Resource Archive - Page 159 of 1217

Bernie Sanders Introduces New Medicare For All Bill, Welcoming War With Insurance Industry

He’s promising more benefits — and facing more opposition.

By Daniel Marans and Jonathan Cohn
HuffPost, April 10, 2019

Bernie Sanders on Wednesday is formally introducing an updated version of his bill to enroll every U.S. resident in a single, government-run health insurance plan.

This new iteration of “Medicare for All” legislation looks a lot like the previous one, which the independent Vermont senator introduced in the fall of 2017. It envisions a government insurance plan that would pay for all medical services with almost no out-of-pocket expenses, making it more comprehensive than either traditional Medicare or employer policies.

The latest version of Medicare for All also includes coverage of home health aides, job counselors, and other supports that allow disabled and elderly people to live on their own, outside of nursing homes or other institutions.

Funding for the legislation would have to come through some combination of taxes and fees, in lieu of what employers and individuals pay for insurance today, with government regulating the prices of prescription drugs, hospital services and every other type of health care service in order to keep the program’s overall costs manageable.

The new bill, like its predecessors, does not offer many details on these financial provisions, making it impossible to say with precision how different groups of Americans would ultimately fare, or whether it would require new deficit spending. But Sanders on Wednesday is distributing a separate list of funding options, including new payroll taxes, and vowing to fight health care industry groups that, he said, were profiting at the expense of the American public.

“The current debate over Medicare for All really has nothing to do with health care, it’s all about greed and huge profits,” Sanders planned to say at a news conference, according to prepared remarks his office circulated in advance. “It is about whether we maintain a dysfunctional system which allows health insurance companies and drug companies to make tens of billions of dollars in profits and their CEOs to make outrageous compensation packages.”

With millions of Americans struggling to pay their medical bills, even with the Affordable Care Act in place, the idea of creating a single, national health insurance program that would cover nearly all medical expenses is attracting greater interest than it has in many decades.

The 2017 Medicare for All bill had 16 Democratic senators as co-sponsors, far more than Sanders had recruited previously, and the 2019 version has nearly as many. Among the Democratic senators on both the old and new bills are Cory Booker of New Jersey, Kirsten Gillibrand of New York, Kamala Harris of California, and Elizabeth Warren of Massachusetts ― all of whom, like Sanders, are seeking the 2020 Democratic presidential nomination.

“The fact that his new bill has attracted support from many other senators, including presidential front-runners, is a sign that politicians are really starting to listen to the people,” Adam Gaffney, president of Physicians for a National Health Plan, said. “It’s an encouraging development, though obviously large obstacles lie ahead.”

And those obstacles loom larger every day. Precisely because Medicare for All is getting more serious attention, it’s also generating more serious pushback ― not just from Republicans and health care industry groups, who are already mobilizing against it, but also from some Democrats, who say the Sanders proposal would be too difficult to pull off, as policy or politics, or simply not a great idea on the merits.

One Democratic senator who supported the 2017 bill, Jeanne Shaheen of New Hampshire, has pointedly declined to endorse the new version. “In the near term, there are faster ways to reach universal coverage by building on the progress we’ve made through the Affordable Care Act, while addressing the high cost of care and medications,” Shaheen told HuffPost.

And all four of the 2020 contenders co-sponsoring the Sanders bill have indicated during campaign appearances they would also support more incremental efforts to achieve universal coverage, such as proposals that would allow employers to keep offering private coverage for employees who want it.

One reason some Democrats have misgivings is the public’s decidedly mixed feelings about the kind of transformation Sanders envisions. Americans like the sound of Medicare for All but, as polls have shown repeatedly, they get skittish when they realize it means giving up private insurance.

“There are 160 million people who get their insurance through their employer,” Rep. Rosa DeLauro (D-Conn.), sponsor of a bill that would create a government insurance plan but make it voluntary for many people, said earlier this year. “You cannot tell them overnight that it is gone.”

Or, at the very least, you cannot do so without expecting a lot of resistance. Although centralized systems in other developed countries deliver high quality, universal coverage at a fraction of what it costs in America, none of those other countries first had to dismantle a scheme as entrenched and expensive as the U.S. system.

Simply enacting such a program would be daunting, especially if the Senate does not modify or abolish the filibuster, which effectively requires a vote of 60 members to pass most legislation. In an interview with HuffPost on Saturday, Sanders indicated that he was wary of abolishing the filibuster.

And although Sanders on Wednesday will cite independent studies showing that a Medicare for All system could actually result in the U.S. spending less money on health care, those studies assume savings from simplified billing and lower payments to health care providers that, some experts worry, might not materialize as planned.

But Sanders is no stranger to skepticism. Almost nobody in mainstream politics took Medicare for All seriously before Sanders made it the linchpin of his 2016 bid for the Democratic presidential nomination. And although he has effectively lost the support of one additional senator ― former Minnesota Democrat Al Franken co-sponsored the 2017 bill but his replacement, Tina Smith, isn’t on the 2019 version ― Sanders now boasts the support of twice as many outside groups as in 2017, including the powerful labor unions, the American Federation of Teachers and the Service Employees International Union.

The new bill is also winning praise from representatives of the disability rights community, who worked closely with Sanders on crafting the provisions for home- and community-based services ― which, today, are typically available only for people whose low incomes qualify them for Medicaid, and even then only on a limited basis. Previous versions of the Sanders bill did not include this coverage.

“We are grateful to Senator Sanders for including home and community-based long term services and supports (LTSS) as part of the Medicare for All bill,” said Nicole Jorwic, senior director of public policy at The Arc. “The ‘All’ includes people on waiting lists for these services all over the country.”

Sanders envisions moving all people into the new government insurance program over the course of four years. That is a key difference between his bill and the latest version of House Medicare for All legislation, which Rep. Pramila Jayapal introduced in February and which calls for a transition of just two years.

But in most respects the two bills are similar ― and on a similar political trajectory. The new version of Jayapal’s legislation included enhancements, including better coverage of long-term care for the elderly and disabled. It also had slightly less support than a previous version: About two dozen incumbent House Democrats who signed onto a Medicare for All bill in the last Congress declined to co-sponsor Jayapal’s. But Jayapal also secured support from new interest groups, including some of the unions that are now signing onto the Sanders bill as well.

Although many Democrats in Congress aren’t ready to support Medicare for All, most seem to favor at least some expansion of government-run insurance programs. And even the most conservative members of the party’s caucus agree on the need to defend the Affordable Care Act’s gains against President Donald Trump, who recently announced his support for a lawsuit that would wipe the law off the books because of one allegedly unconstitutional provision.

But on Capitol Hill, Republicans seem eager to deemphasize “Obamacare,” which polls show becoming more popular, and focus instead on Medicare for All, which has the potential to rattle voters who fear change.

“People say ‘I don’t know what Medicare for All is about,’” Sen. John Barrasso, a Wyoming Republican who happens to be a physician, told HuffPost. “Well as a doctor, I can tell you. It means longer lines and waiting times to get to see a doctor. It means higher taxes. It means fewer choices, less freedom.”

In reality, countries with single government programs and other forms of national health insurance frequently have shorter waits for services ― not to mention far fewer people struggling with medical bills. Just this past week, Gallup published a survey in which one-third of Americans reported that they or a family member postponed medical care because of concerns over cost.

“Thirty-four million have no health insurance, even more are underinsured and one insurance company executive pockets almost $500 million for a merger which will only drive health care costs higher,” Sanders plans to say on Wednesday. “Please don’t tell me that this is a rational health care system.”

Amanda Terkel and Jennifer Bendery contributed reporting.

https://www.huffpost.com…

Doctors’ group welcomes Sen. Sanders’ Medicare-for-All bill

Physician leaders urge Congress to move past incremental proposals towards full single-payer reform

FOR IMMEDIATE RELEASE, April 10, 2019

Contact: Clare Fauke, communications specialist, 312-782-6006, clare@pnhp.org

WASHINGTON, D.C. – Physicians for a National Health Program (PNHP), a nonprofit research and education organization of 23,000 physicians, medical students and health professionals, welcomes the Medicare for All Act of 2019 as an important step towards the organization’s goal of a single-payer national health plan. Introduced today by Sen. Bernie Sanders (I-Vt.), the bill would improve Medicare to include all medically necessary services, while expanding coverage to everyone in the U.S.

“The Affordable Care Act has taught us that merely tinkering around the edges of our broken health care system will only perpetuate its problems: skyrocketing costs, falling health outcomes, medical bankruptcy, and needless death,” said Dr. Adam Gaffney, PNHP’s president and a critical care physician and faculty member at Harvard Medical School. “It’s time to eliminate the greed and waste of private health insurance and move to a Medicare for All system that puts patients ahead of profits.”

Dr. Gaffney notes that despite the advances of the ACA, more than 28 million Americans remain uninsured, with tens of millions more under-insured. Sen. Sanders’ bill would reduce the number of uninsured to zero, allowing everyone in the U.S. to visit the doctor or hospital of their choice for medically necessary care, including dental, vision, and mental health care. It would also largely eliminate patient cost-sharing, which deters many Americans from seeking needed care.

Besides expanding coverage, the Medicare for All Act would go a long way towards containing the nation’s overall health care costs, which are double the per-capita spending of other industrialized nations that provide universal coverage. Without single-payer reform, U.S. annual health spending is projected to reach $5.96 trillion — 19.4 percent of GDP — by 2027.

PNHP commends the inclusion of community and home-based long-term care services in the new bill. However, PNHP also recommends several additional improvements to the Medicare for All Act that would save money and improve patient care. In particular, healthy payment strategies are needed, including global budgeting and the separation of capital and operating payments to hospitals and other institutional providers; ending “value-based” payment systems; and providing a path for the orderly conversion of investor-owned, for-profit health-care providers to not-for-profit status.

Dr. Gaffney encouraged members of Congress to move past the recent flurry of incremental proposals, such as those that claim to “strengthen” the ACA by further subsidizing the private insurance industry, or add a costly public option to our already fragmented system. “Only a true single-payer plan can provide both universal coverage and the hundreds of billions in annual savings necessary to work,” added Dr. Gaffney.

“We look forward to working with Sen. Sanders to strengthen and advocate for this important bill.”

Physicians for a National Health Program (www.pnhp.org) is a nonprofit research and education organization whose 23,000 members support single-payer national health insurance.

Gerald Friedman explains the mixup in reasonable and unreasonable reform

Take it from an economist, Medicare for All is the most sensible way to fix health care

I’ve spent decades studying US health care. Time to get real: Medicare for All is the only reasonable path to controlling costs and covering everyone.

By Gerald Friedman
USA TODAY, April 8, 2019

There is an instinct among political pundits to confuse caution for practicality — an assumption that those who advocate for incremental change are being reasonable, while those pushing for bold reforms aren’t. This is seen most starkly in the debate around health care reform, despite the fact that the “practical” pushers of limited reform fail to address the real problems in our health care system.

We all recognize that the status quo isn’t working. We spend more per person than any other country on health care, but we aren’t getting any bang for our buck. We have lower life expectancy, higher infant mortality rates and more preventable deaths, and too many personal bankruptcies are due at least in part to medical bills.

Where we disagree is the solution. The favorite new “reasonable” plan is “Medicare for America,” a bill from Reps. Jan Schakowsky and Rosa DeLauro that has won the support of big names like Texas presidential hopeful Beto O’Rourke and the Center for American Progress, the left-of-center think tank where the plan originated as “Medicare Extra for All.” It has been extolled in opinion pieces for some of America’s largest newspapers as a “realistic” plan to fix what’s broken in our health care system.

On the other side, if punditry is to be believed, there are the Medicare for All “hard-liners” who believe in expanding a significantly improved Medicare system to every American, with coverage that includes dental, vision and long-term care. This is portrayed as radical or even unreasonable.

Time to get real. As an economist who has spent decades studying our health care system, I can tell you that Medicare for All advocates are the only ones who are being reasonable, because theirs is the only plan that will control health care costs while finally achieving universal coverage.

Insurance companies are middle men

The problem with incremental plans, whether they are public options, buy-ins to Medicare or Medicaid, or pumping more money into subsidies in the Affordable Care Act’s individual marketplace, is that they preserve the private health insurance system weighing down our health care.

This may be why pundits and centrist politicians view those plans as “reasonable,” but it means that they are leaving the main reason for our system’s dysfunction in place: the multipayer, for-profit financing model.

Commercial insurance companies are nothing more than middle men. They add no value to our system, but they do drive up costs with their bloated claims departments, marketing and advertising budgets and executive salaries. We pay for all of these things before a single dollar is spent on the delivery of care.
They also create extra costs for providers who need large administrative staffs to deal with billing systems, accounting for as much as $100,000 per physician.

Any plans short of Medicare for All leaves these costs in place. In other words, they leave hundreds of billions of dollars a year in savings on the table.

Medicare for All attacks costs

The waste goes beyond administrative savings. While pharmaceutical companies and hospital groups are consolidating and forming regional monopolies, our fragmented, multipayer system leaves no one insurance plan with a large enough share of the market to negotiate effectively. That allows these companies to essentially set their own inflated prices and bilk the public for hundreds of billions of dollars.

Is it any wonder that they oppose Medicare for All?

If we’re talking about which health care reform plans are serious about attacking cost, providing universal coverage and making sure everyone has access to health care, Medicare for All is the only reasonable answer. No other plan does this effectively, which is why I suspect that the Center for American Progress has not come out with spending estimates. Basic economic tenets tell us that their plan will not reduce health care spending as effectively.

Is Medicare for All bold? Absolutely. Is it reasonable? You bet. It is time to accept that Medicare for All is the practical alternative.

Gerald Friedman, a health care and labor economist, is an economics professor at University of Massachusetts Amherst and the director of the Hopbrook Institute. Follow him on Twitter: @gfriedma.

https://www.usatoday.com…

Comment:

By Don McCanne, M.D.

The incrementalists who advocate for tweaks to the Affordable Care Act, perhaps with the addition of a Medicare-like public option, claim to be taking a reasonable pathway to reform. But is it really reasonable to advocate for a system that wastes tremendous resources while leaving tens of millions without adequate coverage and impaired health outcomes, not to mention financial hardship? Well it is unreasonable to make such a claim when fundamental structural reform of our financing system through single payer Medicare for All would establish an equitable and affordable system that ensures health care for everyone. Claiming that displacing the dysfunctional private insurance system is unreasonable is, well, unreasonable.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

HSU Explores the Details of “Medicare for All”

Interview with Dr. Ed Weisbart

Jefferson Public Radio, April 9, 2019

The term “Medicare for all” is several years old, but it is certainly gaining traction this year. Some newer members of Congress are pushing for national health care along the lines of Medicare.

Associated Students of Humboldt State University offer a chance for the public to catch up on the concept and potential features of M for A.

AS of HSU brings Dr. Ed Weisbart of Physicians for a National Health Program and Timothy Faust, author of Health Justice Now to campus Thursday (April 11th) at 5:00 p.m.

Dr. Weisbart joins us for an overview of what they want to see in a national health system.

full audio:
https://www.ijpr.org…

Take it from an economist, Medicare for All is the most sensible way to fix health care

I've spent decades studying US health care. Time to get real: Medicare for All is the only reasonable path to controlling costs and covering everyone.

By Gerald Friedman
USA Today, April 8, 2019

Insurance companies are middle men

They also create extra costs for providers who need large administrative staffs to deal with billing systems, accounting for as much as $100,000 per physician.

Any plans short of Medicare for All leaves these costs in place. In other words, they leave hundreds of billions of dollars a year in savings on the table.

Medicare for All attacks costs

Is it any wonder that they oppose Medicare for All?

Is Medicare for All bold? Absolutely. Is it reasonable? You bet. It is time to accept that Medicare for All is the practical alternative.

Gerald Friedman, a health care and labor economist, is an economics professor at University of Massachusetts Amherst and the director of The Hopbrook Institute. Follow him on Twitter: @gfriedma.

https://www.usatoday.com…

CAP acknowledges administrative excesses, but…

Excess Administrative Costs Burden the U.S. Health Care System

By Emily Gee and Topher Spiro
Center for American Progress, April 8, 2019

Anyone interacting with the U.S. health care system is bound to encounter examples of unnecessary administrative complexity—from filling out duplicative intake forms to transferring medical records between providers to sorting out insurance bills. This administrative complexity, with its associated high costs, is often cited as one reason the United States spends double the amount per capita on health care compared with other high-income countries even though utilization rates are similar.

Components of administrative costs

The main components of administrative costs in the U.S. health care system include BIR costs and hospital or physician practice administration.

To date, few studies have estimated the systemwide cost of health care administration extending beyond BIR activities. In a 2003 article in The New England Journal of Medicine, researchers Steffie Woolhandler, Terry Campbell, and David Himmelstein concluded that overall administrative costs in 1999 amounted to 31 percent of total health care expenditures or $294 billion—roughly $569 billion today when adjusted for medical care inflation. A more recent paper by Woolhandler and Himmelstein, which looked at 2017 spending levels, placed the total cost of administration at $1.1 trillion.

Billing and insurance-related costs

Many studies of administrative costs limit their scope to BIR costs. The BIR component of administration is most relevant to systemwide reforms that seek to reduce the expenses related to claims processing, billing rates, or health insurance. The largest share of BIR costs is attributable to insurance companies’ profits and overhead and to providers where BIR costs include tasks such as record-keeping for claims submission and billing.

Applying the NAM’s (National Academy of Medicine) percentages of BIR costs to recent projections of national health expenditures from the Centers for Medicare and Medicaid Services (CMS), CAP estimates that BIR costs will amount to $496 billion for 2019. According to CAP’s calculations, this includes $158 billion in overhead for private insurance; $56 billion for administration of public insurance programs; and $282 billion for the BIR costs of hospitals, physicians, and other care providers.

Excess administrative costs

Most studies that have attempted to identify excess costs in the American health care system rely on comparisons between the United States and Canada. In their 2010 review of the literature on the difference between the two countries’ health expenditures, economists Alexis Pozen and David M. Cutler… (estimated) per capita administrative excess in the United States, when compared with Canada, translates into a gap of $340 billion (adjusted).

Woolhandler and Himmelstein estimate that the United States currently spends $1.1 trillion on health care administration, and of that amount, $504 billion is excess.

All estimates of administrative costs are inherently sensitive to what portion of health care spending one considers administrative. Such tasks, however, can fall into a gray area between administrative and clinical.

Administrative costs for payers

Within the U.S. system, the share of expenditures that are attributable to administrative costs varies greatly by payer. The BIR costs for traditional Medicare and Medicaid hover around 2 percent to 5 percent, while those for private insurance is about 17 percent. Organisation for Economic Co-operation and Development (OECD) data also show that other nations are able to achieve low levels of administrative costs while maintaining universal coverage across all ages of the population.

International health system data demonstrate that the United States is a clear outlier on administrative spending. Countries with single-payer systems are among those with the lowest administrative costs. OECD data also show that within a country, administrative costs are higher in private insurance than in government-run programs.

Countries that have multipayer systems with stricter rate regulation also achieve much lower administrative costs than the United States. If the United States could reduce administrative costs down to Canadian levels, it would save 68 percent of current administrative expenditures; reducing to German-level administrative costs would save 42 percent of current administrative expenditures. However, to assume that by simply adapting another country’s health care system—whether it is Canada’s single-payer Medicare, Germany’s sickness funds, or Switzerland’s heavily regulated private plans—the United States would automatically achieve the same level of administrative costs may ignore other fundamental differences between countries, including the market power of health care providers, political systems, and attitudes toward health care. Nevertheless, the experience of other multipayer systems such as those in Germany and Switzerland suggests that the United States could substantially reduce both administrative expenditures and overall health care spending by bringing down reimbursement rates and regulating insurance—even while continuing to allow multiple payers and private health care providers.

Administrative costs for health care providers

A study of administrative costs in California found that administrative costs represented about one-quarter of physician revenue and one-fifth of hospital revenue, and BIR costs accounted for roughly half of administrative expenditures for physician and hospital services covered by private insurance. In a separate study, Himmelstein and others reported that one-quarter of U.S. hospital spending went toward administration.

As with BIR costs, provider administrative costs in the United States are higher than those in other comparable countries. Hospital administrative costs in the United States far exceed those of other nations. In their comparison of hospital administrative costs among eight Western nations, Himmelstein and co-authors found that the United States had the highest levels, at 25.3 percent of total hospital expenditures. They conclude that in nations where hospital administrators have minimal responsibilities for procuring financing and where the hospital reimbursement system is least complex, administrative costs can be reduced to 12 percent of expenditures. These findings suggest that reforms that introduce global budgeting or limit the need to bargain with multiple payers could potentially bring down excess hospital administrative costs in the United States.

Lower administrative costs in single-payer and multipayer systems

Although administrative costs contribute to the high expenditures in the United States, they are not the primary reason for the health care spending gap. As economist Uwe Reinhardt and others candidly put it, “It’s the prices, stupid.”

Comparative evidence from U.S. states also suggests that America’s multipayer system explains some, but by no means all, of the discrepancy between the United States and other developed nations. Harvard University researchers Joseph P. Newhouse and Anna Sinaiko observe that “there is considerable variation across the states in spending levels, with the lowest quintile of states spending approximately the same percentage as the higher spending OECD countries other than the U.S. This implies that the [United States’] pluralistic financing system may not be an important cause of the large percentage of GDP that the U.S. devotes to health care.”

Systemwide reforms to lower administrative costs

Health care financing experts believe that changes to how Americans pay for coverage could dramatically reduce administrative costs. Researchers simulating the effects of single-payer programs have assumed that administrative costs would be brought down substantially.

Exactly how such lower costs could be achieved is another question. Reducing BIR costs requires simplifying the billing and payment process, which could be accomplished in a number of ways. Two avenues for reducing administrative costs as well as overall health costs are global budgeting and uniform rate-setting. These two concepts are central to health systems around the world and are also responsible for keeping administrative costs lower, whether a country has a multipayer or single-payer system. Another paperwork-reducing option would be a centralized claims clearinghouse to allow providers to submit all claims to a single entity, as they do in Germany and Japan.

All-payer rates and global budgeting

Setting all-payer reimbursement rates would eliminate the need for providers to negotiate rates with individual private insurers, while also giving policymakers better leverage for controlling overall health care cost growth. In the current U.S. system, providers charge different rates to different payers, and the billing process is complicated and opaque. Setting all-payer rates would simplify billing and improve transparency by establishing a single set of rates for each provider, while also giving regulators a tool to protect consumers from exorbitant rates.

Global budgeting—the practice of paying providers revenue based on their expected costs—also holds promise for both lowering administrative spending and overall costs. As opposed to traditional fee-for-service payments, which reward providers for doing more, global budgeting incentivizes providers to deliver care more efficiently. Global budgeting is a feature of many countries with much lower health care administrative costs, including Scotland, Wales, and Germany. As Woolhandler, Campbell, and Himmelstein point out in their 2003 article, “The existence of global budgets in Canada has eliminated most billing and minimized internal cost accounting, since charges do not need to be attributed to individual patients and insurers.” As Germany shows, both single-payer and multipayer systems can use global budgets.

A system combining all-payer rates and global budgeting is already partially in place in the state of Maryland, where each hospital has a single set of rates it bills to Medicare, Medicaid, commercial insurers, and other payers. Maryland’s system is keeping overall cost growth lower than the national trend. According to RAND analysis of hospital costs, Maryland hospitals have administrative costs that are 9 percent lower than the national average.

In their analysis of three universal health care options for Vermont, including single payer, researchers William C. Hsiao, Steven Kappel, and Jonathan Gruber estimated substantial savings from administrative simplicity from each option. The two single-payer options they examined would result in even greater administrative savings of between 7.3 percent and 7.8 percent, depending on the rate-setting mechanism. The group estimated that a third scenario, which would establish a centralized claims clearinghouse while allowing multiple payers, could generate savings equal to 3.6 percent of total expenditures. This suggests that about half of the total administrative savings from a single-payer system could be obtained within a regulated multipayer system.

Policy proposals directed at administrative costs

While major changes to the U.S. health care system have the greatest potential to bring down costs, more incremental changes could reduce administrative waste. A recent bill proposed by Sens. Bill Cassidy (R-LA) and Tina Smith (D-MN) would direct the HHS secretary to set goals to cut “unnecessary costs and administrative burdens” throughout the health care system by 50 percent over the next 10 years. It would also provide grant money for state-based efforts to bring down administrative costs. Some possible avenues for achieving those kinds of reductions include changes to payment rules, improvements to facilitate electronic record-keeping and information exchange, and simplification of public insurance programs.

In their 2009 article in The New England Journal of Medicine, David Cutler, Elizabeth Wikler, and Peter Basch proposed one such package of reforms. The authors estimated that providers could save $17.9 billion to $23 billion annually with several, more incremental changes to the system, including greater adoption of EHR systems; integrated administrative and clinical systems; national and standardized reporting requirements and credentialing of providers; streamlined enrollment in public insurance programs; and greater automation. In a separate report, the same authors proposed additional reforms that they estimated could reduce excess administrative costs by $40 billion, or 25 percent of total health care expenditures.

In a 2010 study published in Health Affairs, Bonnie B. Blanchfield and other Massachusetts researchers concluded that the administrative burden on physician organizations could be reduced by a “single transparent set of payment rules for a system with multiple payers.” The authors recommended that the United States adopt “a standard set of payment requirements, increased payment-rule transparency, standardized forms, and a standard set of data exchange requirements.” Doing so could save $7 billion in billing costs for physician and other clinical services, according to the authors’ estimates.

Conclusion

Although estimates vary, a large body of evidence shows that the United States is spending about twice as much as needed on the administration of health care. Other nations enjoy world-class health care systems while spending a fraction of what the United States does on governance, billing, and insurance.

A structural overhaul of how health care is financed and priced that includes key features of other countries’ systems—whether one payer or many—would go a long way toward eliminating excess administrative costs. Simplifying the payment system should be an essential part of future health reform and would make the U.S. system work better for taxpayers and patients alike.

Emily Gee is the health economist of Health Policy at the Center for American Progress. Topher Spiro is the vice president for Health Policy and a senior fellow for Economic Policy at the Center.

This publication was made possible in part by a grant from the Peter G. Peterson Foundation.

https://www.americanprogress.org…

15 page PDF:
https://cdn.americanprogress.org…

Comment:

By Don McCanne, M.D.

The president and CEO of the Center for American Progress (CAP) is Clintonite Neera Tanden. She played a very active role in keeping Bernie Sanders’ single payer Medicare for All out of the Democratic Party platform to help protect her candidate, Hillary Clinton. Although her candidate lost the presidential election, Tanden has continued to oppose the single payer model of reform.

With the growing popularity of the Medicare for All concept, CAP developed the Medicare Extra for All counterproposal – a proposal that would include a Medicare public option. The promotion of this proposal suggested that it would be better than a single payer model because it would preserve the choice of private insurance options, including employer-sponsored plans and private Medicare Advantage (renamed Medicare Choice). They suggested that administrative savings would help fund the program, but they did not present a compelling case for that.

This current report from CAP is important because it does acknowledge the profound administrative waste in our system, citing many of the important studies confirming this (plus some of the lousy ones). They then suggest that we do not have to change to a single government payer to implement the tools that result in the single payer administrative savings, that these savings can be achieved, “whether one payer or many.”

Although most of the report above is composed primarily of excerpts, the section, “Policy proposals directed at administrative costs,” is duplicated in its entirety. They suggest that implementing these policies could save perhaps tens of billions of dollars. Yet earlier in the article they report, “Woolhandler and Himmelstein estimate that the United States currently spends $1.1 trillion on health care administration, and of that amount, $504 billion is excess.” It appears that they have not made the case that it does not make much of a difference by shifting to single payer when administrative savings of a multiplayer system would be in the tens of billions whereas single payer system savings would be in the neighborhood of half a trillion dollars.

Another problem is that they do not explicitly acknowledge the differences between private insurers in other nations and private insurers in the United States. They are very different creatures. In other nations they function more as social insurance models serving the public good. In the United States they are crafted as business models driven by profits (or “margins” in the nonprofits). If we were to have a multipayer system that produced European efficiencies, then we would have to disband current insurers and replace them with European-style insurers. (American insurers walk out of markets for far more trivial reasons.) Obviously it would be far easier and much more efficient to replace them with an improved and expanded version of Medicare.

The media has already been reporting that Americans want to have a choice of private plans, especially employer-sponsored plans, saying that support for single payer Medicare for All declines if individuals are deprived of private options. This CAP report was designed to support that reasoning. Already today, Sarah Kliff (VoxCare) quotes co-author Topher Spiro as saying, “Uniform rate setting is a key feature of a system that would have lower administrative costs. That could be in the context of a single-payer system or a regulated, multi-payer system.”

This report will be used to say that we can leave the private insurers in place. My immediate response is, “Bull!” See if you can come up with a short, emphatic response that addresses the flawed policy instead – a response that would improve our messaging.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

Dr. Susan Rogers at NMQF 2019

PNHP national board member Dr. Susan Rogers participated in the opening plenary session of the NMQF Summit on Health Disparities and Spring Health Braintrust on April 8, 2019. She issued a clear call for single-payer reform as part of a discussion on the “Impact of the Social Determinants of Health in Building a Sustainable, Healthy Community.”

Physician says key to health care is morality

By Nicki Gorny
Toledo (Ohio) Blade, April 5, 2019

In a constantly churning national news cycle, it’s easy to look at health care from a policy perspective: Which prospective candidates are advocating universal coverage? Which legislators are cheering a legal challenge to the Affordable Care Act?

Toledoan Johnathon Ross can keep up with the best versed of the policy wonks on the issue of health care for all. But Dr. Ross, who knows the limitations of the current system firsthand while trying to connect his own patients with adequate treatment, starts a little further back.

“It will end up being a policy issue eventually,” Dr. Ross said, “but I think it has to be a moral commitment before it’s a policy decision. Or at least those two walk hand-in-hand up the street in our protests, which we may have to do to get it done.”

The MultiFaith Council of Northwest Ohio also honors the 2019 Heroes of Compassion at the MultiFaith Banquet. This year’s honorees are Nazife Amrou, Sister Virginia Welsh, the Islamic Food Bank of Toledo and the YWCA of Northwest Ohio.

Dr. Ross will reflect on the moral underpinnings of health care for all in a keynote speech at the MultiFaith Banquet hosted by the MultiFaith Council of Northwest Ohio at the Islamic Center of Greater Toledo on Sunday. This year marks the 18th annual banquet, which Judy Trautman, chairman of the MultiFaith Council, said is expected to welcome about 150 faith leaders and community members who reflect the region’s diverse religious traditions.

While Dr. Ross doesn’t see himself as traditionally religious, he credits a multitude of traditions in his family background and his upbringing with influencing his views. And in his nearly 30 years of advocacy for universal health care, including formally under Physicians for a National Health Program, he’s been a frequent speaker on the church-basement circuit.

That includes the Compassion Forum 2018: Poor People’s Campaign Teach-In at Monroe Street United Methodist Church in October. Co-sponsored by the MultiFaith Council, it was almost an “edgy” topic for an organization that generally skews away from the political, Ms. Trautman said.

Dr. Ross’ passionate advocacy there caught her attention.

“He’s so passionate and compassionate that he makes a good fit for us,” she said.

Dr. Ross recently retired from a wide-ranging career in medicine, including nearly 40 years as an internist at Mercy Health St. Vincent Medical Center. He has sat on the State Medical Board of Ohio and serves on the Lucas County Board of Health.

Rather than representing a traditional religious community at the MultiFaith Banquet, Dr. Ross jokes that his family tree touches on just about every religious tradition short of Druidry. Russian Jews account for his father’s side of the family, while his maternal family brings in German Protestants, Roman Catholics, and, he thinks, a few Jehovah’s Witnesses.

“When we would get together, religion was kind of taboo. We didn’t talk about it,” he said. “Although at one family party, after a few too many drinks, I can remember my uncle — he’s from the Jewish wing of the family — getting up and singing ‘The Old Rugged Cross.’ ”

Childhood friends added another element to his religious education: When a neighbor struggled to learn his Catholic catechism, Dr. Ross, in an effort to help him study, essentially learned it alongside him. Another friend was devoutly Protestant, so, maybe once a month, Dr. Ross showed up at Sunday school with his friend’s family after a Saturday sleepover.

His exposure to a diverse set of traditions piqued his curiosity. He went on to enroll in religious courses in college and remains knowledgeable on a wide variety of them.

“What I’ve come to the conclusion is that I actually think I believe in all of it,” he said. “To me, existence is a miracle. I can see God just looking out my back window here.”

His advocacy is influenced by these myriad religions, but also, significantly, by first-hand experience. In his work he has crossed paths with the insurance industry and with the limitations it often imposes on patients in poverty. He ran up against rural poverty in New York, where he spent two years with the National Health Service Corps.; Toledo presented a first-hand look at urban poverty and its own set of challenges.

“One of the hardest things about dealing with a poverty population is their lack of access to the care that they need, that you know would be appropriate for them based on the science that you’ve studied for decades,” he said. “You can’t get it to them, because the system is unjust.”

“The world is not fair. I understand that,” he continued. “But it could be fairer than it is. To see decent people, rich and poor, afflicted with illness, and to tell me that for people who are poor, I can’t give them what they need when they’re just as good a person as anybody who is born with wealth or lucky enough to have a job that gives them wealth, just seems so unjust to me. It’s so frustrating.

“You can’t be a caregiver in this health care system and not know the system is unjust. Anybody who says it’s not is just not paying attention.”

While health care’s heated history stretches as far back as President Theodore Roosevelt, whom the doctor credits as the first to propose a national health-care plan, Dr. Ross first involved himself publicly under President Bill Clinton as one of the protesters who went to Little Rock to rally for the cause before Mr. Clinton’s first inauguration in 1993.

Dr. Ross has remained a vocal advocate on the issue since, both a national level, as a past president and current board member of Physicians for a National Health Program, and on a local level: At decades’ worth of rallies, protests and faith-based speakerships, he’s been laying out a moral and a pragmatic case for universal coverage in northwest Ohio.

His message tends to fall on receptive ears in faith communities. As Dr. Ross pointed out, several religious traditions have formally weighed in on the right to health care.

The United Methodist Church affirms health care as “a basic human right,” for example. In a letter to the U.S. Senate in 2017, the U.S. Council of Catholic Bishops emphasized that health-care reform efforts “must begin with the principle that health care is not a privilege, but a right in keeping with the life and dignity of every person.”

At the MultiFaith Banquet, Dr. Ross said he plans to explore this moral and religious side of what’s more often discussed in terms of politics and policy.

“Every single significant — and even some of the insignificant ones, to Americans at least — religious tradition has something that’s akin to the Golden Rule: Do unto others as you would have them do unto you,” he said. “All these religious traditions — you name it, it’s there: Confucianism, Zoroastrianism, Jainism. It’s everywhere.”

For Dr. Ross, this universal teaching becomes the moral impetus for universal health care.

“Will you stand up for your vulnerable neighbor?” he asks. “Will you stand up for your vulnerable family member? Will you stand up for your vulnerable friends?”

https://www.toledoblade.com…

Do we base reform on ideology or on policies that get people the care they need?

Four Ways for Republicans to Fix Health Care

By Joseph Antos and James C. Capretta
The New York Times, April 4, 2019

By backing a flimsy, state-initiated lawsuit to throw out the entirety of the Affordable Care Act, President Trump has made himself and Republican candidates in 2020 vulnerable to attacks that they want to take health insurance away from millions of people.

Yet not all is lost on the issue for Republicans. Many Democrats, by rushing toward a single-payer Medicare for All plan, are being pulled along by ideological yearnings instead of practical realities. Medicare for All would upend all current public and private insurance arrangements, including employer coverage for about 180 million people. Further, even the sponsors admit these plans would require significant middle-class tax increases.

What that means is that the door is open for a responsible Republican plan to improve the nation’s mixed public-private health system. If the party’s leaders were so inclined, they could take advantage of the Democratic overreach by embracing reforms that would build upon what exists and make it work better. Such a conservative reform plan would look something like this:

A Medicaid Compromise

Republicans should embrace a compromise that allows the non-expansion states to expand Medicaid eligibility to 100 percent of the federal poverty line instead of 138 percent as required by the A.C.A. The expansion states could stay at 138 percent if they wanted to. States should also be given more flexibility to run the program with less federal interference in return for accepting limits on overall spending.

Automatic Enrollment

Instead of creating a new insurance program, Congress should make it easier for people to enroll automatically. Eligible individuals could be enrolled in a no-cost plan with the option of paying a premium for more generous coverage.

Equitable Risk-Sharing

Some states have lowered premiums in the individual insurance market by providing reinsurance to insurers or organizing high-risk pools that protect against losses stemming from the very high-expense cases. By lowering the risk of large losses, insurers are able to reduce premiums for all of their customers.

Strengthening Competition and Market Incentives to Control Costs

The most difficult and pressing issue in health care is high and rising costs. Republicans say the answer is stronger market incentives, but they need to back up the rhetoric with concrete reforms. To begin, Congress needs to place an upper limit on the tax break for employer-provided health care to promote more efficient health insurance. The Federal Trade Commission should more aggressively examine business deals that create de facto monopoly providers in local health care markets. Both parties want Medicare to emphasize value instead of volume in the provision of care. To achieve that goal, beneficiaries need clear information on the cost of their care, and they should share in the savings when they choose high-quality, low-cost providers. More broadly, consumers should be able to see the all-in prices they will pay for high-volume procedures. Finally, Republicans should encourage more competition among drug manufacturers and limit abuses that extend monopolistic pricing for years beyond what patent law is supposed to provide.

Republicans keep searching for a politically safe silver bullet that slays Obamacare and yet leaves everyone happy. That plan doesn’t exist.

But voters aren’t looking for a miracle. They would settle for solid progress. It’s time for Republicans to become the party of responsible health care.

Joseph Antos is a scholar in health care and retirement policy at the American Enterprise Institute. James C. Capretta is a resident fellow at the institute.

https://www.nytimes.com…

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By Don McCanne, M.D.

The authors are noted experts in health policy and understand the pros and cons of both market-oriented reform and public financing systems, yet they are driven by their conservative ideology as they dismiss single payer Medicare for All as representing “ideological yearnings.”

The Democrats already made the mistake of yielding to conservative ideology in crafting the Affordable Care Act based on the Heritage model, believing falsely that Republicans would cooperate. Now these authors want to salvage this highly flawed model by merely tweaking it.

Setting ideology aside, the single payer Medicare for All model actually would achieve the goals of true universality, comprehensiveness, accessibility, administrative efficiency, equity, and would use public policies, including tax policies, that would make health care affordable for all of us.

Nobel Laureate Kenneth Arrow showed us that market ideology does not work in health care. Even Nobel Laureate Friedrich A. Hayek, revered by conservatives, in “Road to Serfdom” states, “Nor is there any reason why the state should not help to organize a comprehensive system of social insurance in providing for those common hazards of life against which few can make adequate provision.”

It’s time to throw out stale arguments based on ideology, and enact and implement a program with proven effectiveness – single payer Medicare for All.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

Medicare for all will provide essential health care for millions of underserved Americans

By Elaine Silver, M.D.
The Sacramento Bee, April 4, 2019

What happens to those who have no health insurance – or are underinsured – in Sacramento County?

As a retired physician, I see some of them at the Imani Clinic, a free clinic for the underserved that’s run by UC Davis medical and undergraduate students.

There, people can get basic services and treatment for conditions such as diabetes and hypertension. It’s also where the failures of our nation’s healthcare system are painfully clear.

Since we’re only open on Saturdays, we can’t provide emergency care or even guarantee care when it’s needed. We don’t have access to affordable radiology services or specialty care. It’s devastating to face a situation where a treatment is so crucial but is totally unaffordable.

Rep. Pramila Jayapal (D-Wash.) introduced a new Medicare-for-All bill in the U.S. House of Representatives on Feb. 27 that will finally mend our broken healthcare system. It would give all U.S. residents coverage for essential medical needs, including hospitalization, doctor visits, mental health, vision, dental and long-term care. And it would do so while controlling costs and allowing for free choice of doctors and hospitals.

How can we as a country of enormous wealth and resources continue to look away when people are dying of complications from treatable diseases – or because a cancer wasn’t diagnosed until it was too late to treat?

We spend more per capita on health care than any other country, but since countries like Canada provide total health care for all for less money, we are clearly not spending our health care dollars wisely.

Ensuring that everyone has lifelong health coverage isn’t just the moral and humane thing to do. It’s the best chance we have for healthier, more productive communities.

More than 100,000 people in the Sacramento Valley had no health insurance in 2017, according to the California Health Care Foundation. Thousands more are underinsured. They have health insurance but can’t cover out-of-pocket expenses, including ever-rising premiums, deductibles and copays.

Chances are you know someone who has lost their home or gone bankrupt due to massive medical expenses brought on by illness or injury. Unfortunately, it could happen to so many of us under our current healthcare system.

Just as importantly, this type of single-payer system would actually save money in terms of overall spending compared to what we now spend. That’s largely because it eliminates the middleman, the insurance companies, and allows the single payer – in this case a public agency – to negotiate prescription and medical device prices.

There are so many reasons to support Jayapal’s bill. Among the most shocking to me as an American doctor is that, compared to other wealthy developed nations, our country’s infant and maternal mortality rates are consistently higher. This means that American mothers and babies aren’t getting the care they need at the time they need it.

Besides offering universal coverage, Jayapal’s bill would provide regional funding for rural and urban areas, like the North Valley, that are medically underserved. It will also greatly simplify the lives of doctors, who would no longer have to deal with the burdensome, multi-payer insurance system of today.

While change can be scary, this bill will bring about true health care reform and security. It will ensure that no one is left out because of their health, their job or their socio-economic status, just like every other large, rich country already does.

I urge you to write and call your federal legislators and tell them why you support Jayapal’s Medicare-for-All Act of 2019.

Together, we can create a stronger and healthier America for each one of us and our children for generations to come.

Dr. Elaine Silver is a retired physician in Sacramento County and a member of Physicians for a National Health Program.

https://www.sacbee.com…

James Kahn explains single payer in terms we can all understand

Opinion: Why single-payer would improve California health care

The only big losers are the private insurance companies – and that’s okay with me

By James G. Kahn, M.D., M.P.H.
The Mercury-News, April 2, 2019

How to achieve universal health insurance in California? In our super-progressive, supermajority Democratic state, that’s the health policy question of the day. Not if we should lead the way on universal coverage, but how.

Recently, UC Berkeley economists proposed a solution, dubbed California Dreamin’. Expand current insurance to cover the uninsured, using up to $17 billion in new taxes. That’s a 5 percent bump in health spending. Problem solved, right?

No. While the goal is admirable, the Dreamin’ approach adds a Rube Goldberg appendage to a Rube Goldberg health care financing system. It layers cost and complexity upon cost and complexity. Our insurance system will continue to underperform.

We need to revamp our insurance mess. We can do this with a well-known and proven solution: single-payer.

Also known as improved “Medicare-for-All,” single-payer has these core features: everyone is covered cradle to grave with the same comprehensive benefits package; health care is financed by a single entity; payment is greatly simplified; patients freely choose among doctors; and doctors focus on providing care.

These features aren’t fantasy, they’re standard among wealthy democracies (such as Canada and Australia). They’re captured in the 2017 Healthy California Act, in U.S. Sen. Bernie Sanders’ bill, S1804, and in Rep. Pramila Jayapal’s new HR1384.

Single-payer solves what ails the insurance system in a way that Dreamin’ can only dream about. Here are high points:

Effective insurance: Our current system leaves 5 percent to 10 percent uninsured, and many more underinsured – facing high deductibles, other cost-sharing, and restrictions on covered services. The Dreamin’ approach could fill the uninsured gap but leave millions underinsured, which we know leads to skipped and delayed care.

Some ask, “I like my private insurance. Why give it up?” Just because insurance works well today doesn’t mean it will tomorrow. Most private insurance is employment-based – laid off, lose your insurance. Plus, each year, private insurance deteriorates, with rising cost-sharing and shrinking provider networks. In single-payer, everyone has the same health plan, assuring ongoing shared commitment to quality coverage. Politically, this is critical, as individuals realize the advantage of single-payer over unstable private insurance.

Administrative efficiency: The United States spends 12 percent of health care dollars on excess billing paperwork, from contracting all the way to appealing underpayments. That’s about $1,400 per person per year in administrative bloat, about half at insurers and half via the burden placed on providers. Single-payer captures this 12 percent and puts it into patient care.

Prices: U.S. drugs cost several times more than in Europe. Single-payer would use price negotiations to get a fairer price, with 30 percent savings in drug costs overall.

Affordability: Providing more effective insurance increases costs, by about 10 percent. Reducing administrative waste along with drug prices decreases costs, by about 15 percent. Net costs drop by about 5 percent. Repeating slowly: Net. Costs. 5 percent. Down. Over time, savings grow with global budgets and better data on clinical practices to identify and reduce ineffective practices.

Clinical focus: Freed of distracting reimbursement paperwork, doctors and patients focus on each other! This is what medicine is supposed to be about.

Smart social contract: Perhaps most exciting, single-payer unites us in a just and prudent communitarian undertaking. Single-payer is the poster child for benevolent and smart policy.

It’s benevolent because it truly solves the problems of uninsurance and underinsurance, fulfilling the human right of access to health care. Smart because it saves money – using clever and proven methods to efficiently translate our financial commitments to desired health care. To riff on the venerable advertising slogan: costs less, more filling.

Everyone is in single-payer together – rich and poor alike. This social contract isn’t a good-enough compromise, it’s an improvement for us all. From our fragmented and dysfunctional insurance, step up to universal access to care.

The only big losers are the private insurance companies – yes, they’d really have no role, and that’s okay with me. It’s not un-American; it’s part of the new American dream.

Dr. James G. Kahn is a professor emeritus of Health Policy, Epidemiology and Global Health of UC San Francisco and is past president of Physicians for a National Health Program-California.

https://www.mercurynews.com…

Comment:

By Don McCanne, M.D.

This article has that special combination of explaining clearly single-payer health policy in terms that the general public can easily understand, written by a noted health policy wonk who knows how to communicate. It should be shared widely so people have a better understanding of the health care system that we could have if we select government stewards who would support this social contract that ensures health care for all of us.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

Harvard-Affiliated Doctors and Single-Payer Healthcare Go Way Back

It was the 1980s, in the midst of a rightward shift in American politics, and some physicians across the country had a well-kept secret: they wanted more government in the healthcare system.

By Jonah S. Berger
The Harvard Crimson, April 4, 2019

It was the 1980s, in the midst of a rightward shift in American politics, and some physicians across the country had a well-kept secret: they wanted more government in the healthcare system, according to David U. Himmelstein, a Harvard Medical School affiliate and a doctor at the Harvard-affiliated Cambridge Hospital.

Yet according to Himmelstein, many physicians were hesitant to reveal they supported full government financing of healthcare, despite what he saw as widespread support among members of the profession.

“It was not something you wanted to say very loudly in public,” he recalls.

So in 1986, Himmelstein and a colleague, Stephanie J. Woolhandler, formed an advocacy group, Physicians for a National Health Program (PNHP), to support single-payer healthcare.

The reception among outsiders was part derision and part incredulity.

“One reporter, when we were first starting the group, asked, ‘Physicians for a National Health Program, is that a sister organization to Furriers for Animal Rights?’” remembers Himmelstein.

Within a few years, though, hundreds of doctors had joined the group, drawn in part by a manifesto of sorts that the group published in the New England Journal of Medicine, as well as multiple national television appearances by Himmelstein and Woolhandler.

Today, a Harvard Medical School affiliate is again at the helm of the organization, which now boasts a membership of over 20,000 physicians, medical students, and healthcare professionals. And, as single-payer proposals have moved to the forefront of political debates, PNHP’s influence has likely never been greater.

The ‘Nucleus’

As Himmelstein and Woolhandler worked to recruit doctors to their cause in the mid-1980s, they simultaneously began to craft a policy document outlining what a single-payer healthcare system would look like in practice.

That work, in addition to continuing research around medical access and affordability conducted by a seven-member social medicine group at Cambridge Hospital, largely took place under the auspices of Harvard.

“Cambridge Hospital has been really a sort of a nucleus for a lot of the PNHP work,” says Gordon D. Schiff, a former president of the association who is now an associate professor of medicine at the Medical School.

After all, a single-payer bill introduced in the House of Representatives by former Rep. John J. Conyers, Jr. (D-MI) in 2003 was directly modeled off of PNHP’s single-payer proposal, according to Adam W. Gaffney, an instructor at the Medical School and the current president of PNHP. And when Rep. Pramila Jayapal (D-WA) introduced a revised version of the bill in late February on the steps of the Capitol, she invited Gaffney to speak at the event.

Medical School Associate Professor Danny McCormick, who now leads the Cambridge Hospital working group, says that while it may be relatively unusual for medical researchers to weigh in on controversial public policy questions like single-payer, he believes that when doctors see a solution that would “dramatically improve” health outcomes, it behooves them to speak up.

“There’s nobody better to talk about what the policy solutions are than the people who are intimately involved with doing research,” he says. “And then it’s incumbent upon us both as researchers and as clinicians to talk explicitly about policy solutions.”

The connections between PNHP and Harvard go back for decades. At the time of PNHP’s formation in 1986, according to its members, Harvard provided an optimal home for the fledgling organization that was advocating for a then-radical proposal.

For one, Massachusetts was in the midst of its own fight over single-payer healthcare. A group of seniors called the Gray Panthers was seeking to place a referendum on the ballot calling upon Massachusetts congresspeople to support national health insurance. PNHP was formed in part to prop up the seniors’ efforts, Himmelstein says.

Cambridge also provided a litany of prominent names ready to line up in support of single-payer, including the psychiatrist Leon Eisenberg, then the chair of the Department of Social Medicine at Harvard Medical School, and renowned primary care physician John Stoeckle.

In the years since, Woolhandler says Cambridge Hospital has been “extremely supportive” of the group’s work, despite its clear partisan tilt.

‘A Long Way to Go’

It was early March 2019 and Gaffney, the newly elected president of PNHP, faced determined opposition.

Fox Business channel had invited Gaffney on the air to discuss single-payer healthcare, and the panel of commentators all seemed to want a chance to confront him.

One critic chipped in with what Gaffney later deemed an “outlandish” question: “Why can’t the free market work [with healthcare]… like it does with auto insurance?” Others raised concerns about the supposedly high price tag of PNHP’s vision of healthcare.

As Gaffney waited to respond to the questions, he smiled, cocked his head, and raised his eyebrows, as if these were all arguments he had heard many times before. Then, at his characteristic rapid speaking pace, he fought back.

The appearance garnered praise from left-wing activists and commentators online, including Vermont Senator and leading presidential candidate Bernie Sanders.

“This Doctor SHUTS DOWN Every Argument Fox News Has Against Medicare for All,” Sanders wrote on his website.

Gaffney says he has long considered himself a progressive. But it was not until he saw firsthand the devastating impact of the current system of medical care on his patients that he decided to make advancing the cause of single-payer into his life’s mission.

“I have seen patients in the intensive care unit with life-threatening complications of illnesses that need not have happened,” Gaffney says. “They could have been averted through care.”

At Cambridge Hospital, which is a teaching affiliate of Harvard Medical School, the School of Public Health, and the School of Dental Medicine, Gaffney says he primarily serves vulnerable individuals, many of whom are on Medicaid or lack insurance altogether. Cambridge Health Alliance — a health system that includes Cambridge Hospital and two other hospitals in Boston and Somerville — is the only public hospital system in the state.

For Gaffney, the scale of the problem — including roughly 30 million Americans uninsured and tens of millions more who have insurance but cannot afford care because of high premiums and deductibles — means that insufficient measures will not suffice. Many Democrats in Congress have opted to support a Medicare buy-in option, rather than mandated government insurance. But such compromises make Gaffney indignant.

“What does that do for the rest of the nation that’s uninsured? What does that do for people who have employer-sponsored coverage and it falls short because their deductibles are so high? What is it going to do for the fact that for-profit corporations are increasingly dominating the healthcare delivery sphere?” he asks.

Support for a full-on single-payer approach appears to be building among prominent Democrats, including multiple presidential contenders. When Conyers introduced the first iteration of his single-payer bill in 2003, it garnered just 25 co-sponsors. In 2017, that same bill had 124 co-sponsors, over half the Democratic caucus.

“I don’t think that we’ve ever been closer in my lifetime,” Gaffney says. “We’ve come further in the last couple of years than anyone thought we were going to.”

But, he concedes, “there’s a long way to go.”

https://www.thecrimson.com…

I’ve spent decades studying US health care. Time to get real: Medicare for All is the only reasonable path to controlling costs and covering everyone.

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The only big losers are the private insurance companies – and that’s okay with me

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