A Question of Access
Medical Economics
May 24, 2002
Memo from the Editor
By Marianne Dekker Mattera
At its Annual Session in Philadelphia last month, the American College of Physicians-American Society of Internal Medicine announced a plan that is supposed to ensure that all Americans have health insurance coverage within seven years.
According to ACP-ASIM incoming president, Sara Walker, the plan is meant to build on the health care system already in place in this country, not replace it with the sort of single-payer systems found elsewhere around the world.
I find it difficult to believe that the ACP-ASIM plan stands much of a chance.
Why? Because the organization hasn't answered the hard questions. When asked who's lined up in Congress to sponsor the plan, they had no answer. (In fact, at press time the plan hadn't even been mentioned on the Hill yet.) When asked how much their plan is likely to cost, they had no answer.
Well, actually that's not quite true. We were told that they deliberately didn't do the calculations because they wanted to focus not so much on what insuring everyone would cost, but on what not insuring everyone would cost. Trouble, is, they didn't have numbers for that either.
Frankly, without numbers no one in Congress is going to back this plan-or any plan. Especially not in an election year.
You can't leave the really hard work-gathering the financing numbers that will make or break any health care reform measure-to someone else. I know I'm never anxious to champion a new proposal that means I have to do a lot of the legwork before I can take it any further. I can't imagine even one member of Congress will be thrilled about doing that either.
I'd urge the ACP-ASIM to go back and do some of that legwork. They might also think about how they're going to twist enough arms to get the measures through Congress once they convince someone to introduce it.
For the full editorial: <http://www.memag.com/be_core/m/index.jsp>http://www.memag.com/be_core/m/index.jsp, then, under "In this issue" click "More," then click "Memo from the Editor: A question of access."
Comment: The legwork on financing has been done. Numerous studies, the latest being the landmark California Health Care Options Project, have demonstrated that proposals such as that of ACP-ASIM which build on the current inequitable system will significantly increase costs. For California, that increase is about $3 billion per year. On the other hand, single payer models that would provide comprehensive services for everyone would save Californians about $7 billion per year. Merely multiplying those numbers by a factor of ten would provide a very reasonable estimate of the national financial implications of reform. Reform is not being stalled for the lack of numbers. We have those.
But what about the political legwork? A large minority in Congress personally support national health insurance. But since Americans are not clamoring for comprehensive reform, and many remain sensitive to the Clinton debacle on reform, most politicians are not willing to take a public stance that might risk a negative response from their constituency. The politicians may listen to the PACs, but they will not act on such a sensitive issue until they believe that they have the overwhelming support of the public.
Unfortunately, our citizens are still willing to reject affordable, comprehensive, high quality health care services for everyone, through a program of national health insurance, merely because of their infatuation with anti-government rhetoric. Like many other foolish infatuations, the consequence is a terrible price to pay.