PNHP

US Punishes Cuba for Providing Foreign Medical Assistance

US Punishes Cuba for Providing Foreign Medical Assistance

In the Trump administration’s latest attack on health aid for poor nations, Marco Rubio is punishing Cubans who participate in that nation’s highly beneficial medical assistance program. The US abandonment of health aid is reprehensible, and we must work to reverse it.

Cuba Sends Doctors, the US Sends Sanctions, JACOBIN, March 8, 2025, by Helen Yaffe

The United States calls Cuba’s medical internationalism “human trafficking” – but it’s really an internationalist lifeline for the Global South.

On February 25, US secretary of state Marco Rubio announced restrictions on visas for both government officials in Cuba and any others worldwide who are “complicit” with the island nation’s overseas medical-assistance programs. A US State Department statement clarified that the sanction extends to “current and former” officials and the “immediate family of such persons.” This action, the seventh measure targeting Cuba in one month, has international consequences; for decades tens of thousands of Cuban medical professionals have been posted in around sixty countries, far more than the World Health Organization’s (WHO) workforce, mostly working in under- or unserved populations in the Global South. By threatening to withhold visas from foreign officials, the US government means to sabotage these Cuban medical missions overseas. If it works, millions will suffer.

The predominant global approach, exemplified by the United States, is to regard health care as an expensive resource or commodity to be rationed through the market mechanism. Medical students “invest” in their education, paying high tuition fees and graduating with huge debts. They then seek well-paid jobs to repay those debts and pursue a privileged standard of living. To ensure medics are well remunerated, demand must be kept above supply. The World Economic Forum projects a shortfall of ten million health care workers worldwide by 2030. But the Cuban investment in medical education raises the supply of professionals globally, thus threatening the status of physicians operating under a market system. Critically, the Cuban approach removes financial, class, race, gender, religious, and any other barriers to joining the medical profession.

The key features of the Cuban approach are: the commitment to health care as a human right; the decisive role of state planning and investment to provide a universal public health care system with the absence of a parallel private sector; the speed with which health care provision was improved (by the 1980s Cuba had the health profile of a highly developed country); the focus on prevention over cure; and the system of community-based primary care. By these means, socialist Cuba has achieved comparable health outcomes to developed countries but with lower per capita spending — less than one-tenth the per capita spending in the United States and one-quarter in the UK. By 2005, Cuba had achieved the highest ratio of doctors per capita in the world: 1 to 167. By 2018, it had three times the density of doctors in the US and the UK.

Today Cuba is in the midst of a severe economic crisis, largely resulting from US sanctions. The public health care system is under unprecedented strain, with shortages of resources and of personnel following massive emigration since 2021. Nonetheless, the government continues to dedicate a high proportion of GDP on health care (nearly 14 percent in 2023), maintaining free universal medical provision, and currently has 24,180 medical professionals in fifty-six countries.

Revolutionary Cuba was never solely concerned with meeting its own needs. Between 1999–2015 alone, overseas Cuban medical professionals saved 6 million lives, carried out 1.39 billion medical consultations and 10 million surgical operations, and attended 2.67 million births, while 73,848 foreign students graduated as professionals in Cuba, many of them medics. Add to that the beneficiaries between 1960 and 1998, and those since 2016, and the numbers climb steeply.

The beneficiary nations have been the poorest and least influential globally; few have governments with any leverage on the world stage. Recipient populations are often the most disadvantaged and marginalized within those countries. If Cuban medics leave, they will have no alternative provision. If Rubio and Trump are successful, it is not just Cubans who will suffer. It will also be the global beneficiaries whose lives are being saved and improved by Cuban medical internationalism right now.

Comment:

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

The world community respected the United States for its humanitarian support via USAID which helped to meet the medical needs of countries that lack the resources to do so on their own. One of the first major actions of the Trump administration was to slash the resources and functionality of USAID such that the nations we served were stripped of life-saving medical prevention and care, and further denied food resources to prevent starvation, especially in children. USAID was moved to the State Department wherein Secretary Marco Rubio was set to supervise the degradation of this important agency.

Fortunately, Cuba has made it a national priority to try to fulfill these unmet health needs. Though not as wealthy as the United States, the extent of their success has been phenomenal.  Millions of lives saved; massive suffering and grief averted.

As we abandon the humanitarian mission of USAID, what approach have we taken to honor the work of Cuba in providing these valuable services? None. We don’t honor Cuba for meeting needs that we have abandoned. Instead, we place restrictions on visas for government officials in Cuba and others worldwide who are complicit with Cuba’s overseas medical-assistance.

What? We not only lay waste to our own humanitarian efforts, we try to slow Cuba’s? Hard to fathom, unconscionable.

People of good will in the US have been trying for decades to provide affordable, broad health care for everyone here, while offering meaningful support to poorer nations with even greater needs. President George W. Bush, in his most noble act, founded and fostered the PEPFAR program for foreign health assistance in HIV, and thus super-charged global health assistance. Strong foreign aid in health has been a bipartisan consensus (albeit still just 1% of the US federal budget). Now, in 2025, not only does the new Trump administration want to undo our own programs, it plans to punish a country whose offense is to fulfill the unmet medical needs of poverty-stricken nations.

We ask what kind of government leadership is it that we have elected that would drive us in the direction voiced by Trump, Musk, Miller, and now Rubio? We’re sure that the actions are illegal and impeachable. We also recognize that such outcomes are all but impossible in the foreseeable future.

For now, we ask you to link the ongoing fight for US Health Justice via universal publicly financed health insurance (single payer) to the ongoing fight for global Health Justice via foreign assistance. Write to your representatives and senators, donate to organizations that are advocating for USAID programming and staff, and for Cuba, and participate in public protests. Unified outrage is the only appropriate response.

https://healthjusticemonitor.org…

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.

Health justice groups host “shadow hearing” opposing the nomination of Dr. Mehmet Oz to lead CMS

“Dr. Oz is a TV doctor, and does not represent the views of practicing physicians. He is certainly not someone we can trust to run Medicare.”

FOR IMMEDIATE RELEASE: Friday, March 14, 2025

Media Contact: Anika Thota, PNHP Policy Specialist, anika@pnhp.org

As Dr. Mehmet Oz takes the stage at his confirmation hearing before the Senate Finance Committee, Physicians for a National Health Program (PNHP), and a coalition of labor and health care advocates are hosting a shadow hearing on Friday, March 14 at 9:00 a.m. Eastern to expose the truth about Medicaid cuts, Medicare privatization, and the detrimental effects of Medicare Advantage (MA). You can watch the shadow hearing LIVE here.

Dr. Oz, Trump’s pick to lead the Centers for Medicare & Medicaid Services (CMS), has a history of promoting corporate-backed health schemes rather than prioritizing patient care. That’s why we’re holding a shadow hearing—to expose his dangerous agenda. Throughout his career, Dr. Oz has advocated for dubious medical practices and privatized insurance plans that prioritize profits over patients.

“Dr. Oz is a TV doctor, and does not represent the views of practicing physicians. He is certainly not someone we can trust to run Medicare,” said PNHP President Dr. Diljeet K. Singh. “His record of pushing questionable medical products and corporate-friendly insurance plans mirrors the deceptive tactics of Medicare Advantage, which promises better care but instead delivers delays, denials, and higher out-of-pocket costs.”

Numerous organizations are co-sponsoring our event to shine a light on corporate greed driving the expansion of Medicare Advantage. 

“Medicare Advantage is a scam, and Mehmet Oz is a profiteering hatchet man looking to cash in on people’s pain,” said Sulma Arias, Executive Director of People’s Action. “If Oz is confirmed, he will allow insurance companies to deny and delay our care more often and raise the cost of health care. And because he’s a shareholder, Oz himself will make more money while we get hurt.  Our lives are on the line, and senators need to stand up for us by voting no.”

“Medicare Advantage is a concession that can have negative consequences for retiree health care,” said Rose Roach, National Coordinator of the Labor Campaign for Single Payer. “The Labor Movement fought for – and won – our public Medicare program to secure accessible and affordable health care for all seniors in this country. We demand restoration and expansion of our traditional Medicare.”

Nancy Hagans, RN, President of National Nurses United, said “Our health care system is in crisis. Nurses know that the only way to resolve the fundamental problems in our current profit-driven system is to guarantee health care through Medicare for All. Dr. Mehmet Oz does not support guaranteed health care and has repeatedly shown his commitment to increasing the profits of health insurance companies at the expense of patient care. We urge the United States Senate to listen to the concerns of patients and health care workers across the U.S., and to vote NO on the nomination of Mehmet Oz as CMS Administrator.”

MA plans routinely fail patients when they need care most, trapping seniors in plans that promise choice but instead limit access to doctors and life-saving treatments. At our hearing, speakers will share stories of harm caused by privatized health care, highlighting that Dr. Oz’s perspective on privatized health care is self-serving and disregards the health of the American people.

Primary sponsors for this shadow hearing include Physicians for a National Health Program and Social Security Works. Cosponsors include Be a Hero; Committee of Interns and Residents, SEIU; Cross-union Retirees Organizing Committee (CROC NYC); Healthcare-NOW; Labor Campaign for Single Payer; National Alliance for Retiree Healthcare; National Nurses United; People’s Action; Popular Democracy; Progressive Democrats of America; Puget Sound Advocates for Retirement Action; and Students for a National Health Program.

Medicine Demands Trust—Dr. Oz Has Spent His Career Undermining It

If given the reins of CMS, Dr. Mehmet Oz will not only fail to improve healthcare for our seniors but also use privately managed care to actively harm Americans. The Senate must reject his nomination.

By Dr. Sanjeev K. Sriram, M.D., M.P.H. and Chiamaka Okonwo
Common Dreams, March 13, 2025

Medicine is about trust. As a medical student, I’ve been taught that trust in medicine is built on honesty, evidence, and a commitment to patient well-being—principles that should guide physicians and leaders in healthcare. But how can we trust a man who built a career on misleading patients to oversee healthcare for 160 million Americans?

Dr. Mehmet Oz, a former TV doctor notorious for promoting unproven “miracle cures,” has been nominated by U.S. President Donald Trump to lead the Centers for Medicare and Medicaid Services (CMS)—an agency that millions of seniors, children, and low-income families depend on for care. Yet, he promotes predatory Medicare Advantage programs and unscientific remedies that harm citizens. His nomination cannot stand.

As I take care of my own patients, I am consistently trained to practice evidence-based medicine and uphold ethical standards that prioritize patient well-being. Dr. Oz, in contrast, has used his platform to spread misinformation, undermining the very trust that medicine depends on. Formerly a well-regarded cardiothoracic surgeon, Dr. Oz began his journey toward harm over healing on the “Dr. Oz Show,” a nationally televised program on which he promoted unproven treatments that interfered with patients’ appropriate medical care.

Medicine is about trust. As a medical student, I’ve been taught that trust in medicine is built on honesty, evidence, and a commitment to patient well-being—principles that should guide physicians and leaders in healthcare. But how can we trust a man who built a career on misleading patients to oversee healthcare for 160 million Americans?

Dr. Mehmet Oz, a former TV doctor notorious for promoting unproven “miracle cures,” has been nominated by U.S. President Donald Trump to lead the Centers for Medicare and Medicaid Services (CMS)—an agency that millions of seniors, children, and low-income families depend on for care. Yet, he promotes predatory Medicare Advantage programs and unscientific remedies that harm citizens. His nomination cannot stand.

As I take care of my own patients, I am consistently trained to practice evidence-based medicine and uphold ethical standards that prioritize patient well-being. Dr. Oz, in contrast, has used his platform to spread misinformation, undermining the very trust that medicine depends on. Formerly a well-regarded cardiothoracic surgeon, Dr. Oz began his journey toward harm over healing on the “Dr. Oz Show,” a nationally televised program on which he promoted unproven treatments that interfered with patients’ appropriate medical care.

https://commondreams.org…

Dr. Diljeet Singh on “Healthcare-NOW”

PNHP president Dr. Diljeet Singh appeared on the “Medicare for All” podcast on March 12, 2025. Dr. Singh previewed PNHP’s shadow hearing for Dr. Mehmet Oz, which will expose the many reasons why he cannot be trusted to lead the Centers for Medicare and Medicaid Services.

Oz is “deeply, deeply, deeply invested in for-profit Medicare,” said Dr. Singh, “and this is the guy we’re putting in charge of Medicare.”

Republican cuts to Medicaid would be a waste

By Henry L. Abrons, M.D., M.P.H.
San Francisco Chronicle, Letters, March 9, 2025

Why are Republicans even talking about cutting Medicaid? Don’t they realize that Medicaid is a lifeline to health care for 15 million Californians and over 70 million Americans?

The Republican leadership claims that there is “fraud, waste and abuse” in federal health insurance programs that need to be eliminated.

But fraud and abuse in the Medicaid program don’t add up to much, so the cutters will attack Medicaid eligibility, benefits and provider reimbursements.

Republicans have ignored the enormous savings from bringing all health insurance and health care delivery under a nonprofit program.

Economic research shows that a national single-payer health care program could save over $600 billion per year while making access universal, lowering costs and expanding benefits to include dental care, prescription drugs and even long-term care.

In essence, enacting a single-payer program would be the equivalent of the huge tax cut that the Republicans are promising, but it would go primarily to working families instead of the billionaires.

The specter of cuts to Medicaid has sent tremors through all 50 states and members of Congress are reacting. This could intensify pressure on California’s nine Republican House members to insist on saving Medicaid in the budget reconciliation process.

If Republicans could set politics aside and focus on fiscal responsibility, they would defend Medicaid, improve health care and stop wasting taxpayer money.

https://sfchronicle.com…

Trump Voters Seek Robust Government Role in Health Care

New polling finds that most Trump voters favor government health insurance and regulation to lower prices and financial vulnerability. Our next task is to educate Trump supporters on the advantages of single payer (public) health insurance.

Republicans Once Wanted Government out of Health Care. Trump Voters See It Differently, KFF Health News, Feb. 27, 2025, by Noam N. Levey

Government regulation of health care prices used to be heresy for most Republicans. GOP leaders fiercely opposed the 2010 Affordable Care Act, which included government limits on patients’ costs.

But as Trump begins his second term, many of the voters who sent him back to the White House welcome more robust government action to rein in a health care system many Americans perceive as out of control, polls show.

Republican voters strongly back federal limits on the prices charged by drug companies and hospitals, caps on patients’ medical bills, and restrictions on how health care providers can pursue people over medical debt.

Even Medicaid, the state-federal insurance program that Republican congressional leaders are eyeing to dramatically cut, is viewed favorably by many GOP voters.

Skepticism about government lingers among rank-and-file Republicans. And ideas such as shifting all Americans into a single government health plan, akin to “Medicare for All,” are still nonstarters for many GOP voters.

But as tens of millions of Americans are driven into debt by medical bills they don’t understand or can’t afford, many are reassessing their inclination to look to free markets rather than the government.

In a recent national survey, Fabrizio Ward and Hart Research, which for decades has polled for Democratic candidates, found that Trump voters were more likely to blame health insurers, drug companies, and hospital systems than the government for high health care costs.

Three-quarters of Trump voters back government limits on what hospitals can charge, Ward’s polling found.

Mike Perry, who’s convened dozens of focus groups with voters about health care in recent years, said the support for government price caps is all the more remarkable since regulating medical prices isn’t at the top of most politicians’ agenda. “It seems to be like a groundswell,” he said. “They’ve come to this decision on their own, rather than any policymakers leading them there, that something needs to be done.”

Other forms of government regulation, such as limits on medical debt collections, are even more popular. About 8 in 10 Republicans backed a $2,300 cap on how much patients could be required to pay annually for medical debt.

As Trump and his allies in Congress begin shaping their health care agenda, many Republican leaders have expressed more interest in cutting government than in expanding its protections.

“There is oftentimes a massive disconnect,” Ward said, “between what happens in the caucuses on Capitol Hill and what’s happening at family tables across America.”

Comment:

By Don McCanne, M.D.

The important message here is that it is not only Democrats who are concerned about health care costs so much that they want the government to take action—it is Republicans as well, including those who voted for Trump in 2024. In fact, many Trump supporters think he would do a better job in controlling their health care costs.

Yet there is still significant opposition to single payer / Medicare for All. This is despite numerous studies showing that such a model would be more effective in controlling costs while ensuring access to comprehensive, high quality care for all, affordable for each one of us. They want the government to help, but they remain uncomfortable with the single payer model. So what is going on here?

Most of all, the private insurance industry has been very effective in marketing their products. A predominant example: people on Medicare believe that private Medicare Advantage plans will provide greater benefits at a lower cost than traditional government-managed Medicare. When the insurance product is marketed to them, it seems like that is true. They get a few additional, nominal benefits that are not offered in traditional Medicare, and the up-front costs are lower than premiums in the traditional program especially if including Medigap plans needed to fill coverage holes.

But the financial advantage is illusory. The purpose of health insurance is to provide better access to necessary health care while controlling costs that they would otherwise be exposed to when they need to access that care. Is that the way private Medicare Advantage plans work? No. When beneficiaries need to use their plans, they usually have a limited choice of providers because of the narrow networks covered; they face prior authorization requirements; and they often have greater out-of-pocket expenses because of the deductibles and copays required by the plans, often creating financial hardship. At that point, they might want to return to the greater choices and more affordable coverage of traditional Medicare, but the Medigap plan may no longer be available because of pre-existing conditions (which are ignored at the time of original enrollment).

Actually, what patients want at the time of medical need would be choice of providers, truly comprehensive benefits, with elimination of cost-sharing at the time of service. The way you would get that is through a single payer system, an improved Medicare for All.

Paying for it? This would happen via a public insurance program which would be progressively financed through taxes with those in poverty paying nothing, and increasing with income, with the billionaires paying significantly more than the actual costs. This would be the most equitable method, with no person suffering a financial hardship (when unaffordable costs happen to be one of the greatest sources of dissatisfaction with today’s health care system).

Of course, Republicans have heavily opposed single payer since they greatly favor further reduction in taxes for the billionaires while having the masses fund care through reduced benefits and greater financial contributions. They currently support a privatized Medicare Advantage for All that would do this: fewer paid benefits for lower income individuals and greater cost sharing at the time of service – the opposite of what our system should be providing.

We see that the public broadly does want the government to be involved in fixing our system, providing better care at lower costs. But we really need to do this through the more humanitarian single payer model, rather than through tweaking a system designed to shift our health care dollars to wealthy private investors and away from care.

Our task now is to explain to everyone (including Trump voters!) that they can have the government controls that they want, but that the system needs to be designed so that it works for the people, all of us, rather than being designed to increase the wealth of the private investors at a cost to the average citizen of affordability and access to the care that they need.

Once they understand the system, that’s what they’ll want.

https://healthjusticemonitor.org…

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.

Seniors, Trump pick Dr. Oz wants to take you out of Medicare. Call your senator

By Carol Paris, M.D.
The Knoxville News-Sentinel, March 5, 2025

Seniors: Who do you trust with your health care? If you’re like me, you place a great deal of trust in Medicare, which you’ve paid into for your entire working life. If you’re like most Americans, you definitely don’t trust corporations like UnitedHealth (UHC) to pay for the care you need, when you need it.

Despite public opinion, President Donald Trump’s administration is gearing up to hand even more of our Medicare over to insurers like UHC. They’re planning to push hard for the “Medicare Advantage” (MA) program, which generates huge profits for insurers while punishing seniors with restrictions, surprise costs, and outright denials of care.

Republicans have a blueprint, Project 2025, which seeks to make MA the default enrollment option for Medicare beneficiaries, and a champion, Dr. Mehmet Oz, who supports an even more aggressive plan: Medicare Advantage for All.

The “Advantage” program has been very kind to UHC over the years, boosting its profits into the billions. In 2024, UHC captured 29% of the MA market. It also captured the anger of everyday Americans trying to use their substandard insurance − as well as the scrutiny of Congress and the wrath of medical professionals who are denied the ability to care for their patients.

I know this from personal experience, having recently consulted an orthopedic surgeon for knee pain. My doctor recommended trying an injection before jumping to surgery and explained the various options. I asked what he would recommend personally.

“It doesn’t matter what I recommend,” he said, “only what your insurance will authorize.” When I told him I had traditional Medicare, not a corporate MA plan, his dejection changed to enthusiasm. “That’s wonderful,” he said. “Now I can give you my best advice and administer the injection today.”

Patients and physicians suffer because of the roadblocks thrown up by firms like UHC: prior authorization requirements, restrictive provider networks, and frequent denials of care. These tactics bankrupt patients, lead to physical suffering, and fuel an epidemic of burnout among medical professionals.

Unlike most doctors practicing in the U.S., Dr. Oz sees all this and applauds. He has consistently promoted MA plans, and even proposed putting all Americans into the program. For seniors, that would mean no more public Medicare, not even as an option for those who want it.

Mehmet Oz’s dangerous prescription for health care puts profits over patients

By Sneha Kapil, Mitchell Stoddard, Manasvi Khullar, and Erin Everett
South Florida Sun-Sentinel, March 4, 2025

“I don’t believe in antibiotics!” My patient told me, frustrated that I was not going along with her faith in the healing powers of a supplement. As a young doctor in training, I was unprepared for the current landscape of severe mistrust in health care. My patient had a bacterial urinary tract infection that has long been treated with antibiotics. However, she was refusing antibiotics despite weeks of pain, much to my disappointment. Although this happened to one of us (Manasvi Khullar), all four of us have countless similar stories.

The lack of trust in the health care system has led patients to turn to false promises, not physicians, for their health care needs. Although many failures led to this point, there are multiple people who have perpetuated lies in the name of profit. One of these individuals is Dr. Mehmet Oz, the nominee to run the Centers for Medicare and Medicaid Services (CMS) who will oversee the process of care coverage decisions, the Affordable Care Act and a $1.5 trillion budget.

Oz is a cardiothoracic surgeon, famous for his daytime talk show that reaches millions of Americans. He follows many evidence-based principles — a belief in a healthy diet, the power of activity and social connection. However, he has also often promoted questionable therapies like “magic weight loss cures” and claimed that cellphones can cause breast cancer. One study found that half of his recommendations had zero evidence. Given this, how will Oz use taxpayer money to decide what therapies are covered by Medicare? How does he plan to respond to therapies not based in scientific evidence?

One plan for CMS that Oz has touted is “Medicare Advantage (MA) for All,” which allows CMS to contract with private insurance companies to fulfill Medicare requirements. But reports show that MA patients were denied care by insurance companies that should have been covered, with the plan pocketing the difference. MA plans have also been shown to overcharge the government by adding unnecessary codes to charts. The $88 billion to $120 billion upcharged annually is enough to expand traditional Medicare to include dental, vision and hearing coverage.

Oz proposes making MA the default enrollment option, restricting patient choice and funneling $200 billion annually to insurance companies, which jeopardizes traditional Medicare. Experts estimate expanding MA to cover 75% of enrollees could waste nearly $2 trillion over the next decade without improving health care quality. Rural seniors would suffer the most, as restricted provider networks and underfunded hospitals already limit access to care in these areas. By advocating for “Medicare Advantage for All,” Oz puts the pockets of private corporate interests before quality patient care.

Oz also owns stock in many companies that he would be tasked with regulating. For example, he owns shares in the UnitedHealth Group and CVS Health Corp, the owner of Aetna Insurance. This appears at odds with past statements in which Oz said, “I’ve fought Big Pharma, I’ve gone to battle with Big Tech, I cannot be bought.”

As future physicians, we refuse to inherit a system where patients die while insurance companies post record profits. This nomination leaves millions — especially seniors and women — at risk of losing reliable health care. The American public has demanded change at all levels of government and has elected President Trump to shake things up. Oz is an out-of-the-box thinker who has claimed that he cares about the health of Americans. But senators should act urgently to confront his apparent conflicts of interest and controversial beliefs during the confirmation process. The American people deserve a gifted cardiothoracic surgeon who can provide a steady hand during a time of crisis, not a con man who will sacrifice your health and taxpayer money to make a quick buck.

Sneha Kapil is a third year MD/MS candidate at the University of Miami Miller School of Medicine.

Mitchell Stoddard is a second year DO/MPH candidate at Western University of Health Sciences College of Osteopathic Medicine of the Pacific.

Manasvi Khullar is a fourth year medical student at Touro University California College of Osteopathic Medicine.

Erin Everett is a fourth year MD/MPH candidate at Tulane School of Medicine.

The views represented in this op-ed are their own and not that of their universities.

https://sun-sentinel.com…

Looming Medicaid Cuts & Pushback

The House of Representatives budget resolution suggests massive upcoming cuts to Medicaid, likely via reduced eligibility. Voters of both parties are surprised and worried, expressing disapproval. So are potent media voices. The public values government-funded health care; imagine how popular single payer would be!

FLASH BREAKING: Major news on Republicans CUTTING healthcare, YouTube video (8 min), Feb. 25, 2025, by Brian Tyler Cohen

Liberal Redneck – On Gutting Medicaid and Food Stamps to Cover More Tax Cuts for the Wealthy, YouTube video (8 min), Feb. 26, 2025, by Trae Crowder

“I was a poor kid, I know gross, but I was I was on all these programs. Food stamps subsidized my education all through college; don’t know what I would have done without them and in the intervening years since I have paid back far more in taxes than I ever got for the government. So the point is stop looking at these programs as an endless money glitch for a bunch of freeloaders, and look at them instead as an investment in one of our most vital resources: each other. I am walking breathing talking proof that the ROI can be pretty damn good. We can use these programs to lift up countless other Americans out of poverty.”

“All right, look, giving these rich people even more money is not going to work. You know how I know? Cuz we’ve been doing it for more than 40 goddamn years. If the Blessed urine of our betters was ever going to trickle down to us, I think we’d have felt a drop or two by now. All right so I’m imploring you — wake up stop tongue-polishing the boot that’s on your throat, and recognize the value of investing in your fellow Americans.”

The Debate Over Federal Medicaid Cuts: Perspectives of Medicaid Enrollees Who Voted for President Trump and Vice President Harris, KFF (Kaiser Family Foundation), Feb. 25, 2025, by Amaya Diana, Jennifer Tolbert, & Robin Rudowitz

  • Many Trump and Harris voters said that … they did not recall hearing about changes to health care programs (including Medicaid) during the campaign. Most participants said the government has a role to play in making health care more affordable and accessible … both Trump and Harris voters [said] that state verification procedures prevent individuals from defrauding the program on a large scale …
  • … Participants opposed cutting Medicaid funding to pay for tax cuts that they did not believe would benefit them. Both Trump and Harris voters expressed fears that these changes would jeopardize the program, take away access to health care, result in worse health outcomes, and increase out-of-pocket costs. A few Trump voters did not believe Trump would follow through on the cuts to Medicaid because they believed he understood their financial struggles.
  • Both Trump and Harris voters valued their Medicaid coverage and the access to health care services, mental health services, and medications for themselves and their children it provides. Participants also valued Medicaid because it helps to protect them from financial disaster, alleviates stress, improves health outcomes and often supports their ability to work. Participants said losing Medicaid would “be devastating” and lead to serious consequences for their physical and mental health and exacerbate pre-existing financial challenges.
  • If work requirements were introduced to Medicaid, participants who were working generally felt confident in their ability to meet the requirements; however, they worried about the burden of monthly reporting requirements when those were described to them. Many participants across parties noted that access to treatment for chronic conditions, including prescription medications and mental health treatment, were key in helping to support their ability to work. More Trump voters supported a work requirement but some who were not working were convinced they would qualify for an exemption. Other participants, including both Trump and Harris voters, who were not currently working felt they would face challenges in meeting the requirements. Those who were not working said they wanted to work (and many had been previously working for many years) but were generally unable to because of disability or because they were caring for young children or a sick parent.
  • Both Trump and Harris voters wanted policymakers to focus on improving Medicaid instead of cutting it. For example, some participants said they would like to see enhanced dental benefits, increased doctor availability, and fewer prior authorization requests. Focus group participants wanted policymakers to consider the implications of federal cuts to Medicaid for people, their health, financial stability, and ability to be productive members of society.

Comment:

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

This week’s House budget resolution sets targets for subsequent detailed appropriation bills. The two largest priorities: cut Medicaid for the poor, and slash taxes (predominantly) for the rich. Net result: an increase in debt of nearly $3 trillion – that’s $8500 per person, >$25,000 for a family of three, while growing the ranks of the uninsured.

These strategies are widely unpopular, including the Medicaid cuts, as heard by KFF in their bipartisan focus groups.

The $880 billion in Medicaid cuts is about 10%. Where will that come from? Payment rates are already dangerously low. Benefits are slim. A GOP Congressman in the Tyler Cohen video, when repeatedly asked if he’ll vote against “cuts to Medicaid”, robotically intones with a smirk: “No benefit cuts.” What does that mean? How is that possible? Presumably: the budget cuts will arise from restrictions in eligibility (who qualifies), without removing benefits for those covered. So what’s better, less for the same number of beneficiaries, or excluding millions of beneficiaries? Cruel either way, IMO. But for the GOP rep, it’s all political subterfuge.

I do appreciate that economics was highlighted in both of these decidedly non-economic forums. Brian Tyler Cohen presents the Center for American Progress graphic summary of the budget proposals. And Trae Crowder talks about “return on investment” – his taxes as a worker far exceeding what the government invested in his healthy growing up.

Progressives have been losing the social media wars. With entertaining and whip-smart presenters like these YouTubers, we are making up lost ground!

But what’s most encouraging to me is how much a wide swath of voters like and rely on Medicaid. Not that it’s a perfect program, far from it. Despite its limitations. Just imagine how they’d feel about lifelong universal health insurance, with broad benefits, paying fair rates to providers, and no significant cost-sharing. It would be heaven. It’s called single payer. It’s an important way to unite left, middle, and right against the billionaires (but they’d be covered too).

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Modern Medicare vs. Single Payer

Sadly, Medicare has been twisted into a morass of complex choices and financial vulnerability. Coverage in other nations and with single payer is simple and effective. Let’s take that path!

Bridging the Medicare Cost Gap: Knowing Your Options, The New York Times, Feb. 15, 2025, by Mark Miller

Medicare can cover most of your health care needs when you turn 65, but it doesn’t pay for everything. And one of the most significant financial challenges to watch out for are the out-of-pocket costs you can face aside from monthly premiums — including deductibles and other types of cost sharing.

Just how much you’ll pay, and when, depends on the type of Medicare enrollment that you choose: traditional Medicare, which is operated by the government and provides care on a fee-for-service basis, or Medicare Advantage, which is run by private insurance companies and operates on a managed care model.

There is no built-in annual out-of-pocket limit in traditional Medicare for outpatient and hospitalization services. Protection is available from supplemental insurance coverage – most often it means purchasing Medigap — a policy offered by private insurance companies that covers part or all of Medicare’s cost-sharing requirements.

Medicare Advantage plans come with out-of-pocket limits — but they can be high. When serious medical conditions arise, out-of-pocket costs can be a significant financial hit or make it difficult to afford care altogether. Medicare Advantage plans offer one-stop shopping and extra benefits, but they restrict care to in-network providers and have been criticized for techniques such as “prior authorization.” Traditional Medicare offers the widest access to health providers, and only a small group of medical services require prior authorization.

Medigap

Buying Medigap can be daunting, since the policies come in an alphabet soup of lettered plan choices (A, B, C, D, F, G, K, L, M and N). Medigap premium prices will differ, but the benefits offered by plans are standardized. All Medigap policies cover hospital coinsurance — the costs that you pay for longer stays after deductibles are met. Many cover all or part of the hospital deductible. Medigap plans also cover all or part of the 20 percent of fees for most physician services. They are required to also cover some or all of the cost sharing for outpatient services, and the more robust plans cover the annual hospital deductible and cost-sharing in skilled nursing facilities.

When you first sign up for Part B, which covers doctor visits and outpatient care, that’s when Medicare forbids Medigap plans from rejecting you. The opportunity is available to you during your six-month Medigap Open Enrollment Period, which starts on the first day of the month in which you’re 65 or older. After this period ends, Medigap plans in most states can reject applications or charge higher premiums because of pre-existing conditions.

Medicare Advantage

Jan. 1 through March 31 — this is the time when people enrolled in Advantage can switch plans or move to traditional Medicare. Before making a decision to move to traditional Medicare, make sure you can obtain a Medigap policy. Once you’ve identified a plan that interests you, contact the insurance company for details. The premium will vary.

High-deductible MediGap G plans are not a well-publicized option since Medigap commissions generally are a percentage of the premium, it incentivizes brokers to sell the G plans with the higher premiums.

With Advantage, the exposure can be high in years when you need lots of health care, and out-of-pocket features in the Advantage program vary by plan. It’s not necessarily true that Medicare Advantage will save you money. “The information is published, but it’s very difficult to compare,” Dr. Tricia Neuman of KFF said. “It’s really on the consumer to try to sort through which plan provides the most or least protection, and that’s tough to do.”

More generally, people enrolled in traditional Medicare with supplemental coverage are the least likely to report problems managing their costs, because they have the greatest level of protection, KFF research shows.

Health Care Affordability for Older Adults: How the U.S. Compares to Other Countries, Commonwealth Fund, Dec. 4, 2024, by Munira Z. Gunja, et al.

Nearly a quarter of older adults in the U.S. spent at least USD 2,000 over the past year on out-of-pocket expenses, compared to less than 5 percent in France and the Netherlands who spent an equivalent amount.

Comment:

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

We have long tried to simplify the single payer concept of financing health care by labeling it “Medicare for All,” with the idea that Medicare is a straightforward publicly administered and financed program that serves everyone well. But no longer. These days, it’s a diverse and overwhelming set of options: public traditional Medicare, dozens of supplementary private insurance options (Medigap), and hundreds of private insurance plans (Medicare Advantage) – representing massively complex variation in out-of-pocket costs, benefits, and providers. There is also dual eligibility with Medicaid to assist poor and disabled seniors. Understanding and choosing rationally among Medicare options is impossible.

Simply stated, modern Medicare is a convoluted nightmare that even trained professionals can barely understand. Imagine how intimidated the the average consumer is when receiving reams of information from Medicare, and from private insurers who seek to extract maximum profit from enrollees.

Seniors in other wealthy nations (such as in the OECD) have far superior financial protection for their healthcare, as documented by the recent Commonwealth survey.

What’s behind that success?

  • Seniors don’t need to hassle with intimidating choices. They’re just covered, like everyone else.
  • The coverage is broad and standard. There are no complex and variable rules about benefits, coverage circumstances, and provider panels.
  • Cost-sharing – deductibles especially – is modest. Skipping care for financial reasons is much less frequent, and medical bankruptcy isn’t a phenomenon.

So, we certainly don’t want to keep the current US system with its profoundly complex and expensive administrative excesses that are designed to divert health care funds to wealthy investors while limiting access and choice in health care and leaving millions of people with minimal health care or none at all.

How would US single payer help seniors? Unsurprisingly, it echoes successful foreign practices:

  • Streamlined coverage: Standardize and thus radically simplify the process to obtain insurance. Indeed, nothing would change at age 65 – just a continuation of lifelong insurance.
  • Reduced financial risk: Cover all necessary medical services, with minimal cost-sharing.

US single payer would be equitably funded by using progressive taxes based on ability to pay, ranging from free for those with very low incomes to more generous funding by our billionaires who would be able to fully maintain their current lifestyles with the riches they would retain. Thus payments into the system would be affordable for all.

We would make health care free or nearly so at the point of service, funding the system through global budgets and other rational economic methods that would fairly compensate providers. Physicians, nurses and other health care professionals would be able to devote all of their time to patient care without worrying about their incomes being based on the amount and intensity of services provided.

Everyone would receive the care they needed. It would be both universal and comprehensive.

It would be publicly administered, eliminating the excessive administrative costs and private profits of our current system.

In opinion polling in the US, two-thirds of adults say “yes” to the following proposition: “Would you support the government paying for all health care, if taxes would rise but premiums and cost-sharing would disappear?” Our online household cost calculators confirm that the vast majority of households would save money with single payer.

In today’s massive political upheaval our beneficial institutions – including public insurance programs — are being threatened. How about affordable, comprehensive health care for all (left and right politically)? Wouldn’t that be a giant step toward making America great?

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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.