National Physicians’ Group Urges Broad Federal Health Plan

Declaring “our health-care system is failing,” a national physicians’ group Wednesday proposed a comprehensive federal health plan that would abolish private insurance but still guarantee medical care for every American.

In news conferences around the country and in an article published today in the New England Journal of Medicine, doctors from Physicians for a National Health Program, a 1,200-member physicians’ group, made their case for a fundamental change in the way medical bills are paid.

At UC Irvine Medical Center in Orange, Dr. Howard Waitzkin, an internist and a founding member of the group, cited recent national surveys showing that there are now 35 million Americans with no insurance and another 20 million who are “under-insured,” with coverage that does not pay for all their medical needs.

Rekindles Debate

Though the plan currently lacks congressional sponsorship, its publication in the prestigious journal rekindles the debate about publicly financed health insurance within the medical community.

“As practicing doctors, teachers and researchers, we’re deeply troubled that many people can’t get the most basic health services,” Waitzkin said. “That has got to change.”

Dr. Jerome Tobis, a UC Irvine professor who chairs the medical center’s ethics committee, agreed, saying, “The health-care system today in America is a jungle, and correction is urgently needed.”

Physicians for a National Health Program’s solution is a plan, patterned after Canada’s 20-year-old national health insurance program, that proponents say would cut bureaucracy, do away with the “often unjust dictates of insurance companies,” save up to $50 billion annually but still allow patients to choose doctors, clinics and hospitals.

Instead of paying premiums to insurance companies, individuals under the plan would be taxed, paying an amount roughly equivalent to their premium into a new national health program. Most employers could expect to pay slightly less than they are now paying for health insurance benefits, proponents said.

As Waitzkin and the medical journal article described it, patients would not be billed for any medical service. Rather, all medical costs would be paid directly to providers through the federal program.

Under the program, regional or statewide payment boards would negotiate fees with doctors. Also, the boards would set budgets for hospitals, group practices and health maintenance organizations, a practice that would “eliminate billing,” according to the Physicians for a National Health Program article.

In addition, regional planning boards composed of “expert and community representatives” would decided whether a hospital or clinic could make capital outlays for new diagnostic equipment. That decision would be based on need and quality,” and “for-profit investment would be barred,” the journal article says.

Waitzkin and other Physicians for a National Health Program doctors said they would like to see demonstration projects in several states, including California, before the plan is enacted across the country. But they also hoped that their proposal, which currently has no congressional sponsor, would add new life to the controversy over national health insurance that has raged on and off again since the early 1900s.

According to figures from the California Medical Assn., 22% of all Californians have no medical insurance. In the Los Angeles-Long Beach area, 27% of residents are uninsured; 26% of San Diego County’s residents have no insurance, and 23% of Orange County residents have no insurance.

“What we hope is to spark debate,” said Dr. Isaac Taylor, retired dean of the University of North Carolina Medical School, who kicked off the group’s press conference in Boston on Wednesday.

That was the hope too of Dr. Arnold S. Relman, editor in chief of the New England Journal of Medicine, who published the Physicians for a National Health Program article, as well as another plan for national health insurance in today’s issue.

The second paper in the journal, written by Alain Enthoven and Richard Kronick of Stanford University Business School, proposed a less radical plan for universal health insurance. Their program would retain private insurance but require employers to provide coverage for their workers. Those not covered at work would contribute through taxes, and poor people’s coverage would be totally subsidized by the government.

The authors argued that a complete government takeover of health-care financing, such as the other group suggested, “would represent far too radical a change to be politically feasible in this country.”

Relman did not endorse either plan. But in what amounted to a call to arms to doctors, his editorial in the same edition referred to “our disastrously inadequate health-care financing system. . . .”

“Now is the time for our profession to make common cause with the government and with the major private payers in seeking solutions to a pressing social problem that is not going to solve itself,” he said.

Early reaction to the Physicians for a National Health Program plan ranged from quiet interest to flat rejection. Officials representing the multibillion-dollar insurance industry suggested that such a plan was absurd.

“We do not believe the American public wants a monolithic health-care system,” said Pat Schoeni, director of public affairs for Health Insurance Assn. of America, a Washington lobby that represents 350 national health insurance companies.

“I think there’s certainly problems with the (health) system. . . . Certainly people are not covered,” Schoeni continued. “But the vast majority of people have health care, and everybody has access to emergency care. You may be able to fix the pieces that are wrong without having to redo the whole system.”

Dr. William G. Plested III, a Santa Monica thoracic surgeon who is president-elect of the California Medical Assn., agreed that there is a “crisis” in health care because of the large number of Americans who are uninsured.

However, Plested also questioned whether U.S. consumers would accept a Canadian-style health plan in which high-tech medical supplies are rationed, with some clinics getting scanning machines but others only allowed to have X-rays.

“I don’t think the American consumer will stand for that,” he said.

Like Schoeni, Plested argued against “dismantling” the whole medical system.

But one consumer advocate, Dr. Sidney Wolfe, director of the Public Citizen Health Research Group in Washington, disagreed.

“Those who say, ‘It ain’t broke; don’t fix it,’ are wrong,” Wolfe said. “Our country is in a worldwide scandal with its failure to act. It’s the only industrialized country outside South Africa that does not have national health insurance.”

Wolfe said he agrees with “many elements” of the Physicians for a National Health Program plan, but “the point is we have to get a national health plan. . . .”

“Anyone who says we don’t need national health insurance is just off the wall,” he said.

Though Physicians for a National Health Program has no congressional sponsor for its national health plan, Waitzkin said, some elements of the plan are contained in pending national and California legislation.

In Congress, Sen. Edward M. Kennedy (D-Mass.) will continue to push legislation that would require all employers to provide health insurance for their workers, Kennedy spokesman Paul Donovan said. But unlike the Physicians for a National Health Program proposal, the federal government would play no role in the Kennedy plan.

“There’s no political support” for national health insurance, Donovan said.

However, in the House, Rep. Ronald V. Dellums (D-Berkeley) plans to reintroduce legislation to establish a national health service, Dellums’ aide Max Miller said. Under the bill, which has been pending in revised form since 1977, health care would be funded out of general revenues, progressive taxation of individuals and employer contributions. Under the plan community boards would select area health-care providers, Miller said.

Also in the House, Rep. Henry Waxman (D-Los Angeles) plans to reintroduce a measure, similar to the Kennedy bill in the Senate, that would require all employers, regardless of size, to enroll their workers in a health-care plan. It would also prescribe minimum health benefits for all employees.

In California, Assemblyman Dan Hauser (D-Arcata) plans to reintroduce a bill he first proposed in 1987 that would set up a California health insurance plan. The proposal, which died in committee last year, would not eliminate private insurance, Hauser said, but would require all employers to pay at least 50% of a worker’s health insurance costs.