Sunday, December 25, 2016

The Coming Harm

Posting this here, because I don't think my local newspaper will actually publish it.


To the Editor;

The Republican leadership in congress and President-Elect Trump have pledged to repeal the Affordable Care Act (ACA) as soon as they are able. They make this pledge without any plan to replace the ACA, though they have conveniently set a date for  repeal to go into full effect after the 2018 mid-term elections so as to avoid political exposure from the harm that will occur upon the ACA's repeal. In Virginia, repealing the ACA risks 685,000 Virginians' losing their health insurance coverage, and 319,000 losing the Federal subsidies that help them afford health insurance purchased on the ACA's exchanges. These changes risk reversing the 26% decrease in uninsured Virginians since the ACA went into effect. Congress and the President-Elect have spoken of their desire to retain important protections in the ACA (such as guaranteed issue, which removes the risk of denial of coverage for preexisting conditions), but have not presented any plan to do so that would keep insurance affordable or accessible to the average person. Some of those who voted for Mr. Trump may have done so believing that his call to repeal the ACA was political bluster, and that now that Americans are seeing benefits from the law, it could not be repealed. If so, they committed an awful error: the Congressional leadership has been voting to repeal the law since its passage, and now will have a sympathetic ear (and pen) in the White House. The vote to to repeal the ACA will come as soon as the first week in January, and millions of Americans will face the coming harm on their own, hoping an already stressed safety net may help catch those who again fall through the gaps. Physicians and health care providers like me will do our part to help those caught in an unnecessary trap of our politicians' own creation, while those politicians celebrate a political victory without regard to the harm they will have done. All Americans deserve that our politicians do their part and present a planned replacement for the ACA before thousands are harmed by its repeal.


Sunday, November 13, 2016

Join and support the National Physicians Alliance

I am currently in Washington, DC for the Fall Board of Directors meeting for the National Physicians Alliance (NPA). Given the recent election results, this meeting feels more important than ever.

I joined NPA in 2010 or so, and then became a member of the Communications Committee during the time that Affordable Care Act (ACA) was being debated, passed, opposed, sued, defended, and enacted. I later became the organization's Vice President of Communications, and have continued sharing NPA's mission and message as the ACA began providing health access to millions of Americans in the context of better care and lower costs.

NPA focuses on service, integrity, and advocacy, and is guided by principles emphasizing health justice. Health as defined broadly, as more than the absence of disease: it is a state of wellness, and is influenced by the both the medical system and social determinants of health such as the environment, available educational opportunities, housing, transportation, etc.

With the results of the recent presidential election, many of the core values many of us hold dear are going to be under great pressure. If the ACA is repealed, up to 24 million Americans risk losing insurance. Women's access to reproductive health care risks being severely limited. Medicaid expansion would be rolled back as part of the repeal of the ACA, but the Medicaid program could be fundamentally restructured and lead to more coverage losses. Even Medicare, a program which has bedrock support, might be changed dramatically (information here).

NPA is preparing for the fight to come in the next few years. We must protect access to healthcare. We must ensure that women's access to all aspects of reproductive health remains in place. We must ensure that vulnerable individuals, communities, and populations are protected. We must do all this as we continue to advocate for a more equitable and just healthcare system.

The task is daunting, and it appears that the fight will be long and challenging. And: NPA is prepared and committed to be a voice for physicians and for our patients for the duration of the fight. We need volunteers, we need contacts, we need support, and we need funding.

Join us. Membership is free:

Support us. Your support allows us to carry out key advocacy work without restrictions from outside funders:

These are uncertain, frightening times. But it is not the time to retreat. Now is the team to stand up, come together, and tell those who aim to harm our patients and our profession: #NotOneStepBack.

Wednesday, November 9, 2016

Aquí estaré, por lo que vale

Amanecí esta mañana con una sensación de desesperación y furia. Yo pensé que este país, con ocho años de trabajo y progreso había llegado a un punto que un candidato racista quien atacaba a imigrantes, la comunidad LGBT, de otras creencias y fés no podría llegar a ser presidente de este país.

Me encontré gravemente equivocado.

Y lo siento. Lamento mi parte en esta decisión. Yo voté en contra de Trump, pero temo que quizás no hice suficiente para oponerlo.

Yo regresé a Richmond in 2007 con la meta de trabajar en comunidades de bajos recursos, y especialmente con la comunidad Latina. Pero, en estos ultimos cuatro años me he encontrado afuera de la clínica y más en la clase, como docente de estudiantes de medicina.

Y quizás abandoné el trabajo que era necesario. Y quizás mis esfuerzos no eran suficiente.

Y ahora temo los daños que vienen. El odio y el prejuicio abierto con cual las comunidades por cual me he dedicado serán atacados.

Estoy en este momento averiguando como mejor puedo acompañar esta gente y mís comunidades. Y estoy preparandome para el trabajo e las luchas que vienen para protejer sus derechos, su salud, y su dignidad.

Esta no es mi lucha: yo tengo el privilegio de ser un hombre, americano, médico. El riesgo en esta lucha no es mia: my privilegio y mi posición me protegen. Lo menos que yo puedo hacer es pararme al lado de ellos, de aprender de ellos como crear una comunidad y un país generoso, abierto a todos, dejando nadie atras. Y aquí estaré, por lo que vale, mientras que nos preparamos para el futuro.

Privilege and purpose

"Start where you are. Use what you have. Do what you can."--Arthur Ashe

When I started this blog, some years back, I did so out of a desire to have a voice, to be an advocate for change I thought would make a difference. In the last few years, as my work roles shifted and my obligations stretched into evenings and weekends, I lost the rhythm of blogging. And, if I am honest, I lost the urgency and drive, and my focus.

In 2009, the Affordable Care Act (ACA) was an idea, which became a proposal, which eventually became a law. A law that increased access to health insurance for millions of Americans and especially in communities of color and drastically reduced the numbers of children without insurance. It survived reviews by the Supreme Court, and dozens of votes for its repeal. Under its coverage, insurance companies extended coverage to adult children on their parents' plans, ended the practice of denying health insurance to those Americans with preexisting conditions, and ensured that health insurance companies would spend money on providing health insurance coverage, not just on their own profits. Americans were seeing real benefits from the law, and while not perfect, it was doing its job.

With the urgency to push for healthcare reform and accessible coverage for all, my attention wandered to other issues, which I feel are also terribly important: ensuring medical practice is free of industry influence, that we practice good stewardship and avoid over-treatment, that we speak out against the influence of politics on the doctor/patient relationship, and that we address gun violence as the public health issue that it is.

I also found my role moving away from the clinic. I became medical director of a program focused on training medical students with a commitment to provide care in medically underserved communities after they completed their training. I became the director of a course focused on teaching students about the interactions of patients, physicians and society at large. And I valued these roles, and learned new skills, and moved away from the clinic: down to just two sessions a week.

I found myself waking up today asking if all these changes had been worth it.

In the past few years in Richmond, I have tried to become more aware of my own privilege, and the struggles and obstacles faced by others. I am a white, cis-gendered, heterosexual, married, US-born male physician. I am the very picture of "privilege". I have not faced discrimination, and I carry with me opportunities and status that I have not earned, that I assumed as a part of the culture in which we live. I have tried to recognize this, and  have tried to learn about and be a partner to those who do not have this privilege.

And this is why I woke up today reassessing so many things. Has the clinical work I have done made a difference in the community? Are two sessions a week in clinic enough to be a resource to my patients and to my community? Has my focus on teaching and my non-clinical work taken me away from the people I aim to help?

The results of this election have served to reinforce my privilege. The President-Elect and his supporters have attacked people of color, women, immigrants, Muslims, and members of the LGTBQ community. They oppose a women's right to free reproductive choice. They have control of the Congress and may appoint a number of Supreme Court justices over the course of their term.

They will undo eight years of progress, all in the interest of protecting white privilege, and white male privilege to be precise.

So: as I gather my thoughts and figure out a way forward, I will try and use this space for the purpose for which it was created: to raise my voice outside of my office and the classroom, and to join the voices of so many others rising tonight in pain, and fear, and anger at the harm which is coming. This is not my fight: the privilege I have protects me. The least I can do, then, is to accompany, support, and stand alongside those for whom this fight is personal and high stakes. I can work to understand their worries and learn about their hopes and how we can make our society more just and inclusive, and I can try to be an ally. And I can prepare myself for the work ahead.