PNHP

Coronavirus: A good argument for Medicare for All

Coronavirus: A good argument for Medicare for All

By Alice Rothchild, M.D.
The Seattle Times, March 18, 2020

As an obstetrician-gynecologist and member of Physicians for a National Health Program, I have long supported sweeping changes in how health care in the U.S. is financed, from challenging the cost and gate-keeping roles of health-insurance companies to the price gouging by big pharma. COVID-19 has laid bare the weaknesses in our system and the urgent need for Medicare for All. We cannot nationally isolate or personally buy our way out of this outbreak.

As Washingtonians shelter at home and our economy plunges into recession, the problem with a health-insurance system based on employment becomes increasingly clear. Workers are financially incentivized to avoid screening and show up for work despite symptoms. The threat from loss of wages for small businesses and gig workers as well as those on unpaid sick leave raises the negative impact of insurance payments, copays, premiums and the ability to self-pay. GoFundMe reports that a third of its campaigns are done to pay medical bills. The Trump administration’s talk of sending $250 billion directly to millions of Americans is a desperately needed temporary fix that will explode the deficit and ignore the demands for structural changes.

To make matters worse, the Trump administration’s public-charge rule, recently upheld by the U.S. Supreme Court, allows federal officials to refuse immigrants green cards if they use social-safety-net programs. Add to that the tens of thousands of migrants and asylum seekers housed in the more than 200 immigrant prisons and jails in the U.S., not to mention our general prison population, and we have a vast pool of vulnerable, disenfranchised people who suffer from lack of access to adequate nutrition, health care and housing. Poor communities are most susceptible to infectious disease and to a lack of resources to screen and treat. Recently, 700 public-health experts called on the federal government to maintain safety programs, to fund local health centers in underresourced areas, and to be sure that testing, vaccines and treatment be available regardless of ability to pay.

Even before this crisis, millions of U.S. citizens suffered financial disasters due to medical bills, were forced to declare personal bankruptcy, or forego needed care. Some polling shows there is support for Medicare for All, even in populations that are “satisfied” with their health insurer. Often not reported is that Medicare and Medicaid recipients are even more likely to be “satisfied.” The myth that most citizens are “happy” with their private insurance belies the fact that the private health-insurance industry restricts our choices, dictating which physicians, hospitals, treatments or medications we can use. Under Medicare for All, every physician would be in-network, and physicians and their staff would not spend hours battling with insurers.

Ironically, despite the fact that we spend much more money on health care than other first world countries, we are not the healthiest. U.S. infant mortality is 5.8 per thousand live births, in Canada 4.5 and Britain 4.3. The “mortality amenable to health care,” i.e., deaths that could have been prevented by medical intervention, also reveals distressing numbers: 112 per 100,000 in the U.S., but 78 in Canada, and 85 in the U.K.

Medicare for All would restrain drug prices and dismantle wasteful administrative costs, freeing up billions of dollars for health care. This isn’t about restricting care, but rather developing a more effective and fair way to pay for it. Traditional Medicare spends about 2% on administration, less than one-sixth the cost of private health insurance companies.

The Democratic Party needs to solve the critical, fundamental political and moral question: How can we guarantee that no one is locked out of the health-care system due to cost while providing quality care to all? More than 2,500 physicians have signed an open letter supporting Medicare for All. Our patients desperately need an end to the inhumanity of our health-care system exposed once again by this devastating pandemic.

Dr. Alice Rothchild is a Seattle author, filmmaker, and retired obstetrician-gynecologist. She is the author of three books, most recently “Condition Critical: Life and Death in Israel/Palestine,” and has contributed to a number of anthologies including “Reclaiming Judaism from Zionism: Stories of Personal Transformation.”

https://www.seattletimes.com…

Pandemics and Medicare for All

During Pandemic, Biden Lies About Healthcare

Institute for Public Accuracy, March 16, 2020

Biden claimed at last night’s debate: “With all due respect to Medicare for All, you have a single-payer system in Italy. It doesn’t work there. It has nothing to do with Medicare for All. That would not solve the problem at all.” Sanders responded: “What the experts tell us, is that one of the reasons that we are unprepared and have been unprepared is we don’t have a system. We’ve got thousands of private insurance plans. That is not a system that is prepared to provide healthcare to all people.”

Biden claimed: “The national crisis says we’re responding. It’s all free. You don’t have to pay for a thing. That has nothing to do with whether or not you have an insurance policy. This is a crisis. We’re at war with the virus. We’re at war with the virus. It has nothing to do with copays or anything.”

DAVID HIMMELSTEIN, M.D.

Himmelstein is a distinguished professor of public health at the City University of New York at Hunter College. He said today: “Biden lied about coverage, and also distorted the Italian situation. Italians will not face medical bills, or be reticent to seek care for fear of costs. The problem in Italy is a huge number of terribly sick people who are overwhelming hospitals and doctors. That’s a problem pretty much every nation will face.”

JAMES G. KAHN, M.D., M.P.H.

Dr. Kahn is emeritus professor at the Philip R. Lee Institute for Health Policy Studies, the Department of Epidemiology and Biostatistics, and the Institute for Global Health Sciences in the School of Medicine, University of California San Francisco. He said today: “Biden, abetted by moderator questions focused on immediate action, claimed that he had short-term solutions, whereas Sanders wanted a revolution. Indeed, Sanders proposes both immediate solutions and long-overdue structural reforms to properly address serious long-term problems.

“Once again, Biden falsely equated his health care solution (a public option) and Bernie’s comprehensive reform Medicare for All. Biden’s approach would cost more — much more — and leave 100 million people seriously underinsured, facing large financial barriers, and limit doctor choice. Medicare for All would shift waste in our current system into giving everyone comprehensive first-dollar coverage, with free choice of doctor.”

In an accuracy.org released Sunday and challenging CNN to finally “get it” about Medicare for All, Himmelstein and Kahn anticipated Biden’s arguments about Italy. Said Himmelstein: “Our fragmented system leaves public health separate and disconnected from medical care, and provides no mechanism to appropriately balance funding priorities. Kahn noted that without a Medicare for All system, “we’re handicapping ourselves. In other words, Medicare for All is necessary but not sufficient.”

http://accuracy.org…

Comment:

By Don McCanne, M.D.

Facts about health policy are important. The way those facts are communicated is also important since they can influence the future of our health care.

Two issues were appropriately conflated during the Biden/Sanders debate. One is that nations must be prepared at all times to address current and future public health crises, and the other is that the United States needs to reform its health care financing infrastructure to make it work well for everyone. Bernie Sanders made both those points whereas Joe Biden dismissed the need for financing system reform (“It has nothing to do with Medicare for All”) while discussing the more limited topic of management of a pandemic. This led to his outrageous statement that single payer doesn’t work (in Italy).

The urgency of addressing the Covid-19 crisis aside, the most important long-term health policy debate today is whether we are going to enact and implement a single payer model of an improved Medicare that includes everyone, or if we are going to continue to try to improve the Affordable Care Act plus add a Medicare-like public option. The facts are that the two approaches are a world apart.

Merely making modifications to our current financing infrastructure is the most expensive model of reforming health care and yet it achieves none of the goals of true universality, efficiency, equity, affordability for all individuals and families, free choice of health care professionals and institutions, and other important goals of reform. Yet single payer Medicare for All achieves those goals and more and does so at a cost less than our current national health expenditures, not to mention avoiding the extra cost of trying to stoke our current dysfunctional system.

Bernie Sanders has been consistent in his efforts to accurately describe the Medicare for All model and its clear benefits over our current fragmented financing system. Unfortunately, Joe Biden has been dismissive of the single payer model, making untrue claims about the supposed deficiencies of single payer while also making untrue claims about the benefits of building on Obamacare. Just his claim alone that Medicare for All “would cost more than the entire federal budget” is emphatically untrue (Politifact: “False” 2/13/20).

The distortions and lies about single payer are rampant, and yet much of the media has been remiss in not challenging them. The debates have shown that members of the media have often used these false rhetorical depictions of single payer in the questions they ask, perhaps innocently so, although they are guilty of failing to adequately research these false claims.

Fortunately we have policy experts such as David Himmelstein and James Kahn who are meticulous with the truth and can be an invaluable resource for setting the facts straight. But we need the politicians and the media on board as well. Until they start demanding rigid adherence to the truth, the general public is apt to remain confused and then rely on the spinmeisters for their information. These spinmeisters gladly accept the generous financial support of the health insurance industry, pharmaceutical firms and others who are served so well by our current health care financing system. Should the medical-industrial complex fail in controlling the rhetorical debate, they would find themselves in need of establishing legitimacy should we enact and implement single payer Medicare for All.

PNHP does not support any political candidates for office, but we do encourage all candidates to be thoroughly and accurately informed on health policy so that they will support health care measures that are truly in the best interests of all of us.

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Rural Virginia needs Medicare for All

By Bob Devereaux, M.D.
The Roanoke (Va.) Times, February 1, 2020

With Democratic Party presidential primaries just around the corner the issue of fixing our broken health care system is back in the national conversation. Comprehensive plans proposed by Bernie Sanders and Elizabeth Warren have come under increased scrutiny.

As a family medicine physician in Giles County I am convinced that Medicare for All is the best solution for the health care problems of rural Virginia.

I think we can all agree that there are serious problems in medical care that demand change. Almost 30 million Americans still have no health insurance despite an expansion of coverage under the Affordable Care Act. It is estimated that 30,000 die every year as a consequence of not having insurance.

Co-pays and deductibles are skyrocketing, resulting in 44 million people being under-insured. This really hurts my rural patients who are not earning six figure incomes. Recently one of my patients with a severe respiratory problem refused hospital admission because with her private insurance plan she would still have thousands of dollars of out of pocket costs. Another patient with insurance was charged $1,100 for less than a month supply of insulin, which she could not afford.

Despite spending lots of money on health care and we do spend a lot, nearly twice as much per capita as other developed countries, we are not getting much bang for our buck. A study in the Journal of the American Medical Association last year ranked the U.S. dead last among 11 developed countries in infant mortality and life expectancy.

The solution to this problem is expanding one of the most popular and successful government programs ever, Medicare to the entire U.S. population.

Critics say that this is unaffordable. Not true. What we cannot afford is to perpetuate a system where bureaucratic waste now accounts for over one-third of all health care costs.

Studies indicate that moving from private insurance to Medicare, which has much lower administrative costs and has a fee schedule that limits costs, could save more than $500 billion annually. This combined with further savings from a reformed system of prescription drug pricing, would be more than enough to pay for expanding coverage to all citizens. The savings would also result in the elimination of all co-pays and deductibles and provide for expanding coverage to include dental care, vision care, mental health and prescription drugs. These are services that my patients often cannot afford.

What about taking away the freedom of people to chose their own health insurance? In my experience, my senior patients love traditional Medicare because they can go to any doctor and hospital and with a supplemental policy all of their costs are covered with the exception of some prescription drugs. Meanwhile, my younger patients and I fight a constant battle with private insurance companies who make money by restricting patients choices and limiting care.

Lastly some say Medicare for All would be tantamount to “socialized medicine.” Nothing could be further from the truth. Doctors and hospitals would remain as private entities. My patients would love to be able to change jobs, start a new business or retire early without fear of losing insurance coverage.

In fact implementing Medicare for All would restore free choice to health care. We need a system where doctors and patients together can make medical decisions unencumbered by insurance companies whose profits are dependent on limiting and denying care.

Our 50-year experience with health care being run by the free market has failed. It’s time to take a bold step forward by passing and implementing Medicare For All legislation. This means: “everybody in, no one left out.”

https://www.roanoke.com…

RAND draws wrong conclusion on capping surprise bills

Limiting Out-of-Network Payments to Hospitals Could Produce Cost Savings Similar to Single-Payer Options

RAND, Press Release, March 12, 2020

Placing limits on what hospitals can collect for out-of-network care could yield savings similar to more-sweeping proposals such as Medicare for All or setting global health spending caps, according to a new RAND Corporation report.

RAND researchers examined the potential impact of four proposals for out-of-network payment limits: 125% of Medicare payment rates (a strict limit), 200% of Medicare payment rates (a moderate limit), the average of payments made by private health plans in a state (a moderate limit), and 80% of average billed charges in a state (a loose limit).

The analysis found that limiting out-of-network payments to 125% of Medicare would create the biggest drop in hospital payments.

A more-moderate payment limit set at 200% of Medicare rates would reduce negotiated hospital payments by 8% or 23%, depending on the modeling assumptions, while using the average private payment prices in a state are estimated to reduce negotiated hospital prices by 16% or 30%.

“Under the strict and moderate scenarios, the cost savings created by placing limits on out-of-network hospital bills creates savings that are similar to ideas such as Medicare for All, statewide rate setting and creating global health care budgets, without the particular potential disruption that could come from implementing these plans, although the limits would admittedly create some as-yet unknown level of disruption of their own,” said Christopher Whaley, co-author of the report and a policy researcher at RAND.

https://www.rand.org…

RAND Report: The Price and Spending Impacts of Limits on Payments to Hospitals for Out-of-Network Care

By Erin L. Duffy, Christopher Whaley, Chapin White

Key Findings

Strict out-of-network payment limits on hospital care could yield savings similar to more-sweeping proposals, such as Medicare for All, rate setting, and global budgets

Although cost containment can benefit patients facing rising health costs, such changes are disruptive to hospital revenues

From the Conclusions and Policy Recommendations (Page 21 of the full report)

“Notably, single-payer health care options seek to expand coverage in addition to controlling costs. In comparison, out-of-network payment limits directly address the cost of care for privately insured patients without directly expanding coverage among uninsured and underinsured people. This distinction is important in considering the potential impacts of these health reforms for different subsets of the U.S. population and the policy objectives of proponents of these different approaches.”

https://www.rand.org…

Media reports

“Cutting out-of-network hospital payments may save as much as single-payer system”

https://www.healthcaredive.com…

“Savings from capping out-of-network payment rates could save as much as $124 billion in hospital spending, making the policy a potential alternative to Medicare-for-All.”

https://revcycleintelligence.com…

Comment:

By Don McCanne, M.D.

There has been considerable discussion over what to do about surprise medical bills – bills that arise from care given outside of the insurers’ provider networks. For single payer advocates, it’s easy. Eliminate the private insurers and their networks through enactment of single payer Medicare for All and then all essential care is automatically covered by the public plan.

In this report, RAND has provided an analysis showing that placing a cap on surprise bills can yield savings similar to single payer. This conclusion is prominent in their report and has been picked up by the media. But it ignores all of the many other tremendous advantages of a single payer system – universality, elimination of restrictive provider networks, elimination of financial barriers to care, dramatic reduction in administrative waste, and making health care affordable for everyone through progressive tax policies, to name a few.

It is not as if the authors didn’t understand this. Buried in their conclusions they note that, in addition to controlling costs, single payer directly expands coverage among uninsured and underinsured people, whereas placing limits on out-of-network payments only addresses the cost of care for privately insured patients. It is difficult to see how capping out-of-network payment rates could be considered “a potential alternative to Medicare-for-All” when it fails to correct all of the other profound deficiencies in our health care financing system.

Passing surprise billing legislation would do almost nothing to correct the injustices in our health care system, but it would allow the legislators to once again walk away pretending that they have corrected the problem, when the real problem is so much larger than what they have tackled. We desperately need single payer Medicare for All, and we need it now.

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Public Health Experts: Single-Payer Systems Coping With Coronavirus More Effectively Than For-Profit Model

"Having a healthcare system that's a public strategic asset rather than a business run for profit allows for a degree of coordination and optimal use of resources."

By Jake Johnson
Common Dreams, March 16, 2020

As the coronavirus pandemic places extraordinary strain on national healthcare systems around the world, public health experts are making the case that countries with universal single-payer systems have thus far responded more efficiently and effectively to the outbreak than nations like the United States, whose fragmented for-profit apparatus has struggled to cope with the growing crisis.

“It is too soon to see definite outcomes among competing healthcare systems. But even in this early phase, public health experts say the single-payer, state-run systems are proving themselves relatively robust,” the Washington Post reported Sunday. “Unlike the United States, where a top health official told Congress the rollout of testing was ‘failing‘ and where Congress is only now moving through a bill that includes free testing, the single-payer countries have been especially nimble at making free, or low-cost, virus screening widely available for patients with coughs and fevers.”

While the Trump administration only recently took steps to massively expand COVID-19 testing—sparking concerns that the outbreak in the U.S. is far more severe than official numbers suggest—countries with forms of single-payer healthcare like South Korea and Denmark have for weeks been offering “drive-through” testing and other innovative mechanisms, allowing them to quickly test hundreds of thousands of their citizens and respond accordingly.

“Unhampered government intervention into the healthcare sector is an advantage when the virus is spreading fast across the country,” said Choi Jae-wook, a professor of preventive medicine at Korea University in Seoul.

“It is too soon to see definite outcomes among competing healthcare systems. But even in this early phase, public health experts say the single-payer, state-run systems are proving themselves relatively robust,” the Washington Post reported Sunday. “Unlike the United States, where a top health official told Congress the rollout of testing was ‘failing’ and where Congress is only now moving through a bill that includes free testing, the single-payer countries have been especially nimble at making free, or low-cost, virus screening widely available for patients with coughs and fevers.”

While the Trump administration only recently took steps to massively expand COVID-19 testing—sparking concerns that the outbreak in the U.S. is far more severe than official numbers suggest—countries with forms of single-payer healthcare like South Korea and Denmark have for weeks been offering “drive-through” testing and other innovative mechanisms, allowing them to quickly test hundreds of thousands of their citizens and respond accordingly.

“Unhampered government intervention into the healthcare sector is an advantage when the virus is spreading fast across the country,” said Choi Jae-wook, a professor of preventive medicine at Korea University in Seoul.

Jorgen Kurtzhals, the head of the University of Copenhagen medical school, told the Post that the strength of Denmark’s single-payer system is that it has “a lot of really highly educated and well-trained staff, and given some quite un-detailed instructions, they can actually develop plans for an extremely rapid response.”

“We don’t have to worry too much about whether this response or that response demands specific payments here and there,” said Kurtzhals said. “We are aware that there will be huge expenditure within the system. But we’re not too concerned about it because we have a direct line of communication from the national government to the regional government to the hospital directors.”

None of which is to say that countries with forms of single-payer healthcare or nationalized systems are flawlessly handling the COVID-19 pandemic, which has infected at least 173,000 people and killed more than 6,000 worldwide.

Britain’s National Health Service (NHS), following years of austerity imposed by Conservative governments, is facing staff and supply shortages as hospitals are being overwhelmed with patients. Canada, like the U.K., is struggling with a shortage of ventilators.

But Helen Buckingham, director of strategy and operations at the London-based Nuffield Trust think tank, told the Post that the NHS is in a relatively good position to cope with COVID-19 because it has “a very clear emergency planning structure.”

Additionally, Buckingham noted, “there is no need for people to worry about the tests or vaccine or cost of care if people become ill.”

David Fisman, an epidemiologist at the University of Toronto, said that in a “time of crisis” like the coronavirus pandemic, “having a healthcare system that’s a public strategic asset rather than a business run for profit allows for a degree of coordination and optimal use of resources.”

During the Democratic presidential primary debate Sunday night in Washington, D.C., former Vice President Joe Biden cited Italy’s struggles to contain COVID-19 as evidence that the Medicare for All system advocated by rival candidate Sen. Bernie Sanders (I-Vt.) would not be effective in a pandemic. Italy has been the hardest-hit country outside China with nearly 25,000 cases of the novel coronavirus.

“With all due respect for Medicare for All, you have a single-payer system in Italy,” said Biden. “It doesn’t work there.”

Critics were quick to take issue with Biden’s talking point. “[Single-payer] isn’t the reason Italy is having problems,” tweeted HuffPost healthcare reporter Jonathan Cohn. “Italy’s problem is health system capacity. Independent of health system design.”

Dr. David Himmelstein, co-founder of Physicians for a National Health Program and distinguished professor of public health at the City University of New York at Hunter College, said in a statement Sunday night that the “fragmented system” in the United States “leaves public health separate and disconnected from medical care, and provides no mechanism to appropriately balance funding priorities.”

“As a result, public health accounts for less than 3 percent of overall health expenditures, a percentage that has been falling for decades, and is about half the proportion in Canada or the U.K.,” said Himmselstein. “One result is that state and local health departments that are the front lines in dealing with epidemics have lost 50,000 position since 2008 due to budget cuts.”

On the debate stage Sunday evening, Sanders made the case for transitioning the U.S. to a single-payer program, arguing that the coronavirus “exposes the incredible weakness and dysfunctionality of our current healthcare system.”

“How in God’s name does it happen,” said Sanders, “that we end up with 87 million people who are uninsured or underinsured and there are people who are watching this program tonight who are saying, ‘I’m not feeling well. Should I go to the doctor? But I can’t afford to go to the doctor. What happens if I am sick?'”

“So the word has got to go out, and I certainly would do this as president: You don’t worry,” Sanders added. “People of America, do not worry about the cost of prescription drugs. Do not worry about the cost of the healthcare that you’re going to get, because we are a nation—a civilized democratic society. Everybody, rich and poor, middle class, will get the care they need. The drug companies will not rip us off.”

https://www.commondreams.org…

Medicare for All Explained Podcast: Episode 30

Interview with Dr. Bob Devereaux

March 15, 2020

Dr. Bob Devereaux details the struggles that rural Americans face when trying to access health care, from a lack of specialists and medical facilities to a commercial health insurance industry that requires significant copays and is generally indifferent to their needs. Additional episodes will be uploaded twice monthly. Subscribe in iTunes, or access a complete archive of the podcast, below.

https://medicareforallexplained.podbean.com

Taiwan’s COVID-19 lesson for us

Response to COVID-19 in Taiwan

By C. Jason Wang, MD, PhD; Chun Y. Ng, MBA, MPH; Robert H. Brook, MD, ScD
JAMA, March 3, 2020

Conclusions

Taiwan’s government learned from its 2003 SARS experience and established a public health response mechanism for enabling rapid actions for the next crisis. Well-trained and experienced teams of officials were quick to recognize the crisis and activated emergency management structures to address the emerging outbreak.

In a crisis, governments often make difficult decisions under uncertainty and time constraints. These decisions must be both culturally appropriate and sensitive to the population. Through early recognition of the crisis, daily briefings to the public, and simple health messaging, the government was able to reassure the public by delivering timely, accurate, and transparent information regarding the evolving epidemic. Taiwan is an example of how a society can respond quickly to a crisis and protect the interests of its citizens.

https://jamanetwork.com…

Taiwan’s Response to the Coronavirus Challenge of 2020

By Tsung-Mei Cheng
Taiwan Insight, University of Nottingham, Taiwan Studies Programme, March 5, 2020

Ultimately, the outcome of any infectious disease outbreak depends to a significant degree on the response of not only the government but also the public to the threat. Taiwan’s response to date has played an important role in Taiwan’s so far limited spread of Covid-19, despite its geographic proximity and close economic and cultural ties to China, which is the source of the global Covid-19 outbreak.

https://taiwaninsight.org…

Remarks by President Trump in Address to the Nation

The White House, March 11, 2020

This is the most aggressive and comprehensive effort to confront a foreign virus in modern history.

The virus will not have a chance against us.

No nation is more prepared or more resilient than the United States.

https://www.whitehouse.gov…

MSNBC, March 13, 2020

Dr. Ashish Jha, director of Harvard’s Global Health Initiative, joins Morning Joe to discuss the latest details in the spread of the coronavirus and the staggering government response.

“The federal response really has been a fiasco.”

10-minute video:
https://www.youtube.com…

Comment:

By Don McCanne, M.D.

Taiwan has a single payer national health program. The United States does not. Both nations now face the COVID-19 pandemic. “Taiwan is an example of how a society can respond quickly to a crisis and protect the interests of its citizens. (JAMA)” Yet in the United States, “The federal response really has been a fiasco. (Jha)”

Is the difference due to the single payer system? Well, it is an important factor. Taiwan’s single payer system has removed barriers to health care – certainly crucial during a pandemic. The United States is stumbling around just trying to figure out how we can test people to see who might be contagious. Forget about ensuring payment for care for the critically ill who are uninsured or underinsured.

But more important than insurance coverage is the fact that the Taiwanese government is lead by politicians who understand the importance of ensuring the general welfare of its people. In contrast, the Trump administration has left the nation ill-prepared by neglecting our safety-net public health functions. The President’s response primarily has been to issue his usual blowhard statements that often conflict with both the competent and incompetent members of his administration.

Uwe Reinhardt and Tsung-Mei Cheng recognized the importance of the government role in the health care systems of various nations. They deemed the single payer model to be appropriate for Taiwan, and they helped them achieve it. So it is instructive to see her response to the Taiwanese efforts to limit the harm that could be done by this highly contagious disorder.

(As this comment is being composed, Congress is preparing legislation to expedite testing for COVD-19. Why does the President of the United States need an act of Congress to prompt him into action that he should have taken long ago when it appeared that the pandemic was inevitable? Not to mention that the government should always be maintained in a state of preparedness. And why did he launch his administration with a slash and burn approach with no apparent intent to replace those crucial government functions?)

We’ve known that Taiwan has had lessons for us on single payer, which we have ignored, but do we really have to turn to them to find out about the fundamental basics of governing? Surely we have competent individuals we can elect who would put us on a path toward social justice for all.

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Demand change on health insurance

By Michael Knaebel
The Charlotte Observer, March 12, 2020

Regarding “Dental care can leave patients vulnerable,” (March 8):

Kathy McCracken’s unfortunate story is now the norm: People believe their insurance will cover things, then sadly discover its shortcomings. How much longer will we tolerate this?

Her story contains a wealth of revealing terms: “maxed out,” “$3,000 out-of-pocket,” “major gap,” and worst of all, “extremely vulnerable.” Another example of insurance inadequacy is Medicare Advantage, for-profit privatized Medicare that is craftily marketed to appear preferable to original Medicare.

Americans, wake up and demand the only solution – Medicare for All – before these devastating terms apply to you.

Michael Knaebel is a retired insurance broker and member of the Health Care Justice – North Carolina chapter of Physicians for a National Health Program.

https://www.charlotteobserver.com…

With Coronavirus, ‘Health Care for Some’ Is a Recipe for Disaster

By The Editorial Board
The New York Times, March 6, 2020

In late January, as the new coronavirus was making its first incursion into the United States, the Supreme Court upheld the Trump administration’s contested “public charge” rule, which enables federal officials to deny green cards to immigrants who use social safety net programs. The decision received scant media attention, in part because it was overshadowed by the emerging epidemic. But public health experts warn that the two stories are intimately, perhaps disastrously, related: Infectious disease outbreaks have a long history of preying on society’s most vulnerable, disenfranchised members. Noncitizens who don’t have access to health insurance, nutritious food or safe, affordable housing fall squarely into that category.

Doctors and immigration advocates have long worried that the public charge rule would present a grave public health danger. The rule could deter millions of noncitizens — even those who were not technically subject to its provisions — from using programs like Medicaid, WIC and SNAP or from seeking medical care of any kind, lest they imperil their immigration status.

The wisdom of each of those measures will be sorely tested now, as the coronavirus threatens to morph into a full-blown pandemic.

Already, citizens who are underinsured or uninsured are being slammed with medical bills that they can’t afford when they seek testing and treatment for the virus. Unsurprisingly, experts say that many of them are bound to avoid such care as the outbreak rages on. If quarantines become routine, tens of millions of low-wage workers, many of whom don’t have health insurance or paid sick leave, will not be able to stock up and stay home. One shudders to think what will happen if the courts dismantle the Affordable Care Act in the next year — a move that could ultimately leave 21 million or so more people without health insurance.

It’s easy to see how all this fear might feed on itself in the months ahead and also where that might lead. If citizens struggling to cover their own health care nurture resentments against any group perceived to be getting help to which they themselves are not entitled — or worse, if they grow xenophobic and subscribe to the notion that immigrants carry diseases — they might be compelled to endorse policies even more draconian than those already in play.

The best way to break this cycle of fear and further contagion is to dispense with zero-sum thinking and stitch together a safety net big enough, and strong enough, for everyone.

NYT Reader Comment:

By Don McCanne, M.D.

Why should we have “a safety net big enough, and strong enough, for everyone” only during an epidemic? Every day people face potential financial hardship, suffer from injury and illness and perhaps die prematurely. We need a “safety net” that is ready for all of us, all of the time.

The single payer model of an improved Medicare that covered everyone would do just that. Such a system would have built-in surge capacity plus the support of our public health agencies standing ready for us when the need arises.

Let’s not just tweak the system for one threatened pandemic. Let’s fix it forever for all of us.

https://www.nytimes.com…

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We need Medicare for All now

By Luke Messac, M.D.
Providence (R.I.) Journal, March 12, 2020

The times, they are a-changin’. Last week, Rhode Island state Sens. Sam Bell, Ana Quezada, Gayle Goldin, Dawn Euer and Donna Nesselbush introduced a resolution calling on Congress to pass Medicare for All legislation. In a March 3 hearing in the Senate Committee on Health and Human Services, the chair, Sen. Joshua Miller, made clear that he supports the resolution.

For decades, single-payer health care — a system, now commonly known as Medicare for All, in which one public agency organizes health-care financing, drastically curtailing administrative expenses and eliminating out-of-pocket costs — was seen as a pipe dream. Single-payer was, as President Barack Obama said in 2009, the most rational way to pay for health care. Indeed, a recent study by Yale researchers found single-payer would save 68,000 lives and $450 billion every year. Even still, many reformers argue it is counterproductive to focus on this goal given the powerful special interests — namely, private insurance companies — that oppose it.

It is absolutely true that single-payer health-care legislation would not be easy to pass. The history of similar legislation, in the United States and abroad, demonstrates as much. In the United Kingdom, the Labour Party inaugurated the National Health Service in 1948 even as members of the British Medical Association compared it to Nazism. In Canada, a single-payer health system passed in the early 1960s even after doctors went on strike.

In the United States, Medicare became law in 1965 even after Ronald Reagan warned that if it were to pass, “We are going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free.” These programs faced significant opposition, but today they are widely popular.

The Affordable Care Act made a positive difference, particularly by expanding health insurance to millions of low-income Americans through Medicaid, but it is not enough. High-deductible health insurance plans are proliferating, hundreds of thousands of Americans are bankrupted each year by medical expenses, and hospitals have taken to suing patients when they cannot pay. People with respiratory symptoms who need to be screened for COVID-19 have already faced thousands in out-of-pocket payments. Is this how we want to organize a massive public-health response that requires the trust and participation of the American people?

As doctors, we have a responsibility to talk about the harm that our fragmented and expensive system is causing our patients. I see this harm every day in the emergency room where I work. I saw it in a young woman who presented with ketoacidosis, a potentially fatal complication of diabetes, because she could not afford her insulin. I saw it in the man who came in after an opiate overdose who would not listen to my counseling because all he could think about was the cost of his ER visit.

I saw it most clearly in a middle-aged woman who came in with a chief complaint of a breast mass. Under her gown was a large, foul-smelling, fungating mass of dead and dying tissue. The cancer had been growing on her chest for six months. Fearing the financial burden her condition would impose on her family, she had not sought care until the pain became unbearable. She had reason to fear the costs, as she had spent her career in health insurance. A CT scan revealed the cancer had spread through her body. All we could offer her was hospice. Her suffering is a casualty of our refusal to take up the necessary work of change.

We do not need to live with, and die from, this inhumane system. We can change it. Congressman David Cicilline supports Medicare for All. Congressman Jim Langevin supports Medicare for All. Sen. Sheldon Whitehouse supports Medicare for All. The largest medical-specialty society in the United States, the American College of Physicians, supports Medicare for All. This year, the Rhode Island state legislature has the chance to go on the record, on the right side of history, for Medicare for All. I hope they take it.

Dr. Luke Messac is a resident physician in emergency medicine in Rhode Island. He is the author of “No More to Spend” (Oxford University Press, 2020).

https://www.providencejournal.com…

Statement from prominent economists on Medicare for All

Economists conclude that Medicare for All (M4A) could be considerably less expensive than the current healthcare finance system

By James G. Kahn, Jeffrey Sachs, Anders Fremstad, Robert Reich, Robert Pollin, Leonard Rodberg, Emmanuel Saez, Gabriel Zucman, Alison Galvani, Gerald Friedman
The Hopbrook Institute, February 28, 2020

We are economists interested in public policy and healthcare. Some of us have worked to estimate the cost of alternative healthcare programs. Others have reviewed such estimates. We believe the available research supports the conclusion that a program of Medicare for All (M4A) could be considerably less expensive than the current system, reducing waste and profiteering inherent in the current system, and could be financed in a way to ensure significant financial savings for the vast majority of American households. Of course, the details would depend on the design of the M4A system.

Compared with the current system, Medicare for All would achieve considerable savings on administration and by reducing payments to monopoly drug companies and hospital networks. Within a few years of operation, M4A could save hundreds of billions of dollars per year from these sources. Additional savings will come when a rational healthcare finance system allows needed investments in coordinated care and preventive care, as well as reductions in fraudulent billing. Over time, global budgeting would slow the rate of future healthcare costs significantly, as has been done in Canada and other countries. Bending the cost curve could save more than $2 trillion over the next decade, and even more with a well-designed system. Costs will be predictable, enabling households and businesses to plan in a way that is impossible today.

There are added costs associated with Medicare for All. Universal coverage and increased utilization, coming from reduction or elimination of cost sharing, will add costs, but studies show that these added costs will be far less than the savings outlined above.

The need for increased public funds (replacing premiums) can be financed with some combination of payroll, income, and wealth taxes. By eliminating insurance premiums and out-of-pocket expenses, and lowering overall healthcare costs, Medicare for All will result in enormous savings for almost all households, all except the richest households who will pay more in taxes. Shifting the burden from per-person payments for premiums and cost sharing to income- and wealth-related taxation will magnify the savings for most households. The current system is particularly burdensome for middle-income working households who receive relatively little support through Medicaid or other public programs but are responsible for health insurance premiums either paid directly or by their employer as nonwage compensation. A system that cuts costs and shifts financing to income and wealth taxes will dramatically lower this burden, producing significant savings for workers and businesses.

The net financial savings will be accompanied by substantial improvements in productivity through improved health, and the elimination of “job lock” coming from the need to stay on a job to retain health coverage. Most important, Medicare for All will reduce morbidity and save tens of thousands of lives each year.

James G. Kahn, Professor, Institute for Health Policy Studies, School of Medicine, University of California, San Francisco

Jeffrey Sachs, University Professor and Director, Center for Sustainable Development, Columbia University

Anders Fremstad, Assistant Professor, Economics, Colorado State University

Robert Reich, Carmel P. Friesen Professor of Public Policy, Goldman School of Public Policy, University of California, Berkeley

Robert Pollin, Distinguished University Professor of Economics and Co-Director of Political Economy Research Institute, University of Massachusetts Amherst.

Leonard Rodberg, Professor Emeritus of Urban Studies, Queens College/CUNY

Emmanuel Saez, Professor of Economics, Director, Center for Equitable Growth, University of California at Berkeley

Gabriel Zucman, Associate Professor of Economics, University of California at Berkeley

Alison Galvani, Burnett and Stender Families’ Professor of Epidemiology, Director of the Center for Infectious Disease Modeling and Analysis, Yale School of Public Health

Gerald Friedman, Professor of Economics, University of Massachusetts at Amherst

(Additional endorsers at link)

https://www.hopbrook-institute.org…

Comment:

By Don Mcanne, M.D.

Can’t say it too often.

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The rough political road to optimal health policy

Strikes and Attack Ads: The Hard Roads to Universal Health Care

By Quoctrung Bui and Sarah Kliff
The New York Times, March 10, 2020

It is a common refrain from Bernie Sanders on the campaign trail: The United States is the only developed country that does not provide health coverage to all residents.

“Canada can provide universal health care to all their people at half the cost,” he said at a recent Democratic debate. “The U.K. can do it. France can do it. Germany can do it. All of Europe can do it.”

Mr. Sanders is right: All these countries provide universal coverage. But what he doesn’t talk about is the excruciating battle they went through to get there.

It took Canada more than a decade to move from a patchwork of insurance plans to a single-payer system. At one point, doctors were so incensed that they went on strike for 23 days. Doctors from the United States and Britain flew in to help keep the health system going.

Today, most Britons revere their National Health Service: One lawmaker has called it the closest thing the English have to religion, and the 2012 Olympic opening ceremony honored it with a four-minute song-and-dance routine.

But when it began in the mid-1940s, 89 percent of doctors were opposed. They raised £1.6 million (or £58 million today, equivalent to $76 million) for a “fighting fund” to protest the plan. Some patients showed interest in contributing, too.

Look around the world and you start to see a common theme: Creating universal coverage is hard. The countries with the systems that Mr. Sanders admires went through years of failed legislation, doctor protests and uncertain futures.

Abroad, the arguments made against universal coverage were similar to those we hear today: that it’s just too expensive, or gives government too much control over the practice of medicine.

“No country did this without a huge political conflict,” said Jacob Hacker, a professor of political science at Yale who studies the formation of international health systems. “But once they put in the strong, basic foundations, there was no going back.”

Mr. Hacker said: “People look at the current levels of support that other systems have, and extrapolate backwards to think that universal coverage was always popular. But that isn’t the case. Everywhere this happened, it was a very fierce fight.”

(The article discusses the struggles in Canada, Britain, and Australia.)

Australia, Canada and Britain all overcame enormous opposition to build health systems that their citizens now support. In each case, politicians stood firm, and eventually the outcry subsided.

Could something similar happen in the United States?

Those who study the history of other health systems say it is certainly possible — but will probably be more difficult.

The United States is different in that its medical industry is bigger and more powerful. Health care spending accounts for one-sixth of the American economy, and no industry spends more on lobbying Congress.

Another obstacle comes from the structure of the U.S. government, in which dueling political parties often wield partial control over different branches of government.

“The American political system makes this harder,” said Mr. Hacker, the Yale professor. “The kind of determined, take-no-prisoners approach that happened in some provinces like Saskatchewan doesn’t work as well here.”

That said, there is nothing so structurally different about the United States that leads historians to think of universal coverage as impossible.

https://www.nytimes.com…

Comment:

By Don McCanne, M.D.

The lesson here is clear. All nations that have universal health care systems experienced significant political struggles to achieve them. The fact that there are political barriers ahead is never a reason to not move forward with reform.

In the case of the United States, the leading proposal for universal health care – the single payer model of an improved Medicare for All – once enacted and implemented would be the finest health care system in all the world – the pride of all Americans.

So what are the barriers? It costs too much? No, we are already spending enough to provide comprehensive care for everyone. Doctors and hospitals would be underpaid? No, the hundreds of billions of dollars in administrative waste that would be recovered is enough to adequately fund the system. Waiting times would be too great? No, resource allocation would be improved, helping to reduce some of the excessive queues we now have. Superfluous vested interests such as the private insurers would lose out? Yes, but that would allow health care dollars to be redirected to patient care, where they belong. Anti-government ideologues would be offended? And what is their counter-offer to ensure health care for all? Leave it to the marketplace? Kenneth Arrow taught us that lesson many decades ago.

So what about the politics of 2020? The Republicans wanted to repeal and replace the Affordable Care Act, but they have not found a replacement that would work. In the meantime there had been a crescendo of support for Medicare for All, but now the Democratic leadership has declared that, in order to defeat Donald Trump in the upcoming presidential election, we must abandon Medicare for All. What? That’s a non sequitur. Yet in only one week there was a massive shift of Democratic voters from the candidate supporting Medicare for All to a candidate who was outspoken in opposing it.

There is certainly strong opposition to President Trump within the Democratic Party, but how did the spinmeisters transfer that to voting against one of the most outspoken Trump opponents who happened to be the leading supporter for Medicare for All? As today’s article indicates, there will always be significant barriers to enacting a program of universal health care. We have to identify those barriers and knock them down.

PNHP advocates for a single payer national health program. We do not support any political candidates or any political parties. Rather we ask that all candidates and political parties join us in supporting health care justice for all though enactment of a single payer national health program.

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