David Gill, an emergency physician at Dr. John Warner Hospital in Clinton, often tells the story of a 73-year-old woman with a throat so swollen that she could hardly breathe. Suffering from an allergic reaction, the elderly woman put off seeking medical attention for five hours, afraid of the medical bills she might incur.
Only in the United States, one of the world’s richest, most technologically advanced nations, would anyone with life-threatening symptoms hesitate to seek immediate care, Gill says.
And that’s something Gill hopes to change.
For the second time, the 45-year-old physician is mounting a race for the 15th Congressional District, hoping to dislodge U.S. Rep. Tim Johnson, the Republican incumbent who handily turned back Gill’s challenge in 2004. Gill, who again is making universal health care a central plank of his campaign platform, hopes to tap growing public dissatisfaction with the nation’s broken health-care system.
“Eighteen thousand people die every year in this country from lack of coverage,” he says. “It’s like six World Trade Centers going down.
“It’s not just an issue of compassion, although it is an issue of compassion; it’s an issue of fiscal sanity,” Gill says. “Half of all personal bankruptcies are the result of health-care bills.”
Since the early 1990s, Gill has been a member of the Physicians for a National Health Program, a Chicago-based physician-run organization that proposes a single-payer plan to cover everybody in the United States.
PNHP helped draft the United States National Health Insurance Act, a bill introduced by John Conyers Jr., a Michigan Democrat who chairs the 46-member Congressional Universal Health Care Task Force.
The legislation would extend Medicare coverage — including dental, mental health, prescription drugs, and long-term care — to every American, but it faces strong opposition from private hospitals, insurers, and pharmaceutical companies.
Special interests trump public support
Health care, judging from recent polls, is an issue deserving more than lip service from politicians. According to a national opinion survey conducted on behalf of the nonprofit and nonpartisan Civil Society Institute, 78 percent of Americans believe that government should regulate health care to ensure fair prices, broad access, and quality. Yet 45 million Americans are uninsured and millions more are underinsured.
“We trail most of the developed world on such indicators as infant mortality and life expectancy,” PNHP wrote in a special communication to the Journal of the American Medical Association, the prestigious journal’s first coverage of the organization’s proposal in August 2003.
A single-payer system would be funded by the government in the same fashion as Medicare, replacing the current system of for-profit private insurance companies and health-maintenance organizations. Hospitals, physicians, and health-care providers would be reimbursed by a single government agency, saving at least $286 billion in paperwork annually, according to a study released in early 2004 by researchers at Harvard University and Public Citizen.
“The United States spends more than twice as much on health care as the average of other developed nations, all of which boast universal coverage,” the physician group wrote in JAMA. Americans receive far less care than citizens of other industrialized countries yet pay the highest per capita amount — more than $6,000 per year, according to the Organization for Economic Cooperation and Development Health Database, 2002.
PNHP argues that the United States is among the few nations that treat health care as a consumer product instead of a social service. In a market-driven system, providers compete not by lowering prices but by refusing to provide service.
“You don’t want a health-care system that results in a denial of care,” says Dr. Quentin Young, national coordinator for PNHP and former medical director of Cook County Hospital in Chicago.
Young has advocated national health insurance since he was in medical school more than 50 years ago. “With HMOs and managed care, the doctor is rewarded by limiting your care — fewer tests, fewer consults,” he says.
States forced to take the lead
Because of the federal government’s inaction, some states are taking the lead in finding solutions to the problem. In Illinois, the Healthy Illinois Campaign, endorsed by a large coalition of organizations, is working to develop an affordable voluntary health-insurance plan for small businesses, self-employed people, and individuals. This public-private partnership would allow the state to negotiate affordable premiums with private insurers and lower costs by pooling the risks.
“There is momentum in statewide activity,” says Claudia Lennhoff, executive director of Champaign County Health Care Consumers, whose grassroots organization aids consumers in the struggle for health-care access and justice. “If you look at the last five to 10 years, there have been tremendous grassroots efforts,” Lennhoff says. California, Vermont, Massachusetts, Georgia, and Minnesota have launched statewide health-care plans.
Illinois has 1.8 million uninsured residents, according to the Gilead Outreach & Referral Center, a Chicago-based nonprofit health-care advocacy group. The Health Care Justice Act signed into law by Gov. Rod Blagojevich in August 2004, established a 34-member task force to develop a health-care-access plan by Dec. 31, 2006. So far, however, no public hearings have taken place.
Congressman Johnson, who turned back Gill’s challenge in 2004, agrees that a health-care-delivery crisis exists but favors modifications to the current for-profit system. Citing backlogs in the Canadian system, Johnson has predicted that the PNHP plan would result in higher costs and poorer-quality health care.
Canadians receive a level of care equal to that of insured Americans but at a far lower cost. In the 1990s, Canada’s wealthiest citizens opposed subsidizing a national health-care system that would provide care for the sick and poor, PNHP founders and physicians Stephanie Woolhandler and David U. Himmelstein wrote in an article in the November/December 2002 Oncology News. At the time, health-care costs in Canada were comparable to those in the United States. More than a decade later, life expectancy in Canada is two years greater than in the United States. Average Americans, PHNP asserts, could be assured of even better care than that delivered under the Canadian system — without its waits and shortages — at current levels of U.S. spending.
PNHP’s strategy is to elect more candidates who make health care their No. 1 priority. “There were five races where the incumbent Republican ran against a Democrat supporting a single-payer health-care system,” Young says.
Among the victories: Melissa Bean, who supports the PNHP plan, beat longtime Republican incumbent Phil Crane last year in Illinois’ 8th Congressional District, which covers portions of McHenry, Lake, and Cook counties.
Corporate America may demand help
But the debate over access to health care doesn’t just split along party lines — or between providers and individual consumers. Support for a single-payer system is likely to come from major corporations, who will need to unload the costs of health care as a means of remaining competitive, Young says.
Take General Motors: The manufacturing giant blamed its recent $1.1 billion first-quarter 2005 loss on its $5.6 billion annual health-care expense. And GM isn’t the only company feeling the pain: Health-care costs have “created a competitive gap that’s driving investment decisions away from the U.S.,” Allan Gilmour, vice chairman of Ford Motor Co., said at a recent auto-industry conference. An American-made Ford is $1,500 more expensive than one built in Canada as a result of workers’ and retirees’ health-care costs. That is more than the cost of the steel.
Critics claim that a national health-care program covering all Americans would be unaffordable, but Young disagrees: “The one government plan we’ve got — Medicare — is a huge success.” Administrative costs for Medicare average 2 percent compared with the 15 to 20 percent in administrative costs associated with private insurance. “Medicare cut in half the number of seniors who would be in poverty because of their medical costs,” Young says. Medicare takes advantage of economies of scale and a single-payer system, eliminating multiple layers of expensive bureaucracy.
Prologue is not precedent
The last major attempt, back in the early 1990s, to overhaul the nation’s health-care system was torpedoed by the insurance industry. The $15 million “Harry and Louise” advertising campaign, funded by the Health Insurance Association of America, undermined President Bill Clinton’s little-understood health-care plan by asserting that the plan would restrict consumers’ ability to choose their physicians. Clinton’s Health Security Act, presented to a joint session of Congress in September 1993, was soundly defeated before most people had a chance to debate its ramifications.
The Clinton plan fell far short of providing universal coverage, physicians such as Gill are quick to note.
“The Clintons were talking a lot about it, but theirs weren’t the right solutions,” Gill says. Clinton’s plan left big insurance firms in a central role. “Hillary [Clinton] invited all the players to the table,” Gill says. “She invited the insurance companies and offered them half a loaf.”
The 1,300-page Clinton plan was way too complicated, Gill says. In contrast, the PNHP plan is eight pages.
But just because it’s simple doesn’t mean it’s any more popular with some entrenched groups.
Young says the leadership of the American Medical Association, the nation’s top physicians’ organization, has attempted to characterize single-payer insurance as infeasible even though many of its members are supporters. Some physician specialists fear a reduction in income, but astronomical malpractice-insurance rates are driving physicians out of business and leaving many areas of the country without obstetricians, gynecologists, and neurosurgeons. Obstetrician/gynecologists in Illinois with no history of claims pay $230,000 per year for malpractice insurance, Young says.
More than 12,000 physicians, including two former U.S. surgeons general, have endorsed the PNHP’s proposal. Federally funded, it would put in place mechanisms to control future costs and would restore patients’ choice of physician and hospital.
Conyers, the House sponsor of the single-payer plan, has said that “thousands of physicians are now taking a stand on the side of patients [and are] openly declaring that for-profit medicine is an abysmal failure that keeps over 44 million Americans uninsured.” And Conyers’ view appears to have some statistical basis: A Harvard study published in the Archives of Internal Medicine in February 2004 found that nearly two-thirds of physicians favor single-payer health insurance, far greater than the proportion who support managed care (10 percent) or fee-for-service care (26 percent). Most members of the AMA favor the single-payer approach, but only half of physicians were aware that most of their fellow physicians agreed.
A single-payer health-care plan will not solve all the nation’s ills, PNHP concedes. It would not, for example, encourage healthy lifestyles or necessarily result in improvement of environmental and public-health services. Racial, linguistic, and geographic barriers to health care would persist. Medical students’ education costs that lead to an overabundance of specialists and lack of general practitioners and discourage low-income and minority applicants would not be changed. Patients would still seek unnecessary services, and some physicians would be influenced to fulfill them. Malpractice-insurance rates would remain high.
Yet, argues PNHP, only a single-payer system has the potential to create the savings to make universal coverage a reality.
A place to effect change
David Gill, who has been a physician for 17 years, has practiced emergency medicine in DeWitt County for the past six.
Though he’d been active with other physicians pushing for reform since the early 1990s, his decision to run for Congress was made the night U.S. Sen. Paul Wellstone of Minnesota died in a plane crash. A college professor, Wellstone lacked any political pedigree when he ran for office, but he managed an upset victory by pushing a progressive agenda that resonated with the voters of Minnesota.
Running for Congress, Gill says, is his way of honoring Wellstone’s legacy, putting himself in a place where he can effect change.