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Medicare for All: A Single Solution to the Health Care Fracas

Medicare for All: A Single Solution to the Health Care Fracas

The Affordable Care Act was upheld by the Supreme Court, but many remain dissatisfied. How we can still make health care work

By Robert Weissman
Yes! magazine, June 29, 2012

It will take some time to digest the Supreme Court’s decision yesterday, but it appears to have averted some terrible jurisprudence that might have very seriously restricted the government’s overall ability to regulate the economy and protect citizens.

In upholding most of the Affordable Care Act, the Supreme Court lets stand legislation that offers some important benefits, but only to a portion of those who are uninsured, and will predictably fail to solve our nation’s health care crisis.

However the health reform law ultimately plays out, we know two things for certain: Tens of millions of Americans will remain uncovered as will tens of millions of under-insured who will remain at risk of financial ruin if a major illness strikes; and it will leave the private health insurance and pharmaceutical industries in charge of prices and life-and-death treatment decisions.

There is a single solution to the challenges of providing coverage to the 50 million who are uninsured that would curb out-of-control health care costs and provide a humane standard of care to all who enter the medical system. That solution is an improved Medicare-for-All, single-payer system.

The improved Medicare-for-All approach starts with the premise that health care is a critically needed right that must be afforded to all, irrespective of any individual’s ability to pay for care. It solves the problems of 50 million uninsured Americans simply and directly by establishing that everyone is covered by the improved Medicare-for-All system. Everybody in, nobody out.

Improved Medicare-for-All would prevent the deaths of the 45,000 Americans who die every year from lack of health insurance. It would eliminate the hundreds of thousands of medical bankruptcies—affecting millions of Americans every year—that occur because people can’t pay their medical bills. These deaths and economic tragedies are entirely preventable; a system that permits them to continue is morally repugnant and must be replaced.

The improved Medicare-for-All approach would eliminate the greatest waste in the health care system: the needless costs imposed by private health insurers. These firms impose hundreds of billions of dollars of excess cost on us via excessive profit-taking and executive compensation, marketing expenses, vast bureaucracies devoted to denying care, and imposition of massive paper-pushing obligations on actual health care providers.

It is not for lack of policy justification or moral force that Americans continue to suffer from a malfunctioning health care system. Our failure to have adopted an improved Medicare-for-All system is due in large part to the political power of the health insurance industry.

That political power can be overcome, however, by a grassroots movement that musters enough of its own power. The country cannot continue to survive the continued reign of the private health insurance industry, and it will not.

Winning a single-payer system will not be easy. In the near term, the single-payer movement will need to devote substantial energy to holding off efforts to further privatize and weaken existing Medicare.

The early steps forward in winning expanded and improved Medicare-for-All will likely come from state initiatives, where success will depend on local movements plus assurances that states pursuing improved Medicare-for-All can obtain needed waivers from federal laws and rules.

But there should be no doubt about what must ultimately be achieved. We can no longer tolerate a system that pointlessly kills 45,000 fellow Americans a year. For those who doubt the political potency of this moral imperative, consider that economic facts counsel just as strongly for an improved Medicare-for-All system.

We can be our brother’s (and sister’s) keeper and be cost-effective at the same time. Indeed, it turns out that being cost effective requires that we take care of each other.

Robert Weissman is president of Public Citizen, a national, nonprofit consumer advocacy organization based in Washington, D.C. Public Citizen has supported a single-payer system since its founding more than four decades ago.

http://www.yesmagazine.org/people-power/medicare-for-all-a-single-solution-to-the-health-care-fracas

Did John Roberts Give Mitt Romney A Gift?

By Marcia Angell, M.D.
The Huffington Post, June 29, 2012

The Supreme Court’s decision to uphold the Affordable Care Act, aka Obamacare, puts me in mind of the old proverb: Be careful what you wish for. Democrats on a victory lap should watch their step, because John Roberts may have given Mitt Romney a gift. The impact on the health system will be much smaller than the political fallout, because with or without Obamacare, the American health system will continue to unravel — quickly if Romney is elected, slowly if Obama is re-elected.

First the policy, then the politics:

Obamacare is simply incapable of doing what it is supposed to do — provide nearly universal care at an affordable and sustainable cost. The problem is that three years ago, in his futile efforts to win over Republicans (remember the embarrassing courtship of Olympia Snowe?), Obama gutted the law before it was even passed. He made the private insurance companies the linchpin of the new system, and promised them millions of additional customers and billions of taxpayer dollars. He also did nothing to rein in the profit-oriented delivery system that rewards providers on a piecework basis for doing tests and procedures. So with all the new dollars flowing into the system and no restraints on the way medicine is practiced, the law is inherently inflationary.

Although there are some provisions to curb the worst abuses of the insurance companies, such as excluding people with preexisting conditions, there is nothing in the law that would stop insurers from raising premiums. A senior executive of the industry’s trade association, America’s Health Insurance Plans, told me privately that that’s exactly what the companies will do if regulations cut into their profits. Thus, costs under Obamacare will almost certainly rise even faster than at present. No reform can work well or very long if its costs are unsustainable.

In fact, it is unlikely that Obamacare will ever be fully implemented as it stands. If Romney is elected, with a Republican Congress, it will be quickly overturned. If Obama is re-elected (and I hope he is, despite my disappointment in his health plan), it will come apart more slowly. But unravel it will, as costs rise and it becomes clear that there are still tens of millions of Americans priced out of the system.

Here’s how the unraveling will look:

Many of the uninsured who are subject to the mandate to purchase private insurance will choose to pay the penalty/tax instead. That will lead the insurance companies to raise their premiums, demand that the penalties be greater, or both. Deductibles and co-payments will increase to the point that many people will have insurance they can’t afford to use. (This is the case in Massachusetts.) Many employers will simply stop offering health insurance, since our high unemployment means workers no longer have the leverage to demand it, or they will stop insuring dependents (thus avoiding having to cover grown children to age 26). In addition, because insurers have a strong financial incentive to evade the new regulations requiring them to take all comers, it will take a huge bureaucracy to monitor them.

Next year, states are supposed to set up insurance exchanges to pool risks and offer a menu of approved insurance plans for individuals and small businesses. But they are unlikely to be functioning by 2014, as called for in the law, either because Republican states simply refuse to set them up and hamper federal efforts to step in, or because of the administrative complexities. Some states may also refuse to accept the funds to expand Medicaid, as called for in the law, since the Supreme Court found that they could opt out without losing their existing federal Medicaid funding. Here again, the bureaucracy necessary to aid and monitor state compliance will be huge, diverting resources from health care. In addition, there are likely to be multiple legal challenges to nearly all provisions of the law.

Obamacare partially offsets the costs of federal subsidies to insurance companies and Medicaid costs by cutting Medicare reimbursement to providers. That means hospitals and other health facilities will take a hit, and many are already struggling.

So that’s how it will unravel. There will be efforts to patch it up as we go along, but because Obamacare leaves our current inflationary system largely in place, they are unlikely to be successful.

Now for the politics. Even though the Supreme Court decision will have little long-term effect on our health system, the political ramifications will be great. To be sure, it’s a victory for Obama, but that will be evanescent. Now the Republicans are on the offensive, and greatly strengthened by John Roberts’ insistence that the mandate is a tax, not a penalty. Remember how hard Obama tried to avoid the T-word? Republicans are adept at painting Democrats as tax-happy, and Roberts has helped them to do just that. Pundits wonder what got into the Chief Justice. Was he just trying make the Supreme Court appear to be above politics, given all the recent evidence that it’s not? Or did he do a favor for Romney and the Republicans?

It’s very hard to read, but I think the Democrats would have been better off if the Supreme Court had overturned Obamacare, and I think it would have been better for our health system, as well. The base would be energized, and Democrats would take the offensive. More important, no one would be under the illusion that the health system has been successfully reformed, as many good liberals now are. That mistake will become clear as the system unravels. Democrats will suffer the death of a thousand cuts, rather than a quick blow that could be blamed on our politicized Supreme Court. If the law had been struck down, we could have started right away to work on an effective reform.

The only way to provide health care to all Americans at an affordable cost is by instituting some form of publicly-administered nonprofit system like those in other advanced countries. After all, they manage to provide universal care at less than half the cost, on average, and their costs are rising more slowly. I have long advocated expanding Medicare (which is a single-payer program) gradually by lowering the eligibility age one decade at a time, while phasing out for-profit health facilities and changing doctors’ fees to reward primary care more and specialist care less.

On July 22, 2009, Obama said in a press conference, “Now, the truth is that unless you have what’s called a single-payer system in which everybody is automatically covered, then you’re probably not going to reach every single individual.” Bingo. Too bad he didn’t hang on to that insight, and use his rhetorical skills to make the case strongly to the American public. If he had fought for single-payer health care at the beginning of his administration, while he had both houses of Congress, and mobilized public opinion behind it, he might have made it. After all, the only thing members of Congress need more than industry money is votes.

Dr. Marcia Angell is a senior lecturer at Harvard Medical School and former editor of the New England Journal of Medicine.

http://www.huffingtonpost.com/marcia-angell-md/roberts-romney-health-care_b_1637397.html

Single-payer system would insure more

By Joshua Faucher
Post-Bulletin (Rochester, Minn.), Letters, June 29, 2012

The Patient Protection and Affordable Care Act is anything but a complete solution to our health care crisis. The bill still will leave at least 26 million devoid of insurance coverage. Equally worrisome, it will force many into a relationship with private insurers for coverage that is too expensive and often incomplete. We must react by implementing the non-profit, single-payer insurance system our country needs and deserves.

PPACA has left insurers firmly entrenched between patients and their doctors. Private insurers’ new high-deductible plans, with their massive coverage gaps, paired with the individual mandate, will force  the most vulnerable patients into plans that don’t protect them from medical costs.

This bill also ignores the hidden cost our fragmented insurance system brings to medicine. Thriftless spending on billing and coding administration makes our doctor’s visits seem more expensive than they actually are. Private insurers have scapegoated doctors and patients as wasteful when many go without care they need, and accountable care organizations will force the responsibility for cost savings where they can’t be shouldered.

Examples of single-payer systems, such as the United Kingdom or Canada, show that full participation in a non-profit, publicly accountable plan is the most efficient way to justly spread the cost of care. Only when we implement this true reform in Minnesota, and the rest of the United States, will we finally cover everyone.

Joshua Faucher is a medical student in Rochester, Minn.

http://postbulletin.com/news/stories/display.php?id=1501125

ACA is weak law; we need Medicare for all

By Frederick W. “Rick” Ford
The Palm Beach Post, June 29, 2012

Although the Supreme Court has upheld the Affordable Care Act (ACA), the law is not a remedy to our health care crisis, as it leaves at least 26 million uninsured, will not make health care affordable to Americans with insurance, because of high co-pays and gaps in coverage that leave patients vulnerable to financial ruin in the event of serious illness, and will not control costs.

Why is this so? Because the ACA perpetuates a dominant role for the private insurance industry. Each year, that industry siphons off hundreds of billions of health care dollars for overhead, profit and the paperwork it demands from doctors and hospitals; it denies care in order to increase insurers’ bottom line; and it obstructs any serious effort to control costs.

In contrast, a single-payer, improved-Medicare-for-all system would achieve all three goals – truly universal, comprehensive coverage; health security for our patients and their families; and cost control. It would do so by replacing private insurers with a single, not-for-profit agency like Medicare that pays all medical bills, streamlines administration, and reins in costs for medications and other supplies through its bargaining clout.

The administrative cost savings alone would be $400 billion annually, enough to provide quality care to everyone with no overall increase in U.S. health spending.

The most rapid way to achieve universal coverage would be to improve upon the existing Medicare program by excluding private insurance participation (through so-called Medicare Advantage plans) and expand it to cover people of all ages. There is legislation before Congress, notably H.R. 676, the Expanded and Improved Medicare for All Act, which would do precisely that.

There is only one equitable, financially responsible and humane cure for our health care mess: single-payer national health insurance, an improved Medicare for all.

Frederick W. “Rick” Ford is president of Floridians for Health Care. He resides in Palm Beach Gardens.

PNHP note: This letter was also printed in the Sun Sentinel in Fort Lauderdale.

Major defects in law avoidable with single payer

By Quentin Young, M.D.
Chicago Tribune, Letters, June 28, 2012

The Supreme Court decision on health care reform achieved several goals. It affirmed the constitutionality of the federal health care reform legislation and clearly gave President Barack Obama’s re-election a big boost.

On the other hand, the decision left untouched serious defects in the present reform, including the following:

1. It leaves 26 million people uninsured in 2019 when the law is fully implemented. 2. It does not rein in skyrocketing health care costs. 3. It doesn’t mitigate the epidemic of medical bankruptcy, with 1 million victims in 2011.

These major defects can be avoided by enactment of single-payer, improved Medicare for all, based on the principle of everybody in, nobody out. Such legislation will end the irony of a health system that costs twice as much as systems in other nations, such as Canada and Taiwan, yet fails to cover so many.

Dr. Quentin Young is national coordinator of Physicians for a National Health Program.

http://www.chicagotribune.com/news/opinion/letters/chi-120628young_briefs,0,467211.story

Vt. gov. hails health ruling, pushes bigger plan

By DAVE GRAM
Associated Press, June 28, 2012

MONTPELIER, Vt. (AP) — Vermont’s push for universal, publicly funded, single-payer health care is going ahead no matter what, Gov. Peter Shumlin said Thursday, but he hailed the U.S. Supreme Court decision upholding the federal Affordable Care Act as a big boost for the state’s efforts.

Shumlin called Thursday ‘‘a great day for Vermonters and a great day for Americans.’’ But, he added, ‘‘I would say that of all the states of the Union, the least to be impacted by the Affordable Care Act is probably the state of Vermont.’’

That’s because Vermont’s health care overhaul, which legislation passed last year says will be implemented by 2017, goes well beyond the federal law, in the direction of a Canadian-style public system.

The biggest impact from the federal law will be money: an estimated $400 million a year in tax credits to help people with low and moderate incomes buy health insurance. That’s expected to provide a partial answer to a big and still unanswered question: how Vermont will pay for its new health care system.

The federal government also is expected to provide the state hundreds of millions more to help it set up new computer networks to manage patient information. That’s widely seen as needed to control cost through increased efficiency. The state on Friday will submit an application for a federal grant of up to $118 million, mostly for information technology and the personnel to set it up, said Robin Lunge, Shumlin’s director of health care reform.

But those sums are just a fraction of the roughly $5 billion a year Vermont spends on health care. Critics of the health program backed by Shumlin and his fellow Democrats who control the Legislature complain that a plan has yet to be devised for how it will be paid for. The 2011 law calls for the administration to recommend a financing mechanism when lawmakers return for a new session next January.

Shumlin argues, and did so again Thursday, that Vermont is spending the money now; he just wants to change how that happens. He especially wants to remove the expectation that employers pay for their workers’ health coverage, saying that will be a boon to job creation.

Vermont is fully on board with the federal law’s call for setting up a regulated health insurance marketplace, called an exchange, where consumers will be able to shop for price and compare coverage offered by various types of health insurance beginning in January 2014.

But the state’s 2011 law calls for the exchange to be just a steppingstone toward the goal of having all Vermont residents covered by a public health insurance program, with just one entity — a single payer — sending money to doctors, hospitals and other providers.

Another key to Vermont’s project is cost controls. The state wants to move away from the traditional ‘‘fee-for-service’’ model of paying for health care, in which the more of a procedure a health professional performs, the more he or she gets paid. Instead, various types of ‘‘global budget’’ are being considered, in which hospitals and medical practices would be paid a set amount for caring for a given populations, likely with bonuses for keeping people healthier.

State officials and Vermont’s three-person congressional delegation in Washington have been pushing legislation that would move up the date in the Affordable Care Act when states can get waivers from some of its requirements, from 2017 to 2014. Vermont would use such a waiver — essentially a you-don’t-have-to allowance — to move from the exchange to a single-payer system.

Lunge said a key to getting a waiver under the federal law is ensuring that whatever replaces the exchange results in at least as high a percentage of the population having health insurance.

Shumlin said Thursday that now that the federal law has been upheld, he may have some new allies pushing Congress for waivers among conservative governors likely to have their own reasons to seek outs from some parts of the federal law.

‘‘This decision probably gives us allies in our quest, in our plea for flexibility in Vermont among Tea Party governors (who) are going to want flexibility for different reasons,’’ Shumlin said.

As for the individual mandate, the much-discussed requirement in the federal law that every American must have health insurance or pay a penalty, that won’t be an issue in Vermont, Shumlin said.

‘‘We’ll be the first state in the country where health care is a right and not a privilege and where you get health insurance because of your residency, not because of a mandate,’’ he said.

Health Care Reform: We’re Not Done Yet

By Walter Tsou, M.D.
CommonDreams, June 29, 2012

The Supreme Court has spoken. The Affordable Care Act, briefly on the ropes, has been blessed as the law of the land.

Too many feel that health reform is finally finished and we can move on to the big three issues: the economy, jobs and the deficit. However, because health care is the 800-pound gorilla of the economy, those issues cannot be solved without more far-reaching health reform.

Sorry, lawmakers, but you are going to need to get back in the ring to answer a fundamental question: what is the most cost-effective and constitutional way to finance health care so that we can have quality, affordable health care for everyone?

The answer – single-payer national health insurance, also known as an improved Medicare for all – would save America hundreds of billions of dollars annually. And as the Supreme Court reaffirmed, a program of this type, financed by taxes, is definitely constitutional.

Outrageously, this simple solution was never discussed in the two contentious years of debate surrounding the creation of the ACA because it was deemed “politically impossible.”

“Politically impossible” means that the mere utterance of “single payer” would be enough to prompt the medical-industrial complex, especially the pharmaceutical and insurance industries, to funnel millions of dollars in campaign contributions and lobbying money to opponents of real reform and to tea party groups in order to keep the status quo.

So America continues to promote the least cost-effective way of financing health care, which means that we spend twice per capita on health care than any other nation on earth.

When we were the global leader as we were back in the mid-20th century, we could afford to do this. However, we cannot afford our health care system anymore. It is hopelessly complex, bureaucratic, and outrageously expensive. Employers have shifted the cost to employees and it will only get worse as private insurers raise their premiums.

Beyond skyrocketing premiums, about 18 percent of our gross national product is consumed by health care. That figure will rise to 20 percent by the end of the decade. In order to fund this inefficient system, we have borrowed trillions of dollars over the past 50 years, transforming us into the world’s greatest debtor nation.

No matter who wins the November election, the next administration will be forced to confront the deficit. Unfortunately, it appears that our lawmakers’ tunnel vision only offers slashing Social Security, Medicaid and Medicare for the poor and elderly as a way to reduce government spending. That course would be catastrophic.

No one seems to want to confront the fact that unless we are willing to embrace an improved Medicare for all, with its streamlined administration and bargaining clout, we have no hope of controlling health care costs, ensuring that our country will remain in debt. Had we adopted a single-payer system 20 years ago, we would have turned our national debt into a surplus today.

In a global economy, employers have to add the cost of health insurance to every product or service. When that cost is twice what the world spends, it eventually means that we are pricing our products too high. Manufacturers have moved their major factories overseas because of lower labor costs, of which health insurance is a key component.

Entrepreneurs are everywhere in America, but too many are locked into undesirable jobs because they need the health benefits. Those who want to put their toe into the self-employed world stop because of the risk of losing health benefits which is bad for an economy that needs creativity and risk.

State and local governments are being weighed down by pension obligations and retiree health benefits. Under a single-payer system, Philadelphia could be freed from the unpredictability of these costs and use those precious dollars for our schools, streets, or public safety.

An ABC/Washington Post poll shows that less than 40 percent of Americans view the ACA or the status quo favorably – remarkably low for a “uniquely American” solution.

Our politics have robbed us from even discussing a practical, commonsense solution – improved Medicare for all — that we desperately need in America. If the medical-industrial complex continues to win, health care costs will continue to rise, and the American people will be the losers.

Dr. Walter Tsou is former health commissioner of Philadelphia. He is a board adviser to Physicians for a National Health Program (www.pnhp.org) and resides in Philadelphia.

http://www.commondreams.org/view/2012/06/29-4

So is ACA all there is?

Senator Bernie Sanders
June 28, 2012

In my view, while the Affordable Care Act is an important step in the right direction and I am glad that the Supreme Court upheld it, we ultimately need to do better.  If we are serious about providing high-quality, affordable healthcare as a right, not a privilege, the real solution to America’s health care crisis is a Medicare-for-all, single-payer system. Until then, we will remain the only major nation that does not provide health care for every man, woman and child as a right of citizenship.

http://www.sanders.senate.gov/newsroom/news/?id=8beaca2a-ede7-4add-97ca-18865c0eb0c3

Comment: 

By Don McCanne, MD

The responses to the Supreme Court decision to uphold the basics of the Affordable Care Act were quite predictable. Through all of the cacophony, two predominant views settle out: 1) After a period of celebration, the proponents want to move forward with implementation, and 2) The opponents want to change control of the government so that they can repeal the Act (though maybe proceed with reintroducing limited elements of it).

Yet there is another view simmering under the surface. There is a grave concern that too many people will be left out of the system, that those who have insurance will find that the subsidies are inadequate to provide financial security in the face of medical need, and that the Medicaid program will remain chronically underfunded, resulting in health care access limitations. It will become obvious that these are not acceptable outcomes.

People who understand the single payer model realize that it is the only feasible option, but just as it was buried during the reform process, it will now be buried under the fervor in implementing the Affordable Care Act. We will continue to speak out, but the supporters of the Act will refuse to listen because they are too busy with implementation.

By about 2015 or 2016, those dedicated ACA supporters will see that the numbers really aren’t working, in spite of their efforts – still too many uninsured, costs too high, personal financial hardship rampant, and inability to adequately fund Medicaid because of the stigma of being a welfare program. By then, the celebration of the Supreme Court victory will have long worn off, and our friends will understand that decisions will have to be made as to how to alter course.

Those currently in charge are tinkering incrementalists. They will be looking for solutions such as enhancing consumer empowerment (i.e., keeping insurance premiums down by shifting costs to patients), structural reform of delivery systems (after the failure of accountable care organizations), capping malpractice awards (wrong solution to tort problem), and opening insurance markets across state lines to make insurance affordable (even if health care isn’t). After all, since the ACA provisions aren’t working, it’s time to try the conservatives’ favorite approaches, they’ll reason.

Come on. The solution is staring them in the face – single payer! Yet the resistance will continue. We’ll have ever more of “let’s try this first.”

It will take us until about 2015-2016 to have an impact, only because we’ll have to wade though the muck of ACA reform before our well-meaning friends see that there is only more muck ahead. At that time they will be looking for better solutions, but we cannot wait until then to recharge our campaign. The need is now! We have to establish single payer as a meme. It has to be an automated mentation process.

This means that we have to gear up immediately with an unrelenting campaign to get our friends to understand that single payer is not only the logical solution, but it is the only feasible alternative since it is the only approach that will work. It is long past time for us to replace the concept of political feasibility with the concept of social feasibility.

Let's get real about health reform

By Elizabeth R. Rosenthal, M.D.
The New York Times, Letters, June 29, 2012

Let’s get real about health care reform. Although the Affordable Care Act will bring health insurance to many, it will not bring health care to all or control costs. Millions will still be uninsured or underinsured: one job loss or illness away from bankruptcy. Billions of dollars will continue to be wasted by private, for-profit insurance companies through inflated administrative costs, profits to shareholders and huge salaries for chief executives. These dollars could all be going toward providing health care if we eliminated this unnecessary middleman.

We do not have to look far for a way to do this. Our Medicare program can be expanded to provide care for all. If Congress won’t do this, New York State can lead the way with its own single-payer bill. New York could show the nation how to end the disgrace of allowing so many of the 99 percent to suffer and die for lack of health care that, soon, will be affordable only for the 1 percent.

Dr. Elizabeth R. Rosenthal is a doctor. She resides in Larchmont, N.Y.

Let’s get real about health reform

By Elizabeth R. Rosenthal, M.D.
The New York Times, Letters, June 29, 2012

Let’s get real about health care reform. Although the Affordable Care Act will bring health insurance to many, it will not bring health care to all or control costs. Millions will still be uninsured or underinsured: one job loss or illness away from bankruptcy. Billions of dollars will continue to be wasted by private, for-profit insurance companies through inflated administrative costs, profits to shareholders and huge salaries for chief executives. These dollars could all be going toward providing health care if we eliminated this unnecessary middleman.

We do not have to look far for a way to do this. Our Medicare program can be expanded to provide care for all. If Congress won’t do this, New York State can lead the way with its own single-payer bill. New York could show the nation how to end the disgrace of allowing so many of the 99 percent to suffer and die for lack of health care that, soon, will be affordable only for the 1 percent.

Dr. Elizabeth R. Rosenthal is a doctor. She resides in Larchmont, N.Y.

SCOTUS Rules. What Happens Next?

Mark Dudzic, National Coordinator
Labor for Single-Payer, June 29, 2012

Yesterday’s Supreme Court decision that substantially upholds the Affordable Care Act (ACA) was widely praised by the national labor movement. “Working people won a resounding victory,” proclaimed SEIU President Mary Kay Henry as she thanked President Obama and the members of Congress who supported the ACA.

Likewise, AFL-CIO President Rich Trumka declared himself “pleased and relieved.” However, he also stated that, “We have no illusion that the destination has been reached, and we are more committed than ever to the hard work necessary to achieve our dream of quality health care for all.” One “indisputably constitutional solution,” Trumka suggested, would be to “allow Americans of all ages to buy into an improved Medicare program.”

The National Nurses United (NNU) took a longer-term perspective. Co-President Jean Ross pledged that NNU would step up its campaign for a reform that would be based on “a universal program based on patient need, not on profits or ability to pay. That’s Medicare for all.”

“Medicare is far more effective than the broken private system in controlling costs and the waste that goes to insurance paperwork and profits,” adds NNU Co-President Karen Higgins. “[I]t is universally popular, even among those who bitterly opposed the Obama law. Let’s open it up to everyone.”

Most single-payer advocacy organizations used the occasion of the Supreme Court decision to focus on the inadequacies of the ACA. Healthcare-NOW! points out that there will still be 26 million uninsured and that the ACA, “Embeds private, for-profit insurance in the system’s core, allowing them to continue to profit and game the system at our health’s expense.”

“Contrary to the claims of those who say we are ‘unrealistic,’ a single-payer system is within practical reach,” says a statement signed by eight leaders of the Physicians for a National Health Program. “The most rapid way to achieve universal coverage would be to improve upon the existing Medicare program and expand it to cover people of all ages.”

Vermont Senator Bernie Sanders–the only U.S. Senator who is a current sponsor of single-payer legislation—echoed these sentiments. While expressing support for the Supreme Court decision and the ACA, he asserted that, “the real solution to America’s health care crisis is a Medicare-for-all, single-payer system. Until then, we will remain the only major nation that does not provide health care for every man, woman and child as a right of citizenship.”

“I am proud that Vermont is making steady progress toward implementing a single-payer system,” he added. “I hope our state will be a model to show the rest of the nation how to provide better care at less cost to more people.”

Where Do We Go From Here?

The most immediate consequence of the Supreme Court decision will undoubtedly be political. Pundits are already calling it a momentum changer in the presidential campaign. Indeed, Republicans, with their call to “repeal and replace,” appeared disoriented and mean-spirited. For President Obama it was a triumphal day as he decreed vindication for his vision that, “In America, no illness or accident will lead to a family’s financial ruin.”

The jury is still out, however, on what effect this decision will have on the actual healthcare that Americans will receive under the ACA as well as its effects on the long-term prospects of the fight to make healthcare a right for everyone in America. Certainly, a more sober assessment of the healthcare realities faced by most working Americans and their families would show that we are a long way from President Obama’s aspirational vision.

Many have also expressed concern that the structure of Supreme Court decision may set the stage for future judicial challenges to the social insurance model. The Court refused to anchor the ACA’s individual mandate in the Constitution’s “commerce clause.” This is the clause that has been used to justify nearly every piece of social legislation—from the right to join unions to the food stamp program–since the New Deal. While having no material effect on the implementation of the ACA (the Court ruled that the mandate could be enforced under the constitutional power to tax), this new interpretation, coupled with the Court’s apparent assertion that the federal government cannot force states to comply with all of the provisions of state-administered programs such as Medicaid, could indicate that the Court would be willing to countenance a broader attack on social programs. The Labor Campaign for Single Payer has repeatedly affirmed that, to win, our fight must be part of our broader fight to defend and expand the social insurance model.

Coming at the end of a Supreme Court session that was especially cruel to the labor movement, it is perhaps to be expected that there would be some celebration at what was widely seen as a defeat of labor’s worst enemies. But this must not detract us from the urgency to prepare for a renewed assault on employer-provided healthcare benefits. At a recent strategy meeting of the LCSP Steering Committee and Advisory Board, we heard from union leaders
from around the country who are seeing the writing on the wall. Public employee benefits are under the gun in nearly every jurisdiction. Union Benefit Funds, often the gold standard in employer-funded healthcare, are facing threats to their very survival as ACA regulations impose new mandates while new state insurance exchanges potentially draw off their youngest and healthiest participants. And the 2018 “Cadillac Tax” is beginning to look more and more like a “Chevy Tax” as continued healthcare inflation will trigger this penalty on the hard won benefits of millions more union members than originally predicted.

What Happens Next?

The Affordable Care Act is now indisputably the law of the land. This will create new conditions and new challenges. Many millions will undoubtedly benefit from increased access to healthcare and regulation of the private insurance industry. Many millions more will find out that the right to buy health insurance is not the same thing as the right to healthcare. States will be required to set up healthcare exchanges by 2014 and state-level innovation—including state single-payer reforms—will be barred until at least 2017 (although President Obama did re-affirm his support for efforts to move that date up to 2014).

Certain things won’t change, however. Healthcare will still be treated as a commodity and a profit center rather than as a human right. Millions will continue to be denied access to basic healthcare. Costs will continue to rise two, three, even four times faster than our wages while quality deteriorates. Employer provided healthcare will continue to go the way of defined benefit pensions and healthcare fights will continue to be the biggest cause of strikes, lockouts and union busting.

The labor movement has no choice but to fight on for healthcare justice. And we in the Labor Campaign for Single Payer vow to re-dedicate ourselves to this fight to remove healthcare from the bargaining table and make it a right for everyone in America. We believe that it is labor’s historic responsibility to lead this effort and we will not rest until it fulfills this mission.

We still need a single payer system

By Quentin Young, M.D.
Chicago Sun-Times, Letters, June 29, 2012

The Supreme Court decision upholding the constitutionality of President Barack Obama’s health reform leaves much to be done before the American people have a decent health system. Unfortunately, the reform won’t control costs but will leave 26 million people uninsured and everyone else with “unaffordable underinsurance,” or coverage so skimpy it doesn’t protect from financial ruin in the event of illness.

What is needed now, as Barack Obama noted nearly a decade ago, is enactment of improved Medicare for all, everybody in, nobody out. By replacing our dysfunctional, profit-seeking, private insurance industry with a streamlined single-payer system we can save over $400 billion squandered annually on administrative overhead, enough to cover all 50 million of the uninsured and eliminate co-pays and deductibles for everyone else. Moreover, only a single-payer system can control costs and reduce our nation’s deficit over the long term.

Let us hope that the American people will soon be able to join the citizens of other industrialized, democratic nations, from Canada to Taiwan, in being able to see a doctor without fear of personal debt or national deficit.

Dr. Quentin Young resides in Chicago.

http://www.suntimes.com/opinions/letters/13462027-474/supreme-court-saps-states-power.html

Also see this commentary on Dr. Young’s letter, which was posted on the afternoon of June 28:

Health care law: It may be legal, but it’s not reform, leading doctor says

By Thomas Frisbie
Chicago Sun-Times, BackTalk, June 28, 2012

Don’t expect to see Quentin Young cheering the Supreme Court’s ruling Thursday that the heath care reform legislation is constitutional.

Young, a longtime health-care reform advocate and former chief medical officer of John Stroger Hospital, says the legislation omits a key ingredient: “a decent health system.”

“Unfortunately, the reform won’t control costs but will leave 26 million people uninsured and everyone else with ‘unaffordable underinsurance,’ or coverage so skimpy it doesn’t protect from financial ruin in the event of illness,” Young writes in a letter to the editor of the Sun-Times.

Young, who now is national coordinator of Physicians for a National Health Program, says the only effective cure for the nation’s health care woes is a single-payer health care system, something he points out that Barack Obama once supported.

“By replacing our dysfunctional, profit-seeking, private insurance industry with a streamlined single payer system we can save over $400 billion squandered annually on administrative overhead, enough to cover all 50 million of the uninsured and eliminate co-pays and deductibles for everyone else. Moreover, only a single-payer system can control costs and reduce our nation’s deficit over the long term,” he writes.

http://blogs.suntimes.com/backtalk/2012/06/health_care_law_it_may_be_lega.html