Risking It All
May 22nd, 2005 at 5:54 am by Susie
Author and doctor Robin Cook says the mapping of the human genome presents a very compelling reason for national health insurance:
As a doctor I have always been against health insurance except for catastrophic care and for the very poor. It has been my experience that the doctor-patient relationship is the most personal and rewarding for both the patient and the doctor when a clear, direct fiduciary relationship exists. In such a circumstance, both individuals value the encounter more, which invariably leads to more time, more attention to potentially important details, and a higher level of patient compliance and satisfaction - all of which invariably result in a better outcome.
But with the end of pooling risk within defined groups, there is only one solution to the problem of paying for health care in the United States: to pool risk for the entire nation. (Under the rubric of health care I mean a comprehensive package that includes preventive care, acute care and catastrophic care.) Although I never thought I’d advocate a government-sponsored, obviously non-profit, tax-supported, universal access, single-payer plan, I’ve changed my mind: the sooner we move to such a system, the better off we will be. Only with universal health care will we be able to pool risk for the entire country and share what nature has dealt us; only then will there be no motivation for anyone or any organization to ferret out an individual’s confidential, genetic makeup.
I shared the whole thing with two doctors (relatives). We found a lot of common ground and a practical suggestion on how to resolve what will be the central sticking point for changing to a single payer system. To summarize the discussion, the points of agreement were:
1. The system we have now is spectacularly inefficient and it is getting worse. The principal culprit here is the insurance industry. It is in control, and its incentives are to simultaneously increase the cost of insurance while paying for as little health care as possible.
2. While substantial portions of the population are currently uninsured, the number of people who will be underinsured or uninsured in each future year will be much greater owing to the inability of most employers to keep up with the escalating costs. Health care system costs are currently at about 15% of GNP and shooting upward. They had horror stories such as a local employer with 35 employees whose health insurance increase this year is $125,000, which if incorporated would make his effective health insurance cost about $5 per employee per hour. Year after year, this just cannot continue. So, employees will become less insured or will lose coverage altogether. The situation for the average employed American is tipping towards greater risk and dramatic cost shifts to their household budgets.
3. The doctors said that patients are making things worse. They observed that demands for visits to specialists to treat routine medical conditions are now common, as are demands for excessive diagnostics. It was the reverse of the defensive medicine argument. For most patients, the co-pay costs are trivial even though the system costs are huge. Patients are therefore disappointed when such requests are denied, saying things like, “I want it all.”
4. We agreed that a decision to do nothing is, in fact, a decision to make things even worse.
The sticking point is control of the federal bureaucracy established to run this program. The VA has gotten pretty good reviews in much of the material I have read, but the doctors were full of stories about how awful it was - things like 17 calls to get a vet admitted while he was having a heart attack (initial treatment was being given in the local ER, but the vet had no insurance and subsequent treatment at that hospital would have bankrupted his family), and (my favorite) the VA claims clerk giving a nurse practitioner hell for providing an indigent vet free drugs from her supply of samples - free drugs it seems are un-American. I did agree that we should be careful what we wish for: a health care system run by this Administration and funded by this Congress would probably be a disaster. What they wanted was a quasi-independent government entity whose policy board is appointed for staggered terms that are long enough to even out the partisan unpredictability of Congress and the White House. The example of what a man like Greenspan can do at the head of such a board notwithstanding, that might work.
As soon as genetic engineers began figuring out people’s risk of heart disease, diabetes, etc., I know that a national pool was the only answer. That was *years* ago. How come I’m not rich and famous like R Cook?
Salmo’s summary of the issues is good. I also agree that this “president” and Congress would make a pig’s breakfast of anything they touched.