Western N.Y. physicians call for single-payer health system

By Henry Davis
The Buffalo News, Jan. 28, 2014

If Buffalo is any indication, the campaign for single-payer health insurance didn’t die with the Affordable Care Act.

Advocates in Western New York remain undaunted despite a discouraging history of defeat in the United States in the quest for a Medicare-for-all type health system.

They and others nationwide have seized on the shortfalls and technical problems during the roll out of President Obama’s health care law to refocus attention on a single-payer system similar to Canada’s.

“The same forces that created the disparity and injustice in our health system shaped Obamacare,” said Dr. Kathleen Grimm, a pediatrician and internal medicine specialist who heads a local chapter of Physicians for a National Health Program.

The fledgling chapter is small – about 12 core people – but it represents the most organized effort here in recent memory to pursue single payer.

The group is sponsoring a public talk by Dr. Andy Coates, president of Physicians for a National Health Program, from 5:30 to 7:30 p.m. Thursday in D’Youville College’s Madonna Lounge.

Coates also will visit the University at Buffalo on Friday to encourage more medical students to get involved.

“We have to take sentiment and turn it into action,” said Dr. Robert Milch, a co-founder and the former medical director of Hospice Buffalo, at a recent meeting of the local chapter.

Members like Milch point with optimism to Vermont, which is moving ahead with plans for a statewide single-payer system that could begin in 2017 if officials can agree on a way to finance it.

Vermont is taking advantage of a provision in the Affordable Care Act that allows states to try other ideas for health reform as long as they meet certain standards for cost and coverage.

“Vermont has the best chance to become the single-payer laboratory for the rest of the country,” said Dr. Deb Richter, a former Buffalo physician who heads Vermont Health Care for All, the leading advocacy group in Vermont for a single-payer system.

Single-payer health care is not socialized medicine, in which doctors and hospitals work for the government. It’s a system in which the government is the primary payer of care. Medicare, the federal health plan for those 65 and older, exemplifies a single-payer system.

The case Grimm and others make against the existing health system begins with the fact that the U.S. spends almost twice as much as other developed nations on care. However, the measurable results are at best the same, and problems persist with patient safety, poor access and coordination of care as patients move from one setting to another.

They argue that administrative waste consumes an enormous share of health spending and creates bureaucratic hassles, a problem studies have documented.

The existence of multiple private insurers, for instance, means hospitals and doctors must administer many different contracts with different coverage and policies.

To single-payer advocates, the Affordable Care Act maintains an inefficient, complicated and dysfunctional health system in which policy is influenced by powerful lobbies and medical decisions too often are dictated by financial issues.

“It is very simple in medicine today: If there is a profit motive, you are going to do more,”said Dr. Roberto Diaz Del Carpio, an internal medicine specialist.

“Health care has become a commodity,” he said. “That works if we we’re talking about something like iPhones, and my product is better than someone else’s. But everyone should have good insurance.”

Advocates also criticize the health law for failing to cover millions of Americans while keeping an increasingly costly insurance system tied to employment.

“I see so many people who want to go back to work but fear losing their Medicaid coverage. Health insurance oppresses them,” said Jessica Bauer Walker, executive director of the Community Health Worker Network of Buffalo.

Henry Davis is News Medical Reporter.

Single-payer medical care system would improve Americans' health

By Jessica Bauer Walker
The Buffalo News, Jan. 28, 2014

By Jessica Bauer Walker

The U.S. health care system is sick. We spend twice as much as any other country on medical care and have the best technological advances in the world. Yet our health outcomes are the worst of any industrialized nation, consistently ranking 30th or worse on the World Health Organization index.

Many factors influence health. Research has shown that public health is supported in large part by investment in preventative care as well as the “social determinants of health” such as access to a good education, nutritious food and jobs that pay a living wage.

The Affordable Care Act, or Obamacare, makes some good efforts at improving our health care system. Prohibition of denial of coverage to individuals with pre-existing conditions, expansion of Medicaid, raising the age limit for coverage for young adults on their parents’ plans, and investments in community-based health centers and Community Health Workers in under-served neighborhoods will all improve quality and access in health care.

But we need to go further. An estimated 23 million will still be uninsured by 2019. Many more will be left with inadequate coverage to meet their needs, vulnerable to the epidemic of medical debt, which is the number one cause of bankruptcy in the United States.

In America, we believe citizens have certain rights. We mandate children’s education through public schools, and provide legal representation to those accused of a crime who cannot afford to hire their own. How is it that we do not believe health to be a human right, but instead treat it as a commodity? Health care is bought and sold, controlled by private interests such as insurance and pharmaceutical companies, and increasingly by for-profit hospitals and health care providers.

There is a cheaper, better, more humane way. Single-payer health insurance would create one public agency to organize health financing. Delivery of care would remain largely private but, like Medicare, would cover individuals for all medically necessary services.

Such a system, utilized by many countries healthier than ours, gives patients more choice over their provider and services, and doctors more autonomy to focus on care. Streamlining payment through one nonprofit payer would free up one-third of every health care dollar currently spent on advertising and paperwork, saving more than $400 billion per year – enough to provide comprehensive, high-quality coverage for all Americans.

Buffalo is undergoing revitalization, and part of it needs to be policy changes necessary to create the healthy people who will be the backbone of any robust society and economy. With an eye to the future, let us ask our local, state and national leaders to ensure health and health care as a human right.

Jessica Bauer Walker is executive director of the Community Health Worker Network of Buffalo.