By Laura Ungar
Monday, January 30, 2006
The (Louisville, KY) Courier-Journal
It is the paradox of America’s medical system: While hands can be transplanted and the tiniest babies kept alive, many people cannot afford to see a doctor and live with the threat of financial ruin if they get sick.
Francene Shepard of Louisville had a heart attack in 1999, needed stents to open blocked arteries and ran up about $50,000 in medical bills that went unpaid.
Ian Copeland, a 27-year-old self-employed carpet cleaner who lives in Louisville, goes to the emergency room when he’s sick because he cannot afford a private doctor.
“It’s a gamble,” said his mother, Michelle Copeland. “If something happens, it could be devastating.”
Such stories are increasingly common and are leading to growing support among some politicians and medical groups for implementing a national health system offering care for all, including the 45 million Americans and more than half a million Kentuckians without health insurance.
Earlier this month, the Kentucky House Health and Welfare Committee voted to urge Congress to pass a bill, introduced by Democratic Rep. John Conyers Jr. of Michigan, that would expand Medicare to cover all Americans.
The bill would create a “single-payer” health-care system, publicly financed and privately delivered. All Americans would have access regardless of employment, income or health. Each year, the program would set reimbursement rates for health-care providers and negotiate the cost of prescription drugs.
Critics say such a measure would be too costly and unwieldy, but the passion of supporters was evident when the Kentucky House committee vote was called, and Rep. Kathy Stein, D-Lexington, answered: “Hell, yes!”
Conyers’ office and the group Physicians for a National Health Program are watching Kentucky and hoping that the General Assembly will back the effort.
“It would be historical to have a Southern state endorse universal health care and medicine for all,” said Joel Segal, a legislative assistant for Conyers who handles health-care issues. “This is a life-and-death crisis for many people.”
A possible groundswell
A 2002 report by the Institute of Medicine, which advises the federal government on health issues, said 18,000 adults die each year because they lack health insurance. Overall, the United States has a lower life expectancy than several countries, including Canada and the United Kingdom, that have national systems.
“The health-care system is in a deepening crisis,” said Dr. Steffie Woolhandler, an associate professor of medicine at Harvard University and co-founder of Physicians for a National Health Program. “The public is quite fed up.”
There are signs that the idea of a national system has increasing support here:
A poll last year by the Pew Research Center found that 65 percent of Americans favor national health insurance, even if it means higher taxes.
An Indiana University poll, published in the Annals of Internal Medicine in 2003, said 49 percent of doctors support government legislation to establish national health insurance, while 40 percent oppose it.
Membership in Physicians for a National Health Program, meanwhile, has risen from about 10,000 to 14,000 in recent years.
City councils have passed resolutions in support of the Conyers’ bill in Morehead, Ky.; Baltimore; and Erie, Pa.
Locally, Conyers’ proposal has gained support from the Kentucky Psychiatric Medical Association, the Louisville-based Falls City Medical Society, and Dr. Adewale Troutman, director of the Louisville Metro Health Department.
A faction of the Kentucky Medical Association also supports the idea of a national health system, said its president, Dr. Daniel Varga.
And although Varga and others say they doubt that the United States will be ready, philosophically, to enact a national health plan anytime soon, experts say the debate points to a growing dissatisfaction with the status quo.
That sentiment has been reflected in polls such as one released last week by the Center for American Progress and the Service Employees International Union, which found that nearly nine out of 10 Americans think the current system is broken.
Opposition to proposal
Although opponents agree that the problem of the uninsured must be addressed, they say a national system would drive up taxes, stifle medical innovation and lead to waits for services.
“If you think you can get free health care and you don’t have to pay for it in some way, you’re being naĆÆve,” said Robert Moffit, director of the center for health policy studies at the Heritage Foundation, a Washington-based conservative think tank.
Moffit pointed to a proposal for a state-level universal plan in Oregon that would have required a new personal income tax of as much as 8 percent and a payroll tax for businesses of 3 percent to 11.5 percent.
In addition to tax increases, Moffit said, “once the health-care dollar becomes a part of the federal budget, it competes with education and other priorities.”
State Rep. Bob DeWeese, R-Prospect, a retired physician who voted against the Conyers resolution in the Kentucky House committee, also expressed concern about rising taxes.
He said something must be done about the growing number of uninsured Americans, but “we don’t have to change the whole system to fix this problem.”
Proponents argue that a national health plan would save money. In recent years, increases in insurance premiums have far outpaced inflation. A summary of the Conyers bill says 95 percent of families would pay less for health care under the plan than they do today.
Moffit argued that ultimately, the quality of care would suffer with a national setup, partly because such systems generally don’t invest as much in medical technology.
He also pointed to waits for services. One recent survey by a Canadian economic think tank called the Fraser Institute — which seeks to bring attention to the issue of market competition — found that waiting times there between referrals and treatment averaged 17.7 weeks across specialties last year.
Proponents of national health care say that concern is overblown.
But Julia Costich, chairwoman of the department of health services management at the University of Kentucky, said the Conyers bill stands little if any chance of passing, partly because it calls for such sweeping change.
“I applaud their ambition,” Costich said of proponents, “but it seems very far-fetched.”
Idea spreading
Kentucky is not the first state to show support for a government-run health system. Some states have gone so far as to move toward their owns plans. In Oregon, where voters rejected a single-payer proposal in 2002, supporters are pushing for another measure in 2008.
In Ohio, a coalition claims it has collected tens of thousands of signatures in support of such a plan and hopes to put the issue on the ballot next year.
Maine already has a program offering affordable health-care coverage that aims to cover all uninsured residents eventually.
Dr. Garrett Adams, a retired physician who heads up the Kentucky chapter of Physicians for a National Health Program, said universal health care is a matter of fairness and humanity. His group prefers a national system to state efforts.
Adams said the problems faced by the uninsured are particularly acute in Kentucky, which was shown in a recent Courier-Journal investigation to be among the least healthy states in the nation.
“This is so wrong,” Adams said. “They’re real lives. They’re people.”
Shepard, a 51-year-old home health aide who spoke before the state House Health and Welfare Committee, said that since her heart attack, she has been diligent about getting care at the Family Health Centers’ Portland clinic.
But with a low income, specialized care can be a struggle.
A national program would help her “and others like me who fall through the cracks,” she said in an interview.
One patch of common ground for supporters and opponents is the belief that the current U.S. system has serious problems.
A 2003 ABC News/Washington Post poll showed that more than half of Americans are dissatisfied with the quality of health care, the first majority in three polls since 1993.
Sandie Limpert of Louisville, a 53-year-old graduate student who has gone half her adult life without health insurance, said she believes the system is in such disarray that a major overhaul would be better than small reforms.
“It’s like we’re trying to plug our fingers into the dam,” she said. “But it’s only a matter of time before the whole thing cracks and explodes.”
Reporter Deborah Yetter contributed to this story.
