William H. Bestermann

Nearly all men can stand adversity, but if you want to test a man’s character, give him power.

Abraham Lincoln  

William Bestermann MD

Saturday was a very unusual day.  Christmas is coming in a little more than a week.  My wife and I went to see the Stephen Spielberg movie Lincoln.  One of the central stories concerned Lincoln’s very difficult struggle to pass the 13th amendment that made slavery illegal. After 4 years of war to end that terrible practice, incredible suffering and deprivation, and half a million dead soldiers the opposition in the Congress of the United States seemed insurmountable.

Through it all, Lincoln was the object of derision and scorn.  He suffered savage personal attacks.  He was relentless in his effort to  finally abolish slavery and  the amendment passed.  He experienced a brutal death at the hands of those who hated him.  The scene that showed his pale broken body on a blood-stained pillow was heartbreaking.  Service to those less fortunate may often extract a heavy price.

Just before the movie, my wife and I had gone to the post office to mail some presents to my grandchildren.  There was a very long line and so we just settled in for the wait.  Spirits were generally high all around in keeping with the season.

Before long, I noticed that  the man in front of me had a very serious and obvious health problem.  He was about 50, physically fit, and appeared to be strong and active.  He had blue eyes and a broad smile.  He was clean, well-groomed and articulate.  During the course of the wait, he offered me his business card.  He made his living in a service industry that demanded hard physical effort and he was actively looking for more work.

Rodent Ulcer-Basal Cell Carcinom

His obvious strengths made his physical problem all the more disturbing.  On his cheek, at about the level of his mouth, there was a hole about the size of a golf ball and a half inch deep. He conducted himself as if this severe injury was not there at all.

The problem was an obvious malignancy-a basal cell tumor. The hole had heaped up shiny bits of cancer all around it.  In times past, this ailment was called a “rodent ulcer” and I finally understood where that term came from.  I see many skin cancers but usually they are very small.  They are usually removed before any wound forms that will not heal.  The largest wound I have seen in 40 years of practice was the size of a very small pea.

As the time passed, he was at the front of the line alone, and I told him that I was a doctor.  I told him that I was very worried that the problem on his face was cancer and it was very important that he pursue treatment for this condition.

He told me that he had had this problem for 7 years.  He had not had it fixed because he did not have the money to get the care that he needed.  There are many decent, hard working people where I live in Appalachia who are struggling financially.

The consequences of his predicament may very well be horrific.  This tumor will continue to eat away at his face and it will ultimately reach bone.  It will spread into the bone itself, and move more quickly through the small openings in the bone where nerves exit the brain.  It will move into his mouth, nose and brain.  Left untreated it will kill him.  But it will likely be treated at some point.  What could have been a 15 minute primary care visit will require disfiguring surgery and radiation costing tens of thousands and perhaps hundreds of thousands of dollars.

Just as in Lincoln’s time, the rich and the powerful are just as eager to become more wealthy and powerful at the expense of those who are weaker, less aggressive, and less skilled at manipulating our systems to their advantage.  The slavery of 1864 was a more blatant offense, but how can you have a right to life, liberty, and the pursuit of happiness when you don’t have access to care that will prevent your needless death in your prime.

Again, the Congress seems unable to do what needs to be done to protect those who are less fortunate.  The times call for strong leadership.  Medical professionals should insist on systems that give the right care at the right time for all disease that threaten life and limb.  Our leaders need to move to a balanced solution that demands more effective use of our revenue while increasing the tax rate on the most fortunate among us.  Democracy that does not serve the people will not long endure.

William H. Bestermann, MD practices vascular medicine at the Holston Medical Group in Kingsport, TN.

Brian Klepper PhD
Brian Klepper is a health care analyst, commentator and entrepreneur. He is a Founding Principal of Health Value Direct, which connects health care purchasers to high performing, high impact health care services. He formerly served as CEO of the Washington DC-based National Business Coalition on Health, which represents 5,000 employers and unions, and some 35 million people in 52 regional business health coalitions. Much of Brian’s work has been focused on the mechanisms that underlie America’s health care cost crisis and how institutionalized clinical and business practices have distorted care and cost patterns, driving unnecessary cost. His perspective favors patients, whose medical care often exposes them to needless physical risk, and purchasers, whose health care costs are double those in other developed nations, creating a cascade of negative economic impacts.


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