PNHP

Doctors group: House GOP health plan is a re-branded and far meaner version of the ACA

Doctors group: House GOP health plan is a re-branded and far meaner version of the ACA

The ‘American Health Care Act’ perpetuates the basic structure of the Affordable Care Act, including the subsidization of the private health insurance industry, while cutting benefits to the poor and middle class, and giving hundreds of billions in tax breaks to the rich

FOR IMMEDIATE RELEASE, March 8, 2017
Contact: Mark Almberg, communications director, PNHP, mark@pnhp.org, (312) 782-6006

Physicians for a National Health Program decries the recently released Republican Obamacare replacement bill, the “American Health Care Act” (AHCA). That plan would constitute a major backward step in health policy, compounding the problems of uninsurance and underinsurance while handing over hundreds of billions of dollars to the wealthiest 2 percent of Americans.

Proposed as a replacement of the Affordable Care Act (ACA), the AHCA would maintain its basic structure. The bill would:

• Continue to channel billions of taxpayer dollars through wasteful private insurers;
   
• Sharply reduce the ACA’s subsidies (or “tax credits”) available to lower-income persons, particularly older adults, to purchase coverage;

• End the ACA’s cost-sharing subsidies for copayments and deductibles, increasing the cost of care for those with chronic medical conditions;
    
• Replace the ACA’s “individual mandate” penalty on the uninsured with a 30 percent surcharge on insurance premiums for those who experienced a lapse in insurance coverage;

• Slash federal funding for the Medicaid expansion beginning in 2020, and move towards a “per capita” cap on Medicaid spending that would squeeze state Medicaid budgets and push millions of enrollees out of the program;

• Increase the tax-favored status of Health Savings Accounts, which mostly benefit people in high income brackets;

• Reduce taxes on pharmaceutical, medical device and health insurance companies;

• Offer tax reductions totaling $274.6 billion over 10 years to the wealthiest 2 percent of Americans.

These and other provisions would take the nation in the wrong direction. Even with the ACA in place, 29 million remained uninsured in 2015; the ACHA would only push that number higher. And today, even many Americans with coverage face bankrupting medical bills for copayments, deductibles and uncovered services. By lowering the standards of private insurance plans and ending cost sharing subsidies, the ACHA would only intensify the problem of “underinsurance.”

The AHCA would replace the ACA with a worse, more regressive version of the original bill. This is not what Americans want or need. PNHP instead urges Congress to replace the ACA with a single-payer national health care program. Unlike the ACA or the AHCA, single-payer, Medicare for All reform could effectively control costs while creating a right to high-quality health care for everyone in America.

A more detailed, point-by-point summary of the contents of the GOP House bill, prepared by Drs. Steffie Woolhandler and David Himmelstein, is available here.

Physicians for a National Health Program (www.pnhp.org) is a nonprofit research and education organization of more than 20,000 doctors who support a single-payer national health program. It was founded in 1986.

PNHP on GOP’s re-branded and far meaner version of ACA

Doctors group: House GOP health plan is re-branded and far meaner version of ACA

The ‘American Health Care Act’ perpetuates the basic structure of the Affordable Care Act, including the subsidization of the private health insurance industry, while cutting benefits to the poor and middle class, and giving hundreds of billions in tax breaks to the rich

Physicians for a National Health Program, March 8, 2017

Physicians for a National Health Program decries the recently released Republican Obamacare replacement bill, the “American Health Care Act” (AHCA). That plan would constitute a major backward step in health policy, compounding the problems of uninsurance and underinsurance while handing over hundreds of billions of dollars to the wealthiest 2 percent of Americans.

Proposed as a replacement of the Affordable Care Act (ACA), the AHCA would maintain its basic structure. The bill would:

• Continue to channel billions of taxpayer dollars through wasteful private insurers;
   
• Sharply reduce the ACA’s subsidies (or “tax credits”) available to lower-income persons, particularly older adults, to purchase coverage;

• End the ACA’s cost-sharing subsidies for copayments and deductibles, increasing the cost of care for those with chronic medical conditions;
    
• Replace the ACA’s “individual mandate” penalty on the uninsured with a 30 percent surcharge on insurance premiums for those who experienced a lapse in insurance coverage;

• Slash federal funding for the Medicaid expansion beginning in 2020, and move towards a “per capita” cap on Medicaid spending that would squeeze state Medicaid budgets and push millions of enrollees out of the program;

• Increase the tax-favored status of Health Savings Accounts, which mostly benefit people in high income brackets;

• Reduce taxes on pharmaceutical, medical device and health insurance companies;

• Offer tax reductions totaling $274.6 billion over 10 years to the wealthiest 2 percent of Americans.

These and other provisions would take the nation in the wrong direction. Even with the ACA in place, 29 million remained uninsured in 2015; the ACHA would only push that number higher. And today, even many Americans with coverage face bankrupting medical bills for copayments, deductibles and uncovered services. By lowering the standards of private insurance plans and ending cost sharing subsidies, the ACHA would only intensify the problem of “underinsurance.”

The AHCA would replace the ACA with a worse, more regressive version of the original bill. This is not what Americans want or need. PNHP instead urges Congress to replace the ACA with a single-payer national health care program. Unlike the ACA or the AHCA, single-payer, Medicare for All reform could effectively control costs while creating a right to high-quality healthcare for everyone in America.

https://www.pnhp.org…

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Comment:

By Don McCanne, M.D.

Although the Republican leadership has made feeble attempts at crafting rhetoric to sell their American Health Care Act (AHCA) – their legislation intended to repeal and replace the Affordable Care Act (ACA) – nobody is fooled into thinking that they are proposing an improvement over ACA. Millions would lose their insurance and millions more would have worse coverage that leaves them even more exposed to unaffordable out-of-pocket expenses.

AHCA is being sold as an improvement in access yet clearly access to health care would be further impaired because of the financial barriers to care that it erects. Also, when we already greatly burden American workers with policies that shift wealth from the workers to the wealthy, AHCA would introduce numerous tax changes that would further benefit the wealthy, compounding the injustices of income and wealth inequality.

Although the Democrats are unified in their opposition to AHCA, there is considerable opposition from within the Republican ranks as well. Heartless conservative Republicans want even more cuts in the beneficial programs advanced by ACA, diminishing further protection against health care insecurity and financial insecurity for those with medical needs. Other more moderate Republicans are concerned that the cuts are too deep and heartless, and some are also concerned about the attacks on women’s health care.

The Republicans have been unable to resolve these conflicts behind closed doors. But they did promise that they would repeal ACA immediately and so they are moving ahead with this legislation. If it fails, then they cannot be accused of not having made the effort. Then they can move on to legislation that they are really passionate about – tax reform benefitting the very wealthy.

We must not lose perspective. The nation desperately wants better and more affordable health care. The subject is hot. Although Americans have been dissatisfied with ACA, they now recognize that the Republican proposals would be worse. Many of those who are doing well under ACA have changed from opposition to support of ACA. But those who continue to face financial hardship and impaired access to health care clearly want more and are particularly disappointed that Trump and his fellow Republicans are not delivering on their promise.

ACA was an improvement, but not enough. Its administrative complexity makes it nearly impossible to achieve high quality affordable care for all merely by enacting administrative tweaks. The seven years of Republican strategy has failed to improve on ACA, and their proposals would only make health care access and affordability worse. We need something more.

An improved Medicare for all – a well designed single payer national health program – is precisely what we need. With it we would have affordable, high quality health care for everyone. While the topic of health reform is hot, we need to get this message out. Now.

Obamacare’s flaws could be repaired far more simply and cheaply with a single-payer plan

By Robert Needlman, M.D.
The (Cleveland) Plain Dealer, March 8, 2017

I am proud to be a pediatrician at MetroHealth Medical Center. I think a lot about health and health care. I’m an educated person, with undergraduate and medical degrees from Yale. And yet I can’t really get a grasp on how health care financing in this country works! I read articles, get confused, scratch my head, drink more coffee.

Then I fall back on my personal experience:

Under the Affordable Care Act (Obamacare), my 27-year-old daughter was able to stay on our family’s health plan until age 26, just in time for her to get her first full-time job with benefits (hurrah!).

But a close friend, who is self-employed, hasn’t been able to find an insurance plan under the ACA that is anything other than, well, outrageous, with sky-high premiums and deductibles to match.

So I get that something has to change.

But I just can’t figure out how the changes being talked about could possibly lower prices without cutting people off. And by “people,” I mean people I care about and take care of every day.

The new Republican proposals to give tax credits based on family income sound OK to me, but only if the credits are large enough to actually allow people to purchase decent health insurance. With proposed credits of only about $2,000 per year for a person under age 30, they aren’t.

Replacing existing subsidies with tax credits does save the government money, but only if the credits are less than the subsidies. Getting even less help with insurance bills isn’t going to make it any easier for my friends or my patients to get health care.

Under the new proposal, people who benefited from Medicaid expansion would continue to have good insurance coverage, but only until 2020. After that, who knows? When you’re my age, three years goes by really fast!

On the plus side, it sounds like the new proposals would keep the ACA protection for people with pre-existing conditions. That’s great. But I haven’t heard where the money would come from.

By taking away the requirement that everyone get insurance (the “individual mandate”), the new proposals would reduce the number of healthy people who purchase insurance. But the premiums paid by healthy people provide the money for the medical care used by sick people. Take away the healthy people, and the money goes away too.

The government could try to solve this problem by making people with pre-existing conditions get their care from a high-risk pool. But the money for the high-risk pool would still have to come from somewhere; and if the pool were capped, that would mean that some people with cancer or diabetes, say, might not get the care they need.

And the process for deciding who qualifies as high-risk is murky. Would “high risk” mean my patients whose chronic asthma lands them in the emergency room now and then? Or my patients with ADHD who take expensive medicine? Or the parents who have Lupus, or chronic depression, or colon cancer? Who makes these decisions?

So, with all my degrees, I’m left scratching my head.

But one thing is clear: We spend an enormous amount of money in the United States paying insurance companies to run a health insurance system which is too complicated for us mortals to understand!

In July 2016, for example, just one company (UnitedHealth) reported quarterly revenues of $46.5 billion. (You can look it up yourself; just google “health insurance company profits.”)

In countries like Canada and the United Kingdom, where there is universal health care, big insurance companies play a much smaller role, and take a much smaller cut. Everyone gets a baseline level of health insurance, and people who can afford more can buy it if they want it. Single-payer plans like Canada’s get criticized for being “socialized medicine.” But that’s just name-calling. What these plans are is reasonable, fair, and understandable. Even by someone like me.

Dr. Robert Needlman practices and teaches developmental and behavioral pediatrics at MetroHealth Medical Center and is a professor of pediatrics at Case Western Reserve University. He is the co-founder of Reach Out and Read and the author of “Dr. Spock’s Baby Basics,” and co-author of “Dr. Spock’s Baby and Child Care.” The views expressed in this op-ed are solely his own, not those of the institutions with which he is affiliated.

http://www.cleveland.com…

As Republicans prepare to gut Obamacare, visiting doctor says he has a better idea

By Karen Garloch
The Charlotte Observer, March 7, 2017

Many people scoffed recently when President Donald Trump, while addressing plans to replace the Affordable Care Act, made this unwitting understatement: “Nobody knew that health care could be so complicated.”

But Dr. Robert Zarr – who knows health care complexity from the inside – saw it as an opportunity.

“I couldn’t agree more with the president that we need a much more simplified system,” he said.

To Zarr, that means single-payer, universal health insurance.

It’s not a new idea, of course. Single-payer is the basis of Medicare – the popular federally funded health program for people 65 and older. And it’s also the foundation for health coverage in many other developed countries. But in the United States, the idea of single-payer insurance for all is vilified as “socialized medicine” and an unaffordable government takeover of health care.

“That’s a myth,” Zarr said.

As a past president of Physicians for a National Health Program, Zarr has been pushing for single payer for more than 10 years. He will be in Charlotte Thursday to speak at a meeting of Health Care Justice-North Carolina. The free talk is at 6:30 p.m. at Midwood International and Cultural Center, 1817 Central Ave. RSVP: denisefinck@hotmail.com.

With Republicans preparing to repeal and replace the ACA, Zarr says it could be the right time to switch from the current system, with multiple insurance companies and duplicative administrative costs, to a single-payer, government-financed system that would reimburse private doctors and hospitals to care for people from “cradle to grave.”

Republicans have indicated no interest in a single payer plan – although Trump did flirt with the idea in years past. This week, House Republicans unveiled their proposed replacement plan, which would keep some popular features of the ACA but do away with the mandate to buy insurance. Predictions are that fewer people would have insurance coverage than under the ACA.

In a phone interview, Zarr, a Washington D.C., pediatrician, remained optimistic about getting support for single payer. “In poll after poll, the majority of American physicians and the majority of the American public want single payer,” he said.

He said single-payer insurance would cost no more than people are paying right now. Instead of paying premiums, deductibles and co-pays, Zarr said they would pay taxes to provide health care for everyone. “We’re spending enough,” he said. “We’re just not getting what we deserve.”

Total U.S. health care expenditures amount to $3.2 trillion annually, much more than in other developed nations that provide universal health care. In the United States, despite that higher cost and the expansion of insurance under the ACA, many millions remain uninsured – or underinsured with high deductible plans that result in out-of-pocket costs they can’t afford.

Under a single payer plan, everybody would get care without confusing out-of-pocket expenses. And it would save money by reducing administrative costs in every doctor’s office, hospital and insurance company.

“We can’t afford not to have single payer,” Zarr said. “…The only opponents of the single-payer plan are the misinformed.”

http://www.charlotteobserver.com…

Timothy Jost explains the GOP repeal and replace legislation

Examining The House Republican ACA Repeal And Replace Legislation

By Timothy Jost
Health Affairs Blog, March 7, 2017

On March 6, 2017, the House Republican leadership introduced Affordable Care Act repeal and replacement budget reconciliation bills in the Ways and Means (W&M) and Energy and Commerce (E&C) committees. The bills, collectively titled the American Health Care Act, are the committees’ responses to the instructions they received in the Budget Resolution passed by both houses of Congress in mid-January to prepare budget reconciliation legislation to repeal the ACA.

The committees will begin markup of the bills on March 8, 2017.

If the bills are passed by the committees they will be combined by the House Budget Committee and sent to the House Rules Committee, and then to the full House for a vote. The Congressional Budget Office has not released cost estimates of the legislation and it appears that committee markups will proceed without out CBO reports.

Summing Up

In summary, the legislation’s tax cuts will be very attractive to wealthy Americans and health insurers and providers, who would get a trillion dollars in tax breaks. It could cause consternation for Medicaid recipients and state Medicaid programs, which would see federal funding for Medicaid steadily diminish, potentially thinning out coverage. The legislation could be bad news for recipients of current tax credits who are older, sicker, and poorer, and who live in areas where care is expensive. They may be able to afford low actuarial value coverage with the tax credits the bills would provide them, but they are unlikely then to be able to afford the cost sharing that coverage will impose.

Higher-income younger people, on the other hand, would find coverage much more affordable than it is now under the legislation—the tax credits might fully cover their premiums and leave extra for their health savings accounts. Some insurers could find the state reinsurance money and continuous coverage requirement enough of an incentive to stay in the market, but others may not

Finally, one cannot know without a CBO report how this all works out.  But it is hard to see how the bills pay for themselves, and they could result in significant losses in coverage.

http://healthaffairs.org…

Ways and Means summary of their portion of the “American Health Care Act”:
https://waysandmeans.house.gov…

Ways and Means proposed legislation:
https://waysandmeans.house.gov…

Energy and Commerce summary of their portion of the “American Health Care Act”:
https://energycommerce.house.gov…

Energy and Commerce proposed legislation:
https://energycommerce.house.gov…

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G.O.P. Repeal Bill Would Cut Funding for Poor and Taxes on Rich

By Margot Sanger-Katz
The New York Times, March 6, 2017

Legislative language for what House leaders call the American Health Care Act, released Monday evening, would substantially cut back funding to states that cover poor adults through their Medicaid program. It would cut back on financial assistance for relatively low-income insurance shoppers above the poverty line.

It would offer new financial benefits for the upper-middle class and the rich. Americans higher up the income scale would be eligible for subsidies to help them buy health insurance. Taxes on high incomes would be reversed. And the law would allow people to save more money each year in tax-free health savings and flexible spending accounts — accounts that are most valuable to people who pay high income tax rates and have money to save.

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NYT Reader Comments:

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

That’s enough. Single payer.

https://www.nytimes.com…

‘Financial counselors’ add to administrative overload in health care

Got health insurance? That doesn’t mean you’ll be able to pay your medical bills.

By John Murawski
McClatchy DC Bureau, March 4, 2017

Hospitals around the country are reporting record levels of debt on their books from an unlikely source: patients with health care coverage.

As health insurers and employers have shifted health care costs to patients through high deductibles and other out-of-pocket expenses, people who in the past may not have worried about paying for a hospital visit or a surgical procedure are getting hit with massive medical bills that they can’t pay.

Duke University Health System has seen patient interest-free payment plans rise from $19 million in June 2010 to $43 million in January. The increase is largely attributable to rising deductibles, said Keith Stover, Duke’s vice president of finance and chief financial officer.

Duke is fielding 1,500 patient calls a day, most of them asking why they got a bill since they’re insured, Stover said.

WakeMed Health & Hospitals also is experiencing a spike in patients needing help, setting up an average of 1,810 payment plans per month since October.

Wake Forest Baptist Medical Center in Winston-Salem, North Carolina, started offering zero-interest loans through Commerce Bank in November in response to patient deductibles as high as $14,300.

Southeastern Regional Medical Center in Lumberton, North Carolina, in December began assigning “financial counselors” to patients’ rooms to explain insurance benefits and payment options.

Duke Health’s 225 financial counselors contact patients before their scheduled procedures to discuss insurance benefits and payment options; every Duke clinic now has a full-time financial counselor on staff to work with patients.

UNC Health Care has 200 financial counselors to assist patients. “It’s going to be our responsibility to collect,” said Mark Miller, chief financial officer of UNC Health Care in Chapel Hill, North Carolina. “So much is getting left on the table because we can’t get it from the patient, or because they have chosen not to pay it, or they can’t.”

Republicans in Congress have been unable to coalesce around a single proposal to replace the ACA. But their proposals so far could drive up deductibles by lifting the ACA mandated cap on the out-of-pocket costs patients have to pay.

Consumer advocates say the high deductible trend is unsustainable. “They can be a barrier to care for people,” said Mark Rukavina, principal, Community Health Advisors, a Boston organization that advises nonprofit hospitals on billing, collections and finance.

http://www.mcclatchydc.com…

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Comment:

By Don McCanne, M.D.

In a system already tremendously overburdened with administrative excesses, we now have an escalating need for “financial counselors” because of the explosion in medical debt due to the expansion in the use of high deductibles – a tool to protect insurers by slowing the increase in insurance premiums, but at the cost of reducing the financial protection that is the very reason that insurance exists in the first place.

In crafting the Affordable Care Act (ACA) it was recognized that the actuarial value of the plans would have to be decreased (code language for introducing very high deductibles) to keep premiums affordable, and that required fairly generous subsidies and credits for lower-income individuals if they were going to be able to afford health care. But that left moderate-income families exposed to the larger, less affordable deductibles.

What has really increased the need for financial counselors is that employer-sponsored plans – the mainstay of insurance in the United States – have accelerated the adoption of high deductibles with which many working families struggle. It is now a problem in mainstream America. ACA did not directly address the problem of high deductibles in employer-sponsored plans, but it did compound the problem by tightening up on insurance regulation and design. Without higher deductibles, the premiums for employer-sponsored plans would have been driven up even higher.

So ACA made the problem of high deductibles worse. What about the Republican replace proposals? We will find out this week, but it doesn’t look good. The exchange plans will probably have a less generous tax subsidy, making plans less affordable for lower-income individuals. There will also likely be reduced regulatory requirements for private insurance, allowing them to market plans with lower premiums, but that will shift even more costs to individuals and families through yet higher deductibles and other cost sharing and through a reduction in plan benefits – requiring greater out-of-pocket spending.

So what are we getting? Exactly what we don’t need – more administrative costs in the form of financial counselors who assist us in handling the debt that health insurance was supposed to prevent.

We don’t need this. We should get rid of private insurance and replace it with a well-designed single payer national health program that provides first dollar coverage while containing medical spending through much more patient-friendly policies. We can simply fix Medicare and provide it for everyone.

‘Medicare for all’ is still the best solution

By The Editorial Board
The Capital Times (Madison, Wis.), March 6, 2017

Given the choice between maintaining the Affordable Care Act, as many Democrats propose, or eliminating it, as many Republicans propose, The Cap Times favors retaining as much of the current health care program as is possible and practical.

But we have no illusions. We know that the ACA is more costly and inefficient than it needs to be. We are with the plurality of Americans that favors retaining the parts of the ACA that work well and then reforming it so that it can do more.

The best way to do more is to move, as quickly as is politically possible, toward a single-payer “Medicare for all” program.

The single-payer model treats health care as a basic human right and guarantees that everyone is afforded that right. That’s the correct approach and we are pleased that Congressman Mark Pocan, D-town of Vermont, is a co-sponsor of HR 676 — The Expanded and Improved Medicare for All Act.

While Pocan opposes the efforts of Republicans like Vice President Mike Pence and House Speaker Paul Ryan to gut the Affordable Care Act and usher in a new era of profiteering by insurance companies and for-profit health care corporations, the Democrat from Wisconsin recognizes that the best way to provide health care for all while keeping costs down is to build on the successful Medicare model.

Medicare is not perfect. But the government-run program is treasured by Americans because it is so much more reliable and efficient than private programs. That reliability and efficiency, as well as genuine access to quality care, can be enjoyed by all Americans if reforms of the ACA move us in the direction of a “Medicare for all” system.

http://host.madison.com…

Doctor’s prescription for health insurance: Remove the profit motive

Single-payer advocate speaks in Charlotte March 9

By Herbert L. White
The Charlotte (N.C.) Post, March 5, 2017

Is single-payer health insurance inevitable?

American lawmakers are consumed about repealing and replacing the Affordable Care Act. One path that has been regularly touted as a solution is the single-payer model, which advocates say will assure every citizen has access to equal and quality health care.

One of those advocates, Robert Zarr M.D., a practicing pediatrician in Washington, D.C., and an expert on international health and universal health care, will speak March 9 at 6:30 p.m. at Midwood International and Cultural Center, 1817 Central Ave.

Zarr, who provides care for mostly low-income patients, is also an adjunct professor at George Washington University and Children’s National Medical Center. He is also immediate past president of Physicians for a National Health Program.

A February Kaiser Health Tracking Poll finds attitudes towards ACA have shifted, with 48 percent of respondents favoring the law while 42 percent found it unfavorable. The favorable response is the highest measured in more than 60 Kaiser Health Tracking Polls since 2010. Independent voters are driving the change, with 50 percent now viewing the law favorably.

A May 2016 Gallup Poll found 58 percent of Americans favor replacing ACA with a federally funded healthcare system – such as Medicaid and Medicare – that provides insurance for all. Critics, however, contend such a program amounts to “socialized medicine” which leaves government in control of the delivery of service and weakens care.

Zarr spoke with The Post by telephone from Washington, D.C. Responses are edited for clarity and brevity.

Polling suggests the idea of single payer insurance is popular. Why is that?

Zarr: “The reason why it’s so popular is because one, it’s so easy to understand. The second is that it just makes common sense. We remove the shackles from the insurance companies for the delivery of care, which in our opinion, should be left to the private domain. We feel doctors should be able to open up their own practices if they wish. We feel strongly that a pharmacy should be able to provide medicines and medical supplies without having to worry about bankruptcy themselves.

“We feel this can best be done most efficiently by looking at the data and evidence, not just with Medicare but across the world. The only way we can efficiently do this is by publicly financing it, removing it from the private domain in terms of finance. Private delivery, public finance – that is the easy way for us to understand single payer.”

Why isn’t single payer the law of the land now?

“Probably the best way to answer that is that there is a lot of momentum among the moneyed interests in this country to keep status quo. ACA really is and really was the beginning of a prolongation of our status quo. There’s nothing magical about ACA. It took what we already had and it expanded it. It expanded Medicaid in 20-plus states, and I might add, did not expand it in 20-plus states as well and it relied heavily on the private insurance model. The private exchange model is not just what we see in the exchanges that have been set up but also in Medicare and Medicaid as well, so two-thirds of the recipients in Medicaid are receiving their health insurance through private, for-profit plans and it’s about one-third in Medicare.”

Why isn’t there more political will to remove the profit motive from health insurance?

“I think we need to exert our democratic right through pressure on legislators to make sure they understand they’re jeopardizing their next campaign if they don’t support single payer. The strongest thing we can do right now is raise the temperature so that legislators understand that single payer, HR676, is what this country wants and what we need, both by the people and the delivery community – the doctors, the hospitals, the pharmacies. We need to make it politically toxic to not support 676.”

Has the battle over repeal and replace overwhelmed advocacy for single payer?

Because ACA is under threat right now, with all its faults and all its reliance on for-profit insurance industry, which is not leading us to single payer, it still did put an insurance card in the wallet or purse of 20 million Americans. When we remove that against the people’s will, for every million uninsured, you’re looking at 1,000 deaths per year. There’s a lot of pressure going on right now and congressmen are feeling it because constituents are worried, they are anxious about what’s going to happen.”

What do you see four years into the future for health insurance?

“There is a chronic burnout and fatigue in physicans and it’s bad, very bad. We’re spending more of our time trying to get the simplest of tasks done where you’ve got 15 minutes to get this done. As a patient, it’s getting more and more frustrating with the cost shifting with the difficulty of knowing there’s no transparency. I don’t know the coverage my health plan has until I get sick and I get the bill. My crystal ball tells me if we keep going down this same path, it’s a path to destruction, it’s a path to suffering, it’s a path to early death, and that’s not something I want.

“My crystal ball tells me there is only one end point to this and that is to provide every American an equitable and affordable comprehensive health care that will not bankrupt us. We can put this off another few years, four years, six to eight years, but at some point we’re going to have to get to the only solution that anyone’s been able to come up with, and that’s efficient and not going to bankrupt us and it’s fair for everyone.”

http://www.thecharlottepost.com…

What did Jesus really say?

Two months ago, this doctor was delivering babies. Now he’s at the nexus of the Obamacare fight

By Lev Facher
STAT, March 3, 2017

Dr. Roger Marshall was delivering babies in December. By January, he found himself across a breakfast table from Tom Price, offering emotional support to the Georgia congressman as he endured a contentious confirmation process to become the top health official in the new Trump administration.

Marshall, a few months ago just another doctor from Kansas, is now Congressman Roger Marshall.

Marshall has joined the GOP Doctors Caucus, a group of 16 lawmakers with health care backgrounds who have put themselves at the center of the effort to unwind the Affordable Care Act.

Marshall is as quick as any Republican to slam Obamacare, claiming firsthand experience of its effects from his time at Great Bend Regional Hospital in central Kansas. He helped grow the hospital from a four-bed surgical clinic to the full-service, physician-owned facility it is today.

Like many other Republicans, Marshall said he wants the health care system to rely on the free market rather than Obamacare’s regulations. He measures success in how many people can afford to leave the Medicaid program and enter the private insurance market.

The law’s Medicaid expansion, which Kansas has not adopted despite support from many hospitals, including some of Marshall’s former colleagues, is one of the big sticking points for Republicans. Many GOP-led states adopted it and want to see it preserved in some form.

Marshall doesn’t believe it has helped, an outlook that sheds light on how this new player in Washington understands health policy.

“Just like Jesus said, ‘The poor will always be with us,’” he said. “There is a group of people that just don’t want health care and aren’t going to take care of themselves.”

https://www.statnews.com…

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Old Testament

Deuteronomy 15:11

11 For the poor will never cease out of the land; therefore I command you, You shall open wide your hand to your brother, to the needy and to the poor, in the land.

New Testament

Mark 14:1-10

1 It was now two days before the Passover and the feast of Unleavened Bread. And the chief priests and the scribes were seeking how to arrest him by stealth, and kill him; 2 for they said, “Not during the feast, lest there be a tumult of the people.” 3 And while he was at Bethany in the house of Simon the leper, as he sat at table, a woman came with an alabaster flask of ointment of pure nard, very costly, and she broke the flask and poured it over his head. 4 But there were some who said to themselves indignantly, “Why was the ointment thus wasted? 5 For this ointment might have been sold for more than three hundred denarii, and given to the poor.” And they reproached her. 6 But Jesus said, “Let her alone; why do you trouble her? She has done a beautiful thing to me. 7 For you always have the poor with you, and whenever you will, you can do good to them; but you will not always have me. 8 She has done what she could; she has anointed my body beforehand for burying. 9 And truly, I say to you, wherever the gospel is preached in the whole world, what she has done will be told in memory of her.” 10 Then Judas Iscariot, who was one of the twelve, went to the chief priests in order to betray him to them.

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Comment:

By Don McCanne, M.D.

Dr. Roger Marshall, freshman congressman from Kansas, has already exposed his compromised sense of medical ethics by participating in the establishment of a for-profit, physician-owned private hospital – a prime example of the perversities of the medical-industrial complex. But then he had to bring Jesus into it, saying, “The poor will always be with us.” Marshall says that he doesn’t believe that Medicaid has helped the poor because they “just don’t want health care and aren’t going to take care of themselves.”

In the Old Testament, the Scriptures record that the Lord said, “For the poor will never cease out of the land; therefore I command you, You shall open wide your hand to your brother, to the needy and to the poor, in the land.”

In the New Testament, which presumably is Marshall’s source in the Scriptures since he was quoting the words of Jesus himself, Jesus did say, “For you always have the poor with you…”  But Jesus continued (conveniently omitted by Marshall), “… and whenever you will, you can do good to them.” It seems as though Marshall does not will to do good to the poor. (Though, in context, would Marshall have thought the ointment was wasted? Probably not if it would otherwise have gone to the poor – a point with which those writing or translating the Scriptures thought Jesus might agree. An enigma.)

What I knew about Jesus was derived mostly in my childhood when I attended the Pilgrim Congregational Church in Pomona, California (choir practice on Tuesdays, Boys Brigade on Thursdays, Sunday School Sunday mornings followed by singing in the children’ choir in our church services). I have been forever grateful for the  moral lessons that I learned from the Scriptures, including from the words of Jesus. In my earlier years of awakening I was saddened to see that some of the elders in our church – some of the wealthiest people in town – did not seem to have a commitment to what my perceptions were of what Jesus was trying to teach us, so I left the church. My salvation is that I have found that these moral principles hold just as solidly in the secular world and are practiced by my friends in the social justice movement regardless of their personal religious beliefs or lack thereof. Truth is truth, and fundamental morality exceeds all boundaries.

But when a physician – a profession with ethics dating back to the Hippocratic traditions – uses the words of Jesus to tell us that Medicaid – a public program to help the poor with medical needs – has not helped since they don’t want health care and are not going to take care of themselves anyway, then he must be a hypocrite. Jesus would have turned over the tables in the business offices of his physician-owned hospital. We certainly do not want him, nor his colleagues of like mind, making moral judgements as to how legislation defining how to finance health care for all in America should be crafted.

Why Republicans should support universal health care

By Roger LaBonte, M.D.
The Tennessean, March 3, 2017

President Donald Trump has indicated he wants to repeal and replace Obamacare.

His recent statements before the election seem to indicate his desire for a market-based solution. Several recent articles and editorials have demonstrated how dysfunctional our health care system is, principally by its reliance on the insurance-industrial complex.

Every attempt to correct and improve the system by legislation has given the health-insurance industry new incentives and ways to game the system for its own profit motive. Obamacare has turned out to be no different.

The rate increases in Tennessee of 44 percent to 62 percent, approved last year, and similar increases in other states have shifted more and more cost to employers who are mandated to provide coverage and in turn must pass this on to their employees. Employers should be in rebellion at their increasing cost of providing health care for employees as is currently mandated.

I do not understand why many businesses continue to support our current system. In fact, the only businesses that gain anything by this system of employer-provided health care are the insurance companies themselves, which continue to show huge profits while sucking profits from others.

Many of the newly under-insured will be surprised by what they do not have when they try to access health care. The insurance executives who say they cannot weather the losses incurred by their participation in the health-care marketplaces are still raking in profits for their executives. Shareholders are basically just confirming their unwillingness to include those in most need of health insurance in their risk pools.

Some enlightened businessmen have come to that conclusion, including Richard Master, CEO of MCS Industries, Inc., who has supported single-payer national health insurance.

Many years ago, as a successful businessman, Trump had expressed the opinion that the best business solution to our dysfunctional health care system would be a national health care system with universal coverage for everyone, paid through taxes. I agree with his assessment at that time and hope that he will go back to considering this solution.

Imagine what that would do for the Republican Party’s popularity given that greater than 75 percent of our citizens want universal coverage. Under such an egalitarian and utilitarian system taxes would certainly go up for individuals and businesses, but the amount saved by not having to pay health insurance premiums, co-pays, deductibles, co-insurance and other hidden fees would more than compensate businesses and individuals for the increase in taxes.

With Republicans now in control of all branches of government, let’s hope they can achieve universal healthcare for everyone while lowering the cost to everyone.  Much of the rest of the world has shown us that universal health care is achievable at reasonable costs. More importantly we cannot identify as a caring nation until we properly care for the least among us.

Roger S. LaBonte, M.D. is president of the West Tennessee Chapter of Physicians for a National Health Program.

http://www.tennessean.com…

The G.O.P. and Health Care

By Caroline Poplin, M.D.
The New York Times, Letters, March 3, 2017

Re: “The Hole Republicans Dug” (column, Feb. 28):

David Leonhardt is right. If Republicans want to provide health insurance through “free market” competition, their solution will have the same problems as the Affordable Care Act: Healthy, low-risk families will be forced to buy costly policies more expensive than they need, to cover the expenses of the 5 percent of people responsible for some 50 percent of health care costs, with money left over for insurer profits.

A significant infusion of federal money will be required, contrary to Republican philosophy. If the government pays less, people will have to pay more; insurers or providers must accept less; or people will lose coverage. There is no way to square this circle.

What Americans want and need is not affordable health insurance, but necessary health care. Our fundamental problem is that American health care is expensive, which reduces access. Insurers have done little to reduce cost — look at the skyrocketing prices of drugs — and instead have probably increased it.

If we want all Americans to get the health care they need, the only system we can afford is some version of Medicare for all, with negotiated or regulated prices, just like the rest of the developed world.

Caroline Popline, M.D., J.D., is a primary care physician. She resides in Bethesda, Md.

https://www.nytimes.com…