Single payer health care

[irishbobcat]

Medical Horror Stories: Why We need Single-Payer Health Care
Posted by: Dspisak (IP Logged)
Date: July 16, 2008 08:44AM


Write In Dennis SPisak for Congress-6th District
campaign site: [www.votespisak.org]

Why I Support Singel-Payer Health-Care!

I, Dennis Spisak, approve of this posting.


The Untold Health Care Story: How They Crippled
Medicare

By Lillian B. Rubin

Dissent - Summer 2008

[dissentmagazine.org]

Until recently, my husband and I had been seeing one of
those "Oh-I'm-so-glad-he's-my-doctor" physicians for
two decades. Then one day the mail brought the
announcement that the office was closing its doors and
that the four doctors who had been in the practice were
either retiring or leaving San Francisco. They enclosed
a list of doctors who, they said, had indicated they
had room in their practices. So started my search for a
new primary-care physician.

I looked the list over, saw a familiar name, and dialed
the number. "Yes," the receptionist assured me, "doctor
is taking new patients." It was all very friendly; I
made an appointment; she set about recording the
necessary information, and then the crucial question.
"What insurance do you have?" "Medicare and AARP" (one
of the several medi-gap insurance plans to which those
of us who can afford it subscribe), I replied. I heard
a small intake of breath, a ten-second silence that
felt like much more, and then, "Oh, you should have
told me before that you're Medicare; doctor isn't
taking new Medicare patients." And with that she
severed the connection and, I assume, wiped my
appointment off the book.

I was surprised at the brusque refusal, shaken a bit,
but not yet worried. San Francisco is a city that
seduces with its charms, and with a major medical
school within its borders and two more less than an
hour's drive away, we have plenty of well-trained
physicians practicing here. How hard could it be to
find a good internist? Very hard, it turned out, as I
worked my way down a list of a dozen doctors - some
referred by my retiring internist, some recommended by
friends or friends of friends.

Since the medical community in the city knew of the
shuttering of the office where I'd been cared for, they
were prepared for calls like mine. Some announced on
their voice mail: "The doctor isn't taking any new
Medicare patients"; some asked the fatal question about
insurance before responding to my request for an
appointment; and a few waited until they had noted all
my personal information before asking the question.
Twelve calls; twelve refusals to take Medicare.

Stunned, I sat at my desk looking at the list and
wondering, What happened to the Medicare I once knew,
to the physicians for whom it was simply another part
of their practice, to the government that once
supported it fully before the right-wing mania for
privatization set in? Big questions. But my immediate
concern was to find a doctor who would be available
when my husband or I needed her or him.

Because I'm reasonably well-known in this community, I
decided to get past the front desk by writing to each
of these physicians directly. I laid out my credentials
and accomplishments as if I were applying for a grant
or a job; I dropped some reputable names of people, lay
and professional, who had given me permission to do so,
while at the same time assuring the doctors to whom I
was pleading my case that I continued to be very active
and was in vigorous good health. It was an exercise in
the absurd. There I was, looking for a doctor to
oversee my health and at the same time assuring any who
would listen that I wouldn't need them.

Two weeks later, I was getting desperate. The actual
closure of the medical office was looming, and I still
had not heard from a single physician on my list. I
began to call the offices to ask if the doctor had
received and read the letter I sent. I was brushed off
in the first five with a curt reminder that "The doctor
isn't taking new Medicare patients." Finally, on the
sixth call, the woman on the other end of the line said
she'd ask the doctor and call me back. An hour later,
she called to say that he had read my letter, was
"intrigued," and would like to meet me.

We met, he agreed to take us on, and finally we had a
doctor. But what, I wondered, happens to ordinary folk
who don't write letters and who, if they did, wouldn't
"intrigue" the person at the other end? Was this just
something happening here in San Francisco where some
doctors are charging a thousand-dollar fee for the
privilege of becoming a patient and an annual
membership payment of $500 thereafter?

As my story got out, the answers came pouring in.
Friends and acquaintances around the country had
similar tales to tell, sometimes their own experiences,
sometimes about a friend or family member. Doctors from
New York to California were either refusing to take new
Medicare patients or making it so hard to get into
their offices that it was no better than a direct
refusal.

While this Medicare drama played out in my own life,
health care was center stage in the long, drawn-out
political theater known as the Democratic Party's
primaries. As Senators Barack Obama and Hillary Clinton
argued about the fine points of their respective
universal-health-care promises, President George W.
Bush released plans to reduce budget deficits on the
backs of America's old folks by calling for $208
billion in mandatory budget reductions, with Medicare
taking the biggest hit. In addition to cutting services
and doctors' payments, the administration seeks to slow
the pace of Medicare growth from 7 percent to 5 percent
over the next five years - cuts that come during the
very period when Medicare rolls will grow exponentially
as the first of the baby boomers become eligible for
coverage, and about which no candidate of either party
has expressed any outrage.

THE HISTORY of the struggle for health care in the
United States is a long and bitter one, going back to
1945 when President Harry Truman asked the Congress to
enact a national insurance program "to assure the right
to adequate medical care and protection from the
economic fears of sickness." A coalition of
conservative groups, led by the implacable opposition
of the American Medical Association (AMA) and fueled by
the insurance and pharmaceutical industries, denounced
the Truman plan as "socialistic," stoked public fears
about freedom and choice, and defeated the legislation.

By 1952, Truman, acknowledging that he couldn't win
health care for all, tried softening the opposition
with a compromise proposal, one that would provide care
only for those age sixty-five and over who were
receiving Social Security. But if the universal health
care plan was outright socialism, the new, more limited
legislation was nothing less than a foot in the
socialist door, and the same forces that had fought so
fiercely before joined once again to defeat the scaled-
back proposal.

The same scenario was repeated in 1960 when, with the
support of President John F. Kennedy, Medicare's
backers introduced yet another bill to provide health
care for America's aged. Only this time, the AMA, with
the help of the wives of physicians across the country,
organized what was known as "Operation Coffee Cup" and
enlisted a B-movie actor named Ronald Reagan, who was
then host of the popular Sunday night television
program General Electric Theater, to warn, "One of the
traditional methods of imposing statism or socialism on
a people has been by way of medicine."

Reflecting on the campaign against Medicare, Drew
Pearson, a well-known Washington columnist at the time,
wrote

Ronald Reagan of Hollywood has pitted his
mellifluous voice against President Kennedy in
the battle for medical aid for the elderly. As
a result it looks as if the old folks would
lose out. He has caused such a deluge of mail
to swamp Congress that Congressmen want to
postpone action on the medical bill until 1962.
What they don't know, of course, is that Ron
Reagan is behind the mail; also that the
American Medical Association is paying for it.
. . . Just how [Reagan's] background qualifies
him as an expert on medical care for the
elderly remains a mystery. Nevertheless, thanks
to a deal with the AMA, and the acquiescence of
General Electric, Ronald may be able to out
influence the President of the United States
with Congress.

It took President Lyndon Johnson, a former Senate
leader who knew where all the congressional bodies were
buried, to twist enough arms in Congress to stiffen its
spine. On July 30, 1965, the years of struggle finally
paid off. President Johnson signed into law Title XVIII
of the Social Security Act establishing Medicare and
its companion program, Medicaid, which insures indigent
Americans. The nation had its first (and still only)
government-sponsored, single-payer medical system.
Former President Harry Truman was the first person to
enroll in the program. The fee for Medicare Part B,
which covers doctors visits (Part A covers hospital
care), was $3 a month. Today, there's a deductible of
$135 before Medicare picks up 80 percent of the bill,
and a monthly premium of $96.40 for those earning up to
$82,000, ($164,000 for a couple filing a joint return).
After that, the premiums go up proportionate to income.

While Medicare was a bare-bones program at first,
covering hospital and doctor visits, it was expanded
repeatedly over the next twenty-five years to cover
disabled persons of any age, people with end-stage
renal disease, recipients of the Supplemental Security
Income (SSI) program for the elderly and disabled poor,
chiropractic services, home health care, hospice, and
more.

DESPITE THE immense popular support for Medicare, the
program continued to grate on conservative
sensibilities, and by the early 1980s the conservatism
of the Reagan administration - its distaste for what it
called "social engineering," which meant any federally
financed benefit programs - began to make itself felt.
But the same voices that were railing against
entitlements like Medicare were silent when the program
was amended to cover the federal judiciary, members of
Congress, and the president. No cries of socialism
arose, no concerns about the cost of entitlements, no
jeremiads about freedom and choice were heard from the
congressional opposition or President Reagan when it
was their turn to get government-sponsored health care.

With all the controversy, however, it wasn't until
1995, after the Clinton administration's failed attempt
at universal health care, that the Republican Congress,
urged on by Speaker of the House Newt Gingrich and
backed strongly by the insurance companies, passed the
Medicare Reform Bill, which was much less a step toward
reform than a walk toward privatization. But it
couldn't have happened without the support from some
Democrats and the signature of President Bill Clinton,
who seemed to have lost his veto pen that day. True, he
didn't have the votes to sustain a veto, but that
hasn't stopped George W. Bush from sending back to
Congress legislation that offends his principles,
leaving those bills to languish on the stalemated
congressional back burner with no hope of passage
anytime soon.

Ultimately, the alleged reforms meant, among other
things, an increased reliance on private insurance
companies - subsidized by the federal government - for
the delivery of care. It looked like a good deal at
first, with grand promises from the insurance companies
of more care for less money, and Medicare recipients
flocked to the health maintenance organizations, my
husband and I among them. But it wasn't long before
many of us found out that an insurance company's public
relations campaign has little relation to reality, and
their promises melted away before the imperative of the
bottom line. So, for example, when my husband developed
a persistent urinary-tract infection that our primary
care doctor kept treating unsuccessfully, I finally
asked him why he wasn't referring the problem to a
urologist. He hemmed and hawed, shifted his feet,
dropped his eyes, and finally said almost shamefacedly,
"These HMOs are making it harder and harder to make
that kind of referral." I immediately switched back to
Medicare, where a physician's judgment is still
generally the deciding factor in specialist care.

By 1997, two years after the so-called reforms were
instituted, Senator Ted Kennedy and Representative
Richard Gephardt were so outraged by the continued
assault on Medicare that they wrote in a Washington
Post op-ed piece,

Republicans in Congress - and, unfortunately, a
few Democrats too - want to go beyond the
bipartisan budget agreement and subject
Medicare to death by countless cuts by
increasing the cost of care, skimming off the
healthiest and wealthiest participants, raising
the age of eligibility, means- testing the
program and turning major parts of Medicare
over to the tender mercies of private insurance
companies and managed-care firms.

Then came the Bush years. From its earliest days, this
administration's hostility to Medicare and Social
Security has been no secret. It lost the fight to
privatize Social Security, but the war against Medicare
continues as it pushes people into HMOs by increasing
the monthly cost for Medicare, cutting services, and
reducing payments to hospitals and doctors until the
very existence of the program is threatened. As long
ago as 2005, an AMA survey reported that nearly 40
percent of 5,486 physicians said that if the projected
5 percent cuts were to pass, they would "curtail the
number of new Medicare patients they accept into their
practices."

In the intervening years the situation has only gotten
worse. A recent national survey of a thousand
practicing physicians, released by the Medical Group
Management Association, reports that in anticipation of
the proposed 10.6 percent further payment reductions to
take effect on July 1, 2008, 60 percent of the
respondents reported that they were either limiting the
number of Medicare patients or refusing to accept them
altogether. One Oregon physician reported that he was
"routinely turning away Medicare patients so desperate
to find a doctor that they offered to pay for excess
charges out-of-pocket," a practice prohibited by
Medicare law. Another whose Florida practice is made up
of over 50 percent Medicare patients, agonized over
dropping people who, he said, had become "like old
friends after 28 years in practice." But if the
payments are slashed again, he explained, "I'll have no
choice. It's a business, and if I can't pay the bills,
I can't survive." Chilling news for those of us now in
Medicare, and worse yet for the Baby Boomers who will
become eligible in the next few years.

True, some may argue that doctors already make more
money than most Americans, and it's hard to listen to
their grievances with much sympathy. But doctors are at
the heart of the success of Medicare, and until the
Bush administration's escalation of the war against the
program, they took care of the nation's elders without
complaint. Moreover, their grievances gain force and
legitimacy when we notice that the administration's
proposed budget cuts target doctors, hospitals, and a
variety of patient services but don't lay a glove on
payments to the private insurance companies and their
HMOs, even though many independent experts say federal
payments to those plans are far too high and the
service they provide much too low.

Unfortunately, the election campaign now under way
offers little hope of substantial improvement in the
health care crisis that now afflicts this nation. For
despite what the privatization of Medicare has taught
us about the incompatibility of for-profit insurance
companies with quality patient care, and despite the
fact that federal subsidies to these corporations are
substantially more costly to taxpayers than the
government-run Medicare, no candidate dares to propose
the only universal health care plan that will work: a
government-sponsored, single-payer system along the
lines of the original Medicare [1] Ironically, a recent
study conducted by the Indiana University School of
Medicine's Center for Health Policy and Professionalism
Research Policy and published in the Annals of Internal
Medicine (April 2008) reports that in a survey of 2,200
physicians, 59 percent now support legislation to
establish national health insurance. Reflecting on his
analysis of the data, Dr. Ronald Ackerman, co-author of
the study, concluded that "across the board, physicians
feel that our fragmented and for-profit insurance
system is obstructing good patient care, and a majority
now support national insurance as the remedy." - a
program that worked just fine until a coalition of
conservative forces, insurance companies, the
pharmaceutical industry, and right-leaning and/or
fearful Democrats disassembled it. [2] All this, and I
haven't even mentioned the huge multi-billion-dollar
boondoggle the federal government handed the insurance
companies and the pharmaceutical industry with Medicare
Part D, the prescription drug benefit that went into
effect on January 1, 2006. It would take another whole
article to discuss the many-tiered problems with this
program.

FOOTNOTES:

* [1] Ironically, a recent study conducted by the
Indiana University School of Medicine's Center for
Health Policy and Professionalism Research Policy and
published in the Annals of Internal Medicine (April
2008) reports that in a survey of 2,200 physicians, 59
percent now support legislation to establish national
health insurance. Reflecting on his analysis of the
data, Dr. Ronald Ackerman, co-author of the study,
concluded that "across the board, physicians feel that
our fragmented and for-profit insurance system is
obstructing good patient care, and a majority now
support national insurance as the remedy."

* [2] All this, and I haven't even mentioned the huge
multi-billion-dollar boondoggle the federal government
handed the insurance companies and the pharmaceutical
industry with Medicare Part D, the prescription drug
benefit that went into effect on January 1, 2006. It
would take another whole article to discuss the many-
tiered problems with this program.

=========

[lillian B. Rubin is with the Institute for the Study
of Social Change, University of California, Berkeley.
She is a sociologist, psychologist, and author of
numerous books, including, most recently, 60 on Up: The
Truth about Aging in America (Beacon Press, 2007).]