U.S. Health Care Worse by the Decade

WASHINGTON -- She said his plan doesn't cover everyone; he said she backs an unwise mandate to force people to buy health insurance. She said covering everyone is the heart of the insurance issue; he said cost is what really counts.

And at the end of the back-and-forth between Democratic presidential candidates Hillary Clinton and Barack Obama during a February debate in Cleveland, moderator Brian Williams of NBC News let out what amounted to an exasperated, if polite, sigh. "Well, a 16-minute discussion on health care is certainly a start," Williams said. "I'd like to change up."

Well, Americans would like to change up, too -- up to a less expensive, less irrational health insurance system in which 47 million people aren't left out of coverage. Up to a system in which those who are lucky enough to have coverage aren't confronted with continually rising co-payments and deductibles and convoluted schemes for limiting payment when someone gets really, really sick.

It turns out their doctors want to move up, too. They are way ahead of politicians in daring to go where the rest of the industrialized world has already gone: to a national health insurance system.

New research by the Indiana University School of Medicine shows that 59 percent of doctors support legislation to establish a national health insurance system, up from 49 percent in 2002. Only 32 percent of doctors said they were opposed. A slightly lower percentage, 55 percent, agreed with a different question on what researchers considered "incremental" reform -- that is, one that relies on tweaking the existing employer-based insurance system and filling in the gaps from there.

"National health insurance is national health insurance," says Aaron Carroll, director of the Center for Health Policy and Professionalism Research at the medical school. "They (doctors) support a plan where there is government legislation to establish government financing for health care -- a Medicare-for-all type of plan."

In this campaign that has offered a bumper crop of politicians and a thicket of platitudes about the American health insurance system, no one except Rep. Dennis Kucinich, the Ohio Democrat who long ago abandoned his presidential run, has proposed a national, single-payer system of insurance. The fear factor keeps politicians well behind doctors, even though many physicians might see their incomes shrink under a national health insurance plan.

Carroll says that what struck him most about his current data, compared with the 2002 survey, is the extent to which doctors in every specialty increased their support for a national health plan. "Every group went up that we measured," he told me. Those who back national health insurance the strongest are psychiatrists, who see mentally ill people suffer from some insurers' outright ban on coverage for mental health, or from low reimbursement rates for mental health treatment. Those in pediatrics and emergency medicine were also strong supporters. "Most of the people who are exposed to the uninsured are in primary care, or they're psychiatrists -- and emergency physicians who have to see people come into the ER without insurance all the time," Carroll says.

Carroll's center studies how health care is delivered in the United States, assessing its cost, quality and patients' access. By all those measures, he says, things have gotten worse in the past decade. That's one reason opinion polls taken during the past year or more have shown an increasing proportion of the public warming to national health insurance, even when the questions include the caveat that taxes might have to be raised to pay for it.

So, as they tend to say in those drug-company ads, doctors and patients agree.

It's the politicians who are lacking in courage, too cautious to confront the fear tactics that the insurance industry, the drug industry and other big players roll out every time. As for interest groups that represent doctors, Carroll says, those organizations supporting only incremental reform appear to be out of step. "We know what the representative groups are saying," he notes. "We wanted to see what actual physicians believe."