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Doctors oppose US health plan

By Rebecca Knight in Boston
Financial Times
Published: August 4 2008

The Massachusetts healthcare programme widely seen as a test case for universal health coverage in the US faces mounting opposition from doctors who say the reform is failing.

More than 250 physicians in the state have signed an open letter warning that the healthcare plan, which was signed into law in April 2006 by Mitt Romney, the former Republican governor of Massachusetts, is “already proving fiscally unsustainable”.

The landmark programme, designed to provide universal health insurance, requires all uninsured people to purchase private insurance or face a fine or tax penalty.

The doctors’ discontent with the plan, and their support for a single-payer system — whereby payments to healthcare providers would all be made by one administrative body like Britain’s National Health Service, rather than individual insurers — could send a strong signal to other states considering similar reform measures.

Healthcare is one of the main issues on the presidential campaign trail. Both candidates have called for radical reform of the $2,300bn (€1,477bn, £1,172bn ) healthcare system, although neither supports mandatory insurance payments.

In the letter, the Massachusetts doctors say the state-subsidised insurance offered to low-income families is too expensive and that “few can afford premiums for even the skimpiest coverage”. The doctors also warn that funding the plan in future will be hard because it deepened the state’s “dependence on private insurance, [so] can only add coverage by adding costs”.

The Massachusetts plan is an example of “the same reform being tried over and over”, according to Dr Rachel Nardin, assistant professor of neurology at Harvard Medical School, who wrote the letter. “This kind of incremental reform is very popular because it’s politically feasible: it allows the current stakeholders to stay in play,” she said. “But there are a lot reasons why it can’t work.”

A growing number of US doctors favour switching to a national healthcare plan. According to an earlier survey in the journal Annals of Internal Medicine, 59 per cent of doctors said they backed legislation to establish a national health insurance programme, a rise of 10 per cent from 2002.