I watched my patients die of poverty for 40 years. It’s time for single-payer.

Sarai was 25 years old when she died of Wilson’s disease, an inherited disorder that causes liver failure. A liver transplant could have cured her, but she was uninsured and was denied an appointment at two prominent Chicago transplant hospitals, including my own. Sarai’s plight was brought to my attention when a local religious group held a hunger strike advocating transplant access for Sarai and other uninsured patients. When she died, her congregation marched seven miles, holding her photograph and lugging coffins emblazoned with her name, to launch a sit-in in front of Northwestern University Hospital. Her death certificate named liver disease as her cause of death, but that’s not true. The real cause was inequality. If the United States had a Medicare-for-all health insurance system, she might have been saved.

In nearly 40 years as a doctor, I witnessed time and again how inequality kills. Those without health insurance, such as Sarai (there are almost 30 million in the country), often cannot access the most basic care, let alone complex specialty care. But the problem is more serious than a simple lack of health insurance. What insurance card you hold can literally be a matter of life and death.

Consider how our current multi-payer health insurance system affects hospitals, clinics and patients. I have practiced at three hospitals along a two-mile strip of Ogden Avenue in Chicago. I spent 17 years at Cook County Hospital, now the John H. Stroger Jr. Hospital of Cook County, rising from intern to chief of general medicine. When I practiced at Cook County Hospital, it was largely a hospital for the uninsured.  Despite many improvements, largely because of Medicaid expansion under the Affordable Care Act, many services, such as screening colonoscopies and hip replacements, are still beyond reach for patients and their doctors. I spent a decade at Mount Sinai Hospital, a not-for-profit hospital for the poor in North Lawndale, a neighborhood of concentrated poverty in Chicago. Sinai cares for a mostly minority population that is mostly uninsured or on Medicaid. In my 27 years at these two safety-net hospitals, not one of my patients received an organ or bone marrow transplant. Yet the organs that fed the transplant centers across the region came from the dying patients in these hospitals.  Our patients — the poorest of the poor — gave, but they never received.

– The Washington Post

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