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Can Incrementalism Be the Path to Universal Health Care?
Governor Spitzer and state lawmakers seek an evidence-based plan that will bring comprehensive health care to all of the people of New York State, a result that almost everyone would like to see.
Unfortunately, the Spitzer administration, along with many health care reformers, continually assert, without providing any evidence, that the best way to universal health care is a series of incremental steps that build upon existing programs to bring targeted populations of the uninsured into the "health care" system.
Incrementalists argue that the public opinion polls showing overwhelming public support - not just for a comprehensive government universal health care financing system but also for radical reform - are misleading. They contend that if one digs deeper, one finds that those with health insurance ("those who actually vote") would rather keep the shrinking (and often already inadequate) coverage they have than see the entire system changed. They murmur that it is not "politically feasible" for our leaders to stand up to the power of the private health insurance industry and big pharma. They redefine the public's desire for choice in doctors to hospitals to instead be choice among which insurance company to contract with. They confuse access to comprehensive health care with expanding health insurance.
Yet the experience in the various states that have tried a variety of "incremental approaches" objectively shows that it will not work. "Bold, new experiments in moving our state to universal health care" have invariably withered away over time, often in only a few years.
For instance, the media coverage over the new "universal" health care system in Massachusetts generally failed to mention similar pronouncements from Governor Dukasis two decades previously that fell apart in a few years. Because Massachusetts expanded its subsidies for insurance premiums for low-income people, over 160,000 of those eligible signed up this year. But only 7% of the nearly 250,000 who must buy unsubsidized insurance -- or face a fine of $2,000 in 2008 -- purchased private health insurance this year. Thus the plan will end its first year at least $147 million over budget, with Massachusetts preparing to cut payments to doctors and hospitals and ramp up out-of-pocket costs for patients. And nearly 500,000 in Massachusetts remain uninsured. Yet the leading Democratic Presidential contenders now embrace Massachusetts' mandate for individual purchase of health insurance.
Maine's patchwork approach to universal health care - the Dirigo plan - is not working. Nor have the plans in Vermont, Minnesota, Washington and Oregon. Tennessee's noteworthy TennCare program to help the poor and uninsured is in the process of being dismantled. NY has added targeted programs such as Child Health Plus and Family Health Plus yet more than 5 million New Yorkers annually lack health insurance.
This fall Vermont launched "Catamount Health," a plan to cover all Vermonters by subsidizing private health insurance from MVP and Blue Cross Blue Shield with a combination of tobacco tax money, Medicaid money and new taxes on employers who don't offer health insurance. But as the plan takes its first steps, the inadequate insurance for those who have it, with soaring co-pays, huge deductibles and unaffordable prescription drugs has put the crisis in health care back into the legislative agenda for 2008, front and center.
In contrast, the experiences in the rest of the industrial world provide ample evidence that a comprehensive approach to universal health care will succeed. Not only do the other major industrial countries spend far less on health care than we do, they cover everyone with better health outcomes, even though we have among the best medical professionals, infrastructure and equipment in the world.
Incremental approaches evade the fundamental problems that are causing the ongoing crisis in our health care system. Real change requires addressing the entire structure of financing -- in which employer-based private health insurance dominates. Without facing this, the problem of costs cannot be solved. Most of the money spent on health care in New York comes from government (federal and state) spending, yet private health insurance dominates the system. As Governor Spitzer has pointed out, NY's system of health care financing is often not directly tied to the services being provided, its complexity and irrationality a result of the backroom deal making at the State Capitol.
Incremental approaches have done little to nothing to control costs, while adding more people to the system, thus causing more financial strain on both the government and private sectors, especially in bad economic times. The various stakeholders such as hospitals and insurance companies often actually extract more resources as a result of the political negotiations over expanding access to health care (i.e., ok, you can cover more people but we need to extract higher payments in exchange).
Costs increase over time as health care costs in general continue to rise above the rate of inflation and more people utilize the new programs. Thus states find that they simply cannot afford incremental improvement, and so they must manage an incremental retreat. They end up pushing the costs of the health crisis problem back onto individuals by raising premiums, co-pays and deductibles, through roadblocks to limit participation in government programs and by whittling away at health services.
Perhaps the most fundamental difference between the US and the rest of the industrial world is that we allow health care to be treated as a commodity that is bought and sold on the open market, with the profit motive as a major factor. Access to health care is often based on the ability to pay rather than on need. The profit motive propels the US towards a "sick care" system, even though it is more expensive to cure people once they are ill rather than keeping them healthy. Incremental approaches fail to address these basic problems.
By definition, incremental approaches fall far short of universal coverage. The incremental approach also mistakenly often defines "universal" as everyone having access to health insurance, when what we need is a system that offers comprehensive care to all. Having everyone "in" one system provides a variety of ways to save costs, both within and without the health care system (e.g., reduction in costs impacted by health care such as workers' comp and automobile insurance.)
Take for instance computerized medical records, something that everyone agrees we need. In a fragmented for-profit system individual "players" such as HMOs won't make such common-sense investments since the immediate bottom line, not the long-term interests of the patient or society, prevail. In contrast, a true universal health care system will need to build in incentives for the use of computerized records, in order to allow medical providers demonstrate their efforts to keep the population healthy and to systematically address areas of high cost such as chronic illnesses.
The incremental approach often underestimates the number of uninsured and the problems they face. Every one has heard there are 47 million uninsured in America but few realize that the Census Bureau defines that number by those who lack insurance for the entire year. Perhaps twice as many go without health insurance for some time during any one-year. Thus it is impossible for a program that expands subsidies for private insurance to offer true health security to those who unexpectedly find themselves uninsured.
Further, those who are uninsured but live in medically under-served areas may finally find a way to pay for health care, for instance under New York's Family Health Plus, but that fact by itself will not necessarily bring health care facilities or providers any closer to their door. And they may remain unable to find doctors in their communities willing to accept the reimbursement rates provided (e.g., Medicaid for certain services such as dental care.) Then there is the problem of people who have inadequate insurance. A 2003 Commonwealth study estimated that 16 million adults have inadequate insurance. In September 2007 Consumer Reports found that 29 percent of people with health insurance have coverage so meager they often avoid necessary medical care because of costs, that 43 percent of people with insurance feel unprepared to cope with a costly medical emergency, and that 20 percent were so dissatisfied with their HMO or PPO that they hoped to switch plans.
Worse, most people don't realize they have inadequate insurance until they need it. Private insurance companies increase their profits by denying services to those they insure. As a result, high health care bills now account for a majority of bankruptcy filings, yet 3 out of 4 such individuals had health insurance when they become ill.
Thus at least a third of the American population suffers from a lack of adequate health insurance.
Incremental efforts, by definition, fail to offer comprehensive health solutions. We need a plan for health care that will provide all necessary medical care. This means emergency, primary and preventive care, necessary specialty care including prenatal care, acute hospital care, rehabilitative services, home care, nursing home care, dental care, mental health care, eye care. Look at nursing home care. Medicaid is in crisis, entangling our nursing homes and our county governments. Incremental expansions may be much more likely to exacerbate than to alleviate such problems.
Most experts who study health care admit that a single payer Medicare for all Style program does best at achieving the goals of providing quality, affordable health care to all. Single payer means one entity pays all bills but it doesn't run the delivery system ( e.g., doctors, hospitals). Single payer proposals, by eliminating the cost and bureaucracy of private health insurance, manage to bring everyone in while actually saving costs. Single payer has been rated best by every state that has undertaking the comprehensive cost-benefit analyses of universal health care that New York is presently starting. The single payer proposals are almost always the only ones that meet the goal of actually bringing the entire population into the health care system (i.e., universal coverage.)
Yet many elected officials and health care reformers contend that single payer is not politically feasible, largely due to the opposition of special interests starting with the private health insurance companies that would no longer be needed. Many argue that the massive amounts of money spent by the insurance industry to defeat the Clinton health care plan in 1994, highlighted by their Harry and Louise ads, shows that they can't be defeated. This argument however ignores that Clinton explicitly rejected a single payer approach, deciding instead to try to buy the support of the various stakeholders by throwing money at them in her proposal. The result was so complex and convoluted that many single payer advocates agreed that it should be defeated. The lesson arguably is not that a single payer proposal has no chance but rather that half-baked, flawed incremental approaches are doomed to failure.
Proponents of incrementalism tend to avoid the reality that the special interests oppose many of their proposals anyway, since most involve a reduction of their market share and funding. So right from the start incrementalists have weakened the impact of potential reforms without receiving any concessions in return from the major opponents. Incrementalists accommodate rather than resolve the fundamentally negative impact of private health insurance on health care delivery; indeed, the "reforms" that have been enacted have invariably strengthened rather than curtailed private insurance companies. Incrementalism unfortunately also undercuts the momentum for more comprehensive, effective reforms.
Others argue that moving to a single payer system - despite its positive impacts across the board on issues such as cost, coverage, access, choice, etc. - would be too disruptive, starting with the hospitals, doctors and insurance companies.. More "time" is needed to allow everyone to "adjust" to the new reality. However, little evidence has been presented to back up this assertion.
It should be noted that a number of industrial countries do have multipayer systems. What they don't have is our system of private health insurance, where doctors are forced to navigate a maze of companies, many of them for profit, with their own rules and paperwork. As much as a third of every health care dollar touched by private insurance firms goes to pay for their existence, paperwork and profit. In America, despite the fact that more than 60% of health care costs are now paid directly for by the government (e.g., Medicare and Medicaid), we allow private health insurance to dictate much of the terms of the health care system. In all other industrial countries, the health care system is determined through their system of representative democracy. If private insurance is allowed, it plays a minor supplemental role, operating under strict rules determined by the government, with no role for profit.
The chorus of calls for incremental reform has fallen badly out of tune with respect to what the people of New York want for their health care system and hopelessly out of tempo with what people need for their personal health and security. When Governor Spitzer weighs the evidence he will find that only a single payer system can provide affordable, comprehensive health care for all New Yorkers.
Mark Dunlea is Executive Director of the Hunger Action Network of New York State and a long-time advocate of single payer health care.
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58 Comments so far
Show AllWhy don't we just look at what France did and copy it. Why try and invent a square wheel.
Can Incrementalism Be the Path to Universal Health Care?
Universal? (mandatory giveaways to HMOs & Big Pharma so they can murder us for profits) or Single Payer Medicare for all? Big difference
Either way, of course it can, just like incrementalism can end war, one bullet at a time. "See? We're making progress. We have only 7x10 to the 9th power left and by 2813 war will be part of our past." And we'll have Single Payer Medicare for all about the same time.
Entrenched power will kill us to maintain their control over our lives. Don't doubt it. There is no difference between these monsters and the men who would rape your children. Worse, they'll kill your children, for huge profits, by withholding medical care - DON'T YOU DOUBT IT FOR A MINUTE. Profits over humans.
Peace all.
I've never quite understood the push behind "Single Payer" systems. We already have what amounts to a two tier system, Private health insurance and Medicare for the elderly/medicaid for the disabled. It would seem simple enough to provide those under the poverty level with expanded Medicare/Medicaid and those above it would be required to pay for health insurance, thus expanding the pool of those covered by private insurance. If a person was fired, layed off, became injured and fell below the poverty line then they would be eligible for the expanded gov't program. Kinda like s-Chip but without the age requirement.
Why don't we just look at what France did and copy it. Why try and invent a square wheel...
Come on, we should copy the obviously inferior frogs, limeys, krauts, spanyards, canucks, japs and other foreigners? Do we copy their incomprehensible measurement system? Their un-American ICC? Their anti-Free Enterprise precuationary principle based environmental and food-safety laws? Their decadent 36 hour work weeks, mandatory 4-week vacations, and 6-month paid family leave? Their IPCC global warming scaremongering? Their socialistic public transportation, teeny teeny tiny cars, bicycles and those comical scooters the dagos ride? Their athiestic secular humanism? Are you for a socialistic one-world-government of something.
Don't you know that everything here is the best?
"Can Incrementalism Be the Path to Universal Health Care?"
Easiest question ever.
If the elected representatives who want incrementalism are NOT accepting donations from big pharma and for-profits hospitals, the answer is YES.
If the elected representatives who want incrementalism ARE accepting donations from big pharma and for-profits hospitals, the answer is NO.
Democrats and Republicans accept huge amounts of donations from healthcare industry special interests, therefore, they are extremely unlikely to support single-payer healthcare, and very unlikely to try to advance incrementally.
How did Tommy Douglas, the father of medicare do it?
Health
1944-1948 – Premier Douglas assumed the role of Health Minister during the first term of his government, during which time the first steps towards Medicare were taken. New policies and building projects were based partly on the recommendations of the new Health Services Planning Commission. Major innovations included:
* Free health care for pensioners,
* Free psychiatric hospital treatment for the mentally ill, as well as the construction of Mental Health Clinics,
* Free cancer treatment for those in need,
* The creation of the first comprehensive health services region,
* Construction of new health care facilities,
* The creation of the College of Medicine at the University of Saskatchewan,
* Air Ambulance to transport those in rural areas to central or regional hospitals.
January 1, 1947 – Douglas created Canada's first universal and compulsory hospital insurance program – the Universal Hospital Services plan. It was the first program in North America to provide complete benefits to all residents. The legislation offered:
* Expanded hospital facilities (21 new hospitals over 4 years),
* X-rays and lab services,
* Common drugs and other hospital services,
* Compensation for a share of out of province medical costs,
* With payment for the insurance at a rate of $5 per person to a maximum of $30 per family.
April 25,1959 – Douglas announced his government's revolutionary intention to introduce a universal and comprehensive medical care insurance program for the province. Nearing the end of his government's fourth term in office, and with Prime Minister Diefenbaker's newfound willingness to share in the cost of any universal health plan developed by a provincial government, the time was right for Douglas to proceed with his vision. His plan, however, was strongly opposed by the College of Physicians and Surgeons of Saskatchewan, which not only governed and upheld the competency of the province's medical professionals, but also protected the interests of the doctors.
June 8, 1960 – Douglas and his CCF Party's overwhelming election victory represented the public approval necessary to bring the universal health insurance plan to fruition. Medicare, the revolutionary part of their election platform, was founded upon the following three major themes:
* A public system was necessary because a universal and comprehensive healthcare package would require citizens of the province to pay extremely high private insurance premiums,
* A lot of public money was needed to fund such an extensive program,
* The largesse of the program would require the government to be accountable for it's management.
November 17, 1961 – Saskatchewan Medical Care Insurance Act
The Act, put into legislation by new CCF Premier Woodrow S. Lloyd mere weeks after replacing the departed Tommy Douglas, gave the Medical Care Insurance Commission the power to run the new universal insurance system. In 1962 when the program came into effect, the premiums that replaced the payments for private insurance were $12 per individual per year or $24 for families. All Saskatchewanians would collectively pay for those who were sick, and all could be reassured that a terrible illness in the family wouldn't lead to bankruptcy.
http://www.tommydouglas.ca/tommy/achievements
Hmmmm....it's almost as it canadian voters voted into power a political party that pursued actual healthcare improvements.
Meanwhile in the US, liberals keep voting for democrats that have NO intention of pursuing healthcare improvements.
Face it, Democrats held majorities in congress almost continuously from the end of WWII to 1994, and NEVER implement universal healthcare.
I don't hold republicans to blame for this- I expect them to try and stop universal healthcare, I blame corporate-owned democrats for not implementing it, and using it as bait to manipulate liberals into voting for democrats.
The plight of obsolete HMOs wrings my heart, like those poor laid off old growth loggers who were too dumb to learn anything else and the unhappy German prison camp guards tossed out onto the street when they were no longer needed. Boo hoo.
Apart from practicability, it would be satisfying to put the men and women of the insurance, pharmaceutical and health maintenance industries into a long unemployment line all at once, overnight. Unlike the people in today's unemployment lines, their situation would not be so bad. They'd have free health care while they were looking for real jobs
dlnelson7, PJD: Maybe France should be our little secret. We might want to move there ourselves someday, and it would be better if the place was not flooded with American refugees.
keyinside is correct.
The rank-and-file liberals keep electing Blue Dogs and DLC hacks who in return ABUSE their votes and side with the sellouts. Osama bin Laden couldn't ask for more ! With "Democrats" like these, who the fuck needs Republicans ?!?!?
Recently a friend of mine who is disabled for a variety of reasons (one being asbestos poisoning for which he is supposed to receive some kind of compensation but it's still "pending") had a heart attack. He was taken to the hospital where they put shunts of some kind in as a temporary measure. The doctor told him he needs a quaduple bipass, and if he'd had insurance, it would have been done immediately.
Instead, my friend has to wait for some kind of medical assistance to be approved. This guy is really disabled. He is always out of breath and has a hard time getting around. But he hasn't been approved yet, so his bipass is on hold.
If my friend has another heart attack while he's waiting, it will likely be fatal. In the meantime, people like him are marginalized while "the most powerful country with the most advanced health care system in the world" lets its citizens die for lack of insurance.
And we are told that the Muslim world hates us for our freedoms. Like, I suppose, the freedom to be sick or die all on our own.
pjd , you are correct , they will put you on xanax for anything from p.m.s to an ingrown toenail , whether you're five or 95 , its all about corrupting and sedating the masses....revolution ???? pass the xanax.....
Why is health care, like education, not a right? Some scream about "socialized medicine" when we have socialized (i.e., public) education. Medicare For All would be the right thing to do. First I heard of it was on the "West Wing" three years ago. Good idea then, good idea now.
Don't you all know our "heath-care system" is a form of population control? The above story about the disabled heart attack person is a case in point. Similar to the 45,000+ auto-related deaths every year. Tobacco's death detail gets taxpayer subsidies to continue killing. Not to mention the MIC's Iraq Holocaust.
On of Bush's biggest, most corrupt financial backer is a massive Texas/Southern funeral chain. Since Reagan, business has boomed for them.
Thank you, Mark Dunlea for an excellent article. Too bad every American can't read this. The Ministry of Information will make sure this information never makes it out of the gate.
When I talk to people about single payer health care, they say "I don't want the government telling me who I can see". They seem unaware that at present, their HMO is doing exactly that, and in addition, telling them what treatments they can and can't have. I point out that the government would only pay the bill and they and the doctor of their choice would decide medical care. Then I tell them that they would only pay a 3% income tax increase to pay for it and they rear back and say "I'm not doing that". I then point out that the Conyers/Kucinich plan would cover ALL medical needs, including prescription, dental, long term care, and with no premiums, deductibles, or copays. Moment of silence while they mentally review last years' tax return and medical costs, and then they decide it sounds really good to them. I then tell them there is additional funding with a small tax on employers, far less than they pay now for insurance, 1/2 of 1% charge on stock transfers, and closing tax loopholes for corporations. i think that last part is the icing on the cake for most people. Voila! Another convert.
This information can fit on a postcard and there are at least 80 cosigners on this bill who all have franking privileges, so there are over 5 million people who could be reached at government expense. Of course, probably less than half of them are old enough to vote. Still it's a start. And they could be encourages to inform others. My Congressman, Peter DeFazio, regularly informs me of all his good deeds, of which this is not one. I've been waiting and calling repeatedly for months to hear why not, to no avail. I keep getting told I will be hearing from him, but I get silence on this subject.
Being a nurse, the California Nurses Association has given me a SiCKO viewing party packet, and I am planning several parties (my home is small).
(god , please do not allow the u.s.a. to copy france and their nuclear plants)..... HEALTH CARE-any little person down here in the trenches of life will tell you- WE CANNOT TRUST INSURANCE COMPANIES WITH OUR LIVES !!
"Don't you all know our "heath-care system" is a form of population control?"
And it also provides very useful evolutionary selective pressure! Those without insurance are usually in their situation because of laziness, low intellegence, rebelliousness, or other undesirable traits. Those with good jobs and insurance are creative, intelligent amd hard-working and therefore rich. This is what make America great!
healtchare costs for 'consumers' has risen +60% since 2003. This is not a coincidence, or a market adjustment or whatever. More and more employers are cutting benefits, forcing many people to seek out additional indivdual insurance to close any gaps in their coverage.
On the dem side, forcing everyone to purchase coverage is socialized healthcare, socialized healthcare, but socialized for the Insurance industry, not for the people.
Massachusettes' re ently enacted mandatory insurance law went into effect on 12/31.
Mass. consumers are required to buy it.
If your employer does not offer it, you have to buy individual plans.
If you are financially unable to do so, and you qualify for state-sponsored assistance, your premiums are paid for. It is estimated that 40% of the population falls into this category to some degree.
That means that the state is now dishing out huge sums of money to the insurance industry, paying for individual policies at consumer rates.
Dont the republican parrots sqwauk that socialized medicine is bad? Oh, wait...Its for the corporations. They think that is OK
You already have socialized health care. Congress, the senate, and the white house. Free 100%, health coverage, paid for by the american taxpayer. Why the hell should they worry about the rest of you. Tommy Douglas. One of my personal heros.
Let's face it, if you want any of these progressive things, the US is not the place to go looking for them. Immigrate to a country more civilised (or perhaps the right word is "defect," comrade?)
~ ~ ~
"If for some reason you are not willing to lead, leave it to the rest of us. Please get out of the way." (Kevin Conrad)
Of course this article should mention Dennis Kucinich as the only presidential candidate proposing single-payer not-for-profit health CARE, so you've got to wonder why it isn't mentioned here. The bill he co-sponsored in Congress could have at least been mentioned.
While listing a number of problems with the current system, we should also mention the many people who are unable to change jobs because a new insurance company will not cover their pre-existing conditions--this is hurting productivity and upward mobility for thousands and thousands of people.
A final stab at the Democratic presidential hopefuls and their so-called "universal" plans: What they really seem to do is consolidate the present system down to a handful of favored mega-insurance companies who will profit enormously at the expense of the public, and also at the expense of smaller insurance companies (though my heart isn't bleeding for the last lot).
Imagine what it would be like to call 911 for help because a masked intruder with an ax was breaking into your home, only to be told by the 911 operator that the police would need the name of your insurance company in order to get the required pre-approval for a situation with such potential for injury to you or them.
That won't happen because we have not turned the COMMON GOOD that is police and fire protection over to for-profit insurance companies that would serve only those citizens who purchased insurance from them.
We have socialized police and fire departments, meaning they are staffed by public employees. Single-payer health care would NOT be socialized medicine. Like police and fire protection, it would be financed with progressive taxes but (except for the VA) be provided privately by health care workers and institutions of our individual choice.
The propaganda about incremental change being the only change possible is just that, propaganda from those who want the insurance companies to keep managing our health care for their profit instead of our wellbeing.
Universal health care is the premier "Family Values" issue in America. In our upside-down political world, conservatives "speak" of values, but only liberals can define and act on them. Elect your Democrats, then DEMAND your single-payer plan on MORAL grounds. There in no "incrementalism" that works, and there can be no accomodation with private for-profit insurance. But, without wall-to-wall Democrats you won't even get the time of day from government. Elect first, demand second and compromise not at all with the present "system."
Our political Overseers, bought and paid for by the Richfilth, are like the British East India Company as regards the subjugated Indian population (India not here): Do nothing. Allow nothing to be done. Meet your profit quotas.
Couldn't be simpler.
If you want to think Obama's going to kiss it all better for the white folks, go ahead. America's been on crack for a long time. As long as you have a steady supply of insulated white privilege you can indulge any fantasies you want. Tell yourself how Rich this country is (yes, and Master has nearly all of it and will NEVER give any of it back). The crack unfortunately will be gone soon along with our jobs, our homes, any health care of any kind, and of course with their loss, many will envy the dead and many will join them. Hunger does that to people.
We ignored the Big Dark. We said, "Oh well, we can live in a downsized world. It's not so baaad. We can run faster and faster and harder and harder just to live. Well, The Great Shattering is now upon us. Time for the check, waiter. You can learn to eat 3x a week, can't you? Many of our victims have done so for long periods of time. It'll be character building for you. I'm sure it was for them too.
Pieces of 8.
Where are these public opinion polls that incrementalists cite when stating the views of those of us who have health insurance?! I have health insurance, and I want to see the entire system changed. As far as I can tell, after years of watching my premiums go up, up, and away, and my coverage go "now you have it, now you don't," the only benefit I receive by paying premiums to Blue Cross of California is that my proof of insurance card results in doctors, clinics, and hospitals being willing to accept me as a patient. After that, it's fight after fight after fight, with me paying and negotiating for almost everything, while I have to fight tooth and nail to get Blue Cross to pay what they claim they will pay for.
The private health insurance industry should be thrown out of the equation altogether, and all of its employees should go find something meaningful, productive, and satisfying to do. And big pharma should be heavily regulated.
Jesus and FDR could become President and Vice President and we'd still not have universal health care. HMOs and their investors run the show. I've written "A Crime Not a Crisis: Why Pennsylvania Health Insurance Costs So Much." http://www.healthdemocracy.org/painsure.html It details collusion between HMOs, state legislators and insurance regulators.
Liberals with good health insurance insist that nothing else and nothing less than universal coverage is acceptable. The rest of us, 47 million uninsured, can't wait for justice, so we create it ourselves. See http://www.healthdemocracy.org
When Hillary proposed her Health Plan, she had Zoe Baird, the president of Aetna, in charge of her program. Hillary wanted to make sure the
Insurance Companies were in on the deal.
Time for Hillary to move on and stop the money games that she and her husband have been capitalizing on. Why are the Arabs, like the Saudis donating tens of millions dollars to the Clinton Library in Arkansas? How much did Bill
get from Dubai Ports as a consultant?
Why the Presidential Candidates refuse to make these money makers an issue is the question.
Mandating health insurance makes no sense. Just offer a National Health Insurance policy that competes with the private sector. People that can not afford a policy can be helped by raising the corporate tax. Corporations used to pay more than 40% of the Federal budget 40 years ago, now they pay less than 7%. Guess who makes up that difference...the working people.
The fundamental problem here is that INSURANCE companies are the problem....not a part of the problem, but the actual problem. Insurance is by nature a cost plus business.. that is to say they structure premiums to cover costs plus a percentage for their profit. On the face of this, it seems a rational and reasonable business model. If total claims and admin costs are a million dollars, and 10% is tacked on as profit.... that would seem logical and reasonable. Unfortunately the incentive to keep costs down is destroyed.... There is very little if any real competition between companies........ and so long as costs go up for all the companies, the rate structure can be adjusted without danger of losing customers to a competing company. And in consideration of the size of the insured groups this is inevitable. The result is a total indifference to actual healt care costs. Obviously if it costs 1.5 million this year for what cost 1 million last year, the 10% or whatever guarantees that you will make 50% more. It's pretty simple math.
The result is that escalating health care costs are not of "no concern" to insurance companies.... they are ultimately beneficial.
Actuarial charts will show that among a given group there will be so many heart surgeries, so many cancers, so many msc office calls, so many pregnancies, so many of this and so many of that. It is a simple matter to structure rates for service according to cost of service and continually adjust upward as costs skyrocket........ We can't expect them to operate at a loss now can we??
The result is that it can cost $250,000 for a heart surgery....... and it can ONLY because the insurance companies enable us to pay. The name of the game then becomes denial of service..... it becomes finding ways to discourage folks from pursuing payment and to disqualify them for this and that.
The insurance industry is fundamentally corrupt in it's very nature. It is a "protection racket" in which the healt care provider is the enforcer in the case of health care....... or the lawyers in the case of liability, or ......... If you don't pay your protecton money the doctors will "beat you up".... And in fact that is very much the case as I have found..... not having health insurance....... I pay cash for service when I cannot avoid a doctor....... and I pay MORE than someone with insurance. I walk in the front door and pay......... and I pay more........ Many folks are forced to use the emergency room, and are raped big time. Not only is one penalized for being poor in higher costs....... but in that the understandable reluctance to visit the doctor results inevitably in not treating things when they should be treated..... resulting in serious complications........ and of course lost of income to boot.
Since the Reagan era nearly all aspects of our society have been increasingly structured to punish the "poor" and reward the wealthy..... be it the health care system, the tax structure, or almost anything.
In my lifetime I have seen our society become one that is obsessed with wealth to the point of worship..... obsession with wealth to the exclusion of all other values at all levels from the personal through big business....... We have become a self centered greed based society with little redeeming value...... the health care system is only one aspect of this deep and fundamental problem with American society.
Howard
"In my lifetime I have seen our society become one that is obsessed with wealth to the point of worship… obsession with wealth to the exclusion of all other values at all levels from the personal through big business……. We have become a self centered greed based society with little redeeming value……"
I make a motion that we limit net worth to ten million dollars per person, a high enough figure to maintain the benefits of the profit motive, but low enough to keep a plutocracy from arising.
I further move that this global cap on wealth and power be inversely proportional to the birth rate. The lower the birth rate, the higher the wealth/power cap becomes. This will give people an economic incentive to reverse the global overpopulation that is destroying the planet.
This is Global Online Democracy (G.O.D.), direct and decentralized, in action.
The airbrushing of Dennis Kucinich out of the race is almost complete. His cosponsorship and promotion of HR 696, together with the rest of his platform should be shouted from the rooftops.
I came across the following link on another CD thread and it would seem to be the answer to why we, and the rest of the world, are in such a mess ... Privatize, Consolidate, Extort.
http://iamthewitness.com/doc/RothschildsTimeline-filer/frame.htm
Its amazing to hear about citizens in America not wanting a government run system of health care, like the government is some foreign alien. The privileged in this country have so vilified government that citizens are now consumers and would rather let some unelected group of corp. directors make decisions then them holding our elected representatives accountable. We the people are the government. Why wouldn't we want government to provide health care at a reasonable rate of taxation? If they screw up we would fire them.
A certain amount of a planned economy is essential. That's no more then what every household does when they budget for expenses.
Stop the useless effort to make everything government bad. We have become a good people because we had education for every child, we have social security for everyone when they retire, we have medicare for the disabled and the elderly, these are all successful government programs.
Most progressives at this stage are looking at single-payer, which is not the same as government provided health care.
As for a planned economy, we already have that. A small handful of the world's richest people, representing under 1-3% of the population probably control 50-75% of the world's resources outright, and lobby the remainder to their will...
It is cheaper to pay the $2000 a year(if they can enforce it) than it would be to buy inusrance.
If you buy a private plan you would be spending $300 or more a month. you may be able to purchase a limited plan for $200/
Most of us should not have to do this because the cost will rise when we are sick and will go up yearly any way.
The politicans ruined the health care system like they ruined social security.
We as americans pay enough taxes and throw away enough money into the system for it to be running better than it is.
Costs are out of control. Who wants to pay for the rich to have their free health care.
LindaS
I have Blue Cross too. I have no idea how a anyone with a heart can work for such a monster. I supposedly have 'good' health care too. If this counts as good health care in this world... I just want to cry. Like you said everything is a fight, tooth and nail.
Insurance companies are gamblers. They are bookies, and they don't hesitate to fix the game. Funny how if Blue Cross was a NCAA College team fixing games, the main stream media would dance a different tune.
Way it should be... See any Doctor you choose, if that Dr. decides you need a procedure, it is done. No 'approval', except the patients, no paper work, etc. The government picks up the tab, and we all collectively save money by getting rid of the health insurance industry. Insurance is a leech on money that should go directly to health care.
No one has good health care unless they get the carte blanche plan-the plan the politicans and ceos have that is paid for by all of us.
I paid for health care many years, Isn't it ironic that when you need it the most it is not offered or the cost is prohibitive.
Thank you politicans and big insurance companies. Espeacially the wepucks. After 9-11 I worked for a company that engaged in massive write ups to force employees off of the job only so they would not have to pay health care.
All of you who think you are safe now, are only fooling yourselves.
Corporations will do anything to cut costs and they will move up the ladder to do it.
Doctors really sold their souls when they allowed HMOs to practice medicine without a license and without seeing the patient. If I started treating or denying people treatment they would have me jailed, unless I had enough corporate support and money.
shakker,
Well to be fair, I don't think most Doctors like health insurance companies. They do not have a choice if they want to be in business and continue to try to help people. I know plenty of M.D.'s that have told me as much. Doctors are not the problem, the middle man is.
I have Doctors that say I need procedure, it's the insurance company that keeps me from getting care. I have been forced to look for alternative financing... loans. I supposedly have 'good' health insurance.
If there is a hell, I hope they are saving a particularly warm spot for health insurance CEO's...
Rule #1: Consumers shall make informed market demands in the society's better interests. Rule #2: Producers shall shut up and take orders. Whatever form the successful system takes, these rules will be the secret to its success.
We'll get universal health care when terminal cancer patients start blockading the hospitals they were refused early care in and not a minute sooner. There are CEO's making millions off our health insurance scam and that leaves plenty of cash left over to bribe the US congress.
The US is a sick joke and a prison for those not lucky enough to be wealthy. If you are poor, sick, criminalized or on the "terrorist watch list" you cannot get out of this country to someplace better. The good "Christians" of the United States are glad to let you die in the streets while they drive their massive SUV's to the megachurch in the suburbs.
There are no real health care solutions promised by the top presidential candidates because they HAVE BEEN SOLD OUT.
America's health care plan. Get sick; die.
goner "While listing a number of problems with the current system, we should also mention the many people who are unable to change jobs because a new insurance company will not cover their pre-existing conditions–this is hurting productivity and upward mobility for thousands and thousands of people."
You're partially correct goner and it's really slick how they work it. When you change jobs you lose your insurance from your old job and can't get insurance for ninety days in your new job. Well it just so happens that the insurance companies have a rule that basically says if you go without insurance for more two months they don't have to pay for conditions existing prior to your new insurance date.
So you have a problem and there is a solution. To ensure you don't lose any coverage you are giving the option of Cobra or buying private Insurance. Nine months ago when my job was phased out and I was let go I received a letter and an official document from my insurance company stating when my last day of coverage was. The letter basically explained that if I didn't buy cobra I would have to present this document and proof that I had bought private insurance from someone else before I could maintain coverage for a pre-existing condition.
Cobra insurance and private insurance was going to cost me far more a week than the money I had coming in from unemployment. On top of that jobs are very tight in my field right now so I knew it was going to take a while to find a job. I have lost my insurance and I'm probably going have to prove that any condition that comes up after any new insurance I may get wasn't a preexisting condition.
I know many people who are in the same boat I'm in.
glide625: at first glance your assumption makes sense- medicare for the poor and private insurance for the rich. Of course, that's what we already have, but you put in the caveat of private insurance "for those who can afford it" which is not as many as we want to believe. Crunch all the numbers here or in any other pro-single payer research and you'll find that the combination of the poor, the working poor, the underinsured, and the underinsured 'middle class' that thinks its fine but goes bankrupt when it gets canser, and you'll find that at least 75% of the nation would need the expanded medicare coverage.
I would like more research on what kind of secondary insurance would be available in a single-payer system. The rich could still get their red carpet treatment, but in what form would it be?
Also, combine the falling dollar/ressession with the cancer explosion and finally the fulcrum swings towards single-payer.
So much suffering, just so ANIMALS can live in palatial wealth power and privilege over us. The screams of their victims will drown them.
Peace.
The more the government is involved in health care, the worse it becomes. Universal Health Care in the US would be a nightmare which one can easily determine by viewing what happens in Europe and Canada.
I had a friend who became violently ill while vacationing in Italy. She was allowed one bottle of IV fluids a day despite severe dehydration. No tests were run, no treatment was rendered. This 17 year old would have died of salmonella poisoning had she not been rescued and taken to an American hospital where she immediately improved.
In Canada, healthcare is severely limited by the government.
Since the seventies, the government has become increasingly involved in health care. The result has been that corporations such as pharmaceuticals, HMO's and insurance companies have become wealthier, by siphoning the government funding. A physician is much more likely to care about the health of an individual than an insurance company, yet insurance companies have become increasingly in control.
Reform is definitely needed, but Universal Health Care will escalate the already disturbing trend of more government, less care.
Jstevens "The more the government is involved in health care, the worse it becomes. Universal Health Care in the US would be a nightmare which one can easily determine by viewing what happens in Europe and Canada."
You're funny. None of the common citizens in Europe and Canada or Cuba want to exchange their healthcare system for ours. Why do you think we rate so poorly compared to the countries that have Universal Health Care. Do some research and find out the truth and quit making your self look stupid, cause you're spewing nothing but ignorant propaganda.
In Canada, healthcare is severely limited by the government.
In what ways, can you link to some facts (not myths) to support your statement? I sure haven't seen any information to support your propaganda. Every country that implemented Universal Health Care had some problems at first that's to be expected but there getting better and better everyday which is just the opposite to what taking place in the for profit health care system we have today.
A physician is much more likely to care about the health of an individual than an insurance company, yet insurance companies have become increasingly in control.
And its not going to get any better as long as we have for profit health insurance companies instead of health care companies.
Reform is definitely needed, but Universal Health Care will escalate the already disturbing trend of more government, less care.
That's what happening today, our government is actually less involved and the insurance companies are sucking us dry.
Every thing you're talking about is because of less government involvement not more. Even if the government got involved and heavily regulated the health insurance industry it still wouldn't solve our problems. Under a Universal Health Care system the only involvement the government would be involved in is collecting the funds and paying the health care providers. The government would need to help fund an expansion of basic health care infrastructure across the country at first. This could be done with small business loans to private health care providers.
We need more places to go get complete physicals or basic treatment once or twice a year. This is the only way you're going to get a proactive health care system instead of a reactive health care system.
Please google "Senate Bill 840 in Callifornia" and you will be led to a single payer plan that has been considered in the legislature of CA for over 10 years. Slowly it has been recognized as "the gold standard" of health care reform. Why hasn't it passed in all these years, you ask? A year ago it was passed by both the California Assembly and Senate but was vetoed when it got to Gov. Schwartzenagger's (R) desk. This bill was reintroduced and is currently entering it's second year of legislative review. Meanwhile Governor Schwartzenegger has joined forces with a very ambitious (anonther story) Assemblyman, Fabian Nunez, to write a health care reform bill which keeps the insurance companies in the loop- ie incremental reform. This bill may just pass with the expected disasterous results and ultimate delays of true reform sitting in the Senate waiting. The only positive aspect is that the slow progress of the true reform offered by SB 840 has allowed it to be refined and improved over the years. It has had 2 financial analysis by the Lewin group showing each time the savings that would result. This bill would provide lifelong, comprehensive coverage including prescription drugs, all medical care, vision, dental and durable medical equipment for all Californians and still save millions.- Our opposition??- the health insurance companies and the pharmaceutical companies- surprised???
One of the major complaints about the Canadian health care system is waiting times, whether for a specialist, major elective surgery, such as hip replacement, or specialized treatments, such as radiation for breast cancer. Studies by the Commonwealth Fund found that 24% of Canadians waited 4 hours or more in the emergency room, vs. 12% in the U.S.; 57% waited 4 weeks or more to see a specialist, vs. 23% in the U.S.
In a 2003 survey of hospital administrators conducted in Canada, the U.S., and three other countries, 21% of Canadian hospital administrators, but less than 1% of American administrators, said that it would take over three weeks to do a biopsy for possible breast cancer on a 50-year-old woman; 50% of Canadian administrators versus none of their American counterparts said that it would take over six months for a 65-year-old to undergo a routine hip replacement surgery. Yet U.S. administrators were the most negative about their country's health care system.
In the Canadian Supreme Court case of Chaoulli v. Quebec, Chaoulli argued that the long waits were life-threatening and violated human rights, and that doctors and patients had a right to contract for private health care, despite the prohibitions on those medical services.
Canadians concede that waiting time is a problem that stems from the country's lower costs and commitment to universal coverage. In a letter to the Wall Street Journal, Robert S. Bell, M.D., President and CEO of University Health Network, Torono, said that Michael Moore's film Sicko "exaggerated the performance of the Canadian health system — there is no doubt that too many patients still stay in our emergency departments waiting for admission to scarce hospital beds." Based on 2003 data from the Canadian Community Health Survey,[30] an estimated 1.2 million Canadians do not have a regular doctor because they "cannot find" one.
Sorry, rickster, I'm not making it up.
Health Care is the most complicated problem we have. It's certainly too exhausting to address completely on this forum. But we actually do have a single payer system in the US to view for reference. It's called the VA and it's simply fabulous. I wish I could visit a VA for ALL of my health care needs. Government control at its finest.
jstevens What's your take on this article?
Published on Tuesday, January 8, 2008 by Reuters
France Best, US Worst in Preventable Death Ranking
by Will Dunham
http://www.commondreams.org/archive/2008/01/08/6251/
Jstevens "Sorry, rickster, I'm not making it up."
I know your not making it up, I've read the actual report your post originated from. I've also read many counter opinions. The Canadian system has made a lot of progress since 2003 also, so maybe you need to take another look. Is it a prefect system yet? No but Canadian system is getting better everyday.
50% of Canadian administrators versus none of their American counterparts said that it would take over six months for a 65-year-old to undergo a routine hip replacement surgery.
I know some people who would love to wait six months to undergo a routine hip replacement surgery. I now a person who had gall bladder problem and the doctor would work on her because she didn't have insurance or couldn't come up with a down payment for it. They actually told her that her problem wasn't life threatening yet and to come back when it was. Well guess what after six months her gall bladder finally ruptured and she had to be rushed to the hospital for emergency surgery. She could have very easily have died.
Health Care is the most complicated problem we have.
There's nothing complicated about it. You get health care and live or you don't get health care and you die. What's more complicated than that. The problem is we have for profit health insurance instead of health care, plain as night and day.
"But we actually do have a single payer system in the US to view for reference. It's called the VA and it's simply fabulous. I wish I could visit a VA for ALL of my health care needs. Government control at its finest."
Lets expand it to cover the entire country. By the way I have great respect for the VA system but it's not without its problems and every one of them problems can be traced back to lack/cutting of funding.
This country cannot afford to be without a single payer Universal Health Care system.
Ipenek writes above about California's long struggle to enact Universal Health Care (SB 840) versus the Schwartzenegger-Nunez Massachussetts-style incremental legislation now under consideration ...
KQED's Forum had a program at the end of December with a panel to talk about the Governator's bill, and virtually every caller and e-mailer wanted to talk about single-payer, universal health care. The incremental approaches are extremely unpopular (witness the widespread non-compliance in Massachussetts) and the politicians' continuing fallback to these positions (Kucinich excepted) give new meaning to the term "democracy deficit."
I live in Illinois, where our damnfool Democratic governor is pushing a Mass-Cali-style system, and is holding Chicago's transit system hostage to get it. I am uninsured by choice, in protest of the current system. I will not accept care if taken ill or injured, will not purchase insurance if required by law to do so, and will not subject myself to a tax system that attempts to fine me for my refusal.