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Universal health plan is endorsed
Universal health plan is endorsed
Thousands of doctors back proposal in JAMA
By Liz Kowalczyk, Globe Staff, and Amber Mobley, Globe Correspondent,
Thousands of US physicians have endorsed a broad proposal that would abolish
for-profit hospitals and insurers and transfer all Americans into an
expanded and improved Medicare program for all ages, reigniting the debate
over universal health care a decade after President Clinton's failed plan.
While the four physicians who wrote the plan -- three of whom are affiliated
with Harvard Medical School -- are members of a nonprofit organization that
has long pushed for universal health coverage, the new proposal is important
for two reasons: It was published today in one of the country's most
prestigious and its most widely circulated medical journal, the Journal of
the American Medical Association, and because of the large number of
doctors -- nearly 8,000, including two former surgeons general -- who
JAMA officials said it is unusual for the journal, which has a circulation
of about 700,000 worldwide, to publish an article endorsed by such a large
number of physicians. JAMA's editor, Dr. Catherine DeAngelis, said that an
editorial accompanying the article represents the journal's viewpoint that
it is time for the country to grapple more seriously with major problems in
the health-care system.
"Look, if you don't agree with this plan, it's not a foolproof plan, there
are plenty of problems with it, come up with something better," she said in
an interview. "Let the debate resume. It's sort of been on the back burner
and it's time we get on the stick with this. We are the only developed
country in the world that doesn't have a specific health plan for our
people. It's a disgrace. We have too many people not insured, and this is
In the editorial accompanying the proposal, Rashi Fein of Harvard Medical
School said one drawback of such a comprehensive plan is that it may be too
radical to pass the US political system, but that the doctors' proposal
"should re-energize the debate."
The plan, developed by the Physicians for a National Health Program, based
in Chicago, differs from Clinton's 1993 initiative in fundamental ways.
Clinton sought to avoid large new taxes, instead seeking to require all
companies to offer health insurance with federal subsidies helping small
employers, Fein said. The country's basic system -- employers buying health
insurance from nonprofit and for-profit insurance companies -- would have
The physicians' plan is more radical and more encompassing, including
coverage for the 41 million uninsured Americans as well as incorporating
ways to control costs by setting a national budget, providing a set amount
of money to hospitals for day-to-day operations and major expansions, paying
for nursing home and home care for the elderly, and developing a national
list of drugs the program would pay for.
The government would pay for health care through an expanded version of
traditional Medicare, the federal health insurance program for the elderly.
Most hospitals and clinics would remain privately owned and operated, and
the national health insurance program would pay them a monthly budget for
operating costs. Investor-owned facilities would be converted to nonprofit
status. Private insurance companies would be virtually eliminated. The plan
is endorsed by former surgeons general Dr. David Satcher, who served under
Clinton, and Dr. Julius Richmond, appointed by Jimmy Carter.
One of the doctors' arguments is that for-profit companies and multiple
insurers are diverting money from clinical care for the demands of business.
The physicians estimate that the country would save $200 billion annually by
eliminating profits of investor-owned hospitals and insurance companies and
by reducing administrative costs for hospitals and doctors who must bill
dozens of different insurance companies. Private health insurers now consume
12 percent of premiums for overhead, while Medicare and the Canadian
national health insurance system have overhead costs below 3.2 percent, the
Taxes, the doctors said, would increase. But except for the very wealthy,
higher taxes would be offset by the elimination of insurance premiums and
out-of-pocket copayments and deductibles, they argued.
Lead coauthor Dr. Marcia Angell, a senior lecturer at Harvard Medical School
and former editor of the New England Journal of Medicine, said during a news
conference in Washington, D.C., that the doctors want to curtail the
entrepreneurial aspects of medicine, where insurers and providers avoid
unprofitable patients and try to shift costs back to patients. But she said
they also sought ways to control costs amid skyrocketing insurance premiums.
Dr. Steffie Woolhandler and Dr. David Himmelstein, both physicians at
Cambridge Hospital and associate professors at Harvard Medical School, were
Critics and even advocates of universal health insurance said the doctors'
proposal has major shortcomings. Susan Pisano of the American Association of
Health Plans said private industry, not the government, has led the way in
adopting disease management programs and prescription drug coverage.
"Political pressures on Congress make change and innovation very difficult,"
Giving hospitals a set monthly budget is similar to a form of managed care
called "capitation," in which insurers paid doctors and hospitals a set
amount of money to treat patients. If they kept under the budget, providers
made a profit; if they exceeded the budget, they lost money.
But capitation is now being called a failure by many providers, because it
creates a financial incentive to limit care, and many insurers are moving
away from it.
Further, many health-care economists questioned whether the proposal is
realistic in the United States, given that even Clinton's more modest plan
Liz Kowalczyk can be reached at . Amber Mobley reported
ton, Liz Kowalczyk from Boston.
© Copyright 2003 Globe Newspaper Company.
© Copyright 2003 The New York Times Company
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