Readmissions down; deaths up

Posted by on Friday, Sep 22, 2017

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

While U.S. heart failure readmissions fall, deaths rise

By Mitchel L. Zoler
Internal Medicine News, September 20, 2017

U.S. hospitals have recently shown a consistent and disturbing disconnect between reductions in their heart failure hospital readmission rates and heart failure mortality. Readmissions have dropped while mortality has risen.

“Despite reductions in 30-day heart failure readmissions in 89% of U.S. hospitals” during 2009-2016, “30-day heart failure mortality rates increased at 69% of these ‘successful’ hospitals” during the same period,” Ahmad A. Abdul-Aziz, MD, said at the annual scientific meeting of the Heart Failure Society of America.

“The most concerning question we can ask is whether inappropriate discharges from emergency rooms and observation units” is a driving factor behind the mortality rise despite a readmissions drop, said Dr. Abdul-Aziz, a cardiologist at the University of Michigan in Ann Arbor.

These shifts in the outcomes of U.S. patients hospitalized for acute heart failure episodes are tied to the penalties that the Centers for Medicare & Medicaid Services began slapping on hospitals in 2013 for excess 30-day readmissions for heart failure patients and in 2014 for excess mortality. A problem with these two CMS programs is that the penalty on inferior readmissions performance is a lot stiffer than for excess mortality, Dr. Aziz noted: a 0.2% penalty on payments for high mortality, compared with a 3% penalty for excess readmissions, a disparity that can make hospitals focus more on the readmissions side, he suggested.

Dr. Aziz’s report isn’t the first to make this observation. Study results published earlier in 2017 used CMS Medicare data from 2008 to 2014 to show that during that period, heart failure 30-day mortality rates following hospital discharge rose by 1.3%, while 30-day readmissions fell by 2.1% (JAMA. 2017 July 18;318[3]:270-8). On the basis of these numbers, as many as 5,200 additional deaths to U.S. heart failure patients in 2014 “may be related to the Hospital Readmission Reduction Program” of CMS, Gregg C. Fonarow, MD, said during a separate talk at the meeting.

“CMS thinks that policy reform is the way to improve outcomes of patients hospitalized for heart failure. There was no evidence, no results from randomized trials, but they pushed it on the country. And it has reduced readmissions. But there have been unintended consequences of gaming the system, of keeping patients out of the hospital and giving them outpatient status, and these data raise concerns because 30-day mortality went up,” said Dr. Fonarow, professor and cochief of cardiology at the University of California, Los Angeles. “We should all be extremely concerned about the unintended consequences of payment reform strategies” that aim to improve the management of patients with heart failure.…

Supposedly application of policy science provides higher quality care at lower costs, but in the case of heart failure, with no evidence, policy decisions were made to penalize hospitals 3 percent of their payments if their 30-day readmission rates went up, but only 0.2 percent if the patients died. Thus CMS rewards hospitals that follow the dictum, “Don’t readmit them, let them die.”

One of the criticisms of using Medicare as the model for a single payer system is its large centralized bureaucracy. Policy decisions often seem quite distant from decisions that should be made between health care professionals and their patients.

The Canada Health Act is only 14 pages and it would be half that except the text was repeated in French. The Canadian Medicare system is administered on the provincial level rather than through Ottawa. Likewise, in the United States it is recommended that administration be more decentralized – moving it from Washington, DC to greater state or regional control. That is one of the major reasons that we refer to an Improved Medicare for All.

Imagine making a decision for readmitting a patient with heart failure. Wouldn’t it be far better making that decision based on clinical need rather than being based on a penalty system out of Washington? Not that physicians would do such a thing, but then why do the numbers suggest that they do? An obvious solution is to shoo away the policy bureaucrats and simply do what is right for the patient.

Canada Health Act:…

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Single payer ‘concern trolls’

Posted by on Thursday, Sep 21, 2017

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

There are 3 types of single-payer ‘concern trolls’ — and they all want to undermine universal healthcare

By Adam H. Johnson
Los Angeles Times, September 21, 2017

With momentum building for single-payer healthcare among Democratic voters and a growing number of 2020 hopefuls, Sen. Bernie Sanders unveiled a “Medicare for All” bill last week. Immediately, a number of pundits denounced the legislation as an “unrealistic” “bloated” “disaster” full of “magic math.”

Some of the naysayers are conservatives who simply abhor “big government.” Some have perfectly valid reasons to question the merits of single payer in general or Sanders’ methods in particular. Yet others claim they support universal healthcare in theory (one day, perhaps) but cannot do so now because of a “concern.” They are “concern trolls” — broadly defined as “a person who disingenuously expresses concern about an issue with the intention of undermining or derailing genuine discussion.”

The nuance troll: ‘We need more details!’

Less than 24 hours after the bill’s introduction, New York Magazine’s Jonathan Chait lamented that the bill gets America “zero percent” closer to single payer. While saying he agrees with single payer in theory, he insisted that the 155 million Americans who already have healthcare represent an insuperable barrier, and that the issue of how to move them all to a government-run system “is not a detail to be worked out. It is the entire problem.” After all, as he noted, Lyndon Johnson failed and Hillary Clinton failed and Barack Obama failed to undo the private system. So why bother? It’s too hard; everyone go home.

Nuance trolling is argument by way of tautology, an attempt to pass off power-serving defeatism as savvy pragmatism.

Even if Sanders did lay out how a single-payer transition would work in a technical sense, nuance trolls would find other nits to pick. Where would the money come from? How would you manage all the corporations disturbed? There’s always some essential detail that needs solving before Senate Democrats earn the right to support a bold policy.

And if the demand for nuance seems reasonable enough, consider that pundits rarely require it when it comes to military interventions — Chait and others set this issue aside when it came to invading Iraq in 2003, for instance.

The deficit troll: ‘How do you pay for it?’

Of all the water-muddying tactics, this one is the easiest to set aside. As I’ve noted in these pages before, deficit scare-mongering is used, almost exclusively, as a bludgeon to smear progressive policy proposals. When it comes to launching wars or bailing out banks, these fears vanish.

Money for war is magically always there; money for healthcare must be counted bean by bean.

The feasibility troll: ‘What about the GOP?’

Many pundits seem to believe that leftist politicians must preemptively agree internally to some assumed compromise that is “practical” even before attempting to change the conversation, much less the law. Thus feasibility trolls argue that GOP opposition to government-run health insurance renders futile any such proposal.

That’s ahistorical. Maximalist demands aren’t all or nothing, they’re about establishing broad moral goals that people can rally around.

Progressives lose nothing by setting bold targets right out of the gate. Why not make every Republican lawmaker go back to his or her constituents in 2018 and explain opposition to free healthcare? Force the issue, shift the debate, just as the far right has been doing for years.

President Eisenhower — an early practitioner of concern trolling — told the New York Times in 1957 that he supported integration “in principle” but said activists in the South risked going “too far, too fast.” Give it more time. We need more details.

All meaningful changes to society have been met with these types of objections. But the game of politics isn’t won by waiting for the ideal. Its most successful actors establish a moral goal and fight for it until reality catches up to them.

Adam H. Johnson is a media analyst for Fairness and Accuracy in Reporting.…

The concern trolls – nuance trolls, deficit trolls, and feasibility trolls – counter the vast superiority of the single payer model of health care reform with arguments that seem almost trivial (though sounding quite serious) when compared to the extraordinary social benefit that single payer would bring to America.

Why do they do that? What benefit is there in acknowledging that there is a far better alternative for reform, yet rejecting it based on a search for nuances, or based on hypothetical deficits that would not exist in a well designed program, or, even worse, based on supposed lack of political feasibility for a program that continues to grow in popularity?

Homo sapiens is a weird species.

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Shumlin explains what happened in Vermont

Posted by on Wednesday, Sep 20, 2017

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

Shumlin reflects on single payer failure

By Neal P. Goswami
Vermont Press Bureau, September 19, 2017

Former Vermont Gov. Peter Shumlin said money, wary lawmakers and timing were the core challenges that ultimately caused his failure to deliver on a promise to implement a single-payer health care system in the state.

The former Democratic governor reflected on that failure Tuesday at a forum at Harvard’s T.H. Chan School of Public Health. Shumlin ran for governor in 2010 on a platform that promised voters a single-payer system.

But he announced after his 2014 re-election bid that his administration would not be moving forward with the plan. He cited the tremendous cost of the program and the burden that would be placed on the state’s limited tax base.

“When you actually get into the numbers and you describe to your people when you move to a premium-driven system to one that’s supported by taxes, the tax rates in Vermont were quite staggering compared to what other people were paying,” Shumlin said. “When I came out and said, ‘Listen, to move from a premium-driven system to a tax-based system you’re going to have an 11.5 percent payroll tax, you’re going to have to have a top 9.5 percent income tax on top of our current state income tax,’ I don’t think that was even the biggest problem.’”

The bigger problem, Shumlin said, was wary lawmakers who feared yearly tax increases to support the system because of growing health care costs.

“I couldn’t with a straight face turn to them and say, ‘No, we’ve got this figured out. There’s going to be so much cost-containment you won’t have to do that,’” the former governor said.

Another fiscal challenge also loomed large — how to build a big enough reserve for the expensive health care system. Shumlin said his administration determined that it would require all of the state’s bonding capacity for a decade to secure a reserve large enough to support the system. That would have prevented the state from bonding for infrastructure improvements during that time.

The changing political winds in Washington was another factor. Shumlin said the Republican takeover of the House and Senate limited the Obama administration’s ability to work with Vermont.

“The [Health and Human Services] secretary said to me, ‘Listen, we want to work with you, we wanted to work with you, but we don’t have the capacity to cut out special deals for Vermont while we’re up there on the hill trying to defend Obamacare,” Shumlin said.

Shumlin, like other governors, was also reeling from the disastrous rollout of the state’s online insurance exchange.

“There was no amending Obamacare because the Republican Congress refused.

“Those things all came together to deliver the most difficult thing I’ve ever had to do, which is turn to the people that elected me and say, ‘We’ve done the work, we’ve done the research, we know how the system would work. This is not fiscally responsible to do in Vermont right now.’”

Shumlin said he opted against forcing the issue on lawmakers who were likely to kill the proposal.

“I chose not to do that. I just felt that really, this was my idea, I owned it and I needed to own its failure,” he said.

Shumlin said he hopes political leaders will push for a national single-payer system as an economic issue and beyond its long-time status as a “fringe, lefty issue.”

“I was wrong. I don’t think little states like Vermont can go it alone,” he said. “I do think that the Vermont story should be an example of how a little state tried, learned, and the lesson should not be no, it should be Hell yes, let’s get it done and let’s do it right, let’s give this benefit to all Americans.”…


In Pursuit of a Single-Payer Plan: Lessons Learned

By Peter Shumlin, former Governor of Vermont
Harvard T.H. Chan School of Public Health

30 minute video:…

Although the reason often given for Gov. Peter Shumlin’s withdrawal of the single payer legislation for Vermont was that the taxes would be too high, there were other much more important reasons. The taxes would have been largely offset by reductions in health care spending made through the existing channels, so that wasn’t what was holding it back.

An underappreciated but extremely important factor is that Vermont needed the funds that were being used for Medicare, Medicaid and other federal programs. The glib claims that Vermont merely needed to obtain waivers were belied by the reality. The existing waiver programs would not permit Vermont to dump all funds into a single universal risk pool. The Republican Congress certainly was not going to enact the enabling legislation.

Vermont even dropped the single payer label from its legislation since it was clear that they would not be able to enact a bona fide single payer system. As a result, Vermont would not be able to achieve the savings that a single payer system would bring. Further, it could not establish efficient financing measures that would slow the increase in future health care spending to sustainable levels.

Although Shumlin says that little states like Vermont can’t go it alone, it is really not so much Vermont’s size as it is the hurdles built into the existing health care financing infrastructure. This does not mean that states should not move forward with beneficial measures that can provide some transitional relief until we can establish a universal single payer system.

But he does have a clear message for all of us: “I do think that the Vermont story should be an example of how a little state tried, learned, and the lesson should not be no, it should be Hell yes, let’s get it done and let’s do it right, let’s give this benefit to all Americans.”

Yes, let’s give this benefit to all Americans.

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E.J. Dionne’s inadvertent lesson for us

Posted by on Tuesday, Sep 19, 2017

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

The priority is still to save Obamacare

By E.J. Dionne, Jr.
SouthCoastToday, September 16, 2017

Before supporters of universal health coverage get all wrapped up debating a single-payer system, they need to focus on a dire threat to the Affordable Care Act likely to come up for a vote in the Senate before the end of the month.

The latest repeal bill is an offering from Sens. Lindsey Graham, R-S.C., and Bill Cassidy, R-La., that would tear apart the existing system and replace it with a block grant to the states. Block grants — flows of money for broad purposes with few strings attached — are a patented way to evade hard policy choices. All the tough decisions are kicked down to state capitals, usually with too little money to achieve the ends the block grant is supposed to realize.

This is a matter of urgency because the authority the Senate has to pass Obamacare repeal with just 51 votes expires on Sept. 30. So if the bill comes up, it would likely hit the floor in the last week of this month. All who care about the expansion of health care coverage need to focus their energies on defeating this latest attack on Obamacare. However we eventually arrive at universal coverage, which we must, it will be far easier to get there by building on the ACA.

And assuming the latest repeal effort fails, last week’s push for a single-payer system could come to be seen as a useful initiative provided that “Medicare for All,” as its supporters like to call it, is treated as a goal, not a litmus test. Defining the left pole of the health care debate is helpful, in part because it shows how fundamentally moderate Obamacare is. It is not, as many conservatives have claimed, anything close to a socialist scheme.

And for those whose objective is single-payer, there are many options available that could gradually open the way for it. As Medicare for All’s leading advocate, Sen. Bernie Sanders, I-Vt., noted in an underappreciated tweet in July: “In the short-term, to improve the Affordable Care Act, we should have a public option in 50 states and lower the Medicare age to 55.” Many progressives and moderates who favor universal coverage but are not yet sold on single-payer would embrace options of this sort. Such measures would help a lot of people immediately and make any move to single-payer less disruptive.…

This column by E.J. Dionne is important because it represents the current most prevalent view on health care reform, written by an intelligent, highly respected journalist with great credibility and uncompromising ethics. We need to listen to him.

The more immediate issue that Dionne discusses is the cruel Graham/Cassidy proposal that would take health care away from millions of people. Since action on this bill is imminent, he calls for focusing our energies on defeating it. He is right. The bill needs to be defeated.

The larger issue here is that he demonstrates where the progressive/liberal camp is headed on long term reform. He describes single payer Medicare for all as the left pole of the health care debate, showing “how fundamentally moderate Obamacare is” in comparison. He then mentions what we are hearing from a multitude of reform advocates – that “there are many options available.” He then dials in on the dual option that has now become so prevalent in the national reform dialogue: “we should have a public option in 50 states and lower the Medicare age to 55,” even quoting Bernie Sanders as the authoritative source for this concept.

It has been repeated so many times that a Medicare buy-in and a public option will lead to single payer that it has become a meme. Everyone knows it’s true, well… just because it is.

A Medicare buy-in would have almost no resemblance to the existing traditional Medicare program. It is much more likely that private plans similar to Medicare Advantage plans would be modified to fit a new market, though difficulties would remain in risk pool management, reinsurance, benefit design, and other features that would require the support of Congress, much as they are now supporting the Medicare Advantage plans to give them an advantage over the traditional Medicare program.

A public option would have basically the same problems – creating a plan which will be public in name only but structured like private plans, except that it would be stripped of essential features to avoid giving it an “unfair” advantage over competing private plans. In fact, this is what Congress did with the public option that was part of the Affordable Care Act before it was pulled from the legislation because of Joe Lieberman’s tantrum.

If we follow either or both of these routes we will end up not only with inferior plans but also with none of the efficiencies or benefits of a single payer system. That will then be used as “proof” that single payer cannot work in the United States. Any further transition to single payer would be aborted.

But then there will be other ways we can do it. We’ll just have to turn everything over to the private insurers, except for high risk patients whose care we taxpayers will have to fund. Then we will have the hybrid system which our progressive friends are clamoring for.

It doesn’t have to be this way, but it could happen unless we mobilize the masses.

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Carroll, Frakt, Garthwaite, Reinhardt, and Jha help us choose the best health care system

Posted by on Monday, Sep 18, 2017

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

The Best Health Care System in the World: Which One Would You Pick?

By Aaron E. Carroll and Austin Frakt
The New York Times, September 18, 2017

To better understand one of the most heated U.S. policy debates, we created a tournament to judge which of these nations has the best health system: Canada, Britain, Singapore, Germany, Switzerland, France, Australia and the U.S.

“Medicare for all,” or “single-payer,” is becoming a rallying cry for Democrats.

This is often accompanied by calls to match the health care coverage of “the rest of the world.” But this overlooks a crucial fact: The “rest of the world” is not all alike.

The commonality is universal coverage, but wealthy nations have taken varying approaches to it, some relying heavily on the government (as with single-payer); some relying more on private insurers; others in between.

Experts don’t agree on which is best; a lot depends on perspective. But we thought it would be fun to stage a small tournament.

We selected eight countries, representing a range of health care systems, and established a bracket by randomly assigning seeds.

To select the winner of each matchup, we gathered a small judging panel, which includes us:

* Aaron Carroll, a health services researcher and professor of pediatrics at Indiana University School of Medicine

* Austin Frakt, director of the Partnered Evidence-Based Policy Resource Center at the V.A. Boston Healthcare System; associate professor with Boston University’s School of Public Health; and adjunct associate professor with the Harvard T.H. Chan School of Public Health

and three economists and physician experts in health care systems:

* Craig Garthwaite, a health economist with Northwestern University’s Kellogg School of Management

* Uwe Reinhardt, a health economist with Princeton University’s Woodrow Wilson School of Public and International Affairs

* Ashish Jha, a physician with the Harvard T.H. Chan School of Public Health and the director of the Harvard Global Health Institute

So that you can play along at home and make your own picks, we’ll describe each system along with our choices (the experts’ selections will decide who advances).

(Interactive comparisons follow.)


(The conclusion is available at the link but is omitted here for those who wish to make their own choices in the matchups before knowing the final conclusion.)…

Although this is an interesting exercise, it might be more productive to look at these systems from the perspective of the major problems that we have and what features of other systems might ameliorate them.

The uninsured: Make enrollment automatic. A mandate falls short because of compliance problems.

The underinsured: Reduce cost sharing to levels that will not create financial barriers to care.

High costs: Publicly-administered pricing comes closest to getting it right – legitimate costs plus fair margins.

Lack of choice of physicians and hospitals: Do not create artificial panels that serve third party payers at the cost of patient choice.

Impaired access to specialized services: Do not segregate low-income individuals into chronically underfunded welfare programs.

Profound administrative waste: Hundreds of billions of dollars could be recovered with a much more efficient financing system.

Now look again at how the various systems address these issues. Oops. There is not enough information here since the field of health policy is so much more complex than can be boiled down to simple comparisons. But when you add the other features that cannot be included here, you would end up with a single, equitably-financed, publicly-administered program – not an exact duplicate of any of the nations listed. That could be accomplished by improving our Medicare program and expanding it to include everyone.

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Primary care EHR overload worse than many realize

Posted by on Friday, Sep 15, 2017

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations

By Brian G. Arndt, M.D., John W. Beasley, M.D., Michelle D. Watkinson, M.P.H., Jonathan L. Temte, M.D., Ph.D., Wen-Jan Tuan, M.S., M.P.H., Christine A. Sinsky, M.D. and Valerie J. Gilchrist, M.D.
Annals of Family Medicine, September/October 2017

Primary care physicians spend nearly 2 hours on electronic health record (EHR) tasks per hour of direct patient care. Demand for non–face-to-face care, such as communication through a patient portal and administrative tasks, is increasing and contributing to burnout. The goal of this study was to assess time allocated by primary care physicians within the EHR as indicated by EHR user-event log data, both during clinic hours (defined as 8:00 AM to 6:00 PM Monday through Friday) and outside clinic hours.

From the Discussion

This study provides a validated mechanism for EHR task analysis using EHR system event logs to evaluate primary care physician workload. Our event logs indicate that family medicine physicians spend approximately 45% of their workday (4.5 hours) on the EHR. Direct observation data were consistent with this finding. The remaining 55% of the workday (5.5 hours) was spent on non-EHR activities such as direct patient care, team interactions and meetings, paperwork, e-mail, and other work. An additional 1.4 hours per day of EHR time was spent outside of clinic hours (before 8:00 AM or after 6:00 PM), including 51 minutes per weekend. This extra time equates to an average workday (excluding time providing care to patients in the hospital) of 11.4 hours, representing a considerable encroachment on physicians’ personal and family lives.…

This is serious. In this study, not only did primary care primary care physicians spend almost half of their clinic hours on electronic health records (EHRs), outside of clinic hours they spent an average of an additional 7 hours and 51 minutes – the equivalent of an extra workday per week. Does this investment in time provide enough direct patient benefit to warrant it? Of course not.

We would hope that a single payer system would address this problem, but there is risk that the public stewards would rely heavily on EHRs for administrative purposes and for current data-intensive information technology trends.

Hopefully shifting the culture from the business-oriented medical/industrial complex to a patient-service environment, as should occur with implementation of a well-designed single payer system, would cause the stewards to wake up and take a serious look at such wasteful services that induce physician/nurse burnout and patient malcontentment.

Clearly, we cannot allow this to continue.

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Canada’s Danielle Martin explains in a few words the rationale of single payer

Posted by on Thursday, Sep 14, 2017

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

Senator Sanders News Conference on Medicare for All

C-SPAN, September 13, 2017

(Following is a transcript of Dr. Danielle Martin’s comments, but I would highly recommend viewing the C-SPAN video instead – four minutes beginning at 21:00 – link below.)

Sen. Bernie Sanders: Last, but very much not least, is Dr. Danielle Martin. You know, I think that it is high time that we started taking a look at what countries around the world were doing in providing quality care all of their people in a far more cost effective way than we do, and one of examples of a single payer system that is working well, that is popular, is the Canadian system. Dr. Martin is a Canadian physician, health care administrator, and an associate professor at the University of Toronto. She is the author of a Canadian best selling book, “Better Now: Six Big Ideas To Improve Health Care for All Canadians.” Dr. Martin.

Dr. Danielle Martin: Thank you Senator.

I must say that I am very grateful that so many Americans are interested in learning about the experience of your Canadian neighbors under our single payer health care system, which we also call Medicare.

As a practicing doctor, a hospital administrator, and a citizen, I am so proud to be part if a system where access to doctor and hospital services is truly based on need, not ability to pay. And I’m not the only one. In public polls, 94 percent of Canadians say that our health care system is a source of personal and collective pride, even more than ice hockey! Single payer health care is a symbol to us of what it truly means to be Canadian, that we take care of each other.

My grandparents immigrated to Canada in the early 1950s like so many people who come to this country, hoping to build a better life for their kids. And at that time, there was no universal health coverage in Canada. So when my grandfather had his first heart attack in his early 40s, his world was shaken, and by the time he died nearly a decade later, the family was essentially bankrupted by medical bills. I know that this remains a reality for many in the United States today, but you should know that just north of your border, that kind of a situation is essentially unimaginable.

My generation of Canadians does not remember what it was like to worry about paying a doctor or hospital bill. And despite our challenges, which of course every country experiences, Canadians have a longer life expectancy, lower infant mortality rates, and fewer preventable deaths than in the United States.

Single payer health care is also, as you know, less expensive. In Canada, our administrative overhead is less than 2 percent in our public plan as compared to 18 percent in the private plans here in the U.S. We spend just under $5000 per capita in Canada to cover everyone. You spend nearly $10000 per capita and yet tens of millions of people are uninsured. But most importantly, when my patients are sick I do not need to ask if they have insurance or if they can afford to pay for my services. And throughout my pregnancy, and for the birth of my daughter in a world-class hospital, I was never asked for money, and I never received a bill. I just handed over this card – my Canadian health care card – to my doctor, and that was it.

I wish that all of my American neighbors could experience the same simplicity in their moments of need. And I hope that the American people will seize this opportunity to declare to each other and to the rest of the world that you do believe access to health care is a human right.

Thank you.…

Everyone included. Care based on need. Lower costs. No financial barriers to care. Better outcomes. Less administrative hassle. And greater pride than even for their ice hockey teams!

Are Americans all bonkers, that we continue to reject this?

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PNHP welcomes Sen. Sanders’ Medicare-for-all bill

Posted by on Wednesday, Sep 13, 2017

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

Single-payer legislation a major step forward to solving national health crisis

Physicians for a National Health Program, September 13, 2017

Physicians for a National Health Program (PNHP), a nonprofit research and education organization of 21,000 physicians, medical students and health professionals, welcomes Sen. Bernie Sanders’ single-payer bill, The Medicare for All Act of 2017. Replacing America’s fractured, for-profit health system with improved Medicare for all would provide comprehensive care for everyone, help rein in skyrocketing health costs, and deliver better medical outcomes.

“Congressional leaders can no longer sit on the sidelines watching our broken health system cripple the economy,” said Carol Paris, M.D., president of PNHP. “Every year that we do nothing, health care costs swell by another 5.6%. The only way to both control costs and guarantee access to care is to eliminate the administrative waste and profiteering of the insurance industry.”

At $3.2 trillion per year, the U.S. spends nearly twice as much per capita as any other high-income country on health care, but scores poorly on life expectancy, infant and maternal mortality, and access to health services. Despite the improvements of the Affordable Care Act,  28 million Americans remain uninsured, according to the Census Bureau’s estimate released on Tuesday. Researchers estimate that 36,000 Americans die prematurely each year because they lack insurance. Sen. Sanders’ bill would reduce the number of uninsured to zero, allowing everyone to visit the doctor or hospital of their choice for medically-necessary care, including dental, vision and mental health services.

By eliminating the wasteful, profit-driven private insurance industry, a single-payer program would save the nation hundreds of billions annually on paperwork and profits. Physicians, who now spend an average of nine hours each week on administrative tasks like billing, could focus more time on patient care. Not surprisingly, a majority of American doctors now support Medicare for all.

Under Medicare for all, medical bankruptcy would be a thing of the past. Today, the crushing cost of health care is the top financial problem facing U.S. families. Even many of the insured face obstacles to care: More than half of all workers with employer plans face deductibles of $1,000 or more, and more than one-third of U.S. adults report difficulty paying premiums and deductibles. By untangling health care from employment, workers would be free to switch jobs or launch a new business without losing coverage.

Dr. Paris notes that incremental tweaks like subsidizing ACA premiums, or offering Medicare or Medicaid buy-ins, will do little to change long-term health or financial outcomes. “We’ve tried everything else,” said Dr. Paris. “Medicare for all is the only plan that will solve our nation’s growing health care crisis.”

In 2016, PNHP released its Physicians’ Proposal for Single-Payer Health Care Reform, a proposal based on decades of careful analysis and research. PNHP recommends several improvements to the Medicare for All Act that would save money and improve patient care, including global budgeting of hospitals and other health care institutions; the separation of capital and operating payments to hospitals and other health care institutions; full coverage of all medications, without copayment; the exclusion of investor-owned, for-profit health care providers; and the establishment of a national long-term care program.

“PNHP applauds Sen. Sanders and the thousands of grassroots advocates whose tireless advocacy has pushed single payer to the forefront of the national debate on health care,” said Claudia Fegan, M.D., PNHP’s national coordinator. “We look forward to working with Sen. Sanders to strengthen and advocate for this bill.”…

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Pharmaceutical firms are using inflated development costs to gouge us

Posted by on Tuesday, Sep 12, 2017

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

Research and Development Spending to Bring a Single Cancer Drug to Market and Revenues After Approval

By Vinay Prasad, MD; Sham Mailankody, MBBS
JAMA Internal Medicine, September 11, 2017

Key Points

Question: What is the estimated research and development spending for developing a cancer drug?

Findings: In this analysis of US Securities and Exchange Commission filings for 10 cancer drugs, the median cost of developing a single cancer drug was $648.0 million. The median revenue after approval for such a drug was $1658.4 million.

Meaning: These results provide a transparent estimate of research and development spending on cancer drugs and show that the revenue since approval is substantially higher than the preapproval research and development spending.

From the Introduction

The cost of anticancer drugs continues to increase, with drugs routinely priced more than $100, 000 per year of treatment and some nearing the $200, 000 per year threshold. High drug prices have negative effects on patients and society, and groups of physicians, patients, and policymakers have voiced their opposition to these prices. However, one persistent argument in justification of high drug prices is the sizable outlay made by biopharmaceutical firms to develop new drugs. In a widely publicized analysis from the Tufts Center for the Study of Drug Development, the authors estimate $2.7 billion (inflation adjusted for 2017 US dollars) is needed to bring a single drug to the US market. This figure is more than 8 times higher than the $320.0 million (inflation adjusted for 2017 US dollars) estimate to develop one drug reached by the group Public Citizen. Given such divergent estimates, closer examination is warranted.

We focused on publicly traded pharmaceutical companies with only one US Food and Drug Administration (FDA)–approved drug. We used SEC filings from the approximate time of discovery or initial acquisition of the compound to drug approval to estimate the cost to bring one drug to market. Because, in all instances, these companies were simultaneously developing several compounds, our analysis considers the cost of failure (ie, we include R&D costs for each company’s entire portfolio of drugs, of which only one drug was ultimately approved).


Prior estimates for the cost to develop one new drug span from $320.0 million to $2.7 billion. We analyzed R&D spending for pharmaceutical companies that successfully pursued their first drug approval and estimate that it costs $648.0 million to bring a drug to market. In a short period, development cost is more than recouped, and some companies boast more than a 10-fold higher revenue than R&D spending—a sum not seen in other sectors of the economy. Future work regarding the cost of cancer drugs may be facilitated by more, not less, transparency in the biopharmaceutical industry.…

This study confirms that the pharmaceutical firms are using inflated costs of bringing a product to market in order to gouge us. This cries out for government intervention. A well designed single payer system would fix this while addressing a great many of the other problems with our dysfunctional system of financing health care that results in us paying too much for too little.

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Elizabeth Warren: Success is coming from grassroots efforts

Posted by on Monday, Sep 11, 2017

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

Warren dismisses Dem divisions as lawmakers rally around single-payer

By John Bowden
The Hill, September 9, 2017

Massachusetts Sen. Elizabeth Warren (D) dismissed conflict inside the Democratic Party on Friday in a new interview, noting that Democrats are rallying around health care and other issues.

Warren told the editorial board of The Republican on Friday that the Democratic Party has found agreement on the idea that health care should be a guaranteed right for all citizens.

She added that the true strength of the Democratic Party doesn’t come from the party elites, but rather the grassroots activists who shifted the party left on health care.

“We don’t live in a world where a handful of insiders get to run the Democratic Party — we just don’t live in that world,” Warren insisted. “We live in a world where the heart and soul of the Democratic Party is down at the grassroots — this health care fight has shown the power of the grassroots.

“It’s not only that people have shown it to themselves and to each other, they’ve shown it to the leadership, as well,” she added.

Warren on Thursday announced she would join Sens. Kamala Harris (D-Calif.) and Sheldon Whitehouse (D-R.I.) in co-sponsoring legislation from Sen. Bernie Sanders (I-Vt) establishing a single-payer Medicare-for-all health care system.

“I believe it’s time to take a step back and ask: what is the best way to deliver high quality, low-cost health care to all Americans?” Warren said in a statement Thursday.

“Everything should be on the table — and that’s why I’m co-sponsoring Bernie Sanders’ Medicare for All bill that will be introduced later this month.”…

For our purposes, Sen. Elizabeth Warren’s message is not what is happening within the Democratic Party but rather that the recent surge in support for single-payer Medicare for all has originated within the grassroots and not from the political elites.

Yes, the lead taken by Sen. Bernie Sanders certainly has helped to spark the movement. But it is not Bernie Sanders alone who is bringing other politicians on board. When those politicians went to their home districts, it was the demand of the people that woke them up. “Hey, this single payer movement is the real thing.”

The people lead, politicians follow, and that is not a phenomenon limited to the Democratic Party. So gather the grassroots together and lead. Be there, bring others, and do it.

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