September 15, 2023
Podcast host Joe Sparks considers “direct contracting” agreements (e.g. direct primary care) and finds them preferable to commercial insurance plans in some ways, but a poor substitute for single-payer Medicare for All.
Additional episodes will be uploaded monthly. Subscribe in iTunes, or access a complete archive of the podcast, below.
By Emily Bader
The Maine Monitor, September 11, 2023
Members of the Maine Medical Association over the weekend strongly endorsed a policy statement calling for universal healthcare insurance coverage, becoming only the fifth state medical association to do so, according to advocacy groups.
“I don’t think it’s credible for physicians to stand on the sidelines of this issue of universal access to care … while millions of patients and thousands in Maine don’t have ongoing primary care, access to specialist care, access to hospital care treatment for severe illness without taking on the risk of bankruptcy or not being — simply not being able to afford it,” Dr. Erik Steele, immediate past president of the MMA, said Monday.
“And many of our members, including me, felt we could not stand on the sidelines of that issue without tackling our position on health system reform,” he said.
Founded in 1853, the MMA is a professional and lobbying organization representing approximately 4,000 medical doctors, osteopathic doctors, medical students and retired physicians across the state.
In June, the MMA board approved the statement and members who attended the association’s annual session in Portland voted to endorse it on Saturday, Steele, a Yarmouth family practitioner, said.
The statement calls for immediate action to “create a system that provides access to healthcare for all (as a public good), contains costs, eliminates health disparities, and ensures a robust public health system.”
“A new system must be a full reconfiguration of health care delivery and financing, designed by evaluating the failures and successes of our present models and the systems of other countries,” the statement read.
Universal insurance coverage should be provided either through an “adequately funded single-payer system or a combination of private and public financing where the federal government has, at minimum, regulatory powers over health care delivery to protect consumers and providers from private profit-driven motives.”
An ad hoc committee formed in 2021 surveyed MMA membership and held four listening sessions across the state before finalizing the statement this spring, committee chair and Augusta ophthalmologist Dr. Maroulla Gleaton said.
The way the current system works, where insurance and costs of drugs stand in the way of patient-provider relationships, Gleaton said, is contributing to physician burnout.
Medical students are not taught about handling finances or running a practice, she said.
“You’re not taught that part because you’re supposed to follow what’s best for each individual patient. So that leads to a whole bunch of decisions when you’re out in the real world that really make a lot of unhappiness between the patients and the institution and the goal of trying to get the best care for the patient.”
“It’s getting to be slowly but surely increasingly difficult, I think, for everybody in the healthcare system,” she said.
While the administrative burden on physicians is heavy, “sometimes we don’t even get to see the patients that we would like to take care of but they can’t get access to the office because they just don’t have insurance,” Dr. Paul Cain, an Auburn orthopedist and MMA president said.
A year ago, Gov. Janet Mills’ office said that Maine’s uninsured rate dropped from 8% in 2019 to 5.7% in 2021 through a combination of employer-based coverage and MaineCare. Mills said the drop represented “the largest percentage decline among all states in the nation.”
As of May, 360,187 Mainers were enrolled in MaineCare, the state’s Medicaid program, according to data from the U.S. Centers for Medicare and Medicaid. About a third were able to enroll through MaineCare expansion, according to the Maine Department of Health and Human Services.
Still, complaints about uneven access, long wait times for appointments, and high out of pocket costs are still common.
Only four other states’ medical associations — Hawaii, New Hampshire, Vermont and Washington — have passed similar resolutions, according to Physicians for a National Health Program and Maine AllCare, which call for publicly funded healthcare coverage.
The American Medical Association has not passed a resolution or adopted a statement similar to Maine’s or the other states. Its House of Delegates — made up of representatives of all fifty states’ medical associations — came within 30 votes of endorsing Medicare for all in 2020, Steele said.
“While we are among a small number of medical associations to do this, we think our actions represent a growing consensus of physicians, both in Maine and nationally, that it’s time for every American to have healthcare insurance and to figure out how to do that in a way that’s affordable and equitable,” he said.
August 15, 2023
Podcast host Joe Sparks highlights one of the most under-appreciated benefits of a single-payer national health program:
“Medicare for All will provide more freedom to pick your doctors and hospitals than your current private health insurance plan.”
Additional episodes will be uploaded monthly. Subscribe in iTunes, or access a complete archive of the podcast, below.
PNHP immediate past president Dr. Susan Rogers was interviewed for “Fixing the System,” an examination of single-payer health care that was awarded third prize in the national C-SPAN StudentCam 2023 competition.
“Getting rid of private insurance companies would help a lot,” said Dr. Rogers while explaining the benefits of single payer. “What they’re doing is they’re shifting the cost to patients.”
“Fixing the System” was produced by Eastern Middle School (Silver Spring, Md.) students Adelaide Keller and Linnea Ericson.
PNHP president Dr. Phil Verhoef appeared on “The Rick Smith Show” on January 27, 2023. Dr. Verhoef warned viewers about the rapid privatization of Medicare—started in earnest under the Medicare Advantage program and continuing under the recently launched ACO REACH program.
Commercial insurance companies and other for-profit entities are “looking at REACH as an opportunity to make money,” he said. “The only way you make money as an insurance company is by not covering care.”
PNHP national board member Dr. Ed Weisbart appeared on the Missouri Rural Crisis Center’s “Medicaid Minute: Medicare Edition” podcast on December 6, 2022. Dr. Weisbart warned seniors about the false promises of Medicare Advantage plans. He added that many of the insurers that are active in Medicare Advantage are lining up to administer Traditional Medicare benefits through the ACO REACH program.
“They make more money the less health care you get,” he said, referring to the financial incentives that are present in both Medicare Advantage and REACH. “That is a radical transformation of Traditional Medicare [and] it’s rolling forward unless we stop it.”
By John Geyman
This book has three goals: (1) to bring an historical perspective to how medicine and health care have evolved over the last 100 years, including the transformation of their original ethic of service with a moral purpose and how that ethic has been compromised by corporate greed; (2) to describe where an engulfing medical-industrial complex has brought us in terms of decreasing access to affordable health care, unacceptable quality of care, profiteering and fraud; and (3) to consider whether and how our unsustainable health care system can be brought into line against this deepening crisis in serving the needs of our people.
Copernicus Healthcare: http://www.copernicus-healthcare.org
Amazon: https://www.amazon.com…
By Don McCanne, M.D.
Most of us want a health care system that has a mission to maintain and improve our health, yet we have a system that has lost its way in that its mission places a priority on advancing the interests of the medical-industrial complex at the cost of compromising our health care. John Geyman explains how we got there and how detrimental the impact has been. Although the political barriers to reform seem almost insurmountable, he does show us that there is a path to the essential reform that we need to bring health care justice to all. By understanding the source and nature of the dysfunctions, we can find our way out.
As some of you may have heard, the interruption in the Quote of the Day messages was due to a TIA/stroke suffered by the author. Fortunately, the recovery has been dramatic, though incomplete. As a result, after two decades of daily commentaries in his retirement years, it is time for a change.
Future messages will be from noted health policy experts within and outside of PNHP. We will be receiving the latest from the best. With this change in format, we will also be changing the name to “Health Justice Monitor.” Launch is planned for next week.
I hope that you are as excited as I am as I become a consumer rather than a producer of the latest in health policy science. The more we understand, the sooner we will have health care justice for all.
Peace,
Don McCanne
Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.
By Don McCanne, M.D.
Quote of the Day will take a brief interlude. We are refining our approach to communicating information to educate and advocate for single payer and health care justice for all.
See you soon.
Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.
By Robin Feldman
The Washington Post, April 6, 2021
In the past few decades, three waves of mergers have substantially increased concentration in the pharmaceutical industry.
All told, between 1995 and 2015, the 60 leading pharmaceutical companies merged to only 10.
As a result, now only a handful of manufacturers are responsible for sourcing the vast majority of prescription drugs: Just four companies, for example, produced more than 50 percent of all generic drugs in 2017.
Drug companies were drawn to merging because of the lure of increased market power, improved synergies, larger economies of scale and more diverse product portfolios.
In the period following merger waves one and two, the industry generated fewer new molecular entities each year compared to pre-merger levels. Merged drug companies also spent proportionally less on research than their non-merged competitors.
Consolidation also enabled drugmakers to directly quell competition through what were known as “killer acquisitions,” in which they acquired innovative peers solely to stop potential competition.
In short, consumers were the losers from the two waves of drug company mergers. They confronted higher prices and fewer choices — and saw companies exploring fewer paths that might produce breakthroughs. To make matters worse, around 2010, another wave of mergers began.
As with the earlier waves, giant drug companies have merged. But in a new twist, in recent years, most consolidation has featured bigger players acquiring smaller start-ups. The difference reflects a dramatic shift in the structure of the pharmaceutical industry. Faced with stagnating research productivity, large drugmakers now rely on outsourcing their new drug research to start-ups and other small pharmaceutical firms.
Increasingly, these smaller players specialize in high-risk research and early drug development, with larger firms then gobbling them up and navigating the FDA’s regulatory process. For example, 63 percent of all new molecular entities in 2018 came from smaller biopharma firms, compared with just 31 percent in 2009.
The end result of now three waves of pharmaceutical consolidation is decreased or diverted new drug innovation, fewer treatment options and higher prices. Consumers have lost as firms fuse together to bolster the bottom line.
Robin Feldman is director of the UC Hastings Center for Innovation.
https://www.washingtonpost.com…
By Don McCanne, M.D.
Yesterday we discussed consolidation of UnitedHealth/Optum and how it has become a mega-corporation of the medical-industrial complex. Today’s selection discusses consolidation within the pharmaceutical industry. The article describes how we can expect decreased or diverted drug innovation, fewer treatment options, and above all, higher prices. Works for the industry, but not so well for the people.
We’re just trying to introduce single payer Medicare for All. How much impact can that have on these mega-corporations? Where is our government in all of this? Aren’t they supposed to protect us? Maybe we’re aiming too low by advocating for a social insurance program. Maybe we should be taking over the industry so that we can gear it up to better serve us, the people. International comparisons do rate national health services very high in performance. Maybe if we talk about it a little more we can convince them that Medicare for All is a compromise that they can live with. We think we can too.
Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.
By Dan Goldberg
Capital New York, May 27, 2015
The state Assembly on Wednesday voted for a single-payer health bill, the first time in more than two decades the chamber has taken up the measure.
The vote was 89-47, an overwhelming but largely symbolic step toward universal health insurance. The bill now heads to the Republican-controlled Senate where it is not expected to pass.
Assemblyman Richard Gottfried, chair of the health committee, gave an impassioned speech on the floor in support of the New York Health Act, arguing that it was long past time for New Yorkers to rid themselves of the intrusive insurance companies whose goal is to deny claims rather than provide care.
“You do not have to be an Einstein to understand New York Health is the right choice for New York,” Gottfried said.
Gottfried, a Democrat from Manhattan, spent the legislative session barnstorming the state, trying to gain support for his bill, which would be funded through a progressive income tax and payroll assessments. There would be a net savings of $45 billion in health spending by 2019, Gottfried said, based on an analysis from Dr. Gerald Friedman, a professor at the University of Massachusetts at Amherst, though that figure was attacked by Republicans.
The bill, Gottfried said, would lower costs by getting rid of insurance companies. It would lower administrative costs and allow doctors to focus their time on treating patients instead of fighting for reimbursements.
“What will bring down health care costs is taking out of the equation the more than 20 percent we now spend on administrators whose job it is to fight with insurance companies,” he said.
The plan’s benefits, Gottfried said, would be more generous than any plan on the current market, and there would be no co-pays or deductibles. The bill would also require a care coordinator for every member, though that coordinator is not empowered to choose the type of care a patient receives.
For some Republicans, it was all too good to be true.
“This bill promises remarkable things for New York State residents,” said Assemblyman Andy Goodell, a Republican from Chautauqua. “It says providers, ‘you’ll be paid a lot more money,’ and it says to the employees ‘you’ll contribute a lot less money,’ and it says to the patients ‘you’ll have much broader access,’ and to the employers ‘you’ll pay $45 billion less.’ My background is in math and economics and I haven’t been able to figure out how this all works. … There is no free lunch, there is no free health care.”
Leslie Moran, spokeswoman for the New York Health Plan Association, which represents insurers, said the bill “represents an unrealistic, utopian view of a universal health care system where everyone would be covered, everything would be covered and the system would magically pay for it all.”
One problem, pointed out by Republicans, is that the offering, while generous, is the opposite of what public health officials are pushing, including those in the Cuomo administration, who have professed that insurance systems, and high deductibles and co-pays help ensure people use the health system judiciously instead of opting for more, often unnecessary, care.
“There is a role for insurance companies,” state health commissioner Dr. Howard Zucker said Wednesday before the debate.
The last time a universal health care bill was on the Assembly floor was 1992. It passed but the debate was sidelined because of federal efforts to reform health care, which ultimately failed under the Clinton administration.
The passing of the Affordable Care Act, which subsidizes private insurance for people below a certain income level, was a valid effort, Gottfried said, but ultimately served to highlight why the system needs to be entirely scrapped.
“I think the A.C.A. has made it clear to people … there are profound problems in our health care system that cannot be addressed by incremental change in that system,” Gottfried said.
Wiping out an industry — even the insurance industry — was not seen as popular by many Republicans who worried about the loss of jobs and what might happen should this plan fail.
Goodell asked why the state should go down this road when when Medicaid — a government run insurance program for lower-income residents — is expensive, burdensome and not well liked.
“Why would we want to expand that type of approach,” he asked.
Gottfried responded that his bill would improve Medicaid by putting everyone into one pot. He would, he said, eliminate the two-tiered system. There’d be no greater risk of fraud under this law than in the current Medicaid program.
Republicans also pointed out how much was left to be done. The income tax rates have yet to be decided, but would likely cost the highest earners more than they currently pay for health insurance, while subsidizing lower income residents.
The analysis provided by Gottfried estimates no income tax on the first $25,000, an income tax of 9 percent on income between $25,0001 and $50,000, graduating to 16 percent tax for income over $200,000.
The legislation is also not specific on how to deal with residents of New York State who retire to another state.
That would have to be resolved at a later date, Gottfried said.
“Though we have numerous pages on this legislation, we have numerous holes also,” said Al Graf, a Republican from Holbrook. “There is no way I can go back to my constituents and tell them you may have coverage in the future. … This is an exercise in insanity.”
Moran said there is no certainty that providers would accept government set reimbursement, though Gottfried said almost all would receive more for their services than they are currently being paid.
The bill also “completely disregards the economic contribution of health plans — both to the state and to local communities,” Moran said.
Joseph Borelli, a Republican from Staten Island, cited Vermont, which tried and failed to enact a single-payer health system.
Vermont’s collapse has been a cautionary tale for even the most enthusiastic supporters of government sponsored health insurance, but Gottfried was having none of it.
“New York … bears no resemblance to Vermont,” Gottfried said. “The bill bears very little resemblance to Vermont. Their financing system is different. The two have absolutely nothing to do with one another, nothing! Why don’t you ask me whether New York will flood Just like Texas flooded if we enact this plan. The weather in Texas has as much to do with this as Vermont does.”
Read the bill here:Â http://bit.ly/1JVUg1I
http://www.capitalnewyork.com/article/albany/2015/05/8568890/assembly-pa…
By Michael Virtanen, Associated Press
Democrat & Chronicle (Rochester, N.Y.), May 27, 2015
ALBANY – The New York Assembly voted 89-47 on Wednesday for legislation to establish publicly funded universal health coverage in a so-called single payer system.
All New Yorkers could enroll. Backers said it would extend coverage to the uninsured and reduce rising costs by taking insurance companies and their costs out of the mix.
With no patient premiums, deductibles or co-payments for hospital and doctor visits, testing, drugs or other care, New York Health would pay providers through collectively negotiated rates. It would be funded through a progressive payroll tax paid 80 percent by employers and 20 percent by employees.
Also, waivers would be sought so federal funds now received for New Yorkers in Medicare, Medicaid and Child Health Plus would apply.
“Employers are shifting more and more health care costs to workers or are dropping it entirely,” said Assemblyman Richard Gottfried, chief sponsor. “The only ones who benefit are the insurance companies.”
The Manhattan Democrat estimated universal care would save New Yorkers more than $45 billion annually, cutting the statewide total cost for health care to about $255 billion in 2019.
Assembly Republicans doubted Gottfried’s estimate and questioned what would happen to everyone now employed by insurance companies.
“All I can say right now I think this is the last think New York state needs as far as an additional cost,” said Assemblywoman Jane Corwin, an Erie County Republican. She said they’re still trying to grapple now with the cost of the federal Affordable Care Act. That extended health care coverage to about 1 million New Yorkers, more than half in Medicaid and the others in private insurance with possible tax subsidies to offset costs.
An identical bill hasn’t advanced in the state Senate and isn’t expected to before the legislative session ends in June. Senate Health Committee Chairman Kemp Hannon said Wednesday that Gottfried’s bill faces two major hurdles, resistance from senior citizens to giving up Medicare for a new state program and obtaining federal waivers to apply Medicaid and Medicare funding to support it.
http://www.democratandchronicle.com/story/news/local/2015/05/27/assembly…
Berks Community Television (Reading, Pa.), Oct. 25, 2015
HARRISBURG, Pa. – A bill to create a single-payer health-care system in Pennsylvania will be introduced in the state Legislature by the end of the month.
The legislation is being introduced by Representative Pamela DeLissio of Philadelphia and was crafted with the assistance of HealthCare 4 ALL PA, a not-for-profit advocacy group. David Steil, past president of that organization, says the bill is simply called the Pennsylvania Health Care Plan.
“What it does is create a health-care system that includes every resident of Pennsylvania, that is publicly funded and privately delivered,” says Steil.
The cost of the program would be covered by increased taxes, which Steil acknowledges may present a significant obstacle to passage by the state Legislature.
The plan would increase the state personal income tax by an additional three percent, substantially less than most pay for private insurance. It would also add a 10 percent payroll tax on businesses which, as Steil points out, is much less than what businesses spend on health insurance now.
“The average cost for health care benefits for companies that provide health care is about 17 percent of payroll,” he says. “So at 10 percent of payroll, the saving is significant.”
Similar legislation has been introduced in each legislative session since 2007.
Most recently it was introduced as Senate Bill S-400. None of the earlier versions have not gotten very far. Raising taxes is a hard sell, especially to conservative lawmakers. But Steil insists they’re asking the wrong question.
“The question each one has to ask is not just ‘look at the taxes’ because there are taxes to it, it’s not free,” he says. “The question is, ‘How much less than you’re currently paying is this plan to you?'”
Steil says the bill would also eliminate health-insurance costs on pension plans and vehicle insurance, making the potential savings even larger.
http://www.bctv.org/special_reports/health/pa-legislature-introduces-sin…
Berks Community Television (Reading, Pa.), Oct. 25, 2015
HARRISBURG, Pa. – A bill to create a single-payer health-care system in Pennsylvania will be introduced in the state Legislature by the end of the month.
The legislation is being introduced by Representative Pamela DeLissio of Philadelphia and was crafted with the assistance of HealthCare 4 ALL PA, a not-for-profit advocacy group. David Steil, past president of that organization, says the bill is simply called the Pennsylvania Health Care Plan.
“What it does is create a health-care system that includes every resident of Pennsylvania, that is publicly funded and privately delivered,” says Steil.
The cost of the program would be covered by increased taxes, which Steil acknowledges may present a significant obstacle to passage by the state Legislature.
The plan would increase the state personal income tax by an additional three percent, substantially less than most pay for private insurance. It would also add a 10 percent payroll tax on businesses which, as Steil points out, is much less than what businesses spend on health insurance now.
“The average cost for health care benefits for companies that provide health care is about 17 percent of payroll,” he says. “So at 10 percent of payroll, the saving is significant.”
Similar legislation has been introduced in each legislative session since 2007.
Most recently it was introduced as Senate Bill S-400. None of the earlier versions have not gotten very far. Raising taxes is a hard sell, especially to conservative lawmakers. But Steil insists they’re asking the wrong question.
“The question each one has to ask is not just ‘look at the taxes’ because there are taxes to it, it’s not free,” he says. “The question is, ‘How much less than you’re currently paying is this plan to you?'”
Steil says the bill would also eliminate health-insurance costs on pension plans and vehicle insurance, making the potential savings even larger.
http://www.bctv.org/special_reports/health/pa-legislature-introduces-single-payer-health-care-bill/article_a41a6da0-7996-11e5-b8a4-2ba3ba19b536.html
