Special Report on Healthcare Reform

Arthur J. Sutherland, III, M.D., FACC

 As I approached the end of my clinical career in January 2004, I was disappointed and frustrated with the practice of medicine. It became apparent that the chaotic and fragmented healthcare market we have in America was not functioning for the common good. The most glaring symptoms of dysfunction were reflected in the millions of people who were uninsured or underinsured, the lack of support for preventive medicine, the soaring cost of health care delivery, and the denial and cost shifting efforts of the private insurance industry and the government who both considered health care as a cost factor (and a drag on the economy) as opposed to a basic human right which would be a benefit to our society. In plain words, the commercialization of medicine over the past 70-plus years has been detrimental to both society and to medical professionalism.

Our current economic recession is aggravating this problem with more unemployment and people without adequate health insurance. This puts a greater strain on all health care providers and institutions. Our nation's people are truly in crisis, and the shameful greed displayed in the financial industries is replicated in the for-profit hospital corporations, HMOs, insurance companies, and the pharmaceutical and medical device industries. We are also seeing a commercial "drug store- mini clinic" industry being developed because there are not enough primary care physicians to effectively organize the "medical home" concept of team care.
 
So what is the doctors' role in the current health care reform debate? Physicians have had an honored place in our society because we are a profession where doctors serve as the patient's advocate and put the patient's needs above the narrow financial interests of our work. Unfortunately, a lot of physicians are so frustrated that they do not trust our political system, and they become passive and uninvolved. This attitude may be changing, however. A recent national survey of practicing  physicians was published in the April 2009 Journal of  General Internal Medicine that showed only 9 percent of doctors favored our current health care system, while 91 percent favored national health care reform- 42 percent favored Single-Payer National Health Insurance Program, and 49 percent favored the current system with addition of tax credits or penalties. Therefore, physicians are concerned about the restructuring of the U.S. health care financing system, but we need to consider that there are many myths and misconceptions that cloud the debate over expanding what we have now vs. Single Payer.
 
The AMA has fought pre-paid national health insurance since 1919, calling the concept "socialized medicine" that was somehow linked to the rise of Communism after the Russian Revolution. Dr. Morris Fishbein, who controlled the AMA and the JAMA from 1924-50, continued the label, but today the AMA only represents 27 percent of doctors. The AMA has not endorsed Single-Payer, but supports expanding the present market system to cover more people. The truth is that Single Payer national health care reform is not socialized medicine –
 it is a public-private partnership in the best sense, where funding and inclusion of all our population is accomplished more efficiently by the government than through insurers, while the delivery of health care is provided by the private sector in a much more efficient manner.
 
A Single-Payer as opposed to a Multi-Payer system would restore the promise of traditional American values to health care – supporting the promise of opportunity and security by promoting better health for everyone through well planned health policies of fiscal prudence and fairness to patients and providers alike.
 
For physicians, Single-Payer would result in decreased practice administrative costs and complexity; increased efficiency of the practice team; improved compensation for all the practice services, especially preventive medicine; and promote the "medical home" concept for caring of patients with chronic diseases. Most importantly, Single-Payer would restore the autonomy of physicians; support the much needed primary care base; and allow physicians to practice "patient centered", "evidence based", "quality driven" medicine which is why most of us were attracted to the profession in the first place – to help and serve the patient.
 
We are now into the political process of national health care reform, and it is important for all doctors to become informed and involved. Physicians for a National Health Program, www.pnhp.org, has extensive studies and papers on Single-Payer, and Dr. Don McCanne's "Quote-of-the-Day" is another excellent free resource to follow the debate issues. Being involved means becoming politically active. We particularly need doctors to contact their U.S. Congressperson and Senators. HR 676 is the U.S. House of Representatives' Single-Payer bill, and S 703 is the U.S. Senate's version. Look up these bills and learn the real facts about Single-Payer. Your patients are counting on you to play an active role in health care reform, and doctors all have a lot at stake in the political outcome, also.
 

Arthur J. Sutherland, III, M.D., FACC, is Chairman, TN Chapter Physicians for a National Health Program, asutherland@sutherlandclinic.com