By Nancy A. Melville
Medscape Medical News, March 22, 2012
HOUSTON — David Ansell, MD, chief medical officer at Rush University Medical Center in Chicago, Illinois, is the author of “COUNTY: Life, Death and Politics at Chicago’s Public Hospital.” The book details Dr. Ansell’s 17 years of experience working in deplorable conditions at Chicago’s Cook County Hospital, where he and his colleagues would “care for patients in the morning and picket in front of the county building in the afternoon,” as they became activists for health reform.
Dr. Ansell and his colleagues published a study on conditions at the hospital that ultimately led to the passage of the Emergency Medical Treatment and Labor Act, which made it illegal in the United States to dump patients in need of emergency care, regardless of their insurance status.
In his keynote address here at the American Medical Student Association (AMSA) 62nd Annual Convention, Dr. Ansell declared that “healthcare as a human right is the moral issue of our time,” and urged the audience of future physicians to commit themselves to patient advocacy during their careers.
“We are the natural advocates for the poor,” he said. “Because we see the human condition first hand, it is our obligation to speak up on their behalf. You can’t be a doctor and not be touched by the patients and their struggles.”
Dr. Ansell noted that the fact that his mother’s family perished in the Holocaust instilled in him the strong belief in speaking up in the name of human rights.
“The problem I saw wasn’t that governments could do bad things to people, but that neighbors didn’t speak up on behalf of their neighbors.”
A key focus of Dr. Ansell’s ongoing activism is closing inequalities in healthcare, or what he calls the “death gap,” in the United States, which result in Americans dying younger than residents of most other developed countries. “The idea that one should die because they’re poor is obscene,” he said.
Medscape: You noted that the death gap between the richest and poorest communities in the United States is 24 years, whereas in England it is just 7 years. What key elements could realistically be implemented in the United States to reduce this disparity?
Dr. Ansell: Actually, the gap in the United States is 30 years and the gap in Great Britain is now 13 years. Some of the death gap is the result of the design of our healthcare system; much of the death gap is the result of broader social inequalities; some of it has environmental causes. Regardless, the death gap in the United States is unacceptable. We have a healthcare system that is separate and unequal. Where you go, what services are available, are determined by the insurance card you have.
Those with gold-plated insurance policies get access to the best institutions and the best care. Those with lesser insurance, Medicaid, or no insurance have much more difficulty accessing care. Health reform will give more people a card, but will it get them the care they need when they need it?
We know that 45,000 individuals in the United States die each year because of lack of insurance, and 80,000 die because of racial inequalities. It is one thing to have the income and wealth inequalities we have…, but the notion that we allow people in this, the wealthiest nation in the world, to die because they cannot access care is just not right.
Single-payer healthcare for all is the best solution for the United States. It is fair, allows people choice, and it would treat people equally. This would not address all the reasons for the death gap, but it would go a long way to making our health system more equal.
Medscape: The study that you and your colleagues published was pivotal in bringing about the change needed to address the problem of patient “dumping.” What kinds of studies are necessary to address the inequalities in life expectancy between the “haves” and the “have-nots”?
Dr. Ansell: I don’t think we need more studies. We need solutions. Let’s start by agreeing that healthcare is a human right. I believe our failure as a nation to agree that healthcare is a human right, and not a commodity to be bought and sold, is at the root of the problem and is the moral issue of our time.
If we accept that healthcare is a human right, then we would design and operate our health system around the principles of equal access for all and a series of essential healthcare benefits that people would have as a condition of their “citizenship,” not as a condition of their ability to pay. Again, a single-payer system — Medicare for all — is an important first step.
Medscape: The AMSA and other medical groups are working to make the single-payer option a reality in the United States. What changes need to be made in the current healthcare environment for such a system to succeed?
Dr. Ansell: The collective voices of medical students, doctors, and the public will be necessary. The real opposition to a single payer is the health insurance companies, who are profiting mightily from the current set-up. They will not go down without a big fight.
Medical students, doctors, and other healthcare professionals will need to speak up and educate the public about this. The United States has the most expensive healthcare system in the world by 2-fold. We have more than enough money in the system to serve everyone well and turn the focus from sick care to prevention.
A single-payer system will not solve all our ills, but it will provide fair coverage to many more people at a much lower cost. Doctors are the natural advocates for those with less. It is important that those of us who can speak up for fairness and equality — solid American and democratic values — do so. And we will have to elect folks to office who share these beliefs.
Medscape: You mentioned that you were inspired by the commitment of the Suffragettes to change. What person or movement in the present inspires you?
Dr. Ansell: I am inspired by people like Nelson Mandela, who was imprisoned for 26 years because of his opposition to apartheid and then became the president of South Africa. It reminds me that one has to have the long view of these fights for social justice and equality. If we believe that healthcare is a human right and that a single payer is the solution, then we have to look back on previous struggles for inspiration and lessons.