University of Iowa medical student Shady Henien and Iowa Gov. Terry Branstad held similar views about what ails the state's medical system long before the pair ever met.
Both want to attract more doctors to Iowa. They also agree that medical school student loan debt is too high.
Branstad, 66, and Henien, 27, share something else in common. They're proposing solutions.
In January, Branstad earmarked $2 million in his proposed budget to forgive loans of students who become primary care, emergency medicine and obstetric doctors in rural Iowa. Another $2 million would match grants from hospitals that increases the number of medical residencies.
Henien, a fourth-year medical student, met Branstad last week to pitch his plan, first jotted down three years ago on a cardboard coffee cup sleeve: A medical student loan program that saves UI students tens of thousands of dollars over the life of a loan by offering interest rates that are at least half of those from the federal government.
Henien said he wants to do his part to raise awareness about student debt, an issue with national visibility that has so far focused more on undergraduate students. U.S. medical students graduate, on average, with more than $160,000 in debt.
Proposals to lower the interest on student loans are being debated in Congress because rates for some undergraduates are set to rise July 1.
Branstad came away impressed after a half-hour meeting with Henien. It's "phenomenal" that a busy medical student found the time to work on the plan, Branstad said. Henien's proposal would require state tax incentives to entice private investors to bankroll the student loans. The governor said he'll examine the plan and perhaps put it on his legislative agenda next year.
"He's got a unique idea," Branstad said. "I think it may have some potential."
When Henien, 27, first came up with the idea, some said it would never gain interest outside of medical school.
The idea was too radical, critics said. A loan program that relies on private investors would have to work outside the current student loan system, which largely flows through the federal government.
Henien, the medical school's student government president, remained undaunted. In his life, he has combined a sense of public service with an instinct to dream big, even in the face of adversity, said friends, colleagues and family.
Samir Henien, 59, a neonatologist from Easton, Penn., said he still remembers his son's advice to the freshman class in a speech at the University of Pittsburgh, where Shady was the undergraduate student body president:
"If you want to accomplish something then go out and get it and do big things. If when you ask for advice from others and they tell you that you cannot do something, then tell them 'thank you' and remember to never ask them for advice again."
Shady Henien made such an impact at his alma mater that the university engraved his name a walk between the two signature buildings on campus.
"Everyone who strolls that walk will see his name," University of Pittsburgh Chancellor Mark Nordenberg said. "It doesn't surprise me given his drive that he was able to push this student loan idea forward."
Many proposals to trim student debt
Henien's plan is among myriad proposals and existing programs designed to ease the debt burden on students.
Federal loans have a variety of relief options. Repayment times can be extended. If a borrower meets certain conditions — for doctors, that can mean working in rural or low-income urban areas — monthly repayments can be based on a percentage of a person's income. Loans can also be forgiven. Individual states, including Iowa, offer similar programs.
One problem is demand exceeds supply for some debt relief programs targeted at medical school graduates, said Elizabeth Wiley, 34, president of the American Medical Student Association in Sterling, Va.
High debt levels can discourage some from becoming primary care physicians, a lower paid career path than many specialties.
The stakes are high. Doctors are expected to struggle to meet demand from a wave of new patients, said Wiley, who owes more than $300,000 after graduating from a private medical school. An estimated 32 million uninsured Americans are expected to gain health care coverage in coming years because of federal reforms. Under served areas of the country already have a shortage of physicians.
"Access is so important," Wiley said. "Primary care shortage and a lack of care can devastate a community."
In addition, Congress is debating how to lower interest rates on federal loans, which for most stand at 6.8 percent and higher. One proposal permanently cuts interest rates on all federal loans to 3.4 percent.
Another proposal ties rates to bonds issued by the federal government, which allows interest rates to rise and fall with the market, said Jason Delisle, director of the Federal Education Budget Project at the New America Foundation in Washington, D.C.
Delisle said he's skeptical of plans that complicate the student loan process because they only disguise the end goal: Shift money from taxpayers to loan recipients.
"It still starts with taxpayer dollars and ends up with the students who take out the loans," Delisle said.
Henien pursued numerous projects
Henien tends to ignore naysayers when he believes in an idea. He said his plan will start small: At first, only UI students would be eligible for interest rates well below 3.4 percent — if they stay in Iowa to practice medicine. Those who leave the state could still receive loans, but they would pay more interest.
"There are a lot of ideas people never have the gumption to pursue," said Henien, who will have about $120,000 in student loan debt when he graduates.
Those who know him say Henien has always sought leadership positions and pursued projects he thinks the people he serves will like — even if they don't know it yet.
As the undergraduate student body president, Henien helped create a new tradition. Every year student groups compete to decorate six-foot tall replicas of a panther, the University of Pittsburgh's mascot. Henien said he redoubled his efforts when some initially mocked the idea.
"At first, people were a little leery," said Kathy Humphrey, the university's vice provost and dean of students. "But he believed it was (a good idea), and sure enough…this has become an annual tradition."
In high school, Henien convinced the school board to allow students to eat off campus, his father said. Henien spent one summer talking with a neighboring school district's principal to develop a presentation to convince his school board to approve the measure. The off-campus school lunch policy passed unanimously.
"His friends were amazed," Samir Henien said.
Whatever becomes of Henien's brainchild, he has already raised awareness at the highest levels of Iowa's political class about medical student debt and its effect on the health care system, said Matthew Starks, UI medical school student and physician assistant student body president.
Henien has also demonstrated it's possible to think creatively about solutions to a daunting challenge, he said.
"He's shown there can be real solutions to these problems, and those solutions can come from a grassroots effort," Starks said. "They don't have to trickle down from above. We can make real change right here at home."