Single Payer: The long-term treatment of our ailing healthcare system

12068989_1177542282275508_18531005563961570_o“The future generation of physicians believes in healthcare as a human right.”

– Jawad Husain

Like thousands of other medical students, I train at a safety-net hospital, Boston Medical Center, where patients can be treated no matter what their income or insurance status. The majority of our patients come from underserved, low-income populations. Medicaid, the public insurance program for the poor and disabled, helps so many of our patients obtain life-saving medical care.

At the primary care clinic, I helped care for a resilient young woman named Stephanie (name changed for privacy) who was diagnosed with both HIV and opioid use disorder. Because of Medicaid, Stephanie was able to see an expert on HIV and addictions. This doctor prescribed her antiretroviral medications and buprenorphine maintenance therapy, and helped her through recovery. Now Stephanie appears healthy; both her HIV and opioid use disorder are in full remission. Medicaid helped her regain health, which in turn enabled her to obtain full-time employment while simultaneously working toward a college degree. Without Medicaid, Stephanie would not have been able to afford treatment, which would have left her at high risk to die from AIDS or overdose.

14925708_3498108215536_4449164534997249699_nPresident Trump and the Republican-controlled congress propose taking away life-saving care for patients like Stephanie by repealing the Affordable Care Act (ACA) and making deep cuts to Medicaid. Repealing the ACA is estimated to result in 20 million people losing insurance through reversal of Medicaid expansion and elimination of private insurance subsidies. Republicans also aim to change Medicaid to a block grant program. This would drastically change federal Medicaid funding from a variable amount based on the number of qualified enrollees and their healthcare costs, to a fixed amount for states to spend as they see fit. The problem with block grants is that many conservative states would use this as an opportunity to insure less people through Medicaid and shift more costs onto those who cannot afford insurance on their own. This means less care for the vulnerable patients who rely on Medicaid. It also introduces fiscal uncertainty for safety-net hospitals that treat a high volume of Medicaid patients.

Based on a study published in the New England Journal of Medicine, researchers predict that repealing the ACA will result in the deaths of an additional 43,000 Americans annually–even more than the number of deaths each year from breast cancer.

As a future physician, this is in conflict with my medical ethics. I took the Hippocratic oath, stating I will “do no harm” and that my primary commitment will be to my patients. In contrast, the leaders of our health care system have plans to do significant harm by prioritizing politics over patients. To satisfy the conservative anti-Obama ideology of their base, they are willing to repeal the ACA without a replacement, even if it results in millions of Americans losing insurance and thousands of preventable deaths.

While I recognize the immediate harm that repealing the ACA and block-granting Medicaid would cause for patients like mine, I also see that even with the ACA fully intact, our country is the only developed nation that does not guarantee healthcare as a human right. This is unacceptable. People have little control over if and when they have a medical problem, and when they do, this can profoundly compromise their life, liberty, and pursuit of happiness–not to mention their ability to work and contribute to society.

The fundamental problem, which even the ACA fails to address, is that the for-profit insurance industry is responsible for the injustices of unaffordable care. Private insurance companies add an enormous burden of administrative waste to our system. They have a financial motive to avoid covering the sickest and poorest patients, and to raise premiums to whatever the market will bear. The problems of private insurance can be bypassed with a single-payer system where people pay income-based taxes for insurance, instead of paying premiums, co-pays, and deductibles. This covers comprehensive medical care from any doctor or hospital, without any out-of-pocket costs. 95% of U.S. households would end up saving money, and everyone would be guaranteed lifelong insurance. Other countries with single-payer health insurance programs such as the United Kingdom, Canada, and Sweden spend less and provide universal coverage—isn’t that really what the vast majority of Americans want?

The future generation of physicians believes in healthcare as a human right. Medical students across the country, in organizations like #ProtectOurPatients and Students for a National Health Program, advocated for patients and condemned the urgent threat of ACA repeal through call-ins, protests, and lobby visits as part of a “Do No Harm National Day of Action” on January 30th. As we continue to fight the national emergency of ACA repeal, remember that the complex problems of U.S. healthcare are more like a chronic disease. Let’s not lose sight of the best long-term treatment for our ailing health system: single-payer national health insurance.

To learn more about how you can be part of the movement for truly universal healthcare, become a member of Students For a National Health Program (SNaHP) and join us for our annual SNaHP Summit on March 11, 2017 in Philadelphia.

Jawad Husain is a medical student at Boston University School of Medicine (BUSM). He co-founded the BUSM Students for a National Health Program chapter in 2013 and is a member of the national board of advisors for Physicians for a National Health Program. The opinions expressed in this article are his own, and do not necessarily reflect the views of Boston University School of Medicine or Boston Medical Center.