A Presentation for Health Professional Students

1
(E)Quality For All? Will Med Students in the 21st
Century be the Difference? From the COC to your
Practice
The American Medical Student Association, 2001
Jeff Huebner, MD, Jack Rutledge Fellow
703-620-6600, Ext. 220 1902 Association Drive
Email jrf_at_www.amsa.org Reston, VA
20191 Web www.amsa.org

• A Presentation for Health Professional Students
• Partially adapted from PNHP Slideshow

2
To be, or not to be

• It Will Happen
• Health care is a sacred mission. It is a moral
  enterprise and a scientific enterprise, but not a
  commercial oneI worry about the fate of the
  medical profession because physicians are babes
  in the woodsTheyre gradually losing the respect
  of the publicSooner rather than later we are
  going to have to develop a national health plan.
  Avedis Donabedian, 1919-2000
• Your Professional Responsibility
• The general premise underlying this contract is
  that patients interests must take precedence
  over physiciansself-interest and that
  professionalism also entails service to
  vulnerable populations and civic engagement.
  (Rothman, NEJM, 2000)

3
Will it finally happen in the 21st Century?

• International Timeline Germany 1883, Switzerland
  1911, U.K. 1946, USA 1948 (NOT!), Japan 1961,
  Canada 1966, Australia 1974, Spain 1986, USA 1994
  (NOT!), South Africa 1996, USA ???
• UN Universal Declaration of Human Rights (1948)
  Article 25
• Everyone has the right to a standard of living
  adequate for the health and well-being of self
  and family, includingmedical care

4
The Good, the Bad, the UglyRipped from the
Headlines

• 2000 groups back UHC Md. Initiative claims to
  meet support goal (Balt. Sun)
• 700,000 Coloradans Lack Health Insurance, Study
  Finds (Col. Spr. Gazette)
• Questionable Hospitals 527 Hospitals that
  Violated the Emergency Medical Treatment and
  Active Labor Act A Detailed Look at Patient
  Dumping (Public Citizen)

5
43 MillionUninsured
6
Number Uninsured/In Poverty 1967-1998
Source Social Security Bul, HIAA, CPS
7
Who Are the Uninsured?
Source Himmelstein Woolhandler, Tabulations
CPS, 1999
8
Of all the forms of inequality, injustice in
health care is the most shocking and inhumane
Rev. Martin Luther King, Jr.
Source Census Bureau CPS, 1999
9
U.S. Spending Per Capita for Healthis Greater
than Total Spending in Other Nations
Health Aff 2000 19(3)150Note Public includes
benefit costs for govt. employees
10
Infant Mortality, 1997Deaths In First Year Of
Life/1000 Live Births
Source OECD, 1999 NCHS
11
Life Expectancy For Women, 1997
Source OECD, 1999 NCHSOECD, 1999 NCHS
12
Potential Years of Life Lost per 100,000 People
for All Causes, 1996/1997
Source OECD, 1999 OECD, 1999
13
The Risks The Uninsured

• are more likely to have no regular source (e.g.,
  PCP) of health care (9 of the insured v. 36 of
  the uninsured).
• are more likely to have not visited the doctor
  in the past year (39 v. 54) think of the
  effect on preventive services (pap smears,
  routine physicals, mammograms, prostate exams),
  diagnoses, prenatal care
• are more likely to forego care for serious
  symptoms (23 v. 43). Serious sxs included
  loss of consciousness, cp 1 min, breast lump,
  etc.
• Sources The NewsHour with Jim Lehrer/KFF 2000
• Arch Int Med 2000 1269

14
Med School Deans Managed Care Worsens . . .
Source NEJM 1999 340928
15
Whats at Stake? The Doctor-Patient
Relationship!!!

• Physicians continue to have the most
  prestigious occupation 61 of Americans rate
  physicians highly (Harris Poll, 2000)
• Patient Satisfaction, however, continues to
  decline the dissatisfied with their doctors
  care doubled from 97 to 00 (Roper Center Polls)
• The of medical student applicants decreased by
  6 in 1999, the third straight year of decline
  (Barzansky et al., JAMA, 2000)

16
Who Supports Universal Health Care?

• Believe it or not! Organized Medicine!!!
• All Americans Must Have Health Insurance (Joint
  Statement, June 14, 1999, AAFP, AAP, ACEP, ACOG,
  ACP-ASIM, ACS, AMA)
• 2000 Brings Strange Bedfellows Indeed!
  (www.familiesusa.org) and (www.hiaa.org)
• The Faith Community (www.uhcan.org) The Faith
  Project) Health care is an essential safeguard
  of human life and dignity, and there is an
  obligation for society to ensure that every
  person be able to realize this right.Card.
  Joseph Bernadin
• The Public (polling has consistently showed that
• 80 of the public supports a universal access
  system)

17
The Progressive Voices of Medicine

• Physicians for a National Health Program
  (www.pnhp.org)
• May 1st Congressional Briefing
• see (amsa.org/hp/uhchearing.cfm)
• Physicians Working Group for Single Payer
  (includes 20 national physician-leaders, AMSA
  included, others include representatives of AMWA,
  NMA, and former Sec. Health under Nixon)
• American Medical Student Association
• (www.amsa.org/hp/uhcinitiative.cfm)

18
OK, Doctor, so I want to do something, but what
are the Options?

• Private Market e.g.,Tax credits, MSAs
• Employer/Individual Mandates
• Expansion of Already-Existing Programs (Medicaid,
  CHIP, Medicare)
• Multi-Payer
• AMSA Rx Single-Payer, ie, Medicare-for-All

19
Principles Supported by AMSA for a UHC Plan

• Health Care is a service, NOT a commodity
• Equitably-accessible to ALL residents of the
  United States
• Provides comprehensive, high-quality services
• Publicly-financed and accountable

20
Current Options for Getting off the Snide

• Federal Approaches
• Tax Credits
• Expansion of current programs
• A combination thereof
• The Federal-State Partnership
• State Approaches (The states shall be
  laboratories)
• Maryland Citizens Health Initiative
  (Multi-Payer)
• Maine Universal Single Payer Health Care Plan
• Question 5 Massachusetts
• Many other Ballot Initiatives

21
Myths or Truths? Assorted Claims about Universal
H.C.

• Top 10 List (www.pnhp.org/Students/myths.htm)
• Costs! How will we pay for it?
• The government cant do anything right
• Care will be rationed this is socialized
  medicine
• The poor will just feed off the system

22
To the States v.Inside the Beltway

• MARYLAND SUMMER
• MAINEs Effort for Single-Payer
• Various other Ballot Initiatives
• The States Right to Innovate in Health Care Act
  (Rep. Tierney)
• The Health Security for All Americans Act
  (Wellstone/Baldwin/Obey)
• Family Care Act (Sens.Snowe and Kennedy)
• HR 1142, the Working American Families Access To
  Health Care Act of 2001 (Rep. Conyers) 
• MediKids (Sen.Rockefeller, Rep.Stark)

23
99 in 01 100 ACCESS

• HCR 99 calls for Congress to enact legislation by
  October 2004 to guarantee that all persons in the
  U.S. have access to health care. The Strategy
• Town Meetings/Candlelight Vigils this Fall,
  calling for legislators endorsements, including
  Health Care Justice Week/Month (October 2001).
• Meanwhile, gain national and state/local
  organizational (I.e., your local chapters) and
  individual (you!) support for a grassroots effort
  that targets important and vulnerable 2002
  Congressional candidates.
• Educate/Organize the grassroots and American
  public for the next time this issue reaches the
  Hill. (www.healthtogether.org)

24
Never doubt that a small group of committed
citizens can change the world indeed, its the
only thing that ever has. Margaret Mead

• VOTE! Voter Registration
• Letter-writing/Petition drives/Phone calls
• Push the EnvelopeTalk with your medical
  schoollocal professional societies local
  legislators about UHC!
• Rallies, Marches, Vigils are all around you!
• SCHIP Enrollment Campaigns (www.childrensdefense.o
  rg/SHOUT.html) or (www.coveringkids.org)
• Maryland Summer!

25
And whats a Med Student to do? The Decision is
yours Health Care for All RESOURCES

• Jack Rutledge Fellow (jrf_at_www.amsa.org or x220)
• HPAC UHC Coordinator, Charlie Bergstrom,
  (charberg_at_bu.edu)
• AMSA Website (www.amsa.org/hp/uhcinitiative.cfm)
• Candlelight Vigil Guide and Local Contact Guide
• UHC Options for Reform Guide
• UHC Proposals Comparison
• Sample Letters to Congress and Letters-to-Editor
• AMSA Slideshow
• Coming Fall of 2001 AMSA UHC Curriculum
  (web-based)
• Important UHC Websites/Links
• Updates on HCR 99
• UHC Listserve

26
Everybody In, Nobody Out AMSAs 2001-02 UHC
CampaignRecruit Students for Maryland Summer

• PLEDGES, Guppies
• Speaker or Debate Event
• Letter-Writing or Petition Campaign
• Brown Bag Lunch Discussion
• Letter-to-the-Editor (school newspaper and local
  newspaper)
• Collect One Story

• PLEDGES, Flying Fish
• Candlelight Vigil in HC Justice Month
• Campaign for 99
• Talk with local professional society
• Talk with local legislators
• Talk with dean about formal curriculum
• CHIP/SHOUT
• Event

27
For More Information About AMSAs Initiatives,
Contact
American Medical Student Association Jeff
Huebner, MD, Jack Rutledge Fellow 1902
Association Drive Reston, VA 20191 (703)
620-6600, ext. 220 E-mail jrf_at_www.amsa.org
Check our universal health care initiative web
site for ideas on how you can get
involved! www.amsa.org/hp/uhcinitiative.cfm