PNHP

Do we base reform on ideology or on policies that get people the care they need?

Do we base reform on ideology or on policies that get people the care they need?

Four Ways for Republicans to Fix Health Care

By Joseph Antos and James C. Capretta
The New York Times, April 4, 2019

By backing a flimsy, state-initiated lawsuit to throw out the entirety of the Affordable Care Act, President Trump has made himself and Republican candidates in 2020 vulnerable to attacks that they want to take health insurance away from millions of people.

Yet not all is lost on the issue for Republicans. Many Democrats, by rushing toward a single-payer Medicare for All plan, are being pulled along by ideological yearnings instead of practical realities. Medicare for All would upend all current public and private insurance arrangements, including employer coverage for about 180 million people. Further, even the sponsors admit these plans would require significant middle-class tax increases.

What that means is that the door is open for a responsible Republican plan to improve the nation’s mixed public-private health system. If the party’s leaders were so inclined, they could take advantage of the Democratic overreach by embracing reforms that would build upon what exists and make it work better. Such a conservative reform plan would look something like this:

A Medicaid Compromise

Republicans should embrace a compromise that allows the non-expansion states to expand Medicaid eligibility to 100 percent of the federal poverty line instead of 138 percent as required by the A.C.A. The expansion states could stay at 138 percent if they wanted to. States should also be given more flexibility to run the program with less federal interference in return for accepting limits on overall spending.

Automatic Enrollment

Instead of creating a new insurance program, Congress should make it easier for people to enroll automatically. Eligible individuals could be enrolled in a no-cost plan with the option of paying a premium for more generous coverage.

Equitable Risk-Sharing

Some states have lowered premiums in the individual insurance market by providing reinsurance to insurers or organizing high-risk pools that protect against losses stemming from the very high-expense cases. By lowering the risk of large losses, insurers are able to reduce premiums for all of their customers.

Strengthening Competition and Market Incentives to Control Costs

The most difficult and pressing issue in health care is high and rising costs. Republicans say the answer is stronger market incentives, but they need to back up the rhetoric with concrete reforms. To begin, Congress needs to place an upper limit on the tax break for employer-provided health care to promote more efficient health insurance. The Federal Trade Commission should more aggressively examine business deals that create de facto monopoly providers in local health care markets. Both parties want Medicare to emphasize value instead of volume in the provision of care. To achieve that goal, beneficiaries need clear information on the cost of their care, and they should share in the savings when they choose high-quality, low-cost providers. More broadly, consumers should be able to see the all-in prices they will pay for high-volume procedures. Finally, Republicans should encourage more competition among drug manufacturers and limit abuses that extend monopolistic pricing for years beyond what patent law is supposed to provide.

Republicans keep searching for a politically safe silver bullet that slays Obamacare and yet leaves everyone happy. That plan doesn’t exist.

But voters aren’t looking for a miracle. They would settle for solid progress. It’s time for Republicans to become the party of responsible health care.

Joseph Antos is a scholar in health care and retirement policy at the American Enterprise Institute. James C. Capretta is a resident fellow at the institute.

https://www.nytimes.com…

Comment, NYT Pick:

By Don McCanne, M.D.

The authors are noted experts in health policy and understand the pros and cons of both market-oriented reform and public financing systems, yet they are driven by their conservative ideology as they dismiss single payer Medicare for All as representing “ideological yearnings.”

The Democrats already made the mistake of yielding to conservative ideology in crafting the Affordable Care Act based on the Heritage model, believing falsely that Republicans would cooperate. Now these authors want to salvage this highly flawed model by merely tweaking it.

Setting ideology aside, the single payer Medicare for All model actually would achieve the goals of true universality, comprehensiveness, accessibility, administrative efficiency, equity, and would use public policies, including tax policies, that would make health care affordable for all of us.

Nobel Laureate Kenneth Arrow showed us that market ideology does not work in health care. Even Nobel Laureate Friedrich A. Hayek, revered by conservatives, in “Road to Serfdom” states, “Nor is there any reason why the state should not help to organize a comprehensive system of social insurance in providing for those common hazards of life against which few can make adequate provision.”

It’s time to throw out stale arguments based on ideology, and enact and implement a program with proven effectiveness – single payer Medicare for All.

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Medicare for all will provide essential health care for millions of underserved Americans

By Elaine Silver, M.D.
The Sacramento Bee, April 4, 2019

What happens to those who have no health insurance – or are underinsured – in Sacramento County?

As a retired physician, I see some of them at the Imani Clinic, a free clinic for the underserved that’s run by UC Davis medical and undergraduate students.

There, people can get basic services and treatment for conditions such as diabetes and hypertension. It’s also where the failures of our nation’s healthcare system are painfully clear.

Since we’re only open on Saturdays, we can’t provide emergency care or even guarantee care when it’s needed. We don’t have access to affordable radiology services or specialty care. It’s devastating to face a situation where a treatment is so crucial but is totally unaffordable.

Rep. Pramila Jayapal (D-Wash.) introduced a new Medicare-for-All bill in the U.S. House of Representatives on Feb. 27 that will finally mend our broken healthcare system. It would give all U.S. residents coverage for essential medical needs, including hospitalization, doctor visits, mental health, vision, dental and long-term care. And it would do so while controlling costs and allowing for free choice of doctors and hospitals.

How can we as a country of enormous wealth and resources continue to look away when people are dying of complications from treatable diseases – or because a cancer wasn’t diagnosed until it was too late to treat?

We spend more per capita on health care than any other country, but since countries like Canada provide total health care for all for less money, we are clearly not spending our health care dollars wisely.

Ensuring that everyone has lifelong health coverage isn’t just the moral and humane thing to do. It’s the best chance we have for healthier, more productive communities.

More than 100,000 people in the Sacramento Valley had no health insurance in 2017, according to the California Health Care Foundation. Thousands more are underinsured. They have health insurance but can’t cover out-of-pocket expenses, including ever-rising premiums, deductibles and copays.

Chances are you know someone who has lost their home or gone bankrupt due to massive medical expenses brought on by illness or injury. Unfortunately, it could happen to so many of us under our current healthcare system.

Just as importantly, this type of single-payer system would actually save money in terms of overall spending compared to what we now spend. That’s largely because it eliminates the middleman, the insurance companies, and allows the single payer – in this case a public agency – to negotiate prescription and medical device prices.

There are so many reasons to support Jayapal’s bill. Among the most shocking to me as an American doctor is that, compared to other wealthy developed nations, our country’s infant and maternal mortality rates are consistently higher. This means that American mothers and babies aren’t getting the care they need at the time they need it.

Besides offering universal coverage, Jayapal’s bill would provide regional funding for rural and urban areas, like the North Valley, that are medically underserved. It will also greatly simplify the lives of doctors, who would no longer have to deal with the burdensome, multi-payer insurance system of today.

While change can be scary, this bill will bring about true health care reform and security. It will ensure that no one is left out because of their health, their job or their socio-economic status, just like every other large, rich country already does.

I urge you to write and call your federal legislators and tell them why you support Jayapal’s Medicare-for-All Act of 2019.

Together, we can create a stronger and healthier America for each one of us and our children for generations to come.

Dr. Elaine Silver is a retired physician in Sacramento County and a member of Physicians for a National Health Program.

James Kahn explains single payer in terms we can all understand

Opinion: Why single-payer would improve California health care

The only big losers are the private insurance companies – and that’s okay with me

By James G. Kahn, M.D., M.P.H.
The Mercury-News, April 2, 2019

How to achieve universal health insurance in California? In our super-progressive, supermajority Democratic state, that’s the health policy question of the day. Not if we should lead the way on universal coverage, but how.

Recently, UC Berkeley economists proposed a solution, dubbed California Dreamin’. Expand current insurance to cover the uninsured, using up to $17 billion in new taxes. That’s a 5 percent bump in health spending. Problem solved, right?

No. While the goal is admirable, the Dreamin’ approach adds a Rube Goldberg appendage to a Rube Goldberg health care financing system. It layers cost and complexity upon cost and complexity. Our insurance system will continue to underperform.

We need to revamp our insurance mess. We can do this with a well-known and proven solution: single-payer.

Also known as improved “Medicare-for-All,” single-payer has these core features: everyone is covered cradle to grave with the same comprehensive benefits package; health care is financed by a single entity; payment is greatly simplified; patients freely choose among doctors; and doctors focus on providing care.

These features aren’t fantasy, they’re standard among wealthy democracies (such as Canada and Australia). They’re captured in the 2017 Healthy California Act, in U.S. Sen. Bernie Sanders’ bill, S1804, and in Rep. Pramila Jayapal’s new HR1384.

Single-payer solves what ails the insurance system in a way that Dreamin’ can only dream about. Here are high points:

Effective insurance: Our current system leaves 5 percent to 10 percent uninsured, and many more underinsured – facing high deductibles, other cost-sharing, and restrictions on covered services. The Dreamin’ approach could fill the uninsured gap but leave millions underinsured, which we know leads to skipped and delayed care.

Some ask, “I like my private insurance. Why give it up?” Just because insurance works well today doesn’t mean it will tomorrow. Most private insurance is employment-based – laid off, lose your insurance. Plus, each year, private insurance deteriorates, with rising cost-sharing and shrinking provider networks. In single-payer, everyone has the same health plan, assuring ongoing shared commitment to quality coverage. Politically, this is critical, as individuals realize the advantage of single-payer over unstable private insurance.

Administrative efficiency: The United States spends 12 percent of health care dollars on excess billing paperwork, from contracting all the way to appealing underpayments. That’s about $1,400 per person per year in administrative bloat, about half at insurers and half via the burden placed on providers. Single-payer captures this 12 percent and puts it into patient care.

Prices: U.S. drugs cost several times more than in Europe. Single-payer would use price negotiations to get a fairer price, with 30 percent savings in drug costs overall.

Affordability: Providing more effective insurance increases costs, by about 10 percent. Reducing administrative waste along with drug prices decreases costs, by about 15 percent. Net costs drop by about 5 percent. Repeating slowly: Net. Costs. 5 percent. Down. Over time, savings grow with global budgets and better data on clinical practices to identify and reduce ineffective practices.

Clinical focus: Freed of distracting reimbursement paperwork, doctors and patients focus on each other! This is what medicine is supposed to be about.

Smart social contract: Perhaps most exciting, single-payer unites us in a just and prudent communitarian undertaking. Single-payer is the poster child for benevolent and smart policy.

It’s benevolent because it truly solves the problems of uninsurance and underinsurance, fulfilling the human right of access to health care. Smart because it saves money – using clever and proven methods to efficiently translate our financial commitments to desired health care. To riff on the venerable advertising slogan: costs less, more filling.

Everyone is in single-payer together – rich and poor alike. This social contract isn’t a good-enough compromise, it’s an improvement for us all. From our fragmented and dysfunctional insurance, step up to universal access to care.

The only big losers are the private insurance companies – yes, they’d really have no role, and that’s okay with me. It’s not un-American; it’s part of the new American dream.

Dr. James G. Kahn is a professor emeritus of Health Policy, Epidemiology and Global Health of UC San Francisco and is past president of Physicians for a National Health Program-California.

https://www.mercurynews.com…

Comment:

By Don McCanne, M.D.

This article has that special combination of explaining clearly single-payer health policy in terms that the general public can easily understand, written by a noted health policy wonk who knows how to communicate. It should be shared widely so people have a better understanding of the health care system that we could have if we select government stewards who would support this social contract that ensures health care for all of us.

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

Harvard-Affiliated Doctors and Single-Payer Healthcare Go Way Back

It was the 1980s, in the midst of a rightward shift in American politics, and some physicians across the country had a well-kept secret: they wanted more government in the healthcare system.

By Jonah S. Berger
The Harvard Crimson, April 4, 2019

It was the 1980s, in the midst of a rightward shift in American politics, and some physicians across the country had a well-kept secret: they wanted more government in the healthcare system, according to David U. Himmelstein, a Harvard Medical School affiliate and a doctor at the Harvard-affiliated Cambridge Hospital.

Yet according to Himmelstein, many physicians were hesitant to reveal they supported full government financing of healthcare, despite what he saw as widespread support among members of the profession.

“It was not something you wanted to say very loudly in public,” he recalls.

So in 1986, Himmelstein and a colleague, Stephanie J. Woolhandler, formed an advocacy group, Physicians for a National Health Program (PNHP), to support single-payer healthcare.

The reception among outsiders was part derision and part incredulity.

“One reporter, when we were first starting the group, asked, ‘Physicians for a National Health Program, is that a sister organization to Furriers for Animal Rights?’” remembers Himmelstein.

Within a few years, though, hundreds of doctors had joined the group, drawn in part by a manifesto of sorts that the group published in the New England Journal of Medicine, as well as multiple national television appearances by Himmelstein and Woolhandler.

Today, a Harvard Medical School affiliate is again at the helm of the organization, which now boasts a membership of over 20,000 physicians, medical students, and healthcare professionals. And, as single-payer proposals have moved to the forefront of political debates, PNHP’s influence has likely never been greater.

The ‘Nucleus’

As Himmelstein and Woolhandler worked to recruit doctors to their cause in the mid-1980s, they simultaneously began to craft a policy document outlining what a single-payer healthcare system would look like in practice.

That work, in addition to continuing research around medical access and affordability conducted by a seven-member social medicine group at Cambridge Hospital, largely took place under the auspices of Harvard.

“Cambridge Hospital has been really a sort of a nucleus for a lot of the PNHP work,” says Gordon D. Schiff, a former president of the association who is now an associate professor of medicine at the Medical School.

After all, a single-payer bill introduced in the House of Representatives by former Rep. John J. Conyers, Jr. (D-MI) in 2003 was directly modeled off of PNHP’s single-payer proposal, according to Adam W. Gaffney, an instructor at the Medical School and the current president of PNHP. And when Rep. Pramila Jayapal (D-WA) introduced a revised version of the bill in late February on the steps of the Capitol, she invited Gaffney to speak at the event.

Medical School Associate Professor Danny McCormick, who now leads the Cambridge Hospital working group, says that while it may be relatively unusual for medical researchers to weigh in on controversial public policy questions like single-payer, he believes that when doctors see a solution that would “dramatically improve” health outcomes, it behooves them to speak up.

“There’s nobody better to talk about what the policy solutions are than the people who are intimately involved with doing research,” he says. “And then it’s incumbent upon us both as researchers and as clinicians to talk explicitly about policy solutions.”

The connections between PNHP and Harvard go back for decades. At the time of PNHP’s formation in 1986, according to its members, Harvard provided an optimal home for the fledgling organization that was advocating for a then-radical proposal.

For one, Massachusetts was in the midst of its own fight over single-payer healthcare. A group of seniors called the Gray Panthers was seeking to place a referendum on the ballot calling upon Massachusetts congresspeople to support national health insurance. PNHP was formed in part to prop up the seniors’ efforts, Himmelstein says.

Cambridge also provided a litany of prominent names ready to line up in support of single-payer, including the psychiatrist Leon Eisenberg, then the chair of the Department of Social Medicine at Harvard Medical School, and renowned primary care physician John Stoeckle.

In the years since, Woolhandler says Cambridge Hospital has been “extremely supportive” of the group’s work, despite its clear partisan tilt.

‘A Long Way to Go’

It was early March 2019 and Gaffney, the newly elected president of PNHP, faced determined opposition.

Fox Business channel had invited Gaffney on the air to discuss single-payer healthcare, and the panel of commentators all seemed to want a chance to confront him.

One critic chipped in with what Gaffney later deemed an “outlandish” question: “Why can’t the free market work [with healthcare]… like it does with auto insurance?” Others raised concerns about the supposedly high price tag of PNHP’s vision of healthcare.

As Gaffney waited to respond to the questions, he smiled, cocked his head, and raised his eyebrows, as if these were all arguments he had heard many times before. Then, at his characteristic rapid speaking pace, he fought back.

The appearance garnered praise from left-wing activists and commentators online, including Vermont Senator and leading presidential candidate Bernie Sanders.

“This Doctor SHUTS DOWN Every Argument Fox News Has Against Medicare for All,” Sanders wrote on his website.

Gaffney says he has long considered himself a progressive. But it was not until he saw firsthand the devastating impact of the current system of medical care on his patients that he decided to make advancing the cause of single-payer into his life’s mission.

“I have seen patients in the intensive care unit with life-threatening complications of illnesses that need not have happened,” Gaffney says. “They could have been averted through care.”

At Cambridge Hospital, which is a teaching affiliate of Harvard Medical School, the School of Public Health, and the School of Dental Medicine, Gaffney says he primarily serves vulnerable individuals, many of whom are on Medicaid or lack insurance altogether. Cambridge Health Alliance — a health system that includes Cambridge Hospital and two other hospitals in Boston and Somerville — is the only public hospital system in the state.

For Gaffney, the scale of the problem — including roughly 30 million Americans uninsured and tens of millions more who have insurance but cannot afford care because of high premiums and deductibles — means that insufficient measures will not suffice. Many Democrats in Congress have opted to support a Medicare buy-in option, rather than mandated government insurance. But such compromises make Gaffney indignant.

“What does that do for the rest of the nation that’s uninsured? What does that do for people who have employer-sponsored coverage and it falls short because their deductibles are so high? What is it going to do for the fact that for-profit corporations are increasingly dominating the healthcare delivery sphere?” he asks.

Support for a full-on single-payer approach appears to be building among prominent Democrats, including multiple presidential contenders. When Conyers introduced the first iteration of his single-payer bill in 2003, it garnered just 25 co-sponsors. In 2017, that same bill had 124 co-sponsors, over half the Democratic caucus.

“I don’t think that we’ve ever been closer in my lifetime,” Gaffney says. “We’ve come further in the last couple of years than anyone thought we were going to.”

But, he concedes, “there’s a long way to go.”

https://www.thecrimson.com…

ACP, maybe; AMA, no

Medicare for all, or for anyone who wants it?

Physicians can have an outsized influence on the debate around Medicare for All versus private insurance.

By Robert B. Doherty
ACP Internist, Washington Perspective, April 2019

When Medicare became law 64 years ago this April, many expected that it soon would be expanded to include all Americans, beyond the elderly initially covered. Much to the disappointment of progressives, more than a half-century later, Medicare remains a program only for persons ages 65 years and older and persons with disabilities.

Robert M. Ball, who worked in the Johnson administration and helped draft the legislation that became Medicare, recalled in a 1995 article in Health Affairs on the 30th anniversary of its enactment that “We all saw insurance for the elderly as a fallback position, which we advocated solely because it seemed to have the best chance politically. Although the public record contains some explicit denials, we expected Medicare to be a first step toward universal national health insurance
”

There is a growing political movement today for enacting a Medicare for All program to replace private insurance, or at least to give everyone the choice of enrolling in a version of Medicare with better benefits and lower out-of-pocket contributions. Most of the current candidates running to be the next Democratic nominee for president have coalesced around one option or the other, betting that this will be a winning issue among its primary and caucus voters. And in the House of Representatives, which is controlled by the Democrats, several bills have been introduced to either require or give people the choice of enrolling in a public program modeled on Medicare.

Yet support for Medicare for All, or Medicare for Anyone Who Wants It, isn’t just limited to the Democratic Party and its base voters. The Kaiser Family Foundation, which has been tracking public opinion on different coverage options for decades, reported in January that “Overall, about six in 10 adults favor a national health plan or Medicare-for-all plan.”

Yet, in pollster parlance, support for Medicare for All is soft, amenable to arguments that might sway opinion against it. “Public support for Medicare-for-all shifts significantly when people hear arguments about potential tax increases or delays in medical tests and treatment,” Kaiser’s pollsters said.

Physicians, because they have unique credibility with the public when it comes to matters affecting health, can have an outsized influence on this debate. Will physicians and their professional associations speak out in favor of allowing or requiring people to enroll in a public program like Medicare? Or oppose it?

The New York Times reported on Feb. 23 that a coalition of industry stakeholders, called the Partnership for America’s Health Care Future, has been formed “to kill ‘Medicare for all,’ an idea that is mocked publicly but is being greeted privately with increasing seriousness. Doctors, hospitals, drug companies and insurers are intent on strangling Medicare for all before it advances from an aspirational slogan to a legislative agenda item.” The American Medical Association is a member of the coalition. The coalition opposes not only a single-payer, Medicare for All system, but according to a statement on the coalition’s website, any public option, saying, “Medicare for All, Medicare buy-in, single-payer or a public option 
 moves us toward a one-size-fits-all health care system that is wrong for America.”

Robert Pear, the New York Times reporter who wrote the Feb. 23 story, contacted me to get ACP’s perspective, and he accurately included the following in his story based on our conversation: “But the coalition does not speak for all health care providers. The American College of Physicians, the largest medical specialty organization in the country, has supported a Medicare buy-in for people 55 to 64. And ‘during the whole debate over the Affordable Care Act, we supported having a public option in the individual insurance market in every state,’ said Robert B. Doherty, senior vice president of the college, which represents 154,000 doctors who specialize in internal medicine.”

Indeed, at the direction of our Board of Regents, ACP is currently evaluating ways to cover everyone while reducing costs and administrative complexity. We have not concluded what approaches we will call for. Yet it is pretty evident that it would be hard if not impossible to provide all Americans with affordable coverage that is not dependent on place of employment, residence, or health status (universal coverage), without making publicly financed coverage at least available to everyone.

And, while we believe universal coverage is an essential goal, ACP will include in our recommendations ways to ensure that physicians are fairly compensated for their services, billing is made easier and administrative costs reduced, and patients are able to choose their physicians and have access to the care they need. We anticipate that ACP will be ready to release its recommendations before the end of the year.

It’s not necessarily a bad thing for physician membership organizations to have different views on how best to ensure that Americans have access to affordable coverage, since physicians themselves are a diverse lot. Each physician membership society is obligated to advocate based on the policies established by its members. In ACP’s case, our policies have long supported universal coverage, including options for people to enroll in publicly funded coverage; we are committed to building on those policies to issue proposals later this year to achieve truly universal coverage for everyone.

As we do this, we must counter the narrative that “doctors” as a whole oppose making public insurance available to everyone, because they don’t. And, by making our views known, we hope to influence the debate so that the country commits to the next step toward universal national health insurance, as Medicare’s architects intended more than half a century ago.

Robert B. Doherty is ACP’s Senior Vice President for Governmental Affairs and Public Policy.

http://www.acpinternist.org…

Solution to health plan quandary lies with improved ACA

By Barbara L. McAneny, M.D., President, American Medical Association
AMA, March 20, 2019

Given the high stakes of health reform, the subject will again be a major focus on the campaign trail. Voters will hear multiple similar-sounding proposals, including “Medicare for All,” “Medicare for America” and Medicare buy-ins as a means to achieve coverage for every American.

The AMA strongly believes that all Americans should have access to affordable, quality health insurance coverage. We also believe that the best way to achieve this is to build on the model of private and public coverage already in place, which has successfully increased access to health insurance for millions of Americans previously unable to obtain it.

Disruption aside, the financial burden that would be imposed by a Medicare for All model is unsustainable by any measure. Imagine shifting all current health care spending—by individuals and households, by businesses, and by state and local governments—onto the back of the U.S. Treasury. It has been estimated that Medicare for All would increase federal spending by at least $32 trillion over ten years. How will that be paid for?

https://www.ama-assn.org…

Comment:

By Don McCanne, M.D.

It is common for the media to cite statements from the American Medical Association to claim that physicians are opposed to Medicare for All. Their current president, Barbara McAneny, states, “a Medicare for All model is unsustainable by any measure.” But only about 17 percent of physicians and medical students are members of the AMA; thus it cannot be said that they are representative of America’s physicians.

Contrast the AMA’s position with the statement by Robert Doherty of the American College of Physicians – the specialty society of America’s internists. ACP has “long supported universal coverage, including options for people to enroll in publicly funded coverage.” ACP is “committed to building on those policies to issue proposals later this year to achieve truly universal coverage for everyone.” It almost appears that ACP is ready to endorse single payer Medicare for All, although they seem to have left the door open for Medicare for America – a model designed to be universal that still leaves the option for private employer-sponsored plans in place, even though that would perpetuate some of the deficiencies of our multi-payer system. But at least the ACP is far more willing to accept the greater efficiencies and equity of public insurance than is the AMA.

Anyone who still contends that physicians are opposed to single payer Medicare for All need only attend a meeting of Physicians for a National Health Program. The passion displayed, including that of the nation’s future physicians, will convince you that the spirit of the Hippocratic ethics of the healing arts is alive and well – it is about placing the patient first, above the interests of the medical-industrial complex. It is the single payer Medicare for All model that comes closest to getting these priorities right. We hope that the ACP will come to the same conclusion, and with the current medical student activity at the AMA, we haven’t given up on them either.

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Trump Effort to Dismantle Obamacare Underscores Need for Medicare for All

Interview with Dr. Ed Weisbart

By Scott Harris
Between the Lines, April 3, 2019

After congressional Republicans failed in their more than 70 attempts to repeal the Affordable Care Act, widely known as the ACA or Obamacare, President Trump has adopted a new strategy to end the now popular health insurance program. Trump directed the U.S. Justice Department on March 25 to file a legal brief supporting a lawsuit by conservative attorney generals, upheld by a lower federal court, that ruled the ACA was unconstitutional. If upheld by higher courts, ending the ACA would by some estimates eliminate 20 million Americans’ health care coverage. Dissolving the program would also dramatically reduce Medicaid coverage for millions more — and remove protections for some 50 percent of non-elderly Americans with pre-existing conditions.

Although Trump campaigned for president promising the country that he would replace Obamacare with something better, his administration put forward regulations that will increase premiums for sick Americans, allowed the sale of junk insurance plans that cover very little and permitted state Medicaid programs to require beneficiaries to work, which has led to thousands of low-income citizens to lose their coverage. When asked in recent days what will replace the ACA if he wins his court case, Trump said a replacement plan won’t be announced until after the 2020 election, and then, only if Republicans win.

Between The Lines’ Scott Harris spoke with Dr. Ed Weisbart, chairman of the Missouri chapter of Physicians for a National Health Program. Here, Dr. Weisbart assesses the damage that will be done to the nation’s healthcare system if the lawsuit ending Obamacare is upheld – and the most formidable obstacle preventing the establishment of a universal health care program in the U.S., such as Medicare for All.

DR. ED WEISBART: If we reverse the law, we’ll suddenly go back to these even worse insurance policies that have no limit 
 Today, they cannot restrict you by the dollar amount of your healthcare. They used to put million dollar limits on your care, which you could burn through in a few days in a week or two in a hospital. They used to not cover things if you were sick beforehand; they used to not sell you insurance. They used to drop you when you got sick. There’s a long list of things that the country as a whole has frankly started to take for granted now because they are improving. They are better than how things used to be and it’s hard to imagine losing them.

But that is indeed the current administration’s plan – it’s to take away healthcare from tens of millions of people and make it worse for many of the rest of us. So it’s a dreadful problem. We’ll see worsening of diseases and other things like that. So it’s a terrible strategy for them. On the other hand, they really have managed to put healthcare front and center in our debate again. So good for them, you know, renewed attention to this topic.

BETWEEN THE LINES: If upheld by the courts, as I understand it, dismantling Obamacare would not only throw the tens of millions of people off their ACA insurance plans, but would end Medicare expansion, would affect many millions more by repealing protections for people with pre-existing conditions – which pretty much affects almost everybody living here in America. And so we’re talking about tens of millions, over probably over 100 million people would be negatively affected by the repeal of Obamacare. Do I have that right?

DR. ED WEISBART: I think that’s exactly right. And even if you’re not in one of the groups that are directly affected, having an insurance mechanism for these new people means that hospitals don’t have to transfer the cost of that onto the insured, the otherwise insured. So it hasn’t done nearly enough to control the cost of insurance. But it has done quite a bit. And you’re right, we will see. I don’t know the exact numbers, but roughly 10 million people who are now covered by Medicaid, who wouldn’t be covered by Medicaid. And understand most of the people that would be losing this (Medicaid) are working people. They’re people who work at jobs that are paid minimum wage or barely above minimum wage. They do work that we all rely upon and it’s obscene that they would not be able to have any form of health care. But that’s what’s going to happen if they do reverse it.

BETWEEN THE LINES: What is your response to the idea that President Trump says that he can work with the Democratic, newly-controlled House of Representatives and the Senate to come up with a better plan than Obamacare?

DR. ED WEISBART: I would love that to happen. I have no evidence to base that hope on, but I would love that to happen. His party, has had, what – nine years now since the passage, no, 10 years since the passage of the Affordable Care Act to recommend a substitute for the Affordable Care Act. And the reason they can’t come up with a better substitute is because the ideas behind the Affordable Care Act originated in their party. They essentially wrote it a long time ago and it was their best idea that they could come up with and they don’t have anything else. They have not proposed anything else despite 10 years of talking about “Repeal and Replace.” So if Trump decided that he wanted to work with the Democratic party to move forward on a better solution, I know exactly what that solution should be. It would be improved Medicare for All. I have no confidence that he would go down that road. But you know the scenario you’re painting of what if Trump wanted to work with us, bring it on. I’d be delighted.

BETWEEN THE LINES: Dr. Weisbart, one last question. We only have about a minute or two left. What do you feel the biggest obstacle is in the United States to establishing a single-payer Medicare for All type system?

DR. ED WEISBART: Our democracy is on the ropes. We have once again, allowed largely monied interests to corrupt the way our campaign finance system works. And so our legislators are having to compete for the best campaign finance sources they can get and they follow the money and do what the big monied interests say. We have been through this before. Teddy Roosevelt dealt with it. Every 20 to 40 years, our country goes through having to rescue democracy and we are down to the ropes again with this. But the good news is, healthcare is such an important issue to everyone that I believe people understanding how important health care is, how at risk their health care is, and how linked that risk is to democracy’s survival, I think we can use health care to galvanize the rebirth of our democracy in a good way.

Dr. Ed Weisbart is chair of the Missouri chapter of Physicians for a National Health Program.

full audio:
https://btlonline.org…

Private health insurance is harmful to your health

By Sunny Aslam, MD; Robertha Barnes, MS/MD student; Sydney Russell Leed, MD/MPH student; Kunfeng Sun, MS3; Mike Vidal, MS/MD student; Azwade Rahman, MD/MPH student; and Ella Capello, MS2
Syracuse Post-Standard, April 2, 2019

At the Martin Luther King Day Health Justice Conference at Upstate Medical University, the keynote speaker stated, “Politics is nothing more than medicine but on a societal level.” Her figurative use of the word “medicine” means that elected officials have the responsibility to diagnose and treat issues that affect their communities. As current and future health care providers, we have the duty to do what is best for each patient, and more broadly, to speak up for legislation that can improve the health of all our patients. Because governmental policies have the power to affect the medical outcomes of our patients, it makes sense for us to speak up in support of the New York Health Act (NYHA) and Medicare for All.

Today, every candidate for the 2020 presidential election (including the current president) is talking about health care, and specifically the role that private insurance should have in American health care. The private health insurance industry has had more than half a century to lower costs and improve outcomes, but it has failed miserably, resulting in tens of thousands of premature deaths each year. The profit motive of corporations does not lend itself to caring for the sickest among us, as insurance companies only profit when people are healthy, or when care is denied. The sickest patients often end up on government plans due to job loss, affordability, medical bankruptcy, poverty and expiration of coverage. Physicians know that the administrative burden of confirming coverage, submitting claims and filling out forms for multiple insurers contributes to delays in care and time away from patients.

With the newly elected New York state Assembly and Senate, patients and doctors see the possibility of change with the New York Health Act (NYHA). However, the powerful private insurance industry is pressuring newly elected state officials, many of whom ran on a pro-NYHA platform, to include some role for private insurers. As we’ve learned over the past 50 years, private insurance won’t work to lower costs and guarantee access. In fact, the more privatized health care is, the higher the cost. We as current and future health care providers support the NYHA because it will get us back to the relationship between a physician and the patient, without insurance bureaucrats in between.

Single-payer opponents most often cite the 2018 RAND study to claim the NYHA will increase taxes and amount to a “government takeover” of health care, but the study also predicts that most New Yorkers would pay less under the NYHA. Families would no longer pay an average of $28,000 per year for a private plan covering a family of four. Instead of workers and employers paying premiums to a private insurance company, all state residents would be covered with no co-pays, deductibles, co-insurance, or premiums. Medical bankruptcy would be a thing of the past. Opponents who scream about increased taxes don’t point out that the NYHA will reduce overall costs for almost every family. Unlike private insurance plans, with their narrow “networks” of approved providers, the NYHA would provide more choice, as all doctors and hospitals would be “in-network”; treatments would be determined by patients and doctors, not an insurance company motivated by profit.

Many say we can’t afford universal health care, but we are already paying for it. The U.S. spends nearly 20 percent of our gross domestic product on health care, roughly double the per capita rate of high-income countries with national health plans. Yet we have the shortest life expectancy and higher infant and maternal mortality rates. With the money saved by drastically reducing administrative costs from private insurers and negotiating down prescription drug prices and other supplies, we can cover all Americans without breaking the bank. Access to primary and preventative care will save even more money and lives over the long run.

One of our members works with homeless men and women at local shelters. Many of these patients require urgent examinations for addiction and psychiatric illness, but insurance companies require “prior authorization” before we can see the patient at all. This treatment is often life-saving as well as money-saving, since otherwise the patient will end up with an expensive trip to the emergency room. More importantly, delays in care for mental health and substance abuse can result in death.

It’s time to end the needless suffering and death, medical bankruptcies and endless paperwork imposed by private insurance. We hope Gov. Andrew Cuomo and our state legislators pass the NYHA. It’s the only way to cover all those who live in New York, save money and save lives.

The authors are members of Students for a National Health Program and Physicians for a National Health Program at SUNY Upstate Medical University.

https://www.syracuse.com…

Dr. Adam Gaffney on “Democracy Now!”

PNHP president Dr. Adam Gaffney appeared on “Democracy Now!” on April 2, 2019. He responded to the prospect of yet another health care proposal from President Trump by noting that it would likely be no better than the “vicious” policies that emerged in 2017. He added that the only way to truly solve our ongoing health care crisis is to pass and implement single-payer reform.

“The Status Quo Is Not Sustainable”: How Medicare for All Would Fill Gaps in Obamacare Coverage

Interview with Dr. Adam Gaffney

Democracy Now!, April 2, 2019

As Trump attacks the Affordable Care Act, we look at the growing case for Medicare for all. More than 100 Democratic lawmakers co-sponsored a House bill last month to dramatically revamp healthcare in the United States by creating a Medicare-for-all system funded by the federal government. The bill would expand Medicare to include dental, vision and long-term care, while making the federally run health program available to all Americans. It would also eliminate health insurance premiums, copayments and deductibles. We speak with Dr. Adam Gaffney, president of Physicians for a National Health Program, which has endorsed the measure.

AMY GOODMAN: This is Democracy Now! I’m Amy Goodman, with Juan González.

JUAN GONZÁLEZ: We continue our conversation on healthcare as we look at the growing case for Medicare for all. Last month, more than a hundred Democratic lawmakers co-sponsored a House bill to dramatically revamp healthcare in the United States by creating a Medicare-for-all system funded by the federal government. The National Economic & Social Rights Initiative calls the legislation, quote, “by far the strongest healthcare proposal being considered by Congress.” The legislation comes at a time when as many as 30 million Americans have no health insurance and tens of millions more are either underinsured or struggling to pay their health insurance premiums.

AMY GOODMAN: The bill would expand Medicare to include dental, vision and long-term care, while making the federally run health program available to all Americans. It would eliminate health insurance premiums, copayments and deductibles, while changing how healthcare providers are paid.

Most 2020 presidential hopefuls have declared support for Medicare for all. Despite the growing support, Politico reports a top aide to House Speaker Nancy Pelosi worked to undercut Medicare for all following the 2018 election. In a November 30th meeting with health policy researchers, Wendell Primus reportedly told a group of two dozen that Medicare for all is a distraction that should be scrutinized, encouraging researchers to oppose the legislation. Pelosi has denied the reports.

For more, we’re joined by Dr. Adam Gaffney, president of Physicians for a National Health Program, instructor in medicine at Harvard Medical School, author of To Heal Humankind.

Welcome to Democracy Now!, Dr. Gaffney. So, we see President Trump somewhat turning around, saying he’s not pushing to end Obamacare right now, just right after the election, when he says Republicans will take over the House. What does that mean for the whole debate around Medicare for all, when in Congress they’re just scrambling to keep the Affordable Care Act?

DR. ADAM GAFFNEY: Well, look, I think it’s very important to protect the gains that are already made, namely the Affordable Care Act, which did cover 20 million people and, as we heard from the last guest, provided some security for many families across the country. But at the same time, we have to acknowledge that the status quo is not sustainable. As you said, 29 million people are uninsured. Forty-four million people are underinsured, meaning that they have health insurance, but it doesn’t actually coverage their costs, doesn’t actually give them the financial security they need. Thirty-five percent of nonelderly adults go without needed care over the course of a year because they can’t afford it. One in five don’t fill a prescription because they cannot afford it.

So, there’s no question that we’ve made gains, and we need to protect those, and we need to push back against those who would degrade them in the name of tax cuts for the rich. But at the same time, we have to acknowledge that this is not good enough, and that as long as these holes and gaps exist, conservatives will attack the status quo. So, we can do both at the same time.

JUAN GONZÁLEZ: How do you respond to those critics who say that if Medicare for all were implemented, that many of the best doctors would desert that system and would not make their services available through it?

DR. ADAM GAFFNEY: That’s a very unreasonable claim. If you look at countries, like Canada, for instance, that have a single-payer system, essentially all of the doctors, all of the hospitals are in network. If anything, in fact, a Medicare-for-all system will increase people’s access to physicians and doctors. There won’t be insurance networks that keeps people separated, that keep people siloed, that cause disruptions in care every time your boss changes the insurance options you have or every time you change jobs. Under a Medicare-for-all system, there will be one big network with all doctors and all hospitals included, essentially. So, it’s really not a valid claim.

AMY GOODMAN: President Trump said he’s having his doctors and health executives in the Senate write legislation to replace the Affordable Care Act, like Rand Paul, who’s a doctor, as well as Dr. Barrasso, a senator, as well as Rick Scott, the now-senator from Florida, who Democrats say oversaw the largest Medicaid fraud in U.S.—Medicare fraud in U.S. history. He was formerly the CEO of Columbia HCA, when the hospital company was fined $1.7 billion for Medicare fraud. So, if you could respond to that, but also explain what exactly Medicare for all would look like when it comes to getting rid of the health insurance companies, for example?

DR. ADAM GAFFNEY: So, I mean, to respond to the first question, I think we should be extremely skeptical that whatever they generate is going to be any better than the really vicious piece of legislation that was proposed during the Affordable Care Act effort back in 2017. As we know, those bills would have slashed spending on public healthcare programs like Medicaid, would have slashed funding for the subsidies that make health insurance more affordable for some people. So, I’m very skeptical that whatever they generate is going to be an iota more friendly than the last bit of, again, vicious proposed legislation. Now, in terms of this—

AMY GOODMAN: Can you respond to Rick Scott, the former healthcare executive, who’s now the Senate? This is what he had to say.

SEN. RICK SCOTT: We do know that Medicare for all, which Senator Sanders is all in on, is going to just ruin our healthcare system.

MARGARET BRENNAN: So, are you—I’m sorry, just to clarify, did you just say that—

SEN. RICK SCOTT: It’s going to ruin Medicare, and it’s also going to ruin private insurance.

MARGARET BRENNAN: Did you just say that you expect the White House to come forward with a proposal first?

SEN. RICK SCOTT: Well, I know—I know the—I know, in the end, the White House is going to have to have their plan. And I know it’s going to be difficult with Nancy Pelosi. But what I’m going to focus on is: How do you drive down costs? The Democrats constantly focus on access. The problem is, the cost of healthcare is too high in this country.

AMY GOODMAN: So, he was speaking on CBS’s Face the Nation. Dr. Gaffney, if you could respond to what he’s saying—Democrats focus on access; I focus on cost?

DR. ADAM GAFFNEY: Well, we know that countries that actually have universal access also have higher costs. These two things go hand in hand. The United States has terrible access and also has overall costs that are about double those of other high-income nations. The notion that there’s a trade-off is simply false. And that’s made clear as soon as you look across the national borders. We can—in fact, we need to—achieve universal coverage, but that will also allow us to control costs moving forward.

JUAN GONZÁLEZ: And how would those costs be controlled moving forward?

DR. ADAM GAFFNEY: So, a universal healthcare system like single payer gives you unique ways of controlling costs. So, for instance, in the House bill that was put forward by lead sponsor Pramila Jayapal recently, that bill would basically create a universal healthcare system in which one plan covered everyone. And what we know about those sorts of plans is that they are far more efficient in terms of administrative overhead.

To give you just a couple of numbers, traditional Medicare, the traditional Medicare program, has a 2% overhead, meaning 2 cents of every dollar go to overhead, 98 cents goes healthcare. For private health insurance companies, if you include profits, the overhead is over 10%. That’s an enormous amount of money when you’re talking about trillions of dollars of healthcare spending. That’s just one way in which a public healthcare system is far more efficient than a privatized, fragmented system like we have now.

JUAN GONZÁLEZ: But to follow up on that, in terms of how this would be paid for, clearly there would be some kind of, I would assume, a payroll tax. And we’re looking at, right now, most Americans—it’s hard to tell what most people pay, because you’re dealing with premiums, you’re dealing with deductibles, you’re dealing with copays, you’re dealiong with co-insurance. Everybody has different plans and different employer contributions. So, what would it look like in the paycheck of average Americans if Medicare for all were actually instituted? Have you been able to cost out what it would mean in terms of a general cost to the average worker?

DR. ADAM GAFFNEY: Sure. Well, I mean, keep in mind for one moment—and I’ll address that directly—that we already publicly finance about two-thirds of our healthcare system. So, about two-thirds of healthcare dollars are already taxpayer-financed. But you are right that people—the other third is things like premiums, copays, co-insurance, deductibles and so on. So we would need to replace much of that private spending with public dollars, with taxes. There was an economic analysis recently from the University of Amherst that looked at a mix of taxes that could replace those payments. And, you know, overall, for the average working American, things would get better.

You know, I think it’s also important to keep in mind how harmful these out-of-pocket costs are for working people. People with high deductibles, we know, go without needed care. They avoid doctors. They avoid the hospitals. In fact, they even avoid the emergency room when they have high-severity conditions. So, it is an issue of dollars and cents, but it’s also an issue of people’s health being on the line, people’s lives, in fact.

AMY GOODMAN: And how do you plan to organize for Medicare for all?

DR. ADAM GAFFNEY: Well, my organization, Physicians for a National Health Program, focuses on the medical professional, although we also work to educate the public. But we do focus on the medical profession. There are many other groups that are involved in this fight—National Nurses United, for one, the largest nursing union in the country, many other organizations.

This is a big fight, let’s be honest. Even though it’s a very rational, logical program that we’re proposing, we are going up against powerful interests, namely the insurance industry and, to some extent, the pharmaceutical industry. So this is a big fight. So it’s—

AMY GOODMAN: We’re going to have to leave it there, but we’ll continue the discussion. Dr. Adam Gaffney, president of Physicians for a National Health Program. I’m Amy Goodman, with Juan González. Thanks so much for joining us.

Dr. Adam Gaffney is president of Physicians for a National Health Program. He is an instructor in medicine at Harvard Medical School and the author of “To Heal Humankind.”

https://www.democracynow.org…

Characteristics of Medicare for All and Its Rivals

Medicare for All and Its Rivals: New Offshoots of Old Health Policy Roots

By Steffie Woolhandler, MD, MPH; David U. Himmelstein, MD
Annals of Internal Medicine, April 2, 2019

The leading option for health reform in the United States would leave 36.2 million persons uninsured in 2027 while costs would balloon to nearly $6 trillion. That option is called the status quo. Other reasons why temporizing is a poor choice include the country’s decreasing life expectancy, the widening mortality gap between the rich and the poor, and rising deductibles and drug prices. Even insured persons fear medical bills, commercial pressures permeate examination rooms, and physicians are burning out.

In response to these health policy failures, many Democrats now advocate single-payer, Medicare-for-All reform, which until recently was a political nonstarter. Others are wary of frontally assaulting insurers and the pharmaceutical industry and advocate public-option plans or defending the Patient Protection and Affordable Care Act (ACA). Meanwhile, the Trump administration seeks to turbocharge market forces through deregulation and funneling more government funds through private insurers. Here, we highlight the probable effects of these proposals on how many persons would be covered, the comprehensiveness of coverage, and national health expenditures (Table available at link).

(THE FULL ARTICLE CAN BE ACCESSED FOR FREE AT THE LINK BELOW.)

In 1971, a total of 5 years after the advent of Medicare and Medicaid, exploding costs and persistent problems with access and quality triggered a roiling debate over single-payer plans. As support for Kennedy’s plan grew, moderate Republicans offered a public-option alternative, 1 of several proposals promising broadened coverage on terms friendlier to private insurers. Kennedy derided these proposals by stating, “It calms down the flame, but it really doesn’t meet the need.” President Nixon’s pro market HMO strategy—a close analogue of the modern-day accountable care strategy—ultimately won out, although his proposals for coverage mandates, insurance exchanges, and premium subsidies for low-income persons did not reach fruition until passage of the ACA.

Five years into the ACA era, there is consensus that the health care status quo spawned by Nixon’s vision is unsustainable. President Trump would veer further down the market path. Public-option supporters hope to expand coverage while avoiding insurers’ wrath. Medicare-for-All proponents aspire to decouple care from commerce.

https://annals.org…

Comment:

By Don McCanne, M.D.

Annals of Internal Medicine and its publisher, American College of Physicians, are providing free access to this article. The Table provides an excellent summary of the characteristics of Medicare for All (Single Payer), Medicare for America, Medicare Public Option, Medicaid Public Option, and Trump Administration White Paper and Budget Proposal (and is much easier to read if it is printed out).

The link should be shared with anyone who cares about the future of health care in America. The status quo is unsustainable, so there will be changes. Out of the quagmire there is the opportunity for comprehensive, affordable, equitable health care for everyone, providing that we select the single payer Medicare for All model.

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

Georgia needs to look beyond Medicaid waivers to solve healthcare crisis

By Jack Bernard
Savannah (Ga.) Morning News, April 2, 2019

State Sen. Ben Watson told his colleagues recently, “I believe that healthcare, or lack thereof depending on where you live, is our state’s largest shortcoming. However, I know that by thoroughly vetting legislation and considering new solutions to increase quality and access to care will help our citizens live longer, healthier lives…”

Watson, a Savannah physician, is correct about the healthcare status of Georgians and that coverage is a “right.” He is also correct that Medicaid is not taken by many physicians due to low reimbursement rates, which limits where recipients can be treated.

Chatham County has an uninsured rate of 15 percent for people under 65. That amounts to 36,000 people.

Georgia currently has 1,375,000 residents who are without insurance, the fourth highest number in the country. Current census data also shows that Georgia’s rate of uninsured is 13.4 percent, much higher than the national average of 8.7 percent. Further, Georgia also has a rate of medically uninsured (under 65) that is more than the national average, 16 percent vs. 11 percent. Many other Georgians are under insured.

By any measure, this situation must be deemed a crisis for our county and state. But, as opposed to what Dr. Watson and others may believe, the answer is not less government via health savings accounts and other Medicaid waiver options Gov. Brian Kemp will explore as part his Patients First initiative. The answer is comprehensive national Medicare for All so that these individuals would get the healthcare that they so desperately need while per capita cost will be more in line with other developed nations, all of which have costs much less than ours.

While the Affordable Care Act is not ideal and nowhere near as comprehensive as a single-payer system, the ACA is certainly better than what existed previously. However, President Donald Trump has done everything he can to increase the number of uninsured and decimate the coverage for many others by throwing roadblocks into implementation. He has tried to gut the ACA, causing premium increases for those covered.

These moves by Trump continue a trend by him to discredit anything and everything that his predecessor, Barack Obama, accomplished without regard for how his own moves affect the taxpayers. Trump once again puts his spite and vindictiveness over the nation’s interests. What a shame; it did not have to be this way. And it still does not.

The 14 red states that have not expanded Medicaid under the ACA are now the states with the highest percentage of uninsured. It just makes sense for GOP politicians to want to help their states. This can be easily accomplished by simply having the Federal government pick up the remaining 10 percent of the cost of Medicaid expansion. After all, they are already picking up 90 percent. At least we could reduce the number of uninsured while figuring out how to get enough political support to pass single payer, the obvious long-term solution and one that is increasingly being sought by Americans.

According to studies, we have the most religious democracy in the world. At the same time, we are the only democracy that does not have universal healthcare / insurance. Is that abysmal, immoral hypocrisy really what we want to portray to our citizens in Chatham County, in Georgia, in the United States and in the world? We need Medicare for All.

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

https://www.savannahnow.com…