Author: pnhpf3a_student

“While we believe that nothing short of a single payer system will provide adequate access to healthcare for all people, the ACA has expanded it significantly.”

By Ebiere Okah and Lily Ostrer

As members of Students for a National Health Program (SNaHP) and future health professionals, we endorse the #ProtectOurPatients Campaign and stand with them on January 9th in their efforts to prevent the repeal of the Affordable Care Act (ACA). While we believe that nothing short of a single payer system will provide adequate access to healthcare for all people, the ACA has expanded it significantly. As a result of the ACA, more than 20 million people gained insurance coverage, insurers are no longer allowed to deny coverage due to pre-existing conditions and children are allowed to remain under their parents insurance for a longer period of time. We acknowledge that the ACA has significant shortcomings: it leaves nearly 27 million people uninsured and additional people underinsured and it strengthens the grip that private insurance companies hold on our healthcare system. Nevertheless, the incoming Trump administration’s threats to repeal the ACA would lead to a situation far worse for our patients – and much further from a single-payer system – than the status quo.

While single payer is theoretically an option when the ACA is repealed, it is unlikely to happen under a Trump administration. The president-elect’s pick for Secretary of the Department of Health and Human Services, Tom Price, introduced legislation as a member of Congress that would have replaced the ACA and relied on discredited policies like high-risk pools and individual tax credits. Price has also proposed privatizing Medicare through the use of vouchers. No version of Tom Price’s vision includes single-payer healthcare. Instead, his proposals move far in the opposite direction to privatize care and strip away health coverage from millions of Americans.

While we remain committed to fighting for universal health coverage through a single-payer system, we know that we must also make compromises and sacrifices in the face of the discriminatory and hateful leadership that will soon be ushered into federal office. Where we are now is, unfortunately, defending the ACA and preventing its repeal. That is why we enthusiastically join with other students and future health care providers in building the movement to #ProtectOurPatients and advocating against repeal of the Affordable Care Act. We plan to stand with them in Washington D.C. on January 9th to defend access to healthcare for millions of people and to reiterate that our vision of health justice is one that ensures expanding access to healthcare for all Americans.

This article was originally published by In-Training. You can read the original article here.

By Vanessa Van Doren and Jonathan Michels

Debate about some of the most pressing issues facing our country were lost in the horse race of the 2016 presidential campaign. Among those issues was healthcare. While millions of Americans received health coverage under the Affordable Care Act, an estimated 30 million remain uninsured and medical bills continue to be the leading cause of bankruptcy in the United States. Despite assertions that universal healthcare in the United States is merely a liberal “pipe dream”, a Medicare-for-All health program remains the best option for ensuring that all Americans have access to quality healthcare. In addition, 58% of the population – regardless of political affiliation – support the idea of universal health coverage. Although you might not have heard about it, the campaign to expand health coverage for all Americans gained new momentum during 2016. Here are some of the highlights.

 

1.Bernie Sanders runs for president advocating Medicare-for-all health insurance.

Although he lost the Democratic nomination to Hillary Clinton, Sanders garnered more than 13 million popular votes during the primary campaign by running on a platform supporting healthcare coverage for all Americans. Believing that quality healthcare is a human right, not just a luxury afforded to the 1 percent, Sanders knew that the only way to combat growing health inequities was for the country to implement a health program that covers all Americans and cuts out insurance companies that often impede care. The Sanders campaign showed that the fight for universal coverage is bigger than one person and will require all of us to come together with a unified voice for change.

 

2.Congress grills Big Pharma CEOs over price hiking.

Heather Bresch, the CEO of Mylan Inc., directed the company to raise the price of EpiPen injectors from $109 to $608. Around the same time, Turing Pharmaceuticals’ CEO, Martin Shkreli, also known as the “most hated man in America,” increased the price of an antiparasitic drug by more than fiftyfold. Big Pharma trying to price gouge the public over life-saving drugs is nothing new, right? But hopefully 2016 will be known as the year people realized that instead of being outraged at the Breschs and Shkrelis of the world, we need to start regulating drug prices at the governmental level.

 

3.Donald Trump signals his intention to dismantle Obamacare and implement his own healthcare plan, which could decrease health access for millions of Americans.

Beyond repealing the ACA, it’s unclear what kind of health system Trump will put in its place. Health policy experts from Physicians for a National Health Program believe Trumpcare will be a “meaner (and rebranded) facsimile of the ACA that retains its main structural element – using tax dollars to subsidize private insurance – while imposing new burdens on the poor and sick.” Ironically, Trump frequently advocated for universal healthcare on and off the campaign trail. As early as 2000, he wrote, “We must have universal healthcare…I’m a conservative on most issues but a liberal on this one. We should not hear so many stories of families ruined by healthcare expenses.” A single payer system would greatly reduce healthcare spending through administrative streamlining, something that both Democrats and Republicans can appreciate.

 

4.Physicians and medical students protest medical organizations’ endorsements of U.S. Rep. Tom Price’s nomination to become the next Secretary of Health and Human Services.

Despite Trump’s nearly 20 year history of verbal support for universal healthcare, his choice for HHS Secretary would take the country in a very different direction. Tom Price’s Empowering Patients First Act would dismantle the ACA, Medicare, and Medicaid and replace them with a regressive $1,200 per year tax-credit system that people could use to pay for a small percentage of their health insurance. His plan would also allow insurance companies to deny coverage to people with preexisting conditions if those people had a break in their insurance coverage. This is in addition to Price’s stance against stem cell research, belief that life begins at conception, and lack of support for equal protections for gay and transgender people. Sadly, the American Medical Association, American Academy of Family Physicians, and the Association of American Medical Colleges all released statements endorsing the Price nomination. The medical community quickly mobilized to oppose their organizations’ support for this nomination and continue to push for Price to withdraw before Trump’s inauguration.

 

5.The opioid epidemic continues to cripple communities across the country as a new report from the U.S. Surgeon General shows that more than 20 million Americans have a substance abuse disorder.

Investigations into the current opiate epidemic show how thousands of Americans became addicted to pain medication and later heroin due to over-prescription. Physicians felt powerless to combat their patients’ chronic pain conditions, and Big Pharma downplayed the addictive properties of medications like OxyContin. Some of these patients later became addicted to heroin and entered into another ill-equipped circle of the healthcare system. Current scientific research shows that addiction recovery requires treating both the mind and body. Still, reimbursement rates by insurance companies for social workers and long-term psychiatric treatment continue to pale in comparison to expensive medical procedures. Eradication of such an epidemic will only be achieved by implementing a healthcare system that is not hamstrung by the whims of health insurance companies but instead allows physicians to provide their patients with effective care.

 

6.Quentin Young, a physician and champion for universal healthcare, dies at 92.

After training at Cook County Hospital in Chicago, Young founded and served as Chairman of the Medical Community for Human Rights, a group that provided healthcare for civil rights workers, community activists, and other volunteers working in Mississippi during Freedom Summer. Young served as the personal physician for Martin Luther King, Jr. and later, Barack Obama. He went on to serve as the national coordinator for Physicians for a National Health Program, where he continued to fight for single payer healthcare and justice in medicine. “Health care is a human right,” Young said. “I don’t understand why people in this country still refuse to accept that.”

 

7.The Zika outbreak highlights how unprepared the American public health infrastructure is to respond to national health disasters.

Our lack of a unified, centralized healthcare system impacts more than federal healthcare dollars and access to care. A study conducted during the Zika outbreak scare this past summer gave the US a failing grade on preparedness to combat a potential epidemic, highlighting the importance of a streamlined health system that can quickly respond to a crisis and that all members of society can access.

 

8.Aetna pulls out of ACA marketplaces.

In response to the U.S. government’s concerns that Aetna’s merger with Humana would create a for-profit monopoly, Aetna retaliated by pulling out of the ACA marketplaces. Policy experts began to notice that these merging insurance giants are forming a de facto single payer system. Unlike a streamlined, low-overhead governmental system that will cover everyone, however, a for-profit, non-universal single insurance company will lead to higher costs and less coverage for everyone. Which one do you want?

 

9.Colorado voters reject Amendment 69, single payer legislation also known as “ColoradoCare”, but advocates remain undeterred in the struggle to pass national universal health coverage.

ColoradoCare advocates–supported by progressive powerhouses like Bernie Sanders and Michael Moore–intended Amendment 69 to be the first state-sponsored universal healthcare system in United States history. Unfortunately, nearly 80 percent of Colorado voters rejected the proposal. It is still unknown exactly why the initiative failed to win over the public, but some suspect voters were turned off by the 10 percent tax increase that would have bankrolled the program. Research that compares universal healthcare systems throughout the world with the U.S. shows that Americans pay far less in taxes than these countries and far more in healthcare costs without the quality of care to show for it. Almost immediately after the election, healthcare advocates in the Rocky Mountain State began organizing to build on the momentum that they gained during the hard-fought campaign. “Win or lose,” said Irene Aguilar, a physician and Colorado state Senator, “the issue of guaranteed access to healthcare for everyone without financial barriers was finally brought before the voters.”

 

10.The fight for universal healthcare shows no signs of slowing in the Age of Trump.

Health professional students continue to lead the movement for single payer, universal healthcare in the United States. Students for a National Health Program (SNaHP) held its second annual Medicare-for-All Day of Action, #TreatNotTrick, on October 31st. More than 30 schools across the country participated in this event. Many of these student organizations recently formed the Protect Our Patients coalition to continue to fight for access to healthcare during the new Trump administration. The coalition will hold a rally in Washington D.C. on January 9th – RSVP here!

 

Vanessa Van Doren is a medical student at Case Western Reserve University in Cleveland, Ohio. She is a leader and co-founder of Case Western’s Students for a National Health Program chapter and a student board representative for Physicians for a National Health Program.

 

Jonathan Michels is a freelance journalist, a radiology technologist 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.

“As students and future health care professionals, we are deeply troubled by the AMA and AAMC endorsements of Rep. Price.”

Early Tuesday morning, President-elect Donald Trump announced his selection of Representative Tom Price (R-Ga.) for Secretary of Health and Human Services (HHS), to succeed Secretary Sylvia Mathews Burwell. Almost immediately, the American Medical Association (AMA) and Association of American Medical Colleges (AAMC) expressed strong support for this nomination.

As students and future health care professionals, we are deeply troubled by the AMA and AAMC endorsements of Rep. Price. The policies he has endorsed not only stand in stark contrast to our ideals, but also threaten the well-being of our patients. We question why these organizations—established to protect the interests of all physicians, students, patients, and communities—would ignore the priorities of those they represent. As HHS secretary, Dr. Price will endanger medical institutions and policies, as well as jeopardize our medical education and the very practice of evidence-based medicine.

Though Price, an orthopedic surgeon, claims to prioritize patient, family, and physician needs, his track record suggests decidedly otherwise. In 2015, as leader of the House Budget Committee, he proposed repealing the Affordable Care Act (ACA) in its entirety, privatizing Medicare, making enormous cuts to federal Medicaid funding, and abolishing the mandate that states use Medicaid dollars for patient care. These proposals would guarantee an immediate loss of health insurance for 22 million Americans; increase health care costs for the aged and disabled; and reverse recently-gained protections for vulnerable members of our society, abolishing protections of women’s health, addiction, LGBTQ+, and other necessary medical services.

Despite evidence of the substantial harm his policies would inflict upon patients, Rep. Price continues to advocate for them in his fiscal plan for 2017, promising to destroy the systems already in place to protect the neediest among us and placing the health of millions of Americans at risk.

The AMA’s support of Price lies in direct conflict with the organization’s purported values and its mission “to promote the art and science of medicine and the betterment of public health.” If the AMA is truly committed to promoting the science of medicine, it must recognize that this country cannot afford to place power in the hands of a man who opposes promising scientific breakthroughs like embryonic stem cell research. Similarly, it must ensure that the nation’s HHS secretary values the truth. On the contrary, Rep. Price has demonstrated a severe lack of respect for facts, exemplified by his false claims that women have always been able to afford birth control, and that “not one” has benefited from the ACA’s contraceptive mandate.

If the AMA is truly concerned about the betterment of public health, it is frankly irresponsible to endorse a nominee who wants to decimate Medicaid—which serves more than 70 million Americans who cannot otherwise afford care—and privatize Medicare, creating narrow networks for enrollees, making seniors increasingly responsible for their health expenses, and decreasing access to needed care.

We find the AMA’s paradoxical endorsement objectionable, but unsurprising. This would not be the first time the organization has acted in the interest of profits over patients; it supported the ACA only begrudgingly, and has historically blocked every effort for universal health care reform, despite evidence of the innumerable benefits that a Medicare-for-All system would afford patients and providers alike. While the AMA has failed to represent the priorities and values of its member physicians for decades, the situation at hand poses too great a danger to our nation’s health for the medical community to remain silent.

The AAMC’s endorsement of Price is equally, if not more disturbing, given its role in molding future physicians and its mission to “serve and lead the academic medicine community to improve the health of all.” In its endorsement, the AAMC claims that Price “has long been a proponent of academic medicine.” This blatantly ignores the fact that the financial solvency of most academic medical centers depends directly on Medicare and Medicaid payments, given that individuals covered by these programs comprise a large percentage of those receiving care at these institutions. Without these programs, academic medicine as we know it would cease to exist.

If the AAMC truly wishes to “improve the health of all,” it cannot reasonably justify endorsing the nomination of a man who would strip 22 million people of health insurance, who has vocally opposed expanding health benefits for children, who believes our government has no responsibility to provide coverage to transgender individuals, and who ignores substantial evidence that access to preventative screenings, contraception, and abortion services have overwhelmingly positive impacts on women’s health.

As medical students and physicians, we condemn the AMA and AAMC endorsements of Price for HHS secretary, and are disheartened by professional organizations like the American Academy of Family Physicians (AAFP) and others choosing to follow suit. Price’s stances are incompatible with the values of the medical profession and with the stated missions of the above organizations. Their support reveals a warped set of priorities, with the short-term professional and financial interests of hospitals and physicians superseding the health and wellbeing of patients. We staunchly reject these endorsements and urge their immediate withdrawal.

In endorsing Price’s nomination and contravening their founding principles, the AMA and AAMC have failed to represent us, the future health care providers of this country. As members and supporters of Students for a National Health Program (SNaHP), we will combat every attempt to deny Americans the health care they deserve, and will fight to create a single-payer health care system that covers every person living in this country without discrimination. If the AMA and AAMC truly believe in their own missions, we urge them to join us in this fight.

Please consider adding your name to our statement to show your support in our condemnation of the AMA, AAMC, and others who endorse the nomination of Rep. Price for Secretary of Health and Human Services.

Janine Petito is a fourth-year medical student at Boston University School of Medicine, who plans to complete residency in internal medicine and pursue a career in adult primary care. She is co-chair of the Students for a National Health Program (SNaHP) Political Advocacy Team and a Physicians for a National Health Program (PNHP) student board member.

Andrew Hyatt is a third-year medical student at Boston University School of Medicine, an active member of Students for a National Health Program (SNaHP), and co-chair of the SNaHP Political Advocacy Team.

Michael Zingman is a first-year student at Columbia College of Physicians & Surgeons and active member of Students for a National Health Program (SNaHP).

If you would like to add your name to this list, click on this link:

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“SNaHP stands in solidarity with other student and community organizations that promote peace and justice.”

Students for a National Health Program (SNaHP) will continue to advocate for universal, comprehensive health care reform in the United States. With the results of the presidential election, however, our focus on health care reform must be part of a broader effort for justice.

Discrimination, on both the individual and systemic level, has extensively-studied, irrefutable negative health impacts. SNaHP has traditionally operated in the arena of health care reform, but we realize that providing universal access to health care will not be the silver bullet that ends inequality.

SNaHP stands in solidarity with other student and community organizations that promote peace and justice. And SNaHP is prepared to take action with these groups in the name of preserving the human rights to peace, liberty, and justice.

Trump’s proposal to repeal components of the Affordable Care Act (ACA) would leave 20 million people uninsured. Donald Trump’s hateful rhetoric and regressive policies threaten the well-being of women, Muslim communities, the LGBTQ community, low- and middle-income families, immigrants, and others among the most vulnerable Americans.

Together, our voices can be louder than Donald Trump’s. The results of this election do not change our core values and shared vision. This moment will be remembered in history as the catalyst of a new, unified movement for social justice and progressive action.

Photo courtesy of Amanda Malik.

“The question of class and worker status is a deeper one than we can deal with in a single article or action, but it’s one that physicians in particular need to grapple with if they value social justice.”

-Karim Sariahmed, SNaHP member

For SNaHP’s #TreatNotTrick Philadelphia action, a group of ten people gathered at City Hall. They were mostly medical students with SNaHP, joined by two members of Put People First! PA (PPF-PA) and another local activist.

Our small action became less about projecting something for the public and more of an intimate opportunity to nourish ourselves so we could step into our power together. We heard a personal story from Amanda Malik, a third year at Cooper Medical School of Rowan University, about the perverse way that time spent haggling over patients with insurance companies marks the urgency of providing basic care. We heard from Rebecca Lin, a 1st year at Lewis Katz School of Medicine (LKSOM) who framed the policy issue by describing the absolute numbers of uninsured people (24 million), and the number of preventable deaths due to uninsurance every year (45,000, the same number killed by kidney disease).

I shared some of the history of the Kensington Welfare Rights Union, a working class group that worked to overcome racism and segregation in their community to fight poverty, an effort whose legacy and theory of change lives on through PPF-PA’s campaign to make healthcare a human right in Pennsylvania. It also shines through in the KWRU song “Went Down to the Rich Man’s House,” which we sang together during the action.

The question of class and worker status is a deeper one than we can deal with in a single article or action, but it’s one that physicians in particular need to grapple with if they value social justice. Still, singing this song gave life to the idea that part of what unites healthcare workers with the broader anti-poverty and anti-austerity movements (the source of power able to make the political lift of passing single payer and other significantly redistributive legislation, in my opinion) is our shared ownership of healthcare work.

Med students, nurses, physicians, physical therapists, physicians’ assistants, lab technicians, medical assistants, security guards, pharmacists, environmental service workers, ambulance drivers, and patients all share a powerful stake in winning a system that works for all of us. We are not yet organized enough to harness all of the latent power in this idea that our work belongs to all of us, and not to the insurance executives like CEO of Independence Blue Cross (IBX) Daniel Hilferty, who extract its value. However, part of our encounter last night made it clear that we already have some power.

We were wearing Halloween costumes. Emily Kirchner, a fourth year and a lead organizer for the action, was wearing a dinosaur mask. Tony Spadaro, a third year at Penn Med was wearing a banana suit and holding a paper bag that said “Private Insurance is Bananas.” I shaved my head and drew a fake beard on my face to look more like Dr. Hugo Strange from Batman. We had a good time, and we sang confidently as we marched to the IBX headquarters, just four blocks away from our gathering at City Hall.

When we arrived, we were met by IBX’s head of security, and civil affairs police officers on bikes were lined up in front of the building. We were expecting them to be there, so we just went ahead and lit our candles as Shalonda Cook, another first year from LKSOM, lead us in a vigil to honor the struggle of people fighting for their lives in our broken healthcare system. Then we shared some reflections before heading home.

While doing this we realized that the security force flanking our vigil actually outnumbered us. There are two crucial questions we need to be asking: What are they protecting, and whom are they protecting it from? I think the biggest threat to them is a movement of working and dispossessed people poised to isolate them from hospitals, insurance departments, welfare offices, and other public institutions whose cooperation they take for granted.

This Thursday, November 3rd, PPF-PA will be in the same place to fight back against the outrageous ACA premium increases recently approved for IBX and other insurance companies by the PA Insurance Department. I think the stories shared there will give us some clarity as to who “we” are, and what we are up against in the fight to abolish insurance profiteering and install single payer.

Karim Sariahmed is a second-year medical student at the Lewis Katz School of Medicine at Temple University. In addition to supporting the growth of Temple Med’s SNaHP chapter, he is a member of Put People First! PA. This is the community in Philadelphia that teaches him how to organize alongside many other developing organizers from various healthcare professions and healing traditions. You can read his other work at in-Training and the PPF-PA blog. He tweets @sariahmed.

 

This op-ed was originally published on Common Dreams on September 18, 2016. This version includes a section on how single payer healthcare can help end LGBT health disparities. You can read the original article here.

“This Halloween, medical students are refusing to endorse the horrifying system as it exists. We will don our white coats and witches hats, publicly and politically demanding the ability to #TreatNotTrick.”

A few days ago, I was studying a medical diagram in a coffee shop when a man in his mid-forties walked in. His face was red, he was sweating, he looked upset.

“Please, can anyone help me?” he asked. “My daughter is at Children’s Hospital for seizures and she needs medicine. My credit card is maxed out. I need $16.50.”

A few weeks ago, I was listening to a friend describe a Pennsylvania Insurance Department hearing on proposed rate hikes for marketplace health insurance premiums.

“One insurance company representative actually asked the department to consider the health of the company,” he said. After this hearing, all six insurance firms received rate increases, often more than the rate increases they had requested.

A few months ago, I was standing in the operating room. The attending surgeon was instructing the resident about how to deal with a patient who had insurance difficulties.

“Well, the patient is going to say, ‘My insurance says they won’t pay for it,'” he said. “You say, ‘That’s not my problem. I gave you my advice.'”

Before you dismiss the coffee shop encounter as a panhandler pestering customers, consider that we live in a country where some medications have unaffordable copays, that many people go without needed medicines, and that people often have to make a choice between seeing the doctor and paying their utility bill.

Before you dismiss the big premium increases by pointing to Obamacare’s subsidies, consider that we live in a country where insurance firms helped write the Affordable Care Act, that millions of people remain uninsured despite the ACA, and that copays and deductibles are sharply rising.

Incidentally, the “health of the company” is not the kind of health I give a damn about.

Students for a National Health Program (SNaHP) explores the impact of race, gender, religion, sexual orientation, socioeconomic status, age, ability, and immigration status on access to health care. This webinar was originally broadcast on October 19, 2016. For more information on medical student advocacy, please visit http://student.pnhp.org.

This op-ed was originally published on In-Training on September 18, 2016. This version includes a section on how single payer healthcare can help end LGBT health disparities. You can read the original article here.

“The antidote to division and disparity is unity.”

-Tyler McKinnish, 4th year medical student

“I’m going to a drag show tonight.”

My third year resident asked what I was doing with my day off, and my reply, the gayest of weekend plans, gave her pause.

I felt the same awkward beat in our otherwise amiable conversation, saw the same uneasy shift in her seat, just the day before when I told her about a date I had been on. I’m not exactly inconspicuous about my sexuality in the first place, so I wasn’t prepared for her to be surprised that I’m beyond-a-shadow-of-a-doubt-gay. I had felt uncomfortable for making her uncomfortable, and wasn’t exactly sure why. I wondered if I was allowing some sort of personal insecurity or professional courtesy insinuate discord in a completely innocuous conversational pause. So I could have said “I’m going out” or to a bar, or something similarly vague, but I wanted to test the waters. I wanted to confirm a suspicion that it wasn’t just me, and it wasn’t just once.

I have spent the last 11 months as a student in North Carolina’s largest not-for-profit hospital system, and in all that time have heard very few LGBT physicians speak openly about their lives. Even in conversations overheard in communal spaces- about Tinder dates and husbands, the antics of beloved children, office politics, hectic schedules and Blue Apron dinners- the lives of LGBT people are rarely discussed. When they are, it is in hushed tones and whispers. Physicians in particular seem reticent even to say the word “gay,” and I can only imagine why. For some it is likely out of fear of offending coworkers or patients- for saying the wrong thing in front of the wrong person. For others, whom I hope are the minority, maybe it is out of some actual disdain for LGBT people. For most, however, I suspect it is simply because they are not accustomed to thinking about LGBT people, so personal, real, non-political discussions about us seem foreign and uncomfortable, an ill fitting glove on a surgeon’s busy hand.

Even the other residents, many just a few years older than myself, seem to get a bit squirrely when the topic of conversation involves the LGBT community.  They shy away from discussing the topic, and for most, their few interactions with the LGBT community are not enough to remind them of our existence. What then is the motivation for these future leaders of healthcare to learn about the health of our community? How can they be expected to empathize, to relate, to communicate on a deeply personal level with us, their patients?

The interpersonal ease needed to establish trust between patient and provider might come easily to some, but is only the first barrier. As physicians and physicians-in-training, we ask patients to disclose uncomfortably thorough social and sexual histories which often go beyond the limits of our own experiences. Then we critique them, offering suggestions for risk reduction based on our medical expertise. In order to do this effectively, we are asked to know a lot about communities to which many of us are not members.  A heterosexual, white, female physician is asked to stratify STI and HIV risk beyond the level of “gay vs. not gay,” and tell a bisexual man of color about his statistically higher risk of HIV infection than his white or Hispanic peers, while taking into account his individual risk and screening him appropriately.1 To do so, she must also know that HIV is on the rise in many male sexual minority communities, and that even protected sex is not 100% safe as diseases such as syphilis and herpes may be transmissible even with the use of a condom. Putting patients on PrEP (Pre-Exposure Prophylaxis) medications can decrease the risk of sexually transmitted HIV infections by over 90% in high risk individuals, which includes approximately 1 in every 4 MSM, but in 2015 only 1 in 3 primary care doctors and nurses even knew about PrEP.2

Our hypothetical lady doctor must evaluate her patient’s need for PrEP, but she also can’t forget to have discussions about tobacco, alcohol, and drug abuse and screen for depression, each of which is significantly more common in LGBT patients. Not only does she have to be confident and tactful when talking about these sensitive subjects with her patients, her knowledge about them has to be up-to-date and community-specific.

Transgender people have needs that are not shared by their LGB peers, and that providers may be particularly unlikely to recognize. According to the National Transgender Discrimination Survey, 50% of respondents reported having to teach their doctors about trans* health, which includes an enormous number of healthcare disparities. The rate of attempted suicide in the community is egregiously high at 41%, and the prevalence of HIV is 4 times higher than the national prevalence.3 Even more upsetting, though, are the social inequities suffered by trans* patients. Fifty-five percent of trans people reported losing their jobs simply because they are trans*, and 16% had to resort to illegal trade of sex or drugs simply to survive. Kids are not impervious to these disparities, either: the rate of bullying of trans* kids in schools is nightmarishly high (78%) with nearly 1/3 having been physically, and 1/10 sexually, assaulted.

What will our archetypal physician say when her transwoman patient asks about PrEP? How will she start the conversation with this woman about her life, her anatomy, her safety? Will she know the indications for prescribing PrEP and be willing to do so? She will also need to screen this woman for prostate cancer and sexually transmitted infections (in the correct places), and recall that transwomen with past hormone use need breast cancer screening but not pap smears. How will she go about asking this patient about intimate partner violence? I hope at the very least she will be able to empathize with this woman’s situation, understanding that even to have presented to a doctor’s office she must have overcome enormous adversity.

Healthcare providers, however, are only one component of the disparity perpetual motion machine that is a healthcare system designed for profit. After all, lesbian, gay, and bisexual people are all less likely to have insurance than straight people, or even a usual place to go for medical care; bisexual and lesbian women in particular are less likely to obtain medical services due specifically to cost.4,5 This includes routine screening like pap smears and mammograms, which should be conducted with the same frequency as their heterosexual counterparts but multiple studies have suggested are not.4,6 Trans* people too are significantly underinsured and have worse health outcomes than even their LGB peers; yet, 19% of trans* people have been refused medical care in the past simply for being transgender.

Although a national problem, health disparities within the LGBT community are even greater in the South. Never a state to discriminate discriminately, Tennessee recently passed SB1556, a bill that allows therapists and counselors to refuse service to all variety of LGBT patients when treating them is contrary to any “sincerely held” beliefs. In Mississippi, HB1523 allows universities, government employees, contractors, and private businesses, which includes nearly all of the state’s health care providers, to similarly discriminate against LGBT people for religious beliefs. Here in North Carolina- ground zero for state-sanctioned LGBT discrimination- HB-2 requires that transmen and transwomen use the public restroom congruent with the gender assigned to them at birth. It also eliminates expanded LGBT anti-discrimination policies that previously existed in some cities, removes all local authority to increase minimum wage and benefits for public contractors, and abolishes state-level legal recourse for employment discrimination. Other states have tried, and failed, to pass this type of bigoted legislation as well, including Georgia, Kentucky, Indiana, South Dakota, and West Virginia.

In Florida, the Pulse nightclub shooting has been a horrific and tragic reminder that legislators and their policies are not our only enemies. LGBT people- our friends and family- are under attack, and whether it be from chronic diseases, political negligence, or at the hands of malicious enemies of love and equality, LGBT people are dying.

Justice in healthcare alone cannot solve these problems, but it is one of the most important interventions for the elimination of disparities affecting the LGBT community.  Expensive deductibles and copays that restrict access to healthcare consign low-income people, including many members of the queer community, to choose between illness and poverty. The logistically complex and restrictive system that currently excludes patients and burdens providers must be examined and eliminated in favor of an equitable system: single-payer healthcare. A national single-payer health program is the only feasible means of improving the efficiency and fairness of access to healthcare regardless of race, gender identity, sexual orientation, national origin, religion, disability, age, or any other divisive label. Numerous industrialized nations with superior healthcare outcomes already utilize this system, endorsing the singular notion that healthcare is a human right.

Our system of healthcare is fundamentally broken. LGBT people have disproportionately limited access to healthcare; cost, lack of insurance, fear of judgment, and outright discrimination preclude them from receiving care. When other factors like race, socioeconomic status, and social support compound this lack of access, LGBT people have little hope of becoming LGBT patients. Even when they are able to access care, they cannot be guaranteed that their provider will possess the necessary knowledge or training to offer them comprehensive care; as my own experience shows, nor the comfort. We- as healthcare professionals, trainees, friends, and neighbors- are simply not working hard enough for the LGBT community.

Thankfully, we all have the power to change that. The antidote to division and disparity is unity. It is imperative that we all become advocates for adequate training of healthcare providers. Ask your doctor if they have any training in LGBT health, suggest it in the patient satisfaction survey your hospital provides, refer providers and colleagues to lgbthealtheducation.org for professional development, and use the HRC Healthcare Equality Index to find LGBT-inclusive medical care. Use your voice, your influence, your time as an ally in the fight for a social justice issue that benefits the LGBT community- no matter which, just pick one and get involved. Finally, get educated about single-payer healthcare; join Healthcare-Now!, or Physicians for a National Health Program, or Students for a National Health Program and become a champion of access to affordable, high-quality, and comprehensive healthcare for all.

 

1. Centers for Disease Control and Prevention. HIV Infection Risk, Prevention, and Testing Behaviors among Men Who Have Sex With Men—National HIV Behavioral Surveillance, 20 U.S. Cities, 2014. HIV Surveillance Special Report 15. http://www.cdc.gov/hiv/library/reports/surveillance/#panel2. Published January 2016. Accessed [date].

2. Smith, DK et al. Vital Signs: Estimated Percentages and Numbers of Adults with Indications for Preexposure Prophylaxis to Prevent HIV Acquisition — United States, 2015. MMWR. 2015: 64 (46); 1291-1295. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6446a4.htm?s_cid=mm6446a4_w

3. Grant, Jaime M., Lisa A. Mottet, Justin Tanis, Jack Harrison, Jody L. Herman, and Mara Keisling. Injustice at Every Turn: A Report of the National Transgender Discrimination Survey. Washington: National Center for Transgender Equality and National Gay and Lesbian Task Force, 2011.

4. Buchmueller T, Carpenter CS. Disparities in Health Insurance Coverage, Access, and Outcomes for Individuals in Same-Sex Versus Different-Sex Relationships, 2000–2007. American Journal of Public Health. 2010;100(3):489-495.

5. Ward BW, Dahlhamer JM, Galinsky AM, Joestl SS. Sexual orientation and health among U.S. adults: National Health Interview Survey, 2013. National health statistics reports; no 77. Hyattsville, MD: National Center for Health Statistics. 2014.

6. Mravcak S. Primary Care for Lesbians and Bisexual Women. American Family Physician. 2006: 74(2) 279-286.

Tyler McKinnish is a fourth-year medical student at the UNC School of Medicine and a desperately optimistic future Ob/gyn. He is passionate about LGBT health, academic medicine, and health equity. When not working in the lab or clinic, he enjoys hot yoga, climbing, and cooking.

Despite living in an era of great potential in the fight against disease and death, Americans continue to be haunted by health care profiteers. This Halloween, hundreds of medical and health professional students around the country will call on candidates and elected officials to abolish private health insurance, and to replace the health insurance industry with an expanded and improved Medicare-for-all.

Our message: “Private health insurance is a trick – we just want to treat our patients.”

This national day of action, dubbed #TreatNotTrick, is organized by Students for a National Health Program (SNaHP) and supported by well-known health professional student organizations such as the American Medical Student Association, The Latino Medical Student Association, White Coats 4 Black Lives, and the California Health Professional Student Alliance.

#TreatNotTrick will be an opportunity to put pressure on candidates to include improved Medicare-for-all, or “single payer” health insurance, in their platform just one week prior to the November elections. The decision to organize this national event was made after the success of SNaHP’s “TenOne” day of action in October 2015. During that event, more than 35 actions were organized at dozens of medical schools, and many groups received local media coverage.

[Photo caption: Chicago medical students march in front of Humana’s local headquarters during 2015’s #TenOne action]

There isn’t a week that goes by without a scandalous headline highlighting the broken quality of health care financing in the United States. Recently, mega-insurer Aetna backed out of the Affordable Care Act’s marketplace exchanges in 11 states, significantly reducing access to care in several portions of the country. Shortly after, there was public outcry over a 600% price surge of the life-saving EpiPen by big pharmaceutical company Mylan.

There is a better way to provide care for everyone while also controlling costs: Improve and expand the existing Medicare program to cover all medically necessary services, and enroll everyone from the day they are born.

The timing of #TreatNotTrick is critical. The outcomes of this year’s election will set this country’s political priorities for the next four years or more. A unified call for improved Medicare-for-all so close to the election will demonstrate that affordable, accessible health care for everyone is only possible with single payer. Not only do the majority of Americans want it, but the current system will buckle without it.

The editors of this blog urge all medical and health professional students to add their voice to this call and to get involved by joining or organizing a #TreatNotTrick event this Halloween.

Questions about #TreatNotTrick may be directed to students@pnhp.org.

Here is a list of participating schools and events:

Baltimore:

• Johns Hopkins University School of Medicine

Illinois:

• Pritzker School of Medicine – University of Chicago
• Rosalind Franklin University of Medicine and Science
• Rush Medical College & Rush College of Nursing
• Feinberg School of Medicine at Northwestern University
• Midwestern: Chicago College of Osteopathic Medicine
  Monday, October 31
  11am-1pm
  Information Booth & Letter-Writing Workshop
  Contact: Taysa Bowers, 925 451-5829; tbowers19@midwestern.edu

Ohio:

• Case Western Reserve University School of Medicine
  Monday, October 31st
  Lobby visit to Sen. Sherrod Brown
  Contact: Vanessa Van Doren, vev5@case.edu
• The Ohio State University College of Medicine

Meeting with Mike Stinziano of the Columbus City Council to speak on effective techniques for medical lobbying & ways to influence healthcare legislature as medical students

Minnesota:

• University of Minnesota Medical School
• Mayo Medical School

Madison, Wisconsin:

• University of Wisconsin School of Medicine

Philadelphia, PA

• Lewis Katz School of Medicine at Temple University/Cooper Medical School of Rowan University/Perelman School of Medicine at the University of Pennsylvania
  Monday, October 31st, 6pm, City Hall
  Rally and Vigil

https://www.facebook.com/events/570996616419036/

Contact: Emily Kirchner, ekirchner89@gmail.com, 724 561 8336

Scranton,PA

• The Commonwealth Medical College

New York

• Weill Cornell School of Medicine

Patient testimonials exhibiting the deficits of the health care system

Olin Hall–Olin Lounge/ Weill Education Building–Archibold Student Lounge

Photo ID required to visit campus buildings

10/31-11/3

• New York Metro Region
  NYC Village Halloween Parade + Petitioning for New York Health Act
  October 31, 7-9 PM
  Sixth Avenue at Canal
  https://www.facebook.com/events/208216562921689/

• Icahn School of Medicine at Mount Sinai
• Columbia University College of Physicians and Surgeons
• New York Medical College

Boston, MA

• Boston University School of Medicine
  October 31st, 3-4:30 PM, Talbot Green
  Demonstration and Call-In

https://www.facebook.com/events/323487411336598/

• Harvard Medical School
• Tufts University School of Medicine

Southeast:

• University of Louisville School of Medicine
  Rally with student and physician speakers + Petition for H.R. 676 support in KY
  U of L Health Science Campus Quad
  (500 South Preston btw Muhammad Ali Blvd and East Chestnut St)
  October 31st, 12 pm
  https://www.facebook.com/events/1578361099137154/
  Contact: Mallika Sabharwal,  malsabharw@gmail.com
• Virginia Commonwealth University School of Medicine
• Kirksville College of Osteopathic Medicine – A. T. Still University
• East Tennessee State University Quillen College of Medicine
• Emory University School of Medicine
• University of South Alabama College of Medicine

New Mexico:

• University of New Mexico School of Medicine

Texas:

• Texas College of Osteopathic Medicine
• University of Texas Health Science Center

California:

• Touro University California – College of Osteopathic Medicine
• The David Geffen School of Medicine at UCLA

Caribbean:

• Ross University School of Medicine