2008 Election Platform - AMSA

The United States is the world's only remaining superpower and is a symbol of hope across the world, yet on the issue of healthcare we not lived up to our promise. The US healthcare system is the most expensive per capita while providing only mediocre health outcomes compared to other industrialized nations.¹ Future health professionals, such as the members of AMSA, have a professional responsibility to re-establish US leadership on healthcare. In this spirit, we urge current elected officials and candidates for state and national office to:

Provide Affordable, Quality Healthcare for All
Do Our Fair Share to Address Global Health Challenges
Invest In The Healthcare Workforce
Spend Responsibly

Provide Affordable, Quality Healthcare for All

1. Support a single, public, national health insurance program: cover all necessary medical, dental, and mental health services for all people living in the United States; fund the program with administrative savings and progressive tax systems; eliminate premiums, deductibles, co-payments, and co-insurance; completely cover prescription-drug costs; and ensure portability in all 50 states and national territories ²
2. Increase federal-to-state ratio of funding to Medicaid and widen federal eligibility guidelines to cover pregnant women and children under age 6 with family income at or below 250% of the FPL, and children ages 6 to 19 with family income up to 200% of the FPL.³ Guarantee coverage irrespective of immigration status.
3. Expand Medicare to ensure it provides hospital inpatient care, outpatient care, dental care, mental healthcare, prescription drugs, palliative and end-of-life care, and long-term residential & rehabilitative care through one funding stream. Expand Medicare eligibility to individuals younger than 65 with certain chronic diseases, independent of Social Security Disability Income (SSDI) eligibility, including HIV, diabetes, mental illnesses such as autism and schizophrenia, and disabilities such as developmental delay. ⁴
4. Prohibit insurance companies from denying health coverage based on prior health conditions. Require health plans to ensure minimum standards of benefits from all companies to guarantee the highest standard of care. Prohibit denial of coverage or increased co-payments for consumers of mental health services. ⁵
5. End US waiting lists for AIDS treatment by expanding Ryan White funding to $ 2.8 Billion in 2008 and $ 3.3 billion by 2012.
6. Promote the political and economic empowerment of women and girls by prosecuting employers who underpay women employees, providing funds to states for child-care programs, improving access to family planning resources and education, and strengthening programs to eliminate domestic violence. ⁶

Do Our Fair Share to Address Global Health Challenges

1. Provide at least $50 billion by 2013 for the fight against HIV/AIDS as part of a 1% of the US budget commitment. ⁷
2. Invest in healthcare worker development in the developing world to achieve minimum health workforce densities of 2.3 doctors and nurses per thousand residents in selected countries. ⁸
3. Drop 100% the debt of the 67 most impoverished countries.
4. Support and fund evidence-based AIDS prevention strategies in developing world including male and female condoms, microbicides, injection drug treatment and vaccines.
5. Fight Tuberculosis and Malaria. The U.S. must work to achieve targets agreed by G8 leaders to reduce tuberculosis deaths and prevalence by 50% and reduce the malaria-related disease by 50% by 2010. ⁹

Invest In The Healthcare Workforce

1. Expand the National Health Service Corps at funding levels of $250 million per year between now and 2010 and $500 million by 2015. ¹⁰
2. Support the reauthorization of the Higher Education Act and dedicate an additional $30 billion in funds to student financial aid. Pell Grants must cover at least 75% of the cost of a college education and the interest rate cap on federal student loans must be lowered to 4.0%. The deferral period must extend for the duration of residency, not to exceed 8 years.
3. Expand the scope and funding of Federally-Qualified Community Health Centers and increase their funding with an additional $200 million in 2008. ¹¹
4. Create and fund programs to increase the diversity of the health work force, including programs that particularly increase training of health professionals from underrepresented populations. Support funding for Title VII and Title VIII programs at FY2005 levels minimally. ¹²
5. Restore and reorganize the Commissioned Corps of the U.S. Public Health Service ¹³ and expand the Uniformed Services University for the Health Sciences so that at least 50% of students are specifically trained to care for undeserved populations through the Commissioned Corps.

Spend Responsibly

1. Give the Secretary of DHHS the authority to negotiate with drug companies for fairer prices for pharmaceuticals under Medicare.
2. Adopt public interest licensing policies for drugs developed with public financing. ¹⁴
3. Create and fund a mandatory national registry of gifts from pharmaceutical and medical device manufacturers to health providers. ¹⁵
4. Implement comprehensive, integrated, and evidence-based prevention policies that explicitly address the needs of all at-risk populations including needle exchange and microbicides funding. Mandate education regarding sexual and reproductive health services into publicly funded education systems. ¹⁶
5. Medicaid and Medicare reimbursement rates should reflect the cost and complexity of patients' care needs. ¹⁷

Download Platform as PDF
Comparison Tool of Candidates’ Views on Healthcare with Companion Guide

About the American Medical Student Association The American Medical Student Association (AMSA), with more than a half-century history of medical student activism, is the oldest and largest independent association of physicians-in-training in the United States. Founded in 1950, AMSA is a student-governed, non-profit organization committed to representing the concerns of physicians-in-training. With more than 68,000 members, including medical and premedical students, residents and practicing physicians, AMSA is committed to improving medical training as well as advancing the profession of medicine. AMSA focuses on four strategic priorities, including universal healthcare, disparities in medicine, diversity in medicine and transforming the culture of medical education. To learn more about AMSA, our strategic priorities, or joining the organization, please visit us online at www.amsa.org.

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2008 Election Platform Notes American Medical Student Association

1. OECD (2006), OECD Health Data 2006, OECD, Paris
2. Private, for-profit health insurance is never compatible with universal and comprehensive healthcare access. Establishing a national health insurance system to cover all individuals is the best and most efficient way to finance affordable and comprehensive healthcare that is portable and unburdened with the competing priorities of shareholder returns. "Proposal of the Physicians' Working Group for Single-Payer National Health Insurance." JAMA. 290(6). August 13, 2003.
3. By widening the federal eligibility guidelines to include pregnant women and children under age 6 whose family income is at or below 250% of the federal poverty level and children ages 6 to 19 with family income up to 200% of the federal poverty level, Medicaid will cover more of the categorically needy children in the nation. The current guidelines of 133% and 100%, respectively, do not account for rising health care costs, mounting cost of living, and shrinking steady employment.
4. As Medicare has been a highly effective safety net for seniors once they retire, it can also aid other vulnerable populations with chronic diseases that are not able to access health insurance from their employers.
5. Current federal law allows insurance companies to discriminate between so-called physical and mental illnesses by shifting the costs of mental health services to the patient by increasing out-of-pocket expenses through lower limits on coverage, higher copays, and higher deductibles. Furthermore, covered mental health services should extend to all medical diagnoses listed in the DSM-IVR, including substance disorders.
6. Comprehensive women's health care must take an integrated life-course approach that places women's specific needs with regard to basic primary care, chronic disease, acute illness, pregnancy, reproductive health care, and violence prevention in context with their lives. Kumanyika S, Morssink C, and Nestle M. "Minority Women and Advocacy for Women's Health" American Journal of Public Health. 91(9): September 2001.
7. This sum is required to continue the U.S. fair-share of supporting treatment for at least 33% of those in clinical need, and includes continuing existing bilateral programs ($28 billion for PEPFAR Focus Countries, $6 b for Non-Focus Countries-of which 10% is already earmarked for a broad set of programs to help orphans and vulnerable children), $8 b for the U.S. share of the budget of the Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM), and $8 b in new support for health workers and health systems strengthening required before even current investments can succeed. This total amount is a minimal contribution, and is less than a fair-share towards the worldwide UNAIDS cost estimates. The White House requested $5.76 billion for global AIDS, TB and malaria programs in FY 08 -the fourth year of a five-year global AIDS initiative (source: President Bush's FY2008 Budget Request, DATA.org, February 5, 2008). The current Administration proposal to contribute $30 billion represents a devastating reduction in the percentage of people with AIDS in need who will receive treatment.
8. World Health Organization, World Health Report 2006 (2006), at 11-12. In addition to doctors, nurses, midwives, and health workers with similar skills such as clinical officers, the 2.3 figure does not include the range of other necessary health workers including pharmacists, laboratory technicians, mental health workers, community health workers, and the critical management, administrative, and other support staff.
9. G8 Communiqué, Okinawa Summit, July 23, 2000.
10. The NHSC creates incentives for medical school graduates to enter primary care fields and serve in federally-designated physician shortage areas. Currently, less than 1 out of 5 qualified applicants is accepted for the program. The proposed expansion would double the funding for the program by 2010 and quadruple it by 2015. This program also provides critical staffing for Community Health Centers, the US Public Health Service, and other providers in medically underserved areas. Furthermore, the NHSC is an important vehicle that will ensure diversity of the physician workforce: The leading reasons qualified African American, Latino, and Native American college graduates choose not to enter the health professions are educational costs and high educational debt. Information from Sullivan Commission. "Missing Persons: Minorities in the Health Sciences." Available: http://www.jointcenter.org/healthpolicy/docs/SullivanExecutiveSummary.pdf
11. Health Centers should be able to accommodate 30 million patients by 2025. Insurance is not sufficient to ensure that everyone in America has access to healthcare. Rather, the combination of adequate insurance coverage and a health care home is the key to improving outcomes and reducing disparities. Community Health Centers today provide 16 million people in medically underserved communities in all 50 states, with access to high-quality, affordable primary and preventive care. In addition to basic primary care, Health Centers typically provide other services including mental health care, dental care, vision care, and health education. Health Centers save the healthcare system between $9.9 billion and $17.6 billion. From NACHC website. http://www.nachc.com/advocacy/Files/2007_Policy_Papers_-_all.pdf http://www.nachc.com/press/08062007advisory.asp.
12. Title VII and Title VIII are crucial to ensure access to medical and nursing education for underrepresented racial minorities. These programs, which have been starved for funding in the last two years, must be supported and expanded given the looming physician shortage and current shortage of nurses.
13. The Commissioned Corps provide health care workers to federal agencies and in times of natural or public health disasters, the Commissioned Corps is the key health responder. The Corps provides career opportunities for young professionals, and public health and health care services to underserved populations.
14. Taxpayer funds should not be used to increase the profits of pharmaceutical industry, especially when the high cost of prescription medication prevents patients from receiving adequate treatment.
15. including food, drug samples, travel, souvenirs, and speaking fees of any dollar amount.
16. including, but not limited to, funding and technical support for universal access to male and female condoms, voluntary male circumcision, HPV vaccinations, needle-exchange programs, needle-sterilization kits, and treatment for injection drug users as well as new expanded research on effective microbicides and vaccines.
17. To address chronic diseases, physicians must be rewarded for improving health outcomes through preventative and maintenance measures before patients require costly and invasive procedures.

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