By Patrick Neustatter, M.D.
The (Fredericksburg, Va.) Free Lance-Star, June 27, 2020
A long time ago, when you could do these things, I and retired local family physician Dr. Jay Brock met Dr. Ed Weisbart for breakfast at the 2400 Diner—no mask, no hand sanitizer, huddled up close in a booth.
Remember those days?
Weisbart is a family physician and assistant professor of clinical medicine at Washington University in St. Louis. He is a spokesperson for Physicians for a National Health Program and was recently in the area to talk to medical students at Georgetown.
PNHP is pushing the idea of single-payer national health insurance. The organization has more than 22,000 physicians signed up—including Jay and me.
Although this was a while back, I have repeatedly deferred writing about PNHP because this all-consuming pandemic claimed my attention. But I am getting to it now, partly because the pandemic has given a new urgency to PNHP’s message.
People are losing jobs—and with it, of course, their health insurance. Because of this, the prediction is people will skip doctor visits for their diabetes and blood pressure, or screening tests like colonoscopies, mammograms and pap smears, and get sick.
It’s also predicted bankruptcies will increase—as medical bills are cited as the leading cause of filings.
Not a Fantasy
We three family physicians in a huddle over breakfast quickly got into the weeds. The nitty-gritty of the industry and premiums, policies, co-pays, deductibles, preferred providers and so on.
Weisbart seems like a nice guy, but you could be forgiven for thinking the claim he and PNHP are making, about what could be achieved with a single-payer health insurance, suggests that he’s a little off his trolley.
But the numbers have been crunched, he says, and the conclusion is that we can provide universal coverage for everyone, everywhere—including prescriptions, vision, dental, mental, reproductive, long-term and nursing home care. All with no insurance premium, no deductible, and no co-pay, pretty much for what we’re spending now.
The U.S. spends trillions of dollars (twice as much per head as most equivalent countries), but doesn’t get particularly good health care.
The savings from getting away from “inefficient profit-orientated multiple insurance companies,” where each company has its own administration, billing services, marketing and, of course, shareholders, would be about $500 billion plus a year. The claim is that with these savings, plus what we spend on Medicare and Medicaid, and the addition of modest new taxes based on ability to pay, we could afford it.
And apart from the finances, the current setup is also undesirable because insurance companies call the shots, and have doctors and hospitals competing, not for patients, but to be a provider for the most desirable insurance companies.
This allows the insurance company to be selective about who it will insure. And they try to avoid the sick, expensive patients. In the industry, this is called “lemon dropping.”
Alongside PNHP and its supporters, there are, of course, detractors—especially in the health care industry.
“When I saw the Affordable Care Act pass, I was encouraged to think something like single-payer health care could also be possible” Ed told us. But, unfortunately, despite the name, the ACA has not made health care affordable. And the unaffordability is “disproportionately borne by middle- and lower-income Americans,” he says.
With everyone enrolled in single-payer health care, the collective bargaining clout you could wield on drug companies, medical device companies, hospitals and doctors, would be huge.
Look at the VA, which, unlike Medicare, is not forbidden by law from collectively bargaining. It has negotiated incredible drug prices—“far better than pharmacy benefits companies like Express Scripts ever could,” he said. (Weisbart used to be its chief medical officer.)
However, these super-profitable companies providing health care are like any other. Their mission is to make money. They won’t go quietly. And every politician is always thinking about reelection.
These companies can afford to donate a lot to politicians. “What health care spends on lobbying makes other industries’ contribution look tiny,” noted Weisbart, pointing out that “for each member of Congress, there are two health care lobbyists just from the pharmaceutical industry” alone.
One issue that some may worry about is government overreach. They think this would be a national health service.
“It’s not. It’s a nationally run insurance program,” Weisbart said. The government wouldn’t own the doctors and hospitals. They would still be independent and a privately owned.
And one other stumbling block is the idea of new taxes. But, if you are not paying insurance premiums, or those other out-of-pocket health costs, you’ve got a lot of extra pocket money to afford a small extra tax.
To implement this, “We don’t need to start from scratch” Weisbart pointed out. “We’ve got a system that’s working already.” That system is, of course, Medicare.
Sen. Bernie Sanders’ and Rep. Pramila Jayapal’s proposed Medicare-for-all bills “have considerable support in Congress” he notes.
As we mopped up the last of our, maybe none-too-healthy breakfasts, Ed was philosophical.
There are always opponents, and they’re always trying to spread “FUD”—another of his healthcare industry neologisms standing for “fear, uncertainty and doubt.”
“The current health care system is unsustainable” he noted—and says the students he speaks to get it. “They are real worried about their future.”
We should be, too.