By Eric Naumburg, M.D.
Physicians for a National Health Program – Maryland

On March 29, 2017, several dozen health care activists undertook a project at the U.S. Capitol; the goal was to drop off information about improved Medicare for all to each of the 535 U.S. senators and representatives.

Our purpose was to collect contact information for each health care legislative assistant (LA) and build a database for future communications. Health Over Profit organized the day and the database is available on their website here; use it to contact you legislator. 

We went in teams of two or more and divided up each building by floors. We visited each office, introduced ourselves, identified the group we represented, and told the staff person that we wished to leave information about improved Medicare for all for the health care legislative assistant. The handout was a one-pager that was formatted so that it was a quick read.

In some offices; we asked to speak with the LA or the senator/representative if they were available. This can be time consuming, but it did lead to some interesting exchanges. In general, the staff at the front desk are very polite. The LA business cards are usually sitting at the front desk. Only one door was locked: House Speaker Paul Ryan’s.

If you want to speak to specific legislator or their aide it is better to call the office and set up an appointment. Even if you have an appointment with a legislator, you may end up talking to the aide because when Congress is in session, legislators don’t have control of their daily schedules. Be prepared to leave a handout, as well as your business card, and practice what you want to say. Be sure to follow up at a later date!

Getting more co-sponsors for H.R. 676, the “Expanded and Improved Medicare for All” was not our primary goal. For co-sponsors of H.R. 676, we thanked them for their support and urged them to speak with their colleagues about becoming co-sponsors.

Photo: On the way to the Senate, 435 down, 100 to go.

Efficient. Effective. Practical. Make no mistake, there is a strong conservative case to be made for single payer. This is important because, as our health care crisis deepens, we need to make sure we’re speaking to all Americans. Only then can we can build a broad-based movement that pressures Congress to do the right thing.

To date, no Republican has co-sponsored H.R. 1384, the Medicare for All Act of 2019, nor did any Republican co-sponsor H.R. 676, the previous single-payer bill in the House. In order for this to happen, members need to hear from their constituents. If you live in a red district, we encourage you to call (202) 224-3121 today. (Click here to find your member of Congress.)

When speaking with a conservative member of Congress – or a conservative colleague, friend, or family member, for that matter – keep the following in mind:

Know your audience

Many single-payer advocates argue that “health care is a human right,” but conservatives may be more persuaded by appealing to the values of loyalty, sanctity, and authority. Dr. Ed Weisbart gave an excellent talk recently, titled Progressive Persuasions: Speaking Beyond the Choir, that explores this topic in detail (see video below).

Dispel common myths

Myth: Single payer is socialized medicine!
Reality: Medicare-for-all applies the principles of the free market to the delivery of health care. Under traditional Medicare, doctors and hospitals compete to attract patients through service, quality, and access – rather than competing to be in the best-reimbursed insurance plans. Medicare-for-all would open up this patient-centered free market to all Americans.

Myth: Single payer would lead to rationing!
Reality: Today’s private health insurance is incredibly restrictive, with narrow provider networks, cost-sharing, and a growing list of treatments that simply aren’t covered. Private insurance comapnies have a financial incentive to deny care, and they often do. Medicare-for-all would make it much easier for patients to access medically necessary care.

Myth: Single payer would stifle innovation!
Reality: Americans are justifiably proud of our nation’s leadership in medical innovation, but may not realize that most of those innovations are paid for using public funds. As pharmaceutical companies engage in trivial research designed to extend patents, our National Institutes of Health funds truly pioneering work. Medicare-for-all would strengthen the alignment of research with our most pressing health needs.

Expose the Canadian boogeyman

Some of the most pervasive myths about single payer relate to Canada’s Medicare program. Many Americans have heard that Canadians suffer long wait times, and flock to the United States to seek medical care. Thankfully, these myths are easily disproven. Consider the following:

•    The 2002 Health Affairs study Phantoms in the Snow found that an exceedingly small number of Canadians seek care in the U.S.

•    Waiting lists in Canada can be primarly attributed to lower health spending. Despite this, Canadians do not have to wait to be treated for life-threatening diseases and report fewer unmet health needs overall (see this NBER paper, Table 12).

•    Former Canadian Medical Association Journal editor-in-chief and one-time market proponent David Woods says single payer is essential to controlling costs.

•    George Mason University law professor Frank Buckley believes Republicans should embrace single payer, and points to the benefits of Medicare in his native Canada.

•    Bottom line? Canadian health outcomes are better than American health outcomes, including longer life expectancy and fewer chronic conditions. These gaps have been growing ever since Canada fully implemented its Medicare program in the early 1970s.

Cutting overhead and bureaucracy

Your conservative representative may agree with you that single payer would provide high-quality care, but they may also also argue that the private sector is more efficient than the federal government, and therefore a better steward of our health care dollars.

However, it is our current, market-oriented system that generates the greatest amount of waste and profiteering. Conservatives who hate bureaucracy should be champing at the bit to do away with private insurance company overhead. A February 2017 estimate published in the Annals of Internal Medicine found that single payer would generate $504 billion in administrative savings annually.

Economists and public health experts have consistently shown that single payer is an efficient and effective use of resources. Here are some prominent examples:

•    PNHP co-founders, Drs. David Himmelstein and Steffie Woolhandler, argue that single payer would allow for Liberal Benefits, Conservative Spending.

•    Nobel laureate Angus Deaton favors single payer “because it will get this [health care] monster that we’ve created out of the economy and allow the rest of capitalism to flourish.”

•    Nobel laureate and noted health care economist Kenneth Arrow lauds the Canadian system (with its private practitioners) and says single payer is “better than any other system.”

Boosting American business

Conservative members of Congress often voice concern over the global competitiveness of American business, and rising health care costs are harmful in that regard. Under single payer, U.S. firms might contribute as much to health care as they do now via a payroll tax, but they would no longer need to shop for group policies. They would also be spared the outrageous annual cost increases that have become commonplace in the large- and small-group markets.

For workers, single payer would allow those who are not a good fit for their jobs to seek more productive employment elsewhere instead of staying put in order to preserve health benefits. And would-be entrepreneurs would no longer fear striking out on their own due to a lack of health insurance.

Ultimately, improved Medicare-for-all would ensure a healthier, more financially-secure workforce. Thankfully, employers are starting to take notice:

•    The group Business Leaders Transforming Healthcare “strongly supports legislation to transition the United States to a publicly funded health care system.”

•    MCS Industries founder and owner Richard Master has produced a documentary, FIX IT: Health Care at the Tipping Point, that lays out the business case for single payer.

•    Berkshire Hathaway vice-chairman (and longstanding Republican) Charlie Munger says single payer is the solution to America’s health care woes.

•    Marks Group owner and prominent blogger Gene Marks considers himself a “smaller government, fiscally right-of-center guy,” but has concluded that single payer would be best for business.

Conservative voters are embracing single payer

Now that Congressional Republicans have unveiled the American Health Care Act, a growing number of their supporters are recognizing the empty promise of “repeal and replace.” They are demanding real reform, as evidenced by an April 2017 Economist/YouGov poll that found 46% of Republicans and 40% of Trump voters favor “Expanding Medicare to provide health insurance to every American.”

Single-payer reform is vitally important, and progressives can’t go it alone. Talk to your conservative friends, colleagues, family members, and elected officials. Listen to their concerns. Let them know that a humane, efficient, high-quality health care system is possible, but only if we work together.

The Lancet devotes special issue to growing U.S. health inequality

Leading British medical journal The Lancet has published a series of papers exploring persistent and growing health inequality in the United States. The series was published in the April 8, 2017 issue of The Lancet, and was curated by PNHP co-founders Drs. David Himmelstein and Steffie Woolhandler, along with Dr. Samuel Dickman.

“America: equity and equality in health” explores the effects of racial segregation, mass incarceration, economic inequality, and a lack of universal health care in the U.S. It comes at an important time in the national health care debate, as policymakers are grappling with the failure of the GOP “repeal and replace” bill, the American Health Care Act, and citizens are demanding a better health care system; one that addresses the gaps that remain after implementation of the Affordable Care Act.

Below, you can access links to the series papers; various interviews and events; national media coverage of the series; and an extensive infographic.

To read PNHP’s news release on the series, click here. The full series can be accessed for free (registration required) at thelancet.com/us-health.

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Series Papers

Paper 1: Inequality and the health-care system in the USA
By Samuel L. Dickman, M.D., David U. Himmelstein, M.D., and Steffie Woolhandler, M.D., M.P.H.
http://thelancet.com…

Paper 2: The Affordable Care Act: implication for health-care equity
By Adam Gaffney, M.D. and Danny McCormick, M.D.
http://www.thelancet.com…

Paper 3: Structural racism and health inequities in the USA: evidence and interventions
By Zinzi D. Bailey, Sc.D., Nancy Krieger, Ph.D., Madina Agénor, Sc.D., Jasmine Graves, M.P.H., Natalia Linos, Sc.D., and Mary T. Bassett, M.D.
http://www.thelancet.com…

Paper 4: Mass incarceration, public health, and widening inequality in the USA
By Christopher Wildeman, Ph.D. and Emily A. Wang, M.D.
http://www.thelancet.com…

Paper 5: Population health in an era of rising income inequality in the USA: 1980-2015
By Jacob Bor, Sc.D., Gregory H. Cohen, M.Phil., and Sandro Galea, M.D.
http://www.thelancet.com…

Editorial: America, all things not being equal
By The Lancet
http://www.thelancet.com…

Comment: An agenda to fight inequality
By Sen. Bernie Sanders
http://www.thelancet.com…

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Interviews & Events

Lancet Podcast: America, equity and equality in health
Interview with David Himmelstein, M.D. and Steffie Woolhandler, M.D., M.P.H.
http://www.thelancet.com…

Lancet Podcast: America, equity and equality in health
Interview with Samuel L. Dickman, M.D.
http://usa.thelancet.com…

Symposium: Income Inequality and Health in America
Boston University School of Medicine, April 10, 2017
Panel featuring Zinzi D. Bailey, Sc.D., Jacob Bor, Sc.D., Samuel L. Dickman, M.D., Adam Gaffney, M.D., and Steffie Woolhandler, M.D., M.P.H.
https://livestream.com…

Symposium: Inequality and Health in the U.S.
Harvard Medical School, April 24, 2017
Panel featuring Adam Gaffney, M.D., Samuel L. Dickman, M.D., Jacob Bor, Sc.D., Christopher Wildeman, Ph.D., and Mary T. Bassett, M.D., M.P.H. Panel moderated by Joan Reede, Harvard Medical School. Virtual welcome and remarks by Sen. Elizabeth Warren.
https://hms.mediasite.video.harvard.edu…

Symposium: Equity and Equality in Health
Roosevelt House, Public Policy Institute at Hunter College, May 1, 2017
Program featuring Mary T. Bassett, M.D., M.P.H., Paul Krugman, Ph.D., and David Himmelstein, M.D. Discussion moderated by Lilliam Barrios-Paoli, Ph.D.
http://www.roosevelthouse.hunter.cuny.edu…

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Media Coverage

Inequality is a life and death matter
By Steffie Woolhandler, M.D., M.P.H. and David Himmelstein, M.D.
HuffPost, May 8, 2017
The Republican effort to gut the Affordable Care Act threatens a health care catastrophe. But blocking a backward move isn’t enough. The overall U.S. death rate is rising. The survival gap between rich and poor is widening. Continue reading…

The cost of economic inequality to the nation’s physical health
By Jacob Bor, Sc.D. and Sandro Galea, M.D.
The Boston Globe, April 25, 2017
After its unsuccessful push to reconfigure the U.S. health care system, the Trump administration has signaled that it will turn its attention to tax reform. While the details of the administration’s plan are still unclear, President Trump has indicated in the past a willingness to embrace measures that would greatly favor the wealthy. Continue reading…

Rich Americans live up to 15 years longer than poor peers, studies find
By Jessica Glenza
The Guardian, April 6, 2017
You can’t buy time – except, it seems, in America. Increasing inequality means wealthy Americans can now expect to live up to 15 years longer than their poor counterparts, reports in the British medical journal the Lancet have found. Continue reading…

Rich Americans Live 15 Years Longer Than Poo
r Counterparts: Study
By Anthony Cuthbertson
Newsweek, April 7, 2017
Wealth and health are intrinsically linked in the United States, with rich Americans living between 10 to 15 years longer than their poor counterparts, a study has found. A series of five papers published in the medical journal The Lancet found that a widening income gap, structural racism and mass incarceration are fueling growing health inequalities. Continue reading…

The Richest Americans Live 10 Years Longer than the Poorest
By Alice Park
Time Magazine, April 6, 2017
Money may not buy you happiness, but it may help buy you health, and ultimately a longer life. Researchers analyzing data on income disparities and health outcomes in the U.S. found that health gaps between the rich and poor are widening, and that’s translating to bigger differences in how long people live. Continue reading…

Want to Live Longer? Be Rich
By Jesse Singal
New York Magazine, April 7, 2017
You probably already know that health care in the United States is a bit of a disaster. That’s one of the primary reasons a single piece of bad luck can be ruinous for so many Americans. Continue reading…

Three Insights About Inequality in American Health Care
By Jesse Singal
New York Magazine, April 11, 2017
Lately, it has felt like the debate over Obamacare has masked some of the bigger questions swirling around the U.S. health system. Obamacare is important, yes, but America’s issues on this front run much, much deeper than the presence or absence of that one law. Continue reading…

What we know about the 30 million Americans who are still uninsured
By Julia Belluz
Vox, April 7, 2017
The size of the uninsured group is well-known, but less clear is what this group looks like. A new series in the Lancet on health inequality paints a pretty good picture. People who go without insurance in America are not refusing coverage for ideological reasons: They simply can’t afford to pay. Continue reading…

Lancet series puts spotlight on health inequity in the U.S.
By Paige Minemyer
Fierce Healthcare, April 7, 2017
Societal issues in the U.S., including systemic racism, poverty and mass incarceration, contribute to health inequity, a new series of studies has found. The Lancet released a five-part look at health inequity in the U.S., titled the “United States of Health.” Continue reading…

You Can Thank Racism, Mass Incarceration, and Our Health System for the Survival Gap Between the Rich and Poor
By Nick Keppler
Vice News, April 11, 2017
The United States’ for-profit healthcare system not only fails miserably to offer the same life-extending treatments to the poor as it does the rich, but it also reinforces racial and socioeconomic disparities, according to a wide-ranging five-part series published in the medical journal The Lancet. Continue reading…

The Prison-Health Paradox
By Olga Khazan
The Atlantic, April 7, 2017
A recent review of the impacts of incarceration on health published Thursday in The Lancet hints at a surprising upshot: Getting out of jail can be miserable, but going to jail can temporarily protect health—at least for some men. Continue reading…

When a man goes to prison, his children’s health suffers, too, study finds
By Max Blau
STAT, April 6, 2017
Researchers found that children of incarcerated men have higher rates of asthma, obesity, substance misuse, and behavioral and mental health problems. And the impact can linger for years, even into their adulthood. Continue reading…

Children Of Incarcerated Fathers Often Suffer Health Issues That Can Last Through Adulthood
By Cameron Norsworthy
Romper, April 6, 2017
Incarceration affects families emotionally and socially, and new research shows that there are long-lasting physical complications as well. According to a recent study, the children of incarcerated fathers often suffer health issues to intense degrees, and these health issues are often chronic conditions that can last all the way through adulthood. Continue reading…

Rich black people have worse health than rich white people
By Jessica Hamzelou
New Scientist, April 6, 2017
America’s health is in poor shape. The health gap between the rich and poor is now far bigger than the difference in income – that’s one of the messages from a series of papers published in The Lancet today. But wealth is only part of the problem. Continue reading…

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Infographic

In late November, president-elect Donald Trump named Rep. Tom Price (R-GA) as the man he wanted to head the Department of Health and Human Services. If confirmed by the Senate, Price’s record suggests that he would be a disaster for patients, doctors, and anyone who cares about health justice in the United States. Consider the following:

* As a member of Congress, Price introduced the Empowering Patients First Act, intended to replace the Affordable Care Act. This bill relies on discredited policies such as high-risk pools, individual tax credits, and allowing insurers to sell bare-bones policies. If signed into law, it would eliminate coverage for millions of Americans.

* Together with House Speaker Paul Ryan, Price has pushed for “premium support” (i.e. vouchers) for Medicare. This would threaten traditional Medicare, increase out-of-pocket costs, and bolster the profits of the private insurance and financial services industries.

* Together with Centers for Medicare and Medicaid Services nominee Seema Verma, Price has voiced support for converting Medicaid into block grants. This would allow states to introduce cruel, counterproductive policies that compromise the health of their poorest residents. (Verma’s health savings accounts in Indiana are a prime example.)

* Price has proven hostile to family planning, and has endorsed policies that would place millions of women at risk. His extreme views include opposition to abortion under almost all circumstances, a preference for “religious freedom” over access to contraception, and an obsession with eliminating federal funding for Planned Parenthood.

* Price has a long history of opposing LGBT rights. As HHS secretary, he may decline to enforce nondiscrimination provisions of existing laws. Furthermore, his preferred Medicaid policies would restrict access to HIV/AIDS treatment for the most vulnerable patients.

This is precisely the wrong direction for our health care system. The last thing we need are policies that further deny access to care and that concentrate even more power in the hands of corporate interests. What we do need, now more than ever, is a single-payer national health program – an improved Medicare for all.

We encourage you to contact your senators today and voice your opposition to the nominations of Tom Price (HHS) and Seema Verma (CMS). And while you’re at it, press them to support single-payer legislation in the Senate that would, at long last, provide Americans with universal access to quality health care.

To contact your senators, simply call the U.S. Capitol switchboard at (202) 224-3121. You can also click here for senator-specific contact information (direct phone numbers and email submission forms).

You may also wish to sign the National Physicians Alliance online petition opposing Price’s nomination, which can be endorsed by NPA members and non-members alike. Click here to access the petition, which will be submitted to Congress in the near future.

More on the Price and Verma nominations:

Price contradicts himself on the supposed virtues of high-deductible health plans:
https://www.youtube.com…

PNHP calls on Trump to rescind the Price and Verma nominations:
https://pnhp.org…

SNaHP takes medical societies to task for their endorsements of Price:
https://pnhp.org…

Dr. Don McCanne envisions trouble ahead with the nominations of Price and Verma:
https://pnhp.org…

Dr. Don McCanne decries Verma’s push for “skin in the game” for Medicaid beneficiaries:
https://pnhp.org…

Dr. Adam Gaffney says Price would be a “horrible choice” for health secretary:
http://inthesetimes.com…

RoseAnn DeMoro of NNU critiques Price’s promise of universal “access”:
http://www.alternet.org…

The New York Times reports on opposition to the Price nomination among physicians:
http://www.nytimes.com…

The Wall Street Journal reports on Price’s financial conflicts of interest:
http://www.wsj.com…

ScienceBlogs reveals Price’s membership in an anti-science fringe group:
http://scienceblogs.com…