Those who know how government works will reject universal coverage

American Medical News
Published by the American Medical Association
March 12, 2001
Letters to the Editor

Daniel Joyce, M.D., Niles, Mich.:

"... when the government provides something like health insurance to everyone, people tend to look at it as their right to health insurance versus appreciating the wonderful gift that is being provided to them. I see this all the time in the government programs. The people who are provided these wonderful things are often very ungrateful. If charitable organizations provide the same assistance out of the generosity of their heart, people then realize that it isn't their right and appreciate the kindness as it should be appreciated."

Comment: The American Medical Association professes to serve the public interest in health care matters. Its leadership could do that now by instructing its members on the basic fundamentals of health policy. But before that is possible, the leaders themselves will have to take a crash course in health policy to learn why tax credits and medical
savings accounts, which they support, will never serve the public interest. If the AMA would shift to advocating for patients instead of physicians, the organization would find that they would be supporting a practice environment that is in the best interests of both patients and physicians.

Following are the comments of Tom Mainor, pastor of the Shady Grove Presbyterian Church in Memphis, TN. He has served the Presbyterian Church USA in health care ministries and has a very strong background in health policy.

Needed: clarification of the nature of single payer approaches

Don, et. al.

I am convinced that the frequent caricature of the single payer health care financing as "government-run medicine" needs to be challenged on every level. It side-tracks and mis-describes the effect of a single payer approach.

For example, single payer approaches can involve multiple not-for-profit payer sources, such as Medicare/Medicaid, Blue Cross/Blue Shield, Tenn Care, and such efforts as the Mayo Clinic, Kaiser Permanente, Seattle Puget Sound and other regional or national efforts.

Using a regional budgeting approach, e.g. looking at the kind of services delivered by local and regional hospitals, a budget providing full funding for hospitals, minus the costs normally associated with collection and financing, would provide first rate care for a predetermined population. The hospitals would know what they would receive, receive incremental payments monthly for providing services, and thus be able to better serve the populations they have already been serving. The savings in billing costs and administrative costs could be re-directed into preventive health strategies...

Getting too detailed, but, for example, our MED, the regional hospital here--which not only serves western Tennessee, but also eastern Arkansas, northern Mississippi, the boot heel of Missouri and western KY--is frequently required to take in patients from those other jurisdictions in spite of the knowledge that, say, Mississippi will not reimburse the MED, the University of Tennessee or Tenn Care for the care. Because we are on the Mississippi, I-40/I-55, as well as being a major distribution center, we also have persons being served who come from far away. With regional funding, based upon patient load and acuity, such hospitals could render far better services.

My contention is that we spend far too much for health care without organizing it in such a way as to make the dollars make sense, health-wise. Regional strategies, tied in with revitalized health departments, NIH, the Centers for Disease Control, etc, would be
health-and-cost-effective. With the increase in global warming, the diseases such as West Nile Virus and expanding areas of malaria, AIDS, Ebola and others are going to require a much more effectively integrated health system to do the job that public health did in the early 1900s, in addition to providing the sophisticated technologies at reasonable prices.

We need to realize public profits on drugs that we helped fund, and the pharmaceutical industries charge excessively for. Brazil is an example, currently. The issue is also raising its head in southern Africa and else where.

Then, there is the fair return on investment on behalf of communities which have contributed the building of hospitals through a variety of means, including taxes. These are being bought up for a song by the health conglomerates to the detriment of many large and small community hospitals.

Health care is too important to the well-being of the nation to be left to the vagaries of the market place. It clearly does not increase services in places of greatest need. And the charges on advances in medical technology are outrageously high, and because of the paper trails created, there is rampant overcharging, duplication of charges and other waste.

I could go on. Sorry, didn't mean to get wound up. But, clearly, there are many options out there beyond the current waste of precious lives and resources. Doctors ought to be able to treat patients according to medical standards, with hospital and peer review. Not second-guessed by someone at a health maintenance organization who gets rewarded for denial of care...

Thanks for the ventilation opportunity...

Tom Mainor

Subject: John Foster responds to John Gilman

Even the best and brightest don't really get the skinny!

Spending more Federal dollars to "BUY SERVICES" simply invites drug companies and other vendors to get richer faster. Their prices will all go up.

But not in Medicare where the rules have evolved nicely over the many years, and cost increases have been moderate..

Only a single payer can control the cost of services, which is why, for example, Canadians get cheaper drugs.

Extending Medicare INCREMENTALLY would be a rational way towards a universal plan.

Keene, NH

Subject: Susan Swan comments

Susan Swan, MSN, MPH, a Canadian, and currently a nurse practitioner in Atlanta, comments:

Re: Comments of Tom Mainor

In addition to Rev. Mainor's comments I think it should be pointed out that the single payer system in Canada is not "government run". Doctors are independent, fee for service practitioners. Hospitals are independently owned and operated - ie: we have Catholic hospitals, community hospitals, university hospitals etc. They are run by
voluntary boards of directors, not political appointee's. Lastly, we have to ask the question "Why is the government inherently incompetent"? This "incompetence" arises from the nature of bureaucracy. Any large, multi-layered institution is going to be
inefficient, government or "private". In fact, it is safe to say that most government bureaucracies pale in comparision to Blue Cross-Blue Choice's or Kaiser Permanente's of the world. The American myth that profit driven organizations are by nature well-oiled, finely tuned model's of efficiency must be must be dispensed with. Every bit of evidence points to the contrary. Profits don't influence efficiency and
have no place in healthcare.