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Subject: qotd: A noted Republican physician executive talks about
Date: Thu, 25 Apr 2013 07:32:22 -0700
From: Don McCanne <email@example.com>
To: Quote-of-the-Day <firstname.lastname@example.org>
American College of Cardiology
April 23, 2013
I Am A Republican… Can We Talk About A Single Payer System?
By David May
I am a Republican. For those who know me that is not a surprise. I live
in a red state. I have never voted for a Democratic presidential
candidate. I can field strip, clean and reassemble a Remington 12-gauge
pump blindfolded. And on top of it, I think we should talk about having
a single payer national health care plan. The reason is quite simple. In
my view, we already have one; we just don't take advantage of it.
Firstly, Medicare and the Center for Medicare and Medicaid Services
(CMS) are de facto setting all of the rules now. They are a single payer
system. When we go to lobby the Hill, we lobby Congress and CMS.
Talking to Blue Cross, Aetna, Cigna and United Health care is
essentially a waste of time. All the third party payers do is play off
the Medicare rules to their advantage and profit. They have higher
premiums, pay a somewhat higher benefit and have a significantly higher
level of regulation which impedes the care of their customers. This is
no longer consumer choice but effectively extortion, a less than hidden
shake down in which the "choice" for a family of four is company A at
$900 per month or company B at $1100 per month. The payers are simply
taking advantage of the system, playing both ends against the middle.
Secondly, in order to move forward with true health care finance we need
complete transparency in cost and expense… and we need it now. As was
noted in a recent Time magazine piece on the hidden cost of health care,
our current system is a vulgar, less than honorable construct more akin
to used car sales than medical care, cloaked under the guise of
generally accepted accounting principles and hospital cost shifting.
Thirdly, with a single payer system would potentially come real
utilization data, real quality metrics and real accountability. The
promise of ICD-10 with all of its difficulties is that of a much more
granular claims-made data. We could use some granularity in health care
data and we will never achieve it in big data quantities without a
single payer system.
Lastly, I think that the physicians should be in charge of health care
and not the insurance companies and hospital systems. With a single
price structure, it becomes all about medical decision making,
efficiency, the provision of care to our patients, and shared decision
making, all of which we do well.
How, you might say, could a Republican come to such a position? The
simple answer is I really think it is quite Republican. Oh, I know
there will be many raised eyebrows and many critics. I accept that. I
understand the fact that no single payer system is perfect, that it is
"socialist," that it is "un-American."
I would submit to you, however, that it is un-American to allow many of
our citizens to be uninsured, that it is un-American to shunt money away
from a strong military in order to support a bloated, inefficient and
fraud-laden health care system, that it is un-American not to be open
and above board with the cost of what we do, the expense of that service
and the profit that we make. Mostly, it is un-American to let this
outrageous health care injustice continue.
(David May, MD, PhD, FACC, is chair of the Board of Governors of the
American College of Cardiology. He invites responses to his comments at
the link below.)
Comment: David May provides an important lesson for those who think
that the single payer concept falls on the far left of a linear
political spectrum. Society is not linear; it's four dimensional. If we
look at all dimensions, single payer clearly prevails. We can thank Dr.
May for shattering the traditional but flawed construct of health care