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Doctor's prescription for health insurance: Remove the profit motive

Single-payer advocate speaks in Charlotte March 9

By Herbert L. White
The Charlotte (N.C.) Post, March 5, 2017

Is single-payer health insurance inevitable?

American lawmakers are consumed about repealing and replacing the Affordable Care Act. One path that has been regularly touted as a solution is the single-payer model, which advocates say will assure every citizen has access to equal and quality health care.

One of those advocates, Robert Zarr M.D., a practicing pediatrician in Washington, D.C., and an expert on international health and universal health care, will speak March 9 at 6:30 p.m. at Midwood International and Cultural Center, 1817 Central Ave.

Zarr, who provides care for mostly low-income patients, is also an adjunct professor at George Washington University and Children’s National Medical Center. He is also immediate past president of Physicians for a National Health Program.

A February Kaiser Health Tracking Poll finds attitudes towards ACA have shifted, with 48 percent of respondents favoring the law while 42 percent found it unfavorable. The favorable response is the highest measured in more than 60 Kaiser Health Tracking Polls since 2010. Independent voters are driving the change, with 50 percent now viewing the law favorably.

A May 2016 Gallup Poll found 58 percent of Americans favor replacing ACA with a federally funded healthcare system – such as Medicaid and Medicare – that provides insurance for all. Critics, however, contend such a program amounts to “socialized medicine” which leaves government in control of the delivery of service and weakens care.

Zarr spoke with The Post by telephone from Washington, D.C. Responses are edited for clarity and brevity.

Polling suggests the idea of single payer insurance is popular. Why is that?

Zarr: “The reason why it’s so popular is because one, it’s so easy to understand. The second is that it just makes common sense. We remove the shackles from the insurance companies for the delivery of care, which in our opinion, should be left to the private domain. We feel doctors should be able to open up their own practices if they wish. We feel strongly that a pharmacy should be able to provide medicines and medical supplies without having to worry about bankruptcy themselves.

“We feel this can best be done most efficiently by looking at the data and evidence, not just with Medicare but across the world. The only way we can efficiently do this is by publicly financing it, removing it from the private domain in terms of finance. Private delivery, public finance – that is the easy way for us to understand single payer.”

Why isn’t single payer the law of the land now?

“Probably the best way to answer that is that there is a lot of momentum among the moneyed interests in this country to keep status quo. ACA really is and really was the beginning of a prolongation of our status quo. There’s nothing magical about ACA. It took what we already had and it expanded it. It expanded Medicaid in 20-plus states, and I might add, did not expand it in 20-plus states as well and it relied heavily on the private insurance model. The private exchange model is not just what we see in the exchanges that have been set up but also in Medicare and Medicaid as well, so two-thirds of the recipients in Medicaid are receiving their health insurance through private, for-profit plans and it’s about one-third in Medicare.”

Why isn’t there more political will to remove the profit motive from health insurance?

“I think we need to exert our democratic right through pressure on legislators to make sure they understand they’re jeopardizing their next campaign if they don’t support single payer. The strongest thing we can do right now is raise the temperature so that legislators understand that single payer, HR676, is what this country wants and what we need, both by the people and the delivery community – the doctors, the hospitals, the pharmacies. We need to make it politically toxic to not support 676.”

Has the battle over repeal and replace overwhelmed advocacy for single payer?

Because ACA is under threat right now, with all its faults and all its reliance on for-profit insurance industry, which is not leading us to single payer, it still did put an insurance card in the wallet or purse of 20 million Americans. When we remove that against the people’s will, for every million uninsured, you’re looking at 1,000 deaths per year. There’s a lot of pressure going on right now and congressmen are feeling it because constituents are worried, they are anxious about what’s going to happen.”

What do you see four years into the future for health insurance?

“There is a chronic burnout and fatigue in physicans and it’s bad, very bad. We’re spending more of our time trying to get the simplest of tasks done where you’ve got 15 minutes to get this done. As a patient, it’s getting more and more frustrating with the cost shifting with the difficulty of knowing there’s no transparency. I don’t know the coverage my health plan has until I get sick and I get the bill. My crystal ball tells me if we keep going down this same path, it’s a path to destruction, it’s a path to suffering, it’s a path to early death, and that’s not something I want.

“My crystal ball tells me there is only one end point to this and that is to provide every American an equitable and affordable comprehensive health care that will not bankrupt us. We can put this off another few years, four years, six to eight years, but at some point we’re going to have to get to the only solution that anyone’s been able to come up with, and that’s efficient and not going to bankrupt us and it’s fair for everyone.”

http://www.thecharlottepost.com...