Mass. Doctors Push for Single-Payer

by Dollars and Sense

We found a link to this on, of all places, Marginal Revolution—hardly a lefty site!—in a list of "Assorted Links" under the title "How is the Massachusetts health care plan working out?" The headline of the original link is a little misleading, since it suggests that (a majority of?) doctors in Massachusetts favor single-payer, but the report is really about Mass. docs who are members of Physicians for a National Health Program. But polls have shown that a majority of doctors in the United States favor single-payer, so I wouldn't be surprised if a majority in Mass. did too (especially given some of the snags of the new Mass. "universal" system).

Meanwhile, in today's New York Times there's an article about closed-door sessions with the ailing Mass. Sen. Ted Kennedy to hammer out a consensus about what kind of health care reform congressional Democrats and the Obama administration should go for. "Lobbyists for a wide range of interest groups—some of which were involved in defeating national health legislation in 1993-4—are meeting with the staff of Mr. Kennedy, Democrat of Massachusetts, in a search for common ground." Lots of mention of insurance industry and big pharma lobbyists; no mention whatsoever of single-payer as an option. Forcing people to purchase insurance from private insurers is these folks' idea of universal health care. Similarly, Wednesday's Times reported that Kathleen Sibelius, governor of Kansas, is a leading candidate to be O.'s nominee for Secretary of Health and Human Services. The article quotes an insurance industry lobbyist as saying that she'd be a great pick: "Karen M. Ignagni, president of America's Health Insurance Plans, said Ms. Sebelius would be 'a very smart choice' for health secretary."

Check out this article we ran last year on the high costs of the current system, many of which would remain under a compulsory "universal" system of the sort O. seems to be moving toward. And our March/April issue will include an article on management costs and how single-payer does better.

Now here's that piece on the Mass. PNHP doctors:

Massachusetts doctors say single-payer or bust

By Sarah Arnquist

Massachusetts members of the Physicians for a National Health Program released a report today faulting the state's experiment with health reform for failing to achieve universal coverage, being too expensive and draining funds away from safety-net providers.

The doctors' punch line is that the reform has given private insurance companies more business and power without eliminating vast administrative waste. In fact, it says, the "Connector" in charge of administering the reform adds about 5 percent more in administrative expenses.

In summary, nothing less than single-payer national health reform will work, according to authors Drs. Rachel Nardin, David Himmelstein and Steffie Woolhandler, all professors at Harvard Medical School.



The report criticizes the Urban Institute's largely favorable report that found only 2.6 percent of Massachusetts' residents were uninsured in mid-2008 because it failed to sufficiently reach non-English speakers in its survey.

Reports in Health Affairs this winter also found significant positive support for the reform among employers and the public. There was little evidence of crowd-out.

The PNHP doctors' report says health plans people are forced to buy are not affordable and often skimp, making the mandate that individuals buy them regressive. And moreover, it says, peoples' experiences have shown that insurance does not guarantee access to care. The Boston Globe chronicled the long wait for primary care last September.

A final criticism the 19-page report offers is that the reform is financially unsustainable, as it does "nothing about a major driver of high health care costs, the overuse of high-technology care such as CT scanners and surgeries, and the underdevelopment of primary care."

Last winter, Himmelstein spoke about health reform to students at Johns Hopkins School of Public Health. I asked him if single-payer advocates would work against any national reform effort that wasn't single-payer, as the single-payer camp did in California.

Himmelstein said that if the reform plan looked like the Massachusett's reform he probably would prefer the status quo. He believes the reform has made most vulnerable patients in Massachusetts worse off.

It looks like health reform is going to be a battle on the Left and Right.

Labels: health care, insurance industry, Kathleen Sibelius, national health insurance, Physicians for a National Health Program, single-payer

 

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2/20/2009 11:04:00 AM