Colleen C. Lyons: Medicare for all: Wisely used tax dollars can cover everyone
April 15, 2017
Dr. Edward Gray's commentary of April 2 regarding healthcare in America is another frustrating example of a lack of appropriate experience and background. Taking healthcare system advice from a dental subspecialist is certainly of questionable value, given the narrow vista point from which his views are generated.
As a family physician with more than 30 years of experience caring for all sorts of people, including kids and those with mental health concerns, I know one of American's greatest problems is an ever increasing shortage of primary care doctors, the doctors in the trenches of American medicine. Primary care physicians (family physicians, pediatricians and internists) are the doctors providing the necessary care for nearly 90 percent of what ails you and assisting patients in knowing whether and what specialists to see. Primary care doctors care for their patients over many years and see them back after they've been to the specialist and rare subspecialist.
Every other nation in the world has a healthcare system in which primary care doctors represent 50 to 70 percent of the total physicians and surgeons. America's oft heralded capitalist and free market system has over several decades resulted in a primary care physician workforce of only 30 percent. Numerous studies have shown significant cost savings and improved quality of care when there are higher ratios of primary care physicians per capita, while increased specialists per capita have demonstrated the exact opposite with higher costs and poorer health outcomes.
The 2014 Commonwealth Fund report: "How the Performance of the U.S. Health Care System Compares Internationally" found, yet again, the U.S. ranked last of 11 nations in quality, though we continue to rank No. 1 in cost. The report stated, "U.S. ranks last overall with poor scores on all three indicators of healthy lives — mortality amenable to medical care, infant mortality, and healthy life expectancy at age 60," and, "U.S. physicians face particular difficulties receiving timely information, coordinating care, and dealing with administrative hassles as other countries have led in the adoption of modern health information systems." The United Kingdom (Britain/England), maligned by Fred LaSor in his comments in support of Gray, ranked No. 1 in overall quality with the lowest cost of $3,400 versus America's $8,500 per capita as of 2014.
Having worked as a VA primary care physician for the last five years, I also take issue with the implication of poor quality care provided by the Veterans Health Administration. In truth the VA performs as well as or better than the majority of private sector providers in the United States on a wide variety of measures and certainly at far less expense. The VA has been a leader in initiating numerous safety protocols in hospitals, surgery suites and pharmacy services.
Of course the majority of physicians support malpractice reform and many cite defensive medicine as a significant contributor to healthcare costs in the US. But contrary to popular "wisdom," studies of this issue don't support their views regarding the cost of malpractice insurance and/or defensive medicine as a major factor in the overall cost of U.S. medicine.
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I concur with Dr. Sean Lehmann's April 9 rebuttal of Gray and support "improved Medicare for all" as proposed by Physicians for a National Health Plan (PHNP.org). Let us stop, as Lehmann says, "allowing insurance CEOs and shareholders to make all the decisions. Their only motivation being profit, which is a gross conflict of interest." Trusting an insurance company with your healthcare seems equivalent to trusting a used car salesman; you just don't. Our forefathers knew capitalism needed the oversight and restraints provided by government to curb excessive greed and abuse of the public good.
The 2010 World Health Report issued by the World Health Organization notes, "Abundant evidence shows that raising funds through required prepayment is the most efficient and equitable base for increasing population coverage. In effect, such mechanisms mean that the rich subsidize the poor, and the healthy subsidize the sick. Experience shows this approach works best when prepayment comes from a large number of people, with subsequent pooling of funds to cover everyone's health-care costs."
The Director-General of WHO states, "No one in need of healthcare, whether curative or preventive, should risk financial ruin as a result." Unfortunately, in America that's not infrequently the case. The majority of U.S. bankruptcies are due to medical expenses and the majority of those had health insurance at the onset of their illness. I find it necessary to point out the obvious, health insurance is not healthcare — I believe we in America too often discuss medical insurance coverage as though it were actual healthcare.
If we can't find our way to "improved Medicare for all" and eliminate the insurance middlemen as Canada and France have done at a cost of $4,100 and $4,500 per capita, respectively, then let us at least have nonprofit insurance carriers like Germany and Switzerland have done with a 2014 Commonwealth Fund quality ranking of No. 5 for $4,500 and No. 2 for $5,600, respectively.
Thankfully, a former patient of mine was in Germany as a university student when he was diagnosed with a serious lifelong psychiatric illness. He received far superior care in Germany at no cost to himself than what we attempted to arrange for him upon his return to the U.S. Ultimately, his family realized it would be best to travel with him back to Germany until his symptoms were appropriately controlled with medications.
Interestingly, a recent analysis of U.S. taxpayer expense indicated we already pay more in taxes for healthcare than Switzerland pays in total. Switzerland, the second most expensive healthcare system in the world, provides universal coverage for all its citizens at a cost of approximately $6,200 versus our current $10,000 per capita. We spend tax dollars on the elderly, poor, disabled, veterans and public employees. For the same tax money we could cover everyone, if only we would spend our tax dollars wisely and efficiently on an actual healthcare system instead of the chaos we currently have.
For more information review the following books and/or website:
Regarding how we got in this mess: "SICK: The Untold Story of America's Health Care Crisis — and the People Who Pay the Price" by Jonathan Cohn.
Regarding VA healthcare: "Best Care Anywhere: Why VA Health Care Would Work Better For Everyone" by Phillip Longman.
Regarding improved Medicare for all, see the Physicians for a National Health Plan website at PNHP.org under the "Single Payer" tab. It includes a comparison to the Affordable Care Act (ACA/Obamacare).
Regarding other countries: "The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care," a New York Times best seller by T. R. Reid.
Colleen C. Lyons, MD, practices family medicine in Carson City with more than 30 years of medical practice experience.