Dear Mr. Postman

Dear People Who Know/Care About or Are Aware of Healthcare Reform:

So I’m a medical student in Seattle, which means two things: 1) I don’t sleep that much and 2) my medical school classmates (who I love!) have opinions. About everything. Including healthcare reform. They know every last detail of HR 3200 (that’s the bill before the house right now, don’t worry, I had to look it up too) and can cite lists of the pros and cons of the whole thing and frankly they’re an intimidatingly smart group of people. I do not know these things. But I know the system’s broken in an intangible but certain way.

So when my other non-med school (and also incredibly smart) friends ask for my opinion, I hem and haw like only Karl Rove could have taught me (he didn’t, but he could have, that’s all I’m saying) and I say in a professorial voice “Well, I know the system is not sustainable as it stands.” Which usually suffices. It’s like JP Morgan saying “The market? It will fluctuate.”

BUT – here’s the thing. It’s true. When we graduate, we will have on average $150,000 worth of debt. At 6% interest (I’m not going to calculate it out) compounded annually (you should know what that means, its important) that’s a lot of money for a late 20-something to contemplate paying off.  So its no wonder that no one wants to specialize in primary care*. Put yourself in our shoes: if you had to pay off that much money, would you pick a job that paid you $200,000/yr or that MAYBE paid you less than half of that?

There are primary care doctors out there who have taken out mortgages on their house to keep their clinic open. The fact of the matter is that its just not financially feasible to run a clinic for which you have to pay a staff, pay for HEALTH INSURANCE for that staff, order equipment, buy office supplies, get reimbursed by insurance and Medicaid/Medicare AND make enough money to 1) feed/cloth you and yours AND 2) pay off that aforementioned $150K of debt. Also basically you make less than minimum wage when you account for 60+ hour work-weeks.

So why don’t insurance or the state reimburse doctors properly? It’s like this. Remember back in high school, and you wanted money from your parents? You did your math like this: if I need 30 bucks for dinner, movie, and popcorn for Friday night, I’m going to ask Mom and Dad for $40. Your parents turned it around on you and said “$40? Yeah right. Money doesn’t grow on trees.” And gave you $20. Now try squeeze gas, car insurance, soda, Grapevines, AND dinner, movie, and popcorn out of that $20. Not fair? Fact. And that’s what the state and insurance companies to do doctors offices – under-reimburse because they know doctors are going to overcharge, and guess who the costs get passed onto? That’s right, you. Or your parents, if you’re still on their healthcare. Which is pretty cool.

There’s a bunch of other problems with healthcare in America. Like how over 50% of the population is obese. (No, I didn’t make that statistic up. By the way, did you know that 30% of statistics are made up on the spot? Yes, I did just make THAT one up.) And how obesity, diabetes, and hypertension are like the un-Holy trinity of compounding medical problems? (Also they probably eat at Applebee’s a lot.) I digress. There’s a lot that’s wrong, not all of the fixes are fantastic, but it’s a hell of a lot better than the 44,000 Americans who die every year because they don’t have health insurance.

Finally, if you want one more kicker if you’re still on the fence about this whole reform thing, America’s doctors are behind this change. And we will be taking a pay cut because of it. What more evidence do you need that this is the right thing to do?

Sincerely, transiently,

SM, ¼ MD.

(insert cool latin phrase for contributing letter-writer.)

*Primary care you might wonder? This is basically the nuts and bolts of medicine. Runny nose? Primary care. Preggers? Primary care. (Also: are you crazy to have a baby in this economy?) You get the point.