reform (noun): 1) amendment of what is defective, vicious, corrupt, or
depraved, 2) a removal or correction of an abuse, a wrong, or errors
Physicians for a National Health Program
December 22, 2009
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
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,
* 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
* 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
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
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