PNHP

People are dying. Virginia’s vote on April 21 can help change that.

People are dying. Virginia’s vote on April 21 can help change that.

By Bruce A. Silverman, M.D.
Richmond (Va.) Times-Dispatch, April 2, 2026

I have looked into the eyes of patients who skipped their insulin because they could not afford it. I have watched otherwise preventable cancers progress because someone had no insurance and no way to get a screening. I do this work as a volunteer physician at Goochland County’s free clinic — and I need you to understand something: what happens at the ballot box on April 21 will show up in my exam room.

Vote yes on the redistricting referendum. Here is why:

The science is unambiguous: Lack of coverage kills

This is not a political talking point. It is peer-reviewed medicine.

Researchers at Yale University’s School of Public Health estimate that a Medicare-for-All system could prevent 68,000 unnecessary deaths per year simply by guaranteeing coverage to everyone. That figure, published in The Lancet, does not even count lives lost among the underinsured — people who technically have coverage but skip care because they cannot afford the copays and deductibles.

Now those same Yale researchers have turned their models on the One Big Beautiful Bill — the legislation Congress recently enacted. Their Big Beautiful Bill — the legislation Congress recently enacted. Theirconclusion is staggering: more than 51,000 preventable deaths could occur annually because of its Medicaid cuts and ACA coverage rollbacks. The Yale team projects that Medicaid cuts alone would cause over 20,000 additional deaths per year, climbing above 51,000 when ACA coverage losses and the repeal of nursing home staffing requirements are factored in. That is more Americans than die each year in car accidents.

And it is about to get worse. Roughly one in 10 people who had ACA marketplace coverage last year are now uninsured — because theenhanced premium subsidies that made coverage affordable for millions expired on Dec. 31, and Congress let them die. Virginia insurers have requested premium increases of 20% or higher for 2026, citing the elimination of enhanced subsidies as the primary driver. In Virginia alone, an estimated 47,000 residents are projected to remain uninsured because they simply cannot afford coverage without those subsidies.

As a physician, I know what that means clinically. Uninsured patients don’t vanish. They delay. They deteriorate. They arrive in emergency rooms with conditions that were entirely manageable six months earlier — and they arrive sicker, more expensive to treat, and sometimes too late.

So, what does this have to do with redistricting?

Right now, Republican-controlled legislatures in Texas, Florida, North Carolina and Missouri are redrawing congressional maps mid-decade — not because a census demanded it, but to lock in a congressional majority before you vote this November. The Congress that results from those maps will control Medicaid funding, ACA subsidy restoration, rural hospital reimbursement rates and prescription drug policy for years to come.

Virginia’s referendum is different in every important way. It puts the decision directly to voters — not legislators in a backroom. And it is explicitly temporary: after the 2030 Census, our bipartisan redistricting commission resumes full authority. This is not abandoning the principle of fair maps. It is defending it under fire.

As legislative chair of the Virginia Chapter of Physicians for a National As legislative chair of the Virginia Chapter of Physicians for a NationalHealth Program, I track federal health policy the way I track a patient’s vital signs — because it is one. The 51,000 deaths Yale projects annually from the OBBB are not an abstraction. They are patients. They are your neighbors. Many of them are mine.

What free clinics know that Congress doesn’t

Our free clinic drove over 35,000 miles in a single year just to get our patients to their appointments — because they have no other way to get there. We provide medical, dental and mental health care, all free of charge, because the system failed these patients and someone must catch them.

But free clinics were never designed to replace a functioning system. We are the net beneath the trapeze. And right now, the trapeze artists are being told to let go with no net in sight.

When Medicaid contracts and ACA subsidies lapse, the uninsured surge into clinics like ours — already strained, already underfunded. When uncompensated care overwhelms hospitals, those costs get shifted to private insurers, driving up premiums for people who do have coverage. There is no version of this crisis that is good for anyone.

The bottom line

I took an oath to do no harm. Staying silent while democracy is manipulated and my patients lose their health coverage — and their lives — would be a harm I am not willing to accept.

Yale’s researchers have given us the number: 51,000 deaths per year — every year. That is the human cost of the policy path we are currently Yale’s researchers have given us the number: 51,000 deaths per year — every year. That is the human cost of the policy path we are currentlyon. Virginia has a chance on April 21 to send a congressional delegation shaped by Virginia voters — not by maps drawn in Tallahassee and Raleigh — to fight against that trajectory.

Vote yes. Your neighbor’s life may depend on it.

Dr. Bruce A. Silverman is a retired physician and the volunteer medical director of a free clinic serving uninsured residents of Goochland County. He is also the legislative chair of the Virginia Chapter of Physicians for a National Health Program. The views expressed are his own.

https://richmond.com…

Medicare for All Is an Electoral Winner

Working-class voters already back Medicare for All. Framed like Social Security — as a benefit earned from work, not a handout — it can reach two-thirds support.

By Jared Abbott
Jacobin, April 9, 2026

Medicare for All (M4A) is back. Juliana Stratton, who just won the Illinois Democratic Senate primary, pledged in her victory speech to “fight for Medicare for all.” Graham Platner, the populist veteran and oyster farmer running to unseat Susan Collins in Maine, has made universal health care a centerpiece of his platform. Abdul El-Sayed, running for Michigan’s open Senate seat, is one of the policy’s most prominent champions — he literally wrote the book on it. In California, single-payer has become a near-universal fixture of Democratic gubernatorial platforms, with Katie Porter, Tony Thurmond, Betty Yee, and Xavier Becerra all declaring support. And Rep. Pramila Jayapal has been presenting polling directly to House Democratic colleagues arguing the electoral merits of Medicare for All, even in battleground districts the party must win to flip the House.

But whether M4A is a winning issue or an electoral liability for progressives depends — particularly for those running in red and purple districts — on how the issue is framed to voters.

Polling data makes the framing problem clear. Depending on how you ask, Americans’ support for universal health coverage lands at anywhere between nearly 70 percent to just over 30 percent. When the question leads with outcomes, coverage, access, and affordability, large majorities say yes. Indeed, when you poll Americans on whether the federal government should make sure everyone has health care coverage, 66 percent say yes.

But how you talk about the mechanism government should use to guarantee universal coverage has an enormous impact on how favorably the idea is received.

Simply asking Americans if they favor or oppose Medicare for All tends to land between 55 and 60 percent support. Tell people that the plan would require voters or employers to pay more in taxes, and support drops into the 40s. Further highlight that a M4A model could entail a single national health care system that would not allow people to buy private insurance, and support declines to the 30s.

That swing is not a verdict on the policy idea itself. It is a warning about framing: When M4A sounds like a government handout or restraint on individuals’ freedom to choose, working-class voters tune out. When it sounds like something they’ve paid for, something they’ve earned and deserve, they don’t.

Working-class voters are not opposed to bold health policy. What our research at the Center for Working-Class Politics (CWCP) finds consistently, however, is that they are skeptical of programs that feel like government handouts rather than something they’ve earned.

Consider that Social Security regularly sits at 80 percent support or higher, despite the fact that it is a massive government redistribution program to help the elderly and those who can’t work. Workers don’t experience it that way. To them, it’s a program they’ve paid into, a benefit they’ve earned — it’s a return on decades of contributions. The moment a health care policy sounds like something the government is giving to people, rather than something people have already paid for and deserve, you’ve lost the working-class voters you need most.

Taxes Over Premiums to Fund Single Payer

Health care costs and worries are surging, as is economic inequality. Recently HJM readers proposed paying for single payer with premiums (which we’re used to) instead of taxes (which many reflexively dislike). But only taxes permit the progressive financing approach needed for affordable universal health care.

National Health Expenditure Projections, 2024-33: Despite Insurance Coverage Declines, Health To Grow as Share of GDP, Health Affairs, June 25, 2025, by Sean P. Keehan, et al, Centers for Medicare and Medicaid Services (CMS)

Each year for the full 2024–33 projection period, national health care expenditure growth (averaging 5.8 percent) is expected to outpace that for the gross domestic product (GDP; averaging 4.3 percent) and to result in a health share of GDP that reaches 20.3 percent by 2033 (up from 17.6 percent in 2023).

From the Conclusion

Although the projections presented here reflect current law, future legislative and regulatory health policy changes could have a significant impact on the projections of health insurance coverage, health spending trends, and related cost-sharing requirements, and they thus could ultimately affect the health share of GDP by 2033.

Healthcare Reclaims Top Spot Among U.S. Domestic Worries, GALLUP, March 31, 2026, by Lydia Saad

Healthcare has reclaimed its position as Americans’ foremost domestic concern, returning to the top tier after several years when economic matters commanded more attention. While the percentage highly worried about the availability and affordability of healthcare hasn’t increased over the past year, ongoing public concerns about healthcare costs, including personal challenges in affording care, make this a perennial concern.

Income Inequality Is Surging in the U.S., New Oxfam Report Shows, Forbes, Jan. 8, 2026, by Josie Cox

The richest 1% of households in the United States have accumulated almost 1,000 times more wealth than the poorest 20% over the last three and a half decades, and economic inequality is getting worse at a rapid pace, new research shows.

The analysis, published by Oxfam, found that between 1989 and 2022, a household in the top 0.1% gained an average of $39.5 million in wealth, while a top 1% household gained $8.35 million. By contrast, a bottom 20%-household gained less than $8,500 during the same period.

Over the past year alone, Oxfam noted, the wealth of the 10 richest U.S. billionaires soared by $698 billion. That means that the top 0.1%’s share of total wealth is now at a record high of 12.6%.

“The data confirms what people across our nation already know instinctively: the new American oligarchy is here,” said Abby Maxman, president and CEO of Oxfam America. “Billionaires and mega-corporations are booming while working families struggle to afford housing, healthcare, and groceries.”

Comment:

By Don McCanne, M.D.

Recently, HJM’s editor Jim Kahn asked readers for their input. Readers responded thoughtfully about current problems, views on political context, and a profusion of strategic and tactical ideas.

One suggestion by two readers was that the system should be funded by premiums, not taxes. This is understandable in that most people are generally anathema to taxes, and have been amenable to paying health insurance premiums when they were less expensive and especially if employers paid a significant portion.

Let’s take a close look at whether taxes or premiums should pay for our health care.

A critical consideration is that health care consumes one-fifth of our GDP, and far more than one-fifth of income for the economically less well-off. Assuming that we want to cover everyone’s essential medical care, we need to include them in the risk pool. If each person or family were asked to pay an equal fraction of health care costs as a premium, all low- and most middle-income individuals would be unable to comply, or would do so only by compromising other of life’s necessities – housing, food, or education.

With the recent surge in economic inequality, those at the top would be much more capable of paying, painlessly, into a common pool for health care. Obviously, this would require progressive funding, based on the ability to pay, to subsidize or entirely cover expenses for lower-income individuals and families. Making premiums progressive would be anathema to the idea of premiums, as well as quite complex, adding to our already excessive administrative expenses. On the other hand, we are already accustomed to progressive taxes. We could easily expand these taxes, beginning with zero taxes for the impoverished, expanding to much higher taxes for those who can readily afford them. That applies not only to income but also to wealth taxes — which are naturally attuned to progressive funding. Billionaires might not like the higher taxes, but they could certainly afford them.

The recent Gallup survey shows that health care is now Americans’ foremost domestic concern. We can fix this problem. Even if we dislike taxes, a progressive tax approach would cause us much less concern than widely unaffordable insurance premiums. Making health care accessible and affordable for all is certainly a situation that we could get used to, taxes be damned. It’s the norm in rich nations, so we know how it works.

To my health care justice friends: Please keep reflecting on how we should pay for health care. And elect candidates for Congress and president based on the policy positions you support. And forthrightly communicate to candidates what you believe those positions should be!

https://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

City Council and pope concur: Medicare for All is a common-sense solution

By Monica Maalouf, M.D., Winnie Lin, M.D., and Alec Nicolas Angelo Jotte, M.D.
Chicago Sun-Times, Letters, April 4, 2026

While it didn’t make headlines, Chicago recently became the largest city in the U.S. to pass a resolution calling on Congress to support Medicare for All. The resolution was adopted the same day that Pope Leo XIV, a Chicago native, called upon nations to enact universal health care as a moral imperative.

As physicians practicing in the Chicago area, this moral imperative couldn’t be clearer. Every day, we witness how our health care system prioritizes profits over patients. We see and live the gaps, inefficiencies and devastating consequences of this fragmented system.

While a city-level, nonbinding resolution might seem trivial, this unanimous vote supporting Medicare for All is a declaration that the status quo is no longer acceptable. It’s a rejection of small-scale reforms that force our patients to lose limbs because they chose paying rent over buying insulin. It’s a cry against systems that force us to stand by as women die prematurely of breast cancer because they can’t afford a biopsy.

Chicago’s resolution reflects a growing recognition that incremental changes and new direct-to-consumer price reductions (such as TrumpRx) are simply not enough. It also signals an important shift: Medicare for All is no longer a fringe proposal but is now recognized as a common-sense solution. That recognition was echoed just one day prior to the City Council vote when Illinois Democratic primary voters chose Juliana Stratton, who made Medicare for All central to her campaign for the U.S. Senate nomination.

There is a growing consensus that the federal government should ensure all Americans have health care coverage. Medicare for All represents a solution to providing that coverage while building upon ongoing efforts to reduce health care costs and, per the words of Pope Leo XIV: “Universal health coverage is 
 a moral imperative for societies that wish to call themselves just.”

It is time to move beyond the complicated, inadequate reforms of the Affordable Care Act. There is a growing clarity, and now an increasingly prominent insistence, that a universal, national health program is the best next step. The rest of the Illinois Democratic coalition should take heed and find the courage to move in step with this rising public will.

https://chicago.suntimes.com…

The Big Ugly Threat to Safety Net Hospitals

Analyzing the hospitals put most at-risk by the Republican tax and budget reconciliation bill

By Eileen O’Grady
Public Citizen, March 31, 2026

On July 4, 2025, President Trump signed a Republican budget reconciliation package into law that will decimate affordable health care for millions of Americans and risk the closure of rural hospitals. The One Big Beautiful Bill Act, which opponents of the law nicknamed the Big Ugly Law (BUL), will cut $911 billion in federal spending on Medicaid and CHIP over the next 10 years, according to estimates from the Congressional Budget Office. Draconian work and eligibility requirements for Medicaid recipients mean that millions of people will lose their Medicaid coverage.

The cuts will be devastating to many low-income and disabled individuals who rely on Medicaid. Moreover, they will have knock-on effects on hospitals that disproportionately serve these communities, deepening the financial strain already plaguing rural and safety-net hospitals and compromising their ability to deliver care, potentially leading many to close.

This report identifies and analyzes the hospitals that are most at risk of closing, reducing the medical services they provide, or laying off workers due to Medicaid cuts imposed by the Big Ugly Law.

Key findings:

  • 446 hospitals are at heightened risk of closing or reducing services due to Medicaid cuts.
  • These hospitals collectively have approximately 69,000 beds and served approximately 6.6 million patients in 2024. They employ approximately 275,000 direct patient care workers.
  • The communities served by these hospitals have a larger share of Black and Hispanic residents, as well as people living below the poverty line, compared to other hospitals. Nearly 20% of the at-risk hospitals (85) serve high-poverty areas.
  • 267 (60%) of the at-risk hospitals serve urban areas, and 176 (39%) are rural hospitals.
  • House Republicans who voted for Medicaid cuts have 196 at-risk hospitals in their districts collectively, and Senate Republicans (all of whom voted for Medicaid cuts) collectively have 146 at-risk hospitals in their states. Republicans also represent several of the congressional districts with the highest number of at-risk hospitals.
  • Five states now have over a quarter of all their hospitals at risk: Connecticut, California, New York, Massachusetts, and Washington.
  • Almost half of the at-risk hospitals have special Medicare payment designations that are typically associated with hospitals that are rural or financially vulnerable and play a critical role in the communities they serve, including Critical Access Hospital (19%), Rural Referral Center (16%), Sole Community Hospital (9%), and Medicare Dependent Hospital (4%).
  • In recent months, hospitals have initiated layoffs and reduced services like obstetrics and maternal care, citing financial strain imposed by Medicaid cuts.

The full list of at-risk hospitals is available here.

full report: https://citizen.org…

Trump May Seek Primary Care Help from Cuba

La Verdad, Trump floats “Cuba care corridor” to address U.S. primary care shortage, April 1, 2026, by Clara Desvarío

Palm Beach, FL — At a private dinner with donors last week, President Donald Trump reportedly suggested that the United States could address its growing primary care shortage by sending Americans to Cuba for routine care — perhaps as part of vacations — and recruiting Cuban primary care providers to practice in underserved U.S. communities.

According to a source present at the event, Trump raised the idea in a conversation with a Cuban American Ă©migrĂ© donor, describing Cuba’s neighborhood-based care model as “very powerful.”

“They’ve got doctors on every block—almost,” Trump said, according to the attendee. “We could learn from that. Maybe we send some patients there – beach vacation plus doctor visits. People like vacations.”

The remarks come as the U.S. faces a projected shortage of up to 48,000 primary care physicians by the early 2030s, with rural and low-income areas disproportionately affected.

A policy analyst, Dr. Elena Márquez of the Institute for Comparative Health Systems, noted that Cuba’s system assigns a physician–nurse team to roughly 600–700 residents and emphasizes prevention and home visits.

“Cuba has one of the most intensive primary care models in the world,” Márquez said. “The question is not whether it works—it clearly does on many population measures—but whether it can be meaningfully translated across political and economic systems.”

No formal proposal has been released, and administration officials declined to comment on whether the idea is under active consideration.

Comment:

By Jim Kahn, M.D., M.P.H.

It is hard not to read this with a mix of fascination, irony, and sadness.

Fascination, because the underlying observation is not wrong: Cuba has built a primary care system that is deeply embedded in communities, prevention-oriented, and accountable for defined populations. For decades, health policy analysts have pointed to exactly these features as missing in the U.S. system.

Irony, because the same administration now entertaining “medical vacations” to Cuba has, in practice, supported policies that weaken primary care at home—through underfunding (eg of Medicaid), fragmentation, and persistent neglect of workforce development and payment reform.

And sadness, because the idea implicitly concedes a failure: that we might need to send Americans abroad to access the kind of continuous, community-based care that should be foundational in a high-income country. And sadness, too, that the US has in recent years sabotaged Cuba’s economy including health care through aggressive oil embargoes and other actions.

Would such a primary care initiative be worth considering? I’m ambivalent.

On one hand, expanding access – by any means – has appeal, especially for underserved populations. On the other, importing care from a country whose economy we have long viciously sought to undermine raises vexing ethical and geopolitical questions. Recruiting Cuban clinicians risks exacerbating health workforce pressures there, even as we fail to fix our own.

Ultimately, the proposal underscores a more basic point: we do not lack for strong medical care models worth emulating. What we lack is the political will to implement them. Is this the start of a stunning shift – improving the US by learning from other countries?

P.S. In finalizing today’s April Fools’ post, I saw recent NY Times reporting on the dire health consequences for Cuba’s people of US oil blockade policies. That is no laughing matter; indeed it is inexcusable.

https://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

HJM Reader Ideas

Our recent request for input from HJM readers yielded varied and rich ideas. There was some consensus on current problems (costs, complexity, & profit-taking), varied views on political context (opportunities & barriers), and a profusion of strategic and tactical ideas (both contradictory and compatible). Trump got unexpected callouts for his full-speed-ahead m.o.

HJM readers are, unsurprisingly, well-informed and articulate. Our recent solicitation of ideas yielded a profusion of cogent observations and opinions. I did my best to organize them, without judgement. Thus, HJM readers can get a sense for the range of views, both widely shared and unique.

I summarize responses by category. If you want to scan all summarized comments, see below.

More input is welcome, but I can’t guarantee that I’ll report back. If you’re eager to connect with someone expressing a specific idea, I can explore linking readers 


For Most Vexing / Motivating Current Problems, the most common views were unsurprising: high costs, for individuals and employers; complexity leading to confusion and inefficiency; and widespread profit-seeking by insurers and others. The rich are doing fine, the middle class and especially the poor not so much. Critical provider capacity suffers and improvised solutions (eg value-based payment) don’t help. It’s shameful that the US lacks state-of-the-art insurance.

Current Political Context: Harm vs Advance Single Payer elicited the the central role of economic status: the governing GOP reduces taxes for the rich and cuts government programs intended to help the middle class and poor. There is some optimism in growing condemnation of this dynamic. On broader politics, some readers are pessimistic about both parties, with huge money in politics. More upbeat, one reader noted “collectivism” counteracting the famous US “rugged individualism”. For health care, the rising sense of crisis encounters extensive anti-SP efforts by the profit-makers.

And, finally, for Strategic & Tactical Ideas 
 strategic views run the gamut: step-wise (eg expanding Medicare age and state-based single payer) to all-at-once. Tactics can be summarized as lots & varied & mutually supportive, from mass movements to fireside chats, moral suasion and technical details. Trump’s chutzpah and audacity – his disrespect for normal process, get surprise mention as a model for aggressively pursuing single payer. Framing focuses on universality, cost savings, and ending profiteering. “Premiums” is preferred to “taxes”. Finally, technical suggestions focus on fee-for-service and a tiny role for private supplemental insurance.

Many thanks to the HJM readers who chimed in so thoughtfully. These views rounded out my understanding of options and choices we face on the path to health justice.

1) Most Vexing / Motivating Current Problems

Health Insurance Failures

  • High costs – for individuals & employers (esp public) – 7
  • Un- and Under-insurance
  • Difficulty navigating insurance and care
  • Care denials
  • Inequality – poor suffer, rich do well
  • Medicaid – prove poverty now 2x / year, low payments
  • Shameful US lacks state-of-the-art insurance
  • Key provider capacity loss

Causes

  • Complexity –> confusion & inefficiency – 6
  • Profit seeking (insurance, provider groups) – 7
  • Patients seen as widgets
  • False solutions eg value-based payment

2) Current Political Context: Harm vs Advance Single Payer

Central role of economic status

  • GOP cuts: taxes for the rich & government programs
  • Wealth to rich, others losing economic stability
  • Growing perception that oligarchy = theft
  • Middle / upper class must suffer to move the needle

Other political issues

  • Govt swings between extremes
  • However, both parties fail us
  • Money in politics
  • Dems in opposition must articulate vision
  • Wide fear of taxes, esp for the common good
  • The “rugged individualism” vs “collectivism” split is shifting
  • Trump shows: Exec Branch can get stuff done if it wants

Regarding Insurance

  • Growing perception of a health care crisis
  • Relative satisfaction with Medicare (& Soc Security)
  • Inevitable strong anti-SP marketing by profit-makers
  • Dem Congress may support SP

3) Strategic / Tactical Ideas

Strategy

  • None that will work (pessimism)
  • State-by-state if fed cooperation – 3
  • Lower Medicare age to 50 – 3
  • Start with universal capitated primary care
  • All-at-once, to reveal the savings – 2
  • What would employers like?
  • Inside-Outside (legislation + mass movement)
  • Outreach + marketing, fireside chats
  • Tactic (eg moral vs technical design) tailored to constituency
  • Role of SP in the broader Left
  • Trumpian chutzpah (audacity of audacity)
  • Charismatic president “ram SP down country’s throat”

Framing

  • Universal Coverage 
 One people, one plan – 2
  • Universal coverage costs less for families than now – 3
  • Americans trained to believe govt can’t deliver – 2
  • Affordability + Abundance
  • End profiteering
  • Contrast with war spending
  • Moral imperative currently weak argument
  • “Socialized medicine” trope losing shock value
  • Govt pays for health care, not for insurance – 2
  • Delink from work
  • “Premiums” not “”taxes”

Technical

  • Fee-for-service like Trad. Medicare
  • Medicare QMB for low income
  • Private Insurance – for supplemental coverage

https://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

‘Harmed by the system’ — Physicians suffer moral injury when health care chases profits, not patient care, report says

By Richard Payerchin (fact checked by Keith A. Reynolds and AC Baltz)
Medical Economics, March 24, 2026

Key Takeaways

  • Nearly half of physicians report insufficient time for optimal care, and over one-third face patient loads they view as unsafe, underscoring operational constraints with direct clinical quality implications.
  • Many clinicians recommend evidence-based interventions despite anticipating access failures from insurer utilization management, systemic barriers or patient cost exposure, fostering repeated ethical distress.
  • Moral injury is differentiated from burnout by etiology and phenotype, emphasizing guilt, shame and loss of meaning arising from externally imposed constraints rather than individual coping deficits.
  • A substantial minority are considering leaving their jobs, suggesting workforce destabilization linked to persistent financial and administrative pressures that undermine professional obligations.
  • Single-payer universal coverage is positioned as the principal corrective, though interpretation is tempered by nonrandom sampling through advocacy networks and potential underrepresentation of departed clinicians.

It’s not just burnout when patient numbers increase but doctors are not allowed adequate time and treatments for them.

The pursuit of profit, not patient health, is causing alarming levels of moral injury to physicians who want to treat patients but instead must deal with systemic constraints across U.S. health care, according to results of a new study.

Anti-burnout initiatives, such as wellness programs and resilience training, have helped some physicians cope with workplace stressors. But they don’t change the course of “health care financialization,” in which health systems and insurers prioritize income over patients’ and physicians’ health interests. Those programs also don’t address the moral injury that physicians feel when they want to guide patients toward better health but can’t due to insurance restrictions or systemic racism, according to Physicians for a National Health Program (PNHP).

“Our research shows that the system is failing both physicians and patients,” PNHP President Diljeet K. Singh, M.D., Dr.Ph., said in a news release. “Doctors enter medicine to care for people, but are increasingly forced to navigate barriers that delay or deny treatment to generate profit. When clinical judgment is overridden by financial priorities, patient care suffers.”

What the findings say

“Moral Injury in Medicine: The Human Costs of Practicing in a Profit-Driven System” is the new PNHP report based on two years of research among doctors and patients, including surveys and interviews with 1,207 physicians. The findings are grim, though perhaps not entirely unexpected for physicians fed up when the emphasis on making money supersedes needed patient care.

Among the key findings:

  • 47% of surveyed physicians say they often or always lack enough time to provide optimal levels of care to their patients
  • 35% say they are required to care for more patients than they can safely manage
  • 44% say they often recommend treatments they know their patients will not be able to access because of systemic barriers, insurer practices or financial costs
  • 41% report often feeling complicit in structural racism perpetuated by the health care system in which they work
  • 35% say administrative and insurer pressures to reduce costs affect their ability to provide the best possible care
  • 25% say they are considering leaving their job due to this distress

The report was funded by the Robert Wood Johnson Foundation, a national nonprofit devoted to improving health care and health equity.

“Across the country, physicians and patients are navigating a health care system increasingly shaped by the pursuit of profit rather than health,” Kelsy McIntosh, MPH, program associate at the Robert Wood Johnson Foundation, said in the news release. “Physicians want to deliver high-quality, evidence-based care that aligns with their values and expertise, but too often encounter barriers designed to generate profits. Shining a light on systemic pressures can support designing systems that prioritize patient health over corporate profit.”

What to do next?

The report stops short of prescribing incremental fixes, arguing that the health care industry has repeatedly demonstrated an ability to circumvent or undermine regulatory reforms. Its primary structural recommendation is the implementation of a publicly financed, single-payer universal health care program, a position consistent with the name and organizational mission of PNHP.

The report acknowledges this advocacy context as a study limitation, noting that its survey was distributed through non-random, non-probability-based sampling that included the organization’s own membership networks, which may have attracted physicians who already share its policy views.

PNHP cites factors in Oregon, a state that “has experienced rampant financialization of health care systems, with several high-profile health care buyouts by large corporate entities.” Among the players: Amazon; OneMedical, a membership-based primary care chain of five clinics; and UnitedHealth Group subsidiary Optum, which has an aggressive ownership and growth plan there.

Oregon also has enacted some of the nation’s strictest controls on corporate practice of medicine, and has been edging closer to establishing universal health care at the state level, the PNHP report said.

PNHP notes that the particulars of geography, specialty and practice setting may not be representative across the country. The sample of doctors may underrepresent those who have already left clinical practice, the report said.

Moral injury in health care

PNHP uses the term moral injury, which is borrowed from military psychiatry to describe the psychological harm that occurs when a person is forced to act against their deeply held values.

“Physician moral injury arises when physicians are prevented from delivering evidence-based, optimal patient care due to systemic constraints beyond their control — particularly those imposed by profit-driven goals of the health care industry,” the report said, citing the work of researchers Wendy Dean, M.D., and Simon Talbot, M.D., who first applied the moral injury framework to medicine in 2018.

The report argues that framing physician distress as burnout rather than moral injury has led to ineffective interventions and allowed underlying system failures to go unaddressed. PNHP distinguishes the two conditions on both cause and symptom. Burnout manifests as exhaustion, depersonalization, and diminished personal accomplishment. Moral injury produces guilt, shame, loss of meaning and erosion of professional identity. It stems not from overwork but from being systematically prevented from fulfilling one’s professional obligations.

Standard burnout frameworks locate the problem within the individual physician and prescribe individual-level fixes such as resilience training, mindfulness, reduced duty hours and wellness programs. These approaches, the report argues, have consistently failed to slow physician attrition precisely because they treat a systemic problem as a personal one.

“There’s no amount of yoga that will make me less distressed about how my patients are harmed,” one family medicine physician said in an interview quoted in the report. “My staff is harmed. I’m harmed by this system.”

https://medicaleconomics.com…

Trump Policies Harm to Lung Health

This new article highlights the myriad ways that the current federal administration’s actions harm lung health – by reducing health insurance, vaccines, environmental protections, tobacco and TB controls, and research. The time for single payer health care is now!

Implications of Year 1 Trump Administration Policies for Americans’ Lung Health, American Journal of Respiratory and Critical Care Medicine, March 3, 2026, by Adam W. Gaffney, et al

In 2025, the Trump Administration undertook multiple actions with major ramifications for the pulmonary health of Americans.

The “One Big Beautiful Bill Act” (OBBBA), signed into law by President Trump on July 4, 2025, will terminate healthcare coverage for many low-income Americans with lung disease. The administration’s rollback of environmental protections and reduction in subsidies for clean energy production will worsen air quality and accelerate climate change. Cuts at the Centers for Disease Control and Prevention (CDC) could disrupt occupational health protections and tobacco and asthma control efforts; the Department of Health and Human Services (HHS) leadership’s embrace of anti-vaccine theories will drive vaccine-preventable illness. The termination of federally-funded research grants, including some focused on respiratory diseases, could slow medical progress. And sweeping disruptions to global health aid may impede global tuberculosis control.

In this article, we assess the likely impacts on Americans’ pulmonary health, across the life course, of policies proposed or enacted in the first year of the second Trump Administration, drawing on peer reviewed studies, media reporting, Congressional Budget Office (CBO) reports, government agencies’ impact analyses, and our analyses of national survey data.

Discussion

Lung disease is a leading cause of suffering and death. Policies pursued or enacted during the Trump Administration’s first year will likely increase pulmonary morbidity and mortality, and widen already growing inequalities in lung health and care. These policies — a form of pulmonary structural violence — strip away essential measures that protect the respiratory health of all Americans, from infancy through old age: they appear set to degrade patient care, worsen air quality, accelerate climate change, increase vaccine-preventable and exposure-related respiratory illnesses, undermine tobacco control, upend global TB control, and hobble scientific progress on lung disease.

Such harms — particularly to the developing lungs of children — will long outlast the Trump Administration. In contrast, corporations facing relaxed pollution standards stand to benefit, as do wealthy individuals who are unlikely to work in dangerous jobs or live in polluted areas and who are the primary beneficiaries of tax cuts.

The pulmonary and critical care medicine community — including our already outspoken professional societies — should respond vigorously to this crisis. We must amplify the urgent message that these actions are inflicting imminent harms on our patients. Research should track these policies’ impacts and the magnitude of their harms. Finally, we should advocate for alternative policies informed by decades of research to not only restore, but improve and expand care for every patient with respiratory disease, safeguard workers’ lungs, fight tobacco use, and ensure clean air for all.

Comment:

By Don McCanne, M.D.

Hey! Have you heard that the United States has by far the most expensive health care system in the world – a system that is one of the poorest performing in the industrialized world? Of course you have. What is almost unbelievable is that we have elected an administration that is further compounding the poor performance, as exemplified for lung disease in today’s article.

This is astonishing considering that we have known for decades now how to convert to a high performance system which would be affordable to all by paying for it with progressive income and wealth taxes, which would make health care available to those with low incomes while budgets can be managed by eliminating the profound administrative waste and excess profits of the middlemen, such as the private insurance industry and private equity, that drains our health care dollars to create private wealth for the surplus, wasteful intermediaries. The increased tax assessment for the multimillionaires and billionaires would be enough to meet the deficiencies in tax revenues from lower income individuals, yet would have absolutely no negative impact on the lifestyles of the very wealthy. This would be especially fair considering the great increase in wealth disparities over recent decades.

What is different this time is that we have a window of opportunity to actually reform health care because the incompetence of the current administration has made it obvious to the majority of the public that we have to do something to make health care affordable for all, and that something requires removal of the gross mismanagement of the current administration.

If we want high quality health care that is accessible and affordable for everyone, now is the time to act. Why now? We have the midterm elections coming up shortly. We need to work together elect a Congress that will create the legislative proposal that will enact a single payer, improved Medicare for All. They will have two years at which time we can replace our dysfunctional administration with one that really cares about the people. Our current president has created a political atmosphere in which it is now obvious that a health care system for all of the people has become a mandate. This is the greatest political opportunity we have had to finally get reform right. Prior opportunities, even if well meaning, have fallen back into the false safety zone of incremental reform. Such incrementalism has left us with the most expensive system yet with miserably failing performance.

We no longer have to accept mediocrity. We can truly create a comprehensive healthcare system that is accessible to everyone, and it can be paid for (wait for this!) without creating financial hardship for anyone! NOW is the time to move forward. Don’t just sit there thinking about what we should do. We know what we need to do. The most immediate task is to select midterm candidates who, regardless of political affiliation, support beneficial policies that will get us where we need to be. Again, when is that? It’s NOW!

https://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

47% of physicians say employer puts profits over patients: Study

By Patsy Newitt
Becker’s ASC Review, March 19, 2026

Physicians across the United States are experiencing a deepening crisis of moral injury, and they believe profit-driven healthcare systems increasingly block them from delivering the care their patients need, according to a sweeping new study by Physicians for a National Health Program, an advocacy organization of more than 20,000 physicians, medical students and health professionals who support a universal, single-payer national health program.

The March 17 report, which surveyed more than 1,200 practicing physicians and included focus groups, found that nearly half of physicians often or always feel unable to provide their patients with the best possible care, with two-thirds reporting moderate or severe distress as a result.

The study draws a sharp distinction between burnout — which implies individual depletion and is typically addressed through wellness initiatives — and moral injury, which the authors define as the distress physicians experience when they know what their patients need but cannot provide it due to constraints outside their control.

Physicians in the study were pointed in their rejection of burnout framing; as one family medicine physician said, “When we talk about burnout, it makes it sound like it’s my fault or my colleagues’ fault. The term points to the person being affected. It’s a form of victim shaming.” Notably, 40% of surveyed physicians often or always felt frustrated by the wellness activities their employers offered, saying they simply didn’t help.

The survey was distributed through a non-random, multi-modal recruitment approach using PNHP’s professional networks, medical societies including the Society of General Internal Medicine and the American College of Physicians, listservs, social media, and snowball sampling. It adapted eight items from the validated Measure of Moral Distress for Health Care Professionals and added 14 new questions capturing system-level pressures, financial constraints and administrative burdens. The mean overall moral distress score was 143, compared to 96 in the 2019 benchmark study, suggesting a significant worsening over time. For 18 of 22 survey questions, the most common distress rating was “very distressing,” the maximum level possible.

Here are 10 key things to know from the survey:

1. Forty-seven percent of surveyed physicians indicated their employer often or always prioritized financial goals over best patient care, and 50% felt betrayed by a healthcare system that hindered their ability to provide good care.

2. Additionally, 62% experienced moderate to severe distress over cost-cutting pressures from administrators or insurers.

3. Of the surveyed physicians, 45% often or always felt unable to provide patients with the best possible care, and 68% experienced moderate or severe distress as a result. An additional 47% often or always felt unable to provide optimal care simply due to inadequate time.

4. Forty-four percent of physicians often or always felt that lack of insurance approval blocked medically necessary services, and 51% often or always experienced excessive documentation requirements that compromised patient care.

5. Of the surveyed physicians, 35% often or always felt required to care for more patients than they could safely handle, and 43% often or always felt required to overemphasize productivity metrics at the expense of patient care.

6. Forty-five percent often or always encountered lack of resources or bed capacity that compromised care, and 43% said leadership often or always failed to respond supportively when such failures occurred. Three in 5 physicians experienced moderate or severe distress contemplating these situations.

7. The mean overall moral distress score was 143, compared to 96 in the 2019 benchmark study, suggesting a significant worsening. For 18 of 22 survey questions, the most common distress rating was “very distressing,” the maximum level.

8. On attrition, 27% of physicians had already left a position due to moral distress, 25% are currently considering leaving for the same reason and 42% had previously considered leaving but chose to stay. The workforce consequences are tangible: physician departures have contributed to clinic closures, elimination of services, and dramatically longer patient wait times.

9. Fifty-seven percent of physicians reported moderate or severe distress from working in systems that failed to treat vulnerable patients with dignity, and 41% often or always felt complicit in the structural racism their systems perpetuated. Physicians described patterns of race-based misdiagnosis, discriminatory care based on insurance status, and the rationing of life-sustaining treatment for uninsured and undocumented patients.

10. Nearly half of practicing physicians reported often or always making diagnostic or treatment recommendations they knew their patients would not be able to pursue, due either to insurance barriers or financial toxicity, and for 7 in 10 of those physicians, this provoked moderate or severe distress.

https://beckersasc.com…

HJM Wants to Hear from You

We regularly discuss the latest news and research on problems with health insurance and prospects for single payer. We’ll keep doing that. But we also want to understand what you’re observing, contemplating, and striving for. So today we ask you to chime in.

Three open-ended questions; please provide your thoughts. Send responses to healthjusticemonitor@gmail.com.

1) What problems with current US health insurance do you find most vexing & motivating – i.e., causing the worst harms (health and/or financial), provoking the most intensive frustration with current insurance, boosting popular desire for universal public insurance?

2) How does the current broad political context harm or advance universal public insurance efforts? E.g., an aggressively conservative federal administration (including cuts to public insurance); a determined progressive response; shifting electoral terrain.

3) Your strategic / tactical ideas: What methods to promote reform will break the 60-year impasse on universal health insurance? E.g., federal vs state action; all-at-once vs incremental steps such as lowering the Medicare age or universal primary care; highlighting the moral imperative vs system design optimization?

We will summarize and synthesize the responses and report back to HJM readers. We’ll use respondent names only with permission.

Thanks!

https://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

Chicago City Council testimony in support of Medicare for All

By Claudia Fegan, M.D.
Chicago City Council, Committee on Health and Human Relations, March 10, 2026

My name is Dr. Claudia Fegan, I retired in December of 2024 after 12 years as the Chief Medical Officer of Cook County Health, and 24 years with the system. I am the National Coordinator of Physicians for a National Health Program, a national organization with over 25,000 members, based here in Chicago. I am grateful to all the members of this committee who have already signed on to Alder Cruz’s Resolution Supporting Medicare for All. While many people think access to health care is a national issue to be addressed by congress, this is a crucial issue for Chicago, and I’m thankful for the opportunity to address you today and explain why it is so important to address now, prior to the midterm elections.

As the resolution points out, the city of Chicago spends over $600,000,000 annually to provide health insurance to city employees. Think for a moment what the city could do with those funds if we had universal health care, if employers were no longer expected to pay for their employees to have access to health care. Employers are not expected to be responsible for the education of the children of their employees or guarantee their access to police or fire protection. What could Chicago do with an extra $600,000,000?

A poll of voters from November 2025 showed 90% of Democrats and the majority of independent voters support Medicare for All. Voters want to regain control of their health care and lower costs. We are the only industrialized country that does not guarantee access to health care for everyone living within our borders. Not just every citizen, everyone living here. We already spend enough on health care; we spend more money per person than any other country in the world. We allow patients to be denied access to care they need to maximize the profits of the insurance industry.

There has been a lot written about burnout among people in health care. This past year PNHP partnered with the Robert Wood Johnson Foundation to assess that burnout. Surveying over 1100 practicing physicians, we found what has been labeled as physician burnout is often moral injury inflicted by the financialization of the practice of medicine in this country. We found it has harmed the morale of the entire health care workforce, leading to increased shortages and decreased access to care as professionals retire early, cut back on their hours or leave the practice of clinical medicine altogether. Tragically, there are increasing totals of suicides among physicians. More and more, physicians are frustrated by their inability to offer patients the most appropriate care. They are stymied by required prior authorizations that issue inappropriate denials of care, make treatment recommendations their patients cannot pursue and create conflicts between health goals for their patients and the financial goals of the institutions that employ them.

It would be life-changing for Chicago to take the lead here and make a statement by supporting Medicare for All. If the city that sent the first Black woman to the Senate, that first sent Barack Obama to the Senate and then to the White House could send the message that health care is important for everyone, it would have a tremendous impact and continue our local tradition of initiating progress.

The tide is going to turn in this country. We need to build our power and be prepared to take what we need when the opportunity presents itself. We must be represented by people who have the courage to support our agenda. Medicare for All is something representatives have to be willing to fight for. We have a Congress that has acquiesced its power to a president who doesn’t believe in checks and balances. We will not get universal health care while Donald Trump is in the White House. We must be prepared for when Trump is gone. In 3 years, we must be prepared to seize the opportunity when it presents itself.

Last year, one-third of Americans delayed getting care they needed or skipped care entirely. That is the highest number since Gallup started asking questions about this 30 years ago.

I am reminded of a woman I admitted to the hospital one night a few years ago. Both of her breasts were rock hard. They were infiltrated with cancer with palpable lymph nodes in her axilla. She worked as a hairdresser, owned her own shop but had no health insurance. She was sitting at home waiting to die. She believed she had no other choice. She knew she could not afford her care. Her daughter made her come in. Remarkably we were able to get a dramatic response with treatment. No one should ever have to sit at home waiting to die in this country, when we have treatments that can be lifesaving.

Families are desperate for solutions to their everyday health care problems, skyrocketing drug prices, rising copayments and deductibles, surprise medical bills; and are tired of having to switch doctors because of the revolving door of job-based health insurance.

The United States has struggled with the effects of ‘For Profit” Health Care for decades. The country has never embraced access to health care as a basic human right.

In the United States, we know some 28 million people or 8% of the population are uninsured and that 45,000 people die each year as a direct result of not having insurance.

If there is a lesson for the rest of the world to learn from the United States, it is the lesson of the private insurance industry. The insurance companies have a fiduciary responsibility to make as much money as possible for their shareholders. They also determine which patients have access to which care. There is an inherent conflict of interest here. By eliminating the waste and greed of private insurance, we can afford to cover everyone in our country for all necessary care, and end the scourges of surprise bills, skipped medications, and medical bankruptcy. Medical illness or medical debt is the number one cause of bankruptcy in this country, even though the majority of people who declared bankruptcy had insurance at the time of their precipitating illness.

There will always be limitations on how much money is available to spend on health care. Those decisions need to be based on societal need, cost effectiveness and population health, not profits and financial yields.

We already spend enough money on health care in this country; we just allow too many people who do none of the work of delivering health care to take profit from it. I am asking the Chicago City Council to have the political courage to lead the way and to tell our nation that health care needs to be a right for everyone. Thank you so much.

Read the full Chicago City Council resolution HERE.