By Josh Faucher
Students for a National Health Program blog, May 16, 2016
I’ve been a part of SNaHP since the beginning, watching our annual gathering grow from a few dozen people in a small conference room in 2012, to the massive turnout we had this spring with representatives from around the country.
Each year, I’m impressed with the reality that many of our most enthusiastic and active members are students early in their medical school journeys, many of whom haven’t had much contact with patients yet. When I first began medical school, it was easy to get caught up in the praise and aggrandizement that was heaped upon us – the constant congratulations for joining a profession as well-respected and impactful as medicine. It is true that physicians can have a profound impact on the lives of our patients, curing terrible diseases and lessening the suffering caused by chronic ailments. In looking at the nature of the health care system as a whole, however, I have seen clear examples of how access is rationed based on a patient’s financial resources, and how seeking health care can leave patients vulnerable to harm that affects their livelihoods and economic security.
As a new resident, when I look back on medical school, there were many things that left me less confident in my ability to avoid doing harm as a physician.
Take, for instance, the guest speaker we had during my second year of medical school, a young woman in her 20s (let’s call her Sarah) who recounted her battle with acute lymphocytic leukemia, a cancer that strikes suddenly and can be fatal in a matter of hours. Sarah described to us the physical challenges she faced while receiving chemotherapy, and the fantastic care she had received from her physicians. As I listened to her story, I wondered whether, as a young person who had just entered the workforce, she had the financial resources to pay for her care. At the end of her presentation, I asked her, and it turned out that cancer devastated more than just her body.
Sarah’s illness prevented her from working and when she eventually lost her job, she lost her insurance, too. The hospital bills that followed quickly depleted her savings until she was forced to go on Medicaid. She described this as an extremely difficult experience that caused her considerable shame. For some reason, to this patient and others who told us stories of illness, the consistent assumption seemed to be that future doctors didn’t need to hear about, or wouldn’t be interested in, the financial problems caused by our health care system.
I strongly believe that no one should experience shame or financial ruin just because they get sick. I think many of my classmates would agree, but if patients aren’t given a chance to share that side of their experience, we can’t expect their physicians to become aware of the problem solely through intuition.
There was also the middle-aged man – I’ll call him Bill – who I met during one of my clinical rotations. Bill had a chronic mental illness and an unstable, intermittent employment status, but nevertheless was surviving on his own in the community. He presented to the clinic with shortness of breath after a temporary construction job had been halted because of the discovery that he and his co-workers had been exposed to asbestos. It took multiple visits for us to explain to him that asbestos causes disease many years after exposure, and that, instead, he was experiencing symptoms related to longstanding COPD. Worker’s comp, of course, would not pay to manage this chronic preexisting disease, and Bill experienced considerable distress until we were able to enroll him in Medicare because of his new disability. With a universal, comprehensive insurance system his disease might have been detected earlier, or smoking cessation therapy could have been emphasized when he was young. Instead, he’ll live with COPD for the rest of his life, and will probably die from it.
Then there’s me. I was born with a serious heart defect that required surgery when I was a toddler, and again when I was 13 years old. Despite facing health challenges during my own life, I consider myself privileged. I’m privileged to have had a better outcome than many others in the same situation; I’m privileged to have never missed one of the annual cardiologist visits that will determine when I need to have my next operation; and I’m privileged because I happened to have the best hospital in the country in-network on my insurance while attending medical school.
Nevertheless, despite having insurance, I have to pay hundreds or thousands of dollars in deductibles and copayments out-of-pocket every year to monitor a health condition I have through no fault of my own. If I was like millions of working Americans living paycheck-to-paycheck, unable to save money let alone pay thousands of dollars for medical bills, I might have to skip yearly checkups to take care of other necessities first. If I were truly poor and on Medicaid, I might have to travel long distances or wait many weeks to find a physician who would take me for an appointment. In either case, I might not get the care I need until I deteriorate to a point that would cause me permanent harm.
The Affordable Care Act has not done nearly enough to address the barriers to health care that exist due to our broken insurance system. Under Obamacare, the United States remains the only industrialized capitalist democracy on the planet that does not provide universal health care access to its entire population. Indeed, even if it works as well as it possibly can, Obamacare will leave over 30 million people uninsured and without access to basic care. Those benefiting from the law are forced into a relationship with private insurers, the same companies that previously denied people for preexisting conditions and cut policies when people got sick until those practices were outlawed by Congress.
Now, the insurance companies have a different approach to maximizing their revenue: they lure buyers on the exchange with low premiums, and then slam them with high deductibles. An annual deductible of thousands of dollars before insurance kicks in can quickly empty a family’s savings account, and does little to protect them from health care costs.
As a member of SNaHP and PNHP, I advocate for an alternative along with other medical students and physician: an improved version of Medicare that would apply to the entire population; a universal, single-payer, publicly financed and administered insurance system. By its very nature, such a system would apply to the entire citizenry from birth to death, and would reduce or eliminate out-of-pocket costs for medical care. It could be progressively financed while providing universal, equitable access. Unlike the hodgepodge of secretive private companies providing insurance right now, Medicare-for-all would be transparently financed and publicly accountable through the democratic process. With the entire population invested in the program, the adequacy of reimbursement for medical expenses would be a top priority.
Most importantly, a Medicare-for-all program would reduce our out-of-proportion spending on health care while at the same time expanding coverage and access to everyone. It would greatly reduce the need for providers to maintain complicated administrative structures for billing multiple insurers, and would act as a strong negotiator to prevent unfair profiteering by pharmaceutical and device manufacturers. An analysis by the Lewin Group in 2012 estimated that a single-payer system would have saved my state of Minnesota $4.1 billion in 2014, while economists estimate that single-payer on a national scale would save an estimated $592 billion annually.1 Think of the boost our economy would receive if people were no longer going bankrupt because of medical expenses. Medicare for all would also free the private sector from the burden of providing health insurance as an employee benefit, reducing wage stagnation and making our industries more competitive on the global market.
The need for single-payer health insurance is complex, but the concept itself is simple. The vast majority of my classmates are becoming young physicians with the goal of relieving suffering and providing patients the opportunity to live their lives to the fullest. As economic inequality comes to the forefront as a national issue, medical students are increasingly realizing that the current health insurance system frequently promotes that inequality rather than alleviating it, and just like me they are coming to recognize single-payer health insurance as a necessary, if not sufficient, step to make the provision of health care a tool for social justice.
Our movement has grown larger every year, and the reach of our message has never been broader. If our expanding membership continues to spread awareness about the problems of our health care system and the solutions offered by single-payer health care, our goal will soon be realized and I’ll be able to consider my involvement to be a success.
If you care about a health care system that serves the needs of everyone, not just the privileged or the wealthy, there is room for you in this movement.
Josh Faucher will graduate from Mayo Medical School on May 21 and is pursuing a career in emergency medicine. He co-founded the Mayo Medical School chapter of SNaHP, helped SNaHP grow as a student offshoot of PNHP with national scope, and currently serves as a student member on the PNHP Board of Directors. You can email him at josh.faucher@gmail.com
Reference note
1. Cost and Economic Impact Analysis of a Single-Payer Plan in Minnesota; http://growthandjustice.org/images/uploads/LEWIN.Final_Report_FINAL_DRAFT.pdf
