[GPSCC-chat] Fw: Arnold Relman on saving the U.S. medical system

[Caroline Yacoub]

----- Forwarded Message ----
From: shane que hee <squehee at ucla.edu>
Sent: Tue, January 3, 2012 1:01:34 PM
Subject: Arnold Relman on saving the U.S. medical system


Date: Tue, 3 Jan 2012 11:35:40 -0800
>
>From: Don McCanne <don at mccanne.org>
>
>Subject: Arnold Relman on saving the U.S. medical system
>
>
>The American Prospect
>Jan-Feb/2012
>In Dire Health
>By Arnold S. Relman
>
>Most people assume that insurance is an essential part of the health-care 
>system. Some think it should be provided through public programs like Medicare, 
>while others prefer to see it purchased from private insurance companies, but 
>the majority believe that insurance is needed to help pay the unpredictable and 
>often catastrophic expenses of medical care. That is why so much public policy 
>focuses on extending coverage to as many people as possible and controlling its 
>cost. I think this emphasis on insurance is mistaken. We would have a much 
>better and more affordable health-care system if the reimbursement of medical 
>expenses through public or private insurance plans was replaced by a 
>tax-supported universal access to comprehensive care, without bills for specific 
>services and without insurance plans to pay those bills.
>
>Insurance is not simply a mechanism for spreading financial risks and paying for 
>medical care. Because it usually tries to limit payments to providers, insurance 
>often is an intrusive third party in the doctor-patient relationship and, 
>particularly with private insurance, restricts the freedom of doctors and 
>patients to select the services, specialists, and facilities they want to use.
>
>Furthermore, all insurance plans have administrative expenses, and most private 
>plans take profits that add to the cost of their premiums. The billing and 
>collecting operations that are an integral part of any insured health system are 
>a major expense for doctors and hospitals as well.
>
>For-profit insurance companies, which control most of the private market, are 
>the greatest problem. They have a direct conflict of interest with their 
>customers, because a plan's net income is increased by avoiding coverage of 
>patients with serious illness (who, of course, are most in need of insurance), 
>restricting access to services, and limiting coverage of expensive medical 
>services.
>
>There is, however, a practical alternative to health insurance and the 
>fee-for-service system with which it is usually associated: a not-for-profit 
>system in which a public single payer provides universal access to comprehensive 
>private care delivered by primary-care physicians cooperating with medical 
>specialists in group-practice arrangements.
>
>I do not underestimate the complexity of the changes I am proposing. The odds 
>against it are daunting. Congress might not even begin to debate major reform 
>until the health system is near collapse. But what seems clear is that the best 
>- possibly the only - hope for achieving universal, affordable care lies in the 
>eventual elimination of private insurance and fee-for-service payment and in the 
>creation of a tax-supported system based on group practice. Although this 
>proposal makes good medical, social, and economic sense, its ultimate fate will 
>be decided in the political arena. It cannot become a reality without an 
>informed and aroused public bolstered by the medical profession's strong support 
>for the reform.
>
>(Arnold S. Relman is a professor emeritus of medicine and social medicine at 
>Harvard Medical School and the former editor of The New England Journal of 
>Medicine.)
>
>http://prospect.org/ (As of Jan. 3, Jan-Feb/2012 issue not yet posted online)
>
>
>Comment:  It seems appropriate to begin the new year with the words of the 
>venerable Arnold Relman. Much media attention on reform will be misdirected this 
>year to implementation of the private-insurance-based Affordable Care Act and to 
>its challenge in the U.S. Supreme Court. Dr. Relman reminds us that instead we 
>need to move forward with informing and arousing the public in support of 
>fundamental reform that actually would bring affordable care to all.
>
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