Hsieh outlines his strategy
Taipei Times, Monday, Feb 21, 2005,Page 3

Premier Frank Hsieh defines the goals of his Cabinet as promoting negotiation and stability. `Taipei Times’ staff reporters Ko Shu-ling and Jimmy Chuang recently spoke with the former DPP chairman and Kaohsiung City mayor to find out more about his views on how he plans to approach `negotiation,’ especially on divisive issues such as health insurance, tax reform and cross-strait relations

(excerpt)

TT: Some have criticized as “unfair” your plan to increase the ceiling on indexed health insurance premiums and let the rich pay more. What do you think of this criticism?

Hsieh: A recent opinion poll shows that over 73 percent of voters support the measure. As the national health insurance program is, to some extent, a social insurance mechanism, I believe, as do other highly paid Cabinet officials, that it makes sense to have better-off Taiwanese pay more. The bottom line is that the program is only beneficial as long as society is stable, which is a more important consideration than how much the rich pay in their premiums.

If criticism of the new measure is justified, I’d like someone to explain how. I am not an expert on this, but I listen to the experts’ opinions and do the calculations myself. It’s not a good thing to listen to one person’s opinion and assume that something is wrong.

The change should be made based on three convictions. First, the national health insurance program must continue to work because it is extremely convenient, especially for the underprivileged. Second, because national health insurance is a social program, government intervention is necessary and we are obliged to shoulder certain financial burdens. Finally, we have to come up with strategies not only to save money, but to generate more. I firmly believe our national health insurance policy is among the world’s best.

In a bid to generate more money, we believe it is good to let the better-off pay a little more. While the current ceiling on indexed health insurance premiums is NT$87,600, it will be increased to NT$131,700. In other words, those who make NT$10 million a month will pay the same health premium as those who make NT$131,700.

I also believe the costs of promoting better health, education and disease prevention should be paid by the government rather than the health insurance program.

In addition, we have decided to raise the “health tax” on cigarettes. Our plan is to increase it from NT$5 to NT$10 per pack. It is estimated that such an increase will bring in an extra NT$1.5 billion to NT$2 billion each year. About NT$2 billion from air pollution fees will also be injected into the program.

In addition, we are considering requiring those responsible for public disasters, food poisoning, and major traffic accidents to pay the medical expenses of the victims. However, I don’t think it is right to channel lottery revenues into the program.

I hope to finalize the measure on how to better execute the hospital transfer system and its supplementary plan by July 1 or Jan. 1.

With the implementation of all the measures, I hope we will be able to keep the health insurance program afloat for two or three more years before the second-generation health insurance policy is in place. I believe most people will approve of the measure

By David Lazarus

There’s no simple or straightforward solution to Medicare’s funding woes. At least with Social Security’s looming troubles, the remedies can be narrowed down to three fundamental (albeit unpleasant) options: raise taxes, reduce benefits or borrow a big pile of money.  It’s not so easy with Medicare.

“We cannot solve the problems that face Medicare without dealing with the broader problems that face health care in America,” said Robert Reischauer, president of the nonpartisan Urban Institute — a Washington think tank — and former director of the Congressional Budget Office.

Medicare and Social Security are plagued by the same demographic challenge– the pending retirement of millions of Baby Boomers. Both programs face huge funding shortfalls as fewer workers pay into each system and more retirees take money out.

In the case of Medicare, however, the fiscal difficulties come sooner and are considerably larger. Also, Medicare’s situation is greatly exacerbated by runaway prices for medical treatment and medication.”You can’t solve this by looking at Medicare alone,” Reischauer said. “There are systemic issues that have to be addressed as well. That’s the real problem.”
  
Medicare is the $350 billion-a-year federal health insurance program primarily for people over 65 or those with disabilities. It has about 42 million beneficiaries. (Medicare’s sister program, Medicaid, provides health coverage for about 44 million low-income recipients.)

As I reported Friday, Medicare costs are expected to surpass those of Social Security by 2024. By 2078, Medicare’s annual expenditures will be twice as large as Social Security’s.

The portion of Medicare that pays for hospital stays — the largest component of the program — is expected to be in the red five years from now. It will then have to start spending reserve funds.

By 2019, those reserves are expected to be gone and the program will no longer be able to pay full benefits. Medicare’s deficit over the next 75 years is projected to run as high as $27.7 trillion, compared with a $3.7 trillion shortfall for Social Security over the same period.

Leslie Norwalk, deputy administrator of the Centers for Medicare & Medicaid Services, the government agency overseeing Medicare, said a funding gap of nearly $28 trillion appears daunting, but “within a 75-year window, a lot can happen.”

“There’s a long time between now and then,” she said. “When you think about how much the health care system has changed, it’s very hard to sit in my chair and imagine how things will be 75 years from now.”

Much could happen, Norwalk believes, that could bring down the cost of health care for future generations. But Robert Moffit, director of the Center for Health Policy Studies at the conservative Heritage Foundation, said it’s far more likely that researchers will come up with new drugs and new treatments that will further extend people’s life spans.

“These kinds of breakthroughs will be terribly expensive,” he said. “This will only add to Medicare’s costs.” Reischauer at the Urban Institute said he would tackle Medicare’s issues by effectively reinventing the nation’s health care system.

“I would start at ground zero,” he said. “I would spend a significant amount of money on an independent body charged with evaluating all the procedures and devices in health care and writing practical guidelines.”
  
By following such national guidelines, Reischauer argued, health plans and health care providers throughout the country would be able to eliminate redundancies and introduce new efficiencies.

“We need to begin building a new system brick by brick, and the system needs to be evidence-based,” he said. That’s all well and good, responded Heritage’s Moffit, but it’s not politically realistic to think that the United States can simply throw its existing health care system out the window and start again from scratch.
  
“We can’t do it all at once,” he said of fixing Medicare’s problems. “It’s too big to do all at once.” Moffit’s solution involves changing the Medicare program at first only for the Baby Boomers — those turning 65 after 2010. He would replace the average $6,500 now spent annually on Medicare beneficiaries with a yearly subsidy, perhaps in the form of a tax credit.

Recipients in turn would use the money to choose their own health care plan based on individual needs. If someone wants to spend all his cash on Viagra — which is covered under President Bush’s costly new Medicare drug benefit — that would be his decision.

“This would address some of the long-term cost issues,” Moffit said. “It would not be an open-ended entitlement. “We’re going to be spending a lot more on the Baby Boomers than we did on the World War II generation,” he pointed out. “There’s just a lot more of them. ”

Medicare’s Norwalk called Moffit’s suggestion “a very interesting proposal.” But, she added, “I don’t see it as politically viable.” Ida Hellander, executive director of Physicians for a National Health Program, a Chicago advocacy group, said Medicare’s woes demonstrate the need for universal medical coverage in the United States.

The clear solution, she said, is a so-called single-payer system similar to national health plans in Canada and elsewhere. “You can’t control costs,” she said, “until you have a uniform system.”

Under a single-payer system, any citizen could be treated by any doctor at any hospital. Payroll taxes would replace all existing premiums,deductibles and co-pays.
  
Medicare could serve as the bedrock for creation of a single-payer system. Between that program, Medicaid and Veterans Affairs, Hellander said, taxpayer funds already account for about 60 percent of U.S. health spending.

In California, state Sen. Sheila Kuehl, D-Santa Monica, plans to introduce legislation this week that would establish a single-payer system for state residents.

A recent report by the Lewin Group, a well-regarded health care consulting firm, determined that universal coverage along the lines of what Kuehl is proposing would reduce health care spending in California by $8 billion next year alone.

It also would provide coverage for the nearly 6 million uninsured people statewide and result in lower costs for virtually all California companies now providing insurance to employees, Lewin found.

Heritage’s Moffit rejected the notion of a single-payer system in this country. “That’s exactly the way to go if you want to reduce quality and personal freedom,” he said.
  
However, Reischauer at the Urban Institute said single-payer may ultimately hold the answers not just for Medicare but also covering the 45 million Americans now lacking health insurance.

“If push came to shove, I would want a single-payer system instead of the system we have now,” he said. “But the political obstacles to that are considerable.”
  
There it is again — politics. Proposals for improving health care from both the left and right are routinely dismissed as being politically unrealistic.

All that remains is a sense of chronic crisis and a leadership vacuum when it comes to tackling some of the most important issues facing this country.

Medicare, like Social Security, can be salvaged. It won’t be easy. It will be damned painful, in fact. But we’ll never know how painful unless we try. David Lazarus’ column appears Wednesdays, Fridays and Sundays. He also can be seen regularly on KTVU’s “Mornings on 2.”

Send tips or feedback to: dlazarus@sfchronicle.com.

Copyright 2005 SF Chronicle

By Dr. James Cockey

It’s wonderful to see the recent interest by The Daily Times in health care policy. Our current health care financing system is simply not working. It costs too much and is giving us far too little in return.

I do want to correct The Daily Times’ editorial of Feb. 11, in which the following statement was made: “If we expect coverage for everything, we should take another look at socialized medicine.”

The only socialized medicine model I have seen in the United States with full centralized government control is the Veterans Health Administration system.

No one I know is advocating full government control of health care. Many of us are advocating universal health care coverage, along the lines of Medicare. No one currently considers Medicare “socialized medicine,” although its detractors used this epithet in 1965 when it was being created.

I appreciate the comments of my friend and colleague, Dr. Frank Arena. I do, however, dispute a few of his positions. While the health care of the VHA system has historically not always been the best, recent studies in major medical journals document its superiority to community hospitals on most quality indicators, largely due to extensive use of computerization to meet quality standards.

I also disagree on the relative complexity of Medicare billing. Billing the multitude of private insurers is far more difficult, requiring more employee expertise and time, than the comparatively straightforward and uniform Medicare regulations.

Our patients also have the added advantage of knowing Medicare will cover expected services and do not face the horror of huge uncovered bills due to fine print exclusions of coverage.

The virtues of high deductible health insurance are not as clear to me as they are to Arena. As soon as we advance the idea that “your premiums are fixed and you can’t be canceled as long as you pay the premium,” we are out of a marketplace insurance system and instituting a variation on national health insurance, with premiums fixed either by the government or some quasi-governmental organization. The for-profit health insurance industry depends on risk and premium stratification to maintain profitability.

A high-deductible, catastrophic coverage health plan creates the illusion of increasing consumer choice. It works for well-off, healthy people who can afford the high deductible for routine care and low-cost procedures. It does not work well for poor people, who can barely afford housing and food for their families. It does not work at all for sick people, who would be priced out of the catastrophic market.

Arena’s letter described single-payer, universal health care as “Utopian socialist.” “Utopian” literally means “nowhere.” Variations on single-payer, universal health care are firmly in place every where — in every other industrialized nation on earth. The United States is the only industrialized nation on earth that does not have such a system.

We also spend twice as much per capita on health care as most of the rest of the industrialized world, with health outcomes that place us low compared to other countries. It’s difficult for me to see where universal health care is any more “socialist” than universal public school education or universal rights to libraries or public roads.

Our health care system endangers our economic competitiveness. It bankrupts too many of our friends and neighbors, and does not effectively protect our health compared to the rest of the world. The only reform on the table which addresses all these problems is a single-payer, universal health care system: Medicare for all.

I hope there will be more articles in The Daily Times about health care financing, more letters to the editor and increased pressure on our politicians to act on this very real crisis.

* Dr. James Cockey lives and practices medicine in Salisbury.

Back-breaking bills/Uncovered medical expenses are leading to bankruptcies
By Victoria Colliver, Chronicle Staff Writer

Jeannie Brewer is a physician married to a surgical resident. She and her family have health insurance. She’s not the kind of person you’d expect to be pushed to the verge of financial collapse by medical expenses. Yet Brewer is considering filing for bankruptcy, and part of the reason is the $16,500 in health care costs her family incurs each year that are not paid for by insurance.

“I have got creditors all over me. I am at the point where I don’t know what else to do,” said Brewer, 44, of Alameda. Brewer is one of a growing number of Americans who are discovering that health insurance doesn’t protect them from financial troubles caused by medical expenses. There are several reasons for the trend. Employers have been offering skimpier health care benefits and requiring their workers to pay more for coverage. Policies with high deductibles have become increasingly popular as a way for employers to manage unaffordable premiums.

Between copayments, requirements to pay certain percentages of medical bills and services that just aren’t covered, large numbers of people with insurance are facing burdensome out-of-pocket expenses. Many of them wind up in debt. And a significant percentage of those turn to bankruptcy Court for relief.

“There is a trend toward insurance being viewed as sort of catastrophic protection,” said Jeff Morris, resident scholar at the American Bankruptcy Institute. “The problem, of course, is it doesn’t take a lot of hours at a hospital to generate a bill that is very difficult to pay.”

In Brewer’s case, financial problems stem in part from her daughter’s diabetic condition. Three-year-old Lara must be constantly monitored and tested at least eight times a day. That has prevented Brewer from working normal hours for her employer, Alta Bates Summit Medical Center in Oakland, and held her income to just $35,000 last year.

Her credit card debt has spiraled to about $140,000, including some medical bills, but mostly daily expenses. She and her husband, who earns a modest salary as a resident, also have a combined $360,000 in medical school debt.

Brewer said that if she files for bankruptcy, she will do so as an individual to preserve her husband’s credit rating.

Loopholes in insurance

A Harvard University study of medical bankruptcy released earlier this month found that financial hardship caused by medical bills is not a problem that affects only the uninsured. Most people who file for personal bankruptcy because of health care expenses, like Brewer, actually have health insurance, the study found.
  
“Even the best policies in this country have so many loopholes, it’s easy to build up thousands of dollars in expenses,” said Dr.Steffie Woolhandler, a Harvard associate medical professor and one of the study’s authors.

The study looked at 1,771 bankruptcies filed in 2001 in five states,including California. Almost half of those filers — 46.2 percent — cited illness and medical bills as a major cause of bankruptcy. More than three-quarters had insurance at the onset of illness.

The problem seems to be largely a middle-class phenomenon. Typical medical bankruptcy filers are in their early 40s and have children. Most have at least some college education and own their homes.

Even if people have health insurance to begin with, many lose coverage because they are unable to keep their jobs because of medical problems.

Need for disability insurance

The health insurance industry says the lack of proper disability income protection could be the primary reason for medical-related financial problems.

Disability insurance “doesn’t pay your doctor, but gives you income for food,” said Susan Pisano, spokeswoman for America’s Health Insurance Plans, a trade group for the health insurance industry.

Pisano said it’s difficult to separate medical debt from other financial pressures associated with a health problem, especially loss of income due to an individual’s inability to work full time or to keep a job at all.
  
Even if bankruptcy is averted, the financial strain of an illness can set finances back for years. Berkeley resident Connie Taylor found herself $38,000 in debt when her daughter had to be hospitalized for a psychiatric condition. She didn’t realize that the treating physician was not among her health insurance company’s covered network of doctors.

Extra expenses

“I thought if you had insurance, you had insurance. You would be OK,” said Taylor, 53, a hospital housekeeper. She said she did not know there was such a thing as an out-of-network provider under her policy and was not informed that her daughter’s doctor would cost extra.

The hospital, through its collection agency, placed a lien on her home. Although the episode occurred in 1993, Taylor did not pay off the bill until 2001, with the help of her church and her ex-husband.

For San Francisco resident Anna Chavez, the event that prompted her financial woes was a happy one: the birth of her first child in 2000. While she was glad to get pregnant, it was unplanned. She and her husband had just opened a restaurant in San Mateo and had bare-bones insurance through Blue Cross that didn’t cover childbirth. Unable to change her policy after becoming pregnant, Chavez figured that the couple would be responsible for about $4,000 in out-of-pocket insurance expenses and $1,000 in physician fees.

The couple balked when the hospital charged them $2,300 more than they had estimated. Chavez said she asked the hospital to arrange a payment plan. Instead, she said, the hospital filed a lawsuit, which the couple lost by default. She estimates that after the attorney’s fees and court expenses, the birth of their child cost the couple $10,000.

Understand the terms

A Blue Cross spokeswoman declined to comment on Chavez’s situation, citing privacy concerns. She said customers should work carefully with their brokers to understand the terms of their policies.

Chavez, 35, who is currently uninsured, has since qualified for the state’s Healthy Families program, which covers low- to moderate-income children. She had her second child essentially for free under another state program. That makes her uncomfortable. “I just feel like I was rewarded for not having insurance, and I was not rewarded for trying to do the right thing,” Chavez said.
  
Jeannie Brewer, MD is a CaPA member
E-mail Victoria Colliver at vcolliver@sfchronicle.com.

By Robert Kuttner  

AT DINNER, two sets of parents of college seniors are discussing their dreams for their soon-to-be newly minted graduates. Doctor? Lawyer? Scientist? Entrepreneur?

”I just hope she gets a job with health insurance,” says one mom, breaking the spell. ”The insurance cuts off the day they graduate.” A dad chimes in: ”COBRA coverage costs over $400 a month.” (COBRA is an acronym for a consolidated budget act that allows you to keep your coverage by paying the premium costs out of pocket. It is well named.)

In a country with a rational system of health insurance, your coverage would not be subject to the quirks of when you graduated college, where you worked, or whether you had been sick earlier in your life. But the American system is a patchwork mess of coverage, noncoverage, and inadequate coverage, slightly tempered by well-intentioned efforts to fill in the cracks, which only add to the fragmentation and cost.

Meanwhile, President Bush’s budget proposes to cut some $45 billion out of Medicaid funding over 10 years. The Massachusetts share of the loss would be $1.26 billion.

Medicaid is becoming the monster that’s devouring the rest of state budgets. In recent years, Medicaid costs have been rising at between 9 and 12 percent while state budgets are just about keeping pace with inflation.

But Medicaid costs are rising not because states are becoming more generous with what they cover or because states are liberalizing Medicaid eligibility rules. On the contrary, rules are being tightened and coverage restricted. The Urban Institute finds that actual Medicaid per-patient costs are growing at only about half the rate of private insurance, and a study by the Kaiser Family Foundation reports that 23 states have already taken actions to freeze enrollment or cut benefits.

So why is Medicaid such a drain on state treasuries? Because it is the health insurance of last resort. As fewer employers provide coverage that employees can afford, more and more people are being dumped into the Medicaid pool, leaving states holding the bag.

Not content to cut the federal share, Bush also proposes to turn the program into a capped block grant, which would pass even more of the costs to the states. This, in turn, would lead to even further benefit cuts and more people going without basic medical care or flooding emergency rooms.

Another government health program, the State Children’s Health Insurance Program, was intended to cover kids whose parents made a little too much money to qualify for Medicaid. There are millions of families where one or both parents have inadequate employer-provided insurance or no insurance and the kids are covered under SCHIP. And because parents’ income fluctuates, kids can be bounced from program to program — SCHIP, Medicaid, private insurance — with different eligibility rules and different doctors.

Continue the tour of our absurdly fragmented health system. As part of the same 2005 budget proposal, the president admits that his crown-jewel program, drug coverage under Medicare, will cost not the $400 billion over 10 years that he projected when he jammed the bill through Congress in 2003 but $1.2 billion. Bush officials helpfully explain that with changes in various formulas — in other words, benefit cuts — the cost can be held to a mere $720 billion.

The Medicare drug law, which doesn’t even become effective until 2006, is so outlandishly expensive because it was written to drug industry specifications. The law explicitly prohibits the government from negotiating bulk discounts with drug companies the way VA hospitals and the Canadian national health insurance program do. Seniors covered by Bush’s Medicare drug program and their partner, the American taxpayer, will pay sticker price.

Gentle reader, this is all insane. We have the world’s most expensive medical system and the least reliable insurance coverage. Yes, I know Clinton-care was a political disaster, but it wasn’t true national health insurance. Clinton naively tried to give the insurance companies a big piece of the action, and they gratefully responded by spitting in his eye.

Ordinary people are absolutely sick of the health insecurity and the endless and wasteful paper chase. So, by the way, are doctors. We have what the political scientist Walter Dean Burnham calls a ”politics of excluded alternatives.” If some nervy politician, or group of politicians, called for true universal national health insurance, they would get broad public support. It’s called leadership.

Robert Kuttner is co-editor of The American Prospect. His column appears regularly in the Globe.

EMBARGOED UNTIL 12:01 a.m. EST
February 14, 2005

Contact: David Himmelstein, MD
Steffie Woolhandler, MD
(617) 497-1268
(617) 312-0970
Nicholas Skala (312) 781-6006
nick@pnhp.org

1,700 Doctors: “Bankruptcy Bill Threatens Patients”

Harvard Study Shows Legislation a Danger to Millions Bankrupted by Medical Bills
Physicians Urge Congress to Reject S. 256

On the heels of a major Harvard University study showing that half of all personal bankruptcies are due to illness or medical bills, more than 1,700 American physicians signed a letter released today opposing legislation that would remove protection from patients financially ruined by medical costs.

Bankruptcy law currently offers some protection to the millions of Americans affected by medical bankruptcies each year. If passed, the bill would effectively close bankruptcy as an option and allow creditors to take the homes, cars and other assets of families who suffer a serious illness or injury.

“It’s a sad fact that bankruptcy courts have become the last line of defense for the victims of our broken health system,” said Dr. David Himmelstein, an Associate Professor of Medicine at Harvard Medical School and lead author of the study. “For many families affected by a costly illness, the limited protections of bankruptcy are the only chance to get back on their feet.”

In the letter to the leaders of the Senate Judiciary Committee, which is currently considering the bill, the doctors expressed concern that the new bankruptcy rules would further restrict the ability of patients suffering from medical costs to get needed care for themselves and their families.

“Medical debtors’ access to care is already severely compromised: more than 60 percent go without a needed doctor visit and half don’t fill a prescription because of the costs,” said Dr. Steffie Woolhandler, who is also an Associate Professor of Medicine at Harvard and co-author of the study. “For those unable to seek relief from their debts, the situation will undoubtedly get worse,” she said.

The epidemic of medical bankruptcies, which affect 2 million Americans (including 700,000 children) every year, emphasizes the need for comprehensive health insurance coverage under a national health insurance plan according to the signers, who include former U.S. Surgeon General Julius Richmond.

“Current insurance policies offer paltry protection for the average American,” said Dr. Quentin Young, National Coordinator of Physicians for a National Health Program. “Most of those who are bankrupted by medical bills are middle class people who had coverage but were ruined by the massive holes in their policies. Rejecting this new bankruptcy legislation is just the first step we need to take in healing our sick health system. We need a system of universal, comprehensive Medicare for all.”

A full list of signers of the letter can be viewed at: www.pnhp.org/signers

###

Physicians for a National Health Program is an organization of 13,000 physicians advocating for non-profit national health insurance. PNHP has chapters and spokespersons across the country. For contacts, call (312) 782-6006

EMBARGOED UNTIL 12:01 a.m. EST
February 14, 2005

Contact: David Himmelstein, MD
Steffie Woolhandler, MD
(617) 497-1268
(617) 312-0970
Nicholas Skala (312) 781-6006
nick@pnhp.org

1,700 Doctors: “Bankruptcy Bill Threatens Patients”

Harvard Study Shows Legislation a Danger to Millions Bankrupted by Medical Bills
Physicians Urge Congress to Reject S. 256

On the heels of a major Harvard University study showing that half of all personal bankruptcies are due to illness or medical bills, more than 1,700 American physicians signed a letter released today opposing legislation that would remove protection from patients financially ruined by medical costs.

Bankruptcy law currently offers some protection to the millions of Americans affected by medical bankruptcies each year. If passed, the bill would effectively close bankruptcy as an option and allow creditors to take the homes, cars and other assets of families who suffer a serious illness or injury.

“It’s a sad fact that bankruptcy courts have become the last line of defense for the victims of our broken health system,” said Dr. David Himmelstein, an Associate Professor of Medicine at Harvard Medical School and lead author of the study. “For many families affected by a costly illness, the limited protections of bankruptcy are the only chance to get back on their feet.”

In the letter to the leaders of the Senate Judiciary Committee, which is currently considering the bill, the doctors expressed concern that the new bankruptcy rules would further restrict the ability of patients suffering from medical costs to get needed care for themselves and their families.

“Medical debtors’ access to care is already severely compromised: more than 60 percent go without a needed doctor visit and half don’t fill a prescription because of the costs,” said Dr. Steffie Woolhandler, who is also an Associate Professor of Medicine at Harvard and co-author of the study. “For those unable to seek relief from their debts, the situation will undoubtedly get worse,” she said.

The epidemic of medical bankruptcies, which affect 2 million Americans (including 700,000 children) every year, emphasizes the need for comprehensive health insurance coverage under a national health insurance plan according to the signers, who include former U.S. Surgeon General Julius Richmond.

“Current insurance policies offer paltry protection for the average American,” said Dr. Quentin Young, National Coordinator of Physicians for a National Health Program. “Most of those who are bankrupted by medical bills are middle class people who had coverage but were ruined by the massive holes in their policies. Rejecting this new bankruptcy legislation is just the first step we need to take in healing our sick health system. We need a system of universal, comprehensive Medicare for all.”

A full list of signers of the letter can be viewed at: www.pnhp.org/signers

###

Physicians for a National Health Program is an organization of 13,000 physicians advocating for non-profit national health insurance. PNHP has chapters and spokespersons across the country. For contacts, call (312) 782-6006