I thought Sanders' Single Payer bill was related to HR676.

[redqueen]

I wonder why it's related to HR1201 instead... which only has 7 cosponsors.

It has no consponsors anyway, so it's academic, but still... I'm curious.

Anyway... please call Speaker Pelosi and ask her to get the CBO to score HR 676. Even if you think single payer is a dead-end, the public deserves to know the truth.

800-828-0498.

[Oregone]

1. Sanders has his own

And there is another one floating around too

[redqueen]

2. Sanders' bill is S691, yes... which is related to HR1200...

I was just wondering why it's not related to HR676 instead.

There's another single-payer bill in the Senate? What's that one?

[Oregone]

3. No, not in the Senate. Dingell has a bill

He's introduced one every year since he has served, in memory of his father

[redqueen]

4. Oh yes...

it's good there are more than a few advocates in the House... nothing groundbreaking there.

I was excited when Sanders introduced his bill... but it looks like no other Senators would back him up. Can't say I'm too surprised, really.

[slipslidingaway]

6. At least Wellstone had 4 cosponsors for his bill and it got a score...

we're making great progress.

:(

[redqueen]

10. Geez... now that's depressing.

*sigh*

Still not ready to give up though. :)

[slipslidingaway]

23. :)) n/t

[KharmaTrain]

5. I'm All For Scoring...

While I don't favor Single Payer, I'd like to see the numbers. Let's get all proposals scored...the more the better.

Bottom line is someone will have to pay not only for the system but the changes any healthcare brings. If its a single payer or public option that creates a government run entity, how much will that cost to get up and going and what will it expenses be? Also, if millions are dumped or dump their insurance plans, how much will it cost us to bring all those people onto the public plan. There's going to be a cost and that needs to be addressed...either through raising taxes (which scares Democrats more than any other issue) or some other means. Get it all out there...and with honest, verifiable numbers.

[Oregone]

7. "how much will that cost to get up and going and what will it expenses be"

Probably little to nothing. Medicare already exists, and has an incredibly low overhead dealing with the most expensive patients in America. Of course these plans will incur a cost of covering those additional people, and yes, either a buy in premium or taxes will cover this. Most people understand this.

Someone posted today that single payer was already scored decade ago by the CBO. It resulted in great costs-savings:

http://www.cbo.gov/ftpdocs/64xx/doc6442/93doc171.pdf

Why don't you "favor" it?

[KharmaTrain]

8. Increasing Those Rolls By Millions Will Cost

Even with a low overhead, we're talking about a major shift and burden on a system that has plenty of problems, not as bad as private insurers, but still riddled with beauracracy. It will cost money to hire people to run the claims, Medicare as it currently stands won't be able to handle all the new people and continue to cover those already covered...again, an expense that has to be considered.

I'm not surprised that Single Payer will cost less than what exists now...anything would. For 5 years I ran the books for my father's medical practice...and our two biggest headaches were dealing with the insurance companies and then with Medicare. I detested how insurers could play god by determining what treatments they would pay for or not. Going to single payer gives that power to a government beaurucrat...trading one master for another. I favor as much competition in the market place as possible...similar to what we see with the Postal service. Some people are content on using regular mail and it gets the job done, others want better service and can afford to pay for it, while their tax dollars go to subsidize the postal service. The competition between the two has kept prices low and forced one or the other to be more efficient.

[Oregone]

11. "Going to single payer gives that power to a government beaurucrat...trading one master for another"

No, this is incorrect. In a single-payer system, all procedures are pre-approved at set rates. Therefore, the only people with "power" are the doctors who maintain their own individual patient lists and wait queues. The government ONLY has the power to set rates and fulfill the billing requests. They have no power, whatsoever, in specific medical decisions.

This is the reality, and my experience as a Medicare recipient. Competition between insurance brings nothing of value to the table in terms of costs-savings, innovation or efficiency. The free-market theory doesn't universally apply to every sector of industry the same.

Its just insurance. Its not rocket science. People who make up a risk pool pay in, and they are reimbursed upon need. There is nothing that competition can do to make such a model more efficient, that cannot be done otherwise. It isn't as if this is about making cars, or creating clothes. Insurance is as simple as it is ancient.

[KharmaTrain]

13. "Pre Approved At Set Rates"

That's what insurance companies do as well. So who sets that rate? A beaurucrat in an office who only sees a case number, not a face. Many people on Medicare have umbrella insurance policies for that very reason...to avoid their government benefits running out or to cover procedures and care the doctor feels necessary but a Medicare actuary doesn't.

Doctors have their own overhead and headaches to deal with. Malpractice insurance, rent, drug and medical expenses are prices doctors can't control and are a major reason overall care is high. I strongly favor tort reform as a partial solution, but that still doesn't deal with the rising costs of new drugs that are passed along to doctors and patients. There's nothing in any legislation to deal with this.

By setting rates, that does tell a doctor what he can and can't do in treating a patient. In his final years of practice my father was lucky to break even...paying upwards of 50% of what we earned for malpractice alone. We also had a lot of overdues...insurance companies AND Medicare refusing to cover that we ate rather than turned over to collections.

Competition works...we haven't had any in the medical field in decades.

[Oregone]

14. "to avoid their government benefits running out or to cover procedures and care the doctor feels"

In single-payer, benefits would NEVER run out. ALL necessary medical procedures would be covered, period. Absolute piece-of-mind.

Didn't they just score a tort reform amendment as lowering costs .5%? Its a red herring.

I honestly think you are just seeing this, looking at through the window of a doctor's office. Don't worry...the doctor's in Canada had a strike when it was first implemented. Since, they've learned, and they would strike if it was taken away. They drive nice cars, live in big homes, and enjoy the nicest neighborhoods there. You don't have to worry too much about having your livelihood snuffed out by single-payer.

The bottom line is that you could not possibly cite a positive innovation (or any) in the insurance industry brought on by competition any time recently. Insurance doesn't need innovation. It needs to pay out on claims and collect money. End of story.

[KharmaTrain]

16. It's Not My Livelihood...

My father passed several years ago and I never had any interest in the medical field after seeing all he went through.

Can you ensure benefit would never run out? I haven't seen anything written into a proposal that would say that. And that's not the case right now. We had plenty of instances where we played games with Medicare to keep benefits rolling and, sadly, had some cases where patients were sent home until their benefits kicked in again. If Medicare were the do-all, end-all so many believe, why are umbrella policies through private insurers so popular? There's a case where competition and the private sector do have a role to play and do so cost effectively.

I'm fortunate...I have a very good policy that I really don't want to give up. I have no problems paying into a system for others or even paying higher income taxes or a tax on my policy. My hopes are a public option and competition will lower overall costs, including my insurance and provide care for millions who have been frozen out of the system.

In the end, we may need to end up with a single payer system and so be it. But it needs to be worked in over time. I see this reform as the first step in that direction...getting a handle on runaway costs and getting those in the most need some kind of health care. Again, the costs of malpractice, prescription drugs and other expenses under control. None of these bills go near those areas...but they will have to be addressed...and with it we'll see how things go. Right now, all I care about is getting some genuine reform passed, the status quo can't stand any longer.

[Oregone]

17. "I haven't seen anything written into a proposal that would say that"

Have you seen lifetime caps written into Conyers, Sanders, or Dingell's Bill? How about existing single-payer systems like Canada's? Until you do, the burden of proof for a figment of your imagination lies on your side.

In my own single-payer system, not only do I not have a cap, I do not even have a general accounting accessible to me which shows how much has been spent on me thus far. Why? Its irrelevant. I will always, under any and all conditions, despite past history, be given necessary medical treatment in the order that my doctor determines is most appropriate.

"If Medicare were the do-all, end-all so many believe, why are umbrella policies through private insurers so popular"

In Canada, those exist as supplements for non-necessary procedures & benefits (vision/dental/etc). Of course I will talk about Medicare in that context, being that in America it does not exist in a single-payer system .


"But it needs to be worked in over time"

It really doesn't. It has been implemented cold-turkey in a historical context in other countries. Further, as long as you delay in an imperfect system, people's health and social mobility suffers. To some who "have a very good policy", that seems to be an acceptable price to pay for their own personal comfort.

[slipslidingaway]

18. If you listen to Kucinich speak about SP there is a malpractice pool...

for doctors up to a certain amount, also it would an improved version of Medicare, not what we have today.

How does Canada do it for almost half of what we currently spend.

:shrug:

I agree about putting all facts and numbers on the table.

[KharmaTrain]

19. A Certain Amount...

And where does that amount come from? And how much would that be? How long would it take to implement? What would people who are uninsured do in the meantime? And how much is a certain amount? Who decides? And what if (or should I say when) the pool runs dry, then what?

Knocking down insurance costs...not just to individuals but to doctors through tort reform is how you cut out the profit motive and start to see costs come down. Negotiating prices on prescription drugs and either subsidizing or buying out expensive patents to patent drugs is another area of savings...things that aren't currently being addressed but will have to be in the future.

Again, I'm not in favor of trading one gatekeeper for another...at least at this point and the political will isn't there. I fear an overload of a government system that by its own accounts is ineffecient...a massive influx of millions into the system is more than it can currently handle. Growth has to be built in...costs have to be defined and done in a realistic manner. If this leads to a single payer system that works efficiently then so be it. But the priority right now is to get millions who have no coverage the basics and to build from there.

[Oregone]

20. "through tort reform is how you cut out the profit motive and start to see costs come down."

There is FAR more to be save (perhaps 20 X as much) on the delivery end by consolidating payers. It is estimated that as much as 10% of what is paid to doctors is used to hire extra on-site billers or outsource to specialist (which is not needed in a single-payer system).

This is a red herring.


"a government system that by its own accounts is inefficient"

By what accounts? Medicare is very efficient (2 to 4% overhead depending on methodology).


You need to check and make sure you aren't just carrying water for free. A lot of those talking points seem to be deep rooted in right-wing ideology.

[KharmaTrain]

24. Right Wing Ideology?

Hardly...from real life experience. I've seen it in action...or should I say inaction. Yes, consolidating payers would save money and time but that's not how Medicare does it nor is there any mention of it in any of the health care proposals. I assume you've never seen the paperwork that has to be filed by a doctor when it comes to getting paid. It's an ongoing process and if you mess anything up, either you have to start from scratch or forget about getting a payment. They want details of each visit, each treatment, what was prescribed...it's not just flashing out a bill and getting a check. And there's a very valid reason for this as any big system is open to fraud either by doctors or hospitals or administrators. In many cases we waited 60 or 90 days after a patient was seen or released from the hospital before we could file since, believe it or not, we got payment quicker that way rather than doing it immediately after the visit. As I say, Medicare for all the good things it does for so many people is still an imperfect system and flooding those roles with an additional 30 or 60 million people would compound those problems and delays. Sorry, no right wing claptrap here...just what is likely to happen if you were to completely gut the existing system and expect the government to pick up the slack.

I would have loved to been able to hire someone to do all that paperwork, and yes, many doctors either hire someone specifically to handle those matters or go to a company that does it...either case, the cost is passed along. We never did that, nor sent any overdue bill to collections. I truly want real healtcare reform, but to think the government is the total answer as many who propose single payer overnight are asking for a systemic failure. As I've said in other threads, I see a day where a government centered system will predominate, but that is many years down the road. Right now the priority is to get a handle on escalating costs and get those in need insured...no matter how its done.

[Oregone]

25. "consolidating payers would save money and time but that's not how Medicare does it"

Oh, but it does in a SINGLE payer system, by tautology. The US Medicare system does not operate in a single payer context.


"I would have loved to been able to hire someone to do all that paperwork, and yes, many doctors either hire someone specifically to handle those matters or go to a company that does it."

Not where I live. In British Columbia, there are not 400+ for profit payers with different billing rates and procedures. There is but a single payer. They swipe your card the first time you go, and from there, any secretary can easily handle the billing to ensure the doctor is promptly compensated for their services. This cuts down on the overhead of the doctors office, which is savings that is passed down to the consumers (the people/government)

It amounts to instant savings, far more effective than the red herring that is tort reform.

Where I live, everyone is covered, private doctors thrive, every necessary procedure is pre-approved, the overhead is 1 to 2%, and the per capita expenditure is 60% of what it is in the US. No one ever goes bankrupt from a medical procedure, or is denied necessary treatment. No one is cut-off when they are sick. Sounds terrible, eh?

[KharmaTrain]

26. Glad You're Satisfied

Running a healthcare system serving 24 million is not the same as one that will have to cover upwards of 200 million.

I've read all about single payer and I'm certain it works wonderfully, but I'm also aware that it took many years for that to happen, just as I suggest it will in this country. This is the first step in healthcare reform, just as Medicare has had to be adjusted and revised and will need to be again.

Tort reform is no red herring if you've ever been involved in a malpractice suit. Many go after everyone and anyone in the hospital or who ever saw a patient. We had several cases where my father was initially named as a defendant but was dismissed each time due to the suit being more focused or dropped altogether. Still, it was expensive in hiring a lawyer and then having to make court appearances...and all for nothing. Now should a doctor shoulder the burden of a suit he/she wasn't a part of? Many will prefer to settle than to face the protracted expenses...as either way, if you're named in a suit, your malpractice insurance goes up. Again, someone has to pay those expenses. Reformation of how suits are filed and arbitrated would save billions...yet nowhere near the current legislation.

The last thought...there are those who are going to want additional insurance or at least the option to purchase it. This does not distract from those who can't afford and will be able to get coverage. Those who decide to opt out means more money and resources available for those who need it and can't afford it. The important thing is if I or anyone else wants to self insure, it's our choice, our option...and as I heard Dr. Howard Dean say this evening, I'd like the otpion to be the individual, not the insurance company nor the government.

Thanks for an enlightening discussion

Cheers...

[Oregone]

27. "Running a healthcare system serving 24 million is not the same as one that will have to cover upwar

Wrong. Its exactly the same. Your argument stops there.

The healthcare system in Canada is ran provincially, NOT federally. The provinces are subsidized with federal dollars, which gives them some range of autonomy as long as the insurance programs fill the federal requirements.

In otherwords, the British Columbia system contains just about the same amount of people in the risk pool that an Oregonian branch would if the US adopted single-payer. Get it? Its scalable because the insurance entities are regional, and the US can easily do the same.

Hence, the total number of people is quite irrelevant.


"Tort reform is no red herring"

Funny, being that the CBO recently didn't score it as very meaningful in terms of costs savings.


"there are those who are going to want additional insurance or at least the option to purchase it"

Yes, those people exist in BC too. So what? They have the option to do so. Additional insurance doesn't cover the same thing as the MSP. That is redundant. It covers goodies, luxuries, dental and vision. Everyone is welcome to do that. Its VERY cheap ($200 a month for a family of 4 for everything).

Opting out of the single-payer would be ludicrous though, since people already pay for it (in taxes). Further, supplemental insurance doesn't cover the same procedures. Opt-out of it, sure, but then you would be paying out of pocket for everything. Sounds absurd.


"The important thing is if I or anyone else wants to self insure, it's our choice"

Thats not important at all. It adds zero value to the insurance system.

[slipslidingaway]

22. We should be having a full and open discussion of various ways ...

to cover the most people at the least cost, but we are not, that has already been decided for us.

As you point out there are many questions that are not answered and one reason is because we have not had a real debate.

:(

There is always going to be a gatekeeper, whether it be an insurance company or some group of people in a public position. A Medicare for All system does not and would not be done overnight as some people have mentioned, just like the current HC reform system being discussed it would take a few years to implement. Do I think about money going into some government fund that could be diverted for other use and on loan to the general budget as we have seen with SS...yes.

There are not enough primary care doctors and from what I've read most medical students will not be going into primary care, so the plans that offer the greatest access will be purchased by those who have the most money IMO.


There are some good videos in this series which discuss a variety of issues...we need a real debate.

Health, Money and Fear: Chapter 6 (The Pressure for Profits)

http://www.youtube.com/watch?v=1MNlsdJ1U14

[redqueen]

9. "Get it all out there...and with honest, verifiable numbers."

Exactly. Even if one doesn't support single payer, having that information out there is only fair.

After HCR passes, we'll need such information in order to pressure for improvement, IMO.

[green917]

12. time to get it up and going

If we do it right, it will take very little time and effort to get a universal program up and running because it's already up and running. It's called Medicare and all we have to do is change the requirements to enroll. The total roll out would probably be less than 6 months. As far as cost, the insurance companies just told us, unequivocally, in the AHIP report released yesterday that, no matter what, they're going to raise our premiums by a ridiculous amount. A true public option like Medicare for all would control cost, provide efficient service and cover ALL Americans. It's a no-brainer, unless you're an Insurance executive or a Senator in the employ thereof.

[KharmaTrain]

15. You Said It...Public Option...

Again, to increase the Medicare rolls to cover 40 or so million that currently aren't covered as well as millions of others who will want to switch is gonna cost...and to dismiss those expenses is just as wrong as scaring people with the hoopla the insuarnce companies are throwing around. Yes, we could expand Medicare, but I doubt it would cover all in 6 months...most of the proposals they're talking about on the various bills are set over years. Also be assured that a single payer would mean employers will dump their insurance plans...let someone else pay for it...and that could put many in the middle...no coverage until they can get a goverment plan.

[Cleita]

21. I think they did and it was buried in some committee somewhere.

I suspect if you go to thomas.gov, you might find it somewhere.