PNHP

Urban Institute’s attack on single payer

Urban Institute’s attack on single payer

The Sanders Single-Payer Health Care Plan: The Effect on National Health Expenditures and Federal and Private Spending

By John Holahan, Matthew Buettgens, Lisa Clemans-Cope, Melissa M. Favreault, Linda J. Blumberg, Slyabonga Ndwandwa
Urban Institute, May 9, 2016

Abstract

Presidential candidate Bernie Sanders proposed a single-payer system to replace all current health coverage. His system would cover all medically necessary care, including long-term care, without cost-sharing. We estimate that the approach would decrease the uninsured by 28.3 million people in 2017. National health expenditures would increase by $6.6 trillion between 2017 and 2026, while federal expenditures would increase by $32.0 trillion over that period. Sanders’s revenue proposals, intended to finance all health and nonhealth spending he proposed, would raise $15.3 trillion from 2017 to 2026—thus, the proposed taxes are much too low to fully finance his health plan.

http://www.urban.org/research/publication/sanders-single-payer-health-care-plan-effect-national-health-expenditures-and-federal-and-private-spending

Urban Institute Board of Trustees:
http://www.urban.org/about/board-of-directors

***

An Analysis of Senator Bernie Sanders’s Tax and Transfer Proposals

By Gordon B. Mermin, Leonard E. Burman, Frank Sammartino
Tax Policy Center, May 9, 2016

Abstract

Presidential candidate Bernie Sanders proposes significant tax increases that would raise $15.3 trillion over the next decade. All income groups would pay more tax, but most would come from high-income households, particularly those with very high incomes. Sanders would also implement new government benefits—notably government-financed single-payer health care, long-term services and supports, college, and family leave benefits—and expand Social Security benefits. TPC finds the new government benefits would more than offset new taxes for 95% of households but the combined tax and transfer plan would increase federal budget deficits by more than $18 trillion over the next decade.

http://www.taxpolicycenter.org/publications/analysis-senator-bernie-sanderss-tax-and-transfer-proposals

***

The Urban Institute’s Attack On Single Payer: Ridiculous Assumptions Yield Ridiculous Estimates

By David Himmelstein and Steffie Woolhandler
The Huffington Post, May 9, 2016

The Urban Institute and the Tax Policy Center today released analyses of the costs of Sen. Bernie Sanders’ domestic policy proposals, including single-payer national health insurance. They claim that Sanders’ proposals would raise the federal deficit by $18 trillion over the next decade.

We won’t address all of the issues covered in these analyses, just single-payer Medicare for all. To put it bluntly, the estimates (which were prepared by John Holahan and colleagues) are ridiculous. They project outlandish increases in the utilization of medical care, ignore vast savings under single-payer reform, and ignore the extensive and well-documented experience with single-payer systems in other nations – which all spend far less per person on health care than we do.

The authors’ anti-single-payer bias is also evident from their incredible claims that physicians’ incomes would be squeezed (which contradicts their own estimates positing a sharp rise in spending on physician services), and that patients would suffer huge disruptions, despite the fact that the implementation of single-payer systems elsewhere, as well as the start-up of Medicare, were disruption-free.

We outline below some of the most glaring errors in the Holahan analysis (which served as the basis for Tax Policy Center’s estimates) regarding health care spending under the Sanders plan.

1. Administrative savings, Part 1: Holahan assumes that insurance overhead would be reduced to 6 percent of total health spending from the current level of 9.5 percent. They base this 6 percent estimate on figures for Medicare’s current overhead, which include the extraordinarily high overhead costs of private Medicare HMOs run by UnitedHealthcare and other insurance firms. However, Sen. Sanders’ proposal would exclude these for-profit insurers, and instead build on the traditional Medicare program, whose overhead is less than 3 percent. Moreover, even this 3 percent figure is probably too high, since Sanders’ plan would simplify hospital payment by funding them through global budgets (similar to the way fire departments are paid), rather than the current patient-by-patient payments. Hence a more realistic estimate would assume that insurance overhead would drop to Canada’s level of about 1.8 percent. Cutting insurance overhead to 2 percent (rather than the 6 percent that Holahan projects) would save an additional $1.7 trillion over the next 10 years.

2. Administrative savings, Part 2: Holahan completely ignores the huge savings on hospital administration and doctors’ billing under a streamlined single-payer system. Every serious analyst of single-payer reform has acknowledged these savings, including the Congressional Budget Office, the Government Accountability Office, the Lewin Group (a consulting firm owned by UnitedHealth Group), and even Kenneth Thorpe (a former Clinton administration official who has criticized Sanders’ plan, although his recent estimates of savings are far lower than those he made prior to the current presidential campaign).

These provider savings on paperwork would, in fact, be much larger than the savings on insurance overhead. At present, U.S. hospitals spend one-quarter of their total budgets on billing and administration, more than twice as much as hospitals spend in single-payer systems like Canada’s or Scotland’s. Similarly, U.S. physicians, who must bill hundreds of different insurance plans with varying payment and coverage rules, spend two to three times as much as our Canadian colleagues on billing.

Overall, these administrative savings for doctors and hospitals would amount to about $2.57 trillion over 10 years. Additional savings of more than $1.5 trillion from streamlined billing and administration would accrue to nursing homes, home care agencies, ambulance companies, drug stores and other health care providers.

In total, the Holahan analysis underestimates administrative savings by about $6 trillion over 10 years.

3. Drug costs: Holahan projects that a single-payer plan would have to pay 50 percent higher drug costs than those paid at present by Medicaid. Moreover, their estimate assumes that the U.S. would continue to pay much higher prices for drugs than other nations, despite the fact that a U.S. single-payer system would have much greater negotiating leverage with drug companies than other national health insurance schemes.

Reducing drug prices to the levels currently paid by European nations would save at least $1.1 trillion more than Holahan posits over 10 years.

4. Utilization of care: Holahan projects a massive increase in acute care utilization, but does not provide detailed breakdowns of how big an increase they foresee for specific services like doctor visits or hospital care. However, it is clear that the medical care system does not have the capacity to provide the huge surge in care that he posits.

For instance Holahan’s figures for the increase in acute care suggest that Sanders’ plan would result in more than 100 million additional doctor visits and several million more hospitalizations each year. But there just aren’t enough doctors and hospital beds to deliver that much care. Doctors are already working 53 hours per week, and experience from past reforms tells us that they won’t increase their hours, nor will they see many more patients per hour.

Instead of a huge surge in utilization, more realistic projections would assume that doctors and hospitals would reduce the amount of unnecessary care they’re now delivering in order to deliver needed care to those who are currently not getting what they need. That’s what happened in Canada. Doctors and hospitals can adjust care to meet increasing demand, as happens every year during flu season.

Moreover, no surge materialized when Medicare was implemented and millions of previously uninsured seniors got coverage. Between 1964 (before Medicare) and 1966 (the year when Medicare was fully functioning) there was absolutely no increase in the total number of doctor visit in the U.S.; Americans averaged 4.3 visits per person in 1964 and 4.3 visits per person in 1966. Instead, the number of visits by poor seniors went up, while the number of visits by healthy and wealthy patients went down slightly. The same thing happened in hospitals. There were no waiting lists, just a reduction in the utilization of unneeded elective care by wealthier patients, and the delivery of more care to sick people who needed it.

Bizarrely, despite projecting a roughly $1.6 trillion increase in total payments to doctors over 10 years, Holahan says in his discussion that “Physician incomes would be squeezed by the new payment rates.”

5. Holahan’s argument that the Sanders plan would cause a huge disruption of health care: This argument mirrors scare tactics used by Medicare’s opponents in 1963. Back then, there were claims that doctors would boycott Medicare, and Wall Street Journal headlines warned of a “Patient Pileup,” as “flocks of Medicare beneficiaries … suddenly clog the nation’s 7,200 hospitals.” Nothing like that ever happened, nor did it happen when Taiwan implemented single payer more recently. And there’s no reason to think it would happen here.

Moreover, surveys show that most doctors would welcome national health insurance, and thousands of doctors have recently issued a call (and detailed proposal) for single-payer reform in the American Journal of Public Health.

In summary, Holahan grossly underestimates the administrative savings under single payer; projects increases in the number of doctor visits and hospitalizations that far exceed the capacity of doctors and hospitals to provide this added care; and posits that our country would continue to pay much more for drugs and medical equipment than people in every other nation with national health insurance.

Rather than increasing national health spending, as Holahan claims, Sanders’ plan (and the plan proposed by Physicians for a National Health Program) would almost certainly decrease total health spending over the next 10 years.

Drs. Himmelstein and Woolhandler are professors of health policy and management at the City University of New York School of Public Health and lecturers in medicine at Harvard Medical School. The opinions expressed do not necessarily reflect those institutions’.

http://www.huffingtonpost.com/david-himmelstein/the-urban-institutes-attack-on-single-payer-ridiculous-assumptions-yield-ridiculous-estimates_b_9876640.html

***

Comment:

By Don McCanne, M.D.

The health policy literature is rich with studies, reports and data confirming the that single payer health care financing is much more effective in ensuring universal coverage at lower costs than is our current fragmented, dysfunctional system of financing health care. Yet there has been a recent surge of interest in analyzing the single payer model, directly attributed to Sen. Bernie Sanders’ advocacy for it during his presidential campaign. These reports from the Urban Institute and the Tax Policy Center are the latest which question the well documented fact that single payer would reduce per capita spending.

What is going on here? These two organizations are highly reputable and have produced many studies that are quite credible. Yet the nation’s two leading researchers in single payer, Steffie Woolhandler and David Himmelstein, with their impeccable integrity, have shown that the researchers producing the critical reports have used incorrect assumptions in their analyses. This is not a matter of conflicting opinions, but rather a matter of the factual basis behind the assumptions. Yet the media ignore the facts and distribute only the compromised results from these otherwise reputable individuals and institutions that challenge the savings that would be accrued through the single payer model.

Why would John Holahan and his colleagues at the Urban Institute do this, at this time? Perhaps the composition of the Board of Trustees might give us a clue (link above). Most of them are members of “the establishment”, many of them have served in President Clinton’s administration (as did another critic – Kenneth Thorpe), and some are conservatives opposed to single payer. (The Tax Policy Center is a joint project of the Urban Institute and the Brookings Institution.) The timing of this report suggests that it is more than coincidental that it would be used to help defeat the only current challenger to Hillary Clinton’s quest for the Democratic presidential nomination.

But why would respected researchers agree to such a blatantly political use of their work product? If you check their credentials, they are all deeply involved in health policy research that is designed to improve the function of our health care system, particularly its financing. That is, they are avowed incrementalists. Single payer would displace much of the work they have done with private insurance markets, Medicare, Medicaid, safety-net institutions and other aspects of our dysfunctional system. They are likely not well informed on single payer policy science since that has not been on their radar. This is not questioning the integrity of these researchers but merely an observation as to how they could come up with invalid conclusions. Their minds are simply pre-programmed to produce the results they get.

Hillary Clinton has declared that she will not consider single payer. When the policy community should be making efforts to convince her to support a superior model of reform they are instead discrediting that model in order to support her and Obamacare – the most expensive model of reform and one that fails to accomplish our goals of universality, efficiency and equity. Sadly, that reflects poorly on the policy community.

PNHP is a single issue organization supporting research and education on single payer reform. PNHP does not support nor oppose any political candidates.

The Urban Institute’s Attack On Single Payer: Ridiculous Assumptions Yield Ridiculous Estimates

By David U. Himmelstein, M.D., and Steffie Woolhandler, M.D., M.P.H.
The Huffington Post, May 9, 2016

The Urban Institute and the Tax Policy Center today released analyses of the costs of Sen. Bernie Sanders’ domestic policy proposals, including single-payer national health insurance. They claim that Sanders’ proposals would raise the federal deficit by $18 trillion over the next decade.

We won’t address all of the issues covered in these analyses, just single-payer Medicare for all. To put it bluntly, the estimates (which were prepared by John Holahan and colleagues) are ridiculous. They project outlandish increases in the utilization of medical care, ignore vast savings under single-payer reform, and ignore the extensive and well-documented experience with single-payer systems in other nations – which all spend far less per person on health care than we do.

The authors’ anti-single-payer bias is also evident from their incredible claims that physicians’ incomes would be squeezed (which contradicts their own estimates positing a sharp rise in spending on physician services), and that patients would suffer huge disruptions, despite the fact that the implementation of single-payer systems elsewhere, as well as the start-up of Medicare, were disruption-free.

We outline below some of the most glaring errors in the Holahan analysis (which served as the basis for Tax Policy Center’s estimates) regarding health care spending under the Sanders plan.

1. Administrative savings, Part 1: Holahan assumes that insurance overhead would be reduced to 6 percent of total health spending from the current level of 9.5 percent. They base this 6 percent estimate on figures for Medicare’s current overhead, which include the extraordinarily high overhead costs of private Medicare HMOs run by UnitedHealthcare and other insurance firms. However, Sen. Sanders’ proposal would exclude these for-profit insurers, and instead build on the traditional Medicare program, whose overhead is less than 3 percent. Moreover, even this 3 percent figure is probably too high, since Sanders’ plan would simplify hospital payment by funding them through global budgets (similar to the way fire departments are paid), rather than the current patient-by-patient payments. Hence a more realistic estimate would assume that insurance overhead would drop to Canada’s level of about 1.8 percent. Cutting insurance overhead to 2 percent (rather than the 6 percent that Holahan projects) would save an additional $1.7 trillion over the next 10 years.

2. Administrative savings, Part 2: Holahan completely ignores the huge savings on hospital administration and doctors’ billing under a streamlined single-payer system. Every serious analyst of single-payer reform has acknowledged these savings, including the Congressional Budget Office, the Government Accountability Office, the Lewin Group (a consulting firm owned by UnitedHealth Group), and even Kenneth Thorpe (a former Clinton administration official who has criticized Sanders’ plan, although his recent estimates of savings are far lower than those he made prior to the current presidential campaign).

These provider savings on paperwork would, in fact, be much larger than the savings on insurance overhead. At present, U.S. hospitals spend one-quarter of their total budgets on billing and administration, more than twice as much as hospitals spend in single-payer systems like Canada’s or Scotland’s. Similarly, U.S. physicians, who must bill hundreds of different insurance plans with varying payment and coverage rules, spend two to three times as much as our Canadian colleagues on billing.

Overall, these administrative savings for doctors and hospitals would amount to about $2.57 trillion over 10 years. Additional savings of more than $1.5 trillion from streamlined billing and administration would accrue to nursing homes, home care agencies, ambulance companies, drug stores and other health care providers.

In total, the Holahan analysis underestimates administrative savings by about $6 trillion over 10 years.

3. Drug costs: Holahan projects that a single-payer plan would have to pay 50 percent higher drug costs than those paid at present by Medicaid. Moreover, their estimate assumes that the U.S. would continue to pay much higher prices for drugs than other nations, despite the fact that a U.S. single-payer system would have much greater negotiating leverage with drug companies than other national health insurance schemes.

Reducing drug prices to the levels currently paid by European nations would save at least $1.1 trillion more than Holahan posits over 10 years.

4. Utilization of care: Holahan projects a massive increase in acute care utilization, but does not provide detailed breakdowns of how big an increase they foresee for specific services like doctor visits or hospital care. However, it is clear that the medical care system does not have the capacity to provide the huge surge in care that he posits.

For instance Holahan’s figures for the increase in acute care suggest that Sanders’ plan would result in more than 100 million additional doctor visits and several million more hospitalizations each year. But there just aren’t enough doctors and hospital beds to deliver that much care. Doctors are already working 53 hours per week, and experience from past reforms tells us that they won’t increase their hours, nor will they see many more patients per hour.

Instead of a huge surge in utilization, more realistic projections would assume that doctors and hospitals would reduce the amount of unnecessary care they’re now delivering in order to deliver needed care to those who are currently not getting what they need. That’s what happened in Canada. Doctors and hospitals can adjust care to meet increasing demand, as happens every year during flu season.

Moreover, no surge materialized when Medicare was implemented and millions of previously uninsured seniors got coverage. Between 1964 (before Medicare) and 1966 (the year when Medicare was fully functioning) there was absolutely no increase in the total number of doctor visit in the U.S.; Americans averaged 4.3 visits per person in 1964 and 4.3 visits per person in 1966. Instead, the number of visits by poor seniors went up, while the number of visits by healthy and wealthy patients went down slightly. The same thing happened in hospitals. There were no waiting lists, just a reduction in the utilization of unneeded elective care by wealthier patients, and the delivery of more care to sick people who needed it.

Bizarrely, despite projecting a roughly $1.6 trillion increase in total payments to doctors over 10 years, Holahan says in his discussion that “Physician incomes would be squeezed by the new payment rates.”

5. Holahan’s argument that the Sanders plan would cause a huge disruption of health care: This argument mirrors scare tactics used by Medicare’s opponents in 1963. Back then, there were claims that doctors would boycott Medicare, and Wall Street Journal headlines warned of a “Patient Pileup,” as “flocks of Medicare beneficiaries … suddenly clog the nation’s 7,200 hospitals.” Nothing like that ever happened, nor did it happen when Taiwan implemented single payer more recently. And there’s no reason to think it would happen here.

Moreover, surveys show that most doctors would welcome national health insurance, and thousands of doctors have recently issued a call (and detailed proposal) for single-payer reform in the American Journal of Public Health.

In summary, Holahan grossly underestimates the administrative savings under single payer; projects increases in the number of doctor visits and hospitalizations that far exceed the capacity of doctors and hospitals to provide this added care; and posits that our country would continue to pay much more for drugs and medical equipment than people in every other nation with national health insurance.

Rather than increasing national health spending, as Holahan claims, Sanders’ plan (and the plan proposed by Physicians for a National Health Program) would almost certainly decrease total health spending over the next 10 years.

Drs. Himmelstein and Woolhandler are professors of health policy and management at the City University of New York School of Public Health and lecturers in medicine at Harvard Medical School. The opinions expressed do not necessarily reflect those institutions’.

http://www.huffingtonpost.com/david-himmelstein/the-urban-institutes-attack-on-single-payer-ridiculous-assumptions-yield-ridiculous-estimates_b_9876640.html

PNHP note: Physicians for a National Health Program (PNHP) is a nonpartisan educational and research organization. It neither supports nor opposes any candidate for public office.

Urban Institute’s attack on single payer

The Sanders Single-Payer Health Care Plan: The Effect on National Health Expenditures and Federal and Private Spending

By John Holahan, Matthew Buettgens, Lisa Clemans-Cope, Melissa M. Favreault, Linda J. Blumberg, Slyabonga Ndwandwa
Urban Institute, May 9, 2016

Abstract

Presidential candidate Bernie Sanders proposed a single-payer system to replace all current health coverage. His system would cover all medically necessary care, including long-term care, without cost-sharing. We estimate that the approach would decrease the uninsured by 28.3 million people in 2017. National health expenditures would increase by $6.6 trillion between 2017 and 2026, while federal expenditures would increase by $32.0 trillion over that period. Sanders’s revenue proposals, intended to finance all health and nonhealth spending he proposed, would raise $15.3 trillion from 2017 to 2026—thus, the proposed taxes are much too low to fully finance his health plan.

http://www.urban.org/research/publication/sanders-single-payer-health-care-plan-effect-national-health-expenditures-and-federal-and-private-spending

Urban Institute Board of Trustees:
http://www.urban.org/about/board-of-directors

***

An Analysis of Senator Bernie Sanders’s Tax and Transfer Proposals

By Gordon B. Mermin, Leonard E. Burman, Frank Sammartino
Tax Policy Center, May 9, 2016

Abstract

Presidential candidate Bernie Sanders proposes significant tax increases that would raise $15.3 trillion over the next decade. All income groups would pay more tax, but most would come from high-income households, particularly those with very high incomes. Sanders would also implement new government benefits—notably government-financed single-payer health care, long-term services and supports, college, and family leave benefits—and expand Social Security benefits. TPC finds the new government benefits would more than offset new taxes for 95% of households but the combined tax and transfer plan would increase federal budget deficits by more than $18 trillion over the next decade.

http://www.taxpolicycenter.org/publications/analysis-senator-bernie-sanderss-tax-and-transfer-proposals

***

The Urban Institute’s Attack On Single Payer: Ridiculous Assumptions Yield Ridiculous Estimates

By David Himmelstein and Steffie Woolhandler
The Huffington Post, May 9, 2016

The Urban Institute and the Tax Policy Center today released analyses of the costs of Sen. Bernie Sanders’ domestic policy proposals, including single-payer national health insurance. They claim that Sanders’ proposals would raise the federal deficit by $18 trillion over the next decade.

We won’t address all of the issues covered in these analyses, just single-payer Medicare for all. To put it bluntly, the estimates (which were prepared by John Holahan and colleagues) are ridiculous. They project outlandish increases in the utilization of medical care, ignore vast savings under single-payer reform, and ignore the extensive and well-documented experience with single-payer systems in other nations – which all spend far less per person on health care than we do.

The authors’ anti-single-payer bias is also evident from their incredible claims that physicians’ incomes would be squeezed (which contradicts their own estimates positing a sharp rise in spending on physician services), and that patients would suffer huge disruptions, despite the fact that the implementation of single-payer systems elsewhere, as well as the start-up of Medicare, were disruption-free.

We outline below some of the most glaring errors in the Holahan analysis (which served as the basis for Tax Policy Center’s estimates) regarding health care spending under the Sanders plan.

1. Administrative savings, Part 1: Holahan assumes that insurance overhead would be reduced to 6 percent of total health spending from the current level of 9.5 percent. They base this 6 percent estimate on figures for Medicare’s current overhead, which include the extraordinarily high overhead costs of private Medicare HMOs run by UnitedHealthcare and other insurance firms. However, Sen. Sanders’ proposal would exclude these for-profit insurers, and instead build on the traditional Medicare program, whose overhead is less than 3 percent. Moreover, even this 3 percent figure is probably too high, since Sanders’ plan would simplify hospital payment by funding them through global budgets (similar to the way fire departments are paid), rather than the current patient-by-patient payments. Hence a more realistic estimate would assume that insurance overhead would drop to Canada’s level of about 1.8 percent. Cutting insurance overhead to 2 percent (rather than the 6 percent that Holahan projects) would save an additional $1.7 trillion over the next 10 years.

2. Administrative savings, Part 2: Holahan completely ignores the huge savings on hospital administration and doctors’ billing under a streamlined single-payer system. Every serious analyst of single-payer reform has acknowledged these savings, including the Congressional Budget Office, the Government Accountability Office, the Lewin Group (a consulting firm owned by UnitedHealth Group), and even Kenneth Thorpe (a former Clinton administration official who has criticized Sanders’ plan, although his recent estimates of savings are far lower than those he made prior to the current presidential campaign).

These provider savings on paperwork would, in fact, be much larger than the savings on insurance overhead. At present, U.S. hospitals spend one-quarter of their total budgets on billing and administration, more than twice as much as hospitals spend in single-payer systems like Canada’s or Scotland’s. Similarly, U.S. physicians, who must bill hundreds of different insurance plans with varying payment and coverage rules, spend two to three times as much as our Canadian colleagues on billing.

Overall, these administrative savings for doctors and hospitals would amount to about $2.57 trillion over 10 years. Additional savings of more than $1.5 trillion from streamlined billing and administration would accrue to nursing homes, home care agencies, ambulance companies, drug stores and other health care providers.

In total, the Holahan analysis underestimates administrative savings by about $6 trillion over 10 years.

3. Drug costs: Holahan projects that a single-payer plan would have to pay 50 percent higher drug costs than those paid at present by Medicaid. Moreover, their estimate assumes that the U.S. would continue to pay much higher prices for drugs than other nations, despite the fact that a U.S. single-payer system would have much greater negotiating leverage with drug companies than other national health insurance schemes.

Reducing drug prices to the levels currently paid by European nations would save at least $1.1 trillion more than Holahan posits over 10 years.

4. Utilization of care: Holahan projects a massive increase in acute care utilization, but does not provide detailed breakdowns of how big an increase they foresee for specific services like doctor visits or hospital care. However, it is clear that the medical care system does not have the capacity to provide the huge surge in care that he posits.

For instance Holahan’s figures for the increase in acute care suggest that Sanders’ plan would result in more than 100 million additional doctor visits and several million more hospitalizations each year. But there just aren’t enough doctors and hospital beds to deliver that much care. Doctors are already working 53 hours per week, and experience from past reforms tells us that they won’t increase their hours, nor will they see many more patients per hour.

Instead of a huge surge in utilization, more realistic projections would assume that doctors and hospitals would reduce the amount of unnecessary care they’re now delivering in order to deliver needed care to those who are currently not getting what they need. That’s what happened in Canada. Doctors and hospitals can adjust care to meet increasing demand, as happens every year during flu season.

Moreover, no surge materialized when Medicare was implemented and millions of previously uninsured seniors got coverage. Between 1964 (before Medicare) and 1966 (the year when Medicare was fully functioning) there was absolutely no increase in the total number of doctor visit in the U.S.; Americans averaged 4.3 visits per person in 1964 and 4.3 visits per person in 1966. Instead, the number of visits by poor seniors went up, while the number of visits by healthy and wealthy patients went down slightly. The same thing happened in hospitals. There were no waiting lists, just a reduction in the utilization of unneeded elective care by wealthier patients, and the delivery of more care to sick people who needed it.

Bizarrely, despite projecting a roughly $1.6 trillion increase in total payments to doctors over 10 years, Holahan says in his discussion that “Physician incomes would be squeezed by the new payment rates.”

5. Holahan’s argument that the Sanders plan would cause a huge disruption of health care: This argument mirrors scare tactics used by Medicare’s opponents in 1963. Back then, there were claims that doctors would boycott Medicare, and Wall Street Journal headlines warned of a “Patient Pileup,” as “flocks of Medicare beneficiaries … suddenly clog the nation’s 7,200 hospitals.” Nothing like that ever happened, nor did it happen when Taiwan implemented single payer more recently. And there’s no reason to think it would happen here.

Moreover, surveys show that most doctors would welcome national health insurance, and thousands of doctors have recently issued a call (and detailed proposal) for single-payer reform in the American Journal of Public Health.

In summary, Holahan grossly underestimates the administrative savings under single payer; projects increases in the number of doctor visits and hospitalizations that far exceed the capacity of doctors and hospitals to provide this added care; and posits that our country would continue to pay much more for drugs and medical equipment than people in every other nation with national health insurance.

Rather than increasing national health spending, as Holahan claims, Sanders’ plan (and the plan proposed by Physicians for a National Health Program) would almost certainly decrease total health spending over the next 10 years.

Drs. Himmelstein and Woolhandler are professors of health policy and management at the City University of New York School of Public Health and lecturers in medicine at Harvard Medical School. The opinions expressed do not necessarily reflect those institutions’.

http://www.huffingtonpost.com/david-himmelstein/the-urban-institutes-attack-on-single-payer-ridiculous-assumptions-yield-ridiculous-estimates_b_9876640.html

The health policy literature is rich with studies, reports and data confirming the that single payer health care financing is much more effective in ensuring universal coverage at lower costs than is our current fragmented, dysfunctional system of financing health care. Yet there has been a recent surge of interest in analyzing the single payer model, directly attributed to Sen. Bernie Sanders’ advocacy for it during his presidential campaign. These reports from the Urban Institute and the Tax Policy Center are the latest which question the well documented fact that single payer would reduce per capita spending.

What is going on here? These two organizations are highly reputable and have produced many studies that are quite credible. Yet the nation’s two leading researchers in single payer, Steffie Woolhandler and David Himmelstein, with their impeccable integrity, have shown that the researchers producing the critical reports have used incorrect assumptions in their analyses. This is not a matter of conflicting opinions, but rather a matter of the factual basis behind the assumptions. Yet the media ignore the facts and distribute only the compromised results from these otherwise reputable individuals and institutions that challenge the savings that would be accrued through the single payer model.

Why would John Holahan and his colleagues at the Urban Institute do this, at this time? Perhaps the composition of the Board of Trustees might give us a clue (link above). Most of them are members of “the establishment”, many of them have served in President Clinton’s administration (as did another critic – Kenneth Thorpe), and some are conservatives opposed to single payer. (The Tax Policy Center is a joint project of the Urban Institute and the Brookings Institution.) The timing of this report suggests that it is more than coincidental that it would be used to help defeat the only current challenger to Hillary Clinton’s quest for the Democratic presidential nomination.

But why would respected researchers agree to such a blatantly political use of their work product? If you check their credentials, they are all deeply involved in health policy research that is designed to improve the function of our health care system, particularly its financing. That is, they are avowed incrementalists. Single payer would displace much of the work they have done with private insurance markets, Medicare, Medicaid, safety-net institutions and other aspects of our dysfunctional system. They are likely not well informed on single payer policy science since that has not been on their radar. This is not questioning the integrity of these researchers but merely an observation as to how they could come up with invalid conclusions. Their minds are simply pre-programmed to produce the results they get.

Hillary Clinton has declared that she will not consider single payer. When the policy community should be making efforts to convince her to support a superior model of reform they are instead discrediting that model in order to support her and Obamacare – the most expensive model of reform and one that fails to accomplish our goals of universality, efficiency and equity. Sadly, that reflects poorly on the policy community.

PNHP is a single issue organization supporting research and education on single payer reform. PNHP does not support nor oppose any political candidates.

Mark Pauly’s answer to high drug prices: Walk away

Maybe we are to blame in part for rising cancer drug prices

By Mark V. Pauly, PhD
Philly.com, May 9, 2016

The prices of oral cancer drugs are rising. This will come as no surprise to anyone who has cancer or who knows someone who has it.

Why did these prices increase at this pace?  My visceral reaction, which I suspect is the same as yours, is to rail against “corporate greed,” something we have seen on display for even old drugs to a spectacular extent lately.

But here is my guess. The combination of rising consumer income (even with the recession) and the spread of drug insurance meant that the maximum amount consumers or their insurers were willing to pay for these effective drugs for desperate situations grew. It was growth in demand or consumer value that persuaded drug firms to develop drugs that would be profitable if introduced at higher prices.

If we consumers want to do something about rising prices for cancer drugs, we need (according to the hard-hearted economist) to do what happens when prices for gas, or steak, or designer ties is rising — we need to walk away from them. A tepid demand response will itself temper prices as well as total spending, and perhaps offer a cautionary lesson for future health care price increases.

http://www.philly.com/philly/blogs/health-cents/Maybe-we-are-to-blame-in-part-for-rising-cancer-drug-prices.html

***

S&P Healthcare Claims Index Monthly Report

Key 2015 Takeaways:

The December 2015 S&P Healthcare Claims Indices (the Indices) describe commercial healthcare costs that rose 50% more rapidly in 2015 than in 2014 – 6.50% vs. 4.33%.

Drug costs played a role by significantly increasing for the second straight year – rising 15.83% in 2015 (up from 12.58% in 2014 and 2.73% in 2013).

http://us.spindices.com/index-family/healthcare-claims/all

***

Comment:

By Don McCanne, M.D.

Drug prices are out of control. Wharton School’s Mark V. Pauly, PhD, of “moral hazard” fame, suggests that we, as consumers, can do something about it. We simply walk away from the high-priced drugs we need and then the markets will take care of the prices.

That might satisfy “the hard-hearted economist,” but there are other economic tools that can be used to achieve our objective: ensuring that everyone receives all essential health care services and products. Predominant amongst the alternative methods of health care financing would be single payer Medicare for all.

A publicly-financed system with government administered pricing and first dollar coverage is much more effective than markets in ensuring both appropriate pricing and access. Using the market tool of walking away eliminates access. That might be fine for designer ties, but it isn’t for health care.

More than 2,000 physicians back single-payer healthcare system that would save taxpayers $500 billion annually

The proposal would keep hospitals and clinics private, allow physicians to bill under a fee-for-service model, and be funded by combining current sources of government health spending into a single fund with modest new taxes.

By Jeff Lagasse
Healthcare IT News, May 9, 2016

More than 2,000 doctors backed a single-payer healthcare system in an article published by the American Journal of Public Health.

While Presidential candidate Vermont Sen. Bernie Sanders is running on a Medicare for all platform, the proposal authors called their recommendation strictly non-partisan and described a single-payer system as publicly financed and covering all Americans for medically necessary care.

Under the national health program outlined by the physicians, patients could choose to go to any doctor or hospital of their preference. Most hospitals and clinics would remain privately owned and operated, receiving a budget from the program to cover all operating costs. Physicians could continue to practice on a fee-for-service basis, or receive salaries from group practices, hospitals or clinics.

The program would be paid for by combining current sources of government health spending into a single fund with modest new taxes they claim would be fully offset by reductions in premiums and out-of-pocket spending. Co-pays and deductibles would be eliminated.

The single-payer program, they said, would save about $500 billion annually by eliminating the high overhead and profits of insurance firms, and the “massive paperwork” they inflict on hospitals and doctors.

The physicians also argued that the administrative savings of the streamlined system would fully offset the costs of covering the uninsured, as well as upgraded coverage for everyone else, including full coverage of prescription drugs, dental care and long-term care. Savings would also be redirected to what the group cites as “underfunded health priorities,” particularly public health.

The study also claims the “single payer” would be in a strong position to negotiate lower prices for medications and other medical supplies, yielding additional savings and reining in costs.

Adam Gaffney, a Boston-based pulmonary disease and critical care specialist who was co-chair of the working group that produced the proposal, said in a statement that the nation was at a crossroads.

“Despite the passage of the Affordable Care Act six years ago, 30 million Americans remain uninsured, an even greater number are underinsured, financial barriers to care like co-pays and deductibles are rising, bureaucracy is growing, provider networks are narrowing, and medical costs are continuing to climb,” he said. “Caring relationships are increasingly taking a back seat to the financial prerogatives of insurance firms, corporate providers, and Big Pharma. Our patients are suffering and our profession is being degraded and disfigured by these mercenary interests.”

Marcia Angell, a co-author of the proposal and member of the faculty of global health and social medicine at Harvard Medical School, said in a statement that the country “can no longer afford to waste the vast resources we do on the administrative costs, executive salaries, and profiteering of the private insurance system. We get too little for our money. It’s time to put those resources into real health care for everyone.”

Surveys show support for single-payer national health insurance may be rising among physicians. A 2008 survey of physicians found that 59 percent supported “legislation to establish national health insurance,” up from 49 percent five years earlier.

http://www.healthcareitnews.com/news/more-2000-physicians-back-single-payer-healthcare-system-would-save-taxpayers-500-billion

Mark Pauly’s answer to high drug prices: Walk away

Maybe we are to blame in part for rising cancer drug prices

By Mark V. Pauly, PhD
Philly.com, May 9, 2016

The prices of oral cancer drugs are rising. This will come as no surprise to anyone who has cancer or who knows someone who has it.

Why did these prices increase at this pace?  My visceral reaction, which I suspect is the same as yours, is to rail against “corporate greed,” something we have seen on display for even old drugs to a spectacular extent lately.

But here is my guess. The combination of rising consumer income (even with the recession) and the spread of drug insurance meant that the maximum amount consumers or their insurers were willing to pay for these effective drugs for desperate situations grew. It was growth in demand or consumer value that persuaded drug firms to develop drugs that would be profitable if introduced at higher prices.

If we consumers want to do something about rising prices for cancer drugs, we need (according to the hard-hearted economist) to do what happens when prices for gas, or steak, or designer ties is rising — we need to walk away from them. A tepid demand response will itself temper prices as well as total spending, and perhaps offer a cautionary lesson for future health care price increases.

http://www.philly.com/philly/blogs/health-cents/Maybe-we-are-to-blame-in-part-for-rising-cancer-drug-prices.html

***

S&P Healthcare Claims Index Monthly Report

Key 2015 Takeaways:

The December 2015 S&P Healthcare Claims Indices (the Indices) describe commercial healthcare costs that rose 50% more rapidly in 2015 than in 2014 – 6.50% vs. 4.33%.

Drug costs played a role by significantly increasing for the second straight year – rising 15.83% in 2015 (up from 12.58% in 2014 and 2.73% in 2013).

http://us.spindices.com/index-family/healthcare-claims/all

Drug prices are out of control. Wharton School’s Mark V. Pauly, PhD, of “moral hazard” fame, suggests that we, as consumers, can do something about it. We simply walk away from the high-priced drugs we need and then the markets will take care of the prices.

That might satisfy “the hard-hearted economist,” but there are other economic tools that can be used to achieve our objective: ensuring that everyone receives all essential health care services and products. Predominant amongst the alternative methods of health care financing would be single payer Medicare for all.

A publicly-financed system with government administered pricing and first dollar coverage is much more effective than markets in ensuring both appropriate pricing and access. Using the market tool of walking away eliminates access. That might be fine for designer ties, but it isn’t for health care.

There’s no place for rampant capitalism in treating the sick

By Michael Jones
Los Angeles Times, May 8, 2016

A good friend of mine recently found herself between jobs, with a gap in her health insurance and a recurrence of her kidney stones. What she needed were fluids and pain relief, fast. I’m a gastroenterologist, and hoping to minimize the financial impact, I went with her to our local ER and had a conversation with the attending physician. Maybe we could pass on the CT scan and extraneous lab work?

The attending was in her room for less than two minutes and never examined her. But the CT scan and blood work were ordered. My friend received intravenous fluids (about $1 worth), pain meds (about $5 worth of dilaudid), and a $10,000 bill from the hospital. To add insult to injury, the bill from the ER attending was for service at the highest billable level.

My friend had the good sense and gumption to call the ER group’s practice manager to point out that billing at that level was fraudulent. The ER group had the good sense to reduce the bill by half.

Shortly after that, I received a call from a patient on whom I had performed an upper endoscopy to remove a small gastric polyp. Because removing stomach polyps can be complicated by bleeding, I did the procedure in the hospital rather than an outpatient center. The whole thing took 15 minutes. Anesthesia wasn’t required, just routine conscious sedation. So, my patient wanted to know, what had I done that warranted an $18,000 bill from the hospital?

I had absolutely no explanation. For $18,000, you can just about buy your own endoscope. Amortized costs for an upper endoscopy at this hospital, including the use of the endoscopy unit, salaries for the whole staff, medication and equipment expenses is probably not more than $200 for 15 minutes. By the way, the doctor doing the procedure — in that case, me — typically gets about $175 for an upper endoscopy.

And then there are the costly procedures you could probably do without.

Recently, a surgical group owned by the same hospital hired a surgeon with an interest in esophageal disorders, particularly surgery for acid reflux — heartburn. He’s a good guy and capable.

So the hospital decided to create a “center of excellence” for esophageal diseases. A hurdle quickly became apparent. My town isn’t flush with esophageal experts. The hospital has excellent generalists who could contribute, but just one specialist surgeon who was retiring (hence the new hire). Still, the Joint Commission, an independent healthcare accreditation outfit, would certify the hospital’s new center if certain standards were met and a fee was paid. That’s not exactly the same as excellence.

A marketing plan was developed to get the word out. But really, far fewer than 1% of frequent heartburn sufferers will benefit from surgery. Most people with heartburn would be best served by getting help modifying their lifestyle. That’s particularly true because the behaviors associated with reflux (overeating, obesity, alcohol consumption and smoking, to name a few) are also risk factors for heart disease, diabetes and a variety of cancers.

However, lifestyle modifications are not profitable and surgery is very profitable. The surgeon (and his colleagues who agreed to work with the center) doesn’t want to perform surgery that’s inappropriate or not indicated. He’s not like that. But he’s employed by the hospital. You can see where this is going. The center is up and running.

The American healthcare system is capable of many wonderful things, but not all of them are about health or care. It is just as often about selling you things you probably don’t need at a ridiculous price, or finding ways to charge you a ridiculous price even for what you do need.

The folks driving it aren’t generally physicians, nurses or other “healthcare providers” (to use the parlance of the times). They are businesspeople — executives that run hospitals, pharmaceutical concerns and insurance companies — using healthcare as their instrument to make money. And sadly, the average physician doesn’t have a lot of choice about lashing his raft to these organizations if he wants to practice his trade.

As a nation, we spend far more than other developed countries for healthcare, and our outcomes are not as good. Those other countries generally have some form of a single-payer system. Here, we’re told single-payer horror stories: People are dying in Canada and England waiting for care.

I’ve got news from the front lines of the U.S. system. People are dying here, too, in large numbers, and at the same time they’re going broke paying the bills. Medical expenses, even now that many more people have some form of insurance, are a prime cause of bankruptcy and financial insecurity in the U.S.

No healthcare system is perfect, but here’s what the rest of the civilized world understands: Healthcare is a right. There is no place for rampant capitalism in treating the sick. This advice is harsh but true: When it comes to your healthcare, buyer beware.

Michael Jones is in private practice on the Eastern seaboard.

http://www.latimes.com/opinion/op-ed/la-oe-jones-healthcare-buyer-beware-20160508-story.html

Doctors Agree With Sanders on Universal Health Care; Interview With Dr. Adam Gaffney

By Viji Sundara
New America Media, May 7, 2016

Presidential hopefuls have their own ideas on what to do with the Affordable Care Act (ACA), President Obama’s signature legislation, when they move into the White House.

Sen. Bernie Sanders thinks it should be replaced with a single-payer health plan of the kind Europe and Canada have. This federally administered universal health care program would eliminate copays and deductibles. There’s currently a move afoot in Colorado to have such a plan.

Secretary Hillary Clinton would like to keep the ACA, with a few fixes.

Donald Trump says he will uproot the ACA, get Congress to allow the sale of health insurance across state lines and allow individuals to take tax deductions for insurance premium payments. But that would not help low-income Americans because they do not pay much in income taxes.

This week, the American Journal of Public Health carried a proposal by a working group of more than 2,000 physicians nationwide titled: Moving Forward from the Affordable Care Act to a Single-Payer system. The physicans warn that the risks of continuing the ACA will leave millions uninsured indefinitely.

NAM health editor Viji Sundaram interviewed Dr. Adam Gaffney, a co-chair of the working group.

Your proposal calls for a single-payer health care plan for the United States. Obamacare has helped 16.9 million people become newly insured. Would it not be less disruptive to expand the provisions in the ACA instead of repealing the law and replacing it?

The U.S. health system is highly disruptive as things stand now. You’re liable to lose your insurance at any time – for instance, if you change your job or get divorced. Similarly, those purchasing plans on the “marketplaces” may find that they can keep down premium increases by changing plans on an annual basis. Every time your insurance plan changes, you may need to change all of your doctors and hospitals in order to stay “in network.” This is enormously disruptive to people’s health care. In contrast, in a single-payer system, everyone has free choice of doctors and hospitals.

Your proposal promises health coverage for all. Does this include undocumented U.S. residents?

Yes, it would. The single-payer national health program we envision would include everyone regardless of country of origin, including undocumented residents. If we believe that health care is truly a human right, then this is the right thing to do. At the same time, it is also financially achievable. Immigrants, on average, have lower health care spending as compared to those born in the United States. One study demonstrated that immigrants actually pay more into Medicare than what they use in terms of health care. Everyone would be included in the national health program we envision.

Why do you think there would be no additional government spending if the United States has a single-payer health care plan? Countries such as Canada and the England run their national health program on the backs of taxpayers. Will that happen in the United States as well? Can it be done without raising taxes?

There would be additional government spending with a single-payer plan, but this would be offset by the elimination of spending by individuals and employers on premiums, co-payments, and deductibles. We can expand coverage to everyone in the country and eliminate co-payments and deductibles, and at the same time keep overall current health care spending roughly unchanged.

Some providers criticize single-payer plan as one that will force them to contract with the one payer available. Currently, providers have some choice of insurers. They can even opt out of Medicare and Medicaid.

There are many benefits for practices to have to contract with only one payer: it’s much simpler and is less costly from an administrative perspective.

How would you respond to the criticism of the single payer program as having the capacity to get doctors to sign in with fairly attractive reimbursement rates, but once in, those rates can come down, leaving providers helpless?

Because the vast majority of the nation’s doctors would participate in the national health program, there would be a powerful lobby fighting to ensure that reimbursements remain fair.

In countries that have a single-payer health care system, there seems to be a long waiting period before a patient can see a doctor. How can we keep that from happening in this country?

The problem of waiting times for care in other nations is often exaggerated. Moreover, where there are excessive waiting times for elective procedures, it is often due to underinvestment. We spend much more than other countries on health care, and have the resources to ensure that waiting times for elective procedures are reasonable. It’s also worth noting that we have waiting times in the United States also, though they are not as visible. Indeed, if you have the wrong insurance plan [currently], the waiting time for some providers may, so to speak, be infinite.

The UK allows people to be in both the national health plan as well as subscribe to a private insurance plan, which they can fall back on for expedited care. But your plan calls for an end to commercial insurance.

First, if providers must bill and contend with multiple different insurance plans, we lose the efficiency savings that come with a single universal system. Second, if we give the rich preferential access to superior and expedited care while relegating everyone else to an inferior tier, we make a mockery of the idea of an equal right to health care. Third, the best way to ensure that the quality of health care is superb is having everybody – whether rich or poor – in the same system together.

Medicaid and Medicare depend on the cost shift from private payers. Some providers say the only way doctors are willing to get into the Medicare network is because they get higher payment from commercial insurers.

Doctors would continue to do well under a Medicare-for-All system. The transition to a single-payer system would eliminate the need to bill and contend with a multiplicity of payers, producing substantial savings for practices (and hospitals).

How much could the United States save by switching to a single-payer health plan? What does it currently spend?

It is estimated that upwards of $400 billion a year could be saved from reduced spending on administration and billing that would occur through the transition to a single-payer plan. Additional money could be saved when the national health program enters into direct negotiations with pharmaceutical companies over drug prices. These savings could then be used to cover everybody in the country, while at the same time eliminating copayments and deductibles. Overall health care spending, at the end of the day, would be approximately the same as it is now, but nobody would ever again have to worry about losing insurance, about paying a big deductible if they got sick, or about not having access to the doctor or hospital of their choose.

Dr. Adam Gaffney, M.D. is in the Pulmonary and Critical Care Fellowship Program at Massachusetts General Hospital.

http://newamericamedia.org/2016/05/doctors-agree-with-sanders-on-universal-health-care.php

PNHP note: Physicians for a National Health Program (PNHP) is a nonpartisan educational and research organization. It neither supports nor opposes any candidate for public office.


Kids need healthy mothers

How Are Moms Faring under the Affordable Care Act? Evidence through 2014

By Michael Karpman, Jason Gates, Genevieve M. Kenney, Stacey McMorrow
Urban Institute, May 5, 2016

The number of uninsured mothers fell from 7.5 million in 2013 to 5.9 million in 2014, as the uninsurance rate for mothers reached its lowest point since 1997. The largest declines in uninsurance were found among low- and moderate-income mothers who were targeted by the ACA’s Medicaid expansion and the introduction of subsidized Marketplace coverage, respectively.

Despite these gains in coverage, nearly one in six mothers remained uninsured in 2014, and these mothers were disproportionately young, low-income, Hispanic, noncitizens, less educated, not married, and living in the South. One particularly concerning finding is that about one in five mothers who were likely to have the greatest physical and mental health care needs—those who reported being in less than very good health or having moderate or severe psychological distress—were uninsured.

When asked about the reasons why they do not have health insurance or stopped having coverage, 41.5 percent of uninsured mothers in 2014 said it was because the cost was too high. The next most frequently reported reason was that coverage stopped after pregnancy (18.7 percent). In addition, some mothers identified their inability to get employer-based coverage as a reason for being uninsured, either because they or the person in their family with coverage lost or changed jobs (18.0 percent) or because their current employer does not offer coverage (7.3 percent). Over 5 percent said they had lost Medicaid or other coverage because of a new job or increase in income, and 18.6 percent reported not having coverage for other reasons, such as divorce, separation, or death of a spouse or parent, becoming ineligible because of age or leaving school, denial of coverage from an insurance company, or not needing coverage.

http://www.urban.org/research/publication/how-are-moms-faring-under-affordable-care-act-evidence-through-2014

***

Comment:

By Don McCanne, M.D.

Most would agree that having healthy mothers would be of benefit to their children. Suppose 5.9 million mothers were uninsured, wouldn’t it seem that we should enact health care reform that would address this problem? In fact, we did enact the Affordable Care Act, and between 2013 and 2014 the number dropped from 7.5 million to 5.9 million. Rather than celebrating the “success” of ACA reform, shouldn’t we be advocating for reform that really does work for everyone?

Yesterday, the Physicians’ Proposal for Single-Payer Health Care Reform was released. Under that proposal the number of uninsured mothers would drop to zero. At the following link you can read and download the Proposal and its supporting documents, and provide your personal endorsement:

https://www.pnhp.org/beyondaca

You don’t want to trouble yourself by providing an endorsement? But Mother’s Day is this weekend. Surely you’ll reconsider, you know, for Mom.

Growing Support for a National Health Program and Health Care as a Human Right

By John Geyman, M.D.
The Huffington Post, May 5, 2016

We can thank Bernie Sanders’ presidential campaign for putting single-payer national health insurance (NHI) on the front burner of today’s national political discussion. This is long overdue and especially timely as the two parties debate alternatives for future U. S. health care. It appears that political feasibility for NHI may finally be approaching a time of acceptance, if our democracy can prevail over oligarchy and plutocracy.

The 20,000 physician-strong Physicians for a National Health Program (PNHP) has released today a Physicians’ Proposal for Single-Payer Health Care Reform, updated from its 2003 proposal1, with an accompanying editorial.2 It describes how traditional Medicare can be expanded to cover our entire population for necessary health care, provide comprehensive benefits to all Americans, give us free choice of physician and hospital, reduce waste and bureaucracy, and save money at the same time.

This proposal by a non-partisan, not-for-profit national organization has been endorsed by more than 2,200 physician colleagues in all specialties.3 More recently, it has been endorsed by an additional 560 other health professionals and medical students.4 In its 2004 report, the Institute of Medicine (now the National Academy of Medicine) called for universal health care by 2010, listing single-payer NHI as one of the alternatives; none of the other alternatives could ever be expected to achieve universal coverage, as they remain part of the problem.5

This 2016 election season brings us three very different alternatives concerning future health care in this country: (1) continuation of the Affordable Care Act (ACA) with changes as necessary; (2) a Republican “plan” for health care; and (3) single-payer NHI. Despite some expansions of coverage, especially through Medicaid, the ACA has failed to make health care more affordable, has accelerated waste, bureaucracy and profiteering, and is unsustainable. Yet Hillary Clinton calls for expansion of the ACA to 100 percent coverage with no possible way of doing it by retaining some 1,300 private insurers. She also claims disingenuously that NHI will raise our taxes—without acknowledging that Gerald Friedman’s classic 2013 study found that 95 percent of Americans will pay less for insurance premiums, deductibles, co-payments, actual care and out-of-pocket payments, and that only the wealthiest five percent would pay more.6

Although no concrete plan has yet been advanced by the GOP, we can expect that it will repeal the ACA, then “replace” it with long discredited reliance on free markets in health care, consumer directed health care, health savings accounts, selling insurance across state lines, and high-risk pools.

Neither the ACA nor GOP options will make health care more affordable or accessible.

Single-payer NHI is the only alternative that will achieve universal coverage in an affordable and sustainable way. A strong case for it has been made elsewhere on economic, sociopolitical, and moral grounds.7 It will meet conservatives’ principles regardless of party affiliation, including efficiency, maximal choice, minimal waste, value, and everyone contributes in proportion to his or her income.8 Long an iconic guru of free-market economics, Kenneth J. Arrow has recently acknowledged that “a single-payer system is better than any other system,” as long as private practice is preserved (as it would be with NHI).9

We know that powerful forces are aligned against passage of NHI, including private insurers, Big PhRMA, medical device makers, and other members of the medical-industrial complex. They are empowered further by their hundreds of lobbyists and corporate money in our post-Citizens United world. As Bernie Sanders has observed: “the Koch brothers, as the second-wealthiest family in America with $82 billion in wealth, advocate destruction of federal programs that are critical to the financial and personal health of middle-class Americans.”10

Sorting through the three major financing alternatives for our health care will test whether or not we have a real democracy. Much of the corporate-owned media under-report the single-payer alternative, misinform the public, and perpetuate myths, such as we can’t afford NHI, net spending would go up because of increased taxes, or the government would ration care. These myths and memes have been discussed in detail elsewhere.11 Solid, reliable updated information on NHI can be found on PNHP’s website (www.pnhp.org).

Democracy can win, but we will need progressive leadership. It is encouraging that Bernie is leading in recent polls in a matchup against Donald Trump or any other Republican presidential nominee. With a large and growing grassroots support from across the country, Bernie should have considerable leverage on the Democratic platform, which hopefully can move Hillary to a progressive position on health care. Recall Hillary’s words in 1994, speaking to a group at Lehman Brothers Health Corporation:

“[I]f there is no health care reform this year, and if, for whatever  reason, the Congress doesn’t pass health care reform . . . I believe that by the year 2000 we will have a single-payer system . . . I don’t even think it’s a close call politically. I think that the momentum for a single-payer system will sweep the country . . . it will be such a huge popular issue . . . that even if it’s not successful the first time, it will eventually be.”12

Health care is too important to be gridlocked in polarized partisan camps. All Americans will win with NHI, including the business community, which will be relieved of its burden of paying growing costs of employer-sponsored health insurance. Time will tell whether or not the oligarchy wins again.

John Geyman is professor emeritus of Family Medicine at the University of Washington School of Medicine. Visit: http://www.johngeymanmd.org.

References

1. The Working Group on Single-Payer Program Design. Beyond the Affordable Care Act: A Physicians’ Proposal for Single-Payer Health Care Reform. Available a supplement online version of ref. 1 at http://www.ajph.org.

2. Gaffney, A, Woolhandler, S, Angell, M, Himmelstein, DU. Editorial. Moving forward from the Affordable Care Act to a Single-Payer system. Am J Public Health, 106 (6): e1-e2, June 2016.

3. Carroll, AE, Ackermann, RT. Support for national health insurance among U. S. physicians: five years later. Ann Intern Med 1481: 566-567, 2008.

4. Woolhandler, S, Himmelstein, DU. Setting the record straight on Medicare for All: An open letter from 560 physicians and medical students. The Huffington Post, February 28, 2016.

5. Committee on the Consequences of Uninsurance. Institute of Medicine. Insuring America’s Health: Principles and Recommendations. National Academies Press, Washington, D.C., 150-151, 2004.

6. Friedman, G. Funding H. R. 676: The Expanded and Improved Medicare for All Act. How We Can Afford a National Single-Payer Health Plan. Physicians for a National Health Program. Chicago, Il. July 31, 2013. Available at: https://www.pnhp.org/sites/default/files/Funding%20HR%20676_Friedman_final_7.31.13.pdf.

7. Geyman, JP. The Human Face of ObamaCare: Promises vs. Reality and What Comes Next. Friday Harbor, WA. Copernicus Healthcare, 199-202, 2016.

8. Light, DW. A conservative call for universal access to health care. Penn J Bioethics 9 (4): 4-6, 2002.

9. Arrow, KE. As quoted by Pro-Market. The blog of the Stigler Center at the University of Chicago Booth School of Business, March 15, 2016.

10. Sanders, B. This is what oligarchy looks like. Bernie 2016, January 4, 2016.

11. Geyman, JP. Myths and memes as barriers to health care reform. In Geyman, JP. How Obamacare Is Unsustainable: Why We Need a Single-Payer Solution for All Americans. Friday Harbor, WA. Copernicus Healthcare, 2015, pp. 223-241.

12. Clinton, H. Speaking to a group at Lehman Brothers Health Corporation, June 15, 1994, as reported by Health Care for All-WA Newsletter, Winter 2015, p 9.

http://www.huffingtonpost.com/john-geyman/growing-support-for-a-nat_b_9852148.html

Kids need healthy mothers

How Are Moms Faring under the Affordable Care Act? Evidence through 2014

By Michael Karpman, Jason Gates, Genevieve M. Kenney, Stacey McMorrow
Urban Institute, May 5, 2016

The number of uninsured mothers fell from 7.5 million in 2013 to 5.9 million in 2014, as the uninsurance rate for mothers reached its lowest point since 1997. The largest declines in uninsurance were found among low- and moderate-income mothers who were targeted by the ACA’s Medicaid expansion and the introduction of subsidized Marketplace coverage, respectively.

Despite these gains in coverage, nearly one in six mothers remained uninsured in 2014, and these mothers were disproportionately young, low-income, Hispanic, noncitizens, less educated, not married, and living in the South. One particularly concerning finding is that about one in five mothers who were likely to have the greatest physical and mental health care needs—those who reported being in less than very good health or having moderate or severe psychological distress—were uninsured.

When asked about the reasons why they do not have health insurance or stopped having coverage, 41.5 percent of uninsured mothers in 2014 said it was because the cost was too high. The next most frequently reported reason was that coverage stopped after pregnancy (18.7 percent). In addition, some mothers identified their inability to get employer-based coverage as a reason for being uninsured, either because they or the person in their family with coverage lost or changed jobs (18.0 percent) or because their current employer does not offer coverage (7.3 percent). Over 5 percent said they had lost Medicaid or other coverage because of a new job or increase in income, and 18.6 percent reported not having coverage for other reasons, such as divorce, separation, or death of a spouse or parent, becoming ineligible because of age or leaving school, denial of coverage from an insurance company, or not needing coverage.

http://www.urban.org/research/publication/how-are-moms-faring-under-affordable-care-act-evidence-through-2014

Most would agree that having healthy mothers would be of benefit to their children. Suppose 5.9 million mothers were uninsured, wouldn’t it seem that we should enact health care reform that would address this problem? In fact, we did enact the Affordable Care Act, and between 2013 and 2014 the number dropped from 7.5 million to 5.9 million. Rather than celebrating the “success” of ACA reform, shouldn’t we be advocating for reform that really does work for everyone?

Yesterday, the Physicians’ Proposal for Single-Payer Health Care Reform was released. Under that proposal the number of uninsured mothers would drop to zero. At the following link you can read and download the Proposal and its supporting documents, and provide your personal endorsement:

https://pnhp.org/beyondaca

You don’t want to trouble yourself by providing an endorsement? But Mother’s Day is this weekend. Surely you’ll reconsider, you know, for Mom.

Obamacare is flawed, but there is a solution

The Affordable Care Act has increased access to health care, but it has serious drawbacks

That’s why a large, respected group of physicians is proposing a different, single-payer health care system

By Jessica Schorr Saxe, M.D.
The Charlotte (N.C.) Observer, May 5, 2016

Why, in the age of the Affordable Care Act, would a large, respected group of physicians develop A Physicians’ Proposal for Single-Payer Health Care Reform? On Thursday, this document was released by a panel at the National Press Club and published online in the American Journal of Public Health.

Are you or someone you know forgoing medical care for financial reasons, having trouble with medical bills, being forced to change providers due to network problems, or reeling from arbitrary increases in premiums or deductibles? If so, you know the ACA has drawbacks.

While the ACA has increased access to health care, it falls short in achieving the goals of making care available and affordable to all and controlling costs.

Although millions have gained insurance, the Congressional Budget Office estimates 28 million Americans will remain uninsured in 10 years when the law is fully operational.

Additionally, underinsurance is an increasing, often overlooked problem. The underinsured are those who, despite coverage, are not able to afford their deductibles or out-of-pocket costs. According to the Commonwealth Fund, this included 21 percent of adults below Medicare age in 2014. More than one-third of Americans did not get needed care due to financial barriers, and more than one-third have trouble paying a medical bill.

Free clinics, which expected declining numbers after the ACA, are seeing an influx of insured patients who cannot afford co-pays or deductibles.

Though health care inflation was relatively low for a few years, it is now rising. Currently at about 18 percent of gross domestic product (about twice that of most other developed countries), health care is projected to reach almost 20 percent by 2024.

Administrative costs consume an inordinate amount of our health care budget. Bureaucracy plagues providers and patients. If the forms now contained in the electronic record were hard copies, physicians would be crushed under their weight.

Surely we can agree that Americans are entitled to better care. The Physicians Proposal outlines a better course.

A single-payer health care system, sometimes referred to as Expanded and Improved Medicare for All, would provide comprehensive health care with no deductibles or co-pays. Financing would be federal, much like current Medicare, and paid for largely through progressive taxes. Even those who consider raising taxes anathema would likely be pleasantly surprised to find these taxes are more than offset by reductions in premiums, co-pays and other medical expenses.

Expanded (covering more people) and Improved (more comprehensive) services would be made possible by savings in many areas. Administrative costs would plummet by eliminating private insurance companies, the expensive middle men that siphon off dollars that could otherwise be spent on actual health care. Cutting administrative costs to the level of Canada would save about $500 billion annually. The National Health Plan would negotiate pharmaceutical prices, as do other countries, yielding further and extensive savings. For-profit hospitals and clinics, documented to be of poorer quality and more expensive, would be prohibited.

Single-payer health care is a financing mechanism. Current private hospitals and practices would continue to deliver health care, much as they do now, except that they would submit bills to a single entity. With a unified system, there would be no more separate networks. The opportunity to choose providers and relief from financial barriers would strengthen the currently endangered physician-patient relationship.

Critics insist widespread opposition is an obstacle. In fact, polls show rising support. In 2008, a national survey showed that 59 percent of physicians supported a national health insurance plan, and in December 2015, a Kaiser poll indicated that 58 percent of Americans support Medicare for All. As both physicians and patients feel more beleaguered by our current system, expect those numbers to rise.

Can we afford it? Yes. And, given current trends, we cannot afford to delay its implementation.

If you are or know an individual suffering from lack of access, oppressive medical bills, unbearable bureaucracy, or fear of your own rising medical costs or the collective burden on the U.S. economy, you, too, should support a single-payer health care system.

Dr. Jessica Schorr Saxe is chair of Health Care Justice NC, a chapter of Physicians for a National Health Program. Email: HCJusticeNC@gmail.com. The Physicians Proposal is available at: https://www.pnhp.org/beyond_aca/Physicians_Proposal.pdf.

http://www.charlotteobserver.com/opinion/op-ed/article75899102.html