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Leading British medical journal spotlights ‘inequality and health’ in U.S.

Leading British medical journal spotlights ‘inequality and health’ in U.S.

New studies in The Lancet examine effects of racial segregation, mass incarceration, economic inequality and a lack of universal health care as factors in declining U.S. health outcomes, and point to a growing ‘survival gap’ between rich and poor

FOR IMMEDIATE RELEASE, April 6, 2017, at 6:30pm EST
Contact: Clare Fauke, communications specialist, PNHP, 312-782-6006, clare@pnhp.org

The life expectancy of the wealthiest Americans, which now exceeds that of the poorest Americans by 10 to 15 years, continues to grow, according to a series of papers published today in The Lancet, one of the world’s oldest and most respected medical journals. This “survival gap” is a result of America’s fractured, for-profit health system, as well as its rapidly growing economic inequality, racial segregation and mass incarceration, which is unique among industrialized nations, researchers say.

These topics and several others are discussed in a five-paper series in The Lancet called “America: Equity and Equality in Health,” featuring new data and analysis by prominent U.S. health researchers, as well as a special commentary by Senator Bernie Sanders, I-Vt., in which he calls for a “Medicare for All” single-payer system.

Dr. David Himmelstein, the lead author of the series, says: “Today, 43 million Americans are poor, and although the Affordable Care Act has nearly halved the number of people without insurance, 29 million Americans, many of them poor or near-poor, remain uninsured. Health inequalities are more entrenched than ever, and rather than address them, the U.S. health care system often exacerbates them. In order to tackle health inequalities in the U.S., it is essential that we move towards a non-market financing system that treats health care as a human right.” Himmelstein is an internist, professor of public health at the City University of New York (CUNY) at Hunter College, lecturer in medicine at Harvard Medical School and co-founder of Physicians for a National Health Program.

In his commentary, Sen. Sanders emphasizes the links between economic inequality and health outcomes, stressing the urgent need for a universal health program covering all Americans. He writes: “Such inequality continues to be one of the greatest moral and economic issues of our time. It’s also a huge health issue. 
 The USA has the most expensive, bureaucratic, wasteful, and ineffective health care system in the world. Medicare-for-all would change that by eliminating private health insurers’ profits and overhead costs, and much of the paperwork they inflict on hospitals and doctors, saving hundreds of billions in medical costs.”

The researchers of the five studies are chiefly physicians and public health researchers holding prominent positions at the CUNY, Harvard Medical School, Harvard’s School of Public Health, Boston University School of Public Health, Cornell University, Yale School of Medicine, and several other institutions, including the New York City Department of Health and Mental Hygiene.

Selected highlights of the five studies appear below, followed by “Key Facts” on health inequalities in the U.S. All articles contain extensive data, tables, graphs, and key takeaways from the The Lancet’s editors. For more information, visit www.lancet.com/us-health.

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America: Equity and Equality in Health – a new Series from The Lancet

Study 1. “Inequality and the health-care system in the USA,” by Samuel L. Dickman, M.D., David U. Himmelstein, M.D., and Steffie Woolhandler, M.D., M.P.H.

Since 1986, the top 0.1 percent of American households has accumulated nearly half of all new wealth, and now controls as much wealth as the bottom 90 percent, whose share has fallen steadily. As top incomes have risen, so has extreme poverty. More than 1.6 million households in the U.S, including 3.5 million children, survive on incomes of less than $2 per person per day – the World Health Organization’s definition of extreme poverty; this number has more than doubled since the 1990s.

As economic inequality has deepened, so too has inequality in health. Almost every chronic condition, from stroke to heart disease and arthritis, follows a predictable pattern of rising prevalence with declining income. The life expectancy gap between rich and poor Americans has been widening since the 1970s, with the difference between the richest and poorest 1 percent now standing at 10.1 years for women and 14.6 years for men.

Instead of reducing income-based disparities in health, the market-based American health care system often exacerbates them by its very design. Low-income Americans have worse access to care than do wealthy Americans, partly because so many remain uninsured despite coverage expansions of the ACA. For individuals with private insurance, rising premiums and cost sharing have undermined wage gains and driven many households into debt and even bankruptcy. Meanwhile, the share of health care resources devoted to care of the wealthy has risen.

The uninsured (who are disproportionately poor) pay for much of their care out of pocket and, because they do not have insurers’ negotiating leverage, are charged the highest prices. One in four adults under the age of 65 reported problems paying medical bills; 34 percent of insured Americans with difficulty paying medical bills were unable to pay for food, heat, or housing, 15 percent took out high-interest payday loans, and 42 percent took on extra jobs or worked additional hours to pay medical bills.

Study 2: “The Affordable Care Act: implication for health-care equity,” by Adam Gaffney, M.D., and Danny McCormick, M.D., M.P.H.

Despite the reforms promised by the Affordable Care Act (ACA), financial barriers to care persist and might be worsening. While the ACA has nearly halved the number of Americans without health insurance, the high cost of co-payments, deductibles and co-insurance still drive many insured households into debt, even bankruptcy. The ACA’s Medicaid expansion targeted the poorest Americans, but 19 states – mostly southern states with large minority populations and poor records of health care access – chose to opt out. Even if the ACA were not altered or repealed, 28 million people would remain uninsured in 2024.

“Republican proposals focus on market-based reforms that would slash federal funding for Medicaid, replace the ACA’s subsidies with regressive tax credits, and further privatize Medicare,” says Dr. Adam Gaffney, a pulmonary specialist at Cambridge Health Alliance and Harvard Medical School. “Rather than improve the health inequalities that remain a grave problem even in the era of the ACA, this approach would only make things worse. Real reform is now needed to take us towards a universal single-payer system.”

Study 3: “Structural racism and health inequities in the USA: evidence and interventions,” by Zinzi D. Bailey, Sc.D., Nancy Krieger, Ph.D., Madina AgĂ©nor, Sc.D., Jasmine Graves, M.P.H., Natalia Linos, Sc.D., and Mary T. Bassett, M.D.

Health and health equity are substantially influenced by the places where people live, work, play, and pray. In the U.S., high levels of racialized economic segregation and structural racism are key determinants of public health. The ongoing residential segregation of African Americans is associated with adverse birth outcomes, such as an infant mortality rate that is twice as high for African Americans than it is for whites. Marginalized groups also face an increased exposure to air pollutants, decreased longevity, increased risk of chronic disease, and increased rates of homicide and other crime. Residential segregation also affects health care access, utilization, and quality at the neighborhood, health care system, provider and individual levels.

“Racial and ethnic health disparities in the United States are well documented, but structural racism is rarely discussed as a root cause,” says Dr. Mary T. Bassett, commissioner of the New York City Department of Health and Mental Hygiene. “Structural racism refers to all the ways in which systems foster inequitable outcomes, whether in housing, education, employment, media, health care or the criminal justice system. All have profound effects on health. If we don’t address structural racism, health inequities will persist.”

The authors point to several potential solutions to improve health equity by targeting structural racism, including community programs to address housing and access to health care; policy reform to reduce sentencing laws and imprisonment; and training the next generation of health professionals.

Study 4: “Mass incarceration, public health, and widening inequality in the USA,” by Christopher Wildeman, M.D., and Emily A. Wang, M.D.

On any given day, the U.S. incarcerates more of its citizens (2.2 million) and at a higher percentage (7 percent of the population) than any other country in the world. Mass incarceration shapes inequality in American health, disproportionately affecting African American communities where one in three black men will be imprisoned in their lifetime, nearly six times the rate of white men. An African American child born in 1990 had a 25.1 percent chance of having a father sent to prison; for those whose fathers did not finish high school, the risk was roughly double that, at 50.5 percent. Nearly half of black women currently have a family member or extended family member who is in prison.
Incarcerated individuals have increased prevalence of infectious disease (including sexually transmitted diseases, HIV, and hepatitis C), chronic medical conditions (such as hypertension, diabetes, and asthma), substance abuse and mental health disorders. Upon release, they earn 30 percent less than similar individuals who have never been imprisoned, further compounding the health-poverty trap.

Interestingly, correctional facilities provide many incarcerated adults with their first access to preventive and chronic medical care, since prisons and jails are some of the only places in the U.S. where health care is guaranteed by law. An estimated 40 percent of individuals with chronic medical conditions are diagnosed with a chronic condition while incarcerated, and 80 percent report seeing a medical provider while incarcerated. These gains are short-lived, however, since recently-released inmates are less likely to have a primary care physician and are at a disproportionately high risk of mental health problems.

“Overcrowding, high costs and aggressive policing have led to increasing recognition that mass incarceration has failed,” says Dr. Christopher Wildeman of Cornell University. “But, sweeping reforms are needed to reduce incarceration of technical parole violators, expand community corrections for low-level property and drug crimes, and medical paroles for elderly or sick inmates, in addition to expanded access to health care for individuals affected by the criminal justice system.”

Because the U.S imprisons many more of its citizens than do other developed democracies, mass incarceration might have contributed to the country’s lagging performance on health indicators such as life expectancy. One study suggests that U.S. life expectancy would have increased 51.1 percent more and infant mortality would have fallen 39.6 percent more from 1983 to 2005 if incarceration had remained at the mid-1980s level.

Study 5: “Population health in an era of rising income inequality in the USA: 1980-2015,” by Jacob Bor, Sc.D, S.M.; Gregory Cohen; and Sandro Galea, M.D., Ph.D.

Incomes for poor and middle-income Americans have barely changed since the 1970s and, adjusted for inflation, have actually declined since 2000. Poverty has emerged as an increasingly important risk factor for mortality in American adults, and the expanding “survival gaps” between rich and poor cannot be explained away by individual risk factors such as smoking, obesity and substance abuse.

The survival gap widened in the 2000s, as life expectancy between 35 and 75 years of age increased for wealthy men and women, but did not change for poor men and actually declined for poor women, as measured by both income and level of education. Life expectancy for white Americans without a high school diploma dropped by 5.3 years for women and 3.4 years for men. The increase in deaths from poisonings, suicide, and liver disease together accounted for half of the total increase in mortality in this group.

The life-expectancy gap between college-educated Americans and those with less than a high school education increased by 0.8 years for men and 2.6 years for women from 1990 to 2008. However, the gains in survival enjoyed by white Americans with at least a high school education were not experienced by African Americans, suggesting that the health benefits of education might be cancelled out by factors associated with race and ethnicity such as structural racism.

The authors provided several reasons for the drop in health outcomes for low-income and lesser-educated Americans: (1) less access to technological innovations in medicine and information about complex health risks and preventive behaviors; (2) increasing geographical segregation that creates inequalities in access to health care; (3) reduced economic mobility and increased persistence of poverty; (4) rapidly increasing incarceration rates; and (5) the erosion of public subsidies for health insurance and other health inputs, and increasing exposure to market prices.

The American health care system exacerbates these problems. Even for those with health insurance, rising deductibles and co-payments are shifting more of the costs of care onto users. Since the early 2000s, health spending for wealthier Americans has soared, whereas expenditures have risen modestly for the middle class and actually fallen for those with low incomes, a health-poverty trap driven by medical cost.

Without immediate interventions to reduce inequality, U.S. may see the emergence of a 21st century “health-poverty trap” as economic insecurity can lead to poor health, and poor health can further limit economic productivity, bankrupt households and impoverish families.

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KEY FACTS: Health inequalities in the U.S.

  • The U.S. is one of the most unequal countries in the OECD – only Chile, Turkey and Mexico are more unequal.
  • The life expectancy gap between rich and poor is among the highest in developed countries. The richest 1 percent of Americans live 10-15 years longer than the poorest 1 percent.
  • The life expectancy gap has increased in recent decades, with poverty an increasingly strong risk factor for early death.
  • Many people forgo medical care altogether: 39 percent of low income Americans reported not seeing a doctor because of costs, compared to 7 percent in Canada and 1 percent in the U.K.
  • The U.S. health care system is the most expensive of any other country, yet people with serious illness commonly face financial hardship – 1 in 10 families with medical bill problems have declared bankruptcy.
  • The poorest fifth of American spend 6 percent of their income on private insurance – nearly twice what the wealthiest fifth pay at 3.2 percent.
  • The ACA significantly reduced the number of people who are uninsured – from 48.6 million in 2010, to 28.6 million in 2015, mostly through Medicaid expansions which Congress recently threatened to roll back.
  • Before the 2014 implementation of the ACA, in 2012 43 percent of adults avoided needed care and 41 percent had medical bill difficulties, down to 36 percent and 35 percent in 2014.
  • In 2015, inequalities remain: 25.2 percent of poor Americans are uninsured, compared to 7.6 percent of non-poor Americans; 27.7 percent for Hispanics, 14.4 percent for non-Hispanic blacks and 8.7 percent for non-Hispanic whites.
  • U.S. life expectancy would have increased 51.1 percent more and infant mortality would have fallen 39.6 percent more from 1983 to 2005 if incarceration had remained at its mid-1980s level.

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Physicians for a National Health Program (www.pnhp.org) is a nonprofit research and educational organization of more than 21,000 doctors who support a single-payer national health program. PNHP had no role in funding or otherwise supporting the studies or commentary described above.

An Actual Doctor Debunks 7 Myths About Single Payer Healthcare

By Katie Halper
Paste, April 6, 2017

Debating healthcare policy, along with the medical, ethical, historical, statistical and political elements that go into it, can be daunting, to say the least. But my heart and brain lead me to think that it’s not a good sign that the United States is the only industrialized nation failing to provide universal healthcare as a right. Those other countries are probably onto something.

And so are all the people, organizations, movements, and politicians who are fighting to make single payer a reality.

Before moving on, let’s review what we’re talking about. Single payer, according to Physicians for a National Health Program, “is a system in which a single public or quasi-public agency organizes health care financing.” Under single payer, all residents of the United States would be “covered for all medically necessary services, including doctor, hospital, preventive, long-term care, mental health, reproductive health care, dental, vision, prescription drug and medical supply costs.” The program would be funded by savings derived by “replacing today’s inefficient, profit-oriented” insurance system, with “a single streamlined, nonprofit, public payer.” There would be no premiums, co-pays or deductibles and “95 percent of all households would save money.”

The recent implosion of Trumpcare has only emboldened the single payer movement, which is looking more and more like the only viable alternative to the status quo, or worse. A National Day of Action for Improved Medicare for All has been called for Saturday, April 8th. Congressman John Conyers [MI-D], has picked up so many co-sponsors for his single payer bill, which he re-introduced in January, that he tweeted out, “As I work to convince my fellow Dems to support #MedicareForAll, I thank the GOP for (unwittingly) helping out!” And Senator Bernie Sanders will be reintroducing his Medicare for all bill too. Support for single payer is at an unprecedented level.

But not everyone is so enthusiastic, of course. And the opponents of single payer include insurance companies, lobbies, Republicans and a certain subgenre of Democratic hacks who either genuinely reject universal healthcare programs or who harbor a hatred of Sanders that eclipses their empathy for people whose health and lives are threatened by having inadequate health insurance or no health insurance at all. Their aversion to a single payer plan, they would like us to believe, is based on pragmatism and common sense. (See, for example, this Eric Boehlert tweet, as well as all the people who hearted it, retweeted it or otherwise cosigned it.) Those of us who support single payer, they claim, are naive, radical purists obsessed with a program that will never work in these United States! We just don’t know what we’re talking about.

But Dr. Adam Gaffney definitely knows what he’s talking about. Gaffney is a pulmonary and critical care physician, instructor at Harvard medical school, a board member and secretary of Physicians for a National Health Program and an advocate for a universal single-payer health care system. Gaffney’s writing focusing on policy, politics, and health care history has appeared in The Guardian, The New Republic, The Los Angeles Review of Books, USA Today, Salon, CNN.com, Dissent, US News & World Report, Jacobin, and In These Times. And he is working on a book that explores healthcare as a human right.

Somehow he managed to squeeze in an appearance on the Katie Halper Show, where he debunked common single-payer-phobic myths for me and my co-host, Gabe Pacheco. Below are among the most pervasive—and annoying—myths followed by Dr. Adam Gaffney’s insights.

The interview has been edited for clarity and length and includes follow up questions.

Myth #1: Single payer is not feasible

Reality: Single payer is feasible and popular

It’s not going to be easy, but there’s no question that it can be done. There has been a growing wave of support and a growing movement that has come a long way. Even after Trumpcare imploded and went up in flames, the immediate reaction you heard from voices across the political spectrum was this is going to open the door to single payer. I’m usually the one always making that argument. I didn’t even need to make it this time because everybody else was saying the same thing.

Obviously, the health insurance industry is not really going to go along with this. In fact, they are going to fight it to the death because this would really decimate the private health insurance industry. We should just be honest about that. I don’t think that’s an insurmountable obstacle, but they are a force to be reckoned with . . . The pharmaceutical industry is going to be opposed as well. Not to the same degree as the insurance industry but one thing that is good about a single-payer system is that you can negotiate down drug prices on a national level, which already happens in other countries. You could probably bring brand-name drug prices down by about 50% that way.

We’re already seeing movements coalescing behind the idea that single payer is in fact the last man standing, the only option left.

There’s such a massive disassociation between the right-wing healthcare ethos and what people actually think, even Republicans. I think healthcare, along with certain other social goods, we conceive of them in a different way. Healthcare, education, a number of other things are not simply commodity goods. You can make them into just one more commodity, but it’s a hellish result that you get from it. If you really made healthcare into the equivalent of a car, then that would mean that everybody who doesn’t have a car today would be dying because they wouldn’t be able to go to the doctor. People would be dying in the street; you could turn people away from hospitals; you could turn people away from emergency rooms. There’s just a general philosophical sentiment against that.

No one wants to think that the reason they’re being treated or not treated a certain way is for some corporation’s bottom line. To misquote John Lennon, we can imagine a world without health insurance companies. It’s not hard to do. And once we accept that logic, the feasibility becomes clearer.

Myth #2: Single payer is unaffordable

Reality: It will actually save money

What we’re proposing is an ambitious, grand and egalitarian new system. It’s gonna cost money, but we have savings on the flip side. I’m not worried about losing the battle over finances.

[The case for single payer] took a hit during the primary campaign. Bernie Sanders came out with a sort of single payer proposal and there were these estimates put out by an economist and everybody jumped on the bandwagon, like Paul Krugman, and Ezra Kein, who called it a “puppies and rainbows” plan. Powerful pundits, for better or for worse, have an influence on policy and on Washington. They are actors in this game. It’s enraging. When they say: “Oh, single-payer is great but it’s not doable,” they are contributing to its lack of doability because people respect their columns. I don’t want to overstate their importance in terms of Washington, but to whatever extent they matter, they are contributing to the infeasibility that they say is inevitable.

But we have the numbers and they’re on our side. The administrative savings alone are estimated to be about $500 billion [$503.6 billion] per year because if you go to single-payer systems like Medicare, you can basically cut out a ton of wasteful spending on billing insurance overhead, profits, all of this nonsense.

Then you toss in another $100 billion [$113.2 billion] in pharmaceutical savings. And then you’re talking about real money at that point. You can use that money to cover the cost of insuring everybody and of getting rid of copayments and deductibles, and expanding coverage in new ways like dental care and long-term care, things insurance often already doesn’t cover.

Myth #3: It’s too late for single payer

Reality: It may have been easier earlier on, but it’s not too late

The argument that it would’ve been easier to do earlier is that you wouldn’t have this whole apparatus that you need to deal with. When the U.K created their National Health Service in 1946, there wasn’t this massive, powerful insurance industry; there wasn’t as massive of a powerful pharmaceutical industry. It would’ve been easier in some respects.

That being said, Truman did have a bill for a sort of single-payer-like, national health care system. And that was actually defeated by doctors. The American Medical Association went McCarthyite-crazy on it and sunk it, called it Leninist.

We can send people to the moon, we can create Medicare for All. It’s really not that complicated.

Myth #4: Single payer is such a bad system that Canadians come to America to seek out superior treatment!

Reality: Canadians don’t do that and treatment in Canada is cheaper, more equitable and has better outcomes

The “Canadians coming to the U.S. because they can’t get healthcare in Canada” thing comes up a lot. And there’s actually really no evidence to that at all. It’s a myth. First of all, they couldn’t afford it. If you wanted to come to the United States and get a heart transplant it would cost you millions of dollars. So I don’t know who these Canadians are who have all this money that they would come to the U.S. for something they can get for free in Canada.

A study came out a week or two ago on Cystic Fibrosis, which is a debilitating, genetic lung disease that is often or mostly fatal. It found that people with CF live ten years longer in Canada than they do in the United States. Not only that, they got more lung transplants in Canada than they got in the United States. We’re supposed to be the reigning gods of high-tech care. That’s supposed to be our speciality.

There are always anecdotes about people who are unhappy in other countries. I don’t deny that people have had bad experiences with other systems; you’re dealing with human beings and you’re dealing with different on-the-ground experiences. My answer is as follows: you can take what’s best about American health care now, there are great things about it, and combine that with the best ideas that come from international examples. Between the two of those, we can actually have a really superior healthcare system.

Myth #5: Not having healthcare coverage doesn’t necessarily kill people

Reality: Healthcare coverage saves lives and a lack of coverage kills people

Ross Douthat had a recent column claiming that insurance coverage doesn’t actually save lives. What he says is nonsense. He only cited two studies. One showed lives were saved. The other did not show a statistically significant benefit but it was way too small to actually do so. He didn’t cite the full expanse of the literature.

There’s a lot of studies that have looked at the association of being uninsured, and of dying prematurely. There’s a body of literature supporting the notion that people who aren’t insured wind up dying at higher rates and if you cover more people you actually save lives. Each study shows different numbers but for somewhere between every 300 and 1,000 person you insure, you save one life per year. So if you have 28 million uninsured people, which is what the case is now, even with the Affordable Care Act, there are probably tens of thousands of people dying a year whose lives could be saved if we moved to single-payer. That’s a sobering thought. And it also brings home the idea that American healthcare is not already great, and why the ‘America is already great’ line didn’t really work well for some people.

Another issue is drugs: there’s been a big rise in drug prices, there’s been a proliferation of extraordinarily expensive drugs costing hundresds of thousands of dollars a year. There has been a rise in deductibles, in co-payments. And, as a result, people skip their medications, or they take twice a day medication once a day. Or they don’t even fill the prescription to begin with. There was a heartbreaking story on NPR about people with cancer skipping therapies because they couldn’t afford it. It’s terrible. And we don’t need it. In the UK, in Wales, Scotland, Northern Ireland, except for in a small minority of cases in England, they don’t have any co-payments for drugs. So any drug you’re prescribed by your doctor can be filled for free. And we can do the same thing here.

Myth #6: Experts agree that single payer is a pipe dream

Reality: People who say single payer can’t happen often don’t want it to happen

People who say single payer can’t happen are the people who don’t want it to happen. We all do that. We claim something is impossible if we don’t want to get around to actually doing it. I often feel like it’s impossible for me to do my dishes. I say it’s not feasible. (Then there are people who just accept the conventional wisdom that it can’t be done. And we need to bring those people in and persuade them.)

But first of all, something is going to be impossible if you believe it to be so. It’s a self-fulfilling prophecy. Second of all, it’s not impossible. A Gallup poll of last year found that 58% of the country supports single-payer. It takes a little bit of gumption to claim that something that the majority of the country wants isn’t feasible. That says something sad about the way democracy works.

Myth 7: You can’t fight for single payer while Donald Trump is president and Republicans control congress

Reality: The time is now

Someone could make the critique, “Why are we possibly talking about single payer right now? Trump is in office, Republicans control congress. What chance in hell do we have now?” My response to that would be that now is the time when we coalesce around policy, make the Democratic Party take on that policy and be ready so that when there is a turn in power, when there is a change in government, we can actually make it happen.

Single payer really has the potential to be a unifying issue. People want more health care, not less. They want their parents and their children and themselves to be taken care of. People’s lives are on the line. And it’s a way to move against a lot of other forms of oppression in society including racism. Having a single tier won’t solve racism but it’s a step in the right direction against racial injustice.

Sanders is obviously a long-time single payer supporter. Sanders introduced single payer bills in the past. The healthcare issue was a big part of the primary between him and Clinton. And that helped contribute to the overall dialog that’s been brewing where single payer is increasingly being pointed to as the next step that the Democrats should take on. In response to the Trumpcare fiasco, Sanders is going to introduce a new single payer bill. And it actually opens up a big area for activists because now we have all the Democratic senators or Republican senators that we can pressure: “Sign on to Bernie’s bill. Why aren’t you signing on to Bernie’s bill? What is your reason for not doing that?” And Rep. Conyers has had a single payer bill which he reintroduced in January. So we have a bill in the House currently. And Bernie is going to re-introduce a bill in the Senate. Having those bills out there, even if they lack enough sponsors provides an important organizing focus and will help lead us into the realm of actual policy once we change the people who are in charge of the country. And the grassroots movement is playing a critical role.

I think all these elements are going to come together and bring victory.

Born, raised, and still living in NYC, Katie Halper is a writer, radio show host, filmmaker, comedian, and former history teacher who identifies as a feminist Bernie Bro.

https://www.pastemagazine.com…

There is a choice: Medicare for all

By Jed Maker, M.D.
The Salt Lake Tribune, April 6, 2017

Regarding the recent town hall of Rep. Chris Stewart, I would like to point out that he has no defense for the debacle that is the failed GOP bill to replace Obamacare. His response is a petulant, taunting, “You have Obamacare.”

Actually we have more than that. There is now HR676, the Expanded and Improved Medicare for All Act before Congress.

I am a physician, recently retired, who took care of hundreds of Medicare patients in my 40 years of practice. I heard very few complaints about Medicare. Most people, like me, are happy and relieved to be of Medicare age. The care you receive is no different than that of private insurance. Medicare has controlled health care costs better than private insurance. Medicare has lower administrative costs than private plans. So-called “competition” in the private market has actually driven costs up. Medicare is publicly accountable; private plans are not.

If you are interested in excellent health care and saving billions of dollars while covering all Americans, write or call your representatives in Congress and urge them to support HR676 and/or Sen. Bernie Sanders’ upcoming Medicare for All Senate legislation. You won’t be sorry.

Dr. Jed Maker resides in Salt Lake City.

http://www.sltrib.com…

April 8 National Day of Action for Health Care planned for first day of congressional recess

Energized by the defeat of the American Health Care Act, constituents will rally in 49 cities to demand Improved Medicare for All

FOR IMMEDIATE RELEASE, April 6, 2017
Contact: Clare Fauke, communications specialist, PNHP, 312-782-6006, clare@pnhp.org

As members of Congress return to their home districts for the spring recess, they will be greeted by a broad coalition of doctors, nurses, students and patients demanding “Improved Medicare For All,” a single-payer health plan that covers all Americans. On Saturday, April 8, participants in 49 cities—from New Hampshire to Hawaii—will hold marches, rallies, congressional office visits and “die-ins,” highlighting the urgent need for a national health program.

The April 8 Day of Action was sparked by a renewed interest across the political spectrum in a single-payer, universal health program. Participants will ask their representatives to sign on to H.R. 676, the Expanded and Improved Medicare for All Act. Researchers estimate that replacing the Affordable Care Act with a streamlined, publicly financed single-payer health system like H.R. 676 would yield about $500 billion annually in administrative savings, enough to provide immediate coverage to the 26 million Americans who are currently uninsured, saving nearly 21,000 lives in year one. The savings would also be sufficient to eliminate all copays and deductibles for those already insured. H.R. 676 currently has 90 co-sponsors, 21 of which signed on in the last two weeks. In addition, Senator Bernie Sanders (I-Vt) has announced plans to introduce a single-payer health bill in the U.S. Senate.

“Republican attempts to strip millions of Americans of their health insurance have backfired,” said Dr. Carol Paris, a retired psychiatrist based in Nashville, Tennessee, and president of Physicians for a National Health Program, one of the groups participating in the April 8 Day of Action. “With the swift defeat of the GOP bill, a grassroots movement toward a universal, single-payer health program is growing. Now is the time.”

The Day of Action in Las Vegas is lead by Amy Vilela, whose daughter Shalynne died at the age of 22 of massive pulmonary embolism, caused by an undiagnosed and untreated blot clot. “If we lived in a country where her insurance status did not have an impact on her treatment and care, she would still be alive,” said Ms. Vilela. “I cannot remain silent knowing that other parents might feel the immense pain I’ve endured if our healthcare system does not guarantee healthcare for all.”

National Nurses United, which is also participating in the Day of Action, feels the same sense of urgency. “Nurses will never stop fighting until health care is guaranteed as a human right, not just as a privilege,” said the group’s Co-president Deborah Burger, RN. “Nurses will be out in several states on April 8, calling for Medicare for all, canvassing for the single-payer bill we sponsored in California, SB 562, and making sure our elected officials hear the collective voice of the people, saying we want health care, not health insurance.”

Participating labor groups are fully on board with this message. “To put it simply, health care is a damn human right,” said Cory Aaron, a member of the Brotherhood of Maintenance of Way Employees Division of the Teamsters union who was born in Jasper, Alabama, and now works for the BNSF Railroad near St. Louis. “Everyone should have the health care they need and we are only going to get it by standing together. That’s why my family and I are going to the action on Saturday.” 

The April 8 National Day of Action is coordinated by the Campaign for Guaranteed Healthcare, which includes Healthcare-NOW, Physicians for a National Health Program, Students for a National Health Program, National Nurses United, Progressive Democrats of America, Labor Campaign for Single Payer Healthcare, Our Revolution, the Brotherhood of Maintenance of Way Employees (Teamsters), American Student Medical Association (AMSA) and White Coats for Black Lives. 

Detailed information and local contacts for each of the 43 participating cities can be found here:

Berkeley, CA
Orange County, CA
Los Angeles, CA
Idyllwild, CA
Riverside, CA
West Covina, CA
Boulder, CO
Denver, CO
Loveland, CO
Washington, DC
Fort Lauderdale, FL
Jacksonville, FL
Naples, FL
St. Petersburg, FL
Tampa, FL
Gainesville, FL
Miami, FL
Naples, FL
The Villages, (Central FL)
West Palm Beach, FL
Atlanta, GA
Honolulu, HI
Champaign, IL
Elgin, IL
Louisville, KY
Frederick, MD
Boston, MA
Pittsfield, MA
Minneapolis, MN
St. Louis, MO
Kansas City, MO
Las Vegas, NV
Concord, NH
Albuquerque, NM
New York, NY
Charlotte, NC
Greensboro, NC
Cleveland, OH
Dayton, OH
Toledo, OH
Roseburg, OR
Corvallis, OR
Philadelphia, PA
Memphis, TN
Austin, TX
Virginia Beach, VA
Seattle, WA
Fond du Lac, WI

Physicians for a National Health Program (www.pnhp.org) is a nonprofit research and education organization of more than 21,000 doctors who support a single-payer national health program. It was founded in 1986.

It’s not just Democrats and liberals who support Medicare for all

The Economist/YouGov Poll, April 2-4, 2017

81. Opinion on health reforms – Expanding Medicare to provide health insurance to every American

Percent who favor strongly or favor somewhat:

60% Total

75% Democrat
58% Independent
46% Republican

82% Liberal
60% Moderate
43% Conservative

63% Family income under $50K
58% Family income $50-100K
63% Family income over $100K

80% Clinton voters
40% Trump voters

https://econTabReport.pdf…

***

Comment:

By Don McCanne, M.D.

This poll shows once again that about 60 percent of Americans favor expanding Medicare to cover everyone. To no surprise, about 80 percent of liberals, Democrats and Clinton voters are in support. But what we should be especially aware of is that over 40 percent of conservatives, Republicans and Trump voters also support Medicare for all.

It is wrong to narrowly target the single payer message to liberals and Democrats. The message resonates with a significant percentage of conservatives and Republicans as well. They should certainly be included in the grassroots coalition efforts to support Medicare for all. The majority of the nation working together will get us there.

Conyers: Medicare for All’s time has come

By John Conyers Jr.
Detroit Free Press, April 3, 2017

I’m as happy as anyone with the way the Republicans’ plan to wreck our healthcare system crashed and burned last week. And President Donald Trump is right: Republicans lost because Democrats beat them. We beat them because we were organized, we were unified and we were backed by unprecedented grassroots energy. Members of the U.S. Congress hosted dozens of rallies, advocacy organizations hosted hundreds more and constituents showed up in overwhelming numbers at town halls across this country to make their voices heard.

And what exactly was their message? One of the most poignant moments came at a town hall hosted by U.S. Rep. Diane Black, Republican of Tennessee, where a constituent explained her opposition to the GOP bill using faith. As a Christian, she said, her faith was rooted in helping the unfortunate, not cutting taxes on the rich, so why not expand Medicaid and allow everyone to have insurance? And she’s not alone. Last week, a Quinnipiac survey found that voters overwhelmingly oppose cuts to Medicaid — 74% of them — including 54% among Republicans.

Given the record high support for publicly funded healthcare, economists, policy experts and commentators everywhere have called on the Democratic party to build on our momentum by supporting a single payer system. But perhaps the most convincing case I heard came from Jessi Bohan, the teacher from Cookeville, Tennessee who spoke at Rep. Black’s town hall.

The week after her question went viral she wrote to the Washington Post that she was troubled to see her comments used as a “defense of Obamacare” instead of what they were: an indictment of any healthcare policy that leaves anyone out. As Bohan so eloquently put it, “it is immoral for health care to be a for-profit enterprise” that allows insurance companies to make “enormous sums of money off the sick while people are struggling to pay their medical bills.” If she had it to do over again, she wrote, she would have explained to Black “the Christian case for universal, single-payer health insurance, which would protect all Americans.”

While her message was targeted at Republicans, it is one that many of my colleagues in the Democratic Party need to hear as well. For two weeks, I’ve watched Democrats point to the Congressional Budget Office’s analysis of the Paul Ryan bill and express righteous outrage that it would lead to 24 million Americans losing their insurance. But that same CBO score says that 28 million Americans will still be without insurance even under the Affordable Care Act. I’m impressed that the ACA has expanded Medicaid eligibility in states that have adopted it and more than 20 million previously uninsured now have insurance, but universal healthcare it is not.

Time and time again I’ve heard Democrats dodge questions about their support for universal healthcare by saying they’re focused right now on defending the ACA. Now that we have repelled Paul Ryan’s attack and Donald Trump has signaled that Republicans will move on, the time for those excuses has passed.

For years, I’ve also watched as Democrats, including our presidential nominee last year, have avoided putting their name behind single payer by saying they’re focused on politically achievable short-term goals.

Single payer is politically achievable.

Gallup, the Kaiser Family Foundation, and other polling organizations have found that there is majority support for Medicare for All in America today. But more important, elected officials are not supposed to move to the political center, we are supposed to stake out the moral center and convince others to join us there.

November’s election results showed that we can’t just say “the other side is awful,” however true that may be, and expect Americans to flock to us. To win again, we must be a party of principles and present bold ideas and a vision for the future.

It is true that single-payer healthcare has been implemented in virtually every other advanced democracy on Earth. It is also true that in those countries, people live longer and healthcare is dramatically less expensive than it is here. And finally, it is true that Medicare for All is the direction Americans overwhelmingly want us to go. Nevertheless, I want my colleagues to join me in supporting single-payer not to save money or to win elections, but because it is the moral and just thing to do. If, like me, you believe healthcare is a right to everyone and not a privilege to those who can afford it, let’s be organized and let’s be unified in our support for Medicare for All.

John Conyers represents Michigan’s 13th District in the U.S. Congress. He has introduced H.R. 676 Medicare for All bill in every Congress since 2003.

http://www.freep.com…

***

Comment:

By Don McCanne, M.D.

Congressman John Conyers is right on target. The time has come for an improved Medicare for all. HR 676 now has 84 cosponsors. Single payer, here we come.

Activists Rally: Demand Albany Pass NY Single-Payer Bill

By Dave Lucas
WAMC Northeast Public Radio, April 5, 2017

With the country once again debating the future of health care, activists rallied Tuesday in Albany in support of a bill that would create a universal, publicly-financed health-insurance plan for all New Yorkers.

Rallygoer and Green Party candidate for Albany mayor Dan Plaat believes having a state single-payer plan in place would have a positive impact on local economics.   “It reminds me a lot of the anti-fracking movement. Each year the rally gets a little bit bigger. More partners are made and more people catch on to the necessity and the importance of this issue in getting this law passed, this piece of policy done.”

The New York Health Act has passed twice in the Assembly, which expects to pass it again for the third year in a row. Assembly Health Committee Chair and bill sponsor Democrat Dick Gottfried says support for universal health care is growing with the public and in the state Senate, where it is co-sponsored by nearly half of all senators.

The bill would replace private insurance premiums, deductibles, co-pays, restricted provider networks and out-of-network charges. It would provide comprehensive health coverage for all New Yorkers, regardless of immigration status, health, or employment status, with full choice of doctors and other providers.

Katie Robbins is the Executive Director of the New York Metro Chapter of Physicians for a National Health Program.   “Studies have shown that if the New York Health Act were passed and implemented, you’d have a health care system where 98 percent of New Yorkers would pay less than they do now for health care. Health care costs are rising. The average family plan is $18,000 a year. People know that the increasing deductibles and co-pays, I mean we all know that feeling, if you get sick you worry, ‘Oh shoot, how am I going to pay for this?’ Under our system, we pay for it up front through a payroll tax as well as a tax on capital gains. And then when you need to sue the system, you don’t have to worry about having the money at the time you get sick. It ends this kind of Byzantine practice of tying your health insurance to your job or your marriage.”

The program would be publicly funded based on ability to pay and would eliminate the local share of Medicaid, currently funded through county property taxes.

Platt insists health care should be considered a basic right, nationally and locally. “It would be a great benefit to the city of Albany, all of the residents, because it is ‘everybody in, nobody out.'”

Platt’s campaign platform include economics, the environment, social justice and human rights. He says New York Health affects and is affected by all of these areas.

Robbins notes the bill has 30 co-sponsors in the state Senate, two votes short of a majority. Republicans control the chamber in a power-sharing agreement with the Independent Democratic Conference, and it’s a long shot to reach the floor for a vote. “I think it would start a trend in the country so that other states would do it, and then eventually we would adopt a national ‘Medicare for all’ system that would guarantee health care as a right to all residents of this country. And New York can be the first state to do it, start the trend and lead the way.”

A 2015 study by a UMass Amherst professor estimated that the New York Health Act, if implemented, would save almost $45 billion in the first year alone, reducing burdensome billing expenses, administrative waste in the insurance industry, monopolistic pricing of drugs and medical devices, and fraud.

http://wamc.org/post…

National Catholic Reporter endorses health care as a right

Editorial: Take the lead on health care as a right

National Catholic Reporter, April 1, 2017

The survival of the Affordable Care Act means that millions of people who have never had health coverage before can continue to buy plans from HealthCare.gov or find relief from an expanded Medicaid.

So, yes, let’s breathe a short sigh of relief. But then let’s roll up our sleeves and prepare for the next battle in the war that has been declared on the American middle class and people living in poverty.

Independent Sen. Bernie Sanders of Vermont promises to introduce a bill that would move health care coverage to a single-payer, Medicare-like system. Now is the time for Democrats to come back into the spotlight and use this opportunity to work with Sanders to create a system that works — that works for those who can afford health care insurance and, more vital, for those who cannot.

Other industrialized nations, such as Canada, France and Japan, treat basic health care as a human right for all people. They built their health care systems on that tenet. It’s time for the U.S. to recognize that right in this nation. The right to receive care can no longer be predicated on one’s financial situation. Everyone in this country deserves the same treatment in the emergency rooms, hospitals, and medical and dental offices in all 50 states.

Once we’ve taken our deep breath, that should be the next fight.

https://www.ncronline.org…

***

Comment:

By Don McCanne, M.D.

Another welcome editorial making it clear that preventing the repeal of the Affordable Care Act was important but not enough. We must begin treating health care as a human right for all people by moving health care coverage to a single-payer, Medicare-like system.

Letter: Finally, a bill that can really save health care

By Robert S. Kiefner, M.D.
Concord (N.H.) Monitor, April 4, 2017

In a colossal setback for those who are indifferent to the health and well-being of their fellow Americans, the Republicans failed to repeal and replace Obamacare.

Ironically, it was the Freedom Caucus, a fraternity of cranky old white guys (and cranky younger white guys in training) who torpedoed the bill. By targeting the positive aspects of the ACA for repeal, they unwittingly enlightened and energized people with respect to the real value of the benefits.

There is now a unique opportunity to transcend the ACA, to dramatically decrease administrative overhead, drug costs, co-pays and deductibles while providing truly universal care.

HR 676, the Expanded and Improved Medicare for All Act, now awaits its day in Congress. Seventy-six co-sponsors have signed onto universal healthcare, publicly financed, but privately delivered with much lower costs. What’s not to like? HR 676 should be the bill that brings together the progressives who have long supported healthcare for every citizen, and the fiscal conservatives who want to decrease overall healthcare spending. The dissenters are mainly for-profit insurance companies and Big Pharma, for whom the bill provides long deserved corporate wedgies.

Encourage Reps. Annie Kuster and Carol Shae-Porter to sign on as cosponsors of HR 676. The time has come to really fix health care.

Dr. Robert S. Kiefner resides in Concord.

http://www.concordmonitor.com…

Two problems with a Medicaid work requirement

Don’t expect Medicaid work requirements to make a big difference

By Drew Altman, president and CEO of Kaiser Family Foundation
Axios, April 3, 2017

Medicaid “work requirements.” But their impact depends on how they are implemented and is likely to be very small — because most people on Medicaid who can work already are.

With Trumpcare dead for now, expect Republican governors to begin submitting waiver proposals to the Department of Health and Human Services to move their Medicaid programs in a more conservative direction. Medicaid “work requirements” are likely to be an element of many of those waiver requests, possibly from Republican-led states now looking to expand Medicaid under the Affordable Care Act.

During the Obama administration, HHS rejected mandatory work requirements as inconsistent with the purposes of the Medicaid statute, spurning requests from Arizona, Indiana, and Pennsylvania under a previous governor. Under the Trump presidency, HHS is expected to approve them.

Liberals find Medicaid work requirements repugnant because they believe that Medicaid beneficiaries want to work if they can, and that providing health coverage to people who cannot afford it is an obligation of any moral nation. Conservatives who favor work requirements see Medicaid coverage as another form of government welfare benefit, like cash assistance, requiring reciprocal obligations from beneficiaries, and a disincentive to work.

The reality, though, is that most Medicaid beneficiaries are working already, and the vast majority of those who are not working are likely to be exempted from all but the most draconian Medicaid work requirements when front-line caseworkers apply state rules.

* 59% of all Medicaid beneficiaries who were not on Supplemental Security Income — the program for low-income people with disabilities — were working full time (41%) or part time (18%) in 2015.

* That leaves 41% who were not working. Of those, the vast majority (89%) had reasons for not working, including that they were sick or had a disability (35%), were taking care of a family member (28%), or were in school (18%).

* Another 8% said they could not find a job which, when documented, usually satisfies work requirements.

* All told, just a tiny subset of Medicaid beneficiaries are-able bodied adults who do not have a reason for not working that would fail to pass muster with a state case worker.

https://www.axios.com…

***

Comment:

By Don McCanne, M.D.

Why are some people opposed to other people having health care? In the case of Medicaid, some conservatives would deny people health care merely because they failed to meet certain work requirements. It is not as if this is a ubiquitous problem since, according to this report, only a tiny subset of Medicaid beneficiaries are able-bodied adults who do not have a reason for not working.

Is the denial of medical care a proper punishment for not being able to find a job? Only 3 percent of Medicaid beneficiaries fell into this category – lower than the national unemployment rate. And the conservatives would deny them care? This seems to be an unusually cruel punishment for what is largely a circumstance of fate.

The other issue is who really deserves to be denied health care? Nobody you say? Then why don’t we have a system that guarantees that everyone does have affordable health care when needed, like maybe an improved Medicare for all? Segregating people into arbitrary groups for health care coverage leaves many out, such as what would happen under these conservative work requirements for Medicaid.

HHS Secretary Tom Price and CMS administrator Seema Verma like these work requirements and are eager to grant states the right to exercise them. And we tolerate this in our government? What have we become?

Conyers: Medicare for All’s time has come

By John Conyers Jr.
Detroit Free Press, April 3, 2017

I’m as happy as anyone with the way the Republicans’ plan to wreck our healthcare system crashed and burned last week. And President Donald Trump is right: Republicans lost because Democrats beat them. We beat them because we were organized, we were unified and we were backed by unprecedented grassroots energy. Members of the U.S. Congress hosted dozens of rallies, advocacy organizations hosted hundreds more and constituents showed up in overwhelming numbers at town halls across this country to make their voices heard.

And what exactly was their message? One of the most poignant moments came at a town hall hosted by U.S. Rep. Diane Black, Republican of Tennessee, where a constituent explained her opposition to the GOP bill using faith. As a Christian, she said, her faith was rooted in helping the unfortunate, not cutting taxes on the rich, so why not expand Medicaid and allow everyone to have insurance? And she’s not alone. Last week, a Quinnipiac survey found that voters overwhelmingly oppose cuts to Medicaid — 74% of them — including 54% among Republicans.

Given the record high support for publicly funded healthcare, economists, policy experts and commentators everywhere have called on the Democratic party to build on our momentum by supporting a single payer system. But perhaps the most convincing case I heard came from Jessi Bohan, the teacher from Cookeville, Tennessee who spoke at Rep. Black’s town hall.

The week after her question went viral she wrote to the Washington Post that she was troubled to see her comments used as a “defense of Obamacare” instead of what they were: an indictment of any healthcare policy that leaves anyone out. As Bohan so eloquently put it, “it is immoral for health care to be a for-profit enterprise” that allows insurance companies to make “enormous sums of money off the sick while people are struggling to pay their medical bills.” If she had it to do over again, she wrote, she would have explained to Black “the Christian case for universal, single-payer health insurance, which would protect all Americans.”

While her message was targeted at Republicans, it is one that many of my colleagues in the Democratic Party need to hear as well. For two weeks, I’ve watched Democrats point to the Congressional Budget Office’s analysis of the Paul Ryan bill and express righteous outrage that it would lead to 24 million Americans losing their insurance. But that same CBO score says that 28 million Americans will still be without insurance even under the Affordable Care Act. I’m impressed that the ACA has expanded Medicaid eligibility in states that have adopted it and more than 20 million previously uninsured now have insurance, but universal healthcare it is not.

Time and time again I’ve heard Democrats dodge questions about their support for universal healthcare by saying they’re focused right now on defending the ACA. Now that we have repelled Paul Ryan’s attack and Donald Trump has signaled that Republicans will move on, the time for those excuses has passed.

For years, I’ve also watched as Democrats, including our presidential nominee last year, have avoided putting their name behind single payer by saying they’re focused on politically achievable short-term goals.

Single payer is politically achievable.

Gallup, the Kaiser Family Foundation, and other polling organizations have found that there is majority support for Medicare for All in America today. But more important, elected officials are not supposed to move to the political center, we are supposed to stake out the moral center and convince others to join us there.

November’s election results showed that we can’t just say “the other side is awful,” however true that may be, and expect Americans to flock to us. To win again, we must be a party of principles and present bold ideas and a vision for the future.

It is true that single-payer healthcare has been implemented in virtually every other advanced democracy on Earth. It is also true that in those countries, people live longer and healthcare is dramatically less expensive than it is here. And finally, it is true that Medicare for All is the direction Americans overwhelmingly want us to go. Nevertheless, I want my colleagues to join me in supporting single-payer not to save money or to win elections, but because it is the moral and just thing to do. If, like me, you believe healthcare is a right to everyone and not a privilege to those who can afford it, let’s be organized and let’s be unified in our support for Medicare for All.

John Conyers represents Michigan’s 13th District in the U.S. Congress. He has introduced H.R. 676 Medicare for All bill in every Congress since 2003.

http://www.freep.com…

When it comes to health care, why do we settle?

By Ellen Kaczmarek, M.D.
Citizen-Times (Asheville, N.C.), April 2, 2017

Competition! Americans thrive on it — it is virtually part of our national DNA. From sports to businesses (think free market economy and capitalism) to elections, competition is what we all understand. Being No. 1 is the goal we have been taught to seek.

Yet, we are totally complacent about being No. 37, according to the World Health Organization, in the world. Most of us don’t even realize that’s where the USA stands. In what, you ask? The answer is in health care.

How is this possible? What’s behind this number? This must be fake news! Are these alternative facts?

A flurry of questions accompanies this statement and it should.

For one, How is it possible that we rank No. 37 in health care?

Not to mention that life expectancy in the U.S. is shorter than most of the nations studied by the OECD (Organisation of Economic Cooperation and Development) by about 2 years (78.8 years in the U.S. in 2013 compared with 80.5 years for the OECD average). This is despite the fact that in the United States, health care spending remains much higher on a per capita basis than in all other OECD countries, and was two-and-a half-times greater than the OECD average in 2013 (though with the Affordable Care Act, there has been a notable slow-down in U.S. health spending growth).

The answer is that in most countries (with the exceptions of the U.S., Poland and Greece), universal health coverage ensures access to care for the whole population. This means that prevention of disease and promotion of healthy practices is paramount. It also provides financial protection from the cost of illness, so that medical bankruptcy is nonexistent in those countries.

Second, what is universal health coverage?

Universal health coverage means all citizens have health insurance. This is most cost-effective with a single payer health care system where a “single payer” fund, rather than private insurers, pays for health care costs. The “single payer” part refers to funding, not delivery.

In general, single-payer health care means that all medical bills are paid out of a single government-run pool of money. Under this system, all providers are paid at the same rate, and citizens receive the same health benefits, regardless of their ability to pay. A single-payer fund can have a private health care delivery system, a public delivery system, or a mix of the two (similar to the Medicare and supplemental “Medigap” insurance in this country.)

Isn’t a single payer plan socialism?

A single-payer system is not the same thing as socialized medicine. In a truly socialized medicine system, the government not only pays the bills but also owns the health care facilities and employs the professionals who work there. The Veterans Health Administration is an example of a socialized health system run by the government. The VA owns the health care facilities and pays the doctors, nurses and other health providers.

Medicare, on the other hand, is a single-payer system in which the federal government pays the bills for those who qualify, but hospitals and other providers remain private. (Again, many Medicare recipients purchase “Medigap” policies which cover the difference between the charges for their health care and what Medicare covers.)

Rather than tinker with a system like the ACA that was really only a compromise situation with insurance companies and other special interest groups at best, Americans need to demand a comprehensive reform that eliminates the profit motive from health care and provides a truly universal health coverage system. A single-payer health plan would fill this bill.

Who wants to be 37 when you can be No. 1?

Ellen Kaczmarek, M.D., is a member of Indivisible AVL.org, Health Care Justice of NC and Physicians for a National Health Program.

http://www.citizen-times.com…