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Rescue Plan: Single-payer System Is The Answer To Public Health Insurance Woes
Michael Moore's documentary "Sicko" indicts private health insurance and calls for its abolition. "Sicko" joins an American tradition that includes Lewis Hine's photographs of child laborers (1908) and Harriet Beecher Stowe's antislavery novel "Uncle Tom's Cabin" (1852), two examples among many. But can Moore's theme change our nation in 2007?
Private health insurance, usually obtained if our employers offer it, has dominated access to American medical care for three generations.
Two generations ago, when employer-based private health insurance definitively failed to provide for the elderly and the poor, Medicare and Medicaid were enacted.
As the most recent generation of Americans has grown up, the failures of private health insurance have come to touch each of us in some personal way.
It has failed to:
* Remain affordable. Premiums, co-pays and deductibles mushroom, and employers pass their costs on to employees. Health care benefits present a sticking point in nearly every union contract.
* Cover those who have it. Health care costs related to illness are the main cause of bankruptcies in America, according to a 2005 study by Harvard professors. Astonishingly, of those who were bankrupt because of medical bills, three out of four had health insurance at the outset of their illness.
* Protect the patient-physician relationship. Insurance company interference in decisions that should be made between doctor and patient has become routine. Insurance rules delay and deny payment for diagnostic tests as well as treatments and very often control where a patient may seek care.
* Contain spending. Health costs soar, both per capita and as a percent of gross domestic product.
* Improve quality. The United States lags far behind all other developed nations on a broad index of health outcomes.
* Reverse health disparities. Consider appalling data from the Centers for Disease Control that the ratio of black to white mortality among newborn babies has worsened in recent decades. A study by former Surgeon General David Satcher showed not only that blacks continue to die sooner than whites but that the overall ratio of black to white mortality changed very little between 1960 and 2000.
* Cover the uninsured. Census Bureau data show that more than one in five Americans lack insurance for part of the year and more than one in six have no health insurance for 12 consecutive months or more.
A few years ago, the Journal of the American Medical Association ran a memorable article about the personal suffering and death of victims of our hodgepodge arrangement of access to medical care. The author, a Texas physician, lamented "the system of no system."
Michael Moore calls it "Sicko."
But mainstream politicians recoil from the suggestion that private health insurance has no legitimate role in society, though they repeat the word universal as if in a delirium. Recent state legislation, with the exception of California's single-payer bill, has aimed to rescue private health insurance from a crisis of its own making.
Look at Massachusetts, which this year required individuals to purchase private health insurance. With confusing, expensive and limited-coverage plans, bloated bureaucracy, thousands remaining uninsured and costs continually rising, the bipartisan-supported "Massachusetts miracle" already stumbles toward failure.
Americans know from personal experience that private health insurance ties up an enormous amount of resources in administrative costs and profits at least $350 million annually, according to an article in the New England Journal of Medicine. American and Canadian Medicare both have proven for decades that very low overhead costs are feasible in a public health program.
The resources wasted by private health insurance on administration and profit could be used instead to cover all necessary medical care, for everyone primary care, specialty care, hospital care, dental care, mental health care, home care, rehabilitation, nursing home care and prescription drugs.
Earlier this year, in a New York Times/CBS News poll, 64 percent of those asked agreed that "the federal government should guarantee health insurance to every American."
To share risks, to control costs, to protect the doctor-patient relationship and to reverse shameful disparities, a single-payer system of public health insurance, with everybody in and nobody out, presents the only proposal that is both practical and just.
This is the idea behind a bill in Congress, H.R. 676: "The United States National Health Insurance Act." Among its 78 co-sponsors are Reps. Michael McNulty of Green Island and Maurice Hinchey of Saugerties.
Michael Moore hopes to convince America that our sick-o system of no system, based upon private health insurance, is a disgrace. Can a film move us to embrace a national health program?
See you at the theater!
© 2007 The Times Union
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17 Comments so far
Show AllI don't give a rat's a## about health insurance; I want health care for all. When are journo's going to learn the difference?
I saw SiCKO last night, and it was great. Though doesn't discuss the flaws of other countries' systems, it clearly shows that much more is possibe than what the US currently has. Hopefully this will become a hot topic of discussion soon, with the ramp up to the next presidential election. I'd like to see some candidates take a stand on this, and help the voters clarify who they want to vote for.
One of the things we Americans need to do is start using the right language about healthcare. I shouldn't have to have insurance for it. It is my God given right as a human being to be cared for when sick. When seeing a doctor is seen as a right and not an insurance policy product, there's more chance of fixing what's wrong.
The capitalistic system ceases to work if the business makes the most money when it sells its product those who needs it the least and makes the least or loses money when it sells to those who need their product the most.
"SICO" had a great way of pointing out some of the following problems caused by the PERVERSE INCENTIVES of our medical system.
1) Doctors turn people away who have inadequate or no coverage. . . .
2) Patients forgo treatment until their conditions become urgent. . . .
3) Adults working full-time jobs are advised to go part-time to qualify for Medi-Cal benefits. . . .
4) Others are encouraged to spend down everything they've saved to get public assistance.. . .
5) Hospitals are forced to inflate rates because insurance companies cut reimbursements. . . .
6) We build hospitals without emergency rooms to serve only the insured. . . .
7) Health insurance companies try to sell to the healthiest people and then limit their sales in the area needed the most, pre-existing conditions. . . .
8) We pay for care in the least efficient way possible -- after people get sick and need emergency or hospital care. . . .
With the U.S. medical system the most profit goes to the insurance company that sells the most insurance to the healthiest and avoids covering the neediest.. This leads to a system where everyone has the incentive to do the wrong thing.
So, there is Medigap, Medicare, Medicaid, Medi-Cal, and a medic with medevac, when all that is needed is a Single Payer system.
Arlen
vinlander, that's a tough one. Dennis Kucinich refers to HR676 as Medicare For All, but some people have a recoil reflex about Medicare. Not it's fault, it's being underfunded. The insurance industry is eagerly latching onto the term "universal health care". Unlike the rest of us, they love the Massachusetts model. Right now I'm calling HR676 Health Care For All or single payer health care. Any suggestions?
I saw SiCKO yesterday, it was incredible. Outrageous, heartbreaking, funny.
I asked my son who saw it with me and he said it made him want to move to France. Well, he has just graduated from college with a $30,000 student loan debt and had to hear that the French get to go to college for free. Among many other advantages. But of course, they have their government giving them what they want instead of vice versa. I understood, I felt like it would be a lot easier to just give up on this country since the majority of Americans are so apathetic. I might, but I'm not there yet.
I think what would really chase me out of here is the loss of civil liberties. I want to be free. I'm not feeling very free right now. Anyone who's feeling free is accepting the status quo and I don't.
I keep calling my Congressman, Peter DeFazio, who is considered progressive, but all I get is an office person telling me he's studying it. Last time I called, she said he would make a decision in 6 weeks. How slowly the wheels of justice move. I get the sense everyone in the Senate is holding their breath, hoping it won't get out of the House. I'm calling my Senators anyway. At least they will know where I stand. If enough of us make enough noise, we can create a tipping point. The hard part is getting enough of us.
I just called Nancy Pelosi's office and said it was very important for me for her to support HR676. She's not my Representative but she is my Speaker of the House, and as the most powerful person there I wanted her to know that I didn't think the insurance industry has any business getting rich off our health care needs. I said I have no insurance and am horrified over the idea of a mandated insurance plan; I would be no better off, just poorer.
Kathyodat writes:
I saw SiCKO yesterday, it was incredible. Outrageous, heartbreaking, funny.
I asked my son who saw it with me and he said it made him want to move to France. Well, he has just graduated from college with a $30,000 student loan debt and had to hear that the French get to go to college for free. Among many other advantages.
*************
Count your blessings. I live in a city of one million plus (Jacksonville FL) and the only plzce Sicko is showing is in a theater which is a thirty mile round trip for me and it doesn't even open till 4/6/07.
This despite Sicko topping out at #7 on the weekend revenue figures which puts it ahead of a lot of crap that is playing at multiple locations in my area. Go figure!
Because I remember you mentioning that you were a health professional in another post, I had some questions I wanted your opinion on regarding the terminology being used to frame this whole health care debate. My email is:
tlmac75@yahoo.com
cathy o'dat---
I don't believe Kucinich calls it medicare for all. I believe he calls it by it's right name: "Single-payer Universal Healthcare". John Edwards is noted for calling it medicare for all.
http://www.kucinich.us
Thank you Poet and Brown, and in my own town of Eugene OR, it felt like the opening salvo of this war was fired by our newspaper, the Register-Guard. They posted the wrong times for the four days of weekend opening shows (Friday through Monday) so that when people showed up they would have to wait 2 hours or go home and come back! Being the paranoid that I am, I considered it sabotage. Who is to say if it had a negative impact on how many people actually watched it in Eugene. I guess even a so-called liberal newspaper can learn from the Republicans. Their past history on health care reform helped to discredit them. They were publishing editorials that they were lifting verbatim from insurance industry press releases when Oregon was trying to pass a single payer plan. Our local Peacehealth hospital was also opposed. Of course, the newspaper was full of Peacehealth ads which would have disappeared with singlepayer care. I guess both would have lost. Although as Peacehealth is supposedly nonprofit, why should they care? Never mind, I know why.
I have employer provided health insurance and I am STILL drowning in co-pays, deductibles and ridiculous pharmaceutical costs for prescription medications that I need.
But I'm lucky.
My brother just recently had an accident that required an ambulance trip to the hospital and emergency surgery. He's had to go to the orthopaedic surgeon for follow-up care and now he needs physical therapy in order to be able to return to full health and back to his job.
Unfortunately, he's self employed with no insurance, meaning that for years to come, he'll be drowning in medical bills from this accident. I wish I could help him out financially, but I'm drowning in my own medical bills myself.
It's time for single payer health care NOW. Please call your Congressman or woman and ask them to co-sponsor H.R. 676, the Conyers-Kucinich bill for universal health care.
There's no excuse for the richest country in the world to be forcing nearly 50 million people to go without access to health care and for the rest of us to be paying such high medical bills when we already have insurance. It's a crime.
Likewise, I ask all Ohioans reading this to get involved in your local Progressive Democrats of America chapter (http://www.pdamerica.org) and to get your organisation behind the SPANOhio program (Single Payer Action Network of Ohio, http://www.spanohio.org). When you go see "SiCKO", be sure to leaflet and to get petitions signed to get single payer health care on the November ballot in Ohio.
Universal health care is possible, but we ALL have to make it possible. We can no longer afford to be complacent about this issue, even if you have insurance like me. We must demand a change, we must demand single payer health care for ALL Americans, no matter their employment status, age, medical condition or whatever. This MUST be THE domestic issue of the 21st century and will no doubt be a determining factor in the 2008 Presidential election.
"Of all the forms of inequality, injustice in health care is the most shocking and inhumane." - Dr. Martin Luther King, Jr.
Just reading your comments makes me want to immediately yell to all my fellow Canadians to WATCH THIS FILM! I have viewed it and Moore's movie is incredibly horrifying when as a Canadian, you do not have to jump through the hoops of the American system that calls itself health care. If we are not vigilant, we too will lose this social network that we pay for through a minimal portion of income taxes and take for granted because so many of us have grown up under the system.
It is actually quite recent having been instituted with our Canadian hero, the late Tommy Douglas (a politician who was definitely left leaning - a former leader of our New Democrats, the foremost Canada wide third party). However, the last three administrations, both liberals and tories, have been trying to destabilize our single payer system by cutting back funding which decreases the efficiency of our hospitals and doctors. Then they scream out how inutile and disfunctional the system is and that we would be better off with privatized insurance. NOT!
This is something that is a very hot topic in Canada and should be in the US where you are even less publicly funded for rightful social safety nets. That is why not only Americans should see SiCKO, but also every Canadian who would like to maintain our safety networks.
Kathyodat: France's post secondary education is not free. The students must pay at least 8 Euros a year in fees to attend (that is in American dollars at present, about fifteen dollars). I had a French student in one of my U classes and he told me that was the fee to attend his university -- which also enabled him to apply for out of country education with his tuition covered just as in France. Should Canada ever adopt such a system, count me in. I can easily afford the extra $15 over the nearly 50K$ I presently owe in student loans)
As a student in the late 1980s, I was assigned to read Thomas Moore's "Utopia." During class discussion, I suggested that perhaps the purpose of "Utopia" is not to describe Moore's concept of an ideal society, but to help readers understand that an "ideal society" cannot exist on a large, involuntary scale: no one in my class, regardless of cultural or socioeconomic background, wanted to live in Moore's Utopia. Like those students in my long-ago literature class, Americans who advocate for "single-payer" (perhaps better described as "single-option") healthcare should consider what an AMERICAN socialized-medicine system would very likely entail.
1.) Do we really want the Bush administration (or any other future corporatist and/or authoritarian administration) running the entire American healthcare system?
a.) In the mid-1990s, the county where I live was governed by commissioners whose majority opposed not only abortion but also reliable birth control: during their reign, the county board contracted only with "natural" family-planning clinics to provide services for the county's low-income women. Hormonal birth control was simply not easily available to most women who relied on the county for assistance. Although many insured women do not receive birth-control coverage with their current insurance, some do. Under a socialized-medicine system, the availability of reliable contraception would almost certainly depend upon who occupies positions of political power.
b.) American cultural, religious, and political diversity suggest that we as a nation are unlikely to agree what a socialized system should cover. Preventive care and catastrophic services only? Western medicine only? Certain forms of wholistic medicine, but not others? Also, imagine a Schiavoesque case in an American socialized-medicine setting: would politicians argue for the sanctity of life or the sanctity of a balanced healthcare budget? Whatever the decision, it would be largely outside the control of the patient's family and caregivers.
2.) Having read medical ethics for several years, I know that the current American healthcare system unquestionably discriminates against the poor, but also that socialized medicine discriminates against the sick. By "sick" I do not mean only patients whose serious illnesses are likely to be terminal regardless of what treatment is given or withheld, but those with treatable serious illnesses and chronic, non-fatal conditions. If America provides basic primary care to everyone under a government healthcare budget, who loses? Children with congenital heart disease or children with spina bifida? Adults with chronic renal insufficiency or adults with severe clinical depression? Even with (regrettably) higher tax rates, socialized medicine cannot provide timely, quality care for everyone who needs more than primary/preventive services. Although socialized medicine would not necessarily lead down a slippery slope to an American T4 (the Nazi "euthanasia" program), it is likely to lead to increased emphasis on survival of the fittest.
3.) Some cost-and-quality problems with American medical insurance are directly related to the fact that it is currently a market with few purchasers (employers) and exponential consumers. Although not a panacea, market competition may improve the price of coverage and range of benefits offered. The past 27 years have taught us that the American government is more corporate than benevolent; I would rather pay directly and choose my own medical coverage than pay taxes for what would undoubtedly be a government-funded, corporate-designed (think Kaiser Permanente) system that combines the worst elements of capitalism (high prices) and socialism (limited options).
4.) Many Americans are hungry on a regular basis, but government does not require that everyone live on a food-stamp budget. Many are homeless, yet we are not all limited to public housing. Before supporting socialized medicine, why do we not first demand and create a real safety net for those in need?
5.) Finally, the insurance industry needs reform that will base annual premiums on year-to-year claims experience and other factors. As a person with more than one chronic condition, I believe I should pay more in premiums than someone without any significant medical history. However, I should also receive some "offset credits" for a healthful lifestyle. If an insurance policy had 5 premium-rate tiers, with 1 being the lowest and 5 being the highest, a person who had major surgery in 2007 might be a 4 in 2008, but only a 2 in 2009.
Thank you, thiswoman. Actually, it was in SiCKO that free education in France came up. And it wasn't really free here either. In 1961, it cost $50 a term to register at the University of California. In 1974 it cost $15 a term to register at the community college in Oakland, California. There were no tuition fees at that time.
gershoms horse, you misunderstand the plan. Have you read HR676? It doesn't sound like you have. Why don't you read it before you post your objections? No president will get to decide what will or will not be covered. That is clarified in the bill. Following is the link to the summary website within which is a link to the full measure. And below is the definition of Benefits and Portability from the full measure. There is also a section detailing how it will be paid for.
http://www.healthcare-now.org/hr676.html
SEC. 102. BENEFITS AND PORTABILITY.
(a) In General- The health insurance benefits under this Act cover all medically necessary services, including--
(1) primary care and prevention;
(2) inpatient care;
(3) outpatient care;
(4) emergency care;
(5) prescription drugs;
(6) durable medical equipment;
(7) long term care;
(8) mental health services;
(9) the full scope of dental services (other than cosmetic dentistry);
(10) substance abuse treatment services;
(11) chiropractic services; and
(12) basic vision care and vision correction (other than laser vision correction for cosmetic purposes).
(b) Portability- Such benefits are available through any licensed health care clinician anywhere in the United States that is legally qualified to provide the benefits.
(c) No Cost-sharing- No deductibles, copayments, coinsurance, or other cost-sharing shall be imposed with respect to covered benefits.
Gershoms Horse: Universal single-payer is not socialized medicine, which means that government owns and operates all hospitals/clinics and hires medical staff to provide care.
With single payer, government is the insurer to whom we would all pay premiums through our income taxes, forming one giant risk pool from whom no one is excluded (unlike private insurance that turns away those they feel are likely to get sick). We would have complete freedom of choice when it came to providers, specialists, hospitals, etc.
Hospital emergency rooms would become that again instead of clinics trying mightily to serve the armies of uninsured people who desperately seek their help.
About half of all bankruptcies are due to medical expenses, many of them experienced by people who thought they had insurance.
We would create a healthier populace WHILE SAVING AT LEAST A THIRD OF OUR CURRENT NATIONAL HEALTH CARE BILL.
Only propaganda is keeping us from a single-payer system. I am thankful to (and for) Michael Moore for taking on the task of educating the public in the truth about private insurance. What may once have been a decent system has become a vehicle for the greed of giant corporations instead of help for those they purport to serve.
1.) The difference between "socialized medicine" and "single-payer healthcare" is essentially semantic: when taxpayers fund the entire healthcare system and only politicians control it, government sets ALL the terms, medical as well as financial. Americans who believe that healthcare which is 100% taxpayer-funded and politician-controlled would be accessible, affordable, comprehensive, and timely need to remove their virtual-reality helmets.
2.) In America, large government programs are almost never efficient nor cost-effective. If you disagree, please name at least one that is!
3.) Taxpayer funding of ALL healthcare expenses leads to system overuse, which in turn leads to higher taxes. Why should a system cover "everything" for anyone except the very poor? I earn an average income and have had at least a $500 medical deductible for most of my adult life, yet have known people with much higher incomes who balk at paying ANYTHING out-of-pocket for medical expenses. Only in contemporary America can a family have three cars, two drivers, and five-figure credit-card debt, yet complain about a $50 medical bill and a $15 prescription. Priorities, anyone?
4.) Those most negatively affected by socialized medicine would be the middle class. Socialized medicine almost always results in the development of a "two-tier" healthcare system, the public tier for the poor and middle-class and a private tier for the wealthy. The middle class would be the largest funders of a government-controlled, soon-substandard public tier, but would be unable to afford the private tier.
5.) Canada and the UK do NOT have open-access government-funded healthcare systems, nor would America have one (beyond the short term) due to expense: eventually everything would need approval from a primary-care provider. Primary-care gatekeeping wastes time and money; also, as medical knowledge grows increasingly complex, PCPs simply cannot remain current with everything. For example, my previous PCP (whom I carefully selected based on education, reputation, and hospital affiliation) misdagnosed me at least twice. When I finally saw a specialist, she said misdiagnosis of my condition by PCPs is very common.
6.) Why cover chiropractors but not other practitioners of alternative and complementary treatments? Either cover them all, or cover none.
7.) SOME opposition to socialized medicine is propaganda, but some also results from the experiences of other nations. High taxes, long waits for services, access only to standardized treatments, and care rationing for everyone but the economic and political elite are realities. Be careful what you wish for.
8.) If you believe that American government as we know it is capable of serving the public interest on this or any other issue, where have you been since November 2000? Back to the VR helmet. . .
* * *
Corporatism and socialism share the same toxin: centralized control.
Equality AND diversity
NOT equality = conformity
Gershoms Horse, I suspect I'm wasting my time talking with you because you persist in calling singlepayer health care socialized medicine - a stone-age designation. But you are also disseminating false information. So here goes: I will not reiterate what you are ignoring, but I will say you don't know what you're talking about when you detail what is or is not covered. Obviously you did not follow my suggestion to go to the website and read about it. The bill CLEARLY states that other state licensed care provider professionals also will be reimbursed by the program. The care that is covered is listed, the budget and plan for funding has been developed by policy experts (this isn't really for you, Gershom Horse, because I don't think you are paying attention, but for those your posts are confusing with inaccurate statements).
It's as insane to suggest that single payer works and saves money and lives everywhere in the world it exists but here as it is to say election exit polls accurately reflect the popular vote everywhere but here. Or, as Vinny said in "My Cousin Vinny", 'the law of physics stops here'. We are not quite that unique. But our leaders are spectacularly corrupt. And our media is equally corrupted. Just look at the numbers. We're #37 in health care delivery. #43 in infant mortality. And if you exclude white babies, we bottom out. We're behind every single country in the world with single payer health care with life expectancy. Are you proud yet? They say insanity is to keep on doing the same thing getting the same result and expecting this time will be different. Well, I don't know, but I think it's stupid. I'm smart enough to see the direction we're headed and it isn't good.
kathyodat: accusing me of "disseminating false information," inattention, and ignorance is not only inaccurate, but also inappropriate list behavior.
I have continually analyzed the U.S. healthcare system for 17 years, and have worked for a nonprofit healthcare organization (NOT the insurance industry) for the past eight years. My work involves regular interaction with physicians and physicians-in-training, some of whom are from other nations and have verfied my concerns about government-controlled medicine. It is wrong to discriminate against the poor AND the ill; although I do not know of a simple answer to this ethical and practical problem, I am honest enough to recognize that suboptimal healthcare is not just an American concern.
For more information about government healthcare, please visit the website of the Fraser Institute, a libertarian Canadian organization:
http://www.fraserinstitute.ca
Decide for yourselves.