Health Reform Timeline


Overview of current issues, what’s right and what’s wrong with current law and some very important reference links

PNHP: The Facts On How Much Single Payer Would Cost

#cureALL - 7 minute video outlining the case for Single Payer

Physicians For A National Health Program

National Nurses United

Single Payer Action

Single Payer Now

Labor for Single Payer


International Journal of Health Service: A Five Year Assessment of the Affordable Health Care Act - Abstract excerpt: “This article compares the goals and claims of the ACA with its actual experience in the areas of access, costs, affordability, and quality of care. Based on the evidence, one has to conclude that containment of health care costs is nowhere in sight, that more than 37 million Americans will still be uninsured when the ACA is fully implemented in 2019, that many more millions will be underinsured, and that profiteering will still dominate the culture of U.S. health care. More fundamental reform will be needed. The country still needs to confront the challenge that our for-profit health insurance industry, together with enormous bureaucratic waste and widespread investor ownership throughout our market-based system, are themselves barriers to health care reform.” Full Report. The PPACA is one of the most complex and convoluted laws ever passed - which insured all forms of market gaming. It is past time to scrap it and replace it with the much more simple concept: Improved Medicare for All.

Bloomberg: Out of Pocket, Out of Control


NYTimes: Insured But Not Covered - And check the comments. Click on ‘Reader’s Picks.’

NYTimes: Health Law Case Poses Conundrum for Republicans - They sue to destroy the law and then demand to know what Obama’s going to do about their destruction. Silly. But long time followers of this web site will remember that a recurring theme has been that all of the ‘advantages’ of Obamacare are only there so that politicians of both corporate parties can reap campaign contributions for slowly removing them all.


Copernicus: How Obamacare is Unsustainable and Why We Need a Single-Payer Solution for All Americans


The Hill: New Poll Finds Majority Still Supports Single-Payer


Commonwealth Fund: Over 60 Million Americans Still Face Medical Related Financial Difficulties


New England Journal of Medicine: Medicare at 50 - Origins and Evolution - Or What We Need to Do to Improve It and Make It Universal. Here’s what.


60 Minutes: What Obamacare Doesn’t Do - Cost Control. A great summarization of the cost of health care in the US. But Stephen Brill never talks about the cure, which of course is Single Payer. Brill wrote a similar article for Time magazine “Bitter Pill” about how hospital corporations, Big Pharma are blatantly ripping off sick Americans. The sicker, the more they are cheated, and nothing about this has changed with the implementation of Obamacare.

BioMed Central: $375 Billion Wasted Every Year On Billing and Health Insurance Related Paperwork and Here - Over $1 Trillion every 3 years - enough to cover all that are uninsured today plus upgrade coverage for all that are under-insured, with no increase in overall US health care spending.


PNHP: What Happened in Vermont - A detailed look at what Gov. Shumlin was trying to do, why it was not really single-payer (it was a public-private hybrid), and how the insurance companies mobilized in the background to undermine the effort. No state program can achieve single payer because even in the best case it would still have to compete with Medicare, Medicaid and the VA’s Tricare programs - and federal law prohibits the states from outlawing private insurance plans entirely. Vermont’s attempt veered even further away from the single payer concept - mainly because Shumlin appointed an insurance industry insider to head the board that was to come up with detailed implementation plans. It went downhill from there. But the important point to remember is: It was not single payer, and without the economies of scale that national single payer affords, state plans are severely hampered.


ProPublica: How To Investigate Health Professionals - A state by state guide


ProPublica: When Medical Debts Become an Impossible Burden - Without Single Payer in the USA, regardless of health insurance, we are all just one major illness away from homelessness. Can we really be called a ‘civilized society?’


William J. Clinton Presidential Library: Recently Released Documents: Hillary Clinton’s 1994 Statements On Health Care Reform - “I believe that by the year 2000 we will have a single payer system. I don’t think it’s — I don’t even think it’s a close call politically. I think the momentum for a single payer system will sweep the country. And regardless of the referendum outcome in California, it will be such a huge popular issue in the sense of populist issue that even if it’s not successful the first time, it will eventually be. So for those who think that building on the existing public-private system with an employer mandate is radical, I think they are extremely short-sighted, but that is their choice.” More docs (search engine available):


Natl. Bureau of Economic Research: Can Health Insurance Competition Work? - Me: It’s always amazing to me how many hoops biased observers will jump through to try to ‘prove’ that something is true which is not. PNHP comment: “This technical paper is not worth reading. It was apparently written with the intent of proving that private Medicare Advantage plans show that health insurance competition works. Numerous assumptions were made while largely ignoring the gaming of insurers through favorable risk selection and upcoding for risk adjustment. With all of the authors’ efforts to prove the efficiencies of managed competition through private Medicare Advantage plans, they still showed that this program resulted in “an even larger net cost to taxpayers.”

We need to lay managed competition to rest. Single payer, now.”

Upton Sinclair: “It is impossible to get a man to understand something, when his salary depends on his not understanding it.”


Portside: Why Did Swiss Voters Reject Single-Payer Health Care? - This is a long article that must be read completely in order to understand the dynamics of the current Swiss system vs. that in the US. But basically the reasons are that

1. the Swiss system of health care today is far superior to Obamacare; insurance companies are forbidden from making a profit on medically necessary care - what we call the ‘Cadillac’ plan and there are no ’networks’ all doctors and hospitals are ‘in the plan';

  1. 2.this referendum comes up annually for the Swiss and more and more (though not yet the majority) of Swiss voters are steadily voting for Single Payer and

  2. 3.the insurance industry in Switzerland, like that in the US, is becoming more and more powerful and doing a better job of controlling the propaganda. Bottom line: It’s eventually going to happen there and it’s eventually going to happen here.


NYTimes: As Medicaid Rolls Swell, Cuts in Payments to Doctors Threaten Access to Care - "The Affordable Care Act provided a big increase in Medicaid payments for primary care in 2013 and 2014. But the increase expires on Thursday — just weeks after the Obama administration told the Supreme Court that doctors and other providers had no legal right to challenge the adequacy of payments they received from Medicaid.”

Doctors will now see their fees for primary care cut by 43%. Result? Fewer and fewer doctors are going to accept new Medicaid patients. Doctors that stay in the program are therefore going to see proportionally more and more Medicaid patients, squeezing out time they would normally devote to non-Medicaid patients - the beginning of a death spiral.

This is what ‘the lesser of two evils’ and ‘don’t let the perfect be the enemy of the good’ got us. This is what ACA, MoveOn and the Democratic party called ‘realistic.’ 

Exactly what this web site has been pointing out since Feb. 2009.

Wouldn’t happen with Single Payer.


ProPublica: Nonprofit Hospitals Seize Patient Wages - ...which causes them to loose their homes. “We will be paying them off until we die.” Wouldn’t happen with Single Payer.


NYTimes: US Healthcare Lags Worldwide For Those Over 65 - But “It’s definitely a better picture than when we look at the US population generally...” and Americans generally arrive at 65 sicker than people of other countries.


Health Affairs: Two Theologies Have Blocked Medicare-For-All - Synopsis: Actually two myths. ‘Managed Care’ and ‘Competition.’ They have now both been tried and failed. Time to get past the myths and implement Single Payer.

CFPB: Consumer Advisory: 7 Ways to Keep Medical Debt in Check - Actually there is no way to do that, but it’s worth noting that 52% of all collection accounts are for medical debt, “far outpacing all other types of debt.” Single Payer would make all of this moot.


NYTimes: The Health-Cost Slowdown Isn’t Just About the Economy - A totally bogus article, but check the comments. Sort by “Reader’s Picks.” The author doesn’t get it. The people do.


ProPublica: Using an Exchange Health Care Plan? Check the Fine Print. They’re Changing.


The Hill: Tom Harkin, Co-Author of ACA Says “We Blew It” - “We had the power to do it in a way that would have simplified healthcare, made it more efficient and made it less costly and we didn’t do it. Congress should have enacted single-payer right from the get-go or at least put a public option would have simplified a lot. We had the votes to do that and we blew it.” Exactly what this web site has advocated from the very start (2/15/09). Absolutely stupid and galling!


NYTimes: Underinsurance Remains Big Problem Under Obamacare - “In fact, it may be helping to spread it.” Duh!


NYTimes: Suit on Health Law Puts Focus on Funding - Since the ‘negotiations’ began on the ACA in 2009, this site has pointed out that the few benefits of this law were delayed until 2014 so that legislators could slowly whittle them away in return for more and more contribution money. This is the latest phase. Now the exchanges, which most lower and middle income families depend on to afford the skyrocketing total out-of-pocket costs, are under attack in the Kabuki theatre sometimes referred to as Congress. If this suit is successful, and there is every reason to believe that it will be, millions more Americans will be priced out of the market. Initially, the Dems called it universal and affordable health care. Then later they just called it expanded. Now it won’t even be that. Just more promises followed by bait-and-switch. Wouldn’t happen with Single Payer.


Gallup: Cost Still A Barrier Between Americans and their Doctors - Among other interesting findings: 34% of Americans with private health insurance reported putting off needed medical treatment in 2014, up from 25% in 2013. 57% without any health insurance reported putting off treatment. For those who reported putting off treatment, 22% rated the forgone treatment as ‘for a serious condition,’ the highest number ever recorded by this yearly survey. And yet we pay the highest total cost for health care of any country in the world, and we have a lower life expectancy and poorer overall outcomes than most of the other OECD countries.


Georgia Health News: Grady, Blue Cross At Impasse as Contract Expires - Grady, home to one of the nations best trauma centers, is now out-of-network for those with Wellpoint or Blue Cross, Blue Shield health insurance. So as they pay higher premiums and out-of-pockets and find that less is covered, they also have to hope they don’t get in a car wreck. Wouldn’t happen with Single Payer.


NYTimes: ACA Recasts Insurers as Obama Allies - ‘Recasts’? I think we’ve known all along who his, and the Democrats, friends are - same as the Rethugs without the histrionics.


NYTimes: Cost of Coverage Under ACA to Increase in 2015 - In some cases by as much as 20%. Obama and the Democrats put the insurance companies in charge and this is what happened. MoveOn helped them prevent the Public Option, after refusing to even hear about Single Payer. This is their version of “realistic.” Wouldn’t happen with Single Payer.


Washington Post: Who is Jonathan Gruber? and J Turley - He was Obama’s top advisor for ACA. Here he is at a conference stating that the passage of Obamacare relied on “the stupidity of the American voter” and that the “lack of transparency” during the process was “crucial.”


NYTimes: Providing Health Insurance Still A Struggle for Small Businesses - Wouldn’t happen with Single Payer.


JAMA: Medicare Advantage Plans Are Lying About Their Networks

Center for Public Integrity: Another Whistleblower Suit Alleges Medicare Advantage Fraud - More sham ‘treatments’ used to collect inflated fees. Part of a pattern of denying reimbursements for treatments and drugs and limiting choices for consumers and padding overpayments from the federal government and Here and Here and Here and Here and Here.


JAMA: Health Care Price Transparency and Economic Theory - “the much ballyhooed consumer-directed health care strategy so far has been more a cruel hoax than a smart and ethically defensible health policy.”


NYTimes: Unable to Meet the Deductible or the Doctor - It’s called health care apartheid and it wouldn’t happen with Single Payer.


Associated Press/Univ. of Chicago: Privately Insured in America: Opinions on Health Care Costs and Coverage - A significant and growing minority of Americans with health insurance, more than 16 million people, are concerned that they will not be able to afford their medicals bills, don’t go to the doctor when they are sick, have reduced their savings and retirement plans in order to pay medical bills. 1 in 4 with high deductible plans state that they have gone without food or have exhausted their savings due to health care costs. And we still have 30 million Americans without any health care coverage at all. Are we truly a civilized society when this is going on? Wouldn’t happen with a well designed Single Payer system.


NYTimes: US Finds Many Failures in Medicare Health Plans - Referring to Medicare Advantage


NYTimes: Walmart to End Health Coverage for 30,000 Part-Time Workers - Shameful! And a direct result of Obamacare. Most of these workers are already at poverty level incomes. For some, the exchanges will allow them to get sub-standard coverage at great cost to the average taxpayer. The rest will not be able to afford health coverage even after the subsidies. The Walton family is not only in the top 1%, they are in the top 0.01% wealthiest Americans. Single Payer, financed by steeply progressive tax on the wealthiest Americans is the only answer.


WSJ: Income Inequality and Rising Health Care Costs - We keep hearing that health care costs are rising modestly. Sometimes the contention made is that ACA is the cause of that, but there is no proof of that. What we don’t hear in the same paragraph is that wages are increasing even more modestly, so that health care continues to take a bigger and bigger percentage of take home pay, making it one of the drivers of income and wealth inequality. We all know the obvious fix.


NYTimes: Costs Go Up Fast When ER is In Network, But Doctor is Not


NYTimes: Report: For Many New Enrollees, Care is Hard to Find


Kaiser Health News: Underinsured Enrollees Flood Community Health Centers - As predicted, ‘Bronze Plans’ are essentially health care apartheid. People who only looked at monthly premiums chose plans that don’t protect them from any sort of medical costs. They are paying for nothing and not getting the health care they and their families need - and along with most of the rest of us, are one medical catastrophe away from homelessness. Meanwhile the community health centers that are trying to fill the gap as best they can are being used by the insurance companies as non-reimbursed providers of last resort. How long do you think that is going to last? Wouldn’t happen with Single Payer.


Reuters: HCA Will Face Class Action Over 2011 IPO - HCA originated under the leadership of ex-US Senate leader Bill Frist, paid a record $1.7 Billion Medicare fraud fine while under the leadership of now Florida governor Rick Scott, then taken private by Bain Capital/Mitt Romney and started routinely performing unnecessary cardiac procedures to bump up revenue so that it could maximize profits to the private owners during the IPO. A veritable Republican shyster hall of fame. This is just one more bad result of non-regulated capitalism. Wouldn’t happen with Single Payer. HR 676 John Conyers’ Expanded and Improved Medicare for All - with 62 co-sponsors - rids the health care system of private insurance and converts the health care delivery system to non-profit status.


NYTimes: After Surgery, Surprise $117,000 Medical Bill From Doctor He Didn’t Even Know - Putting a lie to the theory that if a patient ‘has more skin in the game,’ he’ll be more careful in choosing among his options. Wouldn’t happen with Single Payer.


Univ. of South Carolina Study: Fortune 500 Employees Can Expect to Pay More For Health Insurance - Synopsis: As health insurance policy costs rise, even the biggest employers, that supposedly offered the ‘best of the best’ plans, are shifting more and more of the cost to their employees. PNHP response: “As if there were not enough problems already with excess deductibles, narrower provider networks, tiering of health care services and drugs, limiting dependent coverage, and other innovations that impair access and reduce costs, in the face of ever more increasing costs the employers are now raising employee contributions to the plans, shifting to consumer directed plans that place a greater financial burden on the employees, reducing eligibility for their employees, shifting retirees out of their plans, reducing hours for part-time employees in order to avoid ACA penalties, and limiting full-time employee hires while increasing part-time workers. And this is the best of the best!” Wouldn’t happen with Single Payer.


ProPublica: A New Way Insurers Are Shifting Costs to the Sick - The sicker you are and the more you need it, the more you pay for the same generic. After all, if you don’t ‘have skin in the game,’ you would never seek to control your behavior, right? Yet another failure of the ACA and another reason to replace insurance companies with Single Payer.


Annals of Internal Medicine: Comparative Effectiveness of Generic vs. Brand-Name Statins on Patient Outcomes - Summarized conclusions: Generics work. Generics are cheaper. If patients pay more for medications (‘have more skin in the game’), they will not take them and they will die. Therefore shifting costs to patients leads to more death.


Albuquerque Journal: US Squanders $150 Billion per Year on Hospital Bureaucracy

Dallas Morning News: Health Care Insurance Overhead is Costing Us Big Bucks

Portside: Dr. Paul Song’s Address to Labor Campaign for Single Payer - He refers to Gerald Friedman’s economic research showing that simply being able to negotiate drug prices would save America $600 Billion per year, enough to provide universal access to health care; and also the facts that current Medicare administrative overhead is 1.4% (compared to insurance industry average of around 25%) and could be lower if it were not for Medicare Advantage, which has cost taxpayers $280+ Billion in total overpayments (24.4% of all Medicare expenses), and $34 Billion in 2012 alone; and that Medicare is prevented by law from negotiating with BigPharma. “How come when Wellpoint negotiates lower prices, it is good business and the free market at work, but when Medicare tries it, it is government interference?!”


Brookings Institute: Why the Geographic Variation in Health Care Spending Can’t Tell Us Much About the Efficiency or Quality of our Health Care System - Kind of wonkish, but worth including in this archive because it directly challenges conclusions reached by the Dartmouth group upon which the ACOs are based. Essentially it says that variations in costs of health care across the country are mostly due to health related behaviors - smoking, poor eating habits, etc, not some streamlined set of procedures, or some easily eliminated wasteful health care delivery. ACOs don’t work. PPACA doesn’t work. We need Single Payer.


Health Affairs: Study: Bureaucracy Consumes One-Quarter of US Hospital Costs; Highest In The World - Two reasons: 1. the complexity of billing a multiplicity of insurers with varying payment rates, rules and documentation requirements; 2. the entrepreneurial imperative for hospitals to amass profits (or for non-profits, surpluses). Wouldn’t happen with Single Payer.


NYTimes: Medicare: Not Such a Budget-Buster Anymore

Kaiser Health News: Health Law Ups Taxes On Insurers With Big Pay Packages - So what happened is the health insurance companies upped top executive salaries (averaging $5.4 Million in 2013) by more than enough to cover the increase in their taxes. Who really paid more? You and I in the form of premium increases. Some of the executive pay numbers in this article are totally obscene. Wouldn’t happen with Single Payer.

Kaiser Health News: Insurers’ Take On ‘Patient Management’ - This is currently focused on end-of-life, but it’s going to become the norm for everyone if insurers have anything to say about it - and they are running the show right now. Remember all the people who used to say that Obamacare would control costs by making sure that insurers take no more than a 20% profit? But that’s really just a cost-plus scheme, which was originally the idea of the insurers anyway. Whatever they can get defined as a legitimate cost, they can tack an additional 20% on top of that. Your case manager will be calling very soon - even if you’re not sick. Wouldn’t happen with Single Payer.


Center for Public Integrity: How Medicare Advantage Overbills and Cheats the Taxpayers and CMS Medicare and Medicaid Research Review: Measuring Coding Intensity in the Medicare Advantage Program - To the tune of $160 Billion per year. See also entry of 6/4 and 4/3/14, 4/9/13.

PNHP Response: “The history of Medicare Advantage is that of a steady string of abuses. The program began with overpayments of about 14 percent over the cost of caring for Medicare patients in the traditional program. That overpayment was a deliberate ploy of Congress to give the private plans a competitive market advantage in an effort to privatize Medicare. The plans then selectively enrolled healthier, less expensive patients through deceptive marketing practices. When an effort to correct this favorable selection was made through risk adjustment using Hierarchical Condition Categories, the insurers then padded the diagnoses, as mentioned above. Further, since the Affordable Care Act included adjustments to correct the overpayments, the insurance industry heavily lobbied Congress and the Obama Administration to use three years of accounting gimmicks to reduce the impact of these adjustments. Cheat, cheat, cheat...These crooks will continue to cheat the American taxpayers. They will surely use other HCCs to upcode their patients, until that door is finally slammed shut. What then? The private insurers continually tout to their shareholders the importance of “innovation” in health care coverage. They will always be able to find new and more effective ways to cheat us.

One of the more important improvements in an Improved Medicare for All would be to get rid of these crooks once and for all. The sooner the better.”


Health Affairs: For-Profit Medicare Home Health Agencies’ Costs Appear Higher and Quality Lower Compared to Nonprofit Agencies - PNHP Response: “Markets, competition, investor ownership, and profits are touted incessantly as being key to higher quality and lower costs in health care, even though Noble laureate Kenneth Arrow showed us decades ago why markets do not work in health care. Previously studies of hospitals, HMOs, nursing homes, hospices, and dialysis centers have shown us that investor ownership is associated with lower quality and higher costs. We can now add Medicare home health agencies to that list wherein proprietary, for-profit investor ownership is detrimental.

H.R. 676, the Expanded & Improved Medicare For All Act, sponsored by Rep. John Conyers, Jr, is a single payer bill that includes provisions that would eliminate investor-owned, for-profit providers. Today’s article adds to the evidence as to why the leadership of Physicians for a National Health Program supports the elimination of passive investors and profit diversion from our health care system. Health systems must be designed to benefit patients, not market exploiters that sacrifice quality while draining resources from health care. The primary missions are different. One is to take care of patients and the other is to make money.”


NYTimes: Adventures in ‘Prior Authorization’ - Just one more set of unnecessary insurance company administrative nightmares. 20% of your insurance premiums go towards paying the salaries of people whose job is to deny you the health care you need. Wouldn’t happen with Single Payer.


Common Dreams: Don’t Panic, We Can Expand Social Security and Medicare


Aids Institute: Letter to Secretary of Health and Human Services From 300 Patient Advocacy Groups - Summary: Even with ACA, enrolled patients with pre-existing or chronic conditions are still being discriminated against and are facing insurmountable barriers to care. Some examples are: restrictive formularies - including removal of critical drugs from formularies without notice, inadequate provider networks, lack of access to specialists, high cost-sharing, high co-insurance on life-saving medications, utilization management policies such as prior authorization, step therapy and quantity limits. Bottom line: As long as insurance companies are involved, they will find any number of ways to cheat the system in order to maximize their profits. That’s only natural. The only solution is to remove insurance companies from the process. The only way to do that is with Single Payer.


CrossCut (Seattle indy): Glimmers of Healthcare Politics at Meeting of Western Docs - Kshama Sawant, after winning a $15 minimum wage for Seattle workers, turns her attention to health care. What did ACA achieve? Coverage of only about half of the previously uninsured, a shift to underinsurance policies with ultra-narrow networks that eliminate choice, costs (premiums, deductibles, co-pays) that erect financial barriers to adequate care, inadequate subsidies, insurance marketplaces that increase complexity and waste, inadequate cost containment policies. What would Single Payer achieve? Universal care, removal of financial barriers, dramatic reduction in administrative waste, coverage of all essential health care, free choice of doctors/hospitals, elimination of the interventions and excesses of insurance companies, infrastructure that would slow spending to sustainable levels, progressive taxpayer financing based on ability to pay.


New England Journal of Medicine: Money, Sex and Religion - The Supreme Court’s ACA Sequel - PNHP response: “Our incremental, fragmented, and incomplete health insurance system means that different Americans have different access to health care on the basis of their income, employment status, age, and sex. The decision in Hobby Lobby unravels only one more thread, perhaps, but it tugs on a quilt that is already inequitable and uneven. A central goal of the ACA was to repair some of this incremental fragmentation by universalizing certain basic health care entitlements. In ruling in favor of idiosyncratic religious claims over such universality, the Court has once again expressed its disagreement with this foundational health-policy goal.”


NYTimes: CEO Finds Lucrative Work at New York-Presbyterian - Very lucrative. And we wonder why the overall cost of health care in the US is out of control. A large portion of it goes to CEOs and the Board of Directors in the insurance-hospital-pharmaceutical industry.


AlterNet: At Some Point, Progressives Need to Break Up With the Democratic Party - Best article I’ve read in a very, very long time; pointing up issues that have been emphasized on this site since 2010. Progressives’ behavior around Democrats is exactly like that of abused around the abuser.


PNHP: Godzilla Has Risen: The Insurance Industry Under ACA


LA Times: Hobby Lobby Case Proves Necessity of Single Payer


NYTimes: Justices Rule in Favor of Hobby Lobby - Apparently corporations have religious rights, but employees don’t. This ruling is another bizarre and ridiculous legislation from the bench from our politicized Whore Court. 1. The majority opinion makes the implicit assumption that health insurance is some sort of gift to employees from the employer. It is no such thing, but rather a part of an overall compensation package. If the employer has some sort of crazy religious objection to birth control (and I’m not even going to get into the hypocrisy of then objecting to abortion), then the employer does not have to use birth control, but they have no right to control the private lives of the employees. 2. This is just a part of the slow dribble of the elimination of all of the benefits that Obamacare proponents originally touted - which I’ve been predicting since 2009. 3. This wouldn’t be happening with Single Payer - the only rational solution to obtaining universal, affordable health care and at the same time a means to significantly reduce the overall cost of health care in the US - while taking the burden of providing health insurance off the backs of employers.


AJC: Patients Find Fewer Doctors, Hospitals To Choose From - In this case, a matter of life and death. We could have done so much better, and we still can.

NYTimes: Dr. Arnold Relman, Outspoken Medical Editor of the New England Journal of Medicine, Dies at 91 - He won numerous journalism awards and was a loud critic of the ‘medical-industrial complex’ which is more interested in selling profitable products than in helping sick people and is the main cause of the soaring overall cost of medical care in the US. He advocated for one and only one solution during his entire career: Single Payer.


Commonwealth Fund: How The Performance of the US Health Care System Compares Internationally - Synopsis: 11 OECD nations were included in this study. The fully socialized (government owned and operated) system of the UK came in first. USA dead last because of lack of Access and lack of affordability (Equity).  The US was also last in Efficiency.


NYTimes: The Koch Cycle of Endless Cash


JAMA: The Moral Case for Affordable Coverage and How Obamacare Fails to Live Up To It - It’s not universal. It’s not affordable. The proper solution: Single Payer.


Center for Public Integrity: The Medicare Advantage Money Grab and Why Medicare Advantage Costs Taxpayers Billions More Than It Should


Washington Monthly: VA Care: Still the Best Care Anywhere - Short article (first in a series) that puts the current ‘VA scandal’ in perspective. The right wing media, along with MSM stenographers posing as journalists, are using the scandal in Phoenix, AZ as a way to discredit socialized medicine. The backlogs that are at the heart of the scandal could be fixed by Congress tomorrow, but their incentive is not to fix the problem, but rather to milk it for propaganda purposes. The fact is that all major veterans services are unanimous in their praise for the quality of VA health care. Recent surveys of newly discharged patients from VA hospitals rate their care four points higher than newly discharged patients from the private sector. 96% of the VA discharges state that they would turn to VA hospitals for future care needs.


NYTimes: Hospital Charges Surge For Common Ailments - Note that Medicare pays what Medicare pays no matter what the charge. What does this tell you about ‘Improved Medicare for All’, aka Single Payer?


AFLAC: American Workers At the Edge of A Financial Cliff


Medical Group Management Assoc: Statement on the Effect of ACA Exchange Implementation On Medical Group Practices - Deductibles and premiums on the rise. Networks becoming smaller. And now this: “Even though there hasn’t been a huge influx of patients into physician offices as many predicted, simple tasks such as obtaining patient insurance coverage information or finding specialists for in-network referrals have proven to be significant challenges.” “We are consistently denied 'out of network' approvals for the very sick who truly need to continue their care with providers who have worked with the patient for years.” The full report. Too bad Single Payer never got ‘a seat at the table.’ Too bad Obama and the Dems threw Public Option under the bus.


Bernie Sanders: Where Do We Go From Here?

LA Times: Obama ‘Adjusts’ ACA To Fund Insurance Companies If They Incur Losses - Making $ Billions of taxpayer funds available. That’s the definition of bailout.


Health Affairs: Paradigm Lost: Provider Concentration and the Failure of Market Theory - Instead of making health care more affordable, Obamacare has set up a framework that encourages consolidation and monopoly pricing. The opposite of that would be the monopsony system called Single Payer.


NYTimes: More Insured, But the Choices Are Narrowing - CEO of PreferredOne: “We have to break people away from the choice habit that everyone has...We’re all trying to break away from this fixation on open access and broad networks.” Most people only look at the monthly premium when picking an insurance policy. That strategy can lead to homelessness the moment they need to see a specialist or go to a hospital that is not ‘in-network.’ As far as this CEO is concerned, if you don’t like that choice you can always just go find a ditch to lay down and die in. Meanwhile, he’s enjoying his multi-million salary and benefits. Given that kind of income, he doesn’t have to worry about in- or out-of-network. It doesn’t have to be this way. Of course, when PPACA was just a bill, the Obama administration loved to talk about all of its cost containment measures.

Health Affairs: Vertical Integration: Hospital Ownership of Physician Practices Is Associated With Higher Prices and Spending - One intent of ACA was to reduce overall health care spending through the establishment of more efficient integrated systems called Accountable Care Organizations. Instead of reducing spending through greater efficiencies, this consolidation has had the opposite effect by increasing the market power of these organizations. A better approach would be the administered pricing of a Single Payer monopsony system, where patients are no longer victimized by anti-competitive market groups.


Baltimore Sun: Getting Serious About Single Payer - More doctors are getting on board by the day. This article refers to another included on this site from January 17 which is worth reviewing.


ProPublica: MIA In The War On Cancer: Where Are The Low Cost Treatments?


NYTimes: Acceleration Is Forecast for Spending on Health Care


Healthcare-NOW: Public Citizen Report: Single Payer Would be a Boon to the Economy - It would remove unfair burdens from companies that are now forced to provide health insurance for their employees.


Common Dreams: Majority of Med Students Want Single Payer - “The sad truth is that for many health insurance is an umbrella that melts in the rain—when you need it most, it isn’t there. One thing that's clear: the business of corporate medicine is doing very well under the ACA. Health insurer profits, stock value, and CEO salaries are all up. In fact, the entire law was written around preserving the gluttonous bottom lines in American health care. The ACA handed private insurers $500 billion in taxpayer subsidies to continue profiteering off illness in our country. Health insurers profit by avoiding the sick, collecting premiums, denying claims, and shifting more and more costs onto the patient.”

ProPublica: Medicaid Programs Drowning In Backlog


PNHP: Thomas Piketty: “Capital in the Twenty-First Century” - This is a good short summation of what is rapidly becoming a very seminal work. Without a progressive income tax and a progressive wealth tax, capitalism just doesn’t work. With such a tax, we can finance among other things, a health care system that provides basic health care to all - a basic human right.


NYTimes: Even Small Medical Advances Can Mean Big Jump in Bills - Even under Obamacare. A number of people have gotten insurance that couldn’t before, but with large premiums and deductibles. Some of the comments are more interesting than the article. Medicare is not allowed by law to negotiate over the cost of insulin. The ability to negotiate over the cost of pharmaceuticals is part of  ‘Improved’ Medicare for All. Notice how many comments include the statement about waiting until they are eligible for Medicare before getting the treatment they need.


PNHP: Medicare Advantage Scamming the Nation Again


Labor For Single Payer: Organizing Our Way Out Of Labor’s Healthcare Muddle - Democratic leaders who previously were allies of labor have been telling union representatives that they need to “regress to the mean.” But it’s a simple rule of math that if you reduce the factors that exceed the mean, the mean itself constantly adjusts downward. Prior to the concerted efforts by the right to attack unions of the 1980’s, improvements in union contracts had a trickle down effect on non-union benefits. After all, it is only because unions negotiated for health benefits in the first place that non-union workers came to expect them as well (not to mention the 40 hour week, 2 weeks paid vacation, child labor laws, etc). The landscape has changed drastically since then, and ACA has only made things worse for not only unions, but the entire middle class. “If organized labor settles for piecemeal changes and refuses to challenge the link between medical insurance and employment, it will miss the chance to connect with millions of poorly insured and uninsured workers who have no union. The only way to guarantee healthcare for every worker is to guarantee healthcare for all through a single-payer Medicare for All program.”


Forbes: ‘Double Jeopardy’ in American Health Insurance - Summary: It is exactly at the moment when the sick  in the US are most in need of therapy that their ‘tiered’ insurance costs go up. That’s when insurers impose higher ‘cost sharing’ on patients through techniques such as ever higher deductibles, large coinsurance requirements, and tiering of drugs and specialized services with even higher coinsurance requirements for the most expensive tiers. Insurance companies give lip service to sick people having more ‘skin in the game,’ but in reality this simply a profit maximizing strategy on their part - imposed on sick individuals exactly when they have no choice but to get these therapies/drugs no matter what the cost. Wouldn’t happen with Single Payer.


Popular Resistance: Tell Obama: ACA’s A Scam, We Need Medicare for All


Diane Rehm Show: Jimmy Carter Joins the Chorus Calling for Single Payer


Bloomberg: Obamacare Limits Choices Under Some Plans - Actually, all plans. Bought Platinum, got Bronze. Wouldn’t happen with Single Payer.


AP: Health Law Concerns For Cancer Centers - Pre-existing conditions may now be nominally covered, but the best doctors/treatment centers are probably not in any plan.


Kaiser Health News: Warning Opting Out of Your Network is Financially Risky


LA Times: Watch An Expert Teach A Smug US Senator About Canadian Health Care - And here’s the YouTube video.


PNHP: Senate Subcommittee Hearing On Healthcare Access and Cost: Single Payer Lessons For the US - A healthcare policy research analyst outlines 11 basic reasons why - based on empirical research, if the goal is universal affordable healthcare, SP far outperforms the current US approach.

Public Citizen: Testimony of International Experts Underscores Benefits of Single Payer

Unite Here: The Irony of Obamacare: Making Inequality Worse - Many more Americans will gain some form of health care, but with higher premiums, loss of hours, a shift to part-time work, and for many less comprehensive coverage, very limited networks. A Trillion dollars of US taxpayer money transferred directly into the hands of private insurance companies. When ACA first passed, their stock prices doubled. Top executives were paid half a billion in wages and stock options over the last 2 years. Fair competition has been strangled. 388 companies have announced that they would cut worker hours to avoid the law’s requirements. Wouldn’t happen with Single Payer.


NYTimes: When Health Costs Harm Your Credit - Wouldn’t happen with Single Payer.


AlterNet: Why I’m Naming The New Brain Lesion ‘Anthem Blue Cross’ After the Criminals That Denied Care - A great anecdotal argument for Single Payer.


Towers Watson: Employers Experiencing Smallest Increases in Health Costs in 15 Years - Yea! USA! USA! Guess who’s not experiencing smallest increases in health care costs in 15 years. Yep, Employees. The title of this article should be Progressive Deterioration In US Health Plans. Wouldn’t happen with Single Payer.


NYTimes: New Law’s Demands on Doctors Have Many Seeking Networks - Doctors remaining in private practice are turning Medicaid patients away. Most doctors are seeking the ‘security’ of becoming employed by large hospital corporations, which right now have very poor earnings. But left unsaid: These large corporate structures are consolidating at a rapid rate. Once the consolidation phase is complete, they will begin to squeeze all of their employees - doctors, nurses, etc and patients - in order to regain profitability. It’s not going to be pretty. Wouldn’t happen with Single Payer.


Yahoo: GOP Would Bar Poor From Health Care Altogether - But it’s not just the GOP. Remember when the Democrats said that Single Payer was “not realistic.” So they said they were going to support the Public Option. But at the very end of the ‘debate,’ they also dropped the Public Option, again because it was “not realistic.” So this is where “realistic” has gotten us. Rather than stand up for what they said they really believed in, they decided to calculate and compromise away all of the good. Guess they mis-calculated.


New England Journal of Medicine: The Calculus of Cures - Here’s an article in an esteemed journal that clearly illustrates how money interferes with science. The editor of NEJM is Jeffery Drazen, who has been cited by the FDA for making false claims about drugs (levalbuterol) in which he had a large financial interest and who has close ties to at least 20 drug firms from whom he has accepted sizable fees. The actual authors of this article are venture capitalists. Basically the article takes the position that drug trials are just too doggone expensive and who needs them anyway. What this has to do with Single Payer is that in that scenario, one purchaser would have the power to negotiate serious reductions in drug costs - something that is specifically forbidden by PPACA.


Bloomberg: Employers Turn to Private Health Exchanges to Cut Costs - About 1/3 of all employers will be eliminating their own health plans within the next 5 years and sending their employees to private exchanges. This will essentially be a voucher system, so the employer can control their health care expenditures. So more and more, employees will have to bear the additional costs either through higher premiums, further cost sharing (deductibles, co-pays, conditions not covered, etc). This is a continuation of the conversion of health plans from defined benefit to defined contribution plans from the employers’ point of view - and a move in the direction of the old pre-PPACA days. Just one more way that productivity gains are funneled to the large corporation employers. Wouldn’t happen with Single Payer.


Democracy-NOW: Job Killer? How Media Spin Got Obamacare Wrong And Why Single-Payer Could Cure Its Actual Flaws


Albany Herald: In SW Georgia, The Affordable Care Act Is Having Trouble Living Up To Its Name


NYTimes: How Wellpoint Will Profit From PPACA


PNHP: CEO: Bayer Designs Its Products for Rich People, Not Sick People - Be sure and read the ‘Comment’ at the very bottom of the article.


PNHP: Why We Do Not Want Investor Owned Health Care Institutions


NYTimes: Patients’ Cost Skyrocket; Specialists’ Incomes Soar


Journal of Oncology Practice: Why Oncologists Should Support Single-Payer National Health Insurance

Wisconsin State Journal: In Health Care, Need is Trumped by Profit


NYTimes: Ads Attacking Health Law Stagger Outspent Democrats - Koch Bros. see an opening. The Democrats are getting ready to pay a very high price for passing this insurance-centric, and very unpopular law. Now think how much different this scenario would have been if the Democrats had pushed really hard for Medicare for All, or even if they had just left the Public Option in the law. Maybe it wouldn’t have passed, and now they’d be in a position to say that they really tried to get the best possible law - Everybody In, Nobody Out - passed for the good of the people. Maybe it would have passed, who knows - in which case they’d be extremely popular. But they kept saying they had to do what was ‘realistic.’ Yeah, so how does ‘realistic’ feel now?


Albany NY Times Union: Single-Payer Activism Gets Boost From Obamacare

Real Clear Politics: Single-Payer Is Not Dead


NYTimes: Enrollees At Health Exchanges Face Struggle to Prove Coverage - Wouldn’t happen with Single Payer. Everybody In, Nobody Out.


MoJo: New Data Shows How Hospitals Rip You Off


Kaiser Family Foundation: Medical Debt Among People With Health Insurance


Counter Punch: The Left After the Failure of Obamacare


Health Affairs: Medicare’s Rollout vs. Obamacare Glitches Brew - The original Medicare rollout in 1966 cost $867 Million in today’s dollars, and that included the cost of processing 1966 medical bills in addition to the actual rollout. It saved $376 Million by displacing several smaller federal health assistance programs. The Obamacare rollout has cost at least $6 Billion. Most of that cost has been because it is a workaround designed to keep health insurers at the center of the health care system. Obamacare’s exchanges must coordinate thousands of different plans, with premiums, co-payments, deductibles and provider networks that vary county-by-county; Medicare offered a single, uniform plan. Medicare has an overhead of about 2%. Private plan overhead is, on average, at least 20%. Thus, a single payer plan that excluded private insurers could save hundreds of billions in transaction costs. The glitches and associated costs of the Obamacare rollout don’t come from government incompetence, but rather from political cowardice.

Health Reform 2013