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The following is an unofficial transcript of the remarks of Dr. Andrew D. Coates, president of Physicians for a National Health Program, at a summit on single-payer health care convened by Sen. Bernie Sanders, I-Vt., on May 21, 2014, at the Dirksen Senate Office Building in Washington.

Sen. Bernie Sanders: Dr. Andrew Coates is president of Physicians for a National Health Program. He is assistant professor of medicine and psychiatry at Albany Medical College, and practices hospital medicine at a community hospital in Upstate New York. Dr. Coates, thanks for being with us.

Dr. Andrew D. Coates: Thank you, Senator Sanders. It’s a great honor.

I’m representing Physicians for a National Health Program, 19,000 physicians who have been advocating for national health insurance for over 25 years.

Physicians have a special relationship with society. As the profession has evolved, our relationship with society has become profound, but also tangled with business. And what I has happened is almost bewildering to my colleagues many times.

We know from studies, very good research, that the majority of American physicians want national health insurance. And we know that from our daily practice because patients should have access to all necessary care when they need it. I think that question is absolutely settled in this country.

Right now there’s a scandal in the Veterans Administration, and there’s a scandal because those patients should have everything they need. And the entire country knows it. And we should all make it our responsibility to make that happen. That’s the starting point for the dialogue in our nation, and it’s the same starting point among the physicians.

What’s happened lately is that costs have been completely out of control in terms of aggregate, but the plan about what to do about those costs has been to shift them onto individuals.

So in our hospital I understand that emergency room visits are down, they’re falling. The administrators think it’s because of the co-pays, the co-insurance, the deductibles – the new forms of insurance that the patients have. But as the visits to the emergency room are going down, the number of admissions to the hospital are climbing. So the patients who are coming to the hospital are much sicker.

We practice near the southern Vermont border. Many of our staff and some of our patients come from Vermont. We know this community well. It’s a community with a heroin epidemic. The needs are colossal. The poverty is severe. And we see the presentation of very advanced disease from people who have not had access to adequate primary care every day.

Patients don’t have the choice of where they can go. This system shunts them and schleps them wherever. My own doctor, several years ago, cancelled my health insurance, wouldn’t take my health insurance, because she couldn’t come to terms with the company that my employer had chosen.

And so, when you lay out the evidence, like Rob [Weissman] did, the system actually indicts itself. It doesn’t make any sense at all. If the goal were to provide all necessary care for everyone in the United States, the system we have is a failure. Way too many people are left out, there are hideous disparities, African Americans do not get the same care that white patients get, immigrants are actually left out in all kinds of different ways — the most hideous violations of human rights in our country are the medical deportations of undocumented patients who are sick and who are sent back by air ambulance to their home country by the hospital.

And through this, it’s clear to me that physicians want to do their best as caregivers. We want to do what we learned to do. We want to apply the medical science and the human arts at the bedside in the best and exemplary way, and yet our society doesn’t organize to give us those resources.

The farther I go in this advocacy for national health insurance, I think, Why is it that the mainstream of our society is so interested in single payer? Why is it that we’re in The New York Times every week, or The Washington Post, or the U.S. Senate? And I know that the wonderful educational efforts of senators like yourself and representatives are crucial to keep the discussion going, but it’s also the simple fact that this would work.

Single payer would work. We could do this. It would be completely feasible. It could happen rather quickly. We have what it takes. We have the excellent caregivers, we have the infrastructure, and we have the know-how. So it’s something we could do.

There’s one more piece, which is that in a modern democracy, it seems to me that it’s the responsibility of the government to guarantee all necessary care to everyone in the democracy and also to protect the privacy, the decision-making, between the patient and his or her caregiver.

And if you think about that a little further: What would it mean if we had national health insurance? What would it mean if we had access to all necessary care, if we wouldn’t have to worry when our mother needed to make a transition to a nursing home, if wouldn’t have to worry when our child got leukemia, if we didn’t have to worry, like all of my patients – every case I have in the hospital is worried – about the money problem that is going to follow their illness, and it is an absolute national disgrace.

Yes, we can indict that. But let’s think about it the other way. What kind of freedom would we have if we could travel anywhere we wanted and know that there would be an adequate health care infrastructure? If the Adirondacks, where there are underserved populations of my own state, had the hospital and the support staff that they needed?

This would be liberating, and it would change the political culture of our nation to the idea that we can do this together, we all deserve basic human dignity, and we should all be free. And I think that health care is such a modern necessity that that can take our democracy to that place.

Thank you, senator.

****

Later, in the context of a panel discussion about the relationship between state-based and national efforts for single payer, Dr. Coates made these remarks:

Dr. Coates: I think there’s an event that recently happened in Madrid, Spain, [that might be instructive]. The right-wing party in power in Madrid wanted to privatize the public health system. Sell out pieces and parts, close public clinics, lease out hospitals – the whole scheme of privatization.

And the nurses and the doctors had for years educated about the villainy of privatization: that privatization ends up costing a society more of our money, privatization ends up delivering inferior care. They did that for years. And they were very much like we are now – “We don’t have a chance of stopping privatization,” that would be the feeling two or three years ago. “Here it comes, they keep trying, keep trying.”

Well, the movement blossomed. Their time came. Everyone worked together, and they completely stopped the effort to privatize the Madrid health system.

I think that in this country, the single-payer movement is an incipient mass movement. I think Vermont is the best example, perhaps with California, but Vermont because if its size and the dedicated activism of Dr. Deb Richter, of some really tenacious labor leaders, county by county, village by village, the education about single payer is there. Everyone knows that it would work.

Everyone knows. Sen. Sanders started way back, going to Canada and saying this would work for Burlington. And this education, for many, many years, is what is carrying us forward.

So whether it takes place at the county level, or the state level, or the national level, it’s that education that we’re doing that will win the day.

And other thing is that the income inequality, all by itself, creates its own crisis. Richard Wilkinson and Kate Pickett argue that income inequality by itself causes ill health, I wonder if it isn’t just the poverty, but it creates its own crisis and at some point something’s got to give. And the establishment will reach for a good idea that will work. They’re not going to try to invent something brand new, and our day will come.

You can watch a video of the entire proceedings of the summit here.

Insurance News Net, May 21, 2014

Public Citizen issued the following statement by Robert Weissman, the organization’s president, on May 21:

WASHINGTON – Thank you, Senator Sanders, for your leadership in paving the way so that our country finally receives the health care it deserves, through a single-payer, Medicare-for-All system.

Today’s panel discussion is important because we know that single-payer wins the health care argument on the merits. We know that it wins with the American people, and the more they learn about single-payer, the stronger will be their support.

The problem in Washington is that we haven’t had a merits argument on single-payer. Policymakers have decreed it “off the table,” because it’s not “realistic.” By realistic, they mean, it will be too hard to defeat the health insurance industry. That can’t be the way we do policymaking, especially when the stakes are so high.

No other industrialized country follows the U.S. insurance-driven model of high-pay, bad-results. Although the details of their systems vary in important ways, every other industrialized country provides guaranteed coverage to its citizens.

As a result, those countries have far better health outcomes. The Commonwealth Fund finds that the United States performs last among industrialized countries in the rate of mortality amenable to health care — deaths that might have been prevented with timely and effective care with a rate 68 percent higher than the rate in the leading countries. Infant mortality is so high in the United States that the best-performing U.S. states have rates twice as high as those in some industrialized countries.₁

These countries get better results at far lower costs. As a proportion of GDP, we spend at least 50 percent more on health care than every other rich nation. Per person costs in the United States, by World Bank figures, are $8,608. In Germany, it’s $4,875. In neighboring Canada, $5,630.

There are many ways that our health care payment system can be improved. Indeed, the list is seemingly endless, precisely because there are so many problems. But fixing particular problems will only get us so far, because that long list of problems is a direct outgrowth of the multi-payer, private insurance system, with all of its complexities and profit-driven irrationalities.

Here are three illustrative problems that will be fixed when we move to a single-payer, Medicare-for-All system.

First, balance billing.₂ This widespread problem refers to bills for the difference between the amount that an insurance company is willing to pay for treatment and a provider’s total charges. Providers who are not members of a patient’s insurance network have charged patients as much as 9,000 percent of what Medicare would have paid for the same procedure.

Patients can be subjected to balance bills despite making their best efforts to avoid them. For instance, they might receive care at an in-network facility, only to find out later that an out-of-network doctor — even a pathologist with whom the patient never interacted — was involved in their treatment.

This problem is a direct result of the multi-payer system, and the complicated and multiple pricing schemes between providers and insurers. Medicare and Medicaid have both essentially banned balance billing for their beneficiaries. The problem goes away with a rational payment system.

Second, executive compensation. The New York Times reported earlier this month on executive compensation at insurance companies and hospitals, noting that “the biggest bucks are currently earned not through the delivery of care, but from overseeing the business of medicine.”

Asked about extraordinary compensation for insurance company and hospital executives, the New York Times reported, “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.”₃

One might dispute whether this really justifies the need for exorbitant compensation of hospital and insurance administrators and executives, but we know this: With a single-payer system, that “complex structure” and “the need to undertake hundreds of negotiations to set prices,” is eliminated.

And, indeed, it is the case that hospital administrators are much more modestly compensated in other countries.

Third, drug prices. The company Gilead has a new hepatitis C drug (brand name: Sovaldi) that may dramatically improve care and health outcomes for hepatitis C patients. The company is charging roughly $90,000 for a course of treatment. An estimated 3 million people in the United States have hepatitis C. The math is jaw-dropping: the country cannot afford to provide Gilead’s hepatitis C treatment at this price level. Gilead’s price is so outrageous that insurers are revolting – but with what final result, we do not know. What we do know is that it won’t be a rational result; the final price will be too high, and some people — maybe very many people — will very likely be denied treatment.

This example is exemplary of drug pricing trends. As drug prices, especially for biologics, skyrocket, insurers are aiming to reduce pharmaceutical use by imposing huge co-pays,₄ which is certainly the wrong way to stop excessive prescribing and deliver appropriate care.₅ Drug companies are circumventing these co-pays by providing coupons and direct reimbursements to patients. And so the irrational system goes.

A single-payer system would eliminate these problems by providing a fair and rational system for compensating drug makers and incentivizing new research. At minimum, it would involve a single negotiation over price where negotiating power rested with the single-payer; ideally, it would involve replacing the system of compensation via patent monopolies with something that better pays and incentivizes innovators, while avoiding the unjustified consumer rip-offs of the patent monopoly system.₆

These problems, and many more, are endemic to our current health care system.

We have a cure: It is called a single-payer, Medicare-for-All system.

With a single-payer, Medicare-for-All system, we would eliminate all of this wasteful and deadly irrationality. We would – we will – finally recognize that health care is a human right, and that no one should be denied needed care because they can’t afford it.

[1] “Why Not the Best,” New York: The Commonwealth Fund, 2011.

[2] See “Out of Control,” Washington, DC: Public Citizen, 2014.

[3] Elisabeth Rosenthal, “Medicine’s Top Earners Are Not the M.D.s,” New York Times, May 17, 2014.

[4] For the pharmaceutical industry rationalization of this practice, see Suzanne Shelley, “Copay programs’ increased value to manufacturers is matched by rising criticism,” Pharmaceutical Commerce, January 15, 2014.

[5] See: “Research Activities,” Rockville, MD: Agency for Healthcare Research and Quality, Rockville, MD, July 2012, No. 383.

[6] See, for example, the Medical Innovation Prize Fund Act, S.627 (introduced by Senator Bernie Sanders).

http://insurancenewsnet.com/oarticle/2014/05/22/us-sen-bernie-sanders-panel-on-single-payer-health-care-a-508145.html

By Margaret Flowers, M.D.
May 21, 2014 

Thank you for inviting me to participate in this important discussion today.

The first step in the work to move to a single payer plan must be to take stock of where we are and where we are headed. We must do what we can to prevent further damage while we organize for the real solution to our healthcare crisis: a national single payer health system.

We are continuing a trend that began in the 1980s of privatization of every facet of our healthcare system. This is the opposite direction from where we need to go. If we viewed the U.S. healthcare system as an experiment, which it largely is – one that defies sound health policy – we would see that it has failed. If we treated our system as an experiment, we would be required to stop it because of the high number of preventable deaths, wide health disparities and financial ruin caused by illness and medical costs. These are our outcomes despite the fact that the U.S. spends the most per capita each year on health care, two and a half times more than the average OECD nation.

There is no affordable market solution to the healthcare crisis even though the public is being steeped in market rhetoric as we speak. The private health insurance industry has proven for decades that it defies regulation. Our market-based system will continue to increase healthcare spending, leave people out and result in poor health outcomes because the bottom line is profit, not health.  Until we change this fundamental dynamic, we will continue to fail to significantly improve the health of our population.

It is time for an honest national conversation about our healthcare system. We must ask ourselves whether we want to continue to treat health care as a commodity so that people receive only what they can afford or whether we want to join the rest of the industrialized world and create a healthcare system that treats health care as a public good so that people receive the health care they need.

The primary obstacle to a national single payer health system is political will. But we know from past experience that political will can change through public pressure. To effectively create this pressure we must recognize that the U.S. is not a legitimate democracy. It is an oligarchy, or more accurately a plutocracy. Health spending is almost one fifth of U.S. GDP. The medical industrial complex wields tremendous political influence. Therefore, single payer will only be on the table when the public puts it there. There is no easy way to do this, no secret back door. A national single payer health system will come from steadfast determination and strategic organizing and action.

As we are educating, organizing and mobilizing the public to demand a single payer health system, we need to take steps to challenge further privatization of our health system. I have three major areas of concern: the privatization of our public insurances, the trend towards more people being required to purchase inadequate insurance through the exchanges and increasing subsidies to private insurers that will be used as justification to cut social programs.

One harmful trend that should be addressed immediately is the privatization of our public insurances, Medicaid and Medicare. Currently at least 75 percent of Medicaid enrollees are in Managed Care Organizations, private administrators that act like private insurers by keeping a high percentage of their payment for administration, profits and salaries and cherry picking the healthiest patients. This percentage is expected to grow. It is no coincidence that WellPoint moved to buy AmeriGroup after the ACA was passed. They saw a huge profit opportunity in the Medicaid expansion.

We should examine the impact of private industry involvement in Medicaid. Two states have already moved to make their Medicaid completely public – Oklahoma in 2005 and Connecticut in 2012. They cited lower costs and better quality by doing so. They were able to shift more funding to direct patient care. In Maryland, our Medicaid program for children with chronic conditions has an overhead of less than 2 percent and is easier for patients and health professionals to use. We are currently looking into the overhead of our MCOs which we suspect is significantly higher than the public plan. This committee should investigate how much of our public dollars for Medicaid are going to private insurance administration.

Likewise, Medicare Advantage is a private insurance for Medicare patients. Although the Affordable Care Act (ACA) was supposed to curb the wasteful Medicare Advantage plans, reimbursement to them has risen and enrollment has grown at least 30 percent since the ACA was passed in 2010. A study in 2013 found that private insurers in Medicare Advantage were overpaid $34.1 billion in 2012 alone, money that could have gone to expanding Medicare services instead of padding private insurer’s pockets. This committee should be examining why this wasteful spending is occurring especially when Medicare is facing pressure to make cuts.

A very concerning trend is the movement of people eligible for public insurance into purchasing private health insurance on exchanges. The White House signaled early in 2010 through a Fact Sheet that it was OK with this approach for Medicaid. Arkansas was granted a waiver by HHS to subsidize its Medicaid population’s purchase of private insurance on the state exchange. And top White House health care experts, David Cutler and Jonathan Gruber, have indicated support for moving seniors onto the exchanges to purchase private insurance using a defined contribution (read waiver) approach.

Movement in this direction must be adamantly opposed because it would ultimately destroy our public insurances and place our most vulnerable populations at the hands of private industry rather than protecting them through the social safety net.

And finally, we must be wary of further increases in public subsidies for private insurance. The ACA has taken on tremendous financial responsibility for the cost of health care through subsidies to purchase private insurance and to offset out of pocket costs. Hundreds of billions of public dollars are being given directly to the private insurance industry without guarantees that people will be able to afford the health care they need. We must examine whether this transfer is the best use of our public dollars and question any demand for more from the industry. We must not allow what is essentially corporate welfare to be used to justify cuts to necessary social programs.

I want to close with a comment on the approach to single payer. There are currently many efforts towards single payer at the state level including in my own state of Maryland where I am on the steering committee of the Maryland Health Care is a Human Right campaign. Of course, the most advanced state is your home state, Vermont. I believe that these state efforts are important for pushing state health legislation to be the best that it can be and are a way to educate and organize movement towards national single payer. I do not believe that we should allow these efforts to take our focus off of the ultimate goal of a national single payer healthcare system.

There are significant barriers to single payer systems at the state level as you are learning in Vermont. Without a national movement, there is no guarantee that state reform will translate to the national level. And there is no need to experiment. We know what works. We have three health systems in the United States and the ones that have the greatest savings and best outcomes are the Veterans Health Administration and traditional Medicare. These are two types of single payer health systems and both are more effective than the market-based system.

We must continue to communicate that a national single payer health system is possible and that improved Medicare-For-All is the best solution to guarantee that all people living in the U.S. have access to the health care that they need, that people are covered no matter where they are and that will allow the leverage necessary to control healthcare spending in a way that doesn’t reduce coverage. We must move forward without delay because every day our current market-based health system is resulting in preventable suffering, financial ruin and death. This is unacceptable in the wealthiest country in the world. Thank you.

Dr. Margaret Flowers is a pediatrician and an editor of PopularResistance.org. She is co-chair of the Maryland chapter of Physicians for a National Health Program and serves on the board of the Maryland Health Care is a Human Right campaign.

By Anne Meador
DCMediaGroup, May 21, 2014

At a panel hosted by Senator Bernie Sanders (I-VT) on Capitol Hill today, advocates for single payer healthcare criticized the current system in the U.S. as inefficient, expensive and delivering poor results in comparison to wealthy nations who offer universal health coverage to their citizens. 

“We have a completely irrational system. Every other industrialized nation has proven outcomes at less cost,” said Robert Weissman of advocacy group Public Citizen. 

The U.S. is one of few industrialized countries which don’t offer universal healthcare to its citizens. Weissman and other panelists cited high rates of infant mortality and shortened life expectancy for poor women, even as the U.S. far outspends other countries for healthcare.  

In one respect, however, the American healthcare system is unbeatable.

“It’s not true to call healthcare in America a failure,” said Gerald Friedman, Professor of Economics at the University of Massachusetts at Amherst. “It’s very successful, just not at providing healthcare, but at making profits.”

The heart of the problem is the damaging trend of privatization which began in the 1980′s, pitting profit-making enterprises against the public good.

“Costs have been completely out of control, and the plan is to shift those costs onto individuals,” said Dr. Andrew Coates of Physicians for a National Health Program. 

Friedman said access to healthcare in the U.S. is rationed by commodifying it. Thirty percent of Americans have difficulty accessing heathcare, even if they have health insurance. Only four percent of people have difficulty getting healthcare in countries with a single payer system, where government foots the bill for healthcare costs.

Access to healthcare can also be regarded as a moral issue, according to Michael Lighty, Director of Public Policy for National Nurses United. He said that nurses want to be caregivers and exercise their clinical judgment on behalf of patients “under a single standard of high quality.” Market-based healthcare makes that impossible, and the Affordable Care Act has not been a solution. Under the ACA, he said, we have a tiered system with services according to ability to pay.

Far from being a step toward a single payer system, as many supporters claim, the Affordable Care Act further entrenches private health insurance. “There is no affordable market solution to healthcare,” said Dr. Margaret Flowers, a physician and organizer of Popular Resistance. 

Poor patients living in Dr Coates’ area near Vermont can’t afford premiums and co-pays. “What we’re finding is, visits to the ER are going down, while admissions to the hospital are going up. Patients are coming in much sicker.”  From his point of view, wealth inequality is leading to a breaking point. “There are hideous disparities. We concentrate on the top one percent or top one-thousandth of one percent, but the poor are getting poorer,” he said. “Income inequality creates its own crisis. At some point, something’s got to give.”

He thinks that establishing healthcare as a right for all would be a remedy. “It would be liberating,” he said. “We deserve basic human dignity. It would change our basic political culture.”

Panelists seemed to agree that a grassroots political movement was needed to achieve universal healthcare under a single payer system, which they also view as part of a broader struggle.

“Winning single payer will do all kinds of things to advance social justice, because for one it eliminates industry control of an entire sector of the economy,” said Robert Weissman. “Single payer means we’re all in it together. We believe we’re here to take care of each other.”

Senator Sanders called single payer a political and economic issue. “We are taking on obviously very powerful special interests,” he said, “who believe that the function of healthcare is for insurance companies, drug companies and medical equipment suppliers to make as much as money as they possibly can.” He believes that the public supports single payer but mainstream media limits debate and promulgates an anti-government sentiment.

Along with others on the panel, Dr. Flowers believes that progress will be driven from the bottom up. “We know that political will can change,” she said. “Recent studies show that we don’t have a legitimate democracy. Single payer is never going to be put on the table by people in this town when we have a plutocracy. It’s going to be put on the table by us.”

Archived video of Single Payer Summit here.

http://www.dcmediagroup.us/2014/05/21/single-payer-remedy-healthcare-profit/

By Julie Rovner
Kaiser Health News, Capsules blog, May 21, 2014

Advocates for a single-payer “Medicare for all” health system are fanning out across Capitol Hill this week, lobbying members of Congress.

But years of mostly fruitless struggles – and watching the intense opposition to the much less sweeping Affordable Care Act – appears to have left them with a much more clear-eyed view of what it will take for them to accomplish their goal.

“This is tough stuff,” Sen. Bernie Sanders, D-Vt., told a roundtable of advocates he convened in the Dirksen Senate Office Building. “Single-payer health care bills – it ain’t going to take place here in Washington. I suspect it’s going to take place, as it did in Canada, with a state [Saskatchewan] going forward. I hope it will be my state.”

Indeed, Vermont in 2011 passed legislation that would make it the first state to create its own single-payer system, called “Green Mountain Care.” The experiment is set to launch in 2017, the first year that’s allowed under the Affordable Care Act. But key decisions about exactly how the plan would work, in particular how it would be financed, have yet to be made.

Meanwhile, those who have been pushing for a system that would effectively end private insurance say there’s no question they have the facts on their side.

“What we know about single-payer has zero to do with the merits,” said Robert Weissman of Public Citizen, referring to widespread charges by opponents that single payer systems are inefficient and can deny care. “We have proven alternatives in every other industrialized country in the world – better outcomes at less cost.”

That’s challenged, of course, by single-payer opponents who maintain that other countries keep costs down less by being more efficient and more by rationing care.

The advocates even took on the ongoing scandal at the Department of Veterans Affairs, where former service members have reportedly been dying while waiting to get care – despite the fact that the VA system is fully government-run, and not the same as single-payer, where doctors and hospitals would remain private, with pyment from the government.

“If the VA had the resources it needed to work, it would be a model for government-provided health care,” said Michael Lighty of the National Nurses United union.

For the moment, however, the single-payer advocates recognize that their mission is to convince a public that is clearly unhappy with the status quo in health care that a single-payer system is a potential option.

“The most important thing is to show people that change is possible,” said Gerald Friedman, an economics professor from the University of Massachusetts-Amherst. “That’s the role that Vermont has had – showing that it’s possible to get something done.”

And the Affordable Care Act may in fact be nudging the effort along, panelists said. With predictions that many employers will eventually push their workers onto the new health exchanges, “we face a fundamental choice in the long term,” said Lighty of the nurse’s union. “We either are going to have single-payer or individual purchase.”

And single-payer advocates are increasingly confident that’s a fight they can win. Even if it may not be any time soon.

http://capsules.kaiserhealthnews.org/index.php/2014/05/single-payer-advocates-hit-capitol-with-new-sense-of-reality/?utm_campaign=KHN%3A+Afternoon+Edition&utm_source=hs_email&utm_medium=email&utm_content=12851638&_hsenc=p2ANqtz-8y3QveEOLeFyG1uxYrwlie79w9BJrKzPoJlFwvtmZGzVzuRRy8t1OdK70zQrJMKG0LjgI4QIZVxvZj8eDE26shLE7hAQ&_hsmi=12851638

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#