On Obamacare: a med student's view

By Jawad Husain
The Daily Free Press (Boston University), Feb. 23, 2014

I voted for Barack Obama in 2008 because he promised to sign a universal health care law. This aligned with my ambitions to become a doctor who treats patients based on their medical need, not their ability to pay. Finally, the time had come for us to fix our inequitable system and offer our citizens the human right to health.

Six years later, most of the provisions of the Patient Protection and Affordable Care Act have been implemented. However, it’s apparent that political pressure from the private insurance industry and the big drug companies has thwarted the goal of the universal health care.

Obamacare is expected to help an additional 20 million Americans obtain health insurance, mostly through Medicaid expansion and subsidized private insurance, but about 30 million Americans will remain uninsured. According to the American Journal of Public Health, this translates to approximately 30,000 preventable deaths a year.

Mandating Americans who don’t qualify for Medicaid and who don’t have employer-based coverage to buy private insurance policies benefits insurance companies, but does little to make health care affordable.

For example, those enrolling in an exchange-based Bronze Plan will have only 60 percent of their actual health care costs covered by insurance. According to a report by the Kaiser Family Foundation, even after paying premiums, a family may have to spend up to $12,700 out of pocket.

When patients have “more skin in the game,” e.g. higher co-pays and deductibles, they often forgo necessary medical care. Medical costs caused 37 percent of Americans to forgo seeing a doctor or skip filling a prescription in 2013, according to findings by The Commonwealth Fund.

The private insurance industry’s profit-making incentive makes health care a commodity that is unaffordable for the poor. However, there are promising solutions currently being proposed at the state level.

Vermont is already in the process of setting up a statewide single-payer health insurance system.

Vermont’s legislature has declared health care a “public good” and assumes the responsibility to, “ensure universal access to and coverage for high-quality, medically necessary health services for all Vermonters.” This is not “socialized medicine;” doctors and hospitals will remain independent. All medical needs are covered for everyone, and patients are free to choose their doctor.

Canada’s single-payer system has resulted in high-quality universal coverage at a cost that is about half of what the United States spends on health care. Risk is shared across the entire population, administrative costs drop and zero profits go to insurance companies.

If Vermont’s approach succeeds, we can expect other states to follow. Massachusetts gubernatorial candidate Dr. Donald Berwick intends to establish a single-payer system if elected. Congressional Representative John Conyers, Jr. has sponsored a single-payer bill in the House and Senator Bernie Sanders has as similar bill in the Senate.

Single-payer national health insurance is not impossible. Canadians did not always have a single-payer health care system — they demanded it. Their single-payer movement started with a single province.

How many more “unprofitable” Americans have to die or go bankrupt before we too demand our human right to health?

Jawad Husain is a medical student at the Boston University School of Medicine.