Candidates for elected city offices were all asked the same questions by the Bexar County Medical Society and have submitted answers to those questions as shown below.
This information is provided as a service from the Bexar County Medical Society, but is not an endorsement.
BCMS does not make endorsements of any candidates for office nor of elected officials.
This information is provided as a service from the Bexar County Medical Society, but is not an endorsement.
BCMS does not make endorsements of any candidates for office nor of elected officials.
David Cohen
City Council District 9
2017 Mayoral/City Council Candidates
Health Care Questions
1.
Despite affecting everyone in this community, "community
health and wellness" has not been a big priority at City Hall.
"Community health and wellness" had one third of the ranking that
"streets" received in community input via SpeakUPSanAntonio. Yet it
impacts our well-being, workforce, economic development and the prosperity of
San Antonio.
What
health-related areas do you think deserve increased attention, priority, and
local resources, and, if elected, how would you elevate the discussion of
these health issues at City Hall and lead effective action to improve health
and healthcare in our community?
I consider “safety” as the number one obligation of City
Government. Safety includes not only
police, fire and EMS but Public Health.
Metro Health has been critically underfunded. Despite the current risk of vector borne
diseases such as Zika, Dengue, Chagas and Chikungunya, Metro Health has had
only one or two personnel credentialed to spray and control mosquitos and other
vectors. Metro Health has gone without a
Director for two years and only just appointed a new one. Metro Health and/or Bexar County Hospital
District have programs which need to be expanded for mosquito control,
pre-natal and post-natal well baby care, and immunizations. As Medicaid has decreased, I believe we need
to expand low cost community health clinics and increase eligibility for
CareLink and other similar programs. San
Antonio has a disproportionally high rate of diabetes and obesity which lead to
large populations with cardiac, renal, wound care and other issues. Lack of good outpatient care for our indigent
population costs the community greatly in the necessity to provide inpatient
care because of neglect. I plan to work
with our new Head of the Metropolitan Health District, Dr. Colleen Bridger to advocate
for these and other programs and to use the bully pulpit of city government to
encourage the Bexar County Hospital District and other agencies to expand
community access to low cost outpatient care.
A healthy San Antonio including our indigent population improves the
health of residents in all City Council Districts. I plan to not only represent the interests
of District 9 but work for programs which are beneficial to all residents of
San Antonio.
2. Bexar County is the
primary source of funding for indigent health care in our area through the
Bexar County Hospital District and University Health System. How would you, if
elected, promote cooperative efforts to increase services and access to care
for the citizens of San Antonio?
I have alluded to this in the answer to the first
question. The Bexar County Hospital
District (BCHD) which is a separate taxing entity is controlled by a board
appointed by the county government.
Although most of Bexar County is the City of San Antonio, the city government
has little sway over the BCHD. As a
physician on the City Council, however, I can use the bully pulpit of city
government to work with BCHD and advocate for increased funding for indigent
patients and improved access to outpatient care. As a physician in practice in San Antonio, I
find it extremely difficult to get indigent patients of mine into Care Link or
admitted to University Hospital because of the extremely low income ceiling
restricting this care to only the most desperately indigent patients. I would work with not only BCHD but our other
hospitals to advocate for expanded indigent care and seek ways for the city to
stimulate these programs.
3.
The disparity of health care between our poorest and wealthiest zip
codes/districts is quite striking (Bexar County Health Collaborative 2016
report). How would you, if elected, reduce health disparities and improve
health outcomes for our lower income communities/citizens?
As a physician, I see this disparity every day. We have a world class University Hospital and
Medical School, great cancer and cardiac care and marvelous hospitals which are
available to our insured and more affluent population. Because of EMTALA rules our indigent patients
can access this care but only in an emergency setting which is often late for
the patient and costly for the hospitals and community at large. The answer as noted above is to develop lower
cost outpatient programs so that our indigent population can access care earlier
and in a more cost-effective setting.
With a medical school and a new Osteopathic School, we should be able to
staff community outpatient clinics using faculty and students of these schools
to provide better care for our patients and good teaching opportunities. I will look for ways to fund such
programs. “Safety” includes public
health and public health should include community health.
4.
San Antonio has a high incidence of obesity and diabetes mellitus and has been
ranked as high as second in the nation for obesity in recent years. Past city
efforts attempting to improve these rates, such as trying to reduce the
prevalence of sugary drinks in our community, have been met with controversy.
What ideas do you have to reduce the incidence of these chronic health issues?
Obesity and resulting Diabetes is a tough problem. If I can solve this problem, I would like you
to nominate me to be the Surgeon General.
We try though education and public information to encourage good eating
habits, exercise, avoidance of sugary drinks, lard in our tortillas and high
calorie foods. Education and
encouragement only works if the patient wants to follow the advice. Unfortunately, that is not always the
case. We live in a free society and I do
not advocate the coercive programs adopted in New York City and elsewhere to
put high taxes on sugary drinks and ban large cups. I also think that extremely high taxes on
cigarettes so that they cost $17 a pack or so are counterproductive because
they result in an illegal black market.
In a free society, people have a right to make bad choices. We must continue education and encouragement
by continuing to require restaurants and food packaging to display calories and
other nutritional information as well as public service announcements with
nutritional and lifestyle information.
As a community, we must continue to provide good parks, bike trails and
recreational facilities to make it fun and safe to get out of the house and
exercise. We must also accept the fact
that there is a population that will be resistant to all of these efforts, yet
as a city and as physicians we still need to provide them care.
5. According to the CDC, child abuse and
neglect are serious problems that can have lasting harmful effects on its
victims. The goal in preventing child abuse and neglect is clear — to stop this
violence from happening in the first place. What local policies,
resources and efforts will you support to promote safe, stable, nurturing
relationships and environments for all children and families?
Child abuse is a terrible problem. It seems to be increasing in our community
although it is difficult to tell if it is more prevalent or if this problem was
just better hidden and less obvious in the past. There are many victims in these families
including the child but also the abusive parent or parents and enablers who do
not help. The break-up of the nuclear
family as well as the extended family plays a major role in child abuse. The abuser often, but not necessarily has
substance abuse or other mental health issues.
Protection of the child is of paramount importance. Mental health, substance abuse treatment and
family counseling, if successful, can rehabilitate the home environment, which
may be better for the child than being taken away from the family and raised in
a foster care or other setting. Child
protective services is a critical community resource and we need to fund and
staff it so that counselors have appropriate caseloads to carefully monitor and
protect their patients. The city
government needs to support and fund family courts and police units which
intervene in family disturbances. These
are particularly dangerous police assignments but they are necessary to protect
our children as well as our Child Protective Service personnel. Ensuring the protection of our next
generation of San Antonians is a critical mission of city government.
