By Jen Gunter, M.D.
Dr. Jen Gunter’s ‘Wielding the lasso of truth’ blog, Aug. 12, 2014

You know it’s going to be one of those days when one of the first tweets on vacation inquires about the closest hospital.

Victor, one of my 11-year-olds, had something in his eye courtesy of a big gust of wind outside of Westminster Abby. He was complaining enough to let me flip his eyelid and irrigate his eye on the square in front of Big Ben. (I’m sure several people thought I was torturing him).  Despite an extensive search and rinse mission no object or relief was to be found. I fretted about going to the hospital. It wasn’t the prospect of navigating a slightly foreign ER, but simply the prospect of the wait. While I am a staunch supporter of the British NHS in the back of my mind I envisioned a paralyzingly full emergency room and an agonizing 18 hour wait only to find he had nothing in his eye (the basic antechamber of Hell scenario). To ensure we really needed to go I gave Victor a choice between the emergency room and a toy store (Gunter’s 3rd rule), but he declined the toys so off we went to St. Thomas hospital, conveniently right over the bridge.

The hospital was on the aging side and a little drab, but clean and well-marked. I didn’t have to ask anyone for directions. We had to take a number to be registered, but waited less than 5 minutes. I gritted my teeth a bit in preparation for the we-are-not-from-the-UK conversation, but it wasn’t an issue at all. I offered my U.S. insurance number for billing, but was told they didn’t need it. The clerk was, however, impressed with the fact that I flipped his eyelid and irrigated his eye before coming. “Well, you did all the right things,” and looking at his red and watering eye she smiled and said. “Looks like you are in the right place.”

Registration completed, we waited to be seen by the children’s part of the ER. A registrar (resident) did a quick triage within 5 minutes of our registering (also impressed with the eye irrigation) and then a nurse did his vitals and took a history. After that we waited less than 15 minutes for the registrar to do a formal assessment. He wanted ophthalmology to do the evaluation. I was a bit surprised the ER doc wouldn’t do it, but every facility is different and when they found out that Victor was born at 26 weeks and had retinopathy of prematurity they got a bit jumpy. Everyone does. I was OK with ophthalmology checking him out. What I have learned from years of medicine is don’t mess with the local order.

We were walked over to the urgent care clinic and were warned that the ophthalmology registrar was covering the whole hospital so it might be a while. This was our longest wait, about 20-30 minutes. She was very nice (also working on her PhD). Dr. Katie Williams (she gave me permission to use her name and her photo) diagnosed Victor with a corneal abrasion and easily snagged the offending speck of dirt wedged under his eyelid.  Once removed Victor exclaimed, “It’s gone!,” and within a minute or two the redness cleared up. She put in antibiotic ointment and gave us a tube to use at home.

“So where do I pay?” I asked Dr. Williams.

The answer: you don’t. Perhaps they might bill us, she just wasn’t sure.

I was about as dumbfounded at her answer as she was at my asking.

I protested that it wasn’t fair. We had used services and I was very prepared to pay. I also have insurance that covers emergencies when out of network, so I was pretty sure I would be reimbursed at least some of the visit. However, we were just sent away. They do have my address so it is possible I will get a bill in the mail.

I am very curious what similar care would have cost in the U.S. The saddest commentary of all is that it is really impossible to tell as billing practices are so bizarre and opaque. My guess is it would be a minimum of $1,000 in America for cash (which is egregious). If I ever get a bill from the UK, I’ll post a follow-up. If anyone has had similar care in the U.S. and received a bill please do post in the comments. You can remain anonymous if you like.

But what of this idea that national health care means DMV-purgatory worthy waits, Dementor-staffed death panels, Saxon-age medical equipment, and incompetent care? Well, I can tell you we had great care at St. Thomas and Dr. Williams was fantastic. The slit lamp wasn’t brand new, but it worked just fine. Sure it’s an N of one, but I’ve been to the ER more times than I can count with my other son and this was as smooth as the best care we’ve had in the United States.

We could have hit the ER at an opportune time, but to expand my N I’ve also asked many people about their medical care while I’ve been in the UK. Not one person wanted to abandon the NHS. I’ve heard of excellent care and some care that was lacking, but the bad care has nothing to do with the “national” part. Rather it was diagnostic errors or a full hospice unit, things that I hear about with the same incidence back in the world of commercial insurance. Take away the accents and I could easily have been listening to a group of Americans discussing their care. With one exception, no one in the UK is left wondering what the price will be or gets an egregious bill.

It makes you wonder exactly what frightens Americans about the NHS?

Dr. Jennifer Gunter is an OB/GYN and a pain medicine physician whose writings have appeared in USA Today, KevinMD.com, EmpowHer.com, Exceptional Parent, Parents Press, Sacramento Parent, and the Marin Independent Journal.

http://drjengunter.wordpress.com/2014/08/12/an-american-doctor-experiences-an-nhs-emergency-room/

By Public Citizen
Press release, Aug. 15, 2014

WASHINGTON – The U.S. Food and Drug Administration (FDA) recently issued draft guidance that would let the pharmaceutical industry essentially circumvent drug labeling rules and tell doctors that its products have fewer risks than those described in the FDA-approved labeling.

This issue is discussed by Dr. Sidney Wolfe, founder and senior adviser of Public Citizen’s Health Research Group, in an article published in JAMA Internal Medicine today.

In June 2014, the FDA issued draft guidance for the industry on distributing scientific and medical publications about the risks of approved medication and biological products.

According to Wolfe, the guidance, as written, would allow pharmaceutical companies that believe that the FDA-approved labeling information overstates a medication’s risks to tell doctors that the risks are in fact, lower. Company salespeople could inform physicians of the purportedly lower risks by distributing peer-reviewed articles – without the agency either reviewing the data or approving it – and discuss with doctors the information about the lower risks.

Wolfe says that to protect patients and the public health, when new information supports a reduction in risk, the company should inform the FDA and provide the evidence, as is required under current regulations. If the agency is convinced, the label can be changed.

Off-label risk reduction is the wrong approach, Wolfe writes. The article also discusses how people can voice their opinions to the FDA on this by Aug. 25, when the docket on the guidance closes.

The URL link for commenting on the FDA draft guidance is here:
http://www.regulations.gov/#!documentDetail;D=FDA-2014-D-0758-0001

Dr. Wolfe’s article is available here:
http://archinte.jamanetwork.com/article.aspx?articleid=1897291

“Proposed US Food and Drug Administration Guidance for Industry on Distributing Medical Publications About the Risks of Prescription Drugs and Biological Products: A Misguided Approach,” by Sidney M. Wolfe, M.D., JAMA Internal Medicine, Aug. 15, 2014

Public Citizen has initiated a petition that asks the FDA to not permit Big Pharma to undermine information about pharmaceutical risks:
http://action.citizen.org/p/dia/action3/common/public/index?action_KEY=12559&start=150

By Philip Caper, M.D.
Bangor (Maine) Daily News, Aug. 14, 2014

As I’ve written before, the costs of unnecessary complexity in healthcare reform are very high, and they are rising. There are at least three recent examples.

One is the flap over whether people who have received health insurance through the exchanges run by the federal government are eligible to receive government subsidies, as they have been led to believe. Courts have disagreed on this point, opening the door for yet one more food fight about the legality of portions of the Affordable Care Act.

Complex federal legislation, inevitably the product of many authors, is usually full of many minor (and some major) errors. These errors are usually corrected during the process of reconciling the differing House and Senate versions during the “conference committee” process.

Because of the divisive politics leading up to the passage of the ACA, no such committee was ever convened.The House of Representatives simply passed the Senate bill without changes — errors and all — eliminating the need for a House-Senate conference.

One of those errors was the granting of explicit authority for the exchanges run by the states, but not the federal government, to provide subsidies to people they enrolled, even though any common-sense interpretation would conclude that congressional intent was to give all exchanges, whether state or federal, such authority.

Nevertheless, that omission provided an exploitation opportunity to those looking for an excuse to sabotage the entire law. And exploit it they have, bringing a lawsuit that could end up in the Supreme Court. The costs of the ACA in dollars and confusion have risen as a result.

Another example is the (on its face) ridiculous attempt to sue President Obama for failing to enforce with enough enthusiasm a provision of the law requiring some employers to offer health insurance to their employees or pay a fine. This puts Republicans in the interesting position of threatening to sue Obama for failing to vigorously enforce a law they have repeatedly tried to repeal.

Additionally, billions of dollars have now been spent unsuccessfully trying to construct exchanges that comply with the complicated federal requirements imposed by the ACA in an attempt to perfect a marketplace for private insurance. Even some states (such as Massachusetts) where exchanges created pre-Obamacare were already working have experienced chaos, and because of it have thrown tons of their own and federal dollars down a rathole.

These are just a few examples of your tax (and healthcare) dollars at work. Even though these complexities provide full employment for thousands of lawyers, consultants, navigators and other helpers, they don’t buy even one Band-Aid’s worth of healthcare.

The real tragedy here is that if the “policymakers” in Washington were really interested in serving the needs of most of their constituents instead of those of their corporate contributors, all of this expense and confusion could have been avoided. Perhaps instead spent on providing care to the millions who will be left out, even after Obamacare is fully implemented.

The sole purpose of the exchanges is to provide a choice of insurance companies. But the fact is that most people don’t give a hoot about who their insurance carrier is. What they do care about is who their health care provider is. In yet another unintended consequence of this complex law, many insurance companies are now doing their best to limit that choice in order to save themselves money.

Ironically, it is actually cheaper to cover everybody than it is to spend all of the unnecessary time, money and effort collecting the information needed to slice and dice people into smaller and smaller risk pools so we can then decide which of them of “deserve” healthcare. Moreover, risk pools of different types of people (old/young, wealthy/poor, employed/not employed, well/sick) create yet another opportunity for politicians to play us off, one against the other.

I fully expect this unnecessary complexity of the ACA to continue to be exploited by those looking to make a quick buck or another destructive or disingenuous political point. That is unless and until we put a stop to it by sending an unmistakable message to politicians who refuse to do the right thing that we’re mad as hell and not going to take it anymore. A simple expansion of Medicare to everybody would do the trick, and eliminate almost all of the unnecessary complexity of our current insurance industry.

If we were all in the the same system, we’d all have a stake in making it work. That’s how it is in other wealthy countries. Compared to the chaos we have here, that sounds pretty good to me.

What do you think?

Physician Philip Caper of Brooklin is a founding board member of Maine AllCare, a nonpartisan, nonprofit group committed to making health care in Maine universal, accessible and affordable for all. He can be reached at pcpcaper21@gmail.com or through his website at philcaper.net.

http://bangordailynews.com/2014/08/14/health/the-costs-of-complexity-in-health-reform-just-keep-rising/print/

By Morolake Amole
AMSA ‘On Call’ blog, Aug. 13, 2014

The problem with health care in the United States is not that we suffer from inadequate medical resources. Quite the contrary.

We have thousands of highly skilled and dedicated doctors and nurses. We have many top-notch hospitals possessing state-of-the-art equipment and medications. We have significant patient protection laws.

So then how do we explain our country’s poor health outcomes, e.g. that we ranked 19th out of 19 wealthy nations in 2010 on preventing deaths that could have been avoided with medical care?

Here’s a clue: If you compare the U.S. system with those of other industrialized nations, you’ll see that no other country relies so heavily on multiple private insurance plans and has such high financial barriers to care.

Does the Affordable Care Act change this picture? The ACA will, within a few years, increase coverage for about 20 million people through a combination of subsidies for private insurance and an expansion of the Medicaid program (in those states that have agreed to accept it). This increased coverage will likely save many thousands of lives each year.

Yet even when the ACA is fully implemented, 30 million Americans will remain uninsured. Some won’t be able afford a private plan. A recent survey by Kaiser Family Foundation found that 36 percent of Americans between the ages of 18-64 who remain uninsured stated that they opted out of buying insurance because the plans available were too expensive.

Many million more will remain “under-insured,” i.e. vulnerable to severe financial stress if they get sick because they’re enrolled in skimpy health plans with high deductibles and co-pays.

The U.S. health care system is the most expensive in the world. In 2012, our nation spent roughly $2.8 trillion on health care, about $8,508 per person. Yet the ACA has no proven ways to control costs.

So, if the Affordable Care Act is not the final answer, what is?

Many physicians and economists believe that the answer lies in the adoption of a single-payer system. Such a system has already proven successful in Canada, where most care is taxpayer financed but delivered by private doctors and hospitals. One could cite a dozen other examples, from Norway to Taiwan.

Citizens of these nations enjoy high-quality health care, with outcomes that are generally as good as or better than ours – at much lower cost. They’re successful for a variety of reasons.

By establishing a payment system in which citizens pay taxes that are then designated toward health care, there’s an implied idea of transparency in health care spending. Citizens can see how their money is being spent.

Their systems have very low administrative costs, allowing them to spend more resources on providing actual health care. Single-payer systems are also better at controlling costs. They can buy drugs and medical supplies in bulk, and efficiently plan big capital outlays.

Nonprofit single-payer systems take away the power of private insurance companies to come between patients and their doctors. Patients no longer have to look to insurance agents for decisions on health matters, and patients can choose to go to whatever doctor or hospital they want.

And because patients are able to obtain primary care and receive treatment for problems at an earlier stage, they require fewer costly interventions later.

With a single-payer system in the U.S., physicians would be able to concentrate much more on what they were trained to do, and be less burdened with time-consuming and costly insurance paperwork. They’d remain well-compensated (e.g. Canada’s physicians have incomes comparable to their U.S. counterparts, especially when you factor in how little they have to lay out in overhead and malpractice), but primary care physicians would see their incomes rise, reflecting the crucial role they play.

The most important reason for enacting a single-payer national health insurance program, or an “improved Medicare for all,” is that it would achieve the goal of giving everyone equitable access to all medically necessary care. Health care would be re-routed toward its original goal of giving people an improved quality of life.

We should implement a nonprofit single-payer system without delay.

Morolake Amole is a clinical medical student at Meharry Medical College in Nashville.

http://www.amsa.org/AMSA/Homepage/TakeAction/AMSAOnCall.aspx

After my breast cancer scare and exemplary care in the UK, I’ve felt a powerful urge to shout at the Brits: do you know what an extraordinary health system you have?

By Paola Totaro
The Guardian (U.K.), Aug. 12, 2014

I found the lump a fortnight ago while on a work assignment in Vilnius, Lithuania. It was a hot, sunny day in the landlocked capital but as my fingers discovered what felt like a ping pong ball sized growth, ice went through my veins. I am not a catastrophist by nature but within seconds, I had envisaged the worst and by the time I was in the air homeward bound for Heathrow a few days later, I was writing my will in my head.

We have lived in London since 2008 and not a day goes by when the National Health Service isn’t in the news, more often than not for mistakes, delays, apparent inefficiency or targeted for funding cuts. From the red top tabloids to the circulation busting, Daily Mail, sticking the knife into the NHS seems to have become a favoured British sport (paradoxically, Britons still gush with national pride about Danny Boyle’s London Olympics opening ceremony and his eccentrically, flamboyant homage to the NHS.)

Paradoxically too, despite this background hum of complaint, just 11% of Brits have private medical cover, compared to the 54% of Australians who pay for some form of general treatment cover.

Like most other Aussies, I’d paid for private health insurance since my mid 20s. Australia also has a world class public health system but “gap” payments – the costs over and above what is reimbursed by Medicare – can be significant, especially for specialist treatment. Having a family with four kids meant it made even more sense later although I was shocked by a rough, back of the envelope calculation that shows $70,000 went in medical insurance since the mid 1980s.

In Britain, dentistry is pretty much the only medical procedure you pay for, and even that is incredibly cheap: £18.50 for screening and x-rays to a capped, one-off £219 payment for complex, multiple treatments like crowns, bridges and dentures.

All GP visits and diagnostic tests are free while under 16s receive free prescription medicines as well as dentistry, including orthodontics such as braces.

Last year alone, the NHS performed 10,595m operations, up nearly 60% on 10 years ago. Every 36 hours, the NHS deals with one million patients while its hospitals admitted 15,146m people between 2012 and 2013, up by a third on a decade ago. Do UK taxpayers have any idea just how lucky they are?

Suddenly vulnerable that fateful Monday morning, I wasn’t thinking quite so optimistically about the system. Without an appointment, I headed to the local GP surgery at 7.50 am for the first open surgery. Despite widespread national complaint about waiting times, I was in with my usual GP within 35 minutes. Brisk, efficient and thorough, she examined me with empathy and promised King’s Hospital would contact me for tests within seven working days. She insisted I call her if I’d not heard anything by Friday.

Exactly 24 hours later, Royal Mail delivered a letter giving me an appointment with the breast care unit at King’s College Hospital at 11am that Friday (four days later). I couldn’t believe my eyes.

The next day however, a hospital receptionist rang to apologise that they’d over-booked Friday and would I mind moving to the following Monday. The idea of another anxiety-riddled weekend led me to beg that they call me if a cancellation opened up: I live a walk away and could be there in minutes. Unbelievably, an hour and a quarter later, thanks to patient being delayed by a train malfunction, I found myself in the breast unit.

Over the following four hours I saw a specialist consultant, underwent four mammograms, two ultrasounds, a needle-guided aspiration of one lump and an intense and frightening moment when a second lump was found behind the first. Another two mammograms followed, apparently 3D this time, but when I saw the specialist again late that afternoon, I knew from his unabashed smile it would be alright: “I’m convinced there is nothing sinister. These were cysts…we don’t know why and it may happen again, but all you need for now is this antibiotic, just to be sure.” Pathology would be back on Monday but his confidence was clear. I could have hugged the man and he, an oncologist delivering good news, was genuinely happy too.

In the weeks since, I’ve felt a powerful urge to shout at the Brits: “Do you know what an extraordinary health system you have? How civilized your society is to afford everyone, rich, poor, young and old a world class health safety net?”

Back with my GP the following week, I said something similar and this chronically over worked, brisk wonderful woman stopped and rummaged in her drawer: “Look at this,” she said showing me the latest British Medical Journal, “The NHS tops the world’s health systems in a comparison of 11 developed nations … it tops it! And nobody reports it, nobody says a word. Of course we have problems, all systems do but when things go right – which they do more often than not – silence!”

Well, here I am not only saying something but shouting it publicly and loudly: wake up British taxpayers, wake up and appreciate – and protect – what you have built with such vision since the NHS’s birth in 1948.

And Aussies? Please, please don’t ignore the possibility that the proposed GP co-payment, sold as a measure to slash the mounting cost of health care driven, won’t just get hiked over and over again – and the Medicare that you know and do love won’t just disappear before your eyes.

Paola Totaro is an Australian journalist and writer specializing in European affairs, politics, social policy and the arts. She was most recently the London-based Europe correspondent for the Age and the Sydney Morning Herald and has reported widely across politics, education and urban affairs.

http://www.theguardian.com/commentisfree/2014/aug/13/brits-dont-be-fooled-the-nhs-is-brilliant-and-aussies-dont-let-your-guard-down

A study out this week indicates that new “black box” warnings and safety withdrawals have increased since the drug approval process was changed

By Sydney M. Wolfe, M.D.
The BMJ, Aug. 5, 2014

In 1992, because of widespread concern that the US Food and Drug Administration was taking too long to approve drugs, the Prescription Drug User Fee Act (PDUFA) was enacted, authorizing the FDA to collect user fees from drug companies to expedite the approval process. Besides providing funding for an increased FDA staff, the act established performance goals during the approval process to ensure more rapid review.

As of the current fiscal year (October 2013 to September 2014), $760m (£450m; €570m) in drug industry money is allocated to the FDA’s Center for Drug Evaluation and Research, comprising a large proportion, more than 60%, of the center’s drug review expenditure.[1]

The hypothesis posed in a study published this week was that “new black-box warnings and safety withdrawals have increased following PDUFA’s enactment, perhaps as a result of an expedited review process that may not adequately detect serious drug safety problems in the preapproval period.” This was the first study to look at all FDA drug approvals for a long enough time before and after the enactment to examine this question.[2]

The study involved the 748 new molecular entity drugs approved by the FDA between 1975 and 2009. The principal finding was that “drugs approved after the act’s passage [from 1993 to 2009] were more likely to receive a new black-box warning or be withdrawn than drugs approved before its passage (26.7 per 100.0 drugs versus 21.2 per 100.0 drugs at up to sixteen years of follow-up,” a statistically significant 25% increase in the rate of such safety actions.

In the case of drugs withdrawn from the market, the average review time for those approved before PDUFA was around three years, but this had fallen sharply to one year for the post-PDUFA drugs. After PDUFA was passed, the number of approvals of new molecular entity drugs rose dramatically, with 92 approved in 1996 and 1997 combined, considerably more than in any other two year period from 1975 to 2009.[3] Of the 39 new drugs approved in 1997, a fifth (eight) were eventually withdrawn for safety reasons, considerably more than in any year in the 1975 to 2009 interval encompassed by this study.[2] These eight withdrawn drugs were three fluoroquinolone antibiotics, one appetite suppressant, one antidiabetes drug, one statin, one non-steroidal anti-inflammatory drug, and one antihypertensive drug—none arguably breakthrough drugs.

Although the study found that the faster post-PDUFA drug approvals were associated with a higher rate of subsequent safety withdrawals and black box warnings, it could not establish a causal connection between the funding aspects of PDUFA and the increased dangers of these outcomes.

However, coinciding with the original law and its renewal every five years have been legislative changes that often outline specific steps or pathways toward faster drug approval. One such change has given the FDA the authority to mandate post-approval studies to resolve safety issues that have arisen during the pre-approval review of a drug. There is therefore concern that one reason for the outcomes documented in this new study is that the shorter review times—combined with increased FDA authority to require further studies after approval, rather than settling safety issues before approval—have contributed to the increased rate of withdrawals and black box warnings.

In a survey of FDA physicians who review drugs (medical officers) conducted in 1998, by which time the PDUFA effect had clearly sunk in, many of the 53 respondents expressed concern that drugs they thought should not have been approved had been, despite negative safety conclusions. Respondents thought that standards of safety and efficacy had been weakened since the passage of the law. Nineteen medical officers identified a total of 27 approved new drugs in the past three years that they reviewed that they thought should not have been approved. Most of these medical officers said that current FDA standards were “lower” or “much lower” than previous ones. Twelve medical officers identified 25 new drugs that they reviewed in the past three years that in their opinion had been approved too fast.[4]

The most important preventive remedy for this post-PDUFA increase in safety withdrawals and black box warnings would be to restore more thorough reviews of the majority of approved drugs that clearly do not represent a therapeutic breakthrough. For the smaller proportion of drugs that appear to represent important advances, a shorter approval time, without compromising standards of safety or efficacy—as occurred in the case of approval of the antiviral zidovudine, a long time before the PDUFA—is appropriate.

But because these much needed changes have not yet occurred at the FDA, the principle of caveat emptor (and caveat prescriber) must be applied. An important conclusion of the new study was that patients should delay using any new non-breakthrough drug until it has been on the market for several years and is thereby less likely to be subject to a safety withdrawal or a new black box warning. An article published several years ago discusses the “seven year rule,” referring to the suggestion that in the case of drugs that aren’t breakthroughs—the majority of drugs approved—it is safer to wait at least seven years after approval before using them. Even though subsequent withdrawals and new safety warnings beyond seven years will still occur, older alternative drugs are, on average, safer.[5]

The answer to the question in the title of this article seems to be yes, but the source of the impact on the approval process goes beyond the massive drug industry funding itself and is likely to be related to many of the legislative, regulatory, and attitudinal changes that have inevitably accompanied PDUFA and its renewal every five years.

Sidney M Wolfe (Swolfe@citizen.org) is founder and senior adviser, Health Research Group at Public Citizen, Washington, DC, USA.

Notes

Cite this as: BMJ 2014;349:g5012

Footnotes

    Competing interests: I am a coauthor of the Health Affairs article on which this article was based.

    Provenance and peer review: Commissioned; not externally peer reviewed.

References

1. Food and Drug Administration. FY 2015: justification of estimates for appropriations committees. www.fda.gov/downloads/aboutfda/reportsmanualsforms/reports/budgetreports/ucm388309.pdf.
2. Frank C, Himmelstein DU, Woolhandler S, Bor DH, Wolfe SM, Heymann O, et al. Era of faster FDA drug approval has also seen increased black-box warnings and market withdrawals. Health Affairs2014;33:1453-9.
3. Food and Drug Administration. CDER new drug review: 2012 update. www.fda.gov/downloads/aboutfda/centersoffices/officeofmedicalproductsandtobacco/cder/ucm331454.pdf.
4. Lurie P, Wolfe SM. FDA medical officers report lower standards permit dangerous drug approvals. Dec 1998. www.citizen.org/Page.aspx?pid=2339.
5. Wolfe SM. The seven-year rule for safer prescribing. Aus Prescrib 2012;35:138-9.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/.

http://www.bmj.com/content/349/bmj.g5012

By Burkely Hermann
Citizen Vox blog (Public Citizen), Aug. 7, 2014

Lobbying usually gets a bad rap, and sometimes for good reason: it can be part of corporate special interest money’s current corruption of the political system. But during the first-ever national Single-Payer Lobby Day events in May, real people lobbied for a good cause that benefited the general public, not just a wealthy few.

As Congress’ August recess approaches and activists prepare to make in-district visits with their lawmakers’ offices, now is a good opportunity to recall my experience lobbying for single payer.

As an undergraduate student who is currently interning with Public Citizen, I participated in the second day of events, which kicked off with a training for participants. I saw many different faces in the room, which was filled with about 75 people, ranging from nurses, who are part of National Nurses United, physicians who are members of Physicians for a National Health Program (PNHP), union leaders fighting for healthcare justice and concerned citizens who want a universal and inclusive health care system.

Next was an informational panel featuring single-payer advocates, labor leaders and physicians railing against the unjust lack of coverage, administrative waste caused by billing multiple insurance companies and urging Congress to pass a Medicare-for-all single-payer health care system. Representatives Jim McDermott (D-Wash.) and John Conyers (D-Mich.) also spoke to participants about their single-payer bills, H.R. 676 and H.R. 1200. Rep. McDermott focused on building on the existing reforms put in place by the Affordable Care Act, while Conyers advocated directly for single payer.

Participants in the lobby meetings spoke of single payer as a fair and comprehensive solution to the many shortcomings of the Affordable Care Act (ACA). I joined my fellow Marylander single-payer lobbyists, consisting of physicians, labor leaders, concerned citizens and a dietician. A member of PNHP, which advocates for a national single-payer health care system, led our lobbying team, but the group still made decisions collectively.

For each lobby meeting, different members of our group took different roles. The group’s deepest strength was the diversity of stories told in favor of single payer. A nurse who worked in D.C. talked about how, even under ACA, health care was not affordable and told a story of how her colleague didn’t bring her kids to the doctor because she already owed the doctor a co-pay. An elderly private citizen recalled being treated by Austria’s single-payer health care and explained how she wanted the same sort of system in the U.S. A single-payer activist talked about surveys conducted by his organization, Healthcare-NOW! of Maryland, showing that a majority of those living in 10 of Maryland’s counties support single-payer health care. Other individuals, like the labor leaders and seniors, stated that they were glad they had Medicare and wanted to expand it to others.

Our main message was simple: to have a health care system based on human need, not profit, and which would cover everyone, including undocumented immigrants, from birth until death.

We visited five different House offices and two Senate offices. In most instances, representatives’ or senators’ staff members met with our lobbying group to hear our stories about why we support a single-payer health care system. We also had the opportunity to meet directly with Rep. Chris Van Hollen (D-Md.), who made an impromptu stop by our scheduled meeting with his staffers. When asked by our group about support of single-payer legislation, he was not able at the time to provide an answer as to whether he would lend his support for single-payer health care in the future (though he made an important point about Republican governors denying Medicaid expansion money).

The lobby day highlighted the solidarity between doctors, concerned citizens, labor leaders and others around a common cause. It was exciting and empowering to see that my fellow group members were willing to engage in action to support something they cared about.

While the two days of events helped shine an important light on the need for single payer, many of the offices we met with stated that their current task was to defend the recent health care reforms from political attacks.

People are “mad as hell” about the current health care system, built around greed, not human need, and pushing for a single-payer system is the antidote. That sentiment is why it’s so imperative that citizen activists contact their members of Congress and Senators about the urgent need to implement a national single-payer system. If concerned citizens and activists from multiple organizations can lobby lawmakers, sometimes face-to-face, then so can you.

To start this process, sign up to let us know you’re interested in lobbying your member of Congress during the August recess.

Burkely Hermann is a summer intern for Public Citizen’s Congress Watch division and part of Public Citizen’s Online Action Team.

http://www.citizenvox.org/2014/08/07/first-person-perspective-lobbying-for-single-payer-healthcare/