Dr. James C. Mitchiner
Ann Arbor (Mich.) News
March 7, 2010
Count me among those who were not terribly disappointed at the outcome of the recent Senate race in Massachusetts to fill the un-expired term of the late Sen. Edward Kennedy.
The election of Scott Brown, a conservative Republican who until recently was an obscure state senator, in a state well known for its liberal politics, should be construed as nothing less than a revealing denouement of the Democratic health reform agenda. Nor should the outcome of this election be seen as an unanticipated surprise; well before the historic Jan. 19 vote, there was indeed a sense that the Massachusetts voters were collectively acting as the nationās proverbial ācanary in the coal mineā for the Democratsā ambitious social agenda.
Exit polls suggested that votersā concerns over the scope and speed of health care reform provided the primary motivator for their electoral decision. Whether the reforms proposed by the Democratic congressional leadership were too radical, too costly, too confusing or too partisan for the taste of the average independent voter, one conclusion is certain: health care reform, in its current iteration, made people uncomfortable. Clearly, the proposed health bills are unnecessarily convoluted, bureaucratic and controversial. And if Brownās election provides the 41st vote needed to scuttle health care reform in the Senate, perhaps he has done the country – and the Democrats – a big favor. Itās not that I want to wait the next 16 years for yet another attempt at overhauling our deplorable, inept and inequitable health care system. Rather, I join the chorus of those, particularly the Republican congressional leadership, who are demanding that we start over on health care reform. We can begin by recognizing what works: Medicare. Yes, Medicare has its faults. It underpays doctors and hospitals, is going broke, is subject to fraud (although perhaps not to the extent that some claim), and has its own bureaucracy. But it also has an established infrastructure, provides universal coverage and is highly popular among senior citizens.
In terms of reimbursement, its apparent pecuniary stinginess stems from doctorsā need to pay their office overhead, which of course can be traced to the extra costs and time spent dealing with our rapacious for-profit health insurance industry. And the way to āsaveā Medicare from its impending bankruptcy is to expand its risk pool by incorporating younger – and healthier (read: less costly) – beneficiaries, and pay for it through a more progressive tax structure than what now exists.
In other words, we need to extend the benefits of Medicare to all Americans by creating a universal, equitable, portable and more cost-effective single-payer Medicare-for-All health care system.
Single-payerās mischaracterization as āsocialized medicineā can be remedied by educating citizens to understand that a single-payer system will permit them to go to the physician and hospital of their choice, an option they lack now because they are limited to a provider within their health planās network.
Single-payer will permit them to have health insurance coverage independent of their job, and even if they are unemployed. Single-payer will stay with them as they switch jobs or move from state to state. A single-payer system will simplify billing, capture administrative economies of scale, and provide uniform benefits, including coverage for pre-existing conditions. And single-payer will reduce racial, gender, financial and geographic disparities of care.
In his State of the Union address last month, President Barack Obama asked rhetorically, āBut if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me knowā¦. I’m eager to see it.ā
Well, Mr. President, I know of a solution that will meet all those goals: a universal, single-payer, Medicare-for-All program. Iām eager to see it, too.
Dr. James C. Mitchiner is an Ann Arbor emergency physician and the former president of the Washtenaw County Medical Society.