WT: The Philadelphia Area Committee to Defend Health Care is a group of health activists who are interested in the issue of universal health care in the Philadelphia area. We’re interested in changing the Philadelphia city charter to read that the Philadelphia Health Department has a specific function. The ballot reads: "Health care is an essential safeguard of human life and dignity. The Department of Public Health shall be directed to prepare a plan, on or before one year from the date the voters approve addition of this section to the Charter, for universal health care coverage that permits everyone in the City of Philadelphia to obtain decent health care on a regular basis." The charter amendment is a plan - it doesn’t actually obligate the city to pay for universal coverage. But in preparing a plan, it should be able to identify what resources are available for the uninsured and where the gaps are in the current system. It should be able to describe potential sources of funding, or areas where we need to fund, to care for the uninsured. So, my belief is that most health departments in this country are grappling with the issue of access to health care and this city charter change would make access to health care one of the fundamental principles of the Philadelphia Health Department. Philadelphia is the largest city in the country without a public hospital and there are tremendous gaps in the types of services that we can provide for the uninsured. Even trying to find resources for the uninsured that they may not be aware of would be of great benefit. It’s estimated that there are almost 100,000 uninsured persons in Philadelphia County, according to a Philadelphia Health Management Corporation survey. In the five-county area it’s close to a quarter of a million.

WT: The process of getting the proposal on the ballot is an interesting one. We have gathered over 10,000 signatures from all over the city to raise the awareness of this ballot initiative, then we had one of the city council members introduce this initiative to city council. It passed through committee, went to the full council for a vote, and then it was passed unanimously by city council. Mayor Street, I think wisely, decided to support this proposal also. So, once the mayor signed off on it, it became a ballot initiative.

WT: There’s a surprisingly high amount of support among physicians because most doctors recognize issues of access to health care as being a fundamental problem in our society. This proposal is only supposed to help prepare a plan. We anticipate that physicians and hospitals are going to be fundamental players in such a plan and will have to provide input in how the plan is developed.

WT: It’s clear that, once this ballot initiative is passed, and we anticipate that it will pass, that other cities and other communities are going to look at how we did this and hopefully use this as a mechanism for supporting universal health care. We think that Philadelphia can lead on this issue, and that other cities will follow - not just statewide, but nationally. I think that there will be a lot of publicity that will be generated by the fact that Philadelphia passed an initiative for universal health care that others will want to emulate. I think the ultimate goal is the fact is put universal health care on the national agenda again and to ask our legislative leaders to solve this problem.

WT: I think that single payer is certainly going to be one of the most natural solutions, but it’s not going to be something that most cities are going to enact on their own. But working together, there are hundreds of cities across the country that actually wanted to pass a ballot initiative around universal health care. It would be difficult for mayors and governors to ignore this issue and not to support some type of national health insurance program.

WT: Well, it’s been a good issue for the last few decades. But I think that it’s gotten to the point where health care costs are out of control. Most businesses are unable to afford it. Most families find that health care costs are difficult to pay for. And the number of uninsured is going up, not down. So, for lots of reasons, I think we’re getting close to the breaking point where the system is unable to sustain itself.

WT: My guess is that, by putting this on the city charter and making this a fundamental responsibility of the Health Department, that it will become an annual report of access to health care for Philadelphia residents, that it will be updated, hopefully downloaded off the Web, and people can use it as a reference that will be valuable to the citizens of the community. Beyond this, it will hopefully draw the attention of our federal and state leaders to recognize that the current status quo is not solving the problem of the uninsured and, unless we can make some significant changes, will not solve our current crisis.

WT: I think there are increasing numbers of physicians who recognize that the only solution to the uninsured and to controlling health care costs in America is through a properly financed single payer, national health insurance program. Even though the AMA has opposed single payer, and there are lots of status quo groups who want to oppose it, the truth is that most doctors recognize that it’s probably the only solution left. The JAMA proposal, which can be read at www.physiciansproposal.org, is an outline of a single payer national health insurance plan for this country which could address issues of universal coverage, quality health care and affordability. There were about 8,000 doctors from all across the country who supported it, around 500 doctors from the Philadelphia area. The truth is that we spent $1.6 trillion dollars this year - trillion- on health care. In nine years we will double that in how much we spend on health care. The current system is unaffordable and unsustainable. We’re already seeing huge cracks in the system. Hospitals closing. Physicians who are extremely unhappy with medical practice. Until we return health care to what it should be - a fundamental right and the ability for physicians to take care of patients regardless of their insurance status - we’re not going to make medical care what it should be in this country.

WT: If you ask most Americans whether they support universal health, most polls suggest that between 70 and 80 percent of Americans support that idea. If you ask them how much they are willing to pay, most Americans are unwilling to pay much more than what they pay now. The only plan that can actually provide universal coverage for the same cost that we spend now is a national health insurance program.

WT: I think it’s actually a conspiracy of silence. Most physicians actually do support national health insurance. They do it reluctantly, but they realize that the current system is broken. If they were to think about this, they would agree that this is the right thing to do. Over the next two months we’re going to be speaking throughout the Philadelphia area about the ballot initiative. We’ve also been invited to speak to different medical groups, and in those situations we’re also going to talk about the single payer proposal. We’ve received lots of invitations to speak, and I think it’s a statement about the interest out there for national health insurance. We’re not aware of any organized opposition.

WT: The solution to the malpractice crisis is also related to national health insurance, and I’ll explain why. Off the table of the fight between tort reform and caps on pain and suffering is a third factor that no one ever really talks about and that’s the actual economic cost of health care. One of the reasons why malpractice rates are so high is because we don’t provide universal coverage for Americans. If we did, then we could actually say that all future health care costs would be picked up by the health insurance system. You could sue the doctor for pain and suffering, but the actual cost 50 years from now for a child who is brain injured from malpractice would actually be paid for by the national health insurance system. So, that takes millions of dollars off the table, literally, in a malpractice suit. You can look up how much Canadian ob/gyns, orthopedic surgeons, neurosurgeons - which are the three most expensive specialties in Pennsylvania - paid for exactly the same malpractice insurance in 2003: it’s somewhere between one fifth to one seventh of what we pay in Pennsylvania. And they don’t have caps on damages.

WT: Reimbursements probably would be similar to what they are now. Most doctors’ major savings would be in their overhead. You could dramatically reduce your malpractice overhead and also your billing costs. You only have one address to send your bills to. For most physicians, that actually would result in substantial increase in income. Another element is that, similar to the current fight about reducing Medicare payments to physicians, reimbursement to physicians under a single payer system becomes a major national fight. Unlike right now, where it’s sort of off the agenda for most of the public, if every physician knew that their payments were going to be cut, there would be a huge uproar that I think they would change the formula so that physicians are paid fairly.

WT: I got into health care after medical school as an internist and practiced in a public health clinic. My intention was to go into private practice, but I found that working in a public health clinic was so interesting, surprisingly, and the need was so great, that it actually changed my thinking and my politics on this whole issue. There were literally thousands of people coming into public health clinics who had no other source of care. I started getting very interested in why is it that we finance health care in a fashion where some people get health care through private doctors and others go to public health clinics? The self-education on this topic led me to decide to change my career to public health and to study much more about the health care system. I went back to get my Masters in Public Health and I decided public health was a much better career choice. Maybe not as rewarding financially, but a much better choice in terms of what’s meaningful to me in health care.

When I was in the health center one of the doctors came up to me and said, "You know, you should learn more about Physicians for a National Health Program." I knew nothing about it and I decided to go to some local meetings. Although I was a bit skeptical at first, I started becoming much more intrigued by the idea that, if we financed health care differently, a lot of the problems that I was seeing in the public health clinics could be resolved, particularly this issue of the uninsured. The organization has been around since 1990 and has close to 10,000 member physicians who support a national health program. Ironically, it’s also based in Chicago, where the AMA is based. There are other physician organizations interested in a single payer model. The National Medical Association, which represents many of the African American physicians in this country, the American Women’s Medical Association, and the American Medical Students Association all support national health insurance.