My guest today is second-year medical student, Brad Zehr. Welcome to OpEdNews, Brad. Something very interesting happened at the AMA (American Medical Association) recently. What can you tell us about it?
BZ: The Medical Student Section of the AMA adopted a resolution at the Interim AMA meeting in Dallas expressing support for innovative state legislation to achieve universal health care, including but not limited to single-payer health insurance. The reason this policy item was particularly high-profile and groundbreaking was because it is the first instance of any section of the AMA adopting policy in support of single-payer health insurance. Although the Medical Student Section (MSS) is only one of ten sections of the AMA, and although this resolution pertains only to the MSS and not the full AMA, the resolution signals a generational shift in organized medicine's approach to health care reform.
Historically, the AMA has explicitly opposed any forms of single-payer, including opposition to the creation of U.S. Medicare in 1965. The AMA House of Delegates (HOD), which is the highest policy-making body of the AMA and includes representation from all of the AMA sub-sections and from state medical societies and medical specialty societies, still has three policies stating express opposition to single-payer health insurance in the U.S. The MSS boldly voiced support for single-payer despite the HOD's continued hypersensitivity to single-payer.
JB: How did this come about? I understand that you were one of the students responsible for writing the resolution. Was there a knock-down drag-out fight about this? What was the process like? Tell us more, please.
BZ: Several recent developments in U.S. health care contributed to our motivation to submit the single-payer resolution to the AMA-MSS at this particular time. First, the Affordable Care Act includes a lesser known component called "Sec. 1332: Waiver for State Innovation." The section allows states to apply for an exemption from the federal ACA law beginning on January 1, 2017, to implement their own alternative, state-based health care law, given that their state law would cover at least as many people as the ACA would have, that the coverage would be as affordable to individuals and families as the ACA coverage would be, and that the state law would not increase the federal deficit.
Upon receiving approval from the U.S. Department of Health and Human Services and the U.S. Department of the Treasury, such innovative states would receive federal funds equivalent to what they would have received under the ACA in order to implement their alternative health care reform plan.
Vermont is the first, and so far only, state to commit to applying for a Section 1332 State Innovation Waiver. The state plans to establish a state-based single-payer health insurance system beginning in 2017. The program will be called Green Mountain Care and would be the first-ever example of a state-based single-payer system in the U.S. In addition to Vermont, at least half a dozen other states have active single-payer popular movements.
JB: Promising!
BZ: A second recent development that motivated our resolution was the Massachusetts gubernatorial candidacy of Dr. Don Berwick, an internationally recognized health policy scholar and former chief administrator of the U.S. Centers for Medicare and Medicaid Services. Berwick campaigned on a pledge to move Massachusetts toward a single-payer system. His campaign energized a vast progressive base in the state, and he earned endorsements from some of healthcare's most celebrated thought-leaders, including Atul Gawande, Paul Farmer, and John McDonough. Berwick often noted on the campaign trail that Massachusetts has historically been a beacon of progress for the nation, including the passage of so-called "Romneycare" in 2006, which became the model upon which the ACA was based. Berwick's inspiring vision was for Massachusetts to once again lead the nation in health policy reform. Although he lost the Democratic primary to Martha Coakley, he mobilized incredible stores of political energy in the state with his bold commitments.
Finally, we wrote the resolution because single-payer has been conspicuously absent from the health policy conversation at the AMA-MSS throughout this past 15 years of upheaval in U.S. health care. The last time medical students debated single-payer at the AMA was at the interim meeting in 1999. That resolution asked the AMA to study the advantages and disadvantages of a single-payer system, but the MSS did not adopt it.
We submitted a single-payer resolution to the Annual 2014 meeting this past June in Chicago. That resolution was strong: asking the AMA HOD to advocate for national single-payer health insurance. Sixty-one medical students from 18 medical schools co-authored that resolution. However, the MSS Reference Committee recommended the resolution not be adopted based on the argument that asking the AMA HOD to advocate for national single-payer in light of their continued opposition was politically futile and a waste of our limited MSS influence. Furthermore, many student delegates expressed support for single-payer, but said that it should be tried on a state-by-state basis, and that we should keep this policy within the MSS.
With the feedback of dozens of medical students from around the country, we crafted a compromised resolution for re-submission at the Interim meeting in November. This second version of the resolution was internal to the MSS, and asked for support for state-based single-payer. And rather than being co-authored by 61 individual students, it was co-authored by 4 delegations: Massachusetts, Wisconsin, University of Vermont College of Medicine, and SUNY-Downstate College of Medicine. During the MSS General Assembly, the Reference Committee recommended adoption after amending the resolution to be expanded to include other innovative state legislation to achieve universal health care, in order to garner broader support. The resolution was adopted by approximately a two-thirds majority, although only 51 percent was required for adoption.
JB: This is definitely encouraging, but what does it all mean? Vermont's Green Mountain Care won't even kick off until 2017 and it'll take a while to assess its effectiveness. I'm intrigued with the sea-change among you future physicians. You're clearly out of step with the AMA as a whole. How do you explain the gap? What about your own motivation?
BZ: We've asked ourselves these questions often throughout this resolution-writing process. I often return to the words of the immediate past president of the AMA, Dr. Ardis Dee Hoven. In May of this year, she visited some medical students in Detroit. She said, "Students are the lifeblood. They are the future. Medical students are so much better and so much smarter than I was as a student. They're learning early. They're learning the democratic process and the tools they need to make a difference. ... The status quo is unacceptable. We have to move medicine ahead and it is our job to move this forward. You will be the leaders."
From the highest levels of organized medicine, medical students hear that U.S. health care is not working and that we need to advocate for the system we want during our careers. This is exactly what we are trying to do with this resolution. We know that single-payer is one of the best ways to guarantee universal health care while controlling costs. The evidence to support this assertion is extensive, some of which we included in the Whereas clauses of our resolution. We think it is time to treat the AMA's hypersensitivity to single-payer in the U.S. and have an evidence-based debate about the merits of such a system, especially in light of the fact that one state has already committed to it.
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