The following text contains the remarks of Dr. Quentin Young, national coordinator of Physicians for a National Health Program, at a session of the 40th legislative conference of the Congressional Black Caucus Foundation in held in Washington, D.C., on Sept. 16.
Mr. Chairman, Sen. Sanders, Rep. Conyers, fellow panelists and friends,
First, a brief correction to the chairman’s very kind introduction. I used to be a doctor. Two years ago I retired after 62 years of practicing medicine. I enjoyed every minute of it. I didn’t retire out of lack of enthusiasm for medical practice, but out of a desire to see the world we live in change.
I retired and became a full-time volunteer for Physicians for a National Health Program, which is dedicated to achieving single-payer national health insurance.
Our 17,000 doctors in PNHP are the tip of the iceberg. Research conducted at Indiana University shows that today 59 percent of doctors support the idea of government-sponsored national health insurance, and among the general public an even larger percentage – around two-thirds – supports this kind of approach.
So we don’t have an unpopular cause that we have to fight to get to the forefront. We have a popular cause that the private health industry and drug companies have spent hundreds of millions of dollars trying to suppress, as we saw so vividly in the latest round of health care reform.
I want to bring you some information, some of it very fresh. This morning the Census Bureau reported the number of uninsured, and it turns out that last year the number of uninsured increased by over 4 million people, so that the total number of uninsured is now 50.7 million. That’s nearly 51 million people without health insurance.
I don’t think I need to spend a lot of time explaining what that means – the huge, crushing blow that can be inflicted on someone with an illness who doesn’t have health insurance. A common outcome in this picture: personal bankruptcy.
I hope none of you has had the experience of filing for bankruptcy, but if you have, you know that bankruptcy can end your ability to get credit, buy a home, send your kids to college and more.
Well, personal bankruptcy hit 1.4 million Americans last year, and about 62 percent of those bankruptcies can be linked to medical bills. That’s right: nearly two-thirds of personal bankruptcies in our country are associated with medical debt, according to a Harvard study published in the American Journal of Medicine last year.
Our health system has thus become a monster in the life of ordinary folks. You don’t want to get sick and, broadly speaking, you can’t avoid it. But if serious illness strikes, even if you have health insurance, you’re at risk of bankruptcy. Note that the same study found that three-fourths of those who go bankrupt with large medical debt had health insurance when they got sick.
Now take that home and think about it. Our health system, we want to believe, will help people. It will cure your illness, save you from pain and suffering, extend your life. And yet instead we learn that the present system is a major cause of bankruptcy.
Not having health insurance can also be lethal. About 45,000 excess deaths annually can be linked to lack of health insurance, according to research published last year in the American Journal of Public Health. After today’s Census report, that figure is probably closer to 50,000 unnecessary deaths annually.
Here’s another extremely important issue: we have an acute shortage of primary care doctors in the United States. What does that mean?
The ratio of primary care doctors to specialists should be about 70 percent to 30 percent. That was the case for many years. But more recently, due to the corporate domination of our system, we have many more specialists and fewer generalists. Today, only about 30 percent of our physicians are in primary care, and their number is going down.
Well, when you put that to work, you’ll learn that no system – even if PNHP’s proposal, single-payer health insurance, were adopted – will be able to provide our population with the care they need if we lack sufficient numbers of primary care doctors, nurses and other health professionals.
Another point: We spent twice as much on a per capita basis as other industrialized countries on health care costs and yet we have over 50 million uninsured and at least that many people with what we call underinsurance. Underinsurance is where you have a $50,000 hospital bill, and your insurance only pays $25,000. That’s not very good when you’re trying to survive in today’s economy.
I want to emphasize that Physicians for a National Health Program has been for single payer since were founded in 1986. We didn’t take this position out of any ideological considerations or because of some personal preference, but because we’ve learned in the course of our medical practice that only single payer works for everyone.
We have vast national experience with a public, single-payer-like system; it’s called Medicare. Now Medicare was hobbled in 1965 when its opponents could no longer prevent it from being enacted into law. And I assure you that until 1965, nothing substantive in health reform got passed simply because the American Medical Association, a powerful organization of doctors, opposed it.
Well, we won Medicare and Medicaid, but not without some damage on the way to passage. For example, there is no serious pharmaceutical protection under the program. Medicare Part D, which was passed under Bush administration, is an abomination. People can still go broke just from the cost of their medicine in Part D.
So why don’t we have medications in a system that’s supposed to take care of you? The answer again is corporate intervention, corporate intervention that made us go from a potentially cost- and hassle-free system to one that requires substantial cost-sharing and a degree of bureaucratic rigmarole that can drive you nuts. Older people who use Part D will know what I’m talking about.
There are other shortcomings in the Medicare program, like co-pays and deductibles. We all know about these, and some people say, “Well, that’s the American way” or “That’s natural.” We say no, it doesn’t have to be that way. There shouldn’t be any economic barriers to getting health care. To the extent that there are, we have a bad result from the resulting delay in care, especially for the poor.
So even under Medicare we have financial barriers to care, and thus people go from having a treatable cancer to a fatal cancer. Conditions that are treatable don’t get treated and they get worse. That’s the reality under the present Medicare program, as good as it is. I’m not trashing the program. These things are fixable. Congress can fix these problems in one vote.
The larger question is whether we can bring an improved version of Medicare to the rest of the American people, to the entire population. Can extend this kind of system to the tens of millions who are presently outside any system of getting care? We at PNHP believe that is the way to go. We need an improved Medicare for all.
Other industrialized countries, from Taiwan to France, have taken this kind of approach, where health care is regarded as a human right and government acts to safeguard that right. They spend about half of what we do and all, overall, have better medical outcomes that we do.
We aren’t as optimistic about the recently passed health care legislation as some others are. We wish it weren’t so, but we’re very pessimistic about the ability of the new health law to fundamentally resolve our acute health care crisis. Today’s Census Bureau report only underscores this.
One of the major reasons for our pessimism is the continued and actually str
engthened role of the private health insurance industry in our health system. The private insurers are the cause of enormous bureaucratic waste in our system. This problem is not fixed by the new legislation.
It’s true that our national economy is threatened by the rising costs of health care, which go up in double-digits every year, and unfortunately these costs are likely to increase sharply under the new law.
In a shameless way, the insurance companies just recently gave the American people a “gift” of double-digit premium increases, following the passage of this bill. That’s painful, particularly in hard economic times such as these.
That’s why our message is that single payer is not just the best way to remedy our health care mess, it’s the only way. We have to make people understand that by replacing the private insurers with a streamlined, publicly financed system, we’d save about $400 billion annually, enough to provide everyone in the country with comprehensive, quality coverage without spending any more money than our nation does now.
Incidentally, under a single-payer program we would no longer have to witness spectacles where insurance company executives get paid as much as $100 million a year in compensation and where the main goal is to provide handsome return for private investors, or where care is denied so as to maximize an insurance company’s profits. That’s not the way to run a health system.
I agree with a previous speaker that we need to work, and we need to work hard, in this next period. We have to bring single payer back to the table. In some ways it’s already there: in a number of election districts around the country there are incumbents and challengers who support single payer. At the same time there are a number of right-wing fringe politicians who are running for office, including some Tea Party candidates, who if elected would pose a grave peril to any public health programs or any efforts to ameliorate the tragic state of health care in our country today.
We need to get organized. We have a tough fight. We need to build our alliances with organizations of labor, women and peoples of color, victims of racial disparities and inequities in health care. These kinds of alliances have proven to be the key to success in other historic struggles.
There is no guarantee of victory. But we have no choice but to push ahead for the only effective remedy to our health crisis, single-payer Medicare for all.
Thank you.