Friday, April 21, 2017

CD 9 David Cohen

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. 

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.