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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.  


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:

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:

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.


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:  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.


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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