Tue, Apr

Doctor, Doctor


ACCORDING TO LIZ - Americans don’t need health insurance, they need health care. 

Part of the problem is the concentration of medical facilities into fewer and fewer conglomerates with a focus on profit, not care for the patient. 

Another aspect is doctor availability, especially in rural and so-called underserved communities. 

One issue driving this in the United States is the expense of medical school, and the expectation that those who pursue the profession should be guaranteed salaries commensurate with those costs. 

A medical degree will run an aspiring doctor over a quarter of a million dollars – the median cost at public institutions, a third of a million if they elect to pursue a regional degree through the private system. 

Out-of-state medical students paid almost $100,000 a year at the University of South Carolina while the same study showed Puerto Rican residents forked over just $17,786 in fees. Seven of the ten best deals for a medical education were in Texas. 

In Los Angeles, would-be doctors are charged about $45,000 annually by UCLA if you live here and almost 50% more if you hail from another state. But that’s still a bargain compared to USC where a four-year degree will set you back $300,000. 

There are actually tuition-free schools – several in New York, the Cleveland Clinic, and Kaiser Permanente in Pasadena. But buyer beware, living costs and other expenses including… you guessed it, medical coverage, can run these fees up another $40,000 a year. 

And according the Association of American Medical Colleges, average debt on graduation has passed $200,000, a number that continues to accelerate. 

Medical training also demands time and $$$ beyond the basics. Before qualifying as a full-fledged M.D., most students must participate in a residency program for up to seven years depending on their field of specialization. All this entails application fees, travel and interviews, moving and living expenses on top of the stress of the work and competition for the choicest positions.

Loans are available. Very available, since loan officers see medicos-in-the-making as good loan risks, but principle and interest must be repaid so doctors end up working for the bank for years to come. 

Wherein lies the problem for the American consumer. 

To pay off their debt, most American doctors gravitate to high-paying specialties and wealthy metropolitan areas with a patient base that has top-notch health insurance. And pricey liability insurance. 

This limited-by-cost availability of health care for too many contributes to federal and state debt as people turn to hospitals (which should be the medical solution of last resort because their services are so much more expensive) as the only medical option. 

And when they can’t pay, it comes out of our tax dollars. And whatever debt remains, which is still significant, gets added into what the rest of us pay – in fees, co-pays, insurance policies and our own hospital bills. 

Where are the caring general practitioners and kindly traveling rural MDs of yesteryear? Too busy filling out forms, paying off loans, and sticking to time allotments per patient handed down from their for-profit corporate masters. 

When the tried and true doesn’t work, when medical bankruptcies destroy family after family and contribute significantly to the numbers of homeless on our streets, it’s time to look elsewhere. 

Even if new and different ways may feel uncomfortable and the transition difficult, we must not only pursue care – not insurance – for the greatest number of Americans, we must follow the most cost-effective use of healthcare dollars. 

Not allowing the for-profit insurance companies to run rampant has not hurt Canadians or Australians: in fact their costs per person are half those here with significantly better results. 

The overhead costs of running a medical system – labor and expenses that have no direct impact on providing patient care – costs Canadians about $550 per person annually, or 17% of their country’s health expenditures. 

Averaged out over our disparate systems, American costs run $2,500, or 34% of expenditures. 

Per person. The United States has about nine times the population of Canada so that adds up to a lot of moolah. 

Why? Because instead of having only one system, this country has a thousand health insurance providers. And each of those has multiple tiers of plans. 

With multiple million-dollar salaried executives, a myriad of administrators, whole divisions dedicated to denying care, lots of legal departments, IT sectors for the number-crunchers, advertising salespeople, and the impressive buildings and fancy offices in which to house them. 

The paperwork alone – what takes a part-time person in a small private practice north of the border a couple of hours a week to process, requires two fulltime employees here. 

And, yes, they do have private practices in Canada – it’s only the administration of the payments that is centralized. 

The American insurance industry has been fighting to maintain their lucrative business for decades, putting their profits ahead of patient care every step of the way. The millions of dollars that they pay their multitude of executives are matched only by what they pay their lobbyists, and to fund campaigns of politicians who will then vote in their interests. 

And by their advertising campaigns to instill fear of single payer healthcare into the heart of every American. 

Whether you call it the National Healthcare Plan Harry S Truman proposed in 1945 to carry on FDR’s legacy, single payer, or Medicare-for-All, an integrated national health services strategy will help us all. 

There are diverse systems in place around the world and it would behoove the United States to evaluate which type or combination will best serve the interests of the American public. The public – our health and our tax dollars should not be in the hands of private insurance companies where the primary priority is profit. 

Just the $600 billion being poured into healthcare paperwork in the United States could cover our country’s uninsured. And further tax savings through their being covered, would lead to an overall reduction in costs. Healthier people would rely far less on expensive hospital services if they had their own doctor. 

Such a system would also benefit the American economy by stopping people working sick and spreading infections, reducing absences at work and school with their attendant costs to businesses and families. U.S. companies will produce products at more reasonable prices and become more competitive globally without the millstone of employee health plans. 

And it will free up emergency rooms for real emergencies. 

Think about what how fragile your own life is, how an accident or unexpected diagnosis will impact you and your family, especially if your health “care” provider finds a loophole to deny service. People say that they don’t trust the government to make medical decisions for them; can they trust a bean counter for a for-profit insurance company to do any better? 

Healthcare is a human right. 

Without care, the length and quality of life are significantly curtailed. Was the Declaration of Independence – life, liberty and happiness – for all Americans or only for the wealthiest?


(Liz Amsden is a contributor to CityWatch and an activist from Northeast Los Angeles with opinions on much of what goes on in our lives. She has written extensively on the City's budget and services as well as her many other interests and passions. In her real life she works on budgets for film and television where fiction can rarely be as strange as the truth of living in today's world.