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By Katie Halper
Paste, April 6, 2017

Debating healthcare policy, along with the medical, ethical, historical, statistical and political elements that go into it, can be daunting, to say the least. But my heart and brain lead me to think that it’s not a good sign that the United States is the only industrialized nation failing to provide universal healthcare as a right. Those other countries are probably onto something.

And so are all the people, organizations, movements, and politicians who are fighting to make single payer a reality.

Before moving on, let’s review what we’re talking about. Single payer, according to Physicians for a National Health Program, “is a system in which a single public or quasi-public agency organizes health care financing.” Under single payer, all residents of the United States would be “covered for all medically necessary services, including doctor, hospital, preventive, long-term care, mental health, reproductive health care, dental, vision, prescription drug and medical supply costs.” The program would be funded by savings derived by “replacing today’s inefficient, profit-oriented” insurance system, with “a single streamlined, nonprofit, public payer.” There would be no premiums, co-pays or deductibles and “95 percent of all households would save money.”

The recent implosion of Trumpcare has only emboldened the single payer movement, which is looking more and more like the only viable alternative to the status quo, or worse. A National Day of Action for Improved Medicare for All has been called for Saturday, April 8th. Congressman John Conyers [MI-D], has picked up so many co-sponsors for his single payer bill, which he re-introduced in January, that he tweeted out, “As I work to convince my fellow Dems to support #MedicareForAll, I thank the GOP for (unwittingly) helping out!” And Senator Bernie Sanders will be reintroducing his Medicare for all bill too. Support for single payer is at an unprecedented level.

But not everyone is so enthusiastic, of course. And the opponents of single payer include insurance companies, lobbies, Republicans and a certain subgenre of Democratic hacks who either genuinely reject universal healthcare programs or who harbor a hatred of Sanders that eclipses their empathy for people whose health and lives are threatened by having inadequate health insurance or no health insurance at all. Their aversion to a single payer plan, they would like us to believe, is based on pragmatism and common sense. (See, for example, this Eric Boehlert tweet, as well as all the people who hearted it, retweeted it or otherwise cosigned it.) Those of us who support single payer, they claim, are naive, radical purists obsessed with a program that will never work in these United States! We just don’t know what we’re talking about.

But Dr. Adam Gaffney definitely knows what he’s talking about. Gaffney is a pulmonary and critical care physician, instructor at Harvard medical school, a board member and secretary of Physicians for a National Health Program and an advocate for a universal single-payer health care system. Gaffney’s writing focusing on policy, politics, and health care history has appeared in The Guardian, The New Republic, The Los Angeles Review of Books, USA Today, Salon, CNN.com, Dissent, US News & World Report, Jacobin, and In These Times. And he is working on a book that explores healthcare as a human right.

Somehow he managed to squeeze in an appearance on the Katie Halper Show, where he debunked common single-payer-phobic myths for me and my co-host, Gabe Pacheco. Below are among the most pervasive—and annoying—myths followed by Dr. Adam Gaffney’s insights.

The interview has been edited for clarity and length and includes follow up questions.

Myth #1: Single payer is not feasible

Reality: Single payer is feasible and popular

It’s not going to be easy, but there’s no question that it can be done. There has been a growing wave of support and a growing movement that has come a long way. Even after Trumpcare imploded and went up in flames, the immediate reaction you heard from voices across the political spectrum was this is going to open the door to single payer. I’m usually the one always making that argument. I didn’t even need to make it this time because everybody else was saying the same thing.

Obviously, the health insurance industry is not really going to go along with this. In fact, they are going to fight it to the death because this would really decimate the private health insurance industry. We should just be honest about that. I don’t think that’s an insurmountable obstacle, but they are a force to be reckoned with . . . The pharmaceutical industry is going to be opposed as well. Not to the same degree as the insurance industry but one thing that is good about a single-payer system is that you can negotiate down drug prices on a national level, which already happens in other countries. You could probably bring brand-name drug prices down by about 50% that way.

We’re already seeing movements coalescing behind the idea that single payer is in fact the last man standing, the only option left.

There’s such a massive disassociation between the right-wing healthcare ethos and what people actually think, even Republicans. I think healthcare, along with certain other social goods, we conceive of them in a different way. Healthcare, education, a number of other things are not simply commodity goods. You can make them into just one more commodity, but it’s a hellish result that you get from it. If you really made healthcare into the equivalent of a car, then that would mean that everybody who doesn’t have a car today would be dying because they wouldn’t be able to go to the doctor. People would be dying in the street; you could turn people away from hospitals; you could turn people away from emergency rooms. There’s just a general philosophical sentiment against that.

No one wants to think that the reason they’re being treated or not treated a certain way is for some corporation’s bottom line. To misquote John Lennon, we can imagine a world without health insurance companies. It’s not hard to do. And once we accept that logic, the feasibility becomes clearer.

Myth #2: Single payer is unaffordable

Reality: It will actually save money

What we’re proposing is an ambitious, grand and egalitarian new system. It’s gonna cost money, but we have savings on the flip side. I’m not worried about losing the battle over finances.

[The case for single payer] took a hit during the primary campaign. Bernie Sanders came out with a sort of single payer proposal and there were these estimates put out by an economist and everybody jumped on the bandwagon, like Paul Krugman, and Ezra Kein, who called it a “puppies and rainbows” plan. Powerful pundits, for better or for worse, have an influence on policy and on Washington. They are actors in this game. It’s enraging. When they say: “Oh, single-payer is great but it’s not doable,” they are contributing to its lack of doability because people respect their columns. I don’t want to overstate their importance in terms of Washington, but to whatever extent they matter, they are contributing to the infeasibility that they say is inevitable.

But we have the numbers and they’re on our side. The administrative savings alone are estimated to be about $500 billion [$503.6 billion] per year because if you go to single-payer systems like Medicare, you can basically cut out a ton of wasteful spending on billing insurance overhead, profits, all of this nonsense.

Then you toss in another $100 billion [$113.2 billion] in pharmaceutical savings. And then you’re talking about real money at that point. You can use that money to cover the cost of insuring everybody and of getting rid of copayments and deductibles, and expanding coverage in new ways like dental care and long-term care, things insurance often already doesn’t cover.

Myth #3: It’s too late for single payer

Reality: It may have been easier earlier on, but it’s not too late

The argument that it would’ve been easier to do earlier is that you wouldn’t have this whole apparatus that you need to deal with. When the U.K created their National Health Service in 1946, there wasn’t this massive, powerful insurance industry; there wasn’t as massive of a powerful pharmaceutical industry. It would’ve been easier in some respects.

That being said, Truman did have a bill for a sort of single-payer-like, national health care system. And that was actually defeated by doctors. The American Medical Association went McCarthyite-crazy on it and sunk it, called it Leninist.

We can send people to the moon, we can create Medicare for All. It’s really not that complicated.

Myth #4: Single payer is such a bad system that Canadians come to America to seek out superior treatment!

Reality: Canadians don’t do that and treatment in Canada is cheaper, more equitable and has better outcomes

The “Canadians coming to the U.S. because they can’t get healthcare in Canada” thing comes up a lot. And there’s actually really no evidence to that at all. It’s a myth. First of all, they couldn’t afford it. If you wanted to come to the United States and get a heart transplant it would cost you millions of dollars. So I don’t know who these Canadians are who have all this money that they would come to the U.S. for something they can get for free in Canada.

A study came out a week or two ago on Cystic Fibrosis, which is a debilitating, genetic lung disease that is often or mostly fatal. It found that people with CF live ten years longer in Canada than they do in the United States. Not only that, they got more lung transplants in Canada than they got in the United States. We’re supposed to be the reigning gods of high-tech care. That’s supposed to be our speciality.

There are always anecdotes about people who are unhappy in other countries. I don’t deny that people have had bad experiences with other systems; you’re dealing with human beings and you’re dealing with different on-the-ground experiences. My answer is as follows: you can take what’s best about American health care now, there are great things about it, and combine that with the best ideas that come from international examples. Between the two of those, we can actually have a really superior healthcare system.

Myth #5: Not having healthcare coverage doesn’t necessarily kill people

Reality: Healthcare coverage saves lives and a lack of coverage kills people

Ross Douthat had a recent column claiming that insurance coverage doesn’t actually save lives. What he says is nonsense. He only cited two studies. One showed lives were saved. The other did not show a statistically significant benefit but it was way too small to actually do so. He didn’t cite the full expanse of the literature.

There’s a lot of studies that have looked at the association of being uninsured, and of dying prematurely. There’s a body of literature supporting the notion that people who aren’t insured wind up dying at higher rates and if you cover more people you actually save lives. Each study shows different numbers but for somewhere between every 300 and 1,000 person you insure, you save one life per year. So if you have 28 million uninsured people, which is what the case is now, even with the Affordable Care Act, there are probably tens of thousands of people dying a year whose lives could be saved if we moved to single-payer. That’s a sobering thought. And it also brings home the idea that American healthcare is not already great, and why the ‘America is already great’ line didn’t really work well for some people.

Another issue is drugs: there’s been a big rise in drug prices, there’s been a proliferation of extraordinarily expensive drugs costing hundresds of thousands of dollars a year. There has been a rise in deductibles, in co-payments. And, as a result, people skip their medications, or they take twice a day medication once a day. Or they don’t even fill the prescription to begin with. There was a heartbreaking story on NPR about people with cancer skipping therapies because they couldn’t afford it. It’s terrible. And we don’t need it. In the UK, in Wales, Scotland, Northern Ireland, except for in a small minority of cases in England, they don’t have any co-payments for drugs. So any drug you’re prescribed by your doctor can be filled for free. And we can do the same thing here.

Myth #6: Experts agree that single payer is a pipe dream

Reality: People who say single payer can’t happen often don’t want it to happen

People who say single payer can’t happen are the people who don’t want it to happen. We all do that. We claim something is impossible if we don’t want to get around to actually doing it. I often feel like it’s impossible for me to do my dishes. I say it’s not feasible. (Then there are people who just accept the conventional wisdom that it can’t be done. And we need to bring those people in and persuade them.)

But first of all, something is going to be impossible if you believe it to be so. It’s a self-fulfilling prophecy. Second of all, it’s not impossible. A Gallup poll of last year found that 58% of the country supports single-payer. It takes a little bit of gumption to claim that something that the majority of the country wants isn’t feasible. That says something sad about the way democracy works.

Myth 7: You can’t fight for single payer while Donald Trump is president and Republicans control congress

Reality: The time is now

Someone could make the critique, “Why are we possibly talking about single payer right now? Trump is in office, Republicans control congress. What chance in hell do we have now?” My response to that would be that now is the time when we coalesce around policy, make the Democratic Party take on that policy and be ready so that when there is a turn in power, when there is a change in government, we can actually make it happen.

Single payer really has the potential to be a unifying issue. People want more health care, not less. They want their parents and their children and themselves to be taken care of. People’s lives are on the line. And it’s a way to move against a lot of other forms of oppression in society including racism. Having a single tier won’t solve racism but it’s a step in the right direction against racial injustice.

Sanders is obviously a long-time single payer supporter. Sanders introduced single payer bills in the past. The healthcare issue was a big part of the primary between him and Clinton. And that helped contribute to the overall dialog that’s been brewing where single payer is increasingly being pointed to as the next step that the Democrats should take on. In response to the Trumpcare fiasco, Sanders is going to introduce a new single payer bill. And it actually opens up a big area for activists because now we have all the Democratic senators or Republican senators that we can pressure: “Sign on to Bernie’s bill. Why aren’t you signing on to Bernie’s bill? What is your reason for not doing that?” And Rep. Conyers has had a single payer bill which he reintroduced in January. So we have a bill in the House currently. And Bernie is going to re-introduce a bill in the Senate. Having those bills out there, even if they lack enough sponsors provides an important organizing focus and will help lead us into the realm of actual policy once we change the people who are in charge of the country. And the grassroots movement is playing a critical role.

I think all these elements are going to come together and bring victory.

Born, raised, and still living in NYC, Katie Halper is a writer, radio show host, filmmaker, comedian, and former history teacher who identifies as a feminist Bernie Bro.

https://www.pastemagazine.com…

By John Conyers Jr.
Detroit Free Press, April 3, 2017

I’m as happy as anyone with the way the Republicans’ plan to wreck our healthcare system crashed and burned last week. And President Donald Trump is right: Republicans lost because Democrats beat them. We beat them because we were organized, we were unified and we were backed by unprecedented grassroots energy. Members of the U.S. Congress hosted dozens of rallies, advocacy organizations hosted hundreds more and constituents showed up in overwhelming numbers at town halls across this country to make their voices heard.

And what exactly was their message? One of the most poignant moments came at a town hall hosted by U.S. Rep. Diane Black, Republican of Tennessee, where a constituent explained her opposition to the GOP bill using faith. As a Christian, she said, her faith was rooted in helping the unfortunate, not cutting taxes on the rich, so why not expand Medicaid and allow everyone to have insurance? And she’s not alone. Last week, a Quinnipiac survey found that voters overwhelmingly oppose cuts to Medicaid — 74% of them — including 54% among Republicans.

Given the record high support for publicly funded healthcare, economists, policy experts and commentators everywhere have called on the Democratic party to build on our momentum by supporting a single payer system. But perhaps the most convincing case I heard came from Jessi Bohan, the teacher from Cookeville, Tennessee who spoke at Rep. Black’s town hall.

The week after her question went viral she wrote to the Washington Post that she was troubled to see her comments used as a “defense of Obamacare” instead of what they were: an indictment of any healthcare policy that leaves anyone out. As Bohan so eloquently put it, “it is immoral for health care to be a for-profit enterprise” that allows insurance companies to make “enormous sums of money off the sick while people are struggling to pay their medical bills.” If she had it to do over again, she wrote, she would have explained to Black “the Christian case for universal, single-payer health insurance, which would protect all Americans.”

While her message was targeted at Republicans, it is one that many of my colleagues in the Democratic Party need to hear as well. For two weeks, I’ve watched Democrats point to the Congressional Budget Office’s analysis of the Paul Ryan bill and express righteous outrage that it would lead to 24 million Americans losing their insurance. But that same CBO score says that 28 million Americans will still be without insurance even under the Affordable Care Act. I’m impressed that the ACA has expanded Medicaid eligibility in states that have adopted it and more than 20 million previously uninsured now have insurance, but universal healthcare it is not.

Time and time again I’ve heard Democrats dodge questions about their support for universal healthcare by saying they’re focused right now on defending the ACA. Now that we have repelled Paul Ryan’s attack and Donald Trump has signaled that Republicans will move on, the time for those excuses has passed.

For years, I’ve also watched as Democrats, including our presidential nominee last year, have avoided putting their name behind single payer by saying they’re focused on politically achievable short-term goals.

Single payer is politically achievable.

Gallup, the Kaiser Family Foundation, and other polling organizations have found that there is majority support for Medicare for All in America today. But more important, elected officials are not supposed to move to the political center, we are supposed to stake out the moral center and convince others to join us there.

November’s election results showed that we can’t just say “the other side is awful,” however true that may be, and expect Americans to flock to us. To win again, we must be a party of principles and present bold ideas and a vision for the future.

It is true that single-payer healthcare has been implemented in virtually every other advanced democracy on Earth. It is also true that in those countries, people live longer and healthcare is dramatically less expensive than it is here. And finally, it is true that Medicare for All is the direction Americans overwhelmingly want us to go. Nevertheless, I want my colleagues to join me in supporting single-payer not to save money or to win elections, but because it is the moral and just thing to do. If, like me, you believe healthcare is a right to everyone and not a privilege to those who can afford it, let’s be organized and let’s be unified in our support for Medicare for All.

John Conyers represents Michigan’s 13th District in the U.S. Congress. He has introduced H.R. 676 Medicare for All bill in every Congress since 2003.

http://www.freep.com…

By Ed Weisbart, M.D., CPE, FAAFP
Accountable Care News, April 2017

President Donald Trump has declared that the Affordable Care Act (ACA) needs to be replaced with “reforms that expand choice, increase access and lower costs, while providing better healthcare.”¹ I agree with those goals and believe they can be accomplished without compromising the advances brought by the ACA—20 million fewer uninsured Americans, increased support for lower-income Americans and a host of reforms of insurance practices, such as guaranteed issue and prohibition against rescission and against annual or lifetime caps.

Despite these advances, many problems remain. Tens of millions of Americans remain uninsured. Many more are underinsured, finding the cost of care increasingly prohibitive and their choices of physicians and hospitals increasingly constrained by their insurance network administrators. Compared to other modern nations, our per capita healthcare costs remain outlandishly high and our life expectancy tragically short.

Only 72.7% of our healthcare dollar is spent on actual clinical care; 18% is spent on billing and insurance-related administration, including 7.5% by private insurers, 1.3% by public insurers, 2.7% by physicians, 2.8% by hospitals and 3.6% by other services. (An additional 9.4% of our total expense is on administration unrelated to billing and insurance.) If our billing and insurance-related administrative expenses were reduced to levels seen in most other modern nations, we would reap $375 billion in annual savings.²

Unable to address these wasteful inefficiencies, insurers have turned to financial barriers (copayments, coinsurance and deductibles) to reduce utilization and increasingly restrictive networks that inevitably conflict with patient choice. Our system is the most complex, redundant and least aligned with the interests of public health.

Public health campaigns do not align well with today’s business imperatives and simply cannot be given adequate support by the private insurance industry. Churning demands its own long-term strategies. There is no business case for public health.

I have spent many years in executive roles within the health insurance industry and been frequently stymied by the industry’s fiduciary pressures against long-term, public health initiatives. Even when insurers want to pursue such initiatives, their 20% to 25% annual turnover in membership demands that such clinical initiatives quickly produce favorable financial results. For many insurers, roughly half of their membership today will have migrated to a competing plan within three years and been replaced by members from those same plans. Those who ignore this pressure find themselves improving the health of their competitors’ membership.

The ‘Replace’ Portion of ‘Repeal and Replace’

U.S. Representative John Conyers (D-MI), along with 59 cosponsors, recently introduced the most prudent solution to each of these problems, “Expanded and Improved Medicare For All,” as HR676.³ Politics aside, HR676 should be the “replace” portion of the demand to “repeal and replace” ACA. It alone meets each of the stated goals of our new president.

HR676 would address these and other concerns. It is a short bill, just 30 pages, and a relatively easy read.

At a high level, the bill says two things: Fix the problems with Medicare and expand it to all Americans. The bill calls for public funding of healthcare while preserving and enhancing support for private delivery. This is essentially the model used in Canada today.

Medicare would be improved by removing financial barriers and plugging gaps in coverage, providing a single comprehensive benefit design of all medically necessary services as articulated within the bill. It would be expanded to cover virtually all U.S. residents, with specific eligibility criteria established by the program’s director.

According to a recent article in Annals of Internal Medicine,⁴ the cost of these changes would be offset by a 68% reduction in insurance overhead and administration of public programs (saving $220 billion); a 52.6% reduction in billing and administration for hospitals (saving $149.3 billion); a 40.1% reduction in billing and administration for physicians (saving $75.3 billion); and an additional $59 billion in administrative savings for nursing homes, home care agencies, non-physician practitioners and employers.

The authors also project a 31.2% reduction in the cost of outpatient prescription drugs, representing $113.2 billion, bringing the total savings from these components to $616.8 billion. Of note, there are at least 25 other studies⁵ on both a state and federal level that consistently show these savings would fully pay for expansion and improvements.

HR676 calls for financing the program through the establishment of a new Medicare for All Trust Fund built from existing funding sources, including public programs and public employee benefits. In addition, it calls for increasing personal income tax on the top 5% of income earners, and modest and progressive taxes on payroll, self- employment income, unearned income and stock and bond transactions.

The overall program budget would be set through negotiations by providers, state directors and regional directors but ultimately approved and divided regionally by the program director. This budget would contain three discrete, non-fungible sections: operations, capital and education. Health professionals would either be reimbursed through a negotiated, fee-for-service schedule or a salary through a globally budgeted institution, group practice or non-profit, HMO. Balance billing of patients is expressly prohibited.

The bill establishes a diversely representative, 15-member National Board of Universal Quality and Access, with a director of quality of control appointed by the president with the advice and consent of the Senate.

Obviously, HR676 would transform the health insurance landscape, virtually eliminating the market for employer-based and individual private insurance, Medicaid, Medicare supplements, wraps and Parts C and D programs. Most of the employees displaced from their positions within the insurance industry would have a two-year, transition benefit up to $100,000 per year, plus first priority at retraining and job placement within the new system.

Perhaps most importantly, HR676 would establish the foundations of a business case for long-term improvements in public health—something nearly unobtainable in an insurance industry adapted to high levels of membership turnover.

In some ways, Medicare already accomplishes this for our seniors. The Institute of Medicine found that once Americans reach the age of eligibility for Medicare, our life expectancy as compared to that in 17 other modern nations begins to improve. Until age 65, we rank at or near the worst among our peers. Once we reach Medicare eligibility, our ranking by age improves until age 85, when our life expectancy has risen to among the best three nations.⁶

U.S. vs. Canadian Healthcare

We can also project the value of HR676 by comparing the results of our healthcare system with Canada’s. In 1971, President Richard Nixon signed into law the HMO Act, creating the managed care experiment. The same year, Canadian Medicare was fully implemented in all provinces. Until that point, our two nations were nearly identical in overall healthcare costs as a percentage of GDP, and our life expectancies were within one year of each other.

Since that milestone, our overall cost trends have remained unchanged whereas the trend in Canada nearly flattened out.⁷ Simultaneously, their life expectancy rate improved more rapidly than ours so that Canadians now enjoy a 2.5-year advantage.⁸ We were the same; now we spend much more, and they live longer.

Canadians have virtually no risk of bankruptcy from the costs of medical care—even when unable to continue working.

Like all others, the Canadian healthcare system is imperfect. Six percent of Canadians report having unmet health needs due to waiting lists or frankly unavailable services, compared to 1% of Americans reporting this. However, only 1% of Canadians report unmet health needs due to the cost of care, compared to 8% of Americans.⁹ We can do better than Canada, but their results today trump ours in many meaningful ways.

Among many similar studies, a recent Gallup poll found that 58% of Americans, including 73% of Democrats and 41% of Republicans, “support a federally funded, healthcare program for all Americans.”¹⁰

Fifty-nine percent of physicians want national health insurance.¹¹ More than 2,500 prominent physicians have publicly endorsed the June 2016 proposal by the Working Group on Single-Payer Program Design.¹²

President Trump has called for a healthcare strategy that expands choice, increases access, lowers costs and provides better healthcare. An obvious solution is already in Congress—HR676.

Ed Weisbart M.D., CPE, FAAFP, chairs the Missouri chapter of Physicians for a National Health Program, a 30-year-old, non-profit research and education organization. He may be reached at pnhpMO@gmail.com. Visit pnhp.org/hr676 for more information on HR676.

Notes

1. Remarks by President Trump in Joint Address to Congress. Feb. 28, 2017.

2. Jiwani A, Himmelstein D, Woolhandler S, et al. “Billing and Insurance-Related Administrative Costs in United States’ Health Care: Synthesis of Micro-Costing Evidence.” BMC Health Services Research. Nov. 13, 2014.

3. “H.R.676—Expanded and Improved Medicare for All Act.” Congress.gov. Accessed March 10, 2017.

4. Woolhandler S, Himmelstein D. “Single-Payer Reform: The Only Way to Fulfill the President’s Pledge of More Coverage, Better Benefits, and Lower Costs.” Annals of Internal Medicine. Feb. 21, 2017.

5. “How Much Would Single Payer Cost?” Physicians for a National Health Program. Accessed March 10, 2017

6. “Shorter Lives, Poorer Health.” Institute of Medicine. Jan. 9, 2013.

7. “Canada’s Slow Health Spending Growth Continues.” Canadian Institute for Health Information. Oct. 29, 2015.

8. “Comparing the U.S. and Canadian Health Care Systems.” The National Bureau of Economic Research. Accessed March 10, 2017.

9. Ibid.

10. Newport F. “Majority in U.S. Support Idea of Fed-Funded Healthcare System.” Gallup. May 16, 2016.

11. Carroll, A, Ackerman R. “Support for National Health Insurance Among U.S. Physicians: 5 Years Later.” Annals of Internal Medicine. April 2008; 148 (7): 567.

12. “Beyond the Affordable Care Act: A Physician’s Proposal for Single-Payer Health Care Reform.” The Working Group on Single‐ Payer Program Design. Accessed March 10, 2017.

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