Category Archives: Insurance

New Proposal Designed to Confuse Public and Prevent Medicare for All

The Center for American Progress (CAP), a Washington-based Democratic Party think tank funded by Wall Street, including private health insurers and their lobbying group, unveiled a new healthcare proposal designed to confuse supporters of Medicare for All and protect private health insurance profits. It is receiving widespread coverage in ‘progressive’ media outlets. We must be aware of what is happening so that we are not fooled into another ‘public option’ dead end.*

The fact that CAP is using Medicare for All language is both a blessing and a curse. It means Medicare for All is so popular that they feel a need to co-opt it, and it means that they are trying to co-opt it, which will give Democrats an opportunity to use it to confuse people.

This effort could be preparation for the possibility that Democrats win a majority in Congress in 2018 or 2020. It is normal for the pendulum to swing to the party opposite the President’s party during the first term in office. If Democrats win a majority, they will be expected to deliver on health care, but they face a dilemma of having to please their campaign donors, which includes the health insurance industry, or pleasing their voters, where 75% support single payer health care.

The public is aware that the Affordable Care Act (ACA) protects the profits of the medical-industrial complex (private health insurers, Big Pharma and for-profit providers) and not the healthcare needs of the public. “Fixing the ACA” is not popular. Last year during repeal attempts, people made it clear at town halls and rallies that they want a single payer healthcare system such as National Improved Medicare for All (NIMA). By offering a solution that sounds good to the uninformed, “Medicare Extra for All,” but continues to benefit their Wall Street donors, Democrats hope to fool people or buy enough support to undermine efforts for NIMA.

This is an expected development. If we look at the phases of stage six of successful social movements by Bill Moyer (see slide 8), we see that as a movement nears victory, the power holders appear to get in line with the public’s solution while actually attacking it. If the movement recognizes what is happening, that this is a false solution and not what the movement is demanding, then we have a chance to win NIMA. If the movement falls for the false solution, it loses.

Our tasks at this moment are to understand what the power holders are offering, recognize why it is a false solution and reject it.

“Medicare Extra for All” versus National Improved Medicare for All

The basic outline for the new proposal is that people would be able to buy a Medicare plan, a form of ‘public option,’ including the Medicare Advantage plans offered by private health insurers. People who choose to buy a Medicare plan would pay premiums and co-pays, as they do now for private health insurance. The new Medicare system would replace Medicaid for people with low incomes.

Private health insurance would still exist for employers, who currently cover the largest number of people, federal employees and the military. While workers would have the option to buy a Medicare plan, it is unclear how many would do so given that most employers who provide health insurance have their own plans and that private health insurers are experts at marketing their plans to the public.

NIMA, as embodied in HR 676: “The Expanded and Improved Medicare for All Act,” would create a single national healthcare system, paid for up front through taxes, that covers every person from birth to death and covers all medically-necessary care. NIMA relegates private insurance to the sidelines where it could potentially provide supplemental coverage for those who want extras, but it would no longer serve as a barrier for people who need care.

Here are the flaws in the CAP proposal:

  1. CAP’s plan will continue to leave people without health insurance. Instead of being a universal system of national coverage like NIMA, coverage under the CAP plan relies on people’s ability to afford health insurance. Only people with low incomes would not pay, as they do now under Medicaid. Just as it is today, those who do not qualify as low income, but still can’t afford health insurance premiums, would be left out. Almost 30 million are without coverage today. There is no guarantee that health insurance premiums will be affordable.
  2. CAPS’s plan will continue to leave people with inadequate coverage. Under NIMA, all people have the same comprehensive coverage without financial barriers to care. The CAP plan allows private health insurers to do what they do best – restrict where people can seek health care, shift the cost of care onto patients and deny payment for care. This is the business model of private health insurers because they are financial instruments designed to make profits for their investors. People with health insurance will face the same bureaucratic nightmare of our current system and out-of-pocket costs that force them to delay or avoid health care or risk bankruptcy when they have high health care needs.
  3. CAP’s plan will continue the high costs of health care. NIMA has been proven over and over to have the best cost efficiency because it is one plan with one set of rules. It is estimated that NIMA will save $500 billion each year on administrative costs and over $100 billion each year on reduced prices for pharmaceuticals. As a single purchaser of care, NIMA has powerful leverage to lower the costs of goods and services. The CAP plan maintains the complicated multi-payer system that we have today. At best, it will only achieve 16% of the administrative savings of a single payer system and it will have less power to reign in the high costs of care.
  4. CAP’s plan will allow private health insurers to continue to rip off the government. NIMA is a publicly-financed program without the requirement of creating profits for investors. With a low overhead, most of the dollars are used to pay for health care. The CAP plan maintains the same problems that exist with Medicare today. Private Medicare providers cherry pick the healthiest patients and those who have or develop healthcare needs wind up in the public Medicare plan. This places a financial burden on the public Medicare plan, which has to pay for the most care, while private health insurers rake in huge profits from covering the healthy with a guaranteed payor, the government.
  5. CAP’s plan will continue to perpetuate health disparities. NIMA provides a single standard of care to all people. Because all people, rich and poor (and lawmakers), are in the same system, there are strong incentives to make it a high quality program. CAP’s plan maintains the current tiered system in which some people have private health insurance, those with the greatest needs have public health insurance, some people will have inadequate coverage and others will have no coverage at all.
  6. CAP’s plan will continue to restrict patients’ choices. NIMA creates a nationwide network of coverage and consistent coverage from year-to-year so that patients choose where they seek care and have the freedom to stay with a health professional or leave if they are dissatisfied. CAP’s plan continues private health insurers and their restricted networks that dictate where patients can seek care. Private plans change from year-to-year and employers change the plans they offer, so patients will still face the risk of losing access to a health professional due to changes in their plan.
  7. CAP’s plan does not guarantee portability. NIMA creates a health system that covers everyone no matter where they are in the United States and its territories. CAP’s plan maintains the link between employment and health coverage. When people who have private health insurance lose their job or move, they risk losing their health insurance.
  8. CAP’s plan will perpetuate physician burn-out. NIMA creates a healthcare system that is simple for both patients and health professionals to use. Under the current system, which the CAP plan will perpetuate, health professionals spend more time on paperwork than they do with patients and physician offices spend hours fighting with health insurers for authorization for care and for payment for their services. This is driving high rates of physician burnout. Suicides among physicians and physicians-in-training are higher than the general population.

The new proposal is a ‘public option’ wrapped in a “Medicare for All” cloak. It is a far cry from National Improved Medicare for All. And, contrary to what CAP and its allies will tell you, the CAP plan will delay and prevent the achievement of NIMA.

Co-founders of Physicians for a National Health Program**, Drs. Steffie Woolhandler and David Himmelstein, explained why the public option would not work in the last health reform effort:

The ‘public plan option’ won’t work to fix the health care system for two reasons.

1. It forgoes at least 84 percent of the administrative savings available through single payer. The public plan option would do nothing to streamline the administrative tasks (and costs) of hospitals, physicians offices, and nursing homes, which would still contend with multiple payers, and hence still need the complex cost tracking and billing apparatus that drives administrative costs. These unnecessary provider administrative costs account for the vast majority of bureaucratic waste. Hence, even if 95 percent of Americans who are currently privately insured were to join the public plan (and it had overhead costs at current Medicare levels), the savings on insurance overhead would amount to only 16 percent of the roughly $400 billion annually achievable through single payer — not enough to make reform affordable.

2. A quarter century of experience with public/private competition in the Medicare program demonstrates that the private plans will not allow a level playing field. Despite strict regulation, private insurers have successfully cherry picked healthier seniors, and have exploited regional health spending differences to their advantage. They have progressively undermined the public plan — which started as the single payer for seniors and has now become a funding mechanism for HMOs — and a place to dump the unprofitably ill. A public plan option does not lead toward single payer, but toward the segregation of patients, with profitable ones in private plans and unprofitable ones in the public plan.

What we must do

The movement for National Improved Medicare for All experienced tremendous growth in the past few years. All of the flaws of the Affordable Care Act are becoming reality as people are forced to pay high health insurance premiums, face high out-of-pocket costs before they can receive care and have their access to health professionals or services denied. There is a strong demand for NIMA that has resulted in more than half of the Democrats in the House of Representatives signing on to HR 676 and a third of the Democratic Senators endorsing the Senate Medicare for All bill. Medicare for All is becoming a litmus test for the 2018 elections and 2020 Democratic presidential nomination.

Power holders are feeling threatened by support for NIMA. They are looking for ways to throw the movement off track and allow lawmakers who don’t support NIMA to support something that sounds like NIMA. This is why they invented “Medicare Extra for All.” It is common for the opposition to adopt our language when we have strong support.

This is the time when the movement for NIMA needs to remain focused on our goal of NIMA, resist compromising and escalate our pressure for NIMA. We are closer to winning, it’s time to increase our efforts to pass the finish line.

Here are our tasks:

  • We need to expose the reasons for CAP’s proposal. It is designed to protect health insurance industry profits.
  • We need to educate ourselves and others about the reasons why CAP’s proposal is flawed and deficient.
  • We need to educate and challenge lawmakers and candidates who speak in favor of CAP’s proposal and push them to support NIMA.
  • We need to be loud and vocal in our demand for nothing less than NIMA, as described in HR 676.
  • We need to make support for HR 676 a litmus test in the upcoming elections.

We need to practice “ICU” – being independent of political party on this issue by not tying our agenda to the corporate agenda of major political parties, being clear about what will and what will not solve our healthcare crisis, and being uncompromising in our demand for National Improve Medicare for All.

With a concentrated effort for NIMA, we can overcome this distraction*** and win National Improved Medicare for All. This is the time for all supporters of single payer health care to focus on federal lawmakers from both parties. Movements never realize how close they are to winning and victory often feels far away when it is actually close at hand.

The fact that the Democrats are proposing something that sounds like NIMA means we are gaining power. Let’s use it to finally solve the healthcare crisis in the United States and join many other countries in providing health care for everyone. NIMA is the smallest step we can take to head down the path of saving lives and improving health in our country.

* The ‘public option’ dead end occurred during the health reform process of 2009-10. Faced with widespread public support for National Improved Medicare for All, and 80% support by Democratic Party voters, the power holders had to find a way to suppress that support. They created the idea of a ‘public option,’ a public health insurance for part of the population, and convinced progressives that this was more politically-feasible and a back door to a single payer healthcare system. Tens of millions of dollars were donated to create a new coalition, Health Care for America Now (similar in name to Healthcare-Now, a national single payer organization – this was intentional), that organized progressives to fight for this public option and suppress single payer supporters (they were openly hostile when we raised single payer). Many single payer supporters fell for it, and the movement was successfully divided and weakened. Kevin Zeese and I wrote about this in more detail in “Obamacare: The Biggest Health Insurance Scam in History.”

** Read more about this from Dr. Don McCanne of Physicians for a National Health Program in his Quote-of-the-Day.

*** Read more about intentional distractions through incremental approaches to prevent National Improved Medicare for All in this presentation.

Which Path to National Improved Medicare for All?

State-level reforms for universal health care are laudable; they are not single payer

Two states with a long history of state-based healthcare reform efforts, California and New York, are hard at work organizing for state bills labeled as single payer healthcare plans. Other states are moving in that direction too. This raises questions by single payer advocates: Can states create single payer healthcare systems? Does state-level work help or hinder our goal of National Improved Medicare for All (NIMA)?

The movement for NIMA gained momentum throughout 2017, largely due to rising premiums under the Affordable Care Act (ACA) and Republican efforts to worsen the healthcare crisis. Supporters of NIMA mobilized to build support for single payer legislation in Congress, spoke out at Town Halls and pressured lawmakers. As a result, the House bill, HR 676: The Expanded and Improved Medicare for All Act, grew to 120 co-sponsors, the highest number in its 15-year history, and Senator Sanders was successfully pressured to introduce a bill in the Senate, S 1804: The Medicare for All Act.

As momentum grew, the expected push back materialized. In the spring, Democrats in Congress urged people to focus on fixing the ACA and uttered support for various forms of a public insurance, a ‘public option’ or Medicare buy-in. In August, well-known progressives, claiming to be ‘single payer supporters’, published articles arguing that single payer was too much to ask for and outlining ‘incremental approaches’. Members of Congress, including Speaker Nancy Pelosi, complained about Democratic voters making single payer a litmus test in the next elections. Pelosi said, “So I say to people, if you want [single payer], do it in your States.  States are laboratories.” The message was clear, there was too much pressure for NIMA and Democrats didn’t like it. Sending people to work at the state level would lower the heat on Congress.

State Efforts for Universal Health Care

Canada is often pointed to as a model for achieving National Improved Medicare for All in the United States. A universal medical insurance was first created in the province of Saskatchewan in 1962, following decades of increasing socialization of medicine in several provinces and a national law that financed universal hospital coverage at the provincial level. By 1968, a universal publicly-financed Medicare program was adopted nationally. Could the same path occur in the US?

The twenty-first century healthcare system in the United States is much more complex than the Canadian system was in the 1960s. At that time, health care was left up to the provinces. Dr. Don McCanne writes:

We cannot use the example of Saskatchewan and pretend that a state can set up a single payer system that could serve as an example for the nation – a model that could be expanded to all states. No. Saskatchewan began with a tabula rasa. They were able to create a de novo single payer system.

Rather than socializing medicine, the US has experienced decades of increasing privatization. There are a multitude of payers in the US, which include private insurance through employers, unions and individually, public programs, and national programs for federal employees and the military. A state would have to succeed in obtaining multiple waivers from the federal government and changes to federal laws to enact a state-based program. One federal law, the Employee Retirement and Income Security Act of 1974 (ERISA), which prohibits states from regulating employee benefits, is a major obstacle. States also face the hurdle of being required to balance their budgets, a barrier that doesn’t exist at the national level.

As outlined in Public Citizen’s “Roadmap to Single Payer,” a state can potentially make its healthcare system more efficient, but it cannot achieve a pure single payer system; thus, it can’t attain the bulk of savings that a single payer system would have. Within their budget constraints, states would be forced to raise the costs to individuals and businesses or lower coverage if they are not able to meet their needs for care. This has happened in every past attempt by states to achieve universal coverage, as Drs. Steffie Woolhandler and David Himmelstein document in “State Health Reform Flatlines.”

If a state were able to pass a bill outlining a path toward a universal healthcare system and to be granted a federal waiver from the Affordable Care Act (ACA), which are major feats, the state would still face significant barriers, some of which make it impossible to create a pure single payer program.

Barriers to state single payer

1. Federal health plans – There are numerous federal health plans, such as Medicare for seniors and those who qualify for disability, the Federal Employee Health Benefits Program (FEHBP), which includes over 200 plans, the Veterans Health Administration (VA), the Indian Health Service (IHS) and Tri-Care for members of the military; it is not possible to merge all these programs into a single state system.

The Center for Medicare and Medicaid Services (CMS) does not have the authority to give federal Medicare dollars to the state as a block grant. Single payer advocates have opposed passing a federal law that would allow this due to concern that it would dismantle the Medicare Program state-by-state and allow some states to use the law to further privatize Medicare through vouchers.

Some state advocates have considered applying for a new state healthcare plan to be considered a Medicare Advantage plan. These are private plans offered under Medicare. If such a waiver were granted, the state still could not force seniors to choose the state plan, so it would only capture some of the Medicare recipients in the state.

There is a similar situation with the health plans for federal employees. It would require a change in federal law to shift the FEHBP to the state. Perhaps a state could apply to be considered a choice for federal employees but even if it succeeded, it could not compel federal employees to choose their plan. Tri-Care is a program run by the Department of Defense that would also continue to operate outside the new state system. And the VA and IHS would operate independently as well.

It is possible, although this has not been tried yet, that a state could become an intermediary between providers in the state and the various federal programs such that claims would be submitted to the state and the state would collect the payment from the federal program to pay the provider. This would add more administrative complexity and cost to the state program, and providers would still have to interact with the individual plans for authorization of care.

2. Medicaid – Medicaid is a federal program for people with low incomes administered at the state level. A state would have to apply for a waiver to incorporate Medicaid into its new state program. There is greater flexibility for a state to do this than there is for Medicare. States would still have to track how many people qualify for Medicaid to be reimbursed for them by the federal government, another administrative task that adds cost, or would need to ask for a block grant. Single payer advocates have opposed turning Medicaid into a block grant program because that would limit funds during periods of recession when more people qualify for Medicaid. A block grant would not expand as the need expanded. Currently, all states except Connecticut use a mix of private insurance Managed Care Organizations (MCO’s) for Medicaid patients. To streamline its Medicaid system, a state would need to get rid of its multiple Medicaid MCO’s.

3. Employer Health Plans – Employee benefits are protected under a federal law, the Employee Retirement Income Security Act of 1974 (ERISA). While states have the authority to regulate health insurers that operate in their state, they do not have authority to regulate plans offered by businesses that self-insure, which is 60 percent of businesses that provide health benefits. Any interference in employee benefits can be challenged under ERISA and would result in a lengthy and expensive court battle.

California and New York are trying to circumvent ERISA by stating explicitly that their state program “does not create any employment benefit, nor does it require, prohibit, or limit the providing of any employment benefit.” However, a state system would be challenged under ERISA, and recent ERISA challenges have not been favorable. A case between the state of Vermont and Liberty Mutual, which operates as an ERISA plan, went to the US Supreme Court in 2016 and was decided against the state. The case involved a law requiring insurers to report claims data. Even though the Vermont law did not specifically target ERISA plans, it was determined to be preempted by ERISA because it had a “connection” to the ERISA plan. Another impermissible “connection” would occur if “economic effects of the state law force an ERISA plan to adopt a certain scheme of substantive coverage or effectively restrict its choice of insurers.” A state law requiring businesses to pay a payroll tax would likely be viewed as restricting choice.

States can strive for universal coverage, but calling plans single payer is incorrect

For many decades, states have introduced and passed laws aimed at achieving universal health care coverage. None has yet succeeded in being universal or sustainable, but these are admirable efforts that have increased access to care, at least temporarily. It is possible for a state, using the roadmap outlined by Public Citizen, to move towards universal coverage. It is not possible to achieve a pure single payer system at the state level and so states forego the significant savings of a single payer system.

In the drive towards universal health care, states might consider working to get rid of private Medicaid MCOs as Connecticut did so that more Medicaid dollars are available to cover more people and/or more care. Oklahoma had a similar program that was successful. Part of the success of these programs is providing case management for people with significant health needs to avoid preventable emergency room visits and hospitalizations.

Given that states are not able to achieve pure single payer systems, states take a risk when they label themselves single payer or Medicare for All. While it is understandable that these terms are popular and that most advocates for health reform support single payer, and so are inspired to work for it, it is misleading and could harm national efforts.

For example, Vermont passed a law in 2010 requiring the state to develop a plan for universal healthcare coverage. That law allowed the state to contract Dr. William Hsaio, who assisted in the design of the Taiwanese single payer healthcare system in the 1990s, to design their system. Vermont’s system was not a single payer system, yet it was consistently called single payer by the Governor, advocates and the media. It failed, and its failure was blamed on its high cost.

Similarly, Colorado attempted universal healthcare coverage in 2016 through the creation of a state-wide publicly-financed healthcare cooperative: “ColoradoCare would have replaced most private health insurance and taken over the state’s Medicaid program for the poor and people with disabilities, starting in 2019. The ballot initiative did not seek to replace Medicare benefits or current health coverage for veterans, military personnel and civilian defense employees.”

The Colorado plan was called single payer, even though it wasn’t, and its defeat was marked in the media as a second defeat for single payer health care. Prominent Democrats opposed ColoradoCare. Some progressive groups in Colorado also declined to support it, saying that single payer can only be done at the national level. It is hard to argue with them when they are correct. It undermines our legitimacy if single payer advocates are on the inaccurate side of that argument.

Do state efforts help or hinder national efforts?

Advocates for ‘single payer’ at the state level often say that state efforts will help national efforts. Some advocates work for reform at the state level because they believe the public will be more inspired to fight for change at the local than at the national level.

It is true that it is often easier to engage people around local or state efforts. They feel more winnable. But, what happens when the public is told they are working for state-based single payer and then they find out that they have been misled because the goal is not possible? It may be that public trust is lost or that people experience a deep disappointment because they worked hard for something that will never be realized.

And, what would happen if a state succeeded in passing a health law? First, it would take a tremendous effort focused on influencing state, not national, legislators to pass it. Second, that level of state-based pressure would have to be maintained to implement the law. And third, a state campaign would be so focused on these efforts that it would have little time or resources to advocate for change at the national level. Their national fight would be aimed at applying for waivers and winning changes to the Medicare law and ERISA.

Imagine if a highly-populated progressive state such as California or New York were to drop out of the national effort for NIMA to focus on their state. This would be a huge loss. Dr. Woolhandler reminds us:

Living in New York or Massachusetts doesn’t lessen our sense of responsibility for millions in the Deep South and other ‘red state’ areas for whom national legislation is the only realistic option for health care progress.

The only way we will achieve National Improved Medicare for All is if we develop a movement of movements and strategic campaigns focused on that goal. It is going to be a fight, but it is a winnable fight, especially now as the ACA becomes unsustainable and Congress threatens the minor safety net currently in existence. To win, we need to continue to build momentum in our states to pressure members of Congress. This election year is a perfect time to do that, particularly during the primaries when candidates are sensitive about their image.

We need to connect our fights to other struggles to protect public insurances such as Medicaid and Medicare. The solution to preserving our social health systems is to make them universal. Then we have the social solidarity, everybody in and nobody out, to protect and strengthen them.

A study of social movements shows us that we are close to winning NIMA. The power holders will predictably work to throw us off track by sending us down false paths of partial reforms and state-based efforts and lure us into working on elections. We must recognize and resist these distractions. We will win when we have built the popular power to shift the political culture so that no politician can be on the wrong side of this issue. We win when there is a loud and clear public demand for National Improved Medicare for All.

• First published at Health Over Profit

The Exsanguination of Medical Ethics

For thousands of years physicians took oaths to always act in the patient’s best interest when providing care. At the heart of medical ethics, this moral code was passed down through the centuries and reaffirmed by The World Medical Association (WMA) in 1949 and again in 2006. Additionally the WMA specified: “A physician shall not allow his/her judgment to be influenced by personal profit or unfair discrimination,” and “shall not receive any financial benefits or other incentives solely for referring patients or prescribing specific products”.

Medical ethics ran head long into The HMO (Health Maintenance Organization) Act of 1973.  The passage of this act set the stage for the undermining of long established medical ethics. The HMO Act was designed specifically to reduce costs, by charging patients a monthly fee for a set package of health care.  The Act was passed with the knowledge that there had been no systematic analysis done to show that it would not negatively impact health care.  Nonetheless, the Government gave millions of dollars in direct financial assistance to develop the HMO which was designed to be a profit making business.

This HMO economic arrangement put the physicians and other health care providers’ financial interest into conflict with the needs of their patients. The monthly pot of money must provide for profit, salaries, wages and health care.  If too much is spent on the patients, there is less available for profit and wages. So began the Health Insurance, Corporate Medicine assault on medical ethics.

Did the Medical Profession fight to hold on to its ethics so as to always “act in the patient’s best interest when providing medical care”?  No. Tragically the Medical Profession succumbed to the rise of Corporate Health Care by betraying their core medical ethic and became complicit “stewards” of an economic system that puts profits before people—The AMA’s (American Medical Association) Principles of Medical Ethics: V11, gives the following ethical guidelines for physicians:

Mitigate possible conflicts between physicians financial interests and patient interests by minimizing the financial impact of patient care decisions and the overall financial risk for individual physicians.

We have experienced four decades of HMO’s negative effect on health care while they became the darlings of Wall Street earning billions of dollars for investors as health care was rationed by denial of service, restricted benefits, cost cutting, patients dumping, overworked and underpaid staff, and plunging physician’s incomes.

The author D.H. Lawrence (1880-1930) appears to have anticipated these horrors, when he wrote:

The mosquito knows full well, small as he is he’s beast of prey. But after all he only takes his bellyful, he doesn’t put my blood in the bank.

Fast Forward to the ACA (Affordable Care Act) of 2010. One of its chief goals was to “reduce the cost of health care” by giving “financial incentives” to providers for the “Value” they provide in health care. A value-based payment incentive was to be established by bundling payment for certain types of care. Forbes Magazine, advertised as ‘The Capitalist Tool’ stated:

Bundled payments are just price controls by another name—and as such will yield subpar care by encouraging insurers and providers to put their own financial interests above the medical needs of patients.

The ACA was passed with very little known about its effectiveness or risks to Patient Care. Once again it is all about cost cutting. But now with the so called “Value Based Purchasing”, it is no longer about making profits for corporations, but spending less government money — it is about getting more for the Government’s shrinking dollars going to health care spending for Medicare, Medicaid and Social Security Disability.

The politicians want to “save” money, which, in reality, means to redistribute money, but the economics is similar. With some ten trillion dollars in tax cuts for the rich over the last seventeen years, the US treasury has less available for social services as politicians continue to redirect a trillion dollars per year to the military war industry without concerns that it is “costing the government too much”.

The latest Republican Tax Reform Bill of 12/17 will suck out of Medicare an estimated thirty billion dollars. Bundled payments will shrink and the giant vice of shrinking payments, combined with rising costs (hospital profits, rising prices for supplies, drugs, medical equipment, etc.) will inevitably squeeze the life blood out of both the patients and the health care providers.

The exsanguination of medical ethics has helped bring us to this dangerous moment in history.  We have witnessed a craven transformation of medical ethics when physicians, nurses and other health providers are clamoring to sign up for “Value-Based Bundled Care”. The AMA has betrayed their ancient oath as healers, in service to an economic system that puts profits before people.  While deadly epidemics of cancer, heart disease, obesity, diabetes, violence and addiction haunt the nation, we have been led into a partnership with Dracula.

Without Single-Payer American Health Care is Doomed

Of all the forms of inequality, injustice in health is the most shocking and inhuman.

— Dr. Martin Luther King, Jr., Second National Convention of the Medical Committee for Human Rights, Chicago, March 25, 1966.

It is the year 2018, and yet not a day goes by when a patient is unable to receive good care or a doctor questions their career choice.  How have we arrived at this tragic state of affairs? The answer is that our for-profit health care system is the principal cause, not only of poor patient care, but also of physician burnout. Only with a single-payer system, anchored not in the mores of capitalist plunder, but with the understanding that quality government-funded health care is an inalienable right, can both doctors and patients extricate themselves from this suffering.

Even amongst patients that are insured, restrictive health care plans force millions of Americans to work with doctors that they do not wish to work with. No less disconcerting is the fact that Americans are often compelled to stop working with doctors that they have known for years and do not wish to leave. In conjunction with a complicated health condition I have seen dozens of different doctors over the past two years. Should my insurance suddenly change, this painstakingly constructed system of specialists could come crashing to the ground. Moreover, being forced to leave a doctor that you have known for years is a shame, not only because no one will know your medical problems quite like they do, but because once a good doctor-patient relationship is lost it is gone forever.

This revolving door is also very harmful for physicians, because if a doctor has a practice with patients incessantly coming and going, this will invariably foment alienation which can be a driving force behind physician burnout.

The argument that a single-payer system would be impossible to implement in practice, is contradicted by the fact that the overwhelming majority of countries in the West from Vancouver to Vladivostok, have nationalized health care systems that guarantee universal coverage for all of their citizens. The GDP of Cuba is mere pennies compared to that of the United States, and yet all of their citizens enjoy excellent free health care, with an infant mortality rate lower than that of the United States. (They also enjoy superior literacy rates). How can we call ourselves a civilized nation when millions of Americans with serious illnesses are more fearful of bankruptcy and losing their insurance, than they are of death from widespread disease?

A single-payer system recognizes that it is deeply immoral and inhumane to give superior care to the upper middle class and affluent, while denying good care to vast segments of the population. In the absence of a nationalized health care system, do no harm will continue to be applied increasingly to the haves – and not to the have nots.

Liberals have embraced the Affordable Care Act (the very name of which would make Orwell blush) as if it brought about the successful implementation of a single-payer system, when the power of the private insurance companies has, in fact, been bolstered. Moreover, the premiums and deductibles of the new plans are often considerably higher than the plans they replaced, and the number of doctors that take these plans extremely limited. Obamacare also failed to address the sinister problem whereby health insurance is tied to one’s job, as many Americans have found themselves in the Kafkaesque predicament of having good insurance when they are well, but not when they are unwell. This barbarous state of affairs underscores the fact that this inhumane for-profit system is more entrenched than ever before.

This two-tier system also results in preposterous and inane contradictions, such as when I once asked the chair of Dermatology at a prestigious Manhattan teaching hospital whether there were certain situations where he would object to observers being present during any of his doctor’s appointments, to which he replied without hesitation, “Of course!” Yet patients that have Medicaid and community health plans are denied this right when they seek treatment at his very department, and are quite willfully treated as second-class citizens. A morally bankrupt physician that supports privatization and the two-tier system would argue that if a patient is dissatisfied with a particular physician or department they should simply seek care at another clinic. However, the under-insured invariably have extremely limited options – hence they are often at the mercy of such loutishness and knavery.

There is no logical reason why a New Yorker should be denied the right to see any doctor that they wish at Lenox Hill, Mount Sinai, Weill Cornell, Columbia, NYU or Sloan Kettering. Is it not preposterous that millions of Americans live either within walking distance or a reasonable subway ride from these renowned medical institutions, and yet their health insurance prevents them from seeing the majority of physicians that actually work at these institutions? As is the case with the Manhattan rentals market, there is no shortage of five thousand dollar one bedrooms, yet they are accessible to only a small fraction of the population.

The question of who will foot the bill should be asked, not in regards to who will pay for single-payer, but in regards to how we can continue to maintain a system of nine hundred military bases all across the globe. According to that great bastion of Marxist heresy The Washington Post, “The U.S. wars in Afghanistan and Iraq will cost taxpayers $4 trillion to $6 trillion.” And this was written in March 28, 2013. How many hundreds of billions of taxpayer dollars have we spent on sustaining this bloated empire over the past four years? Instead of using this money to establish a health care system that we can be proud of the great beacon of liberty and freedom is arming death squads, and dropping depleted uranium, cluster munitions, and white phosphorus on mostly defenseless human beings. Think about that, the next time someone says we can’t afford a single-payer health care system.

The astounding waste that can be associated with just one new (and deeply flawed) fighter aircraft can boggle the mind, as Mike Fredenburg writes in the curiously subversive July, 2015 issue of National Review:

Indeed, it could be argued that the biggest threat the U.S. military faces over the next few decades is not the carrier-killing Chinese anti-ship ballistic missile, or the proliferation of inexpensive quiet diesel-electric attack subs, or even Chinese and Russian anti-satellite programs. The biggest threat comes from the F-35 — a plane that is being projected to suck up 1.5 trillion precious defense dollars. For this trillion-dollar-plus investment we get a plane far slower than a 1970s F-14 Tomcat, a plane with less than half the range of a 40-year-old A-6 Intruder, a plane whose sustained-turn performance is that of a 1960s F-4 Phantom, and a plane that had its head handed to it by an F-16 during a recent dogfight competition. The problem is not just hundreds of billions of dollars being wasted on the F-35; it is also about not having that money to spend on programs that would give us a far bigger bang for the buck.

Such as a single-payer health care system, for instance. That would give us a nice bang for the buck!

Lamentably, the most pressing problem in this debate is the fact that millions of Americans insist on looking at health care as yet another business. Moreover, the extreme inequality that is glaringly on display in education, where our public schools continue to churn out some of the most illiterate and dehumanized creatures ever to walk the face of the earth, in contrast with the outrageously expensive and infinitely more rigorous prep schools that the affluent are sending their children (granted, not without their own problems), may one day be the destiny of our privatized health care system.

The astronomical cost of college tuition has resulted in over a trillion dollars in student loan debt, while the quality of education has been steadily deteriorating since the end of the 1960’s. As with education, we can either choose to have a good health care system, or we can continue to allow a corrupt few to make staggering amounts of money while generating the most abject misery and suffering for millions of their fellow countrymen.

Tying health insurance to one’s job constitutes one of the most diabolical abuses of corporate power, as the overwhelming majority of Americans with full-time jobs can be fired at the drop of a hat, should they be compelled to take a significant amount of time off from work due to illness. Moreover, primary care physicians that elect not to take insurance at all will neither be able to provide patients with critical in-network referrals, nor will they be able to write prescriptions that will be covered by any health insurance plan.

How can do no harm be implemented in practice when vitally important health care decisions are routinely made by hospital administrators, pharmaceutical CEOs, and insurance executives whose only reason for getting involved in health care in the first place was to maximize the greatest possible profit? Remove the profit motive and compassion, logic, and dignity will be reclaimed. Indeed, no less than our very humanity will be restored.

Why must we continue to allow charlatans and con artists to dictate to doctors how they can treat patients, dictate to patients which doctors they can and cannot see, while also using health care as a financial weapon to wage war on the poor and what is left of our country’s once formidable middle class? Good doctors that are forced by hospital administrators and soul-obliterating insurance companies to provide under-insured patients with inferior care will be prone to feelings of guilt, shame, remorse and depression. Some have even taken their own lives. Indeed, this barbarous and unconscionable state of affairs is indefensible, and cannot hold water in any rational or civilized conversation.

The time has come for Americans to put an end to this foolishness, and to disenthrall themselves from these corrupt elements, that straitjacket and humiliate both doctors and patients alike.

Jacob Hacker Rises Again to Stop Single Payer

Photo by Erik McGregor

In the article linked below, The Road to Medicare for Everyone, Jacob Hacker is once again working to dissuade single payer healthcare supporters from demanding National Improved Medicare for All and use our language to send us down a false path. Once again, he comes up with a scheme to convince people to ask for less and calls those who disagree “purists”. Hacker calls his “Medicare Part E” “daring and doable,” I call it dumb and dumber. Here’s why.

Hacker makes the same assertions we witnessed in August of 2017 when other progressives tried to dissuade single payer supporters.

He starts with “risk aversion,” although he doesn’t use the term in his article. Hacker asserts that those who have health insurance through their employers won’t want to give it up for the new system. Our responses to this are: there is already widespread dislike for the current healthcare system; people don’t like private insurance while there is widespread support across the political spectrum for Medicare and Medicaid; there is also widespread support for single payer; and those with health insurance can be reassured that they will be better off under a single payer system. It is also important to note that employers don’t want to be in the middle of health insurance. Healthcare costs are the biggest complaint by small and medium sized businesses and keep businesses that operate internationally less competitive.

Next, Hacker brings up the costs of the new system and complains that it will create new federal spending. He points to the failures to pass ‘single payer’ in Vermont and California. First, it must be recognized that the state bills were not true single payer bills, and second, states face barriers that the federal government does not, they must balance their budgets. Hacker ignores the numerous studies at the national level, some by the General Accounting Office and the Congressional Budget Office that demonstrate single payer is the best way to save money. Of course, there would be an increase in federal spending, the system would be financed through taxes, but the taxes would replace premiums, co-pays and deductibles, which are rising as fast as health insurers can get away with. Hacker proposes a more complex system that will fail to provide the savings needed to cover everyone, the savings that can only exist under a true single payer system.

Hacker also confuses “Medicare for All” with simply expanding Medicare to everyone, including the wasteful private plans under Medicare Advantage. This is not what National Improved Medicare for All (NIMA) advocates support. NIMA would take the national infrastructure created by Medicare and use it for a new system that is comprehensive in coverage, including long term care, and doesn’t require co-pays or deductibles. The system would negotiate reasonable pharmaceutical prices and set prices for services. It would also provide operating budgets for hospitals and other health facilities and use separate capital budgets to make sure that health resources are available where they are needed. And the new system would create a mechanism for negotiation of payment to providers.

Finally, Hacker tries to convince his readers that the opposition to NIMA will be too strong, so we should demand less. We know that the opposition to our lesser demands will also be strong. That was the case in 2009 when people advocated for the ‘public option’ gimmick. If we are going to fight for something, if we are going to take on this opposition, we must fight for something worthwhile, something that will actually solve the healthcare crisis. That something is NIMA. We are well aware that the opposition will be strong, but we also know that when people organize and mobilize, they can win. Every fight for social transformation has been a difficult struggle. We know how to wage these struggles. We have decades of history of successful struggles to guide us.

One gaping hole in Hacker’s approach is that it prevents the social solidarity required to win the fight and to make the solution succeed. Hacker promotes a “Medicare Part E” that some people can buy into. Not only will this forego most of the savings of a single payer system, but it also leaves the public divided. Some people will be in the system and others will be out. This creates vulnerabilities for the opposition to exploit and further divide us. Any difficulties of the new system will be blown out of proportion and those in the system may worry that they are in the wrong place. When we are united in the same system, not only does that create a higher quality system (a lesson we’ve learned from other countries), but it also unites us in fighting to protect and improve that system.

Hacker succeeded in convincing people who support single payer to ask for something less in 2009 and we ended up with a law that is further enriching the health insurance, pharmaceutical and private healthcare institutions enormously while tens of millions of people go without care. Now, Hacker rises again to use the same scare tactics and accusations that he used then to undermine the struggle for NIMA. This is to be expected. The national cry for NIMA is growing and the power holders in both major political parties and their allies in the media and think tanks are afraid of going against the donor class. Social movements have always been told that what they are asking for is impossible, until the tide shifts and it becomes inevitable.

Our task is to shift the tide. We must not be fooled by people like Jacob Hacker. We know that single payer systems work. We have the money to pay for it. We have the framework for a national system and we have the institutions to provide care. Just as we did in 1965 when Medicare and Medicaid were created from scratch, and without the benefit of the Internet, we can create National Improved Medicare for All, a universal system, all at once. Everybody in and nobody out.

We know that we are close to winning when the opposition starts using our language to take us off track. “Medicare Part E” is not National Improved Medicare for All, it is a gimmick to protect the status quo and convince us that we are not powerful. We aren’t falling for it. This is the time to fight harder for NIMA. We will prevail.

Read Jacob Hacker’s article in the American Prospect here.

• Article first published in Health Over Profit

Is Health Care A Commodity Or Right?

With just a week left before Congress’ budget reconciliation process ends, the Senate is once again peddling a poorly-thought out plan to repeal and replace the Affordable Care Act (ACA). If Senators vote before the September 30 deadline, they only need 50 votes instead of the filibuster-proof 60 votes to pass amendments. And once again, people are rising up in opposition to the plan, making it unpopular and unlikely to pass.

At the same time, support for a National Improved Medicare for All single payer healthcare system is increasing and there are bills in both the House and Senate with record numbers of co-sponsors. Will the United States finally join the long list of countries that provide healthcare to everyone?

Overall, it is a time to be optimistic. The movement for National Improved Medicare for All has made great strides this year. Whether we succeed still hangs in the balance. We discuss what it will take to win and how to proceed.

Join Health Over Profit for Everyone (HOPE), a campaign for National Improved Medicare for All.

First, Some History

Efforts to create a national health insurance have existed in the United States for the past 100 years. Health historian, David Barton Smith, writes (in a draft chapter) that the fundamental struggle in the US has been over the question of whether health care is a commodity that belongs in a market or whether it is a basic necessity that requires the protection of government so that it is universal. Smith breaks up the past one hundred years into five phases and argues that in each phase, compromises were made that failed because they did not meet the fundamental criteria of covering everyone and achieving effective governmental oversight. He refers to these compromises as “more palatable approaches” that were considered to be politically feasible, but each “self-destructed.”

These failures, including the most recent ACA, have driven health care deeper into the pockets of private industry from the provision of medical services to the the production and distribution of pharmaceuticals and medical devices. Doctors are turning their practices over to large institutions, “going corporate,” in order to have the negotiating power to simply exist in this environment. Mergers by health insurers, hospitals and pharmaceutical companies have been acts of desperation, as each sector fights for control. But the bottom line in this fight is profit for a few, not health for the many, and so it is the public who suffers. Dr. Adam Gaffney traces and explains this trend from the 1940s to the present in “The Neo-liberal Turn in American Health Care.”

Make no mistake, currently, in the United States, health care is a commodity, and the profiteers are going wild. Since passage of the ACA, major health insurance company stock values have quadrupled. And they are never satisfied. Democrats and Republicans in Congress are discussing a “bipartisan approach,” as outlined by the Center for American Progress, which is funded by health industry lobbyists, to fix the healthcare system. Their plan is to give billions of more dollars to the industry to encourage it to cover our healthcare needs. They refer to this as “stabilizing the market.”

Any person who says that health care is a right or basic necessity but supports keeping the existing market-based structure is either confused or lying. The market model of health care is a failure. Even Fareed Zakaria, conservative host of CNN, understands this.

This history is important because the elites in power are working to maintain their grip on the system. Incrementalists were out in full force after the failure of repeal attempts this summer. Writers who claim to be progressives argued that those who want National Improved Medicare for All are asking for too much, that it is just not politically feasible and that we must compromise. But what they might consider to be doable won’t solve the healthcare crisis.

Incremental steps that were taken in the past did not succeed because they failed to meet the basic requirements of being both universal and properly overseen by the government. This is why we say that the smallest incremental step that we can take in the US is to create a National Improved Medicare for All, a universal publicly-funded healthcare system that relegates private insurers to a supplemental role to provide extras that the system does not cover. Beyond that, there will still be a lot to do to make sure everyone has their healthcare needs met.

National Improved Medicare for All is on the table

A victory this year is that there are bills in the House and Senate that outline a National Improved Medicare for All healthcare system, and they have record numbers of co-sponsors. HR 676 is considered the ‘gold standard’. It has been introduced every session since 2003 and it has broad support from the single payer healthcare movement. It would truly treat health care as a public necessity and not a commodity.

Under HR 676, all people living in the US would be included in the system, there would be free choice of health professional, the coverage would be comprehensive and care would be provided as needed without financial barriers. HR 676 would create a publicly-financed not-for-profit healthcare system. It currently has 119 co-sponsors, all Democrats, plus Rep. John Conyers, who introduced it.

S 1804 is the Medicare for All Act in the Senate that was introduced on September 13 of this year by Senator Sanders with 16 co-sponsors, all Democrats. It has strengths and similarities to HR 676 as well as weaknesses. Its strengths are that it endeavors to achieve a universal Medicare for All system with more comprehensive coverage than what most people have now. It has strong language protecting women’s reproductive rights and it removes most co-pays and deductibles.

The weaknesses of S 1804 prevent it from fully transforming our healthcare system to a public service. Investor-owned facilities are permitted to continue to operate within the system and budgetary controls that might restrain them were excluded from the bill. Another weakness is the exclusion of long term care and keeping it in Medicaid, which forces people and their families to live in poverty to receive benefits.

Perhaps one of the greatest concerns about S 1804 is the long transition period. Most universal systems are started at once – on a certain date everyone is in the system. This is how we did Medicare as a totally new system in 1965 before we had computers. The delayed implementation period over four years is such a complex transition that there are concerns it will proceed poorly and support for a universal healthcare system will disappear before it is complete. With complexity, comes greater costs. HR 676 would start all at once, which would not only allow the savings needed to cover everyone but would also put us all in the same boat so that we all have an interest to fix any problems that arise.

We created a chart comparing HR 676 and S 1804 and a chart outlining the transition for S 1804.

Jim Kavanaugh of The Polemicist argues that S 1804 may actually be a “Trojan Horse” for the Democrat’s favored proposal, a public insurance they refer to as a ‘public option’ being added to the current mix. We call the ‘public option’ a “Profiteer’s Option” because it will serve as a relief valve for private insurers to jettison people who need care.

Health Over Profit for Everyone (HOPE), a campaign of Popular Resistance, sent a letter to Sanders before he introduced his bill urging him not to compromise from the start. Thank you to all of you who wrote to his office.

Next Steps

Winning the fight for a National Improved Medicare for All healthcare system is possible. It will take preparation and hard work. Our opponents are those who profit from the current healthcare system, such as the pharmaceutical companies behind the opioid epidemic, those who are ideologically opposed to public safety nets, the commercial media, as Yves Smith describes, and legislators from both major parties, even those who claim to be progressive, because our political system is dominated by Wall Street. We can’t be fooled by progressive veneers. President Obama’s ACA was written by and for the medical industrial complex to enrich the few, and he is already receiving hundreds of thousands of dollars for Wall Street speeches.

We counter our opponents through the principals of I.C.U.:

I =Independence – we must be independent of political parties and willing to pressure all members of Congress, the White House and federal institutions to achieve the healthcare system we need. We cannot attach this movement to any political party or politician’s agenda. To have lasting success, this needs to be a multi-partisan effort on the movement’s terms. If one party or person takes ownership, then the issue can become a political football, as the ACA has become.

C = Clarity – we must educate ourselves and others about basic health policy so that we understand what elements are required for the system to meet our goals and our needs. We will be the watchdogs for the system to make it the highest quality system it can be. This includes understanding which proposals are insufficient too, such as the much-promoted public option and lowering the age of Medicare.

U = Uncompromising – we must stay strong and united around the basics that we need to achieve for the National Improved Medicare for All healthcare system to function. We are often told that politics involves compromise, but some compromises undermine our goal. Movements for social transformation have always been told they are asking for too much. We are asking for what many other countries have and what we are already spending enough money to have – a healthcare system that is universal high quality and comprehensive. We spend more than twice per person per year what other countries spend that have achieved this. For those who say we should have anything less than a universal system, we ask: who should be left out?

The People will Win Improved Medicare for All

Our goal for the HOPE campaign is to achieve National Improved Medicare for All. We provide the tools and information you need to accomplish this. Sign up for HOPE here.

People across the country are organizing teach-ins and movie nights, doing outreach in their communities, attending town halls and meeting with their members of Congress. We urge you to join the effort and join the monthly education and organizing national calls.

When we win the fight for a universal healthcare system, it will represent a political sea change in the US that will bring solidarity and empowerment to fight for the many other changes that we require. Health is connected to having an education, a job, a home, clean air and water and much more.

As medical student Mike Pappas describes, we need to look beyond access to care and recognize that:

We must address the social determinants of health. Taking the social determinants of health into account can no longer be something nice to do if there is ‘extra time.’ It must become the focus of medical practice. This will require changing medical education and medical practice.

It’s time for a real healthcare revolution of, by and for the people!

Irma

I’m twelve feet away from the northern eyewall of Hurricane Irma.  Seated behind floor to ceiling panes of glass that can’t be thick enough. “Are they thick enough?” I wonder while staring at the murderous velocity of rain and wind that just a few steps away would lift me whole and launch me into the lake, a tree or another house. With death defying, tornadic ferocity the wind drives rain sideways in every direction at once.  I hear tree trunks and limbs snapping like firecrackers off in the distance.

There’s still running water, but the electricity went off hours ago. There’s no internet. Comcast has opened up thousands of free WiFi hotspots for anyone whose service is down.  You can log on for two hours at a time. Two hours at a time in the teeth of an historic maelstrom.  I enter a username and password and hit a fucking pay wall. Comcastic!

The changes in air pressure are making my ears pop as the wind lives up to its cliché;  it really does sound like a freight train.  130, 140 miles per hour but still not the Cat-5 death dealer that scoured 100% of Barbuda’s housing stock down to its concrete foundations.  Not the 185 miles per hour that would take paint off a car, put the car in a hole and blow the hole away.  This isn’t that, but it’s impossible to say exactly how fortunate I am beyond the fact I’m still sitting here watching the world get ripped apart.

I’m glad I boarded up my house and came to my in-law’s ground floor condo 20 minutes northeast.  In a storm 600 miles wide that’s a difference without a distinction but this condo is better built and stronger than my tract home constructed in 1976 by contractors on acid.  I’ve moved to the kitchen, away from the glass, where I’ve paired off a peanut butter and honey sandwich against a muscular Cabernet/Zin/Sarah blend.  I’m out of milk.

Suddenly the wind dies down and the rain stops. We’re in the eye. I step outside.  I’m told there’s blue sky in the center of a hurricane, but not in this one. Irma’s core is deck plate gray and the driveway is a carpet of leaves, branches and uprooted trunks making the way impassable.  What’s the difference?  I’m not going anywhere anyway. The southern half of the eyewall is coming.  I snap some pictures and go back inside.  The wind picks up fast and the rain with it.  My cats have slept through the whole thing.  One in the master bedroom and two others, a mother and her adult spawn spooned into an indistinguishable pile of warm fur on my bed in the guest room.  I wish I could be that cool and follow their lead. The howling begins and once again I hear tree trunks snapping.

If my in-law’s home suffered cosmetic damage, my own home was a different matter.  Driving south along main arteries through intersections of cockeyed traffic lights, blacked out and dangling, I finally made it to the badly flooded stretch of road that is the only way in or out of my neighborhood.  I drove through sheet flow up to my doors and managed to get through to my street and driveway.  The front yard was strewn with pieces of other people’s houses, tree limbs and branches: the back yard the same, only under water.  Mature shade trees split down the middle and a one story aluminum pool cage now a twisted skeleton of support and cross beams, half thrown up on my roof while the rest lies in and around my pool at strange angles as if gravity hadn’t quite finished its conversation.

The wooden front door gave way under protest, swollen as it was against the jam.  I was greeted with the thick, warmishly fetid organic musk of a diaper pail.  Irma had blown water into my house through every conceivable fissure and crevice a house built in 1976 invariably has.  The baseboards and sheet rock had wicked up the puddled sweat like a sponge, expanding and separating from each other. Everything twelve inches off the deck will have to be cut out and replaced; every square inch of tile, every grout line, will have to be painstakingly scrubbed with soap and bleach. Somehow my paperback copy of Antonia Juhasz’ great work, The Tyranny of Oil sits bloated and destroyed on the bedroom floor.  How ironic.

The $120 in cash and credit cards in my pocket are worthless.  There is nowhere to spend money.  No supermarkets selling food, no gas stations selling gas, no hardware stores selling tools or propane. People everywhere are living off stockpiled meat, water, beer and soda stored in ice chests and everyone seems to have their grills fired up. Checking to see how others close by are doing, one kindly offers 5 gallons of gas when I tell him I’m down to a quarter tank.  Another offers a grilled sausage on a hot dog roll.  I’m a vegetarian, but not today.  Yet another provides a half loaf of sliced bread and cold Gator-Aide.  Everyone has been hit hard, so these spontaneous acts of proximal kindness are meaningful, unexpected and palpable.  In the coming days, waiting for power to be restored, much generosity and cooperation was on offer in this working class neighborhood. Far more than any expressed or received from family or friends of long standing with the means to do more, something – or anything.  And I know why this is so.

We live in a realm of hungry ghosts, a trance state mistaken for normative, acceptable – even civil – society.  But it’s not a society, in the strictest sense, as there is so little that is social about it.  It’s an economic construct marked by disregard, disdain, incivility utterly drained of unity, community or any sense of individual obligation to the whole or the other.  No matter how much one has, insatiable hunger for more persists.  A mind where spaciousness is emptiness; an inversion of abundance into a perception of scarcity and lack.  A Dickensian box where those working for scraps live in an ahistorical matrix deprived of the vocabulary to even describe their reality while those that have real wealth live in a richly textured movie starring themselves in a mythological place where they are generous, compassionate, deserving, loving and kind. It is an abattoir.  An extremely violent gun culture of dog loving infantile grandiosity.

The ballet of my neighbor Juan and his two chainsaws makes me sorry I didn’t record it.  He owns a landscaping business, and he and his crews had been working their asses off since dawn clearing downed trees in a gated community near my open neighborhood.  It was getting on sunset when he came over offering to chop up the last eight feet of a fifty foot shade tree blasted from its moorings in my back yard.  It was an unbelievably kind gesture after the kind of day I’m sure he had.  I watched him cut the trunk and lower limbs into a pile of manageable chunks inside of about 20 minutes. It would have taken me at least an hour if I knew how to do it without killing myself.  All he wanted was a cold beer.  The next day I brought him a case.

It made me think about the current administration’s repeal of the Deferred Action for Childhood Arrivals (DACA) and the millions of Latinos deported by President Obama.  I grew saddened and furious.  In the wake of Hurricane Irma in SW Florida, the road back from neighborhoods turned medieval under tons of fallen trees is being led by thousands of undocumented Mexicans, Hondurans and Guatemalans with chainsaws.  The next time I hear anyone slandering Latinos in any way, especially with the canard that they’re “taking our jobs”, I will step up to them and publicly shame them.  I will describe them and, if practical, strangle them while I whisper in their fucking ear.

As of this writing I’ve had my power back for 6 days.  Six days of hot showers, fresh laundry and air conditioning.  There are still thousands without power in homes inundated with water that has nowhere to go in the super-saturated soil of SW Florida. Overpriced slumlord shit boxes and the homes of retirees on or near the Imperial River less than a mile from my house now experience tidal flow in their kitchens. I turned back from paying my water bill in person when confronted with a quarter mile sheet flow of indeterminate depth blocking the road between me and their office.  This is a major disaster I’m in the middle of and yet I’m one of the fortunate ones.  Had Irma tracked a bit further west sucking up water and energy instead of making landfall in Collier County when and where it did, this disaster could easily have been a much worse and wider catastrophe.  The 10 to 15 feet of predicted storm surge did not happen in the Gulf Coast city of Naples, although they received more than their fair share of flooding and wind borne destruction.  That city will virtually bounce back. Naples on the Gulf contains more private wealth than Beverly Hills and Jackson Hole combined.  They have little need for government assistance there.  They never did.  For them government is an impediment.

East Naples, where the sprawling 55 years old and up trailer park communities are located, jammed with elderly folk on low fixed income living side by side with undocumented aliens is another story.  The undocumented get to live in what’s left of their condemned trailers with the stench of standing water and sewage in the air – ineligible for federal assistance. Immokalee, FL, still further east where Oaxaca meets Port-au-Prince, covered brilliantly in the tome Days of Destruction, Days of Revolt co-authored by Chris Hedges and Joe Sacco, is still another poor, traumatized sacrifice zone.  And few are discussing, far less writing, much about Everglades City, an hour’s drive south of Naples where it took FEMA five days to get on the ground there.  Storm surge and wind have wiped that city off the map; its residents wallow in muck and filth with nowhere to live and nowhere to go.

Irma struck Collier and Lee Counties on Sunday, September 10th. According to an article in the Naples Daily News of September 19th about the situation in Everglades City:

The scores of volunteers who have set up in the city handing out food, water and clothes along with Federal, state and local medical providers was a far cry from the almost-deserted scene in the city for the first week following the storm.

Residents had been left mostly on their own, spending hours each day working in the mud and sludge, often barefoot or in flip-flops, trying to salvage what was left of their homes.

In Everglades City and surrounding communities struck with 10 feet of storm surge, a man scraped his leg picking up a piece of aluminum debris on Monday, the day after Irma passed.  His wife put a Band-Aid on it and by Friday a raging bacterial infection had attacked his vital organs, threatening renal failure and the doctors amputated his leg. The mayor’s mother is in the hospital fighting an infection.  Full time medical assistance from the County only began on Sunday, seven full days after Irma.  According to the same article, health officials administered only 80 tetanus shots to residents before running out of supplies.

Having learned nothing from Katrina, the stench of neo-liberalism’s 40 year death march across America and the world has seeped like carbon monoxide into every gear of the machine we live in.  Capital and its wholly-owned subsidiary, government, can no longer respond effectively to crisis.  This is the fossilization and atrophy of end-stage capitalism, a violent socio-economic bifurcation describing a zombie state eating its own with nothing on the horizon to replace it. “American politics”, as Dr. Manuel Garcia, Jr. aptly puts it, “is how money talks to itself”.

The indiscriminate savagery of Irma is about far more than this unemployed writer’s freezer full of rotted food, shredded roof line and collapsed pool cage.  The path of Irma draws upward into bas-relief the majority of American society’s precarious decline into an irreconcilable cultural and economic abysm.  Radical social change is coming, but not until many hundreds of thousands, likely millions, of American lives are lost.  Not on the romantic front lines of populist revolt at the barricades, but as the unheralded, withering, long term consequence of declining standards of living.

Profound social ferment and revolutionary social restructuring is inevitable, but it will not simply emerge as the result of what it must and has always been – an impulse from the street.  It will also be coincident with a top line driven reconfiguration of titanic pools of capital beginning, perhaps, with the structures of power that have more money than anyone outside of international drug cartels, the fossil fuel juggernaut or the military industrial complex – the insurance industry.  Say what you may about them, but insurance is perhaps the greatest civilizing force in mankind’s entire meteoric footnote.  Without insurance to mitigate against risk, your brand new crane manufactured in South Korea designed to lift cargo out of the holds of container ships in the Port of Los Angeles never gets shipped trans-Pacific to the buyer.  A bank holding a mortgage note on a single family home in SW Florida will insist the owner carry Home Owner’s Insurance and Flood Insurance to mitigate the risk of an unlikely, but catastrophic event.  Like, say, a hurricane.

The question is this:  As anthropogenic climate change throws actuarial calculations out the window and the profitable business of hedging anomalous risk becomes an open ended economic implosion of the rare turned commonplace, how many $150 billion dollar hits do you suppose global insurance consortia and their reinsurers remain willing and able to take?  My guess is not many.  Insurance companies have been generating very public warnings of climate change since at least the mid 1990’s.  When elephants do battle, only the grass suffers, but it will be interesting to see how the insurance industry responds to paying the crippling freight for the fossil fuel industry and how that might contribute toward progressive realignments.

As weak carriers fold, risk portfolios redistribute into stronger hands. Policy deductibles rise insurmountably and covered percentages over and above that drop leaving only the rich able to self-insure and the masses of life long premium payers left with payouts insufficient to make them whole.  Does an utterly sclerotic government lost in a miasma of climate change denial step in to assume a role the private sector no longer deems profitable?  That seems unlikely as well.

At the civilizational fork where far too many obscenely stupid, venal and greedy annihilists are in charge, what will it take to rip the zombie’s head off the deep state?  Hurricanes Andrew, Charlie, Wilma, Katrina, Harvey, Irma and perhaps Maria haven’t seemed to do the trick.  Likewise, eight geriatrics warehoused in a for-profit Hollywood, FL nursing home dying of heat exhaustion when the air conditioning went out caused little more than a momentary stir in the media when the hook became the location of the human dumping ground – right across the street from a Level-1 trauma center.

As we all enter the leading edge of a largely irreversible negative feedback loop of a warming planet, the strength and frequency of hurricanes seems likely to increase.  What happens when they’re all Cat-3 or Cat-4 when they make landfall?  How will capital and government respond?

The only dialect worth exploring is this:  Russia and China are committed to a $20 trillion/20 year plan to build out continental networks of high speed rail to swiftly transport raw materials, finished goods and people as part of the One Belt One Road initiative, together with new, modern port systems to pull up hundreds of millions of people out of penury as part of the next industrial age of man. America spends a trillion dollars a year on bombs, death and dismemberment. One of these plans has a future.  The other does not.

As a low, slow flying entourage of military aircraft containing the Governor of Florida, an exonerated plunderer owing his fortune to an historic Medicare fraud, and the President, who learned his ethics at the knee caps of Roy Cohen, flew by just east of my house, I took cold comfort as I swept dank pools of bacteria rich sludge out of my garage.

Senate Debates Billions for Insurers while Public Demands Medicare for All

Billions More for Crony Capitalist Insurance or Improved Medicare for All

This week we attended a hearing of the Senate Health, Education, Labor and Pensions (HELP) committee where there was broad bi-partisan support for giving billions more to the insurance industry to “stabilize the market.” The government already gives for-profit insurance $300 billion annually and their stock values have risen dramatically since passage of the Affordable Care Act (ACA), so the rush to give them more was disheartening.

That was contrasted with a meeting with the staff of Senator Bernie Sanders about the improved Medicare for all bill he plans to introduce on September 13. Sanders, along with other Senators, is seriously trying to figure out how to transform health care from being a profit center for big business to being a public good that serves the people. That means doing away with the health insurance industry, not giving them billions of public dollars.

The contrast reinforced the need to advocate for improved Medicare for all and push for the best healthcare system we can create.

Healthcare a Commodity or a Human Right?

Senators are back from their long summer recess, and they started off with health care back at the top of the agenda. The Senate HELP committee held its first of four hearings on September 6, and Senator Bernie Sanders is preparing to introduce a Medicare for All bill on September 13. The two efforts are a clear example of the underlying dilemma that we have faced in the United States for the past 100 years: Is health care a commodity or a public good? It can’t be both.

The failed efforts to repeal and replace the ACA took up a lot of time and energy this year and left the country in no better position to deal with the ongoing healthcare crisis. Now, time is really short because private health insurers are announcing their rates for 2018, and they are, not surprisingly, screaming for more money because they have to (*gasp*) pay for health care.

A group of us attended the first Senate HELP committee hearing to convey the message that the people are ready to undertake the serious work of creating a National Improved Medicare for All. Typically, before and sometimes during a hearing, attendees are allowed to hold signs as long as they are not disruptive. On that day, the committee chair, Senator Lamar Alexander, ordered that signs be put away before the hearing even began. He told Dr. Carol Paris, a steering committee member of the Health Over Profit for Everyone campaign, that “we are not talking about improved Medicare for All now.”

Instead, the entire hearing focused on “stabilizing the insurance market,” even though their stock values have quadrupled since 2010. Five health insurance commissioners from different states testified before the senators and answered questions. It appeared that all had been well-prepped by the health insurance industry. The committee members patted each other on the back for being bi-partisan, unfortunately they were working together for the insurance industry, not for the people.

The bi-partisan hearing discussed three main points: making sure that public dollars were available to subsidize insurance costs, reinsuring private health insurers so they would be protected if they had to spend ‘too much’ money on health care and incentives to entice private insurers back into areas that are not profitable. Coincidentally, these were the same points raised in the bi-partisan proposal published this year by the Center for American Progress, a Democratic Party think tank financed in part by health insurance lobbyists. Both parties are clearly on the side of health care as a commodity.

Not one person participating in the hearing questioned whether health care belonged in the market. At least one Senator, Rand Paul, complained about Big Insurance coming to Washington with their hands out and said he would rather pay directly for health care than give the money to Big Insurance. His ideology is far from supporting Improved Medicare for All, but he did call out the corruption.

Perhaps the most disappointing of the day was Senator Al Franken, who has completely bought into the ‘health care is a commodity’ camp. Not only did he advocate for subsidizing and reinsuring private insurers, but he called for a federal reinsurance program to cover the costs of people who need health care, at least after Big Insurance takes their cut. And Franken, who tried to make jokes about the hearing, called for more money to advertise and lure youth into the insurance market, which is about as unethical as pushing cigarettes or candy, and wants heavier enforcement of mandates to purchase health insurance. Franken touted a ‘virtuous cycle’ of giving more money to health insurers so that they lower premiums and more people buy insurance. The problem is that there is nothing very virtuous about spending billions to subsidize an industry that has a greater responsibility to pay its Wall Street investors than to pay for necessary health care. The insurance industry has shown itself to be insatiable, and ready to use their power to extort Congress because they hold people’s lives in their hands.

It was a difficult hearing to attend. The whole time we wanted to stand up and ask whether they could possibly see how ridiculous this all appeared and whether they thought private health insurers added any benefit. But, the Capitol Police made it clear from the start that they would arrest anyone who disrupted without warning, and we had a meeting scheduled with Senator Sanders’ staff after the hearing. We did manage to squeeze out a few “Medicare for All’s” during the hearing.

Healthcare Without the For-Profit Insurance Industry

The meeting with Senator Sanders’ staff was like night and day. We began from the premise that health care is a human right and had a frank discussion of how that could be achieved. The text of his upcoming bill was not available, but for 90 minutes we discussed many of the details of the bill. This meeting was scheduled because of a letter that the Health Over Profit for Everyone steering committee sent to the Senator’s health staffers raising concerns about what was reported to be in the bill. An initial response was lacking, but once the letter was widely circulated in progressive blogs, the staff were ready to meet.

There has been a movement for National Improved Medicare for All in the United States for a long time. People in the movement have debated and reached consensus about how an improved Medicare for all system ought to be structured. Much of that is embodied in John Conyers’ legislation, HR 676: The Expanded and Improved Medicare for All Act, which has 118 co-sponsors. Senator Sanders and his group, Our Revolution, are raising funds and working to build more support for Improved Medicare for All, but they still need to cooperate with those who have been advocating for this if they want full support.

Fortunately, Senator Sanders has demonstrated that he is responsive to public pressure. He started the year off not intending to introduce Medicare for all legislation, but he received push back and changed his mind. Then he started talking about fixing the ACA and introducing a public option, and there was pushback against that. There has also been pressure about the contents of the bill. When it was learned that there would be co-pays, many organizations, including Physicians for a National Health Program, contacted his office to say that co-pays add more complexity to the system and cause people to delay or avoid necessary health care. His staff reported that co-pays have been removed in the bill except for purchasing drugs, in order to encourage the use of generic drugs.

In the process of winning a single payer healthcare system, the movement for National Improved Medicare for All has the role of being the watchdog to make sure that we create the best system we can. We want this system to work for everyone and to be a system that improves health, a system that the United States can be proud of. This is a role that will be ongoing even after we win because we will have to improve the system and constantly guard against those who would try to privatize it so they can profit.

After meeting with Senator Sanders’ staff, we felt more reassured that his intention is to ultimately create a strong National Improved Medicare for All system. There are many provisions in the bill that are to be applauded – providing care to every person in the United States and offering fairly comprehensive coverage – and a few that we will have to work on – such as including long term care, abolishing investor-owned health facilities and a more rapid transition period. On September 13, if all goes well, the text of the bill will be released and we will assess it.

The People Can Win Improved Medicare for All

All in all, we are in a strong position. The Senate HELP committee hearing showed how out of touch many of our legislators are with the people, who favor Improved Medicare for All or are just yearning for affordable health care no matter what form that takes.

And, we know members of Congress can be moved, some more easily than others. This week the architect of the ACA in Congress, former Senator Max Baucus, who had us arrested with six others in 2009 when we stood up and called for single payer to be included in the debate, joined the choir. Baucus said single payer is the answer, commenting “we’re getting there, it’s going to happen.” We were arrested demanding that he put single payer on the table and he refused, calling for more police instead. Now, more than 100,000 preventable deaths later, he supports it. The ACA was born out of the corruption by healthcare profiteers and everyone involved from Obama to Baucus knew it, and everyone from Alexander to Franken knows that remains true today.

The tide is shifting in the United States. After a century of what Professor David Barton Smith, a health historian calls, “more palatable approaches” that have each “self-destructed,” we are clear that health care is a public service, not a financial profit center. We are ready to do the work to make what was once considered impossible, National Improved Medicare for All, become inevitable. Each week, new support for single payer arises. The other surprise this week was the support of centrist Democrat, Senator Jon Tester of Montana, who explained that his farmer parents never had insurance until they were old enough for Medicare.

Hopefully, more legislators will arrive at the wisdom that, as Professor Smith describes:

The practical mechanics of how to make such a universal health insurance system work are a lot easier than patching together the existing hopelessly fragmented private-public health insurance system. The Medicare program actually does this quite well and the cry of Medicare for all has never been silenced. Indeed, no one has ever objected to their ‘mandated’ coverage under Medicare.

The people have the power to finally make the government do the right thing. No more compromises. No more false solutions. Onward to National Improved Medicare for All.

• First published at Health over Profit

To Sen. Sanders: We cannot begin from a position of compromise

At the start of the August congressional recess, Senator Bernie Sanders announced that he will introduce a senate bill this September “to expand Medicare to cover all Americans.” Since the election, the movement for improved Medicare for all, has been urging Sanders to introduce a companion to John Conyers’ HR 676: The Expanded and Improved Medicare for All Act, which currently has a record 117 co-sponsors in the House and is considered the gold standard by the movement.

Recent reports are that Sanders’ bill falls far short of HR 676 in fundamental ways. In fact, Sanders’ bill is a multi-payer system not a single payer system. His bill reportedly would allow private insurers to compete with the public system, allow the wealthy to buy their way out of the public system and allow investor-owned health facilities to continue to profit while providing more expensive and lower quality health care.

As a leader in the Democratic Party in the Senate, Sanders is trying to walk the line between listening to the concerns of his constituency, which overwhelmingly favors single payer health care, and protecting his fellow Democrats, whose campaigns are financed by the medical industrial complex. Sanders needs to side with the movement not those who profit from overly expensive US health care.

Today, August 30, Health Over Profit for Everyone steering committee members and supporters sent the letter at the end of this article to Senator Sanders raising specific concerns and urging Senator Sanders to amend his bill before it is introduced.

CLICK HERE TO SEND AN EMAIL TO SENATOR SANDERS.

There are two realities

It has become the practice in Washington, DC to offer weak bills, which fail to address the roots of the crises we face, to make them ‘politically feasible’. The Affordable Care Act (ACA) is an example of this. It was a compromise with the health insurance, pharmaceutical and private hospital industries from the start – an attempt to appease them with public dollars in exchange for greater access to care. The ACA was built on a foundation of private industry even though the priorities of those industries are profit for a few, not health for everyone. That faulty foundation has perpetuated the healthcare crisis – tens of millions without health insurance, tens of millions more who have health insurance but can’t afford health care and poor health outcomes including tens of thousands of deaths each year.

There are two realities that must be considered. The healthcare crisis will not end until a system is put in place that guarantees universal comprehensive and affordable healthcare coverage through National Improved Medicare for All or another form of single payer system such as a national health service. That is what we call the ‘real reality’, and it simply won’t change until there are real changes in policy that solve it. The political reality of what is ‘politically feasible’ is the other reality. This reality will change as people organize and mobilize to demand what they need. Politicians change their positions when they believe it is necessary to maintain their position of power. It is the task of movements to change what is politically feasible.

The movement for National Improved Medicare for All has been working for decades to educate, organize and mobilize the public to change the political reality. And it is working. There is broad public support for Improved Medicare for All and legislation in the House that articulates the demands of the movement. What is needed now is a companion bill in the Senate that is as strong as HR 676. Once that is introduced, activists will work to secure support for it.

Sanders has it backwards. Rather than starting from a position of strong legislation and building support for it, he is starting from a position of weak legislation that he considers to be more politically feasible. By doing so, he is losing the support of the movement that he needs to pass expanded and improved Medicare for all.

Activists versus legislators

This is where it is important to recognize the difference between activists and legislators. Activists and legislators have different priorities. Activists work to solve crises. Their dedication is to an issue. Legislators work to maintain their position, whether it is re-election, seats on committees, good standing with other legislators or continued funding from Wall Street or other wealthy interests. Legislators compromise when they believe it is in their personal best interest. Activists can only compromise when it is in the interest of solving the crisis they face.

To win National Improved Medicare for All, activists need to follow the principles outlined in I.C.U.:

The “I” stands for independence. Activists must keep their allegiance to their issue independent of the agenda of legislators and political parties. The goal is to solve the healthcare crisis, and politicians from both major parties will need to be pressured to support Improved Medicare for All. Remember, the movement is going against the interests of the big money industries that finance members of Congress.

The “C” stands for clarity. Legislators will attempt to throw the movement off track by claiming that there are ‘back doors’ to our goal or smaller incremental steps that are more ‘politically feasible’. They will use language that sounds like it is in alignment with the goals of the movement even though the policies they promote are insufficient or opposed to the goals of the movement. This is happening right now in the movement for Improved Medicare for All. Numerous people, who consider themselves to be progressive but who are connected to the Democratic Party, are writing articles to convince single payer supporters to ask for less.

And the “U” stands for uncompromising. Gandhi is quoted as saying that one cannot compromise on fundamentals because it is all give and no take. When it comes to the healthcare crisis, the smallest incremental step is National Improved Medicare for All. That will create the system and the cost savings needed to provide universal comprehensive coverage. Throughout history, every movement for social transformation has been told that it is asking for too much. When the single payer movement is told that it must compromise, that is no different. The movement is demanding a proven solution to the healthcare crisis, and anything less will not work.

The momentum is on the side of the movement for National Improved Medicare for All. Act now to push Sanders to amend his bill so that it matches HR 676. Sign and share the petition tool, and read the letter below to understand the concerns about Sanders’ bill.

CLICK HERE TO SEND AN EMAIL TO SENATOR SANDERS.

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Dear Senator Sanders,

For almost fifteen years the movement for National Improved Medicare for All has organized around HR 676: The Expanded and Improved Medicare for All Act, introduced each session since 2003 by Congressman John Conyers. As you know, HR 676 has 117 co-sponsors so far this year. This legislation is considered by the movement to be the gold standard framework for a universal healthcare system in the United States.

We appreciate your support for Improved Medicare for All and the work that you have done to elevate the national dialogue on Improved Medicare for All. We hope to continue to work with you to make this a reality in the near future.

To that end, we are writing to share our concerns about the legislation that you are planning to introduce. These concerns are based on what we have learned about your legislation without having the benefit of reading a draft of it.

In order to maintain the cohesion and strength of the movement for Improved Medicare for All, the legislation in the senate must be in alignment with HR 676. This is important so that the movement is unified and so that the process begins from a position of asking for what we want and need, rather than starting from a position of compromise. It is the task of the movement to build political support for the legislation in Congress.

Here is a list of our concerns:

  1. We oppose the inclusion of copayments and deductibles in an Improved Medicare for All bill.

As outlined in the recent letter to you from Physicians for a National Health Program, including copayments adds administrative complexity and creates a barrier to care, which leads to delay or avoidance of necessary care. Economic analyses indicate that the administrative and other savings inherent in a well-planned single payer system offset the added expense of eliminating copayments and deductibles. HR 676 does not include copayments. The movement for Improved Medicare for All has coalesced around the elimination of these financial barriers to care.

  1. We support a rapid transition to National Improved Medicare for All. The Medicare system was implemented within a year of passage without using computers. Unlike when Medicare became law, the United States now has basic infrastructure in place for a national health insurance based on Medicare. We urge you to utilize the timeline in HR 676, which would start the universal system in less than two years, rather than delaying or phasing it in by age group over time. Beginning with a universal system allows savings and cost controls that can be used to provide comprehensive benefits without cost sharing.
  2. We support a single payer healthcare system. We understand that your legislation will allow employers to continue to provide employee health insurance that duplicates what the national health insurance covers to avoid conflict with the Employee Retirement and Income Security Act (ERISA). We urge you to include a carve out of ERISA for national health insurance so that the new system is a single payer system. Without doing so, your bill will be a multi-payer system. This is required to achieve administrative simplicity and significant cost savings. HR 676 allows private insurance that does not duplicate the benefits of the system. Employers and unions would be able to provide extra benefits beyond what the system covers.
  3. We support a universal system. We understand that your legislation will allow health providers to opt out of the national health insurance system. This would create a parallel health system for the wealthy and undermine the quality of the public system. Universal systems are of higher quality than tiered systems because they create a social solidarity in which everyone has an interest in making the system the best it can be. We urge you to reject a tiered healthcare system as healthcare is a human right and should not be based on wealth.
  4. We oppose inclusion of investor-owned health facilities. Investor-owned health facilities treat health care, which is a necessary public service, as a commodity for profit. These facilities have an incentive to cut corners, under and over treat and charge higher prices. The result is higher cost and lower quality. We urge you to reject profiteering in the healthcare system so that the bottom line is improving the health of our population, not profits for Wall Street.

The above concerns are based on what we know about your legislation at present. We do not know if they are warranted because we have not read the text. Upon reading it, there may be additional concerns.

We hope that you will share the draft text of your legislation with us and address the above concerns before it is introduced. Our support for your Improved Medicare for All legislation will depend upon whether or not it will serve as a companion to HR 676. If it is, we are ready to work in our states to build political support for it. If the above concerns are not addressed, then your bill will not be a single payer Improved Medicare for All bill and we believe it will undermine the movement for HR 676.

We recognize that legislators tend to compromise from the start to build political support for legislation. This has served as a failed strategy because the final legislation is too weak to accomplish its goals. We suggest a different approach of beginning from a position of what is required to solve the healthcare crisis. We have organized for too long to concede from the start on these fundamental principles.

Signed,

Vanessa Beck, Health Over Profit for Everyone Steering Committee
Claudia Chaufan, MD, California Physicians for a National Health Program*
Andy Coates, MD, past president, Physicians for a National Health Program*
Dena Draskovich, Leader of Indivisible Omaha and disabled citizen*
Margaret Flowers, MD, director of Health Over Profit for Everyone
Leslie Hartley Gise MD, Clinical Professor Psychiatry, University of Hawai’i*
Leigh Haynes, People’s Health Movement-USA*
Joseph Q Jarvis MD MSPH, Utah*
Stephen B. Kemble, MD, Physicians for a National Health Program advisory board, past president of Hawaii Medical Association*
Edgar A Lopez MD, FACS, member, Physicians for a National Health Program, Kentuckians for Single Payer*
Ethel Long-Scott, Women’s Economic Agenda Project (WEAP)*
Eric Naumburg, MD, co-chair Maryland chapter of Physicians for a National Health Program*
Carol Paris, MD, president, Physicians for a National Health Program*
George Pauk, MD
Julie Keller Pease, MD, Topsham, Maine
Julia Robinson, MD, People’s Health Movement-USA*
Anne Scheetz, MD, Illinois Single-Payer Coalition, Physicians for a National Health Program and steering committee of Health Over Profit for Everyone*
Mariel Scheinberg, OMS 4, Rowan University School of Osteopathic Medicine*
Lee Stanfield, Health Over Profit for Everyone Steering Committee and Single Payer Tucson NOW*
Bruce Trigg, MD, Public Health and Addiction Consultant
John V. Walsh, MD, California Physicians for a National Health Program*
Robert Zarr, MD, past president, Physicians for a National Health Program*
Kevin Zeese, co-director of Popular Resistance

*For identification purposes only.

• First published at Health over Profit

Response to Nation Article on Single Payer: Improved Medicare for All is the Solution

On August 2, 2017, The Nation published an article by Joshua Holland, “Medicare for All isn’t the Solution for Universal Health Care,” chastising Improved Medicare for All supporters because, in his view, the single payer movement has “failed to grapple with the difficulties of transitioning to a single-payer system.” The article, which doesn’t quote anyone involved in the movement for Improved Medicare for All, begs a response because it shows what liberals opposed to single payer believe. Holland dredges up the same arguments used to keep single payer off the table during the creation of the Affordable Care Act (ACA). He even dusted off a few that were used to try to stop Medicare from coming into existence in the 1960s. And then he attempts to distract single payer supporters away from supporting Improved Medicare for All and settling for something less, as was done successfully in 2009.

The first error that Holland makes is confusing the term “Medicare for All” as meaning that advocates would simply take the current Medicare system, with both traditional and ‘Advantage’ plans, and expand that. This is why it is important to use the phrase “Improved Medicare for All.” As outlined in HR 676: The Expanded and Improved Medicare for All Act, the new system would be based on the current Medicare system, which is already national, but it would be a single public plan that is comprehensive in coverage and does not have out-of-pocket costs or caps. It would ban investor-owned facilities and ban private insurers from selling policies that duplicate what the system covers. A single system is the simplest for patients and health professionals because there is one transparent set of rules.

Most people who purchase health insurance have no idea which plan is best for them because nobody can anticipate what their healthcare needs will be in the future. A study of the Massachusetts health exchange plans done by the Center for American Progress showed that some plans were best for patients with cancer and other plans were best for people with heart disease or diabetes, but that isn’t something that can be advertised up front. Even if it were, people can’t predict if they will be diagnosed with cancer, heart disease or diabetes in the future. HR 676: The Expanded and Improved Medicare for All Act solves this problem by creating a single public plan designed to cover whatever our healthcare needs will be.

A second error that Holland makes is saying that HR 676 calls for the new system to start within a single year. The bill will take effect “on the first day of the first year that begins more than [emphasis added] 1 year after the date of the enactment of this Act.” This means that if HR 676 were to be signed by the President in July of 2018, then it would take effect in January of 2020. Holland raises the concern that we can’t move the whole country into the new Improved Medicare for All system that quickly. In fact, HR 676 has transition periods for the Veteran’s Administration, the Indian Health Service, displaced workers and buying out for-profit health providers.

When Medicare was enacted in 1965, more than 50% of seniors were uninsured and the rest had some form of health insurance. Without computers and without a national health system in place, all 19 million seniors were enrolled in the first year (almost twice as many as were enrolled in the ACA in the first four years). At present, the United States has Medicare infrastructure in place and all practicing health professionals have a National Provider Identifier issued to them by the Centers for Medicare and Medicaid Services (CMS). When the new Improved Medicare for All system takes effect, enrollment will be very simple because there is only one plan that is universal and paid for up front though taxes. All health professionals will be in it. Every person could be sent a card, much as CMS does now for people who are turning 65. For those who do not receive a card, HR 676 has a solution – when they present for care at a health facility, they are assumed to be in the system, are treated first and then are enrolled in the system afterwards.

Next, Holland brings up the same arguments used to prevent universal health care attempts in the past. He states that people don’t want to give up what they have. This is called ‘loss aversion.’ It is a task of the single payer movement to build the public support for Improved Medicare for All necessary to overcome any potential loss aversion. Public figures and elected officials can play a role in building support as well.

Holland raises concerns that employers and seniors won’t want to give up their private plans, but that is based on his mistaken belief that Improved Medicare for All will be the same as current Medicare. The reality is that people will be less worried about giving up what they have if they know that it will be replaced with something better and that they will no longer fear losing their doctor as they will all be in the new system. Improved Medicare for All will provide more comprehensive benefits, no out-of-pocket costs and an unrestricted network of health professionals from which to choose. Employers will no longer be burdened with the high costs of health insurance. People with pre-existing health conditions will no longer worry about losing coverage or having to pay more. Unions and employers can offer supplemental plans for extras not covered by the new system, as is done in countries like France, if they choose to do so.

Holland also raises the concern that people will lose their doctor because they will opt out of the system due to low reimbursements. We are already losing doctors because of the current system. Physician burnout was listed as the second biggest concern by the Surgeon General last year. Under Improved Medicare for All, all health professionals will be in the system. There won’t be any place to opt out to. And why would they want to? Health professionals will save tens of thousands of dollars each year on billing and won’t have to worry about whether a patient has insurance or not. They can see anyone who calls for an appointment. And they will have a system with which to negotiate fair reimbursement. Private health insurance doesn’t negotiate with physicians and hospitals. Each year they make an offer and providers can either basically take it or leave it. Doctors in single payer systems that spend much less per capita than the United States are paid well, so the US can certainly afford to reimburse doctors adequately.

Every transformative change has suffered from loss aversion, but that hasn’t stopped them. When Medicare was enacted, it was called socialized medicine, a government intrusion that would take away people’s choices and freedom and become an opening to government control over our lives. The scare tactics didn’t work and Medicare is one of the most popular parts of our current healthcare system. Desegregation, women’s rights, workers’ rights and more were great changes that were successful and we are a better society for them. Why is the right to health care any different?

Finally, Holland dives into the myth that we can’t afford Improved Medicare for All because it will be too expensive. My first response when I hear this is that the same excuse wasn’t made when we spent $16 trillion to bail out the banks in 2008 and is never made when we invade another country, so why is it raised when it comes to one of the most basic necessities a society can have? The United States has the highest wealth and the highest wealth inequality of industrialized nations. The new “Commitment to Reducing Inequality Index” recommends social spending on education, health and other basic social protections as its top priority. Congress can appropriate the funds to do this. This should be a top priority in the United States as well.

The reality is that the United States is already spending the most on health care per person each year because the market has failed to control costs. That is exactly why we need a single payer system like National Improved Medicare for All. It is the only way to simplify the bloated bureaucracy of the current healthcare system, which would save around $500 billion each year, and to control the costs of medical procedures, medical devices and pharmaceuticals by having a single system that can negotiate fair prices. In addition to the bureaucracy created by a multi-payer system, the US subsidized the insurance industry with more than $300 billion last year. A system based on health, rather than profits for investors, can identify and prioritize our greatest health needs and work to address them.

For example, the US is failing when it comes to care for people with chronic diseases. There are numerous reasons why this is occurring – lack of access to consistent care, inability to afford medications, insufficient time for health education when patients see a health professional, cheap and highly processed food, environmental pollutants and more. An actual health system could take meaningful action to address these issues, and keep people healthier. Think about it: people with high blood pressure or diabetes in the US may not be able to see the doctor regularly or stay on their medicines due to cost, but when they suffer a stroke or kidney failure, and need long term care or dialysis, then they can receive disability benefits and Medicare. How much better and less expensive would it be for everyone to prevent strokes and kidney failure in the first place?

Just as many ‘progressive’ groups did during the health reform process that resulted in the ACA, Holland works to convince us that we don’t need a single payer system, and that we can work with the current system. Once again, Jacob Hacker, a leading advocate for the ACA and single payer opponent, is invoked and we are told that we can add a Medicare buy-in or another form of a public option. We are told that other countries use private insurance, so why can’t we? The Democrats, beholden to the medical industrial complex, want us to believe these false non-solutions that protect the insurance industry. It feels like 2009 all over again.

Rather than go through all of the reasons why these approaches will fail, I urge you to read articles on that topic posted on HealthOverProfit.org (Click here for a list of them). Instead, I refer to a saying used by my now-deceased mentor Dr. Quentin Young: “You can’t cross an abyss in two jumps.” The only way we can get to a universal single payer healthcare system in the United States is by creating a universal single payer healthcare system in the United States. Anything less than that will fail because it will not achieve the savings on administration and prices needed to cover everyone and it will not compete with the powerful private insurance industry.

Throughout time, every great social movement has been told that it was asking for too much. Advocates for worker’s rights, women’s rights, civil rights, etc., were labelled as unreasonable radicals wishing for some pie-in-the-sky change that can’t be achieved. Holland is doing the same to the single payer movement. Don’t fall for it. We have the resources in the US to have one of the top healthcare systems in the world. We have health policy experts who have helped to design excellent systems for other countries. Single payer is a proven solution, unlike the plans being proposed by the Democratic leadership.

One thing that Holland and I do agree on is that there is more than one way to skin a cat, so to speak. We could have an excellent national debate about which type of single payer healthcare system we support – a fully socialized system like the Veteran’s Health Administration, a national health service, or a socialized payer with multiple types of providers as in the Expanded and Improved Medicare for all Act. At the basis of our discussion must be the principles that every person in the US deserves high quality health care without financial barriers.

•  First published in Health Over Profit