Med students promote single payer in California

To watch a video of the lobby day, click here.

By Mark Almberg

The sun was shining in Sacramento as 400 people — mainly medical and health-professional students, but also practicing physicians and community activists — assembled on the Capitol steps.

Their signs read, “Health care for all! People over profits! Everybody in — nobody out!”

It was Jan. 28, 2008 — Lobby Day for a single-payer, universal health care bill in the California Legislature.

A growing movement

“It was our largest mobilization yet,” said Renu Tipirneni, a fourth-year medical student at the University of California-San Francisco (UCSF), noting that last year’s turnout was only about half as big.

Tipirneni, 27, is the Northern California coordinator of the California Alliance for Legislative Action for Universal Health Care (CALAUHC), the group that spearheaded the event. We recently spoke by telephone with Tipirneni and her Southern California counterpart, Parker Duncan.

For three years running, hundreds of medical students and other health-professional students from all corners of the state have descended on the State Capitol for a day of lobbying in support of state Sen. Sheila Kuehl’s “California Universal Healthcare Act,” a state-based single-payer plan currently known as S.B. 840.

The bill has a long history, its outlines having been developed by members of Physicians for a National Health Program (PNHP) in the early 1990s.

Kuehl’s bill would guarantee quality health care coverage for everyone in California by establishing a Medicare-for-All-type program to replace the for-profit insurance companies that currently dominate the California health care system. The bill has wide support and even passed the Legislature in September 2006, only to be vetoed by Gov. Arnold Schwarzenegger.

Tipirneni, known as Renu to her friends, has been part of the medical student movement in support of the single-payer bill for the last four years. During the interview she spoke about why she considers the issue so important and how she got involved.

A question of social justice

“I have felt a strong need to promote social justice for much of my life,” Tipirneni said. “When I started medical school, it was a natural shift to support health care justice.”

She traces her social activism back to her undergraduate days at Cornell University. One summer, as part of a research project, she visited farm worker labor camps in upstate New York to conduct interviews with workers about sanitation practices. The workers’ living conditions were “very inadequate,” she said.

“I was asking farm workers questions about their hand-washing practices. But I couldn’t help thinking about where I was coming from: Cornell was surrounded by agricultural land, and yet most students had no idea how marginalized farm workers were.”

That experience prompted her to join with other students in forming the Farm Worker Advocacy Coalition on campus, which educated other Cornellians about the farm workers’ plight (“No day of rest … no right to organize”) and lobbied the New York State Legislature for agricultural labor law reform.

“That’s where I started to develop many of my organizing skills,” Tipirneni said. She also partially credits her parents, especially her father, for her organizing savvy. She traveled with her father to his native India in 1999 to view several development projects he and others had raised money for, and noted his knack for making personal connections.

“I’m told it takes a certain personality to be an organizer,” she said. “So there’s probably a little bit of parental influence, too,” she laughed.

A vow on entering medical school

Tipirneni said that when she applied to medical school at UCSF she was required to make a personal statement about her medical career. “I said I was going to medical school not just to treat my patients’ diseases, but also to ensure they had access to the health care I would deliver.”

“Early on I identified myself as someone who was interested in health policy,” she said, even though it was not a large part of the curriculum. As it turned out, “I was fortunate to hear lectures on campus by prominent policy experts like Dr. Kevin Grumbach and Dr. Thomas Bodenheimer,” both founding members of Physicians for a National Health Program. “That’s when I first heard about single payer as a concept.”

She learned more at a conference of the American Medical Student Association (AMSA), where she met a number of like-minded students. She subsequently did an intensive study of the policy literature and, in preparation for a trip to Sacramento with two other students, a line-by-line review of Sen. Kuehl’s first single-payer bill.

Most people don’t come to single payer by such a “nerdy” or wonkish path, Tipirneni said. “Many students have compelling personal experiences — a medical crisis that happened to themselves, their families or their friends — that move them in the direction of single payer,” she said. “Others are shaken by their first clinical practice experiences.”

Tipirneni said that medical students who testify at Lobby Day events often relate stories about the hardships they or their patients have faced as a result of our broken health care system. Their stories sometimes bring legislators to tears, she said.

Year-round activity

In the course of her work with the student health care alliance, PNHP has been a steady source of support.
“Another person I met from Physicians for a National Health Program at UCSF was Dr. Richard Quint,” Tipirneni said. “He’s been a terrific advocate for medical students.”

PNHP has also been helpful in raising money for the medical student single-payer movement. “A thousand dollars goes a long way toward paying for the buses to Sacramento,” she said.

Besides organizing the annual Lobby Day, CALAUHC also helps organize talks on single payer — often featuring PNHP spokespersons — on other California campuses. “The value of such talks cannot be understated,” she said. The group also encourages health-professional students to become politically active and to acquire advocacy skills on related social justice issues.

What does she like to do when she isn’t studying or organizing? “Hey, this is California,” she said. “I love hiking, and there’s lots of hiking out here. I also like playing the cello when I can.”

A ‘nontraditional’ student joins the fray

Parker Duncan, a fourth-year medical student at the University of California-Irvine, is frequently called a “nontraditional” student: he’s both a military veteran and was in his 30s before he decided to go to medical school.
“It turns out I’m also nontraditional in my advocacy of a redefinition of the culture of U.S. medicine,” he said, referring to his work for health care reform.

Duncan, 39, started out at Duke University on a very different path. He went to college on an ROTC scholarship, majoring in political science, thinking he might follow in the footsteps of his father, grandfather and great-grandfather and become a lawyer.

He did his post-graduation military service in the Persian Gulf, serving two tours of duty there in the early 1990s. “It was during my first tour, steaming toward the Gulf on the USS Nimitz, that I had my political awakening,” he said.

A turning point

His social consciousness “sat in idle,” he said, until he left active duty. But only a week after his return, he went backpacking through Guatemala with a teacher-friend.

“Guatemala totally lit up something inside of me,” he said. “I could see, feel and touch the problems facing underserved populations.” Sometime thereafter he put his other plans — including his preparations for law school entrance exams — on hold and returned to Guatemala for six months to study Spanish.

“When I returned to the U.S. from Guatemala I became a bilingual counselor at an adult residential facility in San Francisco,” he said. “I was doing healing and advocacy for an underserved population, and I felt confident I was on the right track.”

Duncan said some of the psychiatrists he worked with at the facility had a big influence on his decision to pursue a career in medicine. He subsequently applied to go to medical school at the University of California-Irvine.

The single-payer connection

Duncan chose UC-Irvine because it was launching an innovative program called PRIME-LC (Program in Medical Education for the Latino Community) that focused on training physicians to work in underserved Latino communities. “It was a perfect fit,” he said.

Although he came into contact with the idea of single payer for the first time at an AMSA convention — where, incidentally, he first met Renu Tipirneni — he said his commitment to work for it was reinforced when he heard Dr. Kevin Grumbach of PNHP give a grand rounds in Oakland on the history of health care reform in the United States.
The lecture so impressed him, he ran up to the PNHP literature table and asked how he could get involved. “I said I was from UC-Irvine, and they said, ‘Oh, then you’ve got to meet Dr. Sherif Emil!’”

As it happens, Dr. Emil, a pediatric surgeon, was already known to him as a faculty member who had once ended a lecture a few minutes early to encourage students to learn about “the larger issues in medicine.”

Duncan subsequently arranged for Dr. Emil to give a talk on single payer, and “it was the best-attended, non-mandatory lecture all year long.” It was a catalyst for not only Duncan’s involvement, but for many of his classmates as well.

Duncan said that health care policy is something that is usually neglected in medical school. “It’s only been through organizing for Lobby Day that we’ve been able to introduce many medical students to these concepts. Once they hear about single payer — like S.B. 840 or H.R. 676 nationally — it makes immediate sense to most of them.”

Looking down the road

It’s not all easy going, however. “Some students go into specialties that are not so much directed at patient care, but which have the lure of higher salaries or a ‘better lifestyle,’” he said. “Some don’t know much about health policy and don’t want to learn — it’s sometimes easier to burrow into your own little world.”

At the same time, he’s been heartened by the growing number of medical students who participate in Lobby Day and believes the time spent on speaking and organizing for single payer has been well worth it. He’s also glad to see the emergence of a new generation of leadership among medical students who support single payer.

Just like Tipirneni, he’s been encouraged by the support of his parents, particularly the example set by his mother, an activist in the 1960s and a retired director of public housing. “My mother remains active in politics today as a regional director for MoveOn. She attended this year’s Lobby Day and videotaped the training session I gave on how to lobby your legislator. We recently got together and put together a little film.” (Readers can see the video at http://tinyurl.com/4wqh4t.)

Looking 10 years down the road, Duncan sees himself working in a family practice, probably in a Latino community. But he feels a powerful tug in the direction of politics, as well. Time will tell, he said.

Summing up, Duncan said, “I joined the military because, when and where I grew up, that’s what ‘service to country’ meant. Today, my work with underserved Latino communities and for a rational health care system represents a redefinition of ‘service to country’ that’s much more in line with my values.
“The system has to be fixed,” he said.

Mark Almberg is communications director at Physicians for a National Health Program (www.pnhp.org).