By Jonathan D. Walker, M.D.
Frost Illustrated (Fort Wayne, Ind.), June 13-20, 2012
Part one of two
When it comes to overall health, African Americans tend to do much worse than average. A few examples: according to the Center for Disease Control, death rates for black Americans surpass those of Americans overall for heart disease, cancer, diabetes and HIV. According to a study published in Health Services Research, white males live approximately seven years longer than African American males, and white women live more than five years longer than black women. Finally, African Americans fare far worse when it comes to infant mortality-their rate is almost double the national average.
There are a lot of different reasons for all this. Part of this is genetic – some diseases are simply worse for African Americans, such as prostate cancer and glaucoma (a disease of the eye). Another part of the problem is cultural; African Americans as a group tend to be more apprehensive of the health care system and are less likely to go to a doctor. Other factors include a person’s level of education and income – these can play into lifestyle choices regarding smoking, diet and exercise.
But there is also one huge problem that contributes to this negative outlook for African Americans: lack of insurance. And nowadays, most private insurance plans include such high out-of-pocket expenses that it can be too costly to see a doctor, even if someone has insurance. This is known as “under-insurance,” and it is becoming as much of a problem as having no insurance at all.
How did we end up with so many people – and especially African Americans – struggling to get the health care they need? The answer is complicated, but the basic problem is that we have a very fragmented health care system that consists of a lot of different entities that are looking for ways to maximize profits. Insurance companies deny coverage to anyone they think might cost them money, and keep huge amounts of money that should be used to take care of patients. Drug companies have seen to it that our government cannot bargain over drug prices – as taxpayers, we have to pay whatever price they want. Hospitals are built where the most profitable patients are, often leaving poorer areas with little coverage. Doctors may refuse to see patients who don’t have enough money. The bottom line is that if there are people who aren’t profitable, those people are left out.
It would be great if we could point to one thing to fix. But, there isn’t one thing – the whole system is broken. And, it is even more complicated because everyone in the system feels like they are doing the right thing. They feel they are helping people and want to get their fair share, and it is really hard to convince someone that they might be part of the problem if they believe in what they are doing. The only way people really learn about how cruel our system can be is if they happen to get sick – then they experience firsthand what it is like to have to worry about going broke or bankrupt to stay alive. But most people don’t get sick, so they think everything is OK and they keep the broken system we have because they are afraid to change – especially if their income depends on keeping the system the way it is.
America is the only country in the developed world that is like this. Every other developed country has realized that it is better to make sure that everyone gets the treatment they require. And, that’s something to think hard about. No one in those countries has to worry about whether they can pay the bill for themselves or someone they love – they just get the care they need.
Now, we have been trained to think that all those other countries must be bad; that people have to wait for care and that they are always letting people die to save money. No health care system is perfect, but you should study the problem yourself – don’t just accept what the special interests are saying. You will see that a lot of what we hear is either an exaggeration or just plain wrong. It is hard to imagine how all those people, in all those countries, would be putting up with health care systems that don’t take care of them.
There are a number of ways to design a health care system so that everyone gets the care they need, and even have it be cheaper and with better results compared to our current system. But, no one looks closely at this because powerful special interests work very hard to keep it off the table – special interests like insurance companies, drug companies, hospital associations and doctor organizations. However, there is one man who is trying to change that. He is Representative John Conyers Jr., an African American congressman from Michigan, and in the next installment we will look at what he is trying to do to make all of our lives better.
Dr. Walker is an ophthalmologist in town and a member of Physicians for a National Health Program.
http://www.frostillustrated.com/atf.php?sid=10446
Eye on health
By Jonathan D. Walker, M.D.
Part two of two
In the last installment of this story, we reviewed how African Americans tend to do much worse in our health care system. For instance, death rates for black Americans surpass those of Americans overall for heart disease, cancer, diabetes and HIV. We also discussed that there are a number of reasons for this disparity, ranging from genetics to personal lifestyle choices. But there is one other very important reason — there are more African Americans without insurance. And, that problem arises because we have a very fragmented health care system that has placed profits over patients, so that too many people are left out. And, people who are left out get sicker and die sooner no matter what race they are.
It is important to understand that America is the only country in the developed world that is like this. Every other developed country has realized that it is better to simply make sure everyone can get the treatment they require. Think about that. No one in those countries has to worry about whether they can pay the bill for themselves or someone they love — they just get the care they need.
But, special interests work hard to keep us from exploring those other health care systems. And, they especially like to scare us with stories about Canada. There are problems up there, but the situation is actually much better than you
might think — most Canadians would never switch to a health care system like ours. Besides, Canada is only one of many countries — we don’t have to use their approach.
There are many other ways to design a better health care system. For instance, back in the ’90s, Taiwan was having the same health care problems we are having here. So they looked at every other system in the world, and they ended up deciding that our Medicare system looked pretty good. (Medicare is the government insurance plan for people who are disabled or over 65.)
In the end, Taiwan actually ended up improving on Medicare and now the government negotiates with doctors, hospitals and drug companies to set fair prices, and everyone pays a small tax that is much less than what we pay private insurance companies for coverage in America. Citizens even have smartcards that hold their medical history, so their records are always available. The Taiwanese can see any doctor they want, anytime, and no one worries about getting sick and going broke. And, their health care is as advanced as anywhere in the world. Plus, their businesses are freed from the burden of providing insurance; they can compete much better in the global market because everyone is automatically covered from birth to death.
And, remember that their system is based on our Medicare. Medicare is not perfect, but Americans with Medicare are happier than those with private insurance, and much happier than those with no insurance or under-insurance. All you have to do is ask anyone on Medicare if they want to give it up and buy private insurance — you will see. Plus, you are paying into Medicare with your taxes already. But, you are forbidden to use Medicare for yourself unless you are over 65 or disabled — insurance companies have seen to it that you can’t have something that you are paying for. And, Medicare certainly has problems, but most of them stem from the fact that lobbyists and special interest groups have rigged Medicare to pay out far more than it should. Our health care system would be much better if we improved Medicare and expanded it to cover everyone. This approach is known as a “single payer” system — everyone is paid by one entity rather than by a host of different payers.
It so happens that an African American congressman, Representative John Conyers Jr. from Michigan, has introduced a bill known as “The Expanded and Improved Medicare for All Act,” H.R. 676. This bill would: (1) automatically enroll everyone in the plan, (2) provide comprehensive services covering all medically necessary care and drugs, (3) allow free choice of doctor and hospital, (4) eliminate all co-pays and deductibles, (5) create a public, nonprofit agency to pay all the bills, simplifying administration, paperwork, and bureaucracy while saving an estimated $400 billion annually, (6) finance care through progressive taxation, with people paying less than what they are paying now for private insurance, (7) boost job growth by reducing the burden of health costs on businesses, (8) provide powerful cost control tools like bulk purchasing and global budgeting for long-term, sustainable savings.
It would not introduce “government rationing”— it would be really hard to ration anything if we all were depending on it and paying close attention to how it is run. It would eliminate the real rationing that we have right now that is based on the patient’s ability to pay — if you have money you get care and if you don’t, you won’t. In fact, such a system would restore the doctor-patient relationship by removing barriers created by both private insurers and lack of money. It would be transparent and publicly accountable, fair and efficient — if there were problems we would all want it fixed because we would all be part of it. No one would ever have to worry about getting sick and going broke again, and it would be cheaper because we wouldn’t be wasting money on insurance companies, bureaucracy and paperwork.
Dr. Martin Luther King Jr. once said, “Of all the forms of inequality, injustice in health care is the most shocking and inhuman.” And he was not just talking about African Americans — he was talking about anyone that is afraid to see a doctor because they can’t afford it. Every other developed country in the world has figured this out, but we ignore them. Our politicians are so influenced by special interest groups, and we are so stuck in thinking that we have to keep the system we have, that we put up with the same expensive, fragmented mess – even if it means that any one of us could be bankrupted at anytime if we get sick.
It would be great if people would look at Rep. Conyers’ bill and realize how much sense it makes. It would be even better if people started to demand that we at least try what he is suggesting — if for no other reason than we are all already paying for it but can’t have it. Mostly, it would be best if no one ever had to fear going to a doctor because of medical bills, and no one ever had to grow up experiencing the inequality of health care that Dr. King was talking about.
Dr. Walker is an ophthalmologist in town and a member of Physicians for a National Health Program.
