Dr. Stack wants “Medicare for everyone” David Hoppe Dr. Christopher Stack Until his retirement in 2004, Dr. Christopher Stack was known as one of the city’s leading orthopedic surgeons. Stack graduated from the Indiana University School of Medicine in 1979 and began his practice at the IU Medical Center. He subsequently practiced at the Hamilton Orthopaedic Clinic, Indiana Orthopaedics and Sports Medicine and, after 1997, Drs. Ireland and Stack Orthopaedics. Stack was appointed by Gov. Kernan to the Indiana Mandated Benefits Task Force and served as its chairman. Stack is a member of Physicians For a National Health Program, as well as Hoosiers for a Commonsense Health Plan. He is an active advocate for single-payer health coverage, the idea of “Medicare for everyone.” Stack recently spoke to NUVO about what’s wrong with our approach to providing health care — and what can be done about it. Here are his thoughts on the issue, in his words. What’s always puzzled me is why businessmen don’t go down to Anthem and say, “Hey, what are you guys actually doing for us?” They don’t do anything. Employer-based health insurance amounts to a huge middleman. Socialized medicine, rationing, two-tier health systems — all of these labels are thrown out to scare people. But the truth is we ration health care now. It’s just unofficially rationed by income. You get the health care you can afford. If you can’t afford it, you don’t get good health care. If you have no insurance you can’t go into a lot of doctor’s offices — unless you’re going to die. Private health insurance is dealt with as actuarial, not as social. Medicare is a social insurance. The understanding is that the larger number of healthy people are going to have to pay for the smaller number of unhealthy people. Actuarial insurance is not based on that notion. It says that if you can afford to protect yourself against this contingency, good for you. And if you can’t, too bad. Medicare’s administrative overhead is 5 percent or less, depending on who you read. Compare that to 20-30 percent in the private sector health insurance industry. The calculations I’ve read, done by people who promote a single-payer idea, would eliminate the current insurance industry and provide enough money to cover everyone at current levels. The idea that people are sloppy with their health care because they have health insurance is nonsense. They make it sound like if you have good health insurance you’re going to step out in front of a car and get hit because you won’t care. Medicare for everybody makes the most sense. If you want continuity of care, if you want choice, Medicare is the only way to go. I’ve heard Anthem say the reason why a single-payer plan doesn’t work is because it’s one size fits all, whereas they have thousands of programs to meet your specific need. But that costs them a fortune to administer and it’ll cost you a fortune to pay for it. Medicare for everybody is not socialized medicine. It is simply a single-payer, which means all your reimbursements are going to come from one place. Medicare is not a sign on the door that says: National Health Service, Dr. Stack. It’s not government ownership of anything. It’s the only way, in my opinion, we can control costs. There’s a lot of talk about paying for performance and paying for quality, but the fact is that quality is so hard to measure in medicine — and it’s usually being measured by the people who do the work. Every doctor and every hospital will rigidly maintain that they are three standard deviations above the mean. People will be paying less for fancy procedures and more for a family doctor who will take an hour with somebody to find out exactly what the hell is wrong with them, instead of spending five minutes and trying to guess. Medicare is one of the most lucrative things that ever happened. We started getting paid for stuff that used to be considered charity work. My father was a doctor in Chicago and I saw that first-hand. He’d get payment-in-kind sometimes. Every hospital has a charge master, which is their list of what they charge for everything. You can’t get these right now. If St. Vincent’s put their list online you could shop before you went there. But you don’t know what you’re going to need and you don’t know what it’s going to cost. It’s like going to buy a car and saying, “Maybe I should buy this limousine.” It turns out you don’t really need it, but it’s a nice car. Doctors don’t know what things cost. When I was practicing, I could get some information from the hospital about what an operating room charge was. But you didn’t know what any of the items on the bill would cost. You didn’t know what an anesthesiologist was going to charge. Radiology is completely separate. All you can say is, “Here’s my bill for this procedure.” We spend more on health care than we do on primary education, and our health isn’t any better compared to other industrialized nations. Between 50 and 60 percent of health expenditures are tax-funded. So we’re more than halfway there. There’s nothing radical about what’s being proposed, it’s just a different form. If everybody had Medicare, you would never be obliged to change your family doctor. Nobody’s going to tell you where to go. They don’t have closed panels of providers. A few doctors don’t see Medicare patients. But the rest of the world has to take care of sick people and sick people, by and large, are enrolled. Dr. Stack is a member of Hoosiers for a Commonsense Health Plan, a group of citizens that support a statewide universal health plan. HCHP is working to develop and promote a bill in the 2007 Indiana State Legislature to achieve that goal. In Indiana, over 800,000 people have no health insurance, and significantly more are under-insured, all of whom face barriers to getting needed medical care and financial ruin if they get sick. The HCHP meets the first Friday of every month at the Monroe County Library, 303 E. Kirkwood Ave., Bloomington, at 4 p.m. For more information, or to get involved, visit these Web sites: • Physicians for a National Health Program: www.pnhp.org • Healthcare — NOW!: www.cnhpnow.org • The Conyers bill for single-payer national insurance: www.house.gov/conyers/news_hr676_2.htm. • Chris Stack, MD: firstname.lastname@example.org.