Rep. Keith Ellison (D-Minn.) took lead sponsorship of H.R. 676, the Expanded and Improved Medicare for All Act

March 7, 2018

Physicians for a National Health Program
March 7, 2018

Earlier today, Rep. Keith Ellison (D-Minn.) took lead sponsorship of H.R. 676, the Expanded and Improved Medicare for All Act. This single-payer bill was modeled after a proposal originally crafted by PNHP that appeared in the Journal of the American Medical Association. H.R. 676 would improve Medicare’s benefits by covering all medically necessary care, eliminating copayments and deductibles, and expanding Medicare to cover everyone living in the U.S. The bill now has a record 121 co-sponsors, representing 63 percent of all House Democrats.

Universal health coverage has seen a surge in public support; a recent poll showed 92 percent of U.S. adults (including 82 percent of Republicans) believe that all Americans should have the right to affordable health care. While we celebrate the growing consensus around the goal of universal coverage, health justice advocates must educate policy makers and the public that how we pay for coverage matters; that a well-designed single-payer program like H.R. 676 is the only way to achieve the cost savings that will make universal coverage possible.

Is your representative a co-sponsor of H.R. 676? Check this list to find out. If your representative has not co-sponsored H.R. 676, call and email to express your support for the bill. If you have trouble locating contact information for your representative, you can always call the Capitol switchboard at (202) 224-3121.

Alternative proposals are deeply flawed

Lately, it seems that everyone has a plan for reinventing health care. Most promise political feasibility, but fall short of attaining both universal coverage and the long-term cost savings of single payer.

PNHP analyzed a recent proposal for universal coverage from the Center for American Progress (CAP), whose funders include profit-based health firms such as Blue Cross/Blue Shield, Express Scripts, Health Care Service Corporation, and their lobbying group, America’s Health Insurance Plans. Not surprisingly, CAP’s plan, called “Medicare Extra for All,” (sound familiar?) preserves a major role for private insurers and for-profit providers, which will inflate patient costs and severely limit the program’s ability to control national health care spending.

Here’s a side-by-side comparison showing how the elements of the CAP plan measure up to PNHP Physicans’ Proposal for single payer.

As incrementalist proposals increasingly borrow the language of the single payer movement, many of our friends and colleagues may not understand the important differences between the two. To cut through that noise, PNHP identified three major flaws in the CAP plan that would undermine the success of any national health plan:

  1. The CAP plan maintains a strong role for private insurance, which adds unmanageable cost and complexity to the health care system.
  2. Because it is a fragmented, multi-payer system, the CAP plan has no power to cut costs through national and regional health planning.
  3. The CAP plan includes significant patient cost sharing, which discourages care, drives up administrative costs, and would leave many middle-class families with worse coverage than they have now.

Download PNHP’s one-page handout for more details on CAP’s big three policy flaws.

The future of the single-payer movement

On Saturday, March 3, more than 100 students gathered in New Orleans for the 7th Annual Students for a National Health Program (SNaHP) Summit. After a keynote address from PNHP co-founder Dr. Steffie Woolhandler, students held workshops on topics such as “Single Payer 101,” speaking with health professional colleagues about Medicare for all, and civil disobedience.

Wearing their white coats and holding signs, the students held a lively “second line” parade for single payer that was covered by two local TV news outlets.

Thanks to everyone who made this event possible through your generous contributions to the Nick Skala Student Activist Fund. I look forward to sharing more highlights from the SNaHP Summit in our next email.

Carol A. Paris, M.D.

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TV Stations Follow John Oliver’s Lead in the Movement to Forgive Medical Debt

March 5, 2018

TV Stations Follow John Oliver’s

Lead in the Movement to Forgive Medical Debt

How former debt collectors showed everyone how to buy up people’s medical debt at pennies on the dollar.
John Oliver.jpg

John Oliver purchased nearly $15 million worth of debt for just under $60,000.

Photo by Jesse Dittmar for The Washington Post via Getty Images.

It has become an all-too-familiar sight—websites, posters, collection jars with photos of children, mothers, young people who need medical care they can’t afford. Some will not receive life-saving treatment without this help. All too often, the bills will saddle the family with a debt burden that will follow them for years—sometimes for life.

Getting sick, having a baby, or being injured can result in tens of thousands or even hundreds of thousands of dollars in bills, even for those with insurance. The debt is routinely sold to collection agencies for pennies on the dollar. There, it is packaged and sold, over and over. Interest accumulates on the original debt, so the amount owed by the patient increases although the amount a debt collection agency pays for the debt is small.

Jerry Ashton is working to change that. Ashton was a debt collector and consultant working in New York City when the Occupy movement erupted. He started showing up at Zuccotti Park, and when the discussion among the occupiers turned to debt, he spoke up, explaining the inside story of how debt and debt collection work. When Rolling Jubilee launched, he joined in.

Rolling Jubilee raised money to retire debt that is especially a burden on poor and working-class families, many of them people of color. Since debt could be purchased for pennies on the dollar, the $700,000 raised made it possible for this Occupy spin-off to retire nearly $32 million in debt by the end of 2013, according to the organization’s website.

What was it like to be in the business of forgiving debt instead of collecting it?

“It was a great pleasure,” Ashton told me when I interviewed him in late February. “First of all, the cause was right. It was just.”

In 2014, Ashton joined up with Craig Antico, who also worked in debt collections, to form RIP Medical Debt, a nonprofit organization, which focuses on buying and forgiving medical debt.

Their effort went slowly at first. “The first couple of years our wives were wondering why we were going into debt to get other people out of debt,” he said. “We were struggling.”

“If it had not been for John,” he said, “we would be standing on a street corner with a paper cup.”

Ashton is referring to John Oliver, who, on a June 2016 episode of HBO’s Last Week Tonight, did a scathing report on credit collection practices and the people targeted with repeated phone calls, calls to employers, garnishing wages, court cases, and so on.

It’s all too common an experience: About a third of Americans with credit were contacted by a debt collector or creditor within a year of a recent survey by the Consumer Finance Protection Bureau. Of those, more than half of people who were contacted about a past-due bill were contacted about a medical bill.


Oliver, after excoriating the medical debt system and the politicians who enable it, made an announcement. He had formed a collection agency of his own (which, he said, proves that a complete idiot can create a collections agency), and—with no credentials apart from a minimalist website—purchased nearly $15 million worth of debt for just under $60,000, less than half a cent on the dollar. This purchase entitled him to the names, current addresses, and social security numbers of those who owed the debt, even if the debt was so old it was called zombie debt. And with this information, he acquired the right to try to collect debt.

Debt packs a moral punch in our culture. Most people believe it should be paid, and many families struggle to pay off their debt. According to a 2017 Kaiser Permanente study, 73 percent of families struggling with medical bills cut spending on other household basics, 61 percent use up all or most of their savings, and 58 percent take on an additional job or work additional hours. Still, the size of the debt for some families dwarfs their ability to pay.

Oliver announced on the air that he would not attempt to collect on the debt he’d acquired. Instead, with great fanfare, he forgave it (and congratulated himself for an even bigger giveaway than Oprah’s famous in-studio car giveaway). He worked with RIP Medical Debt to make it happen.

Soon others, inspired by Oliver, contacted RIP Medical Debt. Some donated anonymously—some very publicly.

Last June, the Minnesota Nurses Association announced they had purchased the medical debt of 1,800 Minnesotan families worth $2.6 million via RIP Medical Debt, paying just $28,000 to collection brokers.

“We’d had many discussions about how to repay the community for what they gave nurses during the strike [in 2016 against Allina Health],” Mary Turner, the association president, said in a statement announcing the debt buy-out. “The John Oliver show inspired us, and we decided to see if we could do the same thing.”

We can work to make our homes, lives, and communities healthier.

There are others, too. Two Pensacola, Florida, high school juniors, Samir Boussarhane and Falen McClellan, formed the Pensacola Debt Sharks in September 2016 as a community service project, with the goal of retiring medical debt in northwest Florida. So far, according to their website, they have raised $28,000, enough to retire more than $2 million of debt.

Recently, network television stations have gotten involved. Just this month, KIRO-7 in Seattle spent $12,000 of station money to pay down $1 million in medical debt, mainly in the Puget Sound area, also via RIP Medical Debt. When they invited viewers to donate on the station’s website, supporters paid off another million in debt.

NBC-owned TV stations are buying up debt, too. This month, affiliate stations—including NBC 4 in Los Angeles and NBC 5 in Dallas-Forth Worth, Texas, are donating $150,000 to retire $15 million of medical debt. And they are encouraging viewers to join them in making donations for debt retirement.

Others are donating anonymously, Ashton said, and he expects the numbers to keep growing.

Apart from donating to organizations that buy and retire debt, there are things we can do in our own communities. Ashton believes many hospitals are falling short on the charity care they should be offering to low-income patients. We can query nonprofit hospitals in our area. We can call out medical practitioners who fail to offer charity care or make payment arrangements. We can work to make our homes, lives, and communities healthier.

And we can work to change a medical system that spends way more per capita than other high-income countries yet has worse outcomes, according to 2013 data from the Organization for Economic Cooperation and Development. California lawmakers are debating a single-payer system. The Bernie Sanders movement, Our Revolution, supports “Medicare for All,” as do 121 cosponsors of such a bill in the House and 16 in the Senate. And just in the last few days, the progressive think tank Center for American Progress moved closer to the Sanders position when it released a modified plan for Medicare for All.

Increasing numbers of insured Americans are finding it difficult to afford health care; the number increased substantially just from 2015 and 2017, according to a Kaiser Family Foundation survey. Our health care system should not be structured so people have to beg for money from family, friends, and strangers to get treatment. Medical debt should not exist. The path from Occupy to NBC-TV affiliates retiring medical debt shows that the impetus for change is spreading.

Universal primary care bill moves forward (in Vermont)

March 5, 2018


Universal primary care bill moves forward

Claire Ayer
Sen. Claire Ayer, chair of Senate Health and Welfare. Photo by Erin Mansfield/VTDigger

Legislators on Friday took a small but significant step toward establishing universal, publicly financed primary health care in Vermont.

The Senate Health and Welfare Committee unanimously approved S.53, which would set in motion several years of work toward creating a primary care system that would take effect in 2022.

The bill does not mandate creation of such a system. Instead, it orders detailed planning and analysis, and lays out a long list of conditions — including the development of “appropriate financing” — that must be met.

But advocates said Friday’s vote was an important endorsement for an ambitious plan to expand access to primary care doctors.

“Last year, I couldn’t figure out any way to move this,” Sen. Claire Ayer, D-Addison and the committee’s chairwoman, said of a bill that was first introduced in January 2017. “This is forward progress.”

The first few pages of the bill make a case for a care system that would be available to all Vermonters without patient cost-sharing.

Universal primary care would aim to address health issues “before they become more serious and more costly,” the bill says. That could improve quality of care and patient outcomes, backers say, and could eventually lead to a decrease in “systemwide health care spending.”

In addition to benefiting patients, legislators also say the program should “create model working conditions for primary care physicians, who are currently overburdened with paperwork and administrative duties, and who are reimbursed at rates disproportionately lower than those of other specialties.”

Lawmakers have heard plenty of support for universal primary care. In January, more than 50 people spoke in favor of the program at a hearing jointly hosted by the House Health Care and Senate Health and Welfare committees.

Senate Health and Welfare also has been taking testimony on S.53. Lawmakers heard questions about the feasibility of setting up and administering the program, but they also heard from primary care advocates like Dr. Allan Ramsay, a former Green Mountain Care Board member who serves as medical director of the People’s Health and Wellness Clinic in Barre.

Two days before Friday’s vote, Ramsay told the committee to look past those who doubt the state’s ability to create a universal primary care system.

“Change is difficult,” Ramsay said. “I am sure there will be other important questions along the way, but let’s remember value. You have heard no testimony to date that has questioned the value of expanded access to primary care services.”

S.53 sets up a process to answer those questions Ramsay alluded to. That process consists of several layers of study and assessment:

• The Green Mountain Care Board would pull together and supervise a group consisting of accountable care organizations, federally qualified health centers and “other interested stakeholders” to come up with a draft operational model for universal primary care. That group will answer questions such as who is eligible for publicly financed primary care; who would deliver that care; and how funding “would move through the health care system.”

• A draft plan would be due Jan. 1, 2019.

• The state Human Resources Department and the Department of Vermont Health Access would assess that plan and report back to the Legislature by July 1, 2019.

• Also by July 1, 2019, the Department of Financial Regulation would weigh in.

• The state attorney general, the Green Mountain Care Board and the Department of Financial Regulation would be tasked with preparing a legal analysis due Jan. 1, 2019.

• The care board also would convene a “working group” this year to examine issues such as services that should be included in the primary care program and ways to resolve “coordination of benefits issues.”

The working group’s report would be due Oct. 1, 2018.

Sen. Ginny Lyons, D-Chittenden, said it’s important that the planning effort relies on the expertise of people working in the current health care system such as hospitals, insurers and accountable care organizations.

The idea is to put “all of those people into the room to figure out how to take the resources that we have, within the system, and utilize them effectively to provide free primary care to the citizens of Vermont,” Lyons said.

At the same time, committee members emphasized that much of the preliminary legwork would be performed by state agencies.

“We’re calling it our D.I.Y health care bill,” Ayer said. “Nobody’s climbing over fences to do this work for free. But they’ve all agreed to do it. It’s a great thing.”

After all studies are complete, S.53 calls for the Agency of Human Services to submit a final implementation plan by Jan. 1, 2020.

“The Legislature is supposed to come up with a financing plan for the whole thing in 2020, and it’ll go live in 2022 – that’s the dream,” Ayer said.

At this point, financing may be the biggest question mark. S.53 only generally alludes to funding sources including appropriations from the Legislature; revenue from still-unidentified taxes; and federal funds from Medicaid if authorized by federal waivers.

Legislators are also looking for a smaller revenue source that might provide, in Ayer’s words, “a little pocket money” to support the initial planning effort. At one point, Ayer proposed dipping into hospitals’ “excess revenues” to find that money.

But the committee on Friday eliminated that language. Instead, the bill now proposes to use up to $300,000 in state and federal money that has been set aside for transitioning to Vermont’s all-payer health care model.

Jeff Tieman, president and chief executive officer of the Vermont Association of Hospitals and Health Systems, said the association opposed the committee’s original plan to take hospitals’ excess revenues. He said hospitals are already supporting expanded access to primary care via their participation in the all-payer model, which emphasizes preventative care.

Tieman said hospitals “fully support everyone having access to affordable primary care.” But he added that the association wants to ensure that the push for universal primary care doesn’t jeopardize other health care reform efforts already under way.

On the other hand, advocates like Vermont Businesses for Social Responsibility are unequivocally backing S.53. Dan Barlow, the organization’s public policy manager, said Friday’s vote is the first time in several years that the Legislature “has made an attempt to get back to the larger vision of universal health care – starting with universal primary care.”

“So we see this as a really positive step forward,” Barlow said.

Mike Faher

About Mike

Mike Faher reports on health care and Vermont Yankee for VTDigger. Faher has worked as a daily newspaper journalist for 19 years, most recently as lead reporter at the Brattleboro Reformer where he covered several towns and schools as well as the Vermont Legislature and Windham Superior Court. He previously worked for 13 years in his native Pennsylvania at The Johnstown Tribune-Democrat.


Follow Mike on Twitter @MikeFaher

New Survey: Three of Ten Marketplace and Medicaid Enrollees Are Concerned About Losing Coverage

March 1, 2018

March 1, 2018

New Survey: Three of Ten Marketplace and Medicaid Enrollees Are Concerned About Losing Coverage

Thirty-six percent of Americans who have health coverage through the Affordable Care Act’s marketplaces and 27 percent of people with Medicaid are pessimistic they will be able to keep their coverage in the future, according to a new Commonwealth Fund survey. Nearly half cite actions by the Trump administration or Congress to undermine the law as the main source of their concern.

Despite federal efforts to weaken the law, 11.8 million people selected plans through the marketplaces, about 3.7 percent fewer than during the prior year.

“This year’s enrollment numbers are impressive considering the uncertainty that surrounded the law most of the year, but we found that some people are concerned about being able to keep their coverage in the future,” said the Commonwealth Fund’s Sara Collins, the lead author of the study.

The survey also asked people whether they believe all Americans should have the right to affordable health care. Most said yes, including 99 percent of Democrats, 82 percent of Republicans, and 92 percent of independent voters.

See more results

Health care bureaucracy is killing us softly, slowly

February 24, 2018

Health care bureaucracy is killing us softly, slowly


I am writing this by raising my right eyebrow, which triggers a switch.

I have had ALS, also known as Lou Gehrig’s disease, for 21 long years. It is an expensive disease, especially in my current condition: quadriplegic and ventilator dependent.

My prescriptions are filled through CVS Caremark. In the news recently is the proposed bid of CVS to buy Aetna. Since Aetna provides drugs for Medicare patients, this merger will make CVS-Aetna huge, making it more difficult for patients and doctors to get the drugs they need because profit will be the only goal.

But I am getting ahead of myself. Here’s my story.

Recently, I have been denied two drugs. The first is Rozerem that I have used for chronic insomnia for more than a decade. CVS Caremark demanded my physician reassess my use of this drug and get a “prior authorization.” He called to provide his expert medical judgment, but the representative still denied the authorization, saying my use of this drug is “either unknown or does not meet the requirement.”

So he took time away from seeing other patients to write a strongly worded, three-page appeal letter.

It was particularly powerful because my doctor described his long experience with authorization representatives and their too-frequent “inability to pronounce the names not only of medications, but of illnesses.”

“Prior authorization” clerks, middlemen between physicians and patients — who are neither physicians nor pharmacists, and who have never met the patients they are “serving” — are paid to ensure profits, which depend on denying expensive medications. Many know their role is to not “give away free stuff,” as Washington Republicans often say.

My doctor’s bottom line: The entire process is “nothing less than institutional sociopathy.”

Then the chief medical officer of CVS called, probably scared of being sued, and told my doctor that Rozerem is approved for 10 years! Both of us are glad I’m getting medication I need, even after weeks of worry.

How many other of my doctor’s patients are suffering because, despite his many hours of advocating each day, his treatment decisions are blocked by lay people following guidelines designed to promote profits, not health? I’m sure, being the physician he is, he gets many wins — but at what cost to his practice?

And his “losses,” no doubt, are often tragic.

My second denial was Pulmozyme, which I have taken for 16 years to make my lung secretions less thick. Before I started on it, I had two life-threatening mucous plugs. CVS middlemen concluded Pulmozyme was only for cystic fibrosis. This battle is just beginning.

Did you know American physicians are for more dissatisfied with their careers than those in other developed countries? Why? Mainly because insurance gatekeepers intrude on the doctor-patient relationship — denying drugs, treatments, tests, protocols. Because when for-profit insurers are gatekeepers, profits decide.

Most American doctors spend only 25 percent of each day with patients. They spend twice as much on the phone and at their desks. Canadian doctors, without insurers intruding into their doctor-patient relationship, spend about 5 percent of their time on the phone and at their desks. For doctors, time spent with patients increases satisfaction.

Is it any wonder that Canadian physicians are almost 30 percent happier than American physicians?

Most American physicians support single-payer health care, like the New York Health Act, also called “Improved Medicare for All.” Cost-effective like Medicare (also single-payer), it will provide comprehensive health care with “premiums” paid by a progressive payroll tax, costing most New Yorkers far less than they pay now, even those on Medicare.

Our current multi-payer system adds almost 50 percent to our health care costs. That’s right, folks: All that time my doctor spent to get me one drug?

We paid for that.

Worse, we paid the salaries of the people who can’t pronounce its name or my illness — and the salary of the chief medical officer — and the $18 million total compensation CVS’s chief executive officer got last year after record-setting profits.

We almost pay twice what other countries pay for health care, with far worse health outcomes. The price of Rozerem here is about 240 percent more than Canada.

The New York Health Act has passed the Assembly four times, and needs one GOP senator to have a majority in the senate. My senator here in Katonah, Terrence Murphy, won’t support it.

When it becomes law, profit-making insurance companies will be eliminated from essential health care. Decisions about drugs and everything else will be made by patients and physicians.

If you want to know more, go to, and then call your senator. Your life may depend on it. Mine does.” RIP Catherine, you will be sorely missed.,64769

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