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A DOCTOR'S OP-ED - Every day I walk into the hospital, I am reminded that California’s healthcare system is held together by people doing their best under increasingly impossible conditions.
As a resident physician in neurology at UCLA, I rotate between Ronald Reagan UCLA Medical Center, the Los Angeles County hospital at Olive View, and the Veterans Affairs Medical Center. I chose neurology because the brain is central to who we are—to our memories, our independence, our dignity. It’s a privilege to provide care to people facing terrifying moments like a sudden stroke, or a first-time seizure, and to explain what is happening in their brain and how we can help them regain their health.
But more and more, what determines whether patients recover isn’t medical knowledge. It’s whether they can afford care.
Residents like me routinely work 80-hour weeks to keep emergency rooms and hospitals running. Along with other frontline healthcare workers, we shoulder impossible patient loads. Still, patients pay the price: longer waits, shorter visits, delayed treatment, and rising costs for even basic care. And that is our reality before nearly $100 billion in federal healthcare cuts from HR1 begin to take effect.
As a neurologist, I am trained to recognize a crisis and intervene early—before damage becomes irreversible. Today, the warning signs are unmistakable. Without swift action, California is headed toward a healthcare collapse: emergency rooms closing, hospitals overwhelmed, and millions of Californians losing their healthcare simply because they cannot afford it.
When people cannot afford care, they delay it. I have seen patients wait out symptoms at home, only to arrive days later with devastating, life-altering strokes. Others can’t access newer medications with fewer side effects because they are underinsured, and so they make do with lower cost alternatives.
To make matters worse, bare-bones insurance plans will routinely try to deny covering the costs of necessary hospital stays. I recently cared for a stroke patient that had a very difficult recovery. His insurance company resisted covering most of his hospital stay, which costs thousands of dollars. They even tried to deny a safe discharge plan that included standard rehabilitation—physical, occupational, and speech therapy known to improve recovery. Our care team had to fight just to secure what should have been automatic. The gap between what medicine can offer and what patients can afford is staggering.
This is what keeps physicians up at night as California faces massive federal healthcare cuts. We live in the fourth-largest economy in the world, yet patients here often experience worse access to care than people in far less wealthy countries.
California exceptionalism rings hollow when nearly all of us will eventually confront these barriers. The wealthiest one percent may always find a workaround. Everyone else will not.
That’s why recent remarks by Governor Newsom about the Billionaire Tax are so troubling. This is not an abstract fiscal debate. It’s a real-time threat to patient lives.
The Billionaire Tax is a common-sense emergency solution. A one-time 5% tax on roughly 200 billionaires whose combined wealth exceeds $2 trillion would stabilize healthcare, protect healthcare for millions of Californians, and provide much needed funding for food assistance and K-14 education. This isn’t about punishing success. It’s about preventing collapse.
Without a revenue solution, physicians across California anticipate ER closures across urban and rural communities, ambulance diversions stretching 50 or 100 miles, dangerous delays in care, and skyrocketing premiums for working families and small businesses. Even the wealthiest Californians cannot receive emergency care at a hospital whose ER has closed.
Physicians enter medicine to care for everyone, not just those who can afford it. A healthcare system where people live in fear of illness because treatment is unaffordable is untenable.
Supporting the Billionaire Tax would avert a healthcare disaster and protect the patients we have sworn to serve. For the doctors, nurses, and healthcare workers keeping California’s hospitals running, and the millions of patients who depend on us, the stakes could not be higher. Lives depend on the choices our leaders make right now.
(Brendan Cohn-Sheehy is a resident physician in neurology.
