Many physicians have feared and hated what they used to call “socialized medicine,” but change is in the air. Doctors are busier than ever. Their costs keep rising. Mountains of paperwork take up increasing time and attention. Above all, they are watching, some with dismay, as health care becomes less a social service and more a commodity.

The widely respected Journal of the American Medical Association (JAMA) has focused its attention on the issue by publishing a lengthy proposal for a national comprehensive universal single-payer health plan already endorsed by 8,000 American doctors. While that number has now risen to 10,000, it’s a tiny fraction of the national total. And the American Medical Association, which regards its journal as editorially independent, “strongly disagrees” with the JAMA article. It says: “A solution to the problem of the uninsured is desperately needed – but a single-payer health care system is not the answer.”

Still, it’s a start, just as Maine’s Dirigo universal health plan is a start. The more modest Maine plan, remarkably enacted with bipartisan support, was opposed at first by the state’s organized doctors, as well as hospitals, and was modified to meet their objections. Maine wouldn’t wait for a national solution and wisely took this interim step.

The proposed national plan would divorce health coverage from employment and get the insurance industry out of the picture. It was put forward by Physicians for a National Health Program, a not-for-profit organization of physicians, medical students and other health care professionals. The full text can be found on-line at www.pnhp.org.

Doctors and medical institutions have worked successfully with government through the National Institutes of Health and the Centers for Disease Control and Prevention in the science and technology of medical service. But when it comes to the system for providing health service, profit-making insurance companies, hospitals and drug companies have taken over and cut the doctors out of the loop.

A chief advocate of a universal health plan, emeritus Professor Rashi Fein of the Harvard Medical School, argues that the proposed national plan can stimulate a dialogue in which physicians have a role. He says that doctors, while divided as to a solution, are generally unhappy with the present system and would consider a different approach, not necessarily single-payer, but possibly an extension of Medicare to gradually cover the entire population in a phased approach by age.

Doctors are at the heart of the health care system, and they can help lead the way out of the present chaotic situation, in which 20 percent of the population are uninsured and many others are inadequately insured.

As Professor Fein says, “Let the debate begin.”