Dr. Angela M. Bell is an internal medicine and sports medicine physician in Chicago. In this opinion piece, she shares her perspective on the upcoming 2020 election in the United States. Dr. Bell calls on society to “make space for humanity amongst the profit,” and urges voters to carefully consider which candidate is best placed to address their concerns about healthcare.
Every election is said to be the most important election, but this time it feels different.
The COVID-19 pandemic has put a spotlight on the U.S. Not only have the undercurrents of racism become tidal waves, but the fragility of our healthcare system and its glaring inequities have moved to center stage.
The past 4 years have highlighted exactly how much separates us. I have found myself, at times, wondering how we can call ourselves the “United States” when divisive rhetoric and actions have seeped into everything from football to public health.
I am hoping that the silver lining of this pandemic will be a true uniting around the idea that high-quality healthcare is a right for all.
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I have seen many types of patients during my 10 years as an outpatient internal medicine and sports medicine physician in Illinois. This has been the most enriching part of my job.
Building relationships with people who are rural, urban, young, geriatric, upper-middle-class, or poor, people who have immigrated, and people of almost every ethnicity has been a privilege. I have worked in a large public healthcare system as well as a private practice and have experienced the challenges of both.
The benefit of working in a public healthcare system was that it was a protected bubble with access to specialists, shared electronic health records, access to affordable medication, and the ability to treat uninsured patients.
Some downsides were longer wait times for appointments and tests, and although medications were affordable, we were limited in the medications we could prescribe. Also, the bureaucracy seemed to turn a cold shoulder to innovation that may have improved the most frustrating parts about public healthcare.
The Affordable Care Act was passed while I was working in a public healthcare system, and it did address some of these issues. I was able to get people screening tests like colonoscopies without the year-long wait that had become commonplace.
The expanded coverage allowed patients to get timely imaging studies, like MRIs, and surgeries for conditions that had originally been deemed elective and not covered but that severely impacted the quality of life.
I saw many new, young patients and was able to introduce them to preventive medicine, which saves lives and reduces future healthcare costs.
I also made many diagnoses early in the course of disease, which was a welcomed change. In a public healthcare system, we often see patients at the later stages of disease, which is more detrimental for the patient and more costly for the system.
A big highlight of the Affordable Care Act was access to mental health therapists. In many underserved communities, it is challenging for patients to accept a diagnosis of depression or anxiety — and even more challenging to get them the therapy they need. For once, there were a plethora of options. I was excited about the direction of healthcare.
Unfortunately, in transitioning to private practice, I learned that low reimbursement rates discourage private physicians from accepting patients who had benefited from the Affordable Care Act.
That public healthcare bubble had protected me from my current tumultuous entanglement with insurance companies.
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It is a common misconception that physicians, pharmaceutical companies, and insurance companies work synergistically. This could not be any further from the truth.
Prior authorizations, denials of coverage, high deductibles, and “peer reviews” to beg for testing are, in fact, my archnemeses.
Patient care has come to a halt because patients’ out-of-pocket costs have prevented them from getting tests. I have had patients decline referrals to physical therapy because they could not afford the copay.
Insurance companies have told me that I have to order a cheaper test first, in the hopes that I won’t order the most appropriate, sometimes more expensive, test that I’ve deemed necessary based on my clinical exam. This ultimately costs the system more money because I end up ordering two tests.
I’ve struggled to prescribe newer, more effective diabetes medications because they are not covered, and I’ve struggled to treat patients with asthma or chronic obstructive pulmonary disease, known as COPD, because the cost of inhalers has skyrocketed.
I’ve had to switch back and forth between insulins, as the costs shift and the insurance companies move medications on and off of their formularies unexpectedly.
One of the most notable moments from an annual conference that I attended was when a representative from a top pharmaceutical company was asked the poignant yet simple question, “Why do drugs cost more in the U.S. than in other countries?” His answer was also simple — “because they can.”
We need to set a ceiling for the costs of drugs, tests and medications first, then target insurance companies with astronomical premiums and deductibles.
We are a capitalist society, but we need to make space for humanity amongst the profit.
Pharmaceutical companies should never be allowed to hike the cost of a lifesaving drug by 400% as was done with the EpiPen — a medication used to prevent death in people with severe allergies, often to things like nuts and bee stings.
In the case of the EpiPen, profits were boosted to 1.2 billion dollars, and the CEO’s salary jumped to 19 million dollars, while many Americans were left scrambling until a cheaper generic option became available.
We need a healthcare system in which the best medications and tests are not determined by insurance companies. Instead, organizations like the American College of Physicians should lead the way, as they have prioritized eliminating waste with initiatives like their High Value Care Curriculum.
We need a healthcare system that distributes resources evenly, given that many cities in America are still greatly segregated.
COVID-19 tests, for example, should be delivered to BIPOC — an acronym that stands for Black, indigenous, and people of color — communities with the same expediency as in other communities, especially because mortality rates are highest amongst these groups.
We need a healthcare system that puts resources toward eliminating racism and implicit bias amongst healthcare professionals, because these things lead to poorer quality care and poorer outcomes for members of the BIPOC community.
We need a healthcare system that prioritizes and allows for more time for primary care because early detection of disease and prevention ultimately saves lives, as well as money.
Therapy for mental health needs to be covered by all insurance companies, as it is equally important, and often directly tied to, physical health.
Solitude, bereavement, financial strain, and the effects of social injustices have been detrimental to the mental health of millions, especially over the past year, and treatment of mental health will definitely need to be prioritized.
My friend and colleague, a fellow internal medicine physician named Dr. India Joy Weems, said to me: “Any policy that will effectively increase access to healthcare for the systemically underrepresented and marginalized populations is a win for us all. This is what we need to create, attain, and maintain throughout mankind. Show me a policy that does this without financially harming those people, and I will get behind it 100%.”
I am a strong believer that we as a country are only as strong as our “sickest” link. Whether it’s saving costs or saving human lives, we need to focus on how to unite to make America healthier.
Unfortunately, bogged down by paperwork, bureaucracy, and increasing demands, and with a decreasing allotment of time with patients, many physicians do not have the time to advocate for policy change. In the meantime, it is our vote that can make a difference.
I will never forget a patient I treated in 2015, who presented with neurologic symptoms — memory loss and dizziness.
This prompted me to do a mental status exam, which I always lead with the question, “Who is the president?” Her response, “unfortunately Obama,” was shocking to me, given that she was using her “Obamacare” to see me and would ultimately get diagnosed with brain cancer and eventually receive treatment under that insurance.
Brain cancer has no political affiliation. We have let blind loyalty to political parties prevent us from seeing the collective benefit of policies, simply because of the political affiliations of their authors.
The Affordable Care Act is not perfect, but I believe that it is moving in the right direction. Expanding coverage and expanding health benefits and protections for women and people with preexisting conditions benefits everyone.
We need to realign with science, especially during a pandemic. We need to denounce the politicization of masks with a resounding vote against those who enable or condone this message and vote for evidenced-based healthcare for everyone.
It will take years to move to a place where the majority are satisfied with their healthcare. However, we are at a crossroads. We need to take the road that will unite the most people so that we can recalibrate our nation’s priorities.
I encourage everyone to think about their biggest concerns pertaining to healthcare and read what candidates have to say about those issues on both the national and local levels. Empowered with this knowledge, cast your vote!
One election will not solve all of our problems, but a small step in the right direction is better than one in the wrong direction or no direction at all.
Every election is said to be the most important, but this time it feels different because it is.
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