Single Payer National Health Care.....

[global1]

I for one think that this is the only way to go with respect to health care in the U.S. I never really bought into Barack's or Hillary's plan as both seemed to continue the reliance on the current set-up with all the health insurer companies still involved.

What I would like to do here is to start a dialogue as to how we can - as DU - promote to President-Elect Obama a 'single payer national health care system for the U.S.

I know that Dennis Kucinich was promoting such a plan. I don't believe though that I've ever read how he expected to pull this off.

How do we deal with health insurance companies - if the government takes over. I believe that there would be administrative efficiencies with a single payer. All medical personnel would be dealing with only one administrative body. Forms would be standardized and all of us would be covered.

Currently - I would think that there are numerous administrative headaches with having to deal with a multitude of payers. All the administrative documents are different. All the requirements are different. All the plans are different. Having to deal with all the differences not only takes time and is confusing - but it is costly for everyone having to do so.

So bottom line - if we were to start a lobbying effort with the Pres-Elect - how would we go about it? How would we deal with the insurance companies and all the people that they currently have employed to do all this administrative work? How do we get this all to consolidate around the government?

Do you think that Pres-Elect Obama would be willing to take on a single payer system?

I'm just posing this to get some feedback. I think it is a idea that has come to be.

I'm not so sure that Ted Kennedy would be backing a single payer. What are his views? And Daschle as HHS Sec - what are his views? Do you think we can get Dennis Kucinich to push for this?

Lots of questions - no real answers right now. What do you think?

[CTyankee]

1. A few months ago I would have argued for Hillary's plan cuz I didn't think single payer

(which I prefer) would stand a chance and losing a big fight so early in our new Dem administration would be disastrous to the rest of its term.

Now I am not so sure. With the economic meltdown, we may have the perfect storm that can result in BIG changes. We may be poised at the moment in our history when single payer becomes inevitable, just as Social Security did when FDR took over in the darkest days of the Depression.

I am certain that Obama would not put Daschle in as HHS if they were not on the same page re health care. The only question I have is whether Obama is going to come out for single payer.

[Winterblues]

2. Seems like I heard Rahm, Obama's Chief of Staff say exactly the same thing

I think ted kennedy is working on such a thing right at this moment. It may not happen the first year Obama is in Office but by the end of his eight years I believe it will be what we have. Obama will have to move step by step toward that goal but he won't get it done immediately..But then I could be wrong and he could get it passed within the first hundred days....:shrug:

[Nite Owl]

3. The way I am seeing it right now

they are going to have a government run option and private insurers. It seems that they are setting it up so the private insurers can sort of die off on their own. There might not be very much profit in health care plans if they are forced to follow stringent regulation and oversight.
Anyone else seeing this happening or am I being too optimistic?

[area51]

4. K&R for this important topic.

Every day, 273 people die due to lack of healthcare in the U.S.

We need single-payer NOW.

[slipslidingaway]

5. This interview may help answer some questions...

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=385&topic_id=50402&mesg_id=50402

Part 1
http://www.youtube.com/watch?v=4gjA3CV95i4

Part 2
http://www.youtube.com/watch?v=-FNp0wjAgfo


Also the number of people who will be eligible for Medicare in the next decade is expected to rise substantially, placing more stress on government expenses. At the same time SS will need to start drawing from the SS Trust Fund.


In depth discussion of the Kucinich NOT FOR PROFIT plan. If healthcare is important to you or our nation this is a must see discussion. Please pass this along so people will understand the difference between the healthcare systems being offered.

Each part is roughly a half hour.

snips from the first video...

Speaking of the government paying for Medicare and Medicaid which props up insurance company profits by removing two segments of citizens who have high health care needs.

Arnie Arnesen

"We left the insurance company with the youngest, healthiest people and no wonder they are making a profit, because we've taken away the most expensive part of healthcare, which obviously is going to constantly sink us like a stone. Because insurance is about spreading the risk, we don't spread the risk, in fact what we do is prop up the insurance industry. Which is why they are so frightened about changing anything in the way of a system because it is about their profits and their CEO's and not about our healthcare..."

Dennis Kucinich

"For profit insurance companies make money not providing healthcare..."

[slipslidingaway]

6. President Truman proposes a national health insurance fund...

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=2934033&mesg_id=2934033

http://www.pbs.org/healthcarecrisis/history.htm

http://www.trumanlibrary.org/anniversaries/healthprogram.htm

"On November 19, 1945, only 7 months into his presidency, Harry S. Truman gave a speech to the United States Congress proposing a new national health care program. In his speech, Truman argued that the federal government should play a role in health care, saying "The health of American children, like their education, should be recognized as a definite public responsibility."

...President Truman's plan was to improve the state of health care in the United States by addressing five seperate issues.

...The most controversial aspect of the plan was the proposed national health insurance plan. In the November 19th address, President Truman called for the creation of a national health insurance fund, to be run by the federal government. This fund would be open to all Americans, but would remain optional. Participants would pay monthly fees into the plan, which would cover the cost of any and all medical expenses that arose in a time of need. The government would pay for the cost of services rendered by any doctor who chose to join the program. In addition, the insurance plan would give a cash balance to the policy holder to replace wages lost due to illness or injury.

Harry S. Truman's health proposals finally came to Congress in the form of a Social Security expansion bill, co-sponsored in Congress by Democratic senators Robert Wagner (N.Y.) and James Murray (Mont.), along with Representative John Dingell (D.-Mich). For this reason, the bill was known popularly as the W-M-D bill. The American Medical Association (AMA) launched a spirited attack against the bill, capitalizing on fears of Communism in the public mind. The AMA characterized the bill as "socalized medicine", and in a forerunner to the rhetoric of the McCarthy era, called Truman White House staffers "followers of the Moscow party line".* Organized labor, the main public advocate of the bill, had lost much of it's goodwill from the American people in a series of unpopular strikes. Following the outbreak of the Korean War, President Truman was finally forced to abandon the W-M-D Bill. Although Harry S. Truman was not able to create the health program he desired, he was sucessful in publicizing the issue of health care in America..."

[slipslidingaway]

7. Health Care - The Obama-Biden Plan

http://www.change.gov/agenda/health_care_agenda/

Contact the Transition
http://www.change.gov/page/s/contact

We should also pressure Congress to allow debate on the Conyers/Kucinich bill.


"The Obama-Biden Plan

On health care reform, the American people are too often offered two extremes -- government-run health care with higher taxes or letting the insurance companies operate without rules. Barack Obama and Joe Biden believe both of these extremes are wrong, and that’s why they’ve proposed a plan that strengthens employer coverage, makes insurance companies accountable and ensures patient choice of doctor and care without government interference.

The Obama-Biden plan provides affordable, accessible health care for all Americans, builds on the existing health care system, and uses existing providers, doctors, and plans. Under the Obama-Biden plan, patients will be able to make health care decisions with their doctors, instead of being blocked by insurance company bureaucrats.

Under the plan, if you like your current health insurance, nothing changes, except your costs will go down by as much as $2,500 per year. If you don’t have health insurance, you will have a choice of new, affordable health insurance options.

Make Health Insurance Work for People and Businesses -- Not Just Insurance and Drug Companies.

Require insurance companies to cover pre-existing conditions so all Americans regardless of their health status or history can get comprehensive benefits at fair and stable premiums.

Create a new Small Business Health Tax Credit to help small businesses provide affordable health insurance to their employees.

Lower costs for businesses by covering a portion of the catastrophic health costs they pay in return for lower premiums for employees.

Prevent insurers from overcharging doctors for their malpractice insurance and invest in proven strategies to reduce preventable medical errors.

Make employer contributions more fair by requiring large employers that do not offer coverage or make a meaningful contribution to the cost of quality health coverage for their employees to contribute a percentage of payroll toward the costs of their employees' health care.

Establish a National Health Insurance Exchange with a range of private insurance options as well as a new public plan based on benefits available to members of Congress that will allow individuals and small businesses to buy affordable health coverage.

Ensure everyone who needs it will receive a tax credit for their premiums.

Reduce Costs and Save a Typical American Family up to $2,500 as reforms phase in:

Lower drug costs by allowing the importation of safe medicines from other developed countries, increasing the use of generic drugs in public programs, and taking on drug companies that block cheaper generic medicines from the market.

Require hospitals to collect and report health care cost and quality data.

Reduce the costs of catastrophic illnesses for employers and their employees.

Reform the insurance market to increase competition by taking on anticompetitive activity that drives up prices without improving quality of care.

The Obama-Biden plan will promote public health. It will require coverage of preventive services, including cancer screenings, and increase state and local preparedness for terrorist attacks and natural disasters.

A Commitment to Fiscal Responsibility: Barack Obama will pay for his $50 - $65 billion health care reform effort by rolling back the Bush tax cuts for Americans earning more than $250,000 per year and retaining the estate tax at its 2009 level."

[Greyhound]

8. HR 676 is still currently sitting in committee where it was sent to die.

As long as insurance companies are allowed to exist, we will pay super-premium prices for sub-standard or non-existent care, period.

The Obama-Biden plan does not address poor people, for whom tax credits are meaningless, nor does it restrain the companies ability to deny payment for needed treatment.

The very fact that huge profit margins and a nearly infinite number of processes, forms, and requirements continue to exist puts such an enormous drain on the system that it ensures failure. Translation; People will continue to die so that these parasites can remain.

[librechik]

9. yes yes yes--half our work is done for us if we go this way

please be smart, congress and pass this law.

[slipslidingaway]

10. 2 more R's for this topic??? n/t

[newtothegame]

11. Thanks for posting this....we need to have this discussion

I am a healthcare administrator in Iowa and I agree that there are currently UNBELIEVABLE headaches with the multitude of payers, from documentation requirements, to appeals, to reimubursement methods and levels. I would love to see a single-payer system that changes this. My main concern with single payer is this: currently, we lose money on every single Medicaid patient we see. And we damn near lose money on every single Medicare patient we see. By many accounts, single-payer healthcare would mean reimbursement for all patients at these levels. We simply could not operate. And there would be absolutely no capital for new innovative technologies, procedures that are less invasive, produce better outcomes, etc. While single-payer would provide us reimbursement for care that is currently provide free (we call it "charity care"), we still would never be able to sustain our business if ALL our patients were reimbursed by the government. So I'm not sure how an Obama administration could address this; I simply don't trust the government to reimburse us at sustainable levels if they can't do it with a limited Medicaid/Medicare population now.

[Vinca]

13. 2 points. If we had single payer, your hospital would no longer

be on the hook for employee health insurance. Wouldn't that be a massive savings? Secondly, can you explain to me why the cost of a procedure goes up - let's say an MRI - year after year, even after the piece of equipment is paid for? Maybe hospitals should go back to their former, mostly nonprofit status.

[Donnachaidh]

14. I'll bet the costs go up because hospitals play games with lease-backs

and all such nonsense to get tax breaks. Hospitals buy equipment, use up the tax advantages on the purchase, and then sell them to another party, then enter into an agreement to lease the machine, setting up a brand new gravy train of tax advantages on a machine they (once) owned.

Force the hospitals to go NON profit will stop this sort of tax thievery. Make it UN-profitable for hospitals or medical groups to play games with tax codes.

[newtothegame]

16. You are correct that there would be significant savings on our employee health insurance...

And you are spot-on about the non-profit status of lots of healthcare institutions. I am 100% behind our Senator Chuck Grassley's actions to force hospitals to justify their non-profit status. We are fully able to justify our status through charity and uncompensated care and outreach. The amount we invest in these areas is far more than we would ever pay in taxes. But there are a lot of institutions that are doing a very poor job of justifying their status.
To answer your questions about the cost of an MRI going up, there are a number of factors.

1) If you are commercially insured, we are recovering our losses from Medicare/Medicaid patients through you. Unfortunate but true. Your insurer (and thus you) are subsidizing those losses. Which is why I want single-payer to be much different than just "Medicare/Medicaid for everybody." We could never afford it if everyone was reimubursed like Medicare/Medicaid patients.

2) There is pressure for hospitals to consistently upgrade to the best and brightest, even if the marginal inprovement in outcomes is less than the marginal increase in cost. This is because 1) government reimbursement is higher for some of these technologies and 2) if we don't upgrade to this equipment, our competitors will. Though we are non-profit, if our patients who can travel go to another healthcare provider (especially those who get procedures we actually make money on), we risk going out of business and the patients who can't travel will have lost their local provider. So our upgrade costs for technology are incredible.

3) The current government reimbursement structure does not account for fluctuations in the severity for illness. For instance, while commercial insurers usually reimburse us for a percentage of charges or of costs, the government reimburses us based on what they think they can afford. Problem is the severity and complications of cases vary, and while a really good case can cost as LITTLE as HALF the amount we're being reimbursed, complicated cases can cost AS MUCH AS FIVE TIMES the amount we are reimbursed. This is barely sustinable with our current percentage of Medicare/Medicaid paients; what if ALL patients were reimubursed this way?

There are obviously other pressures, including our unsustainable contract with our nurses union (previous administration's negotiation, not mine, but we are currently paying 2.5 times pay for overtime and 3.5 times pay for holidays), and I feel bad bringing that up in light of our recent conversations about the auto unions, but it's just the fact in our case. But the top 3 are huge. I'm all for single-payer healthcare, and serious HC reform, but I'm telling you there is NO WAY we could provide care if all patients were reimbursed like government patients are right now.

edited for spelling

[global1]

24. A Couple Of General Comments Here For You......

1. See the comment below as to how the Repugs - Reagan/Bush/Bush Jr. bastardized the Medicare/Medicaid system through the years. That needs to be changed to something that is fairer to the providers. Any health care plan that affects the providers ability to give good care won't work.

2. I'm just curious how other countries that have a successful system - pull it off? I believe there are other good working models of government sponsored healthcare that are working.

3. We've heard during the campaign that all Americans should have the same quality of medical care that the Senators and House Reps have - that needs to be looked at closer.

4. One would spread the risk out over more people than currently done by private insurers.

5. Eliminate the costly overhead of the multitude of administrative and marketing departments needed by all the private payers - there would be a massive cost saving here.

6. Seems to me the medical device/equipment & pharmaceutical industries would flourish in a single payer universal system. More reason to develop better, more cost-effective devices/equipment/medicines.

7. Personnel issues of lack of or shortage of nurses, pharmacists, doctors needs to be worked out. Currently the overtime/holiday pay you are having to pay is more due to this shortage and inability to find good medical personnel to cover the workload.

8. Infection control and medical errors contribute greatly to the high costs of healthcare as well and we need to get our hands around these issues to control costs. Medical personnel have to learn to wash their hands and to make sure they check and re-check what they are doing. Many times the shortage situation impacts on these two issues and contributes to the problems.

I personally pay around $1950.00 every two months for coverage by BC/BS. I'm self-employed. This is with a large deductible and I'm gun-shy of even using any of the coverage I have because I'm concerned if I ever have to switch plans - they'll cry - pre-existing condition. So I try to self medicate and not go to doctors. This is the type of behavior that current plans foster. I realize that when I will be forced to use my insurance coverage - it will be something very serious and very expensive.

Instead we should be fostering "WELLNESS" and "PREVENTIVE" Care. Encourage at least a yearly visit in order to maintain the government coverage. Keep people healthy so they don't have to use the system or at least the most critical parts of the system. Let the hospitals deal with the high-acuity patients.

There are ways of managing this so that it works to the benefit of all.

I'd gladly pay more in taxes if I knew I would be covered for everything and didn't have to worry about what I mentioned above. But I'm sure the additional taxes I'd pay would be less than the $12K that I fork over each year now.

Also - take away one less stressor on people the worry about healthcare and personal bankruptcy in case of a catastrophic illness. Just taking away this worry would reduce the stress level many of us experience and perhaps help promote health.

We don't have a healthcare system in the U.S. We have an 'illness care system'. This needs to change.

[newtothegame]

26. Well said....

I've worked for several hospitals that have tried to get into wellness efforts because they feel a responsibility for promoting health, not just curing illness. The insurers will have nothing to do with it; they don't even wanna hear it. Insurers want hospitals to do this for free, without reimbursement, and so with enough pressures on the "illness" side for hospitals, wellness falls to the wayside.

[Cleita]

17. Another single payer plan I read had this suggestion for hospitals.

Every year, government accountants and hospitals would meet and discuss their budget requirements for the year, what it would cost to operate the hospital with all beds full year round, the number of people needed like nurses and doctors as well as other personnel to staff it and all the other costs of doing business. Once a figure is agreed upon the government would give that hospital operating money for the year. It goes without saying that the hospital would be non-profit. The idea behind this is that the hospital would have the incentive to fill all the beds regardless of the patient's ability to pay because the expense of those patients is already paid for. They wouldn't have to worry about getting enough paying patients to meet their overhead as that has already been met for the year so they could concentrate on delivering health care without having to hound patients and worried family for insurance information.

[a kennedy]

12. This in USA today.....regarding Kennedy's health push.....

Kennedy set for major push on health bill

WASHINGTON — When he endorsed Barack Obama for president in January, Sen. Edward Kennedy said it was because his young colleague "understands what Dr. Martin Luther King Jr. called 'the fierce urgency of now.' "

Ten months later, the haunting quote that Obama made a theme of his campaign holds an even deeper significance for Kennedy.

Though battling incurable brain cancer, the 76-year-old Massachusetts Democrat returned to Capitol Hill this week. He's a man on a mission that so far has proved impossible: enactment of comprehensive health care legislation that would provide coverage for the nation's estimated 47 million people who don't have health insurance.

"I am looking forward to working with Barack Obama on health care," Kennedy said Monday as he headed to a luncheon with his staff after a six-month absence. The senator leaned on a silver-headed cane but otherwise looked hale, his trademark white mane intact despite continuing cancer treatments.

Kennedy's reappearance six months to the day after he had the seizure that led to his brain cancer diagnosis sets up a potentially dramatic race against time as he seeks to cajole the notoriously slow-moving Senate into delivering the capstone of his four-decade legislative career.

full araticle: <http://www.usatoday.com/news/health/2008-11-20-Kennedy_N.htm>

[global1]

23. Kennedy Scares Me A Bit - I've Had Dealings With His Office Regarding.....

pharmacy - more specifically - compounding pharmacy - which is patient specific meds that aren't made by Big Pharma. Kennedy has been on the side of Big Pharma and the FDA. I'm thinking it's the influence of Big Money coming from Big Pharma is why he's taken their side. As such - I'm thinking he will still work in the private health insurance companies into any plan he comes up with. As long as the private insurers have their hands in this - it will be one-sided and not acceptable. Single payer universal is the only way to go.

[Cleita]

15. Dennis Kucinich's plan HR676, is simply an extension and improvement of

Medicare for everyone. Medicare has been operating successfully since Lyndon Johnson signed it into law. It's a plan that has proven to be effective and cost effective. Republicans have been trying to weaken it and starve it of needed money to destroy it and I believe they are finally succeeding after twelve years of Reagan/Bush and eight years of Bush II where it has been semi-privatized. It's not rocket science. It's simple and doable. I fear that any other plan is doomed to failure because they are letting the for profit health care industry take taxpayer's money that is meant for Medicare and or National Health Care.

It's a plan that already has a track record of successfully delivering health care to senior citizens. This is the plan you need to back.

[annabanana]

18. There is already a bunch of Doctors on board..

Physicians for a National Health Program is a non-profit research and education organization of 15,000 physicians, medical students and health professionals who support single-payer national health insurance.
http://www.pnhp.org/

The fact that this would also be very good for businesses (would get the whole monkey off their backs, so to speak) should contribute to the kind of momentum required to actually DO THIS. .

[Cleita]

22. Yes, Daschle should consult with them and include them in

the Health Care Board he intends to create to study the situation. They already have done all the research and have the answers for everything that could go wrong, how to fund it and every thing else. They have been studying the problem since 1987. If Daschle intends on inviting the health and insurance lobby to participate, these are the people who can expose any and all lies and spin they might try to bring to the table.

[southernyankeebelle]

19. Single Payer Plan

I think the single payer plan would be great for those especially in the service industry. If america could get the medical costs and medicines down it would help people so they could spend more and small business. Something has to be done.

[Stinky The Clown]

20. I do't care who gets their name on the plan .... single payer universal is the only way to go

[Phoebe Loosinhouse]

21. Let me say loudly and firmly - no more incrementalism!

No more plans that cover only certain segments of society like healthcare just for children or for families or the unemployed or those in a certain income ranges done in relays -

HEALTHCARE FOR EVERYONE RIGHT NOW !!!

[onethatcares]

25. how do they do it in Norway or Sweden?

or in a country where the healthcare system runs like a Timex watch? There has to be a role model out there somewhere, maybe the Danes have it.

I agree with the single payer healthCARE program, hell with the healthINSURANCE nightmare that we already have.

[eridani]

27. With the economic meltdown, single payer is the only option we can afford

We can't afford to allow private insurers continue to siphon money out of the pool of health care dollars to waste on administrative nonsense, and expect to fix anything by throwing a few more federal bucks at incremental reform.

If water is draining out of your bathtub, turning on the taps to full blast will not solve the problem. You have to put the plug in.

[dysfunctional press]

28. it should be the cornerstone of obama's administration...

that, and becoming independent of mideast oil. those two issues SHOULD define his presidency, and they both require BOLD vision and leadership.

[lumberjack_jeff]

29. I favor single payer. However, I don't think we can get there (politically) in one bite.

The first step is mandated universal coverage with public insurance as one of the choices.

As more people choose the public insurance, it will eventually become the single payer system, with other insurance relegated to niche products.

[slipslidingaway]

30. Kick n/t

[LWolf]

31. HR 676

has about 90 cosponsors in the House, iir. That's not insignificant.

I'd love to know what would bring that to the forefront of the agenda again. If Congress passed it, would Obama sign it?

I hope Conyers/Kucinich will keep bringing it back.