Health Care for All Americans
Comments by Lisa Nilles, M.D.
September 23, 2007
Thank you Representatives Conyers and Ellison for your leadership on this issue. And thank all of you for coming. In case you don’t know, there are more and more doctors supporting you and this issue everyday. Only 1/3 of U.S. physicians belong to the AMA. When the AMA makes a statement, they are not representing the voices of all US physicians.
How about here in Minnesota? A study published in Feb. 2007 surveyed Minnesota physicians. They were asked the following question: Which of the following three structures would offer the best health care to the greatest number of people for a given amount of money? They were offered three choices: single-payer, health savings accounts, or managed care. The results? 64% of Minnesota physicians chose single-payer as the type of reform that would provide the best health care to the greatest number of people for a given amount of money.
(L to R): Rep. John Conyers, Rep. Keith Ellison, and Dr. Lisa
Niles at the Minnesota Universal Health Care Coalition forum
on HR676
I support single-payer universal health care because I believe it is the only reform that will enable us to provide comprehensive health care for everyone. I belong to two organizations that work for single-payer; Physicians for a National Health Program, and the Minnesota Universal Health Care Coalition
We can learn a lot from looking at how other countries provide health care. I worked in England as a resident physician in 1989-90 and was very impressed with what I saw firsthand. I worked at the Gloucestershire Royal Hospital, a district hospital in western England. Everyone in England has access to a local general practitioner, and the general practitioner, when needed, refers patients to district hospitals and clinics for more specialized care. At the district level, we could handle most pediatric illnesses, but when further specialized care was needed, we referred patients to the regional hospital. Everyone had access to care, and moved through the system to the level of care they needed. There was a sense of overall planning and coordination of care. Resources, including providers, facilities and equipment, were equitably distributed. It was very gratifying to work there. It felt humane and just.
I then returned to the States and entered the free-for-all that is the American medical system. I worked in a private clinic with patients with various types of insurance, each with its own rules about co-pays and deductibles, about what services were covered, which medications were on the formulary, and which providers were within its network. I also volunteered at a “free” clinic for those with no insurance. Whatever a patient’s insurance status at a given moment, there was the possibility that it could change at any moment due to job loss, change in plans offered by an employer, or change in family income. And then they would be playing with a new set of rules, sometimes having to start all over again with a new provider in new clinic. In contrast to England, access to health care, and continuity of care, is tenuous indeed.
For many people, the system works. They manage to have insurance that truly provides for
their needs from cradle to grave. But too often, and with increasing frequency, people “fall through the cracks” and we hear stories like this one shared by a physician colleague who works at a county hospital in MN: She relates:
This past month I met a woman who had been diagnosed and treated for breast cancer at private Clinic X. One and a half years ago, her husband was laid off, and they extended their insurance coverage for 18 more months with the COBRA plan. Two months after their COBRA expired, she discovered that she had metastatic cancer. She returned to private Clinic X, only to be told that without insurance, and without the ability to offer a cash payment, she could not be seen. She then arrived at our doorstep, records in hand, and we began her treatment while our social workers helped her get emergency medical assistance. Her husband is now employed again, but she cannot get insurance through his employer because of her “pre-existing condition.”
Not only is access to our health care system unpredictable, but once in the system, navigating the bureaucratic maze of the various payers and plans can be a huge stress for both patient and provider. It is often a daily requirement to spend time sorting through paperwork and trying to reach insurance companies on the telephone to get approval and payment for necessary medical care. Faced day in and day out, this is very draining.
Sometimes you have to play games to get medical care. Consider this story from a friend who is a family practitioner who works in a community clinic. An uninsured gentleman came in complaining of chest pain. Based on his symptoms, she suspected that his chest pain was due to heart disease. What was different about this case was that the patient asked her to not mention his complaint of chest pain in the notes. He was savvy enough to know that documentation of chest pain in his medical record would be seen by insurance companies as evidence of a preexisting condition, and on this basis, they could deny him coverage. What does the doctor do?
Falsify the medical record by not accurately reporting this man’s symptoms, or honestly document the visit, knowing that evidence of a pre-existing condition could prevent him from obtaining insurance needed to cover medical treatment? To have to make these choices is
demoralizing and crazy-making.
It doesn’t have to be this way.
About 5 years ago I became acquainted with the work of Physicians for a National Health Program, a group of 14,000 physicians promoting a system of national health insurance, essentially HR 676. I read their proposal, and was struck by the compelling, common-sense plan to restructure the financing of our health care system from an inefficient patchwork of multiple payers and plans into a coordinated, sensible system of one payer, and one plan. A system that places the health care of all residents as its number one priority.
I have learned one fact that, once known, has made the evaluation of all health reforms quite easy. The fact is: We can provide comprehensive health care for everyone at no increased cost.
That has been shown again and again, at the state and national level, year after year, by studies done by public, private and academic institutions. Most recently at the national level: Hilary Clinton’s plan aims to provide a basic level of coverage to all at a cost of $110 billion. In contrast, Rep. Conyer’s and Kucinich’s bill guarantees comprehensive health care for all, at a savings of $50 billion.
We can do this. We can provide comprehensive health care for everyone at no increased cost. Given this, the next question then has to be:
WHY ARE WE NOT DOING IT?
This is a moral question. The Institute of Medicine reports that 18,000 people die each year in the US because they don’t have health insurance. We all know people who, insured or uninsured, are terrified of a serious illness, not only for the pain and suffering that any illness can bring, but also because the cost of such an illness would financially devastate their family.
We can provide comprehensive health care for everyone at no increased cost.
Why are we not doing it?
I have encountered three stumbling blocks to progress on this issue.
1. Many people are afraid of losing what they have. Some physicians are afraid of a loss of income. Others a loss of autonomy. People who currently feel secure and protected by the insurance they have are afraid of losing that.
2. There is the misperception that single-payer financing means “government-run” health care, and that triggers images of waiting lines, rationing, and bloated bureaucracy in people’s minds.
3. And finally, there is the misperception that enactment of single-payer universal health care in this country is “politically impossible.”
For those who have great health care, are happy with their coverage, love their doctor and clinic, the only thing they are going to “lose” in a single-payer system is the name of the insurance company on their card. Instead of Private Insurance Company X, it will read US National Health Insurance. Doctor X, practicing at Clinic Y, and using Hospital Z, will all continue to exist. With the same excellent systems they have developed.
For those who fear that a system of single-payer financing means increased bureaucracy, I submit that there is no way that a single-payer and a single plan system could be as inefficient as myriad of payers and hundreds of plans we have now operating in the United States.
For those who say it is politically impossible, that insurance companies and the pharmaceutical companies have too much money and power - I agree. They do have too much power and money. But I don’t agree that corporate lobbyists run the show. We need a strong citizen lobbying effort to counter their influence. This change is going to happen because the citizens want it.
The way to bring about this change is to educate, organize and advocate for a single-payer universal health care system.
Educate: Kip Sullivan’s book, The Health Care Mess: How We Got Into It and How We’ll Get Out of It. Thorough, honest, and eminently readable.
Organize: Join us. Join MUHCC, uhcan, PNHP. Information on all these organizations is in the back, on the web, and right here in the people around you.
Advocate. Advocate by letting your representatives what you want. Tell them you support HR
676. Ask them if they do. Encourage your church, your club, your organization to endorse HR 676, and join the long list of those who are saying, “Enough. We can do this. We can provide comprehensive health care for all at no increased cost.”
In Minnesota, support the Minnesota Health Care Act, co-authored by Sen. John Marty and Rep. Ken Tschumper, and supported by 57 of Minnesota’s 201 legislators. Join us. We need each and every one of you.
Join us. We need each and every one of you.