Dr. Mary O’Brien, national board member of Physicians for a National Health Program, appears on “Viewpoint” on Current TV to discuss the Supreme Court decision on the constitutionality of the Affordable Care Act, June 27, 2012. Dr. O’Brien is double boarded in emergency medicine and internal medicine in New York, and she teaches at Columbia College of Physicians and Surgeons.
Watch the full clip here.
Dr. Mary O’Brien, national board member of Physicians for a National Health Program, appears on “Viewpoint” on Current TV to discuss the Supreme Court decision on the constitutionality of the Affordable Care Act, June 27, 2012. Dr. O’Brien is double boarded in emergency medicine and internal medicine in New York, and she teaches at Columbia College of Physicians and Surgeons.
Watch the full clip here.
By Don McCanne, MD
June 28, 1012
Go ahead and wade through the cacophony of responses to the Supreme Court decision. It should be a fascinating excursion through society’s exposed soul at its finest, and at its worst. Some of the responses you will hear will rely on refined cognitive processes and others on fundamental reflexive emotions.
You will not hear much new. The sounds will only be louder and more concentrated. Most of you will be able to sort the good policies from the bad policies and identify the special interest sources of the various proposals. Most of us know to keep foremost in our thoughts the only special interest that counts – the patient – with the full understanding that special interests which truly support patients are the ones that we want to pull out of the chaff, leaving behind those such as the private insurers who would serve others using the patient only as marketplace chattel.
We need to continue to guard against the “sound-good” proposals that would seem to move us incrementally toward a high performance system that serves all patients well. By incremental proposals we are not referring to important measures such as reinforcing the primary care infrastructure and expanding the presence of community health centers in underserved communities. Improving the effectiveness and quality of the health care delivery system is a continual process that must always be with us.
The sound-good incremental steps are those that would seem to move us in the right direction but are more like trying to walk up the steep side of a mountain in deep, loose sand. The steps seem to go forward, but the peak is never reached. Yet we will hear pleas to move up this slope. We have been climbing this slope for half of a century, and it’s time to look for another route.
Many will plead to keep the glass half full now that the Act has been upheld, while others of us will complain about the glass being half empty. It is time to end this petty fray when we can have a full glass – affordable, high quality care for everyone – simply by enacting a single payer national health program. Call it an improved and expanded Medicare for all, if you will.
(Yes, the Supreme Court ruled that the individual mandate survives as a tax, and that Medicaid is limited but not invalidated. But these decisions have been only a diversion, and thus are included here only as a parenthetical remark. The decisions were limited to an Act that merely tweaks the status quo, when what we need is a new act that rejects the status quo. The Supreme Court does not have the authority to bring us that act. Above all, we must guard against celebrating the fact that the Affordable Care Act was upheld, if that should mean that we would walk away from the reform that we desperately need.)
FOR IMMEDIATE RELEASE
June 28, 2012
Contact:
Garrett Adams, M.D., M.P.H., president PNHP
Andrew Coates, M.D., president-elect PNHP
Steffie Woolhandler, M.D., M.P.H.
David Himmelstein, M.D.
See Electronic Press Kit with selected spokesperson bios here. For contacts in nearly every state and major city, contact Mark Almberg, PNHP, (312) 782-6006, cell: (312) 622-0996, mark@pnhp.org, or see www.pnhp.org/stateactions.
The following statement was released today by leaders of Physicians for a National Health Program (www.pnhp.org). Their signatures appear below.
Although the Supreme Court has upheld the Affordable Care Act (ACA), the unfortunate reality is that the law, despite its modest benefits, is not a remedy to our health care crisis: (1) it will not achieve universal coverage, as it leaves at least 26 million uninsured, (2) it will not make health care affordable to Americans with insurance, because of high co-pays and gaps in coverage that leave patients vulnerable to financial ruin in the event of serious illness, and (3) it will not control costs.
Why is this so? Because the ACA perpetuates a dominant role for the private insurance industry. Each year, that industry siphons off hundreds of billions of health care dollars for overhead, profit and the paperwork it demands from doctors and hospitals; it denies care in order to increase insurers’ bottom line; and it obstructs any serious effort to control costs.
In contrast, a single-payer, improved-Medicare-for-all system would provide truly universal, comprehensive coverage; health security for our patients and their families; and cost control. It would do so by replacing private insurers with a single, nonprofit agency like Medicare that pays all medical bills, streamlines administration, and reins in costs for medications and other supplies through its bargaining clout.
Research shows the savings in administrative costs alone under a single-payer plan would amount to $400 billion annually, enough to provide quality coverage to everyone with no overall increase in U.S. health spending.
The major provisions of the ACA do not go into effect until 2014. Although we will be counseled to “wait and see” how this reform plays out, we’ve seen how comparable plans have worked in Massachusetts and other states. Those “reforms” have invariably failed our patients, foundering on the shoals of skyrocketing costs, even as the private insurers have continued to amass vast fortunes.
Our patients, our people and our national economy cannot wait any longer for an effective remedy to our health care woes. The stakes are too high.
Contrary to the claims of those who say we are “unrealistic,” a single-payer system is within practical reach. The most rapid way to achieve universal coverage would be to improve upon the existing Medicare program and expand it to cover people of all ages. There is legislation before Congress, notably H.R. 676, the “Expanded and Improved Medicare for All Act,” which would do precisely that.
What is truly unrealistic is believing that we can provide universal and affordable health care in a system dominated by private insurers and Big Pharma.
The American people desperately need a universal health system that delivers comprehensive, equitable, compassionate and high-quality care, with free choice of provider and no financial barriers to access. Polls have repeatedly shown an improved Medicare for all, which meets these criteria, is the remedy preferred by two-thirds of the population. A solid majority of the medical profession now favors such an approach, as well.
We pledge to step up our work for the only equitable, financially responsible and humane cure for our health care ills: single-payer national health insurance, an expanded and improved Medicare for all.
Garrett Adams, M.D.
President
Andrew Coates, M.D.
President-elect
Oliver Fein, M.D.
Past President
Claudia Fegan, M.D.
Past President
David Himmelstein, M.D.
Co-founder
Steffie Woolhandler, M.D.
Co-founder
Quentin Young, M.D.
National Coordinator
Don McCanne, M.D.
Senior Health Policy Fellow
For a fact sheet on health care access, costs, safety-net and women’s health issues, and the evidence-based case for single-payer national health insurance, click here. For bios and video clips of selected PNHP spokespersons, click here.
Physicians for a National Health Program (www.pnhp.org) is an organization of more than 18,000 doctors who advocate for single-payer national health insurance. To speak with a physician/spokesperson in your area, visit www.pnhp.org/stateactions or call (312) 782-6006.
Go ahead and wade through the cacophony of responses to the Supreme Court decision. It should be a fascinating excursion through society’s exposed soul at its finest, and at its worst. Some of the responses you will hear will rely on refined cognitive processes and others on fundamental reflexive emotions.
You will not hear much new. The sounds will only be louder and more concentrated. Most of you will be able to sort the good policies from the bad policies and identify the special interest sources of the various proposals. Most of us know to keep foremost in our thoughts the only special interest that counts – the patient – with the full understanding that special interests which truly support patients are the ones that we want to pull out of the chaff, leaving behind those such as the private insurers who would serve others using the patient only as marketplace chattel.
We need to continue to guard against the “sound-good” proposals that would seem to move us incrementally toward a high performance system that serves all patients well. By incremental proposals we are not referring to important measures such as reinforcing the primary care infrastructure and expanding the presence of community health centers in underserved communities. Improving the effectiveness and quality of the health care delivery system is a continual process that must always be with us.
The sound-good incremental steps are those that would seem to move us in the right direction but are more like trying to walk up the steep side of a mountain in deep, loose sand. The steps seem to go forward, but the peak is never reached. Yet we will hear pleas to move up this slope. We have been climbing this slope for half of a century, and it’s time to look for another route.
Many will plead to keep the glass half full now that the Act has been upheld, while others of us will complain about the glass being half empty. It is time to end this petty fray when we can have a full glass – affordable, high quality care for everyone – simply by enacting a single payer national health program. Call it an improved and expanded Medicare for all, if you will.
(Yes, the Supreme Court ruled that the individual mandate survives as a tax, and that Medicaid is limited but not invalidated. But these decisions have been only a diversion, and thus are included here only as a parenthetical remark. The decisions were limited to an Act that merely tweaks the status quo, when what we need is a new act that rejects the status quo. The Supreme Court does not have the authority to bring us that act. Above all, we must guard against celebrating the fact that the Affordable Care Act was upheld, if that should mean that we would walk away from the reform that we desperately need.)
National Nurses United, Press Release
June 26, 2012
Five years after release of their searing indictment of the failings of the U.S. healthcare system, filmmaker Michael Moore and the real-life stars of SiCKO, will hold a reunion Saturday night in Philadelphia. The event is at 7 p.m. at the Plays and Players Theater, 1714 Delancey Street.
Ironically, the gathering will be one of the first major national events following the expected Supreme Court decision on the Affordable Care Act – and it will serve as a reminder that no matter how the court rules, the national healthcare crisis chronicled in SiCKO is far from over.
Representatives of National Nurses United, the nation’s largest union and professional association of registered nurses, will also speak at the event. When SiCKO was released in 2007, nurses from the organizations that would later come together to form NNU toured the nation with Moore and several of the SiCKO stars to talk about the need to repair our broken healthcare system once and for all.
The solution, say nurses, is expanding Medicare to cover everyone – an approach that may be even more in focus if the Supreme Court overturns the Affordable Care Act. NNU is currently sponsoring health screenings and town hall meetings across California at which people have been describing ongoing battles to get needed care and what next after the court ruling – including the option of how Medicare for all can assure guaranteed healthcare for all.
Two SiCKO stars, 9/11 responder Reggie Cervantes and Donna Smith, who will both be in Philadelphia, have spoken out in the California town halls. See them today at this link: http://www.youtube.com/watch?v=Yvuqrr6ggi8
In the reunion event, Moore will be on stage with Smith and Cervantes. Also there will be other stars of the film, including another 9/11 responder, Billy Maher; two SiCKO subjects who lost loved ones to the broken system, Dawnelle Keys and Julie Pierce; Lee Einer, who was SiCKO’s own health insurance industry whistleblower; Adrian Campbell Montgomery, who slipped over the border to Canada to get care for herself and her young daughter; and Smith’s husband Larry, who with his wife lost everything they had to healthcare expenses though their family had health insurance.
Others speaking at the event will include Patty Eakin, RN, of the Pennsylvania Association of Staff Nurses and Allied Professionals (PASNAP/NNU), and NNU Policy Director Michael Lighty, and Pennsylvania healthcare activists, including Philadelphia- based Healthcare-NOW.
(Media reminder — Leaders of NNU will be available to speak to media immediately upon release of the Supreme Court decision on the Affordable Care Act. To arrange interviews, contact Charles Idelson, 510-273-2246 or 415-559-8991, or Carl Ginsburg, 917-405-1060.)
By Laura Flanders
The Nation, June 27, 2012
Margaret Flowers, MD, is a pediatrician whose exasperation with the American health care system turned her into a single-payer activist. In 2009 she was arrested at the Senate Round Table on Health Insurance for attempting to speak on behalf of a single-payer plan when single payer had been cut out of the conversation.
“When Obama was elected I was optimistic, like many people, because he knew what single payer was,” she told me when we talked. “He’d been on record saying that single payer was the best solution. It was quickly very clear that that this was a predetermined course, that it was more like a marketing campaign.”
As the nation awaited the Supreme Court’s decision on the Affordable Care Act of 2010 (ACA), Flowers sounded more upbeat than aghast at the prospect of the Supreme Court ruling striking down part or more of the Obama law. For Flowers, a single-payer plan, like Medicare for all (which would fund medical care from a single insurance pool run by the state), was always the ideal way to provide universal, affordable, quality care, and contain soaring costs and waste in the process. As for the individual mandate—forcing the public to buy from a for-profit company—she’s called it “crony capitalism on steroids.”
It would be no small thing to move health reform through the legislature again, she agrees. Three years ago, Democratic leaders in Washington foreclosed on single payer, and went on to betray their commitments to single-payer lite—the so-called public option. There’s no evidence there’s been a sea change in Washington. Around the country, though, Flowers believes single-payer supporters are in a stronger place now than they have ever been. (And during oral arguments on ACA this year, Justice Sotomayor was good enough to confirm the constitutionality of a public system.)
Regardless of how the court rules, we’ll still have healthcare woes and groups like Physicians for a National Health Program, will continue to fight for single payer. What follows is a partial transcript of my conversation with Flowers which took place last week, in New York City.
Laura Flanders: Margaret, a lot of media would have you believe that we are on the brink of the Apocalypse: Are we?
Margaret Flowers: Where we stand right now is that there are two things that we need to consider. One, of course is the decision around Medicaid and this is a very important decision, this is much more crucial. If the Supreme Court says that the federal government’s giving states money is tantamount to coercion, that’s a real problem because where does that end? If the federal government says you must meet minimum guidelines for education and we’ll give you money to help your schools, is that coercion? We really rely on government to provide a basic social infrastructure that takes care of people.
Now with the individual mandate, really no matter what happens—if it’s found to be constitutional or not constitutional—we know that the bill didn’t go far enough and the single-payer movement is going to be continuing to push for national Medicare for all. If it’s found to be unconstitutional that provides us with a better opportunity to make that argument; say okay you’ve done everything that you could do in the private insurance framework, it doesn’t work. Now can you really see the facts and see that we need to build a publicly financed system that’s accountable to all people and universal health care.
Let’s talk about the individual mandate. In one piece you co-wrote recently you referred to it as “crony capitalism on steroids.” What did you mean?
The individual mandate requiring people to purchase private insurance and using hundreds of millions of our public dollars that go directly to the private insurance companies is outrageous. If you look at it people having private insurance still doesn’t guarantee that you could see the doctor that you need to see, get the treatment that you need to seek; [it doesn’t guarantee] that you can afford the health care because of co-pays and deductibles… many people are forgoing necessary care even though they have insurance.
And then you look at does private insurance protect you if you have a serious illness? The greatest cause of bankruptcy is medical [costs] and 80 percent of those people that went bankrupt from medical cost had health insurance. So, we’re forcing people to purchase a defective product, we’re putting our private dollars into a private corporation that’s just going to take that money as profit and not give it out to the people for care.
So the Supreme Court should vote it down?
I believe that the Supreme Court should vote down the individual mandate. It’s not a solution, it’s not working in Massachusetts very well, very clearly they are failing. People are still facing serious barriers there. They say they’re worse off than they were five years ago so that should be the answer right there: it doesn’t work.
Howard Dean was speaking recently in Washington said that “did didn’t give a damn” about the individual mandate, but he did think that there were things to preserve in the act. He talked about 30 million previously uninsured Americans’ getting coverage. He talked about 17 million being added to Medicaid if the Act survives a couple of years; tax credits for people who can’t afford it, (again, kicking in in 2014 if the Act as a whole survives.) Do you agree that there are parts of ACA worth saving?
Well, this is the dilemma that we are always placed in where there is a little bit of good for some people, but [let’s] step back and look at the big picture. For one thing, the 30 million people that would gain insurance, what are they actually gaining? About half of those will be given Medicaid. Medicaid is a system that doesn’t work very well, it’s hard to find providers and people are not treated well when they have Medicaid. In many cases they are kind of shifted out of the hospital quickly. The other half is going to be getting private insurance and with the co-pays and the deductibles. They’ll still face serious financial barriers to getting the care that they need, they’ll still face bankruptcy if they have a serious accident or illness. And 20 or so million will still be left out. We are expecting under this legislation—the recent data shows—that maybe 20 million employees will lose their employee benefits under the Affordable Care Act.
We’re not really moving in the right direction and so there’s always something good in there which causes people to defend it without looking at the big picture that too many people are going to be left out.
When Obama was elected I was optimistic, like many people, because he knew what single payer was, he’d been on record saying what single payer was the best solution. We thought we would at least have a discussion, a debate of looking at what were the possibilities. It was quickly very clear that that this was a predetermined course, that it was more like a marketing campaign—it was very scripted toward a predetermined end, and that was what was very upsetting to those of us who advocate for real health reform, you know: evidence-based reform, Medicare for all.
Nonetheless a lot of people got very involved in the campaign. What’s your message to them today as they wonder what’s going to happen and many of them feel that they’ve worked very hard for something that they don’t want to see thrown out, far less told it was all useless?
I know it’s difficult for people that worked really hard to get the Affordable Care Act and for me personally, I think it’s really important, to be honest. And the truth is that the Affordable Care Act was something was heavily influenced by the industries that profit off of our current situation, that doesn’t address the problems that we have, and now we have an opportunity (if the bill is brought down or the individual mandate is found unconstitutional), we have an opportunity to push for real health reform; to come together and stand independent of a political party. One sign that I thought was beautiful was “Get your politics out of my health care.” That’s what it has really got to be about. Let’s all come together and fight for a really top-notch health care system in the United States that serves everybody.
So, who would be the“we” in this case?
Well, it’s interesting because in the same conference where Howard Dean said he didn’t care about the individual mandate, Representative Keith Ellison said, if the bill goes down we immediately must “pounce on this opportunity” to go out there with “Medicare for All” and say this is what we want to have. And the majority of Americans already support that approach—the majority of the physicians do—so this is a real opportunity to clearly define what we as a nation would like to see happen.
Has the movement around [single-payer] healthcare changed in these years?
The one positive that came out of the 2009, 2010 health reform process was that the movement for real health reform, for single-payer, Medicare for all, became much more organized and much larger, with groups all around the country and most states who were advocating for this. I think that they’ll be ready to mobilize when this opportunity arises.
What do you think you’ll be up against in the form of the lobbyists and the corporations that put a $100 million dollars into trying to stop this act, that you think didn’t go far enough.
If we’re pushing for single payer we’re always up against the big dogs – the ones that are profiting off of the current situation, but one thing that’s happened with the advent of the Occupy movement is that people are more and more looking at the truth behind this, seeing the corruption of money in our political system, seeing the corruption of our corporate media and how they really serve the political interest of the people and there has been a growth of independent media, we need much more growth in that area, but I think that all those are real positives towards pushing, exposing the truths and pushing for what we really want this time.
A lot of the media discussion is about the political implications of this decision; I want you to talk about the personal implications for a minute. For the people you would like to be caring for as a doctor. Where are we right now in terms of giving them care and what hangs in the balance?
The politics of the health care decision are something that I’ve never really paid attention to. That’s not important to me. What’s important to me are the patients that we see every day, that I saw when I was practicing, that my colleagues continue to see. We don’t want to turn anybody away. We don’t want to have to ask them if they have insurance first or if they can afford their co-pay before we see them.
What we see in the United States, we’re ranked thirty-seventh in the world [in quality of care, according to the World Health Organization], which is ridiculous because we spend twice as much per person on health care than other industrialized nation and those nations cover everybody and they have better health outcomes. We see that tens of thousands of people are dying every year of preventable causes simply because they don’t have access to care. The number-one cause of bankruptcy in the United States is due to medical costs. That doesn’t happen in any other industrialized nation. They think it’s crazy that people are facing that. What we really need to do is talk about that, talk about the patients.
The bill, the Affordable Care Act does help some people. It doesn’t help them as much as it should and what those kind of politics does is that it takes those kind of people [and pits them against each other]. When we saw the Supreme Court was hearing the decision, there were all these signs saying fight for women’s healthcare, fight for children’s health care —they pit people against each other, saying well, we have to say this because it’s going to help this group.
We want every person to be helped and that’s what a national improved Medicare for all would be: every single person would be “in.” Nobody would be left out. That’s a system that we could build on. We’re hoping that could develop a campaign (if the law’s found not to be constitutional), that’s very simple: drop two words. If we just took “over 65” out of the Medicare bill, then it’s there for everybody. Now we have something that we can tweak and make better.
What can people do after they wake up after the Supreme Court decision and want to get involved in this movement?
It’s very important to contact your members in Congress right away and demand Medicare for all. Very simply, drop those two words, expand the Medicare program—that’s the fastest way to do this. There are a lot of educational materials at Physicians for a National Health Program, that’s PNHP.org. Health Care Now is really the grassroots kind of sister organization, and there are Health Care Now chapters all around the country. It’s Healthcare-Now.org.
Laura Flanders blogs for The Nation. She is also host of Grit TV.
By Diane Archer
Health Affairs Blog, June 26, 2012
Over the last decade, health insurance costs doubled for the average family of four, and health costs ate away at real income, eliminating any wage gains that occurred.
Health insurance premiums (for both employers and workers) now amount to one-quarter of median family income and are projected to rise to 35 percent in the next decade. And these higher premiums are buying thinner and thinner coverage: We are paying more and more every time we go to the doctor or hospital – deductibles and copays have risen rapidly over the last decade. The share of workers paying a deductible greater than $1,000 has risen from 10 percent to over 30 percent since 2006.
Costs are rising for employers as well, and the share of workers who even receive insurance from their employer is plummeting, having fallen from more than 69 percent to 61 percent in the last 10 years. Meanwhile, fewer large employers continue to offer supplemental coverage to retirees. Since the early 1990s, the percentage of large employers offering retiree coverage has fallen from 40 percent to only 21 percent.
Shifting Americans with Medicare into private pools is not a serious solution to the rising cost of health care, given the far higher costs in the private sector. Privatizing Medicare, or even raising the age of eligibility and forcing more of our parents and grandparents into the commercial market, would actually raise overall costs, and it would only save the government money by forcing more of the cost burden onto people who cannot afford it.
By Don McCanne, MD
Regardless of tomorrow’s Supreme Court decision on the fate of the Affordable Care Act, the status quo is dependent on private insurance and the Affordable Care Act model is dependent on private insurance, yet private insurance has been a miserable failure.
You don’t have to wait until tomorrow to decide what approach should be taken in response to the Supreme Court decision. You can start immediately with efforts to replace the private insurers with an improved Medicare for all.
Private Insurance Is Bankrupting Americans: Is Congress Paying Attention?
By Diane Archer
Health Affairs Blog, June 26, 2012
Over the last decade, health insurance costs doubled for the average family of four, and health costs ate away at real income, eliminating any wage gains that occurred.
Health insurance premiums (for both employers and workers) now amount to one-quarter of median family income and are projected to rise to 35 percent in the next decade. And these higher premiums are buying thinner and thinner coverage: We are paying more and more every time we go to the doctor or hospital – deductibles and copays have risen rapidly over the last decade. The share of workers paying a deductible greater than $1,000 has risen from 10 percent to over 30 percent since 2006.
Costs are rising for employers as well, and the share of workers who even receive insurance from their employer is plummeting, having fallen from more than 69 percent to 61 percent in the last 10 years. Meanwhile, fewer large employers continue to offer supplemental coverage to retirees. Since the early 1990s, the percentage of large employers offering retiree coverage has fallen from 40 percent to only 21 percent.
Shifting Americans with Medicare into private pools is not a serious solution to the rising cost of health care, given the far higher costs in the private sector. Privatizing Medicare, or even raising the age of eligibility and forcing more of our parents and grandparents into the commercial market, would actually raise overall costs, and it would only save the government money by forcing more of the cost burden onto people who cannot afford it.
http://healthaffairs.org/blog/2012/06/26/private-insurance-is-bankrupting-americans-is-congress-paying-attention/
Regardless of tomorrow’s Supreme Court decision on the fate of the Affordable Care Act, the status quo is dependent on private insurance and the Affordable Care Act model is dependent on private insurance, yet private insurance has been a miserable failure.
You don’t have to wait until tomorrow to decide what approach should be taken in response to the Supreme Court decision. You can start immediately with efforts to replace the private insurers with an improved Medicare for all.
June 26, 2012
The American Medical Student Association and Physicians for a National Health Program are pleased to announce the winners of the first national single payer essay contest for medical students.
The contest was launched at the 2012 AMSA Annual Convention in Houston, where PNHP leaders Dr. Art Chen, Dr. David Ansell, and Dr. Howard Brody addressed medical students about the need for single payer national health insurance, “improved Medicare for all” to heal the US health crisis.
The first prize winner of an iPad is Jan Hallock at Pacific Northwest University in Yakima, Washington. The first runner-up is Victoria Powell at Virginia Commonwealth SOM in Richmond, Virginia, and the second runner-up is Eric LaMotte at UC San Francisco School of Medicine. Their prizes are $100 and $50 gift cards, respectively. The winning essays are posted below.
Many thanks to over 40 students who submitted terrific essays and to our judges, Dr. Howard Brody, Dr. David Ansell, Danielle Alexander, Dr. Elizabeth Wiley (AMSA 2012-2013 President), and Kristin Huntoon and Richard Alden Bruno (co-chairs of AMSA’s health care for all task force).
Special thanks to AMSA education and advocacy fellow Colin McCluney, who enthusiastically embraced the project and did a terrific job designing and running the contest.
The contest was advertised through The New Physician magazine (circ. 55,000) and at the AMSA Annual Meeting, as well as through PNHP, raising the profile of single payer among medical students. We hope the contest will become an Annual Event. Enjoy!
By Jan Hallock
Pacific Northwest University in Yakima, Washington
“Will this be paid for?”
I sighed silently, hoping the inquirer on the other end of the phone call would accept the only answer I could give.
“Well, Mrs. M, that’s not a question I’m able to answer, but if you look on the back of your insurance card, there should be a phone number for Customer Service. If you call that number, they should be able to help you figure out the cost.”
Mrs. M thanked me and hung up, presumably to spend another twenty minutes on the phone with a series of customer service representatives. I knew there was a good chance she wouldn’t get an answer, because insurance companies are remarkably good at not showing their hand to their customers—they tend to not commit to a certain payment amount, because they generally wait until the procedure is over to decide whether to cover it.
The phone rang again.
“Thank you for calling Dr. K’s office; how can I help you?”
“I have a question about my bill. My insurance said they would cover my annual screening colonoscopy, so why am I getting a $400 bill for it?”
Another sigh. I had chart notes to transcribe, prescription refills to authorize, letters to mail to remind patients to come back for follow-up appointments. Sorting out the fine print of insurance contracts was not how I wanted to spend my time.
“I’m sorry for the confusion, ma’am. Let me get your information, and I’ll contact our billing staff to see what happened.”
I frequently told patients this partial lie: I pretended to not know why they had received a bill for a procedure that their insurance supposedly covered. In reality, I knew that they had received a bill because their insurance had retroactively denied coverage of the procedure. But I still had to spend an average of thirty minutes per patient inquiry learning the details of different insurance policies so I could explain to patients why they ended up with a bill they didn’t expect.
These are obviously anecdotes from my personal experience, not analyses of hard data. But my experience was typical for medical assistants and medical receptionists: at least half the phone calls I received in any given workday had to do with insurance coverage or billing issues, not actual patient care.
This is especially remarkable because I worked for just one doctor, who managed to run her whole practice with just three people: herself, me, and a biller/coder. Think about that: Dr. K could competently manage her patient load and procedures almost by herself, but to work out the insurance payments and patient billing took a full-time trained, certified billing person and one-third to one-half of my time. One and one-half full-time employees, just to deal with insurance companies—is it any wonder that overhead costs are overwhelming doctors in private practice?
One common complaint I’ve heard about a single-payer system is that it would be a bureaucratic nightmare. To be honest, the first time I heard someone argue that, I laughed outright—and then I realized that he was serious. My second reaction was, “Obviously, you’ve never seen how the current system works.” Turns out, he hadn’t: he had insurance through his employer, Microsoft, which offers full coverage for just about everything you can imagine, with no copays. Patients and doctors’ offices alike love Microsoft insurance for its ease of use, its quick payment, and the overall efficiency that comes from their anti-bureaucratic approach to health care coverage. It is the epitome of great health insurance—and the opposite of the insurance coverage most people have.
The gross inefficiency of our current system is, to me, the single biggest problem in our healthcare system, and it is a problem that a single-payer system could easily solve. A single-payer system would streamline all services through one formulary, one billing system, with one set of rules and requirements. Fewer employee hours dedicated to sorting out insurance contract fine print means lower overhead costs, which means lower costs to patients and more physicians being able to stay in private practice. Less time wasted on bureaucratic nonsense means more time devoted to direct patient care, which means longer appointments, better physician availability, and better quality care. This is why I support single-payer health care: better for doctors, better for patients, better for society.
By Victoria Powell
Virginia Commonwealth SOM
In medical school, there is always an upcoming exam, with accompanying late nights and anxiety. Myopia can result from learning about medicine, yet having little exposure to the people that illnesses and injury are happening to. Health policy is a stretch – we’re learning to be doctors, not politicians or administrators. Fortunately, I’ve had a run of experiences that led to my interest in Single Payer, and given these, I feel I have the responsibility to translate my privilege into action.
In 2008, I was highly influenced by the presidential campaign of Ralph Nader. Long respected as an advocate for the people, he was having difficulty being taken seriously as a candidate. I was initially annoyed that he was running against the progressive-seeming champion Obama. Only through a friend’s insistence did I listen to his message. I was particularly inspired by his words on Single Payer. He clearly elucidated the reasons why our payment system was broken, corrupt, and wasteful. Through clear data and heart-wrenching stories, he insisted that Single Payer was the only sustainable and compassionate choice, “Everybody in. Nobody out.” Prior to his campaign, I was interested in medicine because I loved the process of scientific innovation and wanted to help translate bench-to-bedside for my patients. After hearing him, I promised myself that if I gained acceptance to medical school, I would use my position to advocate for those who were tossed aside, made to go into bankruptcy, lost homes and jobs, all because they were simply unlucky enough to have an expensive medical condition and poor insurance.
Single Payer did appear the fairest way to allocate limited resources,
but mainstream health care debate made it seem equivocal whether it would happen in America. I was convinced, but not compelled enough to become an activist. Arguments during the health care law debates resonated – it was too much effort, and the insurance industry was too strong. I heard older doctors grumbling about low reimbursement for Medicare. Could we work within the current system of multiple private insurers? Was Single Payer worth the fight?
My college friend Jay, 21, was shot in the head by a stray bullet on July 4, 2006. He spent over 100 days in the hospital and contracted almost every hospital-acquired infection imaginable. Due to what I previously thought was solely his strength and his parents’ and health care team’s dedication, he not only survived but has recovered to an extent no one thought possible for such a severe injury. He and his parents spoke to my medical school classmates recently. During the presentation, I learned there was another factor affecting his recovery that I hadn’t yet considered – his father’s excellent health insurance. Being under 22 at the time of injury, he was able to remain on his father’s federal employee plan. He had access to the comprehensive rehabilitation he needed and continues to require. Even so, his parents explained the huge chunks of time they had to spend on the phone with insurance companies, on hold with Mozart playing, while they sought authorization for life-saving surgeries. They admitted that this was nothing compared to what some families on his unit were going through. His parents heard not only about the patients who had no coverage, but also those whose families who were desperate because they had to go back to work to keep their coverage. Who would take care of the patient in recovery while they were at work?
It is not only sad for a young person with a brain injury to not receive necessary rehabilitation during the critical period of recovery because of lack of payment. It is a human rights violation. It could mean the difference between independent living, the ability to earn a living, and a lifelong sentence of disability. Patients continue to require rehab after discharge. The quality and frequency depend on their ability to pay. If a Single Payer system existed in America, resources would be distributed among all patients. Health would not be bound to a job. Our society’s medical discoveries would benefit everyone. No one would go bankrupt from medical expenses. No one would be stuck in the cycle of poverty because of payments for illness and injury. It is for these reasons that I not only support Single Payer, but resolve to use my standing as a future physician to fight for it. I will educate others. It will be difficult, but eventually, we will win. And it will be a victory for all Americans.
By Eric LaMotte
UC San Francisco School of Medicine
As the media focus on the Supreme Court’s coming ruling on the Affordable Care Act, they speculate about the various implications the Court’s decision could have on the individual mandate and many other provisions of the law. However, the contemplation of these scenarios is a distraction.
Instead, we should focus on what we already know, which is that over 15 million Americans will remain uninsured, and tens of millions will be underinsured with barebones plans that won’t prevent financial ruin if illness strikes. We will continue to pay nearly twice what the second most expensive country pays for healthcare, and costs will continue to increase unsustainably.
These facts are not seriously disputed, and yet they describe what many Democrats consider the best-case scenario, which would occur if no aspect of the ACA is struck down.
But we can do better. We should advocate publicly for a single-payer system which establishes comprehensive healthcare as a guaranteed right for all Americans, and which compensates healthcare providers rationally, simply, and fairly from a single insurance fund financed by taxpayers.
This simple system, which would effectively eliminate private health insurance and function like an improved Medicare for everyone, would save enough money by dismantling our Kafkaesque healthcare bureaucracies to cover the tens of millions of Americans who are uninsured now, or who are insured but avoid getting care because it is too expensive.
The Supreme Court’s review of the ACA is not just a distraction, but an opportunity as well. It’s a period when the “Overton Window,” the range of possibilities considered at any given moment to be politically feasible, is in flux.
Many of my fellow medical students support single-payer in theory, but are hesitant to become activists because they see it as politically infeasible in the current political climate. This creates an unfortunate Catch-22, but hints at a broad base of support for single-payer which is waiting to be unleashed when it is perceived to enter the political mainstream.
I often hear people talk about single-payer as politically infeasible because of the strength of the conservatives. Although I agree that single-payer currently seems to have little to no chance of passing the House and Senate, I reject that this is because the idea is unpopular. According to a CBS/NYTimes poll 2009, 59% of Americans said the government should provide national health insurance. 78% of medical students surveyed in 2011 said that PPACA did not go far enough in reforming our healthcare system. Rather than unpopularity, it is the health insurance industry’s powerful influence on our policymakers that keeps single-payer from entering the political mainstream.
Indeed, single-payer has recently received endorsements of preference over the ACA by conservatives such as Fox News contributor Charles Krauthammer and Louisiana A.G. Buddy Caldwell. These endorsements are not such a surprise if you consider that despite being to the left politically, single-payer stands head-and-shoulders above the ACA in terms of its merits as sound public policy.
The media have raised the possibility of the ACA (or its downfall) “paving the way” for a single-payer healthcare system, but such a shift is not going to just magically happen without strong resistance from the insurance industry. Achieving a single payer system will only happen if the population demands it loud enough to be heard over the health insurance lobby, a feat made only more difficult by Citizen’s United.
To become effective advocates for their preferred healthcare system, single-payer advocates will have to leverage a strong understanding of policy, not just politics. For example, cost savings will not just be achieved because the system is “government-run”, thereby eliminating profits. Instead, savings will be achieved by eliminating the bureaucratic complexity we have in our system where patients must navigate a fragmented system of provider networks and unpredictable charges.
I want a single-payer system because as a future physician, I want to spend my time treating patients, not dealing with billing personnel over the phone haggling to get treatments approved. As a taxpayer, insurance subscriber, and future patient, I want to spend less money, in a more predictable manner, and be guaranteed that I will get the care that I need.
I believe that we can enact a single-payer system, but I assure you that the road to it will not be paved for us by the successes or failures of the ACA. Although sound public policy is on our side, this means little if we continue to let the health insurance industry dictate which ideas are allowed into the discussion.
June 26, 2012
The American Medical Student Association and Physicians for a National Health Program are pleased to announce the winners of the first national single payer essay contest for medical students.
The contest was launched at the 2012 AMSA Annual Convention in Houston, where PNHP leaders Dr. Art Chen, Dr. David Ansell, and Dr. Howard Brody addressed medical students about the need for single payer national health insurance, “improved Medicare for all” to heal the US health crisis.
The first prize winner of an iPad is Jan Hallock at Pacific Northwest University in Yakima, Washington. The first runner-up is Victoria Powell at Virginia Commonwealth SOM in Richmond, Virginia, and the second runner-up is Eric LaMotte at UC San Francisco School of Medicine. Their prizes are $100 and $50 gift cards, respectively. The winning essays are posted below.
Many thanks to over 40 students who submitted terrific essays and to our judges, Dr. Howard Brody, Dr. David Ansell, Danielle Alexander, Dr. Elizabeth Wiley (AMSA 2012-2013 President), and Kristin Huntoon and Richard Alden Bruno (co-chairs of AMSA’s health care for all task force).
Special thanks to AMSA education and advocacy fellow Colin McCluney, who enthusiastically embraced the project and did a terrific job designing and running the contest.
The contest was advertised through The New Physician magazine (circ. 55,000) and at the AMSA Annual Meeting, as well as through PNHP, raising the profile of single payer among medical students. We hope the contest will become an Annual Event. Enjoy!
By Jan Hallock
Pacific Northwest University in Yakima, Washington
“Will this be paid for?”
I sighed silently, hoping the inquirer on the other end of the phone call would accept the only answer I could give.
“Well, Mrs. M, that’s not a question I’m able to answer, but if you look on the back of your insurance card, there should be a phone number for Customer Service. If you call that number, they should be able to help you figure out the cost.”
Mrs. M thanked me and hung up, presumably to spend another twenty minutes on the phone with a series of customer service representatives. I knew there was a good chance she wouldn’t get an answer, because insurance companies are remarkably good at not showing their hand to their customers—they tend to not commit to a certain payment amount, because they generally wait until the procedure is over to decide whether to cover it.
The phone rang again.
“Thank you for calling Dr. K’s office; how can I help you?”
“I have a question about my bill. My insurance said they would cover my annual screening colonoscopy, so why am I getting a $400 bill for it?”
Another sigh. I had chart notes to transcribe, prescription refills to authorize, letters to mail to remind patients to come back for follow-up appointments. Sorting out the fine print of insurance contracts was not how I wanted to spend my time.
“I’m sorry for the confusion, ma’am. Let me get your information, and I’ll contact our billing staff to see what happened.”
I frequently told patients this partial lie: I pretended to not know why they had received a bill for a procedure that their insurance supposedly covered. In reality, I knew that they had received a bill because their insurance had retroactively denied coverage of the procedure. But I still had to spend an average of thirty minutes per patient inquiry learning the details of different insurance policies so I could explain to patients why they ended up with a bill they didn’t expect.
These are obviously anecdotes from my personal experience, not analyses of hard data. But my experience was typical for medical assistants and medical receptionists: at least half the phone calls I received in any given workday had to do with insurance coverage or billing issues, not actual patient care.
This is especially remarkable because I worked for just one doctor, who managed to run her whole practice with just three people: herself, me, and a biller/coder. Think about that: Dr. K could competently manage her patient load and procedures almost by herself, but to work out the insurance payments and patient billing took a full-time trained, certified billing person and one-third to one-half of my time. One and one-half full-time employees, just to deal with insurance companies—is it any wonder that overhead costs are overwhelming doctors in private practice?
One common complaint I’ve heard about a single-payer system is that it would be a bureaucratic nightmare. To be honest, the first time I heard someone argue that, I laughed outright—and then I realized that he was serious. My second reaction was, “Obviously, you’ve never seen how the current system works.” Turns out, he hadn’t: he had insurance through his employer, Microsoft, which offers full coverage for just about everything you can imagine, with no copays. Patients and doctors’ offices alike love Microsoft insurance for its ease of use, its quick payment, and the overall efficiency that comes from their anti-bureaucratic approach to health care coverage. It is the epitome of great health insurance—and the opposite of the insurance coverage most people have.
The gross inefficiency of our current system is, to me, the single biggest problem in our healthcare system, and it is a problem that a single-payer system could easily solve. A single-payer system would streamline all services through one formulary, one billing system, with one set of rules and requirements. Fewer employee hours dedicated to sorting out insurance contract fine print means lower overhead costs, which means lower costs to patients and more physicians being able to stay in private practice. Less time wasted on bureaucratic nonsense means more time devoted to direct patient care, which means longer appointments, better physician availability, and better quality care. This is why I support single-payer health care: better for doctors, better for patients, better for society.
By Victoria Powell
Virginia Commonwealth SOM
In medical school, there is always an upcoming exam, with accompanying late nights and anxiety. Myopia can result from learning about medicine, yet having little exposure to the people that illnesses and injury are happening to. Health policy is a stretch – we’re learning to be doctors, not politicians or administrators. Fortunately, I’ve had a run of experiences that led to my interest in Single Payer, and given these, I feel I have the responsibility to translate my privilege into action.
In 2008, I was highly influenced by the presidential campaign of Ralph Nader. Long respected as an advocate for the people, he was having difficulty being taken seriously as a candidate. I was initially annoyed that he was running against the progressive-seeming champion Obama. Only through a friend’s insistence did I listen to his message. I was particularly inspired by his words on Single Payer. He clearly elucidated the reasons why our payment system was broken, corrupt, and wasteful. Through clear data and heart-wrenching stories, he insisted that Single Payer was the only sustainable and compassionate choice, “Everybody in. Nobody out.” Prior to his campaign, I was interested in medicine because I loved the process of scientific innovation and wanted to help translate bench-to-bedside for my patients. After hearing him, I promised myself that if I gained acceptance to medical school, I would use my position to advocate for those who were tossed aside, made to go into bankruptcy, lost homes and jobs, all because they were simply unlucky enough to have an expensive medical condition and poor insurance.
Single Payer did appear the fairest way to allocate limited resources, but mainstream health care debate made it seem equivocal whether it would happen in America. I was convinced, but not compelled enough to become an activist. Arguments during the health care law debates resonated – it was too much effort, and the insurance industry was too strong. I heard older doctors grumbling about low reimbursement for Medicare. Could we work within the current system of multiple private insurers? Was Single Payer worth the fight?
My college friend Jay, 21, was shot in the head by a stray bullet on July 4, 2006. He spent over 100 days in the hospital and contracted almost every hospital-acquired infection imaginable. Due to what I previously thought was solely his strength and his parents’ and health care team’s dedication, he not only survived but has recovered to an extent no one thought possible for such a severe injury. He and his parents spoke to my medical school classmates recently. During the presentation, I learned there was another factor affecting his recovery that I hadn’t yet considered – his father’s excellent health insurance. Being under 22 at the time of injury, he was able to remain on his father’s federal employee plan. He had access to the comprehensive rehabilitation he needed and continues to require. Even so, his parents explained the huge chunks of time they had to spend on the phone with insurance companies, on hold with Mozart playing, while they sought authorization for life-saving surgeries. They admitted that this was nothing compared to what some families on his unit were going through. His parents heard not only about the patients who had no coverage, but also those whose families who were desperate because they had to go back to work to keep their coverage. Who would take care of the patient in recovery while they were at work?
It is not only sad for a young person with a brain injury to not receive necessary rehabilitation during the critical period of recovery because of lack of payment. It is a human rights violation. It could mean the difference between independent living, the ability to earn a living, and a lifelong sentence of disability. Patients continue to require rehab after discharge. The quality and frequency depend on their ability to pay. If a Single Payer system existed in America, resources would be distributed among all patients. Health would not be bound to a job. Our society’s medical discoveries would benefit everyone. No one would go bankrupt from medical expenses. No one would be stuck in the cycle of poverty because of payments for illness and injury. It is for these reasons that I not only support Single Payer, but resolve to use my standing as a future physician to fight for it. I will educate others. It will be difficult, but eventually, we will win. And it will be a victory for all Americans.
By Eric LaMotte
UC San Francisco School of Medicine
As the media focus on the Supreme Court’s coming ruling on the Affordable Care Act, they speculate about the various implications the Court’s decision could have on the individual mandate and many other provisions of the law. However, the contemplation of these scenarios is a distraction.
Instead, we should focus on what we already know, which is that over 15 million Americans will remain uninsured, and tens of millions will be underinsured with barebones plans that won’t prevent financial ruin if illness strikes. We will continue to pay nearly twice what the second most expensive country pays for healthcare, and costs will continue to increase unsustainably.
These facts are not seriously disputed, and yet they describe what many Democrats consider the best-case scenario, which would occur if no aspect of the ACA is struck down.
But we can do better. We should advocate publicly for a single-payer system which establishes comprehensive healthcare as a guaranteed right for all Americans, and which compensates healthcare providers rationally, simply, and fairly from a single insurance fund financed by taxpayers.
This simple system, which would effectively eliminate private health insurance and function like an improved Medicare for everyone, would save enough money by dismantling our Kafkaesque healthcare bureaucracies to cover the tens of millions of Americans who are uninsured now, or who are insured but avoid getting care because it is too expensive.
The Supreme Court’s review of the ACA is not just a distraction, but an opportunity as well. It’s a period when the “Overton Window,” the range of possibilities considered at any given moment to be politically feasible, is in flux.
Many of my fellow medical students support single-payer in theory, but are hesitant to become activists because they see it as politically infeasible in the current political climate. This creates an unfortunate Catch-22, but hints at a broad base of support for single-payer which is waiting to be unleashed when it is perceived to enter the political mainstream.
I often hear people talk about single-payer as politically infeasible because of the strength of the conservatives. Although I agree that single-payer currently seems to have little to no chance of passing the House and Senate, I reject that this is because the idea is unpopular. According to a CBS/NYTimes poll 2009, 59% of Americans said the government should provide national health insurance. 78% of medical students surveyed in 2011 said that PPACA did not go far enough in reforming our healthcare system. Rather than unpopularity, it is the health insurance industry’s powerful influence on our policymakers that keeps single-payer from entering the political mainstream.
Indeed, single-payer has recently received endorsements of preference over the ACA by conservatives such as Fox News contributor Charles Krauthammer and Louisiana A.G. Buddy Caldwell. These endorsements are not such a surprise if you consider that despite being to the left politically, single-payer stands head-and-shoulders above the ACA in terms of its merits as sound public policy.
The media have raised the possibility of the ACA (or its downfall) “paving the way” for a single-payer healthcare system, but such a shift is not going to just magically happen without strong resistance from the insurance industry. Achieving a single payer system will only happen if the population demands it loud enough to be heard over the health insurance lobby, a feat made only more difficult by Citizen’s United.
To become effective advocates for their preferred healthcare system, single-payer advocates will have to leverage a strong understanding of policy, not just politics. For example, cost savings will not just be achieved because the system is “government-run”, thereby eliminating profits. Instead, savings will be achieved by eliminating the bureaucratic complexity we have in our system where patients must navigate a fragmented system of provider networks and unpredictable charges.
I want a single-payer system because as a future physician, I want to spend my time treating patients, not dealing with billing personnel over the phone haggling to get treatments approved. As a taxpayer, insurance subscriber, and future patient, I want to spend less money, in a more predictable manner, and be guaranteed that I will get the care that I need.
I believe that we can enact a single-payer system, but I assure you that the road to it will not be paved for us by the successes or failures of the ACA. Although sound public policy is on our side, this means little if we continue to let the health insurance industry dictate which ideas are allowed into the discussion.
By Amal N. Trivedi, MD, MPH; Regina C. Grebla, MGA, MPH, PhD; Lan Jiang, MS; Jean Yoon, PhD; Jent Mor, PhD; Kenneth W. Kizer, MD, MPH
JAMA, June 26, 2012
Abstract
Context: Some veterans are eligible to enroll simultaneously in a Medicare Advantage (MA) plan and the Veterans Affairs health care system (VA). This scenario produces the potential for redundant federal spending because MA plans would receive payments to insure veterans who receive care from the VA, another taxpayer-funded health plan.
Objective: To quantify the prevalence of dual enrollment in VA and MA, the concurrent use of health services in each setting, and the estimated costs of VA care provided to MA enrollees.
Design: Retrospective analysis of 1 245 657 veterans simultaneously enrolled in the VA and an MA plan between 2004-2009.
Main Outcome Measures: Use of health services and inflation-adjusted estimated VA health care costs.
Results: Among individuals who were eligible to enroll in the VA and in an MA plan, the number of persons dually enrolled increased from 485 651 in 2004 to 924 792 in 2009. In 2009, 8.3% of the MA population was enrolled in the VA and 5.0% of MA beneficiaries were VA users. The estimated VA health care costs for MA enrollees totaled $13.0 billion over 6 years, increasing from $1.3 billion in 2004 to $3.2 billion in 2009. Among dual enrollees, 10% exclusively used the VA for outpatient and acute inpatient services, 35% exclusively used the MA plan, 50% used both the VA and MA, and 4% received no services during the calendar year. The VA financed 44% of all outpatient visits (n = 21 353 841), 15% of all acute medical and surgical admissions (n = 177 663), and 18% of all acute medical and surgical inpatient days (n = 1 106 284) for this dually enrolled population. In 2009, the VA billed private insurers $52.3 million to reimburse care provided to MA enrollees and collected $9.4 million (18% of the billed amount; 0.3% of the total cost of care).
Conclusions: The federal government spends a substantial and increasing amount of potentially duplicative funds in 2 separate managed care programs for the care of same individuals.
http://jama.jamanetwork.com/article.aspx?articleid=1197014#AuthorInformation
By Don McCanne, MD
Most veterans who are eligible for enrollment in the Veterans Administration health care system are also eligible for enrollment in Medicare when they turn 65. Many of these veterans elect to enroll in the publicly-financed but private Medicare Advantage plans. This study shows that these private plans benefit greatly by receiving full capitation payments for all care in spite of the fact that they avoid the costs of the care that is actually delivered in our publicly-financed VA system. Thus taxpayers are paying twice for the same care – real care in the VA system and phantom care under the Medicare Advantage plans.
The authors suggest that rules could be changed to rectify this. Either the VA could be authorized to bill the private Medicare Advantage plans for care delivered by the VA (currently prohibited by federal law – a law dating back to before private Medicare plans were available), or the capitation payments to the Medicare Advantage plans could be adjusted downward to reflect the use of VA facilities.
There is a far better choice. The traditional Medicare program could be improved by expanding benefits and eliminating out-of-pocket cost sharing. Then we could get rid of the private Medicare Advantage plans with their profound administrative waste and the restrictions in health care choices that they inflict upon their patients. The VA-eligible patient would be able to choose either Medicare or the VA system, but regardless, we would be paying for the care only once, instead of twice like we are now.
In fact, the improved Medicare system would be so effective that we should all be able to have it as participants in a single payer national health program. Providing veterans with the choice of the VA system would not be much different from providing the rest of us with the choice of an integrated health care delivery system such as Kaiser Permanente. It would be just another health care delivery option under an improved Medicare for all.