Jeoff Gordon, MD: Busy OB doc has time for social justice

Dr Jeoffry Gordon in his OB office. Photos by Shane Finneran.

Editor: I first met Dr Jeoff Gordon in 1971 when he was the medical director of San Diego’s very first free clinic – it was in the middle of Mission Beach, and later came to be known as the Beach Area Community Clinic.  Three years passed and I ended up working for the Clinic in a unique project called the Community Outreach Program – a program initiated by Gordon – where I and a few other trained people would go door-to-door in the beach areas and give a handful of medical screening tests, such as blood pressure, and blood tests for anemia. Anybody we found “positive” would be referred to the low-cost clinic in Mission Beach. Can you imagine that? Free medical testing door to door? Jeoff was – and still is – way ahead of his time.

By Dixon Guizot

Though he doesn’t seem like he’s in a hurry, Ocean Beach’s Dr. Jeoffry Gordon gets a heck of a lot done.

In addition to treating patients and managing his practice, Dr. Gordon speaks to local political clubs. He writes articles for medical journals. He works with the national movement for a single-payer health care solution. And along the way, the doctor stays powerfully well-informed in areas like politics, history, and finance. He recommends works by authors such as Kevin Phillips, Niall Ferguson, and Thomas Frank.

You might think a person with all that to keep him busy wouldn’t have a moment to spare, but Dr. Gordon’s demeanor isn’t rushed. He speaks deliberately, choosing his words carefully. And on a recent Monday afternoon, as we walked to lunch at Rancho’s Cocina from his office at the corner of Cable Street and Santa Monica Avenue, he strolled at a relaxed pace, prompting me to slow my normally anxious stride.

A few weeks before, in early March, I attended a Sunday afternoon meeting of the Point Loma Democratic Club (PLDC), where Dr. Gordon gave an hour-long presentation. In 2009, Dr. Gordon had visited the club – as well as several other San Diego organizations – to share his perspective on health care reform. This year, his talk focused more broadly on the economic health of the United States.

“Both Bill Clinton and Mr. Obama,” Dr. Gordon told the Point Loma club, “have been bought and paid for by Wall Street.” Not surprisingly, the comment drew some protests from the audience, but the doctor seemed unfazed. He pointed out that, with a little research, it’s easy to learn how Norway, in the 1980s, faced a crisis much like our recent meltdown. But Norway’s government limited the damage without bailing out speculators, issuing blanket guarantees, or otherwise encouraging the moral hazard that helped create the problem in the first place.

Dr. Gordon thinks Norway’s approach contrasts mightily with Obama’s handling of our current crisis, which the doctor sees as largely a continuation of the Wall Street coddling initiated by George W. Bush.

Still, Dr. Gordon tends to support Obama. At Rancho’s, where he had a chicken torta and I enjoyed enchiladas verdes, Dr. Gordon said he would vote to re-elect the President in 2012. “He’s the only thing that stands between us and fascism.” And though Dr. Gordon faults both major parties for putting short-term gains in front of the nation’s long-term interests, he sees the Democrats as the team that can change things for the better.

A member of the PLDC forwarded me a recent email from Dr. Gordon to Physicians for a National Health Program. In the email, titled THE NEXT STEP, Dr. Gordon argues that Congressional Democrats should next focus on repealing the anti-trust exemption that prohibits the federal government from regulating the day-to-day business of insurance companies. “With this strategy,” Dr. Gordon wrote, “the Democrats will show they still have the momentum in promoting the interests of the man on the street – and this is an issue they can win again on.”

Dr. Gordon, a native of Massachusetts, has long had an appetite for extra-curricular activities. As an undergrad at Harvard College in the early 1960s, he was drawn to the movement for nuclear disarmament, and he traveled to Washington, DC to protest the acceptance of fallout shelters, which were popping up across the country at an alarming rate. President Kennedy welcomed the protesters and invited them into the White House to discuss the issue.

“In med school,” Dr. Gordon said, “mentors oriented me toward social justice.” One of those mentors was Dr. Jack Geiger, who brought the concept of the community health center (CHC) to the United States in the 1960s. According to Wikipedia, Geiger’s CHCs “became models for what is now a national network of more than 1100 CHCs serving some 20 million low-income and minority patients.”

Dr. Gordon would soon help establish CHCs in San Diego, but he first served as a medical director at UCSD Medical Center, then called University Hospital. Saying he’d “tell the story in its brazen sense,” Dr. Gordon explained how, in the late 1960s, Ronald Reagan – then governor of California – was pushing for drastic cuts in the Medi-Cal program, which would reduce services for people in need.

Like many people in public health, Dr. Gordon was incensed by Reagan’s “immoral behavior” and worked to stop the cuts. His activism eventually cost him his job: for using hospital Xerox machines to make copies of protest flyers, the hospital let him go.

From there, Dr. Gordon focused on community health centers. He helped establish clinics such as the San Ysidro Health Center and North County Health Services, which are still going strong some 40 years later. And in the early 1970s, when San Diego’s CHC for the beach areas needed a full-time medical director, Dr. Gordon took the job.

Proudly, he notes that one of the many activists who worked for him is now president of the American Public Health Association. In addition, Dr. Gordon recalls one Frank Gormlie going door-to-door in  OB in an outreach program to identify the medical needs of community citizens.

After eight years with the beach-area CHC, Dr. Gordon did a residence in family medicine at UCSD. He was also appointed to the California Board of Medical Examiners by then-governor Jerry Brown, who was transforming the board into a combination of doctors and public advocates. While on the board, Dr. Gordon worked on issues such as physician licensing and disciplining, as well as industry issues such as malpractice insurance inflation.

In 1981, Dr. Gordon began practicing in an office in Pacific Beach. In 1998, he came to OB.

“I love Ocean Beach,” he said. “It’s a real place, a community with character and depth. Something worth cherishing. I’ve got patients who are lawyers, bankers, and street people from Ocean Beach. I don’t turn anyone away.”

I asked how the new health care bill would affect his practice, and with a smile, the doctor pointed out that all of his patients would now have insurance.

Of course, Dr. Gordon has seen several patients who have been under-served by our health care system, even with insurance: A woman suffering from diabetes who, after paying her premium of several hundred dollars to Aetna each month, skips half of her insulin doses because of their significant additional cost. A man in intense pain from gall stones who went without the necessary surgery for months because he couldn’t come up with the $1,000 co-payment. A woman desperately needing a hysterectomy as a result of heavy menstrual bleeding, anemia, and early signs of cancer who couldn’t get the procedure without a neurologist’s evaluation, which she couldn’t afford.

Another patient needed neurosurgery to fight debilitating pain in his legs. Per his insurance, he was liable for 20% of the cost, which could total $100,000, $150,000, or more. “I can’t put my family into bankruptcy,” the man said, so Dr. Gordon set out to determine precisely how much the man would owe. But after 24 hours of research, the doctor and his staff – even after working with an administrative contact at the hospital – were unable to find anyone who would give them an estimate. In light of the financial uncertainty, the patient couldn’t commit to the surgery.

Stories like these show just how badly we need reform – but Dr. Gordon is not a fan of the bill approved by Congress and signed by President Obama, which “is probably not going to be as beneficial as a lot of us would have liked.”

“Secondarily,” Dr. Gordon said, “it establishes health care as a human right in the United States.” The new law also will bring about the most progressive tax reform since the JFK era. But the main impact of the reform package, Dr. Gordon believes, is to save the health insurance industry from the “doom-and-death cycle” it has entered in recent years.

This cycle starts with increases in medical costs, which cause insurers to raise rates. The higher rates cause healthier people to look for cheaper insurance, leaving their previous insurer with a larger proportion of less-healthy people – which means the insurer must raise rates more, causing more healthy people to look elsewhere, leaving the insurer with an even larger proportion of less-healthy people…and so on.

Unchecked, the health insurer death spiral results in price hikes that make insurance unaffordable. Anthem Blue Cross, for example, recently raised prices for individual coverage by 30% to 40%, after hiking prices by a similarly hefty margin a year earlier.

The spiral also encourages insurance companies to dump clients who are most likely to need treatment. Aetna, Dr. Gordon said, recently returned to profitability by purging its membership rolls of 8 million people – and Aetna’s CEO, Ron Williams, earned $24 million for presiding over the company’s “re-positioning.” More broadly, the top five health insurers as a whole covered fewer people in 2009 than they did in 2008, while growing profits by 56% to $12.7 billion.

Numbers like those are important pieces of evidence for Dr. Gordon, who peppers his arguments with statistics. To the Point Loma Democratic Club, he pointed out that medical costs in the US have swollen from 5% to 18% of GDP in the last 50 years, while manufacturing output has dwindled from 27% to 12%. He noted that $13 trillion or 15% of American wealth evaporated in the current downturn, and that 44% of families have experienced job loss.

Long stretches of unemployment can be devastating to a person’s and a country’s long-term financial health, Dr. Gordon said, so the fallout “is going to go on and on and on.” And decades of Reaganomics-driven erosion of safety nets and public services, which exacerbate the pain, could be difficult to reverse. “Pretty soon, we’ll have dirty water and people getting dysentery.”

When we discussed how citizens in other developed nations pay roughly half as much as Americans do for health care and get better results, I asked Dr. Gordon to rank by importance the factors pushing US medical costs higher. He said the money wasted by the inefficiency of the “pseudo-market” for health insurance dwarfed the money wasted on things like unnecessary testing, malpractice-related expenses, and coverage of non-citizens.

Therefore, the doctor likes the idea of a single-payer solution like Medicare-for-all. “It’s a great way to start. It’s the one way to start.”

In an article soon to be published in the Journal of the American College of Radiology, Dr. Gordon addresses the current controversy regarding how often women need mammograms. He argues the controversy misses the most important point: that women without health insurance are less likely to get mammograms when needed, and are therefore more likely to die from breast cancer.

To help prove his point, Dr. Gordon refers to data from a Canadian researcher who compared breast cancer outcomes in Des Moines with those in Winnipeg. The data showed that breast cancer survival for American women is significantly dependent on socioeconomic status – which has no impact on survival in Canada, where everyone has insurance.

When he first started working with the Canadian researcher, Congress was engaged in the health care debate, and Dr. Gordon suggested that the data could be used to lobby for a single-payer solution. But the researcher had already tried that. According to Dr. Gordon, Democratic politicians and their staff – while acknowledging the data and the need for single-payer – were afraid of being black-listed if they supported it. “We agree with you,” they said, “but we can’t mention it in public.”

Was that a heartbreaking revelation for Dr. Gordon? I didn’t get that impression. “It’s an observation about how the world works,” he said. Some amount of injustice is inevitable, the doctor seemed to suggest. The question is what are we going to do about it?

At the gathering of Point Loma democrats, the doctor challenged his audience to reacquaint their party with its traditional progressive principles. “The Democratic Party has to stand for social justice,” he said. At Rancho’s, the doctor said he views his presentations to the PLDC and similar organizations as an opportunity to raise awareness and encourage people to rally against inadequate public policies. “I can use my glib tongue to convey to people the tragic consequences.”

I mentioned that, particularly for younger folks like me, obstacles to getting involved might include paying mortgages, raising families, and similar day-to-day constraints on people’s time. Dr. Gordon seemed to suspect other culprits. “Alcohol, marijuana, basketball, baseball, football,” he said. I think I blushed just then, as I recognized a few of my own leisure-time enthusiasms on that list.

Still, I got the sense that Dr. Gordon wouldn’t hold a lack of chastity against anyone. A lack of interest in life and its potential, however, would likely raise his eyebrows.

“Be curious, and look beyond your nose,” Dr. Gordon said as we finished our lunch. “The inquiring mind is a beautiful thing.”