By Don McCanne, M.D.
Quote of the Day will take a brief interlude. We are refining our approach to communicating information to educate and advocate for single payer and health care justice for all.
See you soon.
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By Robin Feldman
The Washington Post, April 6, 2021
In the past few decades, three waves of mergers have substantially increased concentration in the pharmaceutical industry.
All told, between 1995 and 2015, the 60 leading pharmaceutical companies merged to only 10.
As a result, now only a handful of manufacturers are responsible for sourcing the vast majority of prescription drugs: Just four companies, for example, produced more than 50 percent of all generic drugs in 2017.
Drug companies were drawn to merging because of the lure of increased market power, improved synergies, larger economies of scale and more diverse product portfolios.
In the period following merger waves one and two, the industry generated fewer new molecular entities each year compared to pre-merger levels. Merged drug companies also spent proportionally less on research than their non-merged competitors.
Consolidation also enabled drugmakers to directly quell competition through what were known as “killer acquisitions,” in which they acquired innovative peers solely to stop potential competition.
In short, consumers were the losers from the two waves of drug company mergers. They confronted higher prices and fewer choices — and saw companies exploring fewer paths that might produce breakthroughs. To make matters worse, around 2010, another wave of mergers began.
As with the earlier waves, giant drug companies have merged. But in a new twist, in recent years, most consolidation has featured bigger players acquiring smaller start-ups. The difference reflects a dramatic shift in the structure of the pharmaceutical industry. Faced with stagnating research productivity, large drugmakers now rely on outsourcing their new drug research to start-ups and other small pharmaceutical firms.
Increasingly, these smaller players specialize in high-risk research and early drug development, with larger firms then gobbling them up and navigating the FDA’s regulatory process. For example, 63 percent of all new molecular entities in 2018 came from smaller biopharma firms, compared with just 31 percent in 2009.
The end result of now three waves of pharmaceutical consolidation is decreased or diverted new drug innovation, fewer treatment options and higher prices. Consumers have lost as firms fuse together to bolster the bottom line.
Robin Feldman is director of the UC Hastings Center for Innovation.
https://www.washingtonpost.com…
By Don McCanne, M.D.
Yesterday we discussed consolidation of UnitedHealth/Optum and how it has become a mega-corporation of the medical-industrial complex. Today’s selection discusses consolidation within the pharmaceutical industry. The article describes how we can expect decreased or diverted drug innovation, fewer treatment options, and above all, higher prices. Works for the industry, but not so well for the people.
We’re just trying to introduce single payer Medicare for All. How much impact can that have on these mega-corporations? Where is our government in all of this? Aren’t they supposed to protect us? Maybe we’re aiming too low by advocating for a social insurance program. Maybe we should be taking over the industry so that we can gear it up to better serve us, the people. International comparisons do rate national health services very high in performance. Maybe if we talk about it a little more we can convince them that Medicare for All is a compromise that they can live with. We think we can too.
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By Krista Brown, Olivia Webb
The American Prospect, April 5, 2021
It’s not often that the American Hospital Association — known for fun lobbying tricks like hiring consultants to create studies showing the benefits of hospital mergers — directly goes after another consolidation in the industry.
But when the AHA caught wind of UnitedHealth Group subsidiary Optum’s plans, announced in January 2021, to acquire data analytics firm Change Healthcare, they offered up some fiery language in a letter to the Justice Department. “The acquisition… will concentrate an immense volume of competitively sensitive data in the hands of the most powerful health insurance company in the United States, with substantial clinical provider and health insurance assets, and ultimately removes a neutral intermediary.”
If permitted to go through, Optum’s acquisition of Change would fundamentally alter both the health data landscape and the balance of power in American health care. UnitedHealth, the largest health care corporation in the U.S., would have access to all of its competitors’ business secrets. It would be able to self-preference its own doctors. It would be able to discriminate, racially and geographically, against different groups seeking insurance. None of this will improve public health; all of it will improve the profits of Optum and its corporate parent.
UnitedHealth is the largest health care entity in the U.S., using several metrics. United Healthcare (the insurance arm) is the largest health insurer in the United States, with over 70 million members, 6,500 hospitals, and 1.4 million physicians and other providers. Optum, a separate subsidiary, provides data analytics and infrastructure, a pharmacy benefit manager called OptumRx, a bank providing patient loans called Optum Bank, and more. Through Optum, UnitedHealth also controls more than 50,000 affiliated physicians, the largest collection of physicians in the country.
Acquisitions of entities as varied as DaVita’s dialysis physicians, MedExpress urgent care, and Advisory Board Company’s consultants have already changed the health care landscape. As Optum gobbles up competitors, customers, and suppliers, it has turned into UnitedHealth’s cash cow, bringing in more than 50 percent of the entity’s annual revenue.
On a recent podcast, Chas Roades and Dr. Lisa Bielamowicz of Gist Healthcare described Optum in a way that sounds eerily similar to a single-payer health care system. “If you think about what Optum is assembling, they are pulling together now the nation’s largest employers of docs, owners of one of the country’s largest ambulatory surgery center chains, the nation’s largest operator of urgent care clinics,” said Bielamowicz. With 98 million customers in 2020, OptumHealth, just one branch of Optum’s services, had eyes on roughly 30 percent of the U.S. population.
Change Healthcare has access to all of the data that flows between physicians and insurers and between pharmacies and insurers—both of which give insurers leverage when negotiating contracts. Insurers often send additional suggestions to Change as well; essentially their commercial secrets on how the insurer is uniquely saving money. Acquiring Change could allow Optum to see all of this.
If the acquisition proceeds and Change is owned by UnitedHealth, the largest health care corporation in the U.S. will own the ability to peek into the book of business for every insurer in the country.
The most obvious potential outcome of the merger is that the flow of data will allow Optum/UnitedHealth to preference their own entities and physicians above others. This means that doctors (and someday, perhaps, hospitals) owned by the corporation will get better rates, funded by increased premiums on patients. Optum drugs might seem cheaper, Optum care better covered. Meanwhile, health care costs will continue to rise as UnitedHealth fuels executive salaries and stock buybacks.
Optum’s acquisition of Change heralds the end of that status quo and the emergence of a new “Big Tech” of health care. With the Change data, Optum/UnitedHealth will own the data, providers, and the network through which people receive care.
There are signs that the DOJ knows that to approve this acquisition is to approve a new era of vertical integration. In a document filed on March 24, Change informed the SEC that the DOJ had requested more information and extended its initial 30-day review period. But the stakes are high. If the acquisition is approved, we face a future in which UnitedHealth/Optum is undoubtedly “the thing that ate American health care.”
By Don McCanne, M.D.
UnitedHealth/Optum is BIG – the largest health care entity in the U.S. – representing that medical-industrial complex that Arnold Relman warned us about so many years ago. Well, it’s here. And it is structured to make money – a lot of it – and patients just happen to be an essential element in their equation, but patient care is an expense. So much of what they do is to create administrative functions that are designed to reduce spending on patients, and, further, to increase revenues by selling those administrative services. By gaining control of much of the industry – hospitals, doctors, pharmacies, insurance functions – they are in a position to dictate the business terms for health care.
So what will happen should we ever be able to enact and implement a single payer Medicare for All program? The model calls for negotiating rates with physicians, global budgets for hospitals and bulk purchasing of pharmaceuticals. How do you do that with a mega-corporation like UnitedHealth/Optum? Do you really think that they will accept government negotiations for payment rates for health care entities such as doctors, hospitals and pharmacies while not being paid for their large infrastructure that has been designed to increase revenues? Change Healthcare is a data analytics firm that is used to leverage higher revenues (profits, executive salaries, stock dividends and buybacks); it is not for the purpose of providing quality and value in patient care. Again, the entire corporation is structured to make money with patient services being a necessary expense that is to be minimized as much as possible.
Will Medicare for All legislation be written in a way that we can remove passive corporate investors and excess executive salaries from the equation, thus essentially destroying the for-profit corporate structure? Would our conservative courts even uphold such limitations?
Health care should be guided by a patient service ethic rather than a business ethic. Can we rein in the medical-industrial complex, or is it too late? The transition to Medicare for all will certainly cross paths with this corporate monster, and something will have to give.
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PNHP immediate past president Dr. Adam Gaffney appeared on “The Choice” on March 24, 2021. He was joined by Christine Eibner, senior economist at the RAND Corporation, to discuss the merits of a public option compared to single-payer Medicare for All.
Dr. Gaffney argued that, while a public option might help some people, “it would leave the core dysfunctions and injustices of the U.S. health care system intact.”
By Ge Bai, Hossein Zare, Matthew D. Eisenberg, Daniel Polsky, and Gerard F. Anderson
Health Affairs, April 2021
Abstract
The different tax treatment of government, nonprofit, and for-profit hospitals implies different charity care obligations, with the greatest obligation for government hospitals and the least for for-profit hospitals. Prior research has not examined charity care provision among all three ownership types at the national level. Using 2018 Medicare Hospital Cost Reports, we compared charity care provision across 1,024 government, 2,709 nonprofit, and 930 for-profit hospitals. In aggregate, nonprofit hospitals spent $2.3 of every $100 in total expenses incurred on charity care, which was less than government ($4.1) or for-profit ($3.8) hospitals. No hospital ownership type outperformed the other two types with respect to charity care provision in a majority of hospital service areas containing all three types. Using different kinds of analyses, we also found wide variation in charity care provision within ownership types and a lack of a consistent pattern across ownership types. These results suggest that many government and nonprofit hospitals’ charity care provision was not aligned with their charity care obligations arising from their favorable tax treatment. Policy makers may consider initiatives to enhance hospitals’ charity care provision, particularly hospitals with government and nonprofit ownership.
https://www.healthaffairs.org…
By Don McCanne, M.D.
There has long been a concern that nonprofit hospitals fail to provide charity care commensurate with the tax advantages afforded by the government. This study indicates that nonprofit hospitals provide even less charity care than for-profit hospitals (although others have questioned whether for-profit hospitals take liberties in adjusting off bad debt or contractual reductions in charges labeled as charity care).
Although under a single payer Medicare for All system issues would remain regarding the relative status of government, nonprofit, and for-profit hospitals, nevertheless a well designed single payer system should obviate the need for charity care since the system should be truly universal, comprehensive, and equitable.
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NORC at the University of Chicago, April 1, 2021
Eighteen percent of adults in America report having donated to a crowdfunding campaign to pay for medical bills or treatment at some point over the last year. This figure has held steady from surveys over the past year despite the increase in financial hardship, including record levels of unemployment due to the ongoing pandemic. The data come from the latest NORC Spotlight on Health survey powered by AmeriSpeak®.
Nearly 40 percent of Americans who donated to crowdfunding campaigns were from households with incomes of less than $60,000 per year. In 2019, the median household income in the United States was $68,703. Of the Americans who made a donation to a campaign, 36 percent were not working (unemployed or retired) and 6 percent did not have health insurance themselves at the time of the survey.
Crowdfunding is the process by which individuals raise funds from a large number of people through websites such as GoFundMe. The new survey found the numbers of Americans starting such campaigns holding steady relative to 2020. An estimated 6 million Americans started a campaign for themselves or someone in their household, and nearly 9 million Americans started a campaign for someone else. In addition, approximately 16 million Americans made donations to help strangers, a similar number to previous surveys.
Forty-five million Americans reported an estimated 61 million individual donations to campaigns for different diseases and conditions. Twenty-eight percent of Americans who made contributions to crowdfunding campaigns reported having donated to more than one campaign for different diseases or conditions. These new data indicate that, of the 61 million donations to medical campaigns, over half were related either to campaigns for cancer (17 million) or campaigns for accidental injuries (16 million). Other popular donation categories included heart disease (9 million) and mental illness (5 million). There were also an estimated 2 million donations specifically for COVID-19.
“Even as many Americans have struggled over the past year with unemployment and a lack of affordable health insurance, individuals are still donating to crowdfunding sites to help others pay for their medical bills and treatments,” said Mollie Hertel, AM, MPP, senior research scientist at NORC.
“People reported that the vast majority of donations were going to campaigns raising money for cancer treatments and accidental injuries. This information highlights again where gaps in insurance coverage—such as high out-of-pocket costs—may exist and the challenges that Americans with serious illnesses continue to face,” added Susan Cahn, DrPH, also a senior research scientist at NORC and co-author of the study.
Nearly 60 percent of adults in America believe that the government should bear a great deal or a lot of responsibility for providing health care to people who need free or lower-cost medical care. Forty-four percent of Americans think hospitals and clinics bear a great deal or a lot of responsibility when care is unaffordable and 35 percent believe doctors should bear this level of responsibility.
NORC AmeriSpeak Omnibus Survey:
https://www.norc.org…
By Don McCanne, M.D.
Imagine. Forty-five million Americans felt compelled to make charitable cash donations to individuals with ongoing medical needs. What does that say about our health care financing system in America? Well, there are a few important conclusions we can draw from this survey.
The perception of excess medical debt has become quite prevalent, yet as a source of financing health care, crowdfunding hardly makes a dent in our national health expenditures. How can we delay any further the enactment and implementation of single payer improved Medicare for All? President Biden, this question is especially directed at you. Your temporary program to donate our tax funds to private insurance companies to cover high deductibles and other cost sharing takes care of the private insurers and their investors but leaves us taxpayers footing the bill.
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By Ronald Wyatt, M.D., M.H.A.
The Washington Post, April 5, 2021
When I write about health policy or speak with medical colleagues about barriers to care, there is one word — and one word only — that evokes a wide range of responses. Some respond with silence; others with avoidance. Some respond with anger and defensiveness.
The word appeared at the top of a paper I submitted to the Journal of the American Medical Association in 2015 with David R. Williams, a professor of public health and African American studies at Harvard University. The title: “Racism in Health and Healthcare: Challenges and Opportunities.”
The editor of the journal at that time, Howard Bauchner, advised us that the word could not be published and that “racial bias” would be substituted into the title before publication. Using “racism,” he said, would result in “losing readers.” As authors and scientists, we compromised. We agreed to the change, and the article was published.
Just a few weeks ago, six years after that decision to compromise, Bauchner and I spoke by phone. He apologized, saying that progress has been made since then.
Has progress been made? JAMA recently announced that following controversial comments on racism in medicine made by a deputy editor, Bauchner was placed on administrative leave on March 25 while an independent investigation is completed.
Entrenched systemic racism — and the deliberate omission of the word in patient safety circles — is the cause of an astonishing level of preventable harm and death among communities of color that have been devalued and discounted for more than 400 years.
The covid-19 pandemic has laid bare the racial inequities of the U.S. health-care system. Too many health-care executives still perpetuate the ahistoric perspective that our country’s model provides safe and equal care for all. Yet the disproportionate number of deaths to covid-19 among racial and ethnic minority groups exposes the systemic and lethal barriers to care.
Last month, a major health-care trade magazine accepted another article that I contributed to with three colleagues, once again with “racism” in the title. When our editor sent us the final authors’ agreement, we noticed the word had been removed from the title and replaced with “intolerance.” This time, we were not willing to compromise. Our editor later informed us that the article would not be published in the May/June issue as scheduled. We were not given a reason.
I have worked all over the United States and internationally as a champion of addressing health inequity. I can say without hesitation — both as a doctor and a citizen — that racism in the United States is a public health crisis.
Having lived in rural Alabama, my family experienced these inequities personally. When my great uncle, who was like a father to me, fell ill, he was taken to a clinic that was segregated by skin color, and was subsequently admitted to a hospital in Selma in 1973. He died one day later. In 2015, I learned he had a ruptured appendix and was never seen by a physician.
I have advised and worked with large, complex health-care systems in the United States, Britain, Australia and Africa. I have collaborated with organizations such as the American Medical Association, the American Hospital Association and the Joint Commission. I have even discussed race as a risk factor for death with White health leaders, such as former president of the Institute for Healthcare Improvement Don Berwick.
Yet, I still sometimes feel that survival mechanism kick in to compromise and veil the truth that structural and systemic racism is a root cause of preventable harm and death across U.S. health care. I have been warned that if I did not continue to compromise, I would be labeled an “angry Black man” and that colleagues would distance themselves from me.
The days of compromise are over.
Solving systemic racism in public health must start with naming it. We must publish the word. We must say the word. If health-care providers are to be competent in caring for communities that have been marginalized and oppressed for centuries, then they must understand the role racism plays in poor health. This includes chronic illness, delayed or denied care, barriers to access, condescension, assumptions, inadequate diagnoses and overt disregard.
But proactively addressing racism in health care requires much more than completing training modules, launching hollow PR campaigns, hosting inclusivity workshops, hiring diversity chiefs or donating to under-resourced clinics. As any doctor would attest, before a wound can heal, it must be cleansed. This can be a painful process.
The actions needed to improve health care include listening and learning with humility; acknowledging and addressing implicit bias within work cultures; and fostering environments where reporting unfair treatment, without fear of reprisal, is encouraged and celebrated.
Mid-pandemic, we have a once-in-a-lifetime opportunity to transform health care. That change begins with language and proceeds with authentic, deliberate and intentional changes to policy and practices. Specificity matters now more than ever.
The word “racism” must be spoken loudly in hospital hallways, in boardrooms, at kitchen tables, in editorial meetings and in all health professions schools. Racism is a public-health crisis.
Dr. Ronald Wyatt co-chairs the Institute for Healthcare Improvement’s equity advisory group and is faculty for the IHI Pursuing Equity Initiative. He was the first Black chief medical resident at the Saint Louis University School of Medicine.
By Dan Witters
Gallup, March 31, 2021
Nearly one-in-five U.S. adults — 18%, about 46 million people — report that if they needed access to quality healthcare today, they would be unable to pay for it. These results are based on a new study conducted by West Health and Gallup.
This current measure of healthcare unaffordability runs considerably higher among Black adults (29%) and somewhat higher for Hispanic adults (21%) than for White adults (16%). And while unaffordability of care is lower for people 65 and older than for their younger counterparts, White older adults are half as likely to report such a condition as are non-White older people (8% and 16%, respectively).
Needed Care Was Skipped by 18% of Households in Prior 12 Months
While 18% of survey respondents reported that they would be unable to pay for quality care if they needed it today, the same percentage also reported that someone in their household skipped care they needed for cost reasons in the prior 12 months. That time period covers roughly the first year of the COVID-19 pandemic.
The chances of any given household suffering from this form of healthcare insecurity are inversely related to annual household income, with 35% of respondents from low-income households — those earning under $24,000 per year — reporting forgoing care in the prior 12 months. That is five times the rate reported by those from high-income households (7%), defined as earning at least $180,000.
Reduction in Household Spending Due to Cost of Care Spans All Income Groups
With nearly one in five U.S. adults forgoing some healthcare in the prior 12 months due to the cost, many Americans are cutting back on household spending to pay for the care that they currently are receiving. About one in eight adults, for example, say they cut back their spending on food (12%) and over-the-counter drugs (11%) to pay for healthcare or medicine. The proportion doing this rises to about 1/4 of those in households earning less than $24,000 annually. Additionally, 21% of those from low-income households have had to reduce spending on utilities due to the cost of care, underscoring the disproportionate sacrifices made by lower-income households in the COVID-era.
Over one-third (35%) of respondents, in turn, report that they have reduced spending on recreational or leisure activities in the previous 12 months in order to afford care, including 21% of those in households earning at least $180,000 per year.
Majority Support Exists for Cost Containment and Broader Access Policies
As substantial percentages of U.S. adults have had to reduce spending on basic household goods to pay for healthcare, public support runs high for various proposed forms of government action meant to make healthcare more affordable.
For example, over 80% of Americans — including over 70% of Republicans — favor setting caps on out-of-pocket costs for both prescription drugs and general healthcare services for those who are insured by Medicare.
Other options are viewed quite differently by the major political party groups. While 60% of all Americans favor “making Medicare available to everyone,” support ranges from 93% among Democrats to 19% among Republicans. Similarly, 59% favor “expanding and strengthening” the Affordable Care Act; but the 98% of support among Democrats contrasts with 15% among Republicans. Slight majorities of independents endorse both proposals.
Implications
As the U.S. enters its second year of the COVID-19 pandemic, economic recovery, though uneven, has also progressed with 379,000 jobs added in February, considerably exceeding projected forecasts for the month and totaling 17 million recovered jobs since April. The passage of the new $1.9 trillion COVID-19 relief bill, which was debated but not yet passed until after this survey, stands to provide additional relief to large numbers of households and businesses in need.
Despite these reasons for optimism, the cost of healthcare and its potential ramifications continues to serve as a burdensome part of day-to-day life for millions of Americans, illustrating the enduring nature of the issue as the U.S. slowly enters the closing stages of the pandemic. Over a 12-month period that roughly covers the first full year of the COVID-era, 18% of American households had to forgo some degree of needed healthcare because they were not able to afford it due to the cost. And, one year in, 18% of adults report that they would be unable to afford quality care if they needed it today. These realities can spill over into other health issues, such as delays in diagnoses of new cancer and associated treatments that are due to forgoing needed care.
The practical ramifications of widespread reductions in basic household spending to offset the cost of care are considerable and should not come with great surprise given the substantial number of Americans who suffer its effects. Dovetailing with these realities is majority support for a number of public policies currently being considered, underscoring a public that continues to remain open to government action designed to provide relief from healthcare expenses.
By Don McCanne, M.D.
We are spending almost $4 trillion per year on health care, the highest per capita spending of all nations, and yet, because of our dysfunctional health care financing system, far too many U.S. residents are facing potential financial hardship due to these costs. Although the COVID-19 relief bill will provide partial temporary relief for a portion of those affected, it is quite clear that, with the amount we are already spending, the health care financing system still needs major structural reform if we expect to provide affordable access to health care for everyone.
Perhaps the most significant finding in this survey is that the majority now supports government action to make health care more affordable. But only 19% of Republicans favor making Medicare available to everyone, and even less, only 15%, support expanding and strengthening the Affordable Care Act. And yet over 70% of Republicans favor setting caps on out-of-pocket costs for Medicare. So do they want the government involved or don’t they? Since they have come up with no reasonable alternative (medical savings accounts won’t do it), we should move ahead anyway.
U.S.-style private insurance is too expensive and inefficient, and they don’t really want that anyway based on their opposition to the Affordable Care Act. Although other models exist, the most affordable, comprehensive and effective model is single payer improved Medicare for All. The Republicans can either join us or watch, but their inaction can no longer be tolerated.
Although PNHP endeavors to avoid partisan comments, partisan factions set the terms of the debate. We cannot remain silent when health care for all is our mission.
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By George Skelton
Los Angeles Times, April 1, 2021
It was a breakthrough event befitting Cesar Chavez Day: A major poll showed that California voters support providing tax-paid healthcare for immigrants living here illegally.
In all the polling by the nonpartisan Public Policy Institute of California over many years, it had never before found support among likely voters for giving full-blown public healthcare to undocumented immigrants.
Public attitudes toward immigrants without legal status have changed dramatically since Chavez died in 1993.
During the pandemic, people soon realized that their own health largely depended on the health of their neighbors and everyone else.
In a statewide survey, the PPIC asked California adults: “Do you favor or oppose providing healthcare coverage for undocumented immigrants in California?”
When asked of all adults, regardless of whether they were registered voters, most previously have answered that they favored providing the benefit. In this poll, 66% of all adults answered affirmatively, a 12-percentage-point increase since 2015.
And for the first time, likely voters also agreed, and by a large margin: 58% to 39%.
In the 2015 PPIC poll, the answers were reversed: Only 42% of likely voters favored providing healthcare and 55% were opposed. In a 2007 survey, 32% were in favor and 63% opposed.
In the new poll, only Republican voters continued to oppose offering the benefit — a whopping 79%.
Republicans are out of sync with the majority of Californians on many issues — one reason they haven’t elected anyone to statewide office since 2006 and now are essentially irrelevant in the Legislature with a superminority in each house.
Among Democrats, 84% favored providing public healthcare. So did 55% of independents.
Mark Baldassare, the PPIC president and pollster, believes it’s the pandemic that has quickened the acceptance of healthcare for all.
“This is the first time we’ve found likely voters thinking there should be healthcare for undocumented workers,” he says.
“I relate this to the pandemic. It’s one of the most significant changes I’ve seen during the pandemic. People are recognizing that having a healthy society requires taking care of everyone. It’s something people saw during the pandemic. That strikes me as very significant.”
Assemblyman Joaquin Arambula (D-Fresno), an emergency room physician, is pushing a bill to cover everyone by 2026.
“We call a lot of these people essential workers but don’t take care of their essential needs,” Arambula says. “We could not have our bountiful harvests if not for the undocumented workers….
“The question is whether the governor will make universal healthcare a priority.”
By Don McCanne, M.D.
Of course, this is California, the Left Coast of the United States. We have not given up on single payer. AB 1400, CalCare, is our latest attempt. Unfortunately, we have fire damage, drought, a threatened recall election, and, like the rest of the world, a COVID pandemic with all of its political difficulties for our governor, Gavin Newsom. Although he promised us single payer, he does have his hands full at the moment.
We can’t say how single payer will fare in California, but this public support for including coverage for undocumented immigrants in our health care system shows that the fundamental policies underlying the single payer model have gained traction. Unfortunately, political barriers still exist as exemplified by the opposition of 79% of Republican voters.
Support for covering undocumented immigrants may not be entirely altruistic since the recent increase in support coincided with the pandemic, and common sense tells you that providing care to everyone (vaccines, treatment, isolation, etc.) improves the odds of more rapid control, lowering the risk of personally becoming a victim. But altruism likely plays a role to some extent. For those opposed to including the undocumented in the system, there must be a lack of altruism since they are exposed as well and would gain by making the system universal. Or maybe it’s simply ideology.
We’d rather have the entire nation included under a universal system, but California will continue its efforts to move forward, hoping to be a model for the nation, just as Saskatchewan was for Canada. We can still dream of the entire nation moving smartly in unison toward Medicare for All, obviating the need for transitional state efforts. Let’s see if we can’t make that more than a dream.
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April 1, 2021
PNHP Illinois co-president Dr. Monica Maalouf detailed the undeniable and longstanding inequities in U.S. health care, and how the pandemic has made these injustices even more glaring. COVID-19 “took a system that was already inequitable, that already had racism embedded in it, and magnified all of those issues.”
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