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Doctor arrested at Trump’s Nashville rally arrested again in D.C.

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Doctor arrested at Trump’s Nashville rally arrested again in D.C.

By Marion Kirkpatrick
WSMV-TV (Nashville), July 18, 2017

Dr. Carol Paris, one of several protesters arrested at President Donald Trump’s rally in Nashville in March, was arrested again on Monday a protest in Washington D.C.

“I don’t engage [in protests] for the fun of it,” she explained in a phone interview on Tuesday. “I truly believe it’s part of my job as a physician to not only take care of patients individually but also to do anything I can to help fix our healthcare system.”

Paris is president of Physicians for a National Health Program, a single issue advocacy group pushing for a national health program. She was one of the leaders of a protest against the GOP health care bill in Washington D.C. on Monday, and one of 80 people arrested there.

This isn’t her first brush with the law – the Nashville physician was arrested during at a protest before the passage of the Affordable Care Act in 2009. They hoped to “get a seat at the table for a single-payer system.”

“Here were are in 2017, still debating this issue. It goes back to that famous Churchill quote, ‘Americans will do the right thing, but only when we exhaust all the other possibilities,’” Paris said.

Her arrest on Monday was part of a planned event, and participants went through training with advocates and a lawyer, knowing that they could face arrest if they refused to disband when confronted by Capitol law enforcement.

Paris said all their actions were non-violent in nature, and, as she described, “being disruptive in service of the greater good.”

On Wednesday, Paris said she will be back in Washington D.C. to participate in another protest at the Senate office building and participate in a national town hall on health care. She knows there’s a likely possibility she could be arrested again.

“I agree with Republican [leaders], ACA is not a good piece of legislation,” Paris said. “But we can’t go back, we need to go forward, and the only solution is a national health program.”

When asked if she was paying for her arrest-related expenses out-of-pocket, she said yes.

“It’s only a $50 fee, which is not an amount that’s prohibitive to me,” she said. “Some people go and buy shoes. I post bail.”

http://www.wsmv.com…

Doctor arrested at Trump’s Nashville rally arrested again in D.C.

By Marion Kirkpatrick
WSMV-TV (Nashville), July 18, 2017

Dr. Carol Paris, one of several protesters arrested at President Donald Trump’s rally in Nashville in March, was arrested again on Monday a protest in Washington D.C.

“I don’t engage [in protests] for the fun of it,” she explained in a phone interview on Tuesday. “I truly believe it’s part of my job as a physician to not only take care of patients individually but also to do anything I can to help fix our healthcare system.”

Paris is president of Physicians for a National Health Program, a single issue advocacy group pushing for a national health program. She was one of the leaders of a protest against the GOP health care bill in Washington D.C. on Monday, and one of 80 people arrested there.

This isn’t her first brush with the law – the Nashville physician was arrested during at a protest before the passage of the Affordable Care Act in 2009. They hoped to “get a seat at the table for a single-payer system.”

“Here were are in 2017, still debating this issue. It goes back to that famous Churchill quote, ‘Americans will do the right thing, but only when we exhaust all the other possibilities,’” Paris said.

Her arrest on Monday was part of a planned event, and participants went through training with advocates and a lawyer, knowing that they could face arrest if they refused to disband when confronted by Capitol law enforcement.

Paris said all their actions were non-violent in nature, and, as she described, “being disruptive in service of the greater good.”

On Wednesday, Paris said she will be back in Washington D.C. to participate in another protest at the Senate office building and participate in a national town hall on health care. She knows there’s a likely possibility she could be arrested again.

“I agree with Republican [leaders], ACA is not a good piece of legislation,” Paris said. “But we can’t go back, we need to go forward, and the only solution is a national health program.”

When asked if she was paying for her arrest-related expenses out-of-pocket, she said yes.

“It’s only a $50 fee, which is not an amount that’s prohibitive to me,” she said. “Some people go and buy shoes. I post bail.”

http://www.wsmv.com…

Nashville doctor arrested in D.C. while protesting Trump’s health care plan

By Kirk A. Bado
The Tennessean, July 18, 2017

Dr. Carol Paris, one of several protesters who disrupted President Donald Trump’s Nashville rally in March, was arrested by in Washington, D.C., on Monday for protesting the Republican health care plan. 

“I can’t seem to stay out of trouble for long,” she said in a telephone interview Tuesday.

Paris is the current president of the national organization Physicians for a National Health Program and is on the steering committee of Health Over Profit for Everyone.

On Monday, she led a crowd of demonstrators in the atrium of the Hart Senate Office, decrying the Republican health care plan and imploring Congress to expand Medicare to all citizens. 

“I want you to know that doctors are not in favor of this bill. I need your support for this solution, and that is improved Medicare for all!” she said to applause from dozens of supporters.

Holding a similar small green sign she brandished during the Trump rally reading “Improved Medicare for All,” Paris led chants proclaiming health care is a human right, and demanding Congress stop the Republican plan.

The Congressional Budget Office estimated the Republican plan would leave 22 million Americans uninsured.

After about 25 minutes in the atrium, Capitol police removed Paris and several other demonstrators. Wearing her white lab coat and hands restrained behind her back, Paris was escorted out of the building.

“We knew we would be arrested,” she said. “We met with a lawyer and were ready.”

Unlike in Nashville when she was simply told to leave the facility, the Tennessee physician was processed by the police. She paid the $50 fine to have her case resolved through the “post and forfeit” method.

The Republican health care plan seems to have stalled in the Senate, after several key Senators came out against the bill. On Wednesday, Paris plans to help lead a health care town hall before helping participants meet with Senators.

Now, Paris wants to urge Congress to keep the framework of the Affordable Care Act viable through the government sponsored subsides. Trump has threatened to cut off those funds in a message posted on Twitter Tuesday morning.

“The message is that we are not going away and you are energizing us,” said Paris.

http://www.tennessean.com…

Where now on health care reform?

By Sen. Mitch McConnell
Press Release, July 17, 2017

U.S. Senate Majority Leader Mitch McConnell (R-KY) made the following statement regarding a vote to repeal Obamacare:

“Regretfully, it is now apparent that the effort to repeal and immediately replace the failure of Obamacare will not be successful.

“So, in the coming days, the Senate will vote to take up the House bill with the first amendment in order being what a majority of the Senate has already supported in 2015 and that was vetoed by then-President Obama: a repeal of Obamacare with a two-year delay to provide for a stable transition period to a patient-centered health care system that gives Americans access to quality, affordable care.”

https://www.mcconnell.senate.gov…

***

By Donald J. Trump
Twitter, July 17, 2017

Republicans should just REPEAL failing ObamaCare now & work on a new Healthcare Plan that will start from a clean slate. Dems will join in!

https://twitter.com…

***

Comment:

By Don McCanne, M.D.

Just what Quote of the Day readers need – one more opinion amongst the plethora of reactions to the failure of Sen. McConnell’s effort to herd through a bill that could be labeled as “repeal and replacement of Obamacare.” But instead of predicting what might or will happen, let’s skip forward to what the response of single payer advocates should be. There will be no surprises here.

The Republicans want something that they can cite as fulfilling their six year long promise to repeal Obamacare, but that has been complicated by the revelation that their replacement proposals are “mean” and thus opposed by the majority of Americans.

Without going into the various permutations and combinations of what the politicians may do, a few facts stand out:

* The Republican replacement proposals really are mean. Through several mechanisms they would make paying for health care more of an individual responsibility when health care has become so expensive that many Americans simply would be unable to pay the out-of-pocket expenses that the Republican proposals would require. More physical suffering and financial hardship would be inevitable.

* The desire to repeal and replace the Affordable Care Act has been based on the very real deficiencies that have left too many Americans uninsured and underinsured. The Democratic politicians are making overtures that they are willing to work with the Republicans as long as the Medicaid expansions and the improvements in the individual insurance market are protected. Although a few Republicans might find some common ground here on policy, the majority would reject this as an acknowledgement of the defeat of their effort to repeal Obamacare, a bitter pill to swallow considering the intensity and passion of their opposition.

* The concept of single payer – an improved Medicare for all – continues to grow in popularity and is now favored by a majority of Americans. Even a majority of Democrats in the House of Representatives have now agreed to cosponsor John Conyers’ H.R. 676 – the Expanded & Improved Medicare for All Act.

* Although the Democrats in Congress are now coming out and saying that they support single payer, most of them say that our task now instead is to protect the Affordable Care Act. And after this crisis has been averted? They say that we should elect more Democrats in  2018 1n 2020 so that we can move forward with real reform – enacting a “public option” and maybe even enacting a Medicare buy-in for those over 55! Sorry. You can consult the PNHP website to see why these proposals would have hardly even a negligible impact on the health care problems that face us today. The Democratic position is essentially an endorsement of the unsatisfactory status quo.

So what are we to do? Just what we are doing, but a whole lot more of it. We cannot let Americans forget that the Democrats’ Affordable Care Act is grossly inadequate and fundamentally is not amenable to patches. We cannot let Americans forget that the Republican replacement promises proved to be mean (catching even Republicans off guard).

But, above all, we have to emphatically reinforce in the minds of Americans what it is that they find captivating in the single payer model of reform – affordable, accessible, equitable health care for all. That’s right. No surprises. Just health care justice for all.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

Protesters Rally Against GOP Health Care Plan At Senate Office Building

Multiple demonstrators were arrested.

By Kaeli Subberwal & Mollie Reilly
HuffPost, July 17, 2017

Protesters again took to Capitol Hill on Monday to protest Senate Republicans’ proposed health care bill, staging a demonstration in the Hart Senate Office Building, where several people were arrested.

Demonstrators there urged Republican senators to vote against the bill, which would dismantle key portions of the Affordable Care Act and cause millions of people to lose their health care coverage, largely due to cuts to Medicaid.

According to a Capitol Police spokeswoman, five adults were arrested in the atrium of the Hart Senate Office Building. Police also responded to demonstrations in five other locations in the U.S. Capitol, arresting 33 people in total.

“Those who refused to cease and desist were placed under arrest,” she said.

Protesters gathered in the building’s lobby in front of the towering metal sculpture, “Mountains and Clouds,” and took turns explaining how the bill would affect their lives.

One protester explained that she has to visit specialized doctors every six months to check on the progress of her condition.

“I can’t go without treatment. I can’t go without insurance. And I do need Medicaid,” she said. “So I’m asking the president to stop attacking the American people. I’m asking the GOP to stop attacking the American people. I’m asking to kill this bill and save us.”

The protesters then took up a chant of “kill the bill.”

Dr. Carol Paris, the president of Physicians for a National Health Program, spoke about the negative impact that the bill would have on patients.

Police officers were gathered around the entrance to the building, and after several speakers and many chants of “we’re ready to fight, health care is a human right,” they asked people who were gathered around the protesters to move away from the front of the sculpture.

A small group of protesters remained in front of the mountainous structure chanting, and appeared willing to risk arrest. As the area cleared, police arrested several protesters and escorted them out of the building.

Two Republican senators, Rand Paul of Kentucky and Susan Collins of Maine, have already said they will vote against the bill, meaning Senate Majority Leader Mitch McConnell (R-Ky.) can only lose the support of one more GOP senator and still pass the legislation.

Keeping that in mind, protesters specifically put pressure on Sen. Dean Heller (R-Nev.), who previously said he couldn’t support the bill due to its Medicaid cuts. Several demonstrators staged a sit-in in the lobby of his office.

Meanwhile, down the street in Upper Senate Park, protesters staged a “People’s Filibuster” in a light drizzle to protest the same health care bill.

The bill, which was expected to go to a vote in the Senate this week, has been put on hold while Sen. John McCain (R-Ariz.) recovers from surgery. Activist communities see the delay as an opportunity to “dial up the pressure” on lawmakers to oppose the bill, as the event page for the People’s Filibuster reads.

“We’re fighting for health care for all Americans,” Marvell Terry II from the Human Rights Campaign told HuffPost. “And as a person living with HIV, I know firsthand how much health care improves my daily health, and how people like me, with HIV or other chronic illnesses, need adequate health care and access to good health care.”

Terry spoke at the rally, as did Sen. Mazie Hirono (D-Hawaii) and representatives from organizations such as VoteVets and Common Defense.

Stephanie Damassa, a D.C. local, came to the rally with her young baby.

“I just feel like it’s so un-American, and it’s breaking my heart seeing disabled children that are having to come to the Hill every day to lobby Congress,” she said. “As an American, I think it’s sort of our duty to be here. I just had a child myself, and got my insurance bill for $21,000. Without insurance, I couldn’t have afforded that, and to think about all the families throughout our country that are suffering. Our first job should be to protect the vulnerable, and this bill is for the wealthy only, and I just think that’s fundamentally un-American.”

Monday’s demonstrations come in the wake of a series of protests against the health care bill, including a “human chain” march around the Capitol, protests featuring women dressed as handmaids and nationwide sit-ins in senators’ offices that culminated in several arrests.

http://www.huffingtonpost.com…

Protesters Rally Against GOP Health Care Plan At Senate Office Building

Multiple demonstrators were arrested.

By Kaeli Subberwal & Mollie Reilly
HuffPost, July 17, 2017

Protesters again took to Capitol Hill on Monday to protest Senate Republicans’ proposed health care bill, staging a demonstration in the Hart Senate Office Building, where several people were arrested.

Demonstrators there urged Republican senators to vote against the bill, which would dismantle key portions of the Affordable Care Act and cause millions of people to lose their health care coverage, largely due to cuts to Medicaid.

According to a Capitol Police spokeswoman, five adults were arrested in the atrium of the Hart Senate Office Building. Police also responded to demonstrations in five other locations in the U.S. Capitol, arresting 33 people in total.

“Those who refused to cease and desist were placed under arrest,” she said.

Protesters gathered in the building’s lobby in front of the towering metal sculpture, “Mountains and Clouds,” and took turns explaining how the bill would affect their lives.

One protester explained that she has to visit specialized doctors every six months to check on the progress of her condition.

“I can’t go without treatment. I can’t go without insurance. And I do need Medicaid,” she said. “So I’m asking the president to stop attacking the American people. I’m asking the GOP to stop attacking the American people. I’m asking to kill this bill and save us.”

The protesters then took up a chant of “kill the bill.”

Dr. Carol Paris, the president of Physicians for a National Health Program, spoke about the negative impact that the bill would have on patients.

Police officers were gathered around the entrance to the building, and after several speakers and many chants of “we’re ready to fight, health care is a human right,” they asked people who were gathered around the protesters to move away from the front of the sculpture.

A small group of protesters remained in front of the mountainous structure chanting, and appeared willing to risk arrest. As the area cleared, police arrested several protesters and escorted them out of the building.

Two Republican senators, Rand Paul of Kentucky and Susan Collins of Maine, have already said they will vote against the bill, meaning Senate Majority Leader Mitch McConnell (R-Ky.) can only lose the support of one more GOP senator and still pass the legislation.

Keeping that in mind, protesters specifically put pressure on Sen. Dean Heller (R-Nev.), who previously said he couldn’t support the bill due to its Medicaid cuts. Several demonstrators staged a sit-in in the lobby of his office.

Meanwhile, down the street in Upper Senate Park, protesters staged a “People’s Filibuster” in a light drizzle to protest the same health care bill.

The bill, which was expected to go to a vote in the Senate this week, has been put on hold while Sen. John McCain (R-Ariz.) recovers from surgery. Activist communities see the delay as an opportunity to “dial up the pressure” on lawmakers to oppose the bill, as the event page for the People’s Filibuster reads.

“We’re fighting for health care for all Americans,” Marvell Terry II from the Human Rights Campaign told HuffPost. “And as a person living with HIV, I know firsthand how much health care improves my daily health, and how people like me, with HIV or other chronic illnesses, need adequate health care and access to good health care.”

Terry spoke at the rally, as did Sen. Mazie Hirono (D-Hawaii) and representatives from organizations such as VoteVets and Common Defense.

Stephanie Damassa, a D.C. local, came to the rally with her young baby.

“I just feel like it’s so un-American, and it’s breaking my heart seeing disabled children that are having to come to the Hill every day to lobby Congress,” she said. “As an American, I think it’s sort of our duty to be here. I just had a child myself, and got my insurance bill for $21,000. Without insurance, I couldn’t have afforded that, and to think about all the families throughout our country that are suffering. Our first job should be to protect the vulnerable, and this bill is for the wealthy only, and I just think that’s fundamentally un-American.”

Monday’s demonstrations come in the wake of a series of protests against the health care bill, including a “human chain” march around the Capitol, protests featuring women dressed as handmaids and nationwide sit-ins in senators’ offices that culminated in several arrests.

http://www.huffingtonpost.com…

Importance of Medicaid in public health emergencies

U.S. Senate, July 2017

H.R. 1628

AMENDMENT IN THE NATURE OF A SUBSTITUTE

This Act may be cited as the “Better Care Reconciliation Act of 2017.”

SEC. 1903A. PER CAPITA-BASED CAP ON PAYMENTS FOR MEDICAL ASSISTANCE.

(b) ADJUSTED TOTAL MEDICAL ASSISTANCE EXPENDITURES

(6) AUTHORITY TO EXCLUDE STATE EXPENDITURES FROM CAPS DURING PUBLIC HEALTH EMERGENCY.—

(A) IN GENERAL.—During the period that begins on January 1, 2020, and ends on December 31, 2024, the Secretary may exclude, from a State’s medical assistance expenditures for a fiscal year or portion of a fiscal year that occurs during such period, an amount that shall not exceed the amount determined under subparagraph (B) for the State and year or portion of a year if—

(i) a public health emergency declared by the Secretary pursuant to section 319 of the Public Health Service Act existed within the State during such year or portion of a year; and

(ii) the Secretary determines that such an exemption would be appropriate.

(B) MAXIMUM AMOUNT OF ADJUSTMENT.—The amount excluded for a State and fiscal year or portion of a fiscal year under this paragraph shall not exceed the amount by which—

(i) the amount of State expenditures for medical assistance for 1903A enrollees in areas of the State which are subject to a declaration described in subparagraph (A)(i) for the fiscal year or portion of a fiscal year; exceeds

(ii) the amount of such expenditures for such enrollees in such areas during the most recent fiscal year or portion of a fiscal year of equal length to the portion of a fiscal year involved during which no such declaration was in effect.

(C) AGGREGATE LIMITATION ON EXCLUSIONS AND ADDITIONAL BLOCK GRANT PAYMENTS.—The aggregate amount of expenditures excluded under this paragraph and additional payments made under section 1903B(c)(3)(E) for the period described in subparagraph (A) shall not exceed $5,000,000,000.

https://www.budget.senate.gov…

***

Medicaid And The Latest Version Of The BCRA: Massive Federal Funding Losses Remain

By Sara Rosenbaum
Health Affairs Blog, July 14, 2017

Where Medicaid is concerned, the most notable thing about the latest version of the Better Care Reconciliation Act (BCRA) is that despite the drama of the past two weeks—the flood of news coverage regarding the potential impact of the losses; mounting concerns raised by Senators from expansion and non-expansion states alike; and the massive outcry from hospitals, physicians, insurers, and health care organizations—the new iteration leaves untouched the fundamental Medicaid contours of the earlier version.

By 2036, CBO reports, federal Medicaid funding would be about 35 percent below current law, a catastrophe of epic proportions.

The Illusion Of A Public Health Emergency Exemption To The Per Capita Cap

One of Medicaid’s most important dimensions is its irreplaceable role in addressing the immediate and long-term effects of public health crises. Medicaid is by far the nation’s biggest single source of health care financing for dealing with critical public health threats. These threats may begin with an initial, recognized period of a formally declared emergency. They then can morph into events with very long-term effects felt for years or decades after. This was the case with the World Trade Center attacks, which led to an immediate surge in health care spending, followed by years of elevated spending to address the long-term health fallout triggered by the emergency itself. One need think only about Zika or the opioid crisis now gripping the nation to understand the near-term/long-term nature of public health threats.

Medicaid enrollees are disproportionately likely to live in poor communities, and poor communities are disproportionately likely to face public health threats ranging from environmental hazards to infectious disease. These communities also are inherently less likely to have resources to cope with the effects of an emergency. Thus, a program such as Medicaid is crucial in its ability to deploy health care financing resources to the hardest-hit populations. Indeed, two thirds of all Louisiana Medicaid beneficiaries lived in the parishes affected by Hurricane Katrina.

Section 319 of the Public Health Service Act authorizes the HHS Secretary to declare the existence of a public health emergency arising from events such as a “disease or disorder,” “significant outbreaks of infectious diseases or bioterrorist attacks,” or other events identified as public health emergencies by the HHS Secretary. Whether to declare an emergency is entrusted to the Secretary’s judgment, and during the immediate emergency period, the Secretary enjoys expanded powers to deploy resources to designated populations or geographic areas. These special powers end when the declared emergency period ends. In the aftermath, states and local communities effectively are on their own, relying on the resources they have.

In and of itself, a loss of federal health funding as large as that imposed by BCRA elevates the threat risk. This risk grows exponentially when a true crisis hits, if Medicaid is crippled in its ability to provide a large-scale surge in public health care spending both during the emergency and thereafter. To understand how little the revised bill does to mitigate the crippling impact of the initial draft one need only look carefully at what the revisions would do when a true emergency strikes.

The press release accompanying the new draft states that “if a public health emergency is declared, state medical assistance expenditures in a particular part of the state will not be counted toward the per capita caps or block grant allocations for the declared period of the emergency.” But a close read of the actual bill text reveals its fundamental inadequacy.

First, the period of exemption lasts only five years, from January 1, 2020 through December 31, 2024. Emergencies happening after this date won’t qualify for the spending adjustment. Second, the bill provides no additional federal spending during the period of a declared emergency. The draft simply allows states to eventually qualify for additional federal funding in the years following the emergency if they can prove to the Secretary that their spending on the affected population went up compared to prior years and then only for immediate emergency costs. What state will have the money in advance? And what state will be able to take a chance on spending more given the purely speculative nature of whether an emergency will be declared and emergency expenditures recognized?

Third, states would receive no additional funding ever unless the HHS Secretary actually declares an emergency in the affected portion of the state or for the state’s affected populations. Many public health threats may not rise to a level that triggers a formal Secretarial determination, and the Secretary may be inclined not to make such a determination because of other, spillover effects that come with such a determination, such as the elevated demand for other types of resources.

Fourth, the additional amount of federal funding made available would be limited to the difference between what the state spent on the population in connection with the emergency and the state’s previous expenditures for the same population. Expenditures to cope with the emergency aftermath would not count, and of course these expenditures likely would not occur simultaneously with the emergency expenditures. For example, Zika has triggered emergency expenditures aimed at preventing the spread of the virus, but the true costs of Zika will roll out slowly in the form of babies left permanently and severely disabled by the virus.

And here is where the public health implications of BCRA become clear: other than exempting state expenditures on children classified as disabled from the caps, the revised bill, like its predecessor, makes no adjustment for long-term consequences. To be sure, as just mentioned, BCRA does exempt state expenditures on severely disabled children from the federal cap. But because the vast majority of children qualify for Medicaid based on poverty, this type of cramped classification system for measuring exemptions is sure to exclude spending for millions of children in severely compromised health from the exemption process.

Fifth, the bill allows only $5 billion in the aggregate for all additional federal funding over the five-year time period covered by the emergency exemption. In other words, the bill essentially creates a five-year, $5 billion mini-block grant to help all states address Medicaid spending for all emergencies occurring during this time period. The incredibly small size of the block grant alone would be likely to incentivize the HHS Secretary to avoid declaring emergencies out of concern that the money won’t be there to cover them.

In the end, the newest iteration of BCRA does nothing to alleviate the catastrophic effects of its predecessor: the difference in magnitude between what Medicaid can do today and what it will be capable of doing in the future is incalculable.

http://healthaffairs.org…

***

Comment:

By Don McCanne, M.D.

Based on some of the rhetoric being tossed around during the debate on repealing and replacing the Affordable Care Act you might think that the politicians currently in charge of the process do not believe that the government should play much of a role in health care. However, based on today’s excerpt from their “Better Care Reconciliation Act,” it almost seems that they do believe that the government should step up during a public health emergency. Or do they?

There are many government agencies that might play a role during a public health emergency. One of the more important is providing victims with Medicaid funding during these emergencies and for the essential services required in followup. Yet the massive reductions proposed for the Medicaid program by the Republican legislation (close to a trillion dollars over the next decade – “a catastrophe of epic proportions”) would cripple this important resource for emergency coverage.

The Republicans seem to have been caught off guard by the intensity of the reaction to the cruelty inherent in their reform proposals. Taking a second look at what they crafted, it apparently occurred to them that their substitute legislation should be modified to be sure that public health emergencies were covered.

So what did they propose? A mini-block grant capped at a maximum of $5 billion over five years, and, at that, with many restrictions. As Sara Rosenbaum states in her Health Affairs article, “the incredibly small size of the block grant alone would be likely to incentivize the HHS Secretary to avoid declaring emergencies out of concern that the money won’t be there to cover them.” Based on his track record, it would not be difficult to imagine HHS Secretary Tom Price withholding funds for an emergency just because there wouldn’t be any funds left over for inevitable public health emergencies to come, providing him with an excuse for being the heartless skinflint that he is.

Thus, amongst the many other profound deficiencies, the Republicans in their repeal and replace legislation do not make a serious attempt to ensure that the government would have the ability to respond in fulfilling one of the more crucial essential functions of government – providing assistance in a public health emergency. These guys really don’t believe in government.

We need to replace not only the health care financing infrastructure with one that ensures that government will be there for us when we have health care needs, but we also need to replace the stewards of the program with people who understand that we are all in this together and we take care of each other in times of need. We do believe that don’t we?

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

Importance of Medicaid in public health emergencies

U.S. Senate, July 2017

H.R. 1628

AMENDMENT IN THE NATURE OF A SUBSTITUTE

This Act may be cited as the “Better Care Reconciliation Act of 2017.”

SEC. 1903A. PER CAPITA-BASED CAP ON PAYMENTS FOR MEDICAL ASSISTANCE.

(b) ADJUSTED TOTAL MEDICAL ASSISTANCE EXPENDITURES

(6) AUTHORITY TO EXCLUDE STATE EXPENDITURES FROM CAPS DURING PUBLIC HEALTH EMERGENCY.—

(A) IN GENERAL.—During the period that begins on January 1, 2020, and ends on December 31, 2024, the Secretary may exclude, from a State’s medical assistance expenditures for a fiscal year or portion of a fiscal year that occurs during such period, an amount that shall not exceed the amount determined under subparagraph (B) for the State and year or portion of a year if—

(i) a public health emergency declared by the Secretary pursuant to section 319 of the Public Health Service Act existed within the State during such year or portion of a year; and

(ii) the Secretary determines that such an exemption would be appropriate.

(B) MAXIMUM AMOUNT OF ADJUSTMENT.—The amount excluded for a State and fiscal year or portion of a fiscal year under this paragraph shall not exceed the amount by which—

(i) the amount of State expenditures for medical assistance for 1903A enrollees in areas of the State which are subject to a declaration described in subparagraph (A)(i) for the fiscal year or portion of a fiscal year; exceeds

(ii) the amount of such expenditures for such enrollees in such areas during the most recent fiscal year or portion of a fiscal year of equal length to the portion of a fiscal year involved during which no such declaration was in effect.

(C) AGGREGATE LIMITATION ON EXCLUSIONS AND ADDITIONAL BLOCK GRANT PAYMENTS.—The aggregate amount of expenditures excluded under this paragraph and additional payments made under section 1903B(c)(3)(E) for the period described in subparagraph (A) shall not exceed $5,000,000,000.

https://www.budget.senate.gov…

***

Medicaid And The Latest Version Of The BCRA: Massive Federal Funding Losses Remain

By Sara Rosenbaum
Health Affairs Blog, July 14, 2017

Where Medicaid is concerned, the most notable thing about the latest version of the Better Care Reconciliation Act (BCRA) is that despite the drama of the past two weeks—the flood of news coverage regarding the potential impact of the losses; mounting concerns raised by Senators from expansion and non-expansion states alike; and the massive outcry from hospitals, physicians, insurers, and health care organizations—the new iteration leaves untouched the fundamental Medicaid contours of the earlier version.

By 2036, CBO reports, federal Medicaid funding would be about 35 percent below current law, a catastrophe of epic proportions.

The Illusion Of A Public Health Emergency Exemption To The Per Capita Cap

One of Medicaid’s most important dimensions is its irreplaceable role in addressing the immediate and long-term effects of public health crises. Medicaid is by far the nation’s biggest single source of health care financing for dealing with critical public health threats. These threats may begin with an initial, recognized period of a formally declared emergency. They then can morph into events with very long-term effects felt for years or decades after. This was the case with the World Trade Center attacks, which led to an immediate surge in health care spending, followed by years of elevated spending to address the long-term health fallout triggered by the emergency itself. One need think only about Zika or the opioid crisis now gripping the nation to understand the near-term/long-term nature of public health threats.

Medicaid enrollees are disproportionately likely to live in poor communities, and poor communities are disproportionately likely to face public health threats ranging from environmental hazards to infectious disease. These communities also are inherently less likely to have resources to cope with the effects of an emergency. Thus, a program such as Medicaid is crucial in its ability to deploy health care financing resources to the hardest-hit populations. Indeed, two thirds of all Louisiana Medicaid beneficiaries lived in the parishes affected by Hurricane Katrina.

Section 319 of the Public Health Service Act authorizes the HHS Secretary to declare the existence of a public health emergency arising from events such as a “disease or disorder,” “significant outbreaks of infectious diseases or bioterrorist attacks,” or other events identified as public health emergencies by the HHS Secretary. Whether to declare an emergency is entrusted to the Secretary’s judgment, and during the immediate emergency period, the Secretary enjoys expanded powers to deploy resources to designated populations or geographic areas. These special powers end when the declared emergency period ends. In the aftermath, states and local communities effectively are on their own, relying on the resources they have.

In and of itself, a loss of federal health funding as large as that imposed by BCRA elevates the threat risk. This risk grows exponentially when a true crisis hits, if Medicaid is crippled in its ability to provide a large-scale surge in public health care spending both during the emergency and thereafter. To understand how little the revised bill does to mitigate the crippling impact of the initial draft one need only look carefully at what the revisions would do when a true emergency strikes.

The press release accompanying the new draft states that “if a public health emergency is declared, state medical assistance expenditures in a particular part of the state will not be counted toward the per capita caps or block grant allocations for the declared period of the emergency.” But a close read of the actual bill text reveals its fundamental inadequacy.

First, the period of exemption lasts only five years, from January 1, 2020 through December 31, 2024. Emergencies happening after this date won’t qualify for the spending adjustment. Second, the bill provides no additional federal spending during the period of a declared emergency. The draft simply allows states to eventually qualify for additional federal funding in the years following the emergency if they can prove to the Secretary that their spending on the affected population went up compared to prior years and then only for immediate emergency costs. What state will have the money in advance? And what state will be able to take a chance on spending more given the purely speculative nature of whether an emergency will be declared and emergency expenditures recognized?

Third, states would receive no additional funding ever unless the HHS Secretary actually declares an emergency in the affected portion of the state or for the state’s affected populations. Many public health threats may not rise to a level that triggers a formal Secretarial determination, and the Secretary may be inclined not to make such a determination because of other, spillover effects that come with such a determination, such as the elevated demand for other types of resources.

Fourth, the additional amount of federal funding made available would be limited to the difference between what the state spent on the population in connection with the emergency and the state’s previous expenditures for the same population. Expenditures to cope with the emergency aftermath would not count, and of course these expenditures likely would not occur simultaneously with the emergency expenditures. For example, Zika has triggered emergency expenditures aimed at preventing the spread of the virus, but the true costs of Zika will roll out slowly in the form of babies left permanently and severely disabled by the virus.

And here is where the public health implications of BCRA become clear: other than exempting state expenditures on children classified as disabled from the caps, the revised bill, like its predecessor, makes no adjustment for long-term consequences. To be sure, as just mentioned, BCRA does exempt state expenditures on severely disabled children from the federal cap. But because the vast majority of children qualify for Medicaid based on poverty, this type of cramped classification system for measuring exemptions is sure to exclude spending for millions of children in severely compromised health from the exemption process.

Fifth, the bill allows only $5 billion in the aggregate for all additional federal funding over the five-year time period covered by the emergency exemption. In other words, the bill essentially creates a five-year, $5 billion mini-block grant to help all states address Medicaid spending for all emergencies occurring during this time period. The incredibly small size of the block grant alone would be likely to incentivize the HHS Secretary to avoid declaring emergencies out of concern that the money won’t be there to cover them.

In the end, the newest iteration of BCRA does nothing to alleviate the catastrophic effects of its predecessor: the difference in magnitude between what Medicaid can do today and what it will be capable of doing in the future is incalculable.

http://healthaffairs.org…

***

Comment:

By Don McCanne, M.D.

Based on some of the rhetoric being tossed around during the debate on repealing and replacing the Affordable Care Act you might think that the politicians currently in charge of the process do not believe that the government should play much of a role in health care. However, based on today’s excerpt from their “Better Care Reconciliation Act,” it almost seems that they do believe that the government should step up during a public health emergency. Or do they?

There are many government agencies that might play a role during a public health emergency. One of the more important is providing victims with Medicaid funding during these emergencies and for the essential services required in followup. Yet the massive reductions proposed for the Medicaid program by the Republican legislation (close to a trillion dollars over the next decade – “a catastrophe of epic proportions”) would cripple this important resource for emergency coverage.

The Republicans seem to have been caught off guard by the intensity of the reaction to the cruelty inherent in their reform proposals. Taking a second look at what they crafted, it apparently occurred to them that their substitute legislation should be modified to be sure that public health emergencies were covered.

So what did they propose? A mini-block grant capped at a maximum of $5 billion over five years, and, at that, with many restrictions. As Sara Rosenbaum states in her Health Affairs article, “the incredibly small size of the block grant alone would be likely to incentivize the HHS Secretary to avoid declaring emergencies out of concern that the money won’t be there to cover them.” Based on his track record, it would not be difficult to imagine HHS Secretary Tom Price withholding funds for an emergency just because there wouldn’t be any funds left over for inevitable public health emergencies to come, providing him with an excuse for being the heartless skinflint that he is.

Thus, amongst the many other profound deficiencies, the Republicans in their repeal and replace legislation do not make a serious attempt to ensure that the government would have the ability to respond in fulfilling one of the more crucial essential functions of government – providing assistance in a public health emergency. These guys really don’t believe in government.

We need to replace not only the health care financing infrastructure with one that ensures that government will be there for us when we have health care needs, but we also need to replace the stewards of the program with people who understand that we are all in this together and we take care of each other in times of need. We do believe that don’t we?

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

Health debate energizing Tucson ‘Medicare for All’ proponents

By Stephanie Innes
Arizona Daily Star, July 15, 2017

Universal health care is far from the plan Republican leaders are proposing, but it’s getting some love in Southern Arizona.

Advocates cite various factors fueling single-payer popularity.

These include fear about recent Republican efforts to repeal and replace the Affordable Care Act (ACA, also called Obamacare), a public that’s more well-versed in health care and a repackaged “Medicare for All” message that they say makes the single-payer concept more understandable and palatable.

Nowhere was local support for that kind of system more obvious than at a standing-room-only health forum hosted by Tucson Medical Center June 26. A question about single-payer health care drew cheers, not from one or two lone voices, but from a chorus across the room of 700 people.

While the response from expert panelists at the forum was tempered, the audience’s enthusiasm was clear. Signs saying “Healthcare not Wealthcare” and “No More Pay Up Or Die Plans!” dotted the entrance to the event. The crowd was energized.

“Back in 2009, I certainly didn’t know what Medicare for All was. Like most Americans, I knew about employer and non-group insurance. I was so naive,” said forum attendee Andrea Witte, a 52-year-old graphic designer who recently became a supporter of Medicare for All. “It’s just being discussed more, and when I go to events, I think people understand health care better.”

Witte says her personal evolution includes now seeing health care as a basic right — a moral imperative, “instead of a commodity to be rationed based on the size of one’s wallet or the profit-seeking of insurance companies.”

Increased support for Medicare for All is not just local — an April 2017 Economist/YouGov poll found a majority of Americans support “expanding Medicare to provide health insurance to every American.”

The Pew Research Center reported in June that 60 percent of Americans say the federal government is responsible for ensuring health-care coverage for all Americans, while 3 percent say it is not the government’s responsibility.

These views are unchanged from January, but the share saying health coverage is a government responsibility remains at its highest level in nearly a decade, the researchers found.

“Many like me who supported the ACA’s modest reforms now realize that keeping for-profit insurers involved still leaves too many Americans uninsured or underinsured and prevents us from controlling our skyrocketing health-care costs,” Witte said.

California recently considered its own form of single-payer health care, and other states are talking about it.

When people refer to single-payer health care, they are not always talking about the same thing, and some people give the various universal plans other names, such as “Medicaid for All,” referring to the government insurance program primarily for low-income people. The general commonality is one public entity handling health-care financing for the entire country.

The Medicare for All movement supports a system like traditional or original Medicare, which covers mostly people over the age of 65.

Such a plan has been introduced in Congress by U.S. Rep. John Conyers, a Democrat from Michigan. Conyers’ bill calls for a progressive tax based on income, similar to one in Canada, to fund expanded Medicare for all Americans. Democrat U.S. Reps. RaĂșl GrĂ­jalva of Tucson and Ruben Gallego of Phoenix are among the bill’s 113 co-sponsors.

The main Republican argument against single-payer health care is that it is too much big government providing not enough choice for Americans. Sen. Jeff Flake, an Arizona Republican, says he’s against single payer because he believes the best way to provide affordable, quality care for everyone is through “choice and competition in a free-market health-care system.”

Arizona Sen. John McCain says he, too, supports “a free-market solution that would enhance competition, increase choices, drive down costs and improve health-care outcomes.”

Nearly 40 percent of Arizonans already are on government-sponsored insurance — 25 percent on Medicaid and 14 percent on Medicare. That number doesn’t take into account the additional Arizonans who get federal subsidies to help pay for their health insurance through the ACA marketplace.

COMPLEXITY AND COST

Advocates say Medicare for All would provide health coverage to all Americans from birth to death and reduce two major problems with U.S. health care — complexity and cost.

“Health care should be like the fire department. … If your house is on fire, the fire department comes,” Tucson resident Kelly Strachan wrote in a recent letter to Flake and McCain.

“Not everyone’s house will burn, so we can create a big enough risk pool to truly control health-care costs (a large part of which is the profits of the insurance industry),” she wrote.

Eight to 10 years ago, many critics were quick to say socialized medicine would put us on a path to communism, says Strachan, a 56-year-old adjunct Spanish instructor at Pima Community College.

“They immediately would leap to repressive governments,” she said, adding there appears to be less hostility about the concept now.

Strachan frequently posts about single-payer health care on Facebook and chats about it with strangers she encounters in public places like movie theaters. She’s found people are generally willing to talk about it, even if they don’t always agree.

Writing in favor of a single-payer system in the University of Arizona’s Arizona Daily Wildcat on July 3, Andrew Paxton said millennials “would rather pay slightly higher taxes than worry about how to afford insurance, especially as our parents age and medical costs skyrocket.”

GOING BACK TO FDR

Single-payer health care in the U.S. is a concept that goes back as far as the Franklin D. Roosevelt presidency, when publicly funded health care was considered for inclusion in the national Social Security Act.

The public appears to be gaining a new understanding of what it means, says Dr. George Pauk, the Arizona representative on Physicians for a National Health Program. Debate over the Senate and House health bills, as well as the Affordable Care Act, fueled some of the interest, Pauk and others say.

“Almost everyone has a relative struggling to pay or going bankrupt because of medical bills,” said Pauk, a retired endocrinologist from Phoenix who has been campaigning for a single-payer system for 30 years. “We have a segregated health-care system in this country, and there’s been a lot of discrimination in the history of American health care.”

Annual per-capita health expenditures in the U.S. are the highest in the world despite a recent slowdown in spending, the Commonwealth Fund reports.

Insurance companies, acting as middlemen between providers and patients, add a layer of bureaucracy that is not only fueling that cost, but also making health care complicated for consumers, Medicare for All advocates say.

At the same time, the U.S. is not keeping pace on important health measures.

Infant mortality rates here are 5.8 per 1,000 live births, 71 percent higher than the comparable country average and twice the rate of Japan and Sweden, a Kaiser Family Foundation analysis of 2014 data found.

A Kaiser analysis of 2013 data found that for most of the leading causes of death, including disease of the circulatory and respiratory systems, mortality rates are higher in the U.S. than in comparable countries.

Pauk said in general, Americans have been indoctrinated that government is bad and too big.

But insurance companies are also too big, and they are “making a killing on health care,” he said.

It would cost less for doctors to remove insurance companies, he said, and save the U.S. between $300 billion and $500 billion per year.

“The average doctor would not have to have two or three or four people doing billing for them,” he said. “Can you imagine the savings, not having to have those employees?”

Some critics dispute the cost savings.

After Sen. Bernie Sanders proposed a single-payer system during his Democratic presidential run in 2016, the Urban Institute released an analysis that said Sanders’ plan would increase national health expenditures by nearly 17 percent or $6.6 trillion between 2017 and 2026, largely because of the cost of providing additional acute care to non-elderly people who currently have no insurance.

The Urban Institute concluded that physician payments would be squeezed, as would the pharmaceutical and medical-device industries, “perhaps more than is sustainable” and that people could wait longer for care.

The co-founders of Pauk’s group wrote a rebuttal calling the study ridiculous, saying among other things that it ignored the major savings on hospital administration and doctors’ billing that would occur under a streamlined single-payer system.

They also noted that no surge in care occurred in the 1960s when millions of previously uninsured seniors gained coverage through Medicare.

U.S. INDIVIDUALISM

When the single-payer issue came up at the recent TMC forum, Dr. Francisco Garcia, chief medical officer for Pima County, said U.S. individualism “and our reluctance to be told what to do” have always been issues with that route.

Therein lies a huge part of the public’s perception of the ACA — the unpopular mandate that all Americans have insurance, he said.

“That was the rallying cry, ‘I don’t want to be told to buy insurance.’ Whether rightly or wrongly, that has been the downfall,” said Garcia, who is also assistant county administrator for health services.

And yet the ACA was a compromise between those who wanted a single-payer system and people who prefer a more capitalistic, market-oriented approach to health care.

“I actually think that the ACA, with its sometimes significant limitations, was actually a really sane, rational middle-of-the road, market-oriented kind of solution,” Garcia said. “I think that was a good, realistic solution and I long for the day when we can get back there, though I don’t see it yet.”

But Tucson pediatrician Dr. Eve Shapiro says it was a “different time” when President Obama presented his health plan in 2010. Shapiro has advocated for single-payer health care through Physicians for a National Health Program for about 30 years.

“I think he could have gone further in pushing the single payer and ended up with more of a public option,” Shapiro said. “He chose not to. He chose to work with the insurance companies. But I think people are now fed up with the insurance companies.”

Under a pure single-payer system, Americans would pay a progressive tax with no direct health-care costs for premiums, deductibles or co-pays.

That would be cheaper for 90 percent of Americans, said Tucson family physician and University of Arizona professor Dr. Paul Gordon. Gordon is Shapiro’s husband and also a strong supporter of a national single-payer health program.

The public is more likely to support “Medicare for All” versus “single payer,” which is why the messaging is important, Shapiro and Gordon say.

“People think if it’s a government system, the government controls your health care. What we try to explain is that the single payer is a payment system, which means there are no insurance companies and payments go through the government,” Shapiro said.

“But the delivery system is the same — the doctors, hospitals, health centers — that is what we have to make clear to people. Their day-to-day experience of health care wouldn’t change. What would change would be the financing of it.”

$3.2 TRILLION

One thing is certain — for the more than $10,000 per person the U.S. spends on health care each year, we should be expecting “much better value for the dollar,” says health-policy expert Dr. Dan Derksen, a professor at the University of Arizona’s Mel and Enid Zuckerman College of Public Health.

“In 2015, the U.S. had $3.2 trillion in health expenditures. That’s more than twice what other developed countries spend, yet our population health outcomes are not as good as many countries who spend far less — whether it’s in terms of longevity, maternal and neonatal mortality, access to health care and preventive services, and most other parameters,” Derksen said.

“All of the developed countries except the U.S. have ‘single payer’ systems. Each country’s approach to single payer is quite different. Canada is often described as the country closest to what a ‘Medicare for All’ single-payer system looks like.”

Derksen wasn’t surprised by the enthusiasm he heard for single payer at the TMC forum, where he was a panelist. The audience was primarily made up of people who seemed upset about the House and Senate health bills, so single-payer support was to be expected, he said.

During the 2008 election season, there was a strong push for single payer, he says. But he notes one big difference between then and now — today’s general public is more educated about health care, likely because more people have health insurance.

Before 2014, 48 million Americans were uninsured. That number is now down to about 28 million. The newly insured have had to learn about concepts like deductibles, co-insurance and essential health benefits, and are better equipped to identify shortcomings in the system.

Still, Derksen is skeptical of any Medicare for All law happening in the near future, even with added public awareness.

“We’re some years out from that, pragmatically. Many components of the health industry benefit from keeping the status quo,” he said.

“The insurance industry has record revenues, and their stocks rise as consumer health-insurance protections are now on the legislative chopping block.

“Vested interests generally oppose changes that give the government more leverage in negotiating prices, such as the pharmaceutical industry, who would not want to have a single payer with monopoly power to get significant discounts in medications.”

SINGLE ISSUE

Grijalva has long been a supporter of Medicare for All. At a July 6 forum he hosted in Tucson, he said the way to achieve it may be through increments, such as initially lowering the Medicare age to 50.

But Witte and others want more sweeping action now.

“Right now is the perfect opportunity to push for it. People have started to see what profit is doing to health care,” said Lee Stanfield, a 74-year-old retiree who started the group Single Payer Now Tucson more than a decade ago.

“It is so complex, and it’s aided and abetted by the insurance industry. They like it that way.”

When attending public events such as the Fourth Avenue Street Fair, Stanfield has been buoyed by the number of people who say they strongly support Medicare for All and are willing to take flyers and even help hand them out.

“In particular, I am encountering far more young people who know about and favor single payer than in years past, when it was hard to even get them to accept a flyer,” she said. “Bernie Sanders really got the young people on board.”

If anything is to happen with universal health coverage, it’s going to come from people like Stanfield who are at the grassroots level, Shapiro predicts.

“Look what is happening at all these senators and representatives’ offices, with people sitting in and protesting,” Shapiro said.

“I think they are getting the message that they have to do something that is real, that will give people coverage.”

http://tucson.com…

Health debate energizing Tucson ‘Medicare for All’ proponents

By Stephanie Innes
Arizona Daily Star, July 15, 2017

Universal health care is far from the plan Republican leaders are proposing, but it’s getting some love in Southern Arizona.

Advocates cite various factors fueling single-payer popularity.

These include fear about recent Republican efforts to repeal and replace the Affordable Care Act (ACA, also called Obamacare), a public that’s more well-versed in health care and a repackaged “Medicare for All” message that they say makes the single-payer concept more understandable and palatable.

Nowhere was local support for that kind of system more obvious than at a standing-room-only health forum hosted by Tucson Medical Center June 26. A question about single-payer health care drew cheers, not from one or two lone voices, but from a chorus across the room of 700 people.

While the response from expert panelists at the forum was tempered, the audience’s enthusiasm was clear. Signs saying “Healthcare not Wealthcare” and “No More Pay Up Or Die Plans!” dotted the entrance to the event. The crowd was energized.

“Back in 2009, I certainly didn’t know what Medicare for All was. Like most Americans, I knew about employer and non-group insurance. I was so naive,” said forum attendee Andrea Witte, a 52-year-old graphic designer who recently became a supporter of Medicare for All. “It’s just being discussed more, and when I go to events, I think people understand health care better.”

Witte says her personal evolution includes now seeing health care as a basic right — a moral imperative, “instead of a commodity to be rationed based on the size of one’s wallet or the profit-seeking of insurance companies.”

Increased support for Medicare for All is not just local — an April 2017 Economist/YouGov poll found a majority of Americans support “expanding Medicare to provide health insurance to every American.”

The Pew Research Center reported in June that 60 percent of Americans say the federal government is responsible for ensuring health-care coverage for all Americans, while 3 percent say it is not the government’s responsibility.

These views are unchanged from January, but the share saying health coverage is a government responsibility remains at its highest level in nearly a decade, the researchers found.

“Many like me who supported the ACA’s modest reforms now realize that keeping for-profit insurers involved still leaves too many Americans uninsured or underinsured and prevents us from controlling our skyrocketing health-care costs,” Witte said.

California recently considered its own form of single-payer health care, and other states are talking about it.

When people refer to single-payer health care, they are not always talking about the same thing, and some people give the various universal plans other names, such as “Medicaid for All,” referring to the government insurance program primarily for low-income people. The general commonality is one public entity handling health-care financing for the entire country.

The Medicare for All movement supports a system like traditional or original Medicare, which covers mostly people over the age of 65.

Such a plan has been introduced in Congress by U.S. Rep. John Conyers, a Democrat from Michigan. Conyers’ bill calls for a progressive tax based on income, similar to one in Canada, to fund expanded Medicare for all Americans. Democrat U.S. Reps. RaĂșl GrĂ­jalva of Tucson and Ruben Gallego of Phoenix are among the bill’s 113 co-sponsors.

The main Republican argument against single-payer health care is that it is too much big government providing not enough choice for Americans. Sen. Jeff Flake, an Arizona Republican, says he’s against single payer because he believes the best way to provide affordable, quality care for everyone is through “choice and competition in a free-market health-care system.”

Arizona Sen. John McCain says he, too, supports “a free-market solution that would enhance competition, increase choices, drive down costs and improve health-care outcomes.”

Nearly 40 percent of Arizonans already are on government-sponsored insurance — 25 percent on Medicaid and 14 percent on Medicare. That number doesn’t take into account the additional Arizonans who get federal subsidies to help pay for their health insurance through the ACA marketplace.

COMPLEXITY AND COST

Advocates say Medicare for All would provide health coverage to all Americans from birth to death and reduce two major problems with U.S. health care — complexity and cost.

“Health care should be like the fire department. … If your house is on fire, the fire department comes,” Tucson resident Kelly Strachan wrote in a recent letter to Flake and McCain.

“Not everyone’s house will burn, so we can create a big enough risk pool to truly control health-care costs (a large part of which is the profits of the insurance industry),” she wrote.

Eight to 10 years ago, many critics were quick to say socialized medicine would put us on a path to communism, says Strachan, a 56-year-old adjunct Spanish instructor at Pima Community College.

“They immediately would leap to repressive governments,” she said, adding there appears to be less hostility about the concept now.

Strachan frequently posts about single-payer health care on Facebook and chats about it with strangers she encounters in public places like movie theaters. She’s found people are generally willing to talk about it, even if they don’t always agree.

Writing in favor of a single-payer system in the University of Arizona’s Arizona Daily Wildcat on July 3, Andrew Paxton said millennials “would rather pay slightly higher taxes than worry about how to afford insurance, especially as our parents age and medical costs skyrocket.”

GOING BACK TO FDR

Single-payer health care in the U.S. is a concept that goes back as far as the Franklin D. Roosevelt presidency, when publicly funded health care was considered for inclusion in the national Social Security Act.

The public appears to be gaining a new understanding of what it means, says Dr. George Pauk, the Arizona representative on Physicians for a National Health Program. Debate over the Senate and House health bills, as well as the Affordable Care Act, fueled some of the interest, Pauk and others say.

“Almost everyone has a relative struggling to pay or going bankrupt because of medical bills,” said Pauk, a retired endocrinologist from Phoenix who has been campaigning for a single-payer system for 30 years. “We have a segregated health-care system in this country, and there’s been a lot of discrimination in the history of American health care.”

Annual per-capita health expenditures in the U.S. are the highest in the world despite a recent slowdown in spending, the Commonwealth Fund reports.

Insurance companies, acting as middlemen between providers and patients, add a layer of bureaucracy that is not only fueling that cost, but also making health care complicated for consumers, Medicare for All advocates say.

At the same time, the U.S. is not keeping pace on important health measures.

Infant mortality rates here are 5.8 per 1,000 live births, 71 percent higher than the comparable country average and twice the rate of Japan and Sweden, a Kaiser Family Foundation analysis of 2014 data found.

A Kaiser analysis of 2013 data found that for most of the leading causes of death, including disease of the circulatory and respiratory systems, mortality rates are higher in the U.S. than in comparable countries.

Pauk said in general, Americans have been indoctrinated that government is bad and too big.

But insurance companies are also too big, and they are “making a killing on health care,” he said.

It would cost less for doctors to remove insurance companies, he said, and save the U.S. between $300 billion and $500 billion per year.

“The average doctor would not have to have two or three or four people doing billing for them,” he said. “Can you imagine the savings, not having to have those employees?”

Some critics dispute the cost savings.

After Sen. Bernie Sanders proposed a single-payer system during his Democratic presidential run in 2016, the Urban Institute released an analysis that said Sanders’ plan would increase national health expenditures by nearly 17 percent or $6.6 trillion between 2017 and 2026, largely because of the cost of providing additional acute care to non-elderly people who currently have no insurance.

The Urban Institute concluded that physician payments would be squeezed, as would the pharmaceutical and medical-device industries, “perhaps more than is sustainable” and that people could wait longer for care.

The co-founders of Pauk’s group wrote a rebuttal calling the study ridiculous, saying among other things that it ignored the major savings on hospital administration and doctors’ billing that would occur under a streamlined single-payer system.

They also noted that no surge in care occurred in the 1960s when millions of previously uninsured seniors gained coverage through Medicare.

U.S. INDIVIDUALISM

When the single-payer issue came up at the recent TMC forum, Dr. Francisco Garcia, chief medical officer for Pima County, said U.S. individualism “and our reluctance to be told what to do” have always been issues with that route.

Therein lies a huge part of the public’s perception of the ACA — the unpopular mandate that all Americans have insurance, he said.

“That was the rallying cry, ‘I don’t want to be told to buy insurance.’ Whether rightly or wrongly, that has been the downfall,” said Garcia, who is also assistant county administrator for health services.

And yet the ACA was a compromise between those who wanted a single-payer system and people who prefer a more capitalistic, market-oriented approach to health care.

“I actually think that the ACA, with its sometimes significant limitations, was actually a really sane, rational middle-of-the road, market-oriented kind of solution,” Garcia said. “I think that was a good, realistic solution and I long for the day when we can get back there, though I don’t see it yet.”

But Tucson pediatrician Dr. Eve Shapiro says it was a “different time” when President Obama presented his health plan in 2010. Shapiro has advocated for single-payer health care through Physicians for a National Health Program for about 30 years.

“I think he could have gone further in pushing the single payer and ended up with more of a public option,” Shapiro said. “He chose not to. He chose to work with the insurance companies. But I think people are now fed up with the insurance companies.”

Under a pure single-payer system, Americans would pay a progressive tax with no direct health-care costs for premiums, deductibles or co-pays.

That would be cheaper for 90 percent of Americans, said Tucson family physician and University of Arizona professor Dr. Paul Gordon. Gordon is Shapiro’s husband and also a strong supporter of a national single-payer health program.

The public is more likely to support “Medicare for All” versus “single payer,” which is why the messaging is important, Shapiro and Gordon say.

“People think if it’s a government system, the government controls your health care. What we try to explain is that the single payer is a payment system, which means there are no insurance companies and payments go through the government,” Shapiro said.

“But the delivery system is the same — the doctors, hospitals, health centers — that is what we have to make clear to people. Their day-to-day experience of health care wouldn’t change. What would change would be the financing of it.”

$3.2 TRILLION

One thing is certain — for the more than $10,000 per person the U.S. spends on health care each year, we should be expecting “much better value for the dollar,” says health-policy expert Dr. Dan Derksen, a professor at the University of Arizona’s Mel and Enid Zuckerman College of Public Health.

“In 2015, the U.S. had $3.2 trillion in health expenditures. That’s more than twice what other developed countries spend, yet our population health outcomes are not as good as many countries who spend far less — whether it’s in terms of longevity, maternal and neonatal mortality, access to health care and preventive services, and most other parameters,” Derksen said.

“All of the developed countries except the U.S. have ‘single payer’ systems. Each country’s approach to single payer is quite different. Canada is often described as the country closest to what a ‘Medicare for All’ single-payer system looks like.”

Derksen wasn’t surprised by the enthusiasm he heard for single payer at the TMC forum, where he was a panelist. The audience was primarily made up of people who seemed upset about the House and Senate health bills, so single-payer support was to be expected, he said.

During the 2008 election season, there was a strong push for single payer, he says. But he notes one big difference between then and now — today’s general public is more educated about health care, likely because more people have health insurance.

Before 2014, 48 million Americans were uninsured. That number is now down to about 28 million. The newly insured have had to learn about concepts like deductibles, co-insurance and essential health benefits, and are better equipped to identify shortcomings in the system.

Still, Derksen is skeptical of any Medicare for All law happening in the near future, even with added public awareness.

“We’re some years out from that, pragmatically. Many components of the health industry benefit from keeping the status quo,” he said.

“The insurance industry has record revenues, and their stocks rise as consumer health-insurance protections are now on the legislative chopping block.

“Vested interests generally oppose changes that give the government more leverage in negotiating prices, such as the pharmaceutical industry, who would not want to have a single payer with monopoly power to get significant discounts in medications.”

SINGLE ISSUE

Grijalva has long been a supporter of Medicare for All. At a July 6 forum he hosted in Tucson, he said the way to achieve it may be through increments, such as initially lowering the Medicare age to 50.

But Witte and others want more sweeping action now.

“Right now is the perfect opportunity to push for it. People have started to see what profit is doing to health care,” said Lee Stanfield, a 74-year-old retiree who started the group Single Payer Now Tucson more than a decade ago.

“It is so complex, and it’s aided and abetted by the insurance industry. They like it that way.”

When attending public events such as the Fourth Avenue Street Fair, Stanfield has been buoyed by the number of people who say they strongly support Medicare for All and are willing to take flyers and even help hand them out.

“In particular, I am encountering far more young people who know about and favor single payer than in years past, when it was hard to even get them to accept a flyer,” she said. “Bernie Sanders really got the young people on board.”

If anything is to happen with universal health coverage, it’s going to come from people like Stanfield who are at the grassroots level, Shapiro predicts.

“Look what is happening at all these senators and representatives’ offices, with people sitting in and protesting,” Shapiro said.

“I think they are getting the message that they have to do something that is real, that will give people coverage.”

http://tucson.com…

The who and how of improving the U.S. health care system

From Last to First — Could the U.S. Health Care System Become the Best in the World?

By Eric C. Schneider, M.D., and David Squires, M.A.
The New England Journal of Medicine, July 14, 2017

Many Americans believe that the United States has the best health care system in the world, but surprisingly little evidence supports that belief. On the contrary, since 2004, reports from the Commonwealth Fund have consistently rated the performance of the U.S. health care system last among high-income countries, despite the fact that we spend far more on health care than these other countries.

Timely access for people at risk for poor health may be impeded by three features of health care systems: the cost of care and its affordability for individuals, the administrative burden (or hassle) that people confront as they obtain and receive care, and disparities or inequities in the delivery of care based on income, educational attainment, race or ethnic background, or other nonclinical personal characteristics.

The first challenge the U.S. health care system must confront is lack of access to health care. The high-income countries that are top-ranked according to the most recent Fund report (the United Kingdom, Australia, and the Netherlands) offer universal insurance coverage with minimal out-of-pocket costs for preventive and primary care. Affordable and comprehensive insurance coverage is fundamental. If people are uninsured, some delay seeking care, some of those end up with serious health problems, and some of them die.

The second challenge is the relative underinvestment in primary care in the United States as compared with other countries. Other countries make primary care widely, and more uniformly, available. In contrast to the United States, a higher percentage of these countries’ professional workforce is dedicated to primary care than to specialty care, and they enable delivery of a wider range of services at first contact, even at night and on weekends.

The third challenge is the administrative inefficiency of the U.S. health care system. Both patients and professionals in the United States are baffled by the complexity of obtaining care and paying for it. Clinicians and their staff spend countless hours completing documentation to prove that insurance coverage is active, that benefits and services are covered, that services were delivered, and that payment or reimbursement occurred. Coping with the byzantine layers of administration results in high levels of burnout for doctors and other professionals, which can reduce the quality of care. The complexity also affects patients, who receive confusing benefit descriptions, limited information about doctors and hospitals, unintelligible and often unexpected (or “surprise”) bills for services, and unpredictable copayments at labs and pharmacies. It is possible to reduce these barriers to adherence and follow-up by reducing complexity for patients and clinicians: if we changed our reimbursement systems to use global payments, fee schedules, formularies, and defined benefits, it would make benefits and costs more predictable for patients and revenue more predictable for clinicians.

The fourth challenge is the pervasiveness in the United States of disparities in the delivery of care. People with low incomes, low educational attainment, and other social and economic challenges face greater health risks and worse health in all countries, but especially in the United States, which has a less robust social safety net than other high-income countries. Other countries achieve better population health by spending relatively more on social services than on medical care. Along with making insurance coverage available to the poor and ensuring that primary care has a strong presence, dedicating resources through social spending to stable housing, educational opportunities, nutrition, and transportation may reduce the demand for emergency, hospital, and long-term care services.

The United States could achieve the best-performing health care system in the world by undertaking coordinated efforts that address each of these challenges. Ensuring universal and adequate health insurance coverage, strengthening primary care, reducing administrative burden, and reducing income-related disparities by strengthening behavioral health and social service supports could go a long way toward improving the health of the U.S. population.

http://www.nejm.org…

***

Mirror, Mirror 2017: International Comparison Reflects Flaws and Opportunities for Better U.S. Health Care

By Eric C. Schneider, Dana O. Sarnak, David Squires, Arnav Shah, and Michelle M. Doty
The Commonwealth Fund, July 2017

The United States ranks last in health care system performance among the 11 countries included in this study. The U.S. ranks last in Access, Equity, and Health Care Outcomes, and next to last in Administrative Efficiency, as reported by patients and providers. Only in Care Process does the U.S. perform better, ranking fifth among the 11 countries.

http://www.commonwealthfund.org…

***

Comment:

By Don McCanne, M.D.

This NEJM Perspective article is based on the 2017 update of The Commonwealth Fund’s ranking of health care systems in eleven wealthy nations. Once again, the United states ranks last in overall performance, ranking at or near the bottom on access, administrative efficiency, equity, and health care outcomes.

Note particularly the four challenges described in the NEJM commentary: 1) Impaired access, 2) Underinvestment in primary care, 3) Pervasive administrative inefficiency, and 4) Disparities in the delivery of care. These are challenges for which a well designed single payer system would be ideally suited to address, but it must be part of a comprehensive public program addressing other factors contributing to our poor performance, especially in the need for social services.

Canada has a single payer system yet they rank ninth of the eleven systems. This is not a criticism of single payer financing itself, but rather it is a call to be certain that we elect public stewards who design and administer the single payer system with continuing oversight and appropriate intervention in not just the financing of the health care system but also in ensuring appropriate, comprehensive social services.

The authors of “Mirror, Mirror 2017” say that high performance can be achieved with any of three systems: national health service (United Kingdom), single payer (Australia, which requires supplemental insurance), and competing private insurers (Netherlands).

Well, the Netherlands, with its competing private insurers, ranks low in administrative efficiency. Australia requires a combination of public and private insurance and ranks low in equity, wherein varying ability to afford the private plans likely contributes to the inequity. The United Kingdom ranks first overall, but it is unlikely that Americans would support the transfer of our private health care delivery system to the government anytime soon.

So a well designed single payer system seems most appropriate for the United States, and the four challenges described make it clear that the need is urgent.

***

Speaking of a well designed single payer system, nobody has contributed more to our understanding of single payer and its role in achieving health care justice for all than have the co-founders of Physicians for a National Health Program – Steffie Woolhandler and David Himmelstein. Thus it is with great pride that we present the following announcement from Hunter College:

“Hunter College is proud to announce that David Himmelstein and Stephanie Woolhandler – esteemed teachers, brilliant scholars and front-line leaders in the field of public health – have been named Distinguished Professors by The City University of New York.

“’Nationally and around the world, Professors Himmelstein and Woolhandler are known and admired not only for their knowledge, research and expertise, but also for their forceful activism for quality health care,’ said Hunter President Jennifer J. Raab. ‘No one is more deserving of the designation ‘distinguished professor’ than these longtime collaborators.’”

http://www.hunter.cuny.edu…

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

This August, let’s turn up the heat on Congress

Medicare For All PrescriptionClick here to sign up for our “Rx: Medicare for all” campaign

As legislators return to their districts during the month of August, we need to not only express opposition to the various efforts to shred our health care safety net, but also push for a real solution in the form of improved Medicare for all.

We’re urging our members to show up in large numbers at town hall meetings and to participate in “sidewalk town halls” aimed at legislators who are avoiding their constituents. We’re also encouraging members to plan or particpate in other health justice actions leading up to Labor Day.

To sign up for our “Rx: Medicare for all” campaign, please fill out this form. You may also wish to browse a regularly updated schedule of events by visiting the Town Hall Project website.

***

Campaign Toolkit

We have compiled the following materials to assist members during the August recess:

If you have any questions, or would like assistance planning your action, please call (312) 782-6006 or email organizer@pnhp.org.

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Campaign Successes

We will use this space to post recaps, photos, and links to media coverage of campaign actions – please check back frequently throughout the month of August! (For an album of photos related to the campaign, please visit our Flickr page here.)

Chicago, IL (July 28)Chicago Die-In 2017
Die-in for improved Medicare for all

Physicians, medical students, patients, and members of the public gathered at Federal Plaza downtown to applaud the defeat of Trumpcare and to urge Sen. Durbin to support single-payer legislation in the U.S. Senate.

Springfield, IL (July 28)
Die-in for improved Medicare for all
http://m.facebook.com…

NYC Town HallNew York, NY (August 1)
Congressman Nadler’s community town hall

Dr. Betsy Rosenthal and other PNHP members spoke up for improved Medicare for all at a town hall meeting organized by Rep. Nadler (who is himself a co-sponsor of H.R. 676 in the House of Representatives).

El Dorado Hills, CA (August 2)
Sidewalk rally outside Chamber of Commerce meeting attended by Rep. Tom McClintock

Corvallis, OR (August 3)
Town hall meeting with Rep. Peter DeFazio

Tarrytown, NY (August 3)
Screening of FIX IT: Healthcare at the Tipping Point

Memphis Town HallMemphis, TN (August 5)
Town hall meeting with Rep. Steve Cohen

Drs. Art Sutherland and Roger LaBonte participated in the meeting as health care experts. Rep. Cohen is a long-time single payer supporter and a co-sponsor of H.R. 676.
http://www.commercialappeal.com…

Irvine, CA (August 5)
Empty chair town hall meeting for Rep. Mimi Walters

Asheville Town HallFlat Rock, NC (August 7)
Town hall meeting with Rep. Mark Meadows

Single payer supporters came out to Blue Ridge Community College in droves and cheered enthusiastically each time Freedom Caucus leader Meadows mentioned “Medicare for all.”
http://www.motherjones.com…

Narragansett, RI (August 8)
Town hall meeting with Rep. James Langevin
http://www.independentri.com…

MN Town HallMinneapolis, MN (August 9)
Health care forum with Rep. Keith Ellison

PNHP Minnesota board member Dr. Brian Yablon participated in the panel discussion and spoke about single payer during the subsequent Q&A. Rep. Ellison is a noted single payer supporter and co-sponsor of H.R. 676.

Chicago, IL (August 14)
“Solutions Only” congressional field inquiry

PNHP national board member Dr. Susan Rogers participated in this public forum, which was hosted by Rep. Robin Kelly and featured Reps. Jan Schakowsky and Karen Bass, among other civic and health care leaders. Improved Medicare for all was posited as one of the solutions, and Rep. Kelly noted she was a “proud co-sponsor” of H.R. 676.
http://chicago.cbslocal.com…

Kelly Panel

Kalamazoo, MI (August 16)
Sidewalk town hall meeting in front of Rep. Fred Upton’s office

Ranson, WV (August 19)
March for improved Medicare for all at African American Cultural & Heritage Festival

Nashville, TN (August 21)
Solar Eclipse Celebration: PNHP had a table and Dr. Carol Paris was an event speaker

Rep. Conyers and Sen. SandersDetroit, MI (August 22)
Town hall meeting with Rep. John Conyers

H.R. 676 lead sponsor Rep. Conyers welcomed fellow single-payer champion Sen. Bernie Sanders to Detroit for an overflow town hall on jobs and health care at Fellowship Chapel Church.
http://www.mlive.com…

Bethel Park, PA (August 22)
AARP Pennsylvania health care forum & community conversation

Oak Park, IL (August 24)
7th Congressional District town hall meeting with Rep. Danny Davis

Kalamazoo 2017Kalamazoo, MI (August 24)
Health care for all rally at Bronson Park

A large public rally emphasized the principle that health care is a human right and urged Congress to move beyond the debate over the Affordable Care Act and embrace a real health care solution: improved Medicare for all.

Clearwater, FL (August 25)
Town hall meeting with Rep. Charlie Crist
http://www.tampabay.com…

Charlotte PrideCharlotte, NC (August 27)
Single payer table at Charlotte Pride

Members of the Charlotte-area PNHP chapter Health Care Justice – NC rallied for improved Medicare for all at the 2017 Charlotte Pride Festival & Parade. Members spread the word via an info table and also marched in the parade.

Pittsburgh, PA (August 27)
Pittsburgh Post-Gazette / Highmark health care forum

U Chicago 2017Chicago, IL (August 27)
SNaHP welcome dinner & postcard action

Chicago-area PNHP members hosted a dinner for some 40 University of Chicago medical students. Local student leaders prepared postcards for new and returning SNaHP members to send to their legislators regarding H.R. 676.

Rockville, MD (August 31)
Health care town hall with Sen. Ben Cardin

Chicago, IL (September 1)
Delivering medical student postcards to Rep. Dan Lipinski urging him to co-sponsor H.R. 676. To view video of the postcard delivery, visit our YouTube page.