Retired Physician Shares Article he Wrote for Physicians for a National Health Program

April 11, 2018

Dr. Robert Kline has shared an article with the Western Carolina Medical Society that he wrote for Physicians for a National Health Program.  Dr. Kline eagerly wanted to share with his colleagues from WNC. Read the article below. 


Dear colleagues,

I have worked for 32 years as a physician in Western North Carolina. Since retiring from practice in October, I’ve become involved with an organization at the leading edge of improving healthcare in America: Physicians for a National Health Program (

Most of you are familiar with the many roadblocks to care in the current system:

  • fluctuating insurance regulations
  • byzantine billing policies
  • recurrent challenges to your clinical decisions
  • arbitrary formulary fluctuations
  • constantly changing pay for performance schemes (often devoid of clinical rationale) unique to each insurance company
  • shifting patient eligibility standards
  • routine denials of usual and customary charges
  • and chaos when an entire hospital system was excluded by a near-monopoly insurance company

Who in medicine hasn’t heard patient complaints over inadequate coverage, pharmaceutical expense, and skyrocketing  deductibles despite ever escalating insurance premiums? We witness patients forgoing even basic care because of prohibitive costs. There are no easy answers, but I cannot believe that all other developed countries have deluded themselves into settling for substandard medicine when they opt for some variation of single payer universal healthcare.

Despite the world’s highest per capita health spending, the US ranks dismally on multiple outcome measures when compared to our peers in countries of comparable size/wealth who’ve adopted single-payer systems. This includes: overall mortality; deaths attributable to lack of health insurance (45,000/year); hospital admissions for preventable diseases; rates of medical, medication, and lab errors; infant mortality; and years of life lost to treatable diseases (Kaiser Family Foundation and The Commonwealth Fund).

In its current form, Medicare is far from ideal. However, as with other developed nations, we could eliminate the wasteful middlemen of the insurance industry and devote adequate funding for a federal single payer, providing coverage for comprehensive universal healthcare. Unlike protocol in every other similar country, Medicare is prohibited from negotiating prices from pharmaceutical companies which would save $145 billion savings over 10 years, according to the Congressional Budget Office. A Kaiser Family Foundation poll in 2016 found such negotiations are favored by 82% in our country.

Politicians raise the specter of “government rationing” as an objection to single-payer systems, when in fact we currently face rationing based on ability to pay and based on inability to navigate a bewildering menu of health insurance options.

Most countries with universal single-payer healthcare preserve patient choice of provider. A single-payer healthcare system is not “socialized medicine like Great Britain” because while publicly funded, doctors could retain the option of private practice and hospitals could be private or nonprofit.

The crucial question for me: is the current model of American medicine sustainable? CMS found Medicare spending grew 3.6% in 2016 (20% of National Health Expenditure [NHE]), whereas private health insurance grew 5.1% (34% of NHE). Recent polls find 60% of all Americans, including 46% of Republicans and 56% of physicians, now favor some variation of Medicare for all. Proposed legislation has been advanced (e.g. HR 676 and S. 1804). I think any rational solution to the healthcare crisis should be physician led, and that it’s time for those who have actually practiced medicine to get out in front of this effort to improve healthcare in America. Do we really want to leave this entirely to politicians beholden to the very industries they are supposed to oversee, to the flotilla of pharmaceutical and insurance lobbyists? Are we really comfortable with the status quo?

Although I loved my patients and the art of medicine, I too often felt like a doctor interrupted, and I chafed against a deeply flawed system that stood between me and those I served. I hope that, together, physicians and patients can successfully advocate for sensible change and enjoy a stable healthcare system for years to come.

Thanks to all of you persevering in practice, and who still contribute to this phenomenal medical community.

Robert S. Kline MD