A Fresh Approach to Health Care Reform

Birmingham News
March 7, 2010

Recently in clinic at Cooper Green Mercy Hospital, I saw a man in his 50s who had a good relationship with his doctor until three years ago, when he lost his job and his health insurance. Before long, he could no longer afford health care from his doctor. He had a history of "borderline diabetes," but he felt reasonably well, until last month, when his big toe turned black. He came to our emergency room and was admitted with uncontrolled diabetes, kidney disease and gangrene of his toe, which required an amputation.

This man was at least fortunate enough to live in Jefferson County, where an unusual law requires that a portion of the local sales tax revenue goes toward indigent care. But consider a patient I saw at a volunteer clinic in Shelby County, who injured his shoulder through no fault of his own and became unable work at his regular labor job which did not offer health insurance. He received emergency care, but he was unable to pay the money required upfront to see an orthopedic surgeon or have the operation required to restore his shoulder to a level of function necessary to resume his work.

I consider myself fortunate to be a physician who works at a public hospital dedicated to providing quality health care regardless of a person's ability to pay. I get to be what I've wanted to be since I was a kid: a medical doctor who helps people in need, especially those who cannot find help elsewhere.

In the national health care reform debate, I've heard other doctors object to any system in which the government plays a major role in financing care. They say they don't want government getting between them and their patients. These doctors do have some legitimate concerns, but part of me is perplexed. Several times a day, I see patients who had something come between them and their doctor, but it wasn't the government. It was the loss of a job, loss of private insurance, new restrictions imposed by a private insurer or just a simple lack of money.

I see patients like these again and again, often with some really sad stories. They run out of medicines and get sick. Some end up with strokes, heart attacks, amputations, incurable cancers or premature death, all of which may have been prevented if their care had not been interrupted. Some may get to us before they get sick, but only after unnecessary anxiety, disruption and waste of resources, such as emergency room visits or unnecessary duplication of medical tests.

I have no trouble believing the study in the September 2009 American Journal of Public Health estimating that 45,000 people die in the United States each year due to lack of health insurance. That's one death every 12 minutes. An American Journal of Medicine study published last year showed 62 percent of bankruptcies in 2007 were linked to medical bills. Three-quarters of these medical bankruptcies were for people who had health insurance when they first got sick. A report by Families USA showed that 73.6 percent of the medically uninsured in Alabama are members of working families.

The human tragedies buried in these grim statistics occur because our society has not found the will to ensure everyone has lifelong access to health care. The legislation currently being considered in Washington is not going to provide this or do much to control runaway costs.

Before Medicare was passed in 1965, millions of our nation's elderly were without adequate health care and driven into poverty by high medical bills. Once signed into law, our seniors' plights changed overnight. Medicare, even with its imperfections, has served this population relatively well ever since, and with relatively low administrative costs.

Physicians for a National Health Program, using research done by Steffie Woolhandler, M.D., and David Himmelstein, M.D., of Harvard Medical School, estimates that a publicly funded, single-payer system can save about $400 billion annually by eliminating the enormous administrative costs associated with a multi-payer system that includes for-profit, private insurance companies. This would be enough money to cover all of those who are currently uninsured. Additional savings could be attained through bulk purchasing of medicines. I suggest that we start with an overhaul of the Medicare program, which already has an infrastructure in place, and offer it to all citizens.

With this kind of true health care reform, I would be able to say to any patient in Alabama, "Welcome. We're going to do our best to provide you with the care that you need." Wouldn't every doctor like to be able to say that?

Mark Wilson, M.D., practices general internal medicine and is chief of staff at Cooper Green Mercy Hospital. E-mail: