It's Time to Pull the Plug on the US Health Care System

Valley News
Letter to the Editor
May 08

With the Presidential election rapidly approaching there is a lot of interest being generated around health care finance reform. It is certainly on the minds of many Vermonters. This past March, Con Hogan, former Health and Human Services secretary in Vermont; Dr. Deb Richter of Physicians for a National Health Program and state representatives Topper Faun and Hilde Ojibway solicited public testimony through an interactive TV hook-up to areas throughout Vermont. Numerous individuals testified: patients, retiree’s, elected officials, and health care providers.

All agreed: The current health care system is on life support and the plug needs to be pulled!

Retirees testified that promises made to them concerning health care benefits are not being honored. Select board and school board members said they were having a difficult time paying for the medical coverage of their employees; which made for difficult choices, maintain the current medical benefits and cut jobs, or reduce benefits and programs.

I related my story: I am a gynecologist at the Dartmouth Hitchcock Medical Center; I have been a volunteer provider at the Good Neighbor Health Clinic (GNHC) since it opened in 1991 and served on its Board for many of those years.

When we open GNHC, President Bill Clinton and Hillary Clinton were proposing their universal health plan. Then Governor Howard Dean, who cut the ribbon to open the clinic vowed to work to close it, assuming it would not be necessary in a few years. The clinic was to be a temporary fix to serve the under and uninsured of the Upper Valley.

That was more than 15 years ago, and during that time we also have the Red
Logan Dental Clinic. The clinics have more than 3000 patient visits a year,
significantly more than when we opened. We see people in hopes of preventing bad outcomes from chronic diseases. One women who is now 65 started coming to GNHC when she was 57. She was referred to the medical clinic because she was found to have hypertension, diabetes and elevated cholesterol levels. Left untreated, she could have had a stroke, a heart attack, and problems with diabetes which could have affected her sight, kidneys and ability to sense pain in her hands and feet. Today her blood pressure, cholesterol and blood sugars are all normal.

But others are not so fortunate. A 48 year female hadn’t had a physical in years because she had no insurance; she was being seen because she needed a physical exam for a new job. She was found to have diabetes; she suffered damage to her eyes because the condition had gone undiagnosed for years. A self employed carpenter, hadn’t seen a provider in 30 years. He was having problems swallowing and found to have cancer of the esophagus.

No one needs a degree in economics to realize there’s a problem. I recall reading a commentary published last year in the Washington Post by Ezekiel Emanuel MD, PhD. of the National Institutes of Health and Victor Fuchs PhD. Stanford University. “Band-Aids Are Not Enough”. It’s worth repeating here some of the main points in that article.

“Get business out of health care”. Absolutely! The role of third party payers needs to be significantly reduced. Business should not be paying premiums; they should be paying higher wages.

“Guarantee every American an essential benefits package” like the package modeled on what members of Congress get. It is amazing to me that some members of congress who raise the specter of socialized medicine whenever a publicly funded system is mentioned are not willing to give up their medical plan which is government financed.

“The universal basic package should be financed by a dedicated tax that everyone pays such as a value added tax”. Or, I would add, an income tax, which could be offset by employers giving employees an increase in their salary to compensate for their tax increase. The system would work effectively only if there is a single risk pool with everyone contributing.

“Administered the program through an independent National Health Board and regional boards modeled after the Federal Reserve Board” This would ensure the delivery of quality health care which wherever possible would be evidenced based. This would be assured with the creation of the next recommendation.

“Establish an independent Institute for Technological and Outcomes Assessment to systematically evaluate new technologies and quantifies their health care benefits in relation to their costs”

Can we reduce costs? Dr. Jack Wennberg who founded the Center for the Evaluative Sciences, now The Dartmouth Institute, has exposed an incredible amount of waste in the U.S. health care system, this is in addition to the enormous administrative costs we are presently confronted with, not to mention the outrageous salaries some insurance CEO receive nor the necessary profits to shareholders. According to an article in Dartmouth Medicine magazine last spring, Wennberg estimated that “up to one-third of the over $2 trillion that we now spend annually on health care is squandered on unnecessary hospitalizations: unneeded and often redundant tests; unproven treatments; and overpriced cutting edge drugs; devices no better than less expensive products they replaced; and end-of-life care that brings neither comfort or cure. As The Care of Patients with Severe Chronic Illnesses pointed out, if waste were eliminated, the Medicare system could reduce spending by at least 30% while improving the medical care of the most severely ill Americans”.

It is not a question of whether or not we can afford a publically funded health care system. We can; we just lack the political will to enact one.

Paul D. Manganiello MD
Professor of Obstetrics and Gynecology
Dartmouth Hitchcock Medical Center