It's true. When it comes to the topic of universal healthcare, a hot topic this week thanks to the forum at the White House, the media are clearly avoiding any mention of the single payer option, and not just the media. Nothing is off the table -- says Max Baucus and dozens of other talking heads -- but, of course, a single payer system clearly has been ruled out, "at least for now." In my view, the reason why Obama has ruled it out is that it's not feasible politically at present to rule it in, and he wants nothing to stand in the way of the next best solution: universal healthcare.
Luke Mitchell is getting a lot of attention for his excellent article in the February Harper's on "why America won't get the health-care system it needs." Read the article. And check out Amy Goodman's interview with Mitchell yesterday. Curiously, she cuts in and ends the interview just as Mitchell is about to explain why the current system (of which parts would carry over to the proposed universal healthcare system) often kills patients and fails to save money. He quotes from Shannon Brownlee, author of "Overtreated" in this passage about the system we have at present.
In Overtreated, Shannon Brownlee argues that the major problem of health care in the United States is not that there is too little but that there is too much. “We know that people who don’t get enough care have a higher risk of death,” Brownlee told me. “About 20,000 Americans die prematurely each year from lack of access. But getting unnecessary care isn’t any better for you. In fact, about 30,000 Medicare recipients die each year from overtreatment. This sounds counterintuitive until you think about the fact that practically any medical treatment you can name poses some risk.” For instance, doctors regularly test prostate-specific antigen levels in men to see if they have early signs of prostate cancer. As Maggie Mahar, the author of Money-Driven Medicine, explained it to me, this sounds like due diligence, but in fact the National Cancer Institute does not recommend routine PSA testing, because the majority of older men diagnosed with this slow-growing cancer will die of something else before they experience any overt symptoms, whereas if they are treated for prostate cancer, many will experience such side effects as erectile dysfunction, incontinence, and sometimes even death. “When I was at a conference in Berlin last spring, doctors from other countries were shocked that we still do routine PSA testing,” Mahar said. Why do we do it then? “Urologists stand to gain. The prostate-testing market is worth $200 million to $300 million annually. And no doubt many urologists believe they are saving lives.”
Overtreatment, of course, is another word for growth, and it is the natural consequence of a market-driven system. A triage approach, meanwhile, would save money, both by removing some (though not all) of the incentive to overtreat and by simply eradicating the massive bureaucracy that currently is required just to figure out who is paying for what. Physicians for a National Health Care Program notes that “private insurance bureaucracy and paperwork consume one-third of every health care dollar” and that going to a single-payer system “would save more than $350 billion per year.”
Of course, a $350 billion annual saving to the nation and a significant change of saving more lives wouldn't sit well with the industries who have profited from their current system -- no more than it would be attractive to members of Congress who depend on those industries for their political and financial security.
That's why the best option, though said to be "not off the table," is languishing down there on the dirty floor of Congress and in the trash basket of the media, just as it has for years. Don't blame Obama. He knows all too well what is politically possible and is willing to break through into (at least) a universal healthcare system, the less efficient and patient-friendly option. But you might want to throw a brickbat or two at Goodman who ended the interview at the same place CNBC or Fox might have ended it.
