PNHP's Don McCanne Comments on the RAND Study of How to Cover All Oregonians

By Don McCanne, M.D.

This study can be very helpful to those who are considering comprehensive health care reform on a state level. RAND has shown that a single payer system would cover everyone without increasing total health care spending; private health insurance for the nonelderly plus Medicare for seniors and the disabled would cover everyone but would increase total spending; and providing a state-run health plan (public option) would have only a negligible impact on coverage and spending.
Full article here.

Our Nation Needs This Balm as Single-Payer Action Surges Forward

Published on Monday, November 02, 2015 by Common Dreams

Rally for healthcare justice at Chicago's "Bean." (Photo: Donna Smith)

Rally for healthcare justice at Chicago's "Bean." (Photo: Donna Smith)

Over the past few days, more than 700 people from all over the country came together for the annual single-payer strategy conference.  This year, we were in Chicago, my hometown,  Of course we shared ideas, successes, concerns, and knowledge about the kind of healthcare reform that might truly give us the best healthcare system in the world through an improved Medicare for all for life model.

The convening groups represented Healthcare-NOW, the Labor Campaign for Single-Payer Health Care, One Payer States, and Physicians for a National Health Program.

Leaders from this movement get precious little time to gather face-to-face during the year.  There were scores of nurses from all over the country -- New York, Massachusetts, Illinois, Texas, California, Minnesota, Pennsylvania and beyond.  There were doctors from all over the place.  And there were those of us who are patients who have been injured (or might be injured) by our aggressively greedy healthcare system.  Labor leaders brought the hopes of their rank and file membership that someday we will actually allow contract bargaining to surround much more than healthcare benefits and costs that have squeezed out other issues like wages, vacation and other leave benefits and so on.

The conference opened with a joint protest at the Blue Cross/Blue Shield building in Chicago.  One of the great moments for me was seeing the medical students passionately calling for changes to their chosen profession.  It gave me hope for the future and the potential for real change.

But the highlight of the conference for me came in something much less quantifiable but much more powerful -- the balm of knowing that this wonderful nation is filled with compassionate, decent people who believe in the promise of our Declaration of Independence in which we read that all men are endowed by their creator of certain unalienable rights, and that among these rights are life, liberty and the pursuit of happiness.  There can be none of those dearly held rights for Americans when our healthcare system snuffs out any chance for equality and the opportunity to live life to its fullest extent.

We are not enemies of our neighbors, our business owners or our fellow Americans who may hold very different political positions.  When it comes to our unalienable rights, we are one.

On Sunday morning when we convened for the final session, John Lozier of the National Health Care for the Homeless Council called us together.  John reminded us that after Halloween comes the Day of the Dead, and he asked that we silence ourselves -- not an easy task for this many opinionated, wonderful social justice warriors -- and the room grew quiet.  John asked us to remember all of those who have lost the struggle to stay alive in the midst of a cloud of inhumanity that has emboldened those who profit from the pain of others.  I cannot say that it was silent.  Although there was an absence of noise, the energy of compassion swelled in the air.

In those few moments of collective remembrance, the room was filled with a palpable sense of belonging to something greater than ourselves that drives us onward to the day when our healthcare system unites us around healing and health rather than profits and wealth.  I tried to turn my thoughts away to gather myself for the morning's work, but the wonder, comfort and compassion washed over me in waves.  I tried not to weep.  I fought back my tears.  And all at once, I knew why it is not only possible but probable that we will secure the rights we all need to be as free and healthy as our neighbors.  I felt what it might be like to rest in that security and compassion.  And let me say, it was one of my life's "ah ha" moments.  Imagine a society that healed instead of arming itself for the next gun assault our streets.

So, going forward to do the work we envisioned is so much more important than our focus on the healthcare system or other progressive struggles.  It is about who we are as human beings and how we make sure that we can live up to the elegance of the words written in the Declaration and so oft cited by those who would tear us apart for personal gain.  All men, all women, all children are created equal.

Finally, just moments before we needed to part, a dear friend and brilliant woman professor, Lindy Hern, handed me a gift she brought me from her home state of Hawaii.  It is a beautiful little jar of ginger-guava lip balm.  Indeed.  Another balm.  I march on.  We march on.  We will achieve our goal, and soon we will gather in joyous celebration that the years of struggle when we worried about the path forward will wash away, and we will leave our children the promise we hold dear -- a nation that lives up to its earliest bargaining agreement that brought us together almost 240 years ago to believe we are indeed not only deserving of equal rights but endowed with those rights.

Won't you be a part of creating this kind of nation and this kind of world?  Join us.  A better society is coming.  Everybody in, nobody out.  Our battle cry sounds an awful lot like that long ago declaration, and it calls us to action.

This work is licensed under a Creative Commons Attribution-Share Alike 3.0 License

Donna Smith is the Executive Director of Health Care for All Colorado and the Health Care for All Colorado Foundation. 

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Medicaid improving access for the homeless, but…

Below are the comments by Dr. McCanne of PNHP about the article

Early Impacts of the Medicaid Expansion for the Homeless Population
By Barbara DiPietro, Samantha Artiga and Alexandra Gates

Kaiser Family Foundation, November 13, 2014

Comment: By Don McCanne, MD

The experience of the homeless population under the Affordable Care Act (ACA) demonstrates both the benefits of reform under ACA and the flaws of ACA that call for replacement with a single payer system. ACA was better than nothing, but we can have so much more through enactment of a single payer system.

The primary ACA benefit for the homeless is that most of them in expansion states qualify for Medicaid and thus have improved access to health care without financial barriers. Some of the homeless who access health care have been noted to have an increased ability to work and to maintain stable housing. Financial stress is reduced and some have gained access to appropriate disability benefits. These benefits to the homeless are more reasons why calls for simple repeal of ACA are bad policy, devoid of compassion.

Yet the last paragraph from the excerpts above explains why Medicaid managed care is often a poor choice for the homeless (and many other lower-income individuals as well). Homeless patients often are unable to see the health care professionals who would be most accessible and appropriate for them. Transportation concerns are more likely. Essential specialized services may not be available. Managed care intrusions such as prior authorization requirements, limitations and changes in formularies, or other perverse managed care innovations may impair access to important health care services or products. Further, those states that refuse to expand Medicaid are leaving most of the homeless without any coverage and therefore reliant on often inadequately funded safety-net institutions.

There are those who believe that we should merely proceed with implementation of ACA and try to obtain legislative and administrative patches along the way. Compared to the deficiencies in our dysfunctional system, patches have only minimal beneficial impact while increasing the administrative complexity that already overburdens our system. Patches fall way too short of what we need.

We should not repeal ACA since it does provide some temporary benefit until we can implement a single payer system. But we should not let ACA implementation divert us from instituting what we really need - a single payer national health program. Not only would that benefit the homeless, it would benefit all of the rest of us as well.

Read the full post here.  Consider joining MVHCA and attending our Feb. 11 Rally.

A Successful Celebration of CCO Success!

A large and diverse group of people attended the August 12 CCO Celebration sponsored by MVHCA, League of Women Voters of Corvallis, Health Care for ALL Oregon-Abany, Interfaith Health Care Network, and Corvallis Physicians for a National Health Program. At MVHCA we are taking a keen interest in the Coordinated Care model because we realize that Oregon doesn't just need to change the financing of health care to a publicly funded (or single payer) system, but also needs to transform how care is delivered to give everyone the care they need when they need it in an equitable and affordable way.

Assisters from the Benton County Health Department were on hand to provide information about signing up for health care coverage.


There was an amusing and educational skit about the difference between the old way of providing care and the coordinated way making use of Patient Centered Primary Care Homes (PCPCH). In this photo MVHCA Chair Ron Green holds the title card while Ann Brodie introduces the skit.

The skit illustrated how the focus of the PCPCH is centered on the patient, and services like physical, mental, and dental health are coordinated to give the patient better health, better care, for a lower cost -- known as the Triple Aim.  Here, the "Old Way" Dr. Sorry Imlate, played by Mike Huntington, takes a phone call from his wife while patient Shelley Ries waits and wonders why he has no time for her list of questions.

Following Dr. Sorry Imlate,  "CCO Way" Dr Still Imalate, played by Tessa Green,  took the time to examine the patient and introduce her to a councilor who will help her with her depression.


After the skit, Dr. Kristen Bradford, MD, Medical Director , Community Health Centers of Benton and Linn Counties, shared stories from Oregon Health Plan members about how having affordable coverage has changed their lives.

Judy Sundquist, MPH, RD, discussed the metrics that are used to measure the performance of Oregon's Coordinated Care Organizations and commended InterCommunity Health Network Coordinated Care Organization (IHN-CCO) for it's improvements in access to care, immunizations for adolescents, patient satisfaction, medical assistance with smoking/tobacco cessation, and developmental screening of children - first 36 months.


Judy introduced the panelists who spoke about how much the change to coordinated care has helped them in serving the Oregon Health Plan (OHP/Medicaid) members who are in their charge.  The panelists consisted of Kelley Kaiser, CEO of IHN-CCO; Sherlyn Dahl, BSN, MPH, Director of the Federally Qualified Health Centers of Benton and Linn Counties; Kevin Ewanchyna,  MD, Chief Medical Officer; and Larry Eby, MD, Chair, IHN-CCO Community Advisory Council. The panelists made the point that the transformation to coordinated care will not only help OHP members, but the improvements will be implemented for everyone needing care. They emphasized that they do not envision a 2-tiered system of health care.

Governor Kitzhaber recorded a video message of congratulations on the 2 year anniversary of IHN-CCO and it's many accomplishments.

There was time for questions from the audience, and then everyone enjoyed the refreshments.

Thank you to all who organized, presented, attended, and asked insightful questions. A special thanks to Mina Carson for taking the photographs used here.