Glitches

By Andrew D. Coates, M.D., F.A.C.P.
WAMC Northeast Public Radio, Oct. 25, 2013 When I was young I worked as a carpenter’s helper here in rural upstate New York. The man I worked for, a treasure of local lore, is someone who possesses generous good humor and a gift for analogy. On ladders and roofs, in the back-road truck journeys to our jobs, and at the sawhorses we would debate the big questions of life and also share the most pedestrian observations about farm and family life.
 
One day, trying to describe how someone had taken a narrow view of a much larger question, he took a dime out of his pocket and held it at arms length. “Imagine that dime is a hole and all you can see of the world is what you can see through that hole,” he said. “If that’s all you can see, you’ll miss out.”
 
This week “glitches” in signing up for private health insurance through the Affordable Care Act website conquered the news cycle. The gathering storm of weekend talking heads prompted President Obama to summon a Rose Garden press conference on Monday.
 
In turn the talking heads grew even louder all week long, although the amount of the world their debate illuminated now seems smaller than that dime-sized hole.
 
On “The Daily Show,” Jon Stewart lanced the President’s Rose Garden performance, calling it a deal-closing speech from “Glengarry Glen Ross,” David Mamet’s award-winning play and film about failing real estate salesmen who are driven to desperate indignity by their corporate bosses.
 
On Wednesday the House of Representatives Energy and Commerce Committee took testimony about the website “glitches.” As the information technology subcontractors — ironically the two major firms involved are owned by a Canadian firm and a major U.S. insurance company — passed the buck and pointed fingers at public servants, the Republicans’ talking points seemed absurdly hypocritical.
 
The notion that government intervention is always a bad thing seems a bit silly if the point is made while grilling private subcontractors.
 
Tea Party criticizing the White House for website “glitches” seems even more silly, if we recall that the health care proposal put forward by Wisconsin Republican Paul Ryan would dismantle Medicare and set up a “Medicare Exchange” where seniors would log into websites to purchase their Medicare benefits from private insurance companies.
 
The day the House Committee deliberated the White House hosted a meeting with over a dozen top leaders of private insurers. The stated purpose of the meeting was to establish ways of working even more closely with the lucrative corporations to implement the Affordable Care Act. With a parade of insurance company CEOs at the White House against the background of Republican calls to dismantle all public programs in favor of a health care finance system even more dominated by private interests, should we laugh or cry?
 
Finally, by the end of the week Democratic Party supporters of the Affordable Care Act recalled that the Medicare Part D rollout — in which seniors and the disabled were enrolled in private prescription drug plans — was also characterized by a period of “glitches.” But comparing the problems with the president’s program to a bad public policy also seemed a strange talking point.
 
Stunningly, throughout the week, those who keep a keen eye on health policy and politics began to hear that the solution is single payer. While some of the far-right imagine a conspiracy led by the president, most people in the United States know that it doesn’t have to be this way in our wealthy country. Medicare was rolled out in 1965 with typewriters and telephones, not websites. Enrolling everyone over age 65 in one program offered simplicity.
 
The “glitches” in purchasing private health insurance arise from the complexity and bureaucracy of our private insurance system — with hundreds of insurers, thousands of plans, state-by-state as well as federal regulation and the need to mine new databases in order for the federal government to subsidize premium payments for Americans who have incomes below 400 percent of poverty.
 
In reviewing this week’s events in Washington, I am reminded of a view through a hole the size of a dime held at arms length, instead of the world around us.
 
Every day in the hospital I meet patients who can’t afford prescription drugs. Every day in the hospital I work with patients who can’t get timely specialty care, who are on waiting lists. Every day in the hospital we learn about new bottlenecks that deny or delay necessary care, problems caused by private insurance.
 
It is true that it is better to be insured than uninsured and we know this intimately, for every day at the hospital we help uninsured patients find out how to enroll in insurance and apply for charity care. Yet in the big picture private insurance has already failed us, individually and as a nation. It is beyond repair.
 
We stand on one side of a chasm. We stand amid a dysfunctional health system that fails to serve tens of millions of people. On the other side of the chasm, in this wealthy country, another world is waiting.
 
Signing people up for private insurance incrementally will not get us across that chasm. If we relax our focus from the narrow, dime-sized view and look around us, we will realize that we can’t leap that chasm in several jumps. We need fundamental change.
 
Dr. Andrew Coates practices internal medicine in Upstate New York. He is president of Physicians for a National Health Program.
 
You can listen to Dr. Coates’ radio broadcast here: http://wamc.org/post/andrew-coates-glitches