“We lack the funds! You took everything!”
Shocked, I pulled the phone away from my ear to lessen the yelling voice on the other line. I had just informed my patient’s son that his 95-year-old mother could regain her ability to walk; she merely required surgery to fix her hip fracture. This seemed like positive news, or at least I believed. His mother had insurance, “good” insurance, and needed a relatively routine operation. So why was he so enraged?
He collected himself and clarified that his father had recently experienced a lengthy hospitalization. Even with private insurance, the family found themselves buried in medical debt. Over the speakerphone, he conveyed that he couldn’t afford the cost of surgery for his mother. From the stretcher, she gazed up at me, hopeless.
We encounter variations of this narrative on a daily basis. The damage inflicted on patients and their families by our profit-driven healthcare system is impossible to overlook. Yet, most organized medical associations direct their advocacy towards narrow concerns such as scope of practice, reimbursement rates, or tort reform, tackling symptoms instead of the underlying issue.
A movement is necessary to tackle both the immediate and systemic shortcomings of our healthcare system, pushing for policies that safeguard patients and challenge systemic injustices. The vision of a single-payer system, ensuring universal, affordable, and equitable care, seeks to eliminate treatment refusals due to costs, eradicate medical debt, and save billions through streamlined administration. As physicians, we swear an oath to do no harm, yet we observe patients suffering due to a system that prioritizes profits over care. Despite the highest per-capita health spending among affluent nations, the United States achieves poorer outcomes, shorter life expectancy, greater infant mortality, and higher rates of chronic diseases, and is the only wealthy nation lacking guaranteed universal healthcare.
This divide breeds moral distress and burnout. When we are powerless to protect patients from a predatory system, it undermines our sense of purpose. Administrative burdens amplify the harm: the Medscape Physician Compensation Report 2021 found that physicians allocate approximately 30 percent of their time to administrative tasks, battling for authorizations, navigating formularies, and appealing to insurers. We are often compelled to obtain approval from unqualified administrators to provide evidence-based care. When denied, we turn to bureaucrats who have never interacted with our patients, wishing for a change of heart. When that change of heart does not materialize, we must convey the disappointing news to our patients: that they cannot receive the care they require, not due to a lack of medical technology or resources, but because their insurance provider denied it.
And now, with Congress determined to strip down Medicaid, which studies indicate could result in an increase of 25,000 preventable deaths annually, our already daunting task becomes even more challenging. Medicaid serves as a lifeline for millions of our most at-risk patients, and its collapse signifies a final straw. The outrage among physicians regarding these proposed reductions has been swift and extensive. We should recognize this for what it is: evidence of the collective power we can wield when we rally around our patients’ needs.
That energy must be channeled into something enduring. Advocacy is not an auxiliary task; it is our professional obligation to strive for a system that reflects our values. It serves as a refuge for those alarmed by the growing attempts to strip patients of rights and safety nets. And it represents a movement for those who believe that medicine can, and must, be a force for justice.
Back in the emergency room, our patient and her family worked with our financial counselors; she received the surgery she required, completed rehabilitation, and walked once again. Yet that feeling of helplessness, the acknowledgment that, in the eyes of the system, a patient’s life comes with a price tag, and the ensuing moral injury must motivate us to take action.
If we genuinely wish to care for our patients and maintain our own sense of purpose, we must reform the system. This begins by uniting together, in the right place.