P&S Journal: Spring 1994, Vol.14, No.2
Health Care Reform: Responses and Proposed Alternatives
'Real Concern is Fear of Reduced Compensation'
You asked for responses to the Clinton Plan. In general I agree. My major objection is its basis on employment. It is a tax and I would prefer to see it as a specific health care tax, based on a percentage of income. Also that those monies be directed to health care and not thrown into the general fund. Otherwise I strongly support the whole concept.
My major objection to the AMA stance is that they really do not want anything changed; physicians in general fear change.
The AMA makes a strong point that it be employer based; this merely adds to the employer's burden and adds nothing to the quality of the program nor its fiscal and physical access. They also oppose a National Health Board and object to the fact that no place has been reserved for an AMA representative. Twenty some odd years ago when I was Chairman of the National Migrant Health Advisory Committee, Senator Warren Magnuson insisted that no one from organized medicine be on the planning boards.
His point was that they enter into endless discussions, have nothing to offer and in general oppose everything that is helpful. Unfortunately he was right.
They object to the single payor; they want to retain fee for service and I have long held that fee for service and solo practice are the major stumbling blocks to technical excellence, economic stability and equity for provider and consumer. They object to setting a national budget for health care but every patient has to set a budget for his health care and many are now just not seeing physicians until their need is so great they can no longer avoid service. They speak of liability reform and so do we all but they have no better approach than anyone else. In general they oppose and becloud this issue with concern for the patient when the real concern is fear of reduced compensation. We are already paying an enormous price for hospital and medical care in this country and no plan will reduce this-AMA, Clinton, etc. Fortunately we can afford it but we must redirect many of our methods of delivery of health care to gain equity in its distribution.
You asked that we keep the comment short-hard job because this is a complex problem with many variables and many who will oppose progress.