Single Payer National Health Insurance

[malikstein]

Here is a link to the first part of a series explaining how single payer health insurance works. It is very clearly written and coherent. Enjoy.

http://www.dailykos.com/story/2006/11/27/114614/15

[annabanana]

1. good article

I agree right down to my toes, and I also like the cartoon in the article:

[durrrty libby]

2. K & R

[Vinca]

3. If the masses can't understand the concept as described by

this writer, they never will. Concise and to the point. The right wingers should note there would probably be massive economic growth in this country if the health care issue was resolved for business. (Had to add that. They don't seem to care much about the uninsured, but we know damn well they care about their stock portfolios.)

[9119495]

4. Why can't there at least be compromise?

I favor single payer health plans but many people I know just won't go for it. They don't have the spirit of community that I do and would rather pay for their privileged access than risk losing it.

The waste talked about is the most ridiculous aspect of this whole thing. As an incremental step, why not ban all forms of advertising by health and drug providers? Sure, they'll cry "violation of free speech" etc. But if the alternative is a single payer system that ends their existence as we currently know it, why not at least go for that?

[malikstein]

6. privileged access

Reread what the article says. The idea is to extend privileged access to the entire population, not to eliminate it. Among other measures in the proposed system, patients have the right to choose their doctors, which is not currently the case with private insurers.

[9119495]

10. But then there would be no priviliage...

People that are insured enjoy the limited access to their doctors. They like not waiting a tremendous ammount of time. And they benefit from the fact that the uninsured simply don't clog up the Drs' offices because when they get sick, they CAN'T get treatment. The uninsured can't afford it so they suffer through.

The idea of losing some care so that the masses can have more is not supported by many outside DU. It's a tough sell in a culture that has developed a strong sense of entitlement and selfishness exacerbated by the ability of too many people to achieve every material want they desire.

[malikstein]

12. Are you trolling for pharma/insurance?

Your comments make absolutely no sense. You assume that national health care means rationed health care. That's what we have now! Europeans don't have rationed health care. For example, in France, parents of infants are paid to take their child for a checkup. Yes, paid! The idea is to provide preventive care. That way a problem can be corrected before it becomes serious.

[9119495]

30. Umm...

Are you illiterate? I favor National Health Care...and it is in every post on this issue. But, you're probably one of those DU people that nobody talks to.

43 posts, eh? Who is trolling? I usually try to avoid criticizing people with a low post count but you are the one that accused me of being an agent of big pharma. Jesus. I'm trying to show you what actual people are thinking and saying right now but because they don't all think the way you do, you assume they don't exist (and thus the trolling for pharma/insurance).

Have you ever lived without health care? I have and it sucks. I also have an employer plan that charges me $400 a month as a single healthy male. How could I support such a system? I think it is the biggest human rights issue facing our nation and if we don't go to a national plan, our nation may not survive the next fifty years.

[malikstein]

32. Sorry.

I misunderstood the tone of your comments. Thanks for the clarification.

[OzarkDem]

41. You missed these facts

from the linked article

"Under a single-payer system, all Americans would be covered for all medically necessary services, including: doctor, hospital, long-term care, mental health, dental vision, prescription drug and medical supply costs. Patients would regain free choice of doctor and hospital, and doctors would regain autonomy over patient care."

[Vinca]

8. People aren't for it until they wake up one day and discover that

their employer will no longer be footing the health insurance bill and try to buy it on their own. If you're 20 and and in excellent health the premium doesn't sound all that bad. Try being late 50's and in good health. It goes into the stratosphere. If you have any medical history, you won't be able to buy it at any price. Tell people who balk at universal coverage that they're not immune. Even if they're insured, chances are a major illness would cost them big bucks or drive them into bankruptcy. 80% coverage - pretty much the norm these days - is laughable if your bill is hundreds of thousands of dollars. Most people declaring bankruptcy because of medical expenses had insurance. With universal health care, that wouldn't happen.

[9119495]

9. Exactly. That is the debate I'm having with

my mother right now. She thinks the R & D will suffer without drug companies. I counter that Universities can and already do make up their share in research. She also says the gov't plan will stop covering some services if the patient is too old. She also says that a right-wing politician could appoint administrators that would restrict birth control, and abortion access (this is actually a fear I share) but we could neutralize this by making the board of directors independent and non-partisan.

[malikstein]

13. The R&D argument is a lie

direct from the pharmaceutical industry parasites. The basic research is done by universities and NIH, then licensed to pharmaceutical companies. They don't do squat. Read Marcia Angell's "The Truth About the Drug Companies: How They Deceive Us and What to Do About It"

http://www.amazon.com/s/103-6425584-4710201?ie=UTF8&keywords=marcia%20angell&tag=opera-20&index=blended&link%5Fcode=qs

She has an insider's knowledge of the scam, since she was editor of the "New England Journal of Medicine" for many years.

[eridani]

27. Ask her what she thought motivated Jonas Salk--

--who never made so much as one thin dime of off his polio vaccine. Ditto for Alexander Fleming (penicillin) and Banting and Best (insulin). Those have to be the three most important practical medical discoveries of the 20th century.

[OzarkDem]

37. Drug companies don't do basic research

They do drug development based on results of research.

The universities, teaching hospitals and research institutions do the basic research - mostly funded by the federal government.

Drug development research can be expensive, yes, but they are now spending more on marketing than on research.

[SharonAnn]

15. Actually, most of the people in bankruptcy because of medical costs did

have insurance. It was the co-pays and uncovered expenses that did them in.

Think about it. If you have a $100,000 bill and have to pay $20,000 of it, it might as well be $1 million to most people. They can't do it. And, if it's more than $100,000 which can be the case for treatment of many conditions, then it's even more overwhelming.

If there's a cap on out-of-pocket expenses that helps some. But again, if the mother is ill then the family probably needs to hire someone to care for the children, do the housekeeping, cook and do laundry, and that's not even mentioning the care for the ill mother. Those things are not covered by medical insurance.

[Cleita]

20. There is a way to end the for profit insurance companies participation

in health care, where they don't belong. That is to take the profit out of it. There is an organization that is trying to get legislation passed to sell Medicare coverage to employers and individuals. Since Medicare can operate on much less that private health care plans, the insurers will probably find out that they can't compete profitably and will get out of the business. Then we can look to getting true universal health care here.

[malikstein]

28. There's an even simpler way to do it:

In most countries with a single payer system, insurance is a payroll deduction just like social security. You pay according to your means. The rich pay more. The poor pay next to nothing.

[Cleita]

45. True and a deduction would have to be made when we

have a universal single payer health plan. However, in order to do that we have to get the insurance companies out of the health care industry. They won't go unless it becomes unprofitable. One way to do that is to make it unprofitable for them.

Other than that they will keep doing what they do and that is to lobby corrupt Republican Congressmen and Senators to vote in their favor. They will keep spreading misinformation in print media and other like they have been doing in the past. This is the main reason we don't have NHC now.

They convince the public that it would be so bad for them. They plant the information in trusted venues like television news or a weekly news magazine or even your local newspaper. Editors run the stories because they seem legitimate. Here are some of the lies and misinformation from the past.

*You can't trust the government to run anything. Look at the DMV?

*You would be waiting hours in emergency rooms and months for needed surgeries. Then they dig up something that happened in Canda, Great Britain, Sweden or other country that happened decades ago to prove their point.

*Patients are coming here from Canada to get health care. The truth us that sometimes Canadians come here to get specialized care in places like John Hopkins or the Mayo Clinic, but what they don't mention is that Canada Medicare pays for all the expense of that specialized care.

*Doctors and nurses are coming here by the busloads for better jobs. This is an out and out fabrication.

There are many more but these are the main propaganda points that they spread. They are very well organized. So instead of trying to pass legislation that bypasses the for profit health care industry, the one thing that hasn't been tried is to undermine them. I think the time has come.

We passed a universal health care bill in California and Gov. Schwarz. vetoed it as costing too much. Considering that the source of money would be pretty much the same money going for health insurance now, it wasn't true. Surprise, surprise, half of Arnold's campaign contributions come from the health care industry and the insurance industry. So instead we are going to have to tackle this elephant with their own methods.

[OzarkDem]

35. What do they risk losing?

A single payer health plan system would give everyone good health insurance. What's to lose?

Those are some of the myths and bogeymen surrounding health care reform - you don't get the same health care coverage or you don't get to choose your doctors. Not true. Consumers won't be hurt, only private insurance companies.

[malikstein]

53. I'm feeling sadistic

Let's hurt those private insurance companies. We've taken too much hurt from them already.

[loyalsister]

5. Legislators know it's the best plan out there.....

It is obscene to have some of the the best technology (the inventors are here we get it first) and rate below any other country in delivery.

[Lydia Leftcoast]

7. Being in my fifties, I hope I live long enough to see single-payer

in this country.

[Hawkowl]

11. Your money or your Life!

The whole concept of capitalism and competition and a free market in health care and drugs is INSANE! Why? Because it boils down to a simple premise: "Lowest cost dictates who you choose to be your doctor, drug provider, surgeon, etc." How much will you pay to save your life? How do you put a price on that? Simple. You'll pay everything you have and the insurance companies intend to wring every last nickel out of you. Their attitude? Fuck you and give me your money! This is the attitude of a common, criminal. A street thug sticking a gun in your face as he takes your wallet.

[nashville_brook]

14. right now we have a Single PRAYER Health Care system

as in "You don't have a single prayer!"

[Cleita]

19. Since about 60% of health care provided for in this country is from

government, Medicare, Medicaid CHIPs, CHAMPUS, the VA, for example, it would make sense to cover the other 40% and put all those agencies under one roof with one single payer.

[nashville_brook]

21. connecting availability to employment is like

connecting the availabilty of air to your driving record --- or something like that. it doesn't make any sense.

health is a public concern.

[Cleita]

22. Where did I say that?

I said the 40% that aren't covered by single payer should be, that means everyone.

[nashville_brook]

25. i was adding -- didn't mean to imply anything

as in, "yeah, and... this."

[OzarkDem]

39. Very good point

We have to consider that people who have accidents or experience suddne, catastrophic illnesses (like a cancer diagnosis) means they can't work or can only work part time. Its impossible to afford COBRA payments when you aren't working.

[nashville_brook]

42. i have a chronic illness. haven't worked in since 2004 and dread having to work

with the pain i experience on a daily basis. but i have no choice and it's a big catch-22 b/c the illness is going to require sick days and many days where i'm not 100% and sooner or later i'm going to be fired and have to start all over again.

as i write this i'm having so much pain that i can't get out of bed. i have my laptop and my brain... that's about all right now. i can read and post. i can write and sling a good essay every now and then, but i'm done as far as my career is concerned.

[grizmaster]

16. K&R

[RedEarth]

17. What Citizen Activists Can Do

What Citizen Activists Can Do
Educate yourself about single-payer national health insurance with the PNHP website resources and PNHP slideshow.


Sign up for PNHP action alerts on important health policy issues and new research. (PNHP members are automatically subscribed).


Invite a PNHP speaker to speak to your community group about single-payer.


Organize a meeting with your legislators. The citizen single-payer group Healthcare Now has been holding congressional hearings and winning sponsorships for the single-payer bill all over the country. Visit their website for more information.


Write an op-ed or letter to the editor of your local news publications. PNHP has a handout with tips.


http://www.pnhp.org/action/activism.php#citizen

[Cleita]

18. I have posted the link to the Physicians for a National Health Program

many times here at DU in the past, http://www.pnhp.org/
because it is one of the most comprehensive sites about this issue that I have come across. I don't think we can post it too many times.

Thanks for the KOS article. This will be one more bookmark to add to many that I have on this. Welcome to DU. I look forward to other posts about this very important issue.

:-)

[Be the Change]

23. Kucinich and Conyers have introduced the "Medicare for all" bill

http://www.truthdig.com/interview/item/20061128_rep_dennis_kucinich_tackles_health_care/

[OzarkDem]

31. Dennis has worked on this for a long time

He's really looked at all the options and has picked up a lot of bipartisan support.

[LonelyLRLiberal]

24. Thank you.

I am forwarding the link to my son-in-law, a internal med doc who recently left a clinic to become a hospitalist. I'll be interested in hearing from him on the subject. He, BTW, thinks he is a Republican (mainly because he believes it is in his personal financial interest to be Republican).

[Qutzupalotl]

26. Should we incent the insurance industry to help us?

To suddenly lay off a huge segment of the workforce would be disruptive. I want single payer to happen, but I know the insurance industry and big pharma will fight us like they did in '94. They feel threatened, with good reason. We're basically voting them out of a job. But what if we gave them a role?

I realize that cost savings is the goal, and that keeping a bloated beaurocracy won't solve anything. Taking CEO profits away will save a lot--and that prospect alone would make them fight tooth and nail. But if they came to realize that the people are desperate, their profits are criminal AND they can work in the new streamlined single-payer system, that might wear down their resistance. Naturally, we wouldn't be able to find places for all their workers, but maybe the decision-makers? (I hate myself for thinking that!) Maybe 50% of the workforce?

Just HOW they could be utilized, and to what extent, I have no idea. It's just something else to consider in the equation.

Maybe it's impossible. I fear that if we gave them a role of any consequence, some would work to thwart the system.

Still, laying off--how many workers? a million? two million?--can't be good. Finding them SOME role would be better than a pile of pink slips in this economic climate.

[malikstein]

29. The insurance industry has absorbed

a lot of medical care personnel to handle claims. They should be providing medical care, instead. As for the accountants and other classes of workers, they should find other jobs, too, just like those whose job has been outsourced to China. Shutting down private health insurance is a win-win situation for the American economy.

According to the article I posted, 31% of health care expenses are go to waste, inefficiency and profits to private insurers. Say we reduce the overhead to about 2%, which is what Medicare costs. Since we spend about $2 trillion a year on health care, eliminating private insurers should save about $600 billion a year. That's not counting savings from negotiated reductions in the cost of medications, which should probably add a couple of hundred billion more.

What could we do with, say $800 billion in pocket money that is not spent on health care? Could we expand some other sectors of the economy and productively employ those displaced workers from the insurance industry? You betcha!

[nashville_brook]

44. 31% more efficient on administrative costs alone! 800 BILLION

i've read that Medicare is frighteningly cheaper to adminster than private health insurance.... sheesh... 31%... 800 BILLION back into the economy. imagine how that would improve our lot!

[malikstein]

49. I was doing the arithmetic in my head,

so don't take that figure literally. I'm sure that we are talking about hundreds of billions, though.

[area51]

34. "To suddenly lay off a huge segment of the workforce would be disruptive"

Tell that to all the people whose jobs have been offshored/inshored, the textile workers, engineers, medical transcriptionists, I.T. workers, etc. No one gave a rat's ass about those people losing their livelihoods, why worry about insurance co. workers?

All the insurance industry people now pushing paperwork can go to work for the govt. processing paperwork for single-payer/universal healthcare. Problem solved.

[Qutzupalotl]

48. That wouldn't solve the problem

if your goal is cost reduction, you'll need personnel reduction. If we kept all these people on, we'd have practically the same costs. (On edit: --though, admittedly, without the obscene CEO profits.)

We feel it when Ford lays off 20,000. What's another million or two, you ask? How about depressed wages from a job-seeker's market suddenly becoming an employer's market?

"No one gave a rat's ass about those people losing their livelihoods"? Really?

[malikstein]

52. Actually, that doesn't solve the problem

because the private health insurance industry is so inefficient that you would never need anywhere near that many people to administer national health.

Private insurance overhead absorbs 31% of health care dollars.
Medicare absorbs 2%.

[nashville_brook]

61. it would prolly hit marketing people the hardest

and that's a hit i'm willing to take... as a marketing schmoe, i could go the rest of my life without writing and designing another healthcare management brochure.

[OzarkDem]

40. Perhaps they can shift to other lines of insurance

They can sell supplemental health insurance, for those who may want "gold-plated" health care services. Or they can move more into areas like disability insurance - covering replacement income if someone gets sick or injured.

They may not be as big an industry as before, but they'll find ways to diversify.

[nashville_brook]

43. i did marcom for healthcare co's for years, lemme tell ya

we don't need to worry about them. we don't need to take the responsibility for THEM losing workers or money. i understand about mutual benefit negotiation, but you don't negotiate for mutual benefit with the devil -- and these people are devils, make no mistake.


if anything is to be done, there's going to be giant growing pains no matter what.

[Qutzupalotl]

50. ALL of them are devils?

Sure, upper and middle management, I could see...:-)

but for the bottom of the totem pole, even if they're part of the machine, it's not THEIR fault it's broken. All I'm saying is it would be better if we could find a way to absorb the average worker.

Other posts on this thread are rosy about the creation of new jobs. I'm less optimistic about that, but I hope they're right. We gotta do it no matter what.

"Mutual benefit negotiation"--that's a phrase I could have used a post or two ago. :-) Thanks.

[nashville_brook]

51. mutual benefit negotiation -- teehee -- glad you likee

it's yours! :)

[malikstein]

55. Remember that the employees

are just plain folks like you and me. We don't want to screw them, so we need to assure that they will get job placement help and the like.

As for the bosses: show me the nearest street lamp.

[nashville_brook]

58. administration duties are being shipped off regardless

[bighughdiehl]

33. It would be about time

First off...I can't believe I was taken in by the RW spin about this in the 90s under Clinton. Since then I have seen costs go up so much and quality go down. And since every other developed democracy has it, there is no excuse. I also think much has to done about quality of care through the medical educational system. I mean, make incentives for people to go to medical school. Bring the cost of that education under control and stop this 70 hour shifts for interns shit. I wonder how many malpractice suits that is responsible for? We are also one of the few countries that does this to our doctors-it causes mistakes and there is no point to it but sadism. Before even talking about a Single Payer system, though, we must relentlessly deconstruct many RW memes:

Raising taxes on multimillionaires is bad.
"Big Government" is bad. Unfortunately it is possible this one has only been heightened by some shenanigans of the Bush Administartion(it is even possible this was deliberate, IMO).
Care would be rationed(we could point out that it already very much is).
Pharma profits go to R&D-this one might be the easiest to dismantle through simple facts.(oh wait, they don't do facts). Facts are evil secular humanist liberal socialist things...or something.
Poor people should just die-well, there will be more and more poor Americans in the years ahead. So, less people to hold onto this one.
There is tons of work to be done. We can't expect it anytime this decade.

[Vinca]

57. I don't understand why people think raising taxes for health care

is bad. As I explained it to a Republican I was arguing with, my taxes could go up $5,000 a year and I'd immediately be saving $7,000 plus a $5,000 deductible plus 20% out of pocket (if I could afford the policy, that is).

[savemefromdumbya]

36. every american is entitled to healthcare free at the point of use

how one funds it? Get rid of health insurance firms and take it out of the salary. Paris Hilton would have to pay a lot more than 'Joe Blog'

[Phoebe Loosinhouse]

38. One aspect of this that I never see mentioned is that Universal Health would be a HUGE job creator

in just about every sector you can imagine. We would need to build new clinics and hospitals and medical schools and we would have to employ every aspect in the health industry: nurses, doctors, techs, lab workers, maintenance, food workers, etc.

These could be good, decent paying jobs. It's almost like not only is this the ticket to peace of mind and healthcare, it is also a ticket out of poverty and hopelessness so that many people could look forward to something other than low-paying, dead end jobs. Healthcare jobs could replace all the old manufacturing jobs we have shipped elsewhere.

This is a win-win-win-win. Only the self-serving would be against this.

[Cleita]

46. Yep, also it would relieve employers of the increasing burden

of getting health care for their employees and the crushing expense of the medical part of worker's comp. NHC costs much less and delivers much more. It would probably be tied to the deduction for SS and Medicare that is taken from an employees check and matched by the employer. It still could be done for much less than privatized health care is done today.

[malikstein]

54. In contrast to your picture

Gov. Pataki is shutting down 9 hospitals in NY State.

http://today.reuters.com/news/articlenews.aspx?type=domesticNews&storyID=2006-11-29T214449Z_01_N29598120_RTRUKOC_0_US-NEWYORK-HOSPITALS-BUDGET.xml&WTmodLoc=USNewsHome_C2_domesticNews-3

You see, it's too expensive to run them under the current system.

Anybody want to guess how many people will die because of this decision?

[Phoebe Loosinhouse]

56. How many will die and how many will be unemployed

There will be quite a ripple effect.

[nashville_brook]

60. 20 hospitals according to info in this thread

scroll down for a link to a NY Time article

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=102x2634587

[nashville_brook]

59. and imagine the economic security when people don't have to "sell the farm"

to get the healthcare they need.

[proudmoddemo]

47. As a patient, I have a different perspective

A national PPO with an income adjustable deductible (to a maximum of say $3,000) and 15 to 20% copays after the deductible is met to a $6,000 out of pocket maximum (which would also be lowered based on need) after which the plan picks up 100% could work. People should be able to buy into the system with a premium, and the unemployed should get default coverage. The reimbursement rate for this program should be set at the average of current private reimbursement rates, and should be adjusted for inflation/medical advances that require additional expenditures.

This is sort of a national catastrophic insurance. If people wanted to buy better insurance they could. The contract for administering this plan should be out to all existing healthcare companies on an equal basis (this would protect insurance industry jobs). If they wanted to keep their HMO (Kaiser) they could. Doctor's practices would remain intact and private. They'd be free to be part of the national network, or independent. And patients could still see their doctor, and be helped to an extent, if they were out of network. Current state insurance plans for the chronically ill, which basically follow this model, are a guide for implementing this type of plan.

Here's a link to where I state out the reasons for change:

http://healthybagofpolitics.blogspot.com/2006/11/lemon-that-is-american-healthcare.html