Med student: Activism for single payer, equality on the rise

The following is an unofficial transcript of an interview that Vanessa Van Doren, a first-year medical student at Case Western Reserve University School of Medicine, gave to Ed “Flash” Ferenc, host of the labor-oriented, Cleveland-based “America’s Work Force Radio” on WERE-AM 1490, on Feb. 9, 2015. You can listen to the audio recording of this interview beginning at the 39:44 minute mark here:

HOST ED ‘FLASH’ FERENC: When we come back we’re going to talk with a medical student at Case talk about a single-payer health care system in America. Other countries have it; it’s about time we have it here. … Let’s go to Vanessa now. Vanessa Van Doren is a first-year medical student at Case Western Reserve University School of Medicine. She is a native of Boston. You’re probably glad you’re not in Boston -- I heard they’re getting nailed with snow today. Did you know that?

VANESSA VAN DOREN: Oh, yeah. My mom works downtown and she emailed me and told me she doesn’t have work. I wouldn’t mind that.

HOST: We occasionally get dumped on -- we had a pretty good one last week -- but nothing like what they got in Boston or in Buffalo back in November. That was ridiculous. Getting back to Vanessa, she graduated from Brown University, good school, in 2007 with a degree in anthropology, worked as a genetics researcher for several years before deciding to pursue a career in medicine. So you want to be a doctor, right?

VAN DOREN: Yes, after a lot of thinking about it, I guess I do.

HOST: What, specific, I mean, everything is specialized in medicine today. What field do you want to go into?

VAN DOREN: It’s pretty early now, and every time I shadow a new doctor I get excited about another thing, but I think I’m leaning toward infectious disease. I’m interested in global health, too, so there’s a lot of overlap between the two.

HOST: With the Ebola scare, I can understand why. That’s scary stuff. And that doesn’t bother you. You can get exposed. We’ve seen nurses, we’ve seen other things happen here, that kind of stuff doesn’t bother you?

VAN DOREN: No, I actually think we’re pretty safe in the United States. We have much better protocols and better health overall. Especially given how many people are still dying from that, there are thousands who have died in West Africa. I feel that it would be a good thing to get behind.

HOST: Well, we’ve got a good health care system here, we just can’t pay for it. That’s the problem. That’s what you’re here to talk about.


HOST: You’re with an organization that’s called Students for a National Health Program, right? And you have a number of students at Case? Talk to us about the organization. It’s part of a bigger organization, right?

VAN DOREN: Yes. We’re student chapter of Physicians for a National Health Program. That’s an organization of about 19,000 physicians in the United States who are advocating for universal, single-payer health care in the U.S. So our group is a student chapter of that. We started in January and we’ve already got about 50 members that have joined the group so far -- so we’re pretty excited about that.

HOST: What about nationwide? How large is just your organization nationwide, just the students’ part?

VAN DOREN: The student part, I believe there are thousands of students who are involved. About 160 of us are going to a big conference in Chicago next weekend to talk about what we’re going to be doing on a national level a little bit.

HOST: Now that’s going to be in Chicago? Talk to me about that.

VAN DOREN: Yes, that’s in Chicago this weekend, actually. And so eight of us are going from this new group and we’ll be getting together as med students from across the country that want to advocate for universal coverage and for single payer, and how to get more students and physicians involved and the intersections between the goals other groups that are focused on issues of equality and social justice and our own, and members of Congress who support the single-payer bill. Yes, I’m pretty excited about it.

HOST: So, is the discussion on how to implement this kind of thing? Because we’ve often heard it’s Medicare for All.


HOST: Do you want to take the Medicare system as we know it and expand it? Because right now you don’t go on Medicare until you’re 65. So just take that -- and there’d be no age limits? Is that what we’re talking about?

VAN DOREN: Yeah. It would cover every citizen in the United States, much like just about every other developed country in the world does. It would be universal, and the single- payer part of it is how to finance it. So that means that instead of having dozens of different for-profit insurance companies reimbursing hospitals and physicians, the government would be the single payer, it would be streamlined, a lot more efficient, a lot more cost-effective. So they would be responsible for reimbursing.

HOST: So, get the insurance companies out if then, altogether?

VAN DOREN: Yeah, definitely. I don’t think that health care, human lives, should be a commodity like that. That’s something that should be covered for everyone in a developed country.

HOST: Because the insurance companies are the ones kind of dictating who gets what -- medicines, certain health care, or if you have a horrible disease, they can say “You’re not worth saving.” That kind of stuff goes on, doesn’t it?

VAN DOREN: Yes. I mean the Affordable Care Act has improved that. They’ve eliminated exclusions for pre-existing conditions, and tried to standardize some forms of health insurance, so that some things have to be covered now, but it doesn’t go far enough. There are still tens of millions of people who have no coverage whatsoever. 44,000 people die each year due to lack of access to care: that’s just unconscionable. We’re the richest country in the world. We should be able to do that.

HOST: 44,000 people every year.

VAN DOREN: Yes, from unexpected things, from not being able to pay. If you have some kinds of cancer, the medications for that are hundreds of thousands a year a lot of the time. So even if you have health insurance that covers 80 percent of your bills, you’re going to be in a lot of trouble. The leading cause of bankruptcy in the United States is medical bills, which is outrageous. And of people filing for bankruptcy for medical bills, over half of them had insurance, they just didn’t have very good coverage.

HOST: OK. To expand Medicare to all, there’s a Medicare tax. Are you advocating raising that tax to cover everybody and do you know what that tax would be, or is it too premature right now?

VAN DOREN: I think it’s too hard to give exact numbers right now, but the main cost-savings would be from streamlining the system. Instead of having all of these different payers, all these different insurance companies, and this massive bureaucracy and red tape that goes along with that, you’d have one system, one payer. You could eliminate billing departments in hospitals, and if you’re only interacting with one set of rules and one payer, and everyone was covered. The cost savings from that would be enormous, and that would be the primary way we’d be funding the system.

HOST: Yes. I remember the stats on Medicare. Isn’t there, as far as administration, something between 2 and 3 percent, where you have private insurance companies, the margin is something like 15 to 20 percent. Isn’t it something like that?

VAN DOREN: Yeah. It’s much higher.

HOST: So by eliminating that, you would encompass more people getting health care. I that what you’re saying?

VAN DOREN: Yes. Right now we spend about 17 percent of our GDP on health care, but we don’t have universal coverage. We pay about double per capita of what other countries pay. It doesn’t make any sense.

HOST: And we’re the only major industrialized country that doesn’t have a single-payer system -- that’s the crazy thing about this. OK, Vanessa, let’s go back here. I see you had this “White Coat Die-In” on Dec. 10. It caught my attention. What was that all about?

VAN DOREN: So, the die-in was a national event in December at about 90 med schools across the country and over 2,000 med students participated. It started off as response to the Eric Garner and Michael Brown verdicts, and the point of it initially was to recognize that institutionalized racism is a public health crisis, and that it affects all area of society, I mean law enforcement and the courts, as we saw with those cases, but also in medical care. So the focus originally was primarily on institutionalized racism in medicine. And that’s been getting some attention recently. There have been a number of studies coming out recently, showing that white physicians spend less time with black patients.  There’s a particularly study that shows physicians treat white patients versus black patients for a fracture differently. So anyone who’s had a broken leg knows that these are excruciating injuries that require serious pain medication, but this study showed physicians were twice as likely to prescribe Tylenol to black patients and twice as likely to prescribe opiates to white patients. So with all this stuff coming out, and what we’ve learned as med students, we identified this overlap between institutionalized racism in law enforcement and racism in medicine.

And when underlying racism manifests itself in law enforcement, the consequences are very obvious -- a person being choked to death, or grand juries that decide not to indict the perpetrators -- but when a patient dies of diabetes complications due to lack of access to care, or a misdiagnosis because a physician dismissed that patient’s symptoms because of these underlying biases, it’s not as dramatic as killing someone in cold blood but the impact on that person and their family and community is the same.

HOST: Yes.

VAN DOREN: So that’s the rationale for why we had this demonstration.

HOST: And a single-payer system would alleviate that kind of thing because costs would be taken out of it then, right?

VAN DOREN: Yeah, single payer -- I mean it wouldn’t eliminate institutionalized racism, but it would help reduce the burden by providing access to care for all people. And we would still have a long way to go beyond that, to treat patients with the same attention and compassion that they deserve, but single payer would be a crucial step. And actually the group that started the die-in helped identify single payer as a key component in eliminating racism in medical care. So there’s a big overlap between the two.

HOST: So that happened on Dec. 10 at the Case campus, and did you get a good turnout for that? And what about the university. Did the university go along with that?

VAN DOREN: Well, they were pretty involved. We only had about two days to plan it. It was mostly done through Facebook and we simply started inviting people. We had 70 people out there with this quick turnaround, which was exciting. And it wasn’t just students -- there were members of the community, physicians from the university hospitals, there were deans -- a couple of our deans came. My dean, Dr. Haynie, was out there holding a sign -- that was exciting. A big part of Case’s curriculum is talking about the social determinants of health, health policy, and that kind of stuff, so it was exciting to see our faculty members practicing what they preach and out there supporting us. We were lucky.

HOST: And this was part of a national effort, too. I see there were 2,000 medical students at 90 schools?

VAN DOREN: Yeah, and this was all organized through Facebook over about two days. It was pretty amazing to see it broaden out like that.

HOST: Thank god for social media today. It’s amazing.

VAN DOREN: Yes, it was the most Facebooking I’ve ever done on my life, I think.

HOST: Are you going to do something like that again, perhaps?

VAN DOREN: So that group has started chapters at different schools and we’re trying to keep the movement going and the conversation going. One of the big things we’re trying to do now is to have roundtable discussions with med students and physicians who supported the concepts but didn’t want to come out and participate, just to kind of discuss what of roles med students and physicians should have in addressing these kinds of issues. I think that’s an important conversation to have.

HOST: Social media is big and I also see you’re getting into the mainstream media. I see you had a response as a letter to the editor in replying to an Ohio libertarian. Now the libertarians, they don’t want any government intervention, do they?

VAN DOREN: No. Yes, how that letter happened is that Joshua Niforatos, he another first-year medical student at Case – he’s one of the founders of the chapter -- saw the op-ed by Sarah Bevins, one of the leaders of the Libertarian Party in Ohio. Her op-ed was arguing against the Medicaid expansion in Ohio. She argued that government safety-net programs like Medicaid should be totally overhauled and replaced by “free market” solutions. So we wrote just a short letter, just a few hundred words, a letter to the editor, explaining why her argument was wrong -- from any perspective, but predominately financial and ethical perspectives, and to explain why single payer is a better solution to address the problems of high costs, red tape, and lack of access to care -- hallmarks of our current system.

HOST: They don’t seem to understand those 44,000 people who are dying because they don’t have that program that you just referred to. It doesn’t seem to make a difference, though, does it?

VAN DOREN: Yes. That’s the thing that really gets to me, it’s totally unconscionable to say that. I mean that’s what we have with Medicare and Medicaid and CHIP, which is for lower-income kids. If we pull those safety-net programs, what are people going to do? The poverty line for an individual right now is set at $11,670 a year, and Medicaid covers people making under this amount. And in states that are expanding Medicaid, that line is set at about $16,000 a year. So this is a group that Bevins was saying that people should be paying for care just out-of-pocket, which is ridiculous. Private insurance premiums are thousands of dollars a month, and these are people who are struggling to pay rent and put food on the table. Medicaid is not a complete solution, but I just can’t see how a free-market approach would help these people get access to care.

HOST: No. They have a “let them die” attitude. That’s the sad part about it, it really is. Well Vanessa, I think you’re on the right track on this issue. I’d like to keep in touch with you. So you’re a first-year medical student so you have a little way to go, don’t you?

VAN DOREN: Oh, yeah, a long road. But it’s exciting. I’m really glad to be in this field.

HOST: So let’s check in with you, to see how things are going. If you have another demonstration or something like that, feel free to send it over our way to BMA Media and we’ll get it on the show, OK?

VAN DOREN: That would be great. Thank you so much.

HOST: And the national website is Vanessa, thank you so much, keep up the fight, we’ll be in touch, all right?

VAN DOREN: Thanks a lot.