Take it from an economist, Medicare for All is the most sensible way to fix health care
Gerald Friedman, Opinion contributor, April 8, 2019
I’ve spent decades studying US health care. Time to get real: Medicare for All is the only reasonable path to controlling costs and covering everyone.
There is an instinct among political pundits to confuse caution for practicality — an assumption that those who advocate for incremental change are being reasonable, while those pushing for bold reforms aren’t. This is seen most starkly in the debate around health care reform, despite the fact that the “practical” pushers of limited reform fail to address the real problems in our health care system.
In early March, University of Louisville medical students Mallika Sabharwal and Sarah Parker traveled to New York City to participate in the annual meeting sponsored by Students for a National Health Program (SNaHP). Parker is the current president of the SNaHP Chapter at ULSOM, and Sabharwal is the immediate past president. There are currently 67 chapters of the organization at medical schools across the country where a new generation of physicians are working
to win national single payer health care, a greatly improved Medicare for all. SNaHP is the student affiliate of Physicians for a National Health Program.
On Monday, March 18, 2019, Kentuckians for Single Payer Health Care staffed a table at the Breaking Barriers Annual Awards Ceremony of the Metropolitan Disability Coalition. Marcellus Mayes, MDC President, delivered opening remarks. Keynote speaker Pamala Bryant told her uplifting story of overcoming lupus to graduate from New York University and go forward to an acting career and to helping others to achieve. Grace Smith, Donna Fox, Larry Breeden, Matthew Kuhl,
Elisha Smith, William “Bill” Titus, Jr., Barbara Sexton Smith, Mary “Katie” Telek, Krista Riley, Lauren Niemann, D’Angelina McMillan, Amosi Bilombele, and Ella Robinson received awards.
Antonio Wickliffe, Jill Harmer, Charlie Casper, Christine Perlin and Kay Tillow spoke about single payer health care with the participants in the hour before the awards ceremony began.
Mary Downing, who stopped by the KSPH table, volunteered to march for single payer even though she said she would have to use a wheel chair. She said that she is an activist from the 60’s and knows how important it is to demonstrate for what you believe in.
Antonio Wickliffe, a member of MDC and a member of the KSPH Steering Committee, organized the single payer participation.
by Jessica Geddes, University of Kentucky College of Medicine student
On Monday, February 25, 2019, medical students Jessica Geddes and Patrick Osterhaus, members of the Programming Committee of the American Medical Association Chapter at the University of Kentucky College of Medicine, held a panel discussion about Single Payer Healthcare for medical students. The guests included Kentucky State Senator Reggie Thomas, J.D., Dr. Ewell Scott, M.D., and Dr. Glen Mays, Ph.D. in Health Policy and Administration. Senator Thomas is a member of the Democratic Party, and earned a law degree from Harvard Law School in 1978. Dr. Scott earned his medical degree from Case Western Reserve University Medical School in 1966, and recently retired after practicing Internal Medicine in Morehead for over 40 years.
Dr. Mays is the Scutchfield Endowed Professor of Health Services and Systems Research at UK; he earned is undergraduate degree in Political Science from Brown University, and completed both an MPH and PhD in Health Policy and Administration at the University of North Carolina-Chapel Hill before completing a postdoctoral Fellowship in Health Economics at Harvard Medical School.
All panel members agreed that a Single Payer system would effectively lower hospitals’ overhead costs without changing physician salaries very much, but had different ideas of how best to implement such a system. Dr. Scott was in favor of a fast implementation of a Single Payer System, pointing to Taiwan as an example, where a complete healthcare overhaul was achieved in 1995. He said, “our country needs to get over our fear of socialism,” in order to improve healthcare for citizens.
On the other hand, Senator Reggie Thomas advocated for a more gradual approach, suggesting that a good first step would be lowering the age of Medicare eligibility to 55 (from 65), then 45 and so on. He expressed concern over transitioning to single payer too quickly, saying “I don’t want to set something up to fail.” Senator Thomas gave the example of the Affordable Care Act, which was less revolutionary yet faced major opposition and barely passed in 2010 even after several compromises. He also explained one major obstacle to implementing a Single Payer system — lobbying from private insurance companies.
Dr. Mays weighed in on the financial aspects of both methods — he described the shock that would occur due to federal budget increases if Single Payer were to be implemented quickly, and the difficulty that would arise with setting prices for medical services under a Single Payer model. He explained that we would have to trust the federal government to decide payments, but in doing so we risk setting prices too low and causing hospitals to go out of business. He brought up the idea of having private insurance companies coexist with a Medicare for all system, similar to Medicare Advantage Plans today, but other panelists pushed back against this approach. He said we should keep an eye on states such as Maryland, which has been experimenting with an all-payer global budget program, and California, whose state government has been considering implementing a similar program.
On February 10, 2019, Louisville’s justice community gathered to celebrate and honor the life of Tom Moffett. Rhody Streeter made videos of some who worked closely with Tom, and those videos are available here.
Louisville Magazine did an in-depth article on Tom. That is available here.
Kentuckians for Single Payer Health Care is grateful to Tom for the many years of work and inspiration that he gave generously to our movement.
On Saturday, February 16th, 2019, the American Medical Association Region 5 Medical Student Section held a conference at Indiana University School of Medicine in Indianapolis, Indiana. Among the many topics discussed, the anticipated highlights of the event included a healthcare systems debate of a single-payer vs. free market system.
In the near two-hour debate, panelists were asked to define problems with our current healthcare system and debate the effects their model would have on patient access, overall quality, and cost. Dr. Gramelspacher described the overwhelming sentiment of the panel and those in attendance in saying that “the U.S. is the best place in the world to get very sick, but it’s not a good place to stay healthy once you leave the hospital.” While both sides agreed that plethora of private and public 3rd party providers overcrowds the system, the faith in who can effectively reign in the system—a unified government or a sea of independent physician entrepreneurs—is at the core of this issue.
Dr. Kummar and proponents of a single-payer system highlighted the appeal of the bargaining power a single government sponsored insurance entity would have in negotiating pharmaceutical costs. They pointed to studies showing that this effect combined with fact that single-payer would dramatically lower administrative overhead, leading to an estimated saving of 500 billion dollars. Dr. Sinha was outspoken in his firm belief that “healthcare is a right” and that without this commitment to insuring everyone, our poorest citizens will continue to die without care.
Proponents of the free market system highlighted the role of a direct primary care model as a solution. In this system, a clinic would forgo any insurance and charge patients monthly fees for their services. Mr. Habig, whose company helps physicians start their own direct primary care practice, argued that the U.S. is currently far closer to a single-payer system than a free market. He and family medicine resident Dr. Schmale agreed that the only way to solve our healthcare crisis is through deregulation and increased competition. Habig noted that the ideal regulation of the system would be similar to the way current automotive companies are regulated today.
Students were very concerned with the ability of a free market to be driven to provide for poorer populations. As first year UofL medical student Hayley Moss stated, “For people like me who depend on Medicaid, even the lowest market price would be too much.” A poll of the student audience taken at the end of the debate showed that 88% percent supported a single payer system, while 12% supported a free market approach.
LOUISVILLE, KENTUCKY – A Memorial Celebration of the Life of Thomas F. Moffett will be held on Sunday, February 10, 2019 from 3:00 – 5:00 pm at First Unitarian Church, 809 South 4th Street, Louisville, KY. Tom was also known as “The Man in the Red Sweater” and was revered as a tireless Social Justice Activist and advocate for the rights of the underserved and disenfranchised https://www.louisville.com/content/man-in-the-red-sweater . Video presentations by Louisville Mayor Greg Fischer, Former Mayor Jerry Abramson, Activist Mattie Jones and other community leaders will be shown at the program. Sponsoring groups will have information tables and a reception and networking opportunity will follow. Music will be provided by Committed Choir.
Tom’s lifetime of tireless work for racial and social justice serves as a model for all of us. His impact was widely felt on causes ranging from anti-racism and police misconduct to health care and equity in the public schools. Co-sponsors including Kentuckians for Single Payer Health Care, Grace Hope Presbyterian Church, Park DuValle Community Health Center, Louisville Showing Up for Racial Justice (LSURJ), Louisville Chapter of the Fellowship of Reconciliation (FOR), Kentucky Alliance Against Racist and Political Repression, Fairness Campaign, and Human-Kind Productions are working diligently to plan a fitting memorial for Tom and looks forward to your involvement and support.
The Co-sponsors plan to develop a Thomas F. Moffett Social Justice Fund to support continued advocacy and activism by individuals and groups.
On Monday, January 28, 2019, medical students Sarah Parker, Eric Seroogy, and Karen Reynolds, leaders of the University of Louisville Students for a National Health Program (SNaHP), hosted a noontime panel discussion at the medical school.
Sarah Parker and Eric Seroogy posed the questions. Dr. Karen Berg told of a patient in her early 60’s who arrived with extremely advanced open, fungating breast cancer. When she asked the patient why she did not come in earlier, the woman replied that she did not have insurance, that she knew what this was but “All we have is our home–I wasn’t going to let my husband be homeless because of this.”
“This woman literally gave up her life because she didn’t want her husband to lose their only possession,” said Dr. Berg, adding that she favored an expanded Medicare for all or single payer system. She noted that currently the annual cost per physician is $100,000 just for dealing with the insurance companies.
Dr. Kodner spoke of the prior authorization required by Passport. Before they will pay
the physician must justify the treatment. “Quite a few times it’s maddening,” he said as he told of the challenges that confront doctors.
Dr. Casper spoke of the barriers that those without insurance or with inadequate insurance face. She told of a diabetic patient who worked in construction. When he could not pay for his insulin, his toe became infected and he lost the toe. With his big toe missing he did not have proper balance, so he lost his job and his insurance. When he lost the insurance, things got worse and his foot was amputated. He ended up unable to work at all and in a nursing home because he could not pay for the necessary drugs. “This is a moral issue but also does not make economic sense,” she said.
Dr. Tuckson said: “We have the VA and we know it works. Canada has their Medicare system and it works. England has a wonderful National Health Service.” He then responded to the accusation that single payer systems have long waiting times by saying “try seeing an endocrinologist in Louisville.”
He said that in the system we have “Walmart is going to come in and turn us all into clerks.”
Morgan McGarvey said that the Medicaid budget is set for the state of Kentucky and that there is not enough money in state government, but that he did not believe that we would ever get rid of private insurance. Dr. Kodner expressed the opinion that single payer will never happen here–the American mind set is wildly against it, he said.
Others did not agree.
Dr. Casper said that she believed that there was an appetite for single payer in the American public. She said that if
she did not have to spend so much time with insurance company requirements that she would have an increased ability to work with patients. “There is real movement towards a single payer system,” she said.
Dr. Berg said “our health care system is broken.” She knows of patients who have $9,000 deductibles. “The more people who see they cannot afford their care, the faster we will get to single payer. It is cost effective. This will happen in this country.”
The Kentucky Alliance Against Racist and Political Repression recently held their annual dinner at the Louisville Hotel. Kentuckians for Single Payer Health Care was there with an information table during the social hour, a full page ad in the journal, a brief opportunity to speak, and a single payer table. Several hundred gathered to celebrate the achievements of Louisville’s civil rights and social justice movements.
The 40 minute video of Dr. Margaret Flowers at the October 4, 2018, public event in Louisville is now available for viewing and sharing here.
KSPH thanks videographer Stephen Mattingly for making it and medical student and SNaHP President Sarah Parker for placing the video on youtube. The video can also be seen and shared from the KSPH facebook page.