I had a dream

By Charles Mathews
Cap Scan, the journal of the Capital Medical Society (Tallahassee)
July 2010 Edition

I was troubled and sleep-deprived by these past several years of frustrations and struggles to achieve a seemingly simple straightforward goal for this great Republic, namely health care for all, Medicare-type coverage, cradle to grave, such as all other advanced countries  provide their citizens.  Enacting legislation, single payer, has lain in the congressional hopper for years, where it is kept buried by the powerful lobbyists of the health care  oligarchs.

I was discouraged but not surprised to hear the eminent Dr. Arnold Relman, (who is the same age as  this minor dreamer) declaim at his presentation at FSU Med in early April, that single-payer is inevitable, because the present course is utterly unsustainable, but - he  does not expect to see it happen in his (nor my) lifetime.

Then, I read in my May 26 JAMA about a system across our northern border, where those Canadians, all Canadians, have access to all necessary health care. Then, I fell peacefully asleep, and had an amazing dream. In my dream, no money passes directly from the patients to their providers, whether physicians or hospitals. Administrative costs are about 5%, contrasting with 16-20% in the US, with multiple payers involved.  No teams of billing clerks needed - only one bill, to the Provincial government.

Without a fee for service system  so near and dear to us US physicians, the Canadian system is able to provide more primary care providers, the logical base of the health care system. The profession there is not top heavy with specialists and super-specialists, billing for procedures rather than for providing care.

Later, my dream grew troubled, as I lay anxious about those waiting lines, the rationing, said to exist north of the border. The millions of uninsured and underinsured in my country somehow did not intrude upon my dream.

On awakening, still concerned about those Canadians who were standing in lines waiting for care, I called my niece Julie, a long time Toronto resident, to express my concern and sympathy.  Julie was somehow totally unaware of rationing and waiting lines in her country.  As nearly as she could tell, the health care system there is working pretty well, and no-one she knows would change their system for our open market, free enterprise system.

I pondered: Why the difference?  As the co-author of the JAMA article stated, “The fundamental explanation lies instead in their different systems of government. Canada’s head of state can more readily achieve policy changes than US government leaders.  Simply put, in Canada government can more easily do things.”

While this Floridian would never want to move to Canada (those long, cold winters!), how do we achieve health care reform here, without going north. Back to the JAMA  article: “Government inability to act is not the same as limited government. - - - Further health care reform will almost certainly be needed for both budget and health policy reasons. The Constitution is here to stay, but a better and more critical understanding of how it operates today, not in 1789, may help the United States to achieve these reforms.”

So, I had the dream, but my best dream would be for this my country, to be place where every American had access to quality health care, cradle to grave, a Medicare for all, with no financial barriers.  It could happen, it has to happen, but, like Dr. Relman,  I do not expect to live to see it.

Charles R. Mathews, M.D. vintage 1923, OKMed 1945.