#AMAGetOutTheWay: Nurses, Doctors, and Students United

[Melissa Mills]

On Saturday, June 8th nurses, doctors, and medical students stood side-by-side to protest the American Medical Association's (AMA) annual meeting in Chicago. The AMA, which was founded in 1847, is a large, powerful, and wealthy lobbying group. However, it seems that many young physicians and medical students don't agree with the work done by the group. In fact, in 2016, it was reported that the AMA only represented about 25 percent of practicing physicians. This decrease was a significant change from just a few decades ago when nearly 75 percent of all physicians were members.

#AMAGetOutTheWay

If you perform a quick social media search for #AMAGetOutTheWay, you will find support from many healthcare professionals fighting for Medicare for all. Experts believe that adopting a Medicare for all system in the United States would allow us to join the ranks of the rest of the industrialized world where health coverage is universal. They also feel that this would save money and improve health outcomes.

Protesters feel that the AMA isn't fighting for the right initiatives. Adam Gaffney, President for Physicians for a National Health Program and an instructor at the Harvard Medical School, made his feelings known at the rally. "The AMA is not fighting for their patients, they're not fighting for the uninsured, and they're not fighting for the underinsured. We're here today because the AMA is again on the wrong side of history.”

Other groups well-represented at the rally included Students for a National Health Program (SNaHP), National Nurses United, People's Action, and The Center for Popular Democracy. SNaHP published on their website that showing up at the rally showed support by "taking a stand AGAINST corporate greed, misleading advertising, and the profit motive of health care.” National Nurses United is the largest union and professional association for registered nurses and supports Medicare for All.

What is HR 1384?

Medicare for all isn't just a catchy slogan used by Democrats like Bernie Sanders. It's a legislative proposal, HR 1384, that would create a nationwide health insurance program for all U.S residents. A single-payer system such as this would replace the current mixed healthcare system which includes private and public health programs. It also has a provision to allow people to purchase public coverage during a transitional period to this new system.

Who Would Be Covered?

HR 1384 aims to provide coverage to all U.S. residents, documented immigrants, and even undocumented people. The program would prohibit anyone from being excluded because of citizenship status.

How Would it be Funded?

This single-payer system would not require premiums to be paid. However, it would require new federal taxes for both businesses and individuals.

What Would Be Covered?

All medical care would be covered under this system. Those who support HR 1384 proudly boast that it would also cover reproductive health services. This would include maternity and newborn care.

The Power of Unity

Regardless of your opinions about HR 1384, the rally in Chicago is an example of what could happen when healthcare workers come together. It's estimated that there over one million physicians and nearly three million nurses in the U.S. Imagine how workplace problems and care deficiencies could be approached with this type of unity.

Would we be able to solve some of the top problems that plague healthcare? Just think for a minute how discussions about safe staffing, workplace violence, and long working hours might change if these two "strong-in-number" groups stormed the offices of administration and lawmakers across the nation.

Where Do You Stand?

There are so many different conversations that could come from this one event. Do you support a Medicare for all system? And, what do you think about the unity that was displayed at this protest? Oh, and what other issues do you think a unified front could impact?

[GrumpyRN, NP]

19 hours ago, myoglobin said:

I don't have a specific reference for the dialysis, but here are several relating to life threatening waits for vital care: https://www.forbes.com/sites/sallypipes/2019/04/01/britains-version-of-medicare-for-all-is-collapsing/#6b84b08336b8 . Here is one relating to inability to obtain transplants because a hospital beds are not available (despite an organ being available) https://www.bbc.com/news/health-47668136 . Here is another relating to the rising costs and wait times involved with the UK's system https://www.heritage.org/health-care-reform/report/london-calling-dont-commit-nationalized-health-care . Of course I could just as easily list ten articles that support socialized or single payer healthcare. However, the point is that this is a highly contentious issue and nursing and the NNU should equate being "a good nurse" as being a supporter of single payer or socialized healthcare. There are too many other issues such as expanding unions, expanding non for profit hospitals, expanding nursing ratio laws, and limiting (or eliminating H1B or special work visas for nurses) where support if far wider and less contentious (among nurses).

"I don't have a specific reference for the dialysis, but here are several relating to life threatening waits for vital care"

That is deflection. You were caught making an erroneous statement and immediately went to "but this is happening" instead of apologising for misleading people.

The Forbes article is an opinion piece and does not mention that 45,000 Americans die each year because they have no healthcare. Which is better? Wait a few months for none life threatening surgery and then get it or get no surgery at all and die from your problem?

Can't comment on the BBC article as I have never heard of it before and they only have hearsay evidence.

"Here is another relating to the rising costs and wait times involved with the UK's system"

Again you are not looking at the whole picture. The article clearly states that UK pays a lot less than the US in GDP for healthcare and despite what you are trying to say the UK has a better life expectancy than US. Also remember, we have a conservative government that has consistently starved the NHS of funds to try to bring in the US system.

Yes I know the NHS has problems, we are well aware of it but you cherry-picking data and presenting misinformation helps no one.

[myoglobin, ASN, BSN, MSN]

I apologize for not being able to cite a specific source for my opinion on dialysis. I have been told by several hospital clients from the UK that they experienced obstacles in obtaining dialysis. I didn't realize this was a school nursing assignment where every statement required a citation, by definition this is an exchange of opinions. My larger point is that single payer and socialized medicine are complex, highly charged, political issues where reasonable minds and certainly reasonable nurses can disagree. I for one can and do support many things that NNU supports (California ratio laws, more unionization of hospitals especially for profit hospitals, and limiting H1B and related visas for RN's when there really isn't a deficit of nurses). I am also a dues paying member of NNU. However, probably 30 to 40% of RN's oppose single payer (more in red states and less in blue states by and large). Why take such a blatantly political position that alienates so many potential supporters? It is certainly a fact that RN's in the United States earn more money and pay less taxes than what RN's do in the UK. I believe that we already pay way too much in taxes, and that there are better private market options. For example I know several people who have had great success in using health sharing services like Liberty Health Cost sharing and have had medical bills paid costing thousands of dollars for their families for a monthly cost of around ($400.00) for their entire family (consider than the cheapest plan at my hospital is around 400.00 per month and the employer pays HALF the premium and there is a 5k deductible as opposed to only about $1000 with Liberty). Of course health sharing doesn't address all concerns, but it may be part of the solution along with increased health care saving plans, selling policies across state borders, and allowing importation of prescription drugs. Reasonable people can disagree on these issues without the vitriol.

[GrumpyRN, NP]

16 minutes ago, myoglobin said:

I apologize for not being able to cite a specific source for my opinion on dialysis. I have been told by several hospital clients from the UK that they experienced obstacles in obtaining dialysis. I didn't realize this was a school nursing assignment where every statement required a citation, by definition this is an exchange of opinions. My larger point is that single payer and socialized medicine are complex, highly charged, political issues where reasonable minds and certainly reasonable nurses can disagree. I for one can and do support many things that NNU supports (California ratio laws, more unionization of hospitals especially for profit hospitals, and limiting H1B and related visas for RN's when there really isn't a deficit of nurses). However, probably 30 to 40% of RN's oppose single payer (more in red states and less in blue states by and large). Why take such a blatantly political position that alienates so many potential supporters? I believe that we already pay to much in taxes, and that there are better private market options. For example I know several people who have had great success in using health sharing services like Liberty Health Cost sharing and have had medical bills paid costing thousands of dollars for their families for a monthly cost of around ($400.00) for their entire family (consider than the cheapest plan at my hospital is around 400.00 per month and the employer pays HALF the premium and there is a 5k deductible as opposed to only about $1000 with Liberty). Of course health sharing doesn't address all concerns, but it may be part of the solution along with increased health care saving plans, selling policies across state borders, and allowing importation of prescription drugs. Reasonable people can disagree on these issues without the vitriol.

"I have been told by several hospital clients from the UK that they experienced obstacles in obtaining dialysis."

This is hearsay evidence and you should at least say it as such.

"I didn't realize this was a school nursing assignment where every statement required a citation,"

Don't be naive, you made a statement and were unable to back it up with fact.

"My larger point is that single payer and socialized medicine are complex, highly charged, political issues where reasonable minds and certainly reasonable nurses can disagree."

Yes, I agree very complex. No,I don't understand how anyone can disagree on this subject. But then I am British so don't understand how a country and its citizens (including healthcare professionals) can stand by and watch people die through lack of healthcare - something the rest of the developed world takes for granted.

The rest of your statement while interesting - thank you - means nothing to me because as I stated I am British and don't understand the terms you are using.

ETA, reading this back it may appear rather abrupt, sorry it was not meant to be that way. I was trying for fair.

[myoglobin, ASN, BSN, MSN]

18 minutes ago, GrumpyRN said:

"I have been told by several hospital clients from the UK that they experienced obstacles in obtaining dialysis."

This is hearsay evidence and you should at least say it as such.

"I didn't realize this was a school nursing assignment where every statement required a citation,"

Don't be naive, you made a statement and were unable to back it up with fact.

"My larger point is that single payer and socialized medicine are complex, highly charged, political issues where reasonable minds and certainly reasonable nurses can disagree."

Yes, I agree very complex. No,I don't understand how anyone can disagree on this subject. But then I am British so don't understand how a country and its citizens (including healthcare professionals) can stand by and watch people die through lack of healthcare - something the rest of the developed world takes for granted.

The rest of your statement while interesting - thank you - means nothing to me because as I stated I am British and don't understand the terms you are using.

ETA, reading this back it may appear rather abrupt, sorry it was not meant to be that way. I was trying for fair.

a. Again, it is my belief that UK citizens (older ones specifically) often face challenges in getting needed, and in some cases life saving services. This is based upon numerous conversations (first hand experiences) of UK citizens that I have cared for in the hospital, and my neighbors (most of my neighbors are from the UK on vacation).

b. Anyone, in the United States can show up at an ER and get life saving treatment it is the law. I have personally cared for hundreds of homeless people in my career and quite a few of them have been in my hospital for more than 5 or 10 admissions all without Medicaid or any other insurance. Part of health is being able to afford good food, good housing (outside the city), exercise, vacations, all of these things are reduced by high taxes and lower wages which often ensue from socialism (but not always as the Swiss. demonstrate). One of the reasons that we fought to leave the UK was excessive taxation without representation, I intend to use what little representation we have left to oppose even more taxes from our own government.

c. Even many people who might be inclined to support single payer do not approve of proposals that would include the millions who are here illegally. The UK has the advantage that millions are not crossing into its borders against the law, and then getting free school, free healthcare, and in some cases food stamps, and subsidized housing.

[MunoRN, RN]

On 6/15/2019 at 10:59 PM, myoglobin said:

It is one thing to advocate for preventative healthcare, but when it comes in the guise of single payer the issue becomes political. Many nurses who advocate for free market, non single player reforms also believe strongly in preventative healthcare. Also many nurses who believe in single payer do not believe that those who come here contrary to the laws of our country should be supported by the taxes of those who have. By making such a political issue a central theme it appears as if NNU is endorsing the future Democratic candidate thereby alienating the 40% plus of nurses who support Republicans, but would be inclined to support issues like California ratio laws, and expanded nursing unions.

We've been trying the alternatives extensively enough now to definitively say that impairing access to preventative and primary care through financial deterrents does not improve access to preventative and primary care, there aren't other ways of doing this other than a universal care system.

Ratio laws and expanded nursing unions are certainly less contentious, but they also have no effect on increasing access to preventative and primary care and the reductions in overall costs that come from that.

[MunoRN, RN]

On 6/16/2019 at 2:48 PM, Lane Therrell FNP, MSN, RN said:

This nuance is lost on most people, including our legislators, unfortunately. For many (and I would argue most), single payer = universal coverage = wholly government run = socialized medicine, which is why they oppose it (or advocate for it, as the case might be). Maybe it's all a vast misunderstanding, but the future of healthcare delivery is getting based on it...

Meanwhile, speaking as a consumer, I want LESS government involvement in my life, not more. Just look at the shambles our government is in right now (and has been for a long long time). I REALLY REALLY REALLY don't want these people-- who are incapable of speaking rationally, disagreeing amicably, and working together to solve real problems-- having much to do with my personal healthcare decisions over time. And as a healthcare professional, I do not wish to become a government employee (which is what would happen under a full-on socialized model as you define it).

Be all that as it may, I wholeheartedly agree that preventive care must be emphasized, incentivized, encouraged, and promoted more. Preventive care is the key to cost containment and reduction in any model.

I'm all for reducing the overall costs of our healthcare system by not having to pay for those who are here illegally, but other than improving our rate of deportation I'm not sure what you propose doing about that? We already pay for the costs (although there is good evidence that illegal immigrants pay more into the social safety net than they take out) of the emergent healthcare needs of illegal immigrants. Should they be turned away at the ER door? I'm not sure that's a palatable option to even the most staunch conservatives.

[MunoRN, RN]

On 6/15/2019 at 10:52 AM, myoglobin said:

In the UK you are lucky to get dialysis at 65 let alone transplants. However, access to preventative care is more available, but they pay at least 10% more in income and value added (kind of like sales tax) to fund the system.

If your saying the way the US handles dialysis coverage is an example of how things should work, it should be pointed out that dialysis dependent kidney disease is the only subgroup of the US population that gets universal healthcare coverage.

[myoglobin, ASN, BSN, MSN]

3 minutes ago, MunoRN said:

We've been trying the alternatives extensively enough now to definitively say that impairing access to preventative and primary care through financial deterrents does not improve access to preventative and primary care, there aren't other ways of doing this other than a universal care system.

Ratio laws and expanded nursing unions are certainly less contentious, but they also have no effect on increasing access to preventative and primary care and the reductions in overall costs that come from that.

it can be argued that three elements (Medicare, Medicaid, and employer sponsored health insurance supported by tax deductible premiums for companies) have combined to fuel the run away cost of our health care system since the early 1970's. We essentially have a "partial single payer system".Very little in the way of "alternatives" have been adequately explored. Health sharing plans are still only used by a minority of people. Insurance still isn't available across state lines. Pharmacy drugs still cannot be imported in most cases. Heath care savings accounts that are fully tax deductible don't exist for most (backed up by low cost catastrophic policies). These are but a few possible innovations. Preventative health measures are widely available, but seldom used. I have no health insurance, but I practice intermittent fasting, exercise, and low carb DASH diet to control my propensity towards obesity and HTN (in addition to not drinking or doing drugs). American health care is actually quite impressive given that we are probably the most obese, drug using, sedentary, smoking, high stress, poor diet eating people on the planet. The fact that we live as long as we do and can still function to a reasonable age is a huge part of why we spend so much on healthcare. Look, you may ultimately win the battle for single payer, but if Trump is reelected or if the Republicans keep the Senate (or take the House) it is game over for single payer. Meanwhile, those of us who oppose single payer as the greatest advancement of socialism in the last 50 years will have been marginalized and opportunities for gains on less contentious issues (such as ratio laws, more unions, and advocating NPO hospital systems over for profit systems will be lost).

[Lane Therrell FNP, MSN, RN, NP]

6 hours ago, MunoRN said:

I'm all for reducing the overall costs of our healthcare system by not having to pay for those who are here illegally, but other than improving our rate of deportation I'm not sure what you propose doing about that? We already pay for the costs (although there is good evidence that illegal immigrants pay more into the social safety net than they take out) of the emergent healthcare needs of illegal immigrants. Should they be turned away at the ER door? I'm not sure that's a palatable option to even the most staunch conservatives.

I'm not sure how illegal immigration entered the conversation, but I think there are no easy answers when it comes to illegal immigration and healthcare. I agree with you that turning people away at the ER door is not a viable option. It is equally unacceptable that the ER has come to be perceived as healthcare of first resort. The whole system is broken, and none of these things should be politically partisan issues. And yet we've become so polarized that we've lost sight of real issues like, not having enough primary care providers to go around by 2030 for example. (And this will be the case no matter how they get paid for their services.) We all need to work together to rationally and logically solve our very real and growing problems.

[myoglobin, ASN, BSN, MSN]

1. Having enough primary care providers (at lower cost) is one area where NP's can be of service.

2. Illegal immigration, entered because it is one salient point that differs between the UK and the United States (they have far less). Thus, there are fewer people not "paying into the system" supported by their system.

[GrumpyRN, NP]

23 hours ago, myoglobin said:

a. Again, it is my belief that UK citizens (older ones specifically) often face challenges in getting needed, and in some cases life saving services. This is based upon numerous conversations (first hand experiences) of UK citizens that I have cared for in the hospital, and my neighbors (most of my neighbors are from the UK on vacation).

b. Anyone, in the United States can show up at an ER and get life saving treatment it is the law. I have personally cared for hundreds of homeless people in my career and quite a few of them have been in my hospital for more than 5 or 10 admissions all without Medicaid or any other insurance. Part of health is being able to afford good food, good housing (outside the city), exercise, vacations, all of these things are reduced by high taxes and lower wages which often ensue from socialism (but not always as the Swiss. demonstrate). One of the reasons that we fought to leave the UK was excessive taxation without representation, I intend to use what little representation we have left to oppose even more taxes from our own government.

c. Even many people who might be inclined to support single payer do not approve of proposals that would include the millions who are here illegally. The UK has the advantage that millions are not crossing into its borders against the law, and then getting free school, free healthcare, and in some cases food stamps, and subsidized housing.

a) The NHS is good at the life saving stuff less so at the life enhancing stuff. I have already stated that elsewhere. I never said it was perfect. However what good is having access to needed surgery if you as an American don't have the insurance or money to pay for it and it may cause you to declare bankruptcy or lose your home (leading to those "hundreds of homeless" you looked after) if you have that surgery/procedure under the American system.

b) That is a complete misuse of the ED, why should people wait until things are so catastrophic that they can only be seen and treated if it is life threatening. Why not have some preventative care and even screening - again something the NHS does. Look at the different life expectancy between the countries.

Strangely you seem to be meeting an awful lot of UK citizens who according to you cannot actually afford to have vacations and insurance for hospital treatments because according to you we pay too high taxes.

"One of the reasons that we fought to leave the UK was excessive taxation without representation, I intend to use what little representation we have left to oppose even more taxes from our own government." That was 18th century, are you seriously doing a comparison? Actually what you have just written there is the usual code for I don't want to pay.

c) MunoRN has dealt above with your nonsense about illegal immigrants and taxes and here is a reference for you https://www.americanimmigrationcouncil.org/research/adding-billions-tax-dollars-paid-undocumented-immigrants

The same argument applies to the UK.

Why are you continually fixating on the UK NHS? What about the other systems that are out there? The French, the Germans, the Scandinavians all have excellent services but everyone immediately goes to the "Socialist" NHS and then cherry-picks the data.

[myoglobin, ASN, BSN, MSN]

6 minutes ago, GrumpyRN said:

a) The NHS is good at the life saving stuff less so at the life enhancing stuff. I have already stated that elsewhere. I never said it was perfect. However what good is having access to needed surgery if you as an American don't have the insurance or money to pay for it and it may cause you to declare bankruptcy or lose your home (leading to those "hundreds of homeless" you looked after) if you have that surgery/procedure under the American system.

b) That is a complete misuse of the ED, why should people wait until things are so catastrophic that they can only be seen and treated if it is life threatening. Why not have some preventative care and even screening - again something the NHS does. Look at the different life expectancy between the countries.

Strangely you seem to be meeting an awful lot of UK citizens who according to you cannot actually afford to have vacations and insurance for hospital treatments because according to you we pay too high taxes.

"One of the reasons that we fought to leave the UK was excessive taxation without representation, I intend to use what little representation we have left to oppose even more taxes from our own government." That was 18th century, are you seriously doing a comparison? Actually what you have just written there is the usual code for I don't want to pay.

c) MunoRN has dealt above with your nonsense about illegal immigrants and taxes and here is a reference for you https://www.americanimmigrationcouncil.org/research/adding-billions-tax-dollars-paid-undocumented-immigrants

The same argument applies to the UK.

Why are you continually fixating on the UK NHS? What about the other systems that are out there? The French, the Germans, the Scandinavians all have excellent services but everyone immediately goes to the "Socialist" NHS and then cherry-picks the data.

For one thing those systems have even higher taxes than the UK and Canada (which already have higher taxes than the United States). They essentially have a "different social contract". More security and social services in exchange for more taxes, and less freedom (for example I choose not to have health insurance, and we chose to home school our son in Germany this is often treated as a crime). We have become progressively more socialized (the United States) over the last 100 years (ie Social Security, Disability, Medicare, and Medicaid). However, despite our services being less than that of most EU nations we still have a national debt approaching 20 trillion (maybe surpassed, I haven't been keeping close track of late). Just to keep CURRENT services we will probably need to raise retirement ages, raise taxes, and cut benefits. What's clear is that these are highly polarized, and contentious issues that split decisively along "Red state/Blue State lines" I suspect the arguments will rage for decades. That is why these are issues for the ballot box and not for nursing unions who have plenty of far less contentious issues where much agreement can be obtained (more unions, more IP states for NP's, California ratio laws, less H1B visas for RN's, better ancillary staffing, less for profit hospitals in favor of more non profit hospitals). NNU is pushing a good percentage of their members into opposition with them for one issue.