DISQUS

Aaron Roland · 1 year ago

Thanks for the rather comprehensive analysis with so many useful links. I was recently at the Physicians For A National Health Plan annual meeting. One of the most powerful presenters was Michael Lighty, director of administration and public policy for the CNA. Nurses get it. You might find the following op-ed interesting:

A Chance to Begin From Scratch:
Why The Economic Crisis Makes Fundamental Health Care Reform Possible
Aaron M. Roland, M.D.

In the face of an economic crisis of a magnitude unprecedented in more than half a century, pundits are already asking how President-elect Obama will alter his ambitious proposals. The implication is that economic hardship must inevitably lead to budget tightening, scaling back, and even abandonment of the change upon which he had based his campaign.

Certainly, people faced with job insecurity,collapsing investments, shrinking retirement accounts, and declining home values will tighten their belts. And in the face of changing conditions, the new President will have to reconsider his plans.

But in the case of health care, the crisis may have an unexpected effect. It may allow Obama move beyond his modest incremental proposals to something far more comprehensive.

Obama’s existing health care proposals argue for more tightly regulating insurance companies, expanding employer-based health insurance, and opening the Federal employee health program to all citizens. But by even the most optimistic estimates this complex plan will lead to coverage of only about 50% of those currently uninsured and will entail a cost of up to $1 trillion over the next ten years. In a world of $700 billion dollar bank bailouts, this may not sound like much, but in an economic environment where need is widespread, alternatives should be considered.

As recently as August the President-elect offered his own support for an alternative. “If I were designing a system from scratch,” he offered, “I would probably go ahead with a single-payer system.” The rationale for this idea is simple. The current private insurance based health care system has become a bureaucratic nightmare of buck-passing and profiteering. It is rife with waste that has nothing to do with providing quality comprehensive health care. Eliminate the source of that waste and spend it on health care.

Now, only some 65% of private health insurance premiums are spent on health care. Instead, insurance company executives earn hundreds of millions of dollars while corporate marketing departments spend fortunes selling insurance to the healthy just as their utilization departments resist paying for the care of those who become ill.

On the other hand, Medicare, with centralized funding and near universal enrollment of the population it serves, provides better quality care and higher satisfaction at a substantially lower cost than the private health system. Medicare’s bureaucracy takes up only 3% of its funding. No surprise as there are no resources spent on avoiding care for the sick, marketing, underwriting, investor relations, or corporate profits.

The economic crisis offers the new President the opportunity most other reformers have not had—the chance to begin from scratch. The American people have voiced an overwhelming desire for dramatic change. We have come to understand that business as usual isn’t always good business and that the business models that private systems create don’t always work in the public interest. Perhaps most importantly, however, the economic crisis has sensitized us to the need to pay attention to our money.

As a doctor in the trenches of primary care and as a small businessman, I can see no other way forward. For my well-insured patients, a switch to Medicare for all will hardly alter the face of the health care system they currently experience. But it will reduce everyone’s level of economic and health insecurity. None will need to worry if something is covered. There will be no more holding on to unsatisfactory jobs simply to keep insured. The process of paying for care will be simplified.

This is not socialized medicine, but a plan for public finance of our diversified private health care delivery system. An improved Medicare for all offers relief from the waste in the bureaucratic private health care system. It can eliminate a multitude of public and private programs which currently pay for segmented components of health care, eliminate the distinction between health care for the poor and for the rich, and reduce the confusion, waste, and annoyance which providers and patients face in dealing with the 1300 health insurance companies which litter the existing health care landscape

Politics, and political change, has been described as the art of the possible. Remarkably, the crises we face have made the seemingly impossible happen. We have a new President, a man who has inspired our hope. For our health let us begin from scratch. Let crisis and hope lead to real change.

Copyright November 5, 2008
Aaron Roland is a practicing family physician and clinical associate professor at U.C.S.F.

H G Stern, LUTCF, CBC · 1 year ago

WoW, Louise, a tremendous job! It's obvious that you read each of these posts. Kudos!

Thanks for hosting, and for including our post.

personal_injury · 1 year ago

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