UT School of Public Health, Oct. 22, 2014
Robert Zarr, M.D., M.P.H., an alumnus of The University of Texas School of Public Health, was recently appointed president-elect of the organization Physicians for a National Program (PNHP). Zarr earned an M.P.H. at the School of Public Health, which is part of The University of Texas Health Science Center at Houston (UTHealth), and an M.D. at Baylor College of Medicine.
Zarr is a board-certified pediatrician at Unity Health Care in Washington, where he cares for a low-income and immigrant population. The clinic is a federally qualified health center. Zarr will be presiding over sessions of PNHP’s Annual Meeting in New Orleans on Nov. 15 and will fully assume the office of president on Jan. 1, 2015.
In addition to his work with Unity Health Care and PNHP, Zarr is a strong supporter of physical activity as a prescription for health problems. He works with the Parks Rx program coordinated with the National Park Service and George Washington University. “From my angle, as a physician, I’m literally prescribing parks, prescribing nature now,” says Zarr. He says the research on that should be published soon. (Read more about that here.)
Physicians for a National Health Program is a nonprofit research and educational organization of more than 19,000 members (physicians, retired physicians and medical students) who support single-payer national health insurance. Surveys show that among U.S. physicians, pediatricians tend to be among the most supportive of national health insurance. “It seemed fitting for me to volunteer my time with PNHP because I personally see so much of the unnecessary lack of access to healthcare and all its consequences,” says Zarr.
Zarr will be working with PNHP’s founders, Dr. David Himmelstein and Dr. Steffie Woolhandler; as well as other supporters such as Quentin Young who was a personal physician for Martin Luther King, Jr. “These are people who have really wonderful hearts, who have done so much work to improve all of our lives,” says Zarr. “I’m just so honored that they would even think of me as a peer and a leader in their organization.”
“We’re really about a single issue—which is, in my opinion and the opinions of thousands of other physicians around the country the most important first step—we’ve got to eliminate this financial barrier to seeking care,” says Zarr about PNHP. Zarr mentioned the Dallas Morning News article written by the nephew of Ebola patient Thomas Eric Duncan, which mentions that Duncan was uninsured. “Whether we want to face that fact or not, we know that it plays a very important part in delaying care and in receiving care. Once a person takes the initiative to receive care, it’s undoubtedly a factor that millions—right now we’re still at 42 million—Americans are still uninsured, which is nearly one in six. That’s a lot of people and is a crisis.”
Zarr spoke more about epidemic-sized infectious diseases, specifically Ebola in 2014, and also severe acute respiratory syndrome (S.A.R.S) and the situation that occurred in Asia in 2002-2004. “When you have a looming disaster like this [Ebola], a public-health disaster, people need to know that they can receive care without the stigma of not being able to pay or in the worst case without being deported,” says Zarr. “If you look at S.A.R.S. in China, the government was having a hard time getting ahold of the outbreak and was trying to prevent pandemic. What they found was that people weren’t going to the hospital because they couldn’t pay the bill—they were scared. One of the first things the government did was say, ‘Listen, we’ll pay all the bills: anybody who comes in with S.A.R.S.-related symptoms—it’s all paid for.’ And it worked. It was a very important measure.”
Zarr says not having health insurance delayed Duncan’s decision to go to the emergency room when he was having Ebola symptoms. “We’ve already had one person who didn’t have health insurance and we don’t know all the reasons why he went in when he did, but we know that care is definitely delayed when one does not have health insurance.” Duncan died two days after returning to the hospital for the second time.
When a country has a national health insurance program, Zarr says it is important for the citizens to remember that it is not “free.” Zarr described the National Health System’s formation in the United Kingdom of Great Britain and Northern Ireland in 1948, a few years after the end of World War II. He said the government helped people understand that it would be paid for through taxes in the same way that roads, police, fire departments and schools are paid for. “I think it was a really important move on their part,” Zarr said. “People tend to understand it shouldn’t be free—we do pay for it. And we’re paying for it now; it’s just that it’s not equitable now. Not everybody has equal access and that is the issue that we’ve been grappling with for so long.”
As a physician, Zarr said that the additional M.P.H. degree has given him a good foundation in public health to be an advocate for his patients and people without access to health insurance. “An M.P.H. is really a fantastic supplement to any physician’s career really. I think when you graduate with your M.P.H., you leave there understanding that big picture, which you really need to have in order to effect change on a big scale.”
The PNHP supports two Congressional bills: House bill H.R. 676 and the Senate companion bill 1782. “It’s an important step we need to take so that we can reach the level of outcomes and equity that we haven’t seen ever in this country,” said Zarr about the bills. “We’ve had a lot of discussion about ACA [Affordable Care Act] within our organization [PNHP] and there are a lot of things about ACA that are very good: the expansion of Medicaid, the extension of benefits up to age 26 for a young adult to be on his or her parents’ plan, the elimination of preexisting conditions—but at the end of the day, even by 2016 when it’s supposed to be fully implemented, there’s still going to be around 30 million uninsured and many millions more underinsured. Even though people have an insurance card, they’re still going not to have access to the care they need primarily because they won’t be able to afford the copays and the deductibles. They’re very high, even with the silver plan.”
Zarr is a past president of the Washington, D.C. chapter of the American Academy of Pediatrics and served as a CATCH facilitator in D.C. for five years. He holds adjunct professorships at Children’s National Medical Center and George Washington University.
In addition to his work with PNHP and Parks Rx, he is active in a variety of quality improvement initiatives including asthma management, injury prevention, literacy promotion, breastfeeding awareness, youth advocacy, tuberculosis prevention and compliance with early and periodic screening, diagnostic and treatment standards.