By Josh Faucher
Students for a National Health Program blog, May 16, 2016
 
I’ve been a part of SNaHP since the beginning, watching our annual gathering grow from a few dozen people in a small conference room in 2012, to the massive turnout we had this spring with representatives from around the country.

Each year, I’m impressed with the reality that many of our most enthusiastic and active members are students early in their medical school journeys, many of whom haven’t had much contact with patients yet. When I first began medical school, it was easy to get caught up in the praise and aggrandizement that was heaped upon us – the constant congratulations for joining a profession as well-respected and impactful as medicine. It is true that physicians can have a profound impact on the lives of our patients, curing terrible diseases and lessening the suffering caused by chronic ailments. In looking at the nature of the health care system as a whole, however, I have seen clear examples of how access is rationed based on a patient’s financial resources, and how seeking health care can leave patients vulnerable to harm that affects their livelihoods and economic security.

As a new resident, when I look back on medical school, there were many things that left me less confident in my ability to avoid doing harm as a physician.

Take, for instance, the guest speaker we had during my second year of medical school, a young woman in her 20s (let’s call her Sarah) who recounted her battle with acute lymphocytic leukemia, a cancer that strikes suddenly and can be fatal in a matter of hours. Sarah described to us the physical challenges she faced while receiving chemotherapy, and the fantastic care she had received from her physicians. As I listened to her story, I wondered whether, as a young person who had just entered the workforce, she had the financial resources to pay for her care. At the end of her presentation, I asked her, and it turned out that cancer devastated more than just her body.

Sarah’s illness prevented her from working and when she eventually lost her job, she lost her insurance, too. The hospital bills that followed quickly depleted her savings until she was forced to go on Medicaid. She described this as an extremely difficult experience that caused her considerable shame. For some reason, to this patient and others who told us stories of illness, the consistent assumption seemed to be that future doctors didn’t need to hear about, or wouldn’t be interested in, the financial problems caused by our health care system.

I strongly believe that no one should experience shame or financial ruin just because they get sick. I think many of my classmates would agree, but if patients aren’t given a chance to share that side of their experience, we can’t expect their physicians to become aware of the problem solely through intuition.

There was also the middle-aged man – I’ll call him Bill – who I met during one of my clinical rotations. Bill had a chronic mental illness and an unstable, intermittent employment status, but nevertheless was surviving on his own in the community. He presented to the clinic with shortness of breath after a temporary construction job had been halted because of the discovery that he and his co-workers had been exposed to asbestos. It took multiple visits for us to explain to him that asbestos causes disease many years after exposure, and that, instead, he was experiencing symptoms related to longstanding COPD. Worker’s comp, of course, would not pay to manage this chronic preexisting disease, and Bill experienced considerable distress until we were able to enroll him in Medicare because of his new disability. With a universal, comprehensive insurance system his disease might have been detected earlier, or smoking cessation therapy could have been emphasized when he was young. Instead, he’ll live with COPD for the rest of his life, and will probably die from it.

Then there’s me. I was born with a serious heart defect that required surgery when I was a toddler, and again when I was 13 years old. Despite facing health challenges during my own life, I consider myself privileged. I’m privileged to have had a better outcome than many others in the same situation; I’m privileged to have never missed one of the annual cardiologist visits that will determine when I need to have my next operation; and I’m privileged because I happened to have the best hospital in the country in-network on my insurance while attending medical school.

Nevertheless, despite having insurance, I have to pay hundreds or thousands of dollars in deductibles and copayments out-of-pocket every year to monitor a health condition I have through no fault of my own. If I was like millions of working Americans living paycheck-to-paycheck, unable to save money let alone pay thousands of dollars for medical bills, I might have to skip yearly checkups to take care of other necessities first. If I were truly poor and on Medicaid, I might have to travel long distances or wait many weeks to find a physician who would take me for an appointment. In either case, I might not get the care I need until I deteriorate to a point that would cause me permanent harm.

The Affordable Care Act has not done nearly enough to address the barriers to health care that exist due to our broken insurance system. Under Obamacare, the United States remains the only industrialized capitalist democracy on the planet that does not provide universal health care access to its entire population. Indeed, even if it works as well as it possibly can, Obamacare will leave over 30 million people uninsured and without access to basic care. Those benefiting from the law are forced into a relationship with private insurers, the same companies that previously denied people for preexisting conditions and cut policies when people got sick until those practices were outlawed by Congress.

Now, the insurance companies have a different approach to maximizing their revenue: they lure buyers on the exchange with low premiums, and then slam them with high deductibles. An annual deductible of thousands of dollars before insurance kicks in can quickly empty a family’s savings account, and does little to protect them from health care costs.

As a member of SNaHP and PNHP, I advocate for an alternative along with other medical students and physician: an improved version of Medicare that would apply to the entire population; a universal, single-payer, publicly financed and administered insurance system. By its very nature, such a system would apply to the entire citizenry from birth to death, and would reduce or eliminate out-of-pocket costs for medical care. It could be progressively financed while providing universal, equitable access. Unlike the hodgepodge of secretive private companies providing insurance right now, Medicare-for-all would be transparently financed and publicly accountable through the democratic process. With the entire population invested in the program, the adequacy of reimbursement for medical expenses would be a top priority.

Most importantly, a Medicare-for-all program would reduce our out-of-proportion spending on health care while at the same time expanding coverage and access to everyone. It would greatly reduce the need for providers to maintain complicated administrative structures for billing multiple insurers, and would act as a strong negotiator to prevent unfair profiteering by pharmaceutical and device manufacturers. An analysis by the Lewin Group in 2012 estimated that a single-payer system would have saved my state of Minnesota $4.1 billion in 2014, while economists estimate that single-payer on a national scale would save an estimated $592 billion annually.¹ Think of the boost our economy would receive if people were no longer going bankrupt because of medical expenses. Medicare for all would also free the private sector from the burden of providing health insurance as an employee benefit, reducing wage stagnation and making our industries more competitive on the global market.

The need for single-payer health insurance is complex, but the concept itself is simple. The vast majority of my classmates are becoming young physicians with the goal of relieving suffering and providing patients the opportunity to live their lives to the fullest. As economic inequality comes to the forefront as a national issue, medical students are increasingly realizing that the current health insurance system frequently promotes that inequality rather than alleviating it, and just like me they are coming to recognize single-payer health insurance as a necessary, if not sufficient, step to make the provision of health care a tool for social justice.

Our movement has grown larger every year, and the reach of our message has never been broader. If our expanding membership continues to spread awareness about the problems of our health care system and the solutions offered by single-payer health care, our goal will soon be realized and I’ll be able to consider my involvement to be a success.

If you care about a health care system that serves the needs of everyone, not just the privileged or the wealthy, there is room for you in this movement.

Josh Faucher will graduate from Mayo Medical School on May 21 and is pursuing a career in emergency medicine. He co-founded the Mayo Medical School chapter of SNaHP, helped SNaHP grow as a student offshoot of PNHP with national scope, and currently serves as a student member on the PNHP Board of Directors. You can email him at josh.faucher@gmail.com

Reference note

1. Cost and Economic Impact Analysis of a Single-Payer Plan in Minnesota; http://growthandjustice.org/images/uploads/LEWIN.Final_Report_FINAL_DRAFT.pdf

https://student.pnhp.org/201-2/

By Russell Mokhiber
Single Payer Action, May 17, 2016

The Diane Rehm Show this morning was devoted to the topic — The Affordable Care Act Three Years In: What’s Working And What’s Not.

The guests on the show were Julie Rovner, senior correspondent, Kaiser Health News, Stephanie Armour, healthcare reporter, Wall Street Journal, and Susan Dentzer CEO of the Network for Excellence in Health Innovation (NEHI) — what Dentzer describes as “a non-profit think-tank.”

Just yesterday, the Washington Post ran an article about a Gallup poll under the headline — Most Americans want to Replace Obamacare with Single Payer — Including Many Republicans.

But single payer wasn’t raised as a possibility by any of the guests — until a caller raised it about three quarters of the way through the show.

In response, Armour, Dentzer and Rovner all talked about how much more expensive single payer would be than Obamacare.

Only Diane Rehm seemed sympathetic to single payer.

“Bernie Sanders Medicare for All program would create a single payer system,” Dentzer said. “It has very large payroll tax increases and income tax increases in it to fund it. A legitimate question is — is the American public ready to move from the system we have now — yes we have high deductibles for many people, yes they are paying high premiums — but are we willing to move and float all of the those expenses through the government coffers and pay much higher payroll taxes and much higher income taxes?”

Rehm asks Rovner — what would Bernie Sanders proposal cost?

“A lot more than he has floated in income tax increases,” Rovner said. “The Urban Institute last week estimated that it is $18 trillion short of paying for itself.”

With that statement, Rovner gave the back of her corporate hand to David Himmelstein and Steffie Woolhandler, who recently wrote that the Urban Institute’s estimates “are ridiculous.”

“They project outlandish increases in the utilization of medical care, ignore vast savings under single-payer reform, and ignore the extensive and well-documented experience with single-payer systems in other nations — which all spend far less per person on healthcare than we do,” they wrote.

Rovner said that “it’s important to know that what Bernie Sanders is proposing is not what Medicare is.”

“Medicare as it exists today has lots and lots of requirements for patients for co-pays,” Rovner said. “The deductibles are not that high in Medicare, although the hospital deductible is substantial. But the ongoing out of pocket costs can be enormous. That’s why most people who have Medicare have supplemental insurance. What Bernie Sanders is talking about is that there would be no need for supplemental insurance — that this new Medicare would pay pretty much for everything. That is what would make it so expensive. And that would be a level that even other countries who have single payer plans don’t have.”

Ignoring the results of the Gallup poll, Armour says that while single payer “has intrigued people for decades, it has never gotten a majority of support and in the current political climate, it would be very difficult.”

Given that Rehm had three guests dissing single payer, she felt she had to stand up for it. Since when, she asked, did Congress start ignoring “what people want”?

Armour said that while single payer has always had strong support, “it’s been a plurality, not a majority.”

“There simply isn’t fifty percent plus one and there hasn’t been,” Armour said. “What we are seeing now is the other side — give people more skin in the game. Make them pay more of their own health care bills. And maybe they will shop better.”

Shop better? You mean like in states like West Virginia where there is exactly one insurance company in the Obamacare marketplace?

Shop better?

The last time the Diane Rehm show devoted an hour to single payer was in May 2009.

The guests were Bernie Sanders, David Himmelstein, Roger Hickey — who was pushing a public option — and Susan Dentzer, who was then identified as senior policy adviser, The Robert Wood Johnson Foundation, and on-air analyst on health issues, PBS NewsHour.

During that show, Rehm asked Dentzer why we don’t have a single payer system in the United States and Dentzer replied — “we had a private insurance industry develop.”

“It now has revenues in excess of $400 billion a year. And it’s a very effective interest group,” Dentzer said.

Dentzer should know.

While Dentzer’s group calls itself The Network for Excellence in Health Innovation, in fact if you look at its board of directors, it’s dominated by executives affiliated with health insurance companies (Blue Cross Blue Shield of Massachusetts and HCA) and drug companies (Genzyme Corporation, Sanofi and Merck.)

No wonder she’s hostile to single payer.

Russell Mokhiber is editor of the Washington, D.C.-based Corporate Crime Reporter.  He is also founder of singlepayeraction.org, and editor of the website Morgan County USA.

http://www.singlepayeraction.org/2016/05/17/single-payer-and-the-diane-rehm-show/

PNHP note: Physicians for a National Health Program (PNHP) is a nonpartisan educational and research organization. It neither supports nor opposes any candidate for public office.

By Liz Seegert
Medical Economics, May 25, 2016

Health insurance is again in the political spotlight as Democratic presidential candidate Bernie Sanders promotes his version of single-payer that he calls “Medicare for all.” He says it will improve care, reduce administrative burdens and allow physicians to focus just on practicing medicine. Dissenters say it’s a pipe dream that will only lead to rationed care, lower reimbursement rates and long waiting lists.

Single payer is held up by supporters as the ideal egalitarian healthcare model. If other nations can provide expansive medical care for their citizens, they ask, why can’t the U.S.? Opponents disparage the idea as anti-choice; they predict the implosion of the healthcare system and demise of physician autonomy.

Could single payer be the boon to medical practice its supporters insist? Or would we end up with a system that limits care and ignores best practices in favor of the bottom line? Who’s right?

The short answer is, both sides are.

Continue reading…

http://medicaleconomics.modernmedicine.com/medical-economics/news/what-single-payer-healthcare-would-mean-doctors

By David Woods
The Philadelphia Inquirer, May 16, 2016

One hears these days mutterings by disaffected Americans that if Donald Trump becomes president, they will pack their bags and leave for Canada. One assumes, of course, that no wall will be built along the border to thwart their exit.

I made the reverse trip. Having emigrated from Britain to Canada, where I became the editor in chief of the Canadian Medical Association Journal, I opted to come to the United States in 1988 for personal reasons.

But I was also taken with American rugged individualism and a health-care system focused on market forces and competition. I wrote articles for the Economist Intelligence Unit and other periodicals on the wonders of the American system. In print, I debated longtime advocates of single-payer national health insurance, extolling the virtues of the health-care market that others abhorred.

Gradually, though, I too began to have doubts about market-driven health care. Over the 25 years that I’ve lived on the U.S. side of the border, I’ve come to the view that the American health-care system – which still leaves 11 percent of the population uninsured, despite the Affordable Care Act – is inferior to the health systems in Canada and the United Kingdom.

One of the ACA’s architects, Dr. Ezekiel Emanuel, describes the U.S. health system as a “terribly complex, blatantly unjust, outrageously expensive, grossly inefficient, error-prone system.” Unfortunately, that’s still true, six years after the ACA’s passage.

The reform didn’t address the fundamental problem in U.S. health care: It’s more about profit than patients.

Controlling health-care costs is essential to the long-term financial health of the United States. A single-payer system would make truly universal coverage affordable, costing no more than we already spend on health care. Of the $3.1 trillion the United States will spend on health care this year, 63 percent is taxpayer-financed, funding Medicare, Medicaid, and Veterans Affairs, along with private coverage for government employees and tax subsidies for employers.

Because of its fragmented, profit-driven system, the United States spends 18.1 percent of gross domestic product on health care, compared with about 8 percent in Britain and 11 percent in Canada. Much of U.S. health spending is simply wasted. For example, 25.3 percent of hospital expenditures go to administrative costs, compared with 12.4 percent in Canada, where there is a single payer in each province and hospitals are mainly funded on a global or lump-sum basis.

Canadians also save money by training a higher percentage of primary-care doctors relative to specialists, negotiating drug prices with pharmaceutical companies, and prohibiting drug companies from advertising directly to consumers. These measures would save Americans billions annually. Americans spend $1,010 per capita on pharmaceuticals; Swedes spend less than half that, according to the Organization for Economic Cooperation and Development. The reason? Sweden doesn’t pay the list price.

Lobbying and influence-peddling by the pharmaceutical and insurance industries keeps the United States from adopting a single-payer health system. Several presidential candidates this season seemed completely under their hypnotic sway. The private insurance industry brazenly tells me, now a U.S. voter, which doctors I can see, charges me astronomical premiums, not to mention co-pays and deductibles, and then wants me to believe that having publicly funded health care that would allow me to go to any doctor in the United States without a $5,000 deductible would be “socialism.”

And don’t believe the widely held U.S. notion that Canadians suffer long waits for care. That’s a canard. We are not going to cut U.S. health spending to Canadian levels. With our much higher level of spending, waits would not be an issue, even with the population aging. Japan and many countries in Europe already have higher percentages of elderly citizens than the graying of the baby boomers is projected to produce.

In his book “In Search of the Perfect Health System,” British economist Mark Britnell notes that the British love their single-payer National Health Service because of its fairness; it’s available to everyone. He even quotes a former U.K. finance minister who said that the NHS is the closest thing the English have to a religion. Their single-payer system keeps quality indexes up and costs down for the population at large. This enables the British to invest additional funds in education and economic stimulation, areas that also contribute to health and well-being.

The United States should take a lesson from the example of nations with single-payer systems. They offer a measure of hope and optimism that high-quality health care can be the right of all Americans, if they demand it.

David Woods is a former editor in chief of the Canadian Medical Association Journal. hmi3000@comcast.net

http://www.philly.com/philly/health/20160516_Commentary__Single-payer_essential_to_controlling_health-care_costs.html

At a time doctors to the south are looking to Canada for answers, we are at risk of losing the health advantage we have

By Karen Palmer
Toronto Star, May 15, 2016

In a dramatic show of physician support for deep health care reform in the U.S., more than 2,200 physician leaders have signed a “Physician’s Proposal” calling for sweeping change.

The proposal, published May 5 2016 in the American Journal of Public Health, calls for the creation of a publicly financed, single-payer, national health program to cover all Americans for all medically necessary care.

If that sounds familiar, it should. These American doctors are calling for Canadian-style medicare. They want a decisive break from the expensive and inefficient private insurance industry at the heart of the U.S. health care system.

How ironic that at the same time U.S. physicians are calling for a single-payer health system like ours, Canada is in the midst of a legal battle threatening to pave the way for a multi-payer system resembling what has failed Americans.

What’s at stake? A trial about to begin in British Columbia threatens to make the Canada Health Act unenforceable.

The Canada Health Act is federal legislation that guides our health care system. It strongly discourages private payment for medically necessary hospital and physician services covered under our publicly funded medicare plans. This includes out-of-pocket payments in the form of extra billing or other user charges. Legislation in most provinces further prohibits private insurance that duplicates what is already covered under provincial plans.

If patients are billed for medically necessary hospital and physician care, the federal government is mandated to withhold an equivalent amount from federal cash transfers to provinces or territories violating the Act.

At least that’s what supposed to happen.

Unfortunately, the last decade saw a proliferation of extra billing in several provinces, and few instances of government clawing back fiscal transfers. Perhaps, things will change. Health Minister Jane Philpott recently said the government will “absolutely uphold the Canada Health Act.”

In B.C.’s upcoming trial, the plaintiffs — including two for-profit investor-owned facilities, Cambie Surgery Centre and the Specialist Referral Clinic — are attempting to have the court strike down limits on private payment. They support the creation of a constitutionally protected right for physicians to bill patients, either out-of-pocket or through private insurance, for medically necessary care, while also billing the public plan.

In other words, the plaintiffs want to undo our elegantly simple single payer system for hospital and physician care, creating instead a multi-payer system like the U.S. If their constitutional challenge is successful, the door will swing wide open in BC — and across Canada — for insurers to sell what will amount to “private queue jumping insurance” for those who can afford it, potentially harming the rest of us who can’t.

The outcome of this trial could be that those who can pay for care would jump the queue, drawing doctors and other resources out of the public system. Those who can’t pay would likely wait longer. Rather than a solution for wait times, private payment in the Canadian context would make them worse.

Global evidence shows that private insurance does not reduce public system wait times. The Achilles heel of health care in several European countries, such as Sweden, has been long waiting times for diagnosis and treatment in several areas, despite some private insurance. After Australia introduced private insurance to save the government money, those with private insurance have faster access to elective surgery than those without. Divisions in equitable access to care is one of the biggest challenges now facing countries that have adopted multi-payer systems.

Multi-payer systems are administratively complex and expensive, explaining why the U.S. health insurance industry spends about 18 per cent of its health care dollars on billing and insurance-related administration for its many private plans, compared to just 2 per cent in Canada for our streamlined single payer insurance plans. Hospital administrative costs are lowest in Canada and Scotland — both single payer systems — and highest in the U.S., the Netherlands, and the U.K. — all multi-payer systems.

For all of its warts in how we deliver health care in Canada, the way in which we pay for care — a single public payer in each province or territory — avoids the high administrative costs of multi-payer systems.

Abundant evidence shows private insurance is at the root of what ails the U.S. system. Dr. Marcia Angell, co-author of the Physicians’ Proposal, Harvard Medical School faculty and former editor-in-chief of the New England Journal of Medicine, sums it up: “We can no longer afford to waste the vast resources we do on the administrative costs, executive salaries, and profiteering of the private insurance system.”

A Canadian-style single payer financing system would save the U.S. about $500 billion annually.

Meanwhile, in Canada, abandoning our single payer health care system for a U.S.-style multi-payer system would be the worst possible outcome for Canadians. Let’s hope the evidence convinces the judge. The trial begins in September.

Karen Palmer is an advisor with EvidenceNetwork.ca, a health policy analyst, and adjunct professor in the Faculty of Health Sciences at Simon Fraser University.

https://www.thestar.com/opinion/commentary/2016/05/15/why-american-doctors-are-calling-for-canadian-style-medicare.html