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The Commonwealth Fund has done the country an enormous (if oddly incomplete) favor and done an independent detailed comparison of the many health "reform" proposals in congress and the Obama plan.


Of the plans they chose to review, the only plan that both covers everybody and actually controls total costs is the plan that most closely adopts features of single-payer, which is the latest proposal from Pete Stark who is chair of the Health Subcommittee in Ways & Means.
The more publicized proposals – Obama, Baucus, Wyden, the "moderate" consensus plan now known as Building Blocks – are all objectively worse.  

In addition, this from an organization that does NOT support single payer!

It will also provide a follow-up my earlier diary on this report, why the Commonwealth Fund did not include the Conyers bill HR-676 which is a single payer proposal, which Stark’s is not, among their many reviews.

Follow me for more details...

1. Comparison of the Obama, Baucus and Building Blocks Plans:

The table below compares the main features and goals three very similar plans: the latest version of the Obama plan, the proposal from Senator Baucus who as chair of the Budget committee will be playing a major role in whatever passes, and what has come to be known as the "Building Blocks" plan.  The Building Blocks plan is the latest version of the mixed-mandate private-public multi-payer proposal from the mainstream beltway liberal coalition, similar to the Edwards and Clinton plans also associated with Jacob Hacker.

Indeed all three of these proposals are similar in their essence: build on the current system of mostly employer-based coverage purchased from private-for-profit insurance companies, with various mixes of tax breaks and employer and individual mandates to promote more such purchasing from the private for-profit insurers, and some expansion of public options to make up the difference.

Comparison of the Obama, Baucus and Building Blocks Plans

Since details of the Obama plan and the Baucus plan are not fleshed out, since they all derive from the same assumptions and same group of policy wonks, and are as noted so similar, the Commonwealth/Lewin folks decided that they can be lumped together with the Building Blocks plan in most of the further analyses.  To reiterate, Building Blocks, just like Obama and Baucus, aims to achieve universal coverage through a mix of private and public group insurance with a shared responsibility for financing.

The table below shows many of the rest of the plans in congress, from key Senators and Representatives, Republicans and Democrats:

2. Comparison of the All the Rest of the Plans:

Comparison of the All the Rest of the Plans

The Wyden (D-OR) plan establishes a mandate for non-elderly, non-disabled individuals to purchase private insurance, called Healthy Americans Private Insurance (HAPI).  HAPI plans would be offered by private insurers through "Health Help Agencies" created by each state or territory, or through an employer under the Senate bill, or through the federal government if there were not a private plan available in a region.  The income tax exclusion for employer health benefits would be eliminated and a standard tax deduction (Senate version) or tax credit (House version) would be substituted.  Additional subsidies would be available for low-income individuals.

Token proposals from Republican senators Enzi and Burr also mimic the Wyden plan, and McCain’s presidential proposal, in offering the center-right’s favorite solution of eliminating the current employer tax incentive to offer insurance, but replace it with even less than Wyden’s does.

Commonwealth also chose to look at several proposals that do not even claim to care about universality:

Senator Bingaman/ Representative Tammy Baldwin (D) and odd couple Senators Feingold (D) and Lindsey Graham (R), offer the ridiculously timid proposal of some state demonstration grants.  

Bingham/Green (D) expands the disability part of Medicare.  

Kerry/Waxman (D) expands coverage for children via Medicaid/SCHIP and incentives for employer and private coverage.  

Johnson/Buchanan (R) expands what organizations can create private health association plans.  

Durbin/Kind (D) expands access of small businesses to private insurance pools.  

Cantor (R) suggests an expansion of Bush’s Health Savings Accounts for individual purchase of private insurance.

More seriously, Representative Pete Stark's (D–Calif.)  "AmeriCare Health Care Act of 2007" (H.R. 1841) and Senator Edward Kennedy (D–Mass.) and Representative John Dingell's (D–Mich.)  "Medicare for All Act" (S. 1218 and H.R. 2034), expand Medicare to (nearly) everyone, while leaving in place employer-based coverage and private insurance.

Alas, Commonwealth and Lewin chose not to analyze the Conyers' single payer plan, HR-676.  I will come back to why Stark is not single payer and why Commonwealth chose to ignore Conyer HR-676 in item 8 below. But for now, the Stark plan stands in for the best there is (here, in this comparison) from a progressive point-of-view.

3.  Summary of Coverage and Costs Of The Proposals:

So... how many of the currently uninsured will be covered?

And how much will it cost?

And an important, and often neglected, question... who pays what?

The table below provides an overall summary.

Summary of Proposals

4.  Number of the Uninsured Who Would Become Newly Covered:

Looking first at how many of the currently uninsured will become covered?

Out of the estimated total number of 48.9 million, only the Stark Plan, like the Conyers HR-676 plan, would automatically assure that everybody is covered.

Commonwealth/Lewin finds that the Wyden and Building Blocks (including Obama and Baucus to lesser extents) come relatively close but don't actually acheive universal coverage.

The other plans, including all the ones from Republicans do not come close and mostly don't really even try.

Number of the Uninsured Who Would Become Newly Covered

So, what about costs?

5.  Change in Spending Just of the Federal Government:

The graph below shows just the direct costs to the Federal government, not the total cost.

In other words, not the additional costs by individual and families such as premiums, deductibles co-pays,  out-of-pocket due to refusals of insurance company to pay.  It does not include additional costs by employers.  It does not include the additional costs by state or local government.

Change in Spending just of the Federal Government

Not surprisingly, the Wyden Plan, which like the McCain plan from the campaign, takes away the tax corporate deduction for providing insurance and does little to offer pay directly for coverage, saves the Federal Government the most.  While the proposals from Stark, Enzi, Burr and the Building Blocks plan cost the Federal Government the most.  

When the Congressional Budget Office comes out with favorable analyses of the Wyden plan, this is what they mean.  But as we shall see, this is a very incomplete and essentially dishonest view.

6.  Total Change in National Expenditures on Health Care:

This table shows the change in total costs, the total national expenditure on health care.  This is the one that corresponds with Percent of GNP spent on health care, that infamous statistic that shows that U.S. spends twice as much as other developed industrialized nations, but is the only one not covering everybody and the only one bankrupting families if they get sick... and the only one dependent on for-profit private insurance companies.

Total Change in National Expenditures on Health Care

Notice the complete turn-around compared to the JUST federal government view in the prior table.  While the Wyden plan saves the Federal Government money, it actually increases total costs and dumps those cost onto others.

Indeed most of the other plans... Enzi, Baldwin, Burr and alas even Building Blocks (including Obama and Baucus) amount to huge giveaways and supports for the private for-profit insurance companies.

Only the Stark Plan (like Conyers HR-676) actually saves money for the overall system, the country as a whole.  Only Single-Payer like plans can actually control overall total costs. And this from an organization that does not support single payer, and supports Obama/Baucus/Building Blocks.

7.  Who Pays by Stakeholder Under the Different Plans:

This is the real story, typically ignored by proponents of the other plans including the Wyden plan, the various variations of mandate plans (Obama, Baucus, Clinton, Edwards, Building Blocks, etc.) and the Republican proposals.

Who Pays by Stakeholder Under the Different Plans

The Building Blocks plan, like the Obama and Baucus plan, would increase costs overall, and to the federal government and for employers.  The Wyden plan dumps even heavier on employers.  

Regardless of what the CBO or GAO or beltway mainstream may say, being "revenue neutral" and saving the Federal government money is not the most important goal of health care reform.  

We do need to control costs, but it is overall total costs that are what really count.  

And, we also need to provide coverage that is truly Universal for all people, Comprehensive in covering all health needs, and does not bankrupt you if you get sick.

The Stark proposal, like the Conyers' HR-676, takes on access to health care coverage as a national responsibility, paid for by federal taxes, but reducing direct and total costs to states, local governments and for individuals and families.  And as noted, they are the only plans that make a significant overall cost reduction and control.  And they are the only plans that actually result in coverage for everybody!
Of course, worst of all, essentially fraudulent nonsense, are the Republican plans (Enzi and Burr) that provided minimal addition coverage, while lining the pockets of the for-profit private insurance companies even more than now.

---------------------------------------------------------------------------------------------------- ---

8.  How Does Stark plan differ from Conyers HR-676 and Single Payer and why did Commonwealth Ignore it?

Several us have asked the head of the Commonwealth Fund Karen Davis (email: ) and Sara Collins (email: ) why they did not include Conyers’ HR-676, since it is the proposal with the broadest grassroots support and the most sponsors in the House.  One common excuse for ignoring it has been that it has "no chance of passing", but neither do many of the proposals that they did include and it has more support than many.  Commonwealth’s reply has been consistent (several of us got the same reply):

Thanks for your note and interest in work of the Commonwealth Fund.  We do include HR 676 on page 29 of the report as one of several bills that would expand coverage through Medicare or through a central financing mechanism.  Of those bills we opted to model Rep. Stark's Americare bill.  We discuss similar bills as part of a set but had to choose one to model, and in the case of this set, we settled on the Stark bill given his chairmanship of the key Ways and Means Health Subcommittee with jurisdiction over health reform.

Buried on page 29 of the full report (.pdf) (which few will read), we find the following:

People of all ages would be eligible to enroll in Medicare or a Medicare-like program under three bills introduced in 2007.  Senator Edward Kennedy (D-Mass.) and Representative John Dingell (D–Mich.)introduced the "Medicare for All Act" in April
2007 (S. 1218 and H.R. 2034), and Representative Pete Stark (D–Calif.) introduced the "AmeriCare Health Care Act of 2007" (H.R. 1841) in March 2007.  In addition, two bills would cover everyone through a central financing or "single-payer" mechanism.  Under Representative John Conyers’ (D–Mich.)  "United States National Health Insurance Act,"
introduced in January 2007 (H.R. 676), the federal government would collect payroll and income taxes to finance a system of health insurance under which all residents would be eligible for a set of covered benefits.  Representative Jim McDermott’s (D–Wash.) "American Health Security Act of 2007," introduced in February 2007 (H.R. 1200),  would use a similar financing mechanism.  The federal government would distribute tax revenues to states, which would design their own programs subject to national benefit and regulatory guidelines.  The Lewin Group estimated the coverage and cost impact of Rep. Stark’s bill.  

That is not a serious answer.  They did not analyze/compare the Conyers HR-676 and the fact is that that the Stark proposal is not at all like Conyers Single Payer and cannot be honestly lumped together with the Conyers proposal.  

Moreover, they did include as individual separate analyses multiple versions of "eliminate the corporate tax credit" plan.  For shame, for shame!

Indeed, as everybody including Stark himself and Lewin Group acknowledges, the Stark proposal is in fact multi-payer and just the further end of the Baucus/Obama/Building Blocks spectrum.  It is at best "public option on steroids" as it were, but like the other "mixed-mandate private-public multpayer plans" leaves in place employer-based private-for-profit insurance companies as well as the for-profit hospital chains.  Stark's proposal is like the others a "play or pay plan in which employers would still offer private insurance or, if they did not, pay into a public fund to pay for this Medicare-like program.  Alas, even the so-called public option in the Stark plan includes the not-public entirely private for-profit insurance companies'-based FEHBP as an option.  It is an "all-of-the-above" plan that does not fully reform the system, but just requires that everyone buy into it.

Both Conyers and Stark project savings based on reduced/controlled payments to doctors and hospitals.  Single-payer has the advantage of true monospony.  However, under Stark's version of a multipayer plan, like those of Building Blocks/Hacker/Obama/Baucus and the present system, wealthy patients and the doctors and hospitals that serve them could refuse to take the public plan.  We have seen in some public schools systems (e.g., NYC) what happens when the wealthy and upper-middle class opt-out.  As to Stark (and others like HR-1200) have the States significantly involved, this will likely result in a race-to-the-bottom such as we see with Medicaid.

So, real Single-Payer represented by John Conyers HR-676 is significantly different from the Stark proposal.  It is the plan with the most co-sponsors in the House.  It is the plan with the most grassroots support including the national network of PNHP, HealthCare Now, Guaranteed Health-Care, etc. and the endorsement of hundreds of Unions, religious and other and civic organizations. But it must be ignored by the Beltway mainstream.

Admittedly, HR 676 would require that investor-owned providers be converted to not-for-profit status, and that the investors be compensated by public funds at the appraised value of the converted facilities.  As only one example, the hospital corporation HCA has a book value of $24 billion.  In the short-run, that would reduce by close to half of the short-term savings of the Stark proposal.

But that is made up for over the long run with the cost-control and planning that Single-Payer would allow.  Indeed the short-term one-year-out aspect of the Commonwealth/Lewin analysis is another severe shortcoming.

Commonwealth's great service in doing this report is severely compromised by not having included HR-676.  It deserved and deserves to get it own analysis.

Many of us believe that the true reasons for Conyers HR-676/Single Payer being left out include:

  1. A planned policy by the moderate insider powers that be to exclude and ignore Single Payer, as a matter of supposedly honest but we feel, misguided strategy.
  1. That funding sources and board members of these organizations includes folks who come from companies that are opposed to single payer for personal financial and ideological reasons, and that they exercise a de facto veto power over allowable discussion.  I have personally heard this from senior staff and management of both HCAN and the Kaiser Family Foundation; that they would lose funders if they provide support for single payer.  While I have not heard anything so specific about Commonwealth, its board includes folks like Samuel C. Fleming who "is managing director of Briland LLC, which specializes in healthcare investments.  He is chairman emeritus of Decision Resources, Inc., a leading provider of strategic information to the global biopharmaceutical, medical device, and healthcare insurance industries.  Mr. Fleming founded Arthur D. Little Decision Resources.  In 1989, he led a buyout of the firm to form Decision Resources, where he was chairman and chief executive officer through 2003...."
  1. Also Lewin Group is now owned by United Health, one of the largest for profit health insurance companies.  So, the fact that they went out of their way to ignore Single Payer, and frankly any of their results has to be considered suspect and at least subject to critical scrutiny.
  1. If Commonwealth, and for that matter Kaiser Family Foundation and the rest, really want to lay such objections to rest, they could prove otherwise by a including real Single Payer in the future.  All we ask for is  fair seat at the table.  Perhaps as Commonwealth moves forward with part two of this series they will reconsider.

Originally posted to DrSteveB on Tue Jan 13, 2009 at 07:37 AM PST.

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Comment Preferences

  •  tips & recs for (28+ / 0-)

    Thanking commonwealth fund for this report and asking them to include a full comparative analysis to Single Payer in the future

    Karen Davis (email: )
    Sara Collins (email: )

    Peace and health.

    •  Thank, Dr. Steve (5+ / 0-)

      Thanks for the diary & for the email adresses.  I'll send an email commonwealth fund right now.


    •  I have had this argument before (0+ / 0-)

      but any proposal that bans private health care spending (like Canada does) will not fly here.  If this is the primary difference between Starks and Conyers plan, I greatly prefer Stark's plan.  Very few of the other countries with UHC  ban private health care spending (eg UK, Germany, France).  

      •  misleading since... (11+ / 0-)
        the German and French pools are NOT private for profit insurance companies. They function as completely pre-determined regulated public utilities.

        The UK "harley street" private doctor has been part of their problem for years.

        The Swiss and Dutch experiments with private for-profitss are a disaster.

        No other OECD country relies on the private for-profits insurance companies; see:

        •  Disaster? (0+ / 0-)

          Please explain.  Particularly in the Dutch case, their experience with for-profits and regulated markets hardly seems like a disaster.  The Netherlands has been experimenting with more open markets for health care in the past few years, with the experimentation likely to continue for several more.

        •  Not sure what you mean by part of problem (0+ / 0-)

          The UK system is one of universal payment (even if it is a nil contribution because of unemployment or retirement on only state benefit) Anybody choosing to pay for private health insurance makes payments in addition to their contributions to the NHS through the "national insurance" income tax as well as in ordinary taxation.

          The reasons for taking out private insurance are usually (in this order) convenience of choice of treatment dates and better "hotel" facilities. Initially to avoid "waiting list" delays, this factor has reduced somewhat in favor of being able to choose exact date of a procedure. "Hotel" facilities refer to the ability to have a single room rather than being in a small multi-bed bay or larger open "Nightingale" type ward together with a greater choice of meals.

          There is a further private sector which relies on whole cost payment rather than insurance. The most obvious is cosmetic surgery not undetaken for medical or psychological reasons (thus breast enhancement or reductions may be available on the NHS if severe psychological effects are being caused by the current body shape although reconstruction after say cancer surgery is generally available)

          Some procedures or treatments such as osteopathy, acupuncture or homeopathy may have very restricted availability within the NHS and the practitioners usually private.

          The most common private paid for procedures are at NHS GP offices. While regular immunization injections are covered, those needed solely for the purpose of travel are not. Thus things like yellow fever injections and the prescribing of malaria tablets are often done by NHS doctors, the patient pays a private fee for them doing so.

          Obama on Gaza: Silence = Death

          by Lib Dem FoP on Tue Jan 13, 2009 at 08:44:02 AM PST

          [ Parent ]

      •  See, cuz I say the same thing about mandates. (3+ / 0-)
        Recommended by:
        oldjohnbrown, CatJab, bthespoon

        I find them a much tougher sell.

        And if private for-profit insurance continues
        to have a role in financing, we will almost assuredly
        see a class-tiered, junk insurance littered field of options,
        no realistic or effective cost controls and
        continued insurance and pharma lobbying
        like the $400+ million in '07.

        That $400+ million certainly could have no connection
        to the exclusion of a single payer solution from the debate, right?
        Sound policy and not monied politics drives this debate, right?

        Single Payer.
        Just Say It.

      •  I am pretty darn sure (0+ / 0-)

        that Canadians can buy extra healthcare "insurance". I don't know how that works (haven't asked friends). Just watch the wide brush treatment of statements, unless you are Canadian, of course.

        Americans, while occasionally willing to be serfs, have always been obstinate about being peasantry. F. Scott Fitzgerald, the Great Gatsby

        by riverlover on Tue Jan 13, 2009 at 08:05:23 AM PST

        [ Parent ]

        •  extra drug coverage (2+ / 0-)
          Recommended by:
          Ozzie, blueocean
          the key is that all physicians and all hospitals and all clinics, etc. MUST take the public system.

          Provider side of care cannot opt-out.

          And everybody is automatically covered and paid for by taxes.

          Hence slogan of "Everybody-in, Nobody-out".

          •  Doctors in Canada choose (1+ / 0-)
            Recommended by:

            ...whether they would like to be salaried or paid fees for their services.

            I would choose to go to a doctor who is salaried so I could be sure the care he or she would recommend could not be connected to his or her pocket book.

            Unless everyone is in the same protected pool under the same non-discriminatory rules, we cannot utilize the efficiencies of scale we need in order to achieve the systemic savings, protections, quality, choice and reliability that we need to achieve.  As long as we are divided we are conquered.  

            In other words we can't achieve systemic improvements unless we have a system, which we now lack.

            Why would anyone want to opt out of our public highway system, fire protection, parks, etc.?  Where is the sense in that?

      •  simply... (1+ / 0-)
        Recommended by:

        its a matter of getting the health of this country off the market.
        ahem..."Worst financial crisis since the Great Depression"
        and to continue to believe that the insurance industry exists to provide care...
        is like drinking the kool-aid...
        their ultimate responsibility is to provide profits to their stockholders...
        they must stay healthy so they deny us our right to the same.
        they've been allowed to be the gatekeepers to health for too long
        not right.
        we are a sick nation and the only way the healing can begin is through a transparent and accountable program such as single payer...
        medicare for all.
        it just frickin makes sense.

  •  Thanks for the great job in (3+ / 0-)
    Recommended by:
    Ozzie, CatJab, bthespoon

    getting this information out to this community.  I hope this makes the rec list.  

    It is time for all Americans to become informed about our choices in health care.

    We need to understand this.  If we fail to make the effort necessary then we will deserve whatever failures we get stuck with.  

    Everybody needs to take a few minutes this week and look over this information.

  •  Getting US spending in line with (2+ / 0-)
    Recommended by:
    nio, bthespoon

    Getting US spending in line with the rest of the industrial world is key.

    The reason US health care spends about 15% of GDP while other advanced economies spend 7-8% does not get the attention it deserves because they are difficult issues for politicians.

    A great current source to better understand our high costs is a recent book "Code Red: An Economist Explains How to Revive the Healthcare System without Destroy It: - by  David Dranove

    • Administrative costs (doctors, hospitals, government and insurance companies) are about 6% of all spending.  Even if national single payer had 0% administrative costs - no more than a 6% reduction can be reached. Insurance companies do however make good targets for political purposes.
    • Drug company profits and executive compensation is not the reason - as total spending on all supplies (drugs, sheets for hospital beds, bandages, etc.) is about 15%. So only 1-3 percent of cost reduction is possible by reducing drug company profits and executive compensation.  Drug companies are also good targets for politics.
    • Better electronic records could reduce costs but by less than 5%.

    The big reasons for the cost difference between the US and other industrial economies are:

    • Doctors, nurses, technicians, administrators, etc. are paid much more in the US (measured as what these jobs pay relative to averge jobs in their economies).  How can the political class campaign that the many millions of people working in healthcare (and voting) need to have their compensation cut?
    • More than 1/3 of healthcare spending in the US is spent on people in their last 6 months of life of the critically ill.  In other counties, this is far lower as the decision to end costly care is made much earlier.  A costly procedure that may be made available to a person in their 40s, will frequently be denied to a person in their 70s.

    Having these difficult discussion during election season cannot happen - maybe now is the time to have serious discussions on getting US heathcare costs under 10% of GDP while expanding coverage to all.

    The most important way to protect the environment is not to have more than one child.

    by nextstep on Tue Jan 13, 2009 at 08:17:00 AM PST

    •  and also... (3+ / 0-)
      Recommended by:
      Ozzie, CatJab, bthespoon

      ~15% excess direct overhead/profit to for-profit private insurance companies, which do not exist in the entire rest of the developed world.

      ~15% additinal savings by having monospony buying power and rationalization due to bulk purchases, planning where to open hospitals, etc.

      Over 350 billion per year (and increasing).

      •  The buyig power translates (0+ / 0-)

        The buying power approach to savings come from reducing compensation to people working in healthcare and to a lesser extent effeciency.

        I addressed the "15% exces direct overhead/profit" as being part of the total 6% of US healthcare spent on administrative costs.

        The most important way to protect the environment is not to have more than one child.

        by nextstep on Tue Jan 13, 2009 at 10:49:04 AM PST

        [ Parent ]

    •  6 months (0+ / 0-)

      Even the restriction or elimination of procedures which clearly have no effect on the eventual short-term outcome could be sold to the public.

      In general, countries which have universal health care have far longer life expectancy than the USA. Even the UK, which spends about the same percentage of its GDP on its publicly funded system as the USA pays (but provides universal coverage rather than Medicaid/Medicare/VA healthcare/county emergency rooms etc) manages about an extra 6 months.

      So in exchange for 6 months of increasingly aggressive medical treatment which will have no effect on you dying, you will get at least an extra 6 months of healthy living.

      Obama on Gaza: Silence = Death

      by Lib Dem FoP on Tue Jan 13, 2009 at 09:00:26 AM PST

      [ Parent ]

  •  As you discuss collectivizing medical care (0+ / 0-)

    remember, it's our money, not Our money.

    •  who do you trust more... (3+ / 0-)
      Recommended by:
      Ozzie, CatJab, bthespoon
      Private for-profit insurance companies, responsible to their board (giving itself perks and salarie and bonuses) and wall street (demanding increased profits every 3 months), whose fiduciary responsibility is to say not to care (what they call medical loss ratio).


      Government elected by us, and technocrats without self interest in saying no to care?

      •  Remember the last 8 years? (0+ / 0-)

        That government was also elected by us.  If we've only got the one government option, then the next time we end up with incompetent leaders, where do we turn?

        •  Health insurer leadership as incompetent (2+ / 0-)
          Recommended by:
          Ozzie, CatJab

 possible when it comes to caring about people.  How can ANY entity be WORSE than they are?  Millions of us are at their mercy, and they have NONE (unless you work for the government or a large enough employer whose account they do not want to lose, then maybe you might see something that masquerades as morality and mercy....but it's not).

          I've posted this before, but Andy76, you need to watch this.  This is what happens to you when you do not have the protection of a large enough group.  Medicare (Dis) Advantage plans are as highly regulated as "private" health insurance can possibly be.

          As I said before, how much MORE evidence do we need?  How many MORE lives and health care dollars must we stand by and watch be TOTALLY wasted?

          Medicare Private Plans

    •  NOT talking about collectivizing medical care (0+ / 0-)

      We're talking about public insurance with private care.  The insurance is where almost all the waste, and therefore hundreds of billions of dollars in savings, can easily be realized....and we all will not only save hundreds of billions of dollars (collectively) but also have far more reliable coverage with far better choice of providers, quality of care and systemic transparency.  

      How great would our roads be if we all had to buy them on our own?  To make an analogy between public roads and private health insurance...if our roads were privatized too, perhaps a few people could and would "collectivize" for better roads for themselves, but the problem would still be that no one else would be able to drive on them.  (OK for some, lousy for others, except in the case of roads no one would have to die because they couldn't travel anywhere.)  Some things we just need to unite together on for the Good of the Whole, and public health insurance is one of those things (like roads).

  •  The Stark proposal (0+ / 0-)

    It strikes me that the report's calculated outcomes for the Stark proposal make some rather bold assumptions.  First, the analysts assume that everyone who is uninsured will sign up for the public plan, with no ability to opt out.  Thus, they get universal coverage by assumption.  Second, they assume that everyone will eventually end up in the public plan.  Third, they assume that the public plan will pay Medicare rates.  This last assumption is somewhat heroic, since it means assuming that Medicare will not have to raise rates.  According to the report, this means that $80 billion of cost savings can be squeezed out of provider revenues (no mention of what happens to quality or access).  True?  Possibly.  If you buy the assumptions.  I would suggest retaining a significant amount of skepticism regarding these (and any other) hypothetical numbers.

    •  best comparison available (3+ / 0-)
      Recommended by:
      Ozzie, CatJab, bthespoon
      true for any analysis. and obviously I wish they had inclduded HR-676 also.

      but this is the best, most unbiased comparison avaialable.

      andy... what would you suggest?

      •  A few things (0+ / 0-)

        First, you'd need additional detail on the source of the assumptions (e.g. why do they expect 100% uptake?).  Second, it would be more appropriate to consider a range of "cost savings", rather than a single number, based on different sets of assumptions.  Third, some discussion of quality considerations should be part of any plan comparison, despite the obvious difficulties of such a discussion.  (Providers could, for example, choose to offset revenue reductions by lowering quality.)  Fourth, related to the third issue, there should be some consideration of the dynamics of the market (lower rates across the board will almost certainly lead to some hospital closures and physician exit).  Fifth, recognize that regional differences in care provision may also lead to these savings' not being realized.

        My impression is that the CBO may have done a better job in its own report on reform options.

  •  The only way a new system will work (0+ / 0-)
    1. Everyone in America is covered
    1.  It costs ALL tax payers less then they pay now
    1.  It costs ALL business less then they pay now.

    I developed a plan that I thinks attempts to fix healthcare and make sure it is cheaper for those that already have insurance to switch to single payer.

    Go my this diary to learn more of my plan:

    While it is important to get everyone covered, we must not lose focus of the cost.  Tax payers will have no stomach for something that costs them more then they pay now.  The new system has to be a positive for EVERYONE EQUALLY.

  •  Great job, Dr. Steve (1+ / 0-)
    Recommended by:

    It is frustrating that we can't get serious discussion on single-payer because it isn't "politically feasible".

    Single-payer will become politically feasible when enough peer-reviewed publications analyze it's benefits!

    If a nation expects to be ignorant and free, in a state of civilization, it expects what never has and never will be. Thomas Jefferson

    by JDWolverton on Tue Jan 13, 2009 at 10:45:29 AM PST

  •  single-payer proposals that have been analyzed (1+ / 0-)
    Recommended by:

    courtesy of PNHP


    Of course, these are older studies.  But the debate really is no longer about the facts.  Single-payer blows all other systems of financing healthcare out of the water.

    The debate is about values.  If you value freedom (to choose any provider), opportunity (to be employed where and how you wish), and security (that you will never be denied healthcare for any reason), then you logically will support single-payer as the solution to our healthcare financing mess.

    If, on the other hand, your values are more in alignment with those that have created our current system of healthcare financing, then you probably will be content with the outcome of the plans that are "on the table" now.  But these plans will require new money and will not insure everyone.  Let's be absolutely clear about that.

  •  Voice your support (1+ / 0-)
    Recommended by:

    for the consideration of single payer in one of the top level analyses recently produced by RAND and featured by Dr. Don McCanne today at the Physician's for a National Health Plan website.  
    Dr. McCanne suggests a polite and brief letter to RAND COMPARE, attn. Liisa Hiatt, to voice your support for an anlysis of a single payer plan in their otherwise fairly comprehensive analysis.

    Dr. Aaron Roland is a family physician in Burlingame, CA.

    by doctoraaron on Wed Jan 14, 2009 at 06:19:01 AM PST

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