By Patrick Neustatter, M.D.
The (Fredericksburg, Va.) Free Lance-Star, October 5, 2019
The other day, I went on a crusade.
I was, however, just a tag-along. The crusader was retired Fredericksburg family physician Jay Brock, who went to tell members of the Lake of the Woods Democrat Club why they should support single-payer, “Medicare for all” health care.
“If you were starting from scratch,” Brock told the audience of some three dozen, “no one would invent a system like we have now.”
He pointed out the $3.5 trillion we spend on health care in the U.S. is twice as much per person as the average industrialized country. “But though many of us get excellent health care, it’s too unaffordable for too many, so health outcomes in America lag behind the world’s other advanced nations.”
It is a system that does not provide good overall care. Infant mortality is twice that of Scandinavian countries, and ranks 51st in the world overall; maternal mortality has doubled between 1991 and 2014 and is worse than in Kazakhstan.
And we still have 30 million uninsured; somewhere between 40 million and 80 million under-insured; and 643,000 bankruptcies a year because of medical bills.
Under-insured and Unaffordable
Under-insured is a relatively novel but rapidly growing business where the patient has large out-of-pocket expenses. As I noted before, my wife, Paula—who is the picture of health—pays about $800 per month in premiums but has a $6,000 deductible to meet before the insurance kicks in.
“What’s the point in having health insurance you can’t afford to use?” Brock asked his audience.
“We have enough money in the system to cover all needed care for everyone, including vision, dental, mental health and long-term care in nursing homes,” Brock told us. But the problem is, we lose somewhere between $400 billion and $750 billion paying for administration, billing services, marketing and profit for a multitude of different private insurance companies, a massively profitable pharmaceutical industry, hospitals like five-star hotels, and many other businesses that are in the health care game.
Overhead is about 20 percent for the industry as a whole in the U.S., he told us, whereas the overhead for Medicare, and the Canadian single-payer nationalized health care system—which Brock knows about because he trained at McGill University in Montreal and worked there as an assistant professor before coming to Fredericksburg in 1980—is only about 2 percent.
Don’t take my insurance away!
Single-payer is a shorthand for a system that would use the money in the system far more efficiently. Having one insurance vendor would massively simplify the whole business, but primarily if there were no private companies whose fiduciary responsibility is making a profit for their shareholders—which is a conflict with paying for patient care—there would be those extra billions to pay for more care. “Insurance companies don’t treat the patient. They’re just very expensive middlemen,” he noted.
Members of the audience were prompted to ask a lot of questions by this provocative presentation—including the often-voiced “but you would be taking my insurance away!”
“We would not be taking insurance away,” Brock replied, “merely replacing private insurance with a much more efficient, simplified system—probably provided through a government entity of some kind—that would cover all medically necessary care and without additional out of pocket costs.”
“And it’s not socialized medicine,” he explained to another questioner. If it were a socialist set-up, the government would “own” the providers and hospitals (which is the case with the Veterans Administration, which employs its own doctors.)
It would basically be an expansion of the far more efficient government-run Medicare, and so is often touted as “Medicare for all.”
No One HAS it Right
None of the presidential candidates are promoting a bill that is perfect, noted Brock, who has made his presentation to 20 audiences and has bent the ear of many of the local politicians. Their plans either don’t go far enough, or would take too long to implement—though both Bernie Sanders and Rep. Pramila Jayapal have sponsored strong “Medicare for all” bills and have more than 100 co-sponsors.
Together with 20,000 odd other physicians, including myself, he is a member and supporter of Physicians for a National Health Program, and was somewhat dismayed that some of the politicians he spoke with had not heard of PNHP.
The inequality in health care, to my mind, is a reflection of the wealth inequality that the country is suffering from as a whole. Fixing it again comes back to what the bottom line always seems to be: Getting our politicians to confront the massive clout of the rich, and therefore powerful, private industry and build a health care system that will provide what many people think of as a human right—effective, affordable health care for everyone.
Look for Brock on his white horse in shining armor (or at least his Hyundai and dress pants) on his crusade to fight for a fair shake for the sick and ailing, with whom he is all too familiar from caring for them for so many years.
Dr. Patrick Neustatter of Caroline County is the author of “Managing Your Doctor: The Smart Patient’s Guide to Getting Effective Affordable Healthcare.”