The AMA’s First African American Female President, Dr. Patrice Harris on Quest for Health Equity

20190826Harris

Margaret Flinter : Welcome to Conversations on H ealth C are with Mark Masselli and
Margaret Flinter , a show where we speak to the top thought leaders
in health innovation, health policy, care delivery and the great minds
who are shaping the healthcare o f the future. This week Mark and
Margaret speak with Dr. Patrice Harris, president of the American
Medical Association, and the first African American woman to hold
the position in a 172 years. He talks about the AMA ’ s goals to better
address the O pioid cr isis, the need to expand access to behavioral
health interventions for more Americans, and the need to promote
diversity in the healthcare workplace, as well as health equity.

Lori Robertson also checks in , the Managing Editor of FactCheck.org
look s at mi sstat ements spoken about health policy in the public
domain , separating the fake from the facts, and we end with a bright
idea that ’ s improving health and well - being in everyday lives. If you
have comments please e - mail us at [email protected] or find us on
Facebook , Twitter or wherever you listen to podcasts a nd you can also
hear us by asking Alexa to play the program Conversations on Health
Care . Now stay tuned for our interview with Dr. Patrice Harris here on
Conversat ions on Health Care .

Mark Masselli : We ’ re speaking today with Dr. Patrice Harris, a psychiatrist and the
th
174 President of the American Medical Association , the first African
American women to hold this position. Dr. Harris has been Chair of
the AMA ’ s Opi oid task f orce. Dr. Harris earned her master ’ s in
psychology and her MD at West Virginia University. She did her
residency and fellowship in Child and Adolescent Psychiatry at Emory
University in Atlanta. Dr. Harris, welcome to Conversations on Health
Care .

Dr. Patrice Harris : Thank you for having me.

Mark Masselli : I think all of our listeners know that American healthcare is
undergoing such a dramatic transformation and the American Medical
Association is in transition along with it . I wonder if you could talk to
our listeners about what you see as some of the AMA ’ s most
important goals for this new era and the power of this moment for
you and for the organization to advance these goals.

Dr. Patrice Harris : W ell, it ’ s certainly an exciting time to be in le aders hip of the American
Medical Association. Certainly health care delivery is on the minds of
most of the people in our country. We also are faced with significant
challenges , but these are challenges that physicia n s will hardly take
on as we look to our o verall North Star which is improving the health
of the nation. We have decided to look at our work in three major
focus areas , a n d the first is we want to innovate and how we train the
next generation of physicians, again, to meet the challenges. The
s eco nd is specifically improving health outcomes. Now , we have
decided to focus on two areas. That ’ s pre - diabetes and hypertension

20190826Harris

and of course, as you mentioned the opioid epidemic. Then the third
is attacking the dysfunction in healthcare. Today, ther e are so many
burdens, regulations, laws that interfere with physician ’ s ability to
take great care of our patients. So we want to attack the dysfunction
in healthcare. Those are our three areas of the AMA, as we again
meet the challenges head on.

Margar et Flint er : Well, Dr. Harris, I cannot think of a better clinical background for this
role in this era than your background as really a renowned child and
a dolescent psychiatrist and I know that you have a particular focus on
mitigating the impact of chil dhood tra uma, which we ’ ve learned so
much about in recent years in terms of its lifelong impact. You ’ re a
huge advocate for behavioral health services being embedded within
the healthcare system, but really integrated within primary care as
well something that we ’ v e long practice d in our organization and
work with community health centers around th e country to be able to
do that in any setting where we ’ re providing health care services for
children. We would really be interested in hearing more abo ut how
the AMA is w ork ing and seeking to advance the s chool of this
seamless access to behavioral health.

Dr. Patrice Harris : Well, certainly at the foundation of integrating care is access to
affordable, meaningful health coverage. We know that there are so
many in this cou ntry who are now able to access services for mental
disorders for substance use disorders because they have health
insurance. The AMA has as its goal, everyone having access to
affordable, meaningful coverage. Then layer on that a po licy that we
have at th e AMA that amplifies the importance of mental health care
into overall health care, and the importance of expanded Medicai d. So
many folks in our country are now able to access behavior al health
services because they have health insura nce, because they were able
to get their health insurance through their state Medicaid programs.
Those are foundational elements at the AMA which really highlights
the importance of care for those who have mental illnesses and
substance use disorders.

M ark Masselli : Yeah, Dr. H arris, you know West Virginia very well and it ’ s a region
that reflect s some of the highest challenges that we face in
healthcare. West Virginia was one of the original hot spots for opioid
crisis. O pioid prescribing is declinin g, but overdose deaths are no t and
I ’ m wondering if you could talk about the work you ’ ve done , the work
the AMA is doing to address this deadly public health crisis .

Dr. Patrice Harris : Well, you mentioned West Virginia my birth state and in 201 4, the
AM A convened the opioid task f orc e and the purpose of that task
force was to elevate and amplify the work that was already being
done by the physician community on this epidemic, but to also
identify ways to continue to enhance our collaboration and

20190826Harris

partner ship that is required if we want to really end this opioid
epidemic. In 2015, we developed several recommendations to really
focus in on what physicians could continue to do to address the opioid
epidemic. We have seen progress as you mentioned, p rescriptions are
down, physicians are bec oming trained to provide medication assisted
treatment to get the waiver.

Unfortunately, there are still too many , who believe that those who
have a substance use disorder and opioid use disorder have a moral
faili ng or a character flaw. Also , as you ment ioned, though,
prescribing is down, the number of overdose deaths is up and that ’ s
because the epidemic has evo lved as most public health crisi s do.
Now most of those overdose deaths are due to illicitly ma nufactured
fentanyl and heroin. That ’ s why the AMA is laser focus at this moment
on access to treatment. We want to make sure that we eliminate
ba rriers such as prior authorization. W e also want to make sure that
states are monitoring whether or not the insurers in their respective
states are following th e parity laws and so our patients who need
treatment have access to that treatment, eliminating barriers, making
sure that parity laws are enforced. In fact, we ’ ve be en working in a
couple of pi lot states to model how all the states can evaluate that
work .

Margaret Flinter : Well, Dr. Harris a s we think about your efforts to improve health
outcomes in your another laser focus area on diabetes or pre -
diabetes al l of these things rear their head again in the lens of
inequity and health care and certainly Afford able Care Act, Medicaid
expansion in particular was a huge step forward in addressing the
inequity of access because of not having insurance. I wonder if you
could just talk with us a little bit about the efforts at the AMA to
address health equity issues.

Dr. Patrice Harris : For many years, the AMA along with NMA and the HMA [PH] worked
together on a commission to end health disparities and so building on
that great work, we are in proces s of developing a center for health
equity at the AMA. This will be o ur hub for embedding health equity
into the DNA of our organization. We are also very excited about
hiring of our first chief health e quity officer Dr. Aletha Maybank who
did this work in New York , you may be aware of Dr. Maybank.

Margaret Flinter: We are , yeah.

Dr. Patrice Harris : Again , we are committed to make sure the concepts of health equity
and health equity when it comes to communities of color , to women,
to the LGBT Q community. These are all issues that wil l be addressed.
As you mentioned, we need to make sure that there is a diverse
p hysician workforce , that the faces of physicians match the faces of
our patients. We know we ’ ve made some progress, women makeup
over half of our medical school classes , but when it comes to African

20190826Harris

American men, we a re going in the wrong direction. We certainly
need to address a diverse p hysician workforce as a part of our overall
commitment towards health equity.

Mark Masselli : We ’ re speaking today with Dr. Patr ice Harris, a psychiatrist and the
174 th President of th e American Medical Association, the first African
American women to hold this position. Dr. Harris, let ’ s take a moment
and talk about the recent challenges to women ’ s health, especially
reproductive health. Planned P arenthood made the dramatic decision
to withdraw from accepting Title 10 funds over the so called gag ru le.
We know how important that Title 10 funding is for so many of their
programs across the country. The AMA recent ly took some actio ns of
its own. I ’ m wondering if you could shine a light on the filing of a suit
in North Dakota over the state ’ s actions to limit access and the efforts
to restrict access to reproductive health.

Dr. Patrice Harris : The AMA remains st eadfast in our opposit ion to any governmental
interference in the physician pati ent relationship. The Title 10
regulation impeded a physician ’ s ability to talk with their patients
about all legal acceptable alternatives in their healthcare. The North
Dakota laws really requ ired and compelled physicians to give false
misleading informa tion to our patients. We filed suits and amicus
brief regarding the Title 10 gag rule and the North Dakota laws
because again, we remain steadfast in our opposition to any
interference in the patient - physician relationship.

Margaret Flinter : Well, Dr Harri s, I also want to go back to the issue of diversity in
medicine and who is coming into our medical schools and our
residency programs a nd you had referenced that young men of color
be ing less likely to complete their medical education. If I could ask you
t o maybe expand upon that to how we really look at diversity, again,
by geography as well as race and ethnicity, just the tremendous issues
that the rural areas are having in terms of both people who are
growing up in those rural areas entering the health p rofessions. T alk
about this whole issue of diversity and your specific initiatives to
address that .

Dr. Patrice Harris : We ll , certainly the ability to get representatives from communi ties of
color into medical school is an all in proposition. The AMA has a
pipeline program, a doctor ’ s Back to School program, where
physicians go into schools where there are currently under
represented members in medical school. We talk to the young
students, I ’ ve had the wonderful pleasure and privilege of
participating in a couple of those. One of the things I even said about
my presidency is I could be tangible evidence to women to young girls
and young boys from communities of color, that they can aspire to be
a physician and even aspire to be a leader in organized medicin e.

So that ’ s the first part , but certainly we need to start early on and

20190826Harris

make sure that our young students, our young boys are getting the
support and the services they need so that they can succeed in
elementary school, junior high school and high school , so they can
even be prepared to enter undergraduate education and then to go
on to medical school. As one of our programs in our innovation to
train the next generatio n of physicians we have several medical
schools who are working in this area, looking a t pipeline issues. I know
in Atlanta, the Morehouse School of Medicine has multiple pipeline
programs b ecause again, there is no one size fits all approach to this.

Our foundation, the AMA Foundation, which is separate from the
AMA with our philanthropic arm has been giving scholarships to
minorit y medical students for a while. W e know that student debt is a
huge barrier, and especially those who don ’ t have the finan cial
resources to go to undergraduate, let alone to medical school. We ’ re
very proud of the work in that area. The AMA will continue to develop
partnerships in increasing the number of underrepresented groups in
our ranks as physicians .

Mark Mass elli : T he AMA has an eye on innovation. In 2016, you launched H ealth
2047 Inc . , a Silicon Valley base d entity, trying to leverage the
expertise of your members to create entities that can help improve
healthcare delivery and outcomes , I ’ m wondering if you could talk
about some of the projects to emerge from 2047 . Talk to us about the
promise that it may h old for really true disruption.

Dr. Patrice Harris : The AMA believes that it is very important for physicians and the
physician community to be in on th e ground floor of any innovation.
Sometimes products are developed and launched without any
physician in put. It is often the case that particular products don ’ t end
up enhancing physician ’ s ability to take care of our patients, but
actually end up detractin g from that

Mark Masselli : They bri ng more clicks.

Dr. Patrice Harris : Yeah, that ’ s right , death by a 1000 clicks. S o far, we have three
companies that have spun off . The purpose of these compan y is really
to address p hysician pain point s, or areas where we saw a need and
so as one of the companies is about data. Of course, as a psychiatrist,
I know that m y patients want to know that when I exchange data, I do
want to make sure that that data is secu re. We developed a platform
to do that. We ’ re also excited about first mile care and that is really
about increasing the access to the Diabetes Prevention Progr am. That
is an evidence based program developed out of the CDC, where
patients can le arn how to better manage their diabetes and better
manage their risk factors so t hat they don ’ t develop diabetes.

U si ng technology to make sure there is more access to th at programs
that we have first mile care working on that. Most recently, we

20190826Harris

launc hed Zing Health and that is a program for seniors using
technology again to help physicians take better care of our patients,
but also addressing the social determinants of he alth. We know that a
food insecurity and lack of access to transportation impact healthcare .
T he founders of Z ing want to incorporate all of those elements into an
insurance program that addresses those, so that we do improve
health outcomes. We ’ re very ex cited abo ut being in on the ground
floor.

Margaret Flinter : I want to ask you about something that garnered quite a bit of
attention recently and that was the decision by the AMA that it was
withdrawing from a coalition called partner ship for America ’ s Hea lth
Care F uture, which had as part of its tenants b locking medical care f or
all, an idea which anyone who ’ s watched any of the town hall debates
knows has been quite a central feature in many of the discussions
during this presidential campaign. The blogs t hat I read and responses
gave a lot of credit to sort of an activi st voice within the AMA and
then a responsiveness on AMA to that activist voice and but I know
some in your leadership still oppose Medicare for all would prefer to
see the ACA improved upon . What are the strategies to get to
universal coverage. So maybe yo u talk with us about the AMA ’ s
position and your vision really, for the best way forward towards
universal coverage.

Dr. Patrice Harris : The AMA does not support a one size fits all approac h. We do support
improving and expandin g upon the Affordable Care A ct. M illions of
Americans were able to obtain health insurance through the
Affordable Care Act. We believe rather than disrupting the current
system, eliminating coverage options, eliminati ng choice, the AMA
believes that it is the policy of the AMA th at we should build upon the
progress made by the Affordable Care Act, do things like increase the
availability for tax credits, and maybe even enhance tax credits for
younger folks to encourage them to obtain health insurance and
certainly continue to wor k to expand Medicaid in states that at this
po int have not expanded Medicaid. Again , we believe improving upon
the Affordable Care Act is the best path forward.

Mark Masselli : We ’ ve been speakin g today with Dr. Patrice Harris, 1 74th President of
the Am erican Medical Association, and the first African American
woman to hold this position. You can learn more about t heir work by
going to ama.org or you can follow them on Twitter
@ AMERMEDICALASSN or @ Patrice Harris MD. Dr. Harris , m any in the
country a re excited about and will be watching your tenure and for
your vision for improving health care in America. Thank you for joining
us in Conversations on H ealth C are.

Dr. Patrice Harris : Well , thank you ver y much.

Mark Masselli: At Conversations on Health Care we want our audience to be truly in

20190826Harris

the know when it comes to the facts about health care reform and
policy. Lori Robertson is an award winning journalist and managing
editor of FactCheck.org, a nonpart isan, nonprofit consumer advocate
for voters that aim to reduce the level of deception in U.S. politics.
Lori, what have you got for us this week ?

Lori Robertson: I n one of the summer ’ s d emocratic presidential debates, several
candidates glossed over the f act that a Medicare For All plan would
require an increase in federal taxes, but would also eliminate or
reduce health care spending by other payers such as employers and
st
individuals. The link the back and forth in the July 31 debate
concerned how much a Medicare for all proposal would cost in taxes.
O ne side in this argument, Senator Michael Bennett and former Vice
President Joe Biden focused only on the taxes while the other side,
Senator Kamala Harris and New York City Mayor Bill de Blasio focused
on co st in the current health care system. Then it sa id that the plan
that senators Bernie Sanders, Elizabeth Warren and Kamala Harris
have proposed would “ massively raise taxes on the middle cl ass to the
tune of $30 trillion . ”

De Blasio later responded that Be nnett was inaccurate. “ Americans
right now are paying so much money for their health care, ask people
about the reality of premiums, deductibles, co pays , out of pocket
expenses ” De Blasio said . Bennett and Biden then countered that the
plan would cost $30 t rillion or $32 trillion, “ $30 trillion has to
ultimately be paid . ” Harris noted that , “ We are now paying $3 trillion
a y ear for health care in America . ” T otal national health care
expendi tures were $3.5 trillion in 2017 a ccording to the National
Health Expen diture Accounts , we don ’ t know how much Medicare for
all would ultimately cost nor do we know how much Harris ’ s new
health care plan which preserves a role for private insurers would cost.
Many details of these plans are yet to be determined , but t w o
estima tes for Medicare For All , said the fed eral government ’ s cost
would be 32 trillion or 32.6 trillion over 10 years . The government
would have to raise taxes or fees or cut other spending to cover the
cost , but as Bennett and Biden left out, current healthcar e spending
by private insurers, employe rs, individuals and states would be
reduced or eliminated shifting to the federal government. That ’ s my
fact check for this week. I ’ m Lori Robertson, Managing Editor of
F act Check .org

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country ’ s
major political players and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact that you ’ d
like checked, e - mail us at www.chcradio.com , we ’ ll have
FactCheck.org ’ s Lori Robertson check it out for you here on
Conversations on Health Care.

20190826Harris

Mark Masselli: Each week Conversations highlights a bright idea about how to make
wellness a part of our communities and everyday l ives. Currently,
about 2 million p eople around the world are suffering from end stage
renal disease. There are basically two options for these patients
kidney transplants, which are costly and severely lacking in available
donor kidneys or dialysis, also c ostly as well as time consuming,
requiring patients to undergo lead filtering treatments at medical
facilities lasting up to five hours per treatment, costing about $90,000
per year . A Montreal team science project just may pa ve the way for
another solutio n. Anya Pogharian developed a po rtable homeless
dialysis kit that costs about $500 to produce far less than the $30,000
dia lysis machines currently in use. H er idea inspired by her high school
internship working at a dialysis center in Montreal .

Anya Pogha rian : You wouldn ’ t have to make your way to the hospital, which is a
problem for a lot of patients. I mean, it ’ s not necessarily easy to go
three times a week to the hospital, especially if you have maybe
limited mobility.

Mark Masselli: H undreds of hours of research led her to build a prot otype of the
dialysis machine, which is about the size of a typical gameboard, but
pumps and purifies blood just as large scale dialysis machines do. Her
invention has earned her numerous awards and scholarships, and the
attention of one o f Canada ’ s key he matology labs, n ow supporting her
continued research. She hopes this device can be developed
throughout the world, especially Third World countries, where a
significant percentage of the population doesn ’ t have access to either
transplant surgery or dialys is.

Anya Pogharian : 10% of patients living in India and Pakistan who need the treatment
cannot afford it or can ’ t have it in any way , it ’ s not accessible. So
that ’ s really what motivated me to continue .

Mark Masselli: A c heap, portable, easily assembled dialysis machine that could
alleviate the cost and treatment hurdles of ongoing dialysis, keeping
patients healthier longer, allowing them to be treated at home. Now
that ’ s a bright idea.

Mark Masselli: You ’ ve been listenin g to Conversations on Health Care . I ’ m Mark
Masselli.

Margaret Flinter: I ’ m Margaret Flinter.

Mark Masselli: Peace and health.

Margaret Flinter: Conversations on Health Care is recorded at WESU at Wesleyan
University, streaming live at www.chcradio. com , iTunes, or wher e
ever you listen to podcasts. If you have comments, please e - mail us at
[email protected], or find us on Facebook or Twitter. We love
hearing from you. This show is brought to you by the Community

20190826Harris
Heal th Center.