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In a dramatic show of physician support for deeper health reform - and for making a decisive break with the private insurance model of financing medical care - 2,231 physicians called today [Thursday, May 5] for the creation of a publicly financed, single-payer national health program that would cover all Americans for all medically necessary care.
Single-payer health reform, often called "Medicare for All," has been a hotly debated topic in the presidential primaries, thanks in part to it being a prominent plank in the platform of Sen. Bernie Sanders. The new physicians' proposal is strictly nonpartisan, however.
The proposal, which was drafted by a blue-ribbon panel of 39 leading physicians, is announced today in an editorial titled "Moving Forward from the Affordable Care Act to a Single-Payer System" published in the American Journal of Public Health. The editorial links to the full proposal titled "Beyond the Affordable Care Act: A Physicians' Proposal for Single-Payer Health Care Reform" and the names of all the signers, and it appeals for additional physicians to add their names as endorsers. The proposal currently has signers from 48 states and the District of Columbia.
"Our nation is at a crossroads," said Dr. Adam Gaffney, a Boston-based pulmonary disease and critical care specialist, lead author of the editorial and co-chair of the Working Group that produced the proposal.
"Despite the passage of the Affordable Care Act six years ago, 30 million Americans remain uninsured, an even greater number are underinsured, financial barriers to care like co-pays and deductibles are rising, bureaucracy is growing, provider networks are narrowing, and medical costs are continuing to climb.
"Caring relationships are increasingly taking a back seat to the financial prerogatives of insurance firms, corporate providers, and Big Pharma," Gaffney said. "Our patients are suffering and our profession is being degraded and disfigured by these mercenary interests."
Dr. Steffie Woolhandler, a co-author of the editorial and proposal who is a professor of public health at the City University of New York's Hunter College and lecturer at Harvard Medical School, commented: "We can continue down this harmful path - or even worse, take an alternative, 'free-market' route that would compound our problems - or we can embrace the long-overdue remedy that we know will work: the creation of a publicly financed, nonprofit, single-payer system that covers everybody. Today we're saying we must quickly make that shift. Lives are literally at stake."
Dr. Marcia Angell, a co-author of the editorial and proposal, co-chair of the working group, member of the faculty of global health and social medicine at Harvard Medical School and former editor-in-chief of the New England Journal of Medicine, said: "We can no longer afford to waste the vast resources we do on the administrative costs, executive salaries, and profiteering of the private insurance system. We get too little for our money. It's time to put those resources into real health care for everyone."
Under the national health program (NHP) outlined by the physicians:
Surveys show strong, rising support for single-payer national health insurance among physicians. A 2008 survey of physicians found that 59 percent supported "legislation to establish national health insurance," up from 49 percent five years earlier.
Physicians for a National Health Program is a single issue organization advocating a universal, comprehensive single-payer national health program. PNHP has more than 21,000 members and chapters across the United States.
"We must substantially lower the price that Medicare pays for prescription drugs like Leqembi," said the Vermont Independent, "and HHS has the power to do just that."
U.S. Sen. Bernie Sanders on Wednesday urged the Biden administration to use the "full extent" of its executive authority to lower the "outrageously high" price of a new Alzheimer's treatment being reviewed by federal regulators.
"Alzheimer's is a horrible disease," Sanders (I-Vt.), chair of the Senate Health, Education, Labor, and Pensions (HELP) Committee, wrote in a
letter to Xavier Becerra, secretary of the U.S. Department of Health and Human Services (HHS). "We must do everything possible to find a cure for the millions of people who suffer from it. But we cannot allow pharmaceutical companies to bankrupt Medicare and our federal government in the process."
At issue is Leqembi, a drug developed by Eisai, a Japanese pharmaceutical corporation, and Biogen, a U.S. company that previously sought to charge $56,000 for an annual supply of a different Alzheimer's treatment called Aduhelm. Following a pressure campaign led by Sanders and other drug affordability advocates, Biogen reduced the price of Aduhelm—whose efficacy and safety have been questioned by doctors—to $28,200 per year.
"A prescription drug is not effective if a patient who needs that drug cannot afford to take it."
"Despite concerns among the scientific community about the clinical benefit of Leqembi, its manufacturers... plan to charge $26,500 per year for this drug even though the Institute for Clinical and Economic Review, an independent non-profit organization, has estimated that this drug should be sold for as little as $8,900 per year based on its effectiveness," Sanders wrote.
"If just 10% of the 6.7 million older adults with Alzheimer's disease take Leqembi, the Kaiser Family Foundation has estimated that it would cost $17.8 billion—or nearly half of what Medicare Part B spent on all drugs in 2021," noted the Vermont Independent. "And this is just for one drug. As you know, many of the new drugs coming onto the market are even more expensive. This is not sustainable."
Moreover, "the introduction of Leqembi at this unconscionable price would be grossly unfair to seniors suffering from Alzheimer's disease who simply could not afford to pay the 20% co-payment of more than $5,000 a year for this drug," the progressive lawmaker continued. "With a median income of about $30,000 a year for seniors on Medicare the purchase of this one drug would amount to over one-sixth of their limited income."
"People with Alzheimer's disease deserve a drug that is safe, effective, and affordable," he added. "A prescription drug is not effective if a patient who needs that drug cannot afford to take it."
\u201cAlzheimer\u2019s is a horrible disease and we must find a cure. But we cannot allow pharmaceutical companies to bankrupt Medicare in the process. We must substantially lower the price that Medicare pays for prescription drugs like Leqembi, and HHS has the power to do just that.\u201d— Bernie Sanders (@Bernie Sanders) 1686152167
Sanders pointed out that the U.S. Food and Drug Administration (FDA) plans to convene an advisory meeting on Leqembi this week.
"As it considers whether to grant full approval of this drug, FDA has a special responsibility to restore the public trust after its inappropriate relationship with Biogen during the agency's review" of Aduhelm, wrote Sanders, alluding to evidence that the pharmaceutical firm and those tasked with regulating it collaborated before the medicine received a green light.
If the FDA approves Leqembi, HHS "must protect patients and substantially reduce the price," Sanders stressed.
The senator went on the remind Becerra—who routinely expressed support for invoking executive authority to rein in soaring drug prices before he joined the White House—of the powers at his disposal:
Under current law, Medicare has the responsibility to determine whether Leqembi is "reasonable and necessary" for the treatment of Alzheimer's. In my view, charging an outrageously high price for this drug is not reasonable. It will prevent seniors who need this drug from receiving treatment. It will undermine the finances of Medicare. And it will increase the premiums of over 60 million seniors who receive Medicare whether they need to take this drug or not.
If Biogen and Eisai refuse to lower the price of this drug, HHS has the authority (under 28 U.S.C. Section 1498) to break the patent monopoly on Leqembi. Further, HHS can direct the Center for Medicare and Medicaid Innovation to launch a new demonstration project that would limit payment for Leqembi to reflect the drug's actual benefit.
Sanders told Becerra that he and other HELP committee members "look forward to discussing this important issue with you as soon as possible." The panel "would like to know how Biogen and Eisai came up with a cost of $26,500 and what the cost of this drug will mean to the finances of Medicare," Sanders wrote. It "would also like your estimate as to how much Medicare premiums will go up for all seniors if Biogen and Eisai are allowed to charge $26,500 for Leqembi, as well as how many seniors who need this drug would not be able to afford to pay a 20% co-payment for it."
Sanders' letter comes one day after the pharmaceutical giant Merck sued the Biden administration over an Inflation Reduction Act provision that empowers Medicare to directly negotiate the prices of a small number of ultra-expensive prescription medicines with drugmakers.
It also comes less than a month after Sanders condemned Big Pharma CEOs for years of deadly price gouging and reiterated the need to make all prescription drugs affordable at a HELP committee hearing.
"I know that our guests from the drug companies will tell us how much it costs to develop a new drug and how often the research for new cures is not successful," Sanders said in May. "I get that. But what they are going to have to explain to us is why, over the past decade, 14 major pharmaceutical companies... spent $747 billion on stock buybacks and dividends."
"They will also have to explain how as an entire industry pharma spent $8.5 billion on lobbying and over $745 million on campaign contributions over the past 25 years to get Congress to do its bidding," Sanders continued. "Unbelievably, last year, drug companies hired over 1,700 lobbyists including the former congressional leaders of both major political parties—that's over three pharmaceutical industry lobbyists for every member of Congress."
As Sanders put it, "That could well explain why we pay the highest prices for prescription drugs in the world and why today drug companies can set the price of new drugs at any level they wish."
"While Americans pay outrageously high prices for prescription drugs, the pharmaceutical industry and the [pharmacy benefit managers] make enormous profits," the lawmaker lamented. "In 2021, 10 major pharmaceutical companies in America made over $100 billion in profits—a 137% increase from the previous year. The 50 top executives in these companies received over $1.9 billion in total compensation in 2021 and are in line to receive billions more in golden parachutes once they leave their companies."
"In other words, Americans die, get sicker than they should, and go bankrupt because they cannot afford the outrageous cost of prescription drugs, while the drug companies and the PBMs make huge profits," he added. "That has got to change and this committee is going to do everything possible to bring about that change."
"One thing is clear," observed U.N. Secretary-General António Guterres, "this is another devastating consequence of the Russian invasion of Ukraine."
With a renewed call for peace, United Nations Secretary-General António Guterres is warning that the destruction of a huge dam in a Russian-controlled area of southern Ukraine "will have grave and far-reaching consequences" for people in the region, as officials Wednesday took stock of the incredible damage.
Speaking from New York Tuesday, Guterres said the U.N. could not independently verify how the Kakhovka Hydroelectric Power Plant dam in Kherson was destroyed in what the world body called "the most significant incident of damage to civilian infrastructure since the start of the Russian Federation's invasion of Ukraine" in February 2022.
"But one thing is clear," the U.N. chief asserted, "this is another devastating consequence of the Russian invasion of Ukraine."
\u201cMy statement on the destruction in the Kakhovka hydroelectric power plant dam in Ukraine today.\u201d— Ant\u00f3nio Guterres (@Ant\u00f3nio Guterres) 1686089949
Noting that at least 16,000 people have already lost their homes due to the dam's destruction, Guterres called the disaster "yet another example of the horrific price of war on people."
"The floodgates of suffering have been overflowing for more than a year, and that must stop," he said, adding that "above all, I appeal for a just peace, in line with the U.N. Charter, international law, and the resolutions of the General Assembly."
Also speaking Tuesday, U.N. Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator Martin Griffiths said that the dam's destruction "will have grave and far-reaching consequences for thousands of people in southern Ukraine," while noting that "Ukrainian authorities have reported that at least 40 settlements in Kherson are already flooded or partially flooded, a number which is expected to rise."
\u201cThe #Zaporizhzhia Nuclear Power Plant in Ukraine lost a vital source of cooling water when the Kakhovka dam was breached on Tuesday. Though reactors are offline, safety concerns persist.\n\nLearn more in @NucSafetyUCS\u2019s recent paper in @BulletinAtomic\u27a1\ufe0fhttps://t.co/XLj3IKCX9e\u201d— Union of Concerned Scientists (@Union of Concerned Scientists) 1686081272
The International Atomic Energy Agency—the U.N.'s nuclear watchdog—warned Tuesday that the dam's destruction has already caused a "significant' drop in water levels in the reservoir that supplies the Zaporizhzhya Nuclear Power Plant. ZNPP—Europe's largest nuclear power plant—was shelled by Russian forces in March 2022 during fighting for control of the facility, located in the eastern town of Enerhodar.
IAEA Director-General Rafael Grossi further warned that the "absence of cooling water in the essential cooling water systems for an extended period of time would cause fuel melt and inoperability of the plant's emergency diesel generators," although he added that there is no "immediate" safety risk.
Human rights groups echoed many of the U.N.'s concerns. Marie Struthers, Amnesty International's regional director for Eastern Europe and Central Asia, said in a statement that "the human and environmental cost of the destruction of the Kakhovka dam is a huge humanitarian disaster, and the international community must unite to bring those responsible to justice."
\u201cThe destruction of Kakhovka dam is posing a catastrophic risk to many civilians in Ukraine.\u201d— Amnesty International USA (@Amnesty International USA) 1686146460
"The rules of international humanitarian law specifically protect dams, due to the dangers their destruction poses to civilians," Struthers added. "The destruction of the Kakhovka dam is a catastrophe that endangers the life, safety, and well-being of tens if not hundreds of thousands of people living within range of the flood waters. It is literally an open floodgate for catastrophic human and environmental disaster."
Robert Wood, the U.S. alternate representative for special political affairs at the U.N., on Tuesday called the dam's destruction "yet another casualty in Russia's brutal, full-scale invasion of Ukraine."
"I want to make absolutely clear: It was Russia that started this war, it was Russia that occupied this area of Ukraine, and it was Russian forces that took over the dam illegally last year and have been occupying ever since," Wood continued.
\u201cSix + years ago, a U.S. Special Operations unit struck a dam in Syria...\n\nWorth revisiting this reporting today:\u201d— Azmat Khan (@Azmat Khan) 1686079958
"To be clear: Deliberate attacks on civilian objects are prohibited by the law of war," added the American, whose country's military has deliberately attacked countless civilian targets during wartime, including the Tabqa dam in Syria in 2017.
Ukraine and Russia blame each other for blowing up the Kakhovka dam, with Sergiy Kyslytsya, the Ukrainian U.N. ambassador, accusing Moscow of committing "a terrorist act against Ukrainian critical infrastructure" and Vassiliy Nebenzia, his Russian counterpart, charging Kyiv with perpetrating "an unthinkable crime."
The smoke has drifted south from "unprecedented" wildfires in Canada sparked by record spring temperatures.
Smoke from Canadian wildfires fueled by the climate crisis continued to smother eastern regions of the United States on Wednesday, with 13 states issuing air quality alerts affecting millions of people.
New York City had the worst air quality of any major city Tuesday night, and the third worst as of 11:38 am ET Wednesday, behind only Delhi and Dhaka. Both New York and Washington, D.C. have issued Code Red Air Quality Alerts and canceled outdoor activities at public schools.
\u201cNew York City now with the worst air quality in the world among major cities:\u201d— Capital Weather Gang (@Capital Weather Gang) 1686099512
"In the capital city of the United States of America it is medically unsafe to inhale air," the group Climate Defiance wrote on Twitter. "Fossil-fueled climate change has parched Canada, where 6,600,000 acres of forest just burst into flames. Those majestic woodlands are now ash. And we are inhaling the soot."
\u201cBREAKING: in the capital city of the United States of America it is medically unsafe to inhale air.\n\nFossil-fueled climate change has parched Canada, where 6,600,000 acres of forest just burst into flames. Those majestic woodlands are now ash. And we are inhaling the soot.\u201d— Climate Defiance (@Climate Defiance) 1686140401
Millions of people in the U.S. and Canada are breathing unhealthy air for the second day in a row Wednesday, with more than 55 million under air quality alerts in the Eastern U.S. and the Canadian capital of Ottawa also hard hit, CNN reported.
"The smoke—making the Eastern U.S. look like California at the peak of fire season—is not normal," The Washington Post's Capital Weather Gang tweeted. "The air is compromised from Minneapolis to D.C. to Boston, and the worst from western NY to around Ottawa."
\u201cThe smoke -- making the Eastern U.S. look like California at the peak of fire season -- is not normal.\nThe air is compromised from Minneapolis to DC to Boston, and the worst from western NY to arround Ottawa. A thread... 1/\u201d— Capital Weather Gang (@Capital Weather Gang) 1686072533
New York Mayor Eric Adams advised vulnerable residents to stay inside until the smoke cleared.
"This is not the day to train for a marathon," he said, as The New York Times reported.
AccuWeather assessed that the smoke was the worst the Northeast had experienced in more than two decades.
"Unlike other wildfire smoke episodes in the Northeast, where the smoke was primarily present well above the ground, only resulting in hazy skies and more vivid sunrises and sunsets, the smoke in recent days has also been at ground level resulting in poor air quality, low visibility, and serious health risks to people, especially those outdoors," the outlet wrote in a media advisory.
Wildfire smoke is a cause of particulate matter air pollution, which has been linked to a growing number of health hazards from heart and lung disease to poor mental health and cognitive decline. In the U.S. West, regular smoke from climate-fueled wildfires has begun to reverse policy-driven improvements in air quality, and now the East is beginning to see similar impacts.
New York City's air quality on Wednesday was its worst since the 1960s, New York City health commissioner Ashwin Vasan said, according toThe New York Times. AccuWeather, meanwhile, likened spending hours breathing the air in the hardest-hit Northeast cities to smoking five to 10 cigarettes.
\u201cLive view of Lower Manhattan from @Earthcam as dense wildfire smoke settles in close to the surface. Air quality is very poor and visibility has dropped significantly.\u201d— New York Metro Weather (@New York Metro Weather) 1686091573
"If you can see or smell smoke, know that you're being exposed," William Barrett, the national senior director of clean air advocacy with the American Lung Association, told CNN. "And it's important that you do everything you can to remain indoors during those high, high pollution episodes, and it's really important to keep an eye on your health or any development of symptoms."
The smoke is coming from more than 400 fires burning in Canada, as officials in that country said this year could be the worst for fires on record, the Independentreported. In the province of Quebec alone, more than 150 fires were burning as of Tuesday, with more than 110 out of control, forcing thousands to evacuate, The Associated Press reported.
The climate crisis is fueling these fires with record spring heat, and high latitudes are warming faster than the global average, as The Washington Post pointed out. Already in May, Canada saw more than 6.5 million acres burn, far surpassing the average for the month of around 370,000 acres.
"These conditions this early in the season are unprecedented."
"These conditions this early in the season are unprecedented and of course they are deeply concerning to all Canadians," Emergency Preparedness Minister Bill Blair toldCBC News June 1.
Smoke from the Quebec fires is being pushed south over the Great Lakes, Northeast, and Mid Atlantic by a clockwise low pressure system over Nova Scotia, The Washington Post reported further. It has drifted as far south as South Carolina and as far west as Minnesota.
\u201cAs we continue to monitor the widespread smoke from wildfires in Canada, @NOAA's #GOESEast \ud83d\udef0\ufe0f can see some of it being swept up by a large swirling low pressure system. Numerous #AirQuality Alerts are in effect across the central and eastern U.S.\n\nMore: https://t.co/wJGBXDcNu2\u201d— NOAA Satellites (@NOAA Satellites) 1686142437
It's not clear when the smoke will end, though a change in wind direction could improve conditions Friday into Saturday.
"As bad as the smoke and air pollution was on Tuesday, the air quality can be even worse at times across parts of the Northeast on Wednesday and poor air quality is expected to linger in some areas into the weekend," AccuWeather chief meteorologist Jonathan Porter said.
The location of the smoke could also change as the week progresses.
“On Thursday and Friday, the worst smoke and related air quality is expected to shift west across the Great Lakes and parts of Ohio Valley and interior Northeast including the cities of Buffalo, Pittsburgh, and Detroit," AccuWeather director of forecasting Operation Dan DePodwin said.
DePodwin warned that a system in the Ohio Valley region in the coming days or next week could turn into something called a "smoke storm," causing the smoke "to wrap westward across the Great Lakes and then southward through the Ohio Valley and into the mid-Atlantic."
While millions wait for the smoke to lift, climate activists pointed out that a change in political wind is really what is needed to prevent such extreme weather events.
"Hey @POTUS, about that climate emergency?" Fossil Free Media director Jamie Henn tweeted over a picture of a smoke-darkened New York.
Food and Water Watch policy director Jim Walsh also tweeted a smoky D.C. streetscape Wednesday as he headed to Capitol Hill to protest the Mountain Valley Pipeline, a 300-mile natural gas pipeline that Congress fast-tracked as part of the debt ceiling deal signed into law by President Joe Biden on Saturday.
"The hazy sky over D.C. this morning, from climate change charged wildfires in Canada, is just one more way the fossil fuel industry is killing us in their blind pursuit of profit," Walsh said.
Oil Change International U.S. program co-manager Allie Rosenbluth also called out the government of Canadian Prime Minister Justin Trudeau for providing another $2.24 billion in loan guarantees to the Trans Mountain tar sands pipeline.
"This has to stop if we want to have a livable planet," Rosenbluth said. "While Global South, Indigenous, coastal, and other frontline communities feel effects of the climate crisis first and worst, the inability to breathe clean air for millions who are unaccustomed to climate fires, should be a wake up call."
Rosenbluth urged action as international negotiators meet for the Bonn Climate Change Conference in Germany as part of the lead-up to the UN COP28 climate change conference later in the year.
"We cannot dig our way out of this hole with false solutions that prolong the life of fossil fuels," Rosenbluth said. "The response must be to slash carbon pollution by phasing out fossil fuels. And fast."