A Health Care System ‘In the process of collapse’

Ocean Beach Doctor Has Rant Printed in the Union-Tribune

OCEAN BEACH, CA. Dr. Jeoffrey B. Gordon, who has a family practice in OB on Cable Street, had an essay printed in the Sunday editorial section of the Union-Tribune, July 13th. Here it is:

by Jeoffrey B. Gordon

As a family doctor who has practiced in San Diego for more than 25 years, my daily, intimate experience of providing medical care leads me to strongly dissent from Grace-Marie Turner’s views in “How good is our health care system?” (Opinion, June 30).

Daily I see patients without health insurance who have avoided care, omitted pharmaceuticals they could not afford, or had to use emergency rooms at times of true need and incurred extraordinarily huge charges. Every two or three months I see a patient literally at death’s door due to illness previously unexamined due to financial fears.

Turner does not discuss the fact that bills due to the costs of illnesses are the largest cause of personal bankruptcies in the United States. She omits any discussion of the 47 million uninsured citizens (5 million citizens and 2 million non-citizens in California) cast aside by our “good” health care system to fend as they may.

As a case in point, it is important to note that the American Cancer Society has devoted its annual campaign this year to promoting universal access to medical care. It has determined that being poor or uninsured markedly impairs outcomes of cancer patients, and that making improvements in organizing and financing medical services would save more lives than promoting any scientific or technical innovations in the practice of oncology.

Turner omits any reference to the fact that administrative overhead and profits consume between 20 to 30 percent of health care insurance premium dollars, diverting much of these resources from the provision of health services to enrollees. The total value of money not spent on health services by health insurance companies in the United States approaches $400 billion a year – an amount that approximates the total budget of the Pentagon in 2007 (omitting supplemental appropriations for the Iraq war).

Furthermore, in my own practice I must devote about 5 percent of my time and 25 percent of my staff time to dealing with the extraordinary complexities of multiple insurance companies and their rules. These are additional resources diverted away from patient care.

Evidently, Turner advocates for a “free-market” approach to medical care. Turning the provision of medical care from a profession into a commercial business has also had a huge impact in distorting the system of health care resources.

There is a huge deficit in (less well paid) general internists, geriatricians and family doctors: there is a surplus of fancy (and expensive) MRIs and PET scanners, etc; public health and sanitation are underfunded (see the current epidemic of tomato-born diarrhea); all resources are scarce in rural areas, and so on. These considerations demonstrate economic as well as production inefficiencies that no”business” would or could tolerate except under cartel conditions when consumers are weak and extraordinary profits can be made.

Frankly, I think the private personal health insurance system is in the process of collapse. Limitations of benefits and cost-sharing (premiums, coinsurance and deductibles) to limit care and improve profits are becoming so onerous that both businesses and individual families are going without, and an extraordinary bureaucracy is smothering heath care providers.

The universal tax-financed health insurance we have for people over 65 (Medicare) and veterans and military (Tricare) are both more economically efficient and user-and provider-friendly. In my opinion, a Medicare-for-All program or single-payer health system (such as envisioned in California Senate Bill 840) would provide a tremendous advance in economic efficiency, ease in the provision of care, and represent a real solution to our rich country’s health system deficiencies.