PNHP

Modern Medicare vs. Single Payer

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?

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.

Dr. Mehmet Oz holds millions from companies that he’d wield power over if confirmed, report shows

By Amanda Seitz and Brian Slodysko
AP News, Feb. 20, 2025

WASHINGTON (AP) — The wealth of Dr. Mehmet Oz, the celebrity heart surgeon nominated by President Donald Trump to lead the Centers for Medicare and Medicaid Services, has swelled in part from for-profit health care companies over which he’d wield significant power if confirmed, according to a newly filed government ethics report.

In the filing, the 64-year-old former talk show host pledged to divest from those companies within three months of confirmation and said that until then, he wouldn’t participate in any matter that could affect his investments.

Oz’s net worth is between $98 million and $332 million, according to an analysis of the disclosure, which lists asset values in ranges but does not give precise dollar figures. Oz shot to fame and made millions off his daytime talk show. His most recent disclosure shows he also holds millions of dollars worth of shares in health insurance, fertility, pharmaceutical and vitamin companies.

Oz said in the filing that he will sell off parts of his significant and diverse investment portfolio, which ranges from retail giants such as Walmart to tech companies such as Apple.

His roster of investments includes up to $5 million in Inception Fertility, a company with a network of fertility clinics; a maximum of $100,000 with pharmaceutical giant AbbVie; and as much as $600,000 with the nation’s largest health insurer, UnitedHealth Group. He also holds up to $5 million with Nvidia, an artificial intelligence company that outfits hospitals.

And his work as an adviser for iHerb, a website that sells health and beauty supplements, has earned Oz as much as $25 million in company stock, which he pledged to forfeit “as soon as practicable but not later than 90 days after confirmation.” He indicated he would also resign from his position with the company if confirmed.

His investments touch nearly every aspect of the health care system, said Lawrence Gostin, a public health professor at Georgetown University.

“He has his fingerprints and his financing all over the health care system, from services to artificial intelligence to medical products,” Gostin said. “It seems to me that those conflicts are so intertwined in his and his families finances, I don’t know how he disentangles himself from it all.”

A spokesman for Oz did not immediately respond to a request for comment.

If confirmed by the Senate, Oz would be responsible for the programs that more than half the country relies on for health insurance: Medicaid, Medicare and the Affordable Care Act.

Medicaid provides nearly-free health care coverage to millions of the poorest children and adults in the U.S. while Medicare gives older Americans and the disabled access to health insurance. The Affordable Care Act is the Obama-era program that offers health insurance plans to millions of Americans who do not qualify for government-assisted health insurance, but do not get insurance through their employer.

As the administrator for CMS, Oz would make decisions on how the government covers procedures, hospital stays and medications in these programs and the reimbursement rates doctors and other providers get for their services.

Oz ran a failed 2022 bid to represent Pennsylvania in the U.S. Senate as a Republican. During the campaign, he called to expand Medicare Advantage, the increasingly popular version of Medicare that’s run by private insurers who have been accused of defrauding the government by billions of dollars through the program.

Before his turn to politics, Oz was a renowned heart surgeon at Columbia University. He rose to fame on “The Oprah Winfrey Show” with appearances where he discussed weight-loss diets, Botox and anti-aging techniques. Eventually, he landed his own show, which was popular but attracted deep criticism from the scientific community. Some colleagues at Columbia University called for his removal over claims he made about products on TV. Senators, too, scolded him during a 2014 hearing over the weight-loss drugs he promoted.

He has formed a kinship, though, with Robert F. Kennedy Jr., who was sworn in as the nation’s top health official last week. Kennedy and Oz have shared concerns over pesticides and unhealthy foods.

Oz’s confirmation hearing to become CMS administrator has not been scheduled.

https://apnews.com…

To Attack Waste, Go After the Source, Not the Patient

By Jay Brock, M.D.
FXBG Advance, Feb. 19, 2025

It looks like President Donald Trump has given the world’s richest man, Elon Musk—who some are already calling co-president—the responsibility for cutting government spending. If Musk were serious, he would start with eliminating the roughly $1 trillion we will waste this year running our very broken health insurance system. It would save the government money, and it would save every taxpayer and consumer money.

We’ll spend around $5 trillion on “healthcare” this year. Of that, roughly $1 trillion is wasted on costs that have nothing to do with healthcare and everything to do with perpetuating a health insurance system that, unlike those in every other advanced nation, has failed to ensure everyone here has affordable healthcare.

Here are some general estimates of what’s wasted: the numbers are approximate to give an idea of the scope of the problem.

  • Administrative costs: $600 billion (in 2019 dollars) wasted in billing and other bureaucratic burdens compared to what those costs would be in a single payer system like Canada’s. Inflation has likely significantly increased that amount.
  • Excess pharmaceutical costs: $100 billion wasted each year—again, in pre-inflation dollars. (Some healthcare experts think it might be twice that amount.) We pay higher medication prices here than in any other nation.
  • So-called Medicare “Advantage” plans excess costs: $100 billion wasted/year, give or take, according to some healthcare experts. These plans are run largely by for-profit mega corporations, companies that have a fiduciary duty to their stockholders to keep profits as high as possible. If this means that as an enrollee you get less healthcare (or none at all, if your insurance claim is denied), so be it. These plans overcharge the federal government—that is, the American taxpayer (you and me)—without producing better clinical outcomes. These overcharges help the company bottom line but detract from enrollee healthcare.
  • Total profits for just the major health insurance companies averaged $25 billion/year since Obamacare was passed in 2010: $371 billion so far.

These wasted dollars are extraneous costs that have nothing to do with any actual healthcare and everything to do with growing both more profits and a bigger medical bureaucracy.

How best to save all that money? Switching to a single payer system would eliminate that trillion dollar waste. That money could then be spent on actual healthcare, cover everyone with affordable healthcare, and still save hundreds of billions of consumer and taxpayer dollars a year.

Instead, the Administration seems to be focusing more on reducing fraud and abuse regarding Medicaid recipients who are “able bodied” but not working than on making sure everyone has affordable healthcare. Trump aims to cut Medicaid funding as one way to allow him to give further tax cuts to the very wealthiest Americans.

Medicaid cuts will mean reducing access to healthcare for the very people who voted for him.

Take just one example: cutting Medicaid funding jeopardizes rural hospitals and increases the risk of their disappearing. According to a report in Becker’s Hospital Review this week, 432 rural hospitals around the nation are at risk of closing. The top five states affected all went for Trump in 2024:

  • Texas: 47 hospitals at risk
  • Kansas: 46 at risk
  • Mississippi: 28 at risk
  • Oklahoma: 23 at risk
  • Georgia: 22 at risk

Arkansas, Mississippi, and Kansas have the highest percentage (approaching or at 50%) of rural hospitals at risk.

Florida, South Carolina, Tennessee, and Missouri are also among those states with the highest percentage of rural hospitals at risk.

Trump won all those states.

Trump’s base is vulnerable to the negative healthcare impacts of reducing healthcare spending to help pay for those tax cuts.

A Hart Research poll last month revealed that about 8/10 Americans opposed healthcare funding cuts in general, including cuts to Medicaid.

You’d never know from last year’s presidential campaign that unaffordable healthcare was a major concern for a huge number of voters: it was second only to inflation as a topic voters wanted discussed during the campaign. With good reason: three-quarters of Americans worry they won’t be able to afford to pay their medical bills if they get sick.

One can make a valid argument that failing to adequately address unaffordable healthcare helped cost the Democrats the election last year: many people may have voted for Trump more out of punishing Democrats than supporting Trump’s agenda. But Trump’s agenda is what we’ve got.

It looks like Trump will pursue his agenda of cutting healthcare funding, thus reducing healthcare access for many Americans, especially affecting his political base. One can only guess how the electorate will react at midterm elections next year—and in the next presidential election in 2028 —if the Trump Administration in its turn bungles this kitchen table issue that is so important to so many Americans.

https://fxbgadvance.com…

Additional Sources

Prescription for Healthcare—What can Cuba teach us about healthcare delivery?

By Rob Stone, M.D. and Karen Green Stone
WFHB Community Radio (Bloomington, Ind.)

Part One (Jan. 4, 2025)

Part Two (Feb. 8, 2025)

PNHP board adviser and APHA past president Dr. Walter Tsou discusses his recent medical education tour of Cuba on back-to-back episodes of the Prescription for Healthcare podcast.

Dr. Tsou describes a system in Cuba that prioritizes primary care and public health, and that achieves remarkable results with significantly less spending than the United States.

In contrast, our profit-focused system “doesn’t work for Americans,” he says. “It costs too much, it covers too few, and it hurts too many people.”

full Dr. Tsou interview (part one):
https://wfhb.org…

full Dr. Tsou interview (part two):
https://wfhb.org…

Would You Fix a Flat Tire by Emptying the Ashtray?

Then why try to fix healthcare without addressing the waste associated with private health insurance?

By Jay D. Brock, M.D.
FXBG Advance (Fredericksburg, Va.), Feb. 5, 2025

You don’t fix a flat tire by emptying out your car’s ashtray. That would be absurd. But when it comes to health insurance, that’s exactly how to describe what those in charge are doing. And have been doing for generations: barely acknowledging the staggering problems built into our present health insurance system, and doing everything except the obvious to resolve them.

And the failure is largely bipartisan. Both parties’ establishments have failed to deliver on the two most important requirements of any decent health insurance system: make it universal, and make it affordable.

While a significant number of Washington Democrats support a Single Payer System called Medicare for All, which would finally make health insurance both universal and affordable, the party establishment scoffs at the idea. Support among Washington Republicans is apparently nil—their attitude seems to be that we can’t have a system that allows people to sponge off the government. So the United States remains the only advanced nation that does not have universal affordable healthcare.

President Obama recognized that no one in their right mind would deliberately design a system like ours. They would instead go for a Canadian-style Single Payer System. But thinking that you couldn’t put the toothpaste back in the tube, and yearning for Republican buy-in that never happened, he opted for incremental change, and we ended up with the Affordable Care Act (“Obamacare”). While the ACA made some significant improvements, they were incremental and failed to make healthcare either universal or affordable. Just one example: out of pocket ACA costs can reach $9200/year. That’s out of reach for too many enrollees, earning the ACA the unfortunate sobriquet “The Unaffordable Care Act.” Yet Democratic leadership still touts the ACA as the way to go. It’s an empty promise.

Regarding universal affordable healthcare, Republicans are even worse. They have tried multiple times to eliminate the ACA and its real if inadequate improvements. A group of House Republicans have recently introduced a bill to repeal the Inflation Reduction Act of 2022—an Act which limits out of pocket drug costs for seniors to $2,000 this year. The Administration is eyeing $3.3 trillion in cuts to Medicare and Medicaid—even though such cuts are unpopular, including with Republican voters.

We are still waiting for President Trump’s “concept of a plan.”

We have, however, heard from Trump’s nominee to run the giant Department of Health and Human Services, responsible for Medicare and Medicaid programs that cover about 4/10 Americans. Robert F. Kennedy Jr stumbled when he said that, regarding who pays for healthcare, “when healthcare costs hit 20% (of the economy) there are no good options, only bad ones…Shifting the burden between government and corporations and insurers and providers and families is like rearranging the deck chairs on the Titanic….Why are healthcare costs so high in the first place? The obvious answer is chronic disease.”

Good on him for recognizing the role of chronic disease. But reducing the cost burden of chronic disease will take decades to accomplish, and we need affordable healthcare now. And talk about rearranging deck chairs: RFK Jr didn’t bother to mention the roughly one trillion healthcare dollars that are wasted each year in accommodating our current failed health insurance system.

That system can’t provide affordable care for the 3/4 Americans who worry about unaffordable healthcare costs. It leaves 100 million Americans owing $200 billion in medical debt and a half million Americans medically bankrupt every year. It’s why GoFundMe’s and free clinics are an integral component of the American healthcare system. It’s why 70,000 Americans die prematurely each year when they can’t afford timely medical care.

None of this would be the case under a single payer system like Medicare for All. It would eliminate that wasted trillion dollars, enable universal affordable healthcare, and still save hundreds of billions of healthcare dollars a year.

The current Administration thinks otherwise. Instead it is on the same path that previous administrations have taken when it comes to establishing universal affordable healthcare: the path to nowhere. Its nominee for head of the Department of Health and Human Services refuses to say that healthcare is a human right. He will likely also push for the further privatization of our healthcare system, which would be a disaster unless you’re ok with your insurance company denying you the care your doctor recommends for you. The Administration intends to do what it takes to cut government spending to fund even more tax cuts for the richest among us: look for cuts to programs for the poor (Medicaid) and for not-so-poor Americans (Obamacare).

Fed up with the system? Worried it could happen to you? (You should be.) Let our smiling Washington politicians know that you disapprove their trying to fix healthcare’s flat tire by emptying out the ashtray. Ask them to support real health insurance reform: Single Payer Medicare for All.

https://fxbgadvance.com…

Key physician groups stay silent on Kennedy nomination

Prominent doctors' groups draw criticism for not weighing in on HHS nominee

By Jessie Hellmann
Roll Call, Feb. 3, 2025

The nomination of Robert F. Kennedy Jr. to lead the Department of Health and Human Services has concerned doctors and public health experts across the world who are alarmed by Kennedy’s decades-long mission to sow distrust in vaccines.

But key groups representing physicians in Washington have stayed silent in the face of what their members call a threat to public health.

The American Medical Association and the American Academy of Pediatrics, groups with tremendous influence in Washington, are among the professional societies for physicians that have not directly weighed in on Kennedy’s nomination — even after last week’s confirmation hearings in which Kennedy refused to unequivocally disavow falsehoods connecting vaccines to autism.

Dr. Ed Weisbart on CareTalk

PNHP national board secretary Dr. Ed Weisbart appeared on the CareTalk podcast on February 3, 2025. He discussed the dangerous nomination of Dr. Mehmet Oz to lead the Centers for Medicare and Medicaid Services (CMS), and urged listeners to register for a “shadow hearing” hosted by PNHP alongside allies in the health justice movement.

“[Dr. Oz] wants to hand over Medicare to the for-profit insurance industry,” said Dr. Weisbart. “We know that’s an incredibly bad idea … We can’t let this happen.”

USAID Attacked

Elon Musk and his team have been set loose by President Trump to illegally shut down the most powerful US government global humanitarian effort. The financial savings are piddling, the harm massive, the need for powerful response urgent.

U.S. Agency for International Development, Accessed Feb. 3, 2025

“This site can’t be reached”

U.S. Agency for International Development: An Overview, Congressional Research Service, Jan. 6, 2025

The U.S. Agency for International Development (USAID) is the lead international humanitarian and development arm of the U.S. government.

Top Security Officials at Aid Agency Put on Leave After Denying Access to Musk Team, New York Times, Feb. 2, 2025, by Edward Wong, et al.

The two top security officials at the U.S. Agency for International Development were put on administrative lead Saturday night after refusing to give representatives of Elon Musk access to internal systems.

And the agency’s chief of staff, Matt Hobson, a Trump administration political appointee who had started his job days ago, has resigned.

Last week, Trump administration appointees suspended about 60 senior officials and fired hundreds of contractors. Mr. Trump disparaged the agency, telling reporters that it was run by “radical lunatics.” He also praised Mr. Musk as “very smart.”

“USAID is a criminal organization” Mr. Musk wrote in a social media post.

Employees of U.S.A.I.D.’s Washington, D.C. headquarters have been told to attend a Tuesday staff meeting at which they are expecting to be informed of a significant reduction in the workforce. Staffers of U.S.A.I.D. have been given strict instructions not to speak publicly about the staffing cuts or other changes underway at the agency. The U.S.A.I.D. website went dark on Saturday. Some of the signs at the agency’s headquarters have been removed.

ChatGPT, Our Inquiry: What is happening at USAID?

ChatGPT response:

The U.S. Agency for International Development (USAID) is currently undergoing significant upheaval due to recent actions by the Trump administration. President Donald Trump, with support from tech entrepreneur Elon Musk, has initiated efforts to dismantle USAID, aiming to integrate its functions into the State Department. This move aligns with the administration’s “America First” policy and involves a comprehensive review and suspension of U.S. foreign aid programs. (reuters.com)

As part of this initiative, over 100 senior career staff members at USAID have been placed on administrative leave. This action followed an incident where two senior security officials were removed after attempting to prevent personnel from Musk’s Department of Government Efficiency (DOGE) from accessing restricted areas within the agency. Musk has been vocal about his desire to dissolve USAID, describing it as a “criminal organization” and asserting that it is beyond repair. (politico.com)

The agency’s online presence has also been affected; its main website and social media accounts have been taken offline. Additionally, USAID employees at the Washington headquarters received unexpected instructions to stay home, further indicating the agency’s uncertain future. (cnn.com)

These developments have raised concerns among international partners and humanitarian organizations that rely on U.S. aid. Critics argue that dismantling USAID could undermine global humanitarian efforts and diminish U.S. influence abroad, potentially creating opportunities for other nations, such as China, to expand their reach in international development. (bloomberg.com)

In summary, USAID is facing a transformative period marked by administrative restructuring, staff reductions, and a reevaluation of its role in U.S. foreign policy. The full implications of these changes are still unfolding and warrant close monitoring.

Comment:

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

Yesterday’s Health Justice Monitor discussed the human suffering caused globally as President Trump halts US foreign health aid. Today’s report describes the latest development: destruction of the US Agency for International Development (USAID), charged with providing other nations with desperately needed humanitarian assistance. The cost is only 0.6% of our federal budget; the yield in human benefit and international good will is incalculable.

Global health spending in USAID is $7 billion, with a similar amount in PEPFAR, together just 0.2% of the US federal budget. Recently, Trump also undermined global public health capacity by exiting the World Health Organization.

These actions were taken incredibly rapidly, in the 14 days since Trump returned to the White House. They are illegal (disbanding approved programs) and counter to the interests of our nation. Trump is keeping and exceeding his promises, all to benefit his government-hating billionaire supporters. In the process he is destroying US democratic governance and the post-WWII international order. Consistent with the most dire warnings during the election.

This situation constitutes an EMERGENCY: without action on our part, we will see democracy rapidly crumble around us. We must immediately respond, of course without the violence that they are wreaking. Nonviolent massive demonstrations, lawsuits (already happening), and demands that the president and his crime partners resign or face impeachment. And insistence that the Supreme Court clarify that actions taken in defiance of constitutional duties are criminal. The exact shape of the resistance is not yet clear, but we urge creativity in saving our democratic government and fostering humanitarian and national health. Failure to act quickly and powerfully will result in damage that will take decades or even longer to repair.

Enough of mere contemplation of the politics of this disastrous situation. We need ACTION!

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.

Trump Cripples US Foreign Health Aid

The incoming administration’s abrupt suspension of foreign assistance means that life-saving health services are blocked. This is unprecedented and cruel. We must protest publicly, far and wide.

Health Programs Shutter Around the World After Trump Pauses Foreign Aid, The New York Times, Feb. 1, 2025, by Stephanie Nolen

Lifesaving treatment and prevention programs for tuberculosis, malaria, H.I.V. and other diseases cannot access funds to continue work.

Lifesaving health initiatives and medical research have shut down around the world in response to the Trump administration’s 90-day pause on foreign aid and stop-work orders.

In Uganda, the National Malaria Control Program has ceased shipments of bed nets for distribution to pregnant women and young children.

Medical supplies including drugs to stop hemorrhages in pregnant women and dehydration salts that treat life-threatening diarrhea in toddlers cannot reach villages in Zambia.

Dozens of clinical trials in South Asia, Africa and Latin America have been suspended. Thousands of people enrolled in the studies no longer have access to continuing treatment.

Many researchers and program managers broke down in tears as they described the rapid destruction of decades of work.

The programs that have frozen or folded over the past six days supported frontline care for infectious disease, providing treatments and preventive measures that help avert millions of deaths from AIDS, tuberculosis, malaria and other diseases.

Millions of dollars’ worth of supplies that support health clinics are scheduled to reach ports in the coming days, but employees of those programs have been ordered to stop work.

Two-thirds of the staff of the President’s Malaria Initiative, an organization founded by former President George W. Bush that is the largest donor to anti-malaria programs and research worldwide, have been fired.

Since the stop-work order was issued last Saturday in Zambia, all of the vehicles transporting health products have been stopped.

Comment:

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

ENOUGH!

This action is illegal and immoral. Illegal because the White House does not have the authority to end Congressionally-mandated programs. Immoral because the unwarranted precipitous actions will kill people.

Here’s what we feel in our hearts:

We must immediately demand the resignations of President Trump, Vice-President Vance, and their appointed co-conspirators in these and other profound injustices to humanity. If it requires peaceful but massive demonstrations at the White House, then so be it. (We cannot use their violence against humanity as an excuse to commit violence against them.)

We should also call for an emergency session of Congress so that they can appoint temporary custodians of our government, as we arrange for a new leadership that cares about the people rather than their own massive wealth accumulation. Members of Congress who refuse to cooperate should also resign.

We must end this man’s inhumanity to man. Patience and caution should not be used to interfere with bringing justice to America.

Obviously, these actions are not the normal way we do things in America, but neither are the actions that Trump has been taking. A call for his resignation sends a clear message.

Widespread peaceful demonstrations are entirely warranted – to protect health both abroad and at home.

All our actions can adhere to constitutional and legal norms while expressing our outrage, and building a powerful anti-anti-health popular movement.

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.

Doctors Must Fight the RFK Nomination

Doctors must explain to their senators why RFK is unacceptable to those on healthcare’s front lines.

By Daniel Stone, M.D.
The Health Care Blog, Jan. 29, 2025

As a doctor, I consider Secretary Xavier Becerra and his Department of Health and Human Services (HHS) to be allies of practitioners like me. The behemoth federal agency administers Medicare and Medicaid, the Food and Drug Administration, and an army of public health workers. The Surgeon General, symbolic leader of the nation’s healthcare providers, reports to HHS. For decades, the Department has supported medical science in safeguarding the public’s health. Now that sacred trust faces the threat of Donald Trump’s nomination of Robert F. Kennedy Jr. to run HHS.

RFK’s first problem is a stunning lack of qualifications. After a laudable triumph over drug addiction, he used his legal background to work on environmental protection. Kennedy never held a federal government position nor administered any public agency. He now appears poised for on-the-job training at an agency with 80,000 employees and a $1.7 Trillion budget. In contrast, Becerra served for years in Congress and on its Health Sub-Committee. He also served as State Attorney General, managing 4,800 employees. The qualification issue is not political. During Trump’s first term, his last HHS secretary, Alex Azar, had served as HHS general counsel and president of pharmaceutical giant Eli Lilly. RFK has nothing remotely resembling his would-be predecessors’ qualifications.

Unfortunately, RFK’s shortcomings go well beyond mere lack of qualification. His distortions and public denials of established medical science infuriate practitioners like me. He casts baseless doubt on the well-established benefits of vaccines and on the polio vaccine in particular. Despite the seven decades since polio vaccine’s introduction, doctors still see patients who were infected before it was available. My patient Donna, born in 1955, counts herself among this group. She wears leg braces and often struggles with daily activities. For me, she symbolizes those who by accident of birth or happenstance missed the profound benefits of vaccines that RFK now disparages.

RFK also opposes fluoridation of water. Another patient, Judith, age 80, scoffs at such skepticism. She grew up in Niagara Falls, NY, before fluoridation and its dental protection. She remembers her childhood dentist finding 13 cavities and the trauma and pain of prolonged dental work at an early age.

Primary care doctors like me spend our professional lives working to prevent life limiting and life-threatening conditions like those affecting Donna and Judith. We struggle with the challenges of insurance denials, clunky electronic records, healthcare bureaucracy and ballooning patient loads. We don’t need an HHS administrator opposing our efforts to provide standard preventive care. And if RFK’s judgment on vaccines is so poor, who can trust him on other critical healthcare issues like pandemic management or drug authorizations?

How should physicians respond? I recently exchanged messages with a politically diverse group of local medical leaders. They all opposed RFK but disagreed on tactics. Some said that the American Medical Association leadership believes RFK to be headed for confirmation. They fear that failed opposition might jeopardize RFK’s support on Medicaid and Medicare reimbursements.

The local doctors’ reasoning reflects the same transactional “what’s in it for me” approach that led to RFK’s nomination. RFK mortgaged a share of the Kennedy legacy to help Trump win the Presidency. Now Trump is returning the favor with a cabinet position despite RFK’s lack of qualifications and practitioners’ opposition. Should organized medicine really adopt the same “what’s in it for us” approach?

I told my colleagues that I can accept being on the losing side. Despite my efforts, my patients sometimes get sick and even die. But I don’t quit on them or ask, “what’s in it for me?” So I will not shrug my shoulders as those representing America’s doctors swallow RFK’s nomination like a dose of castor oil. The senators voting on RFK have their own doctors and medical societies in their home states. Those doctors must explain to their senators why RFK is unacceptable to those on healthcare’s front lines.

I have belonged to the California Medical Association for more than 20 years and to the American College of Physicians, the nation’s largest medical trade association, for over 30. Although proud of those associations, I will resign from both if they fail to issue strong, evidence-based statements explaining why the RFK nomination is unacceptable. I hope my colleagues do likewise.

As physicians, we take an oath to do no harm. Sometimes doing nothing causes harm. It is time for organized medicine to do the right thing and fight the RFK nomination.

Dr. Daniel Stone is Regional Medical Director of Cedars-Sinai Valley Network, a practicing internist and geriatrician with Cedars Sinai Medical Group, and a member of Physicians for a National Health Program. The views expressed in this column do not necessarily reflect those of Cedars-Sinai.

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Doctors opposing RFK Jr. rally in the lead-up to his confirmation

By Will Stone
NPR, Shots Health News, Jan. 28, 2025

Robert F. Kennedy Jr. will appear before senators this week as he tries to secure his bid to lead the Department of Health and Human Services.

President Trump’s controversial pick — an environmental lawyer descended from a political dynasty who spent years leading a prominent anti-vaccine advocacy group — has emerged as one of the most recognizable figures in the new administration’s proposed cabinet.

The prospect of his confirmation has resulted in opposition from many people in the medical field, who cite his extensive history of promoting inaccurate claims on vaccines, infectious diseases and other areas of medical science. The Senate hearings before two separate committees are slated for Wednesday and Thursday.

Nobel laureates have written that Kennedy would put the nation’s health in jeopardy. The American Public Health Association, representing 25,000 professionals in that field, has come out against his nomination, based on his “consistent disregard for scientific evidence.” And recently thousands of physicians and others in health care have signed onto letters echoing these concerns.

“All we need is a handful of senators,” says Dr. Rob Davidson, executive director of Committee to Protect Health Care, a progressive advocacy group that reports gathering more than 18,000 signatures from physicians (though the list hasn’t been made public). “They should look at his record and it will absolutely confirm that he is a danger.”

As health secretary, Kennedy would wield enormous influence — overseeing agencies that steer public health, biomedical research, pharmaceuticals, health coverage for more than 160 million people, and other essential functions for the country’s health care.

Supporters have embraced his pledge to disrupt the medical establishment, overhaul federal health agencies and research priorities, and reverse the “chronic disease epidemic.”

Kennedy does face “a lot of organized opposition,” says Jay Richards, a senior research fellow at the right-leaning Heritage Foundation, who views that as further evidence of industry efforts to resist his agenda to tackle the “corrupting influences of Big Pharma, Big Food and Big government.”

Backers of Kennedy have launched their own efforts to signal support — one such letter says it has gathered more than 5,000 signatures from physicians, scientists and others in academia (the full list is not public).

When reached for comment over the phone, a spokesperson said Kennedy had met with over 60 senators and is “prepared and excited.”

In his alliance with Trump, Kennedy has played up his promise to address chronic diseases, branded under the slogan “Make America Healthy Again.”

While it’s a broadly appealing message, Kennedy has ascended to this point — not in spite of his past record on vaccines and questioning of the scientific consensus — but because of that, argues Dr. Jeffrey Flier, former dean of Harvard Medical School and an endocrinologist who researches obesity and diabetes.

“Anyone could stand up and say, ‘We have a lot of chronic diseases. We need to look at it,'” Flier says, “The idea that he represents some new insight into the importance of that area and how we should be thinking about it is ludicrous.”

Ross Brownson notes there are many “well-qualified middle to right-leaning experts” who could lead HHS, without the same troubling track record as Kennedy.

“He would not be my choice,” says Brownson, an epidemiologist and expert in chronic disease prevention at Washington University in St. Louis. “Whether the public health world can affect that is a political question.”

Vaccine record to face scrutiny

And Dr. Brett Giroir, former assistant secretary for health under the first Trump administration, says Kennedy’s path to confirmation — and the upcoming hearings — may hinge on whether senators believe that he has “moderated” his views on vaccines.

“Vaccination is one of the cornerstones of public health,” says Giroir, who’s now CEO of Altesa BioSciences, “His reliance on pseudoscience or quasi-science to form his opinions needs to be changed.”

Kennedy has repeatedly brought up the debunked link between vaccines and autism and other misleading claims about their safety. In a 2023 podcast interview, he stated “there’s no vaccine that is safe and effective.” And about five months into the COVID-19 vaccine rollout, he petitioned the federal government to revoke the authorizations for the shots.

Vaccines are considered some of the most studied medical interventions in the world and are estimated to have averted more than 150 million deaths over the last 50 years, according to a recent analysis in the Lancet.

For his part, Kennedy denies spreading misinformation, though his criticism of vaccines is well known.

During an NPR interview in November, Kennedy said his priority is to study vaccine safety and that he will not take vaccines away from anybody. But Giroir says that alone isn’t sufficient because there’s a lot the HHS secretary could do to “negatively impact vaccines” short of pulling them from the market.

For instance, as HHS secretary Kennedy could remove shots from the immunization schedule adopted by the Centers for Disease Control and Prevention, change who sits on the advisory committee that makes recommendations and selectively release data that doesn’t represent overall vaccine safety.

Giroir says Kennedy’s confirmation has some “potential upsides” if he commits to following the scientific process and supporting immunization.

But Dr. Paul Offit, who has followed Kennedy’s activism for years, disagrees vehemently, saying he “has little doubt” Kennedy will take steps to disrupt vaccine programs were he to be confirmed.

“No matter how much data you show him, he refuses to believe it,” says Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, “He’s an anti-vaccine zealot.”

Physicians organize as others remain silent

Despite the outpouring of opposition to Kennedy on social media and in op-eds, some of the most prominent physician organizations have refrained from taking a public stance one way or the other on Kennedy’s confirmation, including the American Academy of Pediatrics and the American Medical Association.