Next civil rights frontier? It surely has to be health care

By Jessica Schorr Saxe, M.D.
The Charlotte Observer, Jan. 14, 2012

"Of all the forms of inequality, injustice in health care is the most shocking and inhumane."
–Martin Luther King, 1966

In the exam room, the patient recounted her complicated illness. When she described symptoms related to her surgery, I suggested she see her surgeon.

She had spoken calmly until this point, but now tears came to her eyes. When she lost her job because of her illness, she lost her insurance and could no longer see any of her trusted physicians. Then followed months without needed care. Hers was just one of the sad money-related stories I hear daily.

Injustice we still tolerate

On Martin Luther King Day, it is easy to congratulate ourselves on our progress in moving beyond segregated schools, lunch counters and drinking fountains. The hard question is this: what injustices do we still accept that should, in fact, be intolerable?

Surely Dr. King would find the next civil rights frontier in health care, with nearly 50 million uninsured, almost 45,000 deaths annually due to lack of insurance, and more than half of all personal bankruptcies linked to illness and medical bills.

While the Affordable Care Act will bring improvements, such as decreasing the ranks of the uninsured, supporting community health centers, and investing in prevention, it leaves many gaps. At least 23 million people will still be uninsured in 2019. Tens of millions will be underinsured, one serious illness away from financial ruin. Most people who suffer medical bankruptcy had private insurance before getting sick. And medical bankruptcy is a cruel double whammy. Already beset with pain, anxiety and fear - due to serious illness - families find themselves financially devastated.

This doesn't happen in other industrialized countries, which have high-quality health systems that cover everyone.

The U.S. spent $7,960 per person for health care in 2010. Most developed countries spent less than half that amount and yet have better health outcomes and, in many cases, similar or better access to technical advances, such as hip replacements, bone marrow transplants, and MRIs.

How is this possible? As a nation, we waste about $350 billion in unnecessary paperwork and bureaucracy, thanks to our fragmented system of financing care through multiple insurers. And, although all countries are suffering from health care inflation, our rise in costs is far higher.

What to do? We should move to an Improved Medicare for All system, in which we share the cost of covering everyone, as we do for other valued services such as education, police, and the fire department.

How could we afford it? Our current public expenditures for health care that don't cover everyone are already greater than the total expenditures of countries that do.

First, we would save by cutting out the insurance company middlemen. Second, we would negotiate lower prices for medications and supplies. Finally, by abolishing private insurance premiums and substituting revenues from taxes based on ability to pay (a mixture of taxes on payroll, personal, and unearned income as well as stock and bond transactions), we would easily cover the uninsured.

Concerned that this is socialized medicine? Not at all. The U.S. has a high-performing socialized medicine system in the Veterans Administration, which owns hospitals and employs doctors and enjoys high patient satisfaction. Improved Medicare for All is not socialized medicine. The bills would be paid by one source, but medical practices and non-profit hospitals would continue to be independent.

Worried about the solvency of Medicare? Medicare actually operates economically, with administrative costs well under half those of private plans and with better cost control. In addition, Medicare has been considerably less inflationary. If billions of dollars were freed up in administrative costs nationally, that could go a long way toward comprehensive (not minimal) coverage for all, as well as fair (and not constantly threatened) payment for doctors and hospitals.

What are those expenses? Insurance companies incur them for designing plans, marketing, and deciding who is - or often isn't - eligible. Hospitals and providers also have excessive costs. While medical practices in Ontario spent $22, 205 per physician annually interacting with Canada's single payer agency, American practices spent $82,975 per physician dealing with health plans.

Use health care dollars to help

Consider the possible savings. This money could be used for actually providing health care.

My dream is to take care of patients and not have the specter of financial issues an unwelcome presence at every visit. I dream that there will be no tears in my office due to the unaffordability of needed care. And I dream that my time - and our health care dollars - will be spent helping people, not mired in bureaucracy.

Do you want to pay a real tribute to Martin Luther King? Be bold and visionary as he was. Fight "the most shocking and inhumane" injustice - and support Improved Medicare for All.

Jessica Schorr Saxe is a Charlotte physician and a board member of the Health Care for All NC.