Proposal of the Physicians' Working Group for Single-Payer National Health

[Cleita]

This is the medical plan or extension and improvement on Medicare that should be extended to all Americans. It will take a strong grass roots movement to accomplish this as the for profit health care industry fights this proposal with the ferocity of a jihad. Their operatives are everywhere spreading disinformation anytime something like this has a chance of being debated in Congress.

I recommend that considering the illigitmate government in Washington these days that we try to do this more locally at a state or even county level. Once the movement spreads then there is a good chance that the federal government is going to have to take the reins as they have the money and the bureacracy to do this.

http://www.physiciansproposal.org/

Introduction

U.S. health care is rich in resources. Hospitals and sophisticated equipment abound; even many rural areas boast well-equipped facilities. Most physicians and nurses are superbly trained; dedication to patients the norm. Our research output is prodigious. And we fund health care far more generously than any other nation.

Yet despite medical abundance, care is too often meager because of the irrationality of the present health care system. Over 39 million Americans have no health insurance whatsoever, including 33% of Hispanics, 21% of African-Americans and Asians, and 11% of non-Hispanic Whites. Many more - perhaps most of us - are underinsured. The world's richest health care system is unable to assure such basics as prenatal care and immunizations, and we trail most of the developed world on such indicators as infant mortality and life expectancy. Even the well-insured may find care compromised when HMOs deny them expensive medications and therapies. For patients, fear of financial ruin often amplifies the misfortune of illness.

For physicians, the gratifications of healing give way to anger and alienation in a system that treats sick people as commodities and doctors as investors' tools. In private practice we waste countless hours on billing and bureaucracy. For the uninsured, we avoid procedures, consultations, and costly medications. In HMOs we walk a tightrope between thrift and penuriousness, under the surveillance of bureaucrats who prod us to abdicate allegiance to patients, and to avoid the sickest, who may be unprofitable. In academia, we watch as the scholarly traditions of openness and collaboration give way to secrecy and assertions of private ownership of vital ideas; the search for knowledge displaced by a search for intellectual property.

For seven decades, opponents have blocked proposals for national health insurance, touting private sector solutions. Their reforms over the past quarter century have emphasized market mechanisms, endorsed the central role of private insurers, and nourished investor-ownership of care. But vows of greater efficiency, cost control, and consumer responsiveness are unfulfilled; meanwhile the ranks of the uninsured have swelled. HMOs, launched as health care's bright hope, have raised Medicare costs by billions, and fallen to the basement of public esteem. Investor-owned hospital chains, born of the promise of efficiency, have been wracked by scandal; their costs high, their quality low. And drug firms, which have secured the highest profits and lowest taxes of any industry, price drugs out of reach of those who need them most.

Many in today's political climate propose pushing on with the marketization of health care. They would shift more public money to private insurers; funnel Medicare through private managed care; and further fray the threadbare safety net of Medicaid, public hospitals and community clinics. These steps would fortify investors' control of care, squander additional billions on useless paperwork, and raise barriers to care still higher.

It is time to change fundamentally the trajectory of America's health care - to develop a comprehensive National Health Insurance (NHI) program for the United States.

Four principles shape our vision of reform.

1. Access to comprehensive health care is a human right. It is the responsibility of society, through its government, to assure this right. Coverage should not be tied to employment. Private insurance firms' past record disqualifies them from a central role in managing health care.

2. The right to choose and change one's physician is fundamental to patient autonomy. Patients should be free to seek care from any licensed health care professional.

3. Pursuit of corporate profit and personal fortune have no place in caregiving and they create enormous waste. The U.S. already spends enough to provide comprehensive health care to all Americans with no increase in total costs. However, the vast health care resources now squandered on bureaucracy (mostly due to efforts to divert costs to other payers or onto patients themselves), profits, marketing, and useless or even harmful medical interventions must be shifted to needed care.

4. In a democracy, the public should set overall health policies. Personal medical decisions must be made by patients with their caregivers, not by corporate or government bureaucrats.

We envision a national health insurance program (NHI) that builds upon the strengths of the current Medicare system. Coverage would be extended to all age groups, and expanded to include prescription medications and long term care. Payment mechanisms would be structured to improve efficiency and assure prompt reimbursement, while reducing bureaucracy and cost shifting. Health planning would be enhanced to improve the availability of resources and minimize wasteful duplication. Finally, investor-owned facilities would be phased out. In each section we present a key feature of the proposal followed by the rationale for our approach. More…

Here is the link to the original article in the JAMA that has the references listed.

http://www.physiciansproposal.org/proposal/Physicians%20ProposalJAMA.pdf

I know there often isn't much interest in health care issues here at DU, so I would appreciate help in keeping this kicked. It is an issue that affects each and every one of us.

[HereSince1628]

1. Thanks, There's a document I will take time to read!

[catmother]

2. this is a very important issue to me. we are the only civilized

country who does not have national health care. it is a crime in a country as rich as ours that many of our citizens do not have health care coverage or some pay ridiculous amounts for coverage. my sister lives in canada and she also posts here. she explained about a month ago how it works. it is not true that people in canada have to wait for surgery. if it's an emergency it gets done. if it's not there may be a wait. so big deal. my sis also says that the doctors make a good living -- they live in nice houses and drive nice cars. i hope this thread keeps going.

[Cleita]

7. Not only that we have to wait here as long for elective surgery

that we pay for. It took me three months to get my cataract surgery waiting in line.

[catmother]

9. wow. i did pretty good. only waited 6 weeks for mine. n/t

[Cleita]

17. ...

:kick:

[crispini]

3. Kicked and recommended!

I am VERY interested in reading this! My mother went to France for a heart procedure there and the hospital was wonderfully well-staffed and she was cared for excellently.

[Nite Owl]

4. Kick

Bookmarking the site too.
This looks like a good start. The first thing that has to be done is separate the work/healthcare tie. Healthcare is a right not a privilege. How often to workers lose their jobs because of an illness or lost time due to a loved one being ill? It doesn't make sense. It seems so clear that the privatization scheme has failed and we should move onto a national program.

[Misskittycat]

5. This is really important.

The number of people now affected (uninsured, underinsured, etc.) is huge and growing. We need to get this going as a grassroots movement.

[leftstreet]

6. Ted Kennedy "Medicare For All"

I know the plans differ, but it's time for America to stop talking about IF - it's time to talk about HOW!

http://www.commondreams.org/views05/0112-37.htm

by US Senator Ted Kennedy
An Address by Senator Edward M. Kennedy at the National Press Club
January 12, 2005
To revitalize the American dream, we also need to renew the battle to make health care affordable and available to all our people. In this new century of the life sciences, breakthrough treatments and miracle cures are steadily revolutionizing the practice of medicine and the quality of life. The mapping of the human genome enables us to understand far more about the molecular basis of disease, and to plan far-reaching cures that were inconceivable only a few years ago.

Sadly, in America today, the miracles of modern medicine are too often the province only of the wealthy. We need a new guarantee for the years ahead that the cost of these life-saving treatments and cures will not be beyond the reach of the vast majority of the American people.

An essential part of our progressive vision is an America where no citizen of any age fears the cost of health care, and no employer refuses to create new jobs or cuts back on current jobs because of the high cost of providing health insurance.

The answer is Medicare, whose 40th birthday we will celebrate in July. I propose that as a 40th birthday gift to the American people, we expand Medicare over the next decade to cover every citizen - from birth to the end of life.

It's no secret that America is still dearly in love with Medicare. Administrative costs are low. Patients' satisfaction is high. Unlike with many private insurers, they can still choose their doctor and their hospital.

For those who prefer private insurance, we will offer comparable coverage under the same range of private insurance plans already available to Congress. I can think of nothing more cynical or hypocritical than a Member of Congress who gives a speech denouncing health care for all, then goes to his doctor for a visit paid for by the Federal Employees Health Benefit Plan.

[Cleita]

8. The nice thing about Medicare is that the bureaucracy is

already in place to administer it, which will reduce new program glitches in the beginning.

[Neil Lisst]

111. The first time I ever heard National Health Care proposed - 1973

Austin, Texas - a lib conference on national health care

Guess who was there to push it? Teddy Kennedy. He was the first national person to get out front on national health care.

Here we are 32 years later, and it's still not here.

[catmother]

10. rep. john conyers introduced a bill. i don't remember the number

it was HR -----. maybe someone knows it.

[Cleita]

12. HR 676. Here's the link to it.

http://thomas.loc.gov/cgi-bin/bdquery/z?d109:h.r.00676:

[catmother]

13. thanks. i just looked it up and was about to post it. n/t

[Telly Savalas]

31. Even though it won't pass...

it's nice to know that someone gives a shit.

[Telly Savalas]

32. 55 Co-sponsors.

Not bad.

http://thomas.loc.gov/cgi-bin/bdquery/z?d109:HR00676:@@@P

[endarkenment]

11. This should be a core Democratic Party platform issue.

UHI. Expand medicare with a real prescription drug benefit, to everyone. End of story.

[stubtoe]

24. Yes, absolutely.

You've put it most succinctly. Let's keep pushing this issue.

[jhain]

14. R&K- and count me as uninsured...

self employed...plenty of times I couldn't take the kids to the doc because I had to pay the health insurance premiums...now, I just can not pay the premiums...

And why the hell should I ?- the times I WAS "fully covered" they bled me to death with 'deductibles'...one child's broken arm cost me over $2,000 out of pocket- with full coverage.

It is f'in bullshit, the entire system.

Now, I have a nosebleed from being on the soapbox. But, I can't afford any gauze, either....

[Cleita]

15. This is whats going on.

It used to be you got some coverage from your insurance once you met the deductible, but now people are not only paying for the insurance but for their health care out of pocket as well. This has got to be stopped.

[catmother]

16. my husband has coverage through his employer. they used to

pay the full cost. but the last 10 years we have to pay part and it goes up every year along with the deductibles and co-pay.

that's why i wouldn't mind my taxes going up if we got the universal care. and no one would have to worry about losing their houses, savings, etc.

[Cleita]

18. Maybe taxes would go up, but then your

employer might be able to raise your wages to cover this because he doesn't have to pay the health insurance expense anymore for his employees.

[catmother]

20. good point. but like i said i wouldn't mind if my taxes went up. it

probably would be less than what where paying in premiums and deductibles. but hey, if the employer wants to pay him more -- good deal. for me one of the most important things is long term care. i have a policy on my husband, but they won't cover me because i have chronic fatigue syndrome and i take certain drugs for the condition. so if i need long term care, we're screwed.

[Cleita]

21. This is the point. With our present system, people are being

denied the health care access that they need. Some one has to really explain to the health care industry that it is the sick who need health care, not the healthy and they should get out of the business so the government Medicare program can take over.

[catmother]

26. i totally agree with you. n/t

[raccoon]

136. He might be able to, but I'd be amazed if he did! nt

[donkeyotay]

19. Never have so many suffered so much for so few

Works for Frist and the boys. Stay the course!

For seven decades, opponents have blocked proposals for national health insurance, touting private sector solutions. Their reforms over the past quarter century have emphasized market mechanisms, endorsed the central role of private insurers, and nourished investor-ownership of care. But vows of greater efficiency, cost control, and consumer responsiveness are unfulfilled; meanwhile the ranks of the uninsured have swelled.

[Cleita]

22. I also heard this week from a friend who has Medicare that

she applied for Medicaid to help where Medicare doesn't. She found out that Medicaid now has a $1,200 (approximate figure, can't remember exact)deductible, but not a year. It's a month. Now please tell me how old people on Social Security and poor people on welfare are supposed to get the money to meet that deductible? Most of them don't get a monthly benefit in SS or welfare to cover it let alone eat. This was one of the cuts to Medicaid that Congress has passed recently.

[Wordie]

74. I don't know your friend's situation, but there are umpteen jillion

different medicaid programs, with different qualification rules, and resource limits, and deductibles, etc., all depending on the person's specific circumstances. That deductible your friend will have to pay won't necessarily apply to everyone. Still, it's not a good situation, and people are going to suffer as a result of this.

[many a good man]

23. Health Care Cost Containment

This is one of the greatest national healthcare proposals ever put forward. Thanks!

But it sidesteps the major issue that confronts us: Health Care Cost Containment. Regardless of whether we get National Health or not, we have to control costs and its gonna be ugly! It will swallow the entire federal entitlement budget!

In less than 20 years Medicare costs will EXCEED social security payments. Its like saying ALL of your SS payments when you retire will have to pay your Medicare deductible. How are people without enormous inflated 401Ks going to survive???

[Cleita]

25. This does address health care costs because it cuts out the

Middle Man or the profiteers. A leaner bureaucracy cuts costs from both ends. Also, like in Canada, fees are negotiated with the private health care providers every year so that everyone leaves the table satisfied.

Drugs are also negotiated in cost, which is why the same drugs are so much cheaper in Canada than here. However, the Pharma companies do not want to give up their gluttonous profits. Also, they claim that they have to charge extra for research and development. It's a half truth that can easily be remedied with grants from the government and other philanthropic associations for research.

Read about all these issues on the Physcians's for National Health Care website at http://www.pnhp.org. They have covered all these concerns in the many articles in their archives.

[dcfirefighter]

27. Bullshit - And I DO support universall health care

Name one government program that contain costs without competition. There aren't any I can think of, but I can think of a HUGE government program that is 'streamlined' and 'cut out the middlemen' and, just like single payer health insurance, the people using the service aren't the people paying for it. It's called the military.

Healthcare costs are growing in every country. Some are growing faster than others.

To truly contain healthcare costs, several things have to happen. Most importantly, those who use healthcare have to have some financial stake in deciding how much to use. A very large percent of people (insured people too) who do not have such a stake use far more medical resources than they really need: they call 911 to get their prescription filled, they visit the ER for a stomach ache, they shop doctors to get medicated for everything.

Universal healthcare can exist while ensuring that users pay, at least a little of their own way. Switzerland has it.

You pay a copay for first visits, except an annual preventive check. You are required to purchase insurance. Insurance companies are required to accept you as a customer. Insurance companies are required to provide a certain level of service. If you cannot afford insurance, or copays, or deductibles (10% of income, i believe) the state will assist you - but you still must make an economic decision.

Without such a feedback mechanism, funding will be controlled by congressional comittees and their associated industry lobbyists. These comitteses will simply decide to fund Amgen's next wonder drug, regardless of cost effectiveness or alternatives.

Conversely, staying healthy doesn't make anyone money - just like using less oil doesn't make anyone money. So there's fewer lobbyists...

Staying healthy DOES reduce your medical costs, and staying healthy reduces your insurer's costs. If your insurer has no profit motive, he doesn't care.

The other thing that needs to be done is to revamp the patent laws and FDA regulations - subjects for other topics.

[Cleita]

28. Canada, Sweden, Denmark, Germany and many others

get it done. We can't, if we keep thinking of health care as a commodity. Another poster on another thread said that in Canada the doctors are well compensated and rich like they like to be here and everyone who needs health care is covered even the unhealthy.

Since there will be no insurer by extending Medicare except Medicare, they won't need any profit. People will be healthier because they will seek out health care before a chronic condition arises that can be taken care of in it's earliest stages. Old people will develop conditions that eventually do them in because that is what old age does to you no matter how healthy you have been in the past.

People go to emergency rooms when they don't need to because they don't have insurance. Also, I have discovered on weekends if you get into a minor accident, it's the only medical place in town that's open.

Also, what you are describing about Switzerland is how Medicare presently works in this country. The problem is we need to extend it to everyone.

[dcfirefighter]

29. I've heard mixed reports on Canada

And I listen with an open, if critical ear.

It's not today or immediately that i'd be worried about. It'd be years from now, after the profit seeking pharmaceutical companies had sufficiently purchased enough political representation.

I think it would be exactly like the military industrial complex. Defense is good, we need more of it, are you unamerican, I'm strong on defence, of course we can find more money for XXXX. Healthcare is important, think about the lives saved, are you heartless? What's another $10B for this new drug?

Switzerland has preventative healthcare. Growing old and dying in a hospital always takes every dollar you have - unless you are VERY rich.

People with insurance also go to emergency rooms for minor ailments.

In switzerland, private insurers compete for customers by offering better prices, better service, or other incentives. In switzerland, private (and public) providers (hospitals, doctors) compete for patients by offering better service, nicer surroundings, or better outcomes. This is not how medicare works.

In your system, the public insurer would be your insurer. It would offer what congress and it's industry lobbiests have determined you'd get. You would go to the doctors and hospitals chosen for you. You may have some choice, but not too much.

[Cleita]

30. I don't know whom you open your ear to when you hear

mixed things about the Canadian system, but right here on DU our Canadians will verify that they like if not love their system. They definitely don't want what we have and are afraid of conservatives who are trying to bring our system to them.

I also had many Canadian friends when I lived up north near the border and they told me the same thing. Sometimes they complained about the waits for elective surgery, but we don't have much better where I live.

Not only that most HMO's are not accepted in my area. Now I heard on the news that two of our major hospitals have severed relations with Blue Cross.

[dcfirefighter]

35. Their system is better than ours, no doubt.

It's just not optimum. Again, the problem I have with it isn't TODAY, it's twenty years from now.

But it seems to me that very few DUers have ever considered the economics of anything. Their heart is in the right place, they just don't know how things get paid for.

I offer a means to provide universal healthcare, pay for it, keep it from spiraling out of control, and continually improve the service.

The only means that universal payer has for controlling costs is by reducing overhead. Overhead can only be reduced so much - there is no containment of the actual service provided. How will your system provide holistic preventative care, unless a lobbyist convinces the subcommittee on health financing to cover it? IT WONT, even if it is cost effective for the patient, because there is no highly profitable company offering it.

I fail to see what the status of HMOs in your area have to do with the conversation.

[Cleita]

37. Twenty years from now?

I think the Canadian system or even the British system that has been in place since the sixties are doing fine. The British system not as good as the Canadian system is still much better than our system.

[dcfirefighter]

57. Different countries, different stakes.

If you think that the hogs won't line up at the $1.7 Trillion dollar trough, you are overly optimistic. Canada's trough is 1/17th ours, and doesn't attract the hogs.

[Cleita]

59. This is my point.

It's time to slaughter the hogs. They are way too fat and not productive for what they cost. Buh bye insurance and HMO's. Buh bye Dr. Frist.

[dcfirefighter]

67. Easier said than done

What about Pfizer, Amgen, GSK, Merck? Gonna slaughter them? Who will make our medicine?

[Cleita]

69. They will. Do you really think they are going to give up

a cash cow even if the milk slows down?

[Lydia Leftcoast]

34. I'm self-employed, my former insurer doesn't operate in Minnesota, and

when I moved here, I had three insurance companies "competing" to insure me.

It wasn't a matter of which company offered the best deal. It was a matter of which one offered the least ridiculously bad deal.

I pay $272 a month (up from $180 just two years ago), and I have basically paid all those premiums for no benefit, because I have never used up my deductible. :grr:

And STILL they raise my rates. :grr:

[dcfirefighter]

36. And would it be different

if the government provided your insurance, and kept raising the rates? Or kept raising your payroll tax? (and don't kid yourself, if universal payer occurs, it's getting funded the same way medicaid is) Likewise, if EVERYONE in minnesota had to purchase insurance, there'd be a lot more than three companies operating. As it is, most of the insured people in minnesota have their insurance purchased by their employer - pretty much giving the advantage to the big boys.

[Cleita]

38. Medicaid is being funded?

Not from what I have heard. Major budget cuts have sliced Medicaid into something not workable anymore. The budget cuts for the rich are doing this.

[dcfirefighter]

43. Not just cuts, but increased costs

Medicaid is already large enough to negotiate prices and enjoy low overhead. So, why isn't it single payer nirvana?

Part of the reason is because it's only used by the old and poor - the same reason mass transit sucks in most places.

But another reason is that the model is flawed.

[Cleita]

45. So who in your family has had to negotiate Medicaid?

Now be truthful.

[dcfirefighter]

49. None. Does this make my opinion useless? n/t

[Cleita]

50. No.

It does explain your opinion though.

[dcfirefighter]

51. How so? Have you been reading?

I support universal healthcare.

I don't support single payer healthcare.

In 'my' system, everyone gets healthcare. Everyone gets the same care. The 'rich' might get a nicer room, or better food, but that's about it.

What is so evil about that?

[Cleita]

52. I never mentioned evil.

Universal health care doesn't work without single payer. It really doesn't. Look at the history of NHC. The Europeans did all the experimenting. Now we should read and learn. Did you read the article?

What is that about food? Shouldn't we all be getting the same quality of food? This comes from the earth. There is no amount of sauces that are going to cover bad food.

[dcfirefighter]

55. I have read quite a bit, and learned.

The thought of letting a RW Christian Controlled government determine what healthcare me or my family receives makes my stomach churn.

That alone is enough reason for me to oppose a single government insurer.

Having read a lot about every system in use by any developed country, I have determined that the Swiss system is the best combination of choice, competition, and sustainability.

Food? What the ????? No. You want steak, you pay for steak. You want lobster, you pay for lobster. Should we let people starve? No. But there is a huge difference between nutritionally adequate and gourmet dining.

Furthermore, I don't think that healthcare is a right. It may be an obligation of the 'haves', but it is not a right. I don't believe that anyone has a 'right' to another's labor, a fact I thought we settled in the 1860s.

Failing to view healthcare as a product of human labor and capital is exactly the error in the proposed model. If the effort in providing it isn't rewarded, who will provide it? If the effort in providing the care is rewarded only by the state, who will set the prices? If the prices are set too low, who will care for those left out? If the prices are set too high, who will pay extra?

So, again, let the market determine the price. Let most of the users pay the price, and, in the name of a social safety net, let the state help the poor make their payments.

[Cleita]

56. Health care isn't a right?

You will deny every child, elderly and helpless person the right to get the healthcare they need? I don't blame the doctors. They too have to survive, but it isn't their obligation to take care of everyone who needs healthcare without some compensation. Yet, I know doctors who do exactly that. We have to do better. Health care is a right like life is.

[dcfirefighter]

58. No it isn't

You don't blame the doctors? What about the masons who built the hosptial? Or the Chemists who made the medication? Or the engineer who made the machinery? Who has to work for free?

Life isn't a right either. Life can be easy, or life can be hard, but you have to work at it. If you were lost in the woods, how much of a right to life would you have? You'd have to feed yourself, find water, and keep yourself warm.

What you SHOULD have a right to, is a right to the earth, or at least your share of it. This, and your own labor are the only things you have a right to. They are more than enough to provide you and your dependents with food and shelter and medical care.

You want $3,000 worth of medical insurance. I want to give you $10,000 worth of land.

[Cleita]

61. Life isn't a right?

Well, Mr. Fireman, if that is what you are, remember that the next time you go fight one. Yes, life can be easy or hard if you can manage it. Tell that to a baby in the crib or an elderly person who can't control their bowels anymore.

[dcfirefighter]

64. Not a right, and obligation

How often do you see sick babies, or the old and infirm. DC has a large poor population, and for many of them, their primary caregivers are the men and women of the DC Fire & EMS Dept. and the local Emergency Departments.

And despite the fact that life isn't a right, I personally have no problem risking mine to save another's. As I mentioned before, it may be an obligation on my part, it's not a right on their part.

[Cleita]

68. Sooo. Wouldn't it be better if they had a little

card that took them through the medical system and you wouldn't have to bother your ass about it?

[dcfirefighter]

73. We don't bother our asses about insurance anyway

it would be better if they had a little card that took them to the neighborhood clinic, or called the house call making PA, or some other wild solution not thought of by the Centralized Ministry of Health. That way, when little johnny falls in the swimming pool and stops breathing the ambulance isn't taking Ms. Doris to the hospital because her meds ran out and she's lonely.

[Cleita]

75. Okay

You are now being ignored by me, but thanks for keeping my thread up. It's very important.

[dcfirefighter]

86. Well, I appreciated the debate

I've never been ignored before, certainly not for failing to agree with someone. Oh well.

[Cleita]

92. You are not on ignore. I didn't say that. I chose to ignore you.

I am reading everything you say, but after this post you are really going to have to offend me more than you already have to make me reply.

[dcfirefighter]

96. I promise you I am not intentionally trying to offend you

I'm just mildly abrasive after midnight.

I do agree this is a very important topic.

[Cleita]

76. Dupe

Sorry.

[Bridget Burke]

142. 'Life, Liberty & the Pursuit of Happiness"

Damned Radicals!

[eridani]

79. Unbelievable that you are a firefighter and can't see the analogy--

--between firefighting and health care. Personally, I prefer "public good" to "right" to describe both. Before you answer a call, do you first check to make sure that the fire was not caused by somebody being stupid and irresponsible, like storing oily rags in the basement, improper wiring, or letting their kids play with matches? Or do you just go and put the damn thing out?

Do you do surveys of census tracts to see if some are more likely to have fires than others, and refuse to provide service just to those that are statistically more likely to have fires? Or maybe you just jack their property taxes up by a factor of three, and if they don't pay, you don't answer their calls. For that matter, why not abolish public funding of the fire department entirely? Just divide the cost of funding it for a year only among those people who have actually had fires that year.

If all of the above seems preposterous when applied to firefighting, it is every bit as preposterous applied to health care. You don't think health care is a public good? Maybe DC should just save a whole bunch of money by eliminating health insurance for you and all all other public employees. If you think you deserve health insurance, why doesn't everybody else deserve it too?

[dcfirefighter]

85. Public Goods

A good which, once provided to one user, must be provided in the same amount to all users due to its non-rival and non-excludable nature.

The presence of a fire department is a public good. Fires spread. In the past, fires have destroyed entire cities. Everyone benefits when we put a fire out.

Uncongested roads are public goods. Lighthouses are the perfect public good. Legislated standards and measures are public goods. A body of law is a public good.

Healthcare, while it is a good, and a good one at that, is not a public good.

Healthcare can be provided to one person, or several. Different amounts can be given to different people. I'm pretty sure I don't want to undergo someone else's chemo. It's not a public good.

Your last paragraph is puerile. My compensation has nothing to do with national healthcare, and adds nothing to the debate.

[eridani]

94. A healthy citizenry is just as much a public good as uncongested roads

Refusing to treat people with communicable diseases will cause them to spread and harm whole communites, just like a fire that is ignored will spread and harm whole communities. BTW, one reason that fires used to spread is that we used to have private firefighting companies who refused to put out fires unless the owners of the building were their paid-up clients. (Luckily, Benjamin Franklin put a stop to that nonsense in the colonial era.)

I don't want chemo if I don't have cancer, and I don't want you smashing my door down and spraying water all over my house if it isn't on fire. If I have cancer, or if my house is on fire, chemo and firefighting are both public goods.

Your compensation has everything to do with national health care. It is your assumption that you are a first class citizen who deserves health care and that others are subhumans who do not that is puerile. (Or maybe "sociopathic" is a better word than "puerile.")

[dcfirefighter]

98. Public Health is a public good, Public Healthcare isn't

it's not semantics

Epidemiology is the purview of the Health Department. Generally, sewing stitches isn't.

Portions of a fire department's activities aren't public goods - but the presence of building codes, a water supply system, and a body of trained and equipped firefighters is: it protects everyone within it's response area.

Chemotherapy, and the chemicals and whatnot associated with it, do not protect everyone within it's area.

I would concede that the knowledge to treat cancer is a public good. If you were arguing that treatments developed by NIH should not be allowed to be patented by private companies, we'd agree. In fact, if you said that patents on medicine were pretty frickin' bogus, I'd agree on that as well.

You infer a lot about my self worth. Rest assured i'm full of self-loathing, and do not consider myself in any class of citizenry. What I'm saying is that if my employer offered to pay me in turnips, and I accepted, that's my business. As it happens, my employer agreed to pay me in US Dollars and benefits, including health insurance.

I have a different concept of 'rights' than you do apparently. I see a conflict of rights between the healthcare provider's right to self ownership and the patients 'right' to healthcare. I choose self-ownership has the primary right. Conversely, I recognize the OBLIGATION of those with means to care for those without.

In another thread, I'd tell you how my concept of rights provides nearly everyone with the means, but that's a different thread.

[eridani]

101. Having a healthy population is just as much a public good--

--as having an educated one is. Since no doctor could practice without the accumulated knowledge of many other people (lots of whom were and are on the public dime), they don't own their skills all by themselves. Since there is no way that any individual not named Bill Gates could pay all the real costs of any serious illness or accident, either you fund this stuff publicly or you don't have it at all. A medical practice specializing in treating only the top 0.1% bracket people who have the bad luck to get seriously hurt is going out of business very quickly.

When single payer was first introduced in Saskatchewan, doctors went on strike. In the first year of single payer, their incomes increased by a third, and that shut them up quickly. All the money that previously went into paying people to tell other people "That's not covered" went into their pockets instead, and they decided they liked it.

[dcfirefighter]

104. Having an educated public is a public good

but only in a democracy
this still doesn't make having a healthy populace a public good.
As I mentioned, the body of medical knowledge is a public good: I have no problem with government medical research, though I would not want government to have a monopoly on medical research.

The skills of the doctor are, as far as I'm concerned, the property of the doctor. Someone else can reproduce them, of course, but those skills are his and his alone. Self-ownership you see. Sure beats being owned by someone else.

Doctors have existed for millenia without public insurance.

I don't doubt that single payer insurance benefits those in the healthcare field greatly. Why do the doctors have the right to the new surplus, and not the taxpayer's who's money it was? Perhaps that money could have been better spent on food, housing or clothing?

[eridani]

107. And during those millenia they were about as useful as witch doctors

Medicine became an effective science only after large amounts of public money were dumped into it. Look at the increase in life expectancy in the 20th century. Any advanced technical skill is the collective property of a pretty large number of people, most of whom were educated on the public dime. The three most important medical discoveries of the 20th century were made on the public dime as well--insulin, antibiotics and the Salk vaccine.

The taxpayers who had unmet health care needs that they could take care of after single payer was introduced were every bit as happy as the providers with extra income.

[dcfirefighter]

109. Educating someone on the public dime doesn't give you a leashold on them

You might be able to ask them to pay for their own education, but you can't make them work for you for the rest of their lives.

What about the taxpayers who's healthcare needs were small, or were happy before? Someone lost. The uninsured gained, as did the healthcare providers.

[eridani]

112. They don't pay for the entire cost of their education

--not anywhere in the world. And most providers in Canada work for themselves anyway--it's just the insurance which is publicly funded. I'd consider the good luck to not have had any unmet medical needs enough of a reward in itself. Just because people are happy that you come around to put out their fire sure doesn't mean that they were happy about having the fire. Why do I need a reduction in my property tax because my house didn't burn? I'm sufficiently pleased not to have needed the service.

[dcfirefighter]

115. Working for yourself

do canadian providers get to post their own rates? Or must they accept what the predetermined rates are? What about the superstar providers? Or are all Canadian physicians exactly equally skillfull and personable? Who gets to see them?

You may not need it, but it helps contain the costs borne by others. It's an extra incentive to stay / get healthy. I don't see it as that important, but I wouldn't preclude insurers trying it.

[eridani]

119. Superstar providers will have more patients

Remember, Canadians are absolutely unrestricted in their provider choice, so the better ones will have more patients. They compete on service and skill rather than price. (Not that there's much competition in rural areas, but that won't change regardless of what insurance system you have.) I'm betting that having the government pick up the cost of malpractice insurance is a pretty good tradeoff for accepting negotiated rates. Not to mention which, most malpractice suits here are filed by people who need to fund further medical care resulting from medical mistakes. Why sue for it if you get that care as a matter of course?

[eridani]

149. Not to mention which "superstars" are vastly overrated

Your chances of surviving a very complex operation are determined almost entirely by the number of such operations a particular hospital or institution does. It has nothing to do with how many "famous names" are on board. In fact, the more competition you have, the more incompetent everybody becomes. That's because in a given area, there are only so many who will need, say, bypass surgery. The number does not increase just because the area has two heart surgery centers. With half the number of operations, and therefore half the practice, the surgical teams become much less competent.

[Lydia Leftcoast]

41. Minnesota already has the highest percentage of insured people in the

country.

I think you've been listening to too many Republicans or DLCers (same difference on this issue).

"Make everyone buy insurance." Yeah, like you could solve the problem of homelessness by requiring everyone to buy or rent housing. :crazy:

If you're actually a DC firefighter, then you undoubtedly have very generous health benefits, and you cannot possibly know what the rest of us go through.

Insurance company keep prices up by the fiction of "coverage groups." They use the presence of a person with a chronic illness in Company X as an excuse to raise Company X's premiums. And yet, all the money from all the clients ultimately goes into the same pot. As a self-employed person, I am treated as a "group of one."

[dcfirefighter]

54. Yes, I live under a rock.

and opinions that disagree with yours are WRONG. sorry.

"make everyone buy insurance" leaves out the important part of "assist those who can't afford it".

[raccoon]

138. Are you aware that some people who aren't lucky enough

to have medical insurance provided by their employer and aren't yet old enough to qualify for Medicare can't get individual medical insurance at because of pre-existing medical conditions? I knew a man who fell into this category. He could've paid high premiums, but he couldn't get health insurance AT ALL because of a pre-existing condition.

And individual medical insurances CAN and DO refuse to cover pre-existing conditions. There isn't a waiting period, they just write a rider to the policy saying they won't cover that condition, EVER.

[Cleita]

39. The rises in premiums are happening and no one is benefitting but the

corporate insurers raking in the benefits. The doctors aren't benefitting, nor the clinics nor the health care workers, nor the patients. It's a sad, sad situation.

[eridani]

40. The Swiss system works because the government deliberately undercuts--

--private insurance. Swiss insurers make money like all other private insurers, that is by underminining the purpose of insurance, which is to spread risk. They do their best to cherry-pick the healthy and wealthy, but to the extent that they actually succeed in doing this, the Swiss government taxes them and distributes the money to the less successful insurance companies to cover their greater costs. It's a complicated jerry-rigged system, which works because Switzerland is not a very big country, and also its most important politics takes place at the cantonal level.

Single payer in Canada offers vastly more choice of hospitals and doctors than most Americans are ever likely to see. Of course, choice is geographically constrained--if you live in a small town hundreds of miles from anyplace else your choices are pretty limited. But that's hardly different from how it is here.

[Cleita]

42. Yes, you are right.

I never favored the Swiss system. We can do so much better once we offer something better than our present system does.

[dcfirefighter]

65. How do you keep the RW Congress from determining covered procedures?

Answer me that someone, instead of talking about people's 'rights', and how wonderful Canada is.

[Cleita]

70. We are now living under a dictatorship.

We can't make them listen. You know this. However, we still can talk. I just wonder how much longer.

[dcfirefighter]

77. A market based universal healthcare program would sail through congress

And it would provide healthcare for everyone.
Why insist on a huge government program?


Furthermore, while the rabid right might still bitch about paying for HPV vaccines, multiple insurers and multiple providers gives several layers of protection - plausible deniability, if you will, to the RW puppets of the Christian extremists.

[Lydia Leftcoast]

81. "Market based" universal health care

:rofl:

Boy, the insurance company must be worried about losing their exorbitant bonuses to try to pull that little number over on us.

[eridani]

84. Global budgeting devolves those decisions to regions

We already have HMO bureaucrats denying us procedures, in case you hadn't noticed.

[eridani]

44. Every other government health plan in the world--

--has vastly less health care than we do, and they take care of everybody.

Most importantly, those who use healthcare have to have some financial stake in deciding how much to use.

Why? This is as silly as deciding to shop for a fire department and having a personal financial stake in it. Here in the real world, most people will never get expensively sick, and most people will never have their houses or businesses catch fire. In every single age demographic, 20% of the people account for 85% of the costs. That's why health care and fire protection should be public goods, paid for by the public. Several Canadian provinces have dropped copays after finding that they prevented exactly as much necessary care as unnecessary care, and in addition the processing costs ate up most of the copay anyway.

BTW, staying healthy actually increases your lifetime medical costs by making it more likely that you will live long enough to join the medically most expensive age demographic. Smoking saves quite a bit of money for society. It doesn't stop you from raising kids or living through your most productive work years--it kills you fairly quickly before you live long enough to get more expensive illnesses, and saves a bundle on Social Security payments as well.

[dcfirefighter]

62. This isn't silly.

Using your fire department analogy: You don't shop for a fire department, mostly because of 1) geographic restrictions and 2) the public good of fire protection - if your neighbor's house fire goes unextinguished, there's a good chance your house will catch fire.

This is not the situation with health insurance. The 80/20 rule is not the reason that fire departments exist as a public service.

Moreover, except for insurance fraud, building owners already have a financial stake in protecting their building.

Most fire departments DO charge a fee for extraneous use of service - too many false alarms, and the like. However, fire departments largely exist as a fixed cost, unlike healthcare service.

Find another analogy.

[Cleita]

66. You know I am getting really annoyed with you.

I worked with volunteer fire departments in rural areas who had really good paramedic training. The reason they were volunteer was because the area was too sparsely populated to have a municpal paid one. Most of them were ex-loggers anyway who had fought many a forest fire on their own, who bandaged many a hand that got severed fingers from the logging operation. Yet, they could have used a comprehensive federal program that would have helped them get better and faster care to the people who needed them.

[dcfirefighter]

71. I'm not asking you to throw them to the wolves

I'm telling you that Governments generally don't contain costs very well in the services they provide. I see this every day in the District and Federal government. (I am exactly what my SN says i am) Government services are slow to adopt new techniques, new technologies, and new models. Governements are slow to fire bad employees. Governments are quick to promote the politically connected, quicker than those who count on making a profit rather than being popular.

Governments do alright in providing monopolies, and public goods.

Preventing epidemics is a public good.
Extinguishing conflagrations is a public good.
Setting broken arms is not a public good.

Your logger friends would have benefitted equally well with private, regulated insurance.

[eridani]

88. Global budgeting contains costs very well.

--as proven by the fact that all countries with universal health care have far better cost containment than we do. And yes, health care is a public good, and as such is something that governments are good at providing? Whythehell would any sane person NOT consider setting broken arms a public good?

I mean, you'd put out a fire caused by a bad wreck, but leave the burned and maimed people by the side of the road if they were uninsured? Putting out the fire is a public good and fixing up the people is not? WTF?!?!?

If governments are so slow in adapting new technology, howthehell did the Internet ever get started?

[dcfirefighter]

90. Would you look up "public good" please?

Is housing a public good? How about clothing? Food? Televisions?

No, none of them are public goods.

They may be provided by the public, but they are not, by definition, public goods.

And of course, we provide emergency care regardless of insurance or ability to pay, as do private hospitals, by law.

DARPA 'invented' the internet. Private enterprise made it what it is today. Governments got on board long after.

[eridani]

97. No, we do not provide care regardless of ability to pay

Sure, we are supposed to, but that doesn't always happen. It is often cheaper for private hospitals to flout the law and pay the fine than to actually provide the care, and when that is the case they do it.

Yes, I'd say housing is a public good. Televisions, no.

DARPA = government. Also, the hacker subculture out of which personal computers arose was entirely funded on the public dime at places like MIT and CalTech. The aviation industry is essentially government run--it couldn't exist without very extensive public subsidies. Boeing's civil aviation group operated for 20 fucking years without making a dime in profit, propped up by government military expenditures.

[dcfirefighter]

99. Then the law needs strengthening

however, every time i've brought an obviously indigent person to a for profit hospital, they've assessed him and given him the care that he's needed. Generally, they just pad everyone elses bill. That's why a trip to the ER costs thousands of dollars.

Housing is a public good? So once a house is provided, no one can be excluded from it, and no one else can offer another house? I'm not trying to be rude, but that is not the commonly accepted definition of 'public good'.

Yes, I know, DARPA is government. I'll even concede the reach with MIT. I'd drop boeings subsidies like a hot rock. Until 3 years ago, most DC offices didn't have the internet.

[eridani]

103. And you always hang around to find out what happens a few hours later?

Google "patient dumping" to find out what happens to a lot of those people after you leave the scene. And it's precisely this bill-padding practice that makes single payer a more efficient and cheaper way to handle billing.

what I mean about housing being a public good is that the public should spend enough on it to eliminate homelessness. Anything above and beyond that can be dealt with by the private sector.

[dcfirefighter]

105. Anything above and beyond can be dealt with by the private sector

a noble cause, and I have no problem supporting that. (actually, I do - but only the means, not the goal).

Regardless, that doesn't make it a public good.
http://www.google.com/search?hl=en&lr=&oi=defmore&defl=en&q=define:Public+good

No, i don't hang around long. And I don't doubt that they don't get the same care an insured patient would. But, I generally think they get what they need - and the insured patient gets more than they need. However, i'm not a physician. Under my plan, they'd both get the same.

[eridani]

116. Could be, but won't be--

--they won't spend the money on it.

[dcfirefighter]

118. Housing Solution

with not a dime of public money spent:

http://www.newcolonist.com/tworate.html

[eridani]

121. Oh, a Georgist!

Henry George for sure had some pretty good ideas--glad to see people are still discussing them. But if there is still a problem left that isn't solved by better land use and taxation policies, the public needs to get involved.

[dcfirefighter]

124. Mutual Aid societies

Back in the day (a tuesday I believe) like minded groups of people formed mutual aid societies. I believe the Amish still do. It's possibly a Consitutionally protected right, though I'm no lawyer.

For single payer to work, competition from private insurers must be eliminated - at least according to 'the plan'. How would you get around that?

[eridani]

126. The German exemption would work

8% of Germans opt out of the public system, and will never be allowed back in.

[flaminbats]

127. remember the Clinton plan?

the mutual aid societies took the form of healthcare alliances..which would provide coverage for employees, the self-employed, and the disabled. Insurance companies would still compete, only they couldn't deny coverage because of a pre-existing condition. And both young and old would would pay an equal share for this coverage.

Most importantly, workers now pay high premiums..but later many become sick and get thrown into a different policy with a high deductable! Insurance companies couldn't do that under the Clinton plan.

[eridani]

147. The Clinton plan was nothing but a bribe to private insurers

"If we give you a whole bunch of public money, would you consider insuring more people pretty please?" If private insurance companies can't deny sick people coverage, they lose their only reason for existence. Smaller insurers would have been particularly harmed, which is why they bought all those "Harry and Louise" ads. Large insurers would have gotten big piles of extra cash and were for it.

[flaminbats]

155. "Harry and Louise" was funded in part by GOPAC

The Clinton plan required employers to insure the employees and pay at least 80% of the premiums, leaving no more than 20% of the premiums for workers to pay. Workers would have paid five to seven dollars directly for every visit to a doctor or hospital. Each plan would be required to at least offer a minimum standard of benefits. Those with pre-existing conditions could neither be turned down OR charged more under that plan, and if not for the portability bill signed by Clinton in the 90's, all workers with pre-existing conditions would now be uninsured.

Insurance companies take money from those who are healthy, they hike the premiums and throw you off when you become sick. How else could they make such a KILLING? :evilgrin:

[eridani]

156. 20% of premiums and copays--

--happen to be very serious burdens on low income and sick people, not to mention which staying with employer-based health insurance is about as stupid as having your employer pay your property tax that funds the fire department.

[eridani]

46. No, cost containment is handled with global budgeting--

--in which regions get assigned capital and operating budgets and are expected to live within them. Providers of a mind to cheat the system can't do it without taking money directly out of their colleagues' pockets, and said colleagues will tend to notice that and make it stop.

Controlling costs is analogous to controlling the movements of a herd of cattle. Global budgeting is analogous to putting a fence around them and letting them move around freely within the confines.

The way we do it (both private insurance and government programs alike) is to hire a whole bunch of cowboys with reins attached to each individual cow. Seriously stupid, and much more expensive.

[Cleita]

48. Amen.

:thumbsup:

[Lydia Leftcoast]

78. Not only that, according to my brother the doctor,

treatment decisions are in effect controlled by clerical workers at the insurance company who have charts of what treatments can be paid for and what can't, all very cut and dried.

Patients may not get the treatments they need because their insurance company won't pay for it (it's outside the little tiny box that the clerical workers are allowed to operate in) or because they haven't met their deductible and the out-of-pocket cost is too high. Or treatment may be delayed because two insurance companies (say, in cases where both the husband and wife have compulsory insurance from their employers and their child is sick) are fighting over which company has to pay for treatment.

When I visited a friend who teaches at a new health sciences university in Japan, he took me on a campus tour, which included the university's rehabilitation hospital. It was a fine facility with private rooms that the patients were encouraged to decorate for themselves, kindly staff, and what looked to me like up-to-date rehab equipment.

Now I know that Japan's national health system is one of the less generous in the world (30% co-pay for most routine conditions), so I asked who pays for the patients' treatment.

I was told that the government picked up the tab, because people who needed this hospital were so badly injured that they fell under the Japanese government's 100% coverage of chronic or life-threatening conditionsl.

[dcfirefighter]

80. Wouldn't treatment decisions under Universal Single Payer

also be made by clerks, or at least congressional comittees?

[Cleita]

82. You obviously haven't read the plan.

The clerks you are talking about will be non-existent. Really look at how Canada does it.

[dcfirefighter]

87. I read the plan 2 years ago

And thought it was a terrible application of socialist theory.

[eridani]

91. And your employer is one of the "good" socialists, I take it?

If you work for an urban fire department, you are a practicing socialist. And if you work for a rural one you are a practicing anarchosyndicalist. Either way, profit and the public good are poor fits--not to say that the public might not farm out aspects of firefighting or health care (making firetrucks or building hospitals, for instance) to for-profit entities, but public oversight should always be there.

[dcfirefighter]

95. Not all government programs are 'socialist'

I don't mind 'Socialized' Public Safety. Plus, if you like putting out fires, it's the only game in town.

I agree with the need for public oversight, and even funding for healthcare. I just don't think that there should be one insurer, protected from competition, writing a blank check to the healthcare industry.

I think that the federal government should establish some mininum standards of coverage are.
I think states should strengthen those requirements.
I think that potential insurers should be required to accept any customer within a state they are licensed in.
I think that the insurers should charge the exact same rates for a given plan for any customer within a state (maybe with a small cost adjustment for expensive areas).
I think that patients should pay a copay for any unscheduled visits
I think that patients should get money back each year if they don't use the system for other than preventative medicine.
I think that patients who spend more than 10% of their income on premiums or copays should get partial assistance from the state.
I think that if a patient is unhappy with his insurer, he should be able to take his business elsewhere
I think that if a patient is unhappy with his doctor, he should be able to take his business elsewhere

[eridani]

100. There would be no blank check to the health care industry

Do you understand global budgeting, or not?

Giving people money for not getting sick or being seriously injured is about as silly as giving them money if their houses don't burn. Copays are a demonstrated waste of time, preventing as many necessary visits as unnecessary ones. I could care less about choosing an insurer, and I would prefer it to be a government that I can vote out of office. I'd much prefer to choose a doctor, which I don't get to do now. People in Canada have absolutely untrammelled free choice of doctors, unless they live out in the middle of nowhere. I want the same free choices that people in Canada now have.

Currently, private insurers leave states that force them to accept anybody, and so as long as there is private insurance, that is going to continue to happen. There is no conceivable way to make a profit in health insurance unless you deliberately exclude sick people, or those likely to get sick. Private insurance is by its nature an attack on the whole idea of insurance in the first place, which is to spread risk. Private insurers are no different from people who tap into your power line between the meter and your house and siphon off as much power as they can.

Germany has an opt-out provision--the catch is that you can't ever get back in. 92% of the population chooses to stay with the public subsidies. I could go along with that.

Essentially, you are describing a complex rigamarole that is far more expensive and offers less choice than single payer.

[dcfirefighter]

102. Explain

Yes, I understand that once the 'global budget' is set, it would tend to work. Who sets the global budget?

Giving people money BACK is different from giving people money. Since I made them pay for it in the first place . . .

I'd like to see your study on copays. I'd also like you to visit H St NE, Washington DC on a sunday night. I would not charge copays for annual checkups, follow up visits, or medication.

Private insurers leave states that make them accept anybody. That's because there are greener fields. But if all states were that way . . . hell, even if one state was that way, somebody would figure out how to make money off of it.

Insurance companies can make a profit without excluding sick people, it's a mathematical possibility. Those that don't will go out of business. They'd make money off the service they provide - spreading risk. If private insurance is so evil, why does it appear to work for homeowner's insurance, automobile insurance, life insurance, etc.?

I don't doubt my proposal is more expensive than a well run single payer. What I doubt is that the single payer system will remain well run forever. I think my plan will get better over time. I think single payer will get worse.

[eridani]

106. Who ever died from not having a car?

Private health insurance does NOT spread risk if they eliminate sick people from their pool.

In Canada, global budgets are set by commissions composed of providers, patients and public health officials. (Actually, there is private insurance in Canada that offers bells and whistles not available in the public system. That's fine by me.)


http://chpps.berkeley.edu/publications/Schauffler%20papers/Cost_Sharing_&_Utilization.pdf

The hypothesis that patient cost-sharing results in lower utilization of recommended clinical preventive services was strongly supported by the results. When compared to employees in non-cost-sharing health plans, employ-ees in cost-sharing plans were less likely to receive are commended preventive service in 11 of the 16 combinations of type of cost-sharing, preventive service, and plan type examined. The results of this study are consistent with the findings of other studies in the literature on the negative effects of cost-sharing on the utilization of preventive care.

How well any public program is run over time depends on the amount and quality of public oversight. Luckily, people most likely to need health care are exactly those people who have the time to do the oversight.

[dcfirefighter]

108. I would not allow them to eliminate the sick from their pool

that is one of the fundamental tenets of the program. Anyone in a given state could join any of the plans offered in that state.

I already agreed to no copays for preventative services. That only makes sense. What I want copays for are using the ED as the GP.

I have less faith in most public programs (my employer included).

[eridani]

110. Single payer eliminates using the ED as the GP

That's a proven fact. Canadians get many more doctor visits than we do, at half the price. If you don't allow private insurers to eliminate the sick, you have destroyed the reason for the existence of private insurance, and you may as well be done with it and go public. Note that public insurance will not cover every single thing, and there will still be a role for private boutique insurance as there is in Canada.

[dcfirefighter]

113. How So?

The folks here in DC on government insurance sure use 911 to get to the ED for a GP call all the time. They'll tell you why they're there.

There would be needs for different private insurance: they could compete on customer service, on 'bells and whistles', on alternative medicine (if it's cost effective, go for it), whatever. Heck, whoever could predict costs best would have a competitive advantage.

[eridani]

114. And you don't have single payer in DC, do you?

Christ! If the customer "service" that private insurers now provide is an example of what you want more of, fuggedaboudit.

[dcfirefighter]

117. I don't understand

1) how does single payer eliminate misusing 911 and EDs?

2) the main problem, and one my proposal rectifies, is that the 'customer' of private insurance today isn't the patient, but rather the patient's employer. So of course the patient service sucks. And in the case of small employers, the customer service sucks too.

[eridani]

120. By making regular doctor vists available without point of service charges

2. If you think employer-provided insurance is bad, try individual plans, where the service sucks much worse.

[dcfirefighter]

122. Aha, but...

if a regular doctor visit is free, but the cab ride is $8 and an hour wait

and the ER visit free and the ambulance ride is free and a 5 minute wait....


If you think individual plans are bad, you should try government insurance....
...individual plans aren't the norm, nor is government insurance, it's impossible to compare - though some individual insurance companies pride themselves on customer service, so it's possible.

[eridani]

125. In Canada there are more regular doctor visits than ER visits

I'm finding it really hard to believe that there are more emergency rooms in DC than doctor's offices. If so, changing how care is paid for isn't nearly enough to solve that problem. My brother has government insurance (Railroad Retirement Board), and he thinks it's pretty good, and in fact recommends extending it to everybody. This of course ignores the fact that insuring only working people is a form of cherry-picking in and of itself. Start making them insure more actually sick people, and the rates would rise dramatically.

If you know of any doctor's offices where you have to wait for 10 hours, post the information.

http://www.thewbalchannel.com/news/5293657/detail.html?subid=22100764&qs=1;bp=t

An 11 News I-Team investigation uncovers a disturbing local trend with emergency room gridlock and delays, in some cases more than 10 hours.

[dcfirefighter]

128. There aren't

its' just that it's easier for some people to use 911 as the taxi service. 10 hours is ridiculous. US Military TriCare is pretty good too. There is more than one way to prevent cherry picking.

[eridani]

129. I didn't realize you were talking about ambulances

That's a different matter. I live in WA state, and our health-care hotline sends quite a few people to BC for basic care, and I haven't heard of anyone using ambulances that way there. Better than a co-pay would be after the fact fines for misusing the service, I think.

[dcfirefighter]

130. A copay for an ambulance would be after the fact

at least if the call originated as a 911 call.

An interfacility transport or even a scheduled transport from home would require insurance or payment. Now why wouldn't a doctor authorize transport for anyone who might possibly need it?

[eridani]

131. The point is not charging for legitimate service--

--but fining people for abuse, sort of like we do to people who pull fire alarms for the hell of it.

[flaminbats]

132. I hope so!

better than demanding an insurance card or copay when someone is dying!

At least requiring a co-payment after calling 911 will force those with no emergency to think next time! Calling 911 when there is no emergency isn't comman like it was in the 80's!

[dcfirefighter]

145. Oh, it's still quite common.

Fining someone would require an admission / finding of guilt. Charging a copay is much easier. Anyone who's legitimately calling an ambulance multiple times a year with regularity should probably move to some sort of facility.

[eridani]

148. And speaking of socialism--

--would anyone like to take a crack at explaining why "capitalist" Taiwan has single payer health insurance and "communist" China does not?

[Lydia Leftcoast]

83. Ask that question in the Canada forum

I dare you.

[dcfirefighter]

89. You dare me?

Would they put me on ignore?

'The Plan' says that "In a democracy, the public should set overall health policies. Personal medical decisions must be made by patients with their caregivers, not by corporate or government bureaucrats. "

Very idealistic. So, 1) this assumes that the public isn't a bunch of dominionist women haters and 2) that the public is going to pay for something and not care how it's spent.

I'll take personal choice over government decree any day.

[Lydia Leftcoast]

93. Okay, so don't ask in the Canada forum

:shrug:

[rman]

60. Poor Cuba can afford better public healthcare then any privitized

healthcare anywhere does.

[Cleita]

63. Yes, they can.

And our country was trying to save Elian.

[Wordie]

33. Published in JAMA, now that's serious. I'm happy to see this. Recommend.

[Cleita]

53. It was back in 2003.

Nothing has changed since then, but it has gotten worse.

[Wordie]

72. I did notice that. I'm happy you're bringing it up again. It's important.

[Czolgosz]

47. k'n'r

[rfkrfk]

123. single health employer is the way to go, single payer won't work. n/t

[endarkenment]

133. well that settles that.

Your oration skills and indisputable logic have settled this debate once and for all.
:sarcasm:

Single payer universal health works just fine in every other major industrial democracy. Not only do these systems work just fine, by all measures of health, they deliver superior results to the population at a much lower cost than our corrupt system does.

[rfkrfk]

134. where has 'single payer - non single employer' been implimented?

please enlighten me

[endarkenment]

135. I give up what on earth are you talking about?

single payer systems exist and function quite well in every major industrial democracy except ours. What exactly is a 'single payer - non single employer' system? Do you mean people working for multiple employers? Why would that be any more complicated than the current social security system, which manages quite well to track your and your employers' FICA payments across multiple employers?

[rfkrfk]

140. where on earth...

is there a health payment plan where
the gov't pays,
but is not also the only employer.


example,Canada,
single payer --> Canada
single employer --> Canada

Canada chooses the doctor

[endarkenment]

143. USA medicare. eom.

[Bridget Burke]

141. Please enlighten US!

We'd like to hear many details of the novel system you propose.

[EFerrari]

137. Go, Cleita! I'm in.

:kick:

[RedEarth]

139. Kick

[stubtoe]

144. This has been an interesting discussion about the possible mechanics

of implementing single-payer health care. But we need to go back and read the Proposal Cleita cites to get back to the heart of the issue:

These physicians are saying "Access to comprehensive health care is a human right".

We must adopt the philosophy that Health Care IS a Human Right. Until we as a nation internalize that philosophy, we'll always find reasons to not implement the policy.

[eridani]

146. I'd call it a public good rather than a right

Do we have a "right" to transportation? Not really, but transportation infrastructure is a public good. Same with health care. Deciding what parts of transportation and what parts of health care should be publicly funded is a non-trivial problem, but every other industrialized country seems to have solved it.

[stubtoe]

154. It is not a trivial problem, of course.

See post 150... we've been able to implement (and defend) Social Security. We have the resources to put universal health care to work. And since the good doctors of the proposal say health care is a human right, well, that's good enough for me. Finding the borders, we can certainly do once we have the conviction.

[Hidden Stillness]

150. We Need to Explain it so They Will Feel it Like Social Security

This is the whole point of course, agreed, but if you notice, this is exactly what the "enemies of the people" do to all of these kinds of proposals in the real world, to completely obfuscate and turn people against an issue before they themselves can learn about it, finally to kill it.

I read the whole PDF article from the link, and it is very well-written, with funding etc. problems all considered, but of course the whole thing was figured and planned-for going all the way back to the days when President Harry Truman first proposed national health care, and it has been getting killed ever since. "Having a workable plan" is not the problem. It is as if there are two steps to a discussion like this, and it is always the second step that kills you. Explaining the proposed program itself, and how it would work, and proving that it would be sustainable, has been done over and over for generations now; fighting off the lies has not. Until we can get the important points out, as you put it "until we as a nation internalize that philosophy," so that it becomes commonsense reasoning and not even memorized responses, then the corporate forces will be able to kill it. Of course, their media will censor and lie about it, but they always do that anyway--note how they are dicksucking Bush, pretending the economy is good!

You find their plants even here on DU, and they always show up on economic threads eventually, pretending to be experts, and laughing at the "silly, ignorant, pie-in-the-sky liberal do-gooders," their usual posture. They lie that corporations shouldn't pay taxes because they will shift all the costs onto consumers, so it will only hurt us anyway, and they lie that people with insurance are so horrible that they will just drain the whole system with their phony non-illnesses, despite all evidence to the contrary. Their attitude that this is all "welfare" is also dangerous and a fake front, as you will find with this type that they generally consider everything to be "welfare" if it helps non-corporate, non-moneyed interests. Remember the bastard Reagan referred to the Department of Education as "subsidized curiosity." Don't be fooled, and believe that their opinions were sensible, or had an end. Then, if you bother explaining the facts to them, they do not listen, do not read, do not think. They are not debating you or trying to clear things up; they want it destroyed.

Most people favor universal health coverage, but we need to make more of a case explaining clearly how their money, which they cannot afford to lose, is being ripped away from them now, by huge rich corporations, for things they get no benefit from, and how much we would all save as a society if the system were made fair. If it could be brought home to them by specifics, then eventually they would fight for this issue as fiercely as they now fight for Social Security, which they know is a lifeline. Most personal bankruptcies are caused by medical emergencies, not wasteful spending; most corporate insurance for low-end service employees--supermarkets, restaurants, etc., the majority--do not cover dental or prescription eyeglasses, etc., and so are largely worthless. The "abuses" of Medicaid patients using Emergency Rooms because they are denied care all the way up to that point would be eliminated, as they would get regular, preventive care, and Medicaid itself, always underfunded, would be eliminated. It would be general funding and free choice with an actual diagnosis, as with Medicare. All studies show--from diabetes to AIDS, all the maintenance type diseases--that people with health insurance live much longer and healthier lives, suffering fewer complications, when they have insurance that covers educational programs that teach them how to live with their diseases and how to regulate things.

The cost-savings would not just be a simple equation of commercial insurance rates vs. taxes to pay for the program, although that would be good enough; it would be huge savings as we would no longer carry corporate criminals like Wal-Mart on our backs, as they cheat their underpaid employees out of health care coverage by having a system where they sign them up to the State's Medicaid programs, so we fund it, then Wal-Mart further cheats their way out of paying their corporate taxes! How much would we save from the removal of all this corporate welfare and all these scams?

We have to concern ourselves less with having to fight off every corporate plant who pretends to be finding real flaws to the proposed system, yet who makes ridiculously stupid remarks about people, and will not think about the responses that are given; and instead make a real attempt to address ourselves to the real concerns of people, answer them, and get the majority really fighting on our side--and their own. Tell people things, and describe situations, that they will recognize for themselves as the truth.

[donkeyotay]

151. a side benefit would be to increase savings

Why have a nest egg just to give it to a hospital?

[stubtoe]

153. Or end up using it all to get into the nursing home of your choice?

[stepnw1f]

152. KICK!!!!!! (nt)