By James Binder, M.D.
The Charleston (W.Va.) Gazette, May 21, 2015
Our country would be better able to help its citizens prevent and manage chronic illnesses if we adopted a single-payer system. Our current primary care structure is designed to treat acute illnesses. Primary care providers do not have adequate time or the training to effectively treat the increasing burden of chronic conditions in our society, conditions such as obesity, diabetes mellitus, substance use disorders, depression.
Obesity will soon be our number one health problem. One-third of adults are obese.
Twenty percent of children 2 to 5 years of age are overweight or obese. Besides being associated with a number of serious medical conditions, such as heart disease and diabetes mellitus, obesity is associated with emotional/mental consequences (discouragement, depression) and social discrimination. Our national security is at risk with 30 percent of young Americans too heavy to meet the requirements for joining the Armed Services.
There are conscientious efforts to prevent and combat obesity being made right now in our communities and schools. However, these are often uncoordinated and unsustainable, not helping our children make lasting changes. A strong, multi-modal, evidence-based approach is needed.
Our current fragmented private insurance infrastructure has not and is not capable of supporting an effective response. Private insurance companies have one priority — to make a profit, not to improve the collective health of our nation.
The world-renowned Institute of Medicine published a blueprint to resolve the obesity epidemic (Progress in Childhood Obesity: How Do We Measure Up, 2006). An effective national response for preventing and treating childhood obesity would have three components:
- Strong leadership and coordination.
- Evaluation of approaches.
- Monitoring progress of specific interventions and making adjustments when necessary.
A single-payer system would provide the infrastructure needed to implement each of these three components. Emphasis would shift from the micromanagement of each decision made by a clinician to the macromanagement of resources.
Micromanagement increases paperwork and expenses, discourages clinicians and patients alike, and is often ill-considered.
I treat a number of children with obesity as a pediatrician in a rural medical clinic. I recently referred a child with a BMI greater than 99 percent to a comprehensive Healthy Kids clinic in Charleston.
This child had failed stage I and II obesity treatments. Despite meeting the specific recommendations of the American Academy of Pediatrics for specialty referral, the family’s private insurance company refused to cover the treatment. The child had not yet developed an associated medical condition (e.g. diabetes mellitus).
This type of micromanagement would be unnecessary in a single-payer system because the emphasis would be on the collective health of the community, not the cost of one referral. It is so important that we return to a model based on caring professional judgment.
Even more importantly, we need to develop and implement programs that really work.
We know that it takes time to help families with such complex issues as weight control. The standard 15-minute clinic visits are not enough time to counsel families on complex issues, especially when there are other problems to discuss and five to seven minutes of that visit is spent on the computer, much of it devoted to meeting insurance company billing demands.
We know families must be involved in the solution since children learn good nutrition and healthy habits in the context of their immediate families. And, we know it takes coordination between communities, schools, industry, medical clinics, and the government to develop and sustain effective interventions.
A single-payer system would allow us to incorporate all these elements into treatment planning since its main goal is the collective health of the community.
Of course, the best strategy is to prevent the problem in the first place. Private insurers attach funding to individual patients. Broader societal goals are not funded. Less than 3 percent of health spending currently goes for prevention. We can do better than that.
A single -payer system would provide the framework to solve the problem and allow us to change our children’s environment. It would not solve the problem for us. We would still have to do that. However, we have the expertise and health professionals needed to accomplish that. We just need the framework. It is another reason many physicians support single payer.
James Binder, M.D., is co-president of the West Virginia Chapter of Physicians for a National Health Program and a pediatrician at Cabin Creek Health Systems.