Click HERE to access archival materials from our Nov. 4-5 conference in Boston!

Location

The Annual Meeting and related events were held at the Boston Park Plaza, located at 50 Park Plaza at Arlington Street, Boston, MA 02116.

Covid Safety Protocols

PNHP’s Board of Directors and medical experts have established Covid safety protocols for the Annual Meeting that include a surgical facemask requirement while not actively eating or drinking; proof of vaccine within the last 5 months (physical card, photo, or electronic record is fine); and proof of a negative Covid test (time-stamped photo of a rapid antigen test is fine) taken within 24 hours of the Summit.

Speakers and Program

See below for final scheduled; conference speakers included:

• Linda Villarosa, contributor to The New York Times’ 1619 Project and author of Under the Skin: The Hidden Toll of Racism on American Lives and the Health of Our Nation (speaking Saturday late afternoon)
• Donald Cohen, executive director of In the Public Interest and co-author of The Privatization of Everything (speaking Saturday late morning)
• Philip Verhoef, M.D., Ph.D., president-elect, PNHP
• Susan Rogers, M.D., president, PNHP

SNaHP Summit: Friday, Nov. 4, 8:00 a.m. to 12:00 p.m. Final schedule HERE

Leadership Training: Friday, Nov. 4, 1:00 to 5:00 p.m.; small group meetings 5:00 to 6:30 p.m.; dinner 6:30 to 8:00 p.m. Final schedule HERE

Annual Meeting: Saturday, Nov. 5, 9:00 a.m. to 5:00 p.m.; small group meetings 5:00 to 7:00 p.m.; dinner (with programming) 7:00 to 9:00 p.m. Final schedule HERE

To request a meeting for a Member Interest Group (MIG), please contact deputy director Matthew Petty at matt@pnhp.org 

This conference was not livestreamed in its entirety, but recordings of select sessions are available at pnhp.org/boston22.

Student and Resident Scholarships

Scholarships were provided to 74 students and residents, helping to cover the cost of travel, lodging, and registration.

PNHP members and the public can support PNHP’s student outreach programs by making a GIFT to the Nicholas Skala Student Fund.

Related Action

Public health workers at the APHA Annual Meeting participated in a “Rally for Public Health Reproductive Justice” on Sunday, Nov. 6 at 1:00 p.m. The rally was held outside the Boston Convention and Exhibition Center entrance on Summer St.

This demonstration against the recent Dobbs v. Jackson Women’s Health Organization decision and continuing attacks on reproductive justice was endorsed by multiple APHA sections and caucuses (Maternal Child Health, Black, Women’s, Peace, LGBT, Socialist, and others); Massachusetts Planned Parenthood; Medical Students for Reproductive Choice; and Physicians for National Health Program.

Related Event

The 2022 Health Activist Dinner at APHA was held Sunday, Nov. 6 from 6:00 to 9:00 p.m. PNHP was a co-sponsor of this event.

This year’s honorees included Michelle Morse, M.D., M.P.H. (Paul Cornely Award); Riyadh Lafta, M.B.Ch.B., Ph.D. (Edward Barsky Award); and Rep. Ayanna Pressley (Paul Wellstone Award). Ted Brown, Ph.D., delivered a keynote address on “A Heroic History of the U.S. Health Left.”

Previous Annual Meetings

Click HERE to view photos from our previous in-person Annual Meeting (2019 in Philadelphia).

Click HERE for materials from our (fall) 2021 virtual Annual Meeting, HERE for materials from our (spring) 2021 virtual Leadership Training, and HERE for materials from our (fall) 2020 virtual Annual Meeting.

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Attending the 2022 PNHP Annual Meeting is entirely voluntary and requires attendees to abide by any applicable rules of conduct or local or state laws that may be announced at any time. Attendees acknowledge the highly contagious and evolving nature of Covid-19 and voluntarily assume the risk of exposure to or infection with the virus by attending the Meeting and understand that such exposure or infection may result in personal injury, illness, disability, and/or death. Attendees release and agree not to sue any persons or entities responsible for coordinating or organizing the PNHP Annual Meeting in the event that they contract Covid-19. Attendees agree to comply with all Covid-related procedures that may be implemented at the Meeting, including mask-wearing.

Table of contents

Click the links below to jump to different sections of the newsletter. To view a PDF version of the shorter print edition of the newsletter, click HERE.

If you wish to support PNHP’s outreach and education efforts with a financial contribution, click HERE.

If you have feedback about the newsletter, email info@pnhp.org.

PNHP News and Tools for Advocates

• Privatize Medicare? Not on our watch
• Medicare for All support grows in Congress
• More state medical societies support Medicare for All
• CBO: Single Payer is good for the economy
• Annual Meeting: Save the Date (Nov. 5, 2022)

Research Roundup

• Data Update: Health care crisis by the numbers
  • Health Costs
  • Health Inequities
  • Coverage Matters
  • Commercial Insurance: A Hazardous Product
  • Privatizing Medicare and Medicaid
  • Health Care for Profit
  • Pharma
  • Dark Money in Health Care
• Studies and analysis of interest to single-payer advocates

PNHP Chapter Reports

• California
• Illinois
• Kentucky
• Minnesota
• New Hampshire
• New York
• North Carolina
• Ohio
• Oregon
• Vermont
• Washington
• Wisconsin

PNHP in the News

• News Articles Quoting PNHP Members
  • Chapters in Action
  • Medicare Direct Contracting Campaign
• Opinion: Op-eds and Guest Columns
• Opinion: Letters to the Editor

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PNHP News and Tools for Advocates

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Privatize Medicare? Not on our watch

PNHP leads campaign against Direct Contracting

On February 24, the Centers for Medicare and Medicaid Services (CMS) made a stunning announcement: The agency was terminating the controversial Medicare Direct Contracting (DC) program four years ahead of schedule, and “rebranding” the program into a new pilot called ACO REACH.

The announcement came less than three months after a delegation of PNHP physicians and medical students launched a campaign against DC with a press conference at the headquarters of CMS’ parent agency, the Department of Health and Human Services. There, PNHP leaders delivered a stack of petitions to HHS Secretary Xavier Becerra, demanding that he immediately end DC and keep Medicare public for future generations.

What is Direct Contracting?

Medicare DC is a pilot program developed during the Trump Administration that would change the way that Traditional Medicare pays for care. Instead of paying providers directly, Medicare pays third-party middlemen called Direct Contracting Entities (DCEs) to “coordinate” beneficiaries’ care. DCEs are allowed to keep up to 40% of these payments as profit and overhead, a dangerous incentive to restrict patient care.

Medicare beneficiaries are automatically enrolled into DCEs without their understanding or consent, and once enrolled, must change primary care providers to opt out. Virtually any type of company can apply to be a DCE, including those owned by commercial insurers, private equity investors, and for-profit dialysis centers. Even though DC is technically a “pilot program,” CMS can scale the program up to all of Traditional Medicare without the approval of Congress.

Campaign wins support in Washington

When the physicians traveled to Washington in November, most members of Congress had never even heard of DC. PNHP members and allies quickly met with their representatives and soon won the support of several influential leaders, such as Medicare for All lead sponsor Rep. Pramila Jayapal. In December, Rep. Jayapal and PNHP president Dr. Susan Rogers published an op-ed in The Hill, “The biggest threat to Medicare you’ve never even heard of,” which was shared thousands of times.

In January, Rep. Jayapal and more than 50 Congressional colleagues sent a letter to HHS Sec. Becerra demanding he immediately end the DC program. The campaign then caught the attention of Sen. Elizabeth Warren, who invited Dr. Rogers to speak about Medicare privatization at a Senate Finance committee hearing on Feb. 2.

In the meantime, PNHP members published op-eds and letters-to-the-editor, and campaign leaders gave dozens of talks and media interviews. By late February, the campaign generated 80 news articles and nearly 50 opinion pieces. In a matter of months, “Direct Contracting” was synonymous with corruption, profiteering, and privatization.

CMS response to the campaign was to “rebrand” DC into the REACH program. Unfortunately, REACH carries over all the most dangerous aspects of DC, and would continue to allow Wall Street middlemen to profit at the expense of Medicare and its beneficiaries.

PNHP immediately responded to CMS’ rebranding with a press statement and video slamming REACH. Less than two weeks later, the campaign sent a letter to CMS and HHS from more than 250 organizations representing health providers, seniors, disabled adults, unions and community groups, demanding an end to REACH and Medicare privatization.

The next phase of the fight against privatization

“The Direct Contracting campaign taught us two important lessons,” said PNHP president Dr. Susan Rogers. “First, health justice advocates have incredible power when we educate, organize, and speak out. Second, when Wall Street profiteers get their hands in public programs like Medicare, it’s not easy to get them out.” Dr. Rogers noted that PNHP and allies would have to redouble their efforts to end REACH, while also fighting against the growth of Medicare Advantage, the version of Medicare run by commercial insurers for profit. “If we want Medicare for All tomorrow, we must fight to keep Medicare public today,” said Dr. Rogers.

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Medicare for All support grows in Congress

Single-payer advocates across the country have been signing up additional Congressional co-sponsors on H.R. 1976, the Medicare for All Act of 2021. When the bill was introduced by Rep. Pramila Jayapal last March, it had 112 co-sponsors. In the weeks after the introduction, activists quickly signed up another three sponsors (Reps. Mike Quigley of Illinois, Kweisi Mfume of Maryland, and Betty McCollum of Minnesota). Over the summer, two more members of Congress (Reps. Zoe Lofgren of California and Melanie Ann Stansbury of New Mexico) signed on. And in just the last few months, the movement signed up another four co-sponsors (Reps. John Garamendi of California, Shontel Brown of Ohio, Donald  Norcross of New Jersey, and Sheila Cherfilus-McCormick of Florida), bringing the total sponsors to 121, the highest number of sponsors ever on a single-payer bill. In every case, the representatives only signed on after sustained pressure from activists, including phone calls, letters, social media “storms” and public actions. For more information about Medicare for All legislation, visit pnhp.org/HouseBill.

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More state medical societies support Medicare for All

Two more state medical associations have recently joined PNHP’s Medical Society Resolutions campaign. In September, PNHP members passed a resolution in the Washington State Medical Association expressing support for “universal access to comprehensive, affordable, high-quality health care … including a publicly-funded national health care program.” The resolution passed with 93% of the vote.

PNHP’s Granite State chapter launched their resolution campaign by sending a survey to the New Hampshire Medical Society. They found that 82% of primary care doctors and 66% of specialists support Medicare for All, and similar percentages would support single payer as the official position of the NHMS. Confident in their success, activists submitted a single-payer resolution to the NHMS Council, which passed by an overwhelming majority in March.

Washington State and New Hampshire join Vermont and Hawaii in passing single-payer resolutions in their state medical societies. To get involved in PNHP’s medical society resolutions campaign, visit medicalsocietyresolutions.org or contact organizer@pnhp.org.

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CBO: Single Payer is good for the economy

The Congressional Budget Office, the federal agency that provides Congress with economic analysis of proposed laws and policies, just released a powerful report on the potential impact of Medicare for All on the U.S. economy. The CBO concluded that single payer would have several positive impacts on workers and households, as well as the national economy:

• Raise wages as employers would no longer provide health coverage to workers.
• Eliminate households’ insurance premiums and most of their out-of-pocket health costs, boosting disposable income.
• Reduce administrative waste in health care, freeing up resources for other sectors of the economy.
• Improve workers’ health outcomes, as well as their longevity and labor productivity.
• Create a long-term care program, which would compensate unpaid caregivers or allow them to take on paid work, and increase wages among care workers.

To learn more about this study and the economic impact of Medicare for All, visit pnhp.org/PayingForIt.

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Research Roundup

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Data Update Spring 2022

Health Costs

Americans delay or skip treatment because of cost. By late 2021, nearly one-third (30%) of Americans reported not seeking treatment for a health problem in the prior three months due to cost, a percentage that tripled since March. One-fifth of adults (21%) reported a member of their household had a health problem worsen after postponing care because of cost. The rate of Americans borrowing money to pay for needed care rose from 7% in December 2020 to 11% in October 2021. An estimated 12.7 million Americans report knowing a friend or family member who died this past year after not receiving treatment because of cost, and Black Americans (8%) are twice as likely to know someone who died as whites (4%). In 2021, many Americans cut back on other necessities to pay for care, including clothing (26%), food (13%) and utilities (8%). “2021 healthcare in America report,” West Health-Gallup, 12/14/2021

Americans routinely delay or skip needed care. In the past two years, 33% of Americans skipped dental care, 25% delayed a doctor visit or procedure, 24% completely skipped a visit or procedure, 18% avoided going to the hospital or ER, and 15% experienced pain because they could not afford medical care. People with ACA Marketplace plans (78%) were much more likely to report delaying or skipping care due to costs than those with any other type of coverage. “Healthcare affordability: Majority of adults support significant changes to the health system,” Robert Wood Johnson Foundation, August, 2021

18 million Americans can’t afford needed medications. Seven percent of U.S. adults (18 million) were unable to pay for at least one doctor-prescribed medication for their household in early 2021, with higher rates among low-income households. In households earning less than $24,000, almost 20% were unable to pay for medications; for those earning less than $48,000, 18% report skipping pills. About 1 in 10 adults say they’ve skipped a pill in the prior year to save money. Witters, In U.S., an Estimated 18 Million Can’t Pay for Needed Drugs, Gallup, 9/21/2021

Nearly one in ten Americans hold medical debt. Roughly 23 million people, or 9% of American adults, owe medical debt, including 11 million who owe more than $2,000 and 3 million who owe more than $10,000. Americans’ collective medical debt totaled at least $195 billion in 2019, with people in middle age (35-64) more likely than other adults to report medical debt. Larger shares of people in poor health (21%) and living with a disability (15%) report medical debt, as well as a larger share of Black adults (16%) compared to White (9%), Hispanic (9%), and Asian American (4%) adults. Rae et al. “The burden of medical debt in the United States,” Kaiser Family Foundation, 3/10/2022

Majority of Americans’ debt is medical. In a new survey, roughly 20% of U.S. households report having medical debt, and medical collections tradelines appear on 43 million credit reports. As of mid- 2021, 58% of bills that are in collections and on people’s credit records are medical bills. Black Americans are twice as likely (28%) to have past-due medical debt compared to white Americans (17%), and debt is more common in regions that did not expand Medicaid. Medical bills on credit reports can result in reduced access to credit, increased risk of bankruptcy, avoidance of medical care, and difficulty securing employment, even when the bill itself is inaccurate or erroneous. “Medical Debt Burden in the United States,” Consumer Financial Protection Bureau, February 2022

Medical debt disproportionately impacts the poor. Nearly 80% of medical debt is held by households with zero or negative net worth. Only 9% of medical debt is held by households with between $1 and $104,000 in net worth, and surprisingly, 13% of medical debt is held by households with more than $104,000. Among those with insurance coverage, 26% percent of Black households hold medical debt compared to 16% of non-Black households. Among the uninsured, 35% percent of Black households hold medical debt compared to 26% of non-Black households. Perry et al., “The racial implications of medical debt: How moving toward universal health care and other reforms can address them,” Brookings Institution, 10/5/2021 

High out-of-pocket costs drive up underinsurance in children. Underinsurance for children (lack of continuous and adequate insurance) rose from 31% in 2016 to 34% in 2019 — an additional 2.4 million children — driven primarily by unaffordable out-of-pocket medical expenses. The recent growth of children’s underinsurance was driven by those in white and mulitracial households, those considered middle-class (incomes above 200% of poverty), and those with private health insurance. Yu et al., “Underinsurance among children in the United States,” Pediatrics, January 2022

Despite Medicare, American seniors face financial barriers to care. One in five U.S. seniors (20%) pay more than $2,000 out of pocket for health care services, while most other wealthy nations average 5% or less. In the U.S., 8% of seniors delayed or avoided care in the past year, and 9% skipped medications, compared to 2% or less in countries like Germany and Sweden. Jacobson, et al., “When costs are a barrier to getting health care: Reports from older adults in the U.S. and other high-income countries,” Commonwealth Fund, 10/01/2021

U.S. life expectancy plummets, trails other higher-income nations. U.S. life expectancy dropped by 2.27 years in men and 1.61 years in women in 2020, the largest drop of any other middle or high-income country except for Russia. The U.S. drop in life expectancy was driven largely by the deaths of young people. In contrast, in several countries with strong public health and universal coverage — New Zealand, Taiwan, Iceland, South Korea, Norway and Denmark — life expectancy either increased or remained the same. Islam et al., “Effects of Covid-19 pandemic on life expectancy and premature mortality in 2020: Time series analysis in 37 countries,” BMJ, 11/03/2021 

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Health Inequities

Maternal mortality crisis grows. The U.S. maternal mortality rate increased by 18% from 2019 to 2020, from 20.1 deaths to 23.8 deaths per 100,000 live births; the 2020 rate is a 37% increase from 2018. Black people had the highest maternal mortality rate (55.3 deaths/100,000 live births), nearly three times higher than white people. The maternal death rate among Hispanic people rose by 44% from 2019 to 2020. The U.S. maternal mortality rate was more than double that of other developed countries. Hoyert, “Maternal mortality rates in the United States, 2020,” National Center for Health Statistics,” February 2022

Latinx/Hispanic Americans have higher rates of preventable cancer. Due to a lack of access to care, Latinx/Hispanic individuals are more likely to suffer from potentially preventable cancers compared to whites. In 2018, 26% of Latinx/Hispanic individuals were uninsured, compared to 9% of whites. Latinx/Hispanic people are more than twice as likely as white people to develop liver cancer or stomach cancer, and are twice as likely to die from those cancers. Compared to white women, Latinas are 32% more likely to get cervical cancer which is almost entirely preventable through screening and vaccination. Miller et al., “Cancer statistics for the U.S. Hispanic/Latino population, 2021,” CA: A Cancer Journal for Clinicians, 9/21/2021

Inequities plague cancer detection and treatment. While overall risk of cancer death is much lower than it was decades ago, racial and geographic disparities persist. Risk of cancer death is 33% higher for Black people and more than 50% higher in Native Americans and Alaska Natives, compared with white people. Even though Black women have a lower rate of breast cancer incidence, they have a 41% higher death rate compared to white women. Breast cancer mortality is also higher in states like Mississippi that did not expand Medicaid and have high levels of poverty. Seigel et al., “Cancer statistics, 2022,” CA: A Cancer Journal for Clinicians, 1/12/2022

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Coverage Matters

VA care reduces both mortality and health spending. For veterans aged 65 and older, getting emergency care in a Veterans Administration (VA) facility reduced 28-day mortality by 46% and reduced 28-day spending by 21% ($2,598) compared to care in a private facility. Chan et al., “Is there a VA advantage? Evidence from dually eligible veterans, Working Paper 29765,” National Bureau of Economic Research, February 2022

Veterans died at lower rates in 2020 compared to the general population. In 2020, American veterans faced an excess mortality rate of 13% in 2020, while the U.S. overall had an excess mortality rate of 23% in the same time frame, despite veterans having higher health risks due to age and conditions like hypertension, diabetes, and obesity. Veterans researchers cite “consistent access to health care and the rapid expansion of VHA telemedicine during the pandemic,” as the reason. Feyman et al., “County-level impact of the Covid-19 pandemic on excess mortality among U.S. veterans: A population-based study,” The Lancet Regional Health – Americas, 10/30/2021

Medicaid expansion saves lives. From 2014 to 2018, Medicaid expansion was associated with nearly 12 fewer deaths per 100,000 adults annually; expansion may lead to an overall 3.8% decline in adult deaths each year. The drop in mortality most benefited women and Black people who are more likely to live in poverty than men and non-Black people, respectively. The greatest reduction in mortality was from respiratory and cardiovascular conditions, suggesting that the decrease in mortality is primarily from greater access to preventive care, specialist referrals, and medications. Lee et al., “Medicaid expansion and variability in mortality in the USA: A national, observational cohort study,” The Lancet, 12/2/2021

Medicare coverage reduces out-of-pocket health spending. Despite a 5% increase in annual medical expenses after 65, older adults’ out-of-pocket health costs dropped by 27%, and their rate of catastrophic health expenditures decreased by 35%, once they enrolled in Medicare at 65. Medicare coverage also led to a 17% reduction in those who delayed seeking care due to cost. Scott et al., “Changes in out-of-pocket spending and catastrophic health care expenditures associated with Medicare eligibility,” JAMA Health Forum, 9/10/2021

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Commercial Insurance: A Hazardous Product

Prior authorization (PA) causes disability and death. In a new survey, nearly all (93%) physicians reported care delays while waiting for insurers to authorize necessary care via PA, and 82% said patients abandoned treatment due to PA struggles with insurers. More than one-third (34%) reported that PA led to a serious adverse event for a patient in their care, such as hospitalization, disability, or even death. “2021 AMA prior authorization (PA) physician survey,” American Medical Association, 2/10/2022

Americans skip or delay care due to insurance hassles. One quarter (25%) of insured, working-age adults have either postponed or skipped necessary care because of administrative obstacles. Nearly three-quarters of patients (73%) reported undertaking tasks like scheduling appointments, obtaining prior authorizations, and resolving problems with bills and insurance premiums. Nearly half of patients who encountered issues with premium payments, and more than one-third of patients who experienced billing or prior authorization problems, delayed or skipped care. Kyle and Frakt, “Patient administrative burden in the U.S. health care system,” Health Services Research, 9/08/2021

Insured families can’t afford cost sharing. In 2019, average out-of-pocket spending limits in commercial insurance plans (for in-network services) were $7,900 for an individual and $15,800 for a family. However, nearly half (45%) of single-person, non-elderly households did not have the liquid assets to cover more than $2,000 in costs, and nearly two-thirds (63%) could not cover more than $6,000. Young et al., “Many households do not have enough money to pay cost-sharing in typical private health plans,” Kaiser Family Foundation, 3/10/2022

The cost of job-based insurance is steadily rising. For the nearly 155 million Americans who get health coverage through their jobs, total average annual premiums are now over $22,200 for families, with workers on average paying $5,969 toward the cost of their coverage, and $7,700 for individuals, with workers paying nearly $1,300 towards the cost. “2021 employer health benefits survey,” Kaiser Family Foundation, 11/10/2021

Employer-plan premiums and deductibles outpace family incomes. Average premiums and deductibles in employer-sponsored health plans climbed to $8,070 in 2020, accounting for 11.6% of the U.S. median household income, up from 9.1% in 2010. Rates were as high as 19% of household income in Mississippi and 18% in New Mexico. Workers with single plans paid about 21% of their premiums; those with family coverage paid 29% of their premiums. Collins et al., “State trends in employer premiums and deductibles, 2010–2020,” The Commonwealth Fund,” 1/12/2022

High insurance costs hurt low-income families hardest. Among those with employer coverage, families below 200% of the poverty line spent an average of 10.4% of their income on premiums and medical care, compared to families above 400% of poverty who spent 3.5% of household income on premiums and medical expenses. Claxton et al., “How affordability of employer coverage varies by family income,” Kaiser Family Foundation, 3/10/2022

ACA Marketplace plans increasingly unaffordable, even for higher earners. For families at 400-600% of poverty ($69,680–$104,520 for a family of two), the premium and deductible for an ACA “Bronze” plan represented 18.3% of income in 2015. By 2019, these costs rose to 26.6% of income. For those aged 55-64 years old, the premium alone is now 18.9% of income. Jacobs and Hill, “ACA marketplaces became less affordable over time for many middle-class families, especially the near-elderly,” Health Affairs, November 2021

Big insurers dominate most metro area markets. Nearly three-fourths (73%) of U.S. metro areas were highly concentrated insurance markets in 2020, up from 71% in 2014. Fourteen states had one health insurer that controlled at least half of their markets. In 91% of metro areas, at least one insurer had a commercial market share of 30% or greater, and in 46% of areas, a single insurer’s share was at least 50%. “Competition in health insurance: A comprehensive study of U.S. markets,” American Medical Association, September 2021

UnitedHealth profits in the pandemic. During the second year of the pandemic, the nation’s largest commercial insurer surpassed revenue and profit projections. UnitedHealth’s 2021 revenue was $288 billion, up 12% from 2020, which is triple its revenue from 2010. UH’s 2021 profit was $17.3 billion, also up 12% from 2020, and quadruple its profits from 2010. While the company is known for insurance, a majority of its revenue ($156 billion) comes from its affiliate Optum, which owns physician practices and specialty pharmacies. “UnitedHealth Group reports 2021 results,” UnitedHealth Group, 1/19/2022

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Privatizing Medicare and Medicaid

Aetna accused of operating a “shadow network” of Medicaid providers. Commercial insurer Aetna, a CVS Health subsidiary, illegally secured contracts with Pennsylvania’s Medicaid program by misrepresenting the number of pediatric providers in its network in order to discourage care and increase profits, according to a federal whistleblower lawsuit. The whistleblower found that many of the providers assigned to the company’s nearly 100,000 child beneficiaries were either not contracted with Aetna, dead, out of state, or did not treat children. Aetna claimed its lower-than-average screening, diagnostic, and treatment rates were due to parental negligence. Tepper, “Aetna lied about provider network to win Medicaid contracts, suit alleges,” Modern Healthcare,” 9/14/2021

Medicare Advantage (MA) costs taxpayers tens of billions more than Traditional Medicare. Medicare overpaid MA insurers by more than $106 billion from 2010 through 2019, with nearly $34 billion during 2018 and 2019 alone. The overpayments were mostly due to upcoding, or MA plans’ fraudulently exaggerating diagnoses to increase patients’ risk scores. In 2019, MA risk scores were 19% higher compared to Traditional Medicare. Under current coding rules, spending on MA is expected to increase by $600 billion from 2023 through 2031, with as much as two-thirds of the increase in spending going toward profits for insurance companies. Schulte, “Medicare Advantage’s cost to taxpayers has soared in recent years, research finds,” Kaiser Health News, 11/11/2021

Medicare Advantage (MA) insurers collect billions for unverified diagnoses. In 2016, MA plans’ fraudulent “upcoding” — using chart reviews and health risk assessments to increase Medicare risk-adjusted payments — cost the federal government $9.2 billion. The nation’s largest insurer, United Healthcare, generated 40% of its risk-adjusted payments, or $3.7 billion, by listing patient conditions unverified through outside medical claims. The top three “upcoded” conditions were vascular disease; major depressive, bipolar and paranoid disorders; and diabetes with chronic complications. Murrin, “Some Medicare Advantage companies leveraged chart reviews and health risk assessments to disproportionately drive payments,” U.S. Department of Health and Human Services, Office of Inspector General, September 2021

Medicare Advantage (MA) plans cited for not paying for care. Four regional MA plans affiliated with UnitedHealthcare and Anthem have been barred from enrolling new members until 2023 after failing to meet the 85% medical loss ratio threshold for three straight years. The enrollment suspensions affected about 80,000 of UnitedHealth’s 7.5 million MA enrollees. Commins, “Anthem, Unitedhealthcare MA Plans sanctioned for missing MLR threshold,” Health Leaders Media, 9/20/2021

Medicare Advantage (MA) market increasingly concentrated. Six insurers control roughly three-quarters of the MA market: UnitedHealth (7.9 million members), Humana (5.1 million), CVS/Aetna (3.1 million), Anthem (1.9 million), Kaiser Permanente (1.8 million), and Centene (1.4 million). Herman, “The big Medicare Advantage players keep getting bigger,” Axios, 1/19/2022

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Health Care for Profit

Private equity flows into health care. Acquisitions by private equity (PE) investors in health care have nearly tripled, from $41.5 billion in 2010 to $119.9 billion in 2019, for a total of approximately $750 billion over the last decade, concentrated in home health, physician practices, and outpatient care. Because PE firms are focused on short-term profits, they tend to prioritize revenue over quality of care and engage in unethical billing practices; they also overburden health care companies with debt, strip their assets, and put them at risk of long-term failure. Experts expect PE investment to increase by 30% to 40% in 2022. Scheffler et al., “Soaring private equity investment in the healthcare sector: Consolidation accelerated, competition undermined, and patients at risk,” American Antitrust Institute and the School of Public Health at UC Berkeley, 5/18/2021

Physician management companies and private equity drive up costs. Compared to hospitals that did not use physician management companies (PMCs) for their outpatient departments and ambulatory surgery centers, hospitals with PMCs charged 16.5% higher prices; hospitals with PMCs backed by private equity increased costs by 25%. LaForgia et al., “Association of physician management companies and private equity investment with commercial health care prices paid to anesthesia practitioners,” JAMA Internal Medicine, 2/28/2022

For-profit hospitals avoid unprofitable services. Government-owned and nonprofit hospitals were 9 percentage points and 6.2 percentage points more likely than comparable for-profit hospitals to offer relatively unprofitable services, like psychiatric care, substance abuse treatment, obstetric care, and hospice. For-profits were 32% more likely to offer a profitable service (such as coronary artery bypass grafting surgery) than an unprofitable service, compared to 27.3% for nonprofits and 22.2% for government-owned facilities. Horwitz and Nichols, “Hospital service offerings still differ substantially by ownership type,” Health Affairs, March 2022

Nonprofit insurance CEOs snagged big raises. Across all U.S. health insurers, CEOs received an average 7.5% raise in 2020 compared with 2019. Although nonprofit insurance CEOs were paid less overall than the heads of for-profit insurers, Blue Cross Blue Shield CEOs were more likely to get a substantial raise in 2020. BCBS of Minnesota CEO Craig Samitt got a 109% raise, to $3.3 million; Hawaii Medical Service Association CEO Mark Mugiishi earned a 89.5% raise, to $1.8 million; and Independence Blue Cross’s now-retired CEO Dan Hilferty received a 73.6% raise, to $9.9 million. Tepper, “BCBS CEOs received bigger raises in 2020 than execs at for-profit insurers, report says,” Modern Healthcare, 10/12/2021

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Pharma

Pharma raises prices, spends lavishly on CEOs and ads. A recent Congressional investigation found that from 2016 to 2020, pharmaceutical companies raised the prices of brand-name drugs by 36%, almost four times the rate of inflation. Despite their claims of needing high prices to fund research, drug firms spent heavily on executive salaries and marketing. The 10 largest pharma companies paid their top executives more than $2.2 billion from 2016 to 2020, including nearly $800 million just to their CEOs. AbbVie, Amgen, Novo Nordisk, and Pfizer spent more than $2.6 billion in direct-to-consumer advertising from 2015 to 2018 on just four drugs. “Drug pricing investigation majority staff report,” U.S. House of Representatives Committee on Oversight and Reform, December 2021 

Pharma gifts to doctors lead to higher drug spending. Pharmaceutical company gifts to rheumatologists, through food and beverages or consulting fees, are linked with a higher likelihood of prescribing drugs and higher Medicare spending. For each $100 in food/beverage payments, Medicare reimbursement increased 6% to 44% ($8,000 to $13,000). The increases were particularly high for infliximab and rACTH, where a payment of $100 to a prescriber was associated with increases of approximately $72,000 and $30,000 in Medicare reimbursements, respectively. Duarte-García et al., “Association between payments by pharmaceutical manufacturers and prescribing behavior in rheumatology,” Mayo Clinic Proceedings, 2/01/2022

Americans spend almost double what the rest of the world combined spends on drugs. The 20 highest-selling drugs generated $158 billion of global revenue in 2020, but due to our high drug prices, U.S. sales represented 64% of that total, or $101 billion. For 17 of the 20 top-selling drugs worldwide, pharmaceutical firms made more money from U.S. sales than from sales to all other countries in the rest of the world combined. Drugs with the highest revenue disparities between the U.S. and the rest of the world include medications for HIV, autoimmune disease, MS, and diabetes. Claypool and Rizvi, “United we spend: For 20 top-selling drugs worldwide, big pharma revenue from U.S. sales combined exceeded revenue from the rest of the world,” Public Citizen, 9/30/2021

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Dark Money in Health Care

Spending by health industry lobbyists increased in 2021. The Pharmaceutical Research and Manufacturers of America (PhRMA) spent nearly $30 million on lobbying in 2021 — a 16% increase over 2020. Other big spenders include the American Hospital Association, which spent $20.8 million in 2021 versus $18.9 million in 2020; the American Medical Association spent $18.8 million in 2021 (about the same as 2020); and America’s Health Insurance Plans, which spent $11.3 million in 2021. Cigna led the lobbying push among individual insurers, increasing its spending by 27% to $9.1 million in 2021 compared with $7.2 million in 2020. Wilson, “Health interests pour cash into D.C. lobbying,” Politico, 1/24/2022

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Studies and analysis of interest to single-payer advocates

Albert et al., “Racism, Chronic Disease and Mental Health: Time to Change Our Racialized System of Second-Class Care,” Healthcare, 9/27/2021. PNHP members Drs. Judy Albert, Claire Cohen, Thomas Brockmeyer, and Ana Malinow describe how the “weathering hypothesis” and adverse childhood experiences set the stage for higher rates of chronic disease, mental health disorders, and maternal mortality seen in Black adults in the U.S. They also illustrate the toll that untreated and overtreated mental health disorders have on Black patients, who have similar rates of mental health disorders as their white counterparts but have fewer outpatient mental health services and higher rates of hospitalizations. They also discuss the impact of Medicaid, which now covers 33% of all Black people in the U.S. but suffers from chronic underfunding and administrative burdens on patients. The physicians propose single-payer Medicare for All as a foundation for addressing structural racism in health.

Greep et al., Physician Burnout: Fix the Doctor or Fix the System?, The American Journal of Medicine, 11/01/2021. Even before COVID-19, burnout affected almost half of American physicians, diminishing the quality of physicians’ lives, and increasing the likelihood of medical errors and physicians leaving practice. Drs. Greep, Woolhandler, and Himmelstein argue that America’s profit-oriented, multiplayer system — including commercial insurers’ practice of restricting care through prior authorizations and narrow networks — exacerbates and even causes burnout. The drive for profit often conflicts with physicians’ obligation to prioritize optimal care, and reduces their clinical autonomy. The authors advocate moving to a single-payer system, eliminating out-of-pocket costs, and removing the profit motive from patient care.

Lee et al., “Medicaid expansion and variability in mortality in the USA: A national, observational cohort study,” The Lancet, 12/2/2021. Despite chronic underfunding and major administrative burdens for patients, Medicaid coverage is proven to save lives. Researchers found that from 2014 to 2018, Medicaid expansion was associated with nearly 12 fewer deaths per 100,000 adults annually; expansion may lead to an overall 3.8% decline in adult deaths each year. The drop in mortality most benefited women and Black people who are more likely to live in poverty than men and non-Black people, respectively. The greatest reduction in mortality was from respiratory and cardiovascular conditions, suggesting that the decrease in mortality is primarily from greater access to preventive care, specialist referrals, and medications.

Gaffney and Podolanczuk, “Inequity and the Interstitium: Pushing Back on Disparities in Fibrosing Lung Disease in the U.S. and Canada,” American Journal of Respiratory and Critical Care, 1/06/2022. Drs. Gaffney and Podolanczuk argue that differential access to quality health care can determine which patients live and die from fibrosing interstitial lung disease (fILD). They point to research showing that among U.S. patients with fILD, patients living in the lowest-income communities, death rates were 51% higher compared to their wealthier counterparts. Moreover, U.S. patients with idiopathic pulmonary fibrosis (IPF) residing in the lowest-income neighborhoods were 64% less likely to have a lung transplant compared to those in higher-income neighborhoods. However, these disparities are not present among similar patients in Canada, pointing to the importance of universal coverage.

Gaffney et al., “Association of Uninsurance and VA Coverage with the Uptake and Equity of COVID-19 Vaccination: January–March 2021,” Journal of General Internal Medicine, 1/11/2022. From January to March 2021, the COVID-19 vaccination rate was 55.3% for those with VA coverage vs. 50.1% for those with non-VA coverage, and 30.4% among the uninsured. VA coverage also increased equity: relative to white adults, VA coverage was associated with markedly higher rates of vaccination among Blacks (13.5 percentage points). Researchers conclude that those who lack coverage are less likely to have an established relationship with a primary care provider, and PCPs have proven to be an important potential source of information on vaccines. They also report that equitable access to VA facilities, greater vaccine supply, and direct outreach efforts such as using mobile vaccination units and air-lifting vaccine teams to remote areas, may have contributed to the more equitable and faster vaccine uptake among VA beneficiaries.

Gaffney et al., “COVID-19 Testing and Incidence Among Uninsured and Insured Individuals in 2020: a National Study,” Journal of General Internal Medicine, 2/09/2022. In 2020, uninsured adults — including many with chronic diseases — were less likely than the insured to have been tested for COVID-19, despite having higher rates of positive test results. Researchers conclude that this discrepancy reflects disparities in access to clinicians between the insured and uninsured. These findings also reflect a larger increase in all-cause mortality among the uninsured relative to the insured in 2020.

Gaffney, et al., “Medical Documentation Burden Among US Office-Based Physicians in 2019: A National Study,” JAMA Internal Medicine, 3/28/2022. Many U.S. physicians report that medical documentation is onerous, takes away time from patients, and increases burnout. A new study aims to quantify the burden of medical documentation on office-based physicians. Researchers found that in 2019, doctors spent about 1.8 hours per day documenting electronic medical records outside of the office, which adds up to 125 million hours spent on documentation work outside of regular business hours.

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PNHP Chapter Reports

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California

PNHP California worked to pass AB 1400, the state’s single-payer bill. PNHP members provided policy recommendations to the bill’s sponsor, attended rallies and car caravans, wrote letters and op-eds, and published ads in local newspapers in support of the bill. PNHP members also worked to pass several municipal single-payer resolutions, including the cities of Arcata, Blue Lake, Trinidad, and Eureka; Humboldt County; and the community services Districts of Manila and Willow Creek. California members have been very active in PNHP’s campaign to stop Medicare Direct Contracting, organizing a campaign to send hundreds of postcards and emails to Rep. Nancy Pelosi on Valentine’s Day in support of Traditional Medicare. To get involved in California, contact Dr. Corinne Frugoni at cfrugoni@reninet.com.

Illinois

In Illinois, as part of the PNHP Medical Society Resolutions Campaign, Dr. Peter Orris submitted a single-payer resolution to the Illinois State Medical Society in December; the chapter will organize to pass the resolution in the coming months. Dr. Pam Gronemeyer is collecting signatures for a Medicare for All ballot proposition in downstate Edwardsville. In November, Dr. Duane Dowell spoke at a “Bans Off Our Bodies” rally for abortion rights, which was endorsed by PNHP-Illinois. To get involved in Illinois, contact Dr. Anne Scheetz at annescheetz@gmail.com.

Kentucky

In Kentucky, PNHP members and allies hosted a rally against Medicare Direct Contracting in front of the Humana Insurance building in downtown Louisville (Humana owns a Medicare Advantage business as well as a Direct Contracting Entity). The event’s theme was, “How the Grinch Stole Medicare,” and included a visit by the Grinch himself reading an original Dr. Seuss-style poem about the threat of privatization. To get involved in Kentucky, contact Kay Tillow at nursenpo@aol.com.

Minnesota

PNHP’s Minnesota chapter held their annual meeting in January with nearly 100 members in attendance. The group discussed legislative plans, organizing strategies, and the summer internship, and enjoyed a keynote address from Dr. Rachel Madley, a former SNaHP leader who now works as legislative assistant to Rep. Pramila Jayapal. PNHP and Health Care for All MN braved sub-zero temperatures for a rally at the State Capitol on January 26 to celebrate the formation of the Minnesota Health Plan Caucus, a group of legislators who support single-payer bills in the state House and Senate. In February, the chapter hosted the “Meet the Minnesota Health Plan Caucus” education event, a panel discussion of the Minnesota Health Plan with lead author Sen. John Marty and other caucus leaders to discuss the features of the bill, how to organize to support it, and the anticipated timeline to get it passed. To get involved in Minnesota, contact pnhpminnesota@gmail.com.

New Hampshire

In New Hampshire, PNHP’s Granite State chapter sent a survey to the New Hampshire Medical Society, gauging their support for single payer. They found that 82% of primary care doctors and 66% of specialists support Medicare for All, and similar percentages said they would support making single payer the official position of the NHMS. In response, activists submitted a single-payer resolution to the NHMS Council, which passed in March with an overwhelming majority. PNHP activists and allies also worked to pass a Medicare for All resolution in the City Council of Keene, making it the sixth NH town to pass a MFA resolution in the last two years. To get involved in New Hampshire, contact Dr. Donald Kollisch at donald.o.kollisch@dartmouth.edu.

New York

In New York, PNHP-NY Metro has built working groups to implement chapter advocacy projects including Medicare privatization, the single-payer New York Health Act, and recruitment of doctors and other health workers into the movement. The chapter has worked hard to block the city’s scheme to move 250,000 municipal retirees into a Medicare Advantage plan by holding educational webinars; writing and distributing detailed analyses of the financial impact on retirees and health inequities; submitting an affidavit supporting a lawsuit; and supporting a retiree resistance group that held several rallies against the mayor’s decision. In March, a judge rejected the city’s plan, although the ruling is being appealed. NY-Metro continues to hold online monthly forums on topics like Direct Contracting and Medicare privatization, and how to fight back against high prescription drug prices. To get involved in NY-Metro, please contact Executive Director Bob Lederer at bob@pnhpnymetro.org.

North Carolina

In North Carolina, Health Care Justice NC members helped persuade Rep. Alma Adams to sign the Congressional sign-on letter against Medicare Direct Contracting, which was released in January. The chapter has developed a strong relationship with Rep. Adams and her staff over the years. To get involved in Health Care Justice NC, contact Dr. Jessica Schorr Saxe at jessica.schorr.saxe@gmail.com.

Members of Health Care for All Western North Carolina (HCFA-WNC) in Asheville have been active in the campaign against Medicare Direct Contracting, holding a watch party for PNHP President Dr. Susan Rogers’ testimony at the Senate Finance Committee in February, and gathering signatures for the Direct Contracting Petition and organizational sign-on letter. To get involved in HCFA-WNC, contact Terry Hash at theresamhash@gmail.com.

Ohio

In Ohio, PNHP members and allies organized a car caravan in Columbus, urging  Rep. Joyce Beatty to sign onto H.R. 1976, The Medicare for All Act. Activists amplified the pressure with an ad targeting Rep. Beatty in the Columbus Dispatch. Allies organized similar events on the same day in three other cities in Ohio, targeting members of Congress who had not signed on to H.R. 1976. To get involved in Ohio, contact Dr. Jim Binder at jamesbinder3@gmail.com.

Oregon

In Oregon, the PNHP chapter is holding weekly “Conversations with Candidates” health policy forums for candidates running for governor and Congress. Sixteen candidates have agreed to be interviewed, and each forum attracts more than 50 audience participants. Chapter members have also been active in rallies across the state for Medicare for All. To get involved in Oregon, contact Dr. Peter Mahr at peter.n.mahr@gmail.com.

Vermont

In Vermont, PNHP members collaborated with multiple health care activists to send a letter to CMS and to the Vermont Attorney General regarding OneCare, a state program similar to Medicare Direct Contracting/REACH. Chapter leaders also met with several candidates to discuss their positions on Medicare for All, including staff representing U.S. Senator Patrick Leahy and Rep. Peter Welch, as well as Lieutenant Governor Molly Gray, and State Senators Becca Balint and Kesha Ram-Hinsdale. The PNHP New England coalition is once again hosting a summer internship for medical students. This spring, they interviewed and selected students for the 2022 session, which will include students from New Jersey, Arizona, Louisiana, Florida, and New York. To get involved in Vermont, contact Dr. Betty Keller at bjkellermd@gmail.com.

Washington

In Washington, chapter members met with key staff of their Congressional representatives, including Sen. Patty Murray, Sen. Maria Cantwell, and Rep. Susan DelBene, asking them to support Medicare for All and oppose Medicare Direct Contracting and privatization. Chapter leaders signed ten Washington State organizations onto the anti-Direct Contracting sign-on letter that was sent to HHS Sec. Becerra in early March. PNHP members also worked to pass a resolution in the Washington State Medical Association expressing support for “universal access to comprehensive, affordable, high-quality health care … including a publicly-funded national health care program.” The resolution passed with 93% of the vote. To get involved in Washington, contact Dr. McLanahan at mcltan@comcast.net.

Wisconsin

In Wisconsin, the Linda and Gene Farley chapter has been active in PNHP’s campaign against Medicare Direct Contracting. In early February, the chapter hosted Dr. Ana Malinow to speak about DCEs with many allied organizations at the Wisconsin Health Matters coalition meeting. After the forum, several groups signed onto PNHP’s organizational letter to HHS Sec. Becerra. Chapter leaders also met with their Congressional representatives to educate them on Direct Contracting and Medicare privatization. To get involved in Wisconsin, contact wisconsin.pnhp@gmail.com.

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PNHP in the News

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News Articles Quoting PNHP Members

Chapters in Action:

“Physicians reflect on Martin Luther King Jr.’s legacy, efforts to combat health care inequities,” ABC News Los Angeles, 1/17/2022, featuring Drs. Paul Song and Susan Rogers

• “Arizonans gather at Senator Sinema’s office over Medicare expansion,” KVOA TV News, 10/20/2022, featuring Dr. Joshua Freedman
• “Organizations advocate for universal health care coverage,” Eureka Times Standard (California), 11/16/2021, featuring Dr. Corrine Frugoni
• “Advocates gear up for battle to provide all Rhode Islanders with a form of Medicare,” Uprise Rhode Island, 2/17/2022, featuring Dr. J. Mark Ryan
• “Cook County Health chief medical officer encourages health care leaders to be staunch patient advocates,” Becker’s Hospital News, 3/15/2022, featuring Dr. Claudia Fegan
• “Two causes, one community,” Hudson Valley One, 3/25/2022, featuring Sherrill Silver

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Medicare Direct Contracting Campaign

“Medicare is being privatized on Biden’s watch, insurance industry SALIVATES,” The Hill TV, 12/9/2022

• “Trump had a scheme to privatize Medicare. The Biden administration isn’t stopping it,” Washington Post, 12/13/2021
• “Future of Trump-era Medicare program spurs fight among Democrats,” Bloomberg, 1/14/2022
• “A quiet experiment is testing broader privatization of U.S. Medicare,” Reuters, 1/14/2022
• “Trump created a program to privatize Medicare without patients’ consent. Biden is keeping it going,” BuzzFeed News, 1/28/2022
• “Provider groups ignite push to keep Direct Contracting Model,” Modern Healthcare, 2/14/2022
• “Biden administration weighs changes to Trump-era Medicare policy,” Politico, 2/16/2022
• “Progressives are up in arms over a Medicare experiment,” Washington Post, 2/17/2022
• “Curbs on insurers, private equity sought for Medicare pay plan,” Bloomberg, 2/22/2022
• “An overhaul of the Medicare Direct Contracting program could bolster revenue for startups,” Business Insider, 2/28/2022
• “Seniors’ Medicare benefits are being privatized without consent,” The Lever, 3/24/2022

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Opinion: Op-eds and Guest Columns

• “I’m an abortion doctor in Texas. My patients are desperate,” by Dr. Sam Dickman, The Guardian, 10/6/2021
• “Medicare is on the menu,” by Dr. Robert S. Kiefner, Concord Monitor (NH), 11/12/2021
• “Inside the Medicare Advantage plans, many now being probed,” by Dr. Stephen Kemble, Honolulu Star Advisor, 11/12/2021
• “The biggest threat to Medicare you’ve never even heard of,” by Dr. Susan Rogers and Rep. Pramila Jayapal, The Hill, 12/9/2021
• “Proposed Medicare changes are unhealthy for consumers,” by Dr. Jonathan Walker, The Journal Gazette (Fort Wayne, IN), 12/23/2021
• “Stealthy effort to privatize Medicare should alarm all Americans,” by Dr. George Bohmfalk, The Pulse: NC Policy Watch, 12/30/2021
• “The latest assault on Medicare,” by Dr. Robert Devereaux, Roanoke Times (Virginia), 1/18/2022
• “Biden’s costly failure to stop Medicare privatization experiment in Ohio,” by Maximilian Brockwell and James Tyler Moore (SNaHP students), Cleveland Plain Dealer, 2/16/2022
• “Is Medicare a public good or a market commodity?,” by Dr. Corrine Frugoni and Patty Harvey, North Coast Journal (CA), 3/3/2022
• “Medicare wolves are at the door,” by Dr. Ahmed Kutty, Keene Sentinel (NH), 3/16/2022
• “COVID-19 coverage for the uninsured is ending,” by Dr. Adam Gaffney, The Nation, 3/29/2022

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Opinion: Letters to the Editor

• “Medicare for All Is the ticket to good health care,” by Dr. Jay Brock, New York Times, 9/17/2021
• “Greedy insurance companies trying to kill Medicare,” by Dr. Pam Gronemyer, St. Louis Post-Dispatch, 11/5/2021
• “Isn’t that what insurance is for?” by Dr. Rick Staggenborg, Albany Democrat Herald, 11/22/2021
• “Stop the corporate Medicare money-grab,” by Dr. Emily Kane, Senior Voice Alaska, 12/1/2021
• “Hands off my Medicare,” by Dr. Kathleen Healey, Napa Valley Register, 1/10/2022
• “It’s a pandemic. Give California single-payer healthcare,” by Dr. Jerome P. Helman, Los Angeles Times, 1/12/2022
• “Reform cures burnout,” by Dr. Johnathon Ross, Toledo Blade, 1/17/2022
• “Insulin costs would vanish with single payer,” by Kay Tillow, Louisville Courier Journal, 1/16/2022
• “Address large deductibles with Medicare for All, by Dr. Rob Stone, Herald Times (Indiana), 1/21/2022
• “We could make Dr. Farmer proud,” by Dr. Jay Brock, Washington Post, 2/28/2022
• “Support health care for all in United States,” by Dr. Alan Unell, The Columbian (WA), 3/2/2022

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On February 24, 2022, the Centers for Medicare and Medicaid Services (CMS) responded to criticism of its Direct Contracting pilot program by … changing the program’s name. CMS announced that Medicare Direct Contracting will come to a close at the end of 2022, and that it will be replaced by the virtually identical REACH model. This new incarnation retains the worst elements of the original program, including:

• Placing third-party middlemen between seniors and the care they need;
• Auto-enrolling seniors who chose Traditional Medicare into REACH, without their full understanding or consent; and
• Paving the way for the complete privatization of Medicare by 2030.

PNHP released a statement detailing our criticisms, and our president, Dr. Susan Rogers, issued a video response letting CMS know that we weren’t fooled by their transparent rebranding effort.

Dr. Susan Rogers to CMS: Not. Good. Enough.

REACH model copies the worst elements of DCEs

CMS claimed that REACH was developed after listening to feedback from concerned shareholders stakeholders, but all of the dangerous and insidious elements of the old program are still present in the new one. In fact, the REACH model also includes new giveaways to industry middlemen, and investors seem quite pleased with the announcement.

Dr. Ed Weisbart explains the shortcomings of REACH

For more details on the newly announced REACH model, check out an 8:30 video from PNHP national board member Dr. Ed Weisbart, who explains the paper-thin nature of the changes offered by policymakers. Direct Contracting was broken beyond repair, and the “fixes” that CMS incorporated into REACH are wholly inadequate.

The only solution is to finally end this sneaky attempt to privatize Traditional Medicare.

Stay tuned as this story develops. In the meantime, be sure to sign and share our petition against Medicare privatization; call your member of Congress at (202) 224-3121; and educate your friends, family members, and colleagues about this ongoing threat to America’s seniors.

Physicians for a National Health Program (PNHP) advocates for a universal, comprehensive single-payer national health program (also called “improved Medicare for all”). Since 1988, we’ve advocated for this reform in the U.S. healthcare system, growing into a nationally influential voice on health care reform with chapters and activists across the country, and a strong and growing student movement. 

PNHP is a member-led organization that performs groundbreaking research on the health crisis and the need for fundamental reform, and uses a combination of popular education, policy expertise and organizing to move the U.S. closer to single-payer health care. 

Since its founding in 2012, Students for a National Health Program (SNaHP) has been the student arm of PNHP, and serves as the medical student representative in the Medicare for All movement. It has grown to over 65 chapters in medical schools with hundreds of active students.

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Mid Level Donor Specialist

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Position description

PNHP has seen increased giving over the last several years thanks to a robust small donor program and a growing major donor program. As an organization primarily made up of physicians, PNHP is fortunate to have donors with high giving potential. 

The Mid level Donor Specialist is a newly created position that is ideal for a candidate with a successful track record of soliciting individual gifts and is looking for an opportunity to lead a donor portfolio as well as help shape the overall fundraising activities of PNHP. 

PNHP is a highly collaborative environment and the Donor Specialist will work closely with the Executive Director and Deputy Director who have responsibility for major donors and small donors, respectively, to craft the overall fundraising strategy. 

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Key responsibilities

Plan and execute a mid-level donor program (65%)

• Develop an annual / ongoing plan to qualify, cultivate, solicit and thank donors
• Maintain a portfolio of roughly 500 donors with goals to increase average donations and identify major donor prospects
• Conduct individual donor contact via email, phone and face to face conversations to build strong 2-way relationships with our donors
• Meet reasonable quarterly targets for growing relationships
• Meet reasonable quarterly targets for fundraising

Maintain PNHP’s donor infrastructure (15%)

• Support the Deputy Director in maintaining PNHP’s current CRM 
• Input information to track donor information, touch points, solicitations, and results
• Produce reports and analysis that to allow PNHP to evaluate its fundraising efforts

Support the overall fundraising plan (15%)

• Participate in planning PNHP’s annual fundraising campaign 
• Lead in drafting donor communications to the mid level portfolio; assist the communications team in drafting donor communications such emails and direct mail to other donor groups
• Support other development activities as needed

Other duties as assigned (5%)

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Key attributes / requirements

• Strong belief that health care is a human right and corporate profiteers are the primary obstacle to ensuring that right 
• Belief in people and their ability to make significant change in society 
• Self starter with the ability to turn goals into strategies and an action plan

• Demonstrated dedication to the implementation of a national improved Medicare for all health program
• At least 2 years of experience in a development, nonprofit fundraising, community organizing, or for-profit sales
• Dynamic human relations skills and comfort with building hundreds of new relationships 
• Must be extremely organized, self-motivated, and reliable with excellent written and verbal communication skills
• Experience managing and motivating donors
• Availability to work some evening and weekend hours as necessary
• Willingness to develop familiarity with national health policy and various health reform efforts

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Salary and benefits

Salary up to $60,000, commensurate with experience.

Excellent benefits package including fully paid family comprehensive medical (platinum level HMO or PPO), dental and vision insurance; PTO.

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Submission requirements

Email your resume along with a cover note expressing your specific interest in PNHP to jobs@pnhp.org with subject line “Donor Specialist Application First Name Last Name.” No calls please. Persons of color, women, LGBTQ-identifying persons and others from underrepresented groups are encouraged to apply.

As the Biden administration continues to inexplicably roll out the Trump-era Medicare Direct Contracting program, PNHP members have been writing op-eds and letters to the editor demanding an end to this stealth privatization attempt. Members have also been appearing on television programs, radio shows, online video segments, and podcasts.

Interested in developing your own letter or op-ed? See our detailed suggestions on writing and submitting, or contact PNHP communications specialist Clare Fauke at clare@pnhp.org.

Television and radio segments

“Medicare is being privatized on Biden’s watch, insurance industry SALIVATES,” by Ryan Grim, Hill.TV, Rising, December 9, 2021

“Secret Trump Program To Privatize Medicare Needs to End,” interview with Dr. Susan Rogers, The Thom Hartmann Program, May 2, 2022

“Seniors’ Medicare Benefits are Being Privatized Without Consent,” The Lever, April 11, 2022

“The Stealth Plan to Corporatize Medicare,” interview with Dr. Ed Weisbart, The Zero Hour with RJ Eskow, March 11, 2022

“They’re Trying to Privatize Medicare!” interview with Diane Archer, The Zero Hour with RJ Eskow, January 19, 2022

“Direct Contracting Entities, Threat to our Healthcare,” interview with Drs. Claire Cohen and Marilyn Vaché, Thinking Green, January 11, 2022

“The Plot to Destroy Medicare,” interview with Dr. Ana Malinow, Thom Hartmann Program, December 13, 2021

“Is There a New Plot to Privatize Medicare Afoot?” interview with Dr. Ana Malinow, Thom Hartmann Program, September 20, 2021

“A Banker in the Exam Room? The Growing Resistance to Medicare Privatization,” interview with Dr. Ed Weisbart, Code Wack Podcast, March 28, 2022

“The end of traditional Medicare as we know it?” interview with Dr. Ed Weisbart, Retirement Revised Podcast, February 28, 2022

“Wall Street’s Latest Attack on Traditional Medicare,” interview with Dr. Ed Weisbart, Code Wack Podcast, October 18, 2021, (part one of this two-part podcast, which covers Medicare Advantage, available HERE)

“The Plot to Take Away Your Medicare, Unveiled!” interview with Dr. Ana Malinow, KSQD Community Radio, Be Bold America!, May 22, 2022

“In the Know: Medicare Direct Contracting,” interview with Dr. Ed Weisbart, KTRS The Big 550 AM, February 28, 2022

“The Corporate Assault on Medicare,” interview with Kip Sullivan, Ralph Nader Radio Hour, January 15, 2022

“The multiple dangers of Direct Contracting Entities,” interview with Kay Tillow, KPFA Radio, Flashpoints, December 2, 2021

“Medicare Direct Contracting call-in,” interview with Dr. Ana Malinow, Redwood Community Radio, KMUD, October 1, 2021

Dr. Susan Rogers op-ed with Rep. Pramila Jayapal

“The biggest threat to Medicare you’ve never even heard of,” by Dr. Susan Rogers and Rep. Pramila Jayapal, The Hill, December 9, 2021

PNHP president Dr. Susan Rogers co-authored a piece with H.R. 1976 (Medicare for All) lead sponsor Rep. Pramila Jayapal describing the dangers of Medicare Direct Contracting, and the urgent need to end the program.

“As a physician and a member of Congress, we’ve never heard a senior ask for their health care to be more complicated, or to have their choice of Traditional Medicare taken away,” they wrote. “But that’s exactly what Direct Contracting would do. Traditional Medicare has proven its value for more than half a century. Instead of selling it off to the highest bidder, let’s strengthen and improve its benefits while working to expand it to cover every American.”

PNHP member op-eds and letters to the editor

• “Privatizing Medicare is the wrong way to go,” by Dr. Joshua Freeman, Arizona Daily Star, March 2, 2023
• “Terminate REACH,” by Dr. George Bohmfalk, Aspen (Colo.) Daily News, October 12, 2022
• “Medicare Dis-Advantage: Shortchanging the Patients While Enriching the Insurer,” by Dr. Leonard Rodberg, Common Dreams, August 30, 2022
• “The Stealth Plan to Privatize Medicare for All,” by Dr. Rick Staggenborg, Counter Punch, August 24, 2022
• “Will Medicare make it to 65?,” by Dr. Ahmed Kutty, The Concord (N.H.) Monitor, August 2, 2022
• “Medicare is in Danger, and Few are Watching,” by Thomas Lane, The Dartmouth, July 1, 2022
• “Congress must stop the pillaging of traditional Medicare,” by Dr. Leonardo Alonso, The Florida Times-Union, May 20, 2022
• “Why Seniors Like Me Are Fighting Against Medicare Direct Contracting and ACO REACH,” by Rick Timmins, Common Dreams, May 19, 2022
• “Threat to Medicare from Direct Contracting Entities/REACH,” by Drs. Stephen Kemble and Philip Verhoef, May 2, 2022
• “Words of caution for Medicare beneficiaries,” by Dr. Robert Kiefner, New Hampshire Union Leader, April 25, 2022
• “Medicare under attack,” by Lauri Hoagland and Ivend Holen, The (Medford, Ore.) Mail Tribune, April 24, 2022
• “Medical privatization,” by Charles M. Casper, Louisville Courier-Journal, March 20, 2022
• “Medicare wolves are at the door,” by Dr. Ahmed Kutty, The Keene (N.H.) Sentinel, March 16, 2022
• “Protect Medicare: Fight plan to code high, treat low,” by Jan Phillips, The Durango (Colo.) Herald, March 16, 2022
• “Is Medicare a Public Good or a Market Commodity?” by Corinne Frugoni and Patty Harvey, North Coast Journal of Politics, People & Art, March 3, 2022
• “A threat to our Medicare system,” by Charles Gutfeld, Wednesday Journal of Oak Park and River Forest (Ill.), February 22, 2022
• “Medicare for All or Medicare At All?” by Jack Carney, Adirondack Almanack, February 17, 2022
• “Biden’s costly failure to stop Medicare privatization experiment in Ohio,” by Maximilian Brockwell and James Tyler Moore, Cleveland Plain Dealer, February 16, 2022
• “How Medicare is quietly being privatized,” by Dr. Abdul El-Sayed, Detroit Metro Times, February 9, 2022
• “A New Medicare Program Threatens Seniors. We Can Stop It.” by Paul Cooper, The River (Hudson Valley, N.Y.), February 9, 2022
• “Speak out to stop hijacking of Medicare,” by Dr. Joan MacEachen, The Durango (Colo.) Herald, February 7, 2022
• “Mother of Mercy! Is This the End of Medicare?” by Dr. Alec Pruchnicki, WestView News (Manhattan, N.Y.), February 5, 2022
• “There goes your Medicare: The trouble with DCEs,” by Elisabeth Marshall, Cascadia Daily News (Bellingham, Wash.), February 3, 2022
• “Is the Government Stealthily Privatizing Medicare without Telling You?,” by F. Douglas Stephenson, Informed Comment, January 31, 2022
• “Trump-era Medicare plan a corporate giveaway,” by Dr. Gregory L. Schmidt, The Cap Times (Madison, Wisc.), January 27, 2022
• “Managed care proponents fail to justify so-called payment ‘reform’,” by Kip Sullivan, Health Affairs, Comment, January 24, 2022
• “The right to choose health care,” by Judith Esterquest and Barbara Estrin, The Riverdale Press (Bronx, N.Y.), January 23, 2022
• “What is a Direct Contracting Entity?” by Pat Kanzler, (Eureka, Calif.) Times-Standard, January 21, 2022
• “The latest assault on Medicare,” by Dr. Robert Devereaux, Roanoke (Va.) Times, January 18, 2022
• “Heads up – another threat to Medicare!” by Ron Forthofer, The Times Call (Boulder, Colo.), January 18, 2022
• “Be wary of Medicare Advantage and Direct Contracting Entities,” by Dr. H. Dixon Turner, Portsmouth (N.H.) Herald, January 17, 2022
• “Medicare: No one is stopping Trump’s scheme to privatize it,” by Bruce Robinson, Boulder (Colo.) Daily Camera, January 13, 2022
• “Hands off my Medicare,” by Dr. Kathleen Healey, Napa Valley Register, January 10, 2022
• “Medicare privatization,” by Mark McKinley, Louisville Courier-Journal, January 9, 2022
• “Cancel Direct Contracting Entity,” by Dr. Rick Staggenborg, Albany (Ore.) Democrat-Herald, January 5, 2022
• “It’s time for you to care about Medicare,” by Dr. George Bohmfalk, The Aspen (Colo.) Times, January 2, 2022
• “Stealthy effort to privatize Medicare should alarm all Americans,” by Dr. George Bohmfalk, The Pulse Blog, NC Policy Watch, December 30, 2021
• “Protect Medicare from greed, ignorance,” by Alyce V. Werkema, Lynden (Wash.) Tribune, December 29, 2021
• “End Medicare Direct Contract Program,” by Paul Cooper, Daily Freeman (Kingston, N.Y.), December 29, 2021
• “Stop Wall Street from Grabbing Traditional Medicare,” by F. Douglas Stephenson, The Smirking Chimp, December 24, 2021
• “Proposed Medicare changes are unhealthy for consumers,” by Dr. Jonathan D. Walker, The (Fort Wayne, Ind.) Journal Gazette, December 23, 2021
• “Health Care Delivery at a Crossroads,” by Dr. Marc H Lavietes, The Spirit (N.Y.), December 13, 2021
• “Draining Medicare,” by Dr. Wayne Hale, Greensboro (N.C.) News & Record, December 13, 2021
• “An Obscure Agency Is Threatening to Hand Medicare Over to Wall Street,” by Dr. Ana Malinow, Truthout, December 3, 2021
• “Stop the corporate Medicare money-grab,” by Dr. Emily Kane, Senior Voice Alaska, December 1, 2021
• “Willie Sutton and the brave new world of Medicare privatization,” by Dr. Marvin Malek, VTDigger, November 30, 2021
• “Medicare and Social Security have been successful,” by David Ross Stevens, News and Tribune (Jeffersonville, Ind.), November 24, 2021
• “Medicare is on the menu,” by Dr. Robert S. Kiefner, Concord (N.H.) Monitor, November 12, 2021
• “A successful Medicare should never be privatized,” by Dr. Elizabeth Rosenthal, The Riverdale Press (Bronx, N.Y.), October 31, 2021

Direct Contracting Entities in the news

• “Protest demands Biden administration terminate Medicare privatization scheme,” by Tim Wheeler, People’s World, August 4, 2022
• “Amazon Joins The Medicare Privatization Spree,” by Matthew Cunningham-Cook, The Lever, July 22, 2022
• “Machinists’ Retirees 751 Resolve to End ACO REACH & the Privatizing of Medicare,” by Kay Tillow, Daily Kos, June 19, 2022
• “‘Medicare Advantage on Steroids’: Advocates Push Back on ACO REACH Model,” by Andrew Donlan, Home Health Care News, May 23, 2022
• “Doctors, Lawmakers See Danger in Moving Medicare Toward Privatization,” by Ginger Szala, Think Advisor, April 29, 2022
• “Big Changes May Be Coming to Traditional Medicare,” by Mark Miller, Morningstar, April 22, 2022
• “How Medicare is Being Slowly and Quietly Put to Death,” by Lee Russ, The Progressive, March 28, 2022
• “Seniors’ Medicare Benefits Are Being Privatized Without Consent,” by Matthew Cunningham-Cook, The Lever, March 24, 2022
• “As Biden Continues Privatization Ploy, Sanders Vows to Reintroduce Medicare for All,” by Jake Johnson, Common Dreams, March 21, 2022
• “House progressives push for CMS to end newly rebranded ACO REACH model,” by Robert King, Fierce Healthcare, March 17, 2022
• “‘Can’t Fool Us’: 250+ Groups Reject Biden Rebrand of Trump’s Medicare Privatization Ploy,” by Jake Johnson, Common Dreams, March 8, 2022
• “PNHP, Community Groups Push HHS To Scrap ACO REACH Model,” by Michelle M. Stein, Inside Health Policy, March 8, 2022
• “Cigna amps up Direct Contracting participation after program revamp,” by Nona Tepper, Modern Healthcare, March 2, 2022
• “Progressives Press for More Changes to Medicare Payment Program,” by Alex Ruoff, Bloomberg Law, March 1, 2022
• “The Biden administration just overhauled a controversial new Medicare program. The changes could drive even more revenue to healthcare upstarts.” by Shelby Livingston, Business Insider, February 28, 2022
• “Under Pressure, the Biden Administration Rebrands Its Medicare Privatization Initiative,” by Branko Marcetic, Jacobin, February 27, 2022
• “‘Band-Aid on a Tumor’: Critics Blast Biden Rebrand of Trump’s Medicare Privatization Scheme,” by Jake Johnson, Common Dreams, February 25, 2022
• “Trump-Era Medicare Pilot Program to Get Reboot From Biden HHS,” by Tony Pugh, Alex Ruoff, and John Tozzi, Bloomberg Law, February 24, 2022
• “Curbs on Insurers, Private Equity Sought for Medicare Pay Plan,” by Tony Pugh, Bloomberg Law, February 22, 2022
• “Medicare’s Controversial Direct Contracting Program Hits Biden Administration’s Radar,” Elder Law Answers, February 18, 2022
• “Progressives are up in arms over a Medicare experiment,” by Rachel Roubein, Washington Post, February 17, 2022
• “Joe Biden Is Quietly Pursuing the Creeping Privatization of Medicare,” by Branko Marcetic, Jacobin, February 16, 2022
• “Biden administration weighs changes to Trump-era Medicare policy,” by Rachael Levy and Adam Cancryn, POLITICO, February 16, 2022
• “Physicians Slam Industry Push to ‘Fix’—Not End—Medicare Privatization Scheme,” by Jake Johnson, Common Dreams, February 16, 2022
• “Warren calls for end to Direct Contracting, reforms to Medicare Advantage risk adjustment,” by Robert King, Fierce Healthcare, February 3, 2022
• “Senators Mull Ways to Cut Costs in Medicare,” by Joyce Frieden, MedPage Today, February 3, 2022
• “Warren Warns ‘Corporate Vultures’ Are Circling Medicare on Biden’s Watch,” by Jake Johnson, Common Dreams, February 3, 2022
• “Trump Created A Program To Privatize Medicare Without Patients’ Consent. Biden Is Keeping It Going.” by Paul McLeod, BuzzFeed News, January 28, 2022
• “The Dark History of Medicare Privatization,” by Barbara Caress, The American Prospect, January 24, 2022
• “Over 50 Lawmakers Urge Administration to End Direct Contracting,” by Sarai Rodriguez, RevCycle Intelligence, January 17, 2022
• “Elizabeth Fowler Defending Trump Program to Privatize Medicare,” Corporate Crime Reporter, January 16, 2022
• “A quiet experiment is testing broader privatization of U.S. Medicare,” by Mark Miller, Reuters, January 14, 2022
• “Future of Trump-Era Medicare Program Spurs Fight Among Democrats,” by Alex Ruoff, Bloomberg Government, January 14, 2022
• “Jayapal Leads 50+ Democrats in Urging Biden to End Trump-Era Assault on Medicare,” by Jake Johnson, Common Dreams, January 5, 2022
• “Medicare Direct Contracting Demo Garners Critics and Defenders,” by Joyce Frieden, MedPage Today, January 4, 2022
  
• “Pressure Grows on Biden to Shut Down Trump-Era Medicare Privatization Scheme,” by Jake Johnson, Common Dreams, December 30, 2021
• “Medicare Privatization Scheme Faced Legal Questions About Profiteering,” by Ryan Grim and Austin Ahlman, The Intercept, December 14, 2021
• “Trump had a scheme to privatize Medicare. The Biden administration isn’t stopping it.” by Helaine Olen, Washington Post, December 13, 2021
• “Advocates Sound Alarm About Pilot Program They Say Could Privatize All of Medicare,” Elder Law Answers, December 10, 2021
• “Docs Come to D.C. to Protest Medicare’s Direct Contracting Program,” by Joyce Frieden, MedPage Today, December 1, 2021
• “Congress ‘Asleep at the Switch’ as Biden Continues Trump-Era Ploy to Privatize Medicare,” by Jake Johnson, Common Dreams, November 30, 2021
• “Physicians petition to end federal direct contracting,” by Nick Moran, Becker’s Hospital Review, November 19, 2021
• “Biden moves forward with Trump Medicare privatization plan,” by Chris Tomlinson, Houston Chronicle, November 8, 2021
• “Direct Contracting Entities: The Latest Scam to Privatize Medicare,” by Lambert Strether, Naked Capitalism, September 27, 2021
• “This latest under-the-radar program could push Medicare deeper into private hands,” by Trudy Lieberman, Center for Health Journalism, March 11, 2021
• “Trump administration attempts to privatize traditional Medicare,” by Diane Archer, JustCare USA, December 17, 2020

One of the most outrageous features of Medicare Direct Contracting (and there are many) is the fact that it would make radical changes to Traditional Medicare, without so much as a vote in Congress. That’s because DCEs originated in the typically under-the-radar, and unaccountable, Center for Medicare and Medicaid Innovation.

Thankfully, elected officials are putting pressure on Health and Human Services Sec. Xavier Becerra to end Direct Contracting, which he has the power to do. This Trump-era program poses a grave threat to seniors and to Medicare as a whole, and it must be stopped immediately.

Rep. Pramila Jayapal organizes against DCEs

H.R. 1976 (Medicare for All) lead sponsor Rep. Pramila Jayapal and her staff have worked closely with PNHP and other health justice organizations to push back against DCEs, both publicly and within the halls of Congress.

• Letter to Sec. Becerra calling for an end to Direct Contracting, led by Rep. Jayapal and signed by 54 members of the U.S. House
• Press release on the Congressional effort to end Medicare Direct Contracting
• “The biggest threat to Medicare you’ve never even heard of,” op-ed co-authored by Rep. Jayapal and PNHP president Dr. Susan Rogers, The Hill, December 9, 2021

Medicare Protectors stand up against privatization

PNHP thanks the following 54 members of the U.S. House of Representatives for signing on to Rep. Jayapal’s letter demanding an end to Direct Contracting:

• Alma Adams (NC-12)
• Karen Bass (CA-37)
• Donald S. Beyer Jr. (VA-08)
• Earl Blumenauer (OR-03)
• Suzanne Bonamici (OR-01)
• Jamaal Bowman, Ed.D. (NY-16)
• Cori Bush (MO-01)
• Salud Carbajal (CA-24)
• Andre Carson (IN-07)
• David Cicilline (RI-01)
• Yvette D. Clarke (NY-09)
• Steve Cohen (TN-09)
• Gerald E. Connolly (VA-11)
• Jim Cooper (TN-05)
• Jason Crow (CO-06)
• Danny K. Davis (IL-07)
• Peter A. DeFazio (OR-04)
• Rosa L. DeLauro (CT-03)
• Mark DeSaulnier (CA-11)
• Debbie Dingell (MI-12)
• Mike Doyle (PA-18)
• Adriano Espaillat (NY-13)
• Sylvia R. Garcia (TX-29)
• Jesús G. “Chuy” García (IL-04)
• Raúl M. Grijalva (AZ-03)
• Jared Huffman (CA-02)
• Pramila Jayapal (WA-7)
• Mondaire Jones (NY-17)
• John B. Larson (CT-01)
• Barbara Lee (CA-13)
• Mike Levin (CA-49)
• James P. McGovern (MA-02)
• Joseph Morelle (NY-25)
• Jerrold Nadler (NY-10)
• Joe Neguse (CO-02)
• Marie Newman (IL-03)
• Eleanor Holmes Norton (DC-00)
• Alexandria Ocasio-Cortez (NY-14)
• Ilhan Omar (MN-05)
• Donald M. Payne, Jr. (NJ-10)
• Mark Pocan (WI-02)
• Katie Porter (CA-45)
• Ayanna Pressley (MA-07)
• Jamie Raskin (MD-08)
• Jan Schakowsky (IL-09)
• Robert C. “Bobby” Scott (VA-03)
• Mary Gay Scanlon (PA-05)
• Mark Takano (CA-41)
• Dina Titus (NV-01)
• Rashida Tlaib (MI-13)
• Bonnie Watson Coleman (NJ-12)
• Peter Welch (VT-At Large)
• Nikema Williams (GA-05)
• John B. Yarmuth (KY-03)

Rep. Katie Porter sounds the alarm on DCEs

Rep. Katie Porter has led on the issue of Direct Contracting from the beginning, having sent an earlier letter to Sec. Becerra (co-signed by Reps. Mark Pocan, Bill Pascrell, Jr., and Lloyd Doggett) expressing concern about the program and calling for an immediate freeze.

She joined a webinar that PNHP co-hosted with National Single Payer on Sept. 23, 2021, and warned viewers about the dangers of letting corporate interests infiltrate a cherished and effective public health program.

“This isn’t hypothetical,” she said. “We know exactly what happens when insurers dip their hands into Medicare, because we’ve already seen that play out in Medicare Advantage.”

CMS leaders speak out about Medicare privatization

Speaking of Medicare Advantage, former Centers for Medicare and Medicaid Services (CMS) Administrator Dr. Don Berwick and former Center for Medicare and Medicaid Innovation Director Dr. Rick Gilfillan authored a crucial two-part Health Affairs blog titled, “Medicare Advantage, Direct Contracting, and the Medicare ‘Money Machine.’”

• Part 1: The Risk-Score Game
• Part 2: Building on the ACO Model

“Given an Orwellian title, Direct Contracting, launched by CMMI, was anything but direct,” they wrote. “‘Indirect Contracting’ would have been a far more accurate name, since the cornerstone of the program was CMS’s opening the door to non-provider-controlled ‘Direct Contracting Entities (DCEs)’ to become the fiscal intermediaries between patients and providers.”

During the final days of the Trump Administration, officials at the Center for Medicare and Medicaid Innovation (CMMI) launched a dangerous and insidious pilot program known as Medicare Direct Contracting. (This program was recently rebranded as REACH by the Biden Administration.)

Left unchecked, Direct Contracting and REACH would allow profit-hungry middlemen to “manage” the care of up to 30 million Traditional Medicare beneficiaries. These middlemen, some of whom have received a huge influx of money from private equity, have every incentive to frustrate patients and deny medically necessary care.

Unless we stop REACH, this program could spell the end of Medicare as a public, nonprofit, social insurance program.

Dr. Ana Malinow explains Direct Contracting Entities

Learn more about Medicare Direct Contracting and REACH

• Fact sheet: Direct Contracting: Quietly Handing Medicare to Wall Street
• Policy primer: Medicare Direct Contracting and REACH
• PowerPoint: Privatizing Medicare through Direct Contracting and REACH

Dr. Susan Rogers testifies before the U.S. Senate

On February 2, 2022, PNHP president Dr. Susan Rogers testified before the U.S. Senate Committee on Finance, Subcommittee on Fiscal Responsibility and Economic Growth, regarding the dangers of Direct Contracting.

• Oral testimony: “Medicare Direct Contracting: A Threat to Seniors and to Medicare’s Future”
• Written testimony: Comprehensive version, complete with links and citations
• Watch the full hearing: Dr. Rogers’ opening remarks start at 42:50; DCE questioning starts at 1:49:35

As Dr. Rogers stated in her testimony, “Medicare was designed as a lifeline for America’s seniors and those with disabilities, NOT a playground for Wall Street investors.”

Doctors deliver petitions directly to HHS

On November 30, 2021, PNHP president Dr. Susan Rogers led a delegation to the doorsteps of the Dept. of Health and Human Services in Washington, D.C. to deliver 13,000+ petitions demanding an end to Medicare Direct Contracting.

If you’d like to JOIN our fight against Medicare Direct Contracting, please call your member of Congress at (202) 224-3121 and ask them to demand HHS end this dangerous and insidious program; hold hearings on DCEs; and establish Congressional oversight of the Center for Medicare and Medicaid Innovation (CMMI). You can also:

• Sign and share our petition calling on the Biden Administration to end DCEs
• Share our organizational sign-on letter with allies in your community
• Watch and share the livestream of our Nov. 30 press event in Washington, D.C.
• Download and print our Traditional Medicare Death Certificate (available in one-page and large-scale versions)
• Read our press release: “Doctors to Biden: Don’t hand Medicare to Wall Street investors”

Photos of PNHP taking action in Washington

Additional information

For the most current information on Direct Contracting and REACH, visit ProtectMedicare.net. To access archival information from the late 2021 and early 2022 phase of this fight, see the following pages:

• Direct Contracting in the News
• Medicare Protectors: Standing up Against DCEs

Table of contents

Click the links below to jump to different sections of the newsletter. To view a PDF version of the shorter print edition of the newsletter, click HERE.

If you wish to support PNHP’s outreach and education efforts with a financial contribution, click HERE.

If you have feedback about the newsletter, email info@pnhp.org.

PNHP News and Tools for Advocates

• PNHP launches Medical Society Resolutions campaign
• New Kitchen Table Campaign highlights America’s maternal mortality crisis
• Meet PNHP’s newly elected board members

Research Roundup

• Data Update: Health care crisis by the numbers
  • Health Costs
  • Health Inequities
  • Coverage Matters
  • Commercial Insurance: A Hazardous Product
  • Privatizing Medicare
  • Health Care for Profit
  • Pharma
• Studies and analysis of interest to single-payer advocates
• Commentary

PNHP Chapter Reports

• California
• Illinois
• Kentucky
• Maine
• Minnesota
• New Jersey
• New York
• North Carolina
• Oregon
• Pennsylvania
• Tennessee
• Vermont
• Washington
• West Virginia

PNHP in the News

• News Articles Quoting PNHP Members
  • Chapters in Action
  • Health Policy and Research
• Opinion: Op-eds and Guest Columns
• Opinion: Letters to the Editor

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PNHP News and Tools for Advocates

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PNHP launches Medical Society Resolutions campaign

Moving organized medicine to Medicare for All should be a top priority

Polling shows that a majority of physicians support single-payer reform, with even stronger support among medical students and early-career physicians. Unfortunately, the vast majority of professional associations that claim to represent physicians do not support Medicare for All, and in some cases actively oppose it.

The lack of support by organized medicine is a huge problem for the Medicare-for-All movement. Medical societies have enormous influence over health care policy at the federal and state level. With the insurance, pharma, and investor-owned hospital industries spending millions each year lobbying against single-payer reform, the Medicare-for-All movement needs the full force of organized medicine fighting back.

As the only physician organization dedicated to single-payer reform, PNHP has a unique responsibility to move the medical profession to support Medicare for All. We’re meeting that challenge by launching the Medical Society Resolutions campaign.

“We can no longer ignore the elephant in the room — the powerful medical societies standing in the way of Medicare for All,” said PNHP president Dr. Susan Rogers. “As physicians, we are the only ones who can organize our colleagues for change.”

What is the Medical Society Resolutions (MSR) Campaign?

Virtually every physician is a member of a local, state, or specialty medical society, and is therefore in a position to propose resolutions that determine what policies their society will support (or oppose). The goal of the MSR campaign is to organize colleagues in the medical profession by passing Medicare-for-All resolutions in every medical society in the U.S.

The MSR campaign follows two years of unprecedented movement towards Medicare for All within organized medicine. In 2019, the American Medical Association only narrowly rejected a student-led pro-single payer resolution, opening the door for future support. Under pressure from activists, the AMA then resigned from the anti-single payer Partnership for America’s Health Care Future. In January 2020, the 159,000-member American College of Physicians — the largest medical specialty society and second-largest physician group after the AMA —  announced its endorsement of Medicare for All, along with a “universal public choice” reform model. The 3,300-member Society of General Internal Medicine followed suit by formally endorsing the ACP’s position.

At the state level, the Vermont Medical Society overwhelmingly endorsed a single-payer resolution in November 2020, becoming the second state society to do so after Hawaii.

All the major associations representing medical students and new physicians have endorsed Medicare for All, including the American Medical Students Association; the AMA Medical Student Section; the Student National Medical Association (representing medical students of color); and the Committee of Interns and Residents.

How to participate in the MSR campaign

Every physician member of PNHP can participate in the MSR campaign by visiting medicalsocietyresolutions.org, where they can see if other PNHP members are actively organizing single-payer resolutions in their state, national, or specialty societies; download and edit a sample resolution; and watch recorded workshops on the nuts and bolts of passing resolutions. Interested members can contact organizer@pnhp.org to get started and connect with other PNHP members in their societies.

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New Kitchen Table Campaign highlights America’s maternal mortality crisis

The U.S. is facing a crisis in maternal mortality. The rate of pregnancy-related deaths in the U.S. has nearly tripled in the past 30 years. Besides the U.S., the only other countries with rising maternal mortality rates are Afghanistan and Sudan. Our maternal mortality rate is more than double that of other high-income nations, and our infant mortality rate is 71% higher. Indigenous mothers are twice as likely — and Black mothers 2.5 times more likely — to die from pregnancy complications compared to white mothers.

The most frustrating aspect of this crisis is that these deaths are mostly preventable. Not with high-tech interventions, but with routine primary care. A majority of pregnancy-related complications and deaths are caused by health conditions that can be identified, managed, or even eliminated with regular preventive care, such as diabetes, heart disease, and hypertension. But addressing these conditions before pregnancy requires a lifetime of regular care, which is out of reach for many Americans — especially people of color — because of costs and insurance barriers.

We won’t solve this crisis with band-aid approaches. Even Medicaid — which now finances nearly half the births in the U.S. — only starts after a person discovers they are pregnant, and in many states ends soon after birth, limiting access to critically important prenatal and postpartum care.

By providing lifelong coverage for all medically necessary health services, including primary care; mental health; contraception and abortion; and pregnancy, childbirth, and postpartum care — Medicare for All is the only plan that would empower patients to prevent, identify, and treat the chronic health conditions that increase risk of pregnancy-related complications and death.

Visit pnhp.org/maternalmortality to explore the full toolkit on America’s maternal mortality crisis, which includes talking points and handouts, a slide set and webinar, videos and podcasts, and a new interactive quiz to test your knowledge of this crisis. Please use these materials in your own advocacy and share with your colleagues and communities. To learn more about PNHP’s Kitchen Table Campaign, contact clare@pnhp.org.

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Meet PNHP’s newly elected board members

At Large Members

Sanjeev Sriram, M.D., M.P.H. has been a PNHP member since 2018. Dr. Sriram completed his medical degree and residency at UCLA, his masters in public health at Harvard, and now practices pediatrics in Maryland. He founded the “All Means All” campaign to center racial equity in single payer, and promotes Medicare for All and health equity in national publications and as “Dr. America” for act.TV. As a board member, Dr. Sriram will urge PNHP to collaborate with racial justice organizations on strategies to broaden single-payer activism, and expand mentorship and professional development opportunities for our student members.

Philip Verhoef, M.D., Ph.D. has been a PNHP member since 2006. Dr. Verhoef received his medical degree and a Ph.D. in pharmacology from Case Western Reserve University, followed by med-peds residency at UCLA. He joined the faculty at the University of Chicago after a fellowship in adult and pediatric critical care, while serving as the president of the Illinois Single Payer Coalition and co-president of PNHP-Illinois. In 2019, Dr. Verhoef moved to Kaiser Permanente in Hawaii, where he serves as an adult/pediatric intensivist and hospitalist and as the associate program director for the internal medicine residency program. As a continuing board member, he plans to develop strategies for physician engagement, including messaging, programming, development, and recruitment, with a specific focus on diverse and underserved communities.

Continuing at-large member: Stephen Chao, M.D. (Texas)

North East Region

Scott Goldberg, M.D. has been a PNHP member since 2009. Dr. Goldberg earned his medical degree at University of Chicago Pritzker School of Medicine (where he launched a SNaHP chapter in 2012) and completed residency in 2019 in internal medicine-primary care at UCSF. He serves as an attending physician at Montefiore Medical Center in the Bronx where he supervises residents in the Primary Care/Social Internal Medicine program, and an assistant professor at the Albert Einstein College of Medicine. As a board member, Dr. Goldberg plans to expand PNHP’s fundraising and membership efforts, with the goal of building the power necessary to shape the culture of organized medicine around single payer.

Continuing North East board members: Mary O’Brien, M.D. (New York) and Janine Petito, M.D. (Massachusetts)

South Region

Ed Weisbart, M.D. has been a PNHP member since 1996. He completed his medical degree at the University of Illinois and family medicine residency at Michigan State University. Dr. Weisbart practiced family medicine for 20 years, served as CMO of Express Scripts from 2003-2010, and retired clinically in 2021. He serves as the chair of the Missouri chapter of PNHP, where he has delivered more than 600 public presentations and published dozens of pieces on single payer. As a board member, Dr. Weisbart will help PNHP increase its influence within the health care policy debate, and strengthen its relationships with adjacent advocacy organizations.

Continuing South Region board member: Jessica Schorr Saxe, M.D. (North Carolina)

North Central Region

Judith Albert, M.D.> has been a PNHP member since 2017. She received her medical degree from the University of Cincinnati, completed residency in obstetrics and gynecology at the University of Pittsburgh and fellowship in reproductive endocrinology at the University of Pennsylvania. Dr. Albert recently retired from having practiced in academic and private practice settings for over 30 years in Pittsburgh. She co-founded a PNHP chapter in western Pennsylvania where she has been involved in anti-racist organizing for several years. As a board member, Dr. Albert hopes to grow the single-payer movement by strengthening PNHP chapters in the region, and building coalitions with anti-racist, fair housing and anti-poverty organizations, as well as labor unions.

Continuing North Central Region board member: Joshua J. Faucher, M.D., J.D. (Illinois)

West Region

Kathleen Healey, M.D. has been a PNHP member since 2018. Dr. Healey completed her medical degree at University of Colorado School of Medicine and her residency at the Naval Medical Center in Oakland. She is an otolaryngologist whose career ranged from military service as a flight surgeon, to solo and group practices. Now retired, Dr. Healey serves as co-chair of PNHP-Napa County and PNHP-California. As a board member, Dr. Healey will work to bring more physicians into our movement, and increase PNHP’s involvement in organized medicine at all levels.

Stephen Kemble, M.D. has been a PNHP member since 1989. Dr. Kemble attended medical school at University of Hawaii and Harvard, and completed residencies in both internal medicine (Queen’s Medical Center) and psychiatry (Cambridge Health Alliance). He is now semi-retired, working part-time in a primary care clinic. Dr. Kemble is past president of both the Hawaii Psychiatric Medical Association and the Hawaii Medical Association, and also served on the Hawaii Health Authority board. As a board member, Dr. Kemble will continue to chair the newly formed PNHP Policy Committee, and help PNHP fight the power of the insurance industry with ongoing public education and community organizing.

Continuing West Region board member: Eve Shapiro, M.D., M.P.H. (Arizona)

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Research Roundup

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Data Update Fall 2021

Health Costs

Both the insured and uninsured struggle with medical costs. Nearly one in four (38%) adults had medical bill or debt problems in the last year, including 46% of those on individual/marketplace plans, 34% of those on employer plans, 55% of Black people, and 47% of low-income people; a third of those with debt said they were paying off $4,000 or more. Among those with medical debt problems, 35% used up all or most of their savings, 35% took on credit card debt, 27% had been unable to pay for basic necessities like food or rent, 23% delayed education or career plans, and 43% received a lowered credit score. Although uninsured people reported medical bill problems at the highest rates, 64% of those with a medical bill or debt problem said they had been insured at the time. Collins et al., “As the pandemic eases, what is the state of health care coverage and affordability in the U.S.? Findings from the Commonwealth Fund health care coverage and Covid-19 survey, March–June 2021,” Commonwealth Fund, 7/16/2021

Even high-income Americans have trouble paying for care. In the past year, nearly one in four Americans (38%) said they had trouble accessing health care because of cost, including 27% of high-income earners; 36% skipped health or dental care because of cost, including 21% of high-income earners; 34% said their insurance denied payment for medical care; 22% had serious problems paying or were unable to pay medical bills; and 44% had out-of-pocket medical expenses exceeding $1,000. Schneider et al., “Mirror, Mirror 2021 — Reflecting poorly: Health care in the U.S. compared to other high-income countries,” Commonwealth Fund, 8/4/2021

Americans’ medical debt reaches record levels. An estimated 17.8% of individuals in the U.S. had medical debt in collections in June 2020, for care provided prior to the pandemic. Collection agencies held $140 billion in unpaid medical bills, up from an estimated $81 billion in 2016. Between 2009 and 2020, unpaid medical bills became the largest source of debt that Americans owed to collection agencies. Residents of states that did not expand Medicaid owed an average of $375 more compared to those in expansion states, roughly a 30% increase from the year before Medicaid expansion. People living in the lowest-income ZIP codes owed an average of $677, compared to $126 in the highest-income ZIP codes. Kluender et al., “Medical debt in the U.S., 2009-2020,” JAMA, 7/20/2021

Providing medications for free leads to greater adherence and cost savings. In a study of patients in Ontario who reported cost-related non-adherence to medications, providing those medications for free increased patient adherence by 35% and reduced total health spending, including hospitalization, by an average of $1,222 per patient per year. Persaud et al., “Adherence at two years with distribution of essential medicines at no charge: The CLEAN Meds randomized clinical trial,” PLOS Medicine, 5/21/2021

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Health Inequities

U.S. life expectancy drops most for people of color. Life expectancy in the U.S. decreased by nearly two years between 2018 and 2020, down to 76.9 at the end of 2020 from 78.7 in 2018. However, the declines were more pronounced among Black people, whose life expectancy decreased by 3.3 years, and Latinx/Hispanic people, whose life expectancy decreased by 3.9 years. By comparison, among a group of 16 peer countries, the average decline in life expectancy was 0.22 years (about two-and-a-half months). Woolf et al., “Effect of the Covid-19 pandemic in 2020 on life expectancy across populations in the USA and other high-income countries: Simulations of provisional mortality data,” BMJ, 5/24/2021

Life expectancy gap widens between urban and rural communities. In 2019, the mortality rate in urban areas of the U.S. was nearly 665 deaths per 100,000 people, but in rural areas was 834 deaths per 100,000 people. Over the past 20 years, the life expectancy gap between rural and urban areas grew by 172%. Cross et al., “Rural-urban disparity in mortality in the U.S. from 1999 to 2019,” JAMA Network, 6/8/2021

Latinx/Hispanic children in the U.S. are twice as likely to be uninsured. The uninsured rate for Latinx/Hispanic children in the U.S. reached 9.3% in 2019, compared to an uninsured rate of 4.4% for non-Latinx/Hispanic youth. There is considerable variation in the uninsured rate based on state, ranging from 1.8% uninsured in Massachusetts to 19.2% in Mississippi. The uninsured rate for Latinx/Hispanic children in states that had not expanded Medicaid by 2019 was more than 2.5 times higher than expansion states (14.9% vs. 5.8%). Whitener and Corcoran, “Getting back on track: A detailed look at health coverage trends for Latino children,” Georgetown University Center for Children and Families, 6/8/2021 

U.S. health spending goes disproportionately to white patients. The U.S. spends about 15% more on health services for white people than for people of color. Per-person spending for white people averaged $8,141, compared to $7,361 for Black people, $6,025 for Latinx/Hispanic people, and $4,692 for Asian, Native Hawaiian, and Pacific Islander people. Spending also differed by types of care. For example, compared to the national average, Black people accounted for 26% less spending on outpatient services, but 12% more on emergency or inpatient care, suggesting they are treated for illnesses at more advanced stages. Dieleman et al., “U.S. health care spending by race and ethnicity, 2002-2016,” JAMA Network, 8/17/2021

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Coverage Matters

Low-cost care improves colon cancer survival rates, especially for Black patients. Between 1987 and 2013, colon cancer patients in the U.S. Military Health System (MHS) — where care is provided with few or no financial barriers — had an 18% lower risk of death, and were 10% less likely to be diagnosed in a later phase of the disease, compared to similar patients in the general population. The better survival rates were also more evident among Black patients in the MHS, who were 26% less likely to die of colon cancer than those in the general population. Lin et al., “Comparison of survival among colon cancer patients in the U.S. Military Health System and patients in the Surveillance, Epidemiology, and End Results (SEER) Program,” Cancer Epidemiology, Biomarkers & Prevention, 6/23/2021

Medicare coverage reduces racial disparities in coverage and care. Eligibility for Medicare coverage was associated with reductions in racial and ethnic disparities in insurance coverage, access to care, and self-reported health, benefiting Black and Latinx/Hispanic people the most. Medicare eligibility shrank disparities in insurance coverage by 53% between Black and white people, and 51% between Latinx/Hispanic and white people. Insurance coverage for Latinx/Hispanic people rose from 77.4% prior to the age of 65 to 91.3% after 65; for Black people, it rose from 86.3% to 95.8%. The proportion of Black and Latinx people who self-reported their health as poor also dropped significantly after they became eligible for Medicare. Wallace et al., “Changes in racial and ethnic disparities in access to care and health among U.S. adults at age 65 years,” JAMA Internal Medicine, 7/26/2021

Workplace “wellness” programs are no substitute for actual health care. A controlled study of workplace wellness programs — which included modules on nutrition, physical activity, and stress reduction — found that employees at the wellness program worksites had better self-reported health behaviors (such as attempting to manage their weight), but found no significant differences in self-reported health, clinical markers of health, health care spending or use, absenteeism, tenure, or job performance. A three-year follow up did not yield detectable improvements in clinical, economic, or employment outcomes. Song and Baicker, “Health and economic outcomes up to three years after a workplace wellness program: A randomized controlled trial,” Health Affairs, June 2021

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Commercial Insurance: A Hazardous Product

High-deductible health plans (HDHP) now the norm. The majority (51%) of private-sector employees are now enrolled in HDHPs, defined as having a deductible of $1,350 for an individual and $2,700 for a family in 2018. HDHP enrollment has grown by 43% over the past five years. “State health compare,” State Health Access Data Assistance Center, Health Policy and Management Division of the School of Public Health at the University of Minnesota, accessed August 2021

High cost-sharing has potentially deadly consequences for lower-income patients. Among patients who had been forced to switch from a low-deductible to a high-deductible health plan (HDHP), researchers found that patients from low-income neighborhoods had fewer emergency department visits or hospitalizations for nonspecific chest pain, but had more hospitalizations for myocardial infarction (heart attack) after ED diagnosis of nonspecific chest pain. Researchers conclude that HDHPs’ higher out-of-pocket costs lead to potentially negative health implications for lower-income populations. Chou et al., “Impact of high-deductible health plans on emergency department patients with nonspecific chest pain and their subsequent care,” Circulation, June 2021

Patients again saddled with Covid care cost-sharing burden. Despite record profits and a recent surge in Covid cases, insurers are dropping their Covid-19 cost-sharing waivers. Across the two largest health plans in each state, 72% are no longer waiving out-of-pocket costs for Covid-19 treatment, with another 10% phasing out their waiver policies by the end of October. Almost half these plans ended cost-sharing waivers in April 2021, citing vaccine availability. Ortaliza et al., “Most private insurers are no longer waiving cost-sharing for Covid-19 treatment,” Kaiser Family Foundation, 8/19/2021

Those with commercial insurance face worse access, higher costs than those in public plans. Compared to people on Medicare, those with employer-sponsored or “marketplace” plans were less satisfied with their care, less likely to have a personal physician, and more likely to report instability in insurance coverage and difficulty receiving medical care or prescriptions due to cost. Reports of medical debt were more common among people who had employer-sponsored coverage (23.4%) and those with individual commercial plans (22.3%) than individuals covered by Medicare (15.6%) or Medicaid (18.3%). Wray et al., “Access to care, cost of care, and satisfaction with care among adults with private and public health insurance in the U.S.,” JAMA, 6/1/2021

Commercial plans save money by denying patient claims. Insurers offering individual ACA “marketplace” plans denied about 17% of in-network claims (40.4 million) in 2019. Patients almost never appeal claim denials: 0.2% of patients appealed their denials, vs. 99.8% that did not appeal. When patients did appeal, insurers upheld 60% of those denials. Even though patients have the right to request an external review after a claims appeal is denied by the insurer, fewer than one in 20,000 denied claims made it to external review. Pollitz and McDermott, “Claims denials and appeals in ACA Marketplace plans,” Kaiser Family Foundation, 1/20/2021

Insurers’ “utilization management” schemes cost the health care system $93 billion per year, with patients paying most of the cost. Insurers are restricting drug formularies, requiring more stringent prior authorizations, and raising patient cost-sharing requirements for prescriptions. These so-called “utilization management” schemes cost the U.S. health system approximately $93.3 billion each year for implementing, contesting, and navigation. Insurers spend approximately $6.0 billion administering utilization management, and drug companies spend approximately $24.8 billion subsidizing patient copays. However, the biggest costs are borne by patients and doctors: Physicians waste $26.7 billion on time spent navigating utilization management, and patients spend $35.8 billion in drug cost sharing, even after copay coupons from manufacturers and charities. The study did not measure the health effects of these schemes, but notes that approximately 20% of prescriptions in the U.S. are never filled. Howell et al., “Quantifying the economic burden of drug utilization management on payers, manufacturers, physicians, and patients,” Health Affairs, August 2021

Insurers gobble up provider practices and keep more of patients’ premiums. Some commercial insurers are expanding aggressively into care delivery, and get to keep more of the premiums they collect when they also own the providers. Federal law limits insurers’ profits to 15-20% of collected premiums, but puts no limits to how much profit a provider can keep. So if an insurer directs enrollees to insurer-owned providers, the company is able to keep more premium dollars. UnitedHealth, for example, owns commercial insurance plans but also operates Optum-branded surgery centers, physician practices, and specialty pharmacies. In 2021, UnitedHealth expects to earn $91 billion in “eliminations,” an accounting term for revenues that stay within the company, a fourfold increase from 10 years ago. Herman, “Profits swell when insurers are also your doctors,” Axios, 7/16/2021

Not all surprise medical bills come from the hospital. Among large employer health plans in 2018, about half (51%) of emergency and 39% of non-emergency ground ambulance rides included an out-of-network charge for ambulance services, sticking patients with surprise bills. Ambulances bring 3 million privately insured people to an emergency room each year. Amin et al., “Ground ambulance rides and potential for surprise billing,” Peterson-Kaiser Family Foundation Health System Tracker, 6/24/2021

Commercial insurers continue pandemic profit streak. At the mid-point of 2021 — as the U.S. entered another wave of Covid hospitalizations and death —  commercial insurers posted massive profits. UnitedHealth led the way with second quarter net profits of $4.3 billion; CVS Health (Aetna), $2.8 billion; Anthem, $1.8 billion; Cigna, $1.5 billion; and Humana, $588 million. Herman, “The vaccine wave kept health care as profitable as ever,” Axios, 8/30/2021

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Privatizing Medicare

Medicare Advantage drives up Medicare spending. Medicare spending for enrollees on privatized Medicare Advantage (MA) plans was $321 higher per person in 2019 than it would have been if enrollees had been covered by traditional Medicare, raising overall Medicare spending by $7 billion. Between 2021 and 2029, federal spending on payments to MA plans is projected to increase by $316 billion, from $348 billion to $664 billion. Biniek et al., “Higher and faster growing spending per Medicare Advantage enrollee adds to Medicare’s solvency and affordability challenges,” Kaiser Family Foundation, 8/17/2021

Medicare Advantage plans find ways to dump dying patients. Commercial Medicare Advantage (MA) plans are finding ways to avoid paying the high costs of end-of-life care. As a result, MA beneficiaries in the last year of life disenrolled to join traditional Medicare at more than twice the rate (5%) of all other MA beneficiaries (2%) in 2017. The U.S. Government Accountability Office found that beneficiaries in the last year of life disenroll because of limitations accessing specialized (and expensive) care under MA. Because Medicare pays MA a fixed fee per enrollee, MA enrollees who switched to traditional fee-for-service Medicare in their last year of life increased Medicare’s costs by $490 million in 2017. “Medicare Advantage: Beneficiary disenrollments to fee-for-service in last year of life increase Medicare spending,” U.S. Government Accountability Office, 6/28/2021

Medicare enrollees face cost problems, but fare better in traditional Medicare than Medicare Advantage. The rate of cost-related problems was lower among beneficiaries in traditional Medicare (TM) (15%) than among those enrolled in Medicare Advantage (MA) (19%) plans. Those with TM plus supplemental coverage (80% of those in TM) had the lowest cost-related problems (12%), but among the remaining 20% of TM enrollees without supplemental coverage, 30% reported cost-related problems. Among Black beneficiaries, those in TM had lower cost problems (24%) than those in MA (32%). Across all plans, the rate of cost-related problems was twice as high among Black beneficiaries compared to white beneficiaries (28% vs. 14%), three times higher among beneficiaries in fair or poor self-reported health than among those good health (34% vs. 11%), and 3.5 times higher among beneficiaries under age 65 with long-term disabilities than among those ages 65 and older (42% vs. 12%). Biniek et al., “Cost-related problems are less common among beneficiaries in traditional Medicare than in Medicare Advantage, mainly due to supplemental coverage,” Kaiser Family Foundation, 6/25/2021

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Health Care for Profit

Despite the pandemic, health industry CEOs have big paydays. The CEOs of 178 health care companies collectively made $3.2 billion in 2020, 31% more than 2019. The CEOs of the six biggest commercial health insurers (Anthem, Centene, Cigna, CVS Health, Humana, UnitedHealth Group) made a combined $236 million in 2020, a 45% increase over 2019. Herman, “Health care executive pay soars during pandemic,” Axios, 6/14/2021

High-revenue hospitals more likely to sue their patients. More than a quarter of the 100 U.S. hospitals with the highest revenues sued patients over unpaid medical bills between 2018 and mid-2020, filing nearly 39,000 court actions (which is likely an undercount since many court records are inaccessible), including lawsuits, wage garnishments, and personal property liens. McGhee and Chase, “How America’s top hospitals hound patients with predatory billing,” Axios, 6/14/2021

Investor-owned hospitals more likely to inflate prices. Most hospitals charge more for a procedure than what it costs them, but for-profit facilities take this markup to extremes. The top 100 revenue-generating hospitals charged patients seven times the cost of service, and for-profit hospitals averaged a nearly 12-fold markup. Nine of the 10 top-markup hospitals were investor owned. While these charges are almost never the actual price paid by insurers, they are used to charge uninsured patients. McGhee and Chase, “How private hospitals make their money: Massive markups,” Axios, 6/14/2021

Investors are cashing in on trauma centers. Investor-owned hospital firms like HCA are rapidly opening “trauma centers,” which treat injuries from events like car crashes, falls, or gunshot wounds. Trauma centers were once operated mainly by established teaching hospitals, but investor-owned HCA has opened trauma centers in 90 of its hospitals and now operates one out of every 20 trauma centers in the country. Once a hospital has a trauma designation, it can charge patients special “trauma team activation” fees of as much as $50,000 per patient for the same care provided in a regular emergency department. Hancock, “In alleged health care ‘money grab,’ nation’s largest hospital chain cashes in on trauma centers,” Kaiser Health News, 6/14/2021

Independent physician practices are now the minority. By the end of 2020, hospitals and corporations owned half of America’s physician practices; nearly 70% of U.S. physicians are now employed by hospitals or corporations like private equity firms and health insurers. In 2019 and 2020, 48,000 physicians quit private practice; of those, more physicians moved to corporate entities than to hospitals. Corporate entities now employ an estimated 20% of all physicians, a 31% increase in the percentage of corporate-employed physicians over two years. “COVID-19’s impact on acquisitions of physician practices and physician employment 2019-2020,” Avalere Health, June 2021

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Pharma

Drug prices are rising at twice the rate of inflation. While the 2020 rate of inflation was 1.3%, the price of a group of 260 widely used prescription drugs rose by nearly 3% overall since 2019. Over the past 15 years, the price of 65 regularly used brand name drugs rose by nearly 280%, while inflation only rose by 32%. Purvis and Schondelmeyer, “Rx price watch report: Trends in retail prices of brand name prescription drugs widely used by older Americans, 2006 to 2020,” AARP Public Policy Institute, June 2021

Medicare drug spending spikes due to prices, not volume. The amount Medicare spent on drugs dispensed at pharmacies increased 26% from 2013 through 2018. The Medicare Payment Advisory Commission attributed nearly all of the growth in spending to higher prices charged by pharmaceutical firms rather than an increase in the number of prescriptions filled by beneficiaries. “Report to the Congress: Medicare and the health care delivery system,” The Medicare Payment Advisory Commission, June 2021

Direct advertising leads to increases in Medicare spending on expensive drugs. Pharma manufacturers spend about $6 billion each year on consumer advertising. The highest ad spenders were AbbVie’s rheumatoid arthritis drug Humira at $1.4 billion; Pfizer’s neuropathic pain drug Lyrica at $913 million; and Eli Lilly’s Type 2 diabetes drug Trulicity at $655 million. Between 2016 and 2018, nearly 60% of Medicare Parts B and D beneficiary spending ($324 billion) went to drugs the industry advertised directly to consumers. Advertised drugs accounted for 8% of total Medicare Part D drugs used but 57% of drug spending. Among the top 10 drugs with the highest Medicare expenditures, four were also among the top 10 drugs in advertising spending in 2018. “Prescription drugs: Medicare spending on drugs with direct-to-consumer advertising,” Government Accountability Office Report to U.S. Senate Committee on the Judiciary, May 2021

Pharma payments to doctors are associated with increased prescribing of more expensive insulin. An analysis of Medicare claims found that more than 51,800 physicians received industry payments worth $22.3 million in 2016. The following year, those physicians wrote, on average, 135 prescriptions for more expensive long-acting insulin, compared with 77 prescriptions written by doctors who did not receive industry payments. The larger number of prescriptions resulted in an average Medicare Part D claim of $300, which was $71 more than claims generated by doctors who did not receive payments. Inoue et al., “Association between industry payments and prescriptions of long-acting insulin: An observational study with propensity score matching,” PLOS Medicine, 6/1/2021

Pharma spends more on dividends and stock buybacks than research and development. The 14 largest drugmakers spent $577 billion on stock buybacks and dividends from 2016 through 2020, which was $56 billion more than was spent on R&D during the same time. In fact, some of the spending categorized as “research and development” was spent “researching” ways to suppress competition — especially from generics — such as filing hundreds of new but very minor patents on older drugs. “Drug pricing investigation: Industry spending on buybacks, dividends, and executive compensation,” U.S. House of Representatives Committee on Oversight and Reform, July 2021

Some of the biggest patient advocacy groups take millions from drug companies, but hide those relationships. All but one of the 15 most prominent patient advocacy organizations — including the American Cancer Society, American Diabetes Association, American Heart Association, and American Lung Association — fail to fully disclose the amount of drug industry funding they receive, and 12 of the 15 leading groups also have representation from the pharmaceutical industry on their boards. One of the groups, the International Myeloma Foundation, received 57% of its funding ($11.5 million) from just two pharmaceutical companies. Researchers found that many of these same groups “appear unable or unwilling to take positions on consumer issues such as lowering prescription drug prices that might anger their drug corporation funders.” “The hidden hand: Big pharma’s influence on patient advocacy groups,” Patients for Affordable Drugs, 6/30/2021

Pharma keeps prices high by buying off lawmakers. Nearly every attempt to lower drug prices at the state level has failed. Not surprisingly, more than one-third of state legislators in the U.S. (at least 2,467) took pharmaceutical industry campaign contributions in the last two years. In Louisiana 84% of lawmakers took cash from pharma during the 2020 election cycle; in California it was 82%; in Illinois, 76%; and in Oregon, 66%. The industry spent slightly more on Democrats ($4.5 million) than on Republicans ($4.4 million). Facher, “Pharma funded more than 2,400 state lawmaker campaigns in 2020, new STAT analysis finds,” STAT, 6/9/2021

Pharma throws cash at Dems who fight Medicare drug negotiations. In early May, Rep. Scott Peters (D-Calif.) led a group of nine centrist Democrats attempting to block Rep. Nancy Pelosi’s bill allowing Medicare to negotiate drug prices. Over the next two days, Rep. Peters received $19,600 from the pharmaceutical industry, including $5,800 from Pfizer CEO Albert Bourla, $5,000 from Eli Lilly CEO David Ricks, $2,900 from Bristol Myers Squibb CEO Giovanni Caforio, $2,900 from Merck CEO Ken Frazier, and three $1,000 checks from three separate PhRMA lobbyists. In total, Rep. Peters took in $66,400 from the pharmaceutical industry between May 4 and June 30. Cohrs, “Pharma CEOs, lobbyists showered Democrat with cash after his attempt to torpedo Pelosi’s drug pricing bill,” STAT, 7/20/2021

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Studies and analysis of interest to single-payer advocates

“Racial Justice Report Card, 2020-2021,” White Coats for Black Lives, September 1, 2021. The goal of the Racial Justice Report Card is to document the racism that continues to permeate our nation’s leading medical institutions, highlight best practices, and encourage academic medical centers to direct their considerable power and resources toward addressing the needs of patients and colleagues of color. The Report Card consists of metrics that evaluate medical institutions’ curriculum and climate, student and faculty diversity, policing, racial integration of clinical care sites, treatment of workers, and research protocols. All of the schools received mostly failing grades.

“Medical debt in the U.S., 2009-2020,” Raymond Kluender, Ph.D.; Neale Mahoney, Ph.D.; Francis Wong, Ph.D.; Wesley Yin, Ph.D.; JAMA Network, July 20, 2021. Between 2009 and 2020, unpaid medical bills became the largest source of debt that Americans owe collections agencies; by 2020, these agencies held $140 billion in unpaid medical bills. That amount only measures debts that have been sold to collectors and does not count all medical bills owed to health care providers. An estimated 17.8% of individuals in the U.S. had medical debt in collections in June 2020, reflecting care provided prior to the Covid-19 pandemic. Medical debt was highest among individuals who lived in the South and in ZIP codes in the lowest income deciles, and was most concentrated in lower-income communities in states that did not expand Medicaid.

“Medical uninsurance and underinsurance among U.S. Children: Findings from the National Survey of Children’s Health, 2016-2019,” Adam Gaffney, M.D., M.P.H.; Samuel Dickman, M.D.; Christopher Cai, M.D.; Danny McCormick, M.D., M.P.H.; David U. Himmelstein, M.D.; Steffie Woolhandler, M.D., M.P.H.; JAMA Pediatrics, August 23, 2021. Researchers found that between 2016-19, the number of uninsured children rose from 5.9 million to 6.3 million, and the number of children with inadequate coverage increased from 16.2 million to 18.1 million. The proportion of children with inadequate insurance (either uninsured or underinsured) was lower in Medicaid expansion states (30.9%) than in non-expansion states (35.3%). Underinsurance was more common among privately-insured (34.8%) than publicly-insured (17.5%) children, likely reflecting the high copayments and deductibles in many private plans. The researchers also found that nearly one in three children with serious chronic illnesses or impairments were inadequately insured.

“Association between high-deductible health plans and cost-related non-adherence to medications among Americans with diabetes: An observational study,” Charlotte Rastas, M.D., M.Sc.; Drew Bunker, M.D.; Vikas Gampa, M.D.; John Gaudet, M.D.; Shirin Karimi, M.D.; Ariel Majidi, M.P.; Gaurab Basu, M.D., M.P.H.; Adam Gaffney, M.D., M.P.H.; and Danny McCormick, M.D., M.P.H.; Journal of General Internal Medicine, July 29, 2021. For Americans with diabetes, being enrolled in a high-deductible health plan (HDHP) substantially increases the risk of not taking prescribed medications due to cost. The study found that among all patients with diabetes, 20% of those enrolled in a HDHP reported forgoing medications due to cost, compared with 16% of those in a traditional commercial plan — a 28% higher rate of missing medication for those with a high deductible. Among patients specifically taking insulin for diabetes, 25% of HDHP enrollees were unable to afford their medication, compared with 19% of those in a traditional plan — a 31% higher rate of missing medications. Researchers also found that among the diabetic patients they studied, those who could not take their medication as prescribed because they could not afford it were more likely to have one or more emergency department visits, and potentially more hospitalizations per year, than patients who were not forced to skip their medications.

“Socioeconomic inequality in respiratory health in the U.S. from 1959 to 2018,” by Adam Gaffney, M.D., M.P.H.; David U. Himmelstein, M.D.; David C. Christiani, M.D., M.S., M.P.H.; Steffie Woolhandler, M.D., M.P.H.; JAMA Internal Medicine, May 28, 2021. This new study suggests that poor lung health and higher rates of respiratory problems may have left lower-income Americans susceptible to the pneumonia often caused by the coronavirus. From 1959 to 2018, socioeconomic disparities in respiratory symptoms, lung disease prevalence, and pulmonary function mostly persisted — and in some instances appeared to widen — despite improvements in air quality and tobacco use, suggesting that the benefits of these improvements have not been equitably enjoyed. Researchers conclude that social class may function as an independent determinant of lung health.

“Racial and ethnic disparities in outpatient visit rates across 29 specialties,” Christopher Cai, M.D.; Adam Gaffney, M.D., M.P.H.; Alecia McGregor, Ph.D.; Steffie Woolhandler, M.D., M.P.H.; David U. Himmelstein, M.D.; Danny McCormick, M.D., M.P.H.; Samuel Dickman, M.D. JAMA Internal Medicine, July 19, 2021. Researchers found that people of color are underrepresented in the outpatient practices of most specialist physicians, including surgical specialists such as orthopedists and medical subspecialists such as pulmonary (lung) specialists. Disparities persisted even after accounting for patients’ insurance, income, education, and health status. For example, Black patients’ visit rates to orthopedic surgeons, urologists, pulmonologists, and cardiologists were 59%, 62%, 63%, and 81% those of white individuals, respectively. Notably, nephrologists — who care for patients with end-stage kidney disease, almost all of whom are covered by Medicare, and many of whom are people of color — provided significantly more care to minority groups than to whites. In contrast, primary care physicians saw patients of color and white patients at roughly equal rates.

“States’ performance in reducing uninsurance among Black, Hispanic, and low-income Americans following implementation of the Affordable Care Act,” Gregory Lines, Kira Mengistu, Megan Rose, Carr LaPorte, Deborah Lee, Lynn Anderson, Daniel Novinson, Erica Dwyer, Sonja Grigg, Hugo Torres, Gaurab Basu, and Danny McCormick, Health Equity, July 21, 2021. Gains in health insurance coverage under the Affordable Care Act (ACA) were small for Black, Hispanic and low-income Americans in many states. This study found dramatic variation in states’ performance in expanding insurance coverage to these populations that have historically had low coverage rates. While the best performing states were able to reduce rates of uninsurance among Black, Hispanic and low-income adults by approximately 60%, the worst performing states reduced uninsurance by less than 10%, a six-fold difference. The study also found that, two years after ACA implementation, in six states one quarter of Black adults remained without insurance coverage; in 20 states, one quarter of low-income adults continued to lack coverage; in 13 states, over 40% of Hispanic adults lacked coverage.

“Changes in racial and ethnic disparities in access to care and health among U.S. adults at age 65 years,” Jacob Wallace, Ph.D.; Karen Jiang, B.A.; Paul Goldsmith-Pinkham, Ph.D.; Zirui Song, M.D., Ph.D.; JAMA Internal Medicine, July 26, 2021. Immediately after age 65 years — the age at which all adults are eligible for Medicare coverage — disparities between white and Black adults and between white and Hispanic adults sharply decrease. After age 65, there were marked reductions in the share of the population that was uninsured, without a usual source of care, unable to see a physician in the past year owing to cost, and in poor self-reported health.

“Promise vs. Practice: The actual financial performance of Accountable Care Organizations,” James G. Khan, M.D., M.P.H. and Kip Sullivan, J.D., Journal of General Internal Medicine, August 13, 2021. The authors collect and compare financial performance data from all four CMS Accountable Care Organization (ACO) programs from 2005 to 2018, examining net CMS cost (gross savings in medical billings minus “bonus” payments to ACOs). They found that overall, ACO programs roughly broke even — from the CMS perspective. That is, when bonuses CMS paid to ACOs are subtracted from gross savings, the programs lost money or saved no more than a few tenths of a percent.

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Commentary

“We can heal from hate crimes by practicing solidarity,” by Christopher Cai, M.D., JAMA Network, June 21, 2021. Former SNaHP leader Dr. Chris Cai reflects on the experience of being a young Asian-American physician. He suggests that Asian- American physicians can heal from recent hate crimes by advocating for policies that dismantle structural racism in medicine and broader society.

“How would Medicare for All affect physician revenue?” by Christopher Cai, M.D., Journal of General Internal Medicine, July 8, 2021. Dr. Cai explains that the available evidence suggests physicians would prosper under single-payer reform. By supporting Medicare for All, physicians — and organized medicine — can both advocate for physicians’ self-interest while advancing legislation that would be enormously beneficial to patients.

“Financial profit in medicine: A position paper from the American College of Physicians,” Ryan Crowley, B.S.J.; Omar Atiq, M.D.; David Hilden, M.D.; Annal of Internal Medicine, September 7, 2021. In this position paper following the group’s endorsement of single-payer reforms, the ACP explains that profit motive in medicine may contribute to a bloated, complex, and fragmented health care system. “In recent years, we have seen health care become increasingly business-oriented with more for-profit entities and private equity investments,” said Thomas G. Cooney, M.D., chair of ACP’s Board of Regents. “We need to be sure that profits never become more important than patient care in the practice of medicine.”

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PNHP Chapter Reports

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California

In California, four physician members met with state Senator Monique Limon in July, sharing stories about patients who could have been helped by a single-payer plan. Sen. Limon is a member of the senate health committee. PNHP-CA members participated in several actions this summer, including a rally at the state capitol in support of the Healthy California Now bill, a rally demanding Gov. Newsom lead the way on single payer, a delegation to the national March for Medicare for All in Los Angeles, and an event celebrating Medicare’s birthday and demanding Medicare for All. To get involved in California, contact Dr. Kathleen Healey at khealey.ent@gmail.com.

Illinois

Many Illinois members have been giving interviews and speeches about Medicare for All.  Shannon Rotolo, PharmD, a leader in the Illinois Single-Payer Coalition and founder of Pharmacists for Single Payer, discussed pharmacy issues on a Healthcare-NOW! podcast, and was quoted in the Journal of the American Pharmacists Association. Co-president Dr. Pam Gronemeyer spoke about Medicare for all on a podcast with Chicago journalist Ben Joravsky, and at the Chicago March for Medicare for All. Dr. Anne Scheetz spoke to the LaSalle Democratic Central Committee and on a panel sponsored by Chicago Jobs with Justice and Illinois Single Payer Coalition. The chapter also participated in several other events this summer, including a Chicago vigil for global vaccine access; a rally for Medicare for All at the office of Rep. Raja Krishnamoorthi; and a campaign by the Chicago-based Jesse Brown VA Medical Center’s Clinical Committee for Black Lives, urging the VA to discontinue the use of race-based algorithms in kidney function calculations. To get involved in Illinois, contact Dr. Anne Scheetz at annescheetz@gmail.com. 

Kentucky

In Kentucky, Kentuckians for Single Payer Health Care found that many seniors who switch back to Traditional Medicare from a commercial Medicare Advantage plan are not protected from being denied a Medigap plan, or charged more, because of pre-existing conditions such as age, health status, claims experience, or medical condition. Dr. Eugene Shively proposed and successfully passed a resolution at the August meeting of the Kentucky Medical Association calling on the state legislature to end Medigap discrimination. In addition to their work on Medigap plans, chapter members helped to organize the Louisville March for Medicare for All in July, earning local media coverage. To get involved in Kentucky, contact Kay Tillow at nursenpo@aol.com.

Maine

Maine’s legislature passed the Maine Health Care Act, authorizing the state to request waivers from the federal government to implement a state universal health program, and requiring that 60 days after the implementation of such waivers, the governor appoint a board to design the state plan. The bill is a result of hundreds of volunteer hours, including testimony, meetings, and the production of educational materials for legislators. PNHP members also participated in the March for Medicare for All in Portland, earning media coverage from one TV station and two of Maine’s largest newspapers.    PNHP’ers in Maine are also gathering signatures for a ballot initiative directing the state legislature to establish a universal health care system in the state. To get involved in Maine, contact Dr. Henk Goorhuis at henk@maineallcare.org.

Minnesota

PNHP-Minnesota hosted a workshop in July on passing local government resolutions in support of Medicare for All. Participants heard from health care activists around the state working on active resolution campaigns, as well as those looking to start new campaigns. To get involved in Minnesota, contact pnhpminnesota@gmail.com.

New Jersey

PNHP’s New Jersey chapter hosted a planning session in June to discuss organizing strategies to win national Medicare for All. Speakers included U.S. Rep. Bonnie Watson Coleman, who is vice-chair of the Congressional Progressive Caucus. To get involved in New Jersey, contact Dr. William Thar at wethar@gmail.com.

New York

In New York, PNHP’s NY-Metro chapter is continuing to focus on organizing around the New York Health Act, which was introduced this year with majority support in both the Assembly and the Senate. Organizing tactics included social media campaigns, as well as a series of in-person rallies outside of the offices of targeted legislators, along with a large rally and “die-in” civil disobedience outside of the state capitol building. This spring and summer, the chapter also focused on fighting a move by New York City to shift its public union retirees over to a Medicare Advantage plan. PNHP-NY Metro and the NY Statewide Senior Action Council worked with concerned union members, providing them with tools to coordinate the larger group of retirees interested in the fight, and by hosting two informational forums about the proposed change and how it would affect retirees. To get involved in New York, contact NY Metro Executive Director Bob Lederer at info@pnhpnymetro.org.   

North Carolina

In North Carolina, board members of Health Care Justice NC — PNHP’s chapter in Charlotte — led several presentations on the topic of the pandemic, health inequities, and Medicare for All to the Atrium Health System pediatric residents, the staff of the Charlotte Center for Legal Advocacy, and to Duke University’s African-American Covid Taskforce Meeting on July 20. After a vote by the board, chapter members have been contacting their elected representatives to advocate for improvements to traditional Medicare, including lowering eligibility age to 60, coverage for dental, vision, and hearing care, a cap on out-of-pocket expenses, and allowing Medicare to negotiate drug prices. To get involved in Health Care Justice NC, contact Dr. Jessica Schorr Saxe at jessica.schorr.saxe@gmail.com.

Members of Health Care for All Western North Carolina (HCFA-WNC) in Asheville presented a Medicare for All resolution to the Asheville City Council and the Buncombe County Commission. Members also picketed in solidarity with NNU nurses Mission Hospital, who were organizing for a new contract. HCFA-WNC joined with six other organizations to plan and sponsor a March for Medicare for All which attracted more than 100 marchers. To get involved in HCFA-WNC, contact Terry Hash at theresamhash@gmail.com.

Health Care for All-NC co-hosted a teach-in with the Freelance Solidarity Project, a division of the National Writers Union, about why Medicare for All matters to all freelance workers, and how they can support it. Panelists included Rhiannon Duryea, the national coordinator for the Labor Campaign for Single Payer; Natalie Shure, a writer for The New Republic; and Dominic Harris, president of UE Local 150 in Charlotte and chair of UE 150’s Medicare for All campaign. PNHP is working with the writers’ union leadership to draft a resolution in support of Medicare for All. To get involved in Health Care for All NC, contact Jonathan Michels at jonscottmichels@gmail.com.

Oregon

Members of PNHP Oregon helped to organize a March for Medicare for All rally in July. The chapter has also joined PNHP’s Medical Society Resolutions Campaign, with the goal of passing resolutions in local chapters of internal medicine and pediatrics specialty societies. Dr. Paul Gormann is helping to organize a new chapter of Students for a National Health Program at Oregon Health and Science University. To get involved in Oregon, contact Dr. Peter Mahr at peter.n.mahr@gmail.com.

Pennsylvania

In Pennsylvania, members of PNHP’s Philadelphia chapter met with the chief of staff of Rep. Dwight Evans to learn why he is hesitant to support H.R. 1976, even though he endorsed previous single-payer bills. The chapter will use his response to strategize next steps in their campaign to win support from all members of the area’s Congressional delegation. To get involved in Philadelphia, contact Dr. Walter Tsou at walter.tsou@verizon.net. 

PNHP’s Western Pennsylvania chapter continues to ally with the local labor movement, and recently visited striking members of the United Steelworkers to build solidarity. The chapter also sponsored the Pittsburgh March for Medicare for All in July, which attracted about 100 single-payer activists. To get involved in Western PA, contact Dr. Judy Albert at jalbertpgh@gmail.com.

Tennessee

In Tennessee, PNHP’s State of Franklin chapter (which includes easternmost Tennessee and southwest Virginia) holds monthly Zoom meetings focused on developing single-payer messaging that will appeal to more conservative friends, family and neighbors. In the past year, guest speakers included PNHP past president Dr. Carol Paris and former insurance executive Wendell Potter. Members have also published multiple op-eds and letters to editors in local media, and joined in coalition with other non-physician groups fighting for Medicare for All. To get involved in Tennessee, contact Dr. Bob Funke at r_funke@charter.net or Dr. Robin Feierabend at robin@firerobin.net.

Vermont

PNHP chapters in Vermont and New Hampshire completed their sixth annual summer internship program in July, with 14 rising second-year medical students. Because this year’s internship was online, students could hear from speakers across the country and globe. Topics included the market failures of health policy, the history of the U.S. health care system, the business model of the private insurance industry, and the history and potential of the Medicare, Medicaid and other public programs. The internship also included sessions on advocacy, such as organizing physicians and chapters, educating medical students, utilizing  traditional and social media, and messages for legislators and the general public. To get involved in Vermont, contact Dr. Betty Keller at bjkellermd@gmail.com.

Washington

In Washington state, PNHP members held a session on the pros and cons of incremental change in the struggle for single payer. The chapter helped organize the March for Medicare for All in Seattle, and facilitated an opening greeting from Medicare for All lead sponsor Rep. Pramila Jayapal. Members hung Medicare for All banners over Seattle freeways on several occasions. To get involved in Washington, contact Dr. McLanahan at mcltan@comcast.net.

West Virginia

PNHP welcomes its first chapter in West Virginia, which formed in January 2021. The new chapter has been busy crafting by-laws, creating a 12-member board, and launching the first SNaHP chapter in the state. The chapter’s first project is a “55 strong” organizing campaign to recruit a PNHP member in each of the 55 counties of the mainly rural state. They are also actively recruiting in the West Virginia State Medical Association and working on Medicare for All municipal resolutions. To get involved in West Virginia, contact Dr. Daniel Doyle at doyledan348@gmail.com.

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PNHP in the News

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News Articles Quoting PNHP Members

Chapters in Action:

“Demonstrators push for ‘Medicare for All’ at west Toledo rally,” WTOL Ch. 11 News, May 22, 2021 [Ohio Chapter]

“Demonstrators in Louisville join nationwide Medicare for All March,” Spectrum News 1 (Louisville), July 24, 2021 [Kay Tillow and Dr. Garrett Adams]

“Thousands march to demand Medicare for All,” Free Speech TV/Rising up with Sonali, July 28, 2021 [Dr. Paul Song]

• “Dozens turn out for Lakewood SPAN Ohio Healthcare Justice Walk,” Cleveland Plain Dealer, May 24, 2021 [Ohio Chapter]
• “In New York City, retirees brace for switch to privatized health care,” The Intercept, August 23, 2021 [Len Rodberg, Ph.D and PNHP NY-Metro Chapter]
• “Pharmacy Benefit Managers: The mystery bureaucrats managing your prescription drugs,” Rhode Island Uprise, August 25, 2021 [Linda L Ujifusa, J.D. and Dr. J. Mark Ryan]
• “Unions should support health care reform, but many aren’t,” Riverdale Press (NYC), July 18, 2021 [Dr. Len Rodberg]

Health Policy and Research:

“Un-vaxxed tax: Should the unvaccinated have to pay more for health insurance?” MSNBC: All in with Chris Hayes, August 12, 2021 [Dr. Adam Gaffney]

• “Pragmatic Advocacy: Advancing racial equity in physician associations,” Health Affairs, July 16, 2021 [PNHP]
• “Many hit hard by pandemic now swamped by medical debt,” U.S. News and World Report/Healthday, July 19, 2021 [Dr. Susan Rogers]
• “Physicians supporting single payer urge medical societies to join effort,” Inside Health Policy, July 19, 2021 [Dr. Susan Rogers]
• “Texas’ Abortion Law Could Worsen the State’s Maternal Mortality Rate,” TIME, September 22, 2021 [Dr. David Eisenberg]
• “Poor Americans more likely to have respiratory problems, study finds,” New York Times, May 28, 2021 [Drs. Adam Gaffney and Steffie Woolhandler]
• “Rural Tennessee is losing more hospitals than anywhere in the country, but Covid-19 isn’t fully to blame,” The Daily Yonder, July 28, 2021 [Dr. Raymond Feierabend]
• “You want me to be blind and toothless?” The Indypendent, July 31, 2021 [Dr. Susan Rogers]
• “When deductibles rise, more diabetes patients skip their meds,” U.S. News and World Report/Healthday, July 30, 2021 [Dr. Danny McCormick]
• “Minorities less likely to receive specialist care,” Reuters/Medscape, July 21, 2021 [Dr. Chris Cai]
• “Why Nevada’s modest public option bill is getting heavy attention,” Nevada Current, May 24, 2021 [Dr. Adam Gaffney]
• “Prescription for health care,” WFHB News, September 9, 2021 [Dr. Ed Weisbart]
• “Concerns mount over looming surge in bankruptcy as COVID medical debt soars,” Newsweek, June 14, 2021 [Dr. David Himmelstein]
• “Patients of color less likely to get specialist care than white patients,” Health Day, July 26, 2021 [Dr. Steffie Woolhandler]

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Opinion: Op-eds and Guest Columns

• “Texas’ uninsured situation is at a crisis point,” by Jack Bernard, The Caller Times (Corpus Christi, TX), May 28, 2021
• “Memorialize those we lost to COVID. Pass the NY Health Act Now,” by Dr. Duncan Maru, The Queens Daily Eagle, June 3, 2021
• “Health care for all works,” by Prof. Ellen Oxfeld, Rutland Herald (Vermont), June 16, 2021
• “Single Payer: A sane, accessible, and affordable health care system,” by Dr. Wayne Strouse, The Chronicle Express (New York), June 21, 2021
• “The COVID-19 case for Medicare for All,” by Drs. Jeanne Corwin, Jim Binder, and Donald Rucknagel (PNHP members among many co-signers), Cincinnati Enquirer, June 23, 2021
• “Improved Medicare for All: simple, universal, affordable,” by Bill Semple, LCSW, Boulder Weekly (Colorado), July 1, 2021
• “Henry Kaiser was right, single-payer health care better for the nation,” by Dr. Samuel Metz, Sandy Post (Oregon), July 6, 2021
• “Doctor: Voting rights are health care rights,” by Dr. Susan Rogers, Common Dreams, July 7, 2021
• “When will U.S. healthcare finally be fixed?” by Jack Bernard, Caller Times (Texas), July 16, 2021
• “Happy birthday, Medicare: You showed that public, universal health insurance is superior,” by F. Douglas Stephenson, LCSW, Common Dreams, July 25, 2021
• “North Carolina, U.S. health care are not the worst but certainly not the best,” by Jack Bernard, Fayetteville Observer, July 30, 2021
• “For its 56th birthday, let’s improve Medicare,” by Dr. George Bohmfalk, Aspen Daily News, July 31, 2021
• “The other pandemic is underinsurance,” by Dr. Marvin Malek, Vermot Digger, August 15, 2021
• “An Oregon physician on why single payer health care honors key conservative tenets,” by Dr. Samuel Metz, Portland Business Journal, August 18, 2021
• “Accountable care organizations don’t cut costs. It’s time to stop the managed care experiment,” by Dr. Jim Kahn and Kip Sullivan, STAT, August 23, 2021
• “Single-payer health care system will improve U.S. health,” by Mary Rossillo (NYU medical student), Albany Times Union, September 8, 2021

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Opinion: Letters to the Editor

• “Stop hesitating on Health Act,” by Helen Meltzer-Krim, Riverdale Press (New York), May 18, 2021
• “In support of Medicare for All,” by Dr. George Bohmfalk, The Aspen Times, June 2, 2021
• “California can have single-payer healthcare right now,” by Dr. Jerome Helman, Los Angeles Times, June 16, 2021
• “Demand Medicare for All,” by Dr. George Bohmfalk, The Aspen Times, June 21, 2021
• “Tell legislators to support amendment,” by Dr. Michael Huntington, Corvallis Gazette Times (Oregon), June 25, 2021
• “We cannot rely on charities; U.S. must overhaul system of health care and how we pay for it,” by Dr. Raymond Feierabend, The Herald Courier (Tennessee), June 27, 2021
• “New rules are nice, but a new program would be better,” by Ken Lefkowitz, The Washington Post, July 8, 2021
• “ACRA, ICHRA and CEOs,” by Dr. George Bohmfalk, The Aspen Times, July 21, 2021
• “Local fight shows need for health care reform,” by Dr. Jay Brock, Fredericksburg Free-Lance Star, July 29, 2021
• “Vote in support of Medicare for All,” by Tanvee Varma (Yale medical student), New Haven Register, July 30, 2021
• “Medicare for All saves lives and $$,” by Dr. Justin Paglino, New Haven Independent, July 30, 2021
• “Health care is a human right,” by Dr. Judy Albert, Pittsburgh Post-Gazette, August 4, 2021
• “Happy birthday, Medicaid! Expand other health care to cover us all,” by Bob Krasen, Columbus Dispatch, August 8, 2021
• “Single-payer is much better system,” by Dr. Kathleen Healey, Napa Valley Register, August 26, 2021
• “Universal health care is solution,” by Dr. Rick Staggenborg, Corvallis Gazette Times (Oregon), August 27, 2021
• “Health care focus,” by Dr. G. Richard Dundas, Rutland Herald (Vermont), September 2, 2021
• “Improved Medicare for All is the answer,” by Dr. G. Richard Dundas, Vermont Digger, September 10, 2021
• “Medicare for All Is the ticket to good health care,” by Dr. Jay Brock, New York Times, September 17, 2021

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Please click HERE to vote by August 29, 2021

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Board Candidate Forum

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At-large delegates (2 seats open)

At-large board member not up for election: Stephen Chao, MD (Texas)

Pam Gronemeyer, MD (Illinois)

Biographical statement: I am a board-certified anatomic and clinical pathologist in Glen Carbon, Illinois, near St. Louis. I received a biology degree from Washington University in St. Louis; attended Tufts University School of Medicine; and completed pathology residencies in Boston and St. Louis. I founded SEMC Pathology, which provides services to seven critical access hospitals in southwestern Illinois.

Statement describing your history of involvement with PNHP and/or single-payer advocacy: I’ve been a member of PNHP for 15 years and have attended almost all of the yearly meetings and trainings. I am co-president of PNHP-IL, board member of Missourians for Single-Payer, and founding member of the Illinois Single Payer Coalition. I have given talks to many groups including business women groups, local progressive groups, the NOW and Healthcare NOW! national meetings.

Statement describing what you would like to contribute to PNHP’s Board of Directors: I could add specialty diversity as a pathologist with experience in small metropolitan and rural hospitals. As a business owner of a  pathology service, I have provided platinum healthcare plans to my employees and their dependents. I was a delegate for Bernie Sanders in 2016 and 2020, and on the platform committee in 2016. I am a hard worker and complete the tasks that I am assigned. I have a good working knowledge of the Internet and social media.

What do you see as the most significant challenge for PNHP now and in the future? As a member of PNHP’s Board, how would you address this issue?  PNHP has to expand the base of individuals who will work for the cause. Currently, our elected officials turn a deaf ear to what the majority of people want. We need a grassroots effort and doctors are integral to the process. People trust their providers and know that the provider is speaking from experience. However, it is only by increasing the number of advocates that we can make Congress and the President listen! We must educate and organize.

Member since: 2005

Sanjeev Sriram, MD, MPH (Maryland)

Biographical statement: I founded the “All Means All” campaign to center racial equity in single payer. I am “Dr. America” for act.TV, write in national publications, and was a Bernie Sanders surrogate in 2020. I completed my MD and residency at UCLA, MPH at Harvard, and now practice pediatrics in Maryland.

Statement describing your history of involvement with PNHP and/or single-payer advocacy: After coming to terms with the ACA’s insufficiencies, I joined the single-payer movement in 2017. Shortly afterward, I joined PNHP. With help from Social Security Works, I founded the “All Means All” campaign to center racial equity in single-payer because there can be no health justice without racial justice.

Statement describing what you would like to contribute to PNHP’s Board of Directors: If elected to PNHP’s Board of Directors, my goals would be to strengthen our commitment to single-payer as a source of racial equity. I want our Board to collaborate with racial justice organizations on strategies to broaden single-payer activism. In addition to these efforts, I will seek more structured mentorship and professional development of our SNaHP allies, in order to build and sustain new generations of physician activists for single-payer.

What do you see as the most significant challenge for PNHP now and in the future? As a member of PNHP’s Board, how would you address this issue? We face challenges in cultural arenas about who is worthy of health care. People of color, particularly those with low incomes, undocumented immigrants, and/or identifying as LGBTQIA, are used as pawns by our opposition. Reproductive health faces similar obstacles. We must collaborate with activists from these communities and strengthen cultures of solidarity. Mothers Against Drunk Driving didn’t just change traffic laws. They made drinking and driving a cultural taboo. PNHP has similar work ahead.

Member since: 2018

Philip Verhoef, MD, PhD (Hawaii)

Biographical statement: I received my PhD in Pharmacology and MD from Case Western Reserve University, followed by med-peds residency at UCLA. I joined the faculty at the University of Chicago after a fellowship in adult and pediatric critical care. In 2019, I moved to Kaiser Permanente in Hawaii, where I work as an adult/pediatric intensivist and hospitalist and serve as the Associate Program Director for the Internal Medicine residency program.

Statement describing your history of involvement with PNHP and/or single-payer advocacy: I joined PNHP in 2006 as a resident. When I moved to Chicago in 2009, I joined the Illinois Single Payer Coalition (president from 2015-2018) and PNHP-Illinois (co-president in 2014). I was faculty sponsor for one of the first SNaHP chapters and have served on the PNHP Board as an advisor from 2012-2016 and board member since 2017.

Statement describing what you would like to contribute to PNHP’s Board of Directors: My contributions will reflect the perspectives brought by my unique attributes: I am an active community physician, working as a subspecialist within an integrated health system; I have extensive research experience, with expertise in health care disparities and hospital-based medicine; I have published numerous op-eds and given dozens of academic presentations on single payer and health care reform to medical audiences; and I have organizational experience at a variety of levels, within nonprofit organizations and academia.

What do you see as the most significant challenge for PNHP now and in the future? As a member of PNHP’s Board, how would you address this issue? PNHP’s most significant challenge is to determine how best to activate physicians to mobilize for single payer. Even while surveys indicate >50% support among active practicing physicians for single payer, our active membership constitutes less than 0.5% of those physicians. As a member of PNHP’s board, I will continue to develop strategies for physician engagement, including messaging, programming, development, and recruitment, with a specific focus on expanding our reach to diverse and underserved communities.

Member since: 2006

North East Region (1 seat open)

Board members in this region not up for election: Mary O’Brien, MD (New York) and Janine Petito, MD (Massachusetts)

Douglas DeLong, MD (New York)

Biographical statement: I am a general internist in upstate New York. I have served in many capacities within the American College of Physicians and am emeritus chair of the ACP Board of Regents. I live with my wife Lynn on a 250-acre farm and love Nordic skiing, sailing, and good eats.

Statement describing your history of involvement with PNHP and/or single-payer advocacy: I have been a longtime dues-paying member of PNHP, attended one Annual Meeting and attempted to start a local chapter. My largest contributions have been my advocacy within the ACP. I am proud that it was during my time as Chair of the Board of Regents that the College passed the New Vision statements.

Statement describing what you would like to contribute to PNHP’s Board of Directors: I would bring with me a 43-year history of putting patients first, coupled with a fair understanding of the complexities of the U.S. health care “system”, knowledge regarding advocacy at both state and national levels, experience on working as a board member/leader, and a large network of fellow internists across the country.

What do you see as the most significant challenge for PNHP now and in the future? As a member of PNHP’s Board, how would you address this issue? We are truly living through a historical time and the greatest challenge will be competition with other high-priority issues. Given the existential threat of climate change, worsening wealth inequality, structural racism, etc., it will be difficult to not be overwhelmed by competing priorities. The solution is for PNHP to leverage each of those issues back into the health care debate emphasizing both the fiscal and social determinant arguments.

Member since: 2008

Scott Goldberg, MD (New York)

Biographical statement: I am an attending physician at Montefiore Medical Center in the Bronx, where I supervise and teach residents in the Primary Care/Social Internal Medicine program, and an Assistant Professor at the Albert Einstein College of Medicine. I graduated with honors from the University of Chicago Pritzker School of Medicine and completed residency in 2019 in Internal Medicine-Primary Care at UCSF.

Statement describing your history of involvement with PNHP and/or single-payer advocacy: I started a chapter of SNaHP in 2012 and joined the PNHP Board as a student delegate in 2013. I worked with other students to create an annual student meeting and implement a national student-led day of action for single payer. I remained on the board as a resident until 2019. I have represented PNHP/SNaHP at medical conferences including the Society of General Internal Medicine and the American Osteopathic Association.

Statement describing what you would like to contribute to PNHP’s Board of Directors: As a PNHP board member, I would like to contribute to the fundraising and membership efforts.

What do you see as the most significant challenge for PNHP now and in the future? As a member of PNHP’s Board, how would you address this issue? The greatest challenge for PNHP is increasing the membership and financial resources of the organization to build real power; power that can shape the culture of organized medicine around single payer and, subsequently, undercut the influence of the health insurance lobby. Board members should be responsible for raising a specific amount of money each year or be asked to abandon their seats. PNHP should set the goal of contacting every U.S. physician, and board members should head up specific regional groups to undertake this endeavor.

Member since: 2009

Marvin Malek, MD, MPH (Vermont)

Biographical statement: After completing my internal medicine residency at Cook County Hospital, I’ve spent my career in community medicine, serving as founding medical director of two community health centers in Vermont. For the last five years, I’ve worked at Springfield Hospital, a safety net hospital for a poor rural community in southeastern Vermont. I’ve worked in ER medicine, primary care, and hospital medicine.

Statement describing your history of involvement with PNHP and/or single-payer advocacy: I have been an active member of PNHP since 1988, writing numerous op-eds and giving talks to church groups, Rotary Clubs, and others. I served as president of the Vermont chapter for eight of the last 12 years, helping develop our summer internship program for medical students. From 2001–2008, I hosted and co-produced Public Health Radio, which explored a variety of public health issues. I ran for both State Representative and for Lieutenant Governor as a candidate of the Progressive Party in Vermont, highlighting single payer reform as the best option.

Statement describing what you would like to contribute to PNHP’s Board of Directors: PNHP could expand its activities with more funding. I would like to step up to support existing efforts and work with other preceptors to cultivate additional fundraising strategies to support the summer internship program, possibly even creating fundraising videos (hopefully with student involvement!). Expanding PNHP’s educational offerings through paid CME events, similar to the one offered at last year’s annual meeting, could serve the dual function of educating the membership and generating funds for the organization.

What do you see as the most significant challenge for PNHP now and in the future? As a member of PNHP’s Board, how would you address this issue? A concern for PNHP is the aging of our active membership, including our leadership. This is somewhat unsurprising given the often heavy workload of mid-career physicians, who often face child care demands at the same time. I will continue to work on our summer internship program to cultivate future leadership. Offering online educational events may be a useful strategy to help chapter leaders draw in more of their membership.

Member since: 1988

Wayne Strouse, MD, FAAFP (New York)

Biographical statement: I’ve practiced for more than 20 years in Upstate NY in a solo practice. I’ve worked in socialized medicine (US Navy), and in a single-payer system (New Zealand), so I have firsthand experience of the benefits of these systems over the current U.S. system.

Statement describing your history of involvement with PNHP and/or single-payer advocacy: I have written multiple single-payer resolutions that have been passed by the NY State Academy of Family Physicians and presented nationally. I have lobbied for single payer during our organization’s Lobby Day and written multiple Op-Ed pieces in my local paper. I’ve staffed the PNHP table at various events as well.

Statement describing what you would like to contribute to PNHP’s Board of Directors: Having worked in a single-payer system, I have personally experienced what it is like to provide and receive care under such a system. Thus, I have a unique perspective and can give the Board “real world” advice regarding what works and what may cause problems from an “in the trenches” viewpoint. I work in a very conservative area, and have discussed single payer with my patients. I understand how to win over this group.

What do you see as the most significant challenge for PNHP now and in the future? As a member of PNHP’s Board, how would you address this issue? Education. Neither physicians nor the public understand what single payer means. We must win the information/misinformation battle. The rest of the world has figured this out, the U.S. cannot. Why is there such inertia for something we all hate? Let’s arm our members with the points/counterpoints, and have a media blitz for a better health system. Let’s provide “off the shelf” Op-Ed pieces that can be easily personalized.

Member since: 2006

South Region (1 seat open)

Board member in this region not up for election: Jessica Schorr Saxe, MD (North Carolina)

Ed Weisbart, MD (Missouri)

Biographical statement: I chair the Missouri chapter of PNHP. I practiced family medicine for 20 years, served as CMO of Express Scripts from 2003-2010, and retired clinically in 2021. I completed my medical degree at the University of Illinois and family medicine residency at Michigan State University.

Statement describing your history of involvement with PNHP and/or single-payer advocacy: Single-payer advocacy has been my core focus since organizing the MO chapter of PNHP in 2012. Since then, I’ve delivered more than 600 public presentations and published dozens of pieces on single payer. My PowerPoint presentations are widely used by single payer advocates across the country.

Statement describing what you would like to contribute to PNHP’s Board of Directors: I would like to help the PNHP board continue to develop, clarify its role, increase its influence, and strengthen its relationships with adjacent advocacy organizations. Like all other board members, I bring a background, skill set, and perspective that should both fit with and enhance the board’s functioning.

What do you see as the most significant challenge for PNHP now and in the future? As a member of PNHP’s Board, how would you address this issue? PNHP must continue its strong commitment to single payer while also making itself more thoughtful about political realities. We should embrace proposals that make meaningful progress towards our goal, even when not our ideal solution. For example: policies that improve and/or expand Medicare should be evaluated and, if found favorable on balance, endorsed by PNHP, not dismissed for apparent imperfections. By holding proposals to a purity test, PNHP grows increasingly irrelevant to important allies.

Member since: 1996

North Central Region (1 seat open)

Board member in this region not up for election: Joshua J. Faucher, MD, JD (Illinois)

Judith Albert, MD (Pennsylvania)

Biographical statement: I am a retired physician in Pittsburgh, PA, having practiced in academic and private practice settings for over 30 years. I received my medical degree from the University of Cincinnati, completed residency in Obstetrics and Gynecology at the University of Pittsburgh and fellowship in Reproductive Endocrinology at the University of Pennsylvania.

Statement describing your history of involvement with PNHP and/or single-payer advocacy: I became involved with PNHP in 2017 when I co-founded a new chapter in Western Pennsylvania. Having participated in anti-racist organizing for several years, I was looking for a way to blend anti-racist advocacy with my medical experience. The fight for Medicare for All is uniquely suited to this purpose.

Statement describing what you would like to contribute to PNHP’s Board of Directors: My goal as a board member is to establish working relationships with PNHP chapters in the North Central region to review strategies and combine tactics for coalition building and community engagement. PNHP members have great strength as educators and our mission aligns very well with anti-racist, fair housing and anti-poverty organizations, as well as labor unions. My aim is to listen and learn from these groups so that we can grow the Single Payer movement.

What do you see as the most significant challenge for PNHP now and in the future? As a member of PNHP’s Board, how would you address this issue? PNHP’s most significant challenge is to amplify the popular support for single payer. Aggressive negative media campaigns by the health care industry and the failed leadership of elected officials continue to obscure the fact that the majority of the public wants universal health care. As a board member, I want to participate in the development of broad citizen outreach to counter the message from corporate entities, exposing the truth about the failed model of for profit insurance.

Member since: 2017

John Crosson, MD (Minnesota)

Biographical statement: I completed my residency in internal medicine at Hennepin County Medical Center, followed by a pathology residency and 35 years on staff at HCMC and as faculty member at the University of Minnesota. During my time at the main safety net hospital in Minnesota, I saw how so many patients suffered because of a lack of readily available, affordable health care.

Statement describing your history of involvement with PNHP and/or single-payer advocacy: I started working for single-payer health care over 25 years ago, initially by contributing money, then joining the PNHP-MN board in the mid-2000s. I am co-chair of the board and am the faculty in charge of eight medical student interns. I will continue to work for M4A until it gets passed.

Statement describing what you would like to contribute to PNHP’s Board of Directors: My major contribution to the board would be my passion to see M4A the law of the land and everyone accessing health care when they need to at an affordable price. I have years of experience in administrative roles and committee work in various organizations, during which time I have introduced many new concepts. Of course, I would continue to contribute financially.

What do you see as the most significant challenge for PNHP now and in the future? As a member of PNHP’s Board, how would you address this issue? Movements require a strong grassroots effort, but people must first be educated about the issue. The biggest challenge facing PNHP is the need to educate health care workers and also the general public about M4A. Health care workers have very little time for issues other than professional responsibilities. Our interns are developing social media connections and brief documents to reach younger health care workers. I will be able to bring these ideas to the board.

Member since: 2010

West Region (2 seats open)

Board member in this region not up for election: Eve Shapiro, MD, MPH (Arizona)

Hugh Foy, MD (Washington)

Biographical statement: After completing residency in general surgery and burn surgery at UW in Seattle, I worked at Pacific Medical Center (former USPHS) and then at Harborview, the regional trauma center. Focusing on education, I served as a residency program director and leader of one of UW School of Medicine’s Colleges.

Statement describing your history of involvement with PNHP and/or single-payer advocacy: I am a co-founder of PNHP Washington state chapter (2005), where I have also served as a board member and vice president. In 2003, I participated in a Global Exchange Tour to Cuba. I’ve spoken at many events, including the PNHP Western Washington Annual Meeting, UWSOM SNHaP Chapter, King County Democratic Party, Seattle-King County EMS CME, March for Medicare for All and Bannering for Medicare for All.

Statement describing what you would like to contribute to PNHP’s Board of Directors: My background in trauma surgery and medical education would bring a perspective gained from care of the underserved. It is essential that we plan the training of the next generation to assure a stable flow of medical providers in an appropriate proportion to meet the needs of universal access.

What do you see as the most significant challenge for PNHP now and in the future? As a member of PNHP’s Board, how would you address this issue? We need to reach out to practicing physicians, providers, and trainees more effectively to build a vocal grassroots support for meaningful health care reform. We need to strengthen our ties with existing health care reform organizations, professional organizations, elected representatives, and media outlets and develop better connections to the media to get our word out to the general public.

Member since: 2003

Kathleen Healey, MD (California)

Biographical statement: I am a board-certified otolaryngologist whose career ranged from military service as a flight surgeon, to solo and group practices. My leadership roles included serving as hospital chief of staff and medical director of a multispecialty group. Now retired, I serve as co-chair of PNHP-Napa County and PNHP-California.

Statement describing your history of involvement with PNHP and/or single-payer advocacy: When I retired three years ago, I joined PNHP and helped form our Napa County chapter in California. In 2019, I became co-chair of our state chapter, PNHP-CA. As a member of our Executive Committee, I chair our state’s monthly Steering Committee of regional chapter representatives.

Statement describing what you would like to contribute to PNHP’s Board of Directors: I would collaborate with the PNHP Board of Directors to develop strategies and tactics for increasing our membership among health professionals, increasing our influence in our medical organizations, partnering with businesses to expand our legislative influence and fundraising, and refining our messaging. I want to ensure good two-way communication between the western region and the national office, keeping our members and chapters apprised of issues and decisions, and bringing local concerns to the board.

What do you see as the most significant challenge for PNHP now and in the future? As a member of PNHP’s Board, how would you address this issue? As the premier physicians’ group dedicated to single payer, one of PNHP’s primary challenges is to bring more physicians into our movement. Increasing our involvement in organized medicine at all levels should increase our membership and our legislative influence. Having our new physicians join these organizations will change the composition of these groups over time. Invite all new PNHP and SNaHP members to join their local medical societies, become delegates, network, and form a single payer “caucus.”

Member since: 2018

Stephen Kemble, MD (Hawaii)

Biographical statement: I attended medical school at University of Hawaii and Harvard, and trained in both internal medicine and psychiatry. I am now semi-retired, working part-time in a primary care clinic. I am past president of both the Hawaii Psychiatric Medical Association and the Hawaii Medical Association. I was appointed to the Hawaii Health Authority in 2011, charged with overall health planning and with designing a universal health system. I  joined PNHP in 1989 and currently serve on the board.

Statement describing your history of involvement with PNHP and/or single-payer advocacy: I have a longstanding interest in social justice, health policy, and health care reform. I have written and spoken extensively on single-payer and health policy. I am an active member of One Payer States, an organization working to win single payer at the state level, pending passage of a national single-payer bill. I chair the OPS Policy Work Group, and have contributed to papers on principles for cost-effective single-payer reform, optimizing payment of hospitals and doctors for a single-payer system, plus a paper on the danger of “Trojan Horses” in single-payer bills that allow perpetuation of the competitive insurance business model.

Statement describing what you would like to contribute to PNHP’s Board of Directors: Dr. Rogers has asked me to chair the newly formed PNHP Policy Committee, and I feel that would be the area where I can contribute the most to the organization.

What do you see as the most significant challenge for PNHP now and in the future? As a member of PNHP’s Board, how would you address this issue? The most significant challenge for PNHP is the entrenched money and power of the private health insurance industry, whose relationship to health care has become largely parasitic. We will need sustained public education and community organization and mobilization to overcome the power of the insurance industry and to achieve the goal of eliminating the private insurance business model from health care.

Member since: 1989

PNHP is committed to focusing on specific “Kitchen Table” issues, to show how single-payer Medicare for All would address Americans’ most pressing health care problems. See below for materials related to our Summer 2021 issue, America’s maternal mortality crisis, and scroll to the bottom for a list of additional topics.

America’s maternal mortality crisis (Summer 2021)

The United States is a tragic outlier among virtually all nations when it comes to large-scale, preventable, and worsening maternal mortality. This crisis is especially acute for Black and Indigenous mothers, and could be significantly reduced by meeting basic health needs through readily accessible, lifelong, and culturally competent care.

We encourage you to share the materials below with your colleagues, family members, friends, and neighbors during the summer of 2021 to remind them that our maternal mortality crisis is a kitchen table issue…and that Medicare for All is a necessary part of the solution.

Complete maternal mortality toolkit

• One-page talking points handout: America’s maternal mortality crisis and Medicare for All
• Comparison chart: America’s maternal mortality crisis: Current system vs. Medicare for All
• PNHP Policy Primer: America’s maternal mortality crisis and Medicare for All
• PowerPoint slides: Our maternal mortality is a solvable problem
• Webinar: Dr. Beth Pineles on maternal mortality
• Test your knowledge: Take PNHP’s interactive quiz on America’s maternal mortality crisis
• Podcast: Dr. Ashley Duhon on reproductive justice and Medicare for All
• Social media: Share on Facebook, Twitter, or Instagram

Webinar: Dr. Beth Pineles on maternal mortality

Quiz: Test your knowledge of U.S. maternal health

If you need assistance with events or actions, contact the PNHP organizing team at organizer@pnhp.org. For help with messaging materials, contact PNHP communications specialist Clare Fauke at clare@pnhp.org.

If you would like to provide expertise or help develop materials for future Kitchen Table topics, please contact PNHP president Dr. Susan Rogers at s.rogers@pnhp.org.

Additional topics

Review previous installments of the Kitchen Table Campaign, and stay tuned for additional topics in the future:

• Surprise billing (January 2020)
• Racial health inequities (February 2020)
• Rural health (March 2020)
• Pandemics and public health emergencies (April 2020)
• COVID-19 and racial health inequities (Spring 2020)
• COVID-19 endangers health care workers (Summer 2020)
• Measuring candidate health plans (Fall 2020)
• Mental health care (Spring 2021)
• Maternal mortality (Summer 2021)

Due to the ongoing surge of the Covid-19 Delta variant, PNHP decided to host our 2021 Annual Meeting in a virtual online format. As much as we wanted to gather in person, we felt that moving the event online was the right thing to do for the health of our members, staff, guests, and the patients that we see everyday in our communities.

Our live sessions took place October 22-23, but we are offering $10 tickets providing post-meeting access to archived content; click HERE to purchase.

Annual Meeting agenda

Friday, Oct. 22

• 8:00-9:00 p.m. Eastern: Labor leader Jose La Luz discussed the role of workers in the Medicare-for-All movement with PNHP board member Dr. Scott Goldberg and PNHP national coordinator Dr. Claudia Fegan.
• 9:00-9:30 p.m. Eastern: “Medicare for All on Capitol Hill” panel; Dr. Rachel Madley, Legislative Assistant to Rep. Pramila Jayapal, and Amirah Sequeira, Legislative Director for National Nurses United, provided the latest updates from Capitol Hill and discussed the current political landscape for Medicare for All

Saturday, Oct. 23

• 11:00 a.m. – 12:00 p.m. Eastern: Health policy and data update from PNHP’s immediate past president Dr. Adam Gaffney
• 12:30-1:30 p.m. Eastern: “The Future of Medicare for All Physician Activism” panel; Dr. Abdul El-Sayed, co-author of “Medicare for All: A Citizen’s Guide,” spoke on the future of physician activism, and PNHP board members Dr. Phil Verhoef and Dr. Judy Albert, along with SNaHP executive board member Marysol Encarnación, discussed strategies and priorities for the coming year, including medical society resolutions, fighting Medicare privatization, and recruiting more physicians into the movement.
• 2:00-3:00 p.m. Eastern: Keynote address from Dr. Rupa Marya, an Associate Professor of Medicine at UCSF and faculty director of the Do No Harm Coalition, an organization of health workers committed to structural change to address health problems. Dr. Marya’s research interests include investigating the health effects of police violence on communities, and the impact of urban regenerative agriculture on the health of historically oppressed people. She is also a member of the Healthy California for All Commission, where she brings her perspectives on equity to the dialogue around single-payer health care in California.

Pre-conference learning and leadership opportunities

Registered attendees were invited to participate in interactive and recorded sessions each day of the week preceding the Annual Meeting (Monday, Oct. 18 – Thursday, Oct. 21):

• Lunch bites: mid-day posting of a 15-minute pre-recorded webinar
• Leadership Training (LT): interactive skill-building workshop
• Member Interest Groups (MIG): interactive session where members convened around topics of mutual interest

Monday, Oct. 18

• Lunch bite: How a Medicare-for-All bill becomes law, with Eagan Kemp
• 7:00-8:00 p.m. Eastern, MIG: Reproductive Health, led by Dr. Diljeet Singh
• 8:00-9:00 p.m. Eastern, LT: Moving Media, with Clare Fauke
• 9:00-10:00 p.m. Eastern, MIG: Research Guild, led by Dr. Jim Kahn & Dr. Danny McCormick

Tuesday, Oct. 19

• Lunch bite: Medicare privatization and DCEs, with Dr. Ana Malinow
• 2:00-3:00 p.m. Eastern, MIG: Retired Physicians, led by Dr. Kathleen Healey & Dr. Carol Paris
• 8:00-9:00 p.m. Eastern, LT: Moving Legislators, with Public Citizen & Municipal Resolutions
• 9:00-10:00 p.m. Eastern, MIG: Pediatricians, led by Dr. Eve Shapiro

Wednesday, Oct. 20

• Lunch bite: Modern Monetary Theory, with Dr. Philip Verhoef
• 10:30-11:30 a.m. Eastern, MIG: Resolutions, led by Dr. Wayne Strouse
• 8:00-9:00 p.m. Eastern, LT: Moving Medicine, with Dr. Jane Katz Field & Kevin Rymut

Thursday, Oct. 21

• Lunch bite: Hospital closures and public health, with Dr. Walter Tsou
• 7:00-8:00 p.m. Eastern, MIG: Rural Health, led by Dr. Betty Keller
• 8:00-9:00 p.m. Eastern, LT: Moving Unions, with the Committee of Interns and Residents (CIR)
• 9:00-10:00 p.m. Eastern, MIG: Young Physicians, led by Dr. Scott Goldberg

Student scholarships

Medical and health professional students are invited to REGISTER for post-meeting access to the conference videos and other materials free of charge. Please spread the word to any and all medical and health professional students who may wish to sign up.

Physician members who want to support the future of our movement can DONATE to the Nicholas Skala Student Activist Scholarship Fund, which makes it possible to offer free online access to student members, and which will fund travel and lodging expenses for students to attend our next in-person meeting.

2020 Annual Meeting

Looking for archival video and other materials from our recent virtual conferences? Click HERE for materials from our (fall) 2020 Annual Meeting and HERE for materials from our (spring) 2021 Leadership Training.