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Organizing for a national, single-payer healthcare system.
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Save the Date: Healthcare-NOW!’s 10th Anniversary Strategy Conference

Wed, 04/23/2014 - 15:21

This year marks our 10th anniversary! Marilyn Clement founded Healthcare-NOW! in 2004 originally under the title “Campaign for a National Health Program NOW.”

We are doing something extraordinary for our National Strategy Conference to mark this occasion: we will be hosting a mega single-payer conference jointly with the Labor Campaign for Single-Payer Health Care and the One Payer States group, all of which will converge on Oakland, California the weekend of August 22-24. After ten years, this will be our first National Strategy Conference on the west coast!

The Healthcare-NOW! and Labor Campaign conferences will be hosted at the International Longshore & Warehouse Union Hall in Oakland, and One Payer States will be hosted a short distance away at the California Nurses Association. We expect over 300 activists to attend, and participants will have the option of attending all three conferences if they choose, along with joint plenaries, keynote speakers, and a Saturday night reception that will bring everyone together.

So mark your calendar for the weekend of August 22-24! We’ll have a call for workshop proposals and a registration page up shortly. We are incredibly excited to bring such a large group of inspiring activists together to learn from one another and energize this movement!

Single-Payer System Would Be a Boon to the Economy, Public Citizen Report Says

Mon, 04/21/2014 - 14:09

New System Would Boost Economy, Reduce Costs and Eliminate Unfair Burdens on Companies That Provide Health Insurance Benefits

WASHINGTON, D.C. – A publicly funded, universal health care system would aid businesses by engendering a more dynamic economy, taming costs and freeing businesses that provide health insurance of the costs of administering benefits and subsidizing the nation’s health care, a Public Citizen report released last week concludes.

“Small businesses have rated the cost of health insurance as their top concern for a quarter century, and large businesses struggle with health care obligations that their international competitors do not have to worry about,” said Taylor Lincoln, research director of Public Citizen’s Congress Watch division and author of the report. “If it weren’t for entrenched partisan alliances, business leaders would have demanded that Congress relieve them of health care burdens long ago.”

Publicly funded universal health care systems – such as the Canadian “single-payer” system, in which the government pays for all covered services – exist in nearly every developed country in the world. In the United States, universal care systems could be implemented either at the federal or state levels. The Affordable Care Act of 2010 includes language permitting states to apply for waivers that would enable them to institute universal care systems beginning in 2017. Vermont has passed legislation declaring an intention to do just that.

Public Citizen’s report, “Severing the Tie That Binds,” outlines three ways a universal health care system would benefit businesses.

First, it would end “job lock” and other economic distortions stemming from our health care financing system that hinder the freedom of individuals to pursue new ventures. Despite common perceptions that the United States is an entrepreneurial bastion, we have among the lowest rates of self-employment and small businesses among industrialized countries, researchers at the Center for Economic and Policy Research reported in 2009.

The researchers hypothesized that the dismal numbers in the United States were due to the high costs that individuals and small businesses here must pay for health care, which those in countries with universal access to health care do not face. By facilitating more entrepreneurship, a universal health care system here would likely boost economic growth, leaving businesses with a larger pool of potential customers.

Second, a universal care system would significantly dampen future increases to health care costs – and perhaps reduce costs – even as it greatly increased access to care. Numerous studies have concluded that the United States spends much more on administrative functions, such as billing and interactions with insurance companies, than other wealthy countries. Meanwhile, pharmaceuticals and procedures in the United States cost much more here than elsewhere.

A universal care system would reduce administrative costs by expanding economies of scale, streamlining processes and cutting insurance companies’ marketing costs and profits from our national health care bill. At the same time, costs for drugs and procedures would be kept in check by increased transparency, as well as increased governmental bargaining power and rate-setting authority.

Third, although a publicly funded, universal care system would likely rely on significant revenue from businesses (such as through a payroll tax), there is reason to believe that total health care-related costs for businesses now providing benefits would decline, in part because a new system would spread costs more fairly.

Businesses that provide health care benefits would no longer have to essentially subsidize those that do not by covering the unreimbursed cost for care provided to the uninsured. Businesses also would be spared the costs of administering health care benefit programs. Meanwhile, funding formulas for universal care may reduce the overall share of national health care costs borne by the business sector by garnering revenue from a broader array of sources.

Elements of the solutions laid out in Public Citizen’s report already exist at the state level or are under consideration. For 35 years, Maryland has set across-the-board rates for hospital care, including care funded by Medicare and Medicaid. This program has saved tens of billions of dollars. In 2014, the scope of Maryland’s program was broadened by establishing overall caps on hospital budgets to counter the economic incentive to provide a greater volume of care. Establishing rate-setting authority and capping overall hospital budgets are hallmarks of the cost-savings mechanisms in universal care systems.

Vermont in 2011 passed legislation that called for it to create a “universal and unified health system” that would take advantage of provisions in the Patient Protection and Affordable Care Act that permit states to apply for waivers to craft their own health care systems beginning in 2017.

“The states might be flying below the radar, but they have a chance to implement solutions that should have widespread appeal,” said Lisa Gilbert, director of the Congress Watch division of Public Citizen. “If businesses leaders allow common sense to guide them, we think they will join the campaign for universal care.”

Forget Obamacare

Mon, 04/21/2014 - 13:41

Vermont wants to bring single payer to America

By Sarah Kliff for Vox

Saskatchewan is a vast prairie province in the middle of Canada. It’s home to hockey great Gordie Howe and the world’s first curling museum. But Canadians know it for another reason: it’s the birthplace of the country’s single-payer health-care system.

In 1947, Saskatchewan began doing something very different from the rest of the country: it decided to pay the hospital bills for all residents. The system was popular and effective — and other provinces quickly took notice. Neighboring Alberta started a hospital insurance plan in 1950, and by 1961 all ten Canadian provinces provided hospital care. In 1966, Canada passed a national law that grew hospital insurance to a more comprehensive insurance plan like the one that exists today.

Saskatchewan showed that a single-payer health-care system can start small and scale big. And across the border, six decades later, Vermont wants to pull off something similar. The state is three years deep in the process of building a government-owned and -operated health insurance plan that, if it gets off the ground, will cover Vermont’s 620,000 residents — and maybe, eventually, all 300 million Americans.

“If Vermont gets single-payer health care right, which I believe we will, other states will follow,” Vermont Gov. Peter Shumlin predicted in a recent interview. “If we screw it up, it will set back this effort for a long time. So I know we have a tremendous amount of responsibility, not only to Vermonters.”

When Shumlin ran on a single-payer platform in 2010, it was unprecedented. No statewide candidate — not in Vermont, not anywhere — had campaigned on the issue, and with good political reason. Government-run health insurance is divisive. When the country began debating health reform in 2009, polls showed single-payer to be the least popular option.

Shumlin just barely sold Vermont voters on the plan (he beat his Republican opponent by less than one percentage point). Then, he got the Vermont legislature on board, too. On May 26, 2011, Shumlin signed Act 48, a law passed by the Vermont House and Senate that committed the state to building the country’s first single-payer system.

Now comes the big challenge: paying for it. Act 48 required Vermont to create a single-payer system by 2017. But the state hasn’t drafted a bill that spells out how to raise the approximately $2 billion a year Vermont needs to run the system. The state collects only $2.7 billion in tax revenue each year, so an additional $2 billion is a vexingly large sum to scrape together.

Continue reading…

The Neoliberal Turn in American Health Care

Mon, 04/21/2014 - 13:24

By A.W. Gaffney for Jacobin

The failings of the Affordable Care Act are rooted in a long shift away from the idea of a truly universal health care.

Last year’s three-ring Congressional shutdown circus — for many little more than a desperate rearguard action by an isolated rightwing fringe to undo the fait accompli of Barack Obama’s health care reform — reinforced with each passing day the gaudy dysfunction of the American political system. But we miss something crucial if we construe the perseverance of Barack Obama’s 2010 Affordable Care Act (ACA) as nothing more than the overdue victory of commonsense health care reform over an irrelevant and intransigent right, or, even more, as the glorious culmination of a progressive dream for American universal health care long deferred.

For many commentators, though, this is precisely what the ACA represents. With the law’s passage in March 2010 and its survival in the face of a constitutional review by the Supreme Court, they have concluded that the battle “over universal health coverage,” as one writer for the Washington Post put it, “is basically over.” Unfortunately, the evidence does not permit such a sanguine conclusion.

Most plainly, when we consider the provisions and limitations of the law, it becomes clear that though it may help many, the ACA fails fundamentally to create what so many had hoped for: a system of universal health care. Leaving millions still uninsured and many more “underinsured” — a well-described and researched phenomenon in which the possession of health insurance still leaves individuals and families with dangerous financial liability when illness strikes — the ACA falls well short of the standard of universal health care as it is understood elsewhere in the social democratic world.

But more broadly, when we consider the ACA through the lens of political economy, an even more concerning narrative emerges, one that says even less about the triumph of social democracy and more about the sharp shift of the political center and the disintegration of the New Deal left. For the law fundamentally leaves intact a system of health care predicated, as we shall see, on key neoliberal health care beliefs, for instance the “moral hazard” of free care, the primacy of health consumerism, and the essentiality of the private health insurance industry.

Continue reading…

A Pro-Single Payer Doctor’s Concerns About Obamacare

Mon, 04/14/2014 - 09:49

By Adam Gaffney for Salon

As a single-payer advocate who is also a doctor, I was concerned after the Affordable Care Act was passed that it didn’t do enough to combat rising underinsurance. A recent study by the Commonwealth Fund, which used new data to demonstrate that in 2012 some 31.7 million Americans were underinsured (i.e. insured, but still with heavy additional out-of-pocket health care expenses), argued that the burden of underinsurance will likely lessen as the ACA fully unfolds. But is there really reason for such optimism?

This is a complicated issue with many moving parts, so one way to tackle it (before immersing ourselves in the exhilarating policy literature) is to pose a simpler question: if your family is insured, and someone gets seriously sick, can you not worry about going broke?

The short answer: it depends on how much you have in the bank, and on the “out-of-pocket maximum” established by the ACA for your particular plan. The out-of-pocket maximum is the most that you would have to pay (after premiums) on things like co-pays for medications or deductibles for hospitalizations, and it can go as high as $12,700 annually for exchange plans under the ACA. But doesn’t the law provide protection for lower-income individuals, for instance, in the form of reduced out-of-pocket limits? The answer is yes – but to a lesser extent than we initially thought, even though, somehow, no one informed us that things had changed.

Continue reading…

Listen: Health Care for All – Texas Open Journal April Episode

Wed, 04/09/2014 - 14:41

Health Care for All – Texas’s Open Journal radio series on healthcare reform was today, Wednesday, April 9th on KPFT 90.1FM (Houston) at 9:30am. Their guest this month was Dr. Gerald Friedman.

Listen here:

Here’s a direct link to the mp3 file (right click to save).

Dr. Gerald Friedman, Professor of Economics at the University of Massachusetts at Amherst was their guest. He is the author of a new study that shows how a nonprofit single-payer system based on the principles of “The Expanded and Improved Medicare for All Act, H.R. 676, would save $1.8 Trillion dollars over the next ten years and still be able to provide high quality health care for everybody.

Email HCFAT your ideas at or call in to 713-526-5738 during the next show. They will be on the air every 2nd Wednesday of the month at the same time.

As Vermont Goes, So Goes the Nation?

Wed, 04/09/2014 - 13:26

By Molly Worthen for The New York Times

When most liberals hear the words “third party,” they have nasty flashbacks to Ralph Nader’s spoiler campaign in 2000. The history buffs among them might think of the populist Greenback Party’s feckless protests against the gold standard in the 19th century or the five presidential campaigns of the Socialist Eugene V. Debs — the last of which, in 1920, he ran from prison.

Third parties seem out of touch with reality, the refuge of idealists with dreams too fragile for the trenches of major party politics. But Democratic skeptics, at least, shouldn’t be too quick to judge. One state is now on the way to single-payer health care, and a third party deserves much of the credit.

Three years ago, Peter Shumlin, the governor of Vermont, signed a bill creating Green Mountain Care: a single-payer system in which, if all goes according to plan, the state will regulate doctors’ fees and cover Vermonters’ medical bills. Mr. Shumlin is a Democrat, and the bill’s passage is a credit to his party. Yet a small upstart spent years building support for reform and nudging the Democrats left: the Vermont Progressive Party. The Progressives owe much of their success to the oddities of Vermont politics. But their example offers hope that the most frustrating dimensions of our political culture can change, despite obstacles with deep roots in American history.

Green Mountain Care won’t begin until at least 2017, but Vermont liberals are optimistic. “Americans want to see a model that works,” Senator Bernie Sanders told The Atlantic in December. (Mr. Sanders is an independent, but a longtime ally of the Progressives.) “If Vermont can be that model it will have a profound impact on discourse in this country.”

Before you dismiss that prospect as wishful thinking, consider: That’s how national health care happened in Canada. A third party’s provincial experiment paved the way for national reform. In 1946, the social-democratic government of Saskatchewan passed a law providing free hospital care to most residents. The model spread to other provinces, and in 1957 the federal government adopted a cost-sharing measure that evolved into today’s universal single-payer system.

It seems natural that America’s experiment in Canadian-style health care should begin in Vermont, a state with a long history of cross-border contact. In Derby Line, Vt., the border runs through the town library. Decades ago, pregnant women from Quebec often drove to Vermont to give birth, preferring American hospitals. Not anymore. When it comes to health care, two countries that share so much have diverged profoundly.

Between 1870 and the Great Depression, Americans and Canadians both worried about the growing gap between the mega-rich and the poor. Their disillusionment fueled the rise of dissenting parties. In Canada, the most successful of these, the social-democratic Cooperative Commonwealth Federation, won control of Saskatchewan in 1944. Canada never passed reforms to match the New Deal, and the C.C.F. capitalized on voters’ frustration with the federal government’s inaction — just as liberals in Vermont are now doing.

It’s risky to compare 1940s Saskatchewan to Vermont today, but “Vermont has some of the features that Saskatchewan had in the 1940s and 1950s. It’s a rural state in which voices from the left have been more legitimate than in other parts of the country,” said Antonia Maioni, a professor of political science at McGill University in Montreal. “Saskatchewan was the last place where you would have expected to have this bold innovation. It was the poorest, most rural, most sparsely populated province. And yet it was the mouse that roared.”

The Vermont Progressives have only eight seats in the State Legislature, but they played a decisive role in the 2010 gubernatorial election. They promised not to play spoiler if the Democratic candidate supported single-payer health care. “Shumlin was very clear on his stance, and it pulled him through a narrow primary — a lot of Progressives were volunteers on that — and then he narrowly won,” Chris Pearson, a Progressive state representative from Burlington, told me. “He kept his promise.”

What explains the success of the Progressive Party? Vermont is small, and “it was expected that I’d knock on every door in my district,” Mr. Pearson said. “Progressives are dedicated to that style of campaigning. It’s also affordable. You can run a House race for $5,000.”

Despite their urban origins in Burlington, the Progressives have won crucial support from rural, traditionally conservative parts of the state, where lifelong Republicans have responded to the same argument that the Populists once used: Without regulation and a public safety net, capitalism will grind the independent farmer into the ground.

The trouble is that the Progressives have no national colleagues pressuring President Obama from the left. The Saskatchewan social democrats and their national successor, the New Democratic Party, forced the ruling Liberals to move left in the 1950s and 1960s as other provincial governments came to favor national reform.

American third parties face many obstacles in national elections, not least financial disadvantages and the ability of the major parties to co-opt dissenters by forming factions (in Canada, rules requiring tight party discipline mean insurgents like the Tea Partiers would probably have to form their own organizations).

But there is a deeper ideological reason. Canada inherited something else from Britain besides the Westminster system. It retained the full spectrum of English politics. This includes the socialist left and the Tory right — both traditions that, despite their differences, call for a strong central government and the restraint of individual liberty in the interest of the community.

The United States, by contrast, is a revolutionary state. The founders feared both kingly tyranny and the rule of the mob, and they bequeathed to us a political spectrum that is the narrowest in the Western world. With few exceptions, even left-wing dissenters have preached some version of free market ideology. The Vermont Progressives’ promise to “promote cooperative, worker-owned and publicly owned enterprises” is a far cry from Debs’s demand that “the capitalist system must be overthrown.”

In times of crisis — during the Civil War, the Great Depression and World War II — Americans have tolerated a radical expansion of the role of government. Harry Truman tried to seize the moment in 1945 by pushing for universal health care, only to be stymied by conservative opponents and the American Medical Association.

American doctors succeeded where Canadian doctors failed (despite multiple doctors’ strikes) because the American political system left individual politicians vulnerable to lobbying. They capitalized on the rhetoric of the Cold War, insisting that “socialized medicine” was one step short of Soviet tyranny. There is also no denying the ugly role that race played in this story: Too many white Americans have rejected reforms for fear that their tax dollars would help black Americans.

Yet the main lesson that Americans can learn from Canada is that political cultures can change. In 1950 Canada was, in many respects, a more conservative country than America, and each step of reform was hard-won. But as Canadians watched new policies produce results, skeptics became supporters. “Many policies that emerged in postwar Canada have changed Canadians’ conception of their relationship to the state,” Professor Maioni told me. “Policies feed political culture.” If the Vermont experiment works, other states will follow. American pragmatism will trump ideology.

Action Alert: Don’t Eliminate Thousands of Immigrants’ Medicare Benefits

Fri, 04/04/2014 - 14:36

President Obama’s 2015 budget proposal would “involuntarily disenroll” some (fewer than 5,000) undocumented immigrants currently receiving some Medicare benefits–even those who have been paying into Medicare for decades–in order to realize minimal savings that will be offset by the costs to hospitals for treating the elderly uninsured.

Tell President Obama that his proposal to cut immigrant Medicare benefits is unfair, heartless, and unnecessary.

It’s unfair. Immigrants–mostly undocumented–contributed $13.8 billion dollars more into Medicare than they received in benefits in 2009, while US-born people generated a $30.9 billion deficit. Immigrants have actually been subsidizing and keeping the Medicare program afloat for US-born residents for decades, and they deserve better not worse coverage than they currently receive for their contributions.

It’s heartless. In order to save only $13 million a year (.0003% of his $3.9 trillion budget) President Obama is willing to put thousands of people’s lives at risk. Imagine losing your health insurance in an instant. How would you pay for your medication or doctor visits? The emergency room will replace the doctor’s office and this could cost us more than it saves.

It’s unnecessary. A national, single-payer healthcare plan, like HR 676, would cover everyone living in the US and save $500 billion a year on healthcare costs. Covering everyone who works and lives here should be our goal–not cutting benefits from hard-working individuals who put more into the system than they take out.

Tell President Obama: “Don’t cut undocumented immigrants’ Medicare coverage. It’s unfair, heartless, and unnecessary. Preserve their right to healthcare and work towards a single-payer healthcare system that would cover everyone living in the US instead.”

Maine House OKs Bill to Study Single-Payer System

Thu, 04/03/2014 - 09:49

By the AP

Maine’s Democratic-controlled House has given initial approval to a proposal to have the state examine whether to implement a universal health insurance coverage system.

The House voted 91-52 in favor of the bill Tuesday that would direct the state to contract with a consultant who would study options for establishing a single-payer system in Maine and submit a proposal to the Legislature.

Single-payer advocates have long been trying to implement the model in Maine with little success. They say a single-payer system will cut costs by streamlining the health insurance process and eliminating unnecessary paperwork.

But critics say the state should focus its resources on providing care to the elderly and the poor and question how the state could afford universal health care.

It faces further House and Senate votes.

Houston Everybody INstitute, May 17

Wed, 04/02/2014 - 08:13

On Saturday, May 17 from 10AM to 4PM in Houston, Health Care for All Texas and Healthcare-NOW! will be hosting the first ‘Everybody INstitute’ in the country. An Everybody INstitute is a one-day training focused on developing skills and strategies for single-payer organizing, messaging, outreach, public education, media, and legislative advocacy.

You can register today to be part of this event, which will re-energize our efforts to take the profit out of health care and guarantee access for all!

There is a suggested registration fee of $25, which will pay for lunch, translation services, and a packet of organizing materials for you to take home. However, no one will be turned away – if the fee would be a financial burden, simply request a scholarship online when you register. If you can make an additional contribution to sponsor a scholarship for someone else, please give generously when you register!

Email if you have any questions.

May 22, National Single-Payer Lobby Day!

Wed, 04/02/2014 - 08:04

Thursday, May 22 will be the first national single-payer lobby day of the year, supported by Healthcare-NOW!, Physicians for a National Health Program, Public Citizen, the Labor Campaign for Single Payer, and others.

Can you schedule a meeting with your Representative and Senators for May 22? You can visit your legislators’ offices in Washington, D.C. or in your district. Email Ben today so we can coordinate meetings across our different organizations.

Meeting face-to-face and describing why you care so passionately about single-payer is the most effective way to get your legislator on board – better than a hundred emails or phone calls. Even more effective is to bring a group of friends!

This will be a great opportunity to add co-sponsors to John Conyers’s Improved and Expanded Medicare for All legislation, HR 676 and Bernie Sanders’s American Health Security Act, S 1782, which would guarantee comprehensive health care for every resident of the United States while reducing costs.

Don’t know who your legislators are? Go here. Email Ben for lobby materials, help identifying whether your Reps. have supported single-payer reform in the past, and how to schedule a meeting at their office.

Is Obamacare In the Interest of Workers?

Mon, 03/31/2014 - 10:41

From the Real News

In round two of our debate with Dr. Margaret Flowers and economist Dean Baker, we discuss whether CBO’s prediction that Obamacare will trigger reduction of work hours will negatively affect workers.

With Hippocratic Oath, Doctors Pledge Allegiance to Patients, Not Profits

Fri, 03/28/2014 - 10:50

By Dr. Philip Caper for Bangor Daily News

The Maine Medical Association recently updated a 2008 poll of their members that asked the question, “When considering the topic of health care reform, would you prefer to make improvements in the current public/private system (or) a single-payer system, such as a ‘Medicare-for-all’ approach?” In 2008, 52.3 percent favored the Medicare-for-all approach. In the updated poll, released last week, that number had risen to 64.3 percent.

It’s pretty unusual for two-thirds of a group of doctors to agree on something as controversial as a single-payer health care system. Until recently, doctors formed the core resistance to “government-run” health insurance in the U.S.

A number of factors account for this impressive change, but the huge administrative burden on practicing physicians created by our plethora of private insurance schemes is certainly near the top of the list.

The other day, I spoke with a Maine physician nearing retirement and looking forward to it. She was recently returning home after a long day in her practice, carrying her “homework,” a pile of administrative paperwork several inches high. Her husband asked her how she got so far behind in her paperwork. “I wasn’t behind at all,” she replied. She did this much paperwork, mostly insurance forms, at least twice a week.

American physicians spend at least three times as much time, money and effort on administrative work related to payment and insurance coverage as our Canadian brethren, with their single-payer system. Administrative hassle is a major factor driving more and more American doctors to sell our practices to large corporations that take care of the back-office work. The Affordable Care Act has only added to that burden. Sixty percent of doctors now work for corporations, and that number is growing.

Working for a corporate provider of health care services is a mixed bag. He who pays the piper calls the tune. As both for-profit and nonprofit health care corporations have become increasingly focused on the bottom line, doctors working for them have come under increasingly subtle and not-so-subtle pressures to generate revenue for their employers.

Some tests and procedures are more profitable than others. Increasingly, doctors’ “productivity” is measured by the amount of profitable revenue we produce rather than by the results we get for our patients. But in health care, profitability is a very unreliable measure of value because doctors’ fees and other health care prices are often set arbitrarily.

When we graduate from medical school, most of us take the Hippocratic Oath, swearing our primary allegiance to our patients. Young doctors tend to take their oath very seriously. Most doctors truly want to do what’s best for patients, not their insurance company or our employers’ bottom line.

But in today’s corporatized and increasingly monetized health care environment, the demands for generation of profit often directly conflict with our clinical judgment. The belief that doctors and other healers act as stewards for our patients’ welfare has long earned us a special place in society and the trust of our patients. That position and that trust, so critical to healing, is now threatened.

This conflict has made many doctors very angry. Practicing a profession that has traditionally been a calling has become a business. Doctors today are caught in a system corrupted by an excessive focus on money that is forcing us to behave in ways that conflict with our professional ethics. We are growing very tired of being told how to practice medicine by insurance company bureaucrats and corporate MBAs.

This is another major cause of the burnout experienced by increasing numbers of doctors. Many older doctors are now simply looking for a way out. Others are calling for systemwide reforms that will allow them to return to focusing on the welfare of their patients. Hence the results of the recent MMA poll.

In an excellent new book called “What Matters In Medicine”, longtime Maine family doctor David Loxterkamp points out that medical care, while often using scientific jargon, methods and tools, is at its core a profession about relationships, not profits. That’s something the bean-counters and policy wonks who have become increasingly influential in determining the nature of our corporatized health care system seem unable to understand.

It’s time to remove corporate profit from the financing of health care, and perverse financial incentives from the direct provision of services. It’s time for improved Medicare-for-all.

Physician Philip Caper of Brooklin is a founding board member of Maine AllCare, a nonpartisan, nonprofit group committed to making health care in Maine universal, accessible and affordable for all. He can be reached at

The Single Payer Movement Expands

Mon, 03/17/2014 - 13:40

From Healthcare Finance News

Even as the Affordable Care Act is in its nascent stages, some states are already looking toward 2017 when they can request waivers to opt out of the healthcare exchanges. And a small, but persistent, movement has popped up toward a single payer system as an alternative to participating in the exchanges.

That grassroots movement is taking place in Pennsylvania.

In March, a report exploring the single payer system was created for the state by Gerald Friedman, professor of economics at the University of Massachusetts at Amherst. He found that a single payer system would cost $128 billion in 2014 as opposed to the current system, which costs $144 billion. It would save 11 percent ($16 billion) of healthcare costs in 2014, mainly by lowering spending on administration and reducing drug costs.

But adopting a single payer system would dramatically change the business of healthcare. And the examples to follow are nearly non-existent.

While rumblings of moving to a single payer system have been heard in states such Hawaii, Oregon and New York, only one state – Vermont – has passed legislation to move toward actually creating a single payer system.

Vermont, which already has 93 percent of its population insured, passed Act 48, which allows the state to begin preparing a single payer system. It requires the state to set parameters for minimum benefits, create a finance plan and put out a contract for an administrator of the program, and allows the state’s current insurance regulatory body to create a benefit package.

Robin Lunge, Vermont’s director of healthcare reform, said that Vermont’s goal is to move the issue of healthcare completely away from the employer. Vermont’s single payer system, she said, would be similar to the one state employees are already on. It would be financed through an employer and individual tax as well as the premium tax credits and subsidies provided through the exchanges.

In Pennsylvania, the single payer system Friedman based his report on would be funded through a variety of means, including a 3 percent income tax on individuals, a 10 percent payroll tax for employers and various federal and state funds.

The state’s Medicare, Medicaid and Veteran’s Administration programs would continue to operate as usual under a plan similar to Vermont’s. In Vermont’s potential single payer system, the system would act as a supplement to government insurance and cover everyone who is uninsured or part of the current state health exchanges.

The big losers in a Pennsylvania’s potential single payer system would be insurance companies, Friedman said. They would lose a big chunk of their business and profit.

“Insurance companies are the victims there,” he said.

Drug companies may also stand to lose profits, Friedman said. One of the biggest savings in the Pennsylvania estimate is $8 billion from reduced medication spending. This would happen because there would be one large pool that would have greater negotiating power (much like the VA, which Friedman said spends 41 percent less on medications than other providers).

Some of the bigger hospitals that can now charge monopoly prices in a market would also have a more difficult time doing so under a single payer system.

Primary care providers would come out better in a single payer system, but specialists might fare worse as payments are leveled out among providers.

The biggest winners under a single payer system in Pennsylvania would be employers, said Friedman. Employer-provided insurance currently costs about 13 percent of payroll in Pennsylvania, he noted.

David Steil, president emeritus of HealthCare4AllPA, the nonprofit organization advocating for a single payer system in Pennsylvania, and a business owner, agrees with Friedman’s assessment of the benefits to employers. “Businesses shouldn’t be in healthcare,” he said.

But Steil doesn’t take quite as negative a view of the impact a single payer system would have on insurance companies as Friedman does. Steil, a former Republican house representative in Pennsylvania, said insurers would more likely have to change the way they do business.

There are many services that wouldn’t be covered under a single payer plan, like elective plastic surgeries or private rooms, home health visits and ambulance services. Insurers, Steil said, could move to providing supplemental coverage for these kinds of services.

“I think they will have to look at changing their business model, but they won’t go out of business,” he said.

Action Alert: Write a Letter to the Editor About Senate Healthcare Hearing

Thu, 03/13/2014 - 14:04

On Tuesday, March 11, a Senate Subcommittee chaired by Bernie Sanders held an unprecedented hearing on what the U.S. can learn from countries with single-payer healthcare systems.

The evidence was overwhelming: expert after expert from Canada, Denmark, Taiwan, and France showed that single-payer costs less while virtually eliminating financial barriers to care for patients. Right-wing critics at the hearing pulled out every misleading myth about single-payer, only to have them debunked by the experts in real world health policy. Here are the highlights.

Can you please take a moment to write a letter to the editor at your local paper about this important Senate hearing? The rest of the country needs to know that single-payer reform, such as John Conyers’s HR676 in the House and Bernie Sanders’s S1782, is the only solution to our crisis of rising health care costs and poor access to care.

Please email us if you need help or if your letter is published.

Here’s a sample letter:

Subject: Congressional Hearing Shows Single-Payer Reform the Best Option

On Tuesday, a Senate Subcommittee – possibly for the first time in the history of Congress – hosted a long overdue hearing on “What the US Health Care System Can Learn from Other Countries.”

Health policy experts from France, Denmark, Canada, and Taiwan painted a startling picture: even after full implementation of the ACA the United States will spend more than any other developed nation, receive inferior access to care, and see similar or worse quality of care. We are the only wealthy country that does not publicly guarantee access to care through a “single-payer” system of universal coverage.

For me, this testimony highlights the tragic consequences of clinging to a for-profit health care system that the rest of the world has escaped from. Our system, despite the ACA, lets people with illness slip through the cracks with devastating consequences, and costs twice as much. It’s time to take the next step and implement guaranteed healthcare for all.

Watch an Expert Teach a Smug U.S. Senator About Canadian Healthcare

Thu, 03/13/2014 - 10:50

From the LA Times

A U.S. politician’s I-don’t-need-no-stinkin’-facts approach to health policy ran smack into some of those troublesome facts Tuesday at a Senate hearing on single-payer healthcare, as it’s practiced in Canada and several other countries.

The countries in question have successful and popular government-sponsored single-payer systems, provide universal coverage and match or outdo the United States on numerous measures of medical outcomes — for far less money than the U.S. spends. To explain this, Sen. Bernie Sanders (I-Vt.) asked seven experts to testify before his subcommittee on primary health and aging.

Those interested in how the U.S. matches up should watch the whole 90-minute session, viewable below. (The official subcommittee hearing record is also available.)

By far the high point of the morning was an exchange between Sen. Richard Burr (R-N.C.) and Danielle Martin, a physician and health policy professor from Toronto. The exchange, in which Martin bats down the myths and misunderstandings about the Canadian system that Burr throws at her, starts at about the 1:00:15 mark.

(The reference to “Premier Williams” is to Newfoundland Premier Danny Williams, whose decision to have a heart valve procedure in Miami, near where he owns a condo, rather than Canada, is widely viewed in Canada as a rich man’s failure to investigate the care available to him closer to home.)

Here’s a lightly edited transcript of the key moments, which start with Burr asking Martin about the observation in her written testimony that wait times for elective surgery in single-payer systems will lengthen as doctors move out of the public system:

BURR: Why are doctors exiting the public system in Canada?

MARTIN: Thank you for your question, Senator. If I didn’t express myself in a way to make myself understood, I apologize. There are no doctors exiting the public system in Canada, and in fact we see a net influx of physicians from the United States into the Canadian system over the last number of years.

What I did say was that the solution to the wait time challenge that we have in Canada — we do have a difficult time with waits for elective medical procedures — does not lie in moving away from our single-payer system toward a multipayer system. And that’s borne out by the experience of Australia. So Australia used to have a single-tier system and did in the 1990s move toward a multiple-payer system where private insurance was permitted. And a very well-known study by Duckett, et al., tracked what took place in terms of wait times in Australia as the multipayer system was put in place.

And what they found was in those areas of Australia where private insurance was being taken up and utilized, waits in the public system became longer.

BURR: What do you say to an elected official who goes to Florida and not the Canadian system to have a heart valve replacement?

MARTIN: It’s actually interesting, because in fact the people who are the pioneers of that particular surgery, which Premier Williams had, and have the best health outcomes in the world for that surgery, are in Toronto, at the Peter Munk Cardiac Center, just down the street from where I work.

So what I say is that sometimes people have a perception, and I believe that actually this is fueled in part by media discourse, that going to where you pay more for something, that that necessarily makes it better, but it’s not actually borne out by the evidence on outcomes from that cardiac surgery or any other.

(The ultimate zinger came at the end of the exchange, when Burr thought he had Martin down for the count about wait times in Canada, and she neatly put the difference between the Canadian and U.S. systems in perspective.)

BURR: On average, how many Canadian patients on a waiting list die each year? Do you know?

MARTIN: I don’t, sir, but I know that there are 45,000 in America who die waiting because they don’t have insurance at all.

IAM Transport Lodge Endorses HR 676

Wed, 03/12/2014 - 11:01

Local Lodge 1635 of the International Association of Machinists and Aerospace Workers (IAMAW) has endorsed HR 676, national single payer health care legislation, sponsored by Congressman John Conyers (D MI). The bill is named the “Expanded and Improved Medicare for All Act.”

Jessica Morris, Recording Secretary, reports that the local lodge took this action “because a single payer option is the best way to ensure access for health care for all.” The local is a Transport Lodge representing 450 members who work for a number of airlines in Albuquerque, New Mexico.

Morris says that the union is looking forward to hearing from James Besante, a medical student and member of Physicians for a National Health Program (PNHP), who will speak on single payer at the upcoming meeting on March 13, 2014.

PNHP, an organization of over 19,000 physicians, can provide speakers on single payer health care to union meetings across the country. Just make a request to (502) 636-1551, and we will work with your union to set it up.

Take Action for Senate Single Payer Bill

Mon, 03/10/2014 - 12:02

The cause of universal healthcare is alive and well. Not only is the state of Vermont moving toward a single-payer system, but Vermont’s U.S. Senator Bernie Sanders has introduced a bill and is holding a hearing this week on the benefits other countries enjoy from a single-payer system that would benefit everyone except the profiteering middlemen who’ve rigged the current system.

Click here to ask your senators to cosponsor and support. This is a joint action with RootsAction.

“The United States is the only major nation in the industrialized world that does not guarantee healthcare as a right to its people,” Sanders said. “It is time that we bring about a fundamental transformation of the American healthcare system. It is time for us to end private, for-profit participation in delivering basic coverage.”

The bill, S. 1782, the American Health Security Act, would be a much more significant change to health coverage than those recently implemented. It would create a much simpler, less wasteful system of paying for healthcare, one that’s in fact been tested in every other industrialized nation in the world, every one of which buys more healthcare for less money than we do in the United States.

The current system remains so broken that change must come. The question is how slowly and how piecemeal, and with how much unnecessary suffering along the way.

Join us in speaking up for universal coverage now!

Please forward this email widely to like-minded friends.

New York State ARA Endorses HR 676, Single-Payer

Thu, 03/06/2014 - 13:23

From Unions for Single Payer

The New York State Alliance for Retired Americans, NYSARA, at its most recent annual meeting, endorsed HR 676, Congressman John Conyers’ national single payer legislation also known as Expanded and Improved Medicare for All.

NYSARA has 440,000 members, many of them retired union members who have maintained affiliation with the retiree group of their union. It is affiliated with the four million member Alliance for Retired Americans, ARA.

HR 676 was brought to NYSARA by New York State United Teachers Retiree Council 12, whose former president July Shultz, co-presidents Sandy Bliss and Jeanne Williams Bennett, and member Bev Alves worked on the resolution.

Alves reports that NYSARA overwhelmingly passed the resolution for HR 676 with one enthusiastic delegate calling out loud “It’s about time.” Alves says that the resolution will be brought to the national ARA this year.

Find more endorsements at

Hillary Clinton Likes Obamacare, Opposes Single-Payer

Tue, 03/04/2014 - 10:48

From the Huffington Post

Hillary Clinton has confirmed, to a paying audience of 20,000 sellers of electronic health records systems, that she supports Obamacare, and opposes single-payer health insurance.

Speaking to a closed-to-the-press meeting of the “HIMSS14″ (Healthcare Information and Management Systems Conference 2014) in Orlando Florida on February 26th, she condemned the Canadian and other nations’ single-payer healthcare systems by saying, “We don’t have one size fits all; our country is quite diverse. What works in New York City won’t work in Albuquerque.” The presumption is that what works in Canada cannot work here, that local control must trump everything in order to fix what’s wrong with American health care.

The data prove her statement to be false, if not irrelevant. America’s healthcare problems are deeper than that. The latest OECD data on healthcare costs show that the U.S. spends by far the world’s highest percentage of GDP on healthcare, 17.7 percent; and also show that the average U.S. life expectancy is 78.7 years; by contrast, Canada spends 11.2 percent, and their life expectancy is 81.0 years. The OECD average expenditure is 9.3 percent , and life expectancy is 80.0 years. So: the U.S. spends twice as high a percentage of GDP as every other OECD nation, and gets markedly inferior results. This makes the U.S. far less economically competitive than it otherwise would be; but, the healthcare industries finance conservative politicians such as Hillary Clinton, Barack Obama, and all Republicans; so, those politicians don’t like single-payer — it would take much of the excess profits out of exploiting the sick, and those excess profits help to fund their campaigns.

The American people’s financial losses produce exceptional financial gains for the investors in healthcare-related stocks, and also inflate the pay for executives in those firms. This helps to fund lots of what conservatives such as Antonin Scalia lovingly call “free speech” — campaign commercials.

A physician in Canada headlined in the Los Angeles Times on 3 August 2009, “A Canadian doctor diagnoses U.S. healthcare,” and he wrote: “Until 50 years ago, we had similar health systems, healthcare costs and vital statistics.” But this situation ended with Canada’s single-payer system, where, “all Canadians have insurance for hospital and physician services. There are no deductibles or co-pays. Most provinces also provide coverage for programs for home care, long-term care, pharmaceuticals and durable medical equipment, although there are co-pays. On the U.S. side, 46 million people have no insurance, millions are underinsured and healthcare bills bankrupt more than 1 million Americans every year.” Nobody goes bankrupt in Canada to pay for needed care. Their system is shared sacrifice, not all of the downsides dumped onto the poorest and the sickest, who can’t pay their bills and end up in emergency rooms until they die of needless ailments.

The Canadian doctor explained that, in that year: “Canada spends 10% of its economy on healthcare; the U.S. spends 16%. The extra 6% of GDP amounts to more than $800 billion per year. The spending gap between the two nations is almost entirely because of higher overhead. Canadians don’t need thousands of actuaries to set premiums or thousands of lawyers to deny care. Even the U.S. Medicare program has 80% to 90% lower administrative costs than private Medicare Advantage policies. And providers and suppliers can’t charge as much when they have to deal with a single payer.”

So, Hillary received many bursts of applause from her audience of people who profit from other Americans’ being vastly overcharged for inferior healthcare. In fact, the transcriber of her speech headlined “Hillary Clinton wows the HIMSS14 crowd.”

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Dr. Radut