Last Week

I cannot believe that we just finished our final friday program! This summer- spent in the wonderful city of New York- has been one of the best experiences of my life. I have learned more not only about Universal Health Care, but also about how the largest city in the US functions through exposure to the politics, culture, and simple day to day runnings of the city! My summer here has strengthened my desire to one day work in the field of medicine as a primary care provider; this I expected. However, I definately did not expect that my summer experience working on Universal health care would cause me to have an epiphany about were I want to do my work. Before this esperience, I had also desired to work in developing nations, because I thought I could have a much larger impact in countries that did not have a soldified way of doing things. After spending the summer doing policy work in the American health system, I discovered that there are exponential ways to help improve our slightly broken system, and that individuals must not give up the fight for bringing health care to every person. I have learned, from my exposure to the dedicated individuals I have spent my summer working for and with, that it is not only possible for single people to create change, but that it is necessary for oneto fight as hard and as long as possible to bring about positive change. I have learned that, even here in this nation filled with citizens who distrust government and this city known for its hardness and skeptism, that hope and determination are the two most powerful agents for doing good.

A Community Coming Together

On Monday evening, I left my office building on W 72nd street and trekked to the subway where I took the train up to 125th street. From there, I walked the 8 blocks up to the Renaissance Housing Projects. Out in front of this housing community's heart, the community center, a line of people of all ages, colors, backgrounds and sizes was forming. The mass of people were all waiting to be let into a community hearing on the 197-A plan developed by Manhattanville Community Board 9. This plan is meant to serve as a framework to guide decisions about the way in which the community will grow and change in the coming future years. The 197-A plan has taken many years to develop and includes initiatives to promote business growth which is environmentally friendly, increase the amount of low-income housing available to residents, create conditions to generate more long term jobs, preserving historic buildings which are important to the culture of Harlem, and outlaw the use of eminent domain for private use of land (among other things). The 197-A plan is extremely important because it is being released just as Columbia (which developed a very different 197-C plan)is planning to utilize the power of eminent domain to seize ten blocks of residential area of Manhattanville to use to expand Columbia's campus and build the largest biotechnology facility in the world. The residents of Manhattanville came together and united in opposition to such a plan by strongly voicing their support of 197-A and requesting that Columbia change its plan to match up with the initiatives created by the people who live and work in Manhattanville. The residents act of uniting together signals that Harlem is sick of being infringed upon by powerful corporations and institutions. The people who live here (and desperately want to stay here) love their neighborhood and realize that if Columbia wins out and is able to seize the land for its personal use and expansion that even those living outside the immediate area will eventually be forced to leave as a result of soaring rent prices and overall exponential increases in cost of living. The community forum was one of the most moving experiences I have had to date in NYC because it illustrated the strength that can come from such a diverse community organizing together to present a united front.

Why Universal HealthCare?

Prior to starting my internship with Rekindling Reform, I was like most of my peers: uninvolved in the fight to gain universal healthcare. I personally had never even thought deeply about the importance of guaranteed medical services regardless of one's insurance status simply because I myself have been covered my whole life by my father's employer plan. I have never not been able to go to the doctor (or any specialty doctor) because of a lack of insurance, and I have never directly had to pay for any of my medical treatment except for the $8 co-pay I shell out when I pick up prescriptions. I was even able to undergo an advanced ankle surgery, which was not "medically necessary for daily life" but which was necessary for me to continue participating in high school and college track. In my town, all of my friends were in a similar situation to me, so it simply never came up to discuss the problems which insurance (or lack thereof) can cause with access to medicine, because all of us had great access to health coverage.
My naiveté on the subject continued into my college years because Cornell requires that all students have some sort of health insurance, allowing students to use their own plans if approved by the university, or forcing them to buy into Cornell's insurance plan. This requirement again created an environment where I was surrounded by students who all had access to treatment. I was first exposed to the stress of health insurance indirectly when older friends of mine from Cornell, who had since graduated and entered into the real world, began complaining about the huge bills they were paying to stay covered.
My innocence was completely shattered when I arrived in New York and began meeting with people who had no insurance. Many of these people worked minimum wage jobs for employers who did not offer health coverage, but some worked higher income jobs, but simply could not afford the high premiums which have continued to rise exponentially even as the actual services provided have declined. These people told me stories of illnesses left untreated which simple antibiotics could have eradicated (because without insurance, doctors won't see sick people) until the condition became so serious that the patient ended up in the emergency room and left with bills for thousands of dollars. The cost of treating the illness at the first sign would have been one tenth of what the individual ended up being forced to pay. Many times these bills go unpaid which increases the cost of treatment for everyone else. Our current system actually encourages this kind of fiscal waste by offering no primary care medical services to those who need them most, the uninsured.
Americans are unique from people of other nations as they view healthcare as a privilege instead of a basic human right. To citizens from France, Germany, Sweden, United Kingdom, South Africa, Australia, Japan Italy, and many many more countries, access to health care is guaranteed, just as service from a fireman or a postal worker or a police force is guaranteed. Even more surprising is that in these nations, citizens pay half of what Americans do (7% of the GNP compared to 15% of ours) and are able to cover everyone. The costs of these services, which we all take for granted, are shared by everyone and paid for by the government through taxes. Health care is just as essential, if not more so, than all of these basic services, yet it is not provided! Health care must be managed by a group that does not seek to make profit so that it becomes as efficient as these basic services. Although America is based upon a free market system, health care is not a commodity to be traded and profited from! Americans must change reevaluate their loyalty to capitalism, solely in the health care arena, as a way to make sure that all citizens in this country, which is no longer thought of as having the best health care system in the world, have access to necessary medical services.

Crisis of Confidence

Last week, on Friday, I underwent a mini-breakdown. Not the panic attack, "oh no, my life is falling apart" type of breakdown, but more so the "I am learning and seeing so much but feel as though I am not actually helping" type of breakdown. I am not sure if other CUSP students feel the same way, but I certainly was hit pretty hard last week by all that I had experienced thus far. I am absolutely loving my internship; the people that are supervising me are amazing, and are not only a wealth of knowledge in various areas of policy, but have also made it their personal goals to make this summer the most stimulating learning experience that they possible can for me. They have enabled me to attend private meetings between key policy-makers and community leaders, intelectual conferences in which most of the other attendees are distinguished professors at ivy leaque schools, and intimate study groups focusing on the realities of health care policy in New York. In other words, I have been allowed let in to events which I would normally never ever have access to!
Now you probably wonder why would all of this- these amazing and enlightening experiences, lead me to a mini breakdown of sorts. It is simply that while I am obviously learning so much, at the same time I wondering how much am I really doing that will help my group achieve its goal of expanding access to health care. I am torn between the greatness of the learning experience and the reality of what I am actually doing. It really boils down to what the true point of this summer is, to learn or to do. Are we CUSP interns here in NYC for these short eight weeks to make an impact in this place, in our own fields, or are we here to have an impact made upon us? Right now, at least for me, I feel as though I have had much more of an impact made upon me than I have myself enacted any change. Of course, I am hoping that in the end it will turn out to be a combination of both, that I will leave knowing that I have grown immensly as a person, and that I was able to help to do something positive for the cause I devoted my summer to.
As this issue had been nagging at me for the whole of last week, I tentatively brought it up to my supervisor, Aaron Beckerman, at one of our many reflective sessions (which take place all over the city in diners or on a park bench, wherever and whenever we can take the time to pause and discuss the significance of the many meetings and events). As he always does, Aaron asked me "how's it going?" and instead of my normal response which encompasses "GREAT! I loved this meeting..." (and I provide a description of what I have been doing for the previous few days), I paused for just a second before carefully answering that I was loving the experience but was a little torn. I explained how I felt, that I was wondering if what I was doing was good for anyone but myself, and then waited to see how Aaron would respond. He looked at me and smiled and said, "kiddo, if all that you accomplish the whole summer is to learn about the importance of the issue of universal health care, then we have succeeded!". "Of course, you have already done so much more than simple learn, as you have already put together valuable research for our group, but the far more valuable thing, is that you have begun to really understand the importance of a health care system that provides equitable and quality medicine to all who need it". Aaron went on to explain that my future dedication, which he hoped would result in part from this summer's experience working with Rekindling Reform, to providing primary medical care while working in support of universal health care would do much more for the issue than any summer project which could be accomplished in 8 weeks. In other words, Aaron was explaining that my education in the political arena of NYC, which would result in shaping the type of person I would become and impact my professional and personal choices in a (hopefully) positive way, was of far more worth to the cause. The group here is trying to build a movement powerful enough to break through the stereotypes and fears which surround any form of de-privatization of health care within the United States (a country which ungroundedly fears anything that remotely resembles socialism in any form). Such a movement requires that not only the professors and intelectuals be knowledgeable, but also the students and the youth and the young professionals. Aaron's hope is that by educating on of these youth, on the verge of adulthood, he can help to widen such a movement to a generation that is definately not known for its activism.

Entry Two

This week I spent learning about the different routes of creating policy changed through the complicated world of New York City, New York State and National politics. I attended a few key meetings, all relating to widening access to healthcare, but each involved a different group. One valuable experiences was a luncheon at the Century Foundation where Arnold Relman, an emeritus professor from Harvard Medical school, presented an overview on his new book. Relman, basically the most well-known and the original advocate for a single-payer health care system, held an interesting view that not only the insurance side of the medical industry needs to be completely redone, but that the medical delivery system itself must be revamped! Relman, who is a Doctor, was calling out to fellow physicians to reorganize into multi-speciality practices which pay salaries instead of fee for service so that more and more doctors would return to focusing on providing primary care instead of entering lucrative but unavailable speciality fields. This take was completely new to me, and caused me to have to reevaluate the way I had begun to organize my own views on what reforms were necessary in order to make health care available to all Americans. I had not gone so far as to question the direction of the whole field of medicine, which I one day hope to enter, but can see now that it is an idea that is worthy of serious examination as America is fast becoming a nation where it is nearly impossible to recruit medical students to enter primary care fields. This trend makes it harder and harder for lower-income and especially the uninsured to even see a doctor until it is either too late, or they end up at the ER in an emergency situation, when a simple and basic yearly check up could have prevented the whole illness.

First Week of Work

I am interning at Rekindling Reform, which is an advocacy group seeking to gain universal healthcare for all New Yorkers and eventually all Americans. It was a subject I was not extremely familiar with before coming to this position, but which I now understand the immense importance! I am the only and the first intern, which makes the experience unique to some of the other students in CUSP.
The first week went very well, as I am surrounded by experts in many different fields which all in some way relate to healthcare. My supervisor, Aaron Beckerman, is one of the most knowledgeable people about NYC, as he has lived here forever! He is an emeritus professor at Yeshiva University and also an adjunct professor at NYU Med in the field social work. He has been wonderful in helping to expose me to as many different healthcare experiences as possible, by sending me to various meetings, not only for Rekindling Reform, but also other healthcare organizations that he is connected with. Last week, I attended a few different RR meetings (including the annual meeting in which Ted Marmor, a political scientist at Yale, presented a call to save Medicare) and also attended a conference hosted by NY Health and Hospitals Corporation, which focused on patient safety in long-term care facilities. This conference was a wonderful experience because it enabled me to interact directly and have discussions with patients, all whom are members of the Community Advisory Boards at their own facilities. On Saturday, I journeyed out to Long Island to attend the annual meeting of Long Island Coalition for a National Health Program.
The combination of all the different meetings is really enabling me to get a taste of health care advocacy from every angle! So far the first week has gone great!