Physicians for National Healthcare

Dr. Paul Sorum’s subject was national health care – what is wrong with it and what is right. Dr. Sorum is a Professor of Internal Medicine and Pediatrics at the Albany Medical College and the Chair of the Capital District chapter of Physicians for a National Health Program.

Dr. Sorum is well qualified to speak on this subject. He has a wide background in primary care practice for children and adults. He teaches evidence-based medicine to medical students, and he has done research in medical decision-making and health psychology in the United States and France.

Dr. Sorum outlines three major problems with the American health system:

1. It provides unequal access to high-quality affordable health care.

2. It is a mixed system – private and public – which means some people (the more affluent) get better care than others.

3. It violates the underlying principle in John Rawl's treatise, A Theory of Justice, which states in terms of health care that the ultimate fairness of any system must be based on the premise that those most in need should get the same quality of care as those least in need.

The cost of health care, no matter what the arrangement, is constantly rising, but these costs are not distributed equitably if the system of taxation is regressive and is based on some fixed system of payroll deductions. Recent efforts to introduce a means test, especially for Medicaid patients, based on income and/or other equities, not only end the principle of entitlements but increase the burden on the poor.

Private plans are usually more costly than publicly financed plans. The administrative costs of private plans are usually 15% or more of the total cost of the plan which is unacceptably high. Dr. Sorum estimates that a Canadian-type public program would save approximately $28 billion from the current cost in the United States. Some have argued that private plans are generally more efficient than public ones, but look at Social Security where the administrative costs are around 3%.

Another factor that contributes to the total cost of health care is reimbursement of physicians and hospitals. This is a subject of constant debate and is complicated by a situation where physicians have both fee-for-service patients and Medicare patients. To some this is a contradiction that may affect the care of both kinds of patients: that is, the cost of a public program may impact negatively on private care. It also contributes to a situation where hospitals over-charge those patients who do not have health insurance to compensate for the lower charges that are provided in insurance contracts.

To summarize: Dr. Sorum recommends a unified public national health single-care system – a single card access publicly financed but with room for some private arrangements. He supports the Conyers bill now before Congress which consists of the following:

An American-styled national insurance program publicly financed but privately delivered and which utilizes the existing Medicare program and which will include all Americans and residents. This means it will include the 45-75 million uninsured Americans and another 50 million who are under-insured. Such a plan could save over $286 billion a year in total health care costs.

Every person living in the United States and the U.S. Territories would receive a United States National Health Insurance Card and i.d. number once they enrolled. The program would cover all medically necessary services, including primary care, in-patient care, outpatient care, emergency care, prescription drugs, durable medical equipment, long-term care, mental-health services, dentistry, eye care, chiropractic, and substance-abuse treatment. Patients have their choice of physicians, providers, hospitals, clinics, and practices.

This is an ideal program but as Dr. Sorum concluded it will take a powerful political coalition to bring such a program to fruition. Something for all of us to think about.