April 2, 2018
Dear Senator Sanders,
The movement for National Improved Medicare for All (NIMA) has organized for 15 years around HR 676: The Expanded and Improved Medicare for All Act, which has 121 cosponsors in this Congressional Session. HR 676 is considered the movement’s gold standard for a universal healthcare system in the United States and recently gained a new lead sponsor in Representative Keith Ellison.
We are writing to urge a united front for National Improved Medicare for All (NIMA) by amending the Senate legislation, S. 1084, to be in alignment with HR 676. Below are our suggestions for improving S. 1804 to make it a strong companion bill to HR 676.
Include long term care.
The exclusion of long term care from the new Medicare system prevents it from being universal. Around ten million people in the U. S. rely on long term care. In the current Medicaid system, they and their families must live in poverty to qualify for coverage. Many people who need long term care cannot effectively access the rest of the healthcare system without it. And because Medicaid is administered at the state level, there is currently wide variation in quality and benefits.
Remove all copayments and deductibles.
As noted in our previous letter and letters from Physicians for a National Health Program, copayments and deductibles serve as financial barriers that keep many people from receiving the medications and care they need. A February 2018 survey by CarePayment/2020 Research found that 64 percent of people in the United States delayed or avoided care in the past year due to the cost, although most of them had health insurance. Out-of-pocket costs increase administrative complexity. As economic analyses show, the additional costs incurred by removing these barriers could be offset with administrative savings in a well-planned system.
Implement a rapid transition to National Improved Medicare for All.
Medicare and Medicaid were implemented as new systems in less than a year without computers. We currently have the infrastructure for a rollout based on the HR 676 timeline, which would commence NIMA in less than two years after passage. This would allow the cost savings to occur sooner, such as administrative savings, negotiated prices and budgetary controls. It would also decrease the amount of time available to for-profit companies to cherry pick patients, undermine the public system, and subvert the system.
Prohibit Medicare Advantage Plans.
A first step in the implementation of national improved Medicare for all must be the explicit elimination of Medicare Advantage. If Medicare Advantage is permitted to operate, it will become the method for continuation of corrupt health insurance industry practices that will undermine the system.
Eliminate investor-owned health facilities.
Investor-owned health facilities have continually shown they place the financial return to their investors above the health of those they serve. By treating healthcare as a commodity, as opposed to a necessary public service, they have the incentive to cut corners, over- and under-treat and overcharge. For-profit providers hurt patients financially or physically and result in a higher cost, lower quality system.
Remove unproven payment schemes.
Currently, S. 1804 includes the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which uses payment schemes that neither cut costs nor improve the quality of care. Instead, what such schemes have done is to impose enormous burdens on how physicians practice medicine. Continuing to include these provisions will increase paperwork and hence, decrease the time physicians spend with patients. They will also punish doctors working with patients who, for a multitude of reasons outside the control of the physician or patient, may not comply with a set treatment plan. And because of the onerous paperwork, MACRA pressures physicians to join Medicare Advantage group practices, which could result in Medicare for All becoming a system of health maintenance organizations with limited networks.
Include budgetary controls.
Adopting a universal national improved Medicare for All system will increase healthcare spending by the federal government. This increase can be offset through reduced administrative costs and negotiated prices. A critical component of controlling healthcare spending is through global operating budgets for facilities that provide healthcare services and separate capital expense budgets to control the distribution of healthcare resources. These budgetary controls not only lower healthcare spending, but they also ensure that healthcare resources are provided where they are needed and reduce paperwork by caregivers, which increases time spent in direct patient care.
We support a truly universal single payer system that provides comprehensive coverage.
We appreciate your willingness to improve S. 1804. We are organizing the first single payer action camp in Washington, DC on April 9 and 10. We request a meeting with you and/or your healthcare policy staff on either of those days to discuss the above concerns in more detail. We can be reached at firstname.lastname@example.org.
The Steering Committee of Health Over Profit for Everyone