Health care should be a priority

Keene Sentinel (NH)
Letter to the Editor
January 2, 2009

The time has come, for many reasons, for a single payer national health care system. The reasons run the gamut from moral to economic to personal. Any one reason can justify the switch to a single payer system as an improvement over what our current one has become, but the convergence of so many reasons make it essential that citizens let it be known that implementing a single payer system should be an important first step, with many positive ramifications beyond health care itself, for our new Administration.

As a family physician, I can personally attest to the large number of community members who delay needed medical care and who go without necessary medications—only to suffer poor health and, on occasion, premature death. It is not uncommon for our neighbors to become impoverished simply trying to pay for basic medical care. And this is in our area, where there is a service-oriented medical center and broad based support within the community. Other areas and regions have a much worse situation, including people being shunted away or forced to sell their homes to pay for medical care. This is unconscionable in a society such as ours. 47 million people in the U.S. have no health insurance, and, with the growing recession, that number will certainly increase.

Incredibly, the money spent per person on health care in the U.S. is twice what it is in other industrialized countries, even though those countries provide health coverage for all residents. How can this be? Contrary to popular belief, this is not because our health care is better than it is in those countries. Instead, the reason is that a huge sum (an estimated $300 billion dollars a year) is spent administering our fragmented, private-insurance-run system, where insurance companies and their handsomely paid C.E.O.’s have every incentive to enroll healthy people and exclude people who are actually going to need expensive medical care. This is a perfect example of privatizing profits, but insisting on socializing costs in the form of Medicare, Medicaid, and hospitals absorbing unpaid medical bills. Private companies which take risks in a capitalist system are entitled to bonanzas when they make correct decisions. Health care insurance companies insist on their bonanzas but they have also come to insist that taxpayers take on their risks. Since we taxpayers are stuck with the big bills anyway, we should be controlling the whole situation. The fact of the matter is that we have had “socialized medicine” in this country for a long time, but only for the people really likely to use expensive care. This socialized system is called Medicare. The insurance companies insure and take premiums from the “safe bets”—younger working people—and make huge profits. That money should be going toward actual health care.

I suspect many of you have dealt with the frustration of trying to get a timely appointment with your own doctor. You may not be aware that the bureaucratic hurdles involved with multiple insurance companies and multiple prescription coverage plans—each with a different formulary (changing each year, no less) and a different set of rules and procedures, greatly stymies your doctor’s ability to see as many patients in a day as he or she used to. Pediatricians, general internists, obstetrician/gynecologists, and family physicians are particularly beset by these ever increasing time consuming hassles, and a growing shortage of these essential primary care physicians is going to make access to health care even worse. It is no wonder that a large and growing number of physicians in this country now support a single payer health system.

Long established American corporations such as the big three automobile manufacturers are failing in part because of having to supply health insurance for their aging and retired workforces—an expense their competitors in other countries do not have. I am not impressed with some of the decisions “the big three” have made in recent years and have reservations about our government directly bailing them out. However, helping all American corporations compete by replacing our current employer-based private insurance-run system with a single payer national health system would help “the big three” without rewarding past mistakes and without showing favoritism to one industry. National health care would also help our economy by enabling people to start new jobs or to start new businesses without losing their health insurance.

I can hear the objections: 1) There will be a big bureaucracy. Yes, a single payer health plan will create a big bureaucracy. Any system affecting all Americans is big. The insurance companies are also all big bureaucracies, as anyone who has tried to call his or her insurance carrier knows, and there are many of them. Many bureaucracies—which all let the government take their risks—is the least efficient “system” you could devise. 2) Government control: remember Harry and Louise, supposedly concerned that “government” would be in their medicine cabinet? Well, not only are the insurance companies in their medicine cabinet, they are telling this couple what medicines they can and can’t take. More and more, someone with no medical training whose job it is to say “no” is telling your doctor what you should or cannot take. 3) “Socialized medicine!” Funny, but my patients with Medicare do not complain about having socialized medical care. They are too grateful finally to have gotten to an age where they don’t have to worry about paying for all their own medical care directly, or having to pay an ever-increasing chunk of their private insurance. They are glad they no longer have to worry about what will happen if they get laid off at age 50 or 55, or if their employer drops health insurance coverage. 4) Expense. Let’s face it, health care in these days of innovative technology is more expensive than when everything a doctor had to offer fit into his black bag. The question is one of keeping down costs. And we currently spend hundreds of billions of dollars each year administering—not actually delivering, but administering—our jerry-rigged, wasteful, bureaucratic, remarkably incomprehensive “system.” Incremental changes to our current system by expanding private insurance coverage to people without insurance will only cause more waste, as insurance companies do their usual jockeying to attract the healthy and exclude/alienate/deny the sick, privatizing the profits and socializing the costs only.

We can and should do better than this. For all these reasons, I urge (and hope that others will urge) Congressman Hodes (phone 223-9814, 358-1023, and/or 202-225-5206) to co-sponsor HR 676, the U.S. National Health Insurance Act. This plan, which would run much like Medicare, would cover all Americans and allow them free choice of doctors and hospitals. It would be paid for primarily with an employer/employee payroll tax that would cost less than what employers and employees who already have private, wasteful insurance plans currently pay.

The time to act is now.

Very truly yours,

John N. Walter, Jr. M.D., M.P.H.