ACA doesn’t fix U.S. health care system, must be replaced with Medicare-for-All

By Public Citizen Inc.
National Journal, Press Release, May 21, 2014

WASHINGTON — There is a solution to the challenge of providing health care coverage to the 50 million Americans who are uninsured, and that solution is a Medicare-for-All, single-payer system, a panel of experts and advocates said today.

The panel kicks off two days of events highlighting the benefits of a single-payer system, which would curb out-of-control health care costs and provide a humane standard of care to all who enter the medical system. Participants of the events include All Unions Committee for Single Payer Health Care-HR 676, American Medical Student Association, Gray Panthers, Healthcare-NOW!, Labor Campaign for Single Payer Healthcare, National Nurses United, National Organization for Women, Physicians for a National Health Program, Progressive Democrats of America and Public Citizen.

“We need a system that provides coverage as a matter of right, and that eliminates the wasteful role of the health insurance industry,” said Robert Weissman, Public Citizen president. “We know there’s a better way, as every other industrialized country shows. It’s past time for the United States to provide health care coverage to everyone as a matter of right, through a national single-payer, Medicare-for-All system.”

The Affordable Care Act (ACA) does not solve the central problems with the American health care system. After the ACA is fully implemented, millions of vulnerable people still will go without coverage, and tens of millions will remain underinsured, facing substantial deductibles, co-pays and co-insurance. A single-payer system would achieve far greater savings than the ACA, which maintains the role of the costly and wasteful private insurance industry. It also would be less complicated to put into place because it is already in place for Americans over 65 in the form of Medicare.

“The Affordable Care Act is reducing the number of uninsured, yet at the end of the day, it is not a program of universal access to care,” said Dr. Andrew Coates, Physicians for a National Health Program president. “Because the major failings of the U.S. system still persist — avoidable death and bankruptcy, racial and socioeconomic disparities, the perverse incentives of profiteering, burgeoning costs — the urgency for single-payer national health insurance has never been greater.”

Added U.S. Rep. John Conyers, Jr. (D-Mich.), “In 2014, it is long past time to recognize affordable, quality health care as a basic human right. While the Affordable Care Act was a historic first step, the only way we can wholly reform the United States’ broken health care model — and provide truly universal coverage to all Americans — is through a single-payer system. It is for these reasons that, since 2003, I have repeatedly introduced H.R. 676, ‘The Expanded & Improved Medicare for All Act,’ that would publicly finance and privately deliver health care to millions of Americans that were previously left behind. The fight for lasting, transformative health care reform that single-payer promises is far from over, and it is only through the efforts of dedicated activists that will keep us marching forward towards progress.”

Added Deborah Burger, National Nurses United co-president, “Registered Nurses see patients suffer every day in a health system dominated by private insurance companies, which restrict access and deny care, as workers increasingly bear the burden of higher health care costs. We must guarantee health care for all based on a single standard of high quality care by establishing a publicly financed and administered system.”

Support for a single-payer health care system is rapidly growing across the United States. More than 58,000 Americans have signed petitions urging legislators to heed the call and implement a Medicare-for-All system.

Gerald Friedman, professor of economics at the University of Massachusetts at Amherst, said, “The single-payer movement is expanding rapidly, with active campaigns in over 20 states. It is likely that there will be referendum campaign in the next few years in several states with advocates looking to establish single-payer system level in 2017. State single-payer system will provide an example that will break the political logjam and inspire national single-payer within the next decade.”

On Thursday, advocates will join lawmakers for a press briefing on the need for single-payer legislation and then will visit offices of members of Congress and urge them to take action on implementing a national, single-payer health system.

http://www.nationaljournal.com/library/156536

The following is a video of a panel discussion titled “Single Payer: Where do we go from here?” with presentations by Sen. Bernie Sanders, I-Vt., Robert Weissman of Public Citizen, Gerald Friedman of UMass-Amherst, Dr. Margaret Flowers of PopularResistance.org, Dr. Andrew D. Coates of Physicians for a National Health Program (pictured above), and Michael Lighty of National Nurses United. The video also includes, near the end, questions and comments from the audience.  The panel was held on May 21, 2014, in Room 430 of the Dirksen Senate Office Building in Washington.

The session begins at the 25-minute mark of this video segment. Please drag the time marker to that point to begin watching the presentations and discussion. The entire session is about an hour-and-a-half long. Dr. Coates’ opening remarks begin at the 48:30 minute mark.

One additional note: The May 21 panel discussion was held one day before a National Lobby Day for Single Payer at the Capitol co-sponsored by PNHP, All Unions Committee for Single Payer Health Care – HR 676, Gray Panthers, Healthcare-NOW!, Labor Campaign for Single Payer, National Nurses United, National Organization for Women, Progressive Democrats of America, and Public Citizen.

The video is available here: http://www.sanders.senate.gov/single-payer-where-do-we-go-from-here

By Jon Perr
Daily Kos, May 20, 2014

With its shameful backlog and secret waiting lists at some of its facilities, the Veterans Health Administration is facing an urgent crisis. But the only reform certain to make things worse would be to privatize the system of 1,700 VA facilities that serve 8.76 million American vets. Despite its troubles, studies consistently show that VA health care is very popular, delivers quality service and costs less than private sector alternatives. Nevertheless, the usual suspects on the right like John Fund and Charles Krauthammer are predictably calling for its replacement by a voucher program.

Appearing on Fox News on Monday, Krauthammer declared, “”Well, if you would suggest that we go to a voucher system, where everybody will get a voucher for treatment in any hospital he or she chooses, and I were a vet, I would choose that,” adding, “I would rather go to Georgetown University Hospital than to a VA.” If that formulation sounds familiar, it should. During the 2012 presidential campaign, GOP nominee Mitt Romney floated the same trial balloon, which just about every veterans’ group in the nation quickly shot down:

“Sometimes you wonder if there would be some way to introduce some private-sector competition, somebody else that could come in and say, you know, that each soldier gets X thousand dollars attributed to them, and then they can choose whether they want to go in the government system or in a private system with the money that follows them,” said Romney. “Like what happens with schools in Florida, where people have a voucher that goes with them. Who knows?”

Actually, many people know exactly what would happen, among them (as ThinkProgress noted) AMVETS, Disabled American Veterans, Paralyzed Veterans of America, and the Veterans of Foreign Wars. Sending millions of older, sicker Americans—many of them requiring specialized care for rare and complex health problems—into the waiting arms of private insurers, private doctors and private pharmaceutical firms is a recipe for chaos and de facto rationing on a grand scale. As the nonpartisan Congressional Budget Office (CBO) concluded its assessment of Paul Ryan’s premium support proposals for Medicare, the result would be a dramatic shift of health care costs onto patients.

As the RAND Corporation explained in 2012 (“‘Socialized’ or Not, We Can Learn from the VA”), the VA system delivers care as good or better than its private sector counterparts, all while doing a much better job of controlling costs for American taxpayers.

RAND’s study, led by Dr. Steven Asch, found that the VA system delivered higher-quality care than the national sample of private hospitals on all measures except acute care (on which the two samples performed comparably). In nearly every other respect, VA patients received consistently better care across the board, including screening, diagnosis, treatment, and access to follow-up…

Among chronic care patients, VA patients received about 70 percent of recommended care, compared with about 60 percent in the national sample. For preventive care, the difference was greater: VA patients received 65 percent of recommended care, while patients in the national sample received recommended preventive care roughly 45 percent of the time…

After adjusting for a changing case mix as younger veterans return from Iraq and Afghanistan, the CBO calculated that the VA’s average health care cost per enrollee grew by roughly 1.7% from 1999 to 2005, an annual growth rate of 0.3%. During the same time period, Medicare’s per capita costs grew by 29.4 %, an annual growth rate of 4.4 %. In the private insurance market, premiums for family coverage jumped by more than 70% (PDF), according to the Kaiser Family Foundation.

Sadly, it wasn’t always this way. The turnaround at the VA isn’t merely, as Paul Krugman explained, “one of the great policy success stories of the past two decades.” Writing in the Washington Monthly, Steve Benen highlighted the 2005 findings of Phillip Longman in “The Best Care Anywhere”:

As Longman explained at the time, “Who do you think receives higher-quality health care? Medicare patients who are free to pick their own doctors and specialists? Or aging veterans stuck in those presumably filthy VA hospitals with their antiquated equipment, uncaring administrators, and incompetent staff? An answer came in 2003, when the prestigious New England Journal of Medicine published a study that compared veterans health facilities on 11 measures of quality with fee-for-service Medicare. On all 11 measures, the quality of care in veterans facilities proved to be ‘significantly better.’ … The Annals of Internal Medicine recently published a study that compared veterans health facilities with commercial managed-care systems in their treatment of diabetes patients. In seven out of seven measures of quality, the VA provided better care.”

In June 2010, Elizabeth McGlynn, associate director of Rand Health, a division of the Rand Corp., concurred with the assessment that “it’s hard to top veterans’ health care.”

“You’re much better off in the VA than in a lot of the rest of the U.S. health-care system,” she said. “You’ve got a fighting chance there’s going to be some organized, thoughtful, evidence-based response to dealing effectively with the health problem that somebody brings to them.”

The combination of its information system and support tools, routine performance reporting and financial incentives for managers who hit quality targets gives it an edge, said McGlynn, who co-authored a comparative study published in the Annals of Internal Medicine in 2004 that found the VA outperformed its community health-care counterparts by 20 percentage points in preventive care. It also performed significantly better on chronic disease care and in overall quality.

Just as telling, a June 2011 study by Amal Trivedi and Regina Grebla published in the journal Medical Care found that the VA delivered much better results for elderly patients than private sector Medicare Advantage (MA) plans:

Among persons aged 65 years or older, the VA health-care system significantly outperformed private-sector MA plans and delivered care that was less variable by site, geographic region, and socioeconomic status.

Back in 2006, the Defense Department reported that “VA Outranks Private Sector in Health Care Patient Satisfaction.” President Bush’s VA Secretary R. James Nicholson called the findings of the annual American Customer Satisfaction Index, “the greatest story never told.”

Veterans who recently used VA services and were interviewed for the 2005 ACSI survey gave the VA’s inpatient care a rating of 83 on a 100-point scale — compared to a 73 rating for the private-sector health care industry. Veterans gave the VA a rating of 80 for outpatient care, five percentage points higher than the 75 rating for private-sector outpatient care and 9 percent higher than the average satisfaction rating for all federal services.

“Although VA has received many wonderful endorsements recently, the support of our veterans — the people who know us best — is the highest praise,” Nicholson said.

As the Washington Post noted last month, “The American Customer Satisfaction Index for 2013 shows that the VA health network, which serves more than 8 million veterans, achieved marks equal to or better than those in the private sector.” (The latest ACSI report is available here.)

At the end of the day, the fiasco at VA could not come at a worse time. While Congress is wrangling over the size of the defense budget, the total costs of the wars in Iraq and Afghanistan could reach up to $6 trillion once veterans’ pensions and health care are factored in. Over the next 10 years, the Veterans Administration will need more money, not less. And redirecting those resources to the private sector as Mitt Romney, Charles Krauthammer and the conservative commentariat urge can have only one outcome. As Krugman summed it up in 2011:

You know what voucherization would mean in practice: the vouchers would be inadequate, and become more so over time, so that veterans who don’t make enough money to top them up would fail to receive essential care. Patriotism!

It’s no wonder the Veterans of Foreign Wars tersely responded to Mitt Romney’s proposal by simply declaring, “The VFW doesn’t support privatization of veterans’ health care.”

http://www.dailykos.com/story/2014/05/20/1300760/-Privatizing-VA-health-care-would-be-the-greatest-tragedy-of-all#

The Morning Consult, May 20, 2014

As the health insurance industry increasingly looks to market directly to consumers for new revenue, legacy brand challenges remain.  The words “greedy”, “money”, “expensive”, and “profit” dominated voter responses when asked to identify what comes to mind when you think of health insurance companies.

This puts insurers in a precarious position with respect to the Affordable Care Act’s health insurance exchanges should health plans choose to raise premiums next year during open enrollment.  Brand connotations will also impact investment decisions as some insurers look to acquire hospitals and physician practices or diversify into consumer-facing health IT products. The following word clouds illustrate the 100 most frequently given responses.

In a word or two, could you please tell me what comes to mind when you think of health insurance companies?

ARE PHARMACEUTICAL COMPANIES LOSING THEIR INNOVATION BRANDING?

In a year defined by mergers and acquisitions, the pharmaceutical industry increasingly faces a public branding challenge.  The words “greedy”, “money”, “expensive”, and “profit” are seen as most identifiable with pharmaceutical drug companies.

Notably absent from responses is the word “innovation”.  The scientific breakthroughs of the blockbuster drug era had at one time placed the pharmaceutical industry top of mind among the most innovative industries for most Americans.  As the pharmaceutical industry continues to reorganize, and in some cases relocate, it will be critical to watch if a new era of personalized medicine and drug innovation can reshape brand impressions among an aging American public.

In a word or two, could you please tell me what comes to mind when you think of pharmaceutical drug companies?

MEDICAL DEVICE COMPANIES DRAW POSITIVE AND CRITICAL REVIEWS

Like other for-profit industry sectors, medical device companies draw critical reactions like “expensive” and “greedy”, but overall the industry draws the most positive praise as well with notable brand attributes like “good”, “innovative”, and “helpful”.

The positive brand attributes stand out as the medical device companies have been among the most active healthcare stakeholders in Washington with repeated attempts to repeal the Affordable Care Act’s excise tax on medical device revenue.

In a word or two, could you please tell me what comes to mind when you think of medical device companies?

HOSPITALS STAND AT THE CROSSROADS OF “EXPENSIVE” AND “GOOD”

As health system consolidation increases, hospitals stand at crossroads with respect to brand impressions.  Negative connotations like “expensive” and “money” stand in stark contrast to “good” and “necessary”.

Increased public focus on price transparency and chargemasters raises negative brand connotations. At the same time, many hospitals are looking to leverage the “good” and “caring” elements of their brands by acquiring physician practices and exploring running their own insurance products.

In a word or two, could you please tell me what comes to mind when you think of hospitals?

DOCS ARE “GOOD” “CARING” AND “PROFESSIONAL” BUT MAYBE “OVERPAID”

Physicians remain widely respected with strong brand attributes.  Words like “good”, “caring”, “professional” and “dedicated” stand out among a majority of positive impressions.  The only negative connotations that appear among the American public include “overpaid” and “expensive”.  As more and more physicians chose hospital employment over private practice, we will be watching to see if these brand attributes change or remain the same.

In a word or two, could you please tell me what comes to mind when you think of doctors?

NURSES ARE THE HEALTHCARE GOLD STANDARD

Nowhere in the healthcare industry is the American public more in agreement than when it comes to nurses.  There isn’t a single negative brand impression associated with nurses among the top 100 most frequent responses.  The issues of being “underpaid” and “overworked” may have implications in a number of states as nursing unions pursue multiple ballot initiatives and state governments consider reforms to long standing scope of practice laws.

In a word or two, could you please tell me what comes to mind when you think of nurses?

AMERICANS LOVE MEDICARE

The potency of Medicare politics is evident when you consider just how strong the brand attributions are for the program.  Worlds like “necessary”, “good”, and “helpful” overshadow even the faintest recognition that the program may be “underfunded”.  If Washington is to take on Medicare reform in earnest, a substantial education and branding effort will be required to convince Americans that the program needs to be changed.

In a word or two, could you please tell me what comes to mind when you think of Medicare?

MEDICAID SEEN AS NEEDED BUT DRAWS MIXED REVIEWS

The American public overwhelmingly identifies Medicaid as being “needed” and “good”, but compared to Medicare, more negative connotations like “fraud”, “wasteful”, and “abused” are registered.  This in part colors the ongoing state debates over whether to expand the Medicaid program as part of the Affordable Care Act.

In a word or two, could you please tell me what comes to mind when you think of Medicaid?

• Topline results

http://www.themorningconsult.com/2014/05/poll-americans-associate-health-industry-with-high-costs/

By Aaron Carroll, M.D.
The Week, May 19, 2014

In the U.S., we throw around the phrase “socialized medicine” a lot, typically referring to a Medicare-for-all system like Canada’s. But when you think about it, a single-payer insurance system leaves the whole medical industry out of the government orbit.

Enter the U.K.’s National Health Service. When it comes to socialized medicine, this is the real deal. Not only is almost all coverage provided as a public service, most hospitals are run by the NHS, where doctors work for the government: It’s single-payer and single-provider (with some exceptions). How well does it work? Aaron Carroll explains below. –Ryan Cooper

http://theweek.com/article/index/261777/britain-shows-how-real-socialized-medicine-works

A presentation by Dr. Andrew Coates

Labor Beat, May 16, 2014

On YouTube at: http://youtu.be/_M4sP6FieEk

This video provides a clear overview of the national health care crisis, the inadequacies of Obamacare, and the argument for an ‘everybody in, nobody out’ single-payer health program. Andrew D. Coates, M.D., gives a motivating presentation of the basics in this debate, backed up by selected PowerPoint graphics prepared by Physicians for a National Health Program (PNHP) and the Illinois Single-Payer Coalition. 

Dr. Coates has many titles (President, PNHP; Clinical Assistant Professor of Medicine and Assistant Professor of Psychiatry, Albany Medical College; Chief of Hospital Medicine, Samaritan Hospital, Troy, NY; Medical Director, Albany County Nursing Home). The talk was recorded at Access Living in Chicago on May 8, 2014.

Dr. Coates concludes that insurers are selling an “unaffordable, defective product” as he compares the U.S. health care system to other industrialized countries. We are a nation of uninsured and increasingly under-insured, facing staggering household debt from medical bills, and in particular exposing under-insured children, women, minorities and retirees to increasing fatality rates and poor health, in order to satisfy a market solution to health care.

He points to the 2013 AFL-CIO resolution’s “commitment to pursue health care for all ultimately through a single-payer system” as an important step forward. 

Dr. Coates calls upon the union movement: “I think that for the trade union movement that if we speak out for what it means for all working people we’re talking about liberating the whole country here with basic economic rights, the right to necessary care. Then we find a way forward for the whole trade union movement. The unions they have the expertise, they know how to lead us forward, they know exactly how to organize people, how to fight … and it’s going to take a fight. There’s no shortcut.”

Length – 25:52

Besides YouTube, this video is also archived at laborbeat.org. It will be broadcast on Chicago Access Network Television.

By Elisabeth Rosenthal
The New York Times, May 17, 2014

Though the recent release of Medicare’s physician payments cast a spotlight on the millions of dollars paid to some specialists, there is a startling secret behind America’s health care hierarchy: Physicians, the most highly trained members in the industry’s work force, are on average right in the middle of the compensation pack.

That is because the biggest bucks are currently earned not through the delivery of care, but from overseeing the business of medicine.

The base pay of insurance executives, hospital executives and even hospital administrators often far outstrips doctors’ salaries, according to an analysis performed for The New York Times by Compdata Surveys: $584,000 on average for an insurance chief executive officer, $386,000 for a hospital C.E.O. and $237,000 for a hospital administrator, compared with $306,000 for a surgeon and $185,000 for a general doctor.

And those numbers almost certainly understate the payment gap, since top executives frequently earn the bulk of their income in nonsalary compensation. In a deal that is not unusual in the industry, Mark T. Bertolini, the chief executive of Aetna, earned a salary of about $977,000 in 2012 but a total compensation package of over $36 million, the bulk of it from stocks vested and options he exercised that year. Likewise, Ronald J. Del Mauro, a former president of Barnabas Health, a midsize health system in New Jersey, earned a salary of just $28,000 in 2012, the year he retired, but total compensation of $21.7 million.

The proliferation of high earners in the medical business and administration ranks adds to the United States’ $2.7 trillion health care bill and stands in stark contrast with other developed countries, where top-ranked hospitals have only skeleton administrative staffs and where health care workers are generally paid less. And many experts say it’s bad value for health care dollars.

“At large hospitals there are senior V.P.s, V.P.s of this, that and the other,” said Cathy Schoen, senior vice president for policy, research and evaluation at the Commonwealth Fund, a New York-based foundation that focuses on health care. “Each one of them is paid more than before, and more than in any other country.”

She added, “The pay for the top five or 10 executives at insurers is pretty astounding — way more than a highly trained surgeon.”

She said that executive salaries in health care “increased hugely in the ‘90s” and that the trend has continued. For example, in addition to Mr. Del Mauro’s $21.7 million package, Barnabas Health listed more than 20 vice presidents who earned over $350,000 on its latest available tax return; the new chief executive earned about $3 million. Data released by Medicare show that Barnabas Health’s hospitals bill more than twice the national average for many procedures. (In 2006, the hospital paid one of the largest Medicare fines ever to settle fraud charges brought by federal prosecutors.)

Hospitals and insurers maintain that large pay packages are necessary to attract top executives who have the expertise needed to cope with the complex structure of American health care, where hospitals and insurers undertake hundreds of negotiations to set prices.

Ellen Greene, a spokeswoman for Barnabas Health, said Mr. Del Mauro’s retirement package was “a function of over four decades of service and reflects his exceptional legacy.” Nearly $14 million was a cumulative payout from a deferred retirement plan, she said, and the remainder included base compensation, a bonus and an incentive plan

Ms. Greene also said Barnabas’s compensation program follows I.R.S. rules and is established by an executive compensation committee with “guidance from a nationally recognized compensation consultant.”

And studies suggest that administrative costs make up 20 to 30 percent of the United States health care bill, far higher than in any other country. American insurers, meanwhile, spent $606 per person on administrative costs, more than twice as much as in any other developed country and more than three times as much as many, according to a study by the Commonwealth Fund.

As a result of the system’s complexity, there are many jobs descriptions for positions that often don’t exist elsewhere: medical coders, claims adjusters, medical device brokers, drug purchasers — not to mention the “navigators” created by the Affordable Care Act.

Among doctors, there is growing frustration over the army of businesspeople around them and the impact of administrative costs, which are reflected in inflated charges for medical services.

“Most doctors want to do well by their patients,” said Dr. Abeel A. Mangi, a cardiothoracic surgeon at the Yale School of Medicine, who is teaming up with a group at the Yale School of Management to better evaluate cost and outcomes in his department. “Other constituents, such as device manufacturers, pharmaceutical companies and even hospital administrators, may not necessarily have that perspective.”

Doctors are beginning to push back: Last month, 75 doctors in northern Wisconsin took out an advertisement in The Wisconsin State Journal demanding widespread health reforms to lower prices, including penalizing hospitals for overbuilding and requiring that 95 percent of insurance premiums be used on medical care. The movement was ignited when a surgeon, Dr. Hans Rechsteiner, discovered that a brief outpatient appendectomy he had performed for a fee of $1,700 generated over $12,000 in hospital bills, including $6,500 for operating room and recovery room charges.

It’s worth noting that the health care industry is staffed by some of the lowest as well as highest paid professionals in any business. The average staff nurse is paid about $61,000 a year, and an emergency medical technician earns just about minimum wage, for a yearly income of $27,000, according to the Compdata analysis. Many medics work two or three jobs to make ends meet.

“It’s stressful, dirty, hard work, and the burnout rate is high,” said Tom McNulty, a 19-year-old college student who volunteers for an ambulance corps outside Rochester. Though he finds it fulfilling, he said he would not make it a career: “Financially, it’s not feasible.”

Elisabeth Rosenthal is a reporter for The New York Times who is writing a series about the cost of health care, “Paying Till It Hurts.” A version of this news analysis appears in print on May 18, 2014, on page SR4 of the New York edition with the headline: Doctor’s Salaries Are Not the Big Cost.