By Harvey Fernbach, M.D., M.P.H.
Yale Medicine, Spring 2017
Cathy Shufroās review of EMBRACE, by Gilead Lancaster, M.D. [Yale Medicine, Winter 2017], encouraged me to read it. Although well-intended, the author made two significant errors in his approach to universal health coverage. He strongly believes that for-profit insurers still have a role, even after years of bad experience by patients, hospitals, and physicians. For-profit insurers are known for cherry-picking customers, steering patients away from specialists, and denying and rationing care for profit. Second, he favorably compares his approach to the Canadian single-payer program and leaves out H.R. 676, Expanded and Improved Medicare for All Act, which has 79 co-sponsors in the U.S. Congress. With input from Physicians for a National Health Program (PNHP.org), H.R. 676 offers comprehensive care for all, is not linked to employment, and would establish a universal single-payer health care system. This means medical, surgical, mental health, dental, prescriptions, hospitals, and long-term care, with no out-of-pocket costs. Numerous studies have demonstrated that this could be done with the same amount currently spent on health care. In 2013, United Health axed their contract with the 1,200-physician Yale Medicine practice, causing harm to many. We can do better with single-payer simplicity.