By Luke Messac, M.D.
Providence (R.I.) Journal, March 12, 2020
The times, they are a-changin’. Last week, Rhode Island state Sens. Sam Bell, Ana Quezada, Gayle Goldin, Dawn Euer and Donna Nesselbush introduced a resolution calling on Congress to pass Medicare for All legislation. In a March 3 hearing in the Senate Committee on Health and Human Services, the chair, Sen. Joshua Miller, made clear that he supports the resolution.
For decades, single-payer health care — a system, now commonly known as Medicare for All, in which one public agency organizes health-care financing, drastically curtailing administrative expenses and eliminating out-of-pocket costs — was seen as a pipe dream. Single-payer was, as President Barack Obama said in 2009, the most rational way to pay for health care. Indeed, a recent study by Yale researchers found single-payer would save 68,000 lives and $450 billion every year. Even still, many reformers argue it is counterproductive to focus on this goal given the powerful special interests — namely, private insurance companies — that oppose it.
It is absolutely true that single-payer health-care legislation would not be easy to pass. The history of similar legislation, in the United States and abroad, demonstrates as much. In the United Kingdom, the Labour Party inaugurated the National Health Service in 1948 even as members of the British Medical Association compared it to Nazism. In Canada, a single-payer health system passed in the early 1960s even after doctors went on strike.
In the United States, Medicare became law in 1965 even after Ronald Reagan warned that if it were to pass, “We are going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free.” These programs faced significant opposition, but today they are widely popular.
The Affordable Care Act made a positive difference, particularly by expanding health insurance to millions of low-income Americans through Medicaid, but it is not enough. High-deductible health insurance plans are proliferating, hundreds of thousands of Americans are bankrupted each year by medical expenses, and hospitals have taken to suing patients when they cannot pay. People with respiratory symptoms who need to be screened for COVID-19 have already faced thousands in out-of-pocket payments. Is this how we want to organize a massive public-health response that requires the trust and participation of the American people?
As doctors, we have a responsibility to talk about the harm that our fragmented and expensive system is causing our patients. I see this harm every day in the emergency room where I work. I saw it in a young woman who presented with ketoacidosis, a potentially fatal complication of diabetes, because she could not afford her insulin. I saw it in the man who came in after an opiate overdose who would not listen to my counseling because all he could think about was the cost of his ER visit.
I saw it most clearly in a middle-aged woman who came in with a chief complaint of a breast mass. Under her gown was a large, foul-smelling, fungating mass of dead and dying tissue. The cancer had been growing on her chest for six months. Fearing the financial burden her condition would impose on her family, she had not sought care until the pain became unbearable. She had reason to fear the costs, as she had spent her career in health insurance. A CT scan revealed the cancer had spread through her body. All we could offer her was hospice. Her suffering is a casualty of our refusal to take up the necessary work of change.
We do not need to live with, and die from, this inhumane system. We can change it. Congressman David Cicilline supports Medicare for All. Congressman Jim Langevin supports Medicare for All. Sen. Sheldon Whitehouse supports Medicare for All. The largest medical-specialty society in the United States, the American College of Physicians, supports Medicare for All. This year, the Rhode Island state legislature has the chance to go on the record, on the right side of history, for Medicare for All. I hope they take it.
Dr. Luke Messac is a resident physician in emergency medicine in Rhode Island. He is the author of “No More to Spend” (Oxford University Press, 2020).