by Moe White –
Indivisible AVL, the activist group that organized after last November’s elections, hosted a “Healthcare for All” forum at A-B Tech’s Ferguson Auditorium on June 27.
Speakers included physicians Carol Paris, Jessica Schorr Saxe, Ellen Kaczmarek, Christina McQuiston, Errington Thompson, and Eric Halvorson, as well as retired speech therapist Beth Gage. The forum was moderated by former state legislator Joe Sam Queen from Haywood County.
Physicians for a National Health Plan
Dr. Paris, now retired, lives in Nashville, TN, and leads Physicians for a National Health Plan (www.PNHP.org), founded in 1987 and claiming 20,000 physicians and other healthcare workers as members. She noted that 28 million Americans never got health insurance at all under the Affordable Care Act, but, according to the Congressional Budget Office, the current GOP plan would add 22 million more to the uninsured, and bring about nearly 29,000 additional deaths each year. Those 50 million would be more than the 45 million uninsured before Obamacare was enacted.
Dr. Paris shared charts showing that per capita spending in the U.S. is more than any other developed nation—$6,470 in public funds, plus $3,490 in private money—yet U.S. life expectancy is lower than that in most industrialized countries.
“The ACA’s biggest flaw was to preserve the for-profit insurance industry. You have to keep them profitable—that’s their fiduciary responsibility. As corporations, they consider medical expenditures on clients ‘a loss’; so they try to keep only young, healthy people in their pool to minimize these losses.” And they hire many people whose only job is to say “no” to coverage.
To deal with insurance companies, the number of medical administrators in hospitals and doctor’s offices has grown by 3,000% in 40 years; today 31% of all healthcare spending pays for medical overhead, administration, and insurance company profits.
In comparison, Medicare for All would comprise one risk pool for all Americans, with public funding (from taxes) but private delivery, like Medicare. Added costs—covering the currently uninsured ($110 billion); improved Medicaid ($74B); and increased utilization of medical services ($142B)—would easily be offset by eliminating administrative costs from insurers ($153B) and providers ($215B), and negotiating drug prices ($178B).
Rationing and other myths
Responding to overblown concerns about rationing, Dr. Saxe, head of Healthcare Justice NC in Charlotte, pointed out that America rations healthcare more than nations with single-payer systems. In Canada, for example, you might wait a month for elective procedures such as orthopedic surgery, but then the procedure is available—at no out-of-pocket cost. Here, on the other hand, people who can’t afford a policy, or are denied Medicaid, will never get that surgery. Those with policies will face a co-payment; others wait years until they’re 65 and on Medicare—when a condition has worsened, making it harder and more costly to treat.
Dr. Ellen Kaczmarek, whose 16-year practice in Asheville includes the uninsured and underinsured, reminded the audience that more than 60% of Medicaid spending goes to support people in nursing homes—not the indigent, lazy, inner-city resident of myth.
She explained that Medicare pays for only a limited time in nursing homes. Thus even well-to-do seniors have to have to spend down their assets—sell homes and cars, give gifts to family members—and apply for Medicaid. Seniors who lived a middle-class life for decades must make themselves impoverished to survive.
Real socialized medicine
Scottish-born Dr. Christina McQuiston, a Mission internist and hospitalist, recently spent three years on sabbatical to help her sister cope with their 94-year-old mother’s advancing dementia.
The UK’s National Health Service truly is socialized medicine, created in 1946 after WWII. All care is paid for through taxes and uses evidence-based medicine—panels of experts who determine the most beneficial treatment. Doctors work on salary, and residents choose a medical practice, primary physician, and can choose their own specialists. World Bank figures show the UK’s healthcare ranking is $3,405 per capita—a third of U.S. spending.
McQuiston experienced the National Health Service in three capacities. First, she took a job working three days a week for NHS, on salary, treating patients. Second, on arriving, she registered with a medical practice as a patient.
When she encountered abdominal pain, she was sent for cervical testing, a mammogram, and a blood test for colon cancer.
“During the mammogram, there was an abnormality discovered. Within three days, I was called to go to a Rapid Access breast cancer center.”
There was no rationing of care, no long wait because of the urgency of her need. “Within two weeks I had had my biopsy.” To her relief, there was no malignancy.
McQuiston was also a caregiver and advocate for her mother. In that third role, she found that the NHS puts its focus on “aging in place, at home.
“They have shifted resources from inpatient hospital care to community and in-home care, which is much more cost-effective” as well as more comfortable and familiar to the patient. Now, says McQuiston, “Similar discussions are under way at Mission.”
Overall, the British system works well. Could it use more money? Of course. Does it have perfect outcomes? No more than any other system. How does it compare with the U.S. system? Extremely well.
Dr. McQuiston was able to register with a physician practice as soon as she returned to Scotland. Back here in Asheville, she is still uninsured, because “I … won’t start work [for a number more weeks], and then I’ll have to wait a month to get coverage”—even as an employee of the largest hospital in western North Carolina.
Politics and (not enough) money
Dr. Errington Thompson worked as a trauma surgeon at Mission beforebecoming Director of Trauma at Marshall University Hospital in Huntington, WV. In Asheville he also hosted a political radio show and wrote regular commentary for The Urban News, a practice he continues today. [see page 19]
Thompson spoke from a political perspective.
“Republicans are corporatists. They love corporations. They also unhesitatingly tell lies: ‘Single payer doesn’t work.’ ‘Just won’t work here in the U.S.’” When asked “Why not?” they have a simple answer. ‘Cuz.’
Thompson pointed out that the propaganda against single-payer always focuses on the bad news. “We hear that ‘single payer is like the VA system,’ but what we don’t see is that the VA system does work in some places, and not in others.” He blames politicians. “When the lights are on and cameras rolling, everyone supports the VA. But there isn’t a single bipartisan bill supporting the VA.”
The government is stingy, even as politicians blast the outcome that is the result of that stinginess. He bashes congressional Republicans.
“The new GOP plan is the first one ever that tries to take healthcare away. That is wrong. It’s evil. It’s immoral. Healthcare for all is moral.”
Obamacare’s weaknesses, Thompson notes, are that “it didn’t negotiate prices for drugs, physician costs, syringes, hospitalization, all that stuff.” Also, expanded Medicaid coverage was challenged in court, which left another 20 million still uninsured.
However, said Thompson, “We are Americans. As part of our DNA, we fix things. We can figure out how to pay for single-payer. We can tax soft drinks, fast foods, speeding tickets.
“We already spend $3.2 trillion per year on healthcare. We just need to re-approach how we spend it.”
The forum was followed by a brief question and answer period.