Ohio’s next generation of doctors and health professionals: “No” to Senate healthcare bill

This op-ed was originally published by the Cleveland Plain Dealer. You can read the article here.5343361247_f84cc7a9a8_m

“We took an oath: “first, do no harm.” This health care bill will prevent our current and future patients from accessing the care they need, so we must stand against it.”

-Gloria Tavara and Nikhil Krishnan

As students from every single medical school across Ohio, we are the ones who will have to tell our patients “no” if the Senate health care bill passes.

We are the ones who will have to look mothers in the eye and tell them that there is no more Medicaid coverage for their children’s asthma. We are the ones who will have to tell our patients struggling with addiction that there is no longer any coverage for their rehabilitation treatment. We are the ones who will have to tell our cancer patients that because they no longer qualify for insurance subsidies, they must pay out of pocket for their chemo or die.

When hardworking middle-class families are driven into bankruptcy because of cuts in Medicaid, we will be unable to help them.

Sen. Rob Portman must oppose the Senate’s health care bill, and any phase-out of Medicaid expansion, so that these conversations never happen.

The American Health Care Act in the House, known in the Senate as the Better Care Reconciliation Act of 2017, rolls back Medicaid expansion, mental health and drug treatment coverage, and preventative care. It undermines essential health benefits like maternity care and prescription drug coverage.

These changes will devastate patients in Ohio and across the nation. We cannot go backward.

The Senate health care bill will strip nearly a million Ohioans of their access to health care.

More than 800,000 Ohioans signed up for insurance after the Affordable Care Act passed, cutting Ohio’s uninsured population in half. If the ACA is replaced with the AHCA or the Senate version, tens of millions of Americans, including approximately 1 million Ohioans, will lose their coverage.

Ohio’s children will be among the hardest hit: They represent 51 percent of Ohio’s Medicaid population.

The American people understand what the AHCA and Senate health care bill represent, and they are afraid. Only 8 percent of Americans wanted the House version to pass, and changes from it to the Senate bill are minimal. The AHCA was rushed through the House in a secret process that excluded everyday Ohioans from a discussion that will impact every aspect of their lives. Now the Senate is attempting the same.

As the state hit hardest by the opioid epidemic, Ohio needs to expand access to addiction services, not decimate them.

Ohio has the highest number of prescription opioid overdose deaths of any state in the nation. Sen. Portman’s Comprehensive Addiction and Recovery Act prioritized “expanding treatment and recovery programs to help Ohioans struggling with addiction.” However, the Senate bill cuts Medicaid funding even more deeply than the House bill, which will lead to severe reductions in basic mental health and addiction services. So much is at stake. Sen. Portman’s support of the current health care bill would threaten to unravel all of the work our state has done to reduce addiction deaths in Ohio.

Killing Medicaid expansion means killing Ohioans.

Twenty-one percent of Ohioans receive health insurance through Medicaid, a successful, popular, bipartisan program which covers everything from nursing home care to education for disabled children. Despite higher-than-expected enrollment after Ohio’s Medicaid expansion, overall costs for the program were nearly $2 billion below original estimates.

The majority of Medicaid recipients live in rural communities, places that support Sen. Portman and expect him to support them in return. We know this, because we see these patients every day.

Sen. Portman knows this too: In March he wrote Senate Majority Leader Mitch McConnell to say that he would not support a plan that takes away stability from Medicaid expansion populations.

By agreeing to phase out Medicaid expansion, Sen. Portman has turned his back on the hundreds of thousands of Ohioans who depend on Medicaid, including victims of Ohio’s opioid epidemic.

Sen. Portman will cast a deciding vote in the passage of the current health care bill. We urge Sen. Portman to carefully consider how this legislation will affect his constituents. This bill will kill our patients.

Senate Majority Leader Mitch McConnell’s bill would do enormous damage to Ohio. That’s indisputable. That’s irrefutable. That’s fact. That’s why Sen. Rob Portman must stand up and vote no, writes the editorial board.

The medical community is united against this health care bill because we know it will destroy the health of our communities. The American Medical Association, the American Heart Association, the American Nurses Association, the National Physicians Alliance, the AARP, Physicians for a National Health Program, the National Medical Association, Universal Health Care Action Network, and many others have all come out against the AHCA and now stand against the Senate bill.

We took an oath: “first, do no harm.” This health care bill will prevent our current and future patients from accessing the care they need, so we must stand against it.

Gloria Tavara and Nikhil Krishnan are medical students at Case Western Reserve University and members of SNaHP.

SNaHP Shots: Katrina Herbst

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SNaHP Shots is a regular column featuring interviews with SNaHP members from around the country who are committed to passing universal healthcare legislation in their lifetimes.

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Katrina Herbst

How long have you been a member of SNaHP?

I am a medical student at Virginia Commonwealth University, and co-president of my school’s SNaHP chapter. I’ve been a member of SNaHP for 2 years, although I started collaborating with my school’s SNaHP chapter on projects involving multiple student organizations almost 4 years ago.

What personal experiences have shaped your decision to take action for universal healthcare?

I worked two very different jobs in Arizona for a few years before medical school. I waited tables at a family-owned Mexican restaurant, and I was a medical scribe in an emergency room. Both jobs exposed me to the realities of how our health system consistently fails to meet the needs of its population.

For example, one of the line-cooks I worked with had not seen a doctor for more than 15 years. By the time he had his blood sugar checked by a pharmacist at a health fair, he had already lost vision in one of his eyes. During my time as a medical scribe, doctors diagnosed a patient with cervical cancer which had metastasized throughout her entire abdomen. Over and over again, I witnessed people avoid seeing doctors because they couldn’t afford their treatment, while many experienced the life-altering progress of preventable diseases.

It is clear that without health insurance, people often don’t go to their doctor, but if they don’t go, their long-term outcomes can be far worse. Now, as a medical student in the era of the Affordable Care Act (ACA), I have seen the U.S. take its first steps towards increasing insurance coverage, particularly for those of lower income, but as anyone who has done a family medicine rotation can tell you, high premiums and out-of-pocket costs are frankly prohibitive. Many continue to opt out. I am a firm believer in preventative care because of these experiences, and this is why I advocate for a single-payer healthcare system.

Despite your busy schedule as a medical student, why have you decided to devote your time and energy to the movement for universal healthcare?

We medical students are very protective of our time, as we don’t often have much to spare. One of the benefits of working with an organization built by healthcare professionals is that those I work with are very sensitive to this. We do our best to work efficiently, but the time also feels well-spent.

How has your involvement in SNaHP encouraged others to join this struggle or to take a closer look at a single-payer healthcare system?

I have been involved in recruiting movements and General Assembly lobby days, but my most meaningful conversations have taken place in the patient-care setting with my professional colleagues. Something as simple as a frustrated comment about finding an affordable antibiotic is an opportunity to provoke a deeper discussion about systemic change. I credit SNaHP and PNHP for providing me the resources to learn to speak intelligently about single payer in a way that might inspire others to consider this alternative.

Do you see the right to healthcare as a single issue or one that is linked with other human rights efforts?

What all human rights efforts have in common is that no single issue is exempt from financial disparity. For example, before women were allowed to establish checking accounts in their own name at banks, they were unable to build the credit required for any purchasing power, even if they were allowed to hold a job and earn a paycheck. Universal health coverage would not eliminate the problem of poverty, but it would remove one of the largest barriers to health access that exist as a result of poverty.

Do you believe that universal healthcare will be achieved during your lifetime?

I do. One of the criticisms of the ACA is that it is partially funded by a portion of the population that does not benefit from it as much as those at the lowest income bracket have. A universal system, on the other hand, would be for everyone. Although many take issue with requiring everyone to participate in a program that some do not need, it’s the most viable solution to provide healthcare for everyone. After all, no one can live their entire life without needing to visit the doctor.

What are some things in your city or state that you can do to make universal healthcare a reality?

The obvious answer is to find like-minded peers and physician mentors and join or create your own SNaHP chapter, and come to our SNaHP summit and our PNHP conference!

As medical students, we also have a huge opportunity to reach our peers. Many medical school curriculum include lectures about health insurance. If your school or professor is agreeable, ask if a few Powerpoint slides could be added to the lecture that highlight how poorly the U.S. fares in comparison to other middle to high-income nations by healthcare expenditure to outcome. Also, objectively illustrate the failures and successes of the ACA. Learning about our present system is intellectually uncomfortable, but that’s how people become motivated to seek change!

And of course, keep bothering your state reps.

Where are you located, and who is/are your state representative(s)?

Virginia has 2 senators, Senator Mark Warner and Senator Timothy Kaine, and 11 representatives.

What has been one of your most gratifying/momentous/hopeful/inspiring experiences as an advocate for single payer?

I wasn’t able to join SNaHP members at the summit this year, but I did get to video conference in for a portion. I was so encouraged by the enthusiasm and energy of my fellow members, especially during their brainstorming power hour. It’s a privilege to be part of a generation of medical students so committed to making a change.

ACTION ALERT: Join SNaHP’s Invite-a-Friend Campaign

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SNaHP is expanding its regional social media presence, and we need your help! If you haven’t already, we encourage you and your friends to join your regional SNaHP page. As a member, we’ll help you keep up with regional news and notify you of upcoming events planned by your local chapter!
Has your chapter held any events or activities lately? We want to know! Post or tweet pictures and updates so that members can stay connected and engaged as we advocate for #singlepayer!


If you haven’t joined SNaHP yet, please join the fight for universal healthcare for all!

Medicine has a problem with racism

“If we want to improve health equity in our nation and fight for racial justice, the answer is a system that provides universal, equal health care for all.”

-Armide Storey

ID-100406820This article originally appeared in In-Training. You can read the article here.

 

With the future of the Affordable Care Act uncertain under President Trump, many Americans are left worrying how they will manage without health care. The Americans who must shoulder this burden are disproportionately people of color. It should come as no surprise to those familiar with the history of health care in this country that once again, our system, purportedly built to protect and promote health, is systematically ignoring the right to health care for communities of color.

The very structure of modern medicine in this country is rooted in the supremacy of white physicians. This is unsurprising, given the larger context of the institutional racism that pervades our society as a legacy of slavery. The 1910 Flexner report, which many credit for the legitimization of the medical profession in the United States, closed all but two African-American medical colleges. While encouraging the integration of men and women students, the report accepted racial segregation in medical education and further suggested that physicians of color “should be trained differently; namely, to ‘humbly’ serve ‘their people’ as ‘sanitarians.’” Today, the majority white voice in medicine and medical education persists; the 2015 American Association of Medical Colleges diversity report demonstrates that only 3 percent of full-time medical school faculty identify as black or African-American.

The structural racism that pervades the medical profession extends beyond physicians to the people they serve. Patients of color, and African-American patients in particular, have been subjected to racism in their care for as long as physicians have served them. Take the case of segregation of hospital admissions: when patients of color were relegated to separate and unequal hospital wards where they suffered from demonstrably worse outcomes than did their white peers.

In 1931, Ms. Juliette Derricotte, the Dean of Women at Fisk University, was critically injured in a motor vehicle accident. The closest hospital, nearby Hamilton Memorial Hospital in Dalton, Georgia, did not admit patients of color. After six hours of searching for a hospital that would accept her as a patient, a Chattanooga facility located 35 miles away agreed to care for Ms. Derricotte. She died in transport.

The injustice of racism in health care is further underscored when one acknowledges how physicians have systematically exploited patients of color for medical experimentation. White physician Thomas Hamilton left African-American slaves in burning-hot pits as he sought a cure for sunstroke. White researchers studied syphilis in black men in the Tuskegee Study, watching them die until 1972 — 27 years after penicillin was proven to be the life-saving treatment of choice for the disease. A young black Henrietta Lacks’ cervical cancer cells were harvested by white physicians without her informed consent and became the first immortal cell line, used across the globe for scientific pursuit. And yet, the scientific gains from these and scores of other unethical studies remain less accessible to patients of color than to their white peers.

Since the 1930s, our nation has taken several steps toward the creation of a more equitable health care system. One of the boldest and most successful steps towards health equity on a federal scale was when Lyndon B. Johnson signed Medicaid and Medicare into law in 1965. These programs expanded health care access for the elderly and the poor, regardless of race. It also condemned hospital segregation and required hospitals to comply with Title VI of the Civil Rights Act in order to be certified. Before Medicare and Medicaid, wealthy patients received twice as much care as the poor. By 1977, poor patients received 14 percent more care than the wealthy. The reversal was and remains much needed, as poor patients continue to suffer worse health outcomes at disproportionately higher rates.

The 2010 Affordable Care Act (ACA) represents another important, though insufficient, step toward health equity in the United States. Among its successes was the provision of coverage to many Americans of color. Of those gaining coverage from 2010 to 2015, 57 percent were patients of color. These patients are disproportionately likely to live in poverty and qualify for Medicaid coverage, and systemic discrimination and marginalization maintain this status quo.

Should the ACA be repealed, 30 million people will become newly uninsured. This includes not only the 19.2 million individuals who gained coverage under the ACA, but an additional 11.8 million served by the individual insurance market, which would collapse after repeal.

The ACA largely accomplished this coverage growth through the expansion of Medicaid to all those earning less than 138 percent of the federal poverty level ($27,821 for a family of three in 2016). However, while expansion was intended to be nationwide, 19 states — most of them Republican-led Southern states with histories of racial segregation–have opted out and Medicaid coverage in those states remains limited. The median income qualification for parents in many of the states not participating in expansion is just 44 percent of the poverty level, or $8,870 for a family of three. Childless adults remain unqualified.

Despite some significant achievements, the U.S. health care system remains unfair on multiple levels. First, people of color continue to experience inequities in health outcomes. Minority and low-income patients with breast and colorectal cancer are less likely to receive recommended treatments as compared to white patients. Black males have a life expectancy almost five years shorter than that of white males. Second, low-income communities — including poor white people — continue to bear a disproportionately high burden of the cost of their care under the ACA, facing skyrocketing deductibles ($3,064 in silver plans, and $5,764 in bronze plans) and unaffordable copays. When one considers that half of Americans cannot afford an unplanned $400 expense, we must acknowledge that health care reform in this country has not gone far enough in erasing its clear history of racism and inequity.

Any health care system in our country will, to a certain extent, be burdened by institutional racism as a result of the legacy of slavery in the United States. Even so, research suggests that a single-payer system could radically reduce health inequity, even if biases persist. Single payer national health insurance would be a system in which a single public agency, rather than private insurance companies, provides health care financing while the provision of care remains largely with private institutions. The evidence to suggest how single-payer would help lessen racial inequity in health care comes in part from the Veterans’ Administration (VA), a quasi-single-payer system here in the United States, in which black patients actually fare better than white patients in multiple measures of health. In the same measures, black Americans outside of the VA system fare much worse.

While it may be comforting to simply defend our current health care system in this time of immense change under a Trump administration, it is important to remember its limits. We cannot ignore that the health inequity gap continued to rise under President Obama and that poor Americans and Americans of color have never been adequately protected by our system. Let us struggle not only against the policies that promise to take us back to “greater” and less equal American health system but also for a change that would promise true equity in health care for all Americans. If we want to improve health equity in our nation and fight for racial justice, the answer is a system that provides universal, equal health care for all.

armide_storeyArmide Storey is medical student at Boston University School of Medicine and co-leader of BUSM’s SNaHP chapter. She is a member of SNaHP’s media and political advocacy teams and believes that single payer is the only way to effectively address the inequity in our healthcare system. She is particularly interested in understanding health as it intersects with class, race, ability, sexuality, and gender.

Single-payer healthcare is the way to go

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Photo courtesy of Pictures of Money

“Ultimately, we all end up paying for others’ healthcare whether we say it explicitly or not. This is the price we pay to avoid having Americans die daily of emergent conditions and congenital diseases.”

– Keanan McGonigle

This letter originally appeared in The Advocate. You can read the letter here.

To paraphrase our commander-in-chief, healthcare is complicated. There are serious trade-offs to be made about short-term savings versus long-term costs; about who should get covered and how; about who should pay for it all.

Health is not like other markets; it takes patient, long-term investment to keep people healthy. One thing is clear though — as U.S. Sen. Bill Cassidy pointed out in his recent op-ed — ultimately, we all end up paying for others’ healthcare whether we say it explicitly or not. This is the price we pay to avoid having Americans die daily of emergent conditions and congenital diseases.

Once we accept this fact, the question becomes how to most efficiently administer care in a way that reduces costs for all of us. The Affordable Care Act said “we leave it to insurers to decide how much to charge so that most everyone is covered”; we ended up with a lot of discontent.

The Republican response will reduce the number of people covered — but we know we’ll end up paying for them anyway, just in a more roundabout way.

The president is a self-purported master of negotiation. But currently providers are at a huge disadvantage in negotiating with drug and device manufacturers: the latter groups have government-sanctioned monopolies. Sicker people are on uneven footing with insurers,  through no fault of their own. This leaves huge segments of the population without coverage.

The solution to both these problems is simple: single-payer. The appeal of a single-payer healthcare system is its simplicity and inclusivity. When one entity negotiates prices with all the groups that keep healthcare so expensive, costs go down. And nobody gets left out. Single payer fulfills the president’s pledge to take care of everyone at lower costs. Now Congress should act on it.

Keanan McGonigle is a medical student in New Orleans.

In the age of Trump, a single-payer healthcare system is needed

hands-699486_1920“My health-care experience has shown me that sometimes it’s simply not enough to pitch in and help patients on a case-by-case basis.”

Jonathan Michels

This article originally appeared in the Winston-Salem Journal. You can read the article here.

Ten years ago, I began transporting sick patients at Forsyth Medical Center. Transporters are some of the hardest working and least recognized workers in the hospital. My job was to transfer patients as smoothly and comfortably as possible onto a clean gurney and transport them to the radiology department. Deceptively simple, transporting turned out to be a crash course in humanity. I decided to pitch in as best as I could.

The very first patient I went to transport by myself died in front of me. My astonishment about the patient’s death amused my seasoned co-workers, who helped me understand that the hospital is a place where sometimes people come to die.

“Why is this happening to me?” asked another patient, terminally ill with cancer. Her words hung in the air as I settled her back into bed. I had no answer for her then, and I still don’t.

Transporting overdose victims, some of them younger than me, underscored the fragility of life. And watching stroke patients relearn basic skills like feeding themselves or walking taught me about the resilience of the human body and spirit. Hope Jahren, the celebrated geobiologist and author, echoed my response when she wrote, “Working in the hospital teaches you that there are only two kinds of people in the world: the sick and the not sick. If you are not sick, shut up and help.”

Medicine has changed a lot even in the short time since I began transporting patients. Despite the much-vaunted health-care reform of 2010, the Affordable Care Act, medicine is still driven by profit, not progress.

Twenty of the highest-paid CEOs included in the Standard & Poor’s 500 index hailed from health-care or pharmaceutical companies, according to a 2016 report from the Associated Press and Equilar. Health-care executives continued raking in millions of dollars in salaries and bonuses in the wake of the Great Recession, while I joined hundreds of other health-care workers who were escorted out of the hospital in a massive layoff. The people who remained, many of whom come to work every day to care for the sick and the helpless (and yes, for a paycheck), increasingly feel the pressure of doing more work with fewer resources.

Now a premedical student at UNC-Greensboro, my health-care experience has shown me that sometimes it’s simply not enough to pitch in and help patients on a case-by-case basis. In order to effectively care for our patients, we need to implement a health-care system that meets the needs of everyone and allows medical providers to do their jobs without the intrusion of hospital administrators or private insurance company executives.

Our health-care system is at a crossroads. While the ACA made some improvements around the edges of our health-care system, it clearly wasn’t enough. We need to go beyond the ACA to a single-payer system, an improved Medicare for all. In January, U.S. Rep. John Conyers of Michigan introduced H.B. 676, which would implement an improved and expanded Medicare-for-all.

More than a decade ago, Donald Trump preached the sensibility of covering all Americans in his book, The America We Deserve.

“We must have universal healthcare,” Trump wrote. “I’m a conservative on most issues but a liberal on this one.”

The proposed replacement program–called the American Health Care Act–put forth by U.S. House Speaker Paul Ryan and Health and Human Services secretary Tom Price gives tax credits for people to buy private insurance and doles out block grants to states to replace the Medicaid expansion provision under the ACA. Critics believe the changes will put more financial burden upon American families and ultimately increase the number of uninsured.

“Although Republicans’ proposals seem unlikely to achieve President Trump’s triple aim (more coverage, better benefits, and lower costs), single-payer reform could,” wrote Dr. Steffie Woolhandler and Dr. David Himmelstein in the Annals of Internal Medicine.

A single-payer system would eliminate for-profit insurance companies and replace them with a non-profit, public-payer system. It would be privately run but government funded just like Medicare, saving billions in administrative costs and giving doctors the freedom of practicing medicine without intrusion. Patients would no longer pay high deductibles or co-pays and there would be no fear of losing health insurance if someone loses their job.

Rather than jettison any recently-won gains in health-care coverage, let’s push the president to renew his support for universal care — and hope that Congress follows suit with H.B. 676.

The only way to get back to the real business of health care — caring for our patients — is to enact universal health care.

JonathanMichels03Jonathan Michels is a freelance journalist, a healthcare worker and a premedical student based in Winston-Salem, NC. After graduating from UNC-Chapel Hill in 2011, Jonathan embedded with social justice activists from around the state including participants in the Occupy Wall Street, marriage equality and Moral Monday movements. When Jonathan isn’t muckraking, he works as an x-ray tech in one of the largest community hospitals in the state. Caring for Winston-Salem’s poor and uninsured informed his belief that every person has a right to healthcare. As student of various Southern organizing movements for social change, it is Jonathan’s experience that fundamental social rights like universal access to healthcare have only been won through collective struggle. Email: jonscottmichels@gmail.com

The 2017 SNaHP Summit: Coming together to make universal healthcare a reality

“We need a real solution that provides affordable, comprehensive healthcare for all Americans from birth until death. And we need those on the front-line of the healthcare system to stand up and demand it.”

-Bryant Shuey

snahp_2017_Cropped“Hello Ms. Jimenez!”

She grimaced when I flipped the light switch but quickly smiled, a sign she just woke up from much needed slumber. This was no ordinary day for Ms. Jimenez; she had delivered her second child the night before, a healthy baby boy born at full term. I congratulated Ms. Jimenez and asked her the standard postpartum questions about breastfeeding, contraception plans, and follow-up appointments. Yes, she had an appointment for her son. But she would not be scheduling any for herself.

Ms. Jimenez did not have health insurance.

She made enough in wages to not qualify for Medicaid but was unable to afford the Affordable Care Act’s marketplace insurance plans. New Mexico has state funding for medical care for pregnant women, but after delivery, people are kicked off. This was especially concerning as her last pap smear suggested a pre-cancerous growth that would require follow up care.

The Affordable Care Act has improved the lives of over 750,000 New Mexicans by expanding the Medicaid program. But it still leaves 26 million adults uninsured in the United States. While the ACA may have been a step in the right direction, the plan still leaves too many without any insurance, has permitted skyrocketing deductibles and premiums, and ignores outrageous drug prices. Ultimately, it falls short of providing affordable, comprehensive, universal health insurance.

Republicans just released the American Health Care Act, the “wonderful new Healthcare Bill” as tweeted by the President early Tuesday morning. But the AHCA will further disrupt America’s  already tenuous health care by downsizing Medicaid benefits for millions of low-income families, reducing premium and out-of-pocket subsidies for poor and middle income Americans and giving tax breaks to only the wealthiest individuals. Ultimately, hurting accessible and affordable healthcare access for the low and middle classes.

The ACA is not doing enough for Americans. And the AHCA is a clear assertion by Republicans that affordable health care is not a priority.

We need a real solution that provides affordable, comprehensive healthcare for all Americans from birth until death. And we need those on the front-line of the healthcare system to stand up and demand it.

In honor of Ms. Jimenez, I am flying to Philadelphia, on March 11th, along with hundreds of health professional students from across the country to attend the Students for a National Health Program summit at Lewis Katz School of Medicine at Temple University.  We refuse to work in a system where private interests dictate patient care. I will join my colleagues in building the movement for improved and expanded Medicare for All, a national health program that would cover all Americans, cut waste, and provide excellent care. Furthermore, it would provide so many uninsured New Mexicans an opportunity to see a doctor without having to ration their grocery budget for the month.

I look forward to practicing medicine in a health system where I can ask patients like Ms. Jimenez standard postpartum questions and know my patients will have follow-up appointments and the medical care they need.  More importantly, I am committed to making this system a reality.

10505321_10204530614889113_1490681028236163208_nBryant Shuey is a medical student at the University of New Mexico and a co-founder of UNM SNaHP. Bryant believes transitioning to a nationalized health system is essential for removing the barriers of cost and access that most Americans face when looking for health care and that it is our duty as future health professionals to advocate for our patients needs by looking to health reform for solutions. Outside of medical school, Bryant is an avid water polo player and enjoys walking his dog Susie. Email: bryantshuey@gmail.com

Appalachia needs a single-payer healthcare system

An edited version of this article was originally published in the Johnson City Press. You can read the article here.

linn-cove-viaduct-curveDuring a rural medical outreach visit in East Tennessee, I met a woman who had become alarmed after she found a lump in her breast. She was 44 years old, only a year younger than her mother was when she died of breast cancer at 45. The patient had not seen a physician in many years because she could not afford the copay and she had to drive 45 minutes to reach her appointment that day. She was working as a waitress and had no health insurance, which further delayed her seeking care. She had a history COPD and methamphetamine abuse, but had been clean for five years. During my exam, I felt a mass in her left breast. My alarm bells were sounding.

Unfortunately, stories like this patient abound in Appalachia and reveal the need for rethinking our healthcare system.

The recent presidential election is likely to bring big changes to healthcare in our country, but we have a choice to make. During these tumultuous times, the way forward is not to strip 20 million Americans of their healthcare by repealing the Affordable Care Act (ACA) without a replacement. Instead, we should pursue the most equitable and just option – a single payer healthcare system. No, this is not “socialized medicine,” which would mean both the financing and delivery of care are government funded. We already have a form of this system for our veterans, and it leaves much to be desired. What I, and 20,000 other medical students and physicians, propose is an improved and expanded Medicare-for-All system.

The ACA has taken necessary steps toward a universal system, but it has fallen short. Among the most popular components are the right to remain free from discrimination for a pre-existing condition, young people remaining on their parents’ plans until they turn 26, and equity in plan cost between men and women. Yet, approximately 27 million people remained uninsured after the landmark legislation was passed and an acceptable reduction in cost was not truly achieved. Supporters of the ACA aimed to bend the curve on ever-increasing healthcare expenditures and while this was accomplished, they still accounted for 18% of GDP last year.

The United States remains the only developed country with for-profit insurance companies and only one of three developed nations that does not guarantee healthcare. We are spending the largest amount per capita ($8,000+) on healthcare expenditures of any nation in the world, but without the best outcomes. The leading cause of bankruptcy in the United States is medical bills, and an estimated 45,000 deaths annually can be attributed to lack of health insurance. Over 100 million Americans forgo professionally recommended medical care due to cost each year. Clearly, we have work to do. A single payer system by way of a Medicare for All structure would allow coverage for all Americans and would actually reduce spending.

Not all states chose to expand Medicaid, including approximately half of those traditionally included in the Appalachian region, leaving lower income earning adults like my patient with the breast mass in a gap between Medicaid and Marketplace subsidies. Americans were left with artificial lines between states that create headaches for Tri-Cities area patients on a daily basis, when the nearest hospital to rural dwellers may be across state lines. Social workers in our local hospitals work tirelessly to coordinate care for patients leaving Tennessee hospitals, but needing follow-up in West Virginia, Virginia, or Kentucky where their health insurance coverage and state law differs.

Paying employees to navigate these complexities is currently unavoidable, but it is my hope that a more streamlined, simple system could render these duties unnecessary. Today we waste about a third of our healthcare dollars to overhead, administrative costs, and insurance profits. Physicians cite administrative burden as one of the leading causes of burn out, leading to decreased quality of care. With a single payer system for all Americans, we reduce this waste and instead direct these funds toward medical care. There is an additional benefit of freeing up physicians to spend longer appointments with patients as needed or increase patient volume.

For Americans living in rural areas, simply getting to a doctor’s office or medical facility, let alone paying for care, can be challenging. This makes seeking appropriate preventive care visits and screening tests even more important. It is a well-known fact that it is cheaper to prevent a chronic illness than to treat it long-term. Consequently, removing the cost barrier to preventive services in Appalachia while we work to improve the number of physicians and hospitals in rural areas is morally imperative but also cost effective.

Uninsured Americans cited lack of affordability and unemployment as their top two reasons for their insurance status. While the national unemployment rate in 2014 was around 6%, in the more economically depressed parts of Appalachia that figure reached as high as 14%. Increased levels of unemployment in the region together with state policies declining Medicaid expansion contribute to higher uninsured rates, and consequently poorer health outcomes. Our mixed system including employer-based health coverage is a relic of a time when most employees remained in the same job for decades and is inappropriate for the more dynamic, shifting workforce of today. Transitioning away from employer-based care would prevent workers from fearing a job change lest they lose their insurance, freeing workers to pursue innovative, entrepreneurial positions they might otherwise have foregone.

The 45th President of the United States has praised the concept of universal healthcare multiple times in the past, citing the improved mortality rates and reduced costs per capita in countries with this structure.

More than a decade ago, Donald Trump preached the sensibility of covering all Americans in his book, The America We Deserve.

“We must have universal healthcare,” Trump wrote. “I’m a conservative on most issues but a liberal on this one.”

In order to capitalize on his promise to take care of “the forgotten” in the United States, including those living in the impoverished communities of coal country, I urge the president to reconsider a Medicare for All system. Not only will it help make this country “great,” it is the right thing to do.

Katie Lee is a medical student at the Quillen College of Medicine. She has served as an Executive Board member for her school’s Students for a National Health Program chapter. This article is a representation of her opinion alone and does not necessarily reflect the stance of the Quillen COM.

Action Alert: Calling Southern medical students to march for universal healthcare

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Physicians and medical students march for healthcare access at the 10th Annual HKonJ.

Southern supporters of universal healthcare, including members of Health Care Justice and Health Care for All NC, are calling for all health professionals and health professions students/trainees to join N.C. White Coats Supporting Healthcare for All in a massive white coat action
at the HKonJ (Historic Thousands on Jones Street) People’s Assembly on Saturday, Feb 11, 2017 in Raleigh, North Carolina from 9:00 until 12:30.

What:
• White Coat participation in this march continues our advocacy for health and healthcare justice, including expansion of Medicaid to 500,000 North Carolinians.
HKonJ is comprised of groups and citizens in NC who, with leadership from the NC NAACP and Reverend William Barber, stand for voting rights, public education, healthcare justice, the environment, and other progressive issues, many of which impact health. The annual gathering helped inspire the Moral Monday movement in which thousands of North Carolinians performed civil disobedience at the state legislature to protest harmful legislation being passed by lawmakers. Many doctors were arrested during the movement to show their support for universal health access! The Moral Monday movement has spread throughout the South and Rev. Barber has taken his powerful message about the importance of agitating for sustained social justice around the country, including to Ferguson, Missouri, and the 2016 Democratic National Convention.

Screen Shot 2017-02-09 at 8.38.50 AMWhy: 
• White coat gatherings carry powerful moral authority, and a massive white coat block in this crowd will send a message to the US and the world that NC health professionals stand for their patients with courage and determination.
• A large turnout of health professionals and students will make a difference in the political climate in NC and the US and will inspire others around the country who are fighting for access to care, Medicaid expansion and other issues that affect our patients.

When:
• Pre-march rally starts at 9:00, march starts at 10:00. Post-march rally runs until about 12:30.
We urge you to come to Mecca Restaurant, 13. E. Martin St., at 8 AM to meet new friends, greet old friends, organize for future actions, and avoid traffic.  A group of us will be there to welcome you. Students and trainees eat for free!

Where:
• Meet at 9 AM on the steps of the Duke Energy Center for the Performing Arts/Memorial Auditorium (Meymandi Concert Hall) at the southwest corner of E. South St and S. Wilmington St. (across the street from Shaw University)
Downtown parking is free on Saturdays.  On this interactive map http://www.godowntownraleigh.com/get-around/parking, the closest deck to our gathering place is the southernmost deck (called Performance Arts Parking Deck)

How:
• Show up in your white coat to the rally.  Signs and banners are also great, but your presence in your white coat is a powerful symbol in itself.  We will have some extra white coats for health professionals to borrow.
• Forward this email and invite your friends/organizations to the Facebook page (NC White Coats Support Healthcare for All).  Tweet (twitter handle @NC_White_Coats), text, taunt—whatever it takes to get your people out.

Information about buses going to the march will be available at www.hkonj.com.

 

Single Payer: The long-term treatment of our ailing healthcare system

12068989_1177542282275508_18531005563961570_o“The future generation of physicians believes in healthcare as a human right.”

– Jawad Husain

Like thousands of other medical students, I train at a safety-net hospital, Boston Medical Center, where patients can be treated no matter what their income or insurance status. The majority of our patients come from underserved, low-income populations. Medicaid, the public insurance program for the poor and disabled, helps so many of our patients obtain life-saving medical care.

At the primary care clinic, I helped care for a resilient young woman named Stephanie (name changed for privacy) who was diagnosed with both HIV and opioid use disorder. Because of Medicaid, Stephanie was able to see an expert on HIV and addictions. This doctor prescribed her antiretroviral medications and buprenorphine maintenance therapy, and helped her through recovery. Now Stephanie appears healthy; both her HIV and opioid use disorder are in full remission. Medicaid helped her regain health, which in turn enabled her to obtain full-time employment while simultaneously working toward a college degree. Without Medicaid, Stephanie would not have been able to afford treatment, which would have left her at high risk to die from AIDS or overdose.

14925708_3498108215536_4449164534997249699_nPresident Trump and the Republican-controlled congress propose taking away life-saving care for patients like Stephanie by repealing the Affordable Care Act (ACA) and making deep cuts to Medicaid. Repealing the ACA is estimated to result in 20 million people losing insurance through reversal of Medicaid expansion and elimination of private insurance subsidies. Republicans also aim to change Medicaid to a block grant program. This would drastically change federal Medicaid funding from a variable amount based on the number of qualified enrollees and their healthcare costs, to a fixed amount for states to spend as they see fit. The problem with block grants is that many conservative states would use this as an opportunity to insure less people through Medicaid and shift more costs onto those who cannot afford insurance on their own. This means less care for the vulnerable patients who rely on Medicaid. It also introduces fiscal uncertainty for safety-net hospitals that treat a high volume of Medicaid patients.

Based on a study published in the New England Journal of Medicine, researchers predict that repealing the ACA will result in the deaths of an additional 43,000 Americans annually–even more than the number of deaths each year from breast cancer.

As a future physician, this is in conflict with my medical ethics. I took the Hippocratic oath, stating I will “do no harm” and that my primary commitment will be to my patients. In contrast, the leaders of our health care system have plans to do significant harm by prioritizing politics over patients. To satisfy the conservative anti-Obama ideology of their base, they are willing to repeal the ACA without a replacement, even if it results in millions of Americans losing insurance and thousands of preventable deaths.

While I recognize the immediate harm that repealing the ACA and block-granting Medicaid would cause for patients like mine, I also see that even with the ACA fully intact, our country is the only developed nation that does not guarantee healthcare as a human right. This is unacceptable. People have little control over if and when they have a medical problem, and when they do, this can profoundly compromise their life, liberty, and pursuit of happiness–not to mention their ability to work and contribute to society.

The fundamental problem, which even the ACA fails to address, is that the for-profit insurance industry is responsible for the injustices of unaffordable care. Private insurance companies add an enormous burden of administrative waste to our system. They have a financial motive to avoid covering the sickest and poorest patients, and to raise premiums to whatever the market will bear. The problems of private insurance can be bypassed with a single-payer system where people pay income-based taxes for insurance, instead of paying premiums, co-pays, and deductibles. This covers comprehensive medical care from any doctor or hospital, without any out-of-pocket costs. 95% of U.S. households would end up saving money, and everyone would be guaranteed lifelong insurance. Other countries with single-payer health insurance programs such as the United Kingdom, Canada, and Sweden spend less and provide universal coverage—isn’t that really what the vast majority of Americans want?

The future generation of physicians believes in healthcare as a human right. Medical students across the country, in organizations like #ProtectOurPatients and Students for a National Health Program, advocated for patients and condemned the urgent threat of ACA repeal through call-ins, protests, and lobby visits as part of a “Do No Harm National Day of Action” on January 30th. As we continue to fight the national emergency of ACA repeal, remember that the complex problems of U.S. healthcare are more like a chronic disease. Let’s not lose sight of the best long-term treatment for our ailing health system: single-payer national health insurance.

To learn more about how you can be part of the movement for truly universal healthcare, become a member of Students For a National Health Program (SNaHP) and join us for our annual SNaHP Summit on March 11, 2017 in Philadelphia.

Jawad Husain is a medical student at Boston University School of Medicine (BUSM). He co-founded the BUSM Students for a National Health Program chapter in 2013 and is a member of the national board of advisors for Physicians for a National Health Program. The opinions expressed in this article are his own, and do not necessarily reflect the views of Boston University School of Medicine or Boston Medical Center.