By Greg Silver, M.D.
Orlando Sentinel, October 12, 2017
The patient looked terrified when she showed me her broken arm that wouldn’t straighten out. “What am I supposed to do?” she asked.
She was a waitress, about 25 years old, working to support her family. She had broken her right arm near the elbow several weeks prior and was seen in a local emergency room. Since she had no insurance, she couldn’t afford the follow-up visits. So the arm healed crooked, and it was now difficult and painful for her to hold a tray.
She was scared of losing her job. I wished I could tell her everything would be OK, but that wasn’t true. What should have been a straightforward treatment process was cut short due to cost, and now she would need surgery to fix it. Without insurance, she couldn’t possibly afford surgery, but she also couldn’t afford to lose her job. I didn’t have an answer.
I’ve been a primary-care physician for 30 years, and these conversations have become heartbreakingly routine. Consider the 45-year-old hairdresser with severe hip arthritis, in constant pain, barely able to stand and work. He badly needs a hip replacement but, without insurance, what is he supposed to do? Or the 63-year-old paralyzed on his left side from a stroke, but who can’t afford to see his doctor or buy his medicine. He knows that he is at high risk for another stroke, or worse. Feeling hopeless he told me, “I hope the next one just kills me.”
Sadly, these stories are uniquely American. Only in America do we force millions of fellow citizens to beg for charity care, suffer the economic cost of huge medical bills or file bankruptcy. Not surprisingly, we live shorter lives with worse health outcomes — life expectancy and infant mortality, for example — than most other industrialized nations. According to the Annals of Internal Medicine, 18,000 Americans die each year from a lack of insurance.
It doesn’t have to be like this.
In the richest nation on Earth, we already spend more than twice as much as other nations that actually provide universal health care. Even with the Affordable Care Act, we leave 28 million people without any coverage. Those with workplace insurance plans face skyrocketing costs: The average family of four pays $11,685 in premiums and out-of-pocket costs per year, and from 2005 to 2015, average deductibles rose 229 percent. Sixty percent of those filing medical bankruptcy actually had insurance coverage when they got sick.
The root cause of our system failure is the private insurance industry and its wasteful bureaucratic complexity, fragmentation and profit motive. We desperately need a streamlined single-payer program that would provide universal coverage for all Americans, such as Rep. John Conyers’ House Resolution 676 and Sen. Bernie Sanders’ Senate Bill 1804. This type of “Medicare for all” system works like today’s Medicare, when all medical bills are paid for by a single government fund, and patients can visit the hospital or doctor of their choice for all medically necessary care.
Can the U.S. afford this? We currently spend more than $3 trillion per year on health care; nearly two-thirds of that is already paid for by your tax dollars. By cutting out the private insurance middlemen and negotiating drug prices, we could easily save $500 billion per year, enough to expand coverage to everyone.
As noted Princeton Professor Uwe Reinhardt once said, “The issue of universal coverage is not a matter of economics. Little more than 1 percent of gross domestic product assigned to health could cover all. It is a matter of soul.”
Medicare for All is efficient, it has been proved, and it’s simply the right thing to do. One day I hope that when a patient looks me in the eye and asks, “What am I supposed to do?” I’ll have a real answer for them.
Dr. Greg Silver practices urgent care in Pinellas and Pasco counties. He is a Florida-based member of Physicians for a National Health Program.
