Souls of the Departed

I was making copies of advertising tear sheets the other day, standing at the copy machine and daydreaming, when the following caught my eye. It is reprinted with permission from Southern California Physician magazine, the November 2009 issue. This magazine probably doesn’t have the distribution of say, the New York Times, or even Weekly World News, but this essay is too important not to share.

Silence is Consent

Speaking up for the public option, by Howard L. Lang, MD

I cannot remain silent. When I read the opinion articles by Drs. Krauss and DiLibero and the predictable answers to the interview with the Libertarian Cato Institute in the September issue, I felt compelled to respond.

The pigeonholing of “government control of health care” puts ideas into a prefabricated box that has infected and distorted the debate about the public option. Simply put, the public option is nothing more than an option for consumers what would expand choice in the insurance marketplace. Without a public option what will restrain the insurance industry? The public option is the key to expanding coverage and choice, bringing down costs and holding the insurance industry accountable. It is not a “government takeover” of health care. Let us not have these labels blind us to the facts.

The facts in the current legislation, as reported in Medscape Business of Medicine, are as follows:

  • The government would negotiate reimbursement rates directly with physicians. The rates could not be lower than Medicare rates but could not be higher than the average rate paid by provided plans. I believe that medical organizations should require the legislation to provide anti trust relief so physicians could collectively bargain with either the government or other third party payers.


  • One amendment (Sen. Charles Schumer, D-NY) for the public option would prohibit tying the rates to Medicare. It would be required to pay for itself through premiums collected. It would not be funded by the U.S. Treasury. Also, there would be no bailout if it didn’t support itself.


  • The plan would be optional for providers to choose whether or not to participate.

  • To put it simply, only consumers who want to enroll in a government-run health plan would do so. Anyone who preferred private insurance could get it.

    Government can enhance human freedom and give people options they would not otherwise have. When you consider the involvement of government in K-12 education, helping students to attend college, and unemployment compensation, you realize that the public insurance option is entirely consistent with the American tradition of using government to open new avenues of choice and opportunity.

    The fate of the public option as of late October is still undetermined. There is a public option in the three committees of the House and in the Senate’s Health, Education, Labor and Pension Committee. There is no public option in the Senate Finance Committee bill.

    There is strong support for the public option in the physician community as well as in the public. A recent poll of physicians funded by the Robert Wood Johnson Foundation, as reported in the New England Journal of Medicine, showed that 63 percent of physicians supported a plan that contained a public and private alternative with 27 percent supporting a private-only option that would provide subsidies for low income individuals to purchase insurance. The researchers found that 58 percent of physicians surveyed supported expanding Medicare eligibility to those between the ages of 55 and 64. A recent national poll showed that 70 percent of Americans favor a public option as a choice.

    Here are more unpleasant facts, not opinion. A Harvard study revealed that 14,000 people per day lose their health insurance and 62 percent of all bankruptcies are from medical costs. This breaks down to 120 people every day, 3,750 people per month, 5 people per hour and 1 American every 12 minutes. All dead because of a broken delivery system which is based on profit, not caring.

    The public option uses government as a nudge toward greater competition. The public option is a monopoly and monopsony buster. The 2008 update of Competition in Health Insurance: A Comprehensive Study of U.S. Markets presents new data on the degree of competition in different regions of the country. The study is intended to help identify areas where consolidation among health insurers may have harmful impacts on consumers, providers of care and the economy. Market shares and concentration measures are presented for 314 metropolitan areas and 42 states. This study finds that the vast majority of markets are highly concentrated and are dominated by one or two health insurers. These findings, coupled with higher insurance premiums, higher profits, lower scope of benefits and high barriers to entry, leads to the conclusion that health insurers are exercising market power in many parts of the country. Without a public option providing competition, more of our fellow citizens will be uninsured and more will die.

    Another issue is cost to consumers and government which the public option will help moderate. In the October Editors note, one part of the cost issue is addressed. I will add that, as reported in teh Washington Post health care premiums have risen by 300 percent over the past 30 years after adjusting for inflation. Hourly earning for workers, adjusted for inflation, have fallen and any wage increases have been consumed by health care costs. The costs for the approximately 46 million uninsured are shifted to the insured. According to an analysis by the Center for American Progress, this raises premiums for the average family by $1100 a year.

    When we look at the entire picture of our health care delivery system it is clear that substantive reform is absolutely necessary. We are talking about the fundamental principles of social justice. Not only would collapse of health reform be a political and policy failure, but a profound moral failure and a blot on our great nation. How we provide health care says a great deal about our country’s heart and soul. Has our soul departed?

    The Ayn Rand and Gordon Gecko philosophy of “Greed is Good” is the antitheses of what this country should stand for.

    Thucydides was once asked: “When will there be justice in Athens?” His reply: “There will be justice in Athens when those who are not injured are as outraged as those who are.”

    I am outraged!

    Howard L. Lang, MD is Past President of the California Medical Association and past chair of the AMA Medical Staff Section.

    Yeah. Pass that along.


    Posted by .(JavaScript must be enabled to view this email address) on 11/16 at 05:51 PM in Yellow Dog Politics

    (1) Comments
    #1. Posted by Cousin Steve on November 18, 2009

    While there is a great amount of truth in this article, I am loath to assume that anything ANYBODY says on the subject of government provided insurance is 100%.  One part I WILL agree with is how the government has given the insurance companies carte blanche for the last 30+ years.  During the Nixon regime, insurance companies were exempted from all anti-trust laws, letting them do basically whatever they wanted.  Sort of like what “Saint Ronald” Reagan did with de-regulation of banking and transportation industries, thereby opening the door for rampant takeovers, monopolization, and foreign takeover of many of our support industries.  The only thing that could do the final blow to our economy was a couple of unnecessary wars, thank you Bush & Bush.  The only way to return to normalization of our economy is to keep Republicans out of office and replace the laws which Roosevelt put into place and were destroyed by the last 4 republicans.  God help us if Caribou Barbie is serious about running for president and wins.

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