May 7, 1999

Luckily for many Americans, particularly those living without health insurance, one member of Congress vows never to rest until his colleagues see the value of implementing a national, single-payer health care system that covers everyone.

Rep. Jim McDermott (D-Wash.), the only psychiatrist in Congress, has introduced a bill to move the country toward a universal, single-payer system each of the last five congressional sessions, but he has failed to convince many other lawmakers that this is the solution the country needs.

Speaking on April 12 at APA's Federal Legislative Institute in Washington, D.C., McDermott lamented that the U.S.'s "bottom line-driven" health care system has made practicing medicine "not very satisfying anymore." Older physicians are leaving medicine in record numbers, he said, and young people are being trained to operate without the luxury of being "scientists."

"They are more and more forced to practice cookbook medicine, that is, doing what HMOs will pay for," he observed.

McDermott stressed that "the current system has become dysfunctional" and will remain so until policymakers agree on a solution that "restores the doctor-patient relationship to the primary role it once held."

He strongly favors a national plan in which decisions about how care is provided are made at the state level, very much like the system in Canada, where provinces have the freedom, within certain parameters, to tailor the health care system within their borders.

McDermott acknowledged that the Canadian system is certainly not problem free, but in the U.S., he emphasized, "there is now no system, so there is no way to fix it."

What is desperately needed, he said, "is a system that doesn't turn doctors into serfs of insurance companies or makes patients into beggars."

Turning more and more of the system over to private industry, as the Republicans in Congress have tried to do, has caused even more people to join the ranks of uninsured Americans than was the case when the Clinton administration began its unsuccessful campaign to reform health care delivery in 1993, said McDermott, a member of the powerful House Ways and Means Committee. Every special interest had an idea of how such a system ought to be structured, but none were willing to look beyond it to work toward a common goal. Unfortunately, following that private-sector route is how the country ended up with a health care system that seems to satisfy no one except the insurance industry, said McDermott.

Since the defeat of the Clintons' health reform initiative, the ranks of uninsured Americans have swelled by about 20 percent, he emphasized. To help reverse this troubling trend, he plans to introduce legislation that would grant a 30 percent tax deductibility for health insurance costs for individuals earning up to $25,000 a year and couples with incomes up to $40,000. Self-employed Americans can deduct 100 percent of their health insurance costs, but those who work for them usually have no comparable method for reducing the cost of this burden, he explained.

He acknowledged that this idea would not solve the problem of those far too many Americans who cannot afford health insurance, but it should benefit between 5 million and 10 million people. The U.S. should be embarrassed that it is the only industrialized country without a national health care plan, he suggested.

McDermott also described for the psychiatrists at the legislative institute his frustrations with the path on which Medicare reform seems to be headed. He has been particularly close to the issue as a member of the recently ended bipartisan commission appointed to suggest ways to reform Medicare in light of an aging population and projected fund shortage in about 15 years.

"Medicare has been a victim of its own success," he noted. It now covers about 99 percent of elderly Americans compared with the situation just before it was established in 1965, when only 45 percent of that population had medical insurance coverage. But the alternative popular with some of his commission colleagues, to replace Medicare with a voucher system in which each eligible person would purchase insurance on the private market without the current benefit guarantees, would result only in "chaos," according to McDermott, as it "rips apart the fabric of a basic system that needs changes, not gutting."

He ended by quoting Winston Churchill: "You can count on Americans to do the right thing, but only after they have tried everything else."