Commentary: The case for a single payer health plan »
Posted By bluetexasvalley 5 months, 1 week ago in Health & Fitness
Medicare advocate Judith Stein says only a public health plan would reduce costs, guarantee choice of doctors and assure quality care for everyone—the requirements for a national health care plan as spelled out by President Obama.
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bluetexasvalley
I am a 60-plus widow, retired after almost 40 years in the newspaper business. My love of politics was learned, first, from my father, a ...
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bluetexasvalley5 months, 1 week ago
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FTA:
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A public plan offers significant savings in administrative costs, savings that private plans have been unable to match. Currently the administrative cost of Medicare at approximately 2 percent, and the administrative cost for private insurance is approximately 19 percent. Estimates are that more than $350 billion could be saved with simplified single-payer administration.
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Unlike a fragmented system of private plans with limited geographic reach and provider networks, a public plan, like Medicare, would be available to anyone, anywhere in the country. This lets beneficiaries stay with the health care providers they have chosen, and to choose their providers in the future, rather than being forced into a limited network of participating providers. This choice – of doctors and other health care providers – is the choice that really matters to people.
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According to Jacob Hacker, a professor of political science at Berkley and a fellow at the New America Foundation, an AARP survey shows that 80 percent of people with Medicare are either "extremely" or "very satisfied" with their health care coverage and with access to their physicians. This is a higher rate than that for 50- to 64-year-olds with private insurance. -
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Charlson5 months, 1 week ago
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AbuAmirahComment removed: Spammer, Hard Banned
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flyonthewallzz5 months, 1 week ago
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I agree, (I think?).
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I think focusing on bringing cost down and then offering the option to buy into a government run cost neutral health insurance program (to compete with industry) is the way to go. Perhaps with the option to buy a high deductible low cost option that would cover catastrophic stuff (say over $10G).
It would be cool, if one could put a Family Practitioner on retainer and then pay a reasonable amount for regular visits.
If the purchase price was on par or even a wee bit higher than what companies with more than 500 employees pay, I think a lot of small businesses and self-employed folks would benefit.
I think it is a battle that can be won.
And I think That is the Battle Obama has chosen, and I approve.
I think fighting for "Socialized medicine" in this country would be similar to tilting windmills.
I have been looking at IRS spreadsheets, and the industry tells the IRS and it's stockholders that it is only operating at a 7.6% profit margin (they deduct 23% for "OTHER").
If the government is so inefficient, then why would the industry fear completion from it?
I think there are about 1/4 of a million college educated folks sitting in cubicals for the insurance industry (9% of industry receipts).
I do not think it would be wise to pull the rug out from under them.
But a few haircuts may be in order.
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willottica-245 months, 1 week ago
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I think single-payer works well for us in Canada, but it could be better.
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1. One thing that is missing in Canada though, is an accounting of the costs to the users.
It's one thing to go in thinking that health care is completely free. This encourages visits to emergency for a runny nose.
If, on the other hand, the Canadian system would present users with an itemized list of costs, they might be able to curtail their own wasteful usage. Show them that their hypochondriatic trip to the hospital really costs $1000 to taxpayers (not nothing) and they might go to their family doctor instead. Or to their pharmacist. Or just stay home.
2. Next thing to improve, have a nominal per-visit fee. Make this fee lower for regular doctor visits, higher for emergency room service. This would encourage triage outside of hospitals.
3. Let doctors do triage properly. If a family doctor is going to recommend that you go to the hospital, have him able to call ahead, so that you don't have to wait in Emergency when you get there. Have him able to schedule you an appointment for whatever it is he thinks you need at the hospital, so you don't have to waste valuable hospital resources in waiting rooms or short-term beds.
4. More family doctors. Encourage them. They're cheaper, provide more personalized service because they know your medical history. Walk-in clinics are fine and dandy, but access to them can discourage the selection of a family doctor. Walk-in clinics and emergency rooms should provide references to family doctors who are accepting new patients. They should do this not when asked, but whenever anyone comes in who could have better been served by seeing a family doctor first.-
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chevydog5 months ago
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Think that we've settled into a single payer vs. current discussion way too early in the game. There are clearly many things wrong with our current system. Maybe single payer can fix some of them. One thing I'd like to see done is akin to what you've started-- set up a hypothetical system, look at its shortcomings, and maybe see what's needed to address them. The best solutions are seldom "pure"; though sometimes they touch places we'd rather not.
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Philosophically we're into a different game with single payer as well. We socialize the costs of certain things -- military, roads, and education come to mind-- without a second thought. We do this on the basis that the benefits are socialized as well. But you and I can both think of (maybe isolated) cases in which they are not. These maybe isolated cases are the things that certain politicians turn into "normal" because politicians can't exist without causes. These are things they do routinely to generate them.
Anyway, if we're going to be getting into socializing the health care costs, should we not be having the discussion as to whether benefits are socialized enough or what to do to insure that they are? Otherwise you have warfare between the "haves" and "have nots" just like you do now.
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memestryker5 months, 1 week ago
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The unspoken truth is that we are always creating jobs through a socialist mechanism--welfare--sometimes it's to build parks, sometimes it's to get business moving forward, and sometimes it's to move paper among healthcare providers. Welfare isn't always going to the poor. It goes anywhere leaders think they can jumpstart employment.
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All of it is actually ways the government uses to keep people working and keep the economy flush.
Healthcare has been used as such a mechanism most recently. We've created all sorts of make-work jobs to transfer files around, "manage" it to keep people from deciding for themselves what services they need, and keep doctors from making those decisions.
We've created groups to handle so-called "out-sourced" work as we attempt to force-fit it to the "core-competency" dogma. An individual may have to call 5 or 6 different organizations to get one type of healthcare, since no one is allowed to control a "supply chain" from beginning to end. The dogma contends that this allows those with core competencies to compete and keeps costs down for everyone.
But the new layers of middlemen, who attempt to forward forms among them and keep various databases up-to-date, have learned the hard way how complex this is. So paperwork would obviously be more efficiently done if a single database were used and the middlemen were cut out--but this model created alot of jobs and those workers spend money, thus putting it back into the economy.
Neither the single-provider model nor the core-compentencies model is a panacea. Both clean up the corruption of the other, and both introduce and eventually build their own flavor of corruption over time, so both develop glaring problems.
Ask Americans who work at places like the World Bank and have to travel a lot what kind of care they receive various places when they use the in-country healthcare rather than visiting fee-based providers who still exist to serve those who have money to spend. -
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pokydoke5 months, 1 week ago
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Our current system is a mess and even worse for those who can't afford it. My wife works for a larger company and she gets fairly good private health care but it is expensive and they deny services all the time and you have to fight to get them. The Company that I work for is very small and they offer no medical coverage at all. I live in Mass and I can get coverage through the state if need be and the cost is pro rated for my earnings. If I lived in Miss I'd get squat if my wife lost her job.It should not matter where you live you should be able to have descent health care at affordable rates.
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memestryker5 months, 1 week ago
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If the government is going to provide healthcare, it should have more control over the population it serves. It should be able to limit the number of children a couple can have or the number of immigrants allowed into the country. Otherwise costs can spiral out of control and cannot guarantee decent healhcare at affordable rates over time.
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beavith15 months, 1 week ago
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the post, to me anyway, amounts to so much handwaving.
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'should' reduce costs and 'will' provide better care.
call me skeptical. why 'should' it or why will 'it'? because she's studied it and she's confident?
great.
i look at social security, medicare and medicaid and i keep shaking my head.
not fer nothing, but the banking crisis continues on. why is health care now suddenly a hot rush job? if the economy is busted, how is universal health care supposed to be paid for?-
HomerJS49Comment removed: Abusive
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dunkirk5 months, 1 week ago
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Seems the stimulus is working, you seem to deny that as can be expected. Why wouldnt universal health care be an improvement over the current situation? The big claim the right makes is we have the best healthcare in the world yet continually overlook that its completely useless if u cant afford it.
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truthiness5 months, 1 week ago
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if yu read all they way through she points out that currently medicare has 2% administrative cost while private insurance has 19% administrative costs.. that's not a should, thats a fact.
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she also points out that private insurance pays for a profit margin, medicare does not. again facts.
these are just two examples of the many ways medicare is cheaper and more efficient.
as to where does the money come from, everyone who is currently paying insurance premium, will instead pay a cheaper insurance tax. added to the above reasons it will be cheaper are the following:
my boss and I currently pay into my private insurance. we also pay taxes into the insurance for 1) fed. politicians, 2) state politicians, 3) fed. civil servants, 4) state civil servants, 5) medicare, 6) medicaid, 7) schipp/chipp, 8) veterans, and 9) active military
none of whom pay into our private insurance. by eliminating those 9 programs and combining them into a single payer you make things cheaper just by reducing the amount of bureaucracy.
now, assuming 5-9 will remain on the taxpayer dole for obvious reasons, once 1-4 start paying their fair share that will also significantly decrease the amount of money you and I are paying per month.
these are the facts. true they have not yet come to be. but they are the facts of the case.-
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truthiness5 months, 1 week ago
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I forgot to add that many of the 44 million who currently cannot afford insurance, would be able to if it was just a little bit cheaper per month. I know when I was without insurance due to cost and being self-employed $25/month would have made the difference.
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Natureboy5 months ago
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"none of whom pay into our private insurance. by eliminating those 9 programs and combining them into a single payer you make things cheaper just by reducing the amount of bureaucracy."
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Exactly. Administrative simplification offers huge benefits. Those who have not worked for a medical provider chasing insurance money have no concept of how ridiculously and needlessly complicated the current system is. -
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Natureboy5 months ago
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You're just barely touching on it.
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You have a patient's chart in front of you. He has VA coverage, Medicare, Medicaid, and worker's compensation due to a work-related medical condition.
Who you bill first depends on his choice in the case of VA vs Medicare, on which diagnoses are being treated in the case of workers comp vs the rest. Your company has contracts with each of these payors, with different reimbursement rates for each procedure. Because of this, any given procedure will have a different contractual allowance depending on which payor is billed. Additionally, coordination of benefit rules factor in, and the maximum allowable can in some cases be determined by a secondary or tertiary payor. How much revenue do you book for each procedure and how easy is it to correct if you made a misstep? If you fail to identify the correct primary payor, how long will it take you to identify the problem and reissue the bill to the correct payor? Once you receive partial payment from Medicare, how long will it take you to chase secondary payment from Medicaid?
This, vs single payor.
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jordan115 months, 1 week ago
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Devil's advocate here;
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1. With everyone in the same pool, there is money to pay for the higher costs of the best in care.
2. keeping private health plans in place could give one segment of society access to better health care. Otherwise, why would anyone want to pay more for the same services?-
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truthiness5 months, 1 week ago
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1. yes
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2. true, but part of the deal when living free. success has its benefits. right now we have public education which everyone pays for, and some people still choose to buy private education. is that unfair? maybe. would it be unfair to tell them they can't. yes.
more money isn't the answer to better education, efficiency in the system is. the same is true with health insurance.. our system is incredibly inefficient. single payer would provide cheaper access to the same care we are currently getting.. how many people who can pay more will do so for the off chance they may need the super duper brain surgery?
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lloydm655 months, 1 week ago
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If someone can offer me a better deal fine.I've had the same health care for thirty five years.My wife signed up for it,and chose the best.TR3 Texas teachers insurance.In order to afford this health policy we give up the big SUV,and kept our cars running by maintaining them.I'm on medicare now my wife died,I still maintain my health plan.Take it from me medicare with out part B,and a supplement,is a losing proposition.Most Hospitals,and Dr's offices won't take you.
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Natureboy5 months ago
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"Take it from me medicare with out part B,and a supplement,is a losing proposition.Most Hospitals,and Dr's offices won't take you."
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That's a given, Lloyd. Medicare Part A only covers inpatient (hospital, nursing home) stays. It is Part B that pays for physician's visits, outpatient care, surgeries, etc.
Most medical practices do gladly accept Medicare, as long as you have Part B so it will pay for the services they provide. -
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truthiness5 months, 1 week ago
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I am extremely happy to finally see someone make this case with facts and figures on the public stage. The case I (and others) have been making in private conversations and on forums like this for a long time.
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the only addition I would make is some sort of copay (above the base tax) system for dependants of those who earn more than the $x (poverty line) per year while not being retired. -
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Ratskii5 months ago
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While there are potential upfront costs with a single payer system, there are numerous long terms savings also.
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1) Better preventative practices that will reduce health costs in the long term.
2) Reduction of administrative costs (estimates are that administrative costs eat up 25 to 30% of the health care dollar under our current system).
3) Long term improvements in getting health care to the poorest segment of the population which will improve America's standing compared to the rest of the world (Last I saw we ranked 17th among all nations).
4) Easier availability of statistical analysis to determine which treatments are effective and which aren't.-
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chevydog5 months ago
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Summarizes things nicely. Just to comment :
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(1) I've never quite been convinced that "prevention" is not a feel-good thing rather than something that actually prevents.
(2) I agree.
(3) Mixed feelings. Not all lack of health care is due to lack of income/job; there is a segment that doesn't get it due to lack of physical availability. This can (and should) be addressed outside reforming the insurance situation.
(4) Also mixed. Of course, this can be done more easily if there is only one system. Otherwise, seems to me that this is more of a psychological problem than anything.
Bottom line, to me-- this is being driven mostly by cost and secondarily by the number of people left uncovered. The other things are improvements that can be supported outside of cost and coverage. But we do need the problem of physical coverage, e.g. rural folks, addressed.
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Georgia505 months ago
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Better choice of doctors?
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Uh huh. Sure.
Patient: "Which doctors can I see for this treatment?"
Government idiot: "Well, let's see...your procedure is not offered in St. Paul, so you'll have to travel to Cincinnati. The specialist there will be on vacation for two weeks. He's booked for the next 8 months. Ah...here's a slot...assuming you live until the end of November, you can see Dr. Smith in Cincinnati on November 14, 4:00 pm."
Patient: "But I will lose over $700 in trip deposits for a cruise we have planned! I can't go then!
Government idiot: "Sure, but this would have cost you a $20 co-pay under pre-Obama. And you would've had to accept treatment right here in St. Paul. The specialist in Cincinnati under Obamacare is free, and you get to travel. We don't pay for the travel, of course."
Patient: "This sucks! I want the old healthcare system back!"
Government idiot: "Uh huh. That's gonna happen. Obamacare is now the nation's biggest employer, and we're all politically involved. By the way, do you vote Republican or Democrat? You know that November slot IS reserved for a Democrat, don't you?"-
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Tangent0015 months ago
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Here's how it works now for millions of Americans:
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Patient: "Which doctors can I see for this treatment?"
Hospital staffer: "Do you have insurance or do you qualify for Medicare?"
Patient: "No."
Hospital staffer: "Then you can't see anyone. Bye now."
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