By Michele Munz
St. Louis Post-Dispatch, July 19, 2012
CLAYTON, Mo. — In a meeting room at a St. Louis County public library, Dr. Ed Weisbart started his health insurance reform presentation with pictures of sick people.
One was self-employed who couldn’t afford health insurance and made too much money to get Medicaid. Another was a factory worker who lost coverage when he became too ill to work. Then there were working parents whose bills for their sick infant drove them into bankruptcy.
“The reason I’m here and that you are here, is because you’ve seen patients like this,” Weisbart told the crowd.
About 40 people from diverse fields filled the room. They included doctors, students, a medical office manager, social worker and even a musician.
They were there to learn about a single-payer health care system that makes free-market advocates cringe. Instead of hundreds of insurance companies and billing agencies, one government-run organization would collect the fees and pay all the costs under the single-payer plan. In a system financed by a progressive tax, advocates argue that people would pay less than what they pay now in premiums and out-of-pocket costs.
Each person would receive comprehensive medical care and choose whichever doctor or hospital they want. Patients would receive no bills. Co-payments and deductibles would be eliminated.
“It basically involves just changing two words in the law,” Weisbart said about the current federal insurance program for older Americans. “Instead of saying Medicare is available at age 65, say it’s available starting at birth.”
However, the American Medical Association, the country’s largest physician group, supports the current mix of private and public insurance options.
“The private sector has been leading the way in developing and piloting innovative health care delivery and payment models to better support and reward physicians who provide high-value health care,” said the AMA’s president, Dr. Jeremy Lazarus.
Single-payer may seem like an impossibility in the U.S. Weisbart, 58, had long thought so too, until President Barack Obama began tackling health care reform.
“I had thought single-payer, great idea, but it’s not going to happen. The interests against it are so vested,” he said. “Then that pesky Obama got elected, and I got all hopey-changey.”
Implementation of the president’s Affordable Care Act is now in full swing after last month’s ruling by the Supreme Court upheld its constitutionality. The legislation moves the country closer to universal health care coverage, but single-payer advocates like Weisbart argue it’s not enough.
Weisbart is a member of Physicians for a National Health Program, which has been advocating for a single-payer system since 1987 and now has 18,000 members. In March, he started a St. Louis chapter.
The group’s first meeting included 10 people at Weisbart’s home in Olivette. Since then, the chapter has organized two presentations to more than 125 medical students at Washington and St. Louis universities and the recent meeting at the library.
Weisbart led the meeting along with a panel that included the president of a Barnes-Jewish Hospital physician group that advises administration on patient care, a family physician who served on the national policy committee for the nation’s second-largest physician group and a third-year Washington University medical student who co-authored “The Health Care Handbook,” praised as a clear guide to our health care system.
Weisbart has a lengthy resume as well. He was drawn to become a doctor by new ideas in improving patient care: Health maintenance organizations and family medicine.
After medical school, Weisbart went to work as a family doctor for an HMO at Rush Medical College, eventually becoming chief medical officer. Later, a 200-member group of private practice doctors in suburban Chicago hired him as director of care and quality.
Then in 2003, locally based pharmacy benefit giant Express Scripts recruited him as its chief medical officer. He retired from Express Scripts two years ago.
Weisbart also has a long list of volunteer work, including seeing patients at the Barnes-Jewish Center for Outpatient Health and the Saturday Neighborhood Health Clinic run by Washington University medical students, both which serve the under- and non-insured. He’s also the medical director for Rx Outreach, a nonprofit mail-order pharmacy based in Maryland Heights that provides medicine for low-income patients.
A year after retiring from Express Scripts, he was approached by community activist Linda Lieb, 54, about organizing a local Physicians for a National Health Program chapter. She had just moved to St. Louis after helping organize a chapter in Huntsville, Ala., and had heard of Weisbart.
After a long career of trying to improve care within the system, Weisbart agreed to start recruiting. “I realized if you support incrementalism, you oppose fundamental change,” he said.
In Huntsville, Lieb experienced difficulty in finding doctors.
“It’s encouraging to see so many physicians here in St. Louis who are working toward this goal,” she said. “Ed has pulled together a wonderful leadership committee of physicians and medical students.”
Support among physicians appears to be growing. A poll published in 2008 shows 59 percent of doctors support national insurance, up from 49 percent five years earlier. The American College of Physicians, the nation’s second-largest doctor group, and the American Medical Student Association have both endorsed single-payer.
“We need to be more vocal. We need to tell our patients we support this,” Dr. Christine Jacobs, a family physician who directs St. Louis University’s family medicine residency program, said at the library meeting. “When I tell my patients, they are surprised. They say, ‘You think that?’ “
The panel members discussed fears about long waits and stifled medical research, arguing that the system would be more efficient and focused with less money and time spent on marketing, administration and underwriting. Administrative costs consume 31 percent of U.S. health spending, studies have found.
Lazarus, of the American Medical Association, points to the current problems in determining how much physicians are reimbursed through Medicare.
“One look at the flawed Medicare physician payment formula provides a clear example of the problems that can arise with a government-run health care system — conflicting agendas and budget constraints can dictate policy rather than the health care needs of our nation’s senior citizens,” he said.
Federal legislation to enact single-payer would address those problems by creating separate budgets for care, education and capital improvements, Weisbart said. An independent, diverse board would monitor reimbursement and quality.
Even with the Affordable Care Act, experts estimate that 26 million will remain uninsured and others will still be dealing with gaps in coverage and rising costs.
Weisbart is driven by memories of patients like the 62-year-old grandmother caring for her three grandchildren and facing eviction, who asked how long she could live without taking her blood pressure pills.
“I don’t want anyone to ask me that question again,” he said.