By Claudia Fegan, M.D.
STAT, January 20, 2017

During the bruising 2016 presidential campaign, Donald Trump vowed to repeal Obamacare “on day one of the Trump administration.” Today is that day. If soon-to-be President Trump makes good on that promise, I urge him to replace it with single-payer national health insurance.

If it, or some other equitable form of insurance, isn’t quickly put in place, I worry about the patients who will die when they lose access to timely health care.

The Affordable Care Act expanded coverage to 20 million people and improved their access to care. Every day I see its beneficial impact on the patients I serve as the chief medical officer at Chicago’s largest public hospital. Tens of thousands of our patients were covered for the first time, many under the law’s Medicaid expansion, and we were able to provide them care that was previously out of their reach.

While the ACA represents an important step forward in other respects, such as eliminating penalties for preexisting conditions and covering children until age 26 on their parents’ plan, our health care system is still the worst of any wealthy nation.

Millions remain uninsured, and most Americans’ coverage comes with gaping holes, like a hospital gown that looks pretty good in front but leaves a lot hanging out in back. Patients often find they can’t afford care, given the high deductibles and copays, and their choice of doctors and hospitals is often restricted. Costs continue to soar, and greedy corporations have gained an even tighter stranglehold on health care.

Defending that status quo, as many Democratic politicians have been trying to do, is a losing battle. The ACA continues to allow insurance companies to limit access to health care, and the pharmaceutical industry to limit access to lifesaving treatment with predatory pricing.

Soon-to-be President Trump and the Republicans want the law repealed. Most people in favor of that happening want something better, not a return to the past. Replacement has to move forward to universal and upgraded coverage and move away from shifting costs to the patients least able to bear the financial burden of illness rather than going backward to the bad old pre-ACA days.

Here’s one inspiring vision of health care reform that would lift the vast majority of Americans: single-payer national health insurance. Enactment of a single-payer plan would demonstrate that we are a caring nation. People shouldn’t die in the richest country in the world due to lack of access to care.

According to a Gallup poll last year (and a similar Kaiser survey), more than half of Americans wanted to repeal the ACA, and most Americans still have a dim view of the law. They know it is not working. They know the deductibles are too high and they can’t afford the copayments. (Curiously, on the eve of its repeal, a growing number of Americans say they support the law.)

But the Gallup poll also showed that 58 percent of Americans — including 41 percent of Republicans and 53 percent of those who favored repeal — wanted the ACA replaced with “a federally funded health care program providing insurance for all Americans,” in other words, single-payer reform. They want a plan that covers the care they need and lets them see the providers they choose with no out-of-pocket costs.

Now is the time for a single-payer health system — improved Medicare for all. It would take the hundreds of billions now wasted on insurance bureaucracy and billing paperwork and use that money to expand and upgrade coverage. It would cover all of the uninsured. And it would abolish copayments and deductibles for the 91 percent of Americans who are currently covered by health insurance.

After Trump’s election, my newly insured patients began to ask if they were going to lose their health insurance. Trump has said he has a plan to cover everyone, cut costs, and cut painful deductibles and copayments that limit access to care. But so far there is no firm plan, he is notoriously unpredictable, and his cabinet nominees indicate that his administration will take a different course.

Single-payer health systems have a proven track record on cost control. When Canada passed its single-payer medical insurance plan in the 1960s, its health spending was commensurate with ours and growing at the same rate. Today, Canada spends about half of what the US does. Much of the savings have come from slashing insurance overhead and paperwork. Where insurance giant Aetna keeps about 20 cents of every premium dollar for itself, the comparable figure for overhead in Canada’s system is 2 cents, and for Medicare it’s 3 cents. And Canada has saved vast amounts by simplifying hospitals’ and doctors’ billing paperwork.

Republican plans for the ACA threaten the health of my patients and millions of other Americans, and the status quo is unacceptable. That’s why I, and the 20,000 colleagues who have joined me in Physicians for a National Health Program, are fighting for single payer — a health reform that would cure America’s health care ills, not just provide some pain relief.

Now is the time to take that step.

Claudia Fegan, MD, is an internist who serves as the national coordinator of Physicians for a National Health Program. She is a coauthor of “Universal Health Care: What the United States Can Learn from Canada” and is a contributor to “10 Excellent Reasons for National Health Care.”

https://www.statnews.com/2017/01/20/obamacare-single-payer-national-health-insurance/

By Michael Corcoran
Truthout, Jan. 19, 2017

The world will change tomorrow when Donald Trump becomes president — and so, too, must the movement for social justice. It is this reality that prompted Mariame Kaba, who for years has been organizing on issues such as the criminal punishment system and domestic violence, to shift gears in the lead-up to the inauguration.

“I have been thinking about how to organize in this current moment, and figure out ways to build the power to resist on various fronts,” she said in a Truthout interview. “I was thinking of an issue that can reach a broad range of people, regardless of where they stand ideologically, racially [or] economically.”

This search led her to the issue of health reform and the need for a public system that guarantees care to everyone. The result will be tomorrow’s Medicare for All National Day of Action, a nationwide online event to be held on Inauguration Day. While Trump is giving his oath of office, thousands of activists across the country will be working online (using the hashtag #medicare4all) to push for the reform: contacting Congress, making memes and forming relationships with other like-minded people.

Participants are encouraged to make use of the official website, Facebook page, Twitter feed and pre-made graphics that can be shared on social media — all devoted to what Kaba calls a “virtual” day of action. “I wanted those who are unable to go down to Washington, DC, where there will be lots of resistance activities, to have a chance to participate,” she said.

The long-term goal, Kaba elaborates, is bigger than just health care reform. She sees the fight for Medicare for All as having the potential to play a central role in building a mass movement against the inequities of capitalism more broadly. “This is ultimately what the struggle is against, and we need to start talking in those terms,” she said, adding that those in power “want to take away your health care and give a tax break to people who are already rich. People can understand redistribution upward.”

We Are All Patients: the Broad Appeal of Medicare for All

There is no shortage of issues that activists can organize around. Trump’s victory has further exposed the world to environmental, media and immigration crises, to name just a few. But the fight for a real health care system, organizers believe, has unique potential to be the hub of a wider movement.

“We have all been patients at one point or another,” said Dr. Carol Paris, the current president of Physicians for a National Health Program (PNHP) in an interview with Truthout. “So, yes, reforming the delivery of health care is something we all need … what many people have now is just an insurance card and the illusion of care.”

Indeed, health care policy is a major concern for workers seeing their paychecks shrink due to the rising cost of health care, as well as the 30 million Americans who remain uninsured despite progress on access from the Affordable Care Act (ACA). It is also a problem for those who have health insurance but are still exposed to massive debt and potential bankruptcy. This exposure causes millions of insured Americans to forego care they need.

The lack of a universal health system has also led to serious racial disparities, the Harvard Business Review observed in 2015, with Black Americans having a shorter life span and worse outcomes than whites on a number of ailments, including “heart disease, diabetes, and cancer, as well as higher risks for HIV infection, homicide, and infant mortality.” The seriousness of the crisis cannot be understated. A 2012 study by consumer advocacy group Families USA concluded that 26,000 people die each year due to a lack of insurance.

Paris has a long history as a health care activist, extending long past her current role as a physician who is president of an organization that provides much of the seminal research on the subject. In May 2009, she was one of the “Baucus 8,” who stepped up at the US Senate Finance Committee hearing on health care reform chaired by Sen. Max Baucus to ask why there wasn’t a single advocate for single-payer health care on a 41-person panel. Baucus had all eight peaceful protesters, including Dr. Paris, arrested.

The Nashville-based doctor was arrested again — which can be seen on video at PNHP.org — two days after President Obama said in his 2010 State of the Union that he would listen to anyone with a “better approach” to reform. “Well, we had a serious set of proposals and tried to let him know,” she said of her arrest, which occurred in Baltimore outside a conference featuring the president. They attempted to give him a letter that urged him to consider Medicare for All to save thousands “of American lives each year, not to mention the prevention of unnecessary suffering.”

“It is important not just to rely on research and data but to organize, to protest and to fight for single-payer,” Paris said to Truthout on the role of activism and organizing. “We have worked with many organizations [that] aren’t solely focused on health care, such as labor groups, who know to get economic justice, creating a Medicare for All system would be an important step.”

The Coming National Debate on Health Reform

While health care is always an important issue, it is going to be front and center in the national debate as Trump and the new GOP Congress seek to rapidly repeal (and supposedly replace) the ACA. This will be a messy, complex process and could cost more than 20 million people their health insurance, according to the Congressional Budget Office. But it will provide a chance for advocates to spread their message.

“In a back-handed way, [the GOP efforts to repeal the ACA] will provide advocates a chance to get our message across,” Paris told Truthout on the phone while watching Bernie Sanders speak at the confirmation hearing for Tom Price, Trump’s appointment for head of Health and Human Services.

“It is going to be up to activists and independent media [outlets] to give legitimacy to Medicare for All as a reasonable, cost-effective alternative to the status quo,” Paris added.

Democrats are promising to fight the repeal and possibly minimize some of the consequences of the GOP’s approach. Even if the repeal could somehow be stopped, however, the fight for Medicare for All remains the ultimate goal for many progressive activists. “Our job today is defend the Affordable Care Act. Our job tomorrow is to create a single-payer system Our job today is defend the Affordable Care Act. Our job tomorrow is to create a single-payer systemOur job today is to defend the Affordable Care Act,” Bernie Sanders recently said on Twitter. “Our job tomorrow is to create a single-payer system.”

Certainly, Sanders has his detractors, including many in the Democratic Party, some of them beneficiaries of large donations from Pharma and the private insurance industry. This bipartisan opposition to Medicare for All is a reality that organizers say the movement must tackle head on.

“Politicians from both parties say it is politically impossible,” Paris said. “But what does that mean? It means that our representatives won’t vote for it. It means many won’t risk alienating their donors at the pharmaceutical and health industries, who fund their campaigns.”

Education and Class Consciousness

Certainly, education must be central to building a movement, which is why organizers’ use of the term “Medicare for All,” over “single-payer” is deliberate. While policy wonks are familiar with the term single-payer, it is still a phrase that confuses many people. “Most people know what Medicare is,” Kaba said.

Amazingly, despite a narrow debate in the media and in Washington that villainizes or ignores the policy, the public is still broadly supportive of Medicare for All (when the question is asked in those terms), and has been for years. In December of 2015, a Kaiser poll showed 58 percent of the public supported the policy, including 81 percent of Democrats. But polls using the term “single-payer” do not fare as well as ones using the term “Medicare for All.”

“Medicare for All has the potential for extremely broad appeal because it would help the vast majority of Americans, including many with quite conservative views,” said PNHP founders David Himmelstein and Steffie Woolhander, in an email to Truthout.

A lack of understanding single-payer and how it is financed has been an obstacle for the movement in the recent past. “If you find that you have to keep explaining what your proposal is, you haven’t done enough, and your opponents can and will destroy your efforts with a few soundbites,” explained Dr. Don McCanne, of PNHP, in response to a failed health reform effort in Colorado that was supported by single-payer activists.

And with a rigid ideological adherence to market-based solutions in the media and in Washington, many Americans are not aware that the United States is an outlier in its lack of a public health care system: The only member of the Organization of Economic Cooperation and Development (a coalition of wealthy nations) without universal care.

An explanation of how outside the norm the US is in terms of providing a safety net — the US ranks 25 out of 34 OECD nations on social spending — can provide a stunning contrast to those who are trying to understand how American capitalism functions, raising class consciousness.

The Sanders presidential campaign, as Truthout observed in August, did help to educate the public about these differences. At times, Sander’s message broke into the dominant media narrative, which typically ignores or wrongly dismisses Medicare for All as impossible, radical or unaffordable. Some recent coverage is laughably bad. Last Friday’s David Brooks column in The New York Times made the ridiculous claim that the Republican Party has granted “the Democratic point that health care is a right.”

But despite these falsehoods being so pervasive in the media, the fruits of a growing class awareness are evident in the rising number of people challenging Democrats’ reluctance to make real changes on the health care front. Last week, a public outcry erupted when 13 Senate Democrats voted against an amendment by Sanders to allow drugs to be imported from Canada, lowering prices for Americans. Sen. Cory Booker, a high-profile Senator who is rumored to have presidential ambitions, was among the group that sided with Republicans to kill the amendment.  In the aftermath of Sanders’ presidential campaign, a vocal and aggressive group of progressives were paying attention to the amendment, and when they saw that Booker received big money from Big Pharma, they connected the dots between campaign finance, Congress and health policy. The result was a flood of indignation toward Booker on social media.

There has been pushback from the establishment, mocking the critiques leveled by the “Sanders Wing” toward the Democratic Party. The surge of opposition to Booker’s vote, however, is promising. It demonstrates not only how many Americans are aware of how private capital can influence health policy, but also how the internet can serve as an effective tool for vocal protest of the congressional machinations that too often happen behind closed doors. The fallout from Booker’s vote is something that Democrats will remember, especially as they plan for the need to connect with progressives in future elections.

What Lies Ahead

After the Medicare for All National Day of Action is over, the work of organizing, educating and agitating will continue. Kaba has plans to create curriculum — a sort of Medicare for All 101 — on the website in the weeks following the inauguration.

Organizers are also encouraging activists to get involved at the local level. There are organizations advocating for Medicare for All across the country. Physicians for a National Health Program, for instance, has chapters in 43 states. Healthcare-Now has chapters in 38 states and is seeking to start chapters where none exist. Single-payer actions are also being organized by a variety of other organizations across the country.

We are in the process of entering a scary new world. But if activists and organizers can keep one another engaged and active, there is a chance that this moment will also be an important occasion for social justice — and the fight for a humane health care system could have impacts for generations to come.

Copyright, Truthout.org. Reprinted with permission.

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The Georgia representative redefines what it means to have conflicts of interest

By Adam Gaffney, M.D.
In These Times, January 19, 2017

Donald Trump’s nominee for Secretary of Health and Human Services (HHS) faced sharp questioning on the ethics of his stock deals—among other issues—at a hearing Wednesday before the Senate Health, Education, Labor and Pensions Committee. Perhaps the most damaging inquiries revolved around a “sweetheart deal” that allowed Rep. Tom Price to buy stock of Australian biotech company Innate Immunotherapeutics as one of a select group of “sophisticated U.S. investors,” as Kaiser Health News reported. After he took advantage of this investment opportunity, the company’s stock price soared.

Things got tense at the hearing when Price acknowledged, in response to questions from Sen. Patty Murray (D-Wash.), that he bought stock after learning about the company from Republican Rep. Chris Collins (R-N.Y.), another investor, who is also on the company’s board. As the Huffington Post’s Paul Blumenthal notes, this raises the specter of insider trading—so long as Price acted on information that was not public. Moreover, as Murray noted, Congress was then debating the 21st Century Cures Act, legislation that had “several provisions that could impact drug developers like Innate Immunotherapeutics.” The bill passed last month.

Shocking? Yes. But the sleazy stock buy is actually just a single episode in a long political career riddled with eyebrow-raising moves—all of which make Price utterly unacceptable as health secretary.

“Medical-industrial complex”     

Price’s medical specialty is orthopedic surgery, but he is perhaps better known as a savvy operator both serving and profiting from the “medical-industrial complex.”

In the last four years, the Georgia representative has traded in excess of $300,000 in health-related stocks, while simultaneously advancing bills with relevance for those companies and also receiving campaign contributions from the very same enterprises, Wall Street Journal reported in December.

Another issue raised at the hearings, including by Sens. Elizabeth Warren (D-Mass.) and Al Franken (D-Minn.), was his purchase last year of stock in a medical device company, Zimmer Biomet. Within a week of that purchase, Price introduced a bill that would have directly benefited the company by protecting it from regulation, as originally reported by CNN.  Subsequently, the company donated to Price’s campaign. (Price contends that his stock account is managed by a stock broker, and that he didn’t know about the purchase until later.)

Be that as it may, Price has shown himself to be a consistent advocate for various corporate health interests over the years, frequently going “to bat for companies whose executives and employees have generously contributed to his campaigns and political action committees,” Kaiser Health News reported.

When powerful national healthcare policymakers have financial interests in healthcare companies, a form of insider trading is all but inevitable. Such individuals always have access to at least one rather valuable nonpublic stock tip: their own future policy plans. Legal or not, these ties are rotten.

“Do no harm”?

And yet, none of this is the real reason why Price would make for a terrible health secretary. For that, look to Price’s evident intent to eviscerate the healthcare safety net, his disdain for LGBT rights, his regressive vision on reproductive healthcare and his climate change denialism.  

Indeed, it would be unfair to cast Price as little more than a tool of the medical-industrial complex. He is a true believer in a coherent right-wing healthcare ideology. He is also, it turns out, a member of a fringe-conservative medical group, the Association of American Physicians and Surgeons, which—according to a 2009 Mother Jones profile—sees no real role for government in healthcare, has shilled for the tobacco industry and publishes a journal that periodically espouses fake science, including articles calling into question vaccine safety.

In spite of his record, at least two mainstream medical groups disgracefully dashed to endorse Price in the wake of his nomination. The American Medical Association (AMA) praised Trump’s pick and urged his prompt confirmation, harkening back to the group’s reactionary past. Even more inexplicable was the endorsement of the Association of American Medical Colleges (AAMC), which represents U.S. medical schools. (Other medical groups, including Physicians for a National Health Program—in which I am active—as well as the National Physicians Alliance, have condemned the choice). But perhaps the AMA and the AAMC were simply happy to have one of their own in a position of power. After all, could Price violate the Hippocratic promise to “do no harm”?

Of course he could. Indeed, he seems intent on it.

“Universal access”

Price seeks to gut the existing healthcare safety net, as a number of senators asserted at Wednesday’s hearing. A bill he introduced in 2015, for instance, would strip insurance from millions. As a recent article in the New England Journal of Medicine reported, “Price’s replacement proposal would make it much more difficult for low-income Americans to afford health insurance. It would divert federal tax dollars to people who can already buy individual coverage without subsidies and substantially reduce protections for those with preexisting conditions.”

Then again, it’s not fair to pick only on Price; his approach is fully consistent with a larger conservative healthcare reform vision. Oddly, that vision is now being branded by Republicans as a plan for “universal access,” as the New York Times reported. Trump likewise claimed in an interview with the Washington Post that he wanted “insurance for everybody.” Price’s answers at the hearing seem consistent with this pseudo-universalist reorientation. He suggested that the Republican plan would not cut coverage and that “nobody is interested in pulling the rug out from under anybody.”

Indeed, Price was able to score some points as a result of our current lack of a universal system, noting that 20 million Americans remain uninsured and that high deductibles prevent people from receiving care. This is true—and it’s a strong argument for single-payer reform—but it’s also true that GOP designs would only exacerbate these injustices.

Unworthy candidate

Liberals who assert that conservatives lack a coherent healthcare vision of their own are wrong. They have a free market vision of healthcare that, in truth, requires significant public subsidization. For instance, at the hearing, Sen. Todd Young (R-Ind.) praised Mike Pence’s privatized Medicaid expansion in Indiana, a program that was engineered by Trump’s Centers for Medicare and Medicaid Services (CMS) nominee Seema Verma. Price agreed that Pence’s program was “really a best practice I think for many other states to follow.”

The Pence-Verma program created “POWER” (Personal Wellness and Responsibility) accounts for Medicaid participants that are theoretically modeled on health savings accounts (HSAs). HSAs, which are invariably tied to high-deductible insurance plans, have been trumpeted by Trump, by Price and by Paul Ryan’s “Better Way” healthcare plan. In Indiana, the Pence-Verma approach has meant that very low-income individuals are expected to deposit funds on a monthly basis into their POWER accounts. As summarized by the Kaiser Family Foundation: Participants slightly above the poverty line who fail to make payments are kicked out of the program for six months, while those below the poverty line who similarly fail to make such payments are downgraded into a worse version of Medicaid that does not cover vision or dental benefits and imposes copayments on these very poor individuals. 

Such spiteful modifications to Medicaid—ostensibly directed to “provide them [participants] with ‘skin in the game,’” as the program’s waiver put it—do not require an act of Congress. They only need the approval of waivers by CMS, which will no doubt be forthcoming with Verma at its head (and with Price above her).

Price, it should be clear, is part and parcel of this larger corporate healthcare advocacy front. He has thrived at the nexus of government and corporate healthcare interests and, at the same time, appears to truly believe in a free market healthcare vision—albeit one that funnels dollars from the government to insurers and pharmaceutical companies, and then back to their investors, like him.

Though the doctor is no doubt an unworthy candidate for health secretary, he is an entirely consistent choice for the incoming Trump administration, and—if not derailed by his stock buys—will be very much at home in the hornet’s nest of free market privatizers, deregulators, ideologues, billionaires, and crony capitalists who will shortly be at the helm of the U.S. government.

Adam Gaffney is a physician and writer with a focus on healthcare politics, policy and history. He is an instructor in medicine at Harvard Medical School and a pulmonary and critical care physician at the Cambridge Health Alliance. His writing has appeared in the New Republic, Los Angeles Review of Books, Salon, CNN.com, USA Today, Jacobin and elsewhere. He’s a board member of Physicians for a National Health Program, a single-payer advocacy organization. The views expressed are his own.

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