By Andrea Parrott
Twin Cities Daily Planet, Dec. 24, 2012
After daily witnessing situations in which patients suffered or had to make decisions detrimental to their health due to difficulties in accessing health care, Dr. Elizabeth Frost and Dr. Ann Settgast had enough. They felt they had to do something that would allow everyone to have health insurance and so, access to health care. The two decided to found the Minnesota chapter of Physicians for a National Health Program (PNHP).
PNHP is a national non-profit organization whose members advocate for single payer health care. The idea of single payer health care is that instead of people paying fees to a private health insurance company, they will pay one fund. Hospitals, doctors, and other health providers would then receive payment from that one fund. Dr. Settgast explained single payer in this way: āSome people use an analogy of ‘Medicare of all’ as a synonym for single payerā¦ Itās an example of a fund where everyone pays into the fund and then that fund pays for health care and private deliverers of health care. So Medicare is like a little micro single payer.”
Twin Cities Daily Planet spoke with the doctors, asking them about the state of health care in Minnesota. The edited interview is below.
What are some personal experiences that led you to advocate for a single payer health program?
Dr. Settgast: Thatās a great question that could take me like 12 hours to answer. Iām a primary care doctor so I take care of patients on a daily basis. Every single day I see reasons why we need single payer. A recent one would be a woman who I took care ofāa Vietnamese woman in her early 60s who came in and I diagnosed her with rheumatoid arthritis, which is terribleāshe had terrible swelling of her hand joints. Really deforming joint disease. She was a full-time employee of a company and her husband worked full time as well. Got her to the rheumatologist. Got her on the right drugs. Her joints totally improved. Her pain was eliminated. She was fully functional. Everything was great.
And then, she just didnāt show up for like two or three years. One day she just shows up on my scheduleā¦ So I came into the room. Sheās a tiny little woman and from the door, I could see her joint was like the size of a golf ballālike hugely swollen. I said, Iāll just change her name, I said āLynn, what happened? Where have you been?ā Since I had seen her, she got laid off from her job and her husband died. And she was only 63 at the time that this happenedā¦ She didnāt have access to health care so she just had to stop her drugs, stop seeing her rheumatologist and her joints deterioratedā¦ I didnāt realize, but she had turned 65, so she was back. And itās disgusting because this womanās hand is ruined and itās totally preventable. We see this stuff every single day. And itās inhumane and itās disgusting as a physician when all you care about is taking care of sick people to see people not access care.
Dr. Frost: A daily basis there are storiesā¦ Yesterday I had a patient who stopped her birth control and now is pregnant. I also today had somebody who had psoriasisā¦ they havenāt had it treated in almost a year now because they donāt have insuranceā¦ Again, again, and again, youāre looking at somebody and apologizing for our medical system. āThatās really unfair. Iām sorry that happened to you.ā You canāt just keep doing that again and again. You have to find some other outlet to feel like youāre making a difference on a larger level.
What do you see as the main health care policy issues in Minnesota?
Dr. Settgast: We are leading the nation in the number of individuals with high deductible health insurance plans. The idea is that this would somehow promote personal responsibility. You have a high deductible so youāre not going to go to the doctor unless you really need to because youāre going to be spending your own money. But what that says is that youāre relying on people who arenāt doctors to decide whether they need medical care or notāis problematic right there. Thatās our job: to say, “No, this is not something serious, youāre OK.” People shouldnāt be relied on to do that at home. But then the other issue that we know, there is actually good data showing that the higher your deductible, the less care you receive. And thereās no way to know that that care isnāt needed. Youāre much more likely to see conditions being under-managed or undiagnosed. People just arenāt going to the office when theyāre sickā¦
Dr. Frost: I think a big huge policy thing thatās really going on in Minnesota right now, of course, is the exchanges and figuring out how to set up the exchanges under the Affordable Care Actāthatās huge. Thatās going to take up a lot of energy in the next year or two, but I donāt know how much itās really going to solve the problem.
Dr. Settgast: Itās not going to solve it because all youāre doing is adding this level of administrative complexity when now people can go shopping in this exchange to get their private health insurance. It might help some people to get some policy, but itās not designing the system so that it will work. Itās adding more complexity to an already chaotic systemā¦ You still have these huge billing departments having to bill multiple payers and youāre still having insurance companies take all this money off the topā¦ for functions that have nothing to do with health care. Thereās still a huge amount of waste still in the system and we havenāt done anything to change that.
What are some of the main health policy issues that you see facing the nation?
Dr. Frost: I think Minnesota is a little bit ahead of the rest of the nation in the area that weāre talking aboutā¦ Like we already offer Medicaid to adults without children.
Dr. Settgast: Our Medicaid eligibility rules are much better hereā¦ I have a brother in Indianaā¦ if he was here he would qualify for coverageā¦
Dr. Frost: Weāre talking a lot about how health care is paid for when we do single payerā¦ I think Minnesota has some of the largest health care disparities. I know that education is the worst in the nation in terms of disparitiesā¦ I donāt know how we compare to other states in terms of health care, but I have a feeling itās not very good. One of the things that really distresses me a lot is especially the Native Americans have terrible, terrible health care statisticsā¦ Itās really, really sad and thatās a population I work with a lot.
Dr. Settgast: The problems in the nation are the same as the problems here: uninsurance, underinsurance, people not having access to care. Thatās all in all of the states.
Dr. Frost: Of course the biggest problem is the insurance industryā¦ Itās not like the politicians are in charge and theyāre guiding the systemāno, they need to figure out what the [insurance] industry might accept and then work within those boundariesā¦ Our politicians are controlled pretty much by the industryā¦ The evidence for a single payer system is so ridiculously strong, itās really amazing that we werenāt able to do more with the Affordable Care Act. Itās really quite astoundingāthat the Affordable Care Act is such a big deal and it does so littleā¦ one of things that was not allowed to be on the table, was not allowed to be discussed at all was the idea that the government would purchase drugs for our elderlyā¦ Now thereās like a gazillon Medicare Part D plans. Each one of those little plans doesnāt have the purchasing power to drive down the price of drugs.
Dr. Settgast: We see the patients who donāt take their medicines, or they take them every other day because they have to make them last.
What are some of the main challenges to making changes in health policy?
Dr. Settgast: The health insurers. Because if you look at the polling data, the public supports single payer, physicians support single payerā¦ We know you can cover everyone for less cost and give everyone high quality coverage.
What happens in the U.S. is if Iām the doctor and I see 20 patients in a day and I diagnose them all with the same thing. Letās say they all have diabetes or uncontrolled sugar. Every patient, depending on their payer, may pay my clinic a different fee because all the payers, the insurance companies, are negotiating with the all the clinics separatelyā¦ so itās hugely complicated, which is part of the costāall these contract negotiations because everybody gets a different deal and so every patient pays differentlyā¦ Itās so unequal. And then if youāre uninsured and you come in, you have a totally different cost than what the insurance pays in the next room.
Dr. Frost: Itās totally unfair. Because youāre uninsured, you have to pay the full priceā¦ if youāre totally uninsured you have to pay the $300 while the insurance pays $200, and Medicaid might pay $175 and Medicare might pay $215ā¦
What progress do you see in addressing health disparities in Minnesota?
Dr. Settgast: I personally think itās crazy to try and address health disparities without having a system that covers everyone. I mean how can you really expect to decrease disparities if you have whole portions of the population that donāt have any access to the system? You canāt do things on a population level if youāre leaving 10 percent of the people outā¦ I mean obviously having a single payer doesnāt eliminate all health care disparities because a lot of health care disparities isnāt necessarily access to the system, but itās the first stepā¦ I mean, how are they going to stand on equal footing in terms of their diabetes control or their hypertension control if they donāt have a doctor because they donāt have health insurance?
Dr. Frost: I think itās important to differentiate between health disparities and health care disparities because health disparities are, a lot of them are socially determined. So if you donāt have a grocery store in the areaā¦ that will make it a lot harder to eat wellā¦ So I think separating those two things are important, but in terms of access to health care, I see again and again and againā¦ somebody gets out of Medicaid and gets a job and loses their insurance so they canāt see you anymore. So once you get backā¦ on your feet, you get back into the system, you canāt treat those diseases that youāve been treatingā¦ So itās that inequality in the health care system, the injustice in the health care system is what makes me so angry, and itās because I see it every day.
Ā© 2012 Andrea Parrott
http://www.tcdailyplanet.net/news/2012/12/23/mn-voices-health-care-challenges-minnesota-tied-access-insurance-says-physician-advo