Monya De, MD MPH

Welcome to Medical Economics' blog section 

which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by 

, who practices internal medicine and integrative medicine in the Los Angeles area.

 The views expressed in these blogs are those of their respective contributors and do not represent the views of 

Monya De, MD, MPHThere were 440,000 people, mostly women, who marched on Washington a day after our latest presidential inauguration, with 750,000 marching in Los Angeles and 100,000 marching in London.

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	Thousands marched, collectively, in Lithuania, Kenya, Antarctica, Poland and Tanzania.

	However, it didn’t matter to the new presidential administration, as it proceeded to issue proclamations weakening the mandate-the part that provides an incentive for healthy people to sign up for insurance-of 

	With no mandate, and fewer healthy people 

signing up for insurance, overall costs rise.

 An executive order ended aid to organizations providing abortion services abroad, ensuring the birth of many more unwanted, hungry babies in developing countries.

	The current administration has everything it needs. Plenty of its voters support a Muslim ban (i.e., sending innocent Syrians back to slaughter) and bringing back pre-existing condition denials to health insurance. Food still gets delivered to the White House, suits are still pressed, the water and most of the lights are on. The machine isn’t stopping.

	Some who voted this administration into power continue to support its policies. They have a legal right to do so. However, for white men who do not support these policies, publicly denouncing these actions and removing support for politicians who engage in them is what the women’s march movement now needs.

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, of the votes that were successfully cast, the president carried whites by a margin of 21%, while he carried men by a margin of 12%. About 61% of white male registered voters are Republican, a full 10% more than the percentage of males of all races that are Republican.

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	No other group has such power to send a message by showing up at protests, calling their elected officials and declaring their priorities publicly. Without their core constituency, Republicans will be doomed in 2018.

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	But now, many who voted Republican in the presidential election are regretting that decision, because, 

, they simply did not take the campaign promise to gut the ACA seriously.

 in large numbers as well, but, across the country, the Republican leadership primarily relies on the votes of white men. For now, this is the group that is most powerful when it steps up. 

	If white men raise their voices, it will be to support their wives, mothers and daughters receiving free breast cancer screenings. It will be to support an aunt who works at a clinic supported by the Medicaid expansion and who is one of the three million people who stand to be unemployed if the ACA is repealed.

It will be to ensure protection from bankruptcy

 for that friend from high school who got diagnosed with MS. It will be to protect African-Americans and Hispanic people from being denied insurance at higher rates because they have higher incidences of chronic disease.

	Those people are their contractors, colleagues, patients and friends. They will be making it known that they do not approve of a house in their neighborhood going into foreclosure because the primary breadwinner has cancer. They will be speaking out against their children’s nanny running out of her blood pressure pills and having a heart attack because she no longer has Medicaid.

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	In the years of the ACA as we know it, urgent care centers proliferated, doctors discovered life-threatening diseases in patients who hadn’t been seen in 10 years and primary care salaries went up. All of these things have some inherent good to them. Some doctors complained about the ACA insurance plans’ payment rates, but the reality was that no individual physician was forced to accept ACA insurance. Rallying for the protection of health care benefits, the physician stands to protect not only his patients, but his colleagues in primary care.

	True, no one is expecting that men will change 

 about whether white men really want to engage at all.

	Not every white Republican constituent will send Paul Ryan and Tom Price a printout of a changed party affiliation. But white men who believe in a healthier country, one where people do not die needlessly from lack of access to medical care, have a chance to make a difference. The women who marched have already done their part.

Articles

Yes, white women voted for Trump in large numbers as well, but, across the country, the Republican leadership primarily relies on the votes of white men. For now, this is the group that is most powerful when it steps up.

White men need to do their part and make healthcare safe again

Monya De. MD, MPHAt the recent national meeting of the American College of Physicians (ACP), I dropped in on a session about medical volunteering. I thought I might hear about an interesting opportunity to volunteer in Africa, or South America perhaps.

	Instead, the first presentation was about volunteering at a free clinic-in America. The physician in charge spoke of an impressive roster of staff-physicians, nurses, medical assistants, who, amazingly, all worked for free to support no-cost healthcare.

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	I asked the doctor what kind of patients attended this free clinic. She answered that the patient population included people not served by the Affordable Care Act. These included people who made too much money for Medicaid (her state hadn't participated in the Medicaid expansion), people who couldn’t afford the policies available on the healthcare insurance exchanges, and people who, for reasons of mental illness or addiction, couldn’t navigate the insurance system well enough to figure out how to find and sign up with a primary care doctor and their needed specialists.

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	These three groups can be found all around the country, and it’s telling that, even with a national mandate for health insurance coverage, free clinics are still serving a need that should be fully met. As laudable as the Affordable Care Act is, it certainly favors the disciplined (people who can save enough of their income to pay for premiums and exorbitant prescription drug costs), lucky (people without financial burdens like an ailing parent or insane student loan interest rates), tech-savvy (to sort through Internet information to find the perfect insurance plan and properly licensed doctor with good reviews) and, well, healthy.

	A free clinic staffed by health professionals volunteering their time is a dicey safety net. The doctor presenting at the ACP conference expressed her concern that more and more doctors are employed rather than owners of their own practices, leaving them with demanding 8 to 5 schedules (make that 8 to 9 with electronic health records charting) and without the ability to clear Wednesday afternoons to volunteer in the community.

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	It's also difficult to find anyone to cover a shift if a nurse or doctor gets sick, since most people are at work.

	Senator Bernie Sanders' dreams notwithstanding, we are a long way from government-sponsored healthcare for all. But until then, 

 affordability of mandated health insurance plans for those who have other unavoidable expenses, control of very high deductibles, simple insurance plan sign-ups and information, and better facilitation of matching patients with doctors and other health care providers.

	Finally, Medicaid expansion would ease the burden of patients trapped in the donut hole of being too poor to afford insurance, but not quite poor enough to qualify for Medicaid.     

	Free clinics are wonderful and an important part of the fledgling healthcare infrastructure in economically struggling areas, but should not be necessary in a wealthy country.

	Americans deserve better.                

Free clinics are wonderful and an important part of the fledgling healthcare infrastructure in economically struggling areas, but should not be necessary in a wealthy country. Americans deserve better.

Author | Monya De, MD MPH

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White men need to do their part and make healthcare safe again

Health professionals volunteer their services when the ACA isn't enough