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Insurance rescinded: People will die

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Insurance rescinded: People will die

H.R. 1628, Better Care Reconciliation Act of 2017

Congressional Budget Office, June 26, 2017

CBO and JCT estimate that enacting the Better Care Reconciliation Act of 2017 would reduce federal deficits by $321 billion over the coming decade and increase the number of people who are uninsured by 22 million in 2026 relative to current law.

Because nongroup insurance would pay for a smaller average share of benefits under this legislation, most people purchasing it would have higher out-of-pocket spending on health care than under current law.

https://www.cbo.gov…

***

The Relationship of Health Insurance and Mortality: Is Lack of Insurance Deadly?

By Steffie Woolhandler, M.D., M.P.H.; David U. Himmelstein, M.D.
Annals of Internal Medicine, June 27, 2017

Abstract

About 28 million Americans are currently uninsured, and millions more could lose coverage under policy reforms proposed in Congress. At the same time, a growing number of policy leaders have called for going beyond the Affordable Care Act to a single-payer national health insurance system that would cover every American. These policy debates lend particular salience to studies evaluating the health effects of insurance coverage. In 2002, an Institute of Medicine review concluded that lack of insurance increases mortality, but several relevant studies have appeared since that time. This article summarizes current evidence concerning the relationship of insurance and mortality. The evidence strengthens confidence in the Institute of Medicine’s conclusion that health insurance saves lives: The odds of dying among the insured relative to the uninsured is 0.71 to 0.97.

From the Discussion

The evidence accumulated since the publication of the IOM’s report in 2002 supports and strengthens its conclusion that health insurance reduces mortality. Several newer observational and quasi-experimental studies have found that uninsurance shortens survival, and a few with null results used confounded or questionable adjustments for baseline health. The results of the only recent RCT, although far from definitive, are consistent with the positive findings from cohort and quasi-experimental analyses.

Several factors complicate efforts to determine whether uninsurance increases mortality. Randomly assigning people to uninsurance is usually unethical, and quasi-experimental analyses rest on unverifiable assumptions. Deaths are rare and mortality effects may be delayed, mandating large studies with long follow-up. Many people cycle into and out of coverage, diluting the effects of insurance. And statistical adjustments for baseline health usually rely on participants’ self-reports, which may be influenced by coverage. Hence, such adjustments may under- or overadjust for differences between insured and uninsured persons.

Our focus on mortality should not obscure other well-established benefits of health insurance: improved self-rated health, financial protection, and reduced likelihood of depression. Insurance is the gateway to medical care, whose aim is not just saving lives but also relieving human suffering.

Overall, the case for coverage is strong. Even skeptics who suggest that insurance doesn’t improve outcomes seem to vote differently with their feet. As one prominent economist (Paul Krugman) recently asked, “How many of the people who write such things… choose to just not bother getting their healthcare?”

http://annals.org…

***

Comment:

By Don McCanne, M.D.

Although the precise numbers are somewhat elusive, this comprehensive review of existing studies confirms that health insurance reduces mortality. The Congressional Budget Office concludes that another 22 million people will be uninsured compared to current law if the Better Care Reconciliation Act were enacted and implemented. If this Republican repeal and replace bill becomes law, more people will die as a result.

Obviously the reduction in mortality is not the sole function of insurance. As the authors of this Annals of Internal Medicine article state, “Insurance is the gateway to medical care, whose aim is not just saving lives but also relieving human suffering.” Importantly, it also provides financial protection, which otherwise would deteriorate under the Republican proposal. (The full landmark article by Steffie Woolhandler and David Himmelstein is available for free at the link above.)

If there ever was a time to intensify the policy debate, this is it. The repeal and replace movement became popular because of the acknowledged deficiencies of the Affordable Care Act – leaving millions uninsured, millions more with inadequate financial protection, perpetuation of a dysfunctional insurance market that takes away choices, while failing to remedy the profound administrative waste that uniquely characterizes the U.S. health care financing system.

The Republicans have done us a favor by showing us that replacement policies that assume perpetuation of our fragmented infrastructure of private plans and public programs cannot remedy the profound deficiencies in our system. With six years of debate, the policies proposed do not correct the fundamental flaws in the financing infrastructure and actually would only compound the problems, including increasing mortality caused by being uninsured.

It is not as if we do not understand optimal health policy. We do. A well designed single payer national health program – an improved Medicare for all – would ensure that all of us would have the essential health care services that we need in a system that would be affordable for each of us. And, oh yes, nobody would die simply because they were uninsured.

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

Insurance rescinded: People will die

H.R. 1628, Better Care Reconciliation Act of 2017

Congressional Budget Office, June 26, 2017

CBO and JCT estimate that enacting the Better Care Reconciliation Act of 2017 would reduce federal deficits by $321 billion over the coming decade and increase the number of people who are uninsured by 22 million in 2026 relative to current law.

Because nongroup insurance would pay for a smaller average share of benefits under this legislation, most people purchasing it would have higher out-of-pocket spending on health care than under current law.

https://www.cbo.gov…

***

The Relationship of Health Insurance and Mortality: Is Lack of Insurance Deadly?

By Steffie Woolhandler, M.D., M.P.H.; David U. Himmelstein, M.D.
Annals of Internal Medicine, June 27, 2017

Abstract

About 28 million Americans are currently uninsured, and millions more could lose coverage under policy reforms proposed in Congress. At the same time, a growing number of policy leaders have called for going beyond the Affordable Care Act to a single-payer national health insurance system that would cover every American. These policy debates lend particular salience to studies evaluating the health effects of insurance coverage. In 2002, an Institute of Medicine review concluded that lack of insurance increases mortality, but several relevant studies have appeared since that time. This article summarizes current evidence concerning the relationship of insurance and mortality. The evidence strengthens confidence in the Institute of Medicine’s conclusion that health insurance saves lives: The odds of dying among the insured relative to the uninsured is 0.71 to 0.97.

From the Discussion

The evidence accumulated since the publication of the IOM’s report in 2002 supports and strengthens its conclusion that health insurance reduces mortality. Several newer observational and quasi-experimental studies have found that uninsurance shortens survival, and a few with null results used confounded or questionable adjustments for baseline health. The results of the only recent RCT, although far from definitive, are consistent with the positive findings from cohort and quasi-experimental analyses.

Several factors complicate efforts to determine whether uninsurance increases mortality. Randomly assigning people to uninsurance is usually unethical, and quasi-experimental analyses rest on unverifiable assumptions. Deaths are rare and mortality effects may be delayed, mandating large studies with long follow-up. Many people cycle into and out of coverage, diluting the effects of insurance. And statistical adjustments for baseline health usually rely on participants’ self-reports, which may be influenced by coverage. Hence, such adjustments may under- or overadjust for differences between insured and uninsured persons.

Our focus on mortality should not obscure other well-established benefits of health insurance: improved self-rated health, financial protection, and reduced likelihood of depression. Insurance is the gateway to medical care, whose aim is not just saving lives but also relieving human suffering.

Overall, the case for coverage is strong. Even skeptics who suggest that insurance doesn’t improve outcomes seem to vote differently with their feet. As one prominent economist (Paul Krugman) recently asked, “How many of the people who write such things… choose to just not bother getting their healthcare?”

http://annals.org…

***

Comment:

By Don McCanne, M.D.

Although the precise numbers are somewhat elusive, this comprehensive review of existing studies confirms that health insurance reduces mortality. The Congressional Budget Office concludes that another 22 million people will be uninsured compared to current law if the Better Care Reconciliation Act were enacted and implemented. If this Republican repeal and replace bill becomes law, more people will die as a result.

Obviously the reduction in mortality is not the sole function of insurance. As the authors of this Annals of Internal Medicine article state, “Insurance is the gateway to medical care, whose aim is not just saving lives but also relieving human suffering.” Importantly, it also provides financial protection, which otherwise would deteriorate under the Republican proposal. (The full landmark article by Steffie Woolhandler and David Himmelstein is available for free at the link above.)

If there ever was a time to intensify the policy debate, this is it. The repeal and replace movement became popular because of the acknowledged deficiencies of the Affordable Care Act – leaving millions uninsured, millions more with inadequate financial protection, perpetuation of a dysfunctional insurance market that takes away choices, while failing to remedy the profound administrative waste that uniquely characterizes the U.S. health care financing system.

The Republicans have done us a favor by showing us that replacement policies that assume perpetuation of our fragmented infrastructure of private plans and public programs cannot remedy the profound deficiencies in our system. With six years of debate, the policies proposed do not correct the fundamental flaws in the financing infrastructure and actually would only compound the problems, including increasing mortality caused by being uninsured.

It is not as if we do not understand optimal health policy. We do. A well designed single payer national health program – an improved Medicare for all – would ensure that all of us would have the essential health care services that we need in a system that would be affordable for each of us. And, oh yes, nobody would die simply because they were uninsured.

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

Priceless benefits would come from single-payer health care system

It’s part of the same moral responsibility that Americans share for public safety and education.

By Joshua Gear, M.D.
Portland (Maine) Press Herald, June 26, 2017

As a piece of legislation intended to provide affordable, quality health care to the greatest number of Americans, the Affordable Care Act has failed miserably. Twenty million Americans remain uninsured and tens of millions more with insurance have trouble affording their co-pays or deductibles. Half a million Americans with health insurance coverage declare bankruptcy every year as a result of medical expenses.

The ACA has been a disaster for providing affordable coverage, but soon our health care system will be in worse shape. Far worse. The “death spiral” of health care coverage, stimulated by a Republican Party hell-bent on undermining any legislation promoted by Barack Obama, has accelerated.

Both the House and Senate versions of the American Health Care Act attempt to stall that death spiral, but the trade-off they offer is less coverage and a certain increase in pain, suffering and premature death to older Americans as well as those who struggle the most to pay their bills. The beneficiaries of the AHCA through tax cuts and subsidies are the super wealthy, the health insurance industry and Big Pharma.

Only weeks after championing the House version and then celebrating its passage in the Rose Garden, President Trump recognized that what House Speaker Paul Ryan, et al., had crafted was “mean” – a remarkable admission for a man who has a profound aversion for the truth.

The Senate version, crafted in secret by 13 hand-picked older white men, was finally offered up four days ago, giving the other 87 members less than a week to critique, discuss and amend before being asked to pass it. Any reasonable person would agree that this is not only unprecedented but also a dangerous way to legislate.

Though their version in many ways is even more “mean” than the House version, those 13 senators may have managed to make it more palatable by extending time lines and shuffling numbers. So it may well pass.

Regardless of how this plays out, whether we continue with the ACA or get some version of the AHCA, America in general and the poor, the elderly and the middle class in particular, will not do well in regard to having their health care needs met over the next several years.

It’s important to recognize that the United States pays nearly two times more in health care costs than any other industrialized country while having far worse outcomes on most measures of care, and still we leave over 10 percent of our citizens without access to care because of lack of insurance.

Being uninsured means being unable to treat chronic conditions such as diabetes, hypertension, chronic obstructive pulmonary disease, schizophrenia, addictions, Crohn’s disease – and the list goes on and on. Failure to treat these chronic conditions results in pain, suffering, expensive trips to the emergency room and premature death. The financial costs are huge to the taxpayers, but they pale in comparison to the emotional costs paid by individuals and families of those with pre-existing conditions.

Call it what you will, but “single-payer” or “Medicare for all” or “socialized medicine” would guarantee quality health care for every American, and it would provide it for a fraction of the cost we pay for health care today. Why? Because a single-payer system would not be burdened by financially supporting insurance or pharmaceutical industries that take advantage of our campaign finance and lobbying laws and in doing so manage to generate enormous profits through limiting patients’ access to care or life-saving treatment.

Our elected officials, on both sides of the aisle, have become intoxicated by the money poured into their campaigns and have become dependent on that money to get re-elected. Their primary focus is to stay employed, i.e., to get re-elected, and access to quality health care by their constituents can be damned.

We guarantee our children access to a quality education through high school for good reason: It makes for a better society and a more robust economy.

And you would not deprive your neighbors a quick response from the local fire department if their house were on fire. If you did, lives could be destroyed or lost and businesses and communities decimated.

Is it any less cruel or ill-advised to deprive those same neighbors access to health care?

Our country needs an affordable, effective health care system. Plans that are not single-payer, quite simply, are motivated by greed and fueled by ignorance. And they are cruel.

There is no question that the ACA needs to be repealed and replaced. It needs to be replaced with comprehensive, universal coverage that is affordable and compassionate. Single-payer.

http://www.pressherald.com…

Dr. David Himmelstein on ‘CBS Evening News’

PNHP co-founder Dr. David Himmelstein appeared on the “CBS Evening News” on June 26, 2017, to discuss the broad scientific consensus that there is a link between a lack of health insurance and mortality. He noted, as part of a larger segment, that the uninsured tend to forego care for even the most serious medical conditions.

Dr. David Himmelstein on ‘CBS Evening News’

PNHP co-founder Dr. David Himmelstein appeared on the “CBS Evening News” on June 26, 2017, to discuss the broad scientific consensus that there is a link between a lack of health insurance and mortality. He noted, as part of a larger segment, that the uninsured tend to forego care for even the most serious medical conditions.

New Gallup and Pew surveys show concern and hope for health care

Cost of Healthcare Is Americans’ Top Financial Concern

By Andrew Dugan
Gallup, June 23, 2017

The cost of healthcare is now the top financial problem facing U.S. families. Concern about healthcare costs is at nearly the same level now as it was in 2007, a time before the recession and the passage of the ACA.

What is the most important financial problem facing your family today (open ended)?

17% – Healthcare costs
11% – Too much debt/Not enough money to pay debts
10% – Lack of money/Low wages
10% – College expenses
9% – Cost of owning/renting a home
8% – High cost of living/Inflation
Other choices 6% or less (see table at link)

http://www.gallup.com…

***

Public support for ‘single payer’ health coverage grows, driven by Democrats

By Jocelyn Kiley
Pew Research Center, June 23, 2017

A majority of Americans say it is the federal government’s responsibility to make sure all Americans have health care coverage. And a growing share now supports a “single payer” approach to health insurance, according to a new national survey by Pew Research Center.

Among those who see a government responsibility to provide health coverage for all, more now say it should be provided through a single health insurance system run by the government, rather than through a mix of private companies and government programs. Overall, 33% of the public now favors such a “single payer” approach to health insurance, up 5 percentage points since January and 12 points since 2014. Democrats – especially liberal Democrats – are much more supportive of this approach than they were even at the start of this year.

Among Democrats, 52% now say health insurance should be provided through a single national insurance system run by the government, while fewer (31%) say it should be provided through a mix of private companies and government programs. The share of Democrats supporting a single national program to provide health insurance has increased 9 percentage points since January and 19 points since 2014.

Nearly two-thirds of liberal Democrats (64%) now support a single-payer health insurance system, up 13 percentage points since January.

Two-thirds of adults younger than 30 (67%) say the government has a responsibility to provide health coverage for all, with 45% saying coverage should be provided through a single national program.

Among Republicans, a greater share of those younger than 30 (39%) than those 30 and older (28%) say the government is responsible for providing health coverage for all; more young Republicans than older Republicans favor single payer (22% vs. 10%).

The share viewing this as a government responsibility has increased 9 percentage points since 2016, from 51% to 60%.

http://www.pewresearch.org…

***

Comment:

By Don McCanne, M.D.

Cost of health care is the top financial concern of Americans, and that has been increasing, now as high as it was before the Affordable Care Act was enacted. The more reassuring news is that support for a government responsibility to provide health coverage for all remains high, and preference for a single payer approach is increasing.

That increase in single payer support is greater amongst Democrats, especially liberals, and amongst adults under 30. Although the concept of single payer is less popular amongst Republicans, some do favor it.

We should take advantage of being sure that those not yet sold on single payer understand two things; 1) They are correct that the Affordable Care Act is not satisfactory because it falls far short of universality and it fails to prevent financial hardship, and thus it needs to be replaced, and 2) The six years of vacuous proposals of the Republican legislators have obliterated any hope that a solution lies within the fantasies of a free market health care nirvana. The Republican proposals acknowledge that government involvement is essential, but they propose an emasculated role – the worst kind of government, heavy with bureaucracy but placing our tax funds into the hands of entrepreneurial rent seekers.

More people are realizing that the circuitous route taken by our health care dollars wastes tremendous resources while depriving too many individuals of the health care access and financial protection that they need. Conservatives and the business community are beginning to understand this. We have to make sure that we provide the information to them that they need to have a clearer understanding of optimal health care financing policy. Not only is $3.2 trillion at stake, our health is as well.

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

New Gallup and Pew surveys show concern and hope for health care

Cost of Healthcare Is Americans’ Top Financial Concern

By Andrew Dugan
Gallup, June 23, 2017

The cost of healthcare is now the top financial problem facing U.S. families. Concern about healthcare costs is at nearly the same level now as it was in 2007, a time before the recession and the passage of the ACA.

What is the most important financial problem facing your family today (open ended)?

17% – Healthcare costs
11% – Too much debt/Not enough money to pay debts
10% – Lack of money/Low wages
10% – College expenses
9% – Cost of owning/renting a home
8% – High cost of living/Inflation
Other choices 6% or less (see table at link)

http://www.gallup.com…

***

Public support for ‘single payer’ health coverage grows, driven by Democrats

By Jocelyn Kiley
Pew Research Center, June 23, 2017

A majority of Americans say it is the federal government’s responsibility to make sure all Americans have health care coverage. And a growing share now supports a “single payer” approach to health insurance, according to a new national survey by Pew Research Center.

Among those who see a government responsibility to provide health coverage for all, more now say it should be provided through a single health insurance system run by the government, rather than through a mix of private companies and government programs. Overall, 33% of the public now favors such a “single payer” approach to health insurance, up 5 percentage points since January and 12 points since 2014. Democrats – especially liberal Democrats – are much more supportive of this approach than they were even at the start of this year.

Among Democrats, 52% now say health insurance should be provided through a single national insurance system run by the government, while fewer (31%) say it should be provided through a mix of private companies and government programs. The share of Democrats supporting a single national program to provide health insurance has increased 9 percentage points since January and 19 points since 2014.

Nearly two-thirds of liberal Democrats (64%) now support a single-payer health insurance system, up 13 percentage points since January.

Two-thirds of adults younger than 30 (67%) say the government has a responsibility to provide health coverage for all, with 45% saying coverage should be provided through a single national program.

Among Republicans, a greater share of those younger than 30 (39%) than those 30 and older (28%) say the government is responsible for providing health coverage for all; more young Republicans than older Republicans favor single payer (22% vs. 10%).

The share viewing this as a government responsibility has increased 9 percentage points since 2016, from 51% to 60%.

http://www.pewresearch.org…

***

Comment:

By Don McCanne, M.D.

Cost of health care is the top financial concern of Americans, and that has been increasing, now as high as it was before the Affordable Care Act was enacted. The more reassuring news is that support for a government responsibility to provide health coverage for all remains high, and preference for a single payer approach is increasing.

That increase in single payer support is greater amongst Democrats, especially liberals, and amongst adults under 30. Although the concept of single payer is less popular amongst Republicans, some do favor it.

We should take advantage of being sure that those not yet sold on single payer understand two things; 1) They are correct that the Affordable Care Act is not satisfactory because it falls far short of universality and it fails to prevent financial hardship, and thus it needs to be replaced, and 2) The six years of vacuous proposals of the Republican legislators have obliterated any hope that a solution lies within the fantasies of a free market health care nirvana. The Republican proposals acknowledge that government involvement is essential, but they propose an emasculated role – the worst kind of government, heavy with bureaucracy but placing our tax funds into the hands of entrepreneurial rent seekers.

More people are realizing that the circuitous route taken by our health care dollars wastes tremendous resources while depriving too many individuals of the health care access and financial protection that they need. Conservatives and the business community are beginning to understand this. We have to make sure that we provide the information to them that they need to have a clearer understanding of optimal health care financing policy. Not only is $3.2 trillion at stake, our health is as well.

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

URGENT: Steffie Woolhandler’s message on California

Speaker Anthony Rendon Statement on Health Care

California State Assembly, June 23, 2017

Yesterday, Republicans in the U.S. Senate released a cynical plan to repeal the Affordable Care Act, posing a real and immediate threat to millions of Californians who only have health coverage because of the ACA.

Preparing California to meet this threat must be the top health care priority for the Legislature, Governor Brown, and organizations that advocate for increasing access to health care.

As someone who has long been a supporter of single payer, I am encouraged by the conversation begun by Senate Bill 562.

However, SB 562 was sent to the Assembly woefully incomplete. Even senators who voted for SB 562 noted there are potentially fatal flaws in the bill, including the fact it does not address many serious issues, such as financing, delivery of care, cost controls, or the realities of needed action by the Trump Administration and voters to make SB 562 a genuine piece of legislation.

In light of this, I have decided SB 562 will remain in the Assembly Rules Committee until further notice.

The fight for single payer also is moving forward on other fronts. The head of the Campaign for a Healthy California, an organization created to pass SB 562, has acknowledged their ultimate goal is to get a single payer initiative on the ballot, and there remains ample time for them to pursue that before November 2018.

https://speaker.asmdc.org…

***

Support Grows for Single-Payer Medicare-for-All Plan Instead of Massive Cuts to Healthcare

Democracy Now!, June 23, 2017

Dr. Steffie Woolhandler: We’re seeing a lot of public support for the idea of single payer. We’re seeing a big movement for single payer at the state level in California. Obviously we’re getting a whole lot more discussion of single payer now than we’ve ever had before.

Amy Goodman: In California, it’s passed the state Senate. It’s got to go through the Assembly, and then it has to go to Governor Brown. Do you think that he will sign off on it?

Dr. Steffie Woolhandler: OK, well, we’re only going to get single payer if the populace keeps the pressure on the politicians. It’s not going to happen automatically. It’s not going to happen because Governor Brown has occasionally in the past said he likes single payer. It’s going to happen because we have a movement that’s strong enough to counter the political power of these rich people, who are getting these huge tax cuts; of the insurance industry, who would have no place in an efficiently run single-payer system; of Pharma, who thinks that they’re going to have to accept lower prices under single payer. In fact, they’re right. So that’s a lot of political power. And the only way to push through that is to really build a movement. But, you know, that really seems possible right now, with polls showing that two out of every three Americans who have an opinion on health care think we need some sort of Medicare-for-all program. So, now is really the time to be pushing this—in fact, the only way to really counter the Republican momentum at this point.

https://www.democracynow.org…

***

Comment:

By Don McCanne, M.D.

Holding SB 562, California’s single payer bill, in the Assembly Rules Committee would mean that no further action would take place on it this year. The Republican ACA repeal bill before Congress is no excuse to block California’s progress on single payer, especially since the repeal bill likely will be defeated within a week or so. The fact that SB 562 needs more work is an even greater reason to move forward with it, not to abandon the effort.

Steffie Woolhandler was interviewed on Democracy Now! yesterday just before California Assembly Speaker Anthony Rendon released his statement announcing that he was putting a hold on the single payer bill. Although she was not aware of his decision, her words seem prescient.

Her pronouncement applies not just to California but to the entire nation. We must make every effort, not simply to keep the single payer momentum going, but to escalate it into a movement that would be impossible to repel.

The immediate task for Californians is to demand that Speaker Rendon move the bill out of the Rules Committee and advance it to other committees so that the essential markups that need to be done can be accomplished. Contact him at: 916-319-2063, @Rendon63rd, or assemblymember.rendon@assembly.ca.gov.

And for the rest of the nation? It won’t come from the politicians. It won’t come from the powerful and rich. It won’t come from the medical-industrial complex. As Steffie says, “we’re only going to get single payer if the populace keeps the pressure on the politicians.” We – all of us – have to do it.

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

Trumpcare: the president delivers a poison pill to his electorate

By Andrew Purcell
The (Glasgow, Scotland) Herald, June 24, 2017

WITHIN five days, Trumpcare could well be on the US statute books. It hasn’t taken long to get there. The journey began on May 4, when the Republican caucus in the House of Representatives gathered to vote on the American Health Care Act (AHCA). For seven years, they had promised to repeal Barack Obama’s signature legislative achievement, but now they had control of both houses of Congress and the White House, they couldn’t agree on a replacement. To conservative hardliners, the bill was too timid. Moderates worried that supporting it could cost them their seats.

Whips played Eye Of The Tiger on the stereo to harden their resolve, and projected an image of General George Patton urging them to “accept the challenge so that you can feel the exhilaration of victory.” Later, once the bill had scraped through 217-213, Republican Congresswoman Ann Wagner said: “The line of the day was out of Braveheart: ‘Freedom!’”

In their minds, these privileged few were Rocky entering the ring, William Wallace leading the charge at Stirling Bridge. Republican Congressman Jason Chaffetz rode in on a scooter, fresh from foot surgery covered by his subsidised government health insurance, to vote for a bill that will make the same operation unthinkably expensive for tens of millions of Americans. If it becomes law, thousands more will die each year because they cannot afford to see a doctor.

In the Rose Garden, President Donald Trump touted the AHCA as “a really incredible health care plan” and promised “we’re going to get this finished.” Then, for six weeks, as the media focused on the investigation into Russian interference in the presidential election, a group of thirteen senators met to draft the Senate’s version of the bill in total secrecy. On Thursday, it was released for the briefest possible period of discussion. By this Friday, it could be law.

The renamed Better Care Reconciliation Act (BCRA) will deprive at least twenty million people of health insurance. It drastically cuts Medicaid, which provides low cost health care for those least able to afford it, reduces subsidies to the working poor and lower middle-class, allows insurers to charge old people five times as much as the young, and lets states opt out of a list of ‘essential health benefits’ so insurers can sell policies that don’t cover maternity or outpatient services, mental health treatment or prescription drugs. Premiums and out of pocket expenses will continue to rise, but people making $200,000 a year will get a tax cut.

Obamacare took a year to draft. Democrats tried to work with Republicans on a bi-partisan bill for months, and when that failed, debated the legislation on the Senate floor for five weeks. Then Minority Leader Mitch McConnell complained that they were “ramming through” the law. Now he is doing everything in his power to shield the Republican alternative from scrutiny. The hypocrisy is stunning, the cynicism absolute.

Polls show only 29% of voters have a favourable opinion of the Republican bill, making it even more disliked than the bank bailout of 2008. The American Medical Association, American Nurses Association, American Academy of Family Physicians, American Association of Retired Persons and American Hospital Association have all spoken out against it.

Even insurers are opposed, despite the many sweeteners to the industry it contains, because the cuts to Medicaid, a reliable source of income, are so deep. “To me, this is not a reform,” Michael J. Dowling, the chief executive of Northwell Health, said. “This is just a debacle.”

A survey of 1,100 doctors found that 66% had a “negative impression” of the AHCA. The Sunday Herald interviewed five medical professionals from five states, all registered Republicans. They were unanimously critical of Obamacare, but even more dismayed by its proposed replacement.

“I consider myself a fiscal conservative, and fiscally this is a horrible thing, because it’s going to keep increasing the cost curve. The only thing conservative about it is it will lower the tax rate for those in the top percent,” said Roger LaBonte, president of the West Tennessee chapter of Physicians for a National Health Plan.

“It’s already a disaster for the Republican Party. If they pass something, it’s a total disaster. If they don’t, it makes them look like a bunch of clowns,” said Jack Bernard, former director of health planning for the state of Georgia.

Republicans have been predicting Obamacare’s collapse from the beginning, and since taking power have helped it along the way, introducing instability in the insurance market by threatening to remove federal subsidies. Insurers, citing losses, have been pulling out of the state exchanges. Next year, more than 30,000 people in Missouri and Ohio will qualify for a government subsidy but have nowhere to spend it, as not one company is selling insurance.

In Arizona, Obamacare cut the number of uninsured in half. More than 600,000 benefited from the expansion of Medicaid to cover those earning up to 133% of the federal poverty level – around $32,000 for a family of four. People buying insurance on the state exchange have been less fortunate, as Blue Cross Blue Shield now enjoys an effective monopoly, and can charge what it likes.

Daniel Derksen, Director of the Arizona Centre for Rural Health, said the proposed cuts to Medicaid, more than $800 billion over a decade, would be disastrous for the state. “This goes beyond repealing Obamacare: it’s really dismantling an essential title of the Social Security Act.” Medicaid will be capped, tied to inflation and guaranteed to buy a little less each year, but not until 2021, after the next presidential election, to soften the political blow.

When Derksen was asked why Republicans are so determined to pass such an unpopular bill, knowing it will hit older people in rural areas – Trump voters – particularly hard. “Well, if you’re going to do a ginormous tax cut, you’ve got to do a ‘pay-for,” he said, “and one of the largest federal expenditures is our Medicaid and Medicare programmes.”

This is the key to understanding the bill. By cutting subsidies and Medicaid, it lowers the projected deficit by roughly $1.2 trillion over a decade. This creates space for a permanent ‘revenue-neutral’ tax cut that can be passed in the Senate with a simple majority. The 3.8% tax cut on investment income in the bill, back-dated to the start of this year, is just an appetiser.

From 2010-2016, Obamacare reduced the number of uninsured from 48.6 million to 28.6 million and eliminated many of the insurance industry’s most egregious abuses, but as a market-based solution, devised in a conservative think tank and pioneered by Republican Governor Mitt Romney in Massachusetts, it stopped far short of meaningful reform.

According to the Organisation for Economic Co-operation and Development, the USA spends $9,500 per capita on health care each year, compared with $5,300 in Germany, $4,000 in the UK and $2,500 in Israel, but has the lowest life expectancy and highest infant mortality rate in the developed world. That is a sick and broken system.

“About 48,000 Americans die every year because of lack of health care. The biggest cause of bankruptcy in this country is people who can’t pay their medical bills,” said Rade Pejic, a chest surgeon from New Orleans. He told how the wife of a doctor friend recently had an outpatient hip operation and received a bill for $97,000, and that his cousin’s appendectomy cost $32,000. These are not extreme cases.

The number of people with no health insurance at all – close to fifty million by 2026 if the GOP bill passes – is the tip of the iceberg. Tens of millions more, on all but the most expensive plans, are under-insured, with high deductibles (the first few thousand dollars the policy holder has to pay before the insurance kicks in) and yawning gaps in their coverage.

A Kaiser Family Foundation survey found that one in five people with health insurance received medical bills last year that they struggled to pay. Of these, 63% reported using up most of their savings, 38% said they ran up credit card debt and 37% asked friends for money. Under the GOP plan, the poor, the sick, the elderly – everyone but the richest – will pay more for meaner and less reliable insurance.

“We’re facing higher and higher deductibles, narrowing networks, because the insurance companies run the show. They dictate health care that doctors practice,” said Alan Kenwood, an emergency room doctor at a hospital in Morris County, New Jersey. “There is a fear of standing up for what’s right because of the power of the lobbies, the insurance and pharmaceutical industries, and they have such deep infiltration into both parties.”

Last year, the chief executive of insurer Centene, Michael Neidorff, earned $22 million. Humana’s Bruce Broussard got $19.7 million. Alan Miller, CEO of hospital chain Universal Health Services, received $51.3 million in salary and stock options.

Most of the senators who drafted the BCRA have received substantial campaign contributions from the health care industry. From 2011-2016, Kindred Healthcare gave McConnell $104,650. Sanford Health gave Senator John Thune $40,246. Blue Cross Blue Shield paid Senator Lamar Alexander $36,250. The list goes on.

The question now is whether Republicans can agree on a bill that will pass the Senate, and then the House, with its fanatically tax-averse Freedom Caucus. McConnell can only afford two “no” votes, and at the last count, seven senators were wavering: three because the BCRA is too much like Obamacare and four worried that the Medicaid cuts will harm their constituents and hamper their re-election chances.

Bernard predicted dire political consequences: “I think if the Republican Party is dumb enough to pass this, they will lose the presidency and a whole series of senatorial seats. When people who are working-class start to see their brothers and sisters and children getting booted off health insurance, you’re gonna hear screaming.”

“It’s quite possible that the level of anger is going to be so great that it’s going to push reform and there’s going to be a strong reaction against the Republican party for pushing the legislation,” said Kenwood.

For a taste of irony amid all this, we should maybe hark back to January 2015, five months before Trump announced his presidential campaign, when he told an anecdote on David Letterman’s show about a friend who spent four days in a Scottish hospital: “He was really in trouble, and they released him and he said, ‘Where do I pay?’ And they said, ‘There’s no charge.’ Not only that, he said it was like great doctors, great care.”

For now, though, as congressional Republicans prepare to put a bill on Trump’s desk that will make health care more expensive, more stressful and less secure for the vast majority of Americans, the President’s talk of “insurance for everyone” is just one more empty promise.

http://www.heraldscotland.com…

Why single-payer health insurance means better patient care

By Phil Kadner
Chicago Sun-Times, June 23, 2017

Most doctors believe a single-payer system “would offer the best health care to the greatest number of people,” according to a survey by the Chicago Medical Society.

More than 1,000 doctors from the Cook County region participated in the survey and 77 percent of those responding had an unfavorable view of the American Health Care Act passed by the U.S. House of Representatives as a replacement for Obamacare, also known as the Affordable Care Act.

In addition to supporting single-payer national health care, the doctors also expressed support for the Affordable Care Act, with 62 percent saying they had a “generally favorable” opinion of Obamacare.

Two out of three doctors, 67 percent, said they had a “generally favorable” view of a single-payer financing health care system.

The U.S. Senate version of health care reform had not been unveiled at the time of the survey, but given the response of the doctors, I think it is fair to say that it would not have received significantly greater support than the House version.

Dr. Ted Brown, president of the Chicago Medical Society, emphasized that the survey focused primarily on three options: Obamacare, AHCA — what is being called Trumpcare — and single-payer national health insurance.

I asked Brown why he believes most of the doctors responding to the medical society’s survey chose single-payer health insurance, which is available in the rest of the industrialized world.

His answer is likely to shock those who believe private industry is more efficient than the federal government.

Brown said that trying to comply with the regulations and paperwork required by dozens of private insurance companies offering hundreds of policies, along with Medicaid and Medicare, is burning doctors out and taking time away from patient care.

“As much as anything, it’s an administrative problem,” Brown said. Doctors may be required to take an opioid training course, for example, eight or nine times to satisfy eight or nine different insurance companies.

They would much rather have one administrative mandate handed down from the federal government.

The federal government? Can that be right.

“I don’t think I’ve ever heard a doctor complain about Medicare regulations,” Brown said. “They’re simple. They’re easy to understand. It’s easy to get an answer if you have a question.”

An astonishing 87 percent of the doctors surveyed agreed that in an ideal system basic health care would be available to all individuals as part of the social contract, a right similar to education, or police and fire protection.

I think the majority of people who oppose national health care don’t understand that private health insurance companies now dictate medical practice to doctors and many of their decisions are based on profit motives, having nothing to do with patient care.

And in many cases no one — including your doctor — knows who is actually making the health care decisions at the insurance companies.

Doctors are being forced to join health care groups and close their private practices because they do not have the time or the financial resources to comply with the paperwork demands of the private insurance companies.

And if doctors defend their patients too vigorously and refuse to comply with the demands of the insurance providers, they are cut out of the system.

“The results of the survey are very significant,” said Dr. Claudia Fegan, national coordinator for Physicians for a National Health Care Program, which has led the fight for single-payer universal health care.

“Practicing physicians do not want to see ACA repealed and they believe the best approach is single-payer.”

http://chicago.suntimes.com…

Why single-payer health insurance means better patient care

By Phil Kadner
Chicago Sun-Times, June 23, 2017

Most doctors believe a single-payer system “would offer the best health care to the greatest number of people,” according to a survey by the Chicago Medical Society.

More than 1,000 doctors from the Cook County region participated in the survey and 77 percent of those responding had an unfavorable view of the American Health Care Act passed by the U.S. House of Representatives as a replacement for Obamacare, also known as the Affordable Care Act.

In addition to supporting single-payer national health care, the doctors also expressed support for the Affordable Care Act, with 62 percent saying they had a “generally favorable” opinion of Obamacare.

Two out of three doctors, 67 percent, said they had a “generally favorable” view of a single-payer financing health care system.

The U.S. Senate version of health care reform had not been unveiled at the time of the survey, but given the response of the doctors, I think it is fair to say that it would not have received significantly greater support than the House version.

Dr. Ted Brown, president of the Chicago Medical Society, emphasized that the survey focused primarily on three options: Obamacare, AHCA — what is being called Trumpcare — and single-payer national health insurance.

I asked Brown why he believes most of the doctors responding to the medical society’s survey chose single-payer health insurance, which is available in the rest of the industrialized world.

His answer is likely to shock those who believe private industry is more efficient than the federal government.

Brown said that trying to comply with the regulations and paperwork required by dozens of private insurance companies offering hundreds of policies, along with Medicaid and Medicare, is burning doctors out and taking time away from patient care.

“As much as anything, it’s an administrative problem,” Brown said. Doctors may be required to take an opioid training course, for example, eight or nine times to satisfy eight or nine different insurance companies.

They would much rather have one administrative mandate handed down from the federal government.

The federal government? Can that be right.

“I don’t think I’ve ever heard a doctor complain about Medicare regulations,” Brown said. “They’re simple. They’re easy to understand. It’s easy to get an answer if you have a question.”

An astonishing 87 percent of the doctors surveyed agreed that in an ideal system basic health care would be available to all individuals as part of the social contract, a right similar to education, or police and fire protection.

I think the majority of people who oppose national health care don’t understand that private health insurance companies now dictate medical practice to doctors and many of their decisions are based on profit motives, having nothing to do with patient care.

And in many cases no one — including your doctor — knows who is actually making the health care decisions at the insurance companies.

Doctors are being forced to join health care groups and close their private practices because they do not have the time or the financial resources to comply with the paperwork demands of the private insurance companies.

And if doctors defend their patients too vigorously and refuse to comply with the demands of the insurance providers, they are cut out of the system.

“The results of the survey are very significant,” said Dr. Claudia Fegan, national coordinator for Physicians for a National Health Care Program, which has led the fight for single-payer universal health care.

“Practicing physicians do not want to see ACA repealed and they believe the best approach is single-payer.”

http://chicago.suntimes.com…

Dr. Steffie Woolhandler on ‘Democracy Now!’

PNHP co-founder Dr. Steffie Woolhandler appeared on “Democracy Now!” on June 23, 2017, to discuss the shortcomings of the Affordable Care Act, and of the Republican proposals to “repeal and replace” the law. She also noted that many Americans, including Republicans, are standing up to demand improved Medicare for all.