I am a fourth year medical student. I’ve dreamed about being a physician since I was in sixth grade. For a long time, my deepest hopes were to get into college, be accepted by a medical school, and maintain the grades and test scores needed to keep me there. My clinical rotations have taken me to hospitals across the state of Pennsylvania-- from Pittsburgh’s North Side to North Philadelphia with stops in rural and suburban communities in between. Now I’m less than a year away from obtaining my medical degree.
Despite many hours of study and months on the hospital wards, I don’t feel any closer to practicing the kind of medicine I’ve always dreamed about than when I watched my first episode of “ER.”
That’s because I now understand that I won’t be able to take care of patients the way they – or I – would like.
"[A single-payer system] is not a government take-over; this is the people reclaiming control over their own health care. This is the only way to keep everyone healthy, and to do it efficiently."
How so? Although we’re living in a time and place where we have more ways than ever before to treat illness, our health care system is broken. It’s clear to me that the current system is set up to make profits for corporate shareholders, not to keep people healthy.
Right now, we are paying exorbitantly – the highest per capita expenditure in the world – for a health care system that leaves too many people out. Even after the Affordable Care Act is fully implemented, 28 million people will still be uninsured in 2026, according to the Congressional Budget Office.
Further, the specter of under-insurance, where insured individuals’ out-of-pocket medical costs are more than 10 percent of their income, is rising. Premiums, deductibles and co-pays are going up, deterring people from seeking needed care and exposing them to the danger of medical bankruptcy.
This very expensive system is also ineffective. I met a patient who first lost her energy, then her appetite, then her hair, and then her insurance in the middle of cancer treatment. She finally lost her oncologist because the latter did not accept Medicaid.
I’ve met parents who guiltily admit they can’t afford their own medicine and use their children’s inhalers when they can’t breathe. I’m trained to ask if patients are taking their medicines and then to follow up: “Do you ever have trouble affording your medications?”
I’ve watched the extent of insurance coverage determine treatment decisions for patients injured in car accidents. Or whether a patient with mental health problems gets treated at all.
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So today I’m pouring my energy into a new dream: to practice medicine in a health care system where everyone gets covered for all medically necessary care. I want to help bring about a single-payer, national health insurance program.
This is not pie in the sky. Last month, the nonprofit Physicians for a National Health Program released “Beyond the Affordable Care Act: A Physicians’ Proposal for Single-Payer Health Care Reform” in the pages of the American Journal of Public Health. The proposal is endorsed by more than 2,200 physicians in all specialties.
Under the proposal, everyone will be covered by a publicly financed, nonprofit national health program, or NHP, for both outpatient and inpatient care, as well as rehabilitation, mental health services, long-term care, dental care, and prescriptions.
And it’s affordable. By replacing our redundant, complex private insurance bureaucracy with a single, nonprofit, streamlined program, we’ll reap savings of roughly $500 billion a year. That’s enough to improve and expand coverage to all – i.e. to eliminate the problems of uninsurance and under-insurance, and eliminate all co-pays and deductibles – without any increase in total health care spending.
The new system will be able to rein in costs. Much like we currently fund fire departments, the NHP will pay global, lump-sum budgets to hospitals, clinics, and nursing homes, rather than charging for each aspirin tablet.
Physicians will be paid based on a fee-for-service schedule covering all patients or by salary. The NHP, as a single buyer, will negotiate prices with drug companies, just like other countries already do, reaping additional savings.
We can finance this program by combining all current sources of government health spending, which already accounts for 64.3 percent of the country’s health bill, with modest new taxes based on ability to pay. Ninety-five percent of all households would save money, according to one study.
This is not a government take-over; this is the people reclaiming control over their own health care. This is the only way to keep everyone healthy, and to do it efficiently.
This is the plan I want for my patients, for my family, for myself. Based on recent polls showing solid majority support for “Medicare for All,” I’m obviously not alone. We should implement this remedy without delay.