Despite formidable foes, a group of physician-activists say they can push the issue of national health insurance to the top of the political agenda and eventually win legislative support for some form of single-payer system in the U.S.
With healthcare issues rated among the top priorities for voters, a clear focus on a national health plan will help any political candidate who decides to adopt it as a cause, predicted Quentin Young, a Chicago internist who is a longtime leader in the movement for national health insurance.
"Our polls show healthcare at the top of the public's mind," Young said. "The candidates can curry favor by saying they're giving healthcare a top priority in their campaigns."
Still, Young said he recognizes that the push for a single-payer system faces sizable obstacles.
"I have this sense of optimism that's maybe not based on realism," he conceded.
Almost 8,000 physicians, including Young, renewed the call for national health insurance earlier this month in the Aug. 13 issue of the Journal of the American Medical Association, denouncing the "irrationality" of a system that leaves about 41 million individuals without coverage.
The article, written by the Physicians' Working Group for Single-Payer National Health Insurance, was released about the same time Young and other physicians-including former U.S. Surgeon General David Satcher and Marcia Angell, former editor in chief of the New England Journal of Medicine-were holding press conferences across the country calling for universal coverage.
Young said the group hopes to succeed where politicians have failed. For many politicians, the issue has become radioactive since the collapse a decade ago of the Clinton administration's proposal for universal coverage.
The public relations blitz was designed to try to ignite political debate as the 2004 presidential campaign kicks into high gear. Only one Democratic presidential aspirant, Rep. Dennis Kucinich of Ohio, has expressed strong support for a single-payer plan.
"Nothing's going to get done if we don't talk about it," said Steffie Woolhandler, an associate professor at Harvard Medical School, co-author of the JAMA article and a founder of Physicians for a National Health Program.
While other countries, pressured by rising healthcare costs, have embraced a single-payer national health insurance system, "The United States alone treats healthcare as a commodity distributed according to the ability to pay, rather than as a social service to be distributed according to medical need," the article said.
Under the doctors' proposal, a national health insurance plan would save at least $200 billion annually by eliminating high overhead and profits for the private, investor-owned insurance industry. Administrative savings, the doctors believe, will offset the costs of covering the uninsured as well as providing full prescription drug coverage to every American.
But the proposal was rejected by the largest doctors' group, the Chicago-based American Medical Association, which believes a single-payer system would only create a new set of problems, including long waits for routine services and a big new bureaucracy.
"The AMA believes that a healthcare system based on a mix of private- and public-sector financing will best benefit the uninsured, improve quality, restrain costs and expand patient choice and individual purchasing power," AMA President Donald Palmisano, a New Orleans surgeon, said in a statement.
The Washington-based Health Insurance Association of America also was critical of the plan and pointed out that the group of doctors calling for a single-payer system represented only about 1% of the nation's physicians.
"Americans have consistently rejected calls for government-run healthcare-for example, last year in Oregon by a wide margin of more than 4-to-1," said Donald Young, president of the association, whose 300 members provide healthcare to about 100 million Americans.