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

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…

New Bill Touts Improved, Expanded Medicare for All

By Ed Weisbart, M.D., CPE, FAAFP
Accountable Care News, April 2017

President Donald Trump has declared that the Affordable Care Act (ACA) needs to be replaced with “reforms that expand choice, increase access and lower costs, while providing better healthcare.”1 I agree with those goals and believe they can be accomplished without compromising the advances brought by the ACA—20 million fewer uninsured Americans, increased support for lower-income Americans and a host of reforms of insurance practices, such as guaranteed issue and prohibition against rescission and against annual or lifetime caps.

Despite these advances, many problems remain. Tens of millions of Americans remain uninsured. Many more are underinsured, finding the cost of care increasingly prohibitive and their choices of physicians and hospitals increasingly constrained by their insurance network administrators. Compared to other modern nations, our per capita healthcare costs remain outlandishly high and our life expectancy tragically short.

Only 72.7% of our healthcare dollar is spent on actual clinical care; 18% is spent on billing and insurance-related administration, including 7.5% by private insurers, 1.3% by public insurers, 2.7% by physicians, 2.8% by hospitals and 3.6% by other services. (An additional 9.4% of our total expense is on administration unrelated to billing and insurance.) If our billing and insurance-related administrative expenses were reduced to levels seen in most other modern nations, we would reap $375 billion in annual savings.2

Unable to address these wasteful inefficiencies, insurers have turned to financial barriers (copayments, coinsurance and deductibles) to reduce utilization and increasingly restrictive networks that inevitably conflict with patient choice. Our system is the most complex, redundant and least aligned with the interests of public health.

Public health campaigns do not align well with today’s business imperatives and simply cannot be given adequate support by the private insurance industry. Churning demands its own long-term strategies. There is no business case for public health.

I have spent many years in executive roles within the health insurance industry and been frequently stymied by the industry’s fiduciary pressures against long-term, public health initiatives. Even when insurers want to pursue such initiatives, their 20% to 25% annual turnover in membership demands that such clinical initiatives quickly produce favorable financial results. For many insurers, roughly half of their membership today will have migrated to a competing plan within three years and been replaced by members from those same plans. Those who ignore this pressure find themselves improving the health of their competitors’ membership.

The ‘Replace’ Portion of ‘Repeal and Replace’

U.S. Representative John Conyers (D-MI), along with 59 cosponsors, recently introduced the most prudent solution to each of these problems, “Expanded and Improved Medicare For All,” as HR676.3 Politics aside, HR676 should be the “replace” portion of the demand to “repeal and replace” ACA. It alone meets each of the stated goals of our new president.

HR676 would address these and other concerns. It is a short bill, just 30 pages, and a relatively easy read.

At a high level, the bill says two things: Fix the problems with Medicare and expand it to all Americans. The bill calls for public funding of healthcare while preserving and enhancing support for private delivery. This is essentially the model used in Canada today.

Medicare would be improved by removing financial barriers and plugging gaps in coverage, providing a single comprehensive benefit design of all medically necessary services as articulated within the bill. It would be expanded to cover virtually all U.S. residents, with specific eligibility criteria established by the program’s director.

According to a recent article in Annals of Internal Medicine,4 the cost of these changes would be offset by a 68% reduction in insurance overhead and administration of public programs (saving $220 billion); a 52.6% reduction in billing and administration for hospitals (saving $149.3 billion); a 40.1% reduction in billing and administration for physicians (saving $75.3 billion); and an additional $59 billion in administrative savings for nursing homes, home care agencies, non-physician practitioners and employers.

The authors also project a 31.2% reduction in the cost of outpatient prescription drugs, representing $113.2 billion, bringing the total savings from these components to $616.8 billion. Of note, there are at least 25 other studies5 on both a state and federal level that consistently show these savings would fully pay for expansion and improvements.

HR676 calls for financing the program through the establishment of a new Medicare for All Trust Fund built from existing funding sources, including public programs and public employee benefits. In addition, it calls for increasing personal income tax on the top 5% of income earners, and modest and progressive taxes on payroll, self- employment income, unearned income and stock and bond transactions.

The overall program budget would be set through negotiations by providers, state directors and regional directors but ultimately approved and divided regionally by the program director. This budget would contain three discrete, non-fungible sections: operations, capital and education. Health professionals would either be reimbursed through a negotiated, fee-for-service schedule or a salary through a globally budgeted institution, group practice or non-profit, HMO. Balance billing of patients is expressly prohibited.

The bill establishes a diversely representative, 15-member National Board of Universal Quality and Access, with a director of quality of control appointed by the president with the advice and consent of the Senate.

Obviously, HR676 would transform the health insurance landscape, virtually eliminating the market for employer-based and individual private insurance, Medicaid, Medicare supplements, wraps and Parts C and D programs. Most of the employees displaced from their positions within the insurance industry would have a two-year, transition benefit up to $100,000 per year, plus first priority at retraining and job placement within the new system.

Perhaps most importantly, HR676 would establish the foundations of a business case for long-term improvements in public health—something nearly unobtainable in an insurance industry adapted to high levels of membership turnover.

In some ways, Medicare already accomplishes this for our seniors. The Institute of Medicine found that once Americans reach the age of eligibility for Medicare, our life expectancy as compared to that in 17 other modern nations begins to improve. Until age 65, we rank at or near the worst among our peers. Once we reach Medicare eligibility, our ranking by age improves until age 85, when our life expectancy has risen to among the best three nations.6

U.S. vs. Canadian Healthcare

We can also project the value of HR676 by comparing the results of our healthcare system with Canada’s. In 1971, President Richard Nixon signed into law the HMO Act, creating the managed care experiment. The same year, Canadian Medicare was fully implemented in all provinces. Until that point, our two nations were nearly identical in overall healthcare costs as a percentage of GDP, and our life expectancies were within one year of each other.

Since that milestone, our overall cost trends have remained unchanged whereas the trend in Canada nearly flattened out.7 Simultaneously, their life expectancy rate improved more rapidly than ours so that Canadians now enjoy a 2.5-year advantage.8 We were the same; now we spend much more, and they live longer.

Canadians have virtually no risk of bankruptcy from the costs of medical care—even when unable to continue working.

Like all others, the Canadian healthcare system is imperfect. Six percent of Canadians report having unmet health needs due to waiting lists or frankly unavailable services, compared to 1% of Americans reporting this. However, only 1% of Canadians report unmet health needs due to the cost of care, compared to 8% of Americans.9 We can do better than Canada, but their results today trump ours in many meaningful ways.

Among many similar studies, a recent Gallup poll found that 58% of Americans, including 73% of Democrats and 41% of Republicans, “support a federally funded, healthcare program for all Americans.”10

Fifty-nine percent of physicians want national health insurance.11 More than 2,500 prominent physicians have publicly endorsed the June 2016 proposal by the Working Group on Single-Payer Program Design.12

President Trump has called for a healthcare strategy that expands choice, increases access, lowers costs and provides better healthcare. An obvious solution is already in Congress—HR676.

Ed Weisbart M.D., CPE, FAAFP, chairs the Missouri chapter of Physicians for a National Health Program, a 30-year-old, non-profit research and education organization. He may be reached at pnhpMO@gmail.com. Visit pnhp.org/hr676 for more information on HR676.

Notes

1. Remarks by President Trump in Joint Address to Congress. Feb. 28, 2017.

2. Jiwani A, Himmelstein D, Woolhandler S, et al. “Billing and Insurance-Related Administrative Costs in United States’ Health Care: Synthesis of Micro-Costing Evidence.” BMC Health Services Research. Nov. 13, 2014.

3. “H.R.676—Expanded and Improved Medicare for All Act.” Congress.gov. Accessed March 10, 2017.

4. Woolhandler S, Himmelstein D. “Single-Payer Reform: The Only Way to Fulfill the President’s Pledge of More Coverage, Better Benefits, and Lower Costs.” Annals of Internal Medicine. Feb. 21, 2017.

5. “How Much Would Single Payer Cost?” Physicians for a National Health Program. Accessed March 10, 2017

6. “Shorter Lives, Poorer Health.” Institute of Medicine. Jan. 9, 2013.

7. “Canada’s Slow Health Spending Growth Continues.” Canadian Institute for Health Information. Oct. 29, 2015.

8. “Comparing the U.S. and Canadian Health Care Systems.” The National Bureau of Economic Research. Accessed March 10, 2017.

9. Ibid.

10. Newport F. “Majority in U.S. Support Idea of Fed-Funded Healthcare System.” Gallup. May 16, 2016.

11. Carroll, A, Ackerman R. “Support for National Health Insurance Among U.S. Physicians: 5 Years Later.” Annals of Internal Medicine. April 2008; 148 (7): 567.

12. “Beyond the Affordable Care Act: A Physician’s Proposal for Single-Payer Health Care Reform.” The Working Group on Single‐ Payer Program Design. Accessed March 10, 2017.

To view a PDF version of this article, click here.

Mississippi shows us why we need a national health program

In the state with the highest medical debt, it’s the middle class who carries the burden

By Max Blau
STAT, March 24, 2017

Americans are no strangers to medical debt, and the burden is most severe in Mississippi, where nearly 40 percent of adults under age 65 owe hospitals or doctors, according to the Urban Institute. But the men and women carrying that debt are not always poor — they’re increasingly middle class.

And their inability, or refusal, to pay their bills is straining hospital budgets and threatening the availability of care.

Mississippi, where the median household income hovers near $40,000, has one of nation’s highest rates of uninsured and underinsured adults. As a result, the state has one of the highest percentage of adults who avoid doctors due to potential costs, said Therese Hanna, executive director at the Center for Mississippi Health Policy.

At the same time, medical debt remains the leading cause of bankruptcies, according to Roy Mitchell, executive director of the Mississippi Health Advocacy Program.

Over the past five years, James Henley Jr., a bankruptcy trustee in Jackson, said he has seen a sharp increase in the number of middle-class residents with bankruptcy claims after “extending their lines of credit, maxing out credit cards, [robbing] Peter to pay Paul.”

https://www.statnews.com…

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Welfare Audit Bill Passes With No Statistics Given on Fraud

By Sarah Smith
U.S. News & World Report, March 29, 2016

Mississippi could hire a private company to audit Medicaid, welfare and food stamp recipients and make sure they aren’t cheating the program under legislation approved by the Senate on Wednesday after a debate in which supporters offered no statistics about welfare fraud.

The bill, which is on its way to Gov. Phil Bryant, had already passed the House on Tuesday.

House Bill 1090 would let the state hire a contractor to help check that recipients live in Mississippi and are who they claim to be. The contractor would also check recipients’ income levels. The measure also requires able-bodied recipients to be working, and it tracks where recipients use their money.

Republican proponents say the bill will bring the state one-time savings of about $4 million to $5 million. Sen. Brice Wiggins, a Republican from Pascagoula who presented the proposal Wednesday, said the state Department of Human Services gave him the estimate.

But that number started to fall apart under questioning from Democratic Sen. Hob Bryan of Amory. He had never seen a number, he said. Could he take a look?

“I am told that — I’m not going to lie, numbers get thrown around all the time,” Wiggins said. “We need this bill to get to that.”

Bryan asked again if the figures came from the Department of Human Services.

“As I said, numbers were all over the place,” Wiggins replied.

Several Democrats pointed out the sponsors have no numbers on fraud.

“How many people are riding the system who aren’t deserving?” asked Sen. David Jordan, a Democrat from Greenwood. “Don’t you think you should have some statistics?”

Wiggins had no statistics to offer. Finding out just how much fraud is going on, he said, is part of the bill’s purpose.

“What is driving some of us up the wall is the notion that somehow the entire class of people receiving Medicaid or other benefits are a bunch of clever, crafty people out trying to steal money from hard working folks and if we could only crack down on this we could balance the state budget,” Bryan said.

https://www.usnews.com…

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Comment:

By Don McCanne, M.D.

The residents of Mississippi have a serious problem with medical bills and resulting debt impacting 40 percent of adults under 65. The fact that their state legislators are not particularly responsive to this problem is represented by the fact that they rejected an expansion of Medicaid under the Affordable Care Act which would have provided coverage to an additional 300,000 Mississippians.

Of course the medical debt problem persists, so the legislature finally acted. But talk about a non sequitur, in this case a double non sequitur.

First, defining the problem. These people needed medical care but did not have adequate means of paying for it and thus were saddled with medical debt. It seems that a logical response would be to set up a health insurance program to pay for the medical expenses. No, even a Medicaid program with 90 percent federal funding was rejected by the legislators.

So they had a second chance, and what did they do? They somehow decided that these people in need were a bunch of flakes who were just after free handouts, so, with no supporting evidence whatsoever, they voted to authorize a private contractor to ferret them out if they relied on public benefits. In spite of this double whammy of incompetence, it does look like the legislators have had one dubious success – they have managed to blame the victim.

Sometimes this states’ rights thing goes overboard. We cater to the legislators and governors of the states while we neglect the needs of the people. Mississippi desperately needs a universal insurance program. It is not as if the federal government has no rightful role because seniors and individuals with long term disabilities have the right to Medicare. Why shouldn’t we extend that right to everyone in Mississippi, or, for that matter, to everyone in the United States? Well, we should.

Several states have proven that it is unethical for us to continue to allow the states to make their own decisions about who should or should not be entitled to health care when so many are harmed by bad governing decisions. Limiting health care coverage to the gentry or whatever other qualifying social order is un-American. Mississippi shows us that it is an absolute imperative that we have a national health program that includes everyone and is effective in removing financial barriers to all needed care. That is just what an improved Medicare for all would do.

“…our fathers brought forth on this continent, a new nation, conceived in Liberty, and dedicated to the proposition that all men are created equal. Now we are engaged in a great civil war, testing whether that nation, or any nation so conceived and so dedicated…”

No, let’s not go there again. Let’s just get heath care out to everyone.

California’s single payer bill – full text of bill released

SB-562, The Healthy California Act

California Legislature, Amended in Senate March 29, 2017

This bill, the Healthy California Act, would create the Healthy California program to provide comprehensive universal single-payer health care coverage and a health care cost control system for the benefit of all residents of the state. The bill, among other things, would provide that the program cover a wide range of medical benefits and other services and would incorporate the health care benefits and standards of other existing federal and state provisions, including, but not limited to, the state’s Children’s Health Insurance Program (CHIP), Medi-Cal, ancillary health care or social services covered by regional centers for persons with developmental disabilities, Knox-Keene, and the federal Medicare program. The bill would require the board to seek all necessary waivers, approval, and agreements to allow various existing federal health care payments to be paid to the Healthy California program, which would then assume responsibility for all benefits and services previously paid for with those funds.

The bill would state the intent of the Legislature to enact legislation that would develop a revenue plan, taking into consideration anticipated federal revenue available for the Healthy California program. The bill would create the Healthy California Trust Fund in the State Treasury, as a continuously appropriated fund, consisting of any federal and state moneys received for the purposes of the act.

Sec. 1 (b)

(2) It is the intent of the Legislature for the state to work to obtain waivers and other approvals relating to Medi-Cal, the state’s Children’s Health Insurance Program, Medicare, the PPACA, and any other federal programs so that any federal funds and other subsidies that would otherwise be paid to the State of California, Californians, and health care providers would be paid by the federal government to the State of California and deposited in the Healthy California Trust Fund.

(3) Under those waivers and approvals, those funds would be used for health coverage that provides health benefits equal to or exceeded by those programs as well as other program modifications, including elimination of cost sharing and insurance premiums.

Sec. 2 TITLE 22.2. The Healthy California Act

Chapter 7. Funding

Article 1. Federal Health Programs and Funding

100650. (b)

(1) The board shall apply to the United States Secretary of Health and Human Services or other appropriate federal official for all waivers of requirements, and make other arrangements, under Medicare, any federally matched public health program, the Affordable Care Act, and any other federal programs that provide federal funds for payment for health care services that are necessary to enable all Healthy California members to receive all benefits under the program through the program, to enable the state to implement this title, and to allow the state to receive and deposit all federal payments under those programs, including funds that may be provided in lieu of premium tax credits, cost-sharing subsidies, and small business tax credits, in the State Treasury to the credit of the Healthy California Trust Fund, created pursuant to Section 100655, and to use those funds for the program and other provisions under this title.

(2) To the fullest extent possible, the board shall negotiate arrangements with the federal government to ensure that federal payments are paid to Healthy California in place of federal funding of, or tax benefits for, federally matched public health programs or federal health programs.

Article 2. The Healthy California Trust Fund

100655. (a) The Healthy California Trust Fund is hereby created in the State Treasury for the purposes of this title.

Article 3. Healthy California Financing

100657. (a) It is the intent of the Legislature to enact legislation that would develop a revenue plan, taking into consideration anticipated federal revenue available for the program. In developing the revenue plan, it is the intent of the Legislature to consult with appropriate officials and stakeholders.

https://leginfo.legislature.ca.gov…

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Comment:

By Don McCanne, M.D.

Now we have the full text of California’s new single payer bill – SB 562. It calls for comprehensive health care coverage for all residents of California with no premium, copayment, coinsurance, deductible, nor any other form of cost sharing, for all covered benefits. “Resident” means an individual whose primary place of abode is in the state, without regard to the individual’s immigration status. It’s the real thing.

Last week, Gov. Jerry Brown seemed to dismiss the idea of a single payer system with this response to reporters, “Where do you get the extra money? This is the whole question.”

Of course, the money is already there and being spent on health care. Current government and private spending combined is enough to pay for a comprehensive system for all residents wherein the administrative savings and other efficiencies frees up enough funds to pay for those currently uninsured and underinsured.

There are two issues that may have prompted the governor’s response: transferring current federal health care funds to the state, and establishing a state tax system to replace current private spending.

The excerpts from SB 562 posted above indicate that it is the “intent” to obtain “waivers and other approvals” that would enable the federal government to transfer to the state funds from Medicare, Medicaid, Chip, ACA, and other federal programs. The problem is that current waiver programs are inadequate to fully accomplish that, and new federal legislation would be required. Considering the composition of the current Congress, that could be a difficult task (a comment that does not require a mastery of understatement).

Health care spending through the private sector is relatively inefficient compared to spending in government programs such as Medicare. Yet when the taxes that would replace private spending are spelled out specifically, they seem overwhelming to the average individual with an aversion to taxes in general. It is difficult for them to see what they are already paying for our health care system that is not particularly transparent such as the component of employer-sponsored health plans that are only nominally paid by the employer, the tremendous tax expenditures for employer-sponsored plans that go disproportionately to higher income individuals, the huge spending for government employee health plans on the federal, state, and local level, and the costs of health care built into the prices of services and products to pay for employee coverage, worker’s comp, liability coverage, and the like. When that spending goes away and is replaced by government spending, the taxes to pay for that can look formidable. Just ask former Gov. Peter Shumlin of Vermont. Then try to sell that to the residents of California. When you try to explain to them that the tax system would be more equitable and efficient, and most would actually pay less overall, they are already blinded by the proposed tax increases that they do see (but are not yet spelled out in SB 562).

What we need is a well designed, national single payer health program. We should continue to pull all stops toward that goal, though it is difficult to see when we will reach the political threshold that will make that possible. Until then we should also support state efforts to relieve the physical suffering and financial hardship that is being wrought on our people by our dysfunctional health care financing system.

Thus we should strongly support SB 562. We should make every effort to obtain “waivers and other approvals,” as difficult as that will be. We should increase our efforts to educate the public on what a really good deal this would be for them, otherwise our efforts could be sunk by a few soundbites from the industries that profit excessively from our sick system (as they were in prior ballot measures in California, Oregon and Colorado).

But while we do this, we cannot let up the least in our advocacy for a national health program. Our brothers and sisters in other states desperately need our help.