SINGLE PAYER HEALTH SYSTEM PRESERVES CHOICE

I am a board-certified family physician unable to actively practice because of effects of bilateral breast cancer radiation on my immune system.  When dealing with a major private health insurance company through my husband’s employment, I was evaded throughout the appeal process until arbitration to pay for services that Medicare would have covered to determine the appropriate treatment for my breast cancer. 

I followed the appeal process that was in the contract, but the company did not. I requested their scientific data four times before receiving it and after contacting the healthcare facilitator. I already had the data, which supported the use of the test, the OncotypeDX, showing it actually saved $2,000 per patient and improved survival.

Every time I sent my appeal letter, I received back a form letter signed by a company physician stating the test should not be used to decide to use Tamoxifen. I repeatedly clearly stated that the test was only valid on Tamoxifen and was used to decide not to do cytotoxic chemotherapy, and in my case I felt comfortable skipping the two sentinel-lymph-node biopsies because of preexisting lymphedema because of my low recurrence scores.

I repeatedly requested an external review with a board-certified oncologist that was guaranteed in the contract. Though promised by a higher-level facilitator, it never occurred. I ultimately obtained an agreement with the company, no doubt aided by the fact that I was a physician who was even credentialed in their system. Hiring a lawyer to plead your case is usually not feasible as only payment of actual medically expenses can be recovered.. I went through this process mainly to increase the chance that this test would be available for other patients when appropriate. I was told by the company that does the test that the insurance company sometimes pays for it; so their coverage and appeal process is obviously arbitrary. I suspect the “physicians” working for the company have a quota for their denials.

These tests incidentally saved over $30,000 for my treatment while allowing me to avoid cytotoxic chemotherapy.  Considering what happened to me as a physician in their system, I can only imagine what would have happened to a nonphysician.

.Incidentally, a $50 million settlement with United Healthcare was announced by New York Attorney General Cuomo to pay for similar denials of care coverage on January 13. There may be more settlements in the future with other companies. United has also found it cheaper to pay hundreds of millions of dollars in settlements to providers for late and denied coverage than to just pay appropriate claims in many states.

When my sister lost her job last spring, she was turned down by Kaiser to continue her policy because her husband had controlled hypertension and elevated cholesterol.  She now has a $10,000-deductible plan.  We save money now that my parents’ Blue Cross supplemental plan was cancelled.

59 % of physicians now would support a single-payer system, and even larger numbers of the general population.  Administration and profits make up about 30% of private insurance costs.  Insurance companies do not provide or coordinate care; they just deny care, making choice in plans irrelevant.  Plans do not encourage preventive care because the average insured person changes plans every two years.

Health spending per enrollee for comparable benefits grew at a rate of 7.3 % a year under private insurance, compared to 4.6 % under Medicare.  Medicare’s administrative costs at 3% are well below the overhead of private insurers.  This may change as the privately operated Medicare “Advantage” plans get bigger subsidies from the taxpayers than traditional government-run Medicare, about 17 % more for fee-for-service plans often with less coverage. Why would Humana and United be spending so much on advertising if these plans were not so profitable. My father even received an offer from Humana through his Teamster’s pension fund at the end of the year. This increase would shorten the time to Medicare insolvency by a year and a half to 2017. President Obama has stated that he plans to address this issue soon.

HR 676 was introduced to implement a single-payer health care system that covers all Americans regardless of preexisting condition or employment status and preserves choice by including all licensed providers  It would be similar to an improved Medicare for all with improved benefits and payments to providers. Financing is through sliding-scale taxation rather than employer mandates. The cost of this plan would be less than what we are currently paying with many uninsured now and worse health outcomes than most developed countries.  It has gained the support of 94 US representatives, many unions, state legislative bodies, cities, counties, faith groups and other organizations that believe that basic health care should be a right.

Sen. Daschle does not feel that it is politically feasible to push the single-payer system despite its advantages, as I found out at the recent Health Care Reform Summit in Denver.  The public option must be maintained to cut costs and insure the uninsured even if it is not the only option.  Massachusetts has found it too costly to extend insurance significantly with its employer mandates.  Subsidizing premiums for private health insurance is merely another bailout reward for undeserving companies.

If  Republicans in Congress are stopping any healthcare reform if it contains a public option as they have threatened, they should do the right thing and drop their own public plan and get their own private insurance. The health care leaders must not cave in to these threats.

Health Care for All Colorado has a very detailed single-payer plan for Colorado that may be introduced in the next legislature.

Health care reform comments can be sent to the Obama administration at www.Whitehouse.gov.

Linda Mulka, MD