Times Union Op-Ed by leader of our PNHP chapter

Expanding Medicare will help
Published in the Albany Times Union on Thursday, December 22, 2005
By Alan D. Miller, MD

I have been a physician for 60 years. The changes during that time in our ability to help patients are astonishing.

We have in this country well-trained physicians working in well-equipped facilities, capable of diagnosing and treating illnesses in a manner that a medical school graduate in 1945 would have found miraculous.

Yet I have never known greater discontent among physicians and patients. Physicians are beleaguered by paperwork and insufficient time to spend with their patients, who in turn find their care to be uncoordinated and impersonal.

Insurance to pay for our health care is becoming more and more expensive, and a serious burden to individuals and those who employ them. More than 45 million of us have no health insurance. That number is increasing daily.

Physicians still enjoy a respected and unique position in our society. Only we may practice medicine. Therefore, we must find a way to be available to everybody.

We carry a dual responsibility: to each patient and to all patients. These, not profit-making, are the determining purposes in our work.

How can we preserve creativeness, flexibility and concern for individuals while eliminating the rigidities, inequalities and capriciousness of the system of multiple, competing, profit-driven health insurance companies?

Remarkably, we have a model at hand: Medicare. It may have its imperfections, but they are open to view and correctable. Its administrative costs are less than 5 percent, compared to the 20 percent to 25 percent that characterize the private health insurance industry. And see what it has accomplished: Very few of the 45 million uninsured are older than 65.

That is why more and more of us, including physicians, employers, elected officials and, above all, patients, are working toward expanding a program like Medicare to our entire population.

This will not solve all of our problems in providing the best possible health care to everyone, but it would be a major, and indispensable, first step. We could provide more care, to all of us, at substantially less cost.

This is one major goal on which all of us agree. It is a necessary and good idea whose time has come.

Dr. Alan D. Miller of Delmar is vice chairman of the Capital Region branch of Physicians for a National Health Program. He was commissioner of the state Department of Mental Hygiene from 1966 to 1975 and associate dean of Albany Medical College from 1975 to 1988.

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Public employee health care benefits to evaporate

According to two recent articles, one in the New York Times and one in the Wall Street Journal, the federal Government Accounting Standards Board has begun to require municipalities - states, counties, cities - to account for how much it will cost them to provide all the health care promised to present and retired public employees. This process, to be completed over the next 3 years, has already started in states like Alaska, Delaware, Maryland and cities like Duluth, Minnesota and Arlington, Texas.

In response public employers have begun slashing the benefits offered to new hires. Retirees' and current employees' health benefits will be next. A union struggle will be enjoined, as public employee unions face an even more defensive struggle to hold on to health benefits.

As of 2006 new hires in Arlington, Texas will have no retirement health benefits. Alaska, facing a health care cost deficit of $5.7 billion, pushed new employees into high deductable/HSA "health savings account" schemes (after some heavy lobbying from the White House). Thankfully, the state constitution protected the benefits of current state workers. In Michigan legislation is being prepared that will shift health care costs onto the retirees, period.

It might be tempting to imagine that this phantom emerged because of neo-conservative sourcery, as in Grover Norquist's desire to shrink the government to a size where he might "drag it into the bathroom and drown it in the bathtub," or George Bush's call for an each-against-all "ownership society." But the fact is that health care costs for all employers, public as well as private, have grown increasingly impossible as health insurance premiums and drug costs continue to escalate.

As Uwe Reinhardt's quip that the big three auto makers are "basically social insurance systems" that sell cars, Mayor Herb Bergson says here of Duluth: "The city isn't going to function because it's just going to be in the health care business."

The wholesale effort on the part of employers - public as well as private - to shift costs onto individuals is under full steam because the existing non-system leaves employers no other choice. Whether employed by a large corporation or a large state, a small city or a small shopkeeper, no employee or retiree will be spared. Behind this wave will be an eddy in which we will soon see the ranks of the uninsured (and the bankrupt!) burgeon - for individually we will simply not be able to meet the costs of our insurance, let alone our sick care.

I think that what is most important for PNHP and other health care reform activists to note about these articles are what they say about the tempo of change. The health care meltdown is accelerating rapidly. This disintegration will be played out not in the coming years but in the coming months.

As this crisis gathers momentum its noise begins to coalesce as a counterpoint harmony and rhythm that leave the single-payer national health insurance solution the only melody to sing - and what an inspiring tune that is! Public employers and employees should be allowed to refocus their attention to public service. Health care should be equally available to all. National health insurance, including prescription drugs and all necessary medical and dental care, including mental health, hospital and long term care is the only workable solution.

Andrew D. Coates, MD

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Iowa!

Over the past few days the Des Moines Register has printed a series of articles that look at how "Iowans are struggling to pay for health insurance and worrying about losing government-paid care. Their stories show how the nation's dysfunctional health-care system creates hardships for ordinary hard-working Iowans." Today, the newspaper's editorial board squarely advocates a single-insurer solution as "A system that works for America."

The articles in this series provide a thoughtful and useful approach to the issues. According to "Four approaches to reform," the solution we in PHNP support would provide more than triple the savings of the other proposals. In "Canada's system offers lessons for Americans" Andie Dominick concludes that "America could learn a lot from countries such as Canada — what does work and what doesn’t. But mostly we could learn from the basic principle behind the health-care system in every other industrialized country: Provide everyone with basic health care."

The following is a sidebar to today's editorial in the Des Moines Register:

"MYTHS AND TRUTHS

Opponents to a taxpayer-financed system that covers everyone use scare tactics to resist change. Some of their common themes:

• Government-financed care would be socialism. America should rely on a free-market economy.

The truth: There is no true free market in many aspects of health care.

There is no free market when the government is a huge purchaser of services and when insurance companies do the buying for individuals. There is no free market when many workers can afford to purchase only the health insurance their employers offer. There is no free market when complex billing systems make it virtually impossible for an individual to shop for the best quality and price.

• There would be rationing of care.

The truth: That one isn't a myth. The myth is that there's no rationing now. Private insurance companies are the epitome of organizations that ration. They don't cover some drugs, some doctors, some services. And there's no greater rationing than leaving millions of people uninsured.

• Canada has universal care and its system is failing.

The truth: Every country has problems with its health-care system, and Canada is no exception. But nearly the same percentages of Canadians as Americans rate their health-care system as excellent.

• The government would be making my health decisions for me.

The truth: Medicare, a tax-financed system of care for seniors, allows enrollees to choose to visit doctors and hospitals that accept Medicare. People still have the right to make their own health-care decisions. Certain procedures aren't covered, but that's no different from private-sector health insurance."

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Welcome!

We in the Capital District chapter of Physicians for a National Health Program hope this blog will allow us to share news and events in our effort to win essential health insurance reform. We advocate a one-insurer system with coverage for all - as Medicare covers nearly everyone over the age of 65, we believe one plan should cover everyone (period). Everyone deserves the same access to our health care system.

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