PNHP

Single-payer health system is the way to go

Single-payer health system is the way to go

By Nick Estes
Albuquerque Journal, Feb. 27, 2016

Bernie Sanders is right to call for “single-payer” national health insurance; basically, Medicare for all. It makes lots of sense.

This is no slam on Obamacare. The Affordable Care Act was a tremendous moral and political achievement. Under the ACA over 30 million people have obtained health insurance coverage – most for the first time.

Insurance carriers can’t deny people because of pre-existing conditions, annual and lifetime caps on benefits are not allowed and young adults can stay on their parents’ policies until age 26. However, America could do much better for its citizens by joining the rest of the advanced countries in adopting a true national health insurance program.

This is not “socialized medicine.” Doctors and hospitals would not become part of a national system. Sanders only wants to take Medicare, a payment system with 50 years of successful experience, and extend it to everyone.

Overall there is little doubt that this would be cheaper to society than the present system that relies in large part on private health insurance.

Single-payer would save several hundred billion per year in the unnecessary administrative costs and profit that now go to private health insurers. It takes huge costs to administer a system that requires each company and each provider to determine which costs are covered – depending on the patient’s particular plan, on which entity provided the service, what type of service was provided, and under what circumstances.

A single government payer also would be in a better position to bargain for reasonable rates from providers, drug companies and medical equipment manufacturers.

We pay twice as much for medical care as the rest of the advanced countries, so there is a lot of room for savings. We could use the money from both these savings pools to cover the 30 million people who still have no health insurance.

I don’t advocate this out of antipathy to the health insurers. It’s just that the economics of health care are completely different than the economics of most other goods and services.

With most products and services we leave it up to the consumer to decide whether he or she wants the item enough to pay for it. In most cases that allocates goods and services efficiently to those who want them the most and can afford them.

That’s not the way we allocate health care. A humane society believes that everyone should get high-quality care when they need it. For the most expensive treatments, we are usually talking about life or death, or at least a decent future life versus living with a terrible disability.

Health care is thus like police and fire protection: We try to supply good quality service to everyone without charging people at the time of the service or requiring them to sign up and pay for a personal protection plan. We all pay for this protection through our taxes.

Medical care is similar. Individuals usually don’t know whether they are going to need expensive treatments some day. Some people die of a sudden heart attack, others die of a disease that required years of treatment. Regardless, an ethical society provides the necessary care.

Even the other necessities of survival – food, clothing and shelter – are different from health care. Like health care, they are needed for life, but they come in vastly different quality and expense levels.

Government rightly provides a basic survival level to everyone (for example, in food stamps), but the free market provides anything people want and can afford above that level.

That doesn’t work for health care. It is not ethical to deliberately withhold necessary health care from anyone for whom it is appropriate, regardless of how expensive the diagnosis and treatment may be.

That is why we adopted Medicare and Medicaid 50 years ago.

But this logic is not limited to senior citizens and the poor. This is why all other advanced countries combine a system of mostly private providers with a form of universal health insurance ultimately supported by taxes.

This approach makes sense for the United States, too, and Bernie Sanders is correct to insist that the idea be laid before the American people.

Nick Estes is retired University of New Mexico counsel.

http://www.abqjournal.com/731181/opinion/singlepayer-health-system-is-the-way-to-go.html

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

Physicians & Medical Students: Sign the open letter on the truth about Medicare-for-All

Setting the Record Straight on Medicare for All: An Open Letter From 560 Physicians and Medical Students

By Steffie Woolhandler and David Himmelstein
The Huffington Post, February 28, 2016

The following statement has been signed by more than 560 physicians and medical students. It was crafted by Andrea Christopher, M.D., Fellow in General Internal Medicine at Harvard Medical School, Adam Gaffney, M.D., Fellow in Pulmonary and Critical Care Medicine at Massachusetts General Hospital and Harvard Medical School, and the two of us, Drs. Steffie Woolhandler and David U. Himmelstein. Other physicians and medical students are invited to read and sign the statement here: medicare-for-all.us

Setting the Record Straight on Medicare for All: An Open Letter From 560 Physicians and Medical Students

The renewed debate over the merits of single-payer health reform has been marred by misleading claims that such reform is unnecessary and unaffordable. We write to set the record straight.

Despite the advances of the Affordable Care Act (ACA), the health care financing system continues to inflict needless suffering on our patients. Nearly 30 million Americans remain uninsured, and co-payments, deductibles and insurers’ narrow networks obstruct care for many more. Insurers skim billions from premiums, and impose expensive and time-consuming paperwork on doctors, nurses and hospitals.

Studies in the most trusted journals have quantified the bureaucratic savings achievable through single payer reform. 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 UK 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.

Recent critics of Medicare for All warn of large increases in government spending, but fail to note that these would be fully offset by savings on private insurance premiums and out-of-pocket costs. Their forecasts of massive surges in doctor visits and hospital care conflicts with past experience of coverage expansions. When 15 million Americans gained insurance under the ACA in 2014, hospital admissions didn’t budge. No surge in hospital use or doctor visits occurred when Medicare and Medicaid were rolled out, or when Canada’s single-payer system started up; doctors saw sick and poor patients more often, but their healthy, wealthy patients a bit less often.

Experience in many nations over many decades provides convincing evidence that single-payer reform is both medically necessary and economically advisable.

In addition to Drs. Gaffney, Himmelstein, Christopher and Woolhandler, this statement has been signed by more than 560 other physicians and medical students.

http://www.huffingtonpost.com/steffie-woolhandler/setting-the-record-straig_24_b_9341782.html

***

Comment:

By Don McCanne, M.D.

With the recent often inaccurate and ill-advised debate taking place in the media over the financing of single payer it is imperative that the record be set straight on the basic, irrefutable facts of single payer. Physicians and medical students who are well informed on the true facts should sign this open letter so that the nation understands clearly that we can ensure that absolutely everyone has free choice of health care in a system that is affordable for everyone, through an improved Medicare-for-All.

Go to medicare-for-all.us to sign the letter.

Colleagues should be encouraged to sign as well. Non-physicians are also encouraged to endorse this letter by signing on to a companion list at this same website.

In a separate release, Steffie Woolhandler explains the background that makes this action an imperative:

“The recent attacks on single payer reform by some liberal economists and politicians are mystifying.  When I met with Hillary Clinton some years ago she acknowledged that single payer would be the cheapest and most efficient way to cover all Americans.  Her only objection then was that single payer wasn’t politically feasible.  Now she’s charging that the numbers don’t add up.  And economists who once projected large savings from single payer, are now saying the opposite, without citing any new data.  They’re playing political games at the expense of the truth.”

Again, please go immediately to medicare-for-all.us to sign the open letter.

Physicians & Medical Students: Sign the open letter on the truth about Medicare-for-All

Setting the Record Straight on Medicare for All: An Open Letter From 560 Physicians and Medical Students

By Steffie Woolhandler and David Himmelstein
The Huffington Post, February 28, 2016

The following statement has been signed by more than 560 physicians and medical students. It was crafted by Andrea Christopher, M.D., Fellow in General Internal Medicine at Harvard Medical School, Adam Gaffney, M.D., Fellow in Pulmonary and Critical Care Medicine at Massachusetts General Hospital and Harvard Medical School, and the two of us, Drs. Steffie Woolhandler and David U. Himmelstein. Other physicians and medical students are invited to read and sign the statement here: medicare-for-all.us

Setting the Record Straight on Medicare for All: An Open Letter From 560 Physicians and Medical Students

The renewed debate over the merits of single-payer health reform has been marred by misleading claims that such reform is unnecessary and unaffordable. We write to set the record straight.

Despite the advances of the Affordable Care Act (ACA), the health care financing system continues to inflict needless suffering on our patients. Nearly 30 million Americans remain uninsured, and co-payments, deductibles and insurers’ narrow networks obstruct care for many more. Insurers skim billions from premiums, and impose expensive and time-consuming paperwork on doctors, nurses and hospitals.

Studies in the most trusted journals have quantified the bureaucratic savings achievable through single payer reform. 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 UK 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.

Recent critics of Medicare for All warn of large increases in government spending, but fail to note that these would be fully offset by savings on private insurance premiums and out-of-pocket costs. Their forecasts of massive surges in doctor visits and hospital care conflicts with past experience of coverage expansions. When 15 million Americans gained insurance under the ACA in 2014, hospital admissions didn’t budge. No surge in hospital use or doctor visits occurred when Medicare and Medicaid were rolled out, or when Canada’s single-payer system started up; doctors saw sick and poor patients more often, but their healthy, wealthy patients a bit less often.

Experience in many nations over many decades provides convincing evidence that single-payer reform is both medically necessary and economically advisable.

In addition to Drs. Gaffney, Himmelstein, Christopher and Woolhandler, this statement has been signed by more than 560 other physicians and medical students.

http://www.huffingtonpost.com/steffie-woolhandler/setting-the-record-straig_24_b_9341782.html

With the recent often inaccurate and ill-advised debate taking place in the media over the financing of single payer it is imperative that the record be set straight on the basic, irrefutable facts of single payer. Physicians and medical students who are well informed on the true facts should sign this open letter so that the nation understands clearly that we can ensure that absolutely everyone has free choice of health care in a system that is affordable for everyone, through an improved Medicare-for-All.

Go to medicare-for-all.us to sign the letter.

Colleagues should be encouraged to sign as well. Non-physicians are also encouraged to endorse this letter by signing on to a companion list at this same website.

In a separate release, Steffie Woolhandler explains the background that makes this action an imperative:

“The recent attacks on single payer reform by some liberal economists and politicians are mystifying.  When I met with Hillary Clinton some years ago she acknowledged that single payer would be the cheapest and most efficient way to cover all Americans.  Her only objection then was that single payer wasn’t politically feasible.  Now she’s charging that the numbers don’t add up.  And economists who once projected large savings from single payer, are now saying the opposite, without citing any new data.  They’re playing political games at the expense of the truth.”

Again, please go immediately to medicare-for-all.us to sign the open letter.

AP-GfK poll on single payer spreads falsehoods

AP-GfK Poll: Support shaky for Sanders ‘Medicare for all’

By Ricardo Alonso-Zaldivar and Emily Swanson
AP GfK, February 25, 2016

At first blush, many Americans like the idea of “Medicare for all,” the government-run health system that’s a rallying cry for Democratic presidential candidate Bernie Sanders.

But mention some of the trade-offs — from higher taxes to giving up employer coverage — and support starts to shrivel.

That’s the key insight from an Associated Press-GfK poll released Thursday. The survey also found that people’s initial impressions of Sanders’ single-payer plan are more favorable than their views of President Barack Obama’s health care overhaul.

A slim plurality of 39 percent supports replacing the private health insurance system with a single government-run, taxpayer-funded plan that would cover medical, dental, vision and long-term care, with 33 percent opposed. Only 26 percent say they support Obama’s hard-won health care law.

Asked whether they would continue to support Sanders’ plan if their own taxes went up, under a third of initial supporters of the plan would keep backing it. About 4 out of 10 flipped to opposition.

About the same share of initial backers would ditch single-payer if it meant that people had to give up employer coverage. Twenty-eight percent would continue to support it.

Higher taxes and an end to employer coverage are both a given under the Sanders plan, which would replace private coverage with a taxpayer-funded program, while also offering more generous benefits such as no deductibles and no copayments, as well as coverage for long-term care.

“That’s pie in the sky,” said Patricia Combs, a retired junior-high math teacher from Springboro, Ohio. “It sounds really good, but I don’t think it’s attainable … people would complain about their taxes being raised.”

Elizabeth Medina of Chicago, an office manager not currently working, said she worries that quality would slip.

“Overall it sounds terrific,” she said. “Yeah! Let’s go for it! But Europe and Canada have their problems with the single-payer system … it’s subpar.”

The poll found that 51 percent of initial single-payer backers would switch to opposition if it took longer for new drugs and treatments to become available. Only 14 percent would continue to support the plan. Such an outcome could happen if drugmakers were required to prove that new medications are therapeutically superior to existing ones. The current standard is that new drugs be safe and effective.

Additionally, 47 percent of initial supporters would reconsider if “Medicare for all” meant longer wait times for non-emergency medical services. That could happen if budget-conscious administrators encouraged doctors and hospitals to be parsimonious in using high-tech imaging. Only 18 percent of poll respondents would continue to support the plan in that case.

Overall, the poll found that health care remains a top issue for Americans, with three-fourths calling it extremely crucial or very important.

Topline

HC15. Would you favor or oppose replacing the current private health insurance system in the United States with a single government-run and taxpayer-funded plan like Medicare for all Americans that would cover medical, dental, vision, and long-term care services?

  39%  Total support
       18%  Strongly support
       21%  Somewhat support

  26%  Neither support nor oppose

  33%  Total oppose
       12%  Somewhat oppose
       22%  Strongly oppose

   2%  Refused/Not answered

HC15a. Would you support or oppose replacing the health insurance system in the United States with a single government-run plan if it meant:

  Your own taxes would increase
    28%  Support
    32%  Neither support nor oppose
    29%  Oppose

  Some people needed to switch doctors
    33%  Support
    37%  Neither support nor oppose
    29%  Oppose

  It took longer for new drugs and treatments to become available
    14%  Support
    34%  Neither support nor oppose
    51%  Oppose

  Longer wait times for nonemergency medical services
    18%  Support
    35%  Neither support nor oppose
    47%  Oppose

  People needed to give up other coverage like employer coverage
    28%  Support
    32%  Neither support nor oppose
    39%  Oppose

  The new system would replace Medicare for seniors
    37%  Support
    35%  Neither support nor oppose
    26%  Oppose

http://ap-gfkpoll.com/featured/findings-from-our-latest-poll-32

Topline
http://ap-gfkpoll.com/main/wp-content/uploads/2016/02/AP-GfK_Poll_February-2016-topline_health.pdf

***

Comment:

By Don McCanne, M.D.

Most polls place support for a single payer Medicare-for-all national health program at about 60%, with some variation based on labels, framing, and polling technique. Yesterday’s Kaiser poll placed it at 50%. This new Associated Press GfK poll places it at about 40%, but it is unusual in that over one-fourth of those polled expressed no preference.  Of those expressing a preference, 54% were supportive and 46% opposed. But there was something else that was also very unusual about this poll.

Yesterday’s Kaiser poll demonstrated that the views on single payer were malleable. When asked about negative features that allegedly are associated with single payer, support declined, whereas support increased when asked about positive features. In this AP-GfK poll they were asked only about allegedly negative features, and support declined. But what were these negative features?

*  Your own taxes would increase – But no mention was made of the savings in premiums, out-of-pocket expenses and other taxes that would more than offset the new taxes, resulting in a net savings.

*  Some people needed to switch doctors – But that is a characteristic of private plans with their narrow networks whereas single payer provides free choice of health care professionals.

*  It took longer for new drugs and treatments to become available – There is no way that the pharmaceutical industry is going to walk away from a $3 trillion market.

*  Longer wait times for nonemergency medical services – Responsible stewards would use capacity adjustment and queue management to prevent excessive queues, as has been done successfully in several other nations.

*  People needed to give up other coverage like employer coverage – But they would be trading that for a superior program with more comprehensive coverage, reduced out-of-pocket costs and greater choices in health care.

*  The new system would replace Medicare for seniors – Who would want to continue with the current Medicare program that pays for only about half of health care when you could have an improved Medicare with more generous benefits?

Why would the Associated Press conduct such a deceptive poll at a risk of impairing its credibility? When you read the AP release, you can’t help but come to the conclusion that it was designed to slam presidential candidate Sen. Bernie Sanders and his support of Medicare for all. They even included a gratuitous comment from an unemployed office manager to the effect that the single payer system is “subpar” like in “Europe and Canada” – an absolute falsehood.

Whatever the intentions of the Associated Press, we must make every effort to dispel the deceptions and disseminate the true facts about single payer Improved Medicare for All. The health of America is at stake.

AP-GfK poll on single payer spreads falsehoods

AP-GfK Poll: Support shaky for Sanders ‘Medicare for all’

By Ricardo Alonso-Zaldivar and Emily Swanson
AP GfK, February 25, 2016

At first blush, many Americans like the idea of “Medicare for all,” the government-run health system that’s a rallying cry for Democratic presidential candidate Bernie Sanders.

But mention some of the trade-offs — from higher taxes to giving up employer coverage — and support starts to shrivel.

That’s the key insight from an Associated Press-GfK poll released Thursday. The survey also found that people’s initial impressions of Sanders’ single-payer plan are more favorable than their views of President Barack Obama’s health care overhaul.

A slim plurality of 39 percent supports replacing the private health insurance system with a single government-run, taxpayer-funded plan that would cover medical, dental, vision and long-term care, with 33 percent opposed. Only 26 percent say they support Obama’s hard-won health care law.

Asked whether they would continue to support Sanders’ plan if their own taxes went up, under a third of initial supporters of the plan would keep backing it. About 4 out of 10 flipped to opposition.

About the same share of initial backers would ditch single-payer if it meant that people had to give up employer coverage. Twenty-eight percent would continue to support it.

Higher taxes and an end to employer coverage are both a given under the Sanders plan, which would replace private coverage with a taxpayer-funded program, while also offering more generous benefits such as no deductibles and no copayments, as well as coverage for long-term care.

“That’s pie in the sky,” said Patricia Combs, a retired junior-high math teacher from Springboro, Ohio. “It sounds really good, but I don’t think it’s attainable … people would complain about their taxes being raised.”

Elizabeth Medina of Chicago, an office manager not currently working, said she worries that quality would slip.

“Overall it sounds terrific,” she said. “Yeah! Let’s go for it! But Europe and Canada have their problems with the single-payer system … it’s subpar.”

The poll found that 51 percent of initial single-payer backers would switch to opposition if it took longer for new drugs and treatments to become available. Only 14 percent would continue to support the plan. Such an outcome could happen if drugmakers were required to prove that new medications are therapeutically superior to existing ones. The current standard is that new drugs be safe and effective.

Additionally, 47 percent of initial supporters would reconsider if “Medicare for all” meant longer wait times for non-emergency medical services. That could happen if budget-conscious administrators encouraged doctors and hospitals to be parsimonious in using high-tech imaging. Only 18 percent of poll respondents would continue to support the plan in that case.

Overall, the poll found that health care remains a top issue for Americans, with three-fourths calling it extremely crucial or very important.

Topline

HC15. Would you favor or oppose replacing the current private health insurance system in the United States with a single government-run and taxpayer-funded plan like Medicare for all Americans that would cover medical, dental, vision, and long-term care services?

39%  Total support
18%  Strongly support
21%  Somewhat support

26%  Neither support nor oppose

33%  Total oppose
12%  Somewhat oppose
22%  Strongly oppose

2%  Refused/Not answered

HC15a. Would you support or oppose replacing the health insurance system in the United States with a single government-run plan if it meant:

Your own taxes would increase
28%  Support
32%  Neither support nor oppose
29%  Oppose

Some people needed to switch doctors
33%  Support
37%  Neither support nor oppose
29%  Oppose

It took longer for new drugs and treatments to become available
14%  Support
34%  Neither support nor oppose
51%  Oppose

Longer wait times for nonemergency medical services
18%  Support
35%  Neither support nor oppose
47%  Oppose

People needed to give up other coverage like employer coverage
28%  Support
32%  Neither support nor oppose
39%  Oppose

The new system would replace Medicare for seniors
37%  Support
35%  Neither support nor oppose
26%  Oppose

http://ap-gfkpoll.com/featured/findings-from-our-latest-poll-32

Topline
http://ap-gfkpoll.com/main/wp-content/uploads/2016/02/AP-GfK_Poll_February-2016-topline_health.pdf

Most polls place support for a single payer Medicare-for-all national health program at about 60%, with some variation based on labels, framing, and polling technique. Yesterday’s Kaiser poll placed it at 50%. This new Associated Press GfK poll places it at about 40%, but it is unusual in that over one-fourth of those polled expressed no preference.  Of those expressing a preference, 54% were supportive and 46% opposed. But there was something else that was also very unusual about this poll.

Yesterday’s Kaiser poll demonstrated that the views on single payer were malleable. When asked about negative features that allegedly are associated with single payer, support declined, whereas support increased when asked about positive features. In this AP-GfK poll they were asked only about allegedly negative features, and support declined. But what were these negative features?

*  Your own taxes would increase – But no mention was made of the savings in premiums, out-of-pocket expenses and other taxes that would more than offset the new taxes, resulting in a net savings.

*  Some people needed to switch doctors – But that is a characteristic of private plans with their narrow networks whereas single payer provides free choice of health care professionals.

*  It took longer for new drugs and treatments to become available – There is no way that the pharmaceutical industry is going to walk away from a $3 trillion market.

*  Longer wait times for nonemergency medical services – Responsible stewards would use capacity adjustment and queue management to prevent excessive queues, as has been done successfully in several other nations.

*  People needed to give up other coverage like employer coverage – But they would be trading that for a superior program with more comprehensive coverage, reduced out-of-pocket costs and greater choices in health care.

*  The new system would replace Medicare for seniors – Who would want to continue with the current Medicare program that pays for only about half of health care when you could have an improved Medicare with more generous benefits?

Why would the Associated Press conduct such a deceptive poll at a risk of impairing its credibility? When you read the AP release, you can’t help but come to the conclusion that it was designed to slam presidential candidate Sen. Bernie Sanders and his support of Medicare for all. They even included a gratuitous comment from an unemployed office manager to the effect that the single payer system is “subpar” like in “Europe and Canada” – an absolute falsehood.

Whatever the intentions of the Associated Press, we must make every effort to dispel the deceptions and disseminate the true facts about single payer Improved Medicare for All. The health of America is at stake.

Clinton’s ‘Public Option’ is a Diversion: We Need Single Payer, Medicare for All

By Don McCanne, M.D.
Common Dreams, Feb. 24, 2016

You remember the public option. During the drafting of the Affordable Care Act (ACA), efforts were made to include a public option – a government-run plan that would compete with the private health plans in the insurance marketplace.

If the private plans proved that they could provide greater value, then they would prevail. If the government could do a better job, then the public option could expand by demand and eventually become the single payer for the nation, so supporters believed.

The original concept for the public option was to allow individuals to buy into the Medicare program instead of purchasing private insurance. There were some obvious problems. Medicare lacked some important features required of the private plans such as catastrophic coverage – establishing a maximum out-of-pocket responsibility of paying for health care. Also, the existing Medicare pool was composed of the elderly and those with long-term disabilities – expensive groups to insure. The exorbitant premium that would have to be charged could not be competitive with the private plans.

It was then decided to establish a new public insurance program that was designed like the private plans and that would have to follow the same rules. The insurance industry immediately opposed this since it would be “unfair” competition considering the government resources backing up the public plan, and the inherently higher administrative costs that the private insurers face, not to mention the need to profit from their operations – profit not being a feature of a publicly owned insurer. Several (anti-competitive) features were proposed for the public option which would give the private insurers a “fair” playing field.

The insurers were still concerned that they could not compete against even a restricted government plan, and thus they continued to oppose it. There is a basis for that concern since the private Medicare Advantage plans are able to “compete” with the traditional Medicare program only because of the overpayments that are being made to the private plans. If they were in the same playing field, the private plans would perish.

Nevertheless, the issue of the public option became moot when Sen. Joseph Lieberman, with no votes to spare, threatened to kill the entire Affordable Care Act if the public option were included.

We were left with the co-ops as a substitute for the public option. The co-ops are nonprofit organizations in which the insured members are the owners. Congress, under the Republicans, has refused to provide promised funds, and half of them have collapsed. They are now being used by opponents of single payer to “prove” that the government would be incapable of running a single-payer system – an obvious non sequitur.

Since the enactment of ACA there have been endless calls to add a public option. Single payer failed to gain traction because of the pervasive meme that single payer was not politically feasible. But if we could just get a public option, that would automatically evolve into a single-payer system, they said.

Then along came Bernie Sanders. He carried the message that not only was single payer politically feasible, it was a moral imperative to achieve health care justice for all.

To the surprise of Hillary Clinton and her campaign staff, Bernie Sanders came out of nowhere and gained traction carrying the single-payer banner, and, as a result, has become a genuine challenge to her candidacy.

Hillary Clinton has always been an opponent of single payer and instead has supported the private insurance industry. Some have misinterpreted a statement of hers many years ago as supporting the fact that we would have single payer in the United States. But that statement was not in support of single payer but rather was her threat to us that if we did not accept her managed-competition model of reform, we would have single payer.

So what was her campaign to do? They decided to bring back the concept of a public option to appease those who were turning to Sanders because of his advocacy of single payer. They are relying on the meme that the public option is our door to single payer (even though it is not true). But what is her version of the public option?

She says we should build on ACA. She has proposed no new federal public option legislation but she is merely suggesting that the states look at Section 1332 of ACA which authorizes waivers for limited innovations on a state level.

Imagine the difficulties that states would have, within the confines of Section 1332, in building their own intra-state public plan. Unless they used private insurance innovations such as high deductibles, narrow provider networks, and tiered services, the premiums would be unaffordable to most. A single-payer system would be funded equitably through progressive taxes, but you could not do that with a public option since that is only one plan in a multi-payer system.

In 2009, David Himmelstein and Steffie Woolhandler explained in very brief terms why the public option is a flawed concept:

“The ‘public plan option’ won’t work to fix the health care system for two reasons.

“1. It forgoes at least 84 percent of the administrative savings available through single payer. The public plan option would do nothing to streamline the administrative tasks (and costs) of hospitals, physicians offices, and nursing homes, which would still contend with multiple payers, and hence still need the complex cost-tracking and billing apparatus that drives administrative costs. These unnecessary provider administrative costs account for the vast majority of bureaucratic waste. Hence, even if 95 percent of Americans who are currently privately insured were to join the public plan (and it had overhead costs at current Medicare levels), the savings on insurance overhead would amount to only 16 percent of the roughly $400 billion annually achievable through single payer – not enough to make reform affordable.

“2. A quarter century of experience with public/private competition in the Medicare program demonstrates that the private plans will not allow a level playing field. Despite strict regulation, private insurers have successfully cherry-picked healthier seniors, and have exploited regional health spending differences to their advantage. They have progressively undermined the public plan – which started as the single payer for seniors and has now become a funding mechanism for HMOs – and a place to dump the unprofitably ill. A public plan option does not lead toward single payer, but toward the segregation of patients, with profitable ones in private plans and unprofitable ones in the public plan.”

Hillary Clinton is now showing us how the public option is a diversion from the reform we really need – single payer. It is up to us, the people, to convince our politicians that single payer is what we want. It will not happen without us.

Dr. Don McCanne is senior health policy fellow at Physicians for a National Healthcare Program (PNHP), a nonprofit, nonpartisan organization of 20,000 physicians who support single-payer national health insurance. He resides in San Juan Capistrano, California.

This work is licensed under a Creative Commons Attribution-Share Alike 3.0 License

http://commondreams.org/views/2016/02/24/clintons-public-option-diversion-we-need-single-payer-medicare-all

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

NY can lead the way on single-payer care

By Liza Featherstone
AM New York, Feb. 24, 2016

Our family’s health insurance is a source of frustration. This week, I’m all over the Internet trying to figure out a creative way to get a vaccine that my doctor recommends, but our insurance doesn’t cover.

The problem — for insured people like me — highlights what’s wrong with for-profit health insurance. The companies have little incentive to provide affordable health care. Medical bankruptcy and difficulties affording care are common even among people who have insurance, as we struggle with copays and deductibles, or go without care we need.

Still, my family is lucky to have insurance. A 2015 Census Bureau report found that 10.5% of New Yorkers have no insurance, and an Urban Institute report projects that a majority of them will be uninsured even after Obamacare is fully implemented.

Being a patient in America is an ongoing argument for a single-payer system — one in which the government provides health care to everyone. Democratic presidential hopeful Sen. Bernie Sanders has made that central to his campaign. He would do it through Medicare.

In New York State, we have a chance now to make it a reality, and we should.

The State Legislature is considering a single-payer plan that I believe would significantly lower the cost of health care. A chunk of what we pay for health care covers insurance companies’ administrative costs, like the chief executives’ compensation. But, as an enormous customer, government would suppress the rising cost of drugs by buying in bulk.

American life expectancy is more than three years shorter than that of our Canadian and British counterparts, but we spend much more on health care.

A bill creating the state’s single-payer plan passed the Assembly last year, and is expected to pass again this year. The bill has more backing now in the Senate than before, but advocates, including Physicians for a National Health Program and many other organizations, are building a grass-roots campaign to harness more support.

Now that a single-payer plan is part of the national political conversation, it is time to push for it in New York.

Liza Featherstone lives and writes in Clinton Hill.

http://www.amny.com/opinion/columnists/liza-featherstone/ny-can-lead-the-way-on-single-payer-care-1.11506833

Single-payer plan benefits citizens

By Herbert S. Strauss, M.D.
Times Union (Albany, N.Y.), Letters, Feb. 21, 2016

Raising taxes has been the third rail of American politics. Large segments of our political establishment, including Hillary Clinton, oppose the Medicare-like single-payer health care system advocated by Bernie Sanders because it entails raising taxes. What is largely ignored is that the country as a whole would save significant sums by doing away with the costly for-profit health insurance industry, for-profit medicine and the excessive cost of prescription drugs. An unwieldy bureaucracy and hopelessly complex financial arrangements have contributed to the high costs.

The average citizen, even while paying moderately higher income taxes, would save money because he would not have to pay the ever-rising insurance premiums, co-pays and deductibles. Even when people are covered for health insurance by their employer, they are burdened by their ever-increasing share of the soaring costs.

All the major industrial countries in the world provide universal health care coverage for all their citizens without the use of for-profit insurance companies, and their per-person health care cost is a fraction of ours. Our own health care cost is rising annually beyond of inflation. Our present system is unsustainable.

The obvious reason why many influential segments oppose single-payer is that increased taxes would disproportionately affect the wealthy, particularly the super rich. During the past decades, a profound wealth redistribution has taken place, largely due to large, unjustifiable tax breaks to the wealthy, engineered by legislators who are beholden to them. The wealthy can well afford a tax increase somewhat in excess of what they otherwise would have to spend for their health care.

The taxes for financing a cost efficient universal health care system would be profoundly beneficial for our country.

Dr. Herbert S. Strauss resides in Saratoga Springs.

http://www.timesunion.com/tuplus-opinion/article/Letter-Single-payer-plan-benefits-citizens-6845926.php

Lessons from Kaiser poll on single payer

Kaiser Health Tracking Poll: February 2016

By Bianca DiJulio, Jamie Firth, Ashley Kirzinger, and Mollyann Brodie
Kaiser Family Foundation, February 25, 2016

The February Kaiser Health Tracking Poll asked the public about broad options for changing the health system that are currently being discussed and finds more Americans (36 percent) say policymakers should build on the existing law to improve affordability and access to care than any other option presented.  Sixteen percent say they would like to see the health care law repealed and not replaced, 13 percent say it should be repealed and replaced with a Republican-sponsored alternative, and 24 percent say the U.S. should establish guaranteed universal coverage through a single government plan.

As debate continues over the idea of universal coverage through a single government plan, the survey finds the public divided, with half saying they favor the idea and 43 percent saying they oppose it, and some opinions swayed after hearing counterarguments. In addition, majorities of Democrats and independents favor the idea, compared to just 20 percent of Republicans. Most Americans think that if guaranteed universal coverage through a single government plan was put into place, uninsured and low-income people would be better off, but there is little consensus among the public about how it would impact their care personally.

This month’s poll also explores the public’s reaction to a few terms used to describe the idea of expanding health insurance coverage to all Americans. Majorities say they have a positive reaction to the terms “Medicare-for-all” and “guaranteed universal health coverage” and fewer say the same for “single payer health insurance system” and “socialized medicine.”  About half (53 percent) of Democrats say they have a very positive reaction to “Medicare-for-all” compared with 21 percent who say the same for “single payer health insurance system.”

Next Steps for the Health Care System

While health care ranks fourth as an important voting issue, presidential hopefuls have proposed a range of visions for the future of the health care system, from the full repeal of the Affordable Care Act (ACA) to the adoption of a universal government plan. The survey finds that when given four broad approaches for the future of the health care system that are currently being discussed, Americans opinions are split with the largest share reporting that they favor building on the ACA and the existing system. Overall, 36 percent say lawmakers should build on the existing law to improve affordability and access to care, 24 percent say the U.S. should establish guaranteed universal coverage through a single government plan, 16 percent say they would like to see the health care law repealed and not replaced, and 13 percent say it should be repealed and replaced with Republican-sponsored alternative.

A closer look at views across parties shows that a third of Democrats (33 percent) favor the idea of universal coverage through a single government plan but more Democrats (54 percent) say they would prefer to build on the existing health care law. A roughly similar share of independents (26 percent) say the U.S. should establish guaranteed universal coverage through a single government plan, and 36 percent say lawmakers should build on the existing health care law. The majority of Republicans (60 percent) say they would like to repeal the health care law whether it’s replaced or not, although 21 percent say they would like to build on the existing law and 9 percent say they would like universal coverage through a government plan.

How Malleable are Americans’ Opinions of Guaranteed Health Coverage From a Government Plan?

Although half of the public says they favor having guaranteed health insurance coverage through a single government health plan, some can be swayed by counterarguments made by critics. For instance, 20 percent overall shift their opinion from favor to oppose after hearing that guaranteed coverage through a single government plan would “require many Americans to pay more in taxes,” 20 percent say they now oppose the idea after hearing that it would “give the government too much control over health care,” and 14 percent say they now oppose it after hearing that it would “eliminate or replace the current health care law.” On the other side of the debate, those who originally said they opposed the idea were also persuaded by arguments, although fewer changed their opinions after hearing the arguments. About one in 10 changed their stance from oppose to favor after hearing that guaranteed coverage would “ensure that all Americans have health insurance as a basic right” (13 percent), that it would “reduce health insurance administrative costs” (11 percent), and that it would “eliminate all private health insurance premiums, co-pays, and deductibles paid by employers and individuals” (11 percent).

Impact of Coverage Through Single Government Plan

Most Americans think that if guaranteed universal coverage through a single government plan was put into place, uninsured and low-income people would be better off (60 percent and 57 percent, respectively). Fewer say that middle class people (34 percent) and people like them (31 percent) would be better off, which is roughly similar to the shares who say these same groups will be worse of or not be impacted much at all. Most (63 percent) say it would not have much impact on wealthy people, just 14 percent say they would be better off and 18 percent say they would be worse off. Democrats and independents are more likely than Republicans to report that all people would be better off through a single government plan.

The country has not had a substantial public debate about single payer legislation recently and there is little consensus among the public about how enacting guaranteed universal coverage through a single government plan would impact their personal health care. Roughly four in 10 say that they think the cost, quality, availability of health care treatments, and choice of doctors and hospitals would stay about the same as it is under the current health care system. About a third say these measures would get worse if universal coverage was put into place and around two in 10 think these measures would get better. Not surprising considering their stances on the idea of guaranteed universal coverage, majorities of Republicans say each measure would likely get worse if such a plan was enacted, while at least half of Democrats say each would likely stay about the same. Additionally, those under age 50, Black and Hispanic Americans, and those with lower incomes are more likely than their counterparts to say that these measures will get better.

Wording Matters

Politicians and pundits use a variety of terms to describe the idea of expanding health insurance coverage to all Americans and this month’s poll explores the public’s reaction to a few of these terms. Nearly two-thirds (64 percent) of Americans say they have a positive reaction to the term “Medicare-for-all” and more than half (57 percent) say they have a positive reaction to the term “guaranteed universal health coverage.” Less than half of Americans report a positive association with the phrases “single payer health insurance system” (44 percent) and “socialized medicine” (38 percent).

Similar to the public at large, more Democrats report having a positive reaction to “Medicare-for-all” and “guaranteed universal health coverage” than say the same about “socialized medicine” or “single payer health insurance system.” Additionally, more Democrats have positive reactions to all of the terms than Republicans and independents do. Around half of Democrats report a very positive reaction to “Medicare-for-all” (53 percent) and “guaranteed universal health coverage” (44 percent), while fewer Republicans say the same for each (17 percent and 9 percent, respectively). Two in 10 Democrats report very positive reactions to “socialized medicine” (22 percent) and “single payer health insurance system” (21 percent), while fewer than one in 10 Republicans do.

Topline

4.  Which of the following comes closest to your view of the future of the US health care system?

  16%  The health care law should be repealed and NOT replaced

  13%  The health care law should be repealed and replaced with a Republican-sponsored alternative
 
  36%  Lawmakers should build on the existing health care law to improve affordability and access to care

  24%  The U.S. should establish guaranteed universal coverage through a single government plan

  6%  None of these/Something else

  4%  Don’t know/refused

5.  Do you favor or oppose having guaranteed health insurance coverage in which all Americans would get their insurance through a single government health plan?

  50%  Favor
       27%  Strongly favor
       23%  Somewhat favor

  43%  Oppose
       13%  Somewhat oppose
       30%  Strongly oppose

  7%   Don’t know/Refused

19.  I am going to read you a list of terms. Please tell me if you have a positive or negative reaction to each term.

a.  Socialized Medicine

    38%  Positive
         15%  Very positive
         23%  Somewhat positive

    49%  Negative
         19%  Somewhat negative
         30%  Very negative

    12%  Other

b.  Medicare-for-all

    64%  Positive
         36%  Very positive
         27%  Somewhat positive

    29%  Negative
         15%  Somewhat negative
         14%  Very negative

    6%   Other

c.  Single payer health insurance system

    44%  Positive
         15%  Very positive
         29%  Somewhat positive

    40%  Negative
         21%  Somewhat negative
         19%  Very negative

    17%  Other

d.  Guaranteed universal health coverage

    57%  Positive
         28%  Very positive
         29%  Somewhat positive

    38%  Negative
         15%  Somewhat negative
         22%  Very negative

    6%   Other

Report:
http://kff.org/health-reform/poll-finding/kaiser-health-tracking-poll-february-2016/

Topline:
http://files.kff.org/attachment/topline-methodology-kaiser-health-tracking-poll-february-2016

***

Comment:

By Don McCanne, M.D.

About half of Americans would prefer a single government health plan for everyone, according to this poll. However, when offered several choices, more would prefer to build on the current system (36%) than would prefer to establish a single government plan (24%). Also, followup questions show that the opinions of a single government plan are quite malleable, depending whether the query has a positive or negative slant.

The malleability of opinion and the poor understanding of the benefits of single payer demonstrate that the public still has a relatively weak understanding of precisely what a single payer system is. We need to intensify our educational efforts.

Perhaps more disconcerting is that more people would prefer to build on the Affordable Care Act than to establish a single government plan. The message of the incrementalists seems to be carrying the day. People believe that we can simply tweak the current system and achieve the same goals as single payer.

What people haven’t grasped are the fundamental differences between the financing infrastructures of our fragmented multi-payer system and a well designed single payer system. Recent Quote of the Day messages describing some of the flaws in our current system have asked the question, “What incremental change would fix this particular problem?” The answers don’t come easy.

It’s easy to say that we can build on the Affordable Care Act by gradually covering more people and by controlling spending by eliminating waste, but these are wishes, not policies. In most instances, there is no simple patch that would work, but rather most changes increase the administrative complexity, add significantly to the costs, and fall short of fully correcting the specific problems addressed.

This is a very important message that we have to deliver. Our current financing infrastructure is not particularly amenable to incremental patches. It is imperative that we replace our flawed infrastructure with one that automatically addresses the problems that we still face in health care financing. Single payer would do that.

This poll also tested labels for a single payer system. Close to two-thirds had a positive reaction to the term, “Medicare-for-all.” People also had a positive reaction to “guaranteed universal health coverage,” but that doesn’t mean much and has been misused as a label for systems that are neither guaranteed nor universal. Yet people seem to be split or confused by the term, “single payer health insurance system.”

“Medicare-for-all” does seem to be preferred, but some opponents are quick to point out the deficiencies in our Medicare program. Adding “improved,” as in “Improved Medicare for All,” defuses that challenge.

So do not let people get away with saying that we’ll simply build on the system we have. Demand that they define the precise incremental steps and how each would move us significantly closer to truly affordable care for absolutely everyone. If you keep pushing them they’ll eventually have to describe a single payer system because patches to our current system just won’t get us there.

Lessons from Kaiser poll on single payer

Kaiser Health Tracking Poll: February 2016

By Bianca DiJulio, Jamie Firth, Ashley Kirzinger, and Mollyann Brodie
Kaiser Family Foundation, February 25, 2016

The February Kaiser Health Tracking Poll asked the public about broad options for changing the health system that are currently being discussed and finds more Americans (36 percent) say policymakers should build on the existing law to improve affordability and access to care than any other option presented.  Sixteen percent say they would like to see the health care law repealed and not replaced, 13 percent say it should be repealed and replaced with a Republican-sponsored alternative, and 24 percent say the U.S. should establish guaranteed universal coverage through a single government plan.

As debate continues over the idea of universal coverage through a single government plan, the survey finds the public divided, with half saying they favor the idea and 43 percent saying they oppose it, and some opinions swayed after hearing counterarguments. In addition, majorities of Democrats and independents favor the idea, compared to just 20 percent of Republicans. Most Americans think that if guaranteed universal coverage through a single government plan was put into place, uninsured and low-income people would be better off, but there is little consensus among the public about how it would impact their care personally.

This month’s poll also explores the public’s reaction to a few terms used to describe the idea of expanding health insurance coverage to all Americans. Majorities say they have a positive reaction to the terms “Medicare-for-all” and “guaranteed universal health coverage” and fewer say the same for “single payer health insurance system” and “socialized medicine.”  About half (53 percent) of Democrats say they have a very positive reaction to “Medicare-for-all” compared with 21 percent who say the same for “single payer health insurance system.”

Next Steps for the Health Care System

While health care ranks fourth as an important voting issue, presidential hopefuls have proposed a range of visions for the future of the health care system, from the full repeal of the Affordable Care Act (ACA) to the adoption of a universal government plan. The survey finds that when given four broad approaches for the future of the health care system that are currently being discussed, Americans opinions are split with the largest share reporting that they favor building on the ACA and the existing system. Overall, 36 percent say lawmakers should build on the existing law to improve affordability and access to care, 24 percent say the U.S. should establish guaranteed universal coverage through a single government plan, 16 percent say they would like to see the health care law repealed and not replaced, and 13 percent say it should be repealed and replaced with Republican-sponsored alternative.

A closer look at views across parties shows that a third of Democrats (33 percent) favor the idea of universal coverage through a single government plan but more Democrats (54 percent) say they would prefer to build on the existing health care law. A roughly similar share of independents (26 percent) say the U.S. should establish guaranteed universal coverage through a single government plan, and 36 percent say lawmakers should build on the existing health care law. The majority of Republicans (60 percent) say they would like to repeal the health care law whether it’s replaced or not, although 21 percent say they would like to build on the existing law and 9 percent say they would like universal coverage through a government plan.

How Malleable are Americans’ Opinions of Guaranteed Health Coverage From a Government Plan?

Although half of the public says they favor having guaranteed health insurance coverage through a single government health plan, some can be swayed by counterarguments made by critics. For instance, 20 percent overall shift their opinion from favor to oppose after hearing that guaranteed coverage through a single government plan would “require many Americans to pay more in taxes,” 20 percent say they now oppose the idea after hearing that it would “give the government too much control over health care,” and 14 percent say they now oppose it after hearing that it would “eliminate or replace the current health care law.” On the other side of the debate, those who originally said they opposed the idea were also persuaded by arguments, although fewer changed their opinions after hearing the arguments. About one in 10 changed their stance from oppose to favor after hearing that guaranteed coverage would “ensure that all Americans have health insurance as a basic right” (13 percent), that it would “reduce health insurance administrative costs” (11 percent), and that it would “eliminate all private health insurance premiums, co-pays, and deductibles paid by employers and individuals” (11 percent).

Impact of Coverage Through Single Government Plan

Most Americans think that if guaranteed universal coverage through a single government plan was put into place, uninsured and low-income people would be better off (60 percent and 57 percent, respectively). Fewer say that middle class people (34 percent) and people like them (31 percent) would be better off, which is roughly similar to the shares who say these same groups will be worse of or not be impacted much at all. Most (63 percent) say it would not have much impact on wealthy people, just 14 percent say they would be better off and 18 percent say they would be worse off. Democrats and independents are more likely than Republicans to report that all people would be better off through a single government plan.

The country has not had a substantial public debate about single payer legislation recently and there is little consensus among the public about how enacting guaranteed universal coverage through a single government plan would impact their personal health care. Roughly four in 10 say that they think the cost, quality, availability of health care treatments, and choice of doctors and hospitals would stay about the same as it is under the current health care system. About a third say these measures would get worse if universal coverage was put into place and around two in 10 think these measures would get better. Not surprising considering their stances on the idea of guaranteed universal coverage, majorities of Republicans say each measure would likely get worse if such a plan was enacted, while at least half of Democrats say each would likely stay about the same. Additionally, those under age 50, Black and Hispanic Americans, and those with lower incomes are more likely than their counterparts to say that these measures will get better.

Wording Matters

Politicians and pundits use a variety of terms to describe the idea of expanding health insurance coverage to all Americans and this month’s poll explores the public’s reaction to a few of these terms. Nearly two-thirds (64 percent) of Americans say they have a positive reaction to the term “Medicare-for-all” and more than half (57 percent) say they have a positive reaction to the term “guaranteed universal health coverage.” Less than half of Americans report a positive association with the phrases “single payer health insurance system” (44 percent) and “socialized medicine” (38 percent).

Similar to the public at large, more Democrats report having a positive reaction to “Medicare-for-all” and “guaranteed universal health coverage” than say the same about “socialized medicine” or “single payer health insurance system.” Additionally, more Democrats have positive reactions to all of the terms than Republicans and independents do. Around half of Democrats report a very positive reaction to “Medicare-for-all” (53 percent) and “guaranteed universal health coverage” (44 percent), while fewer Republicans say the same for each (17 percent and 9 percent, respectively). Two in 10 Democrats report very positive reactions to “socialized medicine” (22 percent) and “single payer health insurance system” (21 percent), while fewer than one in 10 Republicans do.

Topline

4.  Which of the following comes closest to your view of the future of the US health care system?

16%  The health care law should be repealed and NOT replaced

13%  The health care law should be repealed and replaced with a Republican-sponsored alternative

36%  Lawmakers should build on the existing health care law to improve affordability and access to care

24%  The U.S. should establish guaranteed universal coverage through a single government plan

6%  None of these/Something else

4%  Don’t know/refused

5.  Do you favor or oppose having guaranteed health insurance coverage in which all Americans would get their insurance through a single government health plan?

50%  Favor
27%  Strongly favor
23%  Somewhat favor

43%  Oppose
13%  Somewhat oppose
30%  Strongly oppose

7%   Don’t know/Refused

19.  I am going to read you a list of terms. Please tell me if you have a positive or negative reaction to each term.

a.  Socialized Medicine

38%  Positive
15%  Very positive
23%  Somewhat positive

49%  Negative
19%  Somewhat negative
30%  Very negative

12%  Other

b.  Medicare-for-all

64%  Positive
36%  Very positive
27%  Somewhat positive

29%  Negative
15%  Somewhat negative
14%  Very negative

6%   Other

c.  Single payer health insurance system

44%  Positive
15%  Very positive
29%  Somewhat positive

40%  Negative
21%  Somewhat negative
19%  Very negative

17%  Other

d.  Guaranteed universal health coverage

57%  Positive
28%  Very positive
29%  Somewhat positive

38%  Negative
15%  Somewhat negative
22%  Very negative

6%   Other

Report:
http://kff.org/health-reform/poll-finding/kaiser-health-tracking-poll-february-2016/

Topline:
http://files.kff.org/attachment/topline-methodology-kaiser-health-tracking-poll-february-2016

About half of Americans would prefer a single government health plan for everyone, according to this poll. However, when offered several choices, more would prefer to build on the current system (36%) than would prefer to establish a single government plan (24%). Also, followup questions show that the opinions of a single government plan are quite malleable, depending whether the query has a positive or negative slant.

The malleability of opinion and the poor understanding of the benefits of single payer demonstrate that the public still has a relatively weak understanding of precisely what a single payer system is. We need to intensify our educational efforts.

Perhaps more disconcerting is that more people would prefer to build on the Affordable Care Act than to establish a single government plan. The message of the incrementalists seems to be carrying the day. People believe that we can simply tweak the current system and achieve the same goals as single payer.

What people haven’t grasped are the fundamental differences between the financing infrastructures of our fragmented multi-payer system and a well designed single payer system. Recent Quote of the Day messages describing some of the flaws in our current system have asked the question, “What incremental change would fix this particular problem?” The answers don’t come easy.

It’s easy to say that we can build on the Affordable Care Act by gradually covering more people and by controlling spending by eliminating waste, but these are wishes, not policies. In most instances, there is no simple patch that would work, but rather most changes increase the administrative complexity, add significantly to the costs, and fall short of fully correcting the specific problems addressed.

This is a very important message that we have to deliver. Our current financing infrastructure is not particularly amenable to incremental patches. It is imperative that we replace our flawed infrastructure with one that automatically addresses the problems that we still face in health care financing. Single payer would do that.

This poll also tested labels for a single payer system. Close to two-thirds had a positive reaction to the term, “Medicare-for-all.” People also had a positive reaction to “guaranteed universal health coverage,” but that doesn’t mean much and has been misused as a label for systems that are neither guaranteed nor universal. Yet people seem to be split or confused by the term, “single payer health insurance system.”

“Medicare-for-all” does seem to be preferred, but some opponents are quick to point out the deficiencies in our Medicare program. Adding “improved,” as in “Improved Medicare for All,” defuses that challenge.

So do not let people get away with saying that we’ll simply build on the system we have. Demand that they define the precise incremental steps and how each would move us significantly closer to truly affordable care for absolutely everyone. If you keep pushing them they’ll eventually have to describe a single payer system because patches to our current system just won’t get us there.

ACA reform has not eliminated bad debt for hospitals

Bad Debt Is the Pain Hospitals Can’t Heal as Patients Don’t Pay

By John Lauerman
Bloomberg Business, February 23, 2016

A type of pain that hospitals thought they had relieved has come back with a vengeance: it’s called bad debt.

Hospitals have long struggled to collect bills when patients aren’t covered by insurance — creating delinquent accounts. The Affordable Care Act was supposed to relieve some of that strain by helping pay for coverage for millions of Americans and expanding Medicaid in some states to cover the poor.

Yet while millions of people have gained coverage since Obamacare became law in 2010, there’s also been an increase in insurance that comes with high deductibles and cost-sharing. Under those plans, the first few thousand dollars of annual medical expenses come out of patients’ wallets. That’s money that hospitals like Childress Regional Medical Center in the Texas Panhandle region are unlikely to collect.

“It feels like a sucker punch,” said John Henderson, the nonprofit hospital’s chief executive. “When someone has a really high deductible, effectively they’re still uninsured, and most people in Childress don’t have $5,000 lying around to pay their bills.”

The rate of uninsurance in the U.S. has fallen to 9.1 percent from 15.7 percent in 2009. Yet in the first nine months of 2015, about 36 percent of the U.S. insured were covered by high-deductible or consumer-directed health plans that can require considerable out-of-pocket payments, compared with about 25 percent in 2010, according to a CDC survey.

Hospitals are feeling the pressure from those patients. Community Health Systems Inc. operates 195 hospitals in 29 states and is the U.S.’s second-biggest for-profit U.S. hospital chain. This month, it revised its fourth-quarter 2015 provision for bad debt up by $169 million — and said that 40 percent, or about $68 million of that amount, was from patients being unable to pay deductibles and co-payments. Patient bankruptcies also contributed, the company said.

While higher out-of-pocket charges can lower what insurance costs up front, it means more costs for patients on the back end. Under individual Obamacare mid-level “silver” plans, the annual deductible was $2,556, and under less expensive, low-level “bronze” plans it was $5,328 in 2015, according to the Kaiser Family Foundation.

Outside of Obamacare, deductibles are becoming more common, as well. Last year, 81 percent of coverage people got through work came with a deductible, up from 70 percent in 2010, according to Kaiser. The average deductible in a high-deductible, individual plan gained through work was $2,099 last year.

Rural hospitals have been hit particularly hard. Minnesota has long had high rates of care coverage, and many employers have switched to high deductible offerings, according to Joe Schindler, vice president of finance for the Minnesota Hospital Association. Last year, bad debt rose by 20 percent to $425 million at the association’s 140 member hospitals.

http://www.bloomberg.com/news/articles/2016-02-23/bad-debt-is-the-pain-hospitals-can-t-heal-as-patients-don-t-pay

***

Comment:

By Don McCanne, M.D.

The Affordable Care Act (ACA) was supposed to make health care affordable, yet many hospitals are finding that patients are generating more bad debt. A large portion of that is due to the inability of patients to pay the high deductibles and other cost sharing required  by their insurance plans. Patient bankruptcies also compound the problem.

Deductibles are used by insurers to shift some of the spending to patients so that the insurers can keep the premiums for their plans competitive. But much has been written about how these deductibles create financial burdens for patients. And when the patients cannot pay the deductibles, physicians and hospitals are faced with bad debt. With greater use of higher deductibles, the problems with debt will surely increase.

This is a problem inherent in the model of reform perpetuated by ACA. Various policies such as the deductibles are developed to comply with the private insurance model. How would the incrementalists fix this problem? There are too many moving levers.

What we should have instead is a system in which the policies are developed to comply with the needs of patients. Deductibles can be eliminated if we do away with premiums as a means of financing health care.

The financing of a single payer system is not through individual premiums but rather is through a single universal risk pool that is funded equitably through progressive taxes, making health care affordable for everyone. Medical debt simply goes away.

ACA reform has not eliminated bad debt for hospitals

Bad Debt Is the Pain Hospitals Can’t Heal as Patients Don’t Pay

By John Lauerman
Bloomberg Business, February 23, 2016

A type of pain that hospitals thought they had relieved has come back with a vengeance: it’s called bad debt.

Hospitals have long struggled to collect bills when patients aren’t covered by insurance — creating delinquent accounts. The Affordable Care Act was supposed to relieve some of that strain by helping pay for coverage for millions of Americans and expanding Medicaid in some states to cover the poor.

Yet while millions of people have gained coverage since Obamacare became law in 2010, there’s also been an increase in insurance that comes with high deductibles and cost-sharing. Under those plans, the first few thousand dollars of annual medical expenses come out of patients’ wallets. That’s money that hospitals like Childress Regional Medical Center in the Texas Panhandle region are unlikely to collect.

“It feels like a sucker punch,” said John Henderson, the nonprofit hospital’s chief executive. “When someone has a really high deductible, effectively they’re still uninsured, and most people in Childress don’t have $5,000 lying around to pay their bills.”

The rate of uninsurance in the U.S. has fallen to 9.1 percent from 15.7 percent in 2009. Yet in the first nine months of 2015, about 36 percent of the U.S. insured were covered by high-deductible or consumer-directed health plans that can require considerable out-of-pocket payments, compared with about 25 percent in 2010, according to a CDC survey.

Hospitals are feeling the pressure from those patients. Community Health Systems Inc. operates 195 hospitals in 29 states and is the U.S.’s second-biggest for-profit U.S. hospital chain. This month, it revised its fourth-quarter 2015 provision for bad debt up by $169 million — and said that 40 percent, or about $68 million of that amount, was from patients being unable to pay deductibles and co-payments. Patient bankruptcies also contributed, the company said.

While higher out-of-pocket charges can lower what insurance costs up front, it means more costs for patients on the back end. Under individual Obamacare mid-level “silver” plans, the annual deductible was $2,556, and under less expensive, low-level “bronze” plans it was $5,328 in 2015, according to the Kaiser Family Foundation.

Outside of Obamacare, deductibles are becoming more common, as well. Last year, 81 percent of coverage people got through work came with a deductible, up from 70 percent in 2010, according to Kaiser. The average deductible in a high-deductible, individual plan gained through work was $2,099 last year.

Rural hospitals have been hit particularly hard. Minnesota has long had high rates of care coverage, and many employers have switched to high deductible offerings, according to Joe Schindler, vice president of finance for the Minnesota Hospital Association. Last year, bad debt rose by 20 percent to $425 million at the association’s 140 member hospitals.

http://www.bloomberg.com/news/articles/2016-02-23/bad-debt-is-the-pain-hospitals-can-t-heal-as-patients-don-t-pay

The Affordable Care Act (ACA) was supposed to make health care affordable, yet many hospitals are finding that patients are generating more bad debt. A large portion of that is due to the inability of patients to pay the high deductibles and other cost sharing required  by their insurance plans. Patient bankruptcies also compound the problem.

Deductibles are used by insurers to shift some of the spending to patients so that the insurers can keep the premiums for their plans competitive. But much has been written about how these deductibles create financial burdens for patients. And when the patients cannot pay the deductibles, physicians and hospitals are faced with bad debt. With greater use of higher deductibles, the problems with debt will surely increase.

This is a problem inherent in the model of reform perpetuated by ACA. Various policies such as the deductibles are developed to comply with the private insurance model. How would the incrementalists fix this problem? There are too many moving levers.

What we should have instead is a system in which the policies are developed to comply with the needs of patients. Deductibles can be eliminated if we do away with premiums as a means of financing health care.

The financing of a single payer system is not through individual premiums but rather is through a single universal risk pool that is funded equitably through progressive taxes, making health care affordable for everyone. Medical debt simply goes away.