Monday, May 14, 2012

Capital District Alliance for Universal Healthcare And Friends of the Albany Public Library
present a free public forum:

"A Practicing Physician Views the Healthcare System"

Wednesday, May 16, 2012
5:00 –7:00 pm
Albany Public Library, Main Branch
161 Washington Avenue
Albany, New York
Christopher Calder, MD, PhD
Partner, The Neurology Group

Panel and discussion to follow
Co-sponsored by:
Physicians for a National Health Program Capital District Chapter, Single Payer New York, Albany County League of Women Voters, NY StateWide Senior Action Council, NY State Academy of Family Physicians, Hunger Action Network of NY State, New York State Nurses Association, Troy Area Labor Council.
For additional information call 518 482-0420

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Thursday, February 23, 2012

Congratulations Dr. Andrew Coates !

Local physician will lead national group
Andrew Coates chosen by organization that supports universal care

By Cathleen F. Crowley

A local physician and activist was chosen as president-elect of Physicians for a National Health Program, a national organization of 18,000 doctors who support universal health care.

Dr. Andrew Coates, 49, was selected to lead the group by PNHP's executive committee last month. His one-year term starts in 2013.

"We still need real health reform in this country," Coates said. "We still need health care that will provide comprehensive and necessary care for absolutely everyone."

Coates, who often shows up at peace rallies and health care protests in a bow tie and fleece jacket, is director of medical services at Capital District Psychiatric Center, medical director at Albany County Nursing home and a member of the executive board of the Public Employees Federation.

Coates, who is board certified in internal medicine and hospice and palliative medicine, is also a Times Union blogger.

"Andy is a fabulous person who is committed to social justice and that includes health care for all and it includes adequate income and housing and food," said Dr. Richard Propp, a retired doctor who founded the Capital District Alliance for Universal Health Care. "Basically, he is someone who is fighting on all levels for everybody."

Coates founded the region's chapter of PNHP about 10 years ago with Dr. Paul Sorum, a family doctor in Latham.

Sorum said, "He has a very good vision of what a just society should provide in the way of real health care access."

The United States should model its health care system on countries like Canada, Taiwan, New Zealand and England, Coates said.

"What doesn't work is private health insurance," he said.

Coates was raised in Greene County and attended Hamilton College. He has a master's drgree in history from SUNY Albany and a medical degree from Columbia University College of Physicians and Surgeons. He trained at Bassett Healthcare and teaches at Albany Medical College. He lives in Delmar with his wife, Lori Coates, and their three children.
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Thursday, March 31, 2011

Student Rally in Vermont: A Huge Success!

Wednesday, March 23, 2011

Great article to read in The New England Journal of Medicine

State-Based, Single Payer Health Care - A Solution for the United States?

William C. Hsiao, Ph.D.
Department of Health Policy and Management
Harvard School of Public Health, Boston MA

Read the article

Disclosure forms provided by the author are available with the full text of this article at
This article was published on March 16, 2011, at

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Sunday, February 20, 2011

H.R. 676 is Re-Introduced! See the Press Release from PNHP

February 15, 2011
Garrett Adams, M.D., president, Physicians for a National Health Program
Margaret Flowers, M.D., congressional fellow
Quentin Young, M.D., national coordinator, (312) 782-6006
Mark Almberg, communications director, (312) 782-6006,

Doctors’ group hails reintroduction of Medicare-for-all bill

Single-payer health program would cover all 51 million uninsured, upgrade everyone’s benefits and save $400 billion annually on bureaucracy, physicians say

A nationwide physicians’ group today hailed the reintroduction of a popular federal bill that would quickly upgrade the Medicare program and expand it to cover the entire population.

The “Expanded and Improved Medicare for All Act,” H.R. 676, sponsored by Rep. John Conyers Jr., D-Mich., would replace today’s private health insurers – and the Obama law’s individual mandate, which is being challenged as unconstitutional – with a single, streamlined public agency that would pay all medical claims, much like Medicare works for seniors today. (See bill summary here.)

“There’s no doubt that expanding Medicare to all is both constitutional and the most cost-effective way to cover everyone,” said Dr. Garrett Adams, president of Physicians for a National Health Program. “A national single-payer program would save over $400 billion a year on bureaucracy and paperwork alone. Plus, it would use proven, effective cost-control techniques like negotiating drug prices and hospital budgets.”

“An improved Medicare-for-all program would provide comprehensive coverage to all of the 51 million people who are currently uninsured and enhance the coverage that everyone else has, by eliminating co-pays and deductibles,” Adams said. “It would go far beyond the new health law, which would still leave 23 million people uninsured in 2019.”

“In these difficult economic times, with lack of health coverage leading to thousands of deaths and personal bankruptcies each year, and states struggling to pay the high costs of Medicaid and health coverage for state workers and retirees, everyone’s taking another look at single payer,” he said. “Legislation that could lead to a single-payer plan was just introduced last week in Vermont, led by a push from the governor and a report by Harvard economist William Hsiao that single payer would cover everyone and save the state $490 million in 2015 and at about four times that much by 2024.”

“Surveys have repeatedly shown that about two-thirds of the public supports a Medicare-for-all approach,” Adams said. “And a recent survey of physicians shows that a solid majority now favor government legislation to create national health insurance.”

“As the founder of a free medical clinic in rural Tennessee, I can assure you that the need for fundamental health care reform has never been greater,” he said. “It’s time to stop putting the interests of private insurance companies over patient needs and adopt a single-payer national health program in the U.S.”

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Tuesday, January 18, 2011

Kucinich Kicks off Health Care Debate with Renewed Call for Single-Payer

WASHINGTON - January 18 - Speaking today on the House floor, Congressman Dennis Kucinich (D-OH) opposed efforts to repeal health care reform and also renewed his call for a single-payer health care system.

“Everyone knows that health insurance companies make money by NOT providing health care. After all they are in the insurance business. They are not charities.

“With as many as 129 million Americans suffering from pre-existing conditions, insurance companies want Congress to repeal health care reform. The provisions which require covering people with pre-existing conditions would eventually cut into insurance company profits.

“Repeal means Americans will continue to pay more for insurance but get less, that is, if they can afford health care insurance in the first place.

“The very idea of health care reform solely within the context of a for-profit system has been more than problematic. Today, 50 million Americans have no health insurance. What are we going to do for them?

“Rather than waste time on debating how much reform insurance companies will permit - - if any - - it is time to change the debate. It is time to end the for-profit health care model. It is time for not-for-profit health care, single-payer, universal, Medicare for All - - with an emphasis on wellness and personal responsibility. More about that tomorrow.”

Kucinich was a co-author of Medicare For All, H.R. 676, in the 111th Congress. The bill is expected to be reintroduced in the 112th Congress as well.

Source: Common Dreams

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Monday, January 03, 2011

The Annual Drama of the ‘Doc Fix’

By Uwe E. Reinhardt

“Medicare fees to be cut by 25% in 2011,” was the alarming headline in Internal Medicine News on Nov. 3. “Unless Congress acts,” the story continued.

After much suspense and breathless media reports, Congress did act.

So on Wednesday, just in the nick of time, President Obama signed into law a delay of one year for such a disastrous cut. Once again, near disaster had been averted in a recurring drama that reminds one of nothing so much as Kabuki theater.

After all, we had been near the brink many times before, several times in 2010 alone, and each time Congress shrank back from the abyss. By now, the movement is predictable.

But who, then, are the misanthropes who so frighten the daylights out of our senior citizens and the physicians who treat them — or may not?

It turns out not to be a human being at all!

Instead, it is just an innocent formula that Congress imposed on itself as part of the Balanced Budget Act of 1997.

The formula is widely known as the S.G.R., which stands for sustainable growth rate. It replaced what previously had been known as the volume performance standard, enacted as a companion to the Medicare fee schedule introduced as part of the Omnibus Budget Reconciliation Act of 1989.

As might be expected, the precise workings of the S.G.R. formula are daunting and would probably bore most readers; but those interested in the topic can find details online.
In a nutshell, the formula was intended to keep the overall growth of Medicare spending on physician services and certain items incidental to those services (laboratory tests, imaging services and physician-administered drugs) in line with the nation’s ability to pay for that care — measured by the growth of gross domestic product per capita — after accommodating spending increases justified by the growth in the Medicare population, by changes in the law, and by the cost of operating the typical medical practice. These practice costs are tracked by the Medicare Economic Index, widely known as M.E.I.

In effect, the S.G.R. formula forces Medicare to establish in one year a global budget for Medicare spending on physician services in the following year. If that budget is exceeded by actual spending, then the annual update in Medicare’s physician fees in subsequent years — i.e., the increases in the conversion factor for the Medicare fee schedule described in my earlier posts — is to be reduced so that, over time, cumulative actual spending will come in line with the cumulative spending allowed by the S.G.R. construct, both as of April 1, 1996.

The chart below, from a Congressional Research Service analysis, shows how these cumulative spending numbers have behaved over time.

It is seen that in the early years after April 1, 1996, actual spending actually fell short of the budgeted spending allowed by the S.G.R. formula. Subsequent fee updates therefore exceeded the M.E.I. index (see the next chart below).

Since 2002, however, the trajectory of the two cumulative spending figures has reversed, which means that, in principle, the annual fee updates would be reduced and could be negative.

The next chart, taken from the same source, illustrates the relationship between the fee updates dictated by the S.G.R. formula, the actual fee updates passed into law by Congress year after year, and the M.E.I. index of medical-practice costs.

It will be noted that in 2002, Congress actually allowed the S.G.R. formula to dictate the fee update, which spelled a reduction in the conversion factor of 4.8 percent (compare the yellow and the blue bars for that year). It must have come as a shock to physicians. Note that the M.E.I. index for that year rose by 2.6 percent (the green bar).

Thereafter, however, Congress has year after year overridden its own S.G.R. formula with annual legislative “doc fixes,” as a comparison of the blue and yellow bars for these years shows. In common parlance, Congress has kicked the can of budget maintenance down the road year after year, in the process making a mockery of the entire S.G.R. construct.

Because under the S.G.R. construct the annual Medicare fee update (the change in the fee-schedule conversion factor) is to be adjusted not only for the prior year’s difference between actual and S.G.R.-allowed spending on physician services, but also for part of the cumulative differences in these spending figures as of April 1, 1996, the resulting update for calendar year 2011 should, in principle, have resulted in the previously mentioned 25 percent reduction in fees.

But once again common sense triumphed over an equation and Medicare fees will stay at the level to which they had been raised earlier in the fall.

And why this recurring drama over Medicare fees? The chart below provides a clue.

Source: Staff presentation at Dec. 2, 2010 meeting of Medicare Payment Advisory Commission

The lowest line in the first chart (in red) shows Medicare’s fee increases from 2000 to 2009. These updates look so miserly as to make a taxpayer blush.

After all, that line is so much lower than the green line, which represents growth in the M.E.I., the index that measures the annual increase in the cost of operating a medical practice. The American Medical Association believes that the annual fee updates should be based on that index rather than the S.G.R. formula (see “Definitions” in this presentation). At first glance, this recommendation has intuitive appeal.

Indeed, even if one assumed that the M.E.I. should be adjusted downward a bit because physicians should be able over time to increase the productivity with which practice inputs are used, basing fees on the productivity adjusted M.E.I. (the blue line) would still have raised Medicare’s physician fees substantially more than the actual fee increases.

Finally, however, the top line (in black) shows that, in spite of Medicare’s miserly fee updates, total Medicare spending on physician services per Medicare beneficiary actually has grown by fully 60 percent from 2000 to 2009, at an average annual compound rate of 5.4 percent.

That per-beneficiary spending increase looks anything but miserly. Thus, after blushing over miserly fee updates, taxpayers might go on to ask physicians why an average annual compound increase of 5.4 percent in spending per Medicare beneficiary was not enough to give the nation’s elderly good medical care and, if it was not enough, what would have been an adequate annual increase in Medicare spending on physician services — perhaps 7 percent, or 10 percent, of 15 percent, or how much?

Might not a nation breaking under the load of its rising government deficits and private health care spending want to know how much health spending would be enough in the eyes of its physicians?

The difference between the growth in Medicare fees and the growth in Medicare spending is, of course, the growth in the volume of services sold, so to speak, to Medicare. I shall have more to report on it in my next post.


Uwe E. Reinhardt is an economics professor at Princeton. He has some financial interests in the health care field.

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