PNHP co-founder Dr. David Himmelstein appeared on the “CBS Evening News” on June 26, 2017, to discuss the broad scientific consensus that there is a link between a lack of health insurance and mortality. He noted, as part of a larger segment, that the uninsured tend to forego care for even the most serious medical conditions.
By Andrew Dugan
Gallup, June 23, 2017
The cost of healthcare is now the top financial problem facing U.S. families. Concern about healthcare costs is at nearly the same level now as it was in 2007, a time before the recession and the passage of the ACA.
What is the most important financial problem facing your family today (open ended)?
17% – Healthcare costs
11% – Too much debt/Not enough money to pay debts
10% – Lack of money/Low wages
10% – College expenses
9% – Cost of owning/renting a home
8% – High cost of living/Inflation
Other choices 6% or less (see table at link)
http://www.gallup.com…
***
By Jocelyn Kiley
Pew Research Center, June 23, 2017
A majority of Americans say it is the federal governmentâs responsibility to make sure all Americans have health care coverage. And a growing share now supports a âsingle payerâ approach to health insurance, according to a new national survey by Pew Research Center.
Among those who see a government responsibility to provide health coverage for all, more now say it should be provided through a single health insurance system run by the government, rather than through a mix of private companies and government programs. Overall, 33% of the public now favors such a âsingle payerâ approach to health insurance, up 5 percentage points since January and 12 points since 2014. Democrats â especially liberal Democrats â are much more supportive of this approach than they were even at the start of this year.
Among Democrats, 52% now say health insurance should be provided through a single national insurance system run by the government, while fewer (31%) say it should be provided through a mix of private companies and government programs. The share of Democrats supporting a single national program to provide health insurance has increased 9 percentage points since January and 19 points since 2014.
Nearly two-thirds of liberal Democrats (64%) now support a single-payer health insurance system, up 13 percentage points since January.
Two-thirds of adults younger than 30 (67%) say the government has a responsibility to provide health coverage for all, with 45% saying coverage should be provided through a single national program.
Among Republicans, a greater share of those younger than 30 (39%) than those 30 and older (28%) say the government is responsible for providing health coverage for all; more young Republicans than older Republicans favor single payer (22% vs. 10%).
The share viewing this as a government responsibility has increased 9 percentage points since 2016, from 51% to 60%.
***
By Don McCanne, M.D.
Cost of health care is the top financial concern of Americans, and that has been increasing, now as high as it was before the Affordable Care Act was enacted. The more reassuring news is that support for a government responsibility to provide health coverage for all remains high, and preference for a single payer approach is increasing.
That increase in single payer support is greater amongst Democrats, especially liberals, and amongst adults under 30. Although the concept of single payer is less popular amongst Republicans, some do favor it.
We should take advantage of being sure that those not yet sold on single payer understand two things; 1) They are correct that the Affordable Care Act is not satisfactory because it falls far short of universality and it fails to prevent financial hardship, and thus it needs to be replaced, and 2) The six years of vacuous proposals of the Republican legislators have obliterated any hope that a solution lies within the fantasies of a free market health care nirvana. The Republican proposals acknowledge that government involvement is essential, but they propose an emasculated role – the worst kind of government, heavy with bureaucracy but placing our tax funds into the hands of entrepreneurial rent seekers.
More people are realizing that the circuitous route taken by our health care dollars wastes tremendous resources while depriving too many individuals of the health care access and financial protection that they need. Conservatives and the business community are beginning to understand this. We have to make sure that we provide the information to them that they need to have a clearer understanding of optimal health care financing policy. Not only is $3.2 trillion at stake, our health is as well.
Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.
By Andrew Dugan
Gallup, June 23, 2017
The cost of healthcare is now the top financial problem facing U.S. families. Concern about healthcare costs is at nearly the same level now as it was in 2007, a time before the recession and the passage of the ACA.
What is the most important financial problem facing your family today (open ended)?
17% – Healthcare costs
11% – Too much debt/Not enough money to pay debts
10% – Lack of money/Low wages
10% – College expenses
9% – Cost of owning/renting a home
8% – High cost of living/Inflation
Other choices 6% or less (see table at link)
http://www.gallup.com…
***
By Jocelyn Kiley
Pew Research Center, June 23, 2017
A majority of Americans say it is the federal governmentâs responsibility to make sure all Americans have health care coverage. And a growing share now supports a âsingle payerâ approach to health insurance, according to a new national survey by Pew Research Center.
Among those who see a government responsibility to provide health coverage for all, more now say it should be provided through a single health insurance system run by the government, rather than through a mix of private companies and government programs. Overall, 33% of the public now favors such a âsingle payerâ approach to health insurance, up 5 percentage points since January and 12 points since 2014. Democrats â especially liberal Democrats â are much more supportive of this approach than they were even at the start of this year.
Among Democrats, 52% now say health insurance should be provided through a single national insurance system run by the government, while fewer (31%) say it should be provided through a mix of private companies and government programs. The share of Democrats supporting a single national program to provide health insurance has increased 9 percentage points since January and 19 points since 2014.
Nearly two-thirds of liberal Democrats (64%) now support a single-payer health insurance system, up 13 percentage points since January.
Two-thirds of adults younger than 30 (67%) say the government has a responsibility to provide health coverage for all, with 45% saying coverage should be provided through a single national program.
Among Republicans, a greater share of those younger than 30 (39%) than those 30 and older (28%) say the government is responsible for providing health coverage for all; more young Republicans than older Republicans favor single payer (22% vs. 10%).
The share viewing this as a government responsibility has increased 9 percentage points since 2016, from 51% to 60%.
***
By Don McCanne, M.D.
Cost of health care is the top financial concern of Americans, and that has been increasing, now as high as it was before the Affordable Care Act was enacted. The more reassuring news is that support for a government responsibility to provide health coverage for all remains high, and preference for a single payer approach is increasing.
That increase in single payer support is greater amongst Democrats, especially liberals, and amongst adults under 30. Although the concept of single payer is less popular amongst Republicans, some do favor it.
We should take advantage of being sure that those not yet sold on single payer understand two things; 1) They are correct that the Affordable Care Act is not satisfactory because it falls far short of universality and it fails to prevent financial hardship, and thus it needs to be replaced, and 2) The six years of vacuous proposals of the Republican legislators have obliterated any hope that a solution lies within the fantasies of a free market health care nirvana. The Republican proposals acknowledge that government involvement is essential, but they propose an emasculated role – the worst kind of government, heavy with bureaucracy but placing our tax funds into the hands of entrepreneurial rent seekers.
More people are realizing that the circuitous route taken by our health care dollars wastes tremendous resources while depriving too many individuals of the health care access and financial protection that they need. Conservatives and the business community are beginning to understand this. We have to make sure that we provide the information to them that they need to have a clearer understanding of optimal health care financing policy. Not only is $3.2 trillion at stake, our health is as well.
Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.
By Joshua Gear, M.D.
Portland (Maine) Press Herald, June 26, 2017
As a piece of legislation intended to provide affordable, quality health care to the greatest number of Americans, the Affordable Care Act has failed miserably. Twenty million Americans remain uninsured and tens of millions more with insurance have trouble affording their co-pays or deductibles. Half a million Americans with health insurance coverage declare bankruptcy every year as a result of medical expenses.
The ACA has been a disaster for providing affordable coverage, but soon our health care system will be in worse shape. Far worse. The âdeath spiralâ of health care coverage, stimulated by a Republican Party hell-bent on undermining any legislation promoted by Barack Obama, has accelerated.
Both the House and Senate versions of the American Health Care Act attempt to stall that death spiral, but the trade-off they offer is less coverage and a certain increase in pain, suffering and premature death to older Americans as well as those who struggle the most to pay their bills. The beneficiaries of the AHCA through tax cuts and subsidies are the super wealthy, the health insurance industry and Big Pharma.
Only weeks after championing the House version and then celebrating its passage in the Rose Garden, President Trump recognized that what House Speaker Paul Ryan, et al., had crafted was âmeanâ â a remarkable admission for a man who has a profound aversion for the truth.
The Senate version, crafted in secret by 13 hand-picked older white men, was finally offered up four days ago, giving the other 87 members less than a week to critique, discuss and amend before being asked to pass it. Any reasonable person would agree that this is not only unprecedented but also a dangerous way to legislate.
Though their version in many ways is even more âmeanâ than the House version, those 13 senators may have managed to make it more palatable by extending time lines and shuffling numbers. So it may well pass.
Regardless of how this plays out, whether we continue with the ACA or get some version of the AHCA, America in general and the poor, the elderly and the middle class in particular, will not do well in regard to having their health care needs met over the next several years.
Itâs important to recognize that the United States pays nearly two times more in health care costs than any other industrialized country while having far worse outcomes on most measures of care, and still we leave over 10 percent of our citizens without access to care because of lack of insurance.
Being uninsured means being unable to treat chronic conditions such as diabetes, hypertension, chronic obstructive pulmonary disease, schizophrenia, addictions, Crohnâs disease â and the list goes on and on. Failure to treat these chronic conditions results in pain, suffering, expensive trips to the emergency room and premature death. The financial costs are huge to the taxpayers, but they pale in comparison to the emotional costs paid by individuals and families of those with pre-existing conditions.
Call it what you will, but âsingle-payerâ or âMedicare for allâ or âsocialized medicineâ would guarantee quality health care for every American, and it would provide it for a fraction of the cost we pay for health care today. Why? Because a single-payer system would not be burdened by financially supporting insurance or pharmaceutical industries that take advantage of our campaign finance and lobbying laws and in doing so manage to generate enormous profits through limiting patientsâ access to care or life-saving treatment.
Our elected officials, on both sides of the aisle, have become intoxicated by the money poured into their campaigns and have become dependent on that money to get re-elected. Their primary focus is to stay employed, i.e., to get re-elected, and access to quality health care by their constituents can be damned.
We guarantee our children access to a quality education through high school for good reason: It makes for a better society and a more robust economy.
And you would not deprive your neighbors a quick response from the local fire department if their house were on fire. If you did, lives could be destroyed or lost and businesses and communities decimated.
Is it any less cruel or ill-advised to deprive those same neighbors access to health care?
Our country needs an affordable, effective health care system. Plans that are not single-payer, quite simply, are motivated by greed and fueled by ignorance. And they are cruel.
There is no question that the ACA needs to be repealed and replaced. It needs to be replaced with comprehensive, universal coverage that is affordable and compassionate. Single-payer.
California State Assembly, June 23, 2017
Yesterday, Republicans in the U.S. Senate released a cynical plan to repeal the Affordable Care Act, posing a real and immediate threat to millions of Californians who only have health coverage because of the ACA.
Preparing California to meet this threat must be the top health care priority for the Legislature, Governor Brown, and organizations that advocate for increasing access to health care.
As someone who has long been a supporter of single payer, I am encouraged by the conversation begun by Senate Bill 562.
However, SB 562 was sent to the Assembly woefully incomplete. Even senators who voted for SB 562 noted there are potentially fatal flaws in the bill, including the fact it does not address many serious issues, such as financing, delivery of care, cost controls, or the realities of needed action by the Trump Administration and voters to make SB 562 a genuine piece of legislation.
In light of this, I have decided SB 562 will remain in the Assembly Rules Committee until further notice.
The fight for single payer also is moving forward on other fronts. The head of the Campaign for a Healthy California, an organization created to pass SB 562, has acknowledged their ultimate goal is to get a single payer initiative on the ballot, and there remains ample time for them to pursue that before November 2018.
***
Democracy Now!, June 23, 2017
Dr. Steffie Woolhandler: Weâre seeing a lot of public support for the idea of single payer. Weâre seeing a big movement for single payer at the state level in California. Obviously weâre getting a whole lot more discussion of single payer now than weâve ever had before.
Amy Goodman: In California, itâs passed the state Senate. Itâs got to go through the Assembly, and then it has to go to Governor Brown. Do you think that he will sign off on it?
Dr. Steffie Woolhandler: OK, well, weâre only going to get single payer if the populace keeps the pressure on the politicians. Itâs not going to happen automatically. Itâs not going to happen because Governor Brown has occasionally in the past said he likes single payer. Itâs going to happen because we have a movement thatâs strong enough to counter the political power of these rich people, who are getting these huge tax cuts; of the insurance industry, who would have no place in an efficiently run single-payer system; of Pharma, who thinks that theyâre going to have to accept lower prices under single payer. In fact, theyâre right. So thatâs a lot of political power. And the only way to push through that is to really build a movement. But, you know, that really seems possible right now, with polls showing that two out of every three Americans who have an opinion on health care think we need some sort of Medicare-for-all program. So, now is really the time to be pushing thisâin fact, the only way to really counter the Republican momentum at this point.
https://www.democracynow.org…
***
By Don McCanne, M.D.
Holding SB 562, Californiaâs single payer bill, in the Assembly Rules Committee would mean that no further action would take place on it this year. The Republican ACA repeal bill before Congress is no excuse to block Californiaâs progress on single payer, especially since the repeal bill likely will be defeated within a week or so. The fact that SB 562 needs more work is an even greater reason to move forward with it, not to abandon the effort.
Steffie Woolhandler was interviewed on Democracy Now! yesterday just before California Assembly Speaker Anthony Rendon released his statement announcing that he was putting a hold on the single payer bill. Although she was not aware of his decision, her words seem prescient.
Her pronouncement applies not just to California but to the entire nation. We must make every effort, not simply to keep the single payer momentum going, but to escalate it into a movement that would be impossible to repel.
The immediate task for Californians is to demand that Speaker Rendon move the bill out of the Rules Committee and advance it to other committees so that the essential markups that need to be done can be accomplished. Contact him at: 916-319-2063, @Rendon63rd, or assemblymember.rendon@assembly.ca.gov.
And for the rest of the nation? It wonât come from the politicians. It wonât come from the powerful and rich. It wonât come from the medical-industrial complex. As Steffie says, âweâre only going to get single payer if the populace keeps the pressure on the politicians.â We – all of us – have to do it.
Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.
By Andrew Purcell
The (Glasgow, Scotland) Herald, June 24, 2017
WITHIN five days, Trumpcare could well be on the US statute books. It hasn’t taken long to get there. The journey began on May 4, when the Republican caucus in the House of Representatives gathered to vote on the American Health Care Act (AHCA). For seven years, they had promised to repeal Barack Obamaâs signature legislative achievement, but now they had control of both houses of Congress and the White House, they couldnât agree on a replacement. To conservative hardliners, the bill was too timid. Moderates worried that supporting it could cost them their seats.
Whips played Eye Of The Tiger on the stereo to harden their resolve, and projected an image of General George Patton urging them to “accept the challenge so that you can feel the exhilaration of victory.â Later, once the bill had scraped through 217-213, Republican Congresswoman Ann Wagner said: âThe line of the day was out of Braveheart: âFreedom!ââ
In their minds, these privileged few were Rocky entering the ring, William Wallace leading the charge at Stirling Bridge. Republican Congressman Jason Chaffetz rode in on a scooter, fresh from foot surgery covered by his subsidised government health insurance, to vote for a bill that will make the same operation unthinkably expensive for tens of millions of Americans. If it becomes law, thousands more will die each year because they cannot afford to see a doctor.
In the Rose Garden, President Donald Trump touted the AHCA as âa really incredible health care planâ and promised âweâre going to get this finished.â Then, for six weeks, as the media focused on the investigation into Russian interference in the presidential election, a group of thirteen senators met to draft the Senateâs version of the bill in total secrecy. On Thursday, it was released for the briefest possible period of discussion. By this Friday, it could be law.
The renamed Better Care Reconciliation Act (BCRA) will deprive at least twenty million people of health insurance. It drastically cuts Medicaid, which provides low cost health care for those least able to afford it, reduces subsidies to the working poor and lower middle-class, allows insurers to charge old people five times as much as the young, and lets states opt out of a list of âessential health benefitsâ so insurers can sell policies that donât cover maternity or outpatient services, mental health treatment or prescription drugs. Premiums and out of pocket expenses will continue to rise, but people making $200,000 a year will get a tax cut.
Obamacare took a year to draft. Democrats tried to work with Republicans on a bi-partisan bill for months, and when that failed, debated the legislation on the Senate floor for five weeks. Then Minority Leader Mitch McConnell complained that they were âramming throughâ the law. Now he is doing everything in his power to shield the Republican alternative from scrutiny. The hypocrisy is stunning, the cynicism absolute.
Polls show only 29% of voters have a favourable opinion of the Republican bill, making it even more disliked than the bank bailout of 2008. The American Medical Association, American Nurses Association, American Academy of Family Physicians, American Association of Retired Persons and American Hospital Association have all spoken out against it.
Even insurers are opposed, despite the many sweeteners to the industry it contains, because the cuts to Medicaid, a reliable source of income, are so deep. âTo me, this is not a reform,â Michael J. Dowling, the chief executive of Northwell Health, said. âThis is just a debacle.â
A survey of 1,100 doctors found that 66% had a ânegative impressionâ of the AHCA. The Sunday Herald interviewed five medical professionals from five states, all registered Republicans. They were unanimously critical of Obamacare, but even more dismayed by its proposed replacement.
âI consider myself a fiscal conservative, and fiscally this is a horrible thing, because itâs going to keep increasing the cost curve. The only thing conservative about it is it will lower the tax rate for those in the top percent,â said Roger LaBonte, president of the West Tennessee chapter of Physicians for a National Health Plan.
âItâs already a disaster for the Republican Party. If they pass something, itâs a total disaster. If they donât, it makes them look like a bunch of clowns,â said Jack Bernard, former director of health planning for the state of Georgia.
Republicans have been predicting Obamacareâs collapse from the beginning, and since taking power have helped it along the way, introducing instability in the insurance market by threatening to remove federal subsidies. Insurers, citing losses, have been pulling out of the state exchanges. Next year, more than 30,000 people in Missouri and Ohio will qualify for a government subsidy but have nowhere to spend it, as not one company is selling insurance.
In Arizona, Obamacare cut the number of uninsured in half. More than 600,000 benefited from the expansion of Medicaid to cover those earning up to 133% of the federal poverty level – around $32,000 for a family of four. People buying insurance on the state exchange have been less fortunate, as Blue Cross Blue Shield now enjoys an effective monopoly, and can charge what it likes.
Daniel Derksen, Director of the Arizona Centre for Rural Health, said the proposed cuts to Medicaid, more than $800 billion over a decade, would be disastrous for the state. âThis goes beyond repealing Obamacare: itâs really dismantling an essential title of the Social Security Act.â Medicaid will be capped, tied to inflation and guaranteed to buy a little less each year, but not until 2021, after the next presidential election, to soften the political blow.
When Derksen was asked why Republicans are so determined to pass such an unpopular bill, knowing it will hit older people in rural areas – Trump voters – particularly hard. âWell, if youâre going to do a ginormous tax cut, youâve got to do a âpay-for,â he said, âand one of the largest federal expenditures is our Medicaid and Medicare programmes.â
This is the key to understanding the bill. By cutting subsidies and Medicaid, it lowers the projected deficit by roughly $1.2 trillion over a decade. This creates space for a permanent ârevenue-neutralâ tax cut that can be passed in the Senate with a simple majority. The 3.8% tax cut on investment income in the bill, back-dated to the start of this year, is just an appetiser.
From 2010-2016, Obamacare reduced the number of uninsured from 48.6 million to 28.6 million and eliminated many of the insurance industryâs most egregious abuses, but as a market-based solution, devised in a conservative think tank and pioneered by Republican Governor Mitt Romney in Massachusetts, it stopped far short of meaningful reform.
According to the Organisation for Economic Co-operation and Development, the USA spends $9,500 per capita on health care each year, compared with $5,300 in Germany, $4,000 in the UK and $2,500 in Israel, but has the lowest life expectancy and highest infant mortality rate in the developed world. That is a sick and broken system.
âAbout 48,000 Americans die every year because of lack of health care. The biggest cause of bankruptcy in this country is people who canât pay their medical bills,â said Rade Pejic, a chest surgeon from New Orleans. He told how the wife of a doctor friend recently had an outpatient hip operation and received a bill for $97,000, and that his cousinâs appendectomy cost $32,000. These are not extreme cases.
The number of people with no health insurance at all – close to fifty million by 2026 if the GOP bill passes – is the tip of the iceberg. Tens of millions more, on all but the most expensive plans, are under-insured, with high deductibles (the first few thousand dollars the policy holder has to pay before the insurance kicks in) and yawning gaps in their coverage.
A Kaiser Family Foundation survey found that one in five people with health insurance received medical bills last year that they struggled to pay. Of these, 63% reported using up most of their savings, 38% said they ran up credit card debt and 37% asked friends for money. Under the GOP plan, the poor, the sick, the elderly – everyone but the richest – will pay more for meaner and less reliable insurance.
âWeâre facing higher and higher deductibles, narrowing networks, because the insurance companies run the show. They dictate health care that doctors practice,â said Alan Kenwood, an emergency room doctor at a hospital in Morris County, New Jersey. âThere is a fear of standing up for whatâs right because of the power of the lobbies, the insurance and pharmaceutical industries, and they have such deep infiltration into both parties.â
Last year, the chief executive of insurer Centene, Michael Neidorff, earned $22 million. Humanaâs Bruce Broussard got $19.7 million. Alan Miller, CEO of hospital chain Universal Health Services, received $51.3 million in salary and stock options.
Most of the senators who drafted the BCRA have received substantial campaign contributions from the health care industry. From 2011-2016, Kindred Healthcare gave McConnell $104,650. Sanford Health gave Senator John Thune $40,246. Blue Cross Blue Shield paid Senator Lamar Alexander $36,250. The list goes on.
The question now is whether Republicans can agree on a bill that will pass the Senate, and then the House, with its fanatically tax-averse Freedom Caucus. McConnell can only afford two ânoâ votes, and at the last count, seven senators were wavering: three because the BCRA is too much like Obamacare and four worried that the Medicaid cuts will harm their constituents and hamper their re-election chances.
Bernard predicted dire political consequences: âI think if the Republican Party is dumb enough to pass this, they will lose the presidency and a whole series of senatorial seats. When people who are working-class start to see their brothers and sisters and children getting booted off health insurance, youâre gonna hear screaming.â
âItâs quite possible that the level of anger is going to be so great that itâs going to push reform and thereâs going to be a strong reaction against the Republican party for pushing the legislation,â said Kenwood.
For a taste of irony amid all this, we should maybe hark back to January 2015, five months before Trump announced his presidential campaign, when he told an anecdote on David Lettermanâs show about a friend who spent four days in a Scottish hospital: âHe was really in trouble, and they released him and he said, âWhere do I pay?â And they said, âThereâs no charge.â Not only that, he said it was like great doctors, great care.â
For now, though, as congressional Republicans prepare to put a bill on Trumpâs desk that will make health care more expensive, more stressful and less secure for the vast majority of Americans, the Presidentâs talk of âinsurance for everyoneâ is just one more empty promise.
By Phil Kadner
Chicago Sun-Times, June 23, 2017
Most doctors believe a single-payer system âwould offer the best health care to the greatest number of people,â according to a survey by the Chicago Medical Society.
More than 1,000 doctors from the Cook County region participated in the survey and 77 percent of those responding had an unfavorable view of the American Health Care Act passed by the U.S. House of Representatives as a replacement for Obamacare, also known as the Affordable Care Act.
In addition to supporting single-payer national health care, the doctors also expressed support for the Affordable Care Act, with 62 percent saying they had a âgenerally favorableâ opinion of Obamacare.
Two out of three doctors, 67 percent, said they had a âgenerally favorableâ view of a single-payer financing health care system.
The U.S. Senate version of health care reform had not been unveiled at the time of the survey, but given the response of the doctors, I think it is fair to say that it would not have received significantly greater support than the House version.
Dr. Ted Brown, president of the Chicago Medical Society, emphasized that the survey focused primarily on three options: Obamacare, AHCA â what is being called Trumpcare â and single-payer national health insurance.
I asked Brown why he believes most of the doctors responding to the medical societyâs survey chose single-payer health insurance, which is available in the rest of the industrialized world.
His answer is likely to shock those who believe private industry is more efficient than the federal government.
Brown said that trying to comply with the regulations and paperwork required by dozens of private insurance companies offering hundreds of policies, along with Medicaid and Medicare, is burning doctors out and taking time away from patient care.
âAs much as anything, itâs an administrative problem,â Brown said. Doctors may be required to take an opioid training course, for example, eight or nine times to satisfy eight or nine different insurance companies.
They would much rather have one administrative mandate handed down from the federal government.
The federal government? Can that be right.
âI donât think Iâve ever heard a doctor complain about Medicare regulations,â Brown said. âTheyâre simple. Theyâre easy to understand. Itâs easy to get an answer if you have a question.â
An astonishing 87 percent of the doctors surveyed agreed that in an ideal system basic health care would be available to all individuals as part of the social contract, a right similar to education, or police and fire protection.
I think the majority of people who oppose national health care donât understand that private health insurance companies now dictate medical practice to doctors and many of their decisions are based on profit motives, having nothing to do with patient care.
And in many cases no one â including your doctor â knows who is actually making the health care decisions at the insurance companies.
Doctors are being forced to join health care groups and close their private practices because they do not have the time or the financial resources to comply with the paperwork demands of the private insurance companies.
And if doctors defend their patients too vigorously and refuse to comply with the demands of the insurance providers, they are cut out of the system.
âThe results of the survey are very significant,â said Dr. Claudia Fegan, national coordinator for Physicians for a National Health Care Program, which has led the fight for single-payer universal health care.
âPracticing physicians do not want to see ACA repealed and they believe the best approach is single-payer.â
http://chicago.suntimes.com…
By Phil Kadner
Chicago Sun-Times, June 23, 2017
Most doctors believe a single-payer system âwould offer the best health care to the greatest number of people,â according to a survey by the Chicago Medical Society.
More than 1,000 doctors from the Cook County region participated in the survey and 77 percent of those responding had an unfavorable view of the American Health Care Act passed by the U.S. House of Representatives as a replacement for Obamacare, also known as the Affordable Care Act.
In addition to supporting single-payer national health care, the doctors also expressed support for the Affordable Care Act, with 62 percent saying they had a âgenerally favorableâ opinion of Obamacare.
Two out of three doctors, 67 percent, said they had a âgenerally favorableâ view of a single-payer financing health care system.
The U.S. Senate version of health care reform had not been unveiled at the time of the survey, but given the response of the doctors, I think it is fair to say that it would not have received significantly greater support than the House version.
Dr. Ted Brown, president of the Chicago Medical Society, emphasized that the survey focused primarily on three options: Obamacare, AHCA â what is being called Trumpcare â and single-payer national health insurance.
I asked Brown why he believes most of the doctors responding to the medical societyâs survey chose single-payer health insurance, which is available in the rest of the industrialized world.
His answer is likely to shock those who believe private industry is more efficient than the federal government.
Brown said that trying to comply with the regulations and paperwork required by dozens of private insurance companies offering hundreds of policies, along with Medicaid and Medicare, is burning doctors out and taking time away from patient care.
âAs much as anything, itâs an administrative problem,â Brown said. Doctors may be required to take an opioid training course, for example, eight or nine times to satisfy eight or nine different insurance companies.
They would much rather have one administrative mandate handed down from the federal government.
The federal government? Can that be right.
âI donât think Iâve ever heard a doctor complain about Medicare regulations,â Brown said. âTheyâre simple. Theyâre easy to understand. Itâs easy to get an answer if you have a question.â
An astonishing 87 percent of the doctors surveyed agreed that in an ideal system basic health care would be available to all individuals as part of the social contract, a right similar to education, or police and fire protection.
I think the majority of people who oppose national health care donât understand that private health insurance companies now dictate medical practice to doctors and many of their decisions are based on profit motives, having nothing to do with patient care.
And in many cases no one â including your doctor â knows who is actually making the health care decisions at the insurance companies.
Doctors are being forced to join health care groups and close their private practices because they do not have the time or the financial resources to comply with the paperwork demands of the private insurance companies.
And if doctors defend their patients too vigorously and refuse to comply with the demands of the insurance providers, they are cut out of the system.
âThe results of the survey are very significant,â said Dr. Claudia Fegan, national coordinator for Physicians for a National Health Care Program, which has led the fight for single-payer universal health care.
âPracticing physicians do not want to see ACA repealed and they believe the best approach is single-payer.â
http://chicago.suntimes.com…
PNHP co-founder Dr. Steffie Woolhandler appeared on “Democracy Now!” on June 23, 2017, to discuss the shortcomings of the Affordable Care Act, and of the Republican proposals to “repeal and replace” the law. She also noted that many Americans, including Republicans, are standing up to demand improved Medicare for all.
U.S. Senate, June 2017
Title II
SEC. 205. MEDICAL LOSS RATIO DETERMINED BY THE STATE.
Section 2718(b) of the Public Health Service Act (42 U.S.C. 300ggâ18(b)) is amended by adding at the end the following:
â(4) SUNSET.âParagraphs (1) through (3) shall not apply for plan years beginning on or after January 1, 2019, and after such date any reference in law to such paragraphs shall have no force or effect.
â(5) MEDICAL LOSS RATIO DETERMINED BY THE STATE.âFor plan years beginning on or after 24 January 1, 2019, each State shallâ
â(A) set the ratio of the amount of premium revenue a health insurance issuer offering group or individual health insurance coverage may expend on non-claims costs to the total amount of premium revenue; and
â(B) determine the amount of any annual rebate required to be paid to enrollees under such coverage if the ratio of the amount of premium revenue expended by the issuer on non-claims costs to the total amount of premium revenue exceeds the ratio set by the State under subparagraph (A).â.
https://www.budget.senate.gov…
42 U.S.C. 300ggâ18(b):
https://www.law.cornell.edu…
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By Don McCanne, M.D.
By now you likely know that the current Senate proposal to modify the Affordable Care Act (ACA) would sharply reduce spending for the Medicaid program and would result in higher insurance premiums for plans that provide less financial protection, while reducing taxes for the wealthy. The proposal has been appropriately labeled as being âmean.â But to get a feeling of the flawed policy process behind their proposal, letâs look at just one small example: the medical loss ratio.
Under ACA, all insurers, not just the insurers offering exchange plans, must spend a minimum percentage of their premium revenue on health care benefits – 80 percent for individual and small group plans and 85 percent for large group plans. Spending money on health care is considered a loss to the insurers and thus the percentage spent is known as the medical loss ratio. If they spend more than 20 percent or 15 percent, respectively, on administrative costs or profits, then they must provide rebates to the enrollees.
When ACA was crafted, it was acknowledged that the U.S. health care system wasted tremendous resources in administrative excesses. It was not uncommon for some private insurers to keep 30 percent or even more of the premiums for their own administrative costs and profits. By placing limits on the administrative costs, a dent could be made in reducing this waste. It is important to note that only a small fraction of the total waste in our system is recovered by establishing medical loss ratio minimums – only a tiny portion of what would be recovered if we switched to a single payer national health program. But it was a start.
Sec. 205 of Title II of the Better Care Reconciliation Act – the Republican bill – sunsets 42 U.S.C. 300ggâ18(b) – the ACA medical loss ratio provisions (link above), eliminating the 80 and 85 percent federal ratio requirements. It transfers the responsibility to the states. This sounds like no big deal, but when we observe how many of the states are heartlessly refusing to expand their Medicaid coverage, it does not take much imagination that some states will establish policies that will enable private insurers to divert more of the premium dollars to investors and executives, at a cost to plan beneficiaries. After all, as many have reported, this entire scheme has been designed to take health care from the masses and give the monetary gains to the wealthy.
Former Congressman Henry Waxman, a leader in crafting the House version of ACA, states it well in a Los Angeles Times op-ed (June 22, 2017):
âLegislation needs to pass sufficient public scrutiny or itâs unworthy of becoming law. If monumental, transformative legislation can be written in the dark and enacted in a rushâ and childrenâs lives are compromised or ruined so that billionaires can get tax cuts they donât need â it would rank among the worst scandals in U.S. history. Americans of conscience must mobilize now to stop this from happening.â
The real scandal is that we continue to dink around with the most expensive and least efficient model of financing care – our dysfunctional, fragmented system composed of a multitude of private and public plans – when what we really need is to fix Medicare and then include everyone. Under that more enlightened system money spent on health care is not considered a loss but rather a benefit for the health of each of us and the health of the nation at large.
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By Natalie Shure
Pacific Standard, June 23, 2017
The California State Assembly will be busy this summer continuing to shape SB-562, a statewide universal health-care bill that passed the Senate last month. The legislation aims to create a so-called single-payer system: a unified public insurance pool that would cover all residents’ health-care costs, thereby extending coverage to three million previously uninsured Californians, and eliminating the private insurance industry central to the Affordable Care Act. While the bill has garnered widespread enthusiasmâ72 percent of Californians reportedly support government-run universal coverageâit remains light on funding specifics. One analysis conducted by the University of MassachusettsâAmherst pinned the cost of the proposal at $331 billion annuallyâa sum well beyond California’s state budget of $180 billion, but below the state’s $368 billion in health-care spending overall. As legislators deliberate details like how much revenue should be raised through payroll or sales taxes, such unknowns have have made some lawmakers reluctant, including an allegedly skeptical Governor Jerry Brown.
And yet, Republican control over all three branches of federal government has seriously worsened the near-term outlook for equitable health care at the national level: After weeks of working in secret to retool the American Health Care Act, the GOP has finally released the bill it hopes will replace the ACA. It includes deep cuts to Medicaid, allows states to drop minimum coverage standards, and eliminates the taxes on the wealthy built into the ACA. The version passed by the House of Representatives would threaten to leave 23 million more Americans without coverage, beyond the 28 million already uncovered by the ACA. For many, politics surrounding the would-be repeal of Obamacare have crystallized Republican lawmakers’ willingness to lock millions of Americans out of the health-care system in exchange for upper-bracket tax cuts. And even if the AHCA remains a non-starter, there’s no shortage of ways Republicans can deliberately erode Obamacareâa system mired in problems even under better circumstances, that has failed to achieve universal coverage.
Given the fragility of a health-care system so recently overhauled, there’s been a resurgence of calls for single-payer health care in the United States. Bernie Sanders’ Democratic primary campaign reintroduced the concept of single-payer to a national audience, a message that many voters were acutely receptive to given a growing list of Obamacare bugs: declininginsurer participation, rising premiums, shrinking networks, rejected expansions of Medicaid in GOP-controlled states, and cost-sharing tactics by insurers that leave millions unable to afford to even use the insurance they pay for. There’s also mounting evidence that single-payer is more popular than ever: Videos of constituents at town halls calling for expanded Medicare-for-all have gone viral, and recent polls show 60 percent of Americans support the idea.
This groundswell of public enthusiasm has given rise to multiple initiatives to construct single-payer systems at the state-level, in places where local politics are more amenable to leftward reform than Washington’s. California’s bill advanced on the heels of a similar one in May that made it through the New York Assembly. Last week, Nevada’s legislature voted to allow anyone to buy into Medicaid coverageâa move that would effectually create a so-called “public option” that some argue could be a gateway toward single-payer. The overwhelming majority of proponents of state-level single-payer cite a unified national program as their endgame, and state-based overhauls may indeed by the most feasible route there. But using states as Medicare-for-all laboratories also comes with strings attached, and presents structural challenges that wouldn’t apply at the national level.
WHY SINGLE-PAYER COULD WORK IN CALIFORNIA
In many ways, California seems better poised for a single-payer coup than any other state. A Democratic supermajority controls both houses of the California legislature, which has already passed similar bills in 2006 and 2008 (albeit arguably underdeveloped ones, which were subsequently vetoed by Governor Arnold Schwarzenegger). California’s massive population and strong economy could also help it absorb shocks that might destabilize a single-payer system in a tinier state, and could also likely secure lower drug prices by commanding more leverage over negotiations.
California’s unique geographic realities also work in its favor here: Major Metro areas often span across state lines, which not only presents logistical complications surrounding out-of-state providers, but also makes it easier for wealthy taxpayers and health-care providers to relocate to a friendlier jurisdiction. California’s main population centers are practically all exempt from this problem. (Compare California’s situation to that of Vermont, where a single-payer program was abandoned in 2015: With fewer than one million Vermonters, even a mild contraction of the tax base could prove devastating, the state budget would be more vulnerable to recessions, and many state residents receive care at hospitals like Dartmouth, located outside of the state.)
But even beyond considerable political obstacles, the bigger hurdles for state single-payer are more likely to be legal, chief among them the reallocation of billions of federal dollars funneled to each state to bankroll already existing public health-care programs. A study conducted by the University of MassachusettsâAmherst on California’s SB-562 bill estimated these federal payouts were slated to account for over 70 percent of the program’s projected annual cost. But securing them won’t be easy. For one, there’s no existing mechanism to repurpose a state’s share of Medicare. And employer benefits are regulated at the federal level, leaving states without the authority to unilaterally disband the system of employer-provided coverage.
OBSTACLES TO STATE-LEVEL ACTION
While blue states embarking on progressive health-care projects may resent this bind, it’s crucial to remember that ceding control over federal health-care funds to states can just as easily limit access to health care as expand it. When it comes to “state innovation waivers” available through the ACA, Don McCanne, a health policy fellow with Physicians for a National Health Program, notes, “the waivers they want us to get are privatization waiversâthey want us to take Medicaid and turn it over to private insurance companies ⊠if California went to [the Trump administration] and said, ‘give us the waivers so we can set up a government-run insurance system,’ I know they would not ever agree to that ⊠it’s totally opposed to their ideology.”
But giving states total freedom over whatever funds they receive could be even worseâthis is the basic premise behind Medicaid “block grants,” a Republican proposal to distribute fixed amounts of money, over which each state would enjoy complete discretion. Such a scenario could stand to benefit those states progressive enough to build universal health-care systems, but would annihilate already precarious systems in poorer or GOP-dominated areas.
Of course, such explicit state disparities in health-care access are anathema to single-payer advocates, who, by definition, believe in universal coverage for all. A patchwork system that varies by state does little to alleviate the immorality underpinning the tiered system of coverage and care that has galvanized the single-payer fight in the first place. As such, the effectiveness of state-level single-payer experiments as a bridge toward federal reforms will depend on how local movements orient themselves toward national ones. Universal coverage activists often point to the example of Saskatchewan, whose successful provincewide universal coverage program acted as a springboard for Canada’s system. This model demands a sense of national solidarity absent from much of the political discourse in the U.S.
THE IMPORTANCE OF GRASSROOTS ORGANIZING
For activists like McCanne, the promise of state-level single-payer movements lie in their role as vehicles for education and mobilization. Even amid the protracted crisis facing America’s labyrinthine heath-care system, health-care policy is hardly intuitiveâand a well-informed public will be better able to resist the messaging of powerful interest groups against single-payer. Such grassroots organizingâconversations about health-care reform on a house-by-house basisâis the kind of long-game political work that localized movements are uniquely able to deploy.
Ultimately, any movement to secure health-care justice for Californians or New Yorkers must also be understood as a fight for Arkansans and Wisconsinites, not only because the viability of any statewide system will depend on mobilizing pressure against the federal government, but because envisioning the battle for single-payer as an overly localized one risks inoculating us against suffering in red states as soon as blue ones get theirs.
By Amy Goodman
Democracy Now!, June 23, 2017
PNHP Note: To view video of this interview, click here.
Health experts say, given the shortcomings of both the Affordable Care Act and Republican proposals, now is the time to move forward with a simple Medicare-for-all system, known as single payer. In 2015, even Donald Trump appeared to come out in favor of a form of single-payer health insurance. About 20,000 U.S. physicians now support single-payer healthcare, and National Nurses United, the biggest nursing union in the country, is also pushing for the program that would guarantee universal coverage. We speak with Dr. Steffie Woolhandler, a key advocate for Medicare for all.
TRANSCRIPT
This is a rush transcript. Copy may not be in its final form.
AMY GOODMAN: During a 60 Minutes interview in 2015, Donald Trump appeared to come out in favor of a form of single-payer health insurance for the uninsured. I wanted to play this clip.
DONALD TRUMP: Obamacare is going to be repealed and replaced. Obamacare is a disaster, if you look at whatâs going on with premiums, where theyâre up 45, 50, 55 percent.
SCOTT PELLEY: So how do you fix it?
DONALD TRUMP: Thereâs many different ways, by the way. Everybodyâs got to be covered. This is an un-Republican thing for me to say, because a lot of times they say, “No, no, the lower 25 percent, they canât afford private.” Butâ
SCOTT PELLEY: Universal healthcare.
DONALD TRUMP: I am going to take care of everybody. I donât care if it costs me votes or not. Everybodyâs going to be taken care of, much better than theyâre taken care of now.
SCOTT PELLEY: The uninsured personâ
DONALD TRUMP: Right.
SCOTT PELLEY: âis going to be taken care of how?
DONALD TRUMP: Theyâre going to be taken care of.
SCOTT PELLEY: How?
DONALD TRUMP: I would make a deal with existing hospitals to take care of people. And you know what? This is probablyâ
SCOTT PELLEY: Make a deal? Who pays for it?
DONALD TRUMP: The government is going to pay for it. But weâre going to save so much money on the other side. But for the most part, itâs going to be a private plan, and people are going to be able to go out and negotiate great plans with lots of different competition, with lots of competitors, with great companies. And they can have their doctors. They can have their plans. They can have everything.
AMY GOODMAN: That was Donald Trump in 2015. Dr. Steffie Woolhandler, can you respond? Youâre one of the key advocates for Medicare for all. Where does that fit into this picture today? Do you think this is a moment where the time for Medicare for all can be pushed around the country in a very big way, as people across the political spectrum are horrified by the specter of, among other things, tens of millions of people losing their health insurance?
DR. STEFFIE WOOLHANDLER: Yeah, well, the ACA made some modest improvements to the healthcare system, and the Republicans would pull those all back. But the Affordable Care Act was never a very good bill. It left 28 million Americans completely uninsured and tens of millions more with these unaffordable gaps in their coverage, like copayments and deductibles and uncovered services. And thatâs why the Affordable Care Act has been vulnerable to these Republican attacks, because people look at their own situation and say, “Even under Obamacare, under the Affordable Care Act, healthcare still not affordable to me.”
So the best way to fight the Republican attacks is to say, “Letâs move forward from the Affordable Care Act to a single-payer system, rather than backward through repeal.” The single-payer system works, because by having a single, simple Medicare-for-all system, you save so much money on administrative costs and overhead that you can cover all of the uninsured and improve coverage for everybody else who has gaps in their coverage without raising total healthcare costs. And thatâs why about 20,000 U.S. physicians have come together into Physicians for a National Health Program to advocate single payer. Thatâs why the National Nurses United, the biggest nursing union in the country, is pushing single payer. Itâs why Senator Sanders ran on single payer. And itâs why Congressman John Conyers has introduced a bill into Congress, with 112 co-sponsors, for single payer. So now is the time to be saying to the electorate, the ACA was a step forward, but not a big enough step. We need to be moving forward from the ACA to that single-payer, Medicare-for-all plan that Americans need and deserve.
AMY GOODMAN: And how feasible do you think this is? I mean, Senator Bernie Sanders has yet to introduce this bill, the type that Conyers already has introduced in the House.
DR. STEFFIE WOOLHANDLER: OK, my understanding is Sanders is planning to introduce a bill over the summer. The Conyers bill has gained a lot of co-sponsors. More than half of all the Democrats in the House of Representatives now co-sponsor the Conyers bill. Thatâs more co-sponsors than any time in history. Weâre seeing a lot of public support for the idea of single payer. Weâre seeing a big movement for single payer at the state level in California. Obviously weâre getting a whole lot more discussion of single payer now than weâve ever had before.
AMY GOODMAN: Let me ask youâ
DR. STEFFIE WOOLHANDLER: I think weâreâ
AMY GOODMAN: Let me ask you, very quickly. In California, itâs passed the state Senate. Itâs got to go through the Assembly, and then it has to go to Governor Brown. Do you think that he will sign off on it, unlike what happened in Nevada, where the Republican senator, in that case, said no to Medicare for all, even though it was passed by the Nevada Legislature?
DR. STEFFIE WOOLHANDLER: OK, well, weâre only going to get single payer if the populace keeps the pressure on the politicians. Itâs not going to happen automatically. Itâs not going to happen because Governor Brown has occasionally in the past said he likes single payer. Itâs going to happen because we have a movement thatâs strong enough to counter the political power of these rich people, who are getting these huge tax cuts; of the insurance industry, who would have no place in an efficiently run single-payer system; of Pharma, who thinks that theyâre going to have to accept lower prices under single payer. In fact, theyâre right. So thatâs a lot of political power. And the only way to push through that is to really build a movement. But, you know, that really seems possible right now, with polls showing that two out of every three Americans who have an opinion on healthcare think we need some sort of Medicare-for-all program. So, now is really the time to be pushing thisâin fact, the only way to really counter the Republican momentum at this point.
AMY GOODMAN: Well, Dr. Steffie Woolhandler, I want to thank you for being with us, key advocate for Medicare for allâand again, when she referred to Pharma, meaning Big Pharma, the drug companiesâand Dr. Willie Parker, who happens to be joining us from Aspen, Colorado, who is the chair of the board of Physicians for Reproductive Health.
