August 25th, 2009


One Nephrologist to Another about Single Payer

Medicine and Opera is a blog by a distinguished nephrologist, Neil Kurtzman, M.D., subtitled "Comments and reviews of opera, music, and medicine." It is the latter that claims my attention, as I searched to answer to the question of what was the real overhead in Medicare? Dr. Kurtzman has a distinguished resume, and we share some experience in a common field, but we have drawn very different conclusions from our experience.

In response to this entry, I've posted the following on his blog, and invited him over to mine.

Neil Kurtzman Says:
August 14, 2009 at 7:57 am | Reply
They don’t. Very few doctors in practice want a single payer plan. The AMA represents less than a third (and shrinking) of America’s physicians most of whom consider it a relic. If you subtract students and doctors in training, who get free memberships, almost of whom drop the membership when its no longer free the fraction is much smaller. More and more doctors refuse to take new Medicare patients who don’t have supplementary insurance. Medicare’s rates don’t cover the expense of an office visit.

Laurence Lewin Says:
I'm a fellow nephrologist and all I do is see patients. The lucky ones have Medicare, those less fortunate, but still lucky, have Medicaid (MediCal.) And there are some even less fortunate who are "insured" under the category, in Orange County, CA, of "MSI," Medical Services to the Indigent. We don't have a county hospital. These are the people with "insurance." Then, for those who don't have "insurance" there are community clinics that are funded by charity. I have been seeing these patients in this location for 42 years. In 1973, nephrology exploded when the NKF, through extremely effective lobbying, convinced congress that hemodialysis was no longer the "experimental procedure" that many insurance companies classified it as, in the attempt to provide their shareholders with the profits they expected. Do you remember those days, Dr. Kurtzman?

Medicare, a Single Payer, suddenly smiled on, no longer only the old and lame, but anyone with a need for dialysis, and nephrology was well on its way to becoming a profit center in health care. A single favored organ and the wizards who made its substitute work helped to prove what Medicare and Single Payer could do in a defined situation.

Weren't we nephrologists lucky, and our patients? Not so lucky if you just had diabetes and needed regular doctors visits to avoid the complications that lay ahead. If you didn't get the care, it was no consolation that now you could be rescued from death from uremia, but just in the nick of time. Why not apply universal coverage to the victims of other organ system malfunction? If you wish to cast aside Single Payer, which insurance companies would you like to see compete for the lucrative End Stage Renal Disease market? Not a lot of takers. Not much profit in it, at this point.

Bottom line: there isn't enough money to take care of all of the wonderful devices, medicines and tests that science brings to bear on disease. In a democratic society, in the 21st century, health care is a right of citizenship. Flushing money down the drain is a luxury that we can no longer afford. Health care can no longer be looked upon as a sector to be thought of as a profit center for entrepreneurs and profit-making corporations. Single Payer lowers administrative costs, stretching that % of the GDP that is spent on health care and the savings can be directed to cost-effective therapies and prevention.

It isn't easy, but someone of your stature should have more creative inspiration than obfuscation. Come on over to my blog, and continue the discussion.