By Steffie Woolhandler, MD, MPH, and David U. Himmelstein, MD
American Journal of Public Health, January 2017

President Obama inherited an economy in crisis, burgeoning inequality in wealth and health, and a legion of medically uninsured Americans whose ranks had grown by 11 million under the previous administration. He staunched the bleeding but provided no cures.

The Affordable Care Act (ACA; Pub L No. 111–148), Obama’s signature achievement, covered millions, but leaves 9% uncovered. It minimally regulated insurers and imposed a modest new tax on the wealthy but accelerated the corporate takeover of health care and endorsed high-deductible insurance plans that offer illusory protection. It provided $11 billion in new funds for community health centers and public health agencies but drained money from safety-net hospitals and failed to reverse the downward trend in funding for public health.

Aside from the ACA, Obama’s health record is mixed at best. He made some progress on environmental regulation, and the terrible threat of climate change has at least been acknowledged. But the yawning gap between rich and poor—in both wealth and health—has widened.

Continue reading:
http://ajph.aphapublications.org…

‘We are sick of a criminal system based on profit that leaves people hanging without the health care they deserve’

The following is an unofficial transcript of the remarks delivered by Mark Dimondstein, president of the American Postal Workers Union (APWU), AFL-CIO, to a protest rally outside the national offices of the Pharmaceutical Research and Manufacturers of America (PhRMA) in Washington, D.C., on Nov. 18. The protest, which drew more than 150 people – physicians, medical students, unionists and health reform activists – denounced the greed of the pharmaceutical drug industry and called for a single-payer national health system. It featured several rally speakers, one of whom was President Dimondstein, whose union represents more than 200,000 USPS employees and retirees, and nearly 2,000 private-sector mail workers. He was introduced by Dr. Robert Zarr, president of Physicians for a National Health Program, which organized the protest. A 5-minute video of Mark Dimondstein’s remarks can be viewed here.

President Mark Dimondstein’s remarks

It’s nice for me personally to be seeing doctors and medical students when I’m not sick. [Audience laughter, applause.] But we are sick of a system based on profit, a criminal system based on profit, that that leaves the people of this country and humanity hanging without the kind of health care that we all deserve.

Sisters and brothers, the people that I represent, for the most part, do have health insurance right now. But every day it’s going up, every day we have to pay more, every day the benefits go down, every day we’re in a fight with the insurance companies.

And for those who don’t know, the price of future health insurance is being used to choke the public Postal Service that is being demanded to put $5 billion a year into a fund for future health benefits for workers that aren’t even born yet.

So it’s hurting all of us, it’s hurting all of us, sisters and brothers.

And when we go to the bargaining table, guess what: Management always wants, and it’s not just arguing, they want our health benefits, if we can even keep them, to be less and less, and more and more coming out of the wages and benefits of the workers.

So we would all benefit – all of us – from a system of single payer and Medicare for All.

Now, we’re in front of PhRMA. I did a little thinking last night. Big Pharma wants to convince all the people of this country that you have to have this obscene system of profit-making, and CEOs that make $43 million, and lobbyists and enriching – you mention obscene profits – because that’s what’s going to drive the innovation of life-saving drugs.

You’re all in the medical field, so you know who Dr. Jonas Salk was, don’t you? [Shouts of “Yes,” applause.] When he was working on a polio vaccine, which was an epidemic in this country and the world, he purposely decided that his work was not going to be based on personal gain. And when he was asked, “Who has the patent?” You know what he said? He said, “There is no patent. You can’t patent the sun.” You can’t patent the sun.

That patent, by figures today, that figure would have been worth $7 billion to the pharmaceutical industry, and he said no. And you’re here in the tradition of Dr. Salk, practicing medicine and fighting to have a system of practicing medicine that is good for the patients and good for the people of this country.

And we all have stories. We all have family and friends. My wife and I were good friends with the real Norma Rae, Crystal Lee Sutton, an American heroine. And when she got sick, and was fighting brain tumors, the insurance company of her husband cut off the benefits. And she could not afford the life-saving drugs that she needed, and she died at a fairly young age.

When my wife was sick, fighting a life-threatening thing, the medicine she needed, the shot, was $5,000 a pop. We had health insurance. What about all the people that don’t?

And when we say that Big Pharma is criminal, that’s what we mean, because people die on the altar of profits, sisters and brothers. And you know that better than anybody.

We’re very friendly with the Canadian Union of Postal Workers. And when we meet with the Canadian Union of Postal Workers they brag about their health care system. They pull out their medical card – and it’s different by each province – they say, “Here it is. We go anywhere we want to. We have full choice of physicians. We have cradle to grave benefits. And we never see a bill because it’s part of the public good.”

Sisters and brothers, you’re out here fighting for the public good in your way, we feel we’re fighting for the public good in our way, in terms of defense of the public Postal Service. Together, we can fight for the kind of country we need.

It’s not an accident, to me anyway, in my thinking, that the Bernie Sanders campaign electrified this country. And what was one of the main demands of that that campaign? [Shouts of “single-payer health care.”] Single-payer health care. And in a way we should look at that primary season in this election as a referendum on those kind of issues, because the people of this country are ready for a Medicare-for-all single-payer system.

And with advocates and fighters like you, sisters and brothers, working hand in hand with unions like ours and the communities of ours, guess what? We can win, can’t we? [Cheers.]

Sisters and brothers, it’s great to be here with you. Solidarity forever, as we say in the union movement. And carry on your great fight with the great spirit you have here today. Thank you all. [Cheers, applause.]

By Stephanie Innes
Arizona Daily Star, December 6, 2016

PNHP Note: Detailed findings from the bicycle tour mentioned in this article were published in the journal Academic Medicine. “Opposition to Obamacare: A Closer Look,” was authored by Paul R. Gordon, M.D., M.P.H.; Laurel Gray; Alex Hollingsworth, Ph.D.; Eve C. Shapiro, M.D., M.P.H., and James E. Dalen, M.D., M.P.H., Sc.D.

If President-elect Donald Trump wants to reform health care in the U.S., he might do well to consult Tucson physician Dr. Paul Gordon.

Gordon, 61, this year cycled 3,255 miles over three months, listening to Americans talk about the Affordable Care Act (ACA), which is also known by its unofficial yet popular name, “Obamacare.”

The University of Arizona College of Medicine Tucson professor expects to publish some of his findings and observations in academic journals.

A lot of people he met along the way were parroting sound bites, Gordon found. Others said they don’t want to pay for other people’s health care. At the same time, he found the people he encountered were kind and generous with sharing their thoughts, with offers of help to fix flat tires, and to provide lodging and meals.

“We heard stuff that was not present in the survey data,” said Gordon, who rode through rural areas of Maryland, Pennsylvania, Ohio, Michigan, Wisconsin, Minnesota, South Dakota, Montana, Idaho and Washington state.

Some people he met liked the fact that young adults can stay on their parents’ health insurance until the age of 26; that insurance companies can no longer deny them coverage due to pre-existing conditions; and that federal subsidies are available to help people pay for insurance. But others had no idea those three things all happened as a result of the ACA and are part of the law.

Anger

“Given what we heard, I wasn’t all that surprised with how the election went,” said Laurel Gray, 26, medical student who accompanied Gordon on part of the ”Obamacare Listening Tour” to assist with research. “The anti-ACA lobby was very effective at painting an inaccurate picture of what the legislation is.”

A lot of people were angry, she said.

“When you are passing through these rural areas and seeing the reality of what life is like and what it has been like for the past 10 years, it’s very different. I hadn’t realized what a bubble I’d been living in, in Tucson.”

Gordon, who teaches and practices family medicine, and his wife, Tucson pediatrician Dr. Eve Shapiro, have long been supporters of universal health care. That means they’d like to see all Americans have equal access to health care through a single payer system.

But that’s not what the Obamacare Listening Tour was about.

“I never corrected. I just listened. By listening I quickly gained their sense of trust,” Gordon said. “I was just there to listen, not judge.”

Between three and eight people were riding with Gordon at any given time, including Shapiro, his two grown children and Gray, the UA student, who was a social worker before she went back to school to become a physician.

Misinformation

Gordon recalls how much a musician he met in rural Ohio disliked the individual mandate, which was part of the 2010 law, that all Americans have health insurance. The musician doesn’t mind that car insurance is mandatory because owning a car is optional. But being alive isn’t optional and that’s why mandating health insurance is unfair, he told Gordon.

Gordon also tells the story of a hotel manager he met in Knoxville, Maryland who hasn’t seen a doctor in a long time, even though he has employer-sponsored health insurance. He finds the system too complicated, so he avoids it.

And then there was Henry, the South Dakota resident who told Gordon that Obamacare “sucks” but wasn’t clear on the details of it.

“There was so much misinformation,” Shapiro said. “It was sound bites. Everything was Obama’s fault.”

She also noticed a large number of people who, “hate government telling them what to do.”

Complicated system

Gray went through her own learning curve.

“This was my first year needing my own health insurance. I’d always been on my parents’ plan,” she said. “When I started the tour I was embarrassed by my huge gaps in knowledge. I learned a lot.”

Some people Gray met said they could not afford health insurance. In some cases, though, she wondered whether health insurance was not their financial priority.

One certainty Gray took back to school this year, where she is a second year student, is that medical students have an obligation to be politically informed about the system in which they operate.

Gordon and Gray never set up any of their talks with people in advance. Typically they would ride for a few hours and stop at a convenience store along the way, get something to eat or drink, and talk to the people there.

The “Obamacare Listening Tour” jerseys the team wore invited conversation. Gordon and Gray would then dictate and summarize what they’d heard as a voice memo, which they later transcribed.

“At a minimum it informed me of people’s understandings of health insurance and health in general,” Gordon said. “And it helped me to be a better teacher and practitioner. A great lesson is that of listening. We need to listen to our patients. We can’t necessarily fix it, but we can at least listen.”

Gordon himself was never a fan of Obamacare because it includes the insurance industry, and much of the insurance industry is a business that prioritizes its stockholders.

In a single payer system, physicians can still be independent but there’s not another layer of overhead and administrative costs, he explained.

“Health care is complicated. But when you have a single payer system it’s not complicated at all,” he said.

“Damn politicians”

Gordon recalls a 75-year-old woman he met in Spokane, Washington who had similar sentiments as she drank a beer and watched a baseball game.

“Health care is a right,” he recalled her saying. “It’s true. Just raise taxes … But the damn politicians don’t have the balls to raise taxes.”

At this point, no one can predict what will happen to the Affordable Care Act moving forward. But Gordon says it will be hard to remove some of the pieces people don’t like, such as the individual mandate, without increasing costs.

Next up: Gordon would like to cycle across Canada to hear from Canadians firsthand what they think of their health system. He’s interested in doing the same in Taiwan, which also has a government-run single payer system.

http://tucson.com…

By Rose Ann DeMoro
The Huffington Post, Dec. 5, 2016

Now that the dogged opponents of the Affordable Care Act have caught the Obamacare bus, transforming U.S. healthcare is back on the political agenda.

Repeal of the ACA will not curb the persistent, systemic inequities of our profit-focused healthcare system.

Tens of millions, even those with health insurance, still struggle with unpayable medical bills due to rising deductibles and co-pays and skyrocketing prescription drug costs and hospital charges.

Insurance networks sharply restrict patient choice. Millions remain without any health coverage, or simply avoid getting the care they need because they can’t afford it — at great risk to their health. Disparities based on race, gender, age, or where you live remain rampant.

Even advocates of repeal are fearful of the impact of throwing millions off the expanded Medicaid coverage or eroding the ACA crackdown on insurance industry abuses, such as barring coverage for those with pre-existing conditions.

One widely-promoted theme is to replace the tax subsidies the ACA provides to buy private insurance on the ACA exchanges with tax credits or health savings accounts to buy insurance on the open market. But those offer consumers even less protection from skyrocketing premiums or being forced to settle for bare bones junk insurance plans with limited benefits and higher out of pocket costs.

Another proposal is subsidizing federal funding of Medicaid expansion with state block grants. That, too, is problematic, opening the door to severe state budget cuts that would leave many lower income people and families without needed coverage.

Then there’s the Paul Ryan plan to privatize Medicare — a sure-fire way to impoverish millions of seniors forced to fend for themselves on the inefficient, more expensive private market.

The rightwing policy wonks label these approaches “consumer-driven free market health solutions.”

If the well funded, “grassroots” campaign in response is led by the Beltway Foundations and NGO’s to only defend the troubled ACA, then, yes, that’s precisely what will happen.

But the “free market” is exactly what created the healthcare crisis in the U.S. in the first place, creating a health care system largely based on ability to pay that ranked first in the world in spending and far behind most industrial nations in access, out-of-pocket costs and a variety of quality benchmarks.

Instead, let’s build the demand to protect, improve and expand Medicare. It’s the standard by which any healthcare system should be measured. If the Trump administration and the Republican-controlled Congress want to define what the healthcare system should be, let’s start with a truly patient-based approach.

Nurses’ credo for transforming the U.S. healthcare system is to establish a single standard of safe, therapeutic care for all, based on the clinical judgment of doctors, nurses, and other providers.

Only an improved Medicare for all can guarantee healthcare for all based on patient need. Eliminating private insurance and the high premiums, co-pays and deductibles will save families thousands of dollars, free up millions for businesses, increase wages for workers, and save hundreds of billions for taxpayers.

Gone would be the 20 percent waste that is endemic to a system based on private profit. No longer will taxpayers bail out for-profit insurance companies and corporate hospital chains and greedy nursing home operators.

Rather than guarantee high executive salaries and trapped customers, we can expand Medicare through increasing the existing fair share financing.

Here’s a checklist for reform:

• Complete choice of doctor.

• Demonstrated low overhead – Medicare is well known for administrative costs of just 3 percent compared to far higher figures for private insurers due to profits and paperwork.

• Control drug prices? (Yes, if given authority to negotiate bulk discounts with prescription drug corporations.)

• Popular, fair healthcare program supported by nurses, doctors, and a majority of Americans!

Improved Medicare for All checks all the boxes. If Ryan really believes repealing the ACA will “leave no one worse off,” the only way to achieve that is Medicare for all.

California, with Democrats in control of the governor’s office and state legislature, is one state that can set a national model of how to do reform right by adopting a Medicare for all type system.

Medicare remains one of the most popular social reforms in U.S. history. Expanding it to cover everyone is an idea favored by 58 percent of Americans, as a May Gallup poll demonstrated. It’s the real healthcare reform we need.

Rose Ann DeMoro is executive director of National Nurses United (AFL-CIO) and the California Nurses Association.

http://www.huffingtonpost.com…