Excerpt from a communication received from a concerned member of Physicians for a National Health Program (PNHP)
"If we focused on universal access instead of single payer, we would have a much greater chance of dealing productively with these problems. If the resources, intelligence, and good will of PNHP were applied to formulating a universal access scheme incorporating the principles we espouse with the political and social realities that exist, we could move forward. We should even draft concrete proposals for universal access and present them to the political hopper. I do not believe that single payer per se has any real chance of occurring in this country. People who have dedicated their political lives (like Rep. McDermott and Sen. Wellstone) to single payer now admit that it won't be accepted.
"They have moved on - why can't we? I happen to believe that it is an error to have only one insurance vehicle, because there will be no choice for the consumer. Medicare can be as rigid and unfair as HMO's and we ought to have alternatives. The American people often blindly fear and reject government control of their lives; can we expect less of their health? We need to support a balance of power, not 100% centralization."
"Don, I am asking you to send this commentary out on your email list, so that the ideas therein have a chance to be aired and commented on. There out to be room in PNHP for dissent, and time is passing without a solid hope of improving this situation."
Comment: It has been a dozen years since the New England Journal of Medicine published the landmark article, "A National Health Program for the United States: A Physicians' Proposal," by David U. Himmelstein, M.D., Steffie Woolhandler, M.D., M.P.H. and The Writing Committee of the Working Group on Program Design (<http://www.pnhp.org/publications/NEJM1_12_89.htm>http://www.pnhp.org/publications/NEJM1_12_89.htm).
In that article it was stated:
"Most significant, the great majority of Americans support a universal, comprehensive, publicly administered national health program, as shown by virtually every opinion poll in the past 30 years. Indeed, a 1986 referendum question in Massachusetts calling for a national health program was approved two to one, carrying all 39 cities and 307 of the 312 towns in the commonwealth. If mobilized, such public conviction could override even the most strenuous private opposition."
So, why do we not have reform? We continue to ask ourselves that question. Inevitably, we question our own proposal, and now I am speaking as a board member of PNHP. Some suspect that our proposal must be defective, and look for alternative solutions. Today's quote is from a member who is genuinely concerned about the failure of the movement for reform. He very legitimately wants to bring up other options that may seem to be politically feasible. Before I was actively involved in PNHP, although a member, I myself devised a "brilliant" alternative plan, which proposed basic care, elective care, and excluded care as categories for different coverage options. I sent it to Claudia Fegan, M.D., then president of PNHP, and she returned an extensive critique, which, in retrospect, indicated to me that I was quite ill-informed on fundamental issues of health policy. But, foremost, she taught me a lesson that she learned from her father in his negotiations on behalf of unions, and that is that you do not ever put anything on the table at the start of negotiations. Never, never start from a compromised position. I am deeply indebted to Claudia redirecting me down the right path towards reform.
Although I presented only a couple of excerpts from the concerned physician's communication, some of the other options he proposed will be evident from my response. His concerns are very genuine, and his proposals seem to be logical extrapolations from possible explanations for the failure to achieve reform. I present my response both because many others have had similar proposals and we wish to present our concerns about these types of proposals, and also because we want to explain why we must stay the course.
Response to a concerned PNHP Member:
Dear Dr.