First, do no harm. Second, nationalize

By Teryl Zarnow, columnist
The Orange County Register, Aug. 17, 2012

It sounds like a golden age in medical care.

You went to the doctor and received medical care. You didn't jump through hoops such as prior authorization, referrals, or network providers.

"Insurance didn't interfere," recalls Dr. Don McCanne, who practiced family medicine for 31 years in San Clemente before retiring in1997. "You just took care of the patient."

Then in the 1990s came the "managed care revolution."

Suddenly, he says, the private sector "intruded in the relationship between the physician and the patient."

In his practice, McCanne worked evenings and weekends to treat the poor or undocumented without health insurance. Today he sees the same problems getting worse: Medical costs have soared, and many people still don't have access to health care.

McCanne, now 74, volunteers as a policy fellow for Physicians for a National Health Program (PNHP) where he was a past president. His group favors a single-payer national health program often called "Improved Medicare for All."

It's not socialized medicine, just socialized insurance.

I can't decide if the doctor is out of touch with reality or a prophet in blue jeans.


The idea is to take health insurance down to the studs.

The Patient Protection and Affordable Health Care Act, which survived a judicial cliffhanger in the Supreme Court, only remodeled the existing structure.

McCanne believes the act corrects several issues, but doesn't go far enough. His group's position is that when the law is fully implemented in 2017, more people will be insured, but under plans that won't provide adequate coverage. Many low-income families could be left out altogether, and medical costs will continue to rise.

"It didn't fix the system," he says.

McCanne describes an alternative that sounds stunning in its simplicity:

Everyone would be automatically enrolled in a national health plan at birth. There would be no deductible, no out-of-pocket, no coinsurance, and no networks. It's similar to Canada's national insurance.

"It returns choice to the patient and removes monetary barriers to care."

Doctors and hospitals would deal with only one plan, cutting administrative costs and improving planning. Today, McCanne notes, 31 cents of every health care dollar is spent on administrative costs.

We would pay for this insurance through an employer payroll tax and income tax. Physicians for a National Health Program believes most taxpayers would spend less than they do now.

The passion of McCanne and others seems to be fueled by front-line exposure.

This summer a group of doctors and nurses caravanned across California to rally support for national insurance. Participants included PNHP, as well as Campaign for a Healthy California and the California Nurses Association.

Sharon Speck, a pediatric trauma nurse at UCI Medical Center, was on the tour. She doesn't see herself as a radical, more as a compassionate advocate for her patients.

She remembers a 5-year-old who died from leukemia, without the bone marrow transplant that might have saved his life. His insurance didn't cover it.

"It's a social justice issue," Speck says. "I think something's got to change."


McCanne doesn't seem like a doctor who could hustle you in and out of his office in seven minutes without making eye contact. He also doesn't seem like a policy wonk.

The son of a doctor, he seems like a guy fundamentally offended by the way things work today. Too many uninsured patients came to him too late, ignoring a malady until it has reached a late stage.

"We are the only nation that rations health care based on ability to pay... As a doctor, if someone needs health care, I give them health care. That's just the way it should be."

McCanne's group – a non-partisan think tank that seeks to educate the public about what works and what doesn't work in health reform — believes we won't control health care costs until we reform the way we pay for them. The group estimates a single, national insurance plan could save over $400 billion per year in administrative costs.

McCanne also argues we should stop allowing medical costs to drive families into bankruptcy.

"Half of all personal bankruptcies have medical debt as a contributor and of those ... three-fourths were insured... so insurance is not providing the financial protection it's supposed to."

I see the logic, but isn't it a little naive to think the insurance industry and lawmakers are going to fall into line behind a change simply because it makes sense?

"I'm a pragmatic idealist," he responds. "I'm not for incrementalism, which doesn't work at all. ... Or for supporting legislation because it's what we can get passed....

"We support policy that really works."

A little perspective helps.

Hard to remember, for example, the American Medical Association was originally against Medicare. California's Legislature has twice passed statewide single payer insurance bills, vetoed by the governor in 2006 and 2008.

The argument catches my eye now because it's backstroking upstream. Vice presidential candidate Paul Ryan would introduce private insurance back into Medicare. At a time when we're prioritizing shortages, these folks argue against settling.

McCanne sees obstacles in today's more conservative political climate, for sure. Most people who are covered by an employee plan, he believes, don't want to change what they already have for something that sounds uncertain.

Ultimately, though, he believes a single-payer plan will prevail. He thinks the day will come when people will view their health insurance, like Social Security, as another entitlement.

"I don't hold high ideals. The nation holds low ideals on what our health care should be. We should just be doing it right."

In McCanne's upstairs office, underneath the Hippocratic Oath hanging on the wall, is a model of David and Goliath. Against the odds, David scored a knockout.

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