Single-payer is only answer to health reform

2/7/2010

I care for low-income patients in an inner-city Toledo clinic. My work there convinces me that our country never will have high-quality, accessible, affordable health care as long as private insurers make the rules. The best policy solution would be a single-payer system, such as an improved and expanded "Medicare for All."

Recently, I saw a young diabetic woman whose kidneys are failing. Arbitrarily assigned by Medicaid to a health-maintenance organization, she learned that the doctors who have cared for her for 15 years cannot see her anymore. She also faces losing her place on the local list for kidney transplants.

I called the number on her insurance card to protest. I reached a recording that told me I was the 35th caller in line. Two days and three calls later, I finally reached a nurse who told me that my patient may need to go to Cleveland Clinic for her care.

Later that day, I persuaded an insurer to cover two expensive medicines that are not on its formulary for a patient who needs them. My staff and I had contacted health insurance bureaucrats seven times over two weeks. They rejected the request six times before they let us win this game of "Mother, may I?"

Such waste of time and effort occurs daily at our clinic. Yet our frustrations pale in comparison with those of many patients of modest means who do not get health insurance at work and cannot afford the outrageous premiums for individual or family coverage. For them, bankruptcy is one big medical bill away.

The debate in Congress over health-care "reform" has offered the nauseating spectacle of blatant vote-buying, deal-cutting, and lawmakers' catering to private special interests.

The current legislation would maintain or increase profits for HMOs, insurers, pill and bedpan makers, and the Wall Street bankers and stockholders who finance them - what I call the health-care mafia. The legislation would not control costs, cover all Americans, or adequately address serious problems with quality of care.

Rather, it would extend our present dysfunctional system to 30 million more Americans, while 20 million would remain uninsured. The newly insured, like other Americans, would find that their mandatory premiums cost too much and cover too little. Meanwhile, the crushing administrative nightmare of paperwork, bureaucracy, and insurers' profit-taking would only expand.

The legislation would do some good things: expand Medicaid coverage, give more money to community clinics, and curtail some of the worst practices of private insurers. But the problems with its main provisions - especially the individual mandate, which would reinforce private insurers' stranglehold on care -- outweigh these benefits.

If you dislike your current employer-sponsored coverage, tough luck. You'll have to keep it. If you're uninsured, you'll be forced by federal law to pay private insurers' inflated premiums, often for coverage so skimpy that serious illness still could bankrupt you. Refuse, and you'll pay a fine.

Insurance companies would get $476 billion in new public funds, ostensibly to help people buy their defective products. These handouts to for-profit insurers would strengthen their power and make future reform even harder.

In his State of the Union address last month, President Obama said: "If anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know." But the President already knows what that better approach is.

As a candidate, Mr. Obama said that if we were starting from scratch, a single-payer, health-care system would make sense. Indeed it would: Multiple studies confirm that such a system could cover everyone for what we spend now, and allow complete choice of doctors and hospitals.

There would be few or no co-payments because we would save hundreds of billions each year from the administrative efficiencies of a single, national, comprehensive health insurance program. An improved program of Medicare for all would free us from the tyranny of the health-care profiteers.

Americans need to let Congress know that the current health care legislation is unacceptable. That doesn't mean joining the "just say no" chorus of Republican obstructionists.

Instead, lawmakers should immediately take up the single-payer approach. They need to make the improvement of our nation's health a greater priority than the enhancement of private, profit-seeking interests.

Johnathon Ross, an associate clinical professor of internal medicine at the University of Toledo, is past president of Physicians for a National Health Program.