Support Grows For National Health Insurance
Cavacece and some other doctors in the Greater Grand Rapids area are members of Physicians for a National Health Plan, a 15,000-member organization working for a single-payer national health insurance program. The proposal calls for government-provided health insurance for every person, and they claim it would cost less than the health system we have today.
"If you are a fiscal conservative, there is no way you would consider having the system the way we have it now, because it does not do anything to control cost," said Cavacece, associate director of the Grand Rapids Family Medicine Residency at Saint Mary's Health Care since 1996 and a member of Physicians for a National Health Plan for seven years.
According to the physician group, the U.S. spends twice as much as other industrialized nations on health care — an average of $7,129 per person. Yet in 2005 (the last year data was available from the U.S. Census Bureau), nearly 47 million people in the U.S. were without health insurance.
"Private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar. Streamlining payment through a single nonprofit payer would save more than $350 billion per year, enough to provide comprehensive, high-quality coverage for all Americans," states the organization’s Web site.
The National Coalition on Health Care (www.nchc.org), led by individuals such as a former governor of Iowa and a dean emeritus of Harvard Business School, noted in one of its publications that in 2007, total U.S. health expenditures were $2.3 trillion, or $7,600 per person. Health care costs represented 16 percent of the gross U.S. domestic product. The National Coalition on Health Care reports that health care accounted for 10.9 percent of the GDP in Switzerland, 10.7 percent in Germany, 9.7 percent in Canada and 9.5 percent in France, according to the Organization for Economic Cooperation and Development.
The U.S. spends more on health care than other industrialized nations where all of the citizens have health insurance, according to the NCHC. The U.S. health care system "is riddled with inefficiencies, excessive administrative expenses, inflated prices, poor management and inappropriate care, waste and fraud," states the Web site. It also reports that employer health insurance premiums increased by 6.1 percent in 2007 — two times the rate of inflation. The annual premium for an employer health plan covering a family of four averaged nearly $12,100, and more than $4,400 for a single person.
According to the Kaiser Family Foundation and the Health Research and Educational Trust, premiums for employer-sponsored health insurance in the United States have been rising four times faster on average than workers’ earnings since 2000.
Nearly 1.3 million full-time workers lost their health insurance in 2006. The percentage of people with employment-based health insurance has dropped from 70 percent in 1987 to 59 percent in 2006. A third of firms in the U.S. did not offer health insurance coverage in 2006, according to the NCHC.
Rapidly rising health insurance premiums are the main reason cited by all small firms for not offering coverage. The average annual increase in inflation has been 2.5 percent while health insurance premiums for small firms have escalated an average of 12 percent annually.
Cavacece said a single-payer nonprofit national health plan is not socialized medicine.
"Socialized medicine implies that the government not only pays for it but they run it, and that isn't the kind of program we're after," he said. "We're after a socialized insurance like Medicare."
"It doesn't get rid of competition," he added. "Different hospitals, like the three hospitals in Grand Rapids, would compete based on the quality of care they provide and the services they provide."
According to Mark Almberg, communications director of Physicians for a National Health Plan, there are a variety of ways a single-pay model would operate. Payment for health care would be managed by a public or quasi-public agency on a national level or even regional or state levels. Individuals could go to any doctor or hospital they choose but the bills would go to the agency for payment.
"All the delivery is private under this kind of model, which is similar to Canada's," said Almberg.
"It would be like a publicly owned insurance company. It would be administered in the public interest and basically a form of social insurance, much like Medicare is."
Almberg said that "unfortunately" Medicare "has been eroded by efforts to privatize it." To some extent, its quality has suffered somewhat lately, he said, "but it's still an outstanding program that has worked well for tens of millions."
Cavacece said having the U.S. government pay for health care is "the system that makes the most sense. That's what Medicare has been. Actually, Medicare has worked pretty darn well. It's come under fire the last five or 10 years for being stretched so thin, for lack of funding."
Cacacece also noted that private, for-profit insurance companies don't cover people over 65 but Medicare does — and that is the start of a person's life when medical problems become more frequent and more expensive.
Almberg said the Physicians for a National Health Plan, which is headquartered in Chicago, supports HR 676, a bill introduced in 2005 by U.S. Rep. John Conyers Jr., D-Mich. HR 676 would establish a universal health insurance program with a single payer system. Last week at the Democratic National Convention, the California Nurses Association hosted a reception with Conyers in support of the bill. In June, the U.S. Conference of Mayors endorsed it.
Physicians for a National Health Plan was formed in 1986 and has "seen a surge in interest and support over the past year," according to Almberg.
A survey of U.S. physicians published in The Annals of Internal Medicine, published by the American College of Physicians, recently revealed that 59 percent of American doctors support some form of national health insurance. The question has been asked of American doctors in the past but this is the first time more than half indicated their support.
"More and more physicians are concerned that their patients are unable to get adequate care, preventative care," said Almberg. "They're also having to deal with the headache of hiring people just to deal with insurance issues and all this paperwork."
"I'm a patient care guy," said Cavacece. "I live to take care of my patients."
He said he decided to join Physicians for a National Health Plan because of the inequality of health care in this country.
"It's become an administrative nightmare to get anything done for your patients," he said. "Every day I have to make decisions for my patients based on, not what they need, but what their insurance companies will pay for. Every day."
Would a national health care system reduce physician incomes?
Cavacece said he believes a national health care plan would tend to equalize physician incomes. He said the current system provides an "inordinate amount" to doctors who are trained to perform specialized procedures such as colonoscopies and cardiac catheterizations. For example, a gastroenterologist probably does 12 colonoscopies a day, while a family physician might see 20 to 30 patients.
"Is the value of the 12 colonoscopies worth five or six times what the other doctor's work was? I don't think so," he said.
"Of course, it would mean changing some things about how we finance medical education that leaves new doctors with upwards of $250,000 of debt after 4 years of school.
"Plus, the costs of all the new technologies is exponentially rising. If we don't come up with a consistent plan of what each is worth, or if it is really necessary, then the system will go broke," he said. HQ