By Dr. James Cockey
It’s wonderful to see the recent interest by The Daily Times in health care policy. Our current health care financing system is simply not working. It costs too much and is giving us far too little in return.
I do want to correct The Daily Times’ editorial of Feb. 11, in which the following statement was made: “If we expect coverage for everything, we should take another look at socialized medicine.”
The only socialized medicine model I have seen in the United States with full centralized government control is the Veterans Health Administration system.
No one I know is advocating full government control of health care. Many of us are advocating universal health care coverage, along the lines of Medicare. No one currently considers Medicare “socialized medicine,” although its detractors used this epithet in 1965 when it was being created.
I appreciate the comments of my friend and colleague, Dr. Frank Arena. I do, however, dispute a few of his positions. While the health care of the VHA system has historically not always been the best, recent studies in major medical journals document its superiority to community hospitals on most quality indicators, largely due to extensive use of computerization to meet quality standards.
I also disagree on the relative complexity of Medicare billing. Billing the multitude of private insurers is far more difficult, requiring more employee expertise and time, than the comparatively straightforward and uniform Medicare regulations.
Our patients also have the added advantage of knowing Medicare will cover expected services and do not face the horror of huge uncovered bills due to fine print exclusions of coverage.
The virtues of high deductible health insurance are not as clear to me as they are to Arena. As soon as we advance the idea that “your premiums are fixed and you can’t be canceled as long as you pay the premium,” we are out of a marketplace insurance system and instituting a variation on national health insurance, with premiums fixed either by the government or some quasi-governmental organization. The for-profit health insurance industry depends on risk and premium stratification to maintain profitability.
A high-deductible, catastrophic coverage health plan creates the illusion of increasing consumer choice. It works for well-off, healthy people who can afford the high deductible for routine care and low-cost procedures. It does not work well for poor people, who can barely afford housing and food for their families. It does not work at all for sick people, who would be priced out of the catastrophic market.
Arena’s letter described single-payer, universal health care as “Utopian socialist.” “Utopian” literally means “nowhere.” Variations on single-payer, universal health care are firmly in place every where — in every other industrialized nation on earth. The United States is the only industrialized nation on earth that does not have such a system.
We also spend twice as much per capita on health care as most of the rest of the industrialized world, with health outcomes that place us low compared to other countries. It’s difficult for me to see where universal health care is any more “socialist” than universal public school education or universal rights to libraries or public roads.
Our health care system endangers our economic competitiveness. It bankrupts too many of our friends and neighbors, and does not effectively protect our health compared to the rest of the world. The only reform on the table which addresses all these problems is a single-payer, universal health care system: Medicare for all.
I hope there will be more articles in The Daily Times about health care financing, more letters to the editor and increased pressure on our politicians to act on this very real crisis.
* Dr. James Cockey lives and practices medicine in Salisbury.
