“We do not have the money! You took it all!”
Startled, I moved the phone away from my ear to dampen the screaming voice on the other end. I had just explained to my patient’s son that his 95-year-old mother could walk again; she just needed surgery to repair her hip fracture. This was good news, or so I thought. His mother had insurance, “good” insurance, and needed a fairly routine procedure. So why was he furious?
He composed himself and explained that his father had recently endured a long hospitalization. Despite having private insurance, the family was left drowning in medical debt. On speakerphone, he explained that he could not handle the cost of surgery for his mother. From the gurney, she looked up at me, despondent.
We see versions of this story daily. The harm our profit-driven health care system inflicts on patients and their families is impossible to ignore. Yet most organized medical societies focus their advocacy on narrow issues like scope of practice, reimbursement rates, or tort reform, treating symptoms rather than the disease itself.
We need a movement that addresses both the immediate and structural failures of our health care system, advocating for policies that protect patients and confront systemic inequities. The vision of a single-payer system, guaranteeing universal, affordable, and equitable care, aims to end treatment denials due to cost, eliminate medical debt, and save billions through administrative simplification. As physicians, we take an oath to do no harm, yet we witness patients harmed by a system that prioritizes profits over care. Despite the highest per-capita health spending among wealthy nations, the United States delivers worse outcomes, shorter life expectancy, higher infant mortality, and more chronic disease, and remains the only wealthy country without guaranteed universal health care.
This disconnect fuels moral distress and burnout. When we are powerless to shield patients from a predatory system, it corrodes our sense of purpose. Administrative burdens compound the damage: the Medscape Physician Compensation Report 2021 found that physicians spend about 30 percent of their time on administrative work, fighting for authorizations, navigating formularies, and pleading with insurers. We are routinely forced to seek permission from untrained administrators to deliver evidence-based care. When denied, we appeal to bureaucrats who have never met our patients, hoping for a change of heart. When that change of heart never comes, we deliver the bad news to our patients, that they cannot get the care they need, not because of a lack of medical technology or resources, but because their insurance company said no.
And now, with Congress intent on gutting Medicaid, which studies show could lead to an increase of 25,000 preventable deaths a year, our already impossible task becomes even harder. Medicaid is a lifeline for millions of our most vulnerable patients, and its dismantling represents a final straw. The outrage among physicians at these proposed cuts has been swift and widespread. We should see that for what it is: evidence of the collective power we can wield when we unite around our patients’ interests.
That energy must be harnessed into something lasting. Advocacy is not a side project; it is our professional duty to fight for a system that aligns with our values. It is a sanctuary for those alarmed by the rise of efforts to strip patients of rights and safety nets. And it is a movement for those who believe medicine can, and must, be a force for justice.
Back in the emergency room, our patient and her family connected with our financial counselors; she underwent the surgery she needed, completed rehab, and walked again. But that helplessness we feel, the realization that, in the eyes of the system, a patient’s life comes with a price tag, and the moral injury that results must drive us to action.
If we truly want to care for our patients, and preserve our own sense of purpose, we must change the system. That begins by standing together, in the right place.
Toby Terwilliger is an internal medicine-pediatric resident. Alankrita Olson is a public health physician. Ashley Duhon is a gynecologic oncology fellow.
