Time For Single-Payer Helath Insurance - Support SB 562, The Healthy California Act

Time for Single-Payer Health Insurance – Support The Healthy California Act

M. Bakri Musa, M.D.

Insurance companies are the problem; they are not the solution to our current healthcare crisis. The current system is not sustainable, prohibitively expensive, and leave many vulnerable. It is for these reasons that physicians at St. Louise Regional Hospital last month (June 15, 2017) endorsed SB 562, The Healthy California Act, that would provide universal healthcare coverage to all Californians through a single-payer system.

            We depart from our colleagues elsewhere in the state who have chosen to remain silent on this important legislative initiative. Physicians have an obligation to the public in general and our patients in particular to assert our views on such matters. Remaining silent is not a responsible option.

            This legislation is now on hold by the Speaker of the State Assembly. Physicians should grab this opportunity to emulate our fellow professionals in the California Nurses Association in being engaged–and early–so we could have a voice in fleshing out the details of SB 562. Remaining silent would reduce us to be marginal players at best, and be ignored at worst. This legislation will impact us directly.

            Physicians currently navigate a byzantine trail just to get “Treatment Authorization Requests” (TAR) for our patients. We go through a gauntlet of voice mails telling us to “Press 1 for …, Press 2 ….” Our calls are important, we are being repeatedly assured, but not important enough to warrant insurance companies to hire a human being to answer them.

            Patients are assaulted with daunting, mindless and repetitious patient information slips at every encounter. Couldn’t these insurance companies issue “smart cards” like what those Taiwanese have? If with my not-so-smart credit card I could shop at any store in any country with ease, surely our health insurance card could do better than issue just identification cards.

            Peruse your medical bills. Even the most sophisticated struggles to decipher the “Explanation of Benefits,” what with terms like “not covered services,” deductibles, and co-pays liberally sprinkled to justify their reneging to pay in full.

            Health insurers have tinkered with the system with PPOs (Preferred Provider Organizations) and their bewildering list of in-network providers and fee schedules, through capitations and managed care (HMOs), all in the guise of “quality care” and “cost containment.”

            An alphabet soup of initials later, the ugly reality is that providers are crushed with administrative load that impedes quality and compassionate care, quite apart from imposing delays and needless costs. Meanwhile the obscene compensations to healthcare insurance executives escalate unabated.

            Time to get rid of insurance companies and have a single-payer system. The Canadians and Taiwanese are very satisfied with theirs. Their healthcare indices too are far superior to ours, and costs much lower.

            For many Americans, financial catastrophe is only an illness or accident away. SB 562 would spare them that fear.

            As with the introduction of Medicare two generations earlier, the same old bogeyman of socialized medicine is being resurrected against SB 562. Many, including doctors are again being trapped by labels. Is Medicare or Social Security socialistic?

            Worth noting that while Medicare is a governmental program, it is run by private contractors. Civil servants dictating to doctors is a myth. What is not are doctors being dictated to by insurers.

           

            The legislative analyst estimated that SB 562 would cost an eye popping $400 billion annually. What is not appreciated is that we already spend about $370 billion today, while still leaving 2.7 million Californians uninsured. About a third of those insured are vulnerable because of high deductibles and co-pays. Further, taxpayers contribute over half of that $400 billion through Medicare, MediCal, and county hospitals.

            A small but not insignificant portion is borne exclusively by providers and hospitals through uncompensated care. We don’t mandate restaurants to feed the hungry, nor hoteliers to house the homeless. We accept that as our societal obligation.

           

            If all my bills were paid (under SB 562 they would be!), I could lower my fees by a third and would still take home the same amount. With the reduced administrative load of a single payer, I could cut further my fees. With the negotiating clout of nearly 40 million Californians, we would slash the price of drugs and supplies, as currently enjoyed by the Veterans Administration and Canadians.

            An independent study shows that with SB 562 today’s healthcare would have cost about 340 billion, not the current 370. With that we would cover all Californians and upgrade those currently underinsured.

            With SB 562 we would trade insurance premiums for taxes. The latter could be increased only with a supra-majority vote; with premiums, the whims of insurance executives.

            Providing health insurance for all Californians is the right thing to do. That is why St. Louise doctors endorse SB 562. That it would also streamline our practices, pay all our bills, and reduce our administrative load are but welcomed bonuses.

The writer, a general surgeon in private practice in Gilroy, is former President of St. Louise Regional Hospital Medical Staff, Gilroy, Ca. A slightly version of this article wappeared as the in as an Op-Ed piece in the Gilroy Dispatch June 30, 2017.