Medical Care
Section Newsletter
Fall 2003

Chair's Report

Dear Medical Care Section members:

This is going to be a short and sweet introduction to our fall newsletter. I just want to thank many of you who are involved in the Section and I want focus on asking all of you to get more involved. Those who are not regulars should come to APHA in San Francisco this year and join us at our Business Meetings-Saturday and Sunday evening and Monday-Wednesday at 7 a.m. The program states that we start at 7:30 a.m. or 8 a.m., but we are up and running at 7 a.m. because we traditionally have much to share and to do.

There is no end to the number of areas in which our Section shines and takes leadership: global health care issues, global peace and prevention of nuclear proliferation and war, Medicare and pharmaceuticals, managed care, universal health care reform, and ethnic and racial disparities to name but a few. And, to reiterate messages of the past, our committees remain dynamic and diverse. They are both discipline and issue based in areas such quality of care, drug policy and pharmacy, jail and prison health, women's health, veterans’ health, rural and urban health, health economics, social sciences, health services research and history of public health. The Medical Care Section also sponsors the world-class journal Medical Care. Several of our members sit on the Medical Care Editorial Board.

We are excited to have Oli Fein running for the APHA Executive Board. We are excited to have Camara Jones serving currently on the Executive Board. Likewise, we are fortunate to have Ellen Shaffer on JPC, Julie Zito on the Intersectional Council Steering Committee, Alison Hughes on the Action Board and yours truly on TFAIR (task force devoted to reviewing the organization and governance of APHA). Medical Care is a training ground and launching pad for APHA office, which provides even greater opportunity to contribute to APHA's external policy agenda, visibility and internal function.

This is an important transition time in the country. Medicare, as either a viable shell for the future expansion of health insurance or as a principled statement of social insurance policy in the United States, is under severe attack. The Congressional initiative to add drug benefits is an attempt to privatize the entire program and dramatically change it. APHA needs your voices to speak out about this and many other public health and public policy issues.

APHA is also under transition with a new executive director and the revision of its strategic plan. We look forward to having new leadership and new ideas at a time when APHA is earnestly looking at its structure, function and how best to support members, and at whether APHA can more effectively communicate its progressive public health and health policy vision in local and national forums. We will continue to be vigilant. It is clear that the Medical Care Section provides the sense of community, energy and purpose which makes vigilance possible.

Oliver Fein, MD - Candidate for APHA Executive Board

Personal Statement

APHA is a voluntary, national organization that works to improve public health in the United States and around the world. Disparities in resources and health among demographic groups and geographic regions threaten the health of the public. Recent policies to provide tax cuts for the rich, to reduce federal social expenditures through block grants to states, and to limit the role of the federal government to its military and foreign policy activities, challenge public health in the United States. In response, APHA must continue to build diverse membership from frontline public health practitioners employed by governments, voluntary associations, and academic institutions. We need to expand our multi-disciplinary complexion with members from all health professions and their related advocates in law, non-profit organizations and the community. APHA must continue to advocate policies to eliminate racial and other disparities in health care, to build public health infrastructure, to bring about world peace, and to create publicly funded and administered universal health care in the U.S. Internally, APHA’s basic building blocks are its Affiliates, Sections, SPIGs and Caucuses. Organizational improvement should nurture and strengthen these units. The Governing Council should remain the representative elected body of the basic building blocks. The Executive Board should formulate strategic priorities for approval by the Governing Council and participate in policy implementation, drawing on expertise from Affiliates, Sections, SPIGs and Caucuses. The Executive Board must work transparently. I bring to the Executive Board considerable experience within APHA, having served twice on the Governing Council, as Chair of the Medical Care Section (1997-99), as a member of the Committee on Refining the Policy Process and the Nominating Committee (1999-2001), and as member of the Search Committee for the Executive Director (2002). I look forward to the opportunity to expand my service to APHA, the premier public health organization in the United States.


Brief Biographical Sketch

I am a practicing general internist, academic administrator and public health advocate. As Associate Dean for Affiliations and Professor of Clinical Medicine and Public Health at the Weill Medical College of Cornell University, my primary work involves diversifying the clinical educational experience for Cornell students through placements in poverty communities, public hospitals and public health agencies. Other responsibilities include chairing the New York Metro Chapter of Physicians for a National Health Program (PNHP) and the Health System Reform Cluster of the Society of General Internal Medicine (SGIM). Since joining APHA in 1980, I have been active in the Medical Care Section, first as Chair of the Committee for Health Services Research (1990-94), then as Chair of the Medical Care Section (1997-99). Additional service has been on the Editorial Board of the journal Medical Care; APHA Governing Council (1988-90 and 1999-2001); the APHA Committee on Refining the Policy Process (2000), whose recommendations were adopted by the Governing Council; APHA Nominating Committee (2000-01); and the Search Committee for APHA Executive Director (2002). My career, which has been devoted to health care reform, includes three years in the Student Health Organization (SHO), four years as a Research Associate at the Health Policy Advisory Center (Health-PAC), and 17 years at Columbia Presbyterian Medical Center reorganizing health care delivery to the community and introducing public health practice into the curriculum through the Health of the Public Program. In the year before coming to Cornell, I was a Robert Wood Johnson Health Policy Fellow in the office of Senate Majority Leader George Mitchell. I really enjoy combining public health and health policy change with the provision of individual patient care.

Doctors Call for National Health Insurance

Journal of the American Medical Association Publishes Physicians’ Proposal for National Health Insurance Signed by 7,782 Physicians

WASHINGTON, DC, AUGUST 11, 2003 — In an unprecedented show of physician support for National Health Insurance (NHI), 7,782 U.S. physicians propose single payer NHI in an article in the August 13 issue of the Journal of the American Medical Association (JAMA).

The “Physicians’ Proposal for National Health Insurance” was drafted by a blue ribbon panel of leading physicians. The signers include 2 former U.S. Surgeons General, the former Editor-in-Chief of the New England Journal of Medicine, hundreds of medical school professors and deans and thousands of practicing doctors throughout the nation. The signers represent one of the largest authorship groups in JAMA's history. The Proposal was presented in Washington, DC at The National Press Club on Aug. 12, 2003.

“This is an historic moment. Today, thousands of physicians are taking a stand on the side of patients and repudiating the powerful insurance and drug lobbies that block wholesome reform,” said Dr. Quentin Young, a leading Chicago physician who chaired the Department of Medicine at Chicago’s Cook County Hospital and convened the group of prominent physicians that drafted the proposal.

The doctors’ article also critiques the health reform plans that have been offered by President Bush and the major Democratic presidential contenders. “Proposals that would retain the role of private insurers - such as calls for tax-credits, Medicaid/CHIP expansions and pushing more seniors into private HMO’s - are prescriptions for failure. By perpetuating administrative waste, such proposals make universal coverage unaffordable,” said Dr. Young.

The physicians call for national health insurance that would cover every American for all necessary medical care - in essence an expanded and improved version of traditional Medicare.

  • Patients could choose to go to any doctor and hospital. Most hospitals and clinics would remain privately owned and operated, receiving a budget from the NHI to cover all operating costs. Physicians could continue to practice on a fee-for-service basis, or receive salaries from group practices, hospitals or clinics.

  • The program would be paid for by combining current sources of government health spending into a single fund with modest new taxes that would be fully offset by reductions in premiums and out-of-pocket spending.


  • The proposed single payer NHI would save at least $200 billion annually by eliminating the high overhead and profits of the private, investor-owned insurance industry and reducing spending for marketing and other satellite services.


  • Administrative savings would fully offset the costs of covering the uninsured as well as giving full prescription drug coverage to all Americans.


"In the current economic climate, we can no longer afford to waste the vast resources we do on the administrative costs, executive salaries, and profiteering of the private insurance system”, said Dr. Marcia Angell, senior lecturer in the Department of Social Medicine at Harvard Medical School, and former Editor-in-Chief of the New England Journal of Medicine. “We get too little for our money. It's time to put those resources into real health care— for everyone."

The physicians’ call for NHI comes as rising health costs and premiums, and the increasing number of uninsured have stimulated a new round of health reform initiatives. Yet most politicians have steered clear of NHI, offering proposals for incremental reforms of the current system.

“How bad does it have to get before politicians are willing to prescribe the major surgery our health system needs? Premiums are skyrocketing and we already spend twice as much per capita on health care as any other nation. Forty-one million people are uninsured, and millions more are under-insured and can’t afford vital medicines. How bad does it have to get before our politicians admit we need national health insurance?” asked Dr. Steffie Woolhandler, lead author of the proposal and Associate Professor of Medicine at Harvard.

Physicians for a National Health Program (PNHP) was founded in 1987 and includes physicians in every state and medical specialty. For local contacts or other information, contact PNHP’s headquarters in Chicago at (312) 782-6006 or visit: <www.pnhp.org>.

--Reprinted with permission from Physicians for a National Health Program

The APHA Network on Globalization and Health Report: Fall 2003

How does the global economy affect health status and disparities in health status, public health systems and policy, access to coverage within private and public health care systems, occupational health and safety, injury control, environmental health, access to pharmaceuticals and to safe water, and social and economic equality? What do international trade agreements have to do with public health?

Members of the APHA Network on Globalization and Public Health will address these and other issues during the APHA Annual Meeting in November 2003. A Town Hall meeting on Nov. 16, 2003 from 2 to 4 p.m. in San Francisco’s Moscone Convention Center will offer brief presentations, and a chance to network with some local and national research and advocacy groups based in the Bay Area. The meeting will include observers from the September meeting of the international World Trade Organization ministerial in Cancun, Mexico, and members of international Public Health Associations. Join the planning with an e-mail to Ellen Shaffer, <ershaffer@cpath.org>. (Please see final schedule for exact room location.)

This year’s APHA Annual Meeting takes place just before the international gathering of trade ministers in Miami for planning the Free Trade Area of the Americas (FTAA). FTAA would extend NAFTA to the entire western hemisphere (except Cuba). The Network will help sponsor a press conference and other FTAA-related events.

APHA has been actively involved in support of its 2001 resolution, which opposes including health care, water, and other vital human services in international trade agreements. Along with the Center for Policy Analysis on Trade and Health (CPATH) and the American Nurses Association, APHA alerted members of Congress in July that smaller scale nation-to-nation trade agreements were setting dangerous precedents for international agreements such as FTAA. The letter, which was circulated to the US House of Representatives by Rep. Sherrod Brown, explained that US agreements with Singapore and Chile will:

Impede access to life-saving medicines, contradicting Congress’ earlier support for policies that would modify the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS). They will: allow patents to be extended beyond the 20-year term required by TRIPS; require a 5-year waiting period before governments can provide generic producers access to the test data produced by pharmaceutical companies, delaying affordable access to medicines; and restrict how governments provide marketing approval and sanitary permits for medicines. Pharmaceutical companies could block production of generic medicines.


Ease the terms of trade on tobacco products, reducing tobacco tariffs for Singapore to zero. While public health protections have reduced tobacco use in the United States, this provision will make it easier to dump tobacco products in Singapore.

Open the door to further privatization and deregulation of vital human services including standards for health care professionals, and provision of health care and water, sectors better addressed through open international collaboration rather than through commercial trade negotiations. While some services and some professions are exempted from coverage by some trade rules, these exemptions are too narrow to assure full protection. The United States has no exemptions for water and sanitation, leaving the country open to challenges from foreign private corporations and their subsidiaries.

Grant foreign private investors greater rights than U.S. investors. Under NAFTA, similar provisions have led to lawsuits by private companies that overturned important health and environmental protections. Again, this contradicts the negotiating objectives of the Trade Act of 2002.

Other social and public services are poorly defined, leaving trade tribunals rather than elected officials and regulators to decide whether basic public health protections are barriers to trade. Covered services include income security or insurance, social security or insurance, social welfare, public education, health, and child care. Trade panels are not required to have any expertise in health care or public health.

The letter urges Congress to advocate for trade agreements that exclude vital human services such as health care and water, that improve access to life-saving medications, and that do not threaten efforts to reduce exposure to dangerous substances. Further, it encourages support for enforceable commitments to advancing population health and to achieving universal access to health care and to safe, affordable water in the United States and internationally. The US-Singapore and US-Chile Free Trade Agreements do not meet these objectives, and, therefore, should not serve as models for other trade agreements, including the Free Trade Area of the Americas (FTAA) or the Central America Free Trade Area of the Americas (CAFTA).

The CPATH Web site, <www.cpath.org>, provides additional background information on economic globalization and health. APHA groups involved with the Network include: Medical Care Section, Mental Health Section, Environmental Health Section, International Health Section, Injury Control and Emergency Health Services Section, Occupational Health and Safety Section, Peace Caucus, Socialist Caucus, Spirit of 1848, DisAbility Forum, Hawai’i Public Health Association, and the Public Health Association of New York City.

Medical Care Sessions at APHA Annual Meeting

The Medical Care Session will have numerous sessions at this year's APHA Annual Meeting. To learn more about Medical Care sessions click on the text link below or visit the APHA Annual Meeting Website at http://www.apha.org/meetings/sessions.htm

Related Files:
03_MedCare__Sessions.doc

Medical Care Business Meetings

Do you want to become more involved in the Medical Care Section?

Do you want to know what projects the Medical Care Section is working on?

If you are attending the APHA Annual Meeting in San Francisco - join us as we have Medical Care Business Meetings throughout the Annual Meeting.

For more information, click on the text/PDF link.

Related Files:
03_MedCare_BusinessMeetings.d_1.doc

131st Annual Meeting of the American Public Health Association-Program Highlights

There are many exciting general sessions at this year’s Annual Meeting, but we would like to call your attention to the following three:

· President’s Session (3256.1) Monday, Nov. 17, 2:30 P.M.-4:00 P.M.

· Critical Issues in Public Health (4088.1) Tuesday, Nov. 18, 10:30 A.M.-12:00 P.M.

· APHA Closing Session (5190.0) Wednesday, Nov. 19, 4:30 P.M.-6:00 P.M.

Each session will include presentations on issues of great importance to the fulfillment of the public health mission in the 21st century by panels of outstanding experts. The panels are designed to provoke participants to view the future of their profession and to develop strategies for assuring public health effectiveness in the future.

Brief descriptions of these Sessions are provided below. For further information on the Sessions, go to <www.apha.org/meetings/sessions.htm>.

President’s Session

This session will focus on the challenges and opportunities facing public health in the 21st century. Topics to be discussed are: the Institute of Medicine’s recommendations on the future of public health practice and education; strategies to eliminate health disparities; mobilizing public support for universal health care; and a summary of the present state of public health as a “starting point” for the future.


Critical Issues in Public Health

This Session will further amplify the discussion of issues of central concern in the 21st century. The topics to be covered in this session are: new strategies to reduce the prevalence of substance abuse; approaches towards controlling the epidemic of obesity; strategies to reduce the high incidence of traffic accidents; and dealing with the threat of emerging zoonotic infections.

Closing General Session

For the first time, the Closing General Session will feature a panel discussion. Three areas of central concern to public health in the 21st century will be discussed. The topics to be covered are: the impact of the rapidly advancing science of genomics on public health; the threat of new and emerging infectious diseases; and the promise of technology in helping disabled people to overcome their physical limitations.