Health Care
By Hosea W. McAdoo M.D. / The Rag Blog / July 29, 2009
“The Americans will always do the right thing . . . After they’ve exhausted all the alternatives.” — Winston Churchill
After carefully following all the lies, partial truths, myths and wrong ideas I would like to offer some facts and my interpretation based on fifty years as a physician.
First I will try to list facts so you can judge my recommendations.
Our elected leaders have very little collective knowledge about health care and mainly listen to monied lobbyists rather than constituents.
I strongly encourage calling, emailing and writing your deciders; make them listen, that is your job and theirs in a Democracy. Having said that it does seem that they don’t listen to citizens, only to corporate cash.
The AMA is often cited as a voice for American physicians. Only about 19% of physicians belong to the AMA and many of these are retired or belong for the educational benefits. Most physicians genuinely put patient care first. After twenty four to thirty years of education some payback is fair. With the extreme delaying of gratification, few go into medicine purely for money. Most physicians put in fourteen or more hours a day and most work weekends as well. I say all this because about sixty percent of American physicians back a Single Payer system even though it may decrease their income.
Physicians are tired of caring for people who have had to delay care until a disease is too far gone for inexpensive treatment or a good outcome. They are tired of being hassled by 1300 different insurance companies and being paid late or not at all. They are tired of having long time patients moved to another physician because of a job change. They are tired of having the frustration of seeing someone, maybe for free, but not being able to get additional help the patient needs.
We talk of preventive care. Some recent glib TV ads suggest that medical care is only needed for those who smoke, are over weight or don’t eat right. And anyone else should either not be covered or pay a penalty. This is a fairy tale and spending some time in an ER will promptly reverse this thought. First, accidents can happen to anyone. Infectious diseases are no respecter of the fit or unfit. Type I diabetes, Rheumatoid arthritis, much coronary disease, and hypertension are either chronic conditions not caused by poor diet or it’s only one factor. Even if poor fitness was a primary cause, few people live the perfect life and this argument for insurance charges are higher for people who deviate from certain eating standards they should also be higher for football players, race car drivers, divers and those who jog alone at night or have to drive a lot for work.
In all the bizarre recent babble about health care several words and phrases keep coming up. How about “Socialized Medicine,” “care plan unique to America” or “it costs too much.” This is only because Single Payer is off the congressional table and all the new plans require the insertion of private health insurance between the patient and physician with a 30% commission coming off the top.
Some ads suggest one can only retain choice freedom by remaining with private health insurance. Is that what they mean when they give you a list of providers and tell you to choose one for primary care even if your personal physician is not on the list? Medicare is available from any willing provider.
Socialized medicine is what they have in the UK. There physicians are salaried and the hospitals are owned or contracted by the government. This is similar to our VA and military medical systems and was chosen by President Bush and Vice President Cheney during their administration. This system works in spite of problems and has better overall outcomes than does our private insurance system with 18% of the population left out.
The Single Payer is a system with one insurance company: the government. This is like the Canadian system, our Medicare and Medicaid. While Single Payer is unmentionable in the media and in Washington there is no shortage of howling about cost of the plans under consideration. The Republicans say that a small repeal of the Bush tax cuts on the ultra-wealthy is too much of a burden for them to do for their countrymen even as they are relatively under-taxed . The super-rich already have tax breaks that the average American never sees.
If someone mentioned a way to save 30% on all health care covered by insurance it should get attention. Well, it’s Single Payer. The private companies have a 30-33% overhead, Medicare a 3% and the Canadian system is 1.5%. Thirty cents of every dollar you give your insurance company is not giving you care. Ninety-seven cents of the Medicare dollar works for you. You can see where outrageous corporate salaries in the eight figure range drain your dollars. (blogs.webmd.com/mad-about-medicine/2007/08/ceo-compensation-who-said-healthcare-is.html)
A Single Payer system will:
- Cover all citizens.
- Allow freedom of choice of physician.
- Remove the wasted 30% of the health care dollar, the hassle to physicians, reduce wasted personnel who have to sort through insurance of 1300 insurance companies.
- Medicare pays fast with fewer hassles.
- With the extra 30% and collection of funds now going to health care no additional funds will be necessary to cover all with a good basic plan.
I’m sure you have heard the uninformed lately tell us that the American system is the best in the world. While the best we can do in research, education and care potentially can be as good as any country, it has to be averaged for all citizens; when this is done the US falls to 35th to 50thth place in the W.H.O. and other studies.
While those with money or the best insurance get excellent care, read Congress and the President, those with no or poor insurance drag the average down. The Single Payer system will give care to all, raising our overall level to compare with other first world countries. Having one payer will give some price control as Medicare does now.
Citizens must have access to screening procedures such as colonoscopy and mammograms because failure to detect these early cancers early can have devastating results and both diseases are curable with early detection.
The present plans to continue the use of health insurance companies will continue the waste of the first 30% of the health care dollar. Some in Congress suggested that we force all citizens to have private insurance giving the insurance companies another windfall from new clients, with some premiums paid by the government. This continues the welfare to the super rich and a drain on the Treasury.
One foolish Republican Congressman recently suggested that all, even the poor, be forced to purchase some basic kind of insurance. This will make the insurance companies happy, but the client’s inexpensive policy with a deductible of $10,000 will actually have no insurance value because they will not be able to meet the deductible and co-pay leaving them just as they were, but with more money in the pockets of the corporations that steal from the poor and give to the super-rich. This is a very Republican idea.
There are endless examples of the inefficiency of other country’s health care but ask these people for facts; have they talked with those citizens? Do they have an outcome analysis? Have they really looked at and compared with our system? One hears complaints about waiting. In the USA with money any visit or test is immediately available whether needed or not. This is rationing based on money. In Canada there are waits for elective procedures but immediate care for urgent conditions. Yes, it is rationing, but one based on medical need rather than money. There are some in this country who wait forever for any basic or preventative care.
Horror stories abound about delayed care in Canada or the UK but these are more illustrative of error by the primary physician than of the system. Physicians do make judgment errors here as well as in other countries. Watch the TV program, “Medical Mysteries on the Discovery Health network for our own examples of missed diagnosis, delayed treatment and poor care. A recently shown TV ad example discusses a delayed brain tumor in Canada treated promptly in the US. The “tumor” was actually a benign cyst and the ad very misleading. A few minutes on Google will document these falsehoods.
For some good recent discussions see:
Cost of Health Care Reform : Wails of Indignation from the Right and other “RAG BLOG” articles by Dr. Steven Keister and
“THE RAG BLOG”,The Health Care Stories for America Blog
To reach Dr. McAdoo, e-mail him at hwmcadoo@hotmail.com.
Gut feelings can be misleading. Here are some sources and there thousands to open on Google.
Physicians for a National Health Program may be considered biased but represent a huge archive of data from reliable sources which is why they take the stand they do and I do. It is not a belief or feeling but based on data. It does confirm my experiences here and in Canada over the last fifty year.
http://www.medicalnewstoday.com/articles/8800.php
http://www.pnhp.org/facts/singlepayer_faq.php
http://www.pnhp.org/publications/nejmadmin.pdf
http://www.pnhp.org/single_payer_resources/Quality_of_Care.pdf
http://pnhp.org/reader/Section%202%20-%20Health%20Care%20Financing/Hospital%20Admin%20Costs%20+%20For-Profit.pdf
http://www.pnhp.org/publications/payingnotgetting.pdf
Daniel Patrick Moynihan, used to say: “You are entitled to your own opinion, but you are not entitled to your own facts.”
LET’S ADDRESS SOME OF THE CLAIMS IN THE ARTICLE:
1) PRIVATE INSURERS (PI) 30% ADMINISTRATIVE OVERHEAD.
The 30% number is false and cannot be substantiated. It’s folly to expect significant funding from administrative cuts. PI’S goal is profit; do you believe they would leave this kind of money on the table? Efficiencies vary by company, but government bureaucracies are not known for their efficiency. PI administration typically runs 10 – 15%. What the author calls ‘waste’ is mandatory overhead in any system, private or federal.
Beware of comparisons to current federal programs (i.e. Medicare) and Canada. These programs don’t include their cost of funding borne by taxing authorities. They don’t collect premiums and do little marketing. Several in depth studies have shown when all considerations are included; Canada’s TOTAL administrative costs actually exceed the U.S. average.
Most PI’S are public companies, by law they must do costly certified auditing. Federal programs have no audit costs. Another division of government does it for them.
Most PI’S plan administration is far superior to federal administration. They have better paid and educated people, better systems, better controls and more oversight. Billions lost to fraud in the federal programs illustrate this fact.
Lastly, you hear about the drain of high insurance company CEO compensation. The average PI CEO makes about $5M/yr (consistent with CEO pay in most large public non-insurance companies). With about ten large national PI’s that amounts to $50M a year in a pool of hundreds of billions. Compare that to the billions lost in federal program fraud. A single fraud sting in Detroit on 6/24/09 uncovered $50M in fraud – in just one instance!
2) THE 46 MILLION UNINSURED
This group (about 16% of our population) is proffered as justification for a federal program. Keep in mind, all these people actually get health care – they just aren’t insured. Let’s break them down; 14 million qualify for existing federal health care (Medicaid – Medicare) but have failed to enroll or don’t want to pay the minimal premiums. 27 million have PERSONAL incomes over $50k/yr and can afford health insurance but choose to spend their money on other things. Of the rest, most are illegal aliens with little legacy investment in our health care system and who pay little in federal taxes. Immigrants comprise 86% of the increase in uninsured for the period of 1998 – 2003. This group has no money or property so will get free health care under the current emergency services legislation.
3) AMERICA’S HEALTHCARE SYSTEM’S RANKING AGAINST OTHER COUNTRIES:
Advocates of a federal system say the U.S. is 30th or 50th etc. True based on survey outcomes that often include such things as ‘financial fairness’ which skews results to government programs. Many comparisons are apples to oranges. To get the true picture, you must look at the actual statistics.
First; most the ‘top’ 50 are small countries with a fraction of our population and health care demands. Personal health (exercise / diet) is often superior in these countries which greatly contribute to their health regardless of health care system. Americans are typically overweight and exercise little. Our diet consists of processed foods and lacks the portions of fruits and vegetables consumed in many of the ‘top’ countries.
Look at the primary metrics typically used to determine rankings; life expectancy (LE) and infant mortality (IM deaths/1000 births). The difference between the U.S. vs. the European Union vs. Canada is small: LE 78 vs. 78.7yr vs. 80.3 and IM 6.3 vs. 5.7 vs. 5.4. Now look at the figures for the three largest government run ‘single payer’ systems (systems that cover over half the world’s people): China- LE 72.8 IM 20.3, Russia- LE 65.9 IM 10.6, and India LE 68.6 IM 30. They are all inferior to the U.S.
The differences are small.
4) QUALITY OF U.S. HEALTHCARE IS SUBSTANDARD:
Michael Moore in his movie “Sicko” tried to say Cuba had superior healthcare. It’s unlikely you’ll see many people rushing there to get surgery. The fact is; America DOES have the best healthcare, based on technology, quality of facilities/equipment and the education of our doctors. Name a foreign medical school superior to Harvard or John Hopkins. Name a foreign facility superior to M.D. Anderson or the Mayo Clinic. The fact is you see people rushing to the U.S. to get access to our superior physicians, technology and facilities. You can get bad health care in any country including ours, but for the most part you will get the best health care right here.
Regardless, single payer isn’t going to revolutionize our medical industry. If anything; government rules, cuts and control will degrade it.
5) PRE-EXISTING CONDITIONS
Can you imagine getting insurance on a car that’s totaled? On a house that’s burned down? Then expecting the insurance company to pay a claim to restore the insured item? No, because it’s a recipe for failure. A federal health plan open to all with pre-existing conditions will flood the system with people that will overwhelm its capacity. It will balloon costs way beyond the projections that are already unaffordable. Some form of controls, like rationing, will be mandated.
CONCLUSION
The government through its federal programs (Medicare – Medicaid – CHIP – TRICARE – VA) already picks up the tab for about half the health care in this country. Keep that in mind when you hear the arguments about quality or cost. Also keep in mind we have more medical research, drug development and systems technology than just about all the other countries combined.
Single payer health care, under ideal conditions and if run correctly, could be great. It’s a laudable goal. Unfortunately there are three impediments: 1) QUALITY 2) COST AND 3) CONGRESS
QUALITY: There are a lot of uninsured sick people who will pile on the system, driving costs beyond projections, slowing delivery and mandating rationing of care. Under this system you’ll have parity with the crack head, substance abusing bum, morbidly obese and the illegal alien. Are you o.k. with waiting in line behind all these folks when you are sick?
If you’ve ever had to deal with government paperwork and rules you know it’s a nightmare. Just look at our 60,000 page tax code, compared to medical records, authorizations and billing it’s a dream.
How many health care professionals want to take a huge pay cut (and still pay oppressive tax rates to support the system)? Are they going to be happy becoming rank and file union members? Oh, you haven’t heard about the UMWU? Watch the union lard up the system and protect incompetent doctors, technicians and nurses. Just hope you don’t draw the wrong number in the doctor lottery. There will still be ‘optional’ for profit medical services available outside the system. Where do you think the best and brightest will go?
What happens to the incentives that drive drug and medical systems research? How many tax dollars will be needed to replace the billions the industry spends now? What happens to innovation and quality? What about replacement of outmoded medical systems/equipment – systems that change annually?
COST: As a nation, we operate over a trillion in the hole each year. We owe over 11 trillion nationally and trillions more in state and local debt. We just spent a trillion plus on the stimulus and TARP. Medicaid is projected trillions in the hole (a good example of a federal system). Do we think the money fairy’s going to waive a magic wand?
If you think ‘single payer’ means ‘free’ health care, think again. It will NOT make things significantly cheaper and the money will have to come from somewhere (don’t count on the rich, administration reductions or war dividends to do the job).
CONGRESS: We don’t want a rushed plan, particularly one that could further increase debt and deficits. The CBO has already blown the whistle TWICE on proposed plans for fiscal reasons. Let’s be honest, the egotistical, entitled, lobbyist tainted, partisan, career politicians in our House and Senate are incapable of getting the job done right. In the current climate, they’ll prioritize ‘fairness’ and special interest over function; to the determent of the program. We’d be better off hiring Halliburton to do the job.