Single-payer health system for Maine

In an Aug. 12-13 op-ed piece, [Maine House candidate] Bob Walker wrote about how single-payer health care would never bring about an end to the crisis in heath care spending. I beg to disagree. According to Physicians for a National Health Plan, in 2005, half of all U.S. bankruptcies were at least in part due to medical bills, and more than three fourths of people in “medical bankruptcy” had health insurance at the time they became ill.

The Veterans Health Administration is a shining example of what Single Payer Health Care (a single national health plan) could and should be. Amazingly, just 10 years ago, the VHA was in crisis. Mismanagement and misallocation of resources resulted in surgeons who never operated and some hospitals being half empty while others were overwhelmed.

The solution was a change in management. A physician trained in public health, Ken Kizer, oversaw a radical decentralization of management, implementation of pay-for-performance contracts with top executives, and the right to fire incompetent doctors. One of the most essential components of his strategy, though, was an obsessive attention to systematization of quality and safety improvements.

The U.S. health care system’s private sector is still striving mightily to catch up. In 2003, the New England Journal of Medicine compared the VHA with private sector hospitals. On all 11 measures of quality assessed, the VHA was “significantly better.” In 2005, the Annals of Internal Medicine showed that the VHA provided better care in seven of seven measures of quality care in the treatment of diabetic patients.

The National Committee for Quality Assurance (NCQA) ranks health care plans. Their seal of approval is the gold standard for quality of care. Last year, the VHA outperformed the best private hospital systems (including the Mayo Clinic, Massachusetts General, and Johns Hopkins) in all 17 performance measures assessed. As for patient satisfaction, a 2005 independent survey shows 81 percent of VHA patients are satisfied, compared with 77percent of Medicare and Medicaid patients.

The Institute of Medicine considers the VHA’s integrated health information system, which includes performance measures to improve quality, one of the best in the nation. Thus the quality issue is answered: a single-payer system, with good management, can provide quality care that beats the best private institutions. What about cost effectiveness?

The VHA, unlike all private health systems has a nearly guaranteed lifetime relationship with its patients. Thus, it has an incentive to invest in prevention and effective disease management. The savings accrued actually benefit the VHA, so the interests of both the patient and the system are aligned. In contrast, private systems usually see their patients moving into and out of their plans every year, so disease prevention only benefits the competition.

Unlike Medicare, the VHA is allowed by law to negotiate deep drug discounts, which is why a vet can get most prescriptions for under $10. Also unlike Medicare, it provides nursing home care. Even with these tremendous additional benefits, between 1999 and 2003, when VHA enrollment increased by 70 percent, funding increased by only 41 percent.

Single-payer health care is not only feasible. It will also improve quality and safety and reduce overall costs. But we need a national single payer system. A patchwork of state systems, while better than the current patchwork of private plans, will still be bogged down by the inefficiencies of inter-relating with a multitude of private plans, each with its own forms, formularies, and bureaucracy.

Our state is currently experiencing problems with its Medicaid program, with the purchase of poorly designed claims software and expansion at an inopportune time. However, system mismanagement can be corrected. The VHA is a shining example of the possible.

Don’t expect a Republican administration to make the correction, though. As Bob Walker explains, his party is dead set against any single-payer system. They will ensure, perhaps even better than the Baldacci administration, that it doesn’t work too well. The Democrats still have time to do the right thing, to put a Ken Kizer in charge. If they don’t, perhaps a new Green Independent governor will have the honor of creating a cost-effective and high-quality single-payer health system for Maine.

Bob Lodato, M.D., of Charleston, is an internist practicing in Dexter.