By J. David Cox Sr., RN
The Huffington Post, May 22, 2014

The public’s outrage over excessive wait times and rigged recordkeeping at Veterans Affairs hospitals is more than justified. As a former VA nurse, I understand all too well that depriving veterans of timely access to care is a disservice to them and their sacrifice to this nation.

But cleaning house in the VA’s executive ranks will only treat the symptom. The disease plaguing the VA healthcare system is chronic understaffing of physicians and other frontline providers.

Until we fill thousands of vacant positions, open closed hospital beds and provide more dollars for building and maintaining medical facilities, we will never heal what ails the VA.

Physicians are dealing with excessive caseloads and insufficient support staff. Since 2009, 2 million veterans entered the VA health care system for a net increase of 1.4 million new patients. Each physician should be responsible for no more than 1,200 patients at a given time, according to the VA’s own guidelines, yet many VA doctors are treating upwards of 2,000 patients each.

Simply put, there isn’t enough time in the day for the available doctors to treat every veteran who is seeking care in a timely fashion.

Compounding matters is a performance system that sets unrealistic goals and incentivizes managers to increase the number of patients served, instead of improving the quality of care. Rather than face the understaffing issue head-on and risk poor ratings, many managers have taken the easy way out and have cooked the books to mask the wait times.

But blaming those managers for a performance system that was doomed from the start won’t help our veterans get the care they seek any faster.

Truth be told, there is nothing wrong with the VA that can’t be healed by what is right with the VA: the frontline providers who care for our veterans every day.

No one is complaining about the quality of care our veterans receive. That’s because the federal employees who look after our nation’s heroes work hard each and every day to provide them with world-class service.

Unfortunately, those same employees have lived in fear of speaking out about the problems they witness due to an established history of retaliation, including loss of duties and unfounded disciplinary actions. Our members have paid a heavy price for voicing concerns, submitting letters to agency leaders, raising issues in labor management meetings, and testifying before Congress on wait time issues and veterans’ access to care. When they have sounded the alarm, our members have faced retaliation and intimidation time and time again.

Employees shouldn’t feel afraid to speak up when they see managers more concerned with securing bonuses than providing patients with timely access to care for critical medical conditions. In fact, they should be encouraged to bring up these issues so they can be rectified before more veterans go without the treatment they so desperately need.

The waitlist and understaffing issues are one and the same. Until Congress gives the VA the resources to hire enough frontline clinicians to meet demand, our veterans will continue to face long waits. And to be clear, sending veterans to expensive health care providers outside the VA system on a massive scale will not fix the underlying resource deficiencies plaguing our veterans medical centers.

According to the Independent Budget for the Department of Veterans Affairs, developed each year by leading veterans groups, the Veterans Health Administration is facing a $2 billion funding shortfall for the upcoming fiscal year and another $500 million shortfall for fiscal 2016.

As the nation prepares to honor our fallen soldiers this Memorial Day, there is no better time to strengthen our support for the health care system that treats those veterans who made it home.

It’s time for the VA to get back to basics and focus on improving access to care for our nation’s veterans.

 The agency must cut excess management layers and use those resources to boost frontline staffing of doctors, nurses and others directly involved in patient care. The growth of middle management positions within the agency has ballooned to unprecedented levels, from fewer than 300 in 1995 to more than 1,700 by a recent count, costing taxpayers $203 million annually.

The VA long has been held up as a model healthcare delivery system that all other hospitals should emulate. The care our veterans receive is second to none, but that only counts when our veterans actually are treated.

J. David Cox Sr., RN, is national president of the American Federation of Government Employees, AFL-CIO, which represents more than 670,000 federal and D.C. government employees nationwide.

http://www.huffingtonpost.com/j-david-cox-sr/want-to-end-secret-wait-va_b_5372387.html

The following is an unofficial transcript of the remarks of Dr. Andrew D. Coates, president of Physicians for a National Health Program, at a summit on single-payer health care convened by Sen. Bernie Sanders, I-Vt., on May 21, 2014, at the Dirksen Senate Office Building in Washington.

Sen. Bernie Sanders: Dr. Andrew Coates is president of Physicians for a National Health Program. He is assistant professor of medicine and psychiatry at Albany Medical College, and practices hospital medicine at a community hospital in Upstate New York. Dr. Coates, thanks for being with us.

Dr. Andrew D. Coates: Thank you, Senator Sanders. It’s a great honor.

I’m representing Physicians for a National Health Program, 19,000 physicians who have been advocating for national health insurance for over 25 years.

Physicians have a special relationship with society. As the profession has evolved, our relationship with society has become profound, but also tangled with business. And what I has happened is almost bewildering to my colleagues many times.

We know from studies, very good research, that the majority of American physicians want national health insurance. And we know that from our daily practice because patients should have access to all necessary care when they need it. I think that question is absolutely settled in this country.

Right now there’s a scandal in the Veterans Administration, and there’s a scandal because those patients should have everything they need. And the entire country knows it. And we should all make it our responsibility to make that happen. That’s the starting point for the dialogue in our nation, and it’s the same starting point among the physicians.

What’s happened lately is that costs have been completely out of control in terms of aggregate, but the plan about what to do about those costs has been to shift them onto individuals.

So in our hospital I understand that emergency room visits are down, they’re falling. The administrators think it’s because of the co-pays, the co-insurance, the deductibles – the new forms of insurance that the patients have. But as the visits to the emergency room are going down, the number of admissions to the hospital are climbing. So the patients who are coming to the hospital are much sicker.

We practice near the southern Vermont border. Many of our staff and some of our patients come from Vermont. We know this community well. It’s a community with a heroin epidemic. The needs are colossal. The poverty is severe. And we see the presentation of very advanced disease from people who have not had access to adequate primary care every day.

Patients don’t have the choice of where they can go. This system shunts them and schleps them wherever. My own doctor, several years ago, cancelled my health insurance, wouldn’t take my health insurance, because she couldn’t come to terms with the company that my employer had chosen.

And so, when you lay out the evidence, like Rob [Weissman] did, the system actually indicts itself. It doesn’t make any sense at all. If the goal were to provide all necessary care for everyone in the United States, the system we have is a failure. Way too many people are left out, there are hideous disparities, African Americans do not get the same care that white patients get, immigrants are actually left out in all kinds of different ways — the most hideous violations of human rights in our country are the medical deportations of undocumented patients who are sick and who are sent back by air ambulance to their home country by the hospital.

And through this, it’s clear to me that physicians want to do their best as caregivers. We want to do what we learned to do. We want to apply the medical science and the human arts at the bedside in the best and exemplary way, and yet our society doesn’t organize to give us those resources.

The farther I go in this advocacy for national health insurance, I think, Why is it that the mainstream of our society is so interested in single payer? Why is it that we’re in The New York Times every week, or The Washington Post, or the U.S. Senate? And I know that the wonderful educational efforts of senators like yourself and representatives are crucial to keep the discussion going, but it’s also the simple fact that this would work.

Single payer would work. We could do this. It would be completely feasible. It could happen rather quickly. We have what it takes. We have the excellent caregivers, we have the infrastructure, and we have the know-how. So it’s something we could do.

There’s one more piece, which is that in a modern democracy, it seems to me that it’s the responsibility of the government to guarantee all necessary care to everyone in the democracy and also to protect the privacy, the decision-making, between the patient and his or her caregiver.

And if you think about that a little further: What would it mean if we had national health insurance? What would it mean if we had access to all necessary care, if we wouldn’t have to worry when our mother needed to make a transition to a nursing home, if wouldn’t have to worry when our child got leukemia, if we didn’t have to worry, like all of my patients – every case I have in the hospital is worried – about the money problem that is going to follow their illness, and it is an absolute national disgrace.

Yes, we can indict that. But let’s think about it the other way. What kind of freedom would we have if we could travel anywhere we wanted and know that there would be an adequate health care infrastructure? If the Adirondacks, where there are underserved populations of my own state, had the hospital and the support staff that they needed?

This would be liberating, and it would change the political culture of our nation to the idea that we can do this together, we all deserve basic human dignity, and we should all be free. And I think that health care is such a modern necessity that that can take our democracy to that place.

Thank you, senator.

****

Later, in the context of a panel discussion about the relationship between state-based and national efforts for single payer, Dr. Coates made these remarks:

Dr. Coates: I think there’s an event that recently happened in Madrid, Spain, [that might be instructive]. The right-wing party in power in Madrid wanted to privatize the public health system. Sell out pieces and parts, close public clinics, lease out hospitals – the whole scheme of privatization.

And the nurses and the doctors had for years educated about the villainy of privatization: that privatization ends up costing a society more of our money, privatization ends up delivering inferior care. They did that for years. And they were very much like we are now – “We don’t have a chance of stopping privatization,” that would be the feeling two or three years ago. “Here it comes, they keep trying, keep trying.”

Well, the movement blossomed. Their time came. Everyone worked together, and they completely stopped the effort to privatize the Madrid health system.

I think that in this country, the single-payer movement is an incipient mass movement. I think Vermont is the best example, perhaps with California, but Vermont because if its size and the dedicated activism of Dr. Deb Richter, of some really tenacious labor leaders, county by county, village by village, the education about single payer is there. Everyone knows that it would work.

Everyone knows. Sen. Sanders started way back, going to Canada and saying this would work for Burlington. And this education, for many, many years, is what is carrying us forward.

So whether it takes place at the county level, or the state level, or the national level, it’s that education that we’re doing that will win the day.

And other thing is that the income inequality, all by itself, creates its own crisis. Richard Wilkinson and Kate Pickett argue that income inequality by itself causes ill health, I wonder if it isn’t just the poverty, but it creates its own crisis and at some point something’s got to give. And the establishment will reach for a good idea that will work. They’re not going to try to invent something brand new, and our day will come.

You can watch a video of the entire proceedings of the summit here.

Insurance News Net, May 21, 2014

Public Citizen issued the following statement by Robert Weissman, the organization’s president, on May 21:

WASHINGTON – Thank you, Senator Sanders, for your leadership in paving the way so that our country finally receives the health care it deserves, through a single-payer, Medicare-for-All system.

Today’s panel discussion is important because we know that single-payer wins the health care argument on the merits. We know that it wins with the American people, and the more they learn about single-payer, the stronger will be their support.

The problem in Washington is that we haven’t had a merits argument on single-payer. Policymakers have decreed it “off the table,” because it’s not “realistic.” By realistic, they mean, it will be too hard to defeat the health insurance industry. That can’t be the way we do policymaking, especially when the stakes are so high.

No other industrialized country follows the U.S. insurance-driven model of high-pay, bad-results. Although the details of their systems vary in important ways, every other industrialized country provides guaranteed coverage to its citizens.

As a result, those countries have far better health outcomes. The Commonwealth Fund finds that the United States performs last among industrialized countries in the rate of mortality amenable to health care — deaths that might have been prevented with timely and effective care with a rate 68 percent higher than the rate in the leading countries. Infant mortality is so high in the United States that the best-performing U.S. states have rates twice as high as those in some industrialized countries.₁

These countries get better results at far lower costs. As a proportion of GDP, we spend at least 50 percent more on health care than every other rich nation. Per person costs in the United States, by World Bank figures, are $8,608. In Germany, it’s $4,875. In neighboring Canada, $5,630.

There are many ways that our health care payment system can be improved. Indeed, the list is seemingly endless, precisely because there are so many problems. But fixing particular problems will only get us so far, because that long list of problems is a direct outgrowth of the multi-payer, private insurance system, with all of its complexities and profit-driven irrationalities.

Here are three illustrative problems that will be fixed when we move to a single-payer, Medicare-for-All system.

First, balance billing.₂ This widespread problem refers to bills for the difference between the amount that an insurance company is willing to pay for treatment and a provider’s total charges. Providers who are not members of a patient’s insurance network have charged patients as much as 9,000 percent of what Medicare would have paid for the same procedure.

Patients can be subjected to balance bills despite making their best efforts to avoid them. For instance, they might receive care at an in-network facility, only to find out later that an out-of-network doctor — even a pathologist with whom the patient never interacted — was involved in their treatment.

This problem is a direct result of the multi-payer system, and the complicated and multiple pricing schemes between providers and insurers. Medicare and Medicaid have both essentially banned balance billing for their beneficiaries. The problem goes away with a rational payment system.

Second, executive compensation. The New York Times reported earlier this month on executive compensation at insurance companies and hospitals, noting that “the biggest bucks are currently earned not through the delivery of care, but from overseeing the business of medicine.”

Asked about extraordinary compensation for insurance company and hospital executives, the New York Times reported, “Hospitals and insurers maintain that large pay packages are necessary to attract top executives who have the expertise needed to cope with the complex structure of American health care, where hospitals and insurers undertake hundreds of negotiations to set prices.”₃

One might dispute whether this really justifies the need for exorbitant compensation of hospital and insurance administrators and executives, but we know this: With a single-payer system, that “complex structure” and “the need to undertake hundreds of negotiations to set prices,” is eliminated.

And, indeed, it is the case that hospital administrators are much more modestly compensated in other countries.

Third, drug prices. The company Gilead has a new hepatitis C drug (brand name: Sovaldi) that may dramatically improve care and health outcomes for hepatitis C patients. The company is charging roughly $90,000 for a course of treatment. An estimated 3 million people in the United States have hepatitis C. The math is jaw-dropping: the country cannot afford to provide Gilead’s hepatitis C treatment at this price level. Gilead’s price is so outrageous that insurers are revolting – but with what final result, we do not know. What we do know is that it won’t be a rational result; the final price will be too high, and some people — maybe very many people — will very likely be denied treatment.

This example is exemplary of drug pricing trends. As drug prices, especially for biologics, skyrocket, insurers are aiming to reduce pharmaceutical use by imposing huge co-pays,₄ which is certainly the wrong way to stop excessive prescribing and deliver appropriate care.₅ Drug companies are circumventing these co-pays by providing coupons and direct reimbursements to patients. And so the irrational system goes.

A single-payer system would eliminate these problems by providing a fair and rational system for compensating drug makers and incentivizing new research. At minimum, it would involve a single negotiation over price where negotiating power rested with the single-payer; ideally, it would involve replacing the system of compensation via patent monopolies with something that better pays and incentivizes innovators, while avoiding the unjustified consumer rip-offs of the patent monopoly system.₆

These problems, and many more, are endemic to our current health care system.

We have a cure: It is called a single-payer, Medicare-for-All system.

With a single-payer, Medicare-for-All system, we would eliminate all of this wasteful and deadly irrationality. We would – we will – finally recognize that health care is a human right, and that no one should be denied needed care because they can’t afford it.

[1] “Why Not the Best,” New York: The Commonwealth Fund, 2011.

[2] See “Out of Control,” Washington, DC: Public Citizen, 2014.

[3] Elisabeth Rosenthal, “Medicine’s Top Earners Are Not the M.D.s,” New York Times, May 17, 2014.

[4] For the pharmaceutical industry rationalization of this practice, see Suzanne Shelley, “Copay programs’ increased value to manufacturers is matched by rising criticism,” Pharmaceutical Commerce, January 15, 2014.

[5] See: “Research Activities,” Rockville, MD: Agency for Healthcare Research and Quality, Rockville, MD, July 2012, No. 383.

[6] See, for example, the Medical Innovation Prize Fund Act, S.627 (introduced by Senator Bernie Sanders).

http://insurancenewsnet.com/oarticle/2014/05/22/us-sen-bernie-sanders-panel-on-single-payer-health-care-a-508145.html

By Margaret Flowers, M.D.
May 21, 2014 

Thank you for inviting me to participate in this important discussion today.

The first step in the work to move to a single payer plan must be to take stock of where we are and where we are headed. We must do what we can to prevent further damage while we organize for the real solution to our healthcare crisis: a national single payer health system.

We are continuing a trend that began in the 1980s of privatization of every facet of our healthcare system. This is the opposite direction from where we need to go. If we viewed the U.S. healthcare system as an experiment, which it largely is – one that defies sound health policy – we would see that it has failed. If we treated our system as an experiment, we would be required to stop it because of the high number of preventable deaths, wide health disparities and financial ruin caused by illness and medical costs. These are our outcomes despite the fact that the U.S. spends the most per capita each year on health care, two and a half times more than the average OECD nation.

There is no affordable market solution to the healthcare crisis even though the public is being steeped in market rhetoric as we speak. The private health insurance industry has proven for decades that it defies regulation. Our market-based system will continue to increase healthcare spending, leave people out and result in poor health outcomes because the bottom line is profit, not health.  Until we change this fundamental dynamic, we will continue to fail to significantly improve the health of our population.

It is time for an honest national conversation about our healthcare system. We must ask ourselves whether we want to continue to treat health care as a commodity so that people receive only what they can afford or whether we want to join the rest of the industrialized world and create a healthcare system that treats health care as a public good so that people receive the health care they need.

The primary obstacle to a national single payer health system is political will. But we know from past experience that political will can change through public pressure. To effectively create this pressure we must recognize that the U.S. is not a legitimate democracy. It is an oligarchy, or more accurately a plutocracy. Health spending is almost one fifth of U.S. GDP. The medical industrial complex wields tremendous political influence. Therefore, single payer will only be on the table when the public puts it there. There is no easy way to do this, no secret back door. A national single payer health system will come from steadfast determination and strategic organizing and action.

As we are educating, organizing and mobilizing the public to demand a single payer health system, we need to take steps to challenge further privatization of our health system. I have three major areas of concern: the privatization of our public insurances, the trend towards more people being required to purchase inadequate insurance through the exchanges and increasing subsidies to private insurers that will be used as justification to cut social programs.

One harmful trend that should be addressed immediately is the privatization of our public insurances, Medicaid and Medicare. Currently at least 75 percent of Medicaid enrollees are in Managed Care Organizations, private administrators that act like private insurers by keeping a high percentage of their payment for administration, profits and salaries and cherry picking the healthiest patients. This percentage is expected to grow. It is no coincidence that WellPoint moved to buy AmeriGroup after the ACA was passed. They saw a huge profit opportunity in the Medicaid expansion.

We should examine the impact of private industry involvement in Medicaid. Two states have already moved to make their Medicaid completely public – Oklahoma in 2005 and Connecticut in 2012. They cited lower costs and better quality by doing so. They were able to shift more funding to direct patient care. In Maryland, our Medicaid program for children with chronic conditions has an overhead of less than 2 percent and is easier for patients and health professionals to use. We are currently looking into the overhead of our MCOs which we suspect is significantly higher than the public plan. This committee should investigate how much of our public dollars for Medicaid are going to private insurance administration.

Likewise, Medicare Advantage is a private insurance for Medicare patients. Although the Affordable Care Act (ACA) was supposed to curb the wasteful Medicare Advantage plans, reimbursement to them has risen and enrollment has grown at least 30 percent since the ACA was passed in 2010. A study in 2013 found that private insurers in Medicare Advantage were overpaid $34.1 billion in 2012 alone, money that could have gone to expanding Medicare services instead of padding private insurer’s pockets. This committee should be examining why this wasteful spending is occurring especially when Medicare is facing pressure to make cuts.

A very concerning trend is the movement of people eligible for public insurance into purchasing private health insurance on exchanges. The White House signaled early in 2010 through a Fact Sheet that it was OK with this approach for Medicaid. Arkansas was granted a waiver by HHS to subsidize its Medicaid population’s purchase of private insurance on the state exchange. And top White House health care experts, David Cutler and Jonathan Gruber, have indicated support for moving seniors onto the exchanges to purchase private insurance using a defined contribution (read waiver) approach.

Movement in this direction must be adamantly opposed because it would ultimately destroy our public insurances and place our most vulnerable populations at the hands of private industry rather than protecting them through the social safety net.

And finally, we must be wary of further increases in public subsidies for private insurance. The ACA has taken on tremendous financial responsibility for the cost of health care through subsidies to purchase private insurance and to offset out of pocket costs. Hundreds of billions of public dollars are being given directly to the private insurance industry without guarantees that people will be able to afford the health care they need. We must examine whether this transfer is the best use of our public dollars and question any demand for more from the industry. We must not allow what is essentially corporate welfare to be used to justify cuts to necessary social programs.

I want to close with a comment on the approach to single payer. There are currently many efforts towards single payer at the state level including in my own state of Maryland where I am on the steering committee of the Maryland Health Care is a Human Right campaign. Of course, the most advanced state is your home state, Vermont. I believe that these state efforts are important for pushing state health legislation to be the best that it can be and are a way to educate and organize movement towards national single payer. I do not believe that we should allow these efforts to take our focus off of the ultimate goal of a national single payer healthcare system.

There are significant barriers to single payer systems at the state level as you are learning in Vermont. Without a national movement, there is no guarantee that state reform will translate to the national level. And there is no need to experiment. We know what works. We have three health systems in the United States and the ones that have the greatest savings and best outcomes are the Veterans Health Administration and traditional Medicare. These are two types of single payer health systems and both are more effective than the market-based system.

We must continue to communicate that a national single payer health system is possible and that improved Medicare-For-All is the best solution to guarantee that all people living in the U.S. have access to the health care that they need, that people are covered no matter where they are and that will allow the leverage necessary to control healthcare spending in a way that doesn’t reduce coverage. We must move forward without delay because every day our current market-based health system is resulting in preventable suffering, financial ruin and death. This is unacceptable in the wealthiest country in the world. Thank you.

Dr. Margaret Flowers is a pediatrician and an editor of PopularResistance.org. She is co-chair of the Maryland chapter of Physicians for a National Health Program and serves on the board of the Maryland Health Care is a Human Right campaign.

By Anne Meador
DCMediaGroup, May 21, 2014

At a panel hosted by Senator Bernie Sanders (I-VT) on Capitol Hill today, advocates for single payer healthcare criticized the current system in the U.S. as inefficient, expensive and delivering poor results in comparison to wealthy nations who offer universal health coverage to their citizens. 

“We have a completely irrational system. Every other industrialized nation has proven outcomes at less cost,” said Robert Weissman of advocacy group Public Citizen. 

The U.S. is one of few industrialized countries which don’t offer universal healthcare to its citizens. Weissman and other panelists cited high rates of infant mortality and shortened life expectancy for poor women, even as the U.S. far outspends other countries for healthcare.  

In one respect, however, the American healthcare system is unbeatable.

“It’s not true to call healthcare in America a failure,” said Gerald Friedman, Professor of Economics at the University of Massachusetts at Amherst. “It’s very successful, just not at providing healthcare, but at making profits.”

The heart of the problem is the damaging trend of privatization which began in the 1980′s, pitting profit-making enterprises against the public good.

“Costs have been completely out of control, and the plan is to shift those costs onto individuals,” said Dr. Andrew Coates of Physicians for a National Health Program. 

Friedman said access to healthcare in the U.S. is rationed by commodifying it. Thirty percent of Americans have difficulty accessing heathcare, even if they have health insurance. Only four percent of people have difficulty getting healthcare in countries with a single payer system, where government foots the bill for healthcare costs.

Access to healthcare can also be regarded as a moral issue, according to Michael Lighty, Director of Public Policy for National Nurses United. He said that nurses want to be caregivers and exercise their clinical judgment on behalf of patients “under a single standard of high quality.” Market-based healthcare makes that impossible, and the Affordable Care Act has not been a solution. Under the ACA, he said, we have a tiered system with services according to ability to pay.

Far from being a step toward a single payer system, as many supporters claim, the Affordable Care Act further entrenches private health insurance. “There is no affordable market solution to healthcare,” said Dr. Margaret Flowers, a physician and organizer of Popular Resistance. 

Poor patients living in Dr Coates’ area near Vermont can’t afford premiums and co-pays. “What we’re finding is, visits to the ER are going down, while admissions to the hospital are going up. Patients are coming in much sicker.”  From his point of view, wealth inequality is leading to a breaking point. “There are hideous disparities. We concentrate on the top one percent or top one-thousandth of one percent, but the poor are getting poorer,” he said. “Income inequality creates its own crisis. At some point, something’s got to give.”

He thinks that establishing healthcare as a right for all would be a remedy. “It would be liberating,” he said. “We deserve basic human dignity. It would change our basic political culture.”

Panelists seemed to agree that a grassroots political movement was needed to achieve universal healthcare under a single payer system, which they also view as part of a broader struggle.

“Winning single payer will do all kinds of things to advance social justice, because for one it eliminates industry control of an entire sector of the economy,” said Robert Weissman. “Single payer means we’re all in it together. We believe we’re here to take care of each other.”

Senator Sanders called single payer a political and economic issue. “We are taking on obviously very powerful special interests,” he said, “who believe that the function of healthcare is for insurance companies, drug companies and medical equipment suppliers to make as much as money as they possibly can.” He believes that the public supports single payer but mainstream media limits debate and promulgates an anti-government sentiment.

Along with others on the panel, Dr. Flowers believes that progress will be driven from the bottom up. “We know that political will can change,” she said. “Recent studies show that we don’t have a legitimate democracy. Single payer is never going to be put on the table by people in this town when we have a plutocracy. It’s going to be put on the table by us.”

Archived video of Single Payer Summit here.

http://www.dcmediagroup.us/2014/05/21/single-payer-remedy-healthcare-profit/

By Julie Rovner
Kaiser Health News, Capsules blog, May 21, 2014

Advocates for a single-payer “Medicare for all” health system are fanning out across Capitol Hill this week, lobbying members of Congress.

But years of mostly fruitless struggles – and watching the intense opposition to the much less sweeping Affordable Care Act – appears to have left them with a much more clear-eyed view of what it will take for them to accomplish their goal.

“This is tough stuff,” Sen. Bernie Sanders, D-Vt., told a roundtable of advocates he convened in the Dirksen Senate Office Building. “Single-payer health care bills – it ain’t going to take place here in Washington. I suspect it’s going to take place, as it did in Canada, with a state [Saskatchewan] going forward. I hope it will be my state.”

Indeed, Vermont in 2011 passed legislation that would make it the first state to create its own single-payer system, called “Green Mountain Care.” The experiment is set to launch in 2017, the first year that’s allowed under the Affordable Care Act. But key decisions about exactly how the plan would work, in particular how it would be financed, have yet to be made.

Meanwhile, those who have been pushing for a system that would effectively end private insurance say there’s no question they have the facts on their side.

“What we know about single-payer has zero to do with the merits,” said Robert Weissman of Public Citizen, referring to widespread charges by opponents that single payer systems are inefficient and can deny care. “We have proven alternatives in every other industrialized country in the world – better outcomes at less cost.”

That’s challenged, of course, by single-payer opponents who maintain that other countries keep costs down less by being more efficient and more by rationing care.

The advocates even took on the ongoing scandal at the Department of Veterans Affairs, where former service members have reportedly been dying while waiting to get care – despite the fact that the VA system is fully government-run, and not the same as single-payer, where doctors and hospitals would remain private, with pyment from the government.

“If the VA had the resources it needed to work, it would be a model for government-provided health care,” said Michael Lighty of the National Nurses United union.

For the moment, however, the single-payer advocates recognize that their mission is to convince a public that is clearly unhappy with the status quo in health care that a single-payer system is a potential option.

“The most important thing is to show people that change is possible,” said Gerald Friedman, an economics professor from the University of Massachusetts-Amherst. “That’s the role that Vermont has had – showing that it’s possible to get something done.”

And the Affordable Care Act may in fact be nudging the effort along, panelists said. With predictions that many employers will eventually push their workers onto the new health exchanges, “we face a fundamental choice in the long term,” said Lighty of the nurse’s union. “We either are going to have single-payer or individual purchase.”

And single-payer advocates are increasingly confident that’s a fight they can win. Even if it may not be any time soon.

http://capsules.kaiserhealthnews.org/index.php/2014/05/single-payer-advocates-hit-capitol-with-new-sense-of-reality/?utm_campaign=KHN%3A+Afternoon+Edition&utm_source=hs_email&utm_medium=email&utm_content=12851638&_hsenc=p2ANqtz-8y3QveEOLeFyG1uxYrwlie79w9BJrKzPoJlFwvtmZGzVzuRRy8t1OdK70zQrJMKG0LjgI4QIZVxvZj8eDE26shLE7hAQ&_hsmi=12851638