There was a meeting yesterday of a House subcommittee where some important things were said by some front-line healthcare providers and medical educators, and although the important things they said were not well reported, I can sum up the testimony in five words…

Healthcare professionals want single payer.

That is because we have had a front-row seat to the horror show that is our current healthcare system and we have come to realize, some of us more quickly than others, that spiraling costs are the biggest problem we face, and the surest, fastest and most effective way to get those costs under control is to move to a single payer system. "Unless you can stop the insurance industry price gouging, we simply cannot make health care affordable, which means you either have price controls on the insurance industry or you take them out of the equation through single-payer reform," said Geri Jenkins, the co-president of the National Nurses Organizing Committee, which represents 86,000 registered nurses. "If we were to have a debate on containing costs, improving quality and universality, the single-payer advantage would be clear."

Walter Tsou, a University of Pennsylvania professor who is an adviser to Physicians for a National Health Program told the panel that for the last 50 years, government policy has protected insurance industry profits at the expense of taxpayers, doctors and hospitals. "Single-payer is the only reform that can control health care costs," he said bluntly. "Our most famous radical document begins with the words, ‘We the People.’ Not ‘We the Insurers.’ It is time for our own generation’s revolution."

We all know that the single payer discussion is one that we ought to be having, but politicians on every side are scared to death of it, to the point that even though we have a popular Democratic president with strong majorities in both chambers, Democratic legislators took single payer off the table early in the first round of discussions. Unsurprisingly, they regret that decision now. Oops. Probably shouldn’t have done that…

It has been fifteen years since at least a plurality, if not an outright majority, of those of us with initials other than “M.D.” behind our names started to wake up and smell the coffee. Too bad nobody listens to us.

Four of the five panelists, including Conyers, spoke in favor of single-payer. The only person in opposition was Manhattan Institute fellow David Gratzer, a doctor born and trained in Canada, who said the Canadian national-health system struggles to provide care to its citizens. "Like the Soviet Union, everything is free, nothing is available," Gratzer said.

But as long as Congress adequately funds health care, the other panelists said, that won’t be an issue. "If they were to put the same amount of money into their systems as we do into ours, there would be no waits," said Marcia Angell, a Harvard lecturer and former editor of the New England Journal of Medicine.

"The reason our health care system is in such trouble is that it’s set up to generate profits, not to provide care," Angell said, noting that private insurers spend 20 percent on marketing and administrative costs, compared with 3 percent for Medicare. She deemed the health-insurance sector "an industry that offers almost nothing of value."

Most of the panelists dismissed concerns of job losses at private insurers, arguing that employment would increase overall given the increased demand for medical professionals. Jenkins estimated total job creation at 2.6 million.

Gratzer, the one panelist opposed to single payer, gave responses that at times seemed to try the patience of Rep. Rob Andrews (D-N.J.) who chaired the meeting, especially when he suggested that if people just spent more time “hanging out with the family doctor” individual health outcomes would improve. Although he doesn’t bother to tell us where all this extra ‘time’ doctors would spend hanging out with us would come from. Being a fellow healthcare professional, I get professional courtesy when I see my doctor on a regular basis, and he still only spends about five minutes per visit with me, tops. If I get ten it is because I have an issue that we need to discuss, and he spends the rest of his day trying to make up the extra few minutes he spent with me.

Of course the geezers at the AMA have a different and totally predictable slant on it. They not only oppose single payer, but any public option at all.

As the health care debate heats up, the American Medical Association is letting Congress know that it will oppose creation of a government-sponsored insurance plan, which President Obama and many other Democrats see as an essential element of legislation to remake the health care system.

The opposition, which comes as Mr. Obama prepares to address the powerful doctors’ group on Monday in Chicago, could be a major hurdle for advocates of a public insurance plan. The A.M.A., with about 250,000 members, is America’s largest physician organization.

While committed to the goal of affordable health insurance for all, the association had said in a general statement of principles that health services should be “provided through private markets, as they are currently.”

Now lets consider the source of the opposition. Yes, the AMA is the largest physicians group in the country, but that is their last – and fading – claim to relevance. Not only do they represent only about one-third of all doctors practicing in this country, and the doctors they do count as members are mostly specialists and a great n umber of them are nearing retirement. They have very few members under 40 and fewer still general practitioners in their membership.

It also bears remembering that the AMA has consistently opposed every attempt at reform for the better part of a century. This is the same group that opposed Medicare and denounced it as the first step on the path to totalitarianism. Before that, the opposed President Truman when he wanted to reform health care, and before they opposed Truman’s reform they managed to keep a healthcare provision out of FDRs original Social Security legislation.

On the other hand, the American Academy of Family Physicians – the group that is far more likely than the AMA to represent the doctor who returns your call at three a.m. when your child wakes up crying and spiking a temp – has staked out a common-sense position in the middle.

Their official position is that a public option is vital, but at least for now they oppose a single payer option. If I were to draw an analogy I would put it this way: The AAFP is not in favor of “Medicare for all” but they would offer whole hearted and full-throated support to a plan that resembled “S-CHIP for all.” (.pdf here) I would rather have single payer, but I could live with the AAFP’s version, especially when the alternative is the status quo.

The bottom line is this: Reform is coming, whether the AMA wants to accept that fact or not, and enough people have realized that every single argument that is made against a public option fails to stand up to scrutiny, because every single negative scenario they point to, patients already have to deal with every time their doctor orders a test, writes a prescription or schedules a procedure – and enough people are independently arriving at this conclusion that ‘critical mass’ is imminent.