19 January 2007

Crowd for single-payer

It took a lot to get Dr. Cory Carroll out from behind his stethoscope and into activism. But the stories about going without healthcare that he heard from patients, one after another, finally wouldn’t let him rest.

Dr. Carroll joined the Physicians for a National Health Plan, perhaps the most visible and active group behind American healthcare reform, and now speaks to groups in addition to treating patients.

Dr. Carroll was one of four panelists last night at Health Care for All Colorado’s education and action meeting at the Foothills Unitarian Church in Fort Collins, Colo. There he was preaching to the choir for the most part, but he’s spoken to crowds unconvinced about single-payer healthcare, and even crowds unconvinced that there’s a problem.

Like the one at a recent Insurance Underwriters’ convention, for instance.

More than 100 people heard Dr. Carroll; Alexandra Bernasek, a professor of economics at Colorado State University; Nicki Carter, a family nurse practitioner; and Dr. Mark Wallace, vice-chair of Colorado’s Blue Ribbon Commission for Health Care Reform (the 208 Commission).

Dr. Wallace recalled that in his school years, professors warned that American healthcare costs were approaching 12 percent of the gross domestic product. That wasn’t sustainable, the professors said.

Healthcare now consumes 16 percent.

In years past, physicians have been sanguine about the U.S. healthcare system. “But now when I sit with my colleagues, they’re willing to say it’s broken,” Dr. Wallace said.

It’s difficult to ignore the hard data. Even some non-industrialized nations are seeing better outcomes than are found in the United States. There’s also a general understanding that the system needs to be more fair.

“There’s increasing agreement that the system is broken,” said Dr. Wallace.
He told the crowd that we hadn’t come to this impasse because of a lack of technical expertise. So why hasn’t there been a successful reform model in the United States? Something that other reformers in other states could point to, and say let’s do it like that?

“There’s been a lack of political will,” he said.

Dr. Wallace urged the group to talk to their neighbors about the issue, adding that there were folks on his cul-de-sac who doubtless didn’t think there was a problem with U.S. healthcare. “They’re covered,” he said. “They’re doing fine.”

He said that the 208 Commissioners had been charged to find a practical plan that would comprehensively reform healthcare in Colorado. That meant, he said, expanding healthcare services and reducing healthcare costs for Coloradoans.

The commission has thus far worked on bylaws and created its committee structures.

There are committees for:
1) proposals, to solicit plans for change,
2) communications, to tell the public what’s happening, and build consensus for the top plan,
3) operations, dealing with timelines and business, and
4) evaluation, finding a firm to evaluate the proposals.

Dr. Wallace said that the commission wants the proposal they finally choose to be credible. “I ask that we remember that this will come back to politics,” he said.

Newly elected state Rep. John Kefalas, D-Fort Collins, and state Rep. Randy Fischer, D-Fort Collins, attended the forum, as did Betsey Markey, Sen. Ken Salazar’s (D-CO) regional director for the North Central Colorado area.

Kefalas said that passage of reform depended upon how it was framed, that businesses and individuals had to see that it was in their economic interests to fix it.

Questions for the panel began with a man wondering why no one had addressed the biggest determinant of health: lifestyle.

Dr. Carroll agreed with him that lifestyle is key, and described our system as “ill-care” rather than healthcare. He said that there’s no reason a single-payer system wouldn’t pay for evidence-based medicine like acupuncture.

A woman worried over the administrators and insurance workers who would be jobless in a single-payer system

Bernasek, the economics professor, told the woman that there’s no reason single-payer reform wouldn’t include retraining those workers. She also said that saving jobs isn’t a good reason to preserve inefficiency.

“But how many people would lose their jobs?” the woman asked.

“Not as many as are uninsured,” called out another audience member.

A man stood to angrily say that HCAC should set up an intentional process to move the politics, since it wasn’t going to happen on its own.

Eliza Carney of HCAC urged him to volunteer.

Another question came from a man who said he was uninsured. He asked if there were any studies showing that business benefits from a single-payer system.

Bernasek answered that there were, and then shared that a college classmate is a chief economist at Ford Motors. He has admited to her that his stand against single-payer is based on ideology, and that Ford would be better off if this country had a single-payer system.

“The fear is that if we go down this road there will be other incursions on the free market,” Bernasek said.

She told the group that the country she had been raised in, Australia, funds its single-payer healthcare system through a 1.5 percent income tax. That comes to far less than what people pay under the current chaotic U.S. system.

Dr. Wallace said he’d spoken at Colorado’s Club 20 that morning. That’s a generally conservative organization representing Western Colorado business interests. The group’s conversation led them to the realization that healthcare doesn’t operate like an open market.

“What happens when a competitor opens in an open market?” Dr. Wallace asked. “The price goes down. What happens when a new hospital opens in a community? You all here know about this. Prices go up.”

He said that the Club 20 members’ fear concerned who would set prices under a single-payer system.

Dr. Carroll, who was an engineer before he was a physician, said that he’s a person who likes data, and that the data from working, single-payer systems in other countries proves inescapably damning of the U.S. model.

“It’s a no-brainer,” he said. “Why the hell are we paying more to get less?” he asked.

The last comment came from a man who said that America’s future was a bleak one. Executives and politicians, he said, would have healthcare and the rest wouldn’t.

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