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Obama to Republicans: Show me a better plan

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Obama to Republicans: Show me a better plan

Remarks by the President in Vox Live Interview

By Ezra Klein and Sarah Kliff of Vox
The White House, Office of the Press Secretary, January 6, 2017

Excerpts of the President’s comments:

“…the challenge of getting it passed was always the fact that, unlike other advanced countries, we didn’t start with a system in which everybody was covered, and we have a very complicated marketplace, and we have third-party insurers.  And what that meant was that even after we got the law passed anything that dissatisfied people about the health care system could be attributed to — quote, unquote — “Obamacare,” even if it had nothing to do with Obamacare.”

***

“…whenever you look at polls that say 40-something percent are supportive of the law and 40-something percent are dissatisfied — in the dissatisfied column are a whole bunch of Bernie Sanders supporters who wanted a single-payer plan.  (Laughter.)  And so the problem is not that they think Obamacare is a failure; the problem is that they don’t think it went far enough and that it left too many people still uncovered, that the subsidies that people were getting weren’t as rich as they should have been, that there’s a way of dealing with prescription drug makers in a way that drives down those costs.”

***

“If it works, I’m for it.  If something can cover all Americans, make sure that if they have a preexisting condition they can still get coverage, make sure that prescription drugs are affordable, encourage preventive measures to keep people healthy, that makes sure that in rural communities people have access to substance abuse care or mental health care, that Medicare and Medicaid continue to function effectively — if you can do all that cheaper than we talked about, cheaper than Obamacare achieves and with better quality and it’s just terrific, I’m for it.”

***

“In fact, if you look at how this law evolved — and I’ve said this publicly before, if I was starting from scratch, I probably would have supported a single-payer system because it’s just easier for people to understand and manage.  And that’s essentially what Medicare is, is a single-payer system for people of a certain age.  And people are very satisfied with it and it’s not that complicated to understand or to access services.  But that wasn’t available; we weren’t starting from scratch.”

***

“From the very start, in the earliest negotiations in 2009, 2010, I made clear to Republicans that, if they had ideas that they could show would work better than the ideas that we had thought of, I would be happy to incorporate them into the law.  And rather than offer ideas, what we got was a big no, we just don’t want to do this.”

***

“After the law passed, for the last six, seven years, there has been the argument that we can provide a great replacement that will be much better for everybody than what the Affordable Care Act is providing.  And yet, over the last six, seven years, there has been no actual replacement law that any credible health care policy experts have said would work better.  In fact, many of them would result in millions of people losing coverage and the coverage being worse for those who kept it.

“And so now is the time when Republicans, I think, have to go ahead and show their cards.  If, in fact, they have a program that would genuinely work better and they want to call it whatever they want — they can call it Trumpcare, they can call it McConnellcare, or Ryancare.  If it actually works, I will be the first one to say, great, you should have told me that back in 2009.  I asked.  (Laughter.)  I suspect that will not happen.”

***

“I am saying to every Republican right now, if you, in fact, can put a plan together that is demonstrably better than what Obamacare is doing, I will publicly support repealing Obamacare and replacing it with your plan.  But I want to see it first.  (Applause.)  I want to see it first.”

***

“This idea that somehow, oh, this is about Obama preserving his legacy — keep in mind, I’m not the one who named it Obamacare.  (Laughter.)  They were the ones who named it Obamacare, because what they wanted to do was personalize this and feed on antipathy towards me in their party as an organizing tool, as politics. 

“But I don’t have a pride of authorship on this thing.  If they can come up with something better, I’m for it.  But you have to show — and I would advise every Democrat to be for it — but you have to show that it’s better.  And that’s not too much to ask.”

***

“…the answer is the Republicans, yes, will own the problems with the health care system if they choose to repeal something that is providing health insurance to a lot of people, and providing benefits to every American who has health insurance even if they’re getting it through the job, and they haven’t shown us what it is that they’re going to do.  Then they do own it.  Because that is irresponsible.  And even members of their own party, even those who are opposed to me, have said that that is an irresponsible thing to do.”

***

“So if you look at the things that people are frustrated about with Obamacare, the Affordable Care Act, the big things are the subsidies aren’t as high as they’d like and they don’t have as many options as they’d like.  And I’m happy to provide both those things.  I’d sign on to a Republican plan that said we’re going to give more subsidies to people to make it even cheaper, and we’re going to have a public option where there isn’t an option. 

“Here’s the problem.  I don’t think that’s the thing that they want — (laughter) — to do.“

***

“And my advice to the President-elect — in fact, we talked about this when I met with him for an hour and a half right after he got elected — I said make your team and make the Republican members of Congress come up with things that they can show will actually make this work better for people.  And if they’re convincing, I think you would find that there are a lot of Democrats out there — including me — that would be prepared to support it.  But so far, at least, that’s not what’s happened.”

***

“Well, look, this is the irony of this whole debate, is the things that people are most dissatisfied with about Obamacare, about the Affordable Care Act, are things that essentially in other countries are solved by more government control, not less.  (Laughter.)  And so Republicans are pointing at these things to stir up dissatisfaction, but when it comes to, all right, what’s the solution for it, their answer is less government regulation and letting folks charge even more and doing whatever they want and letting the marketplace work its will.”

***

“If we want to control prices for consumers more, then the marketplace by itself will not do that.  And the reason is because health care is not exactly like other products.  It’s not like buying a flat-screen TV.  If you’re sick, or if your kid is sick, most of the time you’re not in a position to negotiate right there and then.  You can’t walk out of the store and say, well, I’m going to see if I can get a better deal.”

***

“The problem is, is that that’s not what’s being proposed by Mitch McConnell, the senator from Kentucky.  Instead what he’s proposing, I gather, is you’re going to repeal the law, then you’re going to come up with something, except you will have taken away all the — the way we pay for the subsidies for working people is we’re taxing wealthier folks at a little bit higher.  So he wants to cut those taxes, and that money would be gone right away.  And then he’s going to promise you, or those people who you’ve been signing up, better health care, except there’s not going to be any money to pay for it.  And nobody has explained to me yet how that’s going to work.”

***

“…then at the very least you should be putting pressure on your members of Congress to say, show us exactly what the deal is going to be for us before you take away the deal that we got.”

***

“The way this process is going to work, there’s this rushed vote that’s taking place this week, next week to — quote, unquote — “repeal Obamacare.”  But really all that is, is it’s a resolution that is then instructing these committees in Congress to start actually drafting a law that specifically would say what’s being repealed and what’s not.  Then, after that, they’d have to make a decision about what’s going to replace it and how long is that going to take.  And that stretches the process out further. 

“And so I think, whether you originally supported Obamacare or you didn’t, whether you like me or you don’t, the one thing I would just ask all the American people to do is adopt the slogan of the great state of Missouri — “Show me.”  (Laughter.)  Show me.  Do not rush this process. 

“And to Republicans, I would say:  What are you scared of?  If you are absolutely convinced, as you have been adamant about for the last seven years, that you can come up with something better, go ahead and come up with it.  And I’ll even cut you some slack for the fact that you’ve been saying you can come up with something better for seven years and I’ve never seen it.  (Laughter.)  But we’ll restart the clock.”

***

Video (1 hour, 9 minutes):
https://www.whitehouse.gov…

Transcript:
https://www.whitehouse.gov…

***

Comment:

By Don McCanne, M.D.

What is the point of today’s message? Virtually everyone wants affordable access to health care, for themselves at least. Most want a better system than what we have under the Affordable Care Act. But the nation is divided as to whether ACA needs to be repealed prior to improving the functioning of our health care financing system.

So the point is that there is broad agreement that we want the system improved, but the Republicans, who are in control, are hamstrung by their anti-government ideology which prevents them from offering the government solutions that we would need that would actually be effective in improving the system.

Repealing ACA would further impair the functioning of our system, so the Republicans would have to introduce effective policies that would more than compensate for the deficiencies that would be created by repeal. Almost any piecemeal solution would require greater regulation and more government spending, anathema to the Republicans. Suggestions to date coming from their camp would leave us worse off than what we currently have. It is no wonder that they refuse to tell us what their replacement proposal would be.

If they really do want to improve the system, and they say they do, then they have two choices. Either provide beneficial tweaks to the current system, which will cost more and require greater regulation, yet fall far short of reform goals, or replace the current system with a single payer national health program – an improved Medicare for all. The latter would greatly improve the financing of health care, ensuring true universality, improved access, greater choice in care, and affordability for each and every individual. And we could do that without increasing spending above our current level.

The Republicans have an opportunity to provide us with a replacement program that would be vastly superior to building on our current dysfunctional system. Both President Obama and President-elect Trump have acknowledged the clear superiority of a single payer system. Most progressives, a majority of moderates and a plurality of conservatives agree. Now all the Republicans need to do is show us.

Dr. Steffie Woolhandler on ‘Democracy Now!’

PNHP co-founder Dr. Steffie Woolhandler appeared on “Democracy Now!” on Jan. 9, 2017, to discuss the prospective repeal of the Affordable Care Act. She predicted that the structure of the law – originally a Republican proposal – would stay in place, albeit in a “meaner” version. She also noted that the health care crisis could not be truly addressed until single-payer legislation was signed into law.

Part One

Part Two

Repeal & Run? Republicans Move to Axe Obamacare, But What Will Replacement Look Like?

Interview With Dr. Steffie Woolhandler (Part 1)

By Amy Goodman
Democracy Now!, Jan. 9, 2017

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

Republicans in the newly sworn-in 115th Congress are moving swiftly to repeal the Affordable Care Act, President Obama’s signature healthcare law. By a vote of 51 to 48 last week, the Senate approved a procedural measure clearing a way for a budget resolution that could repeal major sections of the law. The charge was led by Vice President-elect Mike Pence, who admitted his party has not yet decided how to replace the Affordable Care Act. “The Republicans’ rebranded version of the Affordable Care Act will be much meaner and skimpier,” says Dr. Steffie Woolhandler, a primary care physician. She is a lecturer at Harvard Medical School. “It will have much more in the way of copayments and deductibles, particularly for poor people who are unable to afford it.” Woolhandler is a professor at CUNY-Hunter College and the co-founder of Physicians for a National Health Program.

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

AMY GOODMAN: Republicans in the newly sworn-in 115th Congress are moving swiftly to repeal the Affordable Care Act, President Obama’s signature healthcare law. By a vote of 51 to 48 last week, the Senate approved a procedural method clearing a way for a budget resolution that could repeal major sections of the law. The charge was led by Vice President-elect Mike Pence, who admitted Republicans, well, haven’t yet decided how to replace the Affordable Care Act.

VICE PRESIDENT-ELECT MIKE PENCE: The President-elect and I, working with the leaders of the House and Senate, are determined to keep our promise to the American people. And that all begins with repealing and replacing the failed policy of Obamacare.

AMY GOODMAN: President Obama made a rare trip to Capitol Hill last week, where he told minority Democrats not to help Republicans pass replacement measures that he called “Trumpcare.” At the White House, Press Secretary Josh Earnest said the Republican plan would have devastating consequences.

PRESS SECRETARY JOSH EARNEST: Twenty-two million people are going to lose their health insurance if the Affordable Care Act is repealed. It’s going to rip a hole in the deficit, in the federal budget, and the deficit will go up, if the Affordable Care Act is repealed. That’s not just my conclusion; you can ask the CBO about that.

AMY GOODMAN: Senate Republicans are seeking to end billions of dollars in federal subsidies to states that have expanded Medicaid, as well as subsidies for private health coverage through health insurance exchanges.

For more, we head to Los Angeles, California, where we’re joined by Dr. Steffie Woolhandler, a professor at CUNY-Hunter College here in New York, primary care physician, lecturer at Harvard Medical School, co-founder of Physicians for a National Health Program.

Dr. Steffie Woolhandler, welcome to Democracy Now! In these last minutes we have left, we want to talk about two things. What’s happening? The Republicans call it “repeal and replace.” Democrats are calling it “repeal and run.” And then where you see—if you see there’s any road to single payer? But let’s start with what the Republicans are proposing—or not.

DR. STEFFIE WOOLHANDLER: Well, we think what the Republicans will do is they’ll rebrand the Affordable Care Act with a new name but keep the essential structure of the Affordable Care Act, which is that you use public money to purchase private insurance. The Republicans’ rebranded version of the Affordable Care Act will be much meaner and skimpier. It will have much more in the way of copayments and deductibles, particularly for poor people who are unable to afford it.

So, unfortunately, I think a lot of the structures of Obamacare were in fact structures first proposed by Republicans. They were first implemented in Massachusetts under Romneycare in 2006, first proposed by then-President Nixon and actually fully fleshed out by The Heritage Foundation. So, the very structure of Obamacare was a Republican idea. So I think the Republican replacement will at least structurally look like Obamacare, just be a much meaner—leaner, meaner, rebranded form of the Obamacare legislation.

AMY GOODMAN: Rebranded as Trumpcare. But what do you mean? For example, kids, until they’re 26, can be—can they be on their parents’ insurance? Pre-existing conditions? And what happens to the 20 million, 30 million people who are subsidized, who did not have insurance before, who are the poorest in this country?

DR. STEFFIE WOOLHANDLER: Well, a big issue is that the Republicans will be block granting Medicaid, so just turning over money to the states for Medicaid to pretty much do what they want with it. And we think that what the states will do is create very skimpy, very restrictive Medicare programs, as has happened in Indiana under Governor Pence—Vice President-elect Pence—where the minute a poor person misses a payment, they get thrown off of Medicaid for six months. They have to make copayments, which they can’t afford. And we do expect that that’s what Medicaid will look like going forward, is an extremely skimpy, stripped-down coverage that really does not allow people to get the healthcare they need.

We also anticipate that there will be more copayments, more deductibles for insured Americans. So, some of the protection under the Obamacare legislation will be removed. Probably there will be no guarantee of reproductive coverage, as there is under Obamacare. So, I think most of the punishment will be meted out against poor people, if you will, but will still probably have those structures of Obamacare.

The coverage up to age 26, frankly, that’s the thing that’s most likely to stay in a Republican plan. Pre-existing conditions? That will almost certainly change. According to the plans put forward by Representative Ryan, they’re only going to allow you the protection for your pre-existing conditions if you keep your insurance continuously throughout your life. And as many people know, that is something very, very difficult to do. Many people have a lapse of a day or a month in their insurance. And if you have that kind of lapse, you have no protection about pre-existing conditions, and your insurance company will be allowed to—new insurance company will be allowed to deny you coverage.

AMY GOODMAN: Donald Trump has talked about single payer in the past. And, you know, he’s talked about it on 60 Minutes. These were some of his comments during a Republican presidential debate in April.

DONALD TRUMP: As far as single payer, it works in Canada. It works incredibly well in Scotland. It could have worked in a different age, which is the age you’re talking about, here. What I’d like to see is a private system without the artificial lines around every state. I have a big company with thousands and thousands of employees. And if I’m negotiating in New York or in New Jersey or in California, I have like one bidder. Nobody can bid. You know why? Because the insurance companies are making a fortune, because they have control of the politicians—of course, with the exception of the politicians on this stage. But they have total control of the politicians. They’re making a fortune. Get rid of the artificial lines, and you will have yourself great plans. And then we have to take care of the people that can’t take care of themselves. And I will do that, through a different system.

AMY GOODMAN: And this is Donald Trump in an interview with Scott Pelley on 60 Minutes in 2015, coming out in favor of a form of single-payer health insurance.

DONALD TRUMP: Obamacare is going to be repealed and replaced. Obamacare is a disaster, if you look at what’s going on with premiums, where they’re up 45, 50, 55 percent.

SCOTT PELLEY: So how do you fix it?

DONALD TRUMP: There’s many different ways, by the way. Everybody’s got to be covered. This is an un-Republican thing for me to say, because a lot of times they say, “No, no, the lower 25 percent, they can’t afford private.” But—

SCOTT PELLEY: Universal healthcare.

DONALD TRUMP: I am going to take care of everybody. I don’t care if it costs me votes or not. Everybody’s going to be taken care of, much better than they’re taken care of now.

SCOTT PELLEY: The uninsured person—

DONALD TRUMP: Right.

SCOTT PELLEY: —is going to be taken care of how?

DONALD TRUMP: They’re going to be taken care of.

SCOTT PELLEY: How?

DONALD TRUMP: I would make a deal with existing hospitals to take care of people. And you know what? This is probably—

SCOTT PELLEY: Make a deal? Who pays for it?

DONALD TRUMP: The government is going to pay for it. But we’re going to save so much money on the other side. But for the most part, it’s going to be a private plan, and people are going to be able to go out and negotiate great plans with lots of different competition, with lots of competitors, with great companies. And they can have their doctors. They can have their plans. They can have everything.

AMY GOODMAN: So, that’s President-elect Donald Trump speaking before he was president-elect. Dr. Steffie Woolhandler, you were never a supporter of Obamacare. What do you think of what he’s saying, albeit a while ago?

DR. STEFFIE WOOLHANDLER: Well, I certainly agree with him that single payer works very well in other countries that have it. People in those countries spend about half what we do on healthcare. And they get free healthcare from the day they’re born to the day they die, without copayments or deductibles. I don’t think President Trump is going to enact single payer, but I do think there’s tremendous possibilities for moving forward to single payer. At this point, it’s pretty clear the American people got a good look at Obamacare and said, “This is not a solution. This is not working.” And many of them do in fact support the idea of a single-payer Medicare for all. And that’s what we need to be pushing right now.

AMY GOODMAN: So what is the road to that from here, Dr. Woolhandler?

DR. STEFFIE WOOLHANDLER: Well, we need to be saying that we need to go beyond the Affordable Care Act to a single-payer system. Merely trying to defend the Affordable Care Act at this point is not going to work. The American people have seen it for three years and rejected it. And, you know, 20 million people got insurance, and that’s great, but there were 280 million people who saw no improvements in their healthcare. They still can’t afford healthcare despite having private insurance, because of the copayments and the deductibles in those narrow networks. So we need to go to a system that fixes the healthcare system for everyone. And that’s what’s politically possible right now. Defending the Affordable Care Act looks like defending the status quo in healthcare, and that’s not acceptable to most American voters.

AMY GOODMAN: Dr. Steffie Woolhandler, what you’re saying is too important. We’re going to continue the conversation after the broadcast and post it online at democracynow.org. Is there a road to single payer under President Trump? This is Democracy Now! Dr. Steffie Woolhandler, founder of Physicians for a National Health Program, thanks for joining us.

https://www.democracynow.org…

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3 big reasons Republicans can’t replace Obamacare

The only practical answer to these three dilemmas is Medicare for all — a single-payer system

By Robert Reich
Salon.com, Jan. 9, 2017

Republicans are preparing to repeal the Affordable Care Act, promising to replace it with something that doesn’t leave more than 20 million Americans stranded without health insurance.

Yet they haven’t come up with a replacement. And they won’t, for three reasons.

First, Republicans say they want the replacement to be “market-based.” But Obamacare is already market based — relying on private, for-profit health insurers.

That’s already a problem. The biggest health insurers — Anthem, Aetna, Humana, Cigna and United Health — are so big they can get the deals they want from the government by threatening to drop out of any insurance system Republicans come up with. Several have already dropped out of Obamacare.

Even now they’re trying to merge into far bigger behemoths that will be able to extort even better terms from the Republicans.

Second, every part of Obamacare depends on every other part. Trump said he’d like to continue to bar insurers from denying coverage to individuals with preexisting conditions.

But this popular provision depends on healthy people being required to pay into the insurance pool, a mandate that Republicans vow to eliminate.

The GOP also wants to keep overall costs down, but they haven’t indicated how. More than 80 percent of Americans who buy health insurance through Obamacare receive federal subsidies. Yet Republicans have no plan for raising the necessary sums.

Which gets us to the third big reason Republicans can’t come up with a replacement. Revoking the tax increases in Obamacare — a key part of the repeal — would make it impossible to finance these subsidies.

The two biggest of these taxes — a 3.8-percentage-point surtax on dividends, interest and other unearned income; and a 0.9-percentage-point increase in the payroll tax that helps fund Medicare — are also the most progressive. They apply only to people earning more than $200,000 per year.

Immediately repealing these taxes, as the GOP says it intends to do, will put an average of $33,000 in the hands of the richest 1 percent this year alone and a whopping $197,000 into the hands of the top 0.1 percent, according to the Tax Policy Center.

It would also increase the taxes of families earning between $10,000 and $75,000 — including just about all of Trump’s working class voters.

Worse yet, eliminating the payroll tax increase immediately pushes Medicare’s hospital fund back toward the insolvency that was looming before Obamacare became law.

Ultimately, the only practical answer to these three dilemmas is Medicare for all — a single-payer system. But Republicans would never go for it.

So without Obamacare, Republicans are left with nothing. Zilch. Nada. Except the prospect of more than 20 million people losing their health insurance, and a huge redistribution from the working class to the very rich.

Robert Reich, one of the nation’s leading experts on work and the economy, is Chancellor’s Professor of Public Policy at the Goldman School of Public Policy at the University of California at Berkeley. He has served in three national administrations, most recently as secretary of labor under President Bill Clinton.

http://www.salon.com…

Medicare for all — use formula to replace ACA

By RoseAnn DeMoro
The Hill, Jan. 9, 2017

“Praying for health shouldn’t be the foundation of a modern healthcare system. But that’s where millions of uninsured Americans still find themselves,” wrote The Los Angeles Times columnist David Lazarus Jan. 6, quoting the fears of Los Angeles resident Madelyn Gilbreath about the expected vote by Congress to repeal the Affordable Care Act (ACA).

“I just need to make it one more year and then I’m eligible for Medicare (like her husband who is on Medicare),” Gilbreath told Lazarus. “For my son, I’m just praying he stays healthy.”

That’s a story nurses have heard before, including when a 64-year-old retired teacher asked an operating room nurse who was prepping him for heart surgery in San Diego, “can’t you wait one week until I turn to 65 and qualify for Medicare?”

Why should anyone have to wait to qualify for Medicare, one of the most popular reforms in U.S. history? Expanding Medicare to cover everyone remains a rarely discussed alternative to the reopening of a national healthcare debate.

Far fetched? Apparently not to the incoming President Donald Trump. “As far as single payer, it works in Canada. It works incredibly well in Scotland. It could have worked in a different age, which is the age you’re talking about here,” said Trump in a Republican debate in August, 2015. That age should be the present time.

full article:
http://thehill.com…

RoseAnn DeMoro, executive director of National Nurses United, has emerged as one of the nation’s preeminent advocates for genuine healthcare reform and working people. DeMoro also serves as national vice president and executive board member of the AFL-CIO.

Medicare for all should replace Obamacare

Republicans have no realistic alternative to the ACA. It’s time for single-payer.

By Marcia Angell, M.D.
USA Today, Jan. 6, 2016

Even before the election of Donald Trump, Obamacare was in trouble. Premiums on the government exchanges for individual policies are projected to increase an average of 11% next year, nearly four times the increase for employer-based family policies. And some large insurers are pulling out of that market altogether in parts of the country.

Those who buy insurance on the exchanges often find that even with subsidies, they can’t afford to use the insurance because of mounting deductibles (about $6,000 for individual Bronze plans). It’s become clear that health insurance is not the same as health care.

In 2010 when Obamacare was enacted, about 50 million Americans (16%) were without health insurance. The U.S. was then spending some $2.6 trillion per year on health care. Last year, about 29 million (9%) remained uninsured, and we spent $3.2 trillion on health care in 2015 — $600 billion more than in 2010, while insuring only an additional 7% of Americans. This comes to nearly $30,000 for each person newly insured. That doesn’t seem like much of a bargain. Costs matter. Expanding access to health care, as Obamacare does, is only half the job. The other half requires controlling costs, so the system can be sustained.

The problem is that the underlying causes of the cost inflation were left largely untouched by Obamacare. The system remains in the hands of investor-owned insurance companies, drug companies, and profit-oriented providers that can charge whatever the market will bear — and in health care, the market will bear much more than in most sectors of the economy. Like all markets, this one is driven to expand, and does. Moreover, these industries are consolidating, so that they behave more like oligopolies than competitive businesses. President Obama was so eager for the political support of the health industries that he naively assumed they would modulate their drive for profits in the public interest.

What will the Trump administration do? While Trump calls for “repealing and replacing” Obamacare, he has never said what he would replace it with. But isolated proposals have been offered by other Republicans: They would permit insurance to be sold across state lines, which means that companies in states with lax regulations would be able to sell substandard plans elsewhere; they would abolish the mandate that requires people to buy insurance, but keep the provision that requires insurers to cover people with pre-existing conditions (an idea that would cause premiums to skyrocket); and they would promote health savings accounts, which are essentially tax-free savings plans that favor the wealthy. What is absolutely certain, given the Republican rhetoric and Trump’s nomination of Rep. Tom Price for secretary of Health and Human Services, is that we will move very sharply toward an even more expensive, inadequate and unequal health system.

Bernie Sanders had it right. The best way to provide universal health care at a sustainable cost is to extend Medicare to everyone, while implementing some needed reforms. Medicare is essentially a single-payer system for those over age 65 — government financed, but privately delivered. Because it uses the same profit-oriented providers as the rest of the system, it would need some reforms. That would include shifting hospitals and other providers to a non-profit delivery system, admittedly a huge challenge that could prove as controversial as Obamacare itself. We could ease the transition by switching to universal Medicare one decade at a time, starting by dropping the eligibility age from 65 to 55.

Paying for Medicare for All would require an increase in taxes — perhaps an earmarked progressive income tax for the purpose — but that increase would be offset by the elimination of premiums and out-of-pocket costs, and the slowing of inflation that stems from our market-based system. As it now stands, some 65% of health costs are already paid by the federal government in one way or another. Health policy experts estimate this would increase to 80% with Medicare for All. Since employers would no longer have the expense of providing health insurance, they would be more competitive in global markets and would likely hire more workers.

We are now between a rock and a hard place. Obamacare is faltering and the incoming Trump administration has no realistic alternative. Paradoxically, this might be exactly the right time to push for a national health program. Yes, repeal Obamacare, but not without replacing it, and the best replacement is Medicare for All. Some polls suggest most Americans favor such a system; we should pick up our metaphorical pitchforks and torches and make that preference known.

Marcia Angell is a corresponding member of the Faculty of Global Health and Social Medicine at Harvard Medical School and Faculty Associate in the Center for Bioethics. She stepped down as editor-in-chief of the New England Journal of Medicine in 2000.

http://www.usatoday.com…

President Obama on repealing ACA without replacement

Repealing the ACA without a Replacement — The Risks to American Health Care

By Barack H. Obama, J.D.
The New England Journal of Medicine, January 6, 2017

Health care policy often shifts when the country’s leadership changes. That was true when I took office, and it will likely be true with President-elect Donald Trump. I am proud that my administration’s work, through the Affordable Care Act (ACA) and other policies, helped millions more Americans know the security of health care in a system that is more effective and efficient. At the same time, there is more work to do to ensure that all Americans have access to high-quality, affordable health care. What the past 8 years have taught us is that health care reform requires an evidence-based, careful approach, driven by what is best for the American people. That is why Republicans’ plan to repeal the ACA with no plan to replace and improve it is so reckless. Rather than jeopardize financial security and access to care for tens of millions of Americans, policymakers should develop a plan to build on what works before they unravel what is in place.

Thanks to the ACA, a larger share of Americans have health insurance than ever before. Increased coverage is translating into improved access to medical care — as well as greater financial security and better health. Meanwhile, the vast majority of Americans still get their health care through sources that predate the law, such as a job or Medicare, and are benefiting from improved consumer protections, such as free preventive services.

We have also made progress in how we pay for health care, including rewarding providers who deliver high-quality care rather than just a high quantity of care. These and other reforms in the ACA have helped slow health care cost growth to a fraction of historical rates while improving quality for patients. This includes better-quality and lower-cost care for tens of millions of seniors, individuals with disabilities, and low-income families covered by Medicare, Medicaid, and the Children’s Health Insurance Program. And these benefits will grow in the years to come.

That being said, I am the first to say we can make improvements. Informed by the lessons we’ve learned during my presidency, I have put forward ideas in my budgets and a July 2016 article to address ongoing challenges — such as a lack of choice in some health insurance markets, premiums that remain unaffordable for some families, and high prescription-drug costs. For example, allowing Medicare to negotiate drug prices could both reduce seniors’ spending and give private payers greater leverage. And I have always welcomed others’ ideas that meet the test of making the health system better. But persistent partisan resistance to the ACA has made small as well as significant improvements extremely difficult.

Now, Republican congressional leaders say they will repeal the ACA early this year, with a promise to replace it in subsequent legislation — which, if patterned after House Speaker Paul Ryan’s ideas, would be partly paid for by capping Medicare and Medicaid spending. They have yet to introduce that “replacement bill,” hold a hearing on it, or produce a cost analysis — let alone engage in the more than a year of public debate that preceded passage of the ACA. Instead, they say that such a debate will occur after the ACA is repealed. They claim that a 2- or 3-year delay will be sufficient to develop, pass, and implement a replacement bill.

This approach of “repeal first and replace later” is, simply put, irresponsible — and could slowly bleed the health care system that all of us depend on. (And, though not my focus here, executive actions could have similar consequential negative effects on our health system.) If a repeal with a delay is enacted, the health care system will be standing on the edge of a cliff, resulting in uncertainty and, in some cases, harm beginning immediately. Insurance companies may not want to participate in the Health Insurance Marketplace in 2018 or may significantly increase prices to prepare for changes in the next year or two, partly to try to avoid the blame for any change that is unpopular. Physician practices may stop investing in new approaches to care coordination if Medicare’s Innovation Center is eliminated. Hospitals may have to cut back services and jobs in the short run in anticipation of the surge in uncompensated care that will result from rolling back the Medicaid expansion. Employers may have to reduce raises or delay hiring to plan for faster growth in health care costs without the current law’s cost-saving incentives. And people with preexisting conditions may fear losing lifesaving health care that may no longer be affordable or accessible.

Furthermore, there is no guarantee of getting a second vote to avoid such a cliff, especially on something as difficult as comprehensive health care reform. Put aside the scope of health care reform — the federal health care budget is 50% bigger than that of the Department of Defense. Put aside how it personally touches every single American — practically every week, I get letters from people passionately sharing how the ACA is working for them and about how we can make it better. “Repeal and replace” is a deceptively catchy phrase — the truth is that health care reform is complex, with many interlocking pieces, so that undoing some of it may undo all of it.

Take, for example, preexisting conditions. For the first time, because of the ACA, people with preexisting conditions cannot be denied coverage, denied benefits, or charged exorbitant rates. I take my successor at his word: he wants to maintain protections for the 133 million Americans with preexisting conditions. Yet Republicans in Congress want to repeal the individual-responsibility portion of the law. I was initially against this Republican idea, but we learned from Massachusetts that individual responsibility, alongside financial assistance, is the only proven way to provide affordable, private, individual insurance to every American. Maintaining protections for people with preexisting conditions without requiring individual responsibility would cost millions of Americans their coverage and cause dramatic premium increases for millions more. This is just one of the many complex trade-offs in health care reform.

Given that Republicans have yet to craft a replacement plan, and that unforeseen events might overtake their planned agenda, there might never be a second vote on a plan to replace the ACA if it is repealed. And if a second vote does not happen, tens of millions of Americans will be harmed. A recent Urban Institute analysis estimated that a likely repeal bill would not only reverse recent gains in insurance coverage, but leave us with more uninsured and uncompensated care than when we started.

Put simply, all our gains are at stake if Congress takes up repealing the health law without an alternative that covers more Americans, improves quality, and makes health care more affordable. That move takes away the opportunity to build on what works and fix what does not. It adds uncertainty to lives of patients, the work of their doctors, and the hospitals and health systems that care for them. And it jeopardizes the improvements in health care that millions of Americans now enjoy.

Congress can take a responsible, bipartisan approach to improving the health care system. This was how we overhauled Medicare’s flawed physician payment system less than 2 years ago. I will applaud legislation that improves Americans’ care, but Republicans should identify improvements and explain their plan from the start — they owe the American people nothing less.

Health care reform isn’t about a nameless, faceless “system.” It’s about the millions of lives at stake — from the cancer survivor who can now take a new job without fear of losing his insurance, to the young person who can stay on her parents’ insurance after college, to the countless Americans who now live healthier lives thanks to the law’s protections. Policymakers should therefore abide by the physician’s oath: “first, do no harm.”

http://www.nejm.org…

***

Comment:

By Don McCanne, M.D.

The negative consequences of repealing the Affordable Care Act without replacing it with measures that address some of the problems that ACA was designed to fix have been well publicized. President Obama is right to warn us about repealing ACA without replacing it. But the full story is more complex.

Although the Republicans are moving ahead with including repeal of ACA in the budget reconciliation process, we do not have any details about what is being repealed nor when the repeal would actually take place, if ever. And the Republicans have no clue as to what their replacement would be, especially since it is obvious that their favored proposals such as health savings accounts and selling insurance across state borders would not effectively address the deficiencies that would be recreated by repeal.

Of greater concern, President Obama’s warning about repealing without replacement misses the bigger picture. ACA only tweaked our dysfunctional financing system when we needed comprehensive reform.

Obama touts ACA measures that supposedly saved money by replacing quantity with quality, but, in fact, such measures have not had even a negligible impact on overall cost containment. What they have done is to increase administrative complexity and waste, resulting in an epidemic of physician burnout.

He touts the increase in the numbers of individuals insured, but ignores the deterioration in quality of the coverage through the increase in financial barriers to care, especially high deductibles, and the impaired access that is resulting from expanded use of ever narrower provider networks.

He expresses regret that guaranteeing coverage to individuals with preexisting disorders requires a very unpopular individual mandate to purchase insurance (to prevent adverse selection), and yet he remains silent on the fact that social insurance programs such as Medicare are extremely popular and they rely on automatic coverage instead on an individual decision on whether or not to comply with a mandate.

He repeats the tag line that he used when he rejected single payer reform: we need to “build on what works and fix what does not.” Yet ACA patched only a few problems but did not begin to address the major deficiencies of our health care financing infrastructure, especially those resulting in profound administrative waste. ACA provided tweaks when we needed a new infrastructure.

And then – Primum non nocere – First do no harm. A system in which people are suffering, going broke, and sometimes even dying, is a system which is doing great harm. Reform should not be slogan driven. It should be built on what really does work to actually reduce harm. A single payer national health program – improved Medicare for all – does precisely that.

Dr. Oliver Fein on ‘The Big Picture’

PNHP past president Dr. Oliver Fein appeared on “The Big Picture” on Jan. 6, 2017, to discuss the prospective repeal of the Affordable Care Act. He noted the negative impact that repeal would have on patients, critiqued the “market-based” alternatives proposed by Republicans, and argued in favor of a single-payer national health program.

Note: Dr. Fein’s segment starts at the 15:20 mark.

The Health Care Plan Trump Voters Really Want

By Drew Altman
The New York Times, January 5, 2017

This week Republicans in Congress began their effort to repeal and potentially replace the Affordable Care Act. But after listening to working-class supporters of Donald J. Trump — people who are enrolled in the very health care marketplaces created by the law — one comes away feeling that the Washington debate is sadly disconnected from the concerns of working people.

Those voters have been disappointed by Obamacare, but they could be even more disappointed by Republican alternatives to replace it. They have no strong ideological views about repealing and replacing the Affordable Care Act, or future directions for health policy. What they want are pragmatic solutions to their insurance problems. The very last thing they want is higher out-of-pocket costs.

The Kaiser Foundation organized six focus groups in the Rust Belt areas — three with Trump voters who are enrolled in the Affordable Care Act marketplaces, and three with Trump voters receiving Medicaid. The sessions, with eight to 10 men and women each, were held in late December in Columbus, Ohio, Grand Rapids, Mich., and New Cumberland, Pa. Though the participants did not agree on everything, they expressed remarkably similar opinions on many health care questions. They were not, by and large, angry about their health care; they were simply afraid they will be unable to afford coverage for themselves and their families. They trusted Mr. Trump to do the right thing but were quick to say that they didn’t really know what he would do, and were worried about what would come next.

They spoke anxiously about rising premiums, deductibles, copays and drug costs. They were especially upset by surprise bills for services they believed were covered. They said their coverage was hopelessly complex. Those with marketplace insurance — for which they were eligible for subsidies — saw Medicaid as a much better deal than their insurance and were resentful that people with incomes lower than theirs could get it. They expressed animosity for drug and insurance companies, and sounded as much like Bernie Sanders supporters as Trump voters.

The Trump voters in our focus groups were representative of people who had not fared as well. Several described their frustration with being forced to change plans annually to keep premiums down, losing their doctors in the process. But asked about policies found in several Republican plans to replace the Affordable Care Act — including a tax credit to help defray the cost of premiums, a tax-preferred savings account and a large deductible typical of catastrophic coverage — several of these Trump voters recoiled, calling such proposals “not insurance at all.” One of those plans has been proposed by Representative Tom Price, Mr. Trump’s nominee to be secretary of Health and Human Services. These voters said they did not understand health savings accounts and displayed skepticism about the concept.

When told Mr. Trump might embrace a plan that included these elements, and particularly very high deductibles, they expressed disbelief. They were also worried about what they called “chaos” if there was a gap between repealing and replacing Obamacare. But most did not think that, as one participant put it, “a smart businessman like Trump would let that happen.”

There was one thing many said they liked about the pre-Affordable Care Act insurance market: their ability to buy lower-cost plans that fit their needs, even if it meant that less healthy people had to pay more. They were unmoved by the principle of risk-sharing, and trusted that Mr. Trump would find a way to protect people with pre-existing medical conditions without a mandate, which most viewed as “un-American.”

If these Trump voters could write a health plan, it would, many said, focus on keeping their out-of-pocket costs low, control drug prices and improve access to cheaper drugs. It would also address consumer issues many had complained about loudly, including eliminating surprise medical bills for out-of-network care, assuring the adequacy of provider networks and making their insurance much more understandable.

Republican health reform plans would probably increase deductibles, not lower them. And providing the more generous subsidies for premiums and deductibles that these voters want would require higher taxes, something the Republican Congress seems disinclined to accept.

In general, the focus among congressional Republicans has been on repealing the Affordable Care Act. There has been little discussion of the priorities favored by the Trump voters who spoke to us. But once a Republican replacement plan becomes real, these working-class voters, frustrated with their current coverage, will want to know one thing: how that plan fixes their health insurance problems. And they will not be happy if they are asked to pay even more for their health care.

http://www.nytimes.com…

***

Comment:

By Don McCanne, M.D.

This survey of focus groups composed of Trump supporters confirms the anecdotal reports that many of them have been disappointed by Obamacare, but they want health insurance that is affordable and that works. They believe that President Trump will do the right thing even though they have no idea what that is.

Although they have a poor understanding of the complexities of insurance, what they do want is to keep their out-of-pocket costs low, control drug prices, improve access to cheaper drugs, eliminate surprise medical bills for out-of-network care, adequate provider networks, and make their insurance more understandable. What they seem to want are the policies of a single payer national health program. What they certainly would not want would be any of the replacement proposals of the Republican party if they understood how much worse affordability and access would be.

What we need are the replacement bills so that we can explain the damage they would do, but it appears that those bills are not forthcoming.

What we will probably see is a resolution, but not a requirement, to repeal features of Obamacare at some time in the distant future. The Republicans may then introduce replacement bills which they will tout as reform but will actually advance intolerable changes (privatizing Medicare, slashing Medicaid funding through block grants, establishing high risk pools without adequately funding them, etc.) that the Democrats will have to filibuster. Then the Republicans will be able to claim that they tried to replace Obamacare, but the Democrats blocked their reforms. They can then walk away, hoping everyone will have forgotten their resolution to repeal Obamacare.

The problems that people are blaming on Obamacare will still be there, even though they are mostly problems inherent in the highly flawed, fragmented financing infrastructure that was only minimally patched by Obamacare. When they see that the “repeal and replace” rhetoric was all hot air, they may be ready to accept an insurance program that they can understand and that will meet their needs – a single payer, improved Medicare for all.

Tom Price, Trump’s pick for HHS head, opposed by NYC doctors

By Sheila Anne Feeney
amNewYork, Jan. 5, 2017

The massive rollback of the Affordable Care Act (ACA) that Republicans plan is a “strategic attempt to perpetuate injustice” and — in a nod to Senator Chuck Schumer’s line — will “make America sick again,” Dr. Priscilla Chukwueke, a resident psychiatrist at Harlem Hospital, said Thursday at a Lower East Side news conference.

Chukwueke, who lauded the ACA for expanding access to care for people with mental health disorders, charged that policies championed by Tom Price, President-elect Donald Trump’s nominee for Health and Human Services secretary, put “politics and profits over patients” and would lead to increased anguish for New Yorkers.

Chukwueke was one of about a dozen physicians, including city Health Commissioner Dr. Mary Bassett, who appeared in freezing temperatures outside the Catherine M. Abate Health Center to oppose Price’s nomination.

Price, a former orthopedic surgeon, has advocated segregating sick patients into “high risk pools” and eliminating federal funding of Planned Parenthood. Price has also supported cutting Medicaid and privatizing Medicare.

“In this instance, the Price is very wrong,” said Dr. Oliver Fein, chair of Physicians for a National Health Program. Fein urged New Yorkers to tell Sens. Schumer and Kirsten Gillibrand to vote against Price’s confirmation.

The senators “are standing strong now,” but will need the support of their constituencies to withstand pressure to make compromises, said Fein, noting how a recent outcry reversed the GOP plan to gut the Office of Congressional Ethics.

Price’s preferred method of delivering Medicaid would restrict access to HIV/AIDS treatment for the most vulnerable patients, and Medicare recipients would face higher out-of-pocket prices, while insurers and Wall Street profit at their expense, Fein added.

Bassett said that doctors must not only heal with their hands, but with their voices. “We speak out, we speak up, and we advocate…I’m proud to lend my voice to this effort,” said Bassett. She added that the ACA, Medicare and Medicaid needed expansion, not contraction.

http://www.amny.com…

Additional coverage of the action:

WMBC-TV: News Video – Obamacare Debate
https://www.youtube.com…

NY1: City Doctors Urge Congress to ‘Do No Harm’ to Affordable Care Act
http://www.ny1.com…

CIR SEIU: Facebook Live Video
https://www.facebook.com…

Doctors, Nurses Still Divided on Tom Price

Trump’s choice for HHS secretary ignites debate

By Shannon Firth
MedPage Today, Jan. 5, 2016

WASHINGTON — When President-elect Trump chose Rep. Tom Price (R-Ga.) to be Secretary of Health and Human Services, he poked an already buzzing hornet’s nest.

Like the rest of the country, doctors, nurses, and medical students have very divided opinions about the government’s role in healthcare. Price’s nomination amplifies that division.

The American Medical Association (AMA) voiced immediate support for Price, while the American Medical Students Association (AMSA), Physicians for a National Health Program (PNHP), and National Nurses United (NNU) roundly condemned the nominee. Most other physician and nurse organizations voiced something between concern and resignation.

MedPage Today spoke with the leadership of several physician and nursing groups to understand their concerns and in some cases highlight areas of agreement.

Line In the Sand

On Nov. 29, the AMA backed Price, a member of the association’s House of Delegates, in a press statement: “Dr. Price has been a leader in the development of health policies to advance patient choice and market-based solutions as well as reduce excessive regulatory burdens that diminish time devoted to patient care and increase costs,” wrote Patrice Harris, MD, a psychiatrist from Atlanta and chair of the AMA Board of Trustees.

That statement infuriated many physicians, including AMA members and nonmembers alike.

For example, the Clinician Action Network, led by Manik Chhabra, MD, Navin Vij, MD, and Jane Zhu, MD, MPP, posted a letter that has since gathered 5,000 signatures from clinicians across the country: “We believe that in issuing this statement of support for Dr. Price, the AMA has reneged on a fundamental pledge that we as physicians have taken — to protect and advance care for our patients.”

The letter criticized Price’s record and presumed agenda, such as “the dismantling of Medicaid” and “proposals to reduce funding” for the Children’s Health Insurance Program. The group also worried that essential benefits such as opioid use disorder treatment, prenatal care, and access to contraception would be threatened.

Harris explained that the AMA’s support should not be viewed as a blanket endorsement for every one of Price’s positions. She also recalled the “flurry of objections” that targeted another physician nominee, C. Everett Koop, MD, who served as surgeon general under President Ronald Reagan. Koop is now remembered for his efforts to prevent tobacco use and to promote safe sex for AIDS prevention.

Initially, many physicians were alarmed by Koop’s anti-abortion stance, Harris noted. But “Dr. Koop’s one-time opponents later cited him as a role model for how the U.S. surgeon general can help the nation face serious health care challenges.”

Some Docs Enthusiastic

Others, like Jane Orient, MD, executive director of the Association of American Physicians and Surgeons, who practices in Tucson, Ariz., offered unqualified support for Price’s nomination.

Orient said she shares Price’s views on reproductive rights and does not believe taxpayers should pay for another person’s abortion or birth control, which she said “is quite reasonably priced.”

She said she considers Price’s critics’ concerns for health equity “laughable.”

“Instead of trying to have the optimal medical care for everybody and [giving] people the right to choose their own medical care and the right to control of their own money, they want to take these resources out of the hands of people making decisions for themselves and put it in the hands of bureaucrats who have this whole formula to decide what they think is equitable. And they don’t think it’s equitable for people to spend their own money for their own medical care,” Orient said.

“Tom Price has been in favor of allowing people to do this, even if they’re on Medicare,” she said, referring to Price’s support for Medicare privatization.

Red Flags for Others

While PNHP has been critical of the Affordable Care Act, wholesale repeal is not the solution the group has in mind — that is, unless the ACA were replaced with a single-payer system, Robert Zarr, MD, a pediatrician based here and a past PNHP president, said in a phone interview with MedPage Today.

Instead, Zarr anticipates an acceleration of healthcare privatization: “We’ll see it go a lot faster now that we have a House and a Senate and a White House presumably agreeing on this one premise — which is ‘private is good, public is bad.'”

“People who have HIV, who have advanced kidney disease … people who are living in devastated communities economically … If access to healthcare is made harder and harder, then they’re going to have a shorter lifespan, and they’re going to suffer more before they die.”

Many nurses also oppose Price’s nomination, Deborah Burger, RN, of Santa Rosa, Calif., and co-president of National Nurses United, the largest nurses union in the country, told MedPage Today in a phone interview.

If the ACA is repealed, one of the first steps in that repeal will likely involve a reversal of the tax increases that fund subsidies that help people afford their premiums.

And the revenue for Republicans’ proposed block grants for Medicaid won’t be there, she continued.

Seeking Common Ground

Other nurses like Pamela Cipriano, PhD, RN, president of the American Nurses Association, also criticized Price’s record on diversity and inclusion, as well as his opposition to gay marriage.

As more people declare their gender identity and sexual identity, they have been ostracized and stigmatized by clinicians, said Cipriano: “The healthcare community really needs to step up to make sure that these [LGBTQ] individuals … are being adequately cared for, and if there’s an inherent bias in the leaders of our Health and Human Services [Department], that doesn’t bode well for the healthcare community really embracing their needs.”

Price will very likely be confirmed, said Cipriano. She hopes that he will listen to nursing groups. In addition to supporting continued federal funding for nursing education, Cipriano hopes Price will set partisanship aside and embrace the “triple aim” — improving access, quality, and affordability of healthcare — and continue to advance value-based payment.

The American Congress of Obstetricians and Gynecologists (ACOG), in a letter to Price concerning his opposition to federal funding for abortion and for Planned Parenthood, sounded a warning: “Planned Parenthood clinics provide critical preventative healthcare services to women and men. Abortion is healthcare. ACOG remains committed to protecting each of these critical aspects of women’s health.”

The group also acknowledged areas where Price’s views aligned with its own: Medicare physician payment reform, repeal of the Independent Payment Advisory Board, and medical liability reform.

“Your consistent efforts to find common ground and work together on shared goals are laudable, and your commitment to accomplishments, rather than talking points, is unfortunately all too rare in Washington. We hope that you will use your new role as an opportunity to expand on these collaborative practices,” ACOG wrote.

Laura Wooster, MPH, executive vice president of public policy for the American Osteopathic Association, also sounded a cautious tone in a phone call with MedPage Today. “Other than stating our priorities, it seems premature to really start getting vocal,” she said, explaining that the group doesn’t normally endorse or oppose nominees.

She noted, though, that many of the group’s members have echoed one of Price’s talking points, the “administrative burden” that government involvement in healthcare can sometimes bring.

Senate Opposition Brewing?

Even though confirmation seems assured, Price still must face grilling and probable opposition from Senate Democrats.

On Thursday, Democrats in Congress called for an ethics probe into Price’s financial holdings and investments. Price traded $300,000 worth of shares in health-related companies while in the House, according to The Wall Street Journal.

“There’s enough evidence here that cries out for an investigation. Whether the law was actually broken, whether there [were] quid pro quos or inside information is the better way to put it — we don’t know,” said Senate Minority Leader Chuck Schumer (D-N.Y.) at a news conference, as reported by CNN.

MedPage Today will continue to follow that story.

Shannon Firth is Washington correspondent for MedPage Today.

http://www.medpagetoday.com…

Wilkes Barre Labor Council and Two USW Locals Endorse HR 676

By Kay Tillow
All Unions Committee for Single Payer Health Care – HR 676, Jan. 4, 2017

The Greater Wilkes Barre Labor Council and two United Steelworkers locals in Wilkes Barre, Pennsylvania, have endorsed Congressman John Conyers’ HR 676, national single payer health care legislation, Expanded and Improved Medicare for All.
 
The Labor Council, comprised of 47 locals from 28 unions representing 10,000 members, endorsed HR 676 at their monthly meeting on December 22, 2016, becoming the 152nd central labor council to take this action.
 
The two USW locals together have more than 1,650 members. USW Local 5652, an amalgamated local, represents workers in a variety of jobs including making shelving and heating cabinets for restaurants, manufacturing gears for airplanes, repairing utility trucks, and working at a correspondence school.
 
USW Local 15253 represents workers who do heavy highway construction from the Maryland border to the New York border and from the New Jersey border to the middle of Pennsylvania.
 
William Herbert, Treasurer of Local 5652 said “We’ve been getting ripped off by insurance companies.” He told of the crises faced by even heart attack patients who are confronted with demands for up front payments as high as $1,700. Herbert worked successfully to get his Congressperson, Matt Cartwright, to sign on to HR 676.
 
Herbert made the following statement on behalf of his local:

“USW Local 5652 passed a resolution calling on Congress to pass H.R. 676. For too long the insurance and pharmaceutical industries have been charging outrageous prices for their products. The bill would extend Medicare to everyone and eliminate co-pays and deductibles. We feel that this is the only way to insure health care for all Americans. If this bill passed, we would no longer need to negotiate for health care in our contracts. If an employee gets laid off his insurance would continue at the same level. We urge all Americans to call their Representatives in Congress and the Senate and ask them to pass H.R. 676.”

The HR 676 endorsement resolutions were signed by President Dave Brandt of Local 5652 and President Joseph M. Padavan of Local 15253. Padavan is also president of the Greater Wilkes Barre Labor Council.

Issued by:

Kay Tillow, Coordinator
All Unions Committee for Single Payer Health Care – HR 676
c/o Nurses Professional Organization (NPO)
1169 Eastern Parkway, Suite 2218
Louisville, KY 40217
(502) 636 1551

nursenpo@aol.com
unionsforsinglepayer.org
facebook.com/unionsforsinglepayer

HR 676 would institute a single payer health care system by expanding a greatly improved Medicare to everyone residing in the U. S. Patients will choose their own physicians and hospitals.
 
HR 676 would cover every person for all necessary medical care including prescription drugs, hospital, surgical, outpatient services, primary and preventive care, emergency services, dental (including oral surgery, periodontics, endodontics), mental health, home health, physical therapy, rehabilitation (including for substance abuse), vision care and correction, hearing services including hearing aids, chiropractic, durable medical equipment, palliative care, podiatric care, and long term care.
 
HR 676 ends deductibles and co-payments. HR 676 would save hundreds of billions annually by eliminating the high overhead and profits of the private health insurance industry.
 
In the current Congress, HR 676 has 62 co-sponsors in addition to Congressman Conyers.
 
HR 676 has been endorsed by 627 union organizations including 152 Central Labor Councils/Area Labor Federations and 44 state AFL-CIO’s (KY, PA, CT, OH, DE, ND, WA, SC, WY, VT, FL, WI, WV, SD, NC, MO, MN, ME, AR, MD-DC, TX, IA, AZ, TN, OR, GA, OK, KS, CO, IN, AL, CA, AK, MI, MT, NE, NJ, NY, NV, MA, RI, NH, ID).

The list of union endorsers.
The sample endorsement resolution.