U.S. has 'death panels'

The Blade (Toledo, Ohio), Jan. 9, 2011

The American health care system is severely dysfunctional. We spend about twice as much per person on health care as other wealthy democracies, yet our medical outcomes are mediocre by comparison.

Some 45,000 Americans a year die because they lack health insurance. Thousands more needlessly suffer and die from preventable causes. Others go bankrupt because of medical bills.

Health-care reform is touted as a way to change what's wrong with our system. But the law leaves private health insurers in the driver's seat. That doesn't augur well for change.

During the reform debate, the Tea Party gossip was that government “death panels” would pull the plug on Granny. That is nonsense.

New regulations simply allow me, a primary-care general internist, to bill the government for the time I spend discussing with my Medicare patients specific end-of-life issues, such as having a durable power of attorney for health care and a living will. These are common-sense things that any decent doctor should do.

But this isn't to say that death panels that ration health care don't exist. They do, in the forms of private health insurance companies and Republican-dominated state legislatures.

For insurers, denials of care are a matter of record. A California-based study in 2009 showed that big insurers denied one of every five claims. Every claim that is denied helps pad insurance companies' bottom line. But the consequences of such denials can be catastrophic to real people.

In Texas, Republican Gov. Rick Perry and GOP legislative leaders say they are thinking about canceling their state's participation in Medicaid. The Texas Medicaid program covers about 3.4 million poor people.

A decision to drop out of Medicaid would result in an estimated 3,400 annual deaths in Texas, on top of the 6,100 deaths in the state each year caused by a lack of health insurance, recent research suggests. And who knows how much suffering and disability would result for those who do not die, but go without needed care?

Arizona's Republican-dominated Legislature has canceled Medicaid coverage for about 100 patients who need organ transplants. Two of those patients already have died, so this is truly the decision of a death panel.

Lawmakers claim the policy will save about $4.5 million. But what about the human cost? Just about all of these patients are likely to die over the next four years without coverage. At least some would survive if they kept Medicaid coverage and found matching donors.

There is a way out of this. We can insure all Americans at a reasonable cost by enacting a nonprofit, single-payer national health insurance program — an improved “Medicare for all.”

Clinical decisions would be made by doctors and patients, not by insurance company bureaucrats or bought-and-paid-for politicians. Administrative savings would allow comprehensive coverage for everyone, with no increase in U.S. health spending.

Single-payer financing would streamline the health-care bureaucracy, saving $400 billion a year on administrative and insurance overhead. That would be enough to insure everyone and still eliminate all co-pays and deductibles.

The health-care law defers state experimentation until 2017. But Ohio and other states should get to work now with single-payer reform. Let's get moving. Our lives depend on it.

Johnathon Ross is past president of Physicians for a National Health Program and an executive committee member of the Single Payer Action Network in Ohio.