PNHP

Harvard researchers: ‘Medicare for All’ wouldn’t overwhelm hospitals

Harvard researchers: ‘Medicare for All’ wouldn’t overwhelm hospitals

By Jacqueline Renfrow
Fierce Healthcare, July 22, 2019

There seems to be no evidence that supports the belief that there would be a surge in hospital use if the government implements “Medicare for All,” according to a new analysis published in the Annals of Internal Medicine.

Much of the debate around Medicare for All centers on a fear that there will be a large surge in hospital use, possibly overwhelming the system. But looking at data following both the implementation of Medicare in 1966 and the Affordable Care Act (ACA) in 2014, researchers at Harvard Medical School found no significant increase in hospitalizations.

The analysis, conducted with the help of The City University of New York at Hunter College, instead shows a redistribution of care, and the increase in hospital care among the newly insured would likely be offset by decreases in hospital use for healthier and wealthier Americans.

“When Medicare was being debated in the 1960s, critics warned that the surge in demand among seniors would overload the system, but that’s not what happened,” Adam Gaffney, M.D., lead author of the study and president of the Physicians for a National Health Program, told FierceHealthcare. “Seniors did get more hospital care, which they needed. But wealthier and younger people spent a bit less time in the hospital—which was a good thing. Americans, after all, too often receive unnecessary procedures and elective admissions.”

Following the implementation of Medicare and Medicaid back in 1966, and then the implementation of the ACA in 2014, each of the programs added 10% of the U.S. population into the insurance system.

About the same percentage of Americans are estimated to be put on insurance if Medicare for All is enacted.

Looking at both national surveys and admission records, hospital admissions averaged 12.8 for every 100 persons in the three years before Medicare began, and admissions averaged 12.7 per 100 people in the four years after Medicare began. At the same time, Medicare increased admissions by 3.7 people per 100 among elderly patients and less than one for the poorest of the population while hospitalizations fell 0.5 for younger and wealthier people.

Similarly, average hospital admissions were 9.4 per 100 people pre-ACA and were nine per 100 people, on average, in the two years after implementation. After the ACA, admissions rose by 1.5 per 100 among sicker Americans, but dropped 0.6 per 100 among people in good health.

In essence: Coverage expansions redistributed care.

Gaffney thinks that Medicare for All would have a relatively small net effect on hospital budgets.

“Hospitals should achieve large savings on administration and overhead once we mover to a single-payer system—U.S. hospitals, after all, spend twice as much on administration compared to Canadian hospitals,” he said.

Additionally, hospitals will provide less care that goes unreimbursed, because everyone will be covered. Gaffney says that, as a result, payments to hospitals can fall somewhat without compromising the quantity and quality of care they provide, or, alternatively, that hospitals can increase the amount of care they provide within their existing budgets.

“Future estimates of the cost of Medicare for All should account for the fact that hospital utilization increases are likely to be modest. In other words, we can in fact afford to cover everybody,” Gaffney added.

https://www.fiercehealthcare.com…

Stop the profit-driven insurance system

By Judith L. Albert, M.D.
Pittsburgh Post-Gazette, July 20, 2019

The plight of the Manion family clearly illustrates how private, for-profit health insurance has created an inhumane health care system based on denial of care (July 14, “UPMC-Highmark Agreement Settled but Local Family Still Faces Fallout”).

The recent agreement between UPMC and Highmark will have no lasting impact on the delivery of health care in Western Pennsylvania because these insurers will continue to collect high premiums, deductibles and co-pays while finding new ways to refuse to pay for medical care.

In the Manion family’s situation, a newspaper investigation of their hospital bills was required to remove the threat of a collections agency. No one should have to put up with these bewildering and erroneous billing practices, especially when recovering from serious health problems.

If Kara Manion were over 65, she would have crossed into the safe harbor of traditional Medicare coverage, where patient choice of providers is not limited to narrow networks. We need a national single payer “Medicare for all” system that will eliminate the profit-driven private insurance system and cover all necessary medical care for everyone in order to end this insurance feud for good.

Dr. Judith Albert leads the Pittsburgh chapter of Physicians for a National Health Program.

https://www.post-gazette.com…

Launch of ‘Business for Medicare for All’

Business for Medicare for All

We are business owners who believe our health insurance costs should not increase every year by double digits. Our payments to profiteering health insurers have swelled as our employees have been offered worse health care coverage. At our companies, rising costs paired with declining performance is unacceptable. So why should we accept this exploitation of our companies from health insurers?

We believe a new system that guarantees health care coverage for Americans regardless of where they work is critically important to maintain our profits, grow wages for working families, spur entrepreneurship and compete globally. It is time to cut the middle man — health insurance companies — out of our health care system and pass those savings on to employers of all sizes and their workers.

There is a better way.

These are the core principles we believe in at Business for Medicare for All. All of our members have signed on to support these underlying principles guiding any reform to how we pay for health care:

  • We believe Medicare-for-All must be the top policy priority of American business.
  • We believe the current profit-driven health insurance system poses an existential threat to American business.
  • We believe the current system lowers employee wages and business profits.
  • We believe the current system threatens American innovation and competitiveness.
  • We believe health care guaranteed, regardless of where someone works, is the only business-friendly, economically sustainable way to achieve universal health care in America.

President

Wendell Potter

Business Advisors

Richard Master, CEO and Chairman, MCS Industries
Ben Cohen, Founder, Ben and Jerry’s
Jerry Greenfield, Founder, Ben and Jerry’s
Joe Sanberg, Founder, Working Hero Action
Jen Kimmich, CEO and Co-Founder, Alchemist Beer
Bruce Waldman, Owner, A & H Sportswear
Dan Wolf, CEO, Cape Air
Bastian Lehmann, CEO, Postmates
David Steil, CEO and Owner Micro Trap Corporation
Joe Scott, CEO and President, Easton Coach

Health Care Advisors

Donald Berwick, Co-founder of the Institute for Healthcare Improvement (IHI)
Gerald Friedman, Professor of Economics at the University of Massachusetts Amherst
Dr. Carol Paris, Psychiatrist and immediate past President of PNHP
Dr. Ed Weisbart, Missouri Chair of PNHP, and past CMO of Express Scripts
Gabriel Levitt, Co-founder of PharmacyChecker.com

http://www.businessformedicareforall.org

To sign up:
http://www.businessformedicareforall.org…

Comment:

By Don McCanne, M.D.

Many have said that if only we could get the business community behind the Medicare for All movement then we would have it made. Well, some of our friends and colleagues are launching “Business for Medicare for All.” Let’s see how much interest we can help generate.

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

We cannot ignore the nuances of Medicare for All

Medicare for all: A voter's cheat sheet

By Drs. James G. Kahn and Elliot Marseille
The Hill, July 17, 2019

The discussion of “Medicare for all” in June’s two Democratic primary debates was both gratifying and confusing. While it was heartening to see agreement on the principle of universal health care as a human right, the debate format eliminated any opportunity for nuance.

That’s why we’re clarifying seven critical issues raised in the debates, and which will likely return during the campaign. Full disclosure: We support Medicare for all and we think that with a clear understanding of the facts, most people will too.

1. What is Medicare for all?

It’s a system with a single, public, nonprofit health insurer, instead of the dozens of private and public insurers we have now. It is not “government-run health care.” It is “government-run health insurance.” Like with Medicare today, health care would be provided by independent doctors and hospitals.

Everyone would be covered for life by a single comprehensive benefit package and would choose their own doctors. Private insurance premiums and out-of-pocket costs would disappear, replaced by taxes that are fair and progressive (richer people pay more). Simplified insurance rules and billing would reduce paperwork costs while negotiations would reduce drug prices. Overall, we would save money while covering everyone.

2. What is a Medicare expansion, as opposed to Medicare for all?

Several candidates (e.g., Michael Bennet and Pete Buttigieg) mentioned a public option, such as a Medicare buy-in. A public option could be offered on state health insurance exchanges, providing what might appear to be a cheaper alternative to private insurance. But it won’t solve our problems. A buy-in would leave the complicated multi-payer system in place, so the opportunities for savings on paperwork and pharmaceuticals would disappear. Moreover, the health insurance industry would use every tactic it knows to push the sickest people into the public option, jeopardizing the financial stability of the program.

3. How do you define “working” when it comes to health care?

Rep. John Delaney (D-Md.) said, let’s “keep what’s working” in our current system. What does that mean? Today, millions of Americans remain uninsured or underinsured — with exorbitant deductibles and out-of-pocket costs on top of their ever-rising insurance premiums.

Medical bankruptcy is common, even among the insured — as Sen. Elizabeth Warren (D-Mass.) noted. And people with employer-sponsored private insurance? They lack health-care security. If they lose their job, they lose their insurance. If “working” means decent and reliable coverage, private health insurance is definitely not cutting it.

4. Which health-care choices really matter?

Beto O’Rourke said “Choice is fundamental” as an argument to retain commercial insurance. Yet it is our choice of doctor (not insurance company) that is fundamental to our care and that’s exactly the freedom that commercial insurance denies us — for profit.

5. What do we mean by private insurance under Medicare for all?

When asked, “Who would get rid of private insurance?” Bernie Sanders, Warren, Bill de Blasio, and Kamala Harris raised their hands. Harris later clarified that she wouldn’t want to abolish private insurance altogether. She has a point: Medicare for all could co-exist with private insurance for supplemental services, like fancier hospital rooms, or alternative therapies. However, private insurance for core medical benefits would be unnecessary. In fact, keeping it would undercut the savings we could enjoy from reducing insurance complexity and pharmaceutical prices.

6. What’s a “glide path?”

Buttigieg endorsed a “glide path,” that is, taking intermediate steps to Medicare for all. This makes sense if the timeline is short and the steps are direct. For example, filling in Medicare’s existing coverage gaps and adding all 50-65 year-olds would be excellent first steps. Alternatively, we could move quickly to help everyone suffering today. It only took about a year to roll out Medicare in 1966, without the use of the Internet or computers.

7. How will doctors and hospitals fare under Medicare for all?

Delaney suggested that if hospitals were paid Medicare reimbursement rates, they’d go bankrupt. This is a misrepresentation. First, under most Medicare for all plans, hospitals would be paid lump sums to cover operating costs. Second, payments would be negotiated to assure financial viability. Raising the specter of hospital closures is a scare tactic.

While Medicare for all may sound complex, it boils down to this: Everyone would get comprehensive health coverage for less money than we’re spending now. Don’t let the confusing debate rhetoric fool you. It really is that simple.

James G. Kahn, M.D., is an emeritus professor of health policy at the University of California San Francisco. Dr. Elliot Marseille, DrPH, is CEO of Health Strategies International.

https://thehill.com…

Comment:

By Don McCanne, M.D.

Polls have shown that the majority of the public at large supports Medicare for All, but they also show a poor understanding of the all-important nuances of the single payer model of Medicare for All. Even members of the media do not always grasp the subtle but crucially important features of the model that make it so effective in ensuring affordable, accessible, comprehensive health care for absolutely everyone. Drs. Kahn and Marseille clarify for us some of the important nuances behind the rhetoric.

(A parenthetical comment on the “glide path”: There may be important logistical considerations for phasing in the implementation of a single payer Medicare for All program, but we must be certain that 1) the process is more efficient and effective than implementing the entire program all at once, 2) the transition of phasing out the current fragmented system while phasing in single payer does not result in precarious difficulties in winding down operations while simultaneously providing essential services to those still in transition, 3) any delay is based on crucial policy considerations rather than the politics of ideology, and 4) most important, the entire transition needs to be precisely specified in the original enabling legislation rather than merely defining the first steps with the intent of crafting later legislation for additional incremental steps in the glide path to reform. Half a century ago, Medicare for our retired population was to be the first step toward a Medicare program for all, but we never progressed beyond the first increment of including individuals with long-term disabilities and chronic kidney disease. We do not want to make that mistake again. If a glide path proves to be beneficial, it is imperative that it includes the landing lest we end up with another disaster on our hands.)

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

Medicare Advantage plans are ripping off taxpayers by the billions

Insurers Running Medicare Advantage Plans Overbill Taxpayers By Billions As Feds Struggle To Stop It

By Fred Schulte and Lauren Weber
Kaiser Health News, July 16, 2019

Health insurers that treat millions of seniors have overcharged Medicare by nearly $30 billion the past three years alone, but federal officials say they are moving ahead with long-delayed plans to recoup at least part of the money.

Officials have known for years that some Medicare Advantage plans overbill the government by exaggerating how sick their patients are or by charging Medicare for treating serious medical conditions they cannot prove their patients have.

Getting refunds from the health plans has proved daunting, however. Officials with the Centers for Medicare & Medicaid Services repeatedly have postponed, or backed off, efforts to crack down on billing abuses and mistakes by the increasingly popular Medicare Advantage health plans offered by private health insurers under contract with Medicare. Today, such plans treat over 22 million seniors, more than 1 in 3 people on Medicare.

Now CMS is trying again, proposing a series of enhanced audits tailored to claw back $1 billion in Medicare Advantage overpayments by 2020 — just a tenth of what it estimates the plans overcharge the government in a given year.

At the same time, the Department of Health and Human Services Inspector General’s Office has launched a separate nationwide round of Medicare Advantage audits.

As in past years, such scrutiny faces an onslaught of criticism from the insurance industry, which argues the CMS audits especially are technically unsound and unfair and could jeopardize medical services for seniors.

America’s Health Insurance Plans, an industry trade group, blasted the CMS audit design when details emerged last fall, calling it “fatally flawed.”

Insurer Cigna Corp. warned in a May financial filing: “If adopted in its current form, [the audits] could have a detrimental impact” on all Medicare Advantage plans and “affect the ability of plans to deliver high quality care.”

But former Sen. Claire McCaskill, a Missouri Democrat who now works as a political analyst, said officials must move past powerful lobbying efforts to hold health insurers accountable and demand refunds for “inappropriate” billings.

“There’s a lot of things that could cause Medicare to go broke. This would be one of the contributing factors,” she said. “Ten billion dollars a year is real money.”

Catching Overbilling With A Wider Net

In the overpayment dispute, health plans want CMS to scale back — if not kill off — an enhanced audit tool that, for the first time, could force insurers to cough up millions in improper payments they’ve received.

For over a decade, audits have been little more than an irritant to insurers because most plans go years without being chosen for review and often pay only a few hundred thousand dollars in refunds as a consequence. When auditors uncover errors in the medical records of patients they paid the companies to treat, CMS has simply required a rebate for those patients for just the year audited — relatively small sums for plans with thousands of members.

The latest CMS proposal would raise those stakes enormously by extrapolating error rates found in a random sample of 200 patients to the plan’s full membership — a technique expected to trigger many multimillion-dollar penalties. Though controversial, extrapolation is common in medical fraud investigations — except for investigations into Medicare Advantage. Since 2007, the industry has successfully challenged the extrapolation method and, as a result, largely avoided accountability for pervasive billing errors.

“The public has a substantial interest in the recoupment of millions of dollars of public money improperly paid to health insurers,” CMS wrote in a Federal Register notice late last year announcing its renewed attempt at using extrapolation.

Penalties In Limbo

In a written response to questions posed by Kaiser Health News, CMS officials said the agency has already conducted 90 of those enhanced audits for payments made in 2011, 2012 and 2013 — and expects to collect $650 million in extrapolated penalties as a result.

Though that figure reflects only a minute percentage of actual losses to taxpayers from overpayments, it would be a huge escalation for CMS. Previous Medicare Advantage audits have recouped a total of about $14 million, far less than it cost to conduct them, federal records show.

Though CMS has disclosed the names of the health plans in the crossfire, it has not yet told them how much each owes, officials said. CMS declined to say when, or if, they would make the results public.

This year, CMS is starting audits for 2014 and 2015, 30 per year, targeting about 5% of the 600 plans annually.

This spring, CMS announced it would extend until the end of August the audit proposal’s public comment period, which was supposed to end in April. That could be a signal the agency might be looking more closely at industry objections.

Health care industry consultant Jessica Smith said CMS might be taking additional time to make sure the audit protocol can pass muster. “Once they have their ducks in a row, CMS will come back hard at the health plans. There is so much money tied to this.”

But Sean Creighton, a former senior CMS official who now advises the industry for health care consultant Avalere Health, said payment error rates have been dropping because many health plans “are trying as hard as they can to become compliant.”

Still, audits are continuing to find mistakes. The first HHS inspector general audit, released in late April, found that Missouri-based Essence Healthcare Inc. had failed to justify fees for dozens of patients it had treated for strokes or depression. Essence denied any wrongdoing but agreed it should refund $158,904 in overcharges for those patients and ferret out any other errors.

Essence also faces a pending whistleblower suit filed by Charles Rasmussen, a Branson, Mo., doctor who alleges the health plan illegally boosted profits by overstating the severity of patients’ medical conditions. Essence has called the allegations “wholly without merit” and “baseless.”

Essence started as a St. Louis physician group, then grew into a broader holding company in 2007 backed by prominent Silicon Valley venture capitalist John Doerr with his brother, St. Louis doctor and software designer Thomas Doerr. Neither would comment on the allegations.

How We Got Here

CMS uses a billing formula called a “risk score” to pay for each Medicare Advantage member. The formula pays higher rates for sicker patients than for people in good health.

Congress approved risk scoring in 2003 to ensure health plans did not shy away from taking sick patients who could incur higher-than-usual costs from hospitals and other medical facilities. But some insurers quickly found ways to boost risk scores — and their revenues.

In 2007, after several years of running Medicare Advantage as what one CMS official dubbed an “honor system,” the agency launched “Risk Adjustment Data Validation,” or RADV, audits. The idea was to cut down on undeserved payments that cost CMS nearly $30 billion over the past three years.

The audits of 37 health plans revealed that on average auditors could confirm just 60% of the more than 20,000 medical conditions CMS had paid the plans to treat.

Extra payments to plans that had claimed some of its diabetic patients had complications, such as eye or kidney problems, were reduced or invalidated in nearly half the cases. The overpayments exceeded $10,000 a year for more than 150 patients, though health plans disputed some of the findings.

But CMS kept the findings under wraps until the Center for Public Integrity, an investigative journalism group, sued the agency under the Freedom of Information Act to make them public.

Despite the alarming results, CMS conducted no audits for payments made during 2008, 2009 and 2010 as they faced industry backlash over CMS’ authority to conduct them, and the threat of extrapolated repayments. Some inside the agency also worried that health plans would abandon the Medicare Advantage program if CMS pressed them too hard, records released through the FOIA lawsuit show.

CMS officials resumed the audits for 2011 and expected to finish them and assess penalties by the end of 2016. That has yet to happen amid the continuing protests from the industry. Insurers want CMS to adjust downward any extrapolated penalties to account for coding errors that exist in standard Medicare. CMS stands behind its method — at least for now.

At a minimum, argues AHIP, the health insurers association, CMS should back off extrapolation for the 90 audits for 2011-13. Should CMS agree, it would write off more than half a billion dollars that could be recovered for the U.S. Treasury.

https://khn.org…

Comment:

By Don McCanne, M.D.

We continue to hear that people like their private Medicare Advantage plans that replace traditional Medicare coverage. The most likely reason is that they have premiums that are competitive compared to the Medigap plans that people would need to protect themselves from potential catastrophic losses which the traditional program fails to cover. Individuals also are attracted by the plans’ marginal expansion of benefits.

It is no secret as to how the plans are able to afford to reduce out-of-pocket spending while adding a few benefits. The plans have been very successful in marketing to healthier patients – favorable selection – leaving more costly patients in the traditional program. Once the degree of favorable selection was acknowledged, CMS decided to introduce risk adjustment so that they could recover overpayments to insurers that were gaming the system. Very soon the insurers learned how to upcode their patients, making them seem to have greater health care needs than they really had, thus escaping risk adjustment reductions. Also, each year the insurers were successful in inducing CMS to use innovative methods to increase the annual adjustments in payment rates, helped by the annual letter from Congress endorsing the excess payment increases.

Today’s article indicates the degree to which the private insurers have been successful in overbilling taxpayers for their Medicare Advantage plans – literally billions of dollars. The article also discusses the efforts CMS has made to identify and then recover these excess payments. But what is most important here is what is written between the lines. The implementation of these programs has not resulted in recovery of these excess payments. Based on the battles that are taking place behind the scenes, once compromises are made it is likely that the amounts recovered will be so minimal that they will have no impact on the insurers’ profit and loss statements. Consequently, this results in a tremendous gift of taxpayer funds to the private insurers, and CMS has been passively complicit in this, as has Congress.

What is particularly objectionable is the unfairness, not only to the taxpayers at large, but also to the beneficiaries enrolled in the traditional Medicare program. The exposure to catastrophic costs in the traditional Medicare program is so great that enrollees must purchase relatively expensive Medigap plans to provide that protection if they’re not fortunate enough to be covered by union or employer-sponsored retiree plans. Even there, retirees are often shoved into the Medicare Advantage plans where they lose their choices in physicians and hospitals because of the restrictive provider networks selected by the Medicare Advantage insurers.

Why should we taxpayers be supporting these dishonest (read today’s article) private Medicare Advantage insurers while those of us in the traditional program are being deprived of the extra benefits that Congress has funded for the private insurers? It seems obvious that just plain fairness would require that Congress fund coverage for catastrophic losses in the traditional Medicare program while also funding the extra benefits that the Medicare Advantage plans use as a lure for enrollment, but there is a problem with this approach. It would be a comparatively modest incremental step that would further delay for perhaps decades enactment of the reform we really need – the single payer model of an improved Medicare for all.

Would that get rid of the crooks? No, they will always be with us. But a government that is willing to do the right thing by enacting and implementing a health care program that takes care of all of us would also be a government that would be willing to ferret out the crooks and actually eliminate their malfeasance, though that would have to be an ongoing process since this is an industry that touts its innovations even if those innovations have resulted in ripping us off to such a great degree.

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

Current Affairs: Why a ‘public option’ isn’t enough

Why a "Public Option" Isn't Enough

By Benjamin Studebaker & Nathan J. Robinson
Current Affairs, July 14, 2019

At one point, the meaning of “Medicare For All” was quite clear. Under Medicare For All, every American, instead of having to navigate the tangled and inefficient marketplace of for-profit health insurance corporations, would simply be enrolled in Medicare. Instead of people paying premiums and copays to an insurance company, they would pay taxes, and those taxes would be used to pay providers. As Dr. Abdul El-Sayed wrote in this magazine, Medicare For All is “single-payer healthcare that would provide cradle-to-grave government-supported healthcare for all Americans.”

But as Democrats have realized how well the phrase “Medicare For All” polls with voters, its meaning has been deliberately muddied. Most of the Democratic presidential candidates now support something they call “Medicare For All,” but it’s often not clear what they mean by it. Some, when they clarify specifics, make it clear that what they actually want is a “public option,” i.e. a new kind of government insurance plan that you can buy within the structure of the existing healthcare marketplace.

Why abolish private insurance? Why not just have insurance companies compete against a government plan in an open marketplace where people can choose? That way, everyone who wants Medicare gets it, while people who are satisfied with their current insurance can keep it. Everyone wins. The implication here is that anyone who supports a full single-payer plan, in which everyone would just be insured under a government program, must be rigidly ideological, wanting to shutter the private insurance industry for no good reason. Why would we do that instead of just providing a new option?

To understand why full “single payer” health insurance is the left’s goal, rather than just “another insurance plan on the marketplace,” it helps first to understand the left’s vision for how healthcare should work. In an ideal world, your healthcare would not be something you have to think about very much. If you got sick, you would choose a doctor’s office and make an appointment. You would go to that appointment and see the doctor. Then you would leave. You would not have to apply for insurance, not have to pay bills. And this would be the case no matter who you were or how much money you made. Your relationship is between you and your doctor, not you and your doctor and your doctor’s hospital’s billing department and your insurance company. Leftists dream of making healthcare as easy as possible to receive and universally accessible to all regardless of how much money they have.

Private health insurance is an unnecessary part of the healthcare system. Insurance companies are middlemen, and insurance just exists to make sure that providers get paid. It was the federal government that subsidized private insurance companies and encouraged employers to use them. Other countries didn’t build this kind of healthcare system, for two reasons:

  1. It doesn’t cover everyone.
  2. It creates a bloated, inefficient insurance bureaucracy.

Our government has always been playing catch-up trying to get more people covered. It’s created employer subsidies, Medicaid, CHIP, and the Obamacare exchanges in a desperate bid to get this system to do its job, and despite decades of piecemeal healthcare reforms 13.7 percent of Americans remain without health insurance and millions more have inadequate coverage. Offering to let Americans “buy-in” to Medicare keeps Americans paying premiums, and as long as Americans must personally pay premiums to receive healthcare there are going to be some people who can’t or won’t pay those premiums and go without. It turns Medicare-For-All into a publicly run HMO. Maintaining an employer-sponsored health insurance system means remaining in a situation where large numbers of people go through a period of being uninsured each year, because when you lose your job you lose your insurance. (Currently 1 in 4 Americans go through an uninsured period each year.) Single payer advocates ask the question: “Why have a nightmarish tangle of public and private options, varying by state, with people moving on and off all the time? Why not just pay for healthcare with taxes, cover everyone, and make it free at the point of use?”

Not only will a public option fail to cover everyone, it will do nothing to restrain the growth of healthcare costs. Single payer systems control costs by giving the health service a monopoly on access to patients, preventing providers from exploiting desperate patients for profit. If instead there are a large number of insurance companies, providers can play those insurance companies off each other.

The bloat doesn’t just come from providers. Because insurance works on a profit incentive, the insurance companies must extract rents as well. So the patient is paying to ensure not only that their doctor or hospital is highly-compensated, but that the insurance company generates profit too. Each insurance company has its own managers — its own CEO, its own human resources department, and so on. We have to pay all of these people, and because there are so many private insurance companies, there are so many middle managers to pay.

These duplicate bureaucracies are expensive to maintain and do nothing to improve the quality of care. The providers make them compete to offer higher compensation, and you pay for it. Getting rid of these middle men makes the system far more efficient. People do not associate government with efficiency, but when it comes to moving money from one place to another — which, after all, is all an insurance company does — it can be quite good, and it makes far more sense to have government handle healthcare payments than to leave it to companies with a direct financial incentive to deny treatment.

Private insurance is inconvenient, inefficient, and continues to leave large numbers of Americans with inadequate insurance or no insurance at all. The Affordable Care Act shored up this system by funnelling more public money into subsidies for private insurance. Now these Democratic candidates are proposing to make a new insurance company, call it “Medicare,” and charge you premiums to use it. That doesn’t get rid of the problem of wasteful duplicative bureaucracies, and will guarantee that some people remain uninsured. It was the federal government’s decision to build this bizarre, burdensome system. Nothing about private health care is natural or inevitable. It doesn’t have to be like this.

A single payer system requires a lot of political commitment, because it means going up against the insurance companies and the ritzy providers and telling them they can’t screw us over anymore. They can’t deny us coverage, extract heavy rents, and keep us on the phone forever. If a Democratic candidate doesn’t see a meaningful difference between a public option and single payer, if that candidate sees these things as two different “paths” to the same place, that candidate cannot be trusted to put an end to this madness. They are offering just one more piecemeal reform to prop up a failing system — not a true overhaul.

Single payer healthcare is a tried and tested system, and it isn’t radical. Trying to cobble together “universal” coverage from a patchwork of giant for-profit bureaucracies and government insurance products is senseless. “Eliminating private insurance” rather than “adding choice” may sound unnecessarily sweeping. But private insurance just gets in the way of efficiently paying healthcare providers and covering everybody. Medicare-For-All makes sense, and we shouldn’t let it be watered down.

Use this link for the full version of this article:
https://www.currentaffairs.org…

Comment:

By Don McCanne, M.D.

An inordinately large percentage of individuals who seem to support public insurance has bought the concept that we can avoid disruption of the existing private health plans by the incremental addition of a public option – an optional Medicare plan that individuals can choose to purchase. Supposedly everyone would recognize the superiority of the public option Medicare plan and would eventually shift to that coverage thus ending up with a single payer system. This vision of reform is a fantasy, and today’s article describes, once again, why this pathway will not lead to single payer.

Some say, “Well, isn’t this fine? Those who want their private plans can keep them, and those who prefer Medicare would now have that option.” But the Medicare public option is structured like an individual private insurance plan. It would have a premium, which, in itself, creates considerable administrative complexity – determining the amount of the premium, collecting the premium from the individual, determining the amount of a government subsidy, if any, and crediting that amount to the individual, making premium adjustments each year, and keeping track of shifting between the Medicare option, employer-sponsored plans, plans in the marketplace, and the all too common periods of lapsed insurance coverage. The administrative hassles with premiums alone do not begin to account for the half trillion dollars in other recoverable administrative waste, almost all of which would remain in place if we accept the incremental step of merely adding a public option.

Moving all health care funding to a highly efficient, tax-financed single risk pool while removing financial barriers to the access of health care (eliminating deductibles, coinsurance, etc.) are essential features of a single payer model but would not be achieved through incremental steps, including the step of offering a Medicare public option.

Our current health care financing infrastructure has nothing in common with a single payer system. That transition will have to be made sometime. Until then, we will have to put up with uninsurance, underinsurance, personal financial hardship, profound administrative waste, inequity in financing, inequity in health care, and physical suffering and preventable premature death. Merely adding a public option cannot have more than a negligible impact.

As the authors state, the public option and single payer are not two different paths to the same place. One is just one more incremental tweak that leaves us pretty much where we are, and the other is the infrastructure reform that will accomplish our goals of effectiveness, equity, and efficiency so that we all have the health care that we need. No more delay. We need to end the suffering.

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

Republican business owner and former state lawmaker: We need Medicare for All. Here’s why.

It's time to accept that the free market doesn't work for health care. Patients can't do comparison shopping from the back of an ambulance.

By David Steil
USA Today, July 16, 2019

From 1993 to 2008, I served as a lawmaker with the Republican Party, representing the 31st District in the Pennsylvania House of Representatives, while also building my manufacturing business from the ground up.

In many ways, my story is typical of what the American vision of free market capitalism can deliver. It might surprise you to know that I’m also part of the growing coalition of people nationwide who support Medicare for All.

Despite the fact that Medicare for All has gained traction in large part due to our country’s most famous democratic-socialist, Sen. Bernie Sanders, I’m about as far from a socialist as you can be.

But I know that if we’re going to grow, expand and improve our market-based economy, it’s time to drastically overhaul the way we finance health care.

I also believe it’s possible for markets to fail, because there are services that they’re incapable of providing efficiently. There’s no better example than our health insurance system.

Health care is a market failure

To work well, markets require educated consumers, cost-responsive demand and, most importantly, choice. Across all three metrics for success, our current health insurance system is failing.

The current state of health care delivery leaves patients with a huge information disadvantage. Even if we could access all the information about treatments, medications and pricing — which we normally can’t — almost none of us have the knowledge base to understand it. That allows insurance companies to artificially inflate prices, with little oversight or accountability.

No matter how high prices get — and they are driving health-care spending to an all-time high — we need the same amount of health care. But as insurance companies raise the prices of life-saving treatment, they force people to ration their care, at the cost of their health.

The result: Patients have very few choices in our health care system. Most of the time, the options are to get treatment, or risk even more harm, even if you don’t like the doctor or hospital that your insurance company has directed you to. After all, patients can’t shop around for more affordable doctors from the back of an ambulance.

When medical costs are the primary reason for bankruptcy in this country, there’s no way to spin the truth. Across political parties, lawmakers must have the courage to say, plainly and simply, that our dysfunctional health care system is a market failure.

We must fix this market failure, to save lives and create a more robust economy. Medicare for All offers the best solution.

Relieving businesses of the responsibility of employer-sponsored insurance, which is now priced at $19,616 a year for a family plan, will help expand our economy — by creating jobs, raising wages, maintaining our ability to compete internationally, and supporting small and mid-sized businesses like mine that are starting to buckle under the burden. In recent years, my costs have been rising 8% annually, and that’s low compared to some of my peers.

Medicare for All will also encourage entrepreneurship, the bedrock of our economy. Why? Because people can pursue new jobs and careers knowing that they won’t lose access to health care for themselves or their families.

Sen. Sanders and other proponents of Medicare for All are free to frame the policy as a component of democratic socialism. However, when it comes to health care, their democratic socialism and my capitalism are in agreement.

Let’s focus on the policy, not on loaded terminology.

David Steil is president and CEO of MicroTrap Corp and is on the Board of Advisers of the Business Initiative for Health Policy.

https://www.usatoday.com…

How Medicare for All Would Stop Hospitals Like Hahnemann From Closing

Taking the profit motive out of health care would ensure that hospitals could provide excellent care to all who need it.

By Adam Gaffney, M.D., M.P.H.
The Nation, July 16 2019

On Monday, Vermont Senator Bernie Sanders joined hospital staff, patients, and activists in a large protest outside the doors of Hahnemann University Hospital, a major safety-net hospital in northern Philadelphia. The demonstration came days after another rally at the hospital, attended by an estimated 800 protesters, last week. The crowds were not there to protest the hospital, but to save it. Hahnemann has been losing money, so Joel Freedman, president of the private-equity firm that owns the hospital, has decided that there is no choice but to shutter it for good—and possibly sell off its valuable real estate.

The closure of the hospital has already begun, and its effects are already palpable. A woman was recently struck by a car directly in front of Hahnemann but taken elsewhere, CBS reported, since the hospital relinquished its trauma center status last month. And last week Hahnemann stopped delivering babies. More than 800 pregnant patients received letters informing them that they would have to deliver elsewhere, according to a report by WHYY, despite worries about the lack of maternity facilities in Philadelphia. Meanwhile, hundreds of medical residents at the hospital are now rushing to find a new home where they can learn medicine.

“I am certain this is going to make waves in the health-care ecosystem of Philadelphia,” Kevin D’Mello, a physician who trained in medicine at Hahnemann and has worked there as an inpatient physician for six years since, told me. As D’Mello noted, the population of northern Philadelphia is already “one of the most underserved in the city.”

But things could get worse. After all, in the United States it is profitability—not the health-care needs of a community—that determines which hospitals stay open and flourish, and which wither and die. The story of Hahnemann is the story of not just a single urban hospital with a greedy owner but the dysfunctional and unjust way we finance health care across the nation.

Hahnemann was founded in 1848 as a center of homeopathy, but over the course of the 20th century it transformed into a major tertiary-care academic medical center with almost 500 beds. Designated the very first adult Level I Trauma Center in the city back in 1986, Hahnemann has long provided an array of specialty services, including organ transplantation. Today, the hospital cares for a predominantly low-income, publicly-insured, minority patient population. In 2017, some 17,000 patients were hospitalized there, and another 53,000 visited the emergency room, according to the Philadelphia Inquirer. But despite its public mission, Hahnemann has long been the property of for-profit corporations.

Tenet Health Corporation, a large national health-care company with a storied history of health-care fraud, purchased it in 1998. Just last year, Tenet sold it off to an affiliate of the private equity firm Paladin Healthcare. Now that company’s president Joel Freedman says that Hahnemann is hemorrhaging cash, and that he has no other choice but to shutter it. Others, however, have speculated that the hospital’s valuable property is destined to be used for luxury developments instead. A report last week in The American Prospect suggested that scooping up the hospital and selling it for parts (specifically, its valuable real estate) could have been the plan all along—the ominous start of a new trend as private equity investors eye the healthcare industry.

Regardless, a hospital closure is not an act of nature. The fact that a hospital can close because it is unprofitable is only possible because we allow it, and in this respect, Hahnemann is far from unique. More than 100 rural hospitals across the nation have closed in recent years, leaving many poor communities bereft of access to even basic health-care services. From 2004 to 2014, some 650,000 women of childbearing age in rural counties lost all access to obstetric services, according to a 2017 study. Such women, it should come as little surprise, are disproportionately poor and black.

Unprofitable wards (which also serve disproportionately poor communities of color) are closing within otherwise profitable institutions as well. As the The Nation reported last October, New York Presbyterian, where I trained in internal medicine, is in the process of closing its inpatient psychiatric ward at the Allen Hospital in Northern Manhattan. Critics say this is being done to make way for a lucrative spinal surgery center (the hospital contests that). And last Thursday, just as protesters rallied outside Hahnemann, community members and activists from Democratic Socialists for America, the New York States Nurses Association, and other groups protested outside the Allen Hospital’s doors to fight for the survival of its mental-health ward.

Meanwhile, even as some hospitals close, others are seeing rising profits, or embarking on aggressive capital expansions and acquisitions, propelled by fierce competition. Fancy new towers rise as rural hospitals fall, yet both have a common cause. The poverty of some of our hospitals and the rich fortunes of others are but two manifestations of a single pathology: a dysfunctional, profit-oriented system of hospital payment.

Could Medicare for All, as some have argued, save Hahnemann? The answer is yes, but the point is not merely changing who pays for health care, but how it is paid for. A well-structured single-payer system, unlike other health-care reform proposals, could indeed extract the profit motive from hospital financing. This would not only help save endangered hospitals throughout the country but also help transform them for the better.

For one thing, single payer can be used as a tool to directly push for-profit corporations out of the health-care delivery business altogether, by excluding them from participation in the public plan and buying out their facilities (in this respect, both single-payer bills in Congress can use bolstering). After all, for-profit providers have worse results—and often at higher costs. And as long as hospitals exist as businesses, they can close like businesses when their investors see better opportunities for profit elsewhere.

But investor-owned facilities are not the only problem. Whether hospitals are legally for-profit or nonprofit, most (to varying degrees) are profit-oriented. And to a large extent, they have to be, as a 2018 editorial in the Journal of General Internal Medicine described: Profitable hospitals expand, upgrade, beautify—attracting more patients and revenues—while unprofitable hospitals deteriorate, shed patients, lose staff, suffocate. That may be the law of market competition (which, not surprisingly, means that disadvantaged populations are often the worst-served), but that law need not govern our health-care system.

How would things be different with Medicare for All? Well, single-payer financing would allow us to separately fund hospitals’ capital costs—like new facilities or wards or major upgrades—with public funds. At the same, we can fully cover hospitals’ operating expenses through global “lump sum” budgets, as in Canada (or as proposed in the House Medicare for All bill). With such a financing model, there are no hospital profits, and so profitability ceases to be the criterion that dictates which hospitals open or close, and which expand and beautify. It would remove the incentive for hospitals to chase lucrative service lines, like spinal surgery, at the expense of unprofitable ones, like mental health. And it would ensure that we have hospitals, obstetric units, and mental health wards in the communities that need them—not just where firms think that they will be profitable.

Such a transformation is sorely needed. In her book In Sickness and in Wealth: American Hospitals in the Twentieth Century, historian Rosemary Stevens traced how US hospitals have long contained within their walls two contradictory identities. On the one hand, they are revenue-maximizing, expansionary, businesses. On the other hand, they are community institutions embodying our “hopes and ideals”—of science, but also of solidarity. Yet the two souls of the American hospital co-exist in an unstable equilibrium. More and more, however, we are seeing the business-identity emerge triumphant.

And that is what the struggle to save Hahnemann, and Allen Psych, is all about—to transform hospitals from the businesses they increasingly are becoming into the social institutions our communities deserve, and require.

Dr. Adam Gaffney is a pulmonary and critical-care specialist at the Cambridge Health Alliance and Harvard Medical School, and president of Physicians for a National Health Program.

https://www.thenation.com…

Reducing reform to ‘guaranteed issue’

With ACA Back in Court, Voters Still Litigating Obama’s Role in Health System

By Yusra Murad
Morning Consult, July 11, 2019

In a July 8-10 survey of 1,988 registered voters, a 44 percent plurality said it’s unlikely that the lawsuit will be successful in gutting the ACA, compared to 37 percent who see it as a possibility. Faith in the lawsuit’s success rests comfortably along party lines: Democrats aren’t betting on it, with almost 6 in 10 saying the court is unlikely to upend the ACA, while a majority of Republicans (54 percent) say the opposite.

This is not the ACA’s first confrontation with legal challenges, but this time, top lawmakers from both parties have been relatively less animated about the possibility of repeal. Republicans have worked to distance themselves from the case, wary of its implications for millions of Americans with pre-existing conditions and haunted by the 2018 midterm elections, in which dozens of Republicans were unseated over the issue of health care.

Among voters who think the ACA may be gutted, 60 percent are confident the Trump administration has a replacement plan. That includes 87 percent of Republicans.

For months, President Donald Trump has vowed his administration is on the brink of unveiling a health plan fit to replace the ACA. That plan — or any of its details — has yet to be seen.

https://morningconsult.com…

Republicans make U-turn on health care

By Alexander Bolton
The Hill, July 14, 2019

Senate Republicans are reversing course and now taking a hard look at health care legislation to replace the 2010 Affordable Care Act in case the courts strike down former President Obama’s signature achievement.

There’s a sense of urgency among GOP lawmakers to come up with a plan to replace the most popular components of ObamaCare after a panel of appellate judges on Tuesday aggressively questioned whether the law passes legal muster following Congress’s repeal of the tax penalty for not having insurance.

A nullification in the courts could leave millions of people with pre-existing medical conditions without insurance and disrupt coverage for others.

Just the consideration of legislative action is an about-face from a few months ago when Senate Majority Leader Mitch McConnell (R-Ky.) said Senate Republicans would not move legislation to replace ObamaCare before the 2020 election, arguing it would have no chance of passing Congress, particularly with a Democratic-controlled House.

But on Tuesday, McConnell pledged that the Senate would act swiftly to protect people with pre-existing medical conditions if a GOP-backed lawsuit is successful in overturning ObamaCare.

“I think the important thing for the public to know is there’s nobody in the Senate not in favor of covering pre-existing conditions,” McConnell said.

“We would act quickly on a bipartisan basis to restore” those protections if struck down by the courts, he added.

Sen. Mitt Romney (R-Utah), who as governor of Massachusetts in 2006 implemented a health insurance law that later served as a template for ObamaCare, is taking the lead in negotiations, according to Republican senators who have spoken to him.

Romney is working with Sen. Rick Scott (R-Fla.) and consulting closely with (Sen. Lamar) Alexander (R-Tenn.) and Senate Judiciary Committee Chairman Lindsey Graham (R-S.C.).

Republican lawmakers say they need to be more prepared with ideas to replace ObamaCare than they were in 2017, when a seven-month effort to repeal and place the law failed on the Senate floor in spectacular fashion.

Romney met with Alexander and Graham on Thursday afternoon to discuss what a Republican alternative to ObamaCare would look like, according to a Senate aide familiar with the meeting.

Scott says the goals of the legislation would be to protect people with pre-existing conditions and allow young adults to stay on their parents’ health insurance plan until age 26, two of the Affordable Care Act’s most popular provisions.

“There’s two things that were in ObamaCare — pre-existing conditions and staying on your parents’ plan. We don’t have any idea what’s going to happen in the court case, but what we ought to be doing anyway is trying to figure out how to pass something that covers those two issues,” Scott said.

“A bunch of us have been trying to figure out how to do it,” he said. “We’ve talked to a lot of people.”

Asked how he would pay for any costs associated with protecting people with pre-existing medical conditions and extending health coverage for young people until age 26, Scott asserted the GOP plan will not require a major expenditure.

“It’s not really something to be paid for. It’s something insurance companies have to do, and they’re doing it now,” he said. “They’re all complying with it now.”

“Republicans on this issue of pre-existing conditions can’t have it both ways. You can’t support the lawsuit and say you give a damn about pre-existing conditions,” said Sen. Bob Casey (D-Pa.), a member of the Senate Health Committee. “They have nothing prepared.”

When informed of Romney’s effort to put together a fallback plan to protect people from losing health insurance, Casey said, “They’ve been saying that for at least eight years.”

“This is what happens when the leadership of a political party doesn’t spend much time on health care for 25 years. They come up with loopy ideas,” he said of Scott’s argument that protecting pre-existing conditions would not require significant additional federal spending.

https://thehill.com…

Comment:

By Don McCanne, M.D.

Compared to the problem that our health care system is performing very poorly in spite of the trillions of dollars we are spending on it, this issue of covering preexisting conditions is almost trivial. Yet for a couple of years the Republicans have fixated on it as their proposal for reform should they be successful in abolishing the Affordable Care Act (ACA), whether through legislation or the courts.

Now that two of three appeals court judges have hinted that the individual mandate may be unconstitutional and not severable from the rest of ACA, the Republicans are facing the prospect that they may have to fulfill their promise of a better option for health care reform. In the last election they said that guaranteeing coverage of preexisting conditions and extending coverage for dependents until age 26 was their proposal for reform, even though those policies were already part of ACA. That feeble proposal did not sell well and the control of the House shifted to the Democrats.

Although Republicans have been pursuing in the courts the revocation of the entirety of ACA, they seem to have waited until the threat that they may be successful in eliminating ACA to begin crafting the replacement proposal. Astonishingly, they have reverted to supporting the same guaranteed issue and dependent coverage proposals.

This time they brought in newly elected Sen. Mitt Romney of Romneycare fame – the basis of ACA. There is no hint that they would repeal ACA (Obamacare) and replace it with Romneycare, so what are they to do? They are now also turning to Sen. Rick Scott, former Columbia/HCA chief executive – a company that paid a $1.7 billion fine for Medicare and Medicaid fraud.

So what is Sen. Scott’s solution? Guaranteed issue and dependent coverage. And how is that to be financed? “It’s not really something to be paid for. It’s something insurance companies have to do.” So they get rid of the individual mandate, pass a measure that makes unaffordable insurance even more expensive, and then give individuals the option of not buying the insurance they can’t afford. Some solution.

So where are the Democrats in all of this? Let’s have Medicare for All but we must leave in place the private insurance plans. High premiums? Unaffordable deductibles? Limited choices within provider networks? Surprise out-of-network bills? Gouging by pharmaceutical firms? A Medicare public option would be only one more in the menu of health plans, having eliminated none of the profound administrative waste that greatly adds to the very high costs of our health care system. Some solution.

The single payer model of an improved Medicare for All would fix this. Yet we do not have a Congress nor a president who are willing to move forward with the requisite legislation. Whose fault is that? How can you draw any other conclusion than the fact that the voters have failed in their responsibility to put democracy in action for the benefit of all? It is disingenuous to simply blame “the other party” for our ills.

Physicians for a National Health Program does not support any political party or candidate for office.

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

Medicare for All Explained Podcast: Episode 16

Interview with Neil Buchanan

July 15, 2019

Economist Neil Buchanan warns about the significant costs of maintaining the health care status quo, which poses a growing risk to the U.S. economy. Improved Medicare for All would be much more efficient (and effective). Hosted by Joseph Sparks. Additional episodes will be uploaded twice monthly. Subscribe in iTunes, or access a complete archive of the podcast, below.

https://medicareforallexplained.podbean.com

I Am A Doctor With Breast Cancer, And I Support Medicare For All

By Lisa M. Peck, M.D.
Our Future, July 15, 2019

I have been practicing Internal Medicine in Lake County, Illinois for over 25 years. Every day I meet patients who struggle to afford their health care.

Sadly, stories of failing care aren’t the exceptions in this country: they’re often the rule. Our system is fundamentally broken, and only a fundamental solution can fix it. That’s why we need Medicare For All – now.

After years of advocating for my patients, I find myself on their side of the table. Earlier this year, my mom was diagnosed with a very rare form of aggressive skin cancer. Her medication costs $13,000 a month. She is responsible for $2,000 in the first month, and $450 a month after that. That’s nearly $7,000 a year, and just for one medication.

She still has to pay the premiums for her Medicare supplement and pharmaceutical benefits plus her daily medications, which add up to another $5,000. $12,000 a year is a lot of money for anyone – especially on a fixed income.

I was recently diagnosed with breast cancer. I have insurance, and after an unrelated surgery earlier this year, I’ve met my deductible. My medical expenses should be covered through December, but I still have to meet my out-of-pocket costs. Then it starts all over again in January.

Every day, patients tell me high costs and insurance companies get in the way of getting the care they need. Patients refuse tests because their deductible is too high. Patients ask to switch their medications because they can no longer afford them under their new plan. Patients no longer have insurance because their partners have retired and they can’t afford the high deductibles of the ACA. Doctors and staff spend too much time on these issues, time which would be better spent on direct patient care.

It’s not right. No one should go bankrupt from cancer. No one should have to beg friends, family and strangers to pay for care. No parent should have to mourn a child because they couldn’t afford a vaccine. No one should die or lose a limb from having to ration insulin. No one should have to continue working just to keep health insurance.

Our current health care system is ineffective, inefficient, and cost-prohibitive for many, if not most Americans. The way it prioritizes profits over people’s lives is barbaric.

The United States spends twice as much on health care as other major industrialized countries, and we often have worse outcomes. Our tests, procedures and pharmaceuticals are all much more expensive.

Single-payer health care, as proposed by Rep. Pramila Jayapal and Sen. Bernie Sanders in the 2019 Medicare For All Act, would expand and improve the current Medicare program so everyone can be guaranteed health care, not just access to care.

“Access” to health care means nothing if people don’t seek care because they can’t afford it.

Medicare For All provides comprehensive benefits and choice of provider. Doctors and hospitals can remain private. They would be financed by the government like our current Medicare system but with more benefits for patients.

We can save hundreds of billions of dollars every year by lowering the administrative and marketing overhead and fat profits of the health insurance and pharmaceutical industries. Greater emphasis on primary care also lowers health care costs by facilitating earlier intervention, which would be covered financially not subjected to a high deductible people can’t afford.

Medicare For All would transform our current health care market, which is complex, profit-driven and inefficient, into a simple efficient system for the people.

Many people think doctors oppose single-payer health care. I know for a fact that many doctors wish, as I do, that we had a system which would allow us to spend more time offering care than being forced by insurance companies to act like bill collectors. The professional judgment of health care providers must come ahead of the consideration of private companies, whose primary purpose is to make their shareholders rich.

Health care is a right, not a privilege. It’s time to offer it to every American. We don’t need anymore Band Aids on our health care system. We need real reform. We need Medicare For All.

Lisa M. Peck, MD has been a physician in Lake County, Illinois for 25 years. She is a steering committee member of the Illinois Chapter of Physicians for a National Health Program and she expresses these views as a private citizen.

https://ourfuture.org…

How Women Win with Medicare For All

By Kirsten Magnuson and Ana Malinow, M.D.
Women’s eNews, July 14, 2019

Women should rally around the Medicare-for-All bill introduced in the House of Representatives earlier this year.

Medicare for All as proposed in HR 1384, along with its counterpart in the Senate, would benefit women in several essential ways. Because health insurance coverage would no longer be tied to one’s employment or marital status, women could leave abusive relationships or toxic workplace environments without losing health insurance for themselves or their families.

Our healthcare system is surely broken when some women feel compelled to marry, stay married or remain in a harmful job just to retain their health benefits. This outdated arrangement is a form of subjugation that has no place in our wealthy, democratic nation today. HR 1384 would create a publicly funded healthcare system that would guarantee everyone in the U.S. comprehensive health coverage while leaving the delivery of care mostly private.

It would also include coverage for doctor visits and hospitalizations, vision, dental, mental health, and even long-term care. This means women would no longer be saddled with some of the caretaking responsibilities that often befall them when a parent or other relative becomes severely ill.

Due to centuries of discrimination and asymmetric domestic duties, women and especially women of color are more likely to have low-paying jobs without health benefits. And when women don’t have access to health care, it not only affects them. Their children and other family members who rely on them often suffer, too.

Women who are uninsured or underinsured are especially vulnerable when they become pregnant or new mothers. The United States spends more on health care than other countries, yet our maternal and infant death rates are among the highest of large, wealthy nations. This means that American mothers and babies are not receiving the health care they sorely need.

Dr. Aleksandar Rajkovic, an obstetrician and the husband of one of the authors of this piece, has witnessed the effects of our collapsing healthcare system firsthand. While working in Texas years ago, he encountered an uninsured pregnant patient who experienced abdominal pain for 36 hours before she fell unconscious and was brought to the hospital. Concerned that she and her laborer husband could not afford an emergency room visit, she had told her husband the pain would pass. Sadly, the woman ended up dying of a ruptured ectopic pregnancy, which could have been avoided had she gone to the hospital sooner.

People are suffering and even losing their lives because they can’t afford health insurance at all, or must forgo treatment even though they’re insured, due to exorbitant out-of-pocket costs. Tens of thousands of people die each year in the U.S. due to being uninsured. The Medicare for All Act of 2019 (HR 1384) would ensure no one is forced to choose between essential medical treatment or going bankrupt, and it would be funded through modest progressive taxes, based on what people could afford to pay.

Medicare for All as proposed would also guarantee women reproductive choice. The ability to determine one’s family size and the spacing of one’s children is critical to women who must consider their economic reality, relationship status or career concerns. Yet today, women increasingly face obstacles when it comes to their freedom to choose.

Alabama Gov. Kay Ivey recently signed the strictest abortion law in the country, making it a felony to perform the procedure even in cases of rape and incest. Governors in several other states have approved abortion bans once a fetal heartbeat is detected, which can occur as early as six weeks in pregnancy. These moves represent the latest, pernicious assault on women’s reproductive rights since the U.S. Supreme Court legalized abortion nationwide in 1973.

The Medicare for All Act of 2019 would also allow federal funds to be used for abortion and other reproductive health matters. (The Hyde Amendment  currently prohibits federal funding of abortions except in extreme cases, effectively limiting a women’s constitutional right to choose and affecting poor, young women of color the most.) The decision to terminate a pregnancy or not affects not only a woman’s reproductive health but also her overall health. Thus, it’s one that should be made by her in consultation with her doctor – not politicians.

How many more mothers, daughters, and sisters will needlessly die under our healthcare system before we stand up and say enough is enough? While HR 1384 is now in our legislators’ hands, the choice to keep silent or voice support for it is now ours.

On which side of history will you stand?

Kirsten Magnuson is chair of Health Care for All-California. Dr. Ana Malinow is a past president of Physicians for a National Health Program.

https://womensenews.org…