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PHILADELPHIA - In a sign of physicians' growing discontent with the troubled U.S. health care system, more than 8,000 doctors and medical students have endorsed a proposal for government-financed health insurance that would cover all Americans.
"This offers Americans a true health safety net," former Philadelphia health commissioner Dr. Walter Tsou, who helped draft the proposal, declared Tuesday at a press conference at Philadelphia's City Hall. "It's a plan whose time has come."
The ambitious outline for reform, published in Wednesday's Journal of the American Medical Association (JAMA), was developed by Physicians for a National Health Program, a Chicago-based nonprofit organization that has been pushing for a single-payer insurance system since its inception 16 years ago.
Although the endorsers represent less than 1 percent of the nation's doctors and medical students, the list of signatories is burgeoning daily. That is a direct reflection, observers agree, of physicians' outrage over managed-care policies, the number of uninsured Americans, malpractice insurance costs, Medicare deficits and inadequate prescription drug benefits.
Dr. Ida Hellander, executive director of Physicians for a National Health Program, which has seen membership jump by 1,500 to 10,000 in recent months, said, "For a long time, it was difficult to get any interest in a health care plan. Now, the debate is back on the political agenda."
Spurring discussion is what JAMA aimed to do in publishing the peer-reviewed proposal and an editorial titled "Universal Health Insurance - Let the Debate Resume," said editor-in-chief Catherine D. De Angelis "What (the editorial writer) says and what we believe is: Look, this proposal is not fool-proof But at this point, what we have is not working. Tell us what would be better."
Ed Howard, executive vice president of the Alliance for Health Reform in Washington D.C., a nonpartisan information and education organization, said that a decade ago, it would have been "unheard of" for 8,000 doctors to get behind a single-payer proposal.
Discontent "has been creeping in as managed care has taken over more and more of the marketplace," Howard said. "It's a recognition that, as bad as Canadian doctors may have it, no one tells them how to practice medicine."
Canada and all other industrialized nations have adopted government-financed universal health insurance coverage, and they spend about half as much on health care as the U.S.
The Clinton administration's proposal for a version of universal coverage went down in flames 10 years ago as critics raised the specter of rationed care, lost jobs and less choice of doctors.
Health maintenance organizations arose and successfully arrested spiraling health care costs, but not without limiting treatments, lowering reimbursements, shifting costs and vastly increasing administrative paperwork.
"In this market-driven system, insurers and providers compete not so much by increasing quality or lowering costs, but by avoiding unprofitable patients and shifting costs back to patients or other payers," declares the proposal for single-payer insurance. "This creates the paradox of a health care system based on avoiding the sick."
By eliminating high overhead costs and the role of the for-profit insurance/managed care industry, a national health insurance program could save $200 billion annually - more than enough to cover the 40 million uninsured and 60 million underinsured Americans, the proposal contends.
But a recent Kaiser Family Foundation poll found that while a majority of Americans think increasing health insurance coverage is an important issue, there is little agreement on how to do it, or how to pay for it. About half of Americans say they would not be willing to pay more taxes to cover uninsured Americans.
"We'll never get" national health insurance, said Uwe E. Reinhardt, a Princeton University professor of economics and public affairs. "The bottom line is that that's not the American way, to be my brothers' keeper. We are a self-centered, hard nation."
Reinhardt, who advocates national insurance, says the prospect of saving money by driving out private industry has little appeal. "The American health system is run for the market," he said.
Howard agreed: "The idea of trying to cut out a major player - namely, insurance companies - is a prescription for blood in the streets." Still, even those who think the Physician group's proposal is unrealistic see change as inevitable.
"Those who do not (like the proposal) should develop and propose something better, more effective, and with fewer untoward side effects ," Harvard Medical School health policy expert Rashi Fein wrote in the JAMA editorial. "The 'health care mess' is too real for anyone to ignore it."
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(c) 2003, The Philadelphia Inquirer. Distributed by Knight Ridder/Tribune News Service.
