Cancer Care, Simplified
“Medicare for All” is long overdue, according to cancer specialist Dr. Lou Balizet, who spoke at a health forum in Pueblo, Colorado on December 8, 2009
By Louis Balizet, M.D.
“Everybody talks about it, but nobody does anything about it.” So said Will Rogers about the weather, but he may as well have been referring to our health care system — roundly decried, but still intact. Finally, however, on both state and national levels, well designed plans have emerged to replace our current wasteful chaotic system with the only workable alternative — a single-payer, tax-financed system that eliminates private health insurance, provides universal coverage, and introduces adult supervision (centralized planning). Like the majority of American physicians, I feel that “medicare for all” is long overdue.
I am a medical oncologist who has practiced in Pueblo for 32 years. This is how I imagine my, and my patients’, lives changing under single-payer health care:
1. It will be easier, and cheaper, to administer intravenous chemotherapy to all patients. Currently, uninsured patients needing intravenous chemotherapy receive it in the hospital — a costly and inconvenient alternative to outpatient therapy.
2. Office overhead, and therefore cost, will be reduced by the elimination of the present complicated adversarial billing system, which pits armies of physicians’ employees against armies of insurance company employees (ties go to the insurance companies).
3. Inpatient cancer care will be consolidated, with benefits for patients, oncology nursing staff, and physicians. Central planning will inevitable force the cooperation,if not outright merger, of Pueblo’s two hospitals — an idea initially proposed by the administration of the two hospitals over a decade ago. (The merger was nixed by Uncle Sam’s anti-trust watchdogs, suspected by some of carrying water for the insurance companies.)
4. Approved oral chemotherapy will be available to all. At present, the indigent uninsured depend on physicians’ offices begging free oral drugs from insurance companies — a wasteful and demeaning process that, more often than not, fails to deliver needed treatment. Obviously, with financial status no longer an issue, compliance with treatment, and therefore treatment outcome, will improve.
5. Everybody, not just the insured, will be able to avail themselves of life-saving screening procedures, such as mammograms and colonoscopies. Treatment of cancer, if discovered, will be covered by single-payer universal health care. This will eliminate dangerous delays in care for fear of financial repercussions, which, believe me, happen in this community, and happen a lot.
6. Some marginally effective but outrageously expensive cancer treatments will not be available. Central planning will require the establishment of an American equivalent of Britain’s National Institute for Health and Clinical Excellence (“NICE”), charged with evaluating the value, not just the effectiveness, of new drugs, procedures, and devices. If a drug offers not cure, but only weeks more to a cancer patient’s life expectancy, and is prohibitively costly, society will not he harmed by its exclusion.
7. Consolidation of medical facilities will reach beyond hospital mergers. Pueblo currently has 6 MRI scanners and 2 CAT/PET scanners. These numbers would almost certainly be reduced under central planning, resulting in some delay, compared to now, in scheduling studies. By any rational standard, however, we have excess capacity in Pueblo; necessary studies, in an acceptable timeframe, should still be achievable.
8. Physician compensation would be determined at a state or national level. This would probably result in decreased income for specialists and increased income for primary care providers, as it has in countries with single-payer care. In addition, it would allow for bonusing doctors to practice in medically underserved areas. Pueblo has a worrisome shortage of some types of specialists but an ominous shortage of primary care providers. The present market-driven model of physician remuneration is not only incapable of addressing this problem, it is in large measure responsible for it. By ensuring that all care is remunerated, and by disproportionately rewarding practice in some areas, single-payer, centrally planned health care can do more than anything achievable under the present system to get doctors where they are needed. Enhanced access to primary care physicians would translate into earlier diagnosis of potentially serious conditions such as cancer. I would expect to see fewer advanced cases of cancer if patients did not have to consult their bank account before seeking help for their breast mass, or hoarseness, or bloody cough.
The most obvious winners under single-payer universal health care are patients, particularly those currently uninsured (now numbering upwards of 40 million, and sure to increase with the coming depression), and, I believe, doctors. However, there will be some adjustments, at times difficult. The hundreds of thousands of employees of insurance companies and hospitals and doctors’ offices who spend their entire workday wrangling over who gets to keep 15% of health care premiums will need to be redirected to more productive work — no small task, and one whose importance should not be minimized. Hospitals will revert to being service institutions instead of profit centers. Business acumen will cease to be a prerequisite for a satisfying medical practice. I have not even touched on the ramifications for the pharmaceutical industry, which will be major. However, for patients, especially cancer patients, and doctors, especially cancer doctors, the current system is unsustainable for much longer. Health Care For All Colorado, which proposes a single-payer system for our state, and Physicians for a National Health Plan, who designed a detailed national system, deserve your interest and support. Perpetuation of the current system is bad for our pocketbook, bad for our national pride, and downright malignant.