PNHP

The Supreme Court decision will not eliminate the private insurers

The Supreme Court decision will not eliminate the private insurers

Private Insurance Is Bankrupting Americans: Is Congress Paying Attention?

By Diane Archer
Health Affairs Blog, June 26, 2012

Over the last decade, health insurance costs doubled for the average family of four, and health costs ate away at real income, eliminating any wage gains that occurred.

Health insurance premiums (for both employers and workers) now amount to one-quarter of median family income and are projected to rise to 35 percent in the next decade. And these higher premiums are buying thinner and thinner coverage: We are paying more and more every time we go to the doctor or hospital – deductibles and copays have risen rapidly over the last decade. The share of workers paying a deductible greater than $1,000 has risen from 10 percent to over 30 percent since 2006.

Costs are rising for employers as well, and the share of workers who even receive insurance from their employer is plummeting, having fallen from more than 69 percent to 61 percent in the last 10 years.  Meanwhile, fewer large employers continue to offer supplemental coverage to retirees. Since the early 1990s, the percentage of large employers offering retiree coverage has fallen from 40 percent to only 21 percent.

Shifting Americans with Medicare into private pools is not a serious solution to the rising cost of health care, given the far higher costs in the private sector. Privatizing Medicare, or even raising the age of eligibility and forcing more of our parents and grandparents into the commercial market, would actually raise overall costs, and it would only save the government money by forcing more of the cost burden onto people who cannot afford it.

http://healthaffairs.org/blog/2012/06/26/private-insurance-is-bankrupting-americans-is-congress-paying-attention/

Comment: 

By Don McCanne, MD

Regardless of tomorrow’s Supreme Court decision on the fate of the Affordable Care Act, the status quo is dependent on private insurance and the Affordable Care Act model is dependent on private insurance, yet private insurance has been a miserable failure.

You don’t have to wait until tomorrow to decide what approach should be taken in response to the Supreme Court decision. You can start immediately with efforts to replace the private insurers with an improved Medicare for all.

The Supreme Court decision will not eliminate the private insurers

Private Insurance Is Bankrupting Americans: Is Congress Paying Attention?

By Diane Archer
Health Affairs Blog, June 26, 2012
Over the last decade, health insurance costs doubled for the average family of four, and health costs ate away at real income, eliminating any wage gains that occurred.
Health insurance premiums (for both employers and workers) now amount to one-quarter of median family income and are projected to rise to 35 percent in the next decade. And these higher premiums are buying thinner and thinner coverage: We are paying more and more every time we go to the doctor or hospital – deductibles and copays have risen rapidly over the last decade. The share of workers paying a deductible greater than $1,000 has risen from 10 percent to over 30 percent since 2006.
Costs are rising for employers as well, and the share of workers who even receive insurance from their employer is plummeting, having fallen from more than 69 percent to 61 percent in the last 10 years.  Meanwhile, fewer large employers continue to offer supplemental coverage to retirees. Since the early 1990s, the percentage of large employers offering retiree coverage has fallen from 40 percent to only 21 percent.
Shifting Americans with Medicare into private pools is not a serious solution to the rising cost of health care, given the far higher costs in the private sector. Privatizing Medicare, or even raising the age of eligibility and forcing more of our parents and grandparents into the commercial market, would actually raise overall costs, and it would only save the government money by forcing more of the cost burden onto people who cannot afford it.
http://healthaffairs.org/blog/2012/06/26/private-insurance-is-bankrupting-americans-is-congress-paying-attention/

Regardless of tomorrow’s Supreme Court decision on the fate of the Affordable Care Act, the status quo is dependent on private insurance and the Affordable Care Act model is dependent on private insurance, yet private insurance has been a miserable failure.
You don’t have to wait until tomorrow to decide what approach should be taken in response to the Supreme Court decision. You can start immediately with efforts to replace the private insurers with an improved Medicare for all.

AMSA & PNHP Essay Contest Winners Announced:

June 26, 2012

The American Medical Student Association and Physicians for a National Health Program are pleased to announce the winners of the first national single payer essay contest for medical students.

The contest was launched at the 2012 AMSA Annual Convention in Houston, where PNHP leaders Dr. Art Chen, Dr. David Ansell, and Dr. Howard Brody addressed medical students about the need for single payer national health insurance, “improved Medicare for all” to heal the US health crisis.

The first prize winner of an iPad is Jan Hallock at Pacific Northwest University in Yakima, Washington. The first runner-up is Victoria Powell at Virginia Commonwealth SOM in Richmond, Virginia, and the second runner-up is Eric LaMotte at UC San Francisco School of Medicine.  Their prizes are $100 and $50 gift cards, respectively.  The winning essays are posted below.

Many thanks to over 40 students who submitted terrific essays and to our judges, Dr. Howard Brody, Dr. David Ansell, Danielle Alexander, Dr. Elizabeth Wiley (AMSA 2012-2013 President), and Kristin Huntoon and Richard Alden Bruno (co-chairs of AMSA’s health care for all task force).

Special thanks to AMSA education and advocacy fellow Colin McCluney, who enthusiastically embraced the project and did a terrific job designing and running the contest.

The contest was advertised through The New Physician magazine (circ. 55,000) and at the AMSA Annual Meeting, as well as through PNHP, raising the profile of single payer among medical students.  We hope the contest will become an Annual Event.  Enjoy!

By Jan Hallock
Pacific Northwest University in Yakima, Washington

“Will this be paid for?”

I sighed silently, hoping the inquirer on the other end of the phone call would accept the only answer I could give.

“Well, Mrs. M, that’s not a question I’m able to answer, but if you look on the back of your insurance card, there should be a phone number for Customer Service. If you call that number, they should be able to help you figure out the cost.”

Mrs. M thanked me and hung up, presumably to spend another twenty minutes on the phone with a series of customer service representatives. I knew there was a good chance she wouldn’t get an answer, because insurance companies are remarkably good at not showing their hand to their customers—they tend to not commit to a certain payment amount, because they generally wait until the procedure is over to decide whether to cover it.

The phone rang again.

“Thank you for calling Dr. K’s office; how can I help you?”

“I have a question about my bill. My insurance said they would cover my annual screening colonoscopy, so why am I getting a $400 bill for it?”

Another sigh. I had chart notes to transcribe, prescription refills to authorize, letters to mail to remind patients to come back for follow-up appointments. Sorting out the fine print of insurance contracts was not how I wanted to spend my time.

“I’m sorry for the confusion, ma’am. Let me get your information, and I’ll contact our billing staff to see what happened.”

I frequently told patients this partial lie: I pretended to not know why they had received a bill for a procedure that their insurance supposedly covered. In reality, I knew that they had received a bill because their insurance had retroactively denied coverage of the procedure. But I still had to spend an average of thirty minutes per patient inquiry learning the details of different insurance policies so I could explain to patients why they ended up with a bill they didn’t expect.
These are obviously anecdotes from my personal experience, not analyses of hard data. But my experience was typical for medical assistants and medical receptionists: at least half the phone calls I received in any given workday had to do with insurance coverage or billing issues, not actual patient care.

This is especially remarkable because I worked for just one doctor, who managed to run her whole practice with just three people: herself, me, and a biller/coder. Think about that: Dr. K could competently manage her patient load and procedures almost by herself, but to work out the insurance payments and patient billing took a full-time trained, certified billing person and one-third to one-half of my time. One and one-half full-time employees, just to deal with insurance companies—is it any wonder that overhead costs are overwhelming doctors in private practice?

One common complaint I’ve heard about a single-payer system is that it would be a bureaucratic nightmare. To be honest, the first time I heard someone argue that, I laughed outright—and then I realized that he was serious. My second reaction was, “Obviously, you’ve never seen how the current system works.” Turns out, he hadn’t: he had insurance through his employer, Microsoft, which offers full coverage for just about everything you can imagine, with no copays. Patients and doctors’ offices alike love Microsoft insurance for its ease of use, its quick payment, and the overall efficiency that comes from their anti-bureaucratic approach to health care coverage. It is the epitome of great health insurance—and the opposite of the insurance coverage most people have.

The gross inefficiency of our current system is, to me, the single biggest problem in our healthcare system, and it is a problem that a single-payer system could easily solve. A single-payer system would streamline all services through one formulary, one billing system, with one set of rules and requirements. Fewer employee hours dedicated to sorting out insurance contract fine print means lower overhead costs, which means lower costs to patients and more physicians being able to stay in private practice. Less time wasted on bureaucratic nonsense means more time devoted to direct patient care, which means longer appointments, better physician availability, and better quality care. This is why I support single-payer health care: better for doctors, better for patients, better for society.

By Victoria Powell
Virginia Commonwealth SOM

In medical school, there is always an upcoming exam, with accompanying late nights and anxiety. Myopia can result from learning about medicine, yet having little exposure to the people that illnesses and injury are happening to. Health policy is a stretch – we’re learning to be doctors, not politicians or administrators. Fortunately, I’ve had a run of experiences that led to my interest in Single Payer, and given these, I feel I have the responsibility to translate my privilege into action.

In 2008, I was highly influenced by the presidential campaign of Ralph Nader. Long respected as an advocate for the people, he was having difficulty being taken seriously as a candidate. I was initially annoyed that he was running against the progressive-seeming champion Obama. Only through a friend’s insistence did I listen to his message. I was particularly inspired by his words on Single Payer. He clearly elucidated the reasons why our payment system was broken, corrupt, and wasteful. Through clear data and heart-wrenching stories, he insisted that Single Payer was the only sustainable and compassionate choice, “Everybody in. Nobody out.” Prior to his campaign, I was interested in medicine because I loved the process of scientific innovation and wanted to help translate bench-to-bedside for my patients. After hearing him, I promised myself that if I gained acceptance to medical school, I would use my position to advocate for those who were tossed aside, made to go into bankruptcy, lost homes and jobs, all because they were simply unlucky enough to have an expensive medical condition and poor insurance.

Single Payer did appear the fairest way to allocate limited resources,
but mainstream health care debate made it seem equivocal whether it would happen in America. I was convinced, but not compelled enough to become an activist. Arguments during the health care law debates resonated – it was too much effort, and the insurance industry was too strong. I heard older doctors grumbling about low reimbursement for Medicare. Could we work within the current system of multiple private insurers? Was Single Payer worth the fight?

My college friend Jay, 21, was shot in the head by a stray bullet on July 4, 2006. He spent over 100 days in the hospital and contracted almost every hospital-acquired infection imaginable. Due to what I previously thought was solely his strength and his parents’ and health care team’s dedication, he not only survived but has recovered to an extent no one thought possible for such a severe injury. He and his parents spoke to my medical school classmates recently. During the presentation, I learned there was another factor affecting his recovery that I hadn’t yet considered – his father’s excellent health insurance. Being under 22 at the time of injury, he was able to remain on his father’s federal employee plan. He had access to the comprehensive rehabilitation he needed and continues to require. Even so, his parents explained the huge chunks of time they had to spend on the phone with insurance companies, on hold with Mozart playing, while they sought authorization for life-saving surgeries. They admitted that this was nothing compared to what some families on his unit were going through. His parents heard not only about the patients who had no coverage, but also those whose families who were desperate because they had to go back to work to keep their coverage. Who would take care of the patient in recovery while they were at work?

It is not only sad for a young person with a brain injury to not receive necessary rehabilitation during the critical period of recovery because of lack of payment. It is a human rights violation. It could mean the difference between independent living, the ability to earn a living, and a lifelong sentence of disability. Patients continue to require rehab after discharge. The quality and frequency depend on their ability to pay. If a Single Payer system existed in America, resources would be distributed among all patients. Health would not be bound to a job. Our society’s medical discoveries would benefit everyone. No one would go bankrupt from medical expenses. No one would be stuck in the cycle of poverty because of payments for illness and injury. It is for these reasons that I not only support Single Payer, but resolve to use my standing as a future physician to fight for it. I will educate others. It will be difficult, but eventually, we will win. And it will be a victory for all Americans.

By Eric LaMotte
UC San Francisco School of Medicine

As the media focus on the Supreme Court’s coming ruling on the Affordable Care Act, they speculate about the various implications the Court’s decision could have on the individual mandate and many other provisions of the law. However, the contemplation of these scenarios is a distraction.

Instead, we should focus on what we already know, which is that over 15 million Americans will remain uninsured, and tens of millions will be underinsured with barebones plans that won’t prevent financial ruin if illness strikes. We will continue to pay nearly twice what the second most expensive country pays for healthcare, and costs will continue to increase unsustainably.

These facts are not seriously disputed, and yet they describe what many Democrats consider the best-case scenario, which would occur if no aspect of the ACA is struck down.

But we can do better. We should advocate publicly for a single-payer system which establishes comprehensive healthcare as a guaranteed right for all Americans, and which compensates healthcare providers rationally, simply, and fairly from a single insurance fund financed by taxpayers.

This simple system, which would effectively eliminate private health insurance and function like an improved Medicare for everyone, would save enough money by dismantling our Kafkaesque healthcare bureaucracies to cover the tens of millions of Americans who are uninsured now, or who are insured but avoid getting care because it is too expensive.

The Supreme Court’s review of the ACA is not just a distraction, but an opportunity as well. It’s a period when the “Overton Window,” the range of possibilities considered at any given moment to be politically feasible, is in flux.

Many of my fellow medical students support single-payer in theory, but are hesitant to become activists because they see it as politically infeasible in the current political climate. This creates an unfortunate Catch-22, but hints at a broad base of support for single-payer which is waiting to be unleashed when it is perceived to enter the political mainstream.

I often hear people talk about single-payer as politically infeasible because of the strength of the conservatives. Although I agree that single-payer currently seems to have little to no chance of passing the House and Senate, I reject that this is because the idea is unpopular. According to a CBS/NYTimes poll 2009, 59% of Americans said the government should provide national health insurance. 78% of medical students surveyed in 2011 said that PPACA did not go far enough in reforming our healthcare system. Rather than unpopularity, it is the health insurance industry’s powerful influence on our policymakers that keeps single-payer from entering the political mainstream.

Indeed, single-payer has recently received endorsements of preference over the ACA by conservatives such as Fox News contributor Charles Krauthammer and Louisiana A.G. Buddy Caldwell. These endorsements are not such a surprise if you consider that despite being to the left politically, single-payer stands head-and-shoulders above the ACA in terms of its merits as sound public policy.
The media have raised the possibility of the ACA (or its downfall) “paving the way” for a single-payer healthcare system, but such a shift is not going to just magically happen without strong resistance from the insurance industry. Achieving a single payer system will only happen if the population demands it loud enough to be heard over the health insurance lobby, a feat made only more difficult by Citizen’s United.

To become effective advocates for their preferred healthcare system, single-payer advocates will have to leverage a strong understanding of policy, not just politics. For example, cost savings will not just be achieved because the system is “government-run”, thereby eliminating profits. Instead, savings will be achieved by eliminating the bureaucratic complexity we have in our system where patients must navigate a fragmented system of provider networks and unpredictable charges.

I want a single-payer system because as a future physician, I want to spend my time treating patients, not dealing with billing personnel over the phone haggling to get treatments approved. As a taxpayer, insurance subscriber, and future patient, I want to spend less money, in a more predictable manner, and be guaranteed that I will get the care that I need.

I believe that we can enact a single-payer system, but I assure you that the road to it will not be paved for us by the successes or failures of the ACA. Although sound public policy is on our side, this means little if we continue to let the health insurance industry dictate which ideas are allowed into the discussion.

AMSA & PNHP Essay Contest Winners Announced:

June 26, 2012

The American Medical Student Association and Physicians for a National Health Program are pleased to announce the winners of the first national single payer essay contest for medical students.

The contest was launched at the 2012 AMSA Annual Convention in Houston, where PNHP leaders Dr. Art Chen, Dr. David Ansell, and Dr. Howard Brody addressed medical students about the need for single payer national health insurance, “improved Medicare for all” to heal the US health crisis.

The first prize winner of an iPad is Jan Hallock at Pacific Northwest University in Yakima, Washington. The first runner-up is Victoria Powell at Virginia Commonwealth SOM in Richmond, Virginia, and the second runner-up is Eric LaMotte at UC San Francisco School of Medicine.  Their prizes are $100 and $50 gift cards, respectively.  The winning essays are posted below.

Many thanks to over 40 students who submitted terrific essays and to our judges, Dr. Howard Brody, Dr. David Ansell, Danielle Alexander, Dr. Elizabeth Wiley (AMSA 2012-2013 President), and Kristin Huntoon and Richard Alden Bruno (co-chairs of AMSA’s health care for all task force).

Special thanks to AMSA education and advocacy fellow Colin McCluney, who enthusiastically embraced the project and did a terrific job designing and running the contest.

The contest was advertised through The New Physician magazine (circ. 55,000) and at the AMSA Annual Meeting, as well as through PNHP, raising the profile of single payer among medical students.  We hope the contest will become an Annual Event.  Enjoy!

By Jan Hallock
Pacific Northwest University in Yakima, Washington

“Will this be paid for?”

I sighed silently, hoping the inquirer on the other end of the phone call would accept the only answer I could give.

“Well, Mrs. M, that’s not a question I’m able to answer, but if you look on the back of your insurance card, there should be a phone number for Customer Service. If you call that number, they should be able to help you figure out the cost.”

Mrs. M thanked me and hung up, presumably to spend another twenty minutes on the phone with a series of customer service representatives. I knew there was a good chance she wouldn’t get an answer, because insurance companies are remarkably good at not showing their hand to their customers—they tend to not commit to a certain payment amount, because they generally wait until the procedure is over to decide whether to cover it.

The phone rang again.

“Thank you for calling Dr. K’s office; how can I help you?”

“I have a question about my bill. My insurance said they would cover my annual screening colonoscopy, so why am I getting a $400 bill for it?”

Another sigh. I had chart notes to transcribe, prescription refills to authorize, letters to mail to remind patients to come back for follow-up appointments. Sorting out the fine print of insurance contracts was not how I wanted to spend my time.

“I’m sorry for the confusion, ma’am. Let me get your information, and I’ll contact our billing staff to see what happened.”

I frequently told patients this partial lie: I pretended to not know why they had received a bill for a procedure that their insurance supposedly covered. In reality, I knew that they had received a bill because their insurance had retroactively denied coverage of the procedure. But I still had to spend an average of thirty minutes per patient inquiry learning the details of different insurance policies so I could explain to patients why they ended up with a bill they didn’t expect.
These are obviously anecdotes from my personal experience, not analyses of hard data. But my experience was typical for medical assistants and medical receptionists: at least half the phone calls I received in any given workday had to do with insurance coverage or billing issues, not actual patient care.

This is especially remarkable because I worked for just one doctor, who managed to run her whole practice with just three people: herself, me, and a biller/coder. Think about that: Dr. K could competently manage her patient load and procedures almost by herself, but to work out the insurance payments and patient billing took a full-time trained, certified billing person and one-third to one-half of my time. One and one-half full-time employees, just to deal with insurance companies—is it any wonder that overhead costs are overwhelming doctors in private practice?

One common complaint I’ve heard about a single-payer system is that it would be a bureaucratic nightmare. To be honest, the first time I heard someone argue that, I laughed outright—and then I realized that he was serious. My second reaction was, “Obviously, you’ve never seen how the current system works.” Turns out, he hadn’t: he had insurance through his employer, Microsoft, which offers full coverage for just about everything you can imagine, with no copays. Patients and doctors’ offices alike love Microsoft insurance for its ease of use, its quick payment, and the overall efficiency that comes from their anti-bureaucratic approach to health care coverage. It is the epitome of great health insurance—and the opposite of the insurance coverage most people have.

The gross inefficiency of our current system is, to me, the single biggest problem in our healthcare system, and it is a problem that a single-payer system could easily solve. A single-payer system would streamline all services through one formulary, one billing system, with one set of rules and requirements. Fewer employee hours dedicated to sorting out insurance contract fine print means lower overhead costs, which means lower costs to patients and more physicians being able to stay in private practice. Less time wasted on bureaucratic nonsense means more time devoted to direct patient care, which means longer appointments, better physician availability, and better quality care. This is why I support single-payer health care: better for doctors, better for patients, better for society.

By Victoria Powell
Virginia Commonwealth SOM

In medical school, there is always an upcoming exam, with accompanying late nights and anxiety. Myopia can result from learning about medicine, yet having little exposure to the people that illnesses and injury are happening to. Health policy is a stretch – we’re learning to be doctors, not politicians or administrators. Fortunately, I’ve had a run of experiences that led to my interest in Single Payer, and given these, I feel I have the responsibility to translate my privilege into action.

In 2008, I was highly influenced by the presidential campaign of Ralph Nader. Long respected as an advocate for the people, he was having difficulty being taken seriously as a candidate. I was initially annoyed that he was running against the progressive-seeming champion Obama. Only through a friend’s insistence did I listen to his message. I was particularly inspired by his words on Single Payer. He clearly elucidated the reasons why our payment system was broken, corrupt, and wasteful. Through clear data and heart-wrenching stories, he insisted that Single Payer was the only sustainable and compassionate choice, “Everybody in. Nobody out.” Prior to his campaign, I was interested in medicine because I loved the process of scientific innovation and wanted to help translate bench-to-bedside for my patients. After hearing him, I promised myself that if I gained acceptance to medical school, I would use my position to advocate for those who were tossed aside, made to go into bankruptcy, lost homes and jobs, all because they were simply unlucky enough to have an expensive medical condition and poor insurance.

Single Payer did appear the fairest way to allocate limited resources, but mainstream health care debate made it seem equivocal whether it would happen in America. I was convinced, but not compelled enough to become an activist. Arguments during the health care law debates resonated – it was too much effort, and the insurance industry was too strong. I heard older doctors grumbling about low reimbursement for Medicare. Could we work within the current system of multiple private insurers? Was Single Payer worth the fight?

My college friend Jay, 21, was shot in the head by a stray bullet on July 4, 2006. He spent over 100 days in the hospital and contracted almost every hospital-acquired infection imaginable. Due to what I previously thought was solely his strength and his parents’ and health care team’s dedication, he not only survived but has recovered to an extent no one thought possible for such a severe injury. He and his parents spoke to my medical school classmates recently. During the presentation, I learned there was another factor affecting his recovery that I hadn’t yet considered – his father’s excellent health insurance. Being under 22 at the time of injury, he was able to remain on his father’s federal employee plan. He had access to the comprehensive rehabilitation he needed and continues to require. Even so, his parents explained the huge chunks of time they had to spend on the phone with insurance companies, on hold with Mozart playing, while they sought authorization for life-saving surgeries. They admitted that this was nothing compared to what some families on his unit were going through. His parents heard not only about the patients who had no coverage, but also those whose families who were desperate because they had to go back to work to keep their coverage. Who would take care of the patient in recovery while they were at work?

It is not only sad for a young person with a brain injury to not receive necessary rehabilitation during the critical period of recovery because of lack of payment. It is a human rights violation. It could mean the difference between independent living, the ability to earn a living, and a lifelong sentence of disability. Patients continue to require rehab after discharge. The quality and frequency depend on their ability to pay. If a Single Payer system existed in America, resources would be distributed among all patients. Health would not be bound to a job. Our society’s medical discoveries would benefit everyone. No one would go bankrupt from medical expenses. No one would be stuck in the cycle of poverty because of payments for illness and injury. It is for these reasons that I not only support Single Payer, but resolve to use my standing as a future physician to fight for it. I will educate others. It will be difficult, but eventually, we will win. And it will be a victory for all Americans.

By Eric LaMotte
UC San Francisco School of Medicine

As the media focus on the Supreme Court’s coming ruling on the Affordable Care Act, they speculate about the various implications the Court’s decision could have on the individual mandate and many other provisions of the law. However, the contemplation of these scenarios is a distraction.

Instead, we should focus on what we already know, which is that over 15 million Americans will remain uninsured, and tens of millions will be underinsured with barebones plans that won’t prevent financial ruin if illness strikes. We will continue to pay nearly twice what the second most expensive country pays for healthcare, and costs will continue to increase unsustainably.

These facts are not seriously disputed, and yet they describe what many Democrats consider the best-case scenario, which would occur if no aspect of the ACA is struck down.

But we can do better. We should advocate publicly for a single-payer system which establishes comprehensive healthcare as a guaranteed right for all Americans, and which compensates healthcare providers rationally, simply, and fairly from a single insurance fund financed by taxpayers.

This simple system, which would effectively eliminate private health insurance and function like an improved Medicare for everyone, would save enough money by dismantling our Kafkaesque healthcare bureaucracies to cover the tens of millions of Americans who are uninsured now, or who are insured but avoid getting care because it is too expensive.

The Supreme Court’s review of the ACA is not just a distraction, but an opportunity as well. It’s a period when the “Overton Window,” the range of possibilities considered at any given moment to be politically feasible, is in flux.

Many of my fellow medical students support single-payer in theory, but are hesitant to become activists because they see it as politically infeasible in the current political climate. This creates an unfortunate Catch-22, but hints at a broad base of support for single-payer which is waiting to be unleashed when it is perceived to enter the political mainstream.

I often hear people talk about single-payer as politically infeasible because of the strength of the conservatives. Although I agree that single-payer currently seems to have little to no chance of passing the House and Senate, I reject that this is because the idea is unpopular. According to a CBS/NYTimes poll 2009, 59% of Americans said the government should provide national health insurance. 78% of medical students surveyed in 2011 said that PPACA did not go far enough in reforming our healthcare system. Rather than unpopularity, it is the health insurance industry’s powerful influence on our policymakers that keeps single-payer from entering the political mainstream.

Indeed, single-payer has recently received endorsements of preference over the ACA by conservatives such as Fox News contributor Charles Krauthammer and Louisiana A.G. Buddy Caldwell. These endorsements are not such a surprise if you consider that despite being to the left politically, single-payer stands head-and-shoulders above the ACA in terms of its merits as sound public policy.
The media have raised the possibility of the ACA (or its downfall) “paving the way” for a single-payer healthcare system, but such a shift is not going to just magically happen without strong resistance from the insurance industry. Achieving a single payer system will only happen if the population demands it loud enough to be heard over the health insurance lobby, a feat made only more difficult by Citizen’s United.

To become effective advocates for their preferred healthcare system, single-payer advocates will have to leverage a strong understanding of policy, not just politics. For example, cost savings will not just be achieved because the system is “government-run”, thereby eliminating profits. Instead, savings will be achieved by eliminating the bureaucratic complexity we have in our system where patients must navigate a fragmented system of provider networks and unpredictable charges.

I want a single-payer system because as a future physician, I want to spend my time treating patients, not dealing with billing personnel over the phone haggling to get treatments approved. As a taxpayer, insurance subscriber, and future patient, I want to spend less money, in a more predictable manner, and be guaranteed that I will get the care that I need.

I believe that we can enact a single-payer system, but I assure you that the road to it will not be paved for us by the successes or failures of the ACA. Although sound public policy is on our side, this means little if we continue to let the health insurance industry dictate which ideas are allowed into the discussion.

Private Medicare Advantage plans being paid for phantom care of VA patients

Duplicate Federal Payments for Dual Enrollees in Medicare Advantage Plans and the Veterans Affairs Health Care System

By Amal N. Trivedi, MD, MPH; Regina C. Grebla, MGA, MPH, PhD; Lan Jiang, MS; Jean Yoon, PhD; Jent Mor, PhD; Kenneth W. Kizer, MD, MPH
JAMA, June 26, 2012

Abstract

Context: Some veterans are eligible to enroll simultaneously in a Medicare Advantage (MA) plan and the Veterans Affairs health care system (VA). This scenario produces the potential for redundant federal spending because MA plans would receive payments to insure veterans who receive care from the VA, another taxpayer-funded health plan.

Objective: To quantify the prevalence of dual enrollment in VA and MA, the concurrent use of health services in each setting, and the estimated costs of VA care provided to MA enrollees.

Design: Retrospective analysis of 1 245 657 veterans simultaneously enrolled in the VA and an MA plan between 2004-2009.

Main Outcome Measures: Use of health services and inflation-adjusted estimated VA health care costs.

Results: Among individuals who were eligible to enroll in the VA and in an MA plan, the number of persons dually enrolled increased from 485 651 in 2004 to 924 792 in 2009. In 2009, 8.3% of the MA population was enrolled in the VA and 5.0% of MA beneficiaries were VA users. The estimated VA health care costs for MA enrollees totaled $13.0 billion over 6 years, increasing from $1.3 billion in 2004 to $3.2 billion in 2009. Among dual enrollees, 10% exclusively used the VA for outpatient and acute inpatient services, 35% exclusively used the MA plan, 50% used both the VA and MA, and 4% received no services during the calendar year. The VA financed 44% of all outpatient visits (n = 21 353 841), 15% of all acute medical and surgical admissions (n = 177 663), and 18% of all acute medical and surgical inpatient days (n = 1 106 284) for this dually enrolled population. In 2009, the VA billed private insurers $52.3 million to reimburse care provided to MA enrollees and collected $9.4 million (18% of the billed amount; 0.3% of the total cost of care).

Conclusions: The federal government spends a substantial and increasing amount of potentially duplicative funds in 2 separate managed care programs for the care of same individuals.

http://jama.jamanetwork.com/article.aspx?articleid=1197014#AuthorInformation

Comment: 

By Don McCanne, MD

Most veterans who are eligible for enrollment in the Veterans Administration health care system are also eligible for enrollment in Medicare when they turn 65. Many of these veterans elect to enroll in the publicly-financed but private Medicare Advantage plans. This study shows that these private plans benefit greatly by receiving full capitation payments for all care in spite of the fact that they avoid the costs of the care that is actually delivered in our publicly-financed VA system. Thus taxpayers are paying twice for the same care – real care in the VA system and phantom care under the Medicare Advantage plans.

The authors suggest that rules could be changed to rectify this. Either the VA could be authorized to bill the private Medicare Advantage plans for care delivered by the VA (currently prohibited by federal law – a law dating back to before private Medicare plans were available), or the capitation payments to the Medicare Advantage plans could be adjusted downward to reflect the use of VA facilities.

There is a far better choice. The traditional Medicare program could be improved by expanding benefits and eliminating out-of-pocket cost sharing. Then we could get rid of the private Medicare Advantage plans with their profound administrative waste and the restrictions in health care choices that they inflict upon their patients. The VA-eligible patient would be able to choose either Medicare or the VA system, but regardless, we would be paying for the care only once, instead of twice like we are now.

In fact, the improved Medicare system would be so effective that we should all be able to have it as participants in a single payer national health program. Providing veterans with the choice of the VA system would not be much different from providing the rest of us with the choice of an integrated health care delivery system such as Kaiser Permanente. It would be just another health care delivery option under an improved Medicare for all.

Medicare for All takes show on the road in Calif.

By Mari Edlin
California Healthline, June 26, 2012

Neither the Affordable Care Act nor the challenges it faces in the Supreme Court has stopped the wheels from turning for the California Nurses Association, Physicians for a National Health Program and Campaign for a Healthy California.

The three organizations took to the road last week on a three-week, statewide bus tour to rally for single-payer, national health system — “Medicare for All.”

Akin to the Canadian system, which sprouted in Saskatchewan in the 1940s and quickly spread to other provinces, Medicare for All would replace private insurance with a single public agency paying medical claims – not much different than how Medicare operates today for senior adults.

Short of being a federal initiative, Medicare for All is holding out for buy-in from individual states.

Each stop along the route of the California tour will provide basic medical screenings followed by a public town hall meeting, raising awareness for Medicare and a single-payer system and enabling Californians to express their opinions.

“Our tour will showcase the fact that there is a single payer solution to the health care crisis, while also getting word out to districts to urge legislators to vote,” said Bill Skeen, executive director of the California Chapter of Physicians for a National Health Program in Oakland.

“Right now, we look at Medicare as a program for when we turn 65, but it has proven to work for the Veterans’ Administration, the chronically disabled and for legislators, who get lifetime health insurance despite how long they serve in office,” said Deborah Burger, president of the California Nurses Association.

The campaign is heartened by the California State Legislature’s passage of a statewide, single-payer bill in 2006 and 2008; both were vetoed by Republican Gov. Arnold Schwarzenegger.  SB 810, The California Universal Healthcare Act resurrected in 2010, failed to pass the Senate floor by two votes earlier this year.

The California Nurses Association and the Physicians for a National Health Program agree the Supreme Court ACA rulings will not affect their initiative no matter what direction it takes. But that’s not to say they don’t support some of the law’s provisions, such as guarantee issue and health care coverage of young adults – 26 or younger — under their parents’ plans, Burger said.

“If the law is overthrown, we plan to move forward anyway,” she said. “As a nurse, I see the devastating effect of self-rationed health care, where patients either end up in the emergency room, hospital or in the morgue. Medicare for All will help cut costs and ensure affordability and accessibility.”

Skeen said the Affordable Care Act is built on a shaky foundation and will not change the current underlying private insurance model. “To get health care for all, you have to eliminate private insurance and expand public insurance to everyone,” he said. “If the law is struck down, we’ll just be back to status quo.”

 Another concern, expressed by Don McCanne, senior health policy fellow for Physicians for a National Health Program, is failure of the state’s health insurance exchange to fully cover the uninsured.

Despite the upward pressure on Medicare spending, per capita expenditures for Medicare beneficiaries are expected to increase more slowly than in the private sector, according to the Kaiser Family Foundation. Burger is confident that Medicare for All would provide more savings than accrued through private insurance. Among private insurers, about 30 cents of every dollar goes to administration, lobbying and profit, while the overhead for Medicare is just 3%, Medicare for All proponents point out.

“The industry has a vested interest in the individual mandate, which will require people to buy insurance coverage,” Burger said. “But that’s not the same as Medicare’s goal of getting more people treated and providing better health care.”

Most Medicare for All proponents believe there’s enough money being spent now to provide coverage for everybody — a combination of contributions to Medicare through taxes and redirecting current premiums to Medicare.

We don’t need to spend more money; we just have to spend it differently by eliminating overhead and spending more on patient care, Skeen said.

Skeen, who estimates single payer could save $8 billion, is in favor of making health care into a social service. “Health care should be a given right and not cause people to go bankrupt in order to pay for it,” he said.

He hopes California will follow in the footsteps of Vermont, which last year  passed a single payer health care law.

http://www.californiahealthline.org/capitol-desk/2012/6/medicare-for-all-takes-show-on-the-road.aspx#ixzz1yupVJ5kA

Private Medicare Advantage plans being paid for phantom care of VA patients

Duplicate Federal Payments for Dual Enrollees in Medicare Advantage Plans and the Veterans Affairs Health Care System

By Amal N. Trivedi, MD, MPH; Regina C. Grebla, MGA, MPH, PhD; Lan Jiang, MS; Jean Yoon, PhD; Jent Mor, PhD; Kenneth W. Kizer, MD, MPH
JAMA, June 26, 2012
Abstract
Context: Some veterans are eligible to enroll simultaneously in a Medicare Advantage (MA) plan and the Veterans Affairs health care system (VA). This scenario produces the potential for redundant federal spending because MA plans would receive payments to insure veterans who receive care from the VA, another taxpayer-funded health plan.
Objective: To quantify the prevalence of dual enrollment in VA and MA, the concurrent use of health services in each setting, and the estimated costs of VA care provided to MA enrollees.
Design: Retrospective analysis of 1 245 657 veterans simultaneously enrolled in the VA and an MA plan between 2004-2009.
Main Outcome Measures: Use of health services and inflation-adjusted estimated VA health care costs.
Results: Among individuals who were eligible to enroll in the VA and in an MA plan, the number of persons dually enrolled increased from 485 651 in 2004 to 924 792 in 2009. In 2009, 8.3% of the MA population was enrolled in the VA and 5.0% of MA beneficiaries were VA users. The estimated VA health care costs for MA enrollees totaled $13.0 billion over 6 years, increasing from $1.3 billion in 2004 to $3.2 billion in 2009. Among dual enrollees, 10% exclusively used the VA for outpatient and acute inpatient services, 35% exclusively used the MA plan, 50% used both the VA and MA, and 4% received no services during the calendar year. The VA financed 44% of all outpatient visits (n = 21 353 841), 15% of all acute medical and surgical admissions (n = 177 663), and 18% of all acute medical and surgical inpatient days (n = 1 106 284) for this dually enrolled population. In 2009, the VA billed private insurers $52.3 million to reimburse care provided to MA enrollees and collected $9.4 million (18% of the billed amount; 0.3% of the total cost of care).
Conclusions: The federal government spends a substantial and increasing amount of potentially duplicative funds in 2 separate managed care programs for the care of same individuals.
http://jama.jamanetwork.com/article.aspx?articleid=1197014#AuthorInformation

Most veterans who are eligible for enrollment in the Veterans Administration health care system are also eligible for enrollment in Medicare when they turn 65. Many of these veterans elect to enroll in the publicly-financed but private Medicare Advantage plans. This study shows that these private plans benefit greatly by receiving full capitation payments for all care in spite of the fact that they avoid the costs of the care that is actually delivered in our publicly-financed VA system. Thus taxpayers are paying twice for the same care – real care in the VA system and phantom care under the Medicare Advantage plans.
The authors suggest that rules could be changed to rectify this. Either the VA could be authorized to bill the private Medicare Advantage plans for care delivered by the VA (currently prohibited by federal law – a law dating back to before private Medicare plans were available), or the capitation payments to the Medicare Advantage plans could be adjusted downward to reflect the use of VA facilities.
There is a far better choice. The traditional Medicare program could be improved by expanding benefits and eliminating out-of-pocket cost sharing. Then we could get rid of the private Medicare Advantage plans with their profound administrative waste and the restrictions in health care choices that they inflict upon their patients. The VA-eligible patient would be able to choose either Medicare or the VA system, but regardless, we would be paying for the care only once, instead of twice like we are now.
In fact, the improved Medicare system would be so effective that we should all be able to have it as participants in a single payer national health program. Providing veterans with the choice of the VA system would not be much different from providing the rest of us with the choice of an integrated health care delivery system such as Kaiser Permanente. It would be just another health care delivery option under an improved Medicare for all.

For-profit managed-care Medicaid the wrong path

By Rita Valenti, R.N.
Atlanta Journal Constitution, Letters, June 24, 2012

Re “Goal: Coverage that won’t soak taxpayers” (Opinion, June 17): As a registered nurse with 30 years of patient-care experience, I was appalled by the misinformation in this piece. What does “soak” taxpayers is the unbridled extraction of public funds to private, for-profit, managed-care corporations that use people’s health care needs to make profits — while adding nothing to patient care or healthy outcomes. Adding another layer of private for-profit unaccountable bureaucracy is the problem — not the solution. Health care should not be a commodity, but a right. Public funds need to be used for the public good, not to enrich private companies. An improved federal Medicare for all of us is the first step toward a just and comprehensive health care system.

Rita Valenti, R.N., is a former state assemblywoman. She resides in Clarkston.

http://www.ajc.com/opinion/readers-write-6-24-1462955.html

What about the insurance subsidies?

Health Reform Subsidy Calculator

Kaiser Family Foundation

Based on the Patient Protection and Affordable Care Act (including subsequent amendments in the Health Care and Education Reconciliation Act of 2010), as signed by the President.

The premiums are illustrative examples in 2014 dollars derived from estimates of average premiums for 2016 from the Congressional Budget Office.

Premium subsidies are based on a silver plan (with an actuarial value of 70%), so all premiums shown are for silver coverage. People may be able to pay a lower premium for less comprehensive coverage (i.e., a bronze plan, with an actuarial value of 60%). The tables showing results by age and income also reflect premiums for silver coverage, though the minimum insurance that people would be required to obtain would be bronze coverage.

The actual premium calculated is adjusted for family type, and for age (within the three to one limit specified in the proposal). Subsidized people can enroll in more expensive plans, but must pay the full difference in the premium.

Health Reform Subsidy Calculator:
http://healthreform.kff.org/SubsidyCalculator.aspx#incomeAgeTables

Comment: 

By Don McCanne, MD

On June 28, the Supreme Court will release its ruling on the constitutionality of the Affordable Care Act. If the full Act is repealed, individuals who would have purchased plans in the state insurance exchanges will receive neither their premium subsidies nor their tax credits for out-of-pocket expenses. What precisely would they be losing?

Let’s use the Health Reform Subsidy Calculator to check a few examples. In each example, we will assume that the policyholder is 45, has a family of four, and does not have employer coverage available. For this family living in a region with a medium cost factor, the predicted premium for the silver plan (70% actuarial value) is $14,245. In the examples, we will change only the income level.

Income:  $31,155 (133% of poverty)
Premium payment:  None – covered by Medicaid
Maximum out-of-pocket costs:  None – covered by Medicaid

Income:  $31,156 (133% of poverty plus $1)
Premium payment:  $935
Maximum out-of-pocket costs:  $4,167

Note that at this level, one additional dollar of income results in the family losing the more comprehensive benefits of the Medicaid program, and mandates that they pay a premium of $935 plus potential out-of-pocket expenses of $4,167, for a total exposure of $5,202. That’s a staggering amount at this income level. Compliance surely would be a problem, not by lack of will but simply by inability to pay.

Income:  $93,700 (400% of poverty)
Premium payment:  $8,901
Maximum out-of-pocket costs:  $8,333

Income:  $93,701 (400% of poverty plus $1)
Premium payment:  $14,245
Maximum out-of-pocket costs:  $12,500

So at an income of $93,700, the premium would be $8,901 and the potential out-of-pocket costs would be $8,333, for a total exposure of $17,234. That is quite a dent for a family that is trying to save for two college educations, a retirement fund, and maybe for replacement of the broken-down family automobile. But add just one more dollar of income and the premium shoots up to $14,245 and potential out-of-pocket expenses to $12,500, for a total of $26,745. Then what are you going to cut out of the family budget? And isn’t the $9,511 increase quite a “tax” to pay on that one dollar of additional income?

Just the premium increase alone might cause this family to downgrade their coverage from silver (70% actuarial value) to bronze (60%) in order to save on the premium. If so, this family literally would be placing a bet that none of them would develop a serious medical problem, and it would lose the bet if any of them did so. Should we really be forcing a family to gamble on its health care coverage?

If the Affordable Care Act is repealed, all of this goes away, and many more would remain with no coverage at all. That would be tragic. But even if the Act is upheld, this coverage is still far from satisfactory, and should be unacceptable as a standard for our nation. Regardless of the Supreme Court decision, we should replace the Affordable Care Act with a program that really does work: a single payer, improved Medicare for all.

What about the insurance subsidies?

Health Reform Subsidy Calculator

Kaiser Family Foundation
Based on the Patient Protection and Affordable Care Act (including subsequent amendments in the Health Care and Education Reconciliation Act of 2010), as signed by the President.
The premiums are illustrative examples in 2014 dollars derived from estimates of average premiums for 2016 from the Congressional Budget Office.
Premium subsidies are based on a silver plan (with an actuarial value of 70%), so all premiums shown are for silver coverage. People may be able to pay a lower premium for less comprehensive coverage (i.e., a bronze plan, with an actuarial value of 60%). The tables showing results by age and income also reflect premiums for silver coverage, though the minimum insurance that people would be required to obtain would be bronze coverage.
The actual premium calculated is adjusted for family type, and for age (within the three to one limit specified in the proposal). Subsidized people can enroll in more expensive plans, but must pay the full difference in the premium.
Health Reform Subsidy Calculator:
http://healthreform.kff.org/SubsidyCalculator.aspx#incomeAgeTables

On June 28, the Supreme Court will release its ruling on the constitutionality of the Affordable Care Act. If the full Act is repealed, individuals who would have purchased plans in the state insurance exchanges will receive neither their premium subsidies nor their tax credits for out-of-pocket expenses. What precisely would they be losing?
Let’s use the Health Reform Subsidy Calculator to check a few examples. In each example, we will assume that the policyholder is 45, has a family of four, and does not have employer coverage available. For this family living in a region with a medium cost factor, the predicted premium for the silver plan (70% actuarial value) is $14,245. In the examples, we will change only the income level.
Income:  $31,155 (133% of poverty)
Premium payment:  None – covered by Medicaid
Maximum out-of-pocket costs:  None – covered by Medicaid
Income:  $31,156 (133% of poverty plus $1)
Premium payment:  $935
Maximum out-of-pocket costs:  $4,167
Note that at this level, one additional dollar of income results in the family losing the more comprehensive benefits of the Medicaid program, and mandates that they pay a premium of $935 plus potential out-of-pocket expenses of $4,167, for a total exposure of $5,202. That’s a staggering amount at this income level. Compliance surely would be a problem, not by lack of will but simply by inability to pay.
Income:  $93,700 (400% of poverty)
Premium payment:  $8,901
Maximum out-of-pocket costs:  $8,333
Income:  $93,701 (400% of poverty plus $1)
Premium payment:  $14,245
Maximum out-of-pocket costs:  $12,500
So at an income of $93,700, the premium would be $8,901 and the potential out-of-pocket costs would be $8,333, for a total exposure of $17,234. That is quite a dent for a family that is trying to save for two college educations, a retirement fund, and maybe for replacement of the broken-down family automobile. But add just one more dollar of income and the premium shoots up to $14,245 and potential out-of-pocket expenses to $12,500, for a total of $26,745. Then what are you going to cut out of the family budget? And isn’t the $9,511 increase quite a “tax” to pay on that one dollar of additional income?
Just the premium increase alone might cause this family to downgrade their coverage from silver (70% actuarial value) to bronze (60%) in order to save on the premium. If so, this family literally would be placing a bet that none of them would develop a serious medical problem, and it would lose the bet if any of them did so. Should we really be forcing a family to gamble on its health care coverage?
If the Affordable Care Act is repealed, all of this goes away, and many more would remain with no coverage at all. That would be tragic. But even if the Act is upheld, this coverage is still far from satisfactory, and should be unacceptable as a standard for our nation. Regardless of the Supreme Court decision, we should replace the Affordable Care Act with a program that really does work: a single payer, improved Medicare for all.

Affordable Care Act: We can do better

By Laurence S. Jacobs, M.D.
The Democrat and Chronicle (Rochester, N.Y.), June 18, 2012

The country now awaits the upcoming Supreme Court decision regarding the Affordable Care Act (ACA). No matter what decision is made, however, it is important to recognize the inadequacies of the ACA, and to understand the optimal solution to our health insurance crisis.

It should be recognized that the ACA has a number of commendable features. These include the expansion of Medicaid, enhanced funding for community health centers, restrictions on rescission of policies and on denials of coverage based on pre-existing conditions, and the provision for coverage of children up to age 26 on their parents’ policies. However, these could have all been enacted on a stand-alone basis.

However, the ACA entails many problems, of access, cost, and equity. When fully implemented by 2019, the ACA will cover less than half of our currently uninsured, leaving approximately 26 million people without health insurance. Such uninsurance is presently instrumental in the deaths of about 50,000 people per year, nearly one every minute. Many people forgo needed care because of costs; in 2010, 75 million working age adults went without necessary care due to costs!

Health insurance premiums have more than doubled since 2000; many middle-income families are faced with policies that consume up to 10 percent of income, yet provide poor coverage which offers little protection against financial ruin in case of major illness. Employer programs now cost over $15,000 annually for family coverage, and many covered people will increasingly have to deal with a limited provider network and minimal coverage, as employers reduce options and shift rising costs to employees. Skimpy insurance, with high deductibles, copays and other out-of-pocket expenses, comprise the new norm of unaffordable underinsurance.

While the personal bankruptcy rate due to medical bills in the rest of the industrialized world is zero, more than 60 percent of such bankruptcies in the United States are related to medical bills; almost 80 percent of those being bankrupted had health insurance prior to illness. The rate has not declined in Massachusetts since passage of that state’s health reform bill, as much of the new coverage there is bare bones high deductible policies. Since the ACA contains no effective cost-control measures, the situation summarized above can be expected to worsen if the ACA survives in any form following the Supreme Court decision.

We are alone in the industrialized world in employing a profit-driven private insurance system for funding our health care. The result is a fragmented patchwork of coverage, and chronic conflict between generation of returns for shareholders versus taking care of patients. The fragmentation results in extraordinary inefficiencies, with 31 cents of every health care dollar (totaling $400 billion per year) diverted to overhead, marketing, profit, executive compensation and the imposition of excessive paperwork on providers. In contrast, Medicare runs on an overhead of under 3 percent. Rather than continuing to funnel our health insurance coverage and processes through these private, profit-driven companies, we should follow the example of much of the developed world and institute a single-payer, simplified mechanism for funding our national health care.

Such a scheme would be primarily a payment mechanism. Patients would have free choice of physician, hospital and other health care facilities. Moreover, only a single-payer system offers effective methods for cost control, such as global hospital budgeting, capital planning, negotiated fees and bulk purchasing. It is easy to understand why the health insurance industry and the pharmaceutical industry, stakeholders who benefit from the status quo, have fought against a single-payer plan with every means available to them.

No matter what the Supreme Court decides, we have the opportunity as a country to embrace a solution to this problem, if we have the political will to do so. Two-thirds of the population and 59 percent of physicians support the establishment of a national health insurance program. It is the right thing to do and, increasingly, it is imperative that we do so.

Dr. Laurence S. Jacobs is Professor of Medicine Emeritus at the University of Rochester and Vice-Chair of the Finger Lakes Chapter of Physicians for a National Health Program.

http://www.democratandchronicle.com/article/20120619/OPINION02/120618010/Affordable-Care-Act-We-can-do-better?nclick_check=1

Single payer, not free market, is the answer

By Patricia Downs Berger, M.D.
Letters, Boston Globe, June 16, 2012

In the June 13 op-ed “A free market brings down health costs” Jeff Jacoby asked, “What is the best way to make sure that Americans with chronic medical conditions … can afford the insurance they need?” Jacoby’s answer is the free market, a business model based on “supply and demand, competition, and flexible prices.” He seems to forget that medical care is not a commodity that we buy and sell, but a basic human necessity.

Universal access to affordable, high-quality medical care is what we all want for ourselves and our families, but it can only happen if we have a single-payer system that embodies this goal. Such a system means that there would be a single government entity that would pay health care bills instead of myriad private companies and government plans.

Everyone would have a government-issued medical card to use for medical care that would replace the for-profit health insurance industry coverage, and there would be no more premiums, deductibles, or co-insurance that act as barriers to seeking care.

Single payer would be publicly funded through the tax system and federal and state funds already committed to health care through programs such as Medicare, Medicaid, and the Children’s Health Insurance Program. Single payer is not a pie-in-the-sky theory. Variations have been working well in industrialized nations where health costs are half of what we spend in the United States and health outcomes are better.

Dr. Patricia Downs Berger co-chairs Mass-Care, a campaign for a single payer health care system for Massachusetts. She resides in Brookline.

http://articles.boston.com/2012-06-16/letters/32247699_1_single-payer-health-care-health-costs