Skip to main content

American health care reform has been historically difficult to achieve, both for structural and political reasons. Many of you have heard of, or are advocates of, HR 676, the The United States National Health Insurance Act, a single-payer national health program. Maybe you heard about a Senate universal health care proposal, The Healthy Americans Act, cosponsored by 12 Senators. Perhaps you've been wondering what its chances are for passage. Perhaps you've been mulling over the health plans from Clinton, McCain and Obama (and Edwards), trying to do some comparison shopping. Or, perhaps you just want to know what to expect with a new President in the White House. This review of health reform data will hopefully help put the difficulties of enacting reform in perspective.

For starters, let's look at the political side via this tutorial from Kaiseredu.org. It's important to note that while health care remains an important issue that matters in the upcoming election (along with Iraq and the economy), Republicans, Independents and Democrats do not agree on the issues or the relative importance of health care as an election issue. Those with insurance are satisfied with their own health care coverage (83% to 93% depending on the question), but fear paying more for care (41%) or losing coverage altogether (29%). That >80% satisfaction is a key finding, because people satisfied with what they have a) don't want to give it up and b) are less likely to push for change. And when asked to rank health care along with other important issues facing Americans, Democrats tend to rate health care as more important than either independents or Republicans, so the push for health reform is not unanimous by any means.

Another important difference is that Republicans are more worried about cost-containment and Democrats more interested in expanding coverage. This leads to the following caveat; while much of the public agrees with the goal of  increased coverage, there is no agreement about the best solution to get there. In fact, when all solutions are considered, single payer is way down on the list of "best solution", coming in at an anemic 37% (see slide).  Needless to say, that doesn't make bills like HR 676 any easier to pass. By the way, the uninsured are substantially less likely to vote (in 2002, 30% of the uninsured under 65 voted compared to 49% of the insured under 65).

See also the ambivalence about government vs private insurance in providing medical coverage (government better - 21, private better - 60 if you are a Republican, government better than private 41 to 36 for Democrats. A fifth of the country thinks they are the same or does not know).

By the way, another reason to suggest a lack of political pressure is to  look at the habits of voters. As seen in the slide, half the voters vote on issues, the other half vote on character, values, experience, leadership etc. Given that split, it's tough to make a case that the public is driving change, or that 2008 will be the year health care reform is going to decide the election all by itself.

Well, that's public opinion and public opinion can change. So what do the academics say about the likelihood of health reform and changes in health care financing (i.e. the structural side)? Eh, maybe chances are not so high, at least right away. Echoing the theme of non-agreement of what to do, an article in Health Affairs by Victor Fuchs (the Henry J.Kaiser Jr. Professor Emeritus at Stanford University and a research associate at the National Bureau of Economic Research) writes

Enduring reform must cover the uninsured, reduce inefficiency in funding and delivery of care, improve quality, and tame but not destroy the development of new medical technologies. Obstacles to reform include "special interests," especially as they exploit the U.S. political system; Machiavelli’s Law of Reform, which favors the status quo; and the inability of reformers to agree on a common approach. Short-term prospects for enduring comprehensive reform are virtually nil. Over five to ten years, prospects are fifty-fifty unless there were a major economic, political, social, or public health crisis. In the long run, major reform is inevitable.

So what is Machiavelli's Law of Reform? From The Prince:

He who desires or attempts to reform the government of a state... must at least retain the semblance of the old forms, so that it may seem to the people that there has been no change in the institutions, even though they are in fact entirely different from the old ones.

Still, a major asset to reform hopes is the possibility of same-party control in DC. That has to improve chances of reform but as noted, also in Health Affairs, by William L Roper (dean of the University of North Carolina at Chapel Hill (UNC) School of Medicine and chief executive officer of the UNC Health Care System):

The 2008 election will focus renewed attention on fundamental health care reform. Lessons from past politically driven reform efforts show that although fundamental reforms may make for good politics, a systemic shift in how health care is financed and delivered is unlikely to occur. Calls for fundamental reform over the past twenty-five years have prompted incremental changes that have had a major impact on the U.S. health care system. Many of these changes were driven from outside the political system. The forecast based on past experience is not radical change; it is more of the same.

That resistance to change is something we've covered here. It's partly a function of the resiliency of the health care system, and partly a function of a lack of political pressure to make changes.

Nonetheless, change is in the air. Single party rule in DC is possible (more so for Democrats than Republicans, and Democrats rate health care a higher issue than Republicans do). Costs are driving business and consumers alike to consider health reform. The NY Times this month:

The American carmakers’ problems underscore the need for a government-backed system of universal health care, which would relieve some of the costs that have made competing so much harder.

Who knows? With a Democratic victory in November, and a leader in the White House, a recession in the economy and business pushing to reduce costs, we may just get the perfect storm of events that'll move the ball down the field.

Friday, Feb 29, 2008
A new poll on health care from NPR, the Kaiser Family Foundation and the Harvard School of Public Health finds that a majority of Americans are backing key elements in the health reform proposals of Democratic presidential candidates Hillary Clinton and Barack Obama.

But even if that happens, check the conclusion from the NEJM authors:

Looking forward, the ranking of health care as a top issue in the primaries and plans for serious health care reform proposed by both Democrats and Republicans are major steps toward a larger debate in the 2008 general election and beyond. However, the intensity of the debate, and whether it engages the nation the way the last great health care debate did in the early 1990s, remains to be seen. In addition, the prospects for actual health care reform are tempered by two factors: the wide differences in the two parties' views of what health care reform should look like and the current level of satisfaction that majorities of both parties have with their own health care situations.

Reform needs to happen. Just don't expect it to all happen at once (childrens' coverage has more consensus than adult), or at the expense of what people already have, or even to necessarily look radically different (see Machiavelli), whatever anyone promises.

Sources
This is a follow up on Daily Kos posts here (Medical Crisis: The Shape Of Things To Come), here (Perspective on Health Care Reform), here (What's The Effect Of Recession On The Health Care Safety Net?), and here (Health Stories: HR 5449). The posts use public opinion polling from Kaiser, here with a summary tutorial, narrative supplied by Claudia Deane (formerly of the Washington Post polling unit). Further elaboration appears here in more academic form published in the January 24 New England Journal of Medicine with co-authors from the Harvard School of Public Health and John F Kennedy School of Government). The latest poll from NPR/Kaiser/HSPH is dated 2/28/08, and available here.

Originally posted to Daily Kos on Sun Mar 02, 2008 at 05:32 AM PST.

EMAIL TO A FRIEND X
Your Email has been sent.
You must add at least one tag to this diary before publishing it.

Add keywords that describe this diary. Separate multiple keywords with commas.
Tagging tips - Search For Tags - Browse For Tags

?

More Tagging tips:

A tag is a way to search for this diary. If someone is searching for "Barack Obama," is this a diary they'd be trying to find?

Use a person's full name, without any title. Senator Obama may become President Obama, and Michelle Obama might run for office.

If your diary covers an election or elected official, use election tags, which are generally the state abbreviation followed by the office. CA-01 is the first district House seat. CA-Sen covers both senate races. NY-GOV covers the New York governor's race.

Tags do not compound: that is, "education reform" is a completely different tag from "education". A tag like "reform" alone is probably not meaningful.

Consider if one or more of these tags fits your diary: Civil Rights, Community, Congress, Culture, Economy, Education, Elections, Energy, Environment, Health Care, International, Labor, Law, Media, Meta, National Security, Science, Transportation, or White House. If your diary is specific to a state, consider adding the state (California, Texas, etc). Keep in mind, though, that there are many wonderful and important diaries that don't fit in any of these tags. Don't worry if yours doesn't.

You can add a private note to this diary when hotlisting it:
Are you sure you want to remove this diary from your hotlist?
Are you sure you want to remove your recommendation? You can only recommend a diary once, so you will not be able to re-recommend it afterwards.
Rescue this diary, and add a note:
Are you sure you want to remove this diary from Rescue?
Choose where to republish this diary. The diary will be added to the queue for that group. Publish it from the queue to make it appear.

You must be a member of a group to use this feature.

Add a quick update to your diary without changing the diary itself:
Are you sure you want to remove this diary?
(The diary will be removed from the site and returned to your drafts for further editing.)
(The diary will be removed.)
Are you sure you want to save these changes to the published diary?

Comment Preferences

  •  mcjoan will be posting later this afternoon (25+ / 0-)

    on the presidential candidates and their suggested solutions.

    SNL and others can make fun of the 'boring' health care debates, but it'll become a good deal more heated when the D and R debates happen.

    "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

    by Greg Dworkin on Sun Mar 02, 2008 at 05:37:18 AM PST

    •  excellent review (10+ / 0-)

      thanks for this post.  

      on the political side, perhaps it's worth adding into the equation that Obama is a young candidate and (I think) one we're expecting health care reform from.  I assume he'll be running again in 2012 and asking for our support.  The flip side of that is, my gut says the political pressure will be off if there's an Obama second term, so if we don't get health care reforms made in Obama's first term then they're not going to happen.

      on the mechanics and economics of how health care works now (hint: it's not just "greedy corporate profiteering"), there was an outstanding post-length comment from RickB explaining the costs of the current health insurance system that I'm indebted to him for, and that those who are interested in that sort of thing may want to read over.

      •  emptypockets, Obama has promised . . . (11+ / 0-)

        repeatedly on the campaign trial, healthcare reform will happen before the end of his first term.

        I hope and believe the American people will hold him fully accountable.

        •  holding him to it (4+ / 0-)
          Recommended by:
          skiddie, Rolfyboy6, nyceve, Buffalo Girl

          when you put it that way, I have to recognize the reality that if he's in office and running for re-election, most of us are going to support him with little regard for his record or whether he's held to any of his promises (which have sometimes been diluted or re-parsed by changing circumstances in the past).  Perhaps our focus should better be rested on Congress?

          But to clarify my comment, I was reacting to DemFromCT's quote from Fuchs about short-term reforms unlikely, 5-10 year reforms an even bet, and long-term reforms inevitable.  Politically it is hard for me to imagine that 5-10 year reforms (basically Obama's second term) will be more likely than short-term reforms.  But again, perhaps I am seeing the reform process too president-centrically.

          •  Hell, no. (5+ / 0-)

            ...if he's in office and running for re-election, most of us are going to support him with little regard for his record or whether he's held to any of his promises...

            If Barack fails to do the job, we must primary him.  It know it's painful, but (like loving parents) Progressives must be prepared to administer Tough Love.

            Since nobody here wants to vote Republican, Green, or Nader, the only weapon we have is a Primary challenge against Congressmen, Senators, and (yes, Virginia) Presidents.

            •  Heh (3+ / 0-)
              Recommended by:
              Rolfyboy6, nyceve, wishingwell

              ...Progressives must be prepared to administer Tough Love.

              They have been so unwilling to do that so far, do you think they ever will?

              If they do every do it, boy will it be ugly!!

            •  way to miss the point (2+ / 0-)
              Recommended by:
              elfling, gloryoski

              first of all, unless he's an utter disaster, any primary challenge against "President" Obama that "we' try will fail.

              Second, the point of leverage if YOU REALLY WANT CHANGE is CONGRESS and always will be.  People need to stop focusing on the Presidential race and start focusing on Congress.

              And the other point I think DemfromCt is making is that if you really want healthcare change, especially single payer, the public needs to be persuaded before any Congress or President will make it happen.

              "The only thing necessary for the triumph of evil is for people to mistake writing angry diaries on political blogs for doing something in the face of evil."

              by Buffalo Girl on Sun Mar 02, 2008 at 09:10:30 AM PST

              [ Parent ]

              •  Congress is more important... (0+ / 0-)

                ...I 100% agree.

                But I am objecting to the idea that a Democtratic President becomes immune to Progressive concerns once elected.

                If we hire someone to do a job, and they don't do it, we have to be prepared to fire them.  Otherwise they will keep messing up.

                But perhaps we should table this discussion until 2009...!

                •  regardless of what you think (0+ / 0-)

                  they WILL be immune because it is unlikely you will have ANY capacity to fire them.

                  "The only thing necessary for the triumph of evil is for people to mistake writing angry diaries on political blogs for doing something in the face of evil."

                  by Buffalo Girl on Sun Mar 02, 2008 at 09:51:16 AM PST

                  [ Parent ]

          •  I agree (1+ / 0-)
            Recommended by:
            nyceve

            I think whoever wins, it is imperative it happens in their first term.  If it doesn't happen, the obit will be waiting again and we will have to wait another 15 years.

            In that sense I agree it is much more likely we will have health care reform within 2 years, rather than 10.

            With that said, I think that Obama's plan is so unworkable it doesn't have a prayer of passage.  The only question is if Congress can pass something other than the president's health care plan.

        •  I'd be very pleased if much gets done (2+ / 0-)
          Recommended by:
          nyceve, gloryoski

          already the lowering of expectations is beginning.  It's hard work gettin' health care, hard work.  And we gotta cut them costs first....

        •  After they "hold him fully accountable" ... (1+ / 0-)
          Recommended by:
          Buffalo Girl

          ... health care reform will take another 15-year siesta.

          The Great Obama might saw the lady in half, but he won't make the elephant disappear. The Confluence

          by RonK Seattle on Sun Mar 02, 2008 at 08:53:58 AM PST

          [ Parent ]

      •  Obama (4+ / 0-)
        Recommended by:
        Rolfyboy6, emptypockets, nyceve, lamzdotes

        I believe he has promised universal health care in his first term. (Not that I believe it will happen.)

        •  He has made that promise, but ... (2+ / 0-)
          Recommended by:
          OLinda, deliciae

          ... his proposed solution does not fulfill that promise.

          And all three leading Dem's introduced "universal" plans that offer palliative care for the existing system, while vesting that system more deeply.

          The Great Obama might saw the lady in half, but he won't make the elephant disappear. The Confluence

          by RonK Seattle on Sun Mar 02, 2008 at 09:01:52 AM PST

          [ Parent ]

    •  DfC, even though it is a minority (6+ / 0-)

      that have been touched by "healthcare" issues or have a friend/family member affected.

      They are likely to be a great deal more involved in the political process and bring more people into it.

      I have excellent health care and never have had a complaint vis-a-vis any of my kids or wife. But my mother doesn't have insurance. Seeing that has caused me to do donate spend tens of hours campaigning for politicians who will pursue health care reform.

      Many of the political activists i've talked to consider this their #1 issue.

      So if the next Dem president wants to keep his job...s/he'll have to make sure this gets done.

      •  and there are those (2+ / 0-)
        Recommended by:
        Pat K California, Rolfyboy6

        who have healthcare but the premiums and deductibles are quite high. So many with insurance are finding they cannot afford insurance with the increased rates and the deductibles keep climbing higher and higher. When people have to pay so much out of pocket and more and more procedures are not being covered at all; that is also depressing people and discouraging them.

        An individual has not started living until he can rise above the narrow confines of his individualistic concerns to the broader concerns of all humanity.

        by wishingwell on Sun Mar 02, 2008 at 08:13:29 AM PST

        [ Parent ]

        •  My Thoughts Exactly ... (0+ / 0-)

          I have medical insurance. But I'm desperate for health care reform because I do not know how much longer I can continue to scrape together $11,000 per year to pay for it!!! Lately that rate has been boosted every 6 months. When will I hit that fateful day where I simply can't pay the bill and have to "go naked"? And now DemfromCT says that meaningful reform, although "inevitable", won't happen realistically for "maybe" 5 to 10 years??? CRAP.

    •  Agree, excellent diary (5+ / 0-)
      Recommended by:
      DemFromCT, skiddie, Rolfyboy6, elfling, fayea

      One thing you don't really draw out is the implications of these polls for single payer vs. multi-payer.

      I wouldn't be surprised if there are also some polls that indicate more than 50% support for single payer, but I think the evidence is overwhelming that there is simply no chance of passing a single payer scheme like Canada in the next 8 years.

      Single payer advocates I think really should re-conceive their role in this debate. They should think of themselves as setting the "left" position in contrast to which multi-payer universal health care is the compromise. Because if the debate is only seen to have multi-payer UHC vs. no UHC at all, then in the next eight years the compromise will be an expansion of child health care and not much else. But if a Democratic president can present a UHC scheme as non-radical in contrast to single payer, then I think the chances of getting everyone covered go up.

      By the way, as I periodically state in health care debates, my current employer is a health insurer. My full take on the difference between the two, based on an analysis of other nations, is that single-payer tends to be slightly more efficient than multi-payer UHC in terms of reduced admin costs (on the order of 1% of total costs or less). On the whole, there is no net impact on the quality of care or access to care. National decisions about how much to spend determine whether (and for what conditions) there is significant rationing of care.

      Most importantly, both types of systems can be far better than the current US system, spending around 10% of GDP on health care rather than the 16% we current spend, with quality of care as good or better than that in the US and access to care better than in the US except (usually) for elective treatments and end-of-life care (much of which in the US is of very questionable value in terms of improving QALY--quality adjusted years of life).

      •  Single Payer... (2+ / 0-)
        Recommended by:
        jd in nyc, wishingwell

        ...is unachievable any time soon.  You are absolutely right.

        It is one of the things, maybe the main thing, that always pissed me off about Dennis Kucinich.  All the way back to 2004 he seemed to be under the very mistaken impression that all he had to do was stand up in a debate and announce that America needs single payer.  He (and many other single payers) totally miss the boat on what they need to do.

        They are so rabidly sold on why single payer is the only workable solution, they assume that if they just stand up and say this is what we need that people will be convinced.

        They are also go to meetings all the time made up of mostly single-payer advocates and so just get caught up in thinking there is a huge grassroots movement for single payer health care.

        I'm sorry, but there is not.

        Most people have heard about single payer and rejected it.  The single payer movement needs to be re-worked from the ground up.

        I agree with you that it has critical elements to add to the debate, and very well may be what we need in this country.  But the popular support is simply not there, and that realization requires a fundamental change in approach for single payer advocates.  And I say that with love.

        •  Wrong. (4+ / 0-)

          Over the course of 2007 polling data has markedly improved for single-payer. A 2007 Field Poll (link is in a reply to DemfromCT somewhere in this thread) showed a 12% increase in support for single-payer here in CA, and another poll from August showed that among CA small business, single-payer was the preferred option, the only one that got majority support.

          I agree that the single-payer movement has a lot of work to do, and that part of it involves reworking the message. But you are wrong to say that "the popular support is simply not there." Even if it wasn't there, wouldn't that mean our job is to produce that popular support?

          Single-payer is not just the best option. It's the only option.

          I'm not part of a redneck agenda - Green Day

          by eugene on Sun Mar 02, 2008 at 08:31:15 AM PST

          [ Parent ]

          •  Thinly sourced (1+ / 0-)
            Recommended by:
            jd in nyc

            Wow, you can slice and dice a couple polls from California! That proves the movement of hundreds of millions of single payer advocates is being ignored yet again!!!!!!!!

            It's exactly that attitude that is going to make single payer that much further out of reach for you, me, and everyone else.

          •  We can wait for single payer until the cows come (0+ / 0-)

            home.  Meantime, more and more of us will fall into the ranks of the uninsured.  

            At the end of the day, I would love to see a single payer system put in place but on a practical level, it's not going to be the first plan that the politicos turn to.  When you're talking about eradicating an entire industry, particularly one that donates LOTS of cash to those who make these decisions, it's highly unlikely to happen as the first step in reform.  

            Let's take what we can get and protect as many folks as possible while we work towards single payer.  No sense in an all-or-nothing approach that ensures more and more people will continue to suffer the consequences of being uninsured.

            Conquer the liar with truth. -- The Dhammapada

            by deliciae on Sun Mar 02, 2008 at 06:37:19 PM PST

            [ Parent ]

        •  We gotta stop (0+ / 0-)

          saying that single-payor is impossible.  Our crazy multiple-payor system is exactly why our administrative costs are 2 to 3 times larger than other wealthy countries, approaching $300 billion this year in additional paperpushing.

          Multiple payor also makes quality initiatives much harder - things like electronic medical records, disease management, and investments in prevention are harder to justify economically when the customers will switch plans every 3 years.

          The key barrier to single payor are the health insurance companies - many of them would be out of a job.  That's also why Bush's Healthcare Savings Accounts are so dangerous - creating another constituency against single payor (the financial services industry like Fidelity).

        •  re: single payer, Medicare, and Machievelli (0+ / 0-)

          In the body of this topic there is the assertion that single payer support is "anemic" because it is the choice of only 37%. However, the same slide shows that 74% support Medicare for all. That shows how wording is all, since Medicare is universal health insurance for those over 65. (Moreover, the poll allows multiple choices - when forced to take a single choice, single payer is right in the center of the pack at 15%)

          This phenomenum precisely illustrates the topic author's citing of Machievelli's "law of reform": Single payer is new and sounds scary, so only 37 % support it; universal Medicare sounds familiar so 74% support it.

          Conclusion: stop talking about single payer and fight like hell for universal Medicare. This was basically the tack Edwards took.

          •  single payer and universal health care (0+ / 0-)

            are not the same thing. But machavelli is exactly right about the importance of how the plan looks.

            "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

            by Greg Dworkin on Mon Mar 03, 2008 at 09:43:05 AM PST

            [ Parent ]

            •  Yes to Machievelli, but not to non sequiter (0+ / 0-)

              single payer and universal health care are not the same thing

              Well, that's another point entirely. Within the normal context of the argument over health insurance, no one argues for single payer that doesn't imply universal coverage. Nor does anyone suggest you can't get universal coverage without single payer - hence the Rube Goldbergian plans put forth in Massachusetts and by the Democratic aspirants.

              BTW, in this context, it is best not to mix "insurance" with "health care", universal or not in either case. That loose talk allows opponents to conflate single payer health insurance with the whole health care system, tarring the latter as "socialized medicine" in which the government runs the health care system and pays the doctors, thus slyly eliding that epithet back on to single payer insurance.

              You can call single payer either "socialized insurance" or Medicare for all - hence my point to start with  

              •  socialized medicine is another 'by party' thing (0+ / 0-)

                it doesn't scare, it doesn't block, it's not even an insult to democrats, and for the most part independents.

                Poll Finds Americans Split by Political Party Over Whether Socialized Medicine Better or Worse Than Current System

                BTW, in this context, it is best not to mix "insurance" with "health care", universal or not in either case.

                Not a practical suggestion. In a pure academic realm somewhere in a parallel universe, maybe. Not here, not in this election. People want to know who is covered and what will it cost? That will require discussing health finance, health access and health quality (my preferred split) though it will also require being clear what we are talking about.

                "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

                by Greg Dworkin on Mon Mar 03, 2008 at 10:42:09 AM PST

                [ Parent ]

                •  Clarity of thought and expression required (0+ / 0-)

                  On the contrary, I am suggesting hard-nosed practicality. Socialized medicine is government-run medicine, as in the UK. There is no serious discussion of such a prospect here. It is a red herring.

                  When we allow Republicans to characterize single payer health  insurance as socialized medical care, we not only debase the terms of the argument we cede unncessary ground.

                  All the other issues you relate are independent of the discussion of how to get universal insurance coverage, though such coverage will no doubt affect those issues, in the sense that change in any moving part of a machine affects others.

                  •  nah (0+ / 0-)

                    better to say clarity of politics and human nature required. Lectures on clarity of thought and expression are misplaced.

                    We don't allow or disallow discussions of socialized medicine, e.g., they happen regardless of our intent, so it's best to understand the impact, and plan accordingly.

                    The topic is going to be health plans and health care, health care prpposals and health care reform. We don't get to define what it is called. Remarkable hubris to think we do.

                    "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

                    by Greg Dworkin on Mon Mar 03, 2008 at 11:52:40 AM PST

                    [ Parent ]

      •  I completely (2+ / 0-)
        Recommended by:
        jd in nyc, LABobsterofAnaheim

        agree.  

        It would be far easier to pass a UHC model similar to Germany's than the single payer model in Canada which bans private expenditures on health care.  

        •  But, following Machiavelli's rule of reform.... (4+ / 0-)
          Recommended by:
          jd in nyc, fladem, maracucho, neroden

          What about single payer under another name, i.e., "Medicare for All"? as has been proposed by a political insider like Lawrence O'Donnell.

          To me, I think we need to at least look at ways to take profit out of health care -- it wasn't that long ago that Blue Cross and I think Blue Shield were both non-profit companies. I don't know how you put the genie back in the bottle on this, but that seems like an important part of the puzzle. (Part of the reason that Kaiser, which I'm a lifelong member of, has less problems than the others is that it is still a non-profit corporation.)

          Forward to Yesterday -- Reactionary aesthetics and liberal politics (in that order)

          by LABobsterofAnaheim on Sun Mar 02, 2008 at 08:32:07 AM PST

          [ Parent ]

          •  I think the barrier (0+ / 0-)

            is banning private health care spending, which a number of UHC countries (the UK and Germany, eg) do not do.

            It is important to understand that the Canadian system has a safety valve - the US system.  If the line is too long in Canada, Canadians often will go south and pay privately.  

            I actually think banning private health care spending would be challenged on due process grouns, and very well might be unconstitutional.

          •  Medicare for Everyone! (0+ / 0-)

            But we need to get rid of Medicare (Dis)Advantage and the role of the insurance companies in Medicare Part D.

            Medicare parts A and/or B need to be the model.

            Actually, we'd make huge progress if we just expanded Medicare part A to everyone: the medical costs it covers (catastrophic hospital/surgery stuff) are by far the most fearsome to most people.

            -5.63, -8.10 | Impeach, Convict, Remove & Bar from Office, Arrest, Indict, Convict, Imprison!

            by neroden on Sun Mar 02, 2008 at 06:35:24 PM PST

            [ Parent ]

          •  The Privatisation Trap (0+ / 0-)

            So Blue Cross/Blue Shield go private, then for-profit, then stop fulfilling their mission; NY establishes a new health fund (I can't remember its initials), now it's talking about going private -- rinse and repeat.

            Each privatisation gives a one-shot boost to the public treasury, while giving even more money to the managers -- and then causes the privatized company to stop fulfilling its purpose, necessitating the creation of a new public agency.  And then the rent-seekers try to privatize that one....

            Similar sorts of things happened with Conrail.  Government bailout, privatization, merger, now its successor in northern NY (CSX) is undermaintaining the Water Level Route -- which is of statewide importance -- to the point where there are state and federal investigations, and probably eventually there will be a new infusion of government money....

            Kudos to Kucinich for refusing to privatize the Cleveland (I think?) water system.  He stood for sense when it was unpopular, and was conclusively proved right within just a couple of years.

            Not to be doctrinnaire -- I'm all for privatizing naturally competitive operations, like when the government is running sheep farms or restaurants (which has happened in some countries).

            -5.63, -8.10 | Impeach, Convict, Remove & Bar from Office, Arrest, Indict, Convict, Imprison!

            by neroden on Sun Mar 02, 2008 at 06:44:35 PM PST

            [ Parent ]

        •  Difference between health insurance and delivery (0+ / 0-)

          You buttress the insidious argument that single payer is somehow "socialized medicine". Single payer is universal, government sponsering health insurance. The way in which the health care is delivered is an entirely different animal: it can be through socialized medicine as in the UK (government runs and pays for hospitals, doctors, etc) or it can be through a system like France, a patch-works of private, public, non-profit institutions. The latter is like our current system, except that in France there is universal single-payer insurance on top of it. Obviously, this is what a single-payer system would look like in the US.

          •  our LACK OF UNIVERSAL HEALTHCARE is KILLING US... (0+ / 0-)

            with STRESS... really..

            One thing the propaganda doesn't tell US(A)

            ..Is that even with its minor failings (compared to the totally out of control dysfunctional USA of today) the people in all of the MANY other countries that have what you call "socialized medicine" (but what everyone else calls UNIVERSAL HEALTH CARE) would not trade it in a million years for the nightmare we have here which TERRIFIES them.. Absolutely terrifies them.

            Why do you think insurance companies make huge amounts of money on temporary visitors to the US so they can buy short-term health insurance for the durations of their visits here. Everyone knows someone who got injured here and they remember and shudder..

            People here are under a HUGE amount of stress because of our LACK OF UNIVERSAL HEALTHCARE.

            Chronic, life threatening stress causes brain damage, it slowly destroys the hippocampus, damaging your short term memory..

            Lack of access to healthcare and drugs kills something like 18,000 people a year..

            See this web page..

            http://en.wikipedia.org/...

      •  What evidence would that be, exactly? (2+ / 0-)
        Recommended by:
        Pat K California, Rolfyboy6

        Show me the evidence. I believe you are assuming the evidence is overwhelming, without actually having the facts to prove that point. I have, in another comment here, given polling data that suggests single-payer is much closer than you believe. So I am calling your evidence out. Let's see it.

        If you don't have it or can't produce it, would you be willing to reconsider your assumptions?

        I'm not part of a redneck agenda - Green Day

        by eugene on Sun Mar 02, 2008 at 08:28:41 AM PST

        [ Parent ]

        •  We are projecting human affairs into the future (1+ / 0-)
          Recommended by:
          DemFromCT

          As such, there will never be "proof" of what will happen, so when I say "overwhelming evidence" it has to be a matter of judgment. DemfromCT just went through a number of really important points that have a strong cumulative impact, and I won't repeat them. Here are some other factors that are salient:

          1. The United States almost never nationalizes industries. The only recent example I can think of is airport screeners, and that's because after 9/11 Republicans decided that this was a matter of national defense. Also, it's a tiny industry. Health insurance is not national defense, and it isn't tiny.
          1. Insurers will fight far, far harder if it is a matter of their survivial, vs. merely a matter of increased regulation. You will have to overcome stronger lobbying and (more important) advertising aimed at public opinion. They would use every means available to throw into doubt the cost of the single payer proposal, the ability of Americans to trust a new govt-run institution not to be wasteful or have bad service (like the DMV), etc.
          1. Increased revenues from UHC will partly compensate for increased regulation and lower margins, decreasing resistance even more for this alternative to single payer in comparison.
          1. Hospitals are paid at a higher rate by private insurance than by Medicare (and far more than by Medicaid). Not only do private insurers pay better, but if they leave and there is only one payer, that payer will have enormous leverage over providers and they do not want this. If you can find a single head of a hospital system who is calling for single-payer, let me know.
          1. The Clintons' first attempt at UHC failed for several reasons, but one of them was that people saw it as taking away something familiar and replacing it with something untested. Single payer would do that; UHC would not necessarily do so (The Clinton and Edwards plans would not).
          1. The facts in favor of single payer are not what you think they are. It is NOT massively less costly than multi-payer, nor does tend to provide higher quality, and so there is no pressing need to go with the more radical option. Here are the statistics. Given that fact, inertia, familiarity and industry resistance to change will all strongly favor less radical reforms.
      •  Administration Costs 20-30%, not 1% (2+ / 0-)
        Recommended by:
        ferg, neroden

        Private insurance introduces administration costs of 20-30%, compared to public programs of 3-5%. You are specifically incorrect when you claim 1% difference between Universal Single Payer and Private Insurance companies:

        By the way, as I periodically state in health care debates, my current employer is a health insurer. My full take on the difference between the two, based on an analysis of other nations, is that single-payer tends to be slightly more efficient than multi-payer UHC in terms of reduced admin costs (on the order of 1% of total costs or less). On the whole, there is no net impact on the quality of care or access to care. National decisions about how much to spend determine whether (and for what conditions) there is significant rationing of care.

        Administration costs include: At the insurance company side: Profits, Staffing, Billing, Benefits and Denials. At the Doctor side, staffing to deal with insurance companies. At the employer side, HR departments. At the consumer side, endless hours of tracking down claims and benefits paperwork.

        •  Please re-read my quote (1+ / 0-)
          Recommended by:
          neroden

          I said that in countries with universal health care (i.e., not the US) the average is about 1% higher in total costs. I should have further specified that this total is in relation to GDP. Look at this table for specifics.

          The numbers you want are in the rightmost column.

          In other comments in this diary I say more about differences in admin costs between the US and govt-run systems.

          •  In the US, Insurance companies take 30% ADMIN COS (0+ / 0-)

            In the US, Insurance companies take 30% ADMIN COSTS, and they often don't pay the benefits they promise, they try to avoid paying by denying care.

            (To get an idea of how they think, they call each payment to a healthcare provider a "medical loss")

            One way they avoid these pesky 'medical loss' problems is by taking your money UNTIL YOU GET SICK, and then they find an excuse to DUMP YOU.

            This is called "rescission".

            Here are a bunch of stories about this issue..

            Read and weep..

            http://www.latimes.com/...

            We desperately need to realize that as long as we allow the insurance companies to run this show they will do this kind of thing. This is one situation in which the government needs to get involved because otherwise it is little you against BIG THEM and you will almost always lose.

            Republicans complain constantly about our litigous society but it is THEM who have created this mess by giving the corporations SUCH a huge and obscene advantage that they do whatever they want out of greed and people's lives are OFTEN ruined so badly that they have absolutely no option but to sue.

            WHEN THEY CAN...

            WHY CANT THEY? Lawyers TIME 'is VERY valuable'.. SO

            For each person who GETS to sue there are HUNDREDS of people who suffered injuries who NEVER GET TO SUE, because they cannot find lawyers willing to take their case. Even when they have cases, good cases, they aren't big enough. Maybe they were old, or didn't suffer as they died, or were unemployed and so could not claim lost wages, or they died, and had no children, or they were renters, and didn't have a home they lost.. or a million other reasons..

            LIFE IS CHEAP.. VERY CHEAP..

            Why couldn't they get lawyers? Because often..bluntly..

            OUR LIVES ARE NOT WORTH ENOUGH MONEY TO THEM

            Literally.. Literally

            DON'T get me started..

    •  'tis an excellent review ... (6+ / 0-)

      ... but I have to add, from a point of view of diminished expectations, that developing consensus on how to reform the U.S. health care delivery system has been almost comically impossible for a generation.

      I appreciate Obama's disclaimer that "we need to work on controlling costs first."

      But health care in this country is a $1.5 trillion-plus monster, north of 15 percent of GDP and heading for 20 percent, with costs increasing, according to latest figures I've seen, 7 percent annually.

      I think sometimes that the only way we can reform it is in a way that will actually drive up costs in the short term -- and that is, to compete with it from the ground up.

      Free clinics, staffed by medical personnel who are paid the going rate. Free med school for doctors who give X years to the public system and continue to run "blended" practices.

      And, probably, the partial outsourcing of some unaffordable medical procedures and surgeries. And bring dental in under the new tent, too.

      I don't know that we can reform the existing system in any way that actually means much for quality of care and affordable costs. I think we might have to challenge it from the outside and let it reform itself in response.

      •  Updated Spending Numbers (0+ / 0-)

        Health care spending is $2.1 trillion as of 2006, expected to double by 2017--a number that will be roughly 20 percent of GDP. The projection assumes 6.8 percent spending growth--which is at the low end of recent health spending growth. By 2017, you're looking at $13,000+ annually in per capita health spending, which is an enormous amount of money--particularly given that people like me, in their 20s, tend to do nothing more than see a doctor for a routine physical (if that.)
        http://content.healthaffairs.org/...

        I don't particularly like Republican solutions to health reform, but the right wing does correctly focus on costs--high costs for treating really sick people do price a lot of people (both employers and individuals) out of being able to afford insurance.

    •  CNA/NNOC (2+ / 0-)
      Recommended by:
      DemFromCT, eugene

      DemFromCT, can you comment on how CNA/NNOC's healthcare campaign fits into all of this?  Or will mcjoan's piece cover that at all?

      Based on this quote, doesn't quite sound like they're using the same statistics you are:

      Rose Ann DeMoro, executive director of CNA/NNOC, noted on the call that, "Compulsory insurance purchase is not healthcare and will do nothing to solve our healthcare crisis.  Two-thirds of Americans say they’re ready to move to a single payer, ‘Medicare for All’ system and now it’s time to force the politicians to listen to them."

      And thanks for your magnificent piece.

      •  I love the CNA folks but (1+ / 0-)
        Recommended by:
        maracucho

        I don't know where they got their numbers. I've sourced mine.

        "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

        by Greg Dworkin on Sun Mar 02, 2008 at 07:45:49 AM PST

        [ Parent ]

        •  see also from the ABC/WaPo poll (1+ / 0-)
          Recommended by:
          Rolfyboy6

          Previous polls have asked this differently; one last year asked if people would support or oppose "a national health plan, financed by taxpayers, in which all Americans would get their insurance from a single government plan," and found 40 percent support. The wording in this ABC/Post poll weighs the proposal against the current system, and adds the Medicare model to the description. Context also can play a role; this poll asks about universal health after a long and probing series of questions on the current system.

          interestingly, Claudia Deane, who narrates the tutorial from Kaiser, was at WaPo in 2003 as asst polling director, if memory serves...

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Sun Mar 02, 2008 at 07:52:54 AM PST

          [ Parent ]

        •  Dog ate my homework. (1+ / 0-)
          Recommended by:
          elfling

          Didn't mean to imply you should do mine for me, btw.
          Again, thank you for this important work.

        •  You only have one poll (4+ / 0-)

          The actual polling on this has some rather wide margins. The CNA numbers are at the higher end, and in fact yours is at the low end. I have seen numbers ranging from 35% (an August 2007 Field Poll here in CA, itself a 12% increase from December 2006) to 42% in an August 2007 poll of CA small businesses (which outpolled the individual mandate plan Arnold offered) to 52% supporting higher taxes for universal health care in an October 2007 LA Times/Bloomberg poll. And finally Harvard had a poll showing Americans are not afraid of the "socialized medicine" bogeyman.

          Most people who discuss health care reform simply assume that the public doesn't want single-payer, and never care to look at the numbers.

          The numbers are favorable. The numbers suggest we should make an all-out push for single-payer.

          I'm not part of a redneck agenda - Green Day

          by eugene on Sun Mar 02, 2008 at 08:20:38 AM PST

          [ Parent ]

          •  state polls are apples and oranges to national (1+ / 0-)
            Recommended by:
            maracucho

            polls, and state reform apples and oranges to national reform, but thanks for posting those.

            There is as other commenters have noted, great wisdom in allowing the states to be the labs testing the different systems.

            I also agree (but didn't comment on) socialized medicine bogeymen.

            "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

            by Greg Dworkin on Sun Mar 02, 2008 at 08:39:46 AM PST

            [ Parent ]

            •  The last two polls (0+ / 0-)

              Were national polls.

              I'm not part of a redneck agenda - Green Day

              by eugene on Sun Mar 02, 2008 at 08:57:20 AM PST

              [ Parent ]

              •  the bloomberg poll looked at universal health (0+ / 0-)

                not single payer.

                The HSPH poll looked at 'socialized medicine' not single payer.

                Single payer has a solid 37% (Kaiser) - 40% (WaPo) base, and gets higher depending on how it is described.

                Still a ways to go with the public. Not unachievable, just not there yet.

                "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

                by Greg Dworkin on Sun Mar 02, 2008 at 09:03:00 AM PST

                [ Parent ]

                •  Point being (1+ / 0-)
                  Recommended by:
                  Pat K California

                  If we want to understand the whole range of factors shaping the politics of this issue, those other polls DO matter. Majorities for "universal health care" mean that if we played up that frame, a specific single-payer plan would presumably do well.

                  The "socialized medicine" claim is frequently used by timid Kossacks to argue against a push for single-payer - but the poll suggests this concern is overblown.

                  Finally, I think we're wrong to wish and hope that the polling numbers will look really strong before we start working to make single-payer happen. You'll never see consistent majorities without us taking the initiative and building a single-payer movement that will move those numbers - and therefore move the politicians.

                  What the constellation of polling data should suggest is not that single-payer is going to be enacted in January 2009 - but instead that we are very, very well positioned to begin that necessary political movement.

                  The only reason we aren't doing that movement is people have convinced themselves that single-payer isn't possible - but the evidence suggests otherwise.

                  I'm not part of a redneck agenda - Green Day

                  by eugene on Sun Mar 02, 2008 at 09:11:44 AM PST

                  [ Parent ]

                  •  do it in CA (0+ / 0-)

                    we'll watch.  ;-)

                    "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

                    by Greg Dworkin on Sun Mar 02, 2008 at 09:13:03 AM PST

                    [ Parent ]

                  •  Thank you, Eugene ... (1+ / 0-)
                    Recommended by:
                    eugene

                    ... your comments give me hope.

                    The rest of you "pragmatists" out there ... well, geeze, don't worry about little ol' me and millions like me. We'll just be BANKRUPT and WITHOUT INSURANCE before you decide the "time is now right" to DO SOMETHING.

                    •  don't confuse pragmatism with not caring (2+ / 0-)
                      Recommended by:
                      Pat K California, ferg

                      or lack of activism. The polling data is to explain what we're up against, not to tell us what to do or what the outcomes are.

                      But the data is the data. and data suggests a better shot at the state level for single payer (for CA), whereas at the national level exploration of different ways to define and achieve universal care (rather than focus on single payer alone) may be in the cards.

                      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

                      by Greg Dworkin on Sun Mar 02, 2008 at 11:08:38 AM PST

                      [ Parent ]

      •  I did find something to that effect (2+ / 0-)
        Recommended by:
        eugene, fayea

        from 2003.

        ABC News/WaPO poll (.pdf).

        As noted, support for this universal system is conditional. If it limited Americans’ choice of doctors, support drops sharply, from 62 percent to 35 percent. Likewise, if it meant waiting lists for some non-emergency treatments, support falls to 38 percent.

        Concerns about future costs and coverage help fuel interest in universal coverage. Support ranges from 45 percent among people who're entirely unworried about paying their future health bills to 73 percent among those who are "very" worried. It ranges from 53 percent among those who aren't worried about losing coverage through job loss to 67 percent of those who are. And it's 49 percent among who think the country is not headed toward a system of rationed care - but 68 percent among those who think it is.

        There also are political and ideological aspects to views on universal coverage. Democrats favor it by more than 3-1, and liberals by more than 5-1, while Republicans and conservatives divide evenly.

        "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

        by Greg Dworkin on Sun Mar 02, 2008 at 07:50:03 AM PST

        [ Parent ]

    •  A really great piece (4+ / 0-)
      Recommended by:
      DemFromCT, ferg, elfling, Ronit

      Public attitudes on health care are not nearly as straightforward as people think.

      In the mid 90's the State of Vermont came close to enacting Universal Health Care on its own.  The effort had significant outside funding, and was being led by a  
      popular Vermont Governor (Dean).

      And it failed. Since I was living in Vermont at the time, I followed the debate pretty closely.  I think you can draw a couple of lessons from that effort that are consistent with this article:

      1.  Most people like the care they get.  

      The failure to understand this was the single biggest mistake reform proponents made.  

      1.  Most people think they pay enough for their care.  Any proposal that increases the amount they pay for health care to cover the uninsured will be troubled.
      1.  Most of the anxiety around health care is about the fear that they may lose it.

      When they debate was over, I concluded that a single payer system would be virtually impossible to enact here. (An aside, in my experience on DKOS around this issue I have found very little understanding of what the single payer model in Canada means versus other UHC models like those in Germany or Australia).

      This is why Dean did not campaign on a Single Payer solution in 2003 - he had learned the lessons of the Vermont failure of the mid-90's.

      •  I hope I highlighted (1+ / 0-)
        Recommended by:
        deliciae

        those very points. Thanks for the comment and insight.

        Doesn't mean it can't be done. Does mean it won't be done right away.

        But those points need to be closely looked at when proposals hit the table.

        "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

        by Greg Dworkin on Sun Mar 02, 2008 at 08:23:42 AM PST

        [ Parent ]

    •  There are two fundamental flaws with this post (2+ / 0-)
      Recommended by:
      Pat K California, LillithMc

      One is that no acknowledgment is made - anywhere - that Kaiser is one of California's largest HMOs. Does that invalidate their numbers? Perhaps it does. I would be very, very cautious about using their numbers alone to use as a base for an analysis of the politics of American health care reform.

      The other flaw is that it really doesn't answer the question of when we can expect health care reform, as it doesn't delve deeply enough into the issue of why we don't have it already. It seems pretty clear to me that one main reason is that we progressives keep telling ourselves that single-payer just isn't possible, that Americans will never go for it.

      Is there any other issue on which we surrender before a shot has been fired? Where we talk ourselves out of pushing for our most desired goal?

      The only way we will get real health care reform - which necessarily is single-payer - is if we organize a movement to make it happen. No politician is going to drop it in our laps, not unless we have mobilized and laid the groundwork first. So if we're going to do that, don't we need to stop talking ourselves out of promoting single-payer, and instead look at the reality - yes, become a reality-based community again - and start fighting to make single-payer a reality?

      I'm not part of a redneck agenda - Green Day

      by eugene on Sun Mar 02, 2008 at 08:26:08 AM PST

      [ Parent ]

      •  that's an unwarranted assumption (1+ / 0-)
        Recommended by:
        Buffalo Girl

        the numbers have been peer review published in the NEJM with co-authorship with Harvard School of Public Health. Please check "sources" at the end of my post.

        those kaiser data are excellent... now how you interpret them is another issue altogether ;-)

        No one is surrendering. As the post concludes, reform is inevitable (and single payer is a reasonable place to go). But if you deny the data and ignore the time scale, you are missing the boat on what the post says.

        If you raise unrealistic expectations and then wonder why you failed, you have only yourself to blame.

        "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

        by Greg Dworkin on Sun Mar 02, 2008 at 08:45:50 AM PST

        [ Parent ]

        •  Unrealistic expectations (2+ / 0-)
          Recommended by:
          Pat K California, DemFromCT

          So are you saying single-payer is an unrealistic expectation? It seems to me the proper approach is to use polling data to plan out a strategy to make a winning single-payer movement, not to continue the "talk ourselves out of it" strategy that hasn't gotten us very far these last 15 years.

          I understand the point about the NEJM numbers, but as I pointed out to you elsewhere, if we're going to be talking about polling data on health care reform, we should be realistic and place those numbers into context.

          "Unrealistic expecations" cuts both ways. If we have an expectation that Americans will not or have not begun shedding their previous objections to single-payer, when in fact they have done so, are we not being unrealistic?

          Reform is inevitable. But the timeline is up for grabs. There are many reasons to believe we can make it happen within 5 years, just as there are reasons to believe we're going to have to wait 50 years. I think it's time we stopped trying to guess the future and instead started using real-world numbers - ALL of them - to plan out a movement.

          I'm not part of a redneck agenda - Green Day

          by eugene on Sun Mar 02, 2008 at 08:56:12 AM PST

          [ Parent ]

          •  exacxtly right, eugene (1+ / 0-)
            Recommended by:
            Buffalo Girl

            Reform is inevitable. But the timeline is up for grabs

            Depending on what happens with the economy (trumps everything), the debate that takes place between McCain and [fill in blank] needs to discuss proposal, cost and timeline.

            In this post and others, I've explored some of the barriers to reform, but as I've noted, we may be in for a perfect storm that confounds expectations.

            if anyone is serious about health reform, we need more D's in the Senate, House and WH. it will not happen with divided govt.

            "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

            by Greg Dworkin on Sun Mar 02, 2008 at 09:09:33 AM PST

            [ Parent ]

            •  Agreed on all of it (1+ / 0-)
              Recommended by:
              Pat K California

              Personally I think we should take the SCHIP approach to producing those larger Democratic majorities - define the GOP as a party that is standing in the way of solving our health care crisis.

              As long as we're interested in giving people here the information they need to produce a successful movement I'm totally on board with what you are writing. But I think we need to argue strongly against the notion that the American people are not interested or are opposed to single-payer. The numbers are fluid but trending in our direction. We need to capitalize on that momentum, but in a smart way.

              I'm not part of a redneck agenda - Green Day

              by eugene on Sun Mar 02, 2008 at 09:13:59 AM PST

              [ Parent ]

              •  from a practical perspective (0+ / 0-)

                I think it should be tried in CA, and then move east.
                Let's find out what works and what doesn't, similaer to MA and VT.

                "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

                by Greg Dworkin on Sun Mar 02, 2008 at 09:17:19 AM PST

                [ Parent ]

                •  I don't think that people whose lives are ruined (0+ / 0-)

                  by these issues are really in a position to make themselves heard. They drop off the map, they lose their homes, they become so immersed in their problems that they do not have time to participate in online forums and when they do, they don't articulate their problems well in the blogosphere. They have looked into the abyss, so to those who have not experienced it, they sound like Chicken Littles and none of the influential elite listen to them.

                  Its like that saying about how first they came for the xyz.. I forget the verses..

                  But - its happening - there are a lot of people who are losing their grip on what we have come to see as a normal American life right now. Our dysfunctional healthcare mess is a hue cause of this and its getting worse, quickly, as all the power blocs square off against each other with the hapless human beings in the middle, beseiged from all sides.

                  There must be a limit to how much worse it can get.. but nobody knows what it is. I am sure that its much lower than we are at now. Look at history, things often get very bad before change happens, and when it happens it is often violent. That is what democracy is supposed to help us avoid, but if all of the mechanisms that would make that possible become co-opted by the machine, then the long term outlook is not good.

                  We need to avoid that at all costs.. which means more than keeping people talking, that wont lead anywhere unless there is more pressure for ACTION and COMMITMENTS.

                •  Is that possible though? (0+ / 0-)

                  Individual states may simply not have the financial power or available tax dollars to make this work. Given the national nature of the health care industry, we are likely going to need a national solution.

                  I'm not part of a redneck agenda - Green Day

                  by eugene on Sun Mar 02, 2008 at 12:14:49 PM PST

                  [ Parent ]

      •  I believe that the (0+ / 0-)

        kaiser foundation is a different entity from the HMO.

    •  This certainly puts the "single payer' advocates (1+ / 0-)
      Recommended by:
      DemFromCT

      on notice. As a nurse educator who is quite aware of much of your information, I have despaired at much of the hubris on this site regarding the JRE and HRC plans.

      Those who can make you believe absurdities, can make you commit atrocities-Voltaire

      by hairspray on Sun Mar 02, 2008 at 09:03:54 AM PST

      [ Parent ]

      •  eugene has some great points (0+ / 0-)

        about state level prospects in CA, but CA is not the rest of the country.

        "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

        by Greg Dworkin on Sun Mar 02, 2008 at 09:12:02 AM PST

        [ Parent ]

    •  oops mcjoan will not be posting today (0+ / 0-)

      she was temporarily blinded by the plaid jacket (see story), but should be able to return to posting soon.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Mar 02, 2008 at 11:21:08 AM PST

      [ Parent ]

      •  no word as to whether plaid blindness (0+ / 0-)

        is covered or whether it qualifies as a preexisting condition.

        "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

        by Greg Dworkin on Sun Mar 02, 2008 at 11:22:20 AM PST

        [ Parent ]

  •  If you have healthcare out the wazoo, of course (13+ / 0-)

    you don't think about it or need to. I really do think the remaining 25-30% of Bush supporters/GOP base have a total lack of empathy, pure and simple. They are not their brothers keepers and just plain don't give a damn about anything but their tax rates. It is that simple. They need to be marginalized if we are ever going to make this country "strong" again.

    Support democracy at home and abroad, join the ACLU & Amnesty International http://takeaction.amnestyusa.org Your voice is needed!

    by tnichlsn on Sun Mar 02, 2008 at 05:44:33 AM PST

    •  by healthcare I meant health insurance,, sorry. (2+ / 0-)
      Recommended by:
      OLinda, wishingwell

      Support democracy at home and abroad, join the ACLU & Amnesty International http://takeaction.amnestyusa.org Your voice is needed!

      by tnichlsn on Sun Mar 02, 2008 at 05:45:46 AM PST

      [ Parent ]

      •  Important Distinction (6+ / 0-)

        by healthcare I meant health insurance,, sorry.

        Those two terms get so tangled in the health care debate it is so key to keep them separate.  When we talk about health care, most people actually mean health insurance.  But quality of health care is also a key issue that is wrapped up in this monster as well!

        •  You think about it if you pay for it.... (1+ / 0-)
          Recommended by:
          tnichlsn

          I have decent health insurance, but it costs over $10,000/year, and will probably be over $12,000 next year.

          People who get it through their jobs have no idea how much their employers are paying.

          I would be paying less net, and most employers would too (GM would go back to consistent profitability, for instance) if we switched to single-payer and funded it through increased income taxes.

          I'm not sure what the political gap is preventing single-payer from being politically 'possible'.

          It's good for people paying for insurance, good for people who are uninsured, good for businesses paying for insurance, good for doctors and doctors' offices, good for superrich people paying cash for medical care, and good for people getting insurance through their employers (because they're not tied to their jobs anymore) -- and economically efficient, and good for the public as a whole.

          And bad for who? -- health insurance companies and their CEOs and shareholders (and to a lesser extent their employees).  The definition of a special interest.

          I think the hostility to single-payer is due to reality-impaired right-wing ideology ("It's socialism!  Run and hide!  The government is always worse than private industry!") being way too embedded into people's thinking.

          -5.63, -8.10 | Impeach, Convict, Remove & Bar from Office, Arrest, Indict, Convict, Imprison!

          by neroden on Sun Mar 02, 2008 at 05:54:01 PM PST

          [ Parent ]

    •  Listen To Yourself! (3+ / 0-)
      Recommended by:
      maracucho, elfling, TheTrucker

      How can someone who self-identifies as a "liberal" or "progressive" say something like that???  Your sig implies your strong support for civil liberties, and yet you wish to silence a minority that you don't agree with because you have deemed them defficient.  That's sad and disgraceful.  It is precisely this sort of hypocrisy and vitriol that allows opponents to discredit your movement and drowns out the more reasonable voices.  As a moderate non-partisan, that is disappointing to say the least.

      •  calm down... (3+ / 0-)

        "marginalize" means "defeat them in political combat."

        We had to do that with the civil rights act too, you know.

      •  these people had unlimited/uninterrupted rule (8+ / 0-)

        for 6 years and fucked everything and I do mean everything they played a role in up completely. They do need to be marginalized, a good number need to be put on trial and sent to prison. This website is not a moderate non-partisan website, it's stated purpose is to elect democrats and preferably progressive ones at that. And it is not I alone who have deemed them deficient, it is the nation's 70% who are itching for a change and beyond that history itself.
        And BTW, I am an active member of the ACLU for the precise reason you state. Because if I had my drathers, I'd rendition their leaders off to some hellhole for an extended display of waterboarding, up-close and personal. But my friends a ACLU remind me there is a more democratic way to address these issues...

        Support democracy at home and abroad, join the ACLU & Amnesty International http://takeaction.amnestyusa.org Your voice is needed!

        by tnichlsn on Sun Mar 02, 2008 at 06:27:56 AM PST

        [ Parent ]

      •  marginalized in political debate (2+ / 0-)
        Recommended by:
        tnichlsn, neroden

        read for context.  

      •  He didn't say silence, he said marginalize (3+ / 0-)
        Recommended by:
        Pat K California, tnichlsn, neroden

        It is only just that marginal ideas be marginalized. We are talking here of course about an ideological minority which should be defeated politically.

        Is this kind of marginalization not the usual end in any democratic system of such failed ideas?

      •  Wish I could give 50 mojo's to "Skeptical (1+ / 0-)
        Recommended by:
        elfling

        Indipendent's comment -- "Listen to Yourself"

        Telling someone that they are evil (uncaring and greedy) is not going to win elections and therefore not going to produce change.  It is not easy to convince people that they need to condider health care on a whole life basis as opposed to the "healthy years", yet that is probably the more correct argument.  Most young people see it as "The less I have to spend for health care then the more I can 'invest' in my own future so as to be rich".  The confidence of youth in their individual personal ability to outrun the pack and be successful is not a great evil. It is simply a part of our general human nature  -- that's how it is when we are young.  The problem has many facets not the least of which is currently a major distrust of our governmental systems. This distrust is continually enforced by the Republicans.  The young are convinced that they will pay FICA taxes and Medicare taxes all their lives and then have nothing in the end. And for the Republicans it is a self fulfilling prophecy.  Democrats seem to take a very dim view of the phrase "faith based".  Yet faith is what is necessary to the socialization of retirement and health care.  We will find that socialization of INSURANCE and democracy go hand in hand.  It is the ongoing destruction of democracy that creates the lack of faith.  And the strident screaming of the "we no best because we are compassionate" crowd and their insistence on undemocratic proposals is an excercise in foot shooting.

        "Ours is not to take it from them but to inform their discrestion with education" == Jefferson

        "I know no safe depository for the ultimate power of society but the people themselves" -- Jefferson

        by TheTrucker on Sun Mar 02, 2008 at 08:43:21 AM PST

        [ Parent ]

        •  we've had 6 years of the GOP/Neocon mantra that (2+ / 0-)
          Recommended by:
          Pat K California, TheTrucker

          government is bad and 6 years of their transparent attempts to bankrupt it to the point where we will never be able to afford another government program, let alone healthcare for all. If your premise were valid, 90% of the youth vote would be in league with the "any non-military government program is bad" neocons. In case you hadn't noticed, they aren't. By a never before seen margin they are breaking for the democratic party. And in my opinion, every one of those remaining GOP diehards has just plain fucked-up priorities, fucked up to the point where they have easily done more damage to the US, both short term(4000 dead in Iraq) and long term(dismantling of the Constitution) than bin Laden. Neocons/al Qaeda, opposite sides of the same coin. Both working overtime to destroy America, from the inside and out.

          Support democracy at home and abroad, join the ACLU & Amnesty International http://takeaction.amnestyusa.org Your voice is needed!

          by tnichlsn on Sun Mar 02, 2008 at 09:29:36 AM PST

          [ Parent ]

          •  They are doing this because of demographics (1+ / 0-)
            Recommended by:
            tnichlsn

            The GOP is trying to prevent our instituting new entitlements NOW precisely BECAUSE we will need them so much MORE in the NEAR future.

            I think the GOP insiders realize, but perhaps many Dems are in denial about the high probability that the level of economic equality we saw in the past will never come back, jobs will keep disappearing, because of new technologies increasing productivity exponentially.

            The GOP wont admit that, either, but their actions show that they know it. Look at their aggressive push to eliminate the estate tax, now, while they still can. (before people realize how incredibly terrible that will be in the future, a situation not unlike that in Britain, in say, Jane Austen's time.. inheritance will be everything..)

            The future in 20 years will be one in which a fraction of the people who need to work now will be able to be employed, businesses will not need the unskilled or even many skilled, most jobs will be extremely specialized and technical. Nomatter how low wages will go (supply and demand) they wont go low enough to be cheaper than silicon.

            Productivity will be as high as it is now or more likely, far higher. The only question being, who will BUY the products of industry, with so few people making money. Will people live off of investments or inheritances? I doubt it, healthcare will strip that money from the middle class - which they should be investing.

            If we were honest about that reality we WOULD be instituting things like single payer, for the long haul..  

            We would not be talking about adding new obligations for large or small businesses to insure workers. That is the cowards way out.

            Plus, requiring large businesses but not small to insure workers would be illegal under the WTO agreement, as written. Its 'discriminatory' against mutinationals, as I understand it.

            •  we are certainly in for a very bumpy ride into (0+ / 0-)

              the future. scary...

              Support democracy at home and abroad, join the ACLU & Amnesty International http://takeaction.amnestyusa.org Your voice is needed!

              by tnichlsn on Sun Mar 02, 2008 at 10:35:45 AM PST

              [ Parent ]

              •  50 years in the future.. (1+ / 0-)
                Recommended by:
                tnichlsn

                The Earth's population will stop growing and start shrinking.. and if we can make it that far.. without destroying ourselves.. wow..

                I think we will start seeing the light at the end of the tunnel in a very many ways even sooner.

                (Really, healthcare SHOULD be about finding SOLUTIONS to problems and making people BETTER for good, not about making money on their sickness and making more as they get sicker and sicker..)

                We should consider how our current system seems to destroy so many good things and turn them into bad.. its absolutely terrifying its capacity for that.

                I guess what I am trying to say is that science and humanity need to figure out a way to focus less on greed and more on goals.. Many people see how important that is. It really transcends politics.. Healthcare is a crucial issue, though, because it has the potential to make or break so many lives..

                Even in the next ten of fifteen years, I think we will almost certainly begin to see technological progress overcome the many problems we have today..

                Energy and aging are two big issues that are much closer to being solved than many people realize..

                We could wake up one day to discover that someone had discovered a way to generate energy cleanly without dangerous byproducts like nuclear fission does.. Or a huge improvement in solar power generation efficiency..

                In healthcare, they have already figured out how to make geneticly engineered mice regrow amputated limbs, and even grow new hearts.. and also figured out how to impart that ability to normal mice.. I am not kidding..

                Really, the world is a wonderful place, one of abundance.. we will just need to change our scarcity mindset to one more appropriate... abundance..

                That is the REAL challenge..

                •  to quote my friend from up above-"Wish I could- (0+ / 0-)

                  give 50 mojo's to" Andriamo for your optimism, something I've been in very short supply of lately. I honestly think it is beyond time for "my generation" (and Hillary's) to step back and go quietly into the night and leave your generation to try to sort out the mess we've created or allowed to be created of the country and world. Seems like so many disasters await the generation waiting in the wings to take the reins. Let your generation take charge before we make more of a mess of it all...

                  Support democracy at home and abroad, join the ACLU & Amnesty International http://takeaction.amnestyusa.org Your voice is needed!

                  by tnichlsn on Sun Mar 02, 2008 at 12:05:44 PM PST

                  [ Parent ]

                  •  I'm not as young as you probably think I am.. (1+ / 0-)
                    Recommended by:
                    tnichlsn

                    I'm in my mid 40s. Have had a lot of diversity among my friends over the years, though. And hung out with a lot of scientists and artists, who tend to think in different terms than a lot of people. They know what's possible, and they often are better at spotting bull**** when they see it. At least thats what I would like to think.

                    I'm also, like you, scared. Not as optimistic as I would like. I am just hoping that we make it to that point I was describing. I'd say there's a good chance we won't. More than at any time since the Cold War days.

                    Also, I don't think that any one generation knows any more than any other. Each has their good points, though. Some older people can be rigid, but others can be remarkably free of the baggage that comes when we are theoretically 'on our way up'. Some young people can be incredibly good at cutting right to the important aspects of something, but others can be incredibly naive and gullible.

                    I think we are all being played off against each other these days. Its a cheap trick. Don't fall for it.

                    I guess when I think about politics, my first impulse is fear of fanaticism, extremism. They are the worst.

                    I just wish that (all) people in powerful positions, could make an effort to try to put people ahead of their dogmas, is that too much to ask?

          •  I agree with your analysis even though it (1+ / 0-)
            Recommended by:
            tnichlsn

            actually contradicts my own.  I think that both of these factors are at work in that the young, while thinking about their invinciblity, are also thinking about how very badly they have been screwed by the borrow and spend Republicans,  They are beginning to see that the Republicans want the primary function of government to be the collection of interest on the national debt and the distibution of that interest to the very rich Republicans.  There is perhaps a limit to how steep that hill of the future can be and still allow success even for the very swift and strong.  The Republicans have gone too far.  The young seem a lot smarter than the Republicans have credited.

            "I know no safe depository for the ultimate power of society but the people themselves" -- Jefferson

            by TheTrucker on Sun Mar 02, 2008 at 01:39:11 PM PST

            [ Parent ]

            •  thanks and sorry for the language,.. (0+ / 0-)

              didn't mean to come off as a punk, just very frustrated and depressed at alot of things political lately. cheers.

              Support democracy at home and abroad, join the ACLU & Amnesty International http://takeaction.amnestyusa.org Your voice is needed!

              by tnichlsn on Sun Mar 02, 2008 at 01:54:08 PM PST

              [ Parent ]

    •  people don't understand catastrophic risk (11+ / 0-)

      People who are "insured" don't understand how their insurance will work if they have a serious illness.  They're very much at risk, but don't know it.

      It's the media.

      If the media did stories about people going bankrupt while being insured, and the limitations of insurance, the system would change.  There also should be plenty of stories about insurance cos. cancelling coverage.  You could spend $10-20,000 on insurance a year, and when you need coverage, it won't be there.  The laws protecting people from cancelled coverage are thin and weak.

      The 20% "co-pay" can easily bankrupt the average consumer if a serious illness affects them.

      This type of honest real reporting will NOT happen due to the business interests that control media.  Advertisers surely wouldn't be happy if the american media told the public the real truth.

      •  However .... (0+ / 0-)

        there have been recent "leaks" about this very same thing happening .

      •  maybe it wasn't"reporting" (1+ / 0-)
        Recommended by:
        tnichlsn

        but isn't that what Sicko did? I am appalled that only 37% favor single payer still. I think it shows that a lot of education is needed.

        -7.75, -6.10, http://www.xanga.com/nicolemm

        by nicolemm on Sun Mar 02, 2008 at 09:19:07 AM PST

        [ Parent ]

      •  Heath 'insurance' isn't insurance. (1+ / 0-)
        Recommended by:
        tnichlsn

        It's turned into something else.

        It almost never covers catastrophic, unlikely risks property -- the only thing you actually should insure against.

        But it does cover lots of routine expenses, which if health insurance were really insurance, would be either paid in cash or provided as a government service !

        Now, I pay for health insurance for two reasons:

        (1) I do get some catastrophic coverage.

        (2) More important, and even more messed up: Doctors' offices, hospitals, and labs treat you really badly if you don't have insurance, even if you're throwing around wads of cash.  

        $10,000/year would be plenty for medical expenses -- except that cash patients are overcharged by a massive factor relative to insured patients, and even if you've got the cash, sometimes they just throw uninsured people out!

        You need "insurance" in order to guarantee that the emergency room will SEE you.  A bank account with a million bucks in it won't get you that.

        -5.63, -8.10 | Impeach, Convict, Remove & Bar from Office, Arrest, Indict, Convict, Imprison!

        by neroden on Sun Mar 02, 2008 at 06:02:01 PM PST

        [ Parent ]

      •  Yep! (1+ / 0-)
        Recommended by:
        tnichlsn

        I earn my keep doing communications for an advocacy organization working on health care reform in IL, and you have hit the nail on the head.  ALL the research I have read indicates that personal stories are the way to get this point across - it's the biggest trend in advocacy comm. going.

        So - PLEASE - write letters to the editor.  Contribute your story to an organization that asks you for one.  Use your personal story whenever you are talking to an opponent of health care reform.  It really matters what happens to people, and you never know when the thing YOU say is going to be the thing that opens someone's eyes.

        I'll stop preaching now.  :)

        Conquer the liar with truth. -- The Dhammapada

        by deliciae on Sun Mar 02, 2008 at 06:49:12 PM PST

        [ Parent ]

  •  Big Insurance will fight (5+ / 0-)

    tooth and nail to keep their bloated profits.  They'll use our own money to fight change.

    If Jesus saves well, He'd better save Himself from the gory glory seekers who use His name in death

    by minerva1157 on Sun Mar 02, 2008 at 05:45:23 AM PST

    •  But big insurance (3+ / 0-)
      Recommended by:
      skiddie, wishingwell, minerva1157

      might not be able to withstand the attack.

      Change will come when the hospitals and doctors, as well as other medical providers, demand it. Not before.

      They're starting to, which is good. It will take a while for it to become a tsunami, but it WILL happen.

      And it will be MUCH more drastic than anybody would expect, because the people AND the hospitals and doctors will DEMAND it.

      •  what will hospitals and physicians demand? (3+ / 0-)
        Recommended by:
        amini1, fayea, slaney black

        The main way that other nations control their health care costs is by limiting payment to physicians and hospitals. Physicians in other nations earn far less than in the US, as do hospitals. Are they going to demand that the same sorts of budgetary controls used in other nations apply here, which will reduce their revenue by 30-50%? Never. You should take a look at what happened when Elliot Spitzer tried to shave a percent or two off provider (particularly hospital) incomes. He tried it at the peak of his popularity right after he was elected, and he had his ass handed to him.

        If all you do is switch to single payer and don't reform the way providers are paid, you're going to save a couple of percentage points on the cost of care. And that savings will be eaten up in less than a year, because our health care costs go up 6-7% a year on average.

        •  But (1+ / 0-)
          Recommended by:
          elfling

          if you pay the hospitals and doctors PROMPTLY, make the reimbursement process dead simple, and cover the vast majority of people, their income won't drop by much, if at all.

          The hospitals won't need as many people to do billing and fight with insurance companies, and they'll get paid much faster.

          I'd bet they'd rather have $100 now, and not have to pay 10 people's salaries to get it, then have $1000, maybe, in 2 yrs.

          Especially considering that in many cases (and increasingly so), they won't get much more than that $100, if they get anything.

          Which is why they'll push for it - the lag in being paid is KILLING them, and more than anything, that's what's causing hospitals to close and doctors to leave medicine or go into cosmetic/non-primary areas.

          •  Where are you getting this? (0+ / 0-)

            To say that physicians or hospitals are getting "killed" is absurd. We pay primary care physicians (this is personal income, not practice revenue) over $150K a year on average, specialists over $300K. Our hospitals have average profit margins in the area of 3-5%, about the same as health insurers. Hospitals had record profits in 2006, and I'm sure they didn't do too badly in 2007.

            In addition, a lag in payments is a fact of life for almost all businesses. It's called "accounts receivable" and a 30-45 day lag is quite common in American industries. I've heard Wal-Mart often waits 90 days to pay its suppliers. The average lag in payment is less than 45 days for insurers. There is another way to go, it's called prospective payment or capitation, but physicians and hospitals have traditionally resisted this.

            I'm not saying there aren't a lot of inefficiencies.  There are. We need to handle payments far better, and differently than we do. We spend about twice as much on admin per capita as, say, the Canadians (this includes insurance admin and non-insurance admin). But we also spend twice as much on the care itself. The cost of care itself is far larger than the cost of admin.

            We will never get our costs in line with other nations just by getting our admin costs in line with those nations. The numbers don't add up. I challenge you to show me data indicating otherwise that doesn't come from a single-payer advocate. An impartial source will not corroborate what you say.

        •  not really (0+ / 0-)

          they limit costs by reducing administrative costs

          "The only thing necessary for the triumph of evil is for people to mistake writing angry diaries on political blogs for doing something in the face of evil."

          by Buffalo Girl on Sun Mar 02, 2008 at 10:20:11 AM PST

          [ Parent ]

          •  Show me the evidence (1+ / 0-)
            Recommended by:
            Buffalo Girl

            If you look at any other nation that has lower total costs than we do, they spend considerably less on physicians and hospitals. You have to. It's simply a fact that physicians in America on average earn roughly twice what they do in the rest of the world. Our biggest problem is with specialists. Primary care isn't too bad, but even there we spend more than almost any other nation. And I'm talking income per physician after taking out all administrative costs.

            Our total admin costs when you count everything, insurance and non-insurance, is about 30% of our total cost. In Canada, it's 17%. That's a 13% difference. However, we spend almost twice as much as Canada on health care overall. It simply isn't true that you can make up the difference by eliminating unnecessary admin alone.

            Please go to official government and NGO sources (such as the Commonwealth Fund) and you will find this confirmed.

            •  ok (0+ / 0-)

              Our total admin costs when you count everything, insurance and non-insurance, is about 30% of our total cost. In Canada, it's 17%. That's a 13% difference.

              This part I knew, and was thinking of when I commented.

              However, we spend almost twice as much as Canada on health care overall. It simply isn't true that you can make up the difference by eliminating unnecessary admin alone

              .

              This part I didn't....

              "The only thing necessary for the triumph of evil is for people to mistake writing angry diaries on political blogs for doing something in the face of evil."

              by Buffalo Girl on Sun Mar 02, 2008 at 03:25:36 PM PST

              [ Parent ]

              •  Other ways single-payer saves $ on health care. (0+ / 0-)

                (1) Preventative care.  The cost of uninsured people who get very sick and use the emergency room instead of regular doctors is very large, because emergency room care is fantastically expensive.  I'm not sure the cost has ever been properly computed.  It's probably only one or two percent of total health care costs, but it is likely to be that high.

                This is also the main cause of hospitals panicking about their income: the need to subsidize emergency room care for the indigent.

                Seriously, if you knock 13% off in administration, 1% in indigency, 4-5% in drug costs, and even a little bit in doctor and hospital price inflation, you can likely get us down to 1.5x Canadian per capita costs.  Which is probably good enough.

                -5.63, -8.10 | Impeach, Convict, Remove & Bar from Office, Arrest, Indict, Convict, Imprison!

                by neroden on Sun Mar 02, 2008 at 06:14:28 PM PST

                [ Parent ]

                •  Don't confuse single payer with UHC (0+ / 0-)

                  Please look into the Dutch and German systems, to name two. You will find that they both engage in preventative care and cut down on emergency room use compared to the US. Oh, and they use private payers. In the German case at least they are non-profits.

                  I don't mean this as an insult, but the level of ignorance when people comment on universal health care is vast. The obsession with Canada, which isn't even a very good system by UHC standards is a case in point. If you want single payer, at least look to Scandinavian models. If you want a mostly single payer system but can stomach a private supplemental insurance, then look to the French. If you aren't concerned about what is realistically possible, then look to the English system. I would choose any of these before the Canadian model. Of all the systems with top tier performance, the system in The Netherlands would be by far the easiest to implement here.

        •  Your numbers don't add up. (0+ / 0-)

          Knocking the administrative expense from 20% to 5% of the costs of care and wiping out the insurance-company-profit expense will get you at least two years of savings, if costs go up 6-7% per year.

          -5.63, -8.10 | Impeach, Convict, Remove & Bar from Office, Arrest, Indict, Convict, Imprison!

          by neroden on Sun Mar 02, 2008 at 06:04:09 PM PST

          [ Parent ]

          •  Why do you think I said that? (0+ / 0-)

            You didn't get a reduction from 20% to 5% out of my comment. I'm not sure what you're talking about.

            If you mean total admin cost, including insurance and non-insurance admin, then the current percent is around 30% and we can at best get a reduction to around 17% (where Canada is). If you mean private insurance admin alone, then it is currently around 5% of total health care spending. I am speaking precisely here. Private insurer admin costs are 12-15% of premium, but a lot of people aren't covered by private insurers. First, there are self-funding companies (over half of those who get their insurance from their employment have their employer or union as their insurer, not a separate private company). Self-funding has a lower admin cost of around 10% of medical expenditures. There are also the uninsured, of course. Most importantly almost half of health care spending is government insurance (traditional Medicaid and Medicare, VA system, etc.). So the current private insurance admin contribution is 5-7% of total health care costs right now. Even if you cut it to zero you won't save more than a year's worth of health care cost increases.

        •  As for cost-cutting (0+ / 0-)

          Look at how Medicare keeps costs down.

          Costs still grow -- but not as fast as in private insurance.  Because Medicare is large enough to exert market power.

          The mere existence of single-payer -- provided there aren't riders like the "NO NEGOTIATED PRICES" thing Bush stuck onto the Medicare Part D law -- will reduce the growth rate of payments to doctors, hospitals, and drug companies.

          I would guess that we wouldn't actually reduce payments, but that the inflation rate in payments would be throttled until we approach the payment levels of other countries.

          -5.63, -8.10 | Impeach, Convict, Remove & Bar from Office, Arrest, Indict, Convict, Imprison!

          by neroden on Sun Mar 02, 2008 at 06:09:03 PM PST

          [ Parent ]

          •  agreed (1+ / 0-)
            Recommended by:
            DemFromCT

            You're absolutely right about Medicare being able to control price increases better. Although, I would say this is only partly a result of its size. It's also a result of the fact that the government is the government, and doesn't have to negotiate prices in the same way private companies do.

            I want to be very clear about something: I don't think there is any evidence that the free market or private industry does a better job keeping costs down overall than government. However, there is clear evidence from multiple nations that if government structures the market in the right way, private companies (more highly regulated than our insurers now) can control costs and provide access to quality care as good as any single payer system.

            To me, it's not about whether a properly constructed single-payer or multi-payer universal health care system is better. They can both be so far superior to our current system that the differences pale in comparison. So instead, to me it's about pursuing a system that is actually achievable in the current American context. That rules single payer out, IMO.

            •  there's actually two parts in your comment (1+ / 0-)
              Recommended by:
              jd in nyc

              So instead, to me it's about pursuing a system that is actually achievable in the current American context.

              But in addition it's about achieving universal health care. That's more important than whether it's single payer, which is an option.

              I think you're right to point out that the money savings on the admin side is less than it appears. But single payer as a viable option needs to be looked at more long term (it's not happening politically short term).

              I am neither wedded nor dismissive of single payer and would like all the options on the table. But UHC is the more important goal, as you've noted.

              "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

              by Greg Dworkin on Mon Mar 03, 2008 at 04:39:49 AM PST

              [ Parent ]

    •  Insurers can be brought into the tent (3+ / 0-)
      Recommended by:
      elfling, wishingwell, neroden

      Things are not nearly as simple.

      First, about 1/3 of health insurance is non-profit. It's often said that this doesn't matter, but it does. The top executives of non-profit insurers get paid considerably less than the executives of for-profit insurers. The mentality is also different, and I have seen this first hand. Non-profits generally have (and aim for) considerably lower net income ("profit") than for-profit insurers. For-profit insurers also are now all publicly-traded companies and they do in fact have as their first obligation to deliver a return to their shareholders.

      Because they have higher profits, for-profit insurers are likely to be more affected by reforms that limit insurer profits. Moreover, they are motivated to resist reforms that lower their rate of return to investors, and this is a motivation non-profits simply don't have.

      You can reduce or eliminate the resistance of insurers to reform by creating a trade-off between increasing volume of business and lowering the average profit margin. If revenue increases by 10% from bringing in the uninsured, and profit margins decrease by 10%, then it is a net wash.

      I think the best approach here is similar to what California recently tried to do, and that is increase the minimum Medical Expense Ratio. I know that New York currently has a minimum of around 70%, which is way too low. An 85% minimum to start, rising to 90% or higher over time would be the best approach, IMHO.

      It's worth pointing out that insurer profits and admin are a smaller part of total health care costs than you think. They take 15%-20% of premium currently, but that doesn't mean they take 15%-20% of health care spending, of which about 3-5% is profit and 10%-15% is admin. Nearly 50% of medical spending comes from government programs. If you look at any non-partisan analysis of the admin/profit cost of private insurance, it is around 5-7% of total medical expenditures. The bigger cost of private insurance actually is in its impact on medical costs, because providers of care have far more admin devoted to collecting payment (from private and public payers) than providers in other nations. Any health care reform will ultimately have to streamline the payment system (reducing the complexity of benefit contracts, for example) so that we can cut the waste on the provider side as much as on the insurer side.

      Oh, and most of all we need to reform the provider incentives that drive 90% of our costs. We're all concerned about access to care, but the vast majority of savings are not going to come from reforms to insurance costs. They will come from reforms to the delivery and incentive structure of health care.

      Final thought: don't fall into the trap of thinking that the insurance industry can't be reformed, and therefore single payer is the way to go. If the industry is so strong and resistant to change that it won't change its practices to compete on improving health (as happens in The Netherlands), then the industry certainly won't let let itself disappear entirely. The single payer crowd sometimes says, in effect: we can't wound this beast, so let's kill it!

      •  Sorry ..... (0+ / 0-)

        and I don't mean to be insulting toward Californians , but I would not want to model anything that California has tried to do , or Massachusetts for that matter . But then Deans plans as Governor of Vermont were not unlike the Single Payer concept . I don't know . I just have not been comfortable with the Californian legislature on anything .

      •  This strategy is not stupid: (0+ / 0-)

        "we can't wound this beast, so let's kill it!"

        This is actually a pretty good tactical approach in some situations.  This is almost certainly one of them.

        Get enough people calling for single-payer, and eventually the insurance industry will either (a) capitulate and lose, or (b) come up with a compromise plan which saves itself and is good enough.

        Call for compromise with them in advance, and you'll get a "Republican compromise" where you ask for an OK compromise, but get a not-really-OK compromise -- but one which makes it harder to get the political pressure for a good result.

        Something like Medicare Part D.  It's going to be a lot harder to turn that turkey into something good than it would be if we'd filibustered it and started from scratch in 2009.  :-(

        -5.63, -8.10 | Impeach, Convict, Remove & Bar from Office, Arrest, Indict, Convict, Imprison!

        by neroden on Sun Mar 02, 2008 at 06:19:28 PM PST

        [ Parent ]

  •  A school mate of my son died (15+ / 0-)

    During this past Christmas vacation, of a ruptured appendix, after sitting with his mom for 14 hours in the waiting room of the ER.  When he was finally called, they promptly started surgery, but it was too late and he died during the surgery.  I understand the parents did not have health insurance.

    "Great men do not commit murder. Great nations do not start wars." William Jennings Bryan

    by Navy Vet Terp on Sun Mar 02, 2008 at 05:46:50 AM PST

    •  And he was in the 10th grade (9+ / 0-)

      "Great men do not commit murder. Great nations do not start wars." William Jennings Bryan

      by Navy Vet Terp on Sun Mar 02, 2008 at 05:49:18 AM PST

      [ Parent ]

    •  it is unlikely insurance is why he waited (10+ / 0-)

      there are three aspects of health care that need to be considered in any scenario:

      • health care costs (this discussion)
      • health care access
      • health care quality

      The first issue doesn't come in to it; the second maybe does, the third certainly does, in this unacceptable example. But insurance is not figured into emergency care in terms of speed of evaluation, and if it were after hours, or if the pain were significant, the ER would be the route for just about everyone, insured or not.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Mar 02, 2008 at 05:51:43 AM PST

      [ Parent ]

      •  not enough ER doctors (5+ / 0-)
        Recommended by:
        skiddie, elfling, mmacdDE, wishingwell, fayea

        I'm afraid readers will take "health care quality" to mean how good the doctors are.  But in this context it means of course that but also -- especially -- how many doctors there are, how long they are permitted to spend with each patient, how long their shifts are, and how often they work overnight shifts.

        Frankly I might prefer to have a lazy half-assed doctor see me when he or she is rested and has time to listen to me, than to have the most dedicated and brilliant ER doctor treat me after working 3 overnight shifts in a row for 10 hours each, with only 10 minutes to spend on each patient.  

        This kind of quality of care issue is not tied in to the patient's insurance, as an individual (everyone sees the same overworked, time-strained doctors), but this systemic problem does connect to insurance payments and health care reform as a larger issue.

        •  health care quality (0+ / 0-)

          is more about how good the system is than how good the doctors are. It starts with the triage nurse, and how well the patient is assessed.

          In this case, assuming what's posted is so, then quality care was not delivered and the system failed the patient.

          The case, as described and without doubting the poster, is unusual.

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Sun Mar 02, 2008 at 06:36:42 AM PST

          [ Parent ]

          •  nursing shortage (2+ / 0-)
            Recommended by:
            neroden, fayea

            Part of the problem is that there is a serious shortage of nurses in this country, especially in more rural areas.
            In PA, for instance, there are Recruiting for Nurses ads on TV.

            An individual has not started living until he can rise above the narrow confines of his individualistic concerns to the broader concerns of all humanity.

            by wishingwell on Sun Mar 02, 2008 at 08:23:22 AM PST

            [ Parent ]

            •  And a lot of that is because (1+ / 0-)
              Recommended by:
              neroden

              working conditions for nurses are so terrible that 15 year nursing careers are common, when a typical career should be 40 years.

              Nursing is physically difficult, high stakes, and nurses are not treated with the professional respect they deserve. When they're asked to do too much, patients die. The stress of all that is overwhelming.

              Fry, don't be a hero! It's not covered by our health plan!

              by elfling on Sun Mar 02, 2008 at 11:00:03 AM PST

              [ Parent ]

            •  lack of nursing training programs (1+ / 0-)
              Recommended by:
              neroden

              There used to be a lot of hospital-based programs. Then someone (I don't know who) decided those programs were no good, you should have a BA. But the BA programs didn't grow. My understanding is that there are skads of students trying to get into nursing programs, but very few places each year. This is nuts! Instead it's apparently cheaper for hospitals to bring nurses from Tanzania or hire temp "travel nurses."

      •  No, it IS likely to be uninsured-related. (0+ / 0-)

        I don't know if you've gone into an ER recently, but in some of them, seriously, they try to check your insurance before admitting you.

        Even though I could afford most ER services out-of-pocket (anything short of a multi-day hospital stay), I keep insurance, because they treat you worse if you don't have it.

        Note that he was stuck in the waiting room.  If he'd made it into a hospital bed, he would have been in the hands of doctors, and they do obey their oaths, and don't pay attention to stuff like insurance.  But he was in the waiting room, and the hospital administration people who do the admissions do pay attention to that sort of thing.

        -5.63, -8.10 | Impeach, Convict, Remove & Bar from Office, Arrest, Indict, Convict, Imprison!

        by neroden on Sun Mar 02, 2008 at 06:23:11 PM PST

        [ Parent ]

        •  you don't have nearly enough info (0+ / 0-)

          to speculate as to what happened, where he was, etc.

          But that's not how ERs work, and (yes, I do know how they work). The admin functions do not block patient care. That would violate a number of federal laws.

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Sun Mar 02, 2008 at 06:54:01 PM PST

          [ Parent ]

    •  Very and horribly tragic story, Navy Vet (10+ / 0-)

      probably the reason this child waited is because the ER has become, by default, the primary medical provider for millions and millions of uninsured Americans.

      Waiting times in ERs have lengthened as the health crisis has grown exponentially and worsened.

      •  that's true, but... (4+ / 0-)
        Recommended by:
        elfling, Bob Friend, wishingwell, neroden

        ...acute abdominal pain still gets seen before urgent care cases. There simply is not enough info for us to figure out what happened (surgeons tied up with trauma cases, etc), but that hospital sure as hell better be looking into it through their review committees.

        "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

        by Greg Dworkin on Sun Mar 02, 2008 at 06:03:16 AM PST

        [ Parent ]

        •  Yes . . . (2+ / 0-)
          Recommended by:
          Ozzie, fayea

          and this is somthing, that a lay person like me, wouldn't immediately think of.

          The bottom line remains, that the United States  has an overwhelmed and broken healthcare system--and an equally broken political system, not addressing properly the catastrophe.

        •  and this strain of flu virus (1+ / 0-)
          Recommended by:
          neroden

          this year that the flu vaccine could not prevent is a huge problem in our region and other regions of the country. So more people are going to the ER for the flu who do not have insurance. And much of this flu has symptoms of abdominal pain. Sadly, I am betting the triage nurse thought this young man had a bad case of stomach flu..not realizing his pain went far beyond that.

          An individual has not started living until he can rise above the narrow confines of his individualistic concerns to the broader concerns of all humanity.

          by wishingwell on Sun Mar 02, 2008 at 08:25:18 AM PST

          [ Parent ]

        •  Wal-Mart and CVS clinics (0+ / 0-)

          I cannot understand why otherwise rational people are opposed to in-store clinics, which could get much of the routine stuff out of ERs. In my ideal world, we all have access to a "school nurse" type of person, if not 24/7, then 6 a.m. to 10 p.m., who can deal with the basics at 1/10th the cost of the ER. Then the ER would have time for the serious stuff.

          I ended up in the ER a couple of years ago because I had an infected foot, and my insurance company's telephone hotline said it couldn't wait until Monday morning, and in that community there was nothing else available on Sunday afternoon. In hindsight I wish I had soaked it in soapy hot water and waited until Monday, but when a nurse tells you to get in there immediately, you do it. Total cost was over $800, most of which my insurance company paid but they shouldn't have had to. An in-store clinic could easily have dealt with it for under $100 including the tetanus booster.

    •  Just-in-time, for-profit (0+ / 0-)

      ERs are impacted in part because of uninsured using them as clinics, but a larger factor is that there is a lot of pressure for an ER to be profitable.

      First, there are a fair number of uninsured people who come in either with or without their consent who do need urgent care. Treating the flu in the ER doesn't really cost the hospital all that much on the margin - the cost is just made high to reflect the 24/7 nature of the place - but an auto accident victim does. So, they're squeezed on the revenue side.

      The thing is, ideally, if you goal was to save lives and provide care for everyone (including the wealthy), you'd want an ER to typically run at around 50% capacity, with docs standing around, so you'd have enough to be able to handle surges - multi-car pileups, hurricanes, earthquakes, tornados, epidemics, etc. But if the ER is expected to make a profit on its own, that's not feasible. The question is, is the community willing to chip in to pay its part for this public service, just as they do for police and fire protection.

      Fry, don't be a hero! It's not covered by our health plan!

      by elfling on Sun Mar 02, 2008 at 11:11:56 AM PST

      [ Parent ]

  •  When can we expect reform? (1+ / 0-)
    Recommended by:
    RA

    When Obama delivers it!

    You gotta believe!

    Hope! Hell yeah!

    •  see below (0+ / 0-)

      it's not the promise or prospects, it's the time frame.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Mar 02, 2008 at 05:52:49 AM PST

      [ Parent ]

      •  WTO and NAFTA agreements may prohibit changes (1+ / 0-)
        Recommended by:
        wishingwell

        or at least the ideas that have been floated so far by all three candidates may be prohibited under various provisions of WTO and NAFTA. At least that is what I was reading in a blog entry yesterday on workinglife.com

        Sens. Clinton and Obama: Can We Talk Some Truth About Trade?
        http://www.workinglife.org/...

        The author Jonathan Tasini comes to this conclusion, based on rules in the agreements

        "Significant changes not yet being discussed by the candidates must be made to existing U.S. trade pacts in order to implement the candidates’ priority health care and climate crises proposals. Changes to these agreements are also necessary for candidates’ domestic policy goals of creating jobs, countering wage inequality, rebuilding America’s manufacturing sector and infrastructure, and improving food and product safety and to succeed."

        also, attempts to broaden the numbers of people receiving coverage to  lower prices may run into obstacles in the agreements because:

        "...forbids "measures which restrict or require specific types of legal entity or joint venture through which a service supplier may supply a service,"  which would forbid requirements that certain health services be provided only on a not-for-profit basis."

        The author, Jonathan Tasini says: "Both the Clinton and Obama plans propose some risk-pooling scheme as a way of reducing costs. Well, that provision would be challenged by foreign health insurance providers because:"

        "...under these expansive WTO rules, a new risk pooling system that has the effect of stopping foreign insurance firms from establishing new insurance businesses – for instance, because as a start up they cannot meet the requirements set for access to a risk pool of prospective U.S. clients – qualifies as a WTO-forbidden restriction on market access, even though that is not the intent of such a policy."

        Attempts to reduce drug prices may be illegal..

        Programs that interfere with or limit the distribution of pharmaceuticals are prohibited...absent changes, GATS and other "trade" agreements would provide a new avenue and new grounds for multinational pharmaceutical firms and their allies to attack these important governmental policies, which have generated billions of dollars in taxpayer and consumer savings and could save more if nationally implemented as the Democratic candidates propose. To the extent that formularies may result in limiting the distribution of medicines by foreign pharmaceutical firms, including giant Swiss, French and German firms operating within the United States, they could be considered a GATS-prohibited "exclusive service suppliers" list"

        and so on.

        Honestly, I think we need some more debates to get all of the Presidential candidates to commit to addressing these issues by re-negotiating changes in the WTO and NAFTA agreements or moving to single payer which would sidestep these anti-discrimination provisions. (Thats the way many of the other countries manage with them.)

        •  Yes, single-payer works around it. (0+ / 0-)

          No need to pass that sort of regulation which NAFTA and the WTO regulate -- if you just make a giant government agency, which, in the 'free market', buys all or nearly-all of the health care, and being a near-monopoly, has the power to set prices.

          Incidentally I voted for Tasini in the last US Senate election in NY (he ran in the primary against Clinton).

          -5.63, -8.10 | Impeach, Convict, Remove & Bar from Office, Arrest, Indict, Convict, Imprison!

          by neroden on Sun Mar 02, 2008 at 06:27:41 PM PST

          [ Parent ]

    •  Obama will deliver! Tied in OH...leading TX! (0+ / 0-)

      I hearby announce my endorsement for Barack Obama. I know Senator Obama will want to get pictures with us together like he did with Senator Kennedy. ;)

      by RA on Sun Mar 02, 2008 at 10:10:19 AM PST

      [ Parent ]

  •  In short, we're screwed (0+ / 0-)

    Just like the arcane tax system we enjoy, there are too many people with vested interests in the status quo to make for any meaningful reform, even if it's killing our fellow Americans.

    •  see above (1+ / 0-)
      Recommended by:
      wishingwell

      it's not the promise or prospects, it's the time frame.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Mar 02, 2008 at 05:53:02 AM PST

      [ Parent ]

      •  I agree (1+ / 0-)
        Recommended by:
        Bob Friend

        I think once our nominee takes office, my first priority would be doing something about Iraq, rather than health care. Health care is an issue for me, however, and certainly should be a top priority.
        Any health care plan is going to take serious work by the President and Congress to work out a plan.
        And we all know how long that could go on, since even as a "minority party", the republicans have still been a huge obstruction to passing any kind of progressive legislation.

        •  The simplest plan (0+ / 0-)

          would be the most drastic - nationalize all the hospitals, and offer most doctors a chance to be employed by the govt, paid a salary, and given a list of patients.

          The other option would be to require all hospitals to be non-profit, have a community board that had to approve all major capital expenditures, and limit compensation to executives.

          But that won't happen - yet.

        •  they both can be addressed (0+ / 0-)

          Iraq and Healthcare and both can have a top priority.

          An individual has not started living until he can rise above the narrow confines of his individualistic concerns to the broader concerns of all humanity.

          by wishingwell on Sun Mar 02, 2008 at 08:26:41 AM PST

          [ Parent ]

    •  It may be a 'revolution' situation. (0+ / 0-)

      We may have to wait for it to get worse, to the point where people are willing to tear it out from the roots, before we can make it better.

      That sort of thing does happen.  After all, the New Deal was only made possible by the Great Depression; or for a worse example, real progress in stopping slavery only happened after the slavers in the South hardened their position and won control of the Supreme Court.

      -5.63, -8.10 | Impeach, Convict, Remove & Bar from Office, Arrest, Indict, Convict, Imprison!

      by neroden on Sun Mar 02, 2008 at 06:31:39 PM PST

      [ Parent ]

  •  Two points (10+ / 0-)

    Great post.

    I would like to add two posts.

    1. It will matter who is President.  Obama has promised to start work on universal health care his first year in office and to have it done by the end of his first term.  In contrast, Clinton has said she will sign the Children's Health Insurance bill her first year and will have universal health care by the end of her SECOND term.
    1. Neither will be able to enact health care reform without a majority of 60 democrats in the Senate.  The only candidate who is building a large enough political coalition to sweep this many Democrats into the Congress is Barack Obama.  Without a "working" majority, it will be difficult to pass a comprehensive bill.

    Health care is a human right.

    by Helenann on Sun Mar 02, 2008 at 05:53:08 AM PST

    •  thanks! (5+ / 0-)

      I was hoping you'd come by!!

      The presidential difference will be posted on later by mcjoan. But i think folks need to have their expectations lined up for some realism. Even Obama says 4 years, and Hillary says 8.

      Both of those are realistic goals; sooner is not.

      And the public supports them.

      a majority of Americans are backing key elements in the health reform proposals of Democratic presidential candidates Hillary Clinton and Barack Obama.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Mar 02, 2008 at 05:58:28 AM PST

      [ Parent ]

      •  Exactly (1+ / 0-)
        Recommended by:
        wishingwell

        no matter what is decided, it will take time to see the changes. They won't happen overnight.

        We might see some improvements in a couple of years, but a full overhaul would take more than one president's term.

        •  You are mistaken. (0+ / 0-)

          Senator Kennedy and other colleagues in the Senate have already started the hard work of drafting Obama's plan into legislation.  

          The only way this works is if you get legislation from the Congress in the first 100 days.  After that, the window of opportunity slams shut.

          It will be imperative for the Congress to have a bill ready to discuss very shortly after the inauguration and to move it quickly through the Congress.

          Everyone in the Congress understands this and you better believe that as soon as we know who the Democratic candidate will be (Wednesday?) they will start working on a bill with the candidate so that they are ready to roll on day one!

          Health care is a human right.

          by Helenann on Sun Mar 02, 2008 at 01:58:32 PM PST

          [ Parent ]

    •  I don't think this is true (3+ / 0-)
      Recommended by:
      Lupin, skiddie, murrayewv

      I think both candidates intend to provide widespread comprehensive health insurance coverage, which simply does not address the problem.

      Universe health care and universal insurance cover are not the same things, unless you are talking about a truly single universal insurance organization that does not take profits.

      Do you have a couple of links the summarize their plan contents?

      Come see Greg Mitchell on Thursday Virtually Speaking

      by JayAckroyd on Sun Mar 02, 2008 at 05:59:21 AM PST

      [ Parent ]

    •  recommended for point 2..... (3+ / 0-)
      Recommended by:
      skiddie, nyceve, SnowCountry

      I am tired of the primary and discussions of Obama vs. Clinton on this blog.  But point 2- that we need a majority in the Senate- should not be overlooked.  

      This lack of a strong majority in the Senate is the problem with any issues of the war and reform right now.  

      Obama's plan is not great, but could pass- mostly because it is watered down.  Hillary's plan, since it is more comprehensive, could take longer to pass.  But any plan that asks for more than 4 years to pass is imaginary.  You get elected for 4 years- give us a 4 year plan.  I want a better plan than either has offered me- and so does America.  The middle class young people who don't want to pay premiums and therefore embrace Obama are a problem for me- they probably don't want to pay taxes for children's health care either.  I want people who understand paying for health care comes from all of us, and more health care will lower the price for all eventually.

      You shall know the truth, and the truth shall make you mad. Aldous Huxley

      by murrayewv on Sun Mar 02, 2008 at 06:02:20 AM PST

      [ Parent ]

      •  Clinton's would be faster (1+ / 0-)
        Recommended by:
        murrayewv

        Obama's plan is not great, but could pass- mostly because it is watered down.  Hillary's plan, since it is more comprehensive, could take longer to pass.

        Actually, as the Ruth Marcus article linked in the original post says, a mandate is universally seen as a requirement by both parties.  

        Because of that, I think that Obama's health care plan would be DOA.

        •  That is not true (0+ / 0-)

          Mandates are a way to force people to buy coverage who can afford it but have decided not to buy it.  These are called free riders.  And they account for a very small % of the population.

          Mandates are not a route to universal coverage.  As we have experienced in MA, if the plan is not affordable, you cannot force people to buy it.  MA has exempted about 20% of the uninsured from their mandate; they will remain uninsured.  That is hardly universal coverage.

          In addition, the Netherlands, which has a truly single payer system, financed through taxes, that automatically enrolls people and requires NO premium, only gets to 98% coverage.  They added a mandate to get the last  2% and after more than a year, they are still at 98%.  

          And the best example of how offering affordable coverage can get you to 99% coverage is Part B (the physician services component) of Medicare.  It is completely voluntary for the Medicare population to enroll.  And because it is so affordable, 99% sign up WITHOUT A MANDATE.

          Obama is right - most Americans will buy health insurance if it is affordable relative to their incomes.  And as far as those free riders go -- we can give them a clear choice.  Pay out of their own pocket for their health care or sign up for insurance when they come in for care.  About 67% of the uninsured visit a doctor or emergency room every year.  Thus, within 2 years, about 90% of the remaining uninsured will come in for care and have the opportunity to enroll.  This is a much more effective and efficient approach.

          The government should not be in the business of threatening people with fines if they are uninsured.

          Health care is a human right.

          by Helenann on Sun Mar 02, 2008 at 01:56:07 PM PST

          [ Parent ]

          •  What does insurance cost in MA? (0+ / 0-)

            Is there anyplace I can look at the rates.

            As I see it, the government is not in a position to force private insurers to lose money on people. If you are part of a 'group of one' (an individual) the insurance companies are going to base their estimate of their potential exposure on whatever data you tell them and what they can dig up on you. They will then quote a price. I think that they will have a top limit beyond which, even if they know what their break even point would be, they don't quite it to people because that would be bad public relations. They just tell you, 'sorry, we can't insure you' What Obama proposes to do is require them to give it to you for that price, if you are willing to pay. But it will still be far more than many people can afford. I don't see any way around this other than expanding the size of the group (and mandatory is the only way to do that) OR going to single payer, which puts us all in the same BIG group and eliminates a lot of paper work, AND the risk that people will lose insurance every time something changes, which is happening a lot. Plus, it will eliminate the huge disincentive companies now have to hire older people, which is important because jobs are getting shorter and shorter inaverage duration and many people spend long periods of unemployment. The way it is now, a lot of people get sick, then lose their jobs, then they lose insurance, and once they dont have it, things get ugly fast.

          •  What about people who suddenly get sick (0+ / 0-)

            and end up in the hospital.. My friend Tom was laid off of his job, could not find another, was working sporadically as a painter, suddenly got ill, and ended up in the hospital for three days.. Total bill was over $30,000. He is now trying to pay that off and they are threatening legal action. He was working, but his income was barely enough to pay rent (he lives in a city) but he does not qualify for any of the programs either..

            These days, with a big black mark on your credit, its also hard to get a good job..

            :o

            Hospitals charge uninsured people far more than they charge insurance companies for the same things, too.. which should be illegal.

            •  Your friend (0+ / 0-)

              would have been able to sign up for insurance under Obama's  plan, if he hadn't already, when he was admitted to the hospital.  And he would have had coverage for his hospital costs.  

              And you are right about them charging uninsured more.  It is a terrible situation.

              Health care is a human right.

              by Helenann on Fri Mar 07, 2008 at 04:11:26 PM PST

              [ Parent ]

      •  Why sweat the fine print right now? (0+ / 0-)

        Given the complexity, and the likelihood of incremental change, and the need to work with Congress, I cannot fathom why at least one of the campaigns (HRC) thinks that I'm going to vote based solely on the details of one or the other "ideal" health care plan. Especially not from a person whose last swipe at the problem was so spectacularly unsuccessful that it set the whole process back 15 years.

        I would expect that with a Dem President and a Dem Congress, we should see quick early support for measures such as allowing (and maybe rewarding) states to expand SCHIP and Medicaid eligibility, and perhaps allowing 50+s to buy into Medicare. I would hope those would be coupled with rolling back the prohibition on negotiating drug prices under Medicare D, reigning in payments for drugs not shown to be of any benefit, re-regulating drug advertising direct to consumers.  

  •  Authorization by profit making orgs cannot succee (2+ / 0-)
    Recommended by:
    OLinda, GayHillbilly

    George W. Bush doesn't want you to think of a sick child. Not Graeme Frost. Not Gemma Frost. Not Bethany Wilkerson. Not any of the real children affected.

    He wants you straining your eyes on the fine print of policies, puzzling over the nuances of coverage -- whether you can afford premiums for basic, catastrophic, comprehensive or limited health insurance. Last week on "Real Time With Bill Maher," even Tucker Carlson kind of got it right, saying, "No one child is a metaphor -- he's a kid!" That's the point. They're all kids, each one, one by one. The question is, do you care?

    The actuaries don't. And can't. Health insurance companies make their money by denying care. They maximize profit by authorizing as little care as they can get away with. That's what all those administrative costs -- as high as 30 percent -- and all that paperwork are mostly about. It takes a lot of people to justify denying care.

    It's the opposite of the way the market is supposed to work: Make more money by delivering more product. The health insurance industry makes more money by delivering less product. It maximizes profits by minimizing care.

    Profit-run medicine is not, and cannot be, full care. What is needed is patient- and doctor-run medicine. The State Children's Health Insurance Program (SCHIP) is just that. Our children need care. Our doctors provide it. The government handles the transactions, period. And we pay a lot less and get a lot more, because there are virtually no administrative costs and no profits being taken by outsiders

    Don't think of a sick child, RRI

    While it is certainly true that there are institutional barriers in persuading people that we have a poorly designed health care system, there is both a great deal of evidence that this true, and there is, as noted above, real concern among people who are covered.  That "satisfaction" number is high to be hard. Actual concerted efforts to communicate the ranking of the US health care system among the OECD countries would help enormously.

    SIcko makes this case very well.  And  I was reminded, while thinking about this yesterday how I came to watch the Deadwood seriesl. I don't get HBO, but i do get the New Yorker. And HBO bundled in a copy of the first show.

    I think an effort to widely distribute Sicko would very much help in this communication effort.  Moore will be attacked, of course, but the answer is to watch the documenary. It really makes the central points very clearly.

    •  What's wrong with profit-run medicine? (0+ / 0-)

      Profit-run medicine is not, and cannot be, full care.

      Why not? Nothing in the quote you've provided describes any problems with profit-run medicine.

      I hate this game - talking about the problems of insurance and then pretending like those are the problems of health care. Prohibiting profit driven health care gives you the kind of single-payer system they have in Canada. Allowing profit driven health care gives you the kind of single-payer system they have in France. Which is better? Guess which one was rated best by the World Health Organization?

      •  Denial of care, insurance rescission, bankruptcy (0+ / 0-)

        Actually, by the accounts of every Canadian I know, everyone in Canada loves their health care system. They think we are barbarians for not having one and they always purchase insurance for even short trips to the US because every Canadian can tell you stories of a friend who was injured here who ended up in debt for HUGE amounts of money for some small accident or injury.

        Same with Britian, same with France. I suspect that the insurance companies have hired people to go around the blogosphere to spread, lets face it, lies about the healthcare sstem in many other countries in an attempt to prolong our agony for another decade or two, and its seems to be working. But the healthcare systems in countries that have universal healthcare cost patients NOTHING or close to nothing when they get sick, and they function as well as our does or actually in most cases, MUCH BETTER.

        Plus, they dont KILL people from stress.

  •  It has to start at the state level first or it (3+ / 0-)
    Recommended by:
    ferg, wishingwell, Andy86

    ain't going to happen. That is the way it started in Canada. A bunch of lefty farmers from the midwest get fed up with the way things are going in the good ol USA and move to Saskatchewan (iirc). By force of numbers they changed that province's health-care system 30 years later the rest of Canada adopted a similar plan.

    I have said this repeatedly that a state will have to  get the ball rolling. I'm hoping it will be my state (CA), but it could be any state that a majority of progressives live. This ain't going to be a top down thing. It has to be a bottom up thing. End of story.  

  •  Excellent Post. (2+ / 0-)
    Recommended by:
    DemFromCT, wishingwell

    I really enjoyed the tone of the piece and the ammount of research behind it.  It was thoroughly interesting and informative.  This is EXACTLY the sort of thing that drew me (i.e. a skeptical independent) to this site.  Kudos!

    As for the substance, I think it's interesting to see the difference between the more radicalized elements in our society driving this debate and the general concensus of the silent majority.  This is yet another instance in which the numbers don't add up for one side (liberals) and the facts don't help the other (conservatives).  Personally, I would love to see healthcare reform, but am concerned about the cost.  More importantly, I'd like to see the system tranform into a more pre-emptive one, instead of focusing solely on being responsive.  Any sort of change will be difficult to come by, but I look forward to the debate and hope the issue progresses.  Cheers!

  •  Obama is for single payer, and the hope (1+ / 0-)
    Recommended by:
    Bob Friend

    is that he begin the process.  It is not a system which can be accomplished in a year or two, given the forces involved.  It took Canada twenty years to get their system in place, and they have a better educated and more rational electorate.  Obviously, a lot will depend on what kind of Democratic majority we can give the eventual president in the Congress.

    •  Obama is not for single payer (1+ / 0-)
      Recommended by:
      skiddie

      Obama definitely will not propose single payer or anything close to it. He has stated so plainly. He used to support it long ago. He has flip flopped.

      Progressives who think his health care reform will be at all to their liking will be sorely disappointed. One of his health care surrogates is Jim Cooper, the main player on the Democratic side responsible for killing the Clinton health care plan in 1993. He is against universal coverage. Read what Mike Lux has to say about his direct experience with Jim Cooper

      http://openleft.com/...

      and what Ezra Klein has to say about him.

      http://www.prospect.org/...

      Hillary Clinton is the last person standing for real universal health care, and has devised a brilliant plan, with the addition of a option of a Medicare like nonprofit publicly administered program that could eventually turn into a single payer national health insurance program if enough people choose it. That is why I support her.

      What is most likely to come to be is the bipartisan Wyden/Bennett Senate bill, the Healthy Americans Act (should be the "Bankrupted by Medical Bills Americans Act") that proposes a private insurance based system and eliminates employer provided health insurance. We will all be on our own trying to purchase insurance in the private market. That is what Obama's "post partisan" "unity" and compromise politics will net us, and we should be very scared.

      If what you want is single payer then Obama is NOT your candidate. Hillary Clinton is. Her plan is far more progressive.

      •  Nonsense. Hillary Clinton is DLC to the core (1+ / 0-)
        Recommended by:
        wishingwell

        with her bales of cash from big health care, one might have serious doubts as to her commitment to doing anything about the healthcare mess, or about anything else other than getting herself elected, if recent campaign tactics are any guide.

        •  It's on us, not Obama: (1+ / 0-)
          Recommended by:
          elfling

          the combination of a President with Obama's extraordinary leadership skills and a budding mass movement already supporting HR 676 (which includes over 235 union organizations in 40 states, including 60 Central Labor Councils, as well as many citizens and religious organizations) the American people can be convinced to support Medicare For All

          For that to happen, it will take a mass movement in support of single payer health. Obama speaks eloquently of the fact that real social change is hard and starts from the bottom up through organized movements, not from the top down from a government that institutionalizes fundamental social change only when forced to from below. A mass movement for single payer healthcare has already begun to take shape. My hope is that an Obama Presidency will help give it the space to flourish, and to push Universal Healthcare beyond the bounds of Obama's more modest proposals

          Miles Mogulescu at Huffington Post.

          •  Fiction (2+ / 0-)
            Recommended by:
            7rescue, Valhalla

            This is the #1 fiction about Obama that makes me say that his supporters just take their own dreams and make him in favor of that.

            Obama is not in favor of a single payer health care system.  I do await mcjoan's analysis later today.  But there is this belief out there by some Obama supporters that somehow if we have an Obama presidency that he will suddenly become a single-payer standard bearer.

            It won't happen.

            And that worries about the 'wake up call' when President Obama can't be all things his supporters have decided he is.

            •  You have no idea what will happen or not happen (0+ / 0-)

              You are pontificating.

              •  They WONT be able to implement their proposals as (0+ / 0-)

                they stand..

                They would be illegal under WTO and NAFTA. This is the legacy that Bush has left us, a lock-in of many policies that is going to be VERY hard to get out of.

                Single payer is the only way to not have 'discriminatory' policies towards some vendors and not others.

                Please read this article..

                http://www.workinglife.org/...

                •  We should not expect anyone to implement anything (0+ / 0-)

                  as it stands.  The campaign wish lists are just that.  If and only if we give Obama a mandate and a lot of help in Congress will there be any possibility of major reform.  It's up to us to choose the most progressive electable candidate, then organize.  
                  Hillary cannot deliver a mandate or implement much in the way of reform because of her sky high negatives.

                  •  They both have negatives.. (0+ / 0-)

                    and positives..

                    But we should not fool ourselves about the future, I actually agree with the dairy author in that I think it is going to be VERY hard to get change to happen within the next five or ten years without a crisis. I don't consider the leading candidates proposals to be real change because I don't think they will succeed to make healthcare actualy cheaper for the majority of Americans. Maybe for their children they will, though.

                    How could they, with insurance companies so heavily involved?

                    •  Universality (mandated) will reduce costs (0+ / 0-)

                      "I don't think they will succeed to make healthcare actualy cheaper for the majority of Americans. Maybe for their children they will, though.
                      How could they, with insurance companies so heavily involved?"

                      With the Clinton plan establishes the option of the public Medicare like program, so people are not locked into buying private insurance (which cannot possibly deliver affordable policies that are comprehensive and actually supply people with the services they need and protect them from bankruptcy or destitution in the event of a serious health problem). If the American people choose Medicare like program as their carrier, that will make the decision on our having a national health insurance program or not. No elected official can force a single payer program on the public, that is much like trying to force democracy down people's throats who have not chosen it. But Clinton's plan has set up the possibility of people choosing it for themselves.

                      If most or all people opt for the public program it will reduce costs, but no mechanism short of that will reduce costs. Obam's plan cannot work, it is a joke. It would take pages of detail to demonstrate that, and will likely also require reorganization of the health care delivery system and constant evaluation of the effectiveness and efficiency of services.

                    •  France, France, France! (0+ / 0-)

                      How could they, with insurance companies so heavily involved?

                      France managed to get a single payer system by keeping the insurance companies involved.

      •  neither one of them are for single payer (0+ / 0-)

        You won't see single payer, medicare for all, from either Obama or Clinton.

        Dr Wu, the last of the big time thinkers

        by Dr Wu on Sun Mar 02, 2008 at 08:59:00 AM PST

        [ Parent ]

  •  If you expand coverage, (1+ / 0-)
    Recommended by:
    Bob Friend

    you contain costs because you are more able to realize economies of scale.  Also, early and routine intervention reduces the seriousness of events.  
    Think of routine fire hydrant and alarm inspections.  If the infrastructure is well maintained then an incidence is more easily and effectively contained.

    SOCIALIZE THE FUNDING--PRIVATIZE THE CARE

    How do you tell a predator from a protector? The predator will eat you sooner rather than later.

    by hannah on Sun Mar 02, 2008 at 06:04:38 AM PST

    •  One point of disagreement (1+ / 0-)
      Recommended by:
      OLinda

      If you expand coverage, you contain costs because you are more able to realize economies of scale.

      I don't have any source I can point to but the biggest reasons for health cost being high (other than corporations maximizing profit) are our indulgence to expensive, new technology and doctors ordering more tests to cover their behinds.  The second point I distinctly remember having come from a neurologist and Dem Congressional candidate.

      Economy of scale will not be able to address these causes of high health care cost.

      My Edwards 2008 yard sign will stay up for a long time.

      by Andy86 on Sun Mar 02, 2008 at 06:37:28 AM PST

      [ Parent ]

      •  high cost myths (7+ / 0-)

        People are so confused about high health care costs. The skyrocketing medical costs are more about the transfer of costs than anything else.  The more uninsured or underinsured, the higher the cost for insured people.

        The prices hospitals charge include  payment for EVERY uninsured person who receives care and the cost is ENORMOUS.   Trying to get this simple point across to the people is incredibly difficult, though, because people seem to think that the tooth fairy is paying for care for the uninsured.

        And by the way, when the republicans decrease funding for medicare and medicaid, you pay for that too.  The costs don't magically go away.  It's all part of the transfer of costs system.

        •  not to mention (0+ / 0-)

          the surprisingly large cost of arguing about who will pay for every little thing.

          Fry, don't be a hero! It's not covered by our health plan!

          by elfling on Sun Mar 02, 2008 at 10:14:36 AM PST

          [ Parent ]

        •  I was talking about the cost of health care (0+ / 0-)

          and not the cost of health insurance.

          From http://www.nchc.org/...

          Experts agree that our health care system is riddled with inefficiencies, excessive administrative expenses, inflated prices, poor management, and inappropriate care, waste and fraud.

          This looks like an all encompassing list.

          I don't disagree that health insurance premiums pay for the uninsured, but I have yet to be convinced that that is the reason for "skyrocketing medical costs".

          My Edwards 2008 yard sign will stay up for a long time.

          by Andy86 on Sun Mar 02, 2008 at 10:17:42 AM PST

          [ Parent ]

        •  no, as an unisured I'm paying more (0+ / 0-)

          You make the assumption (as does the press that uninsured don't pay their bills). Many of us do, AND get charged much more.

          fact does not require fiction for balance

          by mollyd on Mon Mar 03, 2008 at 04:50:15 AM PST

          [ Parent ]

      •  As a nurse that works (3+ / 0-)
        Recommended by:
        skiddie, Dianora, Andy86

        in a doctor's office, part of the problem is the public's demand for technology. I work in the specialty of spine care and patients demand MRI's. The doctor I work for is originally from Germany and when he began his practice here he was much more conservative- for example, a new patient with low back pain would receive a prescription for physical therapy and anti-inflammatories. The majority of patients now demand MRI's. An MRI, read by a neuroradiologist, $1500. The majority of MRI's demanded by patients have insignificant findings.I often tell my doctor that the right to an MRI has been recently added to the Bill of Rights!

        •  I have low back pain, probably a herniated disc. (0+ / 0-)

          I was almost immobile from sciatic pain for a month.  I was given pain pills, and told to get BOTH a CTscan AND an MRI.  No further medical advice until I get them, apparently.  Not MY demand, but the Dr's.

          It's not just the patients.

          I'd rather have a bottle in front of me than a frontal lobotomy.

          by beemerr90s on Sun Mar 02, 2008 at 09:17:54 AM PST

          [ Parent ]

          •  Diagnostic services (0+ / 0-)

            in my opinion helps to equalize the gap between inexperienced and experienced doctors.

            Obviously you as a patient don't want the combination of inexperience and no diagnostic radiology, and the doctor doesn't want to be sued for mis-diagnosis.  

            When radiological diagnostics becomes nothing but a trivial expense of time and money, that really is the multi-million dollar question.

            My Edwards 2008 yard sign will stay up for a long time.

            by Andy86 on Sun Mar 02, 2008 at 10:29:16 AM PST

            [ Parent ]

      •  It's true that new machines are expensive to (4+ / 0-)

        run.  But the reality remains that the cost of purchasing an MRI machine, for example, and retaining a staff to run it is the same whether it's used once a week or five times a day.  The latter is only possible if there is a sufficiently large pool of patients that require the service.  You don't get that pool by excluding one sixth of the population that's actually most likely to need the service.  The current solution to under-utilization of equipment--providing the service on the basis of who's covered by insurance rather than who actually needs this diagnostic tool to be applied--increases over-all cost to the detriment of the profession.

        If you start from the assumption that medical care is the lesser of two evils (the greater being premature death), then the use of words such as "indulgence" is demonstrably inappropriate. Just as "getting a child" is not in the same class as "getting a TV," getting health care is not in the same class as getting a facial.  Correcting for debilitating disease and preventing premature death is a social necessity.  A society which fails at those tasks will not survive.

        Since all individuals eventually die, the individual incentive to acquire health care is much less.  Indeed, we all recognize that children have no incentive at all, in part because they are not aware of the difference between life and death.

        How do you tell a predator from a protector? The predator will eat you sooner rather than later.

        by hannah on Sun Mar 02, 2008 at 07:14:39 AM PST

        [ Parent ]

        •  Life and cost (0+ / 0-)

          The current solution to under-utilization of equipment--providing the service on the basis of who's covered by insurance rather than who actually needs this diagnostic tool to be applied--increases over-all cost to the detriment of the profession.

          I agree it helps to lower the cost per CT or MRI scan by getting everyone who uses the service to pay.  Still that only makes a difference of 1/6 of whatever is charged.  It is sizable but is that significant?  I don't know.  All I know is when something is costly, people use it less and when something is free to them, people don't value it.  For now, I would be in favor of a universal coverage, insurance based system with big co-pays.

          If you start from the assumption that medical care is the lesser of two evils (the greater being premature death), then the use of words such as "indulgence" is demonstrably inappropriate.

          When a human life is at stake, all sensible judgements go out the window.   A human life has no fair market value in the classic sense of the term, at least not beyond the potential to earn money.  When a car costs much more to fix than to buy a new one, people usually choose the latter.  With people, we often have to choose reluctantly and often unwisely.  

          Whether or not indulgence applies to treating a patient is in the eye of the beholder.  In a universal health care, single payer system, health services need to be prioritized.  I look forward to that happening and I will be happy to leave this earth if and when I am struck with a major ailment that takes substantial cost and effort to treat.

          My Edwards 2008 yard sign will stay up for a long time.

          by Andy86 on Sun Mar 02, 2008 at 11:15:30 AM PST

          [ Parent ]

  •  We need a better system wherever it comes from. (3+ / 0-)
    Recommended by:
    OLinda, elfling, wishingwell

    People's lives depend on what happens. I don't care if the plan comes from within the government or from a group outside that finally sits down to do something. It seems to me that a large part of the reason we don't get things done is territory. They all want to stake their claim to the best idea & appear to have the only solution. So while they sit around defending the value of their "better mousetrap" the people counting on a change suffer. I would really love to see someone stand up & tell the government (that supposedly work FOR us)& the insurance companies to stuff the egos & get to work.

    My daughter is getting ready to graduate college soon. She is on our insurance & has a non-life threatening heart condition.Her biggest fear is being cut from our insurance & not being able to get coverage for herself that she can afford due to this preexisting condition. And her fear is a valid one.

    Another example is her friend, Chelsea Umbach. She is 22 & going to grad school at UAB. She has been on the wait list for a double lung & heart transplant over a year. Her most recent stay in the hospital was from Sept- Jan. Can you imagine the cost? She takes 27 pills a day as part of her care. She is still on her parent's insurance but it has a cap & the co-pays add up quickly. While it is a blessing to have private insurance there should be some form of coverage for people of average income that will help when normal coverage expires or limits out.

    We contacted both the Clinton & Edwards campaigns to try to get awareness for the needs of people like Chelsea. There was an offer of assistance from the staff of Clinton's Alabama campaign group but nothing has happened yet. Edwards has apparently not been reached & since he is no longer a contender it may not be possible for him to get involved. Obama's campaign is difficult to get inside to the right person so there has been no luck there.

    If you have any ideas on how a change that works can happen please post it & let's start making it an issue. People like Chelsea don't have time to wait for more talk!

    •  I wish Chelsea well (0+ / 0-)

      As we discussed on another diary, one of the crazy aspects of our system is that for people like Chelsea, covered by their parents' insurance as long as they're a student, if she becomes too sick to remain enrolled in school, her coverage will likely expire.

      That's one of the key memes that we need to impress upon people who believe their current coverage is adequate - that you can get too sick to keep it.

      Christopher Reeve, not exactly the working poor, exceeded the lifetime limits of his health insurance policy after a bit more than a year.

      Fry, don't be a hero! It's not covered by our health plan!

      by elfling on Sun Mar 02, 2008 at 11:18:35 AM PST

      [ Parent ]

      •  If you come up with a way to get their attention (1+ / 0-)
        Recommended by:
        elfling

        let me know! I'm on board for that 100%. Most folks think either the government will help you or your insurance will cover it. They have no idea what a mess it is to fall in between those 2.

        My daughter is frantically applying to grad schools so she can buy some time & keep insurance. If she had her way she'd take a year off, work & then start grad school when she fully decided her direction. Unfortunately her heart condition will require that she keep decent coverage or else just feed off the government (get on welfare & use public health). Riding the government meal train isn't her style & the prospects of her starting off in a job with decent benefits right at graduation is slim.

        It floors me that healthcare isn't right up there with economy & the war as key issues. Too bad I couldn't have 5 minutes with each candidate of both parties. I'd have them look some of the people I know that need help & see how they could justify what they have or haven't done to come up with a plan.

  •  once, on this site, (6+ / 0-)
    Recommended by:
    DemFromCT, ferg, beemerr90s, MH in PA, fayea, ripcw

    I posted the finding (as reported here) that the vast majority of Americans are satisfied with their own personal health care situation... and got troll rated!

    Too many people at this site have ideological blinders on regarding this issue.  They have Socialist Utopian visions that should have fallen with the Berlin Wall, but have persisted.

    Enterpriser; Hard core Libertarian: +6.63 / -4.41

    by jimsaco on Sun Mar 02, 2008 at 06:08:50 AM PST

    •  sorry about that, wasn't me (0+ / 0-)

      the polls show that you are right, and it's a driving factor (or lack of a driving factor) for change.

      Any new system will have to satisfy Machiavelli's law of reform.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Mar 02, 2008 at 06:12:01 AM PST

      [ Parent ]

      •  So happy (0+ / 0-)

        I am so happy you pointed it out in this wonderful, thoughtful post, however.  It is key to understanding some of the huge societal and institutional barriers in place blocking major reform.

        It is also why a universal 'hybrid' plan with the option for people to keep their own plans is essential.

    •  Socialist Utopian Visions? (4+ / 0-)
      Recommended by:
      Lupin, skiddie, wishingwell, gobucky

      Do you mean like public education, public roads, buses, subways, air traffic controllers, water... Yeah, let's privatize all that stuff too!

      The fact that 'most people are satisfied' is due to the fact that most people are employees who do not ever see how much smaller their paycheck is due to all the profits and extra admin costs that go to private health insurers (dedicated to try to deny their care). If a single-payer system can guarantee equal or better care and access at an ultimately lower cost due to increased efficiency, and give 'most people' more wages after taxes at the end of the day, they would prefer that.

      However, as BHO, HRC, and Ron Wyden know all too well, we are not starting from scratch and 'Machiavelli’s Law of Reform' needs to be understood in the face of powerful and wealthy vested interests, as stated above.

      So, while we all know where we need to go with this, it has to be a gradual process or nothing. So that may mean an incremental plan in an easier gear to start up the hill, one that is not as ambitious as another, but one that has the possibility of starting a change in the right direction -- given the realities of the political venue.

      Whatever gets the ball rolling in the right direction -- just enough to show improvement to 'most people' so that they get on board with further reform -- and again, gaining momentum, -- is the smart way of getting to the end result that makes the most sense for the country as a whole from a business and a health perspective.

      •  A small disagreement... (4+ / 0-)
        Recommended by:
        ferg, elfling, wishingwell, fayea

        It's not that 'most people are satisfied' because they have employer-sponsored health insurance, it's because they've never been truly sick.
        What would the poll results be if we restricted it to folks who have had cancer or kidney failure?  Or to folks who were in a car accident and needed extensive physical therapy?
        I have health insurance from my employer and I realized how crappy is was when my wife was found to have a pituitary tumor.

        Don't be a DON'T-DO... Be a DO-DO!

        by godwhataklutz on Sun Mar 02, 2008 at 07:19:15 AM PST

        [ Parent ]

    •  You can't figure out why you get troll-rated? (0+ / 0-)

      They have Socialist Utopian visions that should have fallen with the Berlin Wall, but have persisted.

      That's why you get troll-rated. I disagree with most of the people here. (I'm one of those freaks who sees Clinton's plan as the best and most likely to ever lead to universal or single-payer health care.) I haven't yet seen anyone propose anything resembling "Socialist Utopian visions". That's just name calling and it's false.

      Enterpriser; Hard core Libertarian: +6.63 / -4.41

      Maybe you should learn some real political theory before you go throwing around terms you obviously don't understand.

  •  He who hesitates is lost. (3+ / 0-)
    Recommended by:
    TJ, OLinda, wishingwell

    This is the problem.  It will never be easy.  It will never be cheap.  If we would have started single payer after WWII like the Brits, the issue would be mute.  However, we are now tied to the big, sucking vacuum known as the Healthcare industry.  Our chances of freeing the American people from the corporate giants is diluted by the ties our reps have to the pharma, insurance, and healthcare industries.  When the rich guy starts being affected by loss of insurance, that is when change will come.

    Not all who wander are lost. J.R.R. Tolkien

    by temptxan on Sun Mar 02, 2008 at 06:12:34 AM PST

  •  Kevin Sacks in today'sNYT (4+ / 0-)
    Recommended by:
    skiddie, elfling, Bob Friend, wishingwell

    includes mcain's plan and discusses the strategy involved in the general election

    He also reminds us that only 71 percent of Americans are covered by an employer insurance benefit. This leads me to further call into question the very high satisfaction figures. They MUST include people who are currently covered by the VA,  Medicare and SCHIP.   In fact, people, IME, look forward to Medicare eligibility because it works so much better than many private insurance plans.

    And yes, i do want to chime in with the others pointing out what a fine review this was. The Kaiser numbers really do show the depth of the problem.

    Come see Greg Mitchell on Thursday Virtually Speaking

    by JayAckroyd on Sun Mar 02, 2008 at 06:13:09 AM PST

    •  yes, that includes all (4+ / 0-)
      Recommended by:
      ferg, JayAckroyd, wishingwell, Ronit

      and the numbers that support SCHIP are overwhelming. So, when one considers that medicare and SCHIP are popular programs, they can be passed (SCHIP) and used as examples of how to make the system work better. That's exactly why Bush fears SCHIP. It blows the privitization model the GOP adores out of the water. medicare costs, otoh, will have to be addressed honestly for a change.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Mar 02, 2008 at 06:29:15 AM PST

      [ Parent ]

      •  SCHIP is mainly privatized (2+ / 0-)
        Recommended by:
        wishingwell, neroden

        in almost all the states, so it doesn't blow the GOP privatization model anywhere. People don't understand how much cheaper and better SCHIP could be if it were publicly administered.

        •  sure it does (4+ / 0-)
          Recommended by:
          jd in nyc, skiddie, wishingwell, neroden

          because it's a hybrid and not the model the GOP wants and prefers.

          In the end, the SCHIP battle became a proxy war over the duties that government should assume in national health care reform. As SCHIP's reach has grown, the program has wandered into an enormous ideological divide over whether government should be permitted to act as a group sponsor and monitor of plan accountability. The use of government as purchaser and market overseer itself represents a crucial policy and political compromise between advocates of pure public insurance models and proponents of full market deregulation. Certain recent high-profile legislative reforms — Medicare Advantage, Medicare Part D, and the Massachusetts Connector Authority, for example — are evidence of the potential for architectural compromise. Given the need for a compromise providing a robust approach to managing an enterprise as vast as the purchasing of personal health care services, these hybrid systems appear to offer a means of breaking the policy logjam.

          But it was such a solution that the administration sought to halt in the case of SCHIP, precisely because of its implications for broader future reforms.

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Sun Mar 02, 2008 at 07:03:17 AM PST

          [ Parent ]

          •  Hybridization of programs in health care (1+ / 0-)
            Recommended by:
            neroden

            renders them unsustainable economically, and depletes the quality and comprehensiveness of services, reduces accountability, fractures the risk pool, thereby eliminating the option of the public organizing to redress grievances and moving for social change.

            It is a right wing victory to privatize our programs, because it routes them onto a trajectory of unsustainability and poor quality that impugns the reputation of government programs to meet our needs. Every failure and incompetence of privatized services, especially in health care where all the incentives are perversely aligned to deplete comprehensiveness to save money and enhance profitability for the firm involved is yet another blow to the idea that government is competent to supply any public need.

            So no, I do not agree at all that privatized programs blow the GOP long term goals at all, they simply have a longer term frame for their efforts to drown government in the bath tub. Precisely matching their model is not important, they are still well in the game, it will simply take a little longer to achieve their goals.

            If government meets the public expectation that it is too incompetent to administer programs over time, we will never be able to pass another health care program like Medicare, or expand one.

        •  Yeah -- I'm not fond of our private company. (0+ / 0-)

          which runs the NYS version.

          I'm sure a public-run system would make some of the same errors and cause some of the same delays.

          But at least it would wipe out the wasteful delays due to the doctors' offices having to learn yet another different system for submitting claims with a different set of rules and in some cases different codes (*not* the same as NY Medicaid, which is not the same as Medicare, which is not the same as any of the private insurance plans, or the Medicaid in some other state, or the SCHIP in some other state....)  I know people who have had treatment delayed for months due to things this stupid.

          -5.63, -8.10 | Impeach, Convict, Remove & Bar from Office, Arrest, Indict, Convict, Imprison!

          by neroden on Sun Mar 02, 2008 at 07:06:19 PM PST

          [ Parent ]

    •  btw Sacks missed some important points (2+ / 0-)
      Recommended by:
      GayHillbilly, wishingwell

      like the NEW poll that shows public support for the D position, and relies too much on idelologues at Cato for 'balance'.

      Friday, Feb 29, 2008
      A new poll on health care from NPR, the Kaiser Family Foundation and the Harvard School of Public Health finds that a majority of Americans are backing key elements in the health reform proposals of Democratic presidential candidates Hillary Clinton and Barack Obama.

      Sacks misinterprets the reform barriers to be widespread support for McCain's position. That's just wrong. He's quite right that there's no consensus between Ds and Rs as I point out, and he's right that the debate will shift, but he forgets that Rs are a minority and that indies are more aligned with Ds on this.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Mar 02, 2008 at 07:00:46 AM PST

      [ Parent ]

  •  Thanks for the reality check (5+ / 0-)
    Recommended by:
    skiddie, ferg, undersiege, wishingwell, Ronit

    There has been way too many emotional arguments for single payer that aren't grounded in any kind of reality of it's passage. Many people thought that with a D President, universal healthcare or single payer health insurance would be forthcoming  immediately with out any basis in  reality.

    When people heard Obama mention four years to some hybrid of universal care, they were bitter and expressing disappointment.  I would be surprised if he got anywhere close in four years.
    Completely surprised. It would have to take a perfect storm of events and almost complete shift in attitudes by 70% of the population.

    As an example, see how many are against the war. See how many are ignored. As long as you have 2.5 Trillion industry ( Insurance and Health care combined) with big profits involved, it will be impossible to convert the system unless a crisis of unprecedented proportions occured. The perfect Storm.

    Depending on a perfect storm is not going to get us there. Right now, we need to emphasize regulation of the Insurance Industry and cost control on the provider side. Even those will be hard fought battles.

    Anyone depending on immediate relief with a D win will be sorely disappointed unless they accept the $2500 - $5000 rebates offered by McCain which in a close race may tip the balance.

    Support Col Hackworth's watchdog group for the troops with money or a sign

    by Dburn on Sun Mar 02, 2008 at 06:20:16 AM PST

  •  third way (0+ / 0-)

    third way

    I will tolerate an incompetent president as long as no one will ever have a legitimate reason to call me racist.

    by Edgar08 on Sun Mar 02, 2008 at 06:28:33 AM PST

  •  You'll have a better chance for health care (2+ / 0-)
    Recommended by:
    wishingwell, ArtfromMI

    reform if a uniter is elected rather than a divider.

    JustAThoughtThatsAll.com

    by Steve Everett on Sun Mar 02, 2008 at 06:35:32 AM PST

  •  To answer you question (4+ / 0-)
    Recommended by:
    skiddie, ferg, OLinda, beemerr90s

    I have no idea, but I won't be holding my breath if it's all the same to Washington.

    I've been hearing about "socialized medicine" since I was 16, and that was (mumblesomething) years ago.

    No matter any politician's purity of heart, once in the maw, they find that in this fight they'll have to contend with some pretty entrenched interests carrying great big guns.

    Meddle not in the affairs of dragons... for thou art crunchy and good with ketchup.

    by Pariah Dog on Sun Mar 02, 2008 at 06:36:43 AM PST

    •  I agree (1+ / 0-)
      Recommended by:
      Pariah Dog

      and the President has to have health care reform, whatever that means to be a top priority and be willing to fight for it, given there is a big enough majority in the House and Senate, and enough citizens clamoring for it.

      I just described my idea of the perfect storm for health care reform.

      No change is going to happen until plenty of citizens push for it.

      My Edwards 2008 yard sign will stay up for a long time.

      by Andy86 on Sun Mar 02, 2008 at 06:45:13 AM PST

      [ Parent ]

  •  So When? (1+ / 0-)
    Recommended by:
    skiddie

    First we need:

    A president to lead us there.  2009
    A congress to enact us there. 2010
    And a populace who will push us there. ?

    Part of that president's leadership role is to help educate the populace and prime their engines for that push.  My expectations are that both Obama & Clinton would do this.

    And it is contingent upon a majority of our legislative body not being in bed with the Insurance Industry...So get out & support progressives.

    If all of the above can occur, then we will give birth to universal, single payer healthcare system....by (and after looking in the crystal ball)...2012.

  •  Stop calling it single payer (11+ / 0-)

    One thing that keeps universal health coverage from any chance of passage is likely that people keep insisting it be single payer.

    Single payer to most people means you can't pay for your own health care, you can't make your own choices.  And strictly speaking, this is what "single payer" means. If people can pay for their own care, then there's more than one payer.

    Meanwhile, if you look at a country like France, rated the best system in the world by one WHO ranking (with the US 37th), they don't prevent any individual choices at all. They provide basic coverage through a government system, but 85% of people buy supplemental coverage through private insurance companies. People also freely make all of their own decisions regarding their care. For most, reimbursement is provided to the individual at preset rates; but they can freely add their own funds and spend what they like, see any doctor they like, etc.

    The government controls costs by providing high reimbursement levels for the most effective procedures. Treatments of many common predefined conditions, like diabetes, which can   prevent future complications are fully  reimbursed. There are also tiers for covered drugs; highly cost effective drugs are reimbursed at 100%, others at 66%, more questionable or experimental treatments at 33%.    

    There's no reason we can't expand medicare to cover everyone while still  preserving individual freedoms to also purchase private coverage or treatments as they see fit.

    •  Preventative care incentives (1+ / 0-)
      Recommended by:
      acerimusdux

      They also reimburse practices (IIRC) that lower incidences of lifestyle health problems, like obesity and smoking. The real way to control costs is to have a healthier population, which, in the OECD is primarily a question of avoiding doing things that are bad for you.

      Come see Greg Mitchell on Thursday Virtually Speaking

      by JayAckroyd on Sun Mar 02, 2008 at 06:49:30 AM PST

      [ Parent ]

    •  Thank-you so much for this comment! (2+ / 0-)
      Recommended by:
      ferg, acerimusdux

      This whole health-care question is so complex it is very difficult to even get our arms around, but so many folks want to be able to reduce it to a few sound bites.  It just cannot be done.  The term "universal health care" could contain any number of different options, and not all of them would be good.  There will be limits, there will be costs, there will be tradeoffs.

      There are a ton of issues to address, and you have effectively put a few of them on the table.  I tend to prefer the French model, as you have described it.  If the usual responses are to follow I would suggest you duck and cover.

      I'd rather have a bottle in front of me than a frontal lobotomy.

      by beemerr90s on Sun Mar 02, 2008 at 07:02:53 AM PST

      [ Parent ]

    •  Helps if you know what the words mean. (1+ / 0-)
      Recommended by:
      neroden

      Single payer to most people means you can't pay for your own health care, you can't make your own choices.  And strictly speaking, this is what "single payer" means. If people can pay for their own care, then there's more than one payer.

      Strictly speaking, single-payer is about the insurance, not the care. Most people don't pay for their own care.

      Meanwhile, if you look at a country like France, rated the best system in the world by one WHO ranking (with the US 37th), they don't prevent any individual choices at all.

      Yet France is considered a single-payer system. Imagine that.

      •  Let's call it "Medicare for All". (0+ / 0-)

        Medicare parts A and B, to be specific.  (Part C needs to be eliminated and Part D needs to be replaced with something similar to parts A and B.)

        -5.63, -8.10 | Impeach, Convict, Remove & Bar from Office, Arrest, Indict, Convict, Imprison!

        by neroden on Sun Mar 02, 2008 at 07:01:57 PM PST

        [ Parent ]

  •  Cost containment (8+ / 0-)

    We know, for sure, the best way to contain health care costs. And that is with a universal system.  Krugman has been doing a fine job pointing this out.  Our candidates need to do a better job of saying this; when McCain says we need tax credits and a competitive system, he is advocating a strategy that we know has failed. The gatekeeper role of the insurance company raises costs and creates perverse incentives.

    This may have been a debatable proposition in  1992. There was progress being made by insurance companies in lowering cost of care provision, mostly by converting inpatient procedures into outpatient procedures. But that progress stopped long ago.

    We know, for sure, that universal plans are cheaper, because we're surrounded by countries that have such plans.

    I know there is some choir preaching going on in this, but we simply don't push back strongly enough on "it will cost more to make the system universal."  It won't, if you follow atrios' advice and just send everybody a membership card.

    The trouble with any of the incremental plans that involve insurance companies is that cost containment will fail, which will be used, in turn, to argue that we need more cost containment.  "More cost containment" in a privatized system means "less care provided." they will use the "cost containmnent" argument to further restrict care access, increase co-pays and cherry pick the 20 somethings who don't get sick.

    In many ways, the Republican proposals are subsidies to get healthy people into the system in order to increase insurance company profit. Clinton's and Obama's intermediate plans do much the same thing.

    if this must be done incrementally (and I can read numbers as well as the next person), then better to start squeezing the age limits on the current publicly funded programs, lowering the medicare eligibility age, raising the SCHIP means test ceilings, and get more people into taxpayer funded programs. Toss the insurance companies, and their 12 percent subsidy out of the Medicare program, and start talking about how great Medicare is.

    If Clinton and Obama can get this camel's nose under the tent, I'll be very impressed. Because under plans involving private insurers, they will not have access to the information flows needed to figure what is happening, and will have few mechanisms to address the perverse incentives of for profit health care gatekeepers.

    Come see Greg Mitchell on Thursday Virtually Speaking

    by JayAckroyd on Sun Mar 02, 2008 at 06:43:14 AM PST

    •  the SCHIP battle has been fought by proxy (2+ / 0-)
      Recommended by:
      ferg, JayAckroyd

      exactly for that reason.... funded by decreasing Medicare advantage, the privitazation model.

      And call it sequential, not incremental.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Mar 02, 2008 at 06:51:03 AM PST

      [ Parent ]

    •  Mainly Because ..... (0+ / 0-)

      the insurance giants have an insatiable appetite for huge profit . Like a shark they have to maintain a feeding frenzy to hold their body weight which any top heavy organization must do .

      •  It's really simpler than that (2+ / 0-)
        Recommended by:
        elfling, LillithMc

        The responsibility to their shareholders is to make profits.  the best way to make profits is to have a large healthy insured population who do not seek care. One of the things that drives me a little crazy about the republicans take on this is their focus on moral hazard--that somehow people will decide to behave in ways that cause them to go see a doctor.

        So insurance companies have incentives that are perverse with respect to the public policy goal of broad coverage for all citizens.  They are a bad means to implement that policy goal, because  their gatekeeper role leads to citizens inadequately, or not covered at all, except through expensive, inpatient procedures that take place late in the development of an illness, as in an ER.

        There was a comment above that remarked on France providing universal basic health care through taxpayer funding, with private companies provide additional coverage for procedures or pharmaceuticals not fully reimbursed by the government.

        This is obviously the right model; there are procedures that are simply ineffective, and should not be covered by the state system.  Moreover, in a system like this one, the state has access to procedural and outcome information, and can therefore perform assessments of what is and what is not efficacious.

        What is most efficacious in a public health sense--getting people to make better lifestyle decisions--doesn't fit at all well into our insurance model. In the currrent system in the US, there is a significant disincentive for a doctor to see a patient who is trying to control a diabetes or obesity problem.  The copays aren't worth the doc's time.  And the roster fee covers about two visits a year.  While this is going on, of course, the doc is spending significant money getting reimbursed for valid procedures, at high costs.  (My PCP is in a dual practice, and has to have two full time administrators.)

        Also, much of these efforts properly take place outside the medical system per se.  I think it's worthwhile to think the health care system as infrastructure, which is fittingly the role of government to provide. It needn't provide everyone a Maserati, but it should provides roads and traffic lights.  Competitive systems don't do infrastructure provision well, because duplication and redundancy.

        Come see Greg Mitchell on Thursday Virtually Speaking

        by JayAckroyd on Sun Mar 02, 2008 at 08:53:22 AM PST

        [ Parent ]

        •  I For One ... (0+ / 0-)

          certainly agree with all of your above statements . If people can afford to see a doctor at regular intervals that doctor can certainly advise them of the error of their ways in maintaining a healthy body . When this doctor/patient relationship is allowed to thrive people will take the health issues more seriously resulting in prevention before care .

    •  Cost containment (2+ / 0-)
      Recommended by:
      DemFromCT, absurdist

      "More cost containment" in a privatized system means "less care provided."

      True. The problem is this is also true in a public system. The British state run system for example, puts far too much emphasis on cost control. In some respects it is successful in that.  On the whole they do get similar outcomes to us, at near half the overall cost. But, a modern OECD nation should really do better than getting similar outcomes to us.

      This is why I think the battle over single payer is also the wrong battle. In theory a government run system could be better; but in practice it's effectiveness will always depend on who controls the government.

      I'd rather see more individuals be empowered to opt out of for-profit care, without compelling it. And I would like a lot of that non-profit care to come from outside of the government, from competitive, entrepreneurial non-profits.

      Provide basic government coverage. And put suitable restrictions on private  insurance, like outlawing cherry picking, requiring them to take all comers. And especially provide consumers with information to help them make better decisions.

      •  Cost containment or cost effectiveness? (2+ / 0-)
        Recommended by:
        acerimusdux, beemerr90s

        I can imagine a plan where certain therapies are discouraged because they aren't as effective as other inexpensive therapies.  I remember hearing about a study (by Columbia Medical School?) about the relative effectiveness of different hypertension therapies, and a simple diuretic (at 12 cents per day) was just as effective as the $100/wk pills being pushed by Big Pharma.
        If you don't want to take a diuretic, you can pay for the other therapy from your own pocket, or through an insurance plan (paid by your employer).

        Don't be a DON'T-DO... Be a DO-DO!

        by godwhataklutz on Sun Mar 02, 2008 at 07:40:24 AM PST

        [ Parent ]

        •  Yes (1+ / 0-)
          Recommended by:
          beemerr90s

          That's the idea; but it shouldn't be compelled, but rather encouraged through incentives.

          The case the right will always use to scare people off on government health care is the cancer patient or other serious illness who can't get the  treatment they want in Canada or Britain. Of course the right only looks at one side, and not all of the ways the Canadian or British system is preferable to what we have. And in some cases those treatments may really be not cost effective. But I think it is important that people ultimately not be forbidden from making their own decisions there.

          Here is another recent example in Britain:

          One such case was Debbie Hirst’s. Her breast cancer had metastasized, and the health service would not provide her with Avastin, a drug that is widely used in the United States and Europe to keep such cancers at bay. So, with her oncologist’s support, she decided last year to try to pay the $120,000 cost herself, while continuing with the rest of her publicly financed treatment.

          By December, she had raised $20,000 and was preparing to sell her house to raise more. But then the government, which had tacitly allowed such arrangements before, put its foot down. Mrs. Hirst heard the news from her doctor.

          "He looked at me and said: ‘I’m so sorry, Debbie. I’ve had my wrists slapped from the people upstairs, and I can no longer offer you that service,’ " Mrs. Hirst said in an interview.

          "I said, ‘Where does that leave me?’ He said, ‘If you pay for Avastin, you’ll have to pay for everything’ " — in other words, for all her cancer treatment, far more than she could afford.

          Officials said that allowing Mrs. Hirst and others like her to pay for extra drugs to supplement government care would violate the philosophy of the health service by giving richer patients an unfair advantage over poorer ones.

          It's stories like this which they will use to try and attack the idea of any government provided care. So it's important that we are clear that people always should still have the freedom to make their own decisions without it impacting any government provided care.

      •  I Don't Think ... (0+ / 0-)

        the intent of the Single Payer proposal is to induce not-for-profit care , instead to reign in administrative costs . Think of bundling all the nations insurance costs (not health care costs) and hold that thought . Then think of bundling all of the nations health care costs (without insurance applied ).
        Then think of small government community agencies administering payment to health care providers from proceeds that everyone pays into on a fair share basis .No one scenario will change the quality of care except the one where the "private" for profit insurance company determines the quality by attrition of allowed services .

        •  I do (1+ / 0-)
          Recommended by:
          ferg

          HR 676 requires that all participating providers be public or non-profit. Essentially it is trying to massively re-engineer the entire health system into a non-profit system.

          Beyond a certain level there is of course no meaningful savings attained simply by bundling more people into one pool. A small nation doesn't have any higher per person administrative costs than a large nation. There are likewise no administrative advantages in pooling people at a national level rather than a state level, or in some cases even a county level.

          In a nation of 300 million, it is likewise impossible to find any great administrative advantages in having one payer rather than three hundred or a thousand. Any marginal theoretical advantage in administrative efficiency would surely be offset manyfold by the inherent inefficiency of all monopolies, public or private.

          •  the major advantage of one payer (0+ / 0-)

            is that it simplifies the billing dramatically.

            Of course, most of that advantage could be obtained with multiple payers if they all used exactly the same forms, if they all paid the same rate for the same services, and if all you had to do was change the address you sent them to. Of course, that's dramatically different than what we do today, where insurance companies "compete" by being obscure about what they cover when for who.

            Fry, don't be a hero! It's not covered by our health plan!

            by elfling on Sun Mar 02, 2008 at 11:26:58 AM PST

            [ Parent ]

  •  People around here are going to be pissed off (7+ / 0-)

    As bad as the primary wars are, I can't wait until the first year or two of Obama's term, when he's not doing things fast enough for people around here.  Or when he governs from the center.  Expectations for what Obama is going to do have been built up so high that there's almost guaranteed to be some disappointment.  

    The movement for change is going to be long and drawn out.  Not just on health care, but on everything.  We're talking decades, not months.  Just like when the Dems won Congress in 2006 and we weren't out of Iraq 2 months later, a lot of people will be expecting results too soon and will not be prepared for the long haul.  

    Don't like XOM and OPEC? What have YOU done to reduce your oil consumption? Hot air does NOT constitute a renewable resource!

    by Asak on Sun Mar 02, 2008 at 06:44:04 AM PST

    •  It is our job to put pressure on congress as well (2+ / 0-)
      Recommended by:
      elfling, wishingwell

      as the insurance companies and for that matter the whole of the health care industry.  A President can only do so much.  Especially without 60 votes in the Senate.  

      •  Candidates proposals illegal under WTO and NAFTA (0+ / 0-)

        so we will need to change the trade agreements first, which could take YEARS, or simply go to single payer, which is how most of the other WTO countries have done it. Otherwise we ill have to deal with the secretive courts of the WTO and NAFTA for instituting discriminatory trade provisions (discriminatory in that they discriminate against multinationals, insurance companies and pharmaceutical manufacturers)

        This would be very hypocritical because the US was the main country that argued for these laws in teh first place, and they have been applied in other countries, preventing many people from receiving, for example, cheaper AIDS and malaria drugs.

        See
        http://www.workinglife.org/...

        The bottom of the page...  especially the link to the PDF report..

        This is a VERY important issue and I don't know why we are all in denial about this DEAL KILLER...

    •  it is our responsibiilty to educate (5+ / 0-)

      as well as rally. ;-)

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Mar 02, 2008 at 06:51:43 AM PST

      [ Parent ]

    •  Ahh , Expectations .... (1+ / 0-)
      Recommended by:
      GayHillbilly

      I witness too many defeatist arguments that suggest that a President cannot change with ideas of national consensus . Especially if the change is pushed through Congress which could get a boot in the ass from their constituents . I still have faith that there is a real possibility for the changes we desire . History was built on it .

    •  Agree (4+ / 0-)
      Recommended by:
      GayHillbilly, elfling, wishingwell, fayea

      The movement for change is drawn out. One thing I like about Obama is that he seems to understand this. He seems to understand that meaningful change is going to need to be bottom up, from the grass roots.

      If you look at what Obama has accomplished so far in this race, much of it is built on his organizing ability. Bringing change to the health care system will be no different.

      The president isn't going to change everything is one fell swoop. But the movement being built can continue to grow and eventually bring about meaningful change.

    •  One perfect storm will preempt the other (0+ / 0-)

      One year from now, in a big recession, nobody will do anything.  It's just not going to happen in that economic environment, no matter who's Prez. I plan on to keep pushing for it, but realistically the collapse of the health care system is just one more unavoidable thing you can thank the GOP for.

  •  Those Who Wish ..... (0+ / 0-)

    to retire BEFORE age sixty five will have to pay whopping premiums for themselves and their spouse . After sixty five Medicare kicks in and you still have to buy a supplemental . So for many the current system still cost more than many can afford .It's sad that seniors have to spend their 401K or lifes saving on health care , and but for a few short years . That is not a dignified facet of our society .
    This is still not addressing the lower insured and uninsured , but as Wyden's plan suggests the total cost savings would lie in the lower premiums paid to local (county and state) run programs that would make it easier to administrate .
    Under any plan or system that we have or ever had , someone gains , someone loses . Which of those are you ? The Wyden / Bennet plan is by far the best we could hope for .

  •  88% Rated Health Insurance Excellent? (2+ / 0-)
    Recommended by:
    skiddie, wishingwell

    And satisfaction has increased since '94? That is really hard to swallow.

    I know few folks who say that. Most are paying more for less each year.

    After practically forcing employees to switch to an HSA two years ago and paying the $4000 up front deductible, each year since then my employer moves more of the deductible to employees ($800). In 3 more years employees will pay 100% of the deductible. And each year, coverage seems to decrease.

    I think it is "excellent" that I have some type of health insurance. But I think the insurance itself is expensive and minimal.

    In a time of universal deceit, telling the truth becomes a revolutionary act. G. Orwell

    by DickCheneyBeforeHeDicksYou on Sun Mar 02, 2008 at 06:59:47 AM PST

  •  Medicare for everyone (2+ / 0-)
    Recommended by:
    undersiege, LillithMc

    And it must be universal--as is social security--for the same reasons.  Populism suggests eliminating the cap on social security taxation to help pay for this--and to make ss more viable.

    •  Governments Have Always ... (1+ / 0-)
      Recommended by:
      melvynny

      robbed Peter to pay Paul . It's all about the distribution of wealth .
      What if "WE THE PEOPLE" demanded such things as reduction in military "overspending" and subsidies to foreign oil . Cutting tax breaks to companies with Cayman Is. headquarters would be another example .You can probably think of a hundred more inequities imposed on our tax dollars . Why do people sit by and listen to those telling you to tighten up your belt when these immoral give aways exist. It is no joke that the finest health care in the world could be available in the U.S. at a low enough cost if only our priorities were in the right place .

  •  The logic of the (1+ / 0-)
    Recommended by:
    wishingwell

    right on health care:

    http://www.freerepublic.com/...

    This is a link to a Free Republic thread.  They have posted an article about a doctor in Nevada ordering syringes, etc., re-used to increase profit.

    And one genius Freeper pipes up with "Anyone who things this won't happen under Obama/Hillary care, raise their hand!"

    My concern: the right is so astonishingly stupid on the issue of health care reform that facts and logic simply do not compute.  They will reflexively oppose ANY reform proposed by a Democrat, and utilize utter hysteria to try to defeat it.   We have to be armed with a boatload of facts, now, to prepare for this.

  •  83-93% satisified with their current healthcare. (0+ / 0-)

    That's more than want out of Iraq, isn't it?

    •  yep that number's 60% or so (- or +) n/t (1+ / 0-)
      Recommended by:
      wishingwell

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Mar 02, 2008 at 07:18:47 AM PST

      [ Parent ]

    •  A question that might be added would be (0+ / 0-)

      are you satisfied with the healthcare situation for your friends and loved ones?

      Even if you're insured, and comfortable with that, if your kids, or parents, or siblings, or close friends are un- or under-insured, you might find yourself digging deep for a lot of fundraising to get them the care they need. I think this is one of the reasons people are moving to reform.

      Fry, don't be a hero! It's not covered by our health plan!

      by elfling on Sun Mar 02, 2008 at 10:19:53 AM PST

      [ Parent ]

  •  Healthcare vs Health Insurance (4+ / 0-)
    Recommended by:
    undersiege, wishingwell, fayea, ArtfromMI

    I'm in favor of universal (catastrophic) health insurance, but I'm not in favor of universal healthcare.  The former covers folks who are truly sick, so no Viagara for you ED sufferers out there.
    I don't care who you are, but if you fall and break your ankle, I don't want you to have to worry about paying for anything... just go to the hospital and get the damned thing fixed.  That's universal health insurance, and I think that's where we start.
    Should government act as a single-payer?  That's a good debate, but I'll bet most doctors, hospitals, and patients would prefer it.  What conditions should be covered?  That's another good debate, but I think we can start with a rather large number of obvious candidates.

    I believe that Obama is in favor of universal healthcare for children.  That can be another debate, but my priority is to get the health insurance folks out of the business of 'helping' people who are truly sick... they just get in the way.

    Don't be a DON'T-DO... Be a DO-DO!

    by godwhataklutz on Sun Mar 02, 2008 at 07:34:19 AM PST

    •  It Really Boils Down To ... (0+ / 0-)

      many people in all of these type discussions cannot grasp the idea of "life without" without insurance companies .

    •  What makes you qualified to decide? (1+ / 0-)
      Recommended by:
      quotemstr

      ED is a failure to achieve normal function, by most rational standards, and would qualify as "truly sick". On the other hand, pregnancy is a perfectly normal condition, certainly not something that qualifies as "truly sick", so insurance certainly shouldn't cover that.

      You're probably one of those people who makes jokes about restless leg syndrome. So here's hoping you someday develop it, in one of its more severe forms, and your insurance company refuses to pay for the doctor visits or the medication.

      And if you're so clumsy or careless as to fall and break your ankle, why should an insurance company pay for your clumsiness and carelessness? At a certain point lifestyle choices and personal responsibility have to come into play.

  •  health care reform (0+ / 0-)
    It won't happen unless Hillary is elected. It cannot work or be solvent if everyone is not covered and in the system.
    The healthy have to be in the system with the sick or it cannot float.
    If the healthy can opt out and then run to the emergency room in a crisis situation it will not work. The burden would then be put back on the paying insured and the tax payers for this emergency room care.
    •  An quote you might like (0+ / 0-)

      From "Hillary's Economic Plan: Nothing Daring, But More Comprehensive Than Obama's" on Alternet (emphasis mine):

      Healthcare: Clinton and Obama's health plans have been analyzed extensively, so I won't belabor the point. The one thing I'll say is that Clinton's "mandate" -- the requirement for adults to purchase insurance -- has been controversial, but there's no way one can prohibit insurers from discriminating against people with pre-existing conditions without it. The issue is perfectly easy to understand: If insurers can't turn away people who have costly illnesses, and people aren't required to carry insurance, then younger, healthier people will simply go without until they get that $1 million cancer, and then sign up for coverage and stick insurance companies with the bill.

  •  Just so (0+ / 0-)

    So the best case is that a start on single payer may be made in the next 4 years, no matter who gets elected as Prez, and only if we get Dem supermajorities in Congress willing to vote for it (which leaves out half of the current Dems), and only if we figure out a way to hold the present winners harmless (which pretty much eliminates any cost savings).  I suspect that the only problem is that another perfect storm in the economy will render the whole thing moot about one year from now.  There's probably a very narrow window where stuff like this can be done.

    Then again, if most of the American people have so little foresight that they are perfectly happy with the existing system until they personally get screwed, the U.S. will deserve whatever happens.  There's always a penalty to someone for sheer dumbness.

    •  Perhaps ... (0+ / 0-)

      it is not such a task that is so out of reach . If you went to the second link of the story you will see that there are many Republicans who are in support of Single Payer . Personally I think like Obama has said that it's time for change and many who we wish to oppose and call demons are also ready for the call .

  •  so basically people need to give a shit (1+ / 0-)
    Recommended by:
    wishingwell

    Since there is a >80% satisfaction with the current system (among people that have insurance) and the uninsured vote less, there will remain no political pressure to change the current system. Two things need to happen: people that have insurance need to grow a heart somewhere in their chest that beats for people without insurance, and people that don't have insurance need to form a coalition of sorts, or at least vote in their own interests.

    •  That's not quite the question that was asked (0+ / 0-)

      It was >80% were content with THEIR health care situation, NOT necessarily with the current system. Of those, for example, large percentages were concerned about high costs or about losing coverage. I'm assuming a question that wasn't asked was whether they were satisfied with the health care situation for friends and family. How many of us have been approached to pitch in for medical expenses for someone else? Consider Sandra Day O'Connor. She's fine for health care - but her son and grandchildren can't buy insurance due to an expensive preexisting condition. Grandma will probably have to give a lot of  speeches to cover their care.

      Fry, don't be a hero! It's not covered by our health plan!

      by elfling on Sun Mar 02, 2008 at 10:23:46 AM PST

      [ Parent ]

  •  Obstructionists (2+ / 0-)
    Recommended by:
    wishingwell, ArtfromMI

    Those who block universal healthcare are anti-progress. Let's call them the obstructionists they are.

  •  I guess I am (1+ / 0-)
    Recommended by:
    wishingwell

    naive but I remain astonished that because a large percentage of those WITH health insurance are happy with it, they ignore the tens of millions without and would prefer, apparently, that those people die rather than have a change in their own situation.

  •  What is a Tough Love Med Hlth care system? (1+ / 0-)
    Recommended by:
    fayea

    For me it would involve the inclusion of a respect for the concept of the Individual's acceptance of
    PERSONAL HEALTH RESPONSIBILITY in what ever health care package that may eventually come into being.

    By that I mean,for example: Only comfort care for the individual who can afford to pay for a Health Plan but chooses instead to use his/her available funds to live a "drink , eat & make merry life style" INSTEAD ;

    no nine hour long  reparative brain surgeries for the individual motorcycle rider who chooses his/her right not to wear a helmet;

    no liver transplants for the alcoholic who chooses to continue abusive drinking;

    no medical resusitative efforts for the hard drug user overdose individual... and the list goes on.

    Tough Love Medicine requires a hardening of societies collective heart to the making of  an offsetting effort to thwart the
    effects of the multitude of potential medical system leeches who will have the ability to collectively work toward the financial undermining of any health care system.

    Tough Love Medicine however, in my opinion, does not include ruling out needed surgery in the otherwise healthy, active, mentally functioning geriatric patient solely on the basis of an arbitrarily set age limit.

     

    •  Yes But .... (3+ / 0-)
      Recommended by:
      maracucho, Dr Wu, wishingwell

      Health Care ......
      and health care education are two different things .
      I don't think they should be bundled directly in forcing the discussion on how health care is to be paid for .

    •  I think this is an important issue to explore,but (0+ / 0-)

      it's not so cut-and-dried.

      If you want to deny care for me because I didn't wear a helmet, what about folks that:

      ride motorcycles at all
      drive like idiots
      scuba dive
      skydive
      climb mountains
      smoke cigarettes
      don't use a seat belt
      overeat, or don't have a healthy diet
      don't get enough exercise
      don't take their doctor's advice
      don't properly secure, or are otherwise careless with their firearms
      drive small cars or bicycles intead of SUVs
      swim in the ocean (or a pool, for that matter)
      eat sushi, or raw oysters
      etc, etc, etc

      There is merit to the position, but there is also a slippery slope here.  These choices have far-reaching ramifications.

      There is an email going around with a photo of a helmeted guy who amazingy survived a horrific accident with a truck.  The caption below spouts the lesson that you should always wear a helmet, however, no admonishment to deter you from doing what this idiot did, which was run into the back of a semi going 120 mph.

      But I do agree that this issue needs some substantial thought and debate, but I also warn that it will not be an easy problem to resolve.

      I'd rather have a bottle in front of me than a frontal lobotomy.

      by beemerr90s on Sun Mar 02, 2008 at 10:14:35 AM PST

      [ Parent ]

    •  I expect you're being rhetorical but (0+ / 0-)

      How do you determine if someone is a regular hard drug user in the time you have before he must be resussitated?

      Already, in ERs, there is a "oh, he's just homeless and drunk" categorization danger if you come in disoriented and dirty. And there are many ways to be in that state without being drunk or homeless.

      Your 'Tough Love Medicine' would require getting to know the patient and their behaviors, and our medical system does not allow for that.

      Fry, don't be a hero! It's not covered by our health plan!

      by elfling on Sun Mar 02, 2008 at 10:29:45 AM PST

      [ Parent ]

  •  Impressions (0+ / 0-)

    The very sight of CT in your signature sends up a red flag because of the high presence of the medical insurance industry in CT.

    That 18,000 Americans die early for lack of medical insurance coverage should disturb the complacency of the "majority" who do have coverage and are "satisfied" with it.

    I don't know how many hours my peers, bosses, and I have spent on the phones during work breaks haggling/inquiring over insurance. It is not a pretty sight.

    The moment I see an insurance envelope arriving in the mail, my blood pressure goes up. NOT that I normally have high blood pressure. I have very low blood pressure. The very thought of the games insurance companies play raises my blood pressure. That is purely conditioning.

    As soon as you trust yourself, you will know how to live. Johann Wolfgang von Goethe

    by tsunami on Sun Mar 02, 2008 at 08:11:43 AM PST

    •  actually much less a presence (0+ / 0-)

      than it used to be, as Hartford loses influence and jobs. Still a major player, though.

      INDUSTRY GROWTH RATE

      There were 65,640 insurance jobs in Connecticut in 2004. From 1995 to 2005, Connecticut insurance employment grew 2. 4%, the 18th worse insurance job growth rate nationally. In comparison, Iowa's insurance industry grew by 8. 8% during the same period.

      From 2004 to 2014, the Connecticut Department of Labor (DOL) projects a net employment increase of 2,670 insurance company jobs to 68,310 total jobs, which is a 4% growth rate. This is the department's slowest projected growth rate within Connecticut's insurance and finance sector for the time period.

      And the sources for the FP post are listed.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Mar 02, 2008 at 08:32:44 AM PST

      [ Parent ]

  •  Kaiser is biased. Single payer the only answer (2+ / 0-)
    Recommended by:
    LillithMc, ArtfromMI

    Kaiser (Kaiser Permanente)is a for profit health insurer, hospital system and empire. They push their product.

    I push mine: single payer--also known as medicare for all,similar to social security for all. It's cheaper than all the other alternatives and better for you.

    Dr Wu, the last of the big time thinkers

    by Dr Wu on Sun Mar 02, 2008 at 08:20:51 AM PST

    •  nonetheless (1+ / 0-)
      Recommended by:
      wishingwell

      kaiser has good data, peer reviewed and published in collaboration with the Harvard School of Public Health and NPR.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Mar 02, 2008 at 08:34:46 AM PST

      [ Parent ]

      •  Kaiser pro single payer? (0+ / 0-)

        If they're so peer-reviewed and NPR approved, has Kaiser ever published anything that is pro single payer?

        You have to ask questions about how objective they are considering they are in the managed care business and control an empire of hospitals and  insurance companies.

        Dr Wu, the last of the big time thinkers

        by Dr Wu on Sun Mar 02, 2008 at 08:52:20 AM PST

        [ Parent ]

        •  you're mixing up polling data (0+ / 0-)

          with advocacy.

          I have no idea what kaiser wants (I doubt it's what I want), but the foundation side supplies good data.

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Sun Mar 02, 2008 at 08:54:06 AM PST

          [ Parent ]

    •  Actually Kaiser Permanente (0+ / 0-)

      and the Kaiser Family Foundation are two separate entities, and both are non-profit corporations.

      Fry, don't be a hero! It's not covered by our health plan!

      by elfling on Sun Mar 02, 2008 at 10:32:11 AM PST

      [ Parent ]

  •  What I find offensive about these answers (3+ / 0-)
    Recommended by:
    maracucho, LillithMc, ArtfromMI

    The disagreement on solutions is not a matter of which will be the most effective.  The answers listed are more indicative of a public which has no interest in actually solving the problem, but would rather just push the problem off on someone else, or make it some kind of fantasy solution- tax credits...  Those solutions will not work, and they will cost us more than we are already paying right now! In addition to the current cost of healthcare, we will also be taking money directly out of the treasury.  So, we'll effectively increase the government cost, but not really improve our healthcare.

    ♔ ♚ ♕ ♛ ♖ ♜ ♗ ♝ ♘ ♞ ♙ ♟

    by otto on Sun Mar 02, 2008 at 08:21:40 AM PST

    •  Here's Where We Are .... (0+ / 0-)

      It's the year 900B.C. and a group of people were eating around a campfire . One of them got deathly ill and they took his to see some kind of medicine man who demanded things to help this sick person . When that person was healed they often returned to him , but he began to demand more and more to treat them . So they had a discussion around the fire one night and came up with a plan . One suggested a co-op where they would all pool their belongings as offerings if any one of them got sick . A novel plan . But one shrewd fellow said that if they would give "him" all of their treasure trove and he would keep a small portion for himself ,that he would administrate and barter with the medicine man when they got sick . That's where they WENT WRONG !!!

  •  I am actually very skeptical... (1+ / 0-)
    Recommended by:
    maracucho

    ...about the changes of any meaningful healthcare reform being made in, say, the next decade, notwithstanding public statements to the contrary.

    The first thing that stands against healthcare reform is the the fact that the Iraq bill is, say, $5 trillion dollar, the cost of bailing out the US financial system will likely be another $3 to $5 trillion, and that can only be financed through additional debt (and the country is quite indebted already).

    So, in summary, despite the best intentions in the world, I don't think the US can afford meaningful healthcare reform.

    I think the next President's mandate will be swallowed up (by necessity) by more pressing concerns: we're entering a time of crisis, with possibly a very deep depression looming, the US$ losing its role as the world's currency reserve, peak oil, global warming, etc.

    We had a chance to make headway on healthcare reform during the Clinton era when we were rich and prosperous; we missed it (just as we missed a chance under Jimmy Carter to reform our energy policies).

    I think the next decade will be about survival and redefining our role in the world and our values and how we live; not healthcare. We may be lucky to have any healthcare at all.

    OVER HERE: AN AMERICAN EXPAT IN THE SOUTH OF FRANCE, is now available on Amazon US

    by Lupin on Sun Mar 02, 2008 at 08:42:41 AM PST

  •  Phasing in Single Payer (4+ / 0-)
    Recommended by:
    ferg, Dr Wu, LillithMc, ArtfromMI

    Of course we could take a little step each year, and be completely converted over to single payer in a decade. There are several ways to phase in single Payer:

    (1) Age bands: First the elderly (check), then the Poor (check), then the Children, then the 20-year-olds,  etc.

    (2) Competition Option: Permit consumers or businesses to buy into a public program. You've got that 20-30% advantage due to administration costs.

    (3) Provider Categories: Primary Care, Chronic Conditions, Mental Health, Dental, Major Medical.

    (4) Industry Segment (France): Farmers, Manufacturing, Public Sector, Self-employed, Unions, Individuals,

    •  There Was A Discussion ... (0+ / 0-)

      that we had on Senator Wyden's diary when he first came to us with the proposition .He suggested that if his plan could be put into effect in a small geographical area it could be easily implemented and tested . The recipients would begin to participate in the payment procedure as well as the health reception . This is the way I understood it anyway . Maybe a model needs to be designed to test the waters ans then the implementation could branch out .

    •  also (5) state-by-state (0+ / 0-)

      Your point is exactly right.

      I'd think #1 and #2 would be the easiest to actually pass.  San Francisco has already started a #2 option, for example.  I'd think that could spread to California fairly easily.  

      But there doesn't seem to be any movement in the California legislature for a #2 option, which baffles me.  Maybe it's not as exciting as trying to pass a full single-payer.

      •  Truth is (1+ / 0-)
        Recommended by:
        ferg

        Most legislators don't understand the issues. They do understand that replacing insurance premiums with taxes is a third rail, one that is so highly charged that they don't think about ways to put on rubber gloves.

        Specifically, flipping to Single Payer needs funding to the tune of perhaps 6-8% tax increase, paid for of course by not having to pay insurance premiums. That is a fearful analysis. Thus the value of a phased in solution, let's say 1% per year of tax increases so people can see the reduction in costs on the other side of the equation, assuming that insurance companies rerate their policies rather than pocket the profits!

        Covering kids has high moral values, so that one is easy. However, Single Payer analysts would correctly point out that phased in solutions by age group or Public Plan competition fails to address the 20-30% problem. In addition, the Insurance companies are always one step ahead at denying benefits to push the expensive people of their budgets and into the public.

        Pay close attention to phased-in by provider categories, an idea that is completely absent in the think tanks, but is actually embodied in a proposed bill in Colorado. Remove insurance billing from family docs, and you effectively eliminate insurance overhead from our day-to-day health needs, meaning that you directly and effectively pocket the 20-30% admin costs.

        Primary care leads to other health care benefits, like healthier populations over the long-term. Investing in primary care isn't particularly cost-effective for insurance companies because they churn through their policy holders, long before the benefits of primary care bear fruit.

        Also, specialists (i.e. non primary care) are about the only category of doctors with strong anti-single-payer viewpoints. Most family practitioners, clinic workers and nurses are highly favorable to Single-Payer.

        •  phased-in provider categories (0+ / 0-)

          Pay close attention to phased-in by provider categories, an idea that is completely absent in the think tanks, but is actually embodied in a proposed bill in Colorado. Remove insurance billing from family docs, and you effectively eliminate insurance overhead from our day-to-day health needs, meaning that you directly and effectively pocket the 20-30% admin costs.

          That is a very clever approach.  Also, family practice is the most different from a normal insurance model.  It doesn't make sense to add a 20-30% insurance overhead for routine care.

  •  More hope at the state level? (0+ / 0-)

    I am hopeful that states will do something to provide more affordable healthcare. I don't think hardly anyone in federal government has any concern about healthcare except to lower liability, instead of removing or reforming the for-profit healthcare model.

    My individual health insurance premiums has increased 30% in just 3 months (they took a cue from credit card issuers and can raise your cost anytime for any reason). I have yet to be convinced that either Clinton or Obama will make a huge effort on healthcare - so I am waiting for one of them to convince me.

    Inn the meantime I intend to help elect more healthcare conscious candidates at the state level. What else can we do?

    47 million Uninsured in the U.S. Why aren't more Americans outraged?

    by PAbluestater on Sun Mar 02, 2008 at 08:47:51 AM PST

    •  see eugene's comments about CA (0+ / 0-)

      elsewhere in this post.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Mar 02, 2008 at 08:52:25 AM PST

      [ Parent ]

    •  Whatever Reform ... (0+ / 0-)

      may come to pass you can be sure that all eyes will be watching . Nothing is going to be perfect and I'm sure that bugs will need to be ironed out .
      Here's a start - I intend to write my Congresswoman and commend her for considering the Wyden/Bennson Proposal .Maybe we should all touch base with Congress to let them know that we are not just sitting on our hands .

  •  New report on candidates promises vs. WTO commitm (0+ / 0-)

    This is an important analysis of the issues that we will run into if we try to implement the candidates halfway measures.

    http://www.citizen.org/...

    To Implement Domestic Campaign Policy Priorities on Health Care and Global Warming, Candidates Must Alter Existing U.S. Trade Commitments

    Posted: 02/28/2008


    WASHINGTON, D.C. – Public Citizen today identified changes needed to World Trade Organization (WTO) rules and the investment provisions of the North American Free Trade Agreement (NAFTA) to implement a dozen of the presidential candidates’ key health and climate policy proposals.

    The changes were detailed in a report, “Presidential Candidates’ Key Proposals on Health Care and Climate Will Require WTO Modifications, Overreach of WTO Highlighted by Potential Conflicts with Candidates’ Non-Trade Proposals,” available at http://www.citizen.org/...

    “Growing public ire about our current trade and globalization policies’ damage to Americans’ economic prospects has played an enormously important role in this election, with most candidates committing to reform NAFTA,” said Lori Wallach, director of Public Citizen’s Global Trade Watch division. “But candidates and voters have little idea that some of the candidates’ domestic policy priorities on health care and climate change could be limited by the overreach of so-called trade agreements like the World Trade Organization. The need for a comprehensive overhaul of the WTO could not be more urgent.”

    Although they have nothing to do with trade, key health care cost containment proposals on the creation of health insurance risk pooling mechanisms, reduction of pharmaceutical prices and electronic medical record-keeping, a proposal to expand coverage by requiring large employers to provide health insurance and a proposal to establish tax credits for small employers as an incentive to provide health insurance fall within WTO jurisdiction. In addition, proposals that address climate policy, such as increasing CAFE (Corporate Average Fuel Efficiency) standards, banning incandescent light bulbs, establishing new regulation of coal-fired electric plants and establishing national renewable portfolio standards (RPS), green procurement proposals and green industry subsidies come under the jurisdiction of existing U.S. WTO commitments.

    •  thank you (1+ / 0-)
      Recommended by:
      elfling

      I think you've posted this enough times.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Mar 02, 2008 at 08:57:13 AM PST

      [ Parent ]

    •  That Is A Good Piece and.. (0+ / 0-)

      an eye opener many would not have considered . Foreign investors are so dug in to our investment (insurance products ) that they would fight implementation of any plan reducing insurance profits . Despite the state of the economy insurance has touted it's earning to be one of the top investments along with investment banking .So what you suggest is there may be a battle on two fronts . One with the insurance industry and the other with foreign investors . Where did our sovereignty go ?

  •  Medicare for all, no bs (1+ / 0-)
    Recommended by:
    Tuscany

    It did take until Roosevelt's second term to get Social Security.  But bringing the country along is no excuse for inaction.  Even in Roosevelt's second term, if you took a poll, I'm sure you could find the population "split" on the idea of having a government-provided pension for the elderly.  Yet it turned out to be the most popular and long-lived of Roosevelt's achievements.

    It has to be single payer health insurance, and as soon as possible.  It is time we looked to see how it was done in Canada and Europe, then follow suit.

    Why?  we now, as a government, provide health insurance for the most vulnerable to illness in our society--the old and the poor.  This is reverse cherry-picking, bizarre in anyone's minds.  If we don't institute single payer insurance, we are going to be risking coverage to all those currently insured by government, since we are making the government-sponsored pool to expensive to cover.  You are already hearing rumbles from those who want to get rid of Medicare because it is too expensive.

    Instead we should be asking this question:  why are we as a government in effect subsidizing, giving welfare to, insurance companies--by effectively removing the largest and unhealthiest part of their risk pool?  

    Flag lapel pins? Since when did we become a nation of bling warriors?

    by NCJan on Sun Mar 02, 2008 at 08:55:54 AM PST

    •  Its because the insurance companies lobby (0+ / 0-)

      so aggressively and contribute a lot of money to candidates at both the state and national levels. So do the drug companies. They are incredibly powerful.

      But it really comes down to this. Many, many multinational companies with interests in the US have been huge beneficiaries of the private insurance model of paying for health care, both here and all around the world, and they have managed to put legislation and trade agreements in place which have been designed to lock those advantages into place permanently, regardless of what the people in the various countries, including here, may WANT, or even vote for.

      The candidates can talk about changing the ways we pay for health care but it is not going to be easy, because the entrenched interests are so powerful and they also have been anticipating these changes for decades and have been preparing for them.

      I think it WILL be possible, but its clearly going to be a major struggle.

  •  Great summary (3+ / 0-)
    Recommended by:
    DemFromCT, elfling, fayea

    Thanks for a very nice summary with many good references. Polls are seriously limited. I can tell you that I am willing to accept larger taxes in order to help others because that is empty talk- you are not going to reach into my wallet and grab cash. Our ADHD culture encourages rants and demands for single payer systems without laying the groundwork for what would be a massive transition. Look how much difficulty Canada had in bringing in their current system, which came into different provinces at different times.

    As a working doc, I spend more hours each year hassling with insurance companies trying to get them to pay for treatments, even physical therapy. That is friction in the system. The friction is increasing very year. This plus the wasteful overtreatment of those with resources (read Overtreated) will eventually bring down the for-profit edifice. Choice of physicians is actually pretty limited for a well-insured person moving into a new urban area. Many physicians are not accepting new patients. Those who think that they are well insured better not get unfavorable cancer, multiple sclerosis or something like that because they will soon learn that modern treatments help but are brutally expensive. We keep hoping for an easy way out, but there is none.

    Education is a major determinant of health status. If we could reduce the number of high school dropouts and teach about health issues in high school (has to include but not be limited to sexuality and reproduction, which gets people mad) we could improve the overall health of our people.

    •  we also need to rebuild public health (0+ / 0-)

      infrastructure and consider mental health at parity.

      Sigh.

      So much to do, so little support from the public.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Mar 02, 2008 at 09:15:25 AM PST

      [ Parent ]

  •  The Threat of Sickness and Illness .. (0+ / 0-)

    is not something that a citizen should have to worry about paying for . We would all agree to paying for it .The question is how . I don't mind paying a little more to the cause of health care , but I am worried that my extra offerings won't be properly administered and the funding not be skimmed off by greedy third party leeches . A Canadian once told me that " we pay $6.00 for a block of cheese and $6.00 for a pack of smokes for our health care". He went on to say that when you pay that way you don't miss it . The implication is it will have to be paid in some sort of taxable way , but the question is are we already paying for it now ?

  •  Democrat health care plans will fail to deliver (1+ / 0-)
    Recommended by:
    ArtfromMI

    Clinton and Obama plans both fail to deliver on health care reform.  The are trying to graft universal health care onto an expensive, inefficient for-profit system. The only result will be even higher costs.

    US spends 16% of GDP on health vs. 10% for other industrialized nations.  That is a huge economic disadvantage.

    US has poorer health care out comes, higher infant mortality, shorter life span.

    US only covers 70% of population and many of those still driven into bankruptcy by health care costs.

    Only way for US to solve health care problem of cutting costs, insuring 100% and getting better results on par with Western Europe or Japan is to model US system on theirs, Medicare for All, HR676 will do that. Nothing else will.

    •  Agreed .... (1+ / 0-)
      Recommended by:
      Tuscany

      Allowing the same fox to run the same hen house , only to pander to the foxes every need in order to "insure" people rather than to provide them with the basic means to health care .

      •  so dysfunctional that its really dangerous (0+ / 0-)

        I think that is a dangerous situation because people lose faith and trust in government and society in general. We really don't want to go there.

        Politicians making promises they can't keep is a way to alienate people very quickly. The unwillingness to tackle the core affordability issues in particular, scares me. Perhaps they intend to try, but that isn't enough.

        As long as we keep the private insurers involved, and tie coverage to jobs, not only wont we wont be able to afford to do much at all, we will also encourage companies to shed employees in the US, especially older employees, which is the LAST thing we want to do right now. Because companies are shedding employees anyway. The Dems do not want to give the GOP an excuse to blame this on them. Further tying healthcare to jobs will be a big talking point for the GOP in ten or fifteen years, which they will use to explain why haf of America, the lower paid half, lost their jobs in the beginning of the 21st century..

        (Its not the real reasons this will happen, but it will be a contributing factor, the main reason is globalization, we are no longer the only kid on the block, and automation, silicon is cheap and works 24/7 - unlike meat,  and - also otherwise positive changes in business practices that make business much more efficient. i.e. PEOPLE WERE NOT MEANT TO DO BORING MACHINE-LIKE JOBS FOREVER..after all, this is the 21st century.. Machines do that stuff..)

        That JOB-SHIFT will happen. Don't fall into the trap. DONT let the Dems get saddled with the blame by giving us a system that burdens business with further costs PER EMPLOYEE when these costs are better handled by the government.

        Thats what they do almost everywhere else and surprise, IT WORKS. Why are WE saddled with this bad situation HERE? We would have been better off staying a british colony. THEY have universal healthcare there. Even if it isn't perfect, people don't lose their homes and futures because they got sick once.

        But back to my point. Hope isn't enough. They have to DO. They have to succeed. Its not an option to not succeed. We all are not expendable. America is not expendable. We are not a used dishrag, to be thrown away because we are no longer needed. Making promises may win elections but if there is no real URGENT desire to keep them, we are in serious trouble.

        Too many people are just hanging on. They don't understand the finer points of these proposals. When they hear 'affordable' they think really affordable. One person's affordable may be completely out of reach to many other people. People who might be considered 'middle class' by some, and thereby a low priority.

  •  Thanks For Doing This. (1+ / 0-)
    Recommended by:
    DemFromCT
  •  Health Care Reform (0+ / 0-)

    Much of the above, at least partially misses the point. It may be true that the current political and social climate is not truly conducive to real health care reform. But it is also true that the current plans of both candidates, will in my opinion, do more harm than good. First both plans are based on providing "PRIVATE" insurance, further embedding a fundamentally screwed up system. Even if the plans achieve some good at the margins, they will have made "private insurers" as well as institutional providers even more powerful. Secondly both plans depend primarily upon individual financing(as well as employer). Third, neither plan does essentially squat to really reform the focus and or process of delivery in this country. In fact the bottom line for both plans is to not fuck with the system almost at all, just play around with a few financing mechanisms and push out coverage. When I studied Health Care in graduate school, way the hell back in the early 70's, the major issues were seen as just how much could the GDP(a now outmoded term)of this country absorb and reforming(limiting) physician control. One could argue that we are fast approaching a critical juncture in terms of the amount of current resources that are now devoted to Health Care. Assuming that the current rate of increase remains relatively steady I would hazard a guess that we are nearing a crisis/breaking point. That in and of itself could force a fresh look at "real" reform.
    Limiting physician control has been partially accomplished in a negative manner by the growth of institutional delivery organizations and the decline of individual private practice. What has not occurred is any growth of alternative delivery via physician assistants and nurse practitioners. These mechanisms deserve to be substantially expanded, both in their current form as well as expanding them in ways not now found acceptable. That is we could have "specialists" in certain areas of health care delivery that are very specific and trained in quite narrow ways, who would be supervised by more traditionally trained M.D.'s. Additionally a major marketing effort could be undertaken to sell "single payor" health care, as a substitute for employer based payment. It would not be difficult to argue that the cost benefits derived from moving away from employers paying for health care to a system where it is paid for through a tax system would benefit both employers and individuals. In fact it would not be too far fetched to imagine that this marketing could be mounted with allies from large corporations and City and State governments who are facing critical financing issues regarding current and retired employees. Bottom line here are that there are a number of ways to begin moving toward actual Health Care reform but that the politically expedient plans being put forward by both candidates will, in the end, if implemented at all, have the potential of doing more harm, in the long run, than good.

    •  this is a two part presentaion (0+ / 0-)

      come back at 4 pm for mcjoan's essay on the presidential proposals, which I really didn't get into.

      Physician assistant and nurse practitioner growth is current and incremental, not radical change. So are wal-mart walk in care centers, staffed by non-MD's. Neither really creates a medical home and the latter especially is at risk of vanishing in a recession.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Mar 02, 2008 at 10:03:37 AM PST

      [ Parent ]

      •  Lots of issues we need to resolve on healthcare (1+ / 0-)
        Recommended by:
        DemFromCT

        The "medical home" concept is really important

        Medical privacy is also really important. Genetic profiling by health insurance companies, is also really important.

        I don't think that genetic information and the new genetic testing technologies are compatible with the concept of private insurance as we know them. This is why a lot of people are holding off on genetic testing, even though it could give them useful information. They are afraid that they may someday have to buy individual insurance, or that if they have a genetic issue, an employer or insurer would use it to deny coverage or employment. Its an extremely legitimate concern given our lack of privacy protections and the way our insurance system works. Witholding information puts people at risck of rescission, which can be a financial nightmare for already sick people. The LA Times has done a series of articles on this issue, they are worth looking at to see whats in store for the rest of the country if healthcare costs keep going up and the percentage of people forced to buy insurance on the individual market increases. Very few people realize that individual coverage is incredibly expensive. None of the candidates has proposed the level of subsidies that it would cost to deal with this problem if we keep the present insurance system.

        It would dwarf other entitlements. It would be billions of dollars going straight into the drain..  with single payer, we could keep those costs down.

        Another important issue is electronic health recordkeeping. Again, we have an important new technology that could save a lot of lives, but without STRONG privacy protections, it coud cause more problems than it solves.

        This has all been hashed out in Europe, where in this area, they have much stronger privacy laws than here. They also have (in most cases) single payer.

      •  Physician Asst. & Nurse Practitioners (0+ / 0-)

        Unfortunately you didn't seem to get my point. Maybe I wasn't clear. What I was suggesting is that Doc's are over educated, over paid, and the only remaining profession that controls the entire means of production(both intellectually/knowledge and level of supply). What I would like to see is much of the delivery of health care broken up into discrete segments, that could easily be understood, and provided with specially trained individuals(PA's NA's, etc)in that narrow area, under the supervision of a "normal" doc. These specialists could be trained in either 2 or 4 year programs and be paid accordingly. Additionally, as they would only control a limited aspect of the professional knowledge, like the rest of the "industrial revolution", the level and pace of supply, as well as the overall knowledge could be administratively controlled. Health care should more resemble producing any other good, than resembling what constitutes a "guild" structure. Add to that a shift in the gestalt of all life, regardless of quality, or disease, regardless how arcane deserves substantial investments of resources; to, prevention, prevention and accessibility, accessibility, and other related normative values and dump the idea of vast resources going into limited, arcane disease eradication.

  •  Polls are worthless as a guide to action. (0+ / 0-)

    If we depend on one or a dozen "polls" to limit or shape our actions to get a fundamental transforming of health care in America, we will failnow,next year and for the next 20 years. They don't help us except to discourage us.

     A bit of history: America made the choice when health care was 1/3rd of what it is in costs today to allow it to be defined or limited  as a perk or benefit of emplyment. As the postwar economy grew and prospered,more generous benefits came into being. That has stopped for the last twenty ormore years now.

    www no slaves.com, The Economic Populist. Ignorance is Blitz, not Bliss

    by Pete Rock on Sun Mar 02, 2008 at 10:04:03 AM PST

    •  posters who say polls are worthless (0+ / 0-)

      generally have uninformed opinions which are  - erm - worthless. ;-)

      the key, Pete, is how you use the data.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Mar 02, 2008 at 10:12:02 AM PST

      [ Parent ]

      •  My "worthless' opinion (1+ / 0-)
        Recommended by:
        DemFromCT
        It will take a sympathetic president and a combined grass roots/ business/political/union broad wave that has a coherent plan to overturn and sweep away the mob whose job it is to frustrate any threat to private insurance and the for profit model that rules US healthcare.

        Polls may pick up some drift in awareness of chance individuals, but how do you place them as a source or leading indicator as to what to do?

        For Obama or HRC in the race to be president, they are the afferent impulses of their campaign's if accurate. For serious questions of life and death, as in health care, they are not the principal tool or even a defining tool.

        www no slaves.com, The Economic Populist. Ignorance is Blitz, not Bliss

        by Pete Rock on Sun Mar 02, 2008 at 10:24:34 AM PST

        [ Parent ]

        •  ah, as I said it's how you use the data ;-) (0+ / 0-)

          at no time did I say 'use them to tell you what to do'.

          More like 'use them to tell you what to expect'.

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Sun Mar 02, 2008 at 10:59:03 AM PST

          [ Parent ]

          •  Agreed (can't rec your comment) by fiat (0+ / 0-)

            don't want to hijack your thread , but the situation was a fateful choice when the system was a fraction of the size(and not expected to grow out of bounds unchecked) to allow the "private sector" to manage, finance and discover solutions to all its problems directly or indirectly.

             That sixty year old model has finally reached old age and its weaknesses and shortcomings are showing. Keeping doctors away from controlling the system, allowing cost phobias and private insurers to run it and their lobbyists to be the gatekeepers of any changes has to come to an end. It won't happen without a real fight, a dirty, ugly at times fight.
            But it will be a fight, not a "inevitable" reform. No one gives up a trillion dollar golden egg laying goose without a very nasty fight.

            www no slaves.com, The Economic Populist. Ignorance is Blitz, not Bliss

            by Pete Rock on Sun Mar 02, 2008 at 12:55:44 PM PST

            [ Parent ]

  •  I have low expectations, here is what I wish for: (0+ / 0-)
    1. All children under 18 be put on Medicare.  If they are in college, they stay on Medicare until they graduate.
    1. Government and the private sector make a serious effort to lower prices for premiums, no matter where or how a person get coverage.  Our family pays for our own policy, cost is $1044.00 per month.  A $3000.00/year cut in price will make me very happy!
    1. No more exclusions for any pre-existing conditions - NONE!

    Is this too much to ask? I hope not...  

    •  well... (0+ / 0-)
      1. see the new NPR/kaiser/HSPS poll... most people agree with you.
      1. cost is a big issue for a lot of people
      1. check out HR 5449 and also see the first bar in the chart.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Mar 02, 2008 at 10:19:13 AM PST

      [ Parent ]

    •  Are you sure? (0+ / 0-)
      1. What makes kids who go to college special? 20 year olds who can't afford go to college probably can't afford insurance, either. 20 year olds who don't have the academic ability to go to college don't deserve to be punished for that. Why do you think only 20 year olds with academic ability and the financial resources to go to school deserve special treatment? Maybe those who can afford college should use that money to pay for their own insurance, instead.
      1. They are working to lower premiums. That's why people get denied treatment - to keep premiums down. That's also why pre-existing conditions are excluded.
      1. If there were no exclusions for pre-existing conditions who in their right mind would waste their money on insurance before they developed a condition that needed insurance coverage? And then how would insurance companies avoid bankruptcy? I have a significant pre-existing condition. (Of course, in my state that condition isn't covered by health insurance, so this is moot for me, until I move to a different state...) If my expenses were less than insurance premiums I'd be wasting money by buying insurance. If the premiums were less than my expenses the insurance company would be guaranteed to lose money by insuring me, that is, they'd have to deny treatment for previously healthy people who developed new conditions in order to cover their expenses on me.

      Point 1 I suspect is just you being selfish - it's not like anyone forced you to have children. Your points 2 and 3 appear to contradict each other. So which do you really want, lower premiums or improved coverage?

  •  this will be a hard battle with messy solutions (0+ / 0-)

    as I told a much -older gentleman on a plane ride not too long ago.

    the thing is getting people aware of how much reform is needed, and why a uniting, problem-solving candidate like OBama can tackle an issue this messy, whereas a divider like billary will likely pander to much to special interests.

    witness the GOPRANOS.. rethugs: "If they fuck with me or Shaha, I have enough on them to fuck them too." -Paul Wolfowitz, quoted by the UK's Guardian

    by change the Be on Sun Mar 02, 2008 at 10:17:58 AM PST

  •  As much as I want reform... (2+ / 0-)
    Recommended by:
    DemFromCT, fayea

    ...all I can think is that it's mind-bogglingly messy. There are just too many things to consider, too many things to do...I don't think any of our problems can be solved merely by giving free coverage to people, though, because we're not addressing deeper issues with that.

    We need to increase funding for research, for example, so our scientists can come up with better treatments. We need to encourage a stronger focus on translational medicine. We need to do something about prescriptions, but I don't know what. Our doctors are suffering (to one degree or another) because of rising malpractice insurance costs. Our insurance companies often don't cover everything that's needed (and that will surely be an even bigger concern if the insurance is free or otherwise subsidized).

    People who live in cities with major medical center (as I do) often have poorer health in some ways, despite all the specialty hospitals--or rather, because of them. The doctors are always interested in applying the latest and greatest procedure, and it's not always the best approach. Heck, sometimes, eating right and exercising is the way to go, but there's a push to bring robotic surgery and lasers into the equation instead, pushing costs through the roof and not giving any better results.

    There's the American people's demand for health care, which is an awesome thing but can lead to a similar problem as that stated above--people demand brand-name prescriptions and the newest treatments, all at a high cost. And that costs everyone else in the end.

    So no, it won't be simple or cheap. There are too many facets to address. On the upside (more or less), I think the reasons things have gotten like this is because we can do so much more than we used to--gone are the days of biting down on a stick while the doctor saws your legs off. Gone are the days of people just lying in bed, slowly dying, while a doctor shakes his head--because now we can actually treat a lot of those illnesses that used to kill people. But laser surgery and targeted therapy cost more than a stick and saw. They cost more than damp cloths and chicken soup. So it's sort of a trade-off.

    "With a keen eye for details, one truth prevails." - Detective Conan

    by onetruthprevails on Sun Mar 02, 2008 at 10:26:42 AM PST

    •  One thing I have never understood until now (0+ / 0-)

      is why Americans have had to subsidize the pharmaceutical research for the whole rest of the world, it seemed to me, by paying such high prices when others often pay far less.

      From what I ave read recently, I think its basically a quid pro quo. We are, I think, required to have Americans only buy their drugs from American suppliers by the WTO trade agrements we have signed. Its something WE (the US government, because of pressure by lobbyists) pushed for in these international trade agreements in order to ensure that people in other countries paid US pharmaceutical companies the prices they wanted.

      There are lots of gotchas like this as we try to change things. Many of them involve things that are now fairly inflexible, having already have been sold out from under us.

      That does not mean they will be impossible to change, but it will be VERY difficult to do without having to renegotiate lots of other things as well.

      •  Government research, big pharma profits. (1+ / 0-)
        Recommended by:
        neroden

        Another piece of the puzzle is this:  the government, usually via NIH, spends money investigating and researching a drug.  They then turn it over to Big Pharma to market and develop; Big Pharma makes kazillions, the government gets peanuts and the patients, whose taxes paid for the initial research, get hosed.  Call it Big Pharma corporate welfare.

        Taxol is the textbook case.  The numbers as of 5 years ago: NIH spent 40 years and $483 million dollars doing basic research on the drug before handing it over to Bristol-Myers Squibb for roughly $143 million.
        BMS claims they spent $1 billion developing the drug; as of 2003, they'd made $9 billion in sales.   So BMS is ahead $8 billion; the government hasn't even broken even.

        (The government did get a whopping 0.5% royalty on several Taxol related patents BMS filed.  No idea as to how much that was worth.)  

        •  if IP is property, why not have a property tax on (1+ / 0-)
          Recommended by:
          neroden

          if IP is property, why not have a property tax on it?

          In the cases of drugs, this intellectual property tax could be used to make the drugs affordable to people who could not afford them.. The current system is completely out of control.. its literally 'your money or your life'. Its like the bandits in the Old West. There is no brake on the outrageousness of it all in Washington. I wish I wasn't so cynical, but the prices are just obscene.

          I also think patents on drugs should be shorter.. much shorter, than they are.

          An IP tax would also provide an incentive for owners of unused IP to put it in to the public domain and would make people aware of the hidden cost of allowing people to patent things (Low budgets for patent examiners has resulted in outrageous theft of the public information space..people are now patenting many, often obvious things, that should not be patented! Its like a gold rush on ideas.)

          •  Extremely sensible idea. (0+ / 0-)

            I love it.  A tax on holding patents (including design patents) and copyrights (and mask rights, etc.) makes perfect sense.  This merges a lot of different things I've been thinking about.

            I'd exempt trademarks because they exist largely for anti-fraud purposes.

            -5.63, -8.10 | Impeach, Convict, Remove & Bar from Office, Arrest, Indict, Convict, Imprison!

            by neroden on Sun Mar 02, 2008 at 06:48:50 PM PST

            [ Parent ]

  •  my biggest concern (0+ / 0-)

    is that even if Obama or Clinton and Congress has the will to make big changes in the first term, the economy will be so bad that it won't be possible....

    "The only thing necessary for the triumph of evil is for people to mistake writing angry diaries on political blogs for doing something in the face of evil."

    by Buffalo Girl on Sun Mar 02, 2008 at 10:28:35 AM PST

  •  80% happy with appearance of bubble just before (3+ / 0-)
    Recommended by:
    DemFromCT, maracucho, LillithMc

    it pops.  That's my take on the polls.  One factor not really given enough weight in the discussion about when universal hc will be pushed thru is the fact that the current system is just about to implode.  The above noted story of the appendicitis boy in the ER dying of waiting too long, is getting to be a much more common story all over America.  If you really think that by just adding insurance to the people who don't have it, that this problem will be gone, you don't get it.  Sure a lot of the ER wait times are because uninsured can't go to another physician in the community.  But, guess what?  All those community physicians are already extremely busy.  Many are not taking new patients even with insurance.  
    So, here is a really big point:  just how long do you think it will take to acquire more physicians, nurses, nurse practitioners, medical technologist, medical equipment, clinics, etc.?  And, any  method of cost cutting does not include lower wages to all these personnel.  How are you going to get anyone to want to be a doctor by paying them less than they get now, unless there is some other offset?   I happen to be a doctor, and tho I strongly desire single payer for social responsibility, I simply could not, would not work for a lot less than I get now (I'm not that high paid anyway compared to most) unless the threat of malpractice were somehow modulated.  Those of you who don't have the threat of a frivolous lawsuit depriving you of your ability to continue to ply your trade after having paid off over $100,000 in student loans and stayed up all night with patients peeing and puking on you may not understand my point of view.  
    But, when you go to single payer or even some watered down compromise, be prepared to give up some of the things you have now.  Like the right to consider your encounter with doctors and hospitals as a lottery ticket.  Like the right to get much above basic care.  For instance, in my state, the state run Medicaid program has decided that the way to ration care is to draw a line in a list of diagnoses - if what you have falls below the line, you are not covered for that.  One of our below the line diagnoses is pelvic pain in women.  So they just get to continue to live a life of suffering and I as a physician can't even order tests or do surgery to help them.  Even if I waive my fee (which I do a lot), they can't get the needed surgery because of the hospital charges.  So be really careful what you wish for.  
    In spite of all this, I truly do want universal healthcare.  But I do not want to see the  baby thrown out with the bathwater.  It has to be incremental so adjustments can be made as mistakes are made.  Not even Obama can produce or even import enough additional physicians to handle the load created by universal health insurance.  
    Universal health care is way more complicated than Social Security.  It's a lot easier to say your retirement check is just so many $, than to say your illness is below the line.  And the public road system certainly came in incrementally.  I just hope people don't let their utopian ideals get in the way of getting started.  Let's just get started and commit to constant reevaluation and adjustment as need be.  Honestly I expect that a full transformation to single payer to be somewhere between 10 - 20 years IF we work really hard and keep our eye on the ball.  

    I was wise enough to never grow up while fooling most people into believing I had. - Margaret Mead

    by fayea on Sun Mar 02, 2008 at 11:05:38 AM PST

    •  one answer is years (0+ / 0-)

      So, here is a really big point:  just how long do you think it will take to acquire more physicians, nurses, nurse practitioners, medical technologist, medical equipment, clinics, etc.?

      3-7 years depending on specialty... if you start today.

      As for the health care system imploding (or not), please see Perspective On Health Care Reform and The Amazing Noncollapsing U.S. Health Care System — Is Reform Finally at Hand?

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Mar 02, 2008 at 11:12:19 AM PST

      [ Parent ]

      •  actually (0+ / 0-)

        4 years of medical school for those who have completed the undergrad requirements, then typically 3 - 7 years of residency.  Importing foreign physicians is a lot faster and my community has done quite a bit of that - it has turned out just fine with some excellent doctors.

        I was wise enough to never grow up while fooling most people into believing I had. - Margaret Mead

        by fayea on Sun Mar 02, 2008 at 11:35:41 AM PST

        [ Parent ]

        •  yep, but that's the docs (0+ / 0-)

          the rest of the list is shorter. And foreign national nurses fill a lot of gaps as well.

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Sun Mar 02, 2008 at 11:44:17 AM PST

          [ Parent ]

    •  Universal basic & catastrophic -- plus CASH. (0+ / 0-)

      Frankly, for the things which aren't covered, -- which should hopefully not be restricted quite as horribly as Medicaid does -- people who can't afford  to pay for private care will suffer; those who can will pay for it.

      A lot of people end up paying out-of-pocket for treatment for "less obvious" (including lesser psychiatric problems) or "less severe" diseases anyway.

      Universal coverage is a baseline.  Private coverage will continue to supplement it, and cash will most certainly continue to supplement it.

      But people shouldn't have to fear medical bankruptcy, or 14-hour emergency room waits for appendectomies, or inability to pay for antibiotics to cure infectious diseases.

      The malpractice situation is a bit crazy.  On the one hand, I've seen actual cases of malpractice.  They are egregious.  On the other hand, obstetricians (for instance) face far too many meritless malpractice claims.

      Perhaps the answer is twofold: first, make the malpractice standard higher (gross negligence, fraud, or actions no reasonable doctor would have made, plus the existence of actual tangible damages connected to such); second, switch to a 'loser-pays' system for court costs, so doctors aren't eating the court costs of their wins and don't have to get insurance to cover said wins.

      -5.63, -8.10 | Impeach, Convict, Remove & Bar from Office, Arrest, Indict, Convict, Imprison!

      by neroden on Sun Mar 02, 2008 at 06:59:15 PM PST

      [ Parent ]

  •  true (0+ / 0-)

    and I suspect we will need to utilize nurse practitioners and physician's assistants a lot more.  Americans are going to have to be "educated" to accept that change.

    I was wise enough to never grow up while fooling most people into believing I had. - Margaret Mead

    by fayea on Sun Mar 02, 2008 at 11:49:49 AM PST

  •  Always COSTS TOO MUCH? (0+ / 0-)

    Why is it when Healthcare-for-All is discussed, so many respond with "It's too expensive!"

    Same thing happens in discussing controlling pollution, maintaining quality democraticization of education, preserving habitats, restoring the infrastructure, improved prenatal care, teaching art and music in schools, developing clean energy to replace filthy petroleum, making mass transit successful locally and coast to coast...it always "COSTS TOO MUCH!  Forget it.  Enough said."

    But I never hear this cost effectiveness argument dismissing THE IRAQ OCCUPATION, or THE MILITARY INDUSTRIAL CONGRESSIONAL MEDIA COMPLEX, or the TOTALLY publicly subsidized Nuclear Power Boondoggle (which has consistently siphoned funding ways from clean energy alternatives), or the farm subsidies for Big Agribusiness, or subsidies for Big Oil like the depletion allowance, or outsourcing government jobs (for example, Blackwater-style mercenary forces guarding embassies now), or the no-bid contract system of Bushworld war- and disaster-profiteering, and the ENTIRE off-the-record BLACK BUDGET and the federal spending of secrecy institutions like the NSA et al.

    Services  and programs that build, protect and maintain our country and us citizens cost little compared to the INFINITE BUDGETS given to these Monster Money Suckers above.  It's time to redirect monies to programs that will make us a stronger nation right down to the individual citizen.

  •  Remind people: SINGLE PAYER IS CHEAPER. (1+ / 0-)
    Recommended by:
    Valhalla

    I don't know why people don't understand this.  If we could get this fact across to enough Americans, the people desiring cost control and universal coverage would be on the same page.

    -5.63, -8.10 | Impeach, Convict, Remove & Bar from Office, Arrest, Indict, Convict, Imprison!

    by neroden on Sun Mar 02, 2008 at 05:42:22 PM PST

    •  We need to get Corporate America to support us (1+ / 0-)
      Recommended by:
      neroden

      I think there are many many companies in this country (from IBM to Exxon to American Express to McDonald's to Disney and so on) that could easily be persuaded to sign on for single-payer health care.  The only companies who are against it are the Insurance companies.  But it would save the other 95% of Corporate America tons and tons of money if the Government foot the bill.  It would be great for business -- this is the argument we need to make.

      "It is time to be patriotic about something other than war" - John Edwards

      by Valhalla on Sun Mar 02, 2008 at 06:03:45 PM PST

      [ Parent ]

  •  Not up to DK standards (0+ / 0-)

    get real on this - a few cites from Health Affairs is pretty weak.  I've read it for years, cover to cover, and let's just say your discussion is in the shallow end of the pool.

    Let's have a real discussion on single payor, with a more substantive diary.

    •  oh, and by the way (0+ / 0-)

      for someone who has written 3 comments and zero diaries, this would be a wonderful opportunity to take a topic you feel needs some substance and add to the community by providing some, by way of an introduction for yourself. With references, of course.  

      Educate us. It's a worthy topic ;-)

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Mar 02, 2008 at 07:01:49 PM PST

      [ Parent ]

  •  This really is a no-brainer (0+ / 0-)

    Let' say the average family is paying $1000 a month (12,000) a year. Some are higher-some lower. Can't a government sponsored health plan (universal plan) beat that?  It has to or we are really a sick society. Everyone pays in one way or another and then we can begin to have enough medical education so that we can at least educate general practitioners for our 300 million participants. Of course, we will be understaffed until the training produces the qualified doctors. Don't worry about the rich, they'll be as greedy as ever and get their first. But imagine all those millions of kids finally getting some decent health care. That is what it is all about. And then all those healthy kids can pay into the system and keep me happy in retirement.

  •  No .... will have marginal reform, nothing major (0+ / 0-)

    With the GE tightening I do not expect to see much change in congress and no candidate now running is actually advocating major change consistently. For example, being anti-NAFTA is great for Ohio but not worth mentioning in Texas. That shows me there is one commitment (gaining the presidency) and beyond that business as usual.

    The other thing that will hurt healthcare reform is the poor ecomony .... with most people already having healthcare who is going to want to vote for higher taxes for a universal (or near universal program) when offered lower or no new taxes and some improvements on portability, preexisting conditions, and so forth?

  •  Remote Area Medicine (0+ / 0-)

    Sixty Minutes did a piece just last weekend on these guys (ramusa.org), who are seeing people drive hundreds of miles from major metros to their remote 2-3 day rural appearnces--to get free health care. They spoke to the underinsured, which is an unreported number, e.g., you have "good" insurance, but your deductible is $500, which you can't spare without falling from two to three months behind on your mortgage.

    One woman who missed out was in tears because she knew she had others to ask--but she just couldn't bring herself to ask. The reporter said, "But there's no shame in coming here?" and she nodded.

    Many of us, it would appear, are ashamed to ask for help.

    I think the first thing that the next President should do is to start to manage healthcare like the disaster that it is: Set up free healthcare, one week of every month, in every major metro. No shame, no fault, show up, get your emergency care handled, no questions asked, all are welcome, get your ten-year-old eyeglasses Rx updated, find out what it is that's been hurting for three years in your gut, etc.

    It's an emergency that we're ignoring because we're ashamed to admit that we can't handle it ourselves.

Subscribe or Donate to support Daily Kos.

Click here for the mobile view of the site