PNHP past president Dr. Oliver Fein appeared on “The Big Picture” on Jan. 6, 2017, to discuss the prospective repeal of the Affordable Care Act. He noted the negative impact that repeal would have on patients, critiqued the “market-based” alternatives proposed by Republicans, and argued in favor of a single-payer national health program.
Note: Dr. Fein’s segment starts at the 15:20 mark.
By Drew Altman
The New York Times, January 5, 2017
This week Republicans in Congress began their effort to repeal and potentially replace the Affordable Care Act. But after listening to working-class supporters of Donald J. Trump — people who are enrolled in the very health care marketplaces created by the law — one comes away feeling that the Washington debate is sadly disconnected from the concerns of working people.
Those voters have been disappointed by Obamacare, but they could be even more disappointed by Republican alternatives to replace it. They have no strong ideological views about repealing and replacing the Affordable Care Act, or future directions for health policy. What they want are pragmatic solutions to their insurance problems. The very last thing they want is higher out-of-pocket costs.
The Kaiser Foundation organized six focus groups in the Rust Belt areas — three with Trump voters who are enrolled in the Affordable Care Act marketplaces, and three with Trump voters receiving Medicaid. The sessions, with eight to 10 men and women each, were held in late December in Columbus, Ohio, Grand Rapids, Mich., and New Cumberland, Pa. Though the participants did not agree on everything, they expressed remarkably similar opinions on many health care questions. They were not, by and large, angry about their health care; they were simply afraid they will be unable to afford coverage for themselves and their families. They trusted Mr. Trump to do the right thing but were quick to say that they didn’t really know what he would do, and were worried about what would come next.
They spoke anxiously about rising premiums, deductibles, copays and drug costs. They were especially upset by surprise bills for services they believed were covered. They said their coverage was hopelessly complex. Those with marketplace insurance — for which they were eligible for subsidies — saw Medicaid as a much better deal than their insurance and were resentful that people with incomes lower than theirs could get it. They expressed animosity for drug and insurance companies, and sounded as much like Bernie Sanders supporters as Trump voters.
The Trump voters in our focus groups were representative of people who had not fared as well. Several described their frustration with being forced to change plans annually to keep premiums down, losing their doctors in the process. But asked about policies found in several Republican plans to replace the Affordable Care Act — including a tax credit to help defray the cost of premiums, a tax-preferred savings account and a large deductible typical of catastrophic coverage — several of these Trump voters recoiled, calling such proposals “not insurance at all.” One of those plans has been proposed by Representative Tom Price, Mr. Trump’s nominee to be secretary of Health and Human Services. These voters said they did not understand health savings accounts and displayed skepticism about the concept.
When told Mr. Trump might embrace a plan that included these elements, and particularly very high deductibles, they expressed disbelief. They were also worried about what they called “chaos” if there was a gap between repealing and replacing Obamacare. But most did not think that, as one participant put it, “a smart businessman like Trump would let that happen.”
There was one thing many said they liked about the pre-Affordable Care Act insurance market: their ability to buy lower-cost plans that fit their needs, even if it meant that less healthy people had to pay more. They were unmoved by the principle of risk-sharing, and trusted that Mr. Trump would find a way to protect people with pre-existing medical conditions without a mandate, which most viewed as “un-American.”
If these Trump voters could write a health plan, it would, many said, focus on keeping their out-of-pocket costs low, control drug prices and improve access to cheaper drugs. It would also address consumer issues many had complained about loudly, including eliminating surprise medical bills for out-of-network care, assuring the adequacy of provider networks and making their insurance much more understandable.
Republican health reform plans would probably increase deductibles, not lower them. And providing the more generous subsidies for premiums and deductibles that these voters want would require higher taxes, something the Republican Congress seems disinclined to accept.
In general, the focus among congressional Republicans has been on repealing the Affordable Care Act. There has been little discussion of the priorities favored by the Trump voters who spoke to us. But once a Republican replacement plan becomes real, these working-class voters, frustrated with their current coverage, will want to know one thing: how that plan fixes their health insurance problems. And they will not be happy if they are asked to pay even more for their health care.
http://www.nytimes.com…
***
By Don McCanne, M.D.
This survey of focus groups composed of Trump supporters confirms the anecdotal reports that many of them have been disappointed by Obamacare, but they want health insurance that is affordable and that works. They believe that President Trump will do the right thing even though they have no idea what that is.
Although they have a poor understanding of the complexities of insurance, what they do want is to keep their out-of-pocket costs low, control drug prices, improve access to cheaper drugs, eliminate surprise medical bills for out-of-network care, adequate provider networks, and make their insurance more understandable. What they seem to want are the policies of a single payer national health program. What they certainly would not want would be any of the replacement proposals of the Republican party if they understood how much worse affordability and access would be.
What we need are the replacement bills so that we can explain the damage they would do, but it appears that those bills are not forthcoming.
What we will probably see is a resolution, but not a requirement, to repeal features of Obamacare at some time in the distant future. The Republicans may then introduce replacement bills which they will tout as reform but will actually advance intolerable changes (privatizing Medicare, slashing Medicaid funding through block grants, establishing high risk pools without adequately funding them, etc.) that the Democrats will have to filibuster. Then the Republicans will be able to claim that they tried to replace Obamacare, but the Democrats blocked their reforms. They can then walk away, hoping everyone will have forgotten their resolution to repeal Obamacare.
The problems that people are blaming on Obamacare will still be there, even though they are mostly problems inherent in the highly flawed, fragmented financing infrastructure that was only minimally patched by Obamacare. When they see that the “repeal and replace” rhetoric was all hot air, they may be ready to accept an insurance program that they can understand and that will meet their needs – a single payer, improved Medicare for all.
By Sheila Anne Feeney
amNewYork, Jan. 5, 2017
The massive rollback of the Affordable Care Act (ACA) that Republicans plan is a “strategic attempt to perpetuate injustice” and — in a nod to Senator Chuck Schumer’s line — will “make America sick again,” Dr. Priscilla Chukwueke, a resident psychiatrist at Harlem Hospital, said Thursday at a Lower East Side news conference.
Chukwueke, who lauded the ACA for expanding access to care for people with mental health disorders, charged that policies championed by Tom Price, President-elect Donald Trump’s nominee for Health and Human Services secretary, put “politics and profits over patients” and would lead to increased anguish for New Yorkers.
Chukwueke was one of about a dozen physicians, including city Health Commissioner Dr. Mary Bassett, who appeared in freezing temperatures outside the Catherine M. Abate Health Center to oppose Price’s nomination.
Price, a former orthopedic surgeon, has advocated segregating sick patients into “high risk pools” and eliminating federal funding of Planned Parenthood. Price has also supported cutting Medicaid and privatizing Medicare.
“In this instance, the Price is very wrong,” said Dr. Oliver Fein, chair of Physicians for a National Health Program. Fein urged New Yorkers to tell Sens. Schumer and Kirsten Gillibrand to vote against Price’s confirmation.
The senators “are standing strong now,” but will need the support of their constituencies to withstand pressure to make compromises, said Fein, noting how a recent outcry reversed the GOP plan to gut the Office of Congressional Ethics.
Price’s preferred method of delivering Medicaid would restrict access to HIV/AIDS treatment for the most vulnerable patients, and Medicare recipients would face higher out-of-pocket prices, while insurers and Wall Street profit at their expense, Fein added.
Bassett said that doctors must not only heal with their hands, but with their voices. “We speak out, we speak up, and we advocate…I’m proud to lend my voice to this effort,” said Bassett. She added that the ACA, Medicare and Medicaid needed expansion, not contraction.
http://www.amny.com…
Additional coverage of the action:
WMBC-TV: News Video – Obamacare Debate
https://www.youtube.com…
NY1: City Doctors Urge Congress to ‘Do No Harm’ to Affordable Care Act
http://www.ny1.com…
CIR SEIU: Facebook Live Video
https://www.facebook.com…
By Shannon Firth
MedPage Today, Jan. 5, 2016
WASHINGTON — When President-elect Trump chose Rep. Tom Price (R-Ga.) to be Secretary of Health and Human Services, he poked an already buzzing hornet’s nest.
Like the rest of the country, doctors, nurses, and medical students have very divided opinions about the government’s role in healthcare. Price’s nomination amplifies that division.
The American Medical Association (AMA) voiced immediate support for Price, while the American Medical Students Association (AMSA), Physicians for a National Health Program (PNHP), and National Nurses United (NNU) roundly condemned the nominee. Most other physician and nurse organizations voiced something between concern and resignation.
MedPage Today spoke with the leadership of several physician and nursing groups to understand their concerns and in some cases highlight areas of agreement.
Line In the Sand
On Nov. 29, the AMA backed Price, a member of the association’s House of Delegates, in a press statement: “Dr. Price has been a leader in the development of health policies to advance patient choice and market-based solutions as well as reduce excessive regulatory burdens that diminish time devoted to patient care and increase costs,” wrote Patrice Harris, MD, a psychiatrist from Atlanta and chair of the AMA Board of Trustees.
That statement infuriated many physicians, including AMA members and nonmembers alike.
For example, the Clinician Action Network, led by Manik Chhabra, MD, Navin Vij, MD, and Jane Zhu, MD, MPP, posted a letter that has since gathered 5,000 signatures from clinicians across the country: “We believe that in issuing this statement of support for Dr. Price, the AMA has reneged on a fundamental pledge that we as physicians have taken — to protect and advance care for our patients.”
The letter criticized Price’s record and presumed agenda, such as “the dismantling of Medicaid” and “proposals to reduce funding” for the Children’s Health Insurance Program. The group also worried that essential benefits such as opioid use disorder treatment, prenatal care, and access to contraception would be threatened.
Harris explained that the AMA’s support should not be viewed as a blanket endorsement for every one of Price’s positions. She also recalled the “flurry of objections” that targeted another physician nominee, C. Everett Koop, MD, who served as surgeon general under President Ronald Reagan. Koop is now remembered for his efforts to prevent tobacco use and to promote safe sex for AIDS prevention.
Initially, many physicians were alarmed by Koop’s anti-abortion stance, Harris noted. But “Dr. Koop’s one-time opponents later cited him as a role model for how the U.S. surgeon general can help the nation face serious health care challenges.”
Some Docs Enthusiastic
Others, like Jane Orient, MD, executive director of the Association of American Physicians and Surgeons, who practices in Tucson, Ariz., offered unqualified support for Price’s nomination.
Orient said she shares Price’s views on reproductive rights and does not believe taxpayers should pay for another person’s abortion or birth control, which she said “is quite reasonably priced.”
She said she considers Price’s critics’ concerns for health equity “laughable.”
“Instead of trying to have the optimal medical care for everybody and [giving] people the right to choose their own medical care and the right to control of their own money, they want to take these resources out of the hands of people making decisions for themselves and put it in the hands of bureaucrats who have this whole formula to decide what they think is equitable. And they don’t think it’s equitable for people to spend their own money for their own medical care,” Orient said.
“Tom Price has been in favor of allowing people to do this, even if they’re on Medicare,” she said, referring to Price’s support for Medicare privatization.
Red Flags for Others
While PNHP has been critical of the Affordable Care Act, wholesale repeal is not the solution the group has in mind — that is, unless the ACA were replaced with a single-payer system, Robert Zarr, MD, a pediatrician based here and a past PNHP president, said in a phone interview with MedPage Today.
Instead, Zarr anticipates an acceleration of healthcare privatization: “We’ll see it go a lot faster now that we have a House and a Senate and a White House presumably agreeing on this one premise — which is ‘private is good, public is bad.'”
“People who have HIV, who have advanced kidney disease … people who are living in devastated communities economically … If access to healthcare is made harder and harder, then they’re going to have a shorter lifespan, and they’re going to suffer more before they die.”
Many nurses also oppose Price’s nomination, Deborah Burger, RN, of Santa Rosa, Calif., and co-president of National Nurses United, the largest nurses union in the country, told MedPage Today in a phone interview.
If the ACA is repealed, one of the first steps in that repeal will likely involve a reversal of the tax increases that fund subsidies that help people afford their premiums.
And the revenue for Republicans’ proposed block grants for Medicaid won’t be there, she continued.
Seeking Common Ground
Other nurses like Pamela Cipriano, PhD, RN, president of the American Nurses Association, also criticized Price’s record on diversity and inclusion, as well as his opposition to gay marriage.
As more people declare their gender identity and sexual identity, they have been ostracized and stigmatized by clinicians, said Cipriano: “The healthcare community really needs to step up to make sure that these [LGBTQ] individuals … are being adequately cared for, and if there’s an inherent bias in the leaders of our Health and Human Services [Department], that doesn’t bode well for the healthcare community really embracing their needs.”
Price will very likely be confirmed, said Cipriano. She hopes that he will listen to nursing groups. In addition to supporting continued federal funding for nursing education, Cipriano hopes Price will set partisanship aside and embrace the “triple aim” — improving access, quality, and affordability of healthcare — and continue to advance value-based payment.
The American Congress of Obstetricians and Gynecologists (ACOG), in a letter to Price concerning his opposition to federal funding for abortion and for Planned Parenthood, sounded a warning: “Planned Parenthood clinics provide critical preventative healthcare services to women and men. Abortion is healthcare. ACOG remains committed to protecting each of these critical aspects of women’s health.”
The group also acknowledged areas where Price’s views aligned with its own: Medicare physician payment reform, repeal of the Independent Payment Advisory Board, and medical liability reform.
“Your consistent efforts to find common ground and work together on shared goals are laudable, and your commitment to accomplishments, rather than talking points, is unfortunately all too rare in Washington. We hope that you will use your new role as an opportunity to expand on these collaborative practices,” ACOG wrote.
Laura Wooster, MPH, executive vice president of public policy for the American Osteopathic Association, also sounded a cautious tone in a phone call with MedPage Today. “Other than stating our priorities, it seems premature to really start getting vocal,” she said, explaining that the group doesn’t normally endorse or oppose nominees.
She noted, though, that many of the group’s members have echoed one of Price’s talking points, the “administrative burden” that government involvement in healthcare can sometimes bring.
Senate Opposition Brewing?
Even though confirmation seems assured, Price still must face grilling and probable opposition from Senate Democrats.
On Thursday, Democrats in Congress called for an ethics probe into Price’s financial holdings and investments. Price traded $300,000 worth of shares in health-related companies while in the House, according to The Wall Street Journal.
“There’s enough evidence here that cries out for an investigation. Whether the law was actually broken, whether there [were] quid pro quos or inside information is the better way to put it — we don’t know,” said Senate Minority Leader Chuck Schumer (D-N.Y.) at a news conference, as reported by CNN.
MedPage Today will continue to follow that story.
Shannon Firth is Washington correspondent for MedPage Today.
By Kay Tillow
All Unions Committee for Single Payer Health Care – HR 676, Jan. 4, 2017
The Greater Wilkes Barre Labor Council and two United Steelworkers locals in Wilkes Barre, Pennsylvania, have endorsed Congressman John Conyers’ HR 676, national single payer health care legislation, Expanded and Improved Medicare for All.
The Labor Council, comprised of 47 locals from 28 unions representing 10,000 members, endorsed HR 676 at their monthly meeting on December 22, 2016, becoming the 152nd central labor council to take this action.
The two USW locals together have more than 1,650 members. USW Local 5652, an amalgamated local, represents workers in a variety of jobs including making shelving and heating cabinets for restaurants, manufacturing gears for airplanes, repairing utility trucks, and working at a correspondence school.
USW Local 15253 represents workers who do heavy highway construction from the Maryland border to the New York border and from the New Jersey border to the middle of Pennsylvania.
William Herbert, Treasurer of Local 5652 said “We’ve been getting ripped off by insurance companies.” He told of the crises faced by even heart attack patients who are confronted with demands for up front payments as high as $1,700. Herbert worked successfully to get his Congressperson, Matt Cartwright, to sign on to HR 676.
Herbert made the following statement on behalf of his local:
“USW Local 5652 passed a resolution calling on Congress to pass H.R. 676. For too long the insurance and pharmaceutical industries have been charging outrageous prices for their products. The bill would extend Medicare to everyone and eliminate co-pays and deductibles. We feel that this is the only way to insure health care for all Americans. If this bill passed, we would no longer need to negotiate for health care in our contracts. If an employee gets laid off his insurance would continue at the same level. We urge all Americans to call their Representatives in Congress and the Senate and ask them to pass H.R. 676.”
The HR 676 endorsement resolutions were signed by President Dave Brandt of Local 5652 and President Joseph M. Padavan of Local 15253. Padavan is also president of the Greater Wilkes Barre Labor Council.
Issued by:
Kay Tillow, Coordinator
All Unions Committee for Single Payer Health Care – HR 676
c/o Nurses Professional Organization (NPO)
1169 Eastern Parkway, Suite 2218
Louisville, KY 40217
(502) 636 1551
nursenpo@aol.com
unionsforsinglepayer.org
facebook.com/unionsforsinglepayer
HR 676 would institute a single payer health care system by expanding a greatly improved Medicare to everyone residing in the U. S. Patients will choose their own physicians and hospitals.
HR 676 would cover every person for all necessary medical care including prescription drugs, hospital, surgical, outpatient services, primary and preventive care, emergency services, dental (including oral surgery, periodontics, endodontics), mental health, home health, physical therapy, rehabilitation (including for substance abuse), vision care and correction, hearing services including hearing aids, chiropractic, durable medical equipment, palliative care, podiatric care, and long term care.
HR 676 ends deductibles and co-payments. HR 676 would save hundreds of billions annually by eliminating the high overhead and profits of the private health insurance industry.
In the current Congress, HR 676 has 62 co-sponsors in addition to Congressman Conyers.
HR 676 has been endorsed by 627 union organizations including 152 Central Labor Councils/Area Labor Federations and 44 state AFL-CIO’s (KY, PA, CT, OH, DE, ND, WA, SC, WY, VT, FL, WI, WV, SD, NC, MO, MN, ME, AR, MD-DC, TX, IA, AZ, TN, OR, GA, OK, KS, CO, IN, AL, CA, AK, MI, MT, NE, NJ, NY, NV, MA, RI, NH, ID).
The list of union endorsers.
The sample endorsement resolution.
By Jack Bernard
Georgia Health News, Jan. 4, 2016
We are the most religious democracy in the world, and our Judeo-Christian ethic demands that we take care of the downtrodden. But we are also the only advanced democracy without universal health coverage. Are we confused…or just hypocrites?
My bet is that we are very confused. The public’s reaction to Obamacare (also known as the Affordable Care Act, or ACA) is a prime example of our confusion.
Most Americans are preoccupied with making a living and raising a family, and rightly so. They have no time to fully examine health care policy issues.
Surveys show that people do not like Obamacare, especially the mandatory insurance requirement, but most actually agree with numerous aspects of the health law, like waivers for people with pre-existing conditions.
I believe that many people do not understand how insurance works or realize that you cannot get one thing (waivers) without the other (mandates), due to the basic financial model by which insurance operates.
To amplify the confusion, many media outlets in the past few years have featured one-sided coverage and debate about the ACA. There has been too little discussion of the details of what works and what does not.
In earlier generations, new health-related programs such as Social Security and Medicare were also controversial when first proposed. Many of the objections to them were wildly exaggerated, though some skeptics had serious points. But these programs have worked out overall, and Americans have come to value them.
I am a Republican who disagrees with his party when it comes to health reform. I also recognize that the ACA has shortcomings, which many Democrats are now beginning to admit. And I believe that President-elect Donald Trump has a better understanding of how insurance works that many of his critics would admit.
With all that said, I just don’t believe we should shoot ourselves in both feet by attempting to repeal the ACA outright, as advocated by most leading Republicans.
What will Trump’s health care coverage strategy be when he is in the White House?
Apparently, with Trump’s pick of Rep. Tom Price (R-Ga.) to be HHS secretary, a repeal effort is ahead. Trump really appears to want to scrap the ACA. Meanwhile, Price and House Speaker Paul Ryan (R-Wis.) are pushing for what I see as the elimination of traditional Medicare and Medicaid.
I have grave concerns that the GOP has no acceptable alternative to the ACA, nothing that would assure coverage for the tens of millions of Americans who would end up uninsured if Obamacare goes away. The health exchanges alone currently cover 12.4 million citizens. And, what about the millions more covered via Medicaid expansion?
Privatization of Medicare, a goal of Ryan as well as Price, is not viable for economically stressed seniors, and use of vouchers will reduce coverage rather than broadening it. For-profit insurers have a 20 percent overhead/marketing expense versus 3 percent for Medicare. Yes, budgetary caps will be placed on expenditures (to the detriment of seniors). But the justification for privatization is purely ideological, not fiscal.
Block grants for Medicaid would just dump the fiscal problem on the states. Rather than blow up their budgets, states would then cut benefits and recipients, affecting care for the working poor and others.
In the long term, the GOP must change course or face the wrath of voters who will eventually be denied health care. It must advocate for expansion of a program that ordinary people in both parties know works: Medicare. That is the only realistic way to repeal the ACA and get broad political support at the same time.
It should be noted that although taxes would increase under such a plan, insurance premiums would be eliminated. More on how to finance this proposal via corporate and individual taxes can be found at the website of Physicians for a National Health Program: www.pnhp.org.
In the meantime, until there is fundamental legislation to move us in a more effective direction, the ACA is law. All Americans should get behind it. Hopefully, this next Congress will just modify the most problematic areas and give the overall health law a chance to succeed, rather than move to repeal it.
Jack Bernard, the first director of health planning for Georgia, has been a senior executive with several national health care firms. He’s a former chairman of the Jasper County Commission and Republican Party.
By Howard Bauchner, M.D., Editor in Chief, JAMA
JAMA, Editorial, January 3, 2017
The United States is about to embark on a great challenge: how to modify the current system of providing health care coverage for its citizens. However, the fundamental underlying question remains unanswered and was rarely mentioned during the past 8 years—Is health care coverage a basic right or a privilege (regardless of how that coverage is provided or who provides it)? Until that question is debated and answered, it may not be possible to reach consensus on the ultimate goal of further health care reform. Without agreeing to the goal, measuring success will be nearly impossible.
The months and years ahead are filled with uncertainty regarding how the US health care system will evolve.
The ACA needs to be modified, even though it has accomplished a great deal, principally by expanding the number of newly insured individuals. However, much remains to be accomplished, including how to ensure high-quality, affordable health insurance for all residents and how to control the continual increases in annual health care spending, now exceeding $3 trillion.
Sorting out the most effective way to provide health care coverage in the United States is a work in progress and will require careful assessment and likely repeated changes. If the goals of further health care reform are clear and are measured but are not reached, then it will be necessary to return to previous discussions that have included a public option, a single-payer system, lowering the eligibility for Medicare, or further privatization of the health care system.
I hope that all physicians, including those who are members of Congress, other health care professionals, and professional societies would speak with a single voice and say that health care is a basic right for every person, and not a privilege to be available and affordable only for a majority. The solution for how to achieve health care coverage for all may be uniquely American, but it is an exceedingly important and worthy goal, emblematic of a fair and just society.
JAMA is granting free access to the full editorial at this link:
http://jamanetwork.com…
***
By Don McCanne, M.D.
Did you get that? Howard Bauchner, the Editor in Chief of JAMA – the Journal of the American Medical Association – says that “all physicians, including those who are members of Congress, other health care professionals, and professional societies (should) speak with a single voice and say that health care is a basic right for every person, and not a privilege to be available and affordable only for a majority.”
If we get this one right, improved Medicare for all follows.
By Eric Lipton and Matt Flegenheimer
The New York Times, January 3, 2017
House Republicans, facing a storm of bipartisan criticism, including from President-elect Donald J. Trump, moved early Tuesday afternoon to reverse their plan to kill the Office of Congressional Ethics. It was an embarrassing turnabout on the first day of business for the new Congress, a day when party leaders were hoping for a show of force to reverse policies of the Obama administration.
The reversal came less than 24 hours after House Republicans, meeting in a secret session, voted, over the objections of Speaker Paul D. Ryan, to eliminate the independent ethics office.
***
By Don McCanne, M.D.
It is astonishing that a new Congress that has promised to reduce the government’s support of some of the most important social programs in our nation took as their first action, behind closed doors, approval of “their plan to kill the Office of Congressional Ethics.”
Although they rejected the advice of Speaker Paul Ryan not to do this, President-elect Trump also expressed his view through a tweet that this should not have been “their number one act and priority.” We can only speculate as to whether Trump and Ryan were truly concerned about preserving the function of the ethics committee or if it was just that they were concerned about the negative public image that might ensue. It did not take long for the expression of public outrage to convince them that they needed to reverse this action.
The damage is done. The Congressional majority has made a clear statement that they will not let ethics interfere with their attack on our social programs, beginning with the Affordable Care Act. It will be our duty to continue to express our outrage at the unethical implications of making health care less and less affordable for an ever growing number of residents, not to mention all of the other social injustices they intend to advance through their attack on existing programs.
Voters indicated that they wanted to clean up Congress. They must be perplexed that the first action was to try to throw Congressional ethics out the window. It should be a clarion call to all of us to watch very closely every other policy that this Congress attempts to enact.
By Nancy Altman
The Huffington Post, Dec. 30, 2016
New Year’s is a time for resolutions. Consistent with this tradition, powerful Republicans have made clear that they are resolving, in the New Year, to dismantle Medicare, ending it as we know it.
Speaker of the House Paul Ryan has said that destroying Medicare is part of the Republican plan to repeal Obamacare, another Republican resolution for 2017. And Representative Tom Price, powerful chairman of the House Budget Committee, Ryan ally, and likely next Secretary of Health and Human Services, has explained that the Republicans will enact Medicare legislation in the first six to eight months of 2017, since it is probably too big a task to include it in the planned January repeal of Obamacare.
These Republicans are people who carry through on their New Year’s resolutions. In discussing the goal of destroying Medicare in the New Year, Ryan explained, “With a unified Republican government, we can actually get things done.”
These Republicans never say, straightforwardly, that their plan is the repeal and replacement of Medicare. Because of Medicare’s overwhelming popularity, Republicans hide their true intentions behind euphemisms about “saving” it. But no one should be fooled. Their idea of saving Medicare is to destroy it, just as, during the Vietnam war, a U.S. military officer explained, “It became necessary to destroy the town to save it.”
The truth is that Medicare doesn’t need saving. There is no question that, as the wealthiest nation in the world at the wealthiest moment in our history, the United States can afford not just today’s Medicare, but a greatly expanded Medicare. In 1965, when Medicare was enacted, the nation’s Gross Domestic Product was, in real terms, a quarter of what it is today ($4.1 trillion in 1965 versus $16.7 trillion today.) Moreover, Medicare covers the most expensive part of the population – seniors and people with disabilities. Covering the rest of us is easier and cheaper.
Indeed, other industrialized countries spend a small fraction of what the United States spends on health care with better outcomes, despite older populations. Japan, for example, has a much older population than we do, and theirs is aging more rapidly than ours. In 2010, seniors represented 23 percent of the Japanese population, but just 13 percent of the U.S. population. In 2050, American seniors will compose just under 21 percent of the population ― less than Japan’s percentage of seniors today! Yet, the United States today spends three times more per capita than Japan on health care. Despite the additional spending, our health outcomes are worse. Indeed, Japan’s average life expectancy is more than four years longer than that of Americans!
The Republican plan to destroy Medicare will make American costs and health outcomes worse. Despite Medicare covering the most expensive part of the population, it is much more efficient than the rest of the American health care system. Japan and other industrialized countries have what amounts to Medicare for all. No other nation has the crazy patchwork system we have, which includes employer-sponsored private insurance, means-tested insurance, and individual private insurance, in addition to government-run Medicare.
Ryan proposes to make the patchwork system even more of a hodgepodge, with less coverage and higher costs. He wants to end Medicare as we know it and, instead, simply give seniors and people with disabilities fixed cash stipends to fend for themselves, unprotected, on the private market. But before the enactment of Medicare, many seniors and people with disabilities couldn’t get health insurance at any price. And those that managed to find an insurance company willing to cover them paid much higher prices than other Americans.
So why do the Republicans want to destroy Medicare and make our health care system less efficient and more expensive, with less coverage and poorer outcomes? Ideology, pure and simple. Republicans believe that the private sector is always superior to the government. But there are some things the government does better than the private sector. And Medicare is one of them.
Insurance is most inexpensive when everyone is covered under the same plan as the result of mandatory coverage. Only the federal government has the power and the ability to cover everyone, spreading the risk and responsibility as broadly as possible. Indeed, we should be expanding Medicare, not destroying it.
But, driven by ideology, Ryan and his fellow Republicans want to end Medicare as we know it. Ryan proposes to raise the initial age of eligibility for Medicare from its current age 65 to age 67, and to simply give everyone now under the age of 55 cash to buy insurance on their own, eliminating the efficiency of a single, large risk pool.
While those now on Medicare may think that they will be spared, they are wrong. Republicans always say, about their efforts to end Social Security and Medicare, that those aged 55 and over will not be affected, because those politicians recognize that seniors are most concerned about the programs and they vote. This assurance, of course, is insulting, because it assumes seniors are only concerned about themselves and not their children and grandchildren.
Moreover, the blatant assurance is not even true. Many Republican Social Security proposals cut current beneficiaries’ cost of living proposals. And, in the case of Medicare, the impact on current beneficiaries is likely to be even more substantial. If Ryan and his fellow Republicans have their way, Medicare will become increasingly expensive per enrollee, covering an aging and shrinking group, with high medical costs. As the group shrinks, they will have less and less political clout. Everyone not on traditional Medicare, will, by that time, be forced to fend for themselves with private insurance companies. It is extremely foreseeable that at some point, someone will propose treating this very old, small, and expensive population like everyone else. And then their Medicare will be gone, as well.
If we want a health care system in this country that provides everyone with access to the best medical care possible at the lowest possible cost, the way to achieve that is not to end Medicare, but to expand it. That, indeed, was the idea of the program’s founders. They saw Medicare as simply a first step, to be followed soon after by expanding it to include all children, and then more and more of the population, until the United States had Medicare for All.
We should follow that wise plan. As a next step, we should lower the initial age of Medicare eligibility, when people can first claim Social Security retirement benefits, from age 65 to 62. We certainly should not raise the age to 67 and then end the program as we know it, as the Republicans resolve to do. Unfortunately, they are now in control of all branches of government, and so have the political power to do what they want.
To stop them, I urge everyone who is old or hopes to be old someday to make your own Medicare resolution for 2017. Tell your elected leaders: Hands off Medicare except to expand it. And ask your friends to join you. Mobilize and make your voices heard. Then, as a resolution for 2018, we can all resolve to elect leaders who listen to us and have the good sense to expand, not destroy, Medicare.
Nancy Altman is founding co-director of Social Security Works.
By Deirdre Fulton
Common Dreams, Dec. 29, 2016
Medicaid, the nation’s healthcare program for the poor and disabled, is on the chopping block under President-elect Donald Trump and a Republican-controlled Congress—and it will take “intense focus by progressives” to ensure it doesn’t meet a dire fate.
In fact, former National Economic Council director Gene B. Sperling wrote Sunday in a New York Times op-ed, “if Democrats focus too much of their attention on Medicare, they may inadvertently assist the quieter war on Medicaid—one that could deny health benefits to millions of children, seniors, working families, and people with disabilities.”
As Democrats prepare for battles over the two programs, “the Republican effort to dismantle Medicaid is more certain,” Sperling warned—a prediction echoed this week by multiple news outlets.
“Neither Mr. Trump nor Senate Republicans may have the stomach to fully own the political risks of Medicare privatization,” he continued. “But not only have Speaker Paul D. Ryan and Tom Price, Mr. Trump’s choice for secretary of health and human services, made proposals to deeply cut Medicaid through arbitrary block grants or ‘per capita caps,’ during the campaign, Mr. Trump has also proposed block grants.”
Just this month, Vice President-elect Mike Pence told ABC: “With regard to Medicaid…there’s a real opportunity, there’s a real opportunity as we repeal and replace Obamacare to do exactly what the president-elect also said on the campaign, and that is block granting Medicaid back to the states.”
Block-granting can mean funding cuts, The Hill explained:
Block grants would mean limiting federal Medicaid funds to a set amount given to the states, rather than the current federal commitment, which is more open-ended.
Indeed, Sperling pointed to 2012 study (pdf) from the Kaiser Family Foundation, which found that a Medicaid block-grant proposal from Speaker Ryan “would lead to 14 million to 21 million Americans losing their Medicaid coverage by the 10th year, and that is on top of the 13 million who would lose Medicaid or children’s insurance program coverage under an [Affordable Care Act, or Obamacare] repeal.”
A separate Center for Rural Affairs report (pdf), also from 2012, found that “changes in Medicaid are likely to have a disproportionate effect on rural areas.”
Pence’s tenure as governor of Indiana could provide more clues about where the critical safety net program is headed. As governor, Pence implemented a policy requiring poor Medicaid recipients to make monthly payments for their insurance, or else lose benefits.
“That idea could soon be going national,” The Hill wrote, noting that “Trump’s nominee to run the Centers for Medicare and Medicaid Services, Seema Verma, helped Pence develop the changes to Medicaid in Indiana.”
While negotiating this arrangement, one federal official told NPR this week, Verma was “very committed to a particular ideology. That ideology is very much focused on personal responsibility.”
In a statement following Verma’s nomination, Physicians for a National Health Program president Robert Zarr said Verma’s “actions in Indiana signal that she will inflict cruel and unusual punishment on America’s most vulnerable citizens.”
As Common Dreams reported, leading Democrats are planning nationwide rallies for January 15 to gird against this gutting of the U.S. healthcare system.
Deidre Fulton is a staff writer at Common Dreams.
This work is licensed under a Creative Commons Attribution-Share Alike 3.0 License
http://www.commondreams.org…
Dear Quote of the Day list members,
Your email inboxes are no doubt inundated with end-of-year requests for donations “to keep this publication going” or whatever.
This is not a request to donate to Quote of the Day, but it is something much more important.
Regarding the Quote of the Day, I self-fund my activities and am able to do so quite comfortably. I do not receive funds from PNHP, so no dues are diverted to the qotd messages. In my role as senior health policy fellow of PNHP I serve as a volunteer, receiving no pay nor benefits. In fact, I am a monthly contributor to PNHP instead.
So what am I asking that is so important?
At this time when threats to our already inadequate health care system are intensifying we need an increase in people power to help carry to the nation the message of health care justice for all through a single payer national health program – an improved Medicare for all.
A great vehicle that supports the movement is membership in Physicians for a National Health Program. We need to achieve a critical mass of activists and supporters. Although membership is predominantly composed of physicians, medical students and other health care professionals, we also include activists and others who are dedicated to health care justice through single payer reform.
* If you are not a member, please consider joining (click here to join).
* If you are a member but have not recently renewed your membership, please consider doing so now (click here to renew).
* If you are a medical or other health professional student, membership is free (click here to join).
* Considering our national presence, PNHP operates on a remarkably spartan budget funded by dues and individual contributions, thus donations by those who can afford them are greatly appreciated and are put to good use (Contributions to PNHP are tax deductible under section 501(c)(3) of the IRS code – click here to donate).
This is not a message from PNHP but it is simply a personal request, from me to each of you, to join or renew your support for a cause to which I have devoted the remaining productive years of my life.
Peace, love and good health for all,
Don
***
Don McCanne, MD
Senior Health Policy Fellow
Physicians for a National Health Program
www.pnhp.org
don@mccanne.org
By Michael Huntington, M.D.
Corvallis (Ore.) Gazette-Times, Letters, Dec. 29, 2016
My friend, a business owner in Corvallis in his early 50s, tells me the following.
There are now only two health care “insurers” available to him in Benton County. His premium for a single person in 2017 would be about $9,500 per year for a “Gold” plan or about $6,500 for a “Bronze” plan. If he has a heart attack, he would pay an additional $5,000 for a total of about $14,500 (under Gold) or well over $7,000 for a total of well over $13,500 (under Bronze) before reaching his out-of-pocket cap.
One of the insurers, Providence, has no contract with, and will not pay, the emergency room doctors’ fees in this county — so add considerably more for that. Add thousands more dollars after scanning pages of fine print for each policy (or learning by sticker-shock experience) which specialists, services, and medications are not covered.
Premiums for individual policies are rising at a rate of 18 percent to 40 percent per year. My friend can barely afford to pay for his own insurance this year and regrets that he cannot afford coverage for his staff and their families. He feels he shouldn’t have to pay a fifth of his adjusted gross income or half his staff’s wages on health insurance, especially “insurance” that seems intent on preventing his access to health care.
This businessman feels we should have a single payer system as most other developed countries have. It would be good for business owners and everyone else.
Dr. Mike Huntington lives in Corvallis.
http://www.gazettetimes.com…
