Friday, August 15, 2003

Single-payer national health insurance redux.

As noted here on Tuesday, the Physicians' Working Group for Single-Payer National Health Insurance published their recommendations for such a plan in this week's JAMA (abstract only; full text requires subscription). Yesterday's Seattle Post-Intelligencer thoughtfully recommended that the debate should begin on the key questions posed by the doctors' group's recommendations ("Doctors diagnose health care woes":
"[JAMA editorialized that] 'American health care system and the American society face a real problem and are compelled to search for an answer.' . . . In the way of such an answer lie many questions. If we were to tax ourselves to provide a certain level of health care for everyone, what would that level be? How would that be decided and by whom? Who pays for what's not covered and how? Much disease is preventable through proper nutrition and behavior, while a huge portion of health care costs are incurred in the last months of life. Would public funding of health care necessitate a public policy debate on how the funding is allocated? Could an American national health plan be designed to offer the benefits of other nations' programs without the shortcomings? . . . The physicians have opened what should be a healthy -- and long overdue -- debate on an issue that literally touches everyone's life."
How much better a response to the doctors than the knee-jerk opposition of the AMA itself (as opposed to its mostly and almost always editorially independent journal, JAMA) and editorialists such as Jerry Heaster of the Kansas City Star. Heaster writes in today's paper that the announced decrease in physician reimbursements from the Medicare program next year, against the backdrop of Congressional debate over a $400-billion-Medicare-drug-benefit-we-really-can't-afford, highlights the ineptitude of the government when it comes to running really big, complex programs. He ends on a sourly populist note: "There are three ways to do things: the right way, the wrong way and the government way. This is a good example of the government way."

Okay, fine, Congress is blowing it big-time with this budget-busting drug benefit, and they have shown contempt, if not bad faith, in their dealings with physicians in recent years (and even going back some years before that, truth be told). But how much can we know about the operation of a national single-payer system from the history of a government program that is engrafted upon a market-based system? How, in other words, can Medicare possibly get out of the budgetary hole and regulatory morass it is in when it has to coordinate the functioning and financing of its benefits with an otherwise investment-driven and employer-dominated system? Maybe it will turn out that in the long run a single-payer system is a pig in poke and shouldn't be attempted. But we won't know unless there is honest debate on the kinds of important questions identified by the Seattle PI's editorial board, rather than chest-beating and snidely anti-government sloganeering.
posted by tommayo, 8:15 AM

Health care law (including public health law, medical ethics, and life sciences), with digressions into constitutional law, poetry, and other things that matter