Med Students Divided on Healthcare Provisions
Healthcare reform is a political football.
National polls show that 47 percent of Americans oppose and 33 percent approve of the Patient Protection and Affordable Care Act, and debate doesn’t stop at the entrance to the new Georgia Health Science University-University of Georgia Medical Partnership in Athens.
A 2011 study by researchers at Yale University School of Medicine found that 67.6 percent of medical students believe that the affordable care act will increase access, while nearly a third believe it will improve healthcare quality.
The increase in access would come from the requirement that all individuals have health insurance.
Politics aside, the fact is that the U.S Supreme Court ruled in June that most major provisions of the act were constitutional, and their decision said that the legislation “would increase the number of Americans covered by health insurance and decrease the cost of health care.”
Differences of opinion arise from the complexity of the act and the difficulty that many people, medical students included, have in wrapping their heads around all its provisions.
“I do worry about the autonomy and I do worry that the government may tell me how to run my own practice,” said Katie Zhang, a third year student who is now doing clinical rotations at Athens Regional Medical Center.
She has in mind the high-profile provision that will expand Medicaid coverage in states that agree to participate.
“For every Medicaid patient that you see, the doctor is losing quite a bit of money,” Zhang said.
Zhang is planning to become an anesthesiologist, and worries that if she is compelled to accept Medicaid patients reimbursement for their care may not cover the full cost of their treatment.
A Gallup poll shows that such worries about the business side of healthcare are not uncommon: 33 percent of Americans said the bill would make things better for businesses, while 57 percent believe they will be worse off.
On the other hand, Zhang believes some provisions of the act will help alleviate shortages of primary care doctors plaguing Georgia and other states.
In a 2011 report in the Milbank Quarterly, a health policy journal, the authors found that the act’s health insurance expansion will “significantly increase the use of primary care.”
If policymakers see that preventing diseases is cheaper than treating them, Zhang believes compensation will shift toward primary care and prevention and away from defensive medicine. “That might be an incentive for some people to pursue primary care,” she said.
Zhang’s perceptions of healthcare reform are more nuanced than some of her classmates’. Zhang spent three years as a healthcare consultant, gaining some insight into the logistics of medical practice, before enrolling in medical school.
“To them, there are a lot of unknowns,” Zhang explains. “There’s no use in worrying about things that we have no control over and we don’t know how they’re going to be implemented.”
The campus dean for the medical partnership said that students are often too busy to step back and look at the big picture.
“Medical students are much more concerned about what their interest is, how they will be educated, and where they will be matched for the next step in their education,” said Dr. Barbara Schuster. “They talk less about the money.”
Some major medical organizations have voiced support for at least some provisions of the act. The American Medical Association, for example, favors extending health insurance coverage to 32 million more Americans.
“I think that healthcare needs to change in this country,” Schuster said. “This is the first step in looking at healthcare.”
One common misconception is that the act would create so-called “death panels” that would decide how much care people get in the final chapter of life. Katie Zhang is not an M.D. yet, but she has strong feelings about overzealous end-of-life care.
“Instead of choosing sides based on political affiliation,” she said, “we should look at why are we spending so much money and why are we causing so much suffering to patients instead of letting them die with dignity.”
Other students are not so sure about what the act means for them and for medicine going forward.
The Yale survey found that 47.7 percent of medical students are unsure whether the health reform law will improve the quality of U.S. healthcare, and nearly a third of them admitted that they did not understand some major provisions of the act.
“Students right now really know very little about the legislation specifically,” said Schuster. “I think they know their own political feelings and they may answer you based on their politics and less on the knowledge of this very complicated bill.”