When I read Rick Ungar’s latest article in Forbes on single-payer healthcare, I emailed my rather wordy response to him and he encouraged me to post it as a comment on his piece. I did, but it was evidently too long for Forbes, since it didn’t appear when I scrolled through the comments today. So I’m posting it here. If you’d like to read Rick’s piece, click here.
Once again, I am impressed and encouraged by Rick’s willingness to express what I too believe – that we as Americans are surely able to devise a single-payer system that trumps those of other countries and our individual state efforts. However, I must argue with some of his points.
He mentioned the problems revealed by state-based experiments such as “over-usage of the medical system when it is available without co-pays or deductible” and the shortage in medical personnel to handle the rush. I have often worried about the initial onslaught of sick people who, like myself, may have lived with chronic conditions for years without being able to get care because of the co-pays, deductibles, and co-insurance that we can’t afford to even get into a doctor’s office, let alone the 20% (for me anyway) of cost that Blue Cross Blue Shield won’t pay for. If single-payer were miraculously established tomorrow, you bet your ass I’d get myself to the hepatologist to check my diseased liver; the rheumatologist to see if there’s anything that could be done about my relentless arthritis pain; the dermatologist for my eczema and to check for recurrence of skin cancer; the ophthalmologist for my macular edema; and the physical therapist to work on rehabbing the arm that is now painful and semi-functional due to a fall. I would gladly have the quarterly blood tests recommended to monitor my Type II diabetes and primary biliary cirrhosis. And I know so many others who are living with multiple co-morbidities who aren’t getting care, even thought they’re insured, who would also join the rush to treatment.
I don’t think there is any way to avoid that tidal wave of people whose needs have gone unmet for years. But eventually they would go from urgently getting the treatment they’ve been missing to being able to have yearly or quarterly or monthly doctor visits to maintain whatever level of health they could achieve. Eventually prevention and maintenance would be the focus, not trying to catch up from the lack of care that is the custom now.
As for the shortage of docs, that is a valid concern that even now is being considered and which must be included in whatever legislation is passed. I’ve spoken to several members of the American Medical Student Association and many are now being encouraged to focus on primary care instead of specializing. I believe that must be part of any true reform, as well as establishing a “GI Bill” sort of system whereby medical school can be subsidized or paid for entirely in exchange for their commitment to practicing in underserved areas. I believe it’s a basic truth that no doctor who’s in it for the money is ever the best healer and it’s time to shift away from that.
And then there’s the semantics. Personally, I don’t care what it’s called—to me “socialized medicine” elicits a big “So what?” Is it really such a horrible thing that out of all the things our capitalistic system derives profit from, human suffering is one of the few that it doesn’t? Seriously, “free market?” What free market? It is no longer driven by consumer demand, customer satisfaction, or business integrity as it once was. Instead, now, as evidenced by everything from ATM fees to return policies, it’s a matter of “well, that’s the way it is, live with it—resistance is futile!” Business owners seem to be only concerned with making money, not with providing good products or services, not with inspiring customer loyalty, not even with following the law or paying their fair share of taxes. So if our health care is one area of refuge that’s “socialized,” that’s fine with me!
As is paying 4.75% of my income towards a universal healthcare system rather than the 20% I paid in 2010 before I quit going to the doctor. Obviously, concern for our fellow humans is as rare as a banker with integrity, but there are some of us who would gladly pay higher taxes to know that not only we, but everyone we care about, everyone in this country, would have access to the care they need. With all the BS being flung about “shared sacrifice,” this is what it should truly be – everyone pays in BUT everyone also benefits. Canadians can’t understand why Americans aren’t willing to take care of each other so the country could be healthier and neither can I.
However, I am not one of the bleeding-heart single-payer advocates who chants “Health care is a human right.” As far as I can see, there is no such thing as a universally granted human right. Though “life, liberty, and the pursuit of happiness” as well as promotion “of the general welfare” are set in the foundation of this country, our history is rife with examples of how some of us have always, and will always, fight to deny those things to others of us based on race, religion, gender, sexual orientation, economic status, education, and yes, state of health. So health care is no more a “right” than privacy, religion, or opportunity are. It is, however, a basic need. A need that any civilized society seeks to fulfill for its citizens, just as food, water, and shelter are basic needs. Right now, we’re not doing so well with those either, as Republicans destroy housing and food programs and allow corporations to pollute our water and yell, “Let them die!” during presidential debates.
Rick wrote about the “perceived inevitability of rationing in medicine and the wait times to receive medical care.” We have that already. Medicine is rationed based on your ability to pay and there are very few people who have not experienced having to wait for insurance company approval for a treatment or surgery, not to mention the scarcity of appointment times for specialized physicians. Private insurers have never and will never do anything to improve either situation.
I totally agree that we who support single-payer must get out of our preaching-to-the-choir passivity and offer up some solutions that are realistic, not idealistic. However, “controlling out-of-control costs” is not the problem. How have the costs gotten so out of control? Greed. How can they be controlled? No advocacy group, no political party, not even the Supreme Court is going to be able to achieve that unless there is a massive shift in the American consciousness back to the days when making 100% profit on a box of latex gloves, 300% on a medical device, and 500% on a prescription drug was enough. We have to start asking, “How much is enough?” Profit is not “the mortal enemy” of anything except when it becomes the only goal.
I believe that is the underlying, unspoken message of the Occupy protests. We of the 99% are not asking to have the money of the 1%. We’re just asking how much they need to have before they stop grabbing for more and more and more. Seriously, does anyone need to make $13 million a year as CEO of an insurance company??? And what exactly does that person do in the hours of their day to make that much when firefighters are risking their lives for $50,000; when teachers are having to buy school supplies themselves and then being vilified and having their rights to collective bargaining taken away; when Hyatt Hotel workers are expected to trash their backs and knees for minimum wage and no health insurance?
Put me in Warren Buffet’s camp. I make $40,000 a year and I’m willing to pay more taxes to ensure that everyone has health care, food, shelter, education, safety, and good roads. But I don’t believe America will ever be that kind of country again. Selfishness, disregard for the consequences of our actions, and total lack of foresight have been our modus operandi for too long. We are the country of instant gratification, material acquisition, and self-righteous arrogance.
But maybe I’m just cynical. I do believe we are still innovative enough to devise a system whereby private insurance exists for those who choose to pay for it and a governmental system exists for those of us who choose to pay into it. Obviously, the rich are always going to be able to afford more and better everything, including health care. But right now there is no choice for the rest of us – either we skip the rent/mortgage payment, the credit card bills, the grocery store to go to the doctor, or we do without and hope we don’t end up in the emergency room someday.
I know I won’t live to see it (I’ve supposedly got eight years left before liver transplant time and I won’t be having one), but I dream of the day when a baby born in this country gets a birth certificate and a metal health care card that he or she can plunk down at any office, hospital, clinic, rehab facility, mental health facility, dentist, or eye doc and know that the only thing they need to worry about is getting better. I’ll be talking about that dream at DUH—hope you’re there to hear it!
Thanks to Rick for keeping this issue out there. I have no doubt that when it is finally achieved, he will be one of the prophets of America’s best health care system!