Letters from VOTERS
Editor's Note: While the Affordable Care Act (ACA) provides new opportunities to millions of Americans previously without health insurance coverage, its complexities and high cost, even with subsidies, continue to frustrate many people, including the most knowledgeable (story). Through our new Letters from Voters section we present the views and experiences of Maine People, personal stories about trying to get health care for themselves and their families. We believe that these views, virtually to a person, make the ultimate argument for universal health care within our state. Affordable, comprehensive, quality health care for every one in Maine – one that is accountable and focuses on patients and providers alike – at a lower cost. Please share your ideas and your story, and consider joining Maine AllCare in our work to make health care for everyone in Maine a reality.
Another View: Single-payer coverage right fix for flawed Obamacare program
Portland Press Herald – February 4, 2017
Jason Savage, executive director of the Maine Republican Party, is absolutely right about many of the significant flaws found in the Affordable Care Act; some of which he pointed out in his recent piece (“Obamacare editorial ignored the ‘repeal and replace’ scenario” Jan. 27). We all know the law was flawed. One of its greatest faults is that too many people were left out. It is hard to imagine our Congress would even consider passing a law that excludes people unable to afford the cost of the plans on their own and too poor to qualify for subsidies, but that’s exactly what our representatives and senators did. Congress threw us crumbs and suggested we should be grateful.
Savage’s own article is flawed as well. First, he suggests that the Telegram editorial uses hyperbole in making its case, and then suggests that the newspaper and, by extension, we readers, misunderstand and are ignorant of the facts surrounding the ACA. Not so! We are informed and we recognize, better than our elected officials seem to, that Americans want and know they deserve access to high quality, affordable health care.
We believe that health care is a human right. We believe that the core principles of equity, accountability, transparency, universality, and participation must guide how we create access to health care for all. We are long past believing that having either a health insurance policy or a for-profit health insurance industry will work to our benefit. Our collective experiences with insurance have taught us better. We’ve already waited too long for Congress, as Savage suggests, to “try to sort through the issue and see what their solutions look like” because, he says, “There’s no doubt that members of Congress want to see health insurance work for Americans.” Access to health insurance just means more crumbs. And crumbs are not enough. Americans are hungry for universal health care they can count on in moments when they are strong and in good health as well as those moments when they are vulnerable.
Universal health care is both possible and necessary. Now is the time to be bold and innovative. Let’s use our formidable will to create access to health care for all. Now is not the time to rehash ways to make health insurance work. It doesn’t. It didn’t. It won’t. Let’s stop groveling for crumbs and demand enough for all.
By Roger and Peggy Merchand
January 26, 2017
Dear Senator Collins,
I have submitted the following Letter to the Editor to the Bangor Daily News, the Ellsworth American and Penobscot Bay Press. I urge you to consider whether you are representing your Maine constituency when you support abolishing the Affordable Care Act.
Here is my story showing how private health insurance is not working for me and my family.
The US Congress appears to be set on a path to abolish the Affordable Care Act and privatize Medicare regardless of the impact this will have on individual Americans. Here is an example of what your health insurance may cost if Congress proceeds with its plan and you are self-employed, have a job that does not include health insurance, loose your job with its health insurance benefits or retire into a world with privatized Medicare.
This year the private health insurance premium for my healthy family of five is $33,229.68. My wife and I are self-employed. Because we are selling assets to pay for the university education of our two eldest children we are not eligible for the Affordable Care Act subsidy. Our insurance policy is bare bones with a high $10,400 deductible. Premiums are calculated based solely on age. The premium costs per individual are $12,948.48 for me (62 years old), $10,050.48 for my 55 year old spouse, $4,506.96 for my 22 year old daughter and $2,861.88 each for my 20 year old daughter and 11 year old son. That’s before we start paying off our $10,400 deductible!
Based on the costs outlined above, what would your private health insurance cost if the Affordable Care Act is abolished or if Medicare is privatized? Will you be able to afford health insurance of any kind after Congress abolishes the Affordable Care Act and privatizes Medicare? Who is Congress representing when they move to abolished affordable health care and privatize Medicare? Hint: Not you or me!
Are you worried? Write Susan Collins and Bruce Poliquin, who both support abolishing the Affordable Care Act.
East Blue Hill
Stand up for the Affordable Care Act
January 27, 2017, Ellsworth American
It is critical for all citizens and Mainers to be aware that as early as Jan. 23 our present Congress intends to abolish/repeal the Affordable Health Care Act. While there may be broad agreement that this health care act has real problems, it does provide vital, life-saving benefits to millions of Americans and to 75,000 Mainers, including the provision for pre-existing conditions, basic preventive care access and the ability for parents to keep their young adults to age 26 on their health coverage.
We must make Congress accountable and aware that we do not want a drastic or reckless response that would do grave harm to so many fellow citizens. Call, write or email your legislators. Urge them to veto any repeal of the ACA until there is a full and concrete replacement that preserves these most positive of benefits and protects the well-being of so many of our fellow citizens.
Medicare for all
By John Sytsma
Sun Journal, January 12, 2017
Now that this nation is going to be faced with a full-blown attempt to get rid of the Affordable Care Act (with no idea of what will replace it), this is a perfect time for people to raise their voices in favor of the only health care finance system that will work, long term, for the United States — Medicare for all.
Every industrialized country in the world, and some that are not industrialized, have systems that provide universal health care at half the price that people in the United States are paying.
The U.S. wastes billions of dollars and still leaves people without coverage, people who die as a result, and people who suffer medical bankruptcy. As long as the profit motive underlies health care financing, costs will rise, with 20 to 30 percent (called "overhead") going into the pockets of insurers, drug companies and equipment manufacturers. With Medicare, overhead is 3 percent, and it can set reasonable limits on fees, drug costs and the price of equipment.
Not only does the nation save money, but coverage will be universal.
John Sytsma, Farmington
Letter to the editor: Remove profit motive from U.S. health care system
Maine AllCare has received many responses to the Dec. 5 Maine Voices column, “Trump’s health care policy appears heavy on complexity, light on mercy.” One respondent correctly observed that not every industrialized country has a “single-payer” system.
This observation misses the forest for the trees. Indeed, many countries employ private insurance companies. But they are overwhelmingly nonprofit, heavily regulated public utilities.
Insurance companies process Medicare claims, but most of the time Medicare, not the insurance companies, underwrites the costs of care. There is a reason for this. Having a for-profit health insurance system sets the tone for behavior throughout the system.
The United States is the only country in the world where for-profit insurance and other products and service companies are central to its health care system. It is also the only society where profiteering and wealth extraction from sick, frightened and essentially powerless patients by insurance, pharmaceutical, medical device and other corporate providers of health care products and services (some of them nominally nonprofit) are not only tolerated and permitted, but also often celebrated.
In other countries, the mission of the health care system is facilitating the delivery of health care. Instead, our for-profit system often erects financial and other barriers to care (insurance companies), or prices their products out of reach of most Americans (pharmaceutical, medical device companies and corporate service providers), all in the cause of maximizing profitability.
We offer access to the most profitable services to those able to pay for them, often without regard to their clinical necessity or merit, leading to well-documented over-treatment, sometimes with disastrous results.
In other wealthy countries, health care is a right, not a privilege to be purchased by those with the means to do so, and is considered a public service, not a way to get rich quick. This was the column’s central point, and one worth repeating over and over again.
Philip Caper, M.D. Julie Pease, M.D.
board of directors, Maine AllCare
Published in the Portland Press Herald, December 20, 2016
Letter to the editor: Medicare for all is just what the doctor ordered
December 19, 2016
I read Dr. Daniel C. Bryant’s Maine Voices column (Dec. 5 - see below) with interest because I have often wondered what health care professionals think of Obamacare and Medicare.
The biggest problem with Obamacare is the requirement that all with pre-existing conditions be insured. This is impossible for private insurers, because insuring the previously uninsurable is a losing proposition.
The solution would be a true individual mandate through the payroll tax, requiring both employers and employees to contribute, as they do now for Medicare. In exchange, employers would no longer have to provide insurance plans, and employees would no longer have to pay premiums.
Those proposing alternatives say they want health care that is patient-centered but do not explain how our present health care is not. I have had personal experience with both private insurance (formerly through my employer) and public insurance (presently through Medicare). As a patient, I have always been at the center, whether in the doctor’s office or the hospital.
There is more freedom of choice with Medicare. Almost all providers take Medicare, but private insurers restrict you to their networks.
There are those who fear that government-run health insurance could lead to a socialist state in which freedom and personal ambition and energy would be diminished. This needn’t be so if we, through our elected representatives, refuse.
Nobody is proposing a government takeover of the hospitals, because no problem exists that would be solved by it. Two of the most popular government programs, Social Security and Medicare, are socialistic but work well in a capitalist economy.
Like Dr. Bryant, I advocate Medicare for all. I wish that all of my fellow citizens could enjoy the excellent health care that I receive. It would be good for the individual and good for society.
Michael P. Bacon
Portland Press Herald
Maine Voices: Trump’s health care policy appears heavy on complexity, light on mercy
By Daniel C. Bryant Special to the Press Herald
CAPE ELIZABETH — Will Donald Trump make our country’s health care system great again? Of course, for many it was never that great in the first place, but it is important to consider what changes may lie ahead during a Trump presidency. For this, we can turn to his website, where he promises to:
- Repeal the Affordable Care Act. Though Mr. Trump has suggested he may keep some features of the ACA, this may mean that 20 million people will lose their health insurance and millions more will find it increasingly hard to find affordable policies with reasonable coverage.
- Replace the ACA with health savings accounts. In the HSA scheme, individuals with high-deductible plans can set aside thousands of dollars of income a year, tax free, to pay future health care costs.
This, of course, limits HSAs to those with extra money to set aside, who will then be faced with the recurring quandary of whether a medical problem “deserves” their depleting their account or should be ignored because something worse might come along.
- Return health insurance regulation to the states. Dealing with 50 different sets of insurance regulations will be a challenge both to businesses with employees living in multiple states and to the companies that provide insurance to those businesses.
And people with costly medical problems will be tempted to move to states that require insurers to offer good coverage, thus burdening those well-intentioned states; while businesses will be tempted to move to states with low coverage requirements and premiums, thus forcing poorer policies on their employees.
- Maximize flexibility for states in administering Medicaid. Like the above, this “states’ rights” emphasis would give states so inclined a tool for modifying their demographics to their economic advantage: namely, by keeping out the poor and the sick.
- Enable people to purchase insurance across state lines. The resulting competition might well reduce premiums, but in order to maintain their bottom lines, for-profit insurers would have to compensate by reducing coverage or provider reimbursement. And it will be tricky, indeed, for insurers to sell group and individual policies across state lines if every state has a different set of regulations.
- Re-establish high-risk pools. By segregating the sick or likely-to-get-sick into “pools,” we shift some of the extra cost of their care to them, and away from the already more fortunate. The balance of the cost must then be paid by the government, which may or may not be willing to do so.
This all flies in the face of the basic idea of insurance, which is to spread cost over the fortunate as well as the unfortunate, not concentrate it. And what is even worse, it perpetuates a two-class system – normal people, and the sick and poor.
- “Modernize” Medicare. This is too vague a prescription to try to interpret at this point; it could mean anything from lowering the age limit and increasing coverage, to phasing out the program altogether.
Reviewing Mr. Trump’s likely health care policies, we can note two themes, both of concern – complexity and inequity.
Complexity, and its associated financial costs, would come from the co-existence of millions of HSAs, millions of individual and employer-sponsored insurance plans and a variety of Medicaid and other governmental programs, all operating within the competing regulations of the 50 different states among which people and businesses are constantly moving.
Inequity, and its associated social costs, would come from the vastly different access to health care that people of different means and locales would have.
The Affordable Care Act, too, is complex, and, though much more equitable than Mr. Trump’s policies, may well not survive. As for the system that the president-elect’s policies would lead to, it will be unlikely to survive either because of its own complexities, and should not because of its inequities.
In the aftermath of both Barack Obama’s and Mr. Trump’s efforts at health care reform, we will be left then to design a new system, preferably the one we should have had all along – a simple and equitable system of the single-payer, Medicare-for-All type, similar to those that every other industrialized country has adopted.
No, Donald Trump will probably not make our health care system great again, but he may, if inadvertently, help to make it great at last.
Daniel C. Bryant, M.D., of Cape Elizabeth is leader of the Portland chapter of Maine AllCare (maineallcare.org), an organization devoted to getting universal health care in Maine.
Misunderstanding right to health care
In his May 4 BDN letter to the editor, David Smith demonstrated fundamental misunderstandings of Bernie Sanders’ claim that everyone has a right to health care, arguing that implementation of such a definition would entail forcing doctors to provide services on demand and enslaving citizens to one another through the agency of their government.
As a right, health care does not impose a claim or imposition by one to pre-empt challenges from another, such as ownership of property. It affirms a familiar human legacy, such as the right to drink clean water or breathe healthy air — rights contested today by some corporate interests.
Like the right to freedom of speech, religion, to marry the person of one’s choice or to manage one’s savings and expenditures, health care is traditionally expected and valued in any society, performed according to the understandings of that culture. Such rights are valued by people around the world, though they cannot be taken for granted.
Smith also misunderstands the concept of “democratic socialism,” which is not a Marxist or totalitarian plan. Subjection to the requirements of the state and of fellow citizens are no more noteworthy in Sweden than in the United States, yet citizens’ satisfaction with their civic and community lives may be much higher in Sweden.
Vital, dynamic and contested ideas like these deserve to be explored and understood.
Opinion, Bangor Daily News
Health care needs single-payer system
When considering the best way to solve our country's health care woes, I am reminded of Winston Churchill's famous comment about democracy as a form of government, in which he stated, in effect: It's a terrible system, but everything else is worse. This same statement might apply to a single-payer system in medical care as proposed by Bernie Sanders at a recent Democrat presidential debate, for it, too, probably beats everything else.
First, a truly effective system will not be achieved unless we solve the many associated issues that include tort reform to control the exorbitant costs of physician medical malpractice insurance in many states, excessively high cost of drugs, inappropriate use of expensive tests and treatments, and several others. But all these issues can be solved, given the desire and, hopefully, willingness of our legislative bodies to work together for the benefit of all.
Although the Affordable Care Act (ACA, "Obamacare") has been a step forward, it fails to address the problem of waste and complexity in the system. A single payer system would eliminate the entire commercial insurance industry — with $730 billion in revenues and a workforce of 470,000. Not only would this provide a more economical way to use healthcare resources by reducing expenses, it would also likely improve quality, and restore doctors' authority. For all practices, administrative costs would plummet because there would be only one set of payment rules and forms, with the result that prior authorizations, narrow networks, and out-of-pocket payments could be eliminated.
There also appears to be evidence of growing physician support for a single-payer system. For example, a 2014 survey of Maine physicians conducted found that nearly 65 percent of respondents preferred the single-payer option over trying to fix the current system—up from 52 percent in a 2008 survey. Physicians in general now seem more open to a single-payer system.
Notwithstanding the Republicans' constant calls for abandoning ACA, a majority of the population (51 percent) now supports Medicare for all, according to a national poll released recently. Many experts, however, believe that the movement for a single-payer system may start at the state level, since much of the public continues to mistrust Washington.
Although a government-run, single-payer system is the only way to provide effective basic medical health therapy and management, for those who desire a higher level of care — and can afford it — there should be a private-pay system, in contrast to the Canadian system. This would constitute a two-tiered system. This might be objectionable to egalitarians that wish to have a "one size fits all" system, but would be the most pragmatic approach.
Usually those against single payer system trot out the usual vague objections that we are becoming "socialistic." But what about our current Medicare system and Social Security itself; are those not socialistic?
Whether we like it or not, basic healthcare is like a utility—something everyone needs, and in the best interest of our society, everyone should receive. Although there are variations of the general theme as I have enumerated above, we are probably moving inevitably toward a single payer system. When it finally arrives, I believe everyone will be relieved, if not pleased, even including our warring politicians!
Dr. Morton Tavel
Opinion, News-Press.com, April 16, 2016
Medical care isn’t shopping trip
I’m responding to Matthew Gagnon’s April 6 BDN column, regarding a bill he helped write, An Act To Encourage Health Insurance Consumers To Comparison Shop for Health Care Procedures and Treatment. His solution is to have patients compare prices for health care services, choose the cheapest and pocket some of the difference.
This would make a complicated system even more cumbersome and unfriendly. If you have a heart attack, do you really want to spend time getting price quotes? To choose your heart surgeon based on cost?
Health care is not a “perfect market.” There is never enough information to compare services. You don’t know the price of a procedure before it’s done because you don’t know whether there will be complications, how long you will stay, or what drugs you will end up receiving.
Gagnon forgets there may be good reasons for cost outliers. Massachusetts General Hospital costs twice as much as some hospitals, but it accepts the most complicated patients. Don’t we all want it to remain open, despite its costs, in case we need it, someday?
Right now, insurance companies spend 33 percent of our premiums on “administration”: marketing, trying to enroll the healthiest customers and figuring out how to refuse paying for services you may need. Medicare spends only 1 percent on administrative costs. “Medicare for all” could reduce the cost of private insurance by 32 percent.
Medicare for all would unify prices, reduce the complexity of health care costs, end medical bankruptcies and probably cost less overall than our current system.
Meryl Nass, M.D.
Letter to the Editor, Bangor Daily News, April 26, 2016.
Health care is a right
Hardly a week goes by without an announcement in the paper or on a community board in Mardens or Hannaford about a local person stricken by some illness or accident who can’t afford to pay their medical bills regardless of whether they have insurance. The family of the loved one puts out a plea for friends, neighbors and community members to attend a fund raising dinner, an auction, or to buy baked goods in an effort to offset medical bills.
I imagine that people visiting from abroad Japan, England, Egypt, Germany, South Korea, Iceland, Kyrgystan, Peru, Singapore or Spain have a hard time comprehending that the citizens of the most powerful economy on Earth are content with a system in which people must resort to these desperate fundraisers to attempt to cover the cost of health care. These countries and 48 others already provide universal health care for their citizens. When one of their citizens suffers from cancer or some other dire illness there is no need for the family to hurriedly organize bake sales and spaghetti dinners.
In his last debate, former presidential candidate Dr. Ben Carson said that health care in the United States is not a right, but a responsibility. While I wholeheartedly agree that it is our responsibility to keep ourselves as healthy as we can through sound choices, I also believe it should be our right to access affordable health care. All developed nations save the United States see health care as a right, and we need to abandon our disgraceful status as the last holdout. I’m tired of reading about my neighbors struggling to pay for medical expenses. 100,000 Mainers do not have insurance, despite the Affordable Care Act. We need a health care system that allows all of us equal access to health care. Medicare is the closest thing we have to health care as a right. If people of all ages were allowed on Medicare, studies show that it would save us substantially, both individually and as a society. All Mainers should have access to health care for any injury or illness without being financially crippled or sent into bankruptcy. The Rumford-Mexico chapter of Maine AllCare promotes a Medicare-style, single-payer Health Care-For-All system. Anyone who wants to join or learn more about this organization is welcome to attend the next meeting in the Rumford Public Library at 4:30 on this Thursday, March 17. Or visit Maine Allcare at www.maineallcare.org.
Letter to the Editor of the Rumford FallsTimes – Published March 16, 2016
Universal care the answer
I would like to thank columnist Matthew Gagnon for publicly acknowledging that a bad economy results in actual human suffering rather than just reduced earnings and profits in his Jan. 7 Pine Tree Politics column. With this said, now we as a state can focus on what can be done about improving our economic circumstances to help Mainers and reduce their economic dependence on government help.
To be different, Maine needs to establish a taxpayer-funded single-payer health insurance system that covers everybody in the state. The insurance should be provided by a private, established operation that is given a five-year contract with state oversight. This needs to be top-level coverage and not the high-deductible, low-coverage plans that too many people have been forced to pay for in the past.
Here are the benefits of single-payer health for our economic growth: a healthy, ready-to-work labor pool; lower operating costs and less paperwork that interfere with business; lower per-unit production costs, because health benefits are not needed (years ago, I recall reading that $2,000 of an American-made automobile’s manufacturing price is health benefits costs). Lower production costs mean competitive lower wholesale prices or increased business profits.
In addition, people and their families will be willing to move to Maine without fearing the loss of good health insurance coverage or higher costs, and Maine entrepreneurs will be willing to take business risks without having to worry about losing their current employer’s health insurance plans. The self-employed will not be burdened with health insurance paperwork and costs while trying to earn a living.
Navy vet speaking out for "health care for all"
Joe Sirois of Rumford wrote to Gerard Dennison, a representative of Sen. Angus King, advocating for universal single payer health care. Mr. Dennison was visiting constituents in Rumford on behalf of the Senator.
Thank you for being in Mexico today and for the nice chat.
We all know that the United States is about the only Western civilized nation that does not provide health care to all of its citizens. We also know that, as a nation, we spend more on health care and have poorer results than many other countries. There are statistics available from many sources so I won't use that as my reasons for supporting the idea of universal health care.
My main reason for believing that we should have a one-payer universal health care system is ethical.
When I talk about health care I often tell people that I am retired from the U.S. Navy with 28 years of service. I don't do that so that people will thank me for my service. My country has thanked me by providing my wife and me with health care insurance for the rest of our lives. As I told you today, I believe that the mill worker is serving his country too. He (or she) is making something and creating wealth for the nation but doesn't know if he will have a job next month or next year. The CNA making barely above minimum wage caring for our elders in a nursing home is also serving our country and deserves the same health care protection that my wife and I have. And so with the teacher and the retail clerk and everybody else.
I could go on and on but here's my point: If my country could figure out how to ensure health care coverage for all of its retired military personnel, it should be able to figure out how to do it for all of its citizens.
Thank you for representing Senator King in Mexico and for giving me an opportunity to express my concerns about health care.
Maine Doctors Support Single Payer
I was interested to read the article in Friday’s Times Record about the “Broader health care debate for 2016.” Giving prominence to “single payer” makes sense because only a single-payer plan can cover everyone for all medically necessary care, eliminate financial barriers to care, and allow free choice of doctor and hospital. Single payer healthcare would also control costs. Noted healthcare economist Dr. William Hsiao, when he visited Maine in 2010, estimated that if Maine moved to a single-payer system of health care, the state would save $1 billion during the first year alone.
Currently, the criticism of single payer (mentioned in the article) is that it would require a tax increase. In his fiscal study of H.R. 676, “The Expanded and Improved Medicare for All Act,” economist Dr. Gerald Friedman estimated that 95 percent of all households would actually SAVE money. This is because any increase in taxes would be more than offset by a massive decrease in insurance premiums and out-of-pocket expenses. Further, a streamlined single-payer system would reap about $400 billion annually in savings by slashing wasteful administrative costs, the government would be able to use its negotiating clout to bargain for lower drug and medical supply prices and it would be allowed to take other proven measures to save money.
Maine doctors support single payer. In January 2014, 450 Maine physicians responded to a survey question from the Maine Medical Association: “When considering the topic of health care reform, would you prefer to make improvements to the current public/private system or a single-payer system such as a 'Medicare for all' approach'? Nearly 65 percent of Maine doctors preferred the single-payer option, a jump from about 52 percent in a 2008 MMA survey that asked the identical question.
If you’re interested in learning more about health care for all, I urge you to visit the websites of Physicians for a National Health Program (www.pnhp.org) and Maine AllCare (www.maineallcare.org). Please join us in our advocacy for health care for everyone in Maine.
Julie Keller Pease, M.D.
Oct. 7, 2015
Published in The Times Record (Brunswick, Maine), Letters. Dr. Julie Keller Pease resides in Brunswick.
Another View: A ‘for profit’ health care system will continue to fail U.S.
Every other developed country guarantees health care for its citizens, and they all do it for a lesser price.
I’ve read with interest the writing in the Telegram on health care: an editorial that endorsed the notion of increasing health insurance coverage for the working poor (“Our View: Increase in uninsured begs for a new approach,” Sept. 21), and a commentary comparing the economics of health care to baseball (“Commentary: With health care, we’re all free agents,” Sept. 28). Really? I don’t know anyone who has chosen to get sick or need surgery.
The commentary goes on to suggest that the more access we have to health care, the more we’ll want. And the author states that government entitlements and big insurance companies are to blame, as they both “oversee an empire of unnecessary care and fraud.”
I’d suggest that the failed U.S. health care economy can be summed up in two words – “for profit.” Every other developed country guarantees health care for 100 percent of its citizens, and every other developed country does so at a lesser price. The reason is that health care is offered either by the national government or it is so regulated that prices are tightly controlled.
Nowhere else would you see the convoluted practices that we’ve come to think of as normal, like paying more for an “out-of-network provider.” Nowhere else would you see hundreds of thousands go bankrupt or die because they can’t afford health insurance.
In the Sept. 21 editorial, the Portland Press Herald weighed in on the side of Maine accepting the Medicaid funds offered by the federal government.
I’d suggest that we should do more; that we need to follow Vermont’s lead and create a health care financing system in Maine where no one is left behind, like an improved Medicare for All system. It would certainly be more humane, more equitable and less costly than what we have now.
This letter appeared in the October 12, 2014 edition of the Portland Press Herald.
Letter to the editor: Single-payer health plan in Maine would benefit everyone
Steve Mistler’s Sept. 17 article “Number of Mainers without health insurance rose 9 percent in 2013″ notes Maine is one of two states with “a rise in the number of people without health insurance from 2012 to 2013.” Thus, Maine’s uninsured comprise “147,000, or 11.2 percent of the state’s population.”
Mistler reports tactical comments from gubernatorial candidates. No one mentions covering every Maine person with a fair and economical single-payer plan. Can Maine accomplish single-payer, and who would benefit?
- People benefit. Everyone is covered from birth to death – period. No premiums, no searching for the “right” coverage. No bankruptcy when hit by a car or cancer. Health outcomes improve.
- Employers benefit. They escape from the tension between insurer negotiations and worker benefits versus salaries, and create more Maine jobs.
- Health care providers benefit. Physicians reclaim their mission of healing. Hospitals and all providers get simple billing, prompt payment and fewer “authorization” hassles. Dramatic discrepancies in physician salaries disappear, but all make a decent living.
- Maine benefits. Maine creates a patient care-oriented system, and more clinicians choose primary care. No Medicaid hassles, and no “hidden tax” to cover the uninsured. First-year savings of $1 billion (as estimated by health care policy expert Dr. William Hsiao, who testified before the Legislature in 2010) bolsters Maine’s economy.
Maine could accomplish this. The Affordable Care Act allows states to insure their people if they provide coverage at least as comprehensive as ACA benefits, beginning in 2017. Everyone pays Maine a tax on income – when well, not when sick.
Decades of tweaking our profit-oriented system have failed, and our recent tweak drives people crazy and sends billions to insurance companies. They return useless paperwork while maximizing profits. Trying to reward competition excluded 147,000 Mainers and made the ACA prohibitively expensive and dauntingly complex.
William D. Clark, M.D.
This letter appeared in the September 30, 2014 edition of the Portland Press Herald.
Health dollars wasted
A recent study of the hospital costs in eight different nations published in the September issue of Health Affairs has determined that hospital costs in the U.S. in 2011 were much greater than those in all of the nations studied. Lead author Dr. David Himmelstein, a professor at the CUNY/Hunter College School of Public Health and a lecturer at Harvard Medical School, stated, “We are squandering $150 billion each year on hospital bureaucracy and $300 billion is wasted every year on insurance companies’ overhead and the paperwork they inflict on doctors.” And our length of life and other parameters of the U.S. health care system are not as good as the seven other countries and many millions of Americans still have no or very limited insurance.
The evidence for a single payer health care system is getting stronger every day. We Americans simply have to become educated about why and how a single payer system works. Imagine that 450 billion of our “health care” dollars are spent needlessly and not on health care.
William Babson Jr., M.D.
This letter appeared in the Bangor Daily News, September 11, 2014
Big Money vs. Your Meds
For those of you who might not think big money in politics is hurting us, consider this: Since 2007 the prescription drug industry has spent nearly $1 billion lobbying Congress and federal agencies; in addition, the industry has spent nearly $64 million contributing to political campaigns (Center for Responsive Politics). In the Affordable Health Care Act (aka “Obamacare”) of 2010, Congress refused to include any cost controls on prescription medicines for Medicare or Medicaid. It has been estimated by the Center for Economic and Policy Research that exercising such controls could save the U. S. $25 billion to $50 billion per year for Medicare alone.
The cost of prescription medicine has long been a problem in the U.S. According to the International Federation of Health Plans, in 2013 the medicine Celebrex cost between three and nine times here what it did in Canada. Examples like this are numerous. So I checked the Internet for the price of a medication my wife uses. In Canada, it is $40; at my local drug store it’s $160. A more stunning example is a med that costs $43 in Canada versus $300 here in Brunswick.
The Pharmaceutical Research and Manufacturers Association (PhRMA) disingenuously argues that you can’t count on the quality of medication you order from outside the country. Do they mean to tell us the Canadian government is so slipshod that it approves medications that are dangerous for its citizens?
The FDA has long been empowered to prevent the shipment of drugs into the U.S. from foreign countries. But they chose not to exercise those powers too harshly, especially against people – like Grandma - who bought small amounts of cheaper meds from other countries. Then, with the growth of the Internet, mail order pharmacies sprung up all over the place. Some of these offered cheap medicines from foreign countries. Big PhRMA became alarmed at this growth of opportunities for ordinary people to circumvent the FDA, so they put the heat on Congress to stiffen the FDA’s regulations.
In 2012 Congress passed, and President Obama signed, the Food and Drug Administration Safety and Innovation Act (FDASIA) giving the FDA the power to intercept, and destroy, small prescription drug packages being mailed to U.S. consumers from other countries. Yes, you read that correctly — destroy.
Under this law the FDA has been given broad discretion to identify any prescription that “appears to be adulterated, misbranded, or unapproved,” i.e., almost anything they might want to so classify. If they intercept such a package that is headed your way, you have the “opportunity to appear before FDA and introduce testimony on the admissibility of the drug.” If you are successful in this appeal, you may, upon your return from D.C., take your medication when you eventually receive it.
Senators Collins and Snowe both voted for this bill. Representatives Pingree and Michaud voted for the House version. Being proximate to Canada, this situation is not lost on Mainers. In 2004, the City of Portland began encouraging its employees to purchase medicine from Canada. Since then, the city estimates that it has saved about $200,000 per year from the cost of medications.
In 2013, the Maine Legislature passed a bill that allows state residents to purchase medicine from Canada, Great Britain, Australia or New Zealand. The bill, LD 171, was passed by overwhelming majorities in both houses. It was estimated that the State Employee Health Plan would save $3 million per year as a result of this law.
A coalition of groups including PhRMA and drug stores promptly sued the state, contending that LD 171 represents unfair foreign competition. But in May Big PhRMA was tossed out of the suit by the U.S. District Court Judge, thereby depriving the plaintiffs of their strongest partner. Your local drug stores, however, are still in the fight against the state.
LD 171 puts Maine at loggerheads with the U.S. FDA. That is fine with me. This is our chance to stand up to the Big Money cancer that is eating away at our nation.
Let’s not kid ourselves. This is not about the drug industry’s tender-hearted concerns for our health. It’s about very Big Money. Period.
Guest Column in the July 3, 2014, The Times Record, Brunswick, Maine
Cost of drug plans overlooked by critics of Medicare
Republican Rep. Paul Ryan wants to privatize Medicare. He should look instead to drug scams inherent in Medicare Part D.
When it was set up, the government specifically prohibited negotiation of drug costs with drug companies. Why?
I take the prescription drug Nexium for severe gastric reflux. In 2007, when I first obtained Part D coverage, my cost for a month’s supply was $28. The plan paid $106.68, a total drug cost of $134.88. (Once the total drug cost reaches a certain level, changing annually, enrollees enter the coverage gap, aka the “doughnut hole,” after which the enrollee’s costs increase substantially.)
Since 2007, my Nexium costs have risen incrementally. By August 2013, the plan payment increased to $414.06 (total drug cost of $459 a month). I reached the 2013 “doughnut hole” of $2,970.
Later, I got a refill of Nexium. The plan paid $206.17; I paid $146.28; $106.61 was paid by the Affordable Care Act, which provides for a 47.5 percent “doughnut hole” discount.
In January, the plan paid $445.53; I paid $41; my total drug costs this year are only $275 away from the “doughnut hole,” now at $2,850 (note decrease). ACA aid has been negated by the increase in plan cost.
I can obtain Nexium from a Canadian pharmacy where the cost is 100 tablets for $126 (one and two-thirds months’ supply for me), cheaper than buying while in the “doughnut hole.”
On May 27, an over-the-counter version of Nexium became available at $23.98 for 42 20-mg tablets. My cost would be about $70 a month (with no claim to Medicare), yet the insurance company uses a figure of $487 a month for the total drug cost. What is wrong with this picture?
When legislators exhibit outrage over the cost of Medicare, why is there no mention of Medicare Part D?
Published in the June 29, 2014 Portland Press Herald
Letter to the editor: Medicare for all simplifies health care
In his June 22 articles (“When college athletes get hurt, whose wallets should feel the pain?” and "USM ‘doing responsible things’ for athletes”“), Mark Emmert explores the questions “Who pays?” and “Is it fair?” for injured University of Maine athletes. He interviews UMaine officials, caregivers, injured athletes and outside experts.
Any uninsured student entering UMaine must pay $3,000 for health care coverage, in addition to tuition. For serious injuries, like those Emmert describes, the athlete pays $10,000 for deductibles that generate seemingly endless mountains of bills.
UMaine buys insurance that kicks in after the deductible, paying $124,000 for it. UMaine pays $340,000 to provide injured athletes “free rehabilitation services.” Is UMaine doing enough for its athletes? Is it fair to other UMaine students to add a share of the $464,000 to their tuition?
We could establish a less complex, fairer and cheaper option than the one Emmert describes at UMaine. Health policy experts, economists, physicians and Congress people urge us to provide everyone with “improved Medicare for all.” Medicare for All is simple – from your first breath to your last one, you have access to private care, with choice of physician, hospital and rehabilitation facility.
Everyone pays when working (not when sick!), and everyone has the same comprehensive benefit package. It’s cheaper, and experts say more than $350 billion would be saved by changing from a profit-oriented system to a patient care-oriented one. The savings more than offset the $110 billion experts estimate would be required for health care for the currently uninsured.
Do you know that more than $30 million went to Aetna’s CEO in 2013? Why not offer what every other developed country does, and provide taxpaying citizens, UMaine athletes and other students a simpler, equitable and less costly health care option?
Explore “simpler, fairer, cheaper” options at http://maineallcare.org.
William D. Clark, M.D.
managing editor, DocCom
Published in the July 6, 2014 Portland Press Herald
Do the right thing
Using the example of the Affordable Care Act, Kevin Twine’s column (”Making Sausage,” June 16), provides a good analysis of the complexity involved in shaping legislation. He looks at the variables of division of power, popular support, citizen initiatives and the influence of big money. There is an impor- tant message in the Churchill quote he cites about Americans taking a “long time” to do the “right thing” in his exhortation to “keep trying.”
Taking a historical perspective, the struggle for a woman’s right to vote took a “long time.” Susan B. Anthony co-founded the National Woman Suffrage Association in 1869. She died in 1906, having de- voted her life to the cause. It wasn’t until 1920 that the 19th Amendment to the Constitution was rati- fied, which stated that, “The right of citizens of the United States to vote shall not be denied or abridged by the United States or by any State on account of sex.”
Given the fact that more than 46,000 Americans die each year due to lack of access, health care must be seen as a right. The ACA has extended that right to more people. In amendment language, the ACA currently might read, “Residents of the United States have the right to health care provided or subsi- dized, EXCEPT single adults earning poverty wages whose states have opted out of Medicaid, EX- CEPT for young adults whose parents do not have family policies, etc.”
The struggle for universal access to health care WITH NO EXCEPTIONS has been continuing for a long time. It is a moral imperative on the state and federal levels to “keep trying” to do the “right thing.”
Letter to the Editor, Brunswick Times Record, June 24, 2014
To the Editor:
I just saw "The Healthcare Movie", a comparison of the US and Canadian health care systems. Representative Paul Davis was there but unfortunately left early. Had he been able to stay, Paul would have learned some statistics that I think he and his Republican and Democrat colleagues would find both surprising and disturbing. Here are some of them.
45,000 people die in the US each year because they have no health insurance. The number of Canadians who die each year because they have no health insurance: zero. In 2010, 922,819 Americans declared bankruptcy related to medical illness (Harvard Medical School, Administrative Office of the US Courts), and the majority of these people had health insurance. The number of bankruptcies due to medical illness in Canada: zero.
The average deductible and copay costs for a normal delivery in the US is $3,400. The average cost to a Canadian for a normal delivery: nothing. The average cost for the first year's recommended seven "well baby" visits in the US for the uninsured is $668. The average cost to a Canadian for these visits: nothing.
According to Maine Allcare, 105,000 Mainers have no health insurance, even after 25,000 signed up under the Affordable Care Act (ACA). 200,000 remain "underinsured", with $5,000 -15,000 deductible, "catastrophic" health insurance. In the rest of the country, 40 million Americans still have no health insurance, despite millions signing up recently under the ACA. The number of Canadians without health insurance: zero.
The Canadian system is not perfect. Drugs are not covered, and there are longer waits for specialist referrals, elective procedures, and certain tests, like MRI. The median wait for an MRI is 2 weeks and for seeing a specialist, about a month (Wikipedia). However, when there is an urgent need for a test or referral, it gets done quickly.
While health care appears to be free, Canadians pay higher taxes to cover the cost. The movie's website quotes the 2005 single person income tax rate in the US (29%) vs. Canada (32%), a difference of about 10% more in Canada. This translates into $3,000 extra for someone paying $30,000 in federal income tax. After adjusting for health care inflation, this roughly matches the $5,600 a US single paid in 2012 for health insurance.
Our media, fed dis-information by the health insurance industry, portrays the Canadian health system as inferior. However, statistics and Canadian polls clearly show three things: 1. Canadian health outcomes overall are better than those in the US, 2. Canadians spend substantially less per person on health care than we do, and 3. the majority of Canadians like their system and would not want an American style system. Maine Allcare, the Healthcare Movie, and Physicians for a National Health Program have websites for you to learn more.
Published both in The Eastern Gazette of Dover-Foxcroft and The Piscataquis Observer in April 2014.
The BDN May 2 editorial, criticizing Gov. Paul LePage's 182 vetoes was, for the most part, on target.
However, I must take issue with the description of a bill to study health care options in Maine as "transitioning Maine to an entirely government-run health care system." This mischaracterization of the bill (LD 1345) entirely over-simplifies the issues of concern and serves only to feed right-wing paranoia about socialized medicine.
And to suggest that LD 1345 was brought up as a ploy to elicit a veto from LePage is entirely misplaced. People have worked for years on this bill, and it has been brought before the Legislature several times in the past, before LePage's term in office.
LD 1345 is a resolve that proposes to study the most affordable ways to provide basic and life-saving health care to all Maine people. It addresses the millions of dollars that Maine spends on "anything but health care" in our health care budget.
An internationally recognized economist, Dr. William Hsiao, offered testimony to the Legislature in 2010, in which he credibly estimated that Maine could save $1 billion in the first year if we converted to a single-payer health care system. For a fraction of the money, we just spent analyzing Medicaid expansion, Maine could hire Dr. Hsiao or a comparable expert to determine if and how we could save money and provide decent health care for everyone, save lives and improve Maine's health outcomes.
Dr. Julie Pease
Published in the May 16, 2014, Bangor Daily News
Letter to the editor: Facts, 'unfacts' of single-payer health care system
The Feb. 18 Press Herald included a letter to the editor penned by Bryan Dench, “Doctors should reject expansion of Medicaid.”
First, let me separate the “unfacts” in the letter from the facts:I value differences of opinion but do not like publicly expressed opinions that are short on facts. I am a group insurance broker who is a staunch supporter of a single-payer system being implemented in Maine.
- $4 to $10 per week for a policy purchased on the exchange is way too low, even with a generous federally paid-for stipend.
- I personally know of many able-bodied adults in our state who are unemployed and want to work. They are without insurance while unemployed, and even when employed are often not offered coverage. They need to remain healthy to get and keep a job.
- The Affordable Care Act, or Obamacare, does not go far enough. At 17 percent of gross domestic product, the cost of health care in this country is the highest of any developed country by at least 6 percent.
- Our outcomes are the worst as measured by infant mortality, longevity of life, repeated hospitalizations and general health.
- Our administrative costs for doctors and hospitals are ludicrous, and are pretty much unknown in other developed countries.
- Those other developed countries with single-payer systems are unfamiliar with the idea of a denied medical claim.
- Doctors and hospitals are paid more quickly by single-payer systems than here in the U.S.
- Citizens of those countries love their medical single-payer systems.
More healthy citizens, less cost, fewer administrative headaches – no wonder many, many doctors and hospitals support a single-payer system!
Published in the Jan. 18, 2014 Portland Press Herald
Letter to the editor: Single-payer health insurance in Maine merits attention
Though you wouldn’t know it from reading the Portland Press Herald, the Legislature is currently considering a bill – L.D. 1345, “An Act to Establish a Single-payor Health Care System To Be Effective in 2017” – to fund health care for all Maine citizens at an overall cost that would be less than what we currently pay.
And in such a way that Maine businesses would no longer be burdened with health insurance, and could use the resulting savings to pay their employees more and to grow.
And with the likely further result that new businesses would be drawn to the state because health care would not be their responsibility here; and that young people would be drawn as well, because word would be out that Maine is a place where you don’t have to worry about health insurance at all.
On Jan. 9, in the Cross Office Building in Augusta, the Joint Committee on Insurance and Financial Services held a public hearing on L.D. 1345.
About 45 people (one-third of them health care professionals) testified, all but two of them (private health insurance representatives) arguing in favor.
In the coming days and weeks, I hope the newspaper will cover the progress of this important legislation, so that readers can reach informed opinions about it and express them to their legislators.
Daniel C. Bryant, M.D.
Published in the Portland Press Herald on January 17, 2014
Compromise health-care plan doomed to fail
Maybe my memory is tricking me, but I seem to remember a long battle laced with filibusters to get the health-care bill passed in Congress. I remember that even the Democrats dared not mention “single payer health care” (also referred to as “Medicare for all”). I remember more liberal Democrats unsuccessfully trying to include something called “the public option” in the final bill. I thought at the time that they were all scared to mention the control the insurance companies seemed to have over the whole process.
Then there was a supposed victory for Obamacare at the Supreme Court, with only one small problem: Individual states with nutty governors, like ours, could opt out of the plan.
I think that the final bill was a compromise between timid Democrats, obstructionist Republicans and the insurance companies (the silent partners to them all).These are the same insurance companies that have been making life miserable for so many people, for so many years, in so many ways. People were now going to be required to purchase insurance from them.
Of course it’s complicated. Of course it’s unwieldy. Of course it’s hard to figure out. Of course it’s a mess, but it’s dishonest to lay the blame for this solely on Barack Obama. The three branches of our government all failed us.
Now compare it to Medicare. Are you hearing anything about people having trouble signing up for Medicare or Social Security? What we needed was a government that wasn’t kowtowing to the insurance companies. What we needed was a simple government-run program that gave medical coverage to everybody. We needed “Medicare for all.”
Published in the Kennebec Journal on November 16, 2013
Running out of options for affordable health care
I couldn't have been more shocked when I discovered, just recently, that thanks to our governor and his political antics, I will not be eligible for benefits under the Affordable Care Act.
Apparently, with an annual income of $8,000 and two children to support, I'm just too well off (and that doesn't even count the money in the sofa cushions).
I realize that appealing to the governor's conscience is a fool's frustration, but what of the people of Maine? Is it their intention to react to Obamacare in the manner that the states of the former Confederacy have? To allow a bully to determine who'll be treated like a human being and who won't?
I spoke with a sweet woman at the Department of Health and Human Services, who apologized for Mr. LePage and noted that her benefits were also being truncated.
"They've got us right where they want us. The train wreck is coming, but we've been told to let it happen," she said. "Five legislators turned their backs on us, and we're getting asked a lot of questions we can't answer."
I used to think living in America was some sort of blessing, but lately, I've been looking for a way out.
Canada wants me to provide proof that I have at least $30,000 in my bank account before I'll be welcomed in, and I don't think I dare try Sweden after seeing the furniture at Ikea.
So if I get sick, I guess I'll go to the hospital. And run up a bill. And not pay it. Like the governor wants.
The thing that worries me the most is that any country that needs me as its moral voice is in a lot of trouble. Guess I'll go take my vitamins. An ounce of prevention is all I've got right now.
Published in the Portland Press Herald on September 2, 2013