Single-payer health care still best solution

By John Raffensperger, M.D.
The News-Press (Fort Myers, Fla.), Sept. 18, 2012

Fishing is one of the main reasons people come to Southwest Florida. Most of us need a guide to find the fish.

One morning recently, I met my guide at Blind Pass on Sanibel and set off to fish the mangroves and sand holes. He found the right spot and we caught a few fish. During a lull, our conversation turned to health care. Neither of us had health insurance.

My guide, being self-employed, could not pay for health insurance, which would cost more than the mortgage on his home. He was most concerned about how he would pay for a catastrophic event, a situation he had already met when his wife had two major operations.

We both agreed that Obamacare would help people in his situation, but that a single-payer system would be a better solution.

During 40 years of pediatric surgical practice, I became angry when the insurance companies and HMOs refused to pay for a child’s admission to the hospital the day before an operation. They also insisted on children being discharged while they were still in pain and in danger of complications such as bleeding. A child with a corrected birth defect would later be considered to have a “pre-existing condition” and could not get health insurance.

I was particularly incensed by the multimillion-dollar salaries given to executives in the health care industry, investor profit, advertising and bribes to politicians.

The need for extensive paperwork to meet the demands of insurance companies translates into many more employees in doctors’ offices and hospitals. The high overhead in doctors’ practices partly explains why I paid several thousand dollars to specialists for the removal of two small skin cancers—a procedure than any intern could do in a half hour or so.

For-profit-hospitals further aggravate our medical delivery system.

Two recent stories about HCA, the giant healthcare company, partly owned by Bain Capital, illustrate the unscrupulous practices the industry will use to inflate profit. The Aug. 7 story “Hospital chain inquiry cited unnecessary cardiac work” in The New York Times told how HCA physicians performed unnecessary coronary artery operations to bolster profits. An Aug. 15 story in the same paper revealed shoddy care that caused complications such as bed sores. Oh! We must not forget that in the year 2000, when Governor Rick Scott was the chief executive of the company, HCA was forced to settle a huge fraud case involving over-billing of Medicare.

I have visited children’s hospitals in Canada, Cuba, Great Britain, Slovakia, China and Mexico, countries that are blessed with government-run health care systems. The doctors in all of these hospitals provided excellent care at low cost. Especially, in Canada, the research, teaching and patient care is equal to and in some cases superior to that given in our country. Even, 20 years ago, the surgeons in Cuba and Slovakia, communist countries, were performing open heart operations, kidney transplants and other complicated operations with great skill.

We should have a single-payer system to care for life-threatening conditions, but patients should be responsible for a portion of the costs, depending on their means. Patients should pay for most of the costs of “comfort” procedures such as joint replacements so the elderly can continue to play tennis.

The elimination of advertising by the entire health care industry including physicians and hospitals would reduce costs. Independent panels to resolve malpractice issues would also go a long ways to reduce the costs of care. The referral of patients with complex diseases to academic hospitals will further improve care and reduce costs.

Dr. John Raffensperger, is former surgeon in chief, Children’s Memorial Hospital, Chicago. He lives on Sanibel Island.|head