What a bizarre place I work in. Despite overwhelming public opposition by Californians to a government-mandated scheme that has failed in every country in which it was attempted, single-payer healthcare has been revived — strictly along party lines — in the California Legislature with the introduction of SB 810. (SB 810 passed off the Senate Floor today.)

Mere hours after the shocking election of Scott Brown in Massachusetts, Democrats who control the State Legislature in California revived their own universal health care bill. Didn’t they get the message I did?

I do not support socialized, government-controlled medicine because I believe that patients come before bureaucrats. True healthcare reform should be based on four fundamental principles: affordability, access, safety, and choice. Single-payer fails on every account.

Californians deserve a better standard of care.

Affordability
The nonpartisan Legislative Analyst’s Office (LAO) examined the California single-payer proposal that has been repeatedly introduced. What is the price tag that all California taxpayers will get stuck with? According to the LAO report — it’s $200 billion. That’s more than $5,000 in new taxes for every man, woman, and child in California today.

I cannot support an under-funded program that would leave patients with far fewer options for care than they have today … and $200 billion in new taxes for struggling Californians.

Access
The consequences of single-payer coverage are predictable and unacceptable, particularly for those with the most urgent health needs.  

Wait times for patients with invasive breast cancer and other serious conditions are unacceptably long under Canada’s single-payer system, for example. Diagnosis and treatment delay are reflected in both the breast cancer screening rates and survival for Canadian women, which are lower than those of women in the United States.

As the result of Canadian government rationing of technology and resources, some provinces send patients to the United States for heart surgery and high-risk neonatal care.

Canadians, fed up with paying for access to long waiting lists rather than care, are scrambling to privatize their single-payer system. North Korea has the only other single-payer system in the world; all other nations have converted to a multi-tiered system.

This destruction of access to quality care is recognized within the retread bill, itself. The author has carefully exempted all state workers and labor union members from the restrictions imposed by the bill he introduced.

Safety
Studies examining the quality of care in countries with socialized healthcare reveal the universal need to eventually cut costs by rationing care. Patients suffer under a system that requires rationing (i.e., denial) of advanced technology and medical resources.  

Choice
Single-payer schemes mandate a government-run system of healthcare delivery and destroy private markets and competition. Healthcare innovation and new technology are driven by private initiative, not governmental bureaucracy.

I cannot sacrifice medical innovation while our patients look to research for treatment options for devastating conditions like Alzheimer’s disease.

It is frustrating for physicians to have to deal with insurance company regulations, but nothing compared to the frustration of physicians dealing with complex governmental regulations, rationed care, and decreasing reimbursement rates. The evidence is clear in the diminishing number of physicians who accept Medicare and Medi-Cal patients. Unable to function efficiently to lessen administrative burdens, government-controlled medicine simply shifts them to doctors, hospitals, and other providers.  

Bureaucratic imposition under a government-mandated regulatory scheme will inevitably increase for those who care for patients, not decrease.

The way to achieve real healthcare reform is to work at improving affordability, access, safety, and choice in the present system, not to discard both the good and the bad in favor of a single-payer system that will compromise the standard of care for Californians.

I have been a healthcare provider for over 30 years, continuing to practice while serving in the State Legislature the past 11 years. I continue to work for real solutions to the problems we face in healthcare delivery and funding.  

Senator Aanestad, an oral surgeon, represents the 4th Senate District and is a member of the California Senate Health Committee.

 

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D said:

What about Sweden? "North Korea has the only other single-payer system in the world; all other nations have converted to a multi-tiered system." Doesn't Sweden still have a single-payer system?

January 28, 2010

Paul D. said:

What Crack.. I'm really curious to know where the author of this piece gets his 'facts' from, and whether his use of crack is recommended by a doctor or self prescribed. Canada and Australia and most European countries have single-payer health insurance programs. These programs provide universal health care. 1 France 2 Italy 3 San Marino 4 Andorra 5 Malta 6 Singapore 7 Spain 8 Oman 9 Austria 10 Japan 11 Norway 12 Portugal 13 Monaco 14 Greece 15 Iceland 16 Luxembourg 17 Netherlands 18 United Kingdom [ .... ] 36 Costa Rica 37 United States of America 38 Slovenia 39 Cuba Yeah, I'll take Single Payer any day. Reality has shown it works. One day we'll realize that health-care for profit is detrimental to society. Like fire stations, health care should be socialized. It will never work on in a for profit system where its cheaper to let people die [the current system].

January 28, 2010

study up said:

Response to "crack" comment Take some time and do a little homework.The Canadian system was (and to a large extent still is) so dysfunctional, that several months ago, the head of the leading medical association said the system is on the verge of "imploding." Also, since parts of Canada are now allowing people to buy private health insurance and get medical care outside the government system, even Canada is not a single-payer system anymore. This is something that had to be done because, though if you were in an accident and were hurt you would be treated, people who got long-term illnesses often could not get care because money was not put aside for it. Also McLeans (sp??) magazine, a Canadian magazine cited a fact that about 13% of Canadians had great difficulty accessing primary medical care (going to a family doctor). Canada is allowing privatization to take pressure off the public plan — this in a country with a population only about double America's illegal-immigrant population.

January 29, 2010

study up said:

... Sorry, poor phrasing in last comment. It should bluntly say the Canadian healthcare system is still currently a mess and that Canada is relying on privatization (whether they acknowledge it or not) to save the system.

January 29, 2010

MD said:

... If this article is a representation of your intelligence, I tremble thinking of the quality of care your patients receive.

January 29, 2010

Paul D. said:

... "The Canadian system was (and to a large extent still is) so dysfunctional" - So dysfunctional that when compared to the US system, in terms of patient care outcome, the Canadian system ranks 30 versus the US's 37 world rank (Cuba comes in at 39). And that's if you're using the Canadian system as a role model; I am unsure I advocated that. Fortunately, I would personally model the system after one that has been proven to work, such as the French, Italian, Austrian, Norweigian, or Japanese systems; all of which have much better patient outcomes. "the head of the leading medical association said the system is on the verge of 'imploding.'" - in the same article, the CMA head also said "it's possible to make wait lists disappear while maintaining universal coverage and "that competition should be welcomed, not feared.", their problem is one of underfunding; considering their system spends 10% of GDP on healthcare, versus the 16% of GDP spent by the United States on healthcare - the fact that they pay 62% less of GDP versus the US on healthcare, and their system ranks better in terms of patient outcome, I would say that is a testament to the working of the system; not to mention that 82% of Canadians prefer the Canadian system over the US system should tell us something. "Also, since parts of Canada are now allowing people to buy private health insurance and get medical care outside the government system" - excellent, I don't think anyone is arguing getting rid of private insurance. Just providing a bare minimum for everyone; and if people don't like the plan, they have the option of buying private insurance and betting that when they get ill, the for profit insurance company will decide to pay out instead of find a reason to throw them out of the plan as is current practice.

January 29, 2010

Paul D. said:

studying up "a Canadian magazine cited a fact that about 13% of Canadians had great difficulty accessing primary medical care (going to a family doctor)" - that's unfortunate, I haven't looked at that statistic, but thankfully, they have the option, even 'at great difficulty' of seeing a doctor and not filing for bankruptcy. 13% of Americans have no access to medical care aside from showing up to an ER room in an emergency. But I'm not advocating modeling the system after one that's not ranked that much different than the US's (even though it is ranked higher).

January 29, 2010

study up said:

... The world ranking that you quote is a farce. It is meant to show socialist countries as better. In fact if a country has a "universal system" it is automatically given a good rank. Then it uses bias statistics to come up with its findings. For instance, it says that the U.S. has high neonatal deaths versus other countries. Neonatal deaths don't factor in quality of healthcare and other things like the differences in death rates by race (they are different). If you look at perinatal statistics, which include health care, the U.S. comes out at the top. Then there's the issue of longevity. Americans often die younger than others around the world. But if one excludes car-crash deaths and murders, again American longevity comes out on top (or second, depending on the data set.) I'll have to cut this short, but I'll add you stats on GDP are also skewed, and why wouldn't Canadians rank their healthcare higher than here? They are constantly told by their government how great their system is, and we are constantly told how bad our system is.

January 29, 2010

Paul D. said:

CONSPIRACY THEORY!!! THOSE CRAZY SOCIALISTS AT THE WHO!!! CONSPIRACY THEORY!!!

January 29, 2010

Paul D. said:

Speaking of socialists at the WHO The socialists at the WHO ranking those crazy socialist countries like Japan higher than the US! I swear. Next thing we'll hear about is how aside from covering the lazy illegal immigrants, big foot will be covered by the Democratic health care reform. Maybe they'll even cover the Lochness Monster. Buy your propaganda all you want. I've lived in three systems, of the three the worst was the US's. Best Regards, Paul

January 29, 2010

Samhed said:

Bureaucracy? Private insurers aren't bureaucratic? The more you know.

January 31, 2010

study up said:

... Believe what you want, but if you actually look up how the determination of rankings was done, you'll find out that what I described is "exactly" how the rankings were done. My father-in-law is from Austria, and I know people who have been treated in hospitals there and in Germany, and the level of care they get there is not nearly what we get here. Look at ALL the countries that the WHO ranks ahead of us and consider whether some of those countries could actually possibly have the money to compete with our system. What a joke. For all of our system's problems (95% of which are caused by government intervention), anyone who says that our healthcare ranks near the bottom in world standings has NOT studied the facts available. Doctors from around the world come to the United States to learn new techniques, not the other way around.

February 01, 2010

Tim McHugh said:

... Senator, Your critique is so devoid of facts that all I get from it is your opinion that the US has the best health care system. On this we disagree. However, the cost you quote for SB 810 of $5,000 per citizen would be a bargain to me. Right now my wife and I pay over $12,000 for coverage with co-pays and deductibles. 5K would be a 20% decrease and I'd be happier knowing that ALL Californians were covered. Insurance companies bring nothing to the table (except political donations) and they should all be eliminated tomorrow. Hopefully the folks in the 4th district will wise up and send a more enlightened senator to represent them, or at least one that can do math.

February 02, 2010

sandra s said:

Single Payer Well frig you Doctor/Senator Anussted. If you can recommend a proposal that will protect California residents, I'm all ears. But single payer seems like the only solution for now. I have just received a notice from my health care provider (Anthem Blue Cross) increasing my health insurance premium by $166/month to $703. They did this because they can, not because there is a reason. I must cancel my policy now because I cannot afford it.l Anthem has some godd**n nerve to do this to working people while they and their con artist CEOs reap the benefits of multi million dollar salaries for shafting customers, and spending millions of dollars for lobbyists to obstruct health care reform. This is the reason that health care reform is needed more than ever in America and why we need to create local health care co-ops for people that are being opted out of the health care system because of stinking greed. Whether this is done by single payer or not I don't care. I cannot afford insurance anymore, and I will most likely not be able to get it until reform of some form is made. As a breast cancer survivor, I would rather take my chances than put one more dollar in the coffers of corrupt and greedy businesses and people. If single payer is an attempt to solve the problem, then so be it. And obstructionists like you have no concept of what normal working people are going through so keep your trap shut on what you know nothing about. Thank you.

February 03, 2010

Cheryl said:

Problem is more complicated .. A single payer government healthcare program will solve nothing. Instead of insurance companies raising our rates, the government will continually raise our taxes. HMOs are a microcosm of what a single payer government plan would be. Bean counters determine what treatments they will cover and what they will pay. So what will be the improvement of having government bean counters over private bean counters making healthcare decisions? Doesn't anyone remember how HMOs were going to be less expensive? Once they took over, they were no less expensive. We need to bring back the fee-for-service companies and allow insurance to be offered across states lines. It is competition that will bring down premium costs and deductibles, not a government monopoly. Canada does not even have enough primary care physicians. People wait for lengthy periods of time to even be "assigned" a doctor, according to the region in which they live. Hawaii attempted a single payer goverment run healthcare system and it lasted 7 months. Between the fraud and ineffectiveness, the governor cancelled it and reinstituted the private system. One other state, I believe Oregon, has attempted a government run single payer program and that is bankrupting the state as well. Congress states their plan is deficit neutral, they can pay for it by eliminating the fraud / abuse in Medicare. Is not Medicare a government run healthcare program? If they know it is full of fraud / abuse, why haven't they cleaned it up? The last thing we need is socialized medicine in this country. We don't need socialized anything. The government is restricted by the Constitution as to what it is legally allowed to do. Healthcare is not one of those functions. Obama and his cohorts have already violated the Constitution in any number of ways. We need to stop them from continuing this arrogant practice and going any further down the path to the socialization of our country.

February 18, 2010