Prominent progressives have undercut a cherished policy goal of the left. They’re wrong on both the politics and the economics.

By Adam Gaffney, M.D.
The New Republic, March 8, 2016

Around the time that the insurgent campaign of Bernie Sanders hit its stride, a chorus of liberal pundits and economists began to coalesce around a decidedly grim message for the 60 million people in America who remain either uninsured or underinsured: Give up on your pipe dream.

Single-payer, Paul Krugman wrote in one of a series of posts in January, “isn’t a political possibility,” and is in fact “just a distraction from the real issues.” Last week in the American Prospect, sociologist Paul Starr went further in describing single-payer as a “hopeless crusade for a proposal that will go down to defeat again, as it has every time it has come up before.” And in an earlier article, he argued that even if single-payer was possible, other priorities should take precedence. Hillary Clinton is on the record agreeing with such sentiments: As she put it, single-payer “will never, ever come to pass.”

Single-payer universal health care, in other words, is dead on arrival. Time to move on.

Their essential arguments are twofold: Single-payer reform is politically impossible on the one hand, and economically infeasible on the other. However, they are very wrong on both counts. The first argument rests on a severely impoverished political vision, the second on inexcusably flawed economic and policy assumptions. Though the Sanders campaign is facing increasingly daunting obstacles to the Democratic nomination, the American health care question is not going anywhere. These criticisms therefore require greater dissection and contestation—before they congeal as the conventional wisdom.

Let’s first admit the obvious: The political terrain for transformational health care reform is currently quite adverse. A single-payer bill would encounter colossal resistance from, for instance, the health insurance lobby, which is understandably in no great rush to be legislated off the face of the planet (nor does the pharmaceutical industry look forward to long-avoided price negotiations with the government). It’s also true that a Democratic sweep of both houses of Congress is unlikely in the coming election. And Democrats are, in any event, divided on the issue, as this primary election demonstrates.

To proceed, however, from an admission of these facts to an acceptance that the cause should be abandoned is to concede the contest before the first shot has been fired. This is something the Democratic Party has excelled at—with disastrous consequences—for decades. Conservatives, in contrast, have been far more willing to adopt ambitious, long-range political goals, even when contemporaneous political forces are arrayed against them.

As Daniel Stedman Jones describes in his “Masters of the Universe: Hayek, Friedman, and the Birth of Neoliberal Politics,” the articulation of an initially unpopular, highly ambitious, anti-New Deal “neoliberal” program—outlined and promoted in the decades following World War II by economists like Friedrich Hayek and Milton Friedman and associated think tanks—took decades to “bear fruit.” But when political and economic circumstances changed in the 1970s, conservatives had an ambitious program ready to launch, and the right-wing revolutions of Ronald Reagan and Margaret Thatcher could begin in earnest. From the 1980s onward, Jones writes, Hayek’s early “ideological vision” became reality with a vengeance:

“The free market became the organizing principle for microeconomic reform … Trade unions were vanquished and the power of labor was diluted …  Market mechanisms became the models for the operation of health care … The purity that Hayek advocated was meant as an optimistic and ideological and intellectual tactic rather than a blueprint. The results have been extraordinary.”

In the years since Reagan and Thatcher, conservatives have had continued success in pushing the political center—on economic, if not social, issues—further and further rightward. Yet just as the right marched forward to the drum of Hayek, liberals have far too often been content to passively follow behind, albeit while maintaining something of a respectable distance. Nowhere is this clearer than in health care.  

This story is well known and often told: Many—perhaps most—of the key provisions of the Affordable Care Act are derived from (formerly) conservative health policy proposals. As the sociologist Jill Quadagno describes in a 2014 article in the Journal of Health Politics, Policy and Law, the ACA’s “employer mandate” was drawn from Nixon’s 1974 “Comprehensive Health Insurance Plan” (itself a counterproposal to Ted Kennedy’s single-payer plan). Meanwhile, the individual mandate was first articulated by Stuart Butler at the Heritage Foundation, a conservative think tank. And by 1993, Republicans in Congress were proposing a bill (the Health Equity and Access Reform Today Act, or HEART Act) that, as she puts it, had “nearly identical” provisions to the ACA, including “an individual mandate, an employer mandate, a standard benefit package, state-based purchasing exchanges, subsidies for low-income people, [and] efforts to improve efficiency.” (She also does note a few differences, most prominently the ACA’s Medicaid expansion, which is by far the law’s most beneficial provision.)

Yet like Nixon’s 1974 bill, the 1993 Republican embrace of this individual mandate-based plan was provoked, in part, less by an earnest desire to expand health coverage than by a legitimate fear of single-payer reform. The economist Mark Pauly—one of the authors of a slightly earlier version of an individual mandate-based plan prepared with the hope of enticing the first Bush administration—acknowledged this in a 2011 interview with Ezra Klein at The Washington Post: The idea was to deflect “the specter of single-payer insurance,” as he told Klein. 

Today, of course, Republicans are no longer afraid of the menace of single-payer, for a perfectly good reason: The mainstream of the Democratic Party has largely abandoned it. As Steven Brill noted in “America’s Bitter Pill: Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System,” when the Democratic Senate Finance Committee Chairman Max Baucus began formulating a health care agenda after the election of President Obama, he was clear about “one thing” above all else: His proposal would not look like single-payer. Instead, Baucus’s plan would, as Brill writes, be a “moderate plan … that could attract bipartisan support.” Yet despite this massive concession to (or embrace of) conservative health care principles, the ACA failed miserably in attracting bipartisan support: It didn’t even earn a single Republican vote in the House or the Senate. So much for the much-vaunted politics of compromise.

Today, Republicans have by and large abandoned earlier “moderate” positions on health care, and instead tried to lamely recycle various tired nostrums—Health savings accounts! Insurance across states lines! Medicare vouchers!—to a weary nation. Yet the net effect of this push and pull has meant that the health care center has veered rightward to a striking degree, such that today, liberals like Starr and Krugman contend that a law that is largely the same as the Republican HEART Act from the early 1990s should—with perhaps a few tweaks down the road—form the core of our health care system.

The liberal retreat on single-payer is in line with a long history of centrist Democratic thinking that haplessly confuses rearguard action with political vision. Passing a federal single-payer bill would, no doubt, necessitate key electoral victories, a powerful campaign at the governmental level, and a formidable grassroots struggle. Useful initial steps in this direction might include the election of a president determined to pass single-payer, the restoration of single-payer to the platform of the Democratic Party, and vigorous support for such reform by pundits and scholars in high places. That none of these things may wind up happening is a cause of the alleged political “impossibility” of single-payer—not its result.

This brings me to the second of the two core arguments of the single-payer naysayers: “Medicare-for-all” would come at a price we simply cannot afford. The most recent iteration of this argument traces back to Kenneth Thorpe, an economist at Emory University, who published an analysis asserting that the Sanders plan (itself based on calculations of the economist Gerald Friedman, who has also taken a lot of criticism from Krugman and others for his optimistic economic projections under a President Sanders) would be about twice as expensive as his campaign has argued. Thorpe’s numbers spread like wildfire: After being initially reported and evaluated by Dylan Matthews at Vox, they’ve been cited by Starr, Krugman, the editorial board of The Washington Post, and basically everybody else. “[H]is health-care plan rests on unbelievable assumptions,” noted the Post, “about how much he could slash health-care costs without affecting the care ordinary Americans receive.”

But there are many ways to look at the issue of single-payer financing. David Himmelstein and Steffie Woolhandler, health policy professors at the City University of New York School of Public Health and lecturers in medicine at Harvard Medical School, efficiently took apart Thorpe’s numbers in two point-by-point by critiques. To get into the nitty gritty of the major errors in Thorpe’s economic assumptions, I’d direct readers to their article at the Huffington Post. And notably, as they describe in The Hill, Thorpe had himself previously found single-payer to be entirely affordable—indeed, he once asserted that it would reduce costs even as it expanded coverage.

Friedman, Thorpe, and Starr have also engaged in an exchange at the Prospect about these issues. In truth, it seems that more economic analysis may be needed with respect to the precise mix of taxes that are necessary. But the reality is that the specific taxes laid out in Sanders’s slim single-payer proposal are relatively unimportant at the current time; they would have to undergo significant reexamination and revision as the proposal was transformed into an actual bill. At this stage, it’s more useful to take a step back and look at the debate over the affordability of single-payer in more general terms, by asking three larger questions. First, what new costs would a single-payer system generate? Second, what savings would single-payer deliver? And third, could the new costs roughly balance the savings?

First, when speaking about new costs, I mean actual new expenses, not existing private expenditures that become public expenditures. The difference is crucial: with the proper mix of progressive taxes, the transition from private to public spending can be achieved without imposing any economic burden on the non-affluent (and indeed, lightening it for many). But actual new expenses, in contrast, can be seen as a legitimate source of real “new spending.”

For instance, according to the latest estimates from the National Center for Health Statistics, some 29 million people were uninsured in 2015. Covering these individuals requires cash. It’s worth pointing out, however, that many of these individuals are already using health care, with some of the costs either coming out of their own pockets or being passed on to other public or private payers. Replacing those existing expenditures will have zero effect on overall national health spending. At the same time, many of these individuals are, sadly, currently forgoing health care, and to the extent that universal health care allows them to go to the doctor or get tests or medicines they’ve so far been avoiding, some new money will indeed need to be spent.

Second, proposals for “Medicare-for-all” usually call for the elimination of cost sharing, which is to say no copayments, deductibles, and co-insurance. I’d argue that this is an essential aspect of real universal health care (with some notable exceptions, such payments are absent from the systems of Canada and the United Kingdom). The harms of such payments are all too real: As a result of out-of-pocket exposure, an analysis of survey findings published by the Commonwealth Fund last year put the number of underinsured Americans—the insured who lack sufficient coverage against the cost of medical care—at 31 million in 2014. Though discarding such out-of-pocket payments might sound like a pricey proposition, to the extent that these monies are already being spent, their elimination would be a wash, with no net effect on overall national health expenditures. But again, as is the case with the uninsured, insofar as some individuals and families are avoiding health care because of out-of-pocket payments, the elimination of these financial barriers would result in some real increases in health care utilization.

There are some other points to be made (like the additional costs of providing universal long term care and dental care), but in reality these two items—covering the uninsured and improving coverage for the underinsured—are the main new costs that a single-payer national health program would have to cover. Taking that into consideration, is single-payer indeed “unaffordable”?

To answer, we have to look at the opposite side of the equation, at the potential for efficiency savings in such a transition. And clearly, the biggest source of savings is the reduction of the vast bureaucratic apparatus that undergirds the entirety of the health care system, as Himmelstein and Woolhandler emphasize (and have studied in depth). This “apparatus” is devoted to such critical tasks as the compilation of lengthy itemized hospital bills, the pursuit of medical debtors, the design of needlessly complex yet shoddy insurance products, the issuance of bills to innumerable payers, the endless clinical documentation necessary to generate proper payment from insurers, and so forth. Overall, this represents a massive, parasitic drain on the American economy. And so, too, does our unnecessarily high pharmaceutical expenditures. But it is, in particular, the issue of administrative savings that has received insufficient attention in discussions on health care reform.

Frustration with the lack of accurate discussion around such savings (and around single-payer more generally) led several physicians—including myself, Andrea Christopher (a fellow in general medicine at Harvard Medical School), Himmelstein, and Woolhandler—to organize an open letter contesting this crystallizing critique of single-payer. The letter was published in February in the Huffington Post, and has been signed by more than 920 physicians and medical students.  It makes this bottom-line point about the balance of savings and costs:

“We devote 31 percent of medical spending to administration, vs. 16.7 percent in Canada—a difference of $350 billion annually. And single-payer systems in Canada, the U.K., and Australia all use their bargaining clout to get discounts of 50 percent from the prices drug companies charge our patients. The potential savings on bureaucracy and drugs are enough to cover the uninsured, and to upgrade coverage for all Americans—a conclusion affirmed over decades by multiple analysts, including the Congressional Budget Office and the Government Accountability Office.”

Moreover, our letter notes that expansions of health coverage have historically been accomplished without massive increases in health care utilization: Essentially, doctors devote more attention to those who are sick and somewhat less to those who are well, resulting in relatively modest increases in health care use. “Experience in many nations over many decades,” we conclude, “provides convincing evidence that single-payer reform is both medically necessary and economically advisable.”

We can, in other words, afford to provide comprehensive health care to everyone in the nation, free at the point of use, with “one large network” of physicians and hospitals available to all. Currently existing private spending will be largely replaced by public spending, which would require a mix of new taxes. Overall health spending would stay roughly say the same, though future cost increases could be much better controlled. The number of the uninsured would fall from some 29 million to near zero. At the same time, the rest of us who are already insured would be able to stop worrying about which providers are in- or out-of-network, whether or not a doctor’s visit or a medication is worthwhile in light of a steep copayment, how to decipher a daunting medical bill, or the loss of coverage that might accompany dismissal from a job, loss of a partner, or the descent into poverty. This, to me, seems like a very good bargain.

Paul Starr, who (as noted) has penned several recent articles dismissing single-payer (as well as blasting Sanders’s candidacy more broadly), is perhaps most famous for his Pulitzer Prize-winning 1982 book “The Social Transformation of American Medicine.” It’s a book that I read as a first-year medical student, and that has shaped my understanding of the American health care system greatly. In it, he traces the emergence of the American medical profession, and follows how our failure to publicly organize the health system gave way to the rise of a “corporate medical enterprise,” a sector—as he notes in the final chapter—that is “likely to aggravate inequalities in access to health care.” Clearly, this has come to pass.

But I wish to conclude by turning to the very first words of the book. “The dream of reason did not take power into account,” the book begins. “The dream was that reason, in the form of the arts and sciences, would liberate humanity from scarcity and the caprices of nature, ignorance and superstition, tyranny, and not least of all, the diseases of the body and the spirit.” Power—whether of the medical profession or of the corporatized organizations that have since superseded it—complicated the fulfillment of the dream.

The dream, however, is not yet dead. With respect to health, the idea that all lives should be as long and as healthy as is possible—a vision that can only be fulfilled by the universal and equal provision of the very best that modern medical science has to offer—still burns bright. But now, in twenty-first century America, it is not just conservatives, but many liberals, who are among the powerful standing in opposition to its fulfillment.

Adam Gaffney is a physician and writer whose articles have appeared in the Los Angeles Review of Books, Salon, CNN.com, USA Today, In These Times, Jacobin, and elsewhere.

https://newrepublic.com/article/131251/liberals-tried-kill-dream-single-payer

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

The following is a selection of initial obituaries and stories about Dr. Quentin D. Young, prominent leader of PNHP for nearly three decades, who died on March 7. The stories below are from The New York Times, NBC News, The Associated Press, Chicago Sun-Times, Chicago Tribune, The Washington Post, and other local, national, and international news outlets.

Dr. Quentin D. Young, Public Health and Civil Rights Advocate, Dies at 92

By Sam Roberts
The New York Times, March 17, 2016

Dr. Quentin D. Young, a tenacious advocate for public health care and social justice, and a personal physician to the Rev. Dr. Martin Luther King Jr. and Barack Obama when he lived in Chicago, died on March 7 in Berkeley, Calif. He was 92.

His death, at his daughter Polly Young’s home, was announced by Margie Schaps, the executive director of the Health & Medicine Policy Research Group, which Dr. Young founded in 1981 in Chicago, where he lived and worked until two years ago.

Dr. Young campaigned tirelessly for a single-payer universal health care system, insisting that it was no less feasible than Medicare, the national health insurance program for people older than 65, and no more radical than Social Security was when it was first proposed in the 1930s. A single-payer system, he said, would eliminate the need for private health insurance companies, which “are in the business of finding reasons not to give care.”

“It’s true that over the years, I’ve aligned myself with unpopular causes,” he told The Chicago Tribune in 2001. “But over time, they’ve become the majority opinions.” Among those supporting a single-payer system is Senator Bernie Sanders of Vermont, who is seeking the Democratic presidential nomination.

Dr. Young was consulted in the planning stage of President Bill Clinton’s failed health care initiative, which he called “a magnificent exercise in pseudo-openness.” He first met Mr. Obama in 1995 when he was running for the State Senate and became his personal physician and an ally on health care policy. But Mr. Obama did not pursue a single-payer formula as president.

Ralph Nader, a friend of Dr. Young’s and a fellow consumer advocate, called Dr. Young “a physician for all seasons — for his patients, for public health facilities, for workplace safety and for full Medicare for all people with free choice of doctors and hospitals.”

Dr. Young’s social justice conscience was forged early in life — on visits to his grandparents in poverty-stricken rural North Carolina while growing up during the Depression, through membership in the Young Communist League USA, and as a young physician treated women who had had botched illegal abortions.

In the 1960s, he campaigned to desegregate Chicago’s hospitals. In 1966, he treated Dr. King after he was hit by a rock thrown by white demonstrators during a march protesting segregated housing in Chicago.

Dr. Young was a founder of the Medical Committee for Human Rights, which sent doctors to treat civil rights workers in the South, members of the Black Panther Party and protesters battered at the 1968 Democratic National Convention, including the Chicago Seven, who were charged by the government with inciting to riot. (Summoned before a House Un-American Activities Committee investigation into the protests, he refused to say whether he was a member of the Communist Party.)

In the 1970s, Dr. Young was fired as the chairman of the department of medicine at Cook County Hospital for supporting doctors who demanded bargaining rights and better patient care. He successfully sued to be reinstated. In 1983, Mayor Harold Washington named him president of the city’s Board of Health.

Quentin David Young was born on the South Side of Chicago on Sept. 5, 1923, to Jewish immigrants from Eastern Europe: Abraham Young, who sold real estate, and the former Sarah Wolf.

He briefly considered becoming a rabbi and later an actor after landing the part of Punjab on the “Little Orphan Annie” radio series. (He attended acting class with two future patients, the singer Mel Tormé and the author Studs Terkel.)

Dr. Young attended the University of Chicago, left to serve in the Army from 1943 to 1945, and graduated from Northwestern University Medical School in 1948.

His wife, the former Ruth Johnson Weaver, died in 2007. Besides his daughter Polly, he is survived by four other children, Nancy, Barbara, Ethan and Michael Young, all from an earlier marriage; a stepdaughter, Karin Weaver; a stepson, William Weaver; nine grandchildren; and five step-grandchildren.

While maintaining a private practice in the Hyde Park neighborhood of Chicago, Dr. Young was national coordinator of Physicians for a National Health Program, president of the American Public Health Association and a medical commentator on Chicago Public Radio.

In a 1994 interview with Christian Century magazine, he recalled that the young doctors with whom he trained typically viewed their poor patients in one of two ways. “About half the doctors felt that they were witnessing divine justice, a heavenly — or Darwinian — retribution for evil ways, for excesses in drugs, in booze and everything else,” he said.

“The other half,” he continued, “decided that here was the congealed oppression of our society — people whose skin color, economic position, place of birth, family size, you name it, operated to give them a very short stick,” and “you had to address issues of justice, not just medical treatment.”

“It seemed to me the first approach is judgmental and harsh and simplistic,” Dr. Young said. “Taking the alternative view gave me a shot at being a part of the human race.”

http://www.nytimes.com/2016/03/18/us/dr-quentin-d-young-public-health-and-civil-rights-advocate-dies-at-92.html?_r=1

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Quentin Young, Crusading Progressive Doctor Who Cared for MLK, Dies

By Jon Schuppe
NBC News, March 8, 2016

Quentin Young, a Chicago physician renowned for his passionate advocacy for equality in health care — and whose patients included Dr. Martin Luther King Jr., Studs Terkel, and former mayor Harold Washington — has died.

The retired 92-year-old internist for many years ran a private practice in Chicago’s Hyde Park neighborhood, where a young Barack Obama was a patient in the 1990s. The doctor and future president became close, a relationship that evolved into discussions about health care policy, and a shared interest in reform.

Young’s push for a single-payer national health system led him to the nonprofit Physicians for a National Health Program, where he served as national coordinator. A spokesman for the organization confirmed that Young’s Monday death, saying the news had been relayed by his daughter in Berkeley, California, with whom he had been living for the past few years.

“Dr. Young was known for his sharp, clear-eyed analysis of social and economic problems, particularly in health care, his deep commitment to social justice and racial equality, his quick wit, his insuppressible optimism, and his ability to inspire those around him to join him in the battle for a more equitable and caring world,” the group’s president, Robert Zarr, said in a statement.

Zarr shared as an epitaph a quote from Young’s 2013 autobiography, “Everybody In, Nobody Out: Memoirs of a Rebel Without a Pause.” In it, Young wrote: “From my adolescent years to the present, I’ve never wavered in my belief in humanity’s ability — and our collective responsibility — to bring about a more just and equitable social order.”

His death was first reported by DNAinfo Chicago.

Young became a doctor in the early 1950s, and came of age as an activist during the civil rights era, campaigning for more equitable access to medical treatment. He was considered the moral voice of public health in his hometown of Chicago, appearing often on local radio.

He said he grew up in a community of progressives, absorbing leftist politics that drew him to work with civil rights groups. Young marched with and cared for King when he was in town, worked at local Black Panther health clinics and was a founder of the Medical Committee for Human Rights, a group of doctors who gave medical support to demonstrators during the 1964 Freedom Summer in Mississippi.

While running his private practice, Young also worked at the Cook County Hospital, where he rose to chairman of the Department of Internal Medicine.

In 2008, Young retired. Even after giving up his medical practice, he vowed to keep fighting what he called the “corporate takeover” of American medicine.

http://www.nbcnews.com/news/us-news/quentin-young-crusading-progressive-doctor-who-cared-mlk-dies-n533966

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Dr. Quentin Young, longtime health advocate, dies at 92

By Carla K. Johnson
The Associated Press, March 8, 2016

CHICAGO (AP) — Dr. Quentin Young, a longtime health advocate who served as a personal physician to Martin Luther King during the civil rights leader’s stay in Chicago, died Monday at age 92.

Young died of natural causes at the home of his daughter Polly Young in Berkeley, California, she said Tuesday.

A former president of Physicians for a National Health Program, Young pushed for decades to promote single-payer national health insurance. Before that, the Chicago native worked to desegregate Chicago hospitals in the 1950s and marched with civil rights workers in the 1960s.

Civil rights leaders Fannie Lou Hamer and Stokely Carmichael stayed at the family’s Chicago home, his daughter recalled.

“There were always meetings and lively discussions,” she said. “That was an indelible experience of my childhood. We did put in our time at picket lines and at meetings.”

Visiting his mother’s family in rural North Carolina during his childhood helped shape his devotion to social justice work, Polly Young said.

“He remembered as a little child seeing the homes of sharecroppers at the height of the Depression,” she said. “They were living in complete squalor in an apartheid system. He did mention being very appalled by that as a little child.”

Margie Schaps shared an office with Young at the Chicago-based Health & Medicine Policy Research Group, an organization Young founded and where he worked until 2014.

“There was never a rally too small, never an injustice that didn’t deserve him speaking out on it,” Schaps said. “I sat side by side with him for 20 years. We planned and plotted and organized and strategized every day.”

Cook County Board President Toni Preckwinkle called him “a relentless advocate of fairness and justice for all citizens,” noting he was a past chairman of the department of internal medicine at Cook County Hospital.

Young also was a past president of the American Public Health Association.

“His life’s work was transformative, meaningful and contributed to a healthier world for us all,” said Dr. Georges Benjamin, executive director of the American Public Health Association.

Young founded the Medical Committee for Human Rights, a group of health professionals who provided medical care during the civil rights and anti-war protests of the 1960s.

He served as personal physician to Chicago Mayor Harold Washington and author Studs Terkel and also was former Gov. Pat Quinn’s doctor, becoming his adviser and friend.

In August 2001, the two men embarked on a 167-mile walk across Illinois to promote universal health care. Quinn recalled a determined Young, who was in his late 70s at the time.

“He wanted decent health care for everyone, that’s how he spent his whole life,” Quinn said. “He had a great ability to connect to everyone.”

The relationship raised questions at times when Quinn, who maintained a tight circle of advisers, appointed him to state posts. Young withdrew as chairman from the state’s health facilities planning board, after a conflict of interest was discovered. Young had minority interest in a doctor’s office that owned property being leased to a health care system.

Young told AP in a 2013 interview that his political involvement was motivated by a sense of justice, and he admired Quinn.

“I’m not political in the orthodox sense,” Young said at the time. “I believe in fair play.”

Associated Press writers Sophia Tareen and Lindsey Tanner contributed to this report.

http://bigstory.ap.org/article/522be5f5934344838e6c6c4b2196af78/dr-quentin-young-longtime-health-advocate-dies-92

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Dr. Quentin D. Young, ‘tiger for social justice,’ dies at 92

By Maureen O’Donnell and Mitch Dudek
Chicago Sun-Times, March 8, 2016

Dr. Quentin Young provided medical care to the Rev. Martin Luther King Jr., Mayor Harold Washington, the Beatles, Studs Terkel and Mike Royko. He ran a practice in Hyde Park, and his clinic’s patients included Barack Obama.

But rather than the who’s who of his clients, admirers are remembering him for the what’s what. During a 60-year career, Dr. Young was a fierce advocate for quality health care for all and for the construction of Stroger Hospital.

He died Monday at his daughter’s home in Berkeley, California. Dr. Young was 92.

“The Cook County family has lost a giant in public health,” said Dr. Claudia Fegan, executive medical director of the Cook County Health & Hospitals System.

“Dr. Young was a radical, a rebel, a tiger for social justice,” health consultant Michael Gelder said.

In 2008, when he declared Quentin Young Day in Illinois, Gov. Pat Quinn said his health adviser “stood up for patients everywhere, advocating for what he believed to be right – even when it meant risk to his personal safety or his livelihood. . . . Time has consistently shown Quentin Young to be on the right side of history, and his advocacy has bettered his community and the health care industry as a whole.”

The Hyde Park resident — who could safely be called an old lefty — frequently clashed with officials who brought him in to run things because of his expertise and reputation, only to discover he was hard to muzzle and control. He was steadfastly against U.S. participation in the Vietnam War, and pro-labor and civil rights. One of Dr. Young’s favorite sayings was, “Everybody In, Nobody Out,” which became the title of his autobiography.

In the 1950s, he worked to desegregate Chicago hospitals. In the early 1960s, he helped start the Medical Committee for Human Rights, an arm of the civil rights movement. He marched in Selma and tended the injuries and illnesses that befell Freedom Riders in the South.

Later, he was called before the House Un-American Activities Committee because the Medical Committee for Human Rights was viewed as a Communist-friendly group, said Margie Schaps, executive director of the Health & Medicine Policy Research Group, which Dr. Young chaired.

In 1966, when King was struck in the head by a projectile while marching through jeering white protesters in Marquette Park, it was Dr. Young who patched him up.

And when police batons battered protesters during the 1968 Democratic National Convention, Dr. Young dressed the wounds. “To see such a disintegration of norms was very hard,” he once said in an interview. During the Chicago Seven trial, he treated ‘Yippee’ Abbie Hoffman.

He chaired Cook County Hospital in the 1970s. His support of activist doctors who lobbied for unionization and improved patient care led to conflicts, Schaps said: “Quentin was proud of this — he was fired three times, but he always got his job back.”

In the early 1980s, he helped found the Health & Medicine Policy Research Group, which studies the impact of social factors on health, including education, income and environmental toxins.

During Washington’s administration, the mayor tapped Dr. Young to head the city Board of Health.

And “Beginning in the late 1980s, he was perhaps the nation’s most eloquent and high-profile spokesperson for single-payer national health insurance,” according to a statement from the group Physicians for a National Health Program.

His advocacy for a single-payer system left him at odds with Obama on how the Affordable Care Act turned out.

In 2001, at 78, Dr. Young trekked 167 miles across Illinois with Quinn — his patient — to promote health care initiatives.

He walked with a bounce, and people gravitated toward him because of his erudition, Gelder said. The physician could quote from the Greek classics and George Bernard Shaw.

Dr. Young loved talking with King so much that he tried to stretch their encounters. When King had a cold, “I took a 15-minute house call and made it a three-hour afternoon with the master,” he told the Chicago Sun-Times.

His mother and father were Eastern European immigrants. They met in North Carolina, where her family had a general store. “They were the only Jews for miles around,” said his daughter, Polly. Young Quentin’s future activism was stirred by witnessing the hard lives of African-American sharecroppers in North Carolina, she said. Later, his father earned a pharmacy degree from Fordham University. The Youngs settled in Hyde Park and his father sold real estate.

Dr. Young went to Hyde Park High School, the University of Chicago and Northwestern University’s medical school.

He took his children on medical rounds, and to meetings, demonstrations and visits with King.

In the latter part of his career, he had a WBEZ radio show on health and medicine.

In 1960, he and his first wife, Jessie, divorced. He married Ruth Weaver in 1980. She died in 2007. He is survived by two more daughters, Nancy and Barbara; two sons, Ethan and Michael; his stepchildren, Karin and William Weaver; nine grandchildren and two step-great-grandchildren. A Chicago memorial is being planned.

He summarized his philosophy in his autobiography. “From my adolescent years to the present, I’ve never wavered in my belief in humanity’s ability – and our collective responsibility – to bring about a more just and equitable social order. I’ve always believed in humanity’s potential to create a more caring society.”

http://chicago.suntimes.com/obituaries/doctor-activist-quentin-young-dies-at-age-92/

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Dr. Quentin Young was the best of doctors

By Sun-Times Editorial Board
Chicago Sun-Times, March 10, 2016

What always struck us as remarkable about Dr. Quentin Young is that he managed to hold down big, important, establishment jobs.

Dr. Young was a fighter for social justice every day of his life, which can be a terrific way to end up in an unemployment line. He scolded public officials, locally and nationally, who would short-change health care for the poor and powerless. He led the fight, sure to make him enemies, to desegregate Chicago hospitals. Yet he was chairman of Cook County Hospital for many years and once ran the Chicago Board of Health.

Our theory is this: Dr. Young was just too good a doctor and administrator to be exiled for too long. He might get fired — and he was, in fact, dismissed as head of the county hospital three times — but mayors and county board presidents would pick up the phone and bring him back.

The rightness of Dr. Young’s cause was impossible to deny. Anybody could see it. That, too, explained his success. He understood the interplay of social factors, such as poverty and racism, in health care, and he advocated all his life for this larger approach to delivering care.

Dr. Young, who died Monday at age 92, was a rebel because he was the best of doctors.

http://chicago.suntimes.com/opinion/editorial-dr-quentin-young-was-the-best-of-doctors/

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Dr. Quentin Young, Chicago activist for civil rights and public health, dies at 92

By Marwa Eltagouri
Chicago Tribune, March 8, 2016

Dr. Quentin Young, a champion of civil rights and public health reform who was chairman of medicine at Cook County Hospital during a tumultuous period in the 1970s, died Monday, according to his family.

Young, 92, died of natural causes in the Berkeley, Calif., home of his daughter Polly, where he had been living since July 2014, his son Michael said. He had lived in Chicago’s Hyde Park neighborhood for most of his life.

Young maintained his Hyde Park medical practice into his mid-80s while also keeping busy with any number of causes. He pushed to end discriminatory practices at Chicago-area hospitals in the 1950s, co-founded the Medical Committee for Human Rights in the 1960s, marched for civil rights and against war and spent decades advocating for national health care.

“It’s true that over the years I’ve aligned myself with unpopular causes,” Young told the Tribune in 2001. “But over time they’ve become the majority opinions.”

The son of immigrants, Young grew up on the South Side and graduated from Hyde Park High School. He was active in drama and, in a 1992 Tribune interview, recalled taking the “L” to the North side for classes at the Jack and Jill Players with a Hyde Park classmate, Mel Torme. It was also as a young thespian that he met the writer and actor Studs Terkel, who later became a friend and patient.

Young’s studies at the University of Chicago were interrupted by a hitch in the Army during World War II. After getting his bachelor’s degree from the U. of C. in 1944, he received his medical degree from Northwestern University in 1947.

He began his medical training at Cook County Hospital and remained there until 1952. He then spent many years as a physician at Michael Reese Hospital on Chicago’s South Side before returning to Cook County Hospital, where he became chairman of medicine in 1972. He remained there until 1981, working to improve the county public health system’s economic vitality and its ability to help the poor and downtrodden.

Young was fired from his post at Cook County twice and rehired both times after standoffs with the hospital’s governing body. One major issue was his support of young staff doctors who went on strike for improved conditions.

In addition to his position with the county, Young was president of the Chicago Board of Health and the American Public Health Association, and he co-founded the Health and Medicine Policy Research Group.

Alongside his busy medical career, Young was equally active in agitating for social change. He was among the volunteers in the campaign to register black voters during Mississippi’s Freedom Summer in 1964. He participated in one of the historic 1965 marches from Selma to Montgomery, Ala. As founder and national chairman for the Medical Committee for Human Rights, he led efforts to provide medical care to campaign volunteers, civil rights workers and anti-war protesters.

He remained passionate about medical rights and public health equality throughout his life and was a longtime advocate for a single-payer health care system.

In August 2001, at age 77, he took part in an 167-mile, 15-day walk across Illinois to promote universal health care. Former Illinois Gov. Pat Quinn, a patient and close friend, recalled Young’s buoyancy throughout the march and the frequent aphorisms he’d share with those marching alongside him. A favorite: “Everybody in, nobody left out.”

“His wife, Ruth, came with us. We’d all be walking down a two-lane highway with Quentin, and he’d be walking along the center line. And she’d keep saying, ‘Quentin! Get out of the middle of the road!'” Quinn said. “I think that was the only time he was a middle-of-the-roader. He was a progressive — a liberal lion. Never flinched from a battle for his causes.”

In the early 1960s, Young regularly took his five children with him to demonstrations, which often were on behalf of the fight to desegregate public schools.

“Everyone thinks their experiences are normative, but it wasn’t until later that I realized those weren’t,” said Michael Young, who remembered visits to his home by civil rights leaders including Stokely Carmichael.

“My father had a real magnetism,” Michael Young said. “He was able to inspire people to activism in a way that was extraordinary. He was a very positive person and very funny. People sought out his company, and he just had this passionate belief in the causes he embraced.”

Young served as the physician for Martin Luther King Jr. during the civil rights leader’s many stops in Chicago. In his more than 50 years in private practice, other notable patients included Mayor Harold Washington and columnist Mike Royko.

Young is also survived by another son, Ethan; three daughters, Nancy, Polly and Barbara; two stepchildren, William Weaver and Karen Weaver; and nine grandchildren.

A first marriage ended in divorce. His second wife, Ruth, died in 2007.

Services in Chicago are being planned.

http://www.chicagotribune.com/news/ct-quentin-young-dead-20160308-story.html

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Quentin Young, Chicago doctor and social activist, dies at 92

By staff reports and news services
The Washington Post, March 8, 2016

Quentin Young, a Chicago doctor and social activist who protested against segregated hospitals, was a personal physician to the Rev. Martin Luther King Jr. and other civil rights figures who came through the Windy City, and was an advocate for promoting decent health care for all, died March 7 at a daughter’s home in Berkeley, Calif. He was 92.

His death was announced by Margie Schaps, who worked with Dr. Young at the Chicago-based Health & Medicine Policy Research Group, an organization Dr. Young founded. No specific cause was disclosed. Cook County Board President Toni Preckwinkle called Dr. Young — a former president of the American Public Health Association and the universal-health-care advocacy group Physicians for a National Health Program — “a relentless advocate of fairness and justice for all citizens.”

Quentin David Young was born in Chicago in 1923. His father, a Russian immigrant, operated a construction company, and his mother was from Lithuania.

“My parents were liberal and uncommonly permissive in letting us pursue what we wanted,” he told the Chicago Sun-Times.

Drawn to left-wing political groups, he dropped out of the University of Chicago to enlist in the Army in World War II with the aim of combating fascism.

Following his discharge, he received his medical degree from Northwestern University, then became a trainee on the staff of Cook County Hospital. His experience treating botched back-alley abortions led him to become a vocal advocate for legalizing abortion.

“It’s not a choice of abortion or no abortion, but safe abortion or unsafe abortion,” he told the Sun-Times.

While establishing a medical practice in the Hyde Park neighborhood, he also immersed himself in social activism.

He worked to desegregate Chicago hospitals in the 1950s and marched with civil rights workers in the 1960s. Dr. Young helped lead the Medical Committee for Human Rights, a group of health professionals who provided medical care for civil rights and antiwar demonstrators. He helped treat protesters beaten by police during the 1968 Democratic convention in Chicago.

That year, he was asked to appear before a subcommittee of the House Un-American Activities Committee, which was examining the disruption of the convention. A member of the panel asked if Dr. Young was a communist.

“My answer to the question is that it is an unconstitutional invasion of my rights and under these circumstances I would never answer,” he said. “I chastise the chair for daring to ask me that question.”

After filing suit against the FBI, he discovered that the agency had monitored him for nearly 30 years; he was also the subject of intense scrutiny by the Chicago Police Department’s “red squad.”

In 1972, Dr. Young was named director of medicine at Cook County Hospital, which was in turmoil over labor disputes. Amid a strike by interns and resident doctors in 1975, Dr. Young threw his support to the protesters, and the hospital’s governing board fired him. He sued successfully to regain his position.

According to the Sun-Times, he left in 1980 after accusing the county of “malignant neglect” of the hospital. He later served as personal physician to Chicago Mayor Harold Washington and author Studs Terkel, and was former governor Pat Quinn’s doctor, becoming his adviser and friend. In August 2001, Quinn and Dr. Young embarked on a 167-mile walk across Illinois to promote universal health care.

The relationship raised questions at times when Quinn, who maintained a tight circle of advisers, appointed him to state posts. Dr. Young withdrew as chairman of the state’s health facilities planning board after a conflict of interest was discovered. Dr. Young had minority interest in a doctor’s office that owned property being leased to a health-care system.

He had five children with his first wife; their marriage ended in divorce. His second wife, Ruth, died in 2007. A list of survivors was not immediately available.

https://www.washingtonpost.com/local/obituaries/quentin-young-chicago-doctor-and-social-activist-dies-at-92/2016/03/08/444f0272-e55d-11e5-b0fd-073d5930a7b7_story.html

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Dr. Quentin Young, Doctor to Martin Luther King Jr., Dies at 92

By Sam Cholke
DNAinfo Chicago, March 8, 2016

Dr. Quentin Young, the crusading progressive physician to Rev. Martin Luther King Jr., among others, died Monday at his daughter’s house in California.

Young, 93, was a lifelong Hyde Parker and the physician to Obama, former Mayor Harold Washington and to writers like Studs Terkel and Mike Royko.

According to people who had spoken to Young’s family, Young died on Monday at his daughter Polly Young’s house on Monday.

Young was a lifelong advocate for a single-payer health care system and numerous other progressive causes, which he said in 2013 came from his youth growing up in Hyde Park.

“I had the good fortune of being surrounded by progressive people,” Young said in 2013 when his biography was released about being surrounded by communists, progressives and other left-leaning groups in the neighborhood during the Great Depression.

In the past three years, he had started to spend the winters in California to be closer to his children, Nancy, Polly, Ethan, Barbara and Michael Young. But it was only his second time every living outside of the neighborhood.

Young served in the U.S. Army during World War II, but returned to Chicago and graduated from Northwestern University.

He spent nearly 35 years at Cook County Hospital both treating patients and advocating for better health care for African Americans in Chicago.

“The county hospital played a pivotal role in the black community, and they really thought it was theirs – it wasn’t theirs, it belonged to the Democratic Party,” Young said.

He also ran his own practice in Hyde Park, and he treated Rev. Martin Luther King Jr. during a march in Chicago.

“I received the honor of looking after King during the march,” Young said. “He took a rock to the head and had to be sewn up.”

His regular patients included Terkel and Royko, who Young said always gave him a hard time.

“He was always very sarcastic with me and never liked my leftist ideas,” Young said of Royko. “Studs would at least listen to me.”

Young spent more than 25 years advocating for a single-payer health care system in the United States, a cause he continued to fight for until his death on Monday.

On Monday, Physicians for a National Health Program released a statement by Dr. Robert Zarr, the organization’s president.

https://www.dnainfo.com/chicago/20160308/hyde-park/dr-quentin-young-doctor-martin-luther-king-jr-obama-dies-at-93

[PNHP note: the story above has been lightly edited for accuracy and clarity.]

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Dr. Quentin Young Remembered as a Young Radical Who Never Quit

By Sam Cholke
DNAinfo, March 9, 2016

HYDE PARK — Dr. Quentin Young is being remembered in Chicago’s Hyde Park community after his death on Monday for his devotion to social justice and fearlessness during fights for civil rights around the country.

Young, 92, died at his daughter Polly Young’s house in Berkeley, Calif., on Monday and family said he was engaged in progressive politics until the end.

Polly Young said her father’s life ambition was for a single-payer health care system in the United States and was happy to see the issue being debated again in the Democratic presidential primary.

Young spent more than 25 years advocating for reforms to the nation’s health care system, but he had spent most of his life treating those who were advocating for social justice while marching himself.

Young marched alongside the Rev. Martin Luther King Jr. in 1965 from Selma to Montgomery, Ala., and treated King when he was struck by a stone while marching in Marquette Park in Chicago in 1966. Young treated protesters injured by police during the 1968 Democratic Convention in Chicago and was a tireless advocate for more resources during his nearly 35 years at Cook County Hospital.

“I can’t remember a time when he wasn’t active,” Polly Young said Tuesday. Young had moved in withher in 2014, his first time living outside of Hyde Park since World War II.

She said she and her two brothers and two sisters saw all of it first hand.

“He wasn’t necessarily 100 percent doing childcare, his method was to drag his kids along,” said Young, who also is a doctor of internal medicine like her father. “He often dragged us along on hospital rounds, which probably made a big impression on me.”

Quentin Young was one of the first people in Illinois to have joint custody of his children after his divorce in 1958 and on weekends with their father, Young’s children said King, Fannie Lou Hamer and other leaders of the civil rights movement would come to the house and they were expected to keep up in the political discussion.

“There was no filter for the children and we were all engaged in it,” said Michael Young, the youngest son.

Young’s children said there was very little about his life he kept private and they said Young traced his passion for social justice to his youth.

Young grew up on the western edge of Woodlawn in a Jewish part of the neighborhood north of 63rd Street to parents who had emigrated from Eastern Europe and who spoke Yiddish at home.

Polly Young said her father would tell stories about visiting his grandparents in North Carolina, where his grandparents still ran a general store after his parents moved to Chicago.

“He talked about vivid memories of sharecroppers living in squalid huts,” Polly Young said.

She said Young was radicalized in his teens at Hyde Park High School, one of the few integrated schools in Chicago where he first learned about Marxism and civil rights.

Young’s children said his passion for medicine came later in life and he thought briefly about becoming a rabbi after Hebrew school and then an actor when he landed a gig as Punjab on the “Little Orphan Annie” radio series, where Studs Terkel claimed he first met Young.

Polly Young said her father likely pursued medicine at the urging of his pharmacist father. She said he found it to be more than steady, well-paying work, but also an outlet for his desire to get to know people on a personal level and help them.

“He was a people person and his patients revered him and he really enjoyed that,” Polly Young said.

Young’s patients included King and other civil rights activists, and later writers like Terkel and Mike Royko, former Mayor Harold Washington, former Gov. Pat Quinn and President Barack Obama.

But that closeness to powerful politicians also made him a target of their opponents.

Jesse Sinaiko said Young hired him and several of his friends in the early 1970s to keep watch overnight at his office after a break in.

“We had a lot of fun: ordered a pizza, screwed around having chicken fights in wheelchairs and some other stuff,” Sinaiko said.

He said Young initially suspected the break-in was someone looking for drugs, but later told Sinaiko he had come to believe it was a political enemy of his patients.

Young’s children said it was not uncommon for the FBI to show up at the house.

A 1974 lawsuit also revealed that Young had been targeted by the “Red Squad,” a secret unit of the Chicago Police Department that infiltrated and tried to disrupt activist groups in the 1960s and 1970s.

Young’s children said the one thing he was private about was the health of his patients, like Quinn.

“He really was a great doctor, that should not be overlooked,” said Quinn, who started seeing Young in 1985.

Quinn said Young had a great sense of humor and could take a joke and dish it out took — dubbing the former governor “Dairy Quinn” because of his preference for Dairy Queen.

Quinn said Young’s patients loved him and kept in touch after he stopped his primary care practice in the 1980s. He said Obama still asked about Young and asked for his address so he could write Young a letter during a visit to Springfield.

Young’s patients and friends will get one more opportunity to pay their respects.

“There’s going to be a big shindig in Chicago,” Polly Young said.

She said the family is asking people to make donations to Young’s Health and Medicine Policy Research Group and Physicians for a National Health Program in his memory and to advocate for single-payer health care.

https://www.dnainfo.com/chicago/20160309/hyde-park/dr-quentin-young-remembered-as-young-radical-who-never-quit

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Single Payer Advocate Quentin Young Dies at 92

Single Payer Action, March 8, 2016

[Excerpt]

President Barack Obama was the patient of Dr. Young’s practice partner, Dr. David Scheiner, for twenty years before becoming president.

But both Dr. Young and Dr. Scheiner had a policy falling out with Obama over single payer. In 2007, Dr. Scheiner — also a single payer advocate — was invited — then un-invited to a White House roundtable on health policy issues.

In Young’s autobiography — “Everybody In, Nobody Out: Memoirs of a Rebel Without a Pause” — published in 2013, Young writes that “had I been in Congress, I would have unequivocally voted against Obamacare.”

“It’s a bad bill. Whether it’s worse than what we have now could be argued. We rather think because of its ability to enshrine and solidify the corporate domination of the health system, it’s worse than what we have now. But whether it is somewhat better or a lot worse is immaterial. The health system isn’t working in this country — fiscally, medically, socially, morally.”

Young rejected the idea that President Obama should have compromised on single payer in the face of industry opposition.

“I don’t have any sympathy for the idea that the president had to compromise because his opposition was strong,” Young writes. “Winning is not always winning the election. Winning is making a huge fight and then taking the fight to the people — re-electing people who are supporting your program and defeating those who aren’t.”

Young first met the young Barack Obama in the mid-1990s at social gatherings.

At the time, Obama was lecturing at the University of Chicago Law School and practicing law.

“We did not become bosom buddies after a few of these social gatherings — I just viewed him as a nice, bright guy living in the neighborhood,” Young says.

When Obama ran for the Illinois Senate, Young supported him.

“I was happy with his views on health care,” Young writes. “He recognized that major reform was necessary and indicated support for a single-payer approach. No blushing friend, I took every opportunity to solidify his position. While not an official adviser, I tried to influence him as much as I could. My colleagues and I sent him notes touting the advantages of single-payer and the form it might take and talked with him and his staff about it whenever I had the chance.”

Consumer advocate Ralph Nader said that “Dr. Young was a physician for all seasons — for his patients, for public health facilities, for workplace safety and for full Medicare for all people with free choice of doctors and hospitals.”

“He was Barack Obama’s physician friend and mentor about single-payer health insurance,” Nader said. “Yet years later, President Obama excluded him from the roundtable discussions at the White House which he had with representatives of the insurance, drug and hospital companies. Dr. Young’s compassion and wisdom will be sorely missed.”

Dr. Young was an inspiration to single-payer advocates around the country.

“Quentin was my mentor,” said Dr. Margaret Flowers, currently a single-payer candidate for the U.S. Senate in Maryland. “I admire his commitment to social justice. He set the example of what doctors should be doing —  getting out into the streets to support struggles for social justice and using our influence to fight for equal rights, including equal access to high quality health care. He started his career out as a public health officer in West Virginia.”

“To me, he was a superstar. It meant so much to me that he spoke with me the night before our Baucus 8 (the eight single-payer activists who were arrested in 2008 before the first Obamacare hearing before a committee chaired by then Senator Max Baucus) actions and agreed that it was time for such an action. His support gave me the courage to carry through with it.”

“I had the honor of spending time with Quentin in DC, Chicago and Berkeley where he wintered with his daughter. I will always remember how he encouraged me and others to focus on ‘the elegant simplicity of single payer.’ I think it was Quentin who coined the phrase — ‘everybody in, nobody out.’

“Quentin was witty and brilliant and loving. He was energetic and fearless. I am privileged to have crossed paths with him. He touched so many throughout his life. He will be missed.”

Full: http://www.singlepayeraction.org/2016/03/08/single-payer-advocate-dr-quentin-young-dies-at-92/

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He wanted everybody in and nobody out

By Helen Redmond
Socialist Worker, March 21, 2016

Dr. Quentin Young was a health-care reform rock star. He coined the deceptively simple slogan “Everybody in, nobody out” to encapsulate the idea that every human being has the right to guaranteed health care.

That notion has sunk into national consciousness. And it’s a testament to Quentin’s indefatigable efforts and influence that in the current election cycle, the advantages of a national, single-payer health care system is being discussed once again.

We lost Quentin Young on March 7. He was 92.

As a left-wing activist from an early age, Quentin was on the right side of all the struggles for equality, from workers’ rights to the civil rights movement in the 1960s to the fight against the so-called “war on terror.”

Quentin is probably most widely known for his commitment to implement a health care system in the U.S. that put patients first, not the profits of the health care industry. And always and everywhere, Quentin exposed the stark and disgraceful racial disparities in the American health care system.

Quentin was a founding member of Physicians for a National Health Program (PNHP), and it is one of his most enduring legacies. The existence of PNHP is critical to the fight for a single-payer health care system and to keeping alive the idea that health care is a human right. It is truly sick that in the richest country in the world, this idea must continually be asserted. For 22 years, Quentin was PNHP’s national coordinator, and the organization has grown to 20,000 members.

– – –

I heard about Quentin Young long before I met him. I picked up a copy of Hospital: An Oral History of Cook County. In the book, Quentin details the pervasive corruption and patronage at Cook County Hospital, he explains the fierce esprit de corps that existed among County medical staff, and he reveals why patients felt that County was their hospital.

Young was Cook County Hospital’s chair of medicine from 1972 to 1981. Under his leadership, the Occupational Health Service (OHS) and the Jail Health Service (JHS) were established. He writes of the OHS: “Most schools of occupational health essentially trained company doctors; we stressed that this was a worker-orientated occupational health program.”

Quentin was especially proud of the doctors who worked in the JHS, writing, “These doctors stood ready with the Prison Health Project of the ACLU and the Carter administration, and the Justice Department to be expert witnesses on the conditions in numerous jails and prisons in the country where lawsuits were brought.”

County bosses tried to fire Quentin for his outspoken activism, but Quentin wasn’t having it and refused to leave. The door to his office was padlocked. His house staff took the door off the hinges and occupied the space. Attending doctors were ordered not to recognize Quentin as chief, but no one else would take his job. In a show of solidarity, 40 doctors made rounds with him. This was the kind of respect and loyalty that Quentin inspired.

Many years after Quentin worked at County, I took a position as a social worker in the emergency room at the new John Stroger Hospital, the replacement for County, and then in Fantus Clinic. Patients who were overwhelmingly poor, Black or Latino presented in such poor health it was staggering.

How was this possible in a wealthy city like Chicago that had no shortage of medical resources and infrastructure? Quentin explained why in Hospital:

“I used to say there was no room for liberals at County. Only two world philosophies worked with what you saw before you, because the wretched of the earth: alcoholics, drug users, late-stage disease, people with wound infections with maggots in them–I mean really bad. And so you could come up with two conclusions…the one I and many of us embraced–that this was the distilled oppression of society. These were people on the bottom of the economic heap, of racial discrimination, who were born to lose, and their whole life is a testimony to privation, oppression, and what we are seeing is the physical expression of it.”

When I read those words, I understood the social determinants of health on a whole new level and found a further depth of empathy for my patients.

Some days, it felt like the emergency room or the clinic was a war zone, and the unnecessary human suffering, the premature death was too much to bear. I would call Quentin. One time he said to me: “You are seeing the contradictions in their rawest form. The oppression is all around you. Very few situations are like that.” And then he’d get nostalgic and tell me stories about the glory days of County.

– – –

I started writing about health care and interviewed Quentin on many occasions. I got to know him better during the years when the Obama administration developed health care legislation. He spoke at dozens of rallies and meetings.

By a certain point, Quentin wasn’t able to drive anymore–something that really pissed him off–so a group of volunteers drove him to speaking engagements. On the way back after a meeting, we dissected what happened, and I told him he was too soft on people who raised ridiculous arguments against single-payer. He laughed and said people often told him he was too hard on his opponents. But Quentin was the kind of person who listened and took what others thought seriously. He said, “Okay Helen, next time I’ll be harder.”

Quentin refused to support Obamacare despite enormous pressure to do so. The small advances in the law, like regulations against insurances companies pre-existing conditions to reject applicants, paled in comparison to the measures that gave even more power to for-profit health care and capitulated on the vision of “everybody in, nobody out.”

He was accused of being pie-in-the-sky. Liberals who formerly supported single-payer scolded Quentin and said it was never going to happen in America, so just get onboard with the president. Over and over, the hackneyed phrase “Don’t let the perfect be the enemy of the good” was hurled at him.

But Quentin said no. In a world where leaders of social justice movements too often buckle under the pressure to accept crappy, piecemeal reforms that help the fewest people, Quentin Young stood apart for refusing to concede.

To be in Quentin’s presence was to be in the presence of greatness. His greatness was the opposite of what is traditionally thought of as greatness–where a person exerts power and control over others and has a gigantic ego. Quentin’s greatness was grounded in his profound humility, his love for humanity and in his lifelong fight for health care justice and equality for all.

http://socialistworker.org/2016/03/21/he-wanted-everybody-in-and-nobody-out

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Medicare for all really is ‘the only answer’

By the Editorial Board
The Capital Times (Madison, Wis.), March 16, 2016

Dr. Quentin Young, one of the greatest economic and social justice campaigners of the modern era, has died at age 92. Young served as a personal physician for the Rev. Martin Luther King Jr. and organized the Medical Committee for Human Rights, which provided medical support for activists during the 1964 Freedom Summer in Mississippi. He helped to shape and advance the call for an understanding of health care not as a commodity but as a human right.

Young was a friend and ally of this newspaper, a source of insight and inspiration for many years, and an ally in our campaigning for universal health care, which dates back to the days when Capital Times founder William T. Evjue was cheering on the efforts of Franklin Delano Roosevelt and Harry Truman to establish a national health care program. Over the years, we celebrated Young’s work and joined him and his dear friends, the late Madison area physicians Gene and Linda Farley, in championing efforts to establish a single-payer “Medicare for all” health care system in the United States.

More than three decades ago, as he was working to forge the Physicians for a National Health Program movement, Young warned of “the corporate takeover of medicine.” As PNHP notes, “he sounded the alarm about the growing encroachment of corporate conglomerates on U.S. health care, noting that giant investor-owned firms were rapidly subordinating the best interests of patients and the medical profession to the maximization of corporate profit.”

To counter the crisis, PNHP said in its statement on the doctor’s death, Young became “the nation’s most eloquent and high-profile spokesperson for single-payer national health insurance, or improved Medicare for all.” He worked closely with an old ally from civil rights movement days, Congressman John Conyers Jr., D-Mich., on behalf of H.R. 676, “The Expanded and Improved Medicare for All Act,” the single-payer health care proposal backed by dozens of House and Senate members. Young gave credit to the efforts of President Obama — a friend and a patient of the physician’s Chicago clinic — to develop and implement the Affordable Care Act. But while he could identify positive elements of the ACA, Young argued it was an inadequate reform that left too many Americans with no coverage or insufficient coverage and that failed to control costs because it maintained an arrangement where “the insurance companies are still going to make their profits.”

Young, who served as PNHP’s national coordinator for more than two decades, remained an outspoken advocate for single-payer to the end. Making his case for “single-payer national health insurance, government-run, based on the tax system,” Young said in a 2004 interview posted on the organization’s website that “universal health care is no longer the best answer; it’s the only answer. There was a time when there were alternatives that might have worked, but that day is passed. We’ve had too much of a transfer of power from patients and physicians, for that matter, to giant corporate interests that are dedicated to the goal of maximizing profits, which accounts for much of the distress in the American health system.”

During the course of the 2016 presidential race, proposals for single-payer reform have taken hits from the campaigns of Hillary Clinton and a number of the Republicans who are seeking the presidency. Clinton has argued that the plan for single-payer offered by Vermont Sen. Bernie Sanders, her opponent for the Democratic presidential nomination, is “an idea that will never, ever come to pass.”

In the Democratic debate on March 10 in Miami, the former secretary of state complained about “Senator Sanders wanting to throw us into a contentious debate over single-payer.” Sanders, who has hailed Young as “a national hero,” replied: “I think if the rest of the world can do it, we can. And by the way, not only are we being ripped off by the drug companies, we are spending far, far more per capita on health care than any other major country on earth. You may not think the American people are prepared to stand up to the insurance companies or the drug companies. I think they are.”

That was the view that Young advanced in his last years, including in his brilliant 2013 autobiography, “Everybody In, Nobody Out: Memoirs of a Rebel Without a Pause.” The doctor wrote: “I’ve never wavered in my belief in humanity’s ability — and our collective responsibility — to bring about a more just and equitable social order. I’ve always believed in humanity’s potential to create a more caring society.”

The Capital Times has embraced that faith since its founding in 1917, but there is no question that our faith was enhanced and extended by our association with Young. We will honor his memory by continuing to be absolute and unequivocal in our championship of the essential understanding that health care must never be undermined by profiteering. It must always be understood as a human right that should be guaranteed for all.

http://host.madison.com/ct/opinion/editorial/editorial-medicare-for-all-really-is-the-only-answer/article_03994471-dd67-5668-8869-e79ea1a45048.html

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Quentin Young: Doctor and activist

By Anne Gulland
The BMJ, April 27, 2016

Quentin David Young was born and raised in Chicago and was closely associated with Cook County Hospital, the city’s only public hospital. It was during one of the institution’s many crises that Young, an internist by training, was asked to become chief of medicine. Young, who had done hisresidency and internship at the hospital, was a radical with a strong sense of outrage at social injustice and he was appointed in the hope that he would be able to attract like-minded physicians.

Cook County Hospital

The hospital was falling apart—both physically and metaphorically. Because of its reputation it struggled to attract staff so Young set about recruiting a cohort of young, socially committed doctors.

Chief of medicine was a tough job: the hospital was constantly in the headlines and its patients were poor and sick. Young, whose managementstyle was inclusive rather than authoritarian, encouraged dialogue with his staff, which meant that he was often in demand and long days were normal.

A 1979 BBC documentary, I Call It Murder, caught County in all its chaotic glory. It began with an interview with a young doctor who described it as the hospital all the private hospitals “dumped on”—sending it patients who couldn’t pay or were drunk.

Young was fired twice during his tenure as chief of medicine because of his support of, but not participation in, a strike by the hospital’s house staff. Firing someone with such a strong sense of workers’ rights was a foolish decision—Young argued that he was dismissed without due process and was reinstated both times.

After the strikes he set up a committee to save the hospital, which culminated in its being completely rebuilt in 2002, with its future secured. By this time Young had long since left but he had been instrumental in the eventualsuccess. He left County in 1981 and in 1983 was appointed president of health.

Young’s work at the hospital was not all controversy—he set up an occupational health department in partnership with the University of Illinois as he believed it was important that occupational medicine be taken out of the hands of employers. And he restricted the prescription of tranquillisers and sedatives in the outpatient clinic by insisting that prescriptions be countersigned by senior doctors.

Early years

Young was born to Jewish parents, Abe and Sarah, who had fled Europe. His father trained as a pharmacist but eventually made money through real estate. It was during visits to see his maternal grandparents in North Carolina that the seeds of Young’s political activism were sewn. In the racially segregated south, Young would see black women and children toiling in the tobacco fields for white landowners. He wrote, “I was too young to have a political orientation, but I could sense that their worth to their farmer-bosses depended on how much they could pick.”¹

His interest in politics continued throughout school and university, where he joined the American Student Union. In 1940 he enrolled at the University of Chicago but enlisted in the army in 1943 at the age of 19, with dreams of fighting the Nazis. Much to his disappointment he remained in the US, continuing his medical training with the army, first at Cornell University and then at Northwestern University.

While in the army, Young married his childhood sweetheart, Jessie, with whom he had five children. They divorced after 15 years, and he became the first father in the state of Illinois to secure joint custody of his children. He remarried again in 1980 to Ruth Weaver, who predeceased him by nine years.

After serving his residency and internship at County he set up private practice in Hyde Park, on Chicago’s south side, with attending privileges at Michael Reese Hospital. He continued private practice throughout hislife, even while chair of medicine at County, retiring at the age of 86. He was popular among his patients, who did not mind his late running clinics as they knew he liked to take his time with them.

Social justice

At the beginning of his career Young helped found the Committee to End Discrimination in Chicago’s Medical Institutions. Segregation of hospitals was not an official policy, and it was only when the committee obtained figures showing that most births and deaths among the black population happened in the poorer hospitals that Chicago city council ruled that it was unlawful to deny treatment to a patient because of race. Two years later the city ruled that it was unlawful to racially discriminate against staff.

Young even managed to overturn an unofficial colour bar in his own chapter of the American Medical Association. He was invited to run for secretary, on the grounds that the chapter hierarchy did not want a black person gaining the position. Secretary was a stepping stone to chair, and Young knew that he would be able to nominate his successor. He duly nominated a black colleague, Clyde Phillips.

Young was also involved in the wider civil rights movement through the Medical Committee for Human Rights, which he helped found. He provided medical support to those taking part in the historic march from Selma to Montgomery, and became Martin Luther King, Jr’s personal doctor when he visited Chicago. Young treated him only once, when someone hurled a rock at him during a march for fair housing.

Young never lost the fight for campaigning. In the 1980s he was a tireless advocate of single payer national health insurance and became president of the organisation, Physicians for a National Health Program. He was a well known figure on the national stage but was never admitted to the inner sanctum of policy making. He met Hillary Clinton when she began her healthcare initiative as first lady but was unimpressed with her ideas.

He was also disappointed by president Barack Obama’s health reforms, which, he felt, gave too much power to the health insurers. He knew Obama, a fellow Chicago southsider, and supported his candidacy for president. In recent months he was energised by Bernie Sanders’s campaign for the Democratic nomination for president, having met him previously to discuss single payer insurance.

Paragraphs about his political activism could give the impression that Young was a dour man, but nothing could be further from the truth. He was the eternal optimist, the happy warrior who would gladly march out to battle again and again. Nothing bothered him more than a cynical or conservative young person. He was a great raconteur and loved the arts, visiting the Shakespeare festival in Stratford, Ontario, every year.

Biography

Quentin David Young (b 1923; q Northwestern University 1948), d 7 March 2016.

¹ Young Q. Everybody in nobody out: memoirs of a rebel without a pause. Copernicus Healthcare, 2013.

http://www.bmj.com/content/353/bmj.i2393

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Quentin Young (1923-2016): Advocate, Activist, and “Rebel Without a Pause”

By Theodore M. Brown, PhD, Elizabeth Fee, PhD, and Michael N. Healey
American Journal of Public Health, June 2016

This July 1993 editorial by Quentin Young (written in collaboration with Ida Hellander) beautifully captures the spirit of the man and his deep commitments to health reform, political activism, and the quest for social justice. He wrote “Health Care Reform: A New Public Health Movement” as the United States seemed ready for a comprehensive overhaul of its health system. Two major options were in contention: the “managed competition” proposal of the Clinton administration and a Canadian-style “single-payer” proposal strongly promoted by a new advocacy organization, Physicians for a National Health Program (PNHP). Managed competition gave a central role to the private insurance industry, whereas single-payer eliminated private insurance and, as in the Canadian health system and Medicare, relied on government administration and oversight.

Young pointed out that managed competition with its profit incentives and market mechanisms was largely untested. Considerable evidence indicated that US Medicare was far more efficient than private insurance, and the General Accounting Office demonstrated that:

If the United States streamlined administration to Canadian levels by adopting a single-payer system…the savings would be enough to cover health care for every uninsured American.

The Clinton administration considered some modifications of its proposal to win over single-payer advocates but left a major role to private insurance, despite opinion polls showing a national majority in favor of the single-payer plan.

Quentin Young’s life and career moved from the identification of social needs and reform options to professional advocacy and popular political mobilization. Born in Chicago, Illinois, in 1923, the son of Russian and Lithuanian immigrants, he spent some of his childhood in Oxford, North Carolina, and was acutely aware of segregation. By the time he entered high school in Chicago, Quentin had already developed strong political views.

In Hyde Park High School he joined the American Student Union, whose members identifi ed as “progressive” and anti-Nazi. When he entered the University of Chicago Born in in 1940, he became very aware of the disparity in health care options off ered to students. White students were treated at the University hospital, but Black students were sent to Provident Hospital, a run-down and segregated institution.

Continue reading (subscription required)…

http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2016.303219

As health carriers blame losses on Obamacare, their stocks gains continue to be ‘yuge,’ thanks to one great customer: Uncle Sam

By Wendell Potter
healthinsurance.org, March 1, 2016

The first seven years of the Obama administration have been “yuge” for the health insurance industry, to use one of The Donald’s favorite words.

To be more precise, it has been yuge — almost unbelievably yuge, in fact — for the well-heeled folks who own stock in the for-profit companies that dominate the industry, including Cigna and Humana, the two insurers I used to work for.

Medicare Advantage carriers get a raise

And last week, those well-heeled folks got substantially richer, thanks to Obama.

Here’s what happened:

On Friday, February 19, shortly after the stock market closed for the week, the government announced that it was giving a big raise to the private insurance companies that participate in the Medicare Advantage program, the private alternative to traditional Medicare.

Based largely on that news, investors rushed to buy as much of the health insurance companies’ shares as they could get their hands on. By the time the market closed on Friday, February 26, just seven days later, Cigna’s stock was up 5.5 percent. Humana’s was up a whopping 8.1 percent. By comparison, the Dow Jones industrial average was up just 1.5 percent.

How to get rich by traveling back to 2009

Before I describe what the government did that caused the net worth of the industry’s executives and shareholders to spike, let’s take a quick trip back to March 5, 2009, just a little more than six weeks after Obama was sworn as our 44th president.

That was the day Obama hosted the White House Forum on Health Reform, a day-long meeting of about 100 important folks – primarily administration officials, members of Congress, corporate executives, union leaders and lobbyists – that kicked off what would become a year-long ordeal to enact what would become the Affordable Care Act, better known, of course, as Obamacare.

By the end of that day, the share price of almost all the for-profit insurers had slid into the cellar. That was partly because industry shareholders were worried that insurers would be in the Democrats’ crosshairs during the reform debate and partly because disappointing news from General Motors and several big banks had put investors in a general funk. Investors were especially pessimistic that day about how quickly the market and economy would recover from the 2008 crash.

You could have bought a share of Humana stock that day for $17.85 and a share of Cigna stock for $12.77. Bargain hunters could have bought a share of WellCare, a smaller company that specializes in Medicare and Medicaid programs, for just $6.51.

If you and I had been smart, we would have taken a second mortgage on our homes and bought as much of those companies’ as we could get our hands on. We might not be as rich as The Donald, but we would be a heck of a lot richer than we were seven years ago. That’s because very few companies in any industry have rewarded shareholders as much as health insurers have during the Obama years.

Get ready to get upset

So just how much richer would you be? Well, you would be a millionaire today if you would had invested just $99,882.49 in Humana stock on the day of Obama’s forum. Or just $90,407.08 in Cigna stock. Or – read this and cry – just $70,930.49 in WellCare stock.

While the Dow Jones average has increased an impressive 253 percent since March 5, 2009, Humana’s share price is up a truly remarkable 1010 percent. No, that’s not a typo. Cigna’s share price has done even better. It’s up 1113 percent. That’s more than four times better than the Dow. The other big companies aren’t far behind. Anthem is up 469 percent. Aetna is up 628 percent. And UnitedHealth Group is up 814 percent.

But it’s WellCare that takes the prize. Its stock price is up an astounding 1,410 percent. Thanks entirely to its federal and state government customers.

This is a company, by the way, that has been in big-time trouble with the government more than once in recent years. On a rainy day in October 2007, just a little more than a year before Obama was elected president, more than 200 federal and state agents swooped down on WellCare’s headquarter in Tampa, Florida. Four years later, federal prosecutors charged five former WellCare executives with conspiracy to commit Medicaid fraud. They were accused of diverting millions of dollars designated for Medicaid patients to company profits. A federal jury later found four of the executives, including Todd Farha, the company’s former CEO, guilty of, among other things, health care fraud and making false statements to law enforcement officials.

The company was in the headlines again just three months after that 2009 White House forum. In June 2009, WellCare was forced to suspend marketing its Medicare plans after the government discovered that the company had been engaging in activities to confuse and mislead Medicare beneficiaries.

Before long, though, the company was back in the Obama administration’s – and Wall Street’s – good graces. Wall Street financial analysts are especially bullish on WellCare, thanks to Obama. After the government’s recent announcement of the Medicare Advantage pay hike for next year, JPMorgan analyst Gary Taylor upgraded WellCare to “overweight” from neutral – meaning that he thinks the company’s stock is a better value than the stock of many other companies – and he raised his price target from $80 a share to $114 a share. That means he believes the odds are good that WellCare’s stock will increase another 25 percent during the coming year.

(That has to be especially good news to the investment firm T. Rowe Price, which as of December 31, 2015 was WellCare’s biggest shareholder, owning 4,700,778 shares of the company’s stock, or 10.65 percent. If T. Rowe Price had owned that much on March 5, 2009, its holdings would be have been worth about $31 million. Today it would be $431 million.)

Oh woe is us

Despite record-breaking profits year after year, health insurance company executives would like us to believe that Obama has been terrible for health insurers. UnitedHealth’s CEO Stephen Hemsley, who made more than $66 million in 2014, said in November that the company might stop selling policies on the Obamacare exchanges in 2017 because financial results from that segment of its operations have so far been lower than executives had hoped. He said a few weeks ago that the company lost $720 million in 2015 on its individual health insurance business.

If you’re feeling sad for Hemsley, know this: UnitedHealth Group reported a profit of $11 billion (on revenues of more than $157 billion) in 2015, up from $10.3 billion (on revenues of $131 billion) in 2014. When you consider those impressive results, it’s obvious the company’s Obamacare business is a tiny portion of its overall operations, but rather than trying to turn its Obamacare business around for the benefit of the country and its Obamacare enrollees, it is considering bailing out of the exchanges for the benefit of its shareholders.
Private insurer’s best customer: Uncle Sam

Meanwhile, UnitedHealth has been making money hand over fist from federal and state governments, thanks to Obama, just as WellCare has. In fact, far more than half of the $157 billion it took in last year came from Medicare, Medicaid and other government programs (i.e., from you and me, the taxpayers).

While most Americans probably think that the big for-profit insurers get most of their revenue from the private sector – from individuals and employers that provide coverage to their workers – that is no longer true. In fact, if Anthem’s acquisition of Cigna and Aetna’s acquisition of Humana are approved later this year, the remaining big three for-profit insurers – Aetna, Anthem and UnitedHealth – will collect most of their revenues from the government, not from their commercial (private) customers.

Why? As the nation has been aging, enrollment in Medicare has been growing at a fast clip, but enrollment in commercial health plans has been largely nonexistent for years. Just look at how Anthem’s business changed in just one recent year. At the end of 2014, the majority of Anthem’s revenues still came from its commercial health insurance customers. During 2015, however, revenues from the commercial side of its operations actually declined by 4.2 percent, to $37.6 billion, while revenues from its government operations skyrocketed by 21 percent, to $40.1 billion.

So as you can see from these numbers, the biggest customer for the biggest private insurers now is none other than …Uncle Sam. And the states, most of which have turned to private insurers to operate their Medicaid programs, comprise their second biggest customer.

More reason for shareholders to whoop it up

Investors certainly know this. That’s why the companies’ shareholders could hardly believe their good fortune on February 19 when the Obama administration’s Center for Medicare and Medicaid Services (CMS) announced an unexpectedly large bump in pay for the insurers that participate in the Medicare Advantage program.

During the health care reform debate, health care advocates made a big deal of the fact that the government had for years been overpaying private insurers every year just to keep them happy and committed to the Medicare Advantage program. Democrats decided to take advantage of health care reform to end those overpayments.

The industry howled, of course, and predicted that insurers would have to cut Medicare beneficiaries’ benefits and that as a consequence the Medicare Advantage program would begin to wither.

Well, it has done anything but wither. Insurers’ marketing to seniors has been more aggressive than ever, enrollment has grown at a faster clip than ever, and the Medicare Advantage business overall has continued to be very profitable. Enrollment in Medicare Advantage plans now stands at 18 million – a third of all Medicare beneficiaries – up from 10.5 million in March 2009.

So instead of shrinking, enrollment in Medicare Advantage plans during Obama’s watch has increased 71 percent.

Medicare Advantage plans received approximately $170 billion from the government in 2015. Expect that number to swell next year. Although the increased payments will vary for each participating health plan, “many industry observers believe 2017 will be ‘the best rate environment we’ve seen in years,’” John Gorman, a consultant for Medicare Advantage insurers and a former CMS official, told Modern Healthcare on February 19.

As Modern Healthcare reporter Bob Herman wrote:

“Insurers are salivating over the growing membership and revenue base because even a small margin of 2% to 5% reaps billions of dollars in profit for the industry, assuming plans have high quality marks.”

(Insurers that score higher on quality metrics get more of taxpayer’s money.)

Wait. ANOTHER reason for insurers to celebrate???

Herman reported that insurers have another good reason to celebrate. As a result of heavy lobbying by well-connected industry officials (the industry’s biggest trade group, America’s Health Insurance Plans, hired former CMS administrator Marilyn Tavenner, an Obama appointee, as its president and CEO last summer), Congress approved a one-year moratorium on an Obamacare-imposed tax on health insurers.

The insurers’ good fortune undoubtedly will continue well into the future, something you might want to consider as you look at your investment portfolio. Thanks to the hundreds of millions of dollars the industry has doled out in campaign contributions and to pay lobbyists and other influence peddlers over the years, the Medicare Advantage program has many champions in Washington, and on both sides of the political aisle.

One of the program’s biggest cheerleaders, in fact, is Chuck Schumer (D- N.Y.), who will replace Harry Reid as the Democrats’ leader in the Senate next year. If Democrats take back the upper chamber, which is quite possible, Schumer will be Senate Majority Leader. Regardless, he is just one of the industry’s many friends in very high places.

So chances are good that, whichever party comes out on top this coming November, health insurers will continue to do just fine. Even if Bernie Sanders is our next president, the industry’s tentacles will likely only get deeper into both the Medicare and Medicaid programs, thanks to the big investments insurers continue to make in House and Senate campaigns.

Bottom line: Expect to see many more “yuge” years ahead for the industry’s shareholders.

https://www.healthinsurance.org/blog/2016/03/01/no-obamacare-isnt-killing-the-insurance-industry/

Contrary to Claims by the Washington Post and Fortune, the Vast Majority of the Poor Would Gain

By Steffie Woolhandler, M.D., M.P.H., and David U. Himmelstein, M.D.
The Huffington Post, March 4, 2016

In the heat of battling Sen. Bernie Sanders, Hillary Clinton’s camp (and the camp followers at the Washington Post and Fortune magazine) has made a remarkable discovery: National health insurance (aka Medicare-for-All) hurts poor people.

How is that possible? It’s not. But a widely-quoted analysis by Ken Thorpe, a former Clinton administration official, used statistical sleight of hand to zoom in on the tiny slice of the poor who might pay more (while getting better care), and hide the vast majority who would gain.

Here are the real numbers we came up with by analyzing data from the Census Bureau’s 2015 Current Population Survey, the standard source for estimates of income and health insurance coverage.

At present 9.2 million people living in poverty — and 8.8 million just above the poverty line — are uninsured. They often can’t get vital care, and when they do, they face ruinous medical bills. For these 18 million, Medicare-for-All would be a godsend.

Another 10.7 million poor Americans and 21.5 million near-poor have private insurance. For virtually all of them, the new Medicare-for-All taxes would cost less than their current premiums.

Some of this windfall would go directly to families that now pay all or part of their own premiums. The rest would go to employers who now chip in to premiums for the poor and near-poor workers, but most economists believe these gains would be passed on to workers since benefit costs are, in fact, deducted from wages.

About 9.7 million poor and near-poor people have Medicare, without wrap-around private or Medicaid supplements. The vast majority of them would be better off under Medicare-for-All, which would relieve them of Medicare premiums, as well as onerous co-payments and deductibles.

What about the 42 million poor and near-poor Medicaid recipients? This is the group that Thorpe (and recent articles and editorials in the Washington Post and Fortune) claims would be hit hard by the new Medicare-for-All payroll taxes, which their employers would pass on to them by lowering their wages.

Yet, 34.6 million (82 percent) of these 42 million are children, retirees or others who have no earnings. Hence, they wouldn’t pay any new payroll tax.

Two million others earn no more than $7.25 an hour, the minimum wage, so employers couldn’t lower their wages to make up for the new taxes.

Only 3 percent (1.2 million) of poor and near-poor Medicaid recipients earn more than $15 an hour — the minimum wage that Sanders has proposed. That’s the number of poor households at risk of financial losses. But even that overstates how many might be harmed, since some pay out-of-pocket costs that Medicare-for-All would eliminate.

It’s a shame that even this small group might suffer, and we’d recommend that Sen. Sanders tweak his plan to protect them. That shouldn’t be hard.

But his plan would relieve the poor, as well as the middle class, from the daunting co-payments and deductibles that obstruct care and threaten finances. And it would abolish the narrow provider networks that restrict patients’ choice of doctors and hospitals. Instead, Americans could go anywhere for care, a privilege that every Canadian enjoys, but is rapidly vanishing in our country.

In every nation with national health insurance the poor — and middle-class families — fare better than here. They bear less of the health care cost burden, have better access to care, and live longer and healthier lives.

It takes extraordinary mental and rhetorical gymnastics to portray universal health care as bad for the poor. Having mastered that art, perhaps the Clinton team will turn its attention to repealing the law of gravity.

Steffie Woolhandler, M.D., M.P.H, and David U. Himmelstein, M.D., are professors of health policy and management at the City University of New York School of Public Health and lecturers in medicine at Harvard Medical School. The views expressed do not necessarily reflect the views of those institutions.

http://www.huffingtonpost.com/steffie-woolhandler/bernie-sanders-medicare-for-all_b_9385012.html

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

By Trudy Lieberman
Health Review News, March 3, 2016

In late January, as Hillary Clinton and Bernie Sanders battled over a Medicare-for-all health system, PBS NewsHour co-anchor Judy Woodruff in a conversation with her guests David Brooks and Ruth Marcus posed this question: “Essentially the argument is whether you just wipe away what we have done and you go to a single-payer healthcare system, which most Americans say they don’t want, right, I mean..?” (Exchange takes place at 9:00 in the video.)

Neither guest responded to her point, although Marcus noted, “it really is this argument about practicality.” Brooks was silent. Nevertheless, viewers—I was one—might have been flummoxed by her question. I recalled a Kaiser Family Foundation poll a few weeks earlier in mid-December, which found that 58 percent of Americans favored the idea, including 34 percent indicating they strongly favored it. What gives here? Why did Woodruff make the comment and then fail to back it up with evidence?

Presumably she was looking for her guests, the apparent experts, to support (or perhaps challenge) her contention that most Americans want no part of a single-payer health system. But the fact that nobody chose to respond gave her comment an air of finality and truth — one that is all the more impactful given Woodruff’s considerable experience and authority as a journalist.

That perception prompted officials at Physicians for a National Health Program (PNHP), an advocacy group that has long pushed for single-payer, to contact Woodruff and PBS ombudsman Michael Getler about what it said was Woodruff’s “factual error.” In an email exchange that PNHP shared with me, the group cited a number of surveys, including the mid-December Kaiser poll, and pointed out that “surveys repeatedly show that an improved Medicare for All, single payer, is preferred by about two-thirds of the population.” A few days later Getler sent a letter to PNHP’s past president Dr. Garrett Adams identifying a Pew Research Center poll from June 2014 as the source for Woodruff’s assertion. According to Getler, the Pew poll asked respondents who said government does have a responsibility to ensure health coverage whether a mix of private payers and the government, or if the government alone should provide insurance.  The single-payer option was supported by 21 percent.

There were more emails to Getler with Adams arguing that the Pew poll was an outlier and offering more information about the wording of questions and noting the results of many polls suggesting that support for single-payer ranged from around 45 percent to more than 60 percent depending on how the questions were phrased and the choices given to respondents. In one response Getler acknowledged there are “dueling claims about this” that were “not likely to cause a NewsHour correction. I’m not an expert on polling but it is my sense and experience that Pew is widely viewed among experienced journalists as the very best and most authoritative polling outfit.” Finally, he said he had sent all the PNHP materials to the NewsHour.  “I think it is clear that the NewsHour does not believe a correction is called for and they are not going to do one. I have no power to make them do so and I’m not convinced that one is necessary either.”

I discussed all this with Dr. Robert Blendon, who runs the Harvard Program on Public Opinion and often works with news outlets. He said “journalists are supposed to use the most recent poll or the most recent poll conducted by their organization.  The latest poll is usually the most reliable.” Because people change their minds, the latest poll is usually the best gauge of what the public currently thinks. In the case of the NewsHour the most recent poll on January 22 when the broadcast aired was Kaiser’s mid-December poll, Blendon told me.

As for differing polls about support for single payer, he said polls since the time of Harry Truman show high initial support for single-payer, but when pollsters ask whether people would support such a plan if they had to pay more taxes, or would lose their doctors or list other possible consequences, support drops. “Most people say they support Medicare for all until you give them the specifics.” An AP poll released last week is a case in point.  PNHP challenged the results on its blog.

Those specifics can bias the answers, argues Kip Sullivan, a Minneapolis lawyer who works with PNHP. He explained that if a poll compares single payer to Medicare, it usually draws 65 percent approval. A poll that describes single-payer as a single “government plan,” or uses the term “single-payer” and doesn’t mention Medicare draws about a 55 percent approval rate. One that uses the term “single government plan” and asks about single-payer in a line-up of questions — that is, the questioner asks about other options along with single payer — gets only about 45 percent.

So what’s the lesson in all of this? I think you can find it in the framework that HealthNewsReview.org has created to help reporters better cover medical studies and which British journalist John Lister has adapted for reporting on health policy. In its tool kit HealthNewsReview.org warns against using a single source for a story, citing the principles of the Association of Health Care Journalists (AHCJ), which points out “most stories involve a degree of nuance and complexity that no single source could provide. Most one-source stories lack depth and meaning.”  Lister makes a similar point, urging reporters to ask whether the “story unnecessarily suggests a consensus in favor of the policy and ignore opposing views?” Although Woodruff’s comment to her panel of pundits perhaps can’t be held to the same standard as a complete news story, the principle still applies: Health policy news should reflect a diversity of views on the subject and not gloss over nuances — such as poll wording — that are critical to understanding the issues.

In his last e mail to PNHP Getler acknowledged that its exchange with the NewsHour had been helpful “and should the matter come up again, which I think is likely, perhaps they will remember your challenge and my calling it to their attention.” Getler is right. There will be more polls especially as other health policy topics like fixes for the Affordable Care Act, the high price of drugs, and premium support plans for Medicare make their way into the campaign rhetoric just as Medicare-for-all has. The temptation will be to use whatever poll fits your biases or those of your news outlet and grab the juiciest numbers to support them. Those who forget the advice from AHCJ or from John Lister urging journos to broaden their sources, look for diverse opinions, explain their meanings carefully, and consider conflicts of interest will, like PBS in this instance, do a disservice to their audiences.

Trudy Lieberman, a journalist for more than 40 years, is a contributing editor to the Columbia Journalism Review where she blogs about health care and retirement. Lieberman served five years as the president of the Association of Health Care Journalists and fourteen years on the board of directors. A longer bio of Lieberman appears here.

http://www.healthnewsreview.org/2016/03/medicare-for-all-vs-government-plan-nuance-matters-in-coverage-of-health-policy-choices/

We need to institute ‘Medicare for all’

By Caroline Poplin, M.D., J.D.
MedPage Today, March 1, 2016

National health insurance has become a defining issue in the contest for the Democratic nomination. Bernie has put “Medicare for all” squarely back on the table. Hillary calls that pie-in-the-sky: instead, she would build on the Affordable Care Act (ACA). (As she says, market-based private insurance was originally her idea.)

We can all agree that the ACA has benefited many, particularly the poor and the sick.

But Medicare for all has picked up some interesting supporters: for example, Fareed Zakaria, a high-profile TV commentator whose beat is foreign affairs, and Donald Berwick, MD, who, as administrator of the Centers for Medicare and Medicaid Services, supervised the roll-out of the ACA.

Moreover, the Kaiser Family Foundation December 2015 Tracking Poll demonstrates majority support among ordinary Americans (58%); a 2014 survey of physicians and medical students in Maine showed that many doctors also (in Maine at least) would prefer single-payer, especially those practicing primary care.

So it is disappointing that liberal economists whom I respect, such as New York Times columnist and Nobel laureate Paul Krugman, conclude that single-payer would be too expensive and too disruptive — that we should improve the ACA instead.

Krugman, of course, is trained to crunch numbers — I can’t. But from the exam room where I sit, his conclusion doesn’t make sense. The principal advantage of single-payer, after all, is that it is less expensive than our market-based system.

That is not just idle speculation: every other developed nation has either some form of single-payer or highly regulated private insurance with price controls — and they all achieve better health outcomes, with genuinely universal coverage, for at least 30% less (as a fraction of the Gross Domestic Product) than we do, even though we still cover something less than the entire population.

Perhaps the economists simply substituted Treasury payments for employers’ contributions to their employees’ health insurance (something the ACA was specifically designed to preserve), and left everything else in place: that would indeed be a huge hit to the federal budget, particularly since employers, representing a large group of mostly healthy employee families, can negotiate better deals with insurers than individuals can.

But that is not how Medicare for all would work. Instead, it would be like Medicare today, improved to make it even less expensive for the Treasury and individual beneficiaries. Since everyone would receive the same, comprehensive benefits, administrative costs would be much lower. The huge transaction costs engendered by the ACA — hundreds of thousands of annual negotiations between insurers, doctors, hospitals, pharmaceutical benefit managers, and manufacturers — would decline significantly.

There would be no need for the development of hundreds of different plans at different prices, underwriting, or the careful regulation now required to be sure insurers comply with ACA requirements; there would be no need for exchanges.

And ordinary Americans would not need to spend hours each year figuring out which policy they can afford, or “need.” (In fact, most people estimate health risks poorly; women worry about breast cancer more than heart disease, although heart disease kills five times more women than breast cancer.)

There would be no need for poor people whose incomes vary day-to-day to deal with the incredibly complicated business of subsidies, where mistakes can trigger major tax penalties.

Finally — and most controversially — Medicare, which currently sets prices for doctors and hospitals, would extend price controls to other health services, such as prescription drugs and devices, through open procedures with due process and opportunity for comment as mandated by the Constitution. Or Medicare could negotiate prices, as the Department of Veterans Affairs currently does.

Private health service providers would remain private, although market competition simply hasn’t, doesn’t, and won’t, keep prices down in many healthcare markets in a way that benefits consumers. Every other developed nation has recognized this: they all control prices without compromising care.

For those who believe corporations can do no wrong, and government, nothing right, we can continue Medicare Advantage. Employers who wish could opt out, provided they show that their plans are equal to or better than Medicare. To prevent unnecessary disruption, Medicare for all could be phased in over time.

In fact, it may turn out that it is the ACA that is too expensive to be sustained. It is not just a matter of ineffective cost control, but of who pays. ACA supporters believe costs are high because Americans “demand” unnecessary medical services, because they are insured. Therefore, the ACA shifts significant expense to patients, to ensure enough “skin in the game”: the ACA’s so-called “silver plans,” favored by the law, require patients to pay 30% of their annual health care costs in addition to premiums. (Employer-sponsored insurance is moving the same way.)

This means someone who falls ill must pay thousands of dollars of deductible before his expensive insurance kicks in. Sick Americans can still face huge medical debts and bankruptcy, reduced only somewhat since passage of the ACA.

Yes, it is important to get things done in Washington, as long as they are the right things. There will be fierce opposition to Medicare for all, especially from for-profit insurers and providers; it is important to negotiate skillfully, to take a robust initial position, to withhold concessions until the bargaining starts, and to take the long view. The ultimate goal is not “coverage,” but universal, affordable healthcare.

Finally, remember: Medicare is not some exotic Scandinavian import. Medicare is as American as the flag, has served us well for 50 years, and is a solid foundation on which to build.

Caroline Poplin, M.D., J.D., is an attorney and internist in Bethesda, Md. She is a former staff internist for the National Naval Medical Center, and currently practices medicine part-time at the Arlington Free Clinic in Virginia. She also consults for law firms on Medicare and Medicaid fraud.

http://www.medpagetoday.com/Washington-Watch/ElectionCoverage/56479

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