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  • How we pay for medical care in 2014: Paying for quality and efficiency



    Whitney McFadden
    AMSA Health Policy Chair


    Bodenheimer and Grumbach outlined in their book, Understanding Health Policy: A Clinical Approach, a view of health policy and the faults of our current healthcare system. It seems we are very familiar with the pitfalls of our current system. In order to be clear and not dwell too much on the obvious, our system struggles with overuse and underinsurance/lack of insurance that is being addressed with the Affordable Care Act. Today we pay for healthcare out-of-pocket, with individual private insurance, employment based private insurance, or government financing. Insurance plans for healthcare began in the depression due to unstable payments. Medicare was established to cover the elderly and lower income individuals. Currently physicians are paid in a multi-tier system including fee-for-service, episode illness grouping, capitation (per head fee to general practitioner and specialist), and salary.
     
    2014 will be a year of new payment methods for healthcare. The sustainable growth rate (SGR) has historically be underfunded requiring congressional intervention to avoid the reduction in payment to medical reimbursement that would make it unsustainable. This year, a bipartisan fix will change payments to value based on measure of better quality and efficiency instead of the current greater volume and intensity of services. Some evidence exists in community clinics that this method has been successful and alternative payment models (i.e. transitional care) have been attempted as possible solutions. McClellan makes the point that we currently do not know how to create a system that is cheaper and rewards improved health outcomes. 

    One solution is single payer healthcare, which addresses the funding source. However our problems with how payments will be made to increase efficiency would still remain. There are methods by which we can change the way our healthcare dollars are spent, but we will not find those solutions on the national stage. Instead, each clinic and hospital must look at their individual patient population, the diseases they treat, and the access to care in the community in order to develop a system that is financially viable. We would benefit from establishing a medical economics team at every health provider institution to allow for individualized services from technologic tools that we know work well. The team based approach to healthcare that is the foundation for our medical training should extent to healthcare funding. Instead of trying to find the rules that would apply to everyone, we need to establish the framework by which everyone can create their rules, and do it with ease, efficiency, and completeness.

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  • Building a movement for universal health care in Illinois

    By Kathy Wollner, Rush Medical College
    and Zach Bay, Northwestern Feinberg School of Medicine
    Standard responses you get when you ask a medical student to participate in health policy advocacy:

    “The system is too complicated to try to change it.”
    “There’s nothing I can do to make the system better.”
    “I support change but I don’t think we can actually make a difference."
    “I support this but I am too busy.”

    These are the statements we hear time and again and even tell ourselves on occasion. Being both a medical student and a single-payer advocate is certainly not for the easily discouraged. In spite of these challenges, this month in Illinois twenty medical students teamed up to speak out against our inefficient, extremely expensive health care system that doesn’t even begin to take care of everyone. 

    On April 11, AMSA members from Northwestern, Rush, and Rosalind Franklin joined with colleagues from the Illinois Single Payer Coalition in support of the Illinois Universal Health Care Act (HB 311). Over the course of the day, we spoke with or distributed literature to every Representative and Senator in the state legislature. Though diverse in age, culture, race, gender and religion, we were unified by our common commitment to a single payer health care system that will cut out the for-profit middle-man between doctor and patient. Our white coats broadcast our stake in the health care system as health professionals in training.

    Aderonke Bambgose, AMSA president at Northwestern, gave an impassioned speech on the glaring faults of our current health care system:


    Dr. Quentin Young, national coordinator for Physicians for a National Health Program, gave an assessment of the national fight for single-payer and a shout out to students’ commitment to health justice:


    Meeting with policy makers and hearing their different viewpoints on the issues was both challenging and inspiring. It was great to learn that although our voices alone seem weak, we can make our collective voice be heard by sharing our opinion with those elected to represent us. 

    While we know achieving universal health care in Illinois will be an uphill battle, we’re in it for the long haul. How could we not be? The health care system is the world we will take part daily as health professionals and, every more importantly, the reality of health care – or lack there of – for our future patients.

    Here’s some audio coverage of the press conference from CBS local news and additional videos from the press conference can be viewed here.

    If you’re in Chicago and you’d like to get involved in single-payer advocacy, please contact us (email womens.policy@amsa.org)! 

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  • In Support of Single Payer Legislation: Illinois

    Zach Bay and Andeonke Bambgose
    Northwestern University Feinberg School of Medicine

    We need universal health care in this country and as the recent reform process has taught us, it is not likely to happen nationally without a successful state-based example. While Vermont is well on it is way to passing legislation to create a single-payer system, in Illinois we are working to rally support for the Illinois Universal Health Care Act (HR 311).

    Health care should be treated as a human right and not a commodity. Not only is single-payer the right thing to do, it is also the most cost-effective way to cover everyone, according to the recent Harvard study for the Vermont Legislature.

    Over the past few weeks, while recruiting students to take part in our upcoming lobby day, we’ve had many conversations about why this is something we should fight for. For us, the primary answer is that it is absurd that the system treats health care as a commodity. Unlike other commodities, you can die if you don’t have adequate health care. As many as 44,789 deaths per year in the United States are associated with lack of health insurance, more than the number of deaths due to kidney disease. It is unlike other commodities because you don’t die if you don’t have a nice car and you won’t be crippled for life if you don’t have the most expensive food to eat. You won’t have to walk around worrying about the risk of sudden death or losing the sensation in your feet and hands if you don’t have the most expensive clothes. Health care cannot be treated as a commodity because the consequences of not having health care are not frivolous; it is a life and death issue, an issue that significantly pertains to quality of life and your upward mobility in terms of finding a job and being able to take care of yourself and your family.

    In every other developed country, health care is treated as a human right. The World Health Organization (WHO) constitution reads, "the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being." It must be provided to everyone equally. That is why in every other developed country, there is a health coverage system provided by the state. We are 37 out of 191 countries according to the WHO’s ranking of health care system performance because we fail to do this.

    As a nation and as a state, we can do better. We expect better for our profession and for our patients.

    If you are in Illinois and are interested in participated in the April 11 lobby day, you can sign up here.

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  • In Support of Single Payer Legislation: Vermont

    Elizabeth Wiley, JD, MPH
    AMSA Vice President of Internal Affairs
    Last weekend, hundreds of health professions students from across the country gathered at the Vermont State House in Montpelier to rally in support of Vermont single payer legislation. The legislation, passed by the Vermont House last week and developed based on the work done by Dr. William Hsiao, would make the Green Mountain state the first in the nation to adopt single payer health care reform. In the crowd were many AMSA members and leaders.

    “Vermont could be the health care shot heard around the world.”
    --Vermont Gov. Peter Shumlin


    The rally began with Sen. Bernie Sanders (D-VT) offering inspiring words of encouragement to a standing room only crowd. Gov. Peter Shumlin then spoke to the potential for single payer passage. Several student leaders then took the stage to offer insight on why we support universal health care.

    As a medical student, it was heartening to see such an incredible number of schools represented – more than 120 institutions -- standing in solidarity with the citizens of Vermont in their effort to make history. From the University of Vermont School of Medicine to Harvard Medical School to University of New Mexico School of Medicine to Oregon Health & Sciences University, the message of the weekend was clear – if Vermont implements single payer, we will come.

    The rally was sponsored by Physicians for a National Health Program and the American Medical Student Association.

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