PNHP

Health insurance fix: Medicare-for-all

Health insurance fix: Medicare-for-all

By Jack Kotecki
Green Bay (Wis.) Press-Gazette, Feb. 28, 2017

Health care reform is a high priority on the newly elected Congress’ to-do list.

As a University of Wisconsin medical student who grew up in northeastern Wisconsin, I am concerned that the proposals being put forward by Republicans in Congress will harm Wisconsinites’ ability to access and receive the care they need.

It has been well-documented that the Affordable Care Act has failed to significantly control health care costs; I’ve heard firsthand from patients, family members, and friends about the unbelievable increases in insurance premiums they now face. This, then, presents the new Congress with an opportunity to vastly improve the health insurance infrastructure in America.

So far, their plans have been a conglomeration of conservative ideas like health savings accounts and interstate insurance markets. Such plans will fall well short of the true affordability and health care access that Americans deserve. It may seem like we are mired in a hopeless situation, but there is a way to create better more affordable health insurance: Medicare-for-all.

Medicare-for-all (sometimes referred to as “single-payer”) is a simple program. It requires the elimination of for-profit health insurance companies in favor of a nonprofit government entity that covers all medical expenses. Health care payments would be financed through progressive taxation and fully offset by the elimination of premiums and out-of-pocket expenses. Single-payer systems would cover every American, and they would pay less, to boot.

The strength behind Medicare-for-all lies in its ability to control administrative costs. For example, private health insurance companies take between 12 percent and 25 percent of patient premiums to pay for overhead (advertising, underwriting costs, etc.). This is money that doesn’t pay for care and would be all but eliminated in a Medicare-for-all program (traditional Medicare’s overhead was 1.6 percent in 2013). Instead, that money would stay in patients’ pockets, to be used as they see fit.

Medicare-for-all leads to more freedom and control for patients. It eliminates the concept of “provider networks”; patients can choose to see any doctor and hospital they prefer. Departing from the current private insurance provider networks, profit will not fuel decisions surrounding your care, so there is little incentive to deny insurance claims.

Businesses and workers would both benefit tremendously from this program. Businesses would no longer be legally obligated to provide health insurance to their employees and could put more money toward growing their business. Conversely, since health insurance wouldn’t be tied to your job, workers could change careers without worrying about losing their coverage. This would lead to a much more dynamic labor market and help businesses fill job openings.

Critics who argue Medicare-for-all is “socialized medicine” don’t realize, or mention, that the U.S. already has the largest government-run health insurance program in the world, our Medicare program. This program does an excellent job controlling costs, especially considering they insure one of the most expensive subsets of patients, the elderly. Medicare patients also are happier with their insurance, consistently having higher levels of satisfaction with their insurance coverage than those with private insurance plans.

Admittedly, the United States health care system is a complex, economic juggernaut with myriad vested interests. But we do have a cure for the expensive, inadequate health insurance Americans now experience. Medicare-for-all is the insurance program that Americans deserve. It will guarantee affordable coverage for everyone. It will lend more freedom to patients over which doctors and hospitals they use. In the coming weeks, I will be contacting my Congressional representatives’ office and voicing my support for a Medicare-for-all insurance program. I hope that you will consider doing the same.

Jack Kotecki is a first-year medical student at the University of Wisconsin School of Medicine and Public Health and a graduate of Coleman High School.

http://www.greenbaypressgazette.com…

Does the Democratic Party really believe that health care is a right?

By Brian Cooney
The (Danville, Ky.) Advocate-Messenger, Feb. 28, 2017

Over the past seven years, Republicans have regularly voted to repeal all or part of the Affordable Care Act (ACA/Obamacare). Those repeal votes were cheap talk as long as Republicans could count on a Democratic president’s veto. But now, to their surprise, they have their very own President Trump eager to fulfill his campaign promise to eliminate the ACA, and they can’t agree on a replacement.

They know the American public won’t tolerate going back to the status quo before Obamacare (back when we had what Mitch McConnell ignorantly described as “the finest health care system in the world”). Obamacare brought several major improvements to America’s health care system, and most people today want to keep them.

It banned insurance companies from denying coverage or charging higher premiums for pre-existing conditions, and from setting a lifetime limit on how much an insurer has to pay for covered benefits. In the good old days, many people were unaware that a single bout of cancer could leave them bankrupt after their policies maxed out.

Obamacare also required allowing adult children to stay on their parents’ policies until age 26. It put a cap on insurance company profits and limited premium differences between old and young. Through its subsidized insurance exchanges and expansion of Medicaid eligibility, it “reduced the number of uninsured Americans by an estimated 20 million people from 2010 to 2016” (NYT 1/13/17). However, it still left more than 27 million uninsured (more than the combined populations of Belgium and the Netherlands).

The problem for Republicans is that these very popular features of Obamacare require a lot of government supervision and expensive subsidies for those who cannot afford the care they need. The current GOP is an anti-government party that does not believe health care is a right that should be guaranteed by the government.

The problem for Democrats is that, although their 2016 Party platform reaffirms the traditional Democratic belief that health care is “a fundamental right for every American,” they haven’t been willing to commit to reforms that would implement this right. Instead, the platform suggested tweaking Obamacare. However, if health care is a right, then a system that leaves 27 million uninsured fails to respect that right. “Additionally, underinsurance is an increasing, often overlooked problem,” says Dr. Jessica Schorr Saxe of Physicians for a National Health Program:

“According to the Commonwealth Fund, this included 21 percent of adults below Medicare age in 2014. More than one-third of Americans did not get needed care due to financial barriers, and more than one-third have trouble paying a medical bill. Free clinics, which expected declining numbers after the ACA, are seeing an influx of insured patients who cannot afford co-pays or deductibles.”

The U.S. pays much more for health care than other high-income nations, but gets much less. In its recent survey of health care in 11 high-income countries (Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States), the Commonwealth Fund reached this conclusion:

 â€śIn comparison to adults in the other 10 countries, adults in the U.S. are sicker and more economically disadvantaged.  . . .Although the U.S. has made significant progress in expanding insurance coverage under the Affordable Care Act, it remains an outlier among high-income countries in ensuring access to health care. The authors point out that all of the other countries surveyed provide universal insurance coverage.”

The argument over retaining, tweaking or repealing the ACA is a distraction. If health care is a right, then we must have a national program to secure health care for everyone. There is a bill in Congress that would do just that: H.R.676 — Expanded & Improved Medicare For All Act, introduced by Rep. John Conyers (D-MI) with 59 cosponsors.

Medicare as it now exists is a program for the elderly that 77 percent of Americans consider “very important” (second only to Social Security), and 75 percent of recipients say is working well. It is (mostly) a single-payer system in which a government-administered fund pays for services delivered by private hospitals and practitioners. H.R. 676—Medicare for All would create a universal and much more comprehensive single-payer system.

Like the Canadian single-payer system and our current Medicare, it would drastically reduce (by hundreds of billions of dollars) the administrative costs imposed on doctors’ offices and hospitals by the multiple forms and rules of competing private insurers. It would also (as in Canada and Europe) help patients by reducing drug prices through direct negotiation with pharmaceutical companies. These savings would enable the U.S. to cover those uninsured 27 million, and greatly expand coverage for everyone.

Even Donald Trump saw this back in 2000, when he wrote in his book “The America We Deserve” that “We must have universal health care. Just imagine the improved quality of life for our society as a whole. … The Canadian-style, single-payer system in which all payments for medical care are made to a single agency (as opposed to the large number of HMOs and insurance companies with their diverse rules, claim forms and deductibles) … helps Canadians live longer and healthier than Americans.”

According to a recent Gallup poll (5/16/16), 58 percent of Americans (73 percent of Democrats and 41 percent of Republicans) favor replacing the ACA “with a federally funded healthcare system that provides insurance for all Americans.” Yet Hillary Clinton’s majority in the Democratic National Platform Committee voted against single-payer, ignoring the overwhelming preference of Democrats.

The DNC’s vote, and Hillary’s refusal to endorse single-payer, were a vivid reminder that the Democratic Party was still the servant of the health care industry and not of the people. Can it reform before 2018?

https://www.amnews.com…

Should health insurance options control retirement decisions?

If Obamacare Exits, Some May Need to Rethink Early Retirement

By Austin Frakt
The New York Times, February 27, 2017

Here’s another possible consequence of repealing the Affordable Care Act: It would be harder for many people to retire early.

Americans reaching 65 become eligible for Medicare. Before reaching that age, some can get retiree coverage from their former employers. But not very many companies, especially small ones, offer medical insurance to retirees. If early retirees are poor enough, they could turn to Medicaid. To retire early, everybody else would need to turn to the individual health insurance market. Without the subsidies and protections the A.C.A. put in place, health care coverage would be more difficult to obtain, cost consumers more where available, and provide fewer benefits than it does today.

But it is clear that with A.C.A. repeal on the table, people contemplating early retirement may need to reconsider.

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NYT Reader Comments:

By Don McCanne, M.D.
San Juan Capistrano, CA

It seems that our goal should be to remove financial barriers to health care for all of us so we can get the health care we need when we need it.

So why do we make it difficult by establishing such arbitrary qualifications for health coverage: employment status (employer-sponsored plans), older age (65 for Medicare), younger age (CHIP), income (Medicaid), prior military service (VA), ethnic heritage (Indian Health Service), temporary unemployment (COBRA), or whatever?

This complexity contributes greatly to the profound administrative waste in our system – now over a half a trillion dollars a year that could be recovered, according to a report this month in the Annals of Internal Medicine. It also increases instability in our health care with ever-changing provider networks, creating a degree of fragmentation that is unique in the U.S. health care system.

It would be so much simpler and efficient to improve Medicare so that it is appropriate for all ages, and then automatically include everyone, using an equitable method of funding that would be affordable for all.

With the difficulty that Congress is having with decisions on how to improve health care financing, why don’t they finally take a serious look at a proven model that has worked well in other nations – a single payer national health program – in the form of an improved Medicare for all?

https://www.nytimes.com…

Amid GOP Attacks on Health Care, the Movement for Single Payer Is Growing

By Michelle Chen
Truthout, Feb. 27, 2017

This could be the moment that the country finally comes to its senses on single payer, according to Dr. David Himmelstein, co-founder of the advocacy network Physicians for a National Health Program (PNHP).

Facing the inevitable collapse of an unsustainable system, “now there’s much more…appetite for addressing the fundamentals,” Himmelstein said.

One proposal for enacting single payer is simply extending and fortifying the basic infrastructure of Medicare, the centralized plan covering seniors over 65. Even Medicare in its current form is not a pure single-payer program: It suffers from its own funding gaps and contains major coverage deficits patched by semi-privatized or market-based care. (Republicans are now poised to exacerbate these gaps with post-ACA reforms that would replace it with more private, fee-based programs, which could destroy publicly subsidized care generally, endangering both Medicare for seniors and Medicaid for low-income families.)

However, as a blueprint for a workable single-payer network, the popular program could form a politically acceptable foundation for a universal health plan.

According to a recent cost analysis published by Drs. Himmelstein and Steffie Woodhandler, another PNHP co-founder, an enhanced “Medicare for all” system, which would consolidate private insurance schemes into a single, unified care network covering every patient, would save the public a total of more than $610 billion in 2017 alone, including more than $100 billion in reduced drug costs, primarily by cutting administrative waste and bloat, and integrating all services under a transparent, uniform cost structure. Patients, meanwhile, would be guaranteed lifetime coverage without insurance fees or premiums, and no risk of exclusion from coverage.

full article:
http://www.truth-out.org…

Appalachia needs a single-payer health system

By Katie Lee
Johnson City (Tenn.) Press, Feb. 26, 2017

We are all aware that the recent election is likely to bring change in the health care system of this nation, but we have a choice to make. During these tumultuous times in health care policy, the way forward is not to strip 20 million Americans of their health care by repealing the Affordable Care Act  without a replacement. Instead, we should pursue the most equitable and just option — a single payer health care system.

No, this is not “socialized medicine,” which would mean both the financing and delivery of care are government funded. We already have a form of this system for our veterans, and it leaves much to be desired. What a coalition of 20,000 physicians, medical students, and other health professionals propose is a “Medicare-for-all” system.

The ACA has taken necessary steps toward a universal system, but it has fallen short. Among the most popular components are the right to remain free from discrimination for a pre-existing condition, young people remaining on their parents’ plans until they turn 26, and equity in plan cost between men and women.

Yet, approximately 27 million people remained uninsured after the landmark legislation was passed and an acceptable reduction in cost was not truly achieved. Supporters of the ACA aimed to bend the curve on ever-increasing health care expenditures and while this was accomplished, they still accounted for 18 percent of GDP last year.

The United States remains the only developed country with for-profit insurance companies and only one of three developed nations that does not guarantee health care. We are spending the largest amount per capita ($8,000 plus) on health care expenditures of any nation in the world, but without the best outcomes.

The leading cause of bankruptcy in the United States is medical bills, and an estimated 45,000 deaths annually can be attributed to lack of health insurance. Over 100 million Americans forgo professionally recommended medical care due to cost each year. Clearly, we have work to do. A single-payer system by way of a Medicare-for-All structure would allow coverage for all Americans and would actually reduce spending.

Not all states chose to expand Medicaid, including approximately half of those traditionally included in the Appalachian region, leaving lower income earning adults in a gap between Medicaid and marketplace subsidies. Americans were left with artificial lines between states that create headaches for Tri-Cities area patients daily, when the nearest hospital to rural dwellers may be across state lines.

Social workers in our local hospitals work tirelessly to coordinate care for patients leaving Tennessee hospitals, but needing follow-up in West Virginia, Virginia or Kentucky where their health insurance coverage and state law differs. Paying employees to navigate these complexities is currently unavoidable, but it is my hope that a more streamlined, simple system could render these duties unnecessary.

Today we waste about a third of our health care dollars to overhead, administrative costs and insurance profits. Physicians cite administrative burden as one of the leading causes of burn out, leading to decreased quality of care.

With a single-payer system for all Americans, we reduce this waste and instead direct these funds toward medical care. There is an additional benefit of freeing up physicians to spend longer appointments with patients as needed or increase patient volume.

Moreover, Americans living in rural areas face a physical access to care issue in addition to cost barriers. This makes seeking appropriate preventive care visits and screening tests even more important. It is a well-known fact that it is cheaper to prevent a chronic illness than to treat it long-term.

Consequently, removing the cost barrier to preventive services in Appalachia while we work to improve the number of physicians and hospitals in rural areas is morally imperative but also cost effective.

Uninsured Americans cited lack of affordability and unemployment as their top two reasons for their insurance status. While the national unemployment rate in 2014 was around 6 percent, in the more economically depressed parts of Appalachia that figure reached as high as 14 percent. Increased levels of unemployment in the region together with state policies declining Medicaid expansion contribute to higher uninsured rates, and consequently poorer health outcomes.

Our mixed system including employer-based health coverage is a relic of a time when most employees remained in the same job for decades and is inappropriate for the more dynamic, shifting workforce of today. Transition away from employer-based care would prevent workers from fearing a job change lest they lose their insurance, freeing workers to pursue innovative, entrepreneurial positions they might otherwise have foregone.

The 45th President of the United States has praised the concept of universal health care multiple times in the past, citing the improved mortality rates and reduced costs per capita in countries with this structure. In order to capitalize on his promise to take care of “the forgotten” in the United States, including those living in the impoverished communities of coal country, I urge the president to reconsider a Medicare-for-all system.

Not only will it help make this country “great,” it is the right thing to do.

Katie Lee is an aspiring medical professional with a passion for social justice issues. She is a graduate of Vanderbilt University and lives in Johnson City.

http://www.johnsoncitypress.com…

We Represent the Future

By Adam Gaffney, M.D.
Jacobin, Feb. 26, 2018

When future historians chronicle how Medicare for All was finally won, the current moment may prove to be a crucial turning point in their narratives, albeit one contained, most likely, in the earlier chapters. Scholars will have to probe why single payer emerged with such potency at this moment. Proponents have been steadfastly advancing the cause for decades, but it took Bernie Sanders’s insurgent primary campaign to push single payer into the political spotlight.

And it was only last year, amid all the lurid dysfunction and savagery of Trump’s first months in office, when activists helped thwart the Republicans’ Obamacare repeal efforts while simultaneously achieving a historic advance for Medicare for All. For the first time, single-payer bills won support from a majority of Democrats in the House, and — after Sanders’s new bill launched in September — more than a third of those in the Senate. More and more legislators, it seems, knew which way the wind was blowing.

Why now? Because, as historians might one day note, we are at the intersection of two related crises: one in health care, the other in politics.

The first of these may seem like nothing new. There have been health care injustices in America for as long as America has had a health care system. Hospitals once turned away the poor and uninsured in the throes of illness; facilities were once viciously segregated; reproductive rights were once not much more than aspirations. But we also made progress: from the civil rights era, which realized Medicare and Medicaid, to the passage of the Affordable Care Act (ACA), which expanded insurance coverage to twenty million people. But if American health care used to be so much worse, why is it in crisis now?

In part because, despite such wide-ranging reform, the system’s injustices remain unresolved, pervasive, and deadly.

The figures tell the story. Even without Republican rollbacks, twenty-eight million have no insurance, and, according to the Commonwealth Fund, some forty-one million are underinsured. A substantial portion of the nation — predominantly those of low and middle income and disproportionately people of color — cannot afford to see doctors, pay for medicine, or go to the emergency room.

Families who bought silver plans on the Obamacare marketplace still have $8,292 deductibles, but less than half of American households can cover even a $4,000 deductible. Patients take twice-a-day medications only once, skip doses, or fail to fill their prescriptions to save on co-payments. And of course, people die — tens of thousands of people a year — because they lack coverage.

But the crisis in American health care isn’t simply that the aca didn’t go far enough: it’s that there’s no aca 2.0 available to finish the job. Real progress has been made, but the incremental reforms left us with a deeply inhumane system. Meanwhile, the Right is on the prowl, offering a slew of tired, malicious nostrums about personal responsibility, while liberal reformers have mostly run out of ammunition. But the Left has not, and single payer is now the only potent policy weapon still on the table.

Today’s second crisis comes from the larger political economy. Decades of rising inequality have left a substantial proportion of the population wondering if any politician actually represents them. The unequal health care system only exacerbates the problem: wage stagnation has come with rising health care costs, further squeezing workers’ take-home pay. A recent study in the American Journal of Public Health found that, after accounting for income devoted to health care expenditures, economic inequality is even worse than we thought: these costs effectively push an additional seven million people into poverty.

Discontent with the status quo helps explain the unprecedented success of a democratic socialist in the 2016 primary. But the neoliberal crisis has sparked a resurgence in right-wing populism as well. An odious billionaire has risen to power at the head of a right-wing government that spews pollution, slashes the safety net, vilifies immigrants, and redistributes wealth upwards with great efficiency and vengeance.

We should see the Medicare-for-all movement as a powerful response to both crises. It will transform health care, mandating a social right to equitable care, free at point of use. Everyone in the nation will enjoy comprehensive benefits without provider networks, co-pays, or deductibles.

Almost everyone — sick and well, insured and uninsured — has something to gain from this system. Single payer’s universalism is its strength, and the reason we can win it. But the Medicare-for-all movement is both a means and an end: it will clearly make for a happier and healthier nation, but it can also can become a unifying issue within a larger egalitarian political project at a moment of political crisis.

One day, when we read the history of how, against incredible odds, a single-payer national health program was finally created, we will come upon an early chapter that chronicles how Medicare-for-all advocates survived in the political wilderness. We’ll hear about how activists cut their teeth, built coalitions, crafted policy, drafted bills, won over politicians, launched campaigns, swayed opinions, and mobilized the grassroots. It will tell the story of ordinary people forging a powerful movement; it will tell the story of our present.

Fortunately, the next chapter isn’t so far in the future. It will describe how the movement was tempted by — but ultimately rejected — weak and diversionary counterproposals, how it broadened its base, how it skirmished with powerful corporate lobbies with near-bottomless war chests, and how it finally pushed a robust single-payer health care program onto the national legislative agenda.

Let’s forge ahead, confident as the architect of the National Health Service, Nye Bevan, was when he said that “the tides of history are flowing in our direction, that we are not beaten, that we represent the future…”

https://jacobinmag.com…

Listening to Trump voters who have ACA coverage

What They Want in a Health Care Plan

By Jennifer Tolbert and Larisa Antonisse
Kaiser Family Foundation, February 22, 2017

In order to gain a better understanding of the personal experiences of Trump voters with health coverage provided through the ACA and the changes they would like to see in the health system moving forward, the Kaiser Family Foundation (KFF) held focus groups with individuals who voted for Trump in cities in three battleground states: Grand Rapids, Michigan; Columbus, Ohio; and Harrisburg, Pennsylvania.

FOR MANY, MARKETPLACE COVERAGE HAS NOT LIVED UP TO EXPECTATIONS

* Three years into the implementation of the Marketplaces, participants still seemed overwhelmed by their plan choices and confused about key aspects of their plans.

* Participants were particularly frustrated by unaffordable out-of-pocket costs associated with high deductibles.

* The high cost of prescription medications was a common complaint and many Marketplace participants did not believe their plan protected them from these costs.

* Participants also expressed frustration at receiving surprise medical bills for services they thought were covered.

WHAT THEY WANT IN A REPLACEMENT PLAN

* When asked what they would want in an ACA replacement plan, participants’ top priority was coverage that was more affordable—affordable premiums, but most importantly, affordable out-of-pocket costs.

* They also wanted more help for people like them.

* Access to doctors and hospitals was another priority for participants.

* Participants wanted simplification of health plan choices and greater transparency from the insurance companies.

VIEWS OF REPUBLICAN PROPOSALS

* Participants rejected the idea of high deductible plans, even when coupled with premium tax credits to cover the premium and Health Savings Accounts (HSAs) to save for out-of-pocket costs.

* While there was general support for the concept of an HSA, many did not understand what they were and said they did not have the savings, or would not be able to save enough during the year, to cover the out-of-pocket costs associated with a plan with a high deductible.

* Participants also rejected the concept of basing tax credits solely on age regardless of income.

* Frustrated by the complexity and uncertainty of the current system as well as proposals to replace it, several participants advocated for a single-payer system modeled on the Canadian health care system.

http://kff.org…

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Comment:

By Don McCanne, M.D.

These focus groups were uniquely composed of Trump supporters in battleground states who also received health care coverage through the Affordable Care Act. Were they, like many conservatives, supporting the repeal of ACA – a leading issue for Donald Trump in his campaign? If they were not satisfied with ACA, then what did they want?

They remain concerned about three of the leading problems with today’s private health plans – high premiums, high deductibles, and narrow provider networks. Their top priority was affordability – affordable premiums and affordable out-of-pocket expenses. They also want greater access to physicians and hospitals than the narrow networks allow, and they do not want to receive surprise medical bills from out-of-network providers. They also want simplification of health plans (the greatest simplification being single payer).

Although some look upon Trump supporters as being conservatives who want to reduce the role of government, actually several in this group were able to pull together the policy issues and come to the conclusion that, to reduce “the complexity and uncertainty of the current system,” we should enact “a single-payer system modeled on the Canadian health care system.”

President Trump, these are your supporters. You need to read the article from the Annals of Internal Medicine: “Single-Payer Reform: The Only Way to Fulfill the President’s Pledge of More Coverage, Better Benefits, and Lower Costs” by Steffie Woolhandler, MD, MPH and David U. Himmelstein, MD You can download it at this link:

http://annals.org…

Trump says reform is now

Trump: ObamaCare replacement coming in ‘a couple of weeks’

By Max Greenwood
The Hill, February 18, 2017

President Trump said on Saturday that a plan to replace the Affordable Care Act will come “in a couple of weeks.”

“We are going to be submitting in a couple of weeks a great healthcare plan that’s going to take the place of the disaster known as ObamaCare,” he said at a campaign rally in Melbourne, Fla. “It will be repealed and replaced.”

“Just so you understand, our plan will be much better healthcare at a much lower cost,” he added.

http://thehill.com…

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Trump: Tax reform plan is ‘very well finalized’ but will come after ACA repeal

By Jacob Pramuk
CNBC, February 22, 2017

President Donald Trump said Wednesday that a Republican tax reform plan is nearly done but reiterated it will come after an Affordable Care Act repeal measure.

“Before we do the tax — which is actually very well finalized — but we can’t submit it until the health care statutorily or otherwise,” Trump told reporters before a White House budget meeting. “So we’re doing the health care — again moving along very well — sometime during the month of March, maybe mid-to-early March, we’ll be submitting something that I think people will be very impressed by.”

http://www.cnbc.com…

***

Comment:

By Don McCanne, M.D.

Health care reform is going to happen right now. This week members of Congress in town hall meetings throughout the nation are facing thousands of angry citizens who are demanding single payer reform. Wait a minute. Is that right?

Not exactly. The message that they are hearing is they do not want to lose the benefits of the Affordable Care Act but rather they want something better.

Where is that resounding voice of the people demanding single payer reform? President Trump needs to see the new article published this week in the Annals of Internal Medicine that shows him how he actually can provide his wish of  “much better healthcare at a much lower cost.” But he will never see the article if we don’t make enough noise to penetrate the right-wing guard that is surrounding him.

The article he needs to see immediately:

Single-Payer Reform: The Only Way to Fulfill the President’s Pledge of More Coverage, Better Benefits, and Lower Costs

By Steffie Woolhandler, MD, MPH; David U. Himmelstein, MD

http://annals.org…

Why is life expectancy worse in the United States?

Future life expectancy in 35 industrialised countries: projections with a Bayesian model ensemble

By Vasilis Kontis, PhD, James E Bennett, PhD, Colin D Mathers, PhD, Guangquan Li, PhD, Kyle Foreman, PhD, Prof Majid Ezzati, FMedSci
The Lancet, February 21, 2017

Summary

Background
Projections of future mortality and life expectancy are needed to plan for health and social services and pensions. Our aim was to forecast national age-specific mortality and life expectancy using an approach that takes into account the uncertainty related to the choice of forecasting model.

Methods
We developed an ensemble of 21 forecasting models, all of which probabilistically contributed towards the final projections. We applied this approach to project age-specific mortality to 2030 in 35 industrialised countries with high-quality vital statistics data. We used age-specific death rates to calculate life expectancy at birth and at age 65 years, and probability of dying before age 70 years, with life table methods.

Findings
Life expectancy is projected to increase in all 35 countries with a probability of at least 65% for women and 85% for men. There is a 90% probability that life expectancy at birth among South Korean women in 2030 will be higher than 86·7 years, the same as the highest worldwide life expectancy in 2012, and a 57% probability that it will be higher than 90 years. Projected female life expectancy in South Korea is followed by those in France, Spain, and Japan. There is a greater than 95% probability that life expectancy at birth among men in South Korea, Australia, and Switzerland will surpass 80 years in 2030, and a greater than 27% probability that it will surpass 85 years. Of the countries studied, the USA, Japan, Sweden, Greece, Macedonia, and Serbia have some of the lowest projected life expectancy gains for both men and women. The female life expectancy advantage over men is likely to shrink by 2030 in every country except Mexico, where female life expectancy is predicted to increase more than male life expectancy, and in Chile, France, and Greece where the two sexes will see similar gains. More than half of the projected gains in life expectancy at birth in women will be due to enhanced longevity above age 65 years.

Interpretation
There is more than a 50% probability that by 2030, national female life expectancy will break the 90 year barrier, a level that was deemed unattainable by some at the turn of the 21st century. Our projections show continued increases in longevity, and the need for careful planning for health and social services and pensions.

Funding
UK Medical Research Council and US Environmental Protection Agency.

From the Discussion

By contrast, projected life expectancy is lower in countries with higher levels of young adult mortality and major chronic disease risk factors, and possibly less effective health systems. These countries also tend to have higher social inequalities, which might lower national life expectancy by affecting the entire population or through the poor health of the worst-off social groups and communities, which in turn affects the national average. Notable among poor-performing countries is the USA, whose life expectancy at birth is already lower than most other high-income countries, and is projected to fall further behind such that its 2030 life expectancy at birth might be similar to the Czech Republic for men, and Croatia and Mexico for women. The USA has the highest child and maternal mortality, homicide rate, and body-mass index of any high-income country, and was the first of high-income countries to experience a halt or possibly reversal of increase in height in adulthood, which is associated with higher longevity. The USA is also the only country in the OECD without universal health coverage, and has the largest share of unmet health-care needs due to financial costs. Not only does the USA have high and rising health inequalities, but also life expectancy has stagnated or even declined in some population subgroups. Therefore, the poor recent and projected US performance is at least partly due to high and inequitable mortality from chronic diseases and violence, and insufficient and inequitable health care.

http://www.thelancet.com…

***

Comment:

By Don McCanne, M.D.

This study predicts an increase in life expectancy for 35 industrialized nations but notes that the recent and projected performance in the United States is poor. That is “at least partly due to high and inequitable mortality from chronic diseases and violence, and insufficient and inequitable health care.”

More diligent application of beneficial public policies would improve our outcomes. Particular notable is the inequitable health care in our country. It is not that we lack sufficient funds. We are already spending $3.2 trillion – more than enough to provide quality health care for all. It is rather that we fail to elect individuals who understand and would support public policies that would make this a better nation.

This is shameful. We could act to change our course, but we, as a nation, have accepted mediocrity instead.

Brooklynites cheer single-payer health care at congressional town hall

Democrats in Congress are working to protect the ACA, but some New Yorkers aren’t giving up on universal health care

By Caroline Lewis
Crain’s New York Business, Feb. 23, 2017

The future of the Affordable Care Act has been a major point of contention at town hall meetings convened by members of Congress across the country in recent days, with some Republican politicians drawing ire in their districts. At an overflowing and overwhelmingly friendly town hall Wednesday night hosted by Rep. Yvette Clarke in progressive Brooklyn, the Democratic congresswoman predictably defended the ACA.

But audience members, who numbered in the hundreds, showed their most enthusiastic support for an alternative that gets far less attention in the political sphere: universal health care.

A universal, or single-payer, health system would provide everyone access to taxpayer-funded health care, eliminating the need for consumers to sign up for public, private or employer-funded plans.

Democrat-backed bills have long been kicking around the New York Legislature and the U.S. Congress that propose variations on that system. Sen. Bernie Sanders, Democrat of Vermont, championed a “Medicare for All” concept during his presidential campaign. But such proposals haven’t come close to achieving bipartisan support.

The New York Health Act—sponsored by Assemblyman Dick Gottfried and Sen. Bill Perkins, both Manhattan Democrats—passed the majority-Democratic state Assembly in the last two sessions, but it has been stalled in the Republican-controlled Senate.

Of the dozens of audience members who posed questions to Clarke and her invited speakers, just one directly addressed the future of the ACA.

“We could increase subsidies and we could expand Medicaid further, but those are just Band-Aids, not proper solutions,” the young man asking the question began. “At what point will congressional Democrats come out in full force in full support of universal, single-payer health care?”

After sustained applause and cheers from the crowd, Clarke replied, “You’re talking my kind of language. I’ve been for single-payer health care ever since I’ve been in Congress.”

Clarke suggested that the reason there’s pushback against the ACA is that it’s “taking us down that road.”

While President Barack Obama paid lip service to a single-payer system during his 2008 campaign, the Affordable Care Act has maintained a diverse insurance market.

The law did greatly expand the number of people enrolled in government-funded and subsidized insurance plans, though, particularly in New York. As of Jan. 31, more than 2.4 million people signed up for Medicaid through the state’s Obamacare marketplace. The state also has enrolled more than 665,000 people in its Essential Plan, a federally subsidized option created under the ACA for New Yorkers earning less than twice the federal poverty level who don’t qualify for Medicaid.

Clarke is one of 63 members of Congress, all Democrats, who have signed onto the Expanded and Improved Medicare for All Act, calling for single-payer health care. But she said her focus remains on organizing constituents to resist the proposed repeal of the ACA.

Some New Yorkers might have a “certain level of comfort that we have a Democratic state that does to a certain degree do everything it can to preserve the right to health care,” Clarke told Crain’s after the event.

Grassroots efforts to pressure Congress to preserve coverage and federal funding are essential, she said.

“We’re continuing to promote the need for the ACA and to encourage New Yorkers to make their preference known for the ACA, because it would be catastrophic to our health care infrastructure if this is repealed without any replacement,” she said. “And who knows what type of replacement they would offer in any event.”

http://www.crainsnewyork.com…

Single-payer health care touted with American Care act on chopping block

By Katie Lannan
Lowell (Mass.) Sun, Feb. 23, 2017

BOSTON — With President Donald Trump and congressional Republicans pledging to repeal the federal Affordable Care Act, some backers of single-payer health care are holding up their preferred system as an alternative.

Making the shift to a national single-payer system could save more than $504 billion annually in administrative costs, according to a pair of Harvard Medical School lecturers writing this week in an American College of Physicians medical journal.

In an article published Tuesday in the Annals of Internal Medicine, Dr. Steffie Woolhandler and Dr. David Himmelstein called a publicly financed single-payer system “the only way” to fulfill Trump’s campaign promises of more coverage, better benefits and lower costs.

An executive order Trump signed Jan. 20, the day of his inauguration, established the administration’s policy “to seek the prompt repeal” of the Affordable Care Act and directed department and agency heads to “encourage the development of a free and open market in interstate commerce for the offering of health-care services and health insurance, with the goal of achieving and preserving maximum options for patients and consumers.”

Woolhandler and Himmelstein say proposals floated by House Speaker Paul Ryan and Health and Human Services Secretary Tom Price would “shrink the coverage of poor and low-income persons in the United States” and could shift costs onto patients and state governments.

They say replacing the current insurance system with a “single, public plan covering everyone for all medically necessary care” — similar to an expanded Medicare program — could allow for better benefits at a lower cost, with savings used to extend coverage to the 26 million people who remain uninsured.

In Massachusetts, where the uninsured rate is below 3 percent, past efforts to establish a state-level single-payer system have failed to gain much traction on Beacon Hill.

Sen. Jamie Eldridge, who filed legislation that would set up “Medicare for all” in Massachusetts, called the 21 co-sponsors signed onto his bill this session “the largest we’ve had in about six years.” There are 200 members in the Legislature.

“I certainly am a strong supporter of maintaining and protecting the ACA at the federal level, but clearly there are discussions by mostly Republicans in Congress about repealing it and changing it,” Eldridge told the News Service. “And I think it’s an interesting opportunity, interesting time, for single-payer advocates like myself because if you did see changes at the federal level, I think there would be an opportunity to advocate for single-payer health care more strongly at the state level.”

Rep. Denise Garlick of Needham has also filed a “Medicare for all” bill, while Rep. Jennifer Benson of Lunenburg and Sen. Julian Cyr of Truro are sponsoring legislation that would require the state to measure its health-care spending against projected spending under a single-payer system. If the “single-payer benchmark” showed greater savings, state officials would be charged with developing an implementation plan to move towards single-payer.

Versions the Medicare-for-all and single-payer benchmark bills were each included in dead-end study orders last session.

“I think people are realizing that as much as the ACA had protections around pre-existing medical conditions, that it did provide expanded Medicaid, that for a lot of sort of working-class, middle-class families, they probably saw their premiums go up significantly because the ACA wasn’t really designed to reduce health-care costs, it was really designed to cover more people,” Eldridge said. “So if we’re looking to do both in an environment where federal funding could be cut to Massachusetts or other aspects of the ACA, is it time for Massachusetts to take the next step?”

Gov. Charlie Baker has proposed a slate of health-insurance market reforms. His $40.5 billion fiscal 2018 budget includes an annual assessment on certain employers without at least 80 percent of their workers covered by employer-sponsored health care, rate growth caps for health-care providers, a five-year moratorium on new coverage mandates, and additional consumer transparency efforts aimed at helping patients understand the cost of care.

With health-care costs continuing to climb — hitting $57.4 billion in 2015, according to the Center for Health Information and Analysis — and exceeding state spending benchmarks, efforts are underway to rein in medical spending. Senators are studying cost containment practices used in other states, and a commission seeking to address unwarranted variations in prices charged by different providers is due to release its report next month.

Woolhandler and Himmelstein are both professors at the City University of New York’s Hunter College.

http://www.lowellsun.com…