From Invisible to a Player: The Poor in the New Health Care System

37 years ago, at the very tail of the civil rights movement, my community health center (CHC) was established in Oakland to fill an unmet and urgent need. A growing population of immigrants were settling in downtown Oakland and had few choices for health care. Community surveys conducted by local leaders confirmed that residents received significantly less health care than the rest of the population largely due to a shortage of providers and limited English proficiency. And so a group of volunteers and students opened a make shift clinic with a volunteer doctor and an optometrist available for two days a week. As demand grew this little clinic expanded hours and added staff one at a time. Almost four decades later, the clinic has grown to 40+ doctors seeing 20,000 patients who speak any of 10 different languages.

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Medicaid Matters to All of Us

What if I were to tell you that Washington is trying to balance the budget by making cuts to a program that covers 70% of the nation’s nursing home costs and 43% of all births in California? Well they are.

The rancorous debate over how to balance the federal budget includes drastic cuts to Medicaid. And while this program may seem distant to people in power and the general public, the reality is that cuts will effect far more people than you expect and may even impact you or someone you know.

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Play More Video Games

“I don’t study because it gets in the way of my video game time”, 15 year old patient.

Sorry mom and dad, video games are here to stay. In my clinic, this is a topic of discussion every day……actually every hour:

“How many hours of screen time does Mikey get every day?” I ask.
“Tell the truth”, Mom says looking at Mikey.
“brmfbr mbbrm”, says Mikey looking away.
Mother turns to me with the familiar look that telegraphs, “Please tell him something because he will listen to you!”

But what if we could turn the powers of video games for “good” rather than “evil”? How do we manipulate the seductive power of video games to get our kids (or even ourselves) to do things we know are good for us but somehow never gets done?

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The Top 5: Better Care for Less Health Care $

[Originally posted at SFGate:]

 Ok, I confess. I have contributed to the $2.3 trillion that our country spends on health care every year. As a patient I want the best possible care for my family and me. As a physician I am the gatekeeper to expensive procedures, medications, and diagnostic tests. However, by several indices including life expectancy, infant mortality rate, and satisfaction with the health care system, we are not getting our money’s worth.

As discussed ad nauseum during the health reform debate, we can point the finger at any number of parties for the high cost of care: hospitals, the pharmaceutical industry, insurance companies, and patients. I would also add to that list health care providers.

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Budget cuts, the cumulative impact

[Cross Posted from SFGate:]

A few weeks after the release of Governor Brown’s January budget I attended a Senate Subcommittee hearing on Health and Human Services in Sacramento. The Governor’s proposal included increases in co-pays and premiums for beneficiaries of Healthy Families (SCHIP) and Medi-Cal as well as taking $1 billion dollars from First 5, a vital program for young children in my clinic and many other communities across the state. I was there to describe the impact these program cuts would have on children and families.

While I was prepared to give my testimony I was completely unprepared for the heartbreaking testimony given by others who pleaded with the Committee members to spare their programs. The proceeding four hours were some of the most difficult I had ever experienced. As the Senators worked through pages of proposed cuts, lines of foster mothers, chronically ill seniors, advocates, and agency representatives formed to describe the harsh reality of the cuts to lives of real people.

More than once did someone say that people were going to die from these cuts. To be fair, the Senators were sympathetic but only responded with “our hands our tied” rhetoric. The entire morning was brought into focus by one comment: we must recognize the “cumulative impact” these cuts will have for some populations.

As a community health center physician, the communities I take care of are the first to be laid off when a business has to downsize. They are the least able to accommodate a rise in food prices or a hike in college tuition. They are the least likely to have a connection to a legislator or official who can help. They are also more likely to be sick and on multiple medications. They are among the ones who need the threatened services the most, particularly in difficult times such as these.

But it is not just them. Many formally middle class and upper class families are getting pulled down as well. In a private clinic where I work part-time, I see parents who lost a job bringing in their children for one last check up before their health insurance coverage terminates. The next day in my community health center, I will see new patients who formally had private health insurance coming in for urgent problems. In fact, the influx of the newly uninsured is stretching my health center’s fiscal limits.

Unfortunately, $6 billion in proposed cuts to health and human services, including the ones mentioned above, passed in March. Now further hobbled, families are at the breaking point.

The state Republican proposal released last week continues the pile on with further reductions to mental health and early child development programs.

The Governor’s May revised budget released today revealed that the state is unexpectedly bringing in $6.6 billion dollars in revenue. But our problems are not yet solved if you count the $10 billion deficit that remains. Critical health services will continue to be threatened until the budget is resolved with revenue sources.

So what if legislators are unable to agree on tax extensions?

A New York Times Sunday Magazine feature article about Governor Brown quotes him as saying: “You have to keep cutting to the point where people say they want to increase their contribution.”

As intractable as the situation appears, this solution is wrong headed and completely ineffective. A cuts only agenda will grind down the growing numbers of people who are bearing the brunt of this recession past their ability to rebound. They will have nothing left to contribute.

Recognizing the cumulative impact of further cuts on California’s families, we must urge our legislators to pass a final budget that includes sensible tax extensions and revenue sources.



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