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Emotional testimony at first congressional hearing on Medicare-for-all proposal

Emotional testimony at first congressional hearing on Medicare-for-all proposal

By Benjamin Siegel and Andmaryalice Parks
ABC News, April 30, 2019

Lawmakers heard emotional testimony at the first congressional hearing on Medicare-for-all legislation on Tuesday, as the progressive pitch to reshape American health care dominates policy discussions in the 2020 Democratic presidential primary.

The House Rules Committee hearing focused on legislation from Reps. Pramila Jayapal, D-Wash., and Debbie Dingell, D-Mich., co-sponsored by more than 100 Democrats and building on ideas promoted most prominently by presidential candidate Sen. Bernie Sanders.

The House Democrats’ proposal would not require patients to pay for any expenses and would include primary, hospital, dental, vision and maternity care. It would cover prescription drug costs and allow the government to negotiate drug prices directly with manufacturers.

A 35-year-old progressive activist, Ady Barkan, in a wheelchair and unable to speak without the help of a computer program, captivated lawmakers as he called on Congress to approve Medicare-for-all legislation.

“Never before have I given a speech without my natural voice and needed a computer synthesizer,” he said.

While he has private health insurance coverage, Barkan described how is family is forced to pay $9,000 per month for around-the-clock nursing care at home because of his ALS, which he was diagnosed with three years ago.

“We have so little time left together, and yet our system forces us to waste it dealing with bills and bureaucracy,” he said of his family. “That is why I am here today, urging you to build a more rational, fair, efficient, and effective system. I am here today to urge you to enact Medicare-for-all.”

Democrats and Republicans used the first congressional hearing on Medicare-for-all to sharpen their political arguments over the progressive proposal.

“I believe health care is a right for all, not a privilege for the lucky few,” chairman Jim McGovern, D-Mass., a co-sponsor of the House bill, said Tuesday. “This Congress is putting that belief into action.”

“The ACA changed lives. It saved lives. But we knew then it was never going to be the last stop in health care reform, that we were always going to have to come back and build upon those core values. And that’s what today is all about.”

Rep. Tom Cole of Oklahoma, the top Republican on the committee, warned that the proposal would outlaw private insurance, and tried to tie the plan to President Barack Obama’s infamous promise about the Affordable Care Act.

“Even if you like your plan, you really can’t keep it,” Cole warned.

“This bill is a socialist proposal that threatens freedom of choice and would allow Washington to pose one-size-fits-all plans on the American people,” Cole said.

Republicans continued to push political buttons outside the hearing.

Reps. Kevin Brady, R-Texas, and Devin Nunes, R-Calif., top Republicans on the House Ways and Means Committee, have requested a hearing on Medicare-for-All from Chairman Richard Neal.

“This is a fantasy pulled from the farthest corners of the left,” Senate Majority Leader Mitch McConnell said on the Senate floor Tuesday.

Republicans also repeatedly seized on the disruptive impact it would have on the health insurance of tens of millions of Americans.

Witnesses across the political spectrum acknowledged the enormous price tag associated with the undertaking of implementing Medicare-for-All, a point repeatedly raised by Republicans.

Republicans and witnesses also warned against limiting choices for consumers by limiting private health insurance.

“In a country that values diversity, will one program with one list of benefits and set of rules work for everyone?” Grace-Marie Turner, the president of the Galen Institute, asked in her opening remarks.

The Democrats’ bill, which does not include a funding mechanism, also would preserve health care and medical benefits from the Veterans Administration and Indian Health Service, and give consumers two years to phase in to the program.

Sanders’ latest proposal for a single, national health insurance program would give Americans four years to join, instead of two, and handles some long-term care differently. It would also allow for co-pays for prescription drugs capped at $200 annually.

After Democrats’ successful midterm campaigns zeroed in on pre-existing conditions coverage, Republicans on Capitol Hill have seized on the other party’s health care debate ahead of 2020, using procedural votes and committee meetings to highlight questions about Medicare for all’s cost and potential impact on private health insurance.

“Patients and families want more choice and control over their doctors, treatments and coverage. They want lower costs and greater access to care. But government run, one-size-fits-all health care is not the answer,” Rep. Greg Walden, R-Ore., the top Republican on the House Energy and Commerce Committee, said in a statement to ABC News. “The Democrat plan is socialism. Under their plan, Americans will have fewer choices, taxes would skyrocket, and access to care would slow to a crawl.”

In February, Walden requested a Medicare-for-All hearing in the Energy and Commerce Committee, in an effort to highlight questions about the cost of the proposal.

The Mercatus Center at George Mason University estimated last year that Sanders’ plan would cost more than $32 trillion over ten years. Sanders has argued that the federal government is already spending significant sums on health care and could redirect some current spending to the new program, in addition to raising taxes on “extreme wealth.”

Democratic leaders said Tuesday’s hearing would be the first of several in the House on Medicare-for-all legislation. The House Budget Committee will hold a hearing in May on a forthcoming analysis from the nonpartisan Congressional Budget Office of single-payer health care, according to a spokesperson.

The tax-writing Ways and Means Committee, along with the Energy and Commerce Committee, with its jurisdiction over health policy, could also take up the topic later this year.

“The fact that it’s not in the ultimate, top committee that you might have to go to, is just one piece of it,” said Jayapal, who pointed out that she negotiated to hold the first hearing in the Rules Committee. “We want to talk about this and get the ideas out, and have people understand what’s really in the bill.”

“Anything we do to move the debate forward is positive,” Rep. Mark Pocan, D-Wis., a leader of the Congressional Progressive Caucus and co-sponsor of the Medicare-for-All Act of 2019, told ABC News.

The hearing also energized activists: More than 400 nurses stormed the nation’s capital Monday ahead of the hearings in support of the legislation.

National Nurses United, the largest union of registered nurses with more than 150,000 members nationwide, has been an avid promoter and supporter of the legislation for years. The group also campaigned heavily for Sanders during 2016.

On Monday, the nurses protested in front of the Pharmaceutical Research and Manufacturers of America headquarters and lobbied at House Speaker Nancy Pelosi’s office.

The group has grassroots organizing, canvassing and phone-banking events planned around the country in the coming months and, according to the union, its leaders plan to attend the hearings Tuesday to share stories about “patients suffering because of difficulties of the current health care system.”

“My concern is that more incremental solutions may be advanced and may sound attractive, but if implemented wouldn’t solve the fundamental dysfunctions and injustices of the American health care system,” Dr. Adam Gaffney, the president of Physicians for a National Health Program, a 20,000 member single-payer advocacy group, told ABC News.

Gaffney, a critical care doctor and instructor at Harvard Medical School, said he’s worried Democrats could “veer away from policy towards political expediency.”

“This,” he added, “is obviously the beginning of a process, not the end. I’m less concerned with where we start then where we finish up.”

https://abcnews.go.com…

Dr. Farzon Nahvi at House Rules Committee

Dr. Farzon Nahvi, an emergency physician and board member of PNHP’s New York Metro chapter, testified before the House Rules Committee on April 30, 2019. Dr. Nahvi advocated for H.R. 1384, the Medicare for All Act of 2019, so his patients would no longer feel compelled to leave the emergency department against medical advice, for fear of going bankrupt.

Universal Health Care Might Cost You Less Than You Think

We don’t think of the premiums we already pay as taxes, but maybe we should.

By Matt Bruenig
The New York Times, April 29, 2019

As the national debate about health care kicks off ahead of the 2020 presidential election, we’re going to be hearing a lot about the costs of increasingly popular progressive proposals to provide universal health care, like Bernie Sanders’s Medicare for All plan.

One common refrain on the right and the center-left alike: Since the rich can’t foot the bill alone, are middle- and working-class supporters of a more socialized health care system really ready to pay as much for it as people do in some of the high-tax nations that have one?

The problem is, we already do, and we often pay more.

It’s true that by conventional measures, taxes on workers’ wages in the United States are comparatively very low and even very progressive, affecting the lowest-earning workers the least and taxing those who can afford it more.

But these measures obscure an important fact of American life: Unlike workers in many other countries, the vast majority of American employees have private health insurance premiums deducted from their paychecks.

If we reimagine these premiums as taxes, we’d realize that Americans pay some of the highest and least progressive labor taxes in the developed world.

Just how heavy is the burden placed on American workers by employer insurance premiums? By combining data from the O.E.C.D. Taxing Wagesmodel with data from the Medical Expenditure Panel Survey, we can see what percentage of each worker’s compensation — a figure that includes cash wages as well as the taxes and benefits employers pay on behalf of their employees — goes toward taxes and health care, and how progressive these payments really are.

What this data shows is that lower-income workers, higher-income workers, single workers, and married workers with children all contribute around 40 percent of their pay toward taxes and health premiums. And when those health care costs are taken into account, the less well off no longer pay less than high-earners, as they do in taxes alone.

So, while opponents of comprehensive plans like Medicare for All claim those plans will greatly burden middle-class families, the truth is that we already have an unfair system. Middle-class workers in America are charged the same health insurance fees as upper-class workers despite the vast income differences between the two groups, and pay more of their earnings toward taxes and health care than workers in many wealthy countries.

For instance, according to this analysis, American families that earn around $43,000, half of the average wage, pay 37 percent of their wages to taxes and health care premiums. In high-tax Finland, the same type of family pays 23 percent of their compensation in labor taxes, which includes taxes they pay to support universal health care. In France, it’s 2 percent. In the United Kingdom and Canada, it is less than 0 percent after government benefits.

Consider the impact of these insurance premiums on American families with children. Through the earned-income tax credit and the child tax credit, the federal tax code does a lot to ensure that the effective tax rates of lower-middle-class workers go down considerably when they have kids. But these efforts are effectively negated by the burden of employer-based health insurance.

When single workers decide to start a family, they need to switch from an individual health plan to a family health plan. The average individual health plan has an annual premium of just under $6,400 — with employees directly paying around $1,400 of that. For family plans, the premium is around $19,000 with employees responsible for around $5,200.

This jump in premiums for workers who start families is what ensures that middle-class workers with children put around 40 percent of their labor compensation toward taxes and health care, despite policies that reduce their formal taxes.

Moving from our system to a European-style system would make our overall system of taxes and health insurance payments much more progressive for the majority of Americans, because the elimination of private health premiums would more than offset the rise in formal taxes for all but the wealthy.

Although the financing details of Medicare for All remain provisional at the moment, a RAND report on a more concrete single-payer proposal for New York State found that the plan would cut health care costs dramatically for the lowest income group, while increasing them by about 50 percent for the highest income group. Middle-class people would also experience net savings on health care equal to around 10 percent of their income, with only those earning 10 times the federal poverty line or above — that’s $134,000 for an individual or $276,000 for a family of four — paying more than they do now.

If we don’t move toward a European-style health program, we’ll remain stuck in a system where Americans, regardless of their incomes, pay ever larger amounts out of their paychecks to fund health care. The fact that we don’t call these payments “taxes” doesn’t change that fact, so it shouldn’t blind us to the best solutions.

If policymakers in America want to boost the fortunes of the middle class, and especially middle-class families with children, shifting the health insurance burden up the income ladder while bringing down overall health care costs, as Medicare for All would, is one of the surest ways to do that.

Matt Bruenig is the founder of People’s Policy Project, a think tank funded by small donors.

https://www.nytimes.com…

Why only the single payer model of Medicare for All will work

Universal Health Care Might Cost You Less Than You Think

By Matt Bruenig
The New York Times, April 29, 2019

As the national debate about health care kicks off ahead of the 2020 presidential election, we’re going to be hearing a lot about the costs of increasingly popular progressive proposals to provide universal health care, like Bernie Sanders’s Medicare for All plan.

One common refrain on the right and the center-left alike: Since the rich can’t foot the bill alone, are middle- and working-class supporters of a more socialized health care system really ready to pay as much for it as people do in some of the high-tax nations that have one?

The problem is, we already do, and we often pay more.

It’s true that by conventional measures, taxes on workers’ wages in the United States are comparatively very low and even very progressive, affecting the lowest-earning workers the least and taxing those who can afford it more.

But these measures obscure an important fact of American life: Unlike workers in many other countries, the vast majority of American employees have private health insurance premiums deducted from their paychecks.

If we reimagine these premiums as taxes, we’d realize that Americans pay some of the highest and least progressive labor taxes in the developed world.

What this data shows is that lower-income workers, higher-income workers, single workers, and married workers with children all contribute around 40 percent of their pay toward taxes and health premiums. And when those health care costs are taken into account, the less well off no longer pay less than high-earners, as they do in taxes alone.

So, while opponents of comprehensive plans like Medicare for All claim those plans will greatly burden middle-class families, the truth is that we already have an unfair system. Middle-class workers in America are charged the same health insurance fees as upper-class workers despite the vast income differences between the two groups, and pay more of their earnings toward taxes and health care than workers in many wealthy countries.

For instance, according to this analysis, American families that earn around $43,000, half of the average wage, pay 37 percent of their wages to taxes and health care premiums. In high-tax Finland, the same type of family pays 23 percent of their compensation in labor taxes, which includes taxes they pay to support universal health care. In France, it’s 2 percent. In the United Kingdom and Canada, it is less than 0 percent after government benefits.

For instance, according to this analysis, American families that earn around $43,000, half of the average wage, pay 37 percent of their wages to taxes and health care premiums. In high-tax Finland, the same type of family pays 23 percent of their compensation in labor taxes, which includes taxes they pay to support universal health care. In France, it’s 2 percent. In the United Kingdom and Canada, it is less than 0 percent after government benefits.

Although the financing details of Medicare for All remain provisional at the moment, a RAND report on a more concrete single-payer proposal for New York State found that the plan would cut health care costs dramatically for the lowest income group, while increasing them by about 50 percent for the highest income group. Middle-class people would also experience net savings on health care equal to around 10 percent of their income, with only those earning 10 times the federal poverty line or above — that’s $134,000 for an individual or $276,000 for a family of four — paying more than they do now.

If we don’t move toward a European-style health program, we’ll remain stuck in a system where Americans, regardless of their incomes, pay ever larger amounts out of their paychecks to fund health care. The fact that we don’t call these payments “taxes” doesn’t change that fact, so it shouldn’t blind us to the best solutions.

If policymakers in America want to boost the fortunes of the middle class, and especially middle-class families with children, shifting the health insurance burden up the income ladder while bringing down overall health care costs, as Medicare for All would, is one of the surest ways to do that.

Matt Bruenig is the founder of People’s Policy Project, a think tank funded by small donors.

NYT Reader Comment:

By Don McCanne, M.D.

Matt Bruenig’s explanation of why progressive financing of health care is essential is precisely why we need the single payer model of Medicare for All (Jayapal, Sanders). Merely expanding the Affordable Care Act or adding a public option (even if mislabeled Medicare for All) leaves too great of a burden on working individuals and their families.

https://www.nytimes.com…

Comment:

By Don McCanne, M.D.

It’s simple. Read my brief comment above.

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

This advocate says Medicare-for-all won’t slash health prices. Here’s why he supports it anyway.

“It would make my position as a single-payer advocate a lot easier,” says a doctors organization leader. “But that’s not realistic.”

By Sarah Kliff
Vox, April 29, 2019

Adam Gaffney is the president of the Physicians for a National Health Program (PNHP) — and a single-payer advocate whom I’ve found to be especially clear-eyed about what a single-payer system in the United States can and can’t do.

Gaffney works as a critical care doctor and supports Medicare-for-all for lots of reasons. He thinks it will improve access to medical services and make the United States a more equitable place to live.

But he also doesn’t expect that Medicare-for-all would amount to huge cost savings for the United States, at least in the short-run. He isn’t sure whether we can ratchet down our current health care spending (17 percent of the economy) down to the same level as Canada (where they spend about 10.5 percent of gross domestic product on health care).

“It would make my position as a single-payer advocate a lot easier if I could say, ‘hospital spending will fall 50 percent with Medicare-for-all,’” Gaffney says. “But that’s not realistic.”

I saw Gaffney make a short version of this argument in a New York Times article last week, and knew I wanted to get the long version. So I gave him a call and we spoke about what cost-savings he thinks are realistic, how we get there, and how his views on this have changed in the past decade.

What follows is a transcript of our discussion, lightly edited for length and clarity.

Sarah Kliff: Let’s start with something you said to the New York Times for an article last week, that I thought was pretty interesting. This was for an article about possible funding cuts that hospitals might face if we moved to a Medicare-for-All system. And the thing you told the Times was, “We don’t need the insurers, but we do need the hospitals.” Essentially saying, you can’t get too aggressive on cutting hospital revenue. Explain to me why you think that is, and what kind of cuts would be realistic in a Medicare-for-all system?

Adam Gaffney: It would make my position as a single-payer advocate a lot easier if I could say, hospital spending will fall 50 percent with Medicare-for-all, but it’s not realistic. I think there are savings that hospitals can achieve through efficiencies. If we move toward a global budget system, which is what is described in the Jayapal bill, you maximize the administrative savings.

We should be talking about the things we want hospitals to spend less of their revenue on, rather than focusing on the individual prices of services. If we’re going to say, we want to shrink hospital budgets, well, what things do we want the hospital to spend less money on? If you just take the average hospital and simply shrink its budget, you have to make sure it’s happening in the right way.

The way I think about it is we need a new way to finance hospitals. We need to transform them. We can achieve savings in administration costs, and we can finance new capital projects from a different source that isn’t hospital profits. But beyond that I think it’s not feasible to make claims about more dramatic reductions in national health expenditures.

Sarah Kliff: What do you think are the risks of getting budgeting wrong in a Medicare-for-all system? You mention the global budgets that are in the Jayapal bill, which are pretty similar to Canada, and essentially give a hospital a lump sum to take care of patients. How do you decide how big that budget is — and know that it’s the right amount to pay the hospital? Is there a risk of some hospitals closing?

Adam Gaffney: I don’t think that’s going to happen. When Medicare-for-all is passed, it’s not going to happen in a way that causes hospitals to close, or close down certain wings. I think we’ll get the payment structure right, because hospitals will have similar amounts of money to what they had in the year prior to reform. If you slashed hospital budgets after a military coup, sure, hospitals could close. But this nightmare scenario of hospitals closing and doctors fleeing the country, it’s not going to happen that way. We’re going to pass a law that ensures hospitals have the resources they need.

Sarah Kliff: I think something you said just there, that hospitals will have similar amounts of money the year after Medicare-for-all passes, that would surprise a lot of people who support Medicare-for-all and believe that hospitals should face big budget cuts.

Adam Gaffney: It might. And if I think I were speaking to you 10 years ago, I would have said something different. I would have thought well, hospitals in Canada can do this for half as much, why don’t we just do that. But it’s just not realistic.

Sarah Kliff: What changed your mind?

Adam Gaffney: I think awareness of the fact that every dollar spent on health care is being spent on something, so you have to be willing to put your finger on where do I want the reduction to come from. We can eliminate profits. Fire departments don’t have profits, schools don’t have profits. We can get rid of advertising, we can get rid of bonuses, about 50 percent of administrative spending. But beyond that, I’m not going to claim they can produce the same amount of health care for less. I can’t say when that will happen.

Sarah Kliff: Do you see a path for the United States to spend the same amount of money on health care that Canada does? Can we have Canadian prices here?

Adam Gaffney: I don’t know the answer to that question. I know the answer is no in the short-term. If you study other universal health care transitions, there has never been a case where they created a system and suddenly slashed spending in half. I’m not sure any country has reduced their spending in half overnight.

We’re getting into a new stage of the single-payer discussion. At first the emphasis was getting the idea out there, and pushing it into the center of the policy discussion. We weren’t quite as focused on some of the details of how the system would run, and that is what we’re working out now.

Sarah Kliff: I know another way that the plans that your group and Sen. [Bernie] Sanders support differ from many other countries is that they have no type of co-payments or cost-sharing for medical care. When you go to the doctor, you don’t pay a fee. How important is that element of the plan to you? Is that something you could see changing in negotiations?

Adam Gaffney: Ten years ago, I would have said co-pays would be fine. I wouldn’t have been in favor, but I would have thought, what’s the big harm.

Since then I’ve come to realize there are two possible ways to do cost-sharing. It can be set so low that it has no effect on people’s use of health care. You could have a co-pay that costs a nickel. That won’t deter anyone from going to the doctor, so what function is it serving? Then you need a guy to collect all the nickels and carry them down to the bank, and that costs more in terms of administering the nickel co-pays.

If the co-pays are going to be high, then you start asking, why are we trying to make a financial barrier to people using health care? There are decades of data that show that cost-sharing makes people use less health care, but it doesn’t just reduce low-value care. It reduces high-value care, too. There was a recent study showing that high deductibles caused women to have a delay in breast cancer diagnoses.

I could go on and on about this but the point is it just reduces care indiscriminately. That’s how I view it: that cost-sharing reduces use. It keeps people from getting the medicines that they need.

Sarah Kliff: Let’s talk about another design choice in the plans from PNHP and legislators: the set of benefits. The plans you all are proposing cover a wide array of benefits including long-term care, vision, dental. Do you think it’s realistic to build a system like that? Or at some point, in the political process, we’ll see some benefits drop off because a system with more benefits costs more money?

Adam Gaffney: There is no question that, the more you cover, the more expensive it’s going to be. I do think that given how rich our country is, we can afford universal dental care. There are other countries that have universal long term care, like Germany and Japan. But obviously we’re going to have to push to keep it comprehensive.

When they created the National Health Service in Britain, it included dental and vision and all sorts of medical services. But then they added co-pays back for prescription drugs. It was thought the costs were getting excessive. I think co-pays should be kept out of this entirely, but it’s not going to be easy, there is a big health care fight ahead.

https://www.vox.com…

Don’t let ideology determine your health care

By James Fieseher, M.D.
Concord (N.H.) Monitor, April 29, 2019

Health care in America has always been in the crossroads (and crosshairs) of a variety of conflicting interests.

Lately, the economics of health care has clashed with the ethics of coverage. “Should a health care system cover everyone?” vs. “Who will pay for it?” vs. “What services should be offered and at what price?”

About half the country feels that we should cover everyone while the other half feels it’s unfair to mandate or offer health care to those who cannot afford it.

These have all been contributing factors to the ridiculously overpriced and disjointed commixture that we have today, where health care is affordable only for the healthy and wealthy, and the prices are hidden.

This is the very unfair and confusing gallimaufry that conservative ideologues tout as a “free-market system” of health care. How can we call this a “free-market system” or even “capitalism” when the buyer is forced to go only to the nearest hospital, and consume services and goods whose prices are not posted and in many cases whose value is not fully understood by the consumer? How can we say we have a free society when the person taking your money determines which doctor or doctors you can see or which tests that doctor will be allowed to perform to determine your diagnosis?

Americans do not have a capitalistic system of health care; we don’t even have a working model of how our health care system is supposed to work.

Again, the ideologues indicate that since the United States comprises 50 separate states, those states can serve as “individual laboratories” for the health care system that works best for them. That theory doesn’t match the reality because the elements necessary to supply health care are national companies – the insurance, pharmaceutical and pharmacy industries. It also doesn’t address the fact that people don’t always confine themselves to just one state throughout the year.

Ironically, there are working models of health care that are more effective and cheaper than we have in the United States. You have only to look beyond our borders to see that all other industrialized nations have found ways of developing health care systems that are more comprehensive, less costly and their citizens live longer.

A universal system of health care coverage should not be confused with socialism. The measles outbreak in Brooklyn and the opioid epidemic in New Hampshire (and throughout the country) are national problems. Only by addressing our health care needs as a whole country can we obtain comprehensive and affordable health care for ourselves and our posterity.

Don’t let ideology determine your health care. It is costing us our health and our money. It is opening up a further divide in our nation and our neighborhoods. It weakens our small businesses and our economy.

Other nations have taken a common-sense approach to a health care system by abandoning ideology. Instead, they examine their needs and then fashion a plan that they can afford. We should do the same.

https://www.concordmonitor.com…

The illusion of choice in private health insurance

By Thomas O’Rourke, Ph.D., M.P.H.
The (Champaign, Ill.) News-Gazette, April 28, 2019

There is general agreement that Americans love choice, be it internet providers, cable TV options or even ice cream, exemplified by Baskin Robbins’ 31 choices.

Ditto for pizza, be it thick or thin crust, with toppings ranging from sausage or peperoni to pineapple and avocado. No way the idea of “one size fits all” flies in the U.S. Choice is a fundamental American value and an integral part of our identity.

This is clearly evidenced in the ongoing health care debate that has received renewed interest in the media, especially with several proposals to create a universal “Medicare for All” publically financed, single-payer health plan.

A recent Kaiser Family Foundation poll showed that 56 percent of Americans support the idea of a new federal health care program. However, that support quickly evaporates when tradeoffs such as the loss of private insurance options were included. With respect to private health insurance, closer examination shows that consumer choice is more illusory than actual, more fantasy than real.

The private health insurance industry is a mix of for-profit and nonprofit companies of various sizes. Most Americans who have insurance obtain it through employer-sponsored or group health insurance plans.

About 155 million Americans get private health coverage through a public or private-sector employer. Although there are about 850 health insurers, most handle just a small regional area. In contrast, the five biggest health insurance companies, WellPoint, CIGNA, Aetna, Humana and United Healthcare, insure approximately half of the insured population.

From the get go, employees are not the ones who make health care coverage decisions. While there are millions of plans offered by employers throughout the country, if your company even offers coverage through an employer-sponsored plans, your only choice is from your employer.

Employers, not employees, choose insurers and what plan(s) they wish to offer. In turn, the insurers determine the providers you can use, the treatments you can or can’t receive and the prescription drugs you can take. Annually, you can be forced to change provider networks, benefits, out-of-pocket costs and insurers.

Quickly, many employees find that they may have a very limited choice of plans in terms of benefits, costs and choice of physicians or hospitals. Even if you like your insurance, hardly anyone gets to keep the same insurance throughout their life. The only constant is that insurance changes all the time. For those with employer-based health insurance, think back about the insurance you had over the past decade. Odds are it isn’t the same today or maybe even last year.

There are many reasons for this. Private health insurance tied to employment often is not stable as the economy constantly is changing. Change jobs and every aspect of your health insurance changes. Good luck if you leave the job market. You are on your own.

To counter rising health care costs, employers annually may change their employee benefits or change their insurers. Increasingly, employers are requiring employees to pay higher premiums and cost sharing in the form of deductibles and co-payments.

This cost shifting may result in loss of coverage or access due to an inability to pay or result in employees choosing “stripped down” plans with less coverage, resulting in potentially greater exposure to unaffordable costs.

Changes in insurer-provider networks happen all the time and can result in individuals losing their usual sources of care. Employees may be restricted to managed care plans or put into narrower networks with significantly higher costs for going out of network or for care previously available in network.

While choice is a cherished American value, it doesn’t carry over with respect to employer-sponsored private health insurance where effective choice and consumer sovereignty are more fiction than fact.

In the current health care reform debate, beware of proposals ensuring consumer choice by preserving and expanding private health insurance. Based on past and current experience, the saying “If you like your health care plan, you can keep it” rings hollow indeed.

Thomas O’Rourke is professor emeritus of community health at the University of Illinois.

http://www.news-gazette.com…

Town hall reveals popularity of Medicare for All

By Pamella Gronemeyer, M.D.
St Louis Post-Dispatch, April 27, 2019

Fox News must have been somewhat upset during the town hall with Sen. Bernie Sanders on April 15 (“Fox draws nearly 2.6 million viewers for Sanders town hall,” April 16). Moderator Bret Baier asked audience members to raise their hands if they would trade their employer insurance for improved Medicare for All. The audience responded affirmatively with a large show of hands. I hope that the Democratic Party leadership tuned in to this town hall and also saw that the truth about Medicare for All is spreading.

Every year, 66 million Americans change jobs and must switch health care plans, if they are even offered employer health insurance at the new job. Many people who don’t change jobs see their costs increase. In my position as a small business owner, the plans change from year to year with premiums that rose 6.2 percent in 2019.

The Fox town hall hosts tried to attack Sanders because he is supporting free health care. As Sanders stated, the health care would be free when delivered without a copay or deductible but would be paid for by a combination of progressive taxes, a Wall Street tax on transactions, or taxes on corporations that not only pay no taxes but receive government subsidies. Health care should be a human right not a privilege.

https://www.stltoday.com…

Addendum: Ady Barkan added to witness list for House Medicare for All hearing

Ady Barkan to Testify at House Rules Committee Hearing on Medicare for All

Medium.com, April 26, 2019

Dying healthcare activist Ady Barkan will travel from his home in California to testify at a Tuesday hearing of the U.S. House of Representatives Committee on Rules regarding Rep. Pramila Jayapal’s bill to establish a Medicare for All single-payer health care system in the United States. Barkan, a husband and father to a young son, is a longtime progressive activist who captured hearts and minds when he went public with his diagnosis of terminal ALS and confronted Sen. Jeff Flake on a plane during the political battle over the repeal of the Affordable Care Act. At the hearing, Barkan will speak to his own experience with the American health care system in the wake of his ALS diagnosis, underline the importance of including long term care coverage as part of Medicare for All, and address the need to ensure high quality health care to every American as a right. Owing to the advanced progression of ALS, Barkan will deliver his testimony using a computer system that tracks his eye movements and subsequently converts text into speech.

“For 100 years, visionary patients, nurses, doctors and organizers have fought to ensure that everyone in America gets the health care they need,” said Ady Barkan. “But time and again, our movement has been stymied by the corporations and people who make money off of our illnesses. On Tuesday, for the first time ever, Medicare For All will get a hearing in the United States Congress. I congratulate and thank Rep. Jayapal, Rep. Dingell, former Rep. Conyers and Sen. Sanders for their decades of leadership on this historic day.

“I am grateful to Chairman McGovern and Speaker Pelosi for making this hearing possible and inviting me to testify. Tuesday will be just the latest example of why I worked so hard to help Democrats win back the House in November. The American people have heard the message loud and clear: Republicans are bad for your health. Progressives have a plan to fix the American healthcare system once and for all. It will take immense effort and teamwork for me to attend this hearing, but that is what is required — from me and thousands of other healthcare heroes — to deliver us the change that the American people deserve.”

Barkan now requires full-time home care that costs his family $9,000 per month on top of what his insurance company will cover. Traveling from California will require Barkan, who is unable to move or feed himself independently, to board a plane with two full-time caregivers and will expose him to the risk of serious illness. Barkan founded Be A Hero PAC, a political organization aimed at harnessing people power to press for a more just society.

WHEN: Tuesday, April 30 at 10 a.m. Eastern

WHERE: United States Capitol Building, H-313

WHO: Ady Barkan, Progressive Activist

Rep. James McGovern, Chairman of the U.S. House Committee on Rules

To be live-streamed at: https://rules.house.gov

Follow Ady Barkan on Twitter: https://twitter.com/AdyBarkan

https://medium.com…

Comment on Addendum:

By Don McCanne, M.D.

Activist Ady Barkan is laying his life on the line to try to advance the cause of health care justice for all by testifying in support of the Jayapal/Dingell Medicare for All Act of 2019. May he inspire all of us to do our utmost to deliver on the promise of single payer Medicare for All.

Thank you, Ady.

Original QOTD: The House hearing on single payer Medicare for All will likely be a sham

U.S. House of Representatives, Committee on Rules

Hearing: H.R. 1384 — Medicare for All Act of 2019

Tuesday, April 30, 2019 (10:00 AM)

Witnesses

Dr. Dean Baker
Senior Economist, Center for Economic and Policy Research

Dr. Sara Collins
Vice President for Health Care Coverage and Access, The Commonwealth Fund

Dr. Doris Browne
Immediate Past-President, National Medical Association

Dr. Farzon Nahvi
Emergency Room Physician

Ms. Grace-Marie Turner
President, Galen Institute

Dr. Charles Blahous
J. Fish and Lillian F. Smith Chair and Senior Research Strategist, Mercatus Center

https://docs.house.gov/Committee/Calendar/ByEvent.aspx?EventID=109356

Single-Payer Advocates Worry ‘Medicare For All’ Hearing Could Be A ‘Farce’

By Matt Fuller
HUFFPOST, April 25, 2019

When the Rules Committee convenes this hearing on Tuesday, there may not be any witness testifying who will make the case for Medicare for All over other health care plans.

“There is a heated debate right now about what is this best way forward,” Adam Gaffney, the president of Physicians for a National Health Program told HuffPost. “Medicare for All is one proposal. Medicare for All is the best proposal. Is someone going to make that case?”

Gaffney was actually one of the witnesses that single-payer advocates put forward to testify. But the Rules Committee nixed his appearance, along with those of more than a dozen other suggested witnesses.

It’s unclear who decided which experts would testify before the Rules Committee. Staffers on the Rules Committee say no one in leadership directly told them this person or that person couldn’t testify, but sources involved with the planning of the hearing say three criteria were applied to potential witnesses: (1) Is this person a leader of a single-payer group? If so, that person could not testify ― meaning Gaffney was out. (2) Is this person an activist? If so, they couldn’t testify. That meant people like Dr. Sanjeev Sriram, who has repeatedly advocated for Medicare for All, were ruled out. And (3) Has this person said anything negative about the Affordable Care Act?

That last requirement, implemented by House Speaker Nancy Pelosi’s top health care staffer, Wendell Primus, according to sources, is particularly an issue for some single-payer advocates, because they believe the hearing could turn into an exercise in which witnesses seem to endorse all sorts of different approaches to health care ― the ACA, a Medicare buy-in situation, and perhaps, maybe, Medicare for All.

A Pelosi spokesman, Henry Connelly, said in a statement that the Rules Committee had “free rein to choose whichever witnesses they wanted to articulate the strongest case for Medicare For All.”

While the Rules Committee and Pelosi’s staff contest leadership’s role in choosing witnesses, sources close to the process insist Primus was intimately involved.

Single-payer groups and activists are reflexively suspicious of Primus after The Intercept revealed that he had spoken to insurance executives and laid out his own objections to Medicare for All.

Primus also did himself no favors in a March 25 meeting with staff from a number of congressional committees that have health care jurisdiction. He reportedly said the Medicare for All hearing was a “check the box and move on type of thing.”

https://www.huffpost.com…

Comment:

By Don McCanne, M.D.

The House Rules Committee hearing scheduled for April 30 is for H.R. 1384 — Medicare for All Act of 2019, a bill specifically calling for the enactment of the single payer model of Medicare for All. Yet highly qualified experts who support single payer have been excluded as witnesses. So who are the people that will testify?

Dean Baker is an economist who is co-founder of the Center for Economic and Policy Research, considered to be a left-leaning think tank.  He has expressed the view that “a single-minded focus on single payer” could waste “a great opening for progressive health-care reform.” This month he wrote, “lowering the Medicare age to 64 is a really big first step.” If each session of Congress lowered the eligibility age by another year, we would have Medicare for all in 130 years (though it is likely that intervening Congresses would have other ideas).

Sara Collins is vice-president for health care coverage and access at the Commonwealth Fund – an organization with a mission “to promote a high-performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society’s most vulnerable, including low-income people, the uninsured, and people of color.” She recently authored, “The “Medicare for All” Continuum: A New Comparison Tool for Congressional Health Bills Illustrates the Range of Reform Ideas.” The single payer model is at one end of the continuum.

Doris Browne is a retired Colonel of the US Army Medical Corps who founded Browne and Associates, Inc., a “small business that specializes in improving quality health outcomes through increasing awareness and inspiring behavior changes.” She recently served as president of the National Medical Association which advocates for prioritizing preventive care, preserving the health care safety net, and reducing health disparities. A search failed to reveal any position she may have previously taken on single payer.

Farzon Nahvi is an emergency room physician and assistant clinical professor at Mount Sinai Health System. He is an advocate of “a universal healthcare system,” apparently for all the right reasons. It is reported that “Nahvi’s testimony is supposed to be limited to how patient experience would change,” so it is uncertain whether or not he will be able to testify on behalf of single payer.

Grace-Marie Turner is president of the Galen Institute, a public policy research organization that supports “individual freedom, consumer choice, competition, and innovation in the health sector.” She has a long history of outspoken opposition to single payer reform.

Charles Blahous is senior research strategist for the Mercatus Center which claims to be “the world’s premier university source for market-oriented ideas.” He recently authored an analysis of single payer, purported to be the version advanced by Bernie Sanders. The analysis was designed to discredit the single payer model, though it inadvertently demonstrated that the status quo was more expensive than changing to single payer.

So it appears that this is not a hearing on the single payer Medicare for All legislation, as advertised, but it is rather a hearing on not only the pros and cons of various models of reform that have been labeled Medicare for All but also likely will cover briefly the status of health care since the enactment of the Affordable Care Act. What we will fail to see is a full explanation of the single payer model of Medicare for All and why it is vastly superior to the status quo or to the other options for reform.

They’ve stolen the ‘Medicare for All’ label, and now they want to bury it.

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‘Health Care for All,’ the path forward

By James F. Burdick, M.D.
Baltimore Sun, April 25, 2019

The Partnership for America’s Health Care Future was recently launched to fight growing public and political support for a national health insurance plan. This is a massive coalition of over 30 major health care lobbying organizations, including America’s Health Insurance Plans (AHIP), the Pharmaceutical Research and Manufacturers of America (PhRMA) and the Federation of American Hospitals. Although they claim otherwise, this group is pushing for profits rather than the best interests of patients.

And that’s why we — physicians, politicians and the public — must join in our own alliance to push back and advocate for what many know as “Medicare for All” or “single payer,” but I prefer to call “Health Care for All.” While a public or quasi-public agency would oversee health care financing, the delivery of care would still be left to private practitioners. I’ve been advocating for this for years, though the idea has gained traction since Bernie Sanders made it a centerpiece of his presidential campaign in 2015.

Congressional and administrative encroachments — spurred by big business — on the ambitious, but flawed, Affordable Care Act have made health care through private insurance less available and more expensive for many Americans. It is increasingly clear that health care reform must overcome that commoditization.

Many doctors, especially the younger cohort, support the Health Care for All idea. Dr. Steven Schroeder at UCSF, quoted in Kaiser Health News, says “Students [today] come in saying, ‘We want to make a difference through social justice. That’s why we’re here.’” Student delegates to the American Medical Association last year proposed a resolution to delete the AMA policy against single payer.

A Merritt-Hawkins poll also found that, overall, 56 percent of doctors are now somewhat or strongly supportive of a single payer health system, a large increase over 2008. And Physicians for a National Health Program, which advocates “Improved Medicare for All,” has grown in recent years to 23,000 members (including me).

Still, Health Care for All will be fought by vested interests making excessive profits, and it will require strong public and professional pressure to overcome such obstacles and achieve reform. We can start by dispelling some myths:

Will it cost more?

On the contrary, the recent meticulous report from the Political Economy Research Institute at the University of Massachusetts, Amherst, not only confirms other predictions that individuals will not pay more, it concludes that “Medicare for All could reduce total health care spending in the U.S. by nearly 10 percent, to $2.93 trillion, while creating stable access to good care for all U.S. residents.” Cost for Health Care for All is often predicted from our present costs, expanded to cover everyone. But that does not recognize the inefficiency of our expensive, chaotic, less effective health care now. A national system can save us money.

Is Health Care for All politically impossible?

No. Over half of U.S. health care already comes through government programs funded by taxes; it is hardly a stretch to go the rest of the way.

Will it limit our choice of doctors or insurance plans?

Nope. It will include all doctors and all patients, with no insurance chaos to confuse and restrict care. And Health Care for All removes the limitations for workers as well as for employers by not requiring employer contributions to health care insurance.

What if we don’t want government-controlled health care?

That is not how it will be if doctors get on board and help. My great fear is that not enough doctors will grasp the vision for a politically independent, professional board using national data to decide what health care options are right for doctors to provide their patients.

This, then, is how the U.S. public can help strengthen its natural alliance with American doctors to best serve patients. Take a page from the legalistic parody of concern that ends many pharmaceutical ads, urging viewers to “Ask Your Doctor.”

At your next medical visit, ask your doctor about single-payer Health Care for All, and urge him or her to get behind it.

Dr. James F. Burdick is a professor of surgery at Johns Hopkins Medicine and author of the book, “Talking About “Single Payer.”

https://www.baltimoresun.com…

Medicare for All is easily affordable

America’s Biggest Lie: We Can’t Afford Medicare for All

Think about how much your income would go up if you didn’t have to pay for healthcare at all. That would begin to close the gap between productivity and wages for the first time in a generation.

By Les Leopold
Common Dreams, April 23, 2019

Pundits and politicians repeatedly warn us that the country cannot afford costly social services. They caution about the perils of a rising national debt, the supposed near bankruptcy of Medicare and Social Security, and the need to sell public services to the highest bidder in order to save them. We must tighten our belts sooner or later, they tell us, rather than spend on social goods like universal health care, free higher education and badly needed infrastructure.

To many Americans this sounds all too true because they are having an incredibly tough time making ends meet. According to the Federal Reserve, “Four in 10 adults in 2017 would either borrow, sell something, or not be able pay if faced with a $400 emergency expense.” To those who are so highly stressed financially, the idea of paying for a costly program like Medicare for All sounds impossible.

We are the richest country in the history of the world, however, and certainly could afford vastly expanded and improved vital public services if we had the will. What stands in the way is runaway inequality. Our nation’s wealth has been hijacked by the super-rich, with plenty of aid from their paid-for politicians.

Over the past 40 years the top fraction of the top one percent have systematically denied working people the fruits of their enormous productivity. The results of this wage theft can be seen clearly in the chart below which tracks productivity (output per hour of labor) and average weekly wages (after accounting for inflation) of non-supervisory and production workers (about 85 percent of the workforce).

The red line shows the rise of American productivity since WWII. While not a perfect measurement of the power of our economy, it does capture our overall level of knowledge, technical skills, worker effort, management systems, and technology. Ever-rising productivity is the key to the wealth of nations.

As we can see clearly, the productivity trend has been ever upward. Today the average worker is nearly three times as productive per hour of labor as he or she was at the end of WWII. And the workforce is more than three times as large. That means we are a colossal economic powerhouse. But unless you are an economic elite, it doesn’t feel that way.

To understand why we need to look at the blue line – average real worker wages. From WWII to the late 1970s or so, as productivity rose so did the average real wage of nearly all American workers. Year by year most working people saw their standard of living rise. For every one percent increase in productivity, about two-thirds went to labor, and the remaining one-third went to capital investment and profits.

After the late 1970s, however, the story changes dramatically. Real wages stall for more than 40 years, while productivity continues to climb. Had wages and productivity continued to rise in tandem, the average weekly earnings of the American worker would be almost double what it is today, rising from today’s average of $746 per week to $1,377 per week.

What happened? Where did all the money go that once went to working people?

The fatalistic story sold to us by elite-funded think tanks is that the rise of international competition and the introduction of advanced technology crushed the wages of those without the highest skill levels. The typical worker, it is claimed, is now competing with cheap labor from around the world and hence sees his or her wages stall and even decline. And since there really isn’t much anyone can do about globalization or automation, there’s nothing we can do about the stalling wages. Such a convenient story to justify runaway inequality!

The real story is far more complex and troubling. Yes, globalization and automation contribute to stagnant wages. But as the International Labor Organization shows in their remarkable 2012 study, only about 30 percent of this wage stagnation can be attributed to technology and globalization. The main cause is the neo-liberal policy agenda of deregulation of finance, cuts in social spending and attacks on labor unions. And within that mix the biggest driver of wage stagnation can be attributed to financialization – the deregulation of Wall Street which permitted — for the first time since the Great Depression — the rapacious financial strip-mining of workers, students, families and communities. Put simply, the neo-liberal model ushered in by Thatcher and Reagan, and then intensified by Clinton and Blair, moved the wealth that once flowed to working people to financial and corporate elites.

How much money are we losing?

More than we can imagine. Here’s a back-of-the-envelope estimate for just the most recent year on the chart, 2017: The gap between the productivity wage and the current average wage is $631 per week. That is, if the average weekly wage continued to rise with productivity, it would be $631 higher than the current average wage. In 2017, there are 103 million of these workers. So the total amount of “lost” wages that flowed to economic elites is a whopping $3.4 trillion! (103 million x $631 x 52 weeks) And that’s just for one year.

Here’s how to pay for Medicare for All

Current estimates for a single payer system come in at about $3 trillion per year. Americans already are paying $1.9 trillion in payroll and income taxes that go to Medicare, Medicaid and other government health programs. So, we would need to raise another $1.1 trillion to provide universal healthcare and prescription drugs with no co-pays, no deductibles and no premiums.

In the name of fairness, that additional $1.1 trillion to pay for Medicare for All should be raised by taxing back a portion of the $3.4 trillion in wealth that has flowed to the super rich instead of to working people. After all, working people have not had a real wage increase in more than forty years as economic elites have siphoned away tens of trillions of dollars of income that once went to working people, (the gap between the two lines). Wouldn’t it be more than fair to ask the superrich to pay the $1.1 trillion needed for Medicare for All?

There are numerous ways for these economic elites pay their fair share:

  • Financial transaction tax on stock, bond and derivative transactions;
  • Wealth tax on those with over $50 million in wealth;
  • Minimum corporate tax of 35 percent on all corporations with over $100 million in profits who now pay little or nothing like Amazon did this past year;
  • Raise the marginal tax bracket to 70% on all income over $10 million per year;
  • Increase the inheritance tax on the super-rich to prevent the creation of a permanent oligarchy…and so on.

The point is to give Americans what they have been long denied – high quality universal healthcare AND a real wage increase by providing Medicare for All with no co-pays, no deductibles and no premiums.

Think about how much your income would go up if you didn’t have to pay for healthcare at all. That would begin to close the gap between productivity and wages for the first time in a generation.

Wait! Shouldn’t working people pay something for health care coverage?

We already are. We pay payroll taxes for Medicare and a portion of our regular taxes go to fund Medicaid and other public health programs for veterans, Native Americans and public health-related research and regulation.

So next time you hear someone say we can’t afford a public good, that we need to tighten our belts and get used to austerity, think about all that wealth that has flowed to the very top. Think about that big fat gap between productivity and real wages. Think about how runaway inequality has allowed the wealth of the richest nation in history to be hijacked by the super-rich.

It’s time the American people got a real wage increase and Medicare for All would deliver just that.

Les Leopold is the director of the Labor Institute in New York.

https://www.commondreams.org…

Bernie Sanders and the Myth of the 1 Percent; The very rich are richer than people imagine.

By Paul Krugman
The New York Times, April 18, 2019

Even now, most Americans don’t seem to realize just how rich today’s rich are.

One survey found that Americans, on average, think that corporate C.E.O.s are paid about 30 times as much as ordinary workers, which hasn’t been true since the 1970s. These days the ratio is more like 300 to 1.

Why should we care about the very rich? It’s not about envy, it’s about oligarchy.

But we should be able to understand both that the affluent in general should be paying more in taxes, and that the very rich are different from you and me ­— and Bernie Sanders. The class divide that lies at the root of our political polarization is much starker, much more extreme than most people seem to realize.

NYT Reader Comment:

By Don McCanne, M.D.

Although Prof. Krugman has drifted away from the single payer model of Medicare for All, today’s commentary provides the basis for why it is an imperative.

At nearly one-fifth of our economy, with much of the money at the top, the majority cannot afford to pay the per capita costs of health care. Progressive financing is required if we are to include everyone. The current system is fragmented and inadequately progressive. With the various models that assign premiums and cost sharing to individuals, rather than equitable taxes, and with unstable employment (66 million leave their jobs each year), we can never get the financing right. Millions will remain uninsured or underinsured.

With single payer Medicare for All, financing is automatic through the tax system, and everyone is automatically covered. The higher (but fair) taxes that would be paid by the very wealthy would make this possible.

https://www.nytimes.com…

Comment:

By Don McCanne, M.D.

It’s really simple. The money to pay for single payer Medicare for All is already there. It’s just that it is maldistributed with much of it at the top of the income and wealth ladder.

Our current method of funding health care is heavily dependent on individual workers: insurance premiums, insurance deductibles and other cost sharing, out-of-pocket spending for other health services and products, payroll taxes, income taxes, employee health care costs that are built into the prices of products and services that we purchase, and so on. Although a portion of this represents moderately progressive financing (more taxes as taxable income increases), because there is so much money at the top that represents an infinitesimally small health care contribution as a percentage of income or wealth, our health care financing is actually highly regressive, i.e., highly unfair to the workers and their families. Workers pay double digit percentages of their income for health care whereas the very rich pay a small fraction of one percent.

Our national health expenditures are now so high that the disproportionately high share that the workers pay creates financial hardships, especially for those with health care needs. We desperately need to recover some of massive funds that go to the top to reduce the unfair burden on workers. We can easily do that by establishing a single universal risk pool and funding it equitably – based on ability to pay – through progressive tax policies. That way financing of the system is automatic, and everyone is automatically included. Of course, that’s exactly what a single payer Medicare for All system does.

For those who say that creates too great of a burden on the wealthy, it is difficult to have sympathy for those individuals who will have to figure out how they will get by on the hundreds of millions or billions of dollars they have left after they pay their taxes. Besides, where did their money come from? It ultimately came from the workers who are largely responsible for the nation’s productivity. They certainly deserve affordable health care.

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