Michael Kaplan, M.D.: State needs single-payer

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LEE — With an unpredictable president now in the White House, with no track record and conflicting promises about health care in the U.S., we must mobilize and lobby for health care changes that identify and fix what's wrong with our dysfunctional health care system. We must preserve what works, and never settle for a health care system that does not promise quality care to all Americans. We cannot go backwards.

As a family physician practicing in a rural, underserved region, I want to provide care to all, without the barriers our current system places in our patients' path to health. I would also like to do away with the restrictions that private insurance imposes on our practices, restrictions that cause uncountable administrative hassles, which can lead to physician burnout and exacerbate a shortage of primary care providers.

I work for Community Health Programs (CHP), a federally qualified health center (FQHC) that operates a network of health care practices in the Berkshires. Our practices, in North Adams, Adams, Pittsfield, Lee and Great Barrington, are primary care centers staffed by physicians and nurse practitioners specializing in family medicine, pediatrics and adult medicine. CHP also has two dental centers, a family service center and an obstetrics-gynecology practice.

CHP is licensed by the federal government to provide health care to a unique geographical region, and like more than 1,100 such FQHCs around the nation, is funded by private and subsidized insurance, Medicare and Medicaid, federal grants and donations. We have a mandate to provide care for all who need it, without regard to income, immigration status or disability.

Though the Affordable Care Act (ACA), also know as Obamacare, has expanded health care coverage for millions of Americans, and to many in our region, our system's ability to function well is seriously impaired by health care financing that was actually worsened under the ACA. The ACA funneled public dollars into the private insurance industry, with their high administrative costs and profit. We must instead develop tax-supported universal health insurance — an expanded and improved Medicare for All.

Since the advent of the ACA, our patients have experienced rising deductibles and a shrinking network of physicians and hospitals. Many specialists in our area are overbooked or are unwilling to accept the insurance plans, so our patients often are forced to travel as far as Worcester or Boston for care. Many patients from nearby New York state on ACA plans can no longer access CHP health care because of narrow networks. These are just some of the downsides for patients.

Collaborative approach

For physicians who are struggling with providing excellent care to our patients, the administrative burdens are unbearable. Each health plan requires its own excessive paperwork, simply to get our patients the treatment that they need.

For CHP, a bright spot in our network is our success in implementing the patient care standards of the Patient Centered Medical Home or (PCMH), a national initiative. Our Lee practice was recently recertified as a PCMH, which calls for integrated, team-based care that hearkens back to a time when family doctors were more easily able to coordinate care. As a result, our practice now includes many collaborators: on-site psychiatrists, social workers, physical therapists and nutritionists. We work together to provide coordination of care. CHP practices in Pittsfield and Great Barrington are also PCMH-certified.

A key piece of the PCMH effort is the integration of behavioral health with primary care. Research has shown that housing primary and mental health care in a single practice site can markedly improve overall community health — and we are already seeing results. Along with BMC and the Brien Center for Mental Health and Substance abuse, CHP received a federal grant in 2014 to increase mental health services on site at our primary care practices. In this model behavior health clinicians work shoulder to shoulder with primary care practitioners. Already we are seeing improved health among our CHP patients with this on-site mental health access.

All of the above, however imperfect, are endangered by an ineffectual health care financing system. The new administration in Washington plans to dismantle or undermine the ACA, weaken Medicare and Medicaid, and damage the patchwork of financing that has allowed FQHCs and other primary care practices to provide needed care to those who most need it.

Before it was passed, progressive Sen. Bernie Sanders and Rep. Dennis Kucinich arranged to add funding to the ACA to bolster health centers like ours. These men are proponents of true health care financing reform: a government-financed privately-run health care system that would cover all Americans. This system would be an expanded, improved Medicare for All — a single-payer system. The ACA permits states to adopt this approach, by applying for a waiver if all residents are provided with access to high quality, affordable health insurance while retaining the basic protections of the ACA.

A single-payer system would satisfy all these requirements and cover everyone. It would be cost effective and protect government from the ever-increasing expense of our disintegrating financing system. An expanded improved Medicare for All would eliminate deductibles and allow patients to go to any hospital or doctor. I would like to provide integrated care that is available to everyone without financial barriers. A single-payer system is the only way to achieve this goal. To establish this system for Massachusetts contact your legislators and ask them to support: "An act establishing improved Medicare for All in Massachusetts" SD698, HD 3249.

Dr. Michael Kaplan is a family physician.


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