Physician group reignites debate over single-payer plan: nearly 8,000 doctors sign on.(News)

WASHINGTON--The more things change, the more they stay the same.

When a group of 430 physicians introduced a proposal for a single-payer national health insurance system at the American Medical Association House of Delegates meeting in November 1937, the idea was roundly criticized by Dr. Morris Fishbein, editor of the Journal of the American Medical Association.

"Is there a well designed plan to impress the executive and legislative branches of our government with the view that the American medical profession is disorganized, distrustful of its leaders, undemocratic in its action, and opposed to the best interests of the people?" Dr. Fishbein wrote (JAMA 109[22]:1816-17, 1937). He noted that although the proposal was voted down, the AMA stood willing "to do its utmost today, as in the past, to provide adequate medical service for all those unable to pay either in whole or in part.

Sixty-six years later, another group of physicians--this one numbering nearly 8,000--put forth a similar proposal. The AMA wasted no time in stating its opposition--again.

"By implementing a single-player system, the United States would be trading one problem for a whole set of others," AMA president Donald Palmisano said in a statement. "Long waits for health care services, a slowness to adopt new technologies and maintain facilities, and development of a large bureaucracy that can cause a decline in the authority of patients and their physicians over clinical decision-making are all hallmarks of the single-payer system."

And yet, there are signs that organized medicine might not be quite so dead-set against single-payer as it once was, according to Julius Richmond, former U.S. surgeon general and one of the speakers at a press briefing sponsored by Physicians for a National Health Program (PNHP), a group that supports a single-payer system.

For one thing, the group's proposal was published in JAMA. For another, instead of an editorial excoriating the idea, the proposal was accompanied by a more neutral-sounding editorial from Dr. Rashi Fein, a professor emeritus of medical economics at Harvard Medical School, Boston.