By Neil H. Buchanan
Verdict, Justicia.com, Nov. 20, 2014

The two most recent attempts to reform the American health care system, in the early 1990s and early in this decade, were notable for what the would-be reformers refused even to consider: single-payer health care. Although nearly every major nation in the world uses a version of the single-payer system—and, as I will discuss below, even though the U.S. itself has had great success with a partial single-payer plan—both the Clinton and Obama Administrations ruled out universal single-payer reform even as one of the possible options.

Self-styled realists claimed in both instances that the political obstacles blocking adoption of a single-payer plan were insurmountable—so why even try? Defenders of President Obama’s approach noted that his advisors were worried that proposing anything like single-payer would brand the Administration as being too extreme, and that this would lead to huge losses in Congress for the Administration, and perhaps even the loss of Democratic majorities in both the House and Senate. We all know how that worked out for the Democrats, as former Speaker of the House Nancy Pelosi and soon-to-be Minority Leader Harry Reid sit dazed in their smaller offices.

Even that explanation, however, assumes that the Clinton and Obama Administrations were reluctantly trimming their sails, settling for less than they truly wanted. That could be true, I suppose, but there is an even stronger case—based on the totality of the economic policies that both presidents have enthusiastically embraced—that neither president was ever all that interested in seriously challenging the status quo.

The Affordable Care Act (ACA) is actually working rather well, given that it is by design a wasteful system that continues to pump profits into the bank accounts of unnecessary intermediaries. On the substance of what is included in the ACA—no more denials of coverage for preexisting medical conditions, more choices for many consumers, affordable coverage even for people who move between jobs, and millions of previously uninsured people now receiving coverage—Americans genuinely like the law. Even rising Senate Majority Leader Mitch McConnell, in what by the end was a very easy reelection campaign, refused to admit that he would take away the Kentucky version of the ACA, even as he promised to try to repeal the whole law nationwide.

No matter whether it is a marriage of convenience or a matter of deeper ideological commitments, the Obama Administration now finds itself in the position of having the health insurance industry as its greatest (only?) ally. Indeed, it seems that the rest of the political world is aligned to bring an end to “Obamacare.” An economist who advised the Administration has become the unintentional star of videos in which he disparaged voters’ intelligence. The Supreme Court is poised potentially to drive a stake into the heart of the ACA. And the rabid anti-Obama activists in the Republican Party continue to push for the ACA’s repeal.

The interesting question is what comes next, if the ACA fails or is killed. Republicans have never provided a meaningful alternative, and they dare not repeal the more popular parts of the law (including, in addition to the features noted above, the inclusion of children through age 26 on their parents’ policies). Moreover, the more Republicans attack the government for its supposed incompetence in running the ACA, the more we could reach the paradoxical moment where the public rallies behind the ultimate government solution that is single-payer health care.

How to Understand the Now-Infamous Remarks of One Unfortunate Economist: Both Liberal and Conservative Economists Think They Are Smarter Than Everyone Else

Much of the anti-ACA political landscape is by now utterly familiar. We have seen years of posturing by Republicans at all levels of government, dozens of pointless votes in the U.S. House of Representatives to repeal the law, and a razor-thin loss for repeal advocates in the Supreme Court in 2012. All of this makes the ACA a sore spot, and a focus of rage, for the Republican base. Even so, little new has come along to change the political landscape, until this week.

Now, the MIT economist Jonathan Gruber is at the center of a controversy over arrogant and disdainful remarks that he made at some policy/academic forums over the last few years. In particular, Gruber referred blithely to the “stupidity of the American voter” in explaining why he thought the law was written in less-than-clear ways.

Even a political opposition that was not as extreme as today’s Republican party would understandably respond to such comments with glee. Professor Gruber sounds, after all, more than “a bit dickish,” as Jon Stewart put it on his late-night show recently. If the Obama people relied on Gruber, as they clearly did, in setting up the law, then the President’s opponents would be crazy not to make political hay.

The problem is that people are misunderstanding what was at work in Professor Gruber’s comments. Republicans and their allies want to paint this as a case of “liberal condescension,” where the supposedly smug do-gooders in the Obama Administration are caught showing that they have no respect for “real Americans.” But that is most definitely not what was happening.

I am an economist, and I have spent large amounts of time with other economists. The one unimpeachable fact about economists of all political stripes is that they think that non-economists are stupid. (Indeed, one of the reasons that I now teach in a law school is that I found this mindset among economists to be so unfortunate—and unwarranted.) Economists are trained to think that only they can see through the silly nonsense of politicians, lawyers, pundits, and regular people—people who are too dense to understand that wage increases are not necessarily “real” (because they might be offset by inflation), or who fail to notice that a subsidy is the same thing as a tax reduction, or any of a number of other “simple” issues that economists deal with all the time.

Importantly, this disdain for the public is nonpartisan and not at all ideological. In fact, the Economics Department at the University of Chicago, which is famously conservative in its approach to economics, takes pride in its supposed ability to set the world straight and correct people’s dimwitted misunderstandings. One Chicago-School economist once referred to his colleagues’ approach as an “acid bath,” bringing the harsh reality of brutal logic to bear against the confused and sentimental ramblings of the great unwashed masses.

Professor Gruber, therefore, was simply caught saying to his colleagues what economists say to each other all the time: If everyone in the world were as smart as we are, we wouldn’t have to deal with their nonsense; but because they are easily confused, we can use our superior intelligence to take advantage of their shortcomings and dupe them into doing the smart thing. I have heard virtually the same words coming out of the mouths of conservative economists and liberal economists alike, many times.

Even so, and even though nothing that Professor Gruber said actually bears on the substantive content of the ACA, the new narrative is that the Obama Administration was somehow uniquely Machiavellian in its manipulation of the American people. That is not true, but there are plenty of false accusations against this president that Republicans have refused to abandon.

The net result of this new mess, therefore, is that the Republicans will be able to repeat relentlessly the claim that the ACA is a nefarious trick that was foisted on an unsuspecting public. The general suspicion that “we can’t trust Washington” will have inadvertently been enhanced by one economist being recorded saying what all of his colleagues believe.

The Supreme Court and the New Challenge to the ACA

As Professor Michael Dorf explained in his Verdict column yesterday, the Supreme Court has agreed to hear a new challenge to the ACA, King v. Burwell. There, the Court could decide that the subsidies for low-income Americans that allow them to buy insurance under the new health law must be limited to the dozen or so states that have set up their own insurance exchanges. That would leave the citizens of the majority of states without subsidies, because they are currently buying their insurance through exchanges established on the states’ behalf by the federal government.

The merits of that challenge are not the issue in this column, but I have to say that I find the central claim in King to be extraordinarily weak. Even so, a motivated group of conservative justices could decide to engage in naked partisan politics in that case, which would (among other things) allow Chief Justice Roberts to rehabilitate himself in conservatives’ eyes, after his vote to uphold the ACA in the 2012 NFIB v. Sebelius case.

If the Court strikes down the subsidies in the affected states, what would happen next? The so-called “death spiral,” in which the insurance pools in those states would include fewer healthy people, causing rates to rise and push out even more healthy people, is better thought of as a near-death experience. The exchanges would not be “really most sincerely dead” (in the immortal words of the munchkin coroner in The Wizard of Oz), because there would still be a core group of relatively ill people who are just barely able to buy the now-much-more-expensive insurance, and for whom even expensive insurance is better than nothing.

As the New York Times columnist Josh Barro has written, this unfortunate limbo perfectly describes the pre-ACA world in which New York State’s residents lived for years. It was a bad state of affairs, and no one liked it, but it limped along until the ACA radically improved the situation.

The point here, however, is that conservatives’ preferred result in the King case would lead to a new reality in which two-thirds of the country is stuck with especially dysfunctional private insurance markets. The public might well look back fondly on the days when health insurance was briefly affordable under the ACA.

Of course, even now Republicans are doing everything possible to convince the world that the ACA is impossibly broken. Last week, the Obama Administration announced that health insurance premiums would rise in 2015, in some cases by as much as 20%. Although unfortunate, this outcome (if, indeed, it turns out to be true) was quite common before the ACA came into effect. The reason that there was political support for reform in 2009 and 2010, after all, is that the old health care system was broken, and people knew it.

At this point, the Republicans cannot resist any opportunity to attack the ACA. A news article describing the new cost estimates included an Administration official claiming, correctly, that “the Affordable Care Act is working.” The next sentence in the article, however, says that “Republicans quickly pounced on the data as evidence of the opposite.” Their message: Get rid of the ACA, because we cannot trust a new bureaucracy to get things right.

Single-Payer Could Become a Very Real Possibility After All

If Republicans convince the public that the ACA is broken, then there will be a need for an alternative. As I noted above, however, they have offered nothing to replace the ACA. At best, they will return us to the status quo ante, but more likely, they will end up with a system in which the private health care markets are even worse than they were before. Moreover, state-by-state differences will become more pronounced, and businesses will find that their support of Republicans has made conducting business nationwide much more expensive.

If Americans are convinced that the government cannot run the ACA, would they ever believe that the government can do anything right? Strangely, the answer is yes. Once the Republicans and their allies on the Supreme Court—with an inadvertent assist from Professor Gruber—have convinced the public that the government cannot be trusted, while dooming Americans to an even worse private health care market, people will be looking for an alternative that is simple, clear, and tested.

We have such a system, and it is called Medicare. Even the older voters who skew toward the Tea Party love Medicare. (Famously, some of them apparently do not even realize that Medicare is a government-run program.) It is a single-payer system, and it has been working here in the United States for half a century. It is true that the way we formally finance the Medicare program is currently out of balance, but that is entirely fixable. Moreover, because the program has such low administrative costs, its total cost would be much lower than the private insurance system that it would replace.

I am not going to bet the house that the U.S. will adopt “Medicare For All” any time soon. I am certain, however, that the current road down which the Republicans and the Supreme Court are driving the country does not necessarily lead to their version of a utopia. Health care will always require a large amount of government involvement, as even the pre-ACA system showed. At some point, Americans might decide that enough is enough, and every citizen will finally be able to enjoy a tried-and-true program that works.

Neil H. Buchanan, a Justia columnist, is an economist and legal scholar, a Professor of Law at The George Washington University, and a Senior Fellow at the Taxation Law and Policy Research Institute, Monash University (Melbourne, Australia). He blogs at DorfonLaw.org, and he is the author of “The Debt Ceiling Disasters: How the Republicans Created an Unnecessary Constitutional Crisis and How the Democrats Can Fight Back.”

http://verdict.justia.com/2014/11/20/disdainful-economists-hubristic-jurists-fanatical-republicans#sthash.hyfA2tWh.dpuf

Commonwealth Fund report reveals stark comparison to 10 industrialized countries with universal health coverage

By Steven Reinberg
HealthDay News, Nov. 19, 2014

Seniors in America have more chronic health problems and take more medications than seniors in 10 other industrialized countries do, according to a new global survey.

The United States also stood out among the 11 nations surveyed by The Commonwealth Fund for having more seniors struggling to get and afford the health care they need.

Eighty-seven percent of U.S. adults who are 65 and older suffer from at least one chronic illness, and 68 percent have at least two illnesses, which were the highest rates found, the survey showed. Also, 53 percent of older Americans take at least four medications, another record high, and 21 percent spend at least $2,000 in yearly out-of-pocket health care costs, which was second only to Switzerland.

“The retirement of baby boomers means pressure on Medicare will intensify,” Dr. David Blumenthal, president of The Commonwealth Fund, said during a news briefing Tuesday to announce the study findings, which were published online Nov. 19 in the journal Health Affairs.

Despite the moderating of health care costs in recent years, Blumenthal added, “Costs are still going up too fast to be sustainable over the long term, and this will be exacerbated by increasing numbers of elderly individuals.”

The study’s lead author and Commonwealth Fund vice president, Robin Osborn, noted at the news briefing: “Those over 65 in the U.S. will almost double from 2005 to 2030. These sicker adults will likely put a strain on the health care system [which] will need to transform to meet the challenges of an aging population.”

For the survey, the researchers collected responses from more than 15,000 older adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States.

Most all of the other countries have some form of universal health insurance, and American seniors have Medicare, but Osborn said striking differences emerged in the survey:

• Although the U.S. senior group was the youngest of all the countries in the report, they were also among the sickest: 25 percent of older Americans saw at least four doctors in the past year, second only to Germany at 39 percent.
• In addition, more Americans (19 percent) said they skipped essential health care because they could not afford it, and 11 percent said they had trouble paying their medical bills. In France, only 3 percent of seniors said they skipped health care because of cost, and in Norway only 1 percent said they had trouble paying medical bills.
• In terms of out-of-pocket costs, only the Swiss spent more than Americans. In the United States, 21 percent spent $2,000 or more a year, compared with 22 percent in Switzerland and 2 percent in the United Kingdom. In France, on the other hand, virtually no one spent out-of-pocket costs.
• Only 57 percent of U.S. seniors said they were able to see their doctor the same or the next day when they were sick, compared with 83 percent in France and New Zealand, and 81 percent in Germany.
• Americans use of emergency rooms was one of the highest, at 39 percent. Thirty-five percent of these visits were for conditions their doctors could have dealt with had they been available, the researchers found.
• When a specialist was needed, 86 percent of U.S. seniors and 82 percent of seniors in Switzerland were able to see one within four weeks — the highest rates in the survey. Seniors in Canada (46 percent), Norway (46 percent) and Sweden (50 percent) were the least likely to get appointments that quickly.
• U.S. seniors, like seniors in the other countries, appear to suffer from poorly coordinated care or gaps in communication between doctors: 35 percent of U.S. seniors reported having such problems, as did 41 percent in Germany and 37 percent in Norway. In France, only 7 percent said they had these problems. But, the survey showed, American seniors also had better doctor/patient relationships than seniors in many other countries. 

An expert who was not involved with the study had a simple explanation for the key findings on American senior illnesses.

Dr. Steffie Woolhandler, co-founder of Physicians for a National Health Program, said American seniors are sicker because of the inadequate care they received before they turned 65.

“The health care system for the under-65 population is full of gaps, and lots of people fall through the cracks,” she said.

Woolhandler, who is also a professor of health at CUNY School of Public Health at Hunter College in New York City, added that Medicare is also leaving many Americans underinsured and that the Affordable Care Act will not make a major difference.

“We need to be providing much more comprehensive coverage to everyone, including lower co-pays and deductibles,” she suggested.

SOURCES: Steffie Woolhandler, M.D., professor, CUNY School of Public Health, Hunter College, New York City, and co-founder, Physicians for a National Health Program; Nov. 18, 2014, news conference with: David Blumenthal, M.D., president, and Robin Osborn, vice president and director, International Program in Health Policy and Practice Innovations, both Commonwealth Fund; Nov. 19, 2014, Health Affairs, online

http://consumer.healthday.com/senior-citizen-information-31/senior-citizen-news-778/u-s-seniors-health-poorest-global-survey-shows-693917.html?related=true&utm_expid=38353063-2.r5ETjFV6SrG5_xobVbsyDw.1

By Joan Brunwasser
OpEdNews, Nov. 18, 2014

My guest today is second-year medical student, Brad Zehr. Welcome to OpEdNews, Brad. Something very interesting happened at the AMA (American Medical Association) recently. What can you tell us about it?

BZ: The Medical Student Section of the AMA adopted a resolution at the Interim AMA meeting in Dallas expressing support for innovative state legislation to achieve universal health care, including but not limited to single-payer health insurance. The reason this policy item was particularly high-profile and groundbreaking was because it is the first instance of any section of the AMA adopting policy in support of single-payer health insurance. Although the Medical Student Section (MSS) is only one of ten sections of the AMA, and although this resolution pertains only to the MSS and not the full AMA, the resolution signals a generational shift in organized medicine’s approach to health care reform.

Historically, the AMA has explicitly opposed any forms of single-payer, including opposition to the creation of U.S. Medicare in 1965. The AMA House of Delegates (HOD), which is the highest policy-making body of the AMA and includes representation from all of the AMA sub-sections and from state medical societies and medical specialty societies, still has three policies stating express opposition to single-payer health insurance in the U.S. The MSS boldly voiced support for single-payer despite the HOD’s continued hypersensitivity to single-payer.

JB: How did this come about? I understand that you were one of the students responsible for writing the resolution. Was there a knock-down drag-out fight about this? What was the process like? Tell us more, please.

BZ: Several recent developments in U.S. health care contributed to our motivation to submit the single-payer resolution to the AMA-MSS at this particular time. First, the Affordable Care Act includes a lesser known component called “Sec. 1332: Waiver for State Innovation.” The section allows states to apply for an exemption from the federal ACA law beginning on January 1, 2017, to implement their own alternative, state-based health care law, given that their state law would cover at least as many people as the ACA would have, that the coverage would be as affordable to individuals and families as the ACA coverage would be, and that the state law would not increase the federal deficit.

Upon receiving approval from the U.S. Department of Health and Human Services and the U.S. Department of the Treasury, such innovative states would receive federal funds equivalent to what they would have received under the ACA in order to implement their alternative health care reform plan.

Vermont is the first, and so far only, state to commit to applying for a Section 1332 State Innovation Waiver. The state plans to establish a state-based single-payer health insurance system beginning in 2017. The program will be called Green Mountain Care and would be the first-ever example of a state-based single-payer system in the U.S. In addition to Vermont, at least half a dozen other states have active single-payer popular movements.

JB: Promising!

BZ: A second recent development that motivated our resolution was the Massachusetts gubernatorial candidacy of Dr. Don Berwick, an internationally recognized health policy scholar and former chief administrator of the U.S. Centers for Medicare and Medicaid Services. Berwick campaigned on a pledge to move Massachusetts toward a single-payer system. His campaign energized a vast progressive base in the state, and he earned endorsements from some of health care’s most celebrated thought-leaders, including Atul Gawande, Paul Farmer, and John McDonough. Berwick often noted on the campaign trail that Massachusetts has historically been a beacon of progress for the nation, including the passage of so-called “Romneycare” in 2006, which became the model upon which the ACA was based. Berwick’s inspiring vision was for Massachusetts to once again lead the nation in health policy reform. Although he lost the Democratic primary to Martha Coakley, he mobilized incredible stores of political energy in the state with his bold commitments.

Finally, we wrote the resolution because single-payer has been conspicuously absent from the health policy conversation at the AMA-MSS throughout this past 15 years of upheaval in U.S. health care. The last time medical students debated single-payer at the AMA was at the interim meeting in 1999. That resolution asked the AMA to study the advantages and disadvantages of a single-payer system, but the MSS did not adopt it.

We submitted a single-payer resolution to the Annual 2014 meeting this past June in Chicago. That resolution was strong: asking the AMA HOD to advocate for national single-payer health insurance. Sixty-one medical students from 18 medical schools co-authored that resolution. However, the MSS Reference Committee recommended the resolution not be adopted based on the argument that asking the AMA HOD to advocate for national single-payer in light of their continued opposition was politically futile and a waste of our limited MSS influence. Furthermore, many student delegates expressed support for single-payer, but said that it should be tried on a state-by-state basis, and that we should keep this policy within the MSS.

With the feedback of dozens of medical students from around the country, we crafted a compromised resolution for re-submission at the Interim meeting in November. This second version of the resolution was internal to the MSS, and asked for support for state-based single-payer. And rather than being co-authored by 61 individual students, it was co-authored by 4 delegations: Massachusetts, Wisconsin, University of Vermont College of Medicine, and SUNY-Downstate College of Medicine. During the MSS General Assembly, the Reference Committee recommended adoption after amending the resolution to be expanded to include other innovative state legislation to achieve universal health care, in order to garner broader support. The resolution was adopted by approximately a two-thirds majority, although only 51 percent was required for adoption. 

JB: This is definitely encouraging, but what does it all mean? Vermont’s Green Mountain Care won’t even kick off until 2017 and it’ll take a while to assess its effectiveness. I’m intrigued with the sea-change among you future physicians. You’re clearly out of step with the AMA as a whole. How do you explain the gap? What about your own motivation?

BZ: We’ve asked ourselves these questions often throughout this resolution-writing process. I often return to the words of the immediate past president of the AMA, Dr. Ardis Dee Hoven. In May of this year, she visited some medical students in Detroit. She said, “Students are the lifeblood. They are the future. Medical students are so much better and so much smarter than I was as a student. They’re learning early. They’re learning the democratic process and the tools they need to make a difference. … The status quo is unacceptable. We have to move medicine ahead and it is our job to move this forward. You will be the leaders.”

From the highest levels of organized medicine, medical students hear that U.S. health care is not working and that we need to advocate for the system we want during our careers. This is exactly what we are trying to do with this resolution. We know that single-payer is one of the best ways to guarantee universal health care while controlling costs. The evidence to support this assertion is extensive, some of which we included in the Whereas clauses of our resolution. We think it is time to treat the AMA’s hypersensitivity to single-payer in the U.S. and have an evidence-based debate about the merits of such a system, especially in light of the fact that one state has already committed to it.

JB: You’re passionate about this. Have you always been? What drew you to medicine in the first place and do practicing medicine and activism go together well or does one get in the way of the other? 

BZ: Single-payer health care reform was not on my radar going into medical school. Throughout college and grad school, I had followed the national health reform debate, from the 2008 presidential elections through the tumultuous rollout of healthcare.gov in October 2013. I learned about single-payer a year ago by attending the annual meeting of Physicians for a National Health Program, which happened to take place in Boston (10 minutes by bus from my medical school). David Himmelstein, MD, and Steffie Woolhandler, MD, the co-founders of PNHP, presented several hundred slides of data analyzing the poor performance of our current health care system — or “non-system” as they demonstrated. Medical students and physicians respond to evidence and data. The evidence presented at that meeting was so compelling that several classmates and I decided to start a PNHP chapter at our school and to study single-payer in between studying anatomy, physiology, biochemistry, and histology. What we discovered was an energized community of physicians whose priority is to create a health care system where everyone is in, nobody is out, and the profit motive is removed from health financing. I’ve made single-payer a major part of my medical education because I want to practice in a more sane, ethical, and sustainable system.

JB: What’s wrong with what we’ve got now? Aren’t we a lot better off with the Affordable Care Act? So many more people, millions more, are covered. Isn’t that what we’ve been aiming for?

BZ: The ACA will leave about 30 million uninsured and tens of million more underinsured. It is inadequate. Half the states are opting out of the Medicaid expansion. The most popular plans on the exchanges are silver and bronze, which are low cost up front but high cost out of pocket, exposing patients to extreme financial toxicity. Patient choice of doctor and hospital are limited by private insurance networks. The administrative overhead in the private health insurance system is 15 to 20 percent, whereas the overhead of single-payer Medicare is less than 2 percent. Our country spends twice as much per capita on health care as the other advanced nations yet we consistently achieve poorer health outcomes across the board and leave millions out. Physicians are tired of fighting with private health insurance plans to cover the care their patients need.

We need a modern, 21st-century health care system that includes every citizen automatically and simply. The ACA exacerbated the flaws of the pre-ACA system and further entrenched the private health insurance industry. It is a patchwork fix and will not suffice during my career. Millennials have a low tolerance for needless complexity and systemic inequality, and they demand simplicity and fairness. Millennial physicians will not tolerate a system that leaves out millions, outspends all other peer nations for poorer outcomes, and creates daily interferences with treating patients.

JB: Everything you say is true, Brad. I believe the U.S. is the only industrialized country without some form of universal health coverage. But, as you pointed out, the AMA opposed Medicare’s creation back in 1965. And the organization, your resolution notwithstanding, is still adamantly opposed to single payer. So, how realistic is it to think that a bunch of idealistic young’uns are going to turn things around any time soon? done

BZ: The AMA is struggling to maintain its position as the singular voice of American doctors. The percentage of U.S. physicians who are AMA members has declined for decades — from a peak of 75 percent in 1960, to 50 percent in 1973, to about 20 percent in 2008. These figures come directly from AMA CEO Dr. Michael Maves, who addressed the AMA House of Delegates at the 2008 Interim meeting in Orlando. He listed several reasons why the AMA struggles and said, “Perhaps most difficult of all, physicians don’t think that the AMA gets ‘it’ and gets ‘them’ and can act as an agent of positive change. ” When your colleagues back home no longer think of the AMA as ‘stuck in the past’ and see us as future-focused, you will know we are on the right track.”

Medical students participate in the AMA because we want to advocate for patients and for the future of the profession, not to subscribe to any particular political ideology. We study medical ethics in the first year of med school, and then steadily over the next years we observe in hospitals and clinics a fundamental disconnect between the Hippocratic Oath and the reality of American medicine. According to the Oath, the interests of patients trump the interests of physicians and all other interests, including those of profit-seeking health insurance companies. If taking the Hippocratic Oath seriously is perceived as foolish idealism by the system, then it is the system which requires correction.

When the AMA-MSS voiced support for innovative state legislation to achieve universal health care, including single-payer health insurance, it took one step toward treating the AMA’s historical hypersensitivity to single-payer. We invite the AMA to listen carefully to the voice of its youngest members and engage in an evidence-based discussion on single-payer. We hope the AMA takes this opportunity to evolve, keeping in mind its long-term membership goals.

JB: I couldn’t agree with you more. I’m buoyed by you passion for this topic and am consequently cautiously optimistic for the long run. Getting the insurance companies to surrender what has been a cash cow of gargantuan proportions will be another big fight. Any thoughts on that?

BZ: Polling shows a majority of Americans prefer national health insurance. Can you believe it? A 2009 CBS News / New York Times poll showed 59 percent of Americans favor government-run national health insurance.

JB: Great!

BZ: Ultimately, voters will need to force their representatives to write and pass legislation that creates a more equitable health care system. Things might have to get worse, sadly. Right now, our national political discourse is in disarray. Few are optimistic about major national reform in any area of policy, let alone one as sensitive as health care. We will likely need campaign finance reform to get to a place politically where the will of the majority of Americans is prioritized over the will of the wealthiest donors and private health insurance lobbyists.

In the meantime, there are a handful of states where there are popular movements advocating for the creation of state-based single-payer health insurance — Vermont, New York, Massachusetts, Washington, Illinois, Pennsylvania, among others. We want to support those states that will move toward single-payer in the coming decade.

JB: Maybe after people see how well Vermont and any other forward-thinking states are doing with single-payer, it will catch on like wildfire. Anything you’d like to add before we wrap this up?

BZ: For anyone on the fence or skeptical about single-payer, I invite them to listen to a physician debate on single-payer in March 2014 at Albany Medical College.

Last, I want to share a story I recently discovered. In 2004, the Canadian Broadcasting Corporation ran a TV series called “The Greatest Canadian.” The show conducted national polling in the spirit of “American Idol” to identify who is the greatest Canadian in history. The winner was Tommy Douglas, who started Canada’s first province-based single-payer health care system in 1962 Saskatchewan. The system was later adopted nationally. By popular vote in 2004, Canadians deemed the father of their single-payer system their greatest citizen, beating such Canadian luminaries as Wayne Gretzky, Celine Dion, Mike Myers, Alexander Graham Bell, Frederick Banting (co-discoverer of insulin), Neil Young, Jim Carrey, Michael J. Fox, Tecumseh, and John Candy. 

We will create a health care system for all Americans, eventually. Millennial medical students are moving us toward that goal with the adoption of the AMA-MSS resolution supporting state-based single-payer.

JB: This interview has been an eye-opener for me. I’m thrilled that our medical future will be guided by souls such as yourself so dedicated to the true spirit of the Hippocratic Oath. Thanks very much for talking with me, Brad. Good luck to you!

***

PNHP website.

1) The PNHP press release on this resolution —

2) 2003 JAMA article, Proposal of the Physicians’ Working Group for Single-Payer National Health Insurance — the foundational paper describing what single-payer in the U.S. would and would not be (note, the group is set to publish an updated version of the proposal in 2015, but the basic tenets of the proposal will be unchanged).

3) March 2014 Albany Medical College debate on single-payer, audio from which is posted on WAMC Northeast Public Radio website.

Joan Brunwasser is a co-founder of Citizens for Election Reform has been Election Integrity Editor for OpEdNews since December 2005. Her articles also appear at Huffington Post, RepublicMedia.TV and Scoop.co.nz.

http://www.opednews.com/articles/1/AMA-Med-Students-Back-Stat-by-Joan-Brunwasser-Activism_Boston_Health-Care-Socialized-Nationalized_Health-Care-Establishment-141118-643.html

Due to a quirk in the law, 3 million low-income kids could soon lose their insurance. Here’s the best, only way out

By Vijay Das
Salon, Nov.14, 2014

Starting tomorrow, November 15, millions of Americans will go online to obtain or re-enroll in health coverage through the Patient Protection and Affordable Care Act’s (ACA) insurance marketplaces. Working families once again will try to pick a health plan that works for them. Yet this year, the task will be particularly difficult.

A quirk in the ACA, coupled with the expiration of a national children’s health insurance program, will put family coverage out of reach for many. This means that up to 3 million low-income children may lose their insurance because family coverage is too expensive for low-income parents.

A solution exists. But first, let’s explore the ACA problem. Under the law, employers need to provide insurance only for workers – not workers’ families. This has created the so-called “family glitch.” Although premiums paid by workers are capped, there is no limit on the employee’s share of premiums for family members, and these often cost three times as much as an individual’s coverage.

So what are parents to do? What about the Children’s Health Insurance Program (CHIP)? It was expressly designed to help families in these circumstances. Since 1997, CHIP has provided insurance for children 18 and under in families slightly over the poverty level, and all kids in families that can’t afford private insurance.

CHIP is now up for congressional reauthorization. Congress is debating how long to extend the program given that the ACA helps provide private and Medicaid coverage for many children. The ACA’s “family glitch” adds new complications in health care. Politics permitting, Congress hopes to quickly renew the successful program by the end of the year.

But CHIP isn’t a panacea either. Many children eligible for CHIP still lack insurance and access to care. Why? CHIP is a federal block grant. States implement CHIP in their own way. Some create waiting lists when the coffers run empty.

CHIP also struggles to enroll and cover all eligible kids. Many eligible children have parents that are undocumented who are hesitant to get coverage. Application assistance, language access and geography determine the success of outreach of CHIP or any other health program’s enrollment.rtisement