Note: What follows is some of the media coverage given to parallel marches and rallies held on Monday, Jan. 9, in Sacramento and Los Angeles protesting the continuing injustices in U.S. health care and calling for a universal, single-payer health system. The protests were sponsored by the California Health Professional Student Alliance (CaHPSA), the Campaign for a Healthy California, Occupy LA, Occupy Sacramento, PNHP California and other groups. In Sacramento, the rally was immediately followed by student lobbying efforts in the state Capitol.

Health care students demonstrate for single-payer insurance

By Special to The Enterprise
The Davis Enterprise (Davis, Calif.), Jan. 10, 2012

Wailing a mournful tune, an eight-piece New Orleans funeral-style jazz band led about 500 California health professional students and their supporters Monday down Capitol Mall to the north entrance of the state Capitol in Sacramento.

Carrying two mock coffins, they demonstrated their support for a single-payer “Medicare for all” reform to the state’s health insurance laws.

The reason for the coffins was that there are an estimated 1,000 deaths per month in California due to lack of access to health care, demonstrators said. In this state, nearly 7 million do not have health insurance, a major reason why many have difficulty finding care.

The Davis contingent included Mary Zhu, M.D.; Paul Ulbrich, D.O., a retired emergency room physician; Millie Braunstein, R.N., Ph.D., the state vice chairwoman of Health Care for All; and Joan Moses, former president of the Davis League of Women Voters.

The demonstrators, who included more than 30 from Davis and the UC Davis medical school, were mainly composed of medical, nursing, pharmacy and public health students.

Dr. Henry Abrons, chairman of Physicians for a National Health Plan — California, a retired intensive care doctor, observed that he often may treat an asthma, cardiac or respiratory patient on life support in the intensive care unit who was seen in the ER a few weeks earlier, but couldn’t afford to fill a prescription, or have follow-up care by a primary care specialist.

Senate Bill 810, authored by Mark Leno, D-San Francisco, which was positively voted out of the Health Committee last spring, is due for a crucial vote in the Senate Appropriations Committee on Jan. 17. It would establish the process for building a single-payer health insurance agency in California, similar to the federal Medicare agency. Assemblywoman Mariko Yamada, D-Davis, is a co-author of the bill.

Leno said private and public employers have found that their health care premium rates have increased an average of 153 percent over 10 years, compared with an inflation rate of 29 percent. Many speakers at the rally pointed out that the United States spends far more for health care than any other advanced economy, but many public health statistics show poorer outcomes.

SB 810 is designed to use health care dollars more wisely, while providing universal coverage, supporters said.

***
Rally procession brings attention to health coverage

By Kathy Robertson, Senior Staff Writer for Sacramento Business Journal, Jan. 9, 2012

Nurses, medical students, seniors, doctors and members of the Occupy movement rallied in downtown Los Angeles and at the Capitol in Sacramento on Monday to rouse support for guaranteed health coverage for all Americans.

The local rally started at Third Street and Capitol Mall at 11 a.m. and progressed to the Capitol steps at noon. The Occupy movement planned to target insurance denials by health plans.

A New Orleans-style funeral procession remembering those who die every year without coverage gave way to a rally in support of Assembly Bill 810, which seeks to establish a single-payer system in California.

The bill was suspended on the Assembly floor late last session by author Mark Leno, a Democrat from San Francisco. Proponents argue the bill would address California’s budget emergency by lowering state expenditures through a more rational, more cost-effective health care system. They have been trying for at least eight years to get a single-payer system into law. Health insurers oppose it.

The bill would establish a state-administered single-payer system to provide health coverage to all Californians without regard to income or employment status. It would establish a new state agency under control of an appointed healthcare commissioner to run the program.

It’s unclear how the program would jibe with federal health reform, although the federal law allows states to opt out of insurance exchanges in 2017 and get a waiver for innovative alternatives.

***

Supporters Of Single Payer Insurance System March In Downtown LA
CBS Los Angeles, Channel 9 television news, Jan. 9, 2012

Finally these additional sources of coverage:

PNHP’s Dr. William Bronston offers a gallery of photographs of the Sacramento march and rally.

Indymedia’s coverage of the Sacramento march and rally includes a photo of PNHP’s banner at end.

Thanks to PNHP for pulling this together.

After wincing a bit from the free flu shot, my young patient turned to me and said, “What you’re doing here is awesome – it’s so hard get health care!”

“Here” happened to be New York City’s Zuccotti Park in mid-November, the epicenter of Occupy Wall Street, just days before the encampment was broken up by hundreds of Mayor Michael Bloomberg’s armor-clad police in the dead of night. But it could have been anywhere in the United States.

Health care is in fact increasingly unaffordable for the 99 percent. More than 50 million Americans lack health insurance and thus reasonable access to treatment. A recent Harvard study showed about 45,000 excess deaths annually can be linked to lack of insurance.

Even people with insurance face formidable barriers to care like rising co-pays and deductibles. As a result, they are putting off care, getting sicker and ending up in our emergency rooms with serious complications – often facing crushing medical bills later.

This increased “cost sharing” by patients helps explain this week’s report by U.S. Health and Human Services showing the use of medical services has slowed. People can’t afford it.

But lack of care invites serious illness or worse. That’s part of the reason why I and scores of other doctors, nurses, medical students and social workers came down to Zuccotti Park and volunteered our time to give out free flu shots.

But I confess that my desire to help went beyond the Samaritan impulse of preventing illness and aiding the sick, an impulse that, remarkably, still persists among our nation’s health professionals despite the toxic atmosphere of our for-profit health system.

I and many others were impelled to take action because the Occupy movement struck a chord with us. We’re angry that our health economy – like the overall economy – has more than sufficient resources to take care of all of us, but the resources are siphoned off by profit-driven corporations in the interest of “the 1 percent.”

Working on the front lines of health care, we see that economic and social inequalities in our present system make our patients sick. The lack of jobs and decent wages, affordable housing, healthy food and quality education takes a heavy toll on the mind and body, and each workday we see the casualties mounting.

We also recognize that the private health insurance industry and Big Pharma exemplify one of the Occupy movement’s central themes: that unchecked corporate greed tramples human needs. Need I recite the billions in profits these companies make each year, or the outlandish salaries of their CEOs, based on skyrocketing premiums and denials of care?

The private insurers, with all the bureaucracy and paperwork they inflict on us, add enormous costs to the delivery of health care, but add no value. Yet, unfortunately, they remain at the very center of our health system under the federal reform law.

There is a clear solution to our health care crisis. Put patients ahead of corporate greed and establish a nonprofit single-payer health care system – an expanded and improved Medicare for all – with no co-pays or deductibles.

A single-payer system would provide high-quality, comprehensive care for everyone – without exception – for no more money than our nation is paying now. We’d save about $400 billion annually due to lower administrative costs. Such a system would also give us tools to rein in costs, like the ability to negotiate lower pharmaceutical prices.

While helping out at Zuccotti Park, I was gratified to hear others chant a slogan I and millions of other Americans have long embraced: Health care is a human right. We will not stop fighting until that principle is enshrined in law and delivered in practice.

Now that will be truly awesome.

Mary O’Brien, M.D., practices internal medicine and serves on the faculty at Columbia University’s College of Physicians and Surgeons in New York. She is a national board member of Physicians for a National Health Program and co-editor of the book 10 Excellent Reasons for National Health Care.

With media attention focused on the debt-ceiling drama in Washington, and with so many Americans rightly preoccupied with the frightening level of joblessness and bleak state of the economy, it might seem strange to urge a national celebration of Medicare’s 46th anniversary this Saturday, July 30.

After all, if we’re to believe top lawmakers, Medicare is part of the problem, right? Aren’t we supposed to be talking about raising the eligibility age from 65 to 67, reducing benefits, increasing seniors’ co-pays and deductibles or, even more dire, abolishing the program altogether and handing seniors vouchers to buy private insurance?

Wrong. Despite its market-obsessed detractors and those who would weaken the program in the name of deficit reduction, Medicare is the solution, not the problem. More precisely, an improved Medicare for all – a single-payer health system – is the right prescription for treating not only our health care woes, but our ailing economy as well.

How so?

The biggest albatross around the neck of our health care system is the private insurance industry, which remains firmly entrenched under the new federal health law.

Thanks to companies like UnitedHealthcare, WellPoint, Aetna, Humana and Cigna, our nation’s patients, businesses, and health providers are chronically tormented by skyrocketing premiums, denials of care, endless paperwork and bureaucracy, and the spectacle of obscene CEO salaries and insurance company profits.

And what does this so-called system get us? Fifty-one million people who have no coverage at all; 45,000 annual deaths linked to lack of coverage; a million personal bankruptcies annually (62 percent of the total) linked to illness or medical debt; and World Health Organization indicators that put us in 37th place globally, even though we spend twice as much per capita as any other nation.

Waste in our system is staggering. Research shows about 31 cents of each U.S. health care dollar is currently spent on administration, over half of which is unnecessary. That translates into $400 billion wasted annually. If we recaptured that money and applied it to clinical care – as we could under a single-payer system – we’d be able to assure everyone comprehensive, first-dollar, high-quality coverage.

So how does this relate to Medicare? As it happens, Medicare is an excellent model for a more rational, single-payer alternative to our present dysfunctional arrangements.

Medicare works. Patients go to the doctor or hospital of their choice. It’s efficient: its overhead is less than 3 percent, less than a quarter of private insurers’. Costs rise more slowly in Medicare than in the private insurance sector.

Medicare isn’t perfect, of course. The program can be empowered to negotiate with drug companies for lower prices. The deductibles and co-pays can be eliminated. Its funding can be augmented from general revenues or a miniscule tweaking of the general payroll tax rate.

But thanks to Medicare, the health and economic security of millions of seniors, the severely disabled, and our nation’s families have dramatically improved. It should not be weakened or destroyed. Those who advocate doing so will reap a whirlwind of popular rage, as GOP Rep. Paul Ryan, an exponent of ending Medicare, has found out.

In such an environment, the obvious approach of President Obama and Congress should be to join the American people in embracing Medicare, not to cut it. But right-wing ideologues, with personal assists from the president himself, have forced a debate on the wrong issue: the debt ceiling, as opposed to enhancing the health status of the American people.

The paradox in this flawed debate is that the solution to our nation’s fiscal problems would be greatly simplified by the creation of a streamlined, efficient and high-quality single-payer Medicare-for-all program. Data suggests that if we had a single-payer system like other industrialized nations, we’d currently have a federal budget surplus.

The 46th anniversary of Medicare should be a time to celebrate its achievements and to strengthen it by expanding it to all.

Quentin D. Young, M.D., is national coordinator of Physicians for a National Health Program (www.pnhp.org) and former chief of internal medicine at Cook County Hospital in Chicago.

If McDonald’s receives health care waivers from HHS, Vermont should too

Petition: http://action.firedoglake.com/VThealthcare

Physicians for National Health Program (PNHP) and Firedoglake.com are joining forces to urge the Obama administration to grant Vermont the waivers it needs to implement its new health care system.

“Vermont Governor Peter Shumlin signs a historic piece of legislation today that could put Vermont on the path to being the first state with a truly progressive universal health care system” said Dr. Garrett Adams, President of Physicians for a National Health Program. “The people of Vermont, including the state’s doctors, nurses and other health professionals, have inspired the entire nation by their unflagging dedication to winning a publicly financed, comprehensive and equitable health care system based on the principle that health care is a human right.”

If fully implemented, the Vermont legislation would integrate the many pieces of a fractured health insurance system into a more effective unified system for the people of Vermont. The plan would incorporate some of the proven cost control features of a single payer system, such as simplified administration and negotiation for fair prices for pharmaceuticals.

Yet Vermont won’t be able to fully achieve this goal without multiple waivers from federal health care programs such as Medicaid, Medicare, Medicare Part D and the new Affordable Care Act (ACA).

“Vermont’s new law will reform health care at the state level and take a massive step towards a fairer more, efficient system,” said Jon Walker, Senior Policy Analyst at Firedoglake. “If the Obama administration does not grant all the waivers Vermont needs, the system could fall short of its true potential. Large segments of the state’s population wouldn’t be properly brought into the new unified plan.”

During a speech given at the National Governor’s Association earlier this year, President Obama endorsed the idea of giving states the freedom to pursue other health care alternatives. Now that Vermont is ready to move forward with a better plan, the Administration can make good on its commitment. The Obama Administration should instruct federal agencies to provide Vermont with maximum flexibility in the coming years.

“There is a strong desire by single payer supporters in many states to pass legislation that would create a truly universal and publicly funded health system in their state,” said Dr. Margaret Flowers, Congressional Fellow for Physicians for a National Health Program. “They have been watching the efforts in Vermont closely. Considering that 80% of Democrats support the single payer approach, I expect that this will be an important campaign issue and that voters will be asking the President to come through on his stated support for flexibility waivers.”

“We’re thrilled to be working with Physicians for National Health Program on this project” says Firedoglake founder Jane Hamsher. “HHS has granted waivers from the health bill to 30 corporations, including McDonald’s, so that they could provide inferior benefits to their employees than the ACA requires. All we’re asking is that if they can do that, then they ought to allow states like Vermont to cover more people and provide better benefits than they would have under the ACA.”

Firedoglake is one of the leading political blogs on the Internet, with an average 100,000 readers per day. FDL has waged successful campaigns for student loan reform, an audit of the Federal Reserve system, and improvement of PFC Bradley Manning’s pre-trial detention conditions.

PNHP is a nonprofit research and education organization of 18,000 physicians, medical students and health professionals who support single payer national health insurance.

Many people move to Vermont in search of a slower pace; Dr. Deb Richter came in 1999 to work obsessively toward a far-fetched goal.

She wanted Vermont to become the first state to adopt a single-payer health care system, run and paid for by the government, with every resident eligible for a uniform benefit package. So Dr. Richter, a buoyant primary care doctor from Buffalo who had given up on New York’s embracing such a system, started lining up speaking engagements and meeting with lawmakers, whom she found more accessible than their New York counterparts.

“I wrote a letter to the editor, and the speaker of the House called me up to talk about it,” Dr. Richter, 56, recalled recently. “It was astounding. In New York, I couldn’t even get an appointment with my legislator.”

Twelve years later, Dr. Richter will watch Gov. Peter Shumlin, a Democrat, sign a bill on Thursday that sets Vermont on a path toward a single-payer system — the nation’s first such experiment — thanks in no small part to her persistence. Though scores of people pushed for the bill, she was the most actively involved doctor — “the backbone,” Mr. Shumlin has said, of a grass-roots effort that helped sway the Democratic Legislature to pass it this spring even as other states were suing to block the less ambitious federal health care law.

“We wouldn’t be where we are without Deb,” Mr. Shumlin said in an interview. “She’s made this her passion. And like anyone that’s making significant social change, she has qualities of persuasiveness and leadership and good judgment that are hard to find.”

As in all states, the cost of health care has increased sharply in Vermont in recent years. It has doubled here over the last decade to roughly $5 billion a year, taking a particular toll on small businesses and the middle class. All 620,000 of the state’s residents would be eligible for coverage under the new system, which proponents say would be cheaper over all than the current patchwork of insurers. A five-member board appointed by the governor is to determine payment rates for doctors, what benefits to cover and other details.

But much remains to be worked out — so much that even under the most optimistic projections the plan might not take effect until 2017. Most significantly, Mr. Shumlin still has to figure out how much it will cost and how to pay for it, possibly through a new payroll tax. Whether he will still be in charge by 2017 is among the complicating factors.

“If we had the exact same Legislature and the same governor we could get it done,” Dr. Richter said. “It’s a big if, because the opposition has a ton more money to convince people that the governor is evil and this is socialized medicine and all kinds of other scary stuff.”

The opposition will probably include insurance companies, drug makers and some employers who say there are too many unknowns. Many doctors, too, are wary of the change and what it might mean for their income. Dr. Richter said she believed a “slim majority” of the state’s 1,700 licensed physicians were supportive.

“One of the bigger worries I have is we’ve had all this hoopla and nothing’s going to happen,” she said at a coffee shop here recently on a rare quiet afternoon. “But it might also be helpful to us, because it’s going to be hard for any opposition to be steadily pushing for seven years.”

The federal health care law has complicated Vermont’s plans, requiring the state to first create a health insurance exchange to help residents shop for coverage by 2014. The state would then need a federal waiver to trade its exchange for a government-run system.

Dr. Richter said she embraced the idea of a single-payer system as a young doctor in Buffalo, where many of her patients put off crucial treatments because they were uninsured. As a medical student, she saw a patient with a life-threatening heart infection caused by an infected tooth that had gone untreated because he lacked dental insurance.

“He was in the hospital for six weeks, and I was like, ‘This makes no sense,’ ” she said.

She went to a meeting of Physicians for a National Health Program, a group that advocates for a national single-payer system, and started researching the concept. Before long she became a vocal advocate, even becoming president of the physicians’ group, and moved to Vermont.

John McClaughry, a former Republican state senator who is against the new law, said Dr. Richter meant well but did not understand the “long-term damage” it would wreak. In particular, he said the law would drive away businesses that did not want to help pay for it.

“She’ll tell you that putting in single-payer will attract businesses from all over the place,” said Mr. McClaughry, vice president of the Ethan Allen Institute, a conservative research group. “I don’t think she has any appreciation of business decisions at all.”

Since moving with her husband and two sons to a rambling old house within view of the State House, Dr. Richter has given about 400 talks on the single-payer concept, tutored lawmakers in the State House cafeteria and testified before the Legislature more times than she can remember. Once, she presented a printout of all the insurance companies her small practice in Cambridge had billed over five years.

“It was like 190 pages long,” she said. “Here we were, this tiny rural clinic having to bill all these different addresses. And all of them have different rules and reimbursements; I mean, it’s ridiculous.”

Some supporters of single-payer health care say Vermont’s law does not go far enough, mostly because it would allow at least a handful of private insurers to stay in the market indefinitely. Self-insured businesses like IBM, the state’s largest employer, could continue providing health coverage to workers under the law, though they would have to help finance the new system, possibly through a payroll tax.

Physicians for a National Health Program is among the critics, saying the law “falls well short of the single-payer reform needed.” Allowing private insurers to remain in the state will prevent meaningful savings, the group says.

Dr. Richter acknowledges that the law will not allow for “strict single-payer,” but said it still promised “health care for everybody, for less cost.”

“This is not the top of the mountain, but it’s the first time anyone has headed up the mountain,” she said. “No other place in the country has gotten this far.”

I recently returned from a visit of several days to an alternate universe: Canadian health care.

As a physician who has practiced in the United States for 44 years, I have experienced many aspects of our health care system, including its terrible inequities.

Although some Americans get very good health care, there are many who get little or none. Then there are others who get too much: tests, procedures and drugs that they don’t need. The whole system is fragmented, chaotic, inefficient and terribly expensive. We are not getting good value for our enormous expenditure on health care.

Some years ago, having come to the conclusion that a single-payer national health program – an improved Medicare for all – is the solution to our problem, I joined Physicians for a National Health Program (PNHP). I wanted to help bring about a system that provides comprehensive coverage to everyone, removes the extremely wasteful and intrusive private insurance companies from the doctor-patient relationship, and gives every patient free choice of doctor and hospital.

Our new federal health law, unfortunately, doesn’t achieve these key goals.

Over the years, in my talks about single payer, I have often cited Canada’s system as an example worthy of study, if not emulation. But it wasn’t until earlier this month that I paid a visit to Toronto with the express purpose of learning more about how the Canadian single-payer system actually works. I traveled there as part of an 8-member delegation of physicians, health care advocates and policy expert from New York state.

All of us wanted to see “up close and personal” what their Medicare (the name for the Canadian system) looks like and find out how they manage to provide high-quality care for all Canadians and yet spend only half of what we spend, per capita, doing so.

The trip was an eye-opener. We met with physicians in many specialties — both academics and community-based physicians in private practice — and got to shadow them as they went about their work in their offices. We met with health care administrators. We talked to patients. We learned a lot.

Although some of us thought we were coming to the “promised land” of single-payer health care, where everyone has access to high-quality care regardless of ability to pay, our Canadian counterparts were much more blasé about their egalitarian, publicly financed system. They took it for granted. They don’t know anything else and are mainly focused on what is needed to improve it.

One thing that became clear to us is that figuring out what works and what doesn’t work, and how to make a change, is much easier to do in a unified system like Canada’s. We also saw that the single-payer system in practice is not as simple as we thought and that there are still political realities to deal with that control the funding and who gets what part of the pot.

There are still inequities in the system. There is a shortage of physicians and there can be long waits for elective procedures and non-urgent doctor visits. For most Canadians the cost of drugs, dental care and some psychiatric services is not included in the basic package provided by the government. The benefits vary somewhat by province.

But Canada’s medical outcomes are excellent; urgent needs get urgent care; and Canadians live two years longer on average than we do. Problems like medical bankruptcy are virtually unknown. The overwhelming majority of Canadians, when polled, say they’d prefer their system over ours any day.

We learned that doctors in Canada earn a good income not much different from most of those in the United States. Although most have a good quality of life with adequate free time, some are overworked and a few can’t find positions due to lack of facilities in some specialties. But few Canadian physicians emigrate, and in fact each year since 2004 more physicians have returned to Canada than have moved abroad.

Canadians were totally perplexed as to why Americans have put up with our faulty and expensive system for so long. It was hard for me to explain this as I cannot understand it myself. Although polling shows that two-thirds of American are in favor of Medicare for all, their voices are not heard in the media nor in the halls of Congress. On the contrary, our legislators are now debating whether to end Medicare are we know it.

I am more certain than ever of the truth that a single-payer system, like the Canadian one, is the right solution for us. I am energized to continue advocating for such a system here. Hopefully we can soon bring the United States into this alternate universe.

Elizabeth Rosenthal, M.D., is a dermatologist who resides in Larchmont, N.Y. She is a board member of the NY Metro Chapter of PNHP, www.pnhp.org. She has been a dermatologist in private practice in Mamaroneck, NY for 35 years and on the clinical faculty of the Albert Einstein College of Medicine for 37 years.

This is outrageous.

Healthcare-NOW! and Physicians for a National Health Program invites you to join a national educational conference call to learn more about these threats, and what we can do to show that Medicare is the solution to our health crisis, not the problem.

The call will be held Monday, April 11th at 7pm (E). Please RSVP here.

Featured speakers include:
DeAnn McEwen, California Nurses Association/National Nurses United Council of Presidents, ICU nurse at Long Beach Medical Center
Olveen Carasquillo, National Board Member of Physicians for a National Health Program, Chief of Division of General Internal Medicine at the University of Miami School of Medicine
Dr. Margaret Flowers, Congressional Fellow, Physicians for a National Health Program

Click here to RSVP for the call and we will send you the call information by email.

Thank you for fighting back against these efforts to destroy our social safety net, and standing strong for improved Medicare for All.

Rep. Paul Ryan of Wisconsin, the Republican chairman of the U.S. House Budget Committee, unveiled two proposals this week which if enacted would constitute a mortal threat to our nation’s health – particularly to the health of our seniors and our most vulnerable populations.

The first proposal, Senate Joint Resolution 10, would amend the Constitution by imposing rigid and arbitrary restraints on federal spending. The second, his fiscal year 2012 federal budget resolution (misleadingly and eerily called “The Path to Prosperity”), would essentially kill the Medicare program and gut Medicaid, among its other nasty effects.

Both proposals should be emphatically rejected.

Ryan clearly has health care on his hit list. He stressed the problem of health care costs during his final testimony to President Obama’s bipartisan National Commission on Fiscal Responsibility and Reform last December. He said then that he would borrow pieces of the commission’s report for the federal budget, but his latest proposals are in fact much more radical.

The Deficit Commission report stated that if the national health law did not control health care costs, then that ought to trigger more drastic changes in health care spending. Rather than wait for a trigger, Ryan is moving full steam toward the dismantling of our public health programs for the poor and elderly, and the creation of an even more fragmented, privatized and dysfunctional health care landscape than we have now.

Seniors to join the growing ranks of the under-insured

Ryan would change Medicare from a guaranteed benefit program to a limited spending program which pushes more seniors into the private market. Similar to the new federal health law, seniors would be given a defined amount of money that they could use to purchase private insurance on an exchange. Such subsidies are expected to grow more slowly than overall health care costs, so that as insurance premiums rise, seniors would be pushed into skimpier plans that would leave them unable to afford needed care and financially vulnerable should they have a serious accident or illness.

The dismantling and privatization of Medicare, which would be completed by 2022, would actually lead to higher overall health care costs and poorer health for our Medicare population. Health care costs would be higher because of the added private-insurer expenses of profit and inefficient administration. For example, Medicare Advantage plans, run by the insurers, currently cost about 10 times more to administer than the traditional Medicare program.

It is also possible that increased cost-sharing in the form of higher co-pays and deductibles would cause seniors to delay or forgo necessary care leading to greater costs on the back-end for a greater number of and lengthier hospitalizations. (In a darker, bone-chilling moment, one economist recently remarked that delayed care leading to early deaths results in reduced U.S. health spending.)

Further privatization of Medicare will also increase the fragmentation of our health care financing, which will weaken the program’s ability to negotiate fair prices for goods and services.

Ryan describes this change as similar to Medicare part D, for which he voted in 2003. This is another scary thought. The result of Medicare part D was greater confusion and obstacles for seniors, a huge new burden on taxpayers, and windfall profits for the pharmaceutical industry.

Medicaid will shrink in a time of growing need

Regarding Medicaid, Ryan proposes to change the federal portion of the program’s funding to block grants. This means that rather than deciding what part of the population qualifies for Medicaid and adjusting the amount of money allocated based on need, as we do now, states will instead receive a defined lump sum to use as they see fit.

This approach is misleadingly marketed as providing states with greater flexibility. However, Ryan also wants to cut Medicaid spending by $1 trillion over the next 10 years, which will effectively eliminate the Medicaid expansion envisioned under the federal health law and impose even more severe limitations on the number of people and services that will be covered.

In times of growing unemployment and poverty, with more people needing Medicaid, there will be fewer dollars and no guarantee that people will be able to enroll. This will effectively leave millions of our most vulnerable citizens unable to receive necessary services, leading to increased suffering and deaths.

Ryan seriously suggests that those who qualify for Medicaid should be put into the private insurance market in the mistaken belief that this will provide greater choice and cost efficiency. But this is ludicrous, given the well-known track record of the private insurers.

Correct diagnosis, wrong prescription

Ryan does get one thing right: he correctly observes that health care costs are intimately tied to our nation’s budget problems. Health care expenses are expanding way out of line with our economic growth. And yet for all of this spending, a third of our population is either un-insured or under-insured, the medical bankruptcy rate is high, and our health outcomes are relatively poor.

What Ryan fails to understand is that Medicaid and Medicare are not the cause of our rising costs, but rather are the victims of our broken health care system. Medicaid and Medicare costs are actually rising more slowly than our private sector costs. For more on this, see this summary from a congressional briefing on Medicare and the deficit.

Ryan’s plans mirror the austerity measures being pushed in many states across the country and represent an escalation of the worst proposals put forth by the bipartisan Deficit Commission. These growing threats to our social programs require that we step up our defense of the public health infrastructure and make an even louder case for an improved Medicare for all.

As for Ryan’s proposal for a constitutional amendment to cap federal spending, one wonders how much of it is driven by political grandstanding.

S.J.Res.10 would limit federal spending to 18 percent of the gross domestic product, something that hasn’t occurred since 1966. (It’s currently around 24 percent of GDP.) This may sound like a laudable goal until one realizes that during an economic downturn, as we are currently experiencing, there is a much greater need for government spending on programs such as food stamps, unemployment benefits and public health insurance.

A new, arbitrary ceiling on federal outlays could prove disastrous. Noted economist Joseph Stiglitz makes the case that a temporary increase in investment in public programs is required in a downturn in order to make economic recovery possible.

Rep. Ryan hinted at his true agenda during the final meeting of the Deficit Commission when he said that he liked discretionary caps. Significantly, his constitutional amendment would exempt military expenditures in times of war (a seemingly permanent condition for the U.S. today) from such caps.

Greater urgency to protect our right to health care

Section 4 of S.J.Res.10 is also a matter of concern, particularly for single-payer advocates. It states that any bill that raises taxes or imposes a new tax may only pass with a two-thirds majority vote in Congress. Because a national single-payer program would replace current health spending on insurance premiums and out-of-pocket expenses with a new, equitable, and progressive system of taxation to finance universal care, this undemocratic amendment would constitute another obstacle to enacting an improved Medicare for all.

Yet it is precisely single payer that’s the solution to our health care and economic crises: an improved and expanded Medicare-like system that covers everyone. This will achieve the goals of a universal, comprehensive health system which controls our health care costs, relieves businesses of the burden of providing health care coverage and provides a framework within which quality of care and health outcomes will improve. My testimony and that of others presented to the Deficit Commission last summer made that argument.

It is imperative that we take a strong stance to end this assault on our health. Speak to your elected officials today. Tell them to reject Ryan’s proposals. And tell them you want a real solution to our health care crisis: single-payer national health insurance as embodied in H.R. 676.

Dr. Margaret Flowers is a congressional fellow with Physicians for a National Health Program and a pediatrician based in Baltimore. She is also a board member of Healthcare-Now. She can reached by email at: margaret@pnhp.org

Medical, nursing, and public health students from around the country organized a rally to support universal, single-payer health care in Vermont.

The March 26, 2011 event was led by student members of Physicians for a National Health Program (PNHP) and co-sponsored by the American Medical Student Association (AMSA).