By Ewell G. Scott, M.D.
The Journal of the South Carolina Medical Association, February 2009
Bottled water and health care reform have a lot in common these days. How, you say? Well, let’s take a look. Americans now consume treated water in throw away, plastic and polluting containers with refreshing labels, the water itself costing two thousand times as much as that flowing from a water cooler, or our own faucets. In a word, absurd. Ditto for our insistence on continuing to include private health insurance companies as the mainspring of financing health care.
Organized medicine’s resistance to meaningful, sustainable and affordable health care reform is reaching that level of absurd incomprehension. Our medical associations persist in clinging to our failed for-profit patchwork system of employer-based private health care insurance. The official reasons of our largest physician organization are rather weak: To “preserve choice” and a “pluralistic system” are the two oft stated. Indeed, Dr. Arnold Relman, former editor-in-chief of The New England Journal of Medicine, states in his recent book[1] that he can find no evidence that the extra cost imposed on the system by the private for-profit health insurance companies has any benefit.
Thankfully, according to Dr. Aaron Carroll’s recent Indiana University poll of individual American physicians[2], judgments are changing. A majority of us now favor a single-payer program with progressive sustainable funding. Some specialties, such as psychiatry, often a victim of private insurance company negative bias favor single payer to the tune of 85 percent. Even surgeons as a group, for whom hospital insurance was devised, like it better than the present state of affairs.
Polling of regular folks has long shown the majority favor the single-payer approach. But politicians and organized medicine persist in pushing for “incremental” or “consumer driven” change. We all know these labels mean: “no change” and “have the employee pay a greater share of the cost,” respectively. Politicians are running scared of the deep pockets of the private health insurance companies when they tiptoe up to the problem by promising to continue and increase the huge costs of marketing, patient and doctor de-selection and denial of care. A recent survey revealed that only 7 percent of all of us felt secure about financing future health care needs. This astoundingly low fraction underscores and documents our national anxiety level.
Why are our professional organizations out of touch with their own membership? Are they afraid that things will get worse, or our offices will be flooded with the economically unwashed? Will we take a cut in pay? One thing is known for sure. If a simple, uncomplicated financing system were in place, overhead for the practicing physician would drop significantly. A back of the envelope ciphering in my own practice predicts a $30,000 decrease in my billing and collection expense.
As a humane society we must and should believe that access to health care is as much a right as is clear air to breath and pure water to drink. A corollary, and perhaps a bigger hurdle, is that a progressive method of financing must be in place. Is it not bottled water absurd to know that Mr. Bill Gates’ heath insurance premium is the same as your Wal-Mart greeter’s?
It is time for the most important cog in the health care machine, the physician, to get busy and become actively involved in solving this disgraceful situation.
Whatever system finally evolves must have the ability to restrain the cost of medical care, as our resources are indeed limited. Are imaging systems which provide a high definition view of our internal organs giving us better outcomes than a carefully performed history and physical examination? It would seem that our capacity to provide the former is increasing, while the numbers of us trained to do the latter are diminishing. Priorities are out of whack when we spend nearly twice as much per capita as other industrialized countries, and yet the World Health Organization ranking places our system in the mediocre range.
Based on results of our recent national election, it now seems clear that we believe in access to health care for all, and that poor folks have to have some economic assistance achieve this. So, we make a choice. We can accomplish it in an efficient way with a single-payer approach or we can continue with our current wasteful reliance on for-profit private health insurance companies. Subsidies and vouchers would be obviously required, and would be constantly changing. Can you imagine the complicated procedures these would involve?
And another thing: the system must be the same for each one of us. Who wants the “basic plan,” but not the “comprehensive “one? Nobody! We should all have competent medical care from the beginning of life until the end of it. It can be done.
Ewell G. Scott, M.D., F.A.C.P., practices internal medicine in Morehead, Ky.
1. Relman, Arnold, “A Second Opinion,” 2007
2. Carroll, Aaron and Ronald T. Ackermann, “Support for National Health Insurance among American Physicians: Five Years Later,” Annals of Internal Medicine, April 2008.
PNHP note: This is a slightly edited version of the article that appeared in The Journal of the South Carolina Medical Association, Vol. 105, No. 1, February 2009.
https://www.scmedical.org/content/journal