How would they fix chaotic, costly health system?

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Rohit Anand, Dhiksha Balaji, Aparna Narendrula and Jasmine Serpen, Opinion contributors
Published 5:00 a.m. ET Sept. 21, 2020

We hope Trump and Biden discuss health care in the first presidential debate. We’re medical students who already see it’s chaotic, costly and unequal.

In medical school, we rely on acronyms to summarize critical aspects of complicated topics. We have one such acronym to describe key aspects that we hope our health care system will one day embody: USA — universal, simple, affordable. Today, health care in America meets none of these criteria. Our country is the only industrialized nation that has yet to commit to providing all of its residents access to affordable, quality care.

As medical students in Cleveland and leaders of our school’s health justice organizations, we find it fitting that the first 2020 presidential debate will be hosted on Sept. 29on the Health Education Campus, an education hub we share with other health professional students.

Our half-billion dollar HEC stands in stark contrast to Hough, the neighborhood where our school is located. Despite being surrounded by multiple prominent hospital systems, Hough, a predominantly Black neighborhood, suffers from an infant mortality rate nearly four times higher than the national average, and at least 15% of its residents are uninsured. Health inequities continue to be overlooked and perpetuated by our system in Hough and the many other communities like it across the nation. They deserve better. 

Red tape, chaos in US health care 

Given the debate location on a health care campus in a socioeconomically deprived neighborhood, amidst a global pandemic, we sincerely hope that health care reform will be a key focus of the debate between President Donald Trump and former Vice President Joe Biden.

The pandemic highlights the gross inadequacies of our health care infrastructure to meet the most fundamental health needs of Americans, and the urgency with which our system requires reform. Unlike most other nations, American health care is fragmented and disorganized, with quality care buried in layers of bureaucracy.

A hospital in 2008 in Houston. (Photo: Jack Gruber/USA TODAY)

Clinicians and patients are plagued by the red tape and regulations from the insurance industry and lack of price transparency. The organizational structure of our health care system is designed to incentivize drug companies, insurance companies, hospitals and physicians to maximize their own profits. The complex interplay between stakeholders and regulations makes health care unaffordable, both to patients stressed by high deductibles and copays as well as to taxpayers and governments, which finance a majority of health care. Even though we are at the beginning of our training, we have already experienced the toll that administrative burdens place on clinicians and patients alike.

Profits in healthcare: US hospitals function like businesses. That’s why they are struggling amid COVID pandemic.

An American health care system rooted in universality, simplicity and affordabilitywould alleviate many of these issues.

Patients skip treatment due to costs

Universality would allow us to treat everyone in our communities without concern for each individual’s insurance status or ability to pay. Simplicity would improve patient access to timely care and reduce physician burnout rates, which exceed 50%, allowing us to spend far less time on administrative hassles compared with our mentors and to redirect that time toward caring for our patients. Affordability is essential and will improve health outcomes and overall public health. Even this early in our medical training, we are already exhausted by seeing patients forgo treatment due to the financial jeopardy they could be placed in. 

Teacher: Instead of giving me a COVID-19 test, my hospital blindsided me with bills

With over 40,000 lives lost each year due to lack of health care access, incrementalism and discussing the nuances of laws is not sufficient. Americans need and deserve a more comprehensive discussion on health care reform, and the Sept. 29 debate presents that opportunity. We believe that health care questions in this upcoming debate should focus on principles, and not get caught up in technical jargon and a maze of policy particulars.

Every year, graduating medical students across the country recite the Hippocratic oath. They promise to uphold ethical principles sacred to the practice of medicine, including perhaps the most widely known, “do no harm.” We believe the infrastructure of health care in America is an injustice to our patients and a barrier to carrying out those principles. As part of the emerging generation of health professionals, we are personally committed to advocating for a system built on principles that strive to provide equitable care to all and to promote health through addressing the structural and social causes of illness.

Rohit Anand (@ro_anand), Dhiksha Balaji (@DhikshaBalaji), Aparna Narendrula (@a_narendrula) and Jasmine Serpen (@jasmine_serpen) are medical students at Case Western Reserve University School of Medicine in Cleveland. The views expressed here are solely their own and do not reflect those of their institution.


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