PNHP

It’s not burnout — it’s something worse

It’s not burnout — it’s something worse

By Paul Gordon, M.D., M.P.H.
The (Tucson) Arizona Daily Star, April 3, 2026

MA, my 66-year-old patient, was so happy with her Medicare Advantage plan. She could continue seeing me as her doctor and the premiums were ridiculously cheap. Then the unexpected — she developed lupus and her life changed. The referrals I made for various procedures, medications and work-up all required prior authorization. Hours were spent on the telephone trying to speak with someone who could authorize MA’s necessary care. This was all evidence-based, necessary care. Some might call this “cost-saving through the hassle factor”. If you deny it often enough, maybe I’ll just give up.

These perverse profit motives are undermining my profession and making it challenging for me to practice medicine.

A new national study from Physicians for a National Health Program, conducted in partnership with the Robert Wood Johnson Foundation, surveyed over 1,200 physicians and found this experience isn’t rare, but rather the norm. 62% of physicians reported moderate or very high distress caused specifically by administrators’ or insurers’ cost-cutting priorities overriding their clinical judgment.

For years, we’ve been told that healthcare workers are “burning out.” That framing is wrong, and it’s wrong on purpose. What we experience is not burnout, it is moral injury. It is the distress that comes from knowing exactly what your patient needs and being blocked from providing it by a system designed to extract profit. Burnout blames the worker. Moral injury names the system. Burnout implies clinicians can’t handle the job. Moral injury identifies that the job has been restructured to prevent ethical practice.

A landmark study on physician moral injury found that 69% of physicians had contemplated leaving or had actually left a position due to the experience of moral injury.

This is not the profession I entered when I finished my residency training as a family physician.

Imagine you’re the physician being overruled. You feel betrayed, and you are unable to realize the values that led you to this career.

44% of surveyed physicians said that lack of insurance approval or service availability often or always prevented them from delivering medically necessary treatment. In turn, physicians must make the impossible decision of choosing an inferior therapy or spending time and energy they often don’t have on fighting what is frequently a losing battle; 35% of surveyed physicians reported being required to care for more patients than they could safely manage. This inevitably leads to risk of harm, a risk created by the system but imposed upon physicians, violating our moral codes.

This isn’t about physician feelings — it’s about patient harm. These aren’t just physician complaints. When clinicians are blocked from providing care, patients suffer, and the harm falls hardest on marginalized communities. The same study found that 41% of physicians felt complicit in structural racism perpetuated by their profession.

Patients in focus groups described the system as “convoluted,” “corrupt,” and “dysfunctional.”

We need structural change. Immediately, that means eliminating prior authorization barriers. Healthcare has been redesigned from promoting health to extracting wealth. Prior authorization, productivity quotas, and documentation demands are tools of financial control, not clinical quality. Ultimately, it means building a healthcare system where no insurer stands between a physician’s clinical judgment and a patient’s right to care.

If we can fix the structural problems in healthcare where profits are the main concern and institute a single-payer system removing the profit motive from care financing, MA can receive her necessary care, and I can practice the medicine I trained for to be singularly focused on caring for my patients.

Dr. Paul Gordon is a family physician in Tucson and a member of Physicians for a National Health Program.

https://tucson.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 émigré 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.

States Push Back Against Medicaid Managed Care

By Brenda Gazzar
Code Wack Podcast, March 30, 2026

Today, most people on Medicaid get their care through private insurers called Managed Care Organizations, or MCOs – like Aetna and UnitedHealthcare.

Critics say these companies add layers of bureaucracy that make it harder for patients—most of them low-income—to get care. They discourage physicians from accepting Medicaid patients by making them jump through hoops to get treatment pre-authorizations, or even to get paid.

Are Managed Care companies making health care more expensive, not less? How are some states reacting? Are legislators starting to wake up and see through the hype?  Some are.

All this and more is discussed in a recent report from Physicians for a National Health Program, Removing the Middlemen from Medicaid. To unpack it, we spoke with Dr. Alankrita Olson, a public health physician and PNHP board member who advocates for a single-payer healthcare system.

This is the second of a two-part series.

Check out the Transcript and Show Notes for more!

https://heal-ca.org…

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.

One of the Largest Cities in the United States Just Passed a Medicare for All Resolution: What Does It Mean for American Candidates, Patients, Business Owners and Ethical Medical Care Professionals?

By Kimberly J. Soenen
The Fine Print Magazine, March 29, 2026

Two weeks ago, a major milestone was reached by the Single Payer Universal Healthcare movement coalition in the United States.

On Wednesday March 18th, at the Chicago City Council meeting, Lead Sponsor Alderwoman Ruth Cruz (30th Ward) led the Council’s adoption of a Medicare for All Resolution that was introduced by Illinois Single Payer Coalition and their supporting partners. As of this writing, 136 cities and counties have already passed Medicare for All Resolutions in favor of Congress finally enacting (National Improved) Medicare for All. (Senate Bill 1506 / House Resolution 3609).

Sandwiched between military invasions, sky-rocketing inflation, increasing danger at United States airports and a global safety communique issued by the United States of America State Department warning of potential harm to citizens globally as a result of violent policies being executed by the current administration, the passage of the Resolution received little national media attention despite its historical significance.

Many of the people who were instrumental in getting the Chicago Medicare for All Resolution across the line have been working on campaigns of this sort for years. To help THE FINE PRINT readers understand how incremental policy wins of this sort impact patients, medical care professionals, business owners and candidates running for public office, I contacted a few key players to get their take.

“Chicago now ranks as the second-largest city after Los Angeles in the United States to demand Medicare for All. With 50 Alderpeople in the council, getting this resolution passed required significant collaboration between a network of activists, local organizations, and local government leaders. As a national Medicare for All Resolutions campaign, we provide a lot of information and guidance, but it’s really that persistence at the grassroots level – and the leadership of Alderwoman Cruz – that won the resolution,” said Brittany Shannahan, Medicare for All Campaign Organizer for Public Citizen.

“The message is the same as when Cook County (Chicago) passed a similar Resolution in 2019: Medicare for All would save the city money and guarantee care to all residents. No other bill in Congress would do this. Fortunately, a majority of Chicago’s Congresspeople are already cosponsors. This victory broadcasts that six years and two administrations later, Medicare for All is still the main solution to our broken, for-profit healthcare system, and, that it’s up to all of us to keep mobilizing in this way, whether you’re in a small town, a rural county, or a major city,” said Shannahan.

continue reading: https://somepeopleeverybody.substack.com…

‘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…

The Middlemen Making Money Off Medicaid

By Brenda Gazzar
Code Wack Podcast, March 23, 2026

Why are there middlemen in Medicaid – and what are they doing to our most vulnerable patients and physicians? How and why are private insurance intermediaries permitted to put profits ahead of patients? A recent report by Physicians for a National Health Program, titled Removing the Middlemen from Medicaid, pulls back the curtain on Managed Care Organizations (MCOs).

To learn more, we spoke with Dr. Alankrita Olson, a public health physician and advocate for a universal single-payer system. She serves on the board of Physicians for a National Health Program and works to protect and expand healthcare access for all Americans.

This is the first episode of a two-part series.

Check out the Transcript and Show Notes for more!

https://heal-ca.org…

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…

Pope Leo calls universal healthcare a “moral imperative”

By Joshua McElwee
Reuters, March 18, 2026

VATICAN CITY – Pope Leo made a plea on Wednesday for countries to offer their ​citizens universal healthcare, calling it a “moral imperative” that ‌people have access to the health services they need.

Previous popes have called for countries to offer universal healthcare, but calling ​an issue a “moral imperative” is an unusually strong ​term for a pope to use, indicating that ⁠something is required by Catholic teaching.

“Universal health coverage ​is … a moral imperative for societies that wish to ​call themselves just,” the pope said in a meeting with participants in a healthcare conference organised by the World Health Organization ​and European bishops.

“Healthcare must be accessible to the ​most vulnerable … not only because their dignity requires it but also ‌to ⁠prevent injustice from becoming a cause of conflict,” he said. “Health cannot be a luxury for the few.”

Leo’s predecessor, Pope Francis, called in 2021 for healthcare systems to ​be “accessible to ​all,” citing ⁠Italy’s tax-funded health service as an example.

Leo is the first pope from the United ​States, which does not have universal health ​coverage. ⁠At Wednesday’s meeting, he urged bishops in Europe to address inequalities in healthcare.

“Only together can we build communities ⁠of solidarity ​capable of caring for everyone,” ​said the pope. “Caring for the humanity of others helps us to live ​our own lives to the full.”

https://reuters.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…

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