Eternal Optimism

Eternal optimism: a coupling of words I do not believe I have heard before today. In times of adversity and hardship, an eternal optimist looks on the bright side – the glass half full – the grass greener – things could always be worse and we are headed in the right direction.

I just arrived home from The Atlantic‘s Health Care Forum in D.C. where today’s experts in medicine, public health, public policy, and health administration (a medley of self-proclaimed eternal optimists) gathered to discuss our nation’s health care system and future direction. Considering I have been pursuing health care as a career for the past five years, I should have heard the phrase “eternal optimism” before, but this was one of my first experiences where the primary discussion was policy as opposed to health itself. Perhaps health practitioners are forced into realistic worst-case scenarios, and policy-makers are forced to plan optimistically. Somehow, I thought it would be more the opposite. Politicians by nature disagree constantly; the voice of the opposition endlessly proclaims how the current administration is screwing up. That’s one of the many reasons we alternate between Democrat and Republican administrations. On the other end, practitioners provide treatment options, suggesting that patients can heal, that there is hope. Even hospice care is a field that empowers patients to take control and accept their conditions as they are – to enjoy the short time that is left, living to the fullest capacity. In any case, it seemed that eternal optimism was a theme throughout the talk, and it got me thinking…

I consider myself extremely fortunate. My parents immigrated from Iran to earn American educations and to live the American dream. It might sound cliché, but it’s true. I constantly hear about my friends who want to get out – out of their current city, state, region, or the country altogether. Meanwhile, I am a total homebody. I love where I grew up, and I cannot imagine living permanently in any country besides my own. My parents raised me in a manner that made me appreciate something certainly taken for granted in the United States – freedom. Even within the household, my brother and I were free to believe what we wanted, say what we believed, and do what we wanted. Both of us became independent at a young age with discrete moral beliefs and thrived as very different individuals who chose very different paths. That is the beauty of freedom.

There are classic human rights we automatically think of: freedom of religion, freedom of expression, and freedom of assembly (to name a few). I think one big freedom has unfortunately become a privilege in our country – an appropriate standard of living. “Everyone has the right to a standard of living adequate for the health and well-being of oneself and one’s family, including food, clothing, housing, and medical care” (UN Universal Declaration of Human Rights). Certainly, not all things are in our control. A lot of health is determined by genetics, but we have the power to change the environmental and societal impacts on health. We can assume very different prognoses of a sick child  based on where the family falls in the socioeconomic hierarchy, and nobody should be okay with that.

Again, I consider myself extremely fortunate. I have always been healthy. Anytime I complained about co-pays, my parents reminded me to never think of money when it comes to health, that life is more valuable than any dollar amount – especially for preventative services. Unfortunately, the money game for Americans changes quality of life, access to resources, and health outcomes. A big part of today’s health forum discussion revolved around treating the social determinants of health, like education and poverty, investments with positive downstream effects that ultimately reduce costs. The US spends a whopping 17% of its GDP on health expenditures, and yet we have some of the worst health outcomes in the developed world. Stemming from talks of “eternal optimism”, I see so much potential in where our country can head in terms of health care policy, a potential that I do not want to see wasted as I progress up the ladder as a medical professional.

Preventive health care should be the epicenter of medicine, where diseases are detected and treated in early stages. We would like to think we are invincible; in reality, we will all die sometime between this very second and the next century. It’s a shame that primary care is downplayed in the hierarchy of medicine. Specialties are glamorous: there is more money and more respect. At least we are on a positive trend in the medical education system incentivizing careers in preventive health care, but health policies should encourage preventive health as well.

I have heard talk about rationing health care due to limited resources and high expenses, but we can change this thinking if we approach health care differently. When you address treatments before a disease state progresses, you avoid greater costs down the line. For example, it’s better to pay tens of thousands a year for hepatitis treatment early on than to wait until the disease requires a liver transplant upwards of a half million dollars (an intriguing article in case you’re interested in hepatitis C health care spending in relation to new drugs on the market: http://www.usatoday.com/story/news/nation/2014/03/03/stateline-hepatitis-c-drugs-health-care-spending/5973133/). Besides catching chronic and acute illnesses at their early stages (behavioral illnesses included), we should publicly address the burden of health costs. For a chronic illness like Gaucher disease (although this is quite rare), annual enzyme replacement therapy costs about $200,000 a year. Imagine the quality of life of an individual with Gaucher disease who has to struggle with both a physical ailment as well as the unrelenting costs of a chronic illness. Paying premiums suck, but knowing that the money is an investment in one’s future health and covers treatment costs for other individuals with severe health problems makes me better understand the complexities of the system.

We have a long way to go, but I see why there is so much eternal optimism; it fuels movement into a positive direction. By no means am I as educated on this topic as I should be, but I think these are interesting topics to ponder. Hopefully we can all sympathize with the plights of the current health care system and think of ways to improve it for the future of our nation.