Fox News Poll, April 13-15, 2014
14. I’m going to read a list of potential candidates for the 2016 Democratic nomination. Please tell me which one you would like to see as the Democratic presidential nominee.

69%  Hillary Clinton

14%  Joe Biden

6%  Elizabeth Warren

2%  Andrew Cuomo

1%  Martin O’Malley

–   (Other)

4%  (None of the above)

3%  (Don’t know)

15. I’m going to read a list of potential candidates for the 2016 Republican nomination. Please tell me which one you would like to see as the Republican presidential nominee.

15%  Chris Christie

14%  Jeb Bush

14%  Rand Paul

9%  Paul Ryan

8%  Marco Rubio

7%  Ted Cruz

5%  Scott Walker

5%  Rick Santorum

5%  Rick Perry

2%  Bobby Jindal

1%  (Other)

6%  (None of the above)

9%  (Don’t know)…


Clinton urges move away from fee-for-service payment model; says current system is not serving physicians, or patients, well

California Medical Association, April 21, 2014

Former Secretary of State Hillary Rodham Clinton addressed 700 physicians, practice managers, medical students and others at the Western Health Care Leadership Academy in San Diego. Delivering the keynote address live via satellite, Secretary Clinton urged the California Medical Association to work with other like-minded organizations to help advance meaningful health care delivery and payment reform, instead of continuing to “rejigger” a broken system.

“At some point, we have to move away from fee for service payment for medical care,” said Secretary Clinton. “It is not serving physicians well, or any other health care providers, and I don’t believe it’s serving patients well.”

Secretary Clinton told attendees that she shares physicians’ frustration with Congress’s inability to make any progress on fixing the current broken payment system. She said she would like to see more systemic reform so that physicians are fully reimbursed for everything that goes into the care of patients. “It is deeply bothersome to me that it is still not accepted that a lot of what constitutes wellness—things that a physician can be promoting with his or her patients—should be reimbursed by Medicare,” Clinton said. “When a physician sits down with a patient and says ‘I’m going to give you a nutrition regimen. I’m going to have my nurse or my PA check in on you to make sure that you’re walking every day.’ These are all things that would keep that patient out of the operating room for a bypass or a stent or some other expensive intervention.”

“We’re never going to resolve the injustice, the unpredictability, the unfairness that unfortunately permeates the current system,” she said. “We need to move away from this very narrow approach to reimbursing physicians.”

“At some point, I hope we’re going to be able to take a look at the broad base of funding streams, both public and private, that go into funding health care–particularly physicians’ pay—and look more at who the patient is and what the doctor is providing that patient, instead of what the program is and how we can keep trying to put square pegs in a round hole.”

Secretary Clinton also held up California’s implementation of the Affordable Care Act as a model for the nation. “We’re going to be watching closely what happens in California. Seeing what works, and what doesn’t. States like California, intent on covering more citizens and fostering bold experimentation to improve outcomes and reduce costs, will not only lead the way, but help everyone else find the way.”

Secretary Clinton also urged all stakeholders to work together to keep pushing for improvements to the health care system. “The transparency called for under the Affordable Care act is going to reveal a lot of information. Some of it may be surprising. And some of it may even be quite troubling,” said Clinton. “But for the first time, we’re going to see information. And everyone will be able to look at the same information. We can then try and figure out ‘Is there a problem that needs to be fixed?’”

The data collected under the Affordable Care act will, according to Clinton, will allow us to ask questions that will give us much better insight into how we can move towards a more efficient, quality driven health care system.

“I think this is a great opportunity, if we do it with that kind of open attitude of ‘let’s learn what works, let’s make this better.’ Let’s hear from physicians and nurses and pharmacists, you name it. Everyone come to the table. What do you think needs to be changed?”


Position Statement on the Affordable Care Act (ACA)

PNHP California, April 9, 2014


Recognizing that we share core principles with those who worked hard to implement the ACA, including the desire for a healthcare system that is truly universal, affordable and provides comprehensive benefits with one standard of high quality care, we resolve to:

• Build bridges to ACA supporters to forge strong alliances for continued reform.

• Work with our partners towards the successful implementation of ACA and to find solutions for the 3-4 million Californians who are still left out of the system, including the undocumented.

• Support efforts to provide healthcare as a basic human right rather than a commodity available only to those who can afford it.…

Considering the difficulty that President Obama has experienced in passing and then implementing the Affordable Care Act (ACA), it is clear that he is in no position to advocate for single payer reform before he leaves office. Thus it seems reasonable to consider the prospects of enacting single payer reform during the term of our next president. What are the prospects?

As people gain more experience with the ACA reforms, it is likely that many will be disappointed. The marketplace (exchange) plans that most people are selecting have relatively low actuarial values with high deductibles, thus many will experience financial hardship should they have significant health care needs. Also many will be disappointed with the narrow provider networks which will often prevent patients from having their choice of physicians and hospitals. Since employers are now adopting some of these same insurance innovations, many who previously were satisfied with their employer-sponsored coverage may also become much less content with their coverage.

It is thought that, by 2017, enough people will have become dissatisfied with our high-cost, administratively inefficient, dysfunctional system that many of them will be ready for an improved Medicare for all. That happens to be the year that our next president will take office. Will we have a president who is willing to support a vastly superior alternative – a single payer national health program?

Obviously we cannot predict the results of a presidential election this far in advance, but we can take a look at the political climate – a climate which is unlikely to change dramatically in the next few years.

Looking at the Fox poll and other recent polls, the clear front runner is Hillary Clinton. Although it is possible that the Republican Party could rally around a candidate that would be a serious challenge to Clinton, currently she outpolls each of the Republicans under consideration.

Suppose Hillary Clinton were elected president, what could single payer advocates expect? The report on her speech to physicians in California is reproduced above in its entirety, mainly to show what was left out of her message. There is certainly no mention of single payer nor expanding Medicare. She does mention moving away from fee-for-service payments, and expanding payments for “wellness-things,” while holding up California’s implementation of ACA as a “model for the nation.” She also touted information transparency. In her last run for the presidential nomination she had displaced her previous failed proposal with the current ACA model. Based on her comments, it is highly likely that her efforts at reform would be limited refinement of the ACA model, if she can get past the crippling partisan divide in Congress.

Should a Republican be elected, it is likely that efforts would be directed to replacing some elements of ACA with policies supporting less regulation of insurance products, limitation of mandates, and ability of individuals to purchase insurance products in less regulated states. No serious potential Republican candidate supports single payer.

So, no single payer will be coming from the top. Then what can we do? We should intensify our efforts to educate the public at large – so they understand why ACA does not seem to be working well for them, while showing them how single payer is precisely the model we need. We need to create a critical threshold of support coming from the general public. If the demand is intense enough, the politicians will follow.

But a caveat. The single payer message must be loud and clear. People must understand that the ACA model is fundamentally flawed and must be superseded by a single payer system. Many single payer supporters abandoned the cause and chose to support the “progressive” alternative – Obamacare. They continue to be involved in the implementation of this highly flawed model (better than nothing but still highly flawed). Fortunately, there are still organizations, such as PNHP, that are not willing to compromise and dilute the single payer message. Doing so would merely continue us down the incremental path of reform, when there are no incremental steps that bridge the gap between a fragmented system of private and public payers and a single payer system.

PNHP California has adopted a position statement calling for “work(ing) with our partners towards the successful implementation of ACA.” Most of the progressive community is already engaged in supporting ACA, and they really do not need more help. Muddling the message of the single payer purists that remain can only perpetuate inertia in the single payer movement. Some sincerely believe that helping the ACA supporters will result in reciprocal support for our efforts on single payer. Really? They are going to help us disassemble a system that they worked so hard on to build?

Let’s not adulterate our single payer message.