PNHP

Don’t lose any sleep over supply of doctors

Don’t lose any sleep over supply of doctors

By Jason Kelley, M.D.
The Stowe Reporter, March 22, 2012

I have to take issue with the assertions in Mr. Steve Chambers’ letter (Stowe Reporter, March 15) regarding the health-care legislation passed last year by the Vermont Legislature.

He makes it clear that he doesn’t like the legislation, describing it as “reckless,” a “train wreck” and even “Marxist.”

His comments were based on a recent symposium at the public safety building which brought to Stowe three staunch opponents of the legislation.

There’s not room enough to rebut all the assertions made by Mr. Chambers, but as a physician I have to take issue with one point. Among the scare tactics he musters about Vermont’s novel legislation is the claim that untold numbers of doctors will “flee” Vermont when it is implemented.

There are simply no data to support this assertion.

To the contrary, plenty of physicians are attracted to the quality of life that Vermont is so proud of. Indeed, the record shows that the pool of licensed physicians in Vermont has more than kept pace with the growth of the population. As a result, Vermont now boasts the sixth-highest proportion of physicians per capita of any state. That translates into nearly 600 more doctors per capita than the national average.

And if any ideologue physicians left the state, they would quickly be replaced by newly recruited physicians. At a rally at Montpelier last year, 250 medical students and doctors in training from as far afield as Oregon and California made it clear they would be particularly attracted to practicing in our state when universal health care coverage is implemented.

Vermont’s supply of doctors is not something we have to lose any sleep over.

Dr. Jason Kelley lives in Hartford, Vt.

http://www.stowetoday.com/stowe_reporter/opinion/letters_to_the_editor/article_76c24cda-7443-11e1-98f3-0019bb2963f4.html

Healthcare Debate: As Supreme Court Hears Landmark Case, Does Law Do Enough to Fix Health Crisis?


Democracy Now!
March 27, 2012

As the Supreme Court weighs whether the Affordable Care Act goes too far, we host a debate on whether the law goes far enough. The case is reviving the heated tensions that surrounded the healthcare reform law in the debate leading up to its passage two years ago. Although support for the measure is often equated with backing the expansion of health coverage for all Americans, there are some who maintain it didn’t go far enough in helping the uninsured. We speak to Dr. Stephanie Woolhandler, co-founder of Physicians for a National Health Program, and Dr. John McDonough, who played a key role in shaping Mitt Romney’s healthcare reform law in Massachusetts as well as the Affordable Care Act. The new healthcare law is “going to leave tens of millions of Americans woefully underinsured, with gaps in their coverage like copayments and deductibles, so they’ll still be bankrupted by illness. And it’s not going to control cost,” Woolhandler argues. “So we still need single-payer national health insurance regardless of what happens at the Supreme Court.” But McDonough notes that “the moment when there would be sufficient political will for the Congress and the president to come together and pass meaningful, near-comprehensive reform, that might take another 20 years.”

Health Care Jujitsu

By Robert Reich
The Huffington Post, March 26, 2012

Not surprisingly, today’s debut Supreme Court argument over the so-called “individual mandate” requiring everyone to buy health insurance revolved around epistemological niceties such as the meaning of a “tax,” and the question of whether the issue is ripe for review.

Behind this judicial foreplay is the brute political fact that if the Court decides the individual mandate is an unconstitutional extension of federal authority, the entire law starts unraveling.

But with a bit of political jujitsu, the President could turn any such defeat into a victory for a single-payer health care system – Medicare for all.

Here’s how.

The dilemma at the heart of the new law is that it continues to depend on private health insurers, who have to make a profit or at least pay all their costs including marketing and advertising. Yet the only way private insurers can afford to cover everyone with pre-existing health problems, as the new law requires, is to have every American buy health insurance – including young and healthier people who are unlikely to rack up large health care costs.

This dilemma is the product of political compromise. You’ll remember the Administration couldn’t get the votes for a single-payer system such as Medicare for all. It hardly tried. Not a single Republican would even agree to a bill giving Americans the option of buying into it. But don’t expect the Supreme Court to address this dilemma. It lies buried under an avalanche of constitutional argument.

Those who are defending the law in Court say the federal government has authority to compel Americans to buy health insurance under the Commerce Clause of the Constitution, which gives Washington the power to regulate interstate commerce. They argue our sprawling health insurance system surely extends beyond an individual state.

Those who are opposing the law say a requirement that individuals contract with private insurance companies isn’t regulation of interstate commerce. It’s coercion of individuals.

Unhappily for Obama and the Democrats, most Americans don’t seem to like the individual mandate very much anyway. Many on the political right believe it a threat to individual liberty. Many on the left object to being required to buy something from a private company.

The President and the Democrats could have avoided this dilemma in the first place if they’d insisted on Medicare for all, or at least a public option.

After all, Social Security and Medicare require every working American to “buy” them. The purchase happens automatically in the form of a deduction from everyone’s paychecks. But because Social Security and Medicare are government programs financed by payroll taxes they don’t feel like mandatory purchases.

Americans don’t mind mandates in the form of payroll taxes for Social Security or Medicare. In fact, both programs are so popular even conservative Republicans were heard to shout “don’t take away my Medicare!” at rallies opposed to the new health care law.

There’s no question payroll taxes are constitutional, because there’s no doubt that the federal government can tax people in order to finance particular public benefits. But requiring citizens to buy something from a private company is different because private companies aren’t directly accountable to the public. They’re accountable to their owners and their purpose is to maximize profits. What if they monopolize the market and charge humongous premiums? (Some already seem to be doing this.)

Even if private health insurers are organized as not-for-profits, there’s still a problem of public accountability. What’s to prevent top executives from being paid small fortunes? (In more than a few cases this is already happening.)

Moreover, compared to private insurance, Medicare is a great deal. Its administrative costs are only around 3 percent, while the administrative costs of private insurers eat up 30 to 40 percent of premiums. Medicare’s costs are even below the 5 percent to 10 percent administrative costs borne by large companies that self-insure, and under the 11 percent costs of private plans under Medicare Advantage, the current private-insurance option under Medicare.

So why not Medicare for all?

Because Republicans have mastered the art of political jujitsu. Their strategy has been to demonize government and seek to privatize everything that might otherwise be a public program financed by tax dollars (see Paul Ryan’s plan for turning Medicare into vouchers). Then they go to court and argue that any mandatory purchase is unconstitutional because it exceeds the government’s authority.

Obama and the Democrats should do the reverse. If the Supreme Court strikes down the individual mandate in the new health law, private insurers will swarm Capitol Hill demanding that the law be amended to remove the requirement that they cover people with pre-existing conditions.

When this happens, Obama and the Democrats should say they’re willing to remove that requirement – but only if Medicare is available to all, financed by payroll taxes. If they did this the public will be behind them — as will the Supreme Court.

Robert Reich, Ph.D., is professor of public policy at the University of California, Berkeley. This post originally appeared at RobertReich.org.

http://www.huffingtonpost.com/robert-reich/single-payer-health-care_b_1381382.html

NHS dismantling law passes, while risks kept secret

NHS reforms finally become law

By Andrew Woodcock, Tim Schulthorpe
The Independent, March 27, 2012

The Government’s controversial reforms to the NHS became law today after a tortuous 14-month passage through Parliament, when the Queen granted Royal Assent to the Health and Social Care Bill.

The new rules mean the Government can create GP commissioning groups to buy health care for patients and scrap Primary Care Trusts (PCTs).

Labour has bitterly opposed the passage of the new law, insisting it threatens the foundation of the NHS and paves the way for private services to get too involved.

A draft risk register leaked today showed that ministers were warned 18 months ago of the risk that the reforms could lead to a loss of financial control, reduced productivity and emergencies being less well managed.

The Department of Health, which refused to comment on today’s leak, has resisted a ruling from the Information Commissioner that it should release the final version of the risk register in response to a freedom of information request from Labour.

Shadow health secretary Andy Burnham said today’s document showed that ministers were warned before they launched the Bill that it was “likely to cause major damage to the NHS”.

Identifying 43 separate areas of potential risk, the draft register rates each on a scale of one to five, where a rating of one means little likelihood and very low impact and five means almost certain to occur and very high impact.

The likelihood and impact figures are multiplied together to give an overall risk rating, with a maximum score of 25.

Among 13 areas given a risk rating of 16 – with likelihood and impact each assessed at four out of five – were:

* Parliamentary amendments creating “unforeseen consequences for the system”;

* Costs being driven up by GP consortia using private sector organisations and staff;

* Implementation beginning before adequate planning has been done;

* Loss of financial control;

* “Unhelpful conflict” between the NHS commissioning board and regulator Monitor;

* GP consortia going bust or having to cut services for financial reasons;

* GP leaders being drawn into managerial processes which end up driving clinical behaviour.

Other dangers, considered to have a lower rating of 12, included the risk that “NHS role in emergency preparedness/responsiveness is more difficult to manage through a more devolved organisation, and so emergencies are less well managed/mitigated”.

Staff concerns and union action over the reforms could lead to “deterioration in relations, lower productivity in the Department of Health/NHS and delays in programme”, the document said.

And there was a warning that strategic health authorities and primary care trusts might lose “good people” who then have to be re-employed to run the new system.

Mr Burnham told the Guardian: “Now we know why David Cameron refused to publish the risk register before the Bill was through Parliament – it’s because civil servants were telling him his reorganisation was likely to cause major damage to the NHS.

“David Cameron will never be forgiven for knowingly taking these risks with the country’s best-loved institution.”

http://www.independent.co.uk/news/uk/politics/nhs-reforms-finally-become-law-7592991.html

Comment:

By Don McCanne, MD

David Cameron’s conservative government has succeeded in dismantling the National Health Service, turning it over to “GP consortia using private sector organisations and staff,” with “GP leaders being drawn into managerial processes which end up driving clinical behaviour.” The process became final today when the Queen granted Royal Assent.

As a sign of the nefarious process involved, the Cameron government refused an order to release the “risk register” that described the dangers inherent in this legislation that were “likely to cause major damage to the NHS.” Only on the day that the Queen granted her Royal Assent was a draft of the risk register leaked.

The lesson for the United States? Without greater citizen involvement, nominal democracies are, in fact, plutocracies. We bear the consequences of our inaction.

What greater example could there be than the fact that the most watched Supreme Court decision in decades evolves around a consideration as to how large the private insurance industry’s market will be, rather than the consideration that should be under review: whether the people have the right to join together as a nation to ensure health care justice for all.

Comparing the presidential candidates’ views on health reform

By Reid Fletcher
March 27, 2012

PNHP note: The following synopsis of the health care planks of some of the prominent contenders for the U.S. presidency was prepared and offered to us by Reid Fletcher, a second-year student at Northwestern University’s Feinberg School of Medicine. Note that Mr. Fletcher also sketches a picture of the Massachusetts reform of 2006 as part of his analysis. For a more extensive assessment of the latter, see the Mass-Care and PNHP report of last October.

Mitt Romney, Republican Party

Mitt Romney wants to repeal the Patient Protection and Affordable Care Act (ACA) and replace it with a market-based reform. His primary objective is to increase the number of people insured by the wasteful private insurance companies. Despite abundant evidence to the contrary, Romney claims that increasing reliance on the free market will produce more competition and lower costs. His plan would force more seniors into Medicare Advantage (MA) plans which do not provide any added benefit to seniors, are more expensive, and limit the free choice of seniors due to restrictive private insurance care networks. In fact, MA plans are paid, on average, 14 percent more than traditional Medicare per beneficiary. In addition, MA plans are able to game the risk-adjustment system and thereby overcharge Medicare an additional $30 billion annually, or 8 percent of total Medicare spending.

Romney would also block grant the Medicaid system, which would shift costs to the states and ultimately result in fewer benefits being available to lower income individuals. This is essentially a first step toward unraveling the safety net for the very poor, whom Romney admittedly is “not very concerned about.”

His plan also involves a massive expansion of the availability of health savings accounts (HSAs) combined with high deductible plans (HDPs). Individuals and employers can deposit tax-free dollars into HSAs which can be used to pay for medical expenses. The theory behind these plans is that they will make consumers more “cost-sensitive” to the medical services they acquire. In reality, these plans encourage rationing and discourage preventive care. Furthermore, these plans expose patient to greatly increased risk if the HSA runs out due to unexpected illness and the plans have not been demonstrated to lower overall health care costs.

Romney, of course, is also closely associated with the 2006 Massachusetts reform, a description of which is appended.

Newt Gingrich and Rick Santorum, Republican Party

Both Gingrich and Santorum have expressed health reform plans that are essentially identical to Mitt Romney’s plan. The commonalities include the repeal of the ACA, block granting Medicaid, privatizing Medicare, and expanding the use of HSAs.

Barack Obama, Democratic Party

The Obama administration has touted the ACA as the first step toward universal coverage. Unfortunately this is not true. The ACA will leave at least 25 million people uninsured and tens of millions more underinsured. Low income individual will be forced into an expanded, but still poorly funded, Medicaid system. With increasingly fewer providers excepting Medicaid patients, this will prove to be an inadequate solution. Everyone else will be given subsidies to purchase coverage in the broken private insurance market. Studies have shown that the fragmented private insurance system has contributed to the fact that 31 percent of all health care dollars are spent on administration, nearly twice the amount paid in the single-payer Canadian system.

Jill Stein (Green Party) and Rocky Anderson (Justice Party)

Stein and Anderson are both proponents of a single-payer plan, which would essentially be an improved-Medicare-for-all system. Stein is more consistent on this point than Anderson. Anderson, while he supports a single-payer system, has also said he’s leaving  the door open for a market-based reform.

In a single-payer plan, everyone would be automatically covered by a single public insurer. Everyone would be given the same level of coverage and everyone would have the same freedom to see any provider they choose. This system would reduce administrative waste to the acceptable Canadian levels, which would save nearly $400 billion each year, which is more than enough to cover all of those who are currently uninsured or underinsured.

Furthermore, mechanisms like capital planning, global budgeting, and bulk purchasing would help to control ever-increasing health care costs and improve efficiency within the system.

*****

The Massachusetts reform: an analysis

In 2006 the Massachusetts Legislature, under direction from then-Gov. Mitt Romney, passed a major health reform bill which four years later became the model for the ACA supported by the Obama administration. Given the seeming inevitability of Romney winning the GOP nomination and the highly controversial nature of health care reform, it is highly likely the reform in Massachusetts will come to the forefront of the nation’s attention at some point during the fall elections. The Obama campaign will try to weaken Romney by claiming that the Massachusetts plan is successful and a means to increase insurance coverage; meanwhile the Romney campaign will suggest that the Massachusetts reform was successful, but was not the model for the ACA. In truth, both campaigns will be wrong. The Massachusetts was the model for the ACA and it has been unsuccessful.

What was done in Massachusetts?

Like the ACA, the Massachusetts reform increased coverage by expanding public programs for residents up a certain level of the poverty line while forcing everyone else to buy public insurance or face penalties. The net effect has been to push more people into the private insurance market, so as to lower the total number of uninsured, without modifying the existing private insurance system.

An evaluation

While proponents of the Massachusetts reform will point to the fact that the state now has one of the high rates of health insurance coverage in the country (97.3 percent) as evidence of the success of the legislation, a closer look at the situation quickly shows that the reform effort has not been successful.

We will analyze three areas to demonstrate the failure of the Massachusetts reform: insurance for the poor, cost controls, and rate of underinsurance.

Insurance for the poor

One of the biggest changes that came with the Romney reform was to the safety net program that provided coverage to low-income residents. Prior to the reform, the “Free Care Pool” completely subsidized medical services for the uninsured and underinsured up to 200 percent of the poverty line, in addition to partially subsidizing care for residents between 200 percent and 400 percent of the poverty line. Health care reform replaced the Free Care Pool with the “Health Safety Net”, which was covers medical services for those unable to purchase insurance on their own. However, major differences exist between these two programs which have serious implications for the level of coverage for the poor. For example, The Health Safety Net only fully subsidizes care for those up to 150 percent of the poverty line and increases cost sharing for residents up to 400 percent of the poverty line. Thus there is a larger burden placed on the poor, which will ultimately result in avoidance of necessary care and poor outcomes

Cost controls

While Massachusetts now boasts one of the highest level of health insurance coverage in the nation, the state also has one of the highest health care costs per capita. Health care reform has done nothing to
slow the quickly rising costs of health care in Massachusetts, and in fact, by some measures the reform legislation has actually exacerbated the problem. This is largely because the reform failed to address the fundamental defects in the system. Instead of directly addressing the dysfunctional and wasteful private insurance market, the reform pumped more people into the system. Overhead and administrative costs related to private insurance are one of the main drivers of increased health care costs, and the Massachusetts reform, like the PPACA, did nothing to address these deficiencies.

Rates of underinsurance

Rates of underinsurance have skyrocketed in Massachusetts since the implementation of reform. The rising costs of private insurance, combined with the individual mandate to purchase that insurance has forced consumers to opt for low cost options like high deductible health plans. In fact from 2010 to 2011, the number of people in high deductible health plans doubled. These plans shift costs to consumers and have been shown to decrease utilization of necessary medical services. These plans de-incentivize cost-saving preventive care and put consumers at high financial risk if they get sick.

Conclusion

The Massachusetts health reform has not been successful. While the state can boast one of the highest rates of insurance coverage in the country, it also has an excessive amount of underinsurance and skyrocketing health care costs. Given that President Obama’s PPACA was largely based on the Massachusetts reform, the prospects for success of the PPACA are minimal. Simply put, forcing a large percentage of the population into the wasteful and inefficient private health insurance system cannot achieve cost savings or quality coverage for all. The only way to achieve this is to reform the health insurance system, and the most effective way to do this is to implement single payer reform.

NHS dismantling law passes, while risks kept secret

NHS reforms finally become law

By Andrew Woodcock, Tim Schulthorpe
The Independent, March 27, 2012

The Government’s controversial reforms to the NHS became law today after a tortuous 14-month passage through Parliament, when the Queen granted Royal Assent to the Health and Social Care Bill.
The new rules mean the Government can create GP commissioning groups to buy health care for patients and scrap Primary Care Trusts (PCTs).
Labour has bitterly opposed the passage of the new law, insisting it threatens the foundation of the NHS and paves the way for private services to get too involved.
A draft risk register leaked today showed that ministers were warned 18 months ago of the risk that the reforms could lead to a loss of financial control, reduced productivity and emergencies being less well managed.
The Department of Health, which refused to comment on today’s leak, has resisted a ruling from the Information Commissioner that it should release the final version of the risk register in response to a freedom of information request from Labour.
Shadow health secretary Andy Burnham said today’s document showed that ministers were warned before they launched the Bill that it was “likely to cause major damage to the NHS”.
Identifying 43 separate areas of potential risk, the draft register rates each on a scale of one to five, where a rating of one means little likelihood and very low impact and five means almost certain to occur and very high impact.
The likelihood and impact figures are multiplied together to give an overall risk rating, with a maximum score of 25.
Among 13 areas given a risk rating of 16 – with likelihood and impact each assessed at four out of five – were:
* Parliamentary amendments creating “unforeseen consequences for the system”;
* Costs being driven up by GP consortia using private sector organisations and staff;
* Implementation beginning before adequate planning has been done;
* Loss of financial control;
* “Unhelpful conflict” between the NHS commissioning board and regulator Monitor;
* GP consortia going bust or having to cut services for financial reasons;
* GP leaders being drawn into managerial processes which end up driving clinical behaviour.
Other dangers, considered to have a lower rating of 12, included the risk that “NHS role in emergency preparedness/responsiveness is more difficult to manage through a more devolved organisation, and so emergencies are less well managed/mitigated”.
Staff concerns and union action over the reforms could lead to “deterioration in relations, lower productivity in the Department of Health/NHS and delays in programme”, the document said.
And there was a warning that strategic health authorities and primary care trusts might lose “good people” who then have to be re-employed to run the new system.
Mr Burnham told the Guardian: “Now we know why David Cameron refused to publish the risk register before the Bill was through Parliament – it’s because civil servants were telling him his reorganisation was likely to cause major damage to the NHS.
“David Cameron will never be forgiven for knowingly taking these risks with the country’s best-loved institution.”
http://www.independent.co.uk/news/uk/politics/nhs-reforms-finally-become-law-7592991.html

David Cameron’s conservative government has succeeded in dismantling the National Health Service, turning it over to “GP consortia using private sector organisations and staff,” with “GP leaders being drawn into managerial processes which end up driving clinical behaviour.” The process became final today when the Queen granted Royal Assent.
As a sign of the nefarious process involved, the Cameron government refused an order to release the “risk register” that described the dangers inherent in this legislation that were “likely to cause major damage to the NHS.” Only on the day that the Queen granted her Royal Assent was a draft of the risk register leaked.
The lesson for the United States? Without greater citizen involvement, nominal democracies are, in fact, plutocracies. We bear the consequences of our inaction.
What greater example could there be than the fact that the most watched Supreme Court decision in decades evolves around a consideration as to how large the private insurance industry’s market will be, rather than the consideration that should be under review: whether the people have the right to join together as a nation to ensure health care justice for all.

Single-payer system would control health care costs

By Cory D. Carroll, M.D.
The Coloradoan, Letters, March 25, 2012

In medicine, physicians use their training and experience to diagnose and treat patient ills. Over the years, I have witnessed a new condition, not covered in any of my medical school lectures or textbooks, that is at epidemic proportions and worsening. The condition is caused by an out-of-control parasite — the for-profit medical insurance industry.

Decreasing pharmacy benefits, increasing co-pays and out-of-sight deductibles coupled with diminished coverage for care are the symptoms — and there is no foreseeable cure. The for-profit insurance system covers the healthiest Americans and has perfected the art of sucking more and more money from business/patients (higher premiums) and providers (diminished payments) while increasing profits for their executives and shareholders. The governmental programs (Medicare, Veterans Affairs and Medicaid) that are responsible for our elderly, veterans and poor are also cutting back, but these patients are not experiencing the incredibly large increase in out-of-pocket expenses and rarely see a loss of expected services.

The Patent Protection and Affordable Care Act, known by some as “Obamacare,” is a Republican-leaning bill (suggested by Nixon in 1974 and implemented by Romney in 2006) that was an attempt to control costs and protect patients. The two main problems with President Barack Obama’s bill is the legislation is phased in during a four-year period (i.e. it will not be until 2014 until all aspects of the bill will be in place) and it keeps the for-profit insurance industry as a central player (our elderly, veterans and poor still will be covered by the government). The delay in implementing the bill has given the insurance industry ample time to outmaneuver the aspects of the bill that will actually control costs and protect patients. Already, several provisions that should be in effect now have been modified to accommodate the for-profit insurance industry’s whining.

If you support American jobs and desire a stable economy, you need to understand how the lack of medical coverage destabilizes our country. If we had an accessible health care system, for all citizens regardless of employment, businesses would no longer be burdened with escalating health care costs and would be able to generate more jobs — for Americans. Additionally, having affordable access to health care for all citizens would allow entrepreneurs to flourish and allow others to break the corporate chains that keep them from starting private businesses.

If all Americans had guaranteed coverage for necessary medical care, then the medical delivery systems in our communities would be more financially stable and the cost shifting between the “haves” and the “have nots” would cease. Everyone would pay (through a progressive tax system) their fair share. It is insane that the wealthiest nation on the globe allows its citizens to incur personal bankruptcy when they suffer a significant accident or serious illness. Fun fact: The majority of medical bankruptcies occur to individuals/families with insurance.

A single-payer system is not a “government takeover of medicine.” Rather, it is a shift in the financing of health care and would end the inefficiencies and greed of the for-profit insurance industry. It would be the best option to control medical costs and improve health outcomes. A single-payer health care system (not for-profit) is essential if America wants to have a sustainable future.

Dr. Cory D. Carroll lives in Fort Collins.

http://www.coloradoan.com/article/20120326/OPINION04/203260307/Single-payer-system-would-control-health-care-costs

The Medical Golden Rule: Physicians Advocate for Patients

An Expert Interview With David Ansell, MD

By Nancy A. Melville
Medscape Medical News, March 22, 2012

HOUSTON — David Ansell, MD, chief medical officer at Rush University Medical Center in Chicago, Illinois, is the author of “COUNTY: Life, Death and Politics at Chicago’s Public Hospital.” The book details Dr. Ansell’s 17 years of experience working in deplorable conditions at Chicago’s Cook County Hospital, where he and his colleagues would “care for patients in the morning and picket in front of the county building in the afternoon,” as they became activists for health reform.

Dr. Ansell and his colleagues published a study on conditions at the hospital that ultimately led to the passage of the Emergency Medical Treatment and Labor Act, which made it illegal in the United States to dump patients in need of emergency care, regardless of their insurance status.

In his keynote address here at the American Medical Student Association (AMSA) 62nd Annual Convention, Dr. Ansell declared that “healthcare as a human right is the moral issue of our time,” and urged the audience of future physicians to commit themselves to patient advocacy during their careers.

“We are the natural advocates for the poor,” he said. “Because we see the human condition first hand, it is our obligation to speak up on their behalf. You can’t be a doctor and not be touched by the patients and their struggles.”

Dr. Ansell noted that the fact that his mother’s family perished in the Holocaust instilled in him the strong belief in speaking up in the name of human rights.

“The problem I saw wasn’t that governments could do bad things to people, but that neighbors didn’t speak up on behalf of their neighbors.”

A key focus of Dr. Ansell’s ongoing activism is closing inequalities in healthcare, or what he calls the “death gap,” in the United States, which result in Americans dying younger than residents of most other developed countries. “The idea that one should die because they’re poor is obscene,” he said.

Medscape: You noted that the death gap between the richest and poorest communities in the United States is 24 years, whereas in England it is just 7 years. What key elements could realistically be implemented in the United States to reduce this disparity?

Dr. Ansell: Actually, the gap in the United States is 30 years and the gap in Great Britain is now 13 years. Some of the death gap is the result of the design of our healthcare system; much of the death gap is the result of broader social inequalities; some of it has environmental causes. Regardless, the death gap in the United States is unacceptable. We have a healthcare system that is separate and unequal. Where you go, what services are available, are determined by the insurance card you have.

Those with gold-plated insurance policies get access to the best institutions and the best care. Those with lesser insurance, Medicaid, or no insurance have much more difficulty accessing care. Health reform will give more people a card, but will it get them the care they need when they need it?

We know that 45,000 individuals in the United States die each year because of lack of insurance, and 80,000 die because of racial inequalities. It is one thing to have the income and wealth inequalities we have…, but the notion that we allow people in this, the wealthiest nation in the world, to die because they cannot access care is just not right.

Single-payer healthcare for all is the best solution for the United States. It is fair, allows people choice, and it would treat people equally. This would not address all the reasons for the death gap, but it would go a long way to making our health system more equal.

Medscape: The study that you and your colleagues published was pivotal in bringing about the change needed to address the problem of patient “dumping.” What kinds of studies are necessary to address the inequalities in life expectancy between the “haves” and the “have-nots”?

Dr. Ansell: I don’t think we need more studies. We need solutions. Let’s start by agreeing that healthcare is a human right. I believe our failure as a nation to agree that healthcare is a human right, and not a commodity to be bought and sold, is at the root of the problem and is the moral issue of our time.

If we accept that healthcare is a human right, then we would design and operate our health system around the principles of equal access for all and a series of essential healthcare benefits that people would have as a condition of their “citizenship,” not as a condition of their ability to pay. Again, a single-payer system — Medicare for all — is an important first step.

Medscape: The AMSA and other medical groups are working to make the single-payer option a reality in the United States. What changes need to be made in the current healthcare environment for such a system to succeed?

Dr. Ansell: The collective voices of medical students, doctors, and the public will be necessary. The real opposition to a single payer is the health insurance companies, who are profiting mightily from the current set-up. They will not go down without a big fight.

Medical students, doctors, and other healthcare professionals will need to speak up and educate the public about this. The United States has the most expensive healthcare system in the world by 2-fold. We have more than enough money in the system to serve everyone well and turn the focus from sick care to prevention.

A single-payer system will not solve all our ills, but it will provide fair coverage to many more people at a much lower cost. Doctors are the natural advocates for those with less. It is important that those of us who can speak up for fairness and equality — solid American and democratic values — do so. And we will have to elect folks to office who share these beliefs.

Medscape: You mentioned that you were inspired by the commitment of the Suffragettes to change. What person or movement in the present inspires you?

Dr. Ansell: I am inspired by people like Nelson Mandela, who was imprisoned for 26 years because of his opposition to apartheid and then became the president of South Africa. It reminds me that one has to have the long view of these fights for social justice and equality. If we believe that healthcare is a human right and that a single payer is the solution, then we have to look back on previous struggles for inspiration and lessons.

http://www.medscape.com/viewarticle/760728

PNHP statement on the Supreme Court deliberation of the Affordable Care Act

Health law, constitutional or no, fails to remedy ailment: doctors group

Press Release, March 26, 2012

Leaders of Physicians for a National Health Program, an organization of 18,000 doctors who advocate for single-payer national health insurance, released the following statement today:

Regardless of whether the Supreme Court upholds or overturns the Affordable Care Act in whole or in part, the unfortunate reality is that federal health law of 2010 will not work: (1) it will not achieve universal coverage, as it leaves at least 26 million uninsured, (2) it will not make health care affordable to Americans with insurance, because gaps in their policies will leave them vulnerable to bankruptcy in the event of major illness, and (3) it will not control costs.

Why? Because the ACA perpetuates a dominant role for the private insurance industry.  That industry siphons off hundreds of billions of  health care dollars annually for overhead, profit and the paperwork it demands from doctors and hospitals; it denies care in order to increase insurers’ bottom line; and it obstructs any serious effort to control costs.

In contrast, a single-payer, improved-Medicare-for-all system would achieve all three goals – truly universal, comprehensive coverage; health security for our patients and their families; and cost control. It would do so by replacing private insurers with a single, nonprofit agency like Medicare that pays all medical bills, streamlines administration, and reins in costs for medications and other supplies through its bargaining clout.

The major provisions of the ACA do not go into effect until 2014. Although we will be counseled to “wait and see” how this reform plays out, we’ve seen how comparable reforms in Massachusetts and other states have worked over the past few decades. They have invariably failed our patients, foundering on the shoals of skyrocketing costs – even as they have profited the big private insurers and Big Pharma.

The Supreme Court’s ruling is not expected until June. Regardless of how it rules, we cannot wait for an effective remedy to our health care woes any longer, nor can our patients. The stakes are too high.

We pledge to continue our work for the only equitable, financially responsible and humane cure for our health care mess: single-payer national health insurance, an expanded and improved Medicare for all.

https://pnhp.org/news/2012/march/health-law-constitutional-or-no-fails-to-remedy-ailment-doctors-group

Comment:

By Don McCanne, MD

The attention to the Supreme Court deliberations on the Affordable Care Act is an unfortunate distraction since, regardless of the outcome, intolerable levels of uninsurance, undersinsurance, and unaffordability will still be with us. We need to replace the Affordable Care Act with single-payer national health insurance, an expanded and improved Medicare for all.

Please share this pivotal message with others, and feel free to use it as a basis for other communications such as letters to the editor, op-eds, reports to community organizations, and any other modality that can educate others on this crucial issue.

Other resources:

PNHP statement on the passage of the Affordable Care Act (March 2010):
https://pnhp.org/news/2010/march/pro-single-payer-doctors-health-bill-leaves-23-million-uninsured

Fact sheet on single payer, improved Medicare for all:
https://pnhp.org/docs/2011/Improved-Medicare-for-All-Fact-Sheet.pdf

Many other resources are available at www.pnhp.org

Health law, constitutional or no, fails to remedy ailment: doctors group

FOR IMMEDIATE RELEASE
March 26, 2012

Contact:
Garrett Adams, M.D., president PNHP
Andrew Coates, M.D., president-elect PNHP
Oliver Fein, M.D.
David Himmelstein, M.D.
Steffie Woolhandler, M.D.
Mark Almberg, PNHP communications director, (312) 782-6006, mark@pnhp.org

Leaders of Physicians for a National Health Program, an organization of 18,000 doctors who advocate for single-payer national health insurance, released the following statement today:

Regardless of whether the Supreme Court upholds or overturns the Affordable Care Act in whole or in part, the unfortunate reality is that federal health law of 2010 will not work: (1) it will not achieve universal coverage, as it leaves at least 26 million uninsured, (2) it will not make health care affordable to Americans with insurance, because gaps in their policies will leave them vulnerable to bankruptcy in the event of major illness, and (3) it will not control costs.

Why? Because the ACA perpetuates a dominant role for the private insurance industry.  That industry siphons off hundreds of billions of  health care dollars annually for overhead, profit and the paperwork it demands from doctors and hospitals; it denies care in order to increase insurers’ bottom line; and it obstructs any serious effort to control costs.

In contrast, a single-payer, improved-Medicare-for-all system would achieve all three goals – truly universal, comprehensive coverage; health security for our patients and their families; and cost control. It would do so by replacing private insurers with a single, nonprofit agency like Medicare that pays all medical bills, streamlines administration, and reins in costs for medications and other supplies through its bargaining clout.

The major provisions of the ACA do not go into effect until 2014. Although we will be counseled to “wait and see” how this reform plays out, we’ve seen how comparable reforms in Massachusetts and other states have worked over the past few decades. They have invariably failed our patients, foundering on the shoals of skyrocketing costs – even as they have profited the big private insurers and Big Pharma.

The Supreme Court’s ruling is not expected until June. Regardless of how it rules, we cannot wait for an effective remedy to our health care woes any longer, nor can our patients. The stakes are too high.

We pledge to continue our work for the only equitable, financially responsible and humane cure for our health care mess: single-payer national health insurance, an expanded and improved Medicare for all.

******

Background

Statement of Physicians for a National Health Program upon the passage of the health law in March 2010. Fact sheet on the crisis in U.S. health care and the case for single-payer health reform. A recent analysis of the Massachusetts health reform.

*******
Physicians for a National Health Program (www.pnhp.org) is an organization of more than 18,000 doctors who support single-payer national health insurance. To speak with a physician/spokesperson in your area, visit www.pnhp.org/stateactions or call (312) 782-6006.

PNHP statement on the Supreme Court deliberation of the Affordable Care Act

Health law, constitutional or no, fails to remedy ailment: doctors group

Press Release, March 26, 2012
Leaders of Physicians for a National Health Program, an organization of 18,000 doctors who advocate for single-payer national health insurance, released the following statement today:
Regardless of whether the Supreme Court upholds or overturns the Affordable Care Act in whole or in part, the unfortunate reality is that federal health law of 2010 will not work: (1) it will not achieve universal coverage, as it leaves at least 26 million uninsured, (2) it will not make health care affordable to Americans with insurance, because gaps in their policies will leave them vulnerable to bankruptcy in the event of major illness, and (3) it will not control costs.
Why? Because the ACA perpetuates a dominant role for the private insurance industry. That industry siphons off hundreds of billions of health care dollars annually for overhead, profit and the paperwork it demands from doctors and hospitals; it denies care in order to increase insurers’ bottom line; and it obstructs any serious effort to control costs.
In contrast, a single-payer, improved-Medicare-for-all system would achieve all three goals – truly universal, comprehensive coverage; health security for our patients and their families; and cost control. It would do so by replacing private insurers with a single, nonprofit agency like Medicare that pays all medical bills, streamlines administration, and reins in costs for medications and other supplies through its bargaining clout.
The major provisions of the ACA do not go into effect until 2014. Although we will be counseled to “wait and see” how this reform plays out, we’ve seen how comparable reforms in Massachusetts and other states have worked over the past few decades. They have invariably failed our patients, foundering on the shoals of skyrocketing costs – even as they have profited the big private insurers and Big Pharma.
The Supreme Court’s ruling is not expected until June. Regardless of how it rules, we cannot wait for an effective remedy to our health care woes any longer, nor can our patients. The stakes are too high.
We pledge to continue our work for the only equitable, financially responsible and humane cure for our health care mess: single-payer national health insurance, an expanded and improved Medicare for all.
https://pnhp.org/news/2012/march/health-law-constitutional-or-no-fails-to-remedy-ailment-doctors-group

The attention to the Supreme Court deliberations on the Affordable Care Act is an unfortunate distraction since, regardless of the outcome, intolerable levels of uninsurance, undersinsurance, and unaffordability will still be with us. We need to replace the Affordable Care Act with single-payer national health insurance, an expanded and improved Medicare for all.
Please share this pivotal message with others, and feel free to use it as a basis for other communications such as letters to the editor, op-eds, reports to community organizations, and any other modality that can educate others on this crucial issue.
Other resources:
PNHP statement on the passage of the Affordable Care Act (March 2010):
https://pnhp.org/news/2010/march/pro-single-payer-doctors-health-bill-leaves-23-million-uninsured
Fact sheet on single payer, improved Medicare for all:
https://pnhp.org/system/assets/drupal/docs/2011/Improved-Medicare-for-All-Fact-Sheet.pdf
Many other resources are available at www.pnhp.org

Single Payer and the Supreme Court

Surprisingly, several groups seek to challenge the Affordable Care Act from the left

By Robert Kuttner
The American Prospect, March 23, 2012

When the Supreme Court begins its extraordinary three days of hearings on the constitutionality of the Affordable Care Act, one of the oddities will be an amicus brief challenging the act’s individual mandate from 50 doctors who support national health insurance. They point out the inconvenient truth that, contrary to the administration’s representations, the government did not need to require citizens to purchase insurance from private companies in order to meet its goals of serving the health-care needs of the populace. Congress could have enacted a single-payer law.

Since the Constitution unambiguously gives Congress the power to tax, there has never been a serious constitutional challenge to our tax-supported systems of health insurance, Medicare, and the services of the Veterans Health Administration system. In the words of the brief:

“Amici thus submit this brief for the purpose of disputing the primary tenet of the Government’s position, that Congress cannot regulate the national healthcare market effectively unless it has power to require that citizens purchase insurance from private insurance companies. On the contrary, as set forth herein, Congress has already demonstrated that it can regulate healthcare markets effectively by implementing a single payer system such as Medicare or the VHA.”

Much of the brief is devoted to demonstrating the superior efficiencies of single-payer systems, but it is also offers a formidable summary of the constitutional argument against the government’s view of what the Commerce Clause permits.

“Government contends that the provision is not only ‘reasonable’ but also ‘necessary’ to its broader regulation of the national healthcare market. Brief for Petitioners. In particular, the Government contends that the individual mandate is ‘key to the viability of the Act’s guaranteed-issue and community-rating provisions.’ But while it might be true that these provisions will adversely impact private insurers’ profits, and that the individual mandate offsets this adverse impact by guaranteeing the private insurers a large stream of new customers who are required by law to purchase insurance, that is not sufficient to render the individual mandate constitutional. If it were, Congress could ‘reform’ any private industry – whether it be automobiles, coal, pharmaceuticals or any other – by enacting legislation requiring every that American purchase the industry’s goods or services in exchange for some perceived public good the industry provides. Yet Congress has never before enacted such a mandate.”

Ouch.

The brief further contends that none of the cases cited by the government “support the conclusion that the commerce power permits Congress to enact any regulation it finds necessary to the viability of a larger scheme regulating interstate commerce.”

It would be more than a little ironic if a majority of the Court struck down the Affordable Care Act by relying on these arguments. These points have been made by others, of course. But what’s nervy is that some single-payer advocates are tactically allying themselves with the political right in a momentous Supreme Court battle.

The brief is filed in the name of two groups, Single Payer Action and It’s Our Economy, and was written by attorney Oliver Hall. It explicitly asks the Court to uphold the ruling of the Court of Appeals for the Eleventh Circuit finding the individual mandate unconstitutional.

This tactic must have given some single-payer advocates pause, since the most prominent single-payer group, Physicians for a National Health Program (PNHP) and such noted proponents of national health insurance as Drs. David Himmelstein and Steffie Woolhandler of Physicians for a National Health Program are not on the brief.

If the Affordable Care Act were to be struck down, it would be a political blow to the Obama administration, as well as another case of overreach by the Roberts Court.

But the Court could well uphold the act. Some observers have suggested that the conservatives on the Court are having second thoughts about the unintended consequences of the Citizens United decision on unlimited political giving. Justices Scalia and Kennedy, moreover, have gone both ways on prior cases involving the reach of the commerce clause and may decide that this is not the time to further risk the Court as an institution, which severely impaired its credibility in Bush v. Gore.

On the other hand, if the Court struck down only the individual mandate, the rest of the act would live on. And the administration and Congress would have to find other ways to prevent uninsured people from free-riding on the system. As my colleague Paul Starr has proposed, a Court finding that the mandate was illegal would not necessarily kill the whole law. Other incentives and disincentives could be created so that most people would find it attractive to purchase insurance.

The amici have a point. A single-payer program would be more efficient and unambiguously constitutional, and even the Affordable Care Act need not be such a gravy train for the insurance industry. This brief, though risky, could turn out to be constructive mischief.

http://prospect.org/article/single-payer-and-supreme-court