As tempers rise in the health-care debate, I feel the need to add my voice as one of the people who would be most affected by changes to the current system. I am a patient and have been for over 20 years. I was diagnosed with a congenital immune deficiency while in college, and since that time I have undergone more than 20 surgeries. I have been hospitalized more times than I can count with life-threatening infections, and I have been treated with outrageously expensive chemotherapeutic agents as well as intravenous immunoglobulin.

I am also a doctor. I work in private practice as a dermatologist. With health care reform, I expect my income to go down.

I am willing to accept this change not only because it will mean that all my patients have access to health care, but also because I think overall the president’s proposal will improve the practice of medicine. But I understand there is a great deal of fear.

My Medicare patients fear restrictions on access to doctors and procedures. I am not going to argue that this may not happen. There may be longer waits for elective procedures. There may not. We won’t know until we try, and if that happens we can make an effort to do better.

But we simply cannot continue with Medicare as it functions now. There is not an economist in the country that doesn’t feel our health care expenditures are growing at an unsustainable rate. And the facts show we are not getting great care for that money.

Many of my patients fret that they don’t want any government bureaucrats coming between them and their doctors.

But this is already happening. Insurance companies decide what doctors you may see, what tests and procedures physicians may order and what medications we can prescribe. They decide how long you can stay in the hospital, and for no reason that I as a patient or a doctor can understand, they often delay these decisions and deny our claims for payment, even when we have done everything right. I have heard my patients voice their concern about change, but as many patients or more are terrified that things will not change.

I have patients who have lost their jobs and thus their heath insurance and cannot obtain individual insurance due to pre-existing conditions. Patients who lose their jobs and are eligible to continue coverage under COBRA are shocked at the cost. Most cannot afford it.

Every day, I have patients with high deductibles who have put off medically necessary procedures or even basic screening tests like colonoscopies because their deductibles are so high they might as well not have insurance at all.

Let me speak now from my point of view as a long-term patient. My husband has a good job, and our family is insured through him. In addition, I carry private insurance since I know that if he lost his job, I would never be able to buy private insurance. I work in a small private practice. I do not get health insurance through my practice, though we offer it to our employees, because my illness would drive our premiums up to a point at which we would not be able to offer insurance to our employees.