Health Care For All Americans

In the 12/18/2008 New England Journal of Medicine, Robert Steinbrook, M.D., asks "Medical Student Debt - Is There a Limit"? Steinbrook reports that 87% of the students graduating from medical school in 2008 were encumbered by debt, $145,000 for students at public medical schools and $180,000 at private medical schools. He reports median costs of attending medical schools ranging from about $44,000 for public schools and $62,000 for private schools. He reports that 20% of the financial assistance of $2.5 billion provided in 2006-07 were grants and scholarships; the remainder was mostly loans.

The financial burden of a medical education eliminates worthy students who cannot accept the yoke of personal indebtedness, the spectre of burdening their families with escalating debt, or the unlikelihood that a school loan can be arranged under reasonable repayment terms. In the last year, disclosure of the corrupt association between some institutions' financial aid officers and student loan companies makes it clear that this program does not serve our public interest.

Students who graduate with enormous debts focus on specialties which generate enhanced earning power, not necessarily specialties which are most needed by society. Students who graduate with enormous debts will practice in a manner which enhances income, constrained only by insurance company and government rules as well as state/federal fraud and abuse laws. Many of these students may feel that they need to focus more on the business aspects of their medical practices than the professional aspects.

I end the year by again proposing a federally subsidized program for medical (and other needed health professional) education. Students receive appropriate financial support in exchange for an extended service commitment which begins after completion of training in fields which are needed for our health system. We develop a corps of physicians and other health care providers who agree, in exchange for their financial support, to serve in federal health centers which compete with private health systems in a national program which provides adequate and appropriate health care to every citizen.

Let's just do it!

Happy New Year - may it be a year of peace, happiness, prosperity and good health to each of you.