Column: What’s to Fear in Healthcare Reform?

A primary care physician's perspective

Editor’s note: The author will be part of a group of residents who’ll be rallying at 9:30 a.m. Saturday morning near the Ann Arbor Farmers Market to show support for President Obama’s proposed healthcare reform plan, including its public insurance option. 

As a primary care physician, I believe strongly that we need meaningful healthcare reform. In practicing for over 25 years, I have witnessed how impossible it is to get healthcare without insurance. And in the last 10 years I have seen an increasing number of my patients lose their insurance.

It saddens me that I can’t provide adequate care for them. It also has been alarming to me to see how easy it is to lose healthcare coverage, especially in these difficult economic times. It will only get worse without substantial reform. If nothing is done to reform healthcare, the nonprofit Commonwealth Fund predicts that over one-fifth of the nation’s gross domestic product (GDP) will be spent on healthcare by the year 2020. And it won’t mean that more Americans are covered: that year, the number of uninsured is expected to rise to 61 million.

People who are complacent about the problems of the uninsured may be ignoring how vulnerable we all are when there is no promise of universal coverage. Some people lose coverage when they are laid off, some when their small company decides they can no longer afford covering healthcare benefits for their employees. I have patients who are retired but too young to qualify for Medicare who are told that their former employer has dropped healthcare coverage from their retirement benefits.

Still others, who have some insurance, find that they can’t afford the steeply rising premiums so they opt for a plan that only covers catastrophic illness; then they must pay for all clinic visits and preventive care out of pocket. Screening tests like colonoscopies are very expensive, so of course they choose not to do it. I have patients who struck out in their own promising new business only to be devastated by an illness or depleted of capital because of exorbitant premiums.

Perhaps most poignant for me as a mother of a 20-year-old is the plight of young adults who are trying to establish their careers, achieve financial independence, perhaps start a family. Many of them have beginning job positions that do not include healthcare coverage. If they get ill, they may never get ahead of their debt.

The scenario just gets sadder when you consider what happens when an uninsured person gets ill. I have a young patient who has osteomyelitis, a bone infection. Without insurance, she cannot afford the medicine she must take to keep it in check. Medicaid will be her only option for coverage – but she must spend all of her savings and become “medically indigent” in order to qualify. Plus she can’t have a job of any significance because she would then make too much money to continue getting Medicaid. She must choose to remain poor so that she can get healthcare – in what universe does this make sense?

Not long ago surveys showed that a majority of Americans agreed that we need healthcare reform. Now we hear of people’s fear of reform. What happened? Distortions and lies have successfully confused people and confounded the debate. Please don’t believe the manufactured lies. I’m a doctor – I can tell you they are untrue. There won’t be death panels, or socialized medicine, or federal funding of abortion. Medicare won’t be dissolved and there won’t be discrimination in healthcare determined by the government. If you want to know what the proposed bills really contain I encourage you to check out the facts and comparisons provided by The Kaiser Family Foundation website. Keep in mind that the American Nurses Association and even the conservative American Medical Association have endorsed President Obama’s reform agenda.

I cannot imagine anything more unethical than spreading lies in order to instill fear, then to use that fear to further one’s own avaricious goals – and in the process worsen access to healthcare for millions of Americans. This is what many insurance companies are doing. Their lobbyists in Washington provide congressmen with money as well as lies, they encourage disruption of town hall debates on reform, and, through phony “grassroots” groups they fund commercials and websites that spout dishonest propaganda. Then they pay for it all with the money we pay them in insurance premiums! What remarkable irony! The only thing more despicable is to be a congressman who has vowed to represent his constituents, who intentionally misleads, manipulates and frightens them to serve his own greed for power. It doesn’t get lower than that.

Cost projections by Commonwealth Fund have shown that the best way to start curbing health expenditures is to have a public option. Remember, dollars paid as a premium to Medicare are spent on healthcare. There is no money going toward profits, executives salaries, lobbyists, advertising, or routine auditing; therefore bureaucracy and overhead for Medicare are much less than for private insurers.

It is clear to me that the outcome we should be most afraid of is that which will occur if we do nothing. Then we will certainly have 1) rising percentage of our income paid for healthcare, 2) rising numbers of uninsured, 3) more small businesses failing, 4) decreasing ability of American industry to compete in the global market, and 5) rising inequity in income in the U.S.  as executive salaries (from the insurance and pharmaceutical industries, for example!) keep sky-rocketing while individual and small business income suffers. Don’t fear the ridiculous myths of death panels or baby killing. Be worried about what is happening now.

How do you counter lies with the truth when there is no respect given to the truth by the anti-reform gangs? I think there are many other voices, from both parties and outside the realm of politics, that can speak more responsibly and ethically. Let’s make the lies and the liars irrelevant. In the spirit of Ted Kennedy’s legacy of standing up for one’s principles yet choosing to work together, let’s open our minds and hearts and find solutions to this problem.

About the writer: Dr. Amy F. Saunders is a primary care physician practicing medicine at a clinic in Ann Arbor, caring for a large patient population. She received her MD degree from Ohio State University, did a fellowship in general internal medicine at Duke University Medical Center and received a masters degree in public health from the University of North Carolina. 


  1. By Richard
    August 28, 2009 at 11:46 am | permalink

    Very nice column…Its hard for me to say that since you are a Buckeye.

  2. August 28, 2009 at 12:24 pm | permalink

    About 10 – 15% of Americans are uninsured (depending on which statistic you like). I truly would like an overhaul of the system but simply cannot support the Obama plan at this time. First, government run healthcare does not have a good track record; unless people are truly thrilled with Medicare and the VA system. Secondly, there’s a dramatic tax burden here, and bottom line, we need to hold off until the country recovers from the economic crisis. The healthcare situation isn’t good, but it’s not an emergency… and getting the country back on it’s feet economically is the only thing that makes sense right now. The healthcare burden by American’s on the economy is insignificant compared to the proposed costs of the government system. It’s just simply not the time. This can be a great goal to push through next term. After the current policy’s have been examined. Unless of course you feel that the cash for clunkers was a great success…

    My view is simple… this has to wait.

  3. By R. Baillie
    August 28, 2009 at 12:28 pm | permalink

    Well, it would be an emergency for you, Mr. Posner, if you got laid off and lost your insurance!

    And how many older people would be willing to give up Medicare? How many vets would be willing to simply give up VA care?

  4. By Richard
    August 28, 2009 at 12:51 pm | permalink


    No offense, but I don’t think we can afford to wait.

    One of the biggest drags on our economy is the lack of health coverage. We spend more on health care that most of the industrialized world, not to mention the lack of affordable health care is stifling entrepreneurs.

    You say that you cannot support the Obama plan, yet you offer nothing, other than cost, as justification. I think that the emphasis on cost ignores the huge cost burden we are creating by doing absolutely nothing. Its not an “insignificant” cost, its real and its harming our economy.

  5. By Marvin Face
    August 28, 2009 at 1:09 pm | permalink

    I’m on the fence about this thing and have been trying to read as much as possible on both sides of the issue. It’s sad that it has gotten so angry on each side and I always look for reasoned arguments and debate rather than yelling and inflexibility. I have to say that the article starts out positively enough but deteriorates toward the end into name calling which lost me. She invokes Ted Kennedy’s principles of choosing to work together but in the two sentances prior, uses the word “liar” (or liars)three times and refers to people who do not agree with her as “gangs”. Also, using exclamation points is unnecessarily incendiary. You’re not doing much to win anyone over with these tactics I’m afraid. Sorry, still on the fence and looking for balance and reason.

  6. By Duane Collicott
    August 28, 2009 at 2:18 pm | permalink

    I agree with Marvin on this one. I was reading until I got to “lies” and “phony ‘grassroots’ groups,” which are just empty attacks and is where author lost credibility with me. This is quite a bit below the Chronicle’s usual journalistic quality.

  7. By Joe Hood
    August 28, 2009 at 2:27 pm | permalink

    Eek, the same straw man argument. You’re either for this particular version of health care reform or against health care reform entirely, that’s not true.

    Why such a rush to pass this thing last month before anyone read the 1100 page bill?

    What about tort reform, so doctors aren’t killed with high insurance rates? Or perhaps one set of rules for insurance companies to deal with instead of different rules from each state?

    As far as abortion in this health care bill being a lie, how about this little nugget in the bill: delegating to the Secretary of Health and Human Services “the power to make unlimited abortion a mandated benefit in the ‘public health insurance plan’ the government will manage nationwide.”

  8. By Shirley
    August 28, 2009 at 2:43 pm | permalink

    I am strongly in favor of Health Care Reform. The runaway increase in cost of medical care is one very real reason for our financial problem. One of the primary reasons for people to go down hill financially is costly medical care costs due to illness. Also, if we had single payer health insurance we could negotiate costs of medical care and help bring costs down.

    Frankly, I am tired of hearing about how much money Pharmaceutical and Health Insurance companies have and how they finagle costs. Also, I resent the fact that they too often buy favors by donating to political campaigns.

    I have medicare and love it. Also, so many other industrialized countries have single payer and have no complaints. Time we stepped up to the plate!

  9. August 28, 2009 at 4:03 pm | permalink

    I truly disagree with Healthcare being the cause of our problems right now. It would seem that the banks and housing are the cause, and after the government throwing hundreds of billions of our dollars into it, the problem is far from fixed.

    I am not against healthcare reform. I am against this plan at this moment. A complete overhaul of a system at this time without proper due process by all of us is irresponsible. And, I don’t have an alternate solution. I also will not succumb to “my way or the highway” types of arguments. I don’t have a solution, but I also don’t like the current one at this time.

    Medicare and VA systems are flawed and I will not give in to demands of switching to a government run system that hasn’t shown it can properly run what it already does.

    In regards to cost, right now paying my health insurance premiums is cheaper than the tax increase that will be applied to me under this plan. I truly feel sorry for people who have lost their insurance and their jobs. The focus needs to be on getting people jobs and income — otherwise it doesn’t matter what healthcare the government wants to provide. We need to fix the job, housing, and war issues first. Again, I understand everyone has different opinions, but this is mine. Emergency care is provided to every person (whether citizen or not) by law. Let’s just take the time needed to revamp the system correctly.

    The government is not my first, second, or third choice in covering my health. And the process for which we choose to have them control our life (literally) needs to be vetted.

  10. By Eli Nathans
    August 28, 2009 at 4:15 pm | permalink

    I would like to respond to the comments left by Fred Posner, Marvin Face, and Duane Collicott.

    I am not an expert on this subject, and am also busy reading H.R. 3200 and related literature to try to understand exactly what is being proposed here. But I have read enough to think that the proposal is likely to be an improvement, quite likely a very significant improvement, in how our current health care system works.

    The heart of the proposal is the Health Insurance Exchange, to be offered through employers, which is designed to provide Americans with a choice of an array of health care options at different levels of care. By mandating a series of comparable levels (basic, enhanced, premium, and premium plus plans), the bill is attempting to promote transparency and competition between plans, and by making the market more competitive to reduce costs. My understanding is that the public health plan option was created for the same purpose – to make sure that even in smaller markets some competition exists, so that, again, costs are kept down. Various other provisions of the bill are designed to provide a minimum level of coverage to people with insurance – for example, the requirement that insurance not include a pre-existing conditions exclusion – and also to reduce costs – so, the requirement that plans that spend too little on health care rebate a portion of their earnings to their customers.

    The public is already footing the bill for medical costs for the very indigent, through Medicaid, and also, often, because the costs of emergency room visits and other hospital costs incurred by those without insurance are paid for by higher charges imposed on those with insurance. But the way in which this happens often imposes these costs in an arbitrary way – for example, on urban hospitals in poor neighborhoods – and results in many unnecessary costs.

    Again, I am still reading, but so far my impression is that this is a well thought through plan, one that seeks to enhance the strengths of the system we currently have, introduce some necessary additional regulation, and at the same time provide a minimum level of health care insurance for all Americans. It is not perfect, but I have not come across the perfect solution. And just about everyone with whom I have spoken about the current system seems to agree that it is in need of drastic change, that it is inequitable and that costs must be controlled. This bill seems, as far as I can tell, a reasonable response. And if significant change is to be adopted, now is the time.

    I should note that I am one of the organizers of the small demonstration in favor of the administration health care reform bill that will take place tomorrow across the street from the Ann Arbor Farmer’s Market, on the sidewalk behind Community High School. I hope that we will be able to continue this conversation there.

  11. By Marvin Face
    August 28, 2009 at 4:54 pm | permalink


    Thanks for your reasoned response. With all due respect, I don’t think a bilateral conversation can be had at a “demonstration”.

  12. By Richard
    August 28, 2009 at 5:06 pm | permalink


    I take issue with the idea that Medicare and VA are “flawed” systems.

    They certainly cost a lot of money, but so does private insurance. You just aren’t made aware of the total cost of providing service, the bureacracy, reimburmsents etc because its not subject to public oversight like Medicare and the VA.

    If you believe them to be flawed, I would ask you to provide a private sector rationale for providing affordable coverage for my 90 year old grandfather that makes more sense than Medicare.

    I would also point out that prior to Medicare 35 percent of all seniors lived below the poverty line due to the lack of affordable health coverage. The number has dropped by two thirds since Medicare.

    “I predict that 30 years from today, this bill will be a welcome and permanent part of our nation’s heritage that no representative would ever dare repeal. Why? Because it represents the moral principle that we just must not neglect in their age those who have given a lifetime of service to their country.”

    President Lyndon Johnson

  13. By susan
    August 28, 2009 at 6:14 pm | permalink

    The NY Times had an interesting comparison yesterday of U.S and Japanese health care #’s. U.S. infant mortality-7 per 1000 live births and Japanese-3 per 1000., health spending GDP, U.S.-15 and Japan-8, doctors per 10,000 people, U.S.- 26 and Japan-21. Japan has universal health care that runs in the black. Why can’t the U.S look at the way they do it over there and follow suit!

  14. August 28, 2009 at 6:14 pm | permalink

    A single payer system, simply said is the civilized way to do things. Follow the direction of other developed countries and pick at the details later.

  15. By Mary Morgan
    August 28, 2009 at 6:30 pm | permalink

    This might be the article referred to by Susan [#13] – an Aug. 25 NY Times Q&A with John Creighton Campbell, a UM professor emeritus who describes the healthcare system in Japan.

  16. By Madeline Diehl
    August 28, 2009 at 6:30 pm | permalink

    Hello to all, and particularly Marvin. I think the word “demonstration” perhaps is misleading for what we are trying to do tomorrow. Eli and I started planning the event after a dinner party of 6 of us friends (9 if you count our teenaged kids), where we realized:
    1. we ourselves did not exactly know what the proposed legislation will and will not do, partly because of so much misleading information which has been injected into the public debate, and:
    2. we had not been seeing or hearing the kind of bipartisan support for reform which the idea enjoyed last fall. why not?

    We decided to begin educating ourselves about the bill, and to share what we learned at the event Sat. Simple as that.

    There is an excellent article in the latest issue of The New Yorker magazine that explains that a big part of the reason the push for reform is losing momentum is because of a basic psychological fact: people are basically afraid of change, even if it is positive, good change.

    Eli and I have organized this event for Saturday with a group of friends–regular people who do not represent any particular group or political party–to share what we have learned about the proposed legislation during this week of study, and also, to listen to what other people have to say, and learn from that, in the true spirit of mutual respect and community dialogue–much as this forum in the Ann Arbor Chronicle is set up to be–respectful, thoughtful, and, in the Chronicle’s own words, “generous.” I would challenge all of us who do come to the event tomorrow (which is by no means a “demonstration” in the way I think you are picturing that word) to also be what the Chronicle has taken up as their mission–open. We will not be able to make meaningful, needed changes in our society without being open to hear each others’ concerns, needs, fears, and beliefs, and together, only we have truly listened to each other respectfully, can we try to put together a version of the truth that can bring us to a better future. My truth, your truth–maybe neither one understands this issue completely. But together, we can join our perspectives and see things from a much larger perspective. This is the cornerstone of democracy.
    That’s why I will be there tomorrow at 9:30 across from the Farmer’s Market, and I hope you will join me. I think you will find all of us there who are organizing it (which amounts to 10 people or so, again, who are just people) reasonable, open people who are willing to listen to what you have to say, if you say it in a reasonable, mutually respectful way. This is what our democracy is supposed to be, how it is supposed to work. And yes, there have been abuses, and this discussion has not always been straightforward on “both sides.” But I wouldn’t be bringing my kids there tomorrow if I didn’t believe the dialogue we are beginning there as a community won’t provide them with a positive, constructive role model of democracy in action–people talking together as neighbors who share a common fate, people trying to share ideas in a mutually respectful way.
    And so I hope to meet you there with open hands and heart, with my very best regards,

  17. By Rici
    August 28, 2009 at 8:28 pm | permalink

    There was a very interesting interview on Fresh Air this past Monday. T.R. Reid spent time in many different countries to study how their health care plan works. He listed 3 major plans in use in the developed world – not every other country has single payer! And then the 4th model, in effect in most of the rest of the world, is “pay before service.” One problem with the US is that we have elements of *all 4*, which makes billing/reimbursement so extraordinarily difficult. Anyone who is interested in learning about these should listen to the show (although be prepared for him to make a few scathing remarks about the US system(s)).

    Here’s the URL for the show:


    You can listen to the story or download a transcript.

  18. By mr dairy
    August 29, 2009 at 11:13 am | permalink

    The health care industry (funny word “industry”), but that’s what our health care has been become, a very big business that has more to do with profit and politics than it does with health care.

    The Insurance Company/ Doctor/Provider/Pharma and ancillary businesses are by far the biggest bureaucracy we have, far larger and out bureaucratizing any government run health care program like Medicare. Everyone knows and admits that this private bureaucracy has done a poor job or caring for our health. Twice the cost of other developed countries with worse outcomes Health care is already rationed and controlled by these highly profitable businesses.

    The current health care bureaucracy has far more to do with profiting from people’s misery than it does with making people healthy. How could the government do any worse?

    Remove the profit motive from providing health care and we’ll all be in better shape.

  19. By ChrisW
    August 29, 2009 at 11:42 am | permalink

    Everyone seems to be ignoring the real problem — medical costs rising out of control. 30 years ago any given hospital was run by a tiny group of highly professional individuals, usually doctors. As government regulations and insurance complexity has grown, hospitals have become bureaucratic nightmares.

    More government regulation isn’t necessarily the best answer since it was government regulation that caused the problems to begin with. Why do people get healthcare through employers? Because of government wage controls during WWII. Don’t like your HMO? Those were created by Congress in the 1970s. Why have costs risen so much? Because they can — as long as someone is going to pay money for a treatment, there will be someone, somewhere offering it, regardless of it’s medical efficacy. Not to mention that Medicare rules outmoded all older hospitals, forcing hospital systems to go deep into debt with newer facilities ($250 million for a small 48-bed cardiac unit in Ann Arbor alone).

    While there are some competitive pressures at hospitals, it’s illegal to open a hospital in this state without government permission, which to anyone familiar with the real world means bribes and lobbyists.

    The whole “digital medical records” fiasco is just a massive tax on patients, with hospitals employing hundreds of expensive IT personnel and management instead of doctors and nurses.

    Malpractice reform has been completely absent in the discussion even though most doctors admit that 20% of tests are done solely for legal reasons. Why? Because the Democratic party is owned by trial lawyers, just as the Republicans are owned by large corporations.

    If nothing else, Congress should be forced to use whatever system they come up with and they should pay into it just like the self-employed. That may ensure at least a tiny bit of sanity in the system.

  20. By Amy Saunders
    August 29, 2009 at 8:03 pm | permalink

    I appreciate the comments and the dialogue that has been triggered by my article. It seems very fruitful to have a discussion about both the philosophical issues and the practical issues surronding the prospect of health reform.
    I understand that my commentary was viewed as divisive by some, counterproductive to the goal of encouraging collaboratiive dialogue. I apologize for that and it was certainly not my intent to be inflammatory in regard to the debate about solutions to our healthcare problems. I do wish to state that I don’t have anger toward people who disagree with me on the best way to solve them.
    I did make angry statements though and I realize that this forum is not the right way to vent them, especially if they were seen as divisive. However I hope that most readers understand that my emotional reaction was directed toward the people who do want to block honest debate. There ARE organized efforts to encccourage citizens to disrupt town hall meetings so that no discussion can take place, to yell and interrupt and intimidate. This is an intentional plan to get a specific response. There are claims made about healthcare reform that are known by the purveyors of these claims to be untrue – that would be an intentional lie, there is no way to get around that. And the precise intent of these claims is not just to mislead the public, but to frighten and anger them so that the “public debate” becomes one of “are you going to put granny to death or not?” rather than “how are we going to solve this problem?”. It is only the people who know these are lies and intentionally convey them that I am angry wiyh, not people who are now wondering “what is really true here?” and “should I be afraid or not?”. I will not back away from owning that anger and I hope many others feel angry about it too.

    Having said that though, I am sorry that I inserted it in a commentary about the importaance of healthcare reform, since I wanted my message to be a positive one. I do feel that we can constructively deal with the different points of view on the subject and work together to find solutions.

  21. By Madeline Diehl
    August 30, 2009 at 1:13 pm | permalink

    As one of the organizers of Saturday’s event, writing now after it has taken place, the thing I was most struck by was how very many people, even here in Ann Arbor, do not really understand what President Obama is proposing in his plan for healthcare reform. I know there have been intentional efforts by the opposition to mislead and confuse people, as reported in the press. And also, quite frankly, the proposed legislation can be a bit daunting to try to understand, even without that–the bill itself, right now, runs about 1,000 pages.
    If you want to educate yourself more on what the proposed legislation really says, but don’t have time to read the bill itself, the Kaiser Family Foundation has an excellent summary at:
    The website there has the capacity to search by topic if you are concerned about certain issues in the plan.

    Or, go straight to the source, and check out the White House’s own website at:

    The White House even encourages citizens to call up with their questions and concerns at:
    (202) 456-1414

    thanks to everyone who came out for the event Saturday morning to ask questions, express support, express honest disagreement, and also, to those many people who honked their horns and gave us their thumbs up in solidarity. And thanks to the Chronicle for giving us this forum as a way to get the word out.

  22. By Judith Schmidt
    August 30, 2009 at 9:11 pm | permalink

    We need to take a closer look at some other systems, including Germany. Take a look at this April 2009 Frontline series: link