Category: Blog

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

-Suhas Gondi

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

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

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

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

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

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

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

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

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

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

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

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

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

-Vidya Visvabharathy

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What personal experiences have shaped your decision to take action?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

-Gloria Tavara and Nikhil Krishnan

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

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

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

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

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

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

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

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

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

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

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

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

Killing Medicaid expansion means killing Ohioans.

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

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

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

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

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

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

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

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

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

How long have you been a member of SNaHP?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

And of course, keep bothering your state reps.

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

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

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

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

“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

This 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 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.

“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.

“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.

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: jonscottmichels@gmail.com