By Susanne L. King
Berkshire Eagle
LENOX
I WAS talking to colleagues this week about the health care reform bills currently before the state Legislature, and realized once again how complex and confusing this topic can be, even for health care professionals. All involved in health care reform are using buzzwords like “universal” to appeal to residents of our state, 650,000 of whom are uninsured, and 350,000, underinsured. We are a beleaguered population that is literally dying for change.
The Institute of Medicine has described five principles for health care reform: coverage must be universal (covering everyone), continuous (not tied to a job), affordable to individuals and families, and affordable and sustainable for society. In addition, coverage should enhance health and well-being by providing access to high quality care that is effective, efficient, safe, patient-centered and equitable.
Gov. Romney has proposed a plan with a mandate that everyone in Massachusetts must buy health insurance, with partial subsidies for individuals who earn less than $28,710. Romney’s plan would rely on the for-profit insurance industry to provide “bare bones” coverage, which would include deductibles and co-payments. His plan would control costs by tightly regulating expenditures for the poor, but would still leave patients with massive medical bills and possible bankruptcy after an expensive illness. He would enforce his mandate by taking away tax refunds or garnishing wages. This is a tax from a governor who says he’s against new taxes. And as usual, the middle income population would be hardest hit.
Both Senators Robert Travaligni and Richard Moore have also sponsored legislation for health care reform. They also use buzzwords like “health care for all” and “universal.” These words sound good, but are not indicative of what these bills would provide if they were enacted. Sen. Moore’s complex proposal would expand MassHealth and pay for health insurance subsidies for low income workers. Travaligni’s bill would provide tax deductions for health savings accounts and also expand MassHealth enrollment. Both would add more cost to the system, without providing health care for everyone.
In all three plans, choice of provider would be limited by the insurance coverage offered by an employer, or by the patient’s income. This is not equitable or patient-centered. Nor are the plans continuous, since they depend on a person having a job. Finally, they would not be affordable, because they rely on the for-profit insurance industry. Patients would still have to pay insurance premiums, co-payments, and deductibles, that make insurance policies unaffordable.
The only bill that could truly provide universal, continuous, patient-centered health care, that is affordable for both individuals and society, and is sustainable, is the Massachusetts Health Care Trust Legislation, Senate Bill 755. This is the “single payer” bill. All the buzzwords are actually true about this bill.
What single payer means is that the government would collect and dispense the health care funds. In other words, the government is the “single payer” since insurance companies are eliminated. Doctors and hospitals would still be private, and patients could choose where they would go and which providers they would see. Patients would have more choices in such a system. Doctors would have reduced administrative costs. Single payer health care would be “Medicare for everyone,” but without the limits and exclusions of the current Medicare program.
The other bills are unable to provide universal, comprehensive care at an affordable price, because the insurance companies take up to 30 percent of the health care dollar, and doctors and hospitals have additional huge administrative costs dealing with the myriad profit-making insurance companies that are reluctant to relinquish the money they have collected from patients.
Chasing the insurance dollar has become a nightmare for doctors and hospitals. And the cost of health insurance has become a nightmare for patients — one family told me their managed care insurance premium for the upcoming year has risen to $17,400.
Dr. Alan Sager, a professor at Boston University School of Public Health, reports that Massachusetts spends $52 billion per year on health care, 39 percent of which is attributed to administration and overhead costs of insurance companies, doctors, and hospitals. He has calculated that we have enough dollars in the health care system right now to cover everyone, and to provide more comprehensive benefits than are currently available now, including medical, dental, prescription drug and long term care benefits.
We do not need health care “reform” that does not provide universal coverage, is not continuous, is not affordable, is not patient-centered, and does not stem the rising costs of health care. For these reasons, we do not need the bills proposed by Romney, Travaglini or Moore, none of which meet the principles of reform elucidated by the Institute of Medicine, and all of which continue to subsidize insurance companies at the expense of patient health care.
Dr. Donald McCanne, past president of Physicians for a National Health Plan, says, “For a long time it has been clear that the single payer model of reform would provide a real solution to our health care crisis. But many voices have remained silent or muffled because of concerns about political feasibility…. It’s the politics. And more and more of us now realize that we must speak up if we ever expect to change the politics.”
The Joint Committee on Health Care Financing will hold a hearing at the Statehouse in Boston on The Massachusetts Health Care Trust Legislation (S. 755) on July 20. It is sponsored and supported by four of the five legislators from Berkshire County, although Sen. Nuciforo has recently pledged his support for Travaglini’s bill as well. He will need to decide which bill he supports, because the single payer bill and Travaglini’s bill are neither comparable nor compatible.
Please contact your legislators and let them know you support Senate Bill 755, or attend the hearing and give your testimony about your health care experiences. Demand that legislators stop tinkering with the current untenable system and go for single payer health care reform.
Susanne L. King, M.D., is a Lenox physician and frequent Eagle contributor.
