If you ever want to rekindle your hope for American medicine, spend time with medical students. These bright, energetic minds are going into medicine for all the right reasons — to help people, relieve suffering and find new ways to cure illness and eradicate disease.
Their idealism is a pleasure to behold, particularly to a veteran physician like me. Yet I'm painfully aware of how our current health care 'system" can undermine students' idealism, especially if they see no alternative.
Fortunately, a better alternative is waiting in the wings: a single-payer, improved Medicare-for-all program. Most Americans, including 59 percent of physicians, want access to an improved Medicare. I'm pleased to report that our physicians-in-training are strong supporters of this truly universal, comprehensive and affordable alternative.
Why? Even before they graduate, today's medical students learn how our Byzantine, antiquated system of patchwork private insurance undermines medical care. They recognize an imperative to correct social injustice, for both moral and pragmatic reasons.
Medical students learn that as practicing doctors they'll be dealing with dozens of different insurance schemes, each with its own rules, paperwork and bureaucratic headaches.
As physicians-in-training, they encounter patients who have delayed surgery until they qualified for Medicare at age 65 — often with more difficult and sometimes fatal complications as a result. They meet grandmothers who have had to decide between paying for medications for their hypertension and paying the rent.
They see patients with employer-sponsored health insurance get sick, lose their job, lose their insurance and declare bankruptcy. In fact, medical expenses are the most common cause of bankruptcy.
Like everyone else, medical students are shocked when they see these inequities and inefficiencies. They believe your wealth should not determine your health and that poor health should not be able to destroy your wealth. And, of course, they're right.
I recently had a chance to discuss these issues with students at both of the major medical schools in town. Just last month the new St. Louis chapter of Physicians for a National Health Program brought in Dr. Garrett Adams, PNHP's national president, and Dr. Carol Paris, a single-payer advocate from Maryland, to speak with students at those schools.
The sessions were co-sponsored by the American Medical Student Association, a long-standing supporter of a single-payer system that has about 30,000 members nationwide.
It was clear from our local meetings that growing numbers of our medical students reject our dysfunctional, insurance-based system. They want something better. Many understand there is a breathtakingly simple solution: fix the limitations in Medicare and provide it to every American. More than 30 percent of the health care dollar today is wasted on the administrative costs associated with the private health insurance industry; Medicare spent only 1.5 percent on administrative costs during 2011.
A landmark study in the New England Journal of Medicine (2003) showed that by replacing our fragmented, inefficient patchwork of multiple insurers with a single, streamlined, nonprofit agency like Medicare that pays all medical bills, our nation would save about $400 billion annually in reduced administrative costs — enough money to provide comprehensive, high-quality coverage to every American for no more than our nation spends now.
According to Gerald Friedman, professor of economics at the University of Massachusetts-Amherst in the March/April 2012 issue of Dollars and Sense, "a single-payer system would save as much as $570 billion now wasted on administrative overhead and monopoly profits." Spending would increase by $326 billion from expanding coverage and adjusting Medicaid rates. Americans would net a savings of $244 billion, enjoy universal coverage and eliminate the dreadful scenarios described above. Disposable income would increase for 95 percent of Americans.
Because a single-payer system would possess enormous bargaining clout, it also would be able to rein in costs for pharmaceutical drugs and other medical supplies over the long haul.
I believe that adopting an "improved and expanded Medicare for all" is the best way for students and physicians to return to their mission of caring for our patients, rather than squandering our time navigating administrative barriers erected by insurance companies. And make no mistake — these are barriers to care, with dire consequences.
Although we spend more on health care per capita than any other country in the world, American life expectancy ranks 38th.
My colleagues and I came away from our student meetings confident that the future of medicine is in good hands. The medical students we met didn't get lost in jaded political quagmires.
They know it's inevitable. They just want it to happen now.