We Deserve a Better Healthcare System, We Deserve Medicare For All

Recently, I was taking care of a gentleman in his sixties with high blood pressure and diabetes. My goal, I explained to him, was to prevent a heart attack or stroke which are too frequently the  consequence of these diseases. I will closely monitor his kidney function and blood sugar levels so that I can recommend the safest and most effective medications for him so that he can live as long and symptom-free as possible. This medical care is based on the latest medical evidence and guidelines, and I am proud to provide it. 

If I am to truly be a steward of his health, however, it is not enough to focus on his medical care. I must also carefully consider the greater social context of his life. Reducing consumption of refined carbohydrates and sugar is crucial to blood sugar management in patients with diabetes. Are fresh fruits and vegetables still affordable to him or is he mostly eating cheap processed foods to stretch his grocery budget? For this patient, insulin was necessary to prevent painful neuropathy in his hands and feet. How much are the copayments on his insulin? Is he taking the full recommended dose, or is he cutting back because of expense? 

Understanding these social determinants of health is a core competency of high-quality medical care in the twenty-first century. Given that the majority of premature death is attributable to factors other than medical care, I would be remiss as a primary care provider if I didn’t engage with the social and environmental factors that bring illness into my patients’ lives.

One harmful social condition that I must engage with every day is the commercial health insurance system which mediates access to medical services. In this system, insurance companies collect enormous amounts of money through premiums in exchange for limited access to doctors and medications only after you additionally pay co-pays and meet your deductible. 

The expense of co-pays and deductibles all too often push those with chronic illnesses into poverty. Nearly half of the people diagnosed with cancer end up with negative net worth in the subsequent two years. Every year in America 530,000 people file for bankruptcy in part due to medical debt. Many find themselves being sued by hospitals when they struggle to keep up with their bills. 

I see this damage done by our current commercial insurance system every single day. I see how poverty leads to disease which requires medical treatment which then exacerbates poverty and the cycle begins anew. It’s enough to drive you to despondency. 

But let me tell you, I’m not despondent at all. In fact, I’m quite hopeful.

I’m hopeful because there is a presidential candidate who is working to break this cycle of illness and poverty. There is a candidate who believes that health care is a human right. There is a candidate who believes that no one should be impoverished by illness or made ill by the deprivations of poverty. There is a candidate who is fighting for my patients, for me, and for you.

That candidate is Bernie Sanders and his plan for Medicare For All will put an end to the financial destructiveness of our current health care system. By providing a universal, comprehensive health care benefit that is free at point of service for all Americans, we can finally have the health care system we deserve in this country.

As a primary care doctor, I can think of no better advocate for health and well being of my patients than Bernie Sanders and I am proud to join Doctors For Bernie in endorsing him for the democratic nomination.

The incredible expense of getting old in America

The Kaiser Family Foundation has recently done some excellent reporting on the out-of-pocket expenses faced by seniors on Medicare. Using data from the 2016 Medicare Current Beneficiary Survey (MCBS), they found that the average Medicare beneficiary pays $5,460 out-of-pocket each year for health related expenses such as co-pays, medical supplies, or medications. This spending amounts to 12% of these seniors’ total income, reducing the amount of money they have available for food, housing, or transportation.

Elders have struggled with these costs, resorting to putting their health at risk by skipping doses of necessary medications or delaying necessary medical care.

Working in primary care, I see this brutal self-rationing all too often. Elder patients who cannot talk to their grandchildren because they cannot afford hearing aids, who cannot eat the foods they enjoy because they cannot afford dentures. It’s devastating.

For seniors that require long-term care services such as a rehab or skilled nursing facility, average out-of pocket spending was $23,045 or 79% of their income. For context, 70% of people over the age of 65 spend at least some time in a skilled nursing facility. For seniors who need full-time nursing care which is not covered by Medicare, the average cost is $102,200 per year.

Because our current Medicare program does not cover long-term care, seniors are forced to spend-down, essentially selling off all of their assets to pay medical bills until they are impoverished enough to qualify for Medicaid. The majority of people in nursing homes end up in this situation.

Access to needed medical services need not impoverish us in our later years when we should be spending our time and energy with the family and friends that bring meaning and joy to our lives.

Bernie Sanders’ Medicare For All plan addresses all of this. It removes cost-sharing for medical care and expanding benefits to cover hearing, dental care, and long term care services.

The specific proposal to make long-term care services a covered benefit of Medicare is quite popular in polling. Even with a negative framing, Data For Progress found that 60% support while only 27% oppose this benefit expansion.

Seniors are understandably anxious about politicians messing with Medicare. After all, Republicans have tried again and again to reduce Medicare benefits and increase medical costs for seniors. However, single payer Medicare for All makes the program more generous for seniors, while giving all Americans access to the same high quality level of care.

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