The middle aged woman sitting in my exam chair had a patch of white gauze taped to the side of her neck. Years ago she had had skin cancer, and now had a sore that wasn’t healing. I gingerly removed her homemade dressing and was shocked to see her carotid artery exposed and pulsating in a deep, open wound in her neck where cancer had eroded the skin, the fat, and the muscles that protect the artery. It would not be long before the artery ruptured.
She needed university care for treatment, but for some it can take weeks to get a visit approved. She didn’t have time to wait. I sent her to the Emergency Department at Queen of the Valley Medical Center and called a consultant friend at UCSF. My patient spent many hours in the emergency room, and after multiple phone calls she was able to receive her needed care.
How do people get to this point in America? Inability to afford health insurance? Job loss? Too young for Medicare and ineligible for Medicaid? This is just one story. We doctors have many such stories. Most of you know someone who has delayed care due to no insurance or a high deductible, or incurred large medical bills despite insurance. All of the money we spend on premiums, deductibles, “patient portions,” medications, and out-of-network care can add up to enormous sums annually for many individuals and families. Medical bills are the leading cause of personal bankruptcy in the U.S. Health insurance is a major expense for employers, too, which slows business growth and reduces our incomes.
Australia, Canada, Taiwan and Spain have had successful single payer systems for years. Everyone is covered from birth to death. Health care, like police and fire services, is paid for through taxes. Everyone needs health care, and everyone pays into a fund. When health insurance is a choice, as it is now, many people opt out, and the unpaid costs of the care they ultimately need is shifted to our hospitals. This drives up prices for the insured and has resulted in bankruptcy and closure of many hospitals and emergency rooms.
Our health care dollars provide large profits for health insurance companies. In 2017 Blue Cross Blue Shield alone made $1.3 billion in profits. $908 million was spent on brokers’ commissions and $41 million on advertising. Kaiser’s profits in 2017 were $3.8 billion. We pay insurance companies to issue denials, limit medication access, and process authorizations, referrals and claims — slowly. This requires medical offices and hospitals to hire employees to get authorizations, appeal denials, check eligibilities, and collect patient portions. We are No. 1 in the world in administrative costs.
What if that money were spent on providing health care?
Single payer health care for all minimizes administrative costs and eliminates insurance profits, leaving more money for health care. Single payer encourages preventive care and early care, which results in better community health and is significantly less expensive than treating an advanced illness like my patient had. Single payer eliminates restrictive insurance panels. You have the freedom to choose any physician or specialist. Hospitals and physician practices are still privately owned — there is no government takeover — but all reimbursement is from the government.
Our elderly and our poor have government-funded health care. We need to extend those benefits to working families who may be working multiple jobs to get health benefits. Part time workers are not entitled to employer covered health care and may be least able to afford it. Many families must change insurance plans and their doctors with a job change, and job changes are much more frequent now than 70 years ago when health insurance was first tied to employment as a benefit.
Recent polls have demonstrated a growing interest in the United States for single payer Medicare for all. A new bill in Congress, HR 1384, provides for changing our system to single payer to allow us to join other countries with lower costs and better health care outcomes. 107 members of Congress have signed support for the bill, including our district’s Mike Thompson. Thousands of physicians nationwide are supporting Single Payer Medicare for All.
We’d like to invite you to our Napa community forum: “Single Payer/Medicare for All: What it means for your family, your doctor, and your community.” Guest speakers include Napa’s public health physician Dr. Karen Relucio; pediatrician Dr. Ana Malinow; and me. The forum is Wednesday, May 8 from 7 to 9 p.m. at the First United Methodist Church, 625 Randolph St. Participation is free. Please come with your questions.
Single payer may be a new concept for many of us, but it has a proven record in other countries. Single payer is more humane, more efficient, and less costly. Single payer is simply the right thing to do.