AJPH Editorial: ‘Trumpcare or Transformation’
By David U. Himmelstein, M.D. and Steffie Woolhandler, M.D., M.P.H.
American Journal of Public Health, March 21, 2017
Democrats as well as Republicans have offered too little that inspires and too much that appeases the rich and powerful. Trump won by attacking a status quo that is disastrous for many. In health care, the Affordable Care Act (ACA) extended coverage to 20 million and boosted funding for public health and community health centers. But it offered little help to 90% of the population, perpetuated a dysfunctional health care financing system, left 26 million uninsured, saddled covered families with unaffordable deductibles and narrow provider networks, and enriched drug firms, medical conglomerates, and insurers. Mobilizing for a reform that would fix these defects is a far better defense against Trump’s health-damaging plans than calls to retain the pre-Trump order.
Even before the inauguration, congressional Republicans initiated repeal of key pillars of the ACA. But although Republicans are unified in their desire to destroy what Obama wrought, crafting the replacement is more complicated. Unfortunately, going halfway — repealing without replacing — would likely cost thousands of lives (see numbers in PNHP release, below).
The health impacts of the administration’s antiscience bent are hard to gauge, but potentially devastating. Public health advance requires accurate data and honest assessment. When politicians threaten and muzzle scientists studying the environment, label inconvenient truths “fake news,” and propagate falsehoods under the guise of “alternative facts,” they chip at the foundations of scientific progress.
This grim litany reflects what President Trump and his allies want to do. But their agenda is already fraying under the pressure of popular opposition.
Perhaps as important, Democratic politicians are feeling pressed and emboldened to embrace progressive policies.
Moving forward from the ACA to single payer would up-end the market-based approach that has hobbled reform, allowing the redirection of hundreds of billions now wasted on insurers’ overhead, providers’ billing-related paperwork, and excessive drug prices. With that money we could ensure access for all, lift the threat of bankruptcy attributable to illness, and free up funds for much-needed expansions of long-term and mental health care, as well as public health work.
ACA's repeal would cause tens of thousands of deaths, while single payer would save 20,000 more lives than ACA: AJPH editorial
Physicians for a National Health Program, March 22, 2017
Repealing the Affordable Care Act without replacing it, as some conservative hardliners are demanding, would cost a minimum of 37,127 lives over the next two years (14,528 in 2018 and 22,599 in 2019), and perhaps as many as four times that number, according to scientific studies summarized in an editorial in this week’s American Journal of Public Health.
In contrast, the editorial’s authors estimate the impact of replacing the ACA with a universal, single-payer health system, along the lines of the Expanded and Improved Medicare for All Act, H.R. 676, would provide immediate coverage to the 26 million Americans who are currently uninsured, saving at least 20,984 lives in year one.
By Don McCanne, M.D.
There are at least three important concepts in this AJPH editorial by PNHP co-founders David Himmelstein and Steffie Woolhandler:
1. They cite the civil rights and social justice successes of the 1950s and 1960s and describe how there seems to be a growing renewal of that spirit in response to the current political regime.
2. They quantify the tragic loss of life that occurs today because of the inadequacies of the Affordable Care Act, and the increase in loss that would occur under repeal of ACA, while providing very reassuring estimates of the number of lives that would be saved by replacing ACA with a single payer national health program - an improved Medicare for all.
3. By including in their publication this editorial which extols the virtues of moving forward from the ACA to single payer, the prestigious American Journal of Public Health (“One of the 100 Most Influential Journals in Biology & Medicine over the last 100 Years”) has helped to moved the concept of single payer into the mainstream in our national discourse on health care reform.