IT’S INEVITABLE

Dr. K. was one of the most conscientious family doctors I have ever met.  Her physical examinations were unrivaled in their thoroughness, and she knew how to listen; her patients – of whom my wife and I were two – felt they had in her a sympathetic friend of the family.  She was so popular, so good at what she did, that she was forced to stop taking new patients.

I’ve used the past tense because she’s no longer our doctor:  She has quit private practice to become the physician tending to the students at a local university. She misses her old patients, and misses the opportunity to follow patients as they continue through life.  But on balance, she feels that the move she made was right for her.  Her great strength is as a physician, but she was daunted by having to wrestle with insurance companies whose business aim, it seemed to her, was not in providing care but in denying it.

Her successor, Dr. D., is likewise a superb physician, but unlike her predecessor, is less daunted by the red tape that modern medicine – in this country – is heir to.  Once I had occasion to see her, and so I asked her what she thought about single-payer healthcare. Her mouth tightened, and after a pause she said, “well, the current system is broken, that’s for sure.”  I took that to mean that while something had to be done to solve this problem, she wasn’t sure that adopting single-payer was the right solution.

I got a more positive response at the ophthalmological clinic of Dr. F., who recently performed the cataract surgery that is allowing me to post this blog tonight.  The day of the surgery, I asked his anesthesiologist what he thought of single-payer.  He sighed, and said, “it’s inevitable.”  The next day, in a follow-up visit, I asked the surgeon himself about his opinion of the New York Health Act. Immediately he replied, “I’d prefer it to be a national program.”

“So would I,” I said. “But that’s not going to happen any time soon.”

He nodded, then said, “well, I’d have to say that...” then he paused, then continued: “yes, I do support it. It’s inevitable.”

Doctor F. and his anesthesiologist are not the only doctors who feel this way.  Earlier this year, the New England Journal of Medicine published a poll stating that the majority of American doctors now favor single-payer.  That’s quite a change from 57 years ago, when the American Medical Association hired Ronald Reagan to attack Medicare as “socialized medicine.” What has happened since then?

According to Meagan Day, writing in the American socialist magazine JACOBIN, it can be summed up in two words: “Physician Burnout,” which is defined, she says, by the University of California Riverside School of medicine as “1) a feeling of a lack of accomplishment; 2) feelings of cynicism; and 3) a loss of zeal, zest, and enthusiasm for work.” 

Ms. Day writes that “In our current system, there are usually three parties involved in every medical decision: the doctor, the patient, and the insurer. The doctor and patient may agree on a course of treatment, but the insurer decides whether it will be covered. And since many Americans can’t afford ever-growing out-of-pocket medical costs,  that often means that insurers have the final say in whether the treatment will be administered at all.

The majority of Americans receive health coverage from a private insurance company. And while doctors and patients are both theoretically focused on patient health, the insurer is driven by an entirely different motivation: to maximize profit. Insurance companies are financially motivated to deny claims, and they do it all the time, even in life-or-death situations. One in four patients with a chronic or persistent illness or condition have had claims for medication, tests, or procedures denied by their insurer. In 70 percent of those cases, the condition was described as serious. Only 1 percent of patients said they trusted their health insurance provider’s judgment over their doctor’s or their own — and yet the buck stops with insurance companies.

When they deny claims, insurers give doctors and patients all kinds of excuses packaged in obscure industry terminology: formulary exclusion, prior authorization. But the simple fact is that patients aren’t getting the care they need — and doctors aren’t getting the opportunity to actually do their job. All too often, this is deadly for patients. For doctors, it’s depressing and demotivating. It hinders physicians’ ability to practice medicine, makes them feel powerless at work, and divests them of a feeling of personal accomplishment.”

Ms. Day adds to that what she characterizes as a “jigsaw insurance network system” which often forces one to change doctors whenever one changes jobs, or when one’s employer changes insurance companies, resulting in a situation where, ”seeing little purpose in getting to know patients intimately, doctors can become cynical. The lack of continuity leads to feelings of alienation and disinvestment for physicians who may have been attracted to the profession by the prospect of helping and healing people.”

And even if all the above were not so, the sheer labor involved in dealing with a plethora of insurance companies, each with its own requirements and protocols, is a significant drain on every medical practice in this country today. In NEJM’s CATALYST magazine, Marilyn Serafini cites a 2009 study by Lawrence Casalino, MD, PhD, Professor of Health Care Policy and Research at Weill Cornell Medical College.  “[He] put a dollar figure on the time that practitioners were devoting to administrative tasks. He estimated that physicians were spending 3 hours a week interacting with health plans (add another half hour for primary care), and that nursing and clerical staff spent 19.1 hours per week per physician. He estimated the national time cost at as much as $31 billion each year.”

When you take into account all the above, it’s little wonder that so many of our doctors are in favor of Single-Payer.  Now: If we can get the electorate to be aware of NYHA, and to see it – passionately -- as the medical salvation for all of us, then Single-Payer will be, indeed, inevitable.