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TechnoratiMemo to Obama: National Health Insurance The Only Solution
First off, congratulations to you and your party on your sweeping election results!
Together with a sizable majority of Americans, I am again hopeful for the future of our country. My special concern, however, is for our failing health care system and how it is pricing health care beyond the reach of ordinary Americans. Our system has come to the point where none of the many incremental reforms will work. The business model of insurance has failed, and we need to rebuild the system on a social insurance model.
Let me be direct. Although we have many dedicated health professionals, an abundance of the latest technologies, and many fine hospitals, health care has become just another commodity to be bought and sold in a deregulated market based on ability to pay, not medical need. As you well know, industry profits handsomely from the status quo, raking in money through insurance, pharmaceuticals, medical devices, and so on. Industry has a war chest to defend itself and demonstrates its political power each time any new reform is brought up.
But the situation has become dire. There is no end in sight in controlling health care costs as they soar upwards at three or four times the cost of living and family incomes. We have had three decades of incremental attempts to rein in costs, including managed care and consumer-directed health care. None have worked. We have a solution in plain sight - single-payer National Health Insurance (NHI). Market stakeholders are fighting it fiercely, but it's the only real reform that has a chance to work.
Most of your advisers will likely caution you that NHI is too radical for Americans to accept, that you need to be more centrist, and that it is not politically feasible. But therein lies your trap. You wwill be persuaded to add one more incremental attempt to fix things, which will not work, will cost more than ever, will delay real reform, and will add to the pain of so many along the way. Your moment of opportunity will have been lost.
Beyond ideology, these facts support NHI as the treatment of choice in 2009.
- Premiums alone for private health insurance have grown by more than 100 percent since 2000, and are projected to consume all of average household income by 2025, clearly an impossibility way before then.
- According to the Milliman Medical Index, the typical American family of four spent $15,600 on total health care costs in 2008, fully one-quarter of the typical combined family income of $60,000; most consider 10 percent of family income to be the threshold of underinsurance.
- The administrative overhead of private insurers is five to nine times higher than not-for-profit Medicare (average for commercial carriers 19.9 percent, investor-owned Blues 26.5 percent, Medicare 3 percent).
- The inefficiency and bureaucracy of our 1,300 private insurers are not sustainable (e.g., according to the Blue Cross Blue Shield Association, there are 17,000 different hea1th plans in Chicago).
- Private insurers offer much less choice than traditional Medicare; there are near-monopolies in 95 percent of HMO/PPO metropolitan markets, enough to trigger anti-trust concerns by the United States Department of Justice.
- Because of costs, about 75 million Americans are either uninsured of underinsured, with large segments of the population forgoing necessary care and having worse health care outcomes; the United States now ranks nineteenth among nineteen industrialized countries in reducing preventable deaths from amenable causes.
- Wall Street is already questioning the future prospects of the private insurance industry; as of November 18, 2008, the average share prices of the top five private insurers were down by between 60 percent and 77 percent, compared to the Standard and Poor's 42 percent.
I expect that none of this is news to you, but what is neglected by almost all economists, "experts" and pundits is that there is already plenty of money in the system, that we waste about one-third of our health care dollar on our inefficient multi-payer financing system and on unnecessary care, and that NHI will save money, not cost more. NHI is the most fiscally responsible thing we can do now about health care. The Conyers bill in the House (H.R. 676) will be financed by payroll and progressive income taxes that will be less than what individuals and employers now pay. The health insurance industry is being propped up by government subsidies to the employer-based system and to privatized public programs. NHI can save some $350 billion through administrative simplification, while offering coverage for all necessary care, full choice of provider and hospital, and mechanisms for cost containment through bulk purchasing, negotiated fees, and global budgets.
NHI by itself will not solve all of our health care problems, but it will provide a structure (as no incremental approach can) to enable other necessary steps. These include acceptance of health care as a right, transition to a not-for-profit system, reimbursement reform, rebuilding of primary care, evidence-based technology assessment, and quality improvement. None of this will be possible by using reforms that leave an obsolete private insurance industry in place, as is more fully discussed in my recent book "Do Not Resuscitate: Why the Health Insurance Industry is Dying, and How We Must Replace It."
FDR almost went for NHI in the mid-1930s, but he backed off, mainly due to the AMA's opposition. Today, the AMA is marginalized with a membership of no more than 30 percent of physicians, and a majority of American physicians now support NHI. Implementing NHI in your presidency can be your FDR-size legacy. It has become an economic, moral, and social imperative. Overnight NHI can bind us together as one society, all of us in the same boat. We can afford it. Yes, we can!
120 Comments so far
Show AllKind of frustrating to realize that Ralph Nader warned us about this years ago and gave us solutions to this and other problems we are having. Regardless of the serious situation and even with the Democrats on top, politicians don't listen to him, but to voodoo economists. They keep placing bandaids on the heart attack patient.
The evidence points toward being suspicious of the new president. But this is a challenge to the rest of us to force the debate. The words single payer healthcare are now as rare in media and political discussions as the words "invading Iraq will be a big mistake" were in 2002-3. We therefore have to mount as vigorous a campaign to break through this blackout as the anti-invasion effort was. If we succeed with this everything else is possible. If our cynicism keeps us at home then the game really is up.
Go to http://www.healthcare-now.org/ to find out how people are organizing. The Obama/Daschle meetings were overwhelmingly in favor of single payer, but they are being used to rubber stamp the insurance lobby's prefferred plan. Write your congressman in favor of HR 676. Write to Ted Kennedy in favor of single payer. There is a national call in day on January 15th to bombard the Washington offices of our elected officials. Please be active.
What a joke. We all know that Obama is not going to do anything to upset insurance and pharma. There will be a lot of excuses made and you have all heard them before. The dogs of insurance and pharma are being set loose in Washington as you read this.
What Obama gets done (or doesn't get done) in his first couple of years in office could strongly affect his chances for re-election. What happens with health care is a strong point with many voters. I'm hoping re-election in four years is a motivator for him.
Dr. Skigalini
Advocate for Nationalized Health Care
Roman tyrants ... provided the city wards with feasts to cajole the rabble.... Tyrants would distribute largesse, a bushel of wheat, a gallon of wine, and a sesterce: and then everybody would shamelessly cry, "Long live the King!" The fools did not realize that they were merely recovering a portion of their own property, and that their ruler could not have given them what they were receiving without having first taken it from them. A man might one day be presented with a sesterce and gorge himself at the public feast, lauding Tiberius and Nero for handsome liberality, who on the morrow, would be forced to abandon his property to their avarice, his children to their lust, his very blood to the cruelty of these magnificent emperors, without offering any more resistance than a stone or a tree stump. The mob has always behaved in this way – eagerly open to bribes... Étienne de La Boétie - Discourse of Voluntary Servitude
Sioux
DOUG: Well-stated, but I wish it weren't so! And there is the hope that education can alter the mindset of "the mob." Of course in America today what largely passes for an education is just the rudiments of a workforce efficient enough to perform the redundant tasks at hand much like Pavlov's rats in a maze.
Obama hasn't even mentioned National Health Care, not even once, since he got elected.
He says we need economic stimulus and mentions banks, and industry.
He talks about more wars.
But he does not say a WORD about health care.
If you're sick, you're going to have to go to Rick Warren and pray to his God that you will get better. That's Obama's health plan.
What will we all be saying and doing when Obama disappoints us on this issue? As he certainly will, just as he will on Israel/Palestine, Iraq, Afghanistan and a few dozen more. Maybe he'll throw a symbolic bone or two toward alternative energy research, that ultimately goes nowhere, just as it's done for 50 years. Maybe he'll make noises about education that "make a lot of sense" for two weeks and then nothing happens. But he's already said unequivocally that he supports the "free market system," venerates capitalism, wants to project and extend indefinitely the biggest hoax and fraud undertaken by the Bush Crime Ring, the War on Terror, and absolutely does not support single-payer healthcare. He's in the back pocket of Big Insurance and Big Medical/Pharma and has no ears open to NHI proposals.
But maybe he'll do a 180 on all this and surprise everyone! And maybe also George Bush and Dick Cheney, with all their enablers in tow, will turn themselves in to The Hague or the ICC after confessing to war crimes and crimes against humanity, on Jan. 26. The second fantasy is as likely as the first.
U. S. Single Payer Healcare is the only way. Profit does not belong to life and death matters or to everyday health needs and care. Whoever said it first and last is correct: the word *insurance* does not belong with any of the above. Insurance is marketplace gambling and betting on risk taking; the house always wins with insurance and insurance as conceived today is probably a silent partner that helped get us to the financial disaster we all face...round the world. An old professor friend alays said to me: "Insure yourself. Save with discipline." Besides, profit being out of the picture, there is no profit in denial of care and death. Doctors must be freed from the paper "waterboard" they suffer from daily.
Sioux Rose
PIERRE: Two quickee insurance tales: I recently bought a property that needed rehabilitation, and spent 2 months doing so. Finding a decent renter is now on the menu. Yesterday I went to get insurance on the property. I had hoped to use the renter's money to pay for that; but given the delay, elected to do it now. The insurance company charged me an extra fee for not getting the insurance at the time of the sale! I said that since I bought the property outright, it is my choice when to get insurance as I do not have to answer to any bank or loan agreement. The insurance guy told me that I was s--t out of luck, that's the way it is. In other words, I have to pay for those 2 months anyway!
During one of the many hurricanes (7 in a 2-year span) that hit Florida flying debris broke my car's windshield. The demand for repairs was so great there was a 2 week waiting list. I decided to drive to North Florida to get the job done more expeditiously, only to find out my car insurance wouldn't pay for this! Every month they extract $70 from me and over all these years I have never gotten a DIME back. To go without auto insurance is scary (not to mention illegal), but what I see with these forms of insurance, added to the disgusting way the medical type cuts needy people out of the hospital care they require, just proves that insurance itself is a gigantic scam. Gore Vidal once said insurance companies are the piggy banks to the corporations. It's unbelievable how they just take, and when it comes time to give back, invent every excuse under heaven to NOT deliver!
theinitiate
In any one month, by the time you take your kids to the doctor, your husband goes and even one person goes to the dentist and you pay the co-pays for those or the deductible is due for the dentist, then you pay for a prescription or two, how much have you put out over and above your payroll payment on your healthcare insurance? It could add up to 200.00 dollars or more. My payment from my payroll for insurance is $230.00 a ,month. So that's a total of 430.00. Add to that any payments your making on your share of a past medical bill and what do you have, unaffordable healthcare. (Especially,if the car breaks down that month). This will not happen just one month out of the year,either...
Ours was one of the 8,500 groups convened to discuss health care. Just yesterday at our retirement community of 10,000 a couple hundred of us took part in the Tom Daschle/Barak Obama program to solicit feedback from folks about the state of the US health care system.
Very instructive! The passion of the people for single-payer, not-for-profit, National Health Insurance is astonishing. The resentment that we do not have such a system when every other industrialized country does is vehement.
The cat is out of the bag now. Check out the questions on health care on the change.gov web site. They are mostly like these:
"In all other 1st world countries, there's a minimal level of universal healthcare for all citizens. What will your adminstration do to provide truly universal, affordable healthcare for all US citizens, regardless of employment status?"
"We all recognize the insurance industry is the problem, not lack of insurance--what are you going to do about getting single payer (government) health care, as other progressive countries throughout the industrialized world have done?"
"What are the obstacles to implementing the single-payer health care used in Canada, the United Kingdom, and Australia? With a growing number of unemployed or underemployed in 2009, will your administration work towards single-payer as a goal?"
These are the top three questions but there are many more like them.
I hate the term "insurance" as it applies to paying for health/sickness care. Insurance carries the connotation of premiums to be paid to an entity. This entity makes more money the less it pays out for services. Yes "premiums" have to be paid to cover the cost, but we need to have the profit motive removed from the equation.
PEOPLE WHO ADVOCATE THAT HEALTH CARE IS A PRIVILEGE, AVAILABLE TO THOSE WHO CAN AFFORD IT, ARE EVIL AND BARBARICK. HERE IS THE REASON WHY. Dr. Skigalini.
One of the positives about National Health Care is that people are prone to seek preventive health care checks and treatment. This is because cost, such as deductibles, co-pay and other fees inhibit the patient from seeking preventive health check-ups. Only 35% of insured Americans seek adequate and routine preventive health care to ensure they stay healthy. This is because it still cost them fees, co-pays and deductibles. That is a deterrent to preventive health care folks. Because of this, people are dying.
Preventive health care results in longer life span in general. Statistically, Canadians live 7 years longer than Americans. There are several social attributers, such as "less-stressful lifestyles" but because Canadians have Socialized Medicine (National Health Care if you will) they routinely have preventive medical examinations which attributes to longer life on average. Many ailments such as heart disease and early stages of cancer are corrected because of preventive health care.
There are many of us Medical Doctors in the U.S.A. who believe that health care for profit is immoral and inhumane. It is a fact that the U.S.A. can afford to have Nationalized Health care and it will cost average Americans less, not more. It will not bankrupt the economy. CEOs are doing a real fine job at that.
By Nationalizing Health care, so much of the red-tape that bogs down the medical system would be eliminated. Insurance companies and their expensive infrastructures (and overpaid executives) would be unnecessary. Many far-right capitalists think that health care (remember, this includes preventive medical practice) is a privilege that you earn.
There are graveyards full of people that would still be alive if they were not inhibited to use preventive medical checkups because they don't have the financial resources. This is reality that doesn't hit home until it's someone you know or someone you have signed a death certificate for.
Doctors in hospital ICU wards see multitudes of patients that succumb to health problems and check into hospitals only after it's too late. Doctors fight to save them every day but they're too far gone. Patient after patient is wheeled out on a gurney with a sheet over their face, declared legally dead. Why are we letting this happen in our country? Profit?
We can change this culture of avoidance of preventive health care in the U.S.A. Too many patients do not want to get stuck with the medical bills for a checkup. However, like the Canadians, patients would not be reluctant to be checked out if they knew they wouldn't get billed for it. This will save hundreds of thousands of lives each year. PEOPLE ARE DYING !!! Isn't this enough reason fellow Americans?
Selfish, heartless people who believe that health care should be a privilege for those who can afford it are barbaric and evil. Nothing is more precious than human life. Health care should be a right, especially with the resources we have in the U.S.A.
Dr. Skigalini
Advocate for Nationalized Health Care
Don't forget the advantage of medical records. There could be just the one record shared by all providers just as the VA does now.
Public Health Nurses should be empowered with providing primary preventive assessments and basic care at an affordable cost.
There should be a Public Health Nurse clinic associated with every public elementary school in the country, and they should be able to make home visits as well. But this will not happen until the doctors let go of their territoriality when it comes to health
care. There is all kinds of discussion right now about the possible new Surgeon General. But no one has even noticed that no comparable position even exists for the nursing profession. Why not ? Marginalizing the knowledge and skills of nurses and leaving all the managerial decision making to doctors is part of why our health care system is falling apart.
In the early 1960s,when I was a teacher in a public junior high school, there was a nurse in the school. When I was in a pubic NYC high school, in the 1950s, there was a school nurse. What happened to school nurses? I think there are some in the City of NY University system.
National health CARE is the solution, not national health insurance. We wouldn't need insurance if we had national health care. Insurance is not about care, it is about money.
Like it or not, nothing is free. Somebody has to pay for it. Simple as that.
.Thomas, are you aware of the price we are paying for our current system? Do you not know that 50% of all bankruptcies are health care related? Do you not put a price tag on 45 million uninsured Americans?
We simply cannot afford our current health care system.
.
We see things, not as they are, but as we are.
Anais Nin
Absolutely. You misread my comment. Single payer is the only solution to our current dilemma. And we already pay more than enough to cover everyone under it. In fact I'm not sure it might not provide a savings even with everyone covered.
My point was that any care is not free. Someone must pay for it. Programs and policies that might be great ideas are useless if they cannot be paid for.
reference...Thomas More January 7th, 2009 7:19 pm
Single Payer, affordable, discounted, PAY PAY PAY. You just don't get it Thomas and you never will perhaps. You are so immersed in paying for health care that you feel compelled to keep giving your money away to these insurance companies. The middle men and insurance companies are grabbing the insurance money you like paying for so much.
YOU SHOULD HAVE A NHI HEALTH CARD IN YOUR POCKET, SHOW IT TO THE NURSE, SHE SWIPES THE MAGNETIC STRIPE AND YOU SEE THE DOCTOR, NO CHARGE EVER, SIMPLE AS THAT. Cut all those middle men out, downsize from those ivory towers that many doctors practice in and treat every man woman and child.
You and millions of others have been brain-washed by big lobbyist advertising, demonizing comments like "communist," "socialist," "free lunch" and similar. Oh yes, Senator McCarthy is still alive and well Thomas.
My brother is an General MD in Canada and I here in the U.S. We have lines just as long here and people stressing over insurance, forms, forms, forms. There in Ontario, because the efficiency of their system, they see 50% more patients than we do here in the states. The same amount of time is spent with the patients. It's just that there, the patient isn't filling out forms for half an hour, waiting to get approved, writing a check, running their credit cards, all that stupid time-wasting crap.
USA: 58% capitalism / 42% socialism --- health care for profit is broken
Canada: 50% capitalism / 50% socialism --- national health care works
Functionality of existing National Health Plans is far more efficient. Those efficient computer models exist in many other countries and can be rolled-over here in one day. U.S.A. is now # 18 in quality of health care in the world. Canada is # 5. Western Europeans have surpassed us. Eastern Europe is similar to us in quality of health care and China is catching up.
We exacerbate the problem of health care cost by having so many terminally ill patients because they avoid doctors until it's too late because of fees, co-pays and deductibles. It's out of control. Most of that money never makes it to the doctors, their clinics or towards improvements in medicine.
Please get a clue Thomas.
Dr. Skigalini
Advocate for Nationalized Health Care
Thomas,
I must apologize. I reread all your comments. Fundamentally, we agree.
Dr. Skigalini
Advocate for Nationalized Health Care
Thanks! Ardee will tell you that I am obscure in my clarity!
Bill Walz
I pray for a national movement that insists on the single-payer national health plan. Thank you Dr. Geyman for adding your voice to this debate. Can America stop being stupid (see accompanying idiotic arguments against it that are completely tangential to this issue), Can America get over its love affair with greed and construct a compassionate society? The first step was in electing Obama. Now let us begin at the most logical place to begin - Bring health care back to being a profession dedicated to healing the sick and doing no harm. It has become an obscene cash cow that leaves a wake of people needlessly sick, suffering and dying while the money is being counted. Peoples' life savings are devoured by this abomination. Stop this, America, and join the rest of the civilized world in recognizing health care as a fundamental right - as in life liberty and the pursuit of happiness not being taken away by an over-rich medical industry. Please, President Obama listen to Dr. Geyman.
Simply declare that it is illegal to not purchase and maintain a health care insurance policy. 47 million uninsured? No longer, problem solved.
There is a better way.
Let the insurance companies stay involved. Have a large group of medical experts NOT associated with the insurance industry, and I mean Doctors and not "scholars" come up with a universal insurance policy that gives good honest coverage to each individual. THEN -- let the insurance companies in each region* BID on providing coverage. The contract goes to the lowest bidder. No denial of services for any reason including pre-existing conditions. No deductibles. No insurance company input whatsoever other than covering the costs of the insured. Would some doctors abuse this system and overcharge by providing needless services or tests or exams? Probably. So provide a federal government health insurance ombudsman office to handle such situations.
* Define "region"? Could be by state, could be by geography, could be by some other way.
But this will never happen. It is too simple and logical. Besides, the "capitalist free market" insurance companies don't REALLY want to compete.
-- ekaton aka d.k.shaw
Sounds very complex. Something that lends itself to mismanagement and more squandering greed. You must be a genius if you can figure out how to make this work.
Dr. Skigalini
Advocate for Nationalized Health Care
Thanks for the sarcasm, "doctor". I was just throwing an idea out there. Let's hear yours.
-- ekaton aka d.k.shaw
EKATON
"Besides, the "capitalist free market" insurance companies don't REALLY want to compete."
Why in the world would they want to leave that cozy system they have labled "capitalist free market" to compete in a real Capitalist market with the normal regulations and constraints? A real market in other words?
Health care should not be in the market in any case. This is one area where Government should protect and provide.
But this will never happen. It is too simple and logical. Besides, the "capitalist free market" insurance companies don't REALLY want to compete.
-- ekaton aka d.k.shaw
================
\
SO TRUE! never was a contradiction more obvious!
it's rreally the "free marketeers" who are most in FEAR of "free market competition".
SOMEONE TELL OBAMA :
"see obama run. see obama latch himself to the Wheel of Fortune of Free Market....see Obama destroy his presidency".
it was actually a bit tragicomic when in the election campaign...as the economic implosion was alraedy happening and every single "sound fundamentals of capitalism" was exposing itself as the Ponzi scheme that it is -- Obama was STILL professing FAITH in the RELIGION called : the free market capitalism
"I BELIEVE IN CAPITALISM, I BELIEVE IN THE FREE MARKET"........
well...keep hanging on to it President-elect -- and see how your "stimulus" will also be SWALLOWED into the same black hole where it is "free" to disappear...
"I BELIEVE IN CAPITALISM, I BELIEVE IN THE FREE MARKET........"
Ok buddy, life for profit is what you believe in. If you're ever down on your luck, need to make a decision between paying for your food or electric bill instead of treatment, I hope you don't end up dying. I might be the one that has to endorse your death certificate.
Dr. Skigalini
Advocate for Nationalized Health Care
Pay attention, Doc. teddy was sardonically quoting Obama. Those weren't his own views on the "free market". If you paid attention you'd see he feels the same as you about health care.
Thanks Ephraim. I will attempt to slow down and spend a little more time interpreting the acrimony, aspersion, satire and banter. Sorry for the misinterpretation of Teddy's comments.
Straight talk lends itself to faster more accurate comprehension for those of us who tend to read quickly.
I too feel that Obama appears to be appeasing the Washington insiders and falling in-step with status quo. He has such an incredible opportunity to push his influence towards National Health Care. I'm going to give him a a few months to see if he has any tricks up his sleeve. After all, he's not president just yet.
Dr. Skigalini
Advocate for Nationalized Health Care
Obama's recent pledge to control Social Security and Medicare costs don't bode well for single-payer, IMO.
It sets up a classic myopic, "pragmatic", political penny-wise, pound-foolish analysis in response to the health care crisis. A direct transition to single-payer would require a fortune in start-up costs, and it would be the beginning of the end for insurance corporations. It's easy to scrape up a few hundred billion to shore up Wall Street or the auto industry, but with the economy in such rocky shape, it would be suicidal to stage the avalanche of change involved in transitioning away from the status quo to single-payer.
Instead, the good old "art of the possible" Plan B will be brought out. This filling and nutritious Milk-Bone will preserve the insurance corporations and their pernicious role in health care, and will be presented as a sound first step towards a single-payer system. In our dreams.
But it will suffice to keep enough of the poor battered-progressives convinced that at last, the Democrats prevail and are on the right track!
I'm not sure this will happen, but I fear that it could.
· Yr Obd't Servant
We shouldn't expect Obama to step forward with a plan for single payer. We have to create a people's movement to demand it. I'm not sure if your suicidal comment was sarcastic, but single payer represents a clear savings for the country. It's a lifeline to our beleaugered state and local governments. Individuals will pay less in a payroll tax then they now spend on premiums. Private business will also be liberated from the burden of employer-based healthcare. And plan B is going to be massively expensive for the federal government as the private insurance companies get their pipelines installed into the treasury.
Single-payer = a tax cut.
"Single Payer" National Health Insurance is the only answer.
I was disappointed in 2006 when Obama commented about single payer not being a high priority. I'll see if he changes his mind though. I hope Daschle and Gupta say yes to single payer.
SteveC is right about Daschle and Obama isn't on board, but they may all get a big surprise when we get to it. Things they are achanging as we say in the Lone Star State!
Remember the Trans Texas Highway that they were going to shove down our throats? DEAD as a doornail. Craddick is gone as Speaker and we have a moderate Republican as Speaker...starting his second term. Think about that.
California used to be the bellweather state, I'm not sure that is true any longer.
If this country drowns into a Greater Depression which looks all the more likely, then single payer is gonna be more likely when the unemployment rate keeps going up. As for CA being a bellweather state, didn't that stop after 1992? I'll admit that having a moderate Republican as speaker is less hell than having a partisan hack any day. And I hope nobody even tries to reawaken TTH or they'll be dead meat. Thank God the rural folks woke up on this one. TTH is bad for Texas and bad for Mexico.
Have you read any of Daschle's book? Not a chance. If they are going to just give another giant gift to the health insurance industry, like Medicare Part D, I would rather they would just leave it alone. Maybe someone else can fix it.
The PBS News Hour is doing an in-depth series on health care issues, you can read the transcripts on their website. Last night they featured a primary care physician. She is swamped. And they interviewed med school students. Only two percent of medical school students are going into primary care. Why ? Because they have incurred such huge student loan debts (average $60,000 - $70,000 PER YEAR of med school) that they are disproportionately attracted to the specialties which offer higher earnings and the ability to pay off their loans faster. Many of these students are young women who do not want to start families under such a huge debt burden but also know they cannot put off having children until the debt is paid down on a family practitioner's salary. This is part of the reason doctors are so territorial about their turf. It is understandable in a way, but in the long run that territoriality does not serve either the medical community or its clients.
I am physician assistant and have worked in healthcare for twelve years. It's time for single payer healthcare. Start by handing out Medicare cards to every unemployed person in America and increase federal income tax by 1 percent. Give 100 percent loan forgiveness to every new MD coming out med school, and a salary of 100k and cover malpractice with a government policy atno cost to the MD. Make their future raises based on productivity. Make a national formulary for drug coverage and meds to patients free. Fire anyone who defrauds the government and take away their right to healthcare. Their are very few MDs in the current system who make a million dollars. For the most part everyone in healthcare works their ass off. Money is wasted covering for malpractice suits. Fraud comes mainly from disability suits generated by patients not doctors. Fraud comes from selling pain medication on the streets. Doctors get fooled all the time. I'm one of them too. Pratitioners are sick of jumping through hoops and waiting for approval from beuricrats. Single payer now!
Ours was one of the 8,500 groups convened to discuss health care. Just yesterday at our retirement community of 10,000 a couple hundred of us took part in the Tom Daschle/Barak Obama program to solicit feedback from folks about the state of the US health care system.
Very instructive! The passion of the people for single-payer, not-for-profit, National Health Insurance is astonishing. The resentment that we do not have such a system when every other industrialized country does is vehement.
The cat is out of the bag now. Check out the questions on health care on the change.gov web site. They are mostly like these:
"In all other 1st world countries, there's a minimal level of universal healthcare for all citizens. What will your adminstration do to provide truly universal, affordable healthcare for all US citizens, regardless of employment status?"
"We all recognize the insurance industry is the problem, not lack of insurance--what are you going to do about getting single payer (government) health care, as other progressive countries throughout the industrialized world have done?"
"What are the obstacles to implementing the single-payer health care used in Canada, the United Kingdom, and Australia? With a growing number of unemployed or underemployed in 2009, will your administration work towards single-payer as a goal?"
These are the top three questions but there are many more like them.
The pressure is enormous. If this thing does not happen we’ll finally know once and for all our “democracy” is a joke – a fraud!
Having been a casualty of this health care system to the tune of more than $65K on two occaisions for Kidney stone blasting and less than 3 total days in the hospital, my credit is ruined. my employer never provided his 35hr a week employees with medical coverage. nothing like part-time status to relieve them of any responsibilities to their employees. I am not hopeful that there is any political will to challenge this system to any real reformation. Obama's plan is not to do away with third party profiteers,but at best rain them in..to what I ask..if there is a profit to be made it ain't going away..
ekay1946
I know how it is to have giant medical bills. I had quad bypass with no insurance and my credit is gone. I am 6 months away fron Medicaid and am making a list of the medical items I have put off for too long. single payer can't come too soon for me.
My heart goes out to you Ekay. You're truly a victim of a heartless, selfish system. Our health care system amounts to crimes against humanity. I can't count the number of patients I have known who squandered their entire retirement life savings trying to save themselves or a loved family member.
Dr. Skigalini
Advocate for Nationalized Health Care
cjm 1492:delighted you got care and are OK.
ekay -- i am so sorry to hear of your situation ....your description of it is just what i have heard and know to be the case for so many - who are ALL trying their best to just have a decent life and work.
and it is as I have often told friends: the tactic of having workers assigned 35, 30 hrs, or 28 or anything UNDER 40 BUT OVER 24 - is a way for employeers, especially bigger employers, to "DEFINE" workers within a LIMBO.
if they work closer to the higher work hours - they are practically working LIKE FULLtime employees..showing up enough days or hours to be "fed" the "routine" work...BUT INELIGIBLE for full coverage or any.
if they work closer to the lower number -- they have no coverage but are given the "threat" , implicitly, that they can easily be replaced by another "part-timer" or a "per diem" which is ANOTHER tactic.
the ENTIRE "employment based" private insurance system for profit of the USA is not only a DISASTER but IMMORAL and UNETHICAL and CRUEL.
americans , no people, especially in a supposedly RICHEST and MOST POWERFUL nation that can afford to waste resources , human, technological, medical, scientific, natural, labor hours, on WARS and Exploitations --
americans DON"T deserve this kind of treatment. they TOO are HURTING -- and the government as it has followed these "conservative" "on your own" economics and the corporatocracy -- continues to protect and defend the INDEFENSIBLE!
i also have a friend who had to go back to work - when she didn't have to - in order to afford insurance for herself and her husband..but the only way she can have the full coverage is through full-time hours -- which require for her to do the job of at least 2 people. ENSLAVEMENT in order to "have HEALTH" insurance? her husband had a severe accident - and so what happens if SHE gets sick and can't work?
what KIND of society is this that does this to its own people?
IS THIS the "america" that is "shining beacon on the hill?" proclaiming its love of "justice" and "humanity?"
what KIND of society is it?
there countries that are SO POOR they can not even feed their own people properly BUT STILL TRY their darndest to offer what they CAN - such as SOME health treatment even if they really can't afford it.
the USA? BAH! HUMBUG!!
Well put. What I don't understand is why "conservatives" would be against NHI. Most business owners are "conservative". NHI would certainly lower their costs TWO ways. One, they would no longer be responsible for paying commercial health care premiums, assuming they provide health care insurance for their employees. And, two, for those who don't provide health insurance, under NHI their workforce would most likely be healthier and therefore more productive.
The only logical opponents are insurance companies. Rank and file "republicans", like "Joe the plumber" ought to be as much for NHI as rank and file "democrats".
The only real question becomes, "Who owns Barack Obama?"
The answer to that question is, "Follow the money."
-- ekaton aka d.k.shaw
.Why indeed, perhaps it is that folks fear higher taxes to pay for such health care. It is harder to see the hidden costs of such care under our present system I guess. There is an effective propaganda campaign in place with the goal of maintaining the status quo that makes some much wealthier while those who see the real benefits to NHI cannot afford to combat that propaganda.
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We see things, not as they are, but as we are.
Anais Nin
Sioux Rose
EKATON: You have precisely nailed the approaches that WOULD win them over, but keep in mind, you'll never hear your own logic touted on right wing networks, that are too busy yelling about the socialist boogy man and doing their utmost to maintain the dog-eat-dog/me versus you hierarchical class system (or order).
Single payer is not a dead issue with alot of Republicans. My Republican friend who serves on a local school board is completely convinced. Don't write people off, they may be your allies.
Geyman sez: "... a majority of American physicians now support NHI."
***
So does a majority of USAn voters.
NOT supporting NHI are the "representatives" the USAn voters keep "electing."
SINGLE PAYER NOW!!! SAY NO TO GUPTA!!!
Obama has already pledged his support to the insurance companies. The dem/repubs are complicit with the insurance companies. It was Howard Dean who opposed Single Payer when he was governor.
If we want to save the 18,000 lives that are lost every year because of lack of access to health care, we need to take power away from Washington. Sanjay Gupta, the new Health Czar, was not in agreement with "SICKO" - Gupta likes the system as it it. What happened to the push for 'change'?
Nothing happened with the "push for 'change'". Those who voted for Obama are learning that they have been duped (again). They are getting what they were warned about, and what they were told to expect. Nader was and is right. Don't worry, they will four years from now, do the same thing all over again. The will once cagain be voting for "change you can count on" or some such Democratic duopolistic bull crap.
I agree. It always comes down to the voters. The voters get what they vote for and therefore they deserve what they get.
.True as far as it goes. But, in defense of those duped by the millions spent on propaganda, I must say that our system lends itself to such demagoguery and deceit. Why is it that Barack Obama can raise over $700 million in a two year campaign to win a job that pays $400,000/year? Why is it he needs that much money? Why does he now spend, in a time when the economy approaches collapse, $40 million on his inauguration? Is it, after all, a coronation?
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We see things, not as they are, but as we are.
Anais Nin
I am hoping that the conditions are finally right for single payer in the US. The economic downturn will accelerate the number of Americans lacking health care, making it even more of a burden both for those individuals and the society at large.
Meanwhile, the auto companies are on the ropes, not insignificantly because of large health care costs for auto workers. I was impressed to read that the CEO of GM-Canada praised the Canadian single payer system.
The nurses are already on board (at least in California), and more and more doctors are getting fed up with a system where bureaucrats second-guess their medical decisions and where they must hire an army of paper shufflers to fill out forms from a cazillion different insurance companies.
If Obama wants to avoid a catestrophic presidency, he's going to have to do something real about health care. The least we supporters of single payer can do is to remind our representatives, our president, and our fellow citizens that there is indeed a sane, humane solution to the nation's health care crisis.
"remind our representatives, our president, and our fellow citizens that there is indeed a sane, humane solution to the nation's health care crisis."
Good point. I think this Jan 15th is single-payer call your rep day.
Oakknot
Although I agree with everyone who is telling the truth of Obama's refusal to consider NHI, I nonetheless copied the article, then sent it to the transition gang via change.gov. I even asked nicely that it be read. I hold no hope that anything good will come from it; there seems to be a memory hole with the transition team.
Oakknot (if that is the person that posted this piece to change.gov),
How do you navigate that site to find any discussion about NHI? Can one find your post there somehow? I've wanted to register my thoughts there (very pro NHI), but I haven't figured out where the best place to do that is. I have to say, their website design is too flashy and not very functional if you ask me (I realize some here would say the same about the president elect - I'm not quite that cynical, but I'm close).
Dara Parsavand
PS - Just watched some of the special features from Sicko - Elizabeth Warren makes the strong point that 75% of the people that go bankrupt from health care costs ALREADY have health insurance. Those of us who have health insurance who don't want to have solidarity with the uninsured are idiots - we aren't that much better off.
addendum re: memo to Obama:
Healthcare and The Promise of Freedom
If you accept the promise of the American Revolution as already accomplished, you will not be motivated to remove the profit-motive from healthcare to provide greater freedom from unnecessary suffering.
But if you believe and present the promise of the American Revolution as yet to be completed--how can you not evoke the promise of 1776 to challenge the order of things?
Dr.Geyman's points are essential truths that are indisputable, and yet
truths that are usually washed aside because they are inconvenient.
We have seen this phenomenon before, and only when the crusader Gore
staked his whole career upon his cause, did we see some truly
severe cracks in the opposition to attacking global warming.
Only an inspired movement of the population, another crusade, can run any chance
of displacing the biased self-interested inattention of our power centers
to the matter of health for all.
Does the Obama team, so effective in bringing him to office, have the vigor
to reassemble fully and persuade legislators to do what needs to be done, not what has traditionally been called for ?
Although I do feel that his across-the-aisle bipartisan compromise has so far
been helpful, it is also true that the President-Elect must break with all
traditional partisans, to sponsor and endorse that great mass of young
new-thinking and largely uninsured persons who elected him, in a great effort to change how the nation approaches the concept of health care.
Rupert O. Clark, MD
Obama has already made it clear that he doesn't support single payer. We'll probably get a Massachusetts band-aid solution of fining people who don't pay for someone else's insurance ! Glad to live in TX and not TAXachussets !
This article should be sent far and wide to skeptics, ofes, and those who are ignorant about single-payer health coverage.
Poet
Poet:Hello! Happy New Year, if one can call it as a prospect. I've been off doing art, making copies and some paper mail and protesting what's going on in Gaza, mailing a bit at a time, as can. Nice to see your comment(s) again. And yes, re your comment. I think we just keep pushing and pushing in re single-payer...
National Health Insurance, like communists of the past and Muslim jihadis of the present, is a mortal enemy of the Republicans and Democrats, not to mention this nation's insurance companies who pay off the R's and the D's to abort it in the womb. The current Snake Oil Health System of the Snake Oil Republic may get a dose of Red Bull out of this incoming administration but the real health care system of this nation is still praying that you don't get sick.
Mordechai Shiblikov: I'd like to make two teenee weenie points: "womb" doesn't work for me (uterus). I love your last line, but I don't think "this nation is still praying that you don't get sick". The government and the nation are not interchangeable. I wonder if the legislators, administration leaders even care or really think whether people get sick or not. Good segment on DemocracyNow this morning, mentioning how our health care system costs more than those with singlepayer. www.democracynow.org And hello. You're on "a roll".
I agree with your rather sobering analysis. Those making a fortune from the present system will fight any change even the tiniest let alone REAL change in the form of a NHI system. If Obama can pull this off he'd be one of the greatest Pres. in American history bar none. It's not going to happen, so I think we can forget about it. The people with wonderful health Ins. to be blunt don't give a God damn about the rest of with either no coverage ( 45 mil. and growing daily) or with lousy or extremely expensive lousy coverage ( like me.) In fact let me say this the very word coverage is itself becoming an oxymoron to some degree. The BIG Ins. Industry specializes in narrowing coverage while raising the cost and this dynamic cannot go on forever. If allowed to in the end we will essentially have a non-system that includes only 3 classes of people. 1. the wealthy ( or those who are covered reasonably at work) 2. the Gov't employed. 3. the un-covered or under covered. The 3rd class is growing and the other two are rapidly sucking up more and more of the available medical resources. This non-system is eating our economy alive. The sad truth is nobody with power really cares. Why? because, they always have great coverage.
The 3rd class is growing thanks to you brown shirt zionists allowing costly wars for oil and shipping billions of taxpayer money worth of WMDs to rogue nations including Israel in addition to trade deficits caused by "free" trade. Maybe you should learn to live the life of a Palestinian and then you'll actually learn. Your support of "I got mine, FUCK you" attitude has dragged us all into this mess we're now in.
.The real wealth in this nation is found among white anglo-saxon protestants, those who inherited from generation back.
I am at a loss as to how you define "Zionists" but I assume it is a different definition from that of most folks as you somehow link it to extreme selfishness and great wealth. While I doubt anyone can get through to you I would note anyway that the great majority of Jewish Americans are rather liberal in their political views and their agreement about the necessity for social programs to assist the neediest Americans. Most vote overwhelmingly for democratic candidates and those who are responsible for the policies you castigate in your rather incoherent rant vote rather consistently ( always in fact) for republicans.
You need to calm down and do a bit of research.
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We see things, not as they are, but as we are.
Anais Nin
I disagree. JWVerez is correct in linking Zionism (he didn't attack Jews in general), a racist theory of occupation as it is practiced in reality in Israel, to some of our other current, pertinent problems with selfish ideology. A lot of liberal American Jews still dare not criticize Zionism too much and generally give lip service to the project that is Israel. Likewise, a lot of Americans of all kinds still feed the American myth of capitalism.
It's good practice for all of us to try to understand the world as if we were Palestinians. There are more similarities than most realize.
.While you and he may be political allies in this particular topic there is no good reason to fail to read and ponder his meaning:
"The 3rd class is growing thanks to you brown shirt zionists allowing costly wars for oil and shipping billions of taxpayer money worth of WMDs to rogue nations including Israel in addition to trade deficits caused by "free" trade."
This implies so much that is prejudicial and nonsensical regarding both the power and the intent of what he mistakenly labels "zionist" as to make my original comment stand. His claim of the great wealth and power of such "zionists" still misses the boat as to who it is exactly that runs this country. WASPS do and have forever.
We see things, not as they are, but as we are.
Anais Nin
"WASPS do and have forever."
And despite the rhetoric, is not likely to change for the foreseeable future in my opinion.
.Every single time you agree with me you gain IQ points.....;-)
Seriously Thomas, where do they get this crap?
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We see things, not as they are, but as we are.
Anais Nin
Darn, I love getting smarter.
.I know exactly how you feel, why sometimes I can almost tie my own shoelaces!!
.
We see things, not as they are, but as we are.
Anais Nin
That is one of my ambitions. I'm envious.
www.jamescarroll.net/Constantine.html (I liked the book.) The answer to "where (did) they get this crap?".
.Thanks for the link, NYCa, I would conjecture that almost every religion has much to atone for in its history.
.
We see things, not as they are, but as we are.
Anais Nin
Yes, I am referring to zionists in a broad sense. There are zionist rascals in the Arab world, Hindu zionists rising in India, and plenty of Christian zionist fundies in this country, all of whom misuse religion to generate wars and screw the working class to the point of there being virtually no middle class and a very high percentage of low class povertized citizens. You won't find the Religious Right pushing for single payer healthcare even as they loudly proclaim "pro-life". They're pro DEATH on everything no matter which religion. That's why I've become less religious over the years with an occasional outrage. Maybe I sound like Jeremiah Wright when I said that God is PUNISHING America with a broken healthcare system for aiding and abetting the bad behavior of the political elite in Israel against the innocent Palestinians and they even admitted on tv to protecting Hamas. But it's undeniable that the US has a completely smashed healthcare system and there's blatant injustice in Israel thanks to the mighty generous aid to Israel along with Europe's silence.
JWVerez:I can't let this comment go bye without saying something to you. (I don't know if you remember me,) but you can't blame everything bad in the world on zionists. Or Jews. Disclosure:I am a Jew and am opposed to the Israeli government policy towards Palestinians. I am also opposed to my government, the US government's policies in the middle east and Afghanistan. So are many others. You might consider googling "Constantine's Sword", the James Carroll book or the documentary. I usually ignore "off base" extreme comments, but I like you, given that we are both disabled and have that in common.
I'm not blaming the Jews. As for the political zionists in Israel, well, giving them billions of our taxpayer money yearly which they never have to pay back only to see them continue to abuse that "generous" offer of ours I cannot stand. I'll admit though that bailing out Wall Street and reckless war spending in Iraq are the biggest culprits choking this country. In any case, we're borrowing from China and at some point they're gonna hit the foreclosure switch. Then only will this country actually be in a Great Depression the likes of which we've never seen and it will most likely make the one in the 1930s look like a picnic in pale comparison.
I think maybe the time for change is come. I been watching reruns of The Western Tradition on TV. I watched some of them many times. There are patterns.
It's almost like we are powerless and the old Greek gods have us dancing to one tune, then another. If there is such a thing as free will I have yet to see it. People worshiped at the shrine of Ronald Reagan until George II reduced a third of us to serfdom.
The whole question may be moot. The whole thing may come apart.
...The people with wonderful health Ins. to be blunt don't give a God damn about the rest of with either no coverage ( 45 mil. and growing daily) or with lousy or extremely expensive lousy coverage ( like me.)...
- - - - - - - - - - - - - - - - - - - - - -
Sadly, this is so true. It's the American philosophy of "Me first; screw you". It's a pervasive attitude that goes like this: $500 monthly premium payments to a profit-oriented insurance company = patriotism. $50 per month more in taxes deducted from your paycheck = socialism/communism.
Yes, Big Insurance and Big Pharma have powerful lobbyists. But We-the-People can overcome that--if we can rally sufficient numbers. Imagine this scenario: There's a million-citizen-march down the streets of Washington D.C. This group is so large that the Capitol security guards get shoved aside. There's not enough police to arrest everyone. The crowd bursts into the halls of Congress. It doesn't matter how many politicians were bought off by the special interests when there's a crowd of angry citizens standing around every one of them, saying, "You're not leaving until you approve the Conyers bill."
It sure is a nice dream.
Excellent comments Fivecorners. Count me in on the million man march.
Dr. Skigalini
Advocate for Nationalized Health Care
I agree with "five corners", the people with health insurance or medicare supplemental aid or social security help do not care about the rest of us who are either underinsured or cannot get insurance through the Aetnas and Blue Cross et al.
We are forced to go to programs that charge incredible fees for insurance and live in the very few states that offer these insurance programs. there has to be an answer.
I did vote for Obama because the alternative was unthinkable. Clinton was the only one who believed in Universal Health Care but, she wasn't elected was she. Obama at least talked the Health Care talk. Perhaps Jan. 15th should be a national call-in day. There is a health care crisis! I like the scenario of a million citizen march.
Let's make it more than a dream.
I'm sorry to tell you but Hillary Clinton's healthcare policy was exactly the same as Obama's. She was the one initially co-opted by the insurance lobby. Obama, smart fella that he is, just copied her proposals and said I'm as good as her on healthcare. As for a real solution, it was gone from the electoral process more than a year ago. Unless you were for Nader or McKinney, which come to think of it I was.
I "wasted" my vote on Nader. I wish I had "wasted" it on McKinney. She actually tried, with her own body and safety at stake, to bring medicine and other supplies into Gaza. We should all have that kind of intestinal fortitude.
-- ekaton aka d.k.shaw