WASHINGTON - A national organization of 17,000 physicians who favor a single-payer
health care system called on the U.S. Senate today to defeat the health
care legislation presently before it and to immediately consider the
adoption of an expanded and improved Medicare-for-All program.

While noting that the Senate bill includes some “salutary provisions”
like an expansion of Medicaid, increased funding for community clinics
and the curbing of some of the worst practices of the private insurance
industry, the group says the negatives in the bill outweigh the
positives.

The negatives, the group says, include the individual mandate requiring
that people buy private insurance policies, large government subsidies
to private insurers, new restrictions on abortion, the unfair taxing of
high-cost health plans, and cuts of $43 billion in Medicare payments to
safety-net hospitals. Moreover, at least 23 million people will remain
uninsured when the plan finally takes effect, they said.

“We have concluded that the Senate bill’s passage would bring more harm
than good,” the group said in a statement signed by its president, Dr.
Oliver Fein, and two co-founders, Drs. David Himmelstein and Steffie
Woolhandler.

Addressing the Senate in an open letter, they write: “We ask that you
defeat the bill currently under debate, and immediately move to
consider the single-payer approach – an expanded and improved
Medicare-for-All program – which prioritizes the advancement of our
nation’s health over the enhancement of private, profit-seeking
interests.”

The full statement appears below.

To the Members of the U.S. Senate:

It is with great sadness that we urge you to vote against the health
care reform legislation now before you. As physicians, we are acutely
aware of the unnecessary suffering that our nation’s broken health care
financing system inflicts on our patients. We make no common cause with
the Republicans’ obstructionist tactics or alarmist rhetoric. However,
we have concluded that the Senate bill’s passage would bring more harm
than good.

We are fully cognizant of the salutary provisions included in the
legislation, notably an expansion of Medicaid coverage, increased funds
for community clinics and regulations to curtail some of private
insurers’ most egregious practices. Yet these are outweighed by its
central provisions – particularly the individual mandate – that would
reinforce private insurers’ stranglehold on care. Those who dislike
their current employer-sponsored coverage would be forced to keep it.
Those without insurance would be forced to pay private insurers’
inflated premiums, often for coverage so skimpy that serious illness
would bankrupt them. And the $476 billion in new public funds for
premium subsidies would all go to insurance firms, buttressing their
financial and political power, and rendering future reform all the more
difficult.

Some paint the Senate bill as a flawed first step to reform that will
be improved over time, citing historical examples such as Social
Security. But where Social Security established the nidus of a public
institution that grew over time, the Senate bill proscribes any such
new public institution. Instead, it channels vast new resources –
including funds diverted from Medicare – into the very private insurers
who caused today’s health care crisis. Social Security’s first step was
not a mandate that payroll taxes which fund pensions be turned over to
Goldman Sachs!

While the fortification of private insurers is the most malignant
aspect of the bill, several other provisions threaten harm to
vulnerable patients, including:

* The bill’s anti-abortion provisions would restrict reproductive choice, compromising the health of women and adolescent girls.

* The new 40 percent tax on high-cost health plans – deceptively
labeled a “Cadillac tax” – would hit many middle-income families. The
costs of group insurance are driven largely by regional health costs
and the demography of the covered group. Hence, the tax targets workers
in firms that employ more women (whose costs of care are higher than
men’s), and older and sicker employees, particularly those in high-cost
regions such as Maine and New York.

* The bill would drain $43 billion from Medicare payments to safety-net
hospitals, threatening the care of the 23 million who will remain
uninsured even if the bill works as planned. These threatened hospitals
are also a key resource for emergency care, mental health care and
other services that are unprofitable for hospitals under current
payment regimes. In many communities, severely ill patients will be
left with no place to go – a human rights abuse.

* The bill would leave hundreds of millions of Americans with
inadequate insurance – an “actuarial value” as low as 60 percent of
actual health costs. Predictably, as health costs continue to grow,
more families will face co-payments and deductibles so high that they
preclude adequate access to care. Such coverage is more akin to a
hospital gown than to a warm winter coat.

Congress’ capitulation to insurers – along with concessions to the
pharmaceutical industry – fatally undermines the economic viability of
reform. The bill would inflate the already crushing burden of
insurance-related paperwork that currently siphons $400 billion from
care annually. According to CMS’ own projections, the bill will cause
U.S. health costs to increase even more rapidly than presently, and
budget neutrality is to be achieved by draining funds from Medicare and
an accounting trick – front-loading the new revenues while delaying
most new coverage until 2014. As homeowners seduced into balloon
mortgages have learned, pushing costs off to the future is neither
prudent nor sustainable.

We ask that you defeat the bill currently under debate, and immediately
move to consider the single-payer approach – an expanded and improved
Medicare-for-All program – which prioritizes the advancement of our
nation’s health over the enhancement of private, profit-seeking
interests.

Oliver Fein, M.D., President
David U. Himmelstein, M.D., Co-founder
Steffie Woolhandler, M.D., M.P.H., Co-founder
Physicians for a National Health Program