June 15, 2017
Area(s) of Interest: Health Care Reform Medical School 

Students at the UC San Diego (UCSD) School of Medicine recently took a break from their books to spend an afternoon with local Congressman Scott Peters (D-San Diego) to discuss health care policy.

Peters sits on powerful Energy and Commerce Committee, one of the most influential policy-making bodies in Congress when it comes to health care. As such, he frequently finds himself involved in discussions and decision making that impact health care policy.

“If you’re in Congress, or on any committee, you’re always doing health care because it’s such a big part of the federal budget,” he explained.

The process for developing the federal budget is part of what makes health care reform so difficult.

“The federal government has a way of doing business that is anti-innovative, and it’s important for San Diegans to think about this,” he said. The federal government evaluates policies on a one-year cost basis. This means that policies are deemed “good” or “bad” based on how much a policy will cost in one year compared to how much money it will generate in a year.

“You don’t even do this as a homeowner,” he went on, joking that nobody would decline to patch a roof before the rainy season just because of the upfront cost. You consider the long term outcomes when making financial decisions, he said.

Similarly, limiting analysis of health care policy options based on one-year cost outcomes makes innovation and meaningful change difficult.

“[But the government] only looks at this year,” he explained. “They don’t think how much you spend this year and how much you save down the line. But if you look at health care, that’s a really important analytic. There are things we can be doing today to deal with diabetes, congestive heart failure, obesity…it might cost us money this year but will save us money down the line.” But since that is not how the federal government does it, he said, it is difficult to accomplish meaningful change in Congress.

In addition, Peters said that the atmosphere in Washington has been “chaotic” since the election, and that the debates between supporters of the American Health Care Act (AHCA) vs. the Affordable Care Act (ACA) have been increasingly polarizing and partisan.

Peters, a Democrat, is anti-repeal-and-replace and views the effort to dismantle the ACA as an ineffective solution to the health care issue. “What I’ve said [before] and I’ve said in every campaign is that it is a tremendous undertaking…to change the whole health care system.”

One of Peter’s primary frustrations is that members of Congress on both sides tend to resist any changes regarding the ACA. Republicans are unwilling to negotiate since their primary goal is “repeal and replace,” while Democrats are so defensive of the current policy that they are generally unwilling to compromise on any aspect of the ACA.  

“No one should be defensive [about a bill],” Peters said, “You have to make changes to make sure that [the system] really works. It’s very unlikely [that any bill] right out of the box [would] be perfect.”

After a 15-minute briefing on the state of health care in Washington, D.C., the floor opened for a 45-minute Q&A. Medical students, pharmacy students and faculty members were all in attendance.  

Questions from students ranged from the unhealthy food provided to patients in hospitals to federal residency funding and research grants. It took only a few minutes before a faculty member challenged Peters to explain why Congress refuses to consider a single-payer system.

“I think, frankly…that it’s an impractical solution,” Peters stated.

He recounted that Hillary Clinton, in the 2016 election, argued that the best approach to health care was to work within the system. Single payer was a nice idea, Clinton said, but she thought “with some justification, that it was a fantasy.”

Peters, who sees himself as a pragmatist, agrees. “I want to be practical about improving this existing system and making sure we can provide as much care to people as possible—to make it affordable.”

Being an Effective Advocate

Throughout the afternoon, Peters underscored the importance of medical students knowing how to advocate effectively.

As future leaders in medicine, he cautioned, medical student must learn not only how our health care system works but how to change it for the better. Staying engaged with health care policy and advocacy means physicians can provide the best care to patients both inside and outside the exam room.

“You’re the expert on what you know,” he said firmly. If there is a problem that medical students and physicians know about that the government does not—it is up to them to raise the issue and explain obstacles to policy makers, said Peters.

That idea is what drove Cecilia Bonaduce-Leggett, a third-year medical student at UCSD and one of the leaders of the Politics in Medicine Student Interest Group, to organize the town hall with Peters. Bonaduce-Leggett wanted medical students to have an opportunity to speak with Peters during this transitional period in health care and Congressman Peters was more than happy to work with the medical students to plan the event.  

“We need our elected officials to know that we have a real stake in this and the changes made will impact our ability to care for future patients,” said Bonaduce-Leggett.

Bonaduce-Leggett pointed to the impact the cuts proposed in the AHCA will have on UCSD’s Student-Run Free Clinic Project. Over 80 percent of medical students at UCSD participate in the free clinic, which provides care to the underserved in San Diego—a population that will be significantly affected by cuts to Medicare and Medicaid. In addition, medical students participate in grant-dependent scientific research that is also at risk under the current administration.

Upon graduating, medical students will enter into residency programs that are funded by the federal government in order to complete their medical training. Any cuts to residency program funding will further exacerbate the physician shortage in America, Bonaduce-Leggett explained.

The purpose of the town hall event with Peters was to provide medical students an opportunity to advocate, to be heard, but also, to learn.  

“After two years of learning about advocacy and with the rapid changes in health care policy due to repeal-and-replace efforts,” Bonaduce-Leggett said, “I realized that advocacy is not just about being heard, but about being informed, which is why this event was so important for us.”  

Peters taught the medical students about the policy making process and shared his insights about the health care debate in Congress.

As the Senate continues to develop its own version of AHCA, medical students at UCSD will continue their advocacy work. Several students will spend the summer in Sacramento to work with members of the state legislature on health care in California.

And these students will get the chance to make a real impact on the health of California. Last year, for example, UCSD medical student interns worked with Assemblymember Lorena Gonzalez-Fletcher (D – San Diego) on a student-initiated bill to reduce drunk driving by requiring that restaurant and bar servers be trained to identify when a customer has had too much alcohol. The bill was spurred by a tragic drunk-driving accident in 2015 that took the lives of two UCSD medical students and injured three others, who were struck by a drunk driver going the wrong way. The bill was approved unanimously by the Assembly on June 1.

This year, other UCSD medical students will work to build on the partnership with Peters and his office in the hopes of creating a student-initiated bill at the federal level.

Cecilia Bonaduce-Leggett is a third-year medical student at UCSD, member of the California Medical Association, and one of the leaders of the Politics In Medicine Student Interest Group. Jessica J. Pourian is a first-year medical student at UCSD.