By Dr. Richard G. Younge
The Journal News
Sunday, March 18, 2007
I am a family physician, and I work in the Fordham neighborhood of The Bronx.
One day last week as I drove to work I heard a news report about a medical study that had just been published. The study showed that people who come to the emergency room with a heart attack on the weekend do much worse than those patients who develop chest pain during regular business hours. When someone has a heart attack during the week he or she has a better chance of going quickly right from the emergency department to the cardiac care department for an emergency procedure, balloon angioplasty. This treatment can restore blood flow the heart muscle before extensive damage is done. You get better care depending on when you get sick.
The story concluded with the observation that these differences in treatment results could be reduced by assuring that more hospitals have emergency angioplasty available 24 hours a day, 7 days a week. I agree that the health-care system needs to move us toward eliminating the differences in treatment that result from when a person happens to have a heart attack. But this news item got me thinking more broadly about many of the ways that health-care services differ depending on the circumstances under which people get sick – where they live, their income, their age, race or ethnicity and, very importantly, their insurance coverage.
How could the health-care system change to improve care? For a start, we could make the treatment and preventive services of modern health care available to everyone. A national health insurance program that replaced our current system based on private insurers would improve access to care for the 47 million uninsured people in the United States.
Many of the uninsured are children. Providing coverage for all kids would not even be prohibitively expensive, because most children do not get that sick or need expensive services such as angioplasty. Adults – whether they are parents or not – also require comprehensive health insurance, and national health insurance would cover them too. Some people imagine that a national program that covers everyone would be too big and bureaucratic and inefficient. It surprises them to learn that the government insurance program, Medicare that covers the elderly and disabled, spends about 2 percent of its budget on administrative costs. This compares very favorably to private insurers who spend 15 percent or more of the premiums they collect on administration and marketing.
By going to a national health insurance, essentially an improved and expanded Medicare for All system, we could cover all U.S. residents – literally everyone in this country – without spending any more than we already do. We could save the dollars insurance companies spend expensively marketing and advertising their services. We could also save the enormous resources we providers spend trying to sort out who is eligible for which of the existing patch-work system of employment based, government and individual coverage programs. And of course a health-care system that automatically covered everyone would be much simpler, fairer and less nerve-wracking for patients.
In my daily practice, having one insurer working under a national health plan would reduce many of my headaches and frustrations. I would not have to waste precious time and energy figuring out which referral form to use, which specialist takes my patient’s insurance, or which 800 number to call or which rules to follow to try to get approval for services that my patients need. I would not have to rewrite scores of prescriptions because my patients’ employer changed plans. I could focus on patient care. And people would not drop in and out of care or skip important preventive care services because of insurance coverage changes. Nor would they have to worry if they would lose their health insurance if they are so unfortunate as to lose their job.
The neighborhood where I practice has one of the highest rates of uninsured adults in New York City according to the Department of Health and Mental Hygiene’s neighborhood health profile reports. Almost every day I see someone who tells me that they have not seen a doctor in a while because they lost their insurance coverage. Some of them have not had treatment for diabetes, high cholesterol or blood pressure. These health problems put them at increased risk for having a heart attack. Hopefully, if that unfortunate event happens, it will not be over the weekend.
