Why we need real physician leadership

Physicians for a National Health Program, or PNHP, is self-described as “a non-profit research and education organization of 17,000 physicians, medical students and health professionals who support single-payer national health insurance”.

I recently went to the PNHP site. I read their mission statement. Now I feel sick.

In their mission statement, here's what PNHP says guides them:

“The U.S. spends twice as much as other industrialized nations on health care”

Yes, the problem is medical care spending. The high cost of medical care is why medical insurance is expensive – but don’t expect PNHP to tell you that.

“Yet our system performs poorly in comparison”

And that, too, is a medical problem. Question: who is responsible for medical care in your home town?

“and still leaves 45.7 million without health coverage”

Kaiser Family Foundation released a study a couple years ago that revealed 65% of the uninsured have incomes below 2X’s the Federal Poverty Limit.

Why has Medicaid failed to protect the poor? Medicaid is the government program expressly established to provide adequate medical insurance for the poor. Why is it not doing so? Why has our government left so many of the poor without access to medical insurance? I think that is a scandal. PNHP won’t tell you this, because PNHP advocates government-controlled medical care for EVERYONE, not just the poor.

Medicaid’s failure is not speculation, it's real. What is speculative is to believe, despite the evident Medicaid failure, that the government would truly manage a universal, single-payer public plan as its advocates promise.

“This is because private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar.”

One of my former jobs was chief of benefits for a very large employer. If I mentioned the name, everyone would instantly recognize it. We worked with Aetna and Blue Cross. Their administrative overheads amounted to about 5% of our annual claim volume. Why is this relevant? Because the 31% number that organizations like PNHP like to throw around is a cherry-picked number – and PNHP presents it dishonestly. It may be the right number for individual insurance. But in my experience it is clearly not the right number for group plans – where most insured Americans are covered. and besides, it defies logic for PNHP to blame the problem of high medical costs on insurance. In fact, the reverse is true.

“Streamlining payment through a single nonprofit payer would save more than $400 billion per year, enough to provide comprehensive, high-quality coverage for all Americans.”

Think carefully about this statement. PNHP is not saying any “savings” would be returned to the public. PNHP is saying that such "savings" would be paid to physicians. Aside from increasing physician incomes, this means that the public would pay even more for the expensive medical care we now have.

So PNHP presents nothing that will help solve our principal problem - the high cost of medical care. The public has every right to expect physicians to help solve that problem, not simply to demand more money from us. Sadly, PNHP barely acknowledges that problem, and offers no solution – just more spending.

And this is why we need real physician leadership on health policy.