The Democratic Convention and the Single Payer Health Care System- A Pipe Dream!

13876607_935045163291810_6970900724155579177_nAs I listened to the Democratic Convention and their answer to health care I was disappointed, but as I mentioned last week, what did we expect? It was interesting to hear one of the delegates, a physician telling the “world” and “fellow physicians not to fear the single payer system. I suspect, as a primary care physician an all Medicare system would be better than what he sees in his practice with the addition of Medical Assistance, which pays about 10 cents on the dollar. However, he is missing the real point, realize the faults of a government run system.

Amid failures of Obamacare’s health care co-ops, Democrats plan to push their chips all-in with a government-run public health-care option now, The Washington Times reported Thursday. The move can be credited to the progressive influence of Sen. Bernie Sanders, pushing Hillary Clinton and the 2016 Democratic platform further to the left, but more like her original health care program, instead of ceding ground to the congressional Republican’s sway toward scaling back government involvement in health care, he wrote.

“This campaign is about moving the United States toward universal health care and reducing the number of people who are uninsured or underinsured,” Sanders told the Democratic National Convention in Philadelphia on Monday. “Hillary Clinton wants to see that all Americans have the right to choose a public option in their health care exchange.”

Co-ops, non-profit consumer operated and oriented health care plans, were introduced by the Democrats as a designed compromise to get the program passed in lieu of a public option in 2009, but they have been failing to compete in the marketplace and have opted out. The Times reported 16 of the original 23 co-ops have withdrawn from the Affordable Care Act’s web exchange. The move now appears to be all-in on a government-run public option, despite both the House and Senate being controlled by the GOP.

“When its big programs fail, the left’s answer is always bigger programs,” Republican Nebraska Sen. Ben Sasse said. “With co-op failures and crummy choices and costs, the Affordable Care Act’s central planning has been a disaster. It makes no sense for politicians to double down, especially when they’re gambling with the livelihoods of American families.”

We covered the problems of the VA and the lack of progress after the government has invested in millions and billions of dollars. But look at the ridiculous spending. The Veterans Affairs administration spent $20 million on expensive artwork and sculptures amidst the healthcare scandal, where thousands of veterans died waiting to see doctors.

The taxpayer watchdog group Open the Books teamed up with COX Media, Washington, D.C., for an oversight report on spending at the VA, finding numerous frivolous expenditures on artwork, including six-figure dollar sculptures at facilities for the blind.

“In the now-infamous VA scandal of 2012-2015, the nation was appalled to learn that 1,000 veterans died while waiting to see a doctor,” wrote Adam Andrzejewski, the founder and CEO of Open the Books, in an editorial for Forbes. “Tragically, many calls to the suicide assistance hotline were answered by voicemail. The health claim appeals process was known as ‘the hamster wheel’ and the appointment books were cooked in seven of every ten clinics.”

“Yet, in the midst of these horrific failings the VA managed to spend $20 million on high-end art over the last ten years—with $16 million spent during the Obama years,” Andrzejewski said.

The VA spent $21,000 for a 27 foot fake Christmas tree; $32,000 for 62 “local image” pictures for the San Francisco VA; and $115,600 for “art consultants” for the Palo Alto facility. A “rock sculpture” cost taxpayers $482,960, and more than a half a million dollars were spent for sculptures for veterans that could not see them. “In an ironic vignette, at a healthcare facility dedicated to serving blind veterans—the new Palo Alto Polytrauma and Blind Rehabilitation Center—the agency wasted $670,000 on two sculptures no blind veteran can even see,” Andrzejewski said. “The ‘Helmick Sculpture’ cost $385,000 (2014) and a parking garage exterior wall façade by King Ray Studio for the ‘design, fabrication, and installation of the public artwork’ cost $285,000 (2014).”

“Blind veterans can’t see fancy sculptures, and all veterans would be happier if they could just see a doctor,” he said.

But an article last week shows more of the inadequacies of a government run health care system one only has to look at the Native American experience.

It’s a common scenario: A distraught mother brings her young child to the pediatrician, seeking antibiotics for her child’s cold. The doctor determines that the child has a viral infection, not bacterial. Most responsible physicians would explain that prescribing antibiotics could harm to the child (in the form of side effects without benefits) and would worsen the public health problem of drug-resistant bacteria. They understand that antibiotics would be a false “solution” to the problem, and instead help provide other supportive care appropriate to the child’s condition.

Unfortunately, politicians are too prone to advocating false “solutions” to problems, which will be ineffective (at best) or downright harmful (at worst). In the realm of health care policy, one recurrent wrong solution is the continued advocacy by the political Left in a “single payer” government-run health system.

Newsweek recently profiled the many serious problems in the federal government’s Indian Health Service (IHS), which is responsible for the health care of 2 million Native Americans. Government health care is theoretically a “right” provided to these Native Americans, as part of federal legislation as well as federal treaties with the recognized Indian tribes. There’s a cruel joke often told in Indian country: “Don’t get sick after June.” The sick truth beneath those words is that by summertime the Indian Health Service—tasked with providing basic health care to the nation’s 2 million Native Americans and Alaska Natives—has typically blown its meager fiscal year budget for its Catastrophic Health Emergency Fund. Perhaps even more dangerous to the health of natives across the United States: The IHS does not typically provide coverage for preventive services. Without those types of checkups—the mammograms, colonoscopies and other services that are mandated by the Affordable Care Act—cancers don’t get found until it’s too late.

This infuriates many community advocates, like Donald Warne, the first Native American doctor to serve on the national board of directors of the American Cancer Society. “People are suffering and dying unnecessarily,” says Warne, who is also the chairman of the department of public health at North Dakota State University, the only master’s of public health program with a Native American concentration. “If someone does not have insurance, and they’re dependent on IHS, a [cancer] screening does not occur.”

The federal government funds the IHS IHS +%,and employs approximately 2,700 nurses, 900 physicians, 500 pharmacists, and 300 dentists in what is essentially a “single payer” system for these patients. Yet the quality of health care is considered abysmal:

There’s a cruel joke often told in Indian country: “Don’t get sick after June.” The sick truth beneath those words is that by summertime the Indian Health Service — tasked with providing basic health care to the nation’s 2 million Native Americans and Alaska Natives — has typically blown its meager fiscal year budget for its Catastrophic Health Emergency Fund.

Victoria Kitcheyan of the Winnebago Tribe of Nebraska described the horrifying conditions to the US Senate: I am not talking about unpainted walls or equipment that is outdated. I am talking about a facility which employs emergency room nurses who do not know how to administer such basic drugs as dopamine; employees who did not know how to call a Code Blue; an emergency room where defibrillators could not be found or utilized when a human life was at stake; and a facility which has a track record of sending patients home with aspirin and other over-the-counter drugs, only to have them airlifted out from our Reservation in a life threatening state.

You want more evidence of the problems with a singe-payer system, consider the ongoing strife in Ontario, Canada. Because physicians are paid via a single payer system, which happens to be the government, there are rancorous negotiations every few years over what they are paid per service/interaction/procedure/etc.

Our medical association and the provincial government have been unable to come to any agreement. So, for the last 2 years, they have had a contract ‘imposed’ on them – i.e. they’ve/ the provincial government unilaterally decided what to pay them. They have had across the board cuts of 7%, plus additional targeted cuts (e.g. to us in radiology, 30% fee cut to ultrasound, about the same for nuclear medicine, among others).

Their provincial organization recently announced that they reached an impromptu, backroom ‘deal’ about a month ago or so. The deal agrees to further cuts, and places a hard cap on the total budget for paying physicians. A general referendum was set in a rushed timeline (the result of that vote, btw, would not have been binding…it would have simply been ‘advisory’ to the subsequent medical association councilors vote).

The problem is that independent estimates suggest that the hard cap is not enough to meet the growing demand (they set the total budget for an increase of 2.5% per year, plus a top-up payment). The proposal means that if the budget goes over, which most believe it will, the overage will be clawed back from physicians. In other words, we don’t know how much we’ll be cut further, and from whom it will come from.

There has been a large grassroots movement called the ‘Concerned Ontario Doctors’ who overnight became a force of some 14,000 MDs. Multiple specialty societies have joined up and formed a coalition. The coalition is now battling the provincial medical association for fair representation (the deal, by the way, was reached without any real involvement of the negotiations advisory committee…there were two higher-ups at the provincial organization that did the negotiating, bypassing the usual checks and balances).

Now the Coalition has successfully filed a successful legal petition to force a general meeting, resulting in the vote being canceled. Meanwhile, our med association has been spending millions (estimated at $3 million) to ‘sell’ the proposal as being good to its own membership. We receive multiple emails daily saying how we should vote yes. But district leaders are not allowed to use their email directory to contact their own district members (who they represent) to email negatives about the proposal.

This physician has been in practice all that long, but this is the first time that he has seen anything close to this – the general membership battling what is supposed to be its representative body, the provincial medical association. As an aside, all physicians are legally required to pay the medical association annual dues (this was written into provincial law years ago, and was a ‘concession’ to the med association in another negotiation…though its general membership generally disagree with this).

So, why do the Democrats or we think that their program will be any different? Especially when you consider what I pointed out last week. How are we going to finance the program and do we think that the government managing the federal single payer system will be any better than the VA, the America Indians, Massachusetts or Vermont systems health care system and what is being voted on this year in Colorado.

In December, 2014, Vermont Governor Peter Shumlin (D.) announced that he was pulling the plug on his four-year quest to impose single-payer, government-run health care on the residents of his state. “In my judgment,” said Shumlin at a press conference, “the potential economic disruption and risks would be too great to small businesses, working families, and the state’s economy.” The key reasons for Shumlin’s reversal are important to understand. They explain why the dream of single-payer health care in the U.S. is dead for the foreseeable future—but also why Obamacare will be difficult to repeal the most important one is one that I keep mentioning. The Vermont plan would have required a 160 percent tax increase to finance it further. But we can discuss the Vermont system further in another post.

Paul Krugman stated it oh, so well in his column in The New York Times when he stated that a Single-Payer Health Care System is a Pipe Dream. He stated that the Affordable Care Act is “what engineers would call a kludge.” It’s a “awkward, clumsy device with lots of moving parts,” yet it has largely succeeded in what it was designated to do: make health insurance available to all Americans and reduce the number of uninsured by 20 million. But because it’s messy and imperfect, should Democrats “try for something better”- a single-payer. Medicare-type program covering everyone, as Bernie Sanders suggested and then Hillary announced was her aim? No, because there is zero chance of enacting such a proposal as well as the cost of such a program.

A single-payer scheme would require large tax increases ( remember the 160% increase for Vermonters) on not just the wealthy but also the middle class; even if eliminating premiums offset these taxes, as Sanders suggested, they would still be hugely unpopular, and a furious backlash would ensue.

Doctors and the insurance industry would also rebel, and so would the millions of Americans who would lose the good insurance they currently get through there jobs.

Lets not forget that Obamacare barely passed, and didn’t get a single Republican vote. It makes no sense for Democrats “to spend political capital on a quixotic attempt at a do-over, not of a political failure, but of health reform-their biggest victory in many years.”

What a crazy time that we live in with 2 candidates running for President that have the highest disapproval rating. I’m not sure who will be better for the health care system and even more who will be best for our Country!

Do any of you all out there have any suggestions????

 

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