Reflections on Medical Studentsby a 4th Year PNHP Activist :Reflections on Medical Studentsby a 4th Year PNHP Activist Anthony Accurso, MS4 PNHP NY Metro Board SUNY Downstate Medical School Brooklyn, NY Medical Student Forum - Sept 17, 2009


Contents :Contents Tips to Chapter Leaders Reflections on Medical Students


Your Campus or Community :Your Campus or Community General Population “What’s Single Payer?” Inactive Agree-ers “Single Payer is good, but I’m really busy.” Active Agree-ers “I’ll help out once in awhile” Planners: “What’s the next effort?” You: PNHP Activist


Goal: Promote People Up the Pyramid :Goal: Promote People Up the Pyramid General Population “What’s Single Payer?” Inactive Agree-ers “Single Payer is good, but I’m really busy.” Active Agree-ers “I’ll help out once in awhile” Planners: “What’s the next effort?” You: PNHP Activist


Increase Awareness of HR 676 and the Term ‘Single Payer’ :Increase Awareness of HR 676 and the Term ‘Single Payer’ General Population “What’s Single Payer?” Inactive Agree-ers “Single Payer is good, but I’m really busy.” Active Agree-ers “I’ll help out once in awhile” Planners: “What’s the next effort?” You: PNHP Activist ?


Increase Awareness of HR 676 and he Term ‘Single Payer’ :Increase Awareness of HR 676 and he Term ‘Single Payer’ General Population “What’s Single Payer?” Inactive Agree-ers “Single Payer is good, but I’m really busy.” Active Agree-ers “I’ll help out once in awhile” Planners: “What’s the next effort?” You: PNHP Activist Single Payer Speaker Debate vs. AMA Sicko Screening and Discussion Poster Campaign Button Campaign Tabling Pizza


Make Busy Agree-ers More Active :Make Busy Agree-ers More Active General Population “What’s Single Payer?” Inactive Agree-ers “Single Payer is good, but I’m really busy.” Active Agree-ers “I’ll help out once in awhile” Planners: “What’s the next effort?” You: PNHP Activist ?


Make Busy Agree-ers More Active :Make Busy Agree-ers More Active General Population “What’s Single Payer?” Inactive Agree-ers “Single Payer is good, but I’m really busy.” Active Agree-ers “I’ll help out once in awhile” Planners: “What’s the next effort?” You: PNHP Activist Short, concrete tasks and events “Summit” or visibility stunt “Wear a button” Put a PNHP symbol up Sign the Open Letter Join chapter or nat PNHP


Increase Member Initiative :Increase Member Initiative General Population “What’s Single Payer?” Inactive Agree-ers “Single Payer is good, but I’m really busy.” Active Agree-ers “I’ll help out once in awhile” Planners: “What’s the next effort?” You: PNHP Activist ?


Increase Member Initiative :Increase Member Initiative General Population “What’s Single Payer?” Inactive Agree-ers “Single Payer is good, but I’m really busy.” Active Agree-ers “I’ll help out once in awhile” Planners: “What’s the next effort?” You: PNHP Activist Meet monthly as a PNHP chapter Delegate event planning to others. Encourage PNHP national membership Attend Nov. PNHP National Convention.


Train Your Replacement :Train Your Replacement General Population “What’s Single Payer?” Inactive Agree-ers “Single Payer is good, but I’m really busy.” Active Agree-ers “I’ll help out once in awhile” Planners: “What’s the next effort?” You: PNHP Activist ?


Train Your Replacement :Train Your Replacement General Population “What’s Single Payer?” Inactive Agree-ers “Single Payer is good, but I’m really busy.” Active Agree-ers “I’ll help out once in awhile” Planners: “What’s the next effort?” You: PNHP Activist Recruit new students in September Be sure your chapter has MS1 on its governing board Network with other PNHP Chapters – share ideas


Tip #1: Train Your Replacement :Tip #1: Train Your Replacement Medical schools have no “organizational memory.” Recruitment keeps the club alive.


Tip #2: Teach :Tip #2: Teach Classmates want to learn. Health Policy is not well covered in the curriculum.


Tip #3: Inter-Visit :Tip #3: Inter-Visit Get to know students at other chapters Start a movement


Part 2 :Part 2


Observations about Medical Studentsand Persuasive Slides :Observations about Medical Studentsand Persuasive Slides


Medical Student Age :Medical Student Age


Medical Student Age :Medical Student Age High Aptitude Varying degrees of “life experience”


Recommendations :Recommendations Assume high cognitive ability Do not assume prior knowledge of the subject matter


Most Medical Students are between the ages of 21-31 (Young and Healthy) :Most Medical Students are between the ages of 21-31 (Young and Healthy) Latent teenage feeling of invulnerability Few have “tested” their own health insurance May not realize the extent of the problem


High Cost of Health Premiums :Insurance is expensive for the individual: High Cost of Health Premiums National Average Premium for Employer-provided Insurance: Single Coverage $4,479 per year Family Coverage $12,016 per year Annual income at minimum wage = $11,700 Annual income of average Wal-Mart worker = $17,114


Personal Bankruptcies :Personal Bankruptcies Based on 2001 data. Source: David U. Himmelstein, Elizabeth Warren, Deborah Thorne, and Steffie Woolhandler J of Health Affairs, 2 Feb 2005. Personal Bankruptcies 1.5 million households Medical Bankruptcies 750,000 75% had insurance 25% lacked insurance


Personal Bankruptcies :Personal Bankruptcies Personal Bankruptcies 1.5 million households Medical Bankruptcies 750,000 75% had insurance 25% lacked insurance Underinsurance: - Will our insurance be there when we need it? Based on 2001 data. Source: David U. Himmelstein, Elizabeth Warren, Deborah Thorne, and Steffie Woolhandler J of Health Affairs, 2 Feb 2005.


Extrapolate: The Current System is Unsustainable :Extrapolate: The Current System is Unsustainable Source: American Family Physician, November 14, 2005


Extrapolate: The Current System is Unsustainable :Extrapolate: The Current System is Unsustainable Source: American Family Physician, November 14, 2005


Extrapolate: The Current System is Unsustainable :Extrapolate: The Current System is Unsustainable Source: American Family Physician, November 14, 2005


This is scary. :This is scary.


Students have varying degrees of employment experience :Students have varying degrees of employment experience Limited experience with unions, management, labor, contract negotiations. May not realize the difficulty of getting health insurance. May not realize the difference between being an employee vs. private contractor


Traditionally, Health Benefits were part of a contract :Traditionally, Health Benefits were part of a contract Arrived at by collective bargaining between management and labor Management Labor Union Union Rep Negotiation Contract


Why do Small Businesses have a hard time buying insurance? :Why do Small Businesses have a hard time buying insurance?


For Private Insurers, Small Businesses are risky. Indiviudals are riskiest of all. :For Private Insurers, Small Businesses are risky. Indiviudals are riskiest of all. Large Business Small Business Individuals (Consultants, self-employed) $$ Premiums Payouts


Students have varying degrees of financial experience :Students have varying degrees of financial experience Some have never done their own taxes May not understand tax terms “Progressive vs. Flat vs. Regressive.” “Tax Credit, Tax-Sheltered or Pre-Tax Health Savings Account.” Medicare Withholding, FICA, etc.


Regressive taxes are unfair :Regressive taxes are unfair Everybody agrees: Thus, they are hidden in the tax code. Health Savings Accounts are regressive taxes. $10,000 deduction for med. expense Rich Poor 33% 10% Tax Savings Save $3,300 Save $1,000


How does the government encourage employers to provide health insurance? :How does the government encourage employers to provide health insurance? Tax Subsidies. Employer Employee Taxable Income Taxes Reduced Tax Reduced Tax Revenue


Students have varying degrees of knowledge of Insurance Terms :Students have varying degrees of knowledge of Insurance Terms May not understand Insurance Terms Deductible, Copayment, Premium, Risk Pool Pre-existing condition Rescission


Insurance Terminology :Insurance Terminology Premium How much you pay for the plan, per month, just to be enrolled. Copayment: How much you pay for each visit or each medication refill. Deductible How much you have to pay out of pocket before the insurance company starts reimbursing you.


Political Orientation :Political Orientation Some students may benefit from a political context. (Requires periodic .ppt update)


Single Payer in the U.S.? :Single Payer in the U.S.? The Bill is already in Congress: H.R. 676 [109th]: Expanded and Improved Medicare for All Act HR 676 Sponsor: John Conyers: (D) Michigan HR 676 Supporter: Dennis Kucinich: (D) Ohio


Breaking News! Single-Payer Announced in the Senate :Breaking News! Single-Payer Announced in the Senate American Health Security Act of 2009 Introduced to the Senate on Wednesday, April 25, 2009 Authored by Sen. Bernie Sanders (D-VT)


Universal Coverage ≠ Single Payer :Universal Coverage ≠ Single Payer HR 676: Single Payer “Universal Coverage Plans” Insurance mandates “Make it illegal to be uninsured” Tax credits to buy insurance Private Insurance Companies Prevail


Spectrum of Reform :Individual Commodity Public Good Do nothing; market will fix itself Tax credits Individual Mandates Employer Mandates Public Program Expansions: Medicaid, CHIP, Medicare Single Payer/ Expand Medicare U.S. system Spectrum of Reform Socialized Medicine Canada, Taiwan, Sweden UK France, Germany Massachusetts


Students love graphs :Students love graphs Show, don’t tell


Our Public Sector Alone Spends More than Other Countries: Americans Pay for National Health Insurance but Don’t Receive It :Our Public Sector Alone Spends More than Other Countries: Americans Pay for National Health Insurance but Don’t Receive It OECD and “Paying for National Health Insurance—And Not Getting It” Health Affairs: July / August 2002


Growth in the workforce :Growth in the workforce


Private insurers’ High Overhead :Private insurers’ High Overhead


Bureaucracy US vs Canada :Bureaucracy: U.S. vs. Canada, 2003 Money Spent Per Capita on Administrative Costs Source: “Administrative Waste in the U.S. Health Care System,” Woolhandler, Himmelstein & Wolfe Bureaucracy US vs Canada


Hospital Administrative Costs :Hospital Administrative Costs


Physician Office Expenses :Physician Office Expenses


Slide 51:http://www.medicareforall.org/pages/Current_Condition


Most Families Would Save Money :Most Families Would Save Money Source: Lewin Group, January 2005


92% of U.S. Census households earned less than $150,000 :92% of U.S. Census households earned less than $150,000 Source: Lewin Group, January 2005 http://pubdb3.census.gov/macro/032008/hhinc/new06_000.htm


Students love cartoons :Students love cartoons


Warm Up :Warm Up Introduce your topic


Playing Doctor? (cartoon) :Playing Doctor? (cartoon)


Regarding Fear of Single Payer, and the choice of Insurance Company :Regarding Fear of Single Payer, and the choice of Insurance Company Retort: “What Americans Want is Choice of Doctor, not choice of Insurance Company.” followed by …


Some Choices Don’t Really Matter! :Some Choices Don’t Really Matter!


Regarding Government Bureaucracy and Private “Efficiency” :Regarding Government Bureaucracy and Private “Efficiency”


Regarding Incremental Reform :Regarding Incremental Reform Them: “Don’t let the perfect be the enemy of the good.”


Quiz :Quiz What is the most important task for any PNHP officer?


Quiz :Quiz What is the most important task for any PNHP officer? Train your replacement


Now back we go to our chapters to educate.Thank you :Now back we go to our chapters to educate.Thank you -- Anthony A.