David Gill, an emergency physician at Dr. John Warner
Hospital in Clinton, often tells the story of a 73-year-old woman with a
throat so swollen that she could hardly breathe. Suffering from an allergic
reaction, the elderly woman put off seeking medical attention for five
hours, afraid of the medical bills she might incur.
Only in the United States, one of the world’s
richest, most technologically advanced nations, would anyone with
life-threatening symptoms hesitate to seek immediate care, Gill says.
And that’s something Gill hopes to change.
For the second time, the 45-year-old physician is
mounting a race for the 15th Congressional District, hoping to dislodge
U.S. Rep. Tim Johnson, the Republican incumbent who handily turned back
Gill’s challenge in 2004. Gill, who again is making universal health
care a central plank of his campaign platform, hopes to tap growing public
dissatisfaction with the nation’s broken health-care system.
“Eighteen thousand people die every year in this
country from lack of coverage,” he says. “It’s like six
World Trade Centers going down.
“It’s not just an issue of
compassion, although it is an issue of compassion; it’s an issue of
fiscal sanity,” Gill says. “Half of all personal bankruptcies
are the result of health-care bills.”
Since the early 1990s, Gill has been a member of the
Physicians for a National Health Program, a Chicago-based physician-run
organization that proposes a single-payer plan to cover everybody in the
United States.
PNHP helped draft the United States National Health
Insurance Act, a bill introduced by John Conyers Jr., a Michigan Democrat
who chairs the 46-member Congressional Universal Health Care Task Force.
The legislation would extend Medicare coverage —
including dental, mental health, prescription drugs, and long-term care
— to every American, but it faces strong opposition from private
hospitals, insurers, and pharmaceutical companies.
Special interests trump public support
Health care, judging from recent polls, is an issue
deserving more than lip service from politicians. According to a national
opinion survey conducted on behalf of the nonprofit and nonpartisan Civil
Society Institute, 78 percent of Americans believe that government should
regulate health care to ensure fair prices, broad access, and quality. Yet
45 million Americans are uninsured and millions more are underinsured.
“We trail most of the developed world on such
indicators as infant mortality and life expectancy,” PNHP wrote in a
special communication to the Journal of the
American Medical Association, the prestigious
journal’s first coverage of the organization’s proposal in
August 2003.
A single-payer system would be funded by the
government in the same fashion as Medicare, replacing the current system of
for-profit private insurance companies and health-maintenance
organizations. Hospitals, physicians, and health-care providers would be
reimbursed by a single government agency, saving at least $286 billion in
paperwork annually, according to a study released in early 2004 by
researchers at Harvard University and Public Citizen.
“The United States spends more than twice as
much on health care as the average of other developed nations, all of which
boast universal coverage,” the physician group wrote in JAMA. Americans receive far
less care than citizens of other industrialized countries yet pay the
highest per capita amount — more than $6,000 per year, according to
the Organization for Economic Cooperation and Development Health Database,
2002.
PNHP argues that the United States is among the few
nations that treat health care as a consumer product instead of a social
service. In a market-driven system, providers compete not by lowering
prices but by refusing to provide service.
“You don’t want a health-care system that
results in a denial of care,” says Dr. Quentin Young, national
coordinator for PNHP and former medical director of Cook County Hospital in
Chicago.
Young has advocated national health insurance since he
was in medical school more than 50 years ago. “With HMOs and managed
care, the doctor is rewarded by limiting your care — fewer tests,
fewer consults,” he says.
States forced to take the lead
Because of the federal government’s inaction,
some states are taking the lead in finding solutions to the problem. In
Illinois, the Healthy Illinois Campaign, endorsed by a large coalition of
organizations, is working to develop an affordable voluntary
health-insurance plan for small businesses, self-employed people, and
individuals. This public-private partnership would allow the state to
negotiate affordable premiums with private insurers and lower costs by
pooling the risks.
“There is momentum in statewide activity,”
says Claudia Lennhoff, executive director of Champaign County Health Care
Consumers, whose grassroots organization aids consumers in the struggle for
health-care access and justice. “If you look at the last five to 10
years, there have been tremendous grassroots efforts,” Lennhoff says.
California, Vermont, Massachusetts, Georgia, and Minnesota have launched
statewide health-care plans.
Illinois has 1.8 million uninsured residents,
according to the Gilead Outreach & Referral Center, a Chicago-based
nonprofit health-care advocacy group. The Health Care Justice Act signed
into law by Gov. Rod Blagojevich in August 2004, established a 34-member
task force to develop a health-care-access plan by Dec. 31, 2006. So far,
however, no public hearings have taken place.
Congressman Johnson, who turned back Gill’s
challenge in 2004, agrees that a health-care-delivery crisis exists but
favors modifications to the current for-profit system. Citing backlogs in
the Canadian system, Johnson has predicted that the PNHP plan would result
in higher costs and poorer-quality health care.
Canadians receive a level of care equal to that of
insured Americans but at a far lower cost. In the 1990s, Canada’s
wealthiest citizens opposed subsidizing a national health-care system that
would provide care for the sick and poor, PNHP founders and physicians
Stephanie Woolhandler and David U. Himmelstein wrote in an article in the
November/December 2002 Oncology News. At the time, health-care costs in Canada were comparable
to those in the United States. More than a decade later, life expectancy in
Canada is two years greater than in the United States. Average Americans,
PHNP asserts, could be assured of even better care than that delivered
under the Canadian system — without its waits and shortages —
at current levels of U.S. spending.
PNHP’s strategy is to elect more candidates who
make health care their No. 1 priority. “There were five races where
the incumbent Republican ran against a Democrat supporting a single-payer
health-care system,” Young says.
Among the victories: Melissa Bean, who supports the
PNHP plan, beat longtime Republican incumbent Phil Crane last year in
Illinois’ 8th Congressional District, which covers portions of
McHenry, Lake, and Cook counties.
Corporate America may demand help
But the debate over access to health care
doesn’t just split along party lines — or between providers and
individual consumers. Support for a single-payer system is likely to come
from major corporations, who will need to unload the costs of health care
as a means of remaining competitive, Young says.
Take General Motors: The manufacturing giant blamed
its recent $1.1 billion first-quarter 2005 loss on its $5.6 billion annual
health-care expense. And GM isn’t the only company feeling the pain:
Health-care costs have “created a competitive gap that’s
driving investment decisions away from the U.S.,” Allan Gilmour, vice
chairman of Ford Motor Co., said at a recent auto-industry conference. An
American-made Ford is $1,500 more expensive than one built in Canada as a
result of workers’ and retirees’ health-care costs. That is
more than the cost of the steel.
Critics claim that a national health-care program
covering all Americans would be unaffordable, but Young disagrees:
“The one government plan we’ve got — Medicare — is
a huge success.” Administrative costs for Medicare average 2 percent
compared with the 15 to 20 percent in administrative costs associated with
private insurance. “Medicare cut in half the number of seniors who
would be in poverty because of their medical costs,” Young says.
Medicare takes advantage of economies of scale and a single-payer system,
eliminating multiple layers of expensive bureaucracy.
Prologue is not precedent
The last major attempt, back in the early 1990s, to
overhaul the nation’s health-care system was torpedoed by the
insurance industry. The $15 million “Harry and Louise”
advertising campaign, funded by the Health Insurance Association of
America, undermined President Bill Clinton’s little-understood
health-care plan by asserting that the plan would restrict consumers’
ability to choose their physicians. Clinton’s Health Security Act,
presented to a joint session of Congress in September 1993, was soundly
defeated before most people had a chance to debate its ramifications.
The Clinton plan fell far short of providing universal
coverage, physicians such as Gill are quick to note.
“The Clintons were talking a lot about it, but
theirs weren’t the right solutions,” Gill says. Clinton’s
plan left big insurance firms in a central role. “Hillary [Clinton]
invited all the players to the table,” Gill says. “She invited
the insurance companies and offered them half a loaf.”
The 1,300-page Clinton plan was way too complicated,
Gill says. In contrast, the PNHP plan is eight pages.
But just because it’s simple doesn’t mean
it’s any more popular with some entrenched groups.
Young says the leadership of the American Medical
Association, the nation’s top physicians’ organization, has
attempted to characterize single-payer insurance as infeasible even though
many of its members are supporters. Some physician specialists fear a
reduction in income, but astronomical malpractice-insurance rates are
driving physicians out of business and leaving many areas of the country
without obstetricians, gynecologists, and neurosurgeons.
Obstetrician/gynecologists in Illinois with no history of claims pay
$230,000 per year for malpractice insurance, Young says.
More than 12,000 physicians, including two former U.S.
surgeons general, have endorsed the PNHP’s proposal. Federally
funded, it would put in place mechanisms to control future costs and would
restore patients’ choice of physician and hospital.
Conyers, the House sponsor of the single-payer plan,
has said that “thousands of physicians are now taking a stand on the
side of patients [and are] openly declaring that for-profit medicine is an
abysmal failure that keeps over 44 million Americans uninsured.” And
Conyers’ view appears to have some statistical basis: A Harvard study
published in the Archives of Internal Medicine in February 2004 found that nearly two-thirds of physicians
favor single-payer health insurance, far greater than the proportion who
support managed care (10 percent) or fee-for-service care (26 percent).
Most members of the AMA favor the single-payer approach, but only half of
physicians were aware that most of their fellow physicians agreed.
A single-payer health-care plan will not solve all
the nation’s ills, PNHP concedes. It would not, for example,
encourage healthy lifestyles or necessarily result in improvement of
environmental and public-health services. Racial, linguistic, and
geographic barriers to health care would persist. Medical students’
education costs that lead to an overabundance of specialists and lack of
general practitioners and discourage low-income and minority applicants
would not be changed. Patients would still seek unnecessary services, and
some physicians would be influenced to fulfill them. Malpractice-insurance
rates would remain high.
Yet, argues PNHP, only a single-payer system has the
potential to create the savings to make universal coverage a reality.
A place to effect change
David Gill, who has been a physician for 17 years, has
practiced emergency medicine in DeWitt County for the past six.
Though he’d been active with other physicians
pushing for reform since the early 1990s, his decision to run for Congress
was made the night U.S. Sen. Paul Wellstone of Minnesota died in a plane
crash. A college professor, Wellstone lacked any political pedigree when he
ran for office, but he managed an upset victory by pushing a progressive
agenda that resonated with the voters of Minnesota.
Running for Congress, Gill says, is his way of
honoring Wellstone’s legacy, putting himself in a place where he can
effect change.
This article appears in Jun 23-29, 2005.
