (kidneys control blood pressure). Two technicians did my ultrasound; when one said to the other, pointing to the screen, “What is that?” I knew I was in trouble. It turned out I had a very large non-Hodgkins lymphoma in my abdomen, which by pressing on my kidney was causing my rise in blood pressure. The local hospital did a biopsy and their pathologists said it was one of ten types of lymphoma that was not curable, only manageable. I would be dead in five or ten years.
But my cancer doctor, another superior practitioner, wasn’t satisfied. He sent a slide of my cancer cells down to Stanford, where the pathologist who had written the textbook on this cancer changed my diagnosis to the one form of this cancer that was curable. When it came to lymphoma pathology, that doctor was probably the best in the world. Though I never met him, he saved my life. My cancer doctor called me at 7 the next morning and said, “Come in now. You have curable disease, we are starting treatment.”
Are you starting to see the pattern? At each step things could have gone differently, but I was privileged. I began chemo. There were two protocols available, a well-established, standard one that most clinics used and that worked pretty well much of the time, and a brand-new one just created by Stanford researchers (Stanford had long pioneered the treatments for my kind of cancer). This new protocol was aggressive, and some people died from it, but I was young and my doctor thought I could tolerate it. I had 12 doses of this regimen over nine months, which made me feel quite ill—but I survived it. After that came 5 weeks of daily radiation, this time at UCSF, another world leader in cancer treatment. In the waiting room for my radiation treatment there I met a young man from the Middle East, dressed impeccably in a custom-made suit, who had just flown in for his radiation treatments. His family had the means to send him to the best place in the world, and they had sent him here.
The end result is that I was cured and after 40 years I am still cured. Count the number of steps, the number of forks in the road, where my illness and my treatment could have gone the other way, and I would have died. Myriad people all over the world, with my same type of cancer, did die, I’m sure (this was 1985). They didn’t have the superior diagnosticians, the world-class pathologist, the experimental new Stanford treatment protocol, the superior radiologists—not to mention my solid gold insurance policy that paid for everything.
That was forty years ago. In terms of the inequities of medical care, are things better today, or worse? I’m not an expert on the overall quality of medical care, but based on the articles I’ve been reading in the media I would say the same or worse. A recent article said that medical expenses are the most common reason people file for bankruptcy. Inequity of medical care, like injustice generally, doesn’t improve unless there is an enormous investment in policy changes, political will, time and money, and I don’t see that happening. We live in an age of increasing social Darwinism—that is to say, the rich and powerful get the goodies, which they feel they have earned and deserved, and everyone else gets the crumbs.
I’m glad I’m alive, I’m glad my doctors cured and saved me—who wouldn’t be? But as I reflect on my experience my sense of justice is piqued. Every human being has a right to live, and to be well taken care of. What did I do to deserve to be so special? Very little I think, it was just my circumstances. In sharing my story I hope to contribute one small vote for a different world, a better world, where we all have those circumstances, where we take care of each other and care about each other and no-one suffers at the expense of another’s privilege.