Saturday, August 16, 2003

A reader e-mailed me to solicit my comments on the "National Payer" plan that appeared in this weeks JAMA (sorry, abstract only). It is a detailed proposal from the Physicians for a National Health Program . This group advocates the creation of a nationwide single-payer health insurance program. A single-payer system goes against my libertarian leanings, but I wanted to learn more aout this group and their positions. A Google search led me to this paper (PDF) that was presented to the Congressional Black Caucus and the Congressional Progressive Caucus in May of 2001. As I read the May 2001 paper I was struck by the similarities between it and the JAMA article. In fact, it is almost identical. Which to me begs the question: Why was this published in JAMA this week?
JAMA's own Instructions for Authors states in part:
Manuscripts are considered with the understanding that they have not been published previously in print or electronic format ..... also:
A complete report following presentation at a meeting or publication of preliminary findings elsewhere (eg, an abstract) can be considered.
These types of papers are usually accompanied by a "Presented at the Association of....Meeting". The May 2001 paper is not even cited in the references for the latest paper. No mention of the May 2001 paper is made in the accompanying editorial. While this may seem like splitting hairs, I think it may be another sign of the rising political activisim in the medical liturature, as seen in The New England Journal of Medicine and The Lancet. (Thanks to Dr. Smith). If JAMA will print a two-year old paper to advance a certain policy position, would it exclude a paper that presented a well-researched contrary view?

The paper is very detailed and I will post more commentary on it later, especially the "Four principles that shape our vision of reform" (pg 8). Overall I find the paper to be somewhat shrill and sprinkled with "class warfare" inferences. For example:
Hospitals could not use any of their operating budget for expansion, profit, excessive executives' incomes, marketing, or major capital purchases or leases (pg 10) (emphasis mine). IMHO physicians should tread lightly when making arguments for reducing what someone should be paid. The public perception of physician income could make that sound like "the pot calling the kettle black".
Also, the alternatives to their plan are referred to in prejudicial terms such as "Defined conrtibution schemes" (pg 20) and The Medicare HMO program and Medicare voucher schemes (pg 22). Why must academic physicians resort to name-calling?
Perhaps the most distressing thing is that the authors call their plan "...an expanded and improved version of Medicare... ". An expanded version of a plan that is not working and will soon be broke.
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