The Problem With Incrementalism


For seven years, Dr. Ed Weisbart was the medical director at Express Scripts.

That would be medical director for the largest pharmacy benefit manager in the United States.

Express Scripts fills prescriptions for one in three Americans.

Are you a member of the military?

Express Scripts fills your prescriptions.

Express Scripts says it helps to control medical costs.

But that’s only an incremental change.

And Weisbart has come to see incremental change at the enemy of fundamental change.

Weisbart believes we need a single payer system.

Get rid of the major health insurance corporations.

And replace them with one public payer.

Weisbart retired from Express Scripts last year to devote his energies to promoting a single payer system in the United States.

Weisbart started out as a family physician in Chicago.

He practiced 20 years in Chicago and then another nine in St. Louis before joining Express Scripts.

He now still volunteers once a week at free clinics in the St. Louis area.

But his passion is for single payer.

He can’t get excited about Obama’s health care law.

“I realized that if you are working toward incremental change you are in many ways working to oppose fundamental change,” Weisbart says.

“That became increasingly unacceptable to me,” he says.

Weisbart says that given the way health care is now organized in the United States, companies like Express Scripts “serve an important and vital role.”

“But it’s much more important to move toward a single payer system,” he says.

“Express Scripts is an ethical quality focused organization that believes it is providing part of the solution to health care crisis,” he says.

“But their solution is dependent upon the current insurance based model.”

“They believe that lowering the cost of health care makes it more available.”

Would a single payer system put Express Scripts out of business?

“It could,” Weisbart says. “Somebody would have to manage the pharmacy benefit for all Americans.”

The single payer could fill the prescriptions, or the single payer could hire a company to fill them.

During the next round of health care reform, would big business come out in favor of a single payer system?

“This is the question that most consumes me now,” Weisbart says. “I have two students right now working on analyzing this.”

“I understand there are surveys that have shown that the majority of business owners support a single payer strategy,” he says. “So the question is – why aren’t they stronger advocates?”

There are two theories.

“While they might want single payer to reduce their costs, big business asks the question – if the government gets more involved in health care, won’t they get involved with our business?”

“The second is the thought – the government can’t run programs efficiently.”

Weisbart says that two big business sectors would lose big under a single payer system – the health insurance industry and the drug and device industry.

The vast majority of the savings from implementing a single payer system come from the 30 percent in administrative savings you get by eliminating the health insurance corporations.

And a single payer would also be a single purchaser – thus driving down the costs of drugs and devices.

“It’s clear to me that there isn’t going to be a single politician who is going to bring us the kinds of changes we desperately need,” Weisbart says. “We need to continue to advocate for popular consensus, a cultural shift to where we clearly state that current system is unacceptable.”

“Survey after survey show Americans want the principles of single payer. We have a ready populace that wants what we are talking about.”
Weisbart says there are two events that are coming up that could put single payer front and center on the political stage.

One is the Supreme Court decision on Obama’s mandate.

That decision is due in late June.

“If the Supreme Court upholds the vast majority of Obama’s law, that decision is not going to advance single payer in the United States,” he says. “If they uphold it, it will be difficult to gain much traction with the country until 2015.”

“If they reverse it, Americans will be back to wanting some short term and long term solution.”

“It is really obvious that this law comes no where near to what the country needs,” Weisbart says.

“It will do almost nothing to control medical bankruptcy, or affect the plight of the uninsured, and it will possibly exacerbate the plight of the underinsured.”

When making the case for single payer, should activists use the term single payer or Medicare for all?

Weisbart says it depends on who you are talking to.

When talking to doctors, use single payer, not Medicare for All.

“Don’t say the word Medicare to doctors – they are thinking low reimbursement, high deductible, high co-pays and a limited benefit.”

“But the term single payer resonates with physicians – they have 20 or 30 or more insurance companies to deal with and they want to deal with just one.”

When it comes to patients, use Medicare for All.

“Patients have only one payer – the insurance company – so they don’t understand what single payer means.”

“They know that their parents grandparents love Medicare,” he says.”They want Medicare, and they want to give it to every American.”

Russell Mokhiber edits Single Payer Action.


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