A message from Jeoffry Gordon, MD, MPH, a San Diego member of Physicians for a National Health Program (PNHP) and California Physicians Alliance (CaPA):
Subject: Shift in strategy
It seems to me that our current world crisis has changed the political playing field and opened the probable opportunity for a swift move to a national health program. We ought to adjust our rhetoric, strategies, and thoughts accordingly.
(1) The terrorist attack has the unintended byproduct of curing the civil society malaise described by Robert Putnam in BOWLING ALONE (an outcome he predicted), and people are not just rallying around the flag, they are esteeming the government, depending on it for safety and solutions. This is a tectonic shift in attitudes.
(2) We are in a recession; businesses are going to be doing poorly and watching their pennies very closely.
(3) Health insurance companies are at a point in their business cycle where, after competitively driven price cuts and consolidation, they will be requiring repeated >10% price increases to maintain viability (Aetna or PacifiCare/Secure Horizons) or profitability.
(4) The health insurance premium costs are going to be very onerous to all businesses who will be passing on costs to employees or dropping benefits or health insurance altogether.
(5) As people are laid off (and have been in huge numbers in the service industries as a result of 9/11), the number of uninsured is going to explode and many of the newly uninsured are going to be middle class.
Thus the stage is set for an as yet publicly unanticipated crisis - the final breaking point - in the health care system in the USA. The federal government is going to have to step in (and can with the rationale of protecting the public welfare during wartime). The simplest solution and easiest to promote is to expand Medicare to everyone (and not to get into much of the details about how the providers organize themselves). This will have great public support from the newly uninsured and unemployed, and maybe even from the AMA, etc., as doctors and hospitals feel even more squeezed by falling income and will be eager for public subsidy for "a physician full employment program," and by the states who will now be too poor to subsidize their own reformed health systems. As unlikely as it seems, the Republicans (like Bismarck and Lloyd George) are likely to be more successful at pulling off a national health program than the liberals and the Democrats as a way to help the business and corporate classes (except for the health insurance industry) save money (overhead costs) and as a way to reward, support and calm a worried and activated civil society.
PNHP can have a pivotal role in promoting these changes, especially if we anticipate the need, publicize it, and organize around it with a simple implementation strategy. What do you think?
Please circulate this message to whomever you think will be interested.
Jeoffry Gordon, MD, MPH
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