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In the news

PNHP Missouri members are frequent contributors to local news on healthcare issues. Recent appearances can be found here.

Look for inspiration from Taiwan's health care system

By Suzanne Hagan, O.D.
St. Louis Post-Dispatch, Letters, Dec. 16, 2016

I don't know what was said between Donald Trump and the head of the Taiwanese government, President Tsai Ing-wen. But since this is the season for wishing, my hope is that they discussed how medical care is delivered and paid for in our two countries.

If this was the topic of discussion, Trump was likely shocked to find out that a Harvard health economics professor designed Taiwan's system, which is based on our Medicare program for senior citizens, with one exception: Taiwan's program covers everyone. It is paid for by taxes and some government supplements, and has given them a system that covers 99 percent of their population. Since it is based on our traditional Medicare system, which has a very low administrative overhead and no profit motive, it can be administered quite efficiently.

This stands in stark contrast to medical care in the U.S., which, with the exception of traditional Medicare, is administered very inefficiently and expensively by for-profit insurance companies.

If Trump and the Congress want to repeal and replace the so-called Affordable Care Act, they need look no further than our own Medicare system. Expand it to cover everyone, improve it to get rid of co-pays, deductibles and lifetime limits, and the result would be a real gift for all Americans.

Suzanne Hagan resides in Ballwin.

http://www.stltoday.com...


Political divisiveness in health care: Learning to work together

By Ed Weisbart, M.D.
Minnesota Physician, November 2016

You wouldn't know it by looking at the health care debate in America today, but one of our nation's foundational pillars used to be political collaboration. Although the 2009 passage of the Affordable Care Act was intensely partisan, we have a proud, centuries-old legacy of collaboratively solving our problems despite our differences, and many of our past solutions were made stronger because of our differences.

I have had the honor of testifying on a variety of topics in a number of state legislatures across the nation. My experiences make me wonder how our noble national history led to political statements such as these that were said directly to me:

Click here to continue reading.


Americans deserve better than choosing among crummy insurance plans

By Ed Weisbart, M.D.
St. Louis Post-Dispatch, Letters, Aug. 26, 2016

When I read that Aetna was pulling out of the Missouri health insurance marketplace, I immediately reached for my wallet ("Aetna is pulling back," Aug. 17) to see which insurance company I have this year.

The past four years, I've been purchasing my insurance through the online marketplaces that were established by the Affordable Care Act. Prior to the ACA, I received letters from two health insurance companies denying me the ability to purchase insurance because my hypertension rendered me "uninsurable." The ACA made such profit-driven barriers illegal.

Every one of the past four years I've made a different choice: first Anthem, then UnitedHealth, Coventry and now Cigna. Or was it Aetna? That's why I had to reach for my wallet - I frankly could not remember which one I chose this year. I appreciate having these choices because each of the choices is crummy, so I'm glad I can select the least-crummy version.

But I can imagine a world where I would no longer have to make those kinds of choices. I can imagine a world more like traditional Medicare, where I and all my fellow Americans will have the freedom to get care from virtually any physician or hospital.

Click here to continue reading.


Remove health care from the cost of business

By Ed Weisbart, M.D.
St. Louis Post-Dispatch, Letters, Oct. 12, 2015

Patriot Coal’s latest bankruptcy success once again draws attention to the desperate measures some employers take to unburden themselves from the financial burdens of employee health (editorial "Shafted," Oct. 8).

No other modern nation inserts health care into the middle of labor contracts. American workers and businesses both suffer from this accident of history. Workers find their negotiated benefits under constant attack; businesses find the costs an unlevel playing field, driving them to avoid aged and unhealthy employees and still less able to compete with businesses based in countries that have developed more sensible systems.

The United Mine Workers would not need to fight for their right to health care if all Americans, mine workers and the rest of us, were included in a national health insurance program. We have a very popular model for this — Medicare. Beloved by seniors, its flaws could be readily improved (expand the benefit design to include things like dentistry and nutritional counseling; eliminate the financial barriers that have crept in). Expanding Medicare to all Americans would remove health care from the non-productive operating costs borne by American businesses, and introduce free market solutions to the delivery of health care.

Providing all Americans with an improved form of Medicare is the only solution that promises affordable access to the high quality of health care we like to think of as American. The mine workers deserve this; who among us does not?

Dr. Ed Weisbart resides in Olivette. He is chair of the Physicians for a National Health Program-Missouri chapter.

http://www.pnhp.org/news/2015/october/remove-health-care-from-the-cost-of-business


Medicare is the patriotic, prudent, medically vital thing to do

By Ed Weisbart, M.D.
Deseret News (Salt Lake City), Sept. 22, 2015

We need to improve Medicare and provide that to all Americans. It’s the patriotic, prudent and medically vital thing to do.

I appreciate the serious tone that Sally Pipes took in presenting her Koch-funded arguments against single-payer national health insurance (“Government single-payer health coverage may be nation’s future,” Sept. 20). I particularly appreciate that she accurately represented my own comments; that I, along with at least 59 percent of physicians in the U.S., believe the evidence is overwhelming that single-payer would be the most efficient way to finance high quality health care for all Americans.

Our current system produces mediocre results, with the result that the CIA World Fact Book identifies Americans as ranking 51st in life expectancy at birth. Less widely recognized is that our world ranking in life expectancy changes drastically after we hit the age of Medicare eligibility. According to the Institute of Medicine, our life expectancy before age 65 ranks the worst out of 17 modern nations. Once we hit age 65, our life expectancy ranking rapidly climbs to a position nearly the best in the world. As proud Americans, we should honor the fact that we have a world-class publicly financed health care system — Medicare.

Click here to continue reading.


Expand Medicare to improve nation's health care system

By William M. Fogarty Jr., M.D.
St. Louis Post-Dispatch, Letters, July 20, 2015

On July 30, Medicare will celebrate its 50th birthday. This program has been a resounding success for the elderly and disabled of our country and is firmly embedded in our culture and medical care system. It has improved the health of the nation's elderly and removed the threat of medical impoverishment that loomed over them before its enactment.

Medicare is not perfect and fails to cover many necessary services, but it is the basis upon which we can build a health care system that would cover all  Americans, improve the health, economy and security of the country and save billions of dollars every year.

We have a mechanism to replace our incredibly inefficient, wasteful and complex system right before our eyes. It is improved and expanded Medicare for All.

Dr. William M. Fogarty Jr. resides in Webster Groves.

http://www.stltoday.com/news/opinion/mailbag/expand-medicare-to-improve-...


They spend half and live longer

By Ed Weisbart, M.D.
St. Louis Business Journal, Letters, July 10, 2015

Ascension CEO Tony Tersigni is right when he told the St. Louis Business Journal that our nation's current policies relegate health care to a side burner. Finances, not health care, are the focus of our national policies.

Tersigni identifies four health care finance models in the United States -- Canada for seniors, Europe for employees, Great Britain for veterans and Native Americans, and rural India or Cambodia for the uninsured.

One choice stands out as the most efficient use of resources and a fierce acceptance across America -- the Canadian model that forms the basis of our Medicare.

Click here to continue reading.


Medicare for all would benefit everyone

By Judy Dasovich, M.D.
Springfield News-Leader, February 21, 2015

Mark Stringer, director of Behavioral Health for Missouri, recently gave a talk in Springfield on mental health care access and affordability. This was sponsored by the League of Women Voters. I attended with another physician and a nurse practitioner. We all have experience as providers at the Kitchen Clinic, the largest free clinic in the area. There are no psychiatrists available to Kitchen patients and counseling options have been limited. Attempts to find appropriate care for patients with serious mental illness are rarely successful. The volunteers and staff at the free clinic do not have the training to properly treat patients with serious mental illness but are put in a position to do so nevertheless.

When people are ill, they can't work. When they can't work, they have no money or insurance. Without money or insurance, they often end up in jail instead of a clinic or hospital. Usually this is for nuisance crimes such as loitering in a safe place, but sometimes it's for more serious offenses related to their untreated illness. As in other communities, law enforcement and correctional institutions are forced by default to be the providers for a large segment of those who need care. This is medically inappropriate and extremely expensive. The Greene County Jail is already overburdened and underfunded. Needed services, such as Medicaid, can be difficult to access when mental illness makes a patient non-functional. Once those patients end up in jail, services are canceled and they must re-apply.

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Pharmaceutical manufacturers create distrust of vaccinations

By Ed Weisbart, M.D.
St. Louis Post-Dispatch, Letters, Feb. 7, 2015

Children should get vaccinated. The evidence is overwhelming that this is a safe and effective vital strategy for our nation’s health.

Why is there such distrust of vaccinations today?

The answer is simple: Pharmaceutical manufacturers have repeatedly proven themselves as undeserving of our trust.

Click here to continue reading.


Missouri's health is going downhill: poor public health and poor attention to the social determinants

By Josh Freeman, MD
Medicine and Social Justice blog, Jan. 25, 2015

“Our health is going downhill” shouts a headline in the Kansas City Star, January 4, 2009. The local take of this article, by Alan Bavley, was the poor performance of Kansas and Missouri, the two states served by the Star, on the 2014 report on America’s Health Rankings, published by the United Health Foundation, the longest-running ranking of public health status in the nation, since 1990. Bavley emphasizes that both states have dropped significantly in those rankings; Kansas was 12th in 1990 and is now 27th; Missouri was 24th in 1990 and is now 36th.

This leads to a lengthy discussion of why both states have dropped, mainly attributed to a lack of investment in public health, and how there is a geographic disparity, with states on the coasts doing overall better than those in the Midwest: “What explains this dramatic difference between the coasts and the Midwest is broad investments on the coasts in things that make communities healthy,” Bavley quotes Patrick Remington of the University of Wisconsin. What this misses, however, is the even worse news that is hidden by “rankings” data. While in rankings of states there will always be a #1 (in this case, Hawaii) and a #50 (you guessed it, Mississippi) this hides the fact that, overall, states have gotten worse over this 25-year period. The graphs in the print edition of the Star (not included in the on-line edition) show the decrease in rankings noted above for the two states over time. However, on the “America’s Health Rankings” website one can not only look at the map showing relative state rankings but also click on each state and see how its absolute health ratings have changed over time.

Click here to continue reading.


Younger Americans need Medicare, too

By Mimi Signor
St. Louis Post-Dispatch, Letters, Dec. 11, 2014

Americans over age 65 have earned their Medicare card for life. But younger Americans need it, too, as is obvious in Bill McClellan’s column “Kidney transplant works too well” (Dec. 7).

Having Medicare can mean life for Jennifer Joerger, the woman in the story, and for countless others. But Medicare law spells out who deserves it, and when. It is further complicated for those who are too sick to advocate for themselves.

Everyone needs health care. Don’t we all deserve it? Let’s advocate for health care for all of us through the congressional bill HR676, “Improved Medicare for All.”

Mimi Signor, RN, is a member of Missourians for Single Payer Health Care.

http://www.stltoday.com/news/opinion/mailbag/younger-americans-need-medicare-too/article_fd495873-e258-5c37-aa0c-6ec4042d2f9c.html


Restructure our economically unsustainable health care system

By Ed Weisbart, M.D.
St. Louis Post-Dispatch, Letters, Sept. 16, 2014

If public policy decisions were driven by good business sense, the United States would long ago have stopped wasting so much of our health care dollar on the preservation of an irrational insurance industry. With millions remaining uninsured despite 17.6 percent of our gross domestic product being devoted to health care, we must restructure our economically unsustainable system.

New information from a multinational research team reveals yet another piece of information about the United States: More than a quarter (25.3 percent) of our hospital spending is dedicated to administration. Scotland and Canada, whose single-payer systems pay hospitals global operating budgets, with separate grants for capital, had the lowest administrative costs at 11.6 percent and 12.4 percent respectively. Other developed nations form a spectrum varying with their nation’s particular model for health care finance.

If our hospital finance system were as efficient as Canada’s, we would have saved more than $150 billion in 2011.

Click here to continue reading.


Health care can be affordable and accessible

By Gordon D. Fiedler Jr.
The Salina (Kan.) Journal, Aug. 26, 2014

Affordable, accessible health care for all is not a dream but can be a reality, according to David Kingsley, who represents Physicians for a National Health Plan.

Kingsley, of Kansas City, Mo., who has a doctorate in public policy, addressed about 40 people who attended the Salina League of Women Voters Fall Issues Forum Monday night at the Salina Public Library.

He had little good to say about American medical care.

Ours, he said, "is the most complicated health care system ever devised on the face of the Earth."

Click here to continue reading.


Single-payer would provide better health care to more people

By Mimi Signor, R.N.
St. Louis Post-Dispatch, Letters, Aug. 26, 2014

Missouri hospitals believe mandatory commercial insurance will keep them in the black. However, the majority of people who face bankruptcy due to medical costs are those who have insurance. Commercial insurance companies enforce co-pays, deductibles and other high out-of-pocket costs as a disincentive to seeking care. Insurers often deny payment for care in advance or after care has been provided.

We have the ability to cure, but have lost the capacity to care. Rather than bullying the sick into commercial insurance they cannot afford to buy or use, Missouri hospitals should support passage of HR 676, "Improved Medicare for All,” the most fiscally conservative and fair way to provide better health care to more people. Missouri hospitals would receive guaranteed payment from the single payer, Medicare, for care provided. Missourians would get medical care without fear of bankruptcy, and hospitals would not need to dun patients through collection agencies.

Mimi Signor resides in University City.

Read the full article here.


Medicare shows that public, universal health coverage is superior to private insurance

By Pamella Gronemeyer, M.D.
St. Louis Post-Dispatch, August 1, 2014

We are thrilled to help celebrate Medicare's 49th anniversary this week. Medicare, which was passed into law in 1965 under President Lyndon B. Johnson, provides the elderly and disabled health care benefits that would not be available to them in our profit-driven (and -ridden) fragmented insurance market.

In contrast to the ongoing, never-ending partisan disputes over the Affordable Care Act, Medicare has been for 49 years and still is the living proof that public, universal health coverage is superior to private insurance in every way. Medicare is more efficient than private health insurance and is administered at a cost of 3 percent to 4 percent, as opposed to private health insurance, which has administrative costs above 15 percent. Medicare's costs have risen more slowly than those of private health insurance. Medicare provides better access to care, better financial protection and higher patient satisfaction.

The current Medicare system is not perfect, but should be expanded and enhanced to provide universal coverage. We are an exceptional country, and we need to provide exceptional health care to all Americans.

http://www.pnhp.org/news/2014/august/medicare-shows-that-public-universal-health-coverage-is-superior-to-private-insuran


Happy Birthday, Medicare

By Ed Weisbart, MD
St. Louis Post-Dispatch, July 30, 2014

Medicare is today entering its 50th year, and the need to expand it to all Americans has never been greater.

Private health insurers are putting more and more restrictions on which doctors and hospitals can take care of which patients. Premiums, co-pays, co-insurance and deductibles are rising, often sharply. And states like ours are picking and choosing which low-income people to save and which to let die.

We insist on clinging to the uniquely American model of private health insurance despite the fact that it costs us double what every other modern nation spends per person on care, that our life expectancy lags those nations’ by several years, and that it places each of us just one disease away from bankruptcy.

Why do we cling to it so feverishly?

Click here to continue reading.


Medicare for everyone could help solve VA's problems

By Lydia L. Lewis
St. Louis Post-Dispatch, May 26, 2014

Pat McGuire's comment ("VA scandal shows health care and bureaucracy don't mix," May 21) that the VA needs to be scrapped in favor of the same health care that members of Congress get sounds good on the surface and may even get vets an appointment sooner. But Congress members' benefits come from the Federal Employees Health Benefits system, a selection of commercial insurance plans with the federal government paying the employer portion of the premium from which the insured can choose. That means that whatever costs and deductibles, limited provider networks or exclusions they impose would be what our vets will live with.

As for the overall cost to the budget, I do know that the VA is the only entity that is able to negotiate costs with providers and is able to reap deep discounts. Commercial insurers' discounts can go to profit and overhead. Medicare Part D cannot negotiate by law. Putting thousands of vets on private insurance will not bend the cost curve.

Why must everyone avoid the real solution - Medicare for all? Seniors like it; doctors like it; the paperwork gets done for less than 3 percent overhead. Put everyone on enhanced Medicare as proposed by H.R. 676: no deductibles, no co-pays, all medically necessary treatment - including PTSD, TBI, mental health, dental and eye care and long-term care. It's private care and public payment with the market power to negotiate lower costs. No one dies because they can't afford care while CEOs make millions. It's national health statistics we can be proud of. Sounds good to me.

http://www.stltoday.com/news/opinion/mailbag/letters-to-the-editor/medicare-for-everyone-could-help-solve-va-s-problems/article_544b634b-09d9-5457-8bbd-c852f0b4b938.html


The answer is improved Medicare for all

By Judy Dasovich, M.D.
Springfield (Mo.) News-Leader, May 22, 2014

At the News-Leader’s recent economic forum, community members expressed concern about health costs.

Former Mercy President Robert Steele worried that “we’re spending money on health care that does not substantially increase the health of those we’re serving.” Employers tell him that it’s “breaking our bank.” Cox CEO Steve Edwards warns that Missouri hospitals are disadvantaged due to lack of Medicaid expansion.

Architect John Oke-Thomas said his company has been forced to bounce between Cox and Mercy plans in “order to survive.” John Kabell of Teamsters Local 245 says health care is “the biggest issue at the table with every set of negotiations we have.” Brad Thomas of Silver Dollar City says that navigating insurance requirements is a challenge.

I have good news for all these concerned citizens. There is a solution that provides economy, simplicity and security. U.S. House of Representatives Bill 676 and Senate Bill 1782 support a single-payer system of national health insurance, or improved Medicare for all. Traditional Medicare has overhead of less than 3 percent compared to an average of 14 percent for all private insurance companies, some as high as 20-25 percent.

Read more here.


Single-payer advocate makes pitch to doctor executives

By Andis Robeznieks
Modern Healthcare, April 29, 2014

CHICAGO -- The American College of Physician Executives annual meeting drew a record 830 attendees, including one doctor whose presentation on the merits of a national single-payer system may have been something of a surprise.

Dr. Ed Weisbart described himself as a long-time ACPE member who is also a member of Physicians for a National Health Program and now serves as chairman of the single-payer advocacy group's Missouri chapter.

Weisbart, a family physician, had a table full of PNHP literature and a poster indicating that salaries for Canadian physicians are comparable or better than those earned by U.S. doctors. The poster also said that Canadian physicians pay lower malpractice insurance premiums.

His intent, Weisbart said, was to build bridges between the two organizations, and he left with “several pages” of new names to add to the PNHP mailing list. “I think it was time well-spent.”

Click here to continue reading.


Priorities drive debate

Schaefer shows his colors on Medicaid

By Andy Quint
Columbia Daily Tribune, March 16, 2014

Arguing against Medicaid expansion, Sen. Kurt Schaefer, R-Columbia, claims the program is "broken" and the state cannot afford to expand it.

Endless repetition of a claim does not make it true. As a physician working at the Family Health Center in Columbia, where half of my patients have Medicaid and one-quarter have no insurance, I see firsthand how Medicaid helps people. It is lifesaving. And I can say without hesitation that Missouri Medicaid is not broken. Of course it is flawed — as is every piece of American health care finance. It is part of a system that is dysfunctional and inefficient, rewarding high-technology, high-cost, pharmaceutical and procedure-driven care over low-cost, basic interventions such as prevention and lifestyle modification. Nevertheless, Medicaid functions remarkably more efficiently than the alternatives; its flaws are simply a reflection of America's health care system.

Missouri Medicaid's 2 percent overhead matches the national average for Medicaid. That is far below the administrative overhead of private health insurance, which is 15 percent or higher.

Click here to continue reading.


Status quo on Medicaid indefensible

Sen. Schaefer puts politics above doing what is right

By Stephen T. Keithahn
Columbia Daily Tribune, March 2, 2014

As a physician, I read with interest "The Medicaid Debate" in the Tribune last Sunday. I appreciated Rep. Chris Kelly's and Sen. Kurt Schaefer's extensive comments as well as reporter Rudi Keller's pointed questions. Given the legislators' contrasting opinions regarding the expansion of Missouri Medicaid to cover the working poor, however, one of them must be wrong.

The two critical issues in this debate are: 1) what fiscal effect would expansion have on the state budget — i.e. is expansion the "fiscally responsible" thing to do — and 2) is Missouri Medicaid a sufficiently effective public health insurance program in its current form to justify expansion to more than 300,000 individuals?

To the first point, Rep. Kelly referenced multiple independent studies that predict by creating jobs, growing the state economy and shifting costs to the federal level, Medicaid expansion would not only pay for itself but also increase general revenue for the state budget by tens of millions of dollars per year, revenue that could fund needs such as education.

In contrast, Sen. Schaefer believes Medicaid expansion would not pay for itself, requiring the state to find a source for the eventual 10 percent annual contribution. He believes this can be accomplished only by cutting education funding. Sen. Schaefer, however, cites no studies to support his position, whereas earlier this year the Missouri budget director predicted the fiscal benefits of expansion would be realized even beyond 2020, more than paying for the 10 percent contribution. Moreover, when the Missouri legislature removed Medicaid expansion from the current budget, it was forced to cut $14 million from a planned expansion of higher education that would have been funded by the surplus revenue from expanding Medicaid.

Click here to continue reading.


Economist promotes single-payer health care system

By Jodie Jackson, Jr.
Columbia Daily Tribune

A single-payer health care system that eliminates "monopoly profits" for pharmaceutical companies and reduces "administrative bloat" would boost the economy, lead to job creation and make Americans healthier.

That's the summary of an analysis by University of Massachusetts economics Professor Gerald Friedman, who said the Affordable Care Act is simply one step in the direction of a single-payer system.

Friedman, a consultant to the Missouri chapter of Physicians for a National Health Program, spoke last night to a group of physicians, students and others at the University of Missouri School of Medicine.

"The Affordable Care Act does a lot of good things," Friedman said. "But because the ACA does not effectively control cost, it's not sustainable. The solution is single-payer."

Click here to read more.


Doctor prefers a single payer health care system

By Ed Weisbart
Lawton Constitution (Okla.), February 1, 2014

I am a proudly patriotic, fiscally prudent, family physician. For those three reasons, I support a national health insurance program.

Patriots like me prefer to think that America leads the world. Unfortunately, statistics show that we lag far behind in health care. Our diabetics are more likely to get an amputation, our maternal and infant mortality rates are among the worst, and our life expectancy ranks 51st in the world.

We have many of the world’s best doctors and hospitals. So how do we explain our poor health outcomes?

It’s our deeply flawed way of paying for care.

We should demand an explanation for why we continue to spend double any other nation per person on health care, despite our dreadful results.

Nearly two-thirds of that spending comes from our tax dollars. Our public funds for health care are already higher than the total health spending in any other nation. We’re paying more than enough for universal comprehensive health care, but we’re not getting it.

Even more striking, 31 percent of what we spend on health care has nothing to do with actual care. That 31 percent goes to the paperwork and administration inherent in an insurance model designed to be confusing to patients and profitable for big insurance companies.

In contrast, all other nations spend less than 10 percent on overhead. Our own Medicare program has overhead of  roughly 2-5 percent.

Thirty-one percent. That means that of my $1,300 monthly premium, $403 dollars is squandered every month just to prop up the bureaucracy inflicted on us by the health insurance industry.

As a practicing physician, I see the ravages of living with inadequate insurance. I’ve seen my diabetics take their insulin every other day, my hypertensives choosing between prescription and eviction, and my 64-year-old stroke patients choosing to wait until they turn 65, get Medicare, and can afford what they need to stay alive.

This is not the United States I was brought up to believe in.

Yes, we have emergency rooms as a last resort. But patients often defer or forgo care, sometimes with fatal consequences. Further, by limiting universal access to the ER means that we pay the $48,000 average cost of a stroke, but we refuse to pay for a $4 bottle of pills to prevent that stroke. This is both terrible health care and fiscal imprudence. It is inconsistent with our nation’s alleged culture of life.

The good news is that there is a solution, hiding in plain sight. Most seniors love their Medicare program, despite its limitations. Many seniors purchase a wrap or supplement to fill Medicare’s gaps. We could simply embed those supplements into the Medicare program and provide that to all Americans, not just seniors.

Every serious economic analysis shows that the savings from an “improved Medicare for all,” otherwise known as single-payer national health insurance, would more than outstrip its new expenses.

By slashing the administrative waste and redirecting that money to care, and by eliminating premiums, copays and deductibles, 95 percent of Americans would spend less, not more, on health care.

For businesses, these savings would spill over into reductions in workers comp, liability, and even auto insurance. Such a system would also provide more predictable future costs.

Only through a single-payer model can we establish a business case for improving the health of all Americans. With everyone (including Congress) in the same program, we would reap the benefits of timely, effective care, treating hypertension and diabetes rather than continually courting preventable medical disasters.

What are we waiting for?


Opting Out Of Medicaid Expansion: The Health And Financial Impacts

By Sam Dickman, David Himmelstein, Danny McCormick, and Steffie Woolhandler
Health Affairs blog, January 30, 2014

The Affordable Care Act (ACA) was designed to increase access to health insurance by: 1) requiring states to expand Medicaid eligibility to people with incomes less than 138 percent of the Federal Poverty Level (FPL) ($19,530 for a family of three in 2013), with the cost of expanded eligibility mostly paid by the federal government; 2) establishing online insurance “exchanges” with regulated benefit structures where people can comparison shop for insurance plans; and 3) requiring most uninsured people with incomes above 138 percent FPL to purchase insurance or face financial penalties, while providing premium subsidies for those up to 400 percent of FPL.

Recent studies suggest that Medicaid expansion will result in health and financial gains.  Older studies also found salutary health effects of expanded or improved insurance coverage, particularly for lower income adults. These studies also document an increase in utilization of most health care services. Most recently, the Oregon Health Insurance Experiment (OHIE) found a striking increase in emergency department use as well as other outpatient care.

The Supreme Court ruled in June 2012 that states may opt out of Medicaid expansion, and as of November 2013, 25 states have done so. These opt-out decisions will leave millions uninsured who would have otherwise been covered by Medicaid, but the health and financial impacts have not been quantified.

In this post, we estimate the number and demographic characteristics of people likely to remain uninsured as a result of states’ opting out of Medicaid expansion. Applying these figures to estimates of the effects of insurance expansion from prior studies, we calculate the likely health and financial impacts of states’ opt-out decisions.

Click here to read the full study.


ACA doesn't solve core problems

By K.W. Hillis
The Lawton (Okla.) Constitution, Jan. 19, 2014

LAWTON, Okla. -- Affordable Care Act reforms address some problems with health care in the U.S., but it doesn’t solve core issues, said Dr. Ed Weisbart, chair of the Physicians for a National Health Program (PNHP) -- Missouri Chapter.

An advocate of a single-payer national health insurance system similar to Canada’s or Great Britain’s health care systems, Weisbart met with The Lawton Constitution editorial board last week to talk about those core issues and a new bill before Congress.

“We have a crisis in health care in the United States. It undermines our ability to compete globally. It places huge burdens on businesses and on families. It is the biggest driver of bankruptcy in the country. It makes people vulnerable to having real estate bankruptcies,” he said. “That is going on in the context of our wasting approximately a third of what we pay on health care on the administration of it compared to other countries, where they spend around 2-5 percent on health care (administration) ... (we pay) 31 percent.”

Read more here.


Obamacare: not enough

By Suzanne Hagan
Pekin (Ill.) Times, Oct. 24, 2013

Americans for years have been annoyed and angered by escalating health-care costs, declining insurance coverage and millions of neighbors who haven’t been able to get health insurance, and the Affordable Care Act has started to cope with the latter problem.

But it does too little about controlling medical costs, pharmaceutical prices, and the driving force behind much health-care inflation: escalating medical costs and profit-driven insurers.

Amid the Tea Party tantrums about the new law being government taking over the health care too much, the opposite is true: Government hasn’t taken over enough of the U.S. health care system.

So it’s too little. But it’s not too late.

Read more here.


U.S. needs single plan for health insurance

By Suzanne Hagan
St. Louis Post-Dispatch, Sept. 15, 2013

Pity patients like Bev Veals who are trying to juggle chemotherapy while paying bills that their insurance plans were supposed to cover ("Patient's bill soars as new program falters," Sept. 10). Her story resonated with me, since I had the same problem when I was diagnosed with cancer in 2008.

As the Jan. 1 transition date to new insurance marketplaces moves closer, how many more patients like Veals will be hit with bills they can’t pay at a time when they are too ill to work? In no other developed country in the world would a situation like this happen, yet in the U.S. it happens all the time. It's why medical bills are the primary cause of personal bankruptcies in our country.

Read more here.


Medicare for all is GOP's best bet

By Jack Bernard
Springfield (MO) News-Leader, Aug. 21, 2013

While hospitals in Missouri are having their reimbursement cut under the Affordable Care Act (Obamacare), “red’’ leaning states are still trying to figure out whether or not to fully implement the law.

As pointed out in “What’s next? Information about the Affordable Care Act is in short supply in Missouri” in the News-Leader Aug. 11, Missouri has been among the most vehement in its opposition to implementation, going so far as legally prohibiting state employees from assisting.

Hospitals that treat the poor in disproportionate numbers are having their Medicare reimbursements cut under the ACA. Before the Supreme Court made Medicaid expansion voluntary, the law assumed that under the ACA these hospitals would see a decrease in medically indigent patients who would instead be covered by Medicaid.

Read more here.


Let business tend to business, not health care financing

By Dr. Judith Dasovich
Springfield (MO) News-Leader, Aug. 3, 2013

Employee sponsored health insurance (ESI) should be replaced with an affordable, efficient financing system. During World War II, wage controls forced employers to compete for labor through benefits. Today, it is a burden on business and workers. ESI puts American companies at a disadvantage. They have expenses that foreign competitors do not. Negotiations surrounding it sour relations between management and labor. Hiring is constrained by the cost of ESI. Entrepreneurship is stifled. Starting a small business often means buying health insurance through the individual market. This is more expensive and may not be available due to pre-existing conditions. The Affordable Care Act is supposed to outlaw denial of coverage, but it doesn't outlaw price gouging.

ESI is expensive and inefficient. Overhead averages 14% compared to less than 3% for traditional Medicare because of complexity, marketing costs, and administrative pay. One of Springfield's largest employers uses Coventry insurance. Coventry's CEO makes $13 million per year, or $49,765 per day. Doctors, hospitals and businesses are all forced to incur higher overhead because of ESI's business model.

ESI restricts freedom. Patients cannot choose their doctors or hospitals. They have to switch providers if the plan changes. This is dangerous and expensive. Workers pay for insurance while they are healthy. When they get sick, they lose their jobs and insurance. COBRA is time limited and too expensive for most people without incomes. This is an inhumane situation for the worker, but a sweet deal for the insurance companies.

Read more here.

Dr. Dasovich is a Internal Medicine physician and member of PNHP living in Springfield, MO


Expand Medicaid to cover nondisabled working adults

By Ed Weisbart, M.D.
St. Louis Post-Dispatch, July 30, 2013

Medicaid turns 48 years old today and has seldom attracted more attention. On Aug. 14, the Missouri House Interim Committee will hold a public hearing about Medicaid reform in St. Louis.

Missouri provides Medicaid to a number of groups that the federal government considers “optional” for coverage: youth receiving adoption assistance, women with breast cancer, some blind or disabled, and several others. Each group has unique eligibility criteria, creating a patchwork defined more by gaps than benefits.

One group that escapes this patchwork is nondisabled working adults. They serve us in restaurants, provide home care and ring up sales. If not disabled or raising children, they’re not getting Medicaid in Missouri today. They could, under the Affordable Care Act.

Read more here.


Problems with Affordable Care Act show need for single-payer system

By Toni Vafi
St. Louis Post-Dispatch

As promises of the Affordable Care Act continue to wither, the delay of the employer mandate is cause for more disappointment. Initially there was promise of average savings of $2,500 per family annually and visions of a public option. Universal coverage was assured and the oft-stated "if you like your employer based insurance, you can keep it" was evidence that we weren’t going socialist. These were a few of the goodies we expected under the Patient Protection and Affordable Care Act.

What happened? Gone are the $2,500 savings and the public option. Cost control wasn’t part of the ACA. The public option bothered insurance companies, so it was out. Of 60 million uninsured, the ACA will leave at least 30 million still without coverage, and the employer mandate delay will now surely increase the implementation burden on the exchanges, which might not be ready to go by Oct. 1.

Read more here.


Nation should learn from mine workers

By Ian Swenson
St. Louis Beacon

The United Mine Workers of America were back in St. Louis Monday, rallying against Peabody Energy. The UMWA claims that Peabody created a spinoff company, Patriot Coal, that was designed to fail and saddled it with expenses including workers’ health insurance and pensions. When Patriot did in fact file for bankruptcy five years after its creation, 22,000 workers and retirees whose benefits had been reattributed to Patriot Coal lost those earned and negotiated benefits and joined the nearly 50 million Americans without health insurance.

But what do uninsured Americans have to do with you?

Health care is everyone’s problem. Caring for the desperately ill who cannot pay means that everyone who can must pay more. Once you reach age 65, society pays for much of your health care through Medicare. When people such as the Peabody workers are denied coverage and thus the care each of us needs, medical costs go up. No yearly checkups to monitor blood pressure, or diet, or activity level. No colonoscopy to check for colon cancer. No women’s health visits. You get the picture.

Read more here.


Health benefits should not be tied to jobs

Dr. Pamella S. Gronemeyer
St. Louis Post-Dispatch

Last week, physicians and a pharmacy student who are members of Physicians for a National Health Program (Illinois and Missouri chapters) and the Illinois Single Payer Coalition joined thousands of United Mine Workers of America members to support their demand for continuation and fulfillment of the health and pension benefits that the miners have earned as benefits from their long years of working in mines while being exposed to the harmful effects of coal dust, which include the development of black lung disease or carcinomas.

The story of Patriot Coal and its pending bankruptcy hearing is not new but represents another effort of a corporation to both destroy a union and to deprive the laborers of their earned health and pension benefits. As physicians, we have all seen the lung disease created by mining and know how much coal miners need their health benefits. We strongly support them in their continued actions to secure their much-deserved earned benefits.

Once again, this fight points out the need for a Medicare for All program in the United States. If health benefits were not tied to jobs, no one would lose their benefits because an industry felt the need to manipulate the structure of interrelated companies and corporations to insure shareholder return and to subsequently inflict pain and suffering on workers who toiled for many years in underground mines.

Read more here.


The conservative case for expanding Medicaid

Dr. Mark S. Krasnoff
St. Louis Post-Dispatch

Why are Republicans in the Missouri Legislature letting President Obama steal conservative principles from right under their noses?

For years, the federal government has generously compensated hospitals in the form of "disproportionate share" payments for the care provided to the uninsured who cannot pay the high costs of their hospital care. Now the president comes along and cuts off the funds, doing the conservative thing at the federal level, and Rep. Todd Richardson calls it a "gun to the head"?

And what is it that the federal law is coercing Missouri to do? Insure working people with Medicaid, instead of rewarding it only to those so poor or disabled that they can no longer work.

Read more here.


Our ever evolving health care system

By Nathaniel Murdock, M.D.
The Saint Louis American

The great American healthcare experiment is continuing to develop. The next stage is starting, so this is a good time to look back before we look ahead.

How did our healthcare get so tied up with our employment? In World War II, to preserve funds for the war effort, the government froze wages. To compete for workers, employers began to pay for health insurance, supported with business tax deductions. This quickly became an unfettered marketplace, with virtually no regulation on price or quality.

Read more here.


Consumers will benefit from Medicaid expansion

By Ed Weisbart, M.D.
St. Louis Post-Dispatch

Nearly 300,000 more Missourians could soon get access to health care if Missouri state officials decide to provide it. Unfortunately, recent comments by the state Legislature's leadership cause us to believe that they seem poised to deprive Missourians of this basic human right.

We, members of the Consumers Council of Missouri, urge the public to consider this decision carefully and act in the best interest of our friends, families and neighbors. Missourians must insist that members of the House and Senate and Gov. Jay Nixon not tolerate avoidable human suffering. As stewards of health care for hundreds of thousand of poor Missourians, these state officials should increase the role of Medicaid in the manner spelled out by the Affordable Care Act.

It's humane and compassionate and it makes economic sense for Missouri consumers.

Read more here.


Local doctor pushes for single-payer health care system

By Michele Munz
St. Louis Post-Dispatch

CLAYTON • In a meeting room at a St. Louis County public library, Dr. Ed Weisbart started his health insurance reform presentation with pictures of sick people.

One was self-employed who couldn't afford health insurance and made too much money to get Medicaid. Another was a factory worker who lost coverage when he became too ill to work. Then there were working parents whose bills for their sick infant drove them into bankruptcy.

"The reason I'm here and that you are here, is because you've seen patients like this," Weisbart told the crowd.

About 40 people from diverse fields filled the room. They included doctors, students, a medical office manager, social worker and even a musician.

Read more here.