By Dr. Charles Katzenberg
Special to the Arizona Daily Star
Published: 06.09.2009
‘I just want to practice medicine well.” If someone asked me what I would like to see come out of health-care reform, that would be my answer. So how do we get there?
In an ideal system, everyone would have basic health insurance. You might call it social insurance. People would have the choice of any physician and hospital. No one would be excluded. No one’s insurance could be canceled. If you moved; got divorced; or lost a job, spouse or partner, you would still have health insurance. It will need regulatory oversight and cost containment. You might have a copayment. You would be expected to take some personal responsibility for your health.
We would sever the tie between employment and insurance. The system would be funded by tax dollars and it would cost no more than we currently spend.
How close does our current insurance situation come to this scenario? Not very. If you examine the benefits provided by private insurance, you will find that beyond helping to pay medical bills, our current insurance offers little. In fact, our current insurance system doesn’t even do a good job of paying medical bills. A recent publication in the American Journal of Medicine demonstrated that almost two-thirds of bankruptcies involved medical bills and most of those having to declare bankruptcy had health insurance at the onset of their illness.
Our insurance system does not help with access to care or cost containment and does not help me in diagnosing, treating or preventing illness. In fact, it hinders access (48 million Americans are uninsured), promotes medical cost inflation and many physicians spend too much time filling out forms or talking to insurance companies to justify tests and treatments.
What system comes closest to the proposal in Paragraph 1? There is such a system. We call it Medicare. No other American insurance product comes close. If we expand it, we might call it Medicare-for-all or “single payer.” President Obama calls it the “Public Option.” The single payer would be the government. It is social insurance. It is not socialized medicine.
Socialized medicine is the VA system: The government employs the physicians and owns the hospitals. Single payer would keep the bulk of physicians and hospitals in the private sector.
Insurance companies are tools to enroll patients, spread risk and provide payments. If we reform health care so that all Americans are enrolled, the risk will automatically be spread among all Americans and payments will come from a single source or single payer, the government.
It’s hard to find a senior who is unhappy with Medicare and ready to rip up their Medicare card. You will find more than 90 percent satisfied Medicare customers. Physician satisfaction with Medicare is also high. We don’t have to rediscover the wheel; we have only to follow its tracks.