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This episode is sponsored by Athelas, the number one provider of remote patient monitoring.
“Instead of trying to earn a spot on a talk show to help a person dealing with costly treatments for illness, perhaps it is best to lobby policymakers to pass legislation that impacts big numbers of patients dealing with the high costs of treatment, ultimately including that person. Perhaps encouraging businesses, institutions, and organizations to allot funds for health care programs is a more salient idea.
Talk shows end. The need to close the gap in medical funding does not.”
Amanda LaMonica-Weier is a nurse practitioner.
She shares her story and discusses her KevinMD article, “Fund this: Policies can fill medical funding gaps for all.”
Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.
This episode is sponsored by Athelas, the number one provider of remote patient monitoring.
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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.
Transcript
Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Amanda LaMonica-Weier. She is a nurse practitioner, and she wrote the KevinMD article “Fund this: Policies can fill medical funding gaps for all.” Amanda, welcome to the show.
Amanda LaMonica-Weier: Thank you for having me. I’m happy to be here.
Kevin Pho: We’ll get into your article a little bit, but first off, can you share your story and journey to where you are today?
Amanda LaMonica-Weier: Yes. I would say my journey into nursing was a little unconventional, non-traditional. I started out in undergrad studying Spanish and political science, so I got a liberal arts degree, just exploring my many interests that mostly had to do with people and solving problems. I would say that was the core of it. After that, I went and taught abroad in Spain, so I worked on my Spanish a little bit, and then I came back and ended up teaching secondary school within Chicago Public Schools. I taught high school for several years and got a master’s in teaching during that time, and I did that through Teach For America.
After that, I knew I’d had this inkling to go into health care for a very long time, even in undergrad; I just didn’t know quite what that looked like. So I went into a general master’s program at Rush University that is for career-changing people who are going into nursing. I worked at the bedside on a medical-surgical floor, mostly focusing on transplant patients, and then I also worked in a clinical research setting. Then I combined my two major professions and began teaching at Rush University, within the program that I had actually gone through. During that time, I also went back to school to get my doctorate in nursing practice, and now I’m a family nurse practitioner, combining all of those passions.
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Kevin Pho: So tell me about your background in teaching. How does that influence you as a clinician today?
Amanda LaMonica-Weier: It definitely comes in when you’re teaching patients and all that. But I think when I worked in teaching, it was more than just the delivery of content. It’s what you’re teaching, but also the barriers to teaching. I think that there are barriers within health care, and in trying to help people along in their journey, even when you have the same goals, and so it’s about recognizing that. The goals in teaching are to deliver content and have someone master an objective, and the goals in health care are to help people achieve their health goals. So it’s the same, but there are challenges in getting there, and a lot of those challenges are the same: a lot of social determinants of health issues that complicate what is maybe a seemingly simple goal.
Kevin Pho: All right, let’s transition into the KevinMD article that you wrote. It’s titled “Fund this: Policies can fill medical funding gaps for all.” Now, for those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?
Amanda LaMonica-Weier: Yes. One of the things I’ve been intrigued by, especially having studied different systems around the world, is the U.S. approach to health care, and how we often have a lot of people who sometimes get a diagnosis that takes them out financially as well, and just why that happens here a little bit more than in the rest of the world, especially compared to other countries that have the same economic status. So I went into this interesting phenomenon that we have in the U.S., where we have crowdsourcing and funding for health care. We see it on popular talk shows, we see it on GoFundMe, and I think at the core, sometimes the American reaction is that this is charitable and this is a good thing. However, in many countries, this isn’t even needed. My opinion would be that your popularity shouldn’t determine how much you can pay on your health care bills.
One particular personal story that happened to me is that my cousin was diagnosed with several rare conditions, and although he had insurance and his parents were working, it really has taken a financial toll. So we did a lot of the things that people are forced to do, as in have fundraisers. I applied to different talk shows, and people did raise money. I did not get on any talk shows, but the gaps remained. So really, my article looked into that and why those gaps exist. It’s interesting, because even websites like GoFundMe, which claims to be the number one medical fundraiser, the CEO has spoken out about this and said that he doesn’t wish this to be the case. He would like legislation to cover these costs, so that this is not a need. So my article goes into that and highlights some specific examples.
Kevin Pho: Give us a sense of how common these GoFundMes are for medical bills. Certainly I sometimes see it on talk shows, and there are some highlighted cases in mainstream media, but in general, how common are these medical bill GoFundMes?
Amanda LaMonica-Weier: Well, they’re the number one type. There are different subtypes of GoFundMe, and there are currently 250,000 on GoFundMe just for medical care, and they’ve raised $650 million. So it’s just a very interesting way to raise money for health care. If you think about it, it wouldn’t be tax deductible for the people who donate, and then it goes directly to the individual. Many people do use them appropriately, but there have been cases of fraud. So again, it’s not against the people who are using an outlet that they have been forced into. It’s just saying, if we’re going to spend this much money, is there a place we could spend it where it could go further and be a little more equitable?
Kevin Pho: Now, in general, how successful are GoFundMes in terms of raising money for medical bills? Certainly you hear a lot about the success stories, but for every success story, is there a number of unsuccessful GoFundMes?
Amanda LaMonica-Weier: I wouldn’t have those stats, but to your point, if you think about crowdsourcing, many times there are those rare cases where something goes viral and you have people who donate to you who don’t know you. But often you’re going to your own crowd, right? So if you have somebody who is maybe a little bit more economically disadvantaged, typically their network might also reflect that. If you think about that, you’re separating them even more: The people who have that network and resources get a little bit more of that, and the people who don’t are, yes, faced with a higher bill. But those would be interesting stats to drill down on, for sure.
Kevin Pho: So you mentioned that GoFundMe is a uniquely American phenomenon, especially when you compare health care systems to other countries. Comment on that. Why do you think we need GoFundMes in America? And talk about some of the solutions that you would propose.
Amanda LaMonica-Weier: A report that looked at some of the 10 highest countries per GDP found that the U.S. had the highest health care spending, but also the highest spending in the private sector. The other countries had less spending, and they did not have this huge (there’s a really helpful graph that breaks it down), it was about $4,000, when the other countries were maybe at $1,000, so four times as much. So I would really propose more legislative action. If you look at different organizations, even if you go to the American Cancer Society and all that, instead of highlighting specific cases, they are really highlighting legislation and getting legislation that can cover the most people.
Then, reflecting on that report as well, when it looked at health outcomes, the U.S. did not reflect the spending that it had done. It ranked last in life expectancy, and it ranked highest in chronic diseases. So what we’re spending is not reflected in our outcomes.
Kevin Pho: We’ve been talking about reforming the health care system for what seems like decades now, right? And there are many, many solutions out there. So short of a federal solution to our health care system in terms of decreasing medical bills, is there anything an individual can do, short of GoFundMes? Anything from an individual standpoint that can help guard against these large, unexpected medical bills?
Amanda LaMonica-Weier: Unfortunately, I think the federal solution is likely the most, and we’re seeing people reach out to it. There have been tons of articles about more and more people signing up for the ACA, the Affordable Care Act. Most recently, two million people; it has grown exponentially. Two million people this year; it has grown by a lot. So the need is there, and people are responding to that as a choice.
But as an individual, you can make differences at the federal level. You can get involved in local government and have your voice heard. I would say strengthen your voice through other organizations. Again, if something’s important to you, like cancer and cancer research, find these other organizations that have lobbyists and make donations to them. So it’s really you as an individual, but you’re strengthening your voice through organizations, and then you’re strengthening who’s speaking on behalf of you. So it’s not just your legislator, because if you vote and maybe your person doesn’t win and you feel defeated, there are other groups, special interest groups, that are going and speaking on your behalf. So you’re making that dollar count, again, in a more equitable way that would last longer than a one-time donation to an individual. And I’m not knocking that, so maybe do both in the meantime.
Kevin Pho: So as we wait for a potential federal solution, where do you see the future of crowdfunding health care bills? Where do you see that leading?
Amanda LaMonica-Weier: Unfortunately, I think it’s here to stay. I think that many of the aspects of crowdsourced funding are very American. It’s individualistic. Maybe for some people who don’t like government involvement, that’s how they feel; it’s like a separation. I would just encourage people to look again at your question of how much it covers. To the question of my cousin, even, right? We got a significant amount of funds, but it didn’t end up covering it, so the need was still there, even though the fundraiser was, quote, successful. So I would encourage people to continue following, over the longer term, something that they donated to: what happened to that person, and how many more are there that were answered? I would just try to encourage a mind shift first, because I think crowdsourcing makes sense when you look at American culture as a whole.
Kevin Pho: So from your experience with crowdsourcing, from the perspective of a patient who needs those funds, are there any tips that you can give, any lessons that you learned from going through that experience with your cousin?
Amanda LaMonica-Weier: I wouldn’t discourage someone if that’s what they wanted to do. That’s perfectly their right, and it is a system that we live in, as you said, in the meantime. But I would encourage reaching out and, I think, as a clinician, knowing the resources that you have in different areas. For example, I’m based in Chicago, and Cook County has different programs. So really familiarize yourself with the programs that are available. Again, that’s not a federal solution; that’s even a county solution, what’s available to you in your area. And do the research ahead of time, so that when you do have a patient who maybe has a gap in funding, there are things that you can offer based on whatever requirements they are meeting, whether it’s where they live or their age. Sometimes there’s different legislation that covers children. Think proactively about how you can be an advocate in that area with the resources that already exist.
Kevin Pho: We’re talking to Amanda LaMonica-Weier. She is a nurse practitioner, and she wrote the KevinMD article “Fund this: Policies can fill medical funding gaps for all.” Amanda, what are some of your take-home messages that you want to leave with the KevinMD audience?
Amanda LaMonica-Weier: My take-home messages would be that the most powerful way to impact individuals is through legislation. It impacts people through an equitable lens, where everyone can be covered, and it wouldn’t be based on crowdsourcing, where it would matter how sad your story is and that your story needs to be more compelling than the next person’s. Because when we think about people, everyone has value, and when someone is facing a health crisis, they should be focused on the health crisis and not the funding for it.
Kevin Pho: Amanda, thank you so much for sharing your time and insight, and thanks again for being on the show.
Amanda LaMonica-Weier: Thank you. I appreciate it.
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