In Commencement Speech, Kenneth L. Davis, MD, President and CEO of Mount Sinai, Says “These Are Unusual Times; Our Core Values Are at Stake”

Graduates, four years ago, at our first gathering, you each received your white coat—a symbol of compassion. As you’ve worn it, I trust you’ve come to understand that the practice of medicine requires more than study, more than knowledge, more than skill. It also requires compassion and empathy. As graduates of our school, I want you to hold firm to that core value, because the compassion you feel will never allow you to abandon the most vulnerable, or being my brother’s keeper.

I raise this because our ability to treat each and every patient in need of care, to prevent disease, and to optimize care is under threat today. Last week, the House of Representatives passed a bill that sharply conflicts with our core values. I speak, of course, of the American Health Care Act, which, if allowed to become law, would dramatically alter the health care of America.

Since 1965, when President Lyndon Johnson signed the law that created Medicare, the United States has increased access to health care under both Democrats and Republicans. President Ronald Reagan expanded Medicaid to cover more low-income children and their mothers. President George H.W. Bush created the Children’s Health Insurance Program to provide health care coverage for low-income children previously not covered by Medicaid. President George W. Bush further expanded the number of Americans who could receive coverage under Medicaid and added a prescription drug benefit to Medicare. And of course the Affordable Care Act, signed by President Obama, continued the tradition of Americans caring for Americans, drastically reducing the number of uninsured.

Turning back the clock

What the House of Representatives has done turns back the clock. For the first time in over 50 years, we would be diminishing access to health care for tens of millions of our citizens. For the first time in over 50 years, we would become a less compassionate society.

Those who promoted the bill make some extraordinary claims. Among those are: Our most vulnerable citizens would have improved health care; no one would lose their insurance; people with pre-existing conditions would be protected.

Here’s the reality: The bill would slash nearly a trillion dollars from Medicaid—nearly a trillion dollars— causing millions to lose health care coverage. New York State alone stands to lose $7 billion a year. Federal Medicaid funding for Planned Parenthood, which some of you may know was started by Mount Sinai OBGYNs, would be ended, and tax credits could not be used to buy insurance that includes abortion coverage. States would allow insurance companies to charge patients with pre-existing conditions higher rates—thousands, even tens of thousands, more dollars than they’re being charged now. And, of course, we’ve heard that high-risk pools will be established, allegedly to offset some of the rate increases. I need to say a word about those high-risk pools. High-risk pools are not a panacea. They’ve been underfunded in the past. They have been tried before, and by most estimates the number in this bill is inadequate. In fact, 35 states have tried high-risk pools, and in 31 of them they have failed. Most of the pools lost huge amounts of money. The consequence was that patients could not afford to buy into those high-risk pools.

Stripped-down health policies

The House bill also allows states the option to waive the requirement that insurance plans have the essential benefits. Essential benefits under the Affordable Care Act included ambulatory care, emergency care, hospitalization, maternity care, prescription drugs, lab services, pediatric services, mental health and substance abuse, and prevention and wellness services. So what’s left? What kind of stripped-down policies would insurance companies be allowed to sell under the rubric that we’ll have more affordable, less expensive policies? Under the heading of choice, Americans can be sold virtually worthless policies, policies that carry high deductibles and co-pays, policies that will produce awful surprises when the buyer becomes ill and discovers what services are not covered.

One of the essential services that need not be covered is mental health and substance abuse care, this despite the fact that 60 percent of the leading disabilities in the world are brain diseases. When we make mental health coverage optional, what we say is, “You don’t really need that.” But this could not be further from the truth, particularly as many people with mental health problems deny their illness until it is too late, a circumstance that is aided and abetted by this choice.

The Affordable Care Act has delivered health insurance to 16 million Americans. The Act has brought the uninsured rate down to the lowest level in American history. As a result, Americans are healthier and living longer; there is lots of data to support that. The bill passed by the House would roll back those victories. Indeed, the Congressional Budget Office estimates that 24 million Americans would lose health care coverage, and, of course, people without health care insurance often go without health care.

A study published prior to the Affordable Care Act found that nearly 45,000 deaths per year in the United States were a consequence of a lack of health care coverage. The truth is the American Health Care Act, as passed by the House of Representatives, would have devastating consequences for millions of Americans. And the most vulnerable—the poor and the sick—would suffer the most severe consequences.

Unusual request in unusual times

Our society at its best accepts the notion that we take care of each other. In fact this is the idea underlying the economics of health care insurance: We all pay in so that those who do get sick have affordable insurance. Insurance that makes possible the quality of health care we need and does so at an affordable price. For an insurance pool to work, the well and the wealthy must help the sick and the unfortunate. Health insurance, after all, is a subtle social contract, a contract built on the long-held religious ethic of caring for one’s neighbor, especially those who are less fortunate than we might be.

You graduates chose to become doctors today to live up to those principles, simply put, to help others, and this is the ethic that underlies the Mount Sinai Health System. We are committed to caring for everyone. We have always been committed to that core value—serving the most vulnerable as well as the most fortunate; we don’t differentiate. So now I implore you to retain and live the values you’ve been taught here. Practice compassionate care. Help the most vulnerable.

And in that spirit I have a request, a request I have never made at a commencement, but these are unusual times. Our core values are at stake. Lives are at stake. I ask each and every one of you— graduates, parents, family, faculty, and staff—to call or write your senators, demand that they stand by our values, your values. Demand they refuse to rip up the nation’s social contract. Demand that they not turn back the clock on the extension of health care to all Americans.

Please do not allow the rhetoric of choice, free markets, and personal responsibility to eclipse the fact that, as doctors, we are our brother’s keeper.