The single most disheartening line I tell my patients every day is: “Let’s focus on your health, that is the only thing that is important right now.”

Physicians across the country repeat this line almost verbatim whenever a patient expresses any concern about cost. It helps reaffirm our purpose – we went into medicine to save lives, not manage finances – but mostly, it is a way to deflect our discomfort with the truth: we have no idea, and no way of finding out, how much your blood test, CT scan or surgical procedure will cost you.

With the rise of high-deductible insurance plans, there has been a palpable increase in the number of patients who want to know the costs of their tests before they are ordered. This is entirely understandable when people are paying over $13,000 a year in out-of-pocket expenses despite having insurance. Unable to access prices or actually shop around, however, patients begin to decide which parts of their care they can forego altogether.

As efforts to repeal Obamacare falter and Congress considers next steps with healthcare legislation, many see this personal investment as a good thing – “skin in the game” that eliminates inefficiency. These very decision points are the bedrock of their cost containment strategy.

If the cost of their healthcare is too much, House speaker Paul Ryan said, then people will simply “choose not to buy something that they don’t like or want”. Or, as former Republican congressman Jason Chaffetz stated: “Americans have choices. And they’ve got to make a choice” on how much they are willing to spend on healthcare versus other life expenses.

Ultimately, this strategy may work. We may indeed be able to bring down healthcare costs by making people think twice about accessing their care. But this way of thinking is callous to most people’s reality. Americans are not forgoing healthcare in order to buy new designer jeans and handbags, they are skipping pills and missing checkups so that they can put food on the table and put their children through college.

Far from an elegant solution to the spiraling cost of our healthcare system, high deductible plans throw patients and physicians in an impossible bind. Doctors want to take care of patients, but we don’t want that to mean putting them in financial ruin. Understanding that wealth is directly related to health, how are we performing as physicians when in curing one disease, we may be creating another?

There are, of course, other options.

The elephant in the room in the discussion to lower healthcare costs is a Medicare-for-all or single-payer system. As we tirelessly debate about which strategy may hypothetically lower costs, over in Canada the government has steadily been providing healthcare comparable to what we get here in the US, with costs roughly halved.



While this may not have mattered to the average American when insurance companies were picking up the bill, the rise of high-deductible plans have refocused the spotlight. Ironically, as the Republican party encourages us to be smart shoppers when it comes to medicine, it is becoming more and more apparent that the best deal, in fact, is the very type of system they have railed against for decades.

Most importantly, in a universal healthcare system, patients never need to worry about the financial pain their healthcare causes. There are no out-of-pocket costs. As stated in an academic comparison of the Canadian and US healthcare systems, “monetary exchange is practically non-existent between patient and healthcare provider”.

If college tuition or putting food on the dinner table was affordable before walking into the ER, it still would be affordable upon walking out the door. If you need stitches for your cut, such a system wouldn’t pour salt in your wound.

We are at an inflection point in American healthcare. We can double down on our current system where our sick and elderly must decide whether the cost of staying alive is worth the debt it will place them in, or we can opt for a universal healthcare system where we all get the services we need at half the cost we are currently paying, without ever having to worry about anything other than getting better.

As a physician, the choice for me is clear: I want to live and work within a healthcare system where the next time I tell my patient, “Let’s focus on your health, that is the only important thing right now,” I can say so knowing it is the absolute truth.