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…

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…

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.

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…

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…