printable versionPizzo calls for 'revolution' in U.S. health-care system
BY MICHELLE L. BRANDT
Philip Pizzo
Many Americans have grave concerns about the nation's health-care system, but most are hesitant to take the podium and call for the United States to adopt a significant change in its approach to medicine. Not Philip Pizzo, MD, dean of the School of Medicine, who declared his support for a single-payer system for health-care coverage during a March 9 speech at the Commonwealth Club in San Francisco.
"I personally wish we would resolve to move to a single-payer system," he told the audience. "Care would be guarded by quality and delivery and not by financial incentive."
Pizzo started his 40-minute talk with a brief history of U.S. medicine, including a discussion of the origins of the current health-care system. Relying on employers for coverage, as the nation does today, actually began by accident, he pointed out; wage controls during World War II prevented companies from luring workers with higher salaries, so they began offering health benefits.
"It didn't make a lot of sense except it was a way to rationalize how to get money to people in need without increasing their direct compensation," Pizzo said. "That benefits package has stayed as the foundation of our health-care system, which is essentially a non-system."
Millions lack coverage
Having an employer-based system means that a certain number of people— namely the unemployed and underemployed as well as the elderly and sick—may lack access to even basic health care. Pizzo said that 47 million people now are uninsured and millions more are minimally insured.
"Some say we have the world's best health-care system. I don't think we do," he said. "We have the best health-care system for some."
And even those people with health-care coverage encounter problems—such as minimal contact with their physicians or trouble getting appointments.
Pizzo said the problems patients face of having inadequate time with their physicians can be, in part, traced to the rise of managed care, which was implemented as a way to control rising costs and wound up dramatically changing the way U.S. physicians practice medicine.
"Rather than being able to spend time understanding and connecting with patients, rapid turnover began taking place," Pizzo said, citing the advent of 15-minute appointments.
Growing frustration
This in-and-out approach to clinic visits has turned off many patients, and Pizzo hardly blames them. "If someone is not able or willing to spend time or connect with you or understand your concerns, it's hard for you to hold that person, or that profession, in great esteem," he said.
Pizzo noted that physicians themselves are frustrated with the health-care system; he referenced a recent survey showing that most physicians "couldn't wait until they retire." The physicians felt the field of medicine had changed too much, and "they had lost their taste for practicing medicine," he said.
Incremental changes, or "nibbling around the edges," will not be enough to fix our health-care problems, Pizzo said. He called for a "major revolution" and expressed support for the single-payer system, under which private providers would deliver medical services and the government would foot the bill.
Pizzo acknowledged that many Americans are not yet ready to embrace major changes in the health-care system, though there exists a core of advocates for the single-payer approach. State Sen. Sheila Kuehl, D-Los Angeles, for instance, recently introduced legislation that would insure Californians under a single-payer plan. Although it's not expected to become law anytime soon, it has brought more attention to the single-payer approach and stimulated debate on the issue.
In addition to the single-payer system, Pizzo said an idea worthy of careful consideration is the voucher-based model proposed by Victor Fuchs, PhD, the Henry J. Kaiser Jr. Professor of Economics and of Health Research and Policy.
Duty to speak out
Pizzo said it is his obligation as dean to address publicly the problems in the health-care system. "We need to speak out more about the challenges we face and not duck under the cover that we have the best health system around," said Pizzo.
Pizzo's talk touched on a variety of other issues, including conflict of interest among medical researchers and the views of "anti-science" groups. He also discussed what he calls one of the most exciting and challenging areas of medicine: stem cell research. He said that he believes stem cells will lead to important insights and therapies, but that he hopes it's not for naught.
"What good is it if we have a broken health-care system that can't deliver our discoveries?" he asked.