Medicare-for-all Plan Headed for Congress

Published April 1, 2003

A disconcerting letter has been circulating among physicians recently. It’s from a group called Physicians for a National Health Program (PNHP). You might have heard of them. Their chief spokespersons 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 in Congress, crafted by members of PNHP and sponsored by Rep. John Conyers Jr. (D-Michigan). The bill would, according to the group and 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.

Sounds Wonderful

Few would reject such a wonderful proposal … that is, until they’ve 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 paying for health care services … but all would pay higher taxes.
  • The program would cover everything but “cosmetic” medicine.
  • 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.

The PNHP/Conyers plan would be implemented and 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.

Recipe for Disaster

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 for health care services while severely limiting the ability of physicians to provide them.

Is there any doubt that the $150 billion in savings would be had by slashing reimbursement rates and operating budgets? And what about the cost of financing the bureaucracy that administers this program? One gets the impression the people who crafted this 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 it’s been a very long time since Dr. Young had a hand in managing a practice.

Taken at face value, 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 worthy of consideration. It would divorce health insurance from employment by giving individuals the same sort of tax credits 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 health care isn’t a commodity, but a service that should be distributed from each according to his ability, to each according to his need. But health care is a commodity, just as surely as food and shelter are commodities.

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

Dr. Sydney Smith is board certified by the American Board of Family Practice, a fellow of the American Academy of Family Practice, and publisher of MedPundit. This article was first published by Tech Central Station and is reprinted here with permission.