Really fixing U.S. health care
By PAUL DEMARCO - Guest columnist
The State
Tue, Jun. 05, 2007
Imagine you were involved in a discussion about U.S. public schools when someone said: “Socialized education is ruining this country. Tuition should be provided by businesses to their employees or by the government to the very poor. Otherwise, you make your own way.”
That sounds quite strange. America is committed to a nationwide system of taxpayer-supported public schools. Only the staunchest libertarian would question that commitment. But substitute the word “medicine” for “education” in the quotation and change “tuition” to “health insurance” and you have an accurate description of the state of health care in our country.
Why the difference? Why do we so easily accept the notion of public schools but remain so suspicious of public health care?
In a word, profit. The insurance companies know that they can continue to milk the system for decades more until it finally implodes, and they are not going quietly. They are betting that you will sit idly by and watch our system bled dry by an industry ruled by shareholder profits and outrageous CEO compensation.
In a decade or two, when your middle-class neighbor goes bankrupt from an uncovered illness, change will come. But right now Big Insurance is engaged in the same song and dance that Big Tobacco bedazzled us with for years.
The insurance industry’s latest gambit is health saving accounts associated with high-deductible plans. These will do little to address the crisis of the uninsured, but, by the way, they are a great tax shelter if you’re rich and make too much to stash away money in an IRA. Insurance lobbyists also try to frighten the uninitiated with the specters of rationing and waiting times that might accompany a public system.
Rationing is already occurring and will only be improved by a national health program. Right now we ration by income. If you have insurance, you get the care you need. If you don’t, you hesitate and delay, often allowing a simple problem to become serious and expensive; the warning chest pains become a heart attack, the diabetic foot infection becomes gangrene.
Will there be increased waiting times for elective procedures in an American taxpayer-supported (i.e. single-payer) universal health care system? Perhaps. Will there be difficult debates about what will be covered and what will be omitted from a national health care program? Certainly. Will paying for the system be a knock-down, drag-out fight? Absolutely. But given that we pay roughly twice as much per capita as any other nation for health care, it’s likely we already have enough money in the system to cover everyone (and the big secret is that if you make less than $100,000 you will likely pay less with a 2 percent national health program income tax than what you currently pay in premiums, deductibles and out-of-pocket expenses).
A single-payer system will change the debate in a fundamental way, from who we are going to cover to what we are going to cover.
It is a complex issue, but it comes down to whom to trust: an industry that deals with patients at arm’s length and is ruled by the almighty dollar; or physicians, who deal with you face-to-face, who suffer with you when you are unable to access essential care and whose oath calls them to service, not just to higher income.
In my practice, as in many of my colleagues’ offices around this country, money is not a barrier. If you cross the threshold of the waiting room, you will receive medical care regardless of your ability to pay. Try walking into a health insurance office and asking for free insurance. That difference, more than any other, defines the debate.
That’s why I am eager to announce the formation of a new group devoted to creating a single-payer plan for our state and country. The organizational meeting for a South Carolina chapter of Physicians for a National Health Program will be held at 2 p.m. Saturday at Thorny’s Steakhouse, 618 Church St. in Conway. The national group was founded in 1987 and now boasts more than 14,000 members (everyone is welcome; you need not be a physician to join).
We will not rest until America commits to providing decent health care for all her citizens. Come join us on Saturday.
Dr. DeMarco practices internal medicine in Marion. Contact him at pdemarco@mcmed.org.