Category Archives: Health care fallacies

Elizabeth Warren’s Number-Crunchers Out of Sync With Her on Some Big Plans and Is Soaking Rich the Answer. And How Did It Work Out for the French?

73495095_2337220289740950_8378943902677204992_nAs a physician and an economist, I am amazed at the lack of knowledge of both medicine and finance by Ms. Warren and her Team as well as the rest of the Democrats running for President as they tout Medicare for All and give up on Affordable Health Care/ Obamacare. Sahil Kapur and Katia Dmitrieva pointed out that Elizabeth Warren is careful to cite economic experts to back up the costs of her multi-trillion-dollar policy plans. But even those experts disagree among themselves about how or whether those plans will work.

University of California Berkeley economists Emmanuel Saez and Gabriel Zucman advised Warren on her wealth tax and say she could raise $2.75 trillion over a decade by imposing a 2% tax on wealth worth $50 million or more, going up to 3% for a wealth of more than $1 billion.

But Mark Zandi, chief economist at Moody’s Analytics who Warren’s campaign asked to review her separate Medicare-for-All funding plan, which includes an additional 3% tax on wealth over $1 billion among other levies, is skeptical it would bring in that much money.

On health care, Zandi has projected that Warren could raise the $20.5 trillion she estimates it will cost to give everyone free health-care without any new middle-class taxes, even though he disagrees with her vision. Saez and Zucman support her policy in general but their funding approach does raise taxes on the middle class.

The disagreements among those who helped shape and gauge her policies highlight the challenges for Warren as she tries to convince voters that she can generate enough revenue to provide free health care, free public college, universal childcare, forgive a portion of student loans and mitigate climate change, among other ambitious policies.

Saez said in an email that Warren’s health care numbers are “reasonable” — with a caveat.

“Scoring is not hard science, and much will depend on the quality of enforcement. Her numbers assume that enforcement will be excellent,” he said. “We believe this is possible but it will require a big and successful push (a big policy change in and by itself).”

Zandi said the Warren wealth tax will be difficult to enforce, with billionaires likely to use multiple loopholes to avoid it. Several European countries experienced this issue when implementing their own tax programs. Warren has said she would empower the Internal Revenue Service to enforce collection, a promise made by many presidential candidates over the years.

“When considering all of Warren’s policy proposals, which includes a number of different tax increases on the wealthy, tax avoidance may be higher than she is assuming. But this doesn’t mean Medicare-for-All or any of other plans won’t be paid for,” Zandi said in an email.

Warren’s plan to pay for her Medicare-for-All proposal, which she released this month under pressure from rivals, increases her wealth tax and is predicated on avoiding any tax increases on the middle class in the hope of avoiding the political blowback such a move would likely bring.

Under Medicare for All, 98% of the money companies now pay for employees’ health care would be shifted to the government instead.

But Saez and Zucman, who priced out Warren’s tax plan, have floated a different way to pay for Medicare-for-All — a progressive tax that may hit some in the middle class, but would compensate by requiring companies to put the money they would have provided to their employees’ health care into higher paychecks.

Saez said Warren’s employer tax “is a tax on the middle class as economists pretty much all believe that such taxes are effectively borne by workers.” But he said workers are already bearing that cost. “Hence, if you count existing premiums as a pre-existing tax, the Warren plan effectively does not ‘increase’ taxes on the middle class.”

A campaign aide said that Zandi was only scoring her health care plan, while Saez and Zucman were advising her on the wealth tax. Warren tweeted Wednesday, “I knew Mark Zandi was skeptical, so I had him check the numbers on my plan to pay for #MedicareForAll. He confirmed they add up.”

Senator Bernie Sanders, who wrote the Medicare-for-All bill that Warren campaigns on, has released his own suggestions for how to fund it. His ideas include a more aggressive wealth tax than Warren’s and a 4% payroll tax which would hit many Americans though overall they would pay lower costs because of health care savings. He has acknowledged the middle-class would pay more in taxes.

Overall, Zandi backs up Warren’s health care math. He said in the email that Warren can finance her plan without raising taxes on the middle class, even though he doesn’t agree with the policy. And even if the rich don’t pay their fair share, she could find those funds elsewhere.

“Warren’s Medicare for All plan isn’t the only way to provide health insurance to all Americans, rein in growing health care costs and improve health care outcomes,” Zandi wrote in a CNN op-ed that was published on Wednesday. “A more tractable approach in my view is to allow those who like their private health insurance to keep it and to build on Obamacare by giving everyone else an option to get Medicare.”

Mark Cuban: Elizabeth Warren’s Medicare-for-all will take years to achieve

Frank Connor pointed out that Elizabeth Warren unveiled a massive overhaul of the U.S. health care system in her single-payer Medicare-for-all plan. However, Dallas Mavericks owner Mark Cuban believes the proposal will take years to accomplish.

“Getting from where we are, to getting there is not something you can accomplish in 4, 8, 12, or even 20 years,” Cuban told FOX Business’, Maria Bartiromo.

Cuban does, however, believe that health care is a right for everyone and that there is a need for people with lower incomes to have access to healthcare. This, he suggested, may indicate an opportunity for a “hybrid plan.”

“Maybe we can expand Medicaid and Medicare and still have a good capitalist system for health care in the middle,” Cuban said.

Business, he argued, cannot operate when there are communities where there is “disruption and social unrest” and so these areas need a basis of health care.

One of the problems with the health care industry, according to Cuban, is a misalignment of incentives between payers and providers.

“The goal of, hopefully, a health care system is to make people healthy,” he said. “And so you don’t get that, you know, when payers, the insurance companies, and the providers work together.”

Cuban described this as a “malicious circle,” suggesting that the parties involved charge each other more in order to make more money.

“None of their metrics have to do with making people healthier,” he said.

The billionaire businessman does not believe the rise of high deductible insurance programs will lead to the growth of a consumer market in health care or lead to customers shopping for health care pricing. He argued high deductible programs are problematic because they make up such a high percentage of their actual income making it more difficult for them to get care.

Additionally, he noted that people don’t shop for care, they make these decisions based on who they trust.

He also believes that artificial intelligence will help the industry.

“As you get more into artificial intelligence and be able to use data more smartly, then you’re going to see a lot of benefits, particularly in radiology,” he said.

France Tried Soaking the Rich. It Didn’t Go Well.

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What about the idea that Elizabeth Warren pushes that the rich should be taxed to the fullest? Noah Smith noted that in recent years, several prominent economists have brought attention to the problem of growing inequality. These scholars include Thomas Piketty, author of the best-selling book “Capital in the Twenty-First Century,” and Emmanuel Saez and Gabriel Zucman, who in a new book chronicle the rise in American wealth inequality. All three embrace the same solution:  much higher taxes. Piketty has declared that billionaires should be taxed out of existence, and he called for a global wealth tax, while Saez and Zucman helped Democratic presidential candidate Elizabeth Warren design her proposal for a U.S. wealth tax. Piketty and Saez have also suggested taxing top incomes at a rate of more than 80%.

Other economists have struggled to evaluate dramatic proposals like this. Studies on the effects of taxation when rates are moderate might not be a good guide to what happens when rates are very high. Economic theories tend to make a host of simplifying assumptions that might break down under a very high-tax regime. Historical experience is of some help because the U.S. had very high top income taxes in the 1950s, but economic conditions could be very different now.

One way to predict the possible effects of the taxes is to look at a country that tried something similar: France, where Piketty, Saez, and Zucman all hail from.

During the past few decades, as income inequality rose in most rich countries, it stayed relatively constant in France. The biggest reason is government redistribution in the form of taxes and social-welfare spending. France leads its rich-country peers, including the legendarily egalitarian Scandinavian countries, on both measures:

France, therefore, shows that inequality, at least to some degree, is a choice. Taxes and spending really can make a big difference.

But there’s probably a limit to how much even France can do in this regard. The country has experimented with both wealth taxes and very high top income taxes, with disappointing results.

France had a wealth tax from 1982 to 1986 and again from 1988 to 2017. The top rate was between 1.5% and 1.8%, with the total tax rate on fortunes larger than 13 million euros ($14.3 million) hovering at about 1.4%. This is much less than the 6% top rate proposed by Warren (not to mention the 8% proposed by her fellow candidate, Senator Bernie Sanders), but it’s close to the 2% rate Warren would impose on fortunes larger than $50 million.

The wealth tax might have generated social solidarity, but as a practical matter, it was a disappointment. The revenue it raised was rather paltry; only a few billion euros at its peak, or about 1% of France’s total revenue from all taxes. At least 10,000 wealthy people left the country to avoid paying the tax; most moved to neighbor Belgium, which has a large French-speaking population. When these individuals left, France lost not only their wealth tax revenue but their income taxes and other taxes as well. French economist Eric Pichet estimates that this ended up costing the French government almost twice as much revenue as the total yielded by the wealth tax. When President Emmanuel Macron ended the wealth tax in 2017, it was viewed mostly as a symbolic move.

Another French experiment was the so-called supertax, a 75% levy on incomes of more than 1 million euros. Introduced by socialist President François Hollande in 2012, the supertax added to the exodus of wealthy individuals, most notably actor Gerard Depardieu and Bernard Arnault, chairman of LVMH Moet Hennessy Louis Vuitton. Star soccer players threatened to go on strike, and there was fear that France would become a wasteland for entrepreneurs. Meanwhile, the supertax raised much less money than even the wealth tax had — only 160 million euros in 2014. The unpopular tax was repealed two years after its adoption.

France’s experiments with taxing the wealthy at very high rates didn’t raise much money and didn’t prove politically sustainable. The flight of wealthy individuals from the country probably helped reduce inequality on paper, but it’s not clear that their departure left France better off.

It’s possible that similar tax experiments in the U.S. might be more successful than in France. The U.S. economy is much larger than France’s; although a French business owner who moves to Belgium can still do business and move about freely within the European Union, an American mogul who moves to Canada might find access to one of the world’s largest markets restricted. That might allow the U.S. to raise more money from high taxes than France ever could.

But it’s also worth noting that France’s wealth tax and supertax ultimately weren’t that important. Despite repealing the supertax, France managed to increase government revenue and to reduce inequality. The end of the wealth tax will probably be a similar story. France simply didn’t need these flamboyant taxes on the rich to have very high levels of taxation and social spending. That means the U.S. probably doesn’t need them either. Tax increases across the board — on top incomes, capital gains, estates, pass-through businesses, corporations, and so on — might not excite populist firebrands, but they’re probably a more effective strategy for fighting inequality.

‘Save public hospitals’, French health workers urge Macron

Gabriel Bourovitch, Clare Byrne and Aurelle Carabiin looked at the French healthcare system and noted that thousands of French hospital workers demonstrated Thursday over years of cutbacks they say have harmed care in a country with a health system once the envy of the world. Also, remember what I pointed out as Medicare for All pays all doctors and hospital Medicare rates- about 50-60 cents on the dollar. You think when Medicare for All reimburses physicians and hospitals that doctors can pay their staff, their medical education bills, malpractice bills as well as run the hospitals? I think not!

Public hospitals in France have been forced to cut 9.0 billion euros ($9.9 billion) off their debts since 2005, leading to the scrapping of hundreds of beds and dozens of operating theatres while stagnant salaries have fuelled a flight to the private sector.

Calling on President Emmanuel Macron to “save public hospitals”, thousands of hospital doctors, nurses, students, and administrative staff held protests in Paris and a dozen other cities on Thursday.

The protests began in March when emergency room staff, who complain of elderly patients being left for hours on trolleys in corridors while waiting for a bed, began strike action.

Over 260 emergency rooms nationwide are still affected by work stoppages.

On Thursday, staff from other hospital departments joined in the protests.

In Paris, organizers said that some 10,000 demonstrators marched through the city waving placards with a message such as: “Exhausted caregivers = endangered patients”, “Public hospitals in a life-threatening emergency” and “The hospital is suffocating, let’s save it.”

In the southwestern city of Toulouse, 3,000 staff took to the streets, around 400 in Brest and Quimper in the northwest, and a few hundred each in other cities such as Nantes, Lyon, Bordeaux, Lille, and Marseille.

Jean-Michel Carayol, a hospital technician who demonstrated in the Mediterranean port city of Marseille, said the staff were “at the end of their tether and exhausted”.

Monique Aubin, a 61-year-old nurse who also joined the protest, complained of a “lack of materials, even medication” and of being swamped in paperwork which left her little time for patients.

In 2000, the World Health Organization ranked France’s health system the best of 191 countries.

But a study by the Institute for Health Metrics and Evaluation published in The Lancet medical journal in 2017 placed it in 15th place for quality of care.

The country is still one of Europe’s biggest spenders when it comes to healthcare.

In 2016, France spent 12 percent of its GDP on health, well above the western European average of 10 percent, and was also the country where the patient’s share of the health bill was the lowest.

– New winter of discontent? –

The protests have created jitters in the government, which fears that hospital staff could band together with other disgruntled groups such as transport workers who are planning mass strike action in December over pension reforms.

Three health plans in the past two years have failed to appease the anger of beleaguered hospital staff.

In an attempt to head off another winter of discontent, a year after the start of the “yellow vest” revolt, Macron said Thursday the government would unveil plans next week for “substantial” hospital investments.

While arguing that his centrist government had inherited an ailing hospital system, he said he had “heard the anger and the indignation over working conditions” in hospitals.

The protesters are demanding 3.8 billion euros in emergency investment in public hospitals — twice the amount set aside in the draft 2020 budget currently before parliament.

On Thursday, the upper house of the parliament, the right-wing dominated Senate, threw out the draft social security bill at its first reading in protest over what some senators described as Macron’s “disdain” for the workers in the sector.

Economy Minister Bruno Le Maire has warned that hiking health spending will mean having to make cuts elsewhere.

France’s budget deficit is expected to breach an EU limit of 3.0 percent of GDP this year, reaching 3.1 percent.

I am amazed at how easy the voters can be swayed and convinced that everything will be free if “you vote for me!” I say be very wary of what you all wish for because you and the rest of may have to live with the results, as we are all sold a bill of false goods. Be very careful voters!!

 

The 3 Reasons the U.S. Health-Care System Is the Worst, the AMA and more on Medicare for All and an angry teenager scolding the United Nations!

healthcare158[788]The head of the Commonwealth Fund, which compares the health systems of developed nations, pinpoints why America’s is so expensive and inefficient.

Olga Khazan reviewed the three reasons that the U.S. Health Care system is the worst. A woman has her blood pressure taken at the Care Harbor four-day free clinic, which offers free medical, dental, and vision care to around 4,000 uninsured people in Los Angeles.

According to the Commonwealth Fund, which regularly ranks the health systems of a handful of developed countries, the best countries for health care are the United Kingdom, the Netherlands, and Australia.

The lowest performer? The United States, even though it spends the most. “And this is consistent across 20 years,” said the Commonwealth Fund’s president, David Blumenthal, on Friday at the Spotlight Health Festival, which is co-hosted by the Aspen Institute and The Atlantic.

Blumenthal laid out three reasons why the United States lags behind its peers so consistently. It all comes down to:

  1. A lack of insurance coverage. A common talking point on the right is that health care and health insurance are not equivalent—that getting more people insured will not necessarily improve health outcomes. But according to Blumenthal: “The literature on insurance demonstrates that having insurance lowers mortality. It is equivalent to a public-health intervention.” More than 27 million people in the United States were uninsured in 2016—nearly a tenth of the population—often because they can’t afford coverage, live in a state that didn’t expand Medicaid or are undocumented. Those aren’t problems that people in places like the United Kingdom have to worry about.
  2. Administrative inefficiency.“We waste a lot of money on administration,” Blumenthal said. According to the Commonwealth Fund’s most recent report, in the United States, “doctors and patients [report] wasting time on billing and insurance claims. Other countries that rely on private health insurers, like the Netherlands, minimize some of these problems by standardizing basic benefit packages, which can both reduce the administrative burden for providers and ensure that patients face predictable copayments.” In other words, while insurance coverage, in general, is great, it’s not ideal that different insurance plans cover different treatments and procedures, forcing doctors to spend precious hours coordinating with insurance companies to provide care.
  3. Underperforming primary care.“We have a very disorganized, fragmented, inefficient and under-resourced primary care system,” Blumenthal added. As I wrote at the time, in 2014 the Commonwealth Fund found that “many primary-care physicians struggle to receive relevant clinical information from specialists and hospitals, complicating efforts to provide seamless, coordinated care.” On top of a lack of investment in primary care, “we don’t invest in social services, which are important determinants of health” Blumenthal said. Things like home visiting, better housing, and subsidized healthy food could extend the work of doctors and do a lot to improve chronic disease outcomes.

Together, these reasons help explain why U.S. life expectancy has, for the first time since the 1960s, recently gone down for two years in a row.

Two Experts Debunk Four Big Health Care Fallacies

Yuval Rosenbery of The Fiscal Times reported that in a The New York Times op-ed, Ezekiel Emanuel, a health policy expert, and a former adviser in the Obama administration, and Victor Fuchs, a Stanford health economist, look to clarify what they call “four fundamental health care fallacies”:

  1. Employers pay for workers’ health insurance.“Since 1999, health insurance premiums have increased 147 percent and employer profits have increased 148 percent,” they write. “But at that time, average wages have hardly moved, increasing just 7 percent. Clearly, workers’ wages, not corporate profits, have been paying for higher health insurance premiums.”
  2. Medicare for All is unaffordable. As I have mentioned in previous posts Medicare for All is too expensive. “True, Medicare for All would increase federal health care spending. But that is not the same as increasing total health care spending, which was over $3.5 trillion last year,” Emanuel and Fuchs said. “We have our doubts about Medicare for All. But unaffordability is nota reason to oppose it. … When you hear a health care price tag in the trillions, know that the existing system has already brought us there.”
  3. 3. Insurance company profits drive health care costs.“The fact is, we could eliminate those profits and it would hardly matter to the cost of health care. You would not notice it in your premiums. … True, $22.1 billion is a lot of money — but it is 0.6 percent of health spending. And last year alone health care costs increased over $130 billion — six times insurance company profits. Health care spending would not be significantly cheaper if all insurance companies’ profits were zero.”

4. Price transparency can bring down health care costs.“Over 80 percent of the cost of medical care is paid by private and public insurance. Patients have little incentive to seek out the cheapest provider. When pricing websites exist, few patients use them. … Furthermore, price considerations are useful for choosing only about 40 percent of procedures — routine services like colonoscopies, M.R.I. scans and laboratory tests. Most of the expensive services — think heart catheterizations, cancer chemotherapy, and organ transplants — are not the kind of thing you decide based on price.”

AMA President: It’s Still ‘No’ to Single Payer

Shannon Firth, Washington correspondent of the MedPage, noted that Dr. Barbara McAneny still doesn’t believe in the Single Payer system for health care but she and the AMA applauds a ban on pharmacy gag clause and APMs.A single-payer healthcare system in the U.S. would break her practice, said the president of the American Medical Association (AMA), who argued that Medicare and other government programs as currently structured simply don’t pay enough.

“We need a payment system that the country can afford,” said Barbara McAneny, MD, AMA president, and a practicing oncologist/hematologist in New Mexico.

McAneny pointed out that in the portion of her practice that serves the Navajo Nation, 70% of payments are from governmental payers, and “I have struggled for the last 10 years to keep that practice breaking even.”

Medicare payments are designed to cover about 80% of the cost of doing business, McAneny said. If all her commercial patients were to pay Medicare rates, there would be no other place from which to shift costs, she explained. “My doors would be closed. I would no longer be able to make payroll.”

Moving to a single-payer healthcare system won’t fix what’s broken, she said during a meeting with reporters Tuesday to discuss a variety of issues, including drug pricing, value-based payments, and turf battles.

While she said she strongly supported Medicaid expansion in New Mexico, McAneny expressed skepticism about the possibility of a Medicaid “buy-in,” which would allow people to purchase Medicaid-based public insurance plans.

She pointed out that only about a quarter of the population in New Mexico has commercial insurance, and “Medicaid and Medicare do not cover the expenses of providing care.” With fewer patients to cost-shift from, independent practices and small rural practices “would not be able to keep the lights on.”

AMA policy supports patients buying “individually selected health insurance,” subsidized with advanced or refundable tax credits that correspond inversely to income, McAneny said.

McAneny also discussed the Trump administration’s recent efforts to curb drug prices and the challenge of transitioning from fee-for-service to value-based care.

She called the latest bill banning pharmacy gag clauses”really important. When patients discover that they can pay less than the co-pay to buy the drug, they need to know that because patients are going broke out there, trying to buy their drugs.”

Gag clauses prevent pharmacists from telling customers whether paying for their prescription might be cheaper if they paid the cash price instead of using their insurance.

Earlier this week, the Department of Health and Human Services (HHS) announced that drug makers would need to include the list price of any drug paid for by Medicare or Medicaid in their TV advertisements. In an AMA press release, McAneny stated that the HHS move seemed like “a step in the right direction,” although the AMA is opposed to direct-to-consumer advertising in general.

McAneny said greater transparency was a “first step” toward addressing such high drug costs.

“There’s so much the public doesn’t understand about the market, including the true costs of research and development and the role of middlemen, like pharmacy benefit managers and insurance mark-ups, she said.

“Before we suggest any sort of treatment, we think it’ s a good idea to make the diagnosis, and that means really understanding that entire process, which means they’re going to have to pull back the curtain and let us, the healthcare community, really take a look at that and figure out what adds value and what doesn’t,” she said.

McAneny was less supportive of changing the way Part B drugs are bought and paid for. In May, HHS Secretary Alex Azar suggested moving some Part B drugs administered in a physician’s office into the Part D program, in an attempt to negotiate more competitive prices.

“People cannot afford a 20% co-insurance on a drug that costs $5,000 a month,” she said.

In terms of value-based payment, McAneny said she’s excited about the work the physician-focused Payment Model Technical Advisory Committee (PTAC) is doing. Doctors are well-positioned to help design alternative payment models, she noted.

“We see all the time places where healthcare dollars get wasted, and patients don’t get what they want,” she said, so allowing doctors to come up with new methods of care delivery, which incorporate things they’ve always wanted to do for their patients, has “tremendous potential.”

McAneny said she hopes Azar will test as many pilots projects as possible, and see what works, but not penalize groups who fail. “If you’re trying something innovative … sometimes you’re going to be wrong, and those people shouldn’t have to lose their practices… they should be allowed to fail quickly, and move on to something else,” she stated.

McAneny said she will present an alternative model to the PTAC in December.

Her proposed model integrates clinical data from a group of oncology practices with claims data “to set accurate and realistic targets that reflect what oncologists can actually control, rather than the total cost of care,” McAneny told MedPage Today in an email.

“We will measure quality by compliance with physician derived pathways that reflect the best care in the medical literature… [and] improve patient satisfaction by getting patients the care they need, when they need it, at a practice site that knows them and understands what they are going through.”

The model saves money by reducing hospitalizations and “aggressively managing or preventing” adverse effects.

Another challenge in healthcare is the scope of practice, with some physicians expressing concern that nurse practitioners and physicians assistants (PAs) are encroaching on their territory.

McAneny acknowledged that concern, noting that primary care physicians must be “incredible diagnosticians,” she said. “They need to know when a sore throat is a sore throat and when it’s really cancer.”

“In my own practice, where we have everyone working to the top of their license, I value my nurse practitioners and I value my PAs immensely, but I don’t expect them to be oncologists, and I don’t really expect them to be primary care doctors,” she added.

“Everybody has a place in healthcare,” McAneny stressed, “but I do not feel that a nurse practitioner who has gone to nursing school and done one extra year… and has not practiced in that post-doc process, has the same level of expertise to be that diagnostician.”

A new report from the AMA’s Council on Medical Service, “Covering the Uninsured Under the AMA Proposal for Reform,” also reaffirms that stance, calling for improvements in the Affordable Care Act — increasing subsidies, and expanding eligibility and the size of cost-sharing reductions — rather than “threatening the stability of coverage for those individuals who are generally satisfied with their coverage.”

There will be resolutions calling on the AMA to support federal laws that would not eliminate the private health insurance market and to collect data comparing Medicare reimbursement to the cost of delivering services.

ACTION ALERT: The A.M.A. must support Medicare for All!

But we find out that the President of the AMA may not reflect the total view of the national organization of physicians. On June 8, 2019, at 1:30 PM CST, students, physicians, nurses, allied health care workers, and activists from around the country will unite in Chicago to protest the annual meeting of the American Medical Association (A.M.A.).

Representatives of a rapidly growing coalition of Medicare for All supporters, including National Nurses United, Students for a National Health Program, Physicians for a National Health Program, People’s Action, Public Citizen, The Center for Popular Democracy, The Jane Addams Senior Caucus, various labor unions, teachers, activists, and more, will be taking a stand AGAINST corporate greed, misleading advertising, and the profit motive in health care.

And for a system that guarantees quality health care and choice of provider for all Americans, regardless of income.

The action recalls similar campaigns waged throughout the 1960s in which members of the African-American-led National Medical Association, the Medical Committee for Human Rights and the Poor People’s Campaign picketed the A.M.A.’s annual meetings because of its refusal to take a stand against segregated medical services and for allowing local medical societies to discriminate against physicians and patients of color.

When we join together, we can send a powerful message to the A.M.A. and corporate medicine that we won’t stop until every American is guaranteed quality medical care without going into debt or bankruptcy.

Everybody in, nobody out!

Also, I need to comment on that sixteen-year-old who was invited to a United Nation session where she berated the countries all about not taking up the environmental banner and cleaning up the world. She is a spoiled “child” who knows nothing about economics as well as politics and what it would take to move ahead with cleaning up the environment. Where are all the countries to get the trillions of dollars or Euros, etc. to make the changes that she demands?

Greta Thunberg excoriated world leaders for their “betrayal” of young people through their inertia over the climate crisis at a United Nations summit that failed to deliver ambitious new commitments to address dangerous global heating.

If world leaders choose to fail us, my generation will never forgive them

In a stinging speech on Monday, the teenage Swedish climate activist told governments that “you are still not mature enough to tell it like it is. You are failing us. But the young people are starting to understand your betrayal.”

But Thunberg predicted the summit would not deliver any new plans in line with the radical cuts in greenhouse gas emissions that scientists say are needed to avoid catastrophic climate breakdown.

“You have stolen my dreams and my childhood with your empty words,” a visibly emotional Thunberg said.

“The eyes of all future generations are upon you. And if you choose to fail us I say we will never forgive you. We will not let you get away with this. Right here, right now is where we draw the line.”

Suggestion for Miss Thunberg, get an education! Go to the university and get the real facts. Get an education so you can understand the system and the only ways that we can truly deal with our environmental issues! Instead, you sail around the world! Must be nice instead of working or going to school!

And back to health care next week.