Author: pnhpf3a_student

This article originally appeared on Common Dreams. You can read the original post here.

“Despite continued assertions that universal healthcare in the United States is merely a liberal “pipe dream,” public support is growing.”

In the face of a fiercely conservative administration, 2017 has seen an upsurge in popular resistance against measures that threatened to chip away at important–if imperfect–social welfare initiatives, chief among them the ability for Americans to receive quality healthcare.

Activists pushed back against a series of attempts by Republican lawmakers to repeal and replace the Affordable Care Act (ACA) with bills that the Congressional Budget Office estimated would have led to the loss of health coverage for 22 to 23 million Americans.

While it is tempting to remain on the defensive in the face of an agenda that would rob us of our healthcare, citizen activists across the country recognize that merely protecting the ACA would continue to leave the most marginalized populations in this country behind. While many Americans continue to receive health coverage under the ACA, an estimated 28 million remain uninsured and medical bills continue to be the leading cause of bankruptcy in the United States.

According to a national survey conducted by the Pew Research Center, 60 percent of the population believe that the federal government has a responsibility to provide health coverage for all Americans. Despite continued assertions that universal healthcare in the United States is merely a liberal “pipe dream,” a Medicare-for-All health program–a healthcare insurance system that is government-run–remains the best option for ensuring that all Americans have access to quality healthcare.

“Overall,” the report stated, “33 percent of the public now favors such a ‘single payer’ approach to health insurance, up 5 percentage points since January and 12 points since 2014.”

Speaking to a crowd at his church in Plains, Georgia, former President Jimmy Carter prophesied that the U.S. would one day adopt a single-payer health system. And while there are millions of stories of individuals and families who struggle daily for adequate healthcare, and though these stories indicate a health system that remains in the service of profits over patients, 2017 should nonetheless give hope to patients and advocates in the fight for universal healthcare.

Here are some of the highlights.

1. Legislative support surges for Medicare-for-All bill in the House.

House Bill 676 currently has 120 co-sponsors–up from just 49 legislators in 2015. During a spate of attempts by Republican lawmakers to scrap Obama’s signature health law, Democrats needed an alternative plan that would offer a way forward. Enter H.B. 676. Single-payer supporters such as Physicians for a National Health Program (PNHP) and National Nurses United (NNU) have long heralded the bill as being the most comprehensive single-payer legislation to date. Representative John Conyers of Michigan has introduced the single-payer legislation in every congress since 2003. Recently, Conyers agreed to resign his seat due to multiple charges of sexual harassment.  His behavior is abhorrent and demands investigation and prosecution. It also serves as a harsh reminder to the movement that universal healthcare will not be won by the stroke of a lawmaker’s pen. Indeed, the movement is, at its core, a call for redistribution of the power and wealth that serves to protect men like this. The people’s vision of Medicare for All is much greater than a single man in power, it is the collective vision of a grassroots, broad-based coalition of activists and advocates.

2. The Women’s March brings millions into the streets in defense of human rights.

The day following President Trump’s inauguration became the largest single-day demonstration in American history. The Women’s March was championed by women committed to an intersectional platform of justice and on January 21st, 2017, demonstrators across the globe called for a dismantling of systems of oppression. While single-payer healthcare was not in the guiding principles put forth by the march’s organizers, the emphasis on the importance of intersectionality in the fight justice should embolden healthcare advocates to re-envision universal healthcare through the lens of social and racial justice. Healthcare for all is a basic assertion of every person’s human right to health and wellness. 

3. Senator Bernie Sanders unveils the Medicare-for-All Act of 2017.

Amidst a seemingly endless stream of bills promising to repeal and replace Obamacare, Sanders put forth an alternative plan to improve and expand Medicare for all Americans. Sixteen other senators stood alongside Sanders when he introduced Senate Bill 1804, which represented a central and popular platform of his 2016 campaign. Despite garnering the support of several potential Democratic candidates for the 2020 presidential election, others on the left extolled the plan as being unrealistic or inopportune. The gains in popularity among Democrats prompted pundit Bill Scher to proclaim, “The Democratic Party now is, for all intents and purposes, the party of single-payer health insurance.” And it is a big mistake, he said. In this way, the latest attempt to pass universal health coverage mirrors its 100-year history with advocates besieged from members of the media as well as elected officials on both the right and the left. Sanders readily admitted that the bill was doomed to fail in the Republican-controlled legislature, but it represents an important marker in changing attitudes in the U.S. towards universal healthcare.

4. The opioid epidemic continues to rage with the National Center for Health Statistics reporting that 64,000 Americans died from opioids in 2016.

Although Trump declared the opioid epidemic a “public health emergency,” he refused to allocate funds to fight the onslaught of overdoses occurring around the country, despite a one-year death toll that exceeds the number of total American deaths in the Vietnam War. We already know that rampant profiteering by the pharmaceutical industry and over-prescribing by some physicians were key factors in fueling this epidemic. Thanks to a report released this year by The New York Times and ProPublica, we now know that insurance companies played a role, too, by limiting access to safer, and costlier, pain management options. Chronic pain treatment is a relatively new area of medicine and often requires long-term treatment and coordination between physicians, physical therapists, social workers, and other members of the healthcare team, something our current health system is ill-equipped to carry out. Eradicating such a devastating and widespread epidemic will only happen by implementing a healthcare system that is not hamstrung by the whims of party politics or health insurance companies but instead one that provides people with substance abuse disorders rehabilitative treatment that is scientifically proven, and allows physicians the freedom to provide their patients with this effective care.

5. While continuing to wage war on Obamacare, Trump lauds Australia for having “better” healthcare–which happens to be a single-payer system.

Speaking to the press alongside the president of Australia, Trump admitted, “We have a failing health care — I shouldn’t say this to our great gentleman and my friend from Australia, because you have better healthcare than we do.” This isn’t the first time that Trump endorsed single payer. Unfortunately, his actions paint a different picture. In the wake of the legislature’s failure to drive a stake in the ACA, Trump made good on his campaign promise to thwart the healthcare program by cutting funding for enrollment groups to enroll individuals into the program and slashing money allocated for enrollment advertising. A recent Gallup poll showed an uptick in the number of people without insurance, reinforcing the need for an improved Medicare-for-All system that can provide us with real, long-lasting health reform.

6. “Tom, you’re fired.” Health and Human Secretary Tom Price resigns amidst public outrage about his use of at least $400,000 in taxpayer money for travel expenses on privately chartered flights.

Although the first-class joyrides were the death knell for the former orthopedic surgeon and U.S. Representative, Price began his short tenure in the sights of activists who questioned his commitment towards advocating for the healthcare of all Americans. A member of the Association of American Physicians and Surgeons which is devoted to maintaining a free-market healthcare system, Price pushed to replace the ACA with a $1,200 per year tax-credit system that people could use to pay for a small percentage of their health insurance. This is in addition to Price’s stance against stem cell research, his belief that life begins at conception, and his lack of support for equal protections for lesbian, gay, bisexual, and transgender people. The Stop Price campaign was just one of many ways that healthcare advocates, including physicians and medical students, pointed a spotlight on the Trump administration’s close ties to powerful health insurance and pharmaceutical companies. Another successful campaign pressured the Cleveland Clinic to cancel its annual fundraising gala at Trump’s Mar-a-Lago club. Opposition is already being mobilized against Alex Azar, Trump’s pick to replace Price, who was a former president at the pharmaceutical giant, Eli Lilly.

7. The student section of the American Medical Association (AMA) passes a resolution in support of single-payer healthcare and calls on the AMA to rescind its 170-year opposition towards single-payer healthcare.

This powerful resolution was no easy sell, given the clout and history of the AMA. Although membership has steadily declined since the 1950s, the AMA remains the most powerful physicians’ organization in the country, ranking number four among the top 50 lobbying organizations of 2016. The association’s weekly publication, the Journal of the American Medical Association (JAMA), also holds great influence within the medical community. Historically, the AMA opposed expansive social programs during the 20th Century, from Social Security to President Truman’s national health insurance plan to Medicare and Medicaid. The Medical Student Section isn’t the first student arm of the AMA. Members of the AMA’s first student organization, the Student American Medical Association (SAMA), fled the organization in 1967 because of their opposition to the Vietnam War and because they supported issues that the AMA refused to embrace or actively thwarted like civil rights and universal healthcare. The group later changed their name to the American Medical Student Association (AMSA) and its members continue to promote universal healthcare. Meanwhile, members of the Medical Student Section, formed in 1979, continue to work under the auspices of the AMA to change the organization from the inside. “We hope that the passage of this resolution can show that with enough time, teamwork, effort, and organizing, even the most powerful healthcare organizations can come around to single payer,” said Brad Zehr, a member of the AMA-MSS. The resolution will be debated at the AMA’s annual meeting next year in Chicago.

8. In the face of a conservative administration that will undoubtedly quash federal universal healthcare legislation during the next three years, campaigns for state-based single payer healthcare gain steam.

These movements are invariably met with the question: If it didn’t work in Vermont and Colorado, why will it work here? Indeed, the failures in these states are a considerable setback in the movement for state single payer healthcare. While there are certainly barriers to implementing universal healthcare for states, there are no reasons to believe that it couldn’t happen once organizers have built the political will. Further, once a state can implement such a system, organizers hope it will serve as evidence for why a federal single payer system could thrive.

In New York, The New York Health Act (A. 4738 / S. 4840) passed the Assembly 92 to 52. A study shows that the bill would save 98% of New Yorkers money on the healthcare when compared to a policy through their employer or the marketplace. The bill now only needs one state senator to pass in the senate.

In California, grassroots education campaigns have shifted the popular opinion on universal healthcare, with now 70% of Californians supporting state single payer legislation. SB 562 or the Healthy California Act passed the state senate in June.

In Massachusetts, an amendment was adopted by the state Senate as part of a larger healthcare reform bill. The amendment charges the state to measure the impact that a single payer system would have on the cost and delivery of healthcare in Massachusetts. Should it prove to save costs when compared to current state spending, the legislature would be required to state the process of enacting a single payer plan.

In Vermont, organizers refocused after a devastating 2014 political abandonment by Governor Shumlin of Act 48 after its passage. Now organizers are looking at a more political feasible option: primary care for all; bills S53 and H248 have been introduced with tri-partisan support. The hope is that a plan like this would slowly be expanded to cover all sectors of healthcare.

Jonathan Michels is a freelance journalist and a premedical student based in Winston-Salem, North Carolina. He is a member of the media team for Students for a National Health Program.

 

 

Armide Storey is a medical student at Boston University School of Medicine. She is particularly interested in understanding health as it intersects with class, race, ability, sexuality, and gender.

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.

 

Where are you from? Where do you attend medical school?

I am a second-year student at Duke University School of Medicine in the Primary Care Leadership Track in Durham, NC. I am originally from Gainesville, FL, and graduated from Morehouse College. While I haven’t decided on a specialty, I hope to provide care in an under-resourced community.

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

My state representatives are Richard Burr and Thom Tillis.

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

I see my role as a medical student and advocate for universal healthcare as being undeniably intertwined. I chose to attend medical school not only to help and treat patients, but to use my platform as a future physician to advocate for social-political change and this of course includes the movement for universal, comprehensive care.

What personal experiences have shaped your decision to take action?

Like most Americans, I have witnessed and been subject to costly care. I have close family members with chronic illnesses who have delayed care for years as well as insured family members who still have issues affording costly medication and pharmaceuticals.

At times, my parents have even been forced to choose my care over their own. I came of age during the passage of the Affordable Care Act and entered medical school well after the beneficial effects of the reform were manifested in the American public. Nevertheless, the shortcomings of the ACA and the impending elimination of subsidies and benefits that help provide access to care for so many has further solidified my desire to move forward and fight for comprehensive care for all.

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

Certainly. Although our chapter is in the embryonic stage of development–the Duke SNaHP chapter will be North Carolina’s first–classmates have been very receptive to our movement and vision for establishing a student organization that believes in the movement for single-payer healthcare.

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

The right to live a healthy life with access to quality care is undoubtedly tied to other facets of the movement for human rights. When people have to delay care and watch helplessly as their symptoms worsen or choose which vital medication to forego for the month or remain employed at a job they don’t enjoy just for healthcare, this impacts all parts of their lives and the lives of those around them. Healthcare should not be economically stratified. And I believe the right to healthcare is a layered issue that we must confront in many different spaces (i.e., health disparities in communities of color, reproductive rights, queer health services, environmental and residential racism, and beyond).

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

I hope so! And I really believe in the activist spirit of my generational peers to make this happen. It’s certainly a long road ahead but I believe the tide is turning in our favor.

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

Grassroots and interpersonal organizing is critical. Speaking to people in your community about the feasibility of single-payer healthcare is also important. But there’s a myriad of tangible opportunities to support universal healthcare, such as calling your representatives and supporting other progressive organizations in your backyard who share a similar goal.

What has been one of your most gratifying experiences as an advocate for single payer? Give an example of a response you have received from your colleagues in healthcare when you have identified yourself as an advocate for single payer.

The Moral March in Raleigh was beautiful! I was there with other medical students and healthcare professions students advocating for universal healthcare and other social justice causes. In addition, we were advocating alongside other progressive organizations and it was awesome to see the intersections of our respective causes.

Generally, classmates are really receptive and want to know more! A close friend who was on the fence about single-payer healthcare and is also a medical student even seemed convinced following our small, personal discussion! It’s the small victories that matter.

What is one thing you want to share with your medical student colleagues who are not SNaHP members?

Get involved in the fight for universal healthcare and use your platform to advocate for your future patients. Single payer is not an ideological purity test or a hypothetical idea, but a necessity and a very real possibility for this country.

By Vanessa Van Doren, Augie Lindmark, Bryant Shuey, and Andy Hyatt

“There are no silver bullets, but single payer offers a way to reduce the inequalities that exist outside of the hospital.”

Health policy discussions, and the voices within them, are often minimally affected by the very crises they seek to address. It is a privilege to critique policy, yet the finer points of saving lives are secondary to the actual saving part. When faced with a health crisis—a present day example being where thousands of Americans die from lack of health insurance—it is not common that a solution, one established in evidence and efficiency, is readily available. As explained in a recent STAT article, we recognize a solution in an improved Medicare for all health system. Medicare has saved lives. Punditry and pontification have not.

We read Gondi and Khetpal’s response article, “Medicare for all? Not for us!”, with great interest. We were excited to see our peers engaged in health policy discourse and would like to use this opportunity to “sweat the details” of our support for single payer. While Medicare for all may not be for Gondi and Khetpal, it is the preferred solution for the majority of US physicians, and we are proud to include ourselves among them. It is one of many large-scale reforms that are necessary to combat the United States’appallingly poor health outcomes and worsening inequality. Single payer is a tried-and-true system that has been successfully implemented in dozens of countries around the world. When thirty million Americans lack health insurance, and tens of thousands die as a result, the time for abstract, ivory-tower repudiation with no timeline for concrete solutions is over. This is a public health emergency that requires action.

As board members of a national organization allied with many other groups fighting for social justice, we are well aware that single payer is not the unilateral solution needed to address health disparities. There are no silver bullets, but single payer offers a way to reduce the inequalities that exist outside of the hospital. A system in which everyone is able to receive medical care regardless of ability to pay–particularly given the overlap between income inequality and race, gender identity, and other marginalized groups–would go a long way towards a more equitable society.

Gondi and Khetpal accurately identify two important barriers to healthcare access: high pharmaceutical prices and the administrative bloat that contributed to increasing premiums under the Affordable Care Act. A single payer system would allow the government to negotiate for lower prescription drug prices, a currently-illegal action that would save tens of billions of dollars a year. The ACA, in its attempt to increase access at the expense of cost, exemplifies incremental reform that does not address root causes of system failure. Administrative costs, predominantly private billing and insurance-related activities, are one of the most prominent drivers of rising healthcare costs. The ACA marketplaces added needless complexity to a system already swimming in bureaucracy. Single payer addresses the root cause of our system’s lack of financial sustainability by streamlining dozens of insurers, with administrative overhead averaging at 17 percent, into a single payer, Medicare, whose overhead currently runs at 2 percent.

The authors’ response also reinforces some popular misconceptions about the feasibility of single payer. They cite a vigorously disputed Urban Institute estimate of health coverage costs to make the claim that Sen. Bernie Sanders’s Medicare for all bill is inadequately financed (while ignoring the fact that essentially all other high-income nations provide universal coverage at a fraction of what the United States currently spends). Between administrative streamlining and pharmaceutical savings, there is adequate funding to cover the cost of improving and expanding health care to all. The financing analysis of these bills will be forthcoming, but at this stage in the legislative process, it is fairly standard for bills to not include this level of detail.

The claim that the current single payer bills do not discuss cost-effectiveness evaluation is also incorrect. As Section 202 (Payment of Providers and Healthcare Clinician) of HR 676 explains, “The State director for each State, in consultation with representatives of the physician community of that State, shall establish and appoint a physician practice review board to assure quality, cost effectiveness, and fair reimbursements for physician delivered services.” Medical necessity currently guides Medicare coverage and would continue to do so if Medicare were expanded to all US residents.

Gondi and Khetpal also cite one of the RAND study’s findings–that cost-sharing is necessary to prevent over-utilization of services–but fail to mention that it also reduced necessary medical care. Additionally, families in higher cost-sharing categories had higher rates of study attrition, leading to bias in the study’s results. Forcing patients to pay a higher share of health costs will not induce them to compare prices. When was the last time you shopped around for an emergency room? Canada and the United Kingdom (which has had a universal system since 1948) have zero cost-sharing for physician and hospital care, and outside of England, other countries in the UK have zero cost-sharing for prescription drugs. Canada spends 10.4% of its GDP on healthcare, the UK spends 9.1%, and the United States spends 17.1%. To say cost sharing is necessary to “keep a universal healthcare system solvent” contradicts the lived reality of the healthcare systems of these nations.

But what about multi payer, universal systems in Switzerland and the Netherlands? The authors pose these as alternatives to single payer but ignore that these systems do not produce the administrative savings we would need to pay for fully universal care. The Swiss system, for example, is the second most expensive after the United States. The managed care practices utilized in the Dutch system, particularly insurance competition, have failed to reduce health spending and instead drove up individual costs and increased the number of “defaulters” who cannot pay their premiums. Private health insurance companies in the Netherlands and Switzerland are typically not-for-profit and highly regulated–a far cry from the massive CEO salaries and administrative overhead we see in America. Finally, if a single payer universal system works as well as or better than a multi payer universal system, and there is a growing movement for single payer yet none for multi payer, the urgent plight of America’s 30 million uninsured people demands that we move forward with single payer.

We cannot let our discussion of health policy spiral into endless intellectual debate for its own sake. The United States healthcare system is appallingly inadequate in terms of health outcomes, access, and cost. As a group, medical students and physicians come from significantly more affluent backgrounds than the patients they serve. For many medical students, our first one-on-one experiences with lack of access to healthcare happen during our third and fourth years of medical school when we start seeing patients on a daily basis. The reality is that, while many medical students have the luxury of saying that Medicare for all is “not for them,” many patients do not. In our enthusiasm to apply an intellectual eye to everything, we must be careful not to ignore these realities.

It is not enough to critique existing plans without clearly endorsing an alternative. Gondi and Khetpal’s article offers no comprehensive solution to the many issues that we can all agree plague our healthcare system. They treat single payer as a radical, untested idea and ignore the fact that dozens of countries around the world have successfully implemented single payer systems (all of which provide significantly better health outcomes for a fraction of what the United States spends). The biggest challenge to single payer does not come from lack of detail or inadequate financing; it comes from pharmaceutical and health insurance lobbyists funneling massive amounts of lobbying money to our elected representatives. A truly universal system–something that exists in all other industrialized countries–is framed as a radical idea because it threatens the wealthiest, most powerful people in our country. When we are faced with a problem this big, the potential of small-scale fixes is abbreviated.

Health policy and politics cannot be separated. Researching and vocally supporting policy initiatives that have the potential to prevent unnecessary death is not “weaponizing health care for the political left,” it’s our duty as healthcare providers. We hope that Gondi and Khetpal will reevaluate their rejection of Medicare for all and help us hammer out the details that will allow a single payer system to flourish in the United States.

This article originally appeared on STATNews.com. You can read the original post here.

“No bacteria or viruses harm health more than policies that effectively prevent millions of individuals from access to affordable health insurance…”

By Augie Lindmark, Vanessa Van Doren, Bryant Shuey, and Andy Hyatt

Underneath a heap of hospital blankets, Stephen seemed small for a 7-year-old. His chest rose and fell rapidly, a frightening rhythm given his history of asthma. His parents stood nearby as veteran witnesses — Stephen had been admitted to a Cleveland safety net hospital for asthma four times already this year — but familiarity offers little comfort when your child struggles to breathe. When asked if their son used his asthma inhalers, they replied, “It depends. When we can afford them, he takes them. But when we can’t, it could be a few weeks.”

Stephen represents one of more than 430,000 hospitalizations each year due to asthma. At a cost of $56 billion annually, complications from asthma can be prevented with regular medications (inhalers), avoidance of triggers like dust and mold, and access to health care, which usually means access to health insurance. Stephen didn’t have the latter.

Of the diseases we are taught in medical school, a sudden worsening of asthma, known as an exacerbation, is a relatively common cause of illness in children and adults. To identify the cause of a disease, doctors are trained in the differential diagnosis. This bedrock of medical education encourages doctors — those in training, like us, as well as those with years of experience — to compile a list of causes that match a patient’s symptoms. In a way, the differential is half medicine, half Sherlock Holmes.

Chest pain, for example, might include differential diagnoses that range from heart attack to having eaten too many buffalo wings. Yet there’s a particular cause of illness — in Stephen’s case, a nonpulmonary culprit — that is unique to American health care: America’s private health insurance system.

Recent months provide ample context. As the latest Obamacare repeal efforts took the form of Graham-Cassidy 1.0 and 2.0, the GOP bill would have kicked 32 million Americans off their health insurance. Patients with preexisting conditions like asthma would have seen sharp increases in their health insurance premiums (in the case of metastatic cancer, to the tune of six digits), and Medicaid reimbursements to Planned Parenthood would have been banned, effectively barring millions of women from reproductive and preventive health care.

Both Republican and Democratic efforts have done little to change the fact that thousands of Americans die from lack of health coverage. America’s fragmented and inequitable health system is a sinking ship and recent fixes — often in the form of private health insurance industry bailouts or shutouts — are like placing tissue paper over the leaks in this doomed vessel.

No bacteria or viruses harm health more than policies that effectively prevent millions of individuals from access to affordable health insurance to pay for life-altering health care, including the recent ill-conceived executive order. As American health care maintains its appalling position as a leading cause of financial burden and bankruptcy, an equitable response is essential. That means creating a system in which access to health care is based on need, not the ability to pay. As future doctors, we are being trained to identify root causes of disease. That’s why we support Medicare for all.

Momentum toward an improved and expanded Medicare for all health system is at historic highs. The majority of American physicians now support single-payer health care, and 60 percent of Americans believe that the federal government has a responsibility to ensure health care for all citizens.

“There is certainly a moral case to keep DACA alive, but the effects of its repeal on the healthcare system writ large make apparent that it’s also a bad idea for all Americans.”

-Suhas Gondi

The Trump administration’s recent announcement to end the Deferred Action for Childhood Arrivals (DACA) program instilled fear and outrage in communities across the country. As a medical student with friends and classmates with DACA status, I am particularly disappointed in the poor and compassionless judgment of our nation’s leader. I fear for my peers who have worked incredibly hard and overcome the most daunting of obstacles to get where they are today, and who now could see it all taken away from them. Their now tenuous situation is unimaginable to me. But I also fear the impact of this decision on my non-DACA classmates, on our training, and on our futures. There is certainly a moral case to keep DACA alive, but the effects of its repeal on the healthcare system writ large make apparent that it’s also a bad idea for all Americans.

The American Medical Association (AMA) letter to Congress spells out many of the reasons why. Study after study has shown that, due to multiple demographic changes, physician demand will far outpace supply over the next decade. By 2030, the US will face an estimated shortfall of up to 104,900 physicians. Even now, we are witnessing how a lack of doctors in rural and other federally designated Health Professional Shortage areas results in inadequate access to care for too many, and directly contributes to worse health. As AMA CEO James Madara wrote in the letter, “the DACA initiative could help introduce 5,400 previously ineligible physicians into the U.S. health care system in the coming decades,” and work towards alleviating this persisting issue.

Less easily quantifiable is the potential for tremendous loss of academic and economic productivity. DACA protects hundreds of medical students, PhD candidates, residents, post-doctoral scientists, and others who contribute their time, skills, and intellectual capacity towards the advancement of science and the relief of suffering. As if that were not enough, the economics student inside me can’t help but also think about all the publicly and privately invested resources that, through either explicit sponsorship or indirect subsidies, went into the schooling and training of these bright, promising young adults. Deportation eliminates the chance of any “return” on that investment – probably in the form of productive careers of science and service with immeasurable benefits to society.

But the value that medical students and residents with DACA status add to the healthcare workforce and patient care is far understated by numerical estimates and productivity losses. Many of these trainees are multilingual and come from diverse ethnic backgrounds – attributes that are underrepresented among today’s doctors, but are critical in caring for the patient populations that most sorely need effective and compassionate care. Immigrant and minority populations face myriad barriers to accessing healthcare, with difficulties in communication and distrust of the medical establishment chief among them. Having more providers who share a language and culture with these patients can help close these gaps. And for the thousands of undocumented immigrants with pressing medical needs, my classmates with DACA status offer a level of connection and shared experience – foundations for a strong doctor-patient relationship – unlike any the rest of us can offer.

The unique experiences and backgrounds of these individuals enrich the education and development of their colleagues, as well as the care of their patients. Their stories are both inspiring and instructional to those of us with more traditional or more privileged upbringings who hope to serve the most vulnerable patients in our communities. For at least ten years now, evidence has accumulated in the literature of the importance of diversity in medical schools – it builds stronger, more confident, more empathetic doctors who are better prepared to provide culturally competent care and promote health equity. My future patients will benefit if I can learn alongside and from these peers of mine.

Now is not the time to scale back. The deportation of trainees with DACA status would constitute an irrecoverable loss of diversity from our schools and the entire profession. I can say with confidence that my clinical development, and that of my classmates, would be hurt by such a loss.

In the coming days, medical students and trainees at my institution and others across the country will assemble in protest of this executive decision. We do so not only for our classmates with DACA status but also for our future patients and the future of American healthcare.

Clearly, revoking DACA protection isn’t just antithetical to our core beliefs as Americans – it’s also decidedly detrimental to the public interest. While we await the details of a tentative agreement struck between President Trump and Democratic leaders in the Senate, advocates seeking to influence policymakers should draw on both the remarkable stories of individuals protected by DACA and the strong economic and public health cases against repeal.

Congress now faces the opportunity to prevent this blunder and solidify protection for children of illegal immigrants – it’s time to make DACA the law of the land. Our representatives can seize this moment to update our immigration policies to match our nation’s economic goals for the 21^st century and our public health needs for the next decade.

“Dreamers” are our friends, our peers, our lab partners, and our teachers. What we can learn from them can’t be learned from a book or a computer, but what they can teach us will make us better doctors. In more ways than one, they make our healthcare system – and our country – stronger.

Suhas Gondi is a medical student at Harvard Medical School and did his undergraduate studies at Washington University in St. Louis. He previously worked at the Centers for Medicare and Medicaid Services, the Brookings Institution, and the US Senate. He is interested in the systemic problems in American healthcare and hopes to pursue leadership in public service at the intersection of government and healthcare. 

This article originally appeared on KevinMD.com. You can read the original post here.

“Single-payer advocates should ally with women’s advocates and work to repeal the Hyde Amendment to increase support for both causes.”

-Vidya Visvabharathy

As Sen. Bernie Sanders prepares to introduce a universal health care bill in the next few weeks, many progressives who support a universal single-payer program worry about its effects on abortion access. Can we win Medicare-for-all while protecting hard-won reproductive rights? As a woman of color, a reproductive rights advocate, and graduate student of public health, I recognize the importance for marginalized groups to stand in solidarity for progress to happen. I urge single-payer advocates to push to repeal the Hyde Amendment as part of our fight for truly universal health care.

It’s no surprise that the majority of Americans support a national health program. Although the U.S. spends twice as much on health care than other industrialized nations, key health outcomes such as life expectancy and infant mortality fare much worse as compared to our international counterparts. Most of this difference in spending can be traced to our fractured, profit-based insurance industry, which wastes nearly a quarter of our health care dollars on billing, advertising, and profits, none of which contribute to quality of care. In contrast, a single-payer health program is a universal health care model that is publicly financed and covers all Americans for medically-necessary care, such as doctor visits, hospital stays, long-term care, and drugs.

Single-payer has been a long-standing progressive cause, and would seem to have no problem gaining support from all progressive groups. However, many women’s advocacy groups are hesitant to back a single-payer system because it could restrict access to abortion. The Hyde Amendment, passed in 1976 after the landmark Roe v. Wade case legalized abortion, bans all federal funding for abortion services except in the cases of rape, incest, and life endangerment to the mother. Therefore, a single-payer program could not fund abortion, unless explicitly stating that reproductive and abortion services would also be covered. Single-payer advocates should ally with women’s advocates and work to repeal the Hyde Amendment to increase support for both causes.

Progressives can learn a lot from efforts to enact single-payer programs at the state level. For example, in November 2016, Colorado lawmakers tried to enact a health care system similar to single-payer, known as ColoradoCare. However, NARAL (National Abortion and Reproductive Rights Action League) opposed the plan because it would leave more than 550,000 women without access to abortion services due to the state’s constitutional ban on funding for abortions except for life-threatening circumstances. Many women who have access to abortion services through private insurance plans would have lost this coverage under ColoradoCare. According to a statement by NARAL, the bill “is not truly universal” since it does not guarantee abortion services. Ignoring reproductive health caused ColoradoCare to lose key supporters necessary to win universal care.

The statewide single-payer legislation in New York serves as a promising model that explicitly incorporates reproductive services in the health system. The program, known as New York Health, covers all medically-necessary services that are currently covered by the state Medicaid program, including abortions. Diverse health organizations such as New York State Family Physicians and the Reproductive Health Access Project were heavily involved in crafting the bill from the start, underscoring the need for single-payer and women’s health groups to build legislation together.

In order to avoid the mistakes of ColoradoCare at both the state and national level, single-payer groups must explicitly advocate for coverage of abortion services, and work with reproductive health advocates to repeal the Hyde Amendment. While it is laudable that the single-payer advocacy organization Physicians for a National Health Program recently released a statement supporting abortion coverage, supporting causes ideologically is not enough. Reproductive health services, including abortion, must be explicitly written into any single-payer bill. If we want a universal health care system, it must be a system that covers comprehensive reproductive services as well.

Vidya Visvabharathy is a graduate student in Public Health with a concentration in Maternal and Child Health Epidemiology at the University of Illinois at Chicago.

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.

 

Where are you from? Where do you attend medical school?

I grew up in Corryton, TN which is about 30 minutes north of Knoxville, TN and attended the University of Tennessee, Knoxville where I studied Chemistry. Following graduation, I spent a year as an AmeriCorps Health Promoter in the Albany Park neighborhood of Chicago where I taught students about oral health, nutrition and sexual health. I am currently a second year medical student at East Tennessee State University, and I am interested in going into a primary care specialty or Physical Medicine & Rehabilitation.

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

I live in Johnson City, Tennessee, which is in Tennessee’s First District. The House of Representatives member from the first district is Dr. Phil Roe, MD, and our two Senators are Bob Corker and Lamar Alexander. Tennessee has 9 House of Representatives members in total. Both Senators and 7 of our representatives are Republican. Two House members are Democrats.

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

I feel that advocacy is a crucial part of being a physician and learning to be a physician. We have a responsibility to advocate for our patients, and we have all or will all come across patients who do not have health insurance. The best thing we can do for them is to advocate for universal healthcare.

What personal experiences have shaped your decision to take action?

The experience that has most shaped me has been my experience as an AmeriCorps member in Chicago before beginning medical school. Through this experience I got to know individuals in a community that was underserved and not always able to access the care that they needed.

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 think at my school, people have come to associate me and a few other classmates as being very politically and socially engaged so it just naturally comes up in conversations with many of my classmates. Some of the best conversations I have had have been with folks who did not agree with me. Oftentimes, I could share new information about single payer and help them consider issues they had not previously considered. Likewise, they often bring up difficult questions about single payer that challenge me to learn more and hone my knowledge.

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

The right to healthcare is inextricably linked to other human rights movements. There are glaring disparities based on race, gender, socioeconomic status and disability status just to name a few. How do we expect individuals to educate themselves, seek employment, build their own businesses or simply enjoy their lives if they do not have access to quality, affordable healthcare? Health is foundational to many aspects of our lives, and it is a moral failing that we allow such stark disparities in healthcare to exist because these disparities are often closely linked to poor health.

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

Yes, I believe it will be achieved. I’m not sure what form “universal healthcare” will ultimately take, but I believe we will ultimately reach that goal. Living in a predominantly red state, I have many friends, classmates and colleagues who do not agree with me on a variety of issues, but what the vast majority of us do agree on is that everyone deserves a base level of healthcare guaranteed to them.

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

First, go out and vote!! And don’t just vote in national elections. Vote in your local and state elections too. Learn about the candidates. Call them. Tell you what you believe in. It is very easy to forget about local and state politics but so much can be influenced at these levels.

Second, join local organizations. If your school has a SNaHP chapter then join it if you haven’t already. If there is a county political organization that you support, join it! They will help connect with opportunities to get involved.

And keep calling, writing, faxing your state representatives. Make sure they know that you support healthcare for everyone!

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

I think it’s gratifying how often I’ve been having this conversation lately. This conversation was not a very common one just a few years ago and now it has really been gaining traction due to the recent legislation proposed by Congress.

What is one thing you want to share with your medical student colleagues who are not SNaHP members?

Join us and come to our meetings! You don’t even have to be certain that you support single payer, but please join us! The key to making progress on improving healthcare in our country is frank conversation. We all want to improve healthcare for our patients and for everyone in the country. Coming to a consensus will require us to have open conversations about our concerns and how we can address them. As future physicians, we will have a powerful influence on the future of healthcare in this country and it’s important that we take that seriously and work together to improve healthcare for our patients.

 

During the week of August 21, SNaHP co-sponsored the “Stand Up For Medicare For All” campaign urging members of Congress to support single-payer reform. Our members recorded videos for the campaign urging their representatives to #StandUp4Medicare. See below for a series of testimonials courtesy of the A.T. Still University SNaHP chapter in Kirksville, Mo., and click here for more information about how to get involved in the fight for universal health care.

 

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

“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.

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

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.