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Move to Single-Payer System is Crucial
As America prepares to reform our health care system, I wish to add some convictions reached while practicing surgery for nearly a half-century. Until about 15 years ago, doctors were powerful leaders in the health care system, taking their responsibilities seriously, and the system worked well. Then, dark clouds began to assemble and physicians began to lose their grip.
As the system faltered, physicians were not part of any changes except as pawns and bystanders. In short supply, we had crushing demands due to patient loads and were required to run practices of increasing complexity.
New arrivals appeared, calling themselves "health care professionals." Seemingly overnight, they were "stakeholders," and a metamorphosis occurred as medicine became big business. A new gold rush was on, lured by the attraction of the health care dollar.
The language of medicine changed with the arrival of HMOs, PPOs, surgicenters, for-profit hospitals and other schemes popping up like dandelions, fertilized by health care dollars totaling more than 15 percent of our GDP. Special interests arrived in the form of the health insurance and pharmaceutical industries, distributing lobby dollars in all directions and receiving free range in return. Multimillion-dollar salaries and billions in stock options were awarded while the steely-gray clenched faces of bankruptcy adorned middle America.
Hospitals joined in, finding a way to control pesky doctors - they hired them - spawning an undesirable side effect of antagonistic competition. Hospital bills joined inflation in the health care sector, and ear-popping predictions were heard that health care soon would become 20 percent of gross domestic product - up from 7.2 percent in 1970. The cost of all U.S. health care surged to top $8,000 per person annually while Canada's cost for universal health care was half that, and our outcomes were no better than theirs.
Our system lacks social justice for some 45 million Americans without health insurance and more who are underinsured. Huge layoffs due to the current recession are adding to these alarming numbers daily, with workers and dependents suddenly uninsured. Another surge is expected soon, when unemployed new college graduates hit the streets. We are ready to improve this situation by passage of universal health care legislation now.
Beyond that is a way to really fix the health care system. It is called "single payer." Call upon our federal government to implement such a program, recalling that it already runs some of the world's best and most efficient health care programs including Medicare, the National Institutes of Health, the Centers for Disease Control and Prevention and military medicine.
Be aware that single-payer is not socialized medicine. Single payer just means the government is acting as an administrator and best understood as being "Medicare for all." Note that only about 5 percent of Medicare dollars are used in administering the program, while private cost for the same service consumes 30 percent of premium dollars - largely due to profit.
The new administration seems set on reducing health care costs and instituting a system of universal health care while leaving the current system in place, and adding a new federal health care insurance option. This is not adequate. The prior administration wanted an income tax deduction for health care insurance costs, plus health savings accounts - both are flawed and inadequate.
In his June 13, 2005, column in The New York Times, "One Nation Insured," Paul Krugman convincingly extols the virtues of single payer. Krugman, a Times writer and professor at Princeton, was recently awarded the Nobel Prize in economics. Ask Paul. If still skeptical, ask Joe. Joseph Stiglitz, when recently asked "Do you support single-payer health care?" answered. "I think I've reluctantly come to the view that it's the only alternative." Stiglitz is a Columbia professor - and also a Nobel Prize-winning economist.
Single payer could lead a powerful surge to recovery - sort of an economic wonder drug. Polls of Americans strongly favor single payer, yet our government seems reluctant to address this eye-to-eye preferring lesser action and tweaking along as before. We need to send a message to Washington, reminding it who their employers are. There is enough unemployment already, so we do not want to send pink slips to D.C. Feeling bad for the fat -cat special interests is intolerable, not after what they have done to us. Anything less may result in further collapse of a frail, teetering relic. We are near a solution of a serious issue confronting our economy. Doing the right thing now is crucial.
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19 Comments so far
Show AllI live in Rep. Steve Kagan's 8th district in northern Wisconsin. Rep. Kagen has not signed on to HR676(Medicare for all) We have a satellite clinic, of a major Wisconsin clinic system, located in our small north woods community. People are not showing up for treatment. "Business" has dropped off significantly because people can no longer afford insurance,as a result of the present Republican depression.
"people can no longer afford insurance,as a result of the present Republican depression."
the depression is a triumph of bipartisanship.
Single payer will reduce administrative costs; make the nation more competitive in the world market; improve public health and reduce costs.
There is no free market in healthcare at the present time, and the free market solution is inappropriate in healthcare. Viewing healthcare as a commodity the same as a television or freezer fails to address the impact of poor health on employment and families.
Single-payer, tax funded healthcare would allow for the creation of small businesses because folks would not suffer "job lock" because of healthcare costs or pre-existing conditions.
I doubt the US can support healthcare costs being 20 percent of the GDP for long, and certainly reform should be part of economic recovery.
A. Rutherford
Until we get rid of political bribes, nothing will be done.
A huge amount of the problem today is the mountain of paperwork that doctors offices must process: claims, eligibilities, referrals, authorizations, etc. At least with single payer healthcare a lot of this could be elminated leaving more time for the doctor to actually administer healthcare!
If it is money that is holding up a national single payer health care system I would say as long as we have money to spend on useless wars, bankrupt banks, corporate farms and other questionable places, damn it, we have money to pay for single payer health care.
Richard Dillihunt says, "...Hospitals joined in, finding a way to control pesky doctors - they hired them..." Are you referring to 'hospitalists'? That is a new growth industry - and the worse possible thing that could happen to the already bad system we have. I have been warning medical consumers about this new development. Hospitalists are dangerous - they are hired by hospitals to keep your family doctor out of the loop when you are hospitalized. The doctor/patient relationship is no longer sacred. Good luck to all who live in the U$A.
"I have been warning medical consumers about this new development. Hospitalists are dangerous - they are hired by hospitals to keep your family doctor out of the loop when you are hospitalized."
This has not been my experience with hospitalists here in BC, a geographically massive province with specialised care centralised mainly on the south coast. For those living in remote communities who are hospitalised in the city, a hospitalist oversees care in a way that GPs, in many cases hundreds and hundreds of kilometres away, cannot. And even most GPs in the city cannot provide the level of coordination that seriously ill patients require before, during and after hospitalisation require.
Far from keeping GPs out of the loop, hospitalists are responsible for, among much else, ensuring that GPs (and family and community support systems) and the numerous medical personnel on site share critical information effectively. What could possibly be dangerous about that?
I keep pestering my congressman to sign on to HR676. He generally votes the way I'd like, but he's not as good about sponsoring the right bills. That being said, I'm a bit discouraged that single payer will be put in place with the status quo that we have. Representative government does not support these things because there are far too many lobbyists paying for different results than what the general public might want. We need the National Initiative. Please vote for this so we can fix our government. It will not be fixed from within. There's no incentive by our representatives to fix it, because to them it isn't broken. www.ni4d.us.
One aspect of health care "reform" as pushed by the Obama administration that bothers me is their proposal to spend a few billion here or there to computerize medical records as a way of saving a lot of money and allegedly making coordination smoother. I think it is a massive gimmick.
More than a decade ago I worked for a medical records programmer who developed a billing system built around the federal Health Care Finance Administration (HCFA) system. He had dozens of medical office clients from northern Kentucky to Dayton. When there were rule changes requiring modifications to his program, he made them and I installed them in those medical offices' computers. In other words, all those medical offices were already computerized using essentially the same program (it could be customized) more than a decade ago.
Basically, the only way computerization of records gains efficiencies is if inter-office and inter-agency systems are compatible. Without single-payer ("Medicare for all") few efficiencies can be created. For example, if 75 different insurance companies are using 75 different diagnostic-treatment-payment billing systems, which change at the whim of the companies, and a medical office has to adjust to each of them, where is the savings? Also, for legal purposes medical offices may need to keep legacy records of previous billing methodology (Last year patient X qualified for payment for procedure Y, but this year patient A does NOT qualify for procedure Y even though insured by the same company, etc. So sue me!).
The existing insurance system is patently insane except to those profiting from it and even many of them will privately tell you it is insane but what the hell you gotta make a living, right? Yeah, off the misery of others. That's what Amurka does best. The insurance system we have today is no more ethical than Blackwater mercenaries and probably is just as deadly.
-30-
Getting the electorate itself to approve it is a hell of a task. I'm still trying to convince my friendly neighbors to quit associating single payer with race and immigrants. They never listen. Good luck.
Not going to happen. Not as long as our Congress critters all get their health care paid for by the rest of us for life. We need to start a movement to remove all health benefits from elected officials. Only then will we see any action.
I live in Rep Ron Kind's third district in southwestern Wisconsin. I am self employed and have a $10,000 deductible policy. I know I will never see any insurance payments unless I or my wife is really sick. Last Sunday I had to go to the emergency room at our local hospital (in a town of 1500, five miles away, we are so fortunate as farming is a rough business) We told them we had basically no insurance and were advised to call the billing office during the week.
Today they told us when the bill is sent if we pay cash they will give us a 30% automatic discount, standard for the uninsured. So tell me, how can anyone say our present system makes any sense? The cost keeps us from preventative care, and hospitals routinely inflate the cost of procedures when they know insurance is going to pay.Small rural hospitals know insurance companies will refer patients to the larger, metropolitan centers. I just hope medicare is still there when I am eligible in a few years.
Wait until you see what Medicare doesn't cover - and how many obstacles you have to negotiate just to get the treatment your doctor says is imperative. Every day is a fight for me - fighting just to survive, to pay rising co-pays, to get necessary drugs approved (which means changing drug providers), and dance to the tune the insurance companies play - after all, they set the standards, even for Medicare. Of course, if we get single-payer all that nonsense will disappear, since Medicare now struggles with covering only the worst cases with the highest expenses (preventive care is routinely denied) and the most vulnerable population. Getting the mindless bureacracy out of the equation would help - but they are fighting for their jobs in a doomed economy, and they know it.
The '30% automatic discount for cash' is disingenuous. Why ? Because in general, PRIVATE PAY PATIENTS PAY MORE FOR THE SAME SERVICES THAN INSURANCE DOES. This is a dirty little secret I found out a few years back during a very rare sortie into the medical system. (Like you, we are self employed and have catastrophic only insurance).
The reason is that hospitals negotiate with insurance providers to pay set costs for various procedures. But when a private pay
(who may have insurance with a high deductible which they cannot use) patient comes in, they get billed at a higher rate. Like, maybe 30% higher. The 'discount for cash' is actually just bringing the amount down so that if the patient finds out, then the hospital has an excuse in regards to the billing discrepancies. So lame.
I am not the brightest bulb around so would someone tell me where the money will come from and how will it be gathered? The funds would have to be from the public(taxpayers). What would this single payer be required to do? What will the name of it be?
I suspect that your last inquiry is not nearly as important as your penultimate question. The answer to that should simply be that the basic health requirements of every American in this country should be met and that should include mental health as well as dental and vision needs. Undoubtedly that would mean that one's taxes would be increased. But it would also mean that would not go bankrupt or have to worry if their loved ones would have to needlessly die because they did not have health insurance.
Single payer-placing people before profit.
Thanks for the information.
And single-payer is an appropriate name for want of another.
Don't laugh, but I assume, for example, that no matter where I was, if I cut myself serverely, broke a bone or two, started passing a kidney stone, that all I would have to do is get to a hospital for treatment?
Don't laugh again, being hypertensive requiring 2 medications to control the BP, I could go to any doctor for check ups as I do 2 times a year?
Since there has not been any of this 'single-payer', while I was employed I was benefitted by the health insurance of the company and, in this case, BC/BS. With a steady job and income it wasn't so bad as it covered a few medical issues, but this single-payer is what I would think is much better and especially so by not being employed(would that exclude me from medical care?) and having no insurance. But will it fly? I am looking at a corporate controlled congress and that in itself is an incredibly huge resistance to this single-payer deal. The power of the lobbyists has all too often overridden the wants and needs of the majority of the people, evident of clinton's attempt to get that health care reform passed.
"Don't laugh, but I assume, for example, that no matter where I was, if I cut myself serverely, broke a bone or two, started passing a kidney stone, that all I would have to do is get to a hospital for treatment?"
Here in Canada, where we have multiple single-payer systems, administered by the provinces in accordance with the Canada Health Act, the answer is yes. If you were treated in hospital outside your home province, then the hospital would be reimbursed by your home province. If you move from one province to another, your home province is responsible for reimbursing providers for up to three months, then you would be covered under your new province's single-payer system. (It would be less complicated if we had just one single-payer system, but it's not that complicated, and there are many advantages to provincial over federal administration.)
"Don't laugh again, being hypertensive requiring 2 medications to control the BP, I could go to any doctor for check ups as I do 2 times a year?"
Speaking again for the Canadian system(s), the answer is ... sort of. You can't take yourself off to a specialist (other than an emergency medicine specialist) without a referral from a GP or another specialist. But any GP who saw you would be reimbursed, as would any specialist to whom you were referred.