PNHP

Med students are on the right side of Medicare for All debate

Med students are on the right side of Medicare for All debate

By Jack Bernard
Modern Healthcare, Letters, June 15, 2019

Modern Healthcare last week reported that the American Medical Association membership narrowly defeated a resolution to repeal the AMA’s opposition to Medicare for All. Significantly, it was a large contingent of medical students as well as younger physicians who wanted the AMA to endorse single-payer. Physicians for a National Health Program, having thousands of mostly younger members, was there.

As someone with a strong health policy background who has written about the topic extensively, I agree with those med students; Physicians for a National Health Program; Sens. Bernie Sanders, Kamala Harris, Elizabeth Warren and others regarding healthcare reform. Medicare for All is not only a moral imperative and completely feasible, it is the only way to control our nation’s runaway health expenditures.

Those who advocate maintaining Obamacare vs. single-payer assume the effectiveness of private enterprise vs. government. Generally, yes, private enterprise is more efficient than government. However, the exception to the rule is healthcare. Medicare’s overhead is 2% vs. about 12% for the for-profit insurers.

Repeated analyses by the Organisation for Economic Co-operation and Development illustrate that we pay much more per capita than any other affluent democracy for healthcare—every year. All developed nations have greater involvement of government in their healthcare financing systems compared with the U.S. and most have found a way to cover 100% of their citizens at a much lower cost.

Jack Bernard is the former director of health planning for Georgia and a retired health care executive.

https://www.modernhealthcare.com…

AMA’s opposition to single-payer healthcare is uninformed

By Samuel Metz, M.D.
Modern Healthcare, Letters, June 15, 2019

I’m an American Medical Association member. My leadership’s opposition to single-payer healthcare is uninformed and possibly deceptive.

At last week’s meeting, Dr. Daniel Johnson, former AMA president, asked “What is best for patients?” The AMA should not confuse this question with “What is best for physicians?” The questions differ. The answers conflict. The AMA should not pretend otherwise.

Dr. Barbara McAneny, the outgoing AMA president, exacerbates this conflict when she refers to AMA support of “pluralism, freedom of choice, freedom of practice, and universal access for patients.” But physician freedom to reject patients with poor insurance differs from patient freedom to choose physicians. Pluralism of insurance differs from universal access.

Single-payer plans do indeed restrict physician practice by eliminating competition among insurers. Single-payer plans instead create uniform benefits and physician fees. Both compromise physician ability to maximize income.

But single-payer plans do benefit patients. They guarantee access regardless of employment or finances. They reduce patient costs (healthcare taxes, premiums and out-of-pocket payments). They improve outcomes by promoting primary and preventive care. They even provide modest benefits to physicians. Their expenses decrease when every patient becomes a paying patient. Professional costs plummet. But not all physicians consider this benefit worth the compromised income potential.

Every single-payer system provides better care to more people for less money than the dysfunctional, employer-dependent, multirisk-pool American system reinforced by the Affordable Care Act and supported by the AMA.

Even at risk to my income, I want the AMA to acknowledge single-payer. If it won’t, integrity demands that it cite real physician benefits, not specious patient benefits.

https://www.modernhealthcare.com…

In health care, the free-market model has failed

By Kenneth Dolkart, M.D.
Valley News (West Lebanon, N.H.), June 15, 2019

“Medicare for All” is at the confluence of currents running through our nation. Consciousness is rising that we might enjoy the automatic, universal and high-quality care that is taken for granted in many nations. We trail the developed world in metrics of care like longevity, access, equity, infant and maternal mortality, and rates of death from causes otherwise amenable to care. All too often, ZIP code determines life expectancy.

The health industry sector outperforms the stock market, even as schools cannot afford insurance premiums for teachers.

Nurses and doctors watch countless people lose their health, since absent or inadequate medical coverage promotes belated attention to symptoms.

As some Americans enjoy wondrous medical advancements, others cannot afford the insulin they need. And a growing undertow of “diseases of despair,” such as suicide, alcoholism and opioid overdose, have taken their toll.

U.S. life expectancy has been declining the past three years, for the first time since 1918.

The consequences of the deregulation of medical insurance are obvious.

Costs of employee-sponsored family health insurance plans leaped ahead of inflation, from $5,791 in 1999 to $18,142 in 2016, according to the Kaiser Family Foundation. Middle-class incomes have been stagnant as wages are diverted to the “health dollar” and destined for insurance company profits and CEO salaries. Health insurance deductibles have risen 200 percent since 2008, along with other tactics that shift costs to the enrollee and discourage obtaining services.

The private managed care bureaucracy is geared to profit, and overall U.S. administrative costs are four times that of Canada and three times that of European nations, according to the Organization for Economic Cooperation and Development. Absent regulation allows unbridled and unjustified increases in drug and equipment prices. The cartel-like practice of “pay-for-delay” occurs regularly as drugmakers pay off generic companies to not produce cheaper — but otherwise identical — medication.

Apart from antitrust actions, the prices of medical products and services explode beyond what a reasonably functioning market would dictate.

It is evident that applying free-market consumer models to health care is as appropriate as applying rules of baseball to hockey.

Profits above patients

The recent effects of the corporatization of medical “providers” are also clear.

The vanishing primary care doctor runs gauntlets to get tests reimbursed and hires staff solely to interact with insurers. Burnout from the ever-expanded clerical burdens of electronic medical records thins the ranks of doctors and nurses. The promise of electronic medical records was lost when it was hijacked for capturing billings, rather than clinical utility.

(Wouldn’t it be nice if the clinician could “ask Siri” to “find last pathology report” and “schedule blood count in two weeks,” or “analyze drug interactions”?)

Companies with a duty to put stock prices above patient interests cynically exploit the professional accountability of medical staff, as physician and author Danielle Ofri observed in a recent New York Times piece, “Is Exploiting Doctors the Business Plan?”)

Abuse of the public trust is certainly not unique to health care.

Industry-aligned Cabinet billionaires dismantle the federal oversight agencies they command. “Dark money” influence is unabated and oligarchs pull the levers of national legislation. Lobbyists for Big Oil mythologize climate change, big banks set the terms of their next failures and the National Rifle Association legislates a gun dystopia. So too, Big Pharma and health insurers profit from the legislation they draft.

Urban hospitals convert health dollar surplus into real estate investments, while rural hospitals collapse in the absence of coordinated support. The Justice Department tries to dismantle the Affordable Care Act scaffolding while millions of Americans are still on it.

Our multiple, episodically introduced, parallel public insurance systems still leave 30 million Americans uninsured.

Now there are numerous proposals to achieve universal coverage, reduce complexity and cut overall costs. Some “Medicare for All” plans propose incremental dissolution of profit-directed insurance bureaucracies with a single federal payer built upon Medicare. There is no “nationalization” of hospitals or doctors, as some critics charge.

“Medicare for Some” proposals, such as the “public option,” allow non-seniors to purchase Medicare and may be more politically palatable to those with employer-coverage, but they do not reduce complexity nor lower costs, and future recessions will eliminate such coverage for many.

Other well regulated and simplified hybrid systems can be envisioned. Still, any cost-effective system, “all-payer” or otherwise, requires transparent and uniform insurance industry practices, enforcement of existing regulations and the enabling of negotiation between tax-supported payers and drugmakers. So expect smoke, mirrors and twitters of fear, uncertainty and disinformation from the Partnership for America’s Health Care Future — a coalition of lobbying groups including America’s Health Insurance Plans, the American Medical Association, the Federation of American Hospitals and BigPharma — which is already hard at work.

We realize that the anonymous “dark money” financing of election efforts and the sanctioned bribing of Congress is incompatible with a representative democracy. Citizen efforts to create legislation for policies that have long had overwhelming support have been stymied by misinformation and the stoking of division, whether it be by the AMA or the NRA.

Still, the tide may be turning. Young people and an energized electorate are clamoring to “promote the general welfare, and secure the blessings of liberty” offered in the preamble to the Constitution. We will recognize such a democracy when, among other changes, this wealthy nation fulfills the moral imperative of assuring modern, universal and affordable health care to all Americans.

Dr. Kenneth Dolkart is a physician who lives in Grantham

https://www.vnews.com…

New rule using HRAs to further destroy health equity for employees

Employers can fund workers' individual plans under new Trump rule

By Harris Meyer
Modern Healthcare, June 13, 2019

Employers will be able to hand their workers a chunk of tax-sheltered health reimbursement money and send them off to buy an individual health plan under a controversial rule issued by the Trump administration Thursday.

The final rule, which takes effect Jan. 1, 2020, will prompt an estimated 800,000 large and small employers to fund individual coverage through health reimbursement accounts (HRAs) for about 10 million workers, nearly 800,000 of whom would be newly insured.

Reversing prior policy, the 497-page rule lets employers dole out HRA funds—previously used to reimburse out-of-pocket medical expenses—to employees to buy individual-market plans.

While the HRA money can be used mostly for buying plans that meet Affordable Care Act requirements, employers under the rule can establish a special type of “excepted benefit” HRA for employees to use in buying cheaper short-term plans that don’t comply with ACA rules such as pre-existing condition protections. These special accounts are capped at $1,800 a year.

The ACA requires that companies with more than 50 full-time workers provide their employees with health insurance. Employers can satisfy the requirement if they provide adequate HRA contributions to employees to buy individual coverage.

A wide range of groups expressed fears about negative effects on the individual market if employers offloaded their sicker, more costly workers from their employer group plans to the individual market.

“If the administration’s estimates are right, this would result in a huge influx into the ACA-regulated individual insurance market,” said Larry Levitt, senior vice president for health reform at the Kaiser Family Foundation. “But these new accounts could shift employer-provided health insurance to a defined-contribution approach, leaving workers at greater risk for premium increases over time.”

In the final rule issued Thursday, the agencies decided that an “individual coverage” HRA can only be used to buy ACA-compliant plans. But this type of HRA will only be available to workers who are not offered a traditional group plan, according to Matthew Fiedler, an economist at the Brookings Institution’s Center for Health Policy.

Employers that provide a traditional group plan can offer workers an “excepted benefit” HRA, capped at $1,800 a year, that they can use to buy a short-term plan but not an ACA-compliant plan.

The final rule retained the proposed rule’s provision that employers cannot offer the same class of employees the choice of either a traditional group plan or an HRA-funded individual-market plan.

But the agencies declined to include specific enforcement guidance to determine whether employers are targeting individual coverage HRAs to high-cost employees.

The agencies also acknowledged the likelihood that employees will find the new HRA benefit system confusing, and that they may not understand the coverage limitations of short-term plans.

Contrary to the agencies’ finding that the rule would have a net beneficial effect, Brookings’ Fiedler argued that it will increase individual-market premiums and federal premium subsidy costs by encouraging larger employers with sicker workforces to shift their workers into the individual market.

He was particularly critical of the provision allowing use of excepted benefit HRAs, which are tax-sheltered, to buy short-term plans.

“At best, it’s a poor use of federal funds,” he said. “At worst, it will give firms a tool to shift costs from their healthier workers onto their sicker ones.”

https://www.modernhealthcare.com…

Final rule (497 pages): Health Reimbursement Arrangements and Other Account-Based Group Health Plans
https://s3.amazonaws.com…

Trump’s new rule will give businesses and workers better health care options

By Brian Blase (special assistant to the president at the National Economic Council focused on health care policy)
CNN Business, June 14, 2019

While some recklessly claim that the administration has been sabotaging the individual market, this rule makes clear we have been focused on expanding affordable options through choice and competition in all possible venues. We aim to deliver better results than previous policies centered on mandates and a “Washington-knows-best” mentality. Obamacare’s many mandates still keep individual market premiums too high in many parts of the country, but this rule may spur necessary deregulatory reforms as more stakeholders now stand to benefit from a more competitive and free individual market.

https://www.cnn.com…

Comment:

By Don McCanne, M.D.

The Trump administration is once again using the fiction that deregulation and choice and competition in health plans “will give businesses and workers better health care options.” What they are enforcing through the rule-making process is further fragmentation of risk pools, greater administrative complexity and confusion, greater transfer of employees into the deficient individual insurance market (or out of the market altogether), greater use of cruelly inadequate short-term insurance plans, and use of health reimbursement arrangements (HRAs) as a tool to switch employees from guaranteed defined benefit health plans to health plans with ever-diminishing defined contributions, shifting yet more health care costs to the already overburdened employees and their families.

As Matthew Fiedler of Brookings states, “At best, it’s a poor use of federal funds; at worst, it will give firms a tool to shift costs from their healthier workers onto their sicker ones.”

The good news is, once we have enacted and implemented a single payer Medicare for All program, this 496 page rule can be dumped into the electronic trash bin along with billions of other pages from the private insurers and from the administrative-procedures electronic files of the health care professionals and institutions, finally allowing us to use our resources for the benefit of patients in an affordable and equitable health care financing system that benefits all.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

Por qué los estudiantes de medicina exigen Medicare para todos

Por Jessica Osorio, Christian PĂ©rez y Stephanie Navarro, Estudiantes de un Programa Nacional de Salud
La OpiniĂłn, 14 de Junio 2019

Como estudiantes de medicina de EEUU, estamos aprendiendo de la manera más difícil que es más probable que la salud de nuestros pacientes esté determinada por su situación económica y no por su estado de salud.

Si menos personas sin seguro es un objetivo loable, los programas como el ACA, hacen poco para abordar los problemas inherentes a un sistema con fines de lucro que depende de las compañías de seguros comerciales para el racionamiento.

Los EEUU necesitan desesperadamente un sistema de pago Ăşnico y mejorado de Medicare para todos.

Eso se debe a que incluso los que tienen la suerte de tener un seguro privado enfrentan enormes obstáculos para obtener atención. Toma a una de nuestras primeras pacientes, Karen, que se cayó y se lesionó en el trabajo y necesitaba un reemplazo de cadera. Si bien la responsabilidad fue repetidamente aprobada entre el seguro de salud patrocinado por su empleador y el seguro de compensación de su trabajador, la dolorosa condición de Karen empeoró hasta que tuvo dificultad para caminar.

El pronóstico de Karen, con tratamiento, fue excelente. Aunque su equipo de atención médica hizo todo bien, las compañías de seguros se interponían entre ella y el tratamiento que necesitaba desesperadamente.

Ahora es común que los proveedores de salud traten la condición de pacientes no solo con evidencia empírica, como se nos enseña en la escuela de medicina, sino más bien con las limitaciones del seguro de ellos. En lugar de preguntarnos “¿es este el mejor tratamiento?” preguntamos, “¿está cubierto este medicamento o tratamiento?”

Este no es el tipo de medicina que queremos practicar, o debemos tolerar, en una sociedad civilizada.

Incluso a aquellos con gran cobertura se les puede negar el tratamiento necesario. Mientras tanto, los pacientes asegurados a través de sus trabajos o a través de los planes de ACA tienen dificultades para cumplir con las primas, copagos y deducibles en aumento que pueden superar los $ 10,000 por año.

Mientras tanto, los EEUU se ha desempeñado de manera deficiente en los principales indicadores de salud, como la esperanza de vida y la mortalidad infantil.

¿Cuál es la solución? La representante Pramila Jayapal y el senador Bernie Sanders presentaron proyectos de ley que cubrirían a todos para toda la atención médicamente necesaria, incluidas las visitas de los médicos, la hospitalización y la atención a largo plazo.

Nuestros pacientes nunca deben perder un tratamiento médico esencial debido al costo.

La mayorĂ­a del pĂşblico ahora apoya Medicare para todos. Es hora que nuestros funcionarios electos presten atenciĂłn.

https://laopinion.com…

Merriam councilman planning to introduce city resolution in support of single-payer healthcare system

By Leah Wankum
Shawnee (Kan.) Mission Post, June 13, 2019

After sharing their healthcare horror story — an ordeal that cost them thousands of dollars — one Merriam couple is urging the city council to adopt a resolution in support of “Medicare for All.”

Meanwhile, Councilmember Al Frisby is in the process of drafting his own resolution that he plans to introduce in September; if adopted by his fellow councilmembers, the resolution would declare the city’s support for a single-payer healthcare system.

Frisby says the effort to support a single-payer system comes down to saving money. If Congress passes the Medicare for All Act of 2019, the city of Merriam would have the opportunity to participate down the line and provide better healthcare for city employees at a lower cost, thus saving taxpayer dollars, Frisby said.

“It’s been said that we could save a bunch of bucks,” he said. “Because right now it’s about 10 to 12 percent every year that healthcare (cost) goes up. We need to find a way to reduce those costs for our employees.”

The Medicare for All Act would establish a national health insurance program and prohibit deductibles, coinsurance and copayments.

Frisby said he was inspired by Dr. Ed Weisbart, a retired physician in St. Louis who supports Medicare for All.

Although Frisby was absent at the Merriam council meeting Monday, Mayor Ken Sissom told the Snyders about Frisby’s plans to introduce the resolution. Here’s the Snyders’ story:

Merriam resident Stephen Snyder had just five months to go before he would be eligible for Medicare.

He had just turned 65 last year, so when it came time to sign up for health insurance in December, he decided to go with a low-cost plan on the healthcare marketplace — one that saved him hundreds of dollars a month on his premium but put him at risk due to the plan’s higher deductible of $9,000. He figured he could risk it, but then the unexplained falling episodes started happening.

After weeks of waiting for authorization that his insurance would cover the consultations with his cardiologist and neurologist and an MRI scan, he was still left with several hundred dollars’ worth of expenses. And the drop attacks kept happening, sometimes several times a day. A neurosurgeon told him he had a pinched nerve in his spine, so he went through surgery. He is now going through occupational and physical therapy.

And the hospital bills kept coming in. Judy Snyder, his wife and a registered nurse, said they went well past his $9,0000 deductible, including an out-of-network bill of $400.

“If Steve had been on Medicare just six months [earlier], neither the deductible, waiting for authorization or out-of-network would have been an issue,” Judy Snyder said. “I know I’m not the only Merriam resident with one of these difficult stories about our current system.”

The Snyders’ family friend, Dr. David Terry, who practices medicine in Johnson County and spoke at the Merriam council meeting, said the Snyders’ story is common. As a member of Physicians for a National Health Program, Terry is promoting a single-payer healthcare system, which he believes would increase the quality and access to healthcare for all Americans.

“Under our current system, our cost is higher than any other country in the world,” Terry said. “Our quality is lower than most industrialized countries in the world. And our access is restricted by the amount of money that we have to pay and the services that we receive. We do not have the freedoms that we think that we have under our healthcare system.”

Snyder asked councilmembers during their Monday meeting to consider adopting a resolution in support of Medicare for All.

https://shawneemissionpost.com…

Donald Berwick’s endorsement of Medicare for All

Hearing: Pathways to Universal Health Coverage

Testimony by Donald M. Berwick, M.D., M.P.P.
U.S. House of Representatives, Ways and Means Committee, June 12, 2019

Serving as CMS Administrator was the greatest privilege of my professional career. My duties included helping to implement the coverage expansions, quality improvement, and program integrity provisions of the Affordable Care Act, which was passed three months before my arrival.

In effect, I had the honor to help lead “Medicare for Some,” and the successes and potential of that program have given me confidence that a wise choice for this nation would be Medicare for All.

If anyone can show me a payment model that beats Medicare for All in achieving the Triple Aim and universal coverage, I am all ears. But I have as yet seen none. And the nation’s experience with Medicare for Some – as it exists now, and as endorsed by the overwhelming popularity of Medicare in our nation – suggests that we may, indeed, already have an answer in our hands.

I do not wish to minimize or disregard the many obstacles and objections to Medicare for All as a pathway for our nation. But, whereas some others find the obstacles to be insurmountable, I do not. I believe that we have the wits, experience, wealth, and agility to overcome every one, as we have for Medicare as we know it today. To be specific, here are some of the objections:

  • That Medicare for All is unaffordable. I think the opposite may be true; that is, without Medicare for All, health care in our nation may be bound to head, as it is now heading, for true unaffordability. Medicare for All is a positive way out. As I noted above, the level of waste in our health care system is enormous. A publicly accountable, transparent, and mission-oriented payer would offer us as a nation leverage against wasteful health care expenditures that is not achievable in the current, chaotic payment environment.
  • That Medicare for All is a governmental takeover of health care. It is not. Not one single bill that I know of proposes under any form of expanded governmental coverage that government should become the provider of health care for all Americans. Medicare for All is about paying for care – consolidating payment in a public program. It is not about providing care. Care provision, through today’s array of hospitals, clinicians, nursing homes, and so on, would remain as it is – largely private sector and entrepreneurial.
  • That Medicare for All would severely underpay hospitals and clinicians. That would be neither wise nor inevitable. When government becomes the payer for any good or service, and is subject to oversight from Congress, it is and should be held accountable for responsible practices. That is how Medicare works today; and it is how Medicare for All should and would work in the future.
  • That Medicare for All implies a financially unrealistic package of health care services. Any insurer – government or commercial – has to end up implementing a defined benefit package, and the content and comprehensiveness of that coverage will always be subject to debate and negotiation. What Medicare for All does do is to move that dialogue into daylight, as we can consider as a nation what we wish to include in universal coverage and what not. That is exactly what happened, for example, when the ACA extended coverage for clinical prevention services, and when Congress took steps toward assuring mental health care parity. The current commercial insurance system does the same – deciding what is and is not covered – but it does that largely out of sight and without any real form of pubic accountability.
  • That Medicare for All would unacceptably disrupt people’s current relationships with their health care insurers. Indeed, Medicare for All would give every American not now covered by Medicare a new insurer – a public insurer. Whether this threat to existing bonds between people and commercial insurers in fact troubles Americans I find doubtful. I suspect that what most Americans value is their bond with clinicians, not with insurers.
  • That the tax increases implied by Medicare for All are massive. This represents a negative framing of a positive result. Yes, indeed, the fund flows for health care under Medicare for All would become public, as opposed to the private payment now channeled through payroll check deductions and employer contributions to commercial health insurance. These are existing fees – “taxes” really – through private channels. What the American worker cares most about financially is how much he or she takes home at the end of the day. Under Medicare for All, properly designed, that amount – take home pay – goes up, not down.

I end where I began: Medicare for All is not an end in itself. It is a means to achieve what we care about: better care, better health, lower cost, and leaving no one out. I am open to considering any proposal that moves our nation fast and well toward those goals. Compared with Medicare for All, I see none better.

https://waysandmeans.house.gov…

Ways and Means Hearing:
https://waysandmeans.house.gov…

Comment:

By Don McCanne, M.D.

For much of his career, Donald Berwick has been an outspoken supporter of improving quality in health care and, more recently, a supporter of Medicare for All. Until we can enact Medicare for All he does support making improvements in the Affordable Care Act. He supports accountable care organizations (ACOs) and value-based care (VBC) as he believes that they are a means to improve quality.

Because of uncertainties about the benefits and deficiencies of ACOs and VBC, some fear that he may have strayed as a supporter of single payer Medicare for All as he pursues these dubious solutions. His testimony before the House Ways and Means Committee should allay those fears. We can continue our efforts to educate our colleagues and the public on the refinements of an ideal single payer model, such as excluding ACOs, but the fundamentals are solid – comprehensive, high quality, affordable, equitable health care for all – and Donald Berwick clearly supports that.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

AMA narrowly defeats single payer amendment

AMA maintains its opposition to single-payer systems

By Steven Ross Johnson
Modern Healthcare, June 11, 2019

The American Medical Association will remain opposed to proposals for the U.S. to create a single-payer healthcare system. The group voted narrowly to maintain its stance on Tuesday at its annual House of Delegates meeting.

Delegates of the largest physicians’ organization voted 53% to 47% against adopting an amendment to remove the AMA’s formal opposition to a single-payer healthcare system, ending days of contentious debate that pitted the organization’s leadership against a contingent represented largely by medical students.

“As long as we maintain our blanket opposition our AMA cannot ensure we are a part of every conversation,” said Dan Pfeifle, a fourth-year medical student at the University of South Dakota Sanford School of Medicine and an alternate delegate of the AMA’s Medical Student Section.

Delegates ended up voting overwhelming in favor of adopting a report from the AMA’s Council on Medical Service that reaffirmed efforts to improve upon the Affordable Care Act instead of “nationalized” healthcare coverage.

Some of the report’s recommendations included expanding eligibility for tax credits on insurance premiums beyond 400% of the federal poverty level, as well as to expand eligibility for and increase the size of cost-sharing reductions.

“The AMA proposal for reform, based on AMA policy, is still the right direction … to cover the uninsured, and is cognizant that, in this environment, the ACA is the vehicle through … which the AMA proposal for reform can be realized,” the report stated.

The debate over whether the country should adopt a Medicare for All type of system has gotten increased attention in recent months as it has become a key policy issue among several of the Democratic presidential candidates.

The AMA has long opposed single-payer efforts out of concerns that it would lower provider reimbursement rates and limit patient choice on healthcare coverage and services they can access.

But support for a single-payer system has grown among physicians. At the AMA annual delegates meeting last year, supporters got the body to at least study the impact of changing its policy.

This year, the issue sparked a protest outside of the AMA’s meeting on its first day when medical students joined nurses and advocates to call on the organization to drop its fight against Medicare for All.

More broadly, public opinion for single payer has grown over the years so that a majority of Americans now support such a system. According to a survey conducted by the Kaiser Family Foundation in April, 56% of Americans favor a national health plan in which all individuals got their insurance from a single government plan.

https://www.modernhealthcare.com…

Comment:

By Don McCanne, M.D.

The Medical Student Section of the AMA and the medical students who helped organize the protest outside of the Chicago meeting of the AMA House of Delegates may be disappointed because the AMA decided to continue its opposition to single payer reform. But actually it was a phenomenal success in that single payer was defeated by the slim margin of 53% to 47% – a remarkable shift from its previous overwhelming opposition to single payer. As the rationale of the single payer model is better understood, and the ice has been broken by almost half of the delegates, just maybe the AMA might be able to shift to a position of support next June, in plenty of time before the November election.

At any rate, we certainly have the medical students to thank, along with the nurses and other health care professionals and activists. One way we can show our appreciation to the students is to donate to the Nicholas Skala Student Activist Scholarship Fund to provide student scholarships for the Annual PNHP Meeting and Leadership Training and for other student outreach programs:

https://pnhp.salsalabs.org/skalastudentactivistfund

Thankfully, the future of our health care is in their hands.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

Are You Sure You Actually ‘Like’ Your Private Health Insurance?

In 2018, as millions of Americans borrowed $88 billion to pay for health care, 62 CEOs of health care companies made a combined total of $1.1 billion in compensation

By Sanjeev K. Sriram, M.D.
Common Dreams, June 12, 2019

When I talk to friends, family, and colleagues about Medicare for All, sometimes someone asks, “but don’t people like their insurance?” It’s not hard to see where they got that idea. America’s Health Insurance Plans (AHIP), the leading lobbyist for the for-profit insurance industry, says 71 percent of Americans “like” their private health insurance. It’s important to scrutinize the messenger and the message here. If McDonald’s told us that 71 percent of their customers said their food was healthy and nutritious, we’d be reasonably skeptical at the very least.

When independently surveyed, only 16 percent of Americans trust the health insurance industry to put patients before profits. The only group we trust less is Big Pharma (only 9 percent believe these corporations prioritize patients). So how do we make sense of all this? Do people really “like” health insurance plans sold by such untrusted corporations?

As a physician who regularly haggles with insurance companies, I have many four-letter words for that industry. “Like” is not one of them. Similar to millions of Americans with private health insurance, I have paid absurd co-pays, premiums, and deductibles to different insurance companies over the course of my career. I am certain I have never “liked” private health insurance the way I like comic books or the way my wife likes spin classes. I begrudgingly tolerate private health insurance (for now). The same goes for my patients, colleagues, friends, and family. Out of fear of financial ruin, we have allowed ever-increasing portions of our paychecks to go to health insurance companies.

But that is a false sense of security. Even with the Affordable Care Act’s protections against the insurance industry, too many of us worry about dire financial consequences if our health takes a turn for the worse. Four in ten Americans with employer-sponsored health insurance say their family is struggling to pay premiums, medical bills, or out-of-pocket medical costs. Half of us have a family member who is avoiding necessary medical care or prescriptions because of cost.

When push comes to shove and families decide to seek medical attention, their worst fears of financial devastation can come true. Of Americans reporting problems paying medical bills, 73 percent are cutting back on food, clothing, and other basic necessities. Over six in ten of these everyday Americans have already depleted what little savings they had. One in three GoFundMe crowdfunding pages is directed toward paying for health care. For millions of patients and families, private health insurance is a source of, not a savior from, financial hardship.

As a physician and public health policy adviser, I used to believe the insurance industry would become better partners in our health care through the very reasonable guidelines and expectations set by the Affordable Care Act. Over the last several years, I have lost faith and accepted the insurance corporations for what they are: machines of unappeasable greed, accountable only to shareholders, never my patients or other families. In 2018, as millions of Americans borrowed $88 billion to pay for health care, 62 CEOs of health care companies made a combined total of $1.1 billion in compensation. When it comes to our current health care system’s priorities, patients are no match for profits.

We do not have to live like this. Thousands of physicians, medical students, nurses, and our colleagues across health care (but sadly, not the American Medical Association) are joining the Medicare for All movement because we want our work to be about protecting people’s health, not destroying their wealth.

In the current Medicare for All legislation in Congress, patients and families will have full comprehensive benefits without the lurking clouds of financial stress. Prescription drugs will be significantly cheaper because Medicare will finally have the power to negotiate for better prices with Big Pharma corporations. Hospitals will have stable, predictable financing for providing health care to patients and families. Similarly, physicians can expect to spend more time with patients rather than haggling with multiple insurance companies and their endless obstacle courses. Most importantly, every person in America will have the peace of mind of knowing their health care is a basic human right, not a privilege to be negotiated.

Medicare for All recognizes that being healthy is hard work. Preventing, treating, and managing illness takes a lot of effort on the part of patients, doctors, nurses, therapists, social workers, and so on. We are all worthy of health care, regardless of what we earn, where we live, or who we are. When we make health care a basic human right through Medicare for All, we recognize how each of us is vulnerable and none of us should be abandoned.

https://www.commondreams.org…

How red-baiting in medicine did lasting harm to Americans’ health care

Driving the left out of medicine has hurt the cause of universal health care.

By Merlin Chowkwanyun
Washington Post, June 12, 2019

The battle for universal health care has come a long way. Today, the House Ways and Means Committee is holding a hearing on Medicare-for-all, and the plan has recently gained support from high-ranking Democrats, including several presidential contenders. It’s traction that would have been unimaginable even a decade ago.

Even so, the fight for Medicare-for-all will be a war. “You should not be the guinea pigs in some far-left social experiment,” Senate Majority Leader Mitch McConnell (R-Ky.) recently opined. These remarks echo the pitched battle over the Affordable Care Act a decade ago and the famous ads that helped bring down President Bill Clinton’s health-care plan, featuring the fictitious couple Harry and Louise, who fanned fears of limited doctor choice by remarking, “They choose. We lose.”

But the opposition to national health insurance extends far beyond fighting against the policy itself. Its roots are in the McCarthy period of the 1950s, when the medical profession purged from its ranks those doctors with any hint of leftist political orientation, removing critical voices of dissent from the mainstream health policy conversation.

In the half-century since, the profession and its lobbyists have frequently fought against expanded government financing of health care for all. And they have effectively ingrained those critiques into the larger political dialogue, making any kind of debate about health care about not just medicine, but also fundamental faith in government and the welfare state. Until we understand this legacy, we won’t be able to transcend it and have a sober dialogue about the future of health care in the United States.

In 1950, the Journal of the American Medical Association (JAMA) published an editorial by FBI Director J. Edgar Hoover warning about metaphorical “communist germs” and urging physicians to forward “any information of this nature” to the bureau.

Hoover’s editorial wasn’t just some oddity. As the Cold War alignment hardened, the medical establishment vigorously policed its own ranks for any hint of “red” leanings, which meant working closely with the most repressive elements of the government, including the FBI. In this climate, support for left-leaning public policies put doctors’ livelihoods at risk.

In 1951, during a hearing on the motion picture industry, the House Un-American Activities Committee (HUAC) called Los Angeles physician Murray Abowitz to testify about his association with a group called the National Council of Arts, Sciences and Professions (CASP), which HUAC had concluded was “anti-American, pro-Soviet.” HUAC asked Abowitz about other activities, too, including his work with the Civil Rights Congress, a racial justice organization made up heavily, though not exclusively, of Communist Party members.

After the hearings, Abowitz promptly lost his job at Cedars of Lebanon Hospital in Los Angeles (now merged and known as Cedars-Sinai). So did two other doctors, Alexander Pennes and Richard Lippman, an eminent expert on kidney disease, whose names came up in Abowitz’s testimony.

What cost these doctors their jobs? Throwing themselves into progressive causes. That included fighting for national health insurance, higher wages for interns and residents, and an end to racism in hospitals. Lippman had recently helped research a pamphlet that documented patterns of exclusion in Los Angeles facilities, and it didn’t hold back on identifying offending facilities by name. But embracing civil rights so visibly was professionally dangerous, particularly in an era when the American left and the Communist Party were major engines of civil rights agitation.

The 1951 hearing was just the start. A few months later, in January 1952, HUAC returned, broadening its scope to examine “Communist Activities Among Professional Groups in the Los Angeles Area.” An osteopath named Louise Light named names. Soon, Harold Koppelman, a surgeon at Queen of Angels Hospital, received a subpoena from HUAC. It cost him his job. Four additional physicians at Cedars suffered the same fate when they, too, received HUAC summonses.

These firings were the result of an elaborate red-baiting operation constructed by the medical profession, working with government organs such as HUAC and the FBI. In 1952, an FBI agent reported receiving a call from a Cedars trustee who asked him for any information that would help in “establishing” Lippman’s subversive activities.

Two years later, when a state-level analogue to HUAC held hearings on communist infiltration into the medical ranks, it did so at the behest of the Los Angeles County Medical Association (LACMA). During the hearings, it became clear that LACMA’s leaders had been tracking the activities of left-wing Los Angeles physicians for some time. They had monitored protests against the Cedars firings, even attending some events.

Efforts to remove any “red” presence didn’t just involve ferreting out doctors with any hint of leftist political ties or activism. The profession also attacked groups. Into the late 1940s, the Association of Internes and Medical Students (AIMS) was a large activist organization that fought for better working conditions for young physicians, built alliances with like-minded medical students around the world and supported civil rights and national health insurance.

This activism brought it into the crosshairs of the powerful American Medical Association, then at the height of a crusade against government-funded insurance.

The AMA acted swiftly. It opened an investigation of AIMS, writing in JAMA, one of the most influential publications in American medicine, that the organization was “exhibiting communistic tendencies.” A year later, another JAMA commentary criticized AIMS’s support for national health insurance and higher wages and drew on these earlier accusations of communist affiliations to undermine its credibility. It ominously warned that students who joined AIMS might “risk considerable embarrassment.”

The AMA campaign culminated in a report concluding that AIMS regularly published those “affiliated with organizations and institutions that have been cited as Communist fronts” and that it had “a general reputation of being a left wing organization.” The AMA could not, it concluded, “lend its support” to AIMS.

AIMS’s stigmatization had immediate consequences. At an individual level, it cost Sheppard Thierman, an intern at Kings County Hospital, his job. Advertisers withdrew from AIMS’s publication, starving it of its main revenue source. Issues grew scarcer, then thinner, then nonexistent. AIMS chapters withered away.

These episodes — and many others like them — explain why the medical profession has been so averse to national health insurance until very recently. Not only did doctors risk stigma if they supported it in the 1950s, but many on the left also had their careers derailed, skewing the profession’s political complexion.

While doctors’ politics, and accordingly, attitudes toward national health insurance, are starting to shift, the toxic residue of these purges remain. The silencing of progressive physicians during the Cold War has long narrowed the horizons of what was possible in health care. Our health-care system is worse for it, clearly not serving all Americans well. The profession must grapple with its legacy of political repression and how it has shaped American health care, and then reevaluate what policies might lead to better care for all.

Merlin Chowkwanyun is an Assistant Professor of Sociomedical Sciences at Columbia University’s Mailman School of Public Health.

https://www.washingtonpost.com…

Why Single Payer Medicare for All is an Imperative for Labor

The Case for Medicare for All

By James G. Kahn
New Labor Forum, 2019, Vol. 28(2)

Public support for single-payer insurance is astoundingly high, with 68 percent in a recent poll placing high importance on achieving it. The most vociferous supporters are progressives and minorities, but single payer garners support from across the political spectrum. Single payer insurance is not just a policy tweak, nor another layer of complexity on our health-care non-system. It’s revolutionary and transformative and has the potential to both benefit from and build powerful coalitions.

The same cannot be said for all approaches offered by Democrats. They have also proposed several bills for Medicare expansions—mechanisms for individuals to “buy in” to Medicare coverage. At first, they sound attractive, an incremental insurance expansion in the direction of Medicare for All. But close consideration reveals fundamental flaws. There is a long list of reasons that all of us—and especially the labor movement—should oppose these Medicare-for-All impostors in favor of the real deal.

Where should labor position itself? Supportive of any “Medicare” expansion? Or resolutely committed to Medicare for all? After 25 years researching, writing, educating, and advocating in this arena, I propose that single payer is the only solution consistent with universal, affordable health care and with the solidarity values long supported by the labor movement.

Why? There are 13 reasons that Medicare for All is superior to Medicare buy-ins:

  1. Medicare for All insures everyone.
  2. Medicare for All insures everyone well.
  3. Medicare for All keeps everyone in the same game.
  4. Medicare for All removes health care as a bargaining burden.
  5. Medicare for All delinks health care and employment.
  6. Medicare for All enhances administrative efficiency.
  7. Medicare for All controls health-care costs in other ways.
  8. Medicare for All enhances quality.
  9. Medicare for All reduces clinical waste and fraud.
  10. Medicare for All empowers patients.
  11. Medicare for All empowers doctors (and other providers).
  12. Medicare for All fosters a comfortable and lasting patient-doctor relationship.
  13. Medicare for All ends battles to protect myriad pieces of the current health system.

For complicated reasons, largely centered on employer-based health-care plans, some unions have opposed single payer. This misses larger considerations: single payer is about supporting working people (and the unemployed, and the rich) with the resources needed for a comfortable, secure life. The labor movement did as much as any great social reform to foster health and security. Single payer is the next great step in this tradition.

Let coworkers know what the real Medicare for All is: Everyone is covered, with the same comprehensive benefits package, from cradle to grave. This is critical to reduce the opposition of some unions, which represent a large portion of workers with employer-provided health care, but a small portion of working people overall. Everyone needs to understand that true Medicare for All is the only way to assure excellent access to health care, regardless of income and employment, and to empower providers and patients to focus on quality care and on each other, not on insurance glitches and administrative paperwork.

James G. Kahn, MD, MPH, has been a professor of health economics at the University of California San Francisco for 30 years and has been active in Physicians for a National Health Program, including president of the California chapter, since 1994.

(This article appears in the spring 2019 issue of New Labor Forum, published by the CUNY School of Labor and Urban Studies. The journal appears three times a year and includes articles on issues relevant to organized labor and working-class communities.)

https://healthpolicy.ucsf.edu…

For the full article:
http://bit.ly/2I7hvvz

Comment:

By Don McCanne, M.D.

Labor would benefit greatly from enactment and implementation of Single Payer Medicare for All, yet some in the labor movement remain reluctant to give up health plans they have won through labor negotiations. This article explains why labor should welcome the change to a program that is truly universal – including all labor, that is fully prepaid, that is permanent and will always be there, and that expresses the solidarity that has long been supported by the labor movement.

The link (above) to the full four-page article should be distributed widely to be used to explain to labor why Single Payer Medicare for All deserves their strong support, not to mention using it to bring the entire nation into solidarity behind this truly egalitarian proposal.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

Today’s Doctors: Overburdened and Burning Out

By Keith J. Loud, M.D.
The New York Times, Letters, June 11, 2019

To the Editor:

As a physician, I agree with Dr. Danielle Ofri’s assertion that most health care professionals have remained true to the highest ideals of their fields in the face of increasing corporatization and challenging working conditions. But I find her assertion of exploitation — at least of doctors — difficult to reconcile.

By and large physicians in the United States earn far more money than their peers in the rest of the world, placing us squarely in the top 2 percent, if not 1 percent, of American income distribution. The proliferation of health care administrators is attributable to an unnecessarily complex reimbursement system based on a private, for-profit insurance industry.

Yet the American Medical Association, the largest professional organization of physicians, actively lobbies against the administrative simplicity of Medicare for All. Moreover, physician groups have long opposed expansions in scope of practice for nurses, nurse practitioners and others who could allow physicians to concentrate on the most complex patients who need our expertise.

Doctors continue to be seen as leaders in health care. Rather than just lament the current state of affairs, we must acknowledge that we have been complicit, and make amends.

https://www.nytimes.com…