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Curing U.S. Healthcare

We have seen a resurgence of interest in a single payer system. But why? We’re in the midst of a presidential campaign where one of the candidates has strongly advocated for it. We’re several years into the Obamacare rollout, and the results are not pretty. While more people now have coverage, they’re seeing increasing rates, limitations on access to hospitals and physicians, and a shrinking pool of insurers in the exchange marketplaces. Even with full implementation, our uninsured rate would go down from 50 to 30 million Americans. Meanwhile, the costs of healthcare continue to climb. As physicians, the Affordable Care Act has added complexity to our billing and reimbursement, driving up overhead costs and further catalyzing the mass exodus out of independent practice into employment with large hospital-based practices.

There has to be a better way. Our fragmented system serves some very well, some not so well and others not at all. The U.S. healthcare system has elements of every major financing model throughout the world: employer-based premiums with subsidies for the poor, that is, our old system plus the ACA (similar to Germany); government-run health insurance, for example, Medicare (Canada); a wholly state-run system, such as the VA (England); and the out-of-pocket model (most third world countries). For the amount we pay, you’d think we’d be able to provide universal coverage and be at the top of world health statistics. Sadly, neither is true.

How did we arrive at this hodgepodge system? For me, it boils down to whether we believe that healthcare is a right or a privilege as a member of our society. When we get sick, is it reasonable to expect to be taken care of, regardless of our income or ability to pay? Not just for emergency care, but for ongoing potentially lethal but treatable illnesses like diabetes, cancer and lupus? How is this different from expecting the fire department to put out the fire in your home or expecting access to a school for your children? As a society, we’ve been able to accept the idea that it is more effective and efficient to pool our resources through taxes to pay for many essential services. With healthcare, there’s a reluctance to do the same. If we could accept this idea, we could take a proactive, comprehensive approach to financing healthcare for everyone, with lower costs and better results.

There’s hope for the future. Polls show more Americans are supporting a single payer model, aka “Medicare for all.” A Gallup poll, conducted in early May, showed that 58% of Americans favor replacing the ACA with a federally funded healthcare system. The most recent large scale poll of American physicians, conducted in 2008 and published in the Annals of Internal Medicine, showed that 59% of U.S. doctors supported legislation to establish national health insurance. The Chicago Medical Society recently conducted its own small poll of area physicians with similar findings: 55% support national health insurance. Our Council has passed a resolution calling for study at the local, state and national levels into the feasibility and costs of implementing a single payer system. In addition, we plan to replicate our recent poll on a much larger scale and publish the results. Our healthcare system is evolving rapidly and we will remain in the vanguard of positive change for our members and patients.

Kathy M. Tynus, MD
President, Chicago Medical Society

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