John Geyman on the Failure of Obamacare the Medical Industrial Complex and the Single Payer Solution

Dr. John Geyman has been retired from medical practice for over twenty years now. But during that time, he has written more than twenty books as an emeritus faculty at the University of Washington.

John Geyman MD

Most of the books focus on the dysfunction of our medical industrial complex – from the privatization of Medicare to Obamacare and Trumpcare – and how we can replace it with pure single payer Medicare for all.

Let’s go to some of the outliers first. You wrote a book called Flight is a Lifetime Passion.

“I grew up in Santa Barbara during the war,” Geyman told Corporate Crime Reporter in an interview last week. “We were close to a Marine air base. I would look up and see B-17s or Wildcats fly over. I was always looking at the sky. I followed that closely as a teenager.” 

“I wanted to fly in the Navy when I graduated from Princeton, but I flunked my eye test. Even though my eyes were better than 20/20, I had too much astigmatism. And if you are trying to land on a carrier with astigmatism, it doesn’t work out well.”

“I didn’t get to fly then, but I learned to fly during medical school and have flown regularly since those early years. Now I am a united flying octogenarian or UFO – where I fly cancer patients regularly to the mainland from our island for chemo and radiation therapy.”

“It has always been a passion. And I’ve had a number of airplanes, all small ones, some open air. I’ve flown them across the country, including a biplane across from Texas to here in Washington. Flying has been an avocation for me. And I’ve written several books on flying.”

You wrote a book titled Souls on a Walk: An Enduring Walk Unbroken by Alzheimer’s.

“That’s about my wife of 56 years – Gene (Eugenia). She died of Alzheimer’s about eight years ago. She had a sixteen year course of Alzheimer’s. As is often the case in the early part, the signs are subtle. But I took care of her at home the whole way, except for the last four days in the hospital. I wrote about that and shared that experience and the whole problem of taking care of Alzheimer’s patients. She was an artist and painted a beautiful painting, even in the last few months. That book is a sharing of what it was like.”

Do you have any insights into the causes of Alzheimer’s?

“No. And there is still no cure on the horizon. There have been different theories as to the cause, but no one has nailed it down. The biggest risk is just growing older.”

Most of your books deal with the healthcare system broadly. Your early books were The Modern Family Doctor and Changing Medical Practice (1971) and Family Practice: Foundation of Changing Healthcare (1980).

The first book where you deep dive on policy is – Healthcare in America: Can Our Ailing System Be Healed? (2002).

“I was trying to look at the whole system for the first time. I looked at the major trends – decreasing access and increasing costs, specialization, increased technology. I looked at the politics, rationing in our free market society, lessons from other countries.”

Then comes – The Corporate Transformation of Healthcare: Can the Public Interest be Served (2005). Falling Through the Safety Net: Americans without Health Insurance (2005). Shredding the Social Contract: The Privatization of Medicare (2006).

Since then, Medicare has been privatized to a far greater degree. Medicare has effectively been corrupted. Now when you say Medicare for All, you are saying – bring in a corrupted Medicare for All?

“There always has been a pressure to privatize because there is a belief that the private sector is more efficient than the government sector. That’s fallacious. Traditional Medicare started in 1965 as a public single payer program for people over 65. But private insurers have always been pushing. And they say they can do it better. And they got government policy makers to go along.”

“The government has bailed out private insurers along the way with many billions of dollars in overpayments. It has been collusion with the federal government based on a theory that private is better. But it isn’t. There is a huge amount of fraud in both Medicare and Medicaid. In Medicaid overpayments are endemic in more than 30 states, often involving unnecessary or duplicative payments to providers.”

Is there any indication that a single payer system will be any better at deterring fraud than a multi-payer system?

“Billing would be very much simplified. There would be negotiated fees with physicians, with other healthcare professionals that would be reasonable, fair and consistent. There would be negotiated global annual budgets with hospitals, nursing homes and other facilities. Right now, we have an electronic medical record which has become rapidly a billing instrument.”

“There are all kinds of daily profiteering on that. Two thirds of physicians are now employed by big hospital systems or in some cases insurance companies. The pressure on physicians is to upcode or say that you did more in that office visit than you actually did. The electronic record is a big part of the inflation in healthcare costs right now.”

“That would be reined in by simplifying the whole billing system under single payer.”

You wrote a book in 2008 titled The Corrosion of Medicine: Can the Profession Reclaim Its Moral Legacy? Like the general population, doctors are split on the question of single payer.

“There is a lot of distrust throughout our population of government and of Congress. One reason for the distrust is the privatization. There is also a lot of denial about the extent of the problem.”

“The polls show that 84 percent of Democrats support Medicare for All and even 52 percent of Republicans support Medicare for All.”

“But there are some polls asking – if you were forced to give up your employer based insurance, would you still be in favor of Medicare for All? And those polls come out different.”

“The employer based system is being hyped by the coalition against Medicare for All. But it’s a very fragile system. Something like 40 million people lose their jobs or leave their jobs every year. And they lose their health insurance. The average person now has twelve different jobs before they get to be 50 years old. It’s a very unstable system right now.  And we would be much better off with a well run Medicare for All.”

“Under Medicare for All, 95 percent of Americans will pay less than they do now for health care and insurance. It’s a no brainer if you look at the whole system.”

In 2008, you came out with Do Not Resuscitate: Why the Health Insurance Industry is Dying and How We Must Replace It.

You say that we must replace it with a government run single payer. But it’s not just privatization that is undermining Medicare. It’s also rampant government bureaucratization.

“This is true. It’s poor health policy. It’s government at its worst bailing out the private insurance industry. That isn’t to say that Medicare for All, well done, as it is in almost all advanced countries in the world – western Europe, Canada, New Zealand, Australia, Scandinavia. There are solid approaches for determining fair fees, bulk purchasing of drugs and medical supplies – lots of savings though decreased administrative costs.”

“The overhead of private insurers is 18 to 20 percent. Traditional Medicare is 2.5 percent in this country right now.”

“In 1995, Taiwan solved their health care problems with a solid Medicare for All system. I was in practice in Mount Shasta in 1965 when Medicare and Medicaid came in. It was seamless. A patient would come in and show me their card. And the question was – how can I help you? Not – what’s your insurance, as is the first question today when you go to the doctor.”

In 2015 you wrote a book titled How Obamacare is Unsustainable: Why We Need a Single Payer Solution for all Americans. You were not a fan of Obamacare.

“I wasn’t. The politics hijacked it. Now, nine years into Obamacare, it has failed to contain costs or improve quality of care. The Obamacare insurers limit patient choice and access through restrictive and changing networks. Often even a doctor in a network doesn’t know he or she has been changed. And patients often find out after the fact. Premiums have gone up by profiteering private insurers. That continues. More than 27 million are not insured. And 84 million Americans are underinsured. Deductibles keep going up. Deductibles as high as $10,000 a year are in effect. Middle aged Americans are much more likely to die of heart disease than they were in 2010. Obamacare has failed to improve access and contain costs because the private insurers have such a big role in the system. And there is quite a bit of fraud out there.”

You say the vast majority of Americans support single payer. If that is the case, why don’t we have it?

“There is a huge amount of disinformation and rhetoric in the debate over how we should proceed. And much of it is carefully used to discredit Medicare for All.”

“Dr. Don McCanne does the quote of the day for Physicians for a National Health Program. Here is how he frames the situation:

“‘I’m much more worried about our friends than our enemies. A decade ago our friends kicked us out of the negotiations and brought us Obamacare. By now we could have had everyone covered at a cost we could afford, but instead we have tens of millions of uninsured and underinsured who are losing their choices in health care while our national health care expenditures increase at twice the rate of inflation, all the while perpetuating suffering, hardship, and premature death.’”

[For the complete q/a format Interview with John Geyman see 33 Corporate Crime Reporter 38(13), Monday October 7, 2019, print edition only.]

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