Our ever-evolving health care system

By Nathaniel H. Murdock, M.D.
St. Louis American, Dec. 20, 2012

The great American healthcare experiment is continuing to develop. The next stage is starting, so this is a good time to look back before we look ahead.

How did our healthcare get so tied up with our employment? In World War II, to preserve funds for the war effort, the government froze wages. To compete for workers, employers began to pay for health insurance, supported with business tax deductions. This quickly became an unfettered marketplace, with virtually no regulation on price or quality.

Premiums began rising and problems emerged. Employers could no longer afford to fully cover their employees. The elderly became increasingly unable to afford medical care. Many of our parents and grandparents fell into medical poverty, and even more were simply unable to afford any care. Diseases went untreated, often with disastrous consequences.

The next experiment was proposed in the 1960s: the government would provide health care coverage, called Medicare, to all Americans beginning at age 65. No longer would our elderly need to sell their homes to scrape together the resources for life-saving medical care, living in poverty for their final years. It was a humane and compassionate solution to an unacceptable social injustice, and has saved countless millions of lives.

While the senior population immediately embraced Medicare, many medical organizations lobbied extensively against it, perceiving a threat to their autonomy.

One of the few groups that immediately took a strong leadership position in favor of Medicare was the National Medical Association (NMA). I should disclose to you that I am a Past President of the NMA. We supported Medicare when it began, and continue to proudly support it today.

Although Medicare did not pay physicians well, costs continued to escalate. In response, insurance companies developed the “managed care” experiment. They promised physicians that if we discounted our fees, they would direct more of their patients toward us.

The insurance companies could not possibly deliver on this promise. Discounted fees became the new normal. As reimbursement fell, physicians began to spend less time with each patient. Patients found it increasingly difficult to find care. Medical care was arbitrarily cut to reduce costs. Managed care became rationed care, and America didn’t like it.

The next major step is the Affordable Care Act, an important step forward, but much remains to be done.

When picking a doctor, we will still need to look to our insurance company to determine if that doctor is “in network.” Prevention may soon be free, but treatment will continue to bankrupt many. Despite Massachusetts’ health care reform, they have more citizens than ever declaring bankruptcy due to illness.

Most Americans, including most doctors, now feel that a plausible strategy to achieve universal health coverage is to improve Medicare and provide it to all Americans. This is often called a “single-payer” model as the only payer of health care services would be our government, not our employers or insurance companies. Coverage would be for everyone, young and old, in sickness and in health.

Most economists tell us that this solution would actually cost less than we spend today. We’d spend more to cover today’s uninsured, but we’d save even more through simplification and coordination. People could afford to go to their physician for regular maintenance and preventive care. We should be able to decrease many causes of preventable sickness and death. We would save lives.

Those who argue against a single-payer plan claim it would bankrupt the country. They’re wrong; almost every industrialized country provides universal health coverage from birth to death, at a fraction of what we spend.

Insurance companies claim that single-payer will not work. I wonder if their skepticism is related to the fact that this plan would marginalize their role. We need to keep this in mind when we hear their fears. We need to remind them that most other modern countries already do this. Of course it would work; it already does.

I would like to see us have a single-payer with universal comprehensive health coverage for all Americans. This is an idea whose time has come.

Dr. Murdock is a founding member of Physicians for a National Health Program – St. Louis.

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