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Letters to the Editor  |   May 2011
DOs Should Endorse an Evidence-Based National Healthcare Policy
Author Affiliations
  • Jeremy D. Graham, DO, MA (applied social science/medical anthropology)
    Spokane, Washington
Article Information
Evidence-Based Medicine / Professional Issues
Letters to the Editor   |   May 2011
DOs Should Endorse an Evidence-Based National Healthcare Policy
The Journal of the American Osteopathic Association, May 2011, Vol. 111, 348-349. doi:10.7556/jaoa.2011.111.5.348
The Journal of the American Osteopathic Association, May 2011, Vol. 111, 348-349. doi:10.7556/jaoa.2011.111.5.348
To the Editor:  
I read with interest the adulatory review by Donald W. Brown, Jr, DO,1 of Healthcare Solved—Real Answers, No Politics, the treatise by Debra A. Smith, DO, about reforming the US healthcare system. A key assumption of the review warrants response and discussion. 
Dr Brown1 rejects public and universal healthcare plans, and he laments the putative struggles of private finance insurers by asking, “can we realistically expect the government to do better?” One of my osteopathic attendings as an intern was fond of repeating, “You can have your own opinions, but not your own facts.” This same perspective can help provide an answer to Dr Brown's rhetorical question. 
Medicare already performs better than private insurers, consuming approximately 2% to 3% of funding in administrative overhead.2,3 Private insurers' overhead, by contrast, averages more than 12%—and often greater than 30%.2,3 Furthermore, private insurances add no medical value by diverting dollars from patient care into advertising and profit. 
At the physician end of the equation, the cost of pursuing hundreds of different payer sources falls squarely upon US physicians' practices,4 a burden that would not exist in a single-payer system. The total expenditures of public health insurance systems throughout the developed nations is below that of US private insurers, and these systems deliver more effective healthcare to all citizens of those nations at a fraction of US costs.5 
Private insurers' profits climbed through 2009 and 2010 as a result of premium increases6 rather than the nebulous “underwriting... and interest rates” described in Dr Brown's review.1 The profitability of private finance insurers and the value of the Morgan Stanley Healthcare Payor Index (an index of insurance companies' performance) have both risen through the last 3 years—while private insurers have covered fewer Americans.6 
Osteopathic physicians' endorsements of different public health policies will impact our patients, our communities, and our own practices. Our support for public health policy warrants the same rigorous evidence-based scrutiny as do our prescribing choices. Our patient care and our professionalism both pivot on the integrity to place data before ideology. In the end, we as osteopathic physicians serve the health of patients—not that of insurance companies. The majority of US physicians support a comprehensive public healthcare plan for all,7 and the available data support this endorsement. 
Osteopathic medicine sprang from A.T. Still's insight that the medical practices of his contemporaries stood upon little more than the empty repetition of traditional dogmas. Similarly, Dr Still's stand against slavery helped reverse another unsupportable social dogma. Today, data consistently demonstrate higher performance and lower costs of care with national health insurance for all.5 As the professional descendents of Dr Still, osteopathic physicians should endorse health policy that places data over dogma. 
Brown DW Jr. Healthcare solved—real answers, no politics [book review]. J Am Osteopath Assoc. 2010;110(11):680-681.
Himmelstein DU, Woolhandler S, Wolfe SM. Administrative waste in the US health care system in 2003: the cost to the nation, the states, and the District of Columbia, with state-specific estimates of potential savings. Int J Health Serv. 2004;34(1):79-86.
Kahn JG, Kronick R, Kreger M, Gans DN. The cost of health insurance administration in California: estimates for insurers, physicians, and hospitals. Health Aff (Millwood).. (2005). ;24(6):1629-1639.
Casalino LP, Nicholson S, Gans DN, et al. What does it cost physician practices to interact with health insurance plans [published online ahead of print May 14, 2009]? Health Aff (Millwood).. (2009). ;28(4):w533-w543.
Organization for Economic Co-operation and Development. OECD Health Data 2001. Paris, France: Organization for Economic Co-operation and Development; 2001.
Walker EP. Insurers post record profits. Med-Page Today. February 12, 2010. http://www.med-pagetoday.com/Washington-Watch/Washington-Watch/18451. Accessed January 5, 2011.
Carroll EA, Ackerman RT. Support for National Health Insurance among US physicians: 5 years later. Ann Intern Med. 2008;148(7):566-567.