By Rachel Madley
Dec. 31, 2019
Over the past decade, Americans have debated the best way to fix our broken healthcare system, one that allows 35,000 Americans to die each year because they don’t have health insurance and many more to forego necessary treatment or go bankrupt paying for care. This debate has intensified in recent months due to the increasing popularity of Medicare for All, a proposal to create a publicly funded single-payer health system, and its central role in the Democratic presidential race.
First, let’s define what these terms mean: Single-payer Medicare for All would establish a public funding mechanism for healthcare that covers everyone for all medically necessary treatment, including dental, vision, and hearing care. This care would be free to everyone at the point of service, regardless of income, age, employment, or immigration status. Medicare for All changes how care is financed, but not how it’s delivered, thus patients would have free choice of any doctor or hospital. Besides the benefits to patients, Medicare for All would save approximately $500 billion annually in healthcare costs, according to one estimate, by, among other things, cutting out thousands of insurance middlemen and negotiating drug prices at the national level.
Many health professionals support Medicare for All, including a majority of doctors and the largest nurses union in the US, as do a majority of registered voters in the US overall, but biomedical scientists have so far been silent. Yet they do have a stake in the outcome of healthcare reform. Medicare for All would increase the clinical data available for research and allow all patients to benefit from scientific innovation.
Scratch the surface of our health system and we find that it hurts patients directly and indirectly—not just by keeping medical care out of reach, but by hindering the kind of medical research that drives innovation and benefits everyone. Today’s fractured system sequesters patient data within millions of different hospital and insurance databases, with little cross-institutional data sharing. When data are shared by multiple institutions, the coding and format are not standardized, making research on those cohorts difficult or impossible.
But it doesn’t have to be this way. With Medicare for All, patient data won’t be segregated by insurance plan or withheld by private hospitals clinging to their profits. A national system would allow for centralized electronic medical data. We already have evidence of successful data collection within a single-payer program in the Veterans Affairs (VA) health system. The VA’s Corporate Data Warehouse holds more than 9.3 billion health data points that have powered many clinical research studies. The current Medicare system, which covers Americans 65 years and older, also maintains a database of clinical data as well as a data repository specifically for cancer research. Through increased standardization, decreased segregation, and streamlined collection of data, Medicare for All would allow for the creation of similar databases and enable increased breadth and depth of clinical studies at a national level.
Researchers and health providers work tirelessly to determine which medical treatments work best. But in our broken system, much of this research goes out the window as patients only receive the care they can afford or their insurance approves. This is exemplified by fewer uninsured patients and patients on Medicaid, the health insurance system for those with income under 138 percent of the poverty line, receiving the “gold standard” of care for idiopathic pulmonary fibrosis compared to insured patients. Likewise, uninsured or Medicaid-insured lung cancer patients are less likely to receive curative treatments than those with private insurance. In single-payer systems such as that in Canada, chronic disease sufferers experience much fewer life-threatening complications and increased lifespan, likely because their treatment is determined by scientific recommendations, not insurance benefits and ability to pay. Medicare for All would prioritize patient care and allow doctors to make treatment decisions based on scientific data, not financial circumstances.
Many medical advances are funded by the National Institutes of Health, using taxpayer dollars. Government funding contributed to all novel drugs approved by the FDA from 2010–2016, 40 percent of which were first synthesized in public laboratories. Only Medicare for All makes these treatments available to all Americans who helped fund their discovery, without financial barriers.
Like many scientists, I chose to work in medical research because I want to reduce suffering and improve the quality of life for sick patients. But many days, I question the value of my work when I know that many patients can’t access it due to cost. Developing new treatments is an incredible victory for scientists. But once these discoveries leave our labs, they are only accessible to a portion of patients who need them. To a scientist, this feels like running 25 miles of a marathon only to walk off the course just short of the finish line. By fighting for Medicare for All, the scientific community can guarantee our discoveries benefit society the way they’re meant to.
Scientists must add our voice to the chorus of health professionals advocating for Medicare for All. Although often framed as a political issue, Medicare for All is a scientific imperative—necessary to increase clinical research capabilities and allow scientific advances to reach all Americans. Without Medicare for All, scientific research and American patients will continue to suffer.
Rachel Madley is a graduate student in the department of Microbiology and Immunology at Columbia University and an activist for Medicare for All with Students for a National Health Program. The views expressed in this article are the author’s own and do not reflect the view of Columbia University.