As Congress steps up its efforts to craft a comprehensive health care reform bill, Senator Edward Kennedy (in absentia) is leading the charge for a public health insurance option that can compete with private insurers. As far as I can tell, this would not only involve the expansion of Medicaid to cover people who are currently uninsured and earning below a certain income, but it would also offer a cost-based health plan administered by the government or a nonprofit cooperative (the details haven’t been worked out yet) to folks who have had it up to here with private for-profit health plans.

The Republications, of course, are screaming socialized medicine. And rushing to their side is the powerful doctors group, the American Medical Association. According to The New York Times today, the AMA opposes the creation of a government-sponsored insurance plan, claiming it will restrict patient choice by eventually driving out private insurers.

What the AMA is really concerned about are profits — a public health plan, much as Medicare and Medicaid now do, would reimburse doctors for tests and treatment at a lower rate than private insurers and that would threaten many doctors’ six and seven-figure salaries. God forbid!

Fortunately, as Robert Pear in theTimes article and Doug Bremner’s blog notes, the AMA no longer speaks for many doctors. Indeed, there is a large group, the Physicians for a National Health Program, which supports a single-payer system of insurance, in which a single public entity would pay for health services but most care would still be delivered by private doctors and hospitals. As Pear notes, many doctors have become so fed up with the administrative hassles of private insurance that they are looking for alternatives.

In an op-ed piece in The Boston Globe earlier this week, Dr.Steven Bergman, a psychiatrist and author of The House of God, expressed these sentiments with particular eloquence. Under a universal, government-run health care system, Bergman says, doctors would no longer “have to spend an evening filling out dozens of different insurance forms — and then submit them a month later when they are denied or reduced.”

What Bergman doesn’t mention is how fed up many consumers (who don’t have a powerful lobbying group like the AMA to give them voice) have become with for-profit health plans that charge them high premiums and then don’t really cover them when they need care. I wrote about the millions of Americans who are grappling with unaffordable medical bills as a result of such deliberate under-insurance for The Boston Globe last year. This problem has only become more acute, as health insurers seek to hold onto their excessive profits,

As Bergman points out, the administrative cost for a private, for profit health insurance system is approximately 33 percent ($300 billion annually), while the administrative cost for the the two government-run health systems, the VA and Medicare, is about 3 percent. Yet “the level of satisfaction with these two nonprofit systems is high; that of the for-profit is low,” he notes.

Bergman then asks the pertinent question: Why in the world should health care be for profit? Why indeed. The U.S. is currently the only developed nation in the western world that allows for-profit health systems. Yet despite all the evidence in favor of public health insurance, Bergman is concerned that Congress will fold before the combined juggernaut of for-profit health insurers and powerful doctors trying to protect their profits. If that happens, and there is a strong likelihood it will, Bergman calls on doctors and other health care professionals to go on a nationwide strike. Hear hear!

So what can you, the consumer, do? Call your Congressional representative and tell them that you want a public health plan option as part of the current overhaul. And then call your doctor and make sure he or she is ready to man the balustrades.

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