Last year, both the fall and spring semesters lacked their typical week-long breaks, a since reinstated luxury of which students in the Center for Social Concerns’ U.S. Healthcare Policy and Poverty seminar course this semester took full advantage. Their week was spent in the nation’s capital during an immersive trip to Washington, D.C.
The seminar course, led by seniors Aysha Gibson and Colin Stoll, explores the ever-evolving U.S. healthcare system and the effects of its policies on underserved, on-the-margin communities, while emphasizing human dignity and values-based approaches to medical care. Visiting the city where many of these important policies are conceived, debated and executed seems only fitting, and, according to senior and seminar student Caroline Amrol, it was an experience well worth the trip.
“The pre-med program at Notre Dame is great in terms of educating you about science and preparing you for medical school, but they don’t really teach you about the actual healthcare system and how insurance works and everything like that, so I thought this would be a valuable experience to really understand more than how to just treat a patient,” Amrol said.
Like many of her classmates, Amrol is on the pre-health track and was initially drawn to the class for its holistic approach to the study of the healthcare system. The course and the trip aim to use Catholic social teaching as a framework to understand specific principles within the healthcare system, such as preferential options for the poor and care for the common good.
“One seed that we really tried to sew with our seminar team was the importance of being values-based. Even if you don’t subscribe to the language of Catholic social tradition, it's something that can reach across peoples,” Gibson said. “While we do get into the weeds of healthcare policy and premiums and insurance and all of that, we have constant consideration for human dignity and what is not being upheld and how we can honor those that we want to serve as future physicians or leaders in healthcare policy.”
Stoll echoed these sentiments, commenting that “the current healthcare system looks at people as almost numbers in a system in a consumer-based economy. So how do we recognize the dignity of each human person in the system? And how do we recognize the dignity of the people who are left outside of this system as well?”
With half of the course under their belts and loaded with pressing questions, the group ventured to D.C. ready to interact with a wide variety of community leaders, practitioners and policymakers, some of whom were graduates of Notre Dame. “Seeing the wide variety of paths that alumni from Notre Dame have taken and how they each found their own little niche and calling in a different way was really interesting,'' said Stoll. “What one person may be passionate about helps to fuel them and drive them in their work.”
Students had the opportunity to meet with influential policymakers and officials beyond the Notre Dame community, including Martin Schultz, Indiana Congresswoman Jackie Walorski’s legislative director, who focuses on healthcare policy. Students also traveled to Cornerstone, a bipartisan lobbying group with a healthcare focus; Network, a social justice lobbying group led by Catholic sisters; and Children’s National, a D.C. hospital that strives to deal with social and structural determinants of health. With each organization, students discussed various policies and programs, including the Affordable Care Act and its history within the U.S. legal system. The course has considered at length the implementation of the act and the future of its far-reaching effects.
“A big part of our class was learning about the structural inequalities and how that creates health inequalities at a very fundamental level,” Amrol said. During the Children’s National meeting, students and staff members discussed what steps are being taken and what steps need to be taken to address those issues. “One of the people we met with is working to expand asthma treatments to lower-income populations and she was explaining how it’s not just about making sure that people have their inhalers and medical treatments, but also about addressing the underlying problems, such as housing issues where people can’t even get their landlords to fix serious structural issues like mold and other things causing asthma at the basic level,” Amrol added.
On the policy front, Amrol noted that the group learned about the lobbying side of healthcare and how different interests are pushed through Congress and the Senate. “Healthcare is just one of many issues that [Schultz] was in charge of, so that was interesting for a group of students who came in and whose entire focus is healthcare — that’s what all of us want to do — to realize that healthcare is just one of the policies that one person works on.”
In addition to shaking hands with some of D.C.’s best and brightest in healthcare policy, the trip also involved traveling to the borders of the city, where lower-income citizens who are more directly impacted by the policies being discussed and enacted reside. Social Concerns Seminar Assistant Program Director Amber Herkey noted that some of the most important visits are not the ones on the Hill, but rather with people who actually interact with and are touched by this system.
A short metro ride away, Capital Area Food Bank is one of the largest food banks in the area and was the site of a formative, immersive experience for the seminar students. The group assisted with sorting and packaging boxes to be distributed to the community and saw firsthand the stark demographic differences. “The experience provided us with a space to think about health in a more holistic sense — food, security, housing,” said Stoll.
Gibson, Stoll and Amrol each noted that a key takeaway was the community building that occurred among the trip-goers themselves. “It was kind of wild because getting on the train I vaguely knew the names of most people on the trip, so I was basically going to Washington, D.C. with 11 strangers, all who, by the end of the week, turned out to be absolutely amazing,” said Amrol. Each night culminated in a reflection of the day’s events and conversations, an activity that sometimes lasted over an hour due to the group’s collective excitement to talk about the topics. For seminar leaders Gibson and Stoll, this was a huge plus.
With four weeks left of the class, students returned with widened perspectives and a strong basis for further classroom conversations. “A key point to make here is that students go to D.C. and then they come back and we spend four weeks wrestling with these ideas,” Herkey said, emphasizing that there is an opportunity for students to have a direct impact on the Notre Dame and South Bend communities. “Something important to understand is that while immersion learning is an essential feature of this particular seminar, it doesn't exist independent of the grappling that happens right there on campus.”