Category: Blog

“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

“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

“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.

Bryant 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

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

During 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.

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.

Why: 
• 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.

 

“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.

President 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.  

This 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.

 

 

Mallika 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.

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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

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

By Ebiere Okah and Lily Ostrer

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

While single payer is theoretically an option when the ACA is repealed, it is unlikely to happen under a Trump administration.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

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

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

By Vanessa Van Doren and Jonathan Michels

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

 

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

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

 

2.Congress grills Big Pharma CEOs over price hiking.

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

 

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

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

 

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

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

 

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

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

 

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

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

 

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

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

 

8.Aetna pulls out of ACA marketplaces.

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

 

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

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

 

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

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

 

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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