It's now time for significant change in U.S. health care

By David E. Drake
Des Moines Register, June 3, 2011

As a physician I am regularly faced with patients who have inadequate or no health insurance. A person may call my office to discover that their health "insurance" does not cover mental health or they have such a high deductible they can't afford to see me. In both cases my office may refer the person to a clinic with a sliding scale, to the same place where I might refer someone who had no insurance at all.

The provision of health care in the U.S. is neither a system nor is it "insurance" of health. What we have is an increasingly broken and costly disconnected patchwork of private insurance plans that are tied to employment or retirement benefits, the latter of which have also been in jeopardy.

Once one loses their job, within a short time health coverage goes with it. Then if the person fails to meet the poverty guidelines for Medicaid, they might qualify for some coverage by Iowa Cares. Iowa Cares can work well for folks living in Polk County or Iowa City, but the many counties distant from those facilities can find persons traveling a day for a routine medical appointment.

The need for a single-payer of health care is more pressing than ever.

Recently, I was overwhelmed to learn what my own health insurance was going to cost. Having switched from providing coverage to my own family and my one employee in a group to an individual plan -- as my one employee went on Medicare -- I was astounded to learn that the "insurance" carrier had denied me coverage and had listed me as having multiple pre-existing conditions -- 90 percent of which were not accurate.

When corrected in a letter by my primary care physician, the "insurance" company accepted me but at a rate of $700 per month for my own plan and another nearly $800 for my wife and two adult kids. The total premium has come to $1,473.15.

What we need in this state and in the U.S. in a true system of health care coverage - not one plagued by hundreds of separate health plans with different deductibles, co-pays, and co-insurances.

While traveling in the United Kingdom and France recently I stopped and talked to people about their health care. And while it's true that folks will complain about the waiting time to see a specialist not one person wanted to give up their system of health care in exchange for the craziness we find in the United States. In fact several U.K. residents were astounded and disbelieving when I described to them what I face everyday in my office as patients present to me in need of care. Residents of Scotland told me they don't even carry an insurance card.

Vermont is the first state to have the support of its legislature and governor to begin proceeding to develop our nation's first universal health care system of payment. As in Canada, physicians and other health care providers, will be able to remain in private practice and will be able to bill one source for their fees. Vermont is expected to have its single-payer system in effect, using Medicare-for-all as its model, by 2017. In the meantime Blue Cross and Blue Shield, Vermont's main provider of insurance, has not fought the change but sees itself as the possible intermediary between the government and health care providers.

I currently hire a billing service to deal with the complicated challenges of billing and a half-time person in my office who mostly calls insurance companies to verify and clarify benefits. This is a great cost to any medical practice, and I would gladly have staff to only bill one source of payment for my services and to know that everyone who called my office was covered.

We all deserve competent and comprehensive health care - including mental health. Health care should not be tied to employment. I believe it is a right and not a privilege. I know the change will come. I just hope it comes sooner than later.

David E. Drake, D.O., is a physician specializing in family psychiatry. He is in private practice in Des Moines.