Tag Archives: universal health care

Doctors prescribe single-payer national health plan

More than 2,200 physicians are calling for a break from the private insurance model of financing medical care and the creation of a publicly financed, single-payer national system.

“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,” said Dr. Adam Gaffney, a Boston-based pulmonary disease and critical care specialist.

Gaffney co-chaired a working group of more than 2,000 physicians. The group endorsed a single-payer plan — sometimes called Medicare for All or universal care — in a proposal in the American Journal of Public Health.

Doctors in the District of Columbia and 48 states, including Wisconsin, signed on to the proposal, which calls for a national health program providing for:

• Patients to choose to go to any doctor or hospital and for most hospitals and clinics to remain privately owned and operated. Physicians would continue to practice on a fee-for-service basis or receive salaries from group practices, hospitals or clinics.

• Financing of the national health program would be from current sources of government health spending put into a single fund, with new taxes that would be offset by reductions in premiums and out-of-pocket spending. Co-pays would be eliminated, as would deductibles.

• A single-payer system that would save about $500 billion annually by eliminating the overhead of insurance firms and the paperwork they inflict on hospitals and doctors.

• An administrative savings from a streamlined system that would offset the costs of covering the uninsured and upgraded coverage for others, including full coverage of prescription drugs, dental care and long-term care. Savings would be redirected to underfunded health priorities, particularly public health.

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

The physicians’ working group cited a 2008 survey showing 59 percent of Americans supported legislation to establish a national health plan, an increase of 10 percentage points from 2003.

More recently, surveys of Democrats show even higher support for a single-payer plan or an expansion of the Affordable Care Act.

Creating a national health program is a prominent and popular plank in presidential candidate Bernie Sanders’ platform, but the physicians’ group emphasized non-partisanship.

“Our nation is at a crossroads,” Gaffney said.

Dr. Steffie Woolhandler, a co-author of the proposal and a professor of public health at City University at New York’s Hunter College, said, “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.”

Sanders’ campaign goals clash with political realities

Bernie Sanders promises voters a “political revolution” that will fundamentally remake the American economy and its education and health care systems.

“That’s what our campaign is about. It is thinking big,” Sanders said during a debate last month in Charleston, South Carolina. “We are going to have a government that works for all of us, and not just big campaign contributors.”

Often left unsaid by Sanders, but increasingly at the center of Hillary Clinton’s arguments against her rival for the Democratic presidential nomination, is that the political reality of achieving such goals is likely to be a whole lot more complicated.

It would require Sanders not only to win the White House, but to sweep a wave of Democratic lawmakers into office along with him. While Democrats may be able to gain the four or five seats necessary to win back control of the Senate in November, they need 30 seats to recapture power in the House.

But even with majorities in both houses of Congress, Sanders would face challenges. Clinton’s advisers often point out how difficult it was for President Barack Obama to convince a Democratic-led Congress to support the Affordable Care Act in 2010. Sanders’ plan — called “Medicare for All” — would go significantly further by establishing a national health care system run entirely by the government.

Sanders also wants to raise the federal minimum wage to $15 an hour, break up the biggest Wall Street banks, pour $1 trillion into the country’s infrastructure, expand Social Security benefits and make college free at all public universities by raising taxes on Wall Street. All of those ideas are nearly uniformly opposed by Republicans and would face strident opposition in Congress.

Many of those plans would require tax increases on corporations, wealthy taxpayers and middle-class families — a difficult political sell for lawmakers of both parties.

Campaigning at a union hall in Las Vegas on Saturday, former President Bill Clinton called Sanders’ ideas politically unviable, giving the realities of divided government and ability of the Senate minority to block proposals that lack the support of 60 members.

“You can’t get 60 votes!” he exclaimed. “Why, when we’ve got all this gridlock, would we waste any time trying to do something we know we can’t do when there’s so much we can do to get the show on the road? Don’t go down a blind alley.”

Sanders does frequently acknowledge that it will take more than just winning the White House to accomplish his goals.

“No president can walk in there and make changes unless millions of people become engaged in the political process in a way that we have not seen for a very, very long time,” he told more than a thousand supporters gathered in a community college gymnasium in Portsmouth, New Hampshire on Sunday.

He casts his “revolution” in a long line of social movements that have reshaped American society, citing the progress made by civil rights activists, feminists and gay rights advocates. He argues that if voters line up behind him and fight for his plans, their collective power can overcome political intransigency, big campaign donors and special interests.

“Every day the media asks: ‘Your ideas are so ambitious, how are you going to get them done?’” he said. “We will get them done because people are going to demand that we get them done.”

Clinton has tried to counter that message with promises to tell voters exactly what she’d do and how she’d do it if elected. Since launching her campaign in April, she’s rolled out dozens of policy plans, tackling issues from autism to the Islamic State.

“I’m not making promises I can’t keep,” she said during Thursday’s Democratic debate. She added: “Let’s go down a path where we can actually tell people what we will do. A progressive is someone who makes progress.”

Clinton’s ideas are also sure to face opposition from congressional Republicans. And should the GOP nominee become the next president, their promises to roll back the work of the Obama administration will face the same challenges from Democrats eager to protect his legacy.

But in a Democratic primary traditionally powered by the most liberal voters, pragmatism has been less appealing than big promises. Sanders’ aspiration message has struck a chord with progressive Democrats and younger voters, boosting him to a near-win in Iowa and a sizable lead in New Hampshire, which casts the first primary ballots on Tuesday.

“I want to give him a shot,” said Nick Ayoub, 22, of Cambridge, Massachusetts. “You’re never going to know if you don’t try.”

Derek Scalia, 33, of Keene, New Hampshire, said he knows that campaign promises don’t always come true, but he likes Sanders’ vision.

“Bernie is the only one that’s talking about health care as a fundamental human right,” Scalia said. “Every industrialized country in the world offers universal health care.”

Democrats push health care reform, GOP pushes repeal

Americans filled 4.3 billion prescriptions last year, and they’re still ailing from the skyrocketing cost of drugs.

Democratic presidential candidates Bernie Sanders and Hillary Rodham Clinton gave voice to patient problems and consumer complaints this fall, with both issuing plans to rein in outrageous prices for prescription medicine.

“The pharmaceutical industry has become a health hazard for the American people,” said Sanders, an independent senator from Vermont. “We now pay, by far, the highest prices in the world for prescription drugs and one in five Americans … cannot afford to fill the prescriptions their doctors write.”

In 2014, an estimated 34 million people could not fill their prescriptions because of costs. Surveys now show that about 70 percent of Americans believe drug costs are unreasonable and that drug companies put profits before people.

Those polls were conducted before Turing Pharmaceuticals CEO Martin Shkreli made headlines in September for raising by more than 5,000 percent the price of Daraprim, a medication used to treat toxoplasmosis in AIDS patients. 

Within hours of Turing purchasing the right to retail Daraprim, the price for a pill that’s been sold for $13.50  went to $750.

“For Turing to charge insurance companies and self-pay individuals with a cost (so much) greater for the same drug is unconscionable,” said Scott Caruthers, chief pharmacy officer of the AIDS Healthcare Foundation, the largest global AIDS group.

AHF president Michael Weinstein said Turing’s greed “is likely to go down in history as the straw that broke the camel’s back on drug pricing.”

Shkreli announced in late September that he would lower the cost “in response to the anger.”

Sanders, an advocate of universal health care, in mid-September released a prescription drug plan that said the federal government should use its bargaining power to negotiate with companies for better prices; allow imports from licensed Canadian pharmacies; prohibit deals that keep generics off the market; and require drug companies to report information affecting pricing.

Clinton, as first lady, led an effort blocked by congressional Republicans that would have provided comprehensive, universal health care. She responded to Turing’s price-gouging almost immediately, pledging on Twitter a plan to reform the prescription drug market that would “both protect consumers and promote innovation — while putting an end to profiteering.”

Clinton has since issued a series of proposals to address rising drug costs, including a monthly $250 cap on out-of-pocket drugs to help patients with chronic or serious health conditions.

The candidate also proposed requiring that health insurance plans provide for three sick visits per year without counting toward a patient’s annual deductible and offering a refundable tax credit of up to $5,000 for families for excessive out-of-pocket care costs.

“When Americans get sick, high costs shouldn’t prevent them from getting better,” Clinton said in a statement. “With deductibles rising so much faster than incomes, we must act to reduce the out-of-pocket costs families face.”

A survey recently released by the Henry J. Kaiser Family Foundation found that employer-sponsored health insurance premiums rose about 4 percent in 2015, considered a moderate increase. But since 2010, both the share of workers with deductibles and the size of the deductibles have increased sharply — about seven times over the rise in worker wages.

A recent Kaiser analysis found comparable countries outperforming the United States on life expectancy at birth, cost-related barriers to health care access and the burden of disease, which takes into account years of lost life due to premature death and years of life lost to poor health.

The Obama administration expects to see improvements as more people have greater access to care under the five-year-old Affordable Care Act, which mandated insurance coverage, expanded eligibility for Medicaid, prohibited insurers from denying coverage for pre-existing conditions, provided for preventative care and lifted lifetime health benefit caps.

New data from the U.S. Census Bureau shows that the national uninsured rate dropped to a historic low of 9.2 percent in early 2015, with 15.8 million people gaining coverage since the health care marketplaces opened in 2013.

Still, the GOP focus in the health care debate is almost solely on repealing the Affordable Care Act. Congressional Republicans have voted more than 50 times to repeal all or parts of the law and, on Sept. 29, they voted again to advance legislation that would dismantle the ACA.

The House Ways and Means Committee chaired by Wisconsin Congressman Paul Ryan voted along party lines to repeal the mandate requiring Americans to get health insurance and also the mandate requiring larger companies to provide health benefits to employees.

Ryan, in a statement, said, “This bill is a big step toward dismantling Obamacare. … By tearing down many of the worst parts of the law — like forcing people to buy insurance only to later tax them for it — we would stop Obamacare in its tracks and start working toward a more affordable, higher-quality, patient-centered system.”

Wisconsin Gov. Scott Walker also wants the Affordable Care Act repealed, although health care advocates in the state maintain provisions have mostly benefited Wisconsinites.

“The ACA has dramatically reduced the number of uninsured in Wisconsin and improved access to preventive health care,” said Jon Peacock, research director for the nonprofit Wisconsin Council on Children and Families.

The WCCF said by the end of June, more than 230,000 Wisconsinites had signed up for a marketplace plan under the ACA and about 90 percent were eligible for tax credits to offset costs.

San Francisco plans comprehensive health program for transgender residents

The health commission in San Francisco, a city that adopted a universal health care program five years ago, voted last week to expand options for transgender residents.

San Francisco provides hormones, counseling and routine health services but has stopped short of offering surgical procedures, public health director Barbara Garcia said after the vote was announced.

The idea for a new program came out of conversations between public health officials and transgender rights advocates who wanted surgeries covered under San Francisco’s five-year-old universal health care plan. 

At the urging of the San Francisco Board of Supervisors and the San Francisco-based Transgender Law Center, the commission agreed to drop sex reassignment surgery from the list of procedures specifically excluded from the Healthy San Francisco plan.

But Garcia described the move as “a symbolic process” for now because the city currently does not have the expertise, capacity or protocols in place to provide the surgeries through its clinics and public hospital.

“The community felt the exclusion on Healthy San Francisco was discriminatory and we wanted to change that as the first step,” she said.

Instead of expanding the existing plan, the San Francisco Health Commission approved the establishment of a separate program that covers all aspects of transgender health. Garcia hopes to have it running by late next year, but said her department first needs to study how many people it would serve, how much it would cost, who would perform the surgeries and where they would be performed.

“Sex reassignment surgery is not the end all. It’s one service that some transgender people want and some don’t,” she said. “We can probably manage this over the next three years without much of a budget increase because we already have these (other) services covered.”

San Francisco in 2001 became the first city in the country to cover transition surgeries for government employees. Last year, Portland, Ore. did the same.

The number of major U.S. companies covering the cost of surgeries for transgender workers also doubled last year, reflecting a decades-long push by activists to get insurance companies to treat such surgeries as medically necessary instead of elective procedures. 

Kathryn Steuerman, a member of a transgender health advocacy group in San Francisco, said the city’s latest move would help residents avoid going into debt to finance operations related to gender transition, as she did.

“I am filled with hope and gratitude that we are achieving this level of support for the well-being of the transgender community,” Steuerman said.