CALIFORNIA ELECTIONS / PROPOSITION 186 : Study in Key Journal Praises Single-Payer System : Article written by backers of the initiative highlights disagreements among physicians over the measure, which would establish such a system in California.

Physicians backing Proposition 186, the universal health insurance initiative on the Nov. 8 ballot, say in a study published today that a single-payer system would improve many defects in the nation’s health care system.

The article in the Journal of the American Medical Assn., co-authored and researched by a number of Proposition 186 supporters, points up the deep divisions among physicians over the sweeping initiative, which would establish a single-payer system in California.

The doctors who wrote the article are among the 6,000 members of Physicians for a National Health Program, which endorses the measure. The 38,000-member California Medical Assn., the established medical group in the state, remains squarely opposed to Proposition 186.

The article in the prestigious medical journal does not mention Proposition 186, but supporters of the initiative jumped on it as if it were their own, releasing it at news conferences in Los Angeles and San Francisco.

Dr. Steve Tarzynski, a pediatrician with Kaiser Permanente in Inglewood who was part of the working group that drafted the study, said Tuesday that “both liberals and conservatives say you can’t have increased health benefits, at a decreased cost, and maintain quality. We say that’s wrong.

“They also say that if you want increased quality, you have to pay more. We also say that is wrong.”

The article argues that the nation’s health care system clearly does not offer “the best medical services in the world,” as proponents of the status quo insist. To support their arguments, the authors cite what they call examples of failure in the present system, including denial of care to the uninsured, disparities in quality of care by geography and economic status, lack of primary care, and inadequate or no prenatal care.

Citing nearly 100 references, most of them scholarly studies published in academic publications, the authors say that the medically uninsured are far more likely to die of serious illnesses, but also argue that those who have good insurance are likely to be subjected to expensive but only marginally effective or even harmful treatments.

The study criticizes the health reform plan put forward by President Clinton, which now appears dead, because it called for phasing in universal coverage over a period of years, would have maintained the role of health insurance companies in the health care system and would have maintained a system with different tiers, depending on how much money a person could afford to spend.

On each count, the article argues that a single-payer system would be a better alternative.

One of the authors, Dr. Andrew B. Bindman, a San Francisco internist, said one of the aims of the article was to try to turn the debate on health care reform from non-health-related issues to quality-of-care issues.

“The whole discussion has been sabotaged terribly,” Bindman said, referring to the debate over Clinton’s ill-fated package of health care reforms. “For weeks, all we heard was what big businesses and small businesses had to say about health care reform, whether they should have to pay or not, whether health reform would make one more competitive with the other.”

The authors of the article argue that it is possible to measure quality in a health system and put forward a list of principles that they say should be used as measurements. Among them, the physicians argue that any quality health system should provide universal coverage, treat all patients the same, establish continuity of care, create standardized medical records and emphasize preventive medicine.

The study was silent on one of the main criticisms that the California Medical Assn. has of Proposition 186--that it would create an elected office of health commissioner to manage the proposed state-run insurance system. The Proposition 186 system would cover all 31 million Californians, offer a uniform system of benefits and be financed through major increases in personal income and payroll taxes.

“Many of our members favor universal coverage and some kind of a single-payer system, but we don’t think Proposition 186 is the way to get there,” said CMA spokeswoman Danielle Walters. “We have had extensive experience with elective officeholders who control segments of our health care system, and we don’t think they have been successful.”

“Clearly, we don’t think the CMA speaks for all physicians in California,” said Steve Hopcraft, a spokesman for Californians for Health Security, the sponsors of Proposition 186. “The article speaks for itself. We win on access, we win on cost containment, we win on quality of care.”