Appalachia needs a single-payer health system

By Katie Lee
Johnson City (Tenn.) Press, Feb. 26, 2017

We are all aware that the recent election is likely to bring change in the health care system of this nation, but we have a choice to make. During these tumultuous times in health care policy, the way forward is not to strip 20 million Americans of their health care by repealing the Affordable Care Act  without a replacement. Instead, we should pursue the most equitable and just option — a single payer health care system.

No, this is not “socialized medicine,” which would mean both the financing and delivery of care are government funded. We already have a form of this system for our veterans, and it leaves much to be desired. What a coalition of 20,000 physicians, medical students, and other health professionals propose is a “Medicare-for-all” system.

The ACA has taken necessary steps toward a universal system, but it has fallen short. Among the most popular components are the right to remain free from discrimination for a pre-existing condition, young people remaining on their parents’ plans until they turn 26, and equity in plan cost between men and women.

Yet, approximately 27 million people remained uninsured after the landmark legislation was passed and an acceptable reduction in cost was not truly achieved. Supporters of the ACA aimed to bend the curve on ever-increasing health care expenditures and while this was accomplished, they still accounted for 18 percent of GDP last year.

The United States remains the only developed country with for-profit insurance companies and only one of three developed nations that does not guarantee health care. We are spending the largest amount per capita ($8,000 plus) on health care expenditures of any nation in the world, but without the best outcomes.

The leading cause of bankruptcy in the United States is medical bills, and an estimated 45,000 deaths annually can be attributed to lack of health insurance. Over 100 million Americans forgo professionally recommended medical care due to cost each year. Clearly, we have work to do. A single-payer system by way of a Medicare-for-All structure would allow coverage for all Americans and would actually reduce spending.

Not all states chose to expand Medicaid, including approximately half of those traditionally included in the Appalachian region, leaving lower income earning adults in a gap between Medicaid and marketplace subsidies. Americans were left with artificial lines between states that create headaches for Tri-Cities area patients daily, when the nearest hospital to rural dwellers may be across state lines.

Social workers in our local hospitals work tirelessly to coordinate care for patients leaving Tennessee hospitals, but needing follow-up in West Virginia, Virginia or Kentucky where their health insurance coverage and state law differs. Paying employees to navigate these complexities is currently unavoidable, but it is my hope that a more streamlined, simple system could render these duties unnecessary.

Today we waste about a third of our health care dollars to overhead, administrative costs and insurance profits. Physicians cite administrative burden as one of the leading causes of burn out, leading to decreased quality of care.

With a single-payer system for all Americans, we reduce this waste and instead direct these funds toward medical care. There is an additional benefit of freeing up physicians to spend longer appointments with patients as needed or increase patient volume.

Moreover, Americans living in rural areas face a physical access to care issue in addition to cost barriers. This makes seeking appropriate preventive care visits and screening tests even more important. It is a well-known fact that it is cheaper to prevent a chronic illness than to treat it long-term.

Consequently, removing the cost barrier to preventive services in Appalachia while we work to improve the number of physicians and hospitals in rural areas is morally imperative but also cost effective.

Uninsured Americans cited lack of affordability and unemployment as their top two reasons for their insurance status. While the national unemployment rate in 2014 was around 6 percent, in the more economically depressed parts of Appalachia that figure reached as high as 14 percent. Increased levels of unemployment in the region together with state policies declining Medicaid expansion contribute to higher uninsured rates, and consequently poorer health outcomes.

Our mixed system including employer-based health coverage is a relic of a time when most employees remained in the same job for decades and is inappropriate for the more dynamic, shifting workforce of today. Transition away from employer-based care would prevent workers from fearing a job change lest they lose their insurance, freeing workers to pursue innovative, entrepreneurial positions they might otherwise have foregone.

The 45th President of the United States has praised the concept of universal health care multiple times in the past, citing the improved mortality rates and reduced costs per capita in countries with this structure. In order to capitalize on his promise to take care of “the forgotten” in the United States, including those living in the impoverished communities of coal country, I urge the president to reconsider a Medicare-for-all system.

Not only will it help make this country “great,” it is the right thing to do.

Katie Lee is an aspiring medical professional with a passion for social justice issues. She is a graduate of Vanderbilt University and lives in Johnson City.