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In talk-radio parlance: "Long time listener (commenter), first time caller (diarist...)"

I like to read the diaries on health care here.  I will admit that I am a techie (computer programmer-type) who used to work in the health insurance (well, Third Party Administrator) field about 9 years ago.  I will also be up front and let you know that I do support a single payer system, probably somewhere between the Canadian and British models.

As I said above, I do support the concept of a single-payer system, but I feel that we may be taking a tack that may not make us much headway in the battle.  There is a fair amount of insurance company bashing that we see around here, and some of it is certainly deserved.  The for-profit, capitalist market is all we have for the most part for health coverage in our country.

We need to realize, however, that even in single payer (which I support) you still have a 'market,' albeit a very large one with one player.

I just think that health insurance company bashing is not the proper approach to arguing for single payer. Initially, it will lose you any support form the free-market, capitalism-at-all-costs types.  Additionally, many of the ills we're talking about with for profit insurance companies WILL still exist under almost any single payer system.  

NEGOTIATED RATES

You don't like negotiated rates; think that they're screwing your doctors?  Medicare is the king of negotiated rates.  Quite a few insurance  companioes pin their payment schedules to Medicare's schedules.

If negotiated rates are bad, then we must face up to the facts:

http://www.signonsandiego.com/...

Hay and Young are among doctors nationwide who are rejecting new fee-for-service Medicare patients because they're fed up with the government's reimbursement rates. A 4.4 percent cut went into effect Jan. 1.
The article continues:
In reality, health-care costs have risen much faster than the GDP.

The problem may affect care provided to privately insured patients in managed-care organizations, which enroll millions of Californians. That's because many HMOs tie their reimbursement rates to those set by Medicare.

(emphasis mine)

Note two important concepts in that snippet: (1) costs are rising and (2) many HMOs tie their reimbursement rates to Medicare.  Why are those concepts important?  Because simply beating up on insurance companies does not address either one.  If negotiated rates are your battle cry and you even suggest government run single payer, then your position is internally contradictory.  And perhaps more importantly, the negotiated rates battle cry fails to address the cost side at all.

And the problem's not just in California; it's nationwide:

http://www.aafp.org/...

The worst part of the Medicare cuts is that the commercial insurance companies tie their reimbursement rates to the prevailing Medicare rate. Instead of taking a small hit, doctors take a large, across-the-board hit on all reimbursements, at the same time overhead is skyrocketing.

HEARTLESS BUREAUCRACY

You don't like the bureaucracy of for-profit insurance companies?  Think about government bureaucracy.  Sure the profit's gone, but you step into the inefficiencies inherent to govt programs.

Tired of hearing about people being denied services?  Plenty of folks on Medicare get denied stuff every day. (see: http://www.itemcoalition.org/...  I don't want to cut and paste the whole article, but it lists several cases of people being denied coverage by Medicare.)

The simple fact is that there are lists of things covered and things not covered.  I know it seems patently unfair when it's one of your own family or friends whose being denied coverage, but it is sadly a fact of life.  No market, even a single payer plan, could cover everything for everyone.

Now all of that for this...

I still think single payer is the best alternative on the table.  However, I think that this is the wrong tack in taking to push for it.  I'd rather see us talk about the failure of the current system to provide coverage for all. Coverage for all is a simple American concept (I'll stay away from the word "value" for now) that most everyone can get behing.

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.

Read that.  As I read it, in the context that I see, they were talking about forming a government to support and nurture those rights.  So, I do believe that it IS the government's responsibility to see to the health of its citizens. You know that whole "life" and "pursuit of happiness" stuff.  I'd make the argument that health care is critical to those pursuits.

Education is a government run industry (well at least up until the end of high school).  It's free.  It's open to all. Is it perfect?  Not by a long shot.  Are there private models out there?  Of course, but as supplements to the governmentally-offered model.  If you have the means to send you child(ren) to a private school, then you can. But you still have to pay to support the free/public schools (I hope to goodness that vouchers do not become commonplace, but that's another diary).

Why cannot we set up health care in a model similar to schools.  It's a basic right, we should argue.  The other side can argue negotiated rates and heartless bureaucracy back and forth with us.  If we were to argue health care as a basic right as espouses in the declaration of independence, then we place the opposition into the position of arguing AGAINST basic rights.

There was a scene in one of the early seasons of "The West Wing" where Rob Lowe's character was playing devil's advocate with John Mahoney's character's daughter about the concept of school vouchers.  Rob Lowe was arguing that vouchers were good and the other guy's daughter was getting very upset.  When the truth comes out that Rob Lowe was just playing devil's advocate to sharpen the debate, Rob Lowe summarizes his position thusly:

Mallory, education is the silver bullet. Education is everything. We don't need little changes. We need gigantic monumental changes. Schools should be palaces. The competition for the best teachers should be fierce. They should be making six-figure salaries. School should be incredibly expensive for government and absolutely free of charge to its citizens, just like national defense. That's my position. I just haven't figured out how to do it yet.

From: http://www.westwingtranscripts.com/...

I'd like to see the single-payer debate framed in those terms.  Yes health care is ridiculously expensive and complicated.  Yes we should have the best and brightest involved.  And the only way to do that is to effectively nationalize it like education and the military.

Originally posted to Robert in WV on Sat Jun 03, 2006 at 10:57 AM PDT.

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Comment Preferences

  •  Tip Jar (16+ / 0-)

    Alms for the poor; first attempt at a diary; shameless mojo plug in light of the new TU rules.... Whatever you call it, let me know what you think.  Thanks for dropping by.

  •  Reagan's big lie (5+ / 0-)

    inefficiencies inherent to govt programs.

     

    Yeah, we heard all about government inefficiency from Ronnie the Raygun, along with the welfare queen in the Cadilac with 28 kids, or some other such nonsense.

    How about you give us some documantation of this premise, rather than spout a Republican talking point that was old 20 years ago.

    I'll give you another viewpoint, and you can call it beating up on the insurance industry if you wish:

    My sick kid is not a vehicle for profit for corporations and shareholders. That's a basic premise. It means  that it is barbaric and inhumane to see sick, infirm and injured people as vehicles for profit.  We don't kick people when they are down in America.

    Find another way to make a buck.

    -8.0, -7.03 don't always believe what you think...

    by claude on Sat Jun 03, 2006 at 11:47:06 AM PDT

    •  Government inefficiency is not a talking point (2+ / 0-)
      Recommended by:
      Bodean, neroden

      Any operation as large as the government will have certain inefficiencies.  Especially with national level programs like defense and education.

      I'm not sure you understood where I'm trying to go with my thesis.  I think that single payer is the way to go.  I think furthermore that the government is the only way to make it work.  All I'm saying is that we need to be mindful of things like $400 toilet seats and the like.  I am not sure if you're arguing that government inefficiency is a myth or not.  It's a reality and while sometimes treated as a political football, is simply a fact that should be acknowledged and dealt with.  For example:

      The head of the GAO reported in 1995 that audits of federal agencies had "identified hundreds of billions of dollars in accounting errors--mistakes and omissions that can render information provided to managers and the Congress virtually useless."  Most federal agencies continue to suffer from severe financial management problems.

      Maybe I did not make my point clearly ewnough in the diary, but when you write:

      My sick kid is not a vehicle for profit for corporations and shareholders. That's a basic premise

      You'll find me in agreement.  That's why I qwuoted the West Wing snippet in my diary.  I think that the govt is the only solution to this problem.  I just think it's too big for the market to handle.

      But, my overall theme is that I do not think we'll make much headway if all we do is beat up on the ins cos.  I think we need to look bigger and reframe the debate.

      Again, I think we're in agreement here for the most part.

      •  Medicare has lower overhead than privates (4+ / 0-)
        Recommended by:
        samddobermann, alizard, paige, neroden

        The administrative overhead in Medicare is much less than obtains in the HMOs and other private care.  It makes total sense to have one payer so that each doctor's office need not have a lawyer on hand to work its reimbursements through the payment rejection apparatus.  If we spent half the clinics to provide care that we spend on bureaucrats to deny care, then we would have a much more efficient system.

        Profit is the problem.  Nobody has a right to wait for me to get sick so that they can profit from my illness.

        The insurance companies are a significant part of the problem because they are like a mob that skims 30% off the top of every dollar that we spend.  It would be cheaper, certainly, to just give them this money in exchange for doing nothing at all instead of having them earn it creating chaos in our health care environment.

        •  repeating myself (0+ / 0-)

          As I said in posts upthread, there are two things you have to realize before getting into a debate about Medicare admin costs:

          1. Private companies do the daily administration (claims processing) for Medicare Parts A and B, and they always have. When you talk about Medicare being highly efficient, you need to consider that this is a public-private partnership at work.
          1. Medicare admin costs of 4-6% are due in part to the very high medical costs of medicare recipients. PMPM (per member per month) medical costs for Medicare are very roughly twice as high as for commercial insurance and three times as high as Medicaid. That makes it easier to have the admin expense ratio lower than other forms of health insurance. For private Medicare Advantage plans, the admin ratio is 5-10%, not much higher than traditional fee-for-service Medicare's 4-6%.

          (Admin ratio includes salaries, advertising, etc., but does not include profit.)

          •  Huh?!? (1+ / 0-)
            Recommended by:
            alizard
            "For private Medicare Advantage plans, the admin ratio is 5-10%, not much higher than traditional fee-for-service Medicare's 4-6%."

            Are you delusional?  On Wall Street, when evaluating mutual funds, that would be considered a HUGE difference in admin ratio.

            It is a huge difference.  "Not much higher" indeed.

          •  Careful what you are comparing (1+ / 0-)
            Recommended by:
            paige

            Private companies do the daily administration (claims processing) for Medicare Parts A and B, and they always have. When you talk about Medicare being highly efficient, you need to consider that this is a public-private partnership at work.

            I wouldn't call that a public-private partnership, but simply outsourcing. Taking this approach to an extrem, you could call it public-private partnership when Medicare hires a janitorial service to clean their offices.

            Medicare admin costs of 4-6% are due in part to the very high medical costs of medicare recipients. PMPM (per member per month) medical costs for Medicare are very roughly twice as high as for commercial insurance and three times as high as Medicaid. That makes it easier to have the admin expense ratio lower than other forms of health insurance. For private Medicare Advantage plans, the admin ratio is 5-10%, not much higher than traditional fee-for-service Medicare's 4-6%.

            It seems to me that this would be a reason for abolishing private Medicare Advantage plans - why should private for-profit businesses be allowed to raisin-pick their customers and leave only the expensive ones to the government? That's a "privatize the profits, socialize the losses" strategy.

            Also, you are comparing private Medicare plans here, while Robert in WV was talking about private insurance for the general population. As Robert in WV pointed out, private insurance for the general public has an admin overhead more in the 30% or so range, apparently much of that going towards the overhead of figuring out how to restrict the plans to discourage all but the healthiest people to even apply.

            I also disagree with Robert in WV on one point: claims denials are far more common in private insurance than in Medicare for the simple reason that Medicare coverage is far more comprehensive than most private plans.

      •  OK (0+ / 0-)

        i got attitudinal there for a moment.  I don't have a lot of solutions handy, myself, but I'm certain that it's got to be removed from the realm of profit. I might be able to look at some system where the taxpayers pay and you get corporate oversight on somw sort of fixed fee contractual deal.

        I think a real issue will be figuring out how to allocate stuff, and what is defined as necessary and what is defined as elective and where are those lines drawn?  This will draw a lot of fire. Do the taxpayers pays for straightening out teeth? liposuction? face lifts? what kinds of therapies will be allowed?

        I don't especially mind that the wealthy get to buy whatever healthcare services they want, The problem is short changing the rest of us. And being wealthy and not needing the service shouldn't absolve you of paying you share  of the national pool that includes everybody.

        I think we also have to look at the system getting reqally agressive about getting the supplies at vast wholesale discounts. It's an especially egregious fault that there present system forbids the Gov from bargaining for discounts from the suppliers.

        Pay well for efficient management, but forget about anybody using healthcare as a cash cow. It's all gotta be open books and not for profit.

        -8.0, -7.03 don't always believe what you think...

        by claude on Sat Jun 03, 2006 at 01:55:36 PM PDT

        [ Parent ]

        •  I may borrow some of your points (0+ / 0-)

          in debates I have with friends on health care.

          First and foremost, I'd like to see the debate centered on healthcare, not health insurance.

          I don't especially mind that the wealthy get to buy whatever healthcare services they want, The problem is short changing the rest of us. And being wealthy and not needing the service shouldn't absolve you of paying you share  of the national pool that includes everybody.

          I think we also have to look at the system getting reqally agressive about getting the supplies at vast wholesale discounts. It's an especially egregious fault that there present system forbids the Gov from bargaining for discounts from the suppliers.

          Pay well for efficient management, but forget about anybody using healthcare as a cash cow. It's all gotta be open books and not for profit.

          Those are three very salient points.

          I'm not sure how I got this debate sidetracked on govt inefficiencies (perceived or real inefficiencies).  I mentioned it only to point out that opponents to single payer will scream government inefficiency.  

          Leaving alone the fact that the entire system as it is now set up is grossly inefficient (see your points on purchasing power I block quoted above, for example), we rather need to frame the debate as a (I hate the word here, but I'll use it anyways) values debate.  Health care for all should be considered to be a basic right in this country.  Anyone who wants to go forefront and argue against health care for all is on their own, and that's exactly where I'd like to see the other side.

          Actually I like the idea of a public/private partnership that has been mentioned in this thread.  Let the govt make the macro decisions and the privates leverage their expertise at the admin stuff.  The admin stuff can be streamlined extensively if we're all on one set of benefits.  Shoot, you could even let the ins cos continue to sell supplemental policies above and beyond the basic health care package that the government would sponsor.

          You'd just need to set it up so the government sets the mechanics in motion (rates, coverages, payment schedules, etc) and then let the private sector do it's thing on the admin side (which is what "jd in nyc" is arguing for above or below depending on how you sort the comments here).

          I guess I voilated an old maxim about carefully defining your positions and terms up front.  I'm advocating for single payer in terms of who is doing the funding.  I really don't care a whit about who moves the paperwork as long as it's done in an efficient and timely manner.

          •  Bingo (0+ / 0-)

            to what jd in nyc said just below.

            Values debate is what it is, and my "my sick kid IS NOT your vehicle for profit" is the visceral punch that everybody can feel.  I'm pushing that line in every healthcare thread I see, just throwing that punch out there, cause I think it gets the point across at that visceral level where we carry our comfort with values, whichever ones we ascribe to.  However much one can intellectualize/rationalize a value, it's just a veneer  unless you feel it in your guts, so to speak.

            -8.0, -7.03 don't always believe what you think...

            by claude on Sat Jun 03, 2006 at 03:23:46 PM PDT

            [ Parent ]

      •  what about the post office? (2+ / 0-)
        Recommended by:
        alizard, neroden

        The USPS is extraordinarily streamlined and efficient.  They do as much, if not more, than their for-profit competitors, with significantly less resources.

        The notion of government bureaucracy being somehow worse than its corporate counterpart is a misleading assumption.  Sure, sometimes government agencies develop problems due to poor management and wasteful practices, but private companies are even more suceptible to such problems because of the presence of the greed factor.  While a government agency may waste a few grand here and there by hiring more employees than they need, or by instituting overly complex procedural structures, private companies waste millions on things like executive compensation packages.  Be honest now, which do you really think is worse?

        I think you are absolutely on the right track with your basic premise in this diary, I just had to throw in my two cents about this because it always makes me mad when people buy into that "government-is-less-efficient-than-corporations-are" hoo-hah.  This is an assumption that has been force fed to us for over a generation, but it does not reflect reality.  It's simply not true.  

        "Leave the gun ... take the cannoli." -8.38, -7.69

        by Balam on Sat Jun 03, 2006 at 09:00:07 PM PDT

        [ Parent ]

      •  Private inefficiency worse than government (2+ / 0-)
        Recommended by:
        alizard, inkadu
        Unfortunately, with health care, this is a fact.  Inefficiency in private insurance companies is much worse than ineffeciency in Medicare; the numbers are there for everyone to see.

        Krugman's explanation for this is that the private insurance companies have an incentive to kick sick people off the rolls, and build giant bureaucracies to do that.  A universal provider doesn't have that incentive, so that part of the bureaucracy is GONE.  Hence the efficiency improvement.

        Similarly, while there are the usual denial-of-coverage issues with Medicare and Britain's NHS, they are much less extreme than they are with private insurance companies.  The mandatory, long-term coverage means that single-payer systems have an incentive to promote cheap, preventative care.

        Oddly enough, private insurance companies often deny cheap, preventative care; this is perhaps because of an emphasis on short-term profits over future profits, combined with the expectation that the insurance company will be able to avoid paying for the long-term illnesses which result one way or another (by arranging for the patient to lose insurance coverage).

        So your second section is just all wrong.  Sure, government will have some issues like you describe, but it will be better in every way than the private insurance "system".  It's sort of like saying "We shouldn't complain about Repulican corruption, because some Democrats are corrupt too."  If both situations are inefficient, the substantially more efficient one is clearly better!

        ---
        The first section is right; negotiated rates are a major reason single-payer systems are cheaper, and opposing them is silly.

      •  Any organization of more than say, (1+ / 0-)
        Recommended by:
        Robert in WV
        50 people, is going to be inefficient and produce waste.

        Large corporations are as full of waste, skimming, strange arcane rules, and absurdly lazy people as any government agency.

        •  I work at a large customer service center (0+ / 0-)

          that's been paying nearly 500 people $76 to do approximately 15 minutes work per day, for several months. And I don't mean 8 hours of work that should take 15 minutes, I mean 15 minutes of work that should take 5 and web-surfing/nerf basketball/Magic the Gathering for 7 hours and 45 minutes.

          All on the prospect of work that should be "rolling in any day now."

          The waste is egregious and this is one of several sites employing roughly the same amount of people.

          To give you an idea of just how wasteful this is, I recently saw a company email to effect of, "agents taking too much time away from their desk will soon face repercussions, 7 minutes of "personal time" per day for each agent equals an additional ~144,000 we will have to bill the client at the end of the year."

          So there you have it, repercussions for "personal time" away from the desk for seven minutes.

          As I said 7.75 hours per day these agents are idle. How much is the client being billed for "available time?"

          A question begs itself, "why isn't someone taking over one these companies and running them more efficiently and thusly reaping the rewards of free enterprise?"

          This is not a heavily regulated industry, there are no "intrusive" barriers to competition....coming from the government.

      •  VA Medical System (0+ / 0-)

        The VA Medical System is a government model that has become very efficient. They negotiate for the lowest price on everything, while maintaining a very high standard of care, in light of the number of patients that they take care of.
        Government programs don't have to be inneficient, they become inneficient due to provisions that have been mandated by Congress that are of benefit to special interest, i.e. Part 3 Medicare Drug Program, which is nothing more that corporate welfare for the pharmaceutical companies. If Medicare could negotiate prices like the VA does, this program would not be near as expensive, and could provide more even coverage to the patients.
        You have to attack the insurance companies, and the Congress critters that are in their pockets. Until this unholy alliance is broken, there will be no move towards a single payer system.
        Insurance companies are callous in their treatment of patients. If they are in the way of 46 million people receiving health coverage, then they should be run over. Single payer systems in other industrialized countries do not rely on private insurance companies. The insurance companies will have to find somewhere else to put their money.
        On a personal note, my wife cannot get here blood pressure medicine because we have no health insurance, and I don't get paid enough to be able to afford the medicine out of pocket. I live in one of the most conservative counties in Texas, Collin County, there is no provision in this county for low income people to be able to get there medicine. In fact, the county shut down the public hospital a few years back. One county commissioner opined that, "Government should not be in the business of providing health care." Of course they have no problem with sending indigent emergency cases to the public hospital in Dallas County, Parkland Hospital.

        They who would give up an essential liberty for temporary security, deserve neither liberty or security. Ben Franklin

        by Blue in Texas on Sat Jun 03, 2006 at 10:38:12 PM PDT

        [ Parent ]

    •  You're both right and wrong (0+ / 0-)

      What I think neither of you realize is that the govt has been using private (both for-profit and non-profit) insurers to do its operational administration for as long as Medicare has existed.

      The govt does high-level Medicare addministration (setting policies) and private companies do most of the day-to-day administration. This combination is what produces the 4-6% admin costs that everyone talks about.

  •  Medicare (4+ / 0-)
    Recommended by:
    rasbobbo, alizard, Robert in WV, bigchin

    I think one of the important points in the discussion is the percentage of administrative expense under Medicare - iirc, it is around 4 per cent. For profit health insurers run in the neighborhood (it's a very nice gated neighborhood, with lots of expensive homes and private security) of 20-28 per cent.  I worked in insurance on the distribution side for six years, and I believe the system is very badly broken.  Single payer is an important option to begin the fix.

    We are democrats: we are the conscience of America

    by ms badger on Sat Jun 03, 2006 at 11:56:28 AM PDT

    •  I worked in the health care admin side (1+ / 0-)
      Recommended by:
      neroden

      where profits were pretty small (comparatively).  It is true that the sales arms make a very good living (your percentages "feel" right to me).

      My concern is that if we fail to take a systemic perspective on health care and blithly go to single payer, we'll just end up with the same problems under the government plan (except the profit motive which would be theoretically eliminated).

      I'd like the discussion to find the common ground that all deserve health care, especially in a wealthy country such as ours.  If we can all get on board with that idea, then we could look at the best system for delivering that care.  And again, I think single payer is probably the best delivery model,  I haven't figured out the funding side, yet, though.

    •  surprising news (0+ / 0-)

      One thing that almost no one is aware of is that Medicare is administered by private insurers. When Medicare was created in 1966, the government decided that it would be more efficient to use the expertise of private health plans (primarily Blue Cross/Blue Shield plans) to process claims, answer member calls, etc.

      To this day, Medicare Part A and Part B (the heart of Medicare) are administered across the nation by a couple dozen regional private administrators.

      So, when you talk about 4% admin costs (I thought it was 6%, but small difference), be aware that this exists in a public/private partnership.

      A final note on Medicare: the AER (administrative expense ratio) is lower than for other forms of health insurance because medical costs are so much higher per person. This is true for private plans as well as govt. Medicare advantage AERs are almost always under 10% for private plans, not far from the 4-6% the govt gets for Fee-for-Service Medicare. The extra few percent in admin costs for private MA plans is largely the result of care management and sales/marketing costs. The care management reduces the MER at the same time as it increases the AER, so that total costs don't go up. One can argue, of course, that we should be trying to reduce the AER and raise the MER instead (MER = Medical expense ratio).

      Just by way of an FYI.

  •  have to get past the idea of health care as (3+ / 0-)
    Recommended by:
    tryptamine, Robert in WV, Balam

    a commodity that is sold to individuals. the nation's health is as important to its security as the defense department or police. people understand that muy pronto when they are injured or become ill. my guess is that many more people die of disease than terrorism. it really is common sense to have a national plan.

    i'm an agnostic, i'd be an atheist if it weren't for mozart

    by rasbobbo on Sat Jun 03, 2006 at 12:20:11 PM PDT

    •  Exactly. (0+ / 0-)

      I know that the Declaration of Independence does not specifically address rights in the same way as the Bill of Rights does, but the wording about life and the pursuit of happiness are simply (to me at least) a summation of who we are and what we (should) stand for.

      When you or someone who you care for is sick, payment and paperwork should not be on your mind at all, and I think the only way we'll get there is with some form of single payer.

    •  You are so! right about this! (0+ / 0-)
    •  cultural change is needed (1+ / 0-)
      Recommended by:
      samddobermann

      if we are ever to make health care available to everyone.  I've noted elsewhere how the single most significant obstacle to universal health care is the conceptualization of health as a commodity rather than as a human right.

      The trick is, how do you generate that shift in the American system of understanding?

      "Leave the gun ... take the cannoli." -8.38, -7.69

      by Balam on Sat Jun 03, 2006 at 09:09:03 PM PDT

      [ Parent ]

    •  You don't have to guess (0+ / 0-)

      More Americans die from bee stings and lighting strikes than foreign terrorism...

      Al-qeada gets lucky and takes out 3000 people in an isolated attack. Heart disease and cancer kill millions of people, every year.

      On the big list of things that kill Americans (if that has anything to do with "security") terrorism does not register. Terrorists could strike with nuclear weapons and still probably not kill as many people that year (retroactively counting delayed deaths) as heart disease and (unrelated) cancer that year.

      This administration does not care how many Americans die on its watch. Take a look at the leading causes of death and ask yourself how far down you have to go to get to a cause they've even ostensibly attempted to mitigate, or rather don't, unless you have a well-stocked bar or a large standing army.

      •  Heck (0+ / 0-)
        Plain ordinary flu kills around 45,000 Americans every year.

        Medical errors kill around 90,000 Americans every year. In "the best system money can buy."

        If we gave the CDC the budget spent on the Iraq war...

      •  Repugs don't care (0+ / 0-)

        All one would have to do is look at the history of the emergence of the AIDS epedimic in this country, and how Ronald Reagan refused to even acknowledge it, even when one of his friends, Rock Hudson, died of the disease.
        This country is going to have to get past its aversion to taxation for any progress to be made on a single payer health care system. Let us not forget that the single payer that we should be talking about is the government.

        They who would give up an essential liberty for temporary security, deserve neither liberty or security. Ben Franklin

        by Blue in Texas on Sat Jun 03, 2006 at 10:48:29 PM PDT

        [ Parent ]

  •  What Would BushCare Look Like (0+ / 0-)

    I'm very much in favor of single payer, but I had a very frightening thought this morning, and I'll admit it:  What would happen if President Bush, as the Commander in Chief of national healthcare, could issue executive orders that would influence nationwide provision of healthcare?  Based on his track record, he would try to banish science from the provision of medicine, would exalt the unborn and the undead over the living and breathing, and would try to control ever aspect of our medical care for the sake and in the interest of our MORAL health.

    Medicine is an industry - one of the biggest in the country, and no one is going to nationalise it except as part of a general realignment of politics toward the left in this country.  Any scheme that attempts to retain the profits of the current players will be too expensive to be beneficial.

    •  Yes. Emphasize moral + public health arguments (1+ / 0-)
      Recommended by:
      Robert in WV

      I support a single-payer system, and while I feel the public may not be ready yet to accept it, Democrats need to start talking about long-term solutions to health care. It is important that we frame it in primarily as a moral issue: every American citizen has a right to basic care, just like citizens of all other industrialized nations. The public education analogy is an important one to make, and I think many would support a phased approach that covers children first. (Isn't it absurd to argue that all children should be educated, but whether they get to see a doctor should depend on their parents' income?)

      The second argument is one of (anticipated) results. We should say how many lives will be saved if everyone has access to preventative care, how many women won't be faced with having an abortion if they have access to birth control, how essential swift care is in fighting epidemics. Universal health care isn't just moral, but will result in positive outcomes (measured in healthy people) if successfully enacted.

      Republicans will try to say that the private sector is more cost-effective, but we know that the current system is wasteful because of (1) enormous profits, CEO salaries, etc. and (2) many large, parallel bureaucracies that divert money from actual care. A single-payer system would create a single, integrated bureaucracy rather than many inefficient, disparate ones. Additionally, we do pay (in higher costs) for the uninsured, because they receive uncompensated emergency care (ironically, often in cases where preventative care would have been cheaper). However, this efficiency argument must take a backseat to the moral and public health concerns; we will never win an argument with conservatives on their turf (where the important thing is cost rather than care).

      •  Excellent points... (0+ / 0-)

        ...terrible conclusion.

        5 years from now Republicans will be known as heavy-weight champions of waste and inefficiency.

        There is an argument to be made for efficiency and the repubs will not win it. It involves a clever sythesis of public and private administration and as you said, a much more singular bureacracy.

        There are so many simple and extremely demonstrable talking points about the wild fiscal irresponsibility of this administration, its truly unbelievable, and when we get around to comparing the most recent D and R adminstrations it will be clear who champions bureacratic efficiency.

        •  But efficiency isn't the most important goal. (0+ / 0-)

          True, the Republican party right now IS the party of waste and inefficiency. But those conservatives who are honest enough to see how wasteful and fiscally irresponsible this Congress/administration are will conclude that this is because they have been TOO ambitious in spending. The conservative ideology holds that the free market is always most efficient (and, in fact, moral); thus a private solution is always preferable to a public solution. (We have seen this with their attempts to privatize education and Social Security.) I'm convinced that any conservative willing to admit that the current health care system is grossly inefficient will nevertheless believe that a public solution would be even worse.

          Of course we shouldn't ignore this waste and and incompetence on the part of Republicans, or refrain from criticizing such poor leadership. But in order to reach those whose minds we can change, we must talk primarily in terms of progressive values (i.e., society is best when everyone has access to health care) rather than conservative values (which emphasize things like cost, risk, and wealth). Sure, we want to minimize overall cost, but our most important goal is to maximize care.

          •  I totally agree (0+ / 0-)

            as I say I think your point about stressing it as a moral issue is solid.

            I would just like to stress that the Republican party post-Bush will not have the kind of automatic acceptance of superiority in issues of economic theory that it once enjoyed with the public at large.

            A conservative dem would (sadly) probably have great traction fighting for privatised health care, but that's not who'll we'll be fighting (at least outside my nightmares).

            All I'm saying is that however we initiate the marketing campaign for it, we should face questions of efficiency and socialization vs. privatisation head on, and not suffer the every-other-example-in-the-industrial-world-defying bullshit that moving even closer to utter privatization would be more efficient.

            Its definitely a moral issue and it should be actively marketed that way, but we have no more to fear from conservatives on efficiency or privatisation than we do on defense or civil rights, and we must not fail to attack the fallacies of privatisation head on.

            The media response of course will be brutal, but unless we own them or have much more stringent liscensing, that will be the case on every issue.

      •  Polls (0+ / 0-)

        Polls show that 70% of Americans are in favor of a single payer health care plan.

        They who would give up an essential liberty for temporary security, deserve neither liberty or security. Ben Franklin

        by Blue in Texas on Sat Jun 03, 2006 at 10:50:02 PM PDT

        [ Parent ]

      •  Bankruptcy... (0+ / 0-)

        We're also forgetting how medical bills contribute to poverty. Medical bills cause bankruptcy, which causes poverty. Once you're broke, you tend to stay broke. One of the things we can do for American families over the long haul is to protect them for natural disasters that can through any middle class family into poverty.

        I think attacking private insurance and "big hospitals" are a fine political tactic. People hate rich people, and they hate rich people who possess their homes because they can't pay medical bills (Yale Hospital) even more. We're not going to win this fight without a little school-yard emotional reasoning, because we also have to fight the "big government is checking my prostate" phobia.  

      •  Perfect synopsis (0+ / 0-)

        I think you added anopther bullet to the gun with:

        However, this efficiency argument must take a backseat to the moral and public health concerns; we will never win an argument with conservatives on their turf (where the important thing is cost rather than care).

        I only mentioned efficiency and negotiated rates in the diary to say that we need to get away from those agruments.

        This MUST be framed in terms of a values debate (though I still hate throwing the word values into the political realm of debate).  But anyway, we must set the terms of the debate so as to force the opponents to have to stand up and say that health care is NOT a right.  Then and only then will we expose the greed and ruthlessness of the republican position and the corporate greed.  As others have echoed earlier in this thread, "my child is not your profit vehicle."

  •  i love this dicussion (0+ / 0-)

    all you intellectuals/experts in this area of healthcare, please keep up the discussion, please figure out what to do.  

    i have nothing really to add to it because i'm only a nurse and don't understand the business side of the healthcare world.   but i do believe all americans should have the right to health care.  nothing is more frustrating and upsetting to see patients worry if they can pay for tests and procedures instead of concentrating on getting better.

  •  Every single person in this country... (0+ / 0-)

    ...could have health insurance for less than half of what we spend on the military every year.

    We do no have to go the way of the UK or Canada. We can have have our current system AND a system that allows everyone, no matter where they work (or don't) or what their financial situation is.

    We provide insurance for children and those over the age of 65, that 47 year gap is the problem. Most of those years, the health care costs incurred are minimal. Routine screenings, yearly checkups...that is it.

    But by providing those very inexpensive services to people who are by and large healthy....we help them remain healthy, and vastly reduce the costs at the end stage. If we spend 200 bucks for check ups for 200,000,000 people, and those check ups avoid a trip to the ICU for a few days for just a tiny fraction of 1% of them....we SAVE money by doing so.

    It costs less to insure everyone than it does to only insure people who are likely to need medical care.

    Even if we wouldn't save money (and we would)....it would still be the RIGHT thing to do. Richest country on earth, we earned our healthcare, every damn one of us.

  •  Health Insurance Company 'Bashing' (0+ / 0-)

    I just think that health insurance company bashing is not the proper approach to arguing for single payer. Initially, it will lose you any support form the free-market, capitalism-at-all-costs types.  Additionally, many of the ills we're talking about with for profit insurance companies WILL still exist under almost any single payer system.

    I've listened to Bush on the stump when he's pushing Health Savings Accounts.  The line that gets him the biggest applause is We need to get the insurance companies out from in between the patient doctor relationship

    It's a great line that works with everyone - it doesn't much matter to him that HSA's don't do that.

    Insurance companies don't deliver health care - health care providers do. Insurance companies that "manage care" which most do now in one way or another - just get in the way and drive up costs.

    Competition exists in Single Payer systems - including Medicare - providers compete on service, quality and efficiency. Fees are in plain sight (diagnosis based) for all to see.

    I'm not sure what "ills" you're refering to but the supply side waste that exists in the current system will be eliminated in most single payer models.

    There's a great book written by Kip Sullivan titled the "The Health Care Mess (How We Got Into it and How We'll Get Out of It)" ISBN 1-4208-8551-0 that should be required reading for anyone looking to change the existing system.

    •  Back up (1+ / 0-)
      Recommended by:
      Robert in WV

      I'm just going to back you up, there, dorsano.

      Health care wonkery is fine, but for fuck's sake, universal health care is so fucking obviously the way to go that OBVIOUSLY it's not because our side can't make a decent argument. I mean, how many more goddamned countries with universal healthcare are going to have to beat the United States in life expectancy, child mortality, yearly check ups, etc., before people realize that our system is a disaster? There is no RATIONAL argument to be made that has not been made.

      Instead what we have is a generalized distrust of government, courtesy of Ronald Reagan and the conservatives. That is primarily an emotional argument. And the way to beat that emotional argument is another emotional argument. Let's make people MORE afraid of insurance companies. Let's spend MORE time talking about how insurance companies, by evolutionary theory, MUST deny benefits, MUST raise their rates on the sick, MUST screw us over, because they are in business to make a PROFIT, and they make a profit when they REFUSE CLAIMS. It's a terrible goddamn system, and it looks like I was just using reason again, but to sum it up emotionally, "Claude's sick kid is not a vehicle for profit."

      And one more thing: It's about MONEY, and it's about MONEY going to Democrats as much as Republicans. The reason the left hasn't been able to win universal healthcare is not because we don't have the arguments. It's because we don't have the politicans, and we don't have the party. The Democratic Party is itself chock-full of people who peddle conservative, free-market, de-regulatory bullshit propaganda while lining their own pockets. If 100% of elected Democrats would get behind Universal Health Care and argue for it Sunday morning, we would have it. Period.

      •  Back Me Up to Where? (0+ / 0-)

        I don't think I said anything that you disagree with - if  so, please point it out.

        The author of this diary is pointing that bashing insurance companies raises red flags in people's mind and sets up resistance

        that's true - I've seen it first hand

        The author of this diary suggests that the red flag is being raised because they think the insurance company bashers want "government care"

        that's ture - I've seen it first hand

        I am trying to suggest politely that we help people make the distinction between insurance companies and health care providers (doctors, clinics and hospitals).

        Apparently I'm not very good at it - at least in blogsphere - though neighbors, in real time are different another matter I think.  

      •  Universal Health Care (0+ / 0-)

        Health care wonkery is fine, but for fuck's sake, universal health care is so fucking obviously the way to go that OBVIOUSLY it's not because our side can't make a decent argument.

        Most people in the country want some sort of national health insurance - universal coverage.

        There are two things, in my experience, that get in way.

        1). Deep down inside, people are concerned that's it not affordable - thus people need to be shown where the waste is in the current and be convinced that the savings will be recaptured.

        2). The health care insurance and pharma industries reach deep into both parties.

        The Democratic state senator in my district is a perfect example - she's blocked single payer legislation and every incremental step toward single payer since she took office over 15 years ago.

        ---

        Any idea who all voted for the HMO Act which privatised a portion of Medicare and turned it over to HMO's to administer? Check out the Democratic Party - many of them are still office.

        Where do they stand now I wonder?  

  •  Yes to Single payer (0+ / 0-)

    Yes, to single payer but run by who?
    The government-Medicare administration?
    Special Interest Influence still overwhelming.
    Example:Medicare part D ( No drug price negotiation)
    Illegal to buy drugs in Canada-unsafe-Hm.

    HMO, Big Clinics or in general mangaged care plans.

    CEOs with 10 million and over salaries
    Cost of administration at least 34%!
    Closed panels and thus cannot choose your Doctor
    Ominous contracts we call non-competes that prevent doctors from practicing medicine as they were taught.(You lose your job if you disagree)

    Citizens yes, as they will use there everyday commonsense if they are given a mechanism to do it with. I urge you to read the diaries on Health Security America that will give us birth to death insurance with no premiums for those under 19. It will be forbidden to accumulate date and at the same time will set premiums and coverage and above all have a mechanism to control personal health costs. You can find the diaries at www.healthsecurityamerica.com
    Thank you for reading.
    fredb
     

  •  Freudian Misreading (0+ / 0-)

    When I read the title of the diary, I thought it said:

    "SINGLE PRayer Healthcare"

    I thought it was another Faith Based initiative that would save healthcare costs by using Prayer alone, but rising costs forced them to reduce the number of people praying for the sick to one PRAYER per person!

    Sad thing is, I had no problem believing this could happen..

  •  I'm honored (1+ / 0-)
    Recommended by:
    nativist

    that so may people are engaged in this debate.

    There are a lot of great ideas and talking points being bandied about.

    Perhaps we should have a regular Saturday diary in which to meet to refine and polish up these talking points.  Topics might include:

    1. which topics to avoid/downplay (like efficiency and negotiated rates)
    1. which topics to emphasize such as the morals angle.  That one should really put the right-wing fundamentalists in a corner, so to say.
    1. different approaches to the debate.  Some people need facts and figures, which we could find collaboratively with the force of a group of people working together.  Some people will respond better to a Biblical/religious based line of argumentation.  Jesus has a lot to say about caring for your fellow man, especially those who are less fortunate.  Perhaps the wisdom of other religions could be brought into the debate as well.

    (4) Pre-formatted responses to the generic republican/corporate talking points, with ready-to-use evidence to refute them.

    And anything else anyone wants to add to the debate.

    Again, thanks to everyone for helping me refine my thoughts on this topic and sharpen my responses.

    •  My approach when discussing this topic (0+ / 0-)

      has been to argue it on their terms. Usually, conservatives object to single payer on the grounds that government should not be providing this service.

      I've found that garden-variety conservatives are usually against single-payer because they are in favor of a smaller government, which means that they do not want to provide social welfare programs. I will usually then ask "Why is it that the government should be in the business of providing defense and police services, but not providing healthcare?" They will usually argue in some fashon that defense should be in the realm of the federal government, but healthcare (and other social "saftey net" programs) should not.

      Then I quote the preamble to the constitution "We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defense, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America."

      I then point out to them that providing for the well-being of the populace is one of the prime functions of government, as set out by the founders.

      Objective truth is not the same as consensus reality

      by djheru on Sun Jun 04, 2006 at 09:15:29 AM PDT

      [ Parent ]

    •  Robert, I'm with you on this! (0+ / 0-)

      The discussion concerning this has been very enlightening to me. In your original column at the very end you said,"And the only way to do that is to effectively nationalize it like education and the military."

      That woke me up. Nationalizing brings to mind Castro taking over Del Monte and Dole in 1959. Or what Chavez is in the midst of doing down south. The N word sends a chill through any corporation since it means the same as death to a person.

      But if in fact a forum is raised to formatt readily engaged "talking points" et al, it would be wisest at least in the early stages not to invoke the wrath and fury of insurance companies and their lobbyists this early on. I much prefer what was said about "moral right", citing the Declaration and so on.

      Another item not specifically brought up is the benefit to business by expanding Medicare into a single payer system, tax funded. At least I've been led to believe that the cost of private health insurance has become a millstone upon the yoke of business, from GM, Ford and on down. Proponents of Nat'l Health could end up with some strange bedfellows with very deep pockets.

      I'd like to see a wizard step out from Madison Ave or wherever that could package this sturdily enough to sail it past the insurance doomsayers and into the House and Senate.

      Bottom line-we're going to need some some real good friends on this. In order to do that, we're going to need to apply a litmus test for the '06 contenders. There's still time, but we need to get on it. Parse those against change. Maybe that's single issue politics, but it certainly is the biggest.

      Yes, a change is certainly needed, not merely a change of party but a change of system -Eugene V. Debs

      by nativist on Mon Jun 05, 2006 at 06:32:53 AM PDT

      [ Parent ]

  •  Two thoughts (0+ / 0-)
    1. How to keep a govt managed single-payer system simple?  As was obliquely alluded to by someone above, many "inefficiencies" in govt systems are the result of some Congresscritter slipping an obscure porkbarrel rider into an unrelated appropriation - a little set of "rules" that benefit some local constituent and make certain processes just a bit more complex (and inefficient).  Multiply by 435 and the annual number of appropriations bills and the execution of even the simplest, most straightforward task turns into a calculation too complex for string theorists.

    So - how do we control for this?  And can we?

    1.  Has anyone run the numbers regarding the total current cost (including state government costs) of Medicare, Medicaid, VA and Social Security disability benefits?  Would a single-payer plan that absorbed/replaced all of these cost the same?  More? Less?

    Private life is all about managing pain. In business and government, this means externalizing and deferring costs whenever possible.

    by sxwarren on Sun Jun 04, 2006 at 09:41:00 AM PDT

  •  Health Care in America (1+ / 0-)
    Recommended by:
    Robert in WV

    Thanks for this diary.  I hope you continue doing this kind of thing.  The country is ready for health care change.  And, as with Iraq, the people are ahead of our shamefully inactive Congress.

    •  I'll keep posting updates (0+ / 0-)

      and an 'evolution' to our thoughts here.  Maybe we can have something useful for next year's YK07.  I'd love to be able to go and meet up and discuss this topic as it's near and dear to my heart.

      So, that gives us about a year to come up with something solid.

      Enjoy the week.  Hope you can drop by next weekend.

  •  Multiple Efficiencies (0+ / 0-)

    The beauty of single-payer is how it simplifies the entire healthcare process:

    It saves money for businesses, large and small, by not forcing them to shop for insurance and monitor the insurance companies for cost-effective service.  Conservatives in business should love that.

    It saves money for healthcare providers, large and small, by not forcing them to have a large staff just to handle insurance claims.  Conservative healthcare providers should love that.

    Public Citizen did a major study on these savings:
    http://www.citizen.org/...

    Not keeping our citizens healthy, starting from pregnancy, would be like a large corporation letting millions of pieces of equipment fall into disrepair.  Tools that are well-maintained allow more efficiency and competitiveness.  Our national productivity and ability to compete depends on having healthy, well-educated workers.

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