National health care reform and a single-payer system: messiah or pariah?

U.S. health care spending consumed about 14% of the GDP in 1992 and current trends threaten to boost this figure to 18% by the year 2000 (CBO, 1992). Our health care delivery system needs an overhaul but there is evidently little consensus on what format a new system should follow. Persuasive befuddling, and frequently contradictory, suggestions have ranged from the federal government's active involvement in a single-payer national health care plan to enactment of a nationwide mandate compelling (taxing?) employers to provide a minimum health benefit package to all workers. There were two common objectives shared by the major, recently contending health care reform proposals: first, to provide universal access to health care with assurances that coverage is maintained when economic circumstances change or when someone experiences poor health; second, to stunt the growth rate of health care spending nationally. Single-payer alternatives, previously introduced by Congressman McDermott and others, would have required a heavy federal subsidy, regulation, and blocking directing each state to establish and administer a health care system covering its entire population. Currently, the single-payer system has become a fading contender in a dissolving list of health care reform options that previously included a new, widely publicized option embracing managed care and so-called "managed competition." Most recently, however, the single-payer proposals have apparently gone nowhere, seriously sustaining sound political defeat. Divergent views of proponents and detractors of a single-payer plan, its funding and operation, are presented. It has become extremely difficult to get Congress to advance any particular proposal because of dire, unsubstantiated socioeconomic impact hypothesizing and the unrestrained politicizing of the health policy formulation process. On February 10th, 1994, the prestigious American College of Surgeons literally stunned the national health care community by its surprise public declaration of conceptual support for the still highly controversial legislative health care reform long-shot, the Single Payer Health Plan (Mcllarth, 1994). As individual physicians weighed the contentious single-payer health care issue against alternatives (O'Heany and Berry, 1994), many health care provider groups even now remain adamantly opposed to a single-payer system (Mitka, 1994), not unexpectedly including the vocally conservative leadership of the American Medical Association (Culhane, 1994; Cotton, 1994). As spokesman for the American College of Surgeons (ACS). Chairman David Murray MD, indicated that the 60,000-member group acted out of frustration with current insurer-run managed care plans and a desire to bring out reforms that permit patients to choose the physician or surgeon. At the time, Murray emphasized that the college had not endorsed any specific single-payer bills that were pending then in Congress and had a number of significant differences with the former leading contenders which had been sponsored by Rep. Jim McDermott MD (D. Wash.) and Sen. Paul Wellstone (D. Minn) (Mcllarth, 1994). However, testifying subsequently before the House Committee on Education and Labor, Dr. Murray said that single-payer approaches probably present the best assurances that patients could seek care from any physician they choose and that single-payer approaches could probably be made more simple and administratively workable (Cotton, 1994). Again, that time, Dr. Murray expressed concern about the extensive power that would have been granted to health insurance purchasing under the now defunct Clinton administration's "managed competition" health care reform package, HR 3600 (Ibid.). These concerns were shared by others (Geisel, 1993; Wagner, 1993). (ABSTRACT TRUNCATED)