PNHP

Drs. Susan Rogers and Paul Song on KABC

Drs. Susan Rogers and Paul Song on KABC

PNHP President Dr. Susan Rogers and PNHP-CA President Dr. Paul Song appeared on KABC News (Los Angeles) on January 17, 2022. They discussed the legacy of Dr. Martin Luther King, Jr. and the ongoing fight for racial justice across U.S. society, including in health care.

“Dr. King’s words have always resonated with me,” said Dr. Song. “I think he really goes back to the book of Matthew about caring for the least among us. That we’re not defined by how many billionaires we create in society, but really about how we care for the most marginalized, our poor brothers and sisters. Really, those that don’t have a voice in our society.”

Reform cures burnout

By Johnathon Ross, M.D., M.P.H.
The (Toledo, Ohio) Blade, January 17, 2022

We keep seeing and hearing the term “caregiver burnout” used in the news. The term burnout implies a lack of resilience that puts the blame on the victim of the stress that they are undergoing. So much of the stress we face these days is aggravated by our broken sickness care nonsystem on top of the coronavirus pandemic. Our inability to give the care to all who need it because of the financing complexity, narrow networks, drug formularies, and underinsurance is at odds with our moral duty as doctors and nurses to care for everyone the best we can.

Some are starting to realize that burnout is Post Traumatic Stress Syndrome of sorts and realizing “caregiver burnout” is a moral injury, and that caregivers are suffering substantially related to the immorality of our health-care system.

For me, the cure for caregiver moral injury has been advocating for system change to allow caregivers to treat all patients equitably without being controlled or second-guessed by those who profit from our broken system (commercial insurers, PHARMA, for-profit hospitals, for-profit dialysis, long-term care facilities, and the corporate profiteers who are buying physician practices).

The best hope for caregivers and patients is reform based on an improved, expanded Medicare for all. It would do more to improve caregiver morale than counseling and Prozac. Improved, expanded Medicare for all would save money, save lives, and is the moral thing to do. Nothing will change unless caregivers and patients demand it. We will all be patients some day.

Dr. Johnathon Ross is past president of Physicians for a National Health Program.

https://www.toledoblade.com…

Be wary of Medicare Advantage and Direct Contracting Entities

By H. Dixon Turner, M.D.
Portsmouth (N.H.) Herald, January 17, 2022

To the Editor:

Until recently I did not understand the reason for the explosion of ads for Medicare Advantage plans on television. My understanding changed after I received communication from the Physicians for a National Health Plan organization.

Medicare Advantage plans function like HMO’s: they receive a set payment from Medicare for each enrollee and then manage how those funds are used to pay for the enrollee’s health care. The patient’s health care options are often restricted or limited to a selected panel of providers. The plans often encourage over coding which increases the cost of the Medicare Advantage plans compared to traditional Medicare.

Late during the Trump administration an even more insidious effort was made to privatize Medicare. That program established Direct Contracting Entities (DCE), which like Medicare Advantage plans, receive direct monthly payments from the Medicare fund for each enrollee. With DCE plans, seniors can even be automatically enrolled into a DCE without their full knowledge or consent. These DCE plans can spend as little as 60% of the funds that they receive from Medicare for health care services and then keep up to 40% of those revenues as profit! Studies have also shown the DCE’s and Medicare Advantage plans encourage over-coding and the use of medically questionable studies or intervention to further maximize their profits.

As of April 2021 there were 53 DCE’s operating in 43 states and DC. Twenty eight of these plans are investor owned and six more are managed by insurers. Traditional Medicare spends ~98% of its budget on direct patient care while, as mentioned above, DCE’s can retain up to 40% of their revenues as profit. This arrangement provides an incentive for these DCE’s to restrict patient care. In 2019 Medicare spending was $330 billion but by 2025 it is projected that Medicare DCE’s could potentially collect $660 billion from the Medicare Trust Fund.

I would urge seniors to be very wary of signing up for Medicare Advantage Plans since like DCE’s, those plans are designed to improve financial outcomes, not clinical outcomes. Also I would urge everyone to call their Senators and Representative to encourage them to stop the dangerous DCE program. One could also contact Xavier Becerra—the Secretary of Health & Human Services.

https://www.seacoastonline.com…

Investor Profit is Not the Solution for Primary Care

Summary: In the U.S. health care system, primary care is often overlooked by companies and investors in search of profit from more remunerative specialty care. As a result, it can be challenging for Americans to access primary care. With more for-profit companies entering the primary care market, there are a number of worrisome short and long term implications for cost and access to care.

Can New Players Revive U.S. Primary Care?, Harvard Business Review, Jan. 7, 2022, by David Blumenthal

CVS-Aetna, Walgreens, Walmart, Amazon, Optum-United Health Group — they’re all buying primary care practices or hiring primary care practitioners (PCPs) directly. Never before have the titans of capitalism shown such interest in the humble family physician. And therein lies a story with huge but uncertain implications for American health care. This new trend could greatly bolster, or dangerously distort, U.S. primary care, a critical component of a healthy health care system.

Underlying this trend is the fact that primary care in the United States is failing and has been for decades. Millions of Americans have trouble finding or getting access to primary care in a timely and convenient way. Primary care providers are increasingly scarce, even in medical meccas such as Boston, New York, Chicago, and San Francisco. In rural America, they are downright rare. Among high income countries, Americans are least likely to have a regular doctor or a long-standing relationship with a PCP. …

No modern health care system can function without the equivalent of what the family doctor provides. The United States has failed to offer it. Perhaps corporate America can come to the rescue, make a profit, maintain quality, and sustain a vital national service. Whether they succeed could make a huge difference for the future of the U.S. health care system.

Comment:

By Eagan Kemp

I am including that last paragraph to highlight just how absurd the popular discussion is around health care in this country. To pretend that we are going to fix the problem of access to primary care by allowing a number of companies to try to come in and profit from it is just absurd. The many and massive failures of our health care system were already evident before the COVID-19 crises and the crisis has underscored that we can’t continue with such a broken system.

No country has built a successful health care system on the foundation of generating profit and revenue for the wealthy and massive corporations. It is anathema to delivering equitable high-quality health care. With decades of experience failing to do so, America remains the cautionary tale that scares other countries from following our failed experiment of putting profit above patients.

If we want to get serious about ensuring everyone in the U.S. can access the primary (and other) care they need, when they need it, we need Medicare for All. By removing the barriers to care, like out-of-pocket costs, and ensuring sufficient funding for primary care providers to serve the needs of their communities, Medicare for All would finally guarantee health care as right. It is time to take profit out of the system and focus on creating a system that costs less while delivering access, quality, and improved health.

http://healthjusticemonitor.org…

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Medicare for all would cut costs, expand access to care

By Norma Morrison, Ed.D.
Bristol (Va.) Herald Courier, January 16, 2022

Many of us in Northeast Tennessee realize that the health care system in our country is broken.

We also agree with the editorial from the Tampa Bay Times on Jan. 4 that emphasized the inequities in our country that are only getting worse.

Additionally, according to the Associated Press in Dec. 1, 2021, the Tennessee Medicaid Program or Tenncare continues to underpay some hospitals that treat the neediest patients, while disregarding a state law regarding how hospitals are paid. However, there are solutions.

Some solutions are in place such as more people signing up for health coverage on the Affordable Care Act marketplaces due to increased government subsidies which made the premiums more affordable and enhanced outreach efforts which connected more people to insurance options. Our patriotic goal should be to have the best health care in the world. Our loved ones should not die younger than they have to.

Physicians for a National Health Program support universal coverage, equitable funding for hospitals and a strong public health infrastructure through Medicare for All. You and I could visit the doctor or hospital of our choice, without co-pays or deductibles.

By eliminating the profits, wastes and denials of commercial insurance, Medicare for All would save approximately $600 billion per year while expanding coverage for all of us.

The most recent legislation, H.R. 1976 was introduced March of 2021. You can read it at https://www.congress.gov/bill/117th-congress/house-bill/1976.

If you agree with this bill, contact your representatives in Congress and ask them to support this effort to improve our health care in our great country.

When my husband’s mother was hospitalized for breast cancer treatment, his father incurred a medical debt that took 25 years to pay off. We need to eliminate horror stories like his for the good of all.

https://heraldcourier.com…

The Corporate Assault on Medicare

Interview with Kip Sullivan

Ralph Nader Radio Hour, January 15, 2022

Health Care for All Minnesota advisor and longtime PNHP member Kip Sullivan spoke with the Ralph Nader Radio Hour about the decades-long corporate takeover of Medicare, including its latest incarnation: Direct Contracting.

If this Trump-era pilot pilot program goes through, “beneficiaries in the Traditional Medicare program, who deliberately decided not to enroll with an insurance company will now be, without their knowledge and possibly against their will, assigned to a Direct Contracting Entity, which is going to operate very much like an HMO.”

For more information on Medicare Direct Contracting, visit https://pnhp.org/StopDCEs.

To access a complete transcript of Kip Sullivan’s interview, visit https://secureservercdn.net.

https://www.ralphnaderradiohour.com…

Medicare for All Explained Podcast: Episode 69

Highlights, Vol. 3

January 15, 2022

Podcast host Joe Sparks returns with additional highlights from Medicare for All Explained, in honor of Dr. Martin Luther King, Jr. He features clips showing how a single-payer system could reduce the racism that exists in U.S. health care, including:

  • Racial inequities in U.S. health care, featuring Dr. Susan Rogers;
  • COVID-19 and racial inequities, featuring Dr. Susan Rogers; and
  • Sociopolitical determinants of health, and lack of health coverage as a racial justice issue, featuring Dr. Sanjeev Sriram.

“Highlights, Vol. 1” and “Highlights, Vol. 2” can be found HERE and HERE. Additional episodes will be uploaded twice monthly. Subscribe in iTunes, or access a complete archive of the podcast, below.

https://medicareforallexplained.podbean.com

Voting Rights and Single Payer – Strikingly Similar

Summary: The Freedom to Vote Act now facing a filibuster defeat in the US Senate specifies rules to implement fair elections. It is a desperately needed cure for systematic efforts to subvert the principle of one-person-one-vote in order to profit the GOP. Similarly, single payer specifies a set of rules to implement fair (and efficient) health care, a desperately needed cure for our system’s subversion of the right to health care in order to profit the rich. Both reforms enjoy majority support; can they prevail?

Letters from an American, January 12, 2022, by Heather Cox Richardson

The Freedom to Vote Act provisions [our summary from narrative]:

Voting Process: Two weeks of early voting, including nights and weekends, minimum 10 hours a day. Voting by mail and drop box. Election Day a holiday. Uniform standards for voter IDs. Waiting time max 30 minutes. Federal crime to lie to voters to deter voting. Increased penalties for voter intimidation.

Voting Eligibility: Voter registration – uniform rules; automatic at DMV; same-day & online; protection from voter list purges. Federal voting rights for people who have been incarcerated.

Equal Representation: No partisan gerrymandering.

Election Funding: Disclosure of major donors and advertising funders. Harder for PACs to coordinate with candidates. Stronger Federal Election Commission oversight.

Vote Count: Protects local election officers from intimidation and firing for partisan purposes. Expands penalties for tampering with ballots. Regulates election audits. Voting machines must leave a paper record.

Sinema Rejects Changing Filibuster, Dealing Biden a Setback, New York Times, January 14, 2022, by Carl Hulse

President Biden’s campaign to push new voting rights protections through Congress appeared all but dead on Thursday, after it became clear that he had failed to unite his own party behind his drive to overhaul Senate rules to enact the legislation over Republican opposition.

In an embarrassing setback for Mr. Biden, Senator Kyrsten Sinema, Democrat of Arizona, stunned her colleagues just hours before the president was slated to make his case to them in person at the Capitol by taking the Senate floor to declare that she would not support undermining the filibuster to pass legislation under any circumstances.

Comment:

By Jim Kahn, M.D., M.P.H.

Our democracy stands at a crossroads. The GOP is altering state voting laws to make it harder for Democrats to vote, to assure GOP legislator majorities much higher than vote majorities (via gerrymandering), and to install partisan election officials who can declare victory even if the GOP loses. This week, President Biden delivered a long-overdue, impassioned defense of democracy. He is urging Senate passage of The Freedom to Vote Act, already through the House of Representatives. It can win in the Senate only if all 50 Democrats agree to carve out an exception to the filibuster rule that permits 41 Senators to stall legislation. At the moment, prospects are slim, due to opposition by Kyrsten Sinema (AZ) and likely Joe Manchin (WV). Their arguments that protecting the filibuster will restore bipartisanship are not credible.

As I took in Prof. Richardson’s summary of The Freedom to Vote Act, it was obvious how similar this bill is to single payer.

Both are based on laudable goals rooted in fundamental values, using simple, efficient, and equitable means.

The Freedom to Vote Act aims to make voting fair, using procedures to realize the fundamental democratic value of one-person-one-vote. The rules proposed are simple (clear and unconvoluted), efficient (through standardization), and equitable (similarly treating all voters in all states).

Single payer aims to make health care universal, using procedures to realize the fundamental human right to health care. The mechanisms are simple (one payer, standard benefits, uniform payments), efficient (slash administrative burden and profits), and equitable (everyone is similarly covered).

Both end exploitation of systems (voting and health care) for personal and group gain – especially by the rich and powerful.

Both enjoy majority popular support. Democrats in the Senate represent 50-56% of US voters, depending how to count, to the GOP’s 43%. And 70% of voters support the Freedom to Vote Act. National single payer support is 50-60% with neutral phrasing.

I’m not cheered by today’s news about Sen. Sinema’s obstruction. I’m still hoping desperately that she, Sen. Manchin, and all Senate Democrats take the actions so obviously necessary to preserve voting rights and democracy.

Regardless, the linked fights for democracy and for single payer continue.

http://healthjusticemonitor.org…

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Can’t we try harder to find common ground?

Dana Harbor, California, Jan. 11, 2022

By Don McCanne, M.D.

Sandy and I went down to Dana Harbor late this afternoon for our daily walk, my preferred form of rehabilitation since my recent neurological events. As Sandy and I were getting out of our car a very nice gentleman next to us was loading his dog into his SUV as we exchanged the usual pleasantries.

He happened to look down at his cell phone and expressed exasperation at the message that Gov. Newsom wanted to extend health care to all undocumented Californians. Recognizing that we likely had political differences, in a non-challenging tone of voice I said, “You’d better be careful since I’m a supporter of health care reform.”

He said, “Oh, I am too. We definitely need to finance their health care. It’s just that the governor should not allow such loose borders. I’m a supporter of health care for everyone. Have you seen the homeless on the streets of Los Angeles? We need to be taking care of them.”

As he left, with a smile on his face, he said, “I might be for Trump, but I’m not crazy.”

As Sandy and I walked along Dana Point Harbor Island, I thought, there must be much more common ground here.

http://healthjusticemonitor.org…

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Drs. Claire Cohen and Marilyn Vaché on “Thinking Green”

Longtime PNHP members Drs. Claire Cohen and Marilyn Vaché appeared on “Thinking Green,” a program of the New London Green Party on Connecticut Public Access Television, on January 11, 2022. They discussed the threat of for-profit entities in U.S. health care, from Medicare Advantage to the latest scam, Medicare Direct Contracting.

Dr. Cohen reminded us that commercial insurance companies “have their hand in the cookie jar and they’re leeching off the public’s money to make profit.”

For more information on Direct Contracting Entities, visit pnhp.org/StopDCEs.

California Single Payer: Lower Net Cost to Families

Summary: Last week saw the release of a tax plan to finance California’s single payer legislation, AB 1400. It was immediately attacked as a tax increase of $12,250 per family. Hey, wait, don’t premiums and cost-sharing disappear under single payer? Yes indeed! The typical family saves money. Health insurance guaranteed, with savings. And no more medical debt or bankruptcy.

ACA-11 Taxes to fund health care coverage and cost control, California Legislative Information, Jan. 5, 2022

This measure would impose … taxes at specified rates to fund comprehensive universal single-payer health care coverage … [under AB 1400]

(1) An annual excise tax … upon a qualified business … at a rate of 2.3 percent of the gross receipts … minus the first $2,000,000 in annual gross receipts.

(2) (A) A payroll tax … on every employer who pays … 50 or more resident employees … at a rate of 1.25 percent of wages or other compensation … [plus] 1 percent of wages or other compensation in excess of $49,900 per employee.

(3) (A) … a State Personal Income CalCare Tax:

  • $149,509 but not over $299,508 — 0.5% of the taxable income
  • $299,509 but not over $599,012 — 1% of the taxable income
  • $599,013 but not over $1,299,499 — 1.5% of the taxable income
  • $1,299,500 but not over $2,484,120 — 1.75% of the taxable income
  • $2,484,121 and above — 2.5% of the taxable income

California Considers Doubling its Taxes, Tax Foundation, Jan. 6, 2022, by Jared Walczak

A proposed constitutional amendment (ACA 11) in California would increase taxes by $12,250 per household …

Comment:

By Jim Kahn, M.D., M.P.H. and Don McCanne, M.D.

$12,250 per household in new taxes sounds like a lot. This plan includes a 2% payroll tax, a highly progressive income tax (starting at 0.5% at $150,000), and a business excise tax.

However — bottom line — the net savings for a typical middle-class family are highly attractive.

Currently, working families pay a lot for health care:

That’s $10,000, which under single payer disappears. Huge savings.

Plus, employers contribute $16,253 for premiums for family coverage. That high cost keeps wages low, so if it went away (the proposed payroll tax is about 90% lower), annual wages would rise by $10,000 or more.

Thus, for a working family, we’re into net financial gain territory.

And … the actual tax increase for a middle-class family would be way less than the $12,250 average. That’s because the tax plan relies on a very progressive income tax, $750 at $150,000 and really kicking in above $1 million in annual income.

Overall, single payer reduces costs for the vast majority of families, while providing guaranteed health care.

And: no more medical debts or bankruptcy. That’s a huge boost to financial security.

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.