Fein Calls For Taking Profit Out Of Health
by Melinda Tuhus
New Haven Independent
June 24, 2008 1:35 PM
This man wants to get rid of co-pays and deductibles for health insurance, which he calls “remarkably crude ways of controlling demand.” He has a better idea — health insurance for all in a system that allows private coverage with public funding.
Dr. Oliver Fein is taking the reins at Physicians for a National Health Program, a 20-year-old organization of more than 15,000 doctors who support a single-payer plan for all, similar to Medicare for those over 65.
Melinda Tuhus Photo
PNHP President-Elect Dr. Oliver Fein
He told about 30 doctors and medical students over dinner Monday night at Mory’s (that “fabled Yale drinking club,” as one diner described it) that under the current system, the U.S. ranks highest in the number of preventable deaths among 19 developed nations. That’s because 45 million Americans are uninsured, and more than 50 million are underinsured.
One of those attending was Yale historian Jennifer Klein, who wrote a book about what she called “our screwed-up health care system.” She said that back in the 1930s people were organizing health care as a community benefit; it wasn’t a profit-based system. “It had nothing to do with insurance companies, and it had very little to do with employers,” she said. Click here to hear a two-minute lesson in how the system evolved to its current state.
Responding to those flaws, Fein, a practicing physician and professor of public health at Weill Cornell Medical College in New York, said health coverage must be universal, covering everyone. As for undocumented immigrants, he proposed the wording of any new health insurance law should stipulate that “residents” are covered, but then lawmakers should decide what length of residency is required to be eligible for coverage.
Fein enumerated other requirements of a new paradigm of health insurance. “It must be comprehensive. Would there be any exclusions? Yeah, probably, you know, tummy tucks, botox for wrinkles. I might even exclude a private room in the hospital unless medically indicated,” such as if a patient has a roommate with tuberculosis.
“It must be tier-free. Now we have one tier for the elderly, another tier for the poor, another tier for those who are employed, another for those who are uninsured. We really need to think of a single tier of care.”
That’s when he proposed eliminating co-pays and deductibles, “because what they do is cut demand for needed services equal to the amount they cut for unneeded services.” Another tenet of a tier-free system, he said, is that private insurance can supplement, but not duplicate, public coverage.
He said public funding should replace the “regressive” funding of premium-based financing for health insurance. “Right now, the president of a company usually pays the same premium as the secretary in the company. Are their incomes equal? Absolutely not.”
And finally, the new system must have low administrative costs, for which the U.S. has to look no further than its own health care program for elders. “Medicare has an administrative cost of three percent,” he pointed out, “whereas the average commercial insurance in this country has an overhead and profit of roughly 19 to 20 percent.” For some insurers, that number goes up to 30 percent of medical costs.
This reporter was seated next to Veronica Marer, a Canadian-born solo private practitioner in Connecticut. She said with her roots in Canada (and relatives also in France), she’s learned a lot about the single payer health systems in those countries, which she believes are better for more people than the U.S. system. But, she added, “Of course it’s not perfect; there’s rationing of care and waiting for non-emergency procedures.” But she supports single payer not only because it covers more people, but because it’s much more cost-effective. She said with such a system in place, she could do with one fewer of her 2.5 employees. “Not that I want to get rid of anyone,” she hastened to add. “I love my employees.”
One goal of the gathering was to resuscitate the dormant state chapter of PNHP that had existed in the 1990s. John Battista, a psychiatrist and one of the leaders of that chapter, recounted a brief history of their efforts, from “giving talks at churches and all that,” to drafting a single payer bill in 1999; to do that PNHP spun off the Connecticut Coalition for Universal Health Care. The bill failed to pass in the General Assembly, for which Battista blamed the influence of the insurance industry on key lawmakers.
When those present introduced themselves, Michael Connair, an orthopedic surgeon in private practice and an associate clinical professor at the Yale School of Medicine, said he hoped the organization would “modify its spiel slightly to have more appeal.”
Asked to elaborate after the event, Connair replied, “I think there is a knee-jerk prejudice against a single payer system — rightly so, looking at Medicaid or the Canadian system or the deteriorating aspects of the Medicare system. So to use that phrase unnecessarily alienates people. I think the message this organization is trying to get across is that we should have universal health care sponsored by the government, controlled by the government, with the elimination of skimming by the insurance companies and the unnecessary administrative barriers that make life difficult for doctors and patients. I think this organization wants an enlightened European system.
“The Universal Health Care Foundation of Connecticut has a similar message,” Connair continued, “but it seems to be a little more readily accepted — universal health care for all. I think they should unite with the foundation which has the support of providers, consumers and businesses. It would be a shame to duplicate efforts — I think a common presentation of ideas would benefit both. PR [public relations] is important here. You’ve gotta get your foot in the door before people will listen, and you don’t want to turn them off before they’ve heard your message. Americans probably wouldn’t tolerate the Canadian or British systems, but would probably accept some of the European models.” (Disclosure: The Universal Health Care Foundation of Connecticut grants money to the Online Journalism Project, which publishes this website.)
Fein said he hoped one positive outcome of the nation’s economic downturn would be that more people would start thinking about taking the profit out of health care. He also said PNHP is supporting House bill 676 in Congress that would create a single payer system.
A contingent of Connecticut Green Party members was in attendance, including Battista and his wife, psychologist Justine McCabe from New Milford. After Fein’s talk, she pointed out that the Green Party has been a consistent and staunch supporter of single payer health insurance, moreso than almost all the Democrats in Congress (and none of the Republicans).