SINGLE PAYER IS THE ONLY HEALTHY SOLUTION

[Gaspar]

White House (CNSNews.com) - Two days after President Barack Obama told the American Medical Association that in some countries a single-payer health care system "works pretty well," the White House reaffirmed that people in those countries liked their health care, but also said it did not know to which countries the president was referring.

"I don't know exactly the countries. I think if you talk to the people in the countries that have that system, they think their health care is pretty good," White House Press Secretary Robert Gibbs told CNSNews.com Wednesday during the daily press briefing.

Asked again if he knew specifically which countries, Gibbs replied: "I assume Canada, Britain, maybe France. I don't know the exact countries, but again, I don't think the president is going way out on a limb that some people in other countries have a health care system that they like. Just as some Americans like the health care system that they have."

Enough evidence for me.  Lets do it!

What you seem not to understand is that health care is already subsidized. (As are FedEx and UPS WRONG)

And you have yet to explain how exactly single payer would result in poor medicine, or how it's possible to be a larger economic failure than the current system which is bankrupting employers. FRANCE, CANADA, MEXICO, BRITAIN, AND SEVERAL 3RD WORLD COUNTRIES. You are correct in mentioning that the current system is bankrupting employers.  It should have never been an employers responsibility to provide medical care to employees.  The insurance companies and administrative organizations have become predatory and speculative as a result.

And how it could wreck the economy by reducing the overhead expenses of healthcare, which would actually be good for the economy, again, by reducing the costs of businesses here in the US.  THE OVERHEAD SHIFTS TO GOVERNMENT.  It does not disappear.  Government has never streamlined anything.  What was a ridiculous private health insurance system, will become a goliath government bureaucracy.  Government has no capacity for cost controls on itself.

The system will require feeding, and that feeding will come from taxation, so the burden shifts and becomes larger.  The government will need to reduce the perceived financial burden in order to pay for the product.  This will be done as it has in every single country that provides a socialized medical system.  By health-care rationing, reductions in quality and availability of diagnostics, and a simplified formulary.

Again, I ask for a single government run enterprise that is self sustainable or even moderately efficient?

Why don't you just say "Well this will be different." . . . and be done with it?

[we vs us]

That quote made my day. 

Nathanm, My point was to respond first to the assertion that the USPS is an example of a profitable government run industry, and then second was to respond to the strange idea that the USPS was somehow not subsidized.

I have done both, and am still waiting for an example of ANY industry run by the federal government that is functional under normal market circumstances.  If anyone can provide an example then perhaps we can look at the model and apply it to how the government might treat healthcare.

But then again, I think that the exercise is probably pointless, people don't care if the system produces poor medicine, wrecks the economy, or fails economically.  The people want a pony damn it!. . .and they want that pony now!

You're making some weird assumptions.  Government typically provides services that wouldn't be supported by pure market conditions.  For instance, private health insurers have no true incentive to provide affordable healthcare to the elderly, the sick, or the poor.  There's simply no profit in it.  Government steps in and provides those services because they are 1) necessary to a functioning society and 2) a moral and good thing.  But of course it will happen at a loss.  This is why government can never function the way you want it to -- as a business.  It is inherently concerned with things the private sector can or will not. 

But Gaspar for all this kvetching that you're doing about how government simply can't do anything right ever for anyone, I haven't heard one alternative from you.  You're one of our resident free market evangelists, so I'm curious as to what you think the free market solution is when the free market has succeeded in distorting itself? Will somehore MORE freedom and MORE money in the system encourage change?  Or will it just encourage more of the same?

[FOTD]

Gaspar is not familiar with the success of Medicare. %95 approval rating by all involved. So, there.


Here, jump on this! http://www.michaelmoore.com/words/latestnews/index.php?id=14090

[nathanm]

Medicare's overhead is significantly less than that of private insurers. There may be an issue regarding fraud, but that's a lack of political will and funding to pursue it aggressively. I haven't seen any statistics on fraudulent private health insurance claims, so I can't say how that compares.

Additionally, you seem to be discounting the excess overhead inside the doctor's office that comes from having a hundred different insurance plans to bill, thus requiring several employees just to deal with submitting claims. While Medicare is not perfect in this respect, it does require less management from the provider end than a hundred different private insurers.

And all that is before taking into account the savings inherent in eliminating the profit in the basic health insurance product.

As I've said repeatedly, I think it would be a fine idea to have private insurance to pay for "upgrades" like private rooms and whatever else. The single payer system should be there to provide basic care for everybody. People should no longer have to make a choice between insurance and the mortgage. The entire concept of bankruptcy due to medical bills is just sick.

[Gaspar]

But Gaspar for all this kvetching that you're doing about how government simply can't do anything right ever for anyone, I haven't heard one alternative from you.  You're one of our resident free market evangelists, so I'm curious as to what you think the free market solution is when the free market has succeeded in distorting itself? Will somehore MORE freedom and MORE money in the system encourage change?  Or will it just encourage more of the same?

Thanks for asking.  The cost of todays medical care is easy to trace.  Remove the smokescreen from the left, and the protectionism from the right and just look at the problem for what it is.

The insurance company used to compete for YOUR business.  You payed a reasonable price for insurance, or you paid a reasonable cash price to your physician. 

The insurance company asked you questions, "do you smoke?", "do you drink?", "Exercise?"

Your cost for insurance was based on your lifestyle and incentive existed for you to be healthy.  Incentive also existed for the insurance company and your physician to keep you healthy.  If you were unhappy with care or with coverage you fired someone, the physician or the insurance company.

This kept costs low, and coverage options competitive.

Enter the "benefits" system. 

Companies want competitive advantage.  There are two ways to do this:
1. The honest way, by offering a better product or a better price.
2. The dishonest way, by removing competition through elimination of choice.

Insurance companies who had for years offered corporate packages for executives learned that if they expanded that system to include entire workforces they could essentially eliminate individual choice and gain complete control over price and profit.  Of course this would require the elimination of individual medical history evaluation, or at least a narrowing of the gap between what the healthy insured and the unhealthy insured pay.  So they would just cover the risk by charging everyone a little more, and since the employer was paying for the bundle, collections would increase.  Good for insurance companies, good for workers, good for employers right?

Physicians who used to choose what insurance companies they would accept were slowly pushed into signing on with these huge blocks of employee benefit plans.  It was either that or lose patients to younger doctors who were willing to accept the cut rate prices and limited formulates that the insurers began to dictate.  They had to see more patients, and provide more limits on care in order to cover costs.

The insurance companies learned that they now had control over the doctors and hospitals.  This power to squeeze prices forced the market, naturally, to inflate in other areas.  Over time this inflation of course came back to the insurers who simply raised rates and squeezed prices harder. 

Physicians were driven towards specialization as a means to increase their marketability.  This too caused increased costs.  The family doc no longer set bones, read x-rays, and in some cases even cared for patients admitted to hospitals.  This limit on diversity also increased costs.

Today, the physician, the hospital, and the pharmaceutical companies are in "un-natural competition" with each other because they are controlled and regulated by insurance companies with limited (or no) market threats.

You can look at it this way.  If your car insurance company had the power to dictate what car you could drive, and what fuel you could use, and what tires you could drive on,  it would result in unnatural competition between companies like Ford, Michelin, and Phillips 66.  Situations like this will ALWAYS result in inflated costs on one side of the teeter-totter as prices are controlled on the other.  Now that's a pretty ridiculous analogy.  Your auto insurance would never have such power, right?   

What if your employer, or the government provided your auto insurance?. . .

This is not rocket science.  Remove the monopolistic forces and you fix the system.  Only works 100% of the time.

[nathanm]

So what, you want HSAs? You honestly think that people are going to bargain the prices for their bypass surgery?

Maybe this article has a piece or two of the puzzle. A large part of the problem may be doctors recommending (or patients demanding) unneeded tests and procedures when in fact the best thing to do might be to send the patient home with instructions to come back if the problem gets worse.

When doctors decide to be businessmen first, of course they're going to recommend whatever course of action makes them the most money when there are two reasonable alternatives. Between the 20% overhead at private insurers and the overuse of surgery and other expensive procedures, it's no wonder costs are spiraling out of control. No amount of patient control is going to fix that. Patients simply aren't in a position to negotiate.

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=all

And of the industrialized nations, which on this map has the highest per capita expenditure and the worst outcomes? Which one spends out out of every six dollars it earns on health care?

[Gaspar]

So what, you want HSAs? You honestly think that people are going to bargain the prices for their bypass surgery?

Maybe this article has a piece or two of the puzzle. A large part of the problem may be doctors recommending (or patients demanding) unneeded tests and procedures when in fact the best thing to do might be to send the patient home with instructions to come back if the problem gets worse.

When doctors decide to be businessmen first, of course they're going to recommend whatever course of action makes them the most money when there are two reasonable alternatives. Between the 20% overhead at private insurers and the overuse of surgery and other expensive procedures, it's no wonder costs are spiraling out of control. No amount of patient control is going to fix that. Patients simply aren't in a position to negotiate.

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=all

And of the industrialized nations, which on this map has the highest per capita expenditure and the worst outcomes? Which one spends out out of every six dollars it earns on health care?

You don't get it. . .but not because you don't understand. 
Recognize the basal cause, remedy it, and you eliminate these layers of effect. 

We can all see the results of the current system and perhaps even forecast future problems, but until we fix the actual problem, we will continue to finance an unsustainable expansion of cost.  If we allow the government to pay for it (US paying for it through force rather than choice), we seal off any possibility of control, outside of reduction in quality or quantity.

But, this is a moot point.  The two bills have now been recognized as producing an unacceptable expense even to insure a third of the population and will be allowed to silently die. 

We can now focus on fixing the system by removing the controls that the insurance industry has put on individuals and doctors and returning choice of care to the individual.  Unfortunately trust laws were never written to anticipate such monopolistic practices on behalf of an industry, but perhaps now that we recognize such, they may be amended (tung-in-cheek, you can't take a free pony away). 

Reason, again, will lose to pander.  A new plan will be hatched, and then another.  Political diving boards, each one higher than the last.

[FOTD]

Medicare for everyone? Why not?

[FOTD]

"Public Option" is a disgusting idea - a dumping ground for the sick to boost health mafia profits.

We can easily afford the best and we deserve the best - Single Payer - nothing less.

[nathanm]

We can now focus on fixing the system by removing the controls that the insurance industry has put on individuals and doctors and returning choice of care to the individual.  Unfortunately trust laws were never written to anticipate such monopolistic practices on behalf of an industry, but perhaps now that we recognize such, they may be amended (tung-in-cheek, you can't take a free pony away). 

Reason, again, will lose to pander.  A new plan will be hatched, and then another.  Political diving boards, each one higher than the last.

The choice of care is never with the individual. It's with the doctor. Unless you have a cold or some other minor issue you probably shouldn't even be bothering a doctor with. You seem to be under the mistaken impression that it's even possible for there to be a rational free market in essential health care. Insurance company policy (aside from certain abusive practices) is not the source of the problem.

Interestingly, 70% of the US population wants the public option and over half are willing to pay more taxes to get it. Even half of Republicans want the public option.

Not that I think it's worth a damn.

Your ideology seems to be leading you towards the idea that there is one root cause to the cost of health care spiraling out of control, but there's not. There are several different issues all at work here. Insurance company and doctor overhead in dealing with so many payers, artificially restricted supply of physicians, advertising budgets out of control at the pharmaceutical companies, and all sorts of other issues are at play. One big one is the lack of a real social safety net in this country. There is a strong correlation between low socioeconomic status and diabetes, heart disease, hypertension, and stroke, even amongst those with similar diet and exercise habits.

Insulation from the cost of health care is pretty low on the list, as people tend to do what their doctor says, and if their doctor orders expensive tests that aren't really necessary to a diagnosis, most people will have them done without a second thought, insurance or no. I don't know about you, but if I have a heart attack, I'm not going to be in a position to negotiate with the doctors over fees or demand that the ambulance take me to a different, less expensive, emergency room.

[Gaspar]

The choice of care is never with the individual. It's with the doctor. Unless you have a cold or some other minor issue you probably shouldn't even be bothering a doctor with. You seem to be under the mistaken impression that it's even possible for there to be a rational free market in essential health care. Insurance company policy (aside from certain abusive practices) is not the source of the problem.

Interestingly, 70% of the US population wants the public option and over half are willing to pay more taxes to get it. Even half of Republicans want the public option.

Not that I think it's worth a damn.

Your ideology seems to be leading you towards the idea that there is one root cause to the cost of health care spiraling out of control, but there's not. There are several different issues all at work here. Insurance company and doctor overhead in dealing with so many payers, artificially restricted supply of physicians, advertising budgets out of control at the pharmaceutical companies, and all sorts of other issues are at play. One big one is the lack of a real social safety net in this country. There is a strong correlation between low socioeconomic status and diabetes, heart disease, hypertension, and stroke, even amongst those with similar diet and exercise habits.

Insulation from the cost of health care is pretty low on the list, as people tend to do what their doctor says, and if their doctor orders expensive tests that aren't really necessary to a diagnosis, most people will have them done without a second thought, insurance or no. I don't know about you, but if I have a heart attack, I'm not going to be in a position to negotiate with the doctors over fees or demand that the ambulance take me to a different, less expensive, emergency room.

That is the point we just have to disagree on.  I do see the root problem as the cause for all of the above mentioned.  Patients frequently used to acquire a "second" opinion and physicians had no problem, some even recommended it.  They were a well functioning, self policing peer group. 

Don't act like insurance companies are some how responsible for advances in medical care or practice.  No idiot is going to swallow that.

It's so easy to fix the problem, but what have become gargantuan lobby groups and butter baked politicians will never let that happen. 

So, since we won't be allowed to fix the problem, how can we wash our hands of it? 

If we allow it to continue in it's current state, we break the bank and put negative strain on the economy, but the lobbyists will be happy.

If we nationalize  we may be able to cover the population for around 4 trillion dollars over 10 years with some rationing and reduction in care and certainly formulary.  We will need to get the pharmaceutical companies to reduce the money they charge by a significant percentage.  Last week they agreed to this by eliminating much of their R&D budgets.  So we will have fewer new drugs and treatments for disease, but the existing medications will be cheeper.

A fairly significant tax increase will be necessary to finance the system, and it will be President Obama's job to convince the american people. 

Unfortunately the systems President Obama used as examples during his campaign, Canada, Britain, and France are now experiencing a rather strong degree of resistance brought to light by the vary discussion of the United States nationalizing.  Why?  (hint: the answer is hilarious)

With the congressional rape over the last quarter, I doubt that the President will have any support for more debt.  We can't see over the mountain he has already made, and until the people see a working system demonstrating some result from stimulus action and other congressional project slinging, he is walking a thin wire.

What he needs now is a catastrophe, an attack or a natural disaster to turn attention away from this or it will certainly become his albatross.  Heaven forbid, and I pray it doesn't happen, but strategically it is his best out.

[Cats Cats Cats]

Yeah, they dropped their R&D department dollars down.  But they still spend 50x their R&D budget on TV Commercials.

So how about we just make it illegal to advertise drugs on TV/Print that aren't directed at Doctors.  Then they will have plenty of money for R&D.

[Gaspar]

Yeah, they dropped their R&D department dollars down.  But they still spend 50x their R&D budget on TV Commercials.

So how about we just make it illegal to advertise drugs on TV/Print that aren't directed at Doctors.  Then they will have plenty of money for R&D.

Exactly.  They are in an un-natural competition with physicians and insurance companies. . . using the patient to pressure changes in the approved formularies.

It's disgusting.

[FOTD]

Exactly.  They are in an un-natural competition with physicians and insurance companies. . . using the patient to pressure changes in the approved formularies.

It's disgusting.

Recall the days prior to Big Pharma telling you to get hard on teevee?

It is beyond the pale. Prescriptions abound. And pharmecutical addiction is rampant. You just don't hear much about it. The docs get their kickbacks by keeping it all "private" with their patients.

[nathanm]

That is the point we just have to disagree on.  I do see the root problem as the cause for all of the above mentioned.  Patients frequently used to acquire a "second" opinion and physicians had no problem, some even recommended it.  They were a well functioning, self policing peer group. 

Sure, I'm going to get a second opinion about the precancerous wart on my shoulder or whatever, but the most expensive medicine is done when there is no time for second opinions, often when when patient is unconscious. That's why it's a mistake to pretend the patient has total control, much less the power to fix all the problems.

You really think that if there were no formularies, drug advertising would be reduced?!. All that will do is increase the incentive for the drug companies to spend money on ads.

Additionally, I don't think the reason medicine used to cost less is due to second opinions. More expensive testing procedures are a more likely culprit. In the 60s, the tests they order today simply didn't exist, so doctors had to rely more on experience and instinct, which comes at no additional charge.

The main point I'm trying to get across, apparently not very effectively, is that the patient can help keep prices down on time-insensitive elective procedures. Cosmetic surgery, for example. There is an entire other class of medicine where the patient has no power whatsoever, and even when they do have choices to make, they may well be far too shocked to make good decisions. Most people, when someone tells them they (or a family member) are dying, are not in a position to make intelligent decisions regarding health care. In this country we seem to have a fetish with prolonging life, even at the expense of quality of life.

I'm not saying the government or anybody else should step in and say "no more," but our health care expenditures would be significantly reduced if we'd let people die when it was their time rather than keeping them half alive for months on machines in the ICU.