Can't hold tongues on Obama's health law

By David U. Himmelstein, M.D., and Steffie Woolhandler, M.D., M.P.H.
The Nation, March 26, 2012

PNHP note: In February The Nation magazine published an article titled "A spoonful of sugar" by Bernard Avishai. The article was a review of Paul Starr's book "Remedy and Reaction," and included the following comments: "Obamacare, in short, was health care reform’s best — and last — shot, and it would be unconscionable for liberals to remain cavalier about its defense, or Obama’s, for that matter. It’s past time to discard the misguided assumption that in a better economy, or with more of 'a fighter' in the White House, something like a Canadian-style single-payer system might have been (or might sometime fairly soon be) enacted." On March 26, The Nation published four rejoinders to Avishai's piece, three of them by physicians. The reply of PNHP's co-founders appears below.

A bowlful of vinegar

Bernard Avishai ("A spoonful of sugar," Feb. 13) portrays progressive critics of Obama's health care bill as hopelessly naïve and out of touch with political reality. But intimate acquaintance with medical reality drove the criticism from us and our 18,000 colleagues in Physicians for a National Health Program who advocate single payer. As doctors, we're too cognizant that the plan will leave 23 million uninsured and thousands dying each year from lack of coverage; do nothing for our insured patients with coverage so skimpy that serious illness would lead to bankruptcy; strip tens of billions from safety net hospitals; and let medical costs continue to skyrocket, leaving Medicare and public workers' coverage open to savage cuts. Whatever its political merits, the bill is a failure in medical terms.

If anything's naïve, it's Avishai's faith in cost savings from generalizing the Mayo Clinic model (Mayo shuns uninsured and Medicaid patients — and Medicare at some clinics — and was dropped from two big insurers' networks because of its high costs) and from standardized and computerized billing. Computer firms have been promising paperwork savings for forty-six years (see the 1966 video at, but they haven't materialized. He also seems unaware that hospital billing has been standardized and computerized for years (they all use the same ICD coding system, the UB82 billing form). As our studies in The New England Journal of Medicine have shown, single-payer reform could eliminate about $400 billion wasted annually on insurance overhead and billing paperwork; the reforms Avishai lauds will save bupkis.

Obama's reform, closely patterned on a Heritage Foundation proposal, will deliver billions to insurance and drug firms and paltry benefit to Americans. Yet Avishai would have progressives hold their tongues. Should we also hold our tongues about the administration's missteps on civil liberties, education "reform" and the environment?

David U. Himmelstein, M.D., and Steffie Woolhandler, M.D., M.P.H., reside in New York City.