Oliver Fein, of Physicians for a National Health Program, at St. Kate’s: Give single-payer a chance


The American Medical Association has come out against President Obama’s “public option” for health care reform, but the AMA doesn’t represent all physicians. Some physicians’ groups support the public option but others think it doesn’t go far enough to fix changes in a badly broken system. Dr. Oliver Fein, president of the progressive Physicians for a National Health Program (PNHP), found a warm welcome in the Twin Cities last week. Fein was here to present PNHP’s vision for a national single payer health program. PNHP has 16,000 members, including 300 in Minnesota.

Fein, a general internist and professor at the Weill Cornell Medical College in New York, had a full schedule last week speaking at public forums and to physicians at Regions Hospital, the University of Minnesota, and Hennepin County Medical Center.

He was joined by Elizabeth Frost, MD, a family practice physician in St. Paul and co-chair of PNHP Minnesota, at a June 17 forum at the University of St. Catherine’s in St. Paul.

Fein said opponents to single payer mischaracterize the proposal as the government “taking over” the delivery of health care. Instead, single payer is a concept whereby health care services would be paid by a single source.

It’s “an improved Medicare for all,” said Fein. Medicare is much less costly to manage compared to insurance and HMOS. Overhead costs for managing Medicare are 3.1 percent of total costs compared to the 26.5 percent associated with investor-owned insurers, according a study published in the Journal of the American Board of Family Practice.

Opponents claim that single-payer would be too costly. Fein disagrees. A single-payer system would save the nation $400 billion in overhead costs, he said, while giving the 45 million uninsured access to care, and filling in the gaps in care encountered by underinsured people.

Maintaining the status quo will be much more costly than doing nothing, says Fein.

A recent study published by the American Journal of Medicine bears this out. Researchers from Harvard and Ohio University found that over 60 percent of all U.S. bankruptcies in 2007 were driven by medical incidents. The rate reflects a 50 percent increase since 2001.

Whereas the public option proposed by Obama would offer a government-managed alternative alongside for-profit health insurance, a single-payer system would eliminate private insurance companies entirely. Private insurance companies have denounced the public option, fearing that they could not compete with a lower-cost public option plan.

Both Fein and Frost assert that single-payer has not been given a fair hearing during the national health care reform debate. Advocates of the plan were repeatedly denied an opportunity to speak at Congressional hearings presided over by Sen. Max Baucus, chair of the Senate Finance Committee. When advocates, including some doctors and nurses, protested at the hearing room, they were arrested.

The public option still has an uphill battle, but Obama insisted at his June 23 press conference, that “yes, we can” pass health care reform with a public option this year.

Frost views the public option backed by Obama as “a compromise” that would be more costly than single-payer since it keeps the market-based health insurance industry intact.

Many legislators have looked to Massachusetts’s mandatory health insurance law as a national model for reform; but a study published May 28 in Health Affairs found that the Massachusetts law requiring all to show proof of health insurance has resulted in higher costs for those least able to afford it. People still pay premiums to private insurers, with 25 percent or more of their premiums going toward overhead and profit.

“The worst that could happen,” said Frost, “would be the passage of a bad public option like the Massachusetts plan, and people consider[ing] health reform [to be] done.”

Kathlyn Stone is an independent journalist in St. Paul. She maintains a health and science news site at fleshandstone.net.

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