by Lance Dickie

Searing headlines about local job cuts sharpen interest in universal health-insurance coverage. The topic grabs the attention of those vulnerable families and voters broadly defined as the middle class, the engine of change.

Increasingly, the focus is on national single-payer health insurance. Acceptance of the concept is growing, especially among a key constituency: doctors.

Two years ago, I opined the health-care system was not yet bad enough for real change to occur. The economy was propped up by easy credit and the soon-to-be-exposed liar loans of a fraudulent housing boom. The link between having a job and access to medical care was still secure for so many.

Well, yes, the number of Americans without health insurance was estimated at 47 million - a staggering figure - but the topic and threat seemed comfortably distant from most households.

At the same time, coverage was eroding for many wage earners. Benefits were being cut, insurance exclusions were mounting, co-payments and deductibles were climbing, and children of the middle class were entering a stark economy where employers can no longer afford to offer coverage.

Single-payer health insurance is about who pays the bills, not who provides the medical care. Instead of having private insurance, everyone pays into a common fund. Nothing about the health-care-delivery system changes.

No one is employed by the government except the people who write the checks. Call it Medicare for everyone. Instead of waiting until age 65 for decent medical care, everyone - everyone - has access to a doctor.

The public's interest in guaranteed health insurance has been picking up in polls, but a significant change was reported this spring in the Annals of Internal Medicine, a leading medical journal. A study found 59 percent of U.S. physicians now support national health insurance, a jump of 10 percentage points in five years.

Support for national health insurance - private doctors paid by a federally administered plan - has gained support across medical specialties, according to Dr. Aaron E. Carroll, of the Center for Health Policy and Professionalism Research at Indiana University's School of Medicine in Indianapolis.

Doctors have layers of frustrations with the current system of private insurers, Carroll said in a telephone conversation this week. Serving on the front lines of the medical system, they see the toll on patients without insurance and on the underinsured.

For all the grousing about reimbursement rates paid by Medicare, Carroll said doctors work within an operating model that is easier to navigate, and with vastly lower overhead expenses than hundreds of private insurers. Doctors are fed up with the hassles and billing refusals by different people at different companies with different procedures.

Carroll even sees a national single-payer health-insurance plan offering relief for such knotty problems as malpractice insurance. Most of the legal battles focus on the cost of future health care after a bad outcome. Universal coverage resolves that issue. That leaves a much smaller pool of cases where the fight is over punitive payments for true negligence.

The professional and political mosaic of a national single-payer health system is taking shape. In January, the American College of Physicians endorsed single payer as a pathway to universal coverage. In June, the U.S. Conference of Mayors adopted a resolution in support of HR 676, the United States National Health Insurance Act. Rep. Jim McDermott, D-Seattle, is an articulate proponent of the legislation.

So far, the presidential candidates are behind the curve on health-care reform. Dr. John P. Geyman, professor emeritus of family medicine at the University of Washington, laments that Republican John McCain offers no new ideas and Democrat Barack Obama's incremental approach falls short of a fix.

Geyman argues the inefficiencies and high overhead of the current health-care system have led to under-use of essential care for vulnerable populations, and a significant amount of unnecessary and inappropriate care for those who can pay for it.

Change is coming. McCain and Obama owe voters a coherent health plan. Their future employment depends on it.

Lance Dickie's column appears regularly on editorial pages of The Times. His e-mail address is ldickie@seattletimes.com; for a podcast Q&A with the author, go to www.seattletimes.com/edcetera
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