Holy Harry and Louise, they are at it again. Now, everybody is talking about the health care mess in Rhode Island. You know it’s a mess when politicians, who are almost all lawyers, give news conferences and talk about how they are going to fix health care, and the experts they trot out are all lawyers as well, none of whom ever took a call from the 19-year-old mother of a screaming 3-year-old at 3 AM.
We’ve had twenty years of those of us who have taken that call saying it’s a mess, and twenty years of lawyers making big bucks on health care turning their heads away. Notice, none of those lawyers will tell you we have two bankrupt hospitals (we do), and no one is making plans to close them but keep their emergency rooms open. No one is talking about consolidating our community health centers and saving money by getting rid of multiple $300-600,000 salaries of all public money; and no one is talking about creating a hospital regulatory commission and then merging the hospital systems (which are run on about 70 percent public money) to save a whole mess of $500,000-to-million-dollar salaries. And no one is talking about doing the same thing with insurance companies, which add cost but not value to most health care, because hospitals, insurance companies, and community health centers all have lobbyists, aka lawyers, who work to prevent any meaningful change. The best thing someone came up with is a bill to reduce or eliminate prior authorization, which never should have been allowed in the first place. (My clinical colleagues bear some tiny blame here. We should NEVER have cooperated with this corporate intrusion into the doctor-patient relationship. We should have refused, remembering insurance companies need doctors but not the other way around.)
I had the honor of testifying twice in the last 10 days at the legislature about two very good bills introduced by Senator Lauria – a bill to start a desperately needed family medicine residency program in Woonsocket (you need one in Newport too, just saying, but please don’t tell that I leaked that little piece of information) and a bill to create medical school scholarships so students from Rhode Island’s communities can go to medical school for free but commit to coming home to practice primary care in Rhode Island. (Quick shout out to Representative Abney, Senator DiPalma, and the House and Senate Finance Committees. They put in endless hours and listen to hundreds of witnesses, often late into the night, and they treat those witnesses with kindness, dignity, and respect. Then they have to make one difficult decision after the next. They are the stalwarts of democracy itself. Newport and Aquidneck Island should be overwhelmingly proud of these two men. Thank you for sending them to Smith Hill.)
I was the recipient of a scholarship like this, many years ago – the National Health Service Corps Scholarship — which was pretty much phased out in the late 1980s, in favor of a loan repayment program, in which you can get a certain amount of money every year to pay down your medical school loans if you practice medicine in certain medically underserved areas. Loan repayment is better than nothing but not as good at getting kids from our communities to go to health professional school, as most live in fear of big college loan debt.
But I got to go to medical school for free and gave back three years of service, in the mountains of East Tennessee. (I actually fought to stay in Rhode Island but lost – a story for another time.)
As I was testifying, I suddenly understood one aspect of loan repayment programs I’d never understood before. Which is who makes money on loan repayment programs.
Here’s the deal. When I got my scholarship, the government paid my tuition and that was that. (They also gave me a decent living stipend as well.) No runs. No hits. No errors. Nobody left on. But if I had taken out loans, which is what we are asking medical students today to do, I would have had to pay interest on those loans, and that interest would have been someone’s profit on my back. Not only would I have had to work 80 to 100 hour weeks. Not only would I not have had much of a social life. Not only would I spend years studying all the time. But I would have also been paying interest for the privilege of doing that.
How much interest? In today’s world, the average medical school debt is about $275,000. Banks that do student loans charge 6.5 to 9 percent for those loans, in a US government supervised process, at a time when banks borrow money for 4.5 percent or less. Assuming the average student loan interest is 8 percent, then the average medical student is paying $22,000 a year of just interest by the time they finish residency. Which is cruel and unusual punishment by itself. But that also means some banker, who isn’t working 80 hours a week and didn’t spend years in training, is making that $22,000 a year for each and every medical student loan, about $10,000 of which is profit.
So student loans and loan repayment is a big scam. We desperately need primary care doctors – thousand of them in the US, and hundreds in Rhode Island. By not giving them scholarships and just paying their tuition directly, our government is allowing banks and bankers to make money off the hard work and struggle of our medical students, who are training to deliver a service we the people desperately need when they choose primary care.
That’s crazy. Harry and Louise! Where are you when we need you? Please please please go on TV and tell people about this scam — and leave all that silliness about death panels alone.