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After Republican Infighting Dooms GOP Healthcare Plan, Trump Vows to Let Obamacare “Explode”

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After Republican Infighting Dooms GOP Healthcare Plan, Trump Vows to Let Obamacare “Explode”

Interview With Dr. Steffie Woolhandler (Part 1)

By Amy Goodman
Democracy Now!, March 27, 2017

PNHP Note: To view video of this interview (parts 1 & 2), click here. To read a transcript of part 2, click here.

Under President Obama, House Republicans voted more than 50 times to repeal or rewrite the Affordable Care Act. But on Friday, the House couldn’t muster the votes needed to pass its own healthcare law, which some call Trumpcare. Just minutes before the vote was scheduled, President Trump pushed House Speaker Paul Ryan to pull the legislation. The bill was opposed by every Democrat, as well as many members of the ultraconservative House Freedom Caucus and some moderate Republicans. For more. we speak with Dr. Steffie Woolhandler, co-founder of Physicians for a National Health Program. She is a professor at CUNY-Hunter College and a primary care physician. She is also a lecturer at Harvard Medical School.

TRANSCRIPT
This is a rush transcript. Copy may not be in its final form.

JUAN GONZÁLEZ: We turn now to healthcare. Under President Obama, House Republicans voted more than 50 times to repeal or rewrite the Affordable Care Act. But on Friday, the House couldn’t muster the votes needed to pass its own healthcare law, what some call Trumpcare. Just minutes before the vote was scheduled, President Trump pushed House Speaker Paul Ryan to pull the legislation. The bill was opposed by every Democrat, as well as many members of the ultraconservative House Freedom Caucus and some moderate Republicans. The House Freedom Caucus wanted more drastic cuts to Obamacare, while the moderate Republicans were concerned about the potential fallout from the bill, which would have left 24 million more people uninsured while giving a major tax break to the rich.

AMY GOODMAN: President Trump and Vice President Mike Pence had heavily lobbied Republican lawmakers ahead of the vote, but the push from the White House didn’t work, leading to Trump’s first major legislative failure. House Speaker Paul Ryan spoke to reporters shortly after pulling the bill.

SPEAKER PAUL RYAN: I don’t know what else to say, other than Obamacare is the law of the land. It’s going to remain the law of the land, until it’s replaced. We did not have quite the votes to replace this law. And so, yeah, we’re going to be living with Obamacare for the foreseeable future. I don’t know how long it’s going to take us to replace this law.

AMY GOODMAN: At the White House, President Trump warned he is now just going to let Obamacare explode.

PRESIDENT DONALD TRUMP: Thank you very much. We were very close. It was a very, very tight margin. We had no Democrat support. We had no votes from the Democrats. They weren’t going to give us a single vote, so it’s a very difficult thing to do. I’ve been saying for the last year and a half that the best thing we can do, politically speaking, is let Obamacare explode. It is exploding right now. It’s—many states have big problems. Almost all states have big problems.

JUAN GONZÁLEZ: While Trump initially blamed Democrats for the legislative failure, he switched his focus to fellow Republicans over the weekend. On Sunday morning, he tweeted, quote, “Democrats are smiling in D.C. that the Freedom Caucus, with the help of Club For Growth and Heritage, have saved Planned Parenthood & Ocare!” Trump tweeted Sunday morning. A day earlier, he urged, on Twitter, his Twitter followers to watch Judge Jeanine on Fox News on Saturday night. Viewers who tuned in would have heard this:

JUDGE JEANINE PIRRO: My opening statement: Paul Ryan needs to step down as speaker of the House. The reason? He failed to deliver the votes on his healthcare bill, the one trumpeted to repeal and replace Obamacare, the one that he had seven years to work on, the one he hid under lock and key in the basement of Congress, the one that had to be pulled to prevent the embarrassment of not having enough votes to pass. But this bill didn’t just fail. It failed when Republicans had the House, the Senate, the White House.

AMY GOODMAN: That’s Judge Jeanine Pirro on Fox News on Saturday. While House Speaker Paul Ryan remains in that position, many observers say he has been politically damaged. Politico is reporting the push to pass the legislation was harmed in part because Trump didn’t appear to know that much—or care that much—about the details of healthcare policy, unlike many congressmembers, who came to him with questions. The Wall Street Journal reports the Trump administration is now ramping up its efforts to weaken the Affordable Care Act by pushing through rule changes and issuing new waivers.

Meanwhile, Senator Bernie Sanders has announced he’ll soon introduce a bill to create single-payer healthcare. Several progressive groups are backing a single-payer system, including the Working Families Party, the Progressive Campaign Change Committee, CREDO, Social Security Works and National Nurses United.

We’re joined now by Dr. Steffie Woolhandler, co-founder of Physicians for a National Health Program, professor at CUNY-Hunter College, primary care physician, lecturer at Harvard Medical School.

You never supported Obamacare, but you were very critical of what was happening in Congress, Steffie. Can you talk about what did take place, and then what is being talked about now, not in the corporate media—almost no mention of single-payer this weekend—but among progressive politicians and activists?

DR. STEFFIE WOOLHANDLER: Well, our group, Physicians for a National Health Program, thinks we need to be moving forward from the Affordable Care Act to single payer, and not backward through repeal like the Republicans wanted. You know, we thought it was a very big victory this weekend to block the Republican plan. We think it’s from people showing up at those town hall meetings, pushing senators and congressmen in purple states, and making it impossible for the Republicans to do a straight repeal, which is what the Freedom party wanted and which they’d been talking about for the last, you know, seven or eight years.

So this was a victory, but there’s still a lot more—a lot more fighting to go. We’re very heartened to see Senator Sanders and other politicians endorsing the idea of single payer. Certainly within the medical community, there’s a tremendous amount of discussion and media coverage of the single-payer idea. And we think it’s a great time to be putting that idea forward and moving to a Medicare-for-all program.

JUAN GONZÁLEZ: But when you say it was a victory, as Trump has said, he’s vowing to—he said he would let the Obamacare both implode and explode at the same time. But he is basically—what could he do now in—from an executive position, to be able to further damage the ability of people to access healthcare?

DR. STEFFIE WOOLHANDLER: Well, unfortunately, there’s a lot he can do through the regulatory process. You have to have regulatory underpinnings of a health law. And his secretary, Tom Price, secretary of health and human services, is a staunch opponent of the ACA who’s been trying to destroy the Affordable Care Act for years. So, the—

AMY GOODMAN: In fact, when Trump had his press conference, if you can call it that, on Friday, his press moment, standing on one side of him was Vice President Pence. On the other side was Price.

DR. STEFFIE WOOLHANDLER: Right. So I think we’re going to see the Affordable Care Act have death by a thousand cuts. They’re going to do everything they can, from a regulatory standpoint, from a funding standpoint, to undermine Obamacare, weaken it, you know, bleed it to death, if you will. But—

AMY GOODMAN: Talk about how they can do that, because they’re really set on that. They’re saying—they’re saying, actually, that President Obama set 2017 as the year for it to implode. But they say that they’re just going to let it die. What does that mean? And how would they accelerate this? And how could they stop that?

DR. STEFFIE WOOLHANDLER: Well, there’s lots of regulatory decisions you make about what you’re going to insist insurers, insurance companies, do. That’s all in Tom Price’s bailiwick right now. So-called Medicaid waivers, where you’d say to the states, “Hey, we’ll give you the money and let you do pretty much what you want.” Of course, Tom Price is going to be doing that with a lot of these conservative state governments that have no interest in the Medicaid program or in helping poor people. There’s been a lot of lawsuits—

JUAN GONZÁLEZ: So, just to be clear—

DR. STEFFIE WOOLHANDLER: Yeah.

JUAN GONZÁLEZ: On the waiver issue, that would, in essence, let them do what they were wanting to do in the current bill, which was create sort of a block grant situation for states on Medicaid?

DR. STEFFIE WOOLHANDLER: Well, it’s not quite the same as what they were going to do in the bill, but it does allow them to do things like charge Medicaid enrollees premiums. I have to remind you, these people are really, really poor, and if you require them to pay premiums, some months they’re just not going to be able to pay, and they’re going to lose their healthcare.

The other thing I want to remind you of is, there’s been tons of lawsuits against Obamacare, which, under the Obama administration, the Justice Department defended and fought against. But the Trump Justice Department doesn’t have to defend against those lawsuits. So these lawsuits to cut funding and to restrict access to care, that have failed to date, will—you know, much more likely to succeed if the Justice Department is not fighting them.

So, Trump is going to own the healthcare system. I know he and Bannon want to blame the Democrats for the mess that the healthcare system is going to be, but they own it. You know, there’s a whole lot of problems with Obamacare, like the 26 million people who remain uninsured despite Obamacare. Trump is not going to fix that. He’s going to probably make it worse. The high copayments and deductibles—

AMY GOODMAN: Just to be clear on that—

DR. STEFFIE WOOLHANDLER: Yeah.

AMY GOODMAN: Already, over the next 10 years, 24 million people were going to lose their healthcare under the Republican plan. But you’re talking about 26, 24 million people—

DR. STEFFIE WOOLHANDLER: Yeah.

AMY GOODMAN: —beyond what Obama had insured, the—

DR. STEFFIE WOOLHANDLER: I’m talking about right now, while Obamacare is fully in place, or, you know, January 1, Obamacare fully in place, there are 26 million uninsured Americans. That’s not universal healthcare. You know, that’s almost 10 percent of the population with no healthcare. And that’s why our physicians’ organization is saying we need to move forward to single payer. We need to insure those people.

AMY GOODMAN: Now, it’s interesting that one of their big problems was the 55-to-65-year-old lot, that were their—under the Republican plan, their prices—the cost of their insurance was going to escalate. Wouldn’t it have been interesting if they had just said, “OK, we’ll lower Medicare to 55”? And that would have taken care of all that. So, I want to turn to Congressmember Peter Welch, the Democrat from Vermont, his remarks earlier this month during the Energy and Commerce Committee’s markup of the American Health Care Act, the Republican plan.

REP. PETER WELCH: You know, there’s been a lot of discussion about the fact that this bill has just appeared yesterday and that it was being hidden. Was it really being hidden from Democrats in America, or was it being hidden from your Freedom Caucus? They say that this bill is a phony repeal of Obamacare. And you want to know something? They’re right, because there is a lot of plagiarism in this bill. The insurance reforms that all of you voted against, you’re now bragging you’re keeping. The subsidies that you say are horrible, you have changed from a direct subsidy, that actually provided meaningful access to healthcare, to on-the-cheap tax credits that don’t do the job. But that’s an entitlement that you say you’re against. The mandate, you’ve decried the mandate. But what you’ve done is imposed a 30 percent penalty, and the revenues don’t go to the healthcare program. The revenues go to the insurance companies. What is going on here?

AMY GOODMAN: So, that is Vermont Congressmember Peter Welch, who, together with Senator Bernie Sanders of Vermont, says they will both introduce legislation for single payer. So if you could respond to what he said and then talk about what their plan is and your thoughts on it.

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Krugman needs to study up on…Krugman and single payer

How to Build on Obamacare

By Paul Krugman
The New York Times, March 27, 2017

“Nobody knew that health care could be so complicated.” So declared Donald Trump three weeks before wimping out on his promise to repeal Obamacare.

But put politics aside for a minute, and ask, what could be done to make health care work better going forward?

One important answer would be to spend a bit more money. A report from the nonpartisan Urban Institute argues that the A.C.A. is “essentially underfunded,” and would work much better — in particular, it could offer policies with much lower deductibles — if it provided somewhat more generous subsidies.

What about the problem of inadequate insurance industry competition? Better subsidies would help enrollments, which in turn would probably bring in more insurers. But just in case, why not revive the idea of a public option — insurance sold directly by the government, for those who choose it?

There are other more technical things we should do too, like extending reinsurance: compensation for insurers whose risk pool turned out worse than expected. Some analysts also argue that there would be big gains from moving “off-exchange” plans onto the government-administered marketplaces.

https://www.nytimes.com…

***

NYT Reader Comment:

By Don McCanne, M.D.
San Juan Capistrano, CA

Paul Krugman had it right: “I would argue that good economics is also good politics: reformers will do best with a straightforward single-payer plan, which offers maximum savings and, unlike the Clinton plan, can easily be explained” (NYT, 6/13/05).

Studies have shown that the most expensive model of health care financing is a fragmented, multi-payer, public and private system such as we have in the United States. Incremental patches increase costs even more and always fall short on universality, equity, and access while increasing the profound waste of administrative inefficiency (currently over $500 billion per year in recoverable waste – Annals of Internal Medicine, 2/21/17).

We should not accept bad policy because the politics of change is hard. We should support good policy and change the politics. That is happening. There is a surge of support for a single payer improved Medicare for all which would meet our goals of reform at a cost that each of us could afford.

Remember the words of Nobel laureate Paul Krugman, “good economics is also good politics.”

***

Comment:

By Don McCanne, M.D.

It’s too bad that those debating Obama’s ACA versus the Trump/Ryan AHCA didn’t listen to the surge of voices demanding Medicare for all. AHCA was defeated and now the other side wants to fix ACA. Paul Krugman, formerly a single payer supporter, is now in the latter camp.

But look at his proposals to fix ACA. He would pour more money into our costly, inefficient system in order to compensate for the high deductibles that the private insurers use to keep their premiums competitive. That passively perpetuates the profound administrative waste of our system.

He brings up the old saw about private insurer competition, as if over half a century of seeing how ineffective that would be hasn’t taught us anything. Further, he would try to entice more insurers into the market by, yes, pouring in more taxpayer money in in the form of subsidies.

He suggests bringing back the idea of a public option even though the last effort resulted in vitiation of the concept before it was dumped on the trash heap of failed policy politics. The general concept was briefly resuscitated in the form of co-ops – another effort that the insurance industry lobbyists were able to vitiate. Regardless, a public option would be only one small player that would have very little impact in cleaning up the highly flawed, fragmented infrastructure of our health care financing system.

He suggests reinsurance – the taxpayers taking over the role of insuring risk while continuing to richly reward the private insurers for selling us an abundance of superfluous administrative services.

Finally he suggests moving off-exchange plans into ACA exchanges. Wow! Think of all the ways that would provide a major impact in addressing the serious problems we have in health care financing…I can’t think of any either.

The policy debate is over. Tweaking ACA is the most expensive approach we could take, and it would still fall far short of the goals of reform. AHCA would have only made things worse. Single payer is not only more efficient, it also would actually achieve our goal of providing essential health care services to absolutely everyone in a system that is funded equitably so that each of us could afford it.

We have the policy, based on sound economics. Now let’s get the politics right. As Paul Krugman says, good economics is also good politics.

Medicare for All? Sen. Bernie Sanders Poised to Push for Single Payer After GOP Plan Falls Apart

Interview With Dr. Steffie Woolhandler (Part 2)

By Amy Goodman
Democracy Now!, March 27, 2017

PNHP Note: To view video of this interview (parts 1 & 2), click here. To read a transcript of part 1, click here.

On Friday, House Republicans failed to muster enough support to pass the GOP healthcare plan, which some call Trumpcare. In response, Vermont Senator Bernie Sanders has announced he will soon introduce a bill to create a single-payer healthcare system. Several progressive groups are backing a single-payer system, including the Working Families Party, the Progressive Campaign Change Committee, CREDO, Social Security Works and National Nurses United. For more, we speak with Dr. Steffie Woolhandler, co-founder of Physicians for a National Health Program. She is a professor at CUNY-Hunter College and a primary care physician. She is also a lecturer at Harvard Medical School.

TRANSCRIPT
This is a rush transcript. Copy may not be in its final form.

DR. STEFFIE WOOLHANDLER: Well, the Republican plan, which was defeated, was just a meaner version of the Affordable Care Act. Unfortunately, both of those acts have left the private insurance industry in the center of the healthcare system. And we actually need to get the private health insurance industry out. Their overhead and profits and the overhead that they impose on doctors and hospitals are costing us $500 billion annually that we do not need to be spending, $500 billion annually that we could save through a single-payer program, use that money to cover the 26 million Americans who now have no coverage, and then to improve the coverage of insured Americans, who often have insurance they can’t afford to use because of the high copayments, the high deductibles. Now, the deductibles and copayments, that’s a problem that predated Obamacare, but Obamacare failed to fix. And a single payer could eliminate that problem, as it has done in other countries.

JUAN GONZÁLEZ: But how would you propose to get from here to there, given the reality that the Republicans have an even larger now base of support in Congress? They control all the houses, and now they’ll soon have a much more conservative Supreme Court. How would you propose to get from where we are there to single payer?

DR. STEFFIE WOOLHANDLER: OK. Well, we have another election in 21 months. We have another presidential election in less than four years. Things can change. And so, we need to be thinking ahead. We’ve already seen a tremendous amount of change just from people getting out to town hall meetings, getting out on the streets, calling their congressmen. Who would have known a, you know, few months ago that the Republicans would not be able to repeal Obamacare? You know, they’re not—they haven’t been able to do it, largely because there’s been pressure from the electorate on the purple state senators and congressmen. So, people need to be out there in the streets. They need to be contacting their congressmen. They need to be demonstrating, educating and preparing for the day when we really can get single payer, which may be sooner than you think.

AMY GOODMAN: So we keep throwing around that word, “single-payer.” Explain exactly what you mean. And is the Sanders plan—it’s just been discussed this weekend. To go right to this, what would be this system in the United States?

DR. STEFFIE WOOLHANDLER: Well, we haven’t seen the Sanders bill yet, but the sort of things that Sanders and congressmen have been putting forward, like Congressman John Conyers, HR 676, would be, you know, everyone just pays their taxes, and everyone is automatically eligible for a program like Medicare, only it would have no copayments, no deductibles for covered services, no participation by the private health insurance industry, so an expanded and improved Medicare, expanded to everyone, improved so it doesn’t have the kind of gaps in uncovered services that do—you know, do exist in the current Medicare program. We’ve been advocating that plan for decades. Frankly, Congressman Conyers and Senator Sanders have, as well. And I’m not sure what piece of legislation—what the legislation is going to look like that gets introduced in the next few days by Welch and Sanders. But certainly, over the long term, we need to be thinking—

AMY GOODMAN: What would happen to the insurance companies?

DR. STEFFIE WOOLHANDLER: Well, the insurance companies would have no role in an efficient Medicare-for-all program. Some of these insurance companies have overhead of 20 percent, meaning that you give them a dollar in premiums, and only 80 cents ever goes to a doctor or hospital or a drug company. Twenty cents stays right there with the insurance company for their overhead and profit. You have to compare that to traditional Medicare, where the overhead is 2 to 3 percent. So, when you add up all of the administrative costs that insurance companies have, the administrative costs they impose on doctors, like me, and hospitals to try to send bills to multiple payers, we’re talking about potential savings of $400 [billion] to $500 billion annually. That’s the money we need to give universal healthcare to everyone.

JUAN GONZÁLEZ: And where do the various stakeholders in the industry—for instance, I know that the hospitals were very much opposed to the current legislation—

DR. STEFFIE WOOLHANDLER: Yeah.

JUAN GONZÁLEZ: —that the Republicans were pushing for. But where would the doctors and the hospitals and the pharmaceuticals and all these others stand in a battle over Medicare for all?

DR. STEFFIE WOOLHANDLER: OK. Well, in the last battle around the Republican bill, there were no doctors’ groups, no real doctors’ groups, supporting the bill. Everyone opposed it. Certainly, nursing groups and hospitals were opposing it, too. In a battle for single payer, things might line up a little different, in that the insurance industry and the pharmaceutical industry will be totally and completely opposed to single payer. For the insurance—health insurance industry, it’s a life-or-death battle. And we can expect them to use all of their lobbying clout to try to prevent it. Big Pharma hasn’t been very happy in single-payer systems, because in single-payer systems, they—they’re forced to lower their prices, in fact, to about half of what people in the United States pay. And indeed, a single-payer system, by lowering those pharmaceutical prices, would save another $100 billion that we could use to cover people. So, pharma is going to be opposed. Insurance industry, the most opposed, because it’s life and death for them.

AMY GOODMAN: So, Reince Priebus, the chief of staff, former head of the RNC, said this weekend, “Democrats, bring your proposals to us now.” We’re seeing a kind of civil war in the Republican Party. Will we see the same in the Democratic Party?

DR. STEFFIE WOOLHANDLER: I’m doubtful about that. Certainly, at this moment, the Democrats, as an opposition party, tend to be much—tend to unify. When they’re actually running things, the divisions come out much more.

AMY GOODMAN: Well, Bernie Sanders is part of the leadership.

DR. STEFFIE WOOLHANDLER: Mm-hmm, yeah.

AMY GOODMAN: So, are you saying that the leadership might actually endorse a Medicare-for-all proposal? And what does a public option proposal mean, a pre-Medicare-for-all proposal?

DR. STEFFIE WOOLHANDLER: Well, the way the leadership can be brought to endorse single payer is by us, the constituents, out there on the streets, calling them up, pressuring them in all the ways we have, saying, “We want single payer.” That’s what will bring the full Democratic leadership around on this.

Public option? You know, public option would be a small step that would ease some of the pain. It would mean that when you are on the exchange buying things, one of your options would be to pay money and buy into Medicare. But, you know, most Americans do not get their care through the exchange. And the public option really doesn’t generate those massive administrative savings that we need in order to be able to afford healthcare for everyone.

AMY GOODMAN: Dr. Steffie Woolhandler, we want to thank you so much for being with us, professor at CUNY-Hunter College, primary care physician, lecturer at Harvard Medical School, co-founder of Physicians for a National Health Program.

https://www.democracynow.org…

The original content of this program is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License. Please attribute legal copies of this work to democracynow.org. Some of the work(s) that this program incorporates, however, may be separately licensed. For further information or additional permissions, contact us.

Dr. Steffie Woolhandler on ‘Democracy Now!’

PNHP co-founder Dr. Steffie Woolhandler appeared on “Democracy Now!” on March 27, 2017, to discuss Congress’ rejection of the GOP’s American Health Care Act. She discussed the finer points of the ill-fated bill and what we might expect in terms of future policy. She also said that the unpopularity of the “repeal and replace” effort signaled that it was time to move forward to a single-payer national health program.

Part One

Part Two

Bernie Sanders to introduce single-payer health care bill in U.S. Senate

By Peter Hirschfeld
VPR (Vermont Public Radio), March 25, 2017

Less than 24 hours after the disintegration of a Republican effort to repeal and replace the federal Affordable Care Act, Sen. Bernie Sanders told constituents at a town hall meeting in Hardwick Saturday that he’ll introduce a single-payer health care bill in Congress “within a couple of weeks.”

The announcement drew thunderous applause from the approximately 1,000 people in the Hazen Union High School gymnasium, where Sanders shared a stage with Sen. Patrick Leahy and Rep. Peter Welch.

Sanders told the audience that the defeat of the Republican health care bill demonstrates widespread dissatisfaction among Americans with GOP health care policies. And he says he thinks his “Medicare for all” bill will have strong appeal even among the red-state voters that put President Donald Trump in the White House.

Sanders has introduced similar legislation before.

“It is a common sense proposal, and I think once the American people understand it, we can go forward with it,” Sanders said after the town hall meeting.

Welch said that once Sanders’ bill is introduced in the Senate, he’ll introduce the same bill in the U.S. House of Representatives. Welch told the audience that passage of the Affordable Care Act in 2010 was an important step forward.

After the town hall, Welch said he’s realistic about the legislation’s prospects.

“Well, you know, it’s a goal. In this Congress, we won’t pass it,” Welch said. “But I think we have to do keep the goal out there, because we need in this country, like any industrialized country, a health care system that’s affordable, accessible and universal.”

In the wake of the GOP’s failure to repeal the ACA, Welch says he also plans to “reach out to [his] Republican colleagues with specific proposals about some of the things we can do to fix some of the issues in the Affordable Care Act.”

Welch says the individual market, which affects about 6 percent of Americans, “is a problem right now,” and that he’s ready to work across the aisle to find ways to fix it.

Welch says he’s also eager to work with Trump to allow the federal government to negotiate prices with pharmaceutical companies, a move Welch says could save $167 billion annually.

“So my view is that those of us on the Democratic side who did support the ACA have to reach out to our Republican colleagues and offer to work with them on improvements,” Welch said.

http://digital.vpr.net…

Expanded Medicare is easy fix for health system

By Johnathon Ross, M.D.
The Blade (Toledo, Ohio), March 25, 2017

As a physician caring for poor and uninsured patients for decades, I can tell you that the Medicaid expansion under the Affordable Care Act (Obamacare) has saved lives and saved money. It has allowed access to care for hundreds of thousands of low-income Ohioans, leading to early diagnosis and treatment of disease, thereby preventing more costly care, severe disability, or death.

Gov. John Kasich understood these benefits and accepted the Medicaid expansion under Obamacare despite ideologically driven resistance from his fellow Republicans in the General Assembly.

Republicans in Congress have now outlined several tired and unproven ideas to replace that will likely gut the ACA Medicaid expansion. They plan to repeal the taxes on health-care corporations, health insurers, and the wealthy — taxes that helped pay for the Medicaid expansion for the poor and near-poor.

It is beyond comprehension that Congress, in a misguided drive to completely repeal the ACA, would cut this beneficial safety-net care away from poor patients. Real lives are being saved. Cutting or cancelling the Medicaid expansion will lead to higher costs, real suffering, disability, and deaths preventable with appropriate care.

At the same time, it’s important to understand that the ACA did not solve our problems. It didn’t attack the fundamental disease of American health care — its complexity.

Across the world there are only three simple systems proven to work: 1.) a publicly financed national health service, where doctors and other caregivers are public employees (much like our fire departments are set up), and where hospitals are publicly owned and budgeted (Sweden and the United Kingdom); 2.) a single-payer system, where health care is publicly financed but where doctors’ practices and hospitals largely remain in private hands (with hospitals getting lump-sum, annual budgets), and where a public authority negotiates provider fees and prices for medications and supplies (Canada and Taiwan); and 3.) a system of multiple, highly regulated insurers who offer a common, comprehensive benefits package, and where publicly transparent negotiations between hospitals and caregivers produce a single fee schedule and pooling of insurance funds that prevents gaming the system to avoid the sickest patients (Germany, Switzerland, and the Netherlands).

An improved and expanded Medicare for all, as envisioned in legislation introduced by Rep. John Conyers Jr., H.R. 676, would be the embodiment of the second, highly efficient approach. Everyone would be covered and there would be no co-pays or deductibles. The vast majority of households, on the order of 95 percent, would end up saving money.

The Medicare law already exists. Amendments to improve and expand it would be easy to do, either piecemeal or in a sweeping way. Medicare has been improved by amendment many times in the past 50 years. What is needed is the political will.

We know Medicare works. It has been successfully covering the most expensive and complex patients (the chronically ill, elderly, and disabled) that the private insurers would not insure prior to its passage in 1965.

Multiple studies agree that the simplicity of Medicare for all provides hundreds of billions in administrative savings that allow first-dollar comprehensive coverage for all without cutting the pay of caregivers. Medicare allows complete choice of caregiver and hospital. It would save lives, save money, and take the burden of seeking and purchasing health insurance off of businesses and individuals. An improved and expanded Medicare could provide liberal benefits and conservative spending. It is the logical and effective plan that could replace Obamacare to the benefit of all.

Dr. Johnathon Ross is an internal medicine doctor in Toledo.

http://www.toledoblade.com/…

ACA and AHCA fall short, but so does the Commonwealth Fund solution

Where Both the ACA and AHCA Fall Short, and What the Health Insurance Market Really Needs

By David Blumenthal and Sara Collins
Harvard Business Review, March 21, 2017

To understand the ongoing battles about the individual, or non-group, markets and their reform, three points should be kept in mind.

First, these insurance markets were distressed before the enactment of the Affordable Care Act. Second, the ACA improved their functioning but was not sufficient as passed and implemented to stabilize all of them. Neither, however, is the American Health Care Act (AHCA), the repeal and replacement legislation proposed by House Republicans and embraced by President Trump. Third, the reforms that will improve individual markets, which we discuss below, are known. They include greater balance between premium subsidies and penalties for not taking up coverage, using proven mechanisms for stabilizing risks such as reinsurance, and accelerating efforts to control the costs of health care services. To date, the United States has just lacked the political will to adopt them.

What to do

There is no great mystery about how to shore up private insurance markets.

First, we need to create balanced risk pools that include both healthy and less healthy persons in individual insurance markets. This will require two types of actions. Subsidies for young healthy consumers must be increased without decreasing those for older Americans so that so-called young invincibles find the prices of insurance less off-putting but the neediest customers in individual markets can still afford to participate.

However, reducing financial barriers for good risks will not suffice. Unlike many other purchases in our lives, buying insurance is difficult, confusing, and provides little short-term gratification; so healthy young people will always tend to avoid it. That is why creating healthy risk pools for individual markets will require something like the individual mandate that has been so unpopular with conservatives. Unless consumers are required to purchase insurance — or face a meaningful penalty — individual markets may not function effectively over the long term. By meaningful, we mean a financial penalty that equals or exceeds the cost of buying insurance in the first place.

Second, we need to extend subsidies higher up the income scale than the ACA’s limit of 400% of the federal poverty level. This will enable more non-poor individuals — who tend to have lesser disease burdens — to purchase insurance. Unfortunately, health insurance has become so expensive in the United States that even many middle-income families cannot afford to purchase it without the kind of assistance that employers routinely offer their employees.

Third, if we want private insurers to participate in ensuring that Americans have access to affordable insurance, the business of selling this product must be viable. This means managing the inherent uncertainties associated with selling insurance in comparatively unpredictable individual markets. The most effective approaches — used in the Medicare private drug-insurance market without controversy — are reinsurance and risk corridors. The first of these means assuring that reinsurance is available and affordable for plans selling individual and small group products. Risk corridors protect plans that accumulate unexpectedly high risks by giving them access to funds collected from insurers that experience unexpectedly low risks.

Fourth, and perhaps most important, public and private stakeholders must accelerate efforts to control the costs of health care services, which are the primary determinants of the cost of health insurance in all markets, including employer-sponsored, individual, and public. One reason that other countries find it easier to insure their entire populations is that their costs of care are half or less what ours are.

The key to controlling health care costs in the United States is to implement aggressively the payment and delivery-system reforms that were included in the Affordable Care Act but rarely discussed in current debates.

The facts are clear. We can revive individual markets that were failing even before the ACA was enacted and are vital to making affordable care available to Americans. But we will have to pay for that revival — politically and fiscally.

David Blumenthal, M.D., is president of the Commonwealth Fund. Sara Collins is the Commonwealth Fund’s vice president for health care coverage and access.

***

Comment:

By Don McCanne, M.D.

It is quite appropriate that this article was published in the Harvard Business Review since it finds solutions to the deficiencies of both the Affordable Care Act (ACA) and the proposed American Health Care Act (AHCA) in the private health care insurance marketplace. The authors’ proposals are to use government regulations and funds to create a robust market for private insurance plans – an approach that Harvard MBAs understand and support.

They would make the individual mandate more effective by penalizing nonparticipants with a penalty equal to or larger than the insurance premiums. Forcing individuals to buy plans with excessive deductibles and inadequate provider networks is a cruel policy.

They would increase subsidies for middle-income individuals but that would still push individuals into low-actuarial value plans, not solving the problems of impaired access due to narrow networks and unaffordable out-of-pocket costs.

They would relieve insurers of bearing risk through the use of reinsurance and risk corridors. Insurers would be reduced to providing a profusion of expensive administrative functions, while being protected against the usual insurance function of bearing risk, allowing their actuaries to concentrate on profits instead of risk.

They would more aggressively control health care costs but do so through the payment and delivery-system reforms of ACA which have already proven to be quite ineffective. They acknowledge that other countries insure everyone at costs of care that are “half or less what ours are.”

Well how do those other nations include everyone and pay an average of half of what we do? Certainly not by embellishing the private insurance markets and throwing a bunch of government money at them. Yes, some countries do use private insurance but they are so heavily regulated that they qualify as social insurance programs. The governments require that the financing system serves first the needs of patients whereas we structure ours to serve first the needs of insurers while leaving patients exposed to financial hardship and impaired access.

Today we are at a decision point between ACA and AHCA. Absent any last minute back-door deals, the likely outcome will be the defeat of AHCA, and president Trump will walk, leaving ACA in place with little hope for even the very modest changes suggested by Commonwealth’s Blumenthal and Collins. And if it should pass in both the House and the Senate, an unlikely outcome, we will be even worse off than we are.

Instead of a debate between ACA and AHCA, the debate should have been between ACA/AHCA and an improved Medicare for all. We can still have that debate by continuing to educate the public on the deficiencies of ACA and the virtues of single payer Medicare for all, but we will have to make our presence felt lest we get lost in the next agenda item that the Republicans really want – altering the tax system to shift more income and wealth from the workers to the wealthy. That will really be bad for the physical and fiscal health of our nation and its people.

After Speaker Ryan pulls GOP ‘slash and burn’ health bill, doctors group urges passage of a single-payer health plan

Failure of AHCA ‘presents a unique opportunity to move beyond the Affordable Care Act,’ says group’s leader

FOR IMMEDIATE RELEASE, March 24, 2017

Contact:
Clare Fauke, communications specialist, PNHP, 312-782-6006, clare@pnhp.org
Mark Almberg, communications director, PNHP, 312-782-6006, mark@pnhp.org

Physicians for a National Health Program (PNHP), a nonprofit research and education organization of 20,000 physicians, medical students and health professionals, responded to House Speaker Paul Ryan’s decision to cancel a scheduled vote on the American Health Care Act (AHCA). With the AHCA dead on arrival, PNHP urges Congress to instead pass H.R. 676, the Expanded and Improved Medicare for All Act, which would provide immediate, comprehensive coverage to all Americans.

“The Republicans’ slash-and-burn proposal would have pushed millions more Americans off their health insurance, sending the rates of medical bankruptcy and preventable deaths skyrocketing,” said Dr. Carol Paris, president of PNHP.

Today’s failure to pass the AHCA presents a unique opportunity for Congress to move beyond the ACA toward a permanent, sustainable single-payer health program.

“The ACA left 29 million Americans uninsured and channeled billions of taxpayer dollars to a patchwork of wasteful private insurers, each one skimming off its own share of administrative costs and profit that should have been spent on patient care,” added Dr. Paris. “Let’s clear the drawing board – it’s time to adopt a simple, commonsense approach to national health care.”

Dr. Paris called on members of both parties to adopt H.R. 676, introduced by Rep. John Conyers Jr., D-Mich. The Expanded and Improved Medicare for All Act is a streamlined, single-payer plan that would expand coverage to all Americans and save millions in health care costs, achieving President Trump’s campaign promises of more coverage, better benefits and lower costs.

PNHP and other groups are planning a National Day of Action on Saturday, April 8, the first day of the congressional recess. Health care providers in at least a dozen cities will conduct coordinated actions in support of universal guaranteed health care. 

Physicians for a National Health Program (www.pnhp.org) is a nonprofit research and education organization of more than 20,000 doctors who support a single-payer national health program. It was founded in 1986.

Eighteen-wheelers and Buick Enclaves

By Ewell Scott, M.D.
The Morehead (Ky.) News, March 24, 2017

Let us explore this analogy to better understand the advantages of selecting MEDICARE FOR ALL as the sole provider of health insurance financing. Note the key word is financing, not care.

Assume the need to travel to Louisville every day to purchase groceries. You have two choices of transportation. The first is to buy an 18-wheeler and use it.

The second option is a brand new Larry Fannin Buick Enclave, including a chauffeur. The groceries you purchase will be exactly the same, no matter how you get to the supermarket. Parking may be a bit more difficult with the truck. It takes very little wisdom to make the right pick, unless you just want to ride in an 18-wheeler. I would choose the Buick.

Now do this: replace multiple private health insurance companies for the truck and MEDICARE FOR ALL for the Enclave, and health care for groceries in the metaphorical scenario. What do you choose? Your health care would be exactly the same, but the cost will be lower with Medicare for All. How could this possibly be true? Well there are two very good reasons. First, Medicare has the ability to control costs, and Medicare can process your claims and collect the premiums much more efficiently. Remember Medicare’s overhead is 3 percent while private, for profit health care companies usually take 30 percent off of the top. Good Grief.

We here in the USA are wasting 600 billion dollars per year by persisting in our reliance on private health care companies. This is a big lot of loot, when you consider our entire Kentucky State Budget is about 9 billion. I ask anyone reading this article to give me a good reason to continue this insanity.

Happy Travels.

Ewell Scott, M.D., FACP, is a health care reform activist. He resides in Morehead.

http://www.themoreheadnews.com…

Single payer make sense, financially and health-wise

By Maryanne Hidalgo Kehoe, R.N.
The Daily Star (Oneonta, N.Y.), March 24, 2017

Single-payer is not socialized medicine, it is socialized bookkeeping. It is the smart business method to reduce the cost of health care. Single-payer was supported by President Trump when he was still wearing his businessman’s hat.

Congressman Faso (Daily Star, 3/2/17) denies that there is significant cost savings with single-payer. In contrast, Dr. Antoinette Kuzminski (Daily Star, 2/18/17) writes, “Twenty-five percent of the American health care dollar goes to the care and feeding of private insurers — their bureaucracies, their shareholders, their CEOs.”

Savings estimates from moving to a single-payer system range from 11 percent to 31 percent, but it only takes common sense to know that removing the profit-motivated private insurance companies from the mix will save money; lots of money! Money saved would be more than the estimated yearly deficit reduction of $33.7 billion projected by American Health Care Act currently before Congress. Single-payer saves money AND would allow we the people to provide health care for all. Learn more about single-payer at:
https://www.pnhp.org/facts/single-payer-faq#what-is-single-payer

Write, email and call ALL your representatives in New York and Washington, including President Trump. As a businessman and our president, he needs to help all Americans struggling with our very confusing, inefficient and inequitable health care system. Please also support the cause for universal health care in New York. Single-payer Lobby Day and Rally in Albany is on Tuesday, April 04, 2017, at 10 a.m. For more information, go to: http://www.nyhcampaign.org/calendar.

Maryanne Hidalgo Kehoe, RN, MS, FNP, resides in Hartwick.

http://www.thedailystar.com/…

Insurance can’t be focus of improving healthcare

By Michael Sirr, M.D.
Bozeman (Mont.) Daily Chronicle, Letters, March 24, 2017

In my 30 years as an ER doctor, the insurance industry never helped me take care of a single patient. They did waste my time.

Notice how Medicare for all is not being discussed. Until Americans stop wasting 30 percent of their healthcare spending on insurance companies, we will never afford healthcare for all.

Michael Sirr, M.D., resides in Bozeman.

http://www.bozemandailychronicle.com…

With Epic GOP Failure, Dems Urged to Go Bold with Medicare-for-All

Americans rallied against the GOP to defend their right to healthcare, Democrats are being urged to seize on the moment

By Lauren McCauley
Common Dreams, March 24, 2017

With the Republican attempt to replace the Affordable Care Act (ACA) going down in flames Friday as Americans rallied to defend their right to healthcare, Democrats are being urged, both by experts and constituents, to seize on the moment and counter with a plan that will truly provide coverage for all.

Uproar over the GOP’s American Health Care Act (AHCA), which was estimated to strip 24 million people of their healthcare by 2026, prompted a political firestorm as it drove voters across the nation to town halls and local legislative offices to demand that House Republicans vote against the bill.

After the White House called on House Speaker Paul Ryan (Wis.) to withdraw Friday’s scheduled vote (after an aggressive lobby effort on the part of both President Donald Trump and Ryan), many are looking to what happens next.

Though the Republican narrative that Obamacare is “imploding” has been proven to be an unfounded talking point, The Week’s Ryan Cooper argued Friday that Democrats “shouldn’t sit idly by and wait for Republicans to slowly bleed Obamacare to death by other means.”

“They need a counter-offer,” Cooper writes, “one that’s more compelling than the creaky status quo. They need a single-payer, Medicare-for-All plan.”

Similarly, RoseAnn DeMoro, executive director of National Nurses United (NNU), told Common Dreams that ultimately Democrats “are fighting for an unacceptable status quo,” noting that a private insurance market will always prove to be “unaffordable.”

In a press statement she expanded on this idea:

Many of the criticisms of the ACA are, in fact valid. For all the improvements under the ACA, primarily the expansion of Medicaid and crackdown on some insurance abuses, the ACA still left 28 million without health coverage, and millions more struggling with un-payable medical bills and escalating out of pocket costs.

Where the Democrats too fell short was their failure in drafting the ACA to refute the underlying source of the health care crisis in the first place, the contradiction between a health care system that should be based on patient need and the public health and well being, and the insatiable demand of health care corporations for profits first.

Dr. Carol Paris, president of Physicians for National Health Program (PNHP), which has long-advocated for single-payer system, said Friday’s failure by the Republican Party to pass their “slash and burn” healthcare bill “presents a unique opportunity to move beyond” a profit-based system.

Though Paris acknowledged the GOP plan would have “pushed millions more Americans off their health insurance, sending the rates of medical bankruptcy and preventable deaths skyrocketing,” she said the shortcomings of the ACA should not be ignored.

“The ACA left 29 million Americans uninsured and channeled billions of taxpayer dollars to a patchwork of wasteful private insurers, each one skimming off its own share of administrative costs and profit that should have been spent on patient care,” Dr. Paris noted. “Let’s clear the drawing board—it’s time to adopt a simple, commonsense approach to national health care.”

Pointing to the collapse of the GOP’s attempt at reform, DeMoro says it’s clear their party has no viable pathway towards a solution. “The Republicans are ideologically split it appears,” she said. “Trump is trying to maintain that everyone should have healthcare and the cost should go down—that solution, and the only possible solution is Medicare-for-All.”

In a Friday press statement, Rep. Luis  Gutiérrez (D-IL) echoed this call. “We have known for years that the only true healthcare reform that will work is a single-payer system where we take national responsibility for the health of our nation,” he said. “Now that this vote is over, I hope we can return to a serious and sensible discussion of strengthening our healthcare system and the improving the health of all Americans.”

In addition to Medicare-for-All being “quite clearly the best universal health-care policy option for the United States,” The Week’s Cooper also observed that “Obamacare did not finish the job of achieving universal health care, and this is a good chance to move the ball forward.”

The AHCA, Cooper continues, “is extraordinarily unpopular because it takes coverage and subsidies away from people, and a majority believe that it should be the government’s responsibility to make sure everyone is covered. Fundamentally, Medicare is very popular, a fact only partially covered up by generations of red-baiting and duplicitous austerian propaganda.”

Further, he notes that “it also makes an excellent organizing signpost. Medicare-for-All is simple, easy to understand, and hard to argue against or distort.”

The math works out too. Dr. David Himmelstein and Dr. Steffie Woolhandler, both of whom are closely associated with PNHP, published an analysis this week which found that replacing the ACA “with a universal, single-payer health system, along the lines of the Expanded and Improved Medicare for All Act, H.R. 676, would provide immediate coverage to the 26 million Americans who are currently uninsured, saving at least 20,984 lives in year one.”

This is in contrast to the Congressional Budget Office estimate that as many as 24 million people would lose health coverage by 2026 under the AHCA.

Responding to Friday’s developments, Sen. Bernie Sanders (I-Vt.) called the failure of the AHCA a “great victory,” but said that lawmakers’ work would not be complete until healthcare was guaranteed “to all people as a right”:

Contrary to Republican orthodoxy, many of Trump’s blue collar supporters voted for him specifically because he promised to “take care of everybody.” Speaking with some of those voters in West Virginia recently, Sanders found that many do believe that healthcare should be guaranteed as a human right.

Sanders, who made Medicare-for-All a key plank of his 2016 presidential campaign, said recently that the president’s supporters “are catching on that Trump lied.”

Robert Frank, an economics professor at the Johnson Graduate School of Management at Cornell University, argued in a New York Times op-ed Friday that the president could preserve the floundering effort to replace Obamacare while making good on his campaign promises by getting behind a Medicare-for-All, or single payer, healthcare plan.

Trump should use his “political leverage…to jettison the traditional Republican approach in favor of a form of the single-payer health care that most other countries use.”

This work is licensed under a Creative Commons Attribution-Share Alike 3.0 License

http://www.commondreams.org…