Doctor dreams of single payer health care — and so can you

By John Aronno
Anchorage (Alaska) Press, August 30, 2017

Tapeworms are gross. Do not Google “tapeworm.” Ever. To be clear, avoid any use of the word tapeworm as it applies to the internet. If, by some act of God, you have never heard the term, it refers to an infectious disease by way of ingested, parasitic flatworms, which use the digestive tract as a host, planting larvae that grow until, if left untreated, your own body becomes the movie Tremors. Left further untreated, you'll need an elephant gun.

I didn't expect tapeworm to come up when I sat down for a cup of coffee at Black Cup in Anchorage on Monday morning. I was sitting with Dr. Carol Paris, president of Physicians for a National Health Plan (PNHP). The group – founded in the late '80s and now spanning over 20,000 doctors, medical students, nurses, and other health professionals nationwide – has one focus: to get the United States out of a for-profit health care system and on a path towards a single payer system. You know, like everywhere else that matters (and most places that don't).

She broached the term, referencing Berkshire Hathaway's multi-billionaire president Warren Buffett, who has more than once opined that the nation's private insurance industry is “the tapeworm of American economic competitiveness.” Both Buffett and Paris cite supportive statistics: health care spending has risen from just five percent of gross domestic product (GDP) in 1960 to roughly 18 percent today – $3.2 trillion, according to the Centers for Medicare and Medicaid Services. That translates to just under $10,000 per person, including the 28 million who don't have any insurance. By comparison, in 2010, the U.S. Spent $8,233 for every citizen on health care. The closest OECD country was Norway, at $5,388. The average among OECD countries was $3,268. And, yet, we rank between Portugal and Singapore on the actual health care index for 2017.

“We're already paying for the national health care program. We're just not getting it,” Paris told me. “And why's that? Because if they're operating under the constraints of an insurance industry that has, as its fiduciary responsibility, making a profit for their investors, that's their job. And they're doing a very good job.”

Paris believes the for-profit health care industry is in need of a very specific reform: a switch to single payer health care. Such systems, comprising most of the developed world, task the state with financing health care, available to all residents, via taxes and other cost control measures.

The Maryland-based psychiatrist got intimately involved while in private practice beginning in 2003. She was exposed to the ugly underside of not just being a physician but also being a business owner. Paris used her position to try and push through a simple bit of legislation at the state level aimed at regulating what she felt was an out of control industry. She was successful, or so she thought.

“Silly me. I thought I had actually accomplished something, not realizing that it doesn't matter what you pass,” she said behind a wry smile. “Two years later, the regulations were rewritten by the lobbyists for the insurance industry. It had absolutely no teeth. It was the biggest waste of time. It was at that point that I said, 'You know, I don't think it's possible to get insurance companies in this country to be legislated to play fair.'”

Paris was frustrated, and yet she persisted. She joined PNHP and was up front and present in 2009, arguing for a single payer alternative during debate over the Affordable Care Act. Although a single  payer, Medicare for all, “public option” was attempted by Senate Democrats, it quickly evaporated when then-Sen. Joe Lieberman (I-Connecticut) threatened to quash the bill via televised threats of a filibuster.

“It became clear that the decision had been made very early on that single payer national health program was 'politically not feasible,'” she said using air quotes. “When PNHP said that we'd like to have a seat at the table, we were told no.”

She showed up to the debate over the bill in the Senate Finance Committee anyway and raised her voice, demanding single payer be included in the discussion, and was promptly arrested. It wouldn't be the last time. But, she's still speaking. Now, Paris is touring Alaska, with stops in Fairbanks, Anchorage, and Juneau, to take the case to the people.

“The Affordable Care Act attempted to cover everyone, lower costs, and improve quality, which are wonderful goals. That's what a national health program should aim to do,” she told me. “Unfortunately, they tried to do that within the constraints of a for-profit insurance industry that does not have lowering costs for good quality care as their goals. They might like to cover everyone if that can be done in a way that is remunerative for the insurance company. But they're really not all that interested in quality and, in fact, the more affordable health care is, the less profit the insurance industry makes.”

Paris calls the ACA a failure. She also recognizes the failure of several states – including California, Massachusetts, Illinois, and several others – who have attempted single payer on a statewide scale. Only Vermont has actually passed legislation with that aim, but gave up on it in 2014 after costs became untenable. Paris believes that for single payer to work, it needs to be implemented nationwide.

Alaska is a red state, and Paris believes there is a conservative argument to be made in support of single payer health care. Unfortunately, PNHP and other single payer advocates have concentrated their sales pitch to those on the left side of the aisle. That's why she's here.

“That's a failure on our parts that I'm working very hard to rectify. The fact of the matter is, this is utterly conservative in its approach. It's good business to eliminate a middleman that's wasting money and not helping you achieve the goal that you're trying to achieve,” she said reflectively. “I think that people on the right want quality health care for their families and their friends and their neighbors and their fellow Alaskans or their fellow Americans. When they say, 'I want to do away with the Affordable Care Act,' I think what they're saying is, 'I want to see how we can do that in a way that isn't going to bankrupt the country.' Well, I agree with them!”

Putting a spin on the old Reaganism – “Are you better off now than you were four years ago?” – Paris challenges people to ask, “Is the insurance coverage you currently have working for you?” If the answer is “no,” she said the next thing to consider is, “There's an option that hasn't gotten a lot of traction. Decide for yourselves what will be best for you, your families, your friends, and trust your judgment.”

Alaska has the highest medical costs of any state. More than half the population has a preexisting condition, yet only one insurance provider remains in the market exchange (despite the health insurance industry raking in $13 billion last year). We barely fought off an ACA repeal-and-forget attempt that would have left more uncovered and would have undone the expansion of Medicaid that has saved lives. One of our U.S. Senators voted against it. The other is named Dan Sullivan. Our budget deficit leaves us no tenable pathways for independent redress, yet our opioid crisis is just as much an epidemic as anywhere else in the country. Can we please talk about single payer now? Paris is here with that request. We should take her up on it.

“I hope you'll join us,” she concluded.