policy

What It’s Like To Advocate For Healthcare

Make your voice heard. With the ongoing healthcare debate, we are told again and again how valuable our voices are as docs and almost docs. But how do we make our voices heard? One way is to call your representatives. Another is to visit them. A number of medical organizations coordinate annual advocacy days on Capitol Hill for their members to attend. The benefit of meeting in person with Congressional representatives and their staff is that it can help us put a face on the healthcare workforce and establish ourselves as experts in the care of patients. It can create lasting relationships with these representatives that gives us the power to speak for our patients. This year was my third time attending one of these advocacy days held by the American College of Physicians. Yet, I can still remember the uncertainty I felt as I arrived at Washington, DC as a first-year student. Who am I to speak on what ails our healthcare system? What if I don’t know the exact policies? Luckily, the first day was designed to get me up to speed. I received outlines for each issue we were advocating for, including current related bills we should ask our representatives to support. I listened to policy experts speak about the issues and how to best speak about them. I watched example discussions with representatives so that...

Cultural Competency in Healthcare: What Is It and Why Do We Need It?

I was walking along a crowded street when a skinny, darkly colored man entered the flow of traffic in front of me. Looking back to see where he came from, I noticed a seemingly insignificant door at the base of a tall, weathered building. The scene wouldn’t have caught me off guard – a man simply exiting his workplace or home, perhaps – except for the blue and white NHS sign that was displayed on the brick exterior. I was in London, visiting a Bangladeshi community to learn about the social environment of this marginalized population. The man I had seen enter the street was most likely of Bangladeshi nationality given the brown color of his skin and his dark eyes. I was more interested in the building where he came from, though. The NHS label stood for National Health Service, the governing body that provides healthcare for the United Kingdom’s residents. My tour guide later explained that the building housed a free clinic for the homeless and low-income people in the area. Government-funded dollars provided access to healthcare, and I thought that was incredible. This ordinary scene on a rainy day in London, surrounded by people that look and speak very differently than me, started a cascade of thoughts on culture, health, and medical practice. I wanted to learn more about how culture influences healthcare. So, I did...

PODCAST: How Do We Treat Psychiatric Disorders?

From the days of Freud, psychotherapy had been a dominant form of treating psychiatric disorders. But more recently, psychotherapy use has declined in favor of medications. In fact, according to a 2010 study in the American Journal of Psychiatry, the number of patients in outpatient mental health facilities receiving only psychotherapy fell from 15.9 percent to 10.5 percent from 1998 to 2007, while the number of patients receiving only medication rose from 44.1 percent to 57.4 percent. Now, there are a number of reasons behind this shift. On the one hand, many in the science community look down to psychotherapy as an unstandardized mode of treatment. Meanwhile, to these critics, medications have proven to be safe and efficacious after numerous clinical trials. These criticisms seem sound, but is a decline in psychotherapy use for the better? Does the use of medication alone ignore the social and cultural components unique to psychiatric disorders? In the first episode of The Void Podcast, I talk to psychiatrist Dr. Loren Sobel to answer these questions. Dr. Sobel practices psychodynamic therapy—a form of psychotherapy that seeks to uncover the psychological roots of patient’s mental illness. In addition to discussing the effects of the shift from psychotherapy to medication, Dr. Sobel and I speak at-length about the causes—including the scientific community’s greater dependence a biological model of disease. Have a...

Why Medicaid Is Important

President Trump’s budget proposal reveals that his administration plans to cut a whopping $610 billion from Medicaid funding over the next ten years. Including the additional $839 billion that the American Health Care Act plans to slash from Medicaid, the total cuts to the largest health insurance program in the U.S. could round up to nearly $1.5 trillion. That’s an enormous cut. But, it’s expected from a Republican-controlled government that prides itself on fiscal conservatism (sometimes at the expense of people’s livelihood). Medicaid is often criticized, for reasons other than how expensive it is to fund. The main criticisms are that it is an entitlement program that actually provides bad coverage. Some of these criticisms are fair. For instance, individuals on Medicaid have limited access to providers, while providers are reimbursed at low rates for treating  patients—both of these factors sum up to bad coverage. But, criticisms seem to ignore the essence of why Medicaid is important in the first place—it provides coverage to individuals who otherwise wouldn’t be able to access health care. In fact, studies show that its expansion may actually have a positive effect on health care by improving affordability and access. A report by the United States Department of Health & Human Services (HHS) found that 78 percent of Medicaid expansion enrollees indicated that they wouldn’t have been able to access or afford care prior to its expansion....

Pros and Cons of The California Single Payer Bill

The California state Senate passed SB 562 on June 1. The California Single Payer Bill would put an end to private health insurance, as well as Medicare and Medicaid, and replace it with a single-payer health care system. Under a single-payer system, all California residents will be eligible to receive health insurance from a single state-sponsored insurance system called Healthy California. All funding for insurance will come from the state government, which means that there are no out-of-pocket costs for consumers. Single-payer health insurance systems are widely used in European countries, and they have been lauded by Democrats in the United States because they guarantee health insurance for all. In many ways, a single-payer system seems like a dream come true—everyone is covered and consumers don’t have to pay a dime! But, like every health care system, a single-payer system has it’s drawbacks. To better understand what the The California Single Payer Bill will look like, here’s a list of pros and cons: PROS California Single Payer Bill Means Insurance for everyone! This is perhaps the greatest and most palpable benefit of a single-payer insurance system—everyone is eligible to enroll in Healthy California. Under Obamacare, California’s uninsured rate dropped from 17 percent in 2013 to 7 percent today. This is a dramatic improvement, but there are still roughly 3 million people in California that are uninsured. This problem of access will be eradicated completely...

Trump’s Education Budget Cuts Mental Health Money For Schools

President Trump’s new education budget proposes to dedicate no money—that’s right, zero—to fund mental health services and other student support services for public schools. Previously, the government provided schools with $1.65 billion in funding for various initiatives, including mental health services. But, in an attempt to reduce the federal government’s role in education, Trump and Education Secretary Betsy DeVos have decided it’s best to cut all funding for these important student services. Lack of funding is a serious issue for a number of reasons. According to the NIH, just over 20 percent of children have had a seriously debilitating mental disorder either currently or at some point in their life. Nonetheless, according to the American Academy of Pediatrics, only 21% of children with mental health issues actually receive services. There is a disparity between ill children and treatment received, and this gap may grow if funding for school-based mental health services is slashed. The disparity may become an even greater challenge for students who live in areas where community-based mental health services are scarce or too expensive—without school-based services, these children’s options are severely limited. The new education budget’s lack of concern for mental health services may harm children’s health in the long run. A child’s mental disorder may worsen and continue into adulthood if not treated early and appropriately. That’s why school services are vital and even preventive—they...

Trumpcare is Bad for Women’s Health

The American Health Care Act (AHCA), or Trumpcare, doesn’t seem to care for women’s health. The bill—which was narrowly passed by the House of Representatives on May 4th—allows states to withdraw from providing essential health benefits, which includes maternity and preventive care. Under Obamacare, all insurance plans are required to provide ten essential health benefits. This provision protects patients—it mandates insurance companies to cover the costs of important care, while also preventing them from selling barebones coverage to consumers. However, as the AHCA/Trumpcare permits states to waive coverage of essential health benefits, the cost of care will shift from insurance company to the patient. And, patients will be forced to pick up a huge tab out of pocket. This will disproportionately affect women who, without coverage, will have to pay high prices for treatment that’s vital to their health, including birth control, cancer screenings, and routine vaccines. Fortunately, the AHCA/Trumpcare isn’t the law yet. But imagine just how much women will potentially have to pay under its provisions! Amino, a healthcare transparency company, looked through their database of nine billion health insurance claims to uncover the astronomically high prices women patients may have to pay under the AHCA. Here’s a summary: About $1,000 for an intrauterine device (IUD). IUDs provide long-lasting birth control. Depending on the type, they need to be replaced every three to 10 years. $4,000 for...