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  • To save lives and money, choose single-payer health care

    By Morolake Amole

    The problem with health care in the United States is not that we suffer from inadequate medical resources. Quite the contrary.

    We have thousands of highly skilled and dedicated doctors and nurses. We have many top-notch hospitals possessing state-of-the-art equipment and medications. We have significant patient protection laws.

    So then how do we explain our country’s poor health outcomes, e.g. that we ranked 19th out of 19 wealthy nations in 2010 on preventing deaths that could have been avoided with medical care?

    Here’s a clue: If you compare the U.S. system with those of other industrialized nations, you’ll see that no other country relies so heavily on multiple private insurance plans and has such high financial barriers to care.

    Does the Affordable Care Act change this picture? The ACA will, within a few years, increase coverage for about 20 million people through a combination of subsidies for private insurance and an expansion of the Medicaid program (in those states that have agreed to accept it). This increased coverage will likely save many thousands of lives each year.

    Yet even when the ACA is fully implemented, 30 million Americans will remain uninsured. Some won’t be able afford a private plan. A recent survey by Kaiser Family Foundation found that 36 percent of Americans between the ages of 18-64 who remain uninsured stated that they opted out of buying insurance because the plans available were too expensive.

    Many million more will remain “under-insured,” i.e. vulnerable to severe financial stress if they get sick because they’re enrolled in skimpy health plans with high deductibles and co-pays.

    The U.S. health care system is the most expensive in the world. In 2012, our nation spent roughly $2.8 trillion on health care, about $8,508 per person. Yet the ACA has no proven ways to control costs.

    So, if the Affordable Care Act is not the final answer, what is?

    Many physicians and economists believe that the answer lies in the adoption of a single-payer system. Such a system has already proven successful in Canada, where most care is taxpayer financed but delivered by private doctors and hospitals. One could cite a dozen other examples, from Norway to Taiwan.

    Citizens of these nations enjoy high-quality health care, with outcomes that are generally as good as or better than ours – at much lower cost. They’re successful for a variety of reasons.

    By establishing a payment system in which citizens pay taxes that are then designated toward health care, there’s an implied idea of transparency in health care spending. Citizens can see how their money is being spent.

    Their systems have very low administrative costs, allowing them to spend more resources on providing actual health care. Single-payer systems are also better at controlling costs. They can buy drugs and medical supplies in bulk, and efficiently plan big capital outlays.

    Nonprofit single-payer systems take away the power of private insurance companies to come between patients and their doctors. Patients no longer have to look to insurance agents for decisions on health matters, and patients can choose to go to whatever doctor or hospital they want.

    And because patients are able to obtain primary care and receive treatment for problems at an earlier stage, they require fewer costly interventions later.

    With a single-payer system in the U.S., physicians would be able to concentrate much more on what they were trained to do, and be less burdened with time-consuming and costly insurance paperwork. They’d remain well-compensated (e.g. Canada’s physicians have incomes comparable to their U.S. counterparts, especially when you factor in how little they have to lay out in overhead and malpractice), but primary care physicians would see their incomes rise, reflecting the crucial role they play.

    The most important reason for enacting a single-payer national health insurance program, or an “improved Medicare for all,” is that it would achieve the goal of giving everyone equitable access to all medically necessary care. Health care would be re-routed toward its original goal of giving people an improved quality of life.

    We should implement a nonprofit single-payer system without delay.

    Morolake Amole is a clinical medical student at Meharry Medical College in Nashville.

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  • AMSA Lobby Day Expanding Health Care Coverage for All

    Brandon Sandine
    Health Care For All Coordinator
    American Medical Student Association 

    On Wednesday May 21st and Thursday May 22nd members of Physicians for a National Health Program (PNHP), American Medical Student Association (AMSA), Public Citizen and National Nurses United (NNU) gathered together in solidarity to support expanding health care coverage to all people in America. For myself, the events began with AMSA’s Lobby Day Training hosted at George Washington University on May 21st. This was an opportunity for premedical and medical students to learn the basics of political advocacy from health care and community advocacy leaders such as Robert Zarr M.D. (PNHP), Rachel Degolia (Universal Health Care Action Network), and Nick Unger (AFL-CIO).

    I found particularly inspiring the presentation “Organizing and Communicating; Medical Student Advocates” given by Nick Unger. The focus of this discussion style lecture was effective communication strategies. These included active listening/responding, narrative development, and focusing on context rather than content.

    According to Mr. Unger, effective communicators avoid listing facts and instead relate to their audience’s concerns. By doing this you can appeal to the context that your opposition adheres to and gain influence. As someone who has spent a lot of time developing my argument for single-payer, I found Mr. Unger’s communication approach incredibly important; it directly influenced the way I planned to interact with policy makers on Capitol Hill the following day.

    Armed with the knowledge gained in the previous evening's speakers, early Thursday morning AMSA members, including myself, met our constituent groups at PNHP’s official training workshop. We listened to guest speakers such as Representative John Conyers (D-MI) and broke out into our respective groups to develop our legislative meeting strategies.

    My group was primarily composed of NNU members from the Chicago area. I feel I was incredibly privileged to work with this passionate group of nurses who had encountered first-hand the consequences of a healthcare system that treats health care as a marketplace commodity. We decided that they would tell patient stories, of which they had intimate knowledge, that highlighted significant problems in our healthcare system, and I would present an image of how much better a single-payer healthcare system would be.

    We took to the hill for our first meeting with a Legislative Assistant (LA) for Representative Mike Quigley (D-IL). As we entered the meeting space a rush of nerves took hold of us. Thankfully, the LA was very welcoming and put all of us at ease. We began with general introductions, followed by sharing patient stories that were complicated by our current healthcare system’s structure. Kim, a nurse, shared the story of a patient who was denied a minimally invasive procedure because it was too costly, and given instead a less costly but highly invasive procedure with a high risk of infection.

    If we had a single-payer healthcare system that included all residents of America, Kim’s patient would have received the less risky procedure.

    After Kim's story I turned to the LA and asked if she was familiar with John Conyers' bill H.R. 676, Expanded and Improved Medicare For All. While she had heard of the bill, her concerns were that Rep. Quigley was more interested in supporting the ACA. Secondly, she claimed that this just wasn’t the right political atmosphere to pass such a bill as H.R. 676. As a now seasoned single-payer advocate, I was prepared for this kind of opposition. I suggested that the ACA is still going to cause harmful situations like those in our patient stories.

    Additionally, I suggested, supporting the ACA and H.R. 676 are not mutually exclusive. The Congressman can do both!

    As far as the political environment goes, I said that she was right! The current political atmosphere is and will remain closed to the single-payer argument--unless Legislative Assistants such as herself listen to their constituents' arguments and advise congresspeople to change their minds.

    We have one very important ask, I told her. Let Representative Quigley know that his constituents support single payer, and that if he wants our votes, so should he!

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  • The Physicians’ Proposal

    By Brandon Sandine
    AMSA Health Policy State and Local Policy Coordinator

    It’s a simple proposal! And amidst the growing financial and human burden that our current healthcare system induces, it’s the most equitable and economically sensible proposal of all. Everybody in, nobody out. This was the idea that two emphatic physicians concluded some 25 years ago would help alleviate the growing health insurance disparity, and the problems that are associated with lack of insurance, in our country.

    Today the ranks of Physicians for a National Health Program (PNHP) are significantly larger than it was 25 years ago. Yet their realization is still the same. Our country desperately needs to improve access to medical care, for all of its residents, by implementing a universal health insurance program. While national healthcare reform has recently occurred, primarily through The Patient Protection and Affordable Care Act (ACA), approximately 30 million Americans will still remain uninsured. As such, it is imperative that the single-payer agenda passes into legislation.

    At the recent PNHP annual convention this was exactly the focu of discussion. Content at the convention introduced new and old members to changes that the ACA will have on their clinical practice, to how would the House of Representatives Bill 676 - single-payer health insurance - function in our country. For me, an aspiring future physician, it was profoundly influential to see primary care physicians, cardiologists and neurosurgeons all in one room agreeing that their career had fell short of their ideological expectations. Yet, they all knew that a national single-payer healthcare model would significantly decrease the problems most often cited, and increase their personal satisfaction in being apart of healthcare in America.

    This year’s convention was a short reprieve from the daily stresses of the classroom. However, I left with newfound empowerment. Past PNHP president Dr. Claudi Fegan led the concluding remarks from the convention with our paradigmatic slogan, “EVERYBODY IN, NOBODY OUT!”

    If you would like to learn more about Physicians for a National Health Program check out this link. For further information on H.R. 676 read this

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  • Is Healthcare a Right Yet?

    By Vanessa Obas
    AMSA Health Policy Committee - National Policy Coordinator

    Beneath the haze of the government shutdown, the Affordable Care Act (ACA) finally began its open enrollment for government-subsidized health insurance, and the implementation of the law has proven as difficult a road as its passage. In recent weeks, low and middle-income individuals and families experienced technical difficulties and outages with the federally-organized website that has hindered many from enrolling in insurance plans. What’s more, many states, like my home state of Florida, have tried their hand at impeding plan enrollment in their opposition to the ACA. For instance, personnel have been trained to help Americans understand the health care law and navigate the marketplaces. However, in Florida, these navigators have been banned from working on the grounds of county health departments, restricting access to the already-limited number of navigators in the state.

    The passage of the ACA demonstrated that the U.S. accepted what many developed countries had recognized long before: health care as a right not a privilege. Yet, the obstacles created by states like Florida, and the shortfalls of the federally-run website, serve as reminders of the still-existing difficulty in achieving healthcare access for all. The success of open enrollment matters to millions of Americans – insured and uninsured. Many will find themselves needing to drop their existing, inadequate health care plans by January and enroll in plans that meet the newly established minimum standards of coverage. And, of course, there are the millions of Americans looking to the marketplace as their opportunity for less-expensive health care coverage. We can only hope the issues with enrollment will be addressed as even more citizens will need coverage during this period of open enrollment.

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  • Government Shutdown

    Katie Ni
    Health Policy Education and Outreach Coordinator

    On October 1st, the debt ceiling crisis and the federal government shutdown took center stage in a showdown between members of Congress. Unable to agree on the budget for the 2013-2014 fiscal year, Congress initially used the Affordable Care Act (ACA) as ransom. Up to the last hours of the fiscal year, the Democrat-dominated Senate repeatedly rejected proposals from the Republican-dominated House that would in any way defund or change the ACA’s funding. Ultimately no agreement was reached culminating in the current shutdown.

    AMSA supports the Affordable Care Act, health care reform that includes comprehensive coverage, and improved access for the uninsured in the United States. We applauded the Supreme Court decision to uphold the law over a year ago and believe that the ACA is officially law. Continuous efforts by the Republican party to derail the ACA are fruitless, and serve only to disrupt the economy and the daily life of Americans. The shutdown has furloughed millions of federal employees, disrupted government operations, and has threatened to damage the recovering economy. Congress’ failure to decide on a budget is harming the very constituency these legislators are employed to serve.

    The government shutdown has other serious consequences for the health of the public. The CDC is has been unable to track the annual flu outbreak, or continue monitoring other disease trends. The FDA has reduced its number of food inspectors, leaving some foods, particularly foreign imports of seafood, uninspected and to be sold to an unsuspecting public. The Consumer Product Safety Commission cannot recall faulty or dangerous products on the market and the NIH has been unable to admit patients on research protocols.

    Congress is currently at a political impasse. While actively creating legislation to address the debt ceiling and end the shutdown, having both parties agree will be the main challenge for our congressional representatives these next few weeks. On Saturday, the House unanimously passed H.R. 3223, providing backpay for furloughed federal employees. Republican crafted H.R. 3273 was introduced to create a committee with a purpose of ending the shutdown with appointed members by the House and Senate. The Debt Reduction and Economic Growth Working Group has the potential to help, but more immediate solutions will be needed to end the shutdown. AMSA believes Congress’s refusal to end the shutdown remains unacceptable, bears no benefit to the parties involved, and should not involve dismantling the Affordable Care Act.

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