Single-payer system could cure U.S. healthcare - By Richard A. Damon, MD

Reproduced here for fair use and discussion purposes. My comments in bold.
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First, Dr. Damon's letter:
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Inefficiencies by healthcare industry stake holders are driving up the costs in health care for millions of Americans. The financial impact on the economic well being of businesses and the middle and lower income classes is a great failing of the Affordable Care Act.

It’s amazing the public does not see the reality of what is taking place. Richard Master, CEO of MCS Industries in PA, is doing something about it. He just produced a movie -- “Fix It: Healthcare at its Tipping Point.” His company pays $1.5 million to provide employee healthcare coverage. He found that 33 cents of every healthcare premium dollar has nothing to do with delivery of care. Thirty-three percent of the U.S. healthcare budget is being spent on administrative costs, constituting an existential threat to the economy and the well-being of every American. The insurance industry is an unnecessary middleman that adds little if any value to healthcare, but adds enormous costs.

As a result of waste and inefficiency, total U.S. spending on healthcare soared above $3 trillion in 2014, spending nearly 35 percent of the healthcare budget on administration, while Taiwan spent 1.6 percent operating a vastly more efficient single-payer system. The film has a number of interviews from healthcare experts, Don Berwick, Medicare former head, Wendell Potter former insurance executive, doctors, patients, workers in Canada’s healthcare system and others.

“Fix It: Healthcare at its Tipping Point” makes the evidence clear. A business owner and Republican state legislator in PA says, “If conservatives look at single payer, they quickly conclude that it is the least expensive, the most supportive of the free market, and has the most direct effect on operational costs.” Medicare for All is less costly and better in every aspect. Businesses or organizations interested in viewing the film, contact me at richarddamon1929@gmail.com.

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My response:

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Dr. Damon has written the same letter to the editor for years. The details are slightly different, but the content is always the same. To boil it down, he loves government, he loves government control, and he wants single payer healthcare.

Dr. Damon criticizes the health insurance industry because it “…adds little if any value to healthcare.” With the typical imprecision of the political Left, He conflates health insurance with healthcare. Healthcare is the delivery of health services, which is what doctors and hospitals do. Health insurance is a contract that indemnifies an insured against loss due to specified perils, which is what insurance companies do.

Insurance companies do not provide healthcare, so of course they don’t add value to healthcare. That’s not their purpose. In fact, government has impeded this purpose for decades. As government intrudes more and more on private enterprise, things get worse and worse. So now that government has totally mucked up things, the doctor wants government to rush in with even more government and rescue us from its previous “solutions.”

Dr. Damon assures us that single payer is “supportive of the free market,” even though it is a government monopoly funded by confiscatory taxes and puts entire industries out of business. Apparently the doctor does not understand the concept of free markets. 

Dr. Damon condescendingly tells us he is amazed “…that the public does not see the reality of what is taking place.” Well sir, the public does realize what is going on. We complained when ACA was proposed. We noted the problems and provided alternatives. We have objected, and were called obstructionists. We have repeatedly pointed out that ACA is a bad deal, and then are accused of wanting people sick.

Government has failed at this, and inexplicably, Dr. Damon wants even more.

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And his rejoinder:
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Rich,

Your comments in the paper regarding my position on Healthcare show how much misunderstanding exists among those who are not familiar with the actual practice of medicine, the inaccessibility of care by millions of Americans, and what a better system would bring to those uninsured, those underinsured and those who are in financial ruin because of the costs and inaccessibility to care our current system engenders. I hope you do not actually have the closed mind set of those who believe my position is based on my love of government and government control. That belief is not correct and misses the focus of my entire message. It may be boring to many, but I will persist in bringing the message and speaking for those struggling to gain access to care because of inhibiting costs, restricted networks of providers, high deductibles, costly co-pays, and corporate practices that place profiting first. My position is that health care and access to healthcare is a human right for everyone.

There is no question the health insurance industry uses perverse practices. Wendell Potter, former senior executive at Cigna, testified before a Senate panel on healthcare reform. He explained how health insurers make promises they have no intention of keeping, how they flout regulations designed to protect consumers and how they skew the political debate with multimillion dollar public relations campaigns created to spread disinformation. A huge share of health insurance premiums are bankrolled for relentless propaganda and lobbying efforts focused on protecting profits. That is only part of the waste expenditure. The propaganda PR onslaught extends to the political process where ever corporate profits are at stake, impacting every socio/economic issue from climate change to defense policy.

Rich, as a physician for 44 years, I do know the difference between health care and health insurance. The problem is that the many private health insurance companies have conflated their original purpose for existence (to indemnify the insured against loss due to adverse health circumstances) and replaced it with guaranteeing profits by any means as their main objective. Profit making is not bad in and of itself, but profiting by using fraudulent and perverse practices is to be condemned.

Your view of government has been adequately voiced in many of your previous articles. It is not my premise that government should "rush in." It is my premise that a federally funded single payer system which provides for free choice of providers and hospitals, and is universal in coverage from birth to death for every American, has proven to have numerous benefits over our current corporate controlled system, in a number of  other countries. Gerald Friedman (gfriedman@econs.umass.edu.) economist has written about the feasibility of Expanded and Improved Medicare for ALL. I suggest you Google it. Why should Americans be denied the freedom and opportunity of easier access to a healthier state of well-being if they desire it? It is the lack of political will to abandon the influences of corporate control of healthcare insurance, which if achieved, would enable us to improve the delivery of care, at a cost that saves billions of healthcare expenditure, and benefit at least 95% of Americans.

Drug costs would be negotiated at a fair profit level, the costs for medical devices would be fairly contained, duplication from competitive hospital purchases of purchasing expensive diagnostic equipment would be curtailed, global budgeting would be installed and the overwhelming waste of administration would be eliminated. Although I know you feel regulatory practices stifle enterprise, and entrepreneurship, can you seriously imagine the chaos of no regulatory function of government? A Medicare for All single payer system is not remotely a socialized form of medicine care, as many have been misinformed. The distinction is that the government would fund it by taxation {see below., but preserve free choice of physician and hospital and all other preventive and ancillary services. There is no perfect system of healthcare or any other enterprise, but there are better existing systems than what we have that provides for everyone, at a much less costly expenditure.

If you have concerns about the method of funding a single payer system, or doubt the feasibility of how it can be funded,l can supply the specifics, but I think you would benefit from reading the article cited from Gerald Friedman. I have scheduled a showing of the film, "FIX IT: Healthcare at the Tipping Point," which will be shown at the Bozeman Library, Jan 7th, 7-9 pm. If you have genuine interest in the subject and are open to listening and viewing, you should take time to attend.

It is good to have read your point of view.
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I respond to him:
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Dr. Damon,

Thank you for your letter.

Since I made no comments at all regarding “the actual practice of medicine,” it would be impossible for me to misunderstand. I recognize it is common for many on the political Left to attribute disagreement or opposition to things like fear, a closed mind, ignorance, or misunderstanding. This is typical condescension from them. I would have expected it to be beneath you.

It is interesting to me that you deny that you love government control, but government is the mechanism you invoke to achieve your aims. I do not recall reading in any of your many letters about your love of the free market, capitalism, the marvelous innovation of business, or self-determination. Therefore, my assessment stands.

I’m sure you view yourself as fighting for a virtuous high cause. However, clearly it is your desire is that the power of government be wielded to achieve your preferred outcomes, cloaked in the oh-so-noble rhetorical garb of “human rights.” I’m sure it gives you great satisfaction that you’ve done your part to raise consciousness. However, if that is all you have done to alleviate the plight of the poor and suffering, then you have really done nothing.

I fully understand the practices of the insurance industry, having been associated with it for 29 years. But it takes zero experience in either the insurance industry or medicine to know that illegal behavior needs to be prosecuted. If indeed a business like Cigna is guilty of such practices, then we simply need to note that the only reason such practices persist is the failure of government to identify and prosecute the criminals. If government is unwilling or unable to do this now, on what basis do you conclude that government will do any better with single-payer?

You ask, “Why should Americans be denied the freedom and opportunity of easier access to a healthier state of well-being if they desire it?” This innocuous phrasing is obfuscation, also a typical rhetorical tactic of the Left. Inherent in it is the Orwellian idea that forced participation is freedom, based on the improvable assumption that a system run fully by the government will be better than an existing dysfunctional system only half-run by government. That is irrational.

You write, “Although I know you feel regulatory practices stifle enterprise, and entrepreneurship, can you seriously imagine the chaos of no regulatory function of government?” This is a false binary equation. This is not a choice between every regulation and no regulation at all. In fact, capitalism and the free market require government to prosecute liars and thieves. You seem to labor under certain misapprehensions yourself.

Your comment, “A Medicare for All single payer system is not remotely a socialized form of medicine care…” is astonishing. "Not remotely" suggests the polar opposite. That is, it's identified by private activities unmolested by intrusive government, yielding voluntary, mutually beneficial associations with exchanges of value. I frankly cannot conceive of someone believing that single payer in any way is a free market expression. Government forcibly extracts money out of our pockets, spends it where it wants, shuts down competitors, sets prices, access, benefits, and conditions, and this somehow is the free market? Oh, my.

While I appreciate you taking time to write, I had hoped for better.