Medicare For All

June 28, 2017



Medicare For All

The Affordable Care Act has two major flaws: It does not cover everyone – it leaves 19 million Americans without health insurance – and, It is a giveaway program to the insurance companies. Neither flaw seems to bother Republicans. All their proposals seem to make them worse, while all their “improvements” go to the wealthy.

President Trump said on television, “I will replace Obamacare with a program that will cover everyone, it will be cheaper, and you will love it.” A single-payer policy by the Federal Government achieves these criteria and it is the only one that will.

  • Single-payer is Fair. Every American’s medical expenses are covered without having to guess about which insurance company and which policy is best, which providers are in the network, is my prescription in the formulary, etc. Besides, the Federal Government has the strength to negotiate fair prices with providers and pharmaceutical companies which the individual does not.
  • Single-payer is Cheaper. It eliminates the billions of dollars the insurance companies add to the medical costs. It cuts out completely the need for other current tax-paid programs like Medicaid, veterans hospitals, black lung disease payments, etc. It eliminates all the taxes we have to pay to buy insurance for public employees at every level of government. It takes the cost of health insurance out of the cost of everything we buy.

In sum, the cost of health care buys health care and not a myriad of unnecessary administrative costs.

  • Everyone loves Medicare for the elderly, and everyone will love Medicare for All!



William R. Austin

2720 Hamilton Drive

Endwell, NY 13760


27 June 2017


What’s in the Senate’s Better Care Reconciliation Act Proposal?

June 26, 2017

Untangling the web of opioid addictions in the USA

June 26, 2017

The US President’s Commission on Combating Drug Addiction and Opioid Crisis met for the first time on June 16, 10 days ahead of the June 26 International Day against Drug Abuse and Illicit Trafficking. The USA is in the midst of a so-called opioid epidemic and although public health experts warned that there was little new to learn from convening a commission, the multifaceted challenges facing the country are staggering. Of the 20·5 million Americans aged 12 years or older who had a substance use disorder according to the 2015 National Survey on Drug Use and Health, 2 million involved prescription pain relievers and 591 000 had a substance use disorder involving heroin, a fifth of whom were adolescents. The lethality of the opioid epidemic has further overwhelmed the public health response. In 2015 alone, there were about 52 404 deaths in the USA due to drug overdose (63·1% attributed to opioids)—a three-fold rise from 1999. Death counts from overdose, however, are likely underestimated because older adults who overdose rarely have toxicology performed and their death certificates most often list a cause based on underlying conditions.

In stark contrast with the situation in the USA, worldwide, around 80% of patients still have no access to adequate pain management for reasons including strict government policy against narcotics or high prices. Access to pain management is a fundamental human right and inadequate pain management has serious mental, physiological, and societal implications. The Lancet Commission: Global Access to Pain Control and Palliative Care, due for publication later this year, will report on these issues.

Contributing to the US epidemic is the context, and the way, in which Americans gain access to opioids. In the USA, oxycodone analgesics are generally used in all adult age ranges post surgery or for chronic pain. By contrast, morphine is typically prescribed for serious or end-of-life pain management. But many practitioners, for lack of addiction training, continue to overprescribe or misprescribe. For younger adults aged 18-45 years, initial addiction also occurs through medical prescriptions but they tend to turn to heroin to financially maintain their addiction. Since 2011, with the introduction of potent illicit synthetic fentanyl sold as heroin into the market, a rise in deaths in the younger adult group has been witnessed. It is also the inconsistency of approach by and towards the pharmaceutical industry that continues to confound public health treatment and prevention efforts. This month, the US Food and Drug Administration requested that Endo Pharmaceuticals remove its reformulated opioid pain medication Opana ER (oxymorphone hydrochloride) from the market on the basis of concerns about the potential for abuse by injection raised by postmarketing surveillance. Meanwhile, intense marketing and lobbying have allowed Vivitriol, a costly injectable sustained release form of the opioid-blocker naltrexone, to the market with limited data on long-term effectiveness.

How then to navigate the conflict between pain management—a human right—and strengthening the response to the opioid epidemic in the USA? According to Andrew Kolodny, addiction physician and opioid policy expert at Brandeis University, preventing new addictions through rational access and use—and effectively and compassionately treating those who are addicted—is still the way forward. Currently, 10–12 million Americans are on long-term opioids for chronic pain and many might not be able to come off them. Although methadone or buprenorphine are effective options to treat opiate addiction, few have access to insurance coverage or to a clinician able to prescribe them because of state limits on the number of prescriptions per provider. Reassuringly, experts on the President’s Commission agree with evidence-based management, with Mitchell Rosenthal of the National Council on Alcoholism and Drug Dependence stating: “Treatment works. We just have to provide it.”

President Trump’s current budget proposal calls for an additional US$103 million for the Department of Justice to fight illicit drugs and has endorsed the previously committed $500 million to improve addiction treatment. But several experts in attendance at the President’s Commission fear that the American Healthcare Act is working its way through the US Senate and any repeal of Medicaid is a repeal of coverage that exists to treat addiction now and in the future. Furthermore, calls to intensify punitive policies towards heroin and other opioid users, such as imprisonment for drug use and possession, are also likely to be detrimental. Echoing the calls of The Lancet US Series 2017, to achieve health-care equality, evidence-based approaches are needed that treat health as a human right—and are the only way for addiction treatment and prevention efforts to succeed in the long term.

Millions of people have a lot to lose under the AHCA

June 25, 2017


If the Senate votes to pass the American Health Care Act (AHCA), millions of Americans
will be unquestionably worse off. In addition to the 23 million Americans who will lose
their health insurance coverage by 2026, the economic impacts of repealing and replacing
the Affordable Care Act (ACA) are large and wide-reaching.
As Medicaid is slashed, households’ premium costs skyrocket, and protections for people
with preexisting conditions are eliminated, 23 million Americans will lose their health
insurance by 2026. The majority would lose it to breathtakingly large cuts to the vital
Medicaid program (almost $900 billion over the next decade). Further, millions more
would lose the coverage they get through their employer if AHCA passes.

Overall, out-of-pocket costs after premiums would rise by $33 billion each year by 2026 if AHCA is passed. Costs would skyrocket, particularly for those who still needed coverage in the nongroup market—these costs alone would rise by $25 billion.

Nationally, all-else-equal, the AHCA could slow job growth by 1.1 million in 2020, with losses felt in every state. The American Health Care Act (AHCA) drastically cuts spending on Medicaid and subsidies to help people purchase health insurance, while cutting taxes that disproportionately fall on higher-income households. Because low- and moderate-income households tend to spend a much higher share of their disposable income, the overall effect of the AHCA would be less spending and lower aggregate demand across every state and congressional district.


See related work on Health

See more work by Josh Bivens

Drivers of Expenditure on Primary Care Prescription Drugs in 10 High-Income Countries with Universal Health Coverage  

June 16, 2017

Drivers of Expenditure on Primary Care Prescription Drugs in 10 High-Income Countries with Universal Health Coverage


  • Variation in prescription drug spending in nations with universal health coverage is driven by prices & drug choices
  • Countries with single-payer health systems spend less on prescription drugs than those with multipayer systems


In comparing spending on prescription drugs across 10 high-income countries with universal health care coverage, researchers found that differences in prices and drug choices—not the volume of drugs purchased—account for the wide spending variations found. Countries with single-payer systems have greater purchasing power in price negotiations with manufacturers, which may allow them to promote lower prices and encourage use of lower-cost treatments. This, in turn, results in lower pharmaceutical spending than in countries with multipayer systems.

The Issue

The rising cost of prescription drugs presents a challenge for health care systems around the world. As their per capita spending on pharmaceuticals increases, high-income countries with universal coverage are striving to manage costs to maintain affordable drug prices for the people who need them. The drivers of spending growth can include the volume of drugs prescribed, the choice of drugs within a category or class of pharmaceuticals, or factors related to price, including use and availability of generics. Former Commonwealth Fund Harkness Fellow Steven Morgan and coauthors compared 10 high-income countries’ spending on prescription drugs used in primary care by focusing on six common drug categories: hypertension treatments, pain medications, lipid-lowering medications, noninsulin diabetes treatments, medication for depression, and drugs to treat gastrointestinal disorders such as ulcer and heartburn.

Among the 20 OECD countries with gross domestic product per capita of more than $45,000 (Canadian), average per capita expenditures on pharmaceuticals increased by approximately one-third in the past 10 years and more than doubled in the past 20 years.

Key Findings

  • Average spending per capita on the six medication categories varies by more than 600 percent across the 10 countries. Volume of drug use varies by only 41 percent, suggesting that drug choices and prices drive differences in expenditures.
  • Total volume of pharmaceutical use is highest in Germany and Norway. Hypertension medicines account for the largest share of use in all countries.
  • The mix of therapies prescribed (within the drug classes included in the study) led to higher costs in Canada, Australia, France, and Switzerland. In contrast, in New Zealand, Norway, Sweden, the United Kingdom, and Germany, patients were prescribed lower-cost treatments within the drug classes studied.
  • The average daily cost of drug treatment in New Zealand and the United Kingdom is approximately one-third that of other countries. This difference is attributed to lower-cost drug choices. Alternatively, in Canada, patients were prescribed higher-price drug treatments, resulting in significantly higher spending than in other countries. This is especially true for depression and lipid-lowering medications.
  • Switzerland and Canada have the highest list prices for drugs and the highest average per capita expenditures in all six drug categories. List prices are 61 percent higher in Canada and 57 percent higher in Switzerland than the average list prices in the other nine countries.
  • Canada’s high list prices are offset somewhat by a greater use of cost-saving generic drugs. In contrast, a preference for brand-name pharmaceuticals results in 12 percent higher expenditures per capita in Switzerland.

The Big Picture

The wide variation in prescription drug spending seen across the 10 countries stems more from disparities in pricing and mix of drugs rather than from the volume of drugs consumed. The nations with single-payer systems appear to be more successful at maintaining lower costs. The authors suggest that these countries have greater purchasing power in negotiating drug prices with manufacturers and can therefore promote lower prices. In addition, single-payer systems are better able to encourage the use of lower-cost treatments. Results also point to the value of generic alternatives in keeping down drug spending. Public health systems aiming to reduce expenditures could achieve savings by reexamining the drug choices they offer and availing themselves of less-costly options.

About the Study

The authors used market research data from the IMS MIDAS or QuintilesIMS sales database for 2015. This database tracks more than 95 percent of the international pharmaceutical market. They compared data from 10 developed countries that participated in The Commonwealth Fund’s International Health Policy Survey: Australia, New Zealand, Norway, Sweden, the United Kingdom, France, Germany, the Netherlands, and Switzerland. The countries included in the study all offer some form of universal health coverage.

The Bottom Line

Wide differences in spending on primary care prescription drugs in high-income countries can be attributed to prices and prescribing patterns within drug classes, rather than volume of drugs purchased. These drivers are amenable to policy intervention; for instance, price negotiations with pharmaceutical manufacturers or encouraging providers to choose lower-cost drug options.

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