A physicians' group proposal for universal coverage, published today in the Journal of the American Medical Association, would totally remake U.S. healthcare-abolishing private health insurance, for-profit healthcare and copayments and deductibles. Replacing them would be national boards that make coverage decisions, create drug formularies and approve capital projects.
"We endorse a fundamental change in U.S. healthcare," declares the Physicians' Working Group for Single-Payer National Health Insurance, in the JAMA article.
The group, which is affiliated with Physicians for a National Health Program, claims endorsements of the plan from more than 7,000 physicians and medical students.
Included are two former surgeon generals-David Satcher, M.D. and Julius Richmond, M.D., from the Clinton and Carter administrations, respectively-and former New England Journal of Medicine editor Marcia Angell, M.D.
But a decade after President Clinton's proposal for universal healthcare died in Congress, few politicians are stepping forward to endorse a single-payer system. Rep. Dennis Kucinich is the only Democratic presidential candidate to advocate such a system.
The AMA, the publisher of JAMA, disowned the proposal, saying it endorses a system "that builds on the strengths of our current system," according to a statement by AMA President Donald Palmisano, M.D.
Even Rashi Fein, Ph.D., an emeritus professor at Harvard Medical School and a supporter of the plan, concedes in an editorial accompanying the proposal in JAMA that it "may be too radical" to pass Congress. But he adds: "Those who reject its 'solution' are challenged to present (their) own, better and stronger one as a replacement."
The working group writes that the current system "generates huge administrative costs that, along with profits, divert resources from the clinical care to the demands of business. In addition, burgeoning satellite businesses, such as consulting firms and marketing companies, consume an increasing fraction of the healthcare dollar."
By eliminating expensive administrative overhead and duplication of facilities, the proposed national healthcare system would save at least $200 million a year, which would be more "than enough" to cover the uninsured, the group writes.
The article outlines some key aspects of the proposal. The proposed system:
- Abolishes private insurance: Private insurance would "undermine" the government program, the work group writes.
- Draws funds largely from taxes: "While it is critical that the vast majority of funds flow out to providers from a single payer in each region, the mix of taxes used to raise these funds is a matter of tax policy," the group writes.
- Requires healthcare facilities to become not-for-profit: Investor-owned hospitals, HMOs, nursing homes and clinics would revert to not-for-profit status. Investors would be compensated.
- Abolishes co-payments and deductibles: Out-of-pocket costs "discourage preventive care" and are expensive to administer, the group says.
- Creates regional health planning boards: These boards would allocate funds for capital projects.
- Creates wide sweep of coverage: In addition to medical care, the program would cover prescription drugs, equipment, long-term care, rehabilitation services and dental care.
- Establishes national drug formulary: An expert panel would create the formulary, and the program would negotiate prices based on cost, excluding marketing and lobbying.
- Creates board to determine coverage: Boards of healthcare experts and community members would determine which specific health services the government would cover.
- Allows three types of physician payment: Fee-for-service payments or salaries for physicians in institutions receiving global budgets or capitated payments.
- Provides lump sum payments to hospitals: Hospitals would receive a set amount of funds each month for operational costs.