By Mike Shields
Kansas Health Institute
KHI News Service
Nov. 6, 2008
KANSAS CITY, KAN. — More than 15,000 U.S. physicians, including some in Kansas, are calling on President-elect Barack Obama and the new Congress to enact a single-payer, national health insurance plan.
The plan, embodied in proposed federal legislation as HR 676, is sometimes referred to as “improved Medicare for all.” Medicare is the federal program that provides health insurance to those ages 65 and older. It was created in 1965.
Physicians for a National Health Program, which is headquartered in Chicago, sent a letter to Obama and congressional leaders urging them “to do the right thing” and enact a new national program they say would save the nation more than $350 billion a year.
“In large measure Sen. Obama’s victory and the victories of his allies in the House and Senate were propelled by mounting public worries about health care,” said Dr. Quentin Young, the group’s national coordinator. “Yet the prescription offered during the campaign by the president-elect and most Democratic policy makers — a hybrid of private health insurance plans and government subsidies — will not resolve the problems of our dangerously dysfunctional system.”
HR 676 has more than 90 co-sponsors, but has gained little traction since it was first introduced in 2003 by U.S. Rep. John Conyers, a Michigan Democrat.
One of those who signed the letter calling for a single-payer system was Dr. Sharon Lee, director of Family Health Care, a Kansas City clinic that serves the poor.
“The idea is to expand Medicare to cover everyone,” she said, “and by consolidating all the various government (health) programs under one administrative section it would significantly reduce cost and be able to cover the 48 million Americans currently uninsured.”
Dr. Joshua Freeman, chairman of the department of family medicine at the University of Kansas School of Medicine, also supports HR 676.
“I think it is absolutely critical that we have a universal coverage system,” Freeman said. “Every other industrialized country does and even some non-industrialized countries. Just like a fire department, a police department, health care is a core role of society.”
Freeman noted that an economist’s report on various health reform proposals considered last year by the Kansas Health Policy Authority showed that a state-based, single-payer system would save Kansans more than $1.2 billion a year on health spending because it would essentially eliminate insurance companies and the accompanying administrative costs.
The health policy authority did not present that proposal to the Kansas Legislature because its board members considered it politically unfeasible.
But Freeman said the idea of a single-payer system is the only reform proposal with genuine grassroots support.
“There’s only one movement for health reform and that’s for single payer,” he said. “There’s some support out there for premium assistance, tax credits, employer mandates, or some combination of all the above. But that all comes from politicians, policy wonks, academics. There’s no grassroots movement for any of those things and there is a grassroots movement for single payer. There is no other proposal out there that actually has people behind it.”
Freeman recently spoke to a Lawrence group that supports the passage of HR 676.
Lee is a member of a group formed about a year ago, Heartland Health Care for All. She said it is a citizens’ group that includes medical students, doctors, nurses, social workers, church members and others, “organized around the concept that everyone in the U.S. should have health care.”
She said the group is “strongly supportive” of HR 676.
A spokesman for the national physicians’ group said the election this week changed the political equation in ways that could help a single-payer system go forward.
Young, the group’s national coordinator, said at least five additional supporters of single-payer health reform were elected to Congress this week. U.S. Rep. Tom Udall, a New Mexico Democrat and co-sponsor of HR 676, was elected to the U.S. Senate. Young also noted that pro-single-payer ballot initiatives in 10 Massachusetts legislative districts “won by a landslide, on average receiving 73 percent of the vote.”
“A solid majority of physicians endorse such an approach,” Young said. “An April 2008 study in the Annals of Internal Medicine shows 59 percent of U.S. physicians support national health insurance. Opinion polls show two-thirds of the public also supports such a remedy. Now, with strong political leadership, this reform is within reach.”
Critics of a national, single-payer system say it would stymie innovation and competition.
Obama has said that a single-payer system might be a good idea, if the U.S. were starting with a blank slate. But since it isn’t, that solution would be problematic, though “over time it might be that we end up transitioning to such a system.”
His campaign Web site also includes these remarks by him quoted in The New Yorker magazine last year.
“‘If you’re starting from scratch,” Obama said, “then a single-payer system — a government-managed system like Canada’s, which disconnects health insurance from employment — would probably make sense. But we’ve got all these legacy systems in place, and managing the transition, as well as adjusting the culture to a different system, would be difficult to pull off. So we may need a system that’s not so disruptive that people feel like suddenly what they’ve known for most of their lives is thrown by the wayside.”
During the campaign, Obama proposed a plan that would build on the current employer-based health insurance system.
Meanwhile, top congressional leaders aren’t talking about a single-payer system.
U.S. House Speaker Nancy Pelosi has said the first health care bills likely from Congress now that Democrats have a stronger hand in Washington are an expansion of the State Children’s Health Insurance Program and funding for stem cell research.
But Freeman said the mood of the country might be such that the single-payer idea could finally come to pass.
“I’m never the greatest optimist,” he said. “But it’s a pretty amazing thing; this country just elected a Democrat, a black man. This is quite remarkable. Five years ago, if you’d asked me what would come first, a black president or national health insurance, I would have said national health insurance.”
Mike Shields is a staff writer for KHI News Service, which specializes in coverage of health issues facing Kansans. He can be reached at mshields@khi.org or at 785-233-5443, ext. 123.