Advocating for a Single Payer System

Passionate students spread their message to their peers

By Anna Zelivianskaia
Chicago Medicine, January 2014 

Imagine these all-too-likely scenarios: Lisa Palmson recently lost her mother to breast cancer. Due to her family history, the physician recommends tamoxifen as a chemoprevention therapy. However, Lisa is unable to afford the co-pay. Paul Johnson has felt a burning sensation around his stomach for several weeks and it has recently gotten worse. Visits to his primary care physician are mostly covered by his insurance but his PCP refers him to a gastroenterologist whose services are not covered until Paul reaches a large annual insurance deductible. As a result, Paul cannot afford a visit. A year later he is diagnosed with gastric carcinoma due to Helicobacter pylori infection, a preventable cancer when caught early.

These types of scenarios happen every day in physician offices in America. Our health care system allows for high numbers of uninsured and underinsured, which prevents us from achieving the degree of care we are capable of. Medical decisions are no longer between the patient and doctor. Instead, every therapy and test must be approved by insurance companies, which operate with the goal of making a profit. Fortunately, many passionate medical students in Chicago are stepping up to advocate for changes.

Driven by the desire to improve patient care, medical students are educating other students and the public about the merits of a publicly funded, privately delivered, single-payer health care system. Scott Goldberg, an MS2 at the University of Chicago, has advocated for a single-payer system for several years and is now training other students to do so. He has set up workshops on how to write a political op-ed, trained students in community organizing, and even began educating undergraduates on the merits of a single payer. “For me,” he says, “it just made complete sense. Why can’t the richest country in the history of the world provide equitable, comprehensive insurance to all of its citizens? Until we eliminate private health insurance companies, we will never be able to fully achieve the ideal doctor-patient relationship in the American health care system.”

Similarly, Margaret Russell, an MS2 at Northwestern University, educates students on how our health care system works as well as teaches them the skills to change it. She recently presented an informational session on the federal bill for a single-payer system, H.R. 676. For Margaret, the fight is close to home: “I have seen firsthand how our fragmented and unjust insurance system stands in the way of patients receiving adequate care when they need it. … It is morally and ethically wrong for a patient’s insurance status to dictate the quality of their care.”

This passion comes from a fundamental belief that patients are more than their presenting symptoms and vital signs. These students realize that each patient has a unique set of circumstances but is part of a homogenizing system obsessed with profit. However, it is noteworthy that the most fervent student advocates, such as Scott and Margaret, tend to enter medical school believing in the urgent need for health care reform. As a medical community, we must try harder to make advocates out of other students who did not enter with such beliefs or background knowledge. Student-to-student advocacy is inspiring but not enough.

Medical education has changed drastically over the last several years in very commendable ways. Curriculum changes at some schools include education on systematic flaws. However, classroom information often stops at the problems and not at potential solutions or opportunities for student advocacy. Medical schools should constantly improve training in this area since student empowerment is a key step toward patient empowerment. Every medical school should provide systematic education on the inner workings of the medical system and reform options. We need to fix the system together for the sake of our patients.

Anna Zelivianskaia will graduate in 2016 from the University of Illinois at Chicago College of Medicine. The opinions expressed in this column are strictly those of the author and do not necessarily reflect those of the Chicago Medical Society. All members are encouraged to submit opinion pieces.