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Commentary: National health debate needed

By
ELLEN BECK, United Press International

WASHINGTON, Aug. 13 (UPI) -- America needs to begin the debate over whether the country should adopt a government-run national health insurance program covering every citizen -- as the United Kingdom, Canada and others have done.

America does not need its physicians skewing the debate by using this very serious issue -- there are 41 million uninsured Americans -- as a cover for a strategy to protect their six-figure incomes and get rid of the biggest thorn in their sides, the health insurance industry.

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The goal of the National Health Insurance program proposed by the Physicians' Working Group, found in this week's Journal of the American Medical Association, is lofty and pristine: Provide quality health care and prescription medicines for all Americans regardless of ability to pay. The vehicle suggested to do this -- the seniors health care program Medicare -- could possibly be expanded to accomplish this goal.

Beyond that, the proposal smacks of physician revenge for the restrictions of managed care in the 1990s and budget cuts by for-profit hospitals and health care facilities.

To be fair, this is not coming from a majority of American doctors. Though more than 9,000 physicians have signed on to the plan, there are more than 700,000 physicians in the United States.

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The idea is that $200 billion spent each year on administrative overhead -- heaps and piles of paperwork -- by America's multi-payer health insurance system could be saved with a system in which the federal government became the single payer. The Physicians' Working Group said that amount would be enough to pay for national health insurance. In fact, the group contended it is the only way such a program can work.

Questions remain, however, about health care inflation, utilization issues and taxes -- which would have to increase under such a program.

Medicare overhead runs at 2 percent to 3 percent per year, making it very efficient compared to the 12 percent spent by many health insurance companies. Medicare, however, covers 40 million Americans and the big question mark is whether adding another couple hundred million people to the program would not, in fact, increase overhead just by the sheer volume alone. The PWG proposal does not answer that question and is rather short on functional details.

The $1.6 trillion America spends annually for health care would not be reduced under this proposal, but millions would be redirected from the insurance industry to the government and then to health care providers. Here is where it gets dicey: The private insurance industry would not be a player in the NHI program and would not be allowed to compete with it.

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"The insurance/HMO industry's role would be virtually eliminated," the JAMA article said. "Most of the funds to expand care under NHI would come from eliminating insurance company overhead and profits, as well as the administrative expense they impose on health professionals and hospitals."

The proposal doesn't leave those thousands of insurance industry workers out in the cold however. "National health insurance would eliminate many administrative and insurance worker positions, necessitating a major effort at job placement and retraining," the JAMA article said. "Many of these displaced workers might be deployed as support personnel to free up nurses for clinical tasks; others might be retrained to staff expanded programs in public health, home care and the like."

That could be translated into highly educated and trained insurance industry personnel doing anything from emptying bedpans to entry-level clerical work.

After doing away with health plans, the next enemy of physicians is the for-profit health care system.

One of the principles of the PW is stated as: "Pursuit of corporate profit and personal fortune have no place in care-giving. They create enormous waste and too often warp clinical decision making."

Part of the plan, therefore, is to phase out investor-owned health care facilities -- those same for-profits that forced tough contracts on physicians over the past 10 years -- and convert them to non-profit. The government would pay the non-profit hospitals a lump sum -- that "capitation" word doctors hate so much when it is applied to them -- to provide care.

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"These reforms would shift resources from bureaucracy to the bedside, allowing universal coverage without increasing the total costs of health care," the group wrote.

Health care is no stranger to for-profit entities, which often drive research and innovative development. To eliminate them because of instances where poor financial decisions were made on the part of some hospital administrators to benefit the bottom line is not how American business works and it ignores the fact government also can be corrupt, bloated and wasteful of taxpayer money. Fix the problems but don't damn the entire for-profit sector.

Physicians, on the other hand, take care of their own in this proposal. Doctors could charge fee-for-service -- with a binding fee schedule set up by the NHI and organizations representing fee-for-service practitioners, such as medical associations. Sounds like doctors setting their own fee schedule. Physicians also could choose to be paid a salary by a hospital or health care facility.

Physicians have a right to complain about some of managed care excesses and restrictions, about huge administrative and paperwork burdens, about corporate bottom lines and shareholder expectations corrupting quality and quantity of care. There is plenty to gripe about in today's heath care system. This proposal, however, is draconian when it doesn't have to be.

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First, if the plan is to expand Medicare into the NHI, it is necessary to look at how Medicare is administered. While shooting venomous arrows at private health plans this proposal seems to conveniently forget it is the health insurance industry that provides administrative support for Medicare. The Centers for Medicare and Medicaid Services has divided the country into regions with "carriers" -- often Blue Cross/Blue Shield plans -- administering Medicare billing and making coverage decisions throughout that area.

Talk about paperwork. Medicare regulations and requirements run into the thousands of pages.

Earlier this summer Sen. John Breaux, D-La., along with health care associations and private insurers, proposed a national health insurance system using private plans but administered by the government. It has the same fundamental goals as this physician plan without gutting an entire industry and carving a chunk out of for-profit capitalism upon which America is based.

In the Breaux plan, private insurers would be required to offer comprehensive health plans, including prescription drugs, with the government providing a subsidy and ensuring low-income people and the uninsured had adequate basic coverage. This plan also maintained consumer choice - which is high on most consumer priority lists - so that people could choose to pay for a more generous plan if it fit their needs.

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The physician plan would eliminate choice, putting everyone under one system with special "boards" created to determine which medical services would or would not be covered.

Both plans would face enormous challenges and problems and neither might work nor be right for America. That debate has yet to take place among taxpayers who would foot the bill one way or another for any universal type of health insurance.

Realistically, a plan that does away with private health insurance is going to face intense opposition on Capitol Hill from the insurance and the for-profit health care industries. A plan that creates a huge government entitlement program without private sector involvement also is not going to be popular among Republican lawmakers and will go nowhere in a Republican-led Congress and a Republican White House.

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