By David Ray, M.D.
Times Union (Albany, N.Y.), July 29, 2019
The creation of Medicare 54 years ago this month dramatically decreased the impoverishment of America’s senior population due to medical bankruptcy, at the same time measurably improving health care outcomes by assuring access to affordable care.
Health care eats up $3 trillion, 17.9 percent of the total expenditures in the U.S., dwarfing all the other sectors, including military spending. Of this, nearly $1 trillion is spent on administrative costs and inflated charges that add no value to our care.
As a physician, I’ve spent the majority of my 40-year career caring for marginalized and uninsured patients. Over that time, I’ve certainly witnessed the unfortunate consequences of falling through the cracks in the health care system. But recently, I entered the system myself as a patient following a serious accident, and had an opportunity to view, from the inside, the indignities and failures of patient care that are attributable to a system that answers to many masters. In short, what I experienced was in many ways a parody of health care in which I could see the invisible hand of the market in every aspect of my hospitalization. No opportunity for charging was missed (scanning my bar coded armband preceded every encounter) and no infraction of the myriad insurance rules, however irrelevant to my care, was tolerated, to make sure that no bills were contested or reimbursements reduced by one whit.
This was powerful reinforcement for my core belief that our system needs to be overhauled from top to bottom, to rein in cost, removing the many overseers (for-profit insurance companies, pharmacy benefit managers, hospital rating organizations) who drive that cost. Did I get what I needed? Mostly. Am I fortunate enough to have insurance to cover the lion’s share of what will undoubtedly be an astronomical and incomprehensible bill? Yes (by virtue of age I’m a Medicare subscriber). But did the experience confirm what I have felt to be true about our health care mess for decades? Sadly, also yes.
As health care has risen to the top of our national conversation, there has been a tsunami of misinformation propagated by the vested interests in the health care system.
Will a universal Medicare-type payment system limit our access to our doctors? No, providers will continue to see their patients in their offices as they do now, but won’t spend their time begging to be paid for their work.
Will there be rationing of health care? Research on wait times has shown that in existing single-payer systems, urgent care is not delayed at all, and elective care wait times are comparable to ours. Regarding rationing, we have devised the cruelest system possible — if you are uninsured or have huge copays and deductibles, you are likely to never get the care you need.
Does private insurance have to disappear? No, many of the high-functioning, cost-effective health care systems in other developed countries (such as Germany) permit a parallel, but very highly regulated, private insurance system. Insurers are forbidden to deny services or raise premiums without clear justification, and they are nonprofit companies.
Will the transition disrupt our economy? No, it will increase the freedom to seek a higher-paying job or start a business without fear of losing health care coverage, and make our industries more competitive in the world market.
There are many unbiased sources of information about the economics of our health care system available, such as Kaiser Health News or the website of Physicians for a National Health Program.
Improving and expanding Medicare to the entire population makes sense, and there is room for compromise and protection of individuals’ rights if we can convince our representatives that this is what we expect of them.
Dr. David Ray of Menands is the chair of the Capital District Alliance for Universal Health Care and a member of Physicians for a National Health Program.
