Conversations with … Quentin Young, MD

By George Lundberg, M.D.
MedPage Today

Transcript:

GEORGE LUNDBERG, M.D.: Hello, and welcome. I’m Dr. George Lundberg, editor-at-large for MedPage Today, and we are in Chicago taking an opportunity to have a conversation with a famous name: Dr. Quentin Young. Dr. Young, thank you so much for being with us.

QUENTIN YOUNG, M.D.: It’s a pleasure.

LUNDBERG: Dr. Young has been a practicing internist at Hyde Park for many decades. At one time, he was chairman of the Department of Medicine at the Cook County Hospital.

YOUNG: Yes.

LUNDBERG: I believe he’s been an AMA member since 1952.

YOUNG: Exactly.

LUNDBERG: Something like that. In other words, he was once the president of the American Public Health Association. But for the past couple of decades, or maybe 25 years, he’s been best identified as a physician leader for the United States on trying to get basic health care for all Americans, preferably through a single payer type system. His organization is called Physicians for National Health Policy.

YOUNG: Well, that’s a very generous introduction. It’s actually National Health Program, but the “P” is …

LUNDBERG: National Health Program, all right. Say it right.

YOUNG: Physicians for a National Health Program.

LUNDBERG: There you go.

YOUNG: And what’s interesting in my professional lifetime and yours, physicians have become, in this issue, much more liberal. They used to think of the government as the really huge enemy. Now they’ve found something worse than government: Corporations.

LUNDBERG: But why hasn’t the single payer movement, which I have always opposed the name — I think it should be “main payer.”

YOUNG: Okay.

LUNDBERG: Rather than “single,” because Americans hate monopoly.

YOUNG: Yes.

LUNDBERG: They want to have an escape valve of some sort.

YOUNG: Yes.

LUNDBERG: But anyway, despite the fact that Medicare gets very high ratings from patients and many doctors now, and the surveys of physicians …

YOUNG: Yes.

LUNDBERG: …are moving more and more towards the idea of a single payer. But it doesn’t have traction with the government or with the Congress. What’s wrong?

YOUNG: Well, as the power of corporate sector, 20 years at the most, there was no organized corporate medical delivery system, but this was a huge profit center, and for the last 20 years, we’ve seen the disappearance of private practice. And, yes, my colleagues in the medical profession, conservative as they are, have finally found something they hate worse than government, and it is the corporations. They lose the autonomy, which is really, as you well know, really central to the whole medical care transactions.

LUNDBERG: So physicians in America, many of them are unhappy.

YOUNG: To say the least. And while their income isn’t that bad, and we have to be honest about that, their autonomy is. And the domination of the system in the best sense, where doctors made the decisions in collaboration with their patients, that’s almost all gone. And another decade and we’ll have a corporate system with huge salaries and rewards at the top, and people, ordinary doctors and people at the bottom will have a hard time getting decent care.

LUNDBERG: But are you suggesting that in a Medicare-for-all type approach, physicians would have more autonomy?

YOUNG: I think so. It’s not guaranteed. We physicians will always have to assert our autonomy. But that’s what good medical systems are, based on doctors’ capacity to take the facts, interview the patient, and come up with the best answer. It’s a real paradox. Patients really like the medical profession, they trust their doctors, and yet doctors have lost a huge amount of their autonomy; they really don’t have control of the system. And that’s one of the items that we think is going to make national health insurance possible.

LUNDBERG: Well, when we’re having this conversation, we’re all waiting for the Supreme Court to issue its determination.

YOUNG: That’s right.

LUNDBERG: About the constitutionality, or the political acceptability, in some ways, of the Affordable Care Act. We don’t know how it’s going to shake out. What do you think?

YOUNG: Well, for the first time in my life, I think I don’t have the answer. There are two possibilities, they’re quite opposite, and either one could happen. I think the Supreme Court is divided four and four, liberal/conservative, and with Justice Kennedy having the swing vote. And from the preliminary interviews where he heard the arguments on both sides, he seemed like he was inclined toward outlawing the present bill, and I’m no legal expert obviously, but I think he may be right. And as soon as you take the Affordable Care Act off the table because you deem it unconstitutional, you have only two alternatives at marketplace, which is a fiasco, and also single-payer, or, as you would have it, Medicare-for-all.

LUNDBERG: So you would see an overturn of the Affordable Care Act as an opportunity for your movement.

YOUNG: Well, we certainly don’t vie for it, and we don’t have near the political power that would make it happen, but the answer is Yes. I think as soon as they rule, if they rule it unconstitutional, then they have to have an answer. You know very well, you’ve probably said many times, we spent twice as much per capita for our health care with 50 million people out of the loop; that’s ridiculous. And the health care economy is threatening the larger economies, coming to 18 percent of the gross domestic product, and I think we have to fix it fast or our nationhood supremacy is going to go in decline. I really feel that way.

LUNDBERG: I believe almost everybody now agrees with that point of view. I’ve been talking about the excess costs of medical and health care for 25 years probably, but it just keeps going up. But now I believe most people agree with the notion that it’s too expensive. If the court were to say only the …

YOUNG: Mandate.

LUNDBERG: … individual mandate was unconstitutional, the rest went forward, would this be an opportunity to put the public option back on the table?

YOUNG: I think so. There are different states approaching this; some are well along the way. Vermont comes to mind, Hawaii, California, for that matter. But on the other hand, there are many states that are in the clutches of very conservative forces, and in my mind, in the clutches of the corporate sector, and it’s really an abomination. As you know, I’ve been a doctor for some 60 years and enjoyed the entire run, but they’re making it very hard for patients to get the benefits of modern medical science, and the public is learning about it. I think they’re discouraged that they get sick and … actual finding themselves in a dreadful circumstance with bankruptcy as an alternative.

LUNDBERG: Right. I think one of the good things about the Affordable Care Act and all the discussions about it is that a great number of the public have learned a lot more about the system — its faults, its frailties, its difficulties — from the education of the discussion of this, even though the discussion about it has been largely partisan and sometimes filled with faulty information. Nonetheless, there’s been a lot of education about it.

YOUNG: Well, certainly, and it’s born out of necessity. People need health care at one point or another.

LUNDBERG: Of course.

YOUNG: When they’re born or when they’re late in life. But the system is not working; it’s not responsive. I’ve been in practi
ce since World War II, and I saw it, in my eyes, how the confidence and attraction of the health care service — what we doctors gave — slowly went away and became a medical anomaly and became very, very hard for people to get decent care.

And as the triumphs of medicine work against it, people are living longer, meaning they have more years to be ill.

So we have a very crucial fight. And I’m active in the Physicians for a National Program, as you’ve pointed out, and this is my valedictory. I’m pretty old, and I had to have some way, at the end of my life, and I’ve chose national health insurance. It’s going to be hard, because the opponents are extremely wealthy, extremely capable of resisting real reform, but I think it’s the only solution. And I don’t mean for the health system; for the economy. We can’t tolerate the kind of exorbitant costs associated with the present system.

And we think, and we feel it, that the public doctors on one hand and the general public as patients on the other have come to believe that the only way to get out of this mess is to join the rest of the world, and that’s worth noting. All of the other countries that resemble us, you know, that have an industrialized and capitalist kind of system, have all chosen to have a national health service, and they all do better. They have longer life expectancies. They have freedom from diseases that are preventable. It’s just something we shouldn’t put up with.

LUNDBERG: Right. Well, thank you very much, Dr. Quentin Young, for being with us today. Thank you for your lifetime of dedicated service to individual patients and trying to make things better for all people in the United States. We’ll all see what happens and look forward to further reactions.

YOUNG: Exactly.

LUNDBERG: Thank you for being with us. I’m Dr. George Lundberg, at large for MedPage Today.

Dr. George Lundberg is editor-at-large at MedPage Today.

http://www.medpagetoday.com/PublicHealthPolicy/GeneralProfessionalIssues/35173