Tuesday, June 30, 2015

qotd: Did you miss the important PNHP statement on the King v. Burwell decision?

Physicians for a National Health Program
June 25, 2015
'Subsidies upheld, but health needs still unmet': doctors group

Although the Supreme Court has upheld the premium subsidies under the
Affordable Care Act, the law remains incapable of remedying the U.S.
health crisis, physician group says

Physicians for a National Health Program, an organization of 19,000
doctors who support single-payer national health insurance, released the
following statement today:

Today's decision by the Supreme Court in King v. Burwell to uphold the
Affordable Care Act's premium subsidies in about three dozen states will
spare more than 6 million Americans the health and financial harms
associated with the sudden loss of health insurance coverage.

For that reason alone the decision must be welcomed: Having health
insurance is better than not having coverage, as several research
studies have shown.

That said, the suffering that many Americans are experiencing today
under our current health care arrangements is intolerable, with
approximately 35 million people remaining uninsured, a comparable number
underinsured, and rapidly growing barriers to medical care in the form
of rising premiums, copayments, coinsurance and deductibles, and
narrowing networks.

The unfortunate reality is that the ACA, despite its modest benefits, is
not a remedy to our health care crisis: (1) it will not achieve
universal coverage, as it will still leave at least 27 million uninsured
in 2025, (2) it will not make health care affordable to Americans with
insurance, because of high copays, deductibles and gaps in coverage that
leave patients vulnerable to financial ruin in the event of serious
illness, and (3) it will not control costs.

Why is this so? Because the ACA perpetuates a dominant role for the
private insurance industry. Each year, that industry siphons off
hundreds of billions of health care dollars for overhead, profit and the
paperwork it demands from doctors and hospitals; denies care in order to
increase insurers' bottom line; and obstructs any serious effort to
control costs.

In contrast, a single-payer system – an improved Medicare for All –
would achieve truly universal care, affordability, and effective cost
control. It would put the interests of our patients – and our nation's
health – first.

Single payer is simple: everyone in the U.S. would be covered for all
medically necessary care in a single program financed by equitable taxes.

By replacing multiple private insurers with a single, nonprofit agency
like Medicare that pays all medical bills, we would save approximately
$400 billion annually by slashing the administrative bloat in our
current private-insurance-based system. That money would be redirected
to clinical care. Copays, coinsurance and deductibles would be eliminated.

Further, such a single, streamlined system would be able to rein in
costs for medications and other supplies through the system's strong
bargaining clout – again, to our patients' benefit.

A single-payer system would also be legally robust.

Because of the ACA's administrative complexity and flaws – largely
reflecting its accommodation to the private health insurance industry
and other corporate, profit-oriented interests in U.S. health care – it
is particularly vulnerable to the kind of legal challenge we saw today.

Our patients, our people and our national economy cannot wait any longer
for an effective remedy to our health care woes. The stakes are too
high. We need to move beyond the administratively wasteful, complex and
inadequate ACA to a more fundamental, rational single-payer national
health program.

Contrary to the claims of those who say we are "unrealistic," a
single-payer system is within practical reach. The most rapid way to
achieve universal coverage would be to improve upon the existing
Medicare program – which is celebrating its 50th anniversary this year,
showing it has stood the test of time – and expand it to cover people of
all ages. There is legislation before Congress, notably H.R. 676, the
"Expanded and Improved Medicare for All Act," which would do precisely that.

What is truly unrealistic is believing that we can provide universal and
affordable health care in a system dominated by private insurers and Big

The American people desperately need a universal health system that
delivers comprehensive, equitable, compassionate and high-quality care,
with free choice of provider and no financial barriers to access. Polls
have repeatedly shown an improved Medicare for all, which meets these
criteria, is the remedy preferred by two-thirds of the population. A
solid majority of the medical profession now favors such an approach, as

We pledge to step up our work for the only equitable, financially
responsible and humane cure for our health care ills: single-payer
national health insurance, an expanded and improved Medicare for all.


Comment by Don McCanne

Before the release of the Supreme Court decision on King v. Burwell,
there was extensive speculation on the relatively narrow topic of what
would happen if some individuals lost their subsidies for purchasing
plans in the insurance exchanges. Following the decision supporting the
subsidies, much of the reporting has shifted to the view that the
Affordable Care Act (ACA) is here to stay; the inherent infrastructure
of ACA will guide further reform. Unfortunately, this framing of the
issues has diverted us from the conversation that we need to be having.

When considering what needed to be done, ACA fixed very little of our
health care financing system. This victory being celebrated now upheld
premium subsidies that will allow less than two percent of the
population to keep their ACA exchange plans - mostly low-actuarial-value
underinsurance plans. To characterize this as the make-or-break Supreme
Court decision for health care reform is entirely missing the essence of
an equitable health care financing system.

On the day that the Supreme Court decision was announced, a link to the
PNHP statement was included in the Quote of the Day message. That was
not enough. The PNHP statement does catch the essence of the problem and
thus is being distributed in full as today's message. It should be
shared widely with others since true health care equity is what the
nation now needs to be talking about.

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