Anyone who knows Dr. Michael Attas knows that, as a physician, a preacher and a philosopher, he never ceases to turn issues over and over in his head. He seeks new epiphanies and questions certain paradigms. So it’s no surprise his new book, “Medicine at the Crossroads: A Collection of Stories and Conversations to Forge a Vision for Health Care” — while drawn from his popular Trib columns several years ago — nonetheless offers a fresh, inquisitive look at the sprawling, confounding topic of health care.
The fact he’s rearranged, revised and expanded upon these original essays makes his book well worth seeking out. Health care remains one of the most divisive, misunderstood issues of the day. Polls show it ranked as one of the two most dominant issues in the midterms, especially amid ongoing warfare over the long-battered, partially dismantled Affordable Care Act.
“I don’t begin to have the solutions,” the 71-year-old cardiologist said of such issues as health-care access, quality of care and cost. “And this book is not really an Obamacare vs. Trumpcare critique. But we are spending 18.5 percent of GDP on health care and that’s an unsustainable figure. I just noticed in [Friday] morning’s New York Times that it went down to 17.9 percent [of the U.S. economy], but most say it’s going to settle at around 19 or 20 percent. Yet we’re getting a lower return on our investment than any industrialized nation in the world. We’re spending more and getting less return, less bang for our buck. And I think eventually we’ll have to have a legitimate conversation that doesn’t descend into demagoguery.”
Surveys suggest Americans are more confused than ever about health care and want helpful solutions, not rhetoric. Attas says one solution might be a two-tiered system in which every American can access basic health insurance, possibly through a federal program resembling Medicare (though he dismisses “Medicare for all” as too simplistic). Americans wanting more generous health-care coverage could buy that in the competitive marketplace. Right now, though, the political environment is too toxic for such conversations.
“You’ll have to wait till the stock response to any of this is not to throw ‘socialism’ as an epithet into the conversation,” he told me. “Nobody is talking about a government takeover of private practices or hospitals. I mean, the government is not going to come in and nationalize the health-care industry. That’s never going to happen. And that’s socialism. That doesn’t mean we can’t have a legitimate conversation about doing a better job of using the resources we have wisely.
“I mean, here’s a shocking statistic: Twenty-five percent of all federal health-care dollars are spent on the last 30 days of life in terminal diseases. And that’s nuts. We don’t need to be replacing heart valves in 90-year-old people or putting dementia patients on dialysis when their kidneys fail. I can give you historical reasons why that stuff has happened, but we need to have a frank conversation about end-of-life expenditures without Sarah Palin telling us that we’re creating death panels.”
This may be why Attas, retired chief of cardiology at Hillcrest Baptist Medical Center and a retired Episcopal priest, placed so much hope in founding the medical humanities program at Baylor University, the first of its kind. Coursework includes close examinations of the patient-physician relationship, the power of faith in healing and the handling of grief and loss. Attas believed Baylor’s burgeoning pre-med population would benefit more from such studies now rather than in medical schools or residency programs consuming 120-hour weeks. (Dr. Lauren Barron has led this terrific program since Attas’ retirement.)
Much of Attas’ book stems from questions posed by some of these pre-med students. Already he’s writing down more thoughts on medicine, including his own grim in-patient experiences after septic shock nearly killed him a few weeks ago. He complained to me of hospital mattresses but had nothing but good to say of the care he received from physicians and nurses — most of whom didn’t know him.
“Now, my hospitalist was a friend of mine, but he never brought his computer into the room,” Attas said. “He always did his computer work outside, got the lab work data in his brain, came in and talked to me about it and then went back out to chart things. All that was done out of my sight. When he was with me, he was engaging me as a human being, not as a bunch of data, and I really, really liked that. I was just lucky. I got great care early. And they saved my life.”