The Blind Spot in Medicare for All | The Nation

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Craig Brooks

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May 12, 2022, 4:21:44 PM5/12/22
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Kip

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May 12, 2022, 5:04:01 PM5/12/22
to GreatNort...@googlegroups.com, Craig Brooks

Thanks for sending this to us, Craig. But I would say it's worth reading to learn how confused some people are about why US costs are high. The author subscribes to the single most important piece of folklore about the health care crisis: That it is caused by the fee-for-service method of paying doctors. He ignores the insurance industry and the role that managed care has played in driving up costs by driving up prices via higher administrative costs and provoking mergers.

This paragraph in particular illustrates the author's confusion:

"The AMA’s plan to preserve fee-for-service medicine was successful, but its consequences for patient experiences and physician workdays have been disastrous. This system has, in part because of government efforts to catch and prevent health care fraud by private actors, produced ever-expanding documentation requirements that now constitute the bulk of American doctors’ workloads. This is a major factor behind the alarming rates of physician burnout. As the US faces an already severe doctor shortageone in five physicians now plans to leave their job."

This is backwards. It isn't FFS that's causing "ever expanding documentation requirements" and physician burnout, it is managed care ideology -- the folklore about overuse first invented by HMO advocates in the 1970s and the hype that HMOs and other insurance companies that expose doctors to financial incentives and micromanagement (including "click for bonuses").

I used to be a Nation subscriber for decades. I stopped around 2010 when their coverage of the Affordable Care Act got so bad. I was thinking of resubscribing. Maybe I'll write and ask if they would entertain and article from me about the real causes of high US health care costs and the role the demonization of FFS played.

Kip 

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Valerie Swenson

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May 12, 2022, 5:21:26 PM5/12/22
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Valerie Swenson

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May 12, 2022, 5:42:30 PM5/12/22
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Yes, Kip!  Thank you for your eagle eye focus on the lie!

Risk management coding, the coding for ACO, DCE, and the like, is a constant nightmare of threats by the insurance payers to demand sending their people in to review and audit patients' charts!

It’s CRAZY making stuff that’s going on. 

‘Vendors," and insurance people are allowed to access patient charts, threaten audits, and come in a “educate” doctors about finding MORE diagnoses! (When did HIPPA get kicked to the curb?). 

These insurance are paying doctors on counting diagnoses!  Isn’t THAT sick?   Do violinists get paid by counting how many notes they play? 

It’s certainly an undignified way to show respect and value a person. 

Wonderful, brilliant people are leaving health care.  It’s a fair question to wonder if risk management maneuvers is one of the causes.

Val

On May 12, 2022, at 4:03 PM, Kip <ki...@usinternet.com> wrote:

Valerie Swenson

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May 12, 2022, 5:53:40 PM5/12/22
to Kip, Craig Brooks, GreatNort...@googlegroups.com
CORRECTION:  typo corrections are needed in what I just sent, ie HIPAA because I typed too fast in an upset, mad sort of way and I need to tend to making dinner for my family.

v

Craig Brooks

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May 15, 2022, 8:38:18 AM5/15/22
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https://www.thenation.com/article/economy/fee-health-care-ama/

The United States is the only high-income nation to insist that health should be determined by markets and profits rather than rights and dignity. The result is that the prohibitively high cost of American health care causes tens of thousands of preventable deaths every year.
For the first time since the Covid-19 pandemic compounded this long-standing national disaster, Congress is considering the state of America’s health care system. The House recently held hearings on Medicare for All, and the Senate Committee on the Budget is convening parallel proceedings today. In this context, many members of Congress who benefit from the status quo are rehashing their opposition to Medicare for All, citing the importance of defending of “freedom” and “choice.” With thousands of people dying each week precisely because they have no choices in our current health care system, this rhetorical game should fool no one.
Although universal health care appears unlikely to be enacted by this Congress and has never even appeared on President Biden’s agenda, the current hearings serve an important purpose. They remind the US public that our existing system of for-profit health care exclusion is a deliberate policy choice, not an inevitability.
While Medicare for All would be an enormous step forward for the health of Americans and the health of US democracy, it’s essential to recognize that what determines our health care system is not simply who pays but also for what we pay. If we adopt a single-payer structure without remaking the bureaucracy by which the value of care is determined, we will perpetuate the perversity at the core of our system and its world-leading inefficiency.
Despite efforts to implement alternative models over the last two decades, a fee-for-service framework remains embedded in American health care and endures as its dominant underlying driver. Fee for service compensates doctors, clinics, and hospitals based upon number and type of visits involved in a patient’s care, creating incentives for unnecessary procedures, excessive clinic appointments, and the mountains of paperwork that have become the bane of American doctors’ daily lives. This system, which places value on specialized services rather than on primary care, is also a crucial factor behind the worsening shortage of primary-care doctors.
The persistence of fee for service is no accident. It’s the consequence of a long political campaign initiated by doctors that has since been taken over by industry executives and their lobbyists.
Fee for service solidified its central role in American health care in 1965 when Congress passed legislation to create Medicare and Medicaid. For years, the American Medical Association (AMA), a physicians’ lobbying group organized to protect doctors’ economic interests, had been doing all it could to oppose public health-insurance programs like Medicare and Medicaid. They feared that government involvement in health care would lead to a decline in doctors’ earnings and professional status. The AMA campaigned to associate government-financed health care with Cold War fears of a communist takeover of medicine. American doctors had struggled for several decades to build respectable professional status and high incomes. Now, they were told that if “socialized medicine”—that is, health care that’s a public service—came to America, then they would earn no more than Soviet factory workers and would be overwhelmed by bureaucracy and documentation requirements.
When the AMA realized in the 1960s that its efforts to keep government out of health care were failing, it shifted its strategy to protect the fee-for-service model upon which high physician compensation had been built. AMA leadership drew from Relative Value Studies, an experiment the AMA had pioneered in California that created a billing model for the burgeoning private insurance industry, and made a list that they hoped would allow them to control government involvement in health care.
This list, the Current Procedural Terminology (CPT), was comprised of a series of billable procedure codes, stratified by compensation levels. The AMA persuaded doctors across the country that endorsing this list was vital for preserving their autonomy and income. With physician support, the AMA then convinced the government to adopt the CPT list as the foundation of its new billing system when it rolled out Medicare and Medicaid in 1966.
This allowed doctors and hospitals to bill the government just as if it were another private insurance company. The CPT system thereby stymied any substantive changes to the private, fee-for-service model of American health care. More than half a century later, the CPT system, most recently revised as CPT 2022, remains in place.
Fatefully, when the AMA licensed the CPT billing system to the government, it managed to include in the licensing contract a stipulation that prohibited the government from either seeking an alternative billing system or from creating its own. It required the government to mandate that health care organizations use this system to bill Medicare and Medicaid, and required the government to encourage all health care entities, regardless of relation to Medicare and Medicaid, to adopt this system as well. With a brilliant clerical strategy that was largely hidden from public view, the AMA took American health care hostage. Since 1966, it has been virtually impossible to function as an American health care provider without using CPT codes.
As a result, the AMA reaps an undisclosed amount every year from CPT licensing contracts. In 2019, for example, this appears to have been in excess of $100 million. These dollars support the AMA’s lobbying efforts and its prioritization of doctors’ and administrators’ economic interests, often over the interests of patients, public health, and rational improvements to the US health care system. But direct revenue gleaned by the AMA from the CPT billing system pales in comparison to the influence it allows the organization to exercise over the US health care system.

The AMA’s plan to preserve fee-for-service medicine was successful, but its consequences for patient experiences and physician workdays have been disastrous. This system has, in part because of government efforts to catch and prevent health care fraud by private actors, produced ever-expanding documentation requirements that now constitute the bulk of American doctors’ workloads. This is a major factor behind the alarming rates of physician burnout. As the US faces an already severe doctor shortage, one in five physicians now plans to leave their job
Despite our desire as physicians to believe that our patients’ care is determined by the nuances of doctor-patient relationships and the wisdom of our clinical recommendations, the truth is that patient care is largely determined by billing structures. Medical care in America entails only an illusion of choice. Bureaucrats dictate the options in advance, guided not by the goal of the best possible patient care but by the aim of maximizing revenue. The “freedom” of America’s private health care system has come at the cost of real choices—both doctors’ and patients’.
We will not produce genuine change in the American health care system nor can we effectively remedy its inequalities until we address its political-economic determinants. In this moment in which a pandemic has exposed and deepened the chronic crisis of access, quality, and equity in American health care, the medical community needs a new guiding ethic. We must reject the self-serving illusion that caregiving could ever be simply a matter of clinical duties and embrace the fact that care is always also a matter of political responsibility. Rather than continue to acquiesce to systems designed to generate wealth, advance careers, and protect doctors’ professional status, doctors have an ethical duty to organize in solidarity with our coworkers and patients. Collectively, we should demand that our lawmakers build the systems required to ensure highest-quality care for all, beginning with those communities whose needs the American health care industry has historically refused to meet.
To achieve this, Congress must not only establish a single-payer system; it must also reexamine what we mean when we talk about the “value” of care and who it is that determines this. Health care should be, as it is in all peer nations, a fundamental right ensured by the state via public systems paid for with public dollars. Instead of equating value in health care with billing, price, and profit, we need to invest in public systems that render each of these market-oriented terms irrelevant. Only once we have done so will we be able to make a right to health care an actual reality rather than simply an empty rhetorical gesture.

Craig Brooks

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May 16, 2022, 10:04:24 AM5/16/22
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Kip Sullivan has put lots of work into responding to the misleading statements made in the Nation magazine article -- his comments are in blue by what he is referencing - many thanks to Kip:

In "The blind spot in Medicare for all," Eric Reinhart offers the wrong diagnosis for the US health care crisis and, not surprisingly, he offers no solution. Worst of all, his diagnosis -- overuse of medical services due to the fee-for-service (FFS) method of paying doctors -- is music to the ears of the insurance industry, proponents of the privatization of Medicare and Medicaid, and opponents of Medicare for all. His overuse-due-to-FFS diagnosis was invented by HMO advocates in the 1970s to justify subjecting doctors and patients to interference in the doctor-patient relationship by the insurance industry, and today is the number one excuse cited by advocates of privatizing Medicare and Medicaid. Today's advocates of turning Medicare and Medicaid over to insurance companies and newly invented entities called "direct contracting entities" routinely assert precisely what Reinhart asserts in this article: America's health care costs are driven up not by the excessive administrative costs of an insurance industry wielding managed care tools invented by HMOs, but by greedy doctors ordering services patients don't need, and America needs insurance companies to do the dirty work of making doctors knock it off. 

In short, what Reinhart considers to be a "blind spot" among Medicare-for-all advocates -- single payer bills that rely on the FFS method payment -- is in fact an essential, deliberately selected element of the single-payer proposal. He has it backwards. He has a serious blind spot, not the single-payer movement, not Representative Pramila Jayapal and other legislators who sponsor single-payer legislation at the federal and state level.

It is not possible to offer a thorough rebuttal of Reinhart's piece in a short email, nor to offer documentation. I'll refer readers to a 45 minute presentation I made for One Payer States two months ago Kip Sullivan Kick Insurance.mp4 - Google Drive, offer a short summary of my critique here, and invite readers to peruse my comments in blue interspersed through the text of his article (pasted in below).

Reinhart's diagnosis consists of these three statements:

(1) The high cost of US health care is caused by overuse of medical care;
(2) the overuse is caused by the FFS method (which also causes other problems such as physician burnout); and
(3) the FFS method "is embedded in American health care" today "because of a long political campaign initiated by doctors."

Not one of these statements is true.

Re statement (1): US per capita spending is double that of other wealthy nations primarily because our administrative costs are excessive and because every sector of the health care system has become highly consolidated under the onslaught of managed care cost-control tactics, originally unleashed on the country by HMOs and subsequently adopted by virtually the entire insurance industry. Very little overuse has been documented (as opposed to discussed and obsessed about). Pockets of overuse exist in the US, but it is not the reason US costs are high relative to those of other countries. Americans actually get fewer physician and hospital services per capita than residents of other countries that spend half what we do per capita. Burgeoning paperwork and physician burnout are due not to fraud, much less fraud induced by FFS, but to the reigning managed care ideology Reinhart now promotes.

Re statement (2): No research demonstrates that FFS causes the pockets of overuse that do exist. For a quick lesson in how bereft of evidence overuse mavens are, see my reply to overuse gurus Chernew and McWilliams here The Case For ACOs: Why Payment Reform Remains Necessary | Health Affairs The rising load of paperwork physicians deal with is due to a problem Reinhart seems to know nothing about -- the spread of cost-control tactics pioneered by HMOs. It is not due to the FFS method of paying doctors.

Re statement (3): Reinhart is correct that the AMA created the current manual used to determine what code is used for what treatment on claim forms. But his claim that the AMA has "campaigned" for FFS is false. I wish it were true. No one stands up for the FFS method against the constant disinformation about it, at least not anyone with power commensurate with those who have demonized FFS for the last half century.

I have entered comments in blue in the text of Reinhart's article below.

On 2022-05-15 07:37, Craig Brooks wrote:

The United States is the only high-income nation to insist that health should be determined by markets and profits rather than rights and dignity. The result is that the prohibitively high cost of American health care causes tens of thousands of preventable deaths every year. 
For the first time since the Covid-19 pandemic compounded this long-standing national disaster, Congress is considering the state of America's health care system. The House recently held hearings on Medicare for All, and the Senate Committee on the Budget is convening parallel proceedings today. In this context, many members of Congress who benefit from the status quo are rehashing their opposition to Medicare for All, citing the importance of defending of "freedom" and "choice." With thousands of people dying each week precisely because they have no choices in our current health care system, this rhetorical game should fool no one.
Although universal health care appears unlikely to be enacted by this Congress and has never even appeared on President Biden's agenda, the current hearings serve an important purpose. They remind the US public that our existing system of for-profit health care exclusion is a deliberate policy choice, not an inevitability.
While Medicare for All would be an enormous step forward for the health of Americans and the health of US democracy, it's essential to recognize that what determines our health care system is not simply who pays but also for what we pay. This is where Reinhart starts to leave the rails. This last sentence indicates how badly he misunderstands single-payer legislation. The distinguishing feature of a single-payer system is not a change in "who pays." Any legislation purporting to achieve universal coverage is going to change "who pays." That accusation is exactly how Charles Blahous and other critics of single-payer disparage single-payer. "The silly single-payer advocates think merely changing who pays will make universal coverage affordable," is a common cheap shot from the right. Now we have to read this cheap shot in The Nation.

The distinguishing feature of single-payer systems is the enormous reduction in administrative costs achieved by replacing thousands of middlemen (insurance companies, ACOs, and consultants advising providers on how to deal with these bloated middlemen).

Reinhart's statement that single-payer legislation will not change "what we pay for" is also false. Single-payer legislation creates the mechanisms that permit society to make myriad choices about what we pay for -- what regions or communities will get hospitals, ERS, and MRIS, how much to pay primary care docs versus specialists, how much to pay for c-sections versus normal deliveries, how much to pay for drug research and drugs, whether to pay for transportation to appointments ... on and on.


If we adopt a single-payer structure without remaking the bureaucracy by which the value of care is determined, we will perpetuate the perversity at the core of our system and its world-leading inefficiency. 

This last sentence is so loaded with vague words I can't make sense of it. Is he saying there is one "bureaucracy," one agency, somewhere that "determines the value of health care"? If so, he needs to be told there is no such thing. What does it mean to "determine the value of health care"? How would we "remake" this alleged all-powerful agency or bureaucracy? The grand phrase "perversity at the core of our system" is about as vague as one can get, but I'll surmise that the "perversity" is the fee-for-service method of paying doctors and hospitals. This "perversity," incidentally, is at "the core" of every other nation's health care system. So how is it "perverse"? It's the norm.

Despite efforts to implement alternative models over the last two decades, Here Reinhart links to two awful articles the insurance industry and right-wing market advocates approve of.

a fee-for-service framework remains embedded in American health care and endures as its dominant underlying driver. Fee for service compensates doctors, clinics, and hospitals based upon number and type of visits involved in a patient's care, creating incentives for unnecessary procedures, excessive clinic appointments, and the mountains of paperwork that have become the bane of American doctors' daily lives. This system, which places value on specialized services rather than on primary care, is also a crucial factor behind the worsening shortage of primary-care doctors. These last three sentences are music to the ears of the insurance industry, which for decades has inflicted managed care schemes like capitation and utilization review on doctors, all in the name of stopping alleged overuse caused by FFS. It is also music to the ears of the hordes of consultants who advise providers on how to cope with managed care tactics and "value-based payment" schemes. Starting with HMO advocates in the early 1970s, advocates of empowering insurance companies to inflict managed care tactics on the populace have asserted over and over, always with out evidence, that FFS causes overuse, or in Reinhart's words, "unnecessary procedures [and] excessive clinic appointments." Yes, it's true, America underpays for primary care services, but the fact that we have a coding system and the AMA wrote it does not explain that problem. The problem is a combination of the un-free market place (specialists find it easier to form large practices and thereby force insurance companies to pay them more) and dominance of Medicare's fee-setting committee by specialists. This problem is explicitly addressed in single-payer bills such as Jayapal's.

The persistence of fee for service is no accident. It's the consequence of a long political campaign initiated by doctors that has since been taken over by industry executives and their lobbyists. These last two sentences reflect breathtaking ignorance. FFS exists throughout the world, not because greedy doctors everywhere "campaigned" for it, but because it's the most logical way -- the method with the fewest toxic consequences -- to pay for medical care to independent doctors (that is, doctors not beholden to insurance companies or corporations) or doctors in a country where putting them all on Uncle Sam's payroll and paying them a salary would evoke even more opposition than M4A legislation does now. Even in the world Reinhart apparently favors, a world in which doctors are paid either salary or capitation, the insurer (public or private) has to receive some proof that a service was rendered and some indication of what the service was. Otherwise the entire health care system becomes a black box -- money goes in but no one knows what's being purchased with it. That's why all countries have coding systems.

The insurance industry loves to demonize FFS. There is, conversely, no one, including the AMA, "campaigning" to defend FFS -- to clean up the storm of misinformation about FFS promoted by the industry and their allies in the media, academia, and the world of think tanks, and now The Nation.


Fee for service solidified its central role in American health care in 1965 when Congress passed legislation to create Medicare and Medicaid. This last sentence is wrong. There was no magic moment when FFS was "solidified," not in the US, not anywhere on the planet.

For years, the American Medical Association (AMA), a physicians' lobbying group organized to protect doctors' economic interests, had been doing all it could to oppose public health-insurance programs like Medicare and Medicaid. They feared that government involvement in health care would lead to a decline in doctors' earnings and professional status. The AMA campaigned to associate government-financed health care with Cold War fears of a communist takeover of medicine. American doctors had struggled for several decades to build respectable professional status and high incomes. Now, they were told that if "socialized medicine"—that is, health care that's a public service—came to America, then they would earn no more than Soviet factory workers and would be overwhelmed by bureaucracy and documentation requirements. Agree with this last paragraph. Note the irony: It wasn't the enactment of Medicare and Medicaid that brought on "bureaucracy and documentation requirements." It was the invention of the "HMO" as a weapon to oppose the expansion of Medicare to all in the early 1970s that brought on the plague of the middleman parasites and burgeoning paperwork.
When the AMA realized in the 1960s that its efforts to keep government out of health care were failing, it shifted its strategy to protect the fee-for-service model upon which high physician compensation had been built. Total nonsense. Wish that it were true. To repeat: No one defends FFS. AMA leadership drew from Relative Value Studies, an experiment the AMA had pioneered in California that created a billing model for the burgeoning private insurance industry, and made a list that they hoped would allow them to control government involvement in health care. It's true that the AMA developed the CPT, but it's absurd to say they did so to "control government involvement in health care." The World Health Organization produces the long list of diagnoses that are used along with the CPT to fill out claim forms (it's called the International Classification of Diseases). Are we to believe the WHO is also run by greedy doctors working for the AMA?

This list, the Current Procedural Terminology (CPT), was comprised of a series of billable procedure codes, stratified by compensation levels. The AMA persuaded doctors across the country that endorsing this list was vital for preserving their autonomy and income. With physician support, the AMA then convinced the government to adopt the CPT list as the foundation of its new billing system when it rolled out Medicare and Medicaid in 1966.
This allowed doctors and hospitals to bill the government just as if it were another private insurance company. The CPT system thereby stymied any substantive changes to the private, fee-for-service model of American health care. More than half a century later, the CPT system, most recently revised as CPT 2022, remains in place. What is Reinhart's beef? He seems to be saying the US doesn't need a coding system -- we don't need the CPT, we don't need need the ICD10. That's nuts.

Fatefully, when the AMA licensed the CPT billing system to the government, it managed to include in the licensing contract a stipulation that prohibited the government from either seeking an alternative billing system or from creating its own. This is a legitimate beef. So is Reinhart ok with coding systems, just so long as the AMA had no part in creating it? It required the government to mandate that health care organizations use this system to bill Medicare and Medicaid, and required the government to encourage all health care entities, regardless of relation to Medicare and Medicaid, to adopt this system as well. With a brilliant clerical strategy that was largely hidden from public view, the AMA took American health care hostage. Ridiculous statement. There was no "brilliant clerical strategy" to jam FFS down the nation's throat. If "taking hostages" is a useful metaphor, it should be applied to the insurance industry, not the CPT and the AMA (nor the ICD and the WHO). Since 1966, it has been virtually impossible to function as an American health care provider without using CPT codes. True. So what?
As a result, the AMA reaps an undisclosed amount every year from CPT licensing contracts. In 2019, for example, this appears to have been in excess of $100 million. These dollars support the AMA's lobbying efforts and its prioritization of doctors' and administrators' economic interests, often over the interests of patients, public health, and rational improvements to the US health care system. All true. But direct revenue gleaned by the AMA from the CPT billing system pales in comparison to the influence it allows the organization to exercise over the US health care system. Total nonsense. The AMA lost power over the last half century thanks to the demonization of doctors and FFS that allowed the insurance industry to usurp authority that used to belong to doctors and patients. Control of the health care system now lies with the insurance industry (ie United Healthcare), the hospital sector (ie the Mayo and Allina systems), and the drug industry.
The AMA's plan to preserve fee-for-service medicine was successful, The AMA didn't "preserve FFS." It invented a coding system and made big bucks off it. There's a huge difference. but its consequences for patient experiences and physician workdays have been disastrous. This system has, in part because of government efforts to catch and prevent health care fraud by private actors, produced ever-expanding documentation requirements that now constitute the bulk of American doctors' workloads. This is a major factor behind the alarming rates of physician burnout. As the US faces an already severe doctor shortage, one in five physicians now plans to leave their job. This takes the cake for ignorance. Reinhart has it backwards. It is not FFS that has created measurement madness and the "ever-expanding" paperwork load. It is managed care ideology, which began with the demonization of FFS by HMO advocates, and is maintained today by proponents of the insurance industry, DCEs and the privatization of Medicare.
Despite our desire as physicians to believe that our patients' care is determined by the nuances of doctor-patient relationships and the wisdom of our clinical recommendations, the truth is that patient care is largely determined by billing structures. Just nonsense. "Billing structures"? What is that" Whatever it is, it isn't "billing structures" that "determine the nuances of doc-patient relationships." It is United Health Care, Humana, and DCEs/ACOs. Medical care in America entails only an illusion of choice. Bureaucrats dictate the options in advance, guided not by the goal of the best possible patient care but by the aim of maximizing revenue. Why does Reinhart keep referring to "bureaucrats"? Why doesn't he tell us who they are? They are the managers of the insurance industry and other powerful corporations that control doctors and patients today.


The "freedom" of America's private health care system has come at the cost of real choices—both doctors' and patients'.
We will not produce genuine change in the American health care system nor can we effectively remedy its inequalities until we address its political-economic determinants. What "political-economic determinants." Why can't Reinhart point the finger at the insurance industry? In this moment in which a pandemic has exposed and deepened the chronic crisis of access, quality, and equity in American health care, the medical community needs a new guiding ethic. We must reject the self-serving illusion that caregiving could ever be simply a matter of clinical duties and embrace the fact that care is always also a matter of political responsibility. Rather than continue to acquiesce to systems designed to generate wealth, advance careers, and protect doctors' professional status, doctors have an ethical duty to organize in solidarity with our coworkers and patients. Collectively, we should demand that our lawmakers build the systems required to ensure highest-quality care for all, beginning with those communities whose needs the American health care industry has historically refused to meet. That is precisely what single-payer legislation would do. Has Reinhart read Jayapal's bill? If he has, and he has a complaint about it, why not spell it out and tell us what amendments he thinks are necessary?
To achieve this, Congress must not only establish a single-payer system; it must also reexamine what we mean when we talk about the "value" of care and who it is that determines this. Another sentence with words that say nothing. How would Congress "reexamine what we mean when we talk about the 'value" of care? Health care should be, as it is in all peer nations, a fundamental right ensured by the state via public systems paid for with public dollars. Instead of equating value in health care with billing, price, and profit, we need to invest in public systems that render each of these market-oriented terms irrelevant. Another sentence that is difficult to interpret. Single-payer legislation will do this if I understand what this sentence means. Only once we have done so will we be able to make a right to health care an actual reality rather than simply an empty rhetorical gesture.



Kip at a presentation:
https://doc-0s-0k-docs.googleusercontent.com/docs/securesc/jdupk5mc7j7r71d8pl1f4ochq97rfm21/lcfto217npks5vcj4ussnjslo746ou19/1652709450000/08939308064567696407/12713729750389492758/1K78gH3UlaTiUkxols78AS8mt82MGz5Na?e=download&authuser=0




On Sun, May 15, 2022 at 7:37 AM Craig Brooks <craig....@gmail.com> wrote:
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