PNHP

Public retirees being shifted to private insurance exchanges

Public retirees being shifted to private insurance exchanges

As Retiree Health-Care Costs Soar, Public Employers Turn to Private Insurers

By Liz Farmer
Governing, January 9, 2019

The cost of retiree health care is spiraling out of control. In just two years, according to a recent S&P Global Ratings report, unfunded retiree health-care liabilities across the 50 states increased by $100 billion to now just under $700 billion.

The problem is becoming so alarming that Dearborn, Mich., recently borrowed money to help fill the gap, a move deemed risky by financial analysts. A more acceptable approach taking hold, thanks in part to the Affordable Care Act (ACA), is scrapping government-sponsored health plans and instead paying for retirees to purchase a plan on a private health insurance exchange. The change is expected to save some cities hundreds of millions of dollars and make their annual retiree health-care costs more predictable.

Retiree health care, also known as other post-employment benefits (OPEB), is one of the fastest-growing line items in government budgets. That’s because retirees are living longer and medical costs are rising faster than the rate of inflation.

In recent years, some governments have tried to manage costs by simply cutting health-care benefits — something they legally can’t do with pensions. In 2014, Memphis, Tenn., eliminated its 70 percent subsidy for retiree health insurance, and instead, plugged those savings into its vastly underfunded pension system. But unions fought the cuts, suing and pressuring the city to reinstate health care for retirees. With the subsidy gone, agencies were having problems with recruitment and retention, particularly police and fire departments where officers tend to retire well before the Medicare-eligible age of 65.

When Mayor Jim Strickland took office in 2016, he immediately tasked the city’s new chief human resources officer, Alexandra Smith, to fix the problem. That’s when the idea of turning to a health insurance exchange first emerged.

Private exchanges are different than the public, ACA exchanges. The idea is the same in that they pool risk and allow users to shop for their own health plans. But private exchanges are run by insurance and benefits companies. They have been around for much longer, generally catering to the 65 and older crowd looking for a health plan to supplement their Medicare coverage.

In recent years, governments, such as Cobb County, Ga., and the state of Ohio, have turned to these private exchanges for their Medicare-eligible retirees as a way to cut down on costs. But thanks to the ACA, private exchanges can expand their market to include users who are not yet eligible for Medicare. That’s opening up new options for governments that are paying for health care for younger retirees.

For Memphis, joining an exchange gave the city a chance to control their health-care costs because the insurer — rather than the city — is on the hook for big claims.

Shifting that responsibility, says Smith, dropped the city’s OPEB liability by $300 million to total $415 million. Costs going forward will also be more predictable, around $19 million per year. “The volatility we would have had by having retirees on our group insurance plan would have been much higher,” she says. “Now we’re able to better predict what our annual payments are.”

It also gave the city something to offer its younger retirees. While Memphis didn’t reinstate its 70 percent subsidy, it offers $5,000 annually for individuals and $10,000 for public safety retirees in the form of a health reimbursement account for those who aren’t eligible yet for Medicare. The money helps cover a significant portion of the premiums for retirees who buy a plan on the exchange.

Meanwhile, the idea is gaining traction. Ohio’s police and fire pension has already made the jump, and the state’s public employee pension plan is considering a similar move.

http://www.governing.com…

Comment:

By Don McCanne, M.D.

Public employers, in order to help control the costs of their retiree health benefit programs, are dropping the retirees from their own government-sponsored health plans and instead giving retirees a health reimbursement account (HRA) that can be used to purchase health plans through a private insurance exchange. The plan in Memphis provides an example as to how that can work out for the employers and for the retirees.

Instead of paying a 70 percent premium subsidy towards the government-sponsored health plan, Memphis is paying into the HRAs an amount that reduces their post-employment benefit obligation by $300 million, a savings for Memphis of 42 percent! That’s great for their city budget, but what does that do for the retirees?

To begin with, private insurers generally have significantly greater administrative costs, higher executive compensation schedules, plus a need to divert funds to investors (or build capital margins for nonprofits), plus there are the additional administrative costs of the private exchanges. If the retirees have 42 percent fewer funds for their retiree coverage and the coverage is now more expensive than the previous government-sponsored plan, then what gives? It would require some combination of much higher insurance premiums (likely greater than the funds in their HRAs), much greater deductibles and other cost sharing, and a reduction in the health benefits covered by the private plans. All of these can place a significant financial burden on individuals now trying to get by on their modest pensions. They might have to deplete their assets, if they have any, and health care access may be impaired because of these financial barriers. This can’t be good.

We have to end our dependence on an overpriced, inefficient, inequitable, fragmented health care financing system dominated by private insurers. We can do that by enacting and implementing a Single Payer Medicare for All program. Although support is increasing, inertia remains a problem, and we may have to start taking to the streets to get it to happen.

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

Small-business owner supports improved Medicare for All

By Pamella S. Gronemeyer
Illinois Business Journal (Edwardsville), Jan. 2019

I am a physician and an employer, as well as a purchaser and a recipient of my own health care. I strongly support improved Medicare for All, a/k/a/ a single payer health care, because it is the most economically affordable, equitable and patriotic health care for this country. Most other industrialized nations have long ago realized that the health of their nation is no better than the health of their sickest individuals.

As a recent Medicare enrollee, I know that Medicare works. I have conventional Medicare with a supplemental plan and a prescription drug plan. I chose my supplemental plan with a company that treats providers with respect and pays fairly. As a Medicare enrollee, I have my choice of physicians and health-care facilities. I know that the bills will be paid. The downside, however, is that the Medicare supplemental plans and drug plans are not cheap. Many seniors cannot afford these outlays. That is why we need to improve Medicare when we expand it to the entire population. Medicare for All would incorporate dental and vision services as well. The issue of long-term care coverage is still being discussed.

For many years, I have known, as a provider, that Medicare pays a clean claim in 30 days. The Medicare rates are published every year online and are observed. Patients and providers are not pitted against each other in the payment process. Insurance companies often confuse both the health-care provider and patient by telling them conflicting information. Many insurance claims are unpaid beyond 60 days, and it is difficult to run a small business without consistent cash flow. Most insurance companies base their provider rates on a multiple of at least one times Medicare. However, unfairly, some change the rates without notification.

As a small-business owner, I provide health insurance to my employees and their dependents with as low a deductible as possible. I pay the premiums and they pay their deductibles and copays. I do this because I know that my employees are vital to the success of my business and I care about their health and the health of their families. For many years, my premiums rose more than 10 percent a year. While this increase stabilized under the ACA, the premiums rose again 8.2 percent this year. As my employees age (I have good employee retention) their rates go up based on their age. The fact that more and more money is needed to pay health-care premiums limits my ability to give raises. My employees use their health care wisely. The thought that health care for all would create abuse of the system is ridiculous. If we had Medicare for All, I could use the time and energy that it now takes me each October to review available plans, select a plan that is affordable and re-enroll to do my real job of providing pathology and cytology services.

Medicare for All could be paid for by an employer payroll tax that would replace the premiums that my business currently pays to the health insurance company. The employee may pay a small tax that would replace their co pays and deductibles. Would Medicare for All be more expensive than what people are currently paying? Credible economists and healthcare experts say uniformly “NO.” The additional taxes that a person would pay annually are far less than the average person is now paying in premiums to insurance companies. Also, the savings created by a system that spends money for health care and not administrative costs is indisputable. Medicare operates on an overhead of 2 percent to 3 percent; the overhead of private insurance companies is around 20 percent. In addition, the costs of workman’s compensation and retirees’ health benefits would disappear. Malpractice premiums would go down since settlements would no longer include payments for future medical care, because an improved Medicare for All would cover virtually everything.

The entrepreneurial character of Americans is well known. Starting a business would be easier with the knowledge that health-care costs would not discourage people from the process. People would no longer be restricted from creating a business or changing jobs because they are worried about their health care. Medicare for All is a win-win proposition for businesses and for the nation.

Dr. Pamella Gronemeyer is an anatomic and clinical pathologist. She is the director and owner of SEMC Pathology in Highland.

https://www.ibjonline.com…

Health industry insider now tows line for Medicare for All

By Dennis Grubaugh
Illinois Business Journal (Edwardsville), Jan. 2019

The epiphany for Wendell Potter came in 2007 when he saw the reality of health care in America, the difference between the haves and the have-nots.

After spending almost 20 years in health-care public relations and being paid to tout the industry line, he had become disheartened over the state of managed care. Insurance executives were promising the moon to patients but were far more concerned with investors and the effects of potential reforms. Insurance was becoming unaffordable. Millions were going without coverage.

He was aware of the growing crisis but saw it personally when, while visiting his home in Tennessee, he read about an event offering free health care at county fairgrounds in nearby Virginia. He decided to go see for himself the state of the industry.

“What I saw was something I never expected to see in this country,” he said. “People were lined up by the hundreds waiting to get care, some under tents, but a lot of those lines were leading up to barns and animal stalls. It looked like a refugee camp.”

Potter added: “I didn’t know anything like that existed, but I found out there were events like that all over the country.”

Very quickly, Potter went from insurance advocate to insurance reformer. Today, he is the one of the country’s foremost proponents of the Medicare for All movement, the idea of having a single payer — the government — pay for all people’s health care.

Potter spoke recently at Southern Illinois University Edwardsville where he appeared at the invitation of the Missouri Chapter of Physicians for a National Health Program and others.

Potter rose to prominence in 2009 when he testified in Congress during the first Obamacare debate, about the damage caused by the misinformation campaigns he says he helped create while vice president of communications for Cigna.

“I realized I had played some kind of a role in perpetuating the myth of the health-care system,” he said. “I knew as soon as my testimony was over that I would be known by my insurance industry colleagues as Public Enemy No. 1.”

It was quite a change for a man who was raised to believe in the free market.

“One of my first jobs in the industry came during the early Clinton years, when Bill and Hillary Clinton were trying to enact health-care reform. My industry didn’t like it so we teamed up with the drug companies, the big hospital companies and the medical device companies to develop a campaign to make sure it never happened. And, it never happened (until Obamacare).”

He referred to the early effort as a “FUD campaign” — sewing fear, uncertainty and doubt to make sure people were made afraid of any kind of health-care reform.

He said he worked for a system that had an offense and a defense. The offense encouraged people to believe that the U.S. had the best health-care system in the world. The defense was to respond to criticism from patients and doctors when particular cases got too loud.

“More often than not the company would reverse gears and approve whatever was being denied, just to make the story go away,” he said.

Those stories led to the backlash against managed care and led Potter to question what he was doing for a living.

He handled financial communications for Cigna corporate and got to understand how the company made money. Regularly, he fielded calls from the Wall Street Journal and others.

“Press releases and talking points were handed off to lawmakers, who we had contributed to and were friendly to us,” he said.

The manipulation wasn’t unique to Cigna, where he worked 15 years, or to Humana, another insurance company where he worked more than four years, he said. Every large insurance company was lobbying for footing.

As a former journalist for Scripps-Howard papers in Tennessee and elsewhere before his health career, he brings a certain credibility to the table in discussing the situation. He has now written three books on the industry’s shortfalls. He is also founder of the independent investigative journalism group, Tarbell.org.

Now, he talks about what has happened to Obamacare and where reforms need to go next, which he believes is a single-payer system that is likely to take years to approve.

“(Obamacare) has done some good,” Potter said. “More people are insured who were not before but the problem is the number of unemployed Americans is beginning to creep back up again and a lot of people are now underinsured. Their plans have such high deductibles they can’t afford to pay them and the cost keeps going up.”

The parts that people like about Obamacare — younger people being protected on their parents’ policies until they are 26 and coverage for people with pre-existing conditions — have thwarted attempts in Congress to overturn the law. However, a federal judge in Texas last month ruled that Obamacare is unconstitutional because of the mandate that people buy insurance. That makes it more likely that the validity of the Affordable Care Act will again go before the U.S. Supreme Court, which originally approved the law in 2010.

The Democrat surge resulting from the midterm elections will also mean more support for keeping a national health-care law in place. A Medicare for All caucus, comprised of 70 Democrats, was in place when the new Congress was seated early this month.

Insurance companies have doled out millions of dollars to members of both parties to protect their interests, and Potter believes that further reforms are not a question of if but when.

“A lot of the people who opposed Obamacare early on were not opposed to the reforms per se but the fact that they didn’t think it went far enough,” he said. “In my view, when it passed, it was the end of the beginning of reform. It moved us in the right direction, but it kept a lot of the infrastructure of a broken system in place.”

He’s not sure further reforms will come during the Trump administration but does think talks will continue.

“Where we need to be is a system that disciplines costs, brings us all into coverage, and includes outcomes,” he said.

Health-care premiums have risen from about $6,000 a year for families in 1999 to almost $20,000 today. Meanwhile, employers have been shifting more and more of the cost of the premiums from themselves to their workers.

Many people who do have insurance can barely afford the deductibles, which prevents them from getting care.

“Our employer-based system is unraveling,” he said. “Now, business owners are beginning to get on board and realize they can’t keep providing health care.”

Potter is president of the Business Initiative for Health Policy, a public education and advocacy effort focused on advancing the business and economic rationale for adopting a Medicare for All system in the United States, which is the only developed nation in the world without guaranteed universal health care.

The U.S. health-care system was dead last of developed countries before Obamacare was enacted, but is still that way today because of the law’s weaknesses, he said.

https://www.ibjonline.com…

Another similar poll, but not so boring

Americans' Health and Education Priorities for the New Congress in 2019

Politico, Harvard T.H. Chan School of Public Health, January 2019

POLQ1. The new Congress could take action on health care. Here is a list of some things they could do. Because they can only take action on a few of them at a time, we are only asking whether or not you think each of the following should be an EXTREMELY IMPORTANT priority. How about (INSERT ITEM – e.g., c, below)? Should that be an EXTREMELY IMPORTANT priority or not?

c. Providing health insurance coverage for everyone through a taxpayer-funded national plan like Medicare for all

Yes, should be an extremely important priority
Total – 68
Dems – 84
Reps – 39
Inds – 70

No, should NOT be an extremely important priority
Total – 30
Dems – 14
Reps – 60
Inds – 28

Don’t know/ Refused
Total – 2
Dems – 2
Reps – 1
Inds – 2

https://cdn1.sph.harvard.edu…

Comment:

By Don McCanne, M.D.

The results of this poll should not surprise Medicare for All advocates since it looks like many other poll results in recent years. About two-thirds of respondents think that providing health insurance coverage for everyone through a taxpayer-funded national plan like Medicare for all should be an extremely important priority. The various poll results have been remarkably consistent, although this one emphasizes that respondents believe Medicare for All is “an extremely important priority” considering the number of issues that require Congressional attention.

In spite of strong political polarization in this country, about two-fifths of Republicans agree with the 84 percent of Democrats and 70 percent of Independents who concur that Medicare for all is an extremely important priority.

Give the Republicans a decade of having the security of Medicare for All and then ask them if they would want it taken away. The support certainly would have solidified by then.

It is interesting that some Republican politicians keep insisting that we need to reform “entitlements” – cut Social Security and Medicare benefits – yet Republican voters along with all other voters do not want their benefits tampered with. Former Speaker Paul Ryan advocated strongly for “entitlement” reform yet ended up walking away saying that this failure was his one great defeat, yet his Republican voters did not step up to agree with him.

People support Medicare. If everyone were included, the support would be unanimous, except perhaps for a rare nut or two (and, even then, they would be eligible for psychiatric help).

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

House Budget Committee requests CBO report on design considerations for single payer

U.S. House of Representatives, Committee on the Budget

January 8, 2019

Dr. Keith Hall
Director
Congressional Budget Office
Washington, DC 20515

Dear Dr. Hall:

The Affordable Care Act substantially increased the number of Americans who have health insurance and created important consumer protections, such as caps on out-of-pocket costs and prohibiting discrimination against people with pre-existing conditions. However, millions of Americans remain uninsured, and millions more – even though they have insurance – struggle to afford their health care costs. Many members of Congress are considering new approaches to achieve the goal of affordable, high-quality coverage available to everyone. There are several possible pathways toward this goal, ranging from incremental improvements to the Affordable Care Act to a more comprehensive overhaul of the nation’s health care system. One approach that has garnered considerable interest is a single-payer system. Supporters often point to the experience of other countries that have achieved near-universal coverage through single-payer systems. The single-payer systems in other countries differ in important respects, however, and do not necessarily provide a clear blueprint as to how such a system in this country would be designed. Members of Congress developing proposals to establish a single-payer system will face many important decisions that could have major implications for federal spending, national health care spending, and access to care.

To assist Congress with that work, I request that the Congressional Budget Office provide a report on the design considerations that policymakers would confront in developing proposals to establish a single-payer system in the United States. The report would cover the following issues: how the system would be administered; who would be eligible for coverage and how they would be enrolled; what services would be covered and what cos-sharing requirements, if any, would be imposed; what role, if any, private insurers would play; whether other public programs (such as Medicaid, the Veterans Health Administration, the Indian Health Service, and the Military Health System) would continue to exist; how provider payment rates would be established; what participation rules would be established for providers; what methods would be used to contain costs; and how the system would be financed. The report would not necessarily provide CBO’s estimate of the effects of any particular proposal for a single-payer system on federal spending to national health care spending but would, to the extent feasible, provide a qualitative assessment of how the choices with respect to major design issues would affect such spending. The staff contact for this request is Erika Appel, who can be reached at (number omitted to avoid a deluge of calls – DMc).

Sincerely,

John A. Yarmuth
Chairman

Comment:

By Don McCanne, M.D.

Speaker of the House Nancy Pelosi has already stated that the Budget Committee would be holding hearings on Medicare for All. This letter indicates that the process has already begun since the committee does need basic information on what a single payer system is, and the nonpartisan Congressional Budget Office (CBO) serves as an impartial resource for such information. The fact that single payer Medicare for All is now receiving formal consideration in Congress is an important milestone in our journey toward health care justice for all.

Concerns are already being expressed over the background of Keith Hall, the Director of the CBO, who is a Republican and was the chief economist for the White House Council of Economic Advisers under George W. Bush, and was a senior research fellow at the Mercatus Center at George Mason University – a free-market oriented institution that recently released a report critical of Sen. Bernie Sanders’ Medicare for All legislation.

The probability is that the report will be credible since the CBO staff has continued to demonstrate professional integrity and impartiality regardless of the political inclinations of the director. Prior CBO controversies such as the application of dynamic scoring likely will not play a role here. In the unlikely event that they digress and redefine single payer as a more conservative or libertarian model, or if they distort socialist features as being a nefarious route to totalitarianism, the uprising by Medicare for All activists would put their report to rest. But that won’t happen. Likely, at the very worst, we might have to correct some minor distortions or errors, and we do have the credibility to do that. Furthermore, this is only a report and not legislation. The real test comes when the final, definitive legislative is crafted.

Whether or not the report turns out to be useful, we already have a plethora of health policy data that can guide Congress as they create the design and transform it into legislative language. Whatever bill(s) may be produced will have plenty of exposure during this session of Congress, allowing for our input to perfect them for the next session of Congress when we may finally have a real chance of achieving our goal of Medicare for All.

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

How would Medicare for All work?

Interview with Drs. Margaret Flowers and Ana Malinow

By Rose Aguilar and Laura Wenus
KALW (San Francisco) Public Radio, Jan. 8, 2019

House Democrats have promised to hold public hearings on single-payer healthcare proposals, which have been sidelined for years. According to the Washington Post, between 58 and 70 percent of Americans support some form of Medicare for All. We’ll discuss details of existing proposals and how they seek to fix a healthcare system that leaves so many behind. What would it take to provide all Americans comprehensive and affordable healthcare?

full audio:
https://www.kalw.org…

Dr. Margaret Flowers is a pediatrician, national board adviser for Physicians for a National Health Program (PNHP), and coordinator with the Health Over Profit for Everyone campaign.

Dr. Ana Malinow is a primary care pediatrician in San Francisco and past President of PNHP.

Lee Stanfield is a steering committee member of Health Over Profit for Everyone, and founder of Single Payer Now Tucson.

Gov. Newsom calls on the federal government to empower California to enact a single payer system

In First Act as Governor, Gavin Newsom Takes on Cost of Prescription Drugs & Fights for Health Care for All

Office of Governor Gavin Newsom, January 7, 2019

In his first act as California’s 40th Governor, Governor Gavin Newsom announced a series of major, first-in-the-nation executive actions and budget proposals to lower prescription drug and health care costs for all California families and move California closer to the goal of health care for all.

(The Governor) Calls on the federal government to empower California to truly innovate: Governor Newsom has long said California should be the national leader in health care innovation. However, instead of cultivating and rewarding good ideas, current federal law hinders truly transformative innovation, such as a single-payer health care system. Governor Newsom sent a letter today to President Trump and Congressional leaders calling on the federal government to lift these limitations and, instead, empower states like California to enact transformative change that would allow California to develop a single-payer health system to achieve universal coverage, contain costs, and promote quality and affordability.

https://www.gov.ca.gov…

Office of the Governor, Letter, January 7, 2019

The Honorable Donald J. Trump
The Honorable Mitch McConnell
The Honorable Charles E. Schumer
The Honorable Nancy Pelosi
The Honorable Kevin McCarthy

(Brief excerpts from a 6 page letter)

Existing law permits only limited, piecemeal innovation – not the comprehensive reform necessary to address the myriad challenges that Californians face when navigating today’s health care system.

However, to address this ongoing cost crisis in health care in the most effective way, we must have the federal tools to support California’s ability to provide quality healthcare for everyone, financed through a single-payer model like Medicare. We must have the tools to innovate and expand the Affordable Care Act. even as we build towards a more comprehensive, universal system that works for patients, providers, and taxpayers alike.

A comprehensive solution to affordable health care will require both wisdom and courage, with States and the federal government working together as partners. First and foremost, I ask that you amend federal law to enable States to apply for Transformational Cost and Universal Coverage Waivers, empowering California to pursue transformative health care reform, such as a single-payer system. Further, I ask that you build on the progress of the Affordable Care Act, especially by bolstering the affordability provisions of the law.

Sincerely,

Gavin Newsom, Governor of California

https://www.gov.ca.gov…

Comment:

By Don McCanne, M.D.

Various federal policies and programs have prevented states from accomplishing transition into a state-level single payer system. In his first action, moments after his inauguration, Governor Gavin Newsom signed an executive order to create the largest single purchaser for prescription drugs and allow private employers to join the state in negotiating drug prices. Immediately after that, he signed a letter to the President and Congress asking that federal law be amended to permit a single payer financing system, like Medicare, in California. The letter also requested numerous innovations that would build on the progress of the Affordable Care Act.

There should be no confusion about priorities here. The political climate has improved for enactment of a national Medicare for All program, though not until after the next elections. Every effort should be made to set the stage for such an outcome. Because of the uncertainties of being able to accomplish that goal, willing states like California should move ahead with efforts to establish their own single payer systems, such as Saskatchewan did in Canada before the Canada Health Act was enacted. Since there are also uncertainties about the politics of establishing state single payer programs, it is appropriate to move forward with efforts to strengthen the benefits of the Affordable Care Act on a transitional basis. The primary caveat is that that we cannot allow lesser efforts to diminish in the least our resolve to establish a national Single Payer Medicare for All program. If the politics are not aligned, we need to change them.

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

Single-payer advocacy group elects Dr. Adam Gaffney as 2019 president

Dr. Gaffney to lead national physicians group through an “exciting but dangerous moment” for improved Medicare for all

FOR IMMEDIATE RELEASE: January 8, 2019
Contact: Clare Fauke, PNHP communications specialist, clare@pnhp.org

Physicians for a National Health Program (PNHP), a nonprofit research and educational organization, welcomes Dr. Adam Gaffney as its new president for 2019. Dr. Gaffney was unanimously elected at PNHP’s national meeting in November. PNHP now includes 22,000 members across 55 local chapters, as well as 65 chapters of the group’s student arm, Students for a National Health Program (SNaHP).

Dr. Gaffney is a pulmonary specialist at Cambridge Health Alliance / Harvard Medical School. He earned his bachelor’s and medical degrees from New York University, and a master’s in public health degree from the Harvard T.H. Chan School of Public Health. Dr. Gaffney completed his residency in internal medicine at Columbia University Medical Center, where he spent a year as chief resident. He also completed a clinical and research fellowship in pulmonary and critical care medicine at Massachusetts General Hospital.

Dr. Gaffney has led several major research and advocacy efforts within the single-payer movement. In 2016, Dr. Gaffney co-chaired the working group that developed the “Physicians’ proposal for single-payer health care reform.” He also co-chaired the Pharmaceutical Policy Reform Working Group which published “Healing an ailing pharmaceutical system: prescription for reform” in 2018.

Dr. Gaffney is a prolific writer and has published articles in prestigious medical and academic journals such as The Lancet, The BMJ (British Medical Journal), Chest, the European Respiratory Journal, and the Journal of Policy Analysis and Management, as well as mainstream news outlets such as the Washington Post, Guardian U.S., New Republic, Los Angeles Review of Books, Fortune, USA Today, Salon, CNN.com, Dissent, U.S. News & World Report, and Jacobin. His first book, “To Heal Humankind: The Right to Health in History” was published by Routledge in 2017.

“I’m honored to be taking on the role of PNHP president at such an exciting—but also dangerous—moment in the history of the single-payer movement,” said Dr. Gaffney.

Even though 70% of Americans support Medicare for all (including a majority of doctors), Dr. Gaffney expressed concern about political leaders undermining the policy goals of single-payer Medicare for all.

“We’ve been so successful in popularizing the idea of ‘Medicare for all’ that everybody wants in on the slogan—even if they have something completely different in mind, like a public option,” he said. “But tweaks won’t solve the fundamental problems of American health care: persistently high uninsurance, rising underinsurance, unaffordable drugs, narrow provider networks, and the growing corporate domination of health care that prioritizes profits over patients.”

Dr. Gaffney emphasized that an improved Medicare for all system cannot include a role for the bloated, profit-driven private insurance industry, which would undermine the goal of universal coverage. “The only way to achieve universal and comprehensive coverage is to eliminate the profits and administrative waste of the private insurance industry, which drains hundreds of billions of dollars from our health care system each year.”

A physician’s case for a single-payer health care

By John Perryman, M.D.
Daily Herald (Arlington Heights, Ill.), Jan. 8, 2019

Shane Patrick Boyle, a Type 1 diabetic living in Texas, had to move to Arkansas to care for his sick mother. His health insurance did not provide coverage in that state, so he set up a GoFundMe page to help cover his medical expenses until he could obtain new insurance. He got within $50 of his goal, rationing his insulin until he could obtain more.

Then he died from complications of his diabetes.

This tragedy and many others like it demonstrate some of the many failings of American health care.

The United States spends more on health care than every other nation on earth, yet is the only rich country that does not guarantee it for its citizens. Our high costs put incredible strains on patients, their families, businesses and the economy. Medical costs are a leading cause of personal bankruptcy and mortgage foreclosures.

In 2017, the U.S. spent $3.5 trillion on health care, or about $10,700 per person. This represents 18 percent of GDP, or one dollar of every six spent in the American economy. And costs continue to rise.

One might be comforted if we had the best health care in the world. While this is true for some of us, the performance of our system as a whole is severely lacking. Based on reports from the Organization for Economic Cooperation and Development for the year 2017, we ranked 26th in the world in life expectancy, 31st in infant mortality and 26th in maternal mortality. We are the only wealthy nation where our new moms are dying at increasing rates.

Even with passage of the now endangered Affordable Care Act, we still have 28 million uninsured Americans. Based on reports in medical literature, this leads to over 36,000 deaths a year. Tens of millions more are underinsured, meaning that they can’t afford the high out-of-pocket costs of their insurance plan. When faced with a serious illness or injury, they have the choices of going into debt, going broke or going without care. Meanwhile, insurers make billions in profits.

We pay more, but we get less. Where is the money going?

One place where we spend more than other nations is on administrative costs and insurer profits. Commercial insurers have overhead of 12-20 percent, compared to traditional Medicare, which is around 3 percent. All told, higher administrative costs add hundreds of billions a year to our health care tab.

High drug prices are another major contributor. If we negotiated and paid what most other nations do for medicines, we would save about $150 billion a year. The pharmaceutical industry has been raising drug prices relentlessly and made over $40 billion in profits in 2017.

Rising insulin prices killed Shane.

Faced with all of these considerations; the costs, the suffering and death, it is clear that something fundamental needs to change.

A single-payer, improved Medicare for All system provides the best way forward.

Under such a plan, as proposed in house bill HR 676, a government funded, national health insurance system is created. Providers would remain private. All people are provided comprehensive coverage from birth to death for medical, drug, dental, vision and long-term care. Mental health and addiction treatment are covered.

Additionally, there are no out-of-pocket expenses; no co-pays, deductibles or co-insurance.

One might logically ask how we could afford such a system. When factoring in administrative savings from reduced overhead, lower drug costs brought about by negotiating with pharmaceutical companies and other cost reductions, many studies indicate that our health care expenditures would actually be less than what we pay now.

Further evidence of this is demonstrated by what other nations with guaranteed coverage pay. Most of them spend around 11-12 percent of GDP, versus our 18 percent. If we were spending 12 percent of GDP, that would represent a trillion-dollar reduction per year.

More importantly, no one would be financially ruined by illness. No one would die because of a lack of coverage.

These are goals worthy of America. A single-payer system is the best way to achieve them.

Dr. Perryman is a physician in the Rockford area and co-president of the northern Illinois branch of Physicians for a National Health Program.

https://www.dailyherald.com…

Ocasio-Cortez explains how we pay for Medicare for All

Alexandria Ocasio-Cortez slams critics calling her agenda too radical

By Mark Moore
New York Post, January 6, 2019

Rookie Rep. Alexandria Ocasio-Cortez shot back at critics who say her progressive agenda is too radical and expensive, saying there’s nothing revolutionary about providing people with good jobs, health care and an education.

“When you can’t provide for your kids working a full-time job, working two full-time jobs. When you can’t have health care. That is not dignified,” Ocasio-Cortez told CBS’ “60 Minutes” in an interview that aired Sunday.

The 29-year-old newly minted House member is entering office with an ambitious agenda — including Medicare for all, tuition-free public college, and sweeping environmental protections.

“How are you going to pay for all that?” CBS’ Anderson Cooper asked her.

“No one asks how we’re going to pay for this Space Force. No one asked how we paid for a $2 trillion tax cut,” she said. “We only ask how we pay for it on issues of housing, health care and education. How do we pay for it? With the same exact mechanisms that we pay for military increases for this Space Force.”

https://nypost.com…

Selected prior analyses of single payer financing proposals:
https://pnhp.org…

Comment:

By Don McCanne, M.D.

We tend to try to provide an overly detailed answer when people ask how we would pay for health care for everyone through a single payer Medicare for All program. The appropriate answer in most circumstances is that we would pay for it like we do for all other publicly-financed programs – through equitable tax policies which would be affordable for each of us, less than most of us are paying now.

For more specific details, over the past three decades many single payer financing proposals have been analyzed (see link above). The recent Pollin PERI study is another example. They all show that the single payer model covers everyone while making health care affordable for each of us. That is what people need to know. Inevitably, opponents ferret out isolated details, which vary in each proposal, that are used to claim that the system is unaffordable while they fail to mention details of the fundamental design that, in fact, show that health care actually would be affordable for all.

Regardless, we should avoid dead end arguments over the specific details of these reports. We should hold firm on the general position that the efficiencies of a single payer system would offset the additional costs of covering everyone, and that it would be affordable for each of us through equitable public financing. Like Alexandria Ocasio-Cortez says, “we pay for it with the same exact mechanisms that we pay for (any other government program).”

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

Northern Illinois Doctor Believes Single Payer Is The Answer

Interview with John Perryman, M.D.

By Jenna Dooley
Northern Public Radio, January 4, 2019

John Perryman is a pediatrician with Mercyhealth in Roscoe. He sees patients struggling to afford medications. Some families, he says, disappear for stretches of time when they fall off an insurance plan. On this week’s Friday Forum, Jenna Dooley talks with Perryman about his view as well as from a major opponent of the idea.

Perryman is northern Illinois co-president of Physicians for National Health Program, or PNHP. The organization supports single payer insurance, also known as “Medicare for all.” In this scenario, the government handles the expenses so private plans become obsolete.

Perryman says the issue wasn’t on his radar until the Bernie Sanders campaign. As he did more research, he found the data compelling. Sanders didn’t make it to the White House but pieces of legislation remain calling for an overhaul of the U.S. healthcare system.

“It’s, I shouldn’t say perfect,” Perryman said. “It’s just so much better than what we have now in terms of outcomes, cost control, things of that nature.”

But implementing such a system could cost trillions of dollars.

Perryman argues the country is already spending more than the rest of the globe for healthcare and the outcomes don’t always compare well.

“You would be shifting funding from many private insurers to the government, but even now government spending accounts for about two thirds of healthcare spending already,” Perryman argues. “So we’re about two thirds of the way there already. When you factor in the efficiencies that single payer brings, the administrative efficacies, which are massive, savings on drug costs, savings on certain types of medical service costs, the savings will either equal or exceed the expenditure with adding more people and offering more services.”

Perryman notes there are major insurance companies and pharmaceutical companies with clout in Washington that do not support the single payer proposals and will stall anything that tries to make major changes.

There are a lot of jobs associated with those entities; Perryman acknowledges it is a significant number of workers.

“The number of jobs you’re talking about, I believe it’s about 1.7 million jobs,” Perryman acknowledged.  “But it’s about the number of people who get fired every month in this economy. And there are supports in place for those people, so they won’t just be left high and dry.”

There’s also the complexity of explaining a new system to patients. Perryman says the easiest way to explain the benefits of a single payer system is that is gives more control to patients.

“They could choose to see whoever they want to,” Perryman said. “The second is no out of pocket expenses. They don’t have a copay, they don’t have a deductible, anything like that. And that’s really important because that ends up limiting the amount of care that’s used when out pocket expenses are too high. So the two big practical things for them would be they don’t have to pay anything out of pocket and they can go where they want.”

So who or what pays for single payer?

“Taxes would have to make up for it,” Perryman said. “But with what we pay now in payroll taxes, we are already a good chunk of the way there. There would need to be some additional tax revenue somewhere. There are a variety of ideas in terms of what they would be. Perhaps a more graduated payroll tax, taxes on unearned income such as capital gains, state taxes, transaction taxes and stocks, things like that.”

Perryman says not overhauling the system leads to preventable deaths every day.

“What happens is [patients] don’t get the services they need. They don’t fill the prescriptions, they don’t go see the doctor. And there are tens of millions of people who fall into that category. So what ends up happening now with what we have is we have many people die and many people who suffer needlessly, or people who are bankrupted because of healthcare. So that’s why it has to change.”

But not everyone agrees that single payer is the magic bullet.

Robert Moffit is a senior fellow in Domestic Policy Studies at the Heritage Foundation, a conservative think-tank based in Washington D.C. He says it is a mammoth consideration because it would transfer all major decision making over healthcare to federal officials.

“In other words, there’s no alternative,” Moffit said. “If healthcare is an entitlement at the point of service, then, basically, government officials are going to make all the key decisions about who gets care, how they get care, when they get care, and under what circumstances they get care. So the key decisions in such a system are invariably political decisions.”

He fears medical decisions will be driven by budgets or government pricing outside of any kind of independent market.

“I think that that is likely to result in a highly impersonal and bureaucratic system of care delivery,” Moffit said.

Moffit acknowledges criticisms of corporate medicine, and says consumers should have more of a say in their healthcare plan.

“The fact of the matter is most Americans, for example, don’t pick their own health insurance plan or the benefits or the treatments or the medical procedures available to them,” Moffit said. “These decisions are all made by third parties.”

He argues that is the direct result of government policy which allows private insurers to make key decisions in what plans employers can offer.

“One of the arguments that my colleagues at the Heritage Foundation make is that we ought to basically change the fundamental structure of the system so people can pick and choose the kind of healthcare they want and carry it with them from job to job without a tax or a regulatory penalty,” Moffit said. “But the argument against third party payments is a good argument. The problem is that the Medicare bureaucracy is no more sensitive to consumer wants or needs than corporate health insurance.”

Moffit doubts any major overhaul will come in a single piece of legislation.

“The idea that you can solve the problems of the healthcare sector of the economy which is $3.5 trillion in one big bill — which is what President Obama really tried to do — is a huge mistake.” he said. “I don’t think that you can do it. I think the system is too big, it’s too complex to kind of try to do that. I do think we could make some very, very direct changes right now that would loosen things up a little bit and give people more options than they have today.”

For him, that includes giving states authority over insurance.

“Frankly, if California or Vermont or New York want to have a single payer system then they can do it,” he said. “But it will mean though that they’re not going to force the rest of us to finance it or bail them out.”

Moffit also belives individuals and families should have individual tax relief so they can purchase health insurance.

“And they can pick and choose the plan they want without a tax or a regulatory penalty, whether that plan is offered through their employer, or a trade association, or a religious organization, or any other type of group that would offer health insurance like a union or a fraternal organization,” Moffit said.

More consumer control, Moffit argues, would improve trust in the healthcare system.

“They can’t trust politicians. And I don’t think they can trust corporate executives,” Moffit said. “I think they should trust themselves and they should have the authority and the power over their own healthcare dollars and their own healthcare decisions. That’s a radical shift from what we have today where in fact you have no control over any of that.”

Like Perryman, Moffit says there are major obstacles to changing the existing structure.

“An awful lot of people do very well by defending and protecting the status quo,” Moffit said. “If you do not have to face intense competition for goods and services that you’re providing, that’s a pretty good situation.”

Both men agree systemic change is needed, but admit it will be difficult to achieve in a single sweep given competing interests in Washington D.C.

full audio:
https://www.northernpublicradio.org…

Pelosi supports holding hearings on ‘Medicare for all’

By Peter Sullivan
The Hill, January 3, 2019

Speaker Nancy Pelosi (D-Calif.) supports holding hearings on “Medicare for all,” her spokesman said Thursday, marking a major step forward for supporters of a single-payer health system.

Some Democrats have been talking about holding hearings on the issue, but Pelosi’s backing is seen as a boost for those efforts.

Pelosi had said last year only that Medicare for all would “have to be evaluated” and is “on the table.”

Rep. Pramila Jayapal (D-Wash.), the main sponsor of Medicare for all in the House, said Thursday that hearings would likely start in the Rules and Budget committees.

That would leave out the main committees with jurisdiction over the issue: Energy and Commerce and Ways and Means. The chairmen of those committees have not given their backing to Medicare for all, while the chairmen of Rules and Budget have.

Jayapal has been working to update the Medicare for all legislation and said Thursday she hopes to have draft text available “in the next week or two.”

She said she is hoping to eventually have hearings in the Energy and Commerce Committee, and has spoken to its chairman, Rep. Frank Pallone Jr. (D-N.J.), but that he has yet to give a commitment to hold hearings.

“He hasn’t committed that to me but I have the Speaker’s commitment that she will help me to do this,” Jayapal said. “And I spoke to Pallone and Pallone is not opposed, he just hasn’t said yes yet.”

Pallone threw cold water on the idea in November, but that was before Pelosi’s support for hearings.

“I’ve always been an advocate for Medicare for all or single-payer, but I just don’t think that the votes would be there for that, so I think our priority has to be stabilizing the Affordable Care Act, preventing the sabotage that the Trump administration has initiated,” Pallone said in November.

Jayapal said that the bill she is working on will not spell out how the measure would be paid for or which taxes will increase.

“This is really going to be a bill on what the system looks like,” she said.

Some lawmakers are awaiting the details of the new version.

Rep. Joe Kennedy III (D-Mass.) told The Hill in November that he was “hopeful” he could support the new version if issues with last year’s bill were worked out.

(In an 11/30/18 article in The Hill, Kennedy said that the bill needs more vetting and detail, but that he “absolutely” supports the idea of single-payer health insurance, which has the government provide health insurance for everyone. “There’s no doubt that our country needs to continue this progress towards making sure that everybody gets access to health care that you need, when you need it, at a price you can afford,” he said. “That has been something that’s one of the big driving motivators for me in my work here, it’s been something that obviously members of my family have been working on for a very long time.”)

Rep. John Yarmuth (D-Ky.), the chairman of the Budget Committee, said last year that he planned to hold hearings on Medicare for all.

“Chairman Yarmuth plans to hold a hearing this Congress on the various approaches to expanding coverage and making health care more affordable, which would include different Medicare for All options,” spokesman Sam Lau said Thursday.

Rep. Richard Neal (D-Mass.), the Ways and Means chairman, has been more open to the idea, saying in December that Medicare for all deserved “a conversation.”

Democrats, however, face pressure from their left wing on the issue, not only from Jayapal but from a class of new members including incoming Rep. Alexandria Ocasio-Cortez (D-N.Y.).

https://thehill.com…

Comment:

By Don McCanne, M.D.

The political process is evolving as it should. Every seat in the House was open for the midterm election, and the voters placed control of the House in the hands of a majority that supports comprehensive health reform, with many supporting specifically Medicare for All. It is entirely appropriate for the House to now initiate hearings on Medicare for All. Many voters and certainly several members of Congress would like to have more details on what Single Payer Medicare for All would look like and how it would work. The hearings thus can serve an important role in educating Congress and the public at large.

Since President Trump and the majority in the Senate state that they oppose Medicare for All, it is unrealistic to expect that such a program could be enacted in this session of Congress. But the next election is less than two years away and that is a very short time to inform and mobilize the political forces that would be essential for enabling enactment of Medicare for All.

The hearings will be part of the process, but it is important that we continue with our other advocacy activities as well. Special targets should include politicians who do not yet seem to understand why single payer is an imperative, and politicians who profess to be advocates but who could be swayed to support detrimental reform policies in a perversion of the process of political compromise. We need to continue to work with politicians who are already fully on board, but we should also continue our efforts to educate those who say they are opposed, if, for no other reason, they might accept defeat more readily were they to understand the clear social benefit of Medicare for All. Also we cannot let up in the least in our efforts to educate the public at large. Grassroots efforts will continue to be an essential component of the reform effort.

As a 501(c)(3) organization, PNHP does not support any individual politician or political party. We encourage all politicians, regardless of political affiliation, to learn about and support a single payer national health program, an improved Medicare for all, that would ensure comprehensive, affordable health care for everyone.

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