The material in front of me seems incomprehensible: glucose-dependent insulinotropic peptide, uridine 5-diphospho-glucuronosyltransferase, and, my personal favorite, unconjugated hyperbilirubinemia. Only halfway through my first year of medical school, I am expected to speak a language that few understand and fewer want to hear. To talk the talk, I sit at my desk for hours each night, staring at textbooks that rob me of seeing old friends or exploring the city around me. Despite the fact that my twenties are slowly drifting away, the complexities of the human body are the least of my concerns.
In February, my classmates and I completed our Health Care Policy course: the only time in our medical education when we formally study the labyrinth of our current health care system. We heard about the differences between copayments and coinsurance, HMOs and ACOs, adverse selection and moral hazard. Our course directors brought renowned experts to campus and, on our final exam, asked us to address the nuances of malpractice reform.
Of all the concepts we covered, the most important thing I learned is that every aspect of my future is uncertain: how we pay for it, where we deliver it, how we evaluate it, and so on. To borrow a phrase from Don Berwick, the former head of Medicare and Medicaid, I’ve boarded a boat, and I don’t know where it’s going.
These unknowns can be frustrating, and they often fill my head with doubts — did I sign up for the career that lies ahead? Will I recognize it when I arrive? But I know that health care must change, for the evidence is clear: Our health care is the costliest in the world, but produces mediocre outcomes across countless metrics; our private sector fosters unparalleled innovation and choice, but leaves millions uninsured and prices through the roof; physicians are trained on the basis of outcomes and bedside manner, but are paid on the basis of tests; we open our emergency rooms to any who need help, but they may suffer massive financial consequences in return.
These problems can be fixed, and the Affordable Care Act makes great strides toward reaching such ends. However, our work has only just begun. Under the new law, 30 million Americans will remain uninsured in 2022. Health care spending will continue to cripple federal and state budgets. Our population will be older and fatter than ever before. And so on this depressing note, I return to the greatest of my concerns.
What keeps me up at night is not the Krebs cycle or the fact that medicine will be in flux for the foreseeable future. What keeps me awake is the misrepresentation of our issues, the illogical currents rocking our boat from all sides.
Health care is an intricate and significant subject. Yet our public conversation is rarely based in fact and usually hinged on extremes. Government takeovers. The end of Medicare as we know it. Death panels. A quick dose of reality reveals that all these slogans are basically nonsense. Still, these are the tides determining where I will go.
Sometimes, I think it’s funny that a campaign intern or a political consultant can come up with a phrase that determines much of the rest of my life. As a naïve 22-year old, I wish that we could have intelligent discourse, where our leaders confess that any solution will have imperfections and, with that acknowledgment, stand behind the merits of their case. In our civil war over the Affordable Care Act, might such humility have led us to a better bill of wider agreement? I like to imagine a scenario where Democrats admitted that forcing people to buy something can be scary, and Republicans admitted that liberty may not mean the right to have others pay for your risk-taking.
As we enter the age of sequestration and entitlement reforms, I am sadly confident that the one-liners and signed pledges will prevail once more. Health care will continue to evolve under such dysfunction and, studying the nights away, I await the coming changes. Luckily, I’ve found some comfort in the realization that maybe not everything will be different in my future. After all, there’s always unconjugated hyperbilirubinemia.
Nathaniel P. Morris is a student at Harvard Medical School.