Again I find myself looking at the Affordable Care Act, aka ObamaCare and wondering how did we get here? With a rapidly aging population and escalating costs some changes were inevitable. We spend more per patient but get worse results. I have heard and read many blaming the newly arrived sicker immigrants and the lazy minorities. Those attitudes represent the bias in the healthcare system were minority patients are often not treated with the respect they deserve and often get substandard care.  As a minority physician I saw this a Medical student and choice to do rotations in areas with significant minority populations. What I realized is that poor care is not a choice of commission, it is most often a result of omission. The truth is that most patients get great care, but the system often gets it wrong with minority patients. Having family members with great insurance and serious chronic medical issues puts the disparity in care front and center. Lack of insurance is not the most significant problem. The problem is bias. On countless occasions, care is significantly delayed for no apparent reason. As a physician I can make that statement with confidence, because I have experienced it on many occasions. That loud minority patient is not just loud, but loud because after giving the system the benefit of the doubt she or her family is still sitting waiting for urgently needed care. I usually do not announce that I am a physician and thus get to experience the treatment I often heard about but did not believe. I am here to affirm the assertion, if you are a minority patient you will get poor treatment.

Will any of the changes of ObamaCare make the care of minority patients any better? I am not sure, but at least outcomes are being closely tied to pay. Yes I went there. Tying objective criteria to payment is an excellent means of encouraging improved care. We might not want to accept that outlook, but if we expect our patients to take their medications as prescribed why shouldn’t payers expect us to provide evidence based care. If we would enforce some self-regulation we would not be here. For minority patients we are hoping that our care improves with the general expectation of higher standards. This is our hope for ObamaCare.

As a physician I wonder about the goals of Obamacare and lament the loss of freedom. I dread the arrival of the heavy hand of government regulation. The problem is that as physicians we have not been good stewards of our privilege. As a group we are reactive not proactive. Unfortunately we are once again reacting to the new paradigm. Many of these changes have been in the works for significantly longer than the discussion that  surrounds ObamaCare. Instead of organised self-regulation we now have government mandates. These mandates are not the answer, judicious self-regulation is the answer. We need to examine the new paradigm and workout a constructive path to achieving our goals.

No matter what our goals are, the constant absurd chatter about the evils of the law is a waste of precious time. I suggest a more constructive conversation would be to evaluate how we got here, look for the future challenges and proactively respond. We are problem solvers. Let us look closely at the issues and solve the problems before the government goes further in destroying the practice of medicine.


I think I spend most of my day considering how I can improve the life of my kids. How can I help them succeed? How can I help them overcome the low expectations that society has of them. As soon as I think I really do not have anything to worry about someone opens their mouth and I despair. Success starts with education and educational success is about expectations. Education is life long and not about getting a job, it is about being equipped to contribute to society. Expectation start at home.

Children need to see their parents making an effort. They need to understand that life is challenging and that they have to push to succeed. They need to experience failure early so they understand that life is not all strawberries and cream. Only by allowing them to fail can they truly understand the joy of success. This joy is what develops confidence. The type of confidence that laughs at a society that does not expect much from them. They need to develop that confidence early. If you are an American of African heritage that development of confidence needs to happen really early because no matter how well you perform the expectation is that you are not good enough. Confidence in spite of low expectations will allow them to take hold of the new experiences on offer at school.

The evidence is clear that good quality preschool is an important part of preparing kids for success. What is good quality preschool and does poor quality preschool damage your kids? The latter question is what concerns me the most these days. I know I am preparing my kids for success. I am confident that they are well prepared. But in spite of what I do at home the need to learn the social rules cannot be taught from a book. They need to learn to tolerate stupidity without resorting to violence. They

The Princesses
The Princesses

need to learn to work with strangers. They need to learn to identify the predators. Socialization at school is where that all starts.

The unfortunate thing is that the quality of preschool in general is low and I am concerned about the low expectations that  the system has of them. Allowing low expectations of minority kids is driving the nail into the coffin of our country. The majority of the popular soon will be from those minority groups for which expectations are low. If they have not gotten a good education, who will be taking care of the country in our old age?
I am mad, not because I care about the in ability to see that my kids intellect is not defined by her skin color, but that we do not see the harm being doing to this great nation.
Our kids are bored and misbehave. They need to be challenged. It is hard work but it can be done. My experience so far does not give me any hope for improvement in the quality of education and specifically preschool. I still think we can turn it around. Expectation is success. My parents expected their kids to succeed and we did. My teachers expected us to succeed and provided us a challenging educational environment. Thanks. I will do the same for my princesses because they deserve to succeed. They will succeed because I expect it of them.
What are your expectations?