June 26, 2012
The American Medical Student Association and Physicians for a National Health Program are pleased to announce the winners of the first national single payer essay contest for medical students.
The contest was launched at the 2012 AMSA Annual Convention in Houston, where PNHP leaders Dr. Art Chen, Dr. David Ansell, and Dr. Howard Brody addressed medical students about the need for single payer national health insurance, “improved Medicare for all” to heal the US health crisis.
The first prize winner of an iPad is Jan Hallock at Pacific Northwest University in Yakima, Washington. The first runner-up is Victoria Powell at Virginia Commonwealth SOM in Richmond, Virginia, and the second runner-up is Eric LaMotte at UC San Francisco School of Medicine. Their prizes are $100 and $50 gift cards, respectively. The winning essays are posted below.
Many thanks to over 40 students who submitted terrific essays and to our judges, Dr. Howard Brody, Dr. David Ansell, Danielle Alexander, Dr. Elizabeth Wiley (AMSA 2012-2013 President), and Kristin Huntoon and Richard Alden Bruno (co-chairs of AMSA’s health care for all task force).
Special thanks to AMSA education and advocacy fellow Colin McCluney, who enthusiastically embraced the project and did a terrific job designing and running the contest.
The contest was advertised through The New Physician magazine (circ. 55,000) and at the AMSA Annual Meeting, as well as through PNHP, raising the profile of single payer among medical students. We hope the contest will become an Annual Event. Enjoy!
By Jan Hallock
Pacific Northwest University in Yakima, Washington
“Will this be paid for?”
I sighed silently, hoping the inquirer on the other end of the phone call would accept the only answer I could give.
“Well, Mrs. M, that’s not a question I’m able to answer, but if you look on the back of your insurance card, there should be a phone number for Customer Service. If you call that number, they should be able to help you figure out the cost.”
Mrs. M thanked me and hung up, presumably to spend another twenty minutes on the phone with a series of customer service representatives. I knew there was a good chance she wouldn’t get an answer, because insurance companies are remarkably good at not showing their hand to their customers—they tend to not commit to a certain payment amount, because they generally wait until the procedure is over to decide whether to cover it.
The phone rang again.
“Thank you for calling Dr. K’s office; how can I help you?”
“I have a question about my bill. My insurance said they would cover my annual screening colonoscopy, so why am I getting a $400 bill for it?”
Another sigh. I had chart notes to transcribe, prescription refills to authorize, letters to mail to remind patients to come back for follow-up appointments. Sorting out the fine print of insurance contracts was not how I wanted to spend my time.
“I’m sorry for the confusion, ma’am. Let me get your information, and I’ll contact our billing staff to see what happened.”
I frequently told patients this partial lie: I pretended to not know why they had received a bill for a procedure that their insurance supposedly covered. In reality, I knew that they had received a bill because their insurance had retroactively denied coverage of the procedure. But I still had to spend an average of thirty minutes per patient inquiry learning the details of different insurance policies so I could explain to patients why they ended up with a bill they didn’t expect.
These are obviously anecdotes from my personal experience, not analyses of hard data. But my experience was typical for medical assistants and medical receptionists: at least half the phone calls I received in any given workday had to do with insurance coverage or billing issues, not actual patient care.
This is especially remarkable because I worked for just one doctor, who managed to run her whole practice with just three people: herself, me, and a biller/coder. Think about that: Dr. K could competently manage her patient load and procedures almost by herself, but to work out the insurance payments and patient billing took a full-time trained, certified billing person and one-third to one-half of my time. One and one-half full-time employees, just to deal with insurance companies—is it any wonder that overhead costs are overwhelming doctors in private practice?
One common complaint I’ve heard about a single-payer system is that it would be a bureaucratic nightmare. To be honest, the first time I heard someone argue that, I laughed outright—and then I realized that he was serious. My second reaction was, “Obviously, you’ve never seen how the current system works.” Turns out, he hadn’t: he had insurance through his employer, Microsoft, which offers full coverage for just about everything you can imagine, with no copays. Patients and doctors’ offices alike love Microsoft insurance for its ease of use, its quick payment, and the overall efficiency that comes from their anti-bureaucratic approach to health care coverage. It is the epitome of great health insurance—and the opposite of the insurance coverage most people have.
The gross inefficiency of our current system is, to me, the single biggest problem in our healthcare system, and it is a problem that a single-payer system could easily solve. A single-payer system would streamline all services through one formulary, one billing system, with one set of rules and requirements. Fewer employee hours dedicated to sorting out insurance contract fine print means lower overhead costs, which means lower costs to patients and more physicians being able to stay in private practice. Less time wasted on bureaucratic nonsense means more time devoted to direct patient care, which means longer appointments, better physician availability, and better quality care. This is why I support single-payer health care: better for doctors, better for patients, better for society.
By Victoria Powell
Virginia Commonwealth SOM
In medical school, there is always an upcoming exam, with accompanying late nights and anxiety. Myopia can result from learning about medicine, yet having little exposure to the people that illnesses and injury are happening to. Health policy is a stretch – we’re learning to be doctors, not politicians or administrators. Fortunately, I’ve had a run of experiences that led to my interest in Single Payer, and given these, I feel I have the responsibility to translate my privilege into action.
In 2008, I was highly influenced by the presidential campaign of Ralph Nader. Long respected as an advocate for the people, he was having difficulty being taken seriously as a candidate. I was initially annoyed that he was running against the progressive-seeming champion Obama. Only through a friend’s insistence did I listen to his message. I was particularly inspired by his words on Single Payer. He clearly elucidated the reasons why our payment system was broken, corrupt, and wasteful. Through clear data and heart-wrenching stories, he insisted that Single Payer was the only sustainable and compassionate choice, “Everybody in. Nobody out.” Prior to his campaign, I was interested in medicine because I loved the process of scientific innovation and wanted to help translate bench-to-bedside for my patients. After hearing him, I promised myself that if I gained acceptance to medical school, I would use my position to advocate for those who were tossed aside, made to go into bankruptcy, lost homes and jobs, all because they were simply unlucky enough to have an expensive medical condition and poor insurance.
Single Payer did appear the fairest way to allocate limited resources, but mainstream health care debate made it seem equivocal whether it would happen in America. I was convinced, but not compelled enough to become an activist. Arguments during the health care law debates resonated – it was too much effort, and the insurance industry was too strong. I heard older doctors grumbling about low reimbursement for Medicare. Could we work within the current system of multiple private insurers? Was Single Payer worth the fight?
My college friend Jay, 21, was shot in the head by a stray bullet on July 4, 2006. He spent over 100 days in the hospital and contracted almost every hospital-acquired infection imaginable. Due to what I previously thought was solely his strength and his parents’ and health care team’s dedication, he not only survived but has recovered to an extent no one thought possible for such a severe injury. He and his parents spoke to my medical school classmates recently. During the presentation, I learned there was another factor affecting his recovery that I hadn’t yet considered – his father’s excellent health insurance. Being under 22 at the time of injury, he was able to remain on his father’s federal employee plan. He had access to the comprehensive rehabilitation he needed and continues to require. Even so, his parents explained the huge chunks of time they had to spend on the phone with insurance companies, on hold with Mozart playing, while they sought authorization for life-saving surgeries. They admitted that this was nothing compared to what some families on his unit were going through. His parents heard not only about the patients who had no coverage, but also those whose families who were desperate because they had to go back to work to keep their coverage. Who would take care of the patient in recovery while they were at work?
It is not only sad for a young person with a brain injury to not receive necessary rehabilitation during the critical period of recovery because of lack of payment. It is a human rights violation. It could mean the difference between independent living, the ability to earn a living, and a lifelong sentence of disability. Patients continue to require rehab after discharge. The quality and frequency depend on their ability to pay. If a Single Payer system existed in America, resources would be distributed among all patients. Health would not be bound to a job. Our society’s medical discoveries would benefit everyone. No one would go bankrupt from medical expenses. No one would be stuck in the cycle of poverty because of payments for illness and injury. It is for these reasons that I not only support Single Payer, but resolve to use my standing as a future physician to fight for it. I will educate others. It will be difficult, but eventually, we will win. And it will be a victory for all Americans.
By Eric LaMotte
UC San Francisco School of Medicine
As the media focus on the Supreme Court’s coming ruling on the Affordable Care Act, they speculate about the various implications the Court’s decision could have on the individual mandate and many other provisions of the law. However, the contemplation of these scenarios is a distraction.
Instead, we should focus on what we already know, which is that over 15 million Americans will remain uninsured, and tens of millions will be underinsured with barebones plans that won’t prevent financial ruin if illness strikes. We will continue to pay nearly twice what the second most expensive country pays for healthcare, and costs will continue to increase unsustainably.
These facts are not seriously disputed, and yet they describe what many Democrats consider the best-case scenario, which would occur if no aspect of the ACA is struck down.
But we can do better. We should advocate publicly for a single-payer system which establishes comprehensive healthcare as a guaranteed right for all Americans, and which compensates healthcare providers rationally, simply, and fairly from a single insurance fund financed by taxpayers.
This simple system, which would effectively eliminate private health insurance and function like an improved Medicare for everyone, would save enough money by dismantling our Kafkaesque healthcare bureaucracies to cover the tens of millions of Americans who are uninsured now, or who are insured but avoid getting care because it is too expensive.
The Supreme Court’s review of the ACA is not just a distraction, but an opportunity as well. It’s a period when the “Overton Window,” the range of possibilities considered at any given moment to be politically feasible, is in flux.
Many of my fellow medical students support single-payer in theory, but are hesitant to become activists because they see it as politically infeasible in the current political climate. This creates an unfortunate Catch-22, but hints at a broad base of support for single-payer which is waiting to be unleashed when it is perceived to enter the political mainstream.
I often hear people talk about single-payer as politically infeasible because of the strength of the conservatives. Although I agree that single-payer currently seems to have little to no chance of passing the House and Senate, I reject that this is because the idea is unpopular. According to a CBS/NYTimes poll 2009, 59% of Americans said the government should provide national health insurance. 78% of medical students surveyed in 2011 said that PPACA did not go far enough in reforming our healthcare system. Rather than unpopularity, it is the health insurance industry’s powerful influence on our policymakers that keeps single-payer from entering the political mainstream.
Indeed, single-payer has recently received endorsements of preference over the ACA by conservatives such as Fox News contributor Charles Krauthammer and Louisiana A.G. Buddy Caldwell. These endorsements are not such a surprise if you consider that despite being to the left politically, single-payer stands head-and-shoulders above the ACA in terms of its merits as sound public policy.
The media have raised the possibility of the ACA (or its downfall) “paving the way” for a single-payer healthcare system, but such a shift is not going to just magically happen without strong resistance from the insurance industry. Achieving a single payer system will only happen if the population demands it loud enough to be heard over the health insurance lobby, a feat made only more difficult by Citizen’s United.
To become effective advocates for their preferred healthcare system, single-payer advocates will have to leverage a strong understanding of policy, not just politics. For example, cost savings will not just be achieved because the system is “government-run”, thereby eliminating profits. Instead, savings will be achieved by eliminating the bureaucratic complexity we have in our system where patients must navigate a fragmented system of provider networks and unpredictable charges.
I want a single-payer system because as a future physician, I want to spend my time treating patients, not dealing with billing personnel over the phone haggling to get treatments approved. As a taxpayer, insurance subscriber, and future patient, I want to spend less money, in a more predictable manner, and be guaranteed that I will get the care that I need.
I believe that we can enact a single-payer system, but I assure you that the road to it will not be paved for us by the successes or failures of the ACA. Although sound public policy is on our side, this means little if we continue to let the health insurance industry dictate which ideas are allowed into the discussion.
