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Progress Notes features doctors and medical students across the country on the frontlines of our health care system. Our views and experiences are diverse, but we share common goals and values. We speak up to move toward a future where everyone can have access to affordable, high-quality health care. Please share our posts, and follow us on Facebook and Twitter!


Flint needs you

By Dr. Alice Chen
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The Flint water crisis is a health and human rights issue. We need you to make your voice heard to help the victims of this preventable tragedy.

Nutritious food, clean air and water, safe shelter and communities. These are the most basic things our patients need to be able to be healthy and pursue their dreams. Yet, elected officials hid the dangerous levels of lead in the water until a pediatrician sounded the alarm on unusually high lead levels in children.

It's time we follow this doctor's lead and signal the alarm with leaders in Congress.

Send a letter to Congress to make sure Flint gets clean water and access to health care.

Lead poisoning is well known to cause lifelong medical and psychiatric problems for children, sapping the potential of both individual lives and entire communities. Reductions in lead poisoning rates - often against opposition from very powerful interests - is one of the biggest public health triumphs of the past century. The fact that lead poisoning has been allowed to return with a vengeance in one of the nation's poorest communities is an unconscionable tragedy that must be addressed with the greatest urgency.

Call on Congress to make clean water a priority: Provide funds to replace the lead pipes in Flint so people can drink water without being afraid it will make them sick.  And make sure people in Flint get the health care they need.

We know that even as we write, more low-income communities beyond Flint are finding that their water is not as safe as they thought. That’s why it’s so important for doctors and medical students to stand up and speak up now.

 

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Doctors for America: Exciting Work in 2015, Big Plans for 2016


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2015 has been a big year for Doctors for America and the health of the nation. This week, we launch our end-of-year fundraising drive so we can keep going strong into 2016.  We have so much to celebrate. Here are a few highlights from the year:

King v. Burwell: Doctors for America was at the forefront of the monumental King v. Burwell Supreme Court case. We made headlines and made sure the case was understood as a matter of people’s health and lives – not politics.  The Court’s decision in favor of the ACA kept 6.4 million people from losing their ability to pay for health insurance.  

Medicaid Expansion: We kept the heat on state legislators and governors to expand Medicaid in a dozen states including Utah, Texas, Florida, Maine, and North Carolina.

Supporting Key Health Issues: Through the year, Doctors for America supported efforts to renew the Children’s Health Insurance Program, prevent the defunding of Planned Parenthood, address rising drug prices, and protect the nation’s investments in prevention and low-income nutrition programs.

Celebrating our Surgeon General: We celebrated in person or on Periscope the change of command ceremony for our nation’s 19th Surgeon General, our former president and co-founder Dr. Vivek Murthy.

National Leadership Conference: We had our most highly rated National Leadership Conference ever with engaging speakers on social determinants of health, food insecurity, remaining barriers to access, racial disparities, advocacy, and physician wellness.

CDC Gun Research Ban: We made national and international news when we demanded that that Congress end the ban on CDC and NIH gun violence research – just hours before another mass shooting in San Bernardino. Our #EndTheBan hashtag made over 3.2 million Twitter impressions in just 24 hours. We brought together 68 of the nation’s leading medical and public health organizations. And, both President Obama and House Minority Leader Nancy Pelosi spoke up on the issue.

In 2016, we have exciting opportunities to keep moving forward on improving the health of the nation.

As we continue to push on expanding Medicaid, we are hearing rumblings that a couple of states are getting ready to move. We will be right there to build momentum and make the case that expansion is good for people and good for states. We are also building a new campaign on Making the Most of Medicaid, which we will roll out in the early part of the year.

We are also opening a new focus on food insecurity, which affects one in seven of our patients - even though most of us don't know it. Hunger is a health issue that impacts the ability of our patients to be healthy and to keep their chronic conditions in check. Keep your eyes out for our new Food as Medicine initiative, and let us know if you have particular expertise in this area.

We will also work to build on our momentum to remove the CDC and NIH gun research restrictions.  Plus, we have opportunities to bring physician voices to the challenges of rising drug prices, national and international policies on curbing and treating substance abuse including opioids, Supreme Court cases challenging access to abortions and contraception, payment reform efforts, and the myriad other issues that affect the lives of our patients. Of course, with the change of administration on the horizon, we will also be watching carefully to make sure the concerns of doctors and our patients are at the forefront.

Through it all, we will build new avenues to recruit, train, and support physicians and medical students to be the best advocates they can be for their patients and for a healthier America. 

Thank you to all our members and supporters for making Doctors for America possible.  

One final note, we rely on individual donations for the majority of our budget. As we close one year and open a new one, we hope that everyone can contribute whatever we can to ensure that Doctors for America can keep fighting for the health of the nation.  

Please show your support for Doctors for America with a tax-deductible donation today.

 

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Happy Thanksgiving!

By Dr. Alice Chen
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On this Thanksgiving Day, we want to share a heartfelt thank you for being a part of the Doctors for America movement. 

Thank you for coming together by the thousands from all 50 states to fight for equitable, affordable health care for all. Together, we are creating an America where everyone has the opportunity to lead a healthy and fulfilling life.

We create change because you choose action over cynicism - reading an email to get informed, signing a petition, sharing a patient story, writing an op-ed, joining a webinar, putting up a flier, running a campaign.

It is because of your efforts that the uninsurance rate in America is below 10% for the first time ever. Over 17 million more people are insured than when we first began this movement. With your continued efforts, We will get more people signed up for coverage before the end of open enrollment on January 31. We will expand Medicaid in every state and keep working until every person is covered. We will improve affordability, availability, and quality of care. And we will shine a light on social determinants like hunger and gun violence that affect our patients every day.

Did you know that Doctors for America members do all this on top of caring for over 1 million patients a month? Thank you to primary care doctors, psychiatrists, surgeons, neurologists, hospitalists, ob-gyns, anesthesiologists, cardiologists, and doctors of every specialty. To rural and urban doctors for your commitment to underserved communities. To private practice owners and tertiary care academics for improving care in every setting.

A special note of appreciation to those who are on call this weekend - caring for patients, answering their worried questions, bringing warmth and light to the sick during the holidays.

Thank you to physician administrators, researchers, innovators, and policymakers who bring a much needed clinical voice to policies and programs. To those who have committed their lives to public service and the uniformed services. To deans and medical educators for training the next generation of physicians. To retirees who have paved the way for the rest of us. To medical students whose energy and enthusiasm carry all of us forward.

Thank you to those who have donated funds to sustain our movement. Your support has been essential, and we are grateful for you.

Some of you are not doctors or medical students, but you stand with Doctors for America as our supporters and colleagues. Thank you for working alongside us to build a more just and equitable future for the health of the nation.

And thank you to Doctors for America's board members, state directors, advisors, and national campaign leaders who volunteer their time to lead our movement and to our small but mighty staff who support all of us.

On behalf of the whole Doctors for America family, may you and yours have a very happy, safe, and wonderful Thanksgiving.

Warm Wishes,

Alice Chen, MD
Executive Director

 

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Haunted by Gun Violence

By Dr. Lisa Plymate
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I am still haunted, over 30 years later, by the 18-year old woman I saw in the Emergency Room during my residency at the University of New Mexico. She had been shot in the chest, but was fully conscious when she arrived. "I'm not going to die, am I?" she asked plaintively. We worked as hard as we could on her, even cracking open her chest to massage her torn heart, but, tragically, all to no avail.

Years later, while making home visits, I encountered a 78-year old woman with severe rheumatoid arthritis who lived in subsidized housing in Richmond, VA. When I tried to coax her into at least taking walks in her first-floor apartment for exercise, she told me she wouldn't stand up after 2 p.m., because that was when the junior high kids got out of school, and "I might be shot."

Many of us have stories like these that we carry with us from our every day practices. While nothing will erase these tragedies, there is something we can do about them.

Over one thousand doctors and health advocates have signed our petition urging Congress to end the CDC ban on gun violence research. We will be delivering these signatures to Congress the week after Thanksgiving and need your help in gathering even more signatures in the final push, to reach our new goal of 2,000.

Please raise your voice and join us so we can speak up for all our patients, past, present and future, who may be impacted by gun violence. 

This is a problem we can tackle! And we need to start by supporting, not banning, gun violence research at the CDC. Let's gather more of the data we need; let's have a resource that enables us to compare the effectiveness of various interventions.

Thank you for working for our patients and our families.

Lisa Plymate is our Washington State Director and an internist/geriatrician based in Seattle Washington.

 

 

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Tell Congress: End the Ban on Gun Research

By Nina Agrawal, MD
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As physicians, we are outraged that this Nation continues to lose innocent lives from daily gun violence. Despite Sandy Hook and the continued tragedies since then, more than 89 Americans continue to die every day from gun violence

You would be shocked to know that nearly 20 years ago Congress, under intense pressure from the gun lobby, passed a law blocking the Centers for Disease Control and Prevention (CDC) and the National Institute of Health (NIH) from carrying out the necessary research to better understand how to prevent gun violence.

Most recently, in June 2015, the U.S. House Appropriations Committee voted to maintain this funding ban. The result: a significant source of funding for evidence-based, scientific research into the causes of gun violence was blocked entirely, and a signal was sent to the entire scientific funding community that chilled almost all other outside research into this critical issue.

It's time to end the ban on CDC and NIH research so we can find solutions to the gun violence crisis.

Federal scientific data has driven policy to save lives from motor vehicle accidents, sudden infant death syndrome, lead poisoning, and countless other public health crises.  It’s time to do the same with gun violence.

 Add your name to #EndTheBan on gun violence research.  

Physicians must stand together to tell Congress to remove these barriers to common sense evidence-based research and include funding annually to look into the causes of gun violence. I hope you will join us.

Physicians must stand together to tell Congress to remove these barriers to common sense evidence-based research and include funding annually to look into the causes of gun violence. I hope you will join us.

For a safer Nation,

Nina Agrawal, MD

David Berman, DO

Drs. Agrawal and Berman are pediatricians and leaders of the DFA gun violence prevention campaign.

 

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The work ahead

By Dr. Mona Mangat
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What an inspiring Doctors for America 2015 National Leadership Conference!

Passionate, dedicated doctors and medical students from across the country gathered in Washington, DC to learn and connect on how to make the world better for our patients. 

A movement that began 7 years ago is now 16,000 physicians and medical students strong. During that time we played a critical role in the passage of the Affordable Care Act (ACA) and then spent the past several years protecting the law against repeal and defunding attempts.

We have made tremendous progress on expanding access to care and we will continue to fight to expand Medicaid and protect the ACA. Yet, we know access alone is not enough. Too much of what happens outside the clinic walls is outside of our control.

There are still too many Americans who don’t have safe places to walk because of gun violence in their communities, too many children who don’t have access to the food they need to aid their developing bodies. These are the pressing problems facing our patients and communities across the country. These are the challenges physicians must join with community leaders to tackle to ensure we build a healthy America for everyone.

That’s why I am so excited to share with you DFA 2.0. While we honor and respect our history, we are evolving as an organization to meet the pressing health challenges that lie before us. We have a new mission, vision and guiding principles that you can view on our website.

I hope you will join us in the year ahead to continue to address access to care and Medicaid expansion as well as, food insecurity, racial disparities, mental health, substance abuse, drug pricing, gun violence, health innovation, physician well-being, organizing skills, and more.

Change happens because doctors and medical students like you take leadership into their own hands. Whether you care about an existing campaign or a new issue we haven't tackled or listed here, we want to hear from you and help you create the change you want to see.

For a healthier America,

Mona Mangat, Chair
Alice Chen, Executive Director

 

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A message from Stan Brock - See you in October

By Stan Brock
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I am honored to be joining you on October 10th for this year’s National Leadership Conference in Washington, DC as a guest speaker.

At Remote Area Medical (RAM), we are partners in putting patients over politics to improve access to care and help people live healthier lives.

In my travels across the country and around the world, I have witnessed too many people living in fear of sickness and injury simply because they have little or no access to basic medical care. RAM responds to this need by providing free, quality dental, vision, and medical care to those who cannot afford it. In less than 24 hours we turn fairgrounds, schools, jungles, and arenas into mobile medical centers. We are steadfastly committed to stopping pain and ending needless suffering.

I look forward to joining you at the upcoming conference as we celebrate and discuss the pressing work ahead to improve impoverished patients’ access to care.

Register now to attend the 2015 National Leadership Conference.  

See you in October,

Stan Brock
President and Founder
Remote Area Medical ®

P.S. There will also be showing at the conference of Remote Area Medical the movie. You will not want to miss it. Watch the trailer here.

 


 

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Here’s to 50 years

By Dr. Alice Chen
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Fifty years ago today, President Lyndon B. Johnson signed Medicare and Medicaid into law. Together, they cover nearly one out of every three Americans – that’s more than 100 million people.

The Affordable Care Act has continued to open up the doors of care to millions more. However, leaders in 19 states have refused to expand Medicaid leaving nearly four million people without access to care. We have not forgotten about them.

Today, we delivered signatures from physicians and medical students across the country urging these governors to put down their partisan opposition and close the coverage gap. Our message: no matter how long it takes, we will stand up and speak out until everyone is covered.

Since Doctors for America began, we have fought to make sure our patients have access to the care they need.  

When Congress threatened to cut billions of dollars from Medicaid in 2011, thousands of us spoke up to keep the program going. When the Supreme Court ruled in 2012 that states had the option of whether to expand Medicaid, we worked together to tell state leaders that it is not acceptable for people to die for lack of care when the federal funds are already there and available to give them the care they need.

Like any program, Medicaid has its strengths and weaknesses, but it is working and remains a lifeline to care for millions of women, children and families. That is why we will not be silent until it is expanded in every state and strengthened for all.

Today, let's celebrate 50 years of progress through Medicare, Medicaid, CHIP, the Affordable Care Act, and the hard work you put into making sure the most vulnerable among us have the resources they need to live a healthy life.  Post on Facebook, have a celebratory dinner, put up a sign, visit a senior center, or simply take a moment to appreciate how far we've come as a Nation in the past 50 years.

Let us redouble our efforts to make sure everyone in America has access to affordable, high-quality health care and the foundational resources they need to live a healthy life.  

 

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Health reform after King with Professor Timothy Jost and Henry Aaron


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DFA Senior Advisor and University of Chicago professor Harold Pollack talks with two of the Nation's leading experts on health reformProfessor Timothy Jost, and Henry Aaron of the Brookings Institution. They discussed the implications of the King v. Burwell victory and the future challenges and strategies for improving the Nation’s health care.

A full audio recording of the call is available here.

Guest Speakers:

Timothy Jost
Timothy Jost holds the Robert L. Willett Family Professorship of Law at the Washington and Lee University School of Law. He is a co-author of a casebook,Health Law, used widely throughout the United States in teaching health law, and of a treatise and hornbook by the same name. He is also the author of HealthCare Coverage Determinations: An International Comparative Study; Disentitlement? The Threats Facing our Public Health Care Programs and a Rights-Based Response; and Readings in Comparative Health Law and Bioethics, the second edition of which appeared this spring. He has also written numerous articles and book chapters on health care regulation and comparative health law and policy, and has lectured on health law topics throughout the world. His most recent book is Health Care at Risk: A Critique of the Consumer-Driven Movement, which was published by Duke University Press in 2007.

Henry J. Aaron
Henry J. Aaron is currently the Bruce and Virginia MacLaury Senior Fellow in the Economic Studies program at the Brookings Institution. From 1990 through 1996 he was the director of the Economic Studies program.  He is a member of the Institute of Medicine, the American Academy of Arts and Sciences, the advisory committee of the Stanford Institute for Economic Policy Research, and the visiting committee of the Harvard Medical School. He is a member of the board of directors of the Center on Budget and Policy Priorities. He was a founding member, vice president, and chair of the board of the National Academy of Social Insurance. He has been vice president and member of the executive committee of the American Economic Association and was president of the Association of Public Policy and Management. He has been a member of the boards of directors of the College Retirement Equity Fund and Georgetown University.

 

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A Victory for Doctors and their Patients

By Donald Nguyen, MD
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Last week the Supreme Court ruled 6-3 on King v. Burwell and emphatically declared the Affordable Care Act (ACA) is here to stay. It upheld the provision of ACA that provides subsidies to millions of Americans in 36 states, including Ohio, where the Health Insurance Marketplaces are set up by the federal government.

Why are doctors involved in this fight? Doctors are in the front line of fire and we care that patients have coverage and access to care. For those who do not have health insurance through their workplace or through Medicare, the ACA provides two options. There is Medicaid for the very lowest income citizens and there are competing private health insurance plans available for purchase from health insurance exchanges, also called marketplaces. Thanks to the ACA, last year 8.8 million Americans received health coverage through health exchanges and over 16.4 million remarkably have signed up as of 2015. A key strategy of the ACA’s goal of expanding coverage, especially to the working poor, is to use a sliding scale to subsidize the cost of premiums for the private plans purchased through the exchanges.

In King v. Burwell, King claimed that the ACA requires such subsidies only in state health care exchanges. Thirty-six states, including Ohio, declined to set up their own exchanges and instead decided to let the federal government set up exchanges for their states. Most legal experts agreed that King v. Bur-well is about semantics. It is clear from the rest of the ACA that the law means to provide subsidies to Americans in states such as Ohio where the exchange was created and is run by the federal government as well as to provide subsidies in states such as Kentucky that set up their own exchanges. This case is about focusing on a few words in one sentence of the law and ignoring the clear intent of the rest of the law. This case is about hurting those who need health care and who would lose their health insurance without a tax credit. Because King v. Bur-well was not upheld by the Supreme Court, more than 8 million Americans can stay with their insurance and 10,000 would not have to die annually because of lack of health coverage.

Our country has struggled for more than 100 years to find a way to make sure patients don’t die because they don’t have enough money. We have made progress we can all be proud of. In 1965, the Medicare and Medicaid Act was signed into law and thousands of lives are saved every year because of it. On March 23, 2010, the landmark ACA was passed. For the first time in American history, our country can say that it will no longer accept anyone dying for lack of money. The 6-3 ruling confirmed and reaffirmed that the ACA is about improving health and saving lives, not to worsen or destroy them. The SCOTUS has now spoken twice. The ACA is the law of the land, and it is here to stay. So, let’s stop the frivolous repeal attempts. Let’s work on expanding Medicaid to the rest of the nation, and build on the success of countless benefits and protections of millions of Americans.

As a physician, I am proud of my profession, and thank you to the U.S. Supreme Court for siding with my patients.

Donald Nguyen, M.D., is a pediatric urologist in Beavercreek

 

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