In an Aging Nation, Single-Payer Is the Alternative to Dying Under Austerity

Wednesday, June 14, 2017
By Mike Ludwig, Truthout | Report

(Photo: Maxlkt;Edited: LW/TO)

This piece is part of Fighting for Our Lives: The Movement for Medicare for All, a Truthout original series.

Every day about 10,000 people turn 65 in the United States, and the number of people over the age of 85 will more than triple by 2050. As a result, the demand for long-term health care services and end-of-life care will surge in the coming decades, increasing pressure on a system that is already suffering from high costs and workforce shortages. Unless policymakers make serious changes to how we fund and operate the health care system, the process of confronting chronic illness and death in the United States could become increasingly expensive and difficult for everyone but the very wealthy.

This isn't just bad news for the aging baby boomer generation, which is expected to increase the number of people over the age of 65 in the US from 48 million to 88 million by 2050. In the decades to come, many millennials may find themselves navigating the current health care system's complicated mix of government benefits, out-of-pocket costs and private insurance offerings with their elderly parents.

Fighting for Our Lives: The Movement for Medicare for All Meanwhile, the Republican plan to repeal the Affordable Care Act (ACA) that passed the House last month would gut ACA provisions that kept insurance companies from gouging older customers and cut $839 billion from Medicaid over the next decade. The bill would increase private insurance rates for older people with lower incomes and leave 5.1 million people between the ages of 50 and 65 without insurance by 2026, according to the Kaiser Family Foundation. Despite the popular misconception that Medicare covers all of seniors' health care needs, millions of Americans over 65 are also enrolled in Medicaid. Elderly people would certainly suffer if the program saw deep cuts.

The proposed cuts to Medicaid are generally unpopular, and the Republican House bill has slumped in the polls. The repeal effort has recently stalled in the Senate due to deep divisions among Republicans. However, reports now indicate that Senate Majority Leader Mitch McConnell has been hammering out a compromise on Medicaid behind closed doors, with the goal of holding a vote on a Senate repeal package before a July 4 recess. A repeal is not a given, but it will take a sustained push from those who value affordable health care for low-income and working families to prevent a repeal while the GOP has a majority in Congress.

Amid this crucial resistance, a renewed push has also emerged for the creation of something different: a single-payer system. A House bill for a "Medicare for All" health plan has more co-sponsors than ever among progressive Democrats, and grassroots activists are rolling out campaigns across the country. When it comes to the issue of how to best serve elderly patients, advocates say guaranteeing health coverage for everyone would help prepare the system for an aging nation.

Medicaid and Elderly Americans

"The profit-seeking in end-of-life care is the real problem, and we could get rid of it," said Dr. Andy Coates, an assistant professor of internal medicine and psychiatry at Albany Medical College in New York and a member of Physicians for a National Health Program (PNHP), the group of doctors and reformers backing single-payer legislation in Congress.

Coates told Truthout that many patients facing terminal conditions receive "palliative care," which focuses on treating symptoms of serious illnesses, and then "hospice care" at the very end of life. Palliative specialists consider difficult questions posed by life-threatening illness: What treatments may be necessary or desirable, and what treatments would a patient want to avoid even if they could prolong life? How is the patient managing pain? What does the patient still need to get done in life before they die? Palliative specialists focus on both symptom management and psychological wellbeing.

New strategies for delivering care and reforms to Medicare under the ACA show promise for lowering costs and improving palliative and hospice care by empowering patients to take greater control of their medical decisions. Yet patients with chronic and life-threatening conditions are still bounced between providers and experience high rates of expensive and preventable hospitalizations....



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Single-Payer Is Within Reach: What You Need to Know About the Bill for Improved Medicare for All

Wednesday, June 14, 2017
By Margaret Flowers, Truthout | Op-Ed

(Photo: United Workers)

This piece is part of Fighting for Our Lives: The Movement for Medicare for All, a Truthout original series.

As Republicans come under pressure from the White House to complete the process of repealing and replacing the Affordable Care Act (ACA) so they can move on to other priorities, they are finding that this is one campaign promise that is very difficult to keep. The House version of their American Health Care Act (AHCA) has been so heavily criticized that even President Trump says it is too harsh. Republican Senators are currently negotiating their version in secret to avoid too much scrutiny. So far, the Republicans are far from reaching consensus on how to proceed. The people of the United States, on the other hand, are clear on the solution to the health care crisis that they support and are organizing from coast to coast to make it a reality.

The public demand for a National Improved Medicare for All single-payer health care system in the United States is stronger than it has been in decades. The failures of the ACA to cover everyone and control rising health care costs, combined with the threat of the AHCA, which would add at least 23 million more people to the 29 million currently uninsured and further erode the quality of health insurance, have made it clear that we can't continue with the current health care system. This brings to mind a quote by Winston Churchill: "You can always count on Americans to do the right thing -- after they've tried everything else."

All other industrialized nations have some form of publicly funded universal health care system. Many of them are national insurance systems like our Medicare. Some, like the systems in Canada and Taiwan, are actually modeled on US Medicare. Most of them spend half as much on health care (per person per year) as the United States, and they have better health outcomes. No country has adopted a universal health care system and then gone back to its previous system. They have learned that when a system is universal, it is of higher quality precisely because every person has a stake in making it the best it can be.

Fighting for Our Lives: The Movement for Medicare for All People from across the political spectrum are expressing support for a single-payer health care system in the US, from conservatives like Charles Krauthammer to business leaders, such as Warren Buffett and Charlie Munger, to Senator Bernie Sanders. Given the failure of commercial media to cover single payer fairly, if at all, and given many Democrats' attempts to obfuscate it with a public option, there is confusion about exactly what a national improved Medicare for All system is and what it isn't. So, here is a primer on the basics of the single-payer health care system envisioned in Rep. John Conyers' bill, HR 676: The Expanded and Improved Medicare for All Act, which now has more cosponsors than ever before

National Improved Medicare for All

National Improved Medicare for All (NIMA) is a universal publicly financed health care system. Here are the core elements:

1. National: Every person living in the United States and its territories -- including every health professional -- is in the system. No matter where people travel domestically, they are in the system. No one has to worry about going "out of network" because it is one giant network. This also means that if there is a medical center that specializes in a particular condition, patients can go there if they need to -- no matter where they live.

Including everyone in one giant risk pool spreads the risk widely so that no particular state is burdened more heavily than others with covering the cost of care for its residents. In the US, 20 percent of the population has high health needs, using 80 percent of our health care dollars. Fifty percent of the population is healthy, using only 3 percent of our health care dollars. However, any of us can become one of those in the top 20 percent if we have a serious accident or illness. Having a national system gives us the security of knowing that it is there for us when and if we need it. And including everyone increases the likelihood of preventing and controlling epidemics of infectious diseases.

2. Improved: This plan is an improvement over Medicare -- not simply an expansion of our current Medicare system. First, it is more comprehensive than current Medicare and includes all medically necessary care, such as mental health, dental, vision, hearing, rehabilitative and long-term care, medications and medical devices. Current Medicare excludes long-term care, so seniors are forced to spend down their assets before they qualify under Medicaid for long-term care. That would no longer be the case under National Improved Medicare for All. Moreover, the question of what is "medically necessary care" would be answered by patients and their health professionals without interference from health insurers who are more concerned with profits than the health of their enrollees.

Second, because the improved Medicare for All plan is comprehensive, supplemental health insurance would not be necessary, and would not be permitted to duplicate what is covered by the health care system. This is important for maintaining a high standard of quality: There should not be a private system for the wealthy and a public system for the rest of us....


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Rush Holt - Time For Single Payer Health Care System

"This state of affairs is nonsensical, morally reprehensible, and financially wasteful. The fact is, there is a proven, effective way to hold down the cost of health care – a method embraced by many nations throughout the world, and a method that the United States has already implemented successfully for our senior citizens through Medicare. That method is simple: single-payer, universal health care.

I have long supported Medicare for all, and I will fight in the Senate to advance the day when America has truly universal access to health care." -  Rush Holt

Healthcare: Change the Debate Support a Real Public Option

Hat tip goes to Blue Jersey for beating me to the posting of the following article I saw on the Daily Kos Thursday but didn't have time to post myself:

by Dennis Kucinich
Wed Jul 15, 2009 at 08:38:08 PM PDT

Dear Friends,

In mid-May, in an effort to reach consensus, President Obama secured a deal with the health insurance companies to trim 1.5% of their costs each year for ten years saving a total of $2 trillion dollars, which would be reprogrammed into healthcare. Just two days after the announcement at the White House the insurance companies reneged on the deal which was designed to protect and increase their revenue at least 35%

The insurance companies reneged on the deal because they refuse any restraint on increasing premiums, copays and deductibles - core to their profits. No wonder a recent USA Today poll found that only four percent of Americans trust insurance companies. This is within the margin of error, which means it is possible that NO ONE TRUSTS insurance companies.

Then why does Congress trust the insurance companies? Yesterday HR 3200 "America's Affordable Health Choices Act," a 1000 page bill was delivered to members. The title of the bill raises a question: "Affordable" for whom?.

Of $2.4 trillion spent annually for health care in America, fully $800 billion goes for the activities of the for-profit insurer-based system. This means one of every three health care dollars is siphoned off for corporate profits, stock options, executive salaries, advertising, marketing and the cost of paper work, (which can be anywhere between 15 - 35% in the private sector as compared to Medicare, the single payer plan which has only 3% administrative costs).

50 million Americans are uninsured and another 50 million are under insured while for-profit insurance companies divert precious health care dollars to non-health care purposes. Eliminate the for-profit health care system and its extraordinary overhead, put the money into healthcare and everyone will be covered, everyone will be able to afford health care.

Today three committees will begin marking up and amending HR3200. In this, one of the most momentous public policy debates in the past 70 years, single payer, the only viable "public option," the one that makes sound business sense, controls costs and covers everyone was taken off the table.

In contrast to HR3200 ... HR676 calls for a universal single-payer health care system in the United States, Medicare for All. It has over 85 co-sponsors in Congress with the support of millions of Americans and countless physicians and nurses. How does HR-676 control costs and cover everyone? It cuts out the for-profit middle men and delivers care directly to consumers and Medicare acts as the single payer of bills. It also recognizes that under the current system for-profit insurance companies make money NOT providing health care.

This week is the time to break the hold which the insurance companies have on our political process. Tell Congress to stand up to the insurance companies. Ask members to sign on to the only real public option, HR 676, a single-payer healthcare system.

Hundreds of local labor unions, thousands of physicians and millions of Americans are standing behind us. With a draft of HR3200 now circulating, It is up to each and every one of us to organize and rally for the cause of single-payer healthcare. Change the debate. Now is the time.

The time to act is now!

Sincerely Yours,

Dennis Kucinich
United States Congressman

Contact us at feedback@kucinich.us or visit us online at www.kucinich.us