By Andrea Parrott
Twin Cities Daily Planet, Dec. 24, 2012
After daily witnessing situations in which patients suffered or had to make decisions detrimental to their health due to difficulties in accessing health care, Dr. Elizabeth Frost and Dr. Ann Settgast had enough. They felt they had to do something that would allow everyone to have health insurance and so, access to health care. The two decided to found the Minnesota chapter of Physicians for a National Health Program (PNHP).
PNHP is a national non-profit organization whose members advocate for single payer health care. The idea of single payer health care is that instead of people paying fees to a private health insurance company, they will pay one fund. Hospitals, doctors, and other health providers would then receive payment from that one fund. Dr. Settgast explained single payer in this way: âSome people use an analogy of ‘Medicare of all’ as a synonym for single payer⊠Itâs an example of a fund where everyone pays into the fund and then that fund pays for health care and private deliverers of health care. So Medicare is like a little micro single payer.”
Twin Cities Daily Planet spoke with the doctors, asking them about the state of health care in Minnesota. The edited interview is below.
What are some personal experiences that led you to advocate for a single payer health program?
Dr. Settgast: Thatâs a great question that could take me like 12 hours to answer. Iâm a primary care doctor so I take care of patients on a daily basis. Every single day I see reasons why we need single payer. A recent one would be a woman who I took care ofâa Vietnamese woman in her early 60s who came in and I diagnosed her with rheumatoid arthritis, which is terribleâshe had terrible swelling of her hand joints. Really deforming joint disease. She was a full-time employee of a company and her husband worked full time as well. Got her to the rheumatologist. Got her on the right drugs. Her joints totally improved. Her pain was eliminated. She was fully functional. Everything was great.
And then, she just didnât show up for like two or three years. One day she just shows up on my schedule⊠So I came into the room. Sheâs a tiny little woman and from the door, I could see her joint was like the size of a golf ballâlike hugely swollen. I said, Iâll just change her name, I said âLynn, what happened? Where have you been?â Since I had seen her, she got laid off from her job and her husband died. And she was only 63 at the time that this happened⊠She didnât have access to health care so she just had to stop her drugs, stop seeing her rheumatologist and her joints deteriorated⊠I didnât realize, but she had turned 65, so she was back. And itâs disgusting because this womanâs hand is ruined and itâs totally preventable. We see this stuff every single day. And itâs inhumane and itâs disgusting as a physician when all you care about is taking care of sick people to see people not access care.
Dr. Frost: A daily basis there are stories⊠Yesterday I had a patient who stopped her birth control and now is pregnant. I also today had somebody who had psoriasis⊠they havenât had it treated in almost a year now because they donât have insurance⊠Again, again, and again, youâre looking at somebody and apologizing for our medical system. âThatâs really unfair. Iâm sorry that happened to you.â You canât just keep doing that again and again. You have to find some other outlet to feel like youâre making a difference on a larger level.
What do you see as the main health care policy issues in Minnesota?
Dr. Settgast: We are leading the nation in the number of individuals with high deductible health insurance plans. The idea is that this would somehow promote personal responsibility. You have a high deductible so youâre not going to go to the doctor unless you really need to because youâre going to be spending your own money. But what that says is that youâre relying on people who arenât doctors to decide whether they need medical care or notâis problematic right there. Thatâs our job: to say, “No, this is not something serious, youâre OK.” People shouldnât be relied on to do that at home. But then the other issue that we know, there is actually good data showing that the higher your deductible, the less care you receive. And thereâs no way to know that that care isnât needed. Youâre much more likely to see conditions being under-managed or undiagnosed. People just arenât going to the office when theyâre sickâŠ
Dr. Frost: I think a big huge policy thing thatâs really going on in Minnesota right now, of course, is the exchanges and figuring out how to set up the exchanges under the Affordable Care Actâthatâs huge. Thatâs going to take up a lot of energy in the next year or two, but I donât know how much itâs really going to solve the problem.
Dr. Settgast: Itâs not going to solve it because all youâre doing is adding this level of administrative complexity when now people can go shopping in this exchange to get their private health insurance. It might help some people to get some policy, but itâs not designing the system so that it will work. Itâs adding more complexity to an already chaotic system⊠You still have these huge billing departments having to bill multiple payers and youâre still having insurance companies take all this money off the top⊠for functions that have nothing to do with health care. Thereâs still a huge amount of waste still in the system and we havenât done anything to change that.
What are some of the main health policy issues that you see facing the nation?
Dr. Frost: I think Minnesota is a little bit ahead of the rest of the nation in the area that weâre talking about⊠Like we already offer Medicaid to adults without children.
Dr. Settgast: Our Medicaid eligibility rules are much better here⊠I have a brother in Indiana⊠if he was here he would qualify for coverageâŠ
Dr. Frost: Weâre talking a lot about how health care is paid for when we do single payer⊠I think Minnesota has some of the largest health care disparities. I know that education is the worst in the nation in terms of disparities⊠I donât know how we compare to other states in terms of health care, but I have a feeling itâs not very good. One of the things that really distresses me a lot is especially the Native Americans have terrible, terrible health care statistics⊠Itâs really, really sad and thatâs a population I work with a lot.
Dr. Settgast: The problems in the nation are the same as the problems here: uninsurance, underinsurance, people not having access to care. Thatâs all in all of the states.
Dr. Frost: Of course the biggest problem is the insurance industry⊠Itâs not like the politicians are in charge and theyâre guiding the systemâno, they need to figure out what the [insurance] industry might accept and then work within those boundaries⊠Our politicians are controlled pretty much by the industry⊠The evidence for a single payer system is so ridiculously strong, itâs really amazing that we werenât able to do more with the Affordable Care Act. Itâs really quite astoundingâthat the Affordable Care Act is such a big deal and it does so little⊠one of things that was not allowed to be on the table, was not allowed to be discussed at all was the idea that the government would purchase drugs for our elderly⊠Now thereâs like a gazillon Medicare Part D plans. Each one of those little plans doesnât have the purchasing power to drive down the price of drugs.
Dr. Settgast: We see the patients who donât take their medicines, or they take them every other day because they have to make them last.
What are some of the main challenges to making changes in health policy?
Dr. Settgast: The health insurers. Because if you look at the polling data, the public supports single payer, physicians support single payer⊠We know you can cover everyone for less cost and give everyone high quality coverage.
What happens in the U.S. is if Iâm the doctor and I see 20 patients in a day and I diagnose them all with the same thing. Letâs say they all have diabetes or uncontrolled sugar. Every patient, depending on their payer, may pay my clinic a different fee because all the payers, the insurance companies, are negotiating with the all the clinics separately⊠so itâs hugely complicated, which is part of the costâall these contract negotiations because everybody gets a different deal and so every patient pays differently⊠Itâs so unequal. And then if youâre uninsured and you come in, you have a totally different cost than what the insurance pays in the next room.
Dr. Frost: Itâs totally unfair. Because youâre uninsured, you have to pay the full price⊠if youâre totally uninsured you have to pay the $300 while the insurance pays $200, and Medicaid might pay $175 and Medicare might pay $215âŠ
What progress do you see in addressing health disparities in Minnesota?
Dr. Settgast: I personally think itâs crazy to try and address health disparities without having a system that covers everyone. I mean how can you really expect to decrease disparities if you have whole portions of the population that donât have any access to the system? You canât do things on a population level if youâre leaving 10 percent of the people out⊠I mean obviously having a single payer doesnât eliminate all health care disparities because a lot of health care disparities isnât necessarily access to the system, but itâs the first step⊠I mean, how are they going to stand on equal footing in terms of their diabetes control or their hypertension control if they donât have a doctor because they donât have health insurance?
Dr. Frost: I think itâs important to differentiate between health disparities and health care disparities because health disparities are, a lot of them are socially determined. So if you donât have a grocery store in the area⊠that will make it a lot harder to eat well⊠So I think separating those two things are important, but in terms of access to health care, I see again and again and again⊠somebody gets out of Medicaid and gets a job and loses their insurance so they canât see you anymore. So once you get back⊠on your feet, you get back into the system, you canât treat those diseases that youâve been treating⊠So itâs that inequality in the health care system, the injustice in the health care system is what makes me so angry, and itâs because I see it every day.
© 2012 Andrea Parrott
http://www.tcdailyplanet.net/news/2012/12/23/mn-voices-health-care-challenges-minnesota-tied-access-insurance-says-physician-advo