Category: Blog

Nov. 3 Follow-Up to #TreatNotTrick in Philadelphia

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philadelphia_snahpPhoto courtesy of Amanda Malik.

“The question of class and worker status is a deeper one than we can deal with in a single article or action, but it’s one that physicians in particular need to grapple with if they value social justice.”

-Karim Sariahmed, SNaHP member

For SNaHP’s #TreatNotTrick Philadelphia action, a group of ten people gathered at City Hall. They were mostly medical students with SNaHP, joined by two members of Put People First! PA (PPF-PA) and another local activist.

Our small action became less about projecting something for the public and more of an intimate opportunity to nourish ourselves so we could step into our power together. We heard a personal story from Amanda Malik, a third year at Cooper Medical School of Rowan University, about the perverse way that time spent haggling over patients with insurance companies marks the urgency of providing basic care. We heard from Rebecca Lin, a 1st year at Lewis Katz School of Medicine (LKSOM) who framed the policy issue by describing the absolute numbers of uninsured people (24 million), and the number of preventable deaths due to uninsurance every year (45,000, the same number killed by kidney disease).

I shared some of the history of the Kensington Welfare Rights Union, a working class group that worked to overcome racism and segregation in their community to fight poverty, an effort whose legacy and theory of change lives on through PPF-PA’s campaign to make healthcare a human right in Pennsylvania. It also shines through in the KWRU song “Went Down to the Rich Man’s House,” which we sang together during the action.

The question of class and worker status is a deeper one than we can deal with in a single article or action, but it’s one that physicians in particular need to grapple with if they value social justice. Still, singing this song gave life to the idea that part of what unites healthcare workers with the broader anti-poverty and anti-austerity movements (the source of power able to make the political lift of passing single payer and other significantly redistributive legislation, in my opinion) is our shared ownership of healthcare work.

Med students, nurses, physicians, physical therapists, physicians’ assistants, lab technicians, medical assistants, security guards, pharmacists, environmental service workers, ambulance drivers, and patients all share a powerful stake in winning a system that works for all of us. We are not yet organized enough to harness all of the latent power in this idea that our work belongs to all of us, and not to the insurance executives like CEO of Independence Blue Cross (IBX) Daniel Hilferty, who extract its value. However, part of our encounter last night made it clear that we already have some power.

We were wearing Halloween costumes. Emily Kirchner, a fourth year and a lead organizer for the action, was wearing a dinosaur mask. Tony Spadaro, a third year at Penn Med was wearing a banana suit and holding a paper bag that said “Private Insurance is Bananas.” I shaved my head and drew a fake beard on my face to look more like Dr. Hugo Strange from Batman. We had a good time, and we sang confidently as we marched to the IBX headquarters, just four blocks away from our gathering at City Hall.

When we arrived, we were met by IBX’s head of security, and civil affairs police officers on bikes were lined up in front of the building. We were expecting them to be there, so we just went ahead and lit our candles as Shalonda Cook, another first year from LKSOM, lead us in a vigil to honor the struggle of people fighting for their lives in our broken healthcare system. Then we shared some reflections before heading home.

While doing this we realized that the security force flanking our vigil actually outnumbered us. There are two crucial questions we need to be asking: What are they protecting, and whom are they protecting it from? I think the biggest threat to them is a movement of working and dispossessed people poised to isolate them from hospitals, insurance departments, welfare offices, and other public institutions whose cooperation they take for granted.

This Thursday, November 3rd, PPF-PA will be in the same place to fight back against the outrageous ACA premium increases recently approved for IBX and other insurance companies by the PA Insurance Department. I think the stories shared there will give us some clarity as to who “we” are, and what we are up against in the fight to abolish insurance profiteering and install single payer.

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Karim Sariahmed is a second-year medical student at the Lewis Katz School of Medicine at Temple University. In addition to supporting the growth of Temple Med’s SNaHP chapter, he is a member of Put People First! PA. This is the community in Philadelphia that teaches him how to organize alongside many other developing organizers from various healthcare professions and healing traditions. You can read his other work at in-Training and the PPF-PA blog. He tweets @sariahmed.

“Let’s treat our patients, not trick them with private insurance”

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Jack-o'-lanterns carved from pumpkins and lit with tea lights
Photo courtesy of William Warby.

This op-ed was originally published on Common Dreams on September 18, 2016. This version includes a section on how single payer healthcare can help end LGBT health disparities. You can read the original article here.

“This Halloween, medical students are refusing to endorse the horrifying system as it exists. We will don our white coats and witches hats, publicly and politically demanding the ability to #TreatNotTrick.”

A few days ago, I was studying a medical diagram in a coffee shop when a man in his mid-forties walked in. His face was red, he was sweating, he looked upset.

“Please, can anyone help me?” he asked. “My daughter is at Children’s Hospital for seizures and she needs medicine. My credit card is maxed out. I need $16.50.”

A few weeks ago, I was listening to a friend describe a Pennsylvania Insurance Department hearing on proposed rate hikes for marketplace health insurance premiums.

“One insurance company representative actually asked the department to consider the health of the company,” he said. After this hearing, all six insurance firms received rate increases, often more than the rate increases they had requested.

A few months ago, I was standing in the operating room. The attending surgeon was instructing the resident about how to deal with a patient who had insurance difficulties.

“Well, the patient is going to say, ‘My insurance says they won’t pay for it,'” he said. “You say, ‘That’s not my problem. I gave you my advice.'”

Before you dismiss the coffee shop encounter as a panhandler pestering customers, consider that we live in a country where some medications have unaffordable copays, that many people go without needed medicines, and that people often have to make a choice between seeing the doctor and paying their utility bill.

Before you dismiss the big premium increases by pointing to Obamacare’s subsidies, consider that we live in a country where insurance firms helped write the Affordable Care Act, that millions of people remain uninsured despite the ACA, and that copays and deductibles are sharply rising.

Incidentally, the “health of the company” is not the kind of health I give a damn about.

Before you dismiss the attending surgeon’s callous attitude as difficult reality in a changing practice environment, consider that our current inefficient health care system harms patients, that doctors spend hours of their time demanding necessary tests and procedures from health insurance corporations that deny medical care because it threatens their bottom line, and that burnout contributes to hundreds of physician suicides each year.

This picture is horrifying. So horrifying that medical students like me believe that this Halloween is the perfect time to once again focus attention on our fractured health care system.

Our message: Private health insurance is a trick. We just want to treat our patients.

Our demand: An improved, expanded, “Medicare for all” national health program. It’s the only way to provide affordable, quality care for everyone.

Students for a National Health Program (SNaHP) is sponsoring the Second Annual Medicare-for-All National Student Day of Action on October 31, dubbed #TreatNotTrick. More than a few of us will be wearing Halloween costumes.

The actions are co-sponsored by the American Medical Student Association, the Latino Medical Student Association, White Coats for Black Lives, and many regional and local groups.

In Boston, students will host a public demonstration and call-in asking Rep. Mike Capuano to sign on to the single-payer bill, H.R. 676. In Ohio, medical students will visit Sen. Sherrod Brown and ask him to sponsor a Senate single-payer bill. In Philadelphia, students will rally and memorialize the lives lost to uninsurance and underinsurance with a candlelight vigil.

From California to Minnesota to Tennessee, no less than 33 medical schools are hosting campus events, rallies, lobby visits and demanding attention for improved, expanded Medicare for All right before the November elections.

This Halloween, medical students are refusing to endorse the horrifying system as it exists. We will don our white coats and witches hats, publicly and politically demanding the ability to #TreatNotTrick. Join us.

 esk photoEmily Kirchner is a third year medical student at Lewis Katz School of Medicine at Temple University in Philadelphia, Pennsylvania.  She is a member of SNaHP’s media team and political advocacy team. You can read more of her work at in-Training and The Billfold.

Single payer and the struggle to end LGBT health disparities

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This op-ed was originally published on In-Training on September 18, 2016. This version includes a section on how single payer healthcare can help end LGBT health disparities. You can read the original article here.

“The antidote to division and disparity is unity.”

-Tyler McKinnish, 4th year medical student

“I’m going to a drag show tonight.”

My third year resident asked what I was doing with my day off, and my reply, the gayest of weekend plans, gave her pause.

I felt the same awkward beat in our otherwise amiable conversation, saw the same uneasy shift in her seat, just the day before when I told her about a date I had been on. I’m not exactly inconspicuous about my sexuality in the first place, so I wasn’t prepared for her to be surprised that I’m beyond-a-shadow-of-a-doubt-gay. I had felt uncomfortable for making her uncomfortable, and wasn’t exactly sure why. I wondered if I was allowing some sort of personal insecurity or professional courtesy insinuate discord in a completely innocuous conversational pause. So I could have said “I’m going out” or to a bar, or something similarly vague, but I wanted to test the waters. I wanted to confirm a suspicion that it wasn’t just me, and it wasn’t just once.

I have spent the last 11 months as a student in North Carolina’s largest not-for-profit hospital system, and in all that time have heard very few LGBT physicians speak openly about their lives. Even in conversations overheard in communal spaces- about Tinder dates and husbands, the antics of beloved children, office politics, hectic schedules and Blue Apron dinners- the lives of LGBT people are rarely discussed. When they are, it is in hushed tones and whispers. Physicians in particular seem reticent even to say the word “gay,” and I can only imagine why. For some it is likely out of fear of offending coworkers or patients- for saying the wrong thing in front of the wrong person. For others, whom I hope are the minority, maybe it is out of some actual disdain for LGBT people. For most, however, I suspect it is simply because they are not accustomed to thinking about LGBT people, so personal, real, non-political discussions about us seem foreign and uncomfortable, an ill fitting glove on a surgeon’s busy hand.

Even the other residents, many just a few years older than myself, seem to get a bit squirrely when the topic of conversation involves the LGBT community.  They shy away from discussing the topic, and for most, their few interactions with the LGBT community are not enough to remind them of our existence. What then is the motivation for these future leaders of healthcare to learn about the health of our community? How can they be expected to empathize, to relate, to communicate on a deeply personal level with us, their patients?

The interpersonal ease needed to establish trust between patient and provider might come easily to some, but is only the first barrier. As physicians and physicians-in-training, we ask patients to disclose uncomfortably thorough social and sexual histories which often go beyond the limits of our own experiences. Then we critique them, offering suggestions for risk reduction based on our medical expertise. In order to do this effectively, we are asked to know a lot about communities to which many of us are not members.  A heterosexual, white, female physician is asked to stratify STI and HIV risk beyond the level of “gay vs. not gay,” and tell a bisexual man of color about his statistically higher risk of HIV infection than his white or Hispanic peers, while taking into account his individual risk and screening him appropriately.1 To do so, she must also know that HIV is on the rise in many male sexual minority communities, and that even protected sex is not 100% safe as diseases such as syphilis and herpes may be transmissible even with the use of a condom. Putting patients on PrEP (Pre-Exposure Prophylaxis) medications can decrease the risk of sexually transmitted HIV infections by over 90% in high risk individuals, which includes approximately 1 in every 4 MSM, but in 2015 only 1 in 3 primary care doctors and nurses even knew about PrEP.2

Our hypothetical lady doctor must evaluate her patient’s need for PrEP, but she also can’t forget to have discussions about tobacco, alcohol, and drug abuse and screen for depression, each of which is significantly more common in LGBT patients. Not only does she have to be confident and tactful when talking about these sensitive subjects with her patients, her knowledge about them has to be up-to-date and community-specific.

Transgender people have needs that are not shared by their LGB peers, and that providers may be particularly unlikely to recognize. According to the National Transgender Discrimination Survey, 50% of respondents reported having to teach their doctors about trans* health, which includes an enormous number of healthcare disparities. The rate of attempted suicide in the community is egregiously high at 41%, and the prevalence of HIV is 4 times higher than the national prevalence.3 Even more upsetting, though, are the social inequities suffered by trans* patients. Fifty-five percent of trans people reported losing their jobs simply because they are trans*, and 16% had to resort to illegal trade of sex or drugs simply to survive. Kids are not impervious to these disparities, either: the rate of bullying of trans* kids in schools is nightmarishly high (78%) with nearly 1/3 having been physically, and 1/10 sexually, assaulted.

What will our archetypal physician say when her transwoman patient asks about PrEP? How will she start the conversation with this woman about her life, her anatomy, her safety? Will she know the indications for prescribing PrEP and be willing to do so? She will also need to screen this woman for prostate cancer and sexually transmitted infections (in the correct places), and recall that transwomen with past hormone use need breast cancer screening but not pap smears. How will she go about asking this patient about intimate partner violence? I hope at the very least she will be able to empathize with this woman’s situation, understanding that even to have presented to a doctor’s office she must have overcome enormous adversity.

Healthcare providers, however, are only one component of the disparity perpetual motion machine that is a healthcare system designed for profit. After all, lesbian, gay, and bisexual people are all less likely to have insurance than straight people, or even a usual place to go for medical care; bisexual and lesbian women in particular are less likely to obtain medical services due specifically to cost.4,5 This includes routine screening like pap smears and mammograms, which should be conducted with the same frequency as their heterosexual counterparts but multiple studies have suggested are not.4,6 Trans* people too are significantly underinsured and have worse health outcomes than even their LGB peers; yet, 19% of trans* people have been refused medical care in the past simply for being transgender.

Although a national problem, health disparities within the LGBT community are even greater in the South. Never a state to discriminate discriminately, Tennessee recently passed SB1556, a bill that allows therapists and counselors to refuse service to all variety of LGBT patients when treating them is contrary to any “sincerely held” beliefs. In Mississippi, HB1523 allows universities, government employees, contractors, and private businesses, which includes nearly all of the state’s health care providers, to similarly discriminate against LGBT people for religious beliefs. Here in North Carolina- ground zero for state-sanctioned LGBT discrimination- HB-2 requires that transmen and transwomen use the public restroom congruent with the gender assigned to them at birth. It also eliminates expanded LGBT anti-discrimination policies that previously existed in some cities, removes all local authority to increase minimum wage and benefits for public contractors, and abolishes state-level legal recourse for employment discrimination. Other states have tried, and failed, to pass this type of bigoted legislation as well, including Georgia, Kentucky, Indiana, South Dakota, and West Virginia.

In Florida, the Pulse nightclub shooting has been a horrific and tragic reminder that legislators and their policies are not our only enemies. LGBT people- our friends and family- are under attack, and whether it be from chronic diseases, political negligence, or at the hands of malicious enemies of love and equality, LGBT people are dying.

Justice in healthcare alone cannot solve these problems, but it is one of the most important interventions for the elimination of disparities affecting the LGBT community.  Expensive deductibles and copays that restrict access to healthcare consign low-income people, including many members of the queer community, to choose between illness and poverty. The logistically complex and restrictive system that currently excludes patients and burdens providers must be examined and eliminated in favor of an equitable system: single-payer healthcare. A national single-payer health program is the only feasible means of improving the efficiency and fairness of access to healthcare regardless of race, gender identity, sexual orientation, national origin, religion, disability, age, or any other divisive label. Numerous industrialized nations with superior healthcare outcomes already utilize this system, endorsing the singular notion that healthcare is a human right.

Our system of healthcare is fundamentally broken. LGBT people have disproportionately limited access to healthcare; cost, lack of insurance, fear of judgment, and outright discrimination preclude them from receiving care. When other factors like race, socioeconomic status, and social support compound this lack of access, LGBT people have little hope of becoming LGBT patients. Even when they are able to access care, they cannot be guaranteed that their provider will possess the necessary knowledge or training to offer them comprehensive care; as my own experience shows, nor the comfort. We- as healthcare professionals, trainees, friends, and neighbors- are simply not working hard enough for the LGBT community.

Thankfully, we all have the power to change that. The antidote to division and disparity is unity. It is imperative that we all become advocates for adequate training of healthcare providers. Ask your doctor if they have any training in LGBT health, suggest it in the patient satisfaction survey your hospital provides, refer providers and colleagues to lgbthealtheducation.org for professional development, and use the HRC Healthcare Equality Index to find LGBT-inclusive medical care. Use your voice, your influence, your time as an ally in the fight for a social justice issue that benefits the LGBT community- no matter which, just pick one and get involved. Finally, get educated about single-payer healthcare; join Healthcare-Now!, or Physicians for a National Health Program, or Students for a National Health Program and become a champion of access to affordable, high-quality, and comprehensive healthcare for all.

 

  1. Centers for Disease Control and Prevention. HIV Infection Risk, Prevention, and Testing Behaviors among Men Who Have Sex With Men—National HIV Behavioral Surveillance, 20 U.S. Cities, 2014. HIV Surveillance Special Report 15. http://www.cdc.gov/hiv/library/reports/surveillance/#panel2. Published January 2016. Accessed [date].
  1. Smith, DK et al. Vital Signs: Estimated Percentages and Numbers of Adults with Indications for Preexposure Prophylaxis to Prevent HIV Acquisition — United States, 2015. MMWR. 2015: 64 (46); 1291-1295. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6446a4.htm?s_cid=mm6446a4_w
  1. Grant, Jaime M., Lisa A. Mottet, Justin Tanis, Jack Harrison, Jody L. Herman, and Mara Keisling. Injustice at Every Turn: A Report of the National Transgender Discrimination Survey. Washington: National Center for Transgender Equality and National Gay and Lesbian Task Force, 2011.
  1. Buchmueller T, Carpenter CS. Disparities in Health Insurance Coverage, Access, and Outcomes for Individuals in Same-Sex Versus Different-Sex Relationships, 2000–2007. American Journal of Public Health. 2010;100(3):489-495.
  1. Ward BW, Dahlhamer JM, Galinsky AM, Joestl SS. Sexual orientation and health among U.S. adults: National Health Interview Survey, 2013. National health statistics reports; no 77. Hyattsville, MD: National Center for Health Statistics. 2014.
  1. Mravcak S. Primary Care for Lesbians and Bisexual Women. American Family Physician. 2006: 74(2) 279-286.

tyler_mckinnishTyler McKinnish is a fourth-year medical student at the UNC School of Medicine and a desperately optimistic future Ob/gyn. He is passionate about LGBT health, academic medicine, and health equity. When not working in the lab or clinic, he enjoys hot yoga, climbing, and cooking.

NATIONAL DAY OF ACTION: This Halloween, let’s treat, not trick, our patients!

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Despite living in an era of great potential in the fight against disease and death, Americans continue to be haunted by health care profiteers. This Halloween, hundreds of medical and health professional students around the country will call on candidates and elected officials to abolish private health insurance, and to replace the health insurance industry with an expanded and improved Medicare-for-all.

Our message: “Private health insurance is a trick – we just want to treat our patients.”

This national day of action, dubbed #TreatNotTrick, is organized by Students for a National Health Program (SNaHP) and supported by well-known health professional student organizations such as the American Medical Student Association, The Latino Medical Student Association, White Coats 4 Black Lives, and the California Health Professional Student Alliance.

#TreatNotTrick will be an opportunity to put pressure on candidates to include improved Medicare-for-all, or “single payer” health insurance, in their platform just one week prior to the November elections. The decision to organize this national event was made after the success of SNaHP’s “TenOne” day of action in October 2015. During that event, more than 35 actions were organized at dozens of medical schools, and many groups received local media coverage.

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[Photo caption: Chicago medical students march in front of Humana’s local headquarters during 2015’s #TenOne action]

There isn’t a week that goes by without a scandalous headline highlighting the broken quality of health care financing in the United States. Recently, mega-insurer Aetna backed out of the Affordable Care Act’s marketplace exchanges in 11 states, significantly reducing access to care in several portions of the country. Shortly after, there was public outcry over a 600% price surge of the life-saving EpiPen by big pharmaceutical company Mylan.

There is a better way to provide care for everyone while also controlling costs: Improve and expand the existing Medicare program to cover all medically necessary services, and enroll everyone from the day they are born.

The timing of #TreatNotTrick is critical. The outcomes of this year’s election will set this country’s political priorities for the next four years or more. A unified call for improved Medicare-for-all so close to the election will demonstrate that affordable, accessible health care for everyone is only possible with single payer. Not only do the majority of Americans want it, but the current system will buckle without it.

The editors of this blog urge all medical and health professional students to add their voice to this call and to get involved by joining or organizing a #TreatNotTrick event this Halloween.

Questions about #TreatNotTrick may be directed to students@pnhp.org.

Here is a list of participating schools and events:

Baltimore:

  • Johns Hopkins University School of Medicine

Illinois:

  • Pritzker School of Medicine – University of Chicago
  • Rosalind Franklin University of Medicine and Science
  • Rush Medical College & Rush College of Nursing
  • Feinberg School of Medicine at Northwestern University
  • Midwestern: Chicago College of Osteopathic Medicine
    Monday, October 31
    11am-1pm
    Information Booth & Letter-Writing Workshop
    Contact: Taysa Bowers, 925 451-5829; tbowers19@midwestern.edu

Ohio:

  • Case Western Reserve University School of Medicine
    Monday, October 31st
    Lobby visit to Sen. Sherrod Brown
    Contact: Vanessa Van Doren, vev5@case.edu
  • The Ohio State University College of Medicine

Meeting with Mike Stinziano of the Columbus City Council to speak on effective techniques for medical lobbying & ways to influence healthcare legislature as medical students

Minnesota:

  • University of Minnesota Medical School
  • Mayo Medical School

Madison, Wisconsin:

  • University of Wisconsin School of Medicine

Philadelphia, PA

  • Lewis Katz School of Medicine at Temple University/Cooper Medical School of Rowan University/Perelman School of Medicine at the University of Pennsylvania
    Monday, October 31st, 6pm, City Hall
    Rally and Vigil

https://www.facebook.com/events/570996616419036/

Contact: Emily Kirchner, ekirchner89@gmail.com, 724 561 8336

Scranton,PA

  • The Commonwealth Medical College

New York

  • Weill Cornell School of Medicine

Patient testimonials exhibiting the deficits of the health care system

Olin Hall–Olin Lounge/ Weill Education Building–Archibold Student Lounge

Photo ID required to visit campus buildings

10/31-11/3

  • Icahn School of Medicine at Mount Sinai
  • Columbia University College of Physicians and Surgeons
  • New York Medical College

Boston, MA

  • Boston University School of Medicine
    October 31st, 3-4:30 PM, Talbot Green
    Demonstration and Call-In

https://www.facebook.com/events/323487411336598/

  • Harvard Medical School
  • Tufts University School of Medicine

Southeast:

  • University of Louisville School of Medicine
    Rally with student and physician speakers + Petition for H.R. 676 support in KY
    U of L Health Science Campus Quad
    (500 South Preston btw Muhammad Ali Blvd and East Chestnut St)
    October 31st, 12 pm
    https://www.facebook.com/events/1578361099137154/
    Contact: Mallika Sabharwal,  malsabharw@gmail.com
  • Virginia Commonwealth University School of Medicine
  • Kirksville College of Osteopathic Medicine – A. T. Still University
  • East Tennessee State University Quillen College of Medicine
  • Emory University School of Medicine
  • University of South Alabama College of Medicine

New Mexico:

  • University of New Mexico School of Medicine

Texas:

  • Texas College of Osteopathic Medicine
  • University of Texas Health Science Center

California:

  • Touro University California – College of Osteopathic Medicine
  • The David Geffen School of Medicine at UCLA

Caribbean:

  • Ross University School of Medicine

“Healthcare is a human right”: Single-payer testimonials

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“I think it’s fundamentally wrong for some people to live shorter, sicker lives because they can’t afford healthcare.”

-Vanessa Van Doren, medical student and SNaHP member

Members of Students for a National Health Program (SNaHP) and medical students from across the United States are joining together to voice their support for the Physicians’ Proposal for Single-Payer Health Care Reform. To learn more about this important proposal, and to learn how you can advocate for meaningful health care reform, please visit www.pnhp.org/nhi.

Medical School: An invitation for activism towards single-payer

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“If you care about a health care system that serves the needs of everyone, not just the privileged or the wealthy, there is room for you in this movement.”

-Josh Faucher, SNaHP member

I’ve been a part of SNaHP since the beginning, watching our annual gathering grow from a few dozen people in a small conference room in 2012, to the massive turnout we had this spring with representatives from around the country.

Each year, I’m impressed with the reality that many of our most enthusiastic and active members are students early in their medical school journeys, many of whom haven’t had much contact with patients yet. When I first began medical school, it was easy to get caught up in the praise and aggrandizement that was heaped upon us – the constant congratulations for joining a profession as well-respected and impactful as medicine. It is true that physicians can have a profound impact on the lives of our patients, curing terrible diseases and lessening the suffering caused by chronic ailments. In looking at the nature of the health care system as a whole, however, I have seen clear examples of how access is rationed based on a patient’s financial resources, and how seeking health care can leave patients vulnerable to harm that affects their livelihoods and economic security.

As a new resident, when I look back on medical school, there were many things that left me less confident in my ability to avoid doing harm as a physician.

Take, for instance, the guest speaker we had during my second year of medical school, a young woman in her 20s (let’s call her Sarah) who recounted her battle with acute lymphocytic leukemia, a cancer that strikes suddenly and can be fatal in a matter of hours. Sarah described to us the physical challenges she faced while receiving chemotherapy, and the fantastic care she had received from her physicians. As I listened to her story, I wondered whether, as a young person who had just entered the workforce, she had the financial resources to pay for her care. At the end of her presentation, I asked her, and it turned out that cancer devastated more than just her body.

Sarah’s illness prevented her from working and when she eventually lost her job, she lost her insurance, too. The hospital bills that followed quickly depleted her savings until she was forced to go on Medicaid. She described this as an extremely difficult experience that caused her considerable shame. For some reason, to this patient and others who told us stories of illness, the consistent assumption seemed to be that future doctors didn’t need to hear about, or wouldn’t be interested in, the financial problems caused by our health care system.

I strongly believe that no one should experience shame or financial ruin just because they get sick. I think many of my classmates would agree, but if patients aren’t given a chance to share that side of their experience, we can’t expect their physicians to become aware of the problem solely through intuition.

There was also the middle-aged man – I’ll call him Bill – who I met during one of my clinical rotations. Bill had a chronic mental illness and an unstable, intermittent employment status, but nevertheless was surviving on his own in the community. He presented to the clinic with shortness of breath after a temporary construction job had been halted because of the discovery that he and his co-workers had been exposed to asbestos. It took multiple visits for us to explain to him that asbestos causes disease many years after exposure, and that, instead, he was experiencing symptoms related to longstanding COPD. Worker’s comp, of course, would not pay to manage this chronic preexisting disease, and Bill experienced considerable distress until we were able to enroll him in Medicare because of his new disability. With a universal, comprehensive insurance system his disease might have been detected earlier, or smoking cessation therapy could have been emphasized when he was young. Instead, he’ll live with COPD for the rest of his life, and will probably die from it.

Then there’s me. I was born with a serious heart defect that required surgery when I was a toddler, and again when I was 13 years old. Despite facing health challenges during my own life, I consider myself privileged. I’m privileged to have had a better outcome than many others in the same situation; I’m privileged to have never missed one of the annual cardiologist visits that will determine when I need to have my next operation; and I’m privileged because I happened to have the best hospital in the country in-network on my insurance while attending medical school.

Nevertheless, despite having insurance, I have to pay hundreds or thousands of dollars in deductibles and copayments out-of-pocket every year to monitor a health condition I have through no fault of my own. If I was like millions of working Americans living paycheck-to-paycheck, unable to save money let alone pay thousands of dollars for medical bills, I might have to skip yearly checkups to take care of other necessities first. If I were truly poor and on Medicaid, I might have to travel long distances or wait many weeks to find a physician who would take me for an appointment. In either case, I might not get the care I need until I deteriorate to a point that would cause me permanent harm.

The Affordable Care Act has not done nearly enough to address the barriers to health care that exist due to our broken insurance system. Under Obamacare, the United States remains the only industrialized capitalist democracy on the planet that does not provide universal health care access to its entire population. Indeed, even if it works as well as it possibly can, Obamacare will leave over 30 million people uninsured and without access to basic care. Those benefiting from the law are forced into a relationship with private insurers, the same companies that previously denied people for preexisting conditions and cut policies when people got sick until those practices were outlawed by Congress.

Now, the insurance companies have a different approach to maximizing their revenue: they lure buyers on the exchange with low premiums, and then slam them with high deductibles. An annual deductible of thousands of dollars before insurance kicks in can quickly empty a family’s savings account, and does little to protect them from health care costs.

As a member of SNaHP and PNHP, I advocate for an alternative along with other medical students and physician: an improved version of Medicare that would apply to the entire population; a universal, single-payer, publicly financed and administered insurance system. By its very nature, such a system would apply to the entire citizenry from birth to death, and would reduce or eliminate out-of-pocket costs for medical care. It could be progressively financed while providing universal, equitable access. Unlike the hodgepodge of secretive private companies providing insurance right now, Medicare-for-all would be transparently financed and publicly accountable through the democratic process. With the entire population invested in the program, the adequacy of reimbursement for medical expenses would be a top priority.

Most importantly, a Medicare-for-all program would reduce our out-of-proportion spending on health care while at the same time expanding coverage and access to everyone. It would greatly reduce the need for providers to maintain complicated administrative structures for billing multiple insurers, and would act as a strong negotiator to prevent unfair profiteering by pharmaceutical and device manufacturers. An analysis by the Lewin Group in 2012 estimated that a single-payer system would have saved my state of Minnesota $4.1 billion in 2014, while economists estimate that single-payer on a national scale would save an estimated $592 billion annually (1). Think of the boost our economy would receive if people were no longer going bankrupt because of medical expenses. Medicare for all would also free the private sector from the burden of providing health insurance as an employee benefit, reducing wage stagnation and making our industries more competitive on the global market.

The need for single-payer health insurance is complex, but the concept itself is simple. The vast majority of my classmates are becoming young physicians with the goal of relieving suffering and providing patients the opportunity to live their lives to the fullest. As economic inequality comes to the forefront as a national issue, medical students are increasingly realizing that the current health insurance system frequently promotes that inequality rather than alleviating it, and just like me they are coming to recognize single-payer health insurance as a necessary, if not sufficient, step to make the provision of health care a tool for social justice.

Our movement has grown larger every year, and the reach of our message has never been broader. If our expanding membership continues to spread awareness about the problems of our health care system and the solutions offered by single-payer health care, our goal will soon be realized and I’ll be able to consider my involvement to be a success.

If you care about a health care system that serves the needs of everyone, not just the privileged or the wealthy, there is room for you in this movement.

1. Cost and Economic Impact Analysis of a Single-Payer Plan in Minnesota; http://growthandjustice.org/images/uploads/LEWIN.Final_Report_FINAL_DRAFT.pdf
josh_faucherJosh Faucher will graduate from Mayo Medical School on May 21st and is pursuing a career in emergency medicine. He co-founded the Mayo Medical School chapter of SNaHP, helped SNaHP grow as a student offshoot of PNHP with national scope, and currently serves as a student member on the PNHP Board of Directors. You can email him at josh.faucher@gmail.com

New Frontiers for the Civil Rights Movement: Reflections on the 2016 SNaHP Summit

Jonathan Michels

SNaHP Summit 2016

“We will not stop. There is only one outcome.”

-Diane Nash, coordinator of the Freedom Rides and student leader of the Nashville sit-in movement

As a third year medical student, my thoughts are never far from the patients I leave in the hospital at the end of each day. The bloodwork I need to check on, the records I need to request, how someone is doing on a new medicine. Even now, as I write this, I am remembering one shift a few weeks ago. The resident flipped open a chart and narrated her thought process: “The first thing you do is check insurance. It says ‘self-pay’ so there’s not much we can do.”

I wish this was the first time I had heard that statement. It wasn’t.

With these words still ringing in my ears, on Saturday, March 5th,  I descended upon Nashville, Tennessee, with 170 students from 47 schools in 23 states. Those who were among us were future doctors, public health professionals, medical researchers, and even a nurse-midwife. We gathered in Music City for the 5th annual Students for a National Health Program (SNaHP) Summit, held on the medical campus of Vanderbilt University.

SNaHP membership has grown exponentially since the inaugural student summit five years ago, when a handful of students filled a single conference room. Today, the organization has 51 chapters at universities across the country. My colleagues take time away from grueling coursework and ungodly call schedules to meet every spring and work on enacting a single payer, universal health insurance program, one of the pressing civil rights issues of our time.

In fact, the organizers constructed this year’s summit around that very theme: “New Frontiers for the Civil Rights Movement.” The keynote address, given by Dr. Stephen Raffanti, drew connections from HIV/AIDS activism in the 1980s and 1990s to our work fighting for single payer today. Students led sessions on civil disobedience, engaging politicians on the campaign trail, and holding lobby visits with our elected representatives. We learned how to share stories and how to build our movement and train each other.

We learned how to share stories of collective struggle and how to work with one another to build a movement that connects single payer to broader social justice efforts. SNaHP members were among the thousands of medical students who took to the streets in 2015 as part of the White Coat Die-In, protesting police brutality and claiming racism as a public health issue. SNaHP members were counted among the hundreds who rallied and held vigils last October during the #Ten One: Medicare for All Day of Action for the tens of thousands of people who will die each year because they lack health insurance.

This year, the stakes are higher than ever before for our work. One of the Democratic candidates for the presidency supports a single payer, national health insurance program for economic and moral reasons. The other defames it as a pie in the sky impossibility while accepting money from corporations that grow rich off our fragmented for-profit healthcare system. The Republican candidates agree that repealing Obamacare is a priority, because pre-existing conditions should disqualify you from coverage and the thousands of newly-insured individuals who are receiving health care for the first time should go back to ignoring their back pains and strange lumps.

We went to Nashville because we have a lot of work to do. And like Diane Nash, ACT-UP, and the innumerable activists who came before us in America’s civil rights movements, we will not stop until universal single payer healthcare is won.

In the weeks since our conference, SNaHP members have protested bigotry at the University of Illinois at Chicago, pledged to engage political candidates about healthcare reform, developed a plan for getting single payer advocates onto state medical boards, and worked towards planning an action at the Democratic National Convention.

Give us a few more weeks, a few more months, a few more years and I’m hoping that as a resident I won’t have say, “The first thing you do is check insurance.”

 

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Emily Kirchner is a third year medical student at Lewis Katz School of Medicine at Temple University in Philadelphia, Pennsylvania.  She is a member of SNaHP’s media team and political advocacy team. You can read more of her work at in-Training and The Billfold.

 

Future MDs: Americans want single payer healthcare – and yes, it can work!

snahp

In light of the media’s recent attention to single payer healthcare and the release of Bernie Sanders’ proposed plan, Students for a National Health Program (SNaHP) would like to rectify public misconceptions of and clarify our stance on Medicare-for-All.

Several themes have recently emerged in online and print media in arguments against Medicare-for-All type reform. The first is the notion that, in order to cut costs, “Foreign single-payer systems pay doctors less”. While doctors from the US are some of the highest paid in the developed world, their reimbursement is not nearly as reliable as that of physicians abroad. In the US, physicians often have trouble collecting payments from private insurance companies and patients alike. Medicare, on the other hand, reimburses at a reliable rate, and while some have attempted to argue that expanding Medicare to the entire population would reduce physician income, studies of the Canadian transition showed that physician incomes actually rose after transitioning to single payer.

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Why Everyone Should Take Part in #TenOne: A Chicago Student’s Call to Arms

snahp

Despite the Affordable Care Act’s undeniable success in extending health coverage to more people and in curbing some of the health insurance industry’s worst practices, recent reports show our nation still has 33 million people who are uninsured, a comparable number who are inadequately insured, sharply rising deductibles and copays, and skyrocketing pharmaceutical drug prices.

The 2010 health law clearly did not go far enough.

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