Dr. Linda Farley, the Wisconsin physician and nationally recognized advocate for health care reform who died this week at age 80, came to a conclusion after decades spent as a family-medicine provider, medical-school instructor, community-clinic volunteer and public-health specialist. She became an ardent campaigner on behalf of replacing the current for-profit health care system with a single-payer plan. Such a plan would guarantee that all Americans have access to quality care while at the same time cutting costs associated with insurance and health care industry profiteering.
Many of us took our counsel with regard to health-care reform from Dr. Farley, and her husband, Dr. Gene Farley, the retired chairman of the University of Wisconsin Department of Family Medicine who was one of the recognized founders of the specialty of Family Medicine and the originator of one of the nation's first family practice residency programs.
Among those influenced by the Farleys was a young legislator named Tammy Baldwin, who now serves as a key member of the health subcommittee of the powerful House Energy and Commerce Committee and is one of the chamber's most outspoken advocates for the single-payer reform.
Says Baldwin of Dr. Linda Farley, who died after a battle with cancer that never stopped her campaigning for economic and social justice: "She was a dedicated physician, a champion of health care for all, a powerful role model, and a beloved friend. I met Linda close to twenty years ago. Of course, the context of our meeting was organizing for health care for the uninsured. Linda has been a partner in the effort to cover the uninsured for most of my political career. That we are about to begin this health care reform debate in Congress at the time of her death is especially poignant. If we succeed in ensuring health care for all, it will be in no small part because of Linda's life's work."
The confidence in the experience and wisdom of the Farleys, who had worked in so many public and private health care settings, informed the view of Baldwin, myself and thousands of others that only a single-payer system will achieve the stated goals of President Barack Obama and congressional leaders. The Obama administration and Democrats and most Republicans in Congress say they want more and better care for all, with real flexibility for patients who want to keep the same doctor and genuine savings.
But we have also been informed over the years by Farley's reminders that our current broken system does not merely make it harder for ailing Americans to get care and for healthy Americans to maintain their fitness. It also imposes incredible economic hardship on Americans who fall ill.
The extent of that hardship was revealed last week, just days before Dr. Linda Farley's death, in a study that will be published this summer by the American Journal of Medicine. According to the study, medical problems contributed to almost 62.1 percent of all bankruptcies in 2007.
Worse yet, the data from the study show that, from 2001 to 2007, the proportion of all bankruptcies attributable to medical problems rose by 49.6 percent.
That's a particularly unsettling notion, as the current economic meltdown is all but sure to have caused an expansion of the crisis. Thus, as many as two-thirds of the 1.5 million Americans who are being forced into bankruptcy annually end up there because they made the "mistake" of getting sick.
And here is where things get downright scary. According to the study:
• Most of those bankrupted by medical problems had health insurance. More than three-quarters (77.9 percent) were insured at the start of the bankrupting illness.
• Most of the medically bankrupt fell into income categories that the authors of the study identify as "solidly middle class before financial disaster hit." Two-thirds were homeowners, and three-fifths had gone to college.
• In a substantial number of instances, high medical bills coincided with a loss of income as illness forced breadwinners to lose time from work. Often illness led to job loss, and with it the loss of health insurance.
"Our findings are frightening," says Dr. David Himmelstein, the lead author of the study and an associate professor of medicine at Harvard. "Unless you're Warren Buffett, your family is just one serious illness away from bankruptcy. For middle-class Americans, health insurance offers little protection. Most of us have policies with so many loopholes, co-payments and deductibles that illness can put you in the poorhouse. And even the best job-based health insurance often vanishes when prolonged illness causes job loss -- precisely when families need it most. Private health insurance is a defective product, akin to an umbrella that melts in the rain."
Elizabeth Warren, the Leo Gottlieb professor of law at Harvard and one of the leading experts on personal bankruptcy, explains: "For many families, bankruptcy is a deeply shameful experience. People arrive at the bankruptcy courts exhausted -- financially, physically and emotionally. For most, bankruptcy is a last choice to deal with unmanageable circumstances."
And more often than not, notes Warren, a co-author of the report, they arrive because they fell ill or suffered from a chronic condition.
Thus bankruptcy is not for the most part a matter of personal responsibility -- or the lack thereof. It is a matter of bad health and a broken health care system.
How should we respond at a point when the United States is preparing to enter into another national health care debate?
Not with the gimmicks that members of Congress on both sides of the aisle and the Obama administration have been proposing, which leave most Americans in the grip of insurance companies that don't provide adequate or humane coverage when people need it the most.
"We need to rethink health reform," says Dr. Steffie Woolhandler, an associate professor of medicine at Harvard and a primary care physician in Cambridge, Mass., who is another co-author of the study. "Covering the uninsured isn't enough. Reform also needs to help families who already have insurance by upgrading their coverage and assuring that they never lose it. Only single-payer national health insurance can make universal, comprehensive coverage affordable by saving the hundreds of billions we now waste on insurance overhead and bureaucracy. Unfortunately, Washington politicians seem ready to cave in to insurance firms and keep them and their counterfeit coverage at the core of our system. Reforms that expand phony insurance -- stripped-down plans riddled with co-payments, deductibles and exclusions -- won't stem the rising tide of medical bankruptcy."
Woolhandler, who worked with the Farleys over the years, is right.
Only the creation of a single-payer national health insurance system will address not just the health care crisis but the bankruptcy crisis.
As Dr. Linda Farley told us for years: "Single-payer is the cure."
So how do we prescribe it?
The best way is by supporting the efforts of the group with which Farley was long associated: Physicians for a National Health Program, the real reform group that has won the support of more than 16,000 doctors nationwide.
To learn more about Physicians for a National Health Program, visit the group's website at www.pnhp.org.