Monday, July 5, 2010

Improve and Strengthen Medicare by Expanding It to All

Improve and Strengthen Medicare by Expanding It to All


[The following text is the testimony that Dr. Margaret

Flowers presented to the National Commission on Fiscal

Responsibility and Reform at its June 30 hearing in

Washington. Dr. Flowers is congressional fellow for

Physicians for a National Health Program.]


I am Dr. Margaret Flowers and I am here today on behalf

of Physicians for a National Health Program, the

leading physician research, education and advocacy

organization in support of a truly universal single-

payer health system in the United States. I will speak

specifically about the contribution of health care

costs to our national deficit and the evidence-based

remedy to control these costs.


When compared to health care in other advanced nations,

the United States excels in only one area - the amount

of money spent per capita per year. Despite our high

spending, the U.S. leaves a third of the population

either uncovered or underinsured and thus vulnerable to

financial ruin.


Medical debt is a leading cause of bankruptcy and

foreclosure in our nation despite the fact that most

families declaring medical bankruptcy had insurance

when they began incurring such debt.


Our health outcomes are relatively poor, placing us

37th in the world, and we rank the highest in

preventable deaths, over 100,000 preventable deaths per

year, when compared to other advanced nations. It is

clear that we are getting poor value in return for our

health care dollar.


Health care costs, which are rising 2.5 percent faster

than our GDP, are a leading driver of our financial

deficit. In fact, if our health care costs were

comparable to those in other advanced nations, which

provide nearly universal health care with better

outcomes, we would currently experience a budget surplus.


The recent health legislation, misleadingly titled the

Patient Protection and Affordable Care Act (PPACA),

lacks proven cost controls and is predicted to cause

U.S. health care costs to rise faster than if there had

been no reform at all (Centers for Medicare and

Medicaid Services, April 2010) despite continuing to

leave tens of millions out.


Given the impact of health care costs, members of this

commission may attempt to decrease the deficit by

cutting our public health insurance programs, Medicaid

and Medicare; however, doing this would be a mistake

because it would increase poverty, worsen health

outcomes and increase costs.


Since its enactment nearly 45 years ago, Medicare has

substantially lowered poverty among the elderly.

Studies show that health disparities in the U.S. start

decreasing when our population reaches the age of 65.

And the cost of health care per beneficiary is rising

more slowly for those on Medicare than for those with

private health insurance.


Medicaid and Medicare have not caused our rising health

care costs but are victims of our fragmented and failed

market-based model of health care financing. Shifting

the cost of health care from the taxpayer to the

patient will not magically make these health care costs

disappear or become sustainable.


The solution to our economic crisis is to jettison the

costly failed market model of health care and adopt a

publicly financed and independently delivered national

improved Medicare for All. This is commonly known as

"single payer." A national improved Medicare for All

system has myriad benefits:


* Administrative savings of approximately $400 billion

per year, which is enough to provide comprehensive high

quality health care to all who are uninsured and



* Ability to negotiate for pharmaceutical prices as a

monopsony which would lower costs by about 40 percent

and bring our prices in line with those of other

advanced nations.


* Inherent cost controls of global budgeting for health

facilities, negotiated fees, bulk purchasing and

rational, rather than profit-driven, allocation of

capital expenditures and health resources.


* Ability to identify outliers and develop quality

improvement tools.


* Eliminate the burden of rising employee health care

costs on businesses.


* Enhance the competitiveness of U.S. products in

international markets.


* Liberate our population to pursue advanced education

or entrepreneurial enterprises.


* Allow older workers to retire which would increase

job opportunities for our younger workers.


* Stimulate the economy because families would have

more money for discretionary spending.


* Improve the health, and therefore the productivity,

of our workforce.


* Eliminate bankruptcy and foreclosure due to medical



* Eliminate the spend-down required for those who need

long-term care funded by Medicaid.


* Provide true health security to our population so

that nobody has to choose between necessary medical

care and other necessities such as housing, food,

education and clothing.


Given these multiple economic benefits - and I have not

begun to describe the ways in which national improved

Medicare for All would improve patient choice and

quality of health care - it is no surprise that the

single payer approach is supported by the majority of

those in the U.S. and the majority of American

physicians. This was evident once again last Saturday

in the town meetings sponsored by America Speaks when

participants across the nation demanded single payer as

an option to solving the health care crisis and 71

percent voted not to cut Medicaid and Medicare.


Private health insurance is rapidly becoming a thing of

the past. There is a steady trend in fewer people being

enrolled in employee-sponsored health plans. This is

expected to increase under PPACA as businesses have an

incentive to drop insurance benefits and pay the lower

cost penalty.


There is a steady trend in people choosing high

deductible plans which leave them financially

vulnerable in their time of need. As people enter the

individual market, those with health conditions will

find it difficult to afford adequate insurance.


The trends for those who are uninsured and underinsured

will continue upward. Under PPACA, billions of public

dollars will be used to subsidize rising private

insurance premiums for policies that cover fewer and

fewer services. The result is a flow of patient and

public dollars into the coffers of private insurance

corporations with declining return in terms of health

care. This trend is not sustainable.


The alternative scenario of a national improved

Medicare for All will save lives and save money.

National improved Medicare for All will place our

nation on the path of becoming one of the best health

systems in the world - something of which we can all be



This commission has the ability to recommend creating a

financially sustainable universal health system. I urge

the members of this commission to recommend addressing

the deficit through adopting this most popular

approach: national improved Medicare for All. Don't cut

Medicare. Protect it, improve it and expand it to cover everyone.



No comments: