Without Single-Payer American Health Care is Doomed

Of all the forms of inequality, injustice in health is the most shocking and inhuman.

— Dr. Martin Luther King, Jr., Second National Convention of the Medical Committee for Human Rights, Chicago, March 25, 1966.

It is the year 2018, and yet not a day goes by when a patient is unable to receive good care or a doctor questions their career choice.  How have we arrived at this tragic state of affairs? The answer is that our for-profit health care system is the principal cause, not only of poor patient care, but also of physician burnout. Only with a single-payer system, anchored not in the mores of capitalist plunder, but with the understanding that quality government-funded health care is an inalienable right, can both doctors and patients extricate themselves from this suffering.

Even amongst patients that are insured, restrictive health care plans force millions of Americans to work with doctors that they do not wish to work with. No less disconcerting is the fact that Americans are often compelled to stop working with doctors that they have known for years and do not wish to leave. In conjunction with a complicated health condition I have seen dozens of different doctors over the past two years. Should my insurance suddenly change, this painstakingly constructed system of specialists could come crashing to the ground. Moreover, being forced to leave a doctor that you have known for years is a shame, not only because no one will know your medical problems quite like they do, but because once a good doctor-patient relationship is lost it is gone forever.

This revolving door is also very harmful for physicians, because if a doctor has a practice with patients incessantly coming and going, this will invariably foment alienation which can be a driving force behind physician burnout.

The argument that a single-payer system would be impossible to implement in practice, is contradicted by the fact that the overwhelming majority of countries in the West from Vancouver to Vladivostok, have nationalized health care systems that guarantee universal coverage for all of their citizens. The GDP of Cuba is mere pennies compared to that of the United States, and yet all of their citizens enjoy excellent free health care, with an infant mortality rate lower than that of the United States. (They also enjoy superior literacy rates). How can we call ourselves a civilized nation when millions of Americans with serious illnesses are more fearful of bankruptcy and losing their insurance, than they are of death from widespread disease?

A single-payer system recognizes that it is deeply immoral and inhumane to give superior care to the upper middle class and affluent, while denying good care to vast segments of the population. In the absence of a nationalized health care system, do no harm will continue to be applied increasingly to the haves – and not to the have nots.

Liberals have embraced the Affordable Care Act (the very name of which would make Orwell blush) as if it brought about the successful implementation of a single-payer system, when the power of the private insurance companies has, in fact, been bolstered. Moreover, the premiums and deductibles of the new plans are often considerably higher than the plans they replaced, and the number of doctors that take these plans extremely limited. Obamacare also failed to address the sinister problem whereby health insurance is tied to one’s job, as many Americans have found themselves in the Kafkaesque predicament of having good insurance when they are well, but not when they are unwell. This barbarous state of affairs underscores the fact that this inhumane for-profit system is more entrenched than ever before.

This two-tier system also results in preposterous and inane contradictions, such as when I once asked the chair of Dermatology at a prestigious Manhattan teaching hospital whether there were certain situations where he would object to observers being present during any of his doctor’s appointments, to which he replied without hesitation, “Of course!” Yet patients that have Medicaid and community health plans are denied this right when they seek treatment at his very department, and are quite willfully treated as second-class citizens. A morally bankrupt physician that supports privatization and the two-tier system would argue that if a patient is dissatisfied with a particular physician or department they should simply seek care at another clinic. However, the under-insured invariably have extremely limited options – hence they are often at the mercy of such loutishness and knavery.

There is no logical reason why a New Yorker should be denied the right to see any doctor that they wish at Lenox Hill, Mount Sinai, Weill Cornell, Columbia, NYU or Sloan Kettering. Is it not preposterous that millions of Americans live either within walking distance or a reasonable subway ride from these renowned medical institutions, and yet their health insurance prevents them from seeing the majority of physicians that actually work at these institutions? As is the case with the Manhattan rentals market, there is no shortage of five thousand dollar one bedrooms, yet they are accessible to only a small fraction of the population.

The question of who will foot the bill should be asked, not in regards to who will pay for single-payer, but in regards to how we can continue to maintain a system of nine hundred military bases all across the globe. According to that great bastion of Marxist heresy The Washington Post, “The U.S. wars in Afghanistan and Iraq will cost taxpayers $4 trillion to $6 trillion.” And this was written in March 28, 2013. How many hundreds of billions of taxpayer dollars have we spent on sustaining this bloated empire over the past four years? Instead of using this money to establish a health care system that we can be proud of the great beacon of liberty and freedom is arming death squads, and dropping depleted uranium, cluster munitions, and white phosphorus on mostly defenseless human beings. Think about that, the next time someone says we can’t afford a single-payer health care system.

The astounding waste that can be associated with just one new (and deeply flawed) fighter aircraft can boggle the mind, as Mike Fredenburg writes in the curiously subversive July, 2015 issue of National Review:

Indeed, it could be argued that the biggest threat the U.S. military faces over the next few decades is not the carrier-killing Chinese anti-ship ballistic missile, or the proliferation of inexpensive quiet diesel-electric attack subs, or even Chinese and Russian anti-satellite programs. The biggest threat comes from the F-35 — a plane that is being projected to suck up 1.5 trillion precious defense dollars. For this trillion-dollar-plus investment we get a plane far slower than a 1970s F-14 Tomcat, a plane with less than half the range of a 40-year-old A-6 Intruder, a plane whose sustained-turn performance is that of a 1960s F-4 Phantom, and a plane that had its head handed to it by an F-16 during a recent dogfight competition. The problem is not just hundreds of billions of dollars being wasted on the F-35; it is also about not having that money to spend on programs that would give us a far bigger bang for the buck.

Such as a single-payer health care system, for instance. That would give us a nice bang for the buck!

Lamentably, the most pressing problem in this debate is the fact that millions of Americans insist on looking at health care as yet another business. Moreover, the extreme inequality that is glaringly on display in education, where our public schools continue to churn out some of the most illiterate and dehumanized creatures ever to walk the face of the earth, in contrast with the outrageously expensive and infinitely more rigorous prep schools that the affluent are sending their children (granted, not without their own problems), may one day be the destiny of our privatized health care system.

The astronomical cost of college tuition has resulted in over a trillion dollars in student loan debt, while the quality of education has been steadily deteriorating since the end of the 1960’s. As with education, we can either choose to have a good health care system, or we can continue to allow a corrupt few to make staggering amounts of money while generating the most abject misery and suffering for millions of their fellow countrymen.

Tying health insurance to one’s job constitutes one of the most diabolical abuses of corporate power, as the overwhelming majority of Americans with full-time jobs can be fired at the drop of a hat, should they be compelled to take a significant amount of time off from work due to illness. Moreover, primary care physicians that elect not to take insurance at all will neither be able to provide patients with critical in-network referrals, nor will they be able to write prescriptions that will be covered by any health insurance plan.

How can do no harm be implemented in practice when vitally important health care decisions are routinely made by hospital administrators, pharmaceutical CEOs, and insurance executives whose only reason for getting involved in health care in the first place was to maximize the greatest possible profit? Remove the profit motive and compassion, logic, and dignity will be reclaimed. Indeed, no less than our very humanity will be restored.

Why must we continue to allow charlatans and con artists to dictate to doctors how they can treat patients, dictate to patients which doctors they can and cannot see, while also using health care as a financial weapon to wage war on the poor and what is left of our country’s once formidable middle class? Good doctors that are forced by hospital administrators and soul-obliterating insurance companies to provide under-insured patients with inferior care will be prone to feelings of guilt, shame, remorse and depression. Some have even taken their own lives. Indeed, this barbarous and unconscionable state of affairs is indefensible, and cannot hold water in any rational or civilized conversation.

The time has come for Americans to put an end to this foolishness, and to disenthrall themselves from these corrupt elements, that straitjacket and humiliate both doctors and patients alike.

David Penner’s articles on politics and health care have appeared in Dissident Voice, CounterPunch, Global Research, The Saker blog, OffGuardian and KevinMD; while his poetry can be found at Dissident Voice, Mad in America, and redtailedhawk.substack.com. Also a photographer, he is the author of three books of portraiture: Faces of The New Economy, Faces of Manhattan Island, and Manhattan Pairs. He can be reached at 321davidadam@gmail.com. Read other articles by David.