From NEJM: Doctors on Coverage — Physicians’ Views on a New Public Insurance Option and Medicare Expansion

BE, you should send this link to Senator Baucus and his crew as well as to the President's staff. I think it is a common misperception that physicians as a whole are not in favor of a single-payer plan or the public option. Let's try to correct that misperception! I know that every single physician I know is in favor of a single payer system. And, believe it or not, I am not usually the one bringing it up! But I am in Massachusetts and I think we are seeing that the abuses by the Insurers continue despite "universal coverage". We here in Massachusetts are ready for something more...but the rest of the nation is five years behind us. I know that a single payer system is not an option right now on the national level, so let's hope that heavy regulation (I know "regulation" is a dirty word but that is what it is) of the insurers can have the same effect...

I don't think many anesthesiologists support the single-payer plan, especially if it is based on Medicare. Medicare pays so poorly that it would destroy our specialty.

In addition, I think we all should be wary of putting all our eggs in one basket. If that basket is the U.S. government -- which has astronomical debt already and keeps spending and spending and spending -- guess what will happen when costs need to be cut? That's right, Congress will cut physician pay and there will be nowhere to shift the costs this time. Putting the evil insurance companies out of business is tempting, but things could be even worse than they are now if we go to single payer. Be careful what you wish for.

I have read some of the threads but not all. I lived in Spain for over 15 years and have first hand experience and knowledged about that system. It is great IF you are healthy and only require basic coverage be it meds or physician visits. It is absolutely apalling if you have multiple medical problems. The wait is tremendous and there IS a lack of new treatments/therapeutic interventions/imaging because obviously IF you have to provide coverage for ALL there are limits imposed on physicians period. The MD's working for the national system just do NOT feel the need to bust ass period. Why? low pay and plain bad conditions so they take their time and not over work themselves. If they see 10 patients so be it versus the plethora waiting in the waiting rooms. You truly have to have LIVED this system to truly understand what I am speaking of. If you are in your late 50's many interventions are just not offered PERIOD you are not even told about them.
Also, if you nationalize anything, the impetus to come up with new therapies, interventions, innovation is OUT THE DOOR. Money DOES drive much of the greatest advances in medicine folks! once we "socialize" medicine/any other industry why bother to come up with new and innovative ideas? please tell me which country is leading in regards to this? where is the most research generated? food for thought.

I'm with you, efex101. Nice to hear from someone who has real experience with nationalized health care.

So here is my ignorant question:
Why not have some kind of basic health care like that for all people, and those who don't want such appalling conditions once they get multiple medical problems can buy an extra plan?

A two-tier plan like that is a possibility. The basic plan could cover preventive care (*real* prevention, such as vaccinations and support for lifestyle changes, not just early detection of diseases that are already there), emergencies, prenatal care, catastrophic care and whatever else is deemed most essential by the government. Then if people want more, they can buy a policy that covers more, or they can pay out of pocket for more. Of course, this scheme will involve rationing, and that will not be popular, because our culture is not used to that idea. It will also be expensive, and our country may not be able to afford it, especially if the government has to subsidize a lot of people's premiums. It will also have to be administered by the government, who many of us think will do a lousy job.

That would be a phenomenal option but again there has to be rationing of some sort and the American people will most likely be appalled by this. You are talking of the "give me a pill NOW and fix me NOW" mentality here. We also must LIMIT coverage to those WHOM really meet the needs and who will monitor that? me thinks that providing care for illegal immigrants is just not a choice, also those who can afford but just do not WANT to purchase some type of healthcare should not be covered, IF you can afford HC why should I through taxation pay for YOU? I am more than willing to provide my hard earned money for children, physically/mentally impaired, etc but not for anyone wining about the cost of HC yet go and buy cigarrettes/booze/cell phones and balk at a co-pay. Hell no.

Excellent post on SDN by orthospine (he allowed me to copy and paste to this forum). He states very well many of the thoughts that a lot of my colleagues and myself have.

This is a copy of the letter I just mailed to the Senate and the President:


It is possible to revise healthcare in the United States without totally changing its infrastructure and entirely rewriting policies. Over the past few months we have gained, first hand, insight into the effects of government deregulation of a large industry: the housing market. The lesson taught from the housing market crash is basic – you cannot deregulate something once it is regulated. Simply put: a national healthcare plan is something we cannot reverse once it has taken effect. When thinking about such deregulation my mind becomes filled with all too vivid memories of government bail-out dollars and government corporation control. The current system of care is not without its faults with regard to spending. The inefficiencies can be corrected, the access of care can be increased across a significantly greater income spectrum, and the quality of care can be improved. A modification of the current system of healthcare is the best approach to the healthcare crisis of the United States.


The analysis of the healthcare financial arena which includes, but is not limited to, spending, inefficiency, reimbursements, and profits is a complicated machine whose understanding is limited by many factors including investigator bias, lack of clinical knowledge by many investigators, and the lack of a systems based practice that promotes monetary efficiency by healthcare professionals. One thing is certain, however, the cost of care is increasing. Several major factors have contributed to this increase.



PROBLEM: Innovations and breakthroughs require research, and research requires time, manpower, and money. The new wonder drug or the fast noninvasive tests that roll out of the current capitalistic system and enhance the quality of care in this country cost money to develop. Pharmaceutical companies and technology companies need to recover these losses in the form of profit. A government run health care plan where compensations and ultimately profits of these corporations are dictated by the government will ultimately halt or significantly slow the innovations in medicine, most of which have come from the private sector. It would then become the government’s responsibility to finance and promote such advances since many of these corporations would then have little incentive to do so. There is a solution, however, to diminish the cost generated in this aspect of healthcare.

SOLUTION: By applying Nash’s theory of equilibrium, if all pharmaceutical and technology companies were restricted from spending the billions of dollars they currently utilize for marketing purposes, the profit distributions of these companies would not alter significantly from their current percentages, and corporations would lose less money in the form of advertising. These products would, as a result, cost less – enhancing the delivery of care. Moreover, clinicians would make selections on products based on data and not which product was more effectively marketed toward them.


PROBLEM: People are living longer due to enhanced medical care, increased nutritional awareness, and engaging in safe practices, amongst a number of other things. As a result, however, people live significantly longer with chronic conditions that debilitate their victims over time, after long periods of pharmacotherapy, a number of procedures, and significant pain and suffering. It is the diabetic with coronary artery disease, as an example, that costs the system money-not the person hit by a bus. Also, as a result of the enhancement of age, there is an increasing population of the elderly which is disparate to the ratios of the past. Medicare has enough difficulty paying for the elderly with these debilitating conditions.

SOLUTION: Compliant patients with regular follow up should pay relatively lower premiums compared to that of noncompliant patients with poor follow-up. The basis for this is that the practice of preventive medicine decreases the overall cost of their care, which rises exponentially with age. There is another benefit to this measure-it rewards people for living healthier lives.


PROBLEM: Another and more easily controllable factor contributing to the rising cost of increased healthcare is malpractice. Doctors practice defensive medicine. As a result, they order excessive tests and procedures to rule out what is very unlikely, though it has a very small possibility. Increased numbers of tests, unnecessary admissions, and needless prolongation of a hospital admission raises the costs of a hospital stay, increasing the reimbursements paid by insurance companies, which in turn amplifies insurance premiums, and, as a result, healthcare becomes inaccessible to a tremendous number of families.

SOLUTION: The auto insurance industry utilizes a system of full and partial tort options when insuring a vehicle. Tort refers to the victim’s ability to sue for pain and suffering. Individuals with partial tort pay less in premiums, but sacrifice the ability to sue for pain and suffering in more minor situations. Individuals can choose health insurance plans based on their desires and the amount of money they have available to pay their premiums. This addresses the issue of lowering malpractice limits, but allowing it to remain the choice of the individual-not the government.


On its surface, a national healthcare plan is a wonderful idea. The thought of each and every American being able to go to the doctor provides a vibrant image of a healthy United States. This notion is furthered by all the remarks made about how great the national healthcare plans of other first world countries are-promoting the “grass is greener on the other side of the fence” mentality. The reality of the situation is that national healthcare results in rationing of care, restriction of care in certain conditions, and waiting for necessary visits, tests, or procedures. A ninety five year old woman with inoperable and incurable lung carcinoma with a prognosis of three months survival will not receive the millions of dollars in care required to extend her life one additional month. In the few scenarios where examples of national healthcare at work are seemingly effective, the populations are small and there are few socioeconomic and ethnic barriers to care. The foundations of the current system of care can be enhanced and the availability of care can be broadened significantly. Many small steps can ultimately lead to a giant leap forward for all Americans, but a blind giant leap can throw us over the edge.

Okay, here is another analysis of how the overhead of government programs is not as low as people think:

http://www.ahia.net/advocacy/documents/Comparing_HealthCare_Admin_Costs.pdf