Articles and Letters by VA PNHP Members

The following articles and letters to editors in support of single-payer health care were written by members of Virginia Physicians for a National Health Program.

Health care a right, not reason to profit

Dr. Antal E. Solyom
Published in News & Advance: September 15, 2009

With regards to Rep. Bob Goodlatte's positions on the needed health care reform, I would like to call his attention to the following issues.

Competition is healthy, but it should take place among non-for-profit insurance companies, just like there is appropriate competition among non-for-profit hospitals. Nobody should profit from people's diseases and disabilities! That is immoral! Anyone may profit from all sorts of commercial commodities, but people's health and health care are not commodities. To treat them as such degrades human beings into objects of commerce.

Much could be saved by eliminating the profits and the enormous bureaucratic overhead of for-profit insurance companies (of which there are reportedly 1,300!), and those significant savings could go a long way toward the coverage of the uninsured who are rationed out of the current health care "system." Bureaucrats should stay away from the health care decisions to be made by professional providers and their patients! But this must be a requirement for both government (Medicare and Medicaid) and private insurance company bureaucrats.

According to the recent report by the National Census Bureau there were 46.3 million uninsured people in the US last year, up from 45.7 million the year before. An additional 4 million people became uninsured but qualified for public programs. Other data showed that 62% of all bankruptcies were due to medical debt of people most of whom (80%) had health insurance (which was obviously inadequate).

The Institute of Medicine (part of the National Academy of Sciences) reported several years ago that the lack of health insurance had resulted in 18,000 inexcusable deaths every year in our country (some estimates today are much higher), which breaks down to 1,500 deaths per month, or to 50 deaths of real individual human beings every day! Thus, since the last attempt at universal health care in 1993/94 the death toll has been at least 270,000! That is much more than the deaths and disabilities caused the Vietnam War, Gulf War, Iraq and Afghanistan Wars combined!

Could we just insert a little morality of justice into our health care reform?! Could all in Congress simply say: "let all citizens have exactly the same options of insurance coverage that we - who are serving, and are being paid by, the taxpayers! - have." That would require no debates over policies of health care coverage, except for the discussion over appropriate subsidies that some individuals and small businesses need in order to be able to pay the premiums.

Again, if the obscene profits would be taken out of the insurance arrangements that task should not be a heavy lift either.

Profit-Driven Health Insurance Has Outlived Its Usefulness

Susan A. Miller, Guest Columnist
Published in the Richmond Times-Dispatch: July 12, 2009

As I read C. Burke King's Sunday Commentary last week -- "Government Health Plan Would Hurt Quality, Innovation, Choice" -- I wondered what health care system he had been living in until I glanced at the bottom line and realized he is the president of Anthem Blue Cross and Blue Shield.

King asserts that the extension of a government plan, such as Medicare for all Americans, would hurt quality, innovation, and choice. After 29 years practicing family medicine, I will have to call him on these claims. His fear is that "a government plan would destabilize the market, increase cost of private coverage, and reduce quality of care," and that "private insurers would not be able to compete on an un-level playing field."

He repeatedly writes about "government-run plans" as if Medicare or Medicaid is actually "run" by government bureaucrats. The truth is, Medicare is funded by all of us through our taxes and is delivered by the private doctors, nurses, and hospitals that provide health care -- not health insurance.

Medicare and Medicaid patients have complete freedom to choose physicians all over the U.S., as nearly every provider participates in Medicare. Medicaid participation is limited only by the fact that reimbursement is so poor that providers must limit numbers to ensure financial viability.

Employer-based insurance, on the other hand, is chosen by the employer, not by the patient, and the insurance company limits selection of providers to those who have signed a contract.

Which brings me to King's next really irritating claim: "Private plans negotiate with providers to set reimbursement rates." Never once in my career did Blue Cross/Blue Shield representatives ever offer to negotiate rates with me. It was always the 800-pound gorilla presenting a take-it-or-leave-it contract in my office -- while all through the managed-care revolution, insurers were steadily raising my overhead, bundling my codes, and denying my patients care and coverage.

The multiple lawsuits won by physician organizations will attest to the truth of these statements, though as a small private practice, my partners and I never saw a dime of the settlements.

Let's talk about quality and innovation next.

I have worked in the medical quality improvement field for 15 years and am proud to be a Patient Safety Fellow trained at VCU.

My small private practice implemented the use of "hospitalists" five years before the first one was hired at local hospitals, we practiced open-access scheduling 10 years ago, and for a year in the 1990s, received a $30,000 bonus for preventive care guidelines -- until the insurance company unilaterally changed the reward program and pulled the rug out from under us. (It was clearly too expensive to reward us for quality.)

An important article published in JAMA, The Journal of the American Medical Association this year decisively proved that the intrusive, over-the-phone chronic disease management programs touted by insurance companies do not work. What does work is a proactive team in the primary care doctor's office working through the longstanding doctor-patient relationship.

But if I have to hassle with 1,300 different private insurance companies (even though five companies control 80 percent of the market) and spend my time fighting with them over whether my patients need an MRI or can continue taking the drug they have been stabilized on for several years, I don't have time to proactively manage patients' chronic care.

A recent study by Drs. Steffie Woolhandler and David Himmelstein of Physicians for a National Health Program showed what my partners and I always knew: The average primary care doctor spends two hours a week -- and her staff spends a whopping 16 hours a week -- on paperwork generated by the insurance industry. There goes my overhead!

King is right to be worried about competing on a level field with the government plan. Medicare overhead is 3 percent, while the private insurance industry takes 30 percent of the health care dollar for CEO salaries, profit, and administrative overhead.

For those who really want to look at quality metrics, please note that the Veterans Health Administration (the only form of truly socialized medicine in the U.S.) has been beating private hospitals on quality metrics and implementation of electronic records, as well as transparency and medical errors, for 10 years.

What King is worried about is not that "many Americans will be forced into government-run plans" but that when the truth is known, many Americans will choose the government-funded plan.

In fact, 60 percent of the American public does prefer Medicare for all, and 72 percent recently said a governmentsponsored public option should be included in any health care reform.

The 16,000 -- and growing -- doctors of Physicians for a National Health Program, of which I am one, are actively working to protect the health of our patients from a profit-driven health insurance industry that has outlived its usefulness and needs to get up from the table of health reform and allow the providers of care who are in the trenches every day for the people of this country to redesign an American solution: Medicare for all.

Susan A. Miller, M.D., is a clinical professor at Virginia Commonwealth University's department of family medicine. The views expressed in the column are those of the author, and not those of the university.

Letters by other PNHP Members

The following letters to editors in support of single-payer health care were written by members of Physicians for a National Health Program.

Medicare-for-all option would cover everyone, reduce costs

Dr. Thomas Clairmont
Published in the New Hampshire Union Leader: August 21, 2009

Speaker Pelosi has pledged to hold a floor debate and vote on single-payer health reform this fall. This vote on an amendment to HR 3200 (the 1,000-plus page bill favored by the House leadership) would substitute the 27-page HR 676 as the new health care policy of the United States.

This is good news after months of suppression of a bill that should be the gold standard for comparison of plans. This is important to everyone because passage would bring simplicity and stability into your health care planning.

For about 4.5 percent of income, matched by your employer, you would receive a lifetime policy with no co-payments, no deductibles, no out-of-pocket expenses and, most important, no pre-existing conditions exclusions. Your policy would cover your choice of physician and appointments with them, hospital care, diagnostic imaging, laboratory tests, prescriptions, vision care, preventive care, dental care, chiropractic care, emergency care and ambulance transportation, podiatry, speech, physical and occupational therapy, mental health care, substance abuse care, health education, hospice care, adult day care, skilled nursing care, long-term care, and dialysis. This policy would be portable, continuous, and never could be canceled regardless of your employment status.

Please note that passage of this plan covers everyone with the same basic policy. Medicaid would be eliminated; Medicare would be considerably improved. Medical bankruptcy would be eliminated, and the President's goals of universal, affordable, choice, and cost controls would be met. The dreaded doughnut hole in Medicare D would be an unpleasant memory.

Costs would be contained by dramatically reducing administrative expenses, global budgeting, bulk purchasing of prescription drugs, medical supplies and equipment, mandating transparency in pricing, and reducing fraud. No other plan has cost controls built in and, therefore, would be much more expensive.

Although the President keeps saying you can keep the insurance you have, it is the small businessman buying this policy for you. And with insurance premiums rising every year way above the inflation rate, providing this coverage for many is not possible anymore. A fixed percentage of payroll would be a much more affordable option.

The city of Portsmouth paid $9,615 for a family policy in 2000, and this year it's $24,145, representing 10 percent of the property tax bill. Without reform, similar increases of this magnitude would lead to a premium of $60,362 in 2020 and $150,906 in 2030. This clearly demonstrates the need for reform.

Doctors are complaining about insurance company interference with their practice of medicine and the paperwork related to this oversight. This is minimally present in Medicare today and would disappear in the single-payer program.

Please visit Physicians for a National Health Program's web site,, for more information. Don't discount the Medicare-for-all option without a full understanding of this program. Our principles are automatic enrollment, comprehensive coverage, public financing, eliminating administrative waste, maximum choice of physician and hospital, and delivery through a nonprofit, privately controlled system. What does your ideal system look like?

Don't be put off by the lies and distortions blaring across your radio and television. HR 676 covers you for life; it is affordable; and it is simple to understand and implement. And it pays for itself. What does your plan do?

Dr. Thomas Clairmont is an internist in Portsmouth.