It’s the best of times and the worst of times for the advocates of national single payer health care in the United States. So good because the vast majority in the US have embraced the concept of improving Medicare and expanding it to the entire population. So bad because corrupting influences threaten to steal the goal before we can get there.

Let’s take just one issue—for-profit hospitals, nursing homes, and other health care institutions. Shall we allow the profit takers to remain in the new system, like the flawed Senate Medicare for All bill S 1804, does?

Or shall we look at the data, save money while giving superior care, and remove these investor-owned, for-profit institutions from our system? HR 676, the Expanded and Improved Medicare for All Act, introduced in every Congress since 2003, removes the for-profits from the system.

HR 676 is the model single payer legislation written to implement the evidence-based plan of the Physicians for a National Health Program (PNHP). But we could lose HR 676 as a model bill, if we don’t act now.

Congresswoman Pramila Jayapal of Washington’s 7^th District, one of 123 cosponsors of HR 676 in the House, hopes to become the new lead sponsor of HR 676 in the next session. But Representative Jayapal has announced that she plans to change HR 676 to be like S 1804.

That is a disaster in the making. The changes to make HR 676 like S 1804 would destroy HR 676 as a viable, financially sound, single payer bill.

One of the changes to make HR 676 like S 1804 would be to remove the section of HR 676 than bans for-profit hospitals, nursing homes, and other institutions. (There are other problems with S 1804 such as leaving out long-term care, no global budgeting for hospitals, and inserting “value based payments” and ACO’s that are equally destructive, but let’s deal with this one first.)

Dr. Andrew Coates, past president of PNHP who currently practices in Albany, New York, said in a recent interview:

“There should be no profiteering in the delivery of healthcare. I’m not talking about whether highly trained physicians, nurses, or their support staff should be able to make a handsome middle-class living. As a society we should be proud to support professional caregivers. That’s different from people making money simply because they own the laboratory or the hospital or the distribution system.

“For example, nursing homes in the U. S. are mostly owned by private-equity firms like Warburg Pincus, Bain Capital, GE Capital, the Carlyle Group, and others. These corporate owners in turn hire myriad subcontractors to run every aspect of the home, from the kitchen to the janitorial service to the electronic health records to the laundry. And at every step there is someone taking a profit out.”

That will continue to happen if Congresswoman Pramila Jayapal changes HR 676 to match S 1804 and keeps the for-profits in health care.

As Dr. Coates says, “I think it’s appalling that one person’s illness would be an opportunity for another to make money.”

The evidence is clear. Keeping investor-owned, for-profit hospitals and other healthcare institutions will cost us more and will harm patients. So study the evidence and use it to persuade Representative Jayapal and your congressperson to ban the profiteers in health care.

1. For-Profit Hospitals Result in Higher Risk of Death.

Research experts looked at the data including fifteen observational studies involving more than 26,000 hospitals and 38 million patients.

They concluded: “Our meta-analysis suggests that private for-profit ownership of hospitals, in comparison with private not-for-profit ownership, results in a higher risk of death for patients.”

2. For-Profit Hospitals Result in Higher Costs.

Researchers looked at studies involving more than 350,000 patients and compared the cost differences between for-profit and not-for profit hospitals.

They concluded: “Private for-profit hospitals result in higher payments for care than private not-for-profit hospitals. Evidence strongly supports a policy of not-for-profit health care delivery at the hospital level.”

3. For-Profit Dialysis Centers Have Higher Death Rates.

P. J. Devereaux and others published, in the Journal of the American Medical Association, their “Comparison of mortality between private for-profit and private not-for-profit hemodialysis centers.”

After review of an extensive number of observational studies, they conclude:

“Hemodialysis care in private not-for-profit centers is associated with a lower risk of mortality compared with care in private for-profit centers.”

4. For-Profit Hospitals Have Higher Readmission Rates.

In their research article, Manish Mittal and his coauthors analyzed the readmission data of Medicare patients for six major diseases.

They report, “Our analysis demonstrates that the readmission rates of patients were statistically higher in proprietary (for profit) hospitals compared to the government and non-profit hospitals which was independent of their geographical distribution across all six major diseases.”

“This finding we believe has strong implications for policy makers to mitigate any potential risks in the quality of patient care arising from unintended revenue pressure in healthcare institutions,” they conclude.

So we should protect patients from “unintended revenue pressure” and keep the ban on for-profits in HR 676.

The care of human beings should not be a commodity.

As Dr. Coates says: “The care of human beings should not be a commodity. Since the dawn of time people have done their best to tend to the injured or sick. That’s something very basic to humanity. When caregiving becomes a commodity, the goal of health collides with the goal of wealth. In American healthcare today an unbelievable number of interlopers have entered the fray. Their job is to figure out how to extract funds that could otherwise have gone to help the sick.”

So ask Congresswoman Pramila Jayapal and your congressperson to maintain the integrity of HR 676 and keep the profiteers out. Ask them to look at the evidence.

Kay Tillow, Louisville, Kentucky

09/30/2018