By Joyce Marcel
Before Robert W. Backus M.D., who recently retired from family practice after nearly four decades at Grace Cottage Family Health in Townshend, rode off into the sunset, he had plenty to say about the state of the U.S. health-care system.
Backus was revered by the residents of the West River Valley as one of the last of the old-time country doctors. His involvement in the lives of his patients and his community was the stuff of legends.
Unfortunately, that era is gone, for many reasons.
I had a chance in January to spend a couple of hours with Backus for a story that appeared in both Vermont Business Magazine and The Commons [“A legacy of loving care,” News, Feb. 15]. With the defeat of the Republican attempt to gut the Affordable Care Act, it is worth revisiting some what “Doctor Bob” had to say that I wasn’t able to fit into this paper.
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Backus was open and honest about his frustrations with the way medicine is delivered today, and he said that it doesn’t have to be so complicated.
“When I started, we had a little white card with most of your life history on it,” he said.
“Those were the records. When you went to the hospital, the nurses had a blue clipboard with three sheets of papers on it. One was the vital signs, the next was the meds, and the third was the nursing orders.
“It was much more efficient than what we have right now. That’s because the government, insurance, and the legal industries interfere in the practice of medicine, so they mask the patient in a mound of paperwork and rules and regulations.
“You might have guessed I don’t do real well with that. I’m not a fool. I recognize you have to have laws and boundaries. But it’s just so overweening.”
Backus saved his special contempt for what medicine calls “best practices” and “meaningful use.”
“It’s meaningless data for meaningful use,” he said. “It’s this set of criteria imposed by the government and the pharmaceutical industry that drops down like little feathered raindrops and really stinks.
“One of the reasons I come at four in the morning is to look through the day’s patients and do a lot of the crap stuff you have to do to get paid. If you don’t do the meaningful use criteria — tick, tick, tick on the computer — when the bill goes out, you don’t get paid.”
Backus has supported a single-payer or national health-care system since the early 1960s.
“Which is why, in my medical school interview, when they asked, ‘What kind of health-care system do you envision?’ I said, ‘I envision a single-payer health care system.”
Asked to elaborate, he said, “I believe in a system where there is one form for all procedures, one insurance company — you, the government, financed on a non-regressive tax, monitored and mentored and run by the state using the best brains we have in the health-care industry.
“Cherry picking the good ones out of insurance and pharmaceutical companies. Build it and let it run.
“And that was in 1972. And the dean said, ‘Holy Christ, why didn’t you tell me that? I would never give you a chance to get in here.’”
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Today, Backus backs H.R. 676, which Rep. John Conyers, Jr. (D.-Mich.) introduces every year in the House of Representatives. This year, Conyers introduced the Expanded and Improved Medicare for All Act in January, and as of March 27, 72 House members have signed on in support of the bill, including U.S. Rep. Peter Welch, D-Vt.
“It’s Medicare for all,” Backus said. “If you look at what the U.S. has right now, Medicare, Medicaid, and the military insurance covers about 64 to 70 percent of the population.
“All you have to do is pick up the other 30 percent,” he said.
“And what did we do? This half-assed stupid Obamacare thing that just handed it to the people who want to crush it. And they’re gonna. And what’s going to happen to 36 million people who finally got insurance? A great flushing sound to the south. It sucks. I hate this.”
According to Backus, the United States has never had a coherent health-care system. He blames the pharmaceutical companies, the insurers, and the government for interfering in the practice of medicine.
For one thing, Backus is against what he calls “defensive medicine,” where a person in an emergency room gets over-treated.
“Say you fall and crack your head and you have a slight hint of being confused,” he said. “You go into an ER, and they are obliged to do a head CT, a complete history and physical, labs. And then they observe you.
“The costs go into the thousands. The medical establishment is defending itself from potential lawsuits. It’s following algorithms.
“The government is telling you this is the standard of care. It’s ‘best practices.’ But we’re lying to the public. We don’t know what best practices really are and what the standard of care really is.”
In the old days, when someone came in after falling and cracking their head, Backus would listen closely to the medical history.
“Because I would have the time for that,” he said. “And I would let you sit around for a while, and I’d just watch you. And we would have your phone number, and you would be called that evening and again the next morning to see that you were doing OK. And if there was anything worrisome, you would be told to come right back.
“That costs one-tenth of what that visit costs today. So there’s a cost saving right there.”
A while back, the state of Vermont asked Backus to lead a group charged with coming up with a good common benefit package. The group came up with several, but all were deemed too expensive. Nothing came of the project. But Backus still believes that common sense could keep costs down while still providing excellent health care.
The United States just has to develop a bureaucracy that works, Backus said, staffed with “the brightest and the best.”
“So cherry-pick the best out of the insurance companies and big pharma and put them to work.”
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Since attempting to build a single-payer health-care system turned into a financial and medical disaster for Vermont, the state is now pushing something called OneCare Vermont, a state-wide accountable care organization working with Medicare, Vermont Medicaid, and the Commercial Exchange Shared Savings Programs.
Backus is less than impressed.
“It’s a joke,” he said. “Here’s why. Across the world it’s never worked. The One Care model is based on squeezing savings. Vermont has the lowest costs and the highest productivity of any state in the U.S. in terms of medical efficiency.
“So you take a state that’s already squeezed the shit out of everything, and ask it to squeeze more, what are you going to get?
“You’ll go backwards in time. It just doesn’t work.”
Taking a leaf from the playbook of the late Sen. George Aiken, who famously told President Lyndon Johnson to claim victory in Vietnam and then leave, Backus offers Republicans in Congress a way out of the health-care morass.
“Were I they,” he said, “I’d do that Medicare for All and take credit for it. If they were smart politicians, they’d do that.
“It’s where we’re going to wind up eventually, or we’ll crash,” Backus said. “It’s stupid not to do it.”