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A single-payer health-care system is needed

By Jonathan Michels
Winston-Salem (N.C.) Journal, March 3, 2017

Ten years ago, I began transporting sick patients at Forsyth Medical Center. Transporters are some of the hardest working and least recognized workers in the hospital. My job was to transfer patients as smoothly and comfortably as possible onto a clean gurney and transport them to the radiology department. Deceptively simple, transporting turned out to be a crash course in humanity. I decided to pitch in as best as I could.

The very first patient I went to transport by myself died in front of me. My astonishment about the patient’s death amused my seasoned co-workers, who helped me understand that the hospital is a place where sometimes people come to die.

“Why is this happening to me?” asked another patient, terminally ill with cancer. Her words hung in the air as I settled her back into bed. I had no answer for her then, and I still don’t.

Transporting overdose victims, some of them younger than me, underscored the fragility of life. And watching stroke patients relearn basic skills like feeding themselves or walking taught me about the resilience of the human body and spirit. Hope Jahren, the celebrated geobiologist and author, echoed my response when she wrote, “Working in the hospital teaches you that there are only two kinds of people in the world: the sick and the not sick. If you are not sick, shut up and help.”

Medicine has changed a lot even in the short time since I began transporting patients. Despite the much-vaunted health-care reform of 2010, the Affordable Care Act, medicine is still driven by profit, not progress.

Twenty of the highest-paid CEOs included in the Standard & Poor’s 500 index hailed from health-care or pharmaceutical companies, according to a 2016 report from the Associated Press and Equilar. Health-care executives continued raking in millions of dollars in salaries and bonuses in the wake of the Great Recession, while I joined hundreds of other health-care workers who were escorted out of the hospital in a massive layoff. The people who remained, many of whom come to work every day to care for the sick and the helpless (and yes, for a paycheck), increasingly feel the pressure of doing more work with fewer resources.

Now a premedical student at UNC-Greensboro, my health-care experience has shown me that sometimes it’s simply not enough to pitch in and help patients on a case-by-case basis. In order to effectively care for our patients, we need to implement a health-care system that meets the needs of everyone and allows medical providers to do their jobs without the intrusion of hospital administrators or private insurance company executives.

Our health-care system is at a crossroads. While the ACA made some improvements around the edges of our health-care system, it clearly wasn’t enough. We need to go beyond the ACA to a single-payer system, an improved Medicare for all. In January, U.S. Rep. John Conyers of Michigan introduced H.B. 676, which would implement an improved and expanded Medicare-for-all.

More than a decade ago, Donald Trump preached the sensibility of covering all Americans in his book, The America We Deserve.

“We must have universal healthcare,” Trump wrote. “I’m a conservative on most issues but a liberal on this one.”

The proposed replacement program put forth by U.S. House Speaker Paul Ryan and Health and Human Services secretary Tom Price gives tax credits for people to buy private insurance and doles out block grants to states to replace the Medicaid expansion provision under the ACA. Critics believe the changes will put more financial burden upon American families and ultimately reduce the number of uninsured.

“Although Republicans’ proposals seem unlikely to achieve President Trump’s triple aim (more coverage, better benefits, and lower costs), single-payer reform could,” wrote Dr. Steffie Woolhandler and Dr. David Himmelstein in the Annals of Internal Medicine.

A single-payer system would eliminate for-profit insurance companies and replace them with a non-profit, public-payer system. It would be privately run but government funded just like Medicare, saving billions in administrative costs and giving doctors the freedom of practicing medicine without intrusion. Patients would no longer pay high deductibles or co-pays and there would be no fear of losing health insurance if someone loses their job.

Rather than jettison any recently-won gains in health-care coverage, let’s push the president to renew his support for universal care — and hope that Congress follows suit with H.B. 676.

The only way to get back to the real business of health care — caring for our patients — is to enact universal health care.

Jonathan Michels is a local radiology technologist.

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