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“No doctor has ever reminded me that I am black before,” the patient said, laughing and nodding his head to let me know he appreciated my advice.

Just as he was startled by my open recognition of his race, so too was I startled by his reaction.

As his physician, I felt the issue I’d raised wasn’t worth ignoring; if anything, I viewed it as the “elephant in the exam room,” desperately begging to be called out: Black patients continue to suffer higher morbidity and mortality from colon cancer, compared to any other racial group, according to a 2016 study published in the Journal of Clinical and Translational Gastroenterology, and that is a fact that warrants discussion in the doctor’s office.

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Watching President Trump’s State of the Union address Tuesday night, my mind raced back to one of my patients, panting as she strung together a few words. “My difficulty breathing,” she paused, “has gotten worse in the last few weeks.” In her hospital bed, she looked gaunt and tired. She was struggling with homelessness and had stopped taking her HIV medications months ago, as she did not have insurance and could not afford the cost of her medications. As her doctor, I feared that she had a life-threatening lung infection, an unfortunate but preventable complication of her HIV.

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President Donald Trump has had two years of a miserable health care record that helped drive his party’s significant midterm losses. He has undermined protections for people with pre-existing conditions, tried to cut health care coverage from 20 million Americans by repealing the Affordable Care Act, and, when that failed, he sabotaged the ACA at virtually every turn. Seven million fewer people have health insurance than when Trump’s term began.

Looking toward the next election, Trump hoped to use his State of the Union speech for a health care reset. To anyone paying the slightest attention, he failed.

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In 2018, Democrats won the midterm elections on the issue of health care, specifically protecting the Affordable Care Act and its guarantee of coverage for pre existing conditions. It was a hard-earned victory: Passing the ACA was a major reason Democrats lost the House and seats in the Senate in 2010 , and polls showed the ACA was not a winner for Democrats in 2012, 2014 or 2016. Now, the question is: Having won the upper hand on health care, will Democrats give it back in 2020?

What might squander that advantage? A primary battle among Democrats who all favor universal coverage but have differences about how to get there. Candidates seeking advantage in that contest by questioning the purity of one another’s views on health care, or conversely, trying to scare voters with nightmare scenarios about those with more liberal views. And most important, a focus on internecine differences instead of on the sharp contrast between the core Democratic position and the Republican stand on the future of health coverage in our country.

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The CHA Community Benefit Committee meets twice per year, once by conference call and once in-person. Listed below are upcoming meeting dates and times, as well as meeting materials.

2019

Thursday, February 7
2:00 – 3:00 pm
via conference call

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Last week’s announcement by Aetna and Apple of their Attain “experience” designed to enable Aetna members to achieve better health using the Apple watch was the latest in a series of partnerships vying to shake up healthcare from an unconventional angle. Others include Amazon-Berkshire Hathaway-JP Morgan’s collaboration to reshape health insurance, and Uber and Lyft’s numerous partnerships with Sutter, CareMore Health, and other healthcare systems to address transportation challenges for patients.

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Agenda

Before the call, read and respond to VolunteerTalk messages