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  • Introduced by: Edward F. Ragsdale, MD, Delegate, for Madison County Medical Society

    Subject: Disadvantages of Single Payer Health Care

    Referred to: Reference Committee B

    Whereas, congressional Democrats led by Vermont Senator Bernie Sanders are advocating a single payer system of healthcare similar to the British National Health Service. If adopted, the system would be very difficult to cancel and very expensive. Britain’s health program is paid for by a special 12% payroll tax on top of the progressive income tax. When the system is low in funding, care is delayed or denied. Last month, the British government cancelled 50,000 non-emergency surgeries; and

    Whereas, delay and denial of car may be even worse in Canada’s single payer system. This was described in detail in a Wall Street Journal article on 12/13/2017. An extensive study found a median writing time of 21.2 weeks between referral from a general practitioner and receipt of treatment. The 2016 wait was 20 weeks, Canadians could expect to wait 4.1 weeks for a CT scan, 10.8 weeks for an MRI and 3.89 weeks for an ultrasound. 1,041,000 patients are waiting in line in Canada for treatment, 63,500 Canadians came to the U.S. for care in 2016. The delays will cause increased pain and suffering as well as poorer medical outcomes; and

    Whereas, compared to Britain, the United States has a much better record on some very serious diseases such as breast, prostate and colorectal cancer. Access to advance medical technology and innovative drug therapies is much better in the U.S.; therefore, be it

    RESOLVED, as policy, that the Illinois State Medical Society will oppose a government monopoly over health care. This monopoly would outlaw all private health insurance and impose restrictions on private medical practice. A centralized bureaucracy, would govern the financing and the delivery of care. True health reform would produce a better, less expensive program with greater choice and freedom for individual patients and physicians.

    Existing ISMS policy and action related to this issue:

    House of Delegates amended and adopted Resolution B206 (A-16) which calls for ISMS to research and analyze the benefits and difficulties of a single-payer health care system in Illinois (for example, the Illinois Universal Health Care Act) with consideration of the impact on economic and health outcomes and on health disparities, and that ISMS forward this resolution to the American Medical Association (AMA) House of Delegates to request that the AMA do the same. (HOD 2016)

    Board of Trustees did not approve for distribution to ISMS members the Illinois ACP-sponsored survey assessing physicians’ views on various payment models/Medicare for All/single payer system. (BOT - JUNE 2017)

    Board of Trustees directed ISMS to conduct periodic, targeted surveys on health system reform issues being debated in Congress or the Illinois General Assembly as a means to foster member and potential member engagement in ISMS activities; and that such targeted surveys be implemented in lieu of a single large scale member survey on health payment models.(BOT - JAN 2018)

    House of Delegates adopted Resolution 77 (A-06), as amended, which directed that the ISMS oppose efforts by the current State of Illinois leadership to convert health care to a single payer system; and that the ISMS urge the Adequate Health Care Task Force to investigate free market reforms to health care access and funding challenges in Illinois. (HOD 2006)

    Board of Trustees reaffirmed current policy in lieu of Resolution 3 (A-08), Opposition to Single Payer Socialized Medicine. (BOT 2008-OCT)

    ISMS supports private, voluntary catastrophic health insurance, including freedom of choice of physician. It supports the policy of a tax credit or deduction for the premium expense of medical insurance and endorses the principle that, under federal rules and regulations, the costs and premiums for health care, whether incurred directly by an individual or conferred as an employee benefit, should be equally deductible. Inasmuch as the fee coverage by insurance plans may not cover the full fee of the physician, the physician is encouraged to develop a prior agreement with the patient outlining the patient's individual responsibility for the physician's fee. When insurance benefits are assigned to a physician by a patient, care should be exercised by the insurance company, or its agent, in seeing that such wishes of a patient are followed. If an error is made by the insurance company, or its agent, and payment is made to the patient, the insurance company is urged to admit its error and pay the physician as it was originally directed to do. Under such circumstances, recouping of money from the patient should be the responsibility of the insurance company, or its agent, that committed the error and not be the responsibility of the physician. 

    ISMS objects to third party carriers interfering with the practice of medicine and the patient-physician relationship by:

    • Implying to patients that physicians' charges above insurance benefit allowances are excessive;
    • Suggesting to physicians that insurance company reimbursement amounts be accepted as payment in full;
    • Suggesting that physicians perform alternative surgical procedures;
    • Instituting utilization review of hospital patients in the private sector which bypasses local physician review mechanisms;
    • Discriminating against the physician who does not have a separate contractual relationship with the carrier and inhibiting the patient's free choice of physician.

    ISMS endorses long-held principles that:

    • A contractual relationship that exists between a patient and a third party does not involve the physician (unless the physician has agreed to such involvement); and
    • The third party is not involved in the contract existing between the patient and his/her physician (unless such involvement has been agreed to by both patient and the physician).

    (HOD 1982; Revised 2008; Reaffirmed 2015-JAN; Reaffirmed 2015; Reaffirmed 2017)

    The Illinois State Medical Society is opposed to compulsory governmentally-mandated national health insurance plans and will continue to point out its dangers and disadvantages to the public, including those in which quality of care is compromised. It is opposed to national compulsory catastrophic health insurance. Health insurance benefits for mental illness should be comparable to benefits for any other medical condition. Governmental health insurance programs providing reimbursement for medical services under the direction of practitioners other than doctors of medicine or osteopathic medicine should establish a separate category for such reimbursement, with separate payment, and be optional to the insured as long as the plan has a demonstrated physician-supported patient care management program in effect. ISMS will actively oppose any state or federal legislation which proposes reimbursement under health insurance programs for limited license practitioners without direct supervision and responsibility for patient care by a physician licensed to practice medicine in all its branches in Illinois. (HOD 1986; Revised 2008; Reaffirmed 2011; Reaffirmed 2012; Reaffirmed 2015-JAN; Last BOT Review 2015)

    It is the policy of ISMS to publicize and promote the Medical Savings Account (including Health Savings Account) concept as a third major area of emphasis, in addition to medical liability reform and antitrust reform, as appropriate. (HOD 1994; Reaffirmed 2012; Reaffirmed 2015-JAN; Last BOT Review 2015)

    ISMS rejects the idea of an employer mandate for providing health care insurance. (HOD 1994; Reaffirmed 2015-JAN; Last BOT Review 2015)

    ISMS supports prohibiting any organization which issues health insurance policies in the state of Illinois from denying health insurance policies on the basis of pre-existing medical conditions. (HOD 1994; Reaffirmed 2010; Reaffirmed 2015-JAN; Last BOT Review 2015)

    It is the policy of ISMS to provide strong leadership in support of the private practice of medicine. (HOD 1995; Reaffirmed 2012; Reaffirmed 2015-JAN; Last BOT Review 2015)

    All health care insurance companies should return a minimum of 85% of the yearly premium as benefits, regardless of any old or new government regulations. In addition, the administrative costs of each company, expressed as a percent of collected premiums, should be made public on an annual basis. (HOD 2003; Reaffirmed 2015-JAN; Last BOT Review 2015)

    ISMS supports the following health care system reform principles:

    1. Health care delivery and finance system reform should use the current public-private system as a basis and focus on incremental evolutionary change.
    2. All patients should have access to a health benefit plan that would include catastrophic coverage as well as preventive services, appropriate screening, primary care, immunizations, and prescription drug coverage.
    3. Health insurance reform is needed to allow public and private plans to develop innovative coverage plans, including the development of health savings accounts and other high deductible plans to encourage patients, physicians, and other health care providers to pursue high value care.
    4. All health care expenditures should receive equal treatment for purposes of tax deduction and tax credits.
    5. Professional liability reform – including caps on noneconomic damages – should continue to be pursued and defended as a way to reduce direct and indirect costs (defensive medicine) and to address the adverse effect the current medical liability system has on the physician-patient relationship and access to health care.
    6. Use of information technology in health care delivery should be encouraged to improve quality and safety of care, enhance efficiency, and control costs.
    7. Health care education and literacy must be an important part of any medical care financing and delivery system reform.
    8. Health care reform proposals should include provisions for physicians to set and negotiate their own fees in order to adequately compensate physicians and other health care providers for the promotion of personal and public health.
    9. Evidence-based protocols should support, not replace the patient-physician relationship.
    10. ISMS objects to third party insurance carriers interfering with the practice of medicine and the patient-physician relationship.

    (HOD 2007; Revised 2008; Reaffirmed 2011; Reaffirmed 2012; Reaffirmed 2015-JAN; Reaffirmed 2017)

    ISMS supports consumers' right to purchase health insurance across state lines in order to allow people to choose the health insurance plan that best suits them, thereby offering the best form of consumer protection for all. (HOD 2008; Reaffirmed 2012; Reaffirmed 2015-JAN; Last BOT Review 2015)

    Health care must continue as a priority item of funding at the national, state, and local levels. Health care coverage must be expanded to all citizens of the United States. As our health care delivery system evolves, direct, meaningful and obligatory physician input is essential and must be present at every level of debate. The private practice of medicine must be permitted as the U.S. health care delivery system evolves. (HOD 2008; Reaffirmed 2012; Reaffirmed 2015-JAN; Last BOT Review 2015)

    ISMS supports the sale of health insurance across state lines. (HOD 2010; Reaffirmed 2015-JAN; Last BOT Review 2015)

    ISMS supports mandating that individuals earning more than 500% of the federal poverty level acquire health insurance. (HOD 2010; Reaffirmed 2015-JAN; Last BOT Review 2015)

    ISMS believes that the provisions of the Patient Protection and Affordable Care Act (PPACA) which increase the number of Medicaid beneficiaries by 25%, decrease funding for Medicare, including a lack of a fix to the sustainable growth rate formula and lack of tort reform for medical liability cases, are not only financially unsustainable, representing unfunded mandates, but unfairly place the burden on physicians which will lead to the bankruptcy or dissolution of physician practices. ISMS will work for the revision of the flawed PPACA to correct these deficiencies and replace it with a financially sustainable system which incorporates provisions that place a fair contribution by all stakeholders. (HOD 2012; Reaffirmed 2015-JAN; Last BOT Review 2015)

    ISMS supports appropriate changes to Medicare rules that would allow physicians of all disciplines, including those who practice in skilled nursing facilities and as medical directors of nursing facilities, to participate in multiple accountable care organizations, if they so choose. (HOD 2013; BOT 2013-OCT; Reaffirmed 2015-JAN; Last BOT Review 2014)

    ISMS recognizes there are member differences and concerns regarding the implementation of the Affordable Care Act. (HOD 2014; BOT 2015-JAN; Last BOT Review 2015)

    ISMS supports expanding health insurance coverage options for employees of small businesses and other affinity groups. (HOD 2016)


  • The commenting period is now over.
    Comment List
    Robert F. Hamilton, M.D. I favor this resolution

    We must repeatedly state our opposition to single party payer systems, as long as its proponents repeatedly try to find new ways to promote such a system, even though they never present any conclusive new evidence that any single payer systems leave medical care in the hands of the patients and physicians and offer any new and innovative ideas for controlling medical costs other than withholding care by various means.
    Robert F. Hamilton, M.D
    Past-Trustee District 6

    Apr 12, 2018 at 3:55 p.m.

    David W. Miller, M.D. I am not in favor of this resolution

    Single payer as a baseline can provide fundamental safeguards.

    Apr 20, 2018 at 9:23 p.m.

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