AP: Universal Health Care Push Being Revived

[Rose Siding]

COLUMBUS, Ohio -- A push for universal health coverage is being rekindled in some states by the soaring cost of health care and the lack of political support in Washington for federal changes.

Advocates of a single-payer system _ where the government would collect taxes and cover everyone, similar to programs in Canada and across Europe _ have introduced bills in at least 18 state legislatures. Some are symbolic gestures, but heated debate is taking place in California and Vermont.

In Ohio, doctors, union officials and religious leaders are gathering signatures to get a single-payer health system placed on a ballot next year.
....
"There's no other solution out there," said David Pavlick, a member of the United Auto Workers in Cleveland, which has endorsed the Ohio campaign. "The system we have now is immoral, it's foundering and it's on its last legs."
....
Claims that the system would cost less have merit, said John Sheils, vice president of the Lewin Group, a Virginia consulting firm that conducted a study last year of how a single-payer system would work in California. The study found that the state would save $343.6 billion in health care costs over 10 years.

http://www.washingtonpost.com/wp-dyn/content/article/2005/07/09/AR2005070900702.html

[Missy M]

1. I hope something comes of it this time....

I'm going through an illness right now with a family member and the bills are astronomical. If we didn't have insurance it would be all over for us. We still have to pay the deductibles but we have used that up so now we won't have to pick up anymore. Universal health coverage should be the priority in this country right now because everyone deserves the best health care available.

[Rose Siding]

2. The AMA objection is baffling

snip>
BAD MEDICINE? Mainstream medical groups, including the American Medical Association, oppose single-payer systems. The AMA fears they would stifle the development of new medical technology and create longer waits for patient care.

http://www.washingtonpost.com/wp-dyn/content/article/2005/07/09/AR2005070900703.html

They want to develop technology- that we *still* won't be able to afford. And some of us already wait a loooooong time- til enough money's saved- for patient care!

[Missy M]

3. I'm afraid the AMA (doctors) are afraid they won't get the money..

they now enjoy. I'm not saying they don't deserve it but it really is getting out of hand. The doctors are the ones building all the McMansions around here.

[CAG]

9. its all about the money.... follow the money....

any single payer system may reduce the money flowing into physicians hands, particularly specialists

[kodi]

26. actually its the overhead that costs so much in the private sector

federal health programs return about $0.95 directly on patient care, for every dollar spent. in the private sector, the overhead is around $0.15-$0.18 per dollar. that goes to staff and profits for the companies running the system.

figuring about $1.5- $2.1Trillion/year on health care in the US, that dime cost per dollar spent adds up.

[CAG]

28. ...and that doesn't even include any savings from shaving the absurd

20% profit margins of big pharma

[Jackpine Radical]

74. Actually, that's quite an underestimate of the total costs of

the private system.

Consider the bureaucracies that the hospitals & clinics have to have in order to get prior authorizations for treatment, file & track the insurance paperwork, etc. I would bet that in my small outpatient clinic no more than 60% of claims filed are paid timely, accurately & fully, & we have a full-time person who does prior auths, fights the ins. cos. over unpaid claims, etc.

[depakid]

10. Not really- especially if you look at their history

The AMA has traditionally opposed reforms in medicine that would benefit the public when they believed it would hurt their little club/cartel.

Prior to the application of anti-trust laws, the AMA (and various local entities) kept pricing information away from the public and fought various types of competition- to the point of denying doctors priviliges at hospitals- all in an effort to keep the lion's share of the loot in the club.

The AMA as much as any group is responsible for the dismal condition of healthcare in this country.

[SidDithers]

23. Docs were opposed when single payer was developed in Canada...

Tommy Douglas was the Premier of Saskatchewan when the province introduced Medicare in 1961. In 1962, there was a province wide Doctor's strike in Saskatchewan.

"The doctors claimed that the Act would give the government a monopoly on the purchase of medical care which would in turn interfere with their freedom to give the best possible service to their patients. The College proposed that patients should be covered by private insurance companies and that the poor would have their premiums paid by the province."

The Saskatchewan Council of Archives and Archivists has an excellent site with historical information.

Or, google Saskatchewan 1962 Doctor's strike for more info.

http://scaa.usask.ca/gallery/medicare/en_prelude-strike.php
http://scaa.usask.ca/gallery/medicare/en_doc-strike

Sid

[eridani]

25. But they came around later--

--when after the first year their average incomes went up by a third due to all the pent-up demand.

[CAG]

27. evidence-based medicine vs. drug rep bribe-included propaganda

Many of todays docs would be concerned that someone on high will create enforceable guidelines for care derived from evidence-based medicine, which would not allow them to stray far away from the guidelines without careful justification. Then, drug reps wouldn't have the leverage to effectively spew their propaganda and bribes.

[blondeatlast]

35. Not all physician groups oppose UHC.

There is a small, but very vocal and active contingent that supports UHC.

American Medical Student's Association:
http://www.amsa.org/

Physician's Proposal:
http://www.physiciansproposal.org/

Many state nursing organizations are very active as well, none more so than Massachusetts:
http://www.massnurses.org/links/main2.htm

[kath]

59. There's another group, Physicians for a National Health Plan -

http://www.pnhp.org/

[katinmn]

38. AMA members don't necessarily feel that way

generally it's the board of directors that make those statements of support or against something -- and they are mostly old white rich Republican males that have made it to the top of their careers.

I know that the majority of physicians desperately want health care reform.

[Rich Hunt]

68. thank you

I hope this important point does not get lost on people.

Who makes a lot of money off our current system?

Handlers. There is so much fraud in this system that it's unbelievable, and there are a lot of people making piles of money off the flaws in this system, but the doctors take the heat for it. That's because it's easy to scapegoat them, as they're more visible targets.

Wake up, people.

[Conservativesux]

53. The waitng time excuse is bogus. I had to wait three months to see a

urologist and I pay through the nose for an expensive BC HMO policy.

We need universal health care NOW!!!

[bleedingheart]

69. The AMA hated Medicaid and now they love it...

as long as the money comes in they don't care where it comes from.

[lovuian]

4. with costs rising 25% and uninsured increasing its collapsing

States have to do something
Corporations have to do something

People have to do something

it can't keep going on like this!!!

[wildcat78]

33. I won't be able to hire as many dishwashers...

I had a heated debate with my neighbor last night who's an area manager for Macaroni Grill on this subject and other subjects.

His main bone of contention about universal healthcare is that it raises the cost of labor and he won't be able to hire as many dishwasers as he does now. BTW, he hires many non-Americans as dishwashers and cooks for he can get them cheaper than Americans.

I told him that its people like you that are breaking the health care system and encouraging the illigal immigration. His attitude was that Americans don't want to do the job for the wages he's willing to pay.

He told me that this attitude is prevalent across the restaurant industry for the employee's in his industry are more than 50% non native born Americans.

So, I guess we can treat foreigners as second-class citizens. Doesn't that something like slavery...

[TankLV]

49. We had that attitude tried in Hawaii and it was roundly derided

as the bogus claim it was.

The good firms that wanted to pay for bennies for their employees to keep them all LOVED the for.

The forced universal care requirement - made THEIR companies as COMPETITIVE as the others who would normally not provide coverage or any bennies.

It brought down costs astronomically since nobody had to subsidize the emergency room visits and loss of productivity due to seriour illness.

Of course, all that changed with the increased influence of the repukes and pseudo-christians in politics.

[powwowdancer]

5. This is so exciting!

Who'd think that Universal Health Care would even get a back-burner in a fringe rag during a fascist junta's reign of terror? This is the best news since KKKarl Rove was outed for outing Valerie Plame. This is the future, and future generations will judge us by how long we jerk around in getting there. Next we socialize law and then everything should start to level off. Selah.

:dem:
powwowdancer out.

[iverglas]

8. future generations

This is the future, and future generations will judge us by how long we jerk around in getting there.

Yup -- that's why, at the end of a series of public "votes" for a range of candidates (including Pierre Trudeau), and impassioned arguments by their designated advocates on CBC TV, and a number of audience-participation shows (it was entertainment, after all) ...

Tommy Douglas was voted The Greatest Canadian.



His grandson Keifer Sutherland obviously takes after his slightly less geeky dad Donald's side of the family. ;)

As the New Democratic Party (social democrat) Premier of the Canadian province of Saskatchewan a half-century ago, he implemented the public health care system that later became national.

The possibility of initiating a single-public-payer system at the state level in the US is one that should be vigorously pursued, in my outsider's opinion. If Maine would get its system up and running, after several years of dithering now since the electorate voted to establish it, an important first step would have been taken.

[CityDem]

6. It will happen

Big business does not want to fund employee health plans and would rather see the working stiff pay a payroll tax to finance universal health insurance. The repubs will eventually get this message and we will move to a single payer system. However, the rich will find a way to have better coverage through supplemental private plans.

[Vinca]

7. I truly hope we get universal health care here . . . soon.

Every day I worry if this is the day something will happen that I can't afford to pay for.

[lovuian]

11. With these prices NOBODY can afford to pay its ridiculous

Americans want this more than ever and I wonder why Democrats haven't gotten on the band wagon with this issue!!!

With what we paid in Iraq

Social Security Medicare Medicaid would all be seure plus have enough for Universal Health!!!

[area51]

44. "... if this is the day something will happen ...."

Vinca said:

"Every day I worry if this is the day something will happen that I can't afford to pay for."

So do I, Vinca.

And the insane short-sightedness of the nazi party never ceases to amaze me. Universal healthcare is affordable, & will also create a healthier, more productive workforce. And we all know that the nazi party is all about productivity. :evilgrin:

[Vinca]

54. I'm hopeful that when "big bidness" can no longer afford to

provide health insurance for its employees - a reality creeping across America - and they ("big bidness") start squawking to the senators and congress people they've bought and paid for, something, SOMETHING will happen. It has to. Anyone in a position of power in this government should be ashamed every single day they do not discuss a solution to this problem. Sadly, it hasn't been a topic of debate beyond Senator Kerry's health care for kids. I'm happy for the kids, but mom, dad and grandparents need coverage, too. The U.S. of A,, the so-called "richest" country on the planet, has a lousy rating for both health care and infant mortality. It's obscene. But we sure know how to throw a war.

[OETKB]

12. Important Info Source on Single Payer

For 20 years PNHP(Physicians For A National Health Program) have been advocating for a single payer plan. Rather than an activism stance they have been an information source. Check out their website

<pnhp.org>

to bone up on whatever ammunition you need to bring desperately needed reform..

There are two 800 pound gorillas in the room:

1. Distrust of the government.
2. Losing choice through "socialized medicine"

Nether of these issues are insurmountable but to date no one has been able to take the proper leadership to frame what single payer plans are about. However I do agree with the above article that unless we all get involved and let our legislators know we want this problem solved, nothing will happen. Touching private medical care is the non-governmental equivalent of touching the third rail of Social Security.

So my fellow DUers this is an issue(among others of course) worth fighting for. The cost of health care is so out of control it is threatening many aspects of our daily lives. Here in Mass we are also debating Universal Health Care and there is already heated discussion.

[blondeatlast]

41. Are you aware of The Physician's Proposal?

Their proposal is somewhat different, but perhaps a bit more palatable to citizens and physicians (although I prefer PNHP myself).

http://www.physiciansproposal.org/

We need to make DUers aware that there are organizations actively working for UHC.

Thanks for the PNHP cite.

[Lydia Leftcoast]

57. "Losing choice" is a red herring

Under the Canadian and many other socialized medical systems, people can go to any doctor they want.

By the way, when I was covered by Kaiser Permanente, I had an official primary physician but rarely saw her (I think I saw her three times in ten years). Usually, I had to take whoever was on duty when I had a problem. I didn't dislike any of the doctors, nurse practitioners, or physician's assistants that I saw, but I rarely had a choice, and this was with a private HMO.

So the claim about "not being able to choose your own doctor" is bogus.

[classics]

13. The AMA objects because...

most American doctors no longer want to simply treat the sick and make a decent living off it.

They want to be Lords of Medicine and paid appropriately. Thats the problem with capitalism, eventually it can turn even the most noble enterprise into a twisted money game where the participants themselves no longer care about anything but CASH CASH CASH.

[katinmn]

39. Yup. It's not just physicians. It's what our country has become.

The majority of Americans think success is making a ton of money, getting a little corner of power for oneself, and buying more stuff.

[TankLV]

50. Yep - the very idea of doctors' unions is totally ass backwards.

$200-500,000 a year greedy rich fat cats forming a "union" makes me sick.

[raccoon]

70. and after that, they have the attitude,

"I've got mine, to hell with everybody else."

[blondeatlast]

42. Many nurses associations are strongly supportive of UHC.

As someone who has spent way more time in the care of docs and nurses than most, I think you are right on.

I have 2 docs (out of EIGHT) that supposrt UHC, Every nurse I know is strongly in favor.

I think that says a lot--and a lot about the concerted effort to discredit nurses in America.

[reprobate]

43. Many docs WANT UHC.

In conversations with some of the docs who have treated me recently, it's apparently unanimous, at least among these specific docs, that they are completely in favor of UHC.

They see patients every day who lack care or surgery because they are not covered. They do their best to treat them but they are limited in what they can do. It goes against their training and personal goals to not be able to treat people because of the financing involved.

[katinmn]

46. I agree

and I work with a lot of physicians

[OzarkDem]

47. Agree

Most docs would like to see it happen. They're cautious, though, because they don't want a system that interferes with their ability to treat patients.

[RayOfHope]

58. Yep. My sister in law's dad was a dr in Canada

and he moved to the US (and is now a citizen) because he wanted more $.

[Conservativesux]

63. And the specialists I have seen are incompetant boobs. So much

the the quality of life issue with socialized medicine.

The docs in Canada cant be any worse then the quacks here in the US of A.

[niallmac]

14. Doctors aren't the problem and the AMA ain't what it used to be

Look at where the money goes in a multi-payer system and you see a LOT of overpaid bureaucrats. If the AMA objects to a single payer system then they fear losing whatever kickback they receive in the present system. The AMA is an over conservative bunch of disconnected throwbacks who could not adjust to change and so have lots a huge percentage of their membership to new upstart medical specialty societies.
Don't blame the docs en masse knee jerk style in this argument. First of all, you want the best to take care of you and you want them to be rewarded accordingly. The present system honors mediocrity, and disses most MD's if they don't emphasize money over medicine.
A subject this huge necessarily means what I say here is overly simplistic so let me stress the point that the medical providers are not the problem here.

[loudsue]

20. "The AMA is an over conservative bunch of disconnected throwbacks who ..

"The AMA is an over conservative bunch of disconnected throwbacks who could not adjust to change"

Wow, truer words were never spoken!!!

Doctors have NO CLUE what "healing" is about anymore...as a group. I know there are still isolated doctors who really care about "healing" people, and these rare gems are so over-loaded you can hardly get an appointment with them.

The ones who are actual "healers" of people AND who don't try to gouge you for every red cent, are even MORE rare, and precious.

Part of the problem is that lots more medical schools need to be built, and EVERY bright student who is interested in medicine, and has the grades, and has done the background work in school to prove it, should be able to get into a good medical school.

There are people out in the real world who would LOVE to go to medical school and help people, but out-of-this-world tuition, and the lack of openings in medical schools combine to keep out all but the few.... Supply and demand hasn't registered on the medical school community yet.

There are also many therapies that WORK that are considered "Non-traditional", simply because the doctors, and their counterparts in the drug industry, refuse to allow for the fact that other nations DO allow for: every person responds to medicine differently, and just because it's good for lab rats, doesn't mean it's good for EVERY human.

Other countries include herbal, naturopathic, nutrition, and homeopathic studies in their medical schools... all solutions to some problems that help PREVENT conditions that would require taking prescription medication the rest of one's life. But that wouldn't mean a set monthly income for the pharmaceutical industry, would it?

NOOOOOOOOO!

So, we're all stuck with crappy solutions to our healthcare needs, and sometimes die early from the cures prescribed.

It takes ALL KINDS of medicines, and knowledge of cures, in one's medicine bag to treat the whole person back to wellness. Specialists are worth their weight in gold, when they know what they're doing, and are not just using the "latest technique" on every person that walks through their door.

But the dinosaurs who are in the AMA don't want to hear it. Nor do the pharmaceutical companies. But, strangely enough, SOME of the Insurance companies DO!

We need to get HUMANS, and doctors, and the medical schools, and the pharmaceutical companies, and the insurance companies together in one room, and lay down some laws, and get some things moving here.

so sayeth loudsue. so sayeth she. :hi:

:kick::kick::kick:

[Warren Stupidity]

15. Snowball in hell

With the cabal firmly in charge of all three branches of the federal government it it vastly unlikely that we will be seeing universal healthcare in this country any time soon.

[Bleacher Creature]

17. You're wrong about that.

The snowball in hell stands a MUCH better chance.

The thought of the Bushies running this by the Chamber of Commerce and the National Association of Manufacturers is almost laughable. Let's work on getting these guys out, and then there will be a chance.

[Massacure]

34. In the country. But these are being tossed around by individual states.

California has a higher population than Canada does. It would be easy for them to implement a state wide single payer healthcare system and take advantage of bulk orders.

[ret5hd]

16. The REAL problem with universal coverage...

from the insurance industry's point of view...

1) What happens to automobile liability insurance premiums (not covering medical/injury costs)
2) What happens to homeowners insurance premiums (not covering medical/injury costs)
3) What happens to workmans compensation insurance premiums (practically no need for it at all)
4) What happens to medical malpractice insurance premiums (not covering medical/injury costs)

[sled]

21. Hmmm...

They should all be reduced, accordingly???

[ret5hd]

22. well, i think a lot of people would insist on it...

why should we pay the same premium for auto insurance if medical costs are covered by a national health plan?

why should a company have to buy coverage for workplace injuries if everyone is already covered?

etc etc etc

[iverglas]

67. simple answer

(as compared to the long answer in my other post ;) )

why should a company have to buy coverage for workplace injuries if everyone is already covered?

Why should the public have to insure workers against the effects of wrongdoing / negligence on the part of their employers?

Everyone is already covered (e.g. in Canada) for the medical expenses arising from health problems that arise in the ordinary course of life, through no fault of any third party.

There's absolutely no reason why the public should pay for the medical expenses arising from health problems caused by a third party's wrongdoing / negligence.

[shanti]

31. follow the money trail

always.

[reprobate]

45. With the exception of workers comp, the claims of the others have.....

...little effect on premiums. Look at the added premium for each of these things on your policy page. And as for the WC problem, most businesses would be gleeful to be shed of that albatross. As the owner of any roofing company.

[ret5hd]

52. i understand what you are saying, but...

how many automobiles are insured in the u.s? If i remember, it is about 150,000,000. lets say that the medical part of insuring those vehicles is $10 yr. Thats $1,500,000,000 (that's one and a half Billion) a year insurance would lose. Now, i don't know how much the actual charge is per year, but i would guess that $10 a year is low.

Same with homeowners and medical malpractice policies. How many homeowners policies are there? How many doctors are there? After a while, it adds up to real money, doesn't it.?

And I agree that employers would be glad to get rid of WC, but I wasn't postulating as to what the employers of the country would think, but what the insurance industry would think. For that matter, employers would be glad to get rid of health coverage also, which should give us (dems, labor, etc) a clue as to how we should attack this problem.

[reprobate]

62. In part you're right and in part I'm right.

Insurance companies make next to nothing on premiums for these coverages (auto medical and homeowner medical). They barely pay overhead to write the policies. Where I agree with you is that they make their money from investment of the premium, and if the premium income is reduced so will their income, a little, in proportion to the premium reduction.

As far as medical malpractice, I don't see much change coming there, unless the government decides that you lose the right to sue if you're treated by a UMC provider. I really can't see that happening because the docs that would support UMC would not be in favor of their patients losing rights. Sure malpractice coverage needs refining, but that's throwing the baby out with the bathwater.

As far as worker comp is concerned I was involved only from the agent end and not the actuary side, so I really can't give you profit figures for that. But I know the industry when I was involved raked in big premiums on it, so their earnings would have been big in proportion. Of course, I retired from the industry ten years ago, so I'm talking only from my PAST experience.

[iverglas]

66. I'm failing to understand the question ...

In Canada, we have single public payer health insurance ... and also workers' comp programs, automobile insurance, homeowners' insurance, medical malpractice insurance ...

Health care insurance insures individuals against the cost of health problems that arise as an incident of, well, living.

Those other programs insure employers, car owners, homeowners and physicians against the cost to other people of problems that arise as a result of their wrongdoing or negligence.

These are two separate issues.

There is no reason that the public health care plan should bear the burden of costs caused by a third party's wrongdoing or negligence. In the case of health care costs where there is third party liability as a result of his/her wrongdoing or negligence, the actual medical care costs of the individual who has suffered the injury or illness will be covered by the health plan as between the individual and the health plan -- but the plan can be subrogated in any claim made by the individual against the third party. That is, the health care plan could recover the costs of medical care, that the plan had paid on an interim basis, from the insurance of the wrongdoer / negligent third party (or the injured person, in the case of no-fault insurance, I suppose).

So if I am struck by an insured driver (automobile insurance is of course mandatory) and treated under my health insurance, the health plan can recover its costs from the proceeds paid by the driver's automobile insurance. (The subrogation arrangements that exist here are actually somewhat obscure, but the point is that there is no reason why they cannot be made.)

The situation is simply no different from what it would be if an individual in the US with private health insurance were struck by an insured driver, I would think. The private health insurer would recover whatever it had paid out, for medical care, from the insurance proceeds.

There would be no reason to get rid of workers' compensation plans if a universal health insurance plan were adopted. In fact, it would probably be unwise to do so, since that would shift the costs of employers' wrongdoing and negligence to the taxpayers/premium-payers, and there's no reason to do that. Ditto for the other forms of insurance mentioned.

And the insurance industry could go happily along insuring drivers and homeowners (and other property owners) and physicians, and product manufacturers and retailers, and anyone else who might need insurance against the potential health care costs that might be caused by their wrongdoing or negligence.

Those are the private problems of the drivers, homeowners, etc., and there isn't much reason why those costs should be assumed directly by the public.

[leesa]

18. It's the only answer. Managed care has been a disaster.

They MUST control the insurance industry and Big Pharma, however.

[Warren Stupidity]

19. Dem leaders need to get a clue

Cut the crap with the incremental reform approach. Draw a distinct difference between us and them: we are for universal healthcare, they are for more of the same crappy corrupt system. Give people a reason to go to the polls and vote FOR a Democrat.

[halobeam]

29. I don't see being disabled as a repub/dem issue.

Where I am going with this is, how can people on Medicare even afford to pay for meds (20% copay) when they live exclusively on disability? ex: a family of four takes in 1300/month. They pay a 20% copay for all medical, and it begins AFTER a 325./month spendown. There's no money to live on.

If anyone in this position is a repub and STILL voting that way, they are sadly, NUTS. Starvation, illness, deprivation... are not political issues. What fools.

The more simple it is stated, the better the understanding. Dems are for Universal Healthcare, Repubs are NOT.

I agree with you completely.

[stepnw1f]

30. It's A Winning Issue

And a Dem issue for sure. Only a soft cell greedy nut would not think so.

[blondeatlast]

37. Exactly. Incremental approaches will cost FAR more money

and result in horrendous bureaucratic nightmares.

Just sit down and hammer out an UHC proposal with physicians, nurses, patients and present it to the people.

It's clearly a winning issue when some of the US's biggest employers and unions are both beginning to push for it.

[bread_and_roses]

55. YES YES YES...Where are the DEMs???

If they would give people a reason to vote for them...indeed. The political work I do is often among the low-income and disenfranchised. I no longer have the face to go to them and tell them a Democrat is going to make a difference to them.

Please, Dems, give us something to take to people to turn them out to vote.

[applegrove]

24. It works to keep costs down and people healthy. It makes business

more productive and it cuts bankruptcies in half. And then there is people like Andy - who will get to live!

[Mojorabbit]

32. I have only one

worry about it. My hubby is a family physician and we know some docs in hmos who are told what meds to use, how many patients to see an hour, and how to treat patients medically. My hubby is in private practice for that reason. He does not want anyone much less a bureaucrat with no medical background telling him how to practice. People are not cookie cutter made and treatment has to be individualized.

I would worry about gov pulling the same crap. I don't know how it is done in other countries. If gov stays out of the patient care angle it would be heaven. We already pay for treatments,xrays etc for some of his poorer patients as well as meds out of our own pocket and we are by no means wealthy.

[blondeatlast]

36. As a patient, I gotta say for the most part, I can't care about that.

I have had insulin-dependent diabetes since age 7, and the inevitable complications are setting in.

I've been treated on an emergency basis in Canada. There was no need for them to call to get "pre-approval" to treat me, no restriction on care that I'm aware of, and I got as much attention as I've ever receieved from an overworked US doctor--and far more attention from an exceptional nurse (nurses are given the respect they deserve in that system, unlike here, where they are second-class professionals). Sorry--I just generally like nurses better than docs, and I have pkenty of experience with both.

If I lose the health insurance thru my hubby's work, I die--simple as that.

ANY improvement is better than the current situation. I know far too many diabetics like myself who are not getting appropriate care because they have no insurance--these are full time workers too.

Perhaps your husband should look at the Physician's Proposal:
http://www.physiciansproposal.org/

Perhaps also, you should review the long, sad story of our DU friend, Andy Stephenson, may he rest in God's loving embrace.

Keep in mind as well that more and more large employers are seeing the benefits of universal healthcare. When corps like many airlines, Ford and Toyota US are starting to make a stir in that direction, it can't be held back.

I apologize for my anger, but this has to happen soon. If I could offer your husband some advice, I'd say look into the Physician's Proposal--and start thinking about what he will do when UHC is a reality.

I, and I speak for millions, can't wait much longer.

[TankLV]

51. You and your husband get paid very well for what he does.

You live very compfortably.

I'm only concerned about those of us who don't have ANY healthcare or have to choose between food and medicine.

The single payer system would not dictate what you could or could not perscribe - it would ELIMINATE the HMO's, hopefully.

The single payer health care system is the only way.

[iverglas]

56. bureaucrats, medical practice, public payer systems ... and the facts

My hubby is in private practice for that reason. He does not want anyone much less a bureaucrat with no medical background telling him how to practice. ... I don't know how it is done in other countries.

So, I'll tell you. ;)

In the Canadian provincial health care systems, NO prior authorization is required before a physician treats a patient (or orders tests or x-rays, or prescribes medications ...), for example. And there is NO second-guessing of the treatment provided by physicians. ... Unless, I suppose, a physician were ordering truly unusual numbers or types of tests, or providing truly unusual numbers or kinds of treatments ... .

The goal of the Cdn health care plan is to provide health care, not to make a profit by providing health care. Keeping administrative costs down makes sense in a non-profit insurance scheme. The time and energy and money wasted quibbling with professionals about how they do their jobs is just money that could be spent on health care, so we tend to avoid the quibbling.

Physicians are mainly self-employed professionals. Their affinity groups (e.g. the Ontario Medical Association, which is separate from the College of Physicians and Surgeons, the body responsible for professional standards and discipline) bargain the fee schedule, and there may be ceilings on some individual physicians' billings. But there simply is no "bureaucratic" control over their practice apart from that.

Not only are the system's administrative costs significantly lower under those plans -- individual physicians' administrative costs are also significantly lower. Only one insurer to deal with, no account collection problems (whether from insurers or from patients directly), no myriad of procedures to comply with. And no constant fear of being dropped by an HMO or insurer, to interfere with a physician using his/her best professional judgment in treating a patient.

http://content.nejm.org/cgi/content/short/349/8/768

Background

A decade ago, the administrative costs of health care in the United States greatly exceeded those in Canada. We investigated whether the ascendancy of computerization, managed care, and the adoption of more businesslike approaches to health care have decreased administrative costs.

Methods

For the United States and Canada, we calculated the administrative costs of health insurers, employers' health benefit programs, hospitals, practitioners' offices, nursing homes, and home care agencies in 1999. We analyzed published data, surveys of physicians, employment data, and detailed cost reports filed by hospitals, nursing homes, and home care agencies. ... Costs are reported in U.S. dollars.

Results

In 1999, health administration costs totaled at least $294.3 billion in the United States, or $1,059 per capita, as compared with $307 per capita in Canada. After exclusions, administration accounted for 31.0 percent of health care expenditures in the United States and 16.7 percent of health care expenditures in Canada. Canada's national health insurance program had overhead of 1.3 percent; the overhead among Canada's private insurers was higher than that in the United States (13.2 percent vs. 11.7 percent). Providers' administrative costs were far lower in Canada.

Between 1969 and 1999, the share of the U.S. health care labor force accounted for by administrative workers grew from 18.2 percent to 27.3 percent. In Canada, it grew from 16.0 percent in 1971 to 19.1 percent in 1996. (Both nations' figures exclude insurance-industry personnel.)

Conclusions

The gap between U.S. and Canadian spending on health care administration has grown to $752 per capita. A large sum might be saved in the United States if administrative costs could be trimmed by
implementing a Canadian-style health care system.

The authors offered further comment in response to critiques of their article:

http://content.nejm.org/cgi/content/full/349/25/2461

As Sekhon points out, Canada's health care spending is low — 57 percent of the U.S. figure per capita1 — despite universal, nationwide health insurance. Modest differences in net physician income account for little of the cost differential, about 2 percent. However, Canada's frugality has caused shortages of some expensive services. These shortages are overblown in the press, which seldom reports that the rates of most services provided to Canadians — doctor visits, hospital days, immunizations, and even transplantations and hip replacements — are similar to American rates.1 Moreover, the quality of care appears to be similar to that for insured Americans.2

Since the implementation of nationwide health insurance, infant mortality and life expectancy have improved faster in Canada than in the United States.1 Although Canadians may spend too little, they get far better value for their money. A system combining Canadian efficiency and U.S. spending levels, as we have proposed elsewhere,3 would be the world's best.

We disagree with Sekhon that tax-based funding automatically means underfunding. In the United States, government expenditures for health care have expanded faster than private expenditures. Moreover, the government generously supports medical education and research, along with defense contractors and tobacco prices. In Canada, the electorate has recently forced governments to boost health care spending. Government spending can be skimpy or exuberant, depending on who is for it and who is against it.

Someone like a physician would really do well to learn these kinds of facts, since they demonstrate that it can be in the interests not only of patients, but of many physicians -- particularly family physicians -- to reform the existing system in the US.

[Mojorabbit]

64. He is all for a national plan

and has been for years.There would need to be some strong language in the program though to prevent interference in practice for physicians.
One of the above posters stated that anything is better than nothing. I am sure looked at in that way it is true but if you are going to do a job(practice medicine) you want to do it right without shortcuts for your patient's sake.

He did not become a physician to make money. He could probably have made more in business. He is a physician because he wants to help people so this his concern...that he be allowed to do his job well. And... as an aside he does not have health insurance himself. He had a heart attack seven years ago and was dropped from his insurance and cannot get another policy at any price so we know what that is like.

I hope it will finally happen.

[iverglas]

65. well, like I wuz saying ...

One of the above posters stated that anything is better than nothing. I am sure looked at in that way it is true but if you are going to do a job(practice medicine) you want to do it right without shortcuts for your patient's sake.

In the Canadian system -- the one that it makes most sense for the US to look to for ideas, since it is in fact private health care, i.e. provided by self-employed physicians, paid for by public insurance -- there are no such shortcuts required.

Story after story after story has been told at DU by Canadians, about their experiences with our health care system. I have talked about my experience with my father's terminal illness, and my partner's diabetes. No shortcuts taken, or imposed. None. In the last month alone, my partner has seen his family physician, a diabetes expert, a nurse practitioner (for instruction on insulin injection -- although he was diagnosed with diabetes when nearly 50 years old, it now appears that he actually has Type I) and an ophthalmologist (whom he will see again once the insulin has reversed the effects of his recent high blood sugar). Our plan *doesn't* cover his meds and supplies, since we are not low-income and do not have private supplemental insurance (I'm self-employed ...) and our province does not have pharmacare. But they will cost about $140/3 months, which I suspect is less than in the US, as a result of a different govt program, under which the govt negotiates drug prices with the pharmaceutical companies for the benefit of all Canadians.

And surely there is a point at which it is the patients' decision whether they would rather have something than nothing, even if those are the options, which there is no reason for them to be.

As shown in the article abstract I quoted (which I hope you read, and maybe passed on to your husband, who would likely have access to the entire NEJM article), there is no reason why there should be any shortcuts if the US adopted a public-payer system and continued to devote the same level of resources to it as are now spent.

He had a heart attack seven years ago and was dropped from his insurance and cannot get another policy at any price so we know what that is like.

In a public payer system, this simply DOES NOT HAPPEN. There are no "pre-existing conditions", no uninsurable people. Health insurance is a benefit of membership in the society and is provided in return for taxes paid, no matter how much an individual pays in taxes him/herself ... like access to roads and public schools and clean drinking water.

[cap]

60. I have used socialized medicine in Japan and France

they are both two tiered systems... There is a private supplemental insurance offered so that people can have private doctors doing their own thing. It's just that the basics get covered for everyone.

[eridani]

71. Global budgeting takes care of that

Here, Medicare and Medicaid use the same nitpicky individual case analysis to control costs that private insurance uses. In Canada, yearly operating and capital budgets are determined for regions, and decisions about how to stay within budget are up to the locals. In other words, if providers try to game the system, they take money directly out of the pockets of their colleagues, who tend to notice and put a stop to such things.

It's exactly like the problem of controlling the movements of a herd of cattle. Canada does the sensible thing and metaphorically puts a fence around them, allowing them free movement within. We hire a bunch of cowboys to control individual cows with sets of personal reins.

[blondeatlast]

40. The Physician's Proposal for universal coverage:

http://www.physiciansproposal.org/

From the executive summary (I very much agree with the part I bolded):
But an NHI could both expand access and reduce costs. It would squeeze out bureaucratic waste and eliminate the perverse incentives that threaten the quality of care and the ethical foundations of medicine.

Here is the proposal itself:
http://www.physiciansproposal.org/

Other orgs supporting UHC:
American Medical Student's Association (AMSA)
http://www.amsa.org/

No Free Lung\ch (an organization that seeks to draw attention to one of those "perverse incentives that threaten the quality of care and the ethical foundations of medicine."--possibly one you, as a patient, are completely unaware of:
http://www.nofreelunch.org/

[OzarkDem]

48. Physicians are more in agreement

than disagreement w/ single payer plans and universal health insurance. They have the quality care concerns mentioned above.

The big barrier is the private insurance companies who have and will continue to spend hundreds of millions to stop it.

[bvar22]

61. You want Universal healthCare?

Then support the PDA (Progressive Democrats of America), and Dennis Kucinich.

http://pdamerica.org/index.php

The Republican Wing of the Democratic Party will try to kill it.

[sintax]

72. kick n/t

[Sgent]

73. Some doctor's are getting rich (I guess)

But most of your Internal Meds, General Surgeons, Family Physicians, Pediatricians, and OB/GYN types haven't had an increase in salary for 20 years.

A FP/Internal Med in my community makes 80-120k a year -- after 7 years of grad school. Peds makes about the same, OBs about 200 and decreasing, and Gen Surgeons anywhere from 200-300k.

Given the work environments, training, and amount of work put in, to insinuate any of these people are getting rich is assinine. BTW, the above specialties make up the vast majority of medicine.

I think if someone could convince them that universal care would both pay them a reasonable wage, and provide health care, most would support it. The see Medicare & esp. Medicaid as the eventual outcome of a Universal Healthcare, and are rightfully worried.