The following report is from Jerome Helman, M.D.:
I share a special anniversary. In 1965 I graduated from medical school just as Medicare was implemented. On July 30 we celebrated 45 years since the creation of this seminal health care program.
The original plan for Medicare saw the elderly covered first and the rest of our population covered by descending decades. The golden age of medicine was upon us. Seniors were guaranteed the best care and private insurers covered most of the working public.
The dream ended when for-profit health care was introduced in the early 1990s. Relentless increases in premiums, deductibles, co-pays and medication led to the crisis we now face.
In 1997, President Bill Clinton, in his zeal to balance the budget and reduce the national debt, signed into law the Medicare Balanced Budget Act.
Since then physician reimbursements have been cut in half and more, ignoring the ever-increasing expenses of running an office, expenses that all businesses have.
The uncontrolled cost of drugs, medical equipment and medical supplies is borne by all physicians who accept Medicare. The cuts in reimbursements, which Medicare mandates, private insurance companies implement with even greater cutbacks.
As part of the original Medicare policy, the government increased the number and size of medical schools, promoted subspecialty training and encouraged the development of designer drugs to treat diseases through precise molecular mechanisms. With the erosion of fair reimbursements, especially in primary care, Congress has brought about the present crisis in health care.
In spite of Medicare’s fiscal shortcomings and with the forecast of its doom in every presidential election cycle, it can be saved by returning to the original concept of Medicare, a single-payer system for everyone. Instead of working from crisis to crisis, we need to build from strength to strength.
The new Medicare for all or Medicare 2.0 would remove the middle man from the health care equation. Half the health care dollar is now consumed by excessive administrative costs and profits.
With a single-payer insurance system, the physician would realize an immediate 30-percent savings, no longer having to deal with upwards of 1,200 insurance companies and the endless paper work.
Medicare 2.0 would re-establish fair reimbursements to physicians, who finish medical school with an average debt of $150,000 to $200,000, and who cannot afford to enter into primary care.
Today, only 30 percent of primary care residencies are filled by American medical school graduates.
Medicare 2.0 would return primary care to its primacy in our health care system by increasing reimbursements commensurate with their proper value.
Medicare 2.0 would force the government to control prices in the medical equipment and medical supply industries where a motorized wheelchair costs upwards of $12,000.
Medicare 2.0 would control drug prices. Thirty percent of worldwide profits in the Swiss pharmaceutical industry alone comes from the United States. The same low pharmaceutical prices the Veterans Administration pays could be passed on to the public.
Medicare 2.0 would protect us from hospital and drug advertisements. After cigarette advertising was banned in the media, the vacuum was filled with drug advertisements.
The pharmaceutical industry has exploited the public with often misleading ads, creating an unnecessary demand for new and potentially dangerous drugs.
When I see a bus wrapped with a full-length ad expounding the greatness of a local hospital, its staff and facilities, I am saddened by the waste of valuable resources that should go for patient care. With Medicare 2.0, the hospital receives a global fee to operate efficiently and safely.
Forty-five years after graduation, boarded in two subspecialties, I now treat the indigent and hungry in my neighborhood in Venice. Recently, I have seen more middle class and educated patients; many are unemployed and/or have no health insurance. The time has come for Medicare 2.0. As a physician, I will again have cause to celebrate, anniversary or not, when the public is better served.
I am a retired board-certified internist and gastroenterologist in Venice who treats patients at the Venice Family Clinic and lectures on nutrition at the St. Joseph Center. I have practiced medicine in seven states (CA, MI, IL, TX, MA, NH, SC) in private practice, with HMOs and managed care and in the military. I have been involved in peer review, utilization review and medical education. I am a member of Physicians for a National Health Program.