By Elizabeth R. Rosenthal, M.D.
New York Times, Letters, March 5, 2019
To the Editor:
In the near future Medicare for all will join the heap of other impossible dreams that came true: women’s suffrage, Social Security, Medicare, integration and gay marriage.
All we need are bold leaders with imagination and a strong grass-roots movement to support them. They are on their way!
Dr. Rosenthal, a retired dermatologist, is on the board of Physicians for a National Health Program-NY Metro Chapter.
Fox Business, March 1, 2019
Physicians for a National Health Program President Dr. Adam Gaffney discusses why the U.S. should move to single-payer health care system.
Nine minute Fox video:
https://video.foxbusiness.com…
By Don McCanne, M.D.
Considering that most of the Fox panel members were more intent on providing their own right-wing messages against single payer health care, PNHP President Adam Gaffney is quite effective in giving quick, succinct responses on Medicare for All even as he has to override the squawking Fox magpies as they try to disrupt him.
Great job, Adam.
Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.
PNHP president Dr. Adam Gaffney appeared on “Bulls & Bears” on Fox Business on March 1, 2019. He shared the stage with five single-payer skeptics and pushed back against the myths, anecdotes, and distortions they trotted out in order to make the case for improved Medicare for all.
March 1, 2019
Dr. Bohmfalk details the history of fire departments and suggests that, if we can move from exploitative private entities to public entities that serve the common good, then we can do the same in health care. Hosted by Joseph Sparks. Additional episodes will be uploaded twice monthly. Subscribe in iTunes, or access a complete archive of the podcast, below.
By Tessa Stuart and Jann S. Wenner
Rolling Stone, February 27, 2019
Rolling Stone: There’s a lot of debate on the question of single-payer, Medicare for All — we’ve heard that expression just recently. What do you think should be done? Where do you want this to go?
Nancy Pelosi: This is a very interesting debate, and in any debate, as I start off this conversation, you must define your terms. Let’s stipulate to some facts here: When we passed the Affordable Care Act, for us, it was a pillar of health and economic security for America’s working families — 125 million families got better benefits, more reasonably priced, with no annual or lifetime caps, and with no prohibition if you had pre-existing consumer protections. We were on a good path, and when [Republicans] took over [Congress], they let certain things expire. People say, “Well, it’s not doing this or that.” Well, it did until it expired. Restore the reinsurance. Elect more Democratic governors so that Medicaid can be expanded and millions more people can have access in an affordable way. I myself wanted to have the public option. We couldn’t get that through the Senate, but we enabled states to do a public option if they want. This made as drastic a difference as day and night. Now, of course, everyone isn’t covered because in certain states they didn’t expand Medicaid, so now [people are proposing] Medicare for All.
When they say Medicare for All, people have to understand this: Medicare for All is not as good a benefit as the Affordable Care Act. It doesn’t have catastrophic [coverage] — you have to go buy it. It doesn’t have dental. It’s not as good as the plans that you can buy under the Affordable Care Act. So I say to them, come in with your ideas, but understand that we’re either gonna have to improve Medicare — for all, including seniors — or else people are not gonna get what they think they’re gonna get. And by the way, how’s it gonna be paid for?
Now, single-payer is a different thing. People use the terms interchangeably. Sometimes it could be the same thing, but it’s not always. Single-payer is just about who pays. It’s not about what the benefits are. That is, administratively, the simplest thing to do, but to convert to it? Thirty trillion dollars. Now, how do you pay for that?
So I said, “Look, just put them all on the table, and let’s have the discussion, and let people see what it is. But know what it is that you’re talking about.” All I want is the goal of every American having access to health care. You don’t get there by dismantling the Affordable Care Act. As Californians have said to me, “We get billions and billions of dollars out of the Affordable Care Act coming into California. Now they want to get rid of that.” How are they gonna go to single-payer in California without the money from the Affordable Care Act? Anyway, this is not a bumper-sticker war — this is a complicated issue.
By Aida Chavez and Ryan Grim
The Intercept, March 1, 2019
There is Twitter, and there is the real world. Occasionally, the two meet.
It happened over the last week, starting with a visit by a group of children and young activists with the Sunrise Movement to Sen. Dianne Feinstein’s Bay Area office last Friday. Their exchange — about whether the California senator would vote for or co-sponsor the Green New Deal resolution authored by Rep. Alexandria Ocasio-Cortez, D-N.Y., and Sen. Ed Markey, D-Mass. — went viral. It led to a turbocharged debate about whether the video had been edited, but it also brought with it a tangible change in the halls of Congress.
In her now-infamous response to the Sunrise activists, Feinstein said she was in the process of drafting her own, more moderate resolution on confronting climate change that she felt would have a better chance of passing in the GOP-run Senate. The viral Twitter clip, which has racked up more than 9 million views, was the first time many people had heard of Feinstein’s alternative resolution, and when climate activists learned about it, they went into overdrive to stop it. Feinstein, facing pressure, this week elected to shelve it.
The senator’s reversal was one of several moments that has gone unnoticed in the fight for the Green New Deal, as young activists face skepticism from entrenched environmental groups and field regular criticism for their practice of protesting Democrats. What those critics miss is that it was a protest of a Democrat — then-prospective House Speaker Nancy Pelosi — that put the Green New Deal on the map, and now a second action against a Democrat has yielded a second success for the activists.
On Tuesday, the Sunrise Movement led a nationwide day of action, holding office visits, rallies, and office takeovers across 34 states to pressure lawmakers from both parties, including Senate Majority Leader Mitch McConnell, R-Ky., to support Ocasio-Cortez and Markey’s resolution. That their conversations with Democrats have borne more fruit should be instructive as they try to gin up more support the Green New Deal.
When hoping to stop a bold piece of legislation that has broad public support, one of the oldest moves on the Senate floor is to introduce a different version that is claimed to be just as good, but more reasonable. “I’ve been in the Senate for a quarter of a century, and I know what can pass, and I know what can’t pass,” Feinstein said last week.
On Monday, the Sunrise Movement, in the form of roughly 250 Kentucky high schoolers, occupied McConnell’s Senate office, resulting in 35 arrests.
While the sit-in got little attention in the press, it appeared to have gotten McConnell’s. The majority leader, who is up for re-election in 2020, had recently been eager to put the Green New Deal on the Senate floor. All of a sudden, however, he suggested that it would come up at some point before the August recess.
“This wouldn’t have happened without thousands of people across the country pressuring senators of both parties. Two weeks ago, McConnell was excitedly telling the media about his plans. Now, he seems happy to let this vote be forgotten,” said Varshini Prakash, executive director of Sunrise.
By Don McCanne, M.D.
Considerable enthusiasm has been generated amongst single payer Medicare for All supporters with the introduction of Pramila Jayapal’s H.R. 1384 – The Medicare for All Act of 2019. As expected, the opponents are coming out of the woodwork. Perhaps most disappointing have been the responses of those who would prefer to continue to support the Affordable Care Act and add a public option – a Medicare buy-in for some.
In an effort supposedly to keep the Democratic coalition together, Nancy Pelosi and other Democratic leaders are attempting to suppress the Jayapal bill using the rhetoric of the Republicans – “How’s it gonna be paid for?” – knowing that it could not pass in this session of Congress anyway with Republican control of the Senate and The White House. To protect the moderate Democrats in red districts they are advocating for legislative proposals that would support the current, highly deficient system. In so doing they are passing up a tremendous opportunity to educate not only the public at large but also their colleagues in Congress.
Nancy Pelosi and Dianne Feinstein are two seasoned California politicians who believe they have mastered the political process (and, in many ways, they have). But witness Feinstein’s incident that shows that it is never too late to learn new lessons. (As an octogenarian physician/policy analyst, I’m still learning new lessons every day).
Feinstein met with a group of primary and secondary level students who enthusiastically presented her with cogent arguments in support of the Ocasio-Cortez/Markey Green New Deal resolution. In a video that went viral, Feinstein blundered through a surprisingly somewhat rude response and then presented the students with her own pablum version of a green resolution. It did not take her long to realize that her response fell far short of that of a master politician, and so she elected to shelve her resolution. This proved to be a teachable moment for Dianne Feinstein. She may not endorse the Green New Deal, but at least she has more respect for it and for its supporters. The students had something important to say, and much of the world agreed with them, thanks to the viral distribution of their message.
We are seeing a similar process in the House of Representatives right now. The Jayapal bill is precisely the reform we need for our overpriced and underperforming health care system – a system so large that it is approaching one-fifth of our economy. And yet several members of Congress are producing pablum bills to displace the legislation that we need, and Nancy Pelosi is supporting them. As she says, “All I want is the goal of every American having access to health care. You don’t get there by dismantling the Affordable Care Act.” Further she says, “When they say Medicare for All, people have to understand this: Medicare for All is not as good a benefit as the Affordable Care Act.” Has she been practicing composing Trumpisms? The Jayapal Medicare for All Act is vastly superior to ACA – absolutely no contest!
The Green New Deal will not pass in this session of Congress. Neither will the Medicare for All Act of 2019. But we cannot replace these concepts with pablum and walk away. We need to take a lesson from the children who confronted Dianne Feinstein and stand up for the cause. Health security and even our lives are dependent on it. Fight for single payer Medicare for All and reject emasculated substitute measures that would have hardly even a nominal impact on the problems before us.
Activism! Now! Fight unrelentingly for H.R.1384!
Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.
By Jeffrey Sachs
CNN, March 1, 2019
Rep. Pramila Jayapal introduced a sweeping Medicare for All (MFA) bill on Wednesday (H.R. 1384), and the national debate on healthcare is bound to intensify through the 2020 election. Voters rank healthcare costs as their second most important priority, just after the economy. The political fate of MFA will likely depend on one key question: Will it reduce healthcare costs while preserving the freedom to choose health providers?
If properly structured, MFA can do that: cut costs while improving choice.
Medicare for All has come a long way since Sen. Bernie Sanders launched his 2016 presidential campaign on that theme, while fellow Democrats ran from the label. Sanders also faced the wrath of mainstream pundits like Paul Krugman, who described Sanders’ healthcare plan as “smoke and mirrors.” Now, every major Democratic Party candidate endorses the label, (though they will certainly differ on the details) and Sanders could well become president in 2021 on the basis of his clear and persistent MFA advocacy.
No doubt the debate will become heated, even shrill. We are talking about serious money, and the largest single sector of the American economy. Healthcare outlays in the United States account for nearly 18% of the country’s gross domestic product. Profits are soaring in the private healthcare and pharmaceutical industries, both of which will fight fiercely against MFA. President Donald Trump has weighed in, declaring that Democrats are “radical socialists who want to model America’s economy after Venezuela.”
While former President Barack Obama spoke out in favor of a single-payer plan, he avoided the battle back in 2009 with the Affordable Care Act. And by making health insurance available to millions more Americans, the Affordable Care Act allowed private industry to raise prices given the increase in demand. The result is that Obamacare expanded overall coverage, and provided hugely popular guaranteed coverage for pre-existing conditions, while avoiding any decisive steps on cost containment.
MFA picks up at that point. Real cost containment will be the critical issue that either makes or breaks each MFA proposal.
Americans currently pay around $10,000 per person per year in health outlays, compared with roughly half that amount in other high-income countries such as Canada, Japan, the Netherlands, or Sweden. The reasons have been debated and studied in detail. Do Americans use more and better healthcare and therefore also pay more? Alas, no. Americans use roughly the same or less healthcare, but pay far more for health services including drugs, hospital stays, and medical procedures such as an MRI.
The Canada comparison
A comparison of healthcare costs between the US and 10 other high-income countries allows a detailed comparison of the US and Canada, the most relevant peer country. According to the comparative data, the US spends 17.8% of GDP compared with Canada’s 10.3%, amounting to $9,403 per person in the US compared with Canada’s $4,641.
All Canadians are covered by the healthcare system, while 10% of Americans lack public or private insurance coverage. Total pharmaceutical spending per person per year averages a whopping $1,443 in the US, compared with $613 in Canada.
For example, the cholesterol drug Crestor is $86 per month in the US, and $32 in Canada; the arthritis drug Humira is $2,505 in the US, compared with $1,164 in Canada. Yet despite the much higher health spending per person, life expectancy in the US is 78.8 years, while in Canada it is 81.7 years.
The article reaches the following conclusion: “The United States spent approximately twice as much as other high-income countries on medical care, yet utilization rates in the United States were largely similar to those in other nations. Prices of labor and goods, including pharmaceuticals, and administrative costs appeared to be the major drivers of the difference in overall cost between the United States and other high-income countries.”
Huge private costs in the US
US private health insurance costs are out of sight. A typical US family of four covered by employer-based health insurance pays, in total, around $28,000 per year, taking into account the insurance premium paid for by the employer out of the worker’s total compensation, the premium paid directly by the household, and all of the extra costs, including deductibles, co-payments, and out-of-network payments. The cost of healthcare is crippling working-class families, which may explain why it is at the top of the political agenda.
What is the reason for these extraordinary costs in the US? Astronomical administrative costs, for one, are the result of countless and conflicting payments systems facing almost any patient who visits the doctor’s office or hospital. One study in 2014 suggested that America’s extraordinarily complicated multi-payer system leads to administrative costs for billing and insurance that are five times the costs of a simplified payment system such as Canada’s.
The second is the soaring monopoly profits and sky-high salaries along the entire private supply chain, from drug manufacturers to hospitals. The drug companies use their extraordinary monopoly power, whether due to patents or FDA approvals on out-of-patent drugs, to overcharge Americans with markups that are sometimes hundreds of times the production cost of the medicines. And private providers are a highly concentrated industry in most metropolitan areas.
With the mergers and closures of hospitals during the past 20 years, driven by for-profit medicine, this market power has soared, and so too have monopoly profits and healthcare costs facing consumers.
Check out the CEO compensation of the big systems providers — $59 million for Aetna, and $44 million for Cigna in 2017 — or the salaries of the executives of the “not-for-profit” hospitals in your area, often running several million dollars per year.
For these reasons, healthcare costs in the US could be brought down by cutting three main areas: administrative costs, drug prices, and monopoly profits of private insurers, which in turn could be achieved by much lower reimbursement rates for medical services and more effective contracting. Recent studies (here and here) have shown prospective savings on national health expenditures resulting from Medicare for All would save trillions of dollars over 10 years.
Smart cost control
The Jayapal bill is smart on cost control. It would have Medicare negotiate with pharmaceutical companies to drive drug prices down, with the threat of removing the monopoly rights of patents if the drug company doesn’t reach a reasonable agreement on prices. (Technically, the government would issue a compulsory license to competitors). It would have Medicare set an annual budget with hospital providers. This annual budget would focus on healthcare provision rather than wasted time and expenses on billing. It would not permit astronomical management salaries and super-profits.
By wringing massive administrative costs, monopoly profits, and sky-high salaries out of the healthcare system, costs would be slashed, with the savings passed on to households. Remember, if the US paid the same share of income as our peer countries like Canada, the total saving would be on the order of 6% of GDP (from 18% today to around 10-12% as in the peer countries). With a GDP of around $62,000 per person in the US, 6% of GDP saving comes to a cost saving of around $3,700 per person, or around $14,800 for a family of four.
Such savings wouldn’t be achieved in full, or even in the early years. The pushback from industry against cost-cutting will be fierce. Moreover, the sheer inertia of existing costs, prices, budgets, and administrative systems cannot be doubted. But what can be said with confidence is that a well-designed MFA system would put the US on a path toward the reasonably priced healthcare systems of other comparable countries.
Moreover, MFA would allow us to rethink healthcare delivery to take into account perhaps the biggest feasible benefit in health outcomes. America’s current disease burdens often reflect unhealthy life circumstances — great stress, obesity-inducing diets, lack of exercise, drug dependence, and others. These are social ills turning into medical ills.
A fairer, more balanced, health system based on good health rather than maximum profits would turn its attention to helping Americans live healthier lives.
Getting MFA through the political process won’t be easy. The drug industry is one of America’s top lobbies and campaign contributors, befitting a massive economic sector rolling in profits. Lobbying outlays in 2018 across the health sector are estimated at around $549 million and campaign funding in the 2018 election cycle at $255 million. The industry will be ready to fight an MFA plan with guns blazing, and trot out the usual arguments: stop socialized medicine, save personal choice, don’t put yourself into the hands of government bureaucrats, don’t let American become Venezuela — you name it.
Yet Sanders and Jayapal and their many colleagues who have come on board now (including 106 co-sponsors) have the best chance to prevail in our modern history. Americans know that the healthcare system is rigged, and they will support a new system that convincingly shows the way to fair and reasonable healthcare costs.
Jeffrey Sachs is a professor and director of the Center for Sustainable Development at Columbia University.
By Ryan Grim
The Intercept, February 27, 2019
The Medicare for All legislation unveiled Wednesday by Rep. Pramila Jayapal, a Democrat from Washington state, was written with the help of a broad swath of lobbyists and special interest groups, if perhaps not the kind associated with typical health policy legislation on Capitol Hill.
The key outside groups involved in the drafting included nurses, doctors, disability rights activists, and advocates for the elderly, as well as public interest organizations such as Public Citizen and the Center for Popular Democracy.
Along with Consortium for Citizens with Disabilities, the main groups involved in drafting the legislation were National Nurses United, a major nurses union that has long been on the forefront of the fight for single payer; Physicians for a National Health Program; the Center for Popular Democracy, which organizes poor and marginalized communities; Public Citizen; and Social Security Works, which represents more than a million progressive seniors who support expanding the Medicare coverage they have to the rest of the population.
Meanwhile, the insurance and pharmaceutical industries played little to no role in the drafting process — an anomaly on Capitol Hill. Their marginalization in the process represents a major departure from the approach taken with the Affordable Care Act and reflects the type of bill being drafted: one less concerned about the profits, or even survival, of interest groups like insurers and more concerned with delivering care to the largest amount of people in the most cost-effective way.
Noticeably absent from the central drafting room was the Center for American Progress, the leading center-left think tank, which reflects a reticence by many in the progressive policy community to embrace something as sweeping as Medicare for All. The Center for American Progress, instead, has pushed what it calls “Medicare Extra for All,“ an expanded version of a public option that people could buy into.
By Don McCanne, M.D.
Special interests yes, when that interest is for the all of the people and their health, but we need to keep out the “usual suspects.”
Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.
By Shefali Luthra
Kaiser Health News, February 27, 2019
Members of the House on Wednesday offered their version of a “Medicare-for-all” bill that is broader than what’s been put forth by Sen. Bernie Sanders (I-Vt.), whose 2016 presidential run pushed the issue into the political mainstream.
Rep. Pramila Jayapal (D-Wash.) and Rep. Debbie Dingell (D-Mich.) unveiled the “Medicare for All Act of 2019,” which redefines what the change in health care coverage might mean. The specifics included in the bill could play a role in the upcoming Democratic presidential primary campaign because candidates seeking support from the party’s progressive wing leverage the phrase. But often, they use it to mean various things.
Is this bill so different from Medicare-for-all proposals that have come before? And why would those differences matter? Here are the essential takeaways:
In terms of the policy 411, the Jayapal-Dingell bill includes provisions not in other proposals.
In many ways, the proposal sounds familiar: The government would establish a health plan that pays for basically all forms of medical care for all citizens. That’s how it gets the moniker “Medicare-for-all.”
Under this plan, patients would not be responsible for any cost sharing of medical expenses, and the government coverage would include hospitals, doctors, preventive care, prescription meds and dental and vision care. Private insurers would not be allowed to sell plans that compete with the government program.
Senior citizens would be folded into the new Medicare plan, which would be more generous than their current coverage, and the government would make sure any medical care they are getting is not disrupted. The bill leaves two other government health care payers intact: the Veterans Health Administration and the Indian Health Service. Beneficiaries enrolled in these programs would have a choice of enrolling in the new Medicare-for-all plan or sticking with their current coverage.
Just like the Sanders bill, the House legislation covers what it calls “comprehensive reproductive health.” Backers say it is meant to cover abortion — a controversial provision. Right now, government-funded health plans are legally prohibited from providing funds for abortions.
There are differences, too. For one, the transition to the new Medicare-for-all system would take place over two years, which would be a fast turnaround for a substantial task. Sanders’ bill suggested a four-year transition.
The biggest difference: This House vision of Medicare-for-all would also cover long-term care. That isn’t part of the Sanders bill, and it is not covered by Medicare. But for people with disabilities and the elderly, it’s a significant benefit — and one that can get very expensive to pay for out-of-pocket. (The Affordable Care Act included a long-term care provision that was eventually scrapped because of its high cost.)
The House bill also would take a swipe at high prices for prescription drugs by empowering the government to negotiate prices directly with manufacturers and to take away and reissue drug patents if such efforts faltered. This idea, known as “compulsory licensing,” has appeared in drug-pricing bills, but not in other Medicare-for-all legislation.
And the bill wades into one of the hottest Medicare-for-all controversies: the role of private health care. Notably, it permits it. Private plans can cover services not included in the single government health plan. Doctors can also refuse to participate in the program and charge patients cash for medical treatment instead.
“Whether there’s someone out in Beverly Hills who sees the stars and doesn’t partake — that would be possible,” said Dr. Adam Gaffney, a doctor and president of Physicians for a National Health Program, a single-payer advocacy group that supports the legislation. “The way the whole program is structured is to really make it such that that’s a very insignificant overall phenomenon.”
And the legislation takes on wonkier questions, like health care costs — proposing so-called global budgets that set a firm amount the federal government would pay for hospitals, for instance, as a strategy to bring down spending.
Still, the legislation leaves a lot of meaningful details open to interpretation.
Three big ones: what precisely would be covered, what doctors would be paid and how the program would be financed.
Generally, Medicare-for-all would provide “comprehensive benefits,” accounting for health care needs as “medically necessary or appropriate.” That means covering hospital and doctor visits, but also, for instance, mental health, maternity services, addiction treatment, pediatrics and medications.
Where it gets tricky is determining which specific services qualify as “necessary.” Sometimes that’s obvious — insulin for diabetics or a cast for a broken leg.
In other cases, it’s not as clear. Examples include politically controversial treatments, like gender confirmation surgery. Many experts do say the procedure is an important option for people with gender dysphoria. But specific components of it are sometimes deemed cosmetic or unneeded — often by those skeptical of the treatment to begin with.
There are also reconstructive surgeries that provide medical value, but may be deemed cosmetic.
The Department of Health and Human Services would have significant discretion in interpreting what specific services are “medically necessary.” That means political leanings or scientific debates could sway what’s covered, even from administration to administration.
“Reasonable people could disagree on certain things,” Gaffney acknowledged.
The legislation also spells out steps for determining how to pay doctors — a tricky issue, since doctors often complain that traditional Medicare pays them less than does private insurance. But the bill doesn’t set up a reimbursement system.
Of course, there’s the question of how the U.S. pays for the new program. Studies suggest Medicare-for-all would bring down national health care costs. Currently, though, much of that health spending is borne by the private sector. Under the Jayapal-Dingell bill, the money would have to come out of taxpayer dollars.
That would mean new taxes, and that’s a subject that does not appear anywhere in the Jayapal-Dingell bill. (Jayapal has said she will put out a separate list of potential taxes that could finance her single-payer proposal. Sanders also used this strategy — a separate list of “pay-fors” — to make a case for his bill.)
The bill could resonate throughout the 2020 campaign.
The House bill keeps a spotlight on the Medicare-for-all issue — requiring Democratic presidential primary candidates to answer more questions and spell out stances on this particular policy.
That could create some land mines. Medicare-for-all is controversial, and already major health industry groups have ramped up opposition to the broad idea. This bill’s specific provisions, such as its coverage of abortion, would add more adversaries. Its long-term care coverage would further drive up its multitrillion-dollar price tag
But Robert Blendon, a health care pollster at the Harvard T.H. Chan School of Public Health, pointed out that addressing concerns such as the long-term care benefit could add to the measure’s political muscle. It could make the idea more attractive to older voters, who otherwise might be hesitant to change their coverage but who do turn out disproportionately to vote in primaries.
That dynamic, he said, could skew primary results to favor candidates who endorse Medicare-for-all, as opposed to more moderate Democrats who have distanced themselves from the issue. (In a general election, he noted, costs could certainly diminish that support.)
“The long-term care piece is unbelievably significant,” he said. “It surely will help [progressives] with older voters.”
Remarks by Adam Gaffney, M.D., M.P.H.
Introductory Press Conference, H.R. 1384, February 27, 2019
I am so happy to be here today, speaking as a representative of Physicians for a National Health Program, an educational and advocacy organization of physicians across the country who know first-hand that a single-payer Medicare for All system is what this country needs.
I’d like to thank Congresswoman Pramila Jayapal for her leadership on this, and everyone here who’s joining together for this critical cause at this crucial moment.
As physicians, we see daily the harm that a for-profit, fragmented, privatized health care system imposes on our patients. We see the uninsured — the 29 million people without any health coverage — who go untreated, who develop unnecessary complications, who even die as a consequence.
We see the under-insured — the 44 million people who have coverage, but with holes and gaps so big it’s as if they’re not covered at all. These are people who go without needed care. People with asthma who don’t take their inhalers because they can’t afford the prescription. People with heart disease who don’t fill their prescription at all because they can’t afford it. People with multiple sclerosis, mental illness, or cancer who can’t get the care they need because the copays and the deductibles are too high.
Meanwhile, as physicians, we are encumbered with never-ending billing tasks and administrative tasks that take us from the bedside, that take us from the patient, from the practice of medicine itself. We see a corporate calculus replacing the fundamental calling of the medical profession and the profit motive superseding medical science and justice.
No longer. A Medicare for All system would guarantee health care for everyone in America, replacing the current welter of fragmented, inadequate plans that deny claims with universal coverage that is not only comprehensive, but first-dollar; not only portable, but seamless over life; that allows you to see the doctors and go to the hospitals that you want, not the ones that your insurance company tells you you have to go to.
At the same time, such a system would allow us as physicians to again focus on the care of patients, away from billing and back to the beside, which is why we became doctors to begin with.
Thank you so much, everyone, for joining together. The time for half-measures is over. Medicare for All, a single-payer universal health care system, is the name of the game and we’re going to win it!
more information on H.R. 1384:
pnhp.org/housebill
By Robert King
Modern Healthcare, February 27, 2019
House Democrats on Wednesday rolled out an ambitious proposal to extend Medicare to all Americans, eliminate private insurance and drastically overhaul reimbursement for doctors and hospitals.
Rep. Pramila Jayapal (D- Wash.) told reporters that the goal of the Medicare for All Act of 2019, which has more than 100 co-sponsors, is to completely overhaul the U.S. healthcare system and convert it to a government-run entity.
The legislation provides an outline of the thinking of some congressional Democrats on “Medicare for All,” an issue that has been highly debated among Democrats running for president in 2020.
“We believe that the market is broken and that is the core idea that we would like to fix,” She said on a call with reporters Tuesday. “We love to buy our coffee from Starbucks…but there are some things that should not be provided through the for-profit marketplace and we believe healthcare is one of them.”
The legislation would expand Medicare to provide insurance coverage to every American and would ban private insurers from offering any benefits that duplicate the benefits covered by Medicare, likely eliminating most of the private insurance market.
It would also drastically revamp how hospitals and doctors get reimbursed by Medicare.
Each hospital would get an annual prepaid budget to cover all healthcare costs for the facility for the given year. HHS would appoint regional directors that would oversee all hospitals and doctor offices in a specific region.
The director and the hospital would negotiate the budget. Nursing homes, health centers, home health agencies and independent dialysis facilities would also get an annual budget.
The budget would be determined by a host of factors that include the historical volume of services the hospital provided in the area, Jayapal told reporters.
“It is a common practice of most of the developed countries around the world and it has been very successful,” she said of global budgets. “It increases accountability over hospital spending.”
The annual budget could also be changed if there are certain circumstances, Jayapal said.
Doctor offices would still be paid under a fee-for-service model, however some physicians included in certain group practices can opt to get a salary from a hospital or another provider that gets a global budget.
Jayapal expects that around one to two million people would be out of work if the legislation becomes law because of the elimination of most private insurance. She said that 1% of the global budget for hospitals will go to a fund to provide services to displaced workers in the insurance industry.
“This could include pension benefits, include any number of things that would take care of these workers as we transition,” Jayapal said. “I do think there will be a boon to the economy once we get healthcare under control.”
Jayapal added that a private insurance industry could still exist, but they couldn’t cover the same benefits as Medicare, which include coverage of prescription drugs, hospital and physician services and long-term care services. However, an insurers could cover services such as cosmetic surgery or other types of elective benefits.
Healthcare sector lobbyists are expected to put up a vigorous fight against any “Medicare for All” proposal.
America’s Health Insurance Plans, the top lobbying group for the insurance industry, issued a pre-emptive strike on Tuesday in anticipation of the bill’s introduction.
“The vast majority of Americans are satisfied with the coverage they have today,” the group said in a statement. “They have choice and control over their coverage, options, and treatment.”
Jayapal said that money from industry groups would be the biggest obstacle to getting the bill through Congress.
But it’s unclear whether the bill will come up for a vote in the Democratic controlled House. Jayapal said that the legislation will first get a hearing in the House Rules Committee and in the House Budget Committee.
The bill has been referred to the House Energy & Commerce Committee and Ways & Means Committee, which both have healthcare jurisdiction. So far no hearing has been scheduled.
Physicians for a National Health Program, February 27, 2019
WASHINGTON, D.C. – Physicians for a National Health Program (PNHP), a nonprofit research and education organization whose 23,000 members support single-payer national health insurance, endorses the Medicare for All Act of 2019, filed today by its lead sponsor Rep. Pramila Jayapal (D-Wa.) along with more than 100 co-sponsors.
“Accept no substitutes — only single-payer, Medicare for All can fix the grave dysfunctions and injustices of the American health care system,” said Dr. Adam Gaffney, PNHP’s president and a critical care physician and faculty member at Harvard Medical School. “Congress shouldn’t be distracted with incremental plans like a Medicare buy-in or public option. The only way to achieve universal and comprehensive coverage is to eliminate the profits and waste of the private insurance industry, which drains hundreds of billions of dollars from our health care system each year.”
The Medicare for All Act would improve Medicare by providing comprehensive, first-dollar health benefits inclusive of dental, vision, hearing, mental health, and long-term care, as well as the full spectrum of women’s reproductive health care. It would then expand Medicare to cover everyone living in the U.S., regardless of age, income, or employment. Coverage would be lifelong, portable, and seamless; services would be covered free at the point of service without copays or premiums, which serve only to keep patients from the care they need.
Experts predict that single-payer Medicare for All would would save more than $600 billion annually by slashing the administrative waste of private insurance and the paperwork insurers impose on hospitals and doctors ($504 billion) and bargaining down drug prices ($155 billion). These efficiencies would free up enough money for universal, first-dollar coverage without any overall increase in U.S. health spending, while controlling its growth over time.
Currently, the U.S. spends $3.65 trillion per year on health care, double the per-capita spending of other industrialized nations that provide universal coverage. Without single-payer reform, U.S. health spending is projected to reach $5.96 trillion — 19.4 percent of GDP — by 2027.
“Even single-payer opponents admit that, compared to Medicare for All, the status quo will cost U.S. $2 trillion more over the next decade,” said Dr. Claudia Fegan, a Chicago-based internal medicine physician and PNHP national coordinator. “How do they propose we pay for that?”
Dr. Fegan added that although the Affordable Care Act — which relies on a system of private and employer-provided insurance — expanded coverage to many, it failed to reduce the proportion of bankruptcies driven by medical problems, while doing little to expand the health security of all Americans.
While endorsing the Medicare for All Act as a strong single-payer bill, PNHP notes an area for improvement: Since for-profit providers (including hospitals, dialysis centers, nursing homes, home care agencies, and hospices) have been shown to provide inferior care at inflated prices, PNHP recommends moving to a fully nonprofit health system in addition to the bill’s current constraints on profit-making. To achieve an orderly transition of for-profit providers to nonprofit status, the doctors’ group recommends a bond-funded buyout of investor-owned facilities.
Dr. Gaffney welcomed this moment as a key step forward in the movement towards a sustainable, just health care system for the nation. “The system is failing both physicians and patients,” he said. “We can do better. In fact, we have to: The health and future of our nation hangs in the balance.”
Physicians for a National Health Program (www.pnhp.org) is a nonprofit research and education organization whose 23,000 members support single-payer national health insurance.
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FOR IMMEDIATE RELEASE: February 27, 2019
Contact: Clare Fauke, communications specialist, clare@pnhp.org or 312-782-6006
WASHINGTON, D.C. – Physicians for a National Health Program (PNHP), a nonprofit research and education organization whose 23,000 members support single-payer national health insurance, endorses the Medicare for All Act of 2019, filed today by its lead sponsor Rep. Pramila Jayapal (D-Wa.) along with more than 100 co-sponsors.
“Accept no substitutes — only single-payer, Medicare for All can fix the grave dysfunctions and injustices of the American health care system,” said Dr. Adam Gaffney, PNHP’s president and a critical care physician and faculty member at Harvard Medical School. “Congress shouldn’t be distracted with incremental plans like a Medicare buy-in or public option. The only way to achieve universal and comprehensive coverage is to eliminate the profits and waste of the private insurance industry, which drains hundreds of billions of dollars from our health care system each year.”
The Medicare for All Act would improve Medicare by providing comprehensive, first-dollar health benefits inclusive of dental, vision, hearing, mental health, and long-term care, as well as the full spectrum of women’s reproductive health care. It would then expand Medicare to cover everyone living in the U.S., regardless of age, income, or employment. Coverage would be lifelong, portable, and seamless; services would be covered free at the point of service without copays or premiums, which serve only to keep patients from the care they need.
Experts predict that single-payer Medicare for All would would save more than $600 billion annually by slashing the administrative waste of private insurance and the paperwork insurers impose on hospitals and doctors ($504 billion) and bargaining down drug prices ($155 billion). These efficiencies would free up enough money for universal, first-dollar coverage without any overall increase in U.S. health spending, while controlling its growth over time.
Currently, the U.S. spends $3.65 trillion per year on health care, double the per-capita spending of other industrialized nations that provide universal coverage. Without single-payer reform, U.S. health spending is projected to reach $5.96 trillion — 19.4 percent of GDP — by 2027.
“Even single-payer opponents admit that, compared to Medicare for All, the status quo will cost U.S. $2 trillion more over the next decade,” said Dr. Claudia Fegan, a Chicago-based internal medicine physician and PNHP national coordinator. “How do they propose we pay for that?”
Dr. Fegan added that although the Affordable Care Act — which relies on a system of private and employer-provided insurance — expanded coverage to many, it failed to reduce the proportion of bankruptcies driven by medical problems, while doing little to expand the health security of all Americans.
While endorsing the Medicare for All Act as a strong single-payer bill, PNHP notes an area for improvement: Since for-profit providers (including hospitals, dialysis centers, nursing homes, home care agencies, and hospices) have been shown to provide inferior care at inflated prices, PNHP recommends moving to a fully nonprofit health system in addition to the bill’s current constraints on profit-making. To achieve an orderly transition of for-profit providers to nonprofit status, the doctors’ group recommends a bond-funded buyout of investor-owned facilities.
Dr. Gaffney welcomed this moment as a key step forward in the movement towards a sustainable, just health care system for the nation. “The system is failing both physicians and patients,” he said. “We can do better. In fact, we have to: The health and future of our nation hangs in the balance.”
Physicians for a National Health Program (www.pnhp.org) is a nonprofit research and education organization whose 23,000 members support single-payer national health insurance.