PNHP

Medicare for All deserves support

Medicare for All deserves support

By G. Richard Dundas, M.D.
Bennigton (Vt.) Banner, Letters, Jan. 13, 2019

To the Editor:

Over half of Americans delay or don’t get health care because they can’t afford it. That’s because we are the only wealthy nation which does not have universal health care. Thirty million of us are uninsured and many more are underinsured. Even though insured, high deductibles, coinsurance, and copayments keep Americans from accessing care. The cost of care is prohibitive for many of us, and it is nearly twice that of other industrialized nations. The outcomes of patient care (such as infant or maternal mortality) are worse in the U.S. than in most industrialized nations. Our life expectancy is going down instead of up. What can we do? Universal single payer health care could make us a healthier nation at much less cost.

There is a growing movement to switch to a new type of health care financing called “Improved Medicare for All.” For a number of years, there has been a bill in the U.S Congress (HR 676) which outlines how this switch could be accomplished. It now has many more sponsors than ever before (including our Representative Peter Welch), and our new Speaker of the House has promised to hold hearings. It would create a publicly financed, privately delivered health care system that builds on the existing Medicare program. It would improve and expand Medicare to cover all U.S. residents. It would replace our fragmented patchwork of inefficient insurance companies whose primary goal is to make a profit. It is estimated that it will save 500 billion per year by controlling administrative and drug costs and eliminating high executive salaries and huge corporate profits. HR 676 will save money, add extra services such as coverage for dental care, and virtually eliminate out of pocket costs.

Our current system of health care is a failure, so who in their right mind would oppose a new plan? Polls show that the people are for such a plan; however the insurance companies, drug companies, and equipment manufacturers will be in opposition. Their lobbyists have great influence over our politicians and most of our legislators have received campaign contributions from them. There is now hope that the will of the people may prevail. Pramila Jayapal (Democrat from Washington) is now the lead sponsor of HR 676, but there is rumor that the bill is being changed to a Medicare-Buy-In option. This is not the same as the original HR 676 as a buy-in preserves the inefficient, costly insurance companies that have plagued us for years. You should write to her (319 Cannon House Office Building, Washington DC, 20515) and also to Congressman Peter Welch (128 Lakeside Ave, Suite 235, Burlington, VT, 05401) and ask that they support HR 676 as it is now written.

https://www.benningtonbanner.com…

Insurance companies are supposed to be heartless. That’s why we need single-payer.

By Robert Vinetz, M.D.
Los Angeles Times, Letters, Jan. 13, 2019

To the editor:

Michael Kinsley is arguably correct when he writes regarding the denial of coverage for people with preexisting conditions: “The insurance companies are not behaving like heartless monsters. They are behaving like insurance companies.”

Well, they may or may not be monsters, but insurance companies are indeed “heartless.” They are inanimate creations. Their primary goal is to maximize profits, even if they have to be “heartless” and hurt people in doing so.

Do we really want a healthcare system financed and controlled by the heartless motive of corporate profits? Or, do we want one driven by the maxim “people before profits” and the heartening values of the Hippocratic Oath?

As a physician, I’ve made my choice: I support a single-payer, “Medicare for all” system.

https://www.latimes.com…

Portsmouth doctor and single-payer health care advocate predicts 2019 ‘the golden year’

By Paul Steinhauser
Foster’s Daily Democrat (Portsmouth, N.H.), Jan. 12, 2019

Dr. Tom Clairmont is a man on a mission.

Clairmont, a primary care physician in Portsmouth, is a longtime vocal advocate for the single-payer Medicare for all health care plan.

“My job is the try and educate the public,” Clairmont highlighted. “I’ve done letters to the editor. I’ve given talks to the Rotary Club. I’m doing a presentation on Monday night at the Portsmouth Public Library.”

Support for single-payer – a proposed single public system financed by taxes that covers the costs of health care for all of the country’s residents – has risen in public opinion polls in recent years. As of the end of 2018, some 125 Democrats in Congress had pledged their support for the plan.

Single-payer was a key part of Sen. Bernie Sanders’ platform during his 2016 bid for the Democratic presidential nomination, and was a leading issue for many candidates running in last year’s midterm elections, where Democrats won back control of the U.S. House of Representatives.

Now, with the start of the 2020 White House campaign and the spotlight shining on New Hampshire’s first-in-the-nation presidential primary, Clairmont predicted that “2019 is the golden year.”

“This is the year of opportunity for us to really get our message out,” he said. “Sanders started this, lit a spark. A lot of the campaigns throughout the country (in 2018) were elected on Medicare for all.”

Clairmont’s a longtime member of Physicians for a National Health Program, a non-profit research and educational organization of some 22,000 doctors, medical students and health care professionals that for three decades has pushed for a national health insurance system.

“We have been fighting this fight, trying to get people to understand it’s in their interest and it’s beneficial for you to have this program,” he said.

He explained that Sanders’ Senate bill and a longtime House bill for single-payer are based on the original Physicians for a National Health Program proposal.

Opponents of Medicare for all – and there are many – argue that single-payer does not translate into better health care. Instead, they say access to health care would diminish under a single-payer system, and the overall quality of care would decline.

Opponents also claim that single-payer systems cause shortages of general physicians and specialists and reduce access to medical technology. They add that the system would be too expensive.

“Every research paper I can show you that’s come up has shown that single-payer saves money,” Clairmont responded.

He argued that moving to a single-payer system would provide $600 billion per year in savings, adding “the total cost is going to go down. We estimate that 95 percent of people will save money under a single-payer program.”

Pointing to critics, he said “another thing they say is ‘your taxes are going to go up.’”

“Yes, they are. But you have to add your taxes plus your premiums plus your out-of-pocket (costs), plus your co-pays and deductibles and all that,” he added as he claimed that those costs would go down.

As a doctor who sees patients every day, Clairmont said moving to single-payer “would get me away from all these insurance companies interfering with the practice of medicine. I’m sick of getting permissions to perform a test, permissions to send somebody to a certain doctor I like, permissions for almost anything today.”

“My favorite quote is ‘You don’t want a government bureaucrat between you and your doctor.’ Nothing could be further from the truth,” he argued. “You don’t want an insurance company bureaucrat between you and your doctor because those are the people who are interfering with care continually.”

A single-payer system is – of course – a threat to the insurance industry. Claimont said that “our program eliminates those people. We don’t have insurance companies in our program. They are gone.”

Medicare for All: A discussion of House Bill HR676 and what it means to you, Monday, Jan. 14, 6:30 to 8 p.m., Levenson Community Room, Portsmouth Public Library. Sponsored by Physicians for a National Health Program.

https://www.fosters.com…

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.

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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.

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