By BRIAN ETTKIN
Times Union (Albany, NY)
Saturday, May 23, 2009
In Andrew Coates’ first week as a doctoral intern in Cooperstown, he learned a harsh reality that disturbs him to this day: His ability to care for patients is inhibited by their ability to pay for health care.
“As a brand new intern, I went to my teachers and I said: ‘How can I have only learned the state-of-the-art practice of medicine when the ability to pay trumps our ability to provide that? I can’t prescribe the drug that I want to because the patient can’t afford it. I have to question whether or not I can order the test I want to because the patient can’t afford it. What are we going to do about this?’
“And so then began for me a very serious process about how I could make a difference on behalf of all of the patients.”
Coates, an Albany internist and professor at Albany Medical College, sits on the board of directors of Physicians for a National Health Program and is secretary of PNHP’s Capital District Chapter. He has advocated for single-payer health care for more than a decade (he recently started blogging on the subject at http://blog.timesunion.com/coates/) and is scheduled to speak at the single-payer lobby day and rally Wednesday at the state Capitol.
At a pair of U.S. Senate Finance Committee meetings on health care access and coverage earlier this month, 13 medical practitioners and single-payer advocates were arrested when they protested that a single-payer advocate was not included in the discussion.
Coates, 47, speaks thoughtfully and argues persuasively for single-payer health care. A married father of three children who lives in Delmar, he speaks from personal experience too.
After Coates’ father-in-law, Tom Williams, retired from his managerial job at Chrysler in Detroit with “gold-plated” health insurance, he was diagnosed with a rare sarcoma in his knee.
“The history of this tumor was that it would spread, and very few of the patients would survive a year … very, very few patients would survive five years,” Coates said.
Coates said his father-in-law’s insurance covered health care provided by the surgical oncologist with the most experience treating that type of sarcoma. Through treatment, Coates said, his father-in-law was cured and his leg saved.
But about five years after the start of his father-in-law’s treatment at the Mayo Clinic in Rochester, Minn., Coates said, he received a letter from his health insurer that stated, in effect: “Congratulations, you have lived five years. We will no longer pay for any follow-up for the care of your cancer. We have paid enough money for the care of your cancer.”
“And that’s the gold-plated health insurance,” said Coates, who paused to compose himself several times as he recounted his father-in-law’s story. “That’s the Cadillac coverage that the conservatives decry.”
His father-in-law’s cancer has not recurred.
Wearing a bow tie and a sweater vest over a button-down white shirt, his long sleeves rolled up on a workday, Coates sat down for an interview this week with the Times Union, excerpts of which follow:
Q: What’s at stake in the single-payer debate?
A: As I’ve gotten deeper into this cause, I begin to understand that it’s a question of the American democracy. Of course I believe that health is a human right, I passionately believe that. I recognize that’s not a universally shared viewpoint. But health is a necessity of modern life, an unbelievably expensive necessity of modern life, and the only way to provide the necessary care for the sick is for us to share the costs somehow as a society. So I really believe that this becomes a test of the democracy and whether we will have the will to do what’s best for the people and best for the health of the nation, or will we choose profitability of a particular industry as the nation’s priority.
Q: Some government agencies, it’s been noted, don’t operate efficiently. Why should we believe a single-payer health care agency would behave differently?
A: We have how many health insurance companies in the United States, how many different plans, how many different processes on each level? I think it’s over 1,500. We have a massive tangle of bureaucracy now. How many different fee schedules, how many different plan options are there? How many formulary and prior authorization systems? There’s a massive bureaucracy. We have the model of Medicare, which works with as little as one-tenth of the overhead costs of the private insurance industry. We have a positive model, and then we have a massive bureaucracy right now.
As far as the question of you can’t trust the government: I realize that many of us all our adult lives have heard that everything private is good and everything public is bad, and even though I scratch my head and wonder what kind of a people that want to live in a democracy would say such a thing, I realize that that’s kind of a political reality that we live with. I don’t believe that a single-payer system would be perfect. I just believe that would be vastly superior to privatization and profiteering at the expense of the sick.
The health of individuals and the health of people are too important to leave to people who are trying to make a buck. It is the proper role of the public to say so.
Q: How do you respond to critics who decry this is socialism?
A: There are some services that the public has to share. I was being interviewed on the radio once and the caller said, “Isn’t this socialism?” It was (WAMC’s) Alan Chartock who said, “Oh, right, socialism, like the fire department, socialism like the public schools, socialism like the interstate highway system — next caller.” And even with that said, single payer is not a proposal that the government should own the public health care system. It’s a proposal that the government should manage the money that pays for the care privately delivered.
Q: Has the absence of a single-payer system directly affected you as a patient?
A: My own physician dropped my insurance. I have the Empire plan, and over many years, the Empire Plan, which went from not-for-profit to for-profit status, has become increasingly impossible for many physician practices to deal with. So I myself am in the process of finding a new physician who will take my health insurance. These things intervene in all our lives.
Brian Ettkin can be reached at 454-5457 or by e-mail at bettkin@timesunion.com.
Critical condition
More than 45.7 million Americans lacked health insurance in 2007.
More than 18,000 adults die every year from lack of health insurance coverage.
Every other developed nation has some form of national health insurance, and yet U.S. health spending is far higher — 56% higher than in Switzerland, which has the world’s second-most-expensive health care system, and 83% higher than in Canada.
A survey published in 2008 found that 59% of U.S. physicians support national health insurance.
A survey published in 2003 found that administrative expenses consume 31% of U.S. health costs, nearly twice the proportion of Canada’s administrative expenses (16.7 percent).
Sources: U.S. Census Bureau, Institute of Medicine of the National Academy of Sciences, Organization for Economic Cooperation and Development Health Database, Annals of Internal Medicine, New England Journal of Medicine.