PNHP

Stop tinkering with health care and start fixing it

Stop tinkering with health care and start fixing it

By Jay D. Brock, M.D.
The Washington Post, January 15, 2021

Most Americans understand that our health insurance system — the financial basis of our entire health-care system — isn’t working well. The Jan. 5 news article “Health-care venture backed by three corporate giants to close in February,” which reported on how even the wealth and power of Jeff Bezos (who owns The Post), Warren Buffett and Jamie Dimon failed to control runaway health-care costs, showed how dysfunctional our health insurance system is.

The problem? Trying to reduce health-care costs without changing our insurance system, with its huge built-in costs — $600 billion wasted yearly (compared with a single-payer system) in administrative costs alone, according to a recent study — reveals how tinkering with the system without fundamentally changing it is an exercise in futility. Without ridding the system of these useless expenditures, and that means eliminating the current insurance health system in favor of a single-payer plan such as Medicare-for-all, no comparable savings can be realized.

Regrettably, the approach most politicians are taking is to repeat the same mistakes of the past few decades: try to fix the health insurance system by tinkering with it. Unfortunately, doing the same thing over and over again hoping next time will be different just isn’t working.

Maybe it’s finally time for true health-care reform that will eliminate the staggering waste of the current system, reduce costs and allow truly affordable, universal coverage: single-payer, publicly funded, privately delivered Medicare-for-all.

President-elect Biden’s health care approach

One Sentence in Biden Stimulus Plan Reveals His Health Care Approach

An increase in subsidies could drive millions to enroll in Obamacare marketplaces, experts say.

By Sarah Kliff
The New York Times, January 16, 2021

Tucked into President-elect Biden’s $1.9 trillion stimulus plan is a one-sentence provision that could drive billions in federal subsidies to help people afford to buy health insurance.

The proposal would do two things: make upper-middle-income Americans newly eligible for premium subsidies on Obamacare marketplaces, and increase the financial help that already goes to lower-income enrollees. Taken together, some experts expect these changes to drive more sign-ups for Healthcare.gov plans after they fell in the Trump era.

Mr. Biden’s plan tackles one of the Affordable Care Act’s biggest weaknesses: affordability. Surveys of uninsured Americans and those with Healthcare.gov plans routinely find that affordability of premiums ranks as a top complaint.

The affordability challenges are a result of how drafters wrote the health law. They limited premium subsidies to those earning less than 400 percent of the federal poverty line: $51,520 for an individual and $106,000 for a family of four in 2021.

The Biden plan would create a new cap — 8.5 percent of an individual or family’s income on premium contributions — for midlevel health plans. This policy would mostly affect higher-earning Americans who do not currently qualify for subsidies.

The Biden proposal also describes a second policy that appears to be aimed at increasing subsidies for those who already qualify.

NYT Reader Comment:

By Don McCanne, M.D.

It is our private insurance industry that is charging us exorbitant amounts to take away coverage through high deductibles and other cost sharing and through narrow provider networks, while at the same time they are placing a tremendous administrative burden on the professionals and hospitals that provide the care – an administrative burden that we also pay for.

A well designed, single payer, improved Medicare for All is what we need, not more of the administratively burdensome private insurance industry that Biden wants to pay for with even more of our taxes. By condemning Medicare for All, he is missing the opportunity to finally fix our system so it works for everyone.

https://www.nytimes.com…

Comment:

By Don McCanne, M.D.

When affordability is a problem, Biden wants to spend even more through our taxes and give it to the private insurance industry – the source of our profound administrative waste, along with the administrative burden they place on the delivery system.

The private insurance industry is selling us services we don’t want – deductibles and other cost sharing, maintenance of narrow networks, prior authorization administrative costs, while ducking out on paying for surprise bills and other denied benefits.

The tragedy is that a well designed, single payer, Medicare for All program would eliminate the costs of these excessive and unwanted administrative services, but Biden has ruled this out. What is the matter with him? Everyone could be covered at a lower cost if we would just get rid of the private insurers. That is our money they are holding onto, and for that we are giving them up to 15% when our traditional Medicare takes less than 2%? Exorbitant profits for the industry when it is us who are paying the bills.

It doesn’t make sense. We are paying more but getting less, and now Biden wants to give the insurers even more – not exactly the way private markets are intended to work.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

Rx for Success Podcast: The Catalyst

Interview with Dr. Ed Weisbart

January 18, 2021

PNHP-MO chair Dr. Ed Weisbart spoke about his experience organizing physicians in support of single payer in St. Louis, across Missouri, and across the United States. Will we see Medicare for All in the near future? Dr. Weisbart sounds a hopeful note, reminding us that “every major social change has seemed impossible two years before it was accomplished.”

https://rxforsuccesspodcast.com…

MLK Jr.: Do we have the will to end poverty?

My Father, Martin Luther King Jr., Had Another Dream

If he saw the issues of poverty and income inequality that exist today, he would be greatly disappointed.

By Martin Luther King III
The New York Times, January 18, 2021, Martin Luther King Jr. Day

Martin Luther King Jr.: “There is nothing new about poverty. What is new is we now have the techniques and the resources to get rid of poverty. The real question is whether we have the will.”

https://www.nytimes.com…

Comment:

By Don McCanne, M.D.

Over half a century later, we still have the techniques and the resources to get rid of poverty. The question still remains, “Do we have the will?”

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

Medicare for All

By Eve Shapiro, M.D., M.P.H.
Arizona Daily Star, Letters, January 16, 2021

In response to the writer stating that Medicare is the reason doctors are not moving to the Tucson area, let me offer a response. First, we have a shortage of primary care physicians in the US due to the high cost of medical school and the need to repay large loans (specialists make far more than primary care physicians). Second, Medicare is a very reliable payer compared to private insurance with much less hassle. Third, the bill that will be introduced in Congress again this year is an improved Medicare for All. Since everyone is included, physicians’ administrative costs will be far lower, since they are only billing one insurer, effectively increasing their incomes. Look around the world to every other developed country with a single-payer system. Doctors’ job satisfaction is significantly higher with less stress reported.

https://tucson.com…

Are There Trade-offs in Public Health Insurance Design?

Trade-offs in Public Health Insurance Design

By Katherine Baicker, Ph.D.
JAMA Health Forum, January 14, 2021

The importance of access to health care and the financial protections that insurance should provide have never been more salient, and the potential consequences of the costs and gaps within the patchwork system in the US have never been more dire. Would the US population be better off with a simple, single-payer, uniform Medicare-for-all–type of insurance plan?

Trade-offs abound in policy decisions about health insurance. Although the advantages of moving to such a single-payer plan might be appealing, there are large hidden costs that must be considered.

First, having a single health insurance plan to cover the heterogeneous US population can actually make people worse off than tailoring the generosity of benefits to different people’s needs and preferences. In work I carried out with Mark Shepard, PhD, now at the Kennedy School at Harvard University, and Jonathan Skinner, PhD, at Dartmouth College, we highlight that the costs of having a uniform public insurance benefit have increased dramatically since Medicare’s advent in 1965.

One reason for the sharp increase in the costs of having a uniform public insurance benefit is the dramatic advances in health care within the last half century, with many more intensive—and costly—treatments now available. Providing all the care that might possibly be available is a much more expensive proposition now, necessitating forgoing many other things. A second reason is the substantial growth of income inequality. A person with a high income might be willing to devote resources to expensive care of only minimal health benefit, whereas a person with a lower income may need to devote those same resources to housing or education. A third reason is that, as tax rates have risen, the economic cost of raising funds to cover public insurance programs has become much larger.

All of this means that providing the same public insurance plan to everyone would leave segments of the population worse off. This could be higher-income groups, if the public benefit is limited and they are prohibited from going around it; or lower-income groups, if the benefit is comprehensive and too few resources are left to be devoted elsewhere. An alternative that might be better for everyone would be a basic public health plan available to all coupled with increased spending on other social insurance programs for lower-income groups, with the option to augment those benefits with privately purchased wraparound plans—more like the Medicaid-for-all who want it proposal.

A second factor in evaluating the costs and benefits of having a single plan is the trade-offs that are inherent to insurance plan design. Different people value different features in their health insurance, even if the overall generosity of the plan is held constant. Of course, most would prefer lower costs and broader coverage, all else being equal. Although most want the same care but at a lower price, lower cost sharing means higher premiums, whereas narrower networks can lower premiums.

Amitabh Chandra, PhD, at the Kennedy School and the Business School at Harvard University and I explored the answers given by a nationally representative survey sample about what features in a health insurance plan were most important to those surveyed, focusing on the trade-offs among elements such as lower co-payments, more expansive networks, lower premiums, and more comprehensive coverage. People were remarkably divided in their preferences about those dimensions, and given the option, they would make different choices about their insurance coverage.

The impetus for a single-payer plan is often not only the hope of reducing costs but also the goal of expanding coverage. The same survey suggests that altruistic concern for other individuals’ access to care, encouragingly, cuts across the political aisle. Faith in whether the government or the private sector is best able to effectively provide that care is much more sharply divided.

Another potential drawback of having a single plan is that competition among plans has the potential to drive down costs and accelerate innovation. This requires true competition within the insurer market, as well as among clinicians, hospitals, and other health care facilities, which is not the case in many parts of the country. There is genuine debate to be had about the potential for the introduction of a public option to increase choice and competition to promote higher value.

The costs of a single, expansive public program point to the potential benefits of giving enrollees a choice among insurance options—free or heavily subsidized for lower-income populations—to expand coverage while allowing people to make choices that reflect their priorities and drive value. There is an example along these lines in the Medicare Advantage system already in place, and most patients enrolled in Medicaid receive their insurance through privately managed plans.

None of this is meant to say that the current system is serving the US population well now. Individuals are paying more and getting less than they should—and this is particularly true for vulnerable populations. Instead, acknowledging the societal value of expanding coverage and increasing affordability, as well as the unavoidable trade-offs involved in the design of public programs, would move the country toward implementing a fiscally sustainable, high-value public insurance safety net.

Katherine Baicker, PhD, is dean of the Harris School of Public Policy, University of Chicago.

https://jamanetwork.com…

Comment:

By Don McCanne, M.D.

Are there really trade-offs in accepting single payer Medicare for All? What are the hidden costs, if any?

Katherine Baicker says that having a single plan can make people worse off because their needs and preferences are different. Needs and preferences may be different but that is why you need a single plan which can cover all reasonable needs and preferences. You often cannot predict a year in advance what the needs will be.

She states that the costs of having a uniform benefit has increased since Medicare’s advent in 1965, but essentially all costs have increased since then. That is what inflation does, though maybe there is also a disproportionate increase due to increased volume. But if those services are beneficial, we should keep them. We can afford them.

She also mentions the increase in tax rates, though Trump recently reduced tax rates for the wealthy. She says that it might be better to have a basic health plan for everybody coupled to increased spending on other social programs for lower-income groups. It is true that taxes should be progressive to pay for social programs, but that does not mean that benefits should be arbitrarily sorted out for health care coverage. All essential benefits should be included.

She states that premiums, co-payments, provider networks, and comprehensiveness of benefits could be made variable by providing different insurance coverage plans, but those are insurance gimmicks that should have no place in a universal public plan financed by progressive taxes.

She expresses concern that a single plan would forgo the benefits of competition, but that is fine since what we really want instead is cooperation.

But then she concludes with the statement, “None of this is meant to say that the current system is serving the US population well now.” That is correct, and that is why we should want a single, comprehensive program that covers everyone – a single payer, improved Medicare for All – a plan that would serve us all well.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

Structural Racism in the COVID-19 Pandemic

Racial Injustice in U.S. Health Care Calls for a Truth and Reconciliation Commission, Bioethicist Says

Columbia University, Irving Medical Center, January 12, 2021

The COVID-19 pandemic has exacerbated the deep fissures in our nation’s health care system, accentuating tragic disparities largely along racial and ethnic lines and highlighting the need for an immediate exploration of the underlying structural racism so that health care can become more inclusive and equitable, according to Maya Sabatello, LLB, PhD, associate professor of medical sciences in the Division of Ethics in the Department of Medical Humanities and Ethics and in the Department of Medicine at Columbia University Vagelos College of Physicians and Surgeons.

Sabatello, an expert on human rights and the ethical, legal, and social implications of genetics, proposes a COVID-19 Truth and Reconciliation Commission. “These commissions began as a way to help authoritarian governments recover from their abusive pasts and transition toward democracy without being punitive,” Sabatello says. “The United States may not be a fragile democracy, but our health care system—who controls it, who benefits from it—resembles an autocratic regime.”

In a paper published in the American Journal of Bioethics, Sabatello and colleagues outline a forward-looking path to break the cycle of disparity and create a nationally equitable health care system.

Why do you think a Truth and Reconciliation Commission could help address the inequities exposed by the pandemic?

Truth and Reconciliation Commissions are an attempt to establish and publicly record the experiences and scale of the physical and emotional harm caused by past injustices. They help us think about the experiences of victims and perpetrators so we can develop ways to address and overcome systemic issues. A Truth and Reconciliation Commission is aimed at acknowledging wrongdoing and learning from injustices in order to move forward.

A Truth and Reconciliation Commission would allow racial and ethnic communities that have been targets of structural racism and have been disproportionately impacted by the COVID-19 pandemic to speak up and share their experiences in a forum that aims to lead to real change. This would include Black/African American, Latinx, and Indigenous communities but should also be inclusive of other groups experiencing structural discrimination. It would also give clinicians a forum to have conversations around the systemic issues they face in providing equal care so that they can help reconstruct the system. Additionally, it’s a constructive way for administrators of health care systems and politicians to hear the perspectives and the pain that’s caused by their decisions in order to promote systemic and structural changes.

https://www.cuimc.columbia.edu…

Structural Racism in the COVID-19 Pandemic: Moving Forward

By Maya Sabatello, Mary Jackson Scroggins, Greta Goto, Alicia Santiago, Alma McCormick, Kimberly Jacoby Morris, Christina R. Daulton, Carla L. Easter & Gwen Darien
The American Journal of Bioethics, Published online: December 19, 2020

Abstract

The COVID-19 pandemic has taken a substantial human, social and economic toll globally, but its impact on Black/African Americans, Latinx, and American Indian/Alaska Native communities in the U.S. is unconscionable. As the U.S. continues to combat the current COVID-19 cycle and prepares for future pandemics, it will be critical to learn from and rectify past and contemporary wrongs. Drawing on experiences in genomic research and intersecting areas in medical ethics, health disparities, and human rights, this article considers three key COVID-19-related issues: research to identify remedies; testing, contact tracing and surveillance; and lingering health needs and disability. It provides a pathway for the future: community engagement to develop culturally-sensitive responses to the myriad genomic/bioethical dilemmas that arise, and the establishment of a Truth and Reconciliation Commission to transition the country from its contemporary state of segregation in healthcare and health outcomes into an equitable and prosperous society for all.

Conclusions

The COVID-19 pandemic gives a face to decades of segregation, racism and structural discrimination. It forces us to look to the generations of especially Blacks/AAs, Latinxs and AI/ANs that have often endured mistreatment in all aspects of life—from limited educational and employment opportunities to high levels of poverty and environmental neglect, insufficient, often absent, access to basic healthcare services, police brutality, and overrepresentation in the criminal justice system.

The opportunities for moving forward are plenty. Although the COVID-19 pandemic raises numerous questions, it intersects with other areas in which there is an abundance of knowledge that can inform the discussion. In this article, we drew on scholarship in genomics to highlight challenges that are likely to arise. These include collection, use and storage of data for research, fair and equitable access to the benefits of research, testing and surveillance concerns, and lingering healthcare needs and long-term disability among individuals, families, and communities at large. Community engagement and multi-leveled commitment will be vital for ensuring tailored and culturally sensitive approaches to assure that historical wrongs are addressed and remedied. The COVID-19 pandemic calls for self-reflection, broad public engagement and cultural humility to transform our troubled health, socioeconomic and political infrastructures into a sustainable, equitable and prosperous society for all.

Free access to the full article:
https://www.tandfonline.com…

Comment:

By Don McCanne, M.D.

This is yet another article that shows how the COVID-19 pandemic has given a face to decades of segregation, racism and structural discrimination. This one is somewhat unique in that it recommends a Truth and Reconciliation Commission. This, of course, would not obviate the need to enact and implement a single payer, improved Medicare for All, but it would be a great step forward.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

Medicare for All Explained Podcast: Episode 48

Interview with Dr. Susan Rogers

January 14, 2021

PNHP president Dr. Susan Rogers discusses how COVID-19 has laid bare the racial inequities that have always existed in U.S. health care, and how a single-payer system could begin to address those inequities. “Once you take the profit notice out,” she says, “you can put the resources where they’re needed, not where you can make money.”

Additional episodes will be uploaded twice monthly. Subscribe in iTunes, or access a complete archive of the podcast, below.

https://medicareforallexplained.podbean.com

Providing vaccine to detained immigrants

ICE must provide Covid-19 vaccines to all detained migrants

By Nishant Uppal, Parsa Erfani, and Raquel Sofia Sandoval
STAT, January 12, 2021

Targeted vaccination efforts are essential in prisons and jails, where 90 of the 100 largest Covid-19 cluster outbreaks in the United States have occurred.

The spread of Covid-19 in ICE detention centers has also been rampant. On average, the monthly rate of cases in detention was 13.4 times higher than in the general population during the first five months of the pandemic. Yet ICE has been lax in implementing Covid-19 public health measures to protect detainees.

In collaboration with Physicians for Human Rights, we recently interviewed 50 formerly detained individuals. In this evaluation, published Jan. 12, those interviewed explained how ICE failed to comply with its own Covid-19 pandemic response requirements in at least 22 of its facilities — often denying detainees consistent access to soap, masks, and proper symptom-based testing and isolation.

We believe that, first and foremost, ICE should not be detaining individuals and that individuals who are currently detained should be released. But until that happens, the vaccine rollout is an opportunity for ICE to recognize that it is accountable for the health of detainees, who are at a similar risk level for Covid-19 as incarcerated individuals. They live in crowded, congregate facilities with limited social distancing, often sleeping only 3 feet from one another, as our interviews showed. Like incarcerated individuals, ICE detainees must be prioritized for Covid-19 vaccination.

The federal government must abide by its responsibility to detained migrants and spearhead a vaccine-distribution plan for all ICE detention facilities. Only by vaccinating the people most vulnerable to Covid-19 can we move closer towards an equitable post-pandemic future.

Nishant Uppal, Parsa Erfani, and Raquel Sofia Sandoval are students at Harvard Medical School, medical evaluators at the Harvard Student Human Rights Collaborative Asylum Clinic, and research associates at the Peeler Immigration Lab at Harvard Medical School.

https://www.statnews.com…

Physicians for Human Rights: “Praying for Hand Soap and Masks”
https://phr.org…

Comment:

By Don McCanne, M.D.

The rate of active cases of COVID-19 is 13.4 times higher for these detainees than it is for the general population. These are human beings. Of course we have to make available for them COVID-19 vaccine.

It is disappointing to see that most of the comments to the STAT article were dismissive, concentrating primarily on their immigrant status. But didn’t this land belong to the Native Americans, only to be cheated out of much of it by our ancestors? Admittedly, that is a different issue from being vaccinated during a pandemic, but isn’t their immigration status primarily a matter of timing?

Fortunately these Harvard medical students understand the differences and recognize that all of us should have our medical needs met.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

Medicare for All is the answer

By George Bohmfalk, M.D.
The Aspen (Colo.) Times,

Re: “Need health insurance? Mountain Family can help,” by Tamara Tormohlen, commentary, Aspen Times, Jan 7.

Ms. Tormohlen suggests that people needing affordable health insurance might find it through Connect for Health Colorado. I looked for plans posing as a 45-year-old single male making $50,000 a year. Interpreting the results boggles the mind of this old brain surgeon. I can’t imagine anyone but an insurance broker making sense of it.

The least expensive plan, after the advanced premium tax credit, has an annual premium of nearly $4,000, with a deductible of $7,500. That means that, should you need health care, you’d have to pay $11,500 before any insurance kicks in. And when insurance does kick in, it only pays a portion of the bills, and only to doctors and hospitals in the plan’s network. Very few people making $50,000 a year could afford that, which is why most personal bankruptcies and GoFundMe campaigns are due to medical bills.

In contrast, estimates suggest that, under Medicare for All, this same individual would pay under $3,000 a year, with his employer paying half of his 8% payroll tax. For less than $3,000, this person would have access to nearly every doctor and hospital in the country. There would be no deductibles, and prescription drugs, vision, dental and hearing care would be included. No shopping and plan and price comparisons would be needed, as this one-size-fits-all plan indeed would fit every American’s needs. He would pay this in taxes, so his taxes would go up, but he could easily pay those with the $4,000 he would otherwise be paying for just a private insurance premium, and have money left over.

In proposing Medicare for All, it’s not just the money that makes sense. It’s that every American would have the peace of mind and the health care they need, when they need it. No one worries about paying to have their house fire put out. We all pay for it with taxes, and the service is available 24/7. Why should we have to worry about paying to have our illnesses and injuries treated?

https://www.aspentimes.com…

Dr. Paul Song on “Doctors in Politics”

PNHP national board member and PNHP-California president Dr. Paul Song presented a Tuesday Talk to Doctors in Politics on January 12, 2021.  He spoke about how the COVID-19 pandemic has unmasked the flaws in U.S. health care, including the glaring ineffectiveness of employer-sponsored coverage, and how the industry was spending millions to push back against the obvious solution: single-payer Medicare for All.

Eric Foner on American exceptionalism

Capitol Mob Reveals Ongoing Refusal to Accept Black Votes as Legitimate

George Yancy interviews Eric Foner, history professor at Columbia
Truthout, January 12, 2021

What will history make of the horror and disbelief experienced by the world on January 6, when the United States Capitol was violently broken into and vandalized by Trump supporters who attempted to stop the counting of the Electoral College votes legitimately won by President-elect Joe Biden?

The painful and unforgettable events that transpired that day, leaving five people dead, not only speak to the fragility of American democracy but also reveal deeply embedded realities about white supremacy and its current and historical efforts to undermine democratic institutions and ideals.

Eric Foner: As an historian, I was particularly shocked by seeing the Confederate flag displayed in the Capitol. I can’t think of another time in history where the Confederate flag was prominently on display. Maybe there was such a moment. I don’t know. But again, that’s Trump. He has, among many other things, closely identified himself with the Confederacy, with the Confederate flag, Confederate monuments, and all that. It is pretty clear what people who carry the Confederate flag around think it says. This is not just heritage, so to speak. It’s not just respect of history. This is a symbol of white supremacy. Everybody knows that.

George Yancy: But, you know, there is a sense in which America is seen by many Americans as buttressed by a kind of theological destiny, where American “exceptionalism” speaks to a kind of unique mission and superiority that the U.S. has been bestowed. How do you think about the concept of “American exceptionalism” in relationship to the events on January 6?

Eric Foner: You know, to my mind, as a historian, American exceptionalism is the great obstacle to understanding America. It’s built into our culture. It’s very hard for us, even for those who realize how ridiculous it is, to get away from it. But it is ingrained in our culture. And it has all sorts of deleterious effects. You can start at a very simple level and say, well, “American exceptionalism” means that American history is different from other histories of other countries. Well, but that’s obvious. Chinese history is not the same as French history which is not the same as Brazilian history. So to say that different countries have different histories isn’t saying very much. But, of course, if we move up the ladder a little, American exceptionalism says more than that. It says that we have nothing to learn from the rest of the world. There’s no point in knowing about the rest of the world because we are so exceptional that what applies to them doesn’t apply to us.

This struck me years ago when Obamacare was being debated in the Congress. We’re aware that every other country has some kind of health care system, but nobody said why don’t we see what these other countries are doing. What’s going on in Germany or France or England or in Canada? They’re not all the same. They all have distinctive systems, but maybe we can learn something from their experiences. Nobody thinks we can learn anything from other people. And that’s very different from the Progressive Era a century or so ago. Americans really wanted to learn from other places about the processes of urbanization, industrialization, class conflict, which were happening all throughout the industrialized world. And American reformers and social scientists went over to Europe to see what policies were being adopted there.

A very good historian, Daniel T. Rodgers, wrote a book entitled Atlantic Crossings, which has to do with the idea of going back and forth. Now they don’t go back and forth. America tells other people what to do. Sometimes we tell them verbally. Sometimes we tell them by force of arms. Think of Iraq, for example. If you don’t want to be like us, then we’re going to force you to be, whether you want it or not.

https://truthout.org…

Comment:

By Don McCanne, M.D.

American exceptionalism. We can’t learn from other nations. We tell them what to do. We do not provide health care to everyone, yet we also do not listen to other nations that have done that. It is not that we do not have clear minds in people who know how to do it. A single payer improved Medicare for All would work just fine. It’s rather that we are exceptional. And what do we get for that exceptionalism?

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.