SHOULD HEALTHCARE BECOME A HUMAN RIGHT IN THE UNITED STATES?
Medical and Healthcare Professionals Speak Out On Where We Go From Here by Kimberly J. Soenen April 6, 2025
(Illustration by Daniel Vincent Bigelow for “SOME PEOPLE,” 2025.)
THE TRAGEDY OF THE COMMONS
On December 4, 2024, a single still frame captured by a Midtown Manhattan hotel security camera was released to the public by the New York Police Department. On the left side of the frame, a masked man pointing a gun at the back of another man. On the right side of the frame, one man walking away.
Days later, the perpetrator was apprehended by law enforcement after being on the run. It was eventually confirmed the crime was intended to expose the suffering the Commercial Health Insurance Industry business model imposes on American citizens.
This Shakespearean scene immediately ignited a tidal wave of public outcry and debate about how Americans define health, healthcare and Public Health.
It has now been four months since UnitedHealthcare CEO Brian Thompson was allegedly killed by Luigi Mangione. Mangione’s intentions have been widely published. United States Attorney General Pam Bondi is seeking the death penalty for Mangione. This flashpoint crime and proposed sentence has provoked two pressing questions of modern day: How do American citizens define health, and, how do they define violence?
Long before December 4, 2024, a tsunamic movement led by medical professionals, medical residents and citizens advocating for a more humane model of, and approach to, healthcare had grown forceful. The gutting of federal funding for Public Health and scientific research infrastructure since January 20, 2025, however, has emboldened that movement.
As Americans have now normalized Denial of Care, I set out to hear directly from medical professionals of all ages and experience levels on how they are feeling about the future of medical care and Public Health.
IMAGINING A NEW WAY FORWARD
I contacted medical professionals in my network who I’ve known professionally and personally for 30 years in some cases. Unexpectedly, my query went viral peer-to-peer across the country and I was soon positively overwhelmed by the eagerness of medical professionals to contribute their thoughts publicly on the future of Public Health.
I started with Joseph Sakran, MD, MPH, MPA, FACS, the Executive Vice Chair of Surgery and the Director of Clinical Operations at Johns Hopkins Hospital.
“The tragic killing of Brian Thompson is a stark and painful reminder of the frustration and anger that many feel about the failures of our healthcare system. However, let me be absolutely clear: in no way, shape, or form must we justify the cold-blooded murder of Mr. Thompson, or anyone, as a response to systemic issues. Acts of violence cannot and should not be seen as a solution to even the most pressing problems. This incident, while tragic, must serve as a wake-up call to address the deep systemic inequities and inefficiencies in healthcare,” Dr. Sakran said.
Sakran reimagines a healthcare system that prioritizes patients over profits, but welcomes the Commercial Health Insurance industry to remain a participant in the model. He has publicly stated the current healthcare system often prioritizes profits over patients, leaving too many Americans struggling with inadequate care. He does believe this flashpoint crime should propel Americans to enact meaningful reforms, such as supporting legislation like Senate Bill 1655 (The Medicare for All Act of 2023-24), improving transparency, reducing administrative burdens, and prioritizing patient-centered care. Additionally, he wants to call on medical professionals to foster a healthcare system built on “collaboration and trust, where patients, clinicians, and insurers work together rather than in opposition.”
“The tragedy involving Mr. Thompson serves as a grim reminder of the cost of inaction and the urgent need for transformative leadership to address these systemic challenges.” Sakran continued. “Yes, healthcare should be recognized as a fundamental Human Right. Enshrining this principle in state and federal constitutions would establish a moral and legal foundation for addressing inequities and ensuring that every individual has access to quality care, regardless of socioeconomic status. Recognizing healthcare as a Human Right would also help drive the systemic reforms needed to create a more equitable and efficient system.”
He elaborated on what might be possible in the years ahead.
“To truly prioritize patients in a healthcare system, the role of insurers would need a fundamental shift from prioritizing shareholder returns to emphasizing patient outcomes. This transformation is possible if insurers are incentivized to operate within a framework that aligns profitability with the health and well-being of the populations they serve. In a Universal Healthcare system,” Sakran suggests.
“Insurers could play a role by competing on the basis of value rather than Denial of Care. The ‘Denial of Care’ model, as it currently exists, is fundamentally at odds with a healthcare system that seeks to eliminate barriers, Sakran said. “However, by reimagining their role, insurers could complement a Universal Healthcare system by offering supplemental plans or innovative solutions that enhance access and affordability.”
How medical professionals will achieve that trust with the Commercial Health Insurance industry remains unclear. What, specifically, does “value-based care” mean? Value for shareholders, or value for patients? If healthcare access and health outcomes continue to be determined by algorithms, Artificial Intelligence, and Chief Medical Officers who are financially incentivized to deny medical care, where is the “value?”
“We are taught when we are young that we have a level playing field in this country, and we do not. The lack of Universal Healthcare in the United States affects everything, absolutely everything: health, education, housing, Public Safety, employment, family life — everything.”
—Mary Owen, MD, member of the Auk Kwaan Tribe of the Tlingit people, Family Practitioner and an Associate Professor of Medicine in Minnesota
I took those questions to veteran Chicago physician David Ansell, MD, MPH. Ansell is Rush Hospital’s first leader of Health Equity and a thought leader widely known for his critically acclaimed 2011 memoir, “County: Life, Death and Politics at Chicago’s Public Hospital.” He also made famous the concept of The Death Gap with his book “The Death Gap: How Inequality Kills.”
“You have to go into medicine as a calling because it's a great profession. But these challenges with the nature of the business that has created perverse incentives across the board that are disillusioning, and can cause moral distress,” reflected Ansell. “Add to that Commercial Health Insurance, Pharma, Electronic Medical Records, the need to maximize so-called clinical ‘productivity’ and, oftentimes, the Doctor / Patient relationship is compromised by too little time, too much time on the computer, and too much time on needless bureaucracy—like fighting for medications, procedures, physical therapy and the like. This is not to say that high quality care can't be delivered, but profiteering has corrupted the system to the dissatisfaction of so many. The Affordable Care Act places some safeguards, but they are minimally impactful with minimal benefits.” Dr. Ansell said.
Jenny Zhang, MD works in Minneapolis and specializes in Gender affirming care, Preventive Medicine, Addiction Medicine, Refugee and Immigrant Health, Pediatrics, Pre-exposure HIV Prophylaxis and LGBTQIA+ Health.
“As a Family Medicine physician, I am confronted everyday with the multitude of ways our current health insurance system has failed our patients and communities,” said Zhang. “I dream of healthcare reform that would allow patients to see their preferred specialists and healthcare professionals without the barrier of whether or not they are in-network, access to necessary treatments without insurance companies being the gatekeepers to this care and requiring prior authorizations, and freedom from having to stay in toxic jobs or relationships for fear of losing health insurance,” Zhang said.
Regarding the astonishing rate of Denial of Care and delayed care, Dr. Ansell chimed in: “I have had patients refuse breast biopsies and colonoscopies because of copays and deductibles. Most of us who work in healthcare—most Americans and most people in the world— believe that access to healthcare should be a fundamental Human Right. The Emergency Medical Treatment and Active Labor Act work I was involved with back in 1986 then with others—the federal law that regulates the transfer of patients from one hospital to another—enshrined the right to Emergency Care as law of the land in the United States, but we still do not have a Universal Right to healthcare in the United States.”
DISINCENTIVIZING HARM
Over the last two decades, the out-migration of physicians from medical practice has been alarming. According to newest projections published in 2023 by the Association of American Medical Colleges, the United States will face a physician shortage of up to 86,000 physicians by 2036.
Over the last several decades, the amount of control that physicians have over their work environments has been aggressively eroded by Commercial Health Insurance business tactics, a violent phenomenon that has caused moral injury, and much worse, among medical professionals. Many other factors contribute to the mutiny of physicians. The expensive cost of medical school tuition; low medical school admission rates; paralyzing debt after graduation; and high professional risk all take a toll.
Irrespective of the many causes, the results are clear: autonomy and flexibility are increasingly rare commodities for practicing physicians. Commercial Health Insurance “efficiency” pressures force rushed, impersonal care, and frequently result in poor outcomes. This One-Size-Fits-All mechanized, dehumanized, automated care mandate has failed. The byproduct of speed and haste? Fractured Physician/Patient trust.
As patients have become more frustrated with barriers to medical care access, front-line professionals consistently bare the brunt of that anger in hospitals which often manifests in the form of violence. The additional cuts to the National Institutes of Health (NIH), Health and Human Services (HHS) and Center for Disease Control (CDC) are already exacerbating existing frustration, anger and hopelessness. The harm and death being imposed by the party of Donald Trump is astonishing by any measure.
One veteran oncology nurse at Rush Medical Center told me, “Physicians are all burnt out from the chaos in healthcare. They have no fight left in them. Healthcare is awful.”
THE WHISTLEBLOWERS
Vocal opposition to Denial of Care by Artificial Intelligence and algorithms is now front-and-center for physicians in the Health First movement. Mechanisms like PxDx, nH Predict and other machine learning tools now deny medical claims at a horrifying rate.
The first physician to testify about Denial of Care Harm-for-Profit was Dr. Linda Peeno on May 30, 1996. Dr. Peeno then testified two additional times about the Commercial Health Insurance industry and the harm privatization of Public Health infrastructure was causing to patients and ethical medical professionals.
Since May of 1996, Denial of Care and disregard for the health of medical professionals has accelerated, moving countless nurses and physicians to testify before the U.S. Congress about how the current model of healthcare fails not only patients, but colleagues.
In June of 2023, Dr. Jay Wellons, published an article in TIME Magazine that turned a lot of heads: “If Our Politicians Could See What We See: A Pediatric Neurosurgeon on Gun Violence.” That turnkey article seemed to open a welcoming door to more voices weighing in on the state of Public Health in the United States. Medical professionals still fear reprisal for being vocal about the distress and harm they are witnessing in their ORs, EDs, ICUs, clinics and hospitals. Increasingly, going on the record publicly is the only way to protect patients and colleagues from harm but threats to their funding, careers and livelihoods loom large in the current political climate. Despite it, physicians have been publicly opposing the harms prior authorization imposes, advocating for Common Sense Gun Laws, and taking to the streets in historic numbers to protest federal funding cuts to Public Health and scientific research.
Wellons is a Professor in the Departments of Neurological surgery, Pediatrics, Plastic Surgery, Radiology, and Radiological Sciences at the Monroe Carell Jr. Children’s Hospital at Vanderbilt and the Vanderbilt University Medical Center. He holds the Cal Turner, Jr. chair and is chief of the division of pediatric neurosurgery. His book, “All That Move Us: A Pediatric Neurosurgeon, His Young Patients, and Their Stories of Grace and Resilience” is a nuanced, elegant testimony to why physicians should rethink health, and unlearn detachment as a self preservation tool. That is to say, physicians are trained to avoid getting involved in lives of their patients and to avoid politics to advance their careers without reprisal. Wellons strongly encourages both getting involved with the families of patients and engaging civically.
Many physicians have chosen to pivot away from medical practice to work full time on changing healthcare policy and engaging politically. The esteemed host of the podcast America Dissected; Dr. Abdul El-Sayed is one of those doctors. El-Sayed was a candidate in Michigan's 2018 Democratic gubernatorial primary election, placing second out of three candidates. He is also the author of “Healing Politics: A Doctor’s Journey into the Heart of Our Political Epidemic.”
When I asked El-Sayed why he entered medical school, he explained his motivations for entering and his reasons for leaving at once. “When I entered medical school, I did not believe in the system, and, for a lot of folks, I think a lot of them are looking for ways to get out of medicine now. The moral injury coupled with the burn out is just not worth it. Many medical students and physicians feel they are unable to speak out in favor of Single Payer non-privatized National Improved Medicare for All because if they do so, they risk running afoul of someone who could destroy their medical career. That fear of reprisal is a deterrent to change.”
“We are seeing an emotional response to the killing of UnitedHealthcare CEO Brian Thompson because everybody has a story about how this system broke part of them or tried to break them,” El-Sayed said. “It would be extremely unwise for anyone in a position of power in healthcare, or in a position of political power now to not take heed of the current climate.” El-Sayed added: “Look, people are clear about what they want—they want to get care when they are sick. They want to do so in a setting where everyone else can get the care they need, too. This healthcare debate is one of the frontiers in America where powerful people have been siphoning the debate with misinformation for years.”
“The moral injury to physicians piece cannot be ignored anymore. Not after December 4th. We are seeing an emotional response to this crime because everybody has a story about how this system broke part of them or tried to break them. It would be extremely unwise for anyone in a position of power in healthcare, or in a position of political power now, to not take heed of the current climate.”
—Abdul El-Sayed, MD, host of “America Dissected” podcast
Brian Yablon is an Internal Medicine Hospitalist in Minneapolis, a Physicians for a National Health Program Board Member and the Board Co-chair of the Physicians for a National Health Program Minnesota chapter.
“As a practicing hospitalist at a ‘safety net’ hospital I see daily how corporate profiteering in healthcare prevents patients from getting the optimal care they need and/or puts them under extreme financial duress. It also drains staff time, energy, and morale, creating moral distress and exacerbating burnout.” Dr. Yablon shared.
Dave Dvorak, MD, MPH, is presently an attending physician at NorthPoint Health and Wellness Center in Minneapolis, Minnesota. He is a Minneapolis board certified Emergency Medicine Physician whose 30-year career has included work in community-based hospitals, the Veterans Affairs Health System (VA) and urban community health clinics.
“I would like to see the widespread public outrage channeled into real legislative action. I believe that as voters, it is time to impose a litmus test on all candidates for local, state and federal office. Demand to know which side they are on: will they do the bidding of the for-profit health insurance industry and maintain the status quo, or will they commit to the fundamental reform that is desperately needed—a unified, universal and publicly funded health system whose mission is to serve the health needs of people rather than industry profits,” Dvorak said.
“If specific legislation is in play—such as the Senate Bill 1655 / Medicare for All Act—ask them directly whether they will support it. We need to make it clear to political candidates that their very jobs depend upon them supporting a health system that serves people rather than profits. But it will require enormous grassroots activism to counter the influence of incredibly well-funded industry lobbyists,” Dvorak added.
“Rather than expending political capital on trying to pass constitutional amendments, I think right now our efforts should primarily focus on passing the major legislation needed to reform our broken system. Once we have moved to a more equitable, efficient and cost-effective health system that serves Americans, it will be very hard to go backwards,” said Dvorak.
Emergency Medical Technicians (EMTs) and Fire Department professionals are also ensnared in the Denial of Care business model. Minneapolis Fire Department Captain Jeremy Norton is the author of “Trauma Sponges: Dispatches from the Scarred Heart of Emergency Response.” Norton has been speaking out publicly for the last two years in an effort to educate citizens about the Death Gap that Dr. David Ansell has illuminated. Norton and other EMTs find themselves triaging patients daily, only to learn the patients were not able to access the medical care they needed after being stabilized.
“Single Payer and Healthcare for All are necessary, and part of the breaking through we need to do requires we break through so much of this default poisoning of mindset that’s been going on since even before the Affordable Care Act was rolled out,” said Norton.
On May 25, 2020, when the Minneapolis Police used overwhelming physical force on Mr. George Floyd, Floyd died on the street six blocks from Norton’s fire station. Norton and his EMT crew assisted paramedics in the futile attempt to restore Mr. Floyd’s life.
“The people who are working for the for-profit hospitals and Commercial Health Insurance companies use terms of discussion that have so poisoned and polluted society with scare stories about what Universal Healthcare is, it’s become hard to cut through with front line expertise, logic, and reasoning,” said Norton.
“I strongly support implementation of a unified and Universal, Single Payer Healthcare System—publicly funded, privately delivered—that would eliminate the mind-boggling complexity and inefficiencies of the profit-driven private health insurance industry. A Single Payer system guarantees quality coverage for all, removes financial barriers to care, and allows patients free choice of their doctors and hospitals. Virtually every independent study comparing a Single Payer system to our status quo has found that, in regard to cost, quality and access, Single Payer wins decisively every time,” said Dvorak. “Short of sorely needed federal reform, it may be more politically viable for change to begin at the state level. Here in Minnesota, legislators have been working to pass a bill called the Minnesota Health Plan, which would guarantee quality coverage for all Minnesotans via a Single Payer Statewide Universal Healthcare system,” Dvorak said.
The Minnesota Health Plan is poised to become the first Statewide Single Payer Universal Healthcare Program in the United States in 2026. The Healing Greed Agenda, authored by the Minnesota Nurses Association, has gained traction as a roadmap for other states to protect medical professionals and their patients from the Denial of Care Harm-for-Profit business model.
“I have seen too many people suffer because of Denial of Care, lapses in insurance, or changes in insurance coverage determined by administrators who don’t see the real and devastating impacts these have on patients. I believe this dream of equitable access to healthcare could be achieved in a Single Payer health system. In Minnesota, this Single Payer Statewide Universal Healthcare could become a reality with the passage of the Minnesota Health Plan. It is my hope that I will see this happen in my lifetime,” Dr. Zhang agrees.
“Healthcare is a Human Right and should be part of the commons. The United States Constitution states, for the welfare of all, but we know how the words of the Constitution are bent for whatever purpose is needed. Healthcare should be enshrined and explicitly stated as a Human Right in our United States and State Constitutions. In addition, the details of what this includes should be outlined to minimize attempts to limit due to race, religion, or lack of religion, ethnicity, citizenship status, etc. The Medicare for All Act does a good job explaining all the included services, how it’s paid for, how it is administered and accountability, and the healthcare trust fund would not be used for any other purposes like military or other programs.”
—Nancy Westman, APRN, CNP, PMHNP in Minneapolis and Amanda Rae Richter, Licensed Psychologist in Minnesota and Texas
Brian Yablon, MD is an Internal Medicine Hospitalist in Minneapolis and a Board Member of Physicians for a National Health Program (PNHP). He is also the Board Co-chair, PNHP-Minnesota
“I would love locally to see the Minnesota Health Plan get hearings in the legislature, pass and be enacted. Nationally, we need a true Single Payer healthcare system as proposed in the Jayapal bill in the House and in Senate Bill 1655. A well-designed Single Payer system allows people to receive medical care without incurring out-of-pocket fees at the point of care, saves money for individuals and the system and allows best quality healthcare to be the focus of the system rather than cost-shifting and profiteering.” Dr. Yablon said.
“We need to take immediate steps to stop corporate profiteering in the Medicare space and to strengthen our public traditional Medicare program. Doing the latter would enable us to end Medicare Advantage, which has been a cash cow for the insurance industry and a predatory program for seniors. Healthcare is a Human Right and we should enshrine it as one. The Single Payer movement is nonviolent, peaceful, and justice oriented. This stands in contrast to the structural violence and injustice perpetuated by the health insurance industry,” Yablon said.
SYSTEMIC ENTRENCHMENT: Incrementalism vs. Sustainable Legislation
STAT News on April 1st reported that amid the recent termination notices sent to stunned employees of the Department of Health and Human Services (HHS), some employees, including top National Institutes of Health (NIH) officials, were offered the chance to transfer to the Indian Health Service (HIS) in an email signed by Thomas J. Nagy Jr., Deputy Assistant Secretary for Human Resources at HHS. The Indian Health Service has an untenable vacancy rate of approximately 30% because it has been consistently underfunded and deprioritized. The email included a bulleted list of IHS territories where these jobs would be offered, including: Alaska; Albuquerque, New Mexico.; Bemidji, Minnesota.; Billings, Montana.; the Great Plains region; the Navajo Nation; and Oklahoma. It asked employees to indicate a preference for relocation almost immediately.
In early March, the Trump regime announced the cancellation of leases for at least 12 Indian Health Service facilities and 25 Bureau of Indian Affairs offices, representing nearly 30% of all agency locations. Additionally, IHS employees were included in a buyout offer from the Trump regime, alarming tribal officials and Indigenous community leaders who fear that any employees leaving the already understaffed, underfunded agency will force the shutdown of critical health services.
A steady stream of executive orders from the president and cuts made by Elon Musk’s Department of Government Efficiency — combined with chaotic directives— have had a destabilizing effect on agencies that serve tribes. Hundreds of employees at the Bureau of Indian Affairs have been fired. Access to important payment systems has been blocked. Congressionally approved grants have been unilaterally terminated.
Where does this intentional, violent harm to human health leave people and communities?
Mary Owen, MD, is a member of the Auk Kwaan Tribe of the Tlingit people, a Family Practitioner and an Associate Professor of Medicine in Minnesota. She distilled the state of Public Health very succinctly: “We are taught when we are young that we have a level playing field in this country, and we do not. The lack of Universal Healthcare in the United States affects everything, absolutely everything: health, education, housing, Public Safety, employment, family life—everything.”
“The ‘Denial of Care’ model, as it currently exists,” Sakran said “is fundamentally at odds with a healthcare system that seeks to eliminate barriers. However, by reimagining their role, insurers could complement a Universal Healthcare system by offering supplemental plans or innovative solutions that enhance access and affordability.”
I contacted Dennis Gates, MD to ask him about humanity, compassion, economic dignity and the future of Public Health. Gates is the Emeritus Professor of Orthopedic Surgery at Rush University in Chicago and the former President of the American Volunteer Physicians for Viet Nam and World Orthopedic Concern. Retired now, he looks back at how things in medicine and society have changed over the years.
“Our healthcare system needs to change. It is a wonderful method of treating disease for the wealthy and those fortunate enough to have good jobs. For the poor, the marginal, those who lose their jobs—it is a disaster,” said Gates. “Medicare takes care of the elderly marginally, but not the younger. And our United States system is treating disease, not preventing it.”
On the need for increased Preventive Care, Primary Care and Health Literacy Education, Gates said: “It is far cheaper to teach people how to prevent disease, than to cure it. But these methods might hinder the huge profits the Commercial Health Insurance industry makes. I will never understand why we have for-profit, shareholder-beholden companies treating— or rather, not treating— the sick. How can, for example, UnitedHealthcare make huge profits; pay their shareholders, board of directors, and CEO extravagantly; and deny basic care to thousands of its paying customers/patients?”
When asked what keeps him going as an advocate of National Improved Medicare for All (Senate Bill 1655) Dr. El-Sayed took a breath.
“What keeps me going is people deserve better. I am particularly heartened by the young medical students who are out there fighting for a system that is more humane to them and their patients. The number of doctors and medical residents who are unionizing is very promising…Look, this is not a problem without a solution. We just need more political weight and with each day the tide is changing.”
THE HEALTH FIRST MOVEMENT: Healthy Doctors = Healthy Patients
Over the last four years, medical residents have been unionizing across the United States in historic numbers. Although the movement is not a monolith, the physicians of tomorrow are addressing an array of Health First policies and practices to better serve patients. The unionizing trend is focused on the health of the physicians based on the simple premise that if physicians are healthy, patient outcomes will improve, as well.
Residents and fellows come from many different backgrounds and have different needs at this point in their careers which informs what they want to bargain for. Several medical residents discussed that they want increased salaries that allow residents to live beyond paycheck-to-paycheck; benefits that better support their access to healthcare; retirement benefits equivalent to other employees at their institutions; coverage for licensing and board exams; childcare assistance programs to support new parents and families during training; and other initiatives.
“I have wanted to be in medicine since I was five. All of my female role models were in medicine in some form and that really appealed to me. Since then, it has been incredible to be able to be able to support people in their most vulnerable moments.” shared Dr. Nicolette Alberti. Alberti is an MPH at the University of Illinois-at Chicago and she is the also the Great Lakes Regional Vice President of Committee for Interns and Residents.
Like many medical school students who are organizing, residents, fellows and interns at Northwestern Medicine hospitals and clinics voted in early 2024 to unionize, citing a lack of transparency regarding pay raises and healthcare benefits. NU doctors reported regularly working more than 80 hours a week claiming they were overworked and underpaid. Entering 2025, they were in the contract bargaining stage.
Medical residents are often working anywhere from three to eight years as trainees up to 80 hours a week with little control over their work schedules, salary, benefits, and their personal lives. This bodes poorly for morale and patient safety. Physicians in training are in a very vulnerable position during their careers. They have graduated from medical school and have earned their medical degrees but require further training before independently practicing. Additionally, the current system in which they are assigned where they train is a rigid system that does not allow for autonomy much like other professions. This approach, which some have equated with hazing where young physicians are expected to “make the resilience cut” by enduring extensive physical and emotional distress, has led to an increase in medical resident suicides, physician suicides and an out migration of Primary Care Physicians.
“Healthcare is a Human Right and we should enshrine it as one. The Single Payer movement is nonviolent, peaceful, and justice oriented. This stands in contrast to the structural violence and injustice perpetuated by the health insurance industry.”
—Brian Yablon, MD, Internal Medicine Hospitalist, Physicians for a National Health Program Board Member
Medical School enrollment is down, as well, due a number of factors. In a healthcare system that financially benefits from their extensive labor, it is easy to see why this labor population needs protection. For many physicians, unionization is important because medical residents want to see people from all socioeconomic classes succeed in medicine.
Several new organizations, podcasts and books like the Lorna Breen Heroes Foundation have sprouted up in response to this wide scale moral injury. Dr. Jessi Gold’s most recent book “How Do You Feel? One Doctor’s Search for Humanity in Medicine,” The Nocturnists podcast, New England Journal of Medicine’s “Not Otherwise Specified” podcast and Kaiser Health News’ “Arm and a Leg” podcast address these issues head on. “Bill of the Month” is a crowdsourced project produced by National Public Radio (NPR) and Kaiser Health News that investigates and explains real-life medical bills. It has now been published for about eight years and yet still, Denial of Care has only increased in its velocity and scale.
Nicholas “Nick” Kowalczyk is a 31-year-old fellow employed by University of Chicago who has been helping University of Chicago medical residents to unionize. He spent three years in Internal Medicine residency at the University of Chicago and specializes in Nephrology. What started off as an interest in biology for him ultimately turned into an incredible appreciation for the nature of the relationship between physician and patient. That relationship has eroded under the Managed Care industry.
“I started the union effort with a co-resident of mine during the COVID pandemic. Like many residents, we felt like our hospital and administrators were unprepared for the onslaught of patients, especially the number of critically ill patients requiring admission to intensive care units. As the primary face of patient care at the hospital, residents and fellows were expected to take the brunt of the waves even when the number of sick were skyrocketing.” Kowalczyk said.
“There are few careers built on so much trust, potentially spanning several years, that includes not just a simple medical history, but a patient’s personal life as well, Kowalczyk continued: “When you go into a medical office, you almost feel a cleric going into a confessional sometimes; patients share a lot of who they are to their doctors. And as medicine has become more complicated due to its advances, patients look to their physicians for guidance,” he said. “This is all particularly true in nephrology where kidney disease tends to be slow in progression, so you get to know your patient for several years, and with the age of dialysis and transplantation, patients look to us to help navigate these complex questions of what may be best for them…and the questions of dialysis and transplant are understandably scary for a patient.”
The unionizing at University of Chicago is important to Kowalczyk especially at this time. As Jay Wellons wrote, medical students and physicians have been historically expected to stay out of politics and advocacy but he encourages it.
“It is an awesome responsibility, but one that holds a lot of burden especially when trying to navigate the current state of medicine between prior-authorizations and the intensity of practice requiring physicians to see as many patients as possible each day. Those other aspects I did not appreciate until I went into residency and realized the realities of practicing medicine in the United States,” Kowalczyk said.
Kowalczyk worked on the unionization effort for more than three years and due to increasing clinical responsibilities, had to take a step back from his prior union responsibilities and allow what he calls the younger generation to take the baton.
“By the very nature of being a resident/fellow, we are particularly vulnerable to be exploited by the healthcare system. After graduation from medical school, one is required to complete a residency program in order to practice in the United States as a licensed professional. After interviewing with a bunch of hospitals, you are electronically “matched” based on preferred rankings submitted by the hospitals and yourself. After this match, you are required to sign onto the hospital contract without debate or any negotiation. Thus, without a union, you sign a contract that is deemed by the hospital to be “fair,” Kowalczyk said.
“The consequences of this system were felt during the pandemic as residents and fellows were overworked without increases in benefits and without protections, and without a union, we had no way to advocate for ourselves in a meaningful way, such as ensuring that masks were available and that Resident-to-Patient Ratios allowed for good patient care. There were other instances such as a number of safety events in the Emergency Room that could have resulted in serious harm to residents and fellows that seemingly fell on deaf ears when administration was approached.” Kowalczyk said.
His hope is that these continued negotiations will also include many of the issues that residents were passionate about when they first formed the union.
“From the nephrology side, it is important to note that End-Stage Kidney Disease is one of the few conditions that automatically qualifies a patient to Medicare since President Nixon signed it into law in 1972. Before that law, dialysis, a new life-extending therapy, was only offered at a few centers in the United States and due to its rarity, committees were formed made up of people from the community to decide who was worthy of dialysis based on personal attributes, community contributions, and the ability to pay for treatments versus who would be sentenced to the grave. At that time, this was viewed to be unacceptable by the public and the outrage resulted in this reform. Since that time, there has been an unfortunate trend in the corporatization and monetization of healthcare that has mirrored the history of dialysis in general.” Kowalczyk said.
“Ultimately, building a healthcare system that prioritizes patients requires all stakeholders—including insurers—to embrace a culture of collaboration, innovation, and accountability. This is a difficult but achievable goal, and I believe it is essential to creating a system that truly works for everyone.” Dr. Sakran said.
“Without question Senate Bill 1655, Medicare for All, should be enacted,” Dr. Nikki Alberti expressed. “There is no one on this planet who is not worthy of medical treatment. Conceptualizing that only people with insurance, and therefore essentially only employed persons, deserve to be well, submits to the value that we as a people need to be ‘productive’ in order to deserve living a healthy life. This is a principle I, personally, and hope the general public, cannot support”
“We also felt unionizing as medical residents was important from a community perspective. The University of Chicago is the academic center for the Southside of Chicago, a predominantly black and historically underserved part of the city. It took years of debate for it to be the much-needed trauma center that it is today, and we wanted the chance to build a coalition of residents and fellows in ensuring that other community needs are met by the hospital, and a union would allow us to have that voice.” Kowalczyk added.
Dr. Alberti continued: “In my vision for a new United States healthcare system, a patient never asks me about the price of a medication or how much the CT scan will cost. I can see them all in my Primary Care clinic and not in the Emergency Room when their condition is terminal because they had to wait so long for care. In my ideal world, living well is not a luxury to those born into privilege. In my vision, healthcare isn’t something anyone has to think about because it is a given.”
ADVICE FOR MEDICAL STUDENTS: Health Philosophy Transformation
As far as advice for medical professionals entering the field in 2025, Alberti took extra time before responding thoughtfully. “I have so much I would say to medical residents. The first is medicine is the best job in the whole world. That being said, it is a job, don’t let that perspective get away from you. There is so much more to medicine than the biochem and hard science. Don’t underestimate the significance of making sure that your humanity shines through.”
“I've been a doctor for 50 years and despite it all, I love it…” Ansell said, “but many regret their choices and burnout.”
Dr. Dvorak points to the history of legislative change: “States have been called the ‘laboratories of democracy.’ Perhaps it will be certain progressive states who lead the way in meaningful health reform,” said Dr. Dvorak.
“It is without question that healthcare should be a Human Right, not only in the United States but globally,” said Dr. Alberti. “Healthcare existing in the capitalist business world exacerbates already existing systemic racism and distinct anti-poverty inherent to the current medical system. Making this a market exploits people into making impossible choices.”
“So much has changed in healthcare in terms of pharmaceutical drugs and therapies, that similar to dialysis in 1972, are life-extending and even lifesaving. Insulin for a type 1 diabetic is the difference between life and death, do we deny them because of insurance? Or a patient with severe heart failure, do we deny them a chance for a heart transplant or left ventricular assist device? Or a patient with suicidal depression, do we deny them therapy and antidepressants? I don’t understand why as a society we have decided that dialysis is worth paying for but these other drugs and therapies are not. Why do we draw the line there? We need serious reform and a nephrologist who experiences the benefits of a Single Payer in dialysis should support Single Payer in all of medicine,” Kowalczyk said.
“I hope people will learn about the exploitational potential inherent in residency and fellowships and the general ability of unions to empower the workforce to have a voice. I also hope that physicians, particularly residents and fellows, know that getting political is not contrary to our job description, and in fact, it necessitates it.”
—Nicholas Kowalczyk, MD, Nephrologist, University of Chicago
Dvorak had may thoughts on betterment: “Emergency Medicine and Primary Care are both front line settings in which the inequities of our system are most evident. I advise medical students that, as medical professionals, they will have a louder voice than most in any discussion of health reform. I encourage them to tell their stories of real patient encounters—the patient who has forgone the necessary cardiac stress test due to cost, the insurance company that denies coverage of a heart medication that a patient needs, the patient who is unable to follow up with the orthopedist due to an unaffordable deductible, the patient who has been bankrupted by medical bills from a recent hospital stay. I tell students that it is their duty not just to care for individual patients, but also to advocate for an overarching system that is just and makes high-quality care accessible and affordable to all.”
“I hope people will learn about the exploitational potential inherent in residency and fellowships and the general ability of unions to empower the workforce to have a voice. I also hope that physicians, particularly residents and fellows, know that getting political is not contrary to our job description, and in fact, it necessitates it.” Dr. Kowalczyk said.
WHERE DO WE GO FROM HERE?
Let’s revisit that singular security camera frame on December 4th, 2024.
Two men.
One man, holding a gun, consumed by rage, causes the death of another human being in broad daylight with a firearm. The other man, the embodiment of a weaponized bureaucracy intended to harm people for profit with millions of invisible administrative cuts.
Who is the more violent man?
Do Luigi Mangiones and Brian Thompsons sit at our kitchen tables, in our classrooms, in our board rooms, at our neighborhood cafes, in our houses of faith or on our school gymnasium bleachers? Are we all complicit in the ongoing Denial of Care tragedy?
This crime, and the era of Harm-for-Profit, might summon all American citizens to ask: Should Americans assign fiscal priority to lifelong health maintenance as a social cultural, economic, ethical and moral value? Or, is it simply the American Way to profit at any and all cost—even if the “gains” and “growth” are extracted from deliberately untreated illness, injury, disability and preventable death?
Most importantly, who will heal our healers?