Chapter

John Geyman, MD, 1931-2026

John Geyman, a dear friend of HJM, passed away on May 29, at the age of 95. John was a great leader in family medicine and single payer. He will be dearly missed.

By Don McCanne, M.D.

John was a life-long personal friend of ours who served as a mentor and inspiration for me, both in primary care and in a vision for a future health care system that would provide comprehensive health care to everyone with progressive public funding that would be affordable for all.

At the moment, I am too emotional over his loss to us to come up with words that would adequately describe his accomplishments and the feeling they create within me. So I won’t try. Instead, I let AI describe John’s inspirational contributions to improving our health care.

ChatGPT, May 2026

Query: Who was John Geyman, MD?

John P. Geyman was an American family physician, educator, editor, and health policy advocate who is widely regarded as one of the pioneers of modern family medicine in the United States. He served as Professor Emeritus of Family Medicine at the University of Washington School of Medicine and chaired its Department of Family Medicine from 1976 to 1990.

Some of his most notable contributions include:

Helping establish family medicine as an academic medical specialty during its formative years in the late 1960s and 1970s.
Founding and editing The Journal of Family Practice from 1973 to 1990, one of the first major research journals dedicated to family medicine.
Serving as editor of Journal of the American Board of Family Practice (now the Journal of the American Board of Family Medicine) from 1990 to 2003.
Practicing as a rural family physician for many years in Northern California and later in the Pacific Northwest, bringing practical experience to his academic work.
Becoming a leading advocate for health-care reform, particularly single-payer national health insurance, and serving as president of Physicians for a National Health Program from 2005 to 2007.

Geyman was also a prolific author. He wrote numerous books on primary care, health-care policy, Medicare, and the U.S. health system, including critiques of the increasing influence of corporate interests in medicine.

Within family medicine, he was known not only for his clinical and academic leadership but also for helping create the scholarly infrastructure of the specialty—residency programs, research journals, and educational standards that helped family medicine gain recognition as a major medical discipline.

Query: Summarize his major ideas and influence on U.S. health policy

John P. Geyman became especially influential in the second half of his career as a critic of the commercialization of U.S. health care and a leading advocate for universal coverage.

Major Ideas

1. Health care should be treated as a public service, not a market commodity

Geyman argued that the U.S. health system increasingly prioritized profits over patient care. He believed that competition among private insurers, hospital systems, and corporate health-care organizations often increased administrative costs without improving health outcomes.

He frequently criticized:

For-profit insurance models
Corporate ownership of medical practices
Investor-driven health-care organizations
Excessive administrative complexity

2. Support for a single-payer national health insurance system

One of his most prominent positions was advocacy for a single-payer system, similar in some respects to systems in countries such as Canada.

He argued that a publicly financed system could:

Cover everyone regardless of employment or income
Reduce administrative waste
Improve access to primary care
Lower overall health-care spending
Strengthen equity in health outcomes

His views aligned closely with those of Physicians for a National Health Program, where he later served as president.

3. Strong emphasis on primary care

As a family physician, Geyman believed that effective primary care is the foundation of a successful health system.

He argued that:

Family physicians should coordinate care across specialties.
Preventive care deserves greater investment.
Communities need better access to generalist physicians.
Over-specialization can fragment care and increase costs.

Many of his writings highlighted evidence that countries with stronger primary-care systems often achieve better population health outcomes at lower cost.

4. Critique of health-care reform efforts he viewed as incomplete

Geyman was often critical of reforms that expanded insurance coverage while preserving the existing multi-payer structure.

For example, while supporting broader access to care, he argued that reforms such as the Patient Protection and Affordable Care Act did not adequately address:

Administrative overhead
Insurance company profits
Fragmentation of care
Rising health-care costs
Influence on U.S. Health Policy

Geyman’s influence was primarily intellectual and professional rather than legislative.

His impact includes:

Helping shape the academic field of family medicine.
Training and mentoring generations of family physicians.
Providing scholarly support for primary-care-centered health reform.
Serving as a prominent physician voice in the national debate over universal health coverage.
Publishing books and articles that influenced health-policy researchers, medical educators, and reform advocates.

While the United States has not adopted the single-payer system he favored, many arguments that are now common in debates over Medicare expansion, universal coverage, administrative waste, and health-care equity were articulated and popularized in part through Geyman’s work.

Legacy

Geyman’s legacy rests on two interconnected themes:

Building family medicine as a respected medical specialty.
Advocating for a more universal, equitable, and primary-care-focused health system.

Even critics of his policy proposals generally recognize him as an important figure in both the development of family medicine and the ongoing national conversation about how health care should be financed and delivered in the United States.

Godspeed, John

https://healthjusticemonitor.org…

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Administrative change could save Washington $1 billion in health care costs

By Cris M. Currie, Dennis Dellwo, and Shari McEvoy
The Spokesman-Review, May 31, 2026

While it’s no longer news that major federal cuts to Medicare and Washington’s Medicaid (Apple Health) have taken effect and will continue to take effect through 2027 and 2028, few realize their scope or impact.

Currently those people eligible for both programs face additional barriers enrolling in the Medicare Savings Program. Hospitals, especially rural hospitals, and skilled nursing facilities have seen their Medicaid payments slashed, and many are facing closure as a result. Medicaid payments for cancer screening and birth control have stopped. The pandemic era enhanced premium subsidies for ACA Exchange Plans have expired, causing premiums to more than double. Nearly 40,000 Washingtonians have already dropped their health coverage.

Starting in October, many legal immigrants and trafficking victims will no longer get Medicaid. Starting in January, Medicaid eligibility redetermination will be more frequent and difficult. Funding will decrease for states, such as Washington, that had expanded Medicaid coverage, forcing many to return to pre-expansion enrollment. Medicare funding will also be cut, making it even harder for seniors to find providers. In 2028, Medicaid patients will start having copays, and work requirements will be mandated.

All this means healthcare will become increasingly hard to access for low income people as providers stop accepting them due to lower or nonexistent reimbursements. This will likely result in further uncompensated emergency care that will drastically drive up private insurance premiums and employee health insurance deductions. State expenses will increase, since the state is responsible for approximately half the Medicaid funding for over 2 million residents, not to mention healthcare for about 138,000 state employees and about 220,000 retirees. Plus, Washington is still facing a $2.3 billion budget shortfall for the next biennium.

At this point, no relief is on the horizon for individuals, but there’s a way the state can dramatically cut healthcare expenses while improving quality at the same time. For years, most states have contracted with commercial insurance companies, aka managed care organizations, to administer their healthcare programs and, at least theoretically, accept the risks. Washington contracts with five companies that receive a proscriptive payment for each enrollee.

One of those MCOs is Coordinated Care, owned by Centene, the largest Medicaid MCO in the country. With some 98% of its health insurance revenue coming from taxpayers, Centene has faced numerous lawsuits, primarily for Medicaid overbilling and ghost networks, including a 2022 $19 million fraud settlement in Washington. In 2024 Centene made a mind-numbing $3.31 billion in net profit.

All of these companies operate with extremely high overhead comprising roughly 15 cents out of every premium dollar (Medicare’s is about 2 cents). This covers exorbitant executive salaries, gargantuan profits, extreme lobbying and advertising expenses, useless administrative requirements for providers, and an unbelievable bureaucracy to manage the complex applications, prior authorizations, premiums, copays, deductibles and coinsurance to guarantee the profits.

One of the worst practices of the MCOs nationwide is their excessive denial rate. The Office of Inspector General reported 1 in 8 prior authorizations were denied in 2019. Some companies had rates up to 25%, even in the absence of robust oversight by most states.

The real news is that MCOs are completely unnecessary. In 2012, Connecticut eliminated all of them because of their ever increasing costs, high denial rates, inadequate provider networks, lack of care coordination and their inability to prove that they were worth what the state was paying. Instead, Connecticut contracted with non-risk-bearing, far cheaper, administrative service organizations to handle the day-to-day administration. A 2025 report by the Physicians for a National Health Program explains how eliminating the middlemen saved the state billions of dollars in hospital, ER and administrative costs, while increasing provider participation and improving coordination with enhanced primary care.

A 2024 special report, as well as earlier studies, concluded that Connecticut’s MCOs neither saved money nor improved quality, and that stakeholders much preferred the ASO system.

PNHP predicts annual savings of between $750 million and $1.2 billion if Washington were to adopt a similar system. This could significantly blunt the effects of the federal cuts. But why stop with Medicaid? Why not create a single-payer system for all residents and save even more?

Health Care for All-Washington is working with legislators to help them become more knowledgeable about how Connecticut’s Medicaid model could benefit us. Of course, making the switch will involve significant resources, but we should not be deterred, given the substantial benefits.

Cris M. Currie is a retired registered nurse from Mead. Dennis Dellwo is a retired attorney from Spokane and former chair of the Washington House Health Care Committee. Shari McEvoy is a retired nurse practitioner from Spokane. All are members of the Health Care for All-Washington Policy Committee.

https://spokesman.com…

A New Single-Payer Effort Is Underway in Georgia

With Bernie Sanders no longer leading the charge, Medicare for All has slipped from the spotlight. But a new state-level single-payer bill in Georgia — where Republicans refused to expand Medicaid and 1.2 million people are uninsured — shows signs of life.

By Jonathan Michels
Jacobin, May 31, 2026

On a Sunday afternoon in April, Atlanta residents gathered at St Paul’s Episcopal Church to discuss their alarm about the American health care system and what they could do about it. Attendants ranged widely in age, but they were united in their concern over the ballooning costs of medical treatment and the increasing inadequacy of insurance coverage.

Dr Belinda McIntosh, a psychiatrist at Grady Hospital and a member of Georgians for a Universal Health Program, opened the forum by taking the collective temperature of the room to see how sick people were of the country’s inefficient and profit-driven health care system.

“Anyone in here maybe saw a doctor or wanted to see a doctor and had a difficult time figuring that out because of in-network restrictions?” asked McIntosh. A few people raised their hands.

“Anyone been staggered by a medical bill that really shocked you?” This time, more than half of the attendees raised their hands.

If crushing debt and preventable disease were the result of a profit-oriented health system, the health panelists then argued, the cure is improved and expanded Medicare for All. The demand took center stage during the era spanning Bernie Sanders’s two presidential campaigns. Since then, without a champion in the spotlight and with other pressing concerns posed by the second Trump administration, the movement for Medicare for All has been in retreat. The popularity of the demand itself, however, has gone nowhere amid surging health care costs and rising uninsurance rates.

In conversation with Jacobin, Georgia state representative Gabriel Sanchez raised a novel idea. What if the South led the demand for single payer by implementing it first on the state level?

“We have these for-profit institutions sucking the life out of people, frankly just to make an extra buck,” Sanchez said, “and we have yet to really address that issue head-on, and people are suffering because of it.”

Two years ago, Sanchez became the state’s first elected democratic socialist, representing District 42. In keeping with his platform of “health care and housing for all,” which helped propel Sanchez into office over his rival, a centrist Democrat, Sanchez recently submitted legislation to establish a state single-payer system. House Bill 1480 would create a publicly funded health insurance system that would provide universal, cradle-to-grave coverage for all Georgians.

Sanchez modeled his single-payer bill on Vermont Senator Bernie Sanders’s signature federal legislation as well as two prior proposals introduced in the Georgia legislature. The measure contains provisions for some of the unique challenges facing today’s seniors, women, and threatened minority groups; it would reinstate reproductive freedoms under Roe v. Wade, repeal state legislation designed to curtail transgender treatment, and cover vision and dental care, which are currently not included under traditional Medicare.

Few issues have the potential to unite Americans across the political spectrum like health care. Support for Medicare for All is boosting progressive candidates in 2026 Democratic primaries. Even Georgia’s former US representative Marjorie Taylor Greene, perhaps the most stalwart devotee of Donald Trump and the MAGA movement, decried skyrocketing insurance costs amid Republicans’ refusal to rein in unaccountable health care corporations fueling the national affordability crisis.

Georgia now joins other states like New York, California, Washington, and Colorado, each with its own single-payer bill and grassroots movements mobilized to secure its passage. But even among this small cohort, Georgia is unique. “It’s already bad enough on the national level even under Obamacare,” said Sanchez. But “in Georgia specifically, it’s even worse because we didn’t even expand Medicaid.”

No region of the country stands to benefit from Medicare for All more than the South. The legacy of Jim Crow racism, enduring class divisions, and low union density result in a region whose health outcomes continue to lag behind those of the majority of the country.

Seven of the ten states that refused to expand Medicaid under the Affordable Care Act are located in the South, leaving millions of people without health coverage. Georgia has the second-highest percentage of uninsured adults in the country, according to the Kaiser Family Foundation, with an estimated 1.2 million people without coverage.

In 2023, Republican officials in Georgia rolled out a means-tested Medicaid expansion program with work requirements. Unsurprisingly, Georgia Pathways has so far only enrolled an abysmal 3,500 Georgians out of an expected 25,028. A damning report from the US Government Accountability Office blasted Georgia Pathways for failing to deliver on its promises to insure low-income Georgians despite spending more on administrative tasks.

Sanchez’s legislative proposal, meanwhile, establishes health care as a human right, not a privilege. All Georgia residents would receive health coverage regardless of age, income, employment, or citizenship status.

The freshman legislator walks a path forged by past health reformers who waged an unlikely yet valiant campaign to demand universal health care in Georgia during the 1990s. Back then, Rita Valenti, a registered nurse turned Georgia state representative, joined physicians, nurses, members of the disability community, and other health advocates to form Georgians for a Commonsense Health Plan to lead the effort.

Valenti served in the Georgia House of Representatives when doctors and researchers David Himmelstein and Steffie Woolhandler published their influential New England Journal of Medicine article outlining a national health program in the United States.

The 1989 article inspired a groundswell of grassroots organizing activity around the country. Labor unions working alongside organizations such as Physicians for a National Health Program (PNHP), the Universal Health Care Action Network, and others formed the foundation of a renewed movement to pass comprehensive national health reform. Similarly inspired by the call for change, Valenti and other advocates agitated for change at the state level.

In 1992, Valenti introduced HB 1531, the Common Sense Health Plan, a proposal to create a universal, single-payer program in Georgia. Like the Sanchez plan, Valenti called for a board of governors to administer the program and contain costs by reducing administrative waste and prioritizing preventive services.

At that time, health justice organizers hoped to pressure the nascent Clinton administration into advancing a national health program. Enthusiasm for a systematic overhaul on the national level prompted members of the editorial board at the Atlanta Journal-Constitution (AJC), the state paper of record, to throw their support behind Valenti’s state proposal.

“The proposal is not given much chance in this session of the Legislature, despite the fact that ‘health care reform’ has become one of the buzz words of this political season,” wrote the AJC editorial board. “Politicians are sure the voters want it, but they are nervous about giving it to them.”

As predicted, Georgia politicians refused to take up health reform, and the resolution failed in committee. If the Georgia campaign had only been predicated on passing the legislation, it would have been a waste of time and energy.

“We knew that [the Georgia resolution] wasn’t gonna pass,” recalled Valenti. “But what the resolution did was frame the kind of public insurance that we should have and how it should be used, and how it could be directed, and what global budgeting was . . . there would be no co-pays, no deductibles, all of that.”

Valenti used the resolution as an opportunity to educate Georgians about single-payer health care and the need to build upon the grassroots, multiracial movement that secured Medicare and Medicaid during the 1960s.

The demand for comprehensive health reform in Georgia not only elicited positive media coverage but also raised public awareness by underscoring the radical potential for expanding health coverage to all residents. Polls showed 65 percent of Georgians supported expanding health insurance. To put this into context, a recent poll from Data for Progress found comparable support for Medicare for All nationwide.

Netting a similarly enthusiastic response in 1992 in the heart of the conservative South underscores the broad appeal of universal social programs like Medicare for All. Valenti believes even more Georgians would be supportive of comprehensive health reform today.

“More people, especially young folks, are seeing that capitalism does not work for them,” she said.

The history of the single-payer movement shows that merely having a robust policy proposal is not enough to overcome the well-financed forces that stand to lose millions in revenue if comprehensive reform passes and are already mobilized to defend the status quo. Just like today, simply having a majority of public support for your cause is not enough to win, as Valenti and other health advocates learned in the 1990s, when Bill Clinton’s health proposal collapsed amid political compromise, special-interest lobbying, and right-wing attacks.

“I think as we became more politically sophisticated,” Valenti said, “I think we realized that single payer really requires the end of the private insurance industry and that’s not going to happen through a legislative process.”

Sanchez plans to reintroduce his Medicare for All bill during the next legislative session, having received positive feedback from constituents and fellow Democrats. State Representative Sam Park, the minority whip of the Georgia House Democratic Caucus, was among the bill’s five cosponsors. That number could grow, Sanchez said, if Democrats can chip away at the Republican stranglehold over the state legislature in 2026.

Still, Sanchez acknowledged the need to organize with groups like Georgians for a Universal Health Program, a local chapter of PNHP, to rebuff assaults by special interest groups.

“We have to combat [money in politics] with the power of the people and putting the pressure on them to do what is right and in this case passing Medicare for All,” Sanchez said.

Jonathan Michels is an independent journalist and heath care worker based in Atlanta, Georgia, and a former national board member of Physicians for a National Health Program.

https://jacobin.com…

Non-Network Plans in the ACA: A New Low

The federal agency that regulates ACA insurance exchanges has approved an insurance design that places all responsibility for shopping for affordable care on patients. Thus, a disproven free market approach jettisons the protections offered by ACA health plans.

What to know about the non-network plans coming to the exchanges, Modern Healthcare, by Nona Tepper, May 27, 2026

The federal government has opened the door to a potentially lucrative market for companies such as Sidecar Health and Imagine360 that market health plans with no provider networks.

The Centers for Medicare and Medicaid Services published a regulation this month permitting non-network plans on the Affordable Care Act of 2010’s state-run health insurance exchanges next year and its federal marketplaces in 2028.

But it will be up to state regulators whether these non-network plans actually find their way to the exchanges. State authorities will have to consider the benefits of lower-premium coverage and greater choice while preserving consumer protections.

Comment:

By Ana Malinow, M.D.

Under the Affordable Care Act (ACA), exchange health plans must offer essential health benefits and adhere to cost-sharing limits to be Qualified Health Plans (QHP). These rules are intended to protect beneficiaries.

However, the guardrails are about to disappear.

In February, citing a desire to “empower states to innovate and increase competition,” the Center for Medicare and Medicaid Services (CMS) proposed changes for 2027 health plans. A central feature is ending requirements that QHPs standardize cost-sharing, essential benefits, and pre-deductible coverage. This means that consumers will be faced with unstandardized, confusing plan options.

And CMS is proposing that non-network plans can attain QHP status. That is, insurers can offer plans without identified participating providers.

Without evidence, CMS states that non-network plans will “spur innovation, empower consumers to shop for lower-priced care, negotiate directly with providers, and foster competition among providers and insurers.” This is the old and debunked idea of a functioning free market in healthcare.

These non-network plans will be available in state-run health insurance exchanges in 2027 and federal exchanges in 2028.

How are non-network plans different?

Almost all traditional health insurance companies negotiate prices with a set of hospitals and doctors. These “provider networks” help insurers control costs. Plans with generous provider networks tend to be more expensive than plans with narrow networks. Thus, smaller networks usually save consumers money. However, there’s a risk that a desired provider is out of network and thus will force paying out-of-pocket. This protects the insurer but exposes the beneficiary to financial risks.

Non-network plans, in contrast, hold no contracts with providers. These plans decide unilaterally the rates they will pay for specific services, typically as a percent of Medicare rates or a cash price. The difference between what the provider charges and the insurer pays becomes the obligation of the patient. This represents huge financial risk. It is often undertaken at a time when the patient is sick and not focused on finding the best deal.

Non-network plans are part of a growing menu of (bad) options known as alternative health plans. These were developed to win over employers drowning in health benefit costs, which are on track to grow by an estimated 9% in 2026, the highest increase in a decade. One third of employers offered an alternative health plan to workers this year, and the number of employees who choose these plans is growing.

Sidecar Health, one of the leading non-network insurers, promises no networks, no prior authorizations, and transparent costs. On its website, it asks: “What if you could get employees to treat healthcare dollars like their own?” (I hate to break it to you Sidecar, but healthcare dollars are already paid fully by employees, through premiums and lower wages, but never mind.) It is health insurance that “lets members shop for care, just like everything else.” Except that, as Nobel laureate Kenneth Arrow demonstrated, health care is fundamentally unlike any other commodity, and not amenable to “shopping.”

Say you are a Sidecar Health member; how do you get medical care?

First, you search for procedures on the company’s mobile app. You see how much Sidecar Health will pay, along with provider cost and quality data. Then you pick a provider and get care. If you see charges less than the benefit amount, you keep half the savings. If you choose a provider who charges more than the benefit amount, you pay the full difference. If actual charges exceed the amount listed in the app, the plan assumes responsibility for the excess cost. No questions asked (e.g., about which procedure was done), I’m sure!

Several articles have been published (here and here) that raise serious questions about consumer protection for non-network enrollees. For example, do non-network plans protect enrollees from balance billing (charges over the insurer-paid amount) for emergent or urgent services, or for services with limited provider choice? Are very sick patients who absolutely cannot navigate to less expensive providers protected?

And what happens when a patient needs a procedure with multiple providers within a facility? Does the patient go from surgeon to anesthesiologist to physician assistant to dietician shopping for the best overall deal? My head spins with the complexity.

Insurer and hospital industry groups (not typically darlings of HJM) are on the right side of this issue. They warn that non-network plans will attract healthier enrollees, pulling them out of traditional insurance risk pools and thus raise premiums for those left behind. Plus, these plans will spur a rise in uncompensated care.

Despite public comment concerns, CMS this month approved non-network plans in ACA exchanges.

However, there’s one more opportunity to block them: state regulators must decide if non-network plans will be permitted in their exchanges.

Does anyone really believe we can empower consumers to shop around a massively complex health system with a computer app when their appendix is ready to burst?

Only a cruel, insane system dedicated to maximizing insurer profit can design non-network plans.

Or network plans. Or any kind of insurance plan. It is high time we jettison insurance companies altogether and put patients over profit. A national, single payer, improved Medicare for All is the only true empowerment.

https://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

Why Medicare for All is Better than a Public Option or Medicare Buy-In

Public Citizen, May 27, 2026

Our broken health care system continues to fail Americans at every turn. Recent polls show that record levels of everyday Americans are dissatisfied with our broken health care system and that they are ready for Medicare for All. However, too many politicians and skeptical wonks are scrounging around for alternatives when what our system needs is Medicare for All. Stepping back from the fight for Medicare for All to push a lesser alternative threatens the progress we’ve made toward a health care system that would finally put people’s needs ahead of corporate profit.

Trump and his cronies in Congress are making our health care system worse every day and Americans are feeling the pinch. However, prospects for reform can be confusing with competing claims about which reforms would improve health care without increasing costs for working families or exploding the country’s already much too high health care spending.

The reality is that Medicare for All is the only solution that guarantees care for everyone in the U.S., brings down costs for working families, and generates savings for the country as whole. Lesser policies, including a public option or Medicare buy-in, are inferior to Medicare for All when it comes to policy, politics, and grassroots power.

A Public Option or Medicare Buy-In Leaves Too Many Americans at the Whims of Greedy Insurers and Millions Would Remain Uninsured
Insurers Would Take Advantage of Any Public Option or Medicare Buy-In, Just Like They Do With Medicare Advantage
A Public Option Would Keep Healthcare Spending Rising at Unsustainable Levels
There is No Grassroots Movement for a Public Option, Whereas the Movement for Medicare for All Grows Daily
Other Reforms Could Take Us Closer to Medicare for All
Medicare for All Must Remain the North Star for Health Reform

full factsheet: https://citizen.org…

Catastrophic Cost-Sharing in the ACA Marketplace

Changes in ACA Exchange rules foster financial catastrophe by promoting long-term bare bones “catastrophic” plans with $24,000 deductibles, and bronze level plans with out-of-pocket spending up to $34,000.

HHS Finalizes Sweeping Marketplace Changes, Part 1: Higher Bronze Deductibles and Expansion of Catastrophic Plans, Health Affairs Forefront, May 18, 2026, by Katie Keith

On May 15, 2026, the U.S. Department of Health and Human Services (HHS) issued a highly anticipated 1,121-page (!) final Notice of Benefit and Payment Parameters rule for 2027 that makes sweeping changes to marketplace coverage under the Affordable Care Act (ACA). (The rule is available at https://www.cms.gov/files/document/cms-9883-f-patient-protection.pdf)

The final rule touches on topics such as expanded access to catastrophic plans with even higher out-of-pocket costs; new rules for the defrayal of state-mandated benefits; burdensome verification requirements; the elimination of standardized plans; and new policies to implement various provisions of the One Big Beautiful Bill Act (OBBBA).

This article discusses the final rule’s changes to the regulation and sale of catastrophic and bronze plans. A second article will discuss new policies to implement parts of the OBBBA (including immigration-related eligibility changes and elimination of the low-income special enrollment period); new cost-sharing reduction reporting requirements; and prior policies that were adopted in last year’s marketplace rule but set aside in court (including several verification requirements). Changes to essential health benefits requirements, standardized plans, network adequacy, essential community providers, risk adjustment, and other changes to the rules that govern the exchanges, insurers, and agents and brokers will also be addressed.

Trump Administration Embraces Catastrophic Plans with Even Higher Out-Of-Pocket Costs

Catastrophic plans are qualified health plans that do not cover benefits—other than preventive services and three primary care visits—until after the enrollee has reached the plan’s annual maximum out-of-pocket limit (MOOP), which is $10,600 for an individual and $21,200 for a family for 2026. [rising to $24,000 in 2027] ..

For 2027, some bronze MOOPs could be $15,600 for individual coverage and $31,200 for family coverage.

The final rule builds on these changes through three significant changes to catastrophic plans, two of which appear to be unprecedented. First, HHS codifies its recent guidance to allow many more people to categorically qualify for catastrophic coverage based on income alone. Second, beginning with the 2028 plan year, HHS will require catastrophic plans to have an even higher MOOP, meaning most care will not be covered until out-of-pocket expenses are even higher. Third, beginning with the 2027 plan year, HHS will allow catastrophic plans to exist for one year or for up to 10 consecutive years, and insurers that offer multi-year catastrophic plans will have more flexibility to design benefits.

HHS also strikingly suggests that insurers could help consumers with high deductibles by providing enrollees with a loan for their pre-deductible medical costs. Multi-year catastrophic plans could offer even more loan repayment flexibility. According to HHS, as long as a loan requires repayment, the plan would not technically be providing pre-deductible services in violation of the ACA’s requirements.

Comment:

By Don McCanne, M.D. and Jim Kahn, M.D., M.P.H.

Although many individuals and families had health insurance programs through government programs such as Medicare or Medicaid, and others had coverage through job-based private plans, many were still left uncovered. So in 2014 the Affordable Care Act provided the option of purchasing plans through insurance exchanges. Uninsurance dropped as a result, but higher premiums and cost-sharing (including deductibles) made health care finances challenging for many.

The Trump administration wants to greatly reduce government spending on the ACA. But, as the excerpt above explains, these changes shift so much cost to individuals and families that medical care will become unaffordable for many more of the ACA participants. This is detailed in the 1,121 page new rule (which we do not recommend tackling; read the Health Affairs piece instead). We know from news reports that coverage has already been worsened by the Trump administration: less coverage, more financial exposure, and thus inevitably more burdensome personal debt.

Let’s be clear: the upcoming changes to ACA exchange insurance policies challenge the fundamental purpose of insurance. They are a recipe for financial catastrophe for policy holders who have more than trivial health care needs. Cost-sharing of tens of thousands of dollars can be devastating.

All of this could be avoided and absolutely everyone could have comprehensive, affordable health care coverage by enacting and implementing a well-designed single payer Medicare for All program. Do you need a reminder of what that would look like? If so, just ask your favorite AI program to explain it to you. It will be easier and much more satisfying to read than the 1,121 pages of new rules on how to create less coverage and more financial hardship.

Single Payer! Let’s get serious about this.

https://healthjusticemonitor.org…

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What Will it Take to Make Single Payer in California a Reality?

Interview with Dr. Paul Song

Rising Up With Sonali, May 20, 2026

California voters are in the thick of a high-stakes primary race for governor, in which “single payer” healthcare, an issue that was once central, has been pushed to the sidelines. Of the top five candidates, only one has unequivocally adopted a model of healthcare that would put the United States on par with the rest of the industrialized world.

Billionaire Tom Steyer, running as a Democrat, says single payer is the only way to bring down spiraling healthcare costs. But in 2020, Steyer ran for President on a platform touting a “public option,” and attacking Presidential candidate Senator Bernie Sanders’ single payer healthcare plan. Now, Steyer has reversed that position, earning the coveted endorsement of the California Nurses Association (CNA), one of the state’s most aggressive proponents of single payer.

Dr. Paul Song is a member of Physicians for a National Health Program and the former co-chair of the Campaign for a Healthy California. He spoke with Sonali Kolhatkar about what it would take to make single payer healthcare a reality in California.

https://risingupwithsonali.com…

White House Attack on California Medicaid

California Medicaid implemented an innovative program to keep chronically sick individuals at home, rather than in nursing facilities, while saving money. The White House labeled it fraud and is withholding funds. Our frail & failing fragmented insurance approach is suffering from political attack.

Vance says $1.3 billion in Medicaid payments to California will be deferred over fraud concerns, Los Angeles Times, May 13, 2026, by Kevin Rector

Vice President JD Vance said Wednesday that the Trump administration is deferring $1.3 billion in Medicaid reimbursements to California over concerns the state is allowing “fraudsters” to drive up costs to taxpayers, including by pushing unnecessary medications on unsuspecting patients.

“There are California taxpayers and American taxpayers who are being defrauded because California isn’t taking its program seriously. But also, you have people who’ve been prescribed medications that they don’t even need,” Vance said. “Sometimes they’ve had drugs put into their bodies that they don’t need because fraudsters have actually encouraged false prescriptions and false administration and medications.”

“A third of all these programs in the entire country are in Los Angeles. Ask yourself, how is that possible? It’s not,” Dr. Mehmet Oz said. “They’re not that many people dying in Los Angeles. We’re not talking about California, just Los Angeles.”

The announcement was the latest attempt by the Trump administration to highlight and rein in fraud in federal healthcare benefits programs, particularly in blue states.

“We hate fraud. But that’s NOT what this is,” Gov. Gavin Newsom’s office posted on the social media site X. “Vance and Oz are attacking programs that keep seniors and people with disabilities OUT of nursing homes.”

Newsom’s office said that the growth of In-Home Supportive Services placements in California was “simple,” and due to California “keeping more people OUT of far more expensive nursing homes!”

Such services cover assistants who help people with daily tasks such as bathing, laundry or cooking; provide needed care such as injections under the direction of a medical professional; and accompany them to and from doctor’s appointments. A 2020 report by the California state auditor found that nearly three-quarters of IHSS caregivers assist a family member.

Newsom’s office wrote IHSS care costs $30,000 a year, while nursing home care costs $137,000 a year. “SAVING TAXPAYERS: $107K per person,” it wrote.

California Atty. Gen. Rob Bonta also criticized the administration’s moves. “Once again, California appears to be targeted solely for political reasons,” Bonta said. “The Trump administration is planning to defer over $1 billion in Medicaid funding for vital programs that help seniors and people with disabilities remain safely in their homes.

Democratic Sen. Alex Padilla also lashed out at the Trump administration. “The Trump Administration is attacking California over claims that they can’t back up,” Padilla wrote on social media. “Let’s be real, this isn’t about fraud — it’s about punishing a state that didn’t vote for him. Political retribution plain and simple.”

The focus on fraud comes against a backdrop of criticisms that other policy measures pushed by the administration have driven healthcare costs up or made it harder for people to access healthcare — including cuts to Obamacare subsidies and new work requirements in Medicaid, which are expected to strain hospitals around the country and led to millions of people losing healthcare coverage.

Comment:

By Don McCanne, M.D.

The United States has the most expensive health care system, yet its performance ranks lowest among industrialized nations, with more deaths and higher costs. Millions are uninsured or underinsured, impairing access to care and causing widespread financial hardship. For decades we have known that a well-designed single payer system would make comprehensive health care accessible and affordable for everyone in the nation.

The problem has been political barriers that have prevented a system of universal coverage. Instead we ineffectively patch our inefficient and expensive system with weak incremental reforms. This resistance to rational, comprehensive reform has included neoliberal influences on the political left, and even greater resistance by those on the political right.

Today’s excerpt typifies views of the current administration, which operates from the political right wing. In spite of increasing public demand for comprehensive reform, the Republicans recently decreased coverage by cutting subsidies for individual coverage under the Affordable Care Act and increasing barriers to coverage under Medicaid, a program designed primarily for those with limited income. Millions more will have inadequate coverage or no coverage at all. Financial hardship will be common except for the affluent.

To avoid criticism for their lack of action in meeting our health care needs, the current administration resorts to gross distortions and outright lies – trying to direct blame for our sad state of affairs to others rather than acknowledging their own responsibility.

One of their favorite tactics is to accuse health care providers of fraud. Most recently, they attacked a program in California that avoids expensive nursing home care by substituting home health, often provided by family members. Rather than commending the program for greatly reducing costs, they call it fraud and impose a $1.3 billion penalty for allowing such efficiency. Of course the state attacked is Democratic, not one controlled by their conservative friends.

Once again, crass attacks demonstrate that health care reform should focus on enactment of a beneficial, well-proven universal insurance framework – immune to political skirmishes – rather than letting political ideology and tactics further compromise our patchwork insurance.

With the elections taking place over the next two years, we have an opportunity to select government stewards who support beneficial policies to take care of all the people. We can readily do that by rejecting detrimental politics.

https://healthjusticemonitor.org…

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We Can Do So Much Better: It’s Time for Medicare for All

The shortcomings of US healthcare are painfully apparent throughout Rep. Casten’s district, so why won’t he co-sponsor the Medicare for All Act?

By James Martin, M.D.
Common Dreams, May 14, 2026

Ten years ago, when reflecting on his signature legislative achievement, President Barack Obama famously encouraged Americans to think of the Affordable Care Act as a “starter home.” For as much good as the ACA did—expanding coverage to millions, offering policies to people with “preexisting” conditions—it is clear that the foundation of this starter home is starting to crack.

As an emergency medicine physician who has practiced throughout the Chicagoland area for nearly 50 years, I have seen these fault lines up close. Health insurance corporations like Blue Cross Blue Shield and UnitedHealthcare have strayed far from their nonprofit roots, and now routinely delay and deny care for everyday Americans. Put simply, these insurers have an incentive—and even a duty—to skim hundreds of billions of dollars off the top.

Earlier this year, the Chicago City Council recognized this dynamic when it passed a resolution calling for a single-payer national health program, also known as “Medicare for All.”

The resolution passed without objection from any of the city’s 50 aldermen, and concluded by saying council members “enthusiastically support the Medicare for All Act of 2025 and call on our federal legislators to work toward its swift enactment.”

Every representative whose district includes Chicago has already co-sponsored the Medicare for All Act in the US House, and every likely replacement for retiring members of Congress has promised to do the same, with one exception. Rep. Sean Casten (D-Ill.), whose district includes parts of the Garfield Ridge and Clearing neighborhoods west of Midway Airport, has committed to staying in the “starter home,” even though it is coming apart at the seams.

The shortcomings of US healthcare are painfully apparent throughout Rep. Casten’s district, where more than 40,000 of his constituents lacked health insurance before the expiration of enhanced ACA subsidies and the implementation of federal Medicaid cuts. That’s to say nothing of his constituents with sky-high deductibles and limited provider networks who cannot afford to use the coverage they do have.

During my years in the emergency department, I have seen the awful impacts of delayed care. When I practiced at Michael Reese Hospital many years ago, it was distressingly common for me to treat young men with kidney failure. Why? Because their high blood pressure went untreated due to a lack of health coverage to pay for doctor visits and simple medications. They waited until their health issues became unbearable—and much more expensive to treat.

We can do so much better than this, and growing numbers of Americans—including 90% of Democrats in a recent Gallup poll—are starting to demand that we replace our “starter home” with a much more durable healthcare system.

Under a single-payer national health program, Americans would no longer need to worry about what treatments their insurance would cover, what doctors they would be allowed to see, and how much they would be charged out of pocket. I enjoyed a glimpse of this during my 20 years at the Captain James A. Lovell Federal Health Care Center in North Chicago, where I was able to care for veterans, active-duty members of the US military, and their families—without worrying about what their insurance would cover or whether they could afford to pursue treatment.

As Dr. Claudia Fegan, who recently retired as the chief medical officer of Cook County Health, testified before the Chicago City Council, a system like Medicare for All is well within our grasp.

“We already spend enough money on healthcare in this country,” Dr. Fegan said, “we just allow too many people who do none of the work of delivering healthcare to take profit from it. By eliminating the waste and greed of private insurance, we can afford to cover everyone in our country for all necessary care, and end the scourges of surprise bills, skipped medications, and medical bankruptcy.”

Rep. Casten has declined to co-sponsor the Medicare for All Act during his four terms in office, but his position has become increasingly lonely within the Democratic Party, the Illinois Congressional Delegation, and the US medical profession.

Thankfully, it is never too late to do the right thing.

https://commondreams.org…

UChicago Trauma Center saved lives by cutting travel time for shooting victims, study finds

“Objective, concrete evidence validates what community folks on the South Side have been saying for almost three decades,” said Dr. Selwyn Rogers, founding director of the UChicago Trauma Center

By Max Blaisdell and Hyde Park Herald
South Side Weekly, May 12, 2026

A new study found that the University of Chicago Medicine’s Level 1 Trauma Center reduced shooting deaths on the South Side.

The study, published in February in the peer-reviewed journal JAMA Surgery, found that the trauma center’s 2018 opening was associated with a nearly 4% decrease in shooting deaths within the center’s service area. The rest of the city saw no significant change over the same period.

Researchers analyzed publicly available data on more than 45,000 shooting incidents in Chicago between 2010 and 2024, comparing outcomes before and after the trauma center opened in May 2018. They found that after its opening, shooting victims within the center’s service area traveled an average of 3.4 fewer miles and arrived at care roughly 9.5 minutes faster. The study estimates those gains translated to roughly 40 lives saved for every 1,000 shootings.

The study was led by Dr. Michael Poulson, a trauma surgery fellow at UChicago Medicine, with researchers from the University of Michigan and Boston Medical Center at Boston University.

Dr. Selwyn Rogers, the founding director of the UChicago Medicine Trauma Center, said the study confirms what South Siders and activists had long argued.

“Objective, concrete evidence validates what community folks on the South Side have been saying for almost three decades,” Rogers said.

Rogers did not author the study but spoke about its significance in an interview with the Herald. The concept that minutes matter in trauma care is not new, he said. Rogers traced it to military medicine, specifically to WWII and the Korean War, when surgeons pioneered helicopter evacuation and mobile surgical hospitals designed to get wounded soldiers onto an operating table in less than an hour.

“Our hearts beat five liters per minute, and if you have an exsanguinating injury … within minutes, you could die,” he said.

Rogers offered a recent example from his own caseload of a life saved because the patient arrived in a timely manner. In mid-March, a young man arrived at the trauma center after being shot in the thigh, severing his femoral artery. Had the young man gone five more minutes without reaching the center, he would have bled to death, Rogers said.

“Without us being where we are,” Rogers said, “no doubt he would have died.”

The trauma center’s volume has so far exceeded early projections. Rogers said the facility was originally expected to handle about 3,000 trauma activations per year. It now sees more than 6,000 a year and has seen more than 38,000 since opening. About 10% of its most severely injured patients come from outside Illinois, largely because of a lack of comparable facilities in Northwest Indiana.

Rogers said the study’s findings should push policymakers in other cities to address gaps in trauma coverage, particularly in communities that face disproportionate rates of gun violence.

“If you look at the demographics of Northwest Indiana, it deserves an adult Level 1 trauma center, and it doesn’t have one,” he said.

The South Side itself had been without a nearby trauma center for almost three decades after the university closed its trauma center in 1988, a move that shifted the burden of care to Michael Reese Hospital in Bronzeville, which shuttered its own trauma division three years later. That left Advocate Christ Medical Center in suburban Oak Lawn as the only Level 1 trauma center in the area.

Following years of community organizing, activists with the Trauma Care Coalition helped bring about the center’s 2018 reopening. That campaign was galvanized in part by the 2010 death of 19-year-old Damian Turner. Although shot only four blocks from UChicago Medicine, because of the lack of a trauma center there, paramedics were forced to drive Turner nine miles to Northwestern Memorial Hospital, where he died.

Despite recent progress in reducing gun violence citywide, which Rogers said had significantly reduced the number of shooting victims coming to the trauma center, he is worried about potential reversion to the mean. In 2025, the city saw 416 murders, its fewest in six decades, a drop attributed in part to sustained investment in community violence intervention programs. But Rogers expressed concern that budget cuts at the federal level could undermine that progress.

“We should be doubling down,” he said. “But I fear that with the political headwinds and the various things happening at the federal level … we will see a backslide.”

Last July, the Trump administration canceled nearly $160 million in funding for gun violence prevention programs, including ones based in Chicago.

According to Rogers, this approach is wrongheaded, because the long-term goal must be prevention, not just treatment. He compared gun violence to smoking: treating its consequences without addressing root causes would only go so far.

Rogers thus called for extended protection laws for intimate partner violence, additional gun safety laws, and “tackling some of the community risk factors,” like economic disinvestment, racial segregation and lack of access to food, education and stable housing.

“Because the best trauma center,” he said, “is one that you’re glad it’s there, but you never need to use it.”

https://southsideweekly.com…

Dr. Mike Needs to Use His Mic for Single Payer

A hugely popular YouTube doctor persuasively calls out prior authorization denials as an insidious tactic of profit-focused insurers. His remedy is … for-profit appeals software. With access to 30 million listeners, he should instead use his powerful microphone to advocate for the real solution – single payer!

Insurance Companies Are Going To Hate Me For This, Doctor Mike, 14.8M subscribers, YouTube (13 min), May 6, 2026 (417,000 views by May 10)

From the transcript:

0:25 – You most likely won’t be paying for your healthcare out of pocket. No, you’ll be relying on America’s hybrid health care system. You see, many countries around the world offer what’s known as a single payer system where the government provides health care to its citizens free of charge, usually funded by taxes.

The US is a bit different, running a hybrid system in which government funded health care covers some people and others are paid for by employers, individuals, or a combination of the three. It’s rarely simple.

And who manages all those claims? mostly for-profit health insurance companies.

I’m not saying healthcare outside the US is perfect. … But the US health insurance system is deeply and uniquely flawed. …

2:49 – Stephanie [needs] therapy to keep fighting her cancer and relieve her joint pain with a drug called Infiximab. Unfortunately, Stephanie’s insurance provider denied the medication, saying Infiximab didn’t meet guidelines for coverage and was experimental. …

6:28 – But let’s look at this at a bigger scale. Zoom out to what we actually see in the United States. What if my care had millions of customers and millions of stockholders who own pieces of my now publicly traded health insurance company? Well, on one hand, I’d be very rich from owning that stock. And as CEO, my responsibility would not actually be to provide solely good healthcare. It would be to provide a strong financial return to my shareholders and my end-of-year bonus. There would be incredible pressure to raise premium costs, deny coverage, or at the very least make it harder to get approvals. You know, shady stuff.

So, as CEO of my care, I have an idea. What if I build an AI supercomputer to oversee the whole thing and tell it to just increase the rate of denials by just a few percentage points? You know, random rejections left and right, even if the patient is genuinely sick and our policy is supposed to cover them.

Well, patients would file appeals, hire lawyers, and sue me for failing to hold up my end of the bargain, right? Actually, yes, that is right. But it only works if patients actually do it.

This is the bet insurance companies are making. They’re gambling that you will be overwhelmed, confused, defeated, and not bother filing an appeal. In fact, they’re just following basic statistics and human psychology. The more hoops they make you jump through, the less money they’ll have to spend. Health insurers routinely deny 850 million claims a year in the US, and less than 1% of people appeal a denial. That’s a lot of profit that is likely not legitimate. But get this, when patients do appeal, they win over 50% of the time. This is why you’ll hear me say, “Always argue the bill.” Okay, Dr. Mike. So, I’m ready to appeal my denial.

How do I do that? Let me give you a list of everything you need to get your money. Stick with me through the end here, and I’ll also give you a shortcut that can make this much easier. First, find the specific reason you were denied. Whether that’s not medically necessary, experimental, or step therapy required. Then, build your evidence file. This is all the documentation of what you’ve been through so far. doctor’s notes, prior authorizations. … Writing a personal impact statement conveying to the insurer what kind of difference in your life this care will make can have a huge impact on the decision.

Once you have everything together, send it to multiple recipients at once. Not just the insure. Send it to your state department of insurance, attorney general, department of labor, your employer’s leadership, and your congressional representatives.”

[ Then, Dr. Mike recommends “Claimable” – a for-profit company that facilitates these appeals. He emphasizes that he is taking no money for this video. ]

Comment:

By Jim Kahn, M.D., M.P.H.

Dr. Mike is a highly successful social media presence. According to Wikipedia, “Dr. Mikhail “Mike” Varshavski, DO, is a … board-certified family medicine physician and hugely popular YouTuber known for making medical education entertaining and accessible. … He has over 30 million followers across platforms, where he debunks health myths, explains medical cases, and promotes health literacy.”

Great gig. Power to him – extremely effective communicator, and for what I’ve seen accurate.

But in this video he misses a huge opportunity. He has a massive audience, and he identifies how poorly US health insurance functions compared with single payer in other nations. So: Please Mike, endorse single payer. Use your powerful voice, your microphone, to advocate for a real solution.

Don’t shill for an improvised, for-profit solution (Claimable) for a problem which arises from our misguided for-profit insurance “hybrid.”

HJM readers: If you can, share this post (or the sentiment) with Dr. Mike. And let me know if you have a way I can reach him.

https://healthjusticemonitor.org…

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US global health assistance destroyed by DOGE

A new book by a US government whistleblower reveals the truth of early Trump administration elimination of the lead US agency for global health assistance: slashed funding, destroyed programs, millions of added deaths

Into the Wood Chipper, A Whistleblower’s Account of How the Trump Administration Shredded USAID, Simon & Schuster, 2026, by Nicholas Enrich

It had started on Inauguration Day, when President Donald Trump signed an executive order pausing all foreign assistance. Elon Musk, the tech billionaire and social media tycoon, had set out to destroy the agency as a test case to demonstrate the power of The Department of Government Efficiency, or DOGE, his new quasi-governmental creation. He didn’t know what USAID [U.S. Agency for International Development] did, or why it existed in the first place, and he didn’t seem to care. All he knew was that he intended to feed USAID, in his words, “into the wood chipper.”

Even as the administration publicly claimed that lifesaving programs were continuing, behind closed doors they forged ahead on their single-minded mission to destroy USAID. Funding was frozen. The workforce was slashed. Systems crumbled. Contracts were terminated. They even removed USAID’s name from the entrance to its headquarters.

I watched Musk flagrantly lie. Standing next to Trump in the Oval Office, he assured the gathered journalists and their live TV audiences that USAID’s programs to prevent the spread of deadly diseases were still operating. They weren’t. Trump then piled on, pushing absurd lies about our work.

On February 26, the malaria director told us that the primary contractor responsible for USAID’s malaria drugs and supplies was reporting that its contract had just been terminated. This was our flagship malaria contract, essential to continue life-saving drugs and services that protected millions of people from deadly disease, one of the world’s top killers of children under five.

The same day, the head of the tuberculosis team received an email from our partner who implemented our flagship TB contract. It, too, had been terminated. Tuberculosis is the world’s leading infectious disease killer.

Within the hour, I heard the same story from our maternal and child health team.

Those three critical contracts were not the only ones terminated that day. Nearly every Global Health contract received a termination letter, including the ones needed to provide lifesaving services for HIV, polio, neglected tropical diseases, family planning, emerging infectious diseases, and nutrition.

Whatever else we faced over the past weeks, we knew how to write a memo.

The first memo was titled, “Documentation of Challenges and Impediments to Implementing the Lifesaving Humanitarian Assistance Waiver for the Pause on Foreign Assistance.”

The second memo was titled, “Documentation of Bureau Global Health Workforce Reductions.”

The third memo, “Risks to U.S. National Security and Public Health: Consequences of Pausing Global Health Funding for Lifesaving Humanitarian Assistance,” was our official warning to the administration of the impact of halting critical global health programs. This memo presented modeling compiled across each of USAID’s global health programs and documented how the cuts to our programs “will lead to increased death and disability, accelerate global disease spread, contribute to destabilizing fragile regions, and heightened security risks – directly endangering American national security, economic stability, and public health.”

Overall, the modeling and analysis concluded that a staggering 2.6 million additional people would die per year due to the cuts to USAID’s global health programs.

We had the unfortunate distinction of being the first agency on DOGE’s hit list, but the callousness, dishonesty, and ineptitude we experienced offered a preview of how the rest of the Trump presidency was likely to unspool.

Step 1: Fabricate and spread false stories of waste and abuse to win public opinion against the work the agency is doing.
Step 2: Infiltrate and immobilize IT and financial systems to prevent the provision of services.
Step 3: Terminate contracts to ensure that the damage cannot be reversed.
Step 4: Vilify, demoralize and ultimately eliminate the staff.

Comment:

By Don McCanne, M.D.

The first day of Trump’s second term in office, I was shocked by his executive order to shut down USAID. My life has been devoted to health care, not only as a practicing physician, but also as an advocate for comprehensive, affordable health care for everyone. Although my advocacy activities have been limited to the health care system in the United States, I have always been thankful for the role of USAID in providing care for those most needy in other parts of the world.

I originally thought that it would not be problem convincing the people of the United States that we could easily design and implement a system that would work for everyone in our nation. I had hopes that I could then go on and provide help in some of the more needy nations in the world.

On reading this book, my dreams were clobbered. I was often brought to tears realizing that some of the most powerful people in our nation believed that the public’s health was of so little value that we could dump it “into the wood chipper.”

We need a reset. I believe this book will help do that.

Addendum:

By Jim Kahn, M.D., M.P.H.

I’ve spent much of my 37-year academic career analyzing the health benefits and costs of programs that reduce death and illness in low and middle income countries (LMIC). These are exactly the activities which USAID enabled, and were sabotaged by recent abrupt funding slashes. Colleagues and I repeatedly found that spending to prevent and treat AIDS, malaria, TB, and other killer diseases in poor countries is astoundingly cost-effective (less than $50 per added year of life), or even cost-saving by reducing future medical care needs or increasing the ability to work. These programs also generated massive goodwill from supported nations toward the US. Expanding global health assistance was the signal achievement of George W. Bush, and subsequent presidents of both parties built on that. Dismantling this activity is cruel and short-sighted, the epitome of deadly cynicism.

https://healthjusticemonitor.org…

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Comment:

Trump Administration Embraces Catastrophic Plans with Even Higher Out-Of-Pocket Costs

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From the transcript:

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Addendum:

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