Fwd: qotd: Single payer in the next presidential term?

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-------- Original Message --------
Subject: qotd: Single payer in the next presidential term?
Date: Fri, 25 Apr 2014 10:51:46 -0700
From: Don McCanne <don@mccanne.org>
To: Quote-of-the-Day <quote-of-the-day@mccanne.org>



Fox News Poll
April 13-15, 2014

14. I'm going to read a list of potential candidates for the 2016
Democratic nomination. Please tell me which one you would like to see as
the Democratic presidential nominee.

69% Hillary Clinton
14% Joe Biden
6% Elizabeth Warren
2% Andrew Cuomo
1% Martin O'Malley
- (Other)
4% (None of the above)
3% (Don't know)

15. I'm going to read a list of potential candidates for the 2016
Republican nomination. Please tell me which one you would like to see as
the Republican presidential nominee.

15% Chris Christie
14% Jeb Bush
14% Rand Paul
9% Paul Ryan
8% Marco Rubio
7% Ted Cruz
5% Scott Walker
5% Rick Santorum
5% Rick Perry
2% Bobby Jindal
1% (Other)
6% (None of the above)
9% (Don't know)

http://www.foxnews.com/politics/interactive/2014/04/21/fox-news-poll-independents-more-likely-to-back-anti-obamacare-candidates/

****

California Medical Association
CMA Alert
April 21, 2014
Clinton urges move away from fee-for-service payment model; says current
system is not serving physicians, or patients, well

Former Secretary of State Hillary Rodham Clinton addressed 700
physicians, practice managers, medical students and others at the
Western Health Care Leadership Academy in San Diego. Delivering the
keynote address live via satellite, Secretary Clinton urged the
California Medical Association to work with other like-minded
organizations to help advance meaningful health care delivery and
payment reform, instead of continuing to "rejigger" a broken system.

"At some point, we have to move away from fee for service payment for
medical care," said Secretary Clinton. "It is not serving physicians
well, or any other health care providers, and I don't believe it's
serving patients well."

Secretary Clinton told attendees that she shares physicians' frustration
with Congress's inability to make any progress on fixing the current
broken payment system. She said she would like to see more systemic
reform so that physicians are fully reimbursed for everything that goes
into the care of patients. "It is deeply bothersome to me that it is
still not accepted that a lot of what constitutes wellness—things that a
physician can be promoting with his or her patients—should be reimbursed
by Medicare," Clinton said. "When a physician sits down with a patient
and says 'I'm going to give you a nutrition regimen. I'm going to have
my nurse or my PA check in on you to make sure that you're walking every
day.' These are all things that would keep that patient out of the
operating room for a bypass or a stent or some other expensive
intervention."

"We're never going to resolve the injustice, the unpredictability, the
unfairness that unfortunately permeates the current system," she said.
"We need to move away from this very narrow approach to reimbursing
physicians."

"At some point, I hope we're going to be able to take a look at the
broad base of funding streams, both public and private, that go into
funding health care–particularly physicians' pay—and look more at who
the patient is and what the doctor is providing that patient, instead of
what the program is and how we can keep trying to put square pegs in a
round hole."

Secretary Clinton also held up California's implementation of the
Affordable Care Act as a model for the nation. "We're going to be
watching closely what happens in California. Seeing what works, and what
doesn't. States like California, intent on covering more citizens and
fostering bold experimentation to improve outcomes and reduce costs,
will not only lead the way, but help everyone else find the way."

Secretary Clinton also urged all stakeholders to work together to keep
pushing for improvements to the health care system. "The transparency
called for under the Affordable Care act is going to reveal a lot of
information. Some of it may be surprising. And some of it may even be
quite troubling," said Clinton. "But for the first time, we're going to
see information. And everyone will be able to look at the same
information. We can then try and figure out 'Is there a problem that
needs to be fixed?'"

The data collected under the Affordable Care act will, according to
Clinton, will allow us to ask questions that will give us much better
insight into how we can move towards a more efficient, quality driven
health care system.

"I think this is a great opportunity, if we do it with that kind of open
attitude of 'let's learn what works, let's make this better.' Let's hear
from physicians and nurses and pharmacists, you name it. Everyone come
to the table. What do you think needs to be changed?"

http://www.cmanet.org/cma-alert/archives/april-21-2014/#11

****

PNHP California
April 9, 2014
Position Statement on the Affordable Care Act (ACA)

Excerpt:

Recognizing that we share core principles with those who worked hard to
implement the ACA, including the desire for a healthcare system that is
truly universal, affordable and provides comprehensive benefits with one
standard of high quality care, we resolve to:

• Build bridges to ACA supporters to forge strong alliances for
continued reform.

• Work with our partners towards the successful implementation of ACA
and to find solutions for the 3-4 million Californians who are still
left out of the system, including the undocumented.

• Support efforts to provide healthcare as a basic human right rather
than a commodity available only to those who can afford it.

http://pnhpcalifornia.org/2014/04/news-article-pnhp-california-aca-position-paper/

****


Comment by Don McCanne

Considering the difficulty that President Obama has experienced in
passing and then implementing the Affordable Care Act (ACA), it is clear
that he is in no position to advocate for single payer reform before he
leaves office. Thus it seems reasonable to consider the prospects of
enacting single payer reform during the term of our next president. What
are the prospects?

As people gain more experience with the ACA reforms, it is likely that
many will be disappointed. The marketplace (exchange) plans that most
people are selecting have relatively low actuarial values with high
deductibles, thus many will experience financial hardship should they
have significant health care needs. Also many will be disappointed with
the narrow provider networks which will often prevent patients from
having their choice of physicians and hospitals. Since employers are now
adopting some of these same insurance innovations, many who previously
were satisfied with their employer-sponsored coverage may also become
much less content with their coverage.

It is thought that, by 2017, enough people will have become dissatisfied
with our high-cost, administratively inefficient, dysfunctional system
that many of them will be ready for an improved Medicare for all. That
happens to be the year that our next president will take office. Will we
have a president who is willing to support a vastly superior alternative
- a single payer national health program?

Obviously we cannot predict the results of a presidential election this
far in advance, but we can take a look at the political climate - a
climate which is unlikely to change dramatically in the next few years.

Looking at the Fox poll and other recent polls, the clear front runner
is Hillary Clinton. Although it is possible that the Republican Party
could rally around a candidate that would be a serious challenge to
Clinton, currently she outpolls each of the Republicans under consideration.

Suppose Hillary Clinton were elected president, what could single payer
advocates expect? The report on her speech to physicians in California
is reproduced above in its entirety, mainly to show what was left out of
her message. There is certainly no mention of single payer nor expanding
Medicare. She does mention moving away from fee-for-service payments,
and expanding payments for "wellness-things," while holding up
California's implementation of ACA as a "model for the nation." She also
touted information transparency. In her last run for the presidential
nomination she had displaced her previous failed proposal with the
current ACA model. Based on her comments, it is highly likely that her
efforts at reform would be limited refinement of the ACA model, if she
can get past the crippling partisan divide in Congress.

Should a Republican be elected, it is likely that efforts would be
directed to replacing some elements of ACA with policies supporting less
regulation of insurance products, limitation of mandates, and ability of
individuals to purchase insurance products in less regulated states. No
serious potential Republican candidate supports single payer.

So, no single payer will be coming from the top. Then what can we do? We
should intensify our efforts to educate the public at large - so they
understand why ACA does not seem to be working well for them, while
showing them how single payer is precisely the model we need. We need to
create a critical threshold of support coming from the general public.
If the demand is intense enough, the politicians will follow.

But a caveat. The single payer message must be loud and clear. People
must understand that the ACA model is fundamentally flawed and must be
superseded by a single payer system. Many single payer supporters
abandoned the cause and chose to support the "progressive" alternative -
Obamacare. They continue to be involved in the implementation of this
highly flawed model (better than nothing but still highly flawed).
Fortunately, there are still organizations, such as PNHP, that are not
willing to compromise and dilute the single payer message. Doing so
would merely continue us down the incremental path of reform, when there
are no incremental steps that bridge the gap between a fragmented system
of private and public payers and a single payer system.

PNHP California has adopted a position statement calling for "work(ing)
with our partners towards the successful implementation of ACA." Most of
the progressive community is already engaged in supporting ACA, and they
really do not need more help. Muddling the message of the single payer
purists that remain can only perpetuate inertia in the single payer
movement. Some sincerely believe that helping the ACA supporters will
result in reciprocal support for our efforts on single payer. Really?
They are going to help us disassemble a system that they worked so hard
on to build?

Let's not adulterate our single payer message.