PNHP

More Aetna abuses, but wait, there's worse

More Aetna abuses, but wait, there's worse

Aetna sued over out-of-network pay and referrals

By Alicia Gallegos
American Medical News, July 23, 2012
The California Medical Assn. and more than 50 physicians are suing Aetna over alleged retaliation against doctors who refer patients for out-of-network care.
The medical society and doctors say Aetna is underpaying out-of-network physicians, refusing to authorize some out-of-network services and illegally terminating the contracts of doctors who make such referrals.
The insurer’s practices violate California law and interfere with doctors’ medical decisions, said Long X. Do, CMA legal counsel.
The plaintiffs claim some of Aetna’s insurance policies enable patients to receive out-of-network care. However, Aetna discourages such practices and regularly refuses to pay for them, the suit claims.
Similarly, doctors’ contracts with Aetna do not specifically forbid all out-of-network referrals, the suit said. Yet, when doctors make such referrals, Aetna frequently threatens them with a “rate adjustment” or termination from Aetna’s network, according to the suit.
In a statement, Aetna spokeswoman Anjanette Coplin called the suit baseless and denied the insurer is mistreating physicians.
“Doctors who entice patients to have procedures performed at out-of-network facilities that they own without the patient’s knowledge are putting profits over their patients,” she said. “The wildly inflated bills of these facilities drive up the out-of-pocket costs for unwitting patients and needlessly add to premium costs for everyone.”
The CMA is aware of Aetna’s lawsuits, but said its suit has nothing to do with them. CMA’s claim centers on Aetna’s policies and practices, Do said.
http://www.ama-assn.org/amednews/2012/07/23/prsa0723.htm

And…

Silicon Valley Surgeons Risk ‘Moral Authority’ For 200% Returns

By Peter Waldman
Bloomberg, July 18, 2012
The anesthesiolgists’ ball in December 2010 was already raging when Dr. Thomas Elardo and his wife arrived. It was 11 p.m., and the Opera House in downtown Los Gatos, California, was packed with nurses and doctors dancing to ’80s covers by The Microbes, an all-doctor band. Elardo climbed the stairs to the mezzanine bar and was immediately gladhanded by Bobby Sarnevesht, a local entrepreneur, and orthopedist Samir Sharma, who pulled Elardo aside.
Elardo had known Sharma for years, but the orthopedist had never given him the time of day. That night was different — he had something to show Elardo. At the bar, Sharma flaunted a $960,000 check, Elardo recalls. Sharma said it was for his work as a surgeon and investor in an outpatient surgery center in Los Gatos, operated by Sarnevesht.
“They were saying, ‘This is the kind of money you can make. You’ve gotta come in!” recalls Elardo. “I was speechless.”
Founded by Sarnevesht and his mother, Julia Hashemieh, Bay Area Surgical Management has marshaled decades of doctor rage against insurance carriers into a profitable business.
By rejecting the discounted contracts that participating in-network providers sign with insurers, the surgery centers bill insurance companies at their own out-of-network rates, which are 5 to 35 times as much as the in-network facilities charge, and make a killing.
Knee arthroscopies that cost $3,000 in Aetna Inc. (AET)’s network earn nearly $20,000 in facility fees at Bay Area’s surgery centers, according to Aetna, the Hartford, Connecticut-based health insurer. A bunion repair that costs $3,700 in-network got almost $53,000 for Bay Area Surgical Group, one such center. A disc surgery for lower-back pain, called a laminectomy, costs about $6,000 in network yet reaps nearly $120,000 for Bay Area Surgical.
Fed up, Aetna sued Hashemieh and partners in February, claiming they gouge on rates, pay surgeons excessive compensation for referrals and defraud health plans.
http://www.bloomberg.com/news/2012-07-19/silicon-valley-surgeons-risk-moral-authority-for-200-returns.html

Although it is always tempting to take on the abuses of private insurers such as Aetna, this time we should look further: the system by which we finance health care in the United States.
Perhaps the most important contribution of the private insurance industry in the past several decades has been the slowing of health care price increases through the process of provider contracting. Of course, public insurers such as Medicare are more effective, though through administered pricing rather than contracting. Nevertheless, health care prices would be even higher had the private insurers not engaged in contracting.
A problem that has never been satisfactorily resolved, in spite of many efforts, is what to do about charges by physicians and facilities that do not have contracts with the insurers – out-of-network providers. In some instances, the insurers pay nothing, except when required by law in certain emergency situations. In other instances, the insurers may pay at lower rates than they do for in-network providers, leaving the high balances as the responsibility of the patients. Often insurers will attempt to negotiate rates after the fact in order to prevent their clients from being stuck with these very high balances.
It is the latter situation that has become a problem. The Bloomberg article above (a very long, ugly story) goes into detail explaining how some entrepreneurial types in the health care delivery system have leveraged out-of-network care into a very lucrative operation. I dare say that Aetna looks like a saintly organization in comparison.
Why should we care? To quote Anderson, Reinhardt and colleagues, “It’s the prices, stupid!” In spite of the limited success of provider contracting, the private insurers have not been capable of adequately controlling price escalation, which is far greater than in all other nations – nations that depend on some sort of government role in establishing fair prices that cover costs and provide fair margins. We all pay more through higher insurance premiums when gougers are rewarded by the private insurers.
Seeing that everyone receives the care that they need, and controlling prices, are the most important functions that the private insurers should be carrying out. Yet they are doing neither competently. The defect is in the design of our health care financing system. The flaws in a system of competing private plans cannot be repaired. The private insurers will never have enough power, and even if they did, how would they use it? And those greedy health care providers who place business interests above professionalism will always be with us.
By replacing the private insurers with our own universal public financing program – an improved Medicare for all – we can include everyone, set prices at their proper level, and shut down the gougers. What are we waiting for?

Joseph Stiglitz's "The Price of Inequality, " with OECD confirmation

The Price of Inequality

By Joseph E. Stiglitz
W. W. Norton & Company, June 2012

This book attempts to fathom the depths of one aspect of what has happened in the United States – how we became a society that was so unequal, with opportunity so diminished, and what those consequences are likely to be.

****

As we look out at the world, the United States not only has the highest level of inequality among the advanced industrial countries, but the level of its inequality is increasing in absolute terms relative to that in other countries.

****

Our political system has increasingly been working in ways that increase the inequality of outcomes and reduce equality of opportunity. This should not come as a surprise: we have a political system that gives inordinate power to those at the top, and they have used that power not only to limit the extent of redistribution but also to shape the rules of the game in their favor, and to extract from the public what can only be called large “gifts.” Economists have a name for these activities: they call them rent seeking, getting income not as a reward to creating wealth but by grabbing a larger share of the wealth that would otherwise have been produced without their effort. Those at the top have learned how to suck out money from the rest in ways that the rest are hardly aware of – that is their true innovation.

****

This book is not about the politics of envy: the bottom 99 percent by and large are not jealous of the social contributions that some of those among the 1 percent have made, of their well-deserved incomes. This book is instead about the politics of efficiency and fairness. The central argument is that the model that best describes income determination at the top is not one based on individuals’ contributions to society (the “marginal productivity theory”), even though, of course, some at the top have made enormous contributions. Much of the income at the top is instead what we have called rents. These rents have moved dollars from the bottom and middle to the top, and distorted the market to the advantage of some and to the disadvantage of others.

****

Health care for all

The two most important impediments to individuals’ achieving their economic aspirations are the loss of a job and an illness. The two together form a lethal combination, one often associated with bankruptcy. Health care in America has traditionally been provided by employers. This inefficient and antiquated system has contributed greatly to the reality that the United States has the most inefficient and poorest-performing, overall, health care system among the advanced industrial countries. The problem with our health care system is not that we spend too much; it’s that we don’t get value for our money and that too many people don’t have access to health care. Obama’s health care reform partially addressed the latter problem… but it did little to improve efficiency. Our high costs are due in part to rent seeking by insurance companies and the pharmaceutical industry. Other countries have curbed these rents. We have not. Other countries not as well-off as the United States have managed to provide universal access to health care. Most countries treat access to medicine as a basic human right. But even if one doesn’t approach the issue from this principled perspective, our failure to provide access to health care increases the inefficiency of our health care system.

Lack of access to health care contributes significantly to inequality, and this inequality in turn undermines the performance of our economy.

http://books.wwnorton.com/books/detail.aspx?ID=4294967848

And…

OECD Health Working Paper No. 58: Income-Related Inequalities in Health Service Utilisation in 19 OECD Countries, 2008-09

By Marion Devaux and Michael de Looper
OECD (Organisation for Economic Co-operation and Development) ,July 10, 2012

This Working Paper examines income-related inequalities in health care service utilisation in OECD countries. For doctor visits, horizontal equity was assessed, i.e. the extent to which adults in equal need of physician care appear to have equal rates of utilisation.

OECD Working Paper on Income-Related Inequalities in Health Service Utilization

http://www.oecd-ilibrary.org/social-issues-migration-health/income-related-inequalities-in-health-service-utilisation-in-19-oecd-countries-2008-2009_5k95xd6stnxt-en
Click on “PDF” for the 61 page paper.

Comment: 

By Don McCanne, MD

Today’s comment is very brief in order to give you more time to read the excerpts from Nobel Prize-winning economist Joseph Stiglitz’s new book, “The Price of Inequality.” One of the prices we pay is our most expensive but poorest performing health care system. Supporting his theme is the coincidental release of a new OECD working paper showing that the United States has the most inequitable access to physicians of the 19 OECD nations studied.

When you read about rents and inequality in Stiglitz’s book, you’ll understand better why the United States is again first… this time in inequitable access to physician visits!

Joseph Stiglitz’s “The Price of Inequality, ” with OECD confirmation

The Price of Inequality

By Joseph E. Stiglitz
W. W. Norton & Company, June 2012

This book attempts to fathom the depths of one aspect of what has happened in the United States – how we became a society that was so unequal, with opportunity so diminished, and what those consequences are likely to be.

****

As we look out at the world, the United States not only has the highest level of inequality among the advanced industrial countries, but the level of its inequality is increasing in absolute terms relative to that in other countries.

****

Our political system has increasingly been working in ways that increase the inequality of outcomes and reduce equality of opportunity. This should not come as a surprise: we have a political system that gives inordinate power to those at the top, and they have used that power not only to limit the extent of redistribution but also to shape the rules of the game in their favor, and to extract from the public what can only be called large “gifts.” Economists have a name for these activities: they call them rent seeking, getting income not as a reward to creating wealth but by grabbing a larger share of the wealth that would otherwise have been produced without their effort. Those at the top have learned how to suck out money from the rest in ways that the rest are hardly aware of – that is their true innovation.

****

This book is not about the politics of envy: the bottom 99 percent by and large are not jealous of the social contributions that some of those among the 1 percent have made, of their well-deserved incomes. This book is instead about the politics of efficiency and fairness. The central argument is that the model that best describes income determination at the top is not one based on individuals’ contributions to society (the “marginal productivity theory”), even though, of course, some at the top have made enormous contributions. Much of the income at the top is instead what we have called rents. These rents have moved dollars from the bottom and middle to the top, and distorted the market to the advantage of some and to the disadvantage of others.

****

Health care for all

The two most important impediments to individuals’ achieving their economic aspirations are the loss of a job and an illness. The two together form a lethal combination, one often associated with bankruptcy. Health care in America has traditionally been provided by employers. This inefficient and antiquated system has contributed greatly to the reality that the United States has the most inefficient and poorest-performing, overall, health care system among the advanced industrial countries. The problem with our health care system is not that we spend too much; it’s that we don’t get value for our money and that too many people don’t have access to health care. Obama’s health care reform partially addressed the latter problem… but it did little to improve efficiency. Our high costs are due in part to rent seeking by insurance companies and the pharmaceutical industry. Other countries have curbed these rents. We have not. Other countries not as well-off as the United States have managed to provide universal access to health care. Most countries treat access to medicine as a basic human right. But even if one doesn’t approach the issue from this principled perspective, our failure to provide access to health care increases the inefficiency of our health care system.

Lack of access to health care contributes significantly to inequality, and this inequality in turn undermines the performance of our economy.

http://books.wwnorton.com/books/detail.aspx?ID=4294967848

And…

OECD Health Working Paper No. 58: Income-Related Inequalities in Health Service Utilisation in 19 OECD Countries, 2008-09

By Marion Devaux and Michael de Looper
OECD (Organisation for Economic Co-operation and Development) ,July 10, 2012

This Working Paper examines income-related inequalities in health care service utilisation in OECD countries. For doctor visits, horizontal equity was assessed, i.e. the extent to which adults in equal need of physician care appear to have equal rates of utilisation.

OECD Working Paper on Income-Related Inequalities in Health Service Utilization

http://www.oecd-ilibrary.org/social-issues-migration-health/income-related-inequalities-in-health-service-utilisation-in-19-oecd-countries-2008-2009_5k95xd6stnxt-en
Click on “PDF” for the 61 page paper.

Comment: 

By Don McCanne, MD

Today’s comment is very brief in order to give you more time to read the excerpts from Nobel Prize-winning economist Joseph Stiglitz’s new book, “The Price of Inequality.” One of the prices we pay is our most expensive but poorest performing health care system. Supporting his theme is the coincidental release of a new OECD working paper showing that the United States has the most inequitable access to physicians of the 19 OECD nations studied.

When you read about rents and inequality in Stiglitz’s book, you’ll understand better why the United States is again first… this time in inequitable access to physician visits!

Health Law's Flaws Will Spur Drive for Single-Payer Reform

By David Himmelstein and Steffie Woolhandler
Common Dreams, July 20, 2012

It’s good the Supreme Court decided to follow the Constitution rather than play politics. But, from a medical point of view, there’s little to celebrate in its upholding of the Affordable Care Act.

The health reform will leave 26 million uninsured even when it’s fully implemented, and force tens of millions to buy lousy coverage from private insurers. Instead of cutting out the insurance middlemen who caused the health care crisis, Obamacare hands them a trillion-dollar windfall from federal subsidies, mandated premiums and Medicaid managed-care contracts.

Because of this sweetheart deal with the insurance industry, the ACA offers no relief from spiraling health care costs.

The results are predictable. Twenty-six million uninsured means 26,000 deaths each year from lack of coverage. Soaring health costs and ever-skimpier insurance mean financial ruin for more and more Americans; already 800,000 middle-class families are driven into medical bankruptcy each year.

In Massachusetts (where Mitt Romney enacted the model for the ACA in 2006) the number of uninsured has fallen by half to 5.6 percent, but costs have skyrocketed. The premium for the cheapest mandated coverage for a 55-year-old is $5,000, and the policy has a $2,000 deductible – that’s $7,000 out of pocket before insurance kicks in.

Little wonder that medical bankruptcies haven’t fallen in Massachusetts, and surveys have found little improvement in how easy it is to get or afford care.

The unrelenting health crisis in Massachusetts has led doctors there to support more radical reform – single-payer national health insurance – by more than 2 to 1 over Romney/Obamacare; even fewer want to go back to the pre-2006 system.

Single payer – a public plan resembling an expanded and upgraded Medicare – could cover the uninsured and upgrade coverage for the rest of us without any increase in health costs.

By replacing private insurers with a streamlined system of public financing, single payer would save $400 billion each year that’s currently wasted on useless paperwork and insurance profits. And single payer would restore Americans’ right to choose any doctor and any hospital.

In poll after poll, most people support single payer, and surveys show doctors nationwide like it too.

Aside from Republicans’ attempts to repeal the ACA, Washington won’t move on health reform until the ACA is fully implemented in 2014 – and it becomes clear it hasn’t solved the crisis. In the meantime, insurers have a rerun of the disastrous HMO experience of the 1990s in store for us, with HMOs rebranded as ACOs (Accountable Care Organizations).

But activists and lawmakers in several states are already pushing ahead in better directions.

Vermont has passed a bill that lays the groundwork for single payer (the governor calls it “a road map to single payer”). The Hawaii Health Authority, mandated by the Legislature to design a “universal health care system covering everyone in the state,” looks set to follow Vermont’s lead.

Single-payer bills have won majorities in New York’s state Assembly (but not its Senate), and in the California Legislature (where the governor vetoed it). And several other states have pending bills and active single-payer movements.

While federal legislation is essential to assure that every American is covered, one of these state efforts may be the spark plug that gets Congress off its duff. Until then, more and more Americans will find health care a source of suffering instead of succor.

David Himmelstein, M.D., and Steffie Woolhandler, M.D., M.P.H., are professors at the City University of New York School of Public Health at Hunter College and visiting professors of medicine at Harvard Medical School. They co-founded Physicians for a National Health Program (www.pnhp.org).

http://www.commondreams.org/view/2012/07/20-4

Health Law’s Flaws Will Spur Drive for Single-Payer Reform

By David Himmelstein and Steffie Woolhandler
Common Dreams, July 20, 2012

It’s good the Supreme Court decided to follow the Constitution rather than play politics. But, from a medical point of view, there’s little to celebrate in its upholding of the Affordable Care Act.

The health reform will leave 26 million uninsured even when it’s fully implemented, and force tens of millions to buy lousy coverage from private insurers. Instead of cutting out the insurance middlemen who caused the health care crisis, Obamacare hands them a trillion-dollar windfall from federal subsidies, mandated premiums and Medicaid managed-care contracts.

Because of this sweetheart deal with the insurance industry, the ACA offers no relief from spiraling health care costs.

The results are predictable. Twenty-six million uninsured means 26,000 deaths each year from lack of coverage. Soaring health costs and ever-skimpier insurance mean financial ruin for more and more Americans; already 800,000 middle-class families are driven into medical bankruptcy each year.

In Massachusetts (where Mitt Romney enacted the model for the ACA in 2006) the number of uninsured has fallen by half to 5.6 percent, but costs have skyrocketed. The premium for the cheapest mandated coverage for a 55-year-old is $5,000, and the policy has a $2,000 deductible – that’s $7,000 out of pocket before insurance kicks in.

Little wonder that medical bankruptcies haven’t fallen in Massachusetts, and surveys have found little improvement in how easy it is to get or afford care.

The unrelenting health crisis in Massachusetts has led doctors there to support more radical reform – single-payer national health insurance – by more than 2 to 1 over Romney/Obamacare; even fewer want to go back to the pre-2006 system.

Single payer – a public plan resembling an expanded and upgraded Medicare – could cover the uninsured and upgrade coverage for the rest of us without any increase in health costs.

By replacing private insurers with a streamlined system of public financing, single payer would save $400 billion each year that’s currently wasted on useless paperwork and insurance profits. And single payer would restore Americans’ right to choose any doctor and any hospital.

In poll after poll, most people support single payer, and surveys show doctors nationwide like it too.

Aside from Republicans’ attempts to repeal the ACA, Washington won’t move on health reform until the ACA is fully implemented in 2014 – and it becomes clear it hasn’t solved the crisis. In the meantime, insurers have a rerun of the disastrous HMO experience of the 1990s in store for us, with HMOs rebranded as ACOs (Accountable Care Organizations).

But activists and lawmakers in several states are already pushing ahead in better directions.

Vermont has passed a bill that lays the groundwork for single payer (the governor calls it “a road map to single payer”). The Hawaii Health Authority, mandated by the Legislature to design a “universal health care system covering everyone in the state,” looks set to follow Vermont’s lead.

Single-payer bills have won majorities in New York’s state Assembly (but not its Senate), and in the California Legislature (where the governor vetoed it). And several other states have pending bills and active single-payer movements.

While federal legislation is essential to assure that every American is covered, one of these state efforts may be the spark plug that gets Congress off its duff. Until then, more and more Americans will find health care a source of suffering instead of succor.

David Himmelstein, M.D., and Steffie Woolhandler, M.D., M.P.H., are professors at the City University of New York School of Public Health at Hunter College and visiting professors of medicine at Harvard Medical School. They co-founded Physicians for a National Health Program (www.pnhp.org).

http://www.commondreams.org/view/2012/07/20-4

Joseph Stiglitz's "The Price of Inequality, " with OECD confirmation

The Price of Inequality

By Joseph E. Stiglitz
W. W. Norton & Company, June 2012
This book attempts to fathom the depths of one aspect of what has happened in the United States – how we became a society that was so unequal, with opportunity so diminished, and what those consequences are likely to be.
****
As we look out at the world, the United States not only has the highest level of inequality among the advanced industrial countries, but the level of its inequality is increasing in absolute terms relative to that in other countries.
****
Our political system has increasingly been working in ways that increase the inequality of outcomes and reduce equality of opportunity. This should not come as a surprise: we have a political system that gives inordinate power to those at the top, and they have used that power not only to limit the extent of redistribution but also to shape the rules of the game in their favor, and to extract from the public what can only be called large “gifts.” Economists have a name for these activities: they call them rent seeking, getting income not as a reward to creating wealth but by grabbing a larger share of the wealth that would otherwise have been produced without their effort. Those at the top have learned how to suck out money from the rest in ways that the rest are hardly aware of – that is their true innovation.
****
This book is not about the politics of envy: the bottom 99 percent by and large are not jealous of the social contributions that some of those among the 1 percent have made, of their well-deserved incomes. This book is instead about the politics of efficiency and fairness. The central argument is that the model that best describes income determination at the top is not one based on individuals’ contributions to society (the “marginal productivity theory”), even though, of course, some at the top have made enormous contributions. Much of the income at the top is instead what we have called rents. These rents have moved dollars from the bottom and middle to the top, and distorted the market to the advantage of some and to the disadvantage of others.
****
Health care for all
The two most important impediments to individuals’ achieving their economic aspirations are the loss of a job and an illness. The two together form a lethal combination, one often associated with bankruptcy. Health care in America has traditionally been provided by employers. This inefficient and antiquated system has contributed greatly to the reality that the United States has the most inefficient and poorest-performing, overall, health care system among the advanced industrial countries. The problem with our health care system is not that we spend too much; it’s that we don’t get value for our money and that too many people don’t have access to health care. Obama’s health care reform partially addressed the latter problem… but it did little to improve efficiency. Our high costs are due in part to rent seeking by insurance companies and the pharmaceutical industry. Other countries have curbed these rents. We have not. Other countries not as well-off as the United States have managed to provide universal access to health care. Most countries treat access to medicine as a basic human right. But even if one doesn’t approach the issue from this principled perspective, our failure to provide access to health care increases the inefficiency of our health care system.
Lack of access to health care contributes significantly to inequality, and this inequality in turn undermines the performance of our economy.
http://books.wwnorton.com/books/detail.aspx?ID=4294967848

And…

OECD Health Working Paper No. 58: Income-Related Inequalities in Health Service Utilisation in 19 OECD Countries, 2008-09

By Marion Devaux and Michael de Looper
OECD (Organisation for Economic Co-operation and Development) ,July 10, 2012
This Working Paper examines income-related inequalities in health care service utilisation in OECD countries. For doctor visits, horizontal equity was assessed, i.e. the extent to which adults in equal need of physician care appear to have equal rates of utilisation.
By Marion Devaux and Michael de Looper
OECD (Organisation for Economic Co-operation and Development) ,July 10, 2012
This Working Paper examines income-related inequalities in health care service utilisation in OECD countries. For doctor visits, horizontal equity was assessed, i.e. the extent to which adults in equal need of physician care appear to have equal rates of utilisation.
OECD Working Paper on Income-Related Inequalities in Health Service Utilization
http://www.oecd-ilibrary.org/social-issues-migration-health/income-related-inequalities-in-health-service-utilisation-in-19-oecd-countries-2008-2009_5k95xd6stnxt-en
Click on “PDF” for the 61 page paper.

Today’s comment is very brief in order to give you more time to read the excerpts from Nobel Prize-winning economist Joseph Stiglitz’s new book, “The Price of Inequality.” One of the prices we pay is our most expensive but poorest performing health care system. Supporting his theme is the coincidental release of a new OECD working paper showing that the United States has the most inequitable access to physicians of the 19 OECD nations studied.
When you read about rents and inequality in Stiglitz’s book, you’ll understand better why the United States is again first… this time in inequitable access to physician visits!

St. Louis doctor pushes for single-payer health care system

By Michele Munz
St. Louis Post-Dispatch, July 19, 2012

CLAYTON, Mo. — In a meeting room at a St. Louis County public library, Dr. Ed Weisbart started his health insurance reform presentation with pictures of sick people.

One was self-employed who couldn’t afford health insurance and made too much money to get Medicaid. Another was a factory worker who lost coverage when he became too ill to work. Then there were working parents whose bills for their sick infant drove them into bankruptcy.

“The reason I’m here and that you are here, is because you’ve seen patients like this,” Weisbart told the crowd.

About 40 people from diverse fields filled the room. They included doctors, students, a medical office manager, social worker and even a musician.

They were there to learn about a single-payer health care system that makes free-market advocates cringe. Instead of hundreds of insurance companies and billing agencies, one government-run organization would collect the fees and pay all the costs under the single-payer plan. In a system financed by a progressive tax, advocates argue that people would pay less than what they pay now in premiums and out-of-pocket costs.

Each person would receive comprehensive medical care and choose whichever doctor or hospital they want. Patients would receive no bills. Co-payments and deductibles would be eliminated.

“It basically involves just changing two words in the law,” Weisbart said about the current federal insurance program for older Americans. “Instead of saying Medicare is available at age 65, say it’s available starting at birth.”

However, the American Medical Association, the country’s largest physician group, supports the current mix of private and public insurance options.

“The private sector has been leading the way in developing and piloting innovative health care delivery and payment models to better support and reward physicians who provide high-value health care,” said the AMA’s president, Dr. Jeremy Lazarus.

Single-payer may seem like an impossibility in the U.S. Weisbart, 58, had long thought so too, until President Barack Obama began tackling health care reform.

“I had thought single-payer, great idea, but it’s not going to happen. The interests against it are so vested,” he said. “Then that pesky Obama got elected, and I got all hopey-changey.”

Implementation of the president’s Affordable Care Act is now in full swing after last month’s ruling by the Supreme Court upheld its constitutionality. The legislation moves the country closer to universal health care coverage, but single-payer advocates like Weisbart argue it’s not enough.

Weisbart is a member of Physicians for a National Health Program, which has been advocating for a single-payer system since 1987 and now has 18,000 members. In March, he started a St. Louis chapter.

The group’s first meeting included 10 people at Weisbart’s home in Olivette. Since then, the chapter has organized two presentations to more than 125 medical students at Washington and St. Louis universities and the recent meeting at the library.

Weisbart led the meeting along with a panel that included the president of a Barnes-Jewish Hospital physician group that advises administration on patient care, a family physician who served on the national policy committee for the nation’s second-largest physician group and a third-year Washington University medical student who co-authored “The Health Care Handbook,” praised as a clear guide to our health care system.

Weisbart has a lengthy resume as well. He was drawn to become a doctor by new ideas in improving patient care: Health maintenance organizations and family medicine.

After medical school, Weisbart went to work as a family doctor for an HMO at Rush Medical College, eventually becoming chief medical officer. Later, a 200-member group of private practice doctors in suburban Chicago hired him as director of care and quality.

Then in 2003, locally based pharmacy benefit giant Express Scripts recruited him as its chief medical officer. He retired from Express Scripts two years ago.

Weisbart also has a long list of volunteer work, including seeing patients at the Barnes-Jewish Center for Outpatient Health and the Saturday Neighborhood Health Clinic run by Washington University medical students, both which serve the under- and non-insured. He’s also the medical director for Rx Outreach, a nonprofit mail-order pharmacy based in Maryland Heights that provides medicine for low-income patients.

A year after retiring from Express Scripts, he was approached by community activist Linda Lieb, 54, about organizing a local Physicians for a National Health Program chapter. She had just moved to St. Louis after helping organize a chapter in Huntsville, Ala., and had heard of Weisbart.

After a long career of trying to improve care within the system, Weisbart agreed to start recruiting. “I realized if you support incrementalism, you oppose fundamental change,” he said.

In Huntsville, Lieb experienced difficulty in finding doctors.

“It’s encouraging to see so many physicians here in St. Louis who are working toward this goal,” she said. “Ed has pulled together a wonderful leadership committee of physicians and medical students.”

Support among physicians appears to be growing. A poll published in 2008 shows 59 percent of doctors support national insurance, up from 49 percent five years earlier. The American College of Physicians, the nation’s second-largest doctor group, and the American Medical Student Association have both endorsed single-payer.

“We need to be more vocal. We need to tell our patients we support this,” Dr. Christine Jacobs, a family physician who directs St. Louis University’s family medicine residency program, said at the library meeting. “When I tell my patients, they are surprised. They say, ‘You think that?’ “

The panel members discussed fears about long waits and stifled medical research, arguing that the system would be more efficient and focused with less money and time spent on marketing, administration and underwriting. Administrative costs consume 31 percent of U.S. health spending, studies have found.

Lazarus, of the American Medical Association, points to the current problems in determining how much physicians are reimbursed through Medicare.

“One look at the flawed Medicare physician payment formula provides a clear example of the problems that can arise with a government-run health care system — conflicting agendas and budget constraints can dictate policy rather than the health care needs of our nation’s senior citizens,” he said.

Federal legislation to enact single-payer would address those problems by creating separate budgets for care, education and capital improvements, Weisbart said. An independent, diverse board would monitor reimbursement and quality.

Even with the Affordable Care Act, experts estimate that 26 million will remain uninsured and others will still be dealing with gaps in coverage and rising costs.

Weisbart is driven by memories of patients like the 62-year-old grandmother caring for her three grandchildren and facing eviction, who asked how long she could live without taking her blood pressure pills.

“I don’t want anyone to ask me that question again,” he said.

http://www.stltoday.com/lifestyles/health-med-fit/fitness/local-doctor-pushes-for-single-payer-health-care-system/article_79560155-639a-5550-a262-3c0be8f38f69.html#ixzz215mBiZSX

Medicare performs better than private plans

Medicare Beneficiaries Less Likely To Experience Cost- And Access-Related Problems Than Adults With Private Coverage

By Karen Davis, Kristof Stremikis, Michelle M. Doty and Mark A. Zezza
Health Affairs, July 18, 2012

The 2010 survey results indicate that compared to people who are privately insured, Medicare beneficiaries are less likely to have cost-related access problems, high premium and out-of-pocket health care expenses as a share of income, and financial problems because of medical bills. And compared to nonelderly adults with employer-based coverage, Medicare beneficiaries are more likely to have access to a medical home—a primary care provider who knows their medical history well, is accessible, and helps coordinate their care. Studies show that patients with medical homes are less likely to report medical errors or gaps in the coordination of their care and are more likely to be up-to-date with their preventive care.

Given these findings, it is not surprising that Medicare beneficiaries are far less likely than privately insured adults to give their health insurance plan a fair or poor rating, while being far more likely to report excellent quality of care.

Among Medicare beneficiaries, those with Medicare Advantage are more likely than adults with traditional Medicare to give their insurance a fair or poor rating. Although Medicare Advantage enrollees are less likely to spend 10 percent or more of their income on premiums and out-of-pocket expenses, they are more likely to report cost-related access problems than adults with traditional Medicare. This may in part reflect beneficiaries’ experience with private health maintenance organization plans that offer lower premiums in return for limited access to a smaller network of providers.

The evidence reported here from surveys now spanning a decade shows that Medicare is doing a better job than employer-sponsored plans at fulfilling the two main purposes of health insurance: ensuring access to care and providing financial protection.

http://content.healthaffairs.org/content/early/2012/07/16/hlthaff.2011.1357.abstract

Summary by The Commonwealth Fund:
http://www.commonwealthfund.org/~/media/Files/Publications/In%20the%20Literature/2012/Jul/1613_Davis_Medicare_vs_employer_ins_HA_07_18_2012_ITL.pdf

Comment:

By Don McCanne, MD

One of the goals of the Affordable Care Act was to protect private, employer-sponsored health plans – a sector that was considered to be functioning well. In so doing, a less expensive Medicare for all model was rejected. So how do the private plans compare to Medicare?

According to this report, “Medicare beneficiaries are less likely to have cost-related access problems, high premium and out-of-pocket health care expenses as a share of income, and financial problems because of medical bills. And compared to nonelderly adults with employer-based coverage, Medicare beneficiaries are more likely to have access to a medical home – a primary care provider who knows their medical history well, is accessible, and helps coordinate their care,” and are “far more likely to report excellent quality of care.”

Medicare is not perfect and does need improvement, but it performs far better than the best of the private plans – the employer-sponsored health plans. Individual and small group plans have an even worse performance.

Above all, “Medicare is doing a better job than employer-sponsored plans at fulfilling the two main purposes of health insurance: ensuring access to care and providing financial protection.”

Right now, efforts are being made to convert Medicare into a market of private plans. Why should we pay more for less health care choice, greater risk exposure, and poorer quality? Any sane individual who is paying attention should realize that we should be doing the opposite – improve Medicare and then provide it for everyone.

Medicare performs better than private plans

Medicare Beneficiaries Less Likely To Experience Cost- And Access-Related Problems Than Adults With Private Coverage

By Karen Davis, Kristof Stremikis, Michelle M. Doty and Mark A. Zezza
Health Affairs, July 18, 2012
The 2010 survey results indicate that compared to people who are privately insured, Medicare beneficiaries are less likely to have cost-related access problems, high premium and out-of-pocket health care expenses as a share of income, and financial problems because of medical bills. And compared to nonelderly adults with employer-based coverage, Medicare beneficiaries are more likely to have access to a medical home—a primary care provider who knows their medical history well, is accessible, and helps coordinate their care. Studies show that patients with medical homes are less likely to report medical errors or gaps in the coordination of their care and are more likely to be up-to-date with their preventive care.
Given these findings, it is not surprising that Medicare beneficiaries are far less likely than privately insured adults to give their health insurance plan a fair or poor rating, while being far more likely to report excellent quality of care.
Among Medicare beneficiaries, those with Medicare Advantage are more likely than adults with traditional Medicare to give their insurance a fair or poor rating. Although Medicare Advantage enrollees are less likely to spend 10 percent or more of their income on premiums and out-of-pocket expenses, they are more likely to report cost-related access problems than adults with traditional Medicare. This may in part reflect beneficiaries’ experience with private health maintenance organization plans that offer lower premiums in return for limited access to a smaller network of providers.
The evidence reported here from surveys now spanning a decade shows that Medicare is doing a better job than employer-sponsored plans at fulfilling the two main purposes of health insurance: ensuring access to care and providing financial protection.
http://content.healthaffairs.org/content/early/2012/07/16/hlthaff.2011.1357.abstract
Summary by The Commonwealth Fund:
http://www.commonwealthfund.org/~/media/Files/Publications/In%20the%20Literature/2012/Jul/1613_Davis_Medicare_vs_employer_ins_HA_07_18_2012_ITL.pdf

One of the goals of the Affordable Care Act was to protect private, employer-sponsored health plans – a sector that was considered to be functioning well. In so doing, a less expensive Medicare for all model was rejected. So how do the private plans compare to Medicare?
According to this report, “Medicare beneficiaries are less likely to have cost-related access problems, high premium and out-of-pocket health care expenses as a share of income, and financial problems because of medical bills. And compared to nonelderly adults with employer-based coverage, Medicare beneficiaries are more likely to have access to a medical home – a primary care provider who knows their medical history well, is accessible, and helps coordinate their care,” and are “far more likely to report excellent quality of care.”
Medicare is not perfect and does need improvement, but it performs far better than the best of the private plans – the employer-sponsored health plans. Individual and small group plans have an even worse performance.
Above all, “Medicare is doing a better job than employer-sponsored plans at fulfilling the two main purposes of health insurance: ensuring access to care and providing financial protection.”
Right now, efforts are being made to convert Medicare into a market of private plans. Why should we pay more for less health care choice, greater risk exposure, and poorer quality? Any sane individual who is paying attention should realize that we should be doing the opposite – improve Medicare and then provide it for everyone.

The Nation moves to right-center on health care

The Battle for Healthcare Has Just Begun

By the Editors
The Nation, July 11, 2012

If you thought the battle over healthcare reform came to an end when the Supreme Court declared the Affordable Care Act’s individual mandate constitutional, think again. The fight is just beginning. On one side the Republican Party and its big money allies aspire to defeat President Obama, take control of Congress and repeal the largest piece of domestic legislation in forty-five years. Mitt Romney’s plan is even more regressive. He’d not only eliminate insurance for the 30 million Americans covered by the ACA; he would change the way the industry is taxed and regulated, turn Medicare into a voucher program and transform Medicaid into a block grant, which together would strip access to healthcare from as many as 28 million Americans who are currently insured.

On the other side are people-powered progressives determined to implement the law and strengthen its less than ideal aspects to achieve universal coverage (see Wendell Potter, page 4). Under the ACA, for example, states will be empowered to create state-based single-payer systems. Vermont has already passed such legislation, and advocates in California are pushing a similar plan, passed by the legislature twice, only to be vetoed both times by then–Governor Schwarzenegger.

But if the fast and furious attack from the right is any indication, we have our work cut out for us. As many as eight Republican governors—led by Tea Party ideologues like Florida’s Rick Scott, Wisconsin’s Scott Walker, South Carolina’s Nikki Haley, Texas’ Rick Perry and Louisiana’s Bobby Jindal—have refused to implement the law’s expansion of Medicaid to cover some of America’s poorest. In Florida, that would affect some 1.3 million people who make less than 133 percent of the federal poverty level (about $31,000 a year for a family of four). In Texas, where 25 percent of residents are uninsured—the highest rate in the nation—Perry’s intransigence would leave 1.8 million out in the cold.

This cruel, cynical agenda has been enabled by a cabal of groups bankrolled by the 1 percent, such as the Chamber of Commerce and Karl Rove’s Crossroads GPS. Even before the Supreme Court decision came down, these organizations had spent some $235 million on attack ads vilifying “Obamacare,” and they are on track to spend much more by November. Already the Koch-backed Americans for Prosperity has launched a $9 million campaign against the ACA and the Democrats who voted for it. Concerned Women for America has pledged another $6 million.

These ads and the rhetoric emanating from the Tea Party guvs are nothing but open fearmongering and baldfaced lies. They insinuate that the ACA would ration healthcare (in fact, the ACA rations it no more or less than the current system). Governor Scott justified his refusal to expand Medicaid by claiming it would add $1.9 billion to Florida’s budget (though the federal government funds 100 percent of Medicaid expansion in the first three years, and Florida’s own healthcare agency estimates it would cost the state far less). Not to be outdone, Rush Limbaugh hysterically called the ACA the “biggest tax increase in the history of the world” (when, in fact, it contains tax breaks for middle-class Americans).

These lies have done a great deal of damage. Many people are confused about what the act does and does not do, creating a debate that seems to take place in an alternate reality. The stakes in this fight, then, are profound: the health of millions of Americans, of our shared social safety net and—not least—of our democracy itself.

Posted reader comment:

By Don McCanne, MD

It is disappointing to see that the editorial position of The Nation has framed the current status of the health care debate as, on the left, a determination to “implement” and “strengthen” the Affordable Care Act, and, on the right, an effort to “repeal” ACA.

The objection is not with the characterization of the right, but with the implication that the left has settled on a right-center approach designed by conservatives. Token mention is made of the Vermont and California efforts to enact single payer, but, in fact, states do not have the option of diverting federal funds from programs such as Medicare and Medicaid into a state-based single payer program, nor can they bypass federal requirements such as the ERISA restrictions, usurping funds from employer-sponsored self-insured plans.

All the tweaking in the world cannot repair the highly-flawed, fragmented, and egregiously administratively wasteful model of ACA. It needs to be replaced with a bona fide model of social insurance – the most appropriate for the United States being a single payer, improved and expanded Medicare that covers everyone.

Also, it is a mistake to be hung up on a left-right linear polarity when the issue of health care justice should be much more inclusive. In an article this week in the Des Moines Register, retired health executive Jack Bernard stated, “If we Republicans took the Medicare-for-all approach, it would thrust us into the vanguard of reform. Instead of the Democrats stealing our ideas, we could steal theirs.”

The Democrats did steal the Heritage model which was originally introduced by Republicans as a conservative response to the Clinton proposal. Democrats have now succeeded in enacting it, but what a terrible model. It will leave tens of millions uninsured while creating a new standard of underinsurance, imposing financial hardship on those with health care needs.

Everyone should read Jack Bernard’s article, and then we should see if we can get past the simplistic polarization to bring us together to improve our health as individuals and to improve the health of the nation.

Jack Bernard, “Head-in-the-sand ‘solution’ is killing GOP”:
http://www.desmoinesregister.com/article/20120716/OPINION01/307160040/

The Nation editorial:
http://www.thenation.com/article/168844/battle-healthcare-has-just-begun

Nurses Union Will Keep Fighting for Medicare for All

By Rose Ann DeMoro
The Nation, July 17, 2012

Now that the Supreme Court has upheld the Affordable Care Act, former insurance company executive Wendell Potter’s appeal to single payer advocates to “bury the hatchet,” recently published in The Nation, is both misdirected and shortsighted.

Potter argues that insurance industry pirates will exploit left critiques of the ACA to subvert implementation of the law. He calls on proponents of more comprehensive reform to forgive and forget, embracing the massive concessions made by the Obama administration and its liberal allies.

But there are some gaping holes in this thinking.

First, the insurers hardly need to rely on the single-payer movement to sabotage elements of the law they don’t like. They have office towers full of high-priced lawyers who are adept at identifying loopholes in the much-touted consumer protection provisions, like the bans on pre-existing condition exclusions or dropping coverage when patients get sick, or limiting how much money can be siphoned off for profits and paperwork.

Second, let’s not have illusions about the history of the ACA.

Before he was elected, President Obama, an advocate of single-payer when he was in the Senate, called on progressives to push him. Instead, most of the liberals reduced themselves to cheerleading while all the pressure came from the right.

So when the healthcare bill was introduced, the President, with the active encouragement of groups like Health Care for America Now, blocked single payer from consideration. Persuading people through consent, rather than coercion, to accept inadequate solutions for societal needs has long been a key feature of the neoliberal agenda.  It’s one reason so many people vote against their own interests.

To get any hearing from Sen. Max Baucus, who was running the Senate side of the debate, nurses, doctors, and single-payer healthcare activists had to get arrested in a Senate Finance Committee hearing. On the House side, Democrats who proposed single payer amendments endured heavy-handed threats from then-White House chief of staff Rahm Emanuel. Meanwhile, then-Press Secretary Robert Gibbs publicly attacked the “professional left” who will only “be satisfied when we have Canadian healthcare and we’ve eliminated the Pentagon.”

It should not come as a surprise that negotiating with your supporters before engaging political opposition, and lecturing, hectoring and seeking to silence healthcare activists who have worked for years for real reform, Obama and the Democrats ended up with a weaker bill. That bill lacked the public option HCAN and other liberals had claimed would be their bottom line, while HCAN and other liberals embraced the individual mandate – the brainchild of the rightwing Heritage Foundation – as high principle.

Even with its positive elements – yes, it does have some – the Affordable Care Act uses public money to pad insurance profits (the subsidies to buy private insurance), prevents the government from using its clout to limit price gouging by the pharmaceutical giants, does little to effectively control rising healthcare costs for individuals and families that have made medical bankruptcies and self-rationing of care a national disgrace, and falls far short of the goal of universal coverage.

We can, as Michael Moore has said, acknowledge that the Supreme Court decision was a defeat for the opponents of any reform of our healthcare system without pretending that our nation’s health care crisis is over.

For three weeks in June and July, the California Nurses Association/National Nurses United sponsored a tour that drew about 1,000 people to free basic health screenings and another 2,000 to town hall meetings in big cities and rural communities across California. We heard a lot of stories like this one, from Carolyn Travao of Fresno:

I worked for Aetna health insurance for 15 years. When I took early retirement, I thought my Cobra would be manageable. Then they sent me a bill in January for $1,300 a month and I couldn’t pay it.

Soon after,

I had a heart attack. I knew I didn’t have health insurance. I have a mortgage. I had a 401(k) that I knew would get wiped out, so I didn’t go to the hospital. I stayed at home for 16 hours, suffering chest pains, praying that I would die because my son would be left homeless and I do have insurance to pay off my mortgage so if I die he would at least have a home. I couldn’t take the pain any longer and I kept passing out, and he kept saying “Mom, you’re going to die.”

“OK,” I said, “take me to emergency.” So we went to emergency. But when I got home, my bill was $135,000. I have $13,000 left in my 401k. I don’t think I can even start [paying].  I never thought I would lay there and want to die. But I would have rather died knowing that my son would be left homeless with no job.

Since the ACA’s cost control mechanisms for insurance companies are so weak – for example permitting insurers to charge far more based on age and where you live – and hospitals will still largely have free reign to impose un-payable bills, will Carolyn and millions like her really have guaranteed healthcare under the ACA?

Sadly, nurses who have seen far too many patients like Carolyn know the answer all too well. That is why nurses and our organization will never stop fighting for guaranteed healthcare based on a single standard of quality care for all that is not based on ability to pay and is not premised on protecting the profits of healthcare corporations that long ago wrote off patients like Carolyn Travao.

Unlike Wendell Potter and many of the liberals, nurses see the ACA as a floor, not a ceiling. It’s time now for those who say they recognize its limitations and believe in genuinely universal healthcare to join us in pushing for an improved and expanded Medicare for all.

Nurses respect the president.  But they love their patients far too much not to go the distance for their patients’ health and survival.

http://www.thenation.com/article/168928/nurses-union-will-keep-fighting-medicare-all

The Nation moves to right-center on health care

The Battle for Healthcare Has Just Begun

By the Editors
The Nation, July 11, 2012
If you thought the battle over healthcare reform came to an end when the Supreme Court declared the Affordable Care Act’s individual mandate constitutional, think again. The fight is just beginning. On one side the Republican Party and its big money allies aspire to defeat President Obama, take control of Congress and repeal the largest piece of domestic legislation in forty-five years. Mitt Romney’s plan is even more regressive. He’d not only eliminate insurance for the 30 million Americans covered by the ACA; he would change the way the industry is taxed and regulated, turn Medicare into a voucher program and transform Medicaid into a block grant, which together would strip access to healthcare from as many as 28 million Americans who are currently insured.
On the other side are people-powered progressives determined to implement the law and strengthen its less than ideal aspects to achieve universal coverage (see Wendell Potter, page 4). Under the ACA, for example, states will be empowered to create state-based single-payer systems. Vermont has already passed such legislation, and advocates in California are pushing a similar plan, passed by the legislature twice, only to be vetoed both times by then–Governor Schwarzenegger.
But if the fast and furious attack from the right is any indication, we have our work cut out for us. As many as eight Republican governors—led by Tea Party ideologues like Florida’s Rick Scott, Wisconsin’s Scott Walker, South Carolina’s Nikki Haley, Texas’ Rick Perry and Louisiana’s Bobby Jindal—have refused to implement the law’s expansion of Medicaid to cover some of America’s poorest. In Florida, that would affect some 1.3 million people who make less than 133 percent of the federal poverty level (about $31,000 a year for a family of four). In Texas, where 25 percent of residents are uninsured—the highest rate in the nation—Perry’s intransigence would leave 1.8 million out in the cold.
This cruel, cynical agenda has been enabled by a cabal of groups bankrolled by the 1 percent, such as the Chamber of Commerce and Karl Rove’s Crossroads GPS. Even before the Supreme Court decision came down, these organizations had spent some $235 million on attack ads vilifying “Obamacare,” and they are on track to spend much more by November. Already the Koch-backed Americans for Prosperity has launched a $9 million campaign against the ACA and the Democrats who voted for it. Concerned Women for America has pledged another $6 million.
These ads and the rhetoric emanating from the Tea Party guvs are nothing but open fearmongering and baldfaced lies. They insinuate that the ACA would ration healthcare (in fact, the ACA rations it no more or less than the current system). Governor Scott justified his refusal to expand Medicaid by claiming it would add $1.9 billion to Florida’s budget (though the federal government funds 100 percent of Medicaid expansion in the first three years, and Florida’s own healthcare agency estimates it would cost the state far less). Not to be outdone, Rush Limbaugh hysterically called the ACA the “biggest tax increase in the history of the world” (when, in fact, it contains tax breaks for middle-class Americans).
These lies have done a great deal of damage. Many people are confused about what the act does and does not do, creating a debate that seems to take place in an alternate reality. The stakes in this fight, then, are profound: the health of millions of Americans, of our shared social safety net and—not least—of our democracy itself.

Originally posted as a reader comment:
It is disappointing to see that the editorial position of The Nation has framed the current status of the health care debate as, on the left, a determination to “implement” and “strengthen” the Affordable Care Act, and, on the right, an effort to “repeal” ACA.
The objection is not with the characterization of the right, but with the implication that the left has settled on a right-center approach designed by conservatives. Token mention is made of the Vermont and California efforts to enact single payer, but, in fact, states do not have the option of diverting federal funds from programs such as Medicare and Medicaid into a state-based single payer program, nor can they bypass federal requirements such as the ERISA restrictions, usurping funds from employer-sponsored self-insured plans.
All the tweaking in the world cannot repair the highly-flawed, fragmented, and egregiously administratively wasteful model of ACA. It needs to be replaced with a bona fide model of social insurance – the most appropriate for the United States being a single payer, improved and expanded Medicare that covers everyone.
Also, it is a mistake to be hung up on a left-right linear polarity when the issue of health care justice should be much more inclusive. In an article this week in the Des Moines Register, retired health executive Jack Bernard stated, “If we Republicans took the Medicare-for-all approach, it would thrust us into the vanguard of reform. Instead of the Democrats stealing our ideas, we could steal theirs.”
The Democrats did steal the Heritage model which was originally introduced by Republicans as a conservative response to the Clinton proposal. Democrats have now succeeded in enacting it, but what a terrible model. It will leave tens of millions uninsured while creating a new standard of underinsurance, imposing financial hardship on those with health care needs.
Everyone should read Jack Bernard’s article, and then we should see if we can get past the simplistic polarization to bring us together to improve our health as individuals and to improve the health of the nation.
Jack Bernard, “Head-in-the-sand ‘solution’ is killing GOP”:
http://www.desmoinesregister.com/article/20120716/OPINION01/307160040/
The Nation editorial:
http://www.thenation.com/article/168844/battle-healthcare-has-just-begun