Live and let live: Are we closer to a national health program?

By Aaron Burch
Louisville Medicine, October 2015

The protection of patients and physicians has been a continuous fight in America for decades. One of the biggest moments of the modern era of health care came July 30, 1965, when President Lyndon B. Johnson signed Medicare into law.

This year was the 50th anniversary of that historic legislation and celebrations took place across the country. At the Louisville Public Library, the Kentuckians for Single-Payer Healthcare hosted “Medicare – Protect It, Improve It, Expand It!” The event, lovingly referred to as PIE, taught attendees about the history of Medicare in the United States and projected a future of an expanded and improved Medicare system for everyone.

Jonathan Ross, MD, internist from Toledo, Ohio, and past president of Physicians for a National Health Program (PNHP), spoke at the event and gave his vision for the future of medicine. Dr. Ross has argued for single-payer health care since the Clinton administration. Along the way, he’s seen the PNHP grow from a few dozen physicians to more than 25,000 across the United States.

“We took a bus ride to Little Rock after the election of Bill Clinton thinking he would work on health reform. On the bus with me was a man who worked with the Electrical Workers Union. He’d been working on health care reform since FDR. We started talking and he told me, ‘Son, this is a lifetime of work.” Dr. Ross laughed, “Here I am a lifetime later and it’s still a lifetime of work.”

Still, he remains passionate about the potential success of the single-payer system. For years, House Bill 676, sponsored by Congressman John Conyers, has floated around the nation’s capital. HR 676 would establish the “Medicare for All program to provide all individuals residing in the United States and U.S. territories with free health care…” While it has more than 60 Democratic co-sponsors, it hasn’t gone any further than the House of Representatives. That won’t change anytime soon until a more significant number of physicians take up the cause. PNHP activists including Dr. Ross and Dr. Garrett Adams of Louisville know this is a huge undertaking.

“I think we’ve made a pretty good step in the last two decades, but these things take a long time. How long a struggle was women’s suffrage?” Dr. Ross said. “There are certain things which are tipping points, certain things that are necessary to happen. PNHP’s role in this is to get physicians to see the inadequacies of the system. We need to get away from the ‘No, leave government out of our lives’ talk and recognize we need a new system.”

Dr. Ross and other members of the PNHP’s views are simple. There are some things too important to leave to the capitalist marketplace. Among those are sanitation, water, fire, police and, yes, health care.

“The data is solid. For every 1,000 people uninsured, one will die unnecessarily,” said Dr. Ross. “There are 30 million people uninsured. So, 30,000 people are dying unnecessarily every year. I’m not sure what would happen if we had somebody come over and blow up 30,000 people each year, but I have a feeling we would deal with it differently.”

Dr. Ross said, “This situation is a quiet disaster. These people are separated. There’s no publicity for them, but they’re out there.”

Following the successful Medicare PIE event on July 30, Dr. Ross and other representatives met with medical students on campus to talk about ways to get involved and what can be learned from always being skeptical. Dr. Ross recalled a story of one of his patients who passed away unnecessarily.

“He was an assistant manager at a burger shop, I won’t say which one. He had three kids, so he had to think about how to get by with the money he was making. He chose not to purchase the very paltry insurance package provided by his work. When he came to see me, he was seriously overweight. He had trouble breathing, sleeping, and edema in his legs which indicates heart failure. I told him it was a serious problem but there was no place I could send him to get a sleep study without proper insurance and he didn’t have the money to get it done.”

Once a social worker became involved in the case, the man was advised to quit his job. “They said, ‘You have three dependent children. You’ll qualify for Medicaid within the month and then we can order the study. So he quit his job. But, he died in his sleep the night before his sleep study was scheduled,” Dr. Ross said.

“These are the stories we see. Every doctor has stories like this, a near miss or a wounding or sometimes these stories where we lose good hard-working folks who were kicked aside by the health care system. Working with the city population, you see this stuff day after day.”

Talking to his residents at St. Vincent Mercy Medical Center in Toledo, Dr. Ross routinely jokes about the United States having the “best health care system in the world,” emphasizing the social determinants and inadequacies of the health care system. Despite going for laughs, he somberly admits many of his colleagues believe it to be true.

“We cost twice what everyone else does and we don’t do anything substantially better. We have worse mortality and some of the worst childhood health statistics and maternal mortality statistics in the world. Our system is dysfunctional because it’s too complicated. There are too many people trying to make money from it rather than look at it as a social good,” he said. In person, Dr. Ross is a whirlwind of ideas and examples and statistics, but he knows that it doesn’t matter what he alone thinks, but rather what he can do to convince others.

All involved agree that the future of the PNHP and the continued prospect of a single payer system depend on new blood. Medical students and young physicians who will continue to fight and get a seat at the table are becoming increasingly important as older members can no longer maintain their level of activity.

Dr. Adams spoke to the students and residents in attendance. “The most exciting thing happening in PNHP in the last five years is the student movement. The questions and worries they have are taking place across the country. What kind of practice will they have? Will their activism affect their careers? You’ll get courage and encouragement from them.”

Dr. Adams encouraged each of the students to keep a lookout and get involved, saying he was so busy studying for medical school that he didn’t pay attention to the civil rights movement until it was already coming to pass. “It’s crazy to admit that now, but it’s true,” he said.

Both argued that the physicians coming out of medical school now will decide the future of a national health program. Even if HR 676 is never ratified, they argue, there will be physicians who know it is worth fighting for.

“I’m going to give the rest of my life to try and make it happen,” Dr. Ross said. “At the very least, my activism could keep things from being that much worse. While I was in this meeting, I got two e-mails telling me about new ICD-10 classifications I have to learn. And why? It’s about the money. The more specific you can be, the more they’ll pay you in the long run. So here we are bowing down to money, but it isn’t going to make a bit of difference to my care of the patients.”

Dr. Ross travels throughout the country in support of single-payer health care. He is a graduate of Cornell University and the Medical College of Ohio. He also holds a master’s degree in health policy and administration from the University of Michigan School of Public Health. He’s previously been a guest speaker at the University of Louisville and the University of Kentucky.

“We have to change the caregivers’ minds and make them realize they don’t want to be part of an immoral system anymore,” Dr. Ross concluded. “The reason I advocate is that the policy science says it will work. The studies that have been done say it is economically feasible. A national health program would improve the quality of life in America. We know it’s constitutional. So why not? I know why it will work. Tell me why it won’t.”

For more information about Physicians for a National Health Program, visit their website

Aaron Burch is the communications specialist for the Greater Louisville Medical Society.