The Real Choices in American Healthcare

As we go through the primary elections, some Democrats are promising to preserve choice in American healthcare. Imagine trying to decide between taking your sick child to the doctor or feeding your family. This is what "choice" often looks like for many working-class people.

In 2001, my sister was born significantly premature with multiple medical problems. As she was transferred to the NICU, we were told that she would not survive more than a week. However, that four-pound, underdeveloped baby held on to life with everything she had, and after 6 months was discharged. However, she still required a tube in her trachea, a ventilator to breathe for her, and was fed by a machine, among other medical support. Understandably, my parents were wholly focused on my sister's health and ensuring she received the appropriate care.

It was only after she was relatively stable that my parents started to fathom the financial impact of my sister's condition. Even though we had health insurance through my dad's employment, it did little to prevent us from coming close to bankruptcy. The financial strain also took a toll on my parents' marriage. This was my reality growing up with "choice" in healthcare.

Within eleven months of my sister's birth, my parents exhausted their savings, including their 401Ks and my college fund. The financial strain permeated every aspect of our life. At nine-years-old, I was left to play the role of mediator between my parents during arguments. I remember often thinking of ways I could help my family save money. Thankfully, we had a generous extended family who supported us emotionally and financially during these times. We were lucky in that sense. Many people do not have a support network to fall back on.

Our health insurance did not cover adequate nursing or even her prescription feeding formula. My parents had to decide between my sister's health or their financial security. They of course chose my sister's health. After co-pays, denials, and before hitting the yearly out-of-pocket limit, my parents had to pay thousands of dollars every month to keep my sister alive.

Having a for-profit healthcare system parallel to public options would continue to maintain the structural inequities, exorbitant costs, and disparity in access that we see in healthcare today.

I vividly remember seeing my mom on the phone begging the insurance company to cover costs or trying to set up payment plans. When insurance declined coverage, my parents had to call the doctor to ask for cheaper alternatives. When "in-network" healthcare providers gave up hope on my sister, my parents had to pursue out-of-network providers. That was the choice my parents had: pay out-of-pocket or deny my sister a shot at having a normal life.

These were some of the choices my family made along a winding, 8-year path to my sister's recovery. It was only through her tenacity, my parents' unconditional love, and the enormous support of our extended family, that her recovery was possible.

The purported "choice" most of us get with private insurance does not match the common political talking points we often hear. For the most part, we don't have a choice in what insurance we have because it is chosen by our employer. We don't have the choice to pick our healthcare providers because networks restrict us to their providers. We do not even have the choice of medications and treatments in many cases because insurance companies have formularies and lists of what they will approve.

The choices our current system gives us is whether to seek care or put food on the table. Whether to go to the doctor, or hope it gets better on its own without complications. We sometimes have to decide--because of cost--if we should ration medication or stop it altogether. And chronic care for individuals that have permanent or long-standing conditions, like my sister, are left behind. Imagine the emotional and psychological turmoil that these choices create. This is the reality of our current system. As a medical student, I witness patients and their families grapple with the same difficult choices as my family did a few years ago. The story of my family is not a unique circumstance, but merely one example of systemic issues that real people seeking healthcare experience daily.

We stand at a crossroads in American healthcare today, and the decision we make will impact the life of everyone in this country. The choice we have is whether we attempt to slowly adapt our healthcare system to be more equitable and accessible, or fundamentally transform it to ensure that healthcare is a guaranteed human right to every person in this country.

If we really want people to have choice in their healthcare, a universal healthcare system, such as Medicare for All, would accomplish that. It would give us the choice to see the providers we want, get the preventative care we need, and ensure that cost does not make us choose between seeking healthcare and meeting other basic needs. This is not something we can wait on. As we wait to fix our broken system, thousands of people are denied access to healthcare or are crushed by medical debt. Some democratic candidates claim that the way to do this is by keeping private insurance, while expanding coverage to more people. Having a for-profit healthcare system parallel to public options would continue to maintain the structural inequities, exorbitant costs, and disparity in access that we see in healthcare today. Through his Medicare for All plan, Senator Bernie Sanders has proposed a transformative approach to remove the for-profit nature of healthcare and guarantee access to every individual regardless of their ability to pay.

I am learning in medical training how intricately related our health is to our social conditions. We cannot expect people to get well if they have to choose between getting care and paying rent. With the primary elections, we have another choice before us. Will we choose to recognize healthcare as the basic human right it is or will we choose to continue letting for-profit healthcare determine our fate?