Hippocrates In San Diego

Art. 25, Gen. Assy. res. 217A(III) of 10Dec48

I deal with the consequences of our healthcare insurance system every day. I work in two hospitals: one is a large urban public hospital that takes care of a large portion of the county’s uninsured, including homeless people as well as the working poor without adequate insurance; the other is a private hospital that is more like a hotel, with wealthy patients who have private insurance as well as Medicare or MediCal, California’s state insurance program.

The current system is broken for all of the patients I see, in both hospitals. Of course we know why it doesn’t work for my patients at the public hospital; insurance is impossibly expensive for most people who earn lower wages, especially if they have a predisposing illness (many have diabetes, high blood pressure, etc. in their 30’s before they even think about the consequences of not having coverage).

If you earn $1,000 a month working on the dock at Wal-Mart, and your spouse earns $400 a month cleaning houses, after paying $800 for rent (which around here is one step above slum), food, clothes, kids, etc, you’re not able to squeeze any more blood from that rock, so to speak. The $30-a-month plans won’t accept you, because your wife is of child-bearing age and had problems with pregnancy induced hypertension and diabetes, making her a high-risk pregnancy. You have a strong family history of heart disease, and should be having your cholesterol checked starting in your 20’s, but never bothered to (what 20-year-old does) and now you are trying to pay for Lipitor at about $100 a month, so you spread it out by taking one every 3 or 4 days so that your monthly supply lasts a quarter of the year. This makes your doctor mad so he kicks you out of his practice, since you rarely are able to cover the cost of the visit (about $60 per visit) anyway, and you have to search around for weeks to find a doctor who is accepting new cash-only patients (few and far between, believe me). So you go months and months without your medication — maybe you’re too proud to go to the ER to get a refill. At age 42 you have a massive heart attack and die, leaving your wife to try to cover the bills on her $400 a month. They quickly are evicted and end up at a local shelter…

I see this all the time. It’s not a rarity. The older folks in the posh private hospital aren’t faring any better. This new Medicare “Part D” prescription medication coverage, which the Bush administration advertised as providing increased access and coverage for seniors, has actually done the opposite. There are many seniors around here living on Social Security or a pension, who have private coverage for their doctors visits and hospitalizations, but rely on Medicare for their medications, who are paying several hundred dollars more per month for their meds than they were before Part D came into effect. I’m convinced that this was an intentional strategy, to sell it as expanded coverage when in fact it’s meant to reduce access.

What’s the definition of a universal health care system? It’s not socialized medicine. Socialized medicine implies that all doctors are employess of a federal system, working in federal hospitals, run by federal bureaucrats. That is certainly not what the universal healthcare movement wants. We’re talking about a “single-payer” system. Corporations can keep their chains of hospitals private, and doctors can continue to work in private practice or join a group if they so choose. What’s different is that the reimbursements — how doctors and hospitals get paid, and how tests and procedures and office visits are paid for on behalf of the patient — all come from the same system. Instead of hospitals having to hire 1,000 people just to figure out how to submit bills to 12,000 different insurance companies, everything would be fed into a standard system that would be more efficient and more equitable than the current one. This would save everyone money because of the reduced expenses in dealing with a single payer rather than 12,000 different ones. The efficiencies brought about would make access easier for everyone (because you now could never be denied access to a hospital or doctor’s office, since everyone has the same coverage), and the cost savings would allow for coverage of every last man, woman, and child. If we really think the US is the finest example of democratic liberty and justice, we must have a new system. Period.

For more: http://www.pnhp.org/