Demand Better Care for All: Expand Medicare to All!

At my local Kaiser facility today, the pharmacy was bursting at the seams with patients and others waiting for pharmacy services. Children with runny noses clinging to their mothers' legs were fussing, and others were being checked in by a Kaiser employee trying to help manage traffic flow.

When I got up to the counter to pick up my prescriptions, I asked the pharmacy tech about the increased number of people now part of the Kaiser system here in Colorado. I heard weeks ago that more than 40 percent of those who signed up through the Colorado exchange had opted for a Kaiser plan, as I did. The pharmacy tech was very kind but clearly working as hard and fast as she could. She acknowledged that the rise in patient load was pretty incredible and that employees were doing their best to serve people as quickly as possible. I told her I was shocked she was keeping a smile on her face. And I was surprised. If I had my work load rise that much that quickly, I would have a hard time being very happy.

It seems to me that the pent up demand for health care services is going to be one of the next really big hurdles for the dysfunctional U.S. health care system. People who have been either going without insurance all together or only seeing a doctor when an emergency forced them to may now seek care earlier and from primary care providers -- if they now have coverage they can afford to use under the ACA. That isn't rue for everyone, of course. Many millions of people still cannot afford coverage, and millions more bought bare bones plans just to comply with the insurance mandate of the ACA. Those people will continue to avoid care unless and until absolutely necessary.

This is where the deep flaws in the delivery system will be felt most severely. As people need to seek basic health care services and find their providers over-worked and under-staffed, patients will wait for care or resort once again to seeking emergency care services when primary care systems are overwhelmed. It is going to take a good deal of time and a sanely financed system for the U.S. to truly convert to a system in which primary care services are accessible and affordable at appropriate levels and those primary care providers are compensated at appropriate levels for being the backbone of a sane, compassionate system.

Single-payer reform would allow these transformational changes to occur more quickly as reimbursement rates to primary care providers become more ethical and stable rather than being subservient to the reliance on specialists as the system is today. When profits drive the system rather than patients and true health care, we end up with a mess of a delivery system that leaves out millions of people in need of care and cares for millions who may or may not need the intense levels of expensive care given.

I became a Kaiser patient in January after signing up through Colorado's exchange under the Affordable Care Act/Obamacare. Those who read my blogs know I got sick right around this time and needed care almost immediately. Kaiser was good to me from the access side from the beginning. It has taken some time to work out the financial kinks, but overall I am much more pleased with the Kaiser model than I was with my access to care under my old Aetna plan. I am still struggling with a viral infection, and my hubby is worried about Kaiser's ability to respond to me and treat me in the midst of this influx of patients and business. I am less worried. I believe the Kaiser system is better and more coordinated than I was able to access out on my own under Aetna, and I think that makes up for any increased wait time I may or may not face.

The reality we all share is that fixing the access end of our system does not fix the delivery system. Patients will show up now (at least a few more of us) expecting basic health care services to be available, and the delivery system is still structured for a more exclusive crowd accessing more and more specialized care.

We need single-payer. We need an improved and expanded Medicare for all for life system that is structured for the public good and that reimburses providers of primary care for the care that is so vital to so many millions of us. The further down the road we travel toward more profit-driven, greedy, and market-based health care in this country, the more difficult it will be to turn this ship around. We have to make this change if we are to have a humane system that puts health first. And we can do it.

In the meantime, I will continue to fight for single-payer, and I will thank those people like the Kaiser pharmacy tech I saw today who are helping so many people who are finally receiving care they may have needed for some time. We have to care about one another enough to want the best system for all -- and that system is single-payer.