Now Is Not the Time for Compromise on Health Care

Editor's note: This is the campus perspective from our partners at UWire.com. Author Iyah Romm is a Boston University medical student.

Two years ago I had an accident-- I fell down a flight of stairs, landed on my head and as a result, am now legally blind. Why is this relevant? As a medical student, I had access to world-class care unlike most others.

That wasn't the case for Paul, a young man with diabetes I met shortly after my accident. He too lost his vision because-- like at least 46.3 million other Americans and 14,000 more each day-- he was uninsured and couldn't afford the insulin he so desperately needed.

And yet, as sad as this is to say, Paul may be relatively fortunate. A recent study in the American Journal of Public Health estimates that 45,000 Americans die each year simply because they lack health insurance.

We need reform. Desperately.

But in the two years since my accident, despite denying claims left and right, the insurance industry spent $16 million, drawn from premiums, on Congressional campaign contributions to fight health care reform legislation. This summer alone, they spent $1.4 million a day opposing reform through insidious and deceptive advertising and lobbying campaigns.

Insurance companies and the politicians who do their bidding, must be curtailed.

The potential loss of this monumental opportunity for meaningful health care reform poses a great threat to our generation.

But the purported goals of reform-- realizing universal access, "bending" the cost curve and improving quality-- have been obfuscated in Congress. And while these goals permeate President Barack Obama's rhetoric, his proposed plan lacks a robust public option truly open to all and the unapologetic regulatory framework necessary to eliminate malignant industry practices. Instead it contains individual mandates that will drive Americans into the arms of insurance companies-- which is just what they want!

Without real reform, premiums are projected to nearly double by 2020. I do not want to witness the 100th millionth uninsured person but I fear that the current legislation is inexorably wedded to maintaining the status quo. It would rest the future of health care on the free market that has already failed us.

As a national policy leader of the American Medical Student Association, I believe the best solution to our health care crisis is a unified, publicly financed, privately delivered system of guaranteed high quality health care for all. For this reason, I support Representative Anthony Weiner's (D-NY) single payer amendment.

At a minimum, a robust public option that is open to all and publicly financed must be incorporated into any health care reform legislation. Such a public-private hybrid is supported by 62.9 percent of physicians and 72 percent of Americans. The Commonwealth Fund estimates that this plan would save $3 trillion over 11 years. The public option currently in play in the House and the Senate will likely enroll less than five percent of Americans, and as such, will lack the power to be a major market force. "Reform" cannot perpetuate the status quo. Care must be more efficient and less costly. Outcomes must be improved and special interests made disinterested.

Every day, we see countless underinsured patients who are denied medically necessary care and who suffer preventable harm. Treatment decisions are too often driven by what's covered rather than what's necessary. The current system forces doctors to choose medications based on compensation-- not indication-- to anticipate a fight for each test or procedure, and, most disturbingly, to deny, or "ration," care based on ability to pay. As doctors we learn to game the system-- but in the process, we also feed its inefficiencies and drive the "cost curve" in the wrong direction.

We did not go to medical school to spend hours pleading with claims specialists for an ultrasound for a young mother with suspicious breast lumps, or for coverage of an essential, non-formulary drug for a hardworking father with multiple sclerosis.

We are trained in evidence-based medicine, not insurance-based medicine. We are not driven to don our white coats to tell a college student struggling with addiction that, "we're sorry, but your insurance only covers three days of in-patient substance abuse treatment; you have to go home now," knowing full well that she will likely return to substance abuse. We see patients discharged from the hospital just days after open-heart surgery, with nowhere to go, and nobody to care for them. It should not be a surprise to anyone that many such patients end up right back in the hospital.

And we certainly did not sign up to stand idly by, handcuffed by fragmentation, to watch people like Paul suffer unnecessary complications from preventable illnesses. Or to see people with costly conditions like another person I know, Jerome, 17, who have their coverage dumped for no apparent reason just when they need it most; Jerome has HIV.

Now is the time to push back. It is time for our president to uphold his promises to those who elected him, not those with deeper pockets or shriller voices. If Mr. Obama wants to be "the last president to take on health care," we cannot let him compromise this opportunity away.
The current proposals would undoubtedly have some marginal effect but would not suffice. We need a fundamental shift away from this failed structure.

All too often we hear our hopes for progress dismissed with a glib "can't happen." But as students and young professionals, we can, have, and will effect profound change. Let's ensure that the first steps to comprehensive reform, a strong public option, are not sacrificed. Our voices have the power to speak louder than the industries that have failed us, but we must act together and we must act now.

Iyah Romm is a medical student at Boston University. He sits on the Health Care for All Steering Campaign for the American Medical Student Association, and is also the Regional Director for New England (Region 1)