For instance, what about the 60 million people without access to basic medical care? My guess is that they wouldn’t mind having the situation “messed with.” How many more millions have access, but are unhappy with the health care they’re provided on the market? Are you happy with the health care you receive, or would you like Congress to work to improve it?
Conservatives for Patients’ Rights seems to think we’re all extremely happy with our health care situation right now. They’ve put out this ad asking people to tell Congress not to “mess with your health care.” The trouble, of course, is that a very large number of people would probably like Congress to “mess with” their health care.
Why does it have to be an “or” question?
I’m happy with the care I receive, AND I would like to see coverage improved for others who are less fortunate. While it is true nobody is denied care in this country (go to an ER and you will be seen and treated), our healthcare system will work best when people can choose varying levels of care based on their needs. The ER shouldn’t be the safety net.
So while we don’t have 60 million people without access to medical care, we do have 60 million people who have to use our healthcare system very inefficiently because of their lack of coverage. For them, I would like to see better coverage options.
I agree, DtM. One point I’d expand on is with regards to the ER. True, you can get treatment there, and I agree it shouldn’t be the safety net. But the other major reason why it’s not a good option is it doesn’t provide for preventive care. The uninsured need preventive care as much as anybody else.
Can you get ER service for cancer treatments, diabetes treatments, hip replacement if you need one? If you think everyone in this country can get care just because they can go to an ER you are playing semantic games with people’s lives.
My health care sucks.
Your health care…as in the people who give you care, the quality of the equipment, procedures, etc sucks….
Or does your health care POLICY or COVERAGE suck? Please use the correct words.
My health care is great. My policy is what I need and what I can afford. I am happy with the fact that the US still maintains the highest levels of care in the world.
DtheM,
Right. It should come down to a situation where the MAJORITY is on a good system such as single payer health care. Right now those that are on state care aren’t treated very nicely at the doc’s office, etc. If ALMOST all of us or at least the MAJORITY were on state care, we’d see something different.
What is your fear, anyway? If you check other countries, you might find they live longer than we do, are happy with their system, like to talk to their docs, and take better care of themselves overall.
There’s so much proof that single payer universal health care is better that it’s funny you’d worry… so what is your worry.
Right now you’re asking for a small portion of people to keep carrying those that have insurance problems.
I think DtM’s worry (correct me if I’m wrong) is that this is just another huge bureaucracy that will be run by the government, and probably not very well. The government can’t run anything effectively and now they want to act as if they’re the answer to everything. As much as capitalism has seemed to rub many on this site the wrong way, with regulation back in place, it will be the best way forward.
C”Rush”,
“The government can’t run anything”
Bush certainly showed everyone how ineffective Government can be. He led by example.
Yours is a very strange, different ideology, full of self fufilling policy, false arguments, half-truths, and grandiose visions that predict the future with no accuracy whatsoever.
It’s most comical. I think now that most people get that.
That is why you are self-minimizing. You’re trapped in a corner. To appease the right wing base, you have to be a dittohead, full of all the familiar fallacious crap. You act that out here on MN Publius, and it doesn’t take a rocket scientist to see that, C”Rush”.
You are an outrage addict, plain and simple.
Great Job!
Since I’m hogging the comments, here’s another thought.
This AM I listened to Gary Eichten ask 3M’s George Buckley about Minnesota taxes, health care, buisiness practices, etc.
I had a good mind to call in and ask Buckley if he was going to still pay the TIF if 3M is going to leave Minnesota. http://www.house.mn/hrd/issinfo/tifmain.htm
3M built something outside of Alexandria, I believe.
Anyway, it was interesting to hear Buckley talk about health care. It seems it factors in to the overall cost of doing business (duh). Buckley is from Great Britain, and liked the health care system there (it sounded like). They have universal health care.
Right now, I’d like to see us adopt universal health care as a means to stimulate business. Let’s slowly get ourselves out of this mess, and see if we can run a deficit, and then be responsible about getting ourselves back in the black.
I think I’ve said that before. Sorry!
Few thoughts:
I have teacher health care. You know, that Cadillac health care that all teachers get on your dime? Teaching used to be a profession that could offer a decent wage and good benefits. I won’t ever complain about the wage, but the benefits are crippling to middle class families.
Some districts do not even offer health care, and most, like mine, now only offer it for the individual. If a teacher wants to add their family, it costs about $10,000 additional out of pocket. That is almost 25% of most teacher’s annual salaries! And that just gets us to have $40 co-pays and only 80% of charges covered.
Now, you talk about this mythical choice that the free market provides. I have to see one of the doctors Health Partners tells me I can see. I don’t have choice. Health Partners pays their providers some of the lowest fees in the industry, so do you think many providers actually accept it? Hell no. So, I pay one quarter of my salary in order to have high co-pays and only 80% coverage in order to see the providers health partners tells me I can see.
Capitalism can work fantastically in production, and that is where it belongs. In humanistic endeavors, people do not always respond according to “market principles”. Should whether you get the best cancer treatment depend on how much money you make? You can have full coverage and still not be able to afford cancer treatment co-pays and such. If you make more money you sure can have a bigger house, fancier car, and snappier clothes, but whether you live or die should not depend on your income.
And CMan, your kind have led people to believe the government cannot do anything right over the last 8 years, but that was their implicit plan. The government runs many things quite well. The post office, the military, social security has never missed a payment. Medicare sends 97% of money towards care, many fine state universities, federal parks, and probably hundreds of other every day things that we never notice because they are being run well.
Even if you have health care, it is killing the middle class, and small business. You love small business? You should want universal care. It works in the rest of the world in spite of what Limbaugh and Hannity try to tell you.
Ack, teacher health care packages are terrible. What a drain on a super small check.
Oh yeah, my care sucks.
“What is your fear, anyway? If you check other countries, you might find they live longer than we do, are happy with their system, like to talk to their docs, and take better care of themselves overall.”
Could that be due in part to the fact that people in, say, Italy don’t eat at McDonalds every day and tend to be more active? If Single Payer would make people not want to supersize their Big Mac meal, sign me up!
What is my fear…. hmmmm… not a fear, just a skepticism. I do the majority of my work in healthcare, and have for the past two decades. Based on being in the trenches day after day, dealing with the most mundane but necessary of healthcare issues, I believe the advocates of Single Payer have dramatically — grossly - underestimated the cost of effectively running that kind of system in the US.
Plus, I think the model of how the government runs something where there is little consumer choice is the DMV. I don’t want my doctor’s waiting room to feel like the DMV. Maybe it’s just me.
EEWww, McDonalds. Nasty!
You bring up an interesting point, there. My experience with Europe leaves me thinking the diets are totally different. I hear the Greek diet is the best. I’m a sucker for Italian.
To match, we’d have to change eating habits and commuting habits, etc.
Your doctor already services people being helped by the state re: health care. It won’t be the DMV. Which is the lamest office in the land around here, no thanks for that image in my head.
“Plus, I think the model of how the government runs something where there is little consumer choice is the DMV. I don’t want my doctor’s waiting room to feel like the DMV. Maybe it’s just me.”
Forget about the uninsured, for millions of people with health care coverage we are already there Dan.
Don’t you get it that that is what it is like for most middle class these days already! Bully for you that you have good coverage, but most people are fed up. Paying high premiums, high co-pays, with huge deductibles just so we can see the doctor our health insurance company tells us we can see.
Dan, your worst nightmare of “socialized payment” is already here for millions upon millions of us. The only difference is this lousy care is also bankrupting us. Even if socialized care was a lousy as you think, at least it wouldn’t bankrupt us if we got sick.
Alec -
What would you consider a fair monthly rate for you to pay for your family’s healthcare? I’m curious what price tag you put on that.
And then my 2nd question would be what portion of that price tag would you like others (other taxpayers) to fund instead of you?
You all are sooo good at talking about what you should receive. But 1/2 of this equation is what you should pay. I rarely hear that part discussed around here.
Oh, and to expand on my response that I’m pleased with my healthcare…
I like my doctor. I feel that when I need to see a specialist, I can in a reasonable amount of time. When I need an elective procedure done, I have the freedom to do it. I feel like my healthcare support system helps me take care of myself, which is thier job.
I do pay alot for my healthcare each month. But then again, it’s my freakin healthcare. I wouldn’t expect it’s bill to be less than my car payment or my cable bill. It’s my healthcare for god’s sake. It’s probably the #1 thing I’m willing to pay some money for.
Let’s have a better safety net. I’m all for it. the money should already be in the system to make that work.
DtheM,
So you have health care. It’s employer based health care, most likely. Don’t you think the business that employs you could do a little better without having to pay your premiums?
It also sounds like doctor choice is your worry. Yes? I’ll have to look that up. My doctor already bucks the system, and spends as much time as he possibly can trying to listen to us. He’s one in a million, and we drive to lakeville to see him (Dr. Mark Mellstrom). Excellent care.
The irony, Holly, is the example you use. A doctor who “bucks the system” and doesn’t watch the clock.
Government health care would make that less common, not more. If we go the route of european countries, we need to ration care. Ration = limiting.
I’m all for doctor’s not trying to skimp on time with patients. Government healthcare, at least the kind that would save costs as advertised, would be at odds with that.
And I just noticed a comment you made earlier: “Right now you’re asking for a small portion of people to keep carrying those that have insurance problems.”
That is our current tax system, Holly? That is how our government is funded. A few carry the many. Government healthcare won’t change that, only hardwire it.
“I wouldn’t expect it’s bill to be less than my car payment or my cable bill.”
For crappy care our health care is 4 times our car payment, and my family is amazingly healthy. Tell me the market is working great.
How is your care crappy? I’m curious. You say your family is healthy — is that a fluke?
I like paying for health. I’d rather not pay for tons of care. That’s just me.
Let’s not fail to examine this “Rick Scott,” the spokesperson for this group:
http://crooksandliars.com/node/26962
http://www.thenation.com/doc/20090330/hayes?rel=hp_currently
“Having Scott lead the charge against healthcare reform is like tapping Bernie Madoff to campaign against tighter securities regulation. You see, the for-profit hospital chain Scott helped found — the one he ran and built his entire reputation on — was discovered to be in the habit of defrauding the government out of hundreds of millions of dollars.
* * * *
By 1997 the FBI was investigating Columbia/HCA. Days after agents raided company facilities armed with search warrants, Scott was forced to resign. In 2000 the company pleaded guilty to fraud and agreed to pay the government $840 million. Other civil settlements would follow, ultimately totaling a staggering $1.7 billion, making it the largest fraud case in American history.”
Only the Republicans would drag this man out to rail against non-profit health care. “Having Scott lead the charge against healthcare reform is like tapping Bernie Madoff to campaign against tighter securities regulation.”
Rick Scott’s company is the epitome of for-profit hospital systems. I have mixed feelings about for-profit hospitals. Here in the cities, we really don’t have any.
They don’t have a good record of providing charity care to the community, and they have a reputation of making quite an assembly line out of patient care. Probably not a great model.
The Mayo’s of the world, the Fairviews, the HealthEasts and Park Nicollets — they are all not for profit. In general, a better model.
But WestSideGal, saying that Republicans “drag this man out” is making quite a tight association. Do you really want to use Madoff in your associations analogy? Bernie Madoff’s generous political giving skewed heavily Democratic…..
What did you think of the video?
Rick Scott. Good point, it’s funny he’s the one leading the charge against health reform…. and why would people be inclined to listen?
I am one of the lucky ones — I have excellent health care that I only pay $60 a week for (and yes I work for a LARGE company).
But I would gladly take a reduction in my health care coverage if it meant providing some to people who are facing NO coverage at all.
Also I would leave my job and start a small business if I could but I cant because of health care — because I have two kids. And they need health care. I am willing to risk my finances but I am not willing to risk their lives.
We NEED universal coverage - it will jump start small businesses.
So, how do we pay for all of this.
First, costs will immediately drop 20-30% because there is less overhead. Medicare sends 97% of a dollar to actual care, whereas the market sends 70% of a dollar to actual care and the rest to overhead.
So, you ask how much is reasonable to pay? Right now the amount a middle class person pays is crippling. The amount small businesses pay is crippling, and if they don’t provide insurance they cannot compete for the best workers.
So, to answer your question, I would gladly see my income tax rise 5% to help single payer. I think the plans I have seen have had a business increase of about 5-7% increase and personal tax increase of 2%. This would be a boon to small business and consumer spending. Right now I pay 20% of my salary.
So, the shared cost would save the average middle class person thousands and allow small business to compete for the best workers because health care would be taken care of.
One of the righties talking points is that we don’t want the government deciding our care, but right now profit margins and actuarial tables decide our care. I don’t want my health determined by its profitability.
Heck, even if they raised my taxes 10% we would save money, that is how messed up things are. And my wife and I are both professionals, with advanced degrees and good professional jobs.
As a side note, the residual benefits are enormous. Our school district spends 100 million on benefits, the lions share of which is health care. We wouldn’t have an education funding problem is we had single payer. The number one reason university costs go up is because of employee health care. Say good bye to double digit tuition increase every year
First, we do not currently have a fee market health care system in any way shape or form. So whatever you think of our current disaster read the history of it and at least be honest about what it is.
Second, Alec is being dishonest in portrayal of what a single payer system would accomplish. Medicare and private insurance are not truly apples to apples. They provide different services some of which would have to be picked up by a universal system from the private sector. But even if we would take the numbers Alec uses the fact that Medicare doe not often pay the full costs of services means that when a universal system is implemented the total savings would be lower. They would also be nowhere near instant as he claims. There would be years, many most likely, of transition costs.
Third. Doesn’t creating a huge group of unemployed people that formerly worked for private health care go completely against the idea that increasing demand by making jobs (any job) is the road to economic recovery? The only way to make the numbers Alec uses even close to possible would mean tens of thousands of people out of work. I don’t really care about this part but is is a contradiction inherent to the argument made for universal care by many people.
Fourth. The total amount we spend of health care as a nation would not be significantly reduced by a universal plan. How we pay would but Alec’s claims of universal care fixing all budget ills is complete BS. The fact that you separate out the cost of health care from the price of education or other matters does not make the cost go away it only shifts it.
Fifth. If you give those who favor single payer the benefit of the doubt and use a 25% eventual savings in overhead and the cost reductions of all the profits from all the insurance companies currently being used we still end up with the same problems in the end. the cost of health care is growing very quickly. Nothing about single payer will change that. It simply provides a certain amount of time to push the problem under the cover of government borrowing and spending.
The core problem we are facing is that the medical care we are able to provide has become extraordinary. While having a potential fix for nearly everything is wonderful it comes at a cost. My grandfather passed away a couple years ago at the age of 96. He had great medical coverage as part of his federal pension from working for the Army Corps of Engineers. He had a stroke in the eighties and fully recovered, a fake heart valve put in in the early nineties and a leg removed about 6 years later due to bad circulation. His last couple months were spent in an out of the hospital with various circulatory issues. When my mother added up the costs for his medical care since he retired in 1972 the number was staggering. It was when adjusted for inflation more than the total he earned in his entire professional career.
Multiply that story many times and you get the idea of where our problem comes from. Devoting more resources to medical care than the production of the people we are treating is not sustainable. Such cases used to be rare but are now becoming much more common. Until we deal with it we have fixed nothing.
The idea that creating a system that is like Medicare seems all nice and clean. The problem is of course that Medicare is on schedule to bankrupt our country. Democratically controlled economics has a funny characteristic. You can always get more people to support the benefit than you can to support paying for it. Politicians will not want to cut off grandpa from an expensive procedure that gives him a 50% chance of living another 6 months and neither will they be able to support the massive tax increases they would need to have to pay for it. Instead they will do like they have with every other program for decades. Hide the costs by borrowing or otherwise pushing them forward onto future generations.
At some point the whole ponzi scheme system we have in place will fail and cause more pain in its collapse than it ever pretended to prevent. It is only a matter of when.
The death spiral our health care system is in can only be solved with single payer universal health care. The first step to fixing the system has to be the removal of the insurance industry from the equation.
We cannot continue to burden American business with the cost of health care. Costs are rising much faster than inflation, insurance companies take too big a cut and we get mediocre results in return. The whole business model for insuring against sickness is flawed because eventually everyone gets old and either has heart problems. dementia or cancer. So insurance companies try to shed risk by stripping the sick of their coverage. The entire system is broken. It will take time to transition from job based private insurance to a full access, full coverage model. The people currently employed in the Health Insurance Industry can be reemployed in other areas as we transition to a single payer model. It won’t be easy and could be messy, but the current business model is unsustainable.
Job based insurance came about because of government regulation and became institutionalized primarily through large union contracts. It is a model that is not sustainable but so is the single payer one being proposed since it does nothing to deal with the real reason costs are growing at their current rate. For similar examples just take a look at all of the other long term programs from Social Security to public sector pensions. All promise payouts that far exceed our ability to fulfill no matter what tax regiment you want to propose or who you think deserves the “burden” of paying for the things being consumed.
What would you suggest we do, KH? Maybe repeat that for me, if you could.
Holly,
First we have to figure out what we are trying to accomplish. While the idea of true universal care seems warm and fuzzy it would quickly bankrupt us. The care being provided will be limited in any system. Keep in mind that a single payer system will result in two groups. One that uses the state system and the other that can afford private care.
Let insurance companies sell policies across state lines. Let them charge different rates based on factors that determine health risk such as weight, blood pressure, if you ride a motorcycle, etc. That would directly encourage people to care for their own health.
Then require every insurance company to provide a basic policy that anybody can buy regardless of pre-existing conditions or any other factors. I might not be an all inclusive policy and might have a large deductible for non-preventative care and a fairly low maximum payout but it would provide a basic safety net. We would then have to place a tax on policies to collect the funds needed to provide vouchers for people under a set income level to purchase these policies.
If we can split health insurance away from employment and allow people to buy policies that travel with them across state lines and jobs we completely change the dynamic of the industry. People would want to purchase long term policies when they are young and healthy in order to lock in lower rates. Insurance companies would then be encouraged to to keep their clients healthy so their long term costs are lower.
I also think your hope that we, the United States, could figure out an improvement to European systems is unfounded. The countries you reference have a major difference when it comes to creating centrally planned economies. They are much smaller and have much less complicated societies. GB and France are 60 million and Sweden is about 9. Those are more in line with the state of California then the US and none have the cultural diversity we do. The amount of variation our country encompasses makes central planning much, much more difficult and risky.
“Keep in mind that a single payer system will result in two groups. One that uses the state system and the other that can afford private care. ”
This is worth repeating… Unless we move to truly nationalized medicine, where each hospital is Govt run and the docs are all employed by the State (a model which has a whole host of additional downfalls), there will be a two tier system. In Canada, just two years ago, the President of their Canadian Medical Association was the CEO of a black-market healthcare provider. That is how accepted, and respected, the 2ndary market for healthcare has become.
In Germany, too, the market forces are creating more demand for private insurance than the state-run insurance. Germany, at least, is realistic about the cost of state-run insurance. The government bills you 14% of your income (or automatically takes it from your paycheck), and in turn you have just purchased State insurance. While I don’t advocate it, I do think that if we would unfortunately go down the path of a huge public insurer, we should follow that model. Not a blurry, black-box wealth shifting mechanism where people magically have insurance, but people buying in to an insurance risk pool with real dollars that come out of their paycheck that they can see.
Oh, the 14% in Germany that I refer to above (or maybe below, not sure where this post will be located after I hit submit) is capped. Someone who makes $50,000 a year would pay $5,400 a year for healthcare. Someone who makes $200,000 would not pay $28,000….. it would be much closer to the same rate. That is the only fair way of doing it.
There is that subjective, 4-letter F word again… Fair.
Medicare and private insurance are not truly apples to apples
You know, that’s why I don’t like it when people talk about “medicare for everyone.” Right now people are treated poorly if they are on health care assistance. Doctor’s offices ask for your insurance, yell out the details across the room, and neglect to give you those tests you might need.
If we switched to universal health care, we’d see care for the majority, no one left on the health care street, and a very few people who opting to spend a lot of money on private health care.
Since the majority or almost all of the people would be on the same system, and the system would be held accountable to the majority of us, there would be equal treatment at the doc’s office, etc. and quality treatment over all. Or we’d raise hell. Plus other countries have shown it works, and we’re likely to improve on any system out there.
I think it comes down to a shadow cast on our wonderful America by social darwinists. Some feel there is stratification, and that certain people are going to be better than others. Certain people are genetically inclined to go out and get good jobs, be educated, and be healthier.
People who enertain this theory, whether they know it consciously or not,wonder what would happen if we all had health care? The answer: Some people would get help they don’t deserve.
I think we Americans are all equal.
Connect social darwinist theory to employer based health care, and you’ll see there is the thought that easy health care will amount to a lot of people sitting on their ass. After all, that is part of what they work for, isn’t is? Good health care?
I think people work for money so they can have things and take care of their people.
There are far too many Americans without the care, and many of them are good, strong people. Land owners are losing their property due to a distraught, disfuncitional health care system. Health care costs are rising, the workforce is getting smaller due to demographics, and more and more people are wanting to work but can’t find a job.
Health care reform, now. BTW, if we need to encourage work, I’d start by having jobs available… not by reforming or keeping part of an employer based health care system.
I think I need to clarify something, something that is often mistaken by those on the far left.
I, KH (I think), and others are not defending the current system. We want health reform too. We just disagree that the only answer out there is Single Payer. Changing the financier of healthcare doesn’t change the fundamental system. Your employer can pay the bills, Medicare can pay the bills, Blue Cross can pay the bills… that is only a small fraction of the equation. So let’s assume that instead of paying the healthcare bills through our wages, we are now paying the healthcare bills through our taxes. That is actually a rather insificant change.
We need more choice in healthcare, more control at the patient level, and more awareness of what the costs are and what the outcomes would be. For people who will not or cannot take control of their health spending, offer a government-run alternative. But it needs to ration care. Any systemic change needs to ration care. I don’t like saying it, and you don’t like hearing it, but the numbers are on my side on this one.
So who rations the care? A few options:
1. HMOs? no, bad choice for the reasons Alec described
2. Doctors? most will tell you that is not what they want to do, ethically or professionally
3. The US Government? not my choice, but it sounds like it is many of yours
4. The patient/consumer? My choice.
We need a safety net. We need universal care, which to me means that everyone gets access to some basic services, much like every kid gets access to basic education. But to say that Medicare should be the payer for everyone, that is asinine. The very reason our insurance rates are so high is because Medicare doesn’t even cover the cost of providing basic care to its enrollees. That is the model for the future? Medicare will be bankrupt in 2017. It might not even be the model for the next decade….
to say that Medicare should be the payer for everyone, that is asinine.
I’m not saying that. Not medicare for everyone. A better system, one modeled after Britain’s single payer, or France’s single payer.
I’m listening, though. I just don’t see how we can fix the private system without the government having to regulate up the wazoo and use a huge amount of resources… and it probably won’t work, anyway.
I think you are worried about choice in the event we don’t have sufficient care. But the system is already working in several different countries.
We are 50% government healthcare. Why would doubling that make it better?
Because medicare is the most cost effective and efficient health care provision model in the US.
“Overhead for most private health insurance plans range between 10 percent to 30 percent,” says Deloitte health-care analyst Paul Keckley. Overhead includes profit and administrative costs.
“Compare that to Medicare, which only has an overhead rate of 1 percent. Medicare is an extremely efficient health-care delivery system,” says Mark Meaney, a health-care ethicist for the National Institute for Patient Rights”
http://www.cnn.com/2007/HEALTH/06/28/sicko.fact.check/index.html
First, those figures are greatly exaggerated. Medicare’s overhead is 2.1%, and it is insolvent. Its model is unsustainble. It is like saying GM sells inexpensive cars. Doesn’t matter - it’s still going out of business.
Private insurance runs 5-15% overhead. The ones that do 5% overhead are doing well. The ones that are doing 15% are probably about to be taken over.
I know of an article from a a couple years back that does a splendid job of explaining what Medicare’s overhead really is. those who say it is 1-2% don’t understand what thay are reading. If we’re going to have a serious discussion, let’s use accurate facts.
I’ll find that article and post it.
Not to put too fine a point on it… wouldn’t it make sense to look into the single payers systems of other countries for examples of what to do and what not to do? We don’t have to reinvent the wheel here, we just need to make sure that our infant mortality rate isn’t below third world numbers like it is now. All the right pieces are here… there has to be a best practices example to look for in other systems. My friends in Canada have some nice things to say about their system.
Not an expert and finding all this posturing a little confusing… it is going to be a gradual change no matter what is decided now.
While looking at other systems can be informative there is no way to predict how the application of parts of other systems will react when either separated from the whole or applied to a completely different environment.
The population of Canada is 10% of the US and their population is much more homogeneous. Their governmental systems are also much different than ours which plays a very big role in getting any centrally controlled system to work.
The other big factor is the influence the United States has on the health care of other countries. It is impossible to un-weave and understand all the relationships between different suppliers and consumers of the different products involved in providing health care. Much of what the world consumes for health care devices and products is created in the US. Changing our system will drastically effect the systems of other countries.
Think about the MRI machines so often used as examples of unnecessary duplication during the Clinton’s efforts at reform. Let’s say we were able to reduce the number of machines nationally by 50% without causing a change in wait times. The producers of those machines still must pay for the investment of developing the equipment so will split that cost over half the number of machines making each one cost more. If they do not increase the profit margin on each machine by increasing its price further they will have fewer resources to put into developing new and improved machines slowing the steady improvement of our ability to fight illness. While many of the large scale drug and other breakthroughs have a fair amount of government money driving them the majority of the improvements are driven by the desire of businesses to make more money. Either way the numbers shown for savings never look at these factors. They tend to assume that a MRI machine will cost the same no matter how many are produced.
Now take that and multiply it over and over and over. Health care is a massive part of our economy and anybody that tells you they can figure out how to manage it from a central source is lying. The complexity of a system grows exponential even as its size grows lineally. Health care in the US is a system of such extreme complexity that it makes the space shuttle look like a toy block. The problem with single payer is that when it fails and turns in to a shower of debris we will all have been passengers.
Hi KH,
I think we need a state level single payer system. Crossing borders should be easy, but the admin should be state level.
I’m still thinking about the rest of what you wrote.
What’s your opinion re: social darwinism? Is it true some are more equal than others? (Hey, I read a book about that, once).
Is this sort of the long version of George Bush saying “being president is hard. Hard work.”
Your objections are flimsy at best…
1. Scale of Canada versus US not that big a deal. They use a provincial overseer process with a federal system. And as far as homogeneous Canada, you must not have visited there in the last oh ten years. Try Vancouver where you here more languages on an average street corner than the UN.
2. Because the we have a health devices industry, like say the UK, we can’t have a decent health care system for the majority of citizens? Without a massive influx of extra cash from an inefficient American system the multinational pharmaceutical and medical device companies won’t continue to compete with research? Pull the other one… name an exclusively American company that you think would stop innovating or working on new products without “overcharging” American citizens. I bet you won’t find a company that is not involved in foreign medical systems, with the vast majority having a large part of their ownership outside the country.
3. Yes I think that a cheaper product will always sell better if it has the same “specs.” Now I do not believe that the world will drop capitalism because we go to single payer health care. Yes some of the excess profit may get squeezed out and perhaps there might be fewer boutique products but hey it doesn’t matter. What matter’s is the end result of the health care industry has to be good health care without gouging the consumer.
4. Single payer health care is not trying to manage the totality of health care. Your strawman is that no one can figure out a central source or plan with this immense complex part of our economy. This is factual incorrect. No one intends to do that except in the feverish minds of rightwingers babbling about socialism.
The vast majority of Plastic Surgeons will continue on unconcerned. Private clinics or even hospitals run by for profit companies will continue on. No one plans on outlawing the system that exists. Rather to develop a wider ranging health care system that helps more people. Seems to me that all the other single payer systems in every other country has already organized itself. There is no reason America can not do it. We could easily take a state by state approach as we get the program up and running.
The joke is that the USA has the best medical system in the world helping the least amount of people. That is not smart on many levels… the first being we need to compete without this health care boondoggle holding us back.
1. Scale does matter and it matter immensely. You should try reading a little on systems theory. I recommend General Systems Theory by Bertalanffy. And yes Canada has diversity but it is simply not nearly that of the US. And race and language are not the only forms of diversity. The united states has more and larger variations amongst its population than Canada. It simply isn’t rational to claim otherwise. By the way I have been to both Vancouver and Edmonton within the last month.
2. I never claimed that our large medical product sector should preclude us from having good health care. Just that a massive change in our system will without question effect the systems currently being viewed in other countries. That makes using them as models a dubious endeavor.
I also never claimed that any company would “stop” innovating. Just that the amount of money going into a particular product will reduce the rate at which that product is developed. This is not just “boutique” products but everything from properly designed hospitals to new beds that can reduce muscle atrophy and on and on and on. You use terms like “overcharging” with no back-up. Simply repeating rhetoric doesn’t support your argument.
3. So what is a boutique product? Do you know which ones are going to be meaningful and which we can do without? Who is gouging who? What do you consider gouging? There seem to alrea The chances are that in a system where payments are regulated businesses will put more time into things like plastic surgery as those will be the only areas where they will still be able to charge what they want.
4. Single payer must by default manage the totality of the system. If the government is the only provider of insurance they will also be the one determining the prices. That is all that is required to be the single point of control. The ability to set prices means by definition there will be no capitalist or real market activity. You can call what remain anything you want but it does not change the facts of what it would be.
Actually Canada did outlaw other insurance when they went to single payer. They knew that not doing so would result in a heavily stratified system. And as far as the rest of the systems go none have “worked themselves out”. They are all very contentious issues in the political arena in each country. The bigger the country the more contentious it tends to be. The public always demanding more care with no increases in the level of taxes. A recipe for long term disaster.
Keep in mind I really dislike our current system and understand that it is a disaster. But what we have now has nothing to do with market based system or what I would prefer.
From HealthLeaders. http://home.healthleaders-interstudy.com/index.php?p=newsletters
Again, I’m not defending the status quo. I just think we need all of the facts for an enlightened discussion.
— — — — — — — — — — -
“The average per-member-per-month premium for commercial HMOs in now in the $200-$250 range, while the typical PMPM for Medicare is in the $600 range. If the Medicare PMPM were $200 rather than $600, then it would have an administrative overhead of 6.3 percent rather than 2.1 percent-still very good, but not out of the range of the very lowest-cost private insurers.
“For that relatively low overhead, Medicare offers only a single product (little choice except in urban areas where Medicare+Choice is available), provides limited medical management (and that seemingly by lawsuit), conducts provider contracting by fiat (negotiations take place in Congress), and has almost no marketing costs (no competitors).
The other two things that are not mentioned are the hiding of the debt service to other areas of the government, and the shifting of administrative costs to providers by way of mandates and voluminous paperwork.”
Once again, Kerosene Hat hit the nail on the head.
If we truly want to control the runaway costs of healthcare we need to have a difficult discussion about level of care.
We currently provide Cadillac level care that costs a ton of money and treats every single person as if we should spend endlessly to try and extend life.
Until we make difficult decisions on what level of care and cost of care we are willing to spend on issues like premature infants, hemophiliacs (friends kids costs are well over $1M each), transplants and especially end of life care we will go bankrupt whatever system we have.
Is this sort of the long version of George Bush saying “being president is hard. Hard work.”
There was something about having to work on Sunday, too, wasn’t there?
On the serious note, A Nony Noose (Anonymous), I suppose there is that discussion to be had, but not the one social darwinists would like… but rather, what the majority would like. The question to pose is: What is acceptible care? Instead of what we have now, which is: Who can afford treatment?
Holly, having that conversation’s pointless. The most powerful special interest group in the United States is also the one representing the population with the greatest self-interest in medical waste on unjustified efforts to stretch out life: the AARP. That population’s numbers and chokehold on society and public policy are constantly increasing due to a positive feedback loop - the more deaths they succeed in delaying, the more of them there are to keep demanding more and more resources be poured into them. Toss in the sort of absurd oversentimentality that got the legitimate definition of death, higher brain death, tossed in the 80s and gets millions across the U.S. to rally around preserving a seven year old corpse in Florida - to the point of special Federal legislation about it - and I think it’s pretty obvious the outcome of that conversation’s a foregone conclusion.
What are you saying, Steve?
I repeat (but I’m fixing acceptable):
I suppose there is that discussion to be had, but not the one social darwinists would like… but rather, what the majority would like. The question to pose is: What is acceptable care? Instead of what we have now, which is: Who can afford treatment?
The question we might pose: What is acceptable care?
I can think of worse scenarios besides the AARP. Genetic research is going to take us to a new level some day.
I’m trying to find your point, what is it, exactly? Is it that lobby groups will weigh in on the important discussion, and skew our result of what is acceptable care? Or is it that we shouldn’t even have the discussion? The discussion is going on around us, now… and so is it that our legislators shouldn’t be the ones to talk about it?
I wonder what a safeguard can be to protect us from medical discrimination and a “perfect society”. (I’m a sucker for movies like Gattaca). Unfortunately, that discrimination can happen in any medical system, no matter who is the payer. Employer based health care, or single payer universal health care.
We’re lucky to have other nations already try this out. There must be some idea of what is acceptable care and the extent of medical intervention (should we give mammograms to 90 year old women, for example… my grandmother had her annual one this week, she’s 90).
Just as I called for discussion on “end of life” health care a good article came out on the very topic today - http://www.realclearpolitics.com/articles/2009/04/a_threeway_fix_for_health_refo.html