Published by the New York Times December 31, 2017
By Tom Brokaw
President Trump is vowing to return to two of his favorite goals in 2018: a crackdown on immigration and the dissolution of the Affordable Care Act.
When congressional Republicans passed the sweeping tax bill in December, they eliminated the A.C.A.’s health care mandate. But President Trump wants to knock out the entire program.
As I have learned in the past four years, immigration and health care in America have an organic relationship that may escape the president and his supporters if they experience health care only from the outside looking in.
I’ve been an active pilgrim in our medical culture, as a cancer patient, a kidney stone carrier, a victim of a mysterious vertigo condition and the owner of a battered elbow resulting from a hard fall on a New York City street.
What I’ve learned is that American health care is a universe of scientific genius and selfless compassion populated by what seems to be the most diverse population in the country. Spinal surgeons of Russian origin and American training, Ecuadorean eye specialists, Chinese imaging experts, Kazakh physical therapists, East Indian oncologists and an elegant orthopedist from Bologna (we traded New York Italian restaurant recommendations) — I’ve met them all.
It is not just New York hospitals that are an ethnic “purée,” as an Argentine nurse at Sloan Kettering described the mix to me. Most large metropolitan hospitals are staffed by dedicated workers from just about every continent.
Rural American patients welcome well-trained Pakistani and East Indian physicians in private practice and small-town clinics.
In the middle of white-bread Minnesota you’ll see employees of the Mayo Clinic scurrying through the corridors in Muslim head scarves and Sikh turbans.
I was consulting with a Nebraska-born neurologist, the son of a grain elevator operator, while a Mayo-trained Kenyan émigré expertly drew my blood.
The diversity of our health care system isn’t just about immigrants. In rural America, homegrown physicians worry that their commitment to small communities is being severely tested by hospital consolidations.
In Powell, Wyo., I met a doctor, Nathaniel Rieb, the son of a Presbyterian minister, who is the only general surgeon in the town hospital. He stays because if he leaves, then what?
Nathaniel and his wife have five children, including one severely disabled by multiple sclerosis. They met him on a mercy mission to Haiti and immediately made him part of their family. I left our encounter thinking, “I’d like to be Nathaniel’s patient and his neighbor.”
One of Nathaniel’s female colleagues is equally dedicated to rural medical care, especially for women. She has yet to hear much discussion of the different health care needs based on gender in the Affordable Care Act debate.
My professional and personal curiosity prompts me to inquire how physicians choose their specialty.
The gifted Montana trauma surgeon who expertly repaired my wife’s shattered ankle explained that his father was a carpenter, so he grew up liking to fix things.
My friend the writer Tom McGuane is taken with the back story of Dr. Doug Packer, one of the world’s leading electrophysiologists. He rewires damaged hearts. Dr. Packer explained that his family had an auto business and at an early age he liked to tinker with the electrical systems in cars.
He took that passion to Brigham Young University, the Duke Medical School and eventually the Mayo Clinic.
Our eldest daughter set out to be an infectious disease physician but a season working with female Afghan refugees on the Pakistan border before medical school changed her mind. She became an emergency room doctor because she treasured interacting with patients in immediate care.
As a nation, we have major political, financial and medical challenges ahead in re-organizing the 20 percent of the economy that health care represents.
And, as I’ve learned, America remains a cherished destination for gifted and motivated physicians, researchers, nurses, stretcher bearers and wheelchair attendants from around the world. They’re on the front lines around the clock, an up-close and personal experience that is critical to this monumental task.
Those gifted care givers come in many colors from a rich palette of backgrounds. Their world is on a 24-hour cycle of critical decisions, complicated procedures, tender care and emotional exhaustion. We’re lucky to have them.
They deserve to be heard not just by their grateful patients. When the president’s emissaries meet with Congress and the insurance and pharmaceutical industries to negotiate health care, our care givers, in all their diverse and compassionate glory, should be there too.