First of all, this is a good step because so much is in action already. Second, it is clear that the US has a fiscal problem. It can be solved in two ways: one is to copy what is done in countries like Germany, which have a host of private insurers, but they are severely regulated by the government. This would reduce their overhead and profiteering at the expense of the sick. If this won’t sit too well with the Congress, which it may well not, the other way may be even more controversial: proceed to a Single Payer alternative by extending Medicare. Clearly, Medicare has not broken the bank yet, nor has it failed to protect the elderly. If it were extended, say, five years at a time, per year, it would be easily accomplished. The private insurance industry, seeing the handwriting on the wall, would begin to cut its overhead and ridiculous executive pay, and switch to “supplemental” policies.
Clearly, in my view, the ideals of family physicians for a single level of health care must be acknowledged to be unrealistic. Of course, we should include enough benefits in the Single Payer Plan as written to include as many people and as much healthcare as possible, but the fact that some things (like plastic surgeries for cosmetic purposes–not an insubstantial number) would fall outside the Plan makes it imperative to include even more in supplemental policies. If some people want to have prestige healthcare, let them pay for it with supplemental insurance.
Third, there is clearly going to be a need for more primary care physicians. Whether we need to expand the medical schools again is an open question, or whether we need to (finally) provide a way for advanced nurses to shift to equivalence with MD status by getting more education (2 years, say?). (We should do this anyway!) We also need to keep an eye on the relative pay for different specialties, so that medical students won’t need to change to specialists from their original plans to do general medicine or surgery because of their debt. And of course, the AAMC has a role to play in advocating loan forgiveness for students who go into general medicine.
I believe it is time that the Association of American Medical College finally became an advocate for a Single Payer Plan as well as benefits for medical students. It is clearly the next step in evolution of American medicine, so the organization should help lead the way. You may indeed quote me on this!!
Paul J Friedman, MD
Professor Emeritus of Radiology
Former Dean for Academic Affairs, UCSD
UCSD School of Medicine
Former head of the Council of Academic Societies, AAMC
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