PNHP

Health Care Reform: We’re Not Done Yet

Health Care Reform: We’re Not Done Yet

By Walter Tsou, M.D.
CommonDreams, June 29, 2012

The Supreme Court has spoken. The Affordable Care Act, briefly on the ropes, has been blessed as the law of the land.

Too many feel that health reform is finally finished and we can move on to the big three issues: the economy, jobs and the deficit. However, because health care is the 800-pound gorilla of the economy, those issues cannot be solved without more far-reaching health reform.

Sorry, lawmakers, but you are going to need to get back in the ring to answer a fundamental question: what is the most cost-effective and constitutional way to finance health care so that we can have quality, affordable health care for everyone?

The answer – single-payer national health insurance, also known as an improved Medicare for all – would save America hundreds of billions of dollars annually. And as the Supreme Court reaffirmed, a program of this type, financed by taxes, is definitely constitutional.

Outrageously, this simple solution was never discussed in the two contentious years of debate surrounding the creation of the ACA because it was deemed “politically impossible.”

“Politically impossible” means that the mere utterance of “single payer” would be enough to prompt the medical-industrial complex, especially the pharmaceutical and insurance industries, to funnel millions of dollars in campaign contributions and lobbying money to opponents of real reform and to tea party groups in order to keep the status quo.

So America continues to promote the least cost-effective way of financing health care, which means that we spend twice per capita on health care than any other nation on earth.

When we were the global leader as we were back in the mid-20th century, we could afford to do this. However, we cannot afford our health care system anymore. It is hopelessly complex, bureaucratic, and outrageously expensive. Employers have shifted the cost to employees and it will only get worse as private insurers raise their premiums.

Beyond skyrocketing premiums, about 18 percent of our gross national product is consumed by health care. That figure will rise to 20 percent by the end of the decade. In order to fund this inefficient system, we have borrowed trillions of dollars over the past 50 years, transforming us into the world’s greatest debtor nation.

No matter who wins the November election, the next administration will be forced to confront the deficit. Unfortunately, it appears that our lawmakers’ tunnel vision only offers slashing Social Security, Medicaid and Medicare for the poor and elderly as a way to reduce government spending. That course would be catastrophic.

No one seems to want to confront the fact that unless we are willing to embrace an improved Medicare for all, with its streamlined administration and bargaining clout, we have no hope of controlling health care costs, ensuring that our country will remain in debt. Had we adopted a single-payer system 20 years ago, we would have turned our national debt into a surplus today.

In a global economy, employers have to add the cost of health insurance to every product or service. When that cost is twice what the world spends, it eventually means that we are pricing our products too high. Manufacturers have moved their major factories overseas because of lower labor costs, of which health insurance is a key component.

Entrepreneurs are everywhere in America, but too many are locked into undesirable jobs because they need the health benefits. Those who want to put their toe into the self-employed world stop because of the risk of losing health benefits which is bad for an economy that needs creativity and risk.

State and local governments are being weighed down by pension obligations and retiree health benefits. Under a single-payer system, Philadelphia could be freed from the unpredictability of these costs and use those precious dollars for our schools, streets, or public safety.

An ABC/Washington Post poll shows that less than 40 percent of Americans view the ACA or the status quo favorably – remarkably low for a “uniquely American” solution.

Our politics have robbed us from even discussing a practical, commonsense solution – improved Medicare for all — that we desperately need in America. If the medical-industrial complex continues to win, health care costs will continue to rise, and the American people will be the losers.

Dr. Walter Tsou is former health commissioner of Philadelphia. He is a board adviser to Physicians for a National Health Program (www.pnhp.org) and resides in Philadelphia.

http://www.commondreams.org/view/2012/06/29-4

So is ACA all there is?

Senator Bernie Sanders
June 28, 2012

In my view, while the Affordable Care Act is an important step in the right direction and I am glad that the Supreme Court upheld it, we ultimately need to do better.  If we are serious about providing high-quality, affordable healthcare as a right, not a privilege, the real solution to America’s health care crisis is a Medicare-for-all, single-payer system. Until then, we will remain the only major nation that does not provide health care for every man, woman and child as a right of citizenship.

http://www.sanders.senate.gov/newsroom/news/?id=8beaca2a-ede7-4add-97ca-18865c0eb0c3

Comment: 

By Don McCanne, MD

The responses to the Supreme Court decision to uphold the basics of the Affordable Care Act were quite predictable. Through all of the cacophony, two predominant views settle out: 1) After a period of celebration, the proponents want to move forward with implementation, and 2) The opponents want to change control of the government so that they can repeal the Act (though maybe proceed with reintroducing limited elements of it).

Yet there is another view simmering under the surface. There is a grave concern that too many people will be left out of the system, that those who have insurance will find that the subsidies are inadequate to provide financial security in the face of medical need, and that the Medicaid program will remain chronically underfunded, resulting in health care access limitations. It will become obvious that these are not acceptable outcomes.

People who understand the single payer model realize that it is the only feasible option, but just as it was buried during the reform process, it will now be buried under the fervor in implementing the Affordable Care Act. We will continue to speak out, but the supporters of the Act will refuse to listen because they are too busy with implementation.

By about 2015 or 2016, those dedicated ACA supporters will see that the numbers really aren’t working, in spite of their efforts – still too many uninsured, costs too high, personal financial hardship rampant, and inability to adequately fund Medicaid because of the stigma of being a welfare program. By then, the celebration of the Supreme Court victory will have long worn off, and our friends will understand that decisions will have to be made as to how to alter course.

Those currently in charge are tinkering incrementalists. They will be looking for solutions such as enhancing consumer empowerment (i.e., keeping insurance premiums down by shifting costs to patients), structural reform of delivery systems (after the failure of accountable care organizations), capping malpractice awards (wrong solution to tort problem), and opening insurance markets across state lines to make insurance affordable (even if health care isn’t). After all, since the ACA provisions aren’t working, it’s time to try the conservatives’ favorite approaches, they’ll reason.

Come on. The solution is staring them in the face – single payer! Yet the resistance will continue. We’ll have ever more of “let’s try this first.”

It will take us until about 2015-2016 to have an impact, only because we’ll have to wade though the muck of ACA reform before our well-meaning friends see that there is only more muck ahead. At that time they will be looking for better solutions, but we cannot wait until then to recharge our campaign. The need is now! We have to establish single payer as a meme. It has to be an automated mentation process.

This means that we have to gear up immediately with an unrelenting campaign to get our friends to understand that single payer is not only the logical solution, but it is the only feasible alternative since it is the only approach that will work. It is long past time for us to replace the concept of political feasibility with the concept of social feasibility.

Let's get real about health reform

By Elizabeth R. Rosenthal, M.D.
The New York Times, Letters, June 29, 2012

Let’s get real about health care reform. Although the Affordable Care Act will bring health insurance to many, it will not bring health care to all or control costs. Millions will still be uninsured or underinsured: one job loss or illness away from bankruptcy. Billions of dollars will continue to be wasted by private, for-profit insurance companies through inflated administrative costs, profits to shareholders and huge salaries for chief executives. These dollars could all be going toward providing health care if we eliminated this unnecessary middleman.

We do not have to look far for a way to do this. Our Medicare program can be expanded to provide care for all. If Congress won’t do this, New York State can lead the way with its own single-payer bill. New York could show the nation how to end the disgrace of allowing so many of the 99 percent to suffer and die for lack of health care that, soon, will be affordable only for the 1 percent.

Dr. Elizabeth R. Rosenthal is a doctor. She resides in Larchmont, N.Y.

Let’s get real about health reform

By Elizabeth R. Rosenthal, M.D.
The New York Times, Letters, June 29, 2012

Let’s get real about health care reform. Although the Affordable Care Act will bring health insurance to many, it will not bring health care to all or control costs. Millions will still be uninsured or underinsured: one job loss or illness away from bankruptcy. Billions of dollars will continue to be wasted by private, for-profit insurance companies through inflated administrative costs, profits to shareholders and huge salaries for chief executives. These dollars could all be going toward providing health care if we eliminated this unnecessary middleman.

We do not have to look far for a way to do this. Our Medicare program can be expanded to provide care for all. If Congress won’t do this, New York State can lead the way with its own single-payer bill. New York could show the nation how to end the disgrace of allowing so many of the 99 percent to suffer and die for lack of health care that, soon, will be affordable only for the 1 percent.

Dr. Elizabeth R. Rosenthal is a doctor. She resides in Larchmont, N.Y.

SCOTUS Rules. What Happens Next?

Mark Dudzic, National Coordinator
Labor for Single-Payer, June 29, 2012

Yesterday’s Supreme Court decision that substantially upholds the Affordable Care Act (ACA) was widely praised by the national labor movement. “Working people won a resounding victory,” proclaimed SEIU President Mary Kay Henry as she thanked President Obama and the members of Congress who supported the ACA.

Likewise, AFL-CIO President Rich Trumka declared himself “pleased and relieved.” However, he also stated that, “We have no illusion that the destination has been reached, and we are more committed than ever to the hard work necessary to achieve our dream of quality health care for all.” One “indisputably constitutional solution,” Trumka suggested, would be to “allow Americans of all ages to buy into an improved Medicare program.”

The National Nurses United (NNU) took a longer-term perspective. Co-President Jean Ross pledged that NNU would step up its campaign for a reform that would be based on “a universal program based on patient need, not on profits or ability to pay. That’s Medicare for all.”

“Medicare is far more effective than the broken private system in controlling costs and the waste that goes to insurance paperwork and profits,” adds NNU Co-President Karen Higgins. “[I]t is universally popular, even among those who bitterly opposed the Obama law. Let’s open it up to everyone.”

Most single-payer advocacy organizations used the occasion of the Supreme Court decision to focus on the inadequacies of the ACA. Healthcare-NOW! points out that there will still be 26 million uninsured and that the ACA, “Embeds private, for-profit insurance in the system’s core, allowing them to continue to profit and game the system at our health’s expense.”

“Contrary to the claims of those who say we are ‘unrealistic,’ a single-payer system is within practical reach,” says a statement signed by eight leaders of the Physicians for a National Health Program. “The most rapid way to achieve universal coverage would be to improve upon the existing Medicare program and expand it to cover people of all ages.”

Vermont Senator Bernie Sanders–the only U.S. Senator who is a current sponsor of single-payer legislation—echoed these sentiments. While expressing support for the Supreme Court decision and the ACA, he asserted that, “the real solution to America’s health care crisis is a Medicare-for-all, single-payer system. Until then, we will remain the only major nation that does not provide health care for every man, woman and child as a right of citizenship.”

“I am proud that Vermont is making steady progress toward implementing a single-payer system,” he added. “I hope our state will be a model to show the rest of the nation how to provide better care at less cost to more people.”

Where Do We Go From Here?

The most immediate consequence of the Supreme Court decision will undoubtedly be political. Pundits are already calling it a momentum changer in the presidential campaign. Indeed, Republicans, with their call to “repeal and replace,” appeared disoriented and mean-spirited. For President Obama it was a triumphal day as he decreed vindication for his vision that, “In America, no illness or accident will lead to a family’s financial ruin.”

The jury is still out, however, on what effect this decision will have on the actual healthcare that Americans will receive under the ACA as well as its effects on the long-term prospects of the fight to make healthcare a right for everyone in America. Certainly, a more sober assessment of the healthcare realities faced by most working Americans and their families would show that we are a long way from President Obama’s aspirational vision.

Many have also expressed concern that the structure of Supreme Court decision may set the stage for future judicial challenges to the social insurance model. The Court refused to anchor the ACA’s individual mandate in the Constitution’s “commerce clause.” This is the clause that has been used to justify nearly every piece of social legislation—from the right to join unions to the food stamp program–since the New Deal. While having no material effect on the implementation of the ACA (the Court ruled that the mandate could be enforced under the constitutional power to tax), this new interpretation, coupled with the Court’s apparent assertion that the federal government cannot force states to comply with all of the provisions of state-administered programs such as Medicaid, could indicate that the Court would be willing to countenance a broader attack on social programs. The Labor Campaign for Single Payer has repeatedly affirmed that, to win, our fight must be part of our broader fight to defend and expand the social insurance model.

Coming at the end of a Supreme Court session that was especially cruel to the labor movement, it is perhaps to be expected that there would be some celebration at what was widely seen as a defeat of labor’s worst enemies. But this must not detract us from the urgency to prepare for a renewed assault on employer-provided healthcare benefits. At a recent strategy meeting of the LCSP Steering Committee and Advisory Board, we heard from union leaders
from around the country who are seeing the writing on the wall. Public employee benefits are under the gun in nearly every jurisdiction. Union Benefit Funds, often the gold standard in employer-funded healthcare, are facing threats to their very survival as ACA regulations impose new mandates while new state insurance exchanges potentially draw off their youngest and healthiest participants. And the 2018 “Cadillac Tax” is beginning to look more and more like a “Chevy Tax” as continued healthcare inflation will trigger this penalty on the hard won benefits of millions more union members than originally predicted.

What Happens Next?

The Affordable Care Act is now indisputably the law of the land. This will create new conditions and new challenges. Many millions will undoubtedly benefit from increased access to healthcare and regulation of the private insurance industry. Many millions more will find out that the right to buy health insurance is not the same thing as the right to healthcare. States will be required to set up healthcare exchanges by 2014 and state-level innovation—including state single-payer reforms—will be barred until at least 2017 (although President Obama did re-affirm his support for efforts to move that date up to 2014).

Certain things won’t change, however. Healthcare will still be treated as a commodity and a profit center rather than as a human right. Millions will continue to be denied access to basic healthcare. Costs will continue to rise two, three, even four times faster than our wages while quality deteriorates. Employer provided healthcare will continue to go the way of defined benefit pensions and healthcare fights will continue to be the biggest cause of strikes, lockouts and union busting.

The labor movement has no choice but to fight on for healthcare justice. And we in the Labor Campaign for Single Payer vow to re-dedicate ourselves to this fight to remove healthcare from the bargaining table and make it a right for everyone in America. We believe that it is labor’s historic responsibility to lead this effort and we will not rest until it fulfills this mission.

We still need a single payer system

By Quentin Young, M.D.
Chicago Sun-Times, Letters, June 29, 2012

The Supreme Court decision upholding the constitutionality of President Barack Obama’s health reform leaves much to be done before the American people have a decent health system. Unfortunately, the reform won’t control costs but will leave 26 million people uninsured and everyone else with “unaffordable underinsurance,” or coverage so skimpy it doesn’t protect from financial ruin in the event of illness.

What is needed now, as Barack Obama noted nearly a decade ago, is enactment of improved Medicare for all, everybody in, nobody out. By replacing our dysfunctional, profit-seeking, private insurance industry with a streamlined single-payer system we can save over $400 billion squandered annually on administrative overhead, enough to cover all 50 million of the uninsured and eliminate co-pays and deductibles for everyone else. Moreover, only a single-payer system can control costs and reduce our nation’s deficit over the long term.

Let us hope that the American people will soon be able to join the citizens of other industrialized, democratic nations, from Canada to Taiwan, in being able to see a doctor without fear of personal debt or national deficit.

Dr. Quentin Young resides in Chicago.

http://www.suntimes.com/opinions/letters/13462027-474/supreme-court-saps-states-power.html

Also see this commentary on Dr. Young’s letter, which was posted on the afternoon of June 28:

Health care law: It may be legal, but it’s not reform, leading doctor says

By Thomas Frisbie
Chicago Sun-Times, BackTalk, June 28, 2012

Don’t expect to see Quentin Young cheering the Supreme Court’s ruling Thursday that the heath care reform legislation is constitutional.

Young, a longtime health-care reform advocate and former chief medical officer of John Stroger Hospital, says the legislation omits a key ingredient: “a decent health system.”

“Unfortunately, the reform won’t control costs but will leave 26 million people uninsured and everyone else with ‘unaffordable underinsurance,’ or coverage so skimpy it doesn’t protect from financial ruin in the event of illness,” Young writes in a letter to the editor of the Sun-Times.

Young, who now is national coordinator of Physicians for a National Health Program, says the only effective cure for the nation’s health care woes is a single-payer health care system, something he points out that Barack Obama once supported.

“By replacing our dysfunctional, profit-seeking, private insurance industry with a streamlined single payer system we can save over $400 billion squandered annually on administrative overhead, enough to cover all 50 million of the uninsured and eliminate co-pays and deductibles for everyone else. Moreover, only a single-payer system can control costs and reduce our nation’s deficit over the long term,” he writes.

http://blogs.suntimes.com/backtalk/2012/06/health_care_law_it_may_be_lega.html

So is ACA all there is?

Senator Bernie Sanders
June 28, 2012
In my view, while the Affordable Care Act is an important step in the right direction and I am glad that the Supreme Court upheld it, we ultimately need to do better.  If we are serious about providing high-quality, affordable healthcare as a right, not a privilege, the real solution to America’s health care crisis is a Medicare-for-all, single-payer system. Until then, we will remain the only major nation that does not provide health care for every man, woman and child as a right of citizenship.
http://www.sanders.senate.gov/newsroom/news/?id=8beaca2a-ede7-4add-97ca-18865c0eb0c3

The responses to the Supreme Court decision to uphold the basics of the Affordable Care Act were quite predictable. Through all of the cacophony, two predominant views settle out: 1) After a period of celebration, the proponents want to move forward with implementation, and 2) The opponents want to change control of the government so that they can repeal the Act (though maybe proceed with reintroducing limited elements of it).
Yet there is another view simmering under the surface. There is a grave concern that too many people will be left out of the system, that those who have insurance will find that the subsidies are inadequate to provide financial security in the face of medical need, and that the Medicaid program will remain chronically underfunded, resulting in health care access limitations. It will become obvious that these are not acceptable outcomes.
People who understand the single payer model realize that it is the only feasible option, but just as it was buried during the reform process, it will now be buried under the fervor in implementing the Affordable Care Act. We will continue to speak out, but the supporters of the Act will refuse to listen because they are too busy with implementation.
By about 2015 or 2016, those dedicated ACA supporters will see that the numbers really aren’t working, in spite of their efforts – still too many uninsured, costs too high, personal financial hardship rampant, and inability to adequately fund Medicaid because of the stigma of being a welfare program. By then, the celebration of the Supreme Court victory will have long worn off, and our friends will understand that decisions will have to be made as to how to alter course.
Those currently in charge are tinkering incrementalists. They will be looking for solutions such as enhancing consumer empowerment (i.e., keeping insurance premiums down by shifting costs to patients), structural reform of delivery systems (after the failure of accountable care organizations), capping malpractice awards (wrong solution to tort problem), and opening insurance markets across state lines to make insurance affordable (even if health care isn’t). After all, since the ACA provisions aren’t working, it’s time to try the conservatives’ favorite approaches, they’ll reason.
Come on. The solution is staring them in the face – single payer! Yet the resistance will continue. We’ll have ever more of “let’s try this first.”
It will take us until about 2015-2016 to have an impact, only because we’ll have to wade though the muck of ACA reform before our well-meaning friends see that there is only more muck ahead. At that time they will be looking for better solutions, but we cannot wait until then to recharge our campaign. The need is now! We have to establish single payer as a meme. It has to be an automated mentation process.
This means that we have to gear up immediately with an unrelenting campaign to get our friends to understand that single payer is not only the logical solution, but it is the only feasible alternative since it is the only approach that will work. It is long past time for us to replace the concept of political feasibility with the concept of social feasibility.

Dr. Oliver Fein on Democracy Now!

Dr. Oliver Fein, immediate past president of Physicians for a National Health Program, internist, and professor of clinical medicine at Weill Medical College of Cornell University, speaks about the Supreme Court’s ruling on the Affordable Care Act on Democracy Now, June 29, 2012.

Watch the full clip here.

Dr. Mary O'Brien on Viewpoint

Dr. Mary O’Brien, national board member of Physicians for a National Health Program, appears on “Viewpoint” on Current TV to discuss the Supreme Court decision on the constitutionality of the Affordable Care Act, June 27, 2012. Dr. O’Brien is double boarded in emergency medicine and internal medicine in New York, and she teaches at Columbia College of Physicians and Surgeons.

Watch the full clip here.

Dr. Mary O’Brien on Viewpoint

Dr. Mary O’Brien, national board member of Physicians for a National Health Program, appears on “Viewpoint” on Current TV to discuss the Supreme Court decision on the constitutionality of the Affordable Care Act, June 27, 2012. Dr. O’Brien is double boarded in emergency medicine and internal medicine in New York, and she teaches at Columbia College of Physicians and Surgeons.

Watch the full clip here.

The Supreme Court decision

By Don McCanne, MD

The Supreme Court Ruling on the Patent Protection and Affordable Care Act

June 28, 1012

Go ahead and wade through the cacophony of responses to the Supreme Court decision. It should be a fascinating excursion through society’s exposed soul at its finest, and at its worst. Some of the responses you will hear will rely on refined cognitive processes and others on fundamental reflexive emotions.

You will not hear much new. The sounds will only be louder and more concentrated. Most of you will be able to sort the good policies from the bad policies and identify the special interest sources of the various proposals. Most of us know to keep foremost in our thoughts the only special interest that counts – the patient – with the full understanding that special interests which truly support patients are the ones that we want to pull out of the chaff, leaving behind those such as the private insurers who would serve others using the patient only as marketplace chattel.

We need to continue to guard against the “sound-good” proposals that would seem to move us incrementally toward a high performance system that serves all patients well. By incremental proposals we are not referring to important measures such as reinforcing the primary care infrastructure and expanding the presence of community health centers in underserved communities. Improving the effectiveness and quality of the health care delivery system is a continual process that must always be with us.

The sound-good incremental steps are those that would seem to move us in the right direction but are more like trying to walk up the steep side of a mountain in deep, loose sand. The steps seem to go forward, but the peak is never reached. Yet we will hear pleas to move up this slope. We have been climbing this slope for half of a century, and it’s time to look for another route.

Many will plead to keep the glass half full now that the Act has been upheld, while others of us will complain about the glass being half empty. It is time to end this petty fray when we can have a full glass – affordable, high quality care for everyone – simply by enacting a single payer national health program. Call it an improved and expanded Medicare for all, if you will.

(Yes, the Supreme Court ruled that the individual mandate survives as a tax, and that Medicaid is limited but not invalidated. But these decisions have been only a diversion, and thus are included here only as a parenthetical remark. The decisions were limited to an Act that merely tweaks the status quo, when what we need is a new act that rejects the status quo. The Supreme Court does not have the authority to bring us that act. Above all, we must guard against celebrating the fact that the Affordable Care Act was upheld, if that should mean that we would walk away from the reform that we desperately need.)