It’s the middle of the night, and I’m jolted from my brief rest by the familiar ring of my pager. It’s my first year of residency, and I’m on call in the hospital. I answer the page. I need to assess a new admission to the intensive care unit for dangerously high blood sugar in the setting of diabetes. The patient was trying to ration insulin due to cost. Without insulin, the patient’s body started breaking down fats and building up acid in the bloodstream, which caused nausea, vomiting and confusion.
This is a deadly and preventable medical problem. If you haven’t lived it, I’m sure you’ve heard this story before in the news or on the radio — many patients and doctors have told this story. We need to keep telling it over and over until this doesn’t happen anymore. I don’t want us to become desensitized to the inhumanity inherent in our profit-driven health care system.
Despite less than a year being a doctor, I have cared for numerous patients who have tried to ration or avoid care due to cost. These are patients with severe asthma because they cannot afford their inhaler or people who experienced opioid relapses because they cannot access treatment for their addiction. By the time people end up in the emergency department, they are often seriously ill. Many tried to seek care sooner but simply could not access it. Patients also experience delays in care or harm due to unnecessary interference by insurance companies. Insurance companies tell doctors what medications they can and cannot prescribe and which health care providers our patients can and cannot see. This is not normal. No one should ration their care, delay their treatments, or declare bankruptcy due to inability to pay for health care. We cannot fix this problem until we truly recognize health care as a basic human right.
The only solution I see going forward is Medicare for All, or single-payer health care. This means health care would continue to be delivered by hospitals but would be funded by the government. In fact, the U.S. already pays enough to fund a single-payer health care system; we just aren’t getting one. And our increased cost of care doesn’t lead to better quality. We have worse health outcomes compared with peer countries — most of whom have some version of single-payer. If Medicare were expanded to cover everyone, there could be lifelong, seamless coverage that would eliminate disruptions in care and the fear of life-altering hospital bills. Doctors could focus on providing the highest quality of care for our patients, without having to cater to the restrictions of insurance companies.
Granted, Medicare needs improvements. The Medicare for All Act of 2019 would eliminate premiums and copays and expand care to cover vision, hearing, dental, mental health, substance abuse treatment, prescriptions and more. There would be no surprise bills, no gaps in coverage, and nobody would be left out.
Insurance companies and others benefiting from the current system want you to believe that this can never happen. They say implementing Medicare for All would be too expensive or cause rationing. What they don’t tell you is that health care is already too expensive for patients, and people are already rationing care due to their inability to pay for it. They also don’t like to acknowledge the fact that there was no increase in overall utilization after the implementation of Medicare in 1966 or the Affordable Care Act in 2014, despite millions of Americans’ gaining coverage. Decreased utilization among wealthier and healthier Americans more than offset the increase in care for poorer and sicker patients. Hospital administration costs have also grown tremendously in the U.S. due to the bureaucracy of our fragmented system and can eat up more than a quarter of hospital budgets.
Tuesday, March 3, marks the Minnesota Democratic primary. I will be casting my vote for Bernie Sanders as the candidate I trust most to champion the cause of Medicare for All. I hope that, as my medical career progresses, asking patients about their insurance will become as outdated as my pager.
Dr. Rebecca Gieseker lives in Minneapolis.