I’m a member of the 25,000-strong medical school graduating class of Obamacare.
We were pre-med college students during the debate over the Affordable Care Act (ACA) and began medical school during its implementation. We put ourselves into deep debt and studied late into the night with the promise that we would practice medicine in a system that promoted insurance coverage, reduced medical bankruptcy, and incentivized high-quality care.
Increasingly, we see that promise is about to be broken.
And we’re taking notice.
I’ve taken courses founded on ACA principles, with a focus on improving medical quality and minimizing unnecessary and expensive procedures. I’ve been able to advise patients on different contraceptive options and to reassure them that most preventative care — like cancer screening, immunizations and diet counseling — is free. I’ve done all this under the shadows of construction cranes building new hospitals and outpatient facilities financed by the promise that health care would be available to all — not just those capable of paying.
Now, it’s likely that I’ll spend more time treating patients who are uninsured, in the maddening position of knowing that ordering an MRI could bring them closer to both diagnosis and bankruptcy.
I think a lot these days about the West Point Class of 9/11: those who had enrolled in the military academy in peacetime, before that awful day in 2001, and who in 2005 were about to graduate into two unpopular wars. The repeal of Obamacare is certainly no 9/11, but the promise made to those soldiers was broken the same way ours is about to be.
Like those soldiers, my classmates and I across the country will fulfill our obligations with pride. The West Point graduates bravely served our country and kept their oaths to uphold the Constitution. Likewise, I’m proud to join a profession with a sacred code of service to others. I’ll never regret entering medicine, and I still believe in our mission.
But unlike those soldiers, physicians have the autonomy and duty to speak out, especially when our patients are threatened. And that objection will be loudest among the future doctors of America.
We’re not the same doctors of yesterday. In the 1970s, if you were a smart college student interested in making boatloads of money and enjoying high social standing, you went into medicine. Today, high-achieving college students look at the increased hours, ludicrous student debt, systematic burnout and reduced salaries of physicians and explore tech, consulting or finance instead.
This is not in any way to discount the focus of previous generations of doctors on their patients, but if you’re a medical student today, you’re really not in it for the money or the easy life.
You’re in it for the unique opportunity to radically transform people’s lives, to use science in defeating disease as never before, and to raise up diverse communities that have been medically neglected (or victimized!) for decades.
You’re fighting for more coverage for needy patients, for greater access to reproductive care, for lower prices on lifesaving drugs, and for the basic idea that our profession should be measured on quality — not quantity — of care delivered.
My graduating class is among the first wave of medical graduates driven by the promise of Obamacare and educated specifically to practice high-quality, low-cost care.
And there are more of us to come.
A fifth-grader who was inspired by the ACA’s passage in 2010 is now beginning college as a premed student. The demographic shift toward increased diversity among doctors will continue. We are ready to stand side-by-side with patients, who have the most to lose from a return to the backward medical systems that dominated decades past.
If the promise of a health care system based on justice and evidence is broken, know that the future doctors of America won’t be silent.
Nuriel Moghavem is a medical student and a trustee, California Medical Association.
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