An Editorial by Jeffrey Meffert, MD
So, I have this product here. Everyone uses it, some more than others. Some need it to stay alive. Most of the industrial world gives it away for free. Even some developing countries that don’t have very much of it, give away all they’ve got.
In this country, however, we spend 13 percent of our GNP (26-43 percent by 2030) on the stuff, but we’ve turned over distribution of most of it to private corporations with a 15-30 percent overhead cost.
Your grandmother can get some of it for free or at a discount. However, even though that particular program has only a 2-5 percent overhead, we deride it as wasteful and inefficient. But she’s better off than many others who can’t afford it at all or have to save up to buy small bits of it. Yes, this does sound crazy. If free market principles truly applied to medical care, we would all go somewhere else to buy it. It should be a national embarrassment, but we keep saying America has the best health system in the world so often that we believe it.
The time for a national health plan, a single payer plan in which all Americans have basic health care as a privilege of being a citizen of this prosperous country, is long overdue. Powerful economic forces are helping maintain the status quo by generating fear in our patients and by bribing our elected officials (let’s call 21st century lobbying what it really is). The majority of Americans want affordable and comprehensive health care, any way they can get it, right now…as long as you don’t call it “socialized medicine.” Physicians have been trained and manipulated by the insurance and pharmaceutical industry so that our questions and concerns pop forward as reflexively and predictably as a knee whacked with a rubber hammer.
There will be rationing! There already is rationing. We prefer the terms “pre-approval,” “unmet deductible,” “uncovered benefit” and, “when you can’t stand it anymore, go to the ER.” Unless the uninsured, the under-insured, and well-insured all have the same access and care, de-facto rationing is what we’ve got.
It will decrease the quality of care! If by quality of care you mean I can’t get my non-emergent MRI tomorrow or my gallbladder removed this Tuesday, then yes, there may be a decrement. If you prefer to measure a nation’s quality of care by longevity, infant mortality, prenatal care, vaccination rate and preventive health maintenance availability, the United States lags far behind other industrial nations.
But those dismal ratings are because our poor and uninsured are dragging down the stats! That may actually be partly true, but shame on you if you feel that makes it all right. Every major religion has compassion and charity as key tenets of how one should behave. If the poor are dying earlier and middle class infants are dying more often, we should fix the problem rather rationalize its causes.
It will cause massive unemployment! It will cause some, but that starts with the nice lady whose only reason to be on your payroll is to keep shoving those denied payment claims back to the company over and over again. The invention of the motorcar and the self-service elevator put a lot of people out of work also but we got over it. There are other ways to make a living, including in the new “Medicare for Everyone.” Anyway, why should we pay precious health care dollars to someone whose job is to move paperwork from one side of the desk to the other, or whose job it is to stamp “Denied” on your claim? As for the high-flying health insurance CEO (who earns 5 to 125 million dollars a year), unless you’re one of them, who cares?
The stock market and economy will suffer! There might be an adjustment as things sort out but the economy won’t collapse. Some will actually have more spare change to invest. Maybe physicians won’t make as much with our highly profitable health insurance companies but, if we put our investment dollars in something like renewable energy research, our grandchildren will thank us for our foresight.
Taxes will go up! Yes, and what you pay for health insurance will go down. Remember, it isn’t a dollar-for-dollar trade between the current system and a single payer plan. Don’t forget the wasted overhead dollars and your tax dollars going into mismanaged state Medicaid programs (where the money is often diverted into non-health care expenses). Ultimately, some of us will pay more but we will be a healthier and more prosperous nation for that.
I will make less money! Ah, now we come to the real issue. The concept of the multi-millionaire physician is a relatively new one and only arose after doctors bellied up to the insurance-paid health care trough. Not all single payer plans call for all physicians to be salaried (although those salaries are usually quite good compared with others in the nation). In this country we value choice and abhor laziness.
A hard working American physician will always make a comfortable living, although it may be harder to get stinking rich doing it. But maybe we will have patients again instead of health care consumers. And maybe we will be physicians again instead of health care providers. And, just maybe, the field of medicine will get back a piece of its soul.
Jeffrey Meffert, MD divides his time between private practice as a dermatologist and family practitioner and on the clinical faculty of the University of Texas Health Science Center-San Antonio.
Opinions presented in this column express only the views of the author and cannot be regarded as the views of Bexar County Medical Society or “San Antonio Medicine” magazine.
