TCS Daily


Bad Medicine

By Sydney Smith - February 20, 2003 12:00 AM

A disconcerting letter has been circulating among physicians recently. It's from a group called Physicians for a National Health Program. You might have heard of them. Their chief spokesmen are Dr. Marcia Angell, a former editor of The New England Journal of Medicine and Dr. Quentin Young, a public health activist.

The two have been busy making the rounds of talk shows and writing op-eds to publicize their crusade for a national health insurance program. Even Rex Morgan, M.D. is a member. In fact, the current story line of the daily comic strip has him attending a PNHP convention. Unfortunately, unlike Dr. Morgan, the group's agenda isn't confined to the comic pages.

The letter announces that a national health insurance bill will soon be introduced to Congress, crafted by members of PNHP, and sponsored by Democratic Rep. John Conyers, Jr. The bill will, according to the group and to the Congressman, expand our current Medicare system to include everyone. It would control skyrocketing health costs, cover all 42 million uninsured Americans, restore free physician choice to patients, and provide comprehensive prescription drug coverage to everyone. And it would save the nation at least $150 billion annually.

It sounds wonderful. That is, until you read the text of the bill. Some of its high points:

  • The government would purchase all hospitals, nursing homes, and physician practices.


  • The government would allot every hospital, nursing home, and physician practice a yearly operating budget.


  • The government would determine the rate of reimbursement for services.


  • The government would determine the prices of drugs, medical supplies, and medical equipment.


  • Patients would bear no direct responsibility for payment, aside from paying higher taxes.


  • The program would cover everything but cosmetic medicine, including dentistry and eyeglasses.


  • It would be financed by a progressive tax structure, including, among other things, a "health income tax" on the wealthiest 5 percent of the population.

All of this would be overseen by a gargantuan bureaucracy of regional and state health insurance administrators, at the head of which would be a director chosen by the secretary of Health and Human Services. The director would be assisted by an advisory panel selected by the president and made up of health-care professionals, health-care groups, and health "advocacy" groups. The potential for political meddling is unlimited.

This is much more than an expansion of Medicare. It's a Socialist manifesto. It's also a sure-fire recipe for disaster. It encourages unlimited demand of healthcare services while severely limiting the ability of physicians to meet it.

Is there any doubt that the $150 billion in savings would be had by slashing reimbursement and operating budgets? And what about the cost of financing the bureaucracy that administers it? One gets the impression that the people who crafted the proposal have never had to manage a medical practice or struggle with Medicare reimbursement.

In fact, Rex Morgan may be the only member of Physicians for a National Health Program who owns a medical practice. The majority of its membership is made up of academics, public health physicians, and medical students; people who most certainly have never had to meet a payroll.

Marcia Angell, no matter how impressive her credentials, does not speak from experience when it comes to running a practice. As to Quentin Young, he claims to have a long-standing private practice in Chicago. A review of his biographical information, however, indicates that for the past 20 years he has devoted himself largely to public health and advocacy. Chances are that it's been a very long time since Dr. Young had a hand in managing a practice.

The goals of the group are admirable, but there are better ways to achieve them than the complete government take-over of medicine. The American Medical Association, for example, has a plan that is worthy of consideration. It would divorce healthcare insurance from employment by giving individuals the same sort of tax credits that businesses currently get for purchasing health insurance. It keeps the financial control of hospitals and physician practices in the hands of those who run them. It encourages fiscal responsibility on the part of the patient. And it relies on the free market rather than the government.

The members of Physicians for a National Health Program argue that healthcare isn't a commodity, but a service that should be distributed from each according to his ability, to each according to his need. But healthcare is a commodity, just as surely as food and shelter are commodities.

No one would seriously suggest that we put the government in charge of producing and purchasing our bread and housing. We shouldn't put them in charge of our healthcare, either. It might work on the comic pages, but it's already failed miserably in the real world.

The author is a family physician who has been in private practice since 1991. She is board certified by the American Board of Family Practice, and is a Fellow of the American Academy of Family Practice. She is the publisher of MedPundit.
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