A Medical Student’s Hope for The State of the Union
by John Corker | Wright State University
President Obama’s State of the Union address on Tuesday will undoubtedly serve as the launching point for his 2012 re-election campaign. In addition to updating America on his administration’s progress (or lack thereof) in areas both economic and diplomatic, Obama will be using this opportunity in front of a captive audience to begin to paint a portrait of promise for the “better” America that he hopes to lead through the year 2016. Most viewers will be eagerly awaiting Obama’s novel ideas on how to improve the economy and create jobs for the millions of talented Americans still struggling to find work. Many others will want to hear his plans for debt reduction, defense, and education. Unfortunately, according to a recent poll, only about 11% of Americans will be most anxiously anticipating President Obama’s comments on health care.
You can count me among that 11%. In fact, President Obama’s plans for fixing health care will be my sole purpose for watching his address on Tuesday. It’s pretty much the only thing on God’s green earth that could pry me away from studying just three days before the biggest surgical examination of my young life. I don’t care what he says about the economy. His thoughts on debt reduction are irrelevant to me. And I could care less what he wants to do to improve our national defense or our struggling education system. Why? Because it will be impossible to adequately address any of these areas until we fix health care. I won’t bore you here with the political and economic justification for this fact, as I’ve written about it before. But I will take this opportunity to put on my medical student hat and give you some experiential justification for why health care is the only topic for which I’ll tune in on Tuesday.
When I graduate medical school next year, I will own a full quarter million dollars in educational debt; 80% of which can be attributed to the cost of attending medical school. And this total is relatively small among students who do not receive financial support from their parents. Over the course of an average repayment period, with interest, I would end up paying nearly $600,000 in order to settle this debt. And it is solely because of this burden that I have eliminated nearly every primary care specialty (read: areas of need in every community across the country) from my future plans.
To be clear, I truly believe that some of these primary care specialties would promise an extremely enjoyable and fulfilling professional experience. In fact, all reimbursement being equal, Family Medicine would top my list of future specialties. But the harsh reality of my situation dictates a much higher-paying specialty choice, if I hope to relieve myself and my family from the burden of educational debt sometime before 2033. It’s a shame, because a medical student should never have to choose between the well-being of his or her family and the greater good of the community in which he or she lives. So on Tuesday, I want to hear President Obama’s plan for reducing the cost of medical education in order to create an environment where medical students are equitably incentivized to fill a broader variety of critically important needs in their profession.
What’s more, a growing number of enterprising physicians who work for themselves are being forced to close their doors to new Medicare and Medicaid patients (not a good thing with 32 million more scheduled to hit the market in 2013) because government reimbursement rates are too low to generate any sort of profit. And these same physicians will be forced to shut their doors completely to government-insured patients if threatened cuts to these reimbursements ever actually go through. Unfortunately, vital primary care physicians are already being forced to sell their practices to large hospitals because they can no longer afford to operate profitably in today’s system. Hospital reimbursement rates (buttressed by many high-tech, expensive procedures) have grown exponentially in comparison to those of primary care physicians over the past 25 years, and deep-pocketed super hospitals can afford to take short term losses in purchasing these practices in order to ensure their long-term financial growth. On Tuesday, I want to hear President Obama’s plan to create an environment that allows private practice physicians (medicine’s equivalent to the all-American small business owner) to stay in business.
Medicare also funds medical residency training positions across the country (one of which I hope to fill in a year’s time). Unfortunately, that funding is on the chopping block in the current well-intentioned – but ultimately misguided – Congressional deliberations about reducing health care costs. Does President Obama really expect physicians in training to take on 3-5 more years of debt instead of receiving what is already considered to be an inadequate salary? Does he really hope to address a national physician shortage of more than 20,000 (and growing) by further disincentivising bright young Americans from entering the medical profession? Those are questions that I want answered on Tuesday.
Just the other day, I was unable to order the medicine that my patient needed. The hospital (a huge, urban hospital with a Level 1 Trauma Center) was fresh out, as the drug was on national back-order due to shortages created by decreased production. It is one of many commonly used, inexpensive, exceedingly effective drugs that pharmaceutical companies have ceased to produce because it no longer meets their profit margin objectives. In this situation, I had to order an alternate drug with a similar primary effect, but that costs twice as much and causes more inconvenient side effects for my patient. Oh, and the bill for the CT scan (body imaging, press a few buttons from behind a window, takes about 10-15 minutes) that was necessary to rule out a fractured spine in this patient? $3,000. I just thought I’d throw that one in there. On Tuesday, I want to hear President Obama’s plan for creating an atmosphere among hospitals, pharmaceutical and technology companies that incentivizes them to produce the products that patients need at a price that they can afford.
Another one of my patients this past week came in because she had a serious complication from her inflammatory bowel disease, and she was in need of an expensive surgical procedure. She lost her job (and her health insurance) just before she was diagnosed with this disease about six months ago, and had been unable to afford the medications that she needed to keep it under control. She was also forced to switch to a less expensive, less effective asthma medication and stretch the prescription over a period of time much larger than was originally prescribed.
As a result, her asthma was very poorly controlled when she came to us, and she needed sophisticated breathing treatments every 4 hours during her stay in order to get her breathing status to a level that would be safe for surgery. All tolled, a hospital stay that could have been prevented with about $400 of preventative care ended up costing the hospital (and, by proxy, its other patients who actually have the ability to pay) $20,000 of unnecessary health spending. On Tuesday, I want to hear President Obama’s plan for making preventative health insurance plans both universally accessible and required (a necessary and precedented component of any truly workable plan to increase access and reduce costs) for all Americans.
Do you notice a theme here? Each of these problems ultimately boils down to money. The Patient Protection and Affordable Care Act (“Obama care”) includes some admirable components. But it is not the answer to these problems. It does nothing to create an atmosphere in which we can effectively reduce the cost of delivering health care. As things stand, health care costs continue to rise while American patients continue to suffer. And the PPACA will never be allowed to take full effect unless President Obama wins his re-election in 2012. If he hopes to do that, I suggest that he spend a significant amount of his allotted time Tuesday evening explaining to the American public exactly how he plans to relieve them from the suffocating burden of a broken health care delivery system that devours 1 out of every 5 dollars they earn. And if he doesn’t, I encourage every truly concerned American out there to join me in changing the channel…because nothing else he has to say would be worth hearing.John Corker is the NextGen Journal Health Care Correspondent and a third-year student at the Wright State University Boonshoft School of Medicine. He is a 2007 graduate of the University of Notre Dame and a host of the 'Radio Rounds' medical talk show (www.radiorounds.org).