Doctors Call for Single Payer Health Care, Cite Need to Move Beyond ACA

The American Journal of Public Health publishes physicians’ call for sweeping single-payer reform with detailed proposal signed by over 2,200 doctors nationwide

Unveiling of proposal coincides with heightened debate on ‘Medicare for All’ in presidential primaries

In a dramatic show of physician support for deeper health reform – and for making a decisive break with the private insurance model of financing medical care – 2,231 physicians called today [Thursday, May 5] for the creation of a publicly financed, single-payer national health program that would cover all Americans for all medically necessary care.

Single-payer health reform, often called “Medicare for All,” has been a hotly debated topic in the presidential primaries, thanks in part to it being a prominent plank in the platform of Sen. Bernie Sanders. The new physicians’ proposal is strictly nonpartisan, however.

The proposal, which was drafted by a blue-ribbon panel of 39 leading physicians, is announced today in an editorial titled “Moving Forward from the Affordable Care Act to a Single-Payer System” published in the American Journal of Public Health. The editorial links to the full proposal titled “Beyond the Affordable Care Act: A Physicians’ Proposal for Single-Payer Health Care Reform” and the names of all the signers, and it appeals for additional physicians to add their names as endorsers. The proposal currently has signers from 48 states and the District of Columbia.

“Our nation is at a crossroads,” said Dr. Adam Gaffney, a Boston-based pulmonary disease and critical care specialist, lead author of the editorial and co-chair of the Working Group that produced the proposal.

“Despite the passage of the Affordable Care Act six years ago, 30 million Americans remain uninsured, an even greater number are underinsured, financial barriers to care like co-pays and deductibles are rising, bureaucracy is growing, provider networks are narrowing, and medical costs are continuing to climb.

“Caring relationships are increasingly taking a back seat to the financial prerogatives of insurance firms, corporate providers, and Big Pharma,” Gaffney said. “Our patients are suffering and our profession is being degraded and disfigured by these mercenary interests.”

Dr. Steffie Woolhandler, a co-author of the editorial and proposal who is a professor of public health at the City University of New York’s Hunter College and lecturer at Harvard Medical School, commented: “We can continue down this harmful path – or even worse, take an alternative, ‘free-market’ route that would compound our problems – or we can embrace the long-overdue remedy that we know will work: the creation of a publicly financed, nonprofit, single-payer system that covers everybody. Today we’re saying we must quickly make that shift. Lives are literally at stake.”

Dr. Marcia Angell, a co-author of the editorial and proposal, co-chair of the working group, member of the faculty of global health and social medicine at Harvard Medical School and former editor-in-chief of the New England Journal of Medicine, said: “We can no longer afford to waste the vast resources we do on the administrative costs, executive salaries, and profiteering of the private insurance system. We get too little for our money. It’s time to put those resources into real health care for everyone.”

Under the national health program (NHP) outlined by the physicians:

* Patients could choose to go to any doctor and hospital. Most hospitals and clinics would remain privately owned and operated, receiving a budget from the NHP to cover all operating costs. Physicians could continue to practice on a fee-for-service basis, or receive salaries from group practices, hospitals or clinics.

* The program would be paid for by combining current sources of government health spending into a single fund with modest new taxes that would be fully offset by reductions in premiums and out-of-pocket spending. Co-pays and deductibles would be eliminated.

* The single-payer program would save about $500 billion annually by eliminating the high overhead and profits of insurance firms, and the massive paperwork they inflict on hospitals and doctors.

* The administrative savings of the streamlined system would fully offset the costs of covering the uninsured and upgraded coverage for everyone else, e.g. full coverage of prescription drugs, dental care and long-term care. Savings would also be redirected to currently underfunded health priorities, particularly public health.

* The “single payer” would be in a strong position to negotiate lower prices for medications and other medical supplies, yielding additional savings and reining in costs.

Surveys show strong, rising support for single-payer national health insurance among physicians. A 2008 survey of physicians found that 59 percent supported “legislation to establish national health insurance,” up from 49 percent five years earlier.

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“Moving Forward From the Affordable Care Act to a Single-Payer System,” by Adam Gaffney, M.D.; Steffie Woolhandler, M.D., M.P.H.; David U. Himmelstein, M.D.; Marcia Angell, M.D. American Journal of Public Health, June 2016, Vol. 106, No. 6, online first May 5, 2016, 1 p.m. Eastern. Includes link to full Physicians’ Proposal. Article available at this link.

The full, six-page Physicians’ Proposal with reference citations and 2,231 signatures (titled “Beyond the Affordable Care Act: A Physicians’ Proposal for Single-Payer Health Care Reform,” written by a 39-member Working Group on Single-Payer Program Design) is also accessible at the following link

PNHP’s summary of the Physicians’ Proposal is available here: summary

PNHP’s fact sheet on U.S. health care is here

Physicians for a National Health Program is a nonpartisan, nonprofit research and education organization founded in 1987. It includes physicians in every state and medical specialty. For local physician contacts or other information, contact PNHP’s headquarters in Chicago at (312) 782-6006. PNHP had no role in funding the articles described above.

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Vermont Excludes Insurance Companies from Health Care

In 2011, the Vermont legislature enacted Act 48, which replaces private health insurance with a state-funded health care plan covering all Vermont residents. Governor Peter Shumlin, concerned about major flaws in Obamacare, made Green Mountain Care, the centerpiece of his 2010 gubernatorial campaign. In Vermont, as in the rest of the industrialized world, health care is viewed as a basic human right. Green Mountain Care is slated to become operational in 2017.

Like a growing number of Americans, Schumlin feels Obama’s Affordable Health Care Act (ACA) is financially unworkable. Instead of eliminating private insurance companies that suck out  25-33% of every health care dollar for profit and administrative expense* – it guarantees them generous government subsidies.

The US is the only country in the world which allows for-profit insurance companies to insert themselves into the doctor-patient relationship by dictating the types and amount of treatment that will be allowed. Because they allow insurance and drug companies to transform health care into a profit-making commodity, Americans pay twice as much for health care than any other country. Meanwhile they enjoy much poorer health than most of the industrialized world.

In part due to skyrocketing insurance costs under Obamacare (premiums for young adults have nearly doubled), millions of low income Americans remain uninsured. The Congressional Budget estimates that 36 million people will be uninsured in 2015, 30 million in 2016 and 31 million in 2024.

Meanwhile all Americans find the private insurance plans they are required to to buy, under penalty of law, cover far less than Obama originally promised. With the high cost of premiums, deductibles and copayments, they pay more and more of their health care bill themselves.  It doesn’t help that insurance companies are extremely devious about what they do and don’t cover. As many doctors and patients are discovering, the default setting for many health plans is to deny payment.

Green Mountain Care

In 2011 Harvard economist William Hsaio estimated that removing private insurance companies from the health care equation, as stipulated under Vermont’s Act 48, would save $4.3 billion over four years – enough to cover the uninsured, offer better coverage than insurance companies and still have more than a billion dollars left over.

Under Green Mountain Care, a combination of income and payroll taxes (details to be released in January 2015) will replace the $1.9 billion in health insurance premiums Vermonters currently pay. Residents covered by federal plans, such as Medicare, Medicaid, the VA and programs for active duty military personnel would continue to receive coverage through those plans. However, for the sake of administrative efficiency, both Medicare and Medicaid would be streamlined into Green Mountain Care’s unified claims administrative system.

Vermont would be the first state to guarantee health coverage for all its residents, regardless of income. As Michael Ollove notes in Vermont is Single Payer Trailblazer, they were also the first state to constitutionally ban slavery and mandate public funding for universal education, the first to introduce civil unions for same-sex couples and the first to allow gay marriage.

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*Obscene CEO salaries figure prominently in this “administrative” expense. In 2013 the CEOs of the 11 largest for-profit insurance companies received compensation packages totaling more than $125 million.

photo credit: Steve Rhodes via photopin cc