Single payor health insurance, how would we do it?

[Bread and Circus]

I agree with many of you that it is the goal.

Many here seem to act like it would take a snap of the
fingers.

I would like to ask folks what time frame and implementation
schedule they think would work.

At a fundamental level, I think a lot of folks are right
on this but I don't get the sense anyone really would
know how to tell apart a sound plan from an unsound one.

It is my opinion that National Single Payor insurance
would take a huge bipartisan commitment, trillions of
dollars in governmental spending, and 12 to 20 years
to transition.

[alexwcovington]

1. Huge lies

Because it really is a snap of the fingers. Once you make the decision, all you need to do is herd the assets of all the various HMOs into Medicare and cut adminstrative postitions to the bone.

Congratulations. Single-payer health insurance.

Now as for covering EVERYONE... that might take some additional effort to come up with eligibility rules... but there is enough money out there that it can be done, while still cutting the fees to the people who do have to pay.

[DisgustipatedinCA]

2. Take it OUT of the hands of the insurance companies

I don't pretend to know all of the nuts and bolts, the mechanics required, but I do know that all profit and decision-making needs to be taken away from insurance companies, or they'll just keep jacking up premiums year after year, until their profit margin is right back to where it has been.

Nationalize it. I'm not sure where you come up with the trillions of dollars and I'm not in a position to argue with you, but it is my belief that you could take what we've spent on the Iraq war this year and pay everyone's nationalized health care for a year. I also wouldn't have a problem with taxing the upper brackets and large corporations. After all, the corporations should be happy to pay this tax, since they'd be saving a boatload on what they used to pay for their employees' premiums.

[quaker bill]

3. Read "The Two Percent Solution"

It is in there.

[Zorra]

4. Dennis Kucinich wants to phase it in over a 10

year period.

The Kucinich plan is enhanced 'Medicare for All' -- a universal, single-payer system of national health insurance, carefully phased in over 10 years. It addresses everyone's needs, including the 40 million Americans without coverage and those paying exorbitant rates for health insurance. This approach to healthcare emphasizes patient choice, and puts doctors and patients in control of the system, not insurance companies. Coverage will be more complete than private insurance plans, encourage prevention and include prescription drugs.

Health care is currently dominated by insurance firms and HMOS, institutions that are more bureaucratic and costly than Medicare. People are waiting longer for appointments. Fewer people are getting a doctor of their choice. Physicians are given monetary incentives to deny care. Pre-existing illnesses are being used to deny coverage.

Over time, the Kucinich plan will remove private insurance companies from the system -- along with their waste, paperwork, profits, excessive executive salaries, advertising, sales commissions, etc -- and redirect resources to actual treatment. Insurance companies do not heal or treat anyone, physicians and health practitioners do ...and thousands of physicians support a single-payer system because it reduces bureaucracy and shelters the doctor-patient relationship from HMO and insurance company encroachment.

Non-profit national health insurance will decrease total healthcare spending while providing more treatment and services -- through reductions in bureaucracy and cost-cutting measures such as bulk purchasing of prescriptions drugs. Funding will come primarily from existing government healthcare spending (more than $1 trillion) and a phased-in tax on employers of 7.7% (almost $1 trillion). The employers' tax is less than the 8.5% of payroll now paid on average by companies that provide private insurance.

This type of system -- privately-delivered health care, publicly financed -- has worked well in other countries, none of whom spend as much per capita on healthcare as the United States. "We're already paying for national healthcare; we're just not getting it," says Kucinich. The cost-effectiveness of a single-payer system has been affirmed in many studies, including those conducted by the Congressional Budget Office and the General Accounting Office. The GAO has written:
"If the US were to shift to a system of universal coverage and a single payer, as in Canada, the savings in administrative costs (10% to private insurers) would be more than enough to offset the expense of universal coverage."

Over the years, groups and individuals as diverse as Consumers Union, labor unions, the CEO of General Motors, the editorial boards of the Atlanta Journal-Constitution and St. Louis Post Dispatch, and Physicians for a National Health Program have endorsed a single-payer approach. It is sound economics -- what actuaries call 'Spreading the Risk' -- to extend Medicare to younger and healthier sectors of our population, thereby putting everyone in one insurance pool. It permanently saves and improves Medicare, while eliminating duplicative private and government bureaucracies.

http://www.kucinich.us/issues/issue_universalhealth.htm

[Yupster]

11. Why should health care be paid for by employers?

Why not just pay for it out of gneral revenues?

Is there any reason why health care and employment are tied together currently other than it's been that way for 60 years?

[snoochie]

14. Precedent?

Employers and employees have been funding healthcare all this time.

And note that Kucinich's plan doesn't 'tie' healtchare to employment the way it currently is. No more than your medicare is 'tied' to your employment.

[Yupster]

19. So it's because that's the way it's been done?

I wonder what RFK would say about that?

BTW it's important to me because I own a very small business and I do not have health insurance for my company.

A 7.7 % tax added on top of my income tax and my self-employment tax (15 % FICA and medicare) would put me right at 50 %.

I'm thinking of closing my franchise and going to work for a company right now. That would pretty much close the deal for me.

[liberalhistorian]

5. There would be a lot less expense involved, since

you'd totally cut out the profit-hungry bottom-feeding insurance companies and the HMO's, and doctors and hospitals would no longer have to spend a substantial amount of their profits on billing and insurance paperwork. The only people besides the insurance companies that would be screaming would be the ruthless, bloodsucking medical collection agencies, who make tons of money off of the suffering and misfortune of others.

[Booger]

6. off topic, slightly

Why are so many people against this?
Where is the down side?
I'll admit that I'm not well read on the issue and have ridden the HMO train up until this year, when the cost of the same scrip goes from 8 to 30 dollars.

Doctors would still be compensated just as they are now, correct?
Do people perceive this as some situation where there will be 8 hour lines outside the Dr's office?

[berry]

17. Yesterday I was venting about my monthly individual health

insurance premium jumping to $800!!! and a guy I didn't know sympathasized until I said I wanted single-payer, universal health care in this country. He was very nice about it (if a little condescending), but said that for families with special health needs/problems it would mean loss of the kind of care they needed. I hated to ask what his family's problem is, but I do wonder how many people in the present system think they are on to a good deal, and hate to risk the change? I'm pretty sure that his concerns could be addressed in a universal-care plan, but he seemed totally closed to the idea. Just because I'm lucky enough not to have a chronic or catastrophic health problem (yet), I don't want to minimize the fear of families that have that to deal with--though I think they are wrong to fear the change.

If you haven't already heard of this group (see below), check it out--about 5 former Surgeons-General are on board, and about 9,000 doctors have signed on. I think patients (like us) should let our doctors know about this group. It could become a powerful force for change. I hope.

http://www.pnhp.org/

Physicians for a National Health Program - Health Care is a Human Right

[LearnedHand]

24. I have a friend whose son has cystic fybrosis...

...and he cannot EVER get ANY private coverage for his son, who will eventually need a lung transplant. My friend's son is fully, completely covered under a state-implemented single-payor insurance plan, and his son never lacks for the medical treatment he needs -- even if it is unusual, multiple surgeries, etc. He gets any specialist he needs, when he needs it.

[Wapsie B]

26. Because for one thing

insurance companies spend a bundle every year in PR campaigns giving everyone the warm and fuzzy feeling about being with their company. Wellmark Blue Cross Blue Shield has the schpeil down pat.

These insurance companies will not go down without a fight. They feel threatened by the thought of a single payer system. It'd be like going down to the local Mafia boss and telling him to find another way to make his $$$. It ain't gonna happen without some blood being spilled.

[JanMichael]

7. Hate to say it but look to France.

"It is my opinion that National Single Payor insurance
would take a huge bipartisan commitment"

Yes, of course.

"trillions of dollars in governmental spending"

Um...Have you ever looked at other nations and their spending? 14% inflation here, 9% in France. $2,800 per person, per year, 100% covered in France; $4,400 per person, per year, minus 43,000,000 uninsured. Plus is it any different than 2x (assumption) the private expendature?

"and 12 to 20 years to transition."

Why not expect more? Have some confidence?

[JanMichael]

8. Better yet look at this...

http://www.csmonitor.com/2003/0813/p03s01-ussc.htm

Can't freakin' BELIEVE I just linked a CS Monitor article....

[smallprint]

9. If we can put a man on the goddamn moon,

we can get everyone in America health insurance.

Every 1st world country has it.

Cuba has it, and they are under embargo, for chrissakes.

It's not our job to figure every last detail out-- we have a right, as human beings, to have access to health care. Period.


Although I admit I have no idea how we're going to get from here to there!

[snoochie]

12. There ya go!

It's not like it's rocket science... :)

I think Kucinich's plan seems workable. Carol has also looked closely at single payer systems and thinks we can do this.

I can't help but wonder - isn't it to the point yet that we must? What will it take before we get fed up enough to demand change?

I think it's horrid that other countries have this, but we're told we can't. We can, and we will... the question is, when do we want it?

We're paying so much and so are employers, and that's helping to chase jobs out of this country.

How long are Americans going to accept the excuses for staying with a completely broken system? So many people have nothing, but it's still costing us an arm and a leg... this makes no sense.

[nbsmom]

10. You're heading in the right direction.

Single payor doesn't have to be a holy grail, but it's definitely no snap of the fingers. (I try to remember that a lot of the people who write that it should be were probably in elementary or middle school when Hilary was first crafting a single payor plan.)

I'm not entirely sure, but it seems to me that the Canadian plan started in the late 60's, and it really wasn't fully up and running for about 12 years...so your window might just do it.

Of course, it would help if we had a better safety net in the meantime, which is why Dean's plan to use the existing payor Medicaid (on a state-by state basis which makes it both more manageable and accountable) seems to be a sensible stopgap.

I also like the idea of keeping the programs at the state level, because for better or worse, that's how they do it in Canada. You're just not as responsive to the needs of Californians or Hawaiians if you're hunkered down in D.C. Look at existing programs like CHiPS: they add no value and ultimately shortchange the kids. (Definining what is poverty or near-poverty should be a very local and ongoing effort, and the people involved need to be accountable, otherwise you continue to get lame-ass Medicare reimbursement tables...which I'm sure I don't have to tell you about, familydoctor.)

Kucinich's plan, while well-intentioned, has the innate flaw of being an extremely tough sell, plus a HUGE waste of the current resources available in the current system (e.g., the Kaiser model, and the not-for-profit health plans). Remember, some things do actually work better in a free market system...healthy competition tends to develop and evolve responsive solutions. (In a million years, do you think Medicare would have gotten around to developing chronic condition programs for people who live with diabetes, asthma, etc....they don't even have an Rx benefit, for crying out loud.)

I admire the work and thought behind Gephardt's plan, and wish that I thought he had something in the way of political capital...Not sure if it's workable, since it seems to be trying to bite off a little more than can be safely chewed at one sitting...we don't need another think-tank solution, just small steps to get us going on the journey.

I'm starting to think that consumer-driven health plans might be the way to go, if only to make sure that people are actually realizing that it's their $$ that's on the line. CDHPs have the advantage of making sure everyone can be covered (with all the writeoffs and yadda yadda), but the individual basically determines their own level of benefits and buy-in, instead of leaving it in the hands of their employer. CDHPs are also more portable and flexible (imagine how much $$$ we'd save if we could blow off 'open enrollments' for example.)

Yes, weaning folks off the 'group underwriting' model that exists today might look less than doable. But the ultimate goal is to provide everyone with comprehensive, affordable health plans that will still work even if you - God forbid - actually get sick.

[no name no slogan]

15. But there still is SOME competition

The system provides a SINGLE, government-run insurer, delivered by existing private physicians, clinics, hospitals, etc. The only thing that would go away would be the profit-mongering medical insurance companies.

Many major insurers are also leaving the medical insurance field because of the high risk and expense of maintaining membership roles. They are getting increasingly selective in who they cover, and therefore must charge higher fees and assume more risk to provide this coverage (less people in the pool --> higher cost per person AND more risk shared by fewer people).

Sure, stopgap plans have been proposed in the past, and there's nothing wrong with them-- for the short term. But that's still like putting a bandaid on a severed limb. It's too little too late.

Universal coverage in the US isn't even a NEW idea, or a Democratic one. Even Nixon proposed a Universal coverage plan in 1972 because more people were being left behind by insurance companies. Instead we got HMOs and "managed care" that has only increased costs and decreased consumer choice.

The turning point in the US will come when big businesses will refuse to pay the spiraling costs of medical insurance. It was much like that when Canada introduced its universal single-payer coverage.

IMHO, this will happen sooner rather than later. If we elect a candidate who has a PLAN for universal, single-payer coverage, it will be sooner.

[Clete]

13. Not to mention that someone is going to have to

convince the insurance companies and private HMO's to get out of the business. If that cabal can be broken there is a chance we can get a program started. I think we should incrementally start increasing Medicare coverage to wider and wider demographics, like for instance offering it to government employees first and then to private industry because the coverage could be cheaper until Medicare takes over all the insurance business, then we could start concentrating on making sure Medicare's coverage is more inclusive and wider than it is now.

[kentuck]

16. Here is how I would do it.....

Take the amount that people are paying now for health insurance, cut it by 10%, and cut out the middle man, the insurance companies. In return, they would get a single-payer health card which they could go to the doctor of their choice who would be reimbursed from the healthcare fund that every body would pay into, if they were working. All workers would pay a minimal fee, which would be 10% less than that paid at the present time, for complete health coverage.

More than likely, there would be enough money in the health payment system already to pay for a single payer, but if not, then we would use part of the huge taxcut given to the wealthy to make up the difference. It is possible that it might not be necessary.

In effect, it would be a 10% taxcut to every worker. This would tend to stimulate the economy, much more than the Bush taxcut to the wealthy. Dick Gephardt is correct about this.

[nbsmom]

21. Guess it's good you're not doing it, then.

Your plan works as long as everyone is working, and everyone participates.

What about the stay at home moms? Who pays for them? The kids? Who collects? Who bills? What's a reasonable reimbursement? Is it regionally rated?

What about the people who have the piss-poor luck of being born with a lifelong medical condition like diabetes or asthma? What about the woman battling breast cancer who wants a bone marrow transplant? What about the premature triplets?

I think that scenarios like those, more than anything else, makes me shudder at the prospect of centralizing our health care system through single payor. It might solve some problems, but it would create many more.

It's not just about $$$. It's also about making people actively involved in their own health and their own lives...and that, frankly, is a lot more complicated than printing up a bunch of single-payor health cards. *

And, as I've already posted, not every health plan is in it for the $$$. There are several rather large not-for-profit health plans that really are lobbying for an interim solution, because they know that throwing out the entire system is not the answer.

* BTW, I think any smart system would probably not even need to see a card.

[BurtWorm]

18. One way to speed the process along: MDs have to get on board

Is it pure greed that's keeping them from doing so?

[LearnedHand]

25. The doctors? Are you kidding?

They hate the HMO system more than almost anyone else and would remove them from the planet in a heartbeat. We "consumers" of healthcare are not the ones on the front lines of this fucking battle; it's the doctors.

I had an orthopedic doctor who, whenever some "customer service representative" informed him that his request for some procedure was denied, asked the rep from which medical school he or she obtained the MD degree. (Then he got firm!)

[BurtWorm]

28. I know a bunch of doctors who despise HMOs

and a bunch who are servile to them. I would bet the AMA is opposed to single-payer plans. They've traditionally been resistant to any form of socialized medicine.

[Armstead]

20. Start with voluntary expansion of Medicare

IMO the best way to phase it in would be to enable anyone to buy into a Medicare type of plan on a sliding scale fee tied into their income.

Everyone would be eligible, but it would be voluntary and universally available. Those who need it can use it, and tghose who choose private insurance could do that. Also make it open to employers.

A comparison might be with the postal service. That is a public corporation, and you have a choice to mail a package through the post office or a private service like Fed Express.

It would probably lose money, but it could be supplemented from general revenues.

[nbsmom]

22. Do any of you know how Medicare works?

You guys are scaring me.

There are so many, many things to --ahem-- love about Medicare.

Is it the fact that there are two parts, one that you pay for and one that you don't? And that neither Part A or Part B covers drugs?

And don't forget it's 'bring your own blood' -- the first three pints are on you.

[w4rma]

23. Single payer would be nationalizing/socializing the buisnesses of

health insurance companies.

I think that it should be done. I also think that it will be **very** hard to do it. If it is done, IMHO, it will require paying the owners of these buisnesses for their buisnesses and probably much more than their buisnesses are worth.

[LearnedHand]

27. We already have a model.

It's spelled Medicare. Not hard. Easy. They already have the system, and they already have our IDs.

No need to buy out the insurers; it is, afterall, a market-driven economy, yes? If their market goes away because the federal government decides to provide access to healthcare for every living soul in this nation, let the insurance companies do exactly what the rest of us have to do when our jobs are exported to Indonesia: find another job.

[BurtWorm]

30. Another model: The VA

Not a shining model, but a long-established one. Some of what they do--like physical rehabilitation and spinal cord injury care--is unmatched in the private realm.

[LearnedHand]

29. And why use the RW term "socializing"?

That just takes the discussion back to the wingnut level and scares everyone away from the real issue.

Besides, "socialist" systems are those in which the government OWNS the means of productions. Nationalized healthcare is not socialist at all. It's simply that the government collects some money from all who are able to pay taxes, and uses that money to PAY FOR healthcare for everyone.

PAYING FOR /= OWNING

[Wapsie B]

31. What gets me

is the fact that we have no problem with state programs that cover children from poor families or Medicare that covers those over 65. But god forbid if the government should cover those evil working age people.