A health care thought experiment: Suppose we went directly to single payer.

[pnwmom]

Everyone has Medicare. Practically overnight, a whole industry is rendered obsolete. Millions of health insurance industry people lose their jobs in the midst of a deepening recession. A small fraction of them are able to find jobs within the expanded Medicare system. The rest, out of luck.

OR:

Suppose we adopted Ted Kennedy's plan, or one like it -- with universal coverage and a government run, Medicare type option. At first many people stay with their own employer based health insurance. But, over the years, more and more individuals and/or companies switch to the government run option, after realizing that it is a better value. Over time, finding themselves unable to profitably compete with the government plan, private insurers drop out of the health insurance industry and find more profitable pursuits. Eventually, everyone has Medicare.

Which approach is better?

[DemocratSinceBirth]

I Don't Think The Health Insurance Industry Employs That Many People

But creating a national health system overnight is not realistic.

[pnwmom]

3. So noted. n/t

[Oregone]

8. "creating a national health system overnight is not realistic"

Why? Its just insurance. Its not rocket-science. Hell, use a couple floors of AIG to manage the administration.

We already have everyone's info and details. You could use the Social Security database to auto-enroll all recipients overnight to start.

It JUST insurance without profit. Don't let them fool you to think its incredibly complex. You can even take a federalist approach (like Canada) to let each state administer the programs to have flexible billable rates per different regions.

[WillowTree]

29. You think not? Consider this.

Blue Cross Blue Shield of Illinois employs 15,000 people. That's just one company doing business in one state, and they're one of the not-for-profit Blues. Extrapolate for yourself.

But there's another aspect of it that I always think of when I see these threads chanting the "Shut 'em down!" mantra, be it health insurers or AIG or WalMart or whatever that most here seem not to consider at all. And that's the impact on other businesses and industries and the communities where they operate.

Years ago the company that I worked for closed our office. A few days after the closing was announced, I happened to run into the fella who serviced the vending machines in our lunchroom and he was practically in tears saying that our office was one of his best customers and he was going to take an enormous hit when we closed. It got me to thinking about all the "collateral damage" when an office closes or a company goes out of business. Things like the small businesses which clean offices and the companies that do payroll or sell office supplies. And the community at large takes it on the chin, too. Restaurants, fast food shops, grocery stores, service stations lose customer base and the list goes on.

I wish more people would think about the larger picture when they're tempted to go off half-cocked about shutting businesses down. It's not as black-and-white as they seem to think.

[thunder rising]

1. As the article in the New Yorker pointed out...Single payer will not stop Medical kickback and bribe

practices. No doctor should be able to route patients to labs etc that they have ownership in. Doctors must be investigated for kickback practices.

[NYC_SKP]

2. I go with number Two..

First, I think it has a greater chance of passing.

Second, I think, as you indicate, the Ted Kennedy plan could become universal one payer over time, and that the outcome would be better than trying to do it all at once (option one).

I need to add, Medicare is not presently run well.

I have two elderly parents who rely on Medicare plus their TriCare to pick up the rest.

Practically every vendor and service are run like crap, not communication, wasted efforts, unnecessary expenses, it's probably costing four times what it should for how poorly it's managed.

It need some serious top to bottom streamlining and modernization before we apply it to all Americans.

Most of what I hear from the administration makes very good sense, the need to modernize confidential records and a greater emphasis on prevention.

[Selatius]

4. The second approach will fail if poison pill amendments are inserted into said bill.

They could easily insert nonsense amendments that jacks up the price of the Medicare-type option for people. They've already attempted to sabotage Medicare by driving up the costs by creating Medicare Advantage and by banning Medicare from negotiating with pharmaceutical companies with Bush's Medicare Part D "reform."

That said, though, the second option provides the best hope towards transitioning. John Edwards' health insurance proposal included such provisions that would "open the door" to a transition. Of course, John Edwards' campaign flamed out, but Hillary's proposal, which came out after Edwards', was essentially the same as well. It was only Obama's of the three that widely differed from Edwards' and Hillary's proposal.

[pnwmom]

5. You're right. If Kennedy's government plan isn't handled correctly, it will fail.

(And Kennedy's plan appears likely to closely resemble Edward's and Clinton's.)

On the other hand, if the single payers had their dream come true, and the whole population was dropped into the creaky, poorly managed Medicare system we have now -- that could well fail, too. And there would be a hue and cry against national health care and we might end up back where we started.

[Selatius]

6. Medicare isn't ready for such a scenario. It would have to be rehabilitated first.

Namely, rendering to the garbage Medicare Advantage and Bush's "reforms" that hamstrings Medicare from negotiating better prescription drug prices. Those two eliminated would likely save Medicare tens of billions each year, and the revenue stream that goes into Medicare would have to be widened to accommodate everyone else.

I often wonder if we could talk to the English on how to transition to such a system if we had to do it quickly. They got the NHS off the ground despite the fact that their country was essentially reduced to rubble following the last world war with high unemployment and a treasury that was near bankruptcy following war spending. Same with the French for that matter following the last world war, and the French were ranked first in the world by the World Health Organization as far as health care goes.

[Greyhound]

28. The devastation of those nations was an advantage. Everything had to be built from the ground up

and their health care infrastructure was no exception.

Is medicare perfect? Far from it, but as wasteful and inefficient as it is, it enjoys a higher satisfaction rating among it's recipients and does so at 1/10th the overhead of private health care denial plans.

[Oregone]

9. Exactly. Huge problem.

[ThirdWorldJohn]

7. I look on insurance companies as lying murderers that put a big

share of billing on the shoulders of the people that they insure. And the doctors do what they can by dragging their feet and frustrating the people that are paying them. For what reason - I do not know. So Kennedy wants to believe that the insurance companies are going to do the right thing and stop their murders by denying coverage and the patient who is ill will all of a sudden be treated better? WHy would he think that? ANd Kennedy's public option will - I am sure - have extreme limitations. And the free care for those who can not afford health care will be the most slum lord coverage that the insurance companies can get away with.

And that dream that Kennedy says that he has had for years --- The one were the unemployed could have the same healthe care as him --- Yea that dream --- I believe that is what he wants for the poor and the down trodden. Can you taste the sarcasm. I mean he bnever did a thing to stop the murdering ways of the insurance companies that I remember. Kennedy himself has said that health care in the USA is the best that money can buy. So he is admitting that the poor are already getting slammed for being poor and the rich like him are the real l;ove of the insurance companies. Do you really think that the lobbyists that are paid by the insurance companies care about the sick and injured?

I watched a Senate Hearing where a RN testified that her job was to deny coverage to people who had paid insurance so that the insurance companies could make a buck off the patient's death and she grew to hate her job so much that she quit because she began to hate her job and began to feel like she was allowing people to die that should be able to get the treatments that they had paid for.

And then I read that a poor country - Jamaica - has better health care than the GREAT AND ALL MIGHTY USA. It is available to all the citizens and it is affordable. But Kennedy does not see that in his dream for the sick and infirm in the USA does he?

And then I read where the GREAT ALL MIGHTY INSURANCE COMPANIES denied health4 Care to 20,000 people last year in the GREAT AND ALL MIGHTY USA. THese are the companies that are more about the $$$$$$$ Than they are about caring for the people that pay them for God knows what reason. Because they are making money hand over fist by being the murdering scum they are. How much do these lying companies pay the GOD ALL MIGHTY LOBBYISTS on K street and what do they get for their money.

ANd how much does Kennedy's free health care cost the taxpayer. I can not find out. ANd I called his office to inquir4e about the cost. It must be a LARGE amount of the $$$$ for them to decide that I have no business knowing.

But the head of Aetna makes 24 million bucks for his job.

And hospital billing is the most inept and corrupt billing in the USA also. But I called Kennedy's office and they told me that his bill is still being worked out. But it will include the murdering insurance companies but they could not defend that decision. Why should I?????

[customerserviceguy]

10. Here's the possible problem I see with it

You posit that people will see a government option as "a better value". That will only happen one of two possible ways. The first is that the government option somehow has the ability to control costs that the private ones do not, the second is if the government option gives a greater coverage of conditions than do the private options for the same money. These seem to be mutually exclusive goals to me.

I can think of one possible way to acheive lower costs: get rid of the tort system for those electing the public option. You got a beef with a doctor or hospital? Submit it to a workers' comp style of board. Publish the results, so that incompetence is not merely buried in an out-of-court settlement.

If a particular doctor took predominantly government option patients, that doctor might well be able to pay far less in medical malpractice insurance. Hell, we could go one better and have a government option for medical malpractice insurance, and if a doctor took 100% of his or her patients from government option insurance, we might see fit to not charge them more than a registration fee for their government-provided malpractice insurance.

I know folks here are fond of trial lawyers, but the current tort system requires doctors and hospitals to run unnecessary procedures and tests, and when something does go wrong, it takes many years for some sort of justice to be done. It clogs up our courts, and like I said, often keeps the results totally secret, allowing a bad health care provider to just keep going along in the shadows.

[pnwmom]

16. The private insurers have to build in a profit margin that a government plan

doesn't . That is what would make a well-run government plan a better value, in addition to its size adding to its ability to negotiate for better rates.

The private insurers understand that the government run plan would have an advantage, which is why they're fighting so hard to stop it -- or to eliminate its advantages.

[customerserviceguy]

17. The government plan

would have an advantage in being tax-free, but I can't say that they'd be any better at controling costs than the private insurers have been doing. Government salaries for office work tend to be somewhat higher than people in the financial services industries make. I'm talking non-commissioned, of course.

The thing I'd see most likely is that there would be pressure on the government plan to cover more things, more completely, with less of a pre-existing condition period, etc. The government plan would either have to raise rates to fund the better coverage, or would need a larger and larger subsidy from the Treasury. It would be the same political hot potato that Social Security and Medicare have become.

Also, a government option company would attract the people who just got dropped by private insurers, and that's how the private companies would make money. They'd just raise premiums or simply cancel policies (maybe even for entire groups that are considered "high-risk") and would just shove those people on to a plan that has it's own backup funding source. They'd be free to solicit business from low risk groups and individuals with teaser rates not unlike what mortgage lenders and credit card companies do right now.

[pnwmom]

18. The private insurers would be prohibited from raising rates or otherwise

discriminating against higher risk patients.

Assume that a private insurer and the government plan were both well run and were required to take all comers. A private insurer would need to show a PROFIT to their investors -- which a government plan would not have to do. That's how a government plan could save money.

[customerserviceguy]

20. You really think that anybody in Congress

would go for price controls on health insurance policies? As for discriminating against higher risk patients, all they have to do is throw in a bit of a hassle, and people will naturally want to go to something else. Since all the other private ones would either turn down high risk groups and individuals, or quote them high rates, they'd naturally gravitate to the government option plan soon enough, since it really would be absolutely required to take all comers.

Delivery of mail is one area where this has happened. FedEx and UPS are making a nice profit on the overnight market, and the parcel market as well. They've left the expensive rural routes and the non-lucrative magazine, newspaper, and junk mailing to the USPS, which needs a subsidy on a constant basis. And the USPS had a head start in the business when it was a monopoly.

Even if I assume the best-of-all-worlds situation that you do, where there are ethical private health insurers, and a government option that runs efficiently, there are always ways that the private insurers could make sure they grab a profit for their investors. When interest rates rise again, there will be quite a bit of money to be made on the float between when the premiums are paid, and when the bills are paid out. Also, private companies will always hire a lower number of workers to process things than government, and they will pay them lower wages.

If you'll look at my username, you'll see where I get this. I've worked in financial services and medical supply all my life until just recently. I now work at a utility company that is privately owned, but is a monopoly, it may as well be a government agency. The bureaucracy and inefficiency where I'm at is appalling. But at least I have a regular job, even if it's only part time.

You still haven't convinced me that a government option plan wouldn't just be a dumping ground for people that the private health insurers would always find a way to get rid of. Single payer would eliminate that danger entirely.

[LWolf]

11. Go to single payer.

Why assume that there would not be a transition period, which would absorb the impact you suggest? It's there in HR 676.

Just think of all the jobs that would be created when EVERYONE is getting the health care that they need.

[undeterred]

12. You don't keep an industry going for the sake of the jobs.

That's back asswards.

There is tons of insurance to be sold other than health insurance, so most health insurance companies are not going to go out of business. Fixing health care is going to create more employment if it take the cost burden off other employers. The people in the insurance industry losing their jobs are going to get new jobs.

Keeping the for profit greed motive going for the sake of the jobs is like refusing to cut out a tumor because the tumor might die. The insurance companies don't PROVIDE anything, their goal is to take our money and never have to spend a dime of it on us.

[subterranean]

14. And they could still sell supplemental health insurance.

Single-payer wouldn't cover absolutely everything. In most countries with single payer (including Canada), people can supplement it with private insurance for extra benefits that the public plan doesn't cover. I'm sure it would be the same if we had SP here. The insurance companies would need to keep some employees around for that.

[Selatius]

19. In France, they use single-payer health insurance. It covers roughly 80% of your costs.

You cover the remaining 20% how you see fit, but a lot of people in France purchase supplemental insurance to cover the remaining 20% for major surgery and expensive procedures, so if a surgery costs 100,000 Euros, you only have to worry about the 20,000 Euros and not the entire amount, but if you had supplemental insurance, that entity would cover most if not all of the remaining 20,000, provided you pay the monthly premiums and deductibles for your part, of course.

Incidentally, in its last ranking of health care systems, France came in first place according to the World Health Organization. From what I could tell, France's system covers dental, mental health, prescription drugs, as well as major surgery (except elective surgery like rhinoplasty or some sort).

[ejpoeta]

15. that's one of the excuses for continuing the thruway tolls here in wny.

all those jobs! never underestimate the use of anything that can get them to keep their gravy train.

[DatManFromNawlins]

23. What's ass backwards is your post

Insurance reps don't suddenly wake up and start making good money. They earn their keep through commissions from sales of their products. They sell product by maintaining relationships with businesses of a specific nature.

Eliminate their product, you eliminate their commissions.

Eliminate their commissions, and you eliminate their income.

Eliminate their income, and you've just hurt the economy that much more. Sure, they can sell other insurance, but guess where their income starts out? At NOTHING. Ever try paying a mortgage with nothing? How'd that work for you?

I don't see you telling the UAW workers to go fly a kite because they can get other jobs, so why should health insurance reps be any different? Is it simply because you think you can get something out of the deal? Or perhaps because they aren't unionized?

That's just as fucking greedy, regardless of what altruistic bullshit label you try to slap on it.

[ejpoeta]

13. well, i was taken by the guy on bill moyers when talking about the public option.

If you have a public option and keep the private insurance, you have a few problems. Firstly, healthy folks will be in the private insurance, and the sick will be in the public option. The second thing is that the bureaucratic billing system will have to stay in effect because of the numerous different types of insurance. The only way it would work is if everyone were paying into the single system, that being healthy AND sick all paying into the same system. Also,if there is only one entity paying everyone, they could establisha system that everyone can know and understand. The private insurers could still exist as supplemental insurance for things the basic insurance doesn't cover. This does not work unless there is a single payer system.

[Truth2Tell]

21. You could make the same argument

regarding the elimination of the napalm industry or the land mine industry. Or the asbestos industry. And why preserve any forrest land from logging? What about the loggers? And how about the guys working on new space based weapons systems or germ warfare programs? They have families to feed too ya know.

[Juche]

22. The first. Single payer saves $300-400 billion a year. Retraining insurers for new jobs costs $20

http://www.citizen.org/pressroom/release.cfm?ID=1623


The study estimates that national health insurance (NHI) could save at least $286 billion annually on paperwork, enough to cover all of the uninsured and to provide full prescription drug coverage for everyone in the United States.


3. retraining and job placement programs for insurance workers and others who would lose their jobs under NHI (estimated at $20 billion)



----------

Single payer will save about $300 billion a year in less administration, but it will also save another $100 billion or so via using the bulk purchasing power of a nation of 300 million people to negotiate lower prices for medicines and medical supplies.


As others have said, medicare isn't perfect. But it is a step up.

[eridani]

24. You left out a third option

The public option is set up to fail by restricting it to the poor and the sick. It is an underfunded dumping grounds which the healthy get tired of paying for, so it gets its funding cut to the point that it can't function, therefore proving that "government health care" can't possibly work.

[eridani]

25. What will happen to insurance company employees

If the financing of health care is a public good, then public oversight can insure that the claims processing jobs that remain will never be sent out of the country. This is true whether we hire existing insurance companies to do this work or build a separate institutional structure from scratch.

Once the burden of being robbed by expensive middlemen is removed from all other private and public employers, they will be able to afford to hire many more employees. The CA Nurses Study estimates that single payer could provide 2.6 million new jobs this way.

There is a growing shortage of nurses, and we should be funding more training in this field.

Private insurance will not disappear. All countries with universal health care have regulated private insurers who provide plans to fund extras not provided by the basic system.

The above will take care of the majority of employees of insurance companies. The sociopathic CEOs can go pound sand and actually try working for a living.

[AllentownJake]

26. On the Health Insurance Industry

We are about to dismantle and slowly kill an industry that actually makes a tangible, useful product and force a skilled labor force to become Wal-Mart cashiers. It will have downstream effects on many other industries that service that industry.

The reason we are doing this is because saving the industry is not politically popular for some reason.

I fail to see this as a legit argument after that action.

[CTyankee]

30. Health Insurance Industry workers have skills that are fungible in the general work force.

They can go to other forms of insurance. They can be employed by the private insurers that will come into existence, a la the French system. More jobs will be created when companies are not saddled by expensive health care benefits. There will be some dislocation to be sure but the up side of gradually going to Single Payer is so great that we shouldn't be afraid of trying...

[Greyhound]

27. False premise. If they passed 676 tomorrow morning it would still take years to implement.

Half measures will also take years to implement, The difference is that they will ensure that nothing will change. You will be dead and your children collecting Social Security (assuming that it still exists) and the insurance companies will still be dictating who gets what care, when.