The Conversations in Medicine (CiM) Symposium, a lecture series on modern health issues led by a variety of student and administrative groups, held a panel discussion titled, “Can We Afford the Affordable Care Act?” on Tuesday.
CiM, a partnership between the Parents’ Fund and the Office of Pre-Professional Programs and Advising, receives $10,000 from the Parents Fund each year to finance its events.
The panelists at the discussion on the Patient Protection and Affordable Care Act (ACA) included Dr. Roy Ziegelstein, the executive vice chairman of Hopkins Bayview Department of Medicine and vice dean for education at the Johns Hopkins School of Medicine; Rami El-Diwany, an MD/PHD student and founder of Charm City Clinic, which provides health care and support for underprivileged residents of Baltimore; Adam Schneider, a social worker and co-founder of Healthcare for the Homeless and Tyler Mains, a medical student with an interest in public health.
The panel’s objective was to field questions about the ACA, also known as Obamacare, from an audience of over 100 students, faculty and members of the Baltimore community. The ACA, passed in 2010, aims to decrease the number of uninsured Americans by making health insurance more affordable.
All four panelists agreed that the ACA is an overall success. Ziegelstein explained that he is seeing more patients who used to lack access to health care.
El-Diwany had a similar reaction to the ACA.
“The most profound impact it had on me was observing its effects on folks in the lower economic bracket of our country,” El-Diwany said. “As recently as 2010 there were many intentional barriers that prevented those people from getting health insurance, and now they are paying people to go out and enroll people.”
Schneider explained the magnitude of the increase in the insured population.
“30 percent of our patients had insurance one and a half years ago,” he said. “In Maryland, you had to have an income under $5,000 to receive Medicare and a documented disability. At least 90 percent of our patients now have medical care.”
All of the panelists agreed that treating health care as a for-profit business is a poor idea. They criticized the insurance reimbursement payment system and the prevalent idea that health care is a commodity rather than a universal right.
“We are victims of a perverse reimbursement system. We have been incentivized to do expensive procedures,” Ziegelstein said. “It takes me 10 seconds to look at an EKG. I will be reimbursed in those 10 seconds more than a primary care doctor makes in 45 minutes preventing a hospital visit.”
According to Schneider, healthcare is still considered to be a business in the U.S.
“There’s another side that maintains healthcare as a commodity in this country,” he said. “We have seen tremendous stock increases for the for-profit insurers. The government gives money to the private insurers. We have further enriched and entrenched the corporate power that makes healthcare a commodity.”
The panelists also addressed the lack of primary care physicians, which are less common than specialist physicians in the U.S. They stressed that preventive care administered by primary care physicians is the easiest way to improve public health.
“I want everyone to have the opportunity [to receive] primary care,” Tyler said. “I love the emphasis on primary care and the restructuring of payment and moving away from the fee-for-service idea. There is so much health care that is delivered that is not typical medical service.”
Tyler also noted that it is important for doctors to build lasting and positive relationships with their patients.
Schneider also shed light on the social justice goals of the ACA.
“We have further enriched and entrenched the corporate power that makes healthcare a commodity,” he said. “Hopkins could use its substantial political power to call for more robust changes. You all could push Hopkins to do that. Hopkins could also make sure all its employees are paid enough to afford housing. Our institutions don’t need to just seem better, they need to be better.”
After the program, junior Cindy Xun expressed her optimism about the role of Hopkins in spreading health care.
“Looking into the future I think that there will be more awareness that can make medical care more affordable or more prevalent for everyone,” she said. “With Hopkins changing and putting more focus on primary care, it is likely that some other hospitals will focus on primary care and supporting underserved populations.”
This program was also accessible to members of the audience that did not have much background knowledge in public health.
Junior Gabriella Miller, an organizer of CiM’s events, explained the group’s purpose.
“We would like to engage the pre-medical community into discussions about how health care and and its culture influences on our daily lives. We aim for two to three events per semester,” Miller said.
