Uncommon sense on health care

By Alan Bavley
The Kansas City Star, March 29, 2015

Joshua Freeman is chief of family medicine at the University of Kansas Hospital and an inveterate blogger.

He started his “Medicine and Social Justice” blog in 2008 calling for universal health care coverage and has returned repeatedly to the subject. That’s because even though the Affordable Care Act makes coverage available to many people, Freeman doesn’t think it goes far enough.

And while politicians dare not speak its name, Freeman isn’t shy about what he thinks we need: A single-payer, Canadian-style system covering everyone.

Freeman recently gave me an advance copy of his new book, “Health, Medicine and Justice: Designing a Fair and Equitable Healthcare System,” laying out his arguments.

It’s a fine primer on the tangled web of special interests and ultimately futile regulation that passes for a health care system in this country. (Truth in punditry: Freeman cites my reporting in his chapter on the role of profit in health care.)

Freeman provides telling anecdotes: His experience treating uninsured patients whose chronic illnesses were out of control because they couldn’t afford care. His discovery in New Orleans of a safety-net clinic sponsored by Qatar — which means America, the richest nation on Earth, accepts foreign aid to care for its poor.

He’s also good at taking points often made by others and making connections. Yes, we know we spend more on health care than other wealthy nations and despite that, our people aren’t particularly healthy. But the U.S. also spends less on social services, he observes, the kinds of things that elevate people from the poverty that degraded their health in the first place.

But the poor don’t have political clout. Health care providers and insurers do. So that’s where the money goes. “We have a health care system that is designed to make profit rather than health,” Freeman says.

According to Freeman, a single-payer system — basically, Medicare for all — would go a long way toward putting the focus back on patients. It would eliminate the crazy quilt of insurance plans that drive up administrative costs. And it would set more equal and rational payments for medical services. Providers could still compete, Freeman says, but it would be on the basis of quality or personal style.

Perhaps Freeman’s most compelling argument is that a system covering everyone would unite us all, rich and poor. We would all have an equal stake in making sure providers were adequately paid and delivered high-quality care, and that everyone had access to that care.

But Freeman sees health care as a basic human right. That’s still a subject for debate in the United States.

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