An Interview About National Health Insurance

By Ellen R. Hale
Louisville Medicine, Nov 2010

Garrett Adams, MD, MPH, spent 40 years practicing medicine as a pediatrician, as chief of Pediatric Infectious Diseases at the University of Louisville School of Medicine, and as medical director of communicable diseases at the Louisville Metro Department of Public Health and Wellness. In January, he will begin serving as the president of Physicians for a National Health Program, which since 1987 has been the only national physician organization in the United States dedicated exclusively to implementing a singlepayer national health program. As proposed by PNHP, the system would have public funding but private delivery of care. “Under a single-payer system, all Americans would be covered for all medically necessary services, including: doctor, hospital, preventive, long-term care, mental health, reproductive health care, dental, vision, prescription drug and medical supply costs,” according to www.pnhp.org. The Louisville Medicine Editorial Board drafted a list of questions for Dr. Adams. GLMS Communications Associate Ellen Hale interviewed him on the board’s behalf.

Q: How did you become involved in promoting a single-payer national health program?

A: In 2003, I read this JAMA article on the “Proposal of the Physicians’ Working Group for Single-Payer National Health Insurance.” I thought, that just makes sense. I went to the website and endorsed it. At that time, there were 8,000 physicians who had endorsed it; today there are 17,000. I began to think about the way medical care had changed during my years of experience. Doctors were taken away from their patients, and I began to realize that the way medical care was being paid for had really intruded into the physician-patient relationship.

A lot of Americans and even some physicians are not aware of the great disparity in the ability to deliver quality health care among the United States and other developed countries. We’re way behind in terms of the efficiency and in terms of quality. And there’s this unjustified idea that we have “the best health care in the world.” It may be true in isolated instances, but overall it’s just wrong. We’re being dragged back by this market-driven, profit-driven system that has really put a damper on our ability to provide quality care for everyone in this country.

Q: What do you hope to accomplish as president of PNHP?

A: We’d like to grow the organization, particularly in the South. One of our goals will be to spread the message of the advantages of a national health system to people who will benefit from it. Some of the worst health statistics are in the South. So these are the people who would benefit from a good national health system. I’d like to recruit physicians to the idea. There’s a lot of education that needs to be done. Our challenge is uphill because the private health insurance industry and the for-profit health industry are opposed to many of the ideas of a national health plan. A lot of their effort is misinformation and propaganda, so we want to try to counteract that with facts. For example, the term “socialized medicine” came about when Harry Truman proposed it. The insurance industry hired an advertising firm, and they came up with “socialized medicine.” That was during the McCarthy era, and people were just afraid. There’s a lot of fear and distrust of government. I’d like to replace the fear with knowledge and understanding and get our government leaders, physicians and the public to understand that we can do better. We’re hurting ourselves by not adopting a simplified system that is in the hands of the people rather than the corporate, profit-making organizations.

Q: How would the proposed national health program be in “the hands of the people” instead of “the hands of the government?”

A: Government is the people. There are American governmental institutions that function very well. Our plan envisages a board, such as the Federal Reserve Board, that would not be run directly by elected officials but more by professionals. Then regional boards would have citizens, physicians and professionals who would make judgments. Medicare in this country has been very successful. There are problems that should be fixed, but it’s made a huge difference in the health of our seniors and also in the financial health of our seniors. Without Medicare, so many people would be totally broke.

There are some institutions that do well as policies change and as the political power changes in Washington. For example, the Centers for Disease Control and Prevention is an outstanding example of an American government project that’s been very successful and effective. There are lots of things we can be thankful for and proud of that come out of the CDC.

Q: Everyone agrees that costs are rising at an unsustainable rate, but getting agreement on solutions to the problem of rising costs is more difficult. What sort of cost-cutting ideas do you think could get widespread public and political support?

A: A national health insurance model or single-payer model is the only model that will control costs. Second to improved quality and improved health care delivery, control of costs is one of the most important advantages of this system. Right away, you gain 30 cents of every dollar that goes into administrative costs. Twenty percent is the usual administrative expense of an insurance company and then the additional 10 percent is the cost of the providers working with the payers. A dermatologist colleague of mine here asked her billing clerk how many plans were represented in their current bills outstanding. It was 287 plans. That’s where a huge amount of expense and time on the part of the physician could be recouped immediately. Medicare, with its faults, has an administrative expense of 3 percent or less. National health insurance would increase it to be more in line with some other developed countries, around 12 percent. The number of billing clerks at Massachusetts General Hospital is about 300. Toronto General, a hospital of equal size, has three billing clerks.

The ability to purchase pharmaceuticals and supplies in volume bulk purchasing would save huge amounts of money. We’re paying roughly 40 percent more here per prescription. The Medicare Modernization Act of 2003 strictly forbade Medicare from negotiating with pharmaceutical manufacturers for volume discounts.

Q: As part of the new health reform law, there are incentives for providers to begin using more and more HIT tools. But to ensure that patients are receiving the most benefits from adoption of the tools, the law requires that providers meet certain “meaningful use” standards. In what ways can providers and your proposed singlepayer program work together to ensure patients are receiving the most benefits from the adoption of HIT tools?

A: The best example is in France where in 1998 they adopted a “carte vitale.” Every citizen has a card. This would be the ideal. It has all the information – the patient’s medical records, X-rays, consultation results and physicals. The mothers of children under 16 years of age carry the card for their children. So they come to the doctor’s office, the doctor swipes the card, and then he has his monitor and he can see all the information. It’s always updated after the visit. Patients can go to any doctor, any hospital, anywhere.

Q: Physicians currently have complaints about Medicare regarding payment and services covered, and getting Congress to permanently fix the SGR formula has been a problem for years. Why was Medicare chosen as the model for the national health program? In what ways would it be improved under the national health program?