Don't misunderestimate the power of bubbaosity. Bubbaismo. Whatever.
Posted by degustibus at September 18, 2007 03:57 AMBack to the healthcare debate:
15 years ago, I had coverage where there was some deductible ($500 or something) that I had to reach before insurance would pay anything. After that, insurance covered 80% of my costs and I had to pay the other 20%. Doctors charged what they wanted and got paid that amount.
Then along came HMOs, which were supposed to keep costs down. They did this by making a deal with doctors--basically setting prices. Doctors could take it (and all the patients in that insurance pool) or leave it and lose patients. I see on the bills all the time where the office visit costs $75 and the doctor is getting paid $40. This just led to mountains of paperwork (doctors didn't used to submit things to insurance, we had to do that ourselves) and lower pay for doctors, shorter office visits (they spend about 5 minutes with you) and sometimes shortages in some areas.
To me, single-payer is just an extension of this. The gov't would set the price. Instead of insurance companies deciding if they'll cover some treatment or not, the gov't will decide. Will they pay for birth control pills? Imagine the politics that results from this.
Another thing about gov't funded health care (if I've got this idea of single-payer wrong, someone correct me) is the *feel* of it. Right now, if someone smokes and gets lung cancer, I don't feel like I'm paying for their care with my taxes. I may in fact be paying for it through higher insurance premiums, but it doesn't *feel* that way. If it's all done through taxes, then the discussion turns to who "deserves" to be treated and who doesn't.
I'd like to see some solution to why people aren't covered,
--cost
--preexisting conditions and can't get coverage
--don't feel like it(I'm young and healthy)
without changing the service that insured people have. I do think it's stupid for any of this to be done through employers--that never made sense to me. But I think we'll need some incremental steps to get away from that.
I just don't see the advantages to a single-payer system. I think the ideas the dems are coming up with a decent, and I don't think the small differences among their plans matters. As someone pointed out, they don't pass the laws. What comes out of congress will look totally different anyway.
Posted by CG at September 18, 2007 05:31 AMWe need to expand Medicare to cover everyone (that includes the OVER 40,000,000 who now lack health insurance). There would be no problem with pre-existing conditions, and no one would go bankrupt due to medical bills.
America pays the most per capita for health care and yet our health statistics are amoung the WORST in the industrial West.
Posted by Gay Veteran at September 18, 2007 06:12 AMI'd much prefer single payer over universal if I was given a choice.
Did any of y'all see that student in Florida trying to ask John Kerry a question about impeachment. Seems the campus didn't appreciate his question or the time he took to ask it.
Posted by peter at September 18, 2007 06:13 AMA college kid is tasered by a policeman because he asks John Kerry questions about impeachment at a rally? As the boy screams protests, the cable news TV shitheads gleefully play it over and over again. The said cable TV bastards remark,"The guy was a little too passionate about politics!"
FUCK this country!
Posted by Mal Feasance at September 18, 2007 06:17 AMWatch this and just see if it doesn’t get you out of your chair to the phone.
http://www.afterdowningstreet.org/?q=node/26912
President’s office U Florida:
1-352-392-1311 or president@ufl.edu
We need to expand Medicare to cover everyone (that includes the OVER 40,000,000 who now lack health insurance). There would be no problem with pre-existing conditions, and no one would go bankrupt due to medical bills.
But people with Medicare often buy supplemental insurance because of what Medicare doesn't cover. And there's the whole thing about SS and Medicare running out of money, then we need to raise taxes or raise the age of coverage (which wouldn't be an option if everyone had it), it becomes a major political issue, etc, etc.
Posted by CG at September 18, 2007 06:46 AMSeems more people should have spoken up for this guy, unless he was actually out of line. Wasn't there, don't really know. This event doesn't seem all that right. I wonder if the senator made any type of indication of discomfort to the campo's there? I'm speaking here without seeing, just from hearing.
About single payer health plans. There has been a lot of discussion about the varied health care plans put forward by the various Democratic candidates, and much discussion as to what is practical versus what’s best. Since ther seemed to be much confusion about the concept of SINGLE PAYER health plans, I though it important to at least set the record straight.
From Wikipedia:
According to the National Library of Medicine, a "Single-Payer System" is an approach to health care financing with only one source of money for paying health care providers. The scope may be national (the Canadian System), state-wide, or community-based. The payer may be a governmental unit or other entity such as an insurance company. The proposed advantages include administrative simplicity for patients and providers, and resulting significant savings in overhead costs.
On the website of the Physicians for a National Health Program they discuss their proposed plan.
In the case of health care, a single-payer system would be setup such that one entity—a government run organization—would collect all health care fees, and pay out all health care costs. In the current US system, there are literally tens of thousands of different health care organizations—HMOs, billing agencies, etc.
The General Accounting Office projects an administrative savings of 10 percent through the elimination of private insurance bills and administrative waste and the Congressional Budget Office projects that single payer would reduce overall health costs by $225 billion by 2004 despite the expansion of comprehensive care to all Americans.
Some of the obvious benefits of such a system are: the massive numbers of administrative personnel needed to handle itemized billing to 1,500 private insurance companies would no longer be needed and the prohibitive costs to business involved in administering health insurance for their employees would be eliminated. Think of the estimated $1,500 in health care costs involved in each car Detroit manufactures.
Such a system would not only provide universal access for All Americans, it would make our businesses more competitive!
Can it be done? Certainly many legitimate arguments can and have been made that it’s just impossible. It’s true that, assuming roughly a third of the insurance industry in the country is involved in managing health insurance, a significant portion of about 750,000 jobs would be at risk. A single payer system would also be able to seriously negotiate lower prescription drug prices. Perhaps even to the same price level everyone else in the world pays.
There will be huge resistance from big Pharma. And yet, the plaintive whining from the drug companies that, “making new drugs cost more than you can imagine” and if we can’t make a profit, we won’t be making new drugs” ring as hollow as the auto industry bleating that “seat belts will make cars too expensive” and “higher CAFÉ standards will make cars unsafe”! It’s all nonsense! The drug companies spend 2-4 Billion per year on advertising and promotion. Am I the only one who thinks it’s a bad idea for them to be pushing dangerous drugs on the TeeVee screens? There IS room for lower prices without drying up new drug production!
The United States National Health Insurance Act AKA as the Expanded and Improved Medicare for All Act, HR 676, is a bill submitted to the United States House of Representatives by Representative John Conyers Jr., D-MI, along with 38 cosponsors, in 2003, and reintroduced each session. The act calls for the creation of a universal single-payer health care system in the United States, in which the government would provide every resident health insurance free of charge. The bill is currently in the Subcommittee on Health and has 77 cosponsors, including, of course, the ever-forgotten Dennis Kucinich!
There are obviously HUGE resistances to overcome. The battle would be with deeply embedded lobbyists and deep pocketed political funders. Would a single payer proposal EVER be able to pass Congress? Of course! All it takes is political courage and strong, committed leadership…. no wait …… never mind!
But at least we should understand just what single payer plans are and what they are not.
Medicare as it currently exists is unfortunately less efficient than most people think. There's a lot of waste in Medicare. Part of the problem with it is that, as a third-party payer system, people feel like they aren't paying the bill so they overuse the system. And the reimbursement to the doctors is less than they get with private insurance so there's incentive for doctors to order test/treatment that are of no benefit to the patient simply to increase their bill. And the fact that Medicare has such low administrative costs means that the abuse is not easily caught. Increase the oversight and you reduce one of the supposed benefits of expanding Medicare.
It's not the perfect example that many make it out to be.
The Swiss method of single payer has government paying for an HMO type of coverage for any individual or family without coverage. There's still co-pays and all that. A minimum standard is evaluated and set and that minimum is provided for. Everyone else with coverage currently would still keep whatever coverage they have at the rate they pay. This method doesn't change any employement at all, well maybe increases employement in medical and insurance fields for those 40 million more policyholders. This type of fix would catch those falling through the cracks, the uninsured.
Posted by peter at September 18, 2007 07:46 AMHere's my take on why Single Payer would work better for us in the long run.
Posted by Mary at September 18, 2007 08:02 AMWhen my father-in-law got sick, he needed a PET scan in order to determine if he had cancer, and he had another after treatment. He had to travel about an hour to get to a PET scan machine. In Canada, there are (or were at the time, about 4 years ago) only THREE public PET scan machines for the entire country. Ontario doesn't cover the scans at all. People go to private clinics and pay on their own to get them. This is not the direction I want our health care system to go. If the gov't is "the decider" of what gets covered and what doesn't, there's no competition. Then we got politicians saying "if you elect me, I'll cover PET scans" or "if you elect me, I'll make sure your hard earned money isn't used to pay for " I'm just really really against single-payer. I think there are too many unintended bad consequences.
Posted by CG at September 18, 2007 08:31 AMThat should say ""if you elect me, I'll cover PET scans" or "if you elect me, I'll make sure your hard earned money isn't used to pay for (insert whatever procedures conservatives think are evil)".
Posted by CG at September 18, 2007 08:33 AMMedicare as it currently exists is unfortunately less efficient than most people think.
Wrong again.
Medicare is one of the most efficient Federal programs. The problem with Medicare is the coverage threshold is 80% for most services, leaving 20% not covered.
By expanding Medicare to cover 100% of services and not cutting reimbursement to doctors and hospitals, the program could easily provide coverage to all 48 million Americans without insurance.
Posted by Christopher at September 18, 2007 08:35 AMNice essay Mary! Not only is it in the interests of American businesses to get the health care monkey off their backs, you made a good point that almost half of personal bankruptcies are caused by unsustainable health care costs.
The posting of the first reader, Marty, the R.N. was very useful in giving insight to many of the problems with the current system.
I have to disagree with him that the Medicare/Medicaid system was worse than the nightmare he described in dealing with private insurers. He just didn't explain how. Still many good points were made and a single payer system does not have to be government-based only. It may well end up being a combination of public and private administration. Our current system is just unsustainable.
It's obvious that any policy will have drawbacks. What will help is effective management and sensible regulation. Something we've seen nothing of that in the past 7 years.
In my haste to post an answer to requests for information, I forgot to discuss the horrendous problem of liability insurance. Clearly, THAT is another can of worms, but it must be changed in some fundamental ways. This has been a good discussion!
Posted by DeminNewJ at September 18, 2007 08:51 AMMedicare is one of the most efficient Federal programs.
How does that conflict with my statement that Medicare is not as efficient as many people think? It does not. The efficiency of Medicare compared to private insurance systems is often overblown and it's difficult to make apples to apples comparisons. There is a lot of waste in the Medicare system. A lot of money is spent providing treatment to people that provides neither health benefit or improved quality of life to the patient. Simply expanding Medicare as it is is not the answer.
Posted by snark at September 18, 2007 08:55 AMThere is a lot of waste in the Medicare system.
Most definitely, there is! I work with elderly patients as well as the clinicians that treat them and the hoop-jumping has forced both to become experts on the system. The tough part is getting Medicare to pay things that they do cover, but since we're not a provider, rather than force the patient to navigate the system, we send our products to pharmacies that will file everything for them. (and no, I'm not a part of "big Pharma")
Posted by iamcoyote at September 18, 2007 09:35 AMha-ha, the Fed gave into the pressure from the Wall Street moneyboys and gave them the rate cut they had gamed into the system to cut their recent losses. This in the face of spiking oil prices and an already collapsing dollar---this should be interesting!
Foreign capital is foolish to hold dollars that are falling in value, with a central bank that cuts interest rates on the demand of pressed domestic financiers.
This should start the flight of all-important foreign capital from our economy. The meltdown cometh. The days of "affording" universal health care are over.
Posted by euzoius at September 18, 2007 09:36 AMFor all those concerned about "horror stories" about the treatment they get from Medicare. Remember who has been writing legislation like the famous doughnut hole giveaway to Big Pharma and just who has been administering Medicare for the past 7 years.
Don't confuse the current performance to what is has been and can be again. These assclown are ALWAYS trying to convince you that Big Government doesn't work. Well, when they get their greasy paws on the levers of power, they make sure it doesn't!!
Posted by DeminNewJ at September 18, 2007 09:49 AMFACT: Medicare administrative costs are about 2 percent of claims costs.
FACT: Private insurance companies' administrative costs are 20 to 25 percent range of claims costs.
Prove to me how freeing up revenue by reducing administrative costs the way Medicare does is a bad thing?
The savings goes directly into physician reimbursement and patient care.
It's a fairly simple concept to comprehend. Anyone claiming to be knowledgable about Medicare would know the Medicare DRG (Diagnostic Related Group) is divided into four regions that blanket the USA. Often (not always) but often, the reimbursement schedule in the Medicare DRG is higher for than private insurance reimbursement. Keep the physicians happy and they see more patients and provide better care to patients.
Posted by Christopher at September 18, 2007 11:59 AMThe FACT that Medicare expends a significantly lower percentage of it's funds on administrative costs is not at issue. Although there are claims that Medicare's administrative costs are more like 5% but still significantly lower than those of private insurers. And you seem to have dropped out the lower end projections of the private insurer costs which I've commonly seen at 16%. But whatever. The issue is not about administrative costs. It's about efficiency of treatment. And there Medicare wastes a lot of money.
I'm not gonna try to prove anything to you Christopher. Comparing Medicare to private insurers is not an apples to apples comparison with regard to administrative costs or efficiency of treatment. Perhaps you can prove that expanding Medicare to encompass the millions of uninsured will not result in an increase in administrative costs comparable to those of private insurers? I bet you can't.
Posted by snark at September 18, 2007 01:29 PMI'm not gonna try to prove anything to you Christopher.
Of course you're not because you can't. You blather on and on and say nothing. Just hot air and gas. Always hot air and gas.
Posted by Christopher at September 18, 2007 03:54 PMEveryone else with coverage currently would still keep whatever coverage they have at the rate they pay.
That's worked well so far...unless you see how many employers have ended healthcare plans, increasing corporate profits along the way. Think not? Then why does Wal-Mart train it's employees to raid social services? I can't think of a reason...except the massive profits Wal-Mart makes every year.
I'm just really really against single-payer. I think there are too many unintended bad consequences.
You really don't know much about the shitty quality of healthcare in the United States, do you? There is a reason ours is worse than Morocco's. Be really careful what you wish for. You might get it. I can take you to any number of places where CTs, PETs MRIs and As are rationed every day.
Don't know about Canada, but in 1998 there were 75 PET (positron emissions tomography) scanners in the US. Our population -275,000,000 then, yours when you had 5 -25,000,000. You want one at the local Quickie-Mart? Uhhhhhh...are you sure they didn't come here because it was closer?
There is a lot of waste in the Medicare system.
Just think how much of that could be converted to profit!!
I can see where the business model is more efficient. Waste in Medicare is estimated at $12 billion, largely from unscrupulous health care providers fucking old people. Waste in private health care? Nawwww. I wonder how much their advertising costs? Did you know pharmaceuticals are marked up 500,000% over their raw ingredient costs? Let's see, 30% corporate profits on a cost of health care -with 30% profits by the health care insurers- of $2.25 trillion. Ohhhh fuuuuccckkkk, did I forget to say $12 billion was overcharged by doctors providing Medicare and cited as waste? Time to end Medicare. The $2.25 trillion dollar fucking feels good to a few people.
Posted by phidipides at September 18, 2007 10:13 PMJust think how much of that could be converted to profit!!
The fact that it's not profit doesn't make it not waste.
Waste in Medicare is estimated at $12 billion, largely from unscrupulous health care providers fucking old people.
And expanding the system to cover 48 million more people is going to stop unscrupulous healthcare providers from fucking old people AND the poor how? More oversight? More administration? Well, that's gonna start to affect the bottom line.
Waste in private health care? Nawwww.
Never claimed there wasn't waste in private healthcare. Just that expanding Medicare isn't the miracle cure some make it out to be.
Ohhhh fuuuuccckkkk, did I forget to say $12 billion was overcharged by doctors providing Medicare and cited as waste.
No, you did mention it. There's also been studies that show that large amounts of Medicare funded treatments provide little or no health or quality of life improvement to patients. I think that can be considered waste. More oversight? The system has problems.
Time to end Medicare.
Never said anything about ending Medicare either.
The $2.25 trillion dollar fucking feels good to a few people.
Whatever floats your boat.
Posted by snark at September 19, 2007 05:46 AM