By Dr. Tom Gottlieb
The recent Time Magazine Special Report by Stephen Brill Why Medical bills Are Killing Us demonstrates a series of narratives that describe problems in our health care system. The article focuses on the cost of health care services. Brill blames cost problems on insurance companies, medical equipment manufacturers, hospitals (both for-profit and nonprofit) and pharmaceutical companies. He says that excess costs by and large are not related to physician and patient behaviors.
Brill suggests that real solutions might be related to lowering the age for Medicare eligibility and implementing a single-payer system. He further states that these solutions are not feasible. Brill then offers incremental solutions including tightening anti-trust laws, taxing profits up to 75 percent, imposing surcharges on all non-doctor hospital salaries, outlawing chargemasters, amending patent laws, reforming medical malpractice laws and capping insurance payments for imaging.
So there is little good news on health care reform except that the situation is overwhelming. It appears that tinkering around the edges of Americas dysfunctional system for funding health care with private insurance companies and pharmaceutical companies is over. No small reform such as those suggested by Brill will begin to adequately control the legalized theft of the health care dollars.
Universal health care coverage financed by a public single-payer system provides a solution to the health care crisis. We could achieve this through a system known as Improved Medicare for All. Whereas some politicians want to increase the age for Medicare participation, Brill argues that we should allow younger people to participate in Medicare.
Brill states: . . . those numbers would seem to argue for lowering the Medicare age, not raising it . . . Thats not a liberal argument for protecting entitlements while the deficit balloons. Its just a matter of hardheaded arithmetic. He further says: That kind of systemic overhaul not only seems unrealistic but is also packed with all kinds of risk related to the microproblems of execution and the macro issue of giving government all that power.
Do citizens want a single-payer health care system? YES! Pollsters have repeatedly asked Americans a key question: Do you favor or oppose having a national health plan in which all Americans would get their insurance through an expanded, universal form of Medicare-for-All? Responses in a recent Kaiser Health tracking poll show that 58 percent of those surveyed favored a government plan.
Further, Brill does not document the risks of creating universal care or giving all that power to government. In fact, surveys suggest that citizens trust the government more than private insurance companies. A movement is underway. We can beat private insurance companies.
As an attorney and universal care proponent, Diane Archer pointed out on the Health Affairs blog, Congress has three options to rein in runaway prices: It can use Medicare-style techniques to set rates or rate ceilings in the commercial marketplace, including in the new health insurance exchanges, just as every other developed nation does. It can give people under 65 the choice of a public health insurance plan that works like Medicare, competes against the private health plans and brings down costs. Or it can do both.
Universal health care financed by a public single-payer system seems to be the only solution for our health care crisis. This is best done as a national Medicare-style plan, but may instead be a movement that builds state by state.
Tom Gottlieb, M.D., trained as a biochemist at the University of Colorado Boulder and as a physician at the CU School of Medicine. He worked for the Indian Health Service, the CU Division of Clinical Pharmacology, as medical director for the Denver Neighborhood Health Center and in private practice. Gottlieb is now retired and advocating for a single-payer system to fund universal health care. He is a board member of Health Care for All Colorado Foundation.