Why it is essential to prioritize universal coverage [PODCAST]

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“Looking to other countries that provide universal coverage to see what works and what would fit well for the U.S. is an option. Countries like France, Australia, and England provide universal coverage and rank their health care systems very highly, and are culturally and socioeconomically similar to the U.S.

Whatever health care direction the country moves toward, it is essential to prioritize universal coverage. Otherwise, Americans will eventually end up paying for inefficient, expensive services in the form of higher premiums and taxes, while millions of Americans will remain uninsured, without access to health care or life-saving medications. Many, like my friend and patient, will die.

That is too high a cost to pay.”

Payman Sattar is a cardiologist.

He shares his story and discusses his KevinMD article, “Why it is essential to prioritize universal coverage.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Payman Sattar. He is a cardiologist, and he wrote the KevinMD article “Why it is essential to prioritize universal coverage.” Payman, welcome to the show.

Payman Sattar: Thank you very much. Thanks for having me.

Kevin Pho: We’ll get into the article in a little bit, but first off, can you share your story and journey to where you are today?

Payman Sattar: I grew up in Chicago. I was born in Iran. When we came here, my parents were here. We were seeking religious freedom. So when we came, you know, typical immigrant story, you either had to be a physician or a lawyer or an engineer, so I became a physician.

But, you know, when I was younger, we really didn’t have a lot of money. At that time, my parents were in school, and they were also working. We didn’t really have insurance, and one day I became very ill. There was a public health kind of facility in our neighborhood. We went to that, and they really took care of me. I remember being very scared at the time. So when I became a physician, I just really wanted to pay back. When I became a physician, I worked at, you know, a hospital that served a very underserved community, and I did that for about 21 years. Eventually, I saw different opportunities. So that’s kind of my background. I remember being very scared when I was young, so I can only imagine how they’re feeling. So I just felt that they need to pay back.

Kevin Pho: As a cardiologist serving the underserved community for over 20 years, tell me some of the unique challenges that you faced.

Payman Sattar: You know, a lot of the patients don’t have access to good food. It was cheaper to buy cigarettes at one point, so a lot of patients smoked. It was hard to get them to quit smoking. A lot of the typical things that we take for granted for people who do have health insurance, and things like this, as far as activities and things like this. You know, a lot of patients don’t have access to gyms and things like this in their neighborhoods. I don’t know how many times I heard their neighborhood is too dangerous to walk around, just to walk around the block to get some exercise. There are some unique challenges there, things that we kind of don’t even think about at places that have a lot more access.

Kevin Pho: Now, what are some of the things that you did in the exam room to help overcome these challenges that the underserved population faces?

Payman Sattar: A lot of the underserved population that I took care of had some of these challenges, and, you know, a lot of my patients had things that kind of were a disadvantage culturally, let’s say, because maybe there is a food that they like to eat that everyone eats in the family, but it’s not necessarily the best thing. They tend to overdo things like starches and rice and breads and things like this, but it fills them up. They didn’t have access to good-quality foods. There are a lot of food deserts in the area, so they end up going to convenience stores and, you know, filling themselves up with bad processed snacks and foods and salty foods, and there are a lot of things like this.

So there’s a lot of re-education, telling them that yes, maybe they can eat the foods that their family enjoys on occasion, but, you know, as a rule, some of this stuff is not very good for them, so they can’t overdo some of these foods. It was challenging, you know. I didn’t turn things around in one office visit. It took, you know, many repeat visits and things like this, just to keep hacking away at it and trying to chip away at some of their old bad habits, trying to get them on the right path.

Kevin Pho: Let’s talk about the KevinMD article that you wrote. It’s titled “Why it is essential to prioritize universal coverage.” Now, for those who didn’t get a chance to read that article, can you just walk my audience through it and share the story of why you decided to write it?

Payman Sattar: Well, you know, basically, I had a friend who was a musician, and this kind of inspired me to write this. You know, he had some health issues. He was on a lot of medications, and he was doing fine. And then one day he called me and said, “You know, I need this one medication. My insurance coverage changed.” He had Medicaid. “And now this medication is over $300 a month, and I just can’t afford it.” And then when the pandemic came about, all of his gigs dried up, and there was no more income coming in.

Eventually, what happened was he told me that he couldn’t get it. I tried a few things to try to get him the medications, and then I think he was trying not to bother me, and he just stopped taking the medication. About a couple months later, he had a big stroke, and he passed away. It really jarred me. He was a really good friend. And it just made me think about how there are so many people like this. This is just one story. There are probably, you know, thousands of stories like this across the States. So I really felt kind of driven to write about it.

As I was writing about it, I started to think about how did this happen. How did we come to this point where we’re one of the richest nations in the world, but we can’t cover everyone, or we refuse to cover everyone, because we think that people should be responsible for themselves and things like this? And although, you know, I’m not about not being responsible for yourself, there are some issues with just relying, you know, telling people, “You have to be responsible for your own health care. We’re not going to help.”

There was a Nixon-era law that came about where if you came to an emergency room, they would have to take care of you if you took government money, and eventually all the hospitals started taking government money. This was the entire law. When this happened, people got health care. It wasn’t cheap, because you had to go through the emergency room, and that tends to be 30 to 50 percent higher than regular care, depending on where you are. So it had this unintended consequence of people coming to the emergency room for their regular care rather than going to a doctor that they couldn’t afford.

So basically, we do have universal coverage. It’s just a very bad form of it that is very expensive, and there’s no prevention. You don’t get prevention when you go to the emergency room. So it was just a poor-quality, high-cost type of health care that we’re paying for anyway. And these costs eventually get passed on to the insurance companies anyway, because they hike up the prices to people who do have insurance, and everyone’s insurance premiums basically go up.

So I think the lessons of the pandemic allow us to, you know, realize that if you have people who are not covered, who don’t have any insurance, I mean, these sick people can travel among us and infect us, you know? So it really is in our best interest to have those people covered as well, to have them have care, so they’re not just walking through an emergency room and spreading at their jobs, with their families, and things like this. And eventually, it goes beyond just infectious types of diseases. It also affects people who have other issues, and we end up paying for it anyway, if you really think about it.

The prior administration actually, you know, was probably the most pro-free market, pro-self-responsibility. They had that kind of platform, that kind of a stance. However, they gave away 200 million COVID vaccines. This is a very socialist kind of thing to do. Even they realize it’s not socialism. This isn’t socialism. This is, you know, good public health care policy. And then, you know, if we want to be fiscally responsible, we shouldn’t be paying for the most expensive care for the people who don’t have insurance. So I think it’s really beneficial, whatever side of the aisle you are on politically. You know, if you want to get good value for your money, or if you want to make sure that everyone is covered and be empathetic, this is a win-win for both sides, really.

Kevin Pho: As you know, we have the Affordable Care Act, and President Biden is suggesting perhaps a public option to the Affordable Care Act marketplaces. In your view, does that go far enough?

Payman Sattar: I have to see the plan itself. I think the public option is a way. You know, Medicare for All was also looked at, and, you know, in my article, I mentioned how it would have saved, you know, over 600 million lives and, you know, 660 billion dollars. I think that’s something that needs to be looked at. Public options should be looked at, but, you know, if you can’t afford it, if you’re deciding between food and insurance, I don’t think that’s enough. So we have to say, at what level are we just going to insure people, under, like, a Medicaid that’s free?

So I think we need to look at as many plans or as many options as there are out there. We can look to other countries to see what they’re doing right and see how that would fit in with our way of life. There are countries that are like us socially and culturally and politically, so I think we can look to some of those countries. We’re one of the very few countries that doesn’t provide universal health care coverage.

Kevin Pho: So you talk about some of those other countries. For instance, Canada has a single-payer system, the U.K. has a nationalized system, and then you have Switzerland and Germany, which have really tightly regulated private insurers. Do you have a preference in terms of which path we take to universal health care?

Payman Sattar: Every country has its own nuances, so we really have to see what fits in with our priorities, our needs. I think, you know, the problem with some of the single payers is that people want choices in America. America is not a country where we can say, “OK, this is your health care, and that’s it.” You know, people like their choices here. So personally, I would be fine with it, but, you know, there are definitely people out there, and I think forcing it down people’s throats is not the path to go.

I think you really have to convince people. I think you have to give them an option that they’re happy with. Otherwise, a new administration will come in, and then they’ll just reverse everything that was done. So, I mean, I think it has to be something that is palpable to Americans across both sides of the political spectrum. Obviously, not everyone’s going to be happy, but I think if we come up with a plan and say, “This is it,” without any other options, I don’t think Americans are going to be very happy.

Kevin Pho: We’re talking to Payman Sattar. He is a cardiologist, and he wrote the KevinMD article “Why it is essential to prioritize universal coverage.” Payman, what are the things that you said earlier, that we need a plan to satisfy both sides of the aisle? Knowing our current political climate and how polarized our society is, some would say the Affordable Care Act is that unsatisfying compromise. Now, in your view, given our current political situation and given how polarized our society is, what is the most realistic path forward?

Payman Sattar: I really think that we need a plan that covers everyone. And then I think that if people want to get their own private insurance, almost like a fast pass, which I think might be an option that might be palatable to most people, so that, you know, if you want to pay for your own insurance and get special care and things like this, for people who can afford it, that might be an option. You know, it’s probably the people who can’t afford it who are going to look at that and not be satisfied.

However, I think if people are satisfied with their plan, if they can go to a hospital, they can get covered for that, if they can go to their own physician and get good preventive care, not have to go to the emergency room and wait hours and hours for something that really isn’t an emergency, I think people will be satisfied. That’s probably the most realistic for now, and I think this is something that can change over time. The priority should be, let’s just make sure everyone is covered. We can see where we kind of land, what we can do better, what we can, you know, save costs on, and things like this. I think not having everyone covered is the biggest danger right now.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Payman Sattar: Universal coverage is a win-win. It really costs less, and it covers everyone, so everyone will be covered, and we’re not going to be exposing people to dangerous diseases like we had with COVID.

Kevin Pho: Well, thank you so much for sharing your time and insight, and thanks again for being on the show.

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