Here's Why We Need a Single Payer Healthcare System

When I lost my vision in 2005 and began looking for help I found the VA system.  In order to get help with blind rehabilitation I had to become a VA patient which involved a little patience.  At one time all veterans were eligible for healthcare through the VA, but the load on the system required the establishment of a tiered system of care based on need, period of service, area of service, a service connection to the veteran’s health concern and other factors.

I had private insurance, so I wasn’t eligible on the basis of need, but I had been in Vietnam during a period when I would have been exposed to Agent Orange, and blindness is considered a catastrophic disability.

 After about 10 months I attended the Blind Rehab facility in Augusta, Georgia, learned a lot of skills related to getting around and living and received training on a computer using an accessibility program for the blind and visually impaired.  I’m writing this on a computer supplied by the VA loaded with ZoomText.

From 2006 to 2015 the rest of my healthcare consisted of annual physicals and blood pressure medication.  And then during the spring or summer of 2015 I developed a lump on my leg.  I had it biopsied in October and was given a return visit date two weeks later to take out stitches and go over my pathology findings.  Four days later I got a call from the surgeon telling me that I had a particularly malignant form of skin cancer, and he wanted to refer me to Duke Medical Center for further evaluation and treatment.

It was a terrifying time.  Having worked thirty years as a pathologist I knew the implications of the report and in November I was evaluated for spread and scheduled for surgery. 

I had a wide excision of the biopsy site and a skin graft at the beginning of December, and was sent home after five days of lying in bed with a drain and suction over the graft and proceeded to recuperate.

A wide excision is, well, wide.  It took about a month for the pain and swelling to begin to subside. 

All seemed well until September of 2016 when I became suspicious of a couple of lumps near the previous surgery.  A biopsy showed that they were cancer.  There was a lot of discussion about whether these were regional spread or a skin metastasis, since they were on the other side of my leg.  The implications were significant.  Regional spread could be treated locally.  A metastasis would require systemic treatment like chemotherapy.  All of the studies showed only cancer in that area so the decision was one of either amputation or radiation.

Because of my age and the fact that I would probably not make a successful transition to a prosthetic, radiation was considered.  There are immediate and long term risks to radiation.  Immediate risks are of damage to blood vessels or nerves or to joints that might make amputation become necessary.  A failure of the radiation would also mean an amputation.  Long term risks were secondary cancers like bone cancers or another malignant skin cancer.

For most of November and December of 2016 I underwent radiation.  I was fatigued, had symptoms like a bad sunburn, and my skin graft really took the insult poorly.  Parts of the graft were covered by blisters like a bad subburn, but gradually, with the right treatment recovered almost completely.  It has been six months since I began treatment and I go in for a check-up at the end of the month.  Much of my lower leg is a dull red brown, leathery, stiff, tender and sometimes a little achy.

So, medically, I have had good care.  Really good care, I would say.  What’s the problem?

To get care outside of the VA system there must be an authorization.  This requires a request, confirmation from the physician who will be administering the care, with an authorization number generated.  I had to reapply for these every 3 months at first – because I was being followed by my surgeon and later by the radiation oncologist – and later those got extended in length.  Each time I went for care at Duke they had no record of the authorization with the VA insisted on sending directly to Duke.

So, I would go to Duke, find out they knew nothing, make a call to the Non-VA Care office, get the authorization number and proceed.

Duke and the VA both have web sites where patients can keep records like their weight, blood pressure, blood sugars and the like, find out about services being offered, the results of some tests and studies, and in the VA’s case leave messages for your primary care doctor.

The other day when I logged on to my DukeMyChart site there was a message about reviewing my account.  There was a bill for many tens of thousands of dollars and a place to enter your credit card number.  Alternatively, I could call the Duke billing office.  As it turned out, Duke had not been paid for over a year.  Duke now has an office full of clerks that just work on getting reimbursed by the VA.  Another four of five hours on the line with the Non-VA Care office and the Duke Billing office resulted in the billing office getting authorization numbers for past service.

Today, I got a call from Jeff in patient registration telling me that there is no authorization for my upcoming visit.  My conversation with Will at the VA a few days ago left me with the impression that I am now approved for care until January 27 of 2019.  Jeff was not friendly and was not willing to call anyone.  He wanted me to bring my pape stating that I was authorized. Otherwise, I am responsible for the bill.

 I don’t have that paper.  Theoretically, Duke has it.  One of the billing clerks at Duke told me that the VA sends authorizations that get routed as often as not to the wrong office.  Duke clinics and offices seem to be blind to each other.  When the paper arrives at the wrong office it gets folded into a paper star ship and tossed into the nearest black hole.

Both Duke and the VA are big systems that I believe do a good job of caring for people within their respective systems.  The problems begin and continue, unabated, when one system tries to communicate with the other.

There are problems created by HIPPA.  One institution cannot just call the other one or my privacy might be compromised.  I have to be a middle man.

I don’t know why Duke isn’t getting paid.  They say their requests are being denied.  The VA regional reimbursement office is in Salem, Virginia.  There is no one there that I know to talk with to find out why the bills are being denied; or whether they actually are being denied.

Tomorrow I will be on the phone again.  Imagine what it would be like if I was sick.

Views: 161

Comment by Ron Powell on May 19, 2017 at 7:09am

" I guess I can’t envision – or prefer not to imagine – a national simgle payer without a national health service with universal access.  Does developing such a service require legal recognition of the provision of healthcare to be pursuant to a basic human right to healthcare?"

Universal health care can't be provided at a profit.

Single payor means the government pays the bills and controls costs in such a way as to liimit or reduce profit margins for suppliers of drugs, theraputic hardware, and the incomes of  medical and allied health services personell.

Providing health care should no more be viewed as an entrepreneurial activity than providing national defense and security is through military service.

However, keep in mind that while the government is the sole consumer of implenents of national defense, the suppliers and manufacturers make rather healthy sums doing business with the governnment which is us , and we all pay those bills freely with little or no complaint.

Making health care a basic human right would require a shiift in the paradigm uoon which the provision of nedical services is predicated.

Going to med school shouldn't be viewed as a pathway to instant wealth and riches at the expense of the sick, injured, or elderly.

Removal of profit for health  insurers from the mix would nean an increase in the tax burden we bear to pay for the maintainence of the rights we enjoy as American citizens which would include health care.

Single payor means the government pay the bills. 

Ostensibly, we are a democracy. That means we are the government.

Therefore, we would pay the bills collectively through a fair and equitable, enforceable, tax structure.

That's spreading the cost of health care throughout the entire population. Not spreading the risk of loss through a pool of purchasers or consumers who aren't paying for care but coverage.

That's akin to gamblers paying a vig on a sports bet to cover the point spread. The winner is always the bookies. Until now, the winner in health care insurance was always the insurance companies....

Obamacare has caused a sea change in that scenario...

As a result healthcare insurers are withdrawing from the 'market'.


Mr & Mrs Main Street America don't want ObamaCare repealed, they want it improved.


Comment by Rosigami on May 19, 2017 at 9:52am

Even Obama et al didn't see the Affordable Care Act as the be-all and end-all; rather a beginning toward a more universal system.
I am one of those who want to see it improved and not repealed.

Comment by Ron Powell on May 19, 2017 at 11:05am

@TM; "The rights argument will fall flat with half the country..."

Which half might that be?

Comment by Rodney Roe on May 19, 2017 at 12:43pm

Naysayers warn that medical schools would not see applicants, pharma would quit doing research, hospitals would become third rate and patients would have interminable waits for specialty care.  

In other countries where physicians earn a salary there is no end of applicants.  I think that the average doctor would be glad to work for a salary if there were tetirement benefits and forgiveness of school debt.

In the past some young people have gone into medicine because they could fairly quickly become comfortable and have community standing.  Only a handful in my experience go into medicine to make a lot of money.  I'm old and there may have been a shift toward that with the shifting American values where greed is good.

Rosi, I think that Obama actually said that; that he couldn't get a public option, but that was his goal.

We have to remember that what became the Massachusetts state system and then the ACA was based on a poison pill proposal by a conservative think tank as an unacceptable alternative to the Clinton's dream of Universal Health Care.  It was never designed to work, and conservatives were chagrined to find that it succeeded in spite of their plan.

Whatever comes out of the present congress and administration will be something less, even, than that.

Comment by Rodney Roe on May 19, 2017 at 12:47pm

Jonathan, I'm OK with that.  I didn't say anything bad about either Duke medical care or VA medical care, just the bureaucracy.

Incidentally, the program that was put in place called Choice, that was supposed to satisfy the needs of vets who could not get into the system or be seen within a reasonable distance, is an outsourced program that doesn't work, in the opinion of everyone I've talked with who used it, as well as the non-VA Care program has worked.  The VA is promoting it, though, and it may improve.

Comment by Ron Powell on May 19, 2017 at 2:22pm

@TM; Ibelieve that it's a fair and legitimate question. 

A. Because I think your assertion is invalid.

B. Because by any metric or standard you might apply more than 50% of the country favors universal acces to health care.

C. Because most of the people who don't see health care as a fundamental human right  are the 1% who can self insure and wouldn't rely on any health care system underwritten by the government.

I would bet that a substantial majority of Americans would, if given the opportunity, vote in favor of higher taxes instead of higher insurance premiums.

The problem, as is the case with most social programs when first brought into being, is the narrative that preceeds, or accompanies, the roll out.Big money currently influences or controls the debate re health care as a fundamental right.

However, if what we are witnessing at the town hall meetings where Republicans are forced to explain themselves is any kind of indicator, it should be clear that Mr & Mrs  John Q Public are mad as hell and aren't going to take it any more..



Comment by Phyllis on May 20, 2017 at 5:42am

I had a problem with non-payment twice, once it got fixed because the person checking me in did it wrong. The second was when I had an appointment and the doctor had overbooked so he bumped me to the next day. That was a nightmare because the authorization was for the original day. I ended up getting a three way phone call going with the VA and the clinic, they had no way to contact each other, and then they got it resolved. You might try that.

Comment by Rodney Roe on May 20, 2017 at 6:06am

Phyllis, I'v done that.  I think maybe the past billing problem may be on the way to resolution, but then I don't really know what the underlying problem is.  The Duke billing clerk was pretty reserved about the possibility.

When I got the authorization form in the mail yesterday for my upcoming visit it was for a previous date.  I got my primary to call non-VA care and get them to FAX a copy to the local VA clinic (CBOC).  I know it got there but before we drive 20 miles to pick it up I'm going to call and ask for the dates.

If I were a paranoid person I might think they were intentionally trying to screw things up.  

Didn't know you were a vet.  There is a parade here today honoring veterans, not sure why.  

Comment by Phyllis on May 20, 2017 at 6:42am

I don't make a big deal of being a vet because of the rape, it's odd to be thanked for my service when it ended on such a sour note. I hate this choice program, it took me 6 months to get a mammogram at the place I wanted to go to, and it included canceling the original request and resubmitting. My previous problems were pre-choice. Can you ask your provider to authorize you for a year on these referrals? My local VA has started doing that and it has made everything easier as far as going back for rechecks, and even getting referred for PT was done without going back to the VA.

Comment by Phyllis on May 20, 2017 at 6:44am

And I just googled, today is Armed Forces Day. :)


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