PNHP president Dr. Carol Paris appeared on “Rising Up With Sonali” on Free Speech TV and Pacifica radio stations on September 19, 2017. She discussed the GOP’s latest attempt to repeal the Affordable Care Act (aka Graham-Cassidy) and contrasted this effort with Sen. Bernie Sanders’ recently introduced Medicare For All Act.
By Aaron E. Carroll and Austin Frakt
The New York Times, September 18, 2017
To better understand one of the most heated U.S. policy debates, we created a tournament to judge which of these nations has the best health system: Canada, Britain, Singapore, Germany, Switzerland, France, Australia and the U.S.
“Medicare for all,” or “single-payer,” is becoming a rallying cry for Democrats.
This is often accompanied by calls to match the health care coverage of “the rest of the world.” But this overlooks a crucial fact: The “rest of the world” is not all alike.
The commonality is universal coverage, but wealthy nations have taken varying approaches to it, some relying heavily on the government (as with single-payer); some relying more on private insurers; others in between.
Experts don’t agree on which is best; a lot depends on perspective. But we thought it would be fun to stage a small tournament.
We selected eight countries, representing a range of health care systems, and established a bracket by randomly assigning seeds.
To select the winner of each matchup, we gathered a small judging panel, which includes us:
* Aaron Carroll, a health services researcher and professor of pediatrics at Indiana University School of Medicine
* Austin Frakt, director of the Partnered Evidence-Based Policy Resource Center at the V.A. Boston Healthcare System; associate professor with Boston University’s School of Public Health; and adjunct associate professor with the Harvard T.H. Chan School of Public Health
and three economists and physician experts in health care systems:
* Craig Garthwaite, a health economist with Northwestern University’s Kellogg School of Management
* Uwe Reinhardt, a health economist with Princeton University’s Woodrow Wilson School of Public and International Affairs
* Ashish Jha, a physician with the Harvard T.H. Chan School of Public Health and the director of the Harvard Global Health Institute
So that you can play along at home and make your own picks, we’ll describe each system along with our choices (the experts’ selections will decide who advances).
(Interactive comparisons follow.)
Conclusion
(The conclusion is available at the link but is omitted here for those who wish to make their own choices in the matchups before knowing the final conclusion.)
https://www.nytimes.com…
***
By Don McCanne, M.D.
Although this is an interesting exercise, it might be more productive to look at these systems from the perspective of the major problems that we have and what features of other systems might ameliorate them.
The uninsured: Make enrollment automatic. A mandate falls short because of compliance problems.
The underinsured: Reduce cost sharing to levels that will not create financial barriers to care.
High costs: Publicly-administered pricing comes closest to getting it right – legitimate costs plus fair margins.
Lack of choice of physicians and hospitals: Do not create artificial panels that serve third party payers at the cost of patient choice.
Impaired access to specialized services: Do not segregate low-income individuals into chronically underfunded welfare programs.
Profound administrative waste: Hundreds of billions of dollars could be recovered with a much more efficient financing system.
Now look again at how the various systems address these issues. Oops. There is not enough information here since the field of health policy is so much more complex than can be boiled down to simple comparisons. But when you add the other features that cannot be included here, you would end up with a single, equitably-financed, publicly-administered program – not an exact duplicate of any of the nations listed. That could be accomplished by improving our Medicare program and expanding it to include everyone.
Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.
By Jay Brock, M.D.
The Washington Post, Letters, September 18, 2017
Eugene Robinson was correct that Sen. Bernie Sanders’s (I-Vt.) proposal for a “Medicare for All” health insurance system is the “right thing to do” [“An idea no longer on the fringe,” op-ed, Sept. 15]. It would cover everyone with first-dollar coverage for all medically necessary care.
But “Medicare for All” is not socialized medicine, in which the government would own medical facilities and health-care providers would be government employees. Rather, this is socialized insurance, and it is enormously popular among conservatives and liberals already covered by Medicare. The excellent medical system we have now wouldn’t change; how we pay for it would.
Also, regarding those projected 10-year costs: We already spend a “staggering” $3.4 trillion each year on health care and still manage to leave 28 million people without any health insurance and tens of millions more greatly underinsured. An improved “Medicare for All” single-payer system would fix that, with a cost-effective system based on competition among providers that would be the continuing envy of the world. (That $3.4 trillion is enough to cover everyone. We just don’t spend it wisely because we waste as much as $500 billion on administrative costs to accommodate our multiple-payer system.)
It’s only a matter of time before the politicians catch up with the majority of Americans who already want a single-payer system.
https://www.washingtonpost.com…
PNHP-MO chair Dr. Ed Weisbart appeared on “The Real News” on September 18, 2017 to discuss the GOP’s latest push to repeal the Affordable Care Act. He discussed the disastrous effect Graham-Cassidy would have on American health care and urged Congress to reverse course and embrace a proven solution: improved Medicare for all.
By Brian G. Arndt, M.D., John W. Beasley, M.D., Michelle D. Watkinson, M.P.H., Jonathan L. Temte, M.D., Ph.D., Wen-Jan Tuan, M.S., M.P.H., Christine A. Sinsky, M.D. and Valerie J. Gilchrist, M.D.
Annals of Family Medicine, September/October 2017
Primary care physicians spend nearly 2 hours on electronic health record (EHR) tasks per hour of direct patient care. Demand for non–face-to-face care, such as communication through a patient portal and administrative tasks, is increasing and contributing to burnout. The goal of this study was to assess time allocated by primary care physicians within the EHR as indicated by EHR user-event log data, both during clinic hours (defined as 8:00 AM to 6:00 PM Monday through Friday) and outside clinic hours.
From the Discussion
This study provides a validated mechanism for EHR task analysis using EHR system event logs to evaluate primary care physician workload. Our event logs indicate that family medicine physicians spend approximately 45% of their workday (4.5 hours) on the EHR. Direct observation data were consistent with this finding. The remaining 55% of the workday (5.5 hours) was spent on non-EHR activities such as direct patient care, team interactions and meetings, paperwork, e-mail, and other work. An additional 1.4 hours per day of EHR time was spent outside of clinic hours (before 8:00 AM or after 6:00 PM), including 51 minutes per weekend. This extra time equates to an average workday (excluding time providing care to patients in the hospital) of 11.4 hours, representing a considerable encroachment on physicians’ personal and family lives.
***
By Don McCanne, M.D.
This is serious. In this study, not only did primary care primary care physicians spend almost half of their clinic hours on electronic health records (EHRs), outside of clinic hours they spent an average of an additional 7 hours and 51 minutes – the equivalent of an extra workday per week. Does this investment in time provide enough direct patient benefit to warrant it? Of course not.
We would hope that a single payer system would address this problem, but there is risk that the public stewards would rely heavily on EHRs for administrative purposes and for current data-intensive information technology trends.
Hopefully shifting the culture from the business-oriented medical/industrial complex to a patient-service environment, as should occur with implementation of a well-designed single payer system, would cause the stewards to wake up and take a serious look at such wasteful services that induce physician/nurse burnout and patient malcontentment.
Clearly, we cannot allow this to continue.
Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.
By Farzon A. Nahvi, M.D.
The Guardian, September 15, 2017
Speaking to opponents of universal healthcare in the U.S. today is much like speaking to a moon-landing denier or any other conspiracy theorist – they insist on arguing impossibility in the face of proven reality.
As Bernie Sanders, Kamala Harris and 15 other senators release details of their universal healthcare bill – one that guarantees access to healthcare for all Americans while simultaneously creating cost savings – there will be many healthcare conspiracists claiming that such a plan is infeasible. So as we consider these arguments in the coming weeks, we must always be prepared to make sure they pass the “look!” test.
That is, when someone argues that something cannot be done, we needn’t argue. Rather, we simply need to point and say: “Look!”
Someone doesn’t believe we landed on the moon? “But look! There’s an American flag up there!” Someone doesn’t believe we can insure every single American while simultaneously reining in the exorbitant costs of our healthcare system? “But look! Every other developed country in the world is already doing it!”
These medical conspiracists claim that such a system would be impractical, overly expensive, or provide inferior care. But to make these claims in the face of obvious proof is laughable.
If Canada is able to provide coverage for each of its citizens from birth to death, with no out-of-pocket-costs to any of them, all the while providing high-quality care with excellent patient outcomes at half the cost of our system, it is unacceptable to say that we somehow cannot.
Real people living in other countries are currently enjoying these systems. They can change jobs without fear of losing access to their diabetes medications. They can go jogging without worry that one slip and broken bone would send their families into bankruptcy. They can go to their doctor never questioning that, at the end of the day, she has any incentive to do anything but make them better.
So how could one be so bold as to deny this reality?
The truth is that nobody is content with our current healthcare system. We do poorly when it comes to access to care and equity, administrative efficiency and cost containment, as well as basic health outcomes.
We pay more than double what other countries do, and get worse results. Our life expectancies are shorter than any other developed nation. Children die in the US unlike in any other modern society. Medical bills are the leading cause of bankruptcy in the US. Our overspending in healthcare directly limits what we can do with defence, education and infrastructure.
Yet when it comes to talk of change, people become skittish. Doctors become scared that change would mean lower incomes. Patients fear longer wait times and loss of access to services.
The fear of losing the small benefits we currently enjoy is prohibiting us from enjoying far greater ones at half the cost. It’s as if we’re so scared of losing our crumbs that we are ignoring the entire loaf sitting within reach.
We need to learn to trust our eyes and ears and be suspicious of the naysayers fearmongering us away from something better. We can, and should, argue about the precise form our system will take – the US’s universal healthcare system will almost certainly have a different flavour than, say, France’s – but we can no longer accept that such a system is impossible.
Importantly, we should never forget the stakes. Real Americans are going through real pain every day. I have seen a patient come to my emergency room stating: “They diagnosed me with cancer but said they couldn’t see me because I have no insurance. I have nowhere to go.”
I have seen a patient having a florid heart attack walk out against medical advice stating, “Thanks doc, but my brother went through this and lost his house. I’m gonna go.” And I have heard many well-insured patients say “I hear you and you seem nice, but all you doctors want to do is make money off me, so I don’t know who to trust.”
To experience all this while knowing that something better is already out there is simply unacceptable.
Those who deny the plausibility of a universal healthcare system are inevitably the same people who stand to benefit most from our current system. They can argue up, down, left and right, but ultimately they can never pass the “look!” test. The next time they try to claim that universal health care would be impossible in the US, point them to footage of Neil Armstrong bouncing on the moon and dare them to deny reality. A universal healthcare system is not only possible here, but long overdue.
Dr. Farzon A. Nahvi is an emergency medicine physician and an instructor of emergency medicine in New York City.
PNHP board adviser Dr. Diljeet Singh appeared on “The Big Picture” on RT America on September 14, 2017. She spoke with guest host Sam Sacks about Sen. Bernie Sanders’ Medicare For All Act, how universal coverage has become a mainstream expectation, and how single payer would affect the medical community.
C-SPAN, September 13, 2017
(Following is a transcript of Dr. Danielle Martin’s comments, but I would highly recommend viewing the C-SPAN video instead – four minutes beginning at 21:00 – link below.)
Sen. Bernie Sanders: Last, but very much not least, is Dr. Danielle Martin. You know, I think that it is high time that we started taking a look at what countries around the world were doing in providing quality care all of their people in a far more cost effective way than we do, and one of examples of a single payer system that is working well, that is popular, is the Canadian system. Dr. Martin is a Canadian physician, health care administrator, and an associate professor at the University of Toronto. She is the author of a Canadian best selling book, “Better Now: Six Big Ideas To Improve Health Care for All Canadians.” Dr. Martin.
Dr. Danielle Martin: Thank you Senator.
I must say that I am very grateful that so many Americans are interested in learning about the experience of your Canadian neighbors under our single payer health care system, which we also call Medicare.
As a practicing doctor, a hospital administrator, and a citizen, I am so proud to be part if a system where access to doctor and hospital services is truly based on need, not ability to pay. And I’m not the only one. In public polls, 94 percent of Canadians say that our health care system is a source of personal and collective pride, even more than ice hockey! Single payer health care is a symbol to us of what it truly means to be Canadian, that we take care of each other.
My grandparents immigrated to Canada in the early 1950s like so many people who come to this country, hoping to build a better life for their kids. And at that time, there was no universal health coverage in Canada. So when my grandfather had his first heart attack in his early 40s, his world was shaken, and by the time he died nearly a decade later, the family was essentially bankrupted by medical bills. I know that this remains a reality for many in the United States today, but you should know that just north of your border, that kind of a situation is essentially unimaginable.
My generation of Canadians does not remember what it was like to worry about paying a doctor or hospital bill. And despite our challenges, which of course every country experiences, Canadians have a longer life expectancy, lower infant mortality rates, and fewer preventable deaths than in the United States.
Single payer health care is also, as you know, less expensive. In Canada, our administrative overhead is less than 2 percent in our public plan as compared to 18 percent in the private plans here in the U.S. We spend just under $5000 per capita in Canada to cover everyone. You spend nearly $10000 per capita and yet tens of millions of people are uninsured. But most importantly, when my patients are sick I do not need to ask if they have insurance or if they can afford to pay for my services. And throughout my pregnancy, and for the birth of my daughter in a world-class hospital, I was never asked for money, and I never received a bill. I just handed over this card – my Canadian health care card – to my doctor, and that was it.
I wish that all of my American neighbors could experience the same simplicity in their moments of need. And I hope that the American people will seize this opportunity to declare to each other and to the rest of the world that you do believe access to health care is a human right.
Thank you.
https://www.c-span.org…
***
By Don McCanne, M.D.
Everyone included. Care based on need. Lower costs. No financial barriers to care. Better outcomes. Less administrative hassle. And greater pride than even for their ice hockey teams!
Are Americans all bonkers, that we continue to reject this?
Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.
Physicians for a National Health Program, September 13, 2017
Physicians for a National Health Program (PNHP), a nonprofit research and education organization of 21,000 physicians, medical students and health professionals, welcomes Sen. Bernie Sanders’ single-payer bill, The Medicare for All Act of 2017. Replacing America’s fractured, for-profit health system with improved Medicare for all would provide comprehensive care for everyone, help rein in skyrocketing health costs, and deliver better medical outcomes.
“Congressional leaders can no longer sit on the sidelines watching our broken health system cripple the economy,” said Carol Paris, M.D., president of PNHP. “Every year that we do nothing, health care costs swell by another 5.6%. The only way to both control costs and guarantee access to care is to eliminate the administrative waste and profiteering of the insurance industry.”
At $3.2 trillion per year, the U.S. spends nearly twice as much per capita as any other high-income country on health care, but scores poorly on life expectancy, infant and maternal mortality, and access to health services. Despite the improvements of the Affordable Care Act, 28 million Americans remain uninsured, according to the Census Bureau’s estimate released on Tuesday. Researchers estimate that 36,000 Americans die prematurely each year because they lack insurance. Sen. Sanders’ bill would reduce the number of uninsured to zero, allowing everyone to visit the doctor or hospital of their choice for medically-necessary care, including dental, vision and mental health services.
By eliminating the wasteful, profit-driven private insurance industry, a single-payer program would save the nation hundreds of billions annually on paperwork and profits. Physicians, who now spend an average of nine hours each week on administrative tasks like billing, could focus more time on patient care. Not surprisingly, a majority of American doctors now support Medicare for all.
Under Medicare for all, medical bankruptcy would be a thing of the past. Today, the crushing cost of health care is the top financial problem facing U.S. families. Even many of the insured face obstacles to care: More than half of all workers with employer plans face deductibles of $1,000 or more, and more than one-third of U.S. adults report difficulty paying premiums and deductibles. By untangling health care from employment, workers would be free to switch jobs or launch a new business without losing coverage.
Dr. Paris notes that incremental tweaks like subsidizing ACA premiums, or offering Medicare or Medicaid buy-ins, will do little to change long-term health or financial outcomes. “We’ve tried everything else,” said Dr. Paris. “Medicare for all is the only plan that will solve our nation’s growing health care crisis.”
In 2016, PNHP released its Physicians’ Proposal for Single-Payer Health Care Reform, a proposal based on decades of careful analysis and research. PNHP recommends several improvements to the Medicare for All Act that would save money and improve patient care, including global budgeting of hospitals and other health care institutions; the separation of capital and operating payments to hospitals and other health care institutions; full coverage of all medications, without copayment; the exclusion of investor-owned, for-profit health care providers; and the establishment of a national long-term care program.
“PNHP applauds Sen. Sanders and the thousands of grassroots advocates whose tireless advocacy has pushed single payer to the forefront of the national debate on health care,” said Claudia Fegan, M.D., PNHP’s national coordinator. “We look forward to working with Sen. Sanders to strengthen and advocate for this bill.”
Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.
By Elizabeth Rosenthal, M.D.
New York Times, September 13, 2017
To the Editor:
Bravo, Senator Sanders! As a physician for 50 years and an activist with Physicians for a National Health Program, I am overjoyed to see this common-sense legislation. This morning, wearing a T-shirt with “Single-Payer Health Care for People Not for Profit” on the front, I was asked, “What is that?”
“Medicare for All,” I replied.
“Oh, I’m for that” was the reply. “It’s so simple!”
Now comes the big struggle against those who profit from our current system. We must show our legislators that their jobs are in jeopardy if they fail to support this bill.
FOR IMMEDIATE RELEASE, September 13, 2017
Contact: Clare Fauke, communications specialist, 312-782-6006, clare@pnhp.org
WASHINGTON, D.C. – Physicians for a National Health Program (PNHP), a nonprofit research and education organization of 21,000 physicians, medical students and health professionals, welcomes Sen. Bernie Sanders’ single-payer bill, The Medicare for All Act of 2017. Replacing America’s fractured, for-profit health system with improved Medicare for all would provide comprehensive care for everyone, help rein in skyrocketing health costs, and deliver better medical outcomes.
“Congressional leaders can no longer sit on the sidelines watching our broken health system cripple the economy,” said Carol Paris, M.D., president of PNHP. “Every year that we do nothing, health care costs swell by another 5.6%. The only way to both control costs and guarantee access to care is to eliminate the administrative waste and profiteering of the insurance industry.”
At $3.2 trillion per year, the U.S. spends nearly twice as much per capita as any other high-income country on health care, but scores poorly on life expectancy, infant and maternal mortality, and access to health services. Despite the improvements of the Affordable Care Act, 28 million Americans remain uninsured, according to the Census Bureau’s estimate released on Tuesday. Researchers estimate that 36,000 Americans die prematurely each year because they lack insurance. Sen. Sanders’ bill would reduce the number of uninsured to zero, allowing everyone to visit the doctor or hospital of their choice for medically-necessary care, including dental, vision and mental health services.
By eliminating the wasteful, profit-driven private insurance industry, a single-payer program would save the nation hundreds of billions annually on paperwork and profits. Physicians, who now spend an average of nine hours each week on administrative tasks like billing, could focus more time on patient care. Not surprisingly, a majority of American doctors now support Medicare for all.
Under Medicare for all, medical bankruptcy would be a thing of the past. Today, the crushing cost of health care is the top financial problem facing U.S. families. Even many of the insured face obstacles to care: More than half of all workers with employer plans face deductibles of $1,000 or more, and more than one-third of U.S. adults report difficulty paying premiums and deductibles. By untangling health care from employment, workers would be free to switch jobs or launch a new business without losing coverage.
Dr. Paris notes that incremental tweaks like subsidizing ACA premiums, or offering Medicare or Medicaid buy-ins, will do little to change long-term health or financial outcomes. “We’ve tried everything else,” said Dr. Paris. “Medicare for all is the only plan that will solve our nation’s growing health care crisis.”
In 2016, PNHP released its Physicians’ Proposal for Single-Payer Health Care Reform, a proposal based on decades of careful analysis and research. PNHP recommends several improvements to the Medicare for All Act that would save money and improve patient care, including global budgeting of hospitals and other health care institutions; the separation of capital and operating payments to hospitals and other health care institutions; full coverage of all medications, without copayment; the exclusion of investor-owned, for-profit health care providers; and the establishment of a national long-term care program.
“PNHP applauds Sen. Sanders and the thousands of grassroots advocates whose tireless advocacy has pushed single payer to the forefront of the national debate on health care,” said Claudia Fegan, M.D., PNHP’s national coordinator. “We look forward to working with Sen. Sanders to strengthen and advocate for this bill.”
*****
Physicians for a National Health Program (www.pnhp.org) is a nonprofit research and educational organization of more than 21,000 doctors and health professionals who support a single-payer national health program. It was founded in 1986.