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TechnoratiDocumentary Doc Says AARP Is Major Impediment to Single Payer
Paul Hochfeld is an emergency room doctor based in Corvallis, Oregon.
He has just finished a documentary about the nation's health care system.
It's in sixteen chapters.
And it's up on the web at ourailinghealthcare.com.
In it, Hochfeld analyzes major aspects of the health care system - technology, liability, the pressure for profits, the change in the culture, primary care crisis, and insurance.
In the end, he comes down strongly in favor of a Canadian-style single payer, Medicare-for-all type insurance system.
The majority of doctors support single payer.
The majority of the American people support single payer.
And the majority of health economists support single payer.
Then why isn't single payer the law of the land?
Hochfeld cites the usual culprits - the health insurance industry and the pharmaceutical industry.
But then there are the not so usual suspects.
Like AARP.
"AARP is the enemy," Hochfeld says bluntly. "They spend a lot of money on public relations trying to look like they are the good guys. They are part of a PR coalition - Divided We Fail. And yet they lobby and lobby and lobby and lobby in every state. In Oregon two years ago they threatened that if Medicare were put on the table in health care reform, our local legislators would lose their jobs."
"AARP has a for-profit side and a not-for-profit side. Their for-profit side brings in a big chunk of their annual revenues. They allow insurance companies to use their name - because they have the greatest brand name of any in the county - even better than Nike or Coke."
Another major problem Hochfeld identifies in the movie - the paucity of primary care doctors.
Hochfeld says a third of doctors are primary care docs, while two thirds are specialists.
He wants to reverse the numbers - two-thirds primary docs and one third specialists.
In the movie, Hochfeld features a chart showing doctor salaries.
Primary docs come in at an average of $178,000 - while specialists make twice as much.
Hochfeld says he has been criticized by other doctors for including the chart in the movie.
Why?
"Physicians are embarrassed by it," Hochfeld said. "Physicians are concerned that the public will look at how much family doctors are making and say - what are you guys whining about?"
"But these specialists make so much more than primary care providers," Hochfeld said. "We are losing primary care providers. If I were the czar of the health care system, our single payer would do something about medical education. I would say that medical school is free for everybody, including nurse practitioners. I would tell these prospective medical students that if they want to go to medical school, they are going to have to spend three to four years in public service to repay their free medical education. They would come out of medical school without this huge debt of $150,000 to $200,000. And they would taste the satisfaction of being a primary care provider for a period of time. And I would also do something about these reimbursement rates. I would tell doctors that if they wanted to make more than some arbitrary amount of money like $350,000 a year, they should do something else. When I have suggested this salary cap, there are physicians who just get livid. They say - you can't do that, look how hard we worked, look how much time we spent in school. And $350,000? You just can't do that."
"I say - $350,000 is an unfathomably large amount of money for your average person. And I don't think we would have any difficulty in getting people to go to medical school with a salary cap of $350,000."
"The reason we need the cap is to redistribute physician income. I'm not talking about spending less on physicians in total. We just need to close the gap between the primary care doctors and the specialists. And it's not just about money. It's about quality of care. Because we are losing primary care doctors so rapidly, the care people are getting is increasingly fragmented. People don't have primary care doctors. And the sicker they get, the more primary care doctors marginalize their care, partly because they are so busy because there are so few of them."
19 Comments so far
Show AllI'm a member of Progressive Democrats of America (PDA), and the priority for the group is to get HR 676 passed.
As I was tossing in bed early this morning, unable to sleep, it crossed my mind that I'd never seen AARP come out for single-payer healthcare. All it took was a quick Google search to find this article. And boy, am I glad I found it.
The AARP lobby is known for being to most powerful in the country. Its members expect that its lobbying activities will be for the benefit of its members. I doubt that many other AARP members know that AARP works against their interests, by being so closely allied with the pharmaceutical and private health insurance industries.
I know that I'm going to make a point of letting all the over-50s I know about this, and I'm going to let PDA know that AARP's obstruction could undo everything in getting HR 676 passed. AARP isn't going to be very happy once the Boomers know about this.
msanborn January 1st, 2009 11:05 am, those Canadians may be in Detroit to get elective surgery which they'd have to wait for in Canada, or they may simply work at the hospital. You know they way it is in the America -- if you have enough money, you move to the head of the line.
What I know about universal health care in Canada comes from Canadians I've met who work in the US for American companies. Even though they are insured here, they opt to go to Canada for physicals and other treatment. Since the doctors there are not motivated by profit to perform unnecessary tests or surgeries, and aren't being pressured by an HMO bureaucrat to deny treatment to patients with expensive long-term illnesses, they prefer the Canadian medical system.
msanborn, should you ever -- God forbid -- find yourself with cancer or other crippling prolonged illness, I think you'd appreciate the Canadian system over the for-profit US system as well. I know many of my friends or their relatives who have been in those dire circumstances do, and a couple of them used to be conservative Republicans -- until they got sick.
If the Canadian health system is so good why are there so many cars with Canadian plates parked at Detroit hospitals?
"People don't have primary care doctors"
The elite establishment is clearly imploding. Please allow it to implode faster. The people will become their own primary care doctors. Remember what Jefferson said: "Enlighten the people generally, and tyranny and oppressions of body and mind will vanish like evil spirits at the dawn of day”
one reason physician salaries are so high in the USA is the protectionist policies for professionals, supported implicitly by AARP, to bar thousands of highly qualified immigrants from entry into the medical field and compete with existing doctors - in which case a cap would not be needed
the lack of competition is highest in the specialty areas created by an artifical shortage which pulls candidates away from primary care
just the savings from avoided visits to emergency rooms would justify reducing these entry barriers
co-opting AARP by free-market ideologues has become standard operating procedure for those who have no intention to compete - rather the objective is to set up monopoly capitalism at its best, relegating competition as prescribed medicine for the laboring classes via market entry based on "free-market immigration" as they wall off the professional skills markets from immigration to retain their access to priviledged entry and exploitative prices
under the Bush claim that immigrants only take jobs no one else wants, why not let some of them take the abandoned positions in primary care? why is immigrative competition only good for agricultural workers and such but taboo for doctors and lawyers? let the free-market crowd face the same competition they preach to everyone else and in the process, break the monopoly lock on medical costs
Has everyone here seen "SICKO" - one of the best documentaries of our generation. If other countries can provide medical care for all, why can't the USA. The reason is the insurance companies. They increase profits every time they 'deny service'.
I'm a doctor in a small, rural town in West Virginia. I do a mix of primary care and gastroenterology. The average salary for primary care doctors has been quoted at $128,000, not the $178,000 that Dr Hochfeld refers to. At the same time, the local hospital administrator has offered $600,000 for a radiologist and was told by the applicant that he wouldn't even come for an interview unless the salary offer was raised to $750,000/yr!!! The difference between primary care salaries and certain subspecialties is not a 2 fold increase. It's a 5 to 6 fold increase! Medical students come out of med school with $200,000 to $500,000 in debt. The number of them going into primary care is dropping dramatically. I love my job and feel truely blessed by it. But I'll be retiring in the next few years.
90% of the problem in healthcare is the insurance companies and the pharmaceutical industry. The private insurance companies take 25% of the healthcare premium dollar for themselves, leaving 75 cents for actual healthcare. They spend $50 billion a year to deny coverage to people who are sick and need care. It makes no sense whatsoever.
Drug prices have been going up by between 15-19% per year for years. Drugs take up much more of that healthcare dollar than they did 20 years ago. Primary care use to get 13 cents of the healthcare dollar. That's gone down to 8-10 cents. Every politician talks about the need for preventative care and primary care. But if you follow the money, it's being shifted to the insurance co, and the drug co, and the hospital administrations. Subspeciality doctors have kept their percentage of the healthcare dollar constant at about 25%. But primary care has been losing ground.
Medicare pays me about 2/3 of what the private insurance co pay for the same service. I have 75% overhead costs. If we went to a single payer/medicare system, people would have to recognize that medicare has been cost shifting to the private payers for years. If medicare didn't raise it's payments to equal the payments of the private payers, every primary care doctor would be out of business in a week! My life would be a lot easier with just medicare to deal with. But they have to increase their payments.
what nerve to even mention the amount an average MD might be making ....and to suggest salary caps! What is this guy, a commie? to even imagine that someone who has gone through med school should give something back to the society which allowed it to happen....is someone actually thinking rationally here? nothing will be reformable until people return to the basic rule of all sustainable societies always throughout our long sojourn on earth: love your neighbor like you love yourself and your immediate family and friends. or else, die off, die out, and cease to offend mama gaia.
This AARP is not your mother's AARP.
They are primarly a business. That is the reason they endorsed the expensive and ineffective Medicare Drug benefit. That was unpardonable.
For a number of years they have not operated in the interests of seniors. Now they no longer operate in the interests of the rest of the country.
I just emailed the AARP to that effect - "that they were part of the problem" thanks for the article.
The AARP has long been co-opted by the medical industry. It would not surprise me if the founders of the organization are now spinning in their graves at what their creation has mutated into.
www.wunderman-comics.com
Western medicine makes people sicker.
A single payer fee for service puts the power of health back in the hands of the people.
A healthy people would have healthy medicine. Whether people live long or not healthcare is about all health. Healing into life and death.
For-profit insurance of any kind is a symptom of a sick society.
I have to send a copy of this documentary to my sister back east. She knows nothing of single payer--even though I've explained it to her a couple of times, she missed "Critical Condition" when it aired last fall and recently she has been partnering with AARP in connection with my brother's nurses-aid healthcare business.
I love her dearly but I think she may be going to the dark side. Maybe Hochfeld's DVD "Health, Money and Fear" will pull her back.
Good article here. Thank you CD for publishing it. It is amazing how many senior citizens don't know that the AARP is just another greedy insurance company.
In 2003 AARP promoted the Medical Reform Bill that Republicans jammed through the Congress in the dead of night.
Public Citizen reported that AARP spent $7 million in television and newspaper advertising to win support of the bill. The bill, according to Public Citizen, placed AARP in a conflict of interest because it stood to make tens of millions of dollars yearly when the bill passed.
They act like they are the new best friend of senior citizens, but in reality, they are just another scam artist in Bush/Obama Amerika.
I knew AARP was a scum and they pretend to be for the little guy. AARP is just like the rest of the big pharma and insurance scums.
Terrance Mitchell
Redfield, South Dakota
I am glad this article got posted. I never joined AARP, in part because the late wonderful journalist John Hess was always critical of them,as an insurance sales business.
He'd worked for the NYTimes for a long time, and was critical of the newspaper. He worked in the Paris bureau for a time. He has a book published and see www.johnlhess.blogspot.com I really miss his voice on WBAI, radio commentaries www.wbai.org (WBAI is a part of the Pacifica Network; independent radio. Amy Goodman's "Democracy Now" started on WBAI and she'd been News Director there. John Hess was fun on election night after Bill Clinton's second campaign, on the air. Amy Goodman became famous for questioning Bill Clinton when he called the radio station to ask voters to come out, on the morning of election day. Somebody ran and got Amy...a Latino guy was hosting a music show at the time, and he turned the microphone over to Amy who had been in the news department. She interviewed Bill Clinton for about 40 minutes, including Vieqques, bombing it by the military; and Leonard Peltier. To Clinton's credit, he knew a lot, but he got really angry at her and accused her of disrespect "of the President". I heard it "live" and she was tough but respectful.)
John Hess is "famous" for his expose in the 1970s, in the NYTimes of nursing home abuses. There were improvements for a time, but it's bad again. While he was still alive, I was able to let him know about ADAPT, www.adapt.org and the activist group's fight, and legislation to get CCA, Community Choice Act legislation so we can choose if we want to live at home with attendant care or in the more expensive nursing homes (note:nurings homes and prisons are both called "facilities"). There are 100cosponsors of the bill in Congress and it has to be reintroduced in the new congress, of course. (CCA was called MiCassa when I told John Hess about it. The legislation has been in-waiting for over 10years.) I'd like to see CCA legislation incorporated with Conyers Medicare for All legislation.
John Hess' battle for 20years or so was fighting the myth that Social Security was in danger, and pointed out how the folks who wanted to kill social security planted and grew the falsehood that there's a war between the generations.
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