Dana Beyer, MD, for Maryland State Delegate 2010

Health Care 2010

My former chief of medicine, and the former editor of the prestigious New England Journal of Medicine, Dr. Arnold Relman, said that “our health policies have failed to meet national needs because they have been heavily influenced by the delusion that medical care is essentially a business.”

All efforts over the past forty years, both on federal and state levels, have made this assumption, that medicine is a market in the classical economic sense. And this assumption was fortified by the monetization of health care with the establishment of Medicare and Medicaid in the 1960’s alongside the growth in employment based health insurance. The resultant explosion in the number of physicians, the growth in basic and applied research, the development of new drugs and surgical devices and court rulings applying anti-trust law to physicians and hospitals, reinforced the sense that this brave new world was a “medical-industrial complex.”

But the current market model is simply broken. We spend 17% of GDP on health care, twice as much as our closest allies, and have much poorer health as measured by many statistics. In spite of this payout, we have 47 million uninsured in this country, and 770,000 in Maryland. The cost is rising 7% per year, as most people with insurance are aware, with some policies growing in cost by 20-25% per year. We are all being held hostage to the Republican mantra that the market is the solution to every problem, and that personal choice will resolve this crisis.

So what can we do? After a year of strenuous and frustrating effort, the Congress passed the Patient Protection and Affordable Care Act, also known as the private insurance stimulus package, or, as the President likes to say, Romneycare. Over the next four years, major changes will be enacted, making the private insurance market more equitable and less risky for most. States will be able to expand Medicaid, and also experiment themselves with public options. Costs to individuals will be capped, insurance company excesses reined in, spending on marketing and administrative costs capped, community centers expanded, preventive care emphasized, the Medicare “donut hole” filled. A lot of good will be done.

What we do not have is Medicare for All or a public option.

We do not have real competition, or more than a hope that increased private competition and greater use of technology will bring down costs.

We do not have portability, or the security to know that coverage and quality care will be with us for our lifetimes.

We do not have a no-fault malpractice system which would free physicians from practicing defensive medicine.

We do not have an alternative to fee-for-service care.

But it’s a start.

The ultimate goal, which we can encourage with leadership here in Maryland, is a national, tax-supported universal system with the state as a single payer - “Medicare for All.” Taxes are not evil; they are the cost of doing the people’s business in a civilized society.

Universal coverage would allow physicians to  retain their autonomy but with incomes now derived from the non-profit model of pre-paid health coverage for all. They would be relieved of the burden of paperwork and petty bureaucratic control, and would be subsidized to transition to an all-electronic record-keeping system (EMR) which would improve the quality of care, including the development of electronic personal health records (PHR).

Private insurance companies would continue to provide benefits for elective procedures not covered under the basic policy, and physicians would be free to provide those same services, as they now do.

Surveys show this is what the large majority of Americans wants, and nearly 60% of physicians as well. We need to encourage everyone - consumers, physicians, nurses, hospitals and insurers - to bring such a plan to fruition.

I will begin by offering a public option here in Maryland, beginning with coverage options for state active and retired employees, Medicaid, M-CHIP and the new high-risk pool. Maryland can lead the nation in providing quality, affordable health care to all its citizens.  It will take some political courage to start down this road, but the destination is well worth the journey.