Universal health care: Private enterprise can't fix our ailing system
By PAUL DeMARCO
Spartanburg (S.C.) Herald-Journal
Sunday, May 17, 2009
I live in a town with a population of 7,000. I own a pair of shotguns, and I know how to use them — a wood duck and a turkey are mounted on my office wall. I drive a 2001 Dodge Dakota pickup with 150,000 miles on it.
I wear a coat and tie every day to work. I’m in church each Sunday and am not embarrassed to tell you that Jesus is my Savior. I believe in chivalry; I open doors for women and expect my teenage daughter’s dates to come into the house when they visit.
My usual TV-watching dilemma is “The Andy Griffith Show” or “M*A*S*H.” I’m about as old-fashioned, square and conservative as they come.
So where do I get off backing a single-payer national health plan, a plan where everybody’s covered in one big risk pool and health care is publicly financed (but privately delivered)? Shouldn’t I be a rugged individualist, telling people that if they want good health insurance they can pay attention in class, go to college and get a good job with full benefits just like I did?
Well, part of me could do that. No country can survive unless individual responsibility is at the core of its ethos.
But to the other part of me, the go-it-alone attitude just sounds downright mean.
That puts me in about the same mind-set as a Midwestern farmer in the mid-19th century. Farmers then and now are often independent, self-sufficient
and hesitant to incur a debt. But when a neighboring family needed a barn raised, that was a different story. No matter how hearty the farmer, he couldn’t raise a barn alone. And there was a healthy dose of self-interest in the proposition. If I help raise your barn, then when mine needs repairs, I’ll have your help.
So I look at single-payer health care in that conservative light. I recognize that a significant portion of America’s chronic disease burden is self-induced (e.g., some people eat, drink or smoke too much and make themselves sick). But I also know that much of your health is beyond your control — it’s either in your genes or not significantly altered by lifestyle. Think breast cancer and many other malignancies, flu and many other infectious diseases, Alzheimer’s dementia or rheumatoid arthritis.
I don’t suspect that farmers of yore did any research on the family who they helped. Whether the family was industrious or lazy, a barn was built because everyone needed a barn. Without a place to store hay and protect animals in the upcoming winter, livestock would die and the family would soon follow. No farmer, no matter how stoic, would consign his neighbor to that fate.
I support single-payer health care in this tradition. A single-payer program, which would expand Medicare to all Americans (rather than just those 65 and over), would create one large barn-raising community, 300-million strong. We would all chip in our share so that all families could have health care. Almost all of us would end up paying less than we do now (there would be no co-pays or deductibles), and we could choose any doctor or hospital we wanted.
Under our present setup, it’s hit and miss. Money typically dictates who gets care and who doesn’t.
A carpenter who works for a big company with insurance may get care; another who works for a small one can only dream about it.
A woman with lupus loses her job and her insurance and then becomes uninsurable because of her pre-existing condition.
A 60-year-old man with a bad knee is laid off when a plant closes in his rural hometown. Lame and unskilled in a region with rising unemployment, he will limp for five years until he qualifies for Medicare and can have his knee replaced.
Barn-raising worked because it is was a nonprofit enterprise. A farming community bound itself in a social contract. Many countries have single-payer social contracts, including our neighbor Canada, to ensure the health of all their citizens. There are many ways to inject a profit motive into the process, but they all taint it. Until the 1960s, medicine was also primarily a nonprofit endeavor. In recent decades, the huge profits available to for-profit insurance companies and hospitals have often elevated shareholders above patients, resulting in higher costs and inferior care.
All my instincts call for problems to be solved by individuals operating in a free-market economy. But private enterprise cannot solve this one. We have 40 years of evidence of the free market’s failure to control costs or cover everyone.
The plain truth is that the public single-payer systems we already have (Medicare, Medicaid and the VA) provide better coverage with less overhead than private companies. I know that statement is hard for many, including me, to swallow, but it’s true.
Medicare for all will not be a perfect system, but it will be far better than the fragmented, profit-warped system we have.
When America was younger, we knew not to turn our backs on new neighbors in need of a barn. In this older — and I hope wiser — America, we should not turn our backs on those who need health care. Tell your representative and senators to put single payer on the table in Washington.
Paul DeMarco, MD is a general internist who lives in Marion. He is a member of Physicians for a National Health Program (www.pnhp.org).