Medicare is the patriotic, prudent, medically vital thing to do

By Ed Weisbart, M.D.
Deseret News (Salt Lake City), Sept. 22, 2015

We need to improve Medicare and provide that to all Americans. It’s the patriotic, prudent and medically vital thing to do.

I appreciate the serious tone that Sally Pipes took in presenting her Koch-funded arguments against single-payer national health insurance (“Government single-payer health coverage may be nation’s future,” Sept. 20). I particularly appreciate that she accurately represented my own comments; that I, along with at least 59 percent of physicians in the U.S., believe the evidence is overwhelming that single-payer would be the most efficient way to finance high quality health care for all Americans.

Our current system produces mediocre results, with the result that the CIA World Fact Book identifies Americans as ranking 51st in life expectancy at birth. Less widely recognized is that our world ranking in life expectancy changes drastically after we hit the age of Medicare eligibility. According to the Institute of Medicine, our life expectancy before age 65 ranks the worst out of 17 modern nations. Once we hit age 65, our life expectancy ranking rapidly climbs to a position nearly the best in the world. As proud Americans, we should honor the fact that we have a world-class publicly financed health care system — Medicare.

The beleaguered Veterans Administration (VA) system does not represent the only possible model for an American single-payer system. Critics of the VA should realize that our recent years of increased military service have led to vastly increased demands on the VA, without a concomitant adjustment in resources for these new patients. Although significant service problems exist, their clinical outcomes have long been among the best in the nation. Pointing out the VA’s challenges, while intentionally not pointing out that the same issues exist in our private insurance industry, is only meant to be inflammatory and misleading. And it has little to do with questions about national health policy.

Fortunately, there is a robust North American experiment in single-payer versus private insurance: Canada vs. the USA.

Up until 1971, both of our nations were spending roughly the same 7 percent of our GDPs on health care, and had been following the same general cost trend curves. Our life expectancies were within a year of each other.

In 1971, Canada fully implemented its national health insurance. That same year, President Richard Nixon signed the HMO Act into law.

After beginning with a system performing very similarly to our own, Canada now spends roughly half of what we spend, and its life expectancies are now two and a half years longer than ours. Health care is far from perfect in Canada, but it’s dramatically better.

According to the National Bureau of Economic Research, 14 percent of Americans now report having unmet health needs. One percent of us have this problem due to waiting lists or unavailability of a service, 8 percent due to cost issues and 5 percent from an assortment of other reasons. Compare this to the 11 percent of Canadians with unmet health needs: 6 percent of Canadians report the problem as a result of waiting lists or unavailable services, 1 percent due to cost and 4 percent from other reasons. Yes, Canadians have longer waiting lists than we do, but their problem pales in comparison to the number of Americans who never even make it to our waiting lists and have unmet needs due to the cost of care. The key driver of Canadian waiting lists is their decision to fund a system at 50 percent of our own.

Today, 45 years into this Grand North American Experiment, Canadians spend half, have 20 percent less unmet health needs and live 2.5 years longer.

It’s time to call off this experiment. We need to improve Medicare and provide that to all Americans. It’s the patriotic, prudent and medically vital thing to do.

Ed Weisbart M.D. is a family physician and chairs the Missouri chapter of Physicians for a National Health Program. He volunteers at a variety of safety net clinics in St. Louis, Missouri, and across the nation.