SCOTUS shows us we need to take a BIG step back

Let’s say you are a smart high school student who is learning about the American healthcare system for the first time in a civics/social studies class and considers herself unbiased, non-partisan, and open to a variety of perspectives and solutions. You are given an assignment to read this article about how we aren’t getting what we pay for in healthcare – we have the most expensive healthcare system in the world, yet we aren’t any healthier than other developed countries.  You learn about the ACA and all the workarounds that have been implemented in its wake (voluntary Medicaid expansion for states, for example) and finally, today’s Supreme Court decision. That a private corporation that provides health insurance to its workers is exempt from having to provide coverage for birth control – a basic preventive form of health care that allows women to decide when/if to start families, even though birth control is included in the required forms of mandatory minimum coverage.

Would you look at this law and think:

A: “Wow, glad that’s settled. No one will ever challenge the ACA again and this is a great example of religious freedom in America.

B: “This system just allowed a small group of people exemption from the law because these people held an opinion that other people that they have power over (ie., their employees) shouldn’t do something (in this case, take a medication) that they disagreed with.”

It doesn’t take too much imagination to think that this is just one of the many future battles to be waged on the ACA. Because special interests (ie., certain employers) are still intimately involved in seeing that a good deal of the public has access to healthcare thanks to the ACA, the implication is that our system is going to get more and more complicated, exemptions for special groups will continue to be made, and as a result, the public will NOT have the expanded access to affordable, comprehensive healthcare the ACA was (supposedly) designed to promote.

If I were that high school student, I would say – scrap the whole thing and start over.

I would want a system that provided certain mandatory minimum coverages to ALL people, regardless of their bosses’ religious and political inclinations. I would want a system that didn’t jeopardize my ability to plan a family because of my employers’ convictions.

When we have these arguments about whether certain groups should be exempt from certain parts of the law, we are getting mired down in details and missing the bigger picture – that we have “designed” a bizarre and perverse system that has now incentivized employers to take such interest in our sex lives that the SUPREME COURT has to get involved.

A solution – get rid of employer-sponsored health insurance and extend Medicare (with mandatory minimum coverage requirements!) to everyone.

 

Good article about some more philosophical considerations…

Price-posting: Oh Look! Another Healthcare Cost “Solution” Gimmick.

The Surgery Center of Oklahoma has been in the spotlight recently because of its decision to post all of its prices for its procedures online. This has been heralded as increasing transparency in healthcare costs and implicitly demonizes other hospitals in the area that haven’t followed suit, like traditional academic centers.

Why haven’t hospitals done this a long time ago, so the uninsured can bargain shop for their knee replacement  instead of being stuck with a huge bill they’ll have to go into bankruptcy to afford? It’s an attractive idea, especially when presented as oversimplified as it has been to the public.

In isolation, price-posting is just another market-based artifice, more zeitgeist of our accelerating entrenchment in our broken, healthcare-as-commodity model than any real solution. Nothing illustrates it better than this quote in the NYT opinion piece from the co-founder of the Surgery Center himself, “Patients are holding plane tickets to Oklahoma City and printing out our prices, and leveraging better deals in their local markets.”

HOLD UP DOC. There are a few BIG assumptions here:

1) The medical procedure you need is known to you in advance – that is, it isn’t an emergency.

2) You have the ability to pay SOMETHING ,but either don’t have insurance or lack specific coverage for the procedure, etc.

3) You are physically and mentally able to bargain shop for the healthcare you need. There are many people who need healthcare services who aren’t able to do this – people with dementia requiring long-term care, a person in a coma from a car accident, a person with a debilitating psychiatric problem – it’s not hard to bring examples to mind.

We find that what this really represents is a very specific marketing tactic to a targeted audience – mostly healthy people who need an elective surgery to improve their quality of life. Clearly a very important demographic, but it by no means representative of everyone seeking healthcare.

This approach might works for certain places, like outpatient surgery centers, because they don’t have to deal with people who can’t pay. They can throw their hands up and say, “Don’t blame us! This is a fair deal. Our prices are listed with no small print – pay or don’t receive services.” These are not hospitals – they are centers that offer specific, non-comprehensive services.

Meanwhile, other hospitals in the area, like Oklahoma University Medical Center, take care of people who can’t pay.

The NYT opinion piece basically sums the problem of healthcare costs as a lack of knowledge on the part of the consumer.  That IS a problem, but the real problem is summed up simply in one word: profit.

When there is a market-based healthcare system like there is now, we get comical (but tragic!) comparisons like the NYT piece where finding cheap airline tickets through Kayak is used as analogy to “shopping” for health care.

Anyone without a stake in the current system, any American that needs life-saving services, anyone with the presence of mind to take a step back and examine things in context will see this is just. another. tired. gimmick.

The beginning of a real solution to the healthcare cost problem requires the following steps, in order:

1) Recognize every single person’s fundamental vulnerability to disease and death.

THEN

2) Affirm healthcare as a human right, NOT a commodity that is only available to those that can afford it.

THEN

3) Change the system into an “Ultimate Public Utility” model – because it’s something that we ALL benefit from, and are (mostly) unable to predict when we will require.

THEN

4) Realize that a publicly-funded, Single Payer model – improved Medicare for everyone – is the NECESSARY BUT NOT SUFFICIENT next step.

I’ve noticed some Single Payer advocates start to falter when they present Single Payer as the ipso facto solution for every healthcare-related problem. It will not be like that. Very little will change for the average person if we just decide tomorrow to extend Medicare to cover everyone. A Single Payer system’s REAL power is providing the  ONLY framework that will allow us to collate our bloated, fragmented system into one that can be examined and systematically changed in response to population needs. More fundamentally, it is the only one in which population needs can be accurately assessed in the absence of profiteering. It will be a quicker, more centralized, more responsive system because it is structured to be resistant to conflicts of interest. The goal of a Single Payer system is to provide necessary healthcare to everyone, NOT quibble about piecemeal, temporary gimmicks like price-posting.

Students for a National Health Program Summit

Over the past few months, I’ve been helping to organize the 2nd annual Students for a National Health Program summit – a conference designed to help health professions students learn more about how to advocate for single payer national health insurance. It’s getting down to the wire – the conference is this Saturday, May 11 at Physicians for a National Health Program headquarters in Chicago. It’s been a pretty sizable amount of work – I feel like I’m sending a million emails a day – but it’s shaping up to be a great conference. This is the first time I’ve helped to organize something like this, and I’ve actually kind of enjoyed it, despite never considering myself someone who was particularly good at logistics or details. I’ve been incredibly impressed with the other organizers who are all busy med students too. It seems like this has run WAY more smoothly than I anticipated, and it’s no doubt because the other students are doing it because they believe strongly in the cause (not to mention they’re super smart and talented!). I’ve noticed that when counting on people who are volunteering their time, you can unfortunately expect about a third to half of them to flake on some tasks, even if they specifically said they would do them. It just seems to be the nature of the beast. These guys have not only NOT done that, but they’ve been incredibly proactive in volunteering to take on extra work during our organizing conference calls. It’s made me work even harder to ensure we provide a good conference for the other attendees.

One of the things I’m really excited about (which was also true last year when I attended the first conference) is that the group chose to invite other health professions students, and I was able to meet with people in different training programs – nursing, public health, etc. We have several other professions represented this year too, including some premeds, which is great! I think interacting with other health professionals is something that my school has been a bit weak on so far. We’re all working towards the same goal and we’re all in the same system, yet sometimes we don’t even understand what the other’s role is.

We’re going to start the day with an introduction to single payer and a presentation about the role of advocacy that health professionals have played in the past, and what we can do in the future.Then we’re going to talk about HR 676, the House single-payer bill. From there, we’re giving students options of attending one of two breakout sessions which are designed to be more interactive. I’m helping with two of them. The first is a co-presentation with Paul Demos, a former drug rep who is now a medical student. We’re giving a presentation about – my favorite topic – the role of privatization and for-profit corporations in health care! And who better to speak about this than someone who has been in the trenches and really knows what it’s like as a former drug rep. The next presentation that I’m giving is really going to be an interactive session about communication/conversation skills and responding to difficult questions about single payer. I was feeling a bit uncomfortable giving this, to be honest! I was wondering if I even have these skills – sometimes I feel after walking away from someone who disagrees with me we’ve both just annoyed the other. I kind of tried to get out of this presentation or at least get someone to help, but then I realized that it’s completely fine to admit that effective communication skills are a constant learning process. Expecting to always be perfectly poised, articulate, and calm when speaking with someone about something you feel passionate about is unrealistic. The healthcare system is complicated (to say the least), and understanding the economics behind it is something I feel like I’m only beginning to grasp. Instead of giving a presentation, I tried to come up with a framework where we could all learn from each other. There is no doubt that some of the people attending will be much better at this than me, naturally, and I hope that we’ll be able to learn from them. So I designed a couple of scenarios for people to act out. I hope this will be a good experience for everyone, but we shall see! Other presentations/breakout sessions focus on transitioning from sympathizer to activist, a workshop on writing letters to the editor/speaking out, healthcare economics, and more! I have really high hopes for the conference and I hope that I can learn to better convey my optimism that single payer is the most realistic, humane goal for a better future.