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nderneath a heap of hospital blankets, Stephen seemed small for a 7-year-old. His chest rose and fell rapidly, a frightening rhythm given his history of asthma. His parents stood nearby as veteran witnesses — Stephen had been admitted to a Cleveland safety net hospital for asthma four times already this year — but familiarity offers little comfort when your child struggles to breathe. When asked if their son used his asthma inhalers, they replied, “It depends. When we can afford them, he takes them. But when we can’t, it could be a few weeks.”

Stephen represents one of more than 430,000 hospitalizations each year due to asthma. At a cost of $56 billion annually, complications from asthma can be prevented with regular medications (inhalers), avoidance of triggers like dust and mold, and access to health care, which usually means access to health insurance. Stephen didn’t have the latter.

Of the diseases we are taught in medical school, a sudden worsening of asthma, known as an exacerbation, is a relatively common cause of illness in children and adults. To identify the cause of a disease, doctors are trained in the differential diagnosis. This bedrock of medical education encourages doctors — those in training, like us, as well as those with years of experience — to compile a list of causes that match a patient’s symptoms. In a way, the differential is half medicine, half Sherlock Holmes.

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Chest pain, for example, might include differential diagnoses that range from heart attack to having eaten too many buffalo wings. Yet there’s a particular cause of illness — in Stephen’s case, a nonpulmonary culprit — that is unique to American health care: America’s private health insurance system.

Recent months provide ample context. As the latest Obamacare repeal efforts took the form of Graham-Cassidy 1.0 and 2.0, the GOP bill would have kicked 32 million Americans off their health insurance. Patients with preexisting conditions like asthma would have seen sharp increases in their health insurance premiums (in the case of metastatic cancer, to the tune of six digits), and Medicaid reimbursements to Planned Parenthood would have been banned, effectively barring millions of women from reproductive and preventive health care.

Both Republican and Democratic efforts have done little to change the fact that thousands of Americans die from lack of health coverage. America’s fragmented and inequitable health system is a sinking ship and recent fixes — often in the form of private health insurance industry bailouts or shutouts — are like placing tissue paper over the leaks in this doomed vessel.

No bacteria or viruses harm health more than policies that effectively prevent millions of individuals from access to affordable health insurance to pay for life-altering health care, including the recent ill-conceived executive order. As American health care maintains its appalling position as a leading cause of financial burden and bankruptcy, an equitable response is essential. That means creating a system in which access to health care is based on need, not the ability to pay. As future doctors, we are being trained to identify root causes of disease. That’s why we support Medicare for all.

Momentum toward an improved and expanded Medicare for all health system is at historic highs. The majority of American physicians now support single-payer health care, and 60 percent of Americans believe that the federal government has a responsibility to ensure health care for all citizens.

Last month, the Medicare for All Act was rolled out with fanfare as Sen. Bernie Sanders — joined by 16 co-sponsors — offered a blueprint for universal health care in America. Its sister bill in the House of Representatives, the Expanded and Improved Medicare For All Act, has 120 Democratic co-sponsors, making it the first single-payer bill in history to have a majority of Democratic support.

The overwhelmingly popular Medicare and Medicaid programs have saved millions of lives and offer strong, supportive health care to millions of Americans. Why not offer that to all Americans? As the life expectancy gap between rich and poor increases, the only path forward is to ensure that all Americans have affordable health care, regardless of socioeconomic background.

President Trump recently declared his desire to “stabilize markets” which, historically, has meant diverting funds to private insurers who have done an outstanding job of shrinking coverage and fattening corporate profits. Trump’s latest executive order, which eliminates select private insurance subsidies, will ironically dampen private profits at the expense of escalating premiums for the middle class.

Private insurance subsidies are Band-Aids on an already oozing wound, an inefficient private industry that prioritizes the depth of shareholder pockets over patient health. And while subsidies are short-term fixes inadequate for a long-term solution, removing them altogether, as has been the procedure in the latest GOP bills, would further limit patient access to affordable, comprehensive care. This worse-worst situation could be healed with an improved Medicare-for-all system that eliminates profit motives and preferentially places health above all else.

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As medical students, we occupy a unique seat from which to view America’s health system. Our inexperience means we haven’t been indoctrinated into the damaging practices of the private health insurance industry. Our optimism tells us that the system can be changed. We entered medicine out of a desire to help people. But if we participate in a flawed health care system without advocating for structural and equitable change, we trend toward hypocrisy rather than Hippocrates.

Because Stephen’s parents couldn’t afford asthma medications, their son’s breaths were figuratively assigned a price tag. His family, like millions of Americans, is forced to make an impossible decision: pay for food and rent, or purchase medications and health insurance. Recent months have seen patients, students, and health professionals realize this crisis and mobilize toward a better alternative: Medicare for all. We advocate to practice in such a system, where every patient has health care. And where every patient can breathe freely.

Augie Lindmark, Vanessa Van Doren, Bryant Shuey, and Andy Hyatt are medical students the University of Minnesota, Case Western Reserve University, University of New Mexico, and Boston University, respectively, as well as board members of Physicians for a National Health Program, an organization that advocates for an improved and expanded Medicare for All health system.

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  • True health equity can only be achieved through a Medicare-for-all type system where patient outcomes are placed over profits. Those who portray our current system as a better alternative are likely profiting from the illnesses that fuel it and the class differences required for it to remain successful. Those physicians and other health professionals among us who hope for a better America have looked into the economics and understand the facts of the matter that will allow Medicare-for-all to keep wallets and souls equitably filled.

  • Very good article.
    “Creating a system in which access to health care is based on need, not the ability to pay.” The challenges to reach that statement are so big that we really have to stand ‘together’, work hard if we want to progressively see positive outcomes.

  • Asthma symptoms are sometimes due to atypical pneumonia an allergic reaction to the medications a child is being given. The result is perhaps treatment with Prednisone or other steroids which cause a child to grow and become overweight to quickly. This can lead to a continuous feeling of hunger in a child causing many other side affects. If a child is not responding as many people do to most antibiotics and is getting worse after a shot or they have taken a few doses of the antibiotic and it builds up in them you may want to consider if they are allergic to the medication rather than assuming they have asthma. Children have been said to have died from asthma I question if that may not have been the actual case and instead the doctor increased the among or strength of dose a child was on. It is fearful to be a parent to try to talk to a health care provider especially when they are trained to use jargon or speak over most parents heads. Authority does not make a health care provider a God, but it is simple and easy to misuse that authority. If a child dies due that’s in the hospital being cared for the first thing a health care provider will probably say is but we are not God. They should keep that in mind more often when they are treating any child. Most parents and grandparents actually do know their child best. When you put them down or make them defenseless to help their own child you often lose the best advocate that child has. That’s when outcomes are generally worse. I have indeed raised my family and did a good job at it. There have been good health care providers in my life that helped me to save my children’s lives, but there have also been some not so good ones that have made mistakes and which I was afraid of due to their misuse of power. I’m 57 and could be a great grandmother any time. I won’t have any more children but my grand daughters may and if they do I hope they can find good health care providers that will make them and their children feel safe and comfortable and listen to them and not make them afraid so they will know that they are getting the best health care they can get and won’t find it difficult to bring up and be able to discuss any concerns they may have. How does it feel to be able to advocate for them it feels good. To all the good doctors out their and nurses to I want to say thanks. I want them to know how much I appreciate them.

  • Super simplistic view of the problem and a pretty sickening endorsement of a system that most of the best and brightest US physicians are abandoning. If you go to one of these supposed universal utopias everyone has access to “care” sure, but don’t be fooled into thinking that the best practicers of the medical art are part of that system. And so what you’ve done by spreading this bleeding heart nonsense…rather than give everyone equitable care is codify the separation of rich vs poor in the healthcare system. The best doctors will be private pay and won’t accept the 30% reimbursement and administrative burden of people that know very little about business or medicine. How does that sound to everyone? To be locked into a system that only gives me access to mediocre or new inexperienced providers. I could only go to one of the best doctors if I paid out of pocket on top of my exhorbitant and inefficient premiums for a government run system.
    Dont pretend to speak for all medical students. Or that the AMA or any of its state organizations speak for physicians. The AMA is a joke that represents retired and politically motivated physicians from one party.

    • How does one reply to this. Tiredollies is a screed against any rational plan to fix our health care system. T R Reid authored a survey of world health plans which we could adopt given the will and the energy. It is not impossible to improve our health care but their will be winners and losers.

  • Are there psycological tests that may be used to weed out greedy medical school candidates? Refer them to Wall St. where their talents would probably serve our national interests further.

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