Front Burner: What is best di­rec­tion for health-care?

Only ‘Medi­care for All’ can fix our bro­ken care sys­tem

Orlando Sentinel - - FRONT PAGE - By Greg Sil­ver | Guest columnist

The pa­tient looked ter­ri­fied when she showed me her bro­ken arm that wouldn’t straighten out. “What am I sup­posed to do?” she asked.

She was a wait­ress, about 25 years old, work­ing to sup­port her fam­ily. She had bro­ken her right arm near the el­bow sev­eral weeks prior and was seen in a lo­cal emer­gency room. Since she had no in­sur­ance, she couldn't af­ford the fol­low-up vis­its. So the arm healed crooked, and it was now dif­fi­cult and painful for her to hold a tray.

She was scared of los­ing her job. I wished I could tell her ev­ery­thing would be OK, but that wasn’t true. What should have been a straight­for­ward treat­ment process was cut short due to cost, and now she would need surgery to fix it. With­out in­sur­ance, she couldn’t pos­si­bly af­ford surgery, but she also couldn’t af­ford to lose her job. I didn’t have an an­swer.

I’ve been a pri­mary-care physi­cian for 30 years, and th­ese con­ver­sa­tions have be­come heart­break­ingly rou­tine. Con­sider the 45-year-old hairdresser with se­vere hip arthri­tis, in con­stant pain, barely able to stand and work. He badly needs a hip re­place­ment but, with­out in­sur­ance, what is he sup­posed to do? Or the 63-year-old par­a­lyzed on his left side from a stroke, but who can’t af­ford to see his doc­tor or buy his medicine. He knows that he is at high risk for an­other stroke, or worse. Feel­ing hope­less he told me, “I hope the next one just kills me.”

Sadly, th­ese sto­ries are uniquely Amer­i­can. Only in Amer­ica do we force mil­lions of fel­low ci­ti­zens to beg for char­ity care, suf­fer the eco­nomic cost of huge med­i­cal bills or file bankruptcy. Not sur­pris­ingly, we live shorter lives with worse health out­comes — life ex­pectancy and in­fant mor­tal­ity, for ex­am­ple — than most other in­dus­tri­al­ized na­tions. Ac­cord­ing to the An­nals of In­ter­nal Medicine, 18,000 Amer­i­cans die each year from a lack of in­sur­ance. It doesn’t have to be like this. In the rich­est na­tion on Earth, we al­ready spend more than twice as much as other na­tions that ac­tu­ally pro­vide uni­ver­sal health care. Even with the Af­ford­able Care Act, we leave 28 mil­lion peo­ple with­out any cov­er­age. Those with work­place in­sur­ance plans face sky­rock­et­ing costs: The av­er­age fam­ily of four pays $11,685 in pre­mi­ums and out-of-pocket costs per year, and from 2005 to 2015, av­er­age de­ductibles rose 229 per­cent. Sixty per­cent of those fil­ing med­i­cal bankruptcy ac­tu­ally had in­sur­ance cov­er­age when they got sick.

The root cause of our sys­tem fail­ure is the pri­vate in­sur­ance in­dus­try and its waste­ful bu­reau­cratic com­plex­ity, frag­men­ta­tion and profit mo­tive. We des­per­ately need a stream­lined sin­gle-payer pro­gram that would pro­vide uni­ver­sal cov­er­age for all Amer­i­cans, such as Rep. John Cony­ers’ House Res­o­lu­tion 676 and Sen. Bernie San­ders’ Sen­ate Bill 1804. This type of “Medi­care for all” sys­tem works like to­day’s Medi­care, when all med­i­cal bills are paid for by a sin­gle govern­ment fund, and pa­tients can visit the hospi­tal or doc­tor of their choice for all med­i­cally nec­es­sary care.

Can the U.S. af­ford this? We cur­rently spend more than $3 tril­lion per year on health care; nearly two-thirds of that is al­ready paid for by your tax dol­lars. By cut­ting out the pri­vate in­sur­ance mid­dle­men and ne­go­ti­at­ing drug prices, we could eas­ily save $500 bil­lion per year, enough to ex­pand cov­er­age to ev­ery­one.

As noted Prince­ton Pro­fes­sor Uwe Rein­hardt once said, “The is­sue of uni­ver­sal cov­er­age is not a mat­ter of eco­nomics. Lit­tle more than 1 per­cent of gross do­mes­tic prod­uct as­signed to health could cover all. It is a mat­ter of soul.”

Medi­care for all is ef­fi­cient, it has been proved, and it’s sim­ply the right thing to do. One day I hope that when a pa­tient looks me in the eye and asks, “What am I sup­posed to do?” I'll have a real an­swer for them.

The root cause of our sys­tem fail­ure is the pri­vate in­sur­ance in­dus­try.

Greg Sil­ver, M.D., prac­tices ur­gent care in Pinel­las and Pasco coun­ties.

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