By Quentin Young, Physicians for a National Health Program - PNHP
http://www.pnhp.org/letter
We invite you to join in endorsing the "Open Letter to the Presidential Candidates" on single payer national health insurance. After gathering endorsements, we will release the letter to the media and publish it, along with a list of signatories, as an advertisement in major newspapers and magazines.
In this critical election year physicians have a professional obligation to educate the American public on the severity of the health care crisis, and to prescribe an effective remedy.
We seek support from doctors in all specialties. We have already signed up more than 250 physicians in Massachusetts, where this effort began, reflecting disappointment in that state's widely-touted but deeply flawed health reform.
As physicians, we have seen the numbers of uninsured and underinsured soar, costs skyrocket, and quality deteriorate. Meanwhile, doctors drown in a sea of bureaucracy.
It doesn't have to be that way. The United States has an incomparable health care workforce and abundant technical resources. Furthermore, we already spend more than enough to provide excellent care for everyone -- if we had a rational system. But hundreds of billons are wasted each year on private insurance bureaucracy.
What we need is single-payer national health insurance. Only single payer would eliminate the high corporate overhead, profits, and enormous inefficiencies of shifting costs from one payer to another, freeing up funds to cover the uninsured.
Single payer support among physicians is growing. Recently, the American College of Physicians for the first time endorsed single payer reform. Polls of physicians in both Minnesota and Massachusetts have found that nearly two-thirds favor single payer, mirroring a recent AP poll in which 65 percent of the public supported "guaranteed, taxpayer financed health care program like Medicare" for all Americans.
With discussion of health reform back on the front burner, physician activism is more critical than ever before. A striking display of support for national health insurance can help reshape political debate to reflect its wide popularity. As lesser reforms -- such as that in Massachusetts -- predictably fail, it's especially important to deliver the message that real reform can work.
Please join in this initiative. The health of our patients and the future of our profession is at stake. Sign on athttp://www.pnhp.org/letter
Sincerely yours,
Marcia Angell, M.D.
Past Editor-in-Chief, New England Journal of Medicine
Senior Lecturer, Harvard Medical School Quentin Young, M.D.
National Coordinator, Physicians for a National Health Program
Past President, American Public Health Association
Bernard Lown, M.D.
Nobel Laureate Gerald E. Thomson, M.D.
Prof. of Medicine Emeritus, Columbia University
Past President, American College of Physicians
An Open Letter To The Candidates On Single Payer Health Reform
America's health care system is failing. It denies care to many in need and is expensive, error-prone, and increasingly bureaucratic. The misfortune of illness is often amplified by financial ruin. Despite abundant medical resources, care is often inadequate because of the irrationality of our insurance system. Yet our political leaders seem intent on reprising failed schemes from the past, rejecting the single payer national health insurance model that is the sole hope for affordable, comprehensive coverage.
Leading Republicans propose tax incentives to encourage the uninsured to buy coverage, but these subsidies fall far short of the cost of adequate insurance. For cost control, they suggest high co-payments and deductibles. Yet these selectively burden the sick and poor, discourage preventive and primary care, and have little effect on costs, since seriously ill patients - who account for most health spending - quickly exceed their deductibles and are in no position to forego expensive care.
Most leading Democrats offer a mandate model for reform. Under this model, the government would require people (or their employers) to buy private coverage, while offering an expanded Medicaid-like program for the poor and near-poor.
Variants of the mandate model, first proposed by Richard Nixon, were passed with great fanfare in Massachusetts (1988), Oregon (1989) and Washington State (1993). All died quiet deaths. As costs soared, legislators backed off from enforcing the mandates or funding new coverage for the poor. Massachusetts' recent reform, which largely excuses employers from the mandate but imposes steep fines on the uninsured, appears poised to follow a similar path. Of the middle-income uninsured who are required to pay the full premium for coverage, few have signed up. Meanwhile, the state has already announced a $147 million shortfall in funding for subsidies for the poor.
Mandates and tax incentives can add coverage only by increasing costs. They augment the role (and profits) of private insurers, whose overhead is four times Medicare's, and whose efforts to avoid payment impose a costly paperwork burden on doctors and hospitals. The cost cutting measures often appended to such reforms - computerization, care management and medical prevention - have repeatedly failed to yield savings.
In contrast, single payer reform could realize administrative savings of more than $300 billion annually - enough to cover the uninsured, and to eliminate co-payments and deductibles for all Americans. It would also slow cost increases by fostering coordination and planning.
Political calculus favors mandates or tax incentives, which accommodate insurers, drug firms and other medical entrepreneurs. But such reforms are economically wasteful and medically dangerous. The incremental changes suggested by most Democrats cannot solve our problems; further pursuit of market-based strategies, as advocated by Republicans, will exacerbate them. What needs to be changed is the system itself.
We urge our political leaders to stand up for the health of the American people and implement a non-profit, single payer national health insurance system.
Sign Letter at: http://www.pnhp.org/letter


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