The Journal Gazette
Saturday, March 18, 2017 10:01 pm

Repeal or replace? Wrong question

Jonathan D. Walker, M.D.

In my specialty of retinal diseases, we can do much more to treat blindness than even 10 years ago. But if patients don’t come in, we can’t help them.

Unfortunately, going to the doctor in America can be scary – there are confusing rules, networks, copays and deductibles, and they all change depending on which policy you have this year. I can’t tell you how many times I see patients who have lost vision permanently because they were afraid to get checked, or how many times I offer to write off a bill so patients will show up and we can save their vision.

In the meantime, our politicians are arguing over repealing and/or replacing the Affordable Care Act ("Obamacare"), which is like arguing over which thermometer to use when a patient is dying of septic shock. Obamacare is a Band-Aid placed over our dysfunctional health care system. We need to push the reset button and look at things in a completely different way.

And that different way is called single-payer, where instead of multiple payers – you, your employer, the government, different insurance companies – we all put money into the same pot that then pays doctors and hospitals. Medicare is our single-payer national insurance for people over 65, and we all pay into it so they can get the care they need without going bankrupt. But the rest of us are forbidden to use that insurance. A single-payer system would simply expand Medicare, and improve it, so that we can all have a basic level of coverage.

The February issue of Annals of Internal Medicine has an article explaining the advantages of such a system. People would have access to the care they need, without the confusing rules and networks. There would be no exclusions for pre-existing conditions, and we would be freed from the massive administrative costs caused by our complex system. Nor would we have to pay money to for-profit insurance companies for executive salaries, advertising, underwriting, and all those other costs that have nothing to do with providing care.

Of course, there would be increased costs to Medicare, but those costs would be more than offset by the savings on administration and overhead. We might even begin to pay attention and fix public health problems that drive up costs. Or we might actually do something about special-interest groups that cost us so much money – for instance, the way the pharmaceutical industry had Congress pass a law that forbids Medicare to bargain over drug prices.

In his 2000 book "The America We Deserve," Donald Trump said that "We need, as a nation, to re-examine the single-payer plan." And, in an interview the same year, he said, "I would put forth a comprehensive health care program and fund it with an increase in corporate taxes." Since then, he says he doesn’t favor single-payer, but as recently as an interview in 2015, he praised both the Canadian and Scottish health care systems.

Indeed, businessmen are looking at single-payer as a way of freeing themselves of the burden of providing insurance to employees and allowing themselves to concentrate on what they do best: run their business.

In spite of these possibilities, a single-payer system is something that we don’t even talk about. It is dismissed as too expensive or not politically feasible. It is neither of those things – the savings would outweigh the costs, and a recent Gallup poll showed that 58 percent of Americans favor replacing Obamacare with a federally funded health care system. But every time politicians dismiss the idea, you are going to continue to pay thousands of dollars more for your care than you need to, and you are going to increasingly worry about networks, copays and deductibles when you see a doctor.

Now, even though there is a lot of data that indicates the benefits of single-payer, some people find the idea impossible to consider. (I’m sure there will be some irate letters in response to this op-ed, and I’ve even been asked to hire off-duty police in order to talk about the subject in case fights broke out. At a church!) But there is one thing that is indisputable: we need to at least include the idea of single-payer in any discussion about how to fix our system – it has too many advantages for politicians to continue to ignore it.

So as you find yourself paying more and more for health care, take a minute to explore the subject for yourself. Go to the Physicians for a National Health Program website (, and look at the FAQ section; it only takes about 20 minutes. You may realize that we’ve been pointing our health care system in the wrong direction for so long that we can’t see – let alone talk about – a real solution.

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