What Liberals Don’t Get About Single Payer

[xchrom]

http://www.bloomberg.com/news/2014-01-08/what-liberals-don-t-get-about-single-payer.html

Documentarian Michael Moore greeted the introduction of Obamacare with an admission many liberals will cheer. “Obamacare is awful,” he wrote.

Its awfulness, Moore said, stems from “one fatal flaw: The Affordable Care Act is a pro-insurance-industry plan implemented by a president who knew in his heart that a single-payer, Medicare-for-all model was the true way to go.”

Like Moore, I’d prefer a more nationalized health-care system. But his analysis relies on a common mistake that distorts both the benefits of single-payer systems and the deficiencies peculiar to Obamacare.

Insurers are the bogeymen of American health care. That’s in part because they do a lot of the unpopular stuff: They’re the ones who charge you money for health care, who say you can’t get something you want, who your bosses blame when they deduct more money from your paycheck to cover health costs. And it’s hard to see what value they add to the system.

***yes, insurers are weak. that's it.

[el_bryanto]

1. It makes an interesting argument I thought;

Weakness is a relative term though; they certainly are adept at protecting themselves. But are they powerful enough to actually get the best prices for their clients? Are they even trying to?

Bryant

[djean111]

4. Why should they? Their clients HAVE to pay them. It is the law now. n/t

[el_bryanto]

6. In theory, the clients are required to select an insurance provider

But they compete against each other for our business; so if one can negotiate a better price, than they will get more customers, because their rates will be lower.

In practice it sounds like the Pharmacuticals and other players in this arena aren't open to negotiation and the Insurance companies don't have the clout to force them to bargain.

Bryant

[djean111]

9. Exactly. The theory is that prices will go down. The reality will differ, IMO.

The reality is that people are locked into the insurance companies, the insurance companies really do not compete, it seems to me. Couple bells here, couple of whistles there, they can always get ya on the back end of co-payments and out-of-pocket.

[el_bryanto]

10. nods - you might be right; the argument of this article though is that

other aspects of the financial industry are setting the price and forcing the Insurance companies to take it.

Bryant

[djean111]

13. Yes. I agree. But IMO the insurance companies are complicit, because they control

the access to the money for everyone else. Get rid of them, install government controls (hopefully they will negotiate costs down, but I have completely lost my faith in that), and then the costs would likely come down. Those costs would not be so high in the first place, without insurance propping them up. Individual victims, er, customers, can only be squeezed for so much.

[alc]

18. decreased medical cost = lower profit

That's the other side of the MLR. They have a financial incentive to increase medical costs and disincentive to decrease costs.

"competition" may be a reason to decrease cost and premiums. Or they may offer more/better coverage, lower copays/deductibles then ask the regulators for higher premiums. If enough people prefer the extra coverage they make more money by raising raising medical costs. And you can expect providers to start preferring those reimbursement rates and forcing other insurers to raise premiums. Regulators will be a big factor. Will they hold firm and be called death panels? Or allow different premium costs to avoid being called death panels? They can claim that as long as a low-cost option exists it's not a problem but that option will be significantly less useful unless providers accept the lower reimbursement.

[Mass]

2. Very good analysis. France has lower costs because the bargaining power of the state

is a lot stronger than the bargaining power individual insurance companies will have. The fragmentation of the insurance market and the fact that so many are left to fend for themselves explain the high prices more than anything insurance companies may do.

This is indeed a huge argument for single payer, the largest one in fact in my view.

I would not say insurers are weak, but anybody who understands how European healthcare works understands it is the bargaining power of the states that makes the system less expensive,

[Egalitarian Thug]

29. Which French organization is taking a quarter of every French health care Frank?

The ubiquitous false premise of "other countries have insurance, too" is disingenuous, at best.

Other that the fact that they all bear the moniker "Insurance Company", there is no comparison.

[Mass]

30. OK, you are missing the point on purpose, because obviously spouting platitudes

is better than understanding the issue.

If anything, the issue is a huge argument FOR single payer, because the federal government has more ability to negotiate prices than a fragmented private market.

But I am amazed at people like you. No surprise this country still does not have single payer or a decent healthcare system.

[Egalitarian Thug]

35. No, Bloomberg is promoting a false premise. One that ignores or excuses the existence of

completely unproductive organizations by attempting to switch the focus onto the absurd premise that the problem is lack of negotiating strength.

And that's the problem with the very-serious-pragmatic-centrist posture, it requires an assumption of the same false premises as the republican illusions. Ignore the cause, and waste effort fiddling with irrelevant minutiae.

[El_Johns]

37. A 2007 AMA study found that in 299 of the 313 markets surveyed, one health plan accounted for

at least 30% of the combined health maintenance organization (HMO)/preferred provider organization (PPO) market.

In 90% of markets, the largest insurer controls at least 30% of the market, and the largest insurer controls more than 50% of the market in 54% of metropolitan areas.[109] The US Department of Justice has recognized this percentage of market control as conferring substantial monopsony power in the relations between insurer and physicians.[110]

http://en.wikipedia.org/wiki/Health_insurance_in_the_United_States

[djean111]

3. Yes, thank you for posting this.

We will not have affordable health care until the government sets the costs, like other governments do.
Until then, all we have is ACCESS to expensive doctors, hospitals, treatments, and medicine. Pharma and the medical products companies and the doctors and hospitals will just be sucking more and more from the government. Yes, insurance companies are sucking up cash, but the only actual price control I see is saying insurance companies must spend 80% of income on health care. That is a toothless tiger, because they will just be dealing with Pharma and hospitals who CAN raise their prices. So premiums will just go up, albeit with a frowny face letter from a politician.

Looks like the TPP will actually be a huge boon to Big Pharma, going after the affordable generics. Can't have that, ya know.

[LuvNewcastle]

5. We need to have single-payer AND have the government negotiate rates.

The article seems to say that insurance companies would be just fine if we allowed them to negotiate rates. It would be better than what we have, but we would still have the problems that go along with having insurance companies as middle men.

[Hoyt]

7. Article is not totally right, but it's not totally wrong either.

It's a good contrast to single player or Medicare for all are the only way to get to where we need to be in providing health care for all. It's closer to truth considering the changes in expectations that need to be made by providers, payers, and consumers of health care (patients) for the health care system to work for all.

I hope Klein is not tarred-and-feathered for his insight.

[zipplewrath]

27. Pretty much totally wrong

Insurance companies don't particularly "innovate", the providers tend to do that in attempts to achieve the price goals of the insurance providers. They may then "cross pollinate" those methods to other providers. A government run insurance plan (single payer) could and would tend to do the same thing. The biggest immediate savings is the removal of the profit margin from insurance. That's about 15% versus the 3% of Medicare (administrative costs, not profit). Also, the government can remove significant risk from the system by controlling issues of protocols and procedures not to mention controls on liability. As such the risk exposure can be managed better than the providers or insurance companies could ever hope for. About the only thing the article really got right is that "for profit" health providers don't really make much sense. There is no real advantage to for profit hospital chains or doctor coalitions that can't be done as well or better by the government. Doctors can be paid, but drug research and running hospitals should be done by contract from the government. It's how we build aircraft carriers.

[Hoyt]

28. While not here to defend insurance companies, their profits are not 15%. And

Medicare's overhead is not directly transferable/comparable to overhead for total population. Plus, I'm fine with insurance companies having to invest billions of dollars in the systems necessary to manage large populations of patients. Right now, you won't get Congress to approve necessary funding to do that.

We love Medicare. But, most folks don't realize that every claim is paid by a private insurance company; Part D (drugs) is totally handled by private insurance companies; and Medicare Advantage (which 28% of Medicare beneficiaries have voluntarily chosen) is administered by -- you guessed it -- insurance companies.

Right now, insurance companies do a better job dealing with Pharmaceutical companies and some other providers than Medicare. I don't think our government, right now, has the political will to deal directly with providers.

Thus, I think that right now a partnership (friendly or forced upon them) between insurance companies and government is the way to transition to a better health care system for all. We can ratchet down the overhead paid to insurance companies over time, and eventually make them little more than processors/administrators for a government dictated health care system.

If we instituted Medicare for all right now, I don't think there would be a significant difference in premiums, especially if the government has to include in each patient/beneficiary's share, a risk factor. Let the insurance companies carry the risk for the next few years.

[zipplewrath]

32. It's already there

Congress has already funded it, it's called Medicare. Claims are paid by private companies, but that's an extremely contractable service. Roads are actually built by private companies, but the government is still a "single payer" for those roads.

And the only reason that insurance companies do a "better job" of dealing with pharmacutical companies is because the government is prevented BY LAW from doing so, even under the ACA. Part D was set up specifically that way.

Insurance companies should not be in the system at all, nor should profit really. And by leaving them there, it leaves them in control. They aren't going to go away and they will no more go away than the "to big to fail" banks have. And there are plenty of payment processing companies for the government to use to process medical payments.

[Hoyt]

33. I agree with your assessment eventually. But, the government couldn't even get a creditable

enrollment site developed for the ACA. How the heck they screwed up the most visable aspect of the ACA is beyond me (although the contrived law that had to be enacted to get around Republican obstruction was a big part of it).

My point is, we aren't there yet. Will it be 2 more years, 5, etc. I don't know. It shouldn't take 10 more years, but we aren't there right this minute.

And Medicare needs to be changed to decrease deductibles; copays; fraud (Medicare's approach of pay and chase fraud is crazy); set out-of-pocket maximums which Medicare does not have unless beneficiaries purchase a supplement or select a Medicare Advantage Plan; mechanism for preventing care that has marginal outcomes; government has to find the guts to say "No" to providers and patients when proper; providers and patients need to have reasonable expectations; etc.

[zipplewrath]

36. It already exists

ACA didn't exist and the roll out site didn't exist. Medicare already exists, adding more people to it would have been vastly simplier than this complex system of state exchanges, federal exchanges and a large multitude of for profit and not for profit insurance companies. ACA was the hard solution, expanding medicare so that employers could have purchased coverage for their employees would have been vastly simplier. Letting individuals (who qualify) by in would have been simplier too.

[Hoyt]

38. Except, it would not have passed under any scenario. And it would not have eliminated insurers.

They handle a good bit of Medicare from drugs, to claims payment, to Medicare Advantage, to patient/beneficiary questions. And, I don't think the premiums would be much cheaper, if at all. Not to mention the doofuses who think Medicare is akin to communism.

By the time we are through with the ACA for a few years, even the Tparty will be begging for Medicare/caid for all -- well, as long as there is a white wing program and another for "all those other people" they hate.

[zipplewrath]

39. Moving target

Well, first you were saying they couldn't handle it, then you were saying it was to difficult, now you're saying it couldn't pass. I can't keep track of the reasons why medicare for all was a bad idea. Yes, they use insurance companies to handle the billing, but it's because insurance companies make good contractors for doing medical billing. But the government controls the costs and the methods.

[Hoyt]

40. Here, let me simplify it for you. Forget everything but that it would not pass, period.

[zipplewrath]

43. Forget everything else you've ever posted

So all your arguments before should be forgotten?

[Eric J in MN]

8. The health insurance industry

...only takes in $884-billion-a-year. Peanuts! (sarcasm)

[Adrahil]

11. I generally favor single payer, but....

... I'm nervous about a system where I have little or no recourse if the options offered suck. I absolutely think we need a public option, but I'm not convinced about single-payer just yet.

[enlightenment]

16. What recourse do you have with an insurance company?

If they disallow an option, what do you do? Do you drop them for another insurer? Do you pay out of pocket for the option you prefer? If you are able to do either of those things, you are in a financially enviable position - and as such, would have the same kind of choices in a single payer system. Extra, private insurance and/or cash payment are both allowed in most systems.

[Demo_Chris]

21. Under the ACA, none. Obama took that away. nt

[enlightenment]

22. I'm not sure what that means.

Could you be more specific?

[Adrahil]

23. Well, right now, my company offers three insurance options...

... so I do have a choice if I'm not satisfied. I do favor a public option, and I would favor a single payer option if I weren't pretty certain the Repugs would short-change it every chance they got.

[laundry_queen]

17. Can you explain to me about the 'options' you think may suck?

I'm curious. As a Canadian, there is not much that is not an option with our system. You don't pick plans...everyone gets the same plan...and it covers pretty much everything that is essential (it doesn't cover dental, eye care for adults, or drugs...we have private insurance for those things or gov't help if you are low income).

I just want to see if I can clarify things that may be causing your nervousness.

[Adrahil]

24. Well, for example....

... if the reimbursements get too low, the better doctors may not choose to participate. I would personally be willing to pay a bit more to get the doctors I want, but I wouldn't want to jack up everyone elses prices to do it. I personally like the "tier" system offered by the ACA. I would prefer to be able to customize my experience a bit.

[laundry_queen]

25. All doctors participate

single payer means all the doctors are covered under the one system. Reimbursements are a set price, for all doctors. I can choose any doctor I want in the entire country and it will be paid for. Everything is already customized: you pick your doctor, anywhere, any doctor and the system pays. There are no 'tiers'. Everyone has the same access to all the doctors. And no co-pays or deductibles. And some provinces (mine included) have no premiums either. So, I can pick any doctor I want, I don't have to pay for it (at the point of service), and I never have to worry about not being covered. Can't see the negatives in that.

[ScreamingMeemie]

12. "...who say you can’t get something you want..."

Typically it's "who say you can't get something you need."

K&R

[ananda]

14. What human beings in other countries get about single payer.

It works.

[Downwinder]

15. He does not answer his own question.

What value do insurers add to the system?

[Demo_Chris]

20. Answer: none that would not be present in any other system...

Other than a pure cash model.

[NoOneMan]

42. Exactly

Strange article. He just passes blame. There is blame to be passed. But the insurance companies take more value than they add. They do not effectively negotiate rates. They are not helpful.

[Zorra]

19. From my experiences with private insurance companies, it seems to me that their being profit driven

causes them to do everything legally possible to make it difficult for their clients to understand their benefits and what they need to do to claim benefits. It's like a complicated puzzle, a maze that we the people, most of whom have little free time, have to spend hours negotiating just to see if we can claim benefits, or risk getting ripped off because our benefit information is only available at some website that doesn't even work half the time. So when we can't spend an hour or two trying to negotiate the websites, and getting put on hold by crooked insurance company employees who have been company trained to know that our time is limited and that we will hang up in under 10 minutes because we don't have time to be on hold forever trying to find out if our blood test is pre-authorized, we will get burned by their devious little shell game.

They seem are like legalized organized crime, like casino playing with people's health and lives, doing everything they possibly can to make sure the house wins, and people who need health care lose It's a mess, and it is corrupt, and utterly revolting.

Fuck them all, and their shell game too, I'm serious, I hope they all go out of business and the entire for profit healthcare system scam gets destroyed and healthcare consequently gets funded and run by the people.

Here's how it should be: A person needs health care, S/he goes to to be treated by a medical professional. Medical professional provides treatment. Person goes home.

Oh yeah, not to mention that the staff at the doctor's offices who deal with insurance companies on a daily basis can't get clear information and answers from insurance companie and sare never really sure that the insurance company is actually going to pay the valid claim.

[GeorgeGist]

26. I predict Vermont will prove Mr. Klein ...

wrong.

[Hoyt]

31. We are a long way off from knowing how Vermont's innovations will shake out, at least 2017.

So Klein is not wrong about what it takes right now.

Vermont's plan is not really a "single payer plan," it sounds more like a public option plan.

There are several good articles, including the following that hint at the issues involved, below are just two:

http://www.wcax.com/story/24399935/defining-vermonts-single-payer-system

http://www.theatlantic.com/politics/archive/2013/12/can-vermonts-single-payer-system-fix-what-ails-american-healthcare/282626/

I too am hopeful this works out, but if it does it will only be because the vast majority of citizens are ready for a big tax increase (albeit taxes that will be offsetting healthcare costs paid in other ways now), and the public option can actually deliver. I don't think that would have been acceptable to most folks back in 2009 when ACA was enacted (even if it were to their benefit, enough folks didn't believe it).

[1000words]

34. Bottomline: We needed a public service ...

We got a consumer product.

[flpoljunkie]

41. Bottom line, healthcare costs are about 18% of our GDP. It's BIG profits!

Apparently, insurance companies are not making big profits. It's the drug and medical device companies that are raking it in. We pay far more for MRI's than in other countries and our doctors are in the top 1% of income earners.

Congress does not want to bite the hands that fill their campaign coffers. The Healthcare industry has already donated over $33.8 million in the current 2013-14 cycle--55.5% to Republicans, and 40.9% to Democrats. Peanuts for the healthcare industry and their obscene profits!

Just look at the contributors. The first insurance company, Blue Cross/Blue Shield sits at #11, while the doctors are #1.

Top Contributors, 2013-2014


Cooperative of American Physicians $921,290
Pfizer Inc $618,750
American College of Radiology $527,500
American Academy of Orthopaedic Surgeons $523,950
American Hospital Assn $479,374
Amgen Inc $457,690
American Society of Anesthesiologists $437,300
American Dental Assn $422,500
Merck & Co $391,365
McKesson Corp $381,500
Blue Cross/Blue Shield $359,367

http://www.opensecrets.org/industries/indus.php?Ind=H