Will America Enact National Health Insurance in 2009?
Posted 07/28/2008
Quentin Young, MD
The 43rd anniversary of the passage of Medicare is an appropriate time to examine just why this single payer government-run national health insurance has not been expanded to everybody. Despite its deficiencies, Medicare serves the elderly remarkably better than the confusion of for-profit private insurance schemes that have steadily disserved the American patient.
Of course, the failure to have fundamental healthcare reform has been the result of the awesome power of the industry, which profits from the present arrangements -- big pharma, for-profit hospitals, and health insurance giants. In addition to the increasingly frustrated "beneficiaries," America's physicians have suffered under the health system organized to assure returns to investors.
Doctors have, at long last, realized that there is something worse than government: corporate-run healthcare.
Heretofore the prevailing political and health policy wisdom has been that expansion of Medicare to everybody was simply politically unfeasible. Billions of dollars are ready to be spent resisting health reform; recall "Harry and Louise" in 1993.
Recent months have seen a huge shift in public positions on single payer healthcare. In a recent AP poll, 65% of the public agreed that the United States should "adopt a universal health insurance program...like Medicare that is run by the government and financed by taxpayers." In January, the American College of Physicians endorsed single payer for the first time as a pathway to universal coverage. In April, the Annals of Internal Medicine published a national survey of physicians indicating that 59% of doctors support the adoption of legislation to create national health insurance.[1]
Significantly, on June 23, the US Conference of Mayors, representing cities of over 30,000 people, unanimously endorsed legislation for Medicare for All, HR 676.
Could 2009 turn out to be the year this nation takes the leap to enact a national health system?
That's my opinion. I'm Dr. Quentin Young, National Coordinator, Physicians for a National Health Program.
Readers are encouraged to respond to the author at info@pnhp.org or to George Lundberg, MD, Editor in Chief of The Medscape Journal of Medicine, for the editor's eyes only or for possible publication as an actual Letter in the Medscape Journal via email: glundberg@medscape.net
However, many (though not all) of the doctors who have commented on this editorial disagree with Dr. Young. We have a long way to go.
A family practitioner:
Government-run and financed health care will be a huge shell game that places huge power in the hands of an ever-growing and inefficient government. Can someone please demonstrate where our Constitution provides for such a role for government? I was the administrator of a Medicare Home HEalth agency. Nearly 75% of my costs had to do with government-required processes that provided no enhancement of care for the patient. In fact, I was once cited for providing an extra visit to a patient (in the capitated payment system this cost my agency money, not the government).
Most of the money to fund a national health plan will go into more wasteful administrative rules and another huge agency of staff that add nothing to the benefit of the recipient - but which WILL provide more government jobs and therefore more government power.
If you think healthcare is expensive now, just wait until it's free.
A surgeon:
The speaker/author has not viewed the terrible Veterans Administration Health Care. Government medicine has been has been here a long time, and shows how bad such a system can be.
An oral surgeon:
Our practice reluctantly opted out of participation in Medicare. We're oral and maxillofacial surgeons so this was a realistic option. We accept Medicaid as well as most insurance. Why opt out of Medicare? They are the most obnoxious of the bunch to deal with. They represented a small enough part of our practice to make this practical. Submit justification as to why this particular radiograph was needed. Provide justification as to why this particular handicapped patient needed general anesthesia. If these people represented a large enough part of the practice that we couldn't opt out, I'd consider selling used cars.
This same commenter adds:
Most of the poorest Americans are poorest for a reason. Let's reduce those who have lifted themselves up by hard work and responsible behaviour to the level of the lowest. In the short term, young physicians who have invested everything into getting that MD will provide a lot of talent to the system. In the long term, talented young people will not look towards a career in medicine. If you can depend on talented physicians from India forever, more power to you, otherwise, you're sending a capable medical force to the trash heap.
An emergency physician:
With all due respect, who would recommend that our entire healthcare system go to Medicare? I can understand those that perhaps do not deal with Medicare directly, but I assume Dr. Q. Young has dealt with it directly. Medicare is a huge government program that is rapidly going broke; new "quality measures" are little more than roadblocks to allow the government to not pay providers-there is little to do with quality and much to do with denial of reimbursement in these measures.
Further, I would think that Dr. Young would be smart enough to realize that once government controls healthcare, there is no going back. The program will be with us forever once it is started. Can anyone truly imagine the possibility of ridding ourselves of Medicare or Medicaid programs, even if this were to be desired? No, these programs will never go away, even if we as citizens decided that we no longer want them. Too many people become dependent on them. Further, ever try to negotiate with the government? What are people told if there is a questions about taxes? Pay and figure out the problem later. Once government takes control, there are no negotiations. The government tells what providers will be paid. Period. If you don't believe me, try negotiating for better reimbursement from your Medicare provider, or even better from medicaid. Reimbursement for Illinois Medicaid is a joke; there is no negotiations-doctors in Illinois do not cover their costs caring for Medicaid patients. This has lead to patients not being able to find doctors, overcrowded EDs, patients not getting care until their condition is serious. Expect more of the same in Medicare in the future.
Does that mean that there are not problems with the current system? Certainly not. However, one must look with a critical eye at the alternative. Change for change sake without concern for the result is irresponsible. Some change is for good, some change will not be good. It is imperative that we investigate the consequences of any changes fully.
I do worry about access to care. Especially for seniors. However, government run healthcare, like everything else government controls, would be a disaster. To close one's eyes to this reality and take on the Pollyanna view of Universal Healthcare is at best naive, and at worst ignorant.
An opthamologist:
Using Medicare as a model for universal health care is unwise. A) When the entire population has to be covered, there aren't enough tax dollars in the system to finance reimbursement rates at current levels; how many docs will use that as a good reason to quit or decline to see "government patients"? B)Using Great Britain or other countries with socialized medical care as shining examples of proper health care delivery is really pathetic: what none of these systems want publicized is that the primary cost containment mechanism is to triage their most elderly or sickest patients to the morgue, which is the de facto result of limited availability of the most expensive services. C)Resolving the issue of the uninsured or so called non-insurable is clearly a high priority item for moral and ethical reasons, if not the pragmatic problem of reducing the need for patients to dump themselves on the ER so they have to be taken care of under Title 22. Universal health care insurance as a solution to this problem is like using dynamite to dig a hole in the yard to plant a tree. Taking on 40 or 50 million under-insured is bound to create a bigger boondoggle than anything ever witnessed since the fall of Rome. A better method is to simply allow people to be in large risk pools, set premiums based on income or some other reasonable measure, and require insurance carriers to accept participants from any geographic region and with any pre-existing condition. Insurers could be required to set aside a portion of premiums to set up a nationwide fund for extraordinary expenses, so no one person or family is hit with huge bills. Why give government a mandate to tax more and have more power? The same government that can give you everything you want can also take away everything you have. D)Under the best of circumstances, there may always be some degre of compromise between the health care needs of the population and the availability of resources. Universal health care biases the algorithm in favor of the lowest common denominator: the least amount of care for the largest number of people. Why is that acceptable? The goal should be the best care possible for the people who need it most, with all people given access according to their need. There is no universal health care system on earth that does that well as evidenced by the many docs and patients who opt out of it any way they can. E) Free markets work best when there are incentives to provide a product or service, not disincentives. Therefore, "incentivize" patients, doctors, hospitals, and the health care industry. The government can no better be the operator of a universal health care system than it can efficiently run a factory or create wealth. It can be a regulator, even though it may not do that very well. Just look at the trashed housing market and ask, "Where was the regulator of Fannie and Freddie?'; Where was the SEC and the FED?" The current system has it's flaws, but at least the government doesn't have the power to dictate who lives and who doesn't. If politicians get caught up in that power, be prepared to find out what mean nasty fascists they can be, especially if they decide health care "just costs too much." Those who would say our current free market approach is also flawed and failing are only partially correct. We do not have a free market system in health care. Truly doing so would improve things far more imaginatively than even the most remarkable exertions of the government.
But there is hope! Here's a women's health provider:
It may surprise you to hear that some Americans, middle class and adequately covered through insurance provided by employers, still favor a system that covers all Americans and would willingly accept a decrease in efficiancy of service to know that millions do not go uninsured as is now the case. I suspect that the elimination of the paperwork and bureaucracy of the current system would make way for improvements in direct care, and even if it didn't, some of us still have a "one for all" attitude, perhaps unlike the physicians you know who may prefer a system that allows for them to profit hugely from the health care industry, no matter who dies for lack of care.
She adds:
Probably the reason that doctors opt out of accepting Medicare patients is that they don't make enough money. Maybe if they can learn to go for the Honda instead of the Porsche, they can be part of the solution.
And then there are the laypeople. This one broke my heart and made me angry:
I have pre-existing conditions of cancer, epilepsy and depression. I am not considered disabled enough to collect disability and have had trouble all my life with private insurance programs. Currently I am on [state plan], [state]'s Medicaid system. I will lose [it] if I make more than $851 per month.
[state plan], in its infinite wisdom, decided to forgo chemotherapy in my case because the type of cancer I have is rare (Pseudomyxoma Peritonei) and there are only two IPHC treatment centers in the United States. If I had had the chemo, I would have about a 60 % chance of living to 5 years. Without chemo, my chances of survival to five years are 5%.
If we had National Health Insurance, I would be covered if I had to travel to another state for chemo.
Amazingly, I have been cancer free for three years. However, [state policy] policy has forced my doctor to see me every three months and run frequent tests such as CT scans and Colonoscopy to make sure I am indeed cancer free. Also, because of the income limitations imposed on me, I live in a shelter. The City of [my city] pays $130 per night for me to stay on a cot in a shelter. I have been there for a year. For those interested in math, that's $47,500 per year just for a cot.
National Health Care would actually drop the cost of treatment! It would also provide healthcare to those who are currently ignored or criminalized for their diseases. That includes persons with epilepsy, in wheelchairs, with psychiatric conditions and drug addicted.
I could return to my full potential. I have a B.S. in Biology and a dual Masters in Business Administration and Health Administration. I would be paying enough in taxes to offset the cost of my care.
In short, we have a lot of education to do yet. The meme of "socialized medicine" is still held forth as a scare tactic. If this is what physicians are saying to each other, we need to show them, somehow, how universal single-payer health care will benefit them; these responders almost universally seem to think that it will harm them and bring no benefit at all.
Update: I received this email from the publisher of Medscape and wanted to include it here to correct misinformation I inadvertently presented.
Hello,
Medscape is not a "weekly"; it is a platform for a huge amount of information, from a wide variety of sources, changing daily in multiple ways. The 40 or so MedPulses are mostly distributed weekly.
Although intended for physicians, pharmacists, nurses, medical students, and other health care professionals, membership is open to anyone, free of charge.
Register as you like......it will not change what you get...go anywhere on Medscape. Enjoy.
George lundberg MD, EIC. |
