Single Payer Universal Health - an issue we can win on! Please read

[Phoebe Loosinhouse]

A lot of the discussion about a true national health care gets de-railed simply because people do not have a good grasp of the fundamentals.

It is NOT socialized medicine. It is simply gets rid of the gross inefficiencies in our current system. The government would not own the hospitals, the clinics, the doctors, etc.

We CAN afford it- as Dennis Kucinich says
"We're already paying for universal coverage. We're just not getting it."


We can do this. It is smart. It is moral. It will save us money. It will mean that no American will ever again lose their home due to medical bills. It will unleash a wave of creativity and business and industry renaissance as business gets freed from this shackle of tying healthcare to employment. It will make our goods and services more competitive.

The system we have in place right this moment is for the benefit of the few (the insurance industry) at the expense of the many. The following sites will help you frame and discuss and hopefully persuade others that the time has finally come for true, complete healthcare reform. No more tinkering at the edges while leaving the rotting core!



Physicians for a National Health Program
http://www.pnhp.org/

We believe that the current malaise afflicting health policy debate will be short lived; that bold and articulate advocacy for national health insurance can coalesce the broad constituency for change. Please join us in insisting that medicine be a public service, not a business.

Dennis Kucinich
http://www.kucinich.us/issues/universalhealth.php

Universal Health Care
I have a detailed plan to provide universal health care. Others may use that phrase, but their plans leave many Americans without coverage. Under my plan, patients and doctors are put in charge of the system, instead of HMOs and private insurance companies. Patients are able to select their doctors. The costs are completely covered by the government. And we don't end up paying any more than what we're paying now. A new study by researchers at Harvard Medical School and Public Citizen estimates that national health insurance could save at least $286 billion annually on paperwork, enough to cover all of the uninsured and to provide full prescription drug coverage for everyone in the United States.

Graham Walker
an animated five minute presentation
http://www.grahamazon.com/sp/whatissinglepayer.php

I'm a medical student, computer geek, health policy wonk, weblogger, health care activist, and all around good guy. I promise. I believe that the current health system is a mess: disorganized, wasteful, inefficient, and many times, harmful. My goal is to educate. I think there's a lot of facts out there that we don't hear about, and you can bet my bippy that I'm going to be a Great Equalizer if it's at all possible.

Healthcare Now
http://www.healthcare-now.org/takeaction.php?sid=3
Great all around take action site


Massachusetts Nurses Association
http://www.massnurses.org/single_payer/singlepay.htm

MNA Supports Single Payer Health Care Initiative
We are part of a health system which has replaced humanitarian values with the heartless tenets of the market. Why do all attempts to “reform” the system seem only to make the problem worse? For a health system to meet the needs of us and those entrusted to our care, three essentials must be addressed simultaneously and consistently: Access, Quality, Affordability. The Single Payer health care system promises to do all three.

Wall Street Journal
By BENJAMIN BREWER, M.D.

Government-Funded Care
Is the Best Health Solution

Multiple Insurers, Multiple Plans
Create Expensive, Draining Hassle
April 18, 2006

http://online.wsj.com/public/article/SB114528925682927634-_5EosXnvZvOGsZWwHcizX8WTpck_20070418.html?mod=blogs

A recently approved Massachusetts plan designed to force all residents to get health insurance was a step in the right direction, but it doesn't go far enough.

Under the Massachusetts approach, there will still be a maze of plans provided by any number of insurers. That multiplicity is the problem. Multiple insurers and multiple plans create layers of unneeded expense and bureaucracy related to billing, collections and the entire assembly line of middlemen between the service rendered and the payment.

The solution that would really put health-care dollars, and providers, to their best use would be a single-payer system -- namely, government-funded health coverage for all.

[sendero]

1. Seconded...

.. they way health care is paid for in this country is unsustainable. The sooner we fix it, the sooner more people can get the care they need.

We need insurance companies siphoning off 33% of each health care dollar like we need a hole in the head.

[Vinca]

2. I agree. It's time to stop tap dancing around this issue.

Democratic candidates should promote a single payer, universal system and nothing else. No halfways, no in betweens. From a political point of view, it should be a winner. Being a Republican doesn't protect you from losing your health insurance and I suspect many of them would vote Democratic if we make a definite stand.

[depakid]

3. I agree-

Hard not to- but unfortunately, groups like the DLC do not- and their DINO's will do everything in their pwoer to see that it never happens.

[Phoebe Loosinhouse]

6. and the ONLY reason someone would not support something what

is so obviously the superior choice would be if they were in thrall and indebted to the insurance industry. Why would people consciously choose to waste dollars and resources?

I also think that some of them are just not capable of thinking in grand terms. The system we have is irreparably broken and we have to fix it.

Single payer is not socialism, it will not deprive people of CHOICE. These seem to be the 2 most popular straw men.

Also, we do NOT have efficiencies in the system that have made insurance coverage better and cheaper due to competition - just another canard of an industry that really only wants to cover the healthy and leave the ill to die or be bankrupted.

[depakid]

8. It is obvious

just like it's obvious that the pharmaceutical industry shouldn't be getting large taxpayer subsidies and price supports alongside blanket immunity from certain types of lawsuits.

There's no rational justification for those policy choices- and yet, every time, you'll see some DINO's lining up on the Republican bandwagon to support them.

Both my Democratic Senator and my Democratic congressman voted for the Medicare Part D scam. Go figure.

[katinmn]

4. MN gov candidate Becky Lourey is running on this issue

http://www.beckylourey.org/issues/healthcaresecurityplan.html

* Support and facilitate the establishment of universal and affordable health care access in Minnesota by 2010.

* Ensure the universal health care established in Minnesota by 2010 is developed in a manner that leads to increased affordability, access, and comprehensive quality into the future.

Let this be the year of overhauling the health care system!

[AndyTiedye]

5. This Issue Worked So Well for Us The Last Time We Tried It

:sarcasm:
Remember 1994?

[Phoebe Loosinhouse]

7. So we're never allowed to bring it up again?

How about just doing what is right because it is right? Would you prefer to just dodder along the way things are now?

[depakid]

9. No, the poster just doesn't know anything

about health policy or (apparently) politics.

[AndyTiedye]

24. Please Enlighten Me

What am I missing here?

We had the House, the Senate, and all the momentum of a newly-elected President.
We tried to enact universal health care.
Not only did they stop us cold, but they took both the House and Senate the very next year.

This is NOT an issue that is going to have voters flocking to the polls to vote for us.
Last time we tried it, they flocked to the polls to vote against us.

We are up against a century of the health care industry instilling in their patients
the fear of "socialized medicine", plus an essentially bottomless war chest.
Since single-payer essentially puts the health insurance industry out of business,
and everyone in it out of a job, that industry and everyone will to throw everything
they've got into defeating it (as they did in the '90s).

I am not suggesting that we should abandon the fight for access to health care,
but we should not make it a cornerstone of our campaign, because electorally
it hurts us far more than it helps us.

I think we have to give up on single-payer if we want to expand access to health
care at all. Right at the moment, that access is contracting, not expanding.

[depakid]

25. Hillary's "plan"

like many things in the Clinton administration tried to "please everyone."

It was nearly incomprehensible even to people who study public health- in addition to which, it wasn't an open process, and it was led by someone with no credentials. That made it easy pickings for the parasites in the insurance industry through their Harry & Louise ads.

A straightforward single payer plan (like an expansion of Medicare) would have passed- and still would pass, provided that the DINO's would get out of the way and allow health professional and economists to put together responsible public policy.

In terms of an election issue- healthcare is in much more critical condition today than it was in 1992. Even the upper middle class is worried about it- and poll after poll shows that it's an issue that people back by wide majorities.

If the Dems had any sense as a party, they'd be all over this:

Many middle-income Americans lack insurance: study

http://news.yahoo.com/s/nm/uninsured_dc

The fact that they're not is one of the major reason why they lose-

<on edit, see also http://www.democraticunderground.com/discuss/duboard.php?az=show_topic&forum=102&topic_id=2215174 >

[Phoebe Loosinhouse]

26. Excellent summation of the DOA Hillary plan

But AndyTieDye does make a good point about a potential loss of insurance jobs if single payer goes through.

I personally believe that the avalanche of new jobs that would be created if everyone in the country could be assured of healthcare would be amazing. Plus, I think you would see the expansion of existing companies.

It is evident that we will no longer ever again be an economy that is based on manufacturing. But those old manufacturing jobs could conceivably be replaced with with new jobs in healthcare.

[depakid]

45. Many of those insurance jobs amount to nothing more

that parasitism on the system. They don't "produce healthcare."

Instead, we spend billions of our healthcare dollars on people whose purpose is to find clever ways to deny people care- or engage in adverse selection (cherry pick) in ways that degrade primary and chronic care management for things like diabetes. If you read the NY Times' excellent series on the diabtetes epidemic- you'll see that they're a mjot reason why cost effective clinics that DO produce quality results end up going bankrupt.

And that costs us all more money down the line. Insurers woulds rather see amputations down the line, than pay for management- the reasoning being that they don't want to attract dibetics to their plans- and the amputations down the line will be on some other companies (or the federal governments' dime.

Getting rid of the administrative parasite is probably the single biggest benefit to single payer healthcare.

[eridani]

46. No, job losses can be minimized. Think about it.

What actual useful function do insurance companies perform?
And which function requires the largest number of warm bodies?

Claims processing, obviously. That has to be donw whether insurance is public or private.

Now, for the $50,000 question, what function of insurance companies is most likely to be outsourced?
Bingo! The solution sort of writes itself, no? Public insurance could easily make outsourcing illegal.

[AndyTiedye]

28. Single-Payer Would See Even More Opposition from Health Insurers…

…since they would be out of business if it passed.

How would you deal with that?

What would you do with all the people who work in the health insurance industry now?
(Is the government going to hire them all to adminster single-payer?).

I am no particular fan of the health insurance industry, but if you are going to shut down
an entire industry like that, you need to have a plan for the impact of such a move.

[Phoebe Loosinhouse]

31. One industry replaces another

I think their jobs will be replaced with new jobs in an expanded healthcare industry. In fact, I think expanded healthcare could be a giant jobs engine that can help replace not just administrative positions but perhaps also some of our lost manufacturing high wage jobs.

The buggy makers hated the automobile manufacturers, but they were not able to prevent the inexorable juggernaut of modernity.

[Lydia Leftcoast]

60. The slogan for single payer should be

"Never argue with an insurance company again."

[Nederland]

79. What you are missing

Is the events of the last 12 years since then.

Do you think that maybe, just maybe, the fact that health care costs having been rising at double digits rates since 1994 changes the equation a bit? Do you think that the fact that the number of uninsured has nearly doubled since 1994 changes the equation a bit? Everything you say about what happened in 1994 is true, but Christ, it was 12 years ago.

Get your head out of the past friend.

[bunkerbuster1]

15. We've had 12 years of ever-shittier healthcare coverage since then

I've spoken to people across the political spectrum. EVERYONE knows that our system is screwed up. We need to lead on this, and a single-payer plan is clearly the most efficient model.

[IronLionZion]

22. NO, We've never tried it...ever

Hillary-care was written by the biggest insurance companies and corporations in this country. It was NOT a single-payer plan. And I assure you, it was royally FUBAR.


http://en.wikipedia.org/wiki/United_States_health_reform_under_Clinton

[Lydia Leftcoast]

59. That was NOT single payer

It was a jerry-built "plan" tacked together and controlled by our beloved :sarcasm: insurance companies.

You know "managed care," the rules that say your doctor can't get paid for treating you unless some non medically educated clerical worker can find it on a check list?

That idea was part of the Clinton health plan.

As was typical of him, Clinton was afraid most of all of being disliked by the rich and powerful, and so he let the insurance companies plan his health care "program."

That's why it was a disaster.

[jojo54]

10. "Cover the Uninsured" week, May 1 - 7

http://covertheuninsured.org/

It's really a generic website focusing on telling Congress to stop sitting on their duff's and DO SOMETHING! If you go to http://covertheuninsured.org/whatyoucando/congress/, there's a very generic letter to send to your congresspersons, but you can add your own rant if you like.

I did it 'cause I've been without for 6 years. It may not help much but at least I told my comgress people exactly how I feel about this issue.

[elehhhhna]

11. Corporate America NEEDS this solution. It's the only way

we can compete with Europe...versus competing w/the third world. Whether we implement SPHC willl determine who we will emulate--Europe or a tinpot hellhole.

[blindpig]

12. This is THE litmus test

It is desperately needed and an obvious continuation of the New Deal.It is a sure fire winner at the polls. If the Dems cannot or will not run with it speaks volumes.

[warrens]

13. This time, the business community is behind it

In the early 90s, healthcare was still relatively cheap, and the business boys stayed on the sidelines. Now, it's becoming a major liability and even the real pigs in the corporate world realize they have to do something about it. The greedy are happy to get the government to pick up part of the bill; most of the corporate world, though, knows that if their employees can't afford decent healthcare, it will be bad for everyone.

This will be a winner issue by 2008, IMO. Clinton was just too far ahead of his time. He saw it coming, but it was too early to sell it to anyone but the uninsured.

[IronLionZion]

23. GM is definitely on board

I read that up to $1000 on the price of new cars is for health insurance. That's the real reason they move plants to Canada and Mexico.

Employment would skyrocket if the healthcare burden was taken off of small businesses who can't afford it.

At the very least, we should have single-payer for major medical. That's what destroys people.

[pberq]

14. protecting health benefits biggest issue for labor

From yesterday's interview with Roger Toussaint:

http://www.democracynow.org/article.pl?sid=06/04/24/1346222

<snip>
AMY GOODMAN: When you say the Democrats are not much better, explain.

ROGER TOUSSAINT: Well, I think that there were opportunities in the past decade or more to deal with the healthcare problem that the Democrats had available to them, and they fell down on that issue. A consequence is that at every single labor negotiations, protecting health benefits has been the biggest issue, and people have had to trade work rules, past gains, in order to hold on to their health benefits. So that's what I'm thinking of.

[Phoebe Loosinhouse]

16. Lose your health, lose your job, lose your insurance, lose your house

and then go bankrupt. Every American whether they realize it or not, is one major illness away from an abyss they will never be able to crawl out of. Why do our Reps give themselves healthcare for life at taxpayer expense? They don't seem to have any issues with that, do they? They would feel a lot differently if they had to scramble for open enrollment and then had to wait exclusionary periods for pre-existing conditions.

Critical mass and momentum for this issue is here and now.

[NewJeffCT]

17. We really need to sell it as pro-business

And, frankly, it is very pro-business, except for those in Big Pharma & Big Health Insurance.

[Phoebe Loosinhouse]

20. It IS pro-business

think of the money that could be freed up for capital improvements, R&D, dividends for shareholders, increased employment opportunities. New small business start-ups would go through the roof! We would enter a new age of American entrepreneurship and inventiveness. I don't know why the business community has allowed all the social responsibility for healthcare to be yoked to them in the first place. It's anti-capitalism, is what it is!

[area51]

29. Exactly.

Single-payer would spur entrepreneurship, as w/our current broken system most people can't afford to go into business for themselves b/c they can't afford health insurance.

[NewJeffCT]

52. agreed

My wife would love to start her own business, but we rely on her job for our health benefits.

[helderheid]

18. YES!!

[RedEarth]

IMO... this should be the top priority

If you think about it, the cost of healthcare affects everyone...all races, all genders, all everything.....no one is spared. Trying to band-aid a completely broken insurance-based system like we have will never work...single pay insurance is the only logical choice.

[RedEarth]

19. IMO... this should be the top priority

If you think about it, the cost of healthcare affects everyone...all races, all genders, all everything.....no one is spared. Trying to band-aid a completely broken insurance-based system like we have will never work...single pay insurance is the only logical choice.

[Phoebe Loosinhouse]

21. From Kos - must be in the air today

Your Healthcare Now Rationed
by MikMouse
Tue Apr 25, 2006 at 09:41:36 AM PDT

http://dailykos.com/storyonly/2006/4/25/124136/481

A google search on "health care rationing" turns up thousands of stories demonizing the idea of national health care by claiming it will ration health care, as if it were not already massively rationed. There is not a single article pointing out how insurance companies currently ration health care.

[dcfirefighter]

27. Who determines what is covered

I like the having the choice of insurers. I don't want government insurance. I want insurers who compete with each other to provide me with more options and better service.

I do agree with the need for universal coverage. I just don't want it to be a combination of 'the IRS and the Postal Service'.

Many of you will berate me, for having employer provided insurance, and apparently not caring for those who don't. This is not true, and such ad hominem attacks detract from the debate.

Tell me why a government run healthcare insurance system won't be subverted to benefit the industry at the expense of the taxpayer & patient.
We have a government run defense system that has been subverted to benefit the industry at the expense of the taxpayer and the citizen.

Tell me why a one-size fits all government program will fit me, and you, and the guy down the street.

My vote:
1) separate insurance from employment by eliminating the corporate tax break for benefits paid, shift them to be deductible by the personal income taxpayer.
2) shift them even further, such that they're not just deductible, but all the way over to a tax credit
3) eliminate cherry picking by insurers by requiring any insurer that operates in more than one state to insure any applicant according to a predetermined rate structure. Encourage the several states to make a similar requirement for any insurer operating entirely within a state.
4) For low-income / low-wealth persons, provide a subsidy.
5) require everyone to be insured.
6) make patents due to government-funded research part of the public domain -OR- auction them to any American company - then use the revenue to provide that aformentioned subsidy.

[Phoebe Loosinhouse]

30. Hello dcfirefighter!

I am no expert and I don't pretend to have all the answers, but I did provide a number of links, some of which attempt to answer your questions better and in far greater detail than I would ever be able to. Why not invest 15 - 20 minutes and read a little about your concerns?

As far as your personal health care program - it doesn't sound too bad - you have obviously given it some thought. But there remains one major flaw - it leaves the healthcare of Americans in the hands of FOR PROFIT companies. Insurance companies make money if they take in money as premiums but do not pay it out in the form of healthcare. Just a major, basic, flagrant conflict of interest. I have a problem with that.

Here is another Du'er posting in another thread about healthcare discussing how these companies operate.

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=132&topic_id=2585620&mesg_id=2585620.

AbbyR (421 posts) Tue Apr-25-06 04:29 PM
Response to Original message
25. This whole thing disgusts me beyond belief
My husband is dying. We are holding our breath until Medicare kicks in on his birthday in May. He couldn't get disability because he worked (sitting in a wheel chair, just about dying each day) until the last possible minute. I had to force him to stop work by refusing to help him to the car one day.

Medicare will be $88 a month plus $30-some for prescription drug "benefit" and about $150 for a Medigap policy. I'm not sure we will be able to keep the house, as deductibles are still very high.

Yesterday I paid $90 for his breathing medication, which was prescribed but which insurance won't cover. Breathing is now optional?

I'm hoping he makes it until we can get home health under Medicare, because I hate to leave him at home alone, and bathing him is next to impossible.

I know I'm practically incoherent, but I am beyond going crazy over this. You shouldn't have to die while waiting for help, and we make too much (rather, I make too much) to qualify for Medicaid.

I will spend the rest of my life working for health care for all in this country - I just wish I knew where to start.

Abby in Arkansas

That just rips me apart.

Anyway, I am happy to have a serious discussion about a huge issue that impacts just about all American families. I want action and relief for people like Abby R and her husband.

[dcfirefighter]

32. Hello to you as well.

I'm familiar with the Universal Payer proposals, after rereading your links I still have concerns.

Profit is not Evil.

When there is 'perfect' competition, there is no profit. The better the competition, the less profit there is.

The production of our food, our clothing, our homes, our vehicles, etc., is done by for-profit companies. It is this very profit that will induce one provider to be better than the others. The problem arises from collusion / cartelization.

According to your first link, pnhp.org, private health insurance would be 'proscribed' or outlawed. You will take what they have to give you and nothing else. They do bring up the good point that between subsidies and health insurance for government employees, we (the nation of taxpayers) already pay 60% of health costs. I assume that under such a model, where individual states get to control what is covered, that there would be limited women's healthcare insurance in states such as South Dakota and Utah? The pnhp plans is Socialism - a state-run insurance system, protected from competion. While I am a Liberal and a Democrat, I don't believe that Socialism works as well as a properly regulated market.

Dennis Kucinich (whom I like) brings up the point that Medicare is 3% overhead. The doctors & hospital staff that I have spoke with (admittedly a narrow sample) regarding this point out that THEY are required to do the paperwork, etc., such that many of the administrative costs are borne by the provider rather than the Medicare insurer.

One of the links you provided used a fire department anology: Hospitals would be funded much like the fire department is funded. This is a poor analogy: Fire departments are rarely used. Chances are, if you call 911 for a fire, the closest fire station will be able to respond to your emergency. Furthermore, your property directly benefits, in value, due to the proximity of a fire station, as well as in the FD's likelihood of extinguishing your neighbor's building before it catchers yours on fire. Much of the benefit of the fire department is nonrival, in that most people never need to call them, yet benefit from their presence.
Conversely, healthcare is frequently used. If you go to the hospital, chances are, someone else will also be there. In fact, people should see their doctors at least annually. Unfortunately, every hour that the doctor spends on you is an hour that he can't spend on someone else. So, regardless of the economic model, patients compete for scarce health resources. If you have a Single Payer system, there must be some means for determining who gets to see which doctor, who gets to receive what procedure, and who gets to get admitted to which hospital. Generally, this is done by a prioritized wait list. (which is exactly how you'd get an ambulance in most places, if you happened to call for one when they were all busy)
Which brings up my final point, regarding the near universal revile that people hold for copayments. In a system without copayments, some, a signifigant some, will use more of the system than they really need. The copayments need not be onerous, nor do they need to be collected before treatment, and they could be eliminated for ongoing treatment, but I am absolutely sure that a portion of the economic cost has to be borne by the customer. Otherwise people will (and I witness this nearly every day) call 911 to use the ambulance as transportation to the Emergency Department to receive treatment for a headache they've had for days. This means that 'the system' just incurred a cost of $2500 for less than $250 worth of treatment - which has to be made up by economizing somewhere else in the system or by costing the country more than it should. (And if it costs the country more than it should - that means that somebody, somewhere went without a better job, or a better home, or a better education, etc.)

[eridani]

48. Profit may not be evil, but it sure the hell is inappropriate

At least for some things, like health care and fire protection.

[dcfirefighter]

51. I beg to differ

why is it inappropriate for innovators and investors in healthcare to reap a financial benefit from doing so?

What is inappropriate is 1) tying insurance to the employer and not the person and 2) being able to cherry-pick healthy customers

[Lydia Leftcoast]

61. For example, the president of United Health Care

(based in Minneapolis, but forbidden to operate in Minnesota) was given a bonus which amounted to more per hour than a registered nurse earns in a year.

In other words, his bonus was equivalent to the annual salaries of 365 x 24 nurses.

Did you ever hear of a poor insurance company executive?

Meanwhile, all insurance companies are raising premiums and deductibles faster than many people can keep up. I'm healthy and almost never go to the doctor, but my premiums as a self-employed person are now $90 per month higher than they were last year.

THAT's obscene.

[dcfirefighter]

71. That is Obscene

and it is a problem throughout much of the corporate world. It's not due to insurance, but rather the means of corporate governance, and a lack of competition for UHC.

[BrownOak]

92. Free advice.... worth every penny

But before that, let me add that here in NC, the Blues are a not-for-profit organization. I need to get into that business as they made $196M in 2003 and the CEO pulled in $2.5M last year.

Now, for your free advice. Premiums and deductibles are in fact rising at an incredible rate. But you said you're healthy and almost never go to the doctor. So, other than a catastrophic event, what are you really doing with your insurance? Don't waste your money on anything that's going to give you a low deductible. Instead go out and buy a policy with a really high deductible and set up either an HSA or an MSA account where you can deposit the difference between what you would have paid for the lower deductible plan and what you pay for the higher deductible plan.

I'm more of a group insurance geek than a self-employed expert, but I think the MSA would be a better vehicle for you than an HSA. The MSA is also known as an Archer plan and I believe that you can contribute pre-tax dollars to that account whereas with an HSA you cannot do that as a self-employed individual.

When shopping for the insurance (I'm not sure where you live so I can't help you) look for three things. You want to make sure they have a strong PPO network in your area. You want to make sure the Rx benefits are suited for you. If you're young and healthy, consider a plan that carves the Rx benefits out and gives you a discount card to use. If you're not on many meds you can end up saving a bunch with that and then just pay for the Rx out of the MSA. If you do use the Rx then you'll want to see if you can get a high deductible plan with an Rx card. Most carriers will offer you three flavors of Rx coverage-

Discount only as I mentioned above
Rx card with reimbursement only (this actually may be your only option with the MSA. But it's no big deal because you can pay for it and get reimbursed. It's only a cash flow issue.)
Rx card with copay.

Like I said, everyone's situation is unique in that regard. The final piece to look for is the cheapest premium you can find (duh!). The point is that most of your claims are going to be paid by you, so if you have concerns about the "quality" of the carrier it really will only matter if you have huge claims in one year. Don't be afraid to look at people you haven't heard of. The state DOI should have a listing of carriers on their website. You can verify their ratings with companies like AM Best and check the state DOI to see if there are any complaints.

The point of all of this is that if you are healthy then you're in a great position to minimize the impact of the insurance industry on your life. Buy only as little from them as you need and pay for the rest yourself with pretax dollars. The final word of advice is that even though you may be healthy, you should really budget your MSA amount with an eye toward the future. If you can save up and get ahead of the curve you have an advantage for when you will need it later.

[eridani]

67. That benefit need not come in the form of obscene profits

The three greatest medical discoveries of the 20th century were insulin by Banting and Best, penicillin by Fleming, and the Salk vaccine. None made so much as a dime of profit from their contributions. This does not mean they were uncompensated--their compensation was very comfortable salaries plus unlimited funding of whatever further research they wanted to do, which is what your most productive scientists really want. They want to go on to the next thing, not block access to their previous work by charging tolls as high as possible.

[Solon]

69. OK, so you hate Socialism, regardless of how well it works in Europe...

and Canada. You want to preserve our private health insurance for what reason again? Seriously, your two points right there would GUT the money making option for insurance companies entirely, you put those regulations in place, and Health insurance would disappear entirely. With health insurance NOT being tied to employment, as is damned near standard today, you will FURTHER increase the burden on those who most need said insurance. With increased cost comes less customers. Also, if you take away an insurance company's ability to cherry-pick healthy customers, they simply will take none, its cheaper that way.

You seem to think that "Socialism" no matter how limited, is some type of great evil, given this, why are you in a public service to begin with? Why not privatize fire fighting, or police, or PUBLIC utilities like water or gas?

Look, those of us who advocate this type of limited Socialism do so for a good reason. Let me spell it out for you here, some services are NOT optional, fire protection, public safety, and public health should be PUBLIC, not PRIVATE. Think of this, if you had a child at a public school, another "Evil Socialistic structure", and a good half of his or her class is without health insurance because it is too damned expensive, that puts YOUR CHILD AT A HIGHER RISK FOR DISEASE as well. The reason is rather simple, without insurance, most people, even with kids, invest less money in preventative care, are less likely to go to the doctor when their child or themselves are sick, etc. When the option is either going to the doctor this week or paying for food, people will pay for food, 9 times out of 10, so really, what is your point?

[dcfirefighter]

70. Again, Public Goods vs. Private Goods

Public Health, a public good, is not Socialized Medicine. Public Health is the effort to prevent pandemics, not care for individual problems.

Optional or not isn't the argument. Food isn't optional, yet we allow companies to profit supplying us with food.

Public Goods are non-rival. If the Public Health service ensures a clean water supply, it cannot clean the water supply for just one person, nor can one person really detract from the cleanliness of the water supply. If the fire department prevents fires from spreading to become conflagrations, it cannot do it for just one person. Put another way, one person enjoying a conflagration-free city does not detract from another's. You are of course free to promote an argument for privatizing public health or fire protection if you like, I don't think it will be a strong one.

Conversely, the use of a doctor is rival. He can only attend to one patient at any given time. Similarly, health insurance money can only be spent on one person, any one who withdraws money from the pool reduces the amount available for others.

Please refrain from personal attacks, it's unbecoming. I do my job because I'm a humanitarian. Not all humanitarians are Socialists.

Your arguments against the form of health insurance that I'm advocating fall flat. What I propose is very nearly EXACTLY what the Country of Switzerland uses to provide all of it's citizens with health insurance: 1) companies can't cherry pick 2) individuals purchase insurance 3) participation by individuals is compulsory 4) subsidies kick in once payments exceed X% of income.

[Solon]

76. OK, sorry, just thought it ironic that someone...

in a public service would say stuff about Socialism that are negative. Also, I know about the Swiss system, the costs are higher in this type of system, both per capita and overall, than in other and more efficient forms of UHC. Also, given the tight government regulation required by this type of system, it would never work in the "deregulation is good" USA. There are better ways, so why not try those instead?

[dcfirefighter]

81. Public Service doesn't neccessarily imply Socialism

I'm sure there are many military people who aren't fans of socialism.

Likewise, supplying a good at the local level doesn't necessarily imply that it would be better to supply that good at the Federal level. If Washington, DC decides to spend an inordinate amount of Fire Protection and other services, people and businesses can and do decide to relocate.

The Swiss system is cheaper than ours, but more expensive than most of the rest. It may not be the best system, but it's not necessarily the ultimate system. Regardless of effectiveness or efficiency, It would be very difficult to transition from a Single Payer UHC system to another system, even if the other system was demonstrably better.

The deregulation argument is moot. Making a single government provider of insurance is the most extreme form of regulation.

The argument I make isn't that people who can't afford it shouldn't have health insurance, as I think they should. What I argue is that UHC Single Payer, with it's lack of competition, leaves itself wide open to manipulation by special interest groups. It's a case of diffuse costs and concentrated benefits: it the Association of Bloodletters benefits in the millions for getting bloodletting included in the basic insurance package, they have a much stronger incentive to lobby for inclusion than the general public has to lobby against a very small price increase. This occurs regardless of administrative costs. (It also occurs in our current system)

Conversely, there other methods, implementable at the state or even local level, that both provide for individual needs and tend to keep costs in check. One idea that I've been mulling is the idea of a Public Utility Basic Health Insurance system for a locality. Any resident would be covered by the plan. If the plan were too expensive, there'd be an incentive to move elsewhere.

From my readings, for roughly $2000 a person basic healthcare plan can be provided. I believe this includes the various subsidies and use of MC/MA, as the average per capita spending on healthcare in the US is over $6,000. This is no small sum for a locality to come up with. Most localities would have you believe that they are strapped for revenue, and can barely afford to pay for the services they currently provide. To some degree, this is true: if they attempt to raise revenue with income taxes, people choose to live elsewhere; if they raise business taxes, businesses move elsewhere; if they raise sales taxes, people shop elsewhere.

There is, however, a tax that can be raised that cannot be avoided.

The District of Columbia, like many urban areas, has experienced a real-estate boom. The value of existing construction in DC has increased by some $4 Billion a year. Looking closer, we realize that the actual construction is getting less valuable, as the foundations settle, the brickwork cracks, and the mechanical systems age. It's not the buildings that are increasing in value, it's the land under them. More and more people are finding DC a desireable place to own property, mostly because more and more people are finding DC a desireable place to live, work, and do business.

If living in DC implied having universal healthcare, DC would be an even more desireable place to live. Such an implication would tend to further raise the value of land in DC.

Land, by it's nature, cannot be relocated. You can tax it, and it won't leave.

If such a tax were based on land values in DC, the public could raise an additional $4B a year in public revenue without decreasing land values. $6,000 x 600,000 residents is $3.6 Billion, and that's not even looking at recovering costs from MC/MA, or federal employer plans (I assume that private employers would drop their employee insurance plans, which is fine, because that makes it even more attractive to locate your business in DC).

If DC's land normally appreciates $4B a year, and DC suddenly increased taxes on land values by $3.6B a year, we could expect that DC's land would then only appreciate $4B-$3.6B or $400M. However, if the $3.6B is spent on something that attracts residents, business, or commerce, some portion of that spending would accrue to land values. If that portion was 20% (a completely off the wall guess), land would increase by $1.1B.

The knee jerk argument against such a tax is that it would make real estate too expensive to own. This is not true, because such a tax on land values tends to reduce the sale price of land at the expense of the annual carrying (tax) price of land. Because of this effect, there is a tendency to build more on less land: more housing units, more retail space, more office space; all of which tend to reduce the actual cost of housing or doing business, increasing employment, owner-occupancy, as well as wages and disposable income.

[NewJeffCT]

78. I think this is how it will end up here

I believe what will happen eventually is that larger corporations will get tighter & tighter with the amount of health insurance that they provide to employees due to the costs - the percent of workers with health insurance through work has dropped quite a bit in recent years. While, smaller businesses may have to drop coverage altogether, or else offer limited "catastrophe" insurance and maybe some sort of high deductible indemnity plan like we used to have in the old days (they've repackaged it as "consumer directed" health insurance now)

With the money Big Pharma & Big Health Insurance have at their disposal, what will emerge is something that is similar to Switzerland in that it will allow private insurance to stay in business.

While I would prefer an eventual single payer universal system, I also realize it's not realistically going to happen within the next 5-10 years.

[dcfirefighter]

83. Big Pharma and Big Insurance's interests don't completely coincide

I'm quite sure that Big Pharma would benefit under a Single Payer system, all they'd have to do is lobby one group of people (Congress) to insure that their medication is A) covered and B) covered at a good price.

[NewJeffCT]

84. Then why are drugs from Canada so much cheaper?

Because the Canadian government gets them at a cheaper price because they are negotiating on behalf of 32 million or so Canadians. Part of the outrage of the Medicare drug plan was that it did not allow Medicare to negotiate with Big Pharma for lower prices, while still guaranteeing the drug companies billions in profit.

[Telly Savalas]

33. In Canada, a very wide range of essential services are covered

Private insurers offer coverage for things that the government doesn't cover.

This works just fine.

[eridani]

47. Insurance companies provide nothing, and certainly not "service"

What they do is the equivalent of tapping into your powerline between the meter and your house, siphoning off as much as possible. Doctors, nurses, and other practitioners provide actual health care. I can't see any doctor I want to, unlike people in Canada.

Maybe DC should disband the fire department and you could have competition for providing the service. That makes about as much sense, as few people have fires and few get expensively sick. Let's just stick the unlucky with the support of the fire department and health care.

[dcfirefighter]

50. You miss the point

There are places with 'for profit' fire protection, though it is usually provided as a public utility - e.g. the municipality contracts the service to another agency, either a neighboring jurisdiction or a private contractor. If the contract is written well, the fire protection is good.

Learn the difference between public goods and private goods.

As for insurance, the service they provide is spreading risk. The majority of people will pay more into insurance than they'll get out. They benefit from having access to momey if they happen to get expensively sick or injured. Insurance companies also contain costs, or attempt to. As far as I can tell, large, popular government programs don't (United States Department of Defense).

[Lydia Leftcoast]

62. No, YOU miss the point

Doctors have to hire at least one person to handle their insurance claims, since each insurance company wants something different. That adds to the cost of health care.

[dcfirefighter]

73. Then standardize the claim system.

It's quite Consitituional for the Congress to set Standards and Measures.

Or simply regulate the insurance companies so that they most cover the cost of complying with their claim forms (IOW, make them pay for the work done by the claims-processor).

[NewJeffCT]

75. Easier said than done

The insurance industry is primarily regulated at the state level, not the federal level. I believe the industry got an exemption in the 1930s when FDR started regulation of other financial industries at the federal level through the implementation of the SEC, FDIC, etc.

Each state has an insurance commissioner/department that determines the standards for their particular state. There have been calls over the decades to regulate at the federal level, or revoke the exemption, but it has never panned out.

I don't think it's been seriously considered in a long time - even when Democrats had control of both houses of Congress.

[dcfirefighter]

77. Thanks for the info.

There are certain advantages to having insurance regulated at the state level. I believe that there is some means of providing universal healthcare at the state level, which provides each state a real incentive to control costs vs. the costs of other states.

For example, if each state were responsible for funding it's own defence, I doubt we'd see 50% of our discretionary budget going to defense.

[Lydia Leftcoast]

80. Which they would then use as an excuse to raise premiums

Don't think they wouldn't.

[dcfirefighter]

82. 'They' implies collaboration

which, unfortunately, to some degree is true. However, if a standardized system means that it's easier to do business as a health insurance company, SOMEONE will step in and offer lower rates. Perhaps even a non-profit insurance company - it's possible.

[Lydia Leftcoast]

87. Standardizing forms would require collaboration, too

By the way, when I was shopping for insurance three eyars ago, I noticed that all the companies charged approximately the same. So much for competition.

[dcfirefighter]

90. They find the market price, and charge it.

Unfortunately (or fortunately), there are A LOT of regulations you must meet to be licensed insurer, which keeps competition down.

[Lydia Leftcoast]

91. They're not regulated enough if the CEOs can make THAT much money

while they're charging us poor slobs an arm and a leg for skimpy coverage and trying to con us into thinking that Health Savings Accounts are a good deal. (They are--if you have a lot of extra disposable income already and are healthy).

[dcfirefighter]

93. I believe you are right nt

[BrownOak]

95. Again, it's a simple fix

Get rid of the PPO contracts and make medical providers charge the same fee regardless of your insurance. That forces the carriers to compete on the service the actually provide, not on how much leverage they can bring to a contract negotiation.

[BrownOak]

88. Not really

The vast majority of charges that are run through insurance aren't contested. Almost all are processed at the rates agreed upon in the PPO contract.

[eridani]

66. They do the exact opposite of spreading risk

They cherry-pick the healthy precisely to avoid spreading risk. This defeats the entire purpose of insurance.

There is no competition in firefighting, regardless of whether communities farm it out. They farm it out to one outfit at a time, and that outfit is not allowed to boost profits by surveying census tracts and refusing to fight fires in precisely those tracts where fires have been more common.

You want to contain costs? The entire country of Canada has fewer administrators than Blue Cross of Massachussetts alone! Medicare has 3% administrative costs, as opposed to 20-35% for private insurers.

[dcfirefighter]

74. I don't plan on allowing Cherry Picking

Though, this cherry picking works well for me in the Car Insurance field: I'm a good driver, I get cheaper insurance.

Morally, we have a problem when this model is applied to health insurance: I'm healthy, I get cheaper insurance. I agree with this moral reservation, unlike having an accident, EVERYONE will eventually get sick, grow old, and die. Therefore cherry picking should not be allowed.

I fear a single Governement insurance company would become like the DoD, with Amgen replacing Lockheed-Martin. Tell me how a Single Payer Healthcare system is going to contain costs, and keep various lobbyists from trying to have their particular disease/treatment/patent medicine compination from being specifically covered? Will we cover hair treatment, massage therapy, aromatherapy, erectile dysfunction, etc? Because all these things are going to cost more, and you can be sure that the lobbyists for massage therapy (covered by law in at least 5 states) will be salivating at the gate.

If the lack of administrators is all UHC has, and all it needs, why don't we supply all food through a single government provider?

[eridani]

86. The government would only do INSURANCE, not health care itself

Publicly funded, privately delivered, just like the Interstate Highway System. Global budgeting contains costs in Canada just fine. Regions get capital and operating budgets and need to stick with them (though people are still allowed to get stuff on their own dime if they want).

You can control the movements of a herd of cattle by putting a fence around them, or by hiring a bunch of cowboys with individual sets of reins to each cow. The latter is what we do with case review and HMO beancounters; the former is what the Canadians do. It puts the day to day decisions about spending in local hands. If practitioners try to game the system, they take money directly out of the pockets of their colleagues, who tend to notice and to strenuously object.

What is covered is decided by the public, and with what we are now paying, we could all have platinum-plated coverage. Arguments about what should be covered belong in the public sphere, not in the realm of for-profit beancounters. "We are already paying for universal health care' we just aren't getting it." --Dennis Kucinich

[Telly Savalas]

34. Oh, so the hippie socialists at the Wall Street Journal want this.

Just what the world needs: granola-eating investment bankers driving around the country in VW Minibuses preaching that wacky New Age stoner shit about efficient comprehensive health coverage. We'll never appeal to the moderates if we listen to those commie freaks.

[Cleita]

35. Fantastic post.

The reason we haven't had universal health care up until now is because the for profit health care industry, mainly insurance and HMOs have fought this with their lobbyists tooth and nail. To win this we have to derail them first. This is not an easy task because the money and the slick operatives are on their side.

[leftofthedial]

36. why isn't this front and center in the Democratic agenda?

[blondeatlast]

37. Pro-small business, pro-corporate, pro-working Americans!

What's NOT to like?

Unless you are Prudential, MetLife, United Healthcare, Connecticut General...

[frankenforpres]

43. it is not perfect

many people will be made worse off. but that "many" is small compared to the amount of people that will be helped. when you frame it as "everybody wins" you are going to lose that argument(maybe not politically)


i support universal coverage, but it is not utopian. rationing rules will just not be so much determined by finances as they are now. super duper defensive medicine wont be practiced as much.


our status quo is a fucked up system: really great coverage(wealthy and upper middle class), poor coverage(medicaid), no coverage(lower class cant get medicaid)

the people with the really great coverage will be made worse off, but probably not drastically, the others will be far better off

[blondeatlast]

58. True enough. My ideal plan would offer an "opt-out" for those

who want it, since the big bucks for medical practitioners would still be in serving the masses.

And--welcome to DU! :toast:

[hedgehog]

38. Not to mention cutting local property taxes

Counties in NYS are spending a third of their budgets on Medicare with no end in site.

[savemefromdumbya]

39. America loves its HMOs and private insurance companies so much that.....

it couldn't bear to lose those nasty profit-greedy health insurance companies. People would rather lay down and die rather than lose them!

But really, we need a state run system where it oversees and funds 'healthtrusts' Healthtrusts are health entities made up of merged hospitals and primary health centers and labs etc. Rather like many Kaiser Permanentes (except that people will pay for health services from their salaries into the state government and will receive treatment free at the point of use in the healthtrusts). Doctors and other health workers will be paid by the healthtrust. Unemployed would not have to pay. Seniors would be means-tested. Poor seniors would be free, flithy rich seniors would have to pay a copay each month to the state. Patients are free to roam from health trust to healthtrust. For example Johns Hospital health system: main downtown hospital, Bayview, Greenspring and satellite hospitals like Howard County and primary centers would be one health trust. Other hospitals may want to merge with it. People could invest in healthtrusts to boost funds. So what to do with all the nasty private health insurance companies? They could have their own health trusts like Kaiser but would have to give up all their assets to the state government (tee hee).

[BrownOak]

40. It's actually absurdly easy to fix

OK, I'm in this industry so I have a little bit of background on the issue. The call for a Universal Health Plan is based on the assumption that it is more efficient to administer than the current system, hence, the dollars we are currently spending could cover more people. But the reality is that even though studies have shown that the Medicare system is in fact more efficient than the current administrative costs associated with the large heath care payers (Blue Cross, United Healthcare, Cigna, etc.) those private company administrative costs are wildly inflated. The crime associated with all of this is that you would think those extra administrative costs would make those carriers uncompetitive, but that's not the case and the reason behind that ends up screwing both the health care provider and the patient. The only guy happy about all of this is the large carrier.

If you want to fix the American health care system the quickest and easiest thing to do is to get rid of all PPO networks. Let those providers charge whatever they want for their services, but make them charge the same thing to anyone, regardless of their heath insurance coverage or provider. See, the trick that the large carriers rely on is to use their leverage to drive down the price of services from the providers. But those savings don't make it to the end customer buying the insurance, they stay at the insurance carrier.

One of the large commercial carriers will go into a hospital or physic an and negotiate a contract using the size of their customer base they'll drive the prices down as low as possible. Read your local newspapers and from time to time you'll see a story about how Carrier X has canceled their contract with Hospital Y, or vice versa. That's designed to manipulate the public by having them call either their carrier or the provider and complain that they won't be able to use them (either the hospital or the carrier). At the end of the day the carrier will win out and the biggest guy will get the biggest discounts.

That system repeats itself all the way down the line with the carriers and the leased network PPO's and the smaller the client base of that provider the less their discounts at the provider.

So, what happens when you're calculating premiums is that you determine your administrative costs, your cost to reinsure your risk, and the biggest chunk, your claims costs. The smaller guys in the industry (of which I am about the smallest you could imagine) have to run their operations as lean and efficient as possible. But at the end of the day, it's all about the cost of those claims - or more appropriately, the perception of the costs of those claims.

Say for example that I know I will end up with an average PPO discount of 20% on a group with projected claims at $2,000,000. So that makes my claims costs $1,600,000. Let's also say for example purposes that I can do the fixed costs at $500,000 which includes the administrative fees and the cost of the reinsurance to spread the risk. My total for the group is going to end up at $2,100,000.

Now in walks one of the big boys and the first thing they're going to say is that their PPO discounts are what makes the difference for them and that the cost of those claims would get a 40% discount. So now they're starting with a base of $1,200,000. But the next thing they'll do is hit it with administrative and reinsurance costs of $700,000 and come in with a total of $1,900,000 as their base to work from. Sure, the employer will save $200,000 over what a smaller outfit could do for them, but the point here is that the savings are all coming out of the wrong places.

The way the system is currently configured means that the consumer gets to spend more money for lesser quality care each year. The more the insurance companies consolidate (the number of carriers continues to shrink) the more power they have over the providers. They can continue to put pressure on them to lower their rates, which just end up as profits for the large carriers.

Now, take all of that PPO bullshit away and let the free market take over. If we're all paying the same thing for the same service you end up with a system that rewards companies who can compete through becoming more efficient in their administration.

[eridani]

49. Why do big companies pay less per capita than small companies?

Bigger risk pool, right?

Now, for the $50,000 question, what would be the biggest, and therefore cheapest, risk pool of all?

[BrownOak]

56. Not necessarily

I guess it all depends upon what you call a big company as opposed to a small company.

At a really large size you have enough mass to do it yourself in house, which would always be the cheapest.
At a large, you have enough size that you don't have to worry about the risk but may need someone to help you with the admin.
At a midsize, you can assume risk, but would need someone to assume the rest of it.
At a small size, you can only assume so much risk but will need someone to assume a large share of it.

But the problem here is that you cannot assume that the biggest pool will be the cheapest pool. Why? Because at the end of the day, the risk is the same, all you've done is to spread it out more. So the small companies will enjoy a rate reduction, while the large companies will not be so happy. Now there's a lot to be said about that since it would obviously help small business, but it really doesn't do all that much for you in terms of finding a way to squeeze the fat out of the system. One possible thought you could have would be for the government to create a stop-loss pool where employers have to pay in for the right to draw out funds. It essentially becomes the financial backing for the system although at the end of the day those dollars are still coming from the public.

Still, you're not going to see the returns there that you would if you made the administrative end of this more efficient by simply leveling the playing field.

[Lydia Leftcoast]

63. But isn't the "pool" really a fiction?

I am self-employed and pay through the nose for insurance, supposedly because I'm a "pool" of one.

But in fact, there isn't a separate drawer full of my premium money. In actual fact, all the company's money is in one big pot, and the "pool" system is just a lame excuse to penalize some groups for having the gall to have members who get sick.

[BrownOak]

64. Yes... no.... I mean yes....

Yes, the "pool" in the way the insurance company uses it with you and everyone else is a pile of BS. The joke is that if you have a good claims year then pooling will give you an increase, but if you have the bad claims year then pooling will give you an increase. See, it's not a question of you, your company, or your pool being sick, it's a question of carrier profit pressure. Insurance companies, at least the big boys, aren't health companies, they're investment companies. So when the market started sucking out after 9/11 the insurance industry had to make up for those market losses through premium revenues.

Now, that said, it's a natural thing to have increases in health insurance even if the carriers weren't trying to make more money each year. The reason for that is that the cost of health care goes up each year, just like the cost of everything else. What's worse is that this also impacted by what's known as a leveraged trend which makes the increases to your insurance premiums greater than the increase of the cost of services.

The easiest example is that if you consider your premiums as being the pool of money from which your medical claims are paid, along with the other fixed costs. So imagine that you go to the doctor and pay your $20 copay. The original bill was $100 so the insurance company paid $80. The next year, thanks to medical trend, the cost of that same office visit has gone up to $120, a 20% increase. Your natural thought would be that your premium should only go up 20%. But if you don't change your copay then what happens is that you give them your $20 and now the insurance company is looking at a bill of $100, not $80. So the increase for the insurance company is 25%. Of course, when I say the insurance company, I mean you since it's really your money going into the premium. And even more ironic, is that when we talk about medical trend, one of the things that drives up those costs is the strain of the provider system who are struggling under the problems I described in the post above.

Finally, regarding pooling, there really is a pool. That pool is essentially the number of people you have insured. The whole concept of insurance is that by everybody paying a portion you can limit the impact of a single person's claims. (Ironically, this is pretty much a socialist thought.) So if you have a pool of insureds that is a total of two people, and one person has $4000 worth of medical expenses and the other has nothing, you could cover both of them with a premium of $2000 each. Now take those same two guys and then multiply them and you get the point - spread the risk out over a larger group of people and you can predict and manage the costs.

So the idea of the insurance pool is basically all the claims that are incurred by people in the system. That's the amount of risk that you have to spread out. In reality, that risk will actually go up substantially immediately because there's a bunch of people who aren't getting medical care because they lack insurance. The system's pretty content to ignore them until they either demand medical service or they do the polite thing and just die. Preferably they'll do it quietly so the fucking hypocrisy of the whole thing doesn't bother the guys running these large carriers while they're on their way to Vail or Palm Springs on their private jets. But I digress....

So you'll see a blip in claims for a few years but the hope is that after that things should go down because you would have a decrease (not counting for trend) because people will be hopefully getting more wellness care if they have insurance. If you think about the number of women who don't get mammograms because they can't afford it and aren't aware of the places where they can get one for free, and then think about how easy it is to deal with breast cancer if it's caught early enough, you get the idea. But I digress even more....

Anyhow, the bottom line on the pooling is that generally, the more people you have in a pool, the less overall risk you have. That does have a point of diminished return though so the idea that the largest pool would make the greatest savings is somewhat flawed. Hope that helps and sorry to ramble a bit there.

[eridani]

68. Everybody in, nobody out

The entire population of the country in ONE risk pool is as cheap as it could possibly be.

[FrenchieCat]

41. Agreed!

But we have to be "smart" about it....cause besides the fact that it is the solution to our health care problems and we need it, what's important politically is how we frame this very important issue with a plan to get there.......cause that's the "KEY".

http://www.mydd.com/story/2006/1/30/17455/5250
Wes Clark Endorses Transition to Single-Payer
by Scott Shields, Mon Jan 30, 2006 at 05:34:10 PM EST

[flaminbats]

42. neocons love pushing for entitlement reform...

what arguments do Republicans use for "reforming Medicare and Social Security?"

they argue that the baby boomers will take more out than the workers will be paying in, that "entitlement reform" is needed if we wish to keep Social Security solvent, and that younger workers will not pay higher taxes to provide healthcare for the baby boomers.

My response to them is always the same..singlepayer healthcare! Under single-payer healthcare..the payroll tax may be higher, but everyone..young and old is covered. The younger workers would rather pay a higher payroll tax for coverage that doesn't disappear than higher premiums for benefits that legally vanish as they are needed! Just because everyone is covered by Medicare doesn't mean private healthcare becomes nonexistent or rationed!

Neocons hate these arguments...and whenever I push universal Medicare as a form of entitlement reform, the true feelings often come out. Either they want Medicare to be completely abolished..along with the payroll tax, or they want to be covered in return for the money they are paying. Regardless of how they feel, this argument doesn't allow them to dodge the facts. As a neocon is confronted with facts..it becomes more difficult for him to promote any flawless fantasies.

[rucky]

44. We can see it in 10 years (or sooner), if we commit.

it's my #1 issue.

[DrBloodmoney]

53. Count this physician out

without some form of loan-forgiveness. You will never get physicians (*) on-board this idea without this. We are already being squeezed by the HMO's and for-profit hospital corporations. Over the past decade, the best and brightest physicians have moved farther from the front-lines of patient care (primary care physicians) and have increasingly gravitated to the higher compensation found in the subspecialities of medicine. I know that in my graduating class, a very small fraction of the top 1/3 in the class went into primary care. The ones who could (best grades/test scores) went into specialty medicine (me included). The reason: the average loan size for my year was >200,000. My classmates will spend the majority of their professional careers (age 50+) paying that off.

This all translates into far worse care for the healthcare consumer. The less capable physicians have poorer diagnostic skills, which translates into missed diagnoses and undue patient suffering. I certainly wouldn't let my family members be followed by some of the folks in the bottom of my medical school class.

(*): Young physicians (age <40) who missed out on the heyday of financial glory for the medical professional. Post-taxes and overhead these days most primary care physicians make less than six figures of take-home pay.

[BrownOak]

65. I'm interested

Can you tell me the general range difference between what you charge to the biggest insurance company PPO and what you charge to the smallest PPO you deal with on the average CPT code?

[eridani]

89. Loan forgiveness is a great idea IMO.

In Canada, the government picks up most of the tab for medical education.

[Lydia Leftcoast]

96. Until the mid-1970s, there were programs of loan forgiveness

for medical students if they went to practice in designated poverty areas for a certain number of years. (There was a similar program for prospective teachers.)

This would both provide financial relief to graduating doctors but also provide medical services to underserved areas, especially rural areas. Practice in a rural area or an inner city public hospital or clinic for x number of years and your loans are forgiven.

I'm not so inclined to forgive loans for doctors who aim to become plastic surgeons in Beverly Hills. :-)

[area51]

54. kick. (n/t)

[Strawman]

55. it's the fairest and makes economic sense, but unlikely

45 million uninsured is alot of people, but how many of the uninsured vote? Alot of them can't because they're children (10 million http://www.amsa.org/cph/CHIPfact.cfm).

Most people still do have some insurance and I'm skeptical if those people will care enough or want to risk being pushed onto insurance they fear might be worse (even if it's not).

We should have had universal health insurance decades ago.

We will have universal health insurance when a majority of people are uninsured. Right now about 16% of the population are uninsured. http://www.usatoday.com/money/perfi/insurance/2005-08-30-uninsured-usat_x.htm?csp=34

It's inevitable. We will have universal health insurance because the for profit insurance companies have to keep squeezing more money out of the system to make the stockholders happy. It won't be long before less than half of US employees get coverage through work. As it is right now the coverage people do get from work is increasingly lousy and the copays are less and less affordable.

But like everything in this country people will just keep kicking that can down the road and driving to work in their big stupid SUV's... until their jobs get outsourced. Then as they're scraping their W'04 stickers off the bumper and contemplating the $600 or so/month of their unemployment that's going to COBRA, they'll wonder how everything went so wrong.

[Phoebe Loosinhouse]

57. A story that will shock you to your core!!!! (not)

Shocking testimony reveals huge Blue Cross of California abuses
by nyceve
Wed Apr 26, 2006 at 05:31:41 AM PDT
The Los Angeles Times is reporting this morning brazen abuses, dare I say possible criminal activity, by Blue Cross of California

I think after you read this, when you stop shaking with rage, you will understand perfectly well why we must demand single payer healthcare in the United States of America.

There is a deadly inherent conflict between for-profit insurance companies, and the health needs of the American people.

http://dailykos.com/storyonly/2006/4/26/83141/1167

[stepnw1f]

72. Why Isn't This on the Front Page

Jesus Christ on a crutch. This is fucking important! The Duke rape story gets more attention than something good and positive like this. What's wrong with people?

[brook]

85. I believe

the only way we will get national health care is state by state. I urge all Californians to visit this site. Read it and spread the word. I just left a doctor's visit and made sure they had the web address.I leave brochures at some offices and mention it every at every opportunity. We have had a speaker at each of our town's Council meetings for a couple of months. Decent medical care is doable but everyone must do their part to inform the public.

[triguy46]

94. 50% of healthcare in US IS single payer...Medicare. n/t