Monday, December 28, 2009

Radio Debate on Health Care Reform

Dr. Cameron Page jousted on BlogTalkRadio with Gary Anthony Ramsay on December 28. Hear the show here:

Tuesday, December 15, 2009

Celebrating our Accomplishments

NPA NY celebrated this year's accomplishments with our community partners downtown in Manhattan on December 14th. Dr. Manisha Sharma MC'ed with verve and Dr. Aaron Fox spoke eloquently. We were serenaded by the hilarious Billionaires for Wealthcare. More than 125 people who made it out for a great party and we raised $530 and 3 BIG boxes of food for City Harvest.

Sunday, December 13, 2009

12/10 Lobby Day at Capitol Hill

NPA members Drs. Arend, Williams and I joined over 50 physicians in Washington, D.C., on December 10th for a day of action in Washington, D.C, organized by current/former RWJ Clinical Scholars. Our New York contingent joined other physicians from places as far as Illinois, Louisiana, Oregon, and California to meet with our Congressional leaders to ensure that our patients' voices were heard. Though we were mutli-specialty (ob/gyn, urology, internal medicine, psychiatry etc) and multi-affiliated, we all shared a common goal: we want all of our patients to have access to affordable, high-quality, continuous health care. Our NPA-NY group was joined by Drs. Blum and Dreyer, as we met with staff members of Senator Gillibrand and Representative McMahon. Our day of lobbying ended with a press conference with Senate leaders in the Kennedy Caucus Room of the Russell Senate Office Building. For me, the true highlight of the event was meeting so many doctors who decided to take a day off from clinical duties and participate in much-needed advocacy on behalf of their patients. For more.

Wednesday, December 9, 2009

Cost of Delay Vigil - Times Square

Dr. Manisha Sharma spoke at the Cost of Delay Vigil in Times Square on December 8, 2009. Pictured here with Tim Foley.

Cost of Delay Vigil - Queens

On December 8, Dr. Bill Jordan joined 2 other speakers to address a dedicated crowd of Queens residents who support health care reform. This was part of a national night of vigils to highlight the cost of delaying reform, which includes illness, bankruptcy, and even death.

Tuesday, December 8, 2009

Cost of Delay Vigil - - December 8, 2009 - Brooklyn, NY

NPA member, Raphael Pristoop, MD, spoke at the Brooklyn, "Cost of Delay" Vigil, held on December 8, 2009 at 5:00 pm. It was conducted by the's Brooklyn Council and was held in Cadman Plaza, in downtown Brooklyn. The "Cost of Delay" vigil shone a spotlight on the number of Americans in our communities who can't afford to pay the costs of their medical bills and are being forced into bankruptcy. Other Speakers included Brooklyn Borough Vice President and Registered Nurse Yvonne Graham, Gail Muhamad, Special Assistant to Congressman Ed Towns, as well as citizens burdened with devastating health care expenses. Music provided by world class drummer Swiss Chris of Virtual candlelight supplied by motivated MoveOn members with flashlights. Special thanks to its moderator and Media coordinator, Ms. Shawn Walsh. The video was shot by Brooklyn's Council's videograhper Harry Mena.

Photos from the vigil can be viewed at this website:

Wednesday, December 2, 2009

Lobby day to support health reform including access to reproductive health care

On December 2nd hundreds of supporters of health reform attended a lobby day and rally in support of comprehensive health reform that does not include restrictions on access to insurance coverage for abortions. The health reform bill approved by the House in November included an amendment known as the Stupak Amendment that would go beyond the status quo preventing federal funding for abortions. If these provisions are approved, women purchasing coverage through the newly established insurance exchange, or their dependents, would be required to pay for any abortion care out of pocket. The only exceptions delineated are for rape, incest, or threat to maternal life. Not included are threat to maternal health or fetal anomalies.

I led a group of students from the Columbia School of Public Health. We met with representatives for Senator Gillibrand and Representative Rangel. We also attended a rally at which multiple Representatives and Senators expressed their support for access to full spectrum reproductive health care as part of any health reform effort.

Monday, November 30, 2009

Bronx Talk Tackles Health Care Reform

Dr. Jonathan Arend, NPA NY Legislative Director, and Tim Foley of NPA NY's
community partner organization NYC for Change, discuss pending national
health care reform legislation on the local television program Bronx Talk on
November 30. Click here or see below to watch this in-depth conversation.

Monday, November 16, 2009

Calling on the Conscience of Senator Lieberman

A group of NPA physicians joined a vigil outside Senator Lieberman's residence on Sunday evening, November 15, 2009. Several hundred gathered at his former high school in Stamford, Connecticut to appeal to Lieberman's conscience and allow an up or down vote on health care reform, including a public option. Mayor Malloy, Reverend Heichler, Reverend Grubbs, Rabbi Fuchs, and Rabbi Fish spoke with passion in support of a public option. After their speeches the group formed a procession across the street to Lieberman's residence, where spoken and written prayers were delivered. The event was organized by the Interfaith Fellowship for Universal Health Care. In attendance were NPA Drs. Oni Blackstock, Alex Foster, Aaron Fox, William Jordan, Sharon Phillips, and Dana Schonberg.

Read an article in the Stamford Advocate about the event and see a slideshow here.

Friday, November 13, 2009

Thank you, Congressman Towns!

Today I attended the rally organized by The purpose of the rally was to thank Congressman Ed Towns (NY-10) for his part in ensuring the passing of the health care reform bill H.R. 3962. The Honorable Mr. Towns, his staffers, community members, and patients attended the rally. I spoke at the rally; I was pleasantly surprised having the attendees thank me for coming out. It was clear to me that they felt good about having a doctor there with them.
-- Carol V.R. De Costa, M.D., M.S.

Monday, November 9, 2009

Sarah Miller, M.D., and I spoke at an OFA event in Setauket, Long Island on November 9th. We had a great turnout of about 40 attendees, who had lots of great questions about health reform. The forum was specifically regarding women's access to health care, and Dr. Miller shared an experience showing how even women with insurance have trouble getting their needs met. One of her patients needed a birth control method for medical reasons and was turned away many times because her insurance, run by a Catholic organization, did not cover birth control methods under any circumstances. Getting the care she needed required multiple trips to various physicians and would have been much simpler if insurance companies were required to cover basic reproductive health care needs. I recounted the story of a woman I met in the Emergency Department about a year ago who had been ignoring her chest pain for weeks out of fear of the hospital bills she would incur if she came in. By the time I met her, she was gravely ill and required emergency surgery for a ruptured aortic aneurysm. Unfortunately, she did not survive, and left behind a husband, children, and grandchildren who might have had much more time with her if she had had access to the care she needed.

The audience had many questions about how the bill would affect them, including those on Medicare and those who were younger, what services would be provided, and what the current proposals in Congress entail. We had a great time educating and learning from this wonderful audience.

Sunday, November 8, 2009

Phone Bank for Health Care Reform! Historic!

Hours before the historic House vote , about 70 grassroots volunteers, including NPA New York members, made phone calls to urge fellow New Yorkers to call their representatives, demanding their support for health care reform. Together, we made almost 1700 calls to constituents of Representatives Dan Maffei (NY-25) and Scott Murphy (NY-20). Sharon, John and I called over 100 constituents to Rep. Murphy's district. At some point, so many messages were left on Murphy's New York voice mail that we ended up giving out the DC office phone number, his fax number and his email address. Apparently, our group effort had some part on getting Maffei on board, whereas Murphy failed to listen to his constituents. To all our New York Reps who voted for health care reform, we thank you! More here.

Thursday, November 5, 2009

"Die In" For Affordable Health Care

I joined MoveOn.Org members on November 2nd in front of the New York Times building to emphasize the very real death toll caused by lack of access to affordable health care. To memorialize the 122 Americans who die every day because they don't have health insurance, stories of people who died prematurely were read aloud and the readers took a place among the dead on the ground.

I spoke about a patient I saw in the emergency room who had been suffering from chest pain for weeks but did not go to her physician because she had no insurance coverage. She was found to have a dissecting aortic aneurysm and did not survive the surgery to repair it.

The number of 122 dead daily from lack of insurance belies the thousands more who daily suffer permanent disability because they were unable to access health care. I am optimistic that the current legislation will help solve some of these access issues.

See video of the event on YouTube here.
See coverage in the Greenwich Village Gazette here.

Wednesday, November 4, 2009

Black Women's Health Imperative Town Hall Meeting in Baltimore

The Black Women's Health Imperative, Raising Women's Voices and the Mayor's Office of Baltimore organized a town hall on 11/4 in Baltimore entitled "Raising Black Women's Voices for Health Reform".

As a panelist, I provided a physician's perspective for why health reform was needed and specifically addressed disparities in the rate of uninsurance and health outcomes for Black women. The panelists included the founder of BWHI, the interim commissioner for the City of Baltimore Health Dept., a representative from a youth advocacy group, and professor of health policy. The discussion was lively and passionate. Most in the audience were anxious to address to the problem of uninsurance and underinsurance and the rising cost of health care. Many suppported health care reform efforts and were there to share their personal stories. Audience members wer encourage to take action in support of health reform by calling their congress members and spreading the word to family and friends.

Tuesday, November 3, 2009

Dr. DeCosta's Story - Why We Need Healthcare Reform

Dr. DeCosta talks about what happened to her patient in the current healthcare system,and explains why we urgently need healthcare reform.(Videographed & Edited by Junko Ishikawa)

Saturday, October 31, 2009

Healthcare Mythbuster in Elmhurst, Queens

A few weeks ago, I had the privilege of representing the NPA at a Healthcare Mythbusters event recently. It took place at the New Covenant Church in Elmhurst, Queens. Elmhurst is far out on the eastern edge of the borough.

As I walked toward the church, a surprising --- and surprisingly nice --- smell wafted toward me: manure. It turns out that the New Covenant Church is directly across the street from the historic Belmont Racetrack, which is home to the Belmont Stakes, one of the three jewels in the Triple Crown of horse racing.

The event took place in one of the small church’s clean, well-lit reception rooms. There was a vat of sweet iced tea and Jamaican beef patties at the back of the room, courtesy of a local business owner. Attendance was small at first, but grew steadily during the hour and a half I stayed. I was the first panelist to arrive, and I started speaking while people were still trickling in.

I began with a story about a patient who’d had an adverse health outcome because of his lack of insurance, and then segued into how the current legislation would change that. I briefly sketched out the major components of the bills: insurance reform, individual mandate, employer mandate, the health insurance exchange and the public option.

Because there were only eight people in the room, I didn’t sit behind the table at the front of the room. I stood up front, close to people, and tried to make my talk informal and interactive. One audience member, Veronica Beckford, was a staffer for Congressman Gregory Meeks, who represents the sixth district. She was very informed about the legislation and contributed usefully to the discussion.

After going through the different aspects of the legislation, I talked a little about Medicare, and how this legislation would improve it. I immediately got the sense that Medicare was an important issue to people. I emphasized how the legislation would close the “doughnut hole” and would pay hospitals for quality of care, not quantity.

I tried to encourage people not to fall for the insurance industry scare tactics. Reducing unnecessary care that does not make you healthier is not “cutting your benefits,” like the Republicans would have you believe. If anyone can testify that more hospital days and more procedures do not equal better health, it’s a doctor currently working in a hospital.

Overall it was a great experience. I think people left with a more positive impression of the healthcare reform legislation than when they arrived.

My only regret was that I didn't get to visit the Belmont Racetrack. I tried to think up a good joke about not believing the manure that the insurance industry was shoveling. But I didn't tell it, and I'm pretty sure it wouldn't have gone over well anyway.

Dr. Cameron Page

Friday, October 23, 2009

Drs. Carol DeCosta and Manisha Sharma at the Emmanuel Baptist Church

My experience last week at Emmanuel Baptist church was a success. The audience was mainly the prime-time group (50 and over) at the Emmanuel Baptist Church. Reverend Rose Jones Wilson asked me to speak about Osteoarthritis as well as Health Care reform, dispelling the myths.

There were about 40 persons in attendance. Senator Vilmanette Montgomery stopped by and spoke about her support for the public option, however she questioned why children were not directly written in.
The audience was very engaged and wanted the opportunity to keep abreast of the activities in the congress and senate.

Overwhelmingly, the group embraced Dr. Manisha Sharma as she told her story. They also showed their empathy when I shared my story about the patient who was denied a CT scan for months and may now have to have surgery.

A special shout out to Manisha, she was feeling under the weather and insisted on coming out to be supportive of me. She is a great speaker and shared her knowledge about the public health insurance option in an objective manner. We worked well together and were able to answer the majority of the questions.

By Dr. Carol DeCosta

Speaking at the West 75th Street Block Association General Meeting

I was invited to speak at the West 75th Street Block Association General meeting on Oct 22 at 7:30 pm. It took place at the West End Collegiate Church on 77th Street between West End Avenue and Broadway. A representative from NYC for Change, Aliya Quraishi, was also present. We shared the stage. First, Aliya gave a brief overview of the heath care reform legislation. Then I gave the physician's perspective on Health Care Reform and why it is so necessary. The audience was very receptive to my stories and points. Several members of the audience felt moved to share their own stories. One member of the audience described when she was prescribed a medication by her doctor but the insurance company wouldn't cover it. Another member of the audience told the story of when she tried to by her prescriptions in the US it cost $680 so she went to visit her sister in Canada and got them all for $150. Next, we had a question and answer session. Some of the questions I fielded were: Why are drug prices so much higher in the US? Will the public option cover tests for Celiac Disease? Why don' they focus more on nutrition in the Health Care Reform Legislation? Will the Public Option cover chiropractors and alternative medicine? Can I explain the single payer nation health plan model? Who decides how much an x-ray costs? At the end, I received very good feed back from the organizers and audience members. Hopefully some more of these people will get involved.

Rafi Pristoop, MD

Panels on 10/22

I was graciously invited to join 2 panels on October 22nd.

Arlene Geiger moderated a panel for students of John Jay College in the afternoon. The students filled the room, and asked thought-provoking questions on health reform.

The Public Health Association of NYC and the Black and Hispanic Student Caucus of Mailman School of Public Health co-sponsored a panel at Columbia. Dr. Karen Wang and I busted some myths with the best of them (Tim Foley, Mark Hannay, Lamont Carolina, and others). Thanks to Jessica Silk and Lois Uttley inviting us to this lively event.

A common theme in both was concern over reproductive rights being sidelined in the health reform debate.

Wednesday, October 21, 2009

Dr. Manisha Sharma on Health Care Reform

On October 20, 2009 at Hammerstein Ballroom in NYC, Dr. Manisha Sharma preceded President Obama's speech on healthcare reform by sharing her personal battles with health insurance companies, to now fighting for healthcare reform as a doctor and activist.

Tuesday, October 20, 2009

Rally for the Public Option outside Obama's Fundraiser

Drs. Bill Jordan and Alex Blum speaking at the rally on October 20th outside Obama's fundraiser appearance.

Wednesday, October 14, 2009

MoveOn rally in Union Square

Several NPA-NY members were at today's rally in Union Square. Over 100 MoveOn rallies occurred throughout the nation today. The theme for New York was to thank Senator Schumer for his continued support of the inclusion of a public option in health care reform. Several physicians spoke, including our Manel Silva and Alex Blum from Doctors for America. Several MoveOn members spoke about the amount of money they have had to pay in order to stay insured, in some cases well over $10,000 per year.

Hearing the stories of individuals reminds us why we are fighting for a public option. It's not only for people who are uninsured, but also for those who are fighting to pay for their current coverage. It's for people who have pre-existing conditions that would preclude them from attaining affordable insurance.

The key operator in this is affordability. Without a public option, we have a mandate to buy coverage, and absolutely no mechanism to control the out-of-pocket costs for premiums. Without a public option, although the bills may contain useful protections for consumers, they fail to provide one of the most important protections: ensuring that care is not only available but also affordable. rally in Brooklyn

I had the opportunity to speak today at a rally on the steps of Borough Hall in Brooklyn, NY organized by to thank Senator Schumer for his support of the public option and health care reform. About 50 people attended the rally, which was peaceful and supportive of reform. Brooklyn Borough President Marty Markowitz and the President of the Carribean Women's Health Association were also present.

Monday, October 12, 2009

Dr. Silva on The Gary Anthony Ramsay Blog Talk Radio Show

I was interviewed for the web radio show 'Mad in the Middle' hosted by Gary Anthony Ramsay. My co-panelist was Pulitzer prize winning journalist Karen Hunter. The interview itself starts at at 15:45, but the conversation really starts at 17:00. If you want to skip to the best part of the interview, go to 31:45 when the Ms. Hunter starts suggesting that we should reinstitute shame as a public health intervention. But it's an argument I've heard in different forms from both progressives and conservatives- that people need to control their behaviors, and others shouldn't be held accountable for the consequences. Yes, we should have better prevention and wellness programs that address people's behaviors. But not all diseases are solely related to behavior- diabetes often develops from a combination of behavioral and genetic factors, as well as socioeconomic factors that underlie behaviors (i.e. why is that I can predict someone's risk of many diseases by the zip code that they live in?). And the solution is not preventing access to health care services, especially to a physician that can often change behaviors by a simple honest conversation (which has been proven to be more effective than most other interventions for a number of risk taking behaviors). I can tell you this as a physician who works with teenagers in the area of preventative sexual health- shame will not change risky behavior, in fact, their shame and fear is what forced them to seek my services, so we can collectively come to a solution that ensures that they won't get pregnant, have an STD, or be in an abusive relationship (and I always encourage them to speak to their parents about their situation). Lastly, people should not suffer from the very dangerous consequences of renal failure because they ate too much salt over their lifetime. Diseases have consequences and suffering that are not consistent with the behaviors they are related to, and we should not punish each other for that. We should support each other in taking better care of ourselves and our future.

Saturday, October 10, 2009

Talking about health care reform in White Plains

On Saturday, I spoke to a group of about forty members of the Calvary Baptist Church in White Plains as part of their annual Christian Education Retreat. The members were very interested and engaged and they asked many thoughtful questions about health care reform.

My sense was that they wanted to be informed about this issue so that could make up their minds about whether to support the push for health care reform and I do believe by the end of the session most people were very supportive of reform efforts.

On another note, I think churches or other faith-based organizations' core values are very much in line with most of those of health care reform (i.e. health care for all, etc) and can be very effective venues in terms of spreading the word about health care reform to their members and other groups.

Tuesday, October 6, 2009

My outing to East New York, Brooklyn

I attended a mythbuster panel sponsored by Organizing for America out in East New York, Brooklyn. (I saw "out in East New York" because I hopped on to 3 line at its penultimate stop here in Harlem and then took it to its penultimate stop in Brooklyn.) The last time I had been out there was as a 4th year medical student working at a community health center.

There had been a mix-up about the date and time of the panel so only five of us total showed up but what I quickly realized was that more important than the numbers of people who turn out is the spirit and energy of those who do. I met three residents from East New York who were devoted to their neighborhood and wanted to do whatever they could to spread the word about heatlh care reform.

We spoke for about hour and a half starting with health care reform but then moved on to obesity and hypertension as well as other medical conditions that disproportionately plague communities of color. In addition to learning about and supporting health care reform efforts, these inspiring residents wanted to be informed about preventive care and staying healthy. I was glad I could be a source of information for the residents and plan to remain in touch as they continue their efforts to create a healthier community.

Debate: Rep. Anthony Weiner vs Dr. Betsy McCaughey

I was hoping to hear a thoughtful conversation between two people who had very opposing views. I wanted to know the factual basis driving those who are anti-health care reform. But in end, I had a town hall-lite experience. Rep. Weiner presented statistics and well-documented sources about our current health care system, especially focusing on our Medicare system (a co-existing public and private insurance plan that is providing quality care with innovation in need of some changes, like payment reform and decreasing subsidies to private Medicare insurance plans). Before relinquishing the stage to Dr. McCaughey, he warned the audience: "Don't believe her when she cites a page in the bill, it's not there", pre-empting her trademark, "I've read the legislation on page XX" as she points to a gigantic black binder. Dr. McCaughey was more prone to vague references, illogical conclusions and well-known fear-mongering comments like "someone is going to steal granny's purse". During the Q&A session, a pro-Weiner audience member yelled "Answer the question!" to the ever-elusive McCaughey. A pro-McCaughey audience member also heckled Rep. Weiner several times, yelling, "Rude man! Rude man!" It was entertaining and only slightly educational. What I found interesting: 1. There are teabaggers in NYC. 2. Rep. Weiner pointed out that most people are not so enamored with their insurance company that they are afraid to lose it. Rather, people are afraid of losing access to their regular health care provider. For more, read the daily kos or politico.

Saturday, October 3, 2009

NW Bronx for Change / Ben Franklin Club Panel

I had a good experience on the panel today in the Bronx. I shared the stage with Rep Engel, Tim Foley (CIR / SEIU), and Columbia Presbyterian's Community Affairs person. It was a small and amicable crowd of about 50 people. Generally civil with good questions. Engel had to leave early to do battle on Fox News. I had the opportunity to directly dismiss a question about rationing in Canada from my personal experience as a medical student in Montreal.

See the letter to the editor in the Riverdale Press for more information.

My experience at a health care reform panel discussion at Harlem Hospital

I went to Harlem Hospital on October 3rd to hear a panel about health care reform with a specific focus about what reform means for safety net hospitals like Harlem. Congressperson Rangel was in attendance and spoke.

Some of the panelists were more informed about reform than others. A representative from AETNA who was on the panel actually stated that co-ops were a public option. Huh?

Another doc who is in private practice and was representing the Empire State Medical Association told the audience that the public option (which he supported) would put half of private insurers out of business. Huh?

What disturbed me most were a few comments from the people in the audience (several jeers) when the topic of coverage for undocumented immigrants was raised and it was raised frequently. Some folks appeared very much against undocumented immigrants getting coverage on their dime. People were more preoccupied with undocumented immigrant issue, than all other aspects of reform.

I felt disgusted. When it came time for Q and A - I spoke as a physician and said we need to make sure all Americans - undocumented or not - have health coverage because we all will pay in the end (besides, it's the right thing to do) as we are now. Also, I mentioned that many undocumented workers do pay taxes so in effect they are subsizing our care without access to the same care they are subsidizing (this got a chuckle out of Rangel). I expressed that this disproportionate focus on preventing undocumented people from getting health care was a distraction put forth by folks who don't want to see real reform happen. I received alot of support from the several of the panelists on this point.

People in the community went there to learn about reform (I assume) but if I knew nothing and attended that panel I would have been sorely misinformed for the most part.

Friday, October 2, 2009

Meeting with Congressman McMahon, NY District 13

Today I met with Rep McMahon from Staten Island, along with 5 other representatives from progressive organizations, as well as 6 members of the local Tea Party. We had a relatively civil discussion, enabling each side to articulate their point of view and why they disagreed with the opposite view. Although Rep McMahon was not clear about his opinion, it was heartening to hear him press the Tea Party people about their views on Medicare, specifically whether they believe if we should get rid of it. In the end, it was clear that beyond the facts, there were some striking ideological differences about rights, values and the role of government.
The next Monday, Rep McMahon held a townhall meeting where he stated his public support for HR 3200 as well as the public option. Yay!

Thank you Senator Schumer for fighting for health care reform!

A group of women, representing different grassroots organizations in NYC, went to Senator Schumer's Manhattan Office to thank him for his continued support of health care reform and fighting for public option. We met with his staffers, Teri Coaxum, Deputy State Director, and Victor Pichardo, Community Outreach Coordinator. The conversation mostly reinforced our knowledge that the key to passing reform would be mobilizing our bases nationwide to visit, write, or call their representatives.

We dicussed what we were doing to educate and mobilize our own groups, like the the National Grand Rounds for health care providers sponsored by NPA and AMSA, Lobby Day for Young Adults by Young Invincibles, Health Care Myth-busting Sessions, Teach-Ins, Phone Banks, Rallies by Raising Women's Voices, OFA, nycforchange, Democratic Clubs of NYC et al.

What was important to hear was that in spite of the recent Senate Finance Committee vote against the public option, Schumer's staffer/Schumer strongly believe that via some political process, the final bill would contain the public option. I'm hoping that's true. But if not, having seen the spirited efforts of numerous grassroots organizations in NYC this past summer, i know we're all in this for the long haul. So, let's keep up the momentum!

Response to NYTimes Article

Response to
New Twists in the Health Debate
NY Times

To the Editor:

Senator Max Baucus was right when he said there’s a lot to like about the public option. For one, it allows people’s health to be valued over profits.

As a practicing physician who has worked with both private and public insurers, I can assure you that there is a need for competition to ensure appropriate affordable coverage as well as innovation.

And I’m not alone: as a recent study from The New England Journal of Medicine noted, 63 percent of physicians support providing for our patients “the choice of enrolling in a new public health insurance plan (like Medicare) or in private plans.”

Doctors have nothing to gain from promoting the public-plan option, except that we know from firsthand experience what it can do to help secure affordable quality coverage for all Americans. And we are hoping that our elected officials will listen, including Senator Baucus.

Manel Silva
Brooklyn, Sept. 30, 2009

Thursday, October 1, 2009

What will happen to the Uninsured and Underinsured?

On October 1st at the "Assuring Equity Through Health and Health Care Reform" conference at the New York Academy of Medicine sponsored by Albert Einstein College of Medicine, Dr. Manisha Sharma, NPA-NY's Director of Media Relations, and Dr. Manel Silva, NPA-NY's Director, served as panelists for "Covering the the Uninsured and Underinsured", an engaging and lively discussion about an issue central to health care reform. Dr. Oni Blackstock, an NPA-NY member, moderated the panel.

Dr. Sharma spoke movingly about her own patient experience of being uninsured and her own difficulties in obtaining coverage because of a pre-existing condition. Dr. Silva, who works at free clinic for adolescents, spoke specifically about the issue of uninsurance among young adults especially those with chronic conditions. The current health care reform bills and proposals in Congress were also discussed.

Wednesday, September 30, 2009

Use YouTube to Support the Public Option

The majority of Americans (including doctors!) support the public option. And yet, today the Senate Finance Committee voted against the public option & patient choice. So we've joined the on-line "I Support the Public Option" video petition to ensure that our collective voice is heard. At tonight's meeting, we each made our own video and posted it to the website.

Check out the website:
--> Make your own video!
Check out the youtube channel:

Thursday, September 24, 2009

"Why I went to medical school…."

by Nina Agrawal

I went to medical school to help people get healthier not to help CEO’s get wealthier.

I went to medical school because I believe in giving all kids a fair chance in life and not based on their immigration status.

I went to medical school to build relationships with patients not insurance clerks.

I went to medical school to prescribe treatments that are best for my patients not for insurance companies.

I went to medical school to prescribe medications because they work not because the insurance company covers them.

I went to medical school to save lives from illness not from insurance company greed.

I went to medical school because I wanted to make a difference.

*Please support the public option. More than 64% of physicians do.*

Wednesday, September 16, 2009

It's crystal clear: doctors support a public option LIKE MEDICARE

According to a study published yesterday in the New England Journal of Medicine, 63% of doctors support expanding health insurance coverage through both private and public options. NPR reported on this survey with the headline, “poll finds most doctors support public option,” and immediately elicited comment from the American Medical Association, since the organization has equivocated on support of the public option in its public statements, while the study explicitly demonstrated support for the public option among AMA members (62%). Not surprisingly Dr. James Rohack, the president of the AMA (who has previously made confusing comments about the public health insurance option implying that subsidized private plans could be considered a public option), challenged the meaning of the findings, “[the public option] means different things to different people, kind of like the Rorschach ink blot test.” However, his attempts to obfuscate only further emphasize that the official positions of the American Medical Association do not represent the viewpoint of most American doctors (or apparently in some cases even AMA members).

While it is true that there are different versions of the public health insurance option described in the bills coming out of the House, the Senate HELP committee, and the framework envisioned by Jacob Hacker, the findings of this study are not up for interpretation. A Rorschach test is purposely subjective so a clinician can interpret a patients' psychological state. Conversely, good researchers ask precise questions and describe their methods in detail so that their findings can be reproduced. The reputation and influence of peer reviewed journals, like the New England Journal of Medicine, is dependent on publishing quality research.

The consistency and reliability of the research demonstrating doctors’ support for public health insurance similar to Medicare should relieve us all of the fear mongering around “socialized medicine." Ironically, conservative politicians fear "government bureaucrats standing in between them and their doctors," while their doctors do not. The evidence is crystal clear.

In 2003, Ronald Ackerman and Aaron Carroll asked 3188 randomly sampled physicians, “In principle, do you support or oppose government legislation to establish national health insurance?” At that time 49% supported this type of legislation and 40 % opposed.

In 2008, the authors repeated the study, this time with 59% agreeing and only 32% opposing national health insurance. They also asked, “do you support achieving universal coverage through more incremental reform?” 55% supported and 25% opposed this type of proposal.

And now, with the study by Keyhani and Federman we have another question directly relevant to the current health care debate:

Respondents were asked to indicate which of three options they would most strongly support:

1. Public and Private Options: Provide people under age 65 the choice of enrolling in a new public health insurance plan (like Medicare) or in private plans.

2. Private Options Only: Provide people with tax credits or
low-income subsidies to buy private insurance coverage (without
creating a public plan option).

3. Public Option Only: Eliminate private insurance and cover everyone in a single public plan like Medicare.

63% of doctors chose option #1 - the public and private options.
It is not clear to me how Dr. Rohack could be unsure what the public option means in this context. It's right there in the study's methods.

These research findings are robust and consistent: doctors support national health insurance (i.e. Single Payer); but when asked specifically about a public health insurance option similar to Medicare and available to everyone below 65, they overwhelmingly support it. There even seems to be a trend developing where a greater percentage of doctors support public health insurance.

Doctors are not afraid of government health insurance bureaucrats – we already have private insurance companies' utilization reviewers to contend with. The study's findings may be a surprise to some, since doctors tend to be conservative as a whole, but the truth is that most doctors are sick of fighting with insurance companies. The average physician spends 43 minutes per day and $65,000 per year on interactions with health plans; there have already been multimillion dollar class action lawsuits against Aetna, Cigna, Humana, Blue Cross Blue Shield, and others for underpaying doctors (among other charges), and ultimately we have yielded too much decision making capacity to managed care companies.

So when we talk about a public health insurance option, we mean a plan modeled on Medicare. We do not mean a co-op; we do not include a trigger option; and we don't want expanded coverage limited to public subsidies for private plans. The data is there in black and white - in the shape of a bar graph, not an ink blot.

Aaron Fox, MD
NPA - NYC Local Action Network

Thursday, September 10, 2009

Raising Women's Voices health care reform teach-in

Drs. Manel Silva, Local Action Network, Director, and Oni Blackstock, NPA-NYC, spoke at Raising Women's Voices' Community Teach-In For Health Reform - Busting the Myths at Judson Memorial Church on September 10th. Dr.Silva spoke passionately about why we need health reform and Dr. Blackstock addressed and dispelled several common health reform myths in front of an eager and excited crowd of about sixty people. For more on the event, please visit Raising Women's Voices' blog.

Thursday, September 3, 2009

Doctors Support Health Care Reform

Dr. Manel Silva of the National Physicians Alliance addressing a crowd in Jersey City gathered at a candle light vigil in support of health care reform (and from the signs, the crowd is clearly in support of a public health insurance option):

Dr. Viraj Patel, also of the National Physicians Alliance, shared a patients story at a vigil in Manhattan:

59% of physicians support national health insurance and 55% support achieving universal coverage with more incremental reform. We need to get out there and let the country know that doctors want a health care system that is fair and that is focused on the needs of our patients.

Wednesday, September 2, 2009

Health Care Can't Wait

Dr. Alex Blum of DFA

Reclaiming the Healthcare Battle

Dr. Nina Agrawal on GritTV

The Tale of Two Townhalls

Last week, I had the very interesting experience of attending two town
hall meetings on healthcare with Rep Yvette Clarke and Rep Anthony
Weiner (both Democrats in NY).

Despite the fact that they were only a few stops apart on the Q train,
it was like being on two different planets. Despite the fact that the
topic and the Q&A format at both was the same, the process seemed
driven by two different objectives.

First, I arrived at Rep Clarke's town hall at a church in Flatbush. A
few cops stood outside, but otherwise it was quiet. Inside, there was
a noticeable diversity of constituents of all ages and backgrounds
among the 200 or so present. The signs people were holding up were
clearly in support of health care reform. Rep Clarke spent the
majority of her time explaining the content of HR 3200, especially how
people would be affected. There was frequent applause in support of
her efforts and of the House bill. Not a single voice expressed
dissent. The presentation is available on Clarke's website.

Then I got on the Q train and took a bus to CUNY Kingsborough
Community College to hear Rep Weiner speak. A few cops stood outside
as well as several anti-reform protesters holding signs equating Obama
with Nazis, and other equally reprehensible, illogical accusations. I
could hear people shouting before I entered the auditorium. Most of
the anti-reform people were older and white (men were more likely to
get on the mic), while the pro-reform were younger and people of
color. Rep Weiner was attempting to answer people's questions, but
many in the crowd kept shouting him down. This was not a discussion
but rather an argument. There was no opportunity to debate. People
would ask questions and then prevent him from answering. People made
statements disguised as questions - about death panels, government
take-over of care, paying for lazy people who don't want jobs, etc.
When a woman, claiming to be a former enrollment officer for SCHIP,
screamed about the children of illegal immigrants getting health care
I couldn't hold back. I stood up yelled: "But they're children!!!" She
was obviously ignorant or unconcerned with the fact that the current
proposed legislation doesn't cover undocumented immigrants.

For the most part, those in support of health care reform made their
voices heard through the Q & A process. Several health care
professional, some from other countries, shared their views. All
except one nurse and one of the docs who spoke were in support of
health care reform. One man filmed the proceedings while, at the same
time shouting at Rep. Weiner, who nonetheless would directly approach
his camera to make certain points. Rep Weiner, as many of us are
aware, knows his facts. He put a lot of energy into attempting a
discussion about those facts. For many who were there however, the
facts were not the point. As I left the room I was engaged in a
“conversation” with one of the anti-reform people, who kept insisting
that this was a government takeover and that we couldn’t afford it, at
the same time acknowledging that she didn't support private insurance
industry practices. She made no sense. At the end I suggested we
agree to disagree.

Some great quotes:
- By Rep Clarke, regarding the “individual mandate”: "We all have the
intellect, as a species that shares this planet, to understand that we
all have the opportunity to become vulnerable to things such as
communicable diseases, e.g. H1N1 flu.” The point is that we are all
affected (whether through shared vulnerability or shared cost) if
someone without health insurance needs and cannot receive medical
treatment. The unmet cost of insurance or of treatment ultimately
falls on the taxpayer. The benefits of an “Individual mandate” seem
widely misunderstood.

- By a reform supporter in response to a heckler yelling about how
reform would increase his taxes: "I don't have a problem paying my
taxes, I have a problem paying my premiums!"

- By Rep Weiner: "So let me clarify to you what socialism means:
socialism is when the government has control over the means of
production, not just the means of paying for a service. So this is
not socialism, even if you want it to be. Just in case you didn't
understand what the word meant..."

Lesson learned: People are not interested in the facts; and they're
interested in feeling right. The question is, how do we have a
conversation with that?

Manel Silva, MD,
Director, NPA NY Local Action Network

Tuesday, September 1, 2009

MD Town Hall Experience in Rochester

Dr. Javeed Sukhera, DFA regional director in Upstate New York/NPA member, who recently attended a town hall meeting for Eric Massa (D-Corning), wrote about his experience in Physician: Town Hall ignorance stifles respectful debate.

Despite the silence of summer in its halls, the high-school auditorium was packed to the brim with a raucous crowd of Americans, eager to have their voices heard. As a physician, I joined a group of colleagues, united in our pursuit of meaningful health-care reform. We work on the front lines of the nation's health care system. Our privileged roles allow us to bear witness to and alleviate the suffering of our patients. We have also struggled through the challenges of the system. Challenges including insurance companies demanding prior authorizations for medications our patients need, or denying them coverage all together. Frustrations include patients' physical suffering exacerbated by the emotional suffering of financial hardship, lack of insurance, medical debt or even bankruptcy. I arrived at the town-hall meeting for Rep. Eric Massa, D-Corning, with an eagerness for respectful debate. I left with a sense of disgust and disappointment. The atmosphere was so vicious that any attempt at meaningful dialogue was met with perverse heckling including screams that our nation should have "dropped a nuke" on Iraq instead of spending three trillion dollars on the war, and someone screaming "give Obama's wife to the Insurance Industry!" On my walk into the meeting, I stood next to a gentleman wearing a T-shirt with President Obama's face and a Hitler moustache. I heard him argue with a World War II veteran, who told him he should be ashamed of himself. During the course of the meeting, a man shouted that he received timely treatment after a cancer diagnosis, but that if he lived in Canada he would be dead. Another woman shed tears over her fear that health care reform would turn America into a communist country, screaming that the house bill would allow the government to come into citizens' homes and take their children. Another man echoed her concerns, stating that the bill would permit the government access to every Americans' bank account. Their animosity and ignorance are stifling debate instead of promoting it. They have a right to free speech, but citizens have a right to know the facts. Canada and almost every other developed country have far better demographic indicators than the US include life expectancy, especially compared to how much we spend per capita on health. The house bill says nothing of the government coming into homes or dipping into bank accounts. Most importantly, the vast majority of Americans support meaningful health care reform. As a physician it pains me to sit idly and watch the system deteriorate as premiums rise and inefficiencies mount. The cost of inaction is far greater than the cost of making positive change happen. We are a great nation and our citizens deserve a far better health system than the status quo.

Saturday, August 29, 2009

ZYNC TV covers Health Care Rally

ZYNC TV, a Brooklyn-based, Caribbean-focused community news and entertainment program, covered the August 29th Health Care Reform Rally in Times Square. Director of Legislative Affairs, Jonathan Arend's speech, and comments from NPA-NY Local Action Network members, Drs. Javier Garica and Oni Blackstock were included in the coverage.

Turning the Tide: NYC Rally Success

Thanks to all of you who showed up to be a part of an amazing event, organized by the NYCforChange and HCAN coalition of over 80 grassroots organizations. We had amazing speakers -- including Congressmembers Yvette Clark, Carolyn Maloney, and Jerry Nadler, and our very own Jonathan Arend (Legislative Director - NY NPA) and Nina Agrawal (Director of Community Outreach - NY NPA and founder of NYCforChange). There were about 3000 supporters at the rally (estimated by NYPD). People loved the "prescriptions for health reform" (download it here)and were excited to see physicians and medical students at the rally in support of reform. Check out our media coverage!!!

Aaron Fox on NY1
David Herszenson on ABC

NY Times
LA Times (AP)
MSNBC / Washington Post
Huffington Post
Daily Kos
World Journal


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Thursday, August 27, 2009

Patients deserve peace of mind

Sharon Phillips, NPA NY, wrote a compelling letter to the editor to Wicked Local, Concord, MA to share her support for health care reform.

To the editor:

Although I am currently a family doctor practicing in the Bronx, I grew up in Concord. I was disappointed to read of the angry opposition Congresswoman Niki Tsongas received at her Town Hall meeting on Aug. 8. As a physician, I strongly support a public health insurance plan. While private insurance companies pay high executive salaries and operate to maximize shareholder profits, a public health insurance plan would be designed to pay solely for the needs of its members.

While protesters of health reform fear that their options will decrease, the truth is that a public health insurance plan will provide an affordable alternative to prohibitively expensive private insurance and will foster competition to guarantee that quality, affordable coverage will be there for everyone in America when they need it.

Every day I see patients who cannot get the health care they need, either because they have lost their job, their insurance premiums have become unaffordable, or because their insurance company has denied a necessary treatment in order to save money. Several of my patients have been admitted to the hospital this year because they couldn’t afford their medications, turning controllable chronic conditions into emergencies.

Guaranteeing coverage for all through a public health insurance plan will mean that I can spend time with my patients and know that neither of us needs to worry about whether they will have access to the care they need in the future.

My patients deserve this peace of mind. I urge your readers to contact Congresswoman Tsongas to affirm their support for health care reform that includes a strong public health insurance option.

Sharon Phillips, M.D.

Fairhaven Road

Montefiore Medical Center

Bronx N.Y.

Monday, August 24, 2009

A Week of Action

If you are a daily news gatherer, you'd think that meaningful health care reform was doomed for failure and that no one supports the public health insurance option. Media outlets (tv, radio, paper, internet) seem more interested in the anti-reform movement, being funded by multi-billion dollar interest groups, than grassroots efforts of millions in support of the public option. And this obsession with negativity is only fueling the fire. In truth, here in NYC, advocates of the public health insurance option are out in full force. We are unified.

Over the last several days, I participated in several amazing events hosted by various organizations in the NYC metro area. My first event was a Thursday afternoon grand rounds at Bronx Lebanon Hospital. Dr. Bill Jordan, NPA NY, gave a lecture about physicians' role in health care advocacy. He engaged an audience of 50 plus medical students, residents, and faculty in cases discussion about green markets in NYC and NPA action in health care reform debate. Later that night, leaders of grassroots organization gathered at CIR/SEIU for a teach-in on the various legislative plans being considered and for a support-strategy meeting. On Friday, we held a press conference at Ryan Chelsea health center to let our congressional leaders and our President know that we support the public health insurance option. Community members/health activists shared their stories demonstrating the failure of our current health care system. Among them, Dr. Manisha Sharma's personal experience illustrated that even insured patients (premium paying members) are not immune from insurance companies' profit mongering (watch video here). And tonight, I joined a few members of NPA NY and NYC for Change at a Nine Inch Nails concert to rally support among young adults, who are commonly affected by the lack of affordable health insurance.

Though we are a group of local NY/NJ physicians, I know we don't stand alone. About a half million doctors nationwide support the public health insurance option. And we stand with our millions of patient - insured, under-insured, and uninsured - as we fight for a public health insurance option.

We are mobilizing, standing strong, and will make our voices heard.
Stand with us, show your support:
Unity Rally for Health Care, August 29th, 2pm

Karen Wang, MD
NPA NY Local Action Network

More photos, courtesy of Eva Brams

Millions of Americans Don't Have Health Insurance

An ABC- Australia radio piece discusses the predicament of many young Americans who can't afford insurance. In the segment, Carol Decosta, MD, a specialist in Physical Medicine & Rehabilitation, also speaks about her frustrations with insurance companies, in particular their intrusion into her clinical practice and her relationships with her patients.

Wednesday, August 19, 2009

Addressing Fear

An article today in Kaiser Health News discussed the measure of Americans' confidence in reform of our current health care system - confidence is down just in case you were wondering. Much of what was cited in the article was fear of change. That fear was found to be based on mistaken beliefs about the current proposals - a government take-over of health care, covering all 'illegal immigrants' etc.

On a daily basis, whether practicing medicine in the clinic or the hospital, we as physicians counsel patients on their diagnoses and best choices of therapies. Recently, I talked to a mother about getting a spinal tap done to rule out meningitis in her young son with fever. She had significant fears about what this meant and what the risks were. I listened, tried to address those fears and any questions she had while advocating that this was the best therapeutic choice. We are all trained in this, either formally or informally, and it is essential to practicing good medicine.

In discussing the health care reform process, some of us seem to be forgetting some of the basic tools that we use to encourage patients to follow what we see as the best choice of therapy. Listening, addressing questions and concerns in plain language and taking into account where the person is coming from while advocating for what we see as the best option are things we should consider applying to our engagement in the current debate.

There are significant fears in people’s minds about health care reform as the article pointed out. I think a lot of that fear can be assuaged through using language that is neutral yet accurate – others have proposed talking about ‘a family doctor for every family’ or a ‘pediatrician for every child’ instead of ‘universal health care.’ Specifically asking what is it about government-run health care that people are afraid of and then addressing whatever fear that is – bureaucrats will not be taking the place of your doctor.

As physicians, we counsel patients on a daily basis to take medications and undergo procedures that have inherent risks, that they have fears about but that we think are the best option. We have the training to do so. While this is nothing new, this study I think serves as a good reminder that we should use the training that we have to advocate for the health care reform that we see as best for our patients and try not to fall back on political rhetoric (even if instigated by the ‘opposing side’), confusing terminology or brush off people’s concerns and fears. I believe that the current proposal with a public health insurance option is the best for my patients, but the patients have to want it too.

Alex Foster, MD, MPH

Sunday, August 16, 2009

The Whole Foods Alternative

The Whole Foods Alternative: Organic Produce (and Health Insurance Reform) for those who can afford it.

By Aaron Fox, MD

National Physicians Alliance


Wasn’t it just last year that we heard from political pundits that arugula munching Barack Obama was out of touch with average Americans.  Well apparently John Mackey, CEO and co-founder of Whole Foods Market, not only shares President Obama’s concern with the price of arugula but also the price of health care in America.  In a Wall Street Journal op-ed piece, he shares an eight point plan for controlling health care costs, some of which is derived from his own experience in providing health insurance for his employees.  His plan includes promoting high deductable health insurance plans, deregulating health insurance markets and strengthening the individual market, and solving the problem of 46 millions uninsured Americans through charity.  Well sorry, Mr. Mackey, like many of the luxury goods at Whole Foods Market, your health reform ideals are out of touch with the lives of many Americans.


High deductable health insurance plans, or consumer directed health reform, where individuals are responsible for the first $1,000 - $2,500 of health care that they consume (not including premiums) and the insurance company covers catastrophic care, is not a new innovation introduced by Whole Foods and other forward thinking entrepreneurs.  These plans have been around for decades, and while they are certainly less expensive than comprehensive health care benefits, evidence so far shows that they have only had a moderate effect on controlling costs and their impact on quality of care is unknown. 


Unlike CEO Mackey, as a physician, I am not just worried about health care costs, but also the quality of care for my patients.  In the 1970’s, the RAND health insurance experiment studied the impact of different types of health plans, including free care and plans where patients had increasing levels of responsibility for the costs of their care.  Families who were randomly assigned to higher levels of cost sharing consumed less health care than those receiving free care, but they did so by avoiding both necessary and unnecessary care.  For the poorest families, going without care may have saved money, but it also had a real health impact.  In just a decade, it was estimated that the option with free care reduced deaths by 10% for patients with hypertension and low socioeconomic status.  While high deductible plans are attractive to the young and healthy, like those who work at Whole Foods markets, we need to provide high quality health care that is affordable to everyone, especially those who are sick and struggling economically.  In a review of consumer directed health care reform, including high deductible plans with health savings accounts, health economist M. Gregg Bloch, “if consumer-directed plans achieve market dominance, disparities in care by class and race will probably grow.”  


Case in point, this week I saw Ms D, who works as a mental health counselor and receives health insurance through her employer.  Her plan covers office visits, but she has high co-pays for her medications, which she cannot afford.  Her blood pressure and cholesterol have been very elevated, and she requires medication to reduce the risk of heart attack and stroke.  This past visit her blood pressure was great, but her cholesterol had not responded to medications, so I inquired more.  It turns out that she chose to purchase the blood pressure medications because they are cheaper.  While empowering patients in health care decision making is a noble intention, my patient’s decision is one that no one should have to make.


Mr. Mackey uses his op-ed forum to criticize socialized medicine and emphasize personal responsibility, but creating a dichotomy where “government controlled” health care is bad and individual health care decisions are good serves more as a political tool for inciting rage, rather than a model to improve our current dysfunctional health care system.  The bill being debated in the House of Representatives is a compromise between a single payer government plan and one that favors private health insurance, and it seeks to improve the health care system not make a political point. 


I agree with Mr. Mackey’s emphasis on healthful living and disease prevention, but not everyone can afford to shop at Whole Foods and purchase organic produce.  I recommend a healthful diet to all my patients, and many tell me that fresh fruits and vegetables are either too expensive or unavailable in the local convenience shops or “bodegas” where they do most of their shopping.  To respond to the need for affordable produce, the City Council and Department of Health in New York City have developed programs to promote green markets throughout the city and provide incentives where food stamps recipients can use their benefits cards to purchase fresh produce and healthful foods.  Sometimes, the government can do good, and there are provisions for strengthening the federal public health infrastructure within the House health reform bill.


In terms of increasing health care costs, one of the problems shared by both Medicare and private insurance is expanding use of new technologies, and the perverse incentives for doctors to provide more care whether it is beneficial or not.  The House proposal seeks to address these perverse incentives, first, with its funding of comparative effectiveness research, which would help doctors understand which treatments and technologies are of high value, and second, with its Medicare reimbursement reforms, which would pay doctors for improving health outcomes not simply for performing procedures.  To control growth in health expenditures, we should be making it easier for people to access high value care while limiting payment for care with limited or no value.  For example, cutting co-payments for extremely effective cholesterol lowering medications could save $1 billion per year by preventing patients from skipping doses due to costs and therefore preventing heart attacks and strokes.  Sometimes providing free care SAVES MONEY. Patients should also be involved in deciding what care is of high value, but suggesting that a patient with cancer could rationally decide what care is worth the costs is unrealistic. 


Socialism and personal responsibility are value laden terms, but we should not let our ideology get in the way of reform that would improve the lives of millions.  Charity is a nice idea, and Americans are very giving in times of need, but patients should not have to grovel for health care when they are sick; healthful living and prevention is a must, but there are millions of people in need of immediate medical care and who have no means to pay for it; the argument over the “right” to health care has already been decided - people cannot be turned away from emergency rooms if they are ill.  Now, we need to create a rational health care system that serves all Americans, emphasizes healthful living and prevention, and controls the growth in health care costs, not simply one that fits the fantasies of free market ideologues.  

Thursday, June 25, 2009

HCAN Rally in DC June 25, 2009

Twitter Summary:
# Last event of day was spirited discussion w/ staffer of Rep Crowley.3:30 PM
# Now at Doc/Nurse town hall hosted by Dr. Howard Dean. 1st up, Rep Jan Jakowski.11:15 AM
# Rep Jan Jakowski talks about how we need better nurse-patient ratios & more primary care docs (beef up loan forgiveness programs).10:59 AM
# Sen Lautenberg (D-NJ).10:17 AM
# Now NY-NJ-MD Town Hall. Rep Rangel speaking.10:07 AM
# Surprise guest Senator Gillibrand (D-NY).10:03 AM
# Dr. Howard Dean speaking now.9:49 AM
# Dr. Val Arkoosh speaking now. AMA does not represent majority of docs. NPA wants quality, affordable health care for all.9:39 AM
# Just snapped a photo w/ Dr. Howard Dean & Prez-Elect of NPA Dr. Val Arkoosh.9:24 AM
# Now at HCAN rally with thousands across from Capitol. Saw Schumer & Edie Falco speak.9:23 AM
# Met with staffers of Reps Wiener and Engel this morning.9:21 AM
# NPA going strong in DC today.9:19 AM

Tuesday, June 23, 2009

Former governor/DNC chair Dr. Howard Dean supports the public health insurance plan!

NPA-NY joined NYC for Change, CIR, MetroNYHealthcare for all andmany other groups as a co-sponsor of this wonderful event at hunter college. Dr. Dean outlined the necessity of including the public health insurance plan within the national exchange. If excluded from the legislative bill, our health care system would remain unchanged! He asks that we continue to vocalize our support not only in New York but also to reach out to family and friends living other states.

Prognosis: Debt; Treatment: Public Health Insurance Option + Investment in a Public Health Infrastructure

In an editorial titled, "Prognosis: Debt" Fred Hiatt of the Washington Post expresses concern over the (misleading) 1.6 trillion dollar price tag placed on health care reform, but in a way makes a compelling argument for including a public health insurance option in health reform.

He writes that President Obama (and others) have defined the major problem with our health care system as being unsustainable growth in costs, while congressional Democrats have primarily focused on expanding coverage to the uninsured:

congressional Democrats and the most involved interest groups behind them are far more passionate about universal coverage than about controlling costs. Thus Obama's political calculation: Push for health-care reform that delivers universal coverage -- and insist on as many levers to control costs going forward as possible.

He explains that this disconnect between the problem and proposed solution comes from the fact that it's easy to expand coverage but hard to control costs. He states that proposed cost saving measures, such as focusing on prevention, shifting from specialist care to primary care, and changing provider payments from fee for service, all are unproven, and he implies that expanding coverage to include all Americans would inevitably lead to more debt. He gives several suggestions to the President on how to ensure that whatever "new burden" we take on with health care reform "is really paid for".

As a physician, I do think universal coverage and equitability in our health care system is a "moral imperative" - I see patients without health insurance or with inadequate health insurance who have put off necessary care due to costs and suffered the consequences - but for the sake of argument, let us just talk about costs.

If we expand health insurance coverage without controlling costs, as outlined by Mr. Hiatt, we would have the equivalent of the Massachusetts plan. Their health exchange ("Commonwealth Connector Authority") and individual mandate to purchase insurance (with subsidies for lower income individuals and families), along with Medicaid expansion and other measures, has achieved more than 97% health insurance coverage. This initially improved access to care (more individuals had a usual source of care besides the ER and a preventive care visit in the preceding 12 months), and decreased the financial burden of health care costs on some families (with fewer people spending more than 10% of their income on out of pocket costs). However, without a mechanism to control costs, there have been challenges in limiting increases in premiums and some of the gains in affordability have been lost.

This is where the public health insurance option comes in. Massachusetts does not have a true public health insurance option. The Congressional Budget Office's $1.6 trillion estimate on the 10 year costs of the Senate Health, Education, Labor, and Pension committee's health reform bill did not include evaluation of the public health insurance option. A proposal by the Commonwealth Fund for comprehensive health system reform including a public health insurance option, provider payment reform, and investment in public health infrastructure was estimated to have a net impact over ten years of $3 trillion in savings. While the upfront costs in expanding insurance coverage may appear daunting, as long as it is coupled with a mechanism to control costs, it will be a wise investment that improves access, quality, and slows growth in health expenditures.

And the cost savings are not just wishful thinking - lower administrative costs and the ability to negotiate lower rates from providers and pharmaceutical companies would allow a public plan to offer premiums at least 20% less than those of comparable plans in private individual or group markets. This expansion of coverage would not reduce overall health care costs, but these savings are not included in the 1.6 trillion dollar price tag for the HELP committee's proposal. If employers or individuals previously with commercial insurance chose to buy into the public plan and its less expensive premiums, there could be significant savings overall.

A public health insurance plan would also likely reduce the costs of premiums of private health insurance through competition. 94% of health insurance markets are "highly concentrated" by FTC standards and most metro areas only have one or two options for consumers. This near monopoly is not good for costs or quality.

The effects of payment reform may be more difficult for the CBO to estimate, but a public plan would have a clear advantage over private insurers in shifting incentives toward prevention, care coordination, and evidence based medicine. Managed care was supposed achieve these goals in the private sector, but it has failed to control costs or improve quality. Medicare has begun to align payment with outcomes through pay for performance and nonpayment of care for preventable complications instead of simply reimbursing for the volume of care provided. A public plan would have the national scope to influence practice patterns across the country; a public plan would offer transparency and could be held accountable if cost or quality measures were not being reached; and a public plan would have the mission of disseminating effective payment innovations to other payers as a public good.

There are many other reasons why we need fundamental health care reform - most pressingly because it is unconscionable to deny sick patients necessary care because of inability to afford health care costs - but the realities of increasing health care expenditures do require a discussion of costs. While it is unfortunate that a misleading CBO estimate on the costs of one version of the health care bill have decreased momentum for reform, drawing on the lessons from Massachusetts, we can still use this information to promote meaningful change. Relying on the private health insurance industry to control costs would be a mistake. However, adding a public health insurance option is extremely popular, with 72% of Americans supporting a public plan in the most recent poll, and would provide several mechanisms to control costs. The American people are correct on this one, and our elected representatives better be listening.

Aaron Fox, MD
National Physicians Alliance
New York City - Local Action Network