May 20, 2006
Congratulations! After four long years of endless work, sleepless nights, and constant stress, you can finally look forward to three years of even more work, less sleep, and stress that may tempt you to self-prescribe.
But hey, at least there's June!
Of course, you knew all of this coming in. You understood the sacrifices involved and the commitment necessary to become a doctor. You were aware that it would take years of your life and leave you with significant debt.
And yet, you signed up anyway.
You chose this profession because you heard a calling; and in answering that call revealed that you don't just see this as a profession. From now on, doctor won't just be a title you'll hold, it will be a part of who you are - a healer, a saver of life. And no matter where you may be or what situation you may find yourself, you will forever come forward at the first sound of the question, "Is there a doctor in the house?"
This is a good thing. I mention it not to add to the burdens that must already weigh heavily on your shoulders, but to point out that your distinct commitment and compassion for the lives of your fellow human beings is a quality that has intrinsic value far outside the doctor's office or the operating room.
And it is because of this quality that I want to ask something of you.
Life often happens in a way that makes it easy for us to miss the larger obligations we have toward one another. The demands of work and time and money tend to narrow our focus and cause us to turn inward. You might flip on the news or pick up the paper and feel moved by a story about genocide in Darfur or the AIDS epidemic or the fifteen-year-old who was gunned down in front of his house. You may even feel compelled to do something about it. But inevitably, it becomes time to study, or go to work, or cook dinner, or put the kids to bed - and so we often turn away from the big stuff and concentrate on simply surviving the small.
This is perfectly human. It is perfectly understandable. And yet, the survival of our country has always required more. It has required ordinary men and women to look beyond their own lives; to think about the larger challenges we face as a people - and then rise to meet them.
This is what I'd like to ask you to do today.
In a few months, your residencies will begin. And on a daily basis, you will encounter patients with every disease and ailment imaginable. There will be heart problems and lung problems; common colds and deadly flus; broken bones and painful diagnoses.
But after being there for awhile, you will encounter another, more pervasive affliction that affects more than just individual patients. Perhaps you will first notice it when a doctor tells a woman that her husband will need a life-saving procedure that their insurance will not cover and their family cannot afford. Perhaps it will be the late-stage diagnosis of a cancer that could have been prevented with a routine screening that the patient's health care plan just doesn't cover. Perhaps it will be the endless stream of people who wait and wait in an Emergency Room which is the only place that will treat the uninsured.
At some point in your residency, you'll see firsthand that there is something fundamentally broken about our health care system. You'll realize that for millions upon millions of Americans, the care you provide is becoming far too costly for them to afford. And you'll have to decide what, if anything, you're going to do about it.
You've all heard the statistics - 46 million Americans uninsured. 5 million more in just the last four years. Family premiums up 65%. Deductibles up 50%.
It's a cost crisis that traps us all in a vicious cycle. Because the uninsured can't afford health care, they put off seeing a doctor or end up in the ER when they get sick. Then their care is more expensive, and so premiums for all Americans go up. Because everyone's premiums go up, more Americans lose their health care.
From the smallest mom and pop stores to major corporations like GM, businesses who can't afford these rising costs are cutting back on insurance, workers, or both. States with bigger Medicaid bills and smaller budgets are being forced to choose whether they want their citizens to be unhealthy or uneducated. And over half of all family bankruptcies today are caused by medical bills.
This is affecting your profession too. Whether it's Medicaid reimbursements, the rising price of medical malpractice insurance, or having HMOs look over your shoulder, all the hard work and sacrifice you've put in during medical school is becoming less rewarding than it once was.
And so today I ask you to be more than just practitioners of medicine; I ask you to be advocates for medicine. I ask you to be advocates for a health care system that is fair, that is just, and that provides every single American with the best your profession has to offer.
Just like generations before, you must dare to believe - not only as tomorrow's physicians, but as tomorrow's parents, workers, business owners, and citizens. You must choose: Will the medical miracles you perform over the next generation reach only the luckiest few? Or will history look back at this moment as the time when we finally made care available at a cost that we can afford?
There isn't one person sitting here today who wants to turn a sick patient away because they can't pay. Not one person who wants the care they deliver denied to those whose lives depend on it. Each of you has dedicated yourselves to this calling because where there is a sick person, you want to heal them. Where there is a life in jeopardy, you want to save it.
And so today, when you leave here, it will not only be with great knowledge, but with even greater responsibility. Because if we do nothing about the rising cost of health care, it will keep climbing, and in ten years, the number of uninsured could grow to 54 million.
We can solve this problem. Challenging as it may seem, all over America there are already business owners and political leaders and labor representatives and members of the medical profession who are coming up with new and different ways to cut costs and improve quality in our health care system. In Massachusetts, they just signed into law a groundbreaking plan that would cover most all of its citizens.
This can be our future, but everyone needs to stay involved, and everyone needs to put the pressure on Washington, because they sure won't do it on their own. Just a little while ago, we were told that it was "Health Care Week" in the U.S. Senate. Five days later, we had failed to debate even a single bill that would have fundamentally improved access for the 46 million Americans without health insurance.
This is why we need you. We need you to dream, we need you to speak out, and we need you to act. And together, we can build a health care system in this country that finally works for every American.
We can have a system where no matter how many times you switch jobs or how large or small your employer is, you have a health care plan that stays with you forever.
We can have a system that reduces medical error and cuts costs by using 21st century technology to put all of our medical information online. A system where every doctor and nurse can sit by a patient's bedside with a laptop and pull up their entire medical history with the click of a mouse. Where every patient has an electronic bracelet that you could scan to find out the exact type and amount of medication they needed so there are no mistakes made. Where you could go online and monitor a patient's breathing and heart rate while they were home to track their recovery.
We can have a system of evidence-based health care that shares information about what works and what doesn't, so we can actually provide patients with the care they need when they need it.
And we can have a health care system where we focus on preventing deadly and costly illnesses before they occur - where we ensure that every American has routine check-ups and screenings and information about how to live a healthy lifestyle.
We can do all of this - but we need your help to get it done.
Of course, no one's forcing you to meet these challenges. Each of you has been blessed with extraordinary gifts and talent. And so if you want, you can leave here and focus on your own medical career and your own success, not giving another thought to the plight of the growing millions who can't afford the care you will provide. After all, there is no community service requirement in the real world; and no one's forcing you to care.
But I hope that you do. Not because you have a debt to all of those who helped you get to where you are, although you do have that debt. Not because you have an obligation to those who are less fortunate, although you do have that obligation. You need to take on the challenges that your country is facing because you have an obligation to yourself. Because our individual salvation depends on collective salvation. Because it's only when you hitch your wagon to something larger than yourself that you will realize your true potential.
Looking out at this class of 2006, I think my hope is well-placed. With the field you have chosen, you've already shown how much you care about the lives of others; how strongly you have heard the calling to be healers in this world. Today, I ask you to remember that call always, and to remember how it could include more than the patient sitting in your office. It could also include the patients who can't afford to get there, the ones who aren't being provided the best care, and the general health of all Americans.
When you think about these challenges, I also ask you to remember that in this country, our history of overcoming the seemingly impossible always comes about because individuals who care really can make a difference.
A century ago, who would have dared to believe that in just one hundred years, we would add thirty years to the average lifespan and witness a 90% drop in the rate of infant death? Who would have dared to believe that with a simple vaccine, we could eliminate a disease that left millions without the ability to walk? That we could transplant a heart or resuscitate one that stopped? That we could unlock the greatest mysteries of life from the most basic building blocks of our existence?
In a time where you were lucky to live past fifty and doomed if you came down with the flu, who would have dared to believe these things?
The people who once sat in your position - they did. The doctors and nurses, researchers and scientists who came before. Who grew up believing that in America, the most improbable of all experiments, the place where we continue to defy the odds and write our own history, that they could be the ones to improve, extend, and save human life. That they could be the healers.
And as you go forth from here in your own life, you can keep this history alive if you only find the courage to try. Good luck with this journey, and congratulations on all of your achievements. Thank you.