In uncertain times, conviction is the currency by which we measure the worth of our institutions. And right now, our medical schools need to prove their worth. They should do so by publicly endorsing efforts to save and augment the Affordable Care Act.
You are likely familiar with the fundamentals of the law and the routes it provides to affordable health insurance. For tens of millions of our patients, this means the difference between sickness and health, and even life and death.
Estimates suggest that increased coverage prevents nearly 44,000 deaths every year. The law also discards the barbaric practice of denying insurance for pre-existing conditions and offers profound advantages for women’s health care. And students might appreciate that they can stay on their parents’ insurance until age 26, saving hundreds or thousands of dollars.
To a greater or lesser extent, this is common knowledge. But the perspective held by a growing number of medical students is somewhat foreign to most people outside the profession, and even some people within. To understand it, we should recall how the United States approached medicine until just a few years ago.
Most developed countries have a national health care system. For them, medicine is something of a social creed. But in the United States, health care is an individual aspiration. There is no overarching societal desire to ensure everyone has access.
We are the first generation of medical students “raised” with a different mentality.
That mentality also permeates the practice of medicine. We focus on the patient in front of us and tend to lose track of the larger world beyond the office or hospital walls. If a patient does not have insurance, that is just the way it is, and we move on.
However, because of the Affordable Care Act, we are the first generation of medical students “raised” with a different mentality. Our classes reverberate with a new conceptual framework that is to drive our era of medicine: the idea that health care, rather than being a distant dream for many, might be there for everyone. It suggests, finally, a national alignment with the philosophy of endless compassion intrinsic to medicine.
That philosophy underpins our aspirations as future physicians. We spend our formative years not only crafting our knowledge, but also grasping for that impossible goal of limitless empathy. It should come as no surprise, then, that we rose quickly to the Affordable Care Act’s defense. Within weeks of Trump’s election, a student-led movement called #ProtectOurPatients claimed nearly 5,000 members and supporters across 150 medical schools and every state. We rallied our classmates, delivered petitions to Congress, and laid siege to congressional phone lines to support our patients.
So why do we now ask our universities to stand by the ACA? Because something as simple as a public statement, seemingly mere words on paper, gathers energies that cannot otherwise be harnessed.
My fellow students at Georgetown saw this recently when our faculty condemned the executive order on immigration, explicitly calling for a unified front against that abomination. It is always eye-catching when a major institution breaks from seasoned neutrality to defend its values.
The cold, indifferent idea of repeal or anemic replacement is fundamentally incompatible with the principles of medicine.
Of course, you might think “Obamacare” is a less clear-cut ideological battle. To some extent this is true. There is ample room to debate its flaws and the appropriate remedies. But the cold, indifferent idea of repeal or anemic replacement is fundamentally incompatible with the principles of medicine.
To put it bluntly, show me a medical school that doesn’t embrace the call of philanthropy and fraternity, that doesn’t demand we elevate the neediest among us, and I’ll show you where not to study medicine.
But I am willing to bet that school does not exist. I am willing to bet that every medical university is born from that ethos of endless compassion, carefully molded into establishments of service and sacrifice. The foundations rise from an agape love for our patients and communities. Thirty million people suddenly robbed of health care does not align with a single pillar of that practice.
Having been made in this image, there is an indisputable moral obligation for these institutions to oppose grievous violations of decency. We saw it with the travel ban. Now we need to see it in health care. The outrage over ruthless discrimination that brought to bear the strength of our communities is the same outrage we have felt for years as the Affordable Care Act’s opponents spread lies about death panels and mythical economic destruction, lies that may literally cost tens of thousands of people their lives.
Universities can remain neutral when rational debate flourishes on all sides. But until then, the ACA deserves a strong defense. Medical schools should denounce repeal efforts and stand by our patients with the same compassion the schools instilled in us.
A version of this piece first appeared in The Hoya.