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Posted on Sun, Mar 7, 2010 : 6:02 a.m.

Massachusetts Senate election: A call to start over on healthcare reform

By Guest Column

Count me among those who were not terribly disappointed at the outcome of the recent Senate race in Massachusetts to fill the un-expired term of the late Sen. Edward Kennedy.

The election of Scott Brown, a conservative Republican who until recently was an obscure state senator, in a state well known for its liberal politics, should be construed as nothing less than a revealing denouement of the Democratic health reform agenda. Nor should the outcome of this election be seen as an unanticipated surprise; well before the historic Jan. 19 vote, there was indeed a sense that the Massachusetts voters were collectively acting as the nation’s proverbial “canary in the coal mine” for the Democrats’ ambitious social agenda.

030710_james-mitchiner.jpg

Dr. James C. Mitchiner is an Ann Arbor emergency physician.

Exit polls suggested that voters’ concerns over the scope and speed of health care reform provided the primary motivator for their electoral decision. Whether the reforms proposed by the Democratic congressional leadership were too radical, too costly, too confusing or too partisan for the taste of the average independent voter, one conclusion is certain: health care reform, in its current iteration, made people uncomfortable. Clearly, the proposed health bills are unnecessarily convoluted, bureaucratic and controversial. And if Brown’s election provides the 41st vote needed to scuttle health care reform in the Senate, perhaps he has done the country - and the Democrats - a big favor. It’s not that I want to wait the next 16 years for yet another attempt at overhauling our deplorable, inept and inequitable health care system. Rather, I join the chorus of those, particularly the Republican congressional leadership, who are demanding that we start over on health care reform. We can begin by recognizing what works: Medicare. Yes, Medicare has its faults. It underpays doctors and hospitals, is going broke, is subject to fraud (although perhaps not to the extent that some claim), and has its own bureaucracy. But it also has an established infrastructure, provides universal coverage and is highly popular among senior citizens.

In terms of reimbursement, its apparent pecuniary stinginess stems from doctors’ need to pay their office overhead, which of course can be traced to the extra costs and time spent dealing with our rapacious for-profit health insurance industry. And the way to “save” Medicare from its impending bankruptcy is to expand its risk pool by incorporating younger - and healthier (read: less costly) - beneficiaries, and pay for it through a more progressive tax structure than what now exists.

In other words, we need to extend the benefits of Medicare to all Americans by creating a universal, equitable, portable and more cost-effective single-payer Medicare-for-All health care system. Single-payer’s mischaracterization as “socialized medicine” can be remedied by educating citizens to understand that a single-payer system will permit them to go to the physician and hospital of their choice, an option they lack now because they are limited to a provider within their health plan’s network.

Single-payer will permit them to have health insurance coverage independent of their job, and even if they are unemployed. Single-payer will stay with them as they switch jobs or move from state to state. A single-payer system will simplify billing, capture administrative economies of scale, and provide uniform benefits, including coverage for pre-existing conditions. And single-payer will reduce racial, gender, financial and geographic disparities of care. In his State of the Union address last month, President Barack Obama asked rhetorically, “But if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know…. I'm eager to see it.”

Well, Mr. President, I know of a solution that will meet all those goals: a universal, single-payer, Medicare-for-All program. I’m eager to see it, too.

Dr. James C. Mitchiner is an Ann Arbor emergency physician and the former president of the Washtenaw County Medical Society.

Comments

glacialerratic

Mon, Mar 8, 2010 : 10 p.m.

Thick Candy Shell, I think your sample is skewed by your personal affinities. I happen to know a few Canadians myself, including family, many, many friends, including those from my university days in Toronto. What is truly striking is the high regard that Canadians across the political spectrum (yes, their spectrum looks different from ours, particularly these days) have for their health care system. In 2004, Canadians overwhelmingly chose Tommy Douglas as the greatest Canadian ever. Not Gretzky or Orr or Richard. No, it was Douglas, the social democratic premier of Saskatchewan who established a public health care system in his province that became the model for the country.

whodat

Mon, Mar 8, 2010 : 9:27 a.m.

The only way to curb the cost of healthcare is really get at the root cause of why it's so expensive. Attacking the health care companies, which seems to be Obama's main focus, isn't going to lower the cost. Until we as a nation incorporate better health practices into our daily lives, then the cost of health care will continue to rise along with our obesity levels. Until we put down the Doritos for an orange, or the side of french fries for a side of veggies, until we put down the remote control for a jog on a treadmill, then costs will NEVER be lower, and insurers have no choice but to raise premiums. Many people scoffed at the news of Wellpoint (Anthem of CA) raising their premiums on their CA members. But many people didn't realize that they were losing money on that business. For every dollar that they earned in premiums, they were paying out over a dollar in claims expense. Attacking the insurers, which seems to be Obama's MO, isn't solving any real issues, except denying people coverage based on pre-existing condiitons, which definitely something that needs reform. Also, it should be noted that the government subsidizes so much more in the way of corn production than they do for fruits and vegetables, it's ridiculous. Ever wonder why it's cheaper to buy something from McDonalds' Dollar menu than it is to buy fruit and veggies at your local grocery store?

The Grinch

Mon, Mar 8, 2010 : 7:17 a.m.

"Most of the Canadians I know (well over 300) hate their system and say it is highly inefficient" Yeah, that's why there is absolutely no movement whatsoever within Canada to change the system they have--NONE--ZERO. Thick must know the only 300 Canadians who are unhappy.

racerx

Mon, Mar 8, 2010 : 12:47 a.m.

A nation as rich as ours, one who is suppose to care about their citizens, can't seem how to fix health care. Republicans have touted in the past that its the #1 concern of business/industry, yet, they would rather start over, but this is only a stall tactic. Giving Obama any victory, especially one as big as this would hurt them. Though the current proposed bill is not perfect, I just can't imagine telling those 40M American's without health insurance to just wait a little longer. I also can't imagine the fight for Social Security, Medicare or any other social program that some deemed unnecessary at the time. Speaking of Social Security, didn't the Republican's wanted the "market" to control those accounts? If so, think how wiped out we'd all be if that occurred. I digress though. To think, we required insurance for our cars for pete's sake, why not humans?!?

Mick52

Sun, Mar 7, 2010 : 11:08 p.m.

Single payer systems throughout the world have not proven to be successful. I note Dr Mitchiner did not include how much of a pay cut he is willing to take. In the UK with the NHS, Drs make much less than in the US. In re to Canada, and many other countries, it is inappropriate to compare HC with the US. Few countries can match the US in the variety of spending. Medicare has proven to be wrought with problems. Expanding a govt run system that has proven inefficient is not the answer.

PeteM

Sun, Mar 7, 2010 : 11:05 p.m.

I am sure that Dr. Mitchiner is a very intelligent man, and certainly I wouldn't try to argue medicine with him, but this column makes no sense. A new proposal of any kind will not pass. It will be filibustered. The Democrats will likely lose seats in November so proposing single payer (or anything other than the Senate bill) means nothing happens for years if not decades. If Dr. Mitchiner believes that the Senate bill is worse than the status quo fine, but at least be up front about it. There is zero chance that single payer happens, and starting over means leaving 30-40 million uninsured. Secondly, Scott Brown's election was about a lot of things, but he isn't a conservative (pro-choice etc.) and he supports the Massachusetts plan which shares many attributes of the Senate plan. Finally, while healthcare reform doesn't poll well as a concept now, its actual provisions (portability, exchanges, no bars based on pre-existing conditions) poll well.

Thick Candy Shell

Sun, Mar 7, 2010 : 11:02 p.m.

Also, glacialerratic, don't ever talk to any Canadians. Most of the Canadians I know (well over 300) hate their system and say it is highly inefficient. The only saving grace is the prescription drug cost, which if Congress acts can be fixed.

The Grinch

Sun, Mar 7, 2010 : 8:04 p.m.

glacialerratic: don't confuse these discussions with actual FACTS!! These are fact-free zones, don't ya know?

glacialerratic

Sun, Mar 7, 2010 : 6:46 p.m.

Ah, Canada. So close, yet so misunderstood. The most recent (2008) Canadian federal survey of health care indicators showed that the median wait-time to see a specialist physician is just over a month, and 90% of individuals are seen within 3 months. Need a CAT scan? Median wait time is 2 weeks, and 57% needing any kind of diagnostic testing waited less than a month. Non-emergency surgery, perhaps? Median wait time is one month, and 82% of the cases are sewn up within three months. Critical cases are handled immediately. Yes, waiting in an emergency room can be a drag, and in Canada almost a quarter of folks arriving at the ER had a wait of four hours or more, and the coffee's just as bad as here. But more than 80% of Canadians have a regular family doctor, so fewer Canadians are reliant on the ER for primary care. Infant mortality? Got us beat--6.9 deaths per 1000 live births in the US vs. 5.4 in Canada. Furthermore, only 3.8% of Canadians spent more than 5% of after-tax income on prescription drugs--and nearly 88% spent less than 2%. And over 85% of Canadians are very or somewhat satisfied with their health system--there's always room for improvement. As a national health system, Canada (unlike the US) is actually able to measure the cost and effectiveness of the delivery of health care with great accuracy and in great detail and issue annual reports to the public. Take a look: Healthy Canadians A Federal Report on Comparable Health Indicators. http://www.healthcoalition.ca/index-eng.pdf Yes, Canadians criticize aspects of their health system and are concerned about costs and regional and social disparities. But it's a truly remarkable success.

The Grinch

Sun, Mar 7, 2010 : 3 p.m.

Regarding the Canadian Provincial leader who came to the US for heart treatment, see: http://www.nationalpost.com/news/story.html?id=2514581 As seems always the case, Faux Noise and it's Kool-Aid drinkers are telling much less than half of the story.

John Q

Sun, Mar 7, 2010 : 2:21 p.m.

"A Canadian provincial leader recently went to Florida for medical treatment. In other words, he paid for what is supposedly free in Canada." So what? Thousands of Americans go to Mexico every year for health care and prescription drugs. What do you say to that?

John of Saline

Sun, Mar 7, 2010 : 12:36 p.m.

A Canadian provincial leader recently went to Florida for medical treatment. In other words, he paid for what is supposedly free in Canada.

scole

Sun, Mar 7, 2010 : 12:19 p.m.

I have heard from several sources recently that there is no right to health care. True it is not written into the constitution, but let's remember that when the constitution was written George Washington was slowly being assisted to death by therapeutic bloodletting. Things have changed a bit since then, in fact to the point that anything less than absolute cure is unacceptable (I can remember when someone having a complication from surgery was an accepted risk for the chance to get better, not a reason to impune the entire system as incompetent). If there is no right, there is at least the presumption of care for all. If a pedestrian is struck on the road and hurt, when the ambulance arrives, that person will be assessed and transported to the emergency room no matter their ability to pay. If they are injured badly enough (and this is only in the worst cases) and they refuse care, they will be treated and transported anyway, because legally the responders must assume that the person is not thinking clearly due to their injury. If they are unconscious, they will certainly be treated without regard to monetary concerns. Healthcare is not a box that you can pick up at the store when you run out. There may not be a right to care, but it is certainly not a commodity to be sold to the highest bidder as some have suggested recently (except in some rare parts of our system, by those who have the luxury of seeing everything as a commodity. For everyone else it really is a matter of life and death.).

treetowncartel

Sun, Mar 7, 2010 : 12:14 p.m.

A healing art is now a business, that is the problem. Insurance companies need to be non-profitsand there should be catastophic pools simialr to no-faul auto here in Michigan.

SonnyDog09

Sun, Mar 7, 2010 : 11:56 a.m.

Yeah...let's be more like Canada....oh wait..."Access to a waiting list is not access to health care"... That's what the Canadian Supreme Court said. How do you propose to avoid the problems that other "single payer, healthcare as a right" systems have run in to? Or are you just going to pretend that those problems do not exist? See this link from the CBC for more background: http://www.cbc.ca/news/background/healthcare/

David Briegel

Sun, Mar 7, 2010 : 11:52 a.m.

Top Cat, of course, they are all lying. Why don't you tell us how many die according to YOUR sources?

cook1888

Sun, Mar 7, 2010 : 11:05 a.m.

What a great and simple solution. The kind of idea Americans use to be great at. There will be costs of course, but nothing like the enormous start up costs of the current proposal.

Top Cat

Sun, Mar 7, 2010 : 10:50 a.m.

"It is known that 45,000 people or more will die a year due to lack of health care" Really? Would someone verify the source and accuracy of this?

Mad As Hell Nurse

Sun, Mar 7, 2010 : 9:30 a.m.

It is known that 45,000 people or more will die a year due to lack of health care, this is not acceptable. We must move ourselves quickly and do what we can to prevent this. There will be a panel discussion on Health Care at Rackham auditorium Friday March 12 at one PM, part of a conference: "Bring it Back, Take it Forward" The panel will feature Dr Mitchiner, other physicians and speakers. www.BringItBackTakeItForward.org

Basic Bob

Sun, Mar 7, 2010 : 8:45 a.m.

I agree that the bills were "unnecessarily convoluted, bureaucratic and controversial", and we have learned to expect this from the government. The alternative seems to be big government or big insurance, and the *reform* bills promised more of both.

David Briegel

Sun, Mar 7, 2010 : 8:11 a.m.

The "elephant in the room" is the simple fact that we have allowed our public policy to be formed by the highest bidder. The Insurance Companies have rented our govt right under our noses and all the uninformed can talk about is "socialism, communism and Marxism" as though they knew what it meant! Good Luck Dr. Mitchiner, you are the voice in the wilderness!

AAresident

Sun, Mar 7, 2010 : 7:42 a.m.

Bravo!