PNHP

Donald Berwick’s endorsement of Medicare for All

Donald Berwick’s endorsement of Medicare for All

Hearing: Pathways to Universal Health Coverage

Testimony by Donald M. Berwick, M.D., M.P.P.
U.S. House of Representatives, Ways and Means Committee, June 12, 2019

Serving as CMS Administrator was the greatest privilege of my professional career. My duties included helping to implement the coverage expansions, quality improvement, and program integrity provisions of the Affordable Care Act, which was passed three months before my arrival.

In effect, I had the honor to help lead “Medicare for Some,” and the successes and potential of that program have given me confidence that a wise choice for this nation would be Medicare for All.

If anyone can show me a payment model that beats Medicare for All in achieving the Triple Aim and universal coverage, I am all ears. But I have as yet seen none. And the nation’s experience with Medicare for Some – as it exists now, and as endorsed by the overwhelming popularity of Medicare in our nation – suggests that we may, indeed, already have an answer in our hands.

I do not wish to minimize or disregard the many obstacles and objections to Medicare for All as a pathway for our nation. But, whereas some others find the obstacles to be insurmountable, I do not. I believe that we have the wits, experience, wealth, and agility to overcome every one, as we have for Medicare as we know it today. To be specific, here are some of the objections:

  • That Medicare for All is unaffordable. I think the opposite may be true; that is, without Medicare for All, health care in our nation may be bound to head, as it is now heading, for true unaffordability. Medicare for All is a positive way out. As I noted above, the level of waste in our health care system is enormous. A publicly accountable, transparent, and mission-oriented payer would offer us as a nation leverage against wasteful health care expenditures that is not achievable in the current, chaotic payment environment.
  • That Medicare for All is a governmental takeover of health care. It is not. Not one single bill that I know of proposes under any form of expanded governmental coverage that government should become the provider of health care for all Americans. Medicare for All is about paying for care – consolidating payment in a public program. It is not about providing care. Care provision, through today’s array of hospitals, clinicians, nursing homes, and so on, would remain as it is – largely private sector and entrepreneurial.
  • That Medicare for All would severely underpay hospitals and clinicians. That would be neither wise nor inevitable. When government becomes the payer for any good or service, and is subject to oversight from Congress, it is and should be held accountable for responsible practices. That is how Medicare works today; and it is how Medicare for All should and would work in the future.
  • That Medicare for All implies a financially unrealistic package of health care services. Any insurer – government or commercial – has to end up implementing a defined benefit package, and the content and comprehensiveness of that coverage will always be subject to debate and negotiation. What Medicare for All does do is to move that dialogue into daylight, as we can consider as a nation what we wish to include in universal coverage and what not. That is exactly what happened, for example, when the ACA extended coverage for clinical prevention services, and when Congress took steps toward assuring mental health care parity. The current commercial insurance system does the same – deciding what is and is not covered – but it does that largely out of sight and without any real form of pubic accountability.
  • That Medicare for All would unacceptably disrupt people’s current relationships with their health care insurers. Indeed, Medicare for All would give every American not now covered by Medicare a new insurer – a public insurer. Whether this threat to existing bonds between people and commercial insurers in fact troubles Americans I find doubtful. I suspect that what most Americans value is their bond with clinicians, not with insurers.
  • That the tax increases implied by Medicare for All are massive. This represents a negative framing of a positive result. Yes, indeed, the fund flows for health care under Medicare for All would become public, as opposed to the private payment now channeled through payroll check deductions and employer contributions to commercial health insurance. These are existing fees – “taxes” really – through private channels. What the American worker cares most about financially is how much he or she takes home at the end of the day. Under Medicare for All, properly designed, that amount – take home pay – goes up, not down.

I end where I began: Medicare for All is not an end in itself. It is a means to achieve what we care about: better care, better health, lower cost, and leaving no one out. I am open to considering any proposal that moves our nation fast and well toward those goals. Compared with Medicare for All, I see none better.

https://waysandmeans.house.gov…

Ways and Means Hearing:
https://waysandmeans.house.gov…

Comment:

By Don McCanne, M.D.

For much of his career, Donald Berwick has been an outspoken supporter of improving quality in health care and, more recently, a supporter of Medicare for All. Until we can enact Medicare for All he does support making improvements in the Affordable Care Act. He supports accountable care organizations (ACOs) and value-based care (VBC) as he believes that they are a means to improve quality.

Because of uncertainties about the benefits and deficiencies of ACOs and VBC, some fear that he may have strayed as a supporter of single payer Medicare for All as he pursues these dubious solutions. His testimony before the House Ways and Means Committee should allay those fears. We can continue our efforts to educate our colleagues and the public on the refinements of an ideal single payer model, such as excluding ACOs, but the fundamentals are solid – comprehensive, high quality, affordable, equitable health care for all – and Donald Berwick clearly supports that.

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

AMA narrowly defeats single payer amendment

AMA maintains its opposition to single-payer systems

By Steven Ross Johnson
Modern Healthcare, June 11, 2019

The American Medical Association will remain opposed to proposals for the U.S. to create a single-payer healthcare system. The group voted narrowly to maintain its stance on Tuesday at its annual House of Delegates meeting.

Delegates of the largest physicians’ organization voted 53% to 47% against adopting an amendment to remove the AMA’s formal opposition to a single-payer healthcare system, ending days of contentious debate that pitted the organization’s leadership against a contingent represented largely by medical students.

“As long as we maintain our blanket opposition our AMA cannot ensure we are a part of every conversation,” said Dan Pfeifle, a fourth-year medical student at the University of South Dakota Sanford School of Medicine and an alternate delegate of the AMA’s Medical Student Section.

Delegates ended up voting overwhelming in favor of adopting a report from the AMA’s Council on Medical Service that reaffirmed efforts to improve upon the Affordable Care Act instead of “nationalized” healthcare coverage.

Some of the report’s recommendations included expanding eligibility for tax credits on insurance premiums beyond 400% of the federal poverty level, as well as to expand eligibility for and increase the size of cost-sharing reductions.

“The AMA proposal for reform, based on AMA policy, is still the right direction … to cover the uninsured, and is cognizant that, in this environment, the ACA is the vehicle through … which the AMA proposal for reform can be realized,” the report stated.

The debate over whether the country should adopt a Medicare for All type of system has gotten increased attention in recent months as it has become a key policy issue among several of the Democratic presidential candidates.

The AMA has long opposed single-payer efforts out of concerns that it would lower provider reimbursement rates and limit patient choice on healthcare coverage and services they can access.

But support for a single-payer system has grown among physicians. At the AMA annual delegates meeting last year, supporters got the body to at least study the impact of changing its policy.

This year, the issue sparked a protest outside of the AMA’s meeting on its first day when medical students joined nurses and advocates to call on the organization to drop its fight against Medicare for All.

More broadly, public opinion for single payer has grown over the years so that a majority of Americans now support such a system. According to a survey conducted by the Kaiser Family Foundation in April, 56% of Americans favor a national health plan in which all individuals got their insurance from a single government plan.

https://www.modernhealthcare.com…

Comment:

By Don McCanne, M.D.

The Medical Student Section of the AMA and the medical students who helped organize the protest outside of the Chicago meeting of the AMA House of Delegates may be disappointed because the AMA decided to continue its opposition to single payer reform. But actually it was a phenomenal success in that single payer was defeated by the slim margin of 53% to 47% – a remarkable shift from its previous overwhelming opposition to single payer. As the rationale of the single payer model is better understood, and the ice has been broken by almost half of the delegates, just maybe the AMA might be able to shift to a position of support next June, in plenty of time before the November election.

At any rate, we certainly have the medical students to thank, along with the nurses and other health care professionals and activists. One way we can show our appreciation to the students is to donate to the Nicholas Skala Student Activist Scholarship Fund to provide student scholarships for the Annual PNHP Meeting and Leadership Training and for other student outreach programs:

https://pnhp.salsalabs.org/skalastudentactivistfund

Thankfully, the future of our health care is in their hands.

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

Are You Sure You Actually ‘Like’ Your Private Health Insurance?

In 2018, as millions of Americans borrowed $88 billion to pay for health care, 62 CEOs of health care companies made a combined total of $1.1 billion in compensation

By Sanjeev K. Sriram, M.D.
Common Dreams, June 12, 2019

When I talk to friends, family, and colleagues about Medicare for All, sometimes someone asks, “but don’t people like their insurance?” It’s not hard to see where they got that idea. America’s Health Insurance Plans (AHIP), the leading lobbyist for the for-profit insurance industry, says 71 percent of Americans “like” their private health insurance. It’s important to scrutinize the messenger and the message here. If McDonald’s told us that 71 percent of their customers said their food was healthy and nutritious, we’d be reasonably skeptical at the very least.

When independently surveyed, only 16 percent of Americans trust the health insurance industry to put patients before profits. The only group we trust less is Big Pharma (only 9 percent believe these corporations prioritize patients). So how do we make sense of all this? Do people really “like” health insurance plans sold by such untrusted corporations?

As a physician who regularly haggles with insurance companies, I have many four-letter words for that industry. “Like” is not one of them. Similar to millions of Americans with private health insurance, I have paid absurd co-pays, premiums, and deductibles to different insurance companies over the course of my career. I am certain I have never “liked” private health insurance the way I like comic books or the way my wife likes spin classes. I begrudgingly tolerate private health insurance (for now). The same goes for my patients, colleagues, friends, and family. Out of fear of financial ruin, we have allowed ever-increasing portions of our paychecks to go to health insurance companies.

But that is a false sense of security. Even with the Affordable Care Act’s protections against the insurance industry, too many of us worry about dire financial consequences if our health takes a turn for the worse. Four in ten Americans with employer-sponsored health insurance say their family is struggling to pay premiums, medical bills, or out-of-pocket medical costs. Half of us have a family member who is avoiding necessary medical care or prescriptions because of cost.

When push comes to shove and families decide to seek medical attention, their worst fears of financial devastation can come true. Of Americans reporting problems paying medical bills, 73 percent are cutting back on food, clothing, and other basic necessities. Over six in ten of these everyday Americans have already depleted what little savings they had. One in three GoFundMe crowdfunding pages is directed toward paying for health care. For millions of patients and families, private health insurance is a source of, not a savior from, financial hardship.

As a physician and public health policy adviser, I used to believe the insurance industry would become better partners in our health care through the very reasonable guidelines and expectations set by the Affordable Care Act. Over the last several years, I have lost faith and accepted the insurance corporations for what they are: machines of unappeasable greed, accountable only to shareholders, never my patients or other families. In 2018, as millions of Americans borrowed $88 billion to pay for health care, 62 CEOs of health care companies made a combined total of $1.1 billion in compensation. When it comes to our current health care system’s priorities, patients are no match for profits.

We do not have to live like this. Thousands of physicians, medical students, nurses, and our colleagues across health care (but sadly, not the American Medical Association) are joining the Medicare for All movement because we want our work to be about protecting people’s health, not destroying their wealth.

In the current Medicare for All legislation in Congress, patients and families will have full comprehensive benefits without the lurking clouds of financial stress. Prescription drugs will be significantly cheaper because Medicare will finally have the power to negotiate for better prices with Big Pharma corporations. Hospitals will have stable, predictable financing for providing health care to patients and families. Similarly, physicians can expect to spend more time with patients rather than haggling with multiple insurance companies and their endless obstacle courses. Most importantly, every person in America will have the peace of mind of knowing their health care is a basic human right, not a privilege to be negotiated.

Medicare for All recognizes that being healthy is hard work. Preventing, treating, and managing illness takes a lot of effort on the part of patients, doctors, nurses, therapists, social workers, and so on. We are all worthy of health care, regardless of what we earn, where we live, or who we are. When we make health care a basic human right through Medicare for All, we recognize how each of us is vulnerable and none of us should be abandoned.

https://www.commondreams.org…

How red-baiting in medicine did lasting harm to Americans’ health care

Driving the left out of medicine has hurt the cause of universal health care.

By Merlin Chowkwanyun
Washington Post, June 12, 2019

The battle for universal health care has come a long way. Today, the House Ways and Means Committee is holding a hearing on Medicare-for-all, and the plan has recently gained support from high-ranking Democrats, including several presidential contenders. It’s traction that would have been unimaginable even a decade ago.

Even so, the fight for Medicare-for-all will be a war. “You should not be the guinea pigs in some far-left social experiment,” Senate Majority Leader Mitch McConnell (R-Ky.) recently opined. These remarks echo the pitched battle over the Affordable Care Act a decade ago and the famous ads that helped bring down President Bill Clinton’s health-care plan, featuring the fictitious couple Harry and Louise, who fanned fears of limited doctor choice by remarking, “They choose. We lose.”

But the opposition to national health insurance extends far beyond fighting against the policy itself. Its roots are in the McCarthy period of the 1950s, when the medical profession purged from its ranks those doctors with any hint of leftist political orientation, removing critical voices of dissent from the mainstream health policy conversation.

In the half-century since, the profession and its lobbyists have frequently fought against expanded government financing of health care for all. And they have effectively ingrained those critiques into the larger political dialogue, making any kind of debate about health care about not just medicine, but also fundamental faith in government and the welfare state. Until we understand this legacy, we won’t be able to transcend it and have a sober dialogue about the future of health care in the United States.

In 1950, the Journal of the American Medical Association (JAMA) published an editorial by FBI Director J. Edgar Hoover warning about metaphorical “communist germs” and urging physicians to forward “any information of this nature” to the bureau.

Hoover’s editorial wasn’t just some oddity. As the Cold War alignment hardened, the medical establishment vigorously policed its own ranks for any hint of “red” leanings, which meant working closely with the most repressive elements of the government, including the FBI. In this climate, support for left-leaning public policies put doctors’ livelihoods at risk.

In 1951, during a hearing on the motion picture industry, the House Un-American Activities Committee (HUAC) called Los Angeles physician Murray Abowitz to testify about his association with a group called the National Council of Arts, Sciences and Professions (CASP), which HUAC had concluded was “anti-American, pro-Soviet.” HUAC asked Abowitz about other activities, too, including his work with the Civil Rights Congress, a racial justice organization made up heavily, though not exclusively, of Communist Party members.

After the hearings, Abowitz promptly lost his job at Cedars of Lebanon Hospital in Los Angeles (now merged and known as Cedars-Sinai). So did two other doctors, Alexander Pennes and Richard Lippman, an eminent expert on kidney disease, whose names came up in Abowitz’s testimony.

What cost these doctors their jobs? Throwing themselves into progressive causes. That included fighting for national health insurance, higher wages for interns and residents, and an end to racism in hospitals. Lippman had recently helped research a pamphlet that documented patterns of exclusion in Los Angeles facilities, and it didn’t hold back on identifying offending facilities by name. But embracing civil rights so visibly was professionally dangerous, particularly in an era when the American left and the Communist Party were major engines of civil rights agitation.

The 1951 hearing was just the start. A few months later, in January 1952, HUAC returned, broadening its scope to examine “Communist Activities Among Professional Groups in the Los Angeles Area.” An osteopath named Louise Light named names. Soon, Harold Koppelman, a surgeon at Queen of Angels Hospital, received a subpoena from HUAC. It cost him his job. Four additional physicians at Cedars suffered the same fate when they, too, received HUAC summonses.

These firings were the result of an elaborate red-baiting operation constructed by the medical profession, working with government organs such as HUAC and the FBI. In 1952, an FBI agent reported receiving a call from a Cedars trustee who asked him for any information that would help in “establishing” Lippman’s subversive activities.

Two years later, when a state-level analogue to HUAC held hearings on communist infiltration into the medical ranks, it did so at the behest of the Los Angeles County Medical Association (LACMA). During the hearings, it became clear that LACMA’s leaders had been tracking the activities of left-wing Los Angeles physicians for some time. They had monitored protests against the Cedars firings, even attending some events.

Efforts to remove any “red” presence didn’t just involve ferreting out doctors with any hint of leftist political ties or activism. The profession also attacked groups. Into the late 1940s, the Association of Internes and Medical Students (AIMS) was a large activist organization that fought for better working conditions for young physicians, built alliances with like-minded medical students around the world and supported civil rights and national health insurance.

This activism brought it into the crosshairs of the powerful American Medical Association, then at the height of a crusade against government-funded insurance.

The AMA acted swiftly. It opened an investigation of AIMS, writing in JAMA, one of the most influential publications in American medicine, that the organization was “exhibiting communistic tendencies.” A year later, another JAMA commentary criticized AIMS’s support for national health insurance and higher wages and drew on these earlier accusations of communist affiliations to undermine its credibility. It ominously warned that students who joined AIMS might “risk considerable embarrassment.”

The AMA campaign culminated in a report concluding that AIMS regularly published those “affiliated with organizations and institutions that have been cited as Communist fronts” and that it had “a general reputation of being a left wing organization.” The AMA could not, it concluded, “lend its support” to AIMS.

AIMS’s stigmatization had immediate consequences. At an individual level, it cost Sheppard Thierman, an intern at Kings County Hospital, his job. Advertisers withdrew from AIMS’s publication, starving it of its main revenue source. Issues grew scarcer, then thinner, then nonexistent. AIMS chapters withered away.

These episodes — and many others like them — explain why the medical profession has been so averse to national health insurance until very recently. Not only did doctors risk stigma if they supported it in the 1950s, but many on the left also had their careers derailed, skewing the profession’s political complexion.

While doctors’ politics, and accordingly, attitudes toward national health insurance, are starting to shift, the toxic residue of these purges remain. The silencing of progressive physicians during the Cold War has long narrowed the horizons of what was possible in health care. Our health-care system is worse for it, clearly not serving all Americans well. The profession must grapple with its legacy of political repression and how it has shaped American health care, and then reevaluate what policies might lead to better care for all.

Merlin Chowkwanyun is an Assistant Professor of Sociomedical Sciences at Columbia University’s Mailman School of Public Health.

https://www.washingtonpost.com…

Why Single Payer Medicare for All is an Imperative for Labor

The Case for Medicare for All

By James G. Kahn
New Labor Forum, 2019, Vol. 28(2)

Public support for single-payer insurance is astoundingly high, with 68 percent in a recent poll placing high importance on achieving it. The most vociferous supporters are progressives and minorities, but single payer garners support from across the political spectrum. Single payer insurance is not just a policy tweak, nor another layer of complexity on our health-care non-system. It’s revolutionary and transformative and has the potential to both benefit from and build powerful coalitions.

The same cannot be said for all approaches offered by Democrats. They have also proposed several bills for Medicare expansions—mechanisms for individuals to “buy in” to Medicare coverage. At first, they sound attractive, an incremental insurance expansion in the direction of Medicare for All. But close consideration reveals fundamental flaws. There is a long list of reasons that all of us—and especially the labor movement—should oppose these Medicare-for-All impostors in favor of the real deal.

Where should labor position itself? Supportive of any “Medicare” expansion? Or resolutely committed to Medicare for all? After 25 years researching, writing, educating, and advocating in this arena, I propose that single payer is the only solution consistent with universal, affordable health care and with the solidarity values long supported by the labor movement.

Why? There are 13 reasons that Medicare for All is superior to Medicare buy-ins:

  1. Medicare for All insures everyone.
  2. Medicare for All insures everyone well.
  3. Medicare for All keeps everyone in the same game.
  4. Medicare for All removes health care as a bargaining burden.
  5. Medicare for All delinks health care and employment.
  6. Medicare for All enhances administrative efficiency.
  7. Medicare for All controls health-care costs in other ways.
  8. Medicare for All enhances quality.
  9. Medicare for All reduces clinical waste and fraud.
  10. Medicare for All empowers patients.
  11. Medicare for All empowers doctors (and other providers).
  12. Medicare for All fosters a comfortable and lasting patient-doctor relationship.
  13. Medicare for All ends battles to protect myriad pieces of the current health system.

For complicated reasons, largely centered on employer-based health-care plans, some unions have opposed single payer. This misses larger considerations: single payer is about supporting working people (and the unemployed, and the rich) with the resources needed for a comfortable, secure life. The labor movement did as much as any great social reform to foster health and security. Single payer is the next great step in this tradition.

Let coworkers know what the real Medicare for All is: Everyone is covered, with the same comprehensive benefits package, from cradle to grave. This is critical to reduce the opposition of some unions, which represent a large portion of workers with employer-provided health care, but a small portion of working people overall. Everyone needs to understand that true Medicare for All is the only way to assure excellent access to health care, regardless of income and employment, and to empower providers and patients to focus on quality care and on each other, not on insurance glitches and administrative paperwork.

James G. Kahn, MD, MPH, has been a professor of health economics at the University of California San Francisco for 30 years and has been active in Physicians for a National Health Program, including president of the California chapter, since 1994.

(This article appears in the spring 2019 issue of New Labor Forum, published by the CUNY School of Labor and Urban Studies. The journal appears three times a year and includes articles on issues relevant to organized labor and working-class communities.)

https://healthpolicy.ucsf.edu…

For the full article:
http://bit.ly/2I7hvvz

Comment:

By Don McCanne, M.D.

Labor would benefit greatly from enactment and implementation of Single Payer Medicare for All, yet some in the labor movement remain reluctant to give up health plans they have won through labor negotiations. This article explains why labor should welcome the change to a program that is truly universal – including all labor, that is fully prepaid, that is permanent and will always be there, and that expresses the solidarity that has long been supported by the labor movement.

The link (above) to the full four-page article should be distributed widely to be used to explain to labor why Single Payer Medicare for All deserves their strong support, not to mention using it to bring the entire nation into solidarity behind this truly egalitarian proposal.

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

Today’s Doctors: Overburdened and Burning Out

By Keith J. Loud, M.D.
The New York Times, Letters, June 11, 2019

To the Editor:

As a physician, I agree with Dr. Danielle Ofri’s assertion that most health care professionals have remained true to the highest ideals of their fields in the face of increasing corporatization and challenging working conditions. But I find her assertion of exploitation — at least of doctors — difficult to reconcile.

By and large physicians in the United States earn far more money than their peers in the rest of the world, placing us squarely in the top 2 percent, if not 1 percent, of American income distribution. The proliferation of health care administrators is attributable to an unnecessarily complex reimbursement system based on a private, for-profit insurance industry.

Yet the American Medical Association, the largest professional organization of physicians, actively lobbies against the administrative simplicity of Medicare for All. Moreover, physician groups have long opposed expansions in scope of practice for nurses, nurse practitioners and others who could allow physicians to concentrate on the most complex patients who need our expertise.

Doctors continue to be seen as leaders in health care. Rather than just lament the current state of affairs, we must acknowledge that we have been complicit, and make amends.

https://www.nytimes.com…

Gruber and Sommers tell us what we have learned from 10 years of ACA

The Affordable Care Act’s Effects on Patients, Providers and the Economy: What We’ve Learned So Far; NBER Working Paper 25932

By Jonathan Gruber and Benjamin D. Sommers
National Bureau of Economic Research, June 2019

Abstract

As we approach the tenth anniversary of the passage of the Affordable Care Act, it is important to reflect on what has been learned about the impacts of this major reform. In this paper we review the literature on the impacts of the ACA on patients, providers and the economy. We find strong evidence that the ACA’s provisions have increased insurance coverage. There is also a clearly positive effect on access to and consumption of health care, with suggestive but more limited evidence on improved health outcomes. There is no evidence of significant reductions in provider access, changes in labor supply, or increased budgetary pressures on state governments, and the law’s total federal cost through 2018 has been less than predicted. We conclude by describing key policy implications and future areas for research.

From the Conclusion

Disentangling which aspects of the ACA have the largest impacts will be critical as policymakers consider both selective restrictions and expansions of the law’s provisions. The effect of the individual mandate repeal and potential barriers to coverage such as Medicaid work requirements have been the focus of recent political discussions, while early forays into health policy among Democratic presidential contenders often focus on making exchange plans more affordable. Understanding the effects not just of having any health insurance but the particular type of coverage also has important implications for health care quality, costs, and patient outcomes. A better understanding of coverage heterogeneity is particularly critical as state and federal policymakers propose a wide range of solutions, such as a public option on the insurance marketplace, moving more Medicaid beneficiaries to private coverage, and – most dramatically – “Medicare-for-All” in various configurations. Ongoing studies of these issues are warranted to continue to inform changes to the ACA and the U.S.’s health insurance system more broadly in the coming years.

https://www.nber.org…

Comment:

By Don McCanne, M.D.

Jonathan Gruber and Benjamin Sommers are certainly highly qualified to describe what a decade of the Affordable Care Act has done for health care in the United States. The most important change has been to increase the numbers of Americans who are insured, predominantly through the Medicaid program, along with an improvement in health care access that being insured provides. The remaining improvements are fairly negligible when compared to the need that existed ten years ago and the need that still exists.

The authors tell us that we need ongoing studies of potential solutions such as “a public option on the insurance marketplace, moving more Medicaid beneficiaries to private coverage, and – most dramatically – ‘Medicare-for-All’ in various configurations.” So just what studies do we need?

  • Presumably we want everyone to be included. Current studies have shown that, in spite of the increase, we have fallen far short of universality. So when we set up a system that automatically includes everyone, what study do you need to find out if everyone ends up being included? Well, the health policy academics don’t have to do a study of that one since anyone who is discovered to not be enrolled is automatically enrolled on the spot.
  • The financial burden of underinsurance has grown worse since deductibles are increasing. So what study do you need to find out how much of a financial burden the patients would face when out-of-pocket health care spending is eliminated (as with HR 1384, Jayapal)? Well, that lets the policy academics off the hook again since there is no underinsurance if there are no medical bills for cost-sharing that has already been eliminated.
  • Insurance premiums are a burden for working families who do not qualify for government subsidies. Single payer Medicare for All legislation would eliminate regressive insurance premiums and replace them with progressive taxes that would make health care affordable for everyone. What study do you need to show paying less in taxes would cost the family less than paying more in insurance premiums and other out-of-pocket costs? Do we really even need to ask that question?
  • Provider networks, which are a tool to benefit the private insurers, take away from patients choices in their health care while potentially exposing them to higher costs because of surprise bills and out-of-network care. What study do we need of out-of-network care when there is only one universal network for the entire nation, and everyone is automatically included in the network?
  • Our unique American health care financing system has already been demonstrated to waste a tremendous amount of funds on administrative excesses, and the Affordable Care Act added even more administrative requirements. It has been shown in other nations that these administrative excesses are not necessary, and, by design, would be dramatically reduced by enacting and implementing single payer Medicare for All. We wouldn’t need the academic policy community to tell us that waste would be drastically reduced, but it might be informative for them to do another study showing us how many hundreds of billions of dollars we would be saving by recovering that waste – savings that could be spent on health care instead.
  • With regional planning and separate capital budgets we could improve capacity in regions of need thereby improving access to care in areas that are currently underserved, while avoiding excess capacity that can result in overutilization. Do we really need a study to show us that spending money where it is needed better meets the need?

“Ongoing studies of these issues are warranted to continue to inform changes to the ACA…” Really? The overwhelming evidence is that this decade with the Affordable Care Act has demonstrated that it has largely been a failure in achieving universality, elimination of financial hardship from medical bills, affordability for individuals and society, equity, portability, accessibility, administrative efficiency, and a failure of our health policy community to advance reform that would clearly benefit all of America.

That doesn’t mean that Gruber, Sommers and their colleagues in health policy should be out of a job. Look at price and volume in health care – the two mathematical determinants of spending. For instance, when a new drug comes on the market with a $2 million price tag for a single dose, wouldn’t it be helpful to know if it is priced properly? When a preventive measure is being used by millions of individuals, wouldn’t it be helpful to know if it is really effective in preventing what it is alleged to prevent? Surely they can devise a multitude of studies that are designed to help… guess what… the patient!

We’ve had enough studies that are designed to help insurers and passive investors in the medical-industrial complex when they shouldn’t even be in the picture anymore. Kenneth Arrow, who showed that health care markets do not work for patients, was awarded the Nobel Prize. Maybe there are more Nobels for the health policy community if they will only apply their science to the betterment of health for all of us.

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

‘Medicare for All’? American Medical Association says no, drawing protest in Chicago.

By Lisa Schencker
Chicago Tribune, June 10, 2019

Doctors gathered in Chicago for the American Medical Association’s annual meeting this week are increasingly finding themselves at the uncomfortable center of a national debate over “Medicare for All.”

A group of doctors, nurses and medical students protested the meeting, criticizing the association’s opposition to Medicare for All — the idea of expanding Medicare to cover all Americans. And on Monday, the doctors at the meeting heard a speech by Seema Verma, head of the federal Centers for Medicare & Medicaid Services, a Trump appointee who devoted a chunk of her talk to what she sees as problems with the proposal.

She told the audience, to applause, that Medicare for All would lead to higher taxes, lower payments for doctors and rationing of health care, among other things.

“We are deeply committed to helping those who need it, but while doing that, we must put the patients and their doctors in the driver’s seat to make decisions about their care, not the government,” Verma said.

So far the AMA has stood by its opposition to Medicare for All, also sometimes referred to as a single-payer system or universal health care, even as it’s become a hot topic ahead of the 2020 presidential race. Democratic candidate Sen. Bernie Sanders, I-Vt., unveiled a bill earlier this year to move to a single-payer health care system. About 56 percent of Americans surveyed earlier this year by the Kaiser Family Foundation said they would favor all Americans getting their insurance from a single government plan.

Supporters say they’re weary of the growing costs of health insurance, provided by private insurers, and restrictions often placed by insurers on which doctors can be seen and what will be covered. Those opposed to the concept, such as the AMA, say choice is key to health care improvements, and they worry about the government’s ability to effectively administer and fund such a huge system.

“The AMA is absolutely in favor of having every American have health care that needs to be of good quality and affordable,” AMA President Dr. Barbara McAneny said in an interview. The AMA supports the Affordable Care Act, also known as Obamacare, which mandated that all Americans have health insurance and barred discrimination based on preexisting conditions, among other things. “We just aren’t certain that Medicare for All is the right vehicle.”

McAneny said the association shares the frustration many feel with the current health care system, saying, “We cannot continue to spend this quantity of money and create bankruptcies just because someone gets sick.”

But the association believes choice in health care is a better way to go than Medicare for All. McAneny worries about what might happen to a government-run health care system during government shutdowns and about whether it would pay enough to sustain medical care. Now, government health insurance programs Medicare and Medicaid tend to reimburse doctors less than private insurers.

McAneny runs a cancer clinic in New Mexico, where most of her patients are on government health care programs. “I struggle to keep that practice breaking even,” she said. “If I did not have the higher rates of commercial payers to make up the shortfall of what I’m funded for Medicare rates, I would end up having to close that practice and leave a lot of people without service.”

Still, proponents of Medicare for All call the association’s stance antiquated. The group Physicians for a National Health Program protested the association Saturday over its position, shouting “AMA, get out of the way!”

That group contends that without private insurance, hospitals and doctors wouldn’t have to spend as much on administration, freeing up dollars for care. It also wants the AMA to stop being a member of a group that opposes single-payer health care called Partnership for America’s Health Care Future, which includes as members the Blue Cross and Blue Shield Association and the insurance industry’s main lobbying group.

The physicians’ group also notes that many doctors support the concept, pointing to a 2017 survey by physician search firm Merritt Hawkins that found 56 percent of doctors surveyed either strongly or somewhat supported a single-payer health care system.

“It makes the AMA seem awfully out of touch not only with the public but with the physicians they represent,” said Dr. Philip Verhoef, a physician at University of Chicago Medicine, and a member of the national board of Physicians for a National Health Program.

Chicago physician Peter Orris would also like to see the AMA reverse course, saying he believes that Medicare for All would remove unnecessary administrative costs from the system.

Still, Orris remains a member of the AMA despite his differing views from the group. Orris is a professor of occupational and environmental medicine at the University of Illinois at Chicago and a practitioner at the health system’s hospital.

“How are you going to bring everybody along there unless you’re engaging in that debate?” Orris said.

https://www.chicagotribune.com…

Protesters Rally, Disrupt Opening Session at AMA Meeting

Activists urge the association to support Medicare for All

By Joyce Frieden, Washington Editor and Shannon Firth, Washington Correspondent
MedPage Today, June 8, 2019

To chants of “AMA, get out of the way!,” a coalition of several hundred doctors, nurses, medical students, community organizers, and patients rallied outside the American Medical Association‘s (AMA) House of Delegates annual meeting to demand that the organization support a Medicare for All single-payer health system.

“We are here for those who cannot be here today,” Claudia Fegan, MD, national coordinator of Physicians for a National Health Program (PNHP), said as the group began gathering at the headquarters of the Blue Cross and Blue Shield Association, an organization of Blue Cross and Blue Shield insurers. “We are here for those who cannot afford their care. Twenty-nine million people are still uninsured and even the insured have deductibles so high they cannot afford their medications.”

The group also heard from Talisa Hardin of National Nurses United, a labor union for nurses, who criticized the AMA for its “aggressive” lobbying tactics. “The AMA is violating one of its most ethical principles: ‘Do No Harm,’ by being on the wrong side of history,” she said. “We want the AMA to publicly show its support for Medicare for All.”

Jennifer Epps-Addison, co-executive director of the Center for Popular Democracy, a grass-roots lobbying organization, led the group in chants of “Everybody In, Nobody Out!” She explained that her husband was diagnosed with multiple sclerosis a few years ago, and even though she has good health insurance, it costs the family $800 per month in premiums, and still more in other out-of-pocket costs. “This current healthcare system not only doesn’t work for low-income and no-income people, but it doesn’t work for the middle class families who are struggling to get by either,” she said. “My family is one job transition away from risking my husband’s life. That ain’t right.”

After the speakers finished, the group marched from the Blue Cross building to the Hyatt Regency Hotel, where the AMA was meeting. One of the marchers was David Mair, MD, a psychiatrist from Minneapolis and a member of PNHP, who said the AMA “needs to get with the 21st century. I was in the AMA as a student in 2000, and then I started looking at [how] we needed to get coverage for everybody.. I realized after doing much research that the obvious answer was single-payer, and I learned that the AMA was opposed to it.”

The reason the AMA isn’t getting on board with Medicare for All is that “they’re afraid of getting less money [as individual physicians],” Mair told MedPage Today. “The overall cost to run the business would go down [because] you’d have to have less admin staff, fewer prior authorizations, all the nonsense paperwork we have to do now. It’s still possible the pay would come down a little bit, but I think if all the doctors were united and they had the same payer, they could make the case [for higher] reimbursement rates, but they don’t want to bite the hand that feeds them.”

Outside the Hyatt Regency, the assembled marchers heard from other speakers, including Peter Lorenz, a medical student at the Chicago Medical School at Rosalind Franklin University here. “The first step of medical education is to take the Oath of Geneva, a pledge that the health of my patient is my first consideration. I cannot fulfill this oath in a society whose healthcare resources are so unequally distributed, resulting in a ‘pay-to-live’ system that benefits those with means and condemns those without.”

“Just across the river in Streeterville, a primarily affluent and white neighborhood, the life expectancy is 90 years,” he said. “Nine miles away in Englewood, primarily African American and low-income, the life expectancy is a full 30 years less … We have to work together to build a healthcare system that doesn’t perpetuate these injustices. We need Medicare for All.”

While the rally was going on outside, a smaller group of about 30 physicians disrupted the meeting’s opening session. They marched to the front of the room, held up a large banner reading “AMA: Support Medicare for All” along with several signs in the shape of gravestones with messages like “Here lies an infant whose mother couldn’t afford healthcare” and “Here lies your friend waiting for insurance approval.”

Over a dozen activists sat or lay on the ground in front of the stage, and a few stood on the stage by the podium, while activists in wheelchairs chanted and sang along with the group. A few of the activists also shared stories of patients who were harmed by their lack of health insurance. After 10 or 15 minutes, the activists exited peacefully, flanked by a couple of hotel staff; the activists were singing and chanting “Ain’t going to let nobody turn us around” as they left.

During the protest, Sue Bailey, MD, speaker of the AMA House of Delegates — who on Saturday was voted the organization’s president-elect for the coming year — called for order and ultimately a short recess. She reminded the protesters that just as they had a right to speak, the AMA also had a right to convene its meeting.

This is not the first time the AMA meeting has contended with protesters. In 2009, Tea Party activists demonstrated outside the AMA’s meeting to urge the organization not to support the Affordable Care Act, which the AMA later voted to support.

In her speech to the delegates as outgoing president, Barbara McAneny, MD, said she was “proud that the AMA is taking on insurance companies to reform prior authorization, helping a dozen states remove prior authorization for medication-assisted therapy to get timely treatment for a substance use disorder.”

“Our nation’s largest health insurance plans made billions last year,” she said. “Do we want a health system that simply fills insurer’s pockets or one that allows us to deliver our best care to patients?”

https://www.medpagetoday.com…

American Medical Association opposes ‘Medicare for All.’ Students, nurses and activists want to change that

By Tami Luhby
CNN, June 8, 2019

The American Medical Association is coming under increasing fire for opposing “Medicare for All.”

Energized by the growing attention on universal health care in the 2020 presidential campaign and in Congress, medical students, nurses and other activists are expected to rally Saturday at the AMA’s annual meeting in Chicago to urge its leadership to change its position.

Nearly two dozen groups — including those representing doctors, nurses, medical students and other health care workers — are participating in the campaign, organizers say.

The influential association has long opposed a government-run health care system, such as the Medicare for All proposal championed by Vermont Sen. Bernie Sanders, an independent running for the Democratic presidential nomination. It is also a member of the Partnership for America’s Health Care Future, a coalition of health industry groups seeking to quash any momentum behind Medicare for All.

The rally comes as the AMA doubles down on its opposition to universal health care. After being pressed to review its position by its medical students caucus at last year’s meeting, the association recently reaffirmed its commitment to strengthening the Affordable Care Act and making coverage more affordable, in part by increasing the eligibility and amount of federal subsidies for premiums and out-of-pocket expenses.

“Instead of abandoning the ACA and threatening the stability of coverage for those individuals who are generally satisfied with their coverage, the council believes that now is the time to invest not only in fixing the law, but improving it,” the AMA said in a report issued last month.

The association backs the idea that every American deserves quality, affordable health care insurance and that the current situation for patients is “unacceptable,” AMA President Barbara McAneny said in a statement Friday.

Still, the report recommended that the group not support single payer proposals. Among the concerns: a cut in reimbursement rates that could affect the number of doctors willing to participate.

Supporters of universal health care, however, want the AMA to “get out of the way,” said Marti Smith, a Midwest director of National Nurses United, one of the leading advocacy groups backing Medicare for All. The association is focused more on the industry than its patients, she charged.

The next generation of doctors has been particularly vocal in its support for universal health care.

Amanda Snead, who is finishing her first year at the University of Illinois at Chicago’s medical school, said the experience has been eye opening. She’s heard from people who couldn’t leave marriages or jobs because they needed to keep their health insurance.

AMA’s stance is why Snead has joined the Students for a National Health Program, which advocates for a single-payer plan, instead of the association. She’s concerned the current system will interfere with her ability to practice medicine.

“A lot of insurers take the autonomy out of physicians’ hands,” she said. “I want to be able to make the best medical decisions for my patients.”

https://www.cnn.com…

AMA Get Out of the Way!

On June 8, 2019, PNHP joined forces with Students for a National Health Program (SNaHP), National Nurses United, Jane Addams Senior Caucus, Center for Popular Democracy, Democratic Socialists of America, and other social justice organizations to demand the American Medical Association leave the corporate-funded “Partnership for America’s Health Care Future” and end its long-standing opposition to single-payer Medicare for All.

Why health profession students are fighting the AMA

Why we're fighting the American Medical Association

The AMA protects corporate interests, not doctors and patients – and now it’s trying to stop Medicare for All

By Jonathan Michels, Will Cox, Alankrita Siddula and Rex Tai
The Guardian, June 6, 2019

This Saturday, nurses, physicians, and medical students plan to walk out of their clinics and on to the streets of Chicago to confront the American Medical Association at the organization’s annual meeting. Health providers know that the outrageous costs and shameful inequality of American medicine are no accident – and that their patients’ lives are at stake.

The AMA claims to represent the interests and values of our nation’s doctors. But it has long been the public relations face of America’s private health insurance system, which treats healthcare as a commodity. This approach has resulted in some of the worst health outcomes in the industrialized world: the highest rate of infant mortality, the highest number of avoidable deaths, and health spending that eats up nearly 18% of America’s GDP.

The AMA is a major reason why 28 million Americans still don’t have health insurance. Despite recent polls showing that a majority of doctors support the single-payer system Medicare for All, which would fully insure all Americans, the AMA is leading the fight against universal coverage.

By money spent, the AMA is the nation’s third largest lobbying organization of the last 20 years, behind only the US Chamber of Commerce and the National Association of Realtors. By deploying powerful lobbying and misleading media campaigns, the AMA has opposed or hijacked nearly every health reform proposal of the last century, from Social Security to Medicare to the Affordable Care Act.

The AMA has also been a relentless opponent of universal healthcare. In 1949, the group waged an unscrupulous war against President Truman’s proposed national health insurance program, spending millions of dollars to have a political-consulting firm mislabel single-payer healthcare as “socialized medicine”. In 1961, the group doubled down on fearmongering when they hired Ronald Reagan to record an advertisement warning Americans that the passage of Medicare, an imperfect but popular health program for seniors, was a “short step to all the rest of socialism”.

The AMA, however, is finding it increasingly difficult to keep healthcare providers and patients scared of single payer.

Despite industry claims that Americans are “satisfied” with their private health plans, insured patients are saddled with exorbitant co-pays, premiums, and deductibles that keep them from actually getting the care they need. A single illness or injury pushes many Americans into bankruptcy. According to a recent Gallup poll, Americans borrowed a whopping $88bn last year simply to pay for medical expenses. So much for private insurance.

Most Americans – 70% – now favor the creation of a publicly financed but privately delivered single-payer health insurance program, better known as Improved and Expanded Medicare for All. Americans are desperate for affordable healthcare, a system that prioritizes patients over commerce, centers clinical decisions in the hands of physicians, and results in lower costs and better outcomes.

In February, Representative Pramila Jayapal, along with 106 co-sponsors, unveiled the Medicare for All Act of 2019 (HR 1384), while Senator Bernie Sanders’ revamped Medicare for All Act enjoys support from most of the leading Democratic presidential candidates. Even former President Barack Obama recently admitted that his signature health initiative – the Affordable Care Act – is no substitute for single payer.

Faced with soaring public support for Medicare for All, this past summer the AMA joined the “Partnership for America’s Health Care Future”, a benign-sounding corporate group which represents the pharmaceutical and private insurance industries and aims to “change the conversation around Medicare for All”. In order to protect their own economic interests, the “Partnership” is waging a well-funded campaign to turn elected officials away from single-payer by rallying Democrats around the ACA and preventing the Democratic party from including Medicare for All in its 2020 platform.

The campaign is merely the latest example of how the AMA uses the prestige of its white-coated members to push for market-based health reforms that maintain the status quo of our fractured health system: one in which some Americans have a lot, others have a little, and some are left with absolutely nothing.

Medical students and professionals have had enough. This Saturday’s protest is only one example. Last year, the Medical Student Section of the AMA put pressure on their leadership with a resolution demanding the organization suspend its decades-long opposition to single-payer. Single-payer activism is growing on medical school campuses across the nation, perhaps a preview of what the next generation of doctors will expect.

The public agrees with the evidence that Medicare for All is the answer to our broken health system. Until the AMA’s priorities change, it will remain an obstacle to the good of our patients.

Jonathan Michels is a premedical student at the University of North Carolina at Greensboro and a student board member of Physicians for a National Health Program (PNHP), an organization that advocates for an improved and expanded Medicare for All health system.

Will Cox is a longtime healthcare worker and social justice organizer and serves on the board of the North Carolina chapter of PNHP.

Alankrita Siddula is a medical student at Rush University in Chicago and a member of Students for a National Health Program (SNaHP).

Rex Tai is a medical student at the University of Illinois at Chicago. He is a midwest regional delegate for SNaHP and has a background organizing for criminal justice reform and harm reduction in opioid treatment.

The online version has 16 links to references supporting the statements made here:
https://www.theguardian.com…

Comment:

By Don McCanne, M.D.

Although there are many fine people in the AMA (I’m a life member), when it comes to health policy, the reactionaries have dominated, placing the medical-industrial complex in a dominant role over the patients. But there is hope. As these students demonstrate, the coming generation of health care professionals will be supporting the primacy of the patient. That should help clear the way for the enactment and implementation of single payer Medicare for All so that then we will have health care justice for all.

Everybody in! Nobody out!

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