While flipping channels, I came across an episode of the new Melrose Place series. Surprisingly, a plot line in the episode made me think about the cost of health care in America. One of the main characters, Lauren Bishop, is a student in medical school. She is dedicated to medicine and excels in her classes, but financial strife jeopardizes her education. This is an all-too-common scenario in real life; crushing student loans and the lack of ability to pay have led to a shortage in primary care physicians. There are fewer family doctors available to offer preventative care; this results in more patients resorting to expensive specialists or emergency rooms with serious ailments that could have been nipped in the bud if properly monitored. Health insurers and their patients must cover the increased costs of this.

The case of Melrose's Lauren is an extreme example of the need to include educational support in any healthcare reform bill. After a mix-up at the financial aid office, her medical school informs her that she will be kicked out if she can't pay them $25,000 by the end of the semester. Lauren is now out of options, and--this being a nighttime soap--she reluctantly becomes an escort to fund her dream. While obviously a dramatization, the show is unusually realistic in its portrayal of struggling med school students and the financial hardships they often face. How does this affect your health insurance costs? There are several ways in which this happens.

Physicians who must take out hundreds of thousands of dollars in student loans to attend pre-med programs and medical schools must earn higher salaries to compensate. A primary argument in favor of healthcare reform, especially the public option, is that the federal government would be able to use its clout and size to lower reimbursement rates across the board. Ideally, the savings would be passed on to taxpayers. Medicare and Medicaid use a similar method, but it has not been without objections from doctors. The lower payments they receive from these public health insurance plans don't allow them to pay off their debts within a reasonable period of time. An increasing number of doctors have either limited the number of Medicare or Medicaid patients they serve, or refused to take them altogether. A related phenomenon is the trend of medical school graduates choosing to enter a specialty, as opposed to becoming primary care physicians. Most medical specialists make more money while working fewer hours, enabling them to pay off their debts quickly. This logical decision is another factor in the shortage of primary care doctors. Basic economics states that when supply is lower than demand, the price must rise to reach equilibrium. Therefore, the doctors who are practicing general medicine must be paid more.

In addition, potential doctors who must work multiple jobs to support their education (or low-paying residencies afterward), as well as current doctors stressed from large loan payments, may see the quality of their care suffer. Other doctors and hospitals must make up for any errors made when this happens. Health insurance companies are then forced to pay for the same procedure twice. A handful of doctors may become desperate enough to go against their ethics, such as the Hippocratic Oath. Unfortunately, while the fictional Lauren's scenario is rare, other doctors may feel entitled to break their moral code by accepting kickbacks from pharmaceutical companies or defrauding insurance companies. Both of those actions are responsible for billions of dollars in wasted healthcare costs each year, passed on to you in your health insurance quote. Changing the current medical school system would allow more general doctors to make a good living with lower salaries, reducing the cost of healthcare reform in the long run. Costs would decrease due to an increased supply of doctors, as opposed to direct government involvement in determining doctors' salaries. What can we do to improve this situation?

The government can offer more grants and scholarships to deserving medical students. Non-for-profit charities, corporations, and individuals could do the same. If we want more primary care doctors (who have been proven to save the health insurance industry money in the long run), they must be encouraged. Financial aid forms should be made as easy to understand as possible; and loans should be considered as a last resort, not expected to cover the majority of med school expenses. More state medical schools should be opened. A medical school associated with a public university could educate future doctors for under $100,000, significantly less than a private medical school. These students can take out fewer loans, reducing the incentive for them to neglect general medicine in favor of more lucrative specialties. Moreover, many of the recently approved public medical schools have special programs focused on providing healthcare to underserved communities. While these changes would be effective to those students still in the pipeline, what about the doctors who are currently practicing? Loan forgiveness could be offered to primary care physicians or other physicians in underserved fields. Right now, even bankruptcy doesn't eliminate their student loans. As a further incentive, the amount of the forgiven loans should be tax-free. This policy would also result in increased savings for both public and private health insurance plans, while allowing for-profit insurers a greater ability to compete with a public option. We lose many potentially excellent doctors every year due to financial concerns. Some drop out of medical school because they are unable to pay to complete their education, while others look at the increasingly immense cost and forgo medical school altogether. Those who do become doctors will be highly paid, but saddled with over a quarter of a million dollars of student loan debt in some cases. Medical education must be reformed. Doing so will lead to consumers receiving lower health insurance quotes, increased healthcare access for all, and a healthier nation.

(Image: cliff1066 under CC 2.0)

Yamileth Medina is an up and coming expert on Health Insurance and Healthcare Reform. She aims to help people realize that they can get a good health insurance quote right now while waiting for a public option, if it ever gets passed. Yamileth lives in Miami, FL.