By Marsha Fretwell, M.D.
Citizen Times (Asheville, N.C.), March 30, 2018
In contrast to Gov. Roy Cooper’s and the Mission Administrative Physicians’ gallant effort to put a positive spin on the possible conversion of our Mission Health from a non-profit status to for-profit status under the management of HCA Healthcare of Nashville, I would like to present strong opposition to the proposal. As a retired physician whose practice was 97 percent supported by Medicare, I was able to experience directly the joy of practicing under a nonprofit single-payer insurer. I was able to focus on the needs of my patients without concern for their ability to pay. I now refer to myself as “The Last Happy Doctor” to demonstrate the demoralizing effect of for-profit insurance on the practice of medicine.
In this country, we have been experimenting with the ”free-market,” or for-profit system of health care, since the late 1970s, early 80s, giving us nearly 40 years to actually see how this economic model is working. How has this strategy of for-profit financing of health insurance, prescription medications, hospitals, some specialty physicians, and medical equipment providers affected the rest of us…the taxpayers, the employers and individuals purchasing these products, the front line primary care providers, and all recipients of this care?
Comparing ourselves to other industrialized countries that provide universal coverage over this period of time, we have seen only increases in health care costs and diminishing health outcome such as infant mortality and average life span. We have some of the highest costs and are not even covering everyone (more than 22 million individuals remain uninsured). Many of our primary care physicians are leaving practice due to the stress of trying to provide patient centered care in a system that is designed for maximizing profits, not patient outcomes. Finally, the uncertainty and continually rising cost of insurance coverage is threatening the economic viability of our American employers and our city and county governments, and the financial security of many individuals, thereby increasing the frequency of chronic physical and mental illness.
An additional and critical issue, not often discussed in the public and political arena, is: What is the impact of our unequal and unjust health care system on the spiritual and moral life of our nation? Recently in Asheville, the educational organization HealthCare for All WNC sponsored a nonpartisan conference where representatives of the major faith traditions each spoke passionately to the moral obligation of health care. They were unanimous in support of providing heath care to all. Our earliest ancestors were hard-wired in their brains to care for their infants, and for each other, and that wiring persists to our modern times. Why did and do these neural pathways exist? Because families, villages, communities, states, and nations will not survive if they, in fact, do not care for each other. Caring for each other is critical to the survival of this nation. We have already experienced the cyber barbarians interfering in our elections. What further evidence of our vulnerability do we need?
I choose to work toward nonprofit health care coverage for all because I see it as an opportunity to heal some of the painful fractures in our nation and re-establish caretaking as a value common to all citizens in our country. The major argument from those benefiting in power and money from our current system is that a nonprofit system of universal coverage is utopian, idealistic, and won’t work. Well, as outlined above, the for-profit system in place for 40 years has not worked to either lower prices or improve patient outcomes. Secondly, we are not seeking the creation of an “ideal” model of care. We are merely seeking to reduce the inequality and social and economic injustice of the current economic model of care. Other countries of a variety of sizes and ethnic compositions have already demonstrated that having a nonprofit payer of health insurance reduces costs and improves outcomes. This payer must also have the authority to negotiate prices of all prescription medications and health care or medical services.
We are at a crossroads in this nation. We must, and are free to, each make a choice about which economic and moral model will best support our health care system. We can either choose a nonprofit single payer health insurance system that provides adequate health care for all our citizens, or we could choose to continue in a system that is not only unequal and unjust, but has already demonstrated that it is economically not sustainable. The ancients write of societies that are generous, compassionate, and truthful as opposed to those that are greedy, hateful, and living in a delusion. Which do you choose? Make your choice. It is time for change.
Dr. Marsha Fretwell is a retired geriatric medicine physician living in Asheville, North Carolina. She is a member of HealthCare for All WNC (www.healthcareforallwnc.org) an affiliate of Physicians for a National Health Program (www.pnhp.org).