• Jena Martin MD

Healthcare Pathologies

First in a series of #HealthcarePathologies posts

I haven’t posted this photo because you can easily see my scar and how it has misshapen my neck. I got this scar when I was 22. 

At the end of my senior year, when I was still covered under my university health insurance, I had my wisdom teeth pulled. My recovery was complicated by a deep infection, one so serious that I needed emergency surgery and a drain put in my neck. My face swelled up and my lip was pinched. At graduation parties, I talked like a pirate. 

Then, while uninsured and waiting tables during an economic downturn, I developed nearly constant ear infections - my swollen neck had trapped water in my ear. Underneath this was a bone disease, cholesteatoma, that required several years of extirpating surgeries thanks to the indigent care provided by SF General. I couldn’t pay my medical bills and I cried in a pharmacy when an antibiotic cost $180 that I didn’t have. I now don’t hear in my right ear and have constant ringing.  I see an ENT annually to have my mastoid bowl cleaned. 

I knew that my experiences were a small part of dauntingly unjust societal problems that only scraped the surface of my health. But I didn’t want a job in politics or hospital administration. I didn't see anyway to improve these conditions, and I wanted to make things better. That’s when I decided to go to medical school. 

How can the financialization of medicine be more obscure and difficult to understand than medical renal disease or acute liver injury (aka my least favorite areas in pathology)?

*Because the interests enriching themselves

have designed it that way.*

Did you know that health care interests spend the most out of all industries on lobbying in DC? These are the same people who haven't been able to provide adequate PPE for their nurses and doctors. 

Did you know that 500,000 Americans declared bankruptcy due to medical debt in 2019? Now just imagine what those numbers will be for 2020. It is terrifying to not be able to pay your medical bill.

This is not an intellectual problem. It's a problem of special interests.

I've been in private practice as a pathologist for 10 years now and have donated to support efforts for single payer health reform. But I've always held back from commenting on it. I have been intimidated by the complexities in healthcare, and there are many - many of which I don't understand. However, at this moment, I'm no longer able to remain silent. I'm inspired to develop some courage by the vision put forth in this recent essay in the NEJM: Stolen Breaths

The first call to action of that article makes it clear.

Divest from racial health inequities. Racial health inequities are not signs of a system malfunction: they are the by-product of health care systems functioning as intended. For example, the U.S. health insurance market enables a tiered and sometimes racially segregated health care delivery structure to provide different quality of care to different patient populations. This business model results in gaps in access to care between racial and ethnic groups and devastating disparities like those seen in maternal mortality. Universal single-payer health care holds the promise of removing insurance as a barrier to equitable care.

It's time for me to knit together my interests and use whatever leverage I can to speak out for health care reform. I'm not certain of the solutions, but I've been educating myself and hope to write about this process here on my blog. I'll be using my own hashtag, a combination of my interests: #HealthcarePathologies

This first post is a discussion of what I believe to be the root reform needed to begin mending our health care system: Universal health care, with a single payer plan. In other posts, I plan to share other ideas beyond single payer. But this is currently the best articulated alternative to the untenable status quo.

For discussion of what a single payer plan is, I will refer you to the definition put forth by the Physicians for a National Health Plan (PNHP): Single-payer national health insurance, also known as “Medicare for all,” is a system in which a single public or quasi-public agency organizes health care financing, but the delivery of care remains largely in private hands.

Here are my personal talking points that I've developed:

* I believe that health care is a right and not a commodity. Given how this is heard with hostility by some, one could forget about using the word 'right'; universal coverage for all medically necessary care is the ethical thing for our society to do.

It's important to note that we do not currently provide this. When people say they don't want to wait for a surgery like they 'do in the UK', they don't seem to realize that our system is already rationed.

We have a system based on scarcity, not universal access.

Our employer-based system is not intended to provide universal coverage.

* What does insurance even do? Why have we created a massive, bloated middle-man to negotiate the payments between providers and patients?

No one could pay for their healthcare as priced today- once you are insured, 100s of thousands of dollars can be extracted from you.

For-profit health insurance companies and providers are legally obliged to act in the interests of their shareholders, not patients. This should immediately invalidate them from this transaction and from discussions about the future of health care.

Insurers have no incentive to lower costs.

Our government bails out and supports insurers, not patients or doctors, and underfunds public health. Insurers are sucking the lifeblood out of our economy.

*Universal healthcare offers immediate benefits to quality of life: Universal healthcare would mean no more financial barriers to care (no more premiums, copays and deductibles)

Universal care is portable.

Patient’s would have free choice of doctors and hospitals.

* Doctors would regain autonomy over patient care; currently doctors are micromanaged by private insurers or burdened by costly paperwork. Administration outnumbers physicians by 10:1.

* Universal single payer will expand coverage. Our current system of private insurers strips down policies, restricts networks of providers, limits and denies care and increases patient’s co-pays, deductibles and other out of pocket costs. The Medical Loss Ratio (jargon for the amount spent on their product) for insurers is 80%, which they struggle to meet; for Medicare it is 98%.

The irony is that insurers and their representatives  claim that a single payer system will do all of these things. They are projecting their own failings when they malign Medicare for All.

Financial details:

* Medicare for All will be publicly financed but largely privately delivered.

Public financing means public accountability. What we have is a private insurance system with opaque rules and behavior, with profit as their motive and reason for existence. 

*It can easily be paid for by slashing administrative waste, retaining current public funding of care, and introducing modest new progressive taxes. Tax increases would be offset by absence of insurance premiums.

* Single payer will encourage small businesses and entrepreneurship - small businesses could eliminate the costly distraction of administering health benefits.

* Under Medicare-for-all, the researchers found, the United States would spend $3 trillion on health care annually, or about $460 billion less than the country spent in 2017 under the current system, and universal coverage would save almost 69,000 lives in America every year.


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