MARYSOL ENCARNACIÓN MS2
Drexel University College of Medicine
Four months into the Trump administration, I sat with several women in their late 30’s to early 70’s at the round table. The faces that surrounded me belonged to Latina grandmothers, mothers, sisters -- all women who had osteoarthritic knee pain. I was asked to conduct a Spanish-speaking focus group for an evaluation of access to healthcare for these women. After getting their consent and filling out the forms, I began the discussion: “So, how has your knee pain affected your daily life?” They worked as house cleaners, in restaurants, forced to stand all day and many of them not wanting to undergo a necessary procedure because of how much time they would have to take off as a result of the surgery. Many of them had children or dependents at home.
We didn’t have time to discuss insurance coverage at that focus group. The women in the group had several barriers before even getting to a doctor’s office. Lately, some of them had trouble getting recruited for our group.
“Normally, we have a much larger turn-out to these interviews,” the professor told me later.
“Is that so?”
“Yes,” he said, “but with the administration cracking down on deportations, it’s been hard to get people to leave their homes.”
Hispanics have the highest uninsured rates of any ethnic or racial group in the United States (1). We suffer from chronic illnesses such as asthma, diabetes, and hypertension, at higher rates than white Americans (2). These illnesses require longitudinal treatment with reliable insurance, but Latinos’ ability to access insurance is compounded by the discrimination and barriers to care that Hispanics and other ethnic minorities face on a daily basis. One large barrier to care that many Latinos face is the fact their employer does not provide adequate insurance coverage, if any at all (3).
Since the passing of the Affordable Care Act (ACA), 20 million more Americans (4), have access to affordable health insurance with Latinos experiencing the largest decline of uninsured rate of any ethnic group (5). The efforts that the Latino Medical Student Association (LMSA) and other organizations have made to provide pathways for more Latino doctors in the workforce has also demonstrated immense benefit for the Latino patient population. I was in awe with how many impassioned Latino medical students had attended a completely optional Policy Summit. How many of us, for the first time, traveled into the heart of DC legislation and persuaded politicians to better represent our future patients.
Unfortunately we, as a medical community, need to do more. Hispanics still have worse access to and utilization of healthcare services, even after passage of the ACA (6).
Latinos are a growing population with a set of healthcare problems that needs to be addressed immediately. For one, the ACA does currently not cover undocumented immigrants. Undocumentated immigrants from Latin American countries make up at least 12% percent of the total Latino population (7,8), which accounts for 7.4 million Latinos. Even as I write this, the coronavirus pandemic has demonstrated that we are only as healthy as the most vulnerable, and that includes undocumented immigrants. The Medicare for All bill introduced by Senator Bernard (Bernie) Sanders from Vermont, which would cover all US citizens as well as undocumented immigrants, has come under extensive scrutiny from legislators and political pundits, who say a single-payer program would be too costly and too unwieldy of a system for healthcare professionals to handle. This could not be further from the truth.
Economists, epidemiologists, and doctors have come together to support this bill. A recent Lancet article from Yale determined that Medicare for All would save 68,000 lives a year who would have otherwise died from lack of insurance (9). The article also conservatively estimated that Medicare for All would cost 13% less than our current healthcare system, saving the US more than $450 billion annually. This would also benefit providers by reducing their administrative workload and freeing up time for patient care, leading to improved work satisfaction and reduced burnout (10). Another report from the Economic Policy Institute determined that a national program would in fact boost wages, jobs, and labor markets (11). They also determined that this reform would increase job quality and decrease stress of losing a job. Recently, the second largest doctor’s organization, the American College of Physicians endorsed Medicare for All (12).
We as future and current medical professionals should take the time to educate ourselves and speak out on behalf of our future patients. This is absolutely critical because of what is currently at stake. In our country, people who are under- or uninsured face dilemmas every day such as rationing life-saving insulin or not getting the proper mental health treatment leading to detrimental outcomes. Latinos have a 50% chance of getting Type II Diabetes throughout their lifetime and Latinos are more likely to have symptoms at a younger age than an average US adult (13). As a medical student, patients with whom I have worked would entirely benefit from a national healthcare program. They have included a malnourished undocumented woman from Honduras, a woman suffering from drug use disorder, and older folks with blood sugars so high that it’ll make you do a double take. It’s easy to think of these patients as an “other,” especially if you have never lived a life without insurance like I have. But I encourage future doctors to put themselves in their position and empathize with the day to day struggle.
That we live in the richest nation on the planet and treat our nation’s people with utter disregard for human rights is criminal. Several developed countries have demonstrated that a single-payer system is effective, while at the same time, we have all personally seen the effects that being uninsured has on someone’s quality of life. I am encouraging all healthcare providers and students, especially those who are inclined to treat Latino patients, to take to social media, have discussions, and advocate for your patients. Healthcare is a human right, and right now we must fight harder than ever to provide this right for everyone in our nation.
Bibliography
1- Berchick, E.R., Hood, E., and Barnett, J.C.. "Health Insurance Coverage in the United States: 2017." Current population reports. Washington DC: US Government Printing Office (2018). Online.
2 - Quiñones, Ana R, et al. "Racial/Ethnic Differences in Multimorbidity Development and Chronic Disease Accumulation for Middle-Aged Adults." PloS one 14.6 (2019). Online.
3 - Quinn, K. “Working without Benefits: The Health Insurance Crisis Confronting Hispanic Americans.” Commonwealth Fund, Task Force on the Future of Health Insurance for Working …,” 2000. Online.
4- Center on Budget and Policy Priorities. “Chart Book: Accomplishments of Affordable Care Act.” Center on Budget and Policy Priorities, Health (2019). Online
5- Doty, MM, and Collins, S.R.. "Millions More Latino Adults Are Insured under the Affordable Care Act." To the Point (2017). Online.
6 - Ortega, A. N, Rodriguez, H.P., Bustamante, A.V. "Policy Dilemmas in Latino Health Care and Implementation of the Affordable Care Act." Annual Review of Public Health 36 (2015): 525-44. Online.
7 - Migration Policy Institute. “Profile of the Unauthorized Population: United States.” Data Hub. 2016. Online.
8- Noe-Bustamate, L., Flores, A. “Facts on Latinos in the U.S.” Pew Research Center, Hispanic Trends. 2019. Online
9 - Galvani, Alison P, et al. "Improving the Prognosis of Health Care in the Usa." The Lancet 395.10223 (2020): 524-33. Online.
10 - Gundersen, Linda. "Physician Burnout." Annals of internal medicine 135.2 (2001): 145-48. Online.
11 - Bivens, J. “Fundamental health reform like ‘Medicare for All’ would help the labor market.” Economic Policy Institute. 2020. Online
12 - Woolhandler, Steffie, and David U Himmelstein. "The American College of Physicians' Endorsement of Single-Payer Reform: A Sea Change for the Medical Profession." Annals of Internal Medicine 172.2_Supplement (2020): S60-S61. Online.
13 - Centers for Disease Control and Prevention. “Diabetes: Hispanic/Latino Americans and Type 2 Diabetes.” Centers for Disease Control and Prevention: Resources & Publications. Web page last update: 2020. Online.
Comments