By Scott Swartz and Bradley Heinz
San Francisco Chronicle, August 14, 2019
The most difficult part of our first year of medical school wasn’t memorizing anatomy or mastering the patient interview, but seeing firsthand how broken our current health care system is. We pay twice as much as other wealthy nations for health care, but receive some of the worst outcomes.
Many factors contribute to this dysfunction, and one looms large: a medical system dominated by for-profit private insurers. We hear about physicians spending countless hours battling insurance companies instead of actually providing care. It’s disheartening to envision ourselves practicing in a system in which, yearly, thousands die for not having insurance, and hundreds of thousands more face medical bankruptcy.
Thankfully, there is hope for a better future, which we can understand by looking to America’s past.
Last month we celebrated Medicare’s birthday. Medicare is a popular and efficient program that provides high-quality, life-saving care to over 55 million Americans. Fifty-four years ago, President Lyndon B. Johnson signed this program into law, one that critics then called “un-American” and written by “followers of the Moscow party line.”
The question of health care reform has dominated the Democratic presidential candidate debate stage. One proposal, Medicare For All, would expand and improve our existing Medicare system, guaranteeing quality health care as a right to all Americans. Critics of this single-payer system, most of whom receive payouts from private insurance lobbyists, echo Johnson’s critics from half a century ago. Some spread fear, invoking the specter of “socialism,” arguing it’s too drastic, and would spell certain defeat for Democrats.
Others simply preach moderation, supporting breezily named “glide paths” to universal coverage by offering a public option (“Medicare For All Who Want It”) or building upon the Affordable Care Act. Though steps in the right direction, these plans fail for the very reason they’re meant to appeal to voters: They leave our current broken system in place. A health care system dominated by private insurers is one focused on profit achieved by increasing prices and denying care to patients. Merely adding a public option or ACA expansion to this already fragmented system misses the promise of $300 billion of annual administrative savings achieved by transitioning from a patchwork of insurers to one single payer (UMass Amherst, 2018), and does little to curtail unusable high-deductible plans. Medicare For All seizes the opportunity to save 95% of Americans money while providing lifelong coverage.
The prospect of practicing medicine under a single-payer system like Medicare For All gives us hope for our future. We pursued careers in medicine to care for patients, not to fight insurance companies or to fear bankrupting those we treat. We never want to hear of patients rationing medications or spending precious minutes during an emergency to figure out whether the hospital down the street is in network.
We want to practice in a system in which every American is guaranteed comprehensive care, where everything from checkups to dental appointments, hospital stays to eye exams, is covered by one card in each person’s pocket. A system in which every health care provider is in network. A system in which all out-of-pocket expenses — premiums, copays, deductibles — would disappear.
The solution for frustrated patients and for wary physicians-to-be is Medicare For All. We implore politicians to listen to voters, 70% of whom support such a plan (Reuters-Ipsos), and find the courage to continue Johnson’s legacy by fighting for the health care we deserve.
Scott Swartz and Bradley Heinz are second-year medical students at the UCSF/UC Berkeley Joint Medical Program and members of Students for a National Health Program.
