Public option finding favor: The option for government insurance is gaining steam -- even among the nation's doctors.

In two widely different forums Wednesday, Florida doctors and nurses agreed that healthcare reform is desperately needed -- and they're not opposed to a public option as part of the package.

That was the sentiment expressed at a midday meeting in Miami sponsored by SEIU Local 1991, the union for Jackson Health System workers. It was also enunciated by Cecil B. Wilson, the president-elect of the American Medical Association, speaking by telephone from a conference in Orlando.

"Surveys show that nationwide the majority of the American public -- and that includes physicians and AMA members -- are in favor of a public option," said Wilson, an internist from Winter Park.

In fact, as a half-dozen speakers made clear on Wednesday, the issue is no longer whether there should be healthcare reform -- but what the details should include.

By the end of this week, it's expected that the House and the Senate will each have consolidated myriad proposals into a single bill in each chamber -- and each will have the option for government insurance.

"We are much further along" the road to healthcare reform "than we have ever been in this country," said Celia Wcislo, an SEIU division director from Massachusetts, speaking at a forum at Miami Dade College Medical Center.

"We've said from the beginning that we can have successful reform without a public option," said president-elect Wilson. "It's not a critical part of meaningful reform. But we have also said that whatever public option appears, we would look at it and make comments. We have some guidelines" that would determine whether the AMA supported it.

"The keys are "freedom of choice for physicians and patients," Wilson said.

In Miami, L. Toni Lewis, a physician who's president of the Committee of Interns and Residents, expressed amazement that private health insurers complain that a public option would create "competition [that] would drive them out of business," because private companies are supposed to thrive on competition.

Lewis also derided complaints that a government plan "would get between you and your doctor," because private insurers frequently put up barriers to treatments requested by physicians.

David Woolsey, a Jackson emergency physician, said that during his 20 years in the front lines, he has daily witnessed emergency rooms as the "last resorts" for treating the uninsured, since federal law requires that everyone who comes be examined and stabilized.

FOLLOW-UP CARE

But ERs are "the tip of the healthcare iceberg," Woolsey said. The excruciating crunch often comes when the doctor must discuss with an uninsured patient the need for follow-up care for problems like blood in the stool or suspect lumps.

If the patient can't afford to pursue treatments on her own, "then we scramble," said Woolsey, because public care outside ERs often means long waits for appointments or demands of deposits before care is given.

The AMA, too, wants "coverage for everyone" because "those without health insurance are at risk for being sicker and dying sooner," Wilson said.

But the doctors' organization is concerned that that reform could be financed by reducing their income. The AMA battled hard this month to get the Senate to pass a bill freezing doctors' Medicare reimbursement rates for the next 10 years. They lost a vote last week, primarily because some senators are concerned about mounting deficits caused by healthcare.

"The senators abrogated their responsibility to senior citizens," Wilson said. As it is, doctors' Medicare pay could take a 21 percent cut on Jan. 1, the result of a law intended to keep the seniors' healthcare program solvent.

Woolsey, the ER doctor, said he knows many doctors whose primary concern about reform "is about losing the income." But he noted that as a Jackson employee, "I make a fair living doing good things for people. Medicine is beautiful -- doing things never done before -- but we're stressed about how to pay for it."

Bernd Wollschlaeger, a North Miami Beach family physician who's former president of the Dade County Medical Association, told the Miami audience that he has "resigned in protest" from doctors' organizations because many members of those groups maintain that "the uninsured is a myth."

INSURANCE REFORM

Wollschlaeger complained that present reform proposals want to change health insurance, not healthcare, and involve finding ways to give big insurers more money to insure more people -- "corporate welfare reform."

The German-born doctor said that present proposals were "a dead duck in the water" because they did not address how to reorganize the healthcare system to deliver more efficient, less expensive care.

Wollschlaeger said the United States "runs 100 years behind" in terms of healthcare reform. He noted that more than a century ago, German Chancellor Otto von Bismarck got coverage for everyone under the conservative theory that poor sick persons couldn't work, thereby reducing the profits of the rich.