Medicine has a problem with racism

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

-Armide Storey

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

Single-payer healthcare is the way to go

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Photo courtesy of Pictures of Money

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

– Keanan McGonigle

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

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

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

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

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

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

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

Keanan McGonigle is a medical student in New Orleans.

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

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

Jonathan Michels

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

-Bryant Shuey

snahp_2017_Cropped“Hello Ms. Jimenez!”

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

Ms. Jimenez did not have health insurance.

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

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

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

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

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

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

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

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

Appalachia needs a single-payer healthcare system

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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

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

– Jawad Husain

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

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

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

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

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

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

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

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

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

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

Kentucky should move forward, not backward, on healthcare access

kynectThis op-ed was originally published with Scalawag Magazine on January 12, 2017. This version includes a section on how single payer healthcare can help end health disparities in Kentucky and across the country. You can read the original article here.

By Brandi Jones and Mallika Sabharwal, University of Louisville School of Medicine

The patient reached for his bedpan and vomited. He clutched the right side of his abdomen and groaned.

His appendix was inflamed and had to be removed. As the surgeon explained the upcoming procedure, the patient, despite being in obvious pain questioned the necessity of the impending surgery. His concerns became evident when he alluded to having a new job and “waiting for his benefits to kick in.”

While the surgeon gently reassured him of the need for the appendectomy, the patient simply responded, “Now I’m missing work, and I still don’t know how I’m gonna pay for this.”

The unfortunate reality was that although his was the first such experience I encountered on my 8-week surgery rotation, it would not be the last. More than a dozen patients relayed their concerns about the price tag associated with their necessary interventions, their regrets over not being able to get the issues addressed before they became more emergent, and the mounting costs they would face after they were discharged, when they had to get medications and schedule follow up appointments. While I listened to each person’s problems, I couldn’t help but feel that the vast majority of their distress was preventable—if only our system was better suited to truly address the healthcare needs of its people.

One of the main goals of the Affordable Care Act was to increase the number of Americans covered by health insurance, and since the ACA’s enactment, the number of uninsured nonelderly adults has fallen by 37 percent1, with the largest gains among the poor, the near-poor, and minorities.

The law’s expansion of the Medicaid program was a big part of this achievement, enrolling an estimated 9 to 10 million of the previously uninsured. One of the areas most affected by the expansion was in Eastern Kentucky. Pike County, where the coal industry has abandoned jobs and the poverty rate is 23 percent, saw the greatest decrease in the uninsured rate. When the ACA took effect, the uninsured rate dropped from 13 percent to 6.6 percent – that is, approximately half of Pike County’s previously uninsured residents saw direct benefit from this implemented change.

In May 2013, Kentucky, Gov. Steve Beshear introduced a state-based online marketplace, Kynect, in compliance with the ACA and Medicaid expansion. All the plans guaranteed access to essential health benefits such as yearly checkups, emergency room and hospital visits, prescription drugs and care for pregnant women and children. Insurance plans also covered preventative care, like flu and pneumonia shots, routine vaccinations and cancer screening procedures such as mammograms and colonoscopies at no additional cost. Some plans also included dental and vision coverage and if they did not, those coverages could be purchased separately through Kynect.

Kentucky’s method of implementing the ACA was touted as a model for the rest of the country. Research from the Harvard T.H. Chan School of Public Health examined the impact of the traditional Medicaid expansion in Kentucky along with other states that did and did not opt to expand. The study found that the uninsurance rate declined by 14 percentage points in expansion states compared to states that did not expand Medicaid. The Medicaid expansion was economically beneficial, increasing jobs and tax revenues for the state. The Urban Studies Institute at the University of Louisville estimates that expanding Medicaid led to the creation of 12,000 jobs in 2014 alone and will add more than 40,000 additional jobs through 2021, which will only increase tax revenue for the state.

In 2015, however, Kentucky saw many changes following the election of Gov. Matt Bevin. True to the platform upon which he ran, the newly elected governor swiftly proposed to scrap the traditional Medicaid expansion in Kynect and to substitute a model patterned after what Indiana has implemented: a program that pushes health care costs back on Medicaid patients. The premise behind this push is that it will foster less dependency on state support and make individuals more accountable for the resources they utilize. This is not supported by data.2 Despite all signs pointing to this being an ill-advised, non-evidence based decision, the governor is forging ahead with his proposal to transition Kynect, the fully state-run marketplace, to Healthcare.gov, a federally supported state-based marketplace.

What exactly does this look like for Kentuckians? There will no longer be an eligibility and enrollment platform but instead an online portal for individuals to exclusively sign up for Medicaid and other federal aid programs. Enrollment into other insurance programs will be through Healthcare.gov. Insurance plans will be contracted with the federal government instead of the state. As was witnessed in Indiana, it is anticipated that the special waivers being sought would do more to increase the out-of-pocket spending (and added financial barriers for care) than it would for increasing coverage for underinsured Kentuckians. The Kaiser Family Fund reports that 72 percent of constituents said they would prefer to keep the state’s Medicaid program as it is rather than reduce coverage to fewer people. Besides reducing coverage, the plan burdens vulnerable populations, with volunteer or job requirements and locking them out if they are unable to pay a monthly premium.

Under the new waiver, individuals who have Medicaid will have to pay income-based monthly premiums and fulfill varying work requirements in order to maintain their eligibility. If they don’t meet the requirements, they could face penalties, including a temporary loss of coverage. The waiver also eliminates dental and vision coverage and sets up restrictive health savings accounts for members. The aim of this waiver system is to transition individuals towards privately-funded care. The legitimacy of this aim has been under considerable scrutiny in the literature, as it rejects the data suggesting that linking healthcare (or other social supports) to employment is not the key to mobility for most Americans.

Kentucky is a state with a long history of being ranked near the top of some lists (cancer rates, chronic lung diseases, child abuse, obesity) and the bottom of some others (education). But it was able to get a feather in its cap by launching a well-functioning marketplace through Kynect. But Governor Bevin seems to covet our worst rankings. He plans to replace the system that placed us on a national platform in a positive light with an antiquated system that has been shown time and again to be ineffective, impractical, and quite frankly, immoral. Kentucky’s Medicaid waiver proposal is de-humanizing and forces individuals to prove their worth – something uncalled-for when it comes to health care access.

If the Bluegrass State really wants to change the current system, an even better solution to Medicaid expansion is to transition to a single-payer health care system which could provide coverage for doctor, hospital, preventive, long-term care, mental health, reproductive health care, dental, vision, prescription drug and medical supply costs for every person in the state.

How would something at such a level be funded? It’s actually surprisingly simple – by dismantling private, profit-oriented insurance companies and replacing them with a single streamlined, nonprofit, public payer system. There would be no more deductibles or co-pays and no stipulations such as work-hour requirements that keep individuals uninsured. This is a system that would be privately run but government funded – similar to the way things are managed with Medicare of the VA, but improved and expanded. There is no other plan being proposed that has at its foundation a focus on the health care needs of all the people, while also being mindful of our current financial reality.

As future health care professionals who believe that access to care is a human right, we support HR 676, the Expanded and Improved Medicare for All Act. It would save billions in administrative costs3, allow people to choose any doctor or hospital, and would not compromise the current health care system’s capacity with increased wait times. It would not raise costs while still allowing for innovation and the highest quality clinical care.

Although great strides have been made in Kentucky with the introduction of the recent expansion, it is still not enough. The current system, Kynect, is flawed and fails to provide enough coverage for everyone. However, rather than taking two steps backward with Governor Bevin’s proposed waiver, we argue that we must take one leap forward by making health care accessible for everyone.

Kentucky and the country need a single-payer system, a health care system that fully insures individuals and that will go beyond any Medicaid waiver in guaranteeing sustainable, equitable care for all.

1http://kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/

2 http://healthaffairs.org/blog/2016/08/25/in-kentuckys-new-medicaid-plan-evidence-takes-a-back-seat/

3 http://www.pnhp.org/publications/nejmadmin.pdf

jones.headshot (2)Brandi Jones is a third year medical student at the University of Louisville School of Medicine and past-president of the UofL chapter of SNaHP. Her interest in healthcare reform is driven by her previous experience as a mental health provider and her past research related to health disparities.

 

 

CDC headshotMallika Sabharwal is a second year medical student and the president of the University of Louisville School of Medicine chapter of SNaHP. Her interests in healthcare coverage and single payer stemmed from working with Get Covered America.

SNaHP Call-In Day to Stop Health Cuts and Support Single Payer

single payer rally

TO PARTICIPATE, FOLLOW THE LINK OR SEE BELOW!: https://docs.google.com/forms/d/e/1FAIpQLSc-g_sQHevc39ke-AZ1BBZ9E7s1ayeoinV1TpT9rWG_bS1o-A/viewform

~~SHARE WITH OTHER PROGRESSIVE GROUPS TO ELEVATE OUR COLLECTIVE VOICE~

There has been an incredible amount of momentum around protecting the Affordable Care Act and the millions who would lose health insurance should the law be repealed as promised by the incoming administration.

Students and Physicians for a National Health Program is asking you to help us demand even more!

On Friday, January 13th, 2017, we’re asking SNaHP and PNHP chapters nationwide to mobilize students and physicians at their institutions for a call-in day. Our asks are simple:
1) We don’t want to see our patients suffer when 30 million people lose health care coverage: We want to prevent Medicare privatization and the transformation of Medicaid into block grants
2) Even more importantly, we want equitable healthcare for everyone, in the form of single-payer: We want our congresspeople to support H.R. 676, and our senators to support the national single-payer bill Bernie Sanders will be bringing to committee

Please try to call your senators and congresspeople, and have your friends and colleagues do the same!

Find your Congressperson here: http://www.house.gov/representatives/find/

Phone numbers for members of Congress can be found here: http://www.house.gov/representatives/

Phone numbers for Senators can be found here: http://www.senate.gov/general/contact_information/senators_cfm.cfm

#ProtectOurPatients: Defending Healthcare Access in the Wake of Donald Trump

15541959_10208411538867006_6986356909354642239_n“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.