HEALTH CARE / ‘Economic Power Must be Regulated with Prudence’

‘Economic power is headstrong and vehement, and if it is to prove beneficial to mankind it must be securely curbed and regulated with prudence.’ — Pope Pius XI, May 15, 1931.

Government and single payer health care: Caving to the special interests

By Dr. Stephen R. Keister / The Rag Blog / March 19, 2009

This past Sunday I made an exception to my usual regime and watched Meet the Press. From the ongoing discussion two points stood out:

1.) In Europe the “recession” was as prevalent as it is here in the United States However, the level of public anxiety is much more tempered since the majority of Europe’s social democracies have excellent ongoing health care for all; the state sponsored educational systems, through university level — if the student is qualified — are intact, and the unemployment insurance is much more extensive.

2.) During the presidential campaigns none of the candidates discussed help for the poor, and since the inauguration of President Obama there has not been a whisper. Yet the campaign was marked by the sub-rosa text concerning which candidate was a “better Christian!” Perhaps one should recall the Homilies of St. Basil: “The bread that you store up belongs to the hungry; the cloak that lies in your chest belongs to the naked; and the gold that you have hidden in the ground belongs to the poor.” Again, I noted previously that a survey showed that 70% of American “Christians” had not read the Sermon On The Mount!

Why mention these two subjects? Health care is currently one of two items on the front burner for many Americans. Yet we must concede that those blessed with wealth can avail themselves of much better care, such as boutique care at a well known clinic, while the poor are relegated to the Repug’s treatment place of choice, the local emergency room. The rate of chronic disease is statistically much lower among the well-to-do than among the underprivileged. Of course, the other subject in the headlines is the unconscionable executive bonus fiasco within AIG and the other Wall Street financial firms. There are parallels which we will allude to later.

The recent White House Conference on Health Care was a sham as far as the delivery of a program of health care to the citizens of our nation. I have seen no in-depth discussion of the proceedings in the mainstream media; however, there have been a number of excellent expositions of the underhanded back-scratching of the insurance industry on the internet. For the sake of brevity I will call attention to the article by Helen Redmond at SocialistWorker.org, “Left Out From Obama’s Health Care Summit.”

Universal, single payer health care as promoted by Physicians For A National Health Program and Rep. John Conyer’s HR 676 were all but disregarded save for late permission for Dr. Oliver Fine of PNHP to give the single presentation for single payer/universal care.

Interestingly, in the March 13, 2009, Time Magazine there is an article regarding the “gang of nine” in the United States Senate at work producing a plan as a sop to the insurance industries with an estimated cost of approximately 40% more than that propounded by Dr. Fine at the White House conference. Of course, there is no reason to suspect that Dr. Fine and PNHP are dependent on the financial largesse of the insurance companies and the pharmaceutical industry. Further, all the plans, save that of Rep. Conyers and PNHP, hint at the need to require by government fiat that the underprivileged purchase private health insurance. This matter was addressed from the standpoint of constitutionality in my last Rag Blog article.

All of this deferential treatment of the insurance cartel, despite the fact, reported by Bloomberg News on March 11, 2009, that the cost of private insurance has increased in price by 119% for family coverage, since 1999. Yet, every 30 seconds someone in the U.S. files for bankruptcy because of their medical bills. and an estimated 18,000 Americans die each year because of lack of insurance. In a recent poll cited in Op-Ed News, 74% of the public endorsed a “public health insurance plan like Medicare.” This is confirmed by a separate poll in the Huffington Post of the same date showing that 73% of voters approve of a public health insurance plan. Further details are available in Barbara O’Brien’s excellent posting on AlterNet, “Why Conservatives Are Radical on Health Care”

President Obama has shown insight regarding health care at several levels: his opening up of stem-cell research, his executive order regarding the availability of contraceptives, and his recent appointments of Margaret Hamburg and Joshua Sharfstein to the top positions at the FDA. It is gratifying to see people with professional knowledge and integrity, without peripheral connections to the pharmaceutical industries, replacing the Bush hacks that have threatened our pharmaceuticals and food supply for the past eight years.

Yet, in spite of these encouraging moves it would appear that the Obama administration is giving way to the same pressures and incentives from the health insurance industry and pharmaceutical makers that were evident in his appointment of members of the Wall Street gaggle to his Treasury Department and as White House economic advisers. As for health care, one would have expected, from the campaign promises, new faces providing the lead in health care, as one might have expected from an economic team (Krugman, Stiglitz for example) rather than the tired old bunch of Milton Friedman acolytes that ended up overseeing the AIG and related messes. Perhaps, to avoid becoming a one term president, Obama should listen intensely to the voice of the people rather than caving in to the powerful forces that underlie the Washington establishment. There still may be time. Once again the president blew it regarding the Charles Freeman affair by bending to the will of a small but wealthy interest group.

In the entire health care discussion, and I have eluded to this on prior occasion, there has been only minimal discussion regarding the physician shortage, especially among GPs and internists, in this country. In France, for instance, there are enough physicians, with excellent academic back grounds, to make house calls!

If we can ever offer medical care for all there just still would not be enough physicians to provide adequate and thoughtful care. Hence, we must immediately address getting more doctors available, not specialists from India, or exotic specialists trained in the USA. I have previously suggested government subsidization of medical education, in the European model, or creation of a medical academy, such as the Naval Academy at Annapolis, with stipulations that after internship the graduates spend six years in a medically deprived area. Another unique institution has recently appeared in this area, a free standing Osteopathic College of Medicine. This is not affiliated with a university which envelops multiple doctoral programs, nor is there an affiliated large university hospital teaching/research complex. It amounts to what in Europe would be considered, perhaps, an advanced trade school. I had content for three or four years with the students, who tend to be older than those in the university affiliated medical schools, while an attending physician at a local free clinic. These students are intense and devoted and have a first rate passage percentage on the state/national boards. One problem, as with the conventional medical schools, is the high indebtedness upon graduation, that forces them into high paying specialties.

One is delighted to see the growing populism and public anger regarding the bungled health care and economic situations. However, as an old man I am cautious and I have noted several other authors expressing concern that the anger dare not take to the streets as it does in Western Europe. Here we are confronted by a totally different culture that does not tolerate public outcry very well. The progressives and liberals are not cohesive, but tend to be diverse and willing to debate and argue. The right is organized, dominated by rite and ritual, unquestioning of their leadership, and could quite easily put brown shirts on the NRA and follow the “man on the white horse.” We have discussed the Weimar Syndrome previously.

We must keep up a continual barrage of messages to our “representatives,” alluding to the fact that we are aware of their subservience to the powers of the lobbies (which we can confirm on opensecrets.org). We must have local gatherings of unions, civic organizations, and progressive groups and petition our elected representatives. We must write letters to the editor, realizing that many will not be published (as is the case here with The Erie Times News) if they show an overly “liberal” bent, or conflict with the wishes of the newspaper’s advertisers. (Unfortunately, those that appear here seem to be chosen on the basis of eighth grade writing ability and thought processes. It must be emphasized to local governments, as well as to employers, that single payer, universal care, will result in considerable financial savings with employee coverage. Some states like Pennsylvania are pushing state-wide single payer, universal coverage, we must back their efforts with will and determination. Again, this has a chance of passage with help of the citizens. One should note that the MSM is not broadly involved in the discussion.

I intended to refer once again to the matter of physician payment, systemic corruption and waste in research and academia, the immorality of health costs and advertising, the rip offs of the public by the pharmaceutical industry, but with my editor’s permission will broach these matters later.

[Dr. Stephen R. Keister, a regular contributor to The Rag Blog who lives in Erie, PA. He is a retired physician who is active in health care reform. His previous articles on The Rag Blog can be found here.]

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