Universal Health Care does NOT require Single-Payer

[liberalpragmatist]

I am a firm believer in universal health care and I think it's an outrage that the U.S. is the only major industrialized country not to guarantee health coverage to its citizens.

I'm well aware of the arguments for single-payer and I do think that if we were starting from scratch, it would be the best system to put in place. I also believe that scaremongering about the Canadian system is ridiculous.

That being said, I think a lot of American liberals get too hung up on single-payer as the be-all/end-all of universal health care. MANY countries throughout the Industrialized world, including most nations in social-democratic Western Europe, do NOT have single-payer systems, yet have perfectly good outcomes with tightly-regulated private insurance markets or some public-private fusion.

Examples:

- Germany - 85% of the public is covered a Standard Health Insurance Plan, which, though a government-administered plan, is NOT single-payer. Rather, funds are contributed by individuals and businesses, as well as the government. People must pay premiums, which are indexed according to a person's income.

- The Netherlands - All primary and curative care is paid for through private insurance. Individuals have a mandate to purchase insurance and the insurance market is tightly-regulated, with no exemptions or charging people different rates based on their health history. Care for the long-term ill, the elderly, and the infirm is directly financed by the government. Overall, the funding spread is 62% publicly-funded, 38% privately-funded.

- France - In France - whose health care system is ranked the best in the world by the WHO - individuals must purchase insurance through one of several sickness funds, which are essentially not-for-profit insurers. The sickness funds are funded both by the government and businesses. Individuals pay premiums, although most of their medical costs are reimbursed. The government's major role is to act as a regulator and price fixer. The funds must not discriminate on the basis of health, and the government also negotiates the costs of medical procedures and drugs.

Additionally, on top of the basic services provided by the sickness funds, of which there are 5, 85% of the French have supplemental private insurance, which is often provided by the employer.

- Switzerland - Switzerland has a tightly-regulated private insurance market, in which a compulsory, basic level of service is mandated by all insurers, and patients are guaranteed nearly complete access to any doctor or medical provider in their region. Additionally, many Swiss opt to purchase complementary insurance on top of their basic insurance. The complementary insurance covers items like dental care.

- Japan - The majority of the public is covered by compulsory private insurance which is, again, tightly regulated. A basic level of care is mandated across different insurers, and nearly all hospitals are run as non-profits. Funding for the private insurance market, known as the Social Insurance System (SIS), comes through fees paid by employers, supplemented by premiums paid by individuals. Premiums are determined by income. The insurers - "health insurance societies" - are 1800 in number. 63% of the public is covered by these "health insurance societies," in the SIS. The other 37% of the public - mostly the self-employed - is largely insured through a government plan, or National Insurance, which is funded both by premiums on individuals and by government funds and which is administered by local bodies. Additionally, there is supplemental government-financed care for the elderly.

- Countries that do have a single-payer system, or something close to it are the UK, Canada, Australia and most of the Scandinavian countries. The UK's NHS is not merely a universal, single-payer insurer, but a provider, administering a large percentage of the health care system. Canada mandates single-payer, which is administered through the provinces. In Australia, basic care is provided by Medicare, with additional coverage provided by a large market that consists of private insurance companies, non-profits, and a government-run public plan called Medibank (which operates like a private insurer in that it's opt-in and is largely financed by individual premiums).

The take-away from all of this is that while single-payer is a perfectly defensible position, it is not the only way to provide good, universal, health coverage to people. Plenty of developed countries have managed to provide quality health insurance through other ways.

Update - Here's a good piece from http://www.newyorker.com/reporting/2009/01/26/090126fa_fact_gawande">The New Yorker that makes the point that virtually every country, when designing a universal health care system, has built upon what it already has. Britain's NHS was the result of the wartime emergency health system put in place during WWII. The French system was an extension of a voluntary social-insurance scheme. Etc., etc.

[stray cat]

1. the devil really is in the details - I won't endorse something just because it is single payer

or call a plan bad if it is not labeled single payer

[Clio the Leo]

2. thank you ... handy information. NT

[slipslidingaway]

3. Good info, one reason single-payer receives attention is due to

the fact that there has been a bill in Congress for years. As far as I know nobody else has introduced another comprehensive bill that would model one of the other HC systems.

Appreciate the recap.

:)

[liberalpragmatist]

5. I think it's also due to the proximity/bogeyman of Canada

I actually think that conservatives' long-standing bashing of the Canadian system has increased awareness of the program among Americans and among American liberals, especially. The result is that many people realize its strengths, but also assume that most developed countries have something similar. In fact, different countries have all sorts of different schemes for providing universal health care.

While I like the idea of a single-payer system, I think it's simply infeasible right now. Too many people - a majority still - LIKE the insurance they currently have. If you make a single-payer system - even if you don't abolish private insurance - the vast majority will see their current health care dumped and replaced by the public plan.

Now, the public plan may be great, but people are afraid of losing what they have.

Also, there's a good argument that any radical change is going to be extraordinarily disruptive. Don't forget that there are millions of people employed in the current health care model whose jobs would become extraneous under a single-payer system. I'm all for efficiency, but it would be best if that change in their share of employment would occur gradually.

The attraction to a public plan is that over time, if the public plan out-competes the private plan, some estimate that a comfortable majority of Americans would come to be covered by the public plan, which would give many of the advantages of single-payer.

But ultimately, I do think that the one constant across every country's health care system is regulation. Whether it's primarily private, primarily public, or some combination of the two, at its core, government must provide minimum standards of care, must provide a heavy portion of funding, and must exercise stringent cost controls. You can do that in a primarily public system or a private system. Either way, regulation is essential.

[kaygore]

14. Who have you been talking to?

Seriously, I have tried to have a discussion with someone who believes that his/her insurance company provides good value for the cost and is trustworthy, and lukewarm is about the best I can drag out of people, even RW nuts. Perhaps, if I knew more CEOs of large, multinational companies, I would find someone who was still pro-his/her health insurer, but most, when you really start asking anything but surface questions, feel at best uneasy and at worse...hate them and feel raped.

When those who are lukewarm are given facts, such as true costs of the present system, etc., I have seen many of them join the Hate/raped group.

The only thing keeping the insurance companies in business is the sheer ignorance of the American people. As people start to learn the true costs, even the complacent become angry.

Obama has a bully pulpit from which to get the truth of true costs--in dollars, in misery, in lost opportunities, etc.--of the present system and of permitting heath insurance companies to continue to do business as usual: put profits and executive compensation before the well being and health of those whose money they rake in every month.

I didn't like health insurance companies and were wise to their ways before "Sicko." But since "Sicko," I feel that kicking their sorry asses to the curb should be the least of what we do; throwing their sorry asses in jail for the rest of their lives would be much preferred.

There is the letter of the law and the spirit of the law. In their greed and arrogance and sense of entitlement, the people dictating the way insurance companies would treat their clients cost them their souls as far as I am concerned.

And don't get me started on the drug companies or the cancer industry!

[liberalpragmatist]

26. I'm recalling polls

Here are a couple:

http://www.medicalnewstoday.com/articles/79195.php

http://www.cnn.com/2009/POLITICS/03/19/health.care.poll/index.html

[pnwmom]

30. My husband works for a large company that has an excellent health insurance

program offering several different types of plans. Although I vehemently support affordable universal health care, we would be perfectly happy to continue with our current insurance, if that was an option.

[slipslidingaway]

32. Proximity may play a role as well, CBS/NY Times poll show 59%

say they want a national insurance, 49% responded for all needs and another 10% for medical emergencies.


http://www.healthcare-now.org/2009/02/another-poll-shows-majority-support-for-single-payer/

http://www.cbsnews.com/htdocs/pdf/SunMo_poll_0209.pdf

"Americans are more likely today to embrace the idea of the government providing health insurance than they were 30 years ago. 59% say the government should provide national health insurance, including 49% who say such insurance should cover all medical problems.
In January 1979, four in 10 thought the federal government should provide national insurance. Back then, more Americans thought health insurance should be left to private enterprise.

HEALTH INSURANCE: PRIVATE ENTERPRISE VS. GOVERNMENT?

CBS/NYT CBS/NYT

Now ... 1/1979

Private enterprise 32% ... 48%
Government – all problems 49 ... 28
Government – emergencies 10 ... 12
Don’t know 9 ... 12

[eridani]

37. If you have never been expensively sick, your opinion about your insurance iw worthless

It's like your opinion about whether your fire department is any good. What people like about their employer based insurance is that they don't have to bother with the details. I wouldn't mind having my insurance dumped--they cut my doctor out of their preferred provider list. My husband, with Medicare, gets to keep him.

[RC]

4. The Government needs to regulate the insurance companies,

not the insurance companies regulating the government as we have now. Then and only then can we have true health coverage for all.

[harun]

45. That is the big difference here in the U.S. In Europe the governments are the

boss. In the U.S. the insurers are.

[snowdays]

57. But we have a poor history of regulation. No, regulation

is not in the stars for the US. start from scratch or scrap "reform". What is going on in the WH/congress is a disgrace.

[JVS]

6. For practicality's sake it does. We already have a horrifically inefficient private system...

for most people and a well trusted public system for the old (medicare). While regulating insurance companies and adapting them to form a universal healthcare system might have worked in other countries, in the US it would be much simpler to just eliminate them. They're too cancerous to be saved.

[avaistheone1]

7. If we build off our famously inefficient poor health outcome system - we may as well throw

30% of our health care dollars away.
That is alot of money for a system that has poor morbidity and mortality outcomes.

The current system needs to be scrapped.

[Hippo_Tron]

8. I don't see the logic behind this argument

France can regulate and adapt their private insurance companies into a universal healthcare system but the United States can't? What is so different about French insurance companies that makes this so? And as stated in the OP, France has the best health care system in the world according to the WHO. Why should we not be looking to their model if it is the best?

[JVS]

10. You tell me why the US companies are so similar to the French ones that it could be done.

We already spend way more than the French for healthcare per capita and we have huge numbers of people without coverage and huge numbers of people who are insured but have shitty coverage. How can we expect such a fucked up system to do better with less money? Just the prospect of being made into non-profit companies would probably shut many of the companies down in the first place. It would be much more efficient to expand medicare and do away with the private insurance companies.

[Hippo_Tron]

15. A company is a company regardless of what nation it happens to be in

Whether or not it is a for-profit or not-for-profit company is indeed the issue. Non-profits don't have an incentive to maximize profits, only to break even. This means that they will not deny people coverage to make more profits since by law they aren't even allowed to make profits if they are organized as a non-profit. Some of the current insurance companies will get out of the business and some will re-structure. Others will emerge as new non-profits. Either way you are taking the profit out of health insurance, it's just a different way of doing it.

Canada is ranked 30th according to the WHO and France is ranked 1st. I think that is evidence enough as to why we should be looking to the French model.

[JVS]

16. A company can have a very different nature depending on local laws and even business custom.

The private insurers have already failed America. I see no reason to allow them to do so again. Is there any reason to even suspect the insurance companies are interested in the French model?

[Hippo_Tron]

17. If we're looking to the French system...

Then presumably we're going to change our laws in this area to ones that are similar to France's. What is it about French business custom that is so fundamentally different from the United States that you think we can't do this?

[JVS]

18. You point me to evidence that our companies who perform less with more money are capable of french..

results. I don't think they're up to it.

With respect to French law being different, France has its own legal definitions and regulations of corporate entities. Does it really make sense to have to rewrite all of corporate law in order to re-create the French environment here? As far as custom goes, the French insurance companies have not spent the last 35 years turning themselves into bloated organizations engaging in massive amounts of political lobbying. It is not pragmatic to assume that you can simply tell these institutions to behave in a manner contrary to their established way of operating.

[Hippo_Tron]

23. You can force the non-profits to not engage in any lobbying activities

Both as a condition of their tax exempt status and from the government funding that they get. And yes I don't see any problem with re-writing corporate law in order to create the "sickness fund" non-profits that they have in France.

Why do you assume that when the US establishes its own "sickness funds" they would be more like US for-profit insurers rather than the French sickness funds? The US for-profit insurers produce the results that they do because they are for-profit corporations. A "sickness fund" is absolutely nothing like a for-profit corporation. It will not act like a for-profit corporation and it will not produce the results of a for-profit corporation.

A non-profit "sickness fund" will provide more care because it doesn't have an incentive to make any profits. It will provide more care with less costs because the government will control costs just like it does in France.

[JVS]

25. I doubt that the insurance lobby would allow these new sickness funds to be constructed...

when it is in their interests to retain the old system. They're not going to stand by and say "Oh sure, by all means create new organizations to replace us" The kind of struggle you'd have to go through is as great as that for creating single payer, and single payer doesn't carry the risk of keeping these entities around to subvert the process. I also think that you underestimate the scope of rewriting American corporate law in order to create the environment of well regulated corporations found in France. Attempting to create a western european social-democratic institution in the context of the american legal and political system could be every bit as ill-fated as trying to create a kolkhoz or a feudal estate here.

[Hippo_Tron]

35. I doubt it would be any more difficult than single-payer

Both would end for-profit insurance other than for supplemental insurance and thus both would be fought against tooth and nail by the agents who have a stake in the for-profit insurance industry. But you assume that these new "sickness funds" will be some kind of remnants of the old for-profit insurance companies and thus they will subvert the process and I do not see how that is a case. A "sickness fund" will not be organized with the same people or the same incentives as for-profit insurance companies were. It's a completely different system.

Both solutions are politically difficult if not impossible. But if we're going to go down the road of politically difficult to impossible we might as well go with the system that is ranked 1st not he one that is ranked 30th.

[quiller4]

20. a significant portion of health insurance companies

and HMOs are already incorporated as not for profit organizations. Some of the for profit insurance companies are global. They just play by French rules to do business in France.

[Crunchy Frog]

27. France has the experience of the guillotine in its past.

That probably helps keep people in line.

[Mass]

66. The OP is wrong for France. The insurance company is largely public,

managed by the unions and groups of CEOs together. The system is complex and has existed since 1936 as a central system. It is not managed like England or Canada, but it is certainly not managed the way the OP states either. If you were to explain to French people what single payer is, they would tell you it is a French version of single payer (as an American version of single payer could be adapted to the US, via Medicare, for example).

Private companies only allow additional insurances to cover what is not covered by the public system, and this is fairly tightly regulated too, but it is not a huge industry as it is in this country. Only a small part (about 30 % and 0% in case of long-term or chronical diseases) are covered by private insurances. The system is basically state run.

http://brittany.angloinfo.com/countries/france/healthinsure.asp

The Basic System of Social Security

Like other countries, France uses taxation to fund health care for residents but unlike Britain for example, France operates an insurance system. This is a mixed system with the bulk of cover coming from State assurance, and top-up cover coming from mutuelles or private health care insurance companies. All medical facilities are part of the State system but the patient is free to choose their own doctors, specialists, medical facility or hospital.

[liberalpragmatist]

69. I've seen the French system described as "multipayer, nonprofit"

The government oversees the whole system and negotiates prices for medical services and drugs. The sickness funds are independently-administered, however. They do receive some government funds, as well as premiums from individuals and employers.

It isn't considered a "single-payer" system because it is not simply a single, nationwide insurance program that is funded by taxes.

[Mass]

70. I'm French and know pretty much the system. The system is funded by a single nationwide

insurance funded on payroll and income taxes, that is subdivided in local and regional caisses in order to make the payment and administration more practical, but these caisses are linked together and you have to register to the one you live in (no choice involved here). I do not understand the difference you make, but in spirit, the system is single payer, even if it is operated differently than the British system. There is a single nationwide entity divided in administrative smaller entities. It is not government managed, though, as the people managing these entities are elected by workers and management. That may be the difference you make, but it seems a small difference as rigid as is the one the purists make.

What we need is a system where private corporate insurance is out of the picture and where everybody gets the same level of care and pay according to his income and not by head. This is the only way to get a system that is viable for all, and that is something that will not happen without a public option, however it is managed (independent entity or federal administration).

[SpartanDem]

9. How would it be simpler

to create a whole new system than adapting the current one?

[JVS]

11. It is adapting the current one. I propose adapting the successful medicare model.

Your alternative would be to somehow expect the private insurance system, the most expensive system in the world, and expect it to accomplish better results with less money. It's not reasonable. They need to be eliminated.

[kaygore]

12. I will gladly settle for a public option and the private ins cos can compete

My problem is the fact that I don't want another prescription-drug-like give away of tax dollars to companies whose main means of making profits is to deny health care. Further, I want a system that focuses on health and NOT on illness just because illness is more profitable.

Look at the explosion of health "problems" that keep getting enlarged in their scope (pre-this and pre-that) that end up "requiring" life-long consumption of expensive (and highly toxic) drugs. In many cases, (and there is a significant body of research regarding this) simple life-style changes would preclude more drastic and expensive measures, yet we are not given good information from the FDA, the media, or even our health care professionals.

I DO NOT want to be forced to buy into a for-profit insurance company (or even a non-profit one that pays its executives huge compensation). My tax dollars are already supporting the drug companies under the Medicare Prescription Drug Plan without any cost controls or way to bargin for lower prices as they do in other countries. What the insurance companies want is business as usual with the government picking up the tab to pay for the insurance of those who can't pay or for the government to subsidize their risk.

I would LOVE a single-payer plan. It makes the most sense and would be the most efficient and cost-effective alternative. I have used the plan in the UK and it is WONDERFUL!

However, I am for choice and thus would accept permitting people who currently like their health care plan through their insurance company to keep it (by the way, I now make a point of asking even random people I meet on the street if they like their health care plans and not them, not friends, not family, none of them are happy with what their money buys them in the way of health insurance--NO ONE, except my brother who is in the military and my older relatives on Medicare--both groups who have single-payer government plans, by the way, that I have asked trusts their insurance company or believes that they are getting value for what the insurance costs.

I may just be talking to the wrong people. I have been hanging out in Tidewater Virginia (somewhat conservative), Morehead City, NC (very conservative), San Diego, CA (moderate), and Portland, OR/White Salmon, WA (somewhat liberal to very liberal). Seems to be a cross section of the US, but then somewhere, someone, other than our elected officials whoring for the big bucks from the insurance companies, must like their insurance companies, right?

I also believe that if Max Baucus and most of the members of the Senate Fiance Committee were not in the pockets of the insurance and drug companies, we could have an open discussion on this topic with everyone, including single-payer having equal representation in the discussions (rather than 99% of the representation being from those opposed to an equitable, just, cost-effective, efficient system--such as the insurance companies and such groups as, can you believe, the Heritage Foundation!!!!) AND we could examine the pros and cons rationally of all the systems that provide outstanding and cost-effective health care and come up with something that would be great. HOWEVER, that ain't going to happen unless we keep screaming for single-payer so at least we may get a public option.

I think we saw again behind the masks of such whores as Max Baucus in the Senate Finance Committee's hearing the other day when he claimed to be willing to consider single-payer or an equitable option at the same time he denied 66% of the US citizens a place at the table and had those arrested who merely asked that their voices be heard on record while he sneered that more police were needed.

I am so tired of the egregious greed and arrogance. Having the vultures who have been picking at our bones make the laws will only continue to fatten their bank accounts while U.S. citizens continue to sicken and die.

[Time for change]

13. Thank you -- I'm afraid that if too many liberals

insist on single payer, we may end up with nothing.

I believe that the key is that a very good public option must be offered. If the private insurance companies don't wish to compete with that, then fine, let them fold. Or, if they want to successfully compete with an excellent public option plan, then they'll probably have to offer a comparable product. I don't see anything wrong with that -- as long as health care is universally available to anyone who wants it.

[Faryn Balyncd]

24. Another significant danger is that the corporatists may strip out the public option, leaving a plan

that is essentially an unaffordable corporate give-away that still leaves Americans without affordable healthcare.

We will never be able to afford comprehensive healthcare for all Americans, until we take on the insurance companies.

I am in total agreement with your 2nd paragraph, but with significant numbers of Democratic Senators lining up with the insurance companies (Ben Nelson, Chuck Schumer, Arlen Spector, even Ron Wyden), and Zeke Emanuel pushing (as a "White House adviser") a plan the not only has no public option, but privatizes Medicare, we are in for the fight of our lives if we are to get a plan that preserves the public option that Obama supports and promised.

[Time for change]

41. Yes, that is the main danger

We must preserve the public option.

[avaistheone1]

28. If too many liberals insist? lol

The polls are showing the American public both Democrats and Republicans strongly prefer the single payer option. This is not about what some fringe group of radical liberals want. Try again.

[Time for change]

42. What the polls show is that Americans want universal health care

I don't recall any polls that differentiate singler payer from any other way of achieving universal health care. YOU try again -- like try to find a poll that says what you claim.

[avaistheone1]

49. No problem. Here you go. Polls show Americans strongly favor SINGLE PAYER

Single Payer Ballot Question Passes by Landslide in 10 Districts
http://www.pnhp.org/news/2008/november/single_payer_ballot_.php

Here's another
http://www.consumerwatchdog.org/resources/PollMemo.pdf

Oh another!
http://www.cbsnews.com/htdocs/pdf/SunMo_poll_0209.pdf

More!
http://abcnews.go.com/images/pdf/935a3HealthCare.pdf

[Time for change]

59. Did you read your links?

None of them asks respondents to make a choice between a single payer system and any other form of universal health care. The only one that even mentions the term "single payer" is the first link, and that one doesn't make a distinction between single payer and other type of universal coverage.

People want universal coverage. They want to make sure that they are covered by a government plan that will provide the health care that they need. Very few give a damn whether or not other people have the option of using private health insurance.

[eridani]

38. If we don't insist on single payer, any public option is going to be an underfunded pile of shit

Health Policy Q&A with PNHP Co-founders Drs. David Himmelstein and Steffie Woolhandler on 04/17/2009


PNHP should tell the truth: The “public plan option” won't work to fix the health care system for two reasons. .

1. It foregoes at least 84% of the administrative savings available through single payer. The public plan option would do nothing to streamline the administrative tasks (and costs) of hospitals, physicians offices, and nursing homes. They would still contend with multiple payers, and hence still need the complex cost tracking and billing apparatus that drives administrative costs. These unnecessary provider administrative costs account for the vast majority of bureaucratic waste. Hence, even if 95% of Americans who are currently privately insured were to join a public plan (and it had overhead costs at current Medicare levels), the savings on insurance overhead would amount to only 16% of the roughly $400 billion annually achievable through single payer.

2. A quarter century of experience with public/private competition in the Medicare program demonstrates that the private plans will not allow a level playing field. Despite strict regulation, private insurers have successfully cherry picked healthier seniors, and have exploited regional health spending differences to their advantage. They have progressively undermined the public plan—which started as the single payer for seniors and has now become a funding mechanism for HMOs, and a place for them to dump the unprofitably ill. A public plan option does not lead toward single payer, but toward the segregation of patients; with profitable ones in private plans and unprofitable ones in the public plan.

Would a public plan option stabilize the health care system, or even be a major step forward?

The evidence is strong that such reform would have at best a modest and temporary positive impact—a view that is widely shared within PNHP. Indeed, we remain concerned that a public plan option as an element of reform might well be shaped in a manner to effectively subsidize private insurers by requiring patients to purchase coverage while relieving private insurance of the highest risk individuals, stabilizing private insurers for some time and reinforcing their control of the health care system.

Given the above, is it advisable to spend significant effort advocating for inclusion of such reform? No, for two reasons:

1. We are doctors, not politicians. We are obligated to tell the truth, and must answer for the veracity of our stance to our patients and colleagues over many years. Ours is a very different time horizon and set of responsibilities than politicians'. Falling in line with a consensus that attempts to mislead the public may gain us a seat at the debate table, but abdicates our ethical obligations.

2. The best way to gain a half a pie is to demand the whole thing.

Is fundamental reform possible?

We remain optimistic that real reform is quite possible, but only if we and our many allies continue to insist on it.






If we have to compromise at the end of the process, what should a public option look like?

This opinion article is compiled from conversations held during April, 2009, with health care reform advocates, including Physicians for a National Health Plan, Health Care for All NJA? and other advocates.
This draft (4-18-09) prepared for discussion, by Craig Salins

In other words, if we can’t get our pony, what should the kitten that we will settle for look like? Congress is finally considering serious health care reform, pushed by the Obama administration and by a worsening crisis nationwide. There are several competing options and proposals, representing a diversity of interests, each seeking to broaden coverage to all or most Americans and at an affordable cost.

One proposed option is simply to expand Medicare to everyone. It would cover all Americans, all ages, be financed publicly, and delivered privately through existing local health services and facilities.

Another option is to leave existing private insurance plans in place, for any Americans who want to keep their existing plan, while simultaneously establishing a public plan which would be open anyone—those who don't currently have coverage, or who desire to switch to a public plan. The expectation is that such a public plan would provide good benefits at a lower price, by operating on a non-profit basis, with a single risk pool nationwide, without expensive overhead.

But such a plan could be hijacked or derailed in Congress by special interests. If not designed with safeguards and combined with tight regulation of private insurance, a public plan could become simply a dumping ground for older, sicker enrollees at taxpayer expense, while letting the insurance industry reap a bonanza in public subsidies and profit: for enrolling healthy people who cost very little.

The insurance industry is already opposing the creation of a public plan option. They complain that it would compete with their established plans (it would, of course—fair competition is the point.) But the insurance industry might use their political clout through Congressional debate to “shape” the public plan so that it cannot succeed—or so that it works to their advantage, perhaps by taking sicker, more costly patients off their hands, leaving low-cost healthy patients to be milked for higher profit.

A public plan option must be designed with the public interest in mind—and not by those in the insurance industry who have private profit in mind at taxpayer expense!

These features below must be part of any public plan option—to achieve a plan that will work for all.

1. Any public option should directly pay providers (like Medicare does) - using a single, efficient public “payer” to pay for services delivered by private health care providers and facilities chosen by the patient. (This contrasts with a referral or “connector” plan, such as the Federal Employee Benefits Health Plan, that simply enrolls people in existing private insurance plans. A connector scheme is expensive, due to an extra layer of administration to broker the arrangement and the expensive overhead of private insurance.)

2. Comprehensive benefit package, one set of benefits for everyone regardless of age, employment status, enrollment group, geography, health status, or any other factor.

3. Free and complete choice of health care providers, including hospitals, clinics, all services.

4. Affordable. No excessive co-pays or deductibles. Appropriate cost-sharing from employers, individuals, and from public sources/programs such as Medicaid and Medicare.

5. Available to everyone including employers, employee groups, and any individual.

6. Guaranteed acceptance* No denial of coverage to anyone for health status, pre-existing conditions, or for any reason. No waiting period. No penalties for not previously having insurance.

7. Immediate enrollment and coverage* in a plan of patient's choice, at the point of first medical contact for those not previously enrolled in a coverage plan. No delay when coverage starts.

8. Community rating* Insurance premiums based on health care risks and costs for the entire population - not on any particular subset of risks and costs, such as those with chronic disease.

* These features should apply by law to all health care insurance - public or private - as a matter of public policy.

Also, if for now, Congress fails to enact HR 1200, HR 676, S 703, or a similar single-payer plan, such that private for-profit health insurance coverage continues to be part of the national mix of options—

There must be robust and effective regulation of private insurers:

1. to limit overhead administrative costs and investor profit (as is done now with regulation of public utilities); and
2. to prevent "cherry-picking"—enrolling only the healthy, and excluding those with pre-existing conditions or chronic disease, etc.; and
3. in general, to prevent the public plan option from becoming a taxpayer-supported dumping ground of sicker patients, while private insurance reaps a windfall from enrolling only the healthy.

Regulation of private insurance plans must include—at a minimum—the features above marked by (*).

Private insurance is the problem

Rather than solving the challenge of affordable health care for all, private insurance IS the problem.

Why? Because real savings can only be realized by eliminating the inefficiency that is built in to the private health care insurance system. A public option plan foregoes at least 84% of the administrative savings available through a nationwide single payer system—publicly-financed, covering everyone, and delivered through private and community-based providers of the patient's choice.

When there are hundreds of private insurance plans, hospitals and doctors need an army of clerks to handle all the different rules and limitations in processing payment and claims. Also, under our current system, the insurance industry spends greatly on screening efforts to “cherry pick” only the profitable enrollees, by excluding those with pre-existing conditions and chronic illnesses. The net effect is profitability for insurance companies, but too many uninsured, and higher costs to the public.

Until and unless there is a single-payer system, effective cost control depends on tight regulation of private insurance, to limit overhead costs where too many health care dollars are actually wasted—such as for marketing costs, investor profit, excessive compensation to CEOs and top management, corporate lobbying and campaign contributions, etc.

[Time for change]

43. You say that the insurance companies will not allow a level playing field

A public option will force a level playing field by forcing the insurance companies to compete with it. I don't see how they can. How can private insurance companies offer a comparable package while trying to make a profit? They will be forced to offer a decent plan or get out of the market. That's why they are so hostile to the idea of a public option. They know they can't compete with it.

As for the cost, that depends upon a lot of details other than whether the system is single payer or not. With a public option, the system is essentially single payer for those who choose to participate in it.

[eridani]

60. Study up on Medicare Advantage

They compete by cherrypicking and government subsidy.

Health Policy Q&A with PNHP Co-founders Drs. David Himmelstein and Steffie Woolhandler on 04/17/2009
PNHP should tell the truth: The “public plan option” won't work to fix the health care system for two reasons. .

1. It foregoes at least 84% of the administrative savings available through single payer. The public plan option would do nothing to streamline the administrative tasks (and costs) of hospitals, physicians offices, and nursing homes. They would still contend with multiple payers, and hence still need the complex cost tracking and billing apparatus that drives administrative costs. These unnecessary provider administrative costs account for the vast majority of bureaucratic waste. Hence, even if 95% of Americans who are currently privately insured were to join a public plan (and it had overhead costs at current Medicare levels), the savings on insurance overhead would amount to only 16% of the roughly $400 billion annually achievable through single payer.

2. A quarter century of experience with public/private competition in the Medicare program demonstrates that the private plans will not allow a level playing field. Despite strict regulation, private insurers have successfully cherry picked healthier seniors, and have exploited regional health spending differences to their advantage. They have progressively undermined the public plan—which started as the single payer for seniors and has now become a funding mechanism for HMOs, and a place for them to dump the unprofitably ill. A public plan option does not lead toward single payer, but toward the segregation of patients; with profitable ones in private plans and unprofitable ones in the public plan.

Would a public plan option stabilize the health care system, or even be a major step forward?

The evidence is strong that such reform would have at best a modest and temporary positive impact—a view that is widely shared within PNHP. Indeed, we remain concerned that a public plan option as an element of reform might well be shaped in a manner to effectively subsidize private insurers by requiring patients to purchase coverage while relieving private insurance of the highest risk individuals, stabilizing private insurers for some time and reinforcing their control of the health care system.

Given the above, is it advisable to spend significant effort advocating for inclusion of such reform? No, for two reasons:

1. We are doctors, not politicians. We are obligated to tell the truth, and must answer for the veracity of our stance to our patients and colleagues over many years. Ours is a very different time horizon and set of responsibilities than politicians'. Falling in line with a consensus that attempts to mislead the public may gain us a seat at the debate table, but abdicates our ethical obligations.

2. The best way to gain a half a pie is to demand the whole thing.

Is fundamental reform possible?

We remain optimistic that real reform is quite possible, but only if we and our many allies continue to insist on it.






If we have to compromise at the end of the process, what should a public option look like?

This opinion article is compiled from conversations held during April, 2009, with health care reform advocates, including Physicians for a National Health Plan, Health Care for All NJA? and other advocates.
This draft (4-18-09) prepared for discussion, by Craig Salins

In other words, if we can’t get our pony, what should the kitten that we will settle for look like? Congress is finally considering serious health care reform, pushed by the Obama administration and by a worsening crisis nationwide. There are several competing options and proposals, representing a diversity of interests, each seeking to broaden coverage to all or most Americans and at an affordable cost.

One proposed option is simply to expand Medicare to everyone. It would cover all Americans, all ages, be financed publicly, and delivered privately through existing local health services and facilities.

Another option is to leave existing private insurance plans in place, for any Americans who want to keep their existing plan, while simultaneously establishing a public plan which would be open anyone—those who don't currently have coverage, or who desire to switch to a public plan. The expectation is that such a public plan would provide good benefits at a lower price, by operating on a non-profit basis, with a single risk pool nationwide, without expensive overhead.

But such a plan could be hijacked or derailed in Congress by special interests. If not designed with safeguards and combined with tight regulation of private insurance, a public plan could become simply a dumping ground for older, sicker enrollees at taxpayer expense, while letting the insurance industry reap a bonanza in public subsidies and profit: for enrolling healthy people who cost very little.

The insurance industry is already opposing the creation of a public plan option. They complain that it would compete with their established plans (it would, of course—fair competition is the point.) But the insurance industry might use their political clout through Congressional debate to “shape” the public plan so that it cannot succeed—or so that it works to their advantage, perhaps by taking sicker, more costly patients off their hands, leaving low-cost healthy patients to be milked for higher profit.

A public plan option must be designed with the public interest in mind—and not by those in the insurance industry who have private profit in mind at taxpayer expense!

These features below must be part of any public plan option—to achieve a plan that will work for all.

1. Any public option should directly pay providers (like Medicare does) - using a single, efficient public “payer” to pay for services delivered by private health care providers and facilities chosen by the patient. (This contrasts with a referral or “connector” plan, such as the Federal Employee Benefits Health Plan, that simply enrolls people in existing private insurance plans. A connector scheme is expensive, due to an extra layer of administration to broker the arrangement and the expensive overhead of private insurance.)

2. Comprehensive benefit package, one set of benefits for everyone regardless of age, employment status, enrollment group, geography, health status, or any other factor.

3. Free and complete choice of health care providers, including hospitals, clinics, all services.

4. Affordable. No excessive co-pays or deductibles. Appropriate cost-sharing from employers, individuals, and from public sources/programs such as Medicaid and Medicare.

5. Available to everyone including employers, employee groups, and any individual.

6. Guaranteed acceptance* No denial of coverage to anyone for health status, pre-existing conditions, or for any reason. No waiting period. No penalties for not previously having insurance.

7. Immediate enrollment and coverage* in a plan of patient's choice, at the point of first medical contact for those not previously enrolled in a coverage plan. No delay when coverage starts.

8. Community rating* Insurance premiums based on health care risks and costs for the entire population - not on any particular subset of risks and costs, such as those with chronic disease.

* These features should apply by law to all health care insurance - public or private - as a matter of public policy.

Also, if for now, Congress fails to enact HR 1200, HR 676, S 703, or a similar single-payer plan, such that private for-profit health insurance coverage continues to be part of the national mix of options—

There must be robust and effective regulation of private insurers:

1. to limit overhead administrative costs and investor profit (as is done now with regulation of public utilities); and
2. to prevent "cherry-picking"—enrolling only the healthy, and excluding those with pre-existing conditions or chronic disease, etc.; and
3. in general, to prevent the public plan option from becoming a taxpayer-supported dumping ground of sicker patients, while private insurance reaps a windfall from enrolling only the healthy.

Regulation of private insurance plans must include—at a minimum—the features above marked by (*).

Private insurance is the problem

Rather than solving the challenge of affordable health care for all, private insurance IS the problem.

Why? Because real savings can only be realized by eliminating the inefficiency that is built in to the private health care insurance system. A public option plan foregoes at least 84% of the administrative savings available through a nationwide single payer system—publicly-financed, covering everyone, and delivered through private and community-based providers of the patient's choice.

When there are hundreds of private insurance plans, hospitals and doctors need an army of clerks to handle all the different rules and limitations in processing payment and claims. Also, under our current system, the insurance industry spends greatly on screening efforts to “cherry pick” only the profitable enrollees, by excluding those with pre-existing conditions and chronic illnesses. The net effect is profitability for insurance companies, but too many uninsured, and higher costs to the public.

Until and unless there is a single-payer system, effective cost control depends on tight regulation of private insurance, to limit overhead costs where too many health care dollars are actually wasted—such as for marketing costs, investor profit, excessive compensation to CEOs and top management, corporate lobbying and campaign contributions, etc.

[mvd]

19. I believe that a public plan should cover all needed treatment

I think health care should be a right and funded like grade school public education, the police, and fire fighting. It's certainly as important. There can still be private plans to cover things such as cosmetic surgery.

I realize that we might not get to it right away. I think the plan talked about by Sebelius will do more than she says it will, and once it does, I do not believe this administration will try to stop it. The trick is in getting a viable public option through the Nelsons and Baucuses in our party.

[JVS]

21. I agree.

Also, once there is a public option, the private companies will wither. There might be a few that specialize in keeping rich people's facelifts from coming undone, but not the essentials.

[vaberella]

22. Exactly. n/t

[babylonsister]

62. See post #52. Things to contemplate. nt

[newinnm]

29. Prescription Drugs

I didn't know until today that Canadian Medicare didn't provide for prescription drugs, dentistry or optometry for its people. Any thoughts?

http://www.drugcoverage.ca/

nnnm

[eridani]

39. They also have health care as part of the general budget, which we want to avoid

When the Canadian system was established, drug expenses were far lower. HR 676 includes prescriptions, and has health care money in a trust like Social Security.

[PBS Poll-435]

31. The NHS Trust System is the strongest in the world

nt

[busymom]

50. LOL unless you are sick.

I have lived and worked in the country and have close family friends that are British who still do.

The NHS Trust is far from the strongest in the world.

[Sunnyshine]

33. Single payer is a descriptive phrase for how cost are met to pay for Universal Health Coverage.

It is the most straight forward imho, which is why it is the best long term solution over hybrid systems.

The British/Scandinavian/Spanish system of single payer,health care providers are simply salaried by the community and have to deliver health care within a fixed budget. This means that there is every incentive for them not to waste funds on unnecessary tests and the use, for example of expensive medical scanning in situations when cheaper - as effective alternatives are available. Comparative effectiveness between hospitals is measured and publicly reported.
Ineffective practice is rooted out because hospitals are public institutions- they cannot profit by providing more care. http://en.wikipedia.org/wiki/Single-payer_health_care

Contrast that with this:

In the North American system of paying for-profit institutions via Medicare type systems (which effectively pay for volume of work in the same way as private insurance), the system may retain some issues of moral hazard. Medicare itself recognizes that the present system rewards failure. For example some hospitals were found to provide excellent service with low re-admission rates, but others had poorer medical performance with higher re-admission rates. Because the system pays for the volume of work done and not the quality of outcomes, this results in the good hospitals receiving LESS funding than the bad ones. Because in this system a doctor in general practice only gets paid when a service is delivered, even general practitioners tend to run tests and treat the "worried well" because giving advice to the patient is not well rewarded by the payment system whereas performing tests is. The doctor earns nothing if patients do not come through the door.http://en.wikipedia.org/wiki/Single-payer_health_care

Single payer advocates have considered all the above. I once shared your pov, but the bottom line is that insurers/private institutions purposely blur the ethics of medicine and tangle up the system by injecting bias into what is an unbiased need. They complicate the PT/MD relationship and ultimately inflate the delivery cost. They are industrial sized filters that should never be applied to health care or the human act of caring for someone regardless of circumstance. I work in HC. That is my take on it.

OP's like these keeps this discussion going. I appreciate the chance to address this topic and thanks for reading my long reply.

[grantcart]

34. While agreeing with the basic point of the well written OP that change will be evolutionary,

a couple of points are somewhat misleading;

The call for single payer health care in the United States is, IMHO, a shorthand call for the elimination of 'for profit' health delivery systems, and that many people who are saying "single payer" would not in principle care if it was the German system or the British system, it is too difficult to get a nuanced position in a slogan and "single payer" expresses the basic point of;

1) Universal access to health not based on the ability to pay.

2) That the primary health care administrator not be a 'for profit' entity.


For example the German system everyone pays the same percentage of fees and it goes to the government. The individual picks an approved "not for profit" insurance company to administer their plan. The actual health care providers - doctors, etc. can be either for profit or not for profit.

In my mind, since the government is collecting the revenue and it is paid to a narrow group of 'not for profit' organizations it is infact a 'single payer' system. You may be technically correct that it is not classified as a 'single payer' system but it certainly works like one.

The ideological argument that is going on is whether or not we have a combined system, like the Netherlands - or sadly even weaker, or whether we have one where the government is the primary payer of the fees (whether it is in a national bureacracy like the UK - almost impossible to implement here, or the German system - which would be a much more evolutionary step.

Finally considering the New Yorker article.

All the facts are correct but again I think it is misleading and misses the point. To begin with it cites only two countries in detail (UK and Switzerland) and you extrapolate this to "virtually every country".

The transition in the UK was clearly the result of a modest evolution out of war time to peacetime.

The article spends a great deal of space comparing the evolution in Switzerland, which is more complicated. Nothing in Switzerland is like any other country. The local Canton is invested with so much authority and there is so little social mobility outside of the cities is that it runs like a little village council. While welfare is given in Switzerland the local Canton is run by local citizens who know the intimate details of every life story and decide whether or not local applicants should be given welfare services or not. It is one of the reasons that Switzerland has one of the highest suicide rates in the world.

The article didn't take a look at countries that didn't fit its narrow thesis and are more similar to the US. It mentions Canada in passing but doesn't go into detail. Canada wasn't a simple war time change. Canada came together on a moral position and changed their health system to match it, it was existential, not evolutionary.

Since 1962, Canada has had a government-funded, national healthcare system founded on the five basic principles of the Canada Health Act. The principles are to provide a healthcare system that is: universally available to permanent residents; comprehensive in the services it covers; accessible without income barriers; portable within and outside the country; and publicly administered.

http://www.medhunters.com/articles/healthcareInCanada.html

In Canada, even the conservative party considers universal health care "sacrosanct". http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=132x8392788

The main reason why the United States doesn't have universal care (either single payer or mandatory insurance) is not historical but political.

1) All of the other countries use a parlimentary system that concentrates all of the political power -executive and legislative - into a ruling coalition and they can make bold moves, and then suffer the consequences.

2) Other countries, like Canada and Australia don’t have a problem learning from other countries’ success stories, particularly that of the UK. When was the last time the US decided it was a good idea to use something from another country?

Our system divides the power between the legislative and executive branches and gives minority parties substantial power making any radical changes almost impossible baring a massive seismic upheaval like 1933 or WWII. This stability makes change more modest and incremental but it makes any large structural change almost impossible.

For this reason I believe that your well written OP's main point is correct. Our only hope is for evolutionary steps, a large jump to a single payer system is not likely. However I am concerned that the administration may be trying to ensure that this evolution will not proceed to a truley universal system. Secretary Sebelius' statement today seemed to indicate that was the case.

This point was discussed in this thread and other posters thought that was 'pro forma' and that once a public option is included the private providers will be 'crowded out' and we will evolve, as per your OP, to a universal system.
http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=132x8393911

[eridani]

40. The crowding out of private insurance will happen only if the public plan is adequately funded

That can't happen if we allow people to waste money on private insurance profits and administrative nonsense.

[grantcart]

47. True but a completely 'revenue nuetral' public plan

that had the same demographic spread as a private insurer would gain big efficiencies and offer better care

1) Takes out a redundant profit center

2) Eliminates expensive decision making apparatus for treatment approval

[eridani]

61. Fine. Given the history of Medicare Advantage, tell me how we enforce those demographic spreads

Health Policy Q&A with PNHP Co-founders Drs. David Himmelstein and Steffie Woolhandler on 04/17/2009
PNHP should tell the truth: The “public plan option” won't work to fix the health care system for two reasons. .

1. It foregoes at least 84% of the administrative savings available through single payer. The public plan option would do nothing to streamline the administrative tasks (and costs) of hospitals, physicians offices, and nursing homes. They would still contend with multiple payers, and hence still need the complex cost tracking and billing apparatus that drives administrative costs. These unnecessary provider administrative costs account for the vast majority of bureaucratic waste. Hence, even if 95% of Americans who are currently privately insured were to join a public plan (and it had overhead costs at current Medicare levels), the savings on insurance overhead would amount to only 16% of the roughly $400 billion annually achievable through single payer.

2. A quarter century of experience with public/private competition in the Medicare program demonstrates that the private plans will not allow a level playing field. Despite strict regulation, private insurers have successfully cherry picked healthier seniors, and have exploited regional health spending differences to their advantage. They have progressively undermined the public plan—which started as the single payer for seniors and has now become a funding mechanism for HMOs, and a place for them to dump the unprofitably ill. A public plan option does not lead toward single payer, but toward the segregation of patients; with profitable ones in private plans and unprofitable ones in the public plan.

Would a public plan option stabilize the health care system, or even be a major step forward?

The evidence is strong that such reform would have at best a modest and temporary positive impact—a view that is widely shared within PNHP. Indeed, we remain concerned that a public plan option as an element of reform might well be shaped in a manner to effectively subsidize private insurers by requiring patients to purchase coverage while relieving private insurance of the highest risk individuals, stabilizing private insurers for some time and reinforcing their control of the health care system.

Given the above, is it advisable to spend significant effort advocating for inclusion of such reform? No, for two reasons:

1. We are doctors, not politicians. We are obligated to tell the truth, and must answer for the veracity of our stance to our patients and colleagues over many years. Ours is a very different time horizon and set of responsibilities than politicians'. Falling in line with a consensus that attempts to mislead the public may gain us a seat at the debate table, but abdicates our ethical obligations.

2. The best way to gain a half a pie is to demand the whole thing.

Is fundamental reform possible?

We remain optimistic that real reform is quite possible, but only if we and our many allies continue to insist on it.






If we have to compromise at the end of the process, what should a public option look like?

This opinion article is compiled from conversations held during April, 2009, with health care reform advocates, including Physicians for a National Health Plan, Health Care for All NJA? and other advocates.
This draft (4-18-09) prepared for discussion, by Craig Salins

In other words, if we can’t get our pony, what should the kitten that we will settle for look like? Congress is finally considering serious health care reform, pushed by the Obama administration and by a worsening crisis nationwide. There are several competing options and proposals, representing a diversity of interests, each seeking to broaden coverage to all or most Americans and at an affordable cost.

One proposed option is simply to expand Medicare to everyone. It would cover all Americans, all ages, be financed publicly, and delivered privately through existing local health services and facilities.

Another option is to leave existing private insurance plans in place, for any Americans who want to keep their existing plan, while simultaneously establishing a public plan which would be open anyone—those who don't currently have coverage, or who desire to switch to a public plan. The expectation is that such a public plan would provide good benefits at a lower price, by operating on a non-profit basis, with a single risk pool nationwide, without expensive overhead.

But such a plan could be hijacked or derailed in Congress by special interests. If not designed with safeguards and combined with tight regulation of private insurance, a public plan could become simply a dumping ground for older, sicker enrollees at taxpayer expense, while letting the insurance industry reap a bonanza in public subsidies and profit: for enrolling healthy people who cost very little.

The insurance industry is already opposing the creation of a public plan option. They complain that it would compete with their established plans (it would, of course—fair competition is the point.) But the insurance industry might use their political clout through Congressional debate to “shape” the public plan so that it cannot succeed—or so that it works to their advantage, perhaps by taking sicker, more costly patients off their hands, leaving low-cost healthy patients to be milked for higher profit.

A public plan option must be designed with the public interest in mind—and not by those in the insurance industry who have private profit in mind at taxpayer expense!

These features below must be part of any public plan option—to achieve a plan that will work for all.

1. Any public option should directly pay providers (like Medicare does) - using a single, efficient public “payer” to pay for services delivered by private health care providers and facilities chosen by the patient. (This contrasts with a referral or “connector” plan, such as the Federal Employee Benefits Health Plan, that simply enrolls people in existing private insurance plans. A connector scheme is expensive, due to an extra layer of administration to broker the arrangement and the expensive overhead of private insurance.)

2. Comprehensive benefit package, one set of benefits for everyone regardless of age, employment status, enrollment group, geography, health status, or any other factor.

3. Free and complete choice of health care providers, including hospitals, clinics, all services.

4. Affordable. No excessive co-pays or deductibles. Appropriate cost-sharing from employers, individuals, and from public sources/programs such as Medicaid and Medicare.

5. Available to everyone including employers, employee groups, and any individual.

6. Guaranteed acceptance* No denial of coverage to anyone for health status, pre-existing conditions, or for any reason. No waiting period. No penalties for not previously having insurance.

7. Immediate enrollment and coverage* in a plan of patient's choice, at the point of first medical contact for those not previously enrolled in a coverage plan. No delay when coverage starts.

8. Community rating* Insurance premiums based on health care risks and costs for the entire population - not on any particular subset of risks and costs, such as those with chronic disease.

* These features should apply by law to all health care insurance - public or private - as a matter of public policy.

Also, if for now, Congress fails to enact HR 1200, HR 676, S 703, or a similar single-payer plan, such that private for-profit health insurance coverage continues to be part of the national mix of options—

There must be robust and effective regulation of private insurers:

1. to limit overhead administrative costs and investor profit (as is done now with regulation of public utilities); and
2. to prevent "cherry-picking"—enrolling only the healthy, and excluding those with pre-existing conditions or chronic disease, etc.; and
3. in general, to prevent the public plan option from becoming a taxpayer-supported dumping ground of sicker patients, while private insurance reaps a windfall from enrolling only the healthy.

Regulation of private insurance plans must include—at a minimum—the features above marked by (*).

Private insurance is the problem

Rather than solving the challenge of affordable health care for all, private insurance IS the problem.

Why? Because real savings can only be realized by eliminating the inefficiency that is built in to the private health care insurance system. A public option plan foregoes at least 84% of the administrative savings available through a nationwide single payer system—publicly-financed, covering everyone, and delivered through private and community-based providers of the patient's choice.

When there are hundreds of private insurance plans, hospitals and doctors need an army of clerks to handle all the different rules and limitations in processing payment and claims. Also, under our current system, the insurance industry spends greatly on screening efforts to “cherry pick” only the profitable enrollees, by excluding those with pre-existing conditions and chronic illnesses. The net effect is profitability for insurance companies, but too many uninsured, and higher costs to the public.

Until and unless there is a single-payer system, effective cost control depends on tight regulation of private insurance, to limit overhead costs where too many health care dollars are actually wasted—such as for marketing costs, investor profit, excessive compensation to CEOs and top management, corporate lobbying and campaign contributions, etc.

[eridani]

36. None of those countries allow unregulated profits

Our insurance companies are such an ummitigated disaster that we have to get rid of them. They won't tolerate regulation any better than they will tolerate single payer, so why not go for the gold? BTW, single payer does not rule out supplemental insurance for bells and whistles.

[CTyankee]

44. What is missing from the posts comparing European systems to cherry pick the "best" for the US

is the acknowlegement that each of these countries listed have an overall more comprehensive "safety net" for their citizens than we have here. A health care system needs to be considered in the context of other aspects of American lives. When we say we have great private health insurance from our employer, we aren't looking past the immediate present. If your job is lost due to lay offs and downsizing, you end up with a hugely expensive COBRA at exactly the time in your life when you don't have the means to pay for it.

European countries also take very seriously their commitment to their next generation and thus the care of children is a significant part of their overall system. If a kid can qualify for the university, he/she gets a state funded education and does not face a mountain of debt upon graduation. That is also a huge help for young people just starting out, being able to take lower paying jobs.

Maternity leave and day care are well subsidized in most European countries (I know that in Italy parents must pay for day care, but I don't know their costs). Every working parent in the U.S. has the worry of finding affordable day care. Maternity leave is typically not subsidized, but if it is, it is not much (I was surprised to learn that my daughter, working in New York, had a maternity leave subsidy but then found out it was owned by a German company).

So these are considerations we have to look at as we debate the issue of health care.

[busymom]

51. thumbs up nt.

[Bluenorthwest]

46. I notice that the plans I like in other countries,

while not being all single payer, are all 'non profit' or single payer. France, Canada, UK, Austrailia, the Scandinavians nations, all seem to share a not for profit private sector involvemnt or are flat out single payer. None of them offer no public option, none of them are arragned around for profit private Insurance Companies.
It is the Insurance Companies power and profit that the majority of Americans wish to see removed from the table. Few human beings are willing to say it would be nice to heal our son, but if we did, Humana would not be able to pay dividends, so we understand why he must die.
The only groups of people who have a shred of respect for Insurance Companies are their employees and their shills in Cogress. The rest of America has no wish to keep them going at all.

[slipslidingaway]

55. Exactly... "are all 'non profit' or single payer..." n/t

[TreasonousBastard]

48. Every time I post similar thoughts...

I get roundly condemned as a tool of the insurance companies, or worse.

But, "single payer" has become synomymous with universal health care and is now a mantra. I can't see any way that this could end well if we lose the real chance for reform in a battle over semantics and ideology on both the left and the right.

And, again I add, a large part of the problem is the expense of the delivery of medical services here. What does a routine pregnancy cost in France or Japan? More or less than the 14 grand or so here? Do other countries rush into caesarians like we do?

What about a lifetime of dialysis? Transplants? Cancer, Alzheimer's, or other long term care? Does ANYONE spend as much on these as we do? And get so little for the money?

[busymom]

52. You and me both...

Something else to think about when you are bringing up chronic healthcare issues.

With a single payer option, you will see rationing. There is only so much money to go around.

I can tell you that when I lived and worked in Germany, if you had cancer and smoked, you did not receive treatment until you stopped smoking. Many major medical centers mandated this. Basically, the thinking was "why treat it if you are going to kill yourself anyway". Organ transplantation simply is not done beyond a certain age, nor is dialysis.

That is all not necessarily wrong, btw.

But we have become a very, very spoiled society. We want grandma to be kept alive on the drip as long as possible regardless of whether she is demented and her quality of life is poor. If our leg hurts, we want an MRI. If we need surgery, we want to be able to conveniently choose a date and time and the physician to do it...and not have to wait 3 or 6 months. When we ring our call bell, we expect the nurse to come running. All of these things cost money!

Also, There are lawsuits in this country that have named physicians for giving too much pain medication or conversely, not enough pain medication...

That is also another thing that will need to be addressed...lawsuits.

We can't sue over every fart. Not every child has Cerebral Palsy because of an error made by an OB, not every bad pregnancy outcome is the fault of the doctor...surgery carries real risks...and so do certain drugs. That is a part of life and lawsuits need to be more stringently regulated.

[Luminous Animal]

53. Learn from activist history - You ask for everything

then compromise down.

Starting at a position of compromise results in a worse compromise.

[snowdays]

56. and we are that in action already!!

[Political Heretic]

54. "Single Payer" has just become a popular catch-phrase for the left

...to be uttered mindlessly while stamping feet and jumping up and down.

But as someone said up thread, the devil is really in the details. A so-called single payer plan can still be terrible, and hyrbid plans may be outstanding.

[avaistheone1]

58. Oh dear, you must be flummoxed! You are on a lefty board, that supports a lefty president.

So why are you knocking the left? Did you lose your way to free republic board?

BTW I support those brave brave doctors and nurses who stood up at the Senate hearing to demand a voice, and a seat at the table to discuss single-payer health care. When a democratic government does not support the critical needs and wants of the people then the government is broken.

[Political Heretic]

65. A "lefty" President?

President Obama is many things, many of them very good and welcome. But "lefty" is not one of them.

BTW I support heath care that works over sloganeering. And my opinion is that "single payer" has become more of a catch phrase, and that some people really don't have a full grasp of the options for health care - so much so that they would ignore some outstanding approaches because it didn't have the words "single payer" in it.

Many of the outstanding plans in Europe are public but not single payer. I am not against single payer. I am against mindlessness.

[Luminous Animal]

63. And you conclude "mindlessly" how?

I know for a fact that the so-called "left" understands "Single Payer" very well and why a public option is necessary for a healthy pro-worker society. In every country cited in the OP, a public option covers, without restrictions, the under-employed, the unemployed, and the sustenance employed. That is, if you cannot afford supplemental private insurance, you will receive the same quality of care from the government administered program as those who can afford supplemental insurance.

[Political Heretic]

64. By reading.

:)

[Luminous Animal]

68. By reading what?

[Mass]

67. Here is the description of the French system, largely a state system.

Private insurances are very rarely used except as a supplement and the bulk of the system is linked to taxes, managed by a huge central "caisse", securite sociale.
http://brittany.angloinfo.com/countries/france/healthinsure.asp
The Basic System of Social Security

Like other countries, France uses taxation to fund health care for residents but unlike Britain for example, France operates an insurance system. This is a mixed system with the bulk of cover coming from State assurance, and top-up cover coming from mutuelles or private health care insurance companies. All medical facilities are part of the State system but the patient is free to choose their own doctors, specialists, medical facility or hospital.

Here is the description of the system as described by the article referenced at the beginning;

Today, Sécurité Sociale provides payroll-tax-financed insurance to all French residents, primarily through a hundred and forty-four independent, not-for-profit, local insurance funds. The French health-care system has among the highest public-satisfaction levels of any major Western country; and, compared with Americans, the French have a higher life expectancy, lower infant mortality, more physicians, and lower costs. In 2000, the World Health Organization ranked it the best health-care system in the world. (The United States was ranked thirty-seventh.)

In fact this explanation can be misleading, as the funds are not independent in the way it implies. They are all organized in a hierarchical organization with one national fund that manages regional funds that manage local funds that are charged of distributing the funds based on need. They have no real autonomy when it comes to what to distribute to whom. All is managed at the national level. Everything is negotiated at the national level, with involvement of unions, corporation unions, and the government. I am not sure what the OP calls a single payer system, but, in my mind, a system where the same services are given to everybody and where people pay according to their revenues rather than their need, however it is administered, is about as single payer as it can be.

[Honeycombe8]

71. No, God, no! A post on health care that makes sense! Stop it at once!

If you insist on making sense and posting sensible, intelligent posts, I may just have to stop reading your posts.

In the future, you should just criticize whatever the latest health care reform plan is, with total disregard to facts, and leave it at that. S'easy. No thought required.

And no more of these sensible posts, ya'hear?