This article was originally published by The Progressive. You can read the original article here.
“…Amazon approaches health care as another market, like books or groceries, focusing our attention on corporate engineering rather than the structural barriers that keep people from getting care.”
In late January, Jeff Bezos, Warren Buffett, and Jamie Dimon announced that Amazon, Berkshire Hathaway, and JPMorgan would be collaborating on a new “health care venture.” More recently we learned that Atul Gawande, the celebrated endocrine surgeon and writer for The New Yorker, will be its CEO, starting on July 9.
We don’t know much about what the project actually seeks to accomplish. Other than Gawande’s comment that “the system is broken, and better is possible,” the venture has not clearly named the health care problems it is attempting to solve or even offered a mission statement.
How might a new team of billionaires, led by a prominent surgeon and storyteller, approach our health care system? To get a better idea, it may be useful to look at Amazon and its chief executive officer, Jeff Bezos.
This month, Amazon helped fund a ballot challenge to repeal a tax that would have raised $48 million to combat homelessness in Seattle. This affront to the poor is unsurprising, because for most of its existence Amazon has been avoiding taxes as it seeks to more efficiently accrue new market shares.
In 2017, the European Union ordered Amazon to pay €250 million in back taxes it had evaded through an elaborate series of shell companies created around its Luxembourg headquarters in 2003. Amazon also has a track record of eliminating retail jobs, paying minimal or no property taxes, and abusing its workers. Despite this, poor cities with crumbling infrastructure like Philadelphia, my home, are courting Amazon with the help of state-level tax breaks, hoping to be chosen as the site of its new headquarters.
Outside the realm of private joint ventures, there is widespread agreement that our current health care system is in crisis. Leaders in the struggle for better care are emerging from the new Poor People’s Campaign, a continuation of the project launched by the Reverend Martin Luther King Jr. in 1968, and other advocates of Medicare For All.
As a member of Put People First! PA, a human rights organization led by poor and working class people, I understand Amazon’s exploits as a story about poverty and dispossession, not innovation. Our economy stratifies us by markers including income, race, nationality, gender, age, and ability, justified by a narrative about poverty which qualifies all of us as either “deserving” or “undeserving.”
The poor are widely denied health care and other fundamental needs on these bases. It is in this context that Amazon approaches health care as another market, like books or groceries, focusing our attention on corporate engineering rather than the structural barriers that keep people from getting care.
I’m disheartened to see that one of medicine’s moral voices is joining their team. Gawande, perhaps best known for his writing on the end of life in Being Mortal, has implemented quality improvement projects in diverse settings to make surgery safer. But I have no illusions that any amount of positive influence from one good person can change what Amazon stands for.
As Dr. Steffie Woolhandler of Physicians for a National Health Program commented about the project, Amazon and its partners have only one interest in health care: saving money. This project is only worthwhile if it gives them a unique competitive advantage.
As JPMorgan CEO Jamie Dimon reassured his clients, the new venture is invested only in its own employees and its own bottomline. It has no interest in guaranteeing health care access to everyone. And while the venture is nominally “nonprofit,” that distinction is not meaningful in a health care environment in which so-called nonprofits like Independence Blue Cross are shifting costs on to people across Pennsylvania.
More than 2,500 people have been arrested so far in Poor People’s Campaign demonstrations across the country, demanding policies to address rampant poverty and racism, including Medicare For All. U.S. Representative Keith Ellison, Democrat of Minnesota, was the keynote speaker at a recent Single Payer Strategy Conference in Minneapolis.
Health care inequity is a moral crisis that only the moral leadership of social movements can address. The fantasy of a magical fix handed down from a team of billionaires is at best a distraction. Knowing Amazon’s track record of exploiting its own workers, it could likely turn into something dangerous to health care workers and patients.
In the documentary Being Mortal, based on Atul Gawande’s book, there is a scene in which an older man dies peacefully on his own terms, surrounded by his family. The scene made me think of Isabella (Bella) Oliveras, a member of Put People First! PA who died in early 2017, from complications of a treatable disease. She was in her thirties.
At the time of Bella’s death, the group was helping her raise money for a motorized scooter, which her insurance would not cover although she was wheelchair-bound. The absence of stories like hers from our conversations about the end of life reflects our nation’s general failure to identify poverty as the central driver of health care outcomes.
Amazon and its business partners will not seriously engage this. They will likely not get us closer to universal, public insurance financing or meaningful checks on the profiteers that drive costs. We should look instead to the vision that Martin Luther King Jr. had at the end of his life. As he expressed it:
“There are millions of poor people in this country who have very little, or even nothing, to lose. If they can be helped to take action together, they will do so with a freedom and a power that will be a new and unsettling force in our complacent national life.”
Karim Sariahmed is a 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 article was originally published by STAT News. You can read the original article here.
“The AMA’s opposition to Medicare for All puts the organization at odds with the public and with America’s doctors.”
Fifty years ago this month, at the 1968 meeting of the American Medical Association, a fourth-year medical student named Peter Schnall seized the microphone and scolded several hundred of the most prestigious, highly educated white men in America.
“Organized medicine has never felt responsible and accountable to the American people for its actions and continues to deny them any significant voice in determining the nature of services offered to them,” Schnall chastised the group.
“Shut up!” yelled the doctors, who were accustomed to being treated with respect and deference, not with outrage and indignation.
Schnall’s outburst, coordinated by members of Martin Luther King Jr.’s Poor People’s Campaign and the Medical Committee for Human Rights, aimed to be a wake-up call to an institution that was highly successful at protecting physicians’ “interests against encroachment” but failed to meet the public health and human needs of patients by opposing both civil rights and the expansion of safety-net health programs.
At a time when Jim Crow racism harmed the health of millions of African-Americans in the South, the AMA repeatedly rebuffed requests from the National Medical Association, an organization that represents African-American physicians, to work together to end racial health disparities.
Even after the passage of the Civil Rights Act in 1964, the AMA allowed local medical societies to discriminate against physicians and patients of color. The AMA also mobilized attacks against major social programs intended to benefit all Americans, from Social Security to Medicare and Medicaid. In 1948, the AMA leadership spent millions on a campaign to characterize President Truman’s popular universal health care plan as “socialized medicine.”
Today, in the midst of a revived Poor People’s Campaign, physicians and medical students are again pressuring the AMA to be more responsive to the needs of the nation’s uninsured and underinsured. At the AMA’s House of Delegates annual meeting in Chicago this weekend, its Medical Student Section will ask the AMA to end its decades-long opposition to a single-payer health insurance program, a system better known as Medicare for All that would be publicly financed but privately delivered. Why bother? For better or for worse, the AMA sets the agenda for American health policy.
It is clear to medical students that no matter how well they are trained, far too many Americans will remain sick and poor under market-based medicine.
Our wildly inefficient system is currently dominated by private insurance companies, a health care model spearheaded by the AMA. It produces some of the worst health outcomes in the industrialized world — the U.S. has the highest infant mortality rate and the highest number of avoidable deaths — and devours an ever-increasing share of our economy, with health spending accounting for a whopping 17.9 percent of our gross domestic product. Despite the improvements of the Affordable Care Act, 28 million Americans remain uninsured, without access to primary care that could prevent costly and life-threatening diseases. Those fortunate enough to have insurance face prohibitively expensive co-pays, premiums, and deductibles that limit access to care, and medical expenses are a leading cause of bankruptcy.
Contrary to the AMA’s assertions, a single-payer system would give health care providers more autonomy because their clinical decisions wouldn’t be second-guessed by insurance companies. Patients would have free choice of any doctor, allowing providers to compete based on quality of care. Physicians would spend less time on administrative responsibilities like paperwork and billing, and more time seeing patients, which boosts both their work satisfaction and income. In fact, when Canada implemented its single-payer program, physicians enjoyed long-term salary increases.
The AMA’s opposition to Medicare for All puts the organization at odds with the public and with America’s doctors. Sixty percent of Americans believe the federal government has a responsibility to provide health coverage for all; 51 percent specifically support the creation of a single-payer health system, as does the majority (56 percent) of practicing physicians. The single-payer bill in the House of Representatives, H.R. 676, now has a record 122 co-sponsors; in the Senate, Bernie Sanders introduced his updated Medicare for All Act in 2017 with a record 16 Senate co-sponsors, including most of the leading Democratic contenders for president in 2020.
In the AMA’s evaluation of these and other health system reform proposals, it asserts that a national health program could lead to a concentration of market power in the hands of the government, limiting patient choice and physician autonomy: “Reform proposals should balance fairly the market power between payers and physicians or be opposed.”
Although the AMA’s membership has steadily declined since the 1950s, it remains the most powerful doctors group in the country. The growing Medicare for All campaign is unlikely to be won without its support.
Will the AMA choose to move toward guaranteeing health care as a human right or continue down the wrong side of history by linking patients’ health to the vagaries of the private insurance market?
The activists who staged the protest at the AMA meeting in 1968 hoped that the organization would finally recognize health as a human right. It didn’t. A lot has changed in the ensuing 50 years. It’s time the AMA does, too.
Jonathan Michels is a premedical student at the University of North Carolina at Greensboro. Robertha Barnes is an MS/MD student at SUNY Upstate Medical University. Sydney Russell Leed is an MD/MPH student at SUNY Upstate Medical University. All are board members of Physicians for a National Health Program, an organization that advocates for an improved and expanded Medicare for All health system.
Students for a National Health Program, Health Care for All NC and other national and state single-payer organizations will march alongside North Carolina teachers as they rally for respect this Wednesday, May 16 in Raleigh, North Carolina.
One of the primary issues affecting public teachers across the country has been the rising cost of their health coverage. West Virginia educators recently underscored the connection between jobs and health when they initiated a massive walk-out and demanded action over their increasingly expensive, yet meager, healthcare coverage.
“It’s the insurance,” confirmed one of the striking teachers. “That’s the big deal.”
In North Carolina, health insurance premiums are skyrocketing for all of us and our teachers pay an outrageous average of $10,000 a year to cover their families.
As healthcare professionals and advocates fighting for a universal, single-payer health system, we believe the purpose of both healthcare and public education is to serve the common good of the community, not the bottom lines of corporations.
Together, as members of professions whose goal is to foster, care for, and promote the health of our communities, we condemn this endless attack on North Carolina educators.
Teachers are fighting for the future of our children. With our common values, it is our obligation to support them in the classroom and in the public square.
The North Carolina teachers’ rally is an opportunity for us to show our support for public education, clarify that we offer an answer to the healthcare crisis, and emphasize the connection that Improved Medicare-for-All should have in a larger movement for social justice.
Here is how you can help:
Wear your white coat at the march and rally on Wednesday, May 16 in Raleigh.
Healthcare workers and single-payer advocates will assemble between 10:00 and 10:30am at 700 S. Salisbury Street in Raleigh, North Carolina. The march to the Legislative Building will begin at 10:30.
The Rally for Respect on Bicentennial Plaza starts at 3:30 p.m
Post on social media using #MEDforED and pledge your support for NC teachers.
Tell people about Improved Medicare-for-All! Rarely do we have a tangible answer for such a widespread, systemic problem like our current healthcare crisis. The good news is that we have several pieces of legislation that can fix our collective heartache: House Bill 676 and Senate Bill 1804 both expand Medicare for all Americans.
This article was originally published by The Advocate. You can read the original article here.
“We will not stand for a system that prevents us from providing the care our patients need.”
– Ashley Duhon and Sara Robicheaux
As a medical student, you never forget the first time a patient says, “Thank you for your help, but I can’t afford it.” It’s the one sentence that could stop any treatment plan, regardless of the potential benefits.
Medical textbooks aid in the diagnosis and treatment of patients, but they fail to tell us how to help a patient who cannot afford care. Like millions of Americans, many of our patients leave clinics with a choice between addressing their critical health needs or paying for basic necessities. As medical students and future physicians, we cannot ignore the system that denies our patients access to the care they need and deserve.
Over the course of history — from the Greensboro sit-ins of the 1960s civil rights movement to today’s high school students leading the fight for stricter gun regulations — students have been powerful agents of social and political change.
Based on this proud tradition of student-led activism, we recently gathered in New Orleans with more than 100 fellow medical students from across the country for the annual summit of Students for a National Health Program (SNaHP). SNaHP is a national organization of medical and health professional students advocating for a single-payer, Medicare-for-all health system. The event was organized and led by passionate students who believe every patient deserves access to quality, affordable health care. Wearing our white coats and holding “Medicare for All” signs, we danced and marched in a second line parade for health justice, crossing paths with University Medical Center and Tulane Medical Center.
The day concluded with a keynote presentation by Bethany Bultman, CEO of the New Orleans Musicians’ Clinic, who explained how the majority of performance artists in New Orleans are uninsured and rely on the Musicians’ Clinic to access basic health services. Musicians are at the heart of the city’s culture, but fall through the cracks of our fractured health system — often earning too much money to qualify for Medicaid, but not enough to afford private insurance.
Musicians aren’t the only New Orleanians who experience health care rationing. According to data from the U.S. Census Bureau, approximately 54,417 people in New Orleans still do not have any form of health insurance.
Our medical education can only benefit our future patients if an insurance company deems they are worthy of care. While we are taught to see all patients as humans deserving of the highest quality care, private insurers see patients as nothing but profit. We will not stand for a system that prevents us from providing the care our patients need. In this historic political moment of student-led activism, our time is now. Your health is too important for it not to be.
Hope this message finds you well. Many of us are still mourning the tragic death of Stephon Clark, 22-year-old unarmed black man shot and killed by the police in his grandmother’s backyard. This event is tragic and unacceptable, and yet the story is all-too familiar. Stephon Clark joins an ever-growing litany of black lives ended by police violence. The White House thinks this is a “local matter”, but we disagree. This is a national public health crisis.
We are calling on all medical and nursing schools across the nation to join us on April 17th, 2018 at 12pm as we hold a National White Coats for Black Lives die-in demonstration.
It is our duty as future health professionals to use our platform to amplify the voice of our community. We cannot keep ignoring the institutional racism upon which our nation was founded and which persists up to this day. We cannot overlook the racial disparities present in communities of color. We will not remain silent as communities become unhinged by continued violence and persecution. These injustices affect communities at large and increase physical and mental illness burdens in these communities. We have to do more.
Our demands are clear. We stand in solidarity with all the victims of police violence. We demand justice for the victims and police accountability. We urge our own healthcare institutions to increase mental health resources and provide trauma-informed care to afflicted communities.
If you agree with the aforementioned, please join us for our national die-in! This is a google folder with more resources. In it, you will find the following:
If you agree with our demands, please sign your name on our petition.
If you would like to do a demonstration at your school, please register your school here.
Our action guide should help make planning for this event easy and consistent.
The google folder also includes our flyer, media advisory, fact sheet on structural racism, Op Ed guide, and press release (TBA).
“Embracing single payer demands not only a radical revision of how health care is financed but the courage to move beyond half-measures.”
For more than 100 years, Americans have searched for a cure for health care inequality. Instead, we’ve been prescribed placebos: watered-down poverty programs and party politics.
Despite attempts to ease the pain with reforms like Medicaid and the Affordable Care Act (ACA), we continue to rely on a market-driven health care system. After stitching together the remnants of various poverty programs we are left with a system so dysfunctional and freakish it would make Dr. Frankenstein recoil.
After signing the Health Reinsurance Act—the result of a contentious battle for a national health program that was ultimately foiled by the American Medical Association—Republican President Dwight Eisenhower handed the pen to Esther Lape, a social scientist and longtime universal health care advocate. Disappointed that the bill fell far short of her expectations, Lape reportedly waved the souvenir in the air and declared, “This represents a puny little bone in the vertebrae of what I had in mind!”
What Lape envisioned would be transformative: quality health care for everyone.
The ACA reforms initiated by Democrats provided some patient protections and increased health access for 20 million Americans since it was implemented in 2010. Its primary mission, however, was to ensure that Americans would have to rely on the for-profit insurance market.
Merely protecting the ACA would leave the most marginalized populations behind. Despite the ACA’s improvements, 28 million Americans remain uninsured, without access to primary care that could prevent costly and life-threatening diseases. Those fortunate enough to have insurance are assaulted by prohibitively expensive co-pays, premiums and deductibles that limit access to care.
This past year we saw an upsurge in popular resistance against Republican attacks on important—if imperfect—social welfare initiatives, especially health care for the most vulnerable. Activists pushed back attempts to repeal and replace the ACA with bills that would lead to the loss of health coverage for at least 22million Americans.
As a premedical student and a health care worker, I bear witness to a broad spectrum of suffering; the kind that we are all likely to face at some point during our lives. But what haunts me at the end of each shift is the pain that could have have been prevented if patients who are uninsured or under-insured had been able to access care sooner.
Take for instance the young woman who checked into the emergency room because she was uninsured and couldn’t afford the anti-inflammatory drugs that her doctor prescribed for her Crohn’s disease. Her symptoms worsened and when I x-rayed her, she was likely headed for invasive surgery.
Based on my personal experiences working in health care, I believe that the prescription for our collective heartache is improved Medicare for all: An insurance system that is government-financed but privately delivered and could save the U.S. nearly $600 billion annually while providing all Americans with access to quality health care.
Our health care system is once again at a crossroads.
Here in North Carolina, the General Assembly refused to expand Medicaid under the ACA, denying thousands access to basic care.
State Representative Donny Lambeth, a Republican, recently proposed House Bill 662, also known as Carolina Cares, that would finally expand Medicaid. However, as the Winston-Salem Journal reported earlier this month, some members of the General Assembly say that even if work requirements like those in Kentucky and Indiana are put into place, they won’t support providing health care to the state’s neediest citizens.
Meanwhile, the majority of Americans are increasingly realizing what 100 years of struggle has taught Medicare-for-all supporters already know: any measure other than national health insurance will fail.
Support for single payer is growing. According to the Pew Research Center, 60 percent of Americans believe that the federal government has a responsibility to provide health coverage to everyone. H.R. 676, the single-payer bill in the House, now has a record 120 co-sponsors; Sen. Bernie Sanders’ Medicare for All Act has 16 co-sponsors, including potential candidates for the presidential nomination.
It’s true that in our time, just as in Lape’s era, embracing single payer demands not only a radical revision of how health care is financed but the courage to move beyond half-measures.
As the popular saying goes, “You can’t cross a chasm in two small jumps.”
Imagine a health care program that provides affordable, quality care to every person—ourselves, our families and our neighbors—regardless of age, income or employment; a model proven to work in every other developed nation.
Isn’t that reason enough to take a leap?
Jonathan Michels is a freelance journalist, a healthcare worker and a premedical student based in Winston-Salem, NC. After graduating from UNC-Chapel Hill in 2011, Jonathan embedded with social justice activists from around the state including participants in the Occupy Wall Street, marriage equality and Moral Monday movements. When Jonathan isn’t muckraking, he works as an x-ray tech in one of the largest community hospitals in the state. Caring for Winston-Salem’s poor and uninsured informed his belief that every person has a right to healthcare. As student of various Southern organizing movements for social change, it is Jonathan’s experience that fundamental social rights like universal access to healthcare have only been won through collective struggle. Email: firstname.lastname@example.org
This article originally appeared inThe Pulse. You can read the original post here.
“The SNaHP Summit last year was a great tool for broadening my knowledge base about the nitty-gritty details of ‘Medicare for All’.”
On Saturday March 3, 2018, the Louisiana State University Health Science Center chapter of Students for a National Health Program (SNaHP) will host the 7th annual SNaHP Summit from 9:00 a.m. to 7:00 p.m. in New Orleans, Louisiana. The annual summit is a one-day event that gathers students from multiple disciplines to learn about what a national health program would look like in the United States, and how to think about and advocate for beneficial change in our healthcare system. Attendees network with students from all over the U.S., learn how to talk about health policy, and contribute to national strategy for single-payer advocacy. Dr. Steffie Woolhandler, MD, MPH, FACP, co-founder of Physicians for a National Health Program (PNHP), is a graduate of LSUHSC School of Medicine, and will be speaking at the summit.
There are currently 61 SNaHP chapters in 28 states across the country. SNaHP, the student branch of Physicians for a National Health Program (PNHP), advocates for a comprehensive single-payer health program for America.
Members of SNaHP assert that, “A single publicly funded, privately delivered universal healthcare system is necessary for us to provide high-quality care to all our patients.” Advocates point out that although the U.S spends over 17 percent of the GDP on healthcare, more than twice as much as any other industrialized nation, it underperforms in health indicators like life expectancy, infant mortality, and immunization. Furthermore, 33 million people in America are uninsured, which can make simple preventative measures that could deter costly chronic illness and life-threatening diseases inaccessible until it is too late. Additionally, for-profit health insurance companies make necessary healthcare prohibitively expensive even for many insured Americans.
SNaHP members believe a single payer system is the most efficient solution to providing quality healthcare to all U.S. citizens. On paper, it would save $400 billion a year. It would also improve and extend the quality of life of Americans, reduce hospital visits, and enable people to continue working and contributing to the economy.
Second-year medical student and chapter president, Justin Mckone, founded the LSU chapter of SNaHP in 2017.
“I started the SNaHP chapter at LSU to make sure everyone has access to healthcare,” Mckone said. “LSU prepares students to be well-trained and highly educated providers, but if our patients cannot afford our services then all our training and knowledge is wasted.”
He found other students with similar interests. David Lyle, second-year medical student and SNaHP treasurer, said, “I joined SNaHP to get involved with the politics of healthcare. As a healthcare provider, it seems that you should be involved in the decisions on who gets access to that healthcare.”
There are currently 68 LSUHSC students interested in SNaHP, including students from the medical, nursing, and public health schools.
In March of 2017, four members traveled to Lewis Katz School of Medicine at Temple University in Philadelphia, PA, to attend the 6th annual SNaHP Summit. Over 170 students attended. LSU students were able to collaborate with nursing, physician’s assistant, nurse practitioner, social work, and medical students from all over the country. There was a panel discussion, breakout sessions on topics like “Legislative Advocacy at the Nexus of Primary Care and Public Health”, planning for chapters organized by region, and a keynote presentation on healthcare justice by Nijmie Dzurinko.
Ashley Duhon, second-year medical student, and SNaHP Secretary, attended the 2017 Summit and looks forward to welcoming students to New Orleans for the 2018 Summit.
“The SNaHP Summit last year was a great tool for broadening my knowledge base about the nitty-gritty details of ‘Medicare for All’ and about how to get involved with advocacy for an issue I care so deeply about,” Duhon said. “I am excited for this year’s conference because this will be a valuable time to work on an action plan for our organization for ways to continue advocating to our Congressmen and educating our fellow medical students on why Medicare for All is the best possible healthcare system for our patients. In addition, I believe this will be a great opportunity for medical students around the country to see the rebuilding and growth that our healthcare system here in New Orleans has experienced since Hurricane Katrina”.
In July, the SNaHP national board asked if the LSU SNaHP chapter would be interested in hosting the 2018 Summit. The LSU chapter met with school administrators, and drafted a proposal for the cost of renting space and personnel at LSU. The SNaHP board accepted the proposal.
Any student from any school can register for the conference. Registration is $30 for conference admission only, and $80 for conference admission and housing for the weekend. Students can visit www.student.pnhp.org to register for the summit.
Claire Mickey is a medical student at Louisiana State University School of Medicine in New Orleans, Louisiana. She is the LSU SNaHP chapter VP of Education.
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.
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.
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 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.
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.
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.