Photo by Larry Canner
Dr. Garrett Adams, left, president of Physicians for a National Health Program, was honored as a Distinguished Alumnus of the Johns Hopkins Bloomberg School of Public Health at a program on Aug. 30 in Baltimore. Dr. Adams participated in a panel with two other award recipients titled “Access to Health Care Among Underserved Populations.” The event was chaired by the school’s dean, Dr. Michael Klag, right, who asked each panelist to open with a brief statement before addressing three questions.
By Garrett Adams, M.D., M.P.H.
I am deeply grateful to the JHU Bloomberg School of Public Health for this singular honor – grateful not only personally for the award, but for the validation that Dean Klag and the Award Committee have given to the related projects that have occupied my retirement: (1) advocacy for publicly funded national health insurance with the Physicians for a National Health Program and (2) free medical services at the Beersheba Springs Medical Clinic in Tennessee for persons who don’t have health care because they don’t have insurance and cannot pay expensive health care costs.
All health reform efforts must focus on what is best for the people. How do we relieve suffering? Former Surgeon General Julius Richmond said, “Statistics are people with the tears wiped dry.” There are stories illustrating this truth at the Beersheba Clinic website, www.beershebaclinic.org. For example, Clay Morgan, a successful automobile mechanic in Henry County, Kentucky, owned his business, but lost it and was bankrupted paying for treatment for malignant melanoma. He was cured, but the melanoma returned. Rather than bring more medical debt on his family, Clay went into the backyard and took his own life.
Question 1. What are the possible solutions to solving/addressing the problem of little to no access to health care in the U.S.?
Nearly everyone in this country is just one major illness or one job loss away from bankruptcy because the United States, an outlier among developed nations, is the only country that does not provide universal health care to all of its citizens. A recent Commonwealth Fund study showed that 42 percent of Americans do not believe they can afford health care if they have a major illness. One-third said they did not go to the doctor when sick, did not get recommended treatment, or did not fill a prescription because of cost.
To reform the American health care system we must eliminate the business model approach, the profiteering and the investor-owned profit taking of the medical-industrial complex.
The Affordable Care Act is not the answer. The Congressional Budget Office estimates that if the ACA works as planned, 30 million people will still be uninsured in 2022. As Clay Morgan’s story illustrates, any number of uninsured people is unacceptable – hence the urgency of establishing a single-payer system. Furthermore, single payer is the only way to control runaway health care costs, consuming now $2.7 trillion and forecasted to consume nearly 20 percent of our GDP and $13,700/person by 2020.
In their book “The Spirit Level” Richard Wilkinson and Kate Pickett describe how “greater equality makes societies stronger.” Wilkinson and Pickett show that more equal societies have better health and fewer social problems. A single-payer national health system will immediately create a more egalitarian society in America and will lift all boats.
Question 2. What is the role of primary care in these situations?
Dr. John Geyman in his book “Breaking Point, How the Primary Care Crisis Endangers the Lives of Americans” states that all attempts to rebuild primary care are fruitless without fundamental system reform. Some of the ways that national health insurance will facilitate building primary care include:
* Expansion of primary care to meet the need of universal access for the entire population.
* Changing physician payments from the present skewed fee-for-service system favoring highly reimbursed specialty procedures to a system that favors generalist care.
* Accountability from providers, hospitals and other facilities working with annual budgets and negotiated reimbursements.
* Replacing our dysfunctional graduate medical education financing with new funding based on physician workforce needs.
* Covering the costs of malpractice liability insurance.
* Changing the focus from creating profits to providing service.
Dr. Geyman states, “As with other challenges to our democracy – from Social Security and civil rights to Medicare – this will be a class struggle pitting the majority against the power and money of the few, real people against corporations. Reforming the system and rebuilding primary care will take many years.”
Question 3. What do schools of public health need to do to help with the solution?
Clearly, the schools of public health can help the primary care crisis by encouraging generalist training and helping to devise creative ways to deliver primary care to all populations.
Today, Dean Klag, you and the Alumni Awards Committee took a step for health reform by honoring the Physicians for a National Health Program, an organization of 18,000 physicians and health professionals who advocate and educate for single-payer, publicly funded national health insurance (www.PNHP.org).
The JHU Bloomberg School of Public Health is the world’s public health school. Today you recognize alumni addressing health needs in sub-Saharan Africa and other global populations, and also right here, in our own backyard. We look for your continued leadership in healing America’s suffering from its broken health care system.
References
Schoen, C., Osborn, R., et al. “How health insurance design affects access to care and costs by income in eleven countries.” Health Affairs, December 2010.
Wilkinson, R. and K. Pickett. “The Spirit Level: Why Greater Equality Makes Societies Stronger.” New York. Bloomsbury Press, 2009.
Geyman, J.P. “Breaking Point: How the Primary Care Crisis Endangers the Lives of Americans.” Friday Harbor, WA: Copernicus Healthcare, 2011.