If you ever want to rekindle your hope for American medicine, spend time with medical students. These bright, energetic minds are going into medicine for all the right reasons — to help people, relieve suffering and find new ways to cure illness and eradicate disease.

Their idealism is a pleasure to behold, particularly to a veteran physician like me. Yet I’m painfully aware of how our current health care ‘system” can undermine students’ idealism, especially if they see no alternative.

Fortunately, a better alternative is waiting in the wings: a single-payer, improved Medicare-for-all program. Most Americans, including 59 percent of physicians, want access to an improved Medicare. I’m pleased to report that our physicians-in-training are strong supporters of this truly universal, comprehensive and affordable alternative.

Why? Even before they graduate, today’s medical students learn how our Byzantine, antiquated system of patchwork private insurance undermines medical care. They recognize an imperative to correct social injustice, for both moral and pragmatic reasons.

Medical students learn that as practicing doctors they’ll be dealing with dozens of different insurance schemes, each with its own rules, paperwork and bureaucratic headaches.

As physicians-in-training, they encounter patients who have delayed surgery until they qualified for Medicare at age 65 — often with more difficult and sometimes fatal complications as a result. They meet grandmothers who have had to decide between paying for medications for their hypertension and paying the rent.

They see patients with employer-sponsored health insurance get sick, lose their job, lose their insurance and declare bankruptcy. In fact, medical expenses are the most common cause of bankruptcy.

Like everyone else, medical students are shocked when they see these inequities and inefficiencies. They believe your wealth should not determine your health and that poor health should not be able to destroy your wealth. And, of course, they’re right.

I recently had a chance to discuss these issues with students at both of the major medical schools in town. Just last month the new St. Louis chapter of Physicians for a National Health Program brought in Dr. Garrett Adams, PNHP’s national president, and Dr. Carol Paris, a single-payer advocate from Maryland, to speak with students at those schools.

The sessions were co-sponsored by the American Medical Student Association, a long-standing supporter of a single-payer system that has about 30,000 members nationwide.

It was clear from our local meetings that growing numbers of our medical students reject our dysfunctional, insurance-based system. They want something better. Many understand there is a breathtakingly simple solution: fix the limitations in Medicare and provide it to every American. More than 30 percent of the health care dollar today is wasted on the administrative costs associated with the private health insurance industry; Medicare spent only 1.5 percent on administrative costs during 2011.

A landmark study in the New England Journal of Medicine (2003) showed that by replacing our fragmented, inefficient patchwork of multiple insurers with a single, streamlined, nonprofit agency like Medicare that pays all medical bills, our nation would save about $400 billion annually in reduced administrative costs — enough money to provide comprehensive, high-quality coverage to every American for no more than our nation spends now.

According to Gerald Friedman, professor of economics at the University of Massachusetts-Amherst in the March/April 2012 issue of Dollars and Sense, “a single-payer system would save as much as $570 billion now wasted on administrative overhead and monopoly profits.” Spending would increase by $326 billion from expanding coverage and adjusting Medicaid rates. Americans would net a savings of $244 billion, enjoy universal coverage and eliminate the dreadful scenarios described above. Disposable income would increase for 95 percent of Americans.

Because a single-payer system would possess enormous bargaining clout, it also would be able to rein in costs for pharmaceutical drugs and other medical supplies over the long haul.

I believe that adopting an “improved and expanded Medicare for all” is the best way for students and physicians to return to their mission of caring for our patients, rather than squandering our time navigating administrative barriers erected by insurance companies. And make no mistake — these are barriers to care, with dire consequences.

Although we spend more on health care per capita than any other country in the world, American life expectancy ranks 38th.

My colleagues and I came away from our student meetings confident that the future of medicine is in good hands. The medical students we met didn’t get lost in jaded political quagmires.

They know it’s inevitable. They just want it to happen now.

Me too.

Dr. Ed Weisbart is chairman of Physicians for a National Health Program—St. Louis.

Health care costs for a family of four covered by workplace health insurance will exceed $20,000 for the first time ever this year — $20,728 to be precise — according to a new study released Tuesday. That’s $1,335 more than in 2011.

A family of four will pay $5,114 in premiums for a preferred provider organization plan, a common type of health insurance, along with $3,470 in out-of-pocket costs like co-payments for doctor visits and prescription drugs, according to the report issued by Milliman, a firm that consults with companies on employee benefits. The remainder of the expenses will be paid by employers, though money spent on health care and other fringe benefits is money not spent on higher wages.

Relentless increases in health care costs, which the federal government says rose to $2.6 trillion in 2011, are squeezing employers, workers, families and government budgets every year.

Almost 50 million Americans had no health insurance as of the 2010 census, more people are going without medical care they need because of cost, employees are being asked to shoulder a greater share of the burden for health care costs while seeing their benefits scaled back, and more companies are dropping coverage for workers. Meanwhile, the United States falls behind other industrialized nations on measures of health care quality, in spite of all this spending.

Family health care costs grew by 6.9 percent between 2011 and 2012, slower than in previous years, but Milliman suggests there’s little comfort in that.

“The rate of increase is not as high as in the past but total dollar increase was still a record,” the report says. “The dollar amount of the increase overshadows any relief consumers might derive from the slowing percentage increase.” The health care reform law enacted by President Barack Obama in 2010 “has had only a limited effect” on health care costs, the report continues.

Spending on physician services will reach $6,647 and spending on hospital stays will rise to $6,531, making them the two biggest components of a typical family’s annual health care expenses, the report says.

Health care costs varied among the 14 metropolitan areas that Milliman analyzed. Miami and New York City are the most expensive, with costs about 20 percent higher than the national average. The report says that Phoenix, Atlanta and Seattle were the only three cities where annual costs are projected to be less than $20,000 this year.

With health care premiums rising three times faster than workers’ income, more and more unions have come to see the existing health care system as unsustainable, despite their best efforts at the bargaining table.

In Oregon, activists are responding by rejuvenating a dormant campaign to win a health care system that covers everyone—and pays for it by cutting out the insurance companies. The concept is called “single payer.”

This isn’t the first time that Oregon activists have tried to win single payer. Ten years ago, they put an initiative on the ballot, but despite initially promising polls, the measure was trounced—victim of a flood of insurance company money and the sharp opposition of the Oregon AFL-CIO, which called it a threat to union health plans.

Times have changed.

When Portland Jobs with Justice began making the rounds of local union halls in 2008, urging support for national single-payer legislation sponsored by Representative John Conyers, the response was generally sympathetic. The national AFL-CIO has endorsed single payer on principle, and current state President Tom Chamberlain has been a consistent supporter.

The current focus isn’t just gaining endorsements, however.

Three activists from the Vermont Workers Center toured Oregon in December at the invitation of local Jobs with Justice chapters to spread the word on how they won landmark legislation laying the groundwork for a single-payer health care system in their state.

Their essential message: take it to the grassroots. Don’t split hairs over policy analysis. Don’t try to win over legislators who have heard all the arguments but haven’t felt the heat from their constituents. Don’t even use technical terms like “single payer,” unless you’re talking to people who already know what it means.

Instead, talk about health care as a human right—something everybody should have, regardless of the state of their bank account or their immigration papers, their medical condition, their job, their age, race, or gender, or whether some insurance underwriter thinks they’re a “good risk.” Seek out the people in all walks of life who have been burned by the health care system, get their stories, and turn them into effective activists and advocates.

For three years Vermonters built support in every corner of the state through one-on-one surveys, photo petitions, and public meetings where politicians were invited to hear testimony, comparable to the Workers’ Rights Board hearings that are a standard part of the Jobs with Justice toolkit.

The Vermonters’ tour made a tremendous impact, from metropolitan Portland to rural communities in eastern Oregon. Not everyone agreed with every aspect of the VWC approach, but everyone was talking about it. By the end of January, a new statewide coalition had convened to “create a comprehensive, affordable, publicly funded, universal health care system serving everyone in Oregon and the United States.”

By April, the coalition had a name—Health Care for All-Oregon—and close to 50 affiliates, including several statewide unions, immigrant rights groups, and community organizations ranging from the Rural Organizing Project to Elders in Action to Sisters of the Road (which advocates for the homeless).
Some, like Physicians for a National Health Program (PNHP) and the Mad as Hell Doctors (whose cross-country tour in 2009 brought the message to a host of new audiences), make single payer their main focus. The majority of affiliates have other priorities, but have come to understand that the collapse of our health care system threatens everything else on their agenda.

The Oregon Latino Health Coalition, which has labored tirelessly under the radar to secure medical services for the state’s 150,000 undocumented, recognized immediately that the Health Care for All human rights framework provides an opportunity for open advocacy without being isolated or marginalized. In voting to affiliate, the Representative Assembly of the Oregon Education Association noted that the skyrocketing cost of teachers’ health benefits is draining money out of the classroom and has left the union increasingly vulnerable to attack.

State vs. National

For unions, perhaps the biggest sticking point has been the question of state vs. national legislation. When Congress passed the Affordable Care Act in spring 2010 and ended, for the time being, the prospect of any genuine national health care reform at the federal level, Portland Jobs with Justice made a strategic decision to pursue state legislation as a way to keep single payer before the public.

Working with state Representative Michael Dembrow (who is also a Teachers union officer and Jobs with Justice member), with activists from the 2002 initiative campaign, and with PNHP and the Mad as Hell Doctors, we drafted a bill that attracted a dozen legislative co-sponsors. In March 2011, supporters of the Dembrow bill staged a mass rally on the Capitol steps followed by a dramatic two-hour hearing before the House Health Care Committee. The legislation didn’t make it to the House floor, but it has more than proved its value as an organizing tool, energizing new activists across the state.

Some single-payer supporters question how far it can be implemented at the state level. They point to a host of federal laws and regulations that would need to be waived, and the difficulty of achieving the cost savings of a truly universal risk pool when the program stops at the state line.

This has in fact been a problem in Vermont, whose new law, while a giant step in the right direction, falls short of single payer. (Many Vermonters remain outside the risk pool, and funding, while administered by the state, still comes from multiple sources.) Unions with multi-employer Taft-Hartley health plans, which often cross state lines, worry that a statewide risk pool will not be viable enough to maintain the level of coverage they currently enjoy.

For this reason, Portland Jobs with Justice has made national legislation the ultimate objective, and has taken the position that the best union health plans set the standard by which any public plan should be assessed. Significantly, the “insurance exchange” provisions of the Affordable Care Act directly undermine Taft-Hartley trusts, by giving small employers a way to bypass unions and buy inferior, cut-rate insurance coverage for their workers. For unions, the Affordable Care Act is no solution: even if it survives the current Supreme Court challenge, its lack of cost controls and other internal contradictions will render it unworkable.

The challenge for us is to be ready with an alternative that has popular support, and the more states join Vermont in projecting such alternatives, the better.

Health Care for All-Oregon wants to bring everyone together to hammer out a strategy that works for all. The immediate task in Oregon, though, is not legislation but building the kind of mass base that changes the political climate in the state and makes legislation possible.

Efforts to pass single-payer bills in Vermont go back 20 years, but it was only after the Vermont Workers Center did three years of organizing around the principle of health care as a human right that they got results. Now that the Oregon coalition is up and running, we’ll see how much of Vermont’s game plan can be successfully exported.

Peter Shapiro is an organizer with Portland Jobs with Justice.

Join Healthcare for the 99% in recognizing Mental Health Awareness Month this May. Mental health is an integral part of overall health, and its prevalence and severity are yet another reason to demand single-payer healthcare. About one in six adults lives with a disorder of the brain such as depression, bipolar disorder, schizophrenia and post-traumatic stress disorder. The pain caused by mental illness radiates even further, through family, friends, neighbors, co-workers and more, into the fabric of our society. Mental health is also a key issue for our veterans, many of whom return home with PTSD caused by violence seen and experienced in combat. The pervasiveness of mental illness calls for a single-payer healthcare system, as such a system would finance mental healthcare for many of those who cannot afford it on their own.

So if one in six adults lives with a mental illness, why don’t we all know a lot of mentally ill people? You do. However, stigma prohibits many people from speaking openly about their mental health problems. Our language is riddled with offensive terminology (“schizo”, etc). Incorrect ideas about mental illness abound, such as the idea that mentally ill people are obviously strange or abnormal, or that mentally ill people will never recover from their illnesses.

Contrary to popular belief, some mental illnesses do in fact go away with treatment, and those who do have lifelong illnesses can still live extremely normal lives. However, this requires treatment, generally a combination of medication and therapy, and that requires insurance and money. Mental illness left untreated often leads to poverty and eventually to homelessness. When people cannot get out of bed or perform daily activities, they soon end up out of work, and this can snowball into homelessness and abject poverty. All of this can be prevented by treatment of the mental illness. However, therapy can cost two hundred dollars a session or more, and even good insurance often covers only 12 sessions a year. This is absolutely inadequate, and yet further sessions are often prohibitively expensive. Add to that the cost of medication, which drug companies drive up as much as possible by patenting their drugs so that no generic form is made, causing some drugs to cost as much as $8 per pill without insurance, or when insurance companies refuse to pay. Additionally, since in American society health insurance is tied to jobs, when one loses one’s job one loses health insurance as well, compounding the problem: exactly when the mental health treatment is most needed, all funding for it is taken away. It’s simple: some people can afford treatment and can lead relatively normal, healthy lives, and others who cannot afford treatment get sicker and sicker as society turns away.

It has also been established that poverty and homelessness can themselves lead to mental health problems, as the impoverished and homeless face factors the rest of us don’t. The stress of having many unpaid bills or not having food or shelter, as well as a lack of security for the future, can be the catalyst for a mental illness, or can exacerbate an existing one. The homeless are also far more likely to be victims of crime and trauma. The poor and the homeless generally do not have the money for early treatment that can stop the disorder from becoming severe (or for any treatment at all).

When mental illness becomes severe, with a person of any socioeconomic class, suicide is always a concern. A death by suicide is always a tragedy, yet becomes even more tragic when one realizes how preventable these deaths are. Ninety percent of those who die by suicide have a psychiatric illness that is not only diagnosable, but also treatable. But if people are denied the means to treat their mental health problems, they are often quite literally being left to die.

America needs single-payer healthcare. It will ensure that all of the mentally ill get the treatment they deserve and that they can live normal, successful lives. Insurance companies must stop letting people fall through the cracks by refusing to provide adequate mental health benefits. When single-payer healthcare becomes a reality, the mentally ill will have the support and resources to live the fruitful and happy lives they were meant to live.

Our medical and medical insurance ethos sadly is that sick people are good for business. That health care should be a money making machine is the mentality of a nation tricked into believing for-profit health care and medical insurance are superior to national health care as practiced in every other industrialized nation. In contrast the ethos of national healthcare is to keep people healthy in order to save buckets of money. It works. Every nation with national health care delivers health care for all at a fraction of the cost Americans pay. The incentives of public health care are opposite to those of a for-profit system.

I am a WWII veteran. My response to conservatives who are certain government can’t do anything right is that I am grateful for VA health care and for Medicare, both run by “the government” and paid for in the same way we pay for public education and the fire department, i.e., through public taxation.

“In the box” thinking places profit over the health of the nation. It prevents Americans from having full medical insurance from day one. Unlike citizens of every other industrialized nation, Americans must wait until old age to get 80% rather than total coverage as in other nations.

We are the only industrialized nation in the world in which parents are forced to advertise in the local newspaper that an account has been set up at a local bank to accept donations to pay for treatment of a child with life threatening cancer. No Canadian, French, or English parent would need to “pass the hat” or to ask for charity in order to save the life of a child. In other nations it is never “charity”, but “healthcare with dignity.”

We are the only nation where private insurance companies can restrict services to a particular state forcing clients to travel thousands of miles for treatment, or dictate where a client can get a blood transfusion, or deny payment for a bone marrow donor search.

“Why should I pay for the health care of my neighbors?” is the outraged cry of conservatives. With national healthcare the answers are: (1) My neighbors pay for mine. (2) It is the ethical thing to do. (3) costs are half or less than half of what we pay now and would cover everyone.

Every other advanced nation pays a fraction of what the U.S. does. Canadians pay $3,000 per capita to cover everyone while the U.S. pays $7,000 per capita and leaves out 47 million plus an equal number of at risk underinsured souls. European nations pay a third of what we do with better outcomes.

A National health care system would make us feel good about ourselves. At last we could say with pride to the world, “We are willing to pay for the healthcare of our neighbors just like everyone else.”

Live in Oklahoma and want to get involved? Ron du Bois is one of the founders of Oklahomans for Universal Health Care and the convener of Stillwater Speaks Health Care Committee. Please contact Ron at (405) 377-2524 or duboisr@sbcglobal.net for more information.

Doctors, nurses, patients, senior citizens, anti-poverty advocates, faith leaders and medical administrators joined Assemblymember Richard Gottfried and Senator Thomas Duane in unveiling an updated and revised single payer legislative proposal for New York State. More than 70 state lawmakers are cosponsors

Assemblymember Gottfried had initially drafted a single payer plan for New York in the early 90s. The revised legislation incorporates changes that have been made in the state’s oversight of health care in the interim, advances in how to provide medical services, and the recent federal changes in the health care system. The legislation builds upon the momentum from last May when Vermont became the first state to enact a universal health care system which the Governor plans to make a single payer system, where on programs pays all bills.

“The current system doesn’t work for patients or health care providers, or for the employers, individuals, and taxpayers who pay for care and coverage today,” said Assembly Health Committee Chair Richard N. Gottfried, author of the bill. “We can get better coverage, get all of us covered, and save billions by having New York provide publicly-sponsored, single-payer health coverage, like Medicare or Child Health Plus but for everyone.”

“Our current health insurance system is driven by uncertainty. Will my family have coverage? Can we afford it?,” said Senator Duane. “Single-payer is about removing that fear from peoples’ lives. It will allow all New Yorkers the same comfort that our seniors get from Medicare, and that our veterans get from TRICARE. It will allow entrepreneurs to worry about product innovation, not health insurance costs. It is time for single-payer in New York.”

Joining Assemblymember Gottfried and Senator Duane at the press conference were Katie Robbins of Health-Care Now!, Vito Grasso, Executive Vice-President of the NYS Academy of Family Physicians, Dr. Asiya Tschannerl of Physicians for a National Health Program, Mark Dunlea of Single Payer NY / Hunger Action Network of NYS, Shaun Flynn of the NYS Nurses Association, and Rev. Bebb Stone.

Assemblymember Gottfried convinced lawmakers four years ago to fund a study of the most cost-effective way to provide health care to all New Yorkers. The answer was single payer, which would reduce overall health care expenditures in New York by $20 billion annually by 2019. The state study said that single payer would be $28 billion cheaper annually by 2019 than the insurance mandate enacted by Congress. In addition to saving money, single payer was the only plan that guaranteed that everyone would have access to health care services.

“The Presbyterian Church U.S.A. has called single payer health care reform ‘a moral imperative’ since 2008. If I want health care coverage for myself ( and I do), how can I not want it equally for my neighbor whom I am commanded to love as myself?” asked Rev. Bebb Stone. “We believe that the value of persons requires that each person have full access to essential services without regard to ability to pay and on terms that enhance the dignity of the individuals” according to the 2008 resolution.

The proposal would provide comprehensive health coverage for all New Yorkers. Every New York resident would be eligible to enroll, regardless of age, income, wealth, employment, or other status. There would be no premium, deductibles, or co-pays. Coverage would be publicly funded. The benefits will include comprehensive outpatient and inpatient medical care, primary and preventive care, prescription drugs, laboratory tests, rehabilitative, dental, vision, hearing, etc.

“Even if the recent federal health insurance mandates survives the legal challenges, it fails to provide health care coverage to everyone and is financially unsustainable. Tens of millions of Americans will discover that the insurance they are forced to buy fails to pay for the health services they will need. Everyone knows that there is a better solution – single payer, expanded and improved Medicare for all – and New York should be the first one to put it in place,” said Mark Dunlea, Executive Director of Hunger Action Network.

“The simplest and quickest way to reduce health care costs is to eliminate the money wasted on health insurance, its profits and administrative costs, and the bureaucratic barriers it presents to health providers and consumers. If we got rid of insurance companies nationally, the annual savings would be more than $400 billion,” added Dunlea, chair of the state legislative committee of Single Payer New York, an umbrella organization.

“As a physician working in the Bronx, I see every day the profound limits of medicine when patients must ration their care due to high copays and deductibles,” said Dr. Asiya S. Tschannerl with Physicians for a National Health Program. “And too many patients have told me that they earn just a few dollars too much to qualify for Medicaid, and are now facing the horrible dilemma of – “do I reduce my income? or go without insurance since I couldn’t afford it.” Enough is enough. We need a truly universal healthcare system like every other industrialized nation on this planet. Healthcare is a human right, not a privilege! A Single Payer expanded and improved Medicare for all would guarantee healthcare for all,” added Tschannerl, a member of Doctors for the 99% and Occupy Wall Street.

“We must end funding the waste, greed, and corruption of the health insurance companies, and move these resources to funding and providing actual healthcare. Insured or not, the Affordable Care Act pits people’s needs against profits for corporate-run healthcare. We can reverse this trend and recognize the right to healthcare by implementing the New York Health bill,” stated Katie Robbins of Healthcare-NOW! NYC.

“The Nurses Association firmly supports the establishment of a more equitable coverage system that directs scarce healthcare dollars towards providing universal access to high quality, cost-efficient health care for all New Yorkers – regardless of their age, income, health or employment status,” according to Deborah Elliott, RN, MBA, Deputy Executive Director, New York State Nurses Association.

Under the revised bill, health care would no longer be paid for by insurance companies charging a regressive “tax” – premiums, deductibles and co-pays – imposed regardless of ability to pay. Instead, New York Health would be paid for by assessments based on ability to pay, through a progressively-graduated payroll tax (paid 80% by employers and 20% by employees, and 100% by self-employed) and a surcharge on other taxable income. A specific revenue plan, following guidelines in the bill, would be submitted to the Legislature by the Governor.

Federal funds now received for Medicare, Medicaid, Family Health and Child Health Plus would be combined with the state revenue in a New York Health Trust Fund. New York would seek federal waivers that will allow New York to completely fold those programs into New York Health. The “local share” of Medicaid funding – a major burden on local property taxes – would be ended.

Private insurance that duplicates benefits offered under New York Health could not be offered to New York residents.

Assemblymember Gottfried, in his official sponsor memo, noted that “New Yorkers have experienced a rapid rise in the cost of health care and coverage in recent years. This increase has resulted in a large number of people without health coverage. Businesses have also experienced extraordinary increases in the costs of health care benefits for their employees. An unacceptable number of New Yorkers have no health coverage, and many more are severely underinsured.

“Health care providers are also affected by inadequate health coverage in New York State. A large portion of voluntary and public hospitals, health centers and other providers now experience substantial losses due to the provision of care that is uncompensated.”

For decades, the attempts at health care reform have aimed to increase access. The United States is one of the few industrialized nations in the world that does not provide universal health care to its citizens. And repeatedly, those who oppose it have been forced to argue that access isn’t the problem some make it out to be. Why?

The emergency department, they say. After all, it is a commonly held belief that no one can be denied care there. So — in essence — everyone can get free health care if they need it. We have a universal system after all.

That, of course, is not true.

It’s not even close. Let’s start with the idea that emergency rooms must provide you care.

What’s important to remember is that you can’t be refused emergency care. That’s because the Emergency Medical Treatment and Active Labor Act (EMTALA) requires that any hospital that takes Medicare or Medicaid must check you for emergent conditions and treat them if they exist. Since nearly every hospital in the country takes federal funds from one of these programs, nearly all hospitals are subject to EMTALA.

But “emergency medical condition” has a pretty narrow definition. It includes active labor for women and acute conditions that would cause death, serious bodily organ harm or serious bodily function impairment if they were not treated right away.

If politicians are meaning to say that women have universal access to delivery care, then I suppose there’s an element of truth to that. But there’s no guarantee of prenatal care in the emergency department.

If they are saying that we have universal access if we’re acutely having a heart attack, then I suppose there’s truth to that as well. But there’s no such access for lipid panels, stress tests or prescriptions for cholesterol medications that might help you avoid the heart attack in the first place.

If you’re acutely obstructed by massively advanced colon cancer, it’s likely you can get emergency surgery to end the blockage. But your cancer is likely too far advanced to cure at that point. Moreover, you’re not going to get chemotherapy in the emergency department nor could you have gotten the colonoscopy that might have detected the cancer far earlier.

You can’t get preventive care in the emergency department. You can’t get screened for a host of disorders. You can’t get treatment for your depression there or really for any chronic mental disorders. You can’t get help with your child’s autism, ADHD or developmental delay.

And even if you could, it wouldn’t be free.

That’s the second and perhaps more misunderstood part of this emergency department misconception. The costs of treatment in the emergency room are not quickly dismissed or written off. You’ll get that emergent care, but you’ll also be charged for it.

And hospitals aren’t going to let that go easily. A recent article in the New York Times detailed how Accretive Health, a medical debt collector, is using aggressive tactics such as confronting patients in their hospital beds to collect the money owed for even emergent care. The article also describes how collection agencies have long been used to go after patients after they’ve left the treatment facility. In some cases, patients were even confronted and stalled by debt collectors as they entered the emergency department on some later occasion so that the company could collect on old bills before more care was offered.

An even more recent story covered by Kaiser Health News and NPR reported on a family of four sued by its local nonprofit hospital. The family earned about $25,000 a year — below the poverty line — but the parents did not qualify for Medicaid in Ohio. It seems that the hospital had sued almost 1,600 people for unpaid medical bills from 2009 to 2011. Further, the piece reported, “[w]hile Ohio has a law that prevents foreclosures based on medical debt alone, it is legal for hospitals to garnish patient wages, attach bank accounts and get a lien on any future earnings, including from the sale of a house.”

It might even be worse in North Carolina, where a group of nonprofit hospitals sued 40,000 patients from 2005 to 2010. This is problematic because nonprofit hospitals are supposed to provide a certain level of charity care in exchange for their tax-exempt status. A recent review found that three hospitals in Illinois were providing a very small amount of care for free or at discounted rates. This has led to a number of facilities losing their nonprofit status and legislators to try to pass new laws requiring specify charity care minimums for nonprofit status.

Before you get all riled up, I understand that hospitals need money to run. The American Hospital Association reports that hospitals lost upward of $40 billion in unpaid bills in 2010 alone. I’m not suggesting care should be given out freely or that hospitals should be forced to operate at a loss. But let’s acknowledge that patients will be held accountable for the costs of their care, even in the emergency room. If they can’t pay those bills, their credit can be ruined. Medical bills are a very significant cause of bankruptcy in this country.

So it’s true that an emergency room won’t let you die if you show up at the door, but short of that, you can’t get care for a host of medical issues. And, while they will provide that lifesaving care to you even if you have no insurance and no money, they will send you a bill. And if you can’t pay, it may cause you, and your family, financial ruin.

That’s a far cry from universal health care, and nothing to brag about.

Editor’s note: Dr. Aaron E. Carroll is an associate professor and vice chair of health policy and outcomes research in the department of pediatrics at the Indiana University School of Medicine. He blogs about health policy at The Incidental Economist and tweets at @aaronecarroll.

Having trouble finding a doctor?

You’re not alone.

Tens of millions of adults under age 65 – both those with insurance and those without – saw their access to health care worsen dramatically over the past decade, according to a study abstract released Monday.

The findings suggest that more privately insured Americans are delaying treatment because of rising out-of-pocket costs, while safety-net programs for the poor and uninsured are failing to keep up with demand for care, say Urban Institute researchers who wrote the report.

Overall, the study published in the journal Health Affairs found that one in five American adults under 65 had an “unmet medical need” because of costs in 2010, compared with one in eight in 2000. They also had a harder time accessing dental care, according to the analysis based on data from annual federal surveys of adults.

“For decades, Americans have been facing costs rising well above wage levels,” said Lynn Quincy, senior policy analyst for Consumers Union, a nonpartisan group. “These are real families. . . . It’s very concerning.”

The 2010 health care law, which will expand health coverage to 30 million people starting in 2014, won’t necessarily solve all those access problems, the study said. That’s because the law, which is under review by the Supreme Court, may not alter the trend toward private insurance policies with larger deductibles and higher co-payments or address some of the barriers within public coverage. While the law does increase payments temporarily to primary care doctors who see people covered by Medicaid, it will not force more doctors into the program, or require states to provide dental coverage to adults.

Quincy noted that the law does offer several new strategies, such as new payment methods to control rising costs, which could help improve access, but there’s no guarantee they will work.

Read more here: http://www.mcclatchydc.com/2012/05/07/147985/health-care-increasingly-out-of.html#storylink=cpy#storylink=cpy

On May 4, 2012, the Missouri Health Care Policy committee gave a formal hearing to MO HB1405, a bill that would establish a MO state-wide single payer health plan. Two Physicians for a National Health Program physicians testified and one more wrote a strong letter in support. The bill has been consistently advanced thanks to the efforts of Missourians for Single Payer.

The first video below is the introduction of the bill from Rep. Mike Brown of the Kansas City area; the second is the testimonies, running a total of about 15 minutes. A big shout-out of thanks to Rep. Brown and all of our great co-sponsors.

We have to really thank Progress Missouri, a multi-issue progressive advocacy organization, for recording this and so generously sharing it with us all.

Ed Weisbart MD
PNHP-STL, Chair

Michael Brown Introduces HB1405

Members of the St. Louis chapter of Physicians for a National Health Program testify in support of single payer for Missouri

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