Faceoff: Reforming a Sick System

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WASHINGTON, Sept. 8 (UPI) — In August a group of almost 8,000 doctors — including two former U.S. surgeons general and the former editor in chief of the New England Journal of Medicine — dropped a bombshell into the healthcare debate. Under the auspices of the group Physicians for a National Health Program, they signed on to an article published in the Journal of the American Medical Association calling for the establishment of some form of government-funded, single-payer national health insurance.

They say their proposal, which is based on expanding the existing U.S. Medicare system, would cut annual private-industry costs by more than $200 billion and cover all Americans including those currently without health insurance.


Opponents of the single-payer approach say it would create at least as many problems as it may solve. They hold out the specter of long waits for health services, government interference in medical care and another burgeoning federal bureaucracy as arguments against the idea.
Question: Is a federal single-payer plan a viable healthcare reform? UPI’s Peter Roff and Jillian Jonas, a freelance journalist working in New York, face off from opposite sides of this critical question.

Jonas: We’ve got an emergency here!
As a freelancer, I have experienced almost every available form of coverage: full private coverage, which I was forced to drop because the premiums exponentially increased; “lower” cost semi-coverage; even lower costing catastrophic coverage — for an emergency only, where the hospital but not the doctors would be covered; and no coverage at all.

Full coverage is best.

It’s difficult to comprehend that in the world’s wealthiest nation, medical coverage is considered a benefit, primarily dependent upon where an individual works.

According to the American College of Physicians, the uninsured are more likely to delay seeking treatment, less likely to use preventative services and up to four times as likely to require both avoidable hospitalizations and emergency hospital care.

Guess who foots the bill for that care?

The Physicians for a National Health Program plan offers enormous advantages, while refocusing a debate dominated by profit. They say it’s more efficient, less expensive and most importantly, every citizen would be eligible.

“In this market-driven system, insurers and providers compete not so much by increasing quality or lowering costs, but by avoiding unprofitable patients and shifting costs back to patients or other payers … This creates the paradox of a healthcare system based on avoiding the sick,” the group said.

Overhead, medical malpractice premiums and the cost of prescription drug prices would also decrease, in part because the federal government, as a monopoly purchaser, could effectively set prices.

Despite the rhetoric of the medical, insurance and pharmaceutical lobbies, this proposal is not suggesting a national health service, as is the system in England. We’re not talking about socialized medicine.

PHNP maintains the system and any tax increase, “would be fully offset by reductions in employer healthcare costs and premiums and out-of-pocket spending,” and point to the support of the three major auto manufacturers who have all endorsed Canada’s health system “from a business and financial standpoint.”

As in Canada and Denmark, the government would not employ doctors, but rather they would remain in private practice, billing the government for previously negotiated rates.

There could be longer waits, but PNHP promises urgent care would always be provided immediately.

Canada also has lower infant mortality rates, a longer average life span and its government health spending per capita is roughly half as compared with the United States. Clearly, they are doing something right.

It’s disingenuous for Republicans to decry the interference in medical care; these are many of the same people who have continually fought against a meaningful Patient Bill of Rights. Most of us have personally experienced health insurance companies denying medications or procedures and directly interfering with a physician’s treatment.

This plan isn’t the result of some fringe group of Communist doctors. Rather, it’s the result of building outrage of doctors over intrusive HMOs, mountains of paperwork and skyrocketing malpractice insurance costs, all while the insurance and pharmaceutical industries rake in record profits.
It’s time we offered medical care for everyone and a genuine safety net, whether the PHNP proposal or something else.

Roff: The best care anywhere.

According to the Center for Health Transformation, Medicare will consume 20 percent of the federal budget by the end of the current decade, up from 12.4 percent in 1999. And the number of Medicare recipients will almost double by 2030.

That, CHT, is the future of the current system. The present doesn’t look good either.

“Adding to the crisis are numerous challenges,” CHT says, “including rising prescription drug costs and the push for a Medicare prescription drug benefit, patient safety issues, and increases in the number of people with diabetes, which already account for one in every seven dollars of Medicare spending.”
A proposal such as PHNP has put forward, one that maintains the fiction of a private system where the government holds the purse-strings and the cards, does not fit onto the back of Medicare without destroying the quality of American healthcare.

Making healthcare more affordable, more available and more reliable means finding new solutions to existing problems rather than relying on a 1960s Washington-approach to fix what’s broken.

Everyone has reasons to complain about healthcare. It’s bloated, error-ridden and bureaucratic thanks in no small part to the dictates set down by the government.

It is also the best healthcare system anywhere in the world.
The United States produces more medical innovations, more life-savings drugs, provides better care, spends more money and does more to keep people alive and healthy than most other countries. In the American healthcare system you get what you pay for — and often what you don’t.

Any reform that does not have, as the first priority, the preservation of these features will fail.

The goal should be reforms that produce better health, better medicine and lower costs, not a more streamlined process for paying the bill.
The center’s founder, former U.S. House Speaker Newt Gingrich, says there are seven key principles any real reforms must include. An effective, innovative 21st century healthcare system, Gingrich has written, must be: patient centered; values driven; knowledge intense; innovation rich; information-age based; centered on informed patient choice and accountability; and market mediated.

The PHNP proposal fails on most of these points.

It is provider-, not patient-centered, formulaic, bureaucratic, based on obsolete technology rather than information-age breakthroughs and, because it keeps costs down by making the federal government virtually a monopoly purchaser, corrupts the marketplace.

Making doctors and hospitals arms-length employees of the government is not an effective way to fix healthcare in America; in fact, it will make things worse.
“Unless Medicare — and the health and healthcare system in general — are transformed, the strain on the budget will be unsustainable and the cost in human lives and human suffering unthinkable,” the center says.

The PNHP proposal does not transform Medicare or U.S. healthcare. It simply consigns another segment of the population to the existing system. It may make things simpler for doctors and other healthcare providers but it will not make things better for patients.