Health Care ... what do you see as the answer?

[Stinky The Clown]

Take your pick and if so disposed, expostulate a bit.

[Selatius]

1. Single-payer is what Kucinich, the so-called "communist," advocates. n/t

[Telly Savalas]

6. Single-payer is also what most political parties (including conservatives)

in most other Western Democracies support(*). It's truly mind-blowing how far behind the U.S. is on this issue.

This isn't a left-wing issue. Saying that health-care is a public good which the government should help provide is no more "commie" than arguing that roads and highways are a public good which the government should help provide.




* Granted, some conservatives support two-tier systems or private supplemental coverage, but they can't get away with openly advocating getting rid of the underlying single-payer universal systems in their countries.

[Mass]

2. I dont know anybody who advocate your option n 3 as the end game.

[BootinUp]

3. Transition to single payer

Start by lowering the eligibility age for Medicare. And educate Americans on the cost savings and other advantages. Here is an excellent detailed article on the subject:

The Health Care Crisis and What to Do About It
By Paul Krugman, Robin Wells

Thirteen years ago Bill Clinton became president partly because he promised to do something about rising health care costs. Although Clinton's chances of reforming the US health care system looked quite good at first, the effort soon ran aground. Since then a combination of factors—the unwillingness of other politicians to confront the insurance and other lobbies that so successfully frustrated the Clinton effort, a temporary remission in the growth of health care spending as HMOs briefly managed to limit cost increases, and the general distraction of a nation focused first on the gloriousness of getting rich, then on terrorism—have kept health care off the top of the agenda.

But medical costs are once again rising rapidly, forcing health care back into political prominence. Indeed, the problem of medical costs is so pervasive that it underlies three quite different policy crises. First is the increasingly rapid unraveling of employer- based health insurance. Second is the plight of Medicaid, an increasingly crucial program that is under both fiscal and political attack. Third is the long-term problem of the federal government's solvency, which is, as we'll explain, largely a problem of health care costs.

The good news is that we know more about the economics of health care than we did when Clinton tried and failed to remake the system. There's now a large body of evidence on what works and what doesn't work in health care, and it's not hard to see how to make dramatic improvements in US practice. As we'll see, the evidence clearly shows that the key problem with the US health care system is its fragmentation. A history of failed attempts to introduce universal health insurance has left us with a system in which the government pays directly or indirectly for more than half of the nation's health care, but the actual delivery both of insurance and of care is undertaken by a crazy quilt of private insurers, for-profit hospitals, and other players who add cost without adding value. A Canadian-style single-payer system, in which the government directly provides insurance, would almost surely be both cheaper and more effective than what we now have. And we could do even better if we learned from "integrated" systems, like the Veterans Administration, that directly provide some health care as well as medical insurance.

The bad news is that Washington currently seems incapable of accepting what the evidence on health care says. In particular, the Bush administration is under the influence of both industry lobbyists, especially those representing the drug companies, and a free-market ideology that is wholly inappropriate to health care issues. As a result, it seems determined to pursue policies that will increase the fragmentation of our system and swell the ranks of the uninsured.

continued:
http://www.nybooks.com/articles/18802

[Dr.Phool]

4. John Conyers has a bill right now, H.R. 676

Read more at www.healthcare-now.org

A comprehensive transition to a single-payer system that expands the existing program to cover ALL Americans regardless of age, income, or employment status.


Let me tell you something. I've spent almost every day for the last 2 months working, gathering signature cards for my friend John Russell's congressional campaign. ( www.johnrussellforcongress.com ) John is a certified Nurse Practitioner at St. Joseph's Hospital in Tampa. He also has a degree in Economics, and a Master's in Healthcare Systems Management.

In talking with voters every day, and doing my own "polling", NO OTHER SINGLE ISSUE resonates more with voters than Universal Healthcare.

HR676 differs from socialized medicine, in that it is publicly funded and privately administered. You can keep your own doctor, etc.

[TheBaldyMan]

5. Cradle to Grave, I am biased - I'm British and benefit from the NHS

Comprehensive, universal healthcare provided on a clinical needs basis. It has to be rationed but you can get supplemental private health insurance. Financed by general taxation.

Sorry no plastic surgery (except for burns & reconstructive surgery)

[Yupster]

7. It's got to be single payer

The way medicare and medicaid costs are escalating percentage wise, there really isn't any other choice.

[Raksha]

8. Single payer, obviously. It's the only thing that makes any sense.

I like Dennis Kucinich's Medicare for all proposal.

[Stinky The Clown]

9. I'm surprized so few voted for "Single payer basic with umbrella . . . . .

. . . . . policies for those who can pay" It seems to me this is the way forward. Everyone gets basic health care as an entitlement. Those who want more (I dunno ..... private hospital rooms? Name-your-own-doc? Coverage for elective work like cosmetic surgery?) can still purchase private insurance or employers can give a premium benefit by providing this umbrella policy.

[mrgorth]

10. I think this is a good idea.

Thanks for explaining it.

[nickshepDEM]

11. Single payer... But Id settle for Rahm Emanuel's voucher plan.

[eridani]

12. PNHP statement on the recently passed MA plan

STATEMENT ON MASSACHUSETTS HEALTH CARE BILL

Physicians for National Health Care
April 5, 2006

It’s a stirring scene. The Governor, legislative leaders and leaders of Health Care For All standing in the State House Rotunda declaring victory in the fight for universal health coverage. Unfortunately, this week’s tableau merely repeats one from 20 years ago when Governor Dukakis was celebrating passage of his universal healthcare bill. That plan imploded within two years, and today about 250,000 more people are uninsured in Massachusetts than the day it was signed. Unfortunately, Massachusetts’ new health reform legislation looks set to repeat that disaster.

What’s in the New Bill?

The new bill includes three key provisions meant to expand coverage. First, it would modestly expand Medicaid eligibility. Second, it would offer subsidies for the purchase of private coverage to low-income individuals and families, though the size of the subsidies has yet to be determined. Finally, those making more than three times the poverty income (about $30,000 for a single person) would have to buy their own coverage or pay a fine.

To help make coverage more affordable, a new state agency will connect people with the private insurance plans that sell the coverage, and allow people to use pre-tax dollars to purchase coverage (a tax break that mostly helps affluent tax payers who are in high tax brackets). This new agency is also supposed to help design affordable plans.

Businesses that employ more than 10 people and fail to provide health insurance will be assessed a fee (not more than $295) to help subsidize care. Additionally, hospitals won a rate hike assuring them better payments from state programs, and several provisions were included that are meant to attract additional Federal funding to help pay for the Medicaid expansion.

What’s Wrong With This Picture?

First, the politicians assumed that only about 500,000 people in Massachusetts are uninsured. The Census Bureau says that 748,000 are uninsured. Why the difference? The 500,000 figure comes from a phone survey conducted in English and Spanish. Anyone without a phone or who speaks another language is counted as insured. The 748,000 figure comes from a door-to-door survey carried out in many languages (including Portuguese and Haitian Creole, common languages in Massachusetts). In sum, the reform plan wishes away 248,000 uninsured people who don’t have phones or don’t speak English or Spanish. It provides no funding or means to get them coverage.

Second, the linchpin of the plan is the false assumption that uninsured people will be able to find affordable health plans. A typical group policy in Massachusetts costs about $4500 annually for an individual and more than $11,000 for family coverage. A wealthy uninsured person could afford that – but few of the uninsured are wealthy. A 25 year old fitness instructor can find a cheaper plan. But few of the uninsured are young and healthy. According to Census Bureau figures, only 12.4% of the 748,000 uninsured in Massachusetts are both young enough to qualify for low-premium plans (under age 35) and affluent enough (incomes greater than 499% of poverty) to readily afford them. Yet even this 12.4% figure may be too high if insurers are allowed to charge higher premiums for persons with health problems; only half of uninsured persons in those age and income categories report that they are in “excellent health”.

The legislation promises that the uninsured will be offered comprehensive, affordable private health plans. But that’s like promising chocolate chip cookies with no fat, sugar or calories. The only way to get cheaper plans is to strip down the coverage – boost copayments, deductibles, uncovered services etc.
Hence, the requirement that most of the uninsured purchase coverage will either require them to pay money they don’t have, or buy nearly worthless stripped down policies that represent coverage in name only.

Third, the legislation will do nothing to contain the skyrocketing costs of care in Massachusetts – already the highest in the world. Indeed, it gives new infusions of cash to hospitals and private insurers. Predictably, rising costs will force more and more employers to drop coverage, while state coffers will be drained by the continuing cost increases in Medicaid. Moreover, when the next recession hits, tax revenues will fall just as a flood of newly unemployed people join the Medicaid program or apply for the insurance subsidies promised in the reform legislation. The program is simply not sustainable over the long – or even medium – term.

What Are the Alternatives?

The legislation offers empty promises and ignores real – and popular - solutions.

A single payer universal coverage plan could cut costs by streamlining health care paperwork, making health care affordable. Massachusetts Blue Cross spends only 86% of premiums paying for care. It spends the rest - more than $700 million last year - on billing, marketing and other administrative costs. Harvard Pilgrim and Tufts Health Plan – our other big insurers - are little better; each took in about $300 million more than it paid out. That’s ten times as much overhead per enrollee as Canada’s national health insurance program. And our hospitals and doctors spent billions more fighting with insurers over payments for each bandaid and aspirin tablet.

Overall, Massachusetts residents will spend $13.3 billion on health care bureaucracy this year – nearly one third of our total health bill. If we cut bureaucracy to Canada’s levels we could save $9.4 billion annually, enough to cover all of the 748,000 uninsured in Massachusetts and to improve coverage for the rest of us.

Study after study – by the Congressional Budget Office, the General Accounting Office and even the Massachusetts Medical Society - have confirmed that single payer is the only route to affordable universal coverage.

And single payer is popular. The Massachusetts Nurses Association supports it along with dozens of other labor, seniors and consumer groups; so do 62% of Massachusetts physicians according to a recent survey. National polls find that almost two-thirds of Americans favor a tax-funded plan like Medicare that would cover all Americans.

But single payer national health insurance threatens the multi-million dollar paychecks of insurance executives, and the outrageous profits of drug companies and medical entrepreneurs.

It’s time for politicians to stand up to the insurance and drug industries and pass health reform that can work.

Steffie Woolhandler and David Himmelstein are primary care physicians at Cambridge Hospital and Associates

Press release April 5, 2006

http://www.pnhp.org/news/2006/april/massachusetts_health.php

Steffie Woolhandler, M.D., 617-497-1268
David Himmelstein, M.D., 617-665-1032
Nick Skala, 312-782-6006

Physicians for a National Health Program is an organization of 14,000 physicians that support universal access to health care. PNHP is headquartered in Chicago and has chapters and spokespeople across the U.S. To contact a physician-spokesperson in your area, contact [e-mail] or call 312-782-6006. www.pnhp.org.

[blondeatlast]

15. PNHP is the best advocate for a U/SP out there.

More DUers need to know about this group. Thanks for getting the word out.

I knew something didn't smell right with the MA plan.

[Vinca]

13. The only answer is single payer, similar to Canada and most

of the other civilized countries of the world. I'm a bit mystified by the Massachusetts "no fault" health insurance law. If the insurance companies don't rein in their greed, average people will not be able to afford insurance whether it's written into law or not. One way to control costs is to emulate or expand the V.A. system, which is, from all accounts, the most efficiently run operation in the country.

[blondeatlast]

14. Single-payer, in whatever form, is good for BUSINESS and good for citizens

Dilute the risk pool and the cost comes down drastically.

U/SP levels the playing field for small businesses too.

With the rising costs for employers to offer insurance plans many businesses are seeing that U/SP is the best way to go.

[area51]

16. options

I voted for single-payer, but what is the difference between single-payer & "cradle-to-grave"?