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Doctors rally around universal health care

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Doctors rally around universal health care
Physicians say plan may save state $10 billion in administrative costs
By Rebecca Vesely, STAFF WRITER

SAN FRANCISCO -- Offering a "second opinion" on the national health care debate, Bay Area physicians and medical students gathered at San Francisco General Hospital on Tues-day to propose a government-financed national health system.
The physicians were among 7,782 nationwide -- including about 1,400 in California -- who signed onto an article published in today's Journal of the American Medical Association outlining a plan to provide health care for all residents.

"We believe the system is critically ill, and it's time for major surgery," said Dr. Kevin Grumbach, chief of family medicine at San Francisco General Hospital.

Their "Physicians' Proposal for National Health Insurance," would expand Medicare into a single-payer system akin to Canada. It would eliminate employee-based insurance and be funded through current government health spending programs and "modest" new taxes.

Former Surgeons General David Satcher and Julius Richmond also support the plan.

The physicians estimate a single-payer system would save $200 billion in administrative costs, including $10 billion in California. Physician compensation would not change under the plan, they said.

"For physicians, the gratifications of healing gives way to anger and alienation in a system that treats sick people as commodities and physicians as investors' tools," the physicians, led by Dr. Steffie Woolhandler of Harvard Medical School, wrote in the article.

Their proposal is similar to a statewide bill sponsored by Sen. Sheila Kuehl, SB 921, that passed the state Senate in June and will be taken up in early 2004 in the Assembly. The physicians support the Santa Monica Democrat's bill.

"The national health care crisis is very much a crisis in California -- we have a much worse situation that in other states," said Dr. James Kahn, a professor of health policy at University of California, San Francisco and an Oakland resident.

Nearly 41 million Americans -- seven million in this state -- are uninsured.

Leveling the playing field

Dr. Avrum Gratch, a retired orthopedic surgeon who practiced in Berkeley, said a single-payer system wouldn't limit access to specialists like himself. Instead, it would level the playing field, allowing patients to choose their own physician.

"A specialist would not discriminate against a person's ability to pay," Gratch said.

More than half of California specialty doctors refuse to treat low-income patients, according to recent studies, because of declining Medi-Cal reimbursement rates.

On Monday, the Bush administration announced it will cut physician reimbursements for Medicaid (the national version of Medi-Cal) by 4.2 percent in January unless Congress passes legislation curbing the cut.

California has one of the lowest reimbursement rates, and the new state budget, signed early this month by Gov. Gray Davis, cut Medi-Cal reimbursements by another 5 percent.

The physicians denounced plans proposed by many of the leading Democratic presidential candidates to cover more of the uninsured through employer mandates, Medicaid expansion, vouchers and pricing caps.

Those plans would "perpetuate administrative waste" and "augment bureaucracy," the physicians wrote in the JAMA article.

Prescription drug plans

They also said bills passed by Congress to add a prescription drug benefit to Medicare would profit private insurance companies while shortchanging seniors.

The American Medical Association and the American Association of Health Plans, representing the managed care industry, opposed the physicians' proposal.

"A single-payer system is not the answer," AMA President Dr. Donald J. Palmisano said in a statement. "Long waits for health care services, a slowness to adopt new technologies and maintain facilities, and development of a large bureaucracy ... are all hallmarks of the single-payer system."

Instead, the AMA advocates refundable tax credits for the uninsured to buy health care and a mix of public and private financing.

Kahn of San Francisco General said the AMA doesn't reflect many physicians' views or patient interests.

"The AMA in the 1960s was against the creation of Medicare, calling it socialized medicine," Kahn said. "Unfortunately, they haven't moved past that view."

Dr. Ursula Rolfe, a retired physician who worked for years at Children's Hospital Oakland, said she has been waiting for a national health plan since she was a student at Stanford University Medical School.

That was in the early 1950s.

"This country has public schools, public libraries, even public golf courses," she said. "Why not public health care?"

Contact Rebecca Vesely at .

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