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

The Sacrifices of Empire

(The 4th of 8 posts regarding my 2002 decision to emigrate from the US to New Zealand)

It only became clear once I left the US the immense sacrifices Americans make for their cheap gasoline and consumer goods (see previous post). The most obvious is a range of domestic programs that other developed countries take for granted. These include publicly financed universal health care (in all industrialized countries except the US) and a range of education, jobs and social programs enacted under Roosevelt, Kennedy, Johnson and Nixon, which Reagan, Bush and Clinton repealed.

With a so-called war on terror on multiple fronts (I can count at least ten countries the US is at war with), federal block grants to states and cities have all been diverted to Pentagon spending. In city after city, there is no money to repair badly decrepit roads and bridges or provide adequate street lighting and policing. While dozens of clinics, libraries and homeless shelters shut their doors and teachers, cops and other state and local employees get laid off.

Sacrificing Democratic Rights and Civil Liberties

As citizens of the world’s greatest military power, Americans also make major sacrifices in terms of democratic governance and civil liberties. This, too, only became clear once I became an expatriate.

Genuine democracy is totally incompatible with military empire. If allowed some say whether to spend most of their tax dollars on weapons and war, the vast majority of Americans would respond with a resounding “no.” Civilian populations are universally repelled by the carnage of war. Women, who comprise more than fifty percent of the population, consistently oppose any military tactics that kill large numbers of civilians. Likewise taxpayers of both sexes expect to see their hard earned tax dollars spent on public programs that benefit them. Not to enrich Wall Street banksters and corporate war profiteers.

Ordinary Romans felt the same way. Which was the main reason their leaders abandoned democracy when they undertook to expand the Roman republic into an empire.

Creating a Constitution Conducive to Empire

There’s also a clear link between the growing wealth an power of banks and multinational corporations and the recent attack on democratic rights and civil liberties (the repeal of habeas corpus and legalized government spying authorized under the Patriot Act and NDAA).

This relates, in my view, to structural flaws in the US system of government that make it less democratic than other industrialized countries. These mostly relate to what the Constitutional framers referred to as “separation of powers.”

In social studies we were taught these “checks and balances” were intended to make the US government more democratic. However it’s clear from the writings of Hamilton, Madison and other constitutional framers that their real intent was to minimize the risk of a direct popular vote harming the interests of wealthy landowners and merchants.

In their writings, the founding fathers make no secret of their imperialistic ambitions (their plans to declare war on the Native Americans and Mexicans who possessed the lands west of the 13 original colonies). This military expansionsim was extremely unpopular with a mainly rural, farming population that experienced immense personal and economic hardship during the Revolutionary War.

And military expansion didn’t end when the US seized the Southwest and California from Mexico. In 1895, the US declared war on Spain to expand the empire to include Cuba, Puerto Rico, Hawaii, the Philippines and other Pacific islands.

Parliamentary Democracy=One Man One Vote

Unlike the majority of industrialized countries, the US doesn’t employ a “one-man-one-vote” system of representational democracy. The only hope our Constitutional framers had of enacting their pro-business, pro-military agenda was to establish two branches of government (the Senate and Presidency) that wouldn’t be determined by direct popular vote. The idea was to block populist legislation enacted by the democratically elected House of Representatives

After 11 1/2 years experience with New Zealand’s, parliamentary democracy, I have absolutely no doubt that it’s more democratic than the US system. Under a parliamentary system, the head of the party controlling the majority of legislative seats automatically becomes chief of state. The moment the prime minister loses the majority he/she needs to pass legislation, the government collapses and a new election is called. This is in marked contrast to the US Congress. The latter has been virtually paralyzed for 30 years – while American schools and the US health care system continue to disintegrate in front of our eyes.

Another important advantage of a parliamentary democracy is the establishment of an official opposition party, which is expected to attack and embarrass the party in power. The result is vigorous and often raucous parliamentary debate, characterized by booing, cheering and outright heckling by members of the opposition parties.

Open “bipartisan consensus,” which is so heavily promoted by the US mainstream media, would be extremely unpopular in New Zealand. The majority of Kiwi voters retain a strong working class consciousness and are extremely dismissive of politicians with open ties to the corporate and business lobby.

Video of Question Time in NZ Parliament:

Fast Food Restaurants Cost Taxpayers Nearly $8 Billion

 

Why Are We Subsidizing Profitable Corporations?

Over the past few days, the corporate media has been trumpeting September’s “low” 7.2% unemployment rate. For the most part, the mainstream media fails to report that joblessness has only decreased 0.1% since August. Or that 20,000 of the 148,000 jobs created were temporary jobs. They also neglect to mention that most new jobs since the 2008 economic crisis don’t pay enough to live on. Which means that US taxpayers subsidize minimum wage workers to the tune of $7.8 billion a year. Given the current $17 trillion government debt, this seems like a major chunk of change.

In 2012, half of US jobs paid under $33,000 annually. Most of these minimum wage jobs are in America’s fast food restaurants, where employees struggle to get by on $7.25 an hour.

According to a recent University of Berkeley/University of Illinois study, 52% of fast food workers rely on federal programs like Medicaid, food stamps, the Earned Income Tax Credit, and Temporary Assistance for Needy Families to provide for their children. This is due partly to poverty-level wages and partly to heavy reliance by fast food outlets on part time workers (under 30 hours per week). MacDonald’s et all are reluctant to take on full time employees owing to the new requirement (under Obamacare) that they provide health insurance for full time workers. .

Something seems terribly wrong here. MacDonald’s, Subway, Burger King, Wendy’s, Domino’s Pizza are all highly profitable corporations. So why is the US taxpayer bailing them out by providing health care, food stamps, and other federal benefits for their employees and their families?

Work Week Shrinking Under Obamacare

Under Obamacare, employers are only required to provide health insurance if workers put in more than 30 hours a week. Investors.com has been tracking employers that are either cutting work hours or only hiring part time workers to reduce their obligation under the new law.

When employers cut back their full time workers, Obamacare shifts responsibility to the federal government (through expanded Medicaid programs and premium subsidies) to provide health coverage for minimum wage workers. Thus in addition to subsidizing MacDonald’s, Subway, Burger King, Wendy’s, Domino’s Pizza, the taxpayer is also subsidizing highly profitable insurance companies like Aetna, United Health Care, and Blue Cross/Blue Shield.

The Government Accountability Office reports that Obamacare will increase the federal deficit by $6.2 trillion. $709 billion of this will fund Medicaid expansion (from 2014-2023). The rest will take the form of direct subsidies to insurance companies.

Sarah Palin Describes Obamacare as Corporatism

In a recent oped on Breitbart, former Alaska governor Sarah Palin describes Obamacare as “a sort of corporatism, which is the collusion of big government with big business.” While she and I disagree on many issues, that we definitely agree on.

She goes on to predict that the exorbitant costs will cause a breakdown in the US health care system. When this happens, she believes, Americans will clamor for the government to enact a single payer system which excludes parasitic health insurance companies from the health care equation.

I sure hope she’s right. Palin makes the unsubstantiated claims that single payer funding will lead to death panels and higher costs. There are no death panels in Medicare, which is a single payer system. Moreover Medicare, which was enacted in 1965, enables senior citizens to access health care far more cheaply and efficiently than private insurance does.

Nor are there death panels in the dozens of other countries that publicly fund health care. Even more importantly, they all pay about half what the US does for medical services. Seems to me it’s high time for the US to catch up with the rest of the civilized world. Except for the US, all other industrialized countries guarantee that all citizens, regardless of income, have the right to see a doctor when they’re sick.

photo credit: caribb via photopin cc

Originally published in Veterans Today