PNHP

After court ruling, problems remain

After court ruling, problems remain

By Christine Adams, Ph.D.
Houston Chronicle, Letters, June 29, 2012

Regarding “Decision affirms division” (Page A1, Friday), the Supreme Court’s ruling to uphold the Affordable Care Act (ACA) does not solve our health care crisis. ACA does provide mild but temporary relief for many Americans (allowing children to remain on parents’ health insurance until age 26; eliminating pre-existing conditions exclusions, etc.).

However, single-payer national health insurance is the only solution to our health-care crisis. Only a single-payer national health care system can control costs without jeopardizing quality health care.

The U.S. is now an outlier compared to other industrialized nations by not providing guaranteed health security to all its citizens and legal residents. These nations spend half as much per person on health care as we do. (Germany just reported a surplus of $5.28 billion in its national health insurance program.)

Yet they still provide as good or better medical outcomes as we do. They can reduce costs without sacrificing quality because they have eliminated the root cause of out-of-control spiraling health care costs: for-profit health insurance companies that siphon off billions of dollars from health care each year for unnecessary expenses that have nothing to do with health care.

We need Congress to pass a single-payer national health insurance program so we can eliminate financial barriers to health care, improve efficiency, control costs and maintain high-quality health care.

Christine Adams is a licensed psychologist. She resides in Houston.

http://www.chron.com/opinion/letters/article/Letters-Mulling-over-health-law-ruling-3674585.php

The remedy for health care system is universal Medicare

By Jack Bernard
Kansas City Star, July 1, 2012

A physician friend recently said to me “Once every 15 years, health care reform comes around. If we do not succeed this time, we will have to wait another 15 years.”

Unfortunately, he is correct, and that is why it is good for Kansans that Obamacare (the Affordable Care Act) was passed and found constitutional. However flawed, it is better than nothing at all, especially for the 350,000 Kansas residents who are uninsured (according to the Kansas Health Institute).

Yes, Obamacare will eventually expand coverage and stop some of the most abusive insurance industry practices. But, was it the “right” prescription for both Kansas and the nation?

Obama won in 2008, advocating hope and change (although the Democrats lost in Kansas, as usual). The health care question was: “What can be done to get us on the correct path to have affordable, high-quality health care for our citizens?” With the public obviously ready for change, Obama and the Democratic majority had the opportunity of a lifetime. But they caved in to various political pressures and the lobbyists from the insurance and medical industries and deserted single payer insurance, their real preference.

The 2010 elections are past. The 2012 elections are looming large. The Republicans zeroed in on jobs and the terrible economy in 2010. The Democrats ran for cover, especially on health care. The economy, inherited or not, was the main cause of their defeat.

Would a different strategy on health reform, either universal Medicare or the Senate Majority Leader Harry Reid’s plan for covering those aged 55-64 through Medicare, have worked better for them? Given what happened, a 2010 rout of Democrats across the board, it clearly would have been worth a try for both electoral and technical reasons.

We did end up with a health care reform law. But, strangely enough, it was stolen from Romneycare and the Republican side of the aisle simply because of the political cost to the Democrats of inaction. It is a horse put together by a committee — ineffective, complex and political. If Romneycare is any indication, it will clearly not control costs to the taxpayer, the top health care concern of most Americans.

The public does not understand the new health care reform law’s true benefits, which are substantial in regard to access. Short-term, Democrats will again lose independent voters in many swing states vital to their 2012 chances.

Plus, this administration squandered the chance for real reform, a simple expansion of Medicare. The “government takeover” catch phrase scared them off.

Universal Medicare is a concept that makes sense technically and fiscally. The U.S. currently has per capita health expenditure costs double that of other developed nations on single-payer systems.

Medicare For All can be paid for through payroll and employer taxes, just like Medicare and Social Security are now. It is affordable because private insurance marketing and administrative costs (30 percent of the premium) are eliminated for employees and the firms employing them. Costs can be controlled through the Independent Payment Advisory Board, an independent panel set up under Obamacare. And, just like those programs, it would find immediate acceptance by the American public after implementation.

For more information on costs and benefits, please go to the website of Physicians for a National Health Program at www.pnhp.org.

Taking the long view, universal Medicare will eventually be implemented in the U.S., because of increasing premium costs and cost shifting if nothing else. But in 15 or 20 years, our health care cost and quality problems will be even worse because of congressional inaction.

Jack Bernard is a retired health care executive who worked with Kansas hospitals on planning and cost-containment issues. He now is a Republican county commissioner in Monticello, Ga., an Atlanta suburb.

Read more here: http://www.kansascity.com/2012/07/01/3683661/as-i-see-it-the-remedy-is-medicare.html#storylink=cpy

Republican health care executive on single payer

The remedy is universal Medicare

By Jack Bernard
The Kansas City Star, July 1, 2012

We did end up with a health care reform law. But, strangely enough, it was stolen from Romneycare and the Republican side of the aisle simply because of the political cost to the Democrats of inaction. It is a horse put together by a committee — ineffective, complex and political. If Romneycare is any indication, it will clearly not control costs to the taxpayer, the top health care concern of most Americans.

The public does not understand the new health care reform law’s true benefits, which are substantial in regard to access. Short-term, Democrats will again lose independent voters in many swing states vital to their 2012 chances.

Plus, this administration squandered the chance for real reform, a simple expansion of Medicare. The “government takeover” catch phrase scared them off.

Universal Medicare is a concept that makes sense technically and fiscally. The U.S. currently has per capita health expenditure costs double that of other developed nations on single-payer systems.

Medicare For All can be paid for through payroll and employer taxes, just like Medicare and Social Security are now. It is affordable because private insurance marketing and administrative costs (30 percent of the premium) are eliminated for employees and the firms employing them. Costs can be controlled through the Independent Payment Advisory Board, an independent panel set up under Obamacare. And, just like those programs, it would find immediate acceptance by the American public after implementation.

For more information on costs and benefits, please go to the web site of Physicians for a National Health Program at www.pnhp.org/.

Taking the long view, universal Medicare will eventually be implemented in the U.S., because of increasing premium costs and cost shifting if nothing else. But in 15 or 20 years, our health care cost and quality problems will be even worse because of congressional inaction.

(Jack Bernard is a retired health care executive who formerly worked with Kansas hospitals on planning and cost containment issues. He is now a Republican county commissioner in Monticello, Ga., a suburb of Atlanta.)

http://www.kansascity.com/2012/07/01/3683661/as-i-see-it-the-remedy-is-medicare.html

Comment: 

By Don McCanne, MD

This op-ed is of special significance for us for two reasons: 1) Medicare for All is not only a liberal/progressive issue as these are the words of a Republican health care executive, and 2) The efforts of PNHP to communicate the single payer message are gaining traction as he cites us as an authoritative source.

Jack Bernard is to be commended for his persistent efforts to inform the public on a better health care alternative. We need to renew and expand our important work on behalf of health care justice for all. It’s working.

Bernie Sanders, Nurses: We Still Need ‘Medicare for All’

By John Nichols
The Nation, June 28, 2012

There have been few steadier Congressional hands throughout the debate over health care reform than that of Vermont Senator Bernie Sanders. Principled in his support for the real reform of “Medicare for All,” yet pragmatic in his advocacy for Affordable Care Act provisions that expand public health programs and allow states to experiment with single-payer options, Sanders has been in the thick of every fight over President Obama’s signature reform. And the ensuing legislative and legal battles over its implementation.

What Sanders says about Thursday’s Supreme Court decision upholding the ACA provides important insights for progressives as they respond to a complex decision that, in the words of the National Nurses United union, “should not be seen as the end of the efforts by health care activists for a permanent fix of our broken health-care system.”

So what does Sanders say?

On the ruling, his line is upbeat:

“Today is a good day for millions of Americans who have pre-existing conditions who can no longer be rejected by insurance companies. It is a good day for families with children under 26 who can keep their children on their health insurance policies. It is a good day for women who can no longer be charged far higher premiums than men.

“It is a good day for 30 million uninsured Americans who will have access to health care. It is a good day for seniors who will continue to see their prescription drug costs go down as the so-called doughnut hole goes away. It is a good day for small businesses who simply cannot continue to afford the escalating costs of providing insurance for their employees. It is a good day for 20 million Americans who will soon be able to find access to community health centers.”

But that does not mean that Sanders is satisfied.

“In my view, while the Affordable Care Act is an important step in the right direction and I am glad that the Supreme Court upheld it, we ultimately need to do better,” the independent senator says. “If we are serious about providing high-quality, affordable health care as a right, not a privilege, the real solution to America’s health care crisis is a Medicare-for-all, single-payer system. Until then, we will remain the only major nation that does not provide health care for every man, woman and child as a right of citizenship.”

Sanders’s Vermont is taking the lead in seeking to implement a state-level single-payer system-much as Canadian provinces too the lead in the 1940s and 1950s in developing who would eventually be that country’s national health care system. The court’s ruling won’t slow that push down, and it could actually speed it up, as attention focuses on fights over state-run Medicaid programs. Sanders says, “I hope our state will be a model to show the rest of the nation how to provide better care at less cost to more people.”

Agreed. Amid the celebration of the Supreme Court ruling by those who did not want to go backward, there is a need for a firm focus on going forward. “Stepping up the fight for Medicare for All is even more critical in the midst of the still persistent economic crisis,” notes National Nurses United co-president Deborah Burger, RN, who noted that nurses have seen deep declines in health status among patients suffered the loss of jobs, homes and insurance coverage.

NNU notes that “the Affordable Care Act still leaves some 27 million people without health coverage, does little to constrain rising out of pocket health care costs, or to stop the all too routine denials of needed medical care by insurance companies because they don’t want to pay for it.”

It is for that reason that NNU co-president Jean Ross, RN, echoes Sanders: “The continuing fiscal crisis at all levels of government and the anemic economic recovery remind us that rising health care costs and shifting costs to workers burden our society, cause much of these fiscal problems, and limit the opportunities for working people. Only real cost control through a national health program can solve this crisis. Improved Medicare meets that challenge.”

“Medicare is far more effective than the broken private system in controlling costs and the waste that goes to insurance paperwork and profits, and it is universally popular, even among those who bitterly opposed the Obama law,” adds NNU co-president Karen Higgins, RN. “Let’s open it up to everyone, no one should have to wait to be 65 to be guaranteed health care.”

That’s correct.

The Supreme Court’s ruling can be celebrated on some levels, as Sanders well notes.

But the senator and his allies in the struggle for the real reform of Medicare for All speak a profound truth when they say, “We ultimately need to do better … the real solution to America’s health care crisis is a Medicare-for-all, single-payer system.”

http://www.thenation.com/blog/168649/bernie-sanders-nurses-we-still-need-medicare-all

Affordable Care Act: good news or bad?

By Samuel Metz, M.D.
The Oregonian, July 2, 2012

Is the Supreme Court decision upholding the Affordable Care Act good news or bad? It depends on who you are.

If you are President Obama, the news is good. The highest court in the land just validated the showpiece legislation of your first years in office. Election prospects just go brighter.

If you are Gov. John Kitzhaber or one of the 600,000 Oregonians in the Oregon Health Plan, the news is also good. This decision preserves critically important support from the ACA to the health care transformation process, a dramatic method of health care delivery with potential to provide better care at lower cost for 15 percent of Oregon’s population.

And if you are a health insurance executive, the news is spectacular. The Supreme Court just confirmed a law requiring every American to purchase your product regardless of price, or face a penalty. Protests on the Supreme Court steps were drowned out by the clinking of whiskey glasses in health insurance boardrooms around the country.

For the rest of us, however, it is bad news indeed. Yes, the ACA will dramatically increase the number of insurance policies sold, but it won’t make policies cheaper, nor will it make health care more affordable or more accessible.

In fact, the ACA will increase health care spending by $400 billion annually. This extra cost will not appear on the federal budget because costs are passed on to us, the patients, via compulsory purchases of insurance, increased premium prices and dramatically increased out-of-pocket spending.

Nor will the ACA protect American families from financial and medical catastrophe if one of us gets the wrong disease at the wrong time. Our most vulnerable families still face the unhappy choice of spending their last dollar on their mortgage or on their health care deductible.

Every industrialized country in the world provides better care to more people for less money than we do. None use our uniquely American style of private health insurance. Let’s get real: If we plan a radical and painful makeover of our disastrous health care system, doesn’t it make more sense to emulate these systems that work (using publicly funded universal health care) rather than one that doesn’t? And the one system that we absolutely know doesn’t work is the one we have now.

Unhappily, the ACA is guaranteed to produce one sure-fire result. Americans will become more dependent than ever before on private health insurance for their only access to health care. If you like what private health insurance has inflicted on our society up to now, just wait until you see what the newly approved ACA will do to us in the future.

Neither Congress nor the ACA will save us from health care Armageddon. We in Oregon must take charge of our future. It’s time to create our own reality-based, cost-effective, publicly funded universal health care system and say tell the Supreme Court and ACA to take a hike.

Dr. Samuel Metz is a Portland anesthesiologist and a member of Physicians for a National Health Program and Mad As Hell Doctors, both advocates for single-payer health care, and of Health Care for All Oregon, an umbrella organization advocating for publicly funded universal care for all Oregonians.

http://www.oregonlive.com/opinion/index.ssf/2012/07/affordable_care_act_is_bad_new.html

Aging Americans agree on Medicare

By Jack Bernard
USA Today, Letters, June 29, 2012

I can understand why my neighbors do not care for the individual health care mandate, but I do not understand what their problem is regarding national health insurance.

We have had national health insurance for nearly 50 years. We call it Medicare. Folks in my generation support it. Just ask the older demonstrators at the 2009 town-hall meetings who said, “Keep the government out of my Medicare.”

Yes, Medicare only covers people older than 65, but there is no magic in that number. With the risk spread among younger, healthier people, funding shortfalls will soon be a thing of the past.

The correct solution to covering the uninsured has never been ObamaCare. If the GOP were smart, it would just propose “Medicare for all” as an alternative.

Jack Bernard resides in Monticello, Ga.

http://www.usatoday.com/news/opinion/letters/story/2012-06-28/supreme-court-health-care-big-government/55901960/1

Expand Medicare to include all Americans

By Jonathan Kotch, M.D.
The Herald Sun (Durham, N.C.),

The Affordable Care Act, including its individual mandate that virtually all Americans buy health insurance, is constitutional. Five Justices agreed that the penalty that someone must pay if for refusing to buy insurance is a tax that Congress has the power to impose.

The new law does a number good things that have already gone into effect, such as extending eligibility for health insurance coverage on their parents’ policies for more than 3 million children under 26 years of age. However, these improvements come with a cost, the cost of subsidizing an unnecessary health insurance industry which consumes 20 percent to 30 percent of our health care dollars for overhead and profit.

In fact, we don’t need health insurance at all. All we need is to apply our 47 years of experience with Medicare, one of the most popular social programs in the history of the United States, to make it even better, and to start it at birth instead of at age 65. With such an approach, all Americans would be included, health care costs could be contained, people would be able to choose their health care providers, and the emphasis on primary and preventive health services would improve the quality of care for all.

Jonathan Kotch, M.D., M.P.H., F.A.A.P., resides in Durham and works with For OccupyHealthandWellnessNC.org.

http://www.heraldsun.com/view/full_story/19150248/article-Letters–July-1

Medicare for all is best way to reform health care

By Elizabeth R. Rosenthal, M.D.
The Journal News (Lower Hudson Valley, N.Y.), July 1, 2012

There is a better path to health-care reform.

Although the Supreme Court has upheld the Affordable Care Act, the law will not remedy the U.S. health crisis.

As a physician for 45 years, 36 of them in private practice in Mamaroneck, I have seen, close up, how our “nonsystem” of health care is failing us as patients and physicians. Because access to care is largely decided by ability to pay, many are suffering and dying for lack of it.

The massive paperwork demands by the private for-profit health insurance companies force physicians to spend less time with their patients. Since our system is fragmented and chaotic, it is difficult for either group to navigate.

Because our system is dominated by this private, for-profit health insurance industry, millions are uninsured or underinsured: one serious illness away from financial ruin. Billions of dollars is wasted through inflated administrative costs, profits to shareholders and huge CEO compensation. These dollars could all be going toward providing health care if we eliminated this unnecessary middleman.

We do not have to look far for a way to do this. Our 46-year-old Medicare program can be expanded and improved to provide care for all at the cost we are now paying. Such a single-payer system also makes business sense.

A publicly financed single-payer system would eliminate business’ burden of providing health insurance benefits to employees, a potential labor cost savings of 10 percent to 12 percent, as well as elimination of benefits management costs and related labor negotiation costs. It could cut workers’ compensation insurance expenses by up to 50 percent. It would help U.S. businesses compete with foreign businesses that already have the advantage of producing goods in nations with publicly financed health-care systems.

There is legislation before Congress, notably HR 676, the “Expanded and Improved Medicare for All Act,” which would do precisely that.

Polls show such an approach is supported by about two-thirds of the public and a solid majority of physicians.

If Congress won’t do this, New York can lead the way with its own single payer bill (A07860/S5425), recently introduced by Assemblyman Richard Gottfried and Sen. Tom Duane.

Then New York could show the nation how to end the shame and disgrace of allowing so many of the 99 percent to suffer and die for lack of health care that, soon, will be affordable only for the 1 percent.

The writer lives in Larchmont.

http://www.lohud.com/article/20120702/OPINION/307020027/?nclick_check=1

Republican health care executive on single payer

The remedy is universal Medicare

By Jack Bernard
The Kansas City Star, July 1, 2012
We did end up with a health care reform law. But, strangely enough, it was stolen from Romneycare and the Republican side of the aisle simply because of the political cost to the Democrats of inaction. It is a horse put together by a committee — ineffective, complex and political. If Romneycare is any indication, it will clearly not control costs to the taxpayer, the top health care concern of most Americans.
The public does not understand the new health care reform law’s true benefits, which are substantial in regard to access. Short-term, Democrats will again lose independent voters in many swing states vital to their 2012 chances.
Plus, this administration squandered the chance for real reform, a simple expansion of Medicare. The “government takeover” catch phrase scared them off.
Universal Medicare is a concept that makes sense technically and fiscally. The U.S. currently has per capita health expenditure costs double that of other developed nations on single-payer systems.
Medicare For All can be paid for through payroll and employer taxes, just like Medicare and Social Security are now. It is affordable because private insurance marketing and administrative costs (30 percent of the premium) are eliminated for employees and the firms employing them. Costs can be controlled through the Independent Payment Advisory Board, an independent panel set up under Obamacare. And, just like those programs, it would find immediate acceptance by the American public after implementation.
For more information on costs and benefits, please go to the web site of Physicians for a National Health Program at www.pnhp.org/.
Taking the long view, universal Medicare will eventually be implemented in the U.S., because of increasing premium costs and cost shifting if nothing else. But in 15 or 20 years, our health care cost and quality problems will be even worse because of congressional inaction.
(Jack Bernard is a retired health care executive who formerly worked with Kansas hospitals on planning and cost containment issues. He is now a Republican county commissioner in Monticello, Ga., a suburb of Atlanta.)
http://www.kansascity.com/2012/07/01/3683661/as-i-see-it-the-remedy-is-medicare.html

This op-ed is of special significance for us for two reasons: 1) Medicare for All is not only a liberal/progressive issue as these are the words of a Republican health care executive, and 2) The efforts of PNHP to communicate the single payer message are gaining traction as he cites us as an authoritative source.
Jack Bernard is to be commended for his persistent efforts to inform the public on a better health care alternative. We need to renew and expand our important work on behalf of health care justice for all. It’s working.

Medicare for All: A Single Solution to the Health Care Fracas

The Affordable Care Act was upheld by the Supreme Court, but many remain dissatisfied. How we can still make health care work

By Robert Weissman
Yes! magazine, June 29, 2012

It will take some time to digest the Supreme Court’s decision yesterday, but it appears to have averted some terrible jurisprudence that might have very seriously restricted the government’s overall ability to regulate the economy and protect citizens.

In upholding most of the Affordable Care Act, the Supreme Court lets stand legislation that offers some important benefits, but only to a portion of those who are uninsured, and will predictably fail to solve our nation’s health care crisis.

However the health reform law ultimately plays out, we know two things for certain: Tens of millions of Americans will remain uncovered as will tens of millions of under-insured who will remain at risk of financial ruin if a major illness strikes; and it will leave the private health insurance and pharmaceutical industries in charge of prices and life-and-death treatment decisions.

There is a single solution to the challenges of providing coverage to the 50 million who are uninsured that would curb out-of-control health care costs and provide a humane standard of care to all who enter the medical system. That solution is an improved Medicare-for-All, single-payer system.

The improved Medicare-for-All approach starts with the premise that health care is a critically needed right that must be afforded to all, irrespective of any individual’s ability to pay for care. It solves the problems of 50 million uninsured Americans simply and directly by establishing that everyone is covered by the improved Medicare-for-All system. Everybody in, nobody out.

Improved Medicare-for-All would prevent the deaths of the 45,000 Americans who die every year from lack of health insurance. It would eliminate the hundreds of thousands of medical bankruptcies—affecting millions of Americans every year—that occur because people can’t pay their medical bills. These deaths and economic tragedies are entirely preventable; a system that permits them to continue is morally repugnant and must be replaced.

The improved Medicare-for-All approach would eliminate the greatest waste in the health care system: the needless costs imposed by private health insurers. These firms impose hundreds of billions of dollars of excess cost on us via excessive profit-taking and executive compensation, marketing expenses, vast bureaucracies devoted to denying care, and imposition of massive paper-pushing obligations on actual health care providers.

It is not for lack of policy justification or moral force that Americans continue to suffer from a malfunctioning health care system. Our failure to have adopted an improved Medicare-for-All system is due in large part to the political power of the health insurance industry.

That political power can be overcome, however, by a grassroots movement that musters enough of its own power. The country cannot continue to survive the continued reign of the private health insurance industry, and it will not.

Winning a single-payer system will not be easy. In the near term, the single-payer movement will need to devote substantial energy to holding off efforts to further privatize and weaken existing Medicare.

The early steps forward in winning expanded and improved Medicare-for-All will likely come from state initiatives, where success will depend on local movements plus assurances that states pursuing improved Medicare-for-All can obtain needed waivers from federal laws and rules.

But there should be no doubt about what must ultimately be achieved. We can no longer tolerate a system that pointlessly kills 45,000 fellow Americans a year. For those who doubt the political potency of this moral imperative, consider that economic facts counsel just as strongly for an improved Medicare-for-All system.

We can be our brother’s (and sister’s) keeper and be cost-effective at the same time. Indeed, it turns out that being cost effective requires that we take care of each other.

Robert Weissman is president of Public Citizen, a national, nonprofit consumer advocacy organization based in Washington, D.C. Public Citizen has supported a single-payer system since its founding more than four decades ago.

http://www.yesmagazine.org/people-power/medicare-for-all-a-single-solution-to-the-health-care-fracas

Did John Roberts Give Mitt Romney A Gift?

By Marcia Angell, M.D.
The Huffington Post, June 29, 2012

The Supreme Court’s decision to uphold the Affordable Care Act, aka Obamacare, puts me in mind of the old proverb: Be careful what you wish for. Democrats on a victory lap should watch their step, because John Roberts may have given Mitt Romney a gift. The impact on the health system will be much smaller than the political fallout, because with or without Obamacare, the American health system will continue to unravel — quickly if Romney is elected, slowly if Obama is re-elected.

First the policy, then the politics:

Obamacare is simply incapable of doing what it is supposed to do — provide nearly universal care at an affordable and sustainable cost. The problem is that three years ago, in his futile efforts to win over Republicans (remember the embarrassing courtship of Olympia Snowe?), Obama gutted the law before it was even passed. He made the private insurance companies the linchpin of the new system, and promised them millions of additional customers and billions of taxpayer dollars. He also did nothing to rein in the profit-oriented delivery system that rewards providers on a piecework basis for doing tests and procedures. So with all the new dollars flowing into the system and no restraints on the way medicine is practiced, the law is inherently inflationary.

Although there are some provisions to curb the worst abuses of the insurance companies, such as excluding people with preexisting conditions, there is nothing in the law that would stop insurers from raising premiums. A senior executive of the industry’s trade association, America’s Health Insurance Plans, told me privately that that’s exactly what the companies will do if regulations cut into their profits. Thus, costs under Obamacare will almost certainly rise even faster than at present. No reform can work well or very long if its costs are unsustainable.

In fact, it is unlikely that Obamacare will ever be fully implemented as it stands. If Romney is elected, with a Republican Congress, it will be quickly overturned. If Obama is re-elected (and I hope he is, despite my disappointment in his health plan), it will come apart more slowly. But unravel it will, as costs rise and it becomes clear that there are still tens of millions of Americans priced out of the system.

Here’s how the unraveling will look:

Many of the uninsured who are subject to the mandate to purchase private insurance will choose to pay the penalty/tax instead. That will lead the insurance companies to raise their premiums, demand that the penalties be greater, or both. Deductibles and co-payments will increase to the point that many people will have insurance they can’t afford to use. (This is the case in Massachusetts.) Many employers will simply stop offering health insurance, since our high unemployment means workers no longer have the leverage to demand it, or they will stop insuring dependents (thus avoiding having to cover grown children to age 26). In addition, because insurers have a strong financial incentive to evade the new regulations requiring them to take all comers, it will take a huge bureaucracy to monitor them.

Next year, states are supposed to set up insurance exchanges to pool risks and offer a menu of approved insurance plans for individuals and small businesses. But they are unlikely to be functioning by 2014, as called for in the law, either because Republican states simply refuse to set them up and hamper federal efforts to step in, or because of the administrative complexities. Some states may also refuse to accept the funds to expand Medicaid, as called for in the law, since the Supreme Court found that they could opt out without losing their existing federal Medicaid funding. Here again, the bureaucracy necessary to aid and monitor state compliance will be huge, diverting resources from health care. In addition, there are likely to be multiple legal challenges to nearly all provisions of the law.

Obamacare partially offsets the costs of federal subsidies to insurance companies and Medicaid costs by cutting Medicare reimbursement to providers. That means hospitals and other health facilities will take a hit, and many are already struggling.

So that’s how it will unravel. There will be efforts to patch it up as we go along, but because Obamacare leaves our current inflationary system largely in place, they are unlikely to be successful.

Now for the politics. Even though the Supreme Court decision will have little long-term effect on our health system, the political ramifications will be great. To be sure, it’s a victory for Obama, but that will be evanescent. Now the Republicans are on the offensive, and greatly strengthened by John Roberts’ insistence that the mandate is a tax, not a penalty. Remember how hard Obama tried to avoid the T-word? Republicans are adept at painting Democrats as tax-happy, and Roberts has helped them to do just that. Pundits wonder what got into the Chief Justice. Was he just trying make the Supreme Court appear to be above politics, given all the recent evidence that it’s not? Or did he do a favor for Romney and the Republicans?

It’s very hard to read, but I think the Democrats would have been better off if the Supreme Court had overturned Obamacare, and I think it would have been better for our health system, as well. The base would be energized, and Democrats would take the offensive. More important, no one would be under the illusion that the health system has been successfully reformed, as many good liberals now are. That mistake will become clear as the system unravels. Democrats will suffer the death of a thousand cuts, rather than a quick blow that could be blamed on our politicized Supreme Court. If the law had been struck down, we could have started right away to work on an effective reform.

The only way to provide health care to all Americans at an affordable cost is by instituting some form of publicly-administered nonprofit system like those in other advanced countries. After all, they manage to provide universal care at less than half the cost, on average, and their costs are rising more slowly. I have long advocated expanding Medicare (which is a single-payer program) gradually by lowering the eligibility age one decade at a time, while phasing out for-profit health facilities and changing doctors’ fees to reward primary care more and specialist care less.

On July 22, 2009, Obama said in a press conference, “Now, the truth is that unless you have what’s called a single-payer system in which everybody is automatically covered, then you’re probably not going to reach every single individual.” Bingo. Too bad he didn’t hang on to that insight, and use his rhetorical skills to make the case strongly to the American public. If he had fought for single-payer health care at the beginning of his administration, while he had both houses of Congress, and mobilized public opinion behind it, he might have made it. After all, the only thing members of Congress need more than industry money is votes.

Dr. Marcia Angell is a senior lecturer at Harvard Medical School and former editor of the New England Journal of Medicine.

http://www.huffingtonpost.com/marcia-angell-md/roberts-romney-health-care_b_1637397.html

Single-payer system would insure more

By Joshua Faucher
Post-Bulletin (Rochester, Minn.), Letters, June 29, 2012

The Patient Protection and Affordable Care Act is anything but a complete solution to our health care crisis. The bill still will leave at least 26 million devoid of insurance coverage. Equally worrisome, it will force many into a relationship with private insurers for coverage that is too expensive and often incomplete. We must react by implementing the non-profit, single-payer insurance system our country needs and deserves.

PPACA has left insurers firmly entrenched between patients and their doctors. Private insurers’ new high-deductible plans, with their massive coverage gaps, paired with the individual mandate, will force  the most vulnerable patients into plans that don’t protect them from medical costs.

This bill also ignores the hidden cost our fragmented insurance system brings to medicine. Thriftless spending on billing and coding administration makes our doctor’s visits seem more expensive than they actually are. Private insurers have scapegoated doctors and patients as wasteful when many go without care they need, and accountable care organizations will force the responsibility for cost savings where they can’t be shouldered.

Examples of single-payer systems, such as the United Kingdom or Canada, show that full participation in a non-profit, publicly accountable plan is the most efficient way to justly spread the cost of care. Only when we implement this true reform in Minnesota, and the rest of the United States, will we finally cover everyone.

Joshua Faucher is a medical student in Rochester, Minn.

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