Can someone explain single payer to me?

[Joe the Revelator]

Why are some people so passionate about it? Why is it better then other option on the table? Why does congress seem so scared of it? I need to get myself informed on this issue....

[Muttocracy]

1. checkout the E. Kucinich video in the video forum - short answer = insurance lobby

[Joe the Revelator]

8. Thats a hell of a video.

[baldguy]

2. Medicare for everyone.

Take the insurance profiteers out of the equation.

[Joe the Revelator]

4. Well this is a no brainer to me then....what other option would even be viable

it would seem that anything else would be more of the same.

[Dragonfli]

10. That is absolutely correct - also why so many are afraid of it

And why so much money is being used to buy congress.

[question everything]

37. There is always the question on how to fund it

and the answer should be with our taxes.

Our medical premiums have been rising 20% every year now. I would rather pay the same amount in tax and know that I will always be covered, pre-existing conditions or not.

And since this is taxes, there should not be the question of who should be covered.

I often compare it to public education. We all support it through our taxes, whether we have children in school or not. And, while we support health care for all with our taxes, as with private schools, those of us who want to visit providers outside the system should be able to do so, paying from our pockets.

These are my suggestions. I don't think that any plan is talking about taxing all of us - at progressive rates, of course.

[msongs]

3. corporations (the single payer) gives $$$ millions to congress to deny health care reform nt

[DJ13]

5. Imagine you're a Senator

Now imagine you get sick, who pays for it?

[Joe the Revelator]

9. haha....great answer

[Dragonfli]

6. This is a source to answer your questions

http://www.pnhp.org/facts/single_payer_resources.php

The video up-thread is a good short explanation but I thought I would give you some meat to enable you to become very well informed on the issue :-)

[Joe the Revelator]

12. Thanks

:)

[spoony]

45. Great resource, thanks for the link!

:)

[truedelphi]

7. Yes the video that is posted in response one is a

great way to start.

Her ein california, the Single Payer option is so favored by the public that it passed the legislature. Then our Governor, Ahnold, vetoed it.

So people put together a bill in California that would limit the insurer's ability to receive more than 15% profit on the current health system. Surely that would be enough - grocery stores runon like 2% profit, most industries run on far less. I mean, even Real Estate agencies only ask for 7%,

But that second bill never got anywhere.

The Big Health INsurer's want between 24 and 30% and that is a heck of a lot of money to pay. To ensure that they receive that much profit, they strangle the insured's ability to get decent healht care. For instance my $ 1,000 a month Kaiser Permanente policy "entitled" my household to a mis -diagnosis that almost cost my husband his life, and that stalled me around on healthcare I needed until our Cobra eligibility expired.

The movie "Sicko" will provide a great more deal of examples on this.

[alarimer]

11. Think no premiums, copayments or deductibles.

In Canada, it comes out of your taxes, like Medicare.

But more importantly it means that you cannot be denied care EVER for any reason. No insurance company beancounters deciding what you get for health care. You and your doctors and no one else decide. The government simply pay for it. You pay for it in taxes. But your employer does not pay, so you can take any job you like.

[Joe the Revelator]

13. What are the downsides? Are there any?

[MannyGoldstein]

16. Unemployment for A Lot Of People in the Insurance Industry

Docs and pharamas will get paid less, because a single payer can drive a hard bargain (as can, say, Wal-Mart). But don't worry, they'll still be paid a multiple of what most people get.

[Warpy]

19. Docs and pharma don't seem to be hurting in any country that has it

and many of the clerks now employed by for profit insurance will be absorbed into a government administration.

The pieces of garbage whose jobs are to deny coverage and deny care will have to find honest work, though.

Maybe they can work for collection agencies.

[TankLV]

20. Yeah - there was one idiot here the other day crying his poor eyes out...!

[MrMickeysMom]

25. Cluck, cluck...

Right now lots of personnel and costs in physician offices are wasting a lot of dollars in dealing with all the administrative insurance bullshit they have to go through to treat patients.

The upside therefore is the issue for US... We're paying for it. Fuck the insurance companies for being the blood suckers they are.

Now if anyone feels bad for the obscene profits lost from health insurance, then have them reinvent themselves. If insurance companies REALLY wanted to diversify, they would get into an offshoot business of "wellness". For example, you want to look like a million and feel like a million? Buy a wellness plan for a premium. Of course, you could invest your own time as a consumer and stay well, but I'm sure there is quite a market for buying into this "new" product, and it's the kind of diversification that could fall in the category of "insure". Like, "insure wellness".

[JVS]

31. Oh noes! Not the insurance industry we all know and love so well.

[ContinentalOp]

21. Potential downsides:

Many of the people employed by the for-profit health insurance industry would probably be put out of work. Pharmaceutical companies might make less money if the government had a lot of bargaining power and got prescription drug prices down.

Doctors and hospitals would have to accept whatever rate the government decides to pay for a particular procedure. This may mean less money for some things, but as far as I know this would be an improvement over the existing plan where they have to haggle with the private insurance companies who only pay a fraction of what the doctors ask. So doctors raise their fees to try to get more out of the insurers, and this creates a spiraling problem. I'm no expert on this so I may have the details wrong, but the existing doctor/insurer relationship sounds pretty screwed up.

I think these are all small prices to pay though. I'm just trying to play the devil's advocate here. I really can't think of any other legitimate downsides.

[JDPriestly]

23. Doctors would probably be happy if they could just get paid

to do a good job -- and not be rushed into handling as many patients as possible within a short time. Also, if doctors didn't have to spend so much time filling out forms and if they didn't have to hire so many people to help them with their paperwork for the various insurance companies, they would be much happier, I think, judging from people I know in the medical profession.

[shireen]

44. might not be so bad

A fairly large percentage of the people employed by the insurance companies could continue doing that job under a different structure. Even with single-payer, i assume that the government would depend on private companies to handle the administrative stuff.

With insurance company scammers out of the way, it's likely that doctors and other healthcare workers, and hospitals can negotiate reasonable salaries with the government. Doctors deserve to be paid well (not outrageously overpaid, but they deserve a good salary for the job they do). In addition, the government can provide additional benefits for doctors who choose to be primary care providers and/or agree to work in rural areas.

Regarding big Pharma ... a lot of the research money for new medications come from government grants via the NIH. There is tremendous amount of government sponsored basic research that provides the foundation for these companies. Without us taxpayers, many of them would not exist.

[mwooldri]

26. Downsides happen if the system isn't properly funded.

I'm all for advocating single payer. Give you an idea in terms of numbers: Medicare covers about 46 million people and the US government sets aside $400 billion for it (and it still doesn't pay for everything). The UK's NHS system covers 60 million people and gets about $160 billion in funding (£100 billion) but pays for pretty much everything.

You might think "impressive" - the UK insures everyone for a lot less money. True, but there are two big major downsides: waiting lists and unavailability of certain treatment options. You can only buy so many doctors and nurses for $160 billion and demand for services outstrips the available supply. Therefore non life-threatening healthcare is rationed. Also some extremely costly drugs aren't available, especially specialist cancer fighting drugs. My sister works as a nurse in the UK and she hears of cases where a patient is diagnosed with a particular cancer, the doctors want to prescribe XYZ drug - it's cleared and OK to be prescribed, but the NHS won't cover that drug - so the patient either is forced to "go private" and pay for the drug themselves, or they simply go without and plan their funeral.

I'd much like to have a UK style NHS system over here - provided it's properly funded. This means that drugs that are available are covered, and waiting lists if any are minimized.

Mark.

[emilyg]

35. Good post.

[question everything]

39. Treatments may be rationed

For most people, 90% of their medical expenses for their whole life are generated in the last year, or six months of their lives. We are a society that does not accept the fact that no one leaves this life alive. We try to use the latest gadgetries and tests and treatments to extend life by a few months.

I can see a situation where someone - who? - would decide that since this is our tax money, we have a right to decide who gets what treatment and when.

I think that Oregon has had(?) some kind of a system for the poor and it put some limits on some treatments. Not sure about the details.

By the way, I think that Canada and Britain are not the best models. I have heard that the French and the German systems are better, but do not know the details.

[patrice]

43. Treatment is rationed now, by the Insurance Companies.

Honestly, you don't think they just pay whatever claims come in, do you? And you HAVE heard of pre-approval.

And in long-term care there's a reimbursement ratio that the state modifies periodically and a data collection and management system that determines and shapes the flow of federal and state dollars into geriatric care systems.

Rationing by any other name is STILL rationing.

[patrice]

42. Some of those currently managing claims and payments will have to retrain.

The records system we need to help create the cost efficiencies is going to be very expensive.

My MIL was on Medicare for the last 5 years of her life; we never had any problems at all.

[ContinentalOp]

14. The health insurance industry makes big profits at the expense of our health.

If we took the profit motive completely out of health insurance, and the government were the "single payer" that paid for everyone's hospital bills, prescriptions, doctors fees, etc (keep in mind those are all still private businesses, this isn't "socialized medicine"), then we would see the following improvements:

- The cost of health care would go down by taking the insurance industry profits out of the mix.

- Nobody would be denied coverage just so that an insurance company can make a few extra bucks.

- Billing would be greatly simplified for health care providers, which should cut costs even further. Right now a lot of time and money is spent dealing with insurance industry paperwork, and some doctors will deny you care if they don't want to deal with your particular insurance company.

- The government would become one single massive buyer with a lot of bargaining power to get us better deals on things like prescription drugs.

If you don't have a mandated single payer plan and you allow private industry to compete with a voluntary public system you'll have a situation where the private insurers provide inexpensive insurance for only the healthiest people and then kick them out of the system once they become a risk. The public plan will be incredibly expensive as it will be the refuge for all of those who are rejected by the HMOs due to age, or preexisting conditions.

[Joe the Revelator]

18. The more I read, the more on-board I get

[MrMickeysMom]

15. Okay, I'll try

I equate the model of single payer just like Medicare, which instead of being run privately with a board of directors, is run by the govt, which of course, the board of directors being congressional. This model exists already for seniors as a much lower cost in low over head. It offers payment for any doctor you want to treat you (under Medicare, that's just everybody). Everybody pays into it, as an employee, and since everybody pays into it, costs are spread out over a much wider base. Therefore, cost per person is low all care is handled.

If you want, say, a special elective surgery, there may be a waiting list, but regular and emergency care, you are taken care of. If you take profits and administrative overhead (which is at least 30%) out of the private health insurance model, I believe you'd save 30 billion a year. You'll provide more work and services for an extra 45 to 47 million people because more people will be available for those services. This opens up the kind of health related jobs that keep people well, and they are good middle class jobs.

Single Payer also helps business, because business don't have to worry about carrying insurance for employees and retirees. That's huge.

Congress is corrupt with their trough of insurance companies, so that's why I believe they will go kicking and screaming into passing single payer legislation. They stand to loose campaign finance. Well, too bad, we've needed campaign finance reform forever. See the movie, "Sicko", and you'll get somewhat of an idea.

Funny, you see these right wing assholes with lots of income complain about Medicare, then they all sign up for it.

Finally, there were a couple of good articles right here today on DU today about Single Payer, which in it's HR form is HR 676.

[Joe the Revelator]

17. Thanks!

I was curious about the waiting lists.

[MrMickeysMom]

22. No problem, Joe!

Now, if we could get congress to cotton on the same way, we'll be going in the right direction.

[kaygore]

28. Well said!

[MrMickeysMom]

29. Kind of makes you want to shout it down the throat of your congress critter...

... doesn't it?

Thanks.

[patrice]

41. Medicare overhead is 5% of its total, 2% if you take Medicare+ out of it, according to

PNHP.

[MrMickeysMom]

48. Help me with that reference, if you don't mind

Of that estimate of overhead, my best friend has said, "You don't actually believe that, do you?"

I didn't recognize the acronym PNHP.

I'd like to make an intelligent assessment of Medicare in and of itself, before this HMO stuff was added.

Please!

[patrice]

49. Physicians for a national HEALTH Program (emphasis added)

http://www.pnhp.org/

Many references and resources there.

[MrMickeysMom]

51. Thank you for that...

I'm reading them now.

Interesting how Paul Wellstone tried to pass this legislation and where we could have been now as a result of it!

[krispos42]

24. The basic idea behind insurance...

... is that the insurance provider spends a lot of time and money studying risks and assigning them probabilities. Then when you approach them and say "I need to insure something" they can look at you, at what you want insured, how long you want it insured, and how that insured thing is going to be used. They price it accordingly based on individual factors.

All that money goes into a giant pool. Most of it gets invested rather than just sitting in a bank account someplace, earning interest and dividends while the insurance company waits for a large disaster that would require large payouts.



With single payer, the risk pool becomes everybody in the country from birth until death. Since you're almost certain to need medical care at some point in your life (unless you die in such a way that all the coroner has to do is pronouce and toss you in a body bag), the idea of having battalions of people slicing and dicing data to determine risks and rewards become moot.


In other words, the reason for the competitive system (free market rewards those that do the best risk assessments) becomes moot. The insurance company simply receives a bill from a doctor and cuts a check.

Something that they were doing 4,500 year ago in ancient Sumer with clay tablets and abacuses, by the way. And something that is emminately suited to boring, competent, dedicated, stable public servants with decently-paid careers with decent benefits.


And this terrifies the insurance companies. They're being forced to realize that they don't actually cure anything or heal anybody or advance medical science. They just redistribute wealth from every in the plan to those that file a claim... while skimming off a healthy chunk for themselves.

[kaygore]

27. I used single payer in the UK

Single payer: Medicare for all is the best way to explain it. The government would handle all medical costs. We would pay through our taxes. As we now pay three times more than any other industrial nation and yet rank at the bottom for health care, the costs would go down and the services would go up. Medicare has 1/3 the overhead of private insurance companies. We would have more flexibility to choose our doctors and less cost and red tape.

The downside, from talking with friends in the UK who came from non-single payer countries, such as the US and Greece, may be that we will focus on what actually works and not have tests simply to have tests. For example, there is significant research that suggests that mammograms are actually more dangerous than helpful (please don't flame me). Mammograms are not given willy nilly in the UK. I suspect that in the US, given the ease with which Americans are seduced by advertisement, that should we go to a single-payer system based on solid research and heath rather than focused on illness, then there will be a market for those who want all those tests that the government will not pay for. As for longer wait times--that's hooey. I can provide fact after fact to show that that is simply a scare tactic.

Also, in the UK, the doctors don't dispense antibiotic for any ache and pain. The upside of that is that people have stronger immune systems and are less drug resistant. Since too many doctors in the US are simply pill pushers rather than actual heath care providers, actually having a system that focuses on health rather than illness might also freak some of us out!

I do have some experience with a national single payer health care system. My friend was hired as a UK hire to her job with Intel in the UK (she's an American). She was in the UK for three years, using their health care system. She was surprised that despite having no worries about health care costs and having at least six weeks of paid vacation time plus holidays a year and all the time off she needed when he dad was sick and then died, her taxes were only slightly more than they were as a percentage of income in the US! So, that single payer health care would mean that we would have significantly higher taxes is a LIE!!!!

My friend was assigned a doctor but that was simply the one closet to where she lived. She could chose any she liked. I had to take her to the emergency room one weekend when she cut herself making dinner and it wouldn't stop bleeding. In the US, my dad almost died in the emergency room and in all the times I have taken a relative or friend to a US emergency room, the wait was always hours. The wait in the UK was less than 20 minutes!

When I had my emergency in 2006, I had to go to the emergency room late on the Wednesday before Thanksgiving in the US. My US surgeons FAXed my files to the UK hospital (Moorfields Eye Hospital)in case my macula was degenerating (I was scheduled for surgery for a hole in my macula when I returned from the UK--could not get a sooner surgery time in the US so I went to visit my friend in the UK for six weeks after the 2006 elections). In the UK, I had the same tests run on the very same equipment that they were run in the US--very expensive tests as I had a $5000 deductible (and $500 a month premiums) in the US, so I knew what those tests cost.

[applegrove]

30. Here are some basic articles.

http://www.healthcareforalleducationfund.org/basics.html

[TreasonousBastard]

32. I'm one of the few lonely voices saying be careful about it...

Nobody I know who is actually on Medicare, Medicaid, Indian Health Service, or VA healthcare is advocating expansion of those programs to everyone. They are, like me, thankful that they do exist at all, but the plans are not at all complete. Unlike other countries, Medicare has enormous gaps in basic coverage that requires supplementary plans, and the other gummint plans are patchwork at best, lethal at worst.

Nobody in Europe except the Brits have anything close to what people around here are calling "single payer" and the Brits are closer to he bottom of the European healthcare ratings according to WHO. France and Italy are on top, and they have hybrid systems.

Most of the advocacy I've seen for "single payer" I've seen is not so much for single payer, but hatred of health insurance companies. A bill for $77,000 for a morning in the hospital, as my mother just got, is not the problem, but insurance company profits are.

It wasn't that long ago that malpractice suits were being blamed for high medical costs, and in some cases there was a lot of truth to that. Now, it's insurance companies and drug companies. They're running out of bogeymen to blame and eventually will have to accept that we just have an inefficient method of providing healthcare.

Let's start with doctor's pay-- primary care providers (used to be called Family Doctors) average not much over $100,000. Dermatologists average over $400,000. So, adding up up student loans, overpriced housing, all the other lifestyle bills a doctor is supposed to run up, and a smidgeon of plain ol' greed, a two minute microeconomic analysis shows us one way that basic healthcare is being rationed by the market. I don't mind doctors making a lot of money, but gravitating toward high paying specialties and leaving important areas uncovered is a serious problem. (And, with all the competition for dermatology residencies, could that mean the best and the brightest treating rosacia and lesser lights figuring out what that pain in your right side is?)

It gets worse when Medicare sets pay schedules that reduce your family doctor's income even more and doesn't pay on time. Medicaid ran into that wall years ago when it was damn difficult to find a doctor who would accept any new Medicaid patients and often turned old ones over to the clinica or emrgency room.

But, hey, get rid of the insurance companies and expand Medicare to all and everything will be just fine.

(Simple answers are always the best ones until you have to solve a problem.)

[John Q. Citizen]

34. The thought has long been that single payer works so well in Canada that we should do it here.

I agree.

In fact I am calling for a single payer fee for service system here in the US.
But I'm opposed to a national health Service like the British have. i want my doctors and hospitals independent.

A single payer entity can negotiate fair fees for services, can negotiate for fair prices on equipment and drugs. And that entity must be accountable in a democratic way to all of us. We know private insurance companies are responsible only to their stock holders. And they don't provide healthcare. Private insurance is just paper shuffling and stock holder profits.

please check out Physicians for a National Health Program. I don't know if you hold an MD, or if you ever had to solve problems related to working as an MD,

http://www.pnhp.org/

There are a lot of resources about current thinking on single payer fee for service systems.

[TreasonousBastard]

36. Small points...

the population of Canada is a few million fewer than the population of California, so attempting to use their system nationwide here would be ummm... problematic.

As I was informed by an actual Canadian, or at least someone living in Canada and using their system, the last time I brought this up-- the Canadian systems (and there are several as they are run by the provinces) are only "single payer" in the sense that basic wellness, lifesaving and some other stuff is taken care of. For much care, supplemental insurance policies are available and recommended. This is a good system, but I suspect it falls short of what a lot of people here are looking for.

The Canadian system is a lot cheaper than ours to administer, and those supplemental policies are very cheap, but this may be because their health delivery system is more effective and cheaper than ours. I don't know for sure about Canada, but I have heard that European doctors don't graduate with over half a million in debt following them around, and that sounds like a good start.

And, here I'm only talking basic care. When it gets to heart transplants, dialysis, and other insanely expensive procedures and treatments here, I have no idea how these fit into other countries' health programs or what we could do to reduce the expense and expand their use here.

Ultimately, my objection is considering universal care to be synonymous with single-payer. Universal is good, single payer we don't really know.

[John Q. Citizen]

46. The population of Montana is less than a million so Social Security works here but not in New York?

I don't understand why you contend the size of a population would be critical as to whether a system would work.

By that reasoning, every single country of Europe isn't a good health care model because their population's individually are far smaller than the US. But that doesn't make any sense. The larger the insurance pool, the cheaper the cost per person, since the whole point of insurance is to spread the risk. Insurance is a socialistic concept. so why not just socialize it?

FDIC is a single payer bank deposit insurance system. It works here, even though we have a population that's bigger than Spain's.

I do know for sure about Canada, even if you don't. I know for sure because I can go look and see what's covered by each Provence. I can go look at what private insurers are selling. Google can assist you to do the same.

I notice a lot of private Canadian companies sell insurance so that if you are hospitalized you can get a private room. Many sell dental coverage and cosmetic coverage as well. And foreign travel health insurance.

[John Q. Citizen]

33. In a single payer system all healthcare expenditures are made by one

single payer.

For instance, in Canada the Provincial Health Authority collects taxes and then pays all healthcare claims submitted by private doctors, clinics and hospitals.

Instead of having redundant collection of funds and payouts by multiple government agencies (like Medicare, Medicaid, SCHIP) and multiple collection of funds and payouts by private health insurance companies, only one payer collects funds and distributes funds.


That makes negotiating drug prices pretty easy to do. It also makes negotiating fees for services and equipment pretty easy to do.

Social Security is single payer retirement insurance. SS Administration collects the premiums and th SS Administration distributes the Social Security benefits.

Single payer creates passion because it has a long proven track record (in Canada) of containing costs while inuring everyone. No one loses their home to get a needed operation or has to go without medicine because they can't afford it.

Private health insurance companies are opposed to the government cutting in on their racket, and they spend a pile of money on Congress instead of on health care.

[patrice]

38. Without Single Payer, the shell game is going to be about how EXACTLY the cost cutting will be

done, so that you can get something that is affordable for everyone.

What ARE they going to cut and how? Imagine the thousands of detailed decisions about an individual that result in somekind of medical outcome. What goes? What stays? There's a reason Nurses are organizing; they're the ones on the front lines. They will be responsible for making it "work".

There are also those who want expansion in services to include more preventative and complementary treatments. How's THAT going to happen and cut costs at the same time?

Single Payer at least says "Let's cut the stuff that ISN'T part of the medical care."

[patrice]

40. Everything in a Single Payer system stays Private except the mechanism by which claims and

payments are made. That mechansims becomes standardized across the board and the government does all of the processing. It acts only as the conduit between providers and recipients.

This reduces many, many, many different forms and procedures and rules and other variations that doctors and hospitals and insurance companies have to pay all kinds of staff to manipulate in order to make the current systems provide care and payments. Physicians for a National Health Program http://www.pnhp.org/ estimates the savings to providers alone at something near $200 Billion a year. What other services might that $200 Billion a year finance?

[dysfunctional press]

47. it takes the profit out of the healthcare industry.

and that represents A LOT of campaign cash.

[patrice]

50. No it doesn't. All private providers and care givers REMAIN private.

ONLY the payment processing is affected. Payments in and out are processed by the same government mechanism that processes Medicare/Medicade payments. This eliminates the necessity of providers and care givers having to hire numerous persons who process all of the multidinous variations in claims and payments. This savings in the overhead incurred by providers and care givers could be passed on in lower costs to us and also EXPANSION of services covered(!).

[dysfunctional press]

52. check again, and then try again...

single-payer means that the for-profit health insurance companies will no longer exist.

so, yes, it does take the profit out of the system.

and the insurance companies are BIG campaign donors come election time.

sorry. :shrug:

[patrice]

53. Link please.

[dysfunctional press]

54. link to what?

:shrug:

the definition of single-payer?
doesn't your computer have google...?