By Brenda Gazzar
Code Wack Podcast, February 6, 2023
What say should doctors have in reforming America’s healthcare system? Are their decades-long efforts to stop the commercialization of medicine having an impact? How can health professionals, and students in the health sciences, get involved in the movement for single-payer health care?
To find out, we spoke to the new president of Physicians for a National Health Program (PNHP), Dr. Philip Verhoef, an adult and pediatric intensivist and Clinical Associate Professor of Medicine at the John A. Burns School of Medicine at the University of Hawaii-Manoa.
Find out the main strategies, goals and challenges of PNHP, the only single-issue, physician-led organization advocating for Medicare for All in America. And learn about the growing influence of Students for a National Health Program (SNaHP) in the single-payer movement.
Dispatcher: 911, what’s your emergency?
Caller: America’s healthcare system is broken and people are dying!
Welcome to Code WACK!, where we shine a light on America’s callous healthcare system, how it hurts us and what we can do about it. I’m your host, Brenda Gazzar.
This time on Code WACK! What role do physicians and other healthcare professionals play when it comes to advocating for a single-payer healthcare system? What are the main goals of Physicians for a National Health Program, the only single-issue physician-led organization advocating for Medicare for All in America? To find out, we spoke to the new president of PNHP, Dr. Philip Verhoef. Verhoef is also an adult and pediatric intensivist and clinical associate professor of medicine at the John A. Burns School of Medicine at the University of Hawaii-Manoa.
So welcome to Code WACK!, Dr. Verhoef!
Verhoef: Thank you.
Q: Let’s talk about Physicians for a National Health Program. It was founded in 1987, and here we are 36 years later, still fighting the commercialization of health care. Would you say the prospects for PNHP’S vision of a truly equitable healthcare system for all have improved since then?
Verhoef: I wish I could say that we were closer now than we were then to achieving a universal healthcare system. If you look over these last 35 years or so, we’ve seen attempts at getting a universal system up and running only to be completely squashed by corporate interests. So you might recall Hillary Clinton actually pushed a universal healthcare system that was just squarely defeated by everyone at the time in the early 90s. We tried as an organization to get single payer, at least at the table for the talks around the ACA back when Obama got elected and we were roundly shut out.
You know, we’ve had a bill introduced in Congress now for every Congress for the last 20 years since Rep. (John) Conyers introduced the first one in 2003. That was a bill that we helped work with his office staff on to be the aspirational single-payer bill that we want to see and yet here we are, since PNHP’s forming, we’ve got more and more privatization of Medicare out there in the forms of Medicare Advantage and this upcoming ACO REACH program. These are all ways that the federal government is actually taking Medicare and putting it in the hands of private insurance companies without, you know, holding onto it themselves and so, in many ways, you might argue we’re in worse shape now than we were 35 years ago in spite of the efforts that we have made on this particular front.
Yes, that’s a little depressing.
Verhoef: <Laugh> It is totally depressing. But, you know what? We’re not going to stop fighting, right? We want what’s best for our patients. We want what’s best for our whole country. You know, it’s hard. Every year I update my slides for PNHP, for the talks that I give, and you just watch how much more we spend than other countries in the world and then you watch our inequities get worse and you watch our life expectancy go down year after year and you say, ‘golly, how is it that we just keep making things worse in spite of ourselves?’ But on the other hand, if we weren’t fighting this fight, I would hate to imagine where things might actually be if we didn’t have folks actually protesting and fighting some of these really awful moves that will only hurt our American citizens.
Q: Right. Good point. PNHP membership includes doctors, other health professionals, and even members of the public. How does PNHP recruit doctors?
Verhoef: So we spend a lot of time just trying to get the word out there about what PNHP is, who PNHP is, and what single payer is. And so I can talk about my own personal experience. You know, honestly, I started getting involved when I was a resident, and then as I continued my training and became a faculty member, I was frequently giving talks to physicians, right? To educate them about our American healthcare system and about ways that we could change it or make it better. I’ve worked with student groups. I’ve worked with community groups where I’ve gone out and talked about what this is because, you know, it’s interesting. In 2016, single payer actually made it onto the main stage, right, as Sen. (Bernie) Sanders was engaged in his presidential campaign, we started talking about it and a lot of people had no idea what it is.
And, you know, we at PNHP said, ‘hey, we’ve been talking about this for 25 years. Come to us, we will educate you.’ And so that’s a big part of what PNHP does. But I think one of the things that we see now is that we won’t achieve single payer unless we get more healthcare professionals, more people behind it and so a lot of the work that we’re doing now is really targeted at expanding our membership, expanding the knowledge base among professional organizations and state medical societies. So we’re making a real concerted effort to shore up our ranks a little bit to get the buzz out there when you actually poll physicians, the vast majority support single payer. So of those that are out there that know about it, they like the idea. We just need to basically get those folks motivated and marching and supporting and actively working with us to make this a reality for our country.
Q: What do you see as the organization’s biggest challenges today?
Verhoef: You know, our biggest challenge is the fact that the fight that we’re up against is a fight against resources and money that outnumber anything that we have by orders of magnitude. You know, the private insurance industry, the pharmaceutical industry, for-profit hospital corporations, they have pockets that are so, so deep, and they will use those resources to influence legislation, to influence legislators. It’s not that we’re not going to win, but we’re not going to win by outspending them, right? We’re not going to be able to spend more money trying to influence legislators, that’s not going to be how we get single payer. We have to get single payer by organizing all of the physicians out there to say, ‘look, we’re not going to participate in this system that actively hurts patients, that actively leads to thousands of deaths per year in this country, simply by virtue of not having health insurance.’
I mean, that’s crazy. We literally watch people die as a function of lack of healthcare coverage. And so we’re not going to get single payer, I think, until we can get the majority of physicians out there saying, ‘we’re not going to participate in this system.’ You know, I’m not advocating for people to strike because I think that hurts people too. But I think we have to use our power within physician organizations and taking a cue from some of the labor organizing that’s out there to say, look, we can’t do this anymore. This is killing people. It goes against what we all join this profession for. So our biggest challenge is that we’re fighting a beast that’s just so much stronger than we are. I think there’s still a lot of physicians that don’t know entirely what single payer is and how it could benefit them.
And so it’s really on us to try and spread this out there so that people really understand. But we welcome doing that. I’ll give a talk every day if folks want to hear it about, you know, why I think single payer is the solution. We just need to, to bring people in and get them listening and understanding what’s going on. But we have the army of folks to do that. But, you know, it’s combating some of the misinformation that’s out there and really trying to say, ‘look, we don’t want corporate interests involved in our healthcare anymore. We don’t want people profiteering off of us.’ And so that’s the battle that we’re, that we’re really up against.
Q: PNHP also sponsors a program for medical students called Students for a National Health Program or snap. How’s that going? And why do you think it’s important to include these students?
Verhoef: Oh, it’s going awesome. It’s been one of the most inspiring things that we’ve done in the organization over the last 10 years. And, you know, I was involved in some of the earliest SNaHP chapter formations when we were just building this thing out when I was in Chicago and it was really incredible to see the enthusiasm of medical students who want to do what’s right for patients and it’s kind of remarkable because most medical schools don’t teach a lot about what our healthcare system is, or what are the economics or the ways that coverage happens or any of these kinds of topics and yet at the same time, I want students to understand that this is the career that they’re getting into. And so as an organization, we committed to building up these student chapters, to supporting students learning about single payer themselves.
And honestly, it’s been tremendously exciting because students, they haven’t been influenced by whatever healthcare system they end up going to work in. You know, they’re still open books ready to learn about what’s out there, and I want to see them advocate. I believe that physicians have a duty to advocate for their patients. And so, you know, I often tell students, ‘look, I don’t care what you advocate for. I want you to advocate for something, right? Something that you believe in that will make patient care better.’ And you know, I often tell ’em, ‘but you should advocate for single payer, right? You should advocate for healthcare reform because you know, because of how hurt patients are by our American healthcare system.’ And so our ranks have grown by substantial numbers and when we were at our national meeting this last fall, our numbers of students were almost as great as the numbers of non-students.
And that’s really exciting, right? Because now we have students who know all about our healthcare system. They know about a potential solution. They take that into their residency training, they take that into their clinical practice, and they can continue to fight. I don’t have to educate them anymore about what the optimal solution is to our broken healthcare system. They already know they’re already bought in and so we look at this as part of the long game. Yeah, I don’t know when single payer’s going to happen in this country. I have faith that it will, and I’m going to continue to work to make it so, but the more students that we can bring into this, the more physicians we will have out there who support this as a solution, who can get behind it. And so they have brought an amazing energy to PNHP’S efforts. We have now SNaHP representatives serving on our national board. Several of them are serving on our board, so they’re literally influencing the direction that PNHP goes and I just couldn’t be more excited about the involvement of students in PNHP.
Q: So Dr. Verhoef, what do you hope to accomplish in your two-year term as president of PNHP?
Verhoef: So I’ll tell you what I don’t think we’re going to get, I don’t think we’re going to get single payer in these two years, but I want to see us move the needle substantially, right? And what does that look like to me? It means fighting off privatization at every opportunity, continuing to raise the specter of the harm that privatization does. So I think that’s the first thing. The second thing is let’s build our ranks much, much greater, right? So let’s reach out to medical societies, professional organizations. Let’s get the word of single payer out there to these physician groups. We know that there are folks out there that support this. Let’s make single payer a mainstream thing that the American College of Physicians says, ‘we’re going to actively support this.’ The American Academy of Pediatrics says, you know, ‘single payer is the best thing for our children’s health in this country,’ right?
We want to bring it up to that level and so we also want to work with state medical societies to really move the AMA on this, right? You know, every state medical society has a delegation to the American Medical Association. If we can change the AMA from within and use the AMA, which is the largest physician group in this country, if we can get the AMA to start advocating for single payer, I think that’s going to be a game changer.
I want to see us continue to work with our allies. So these are other political organizations, labor movements, anybody who feels like healthcare is an important part of what they advocate for, we want to support them and give them the tools to argue that single payer is critical for the labor movement, right? That it should be a critical part of the Green New Deal, right? Or that it should be part of any progressive agenda and so you know, building further those relationships I think is also really, really critical.
Q: So how likely is it that the AMA, or the American Medical Association, would support single payer anytime in the near future?
Verhoef: You know, we make progress every year, and a lot of that progress comes from the students. Every year, they introduce single-payer support sort of resolutions within the AMA, and they get further and further to those being adopted as part of AMA policy. It’s been a stunning thing to watch and a real, you know, the students are taking the bull by the horns here. They got remarkably close to a supportive vote on single payer at the last AMA meeting. And so we expect, you know, to continue to work within the student chapters or through people’s state and local medical societies, I think it’s possible.
You know, it’s funny, I personally stopped being a member of the AMA a number of years ago because I didn’t feel like they represented my interests. They were representing sort of corporate conservative interests and not my interests. But as I take on this role as PNHP president, I’m strongly considering reengaging with the AMA now that I can take some time to work from within, you know. Let’s change this organization. Let’s bring this narrative up. Let’s fight hard for this. And I think that that’s going to be key, you know, is for physicians to look at this as an opportunity and not as a barrier, you know?
Q: Wow, that’s great. Where would you like to see PNHP in five years?
Verhoef: Oh, in five years, I would love us to have four times as many members as we do. I would love our staff to be twice as big. I’d love to see us out there building new SNaHP chapters and creating the next wave of physician activists. I’d love to see us with a real consistent permanent presence in DC. We aren’t a big enough organization, and, and we’re a 501c3 so honestly, we’re not going to engage in a lot of aggressive lobbying, but there is so much education to be done and if we could begin to build that presence and work with, you know, legislators on Capitol Hill to help them understand why this is the solution, these are all directions that I’d love to see us be in five years, you know, so we’re going to work towards that.
It’s a bit of a cycle in a good way, a spiral in the sense that if we get more members, we get more resources. If we get more resources, we can build this and if we build this out further, we can bring in even more members and these kinds of things feed forward and that’s very much where I’d like to see us going is really expanding as an organization and then building the amount of power that we have to truly influence the direction of health care in this country.
Q: How many members does PNHP have right now?
Verhoef: So on the books, we say around 25,000 members, and that’s primarily physicians, although again, anyone can join.
Q: Is there anything else you want to mention, Dr. Verhoef, about PNHP?
Verhoef: You know, I’m really proud to be a part of PNHP because it represents, I think, what so many of us, we simply want the best care for our patients. We want them to be able to get what they need, and we want to see people healthy. Those of us that engage in this advocacy, it’s not stuff we do because we seek fame. It certainly doesn’t pay us anything. This is work that we do as physicians outside of our otherwise, you know, busy lives. But it’s because we believe in it and we really believe that this is the best solution to really help out patients in this country and so we’re going to keep fighting. If you meet a doc who’s an PNHP active member, they are fighting like crazy for what they think is right and I’m really proud of that.
Thank you, Dr Verhoef. Stay tuned. Next time we’ll talk to Dr. Verhoef about the privatization of Medicare.
Find more Code WACK! episodes on ProgressiveVoices.com and on Nurse Talk Media. You can also subscribe to Code WACK! wherever you find your podcasts.
This podcast is powered by HEAL California, uplifting the voices of those fighting for healthcare reform around the country. I’m Brenda Gazzar.