Doctors Group Calls for Single-Payer System

August 13, 2003
Nearly 9,000 doctors, including two former U.S. surgeons general and a former editor of the New England Journal of Medicine, have signed on to a drive to create a Canadian-style single-payer health insurance system.

Physicians for a National Health Program, a group based in Chicago, drafted a proposal published in the Journal of the American Medical Association, one of the country's top medical journals. They hope to jumpstart a movement among doctors and push the Democratic presidential candidates into embracing the issue.

The physicians call for national health insurance that would cover every American for all necessary medical care - in essence an expanded and improved version of traditional Medicare.

• Patients could choose to go to any doctor and hospital. Most hospitals and clinics would remain privately owned and operated, receiving a budget from the NHI to cover all operating costs. Physicians could continue to practice on a fee-for-service basis, or receive salaries from group practices, hospitals or clinics.
• The program would be paid for by combining current sources of government health spending into a single fund with modest new taxes that would be fully offset by reductions in premiums and out-of-pocket spending.
• The proposed single payer NHI would save at least $200 billion annually by eliminating the high overhead and profits of the private, investor-owned insurance industry and reducing spending for marketing and other satellite services.
• Administrative savings would fully offset the costs of covering the uninsured as well as giving full prescription drug coverage to all Americans.

The doctors argue that from both a moral and financial perspective, citing more than 41 million uninsured Americans and the death of 18,000 adults annually from lack of coverage. They also say their system would save at least $200 billion a year by eliminating the overhead and profits of the private insurance industry.

"Health care is an essential safeguard of human life and dignity and there is an obligation for society to ensure that every person be able to realize this right," the group quotes the late Cardinal Joseph Bernardin as saying.

But critics are numerous and include the American Medical Association, and interest in Congress is minimal to the point of being nonexistent. As long as Republicans remain in control, there is virtually zero chance of a single-payer system being instituted.

AMA President Donald Palmisano listed what he said were the shortcomings of a single-payer system:

• Long waits for health care services.
• A slowness to adopt new technologies and maintain facilities.
• Development of a large bureaucracy that can cause a decline in the authority of patients and their physicians over clinical decision-making.

Conservatives argued that the doctors overlooked much simpler, more workable ideas. "While sound ideas such as medical savings accounts are routinely dismissed, universal health care is a poor idea that just won't die," said Investor's Business Daily.

Those who support a single-payer system claim that besides providing universal coverage, it could be cheaper and more effective.

"A universal health care plan could merely be an extension of Medicare ... Instead of paying insurance premiums that have double-digit increases every year, employers would pay into a national fund - similar to the way they do with Social Security today," argued columnist Dave Zweifel of the Capital Times in Madison, Wis.

"That money, along with a substantial reduction in administrative costs - Medicare administration costs are estimated at about 2 percent to 3 percent, while private insurance company costs hover around 16 percent - could form the basis of a system that guarantees health coverage to every man, woman and child in America, Zweifel wrote.

"Obviously this is a political fight," said Dr. Gordon Schiff of Chicago's Stroger Hospital. "This will be a major issue in the election and there's a fight within the medical community." He said the 8,880 doctors who signed the petition were just the tip of the iceberg, noting there are more than 836,000 doctors in the U.S.

The Health Insurance Association of America called the proposal a "risky scheme."

The full text of the proposal is on the group's Web site.