Single Payer, Single Pool?

[MineralMan]

That's what I want. We have 300+ million people in this country. Everyone is charged the same amount in my preferred system, from the infant to the hospice patient. To control costs, every provider may only charge the same amount for the same procedure. Unnecessary procedures and tests will not be funded. Cosmetic and other vanity treatments will not be financed, but restorative cosmetic surgery will.

If you show up at the emergency room with something not an emergency, you will be directed to a nearby clinic. If you show up at a clinic with an emergency, you will be transported to the nearest emergency room equipped to handle that kind of case.

Pharmaceuticals will be priced at a break-even level, with a fixed profit-margin for companies that produce them. In no case will Americans pay more for a given pharmaceutical than anyone else. The government may, and will, negotiate prices for pharmaceuticals and gouging will lead to the instant loss of the patent on the drug.

For those below a certain level of income, a sliding scale of subsidies would apply, and those people would be covered by the rest of us, who can afford to do so.

No opt-outs. No extras. One standard. One price. Everyone gets the benefit of medical technology at the same level. Everyone pays for everyone, unless you are poor, in which case you are still covered at the same level.

As far as I am concerned, this is the only fair and equitable system. Anything else is bullshit. I don't care who administers it, but it must be on a no-profit basis, with salary limits if it is administered by private companies.

That is all.

[MineralMan]

1. I'll add one more thing...

Educational expenses for physicians, nurses, and other workers in the medical professions will be subsidized 100% by the system at any Land Grand University in the US. In return, recipients of this subsidized education will work within the single payer, single pool system for at least double the number of years their education was subsidized. Dropouts from the system may either pay back the costs or work at a level commensurate with the training level they reached. Salaries will be capped at amounts linked to elected officials' salaries.

[Oregone]

4. Work withing the single-payer system?!?

You do realize that doctors, physicians and nurses can work publicly or privately AND still be paid by a single-payer system?

Single-payer is just insurance socialization. It has nothing to do with socializing the medical end, so I'm not sure what you mean by "recipients of this subsidized education will work within the single payer, single pool system for at least double the number of years their education was subsidized". All physicians, public, privately, or self-employed, would already be withing the single-payer system. That being, their services would be paid for by the public insurance.

There is something to be said about taking steps to make sure you have an appropriate level of health care workers. But, in terms of creating rich private doctors for no cost to them, well, I think you are pushing it a tad. Now, there are tons of loan forgiveness programs out there as is, but to do this across the board for private practice is ridiculous (and I know you didn't say "for private practice", but single-payer pays private practitioners).

[MineralMan]

6. OK, I guess what I mean by that is that they would have

to accept the standard payment for services rendered to covered patients for that time period, and would not be allowed to not accept such patients for treatment during that term, in exchange for getting their free education.

This would insure a new supply of medical professionals, while offering a fixed time period under which they would be required to accept patients covered under the system.

I guess I take a more socialistic point of view on this than you do. I never claimed to be a big fan of purely private medical practice.

I'd extend that, too, to medical facilities. They would not be allowed to reject patients who are in the system, unless they declare themselves to be completely private and accept none of those patients. I'm quite certain that few would take that option. Lots of empty beds in hospitals these days, and Medicare patients are paying the bills.

[Oregone]

8. The thing about it is, they really have no choice but to accept the payment plan (or enroll)

Because such systems should outlaw private insurance covering that which the public insurance covers (hence "single-payer"). Anything else creates a two-tiered class system, and the rich writing the laws will make sure the public tier is underfunded and their contribution to it is minimal.

So, to pretty much practice and be paid, you gotta accept you will be paid by the single public insurance plan.

Although single-payer may not be the most progressive approach, I definitely see the benefit where I live. Private health clinics are everywhere, sprawling and thriving, and you are never but a quick jaunt and a short wait from a doctor. I don't know if the government could operate all these hundreds of clinics centrally as well (especially with them on every corner in some areas). Who knows?

[MineralMan]

12. Yeah. I live in a major metro area, too, and if you're insured,

there's no problem with same-day appointments with primary providers, and almost no wait for hospital care, since most of the hospitals are actively competing for patients.

It's different in rural and small town America, though. However, I suspect that increasing the number of educated medical pros through education subsidies and expansion of medical schools would ameliorate that problem.

Feeder clinics in more rural areas seems to me to be the answer. Primary care only, with obstetrics, and basic emergency care. Everyone with more serious needs gets stabilized and transported. Need an MRI? Off you go to Boise or Fargo. The Medi-Bus leaves at 9 AM. Need some stitches, an x-ray, a broken bone set? No problem...we can do that right here.

We have a lot of facilities that are infrequently used...mainly because we don't have a viable transport system. Jobs come with all this, too. Oh? You flew choppers in the service? Well, then, we have a medical airlift job just waiting when you get out.

We can do so much better than we currently do. So much better.

I remember the time I collapsed with viral encephalitis in Quartzite, Arizona, back in 1991. I got airlifted to Palm Springs. My insurance company excluded air transport, so I got a bill for $5000 for that short ride. When I called the company to arrange a payment schedule, the person I talked to said, incredulously, "You want to PAY?" I did pay. Most people didn't, I guess, so I paid for a few other transports. If they were all paid for, the cost would be less for each trip.

Our current system sucks hard.

[Oregone]

2. "Everyone is charged the same amount in my preferred system"

Not in mine at all. $5000 bucks for the family who nets $50 K a year is much more of a burden than $5000 bucks to Warren Buffet.

When you have a single-payer system, you have the option to fund it progressively based on income, via taxes. Why would you pass that option up? You don't need to subsidize the poor if you do this, as their additional tax burden would be beyond negligable, if increased at all.

And BTW, I think that "extras" can only enhance a single-payer system. Its a hard case to make, that society should be burdened with cosmetic orthodonics, and other dental enhancements. I see nothing wrong with private supplemental plans to cover these traditionally high deductible/hi co-pay services that operate via self-rationing. You would open the flood gates covering these with no deductible/no co pays.

[MineralMan]

3. The sliding scale I mentioned would take care of this, I have

no doubt. I didn't supply any numbers, so all of that is dealable with using a tax credit system.

As for the suplemental stuff, I have no problem with that, as long as it is limited to funding elective, non-essential treatments. Otherwise, you'd soon find that things get shifted so that necessary treatments get defined as non-essential.

Medicare, with supplements, works pretty well, although not perfectly.

[Oregone]

5. If you want everyone to pay the same, your sliding scale wouldn't go to infinity

And hence, the burden for the middle class would be well above that for the upper 1%. Thats just the bottom line reality, just like payroll caps. There is not any reason at all to not raise it via taxation and have everyone pay a *different* amount based upon their income (or wealth)

You should look at the Canada model in terms of how they separate non-essential from essential. No, you just dont see essential things get shifted (there are bottom line standards). But as far as dental, eye-wear, etc, go, cheap supplements cover em.

[MineralMan]

7. Well, I'm not an expert on this at all.

I'm just frustrated with the current system and eager to be part of the socialized medical system we already have in place, which I can do in just over one year from now. Yes, I'll be buying a supplement. I don't need the pharma supplement at this point, however, and will not buy into that horribly-planned one.

Quite frankly, we already know how to do this whole thing. We just don't have the will to do it.

Actually, I like the French model best of the ones I've looked at, at least on the surface. It's a blend of private and government coverage. Sweden does it well, too. Canada...well...not so much, perhaps.

[Oregone]

11. Canada does it a lot better than what most people think

They go straight single payer, although there are also a variety of regional socialized hospitals/clinics.

Yes, when there are not enough practitioners or equipment to serve the needs of the people, wait lists can form. Here in my province, the median wait time is a measly 4.5 weeks for non-emergency elective surgery. Honestly, I never saw anything better in the states--maybe they just don't keep track. But as for the *single-payer* insurance, its fantastic. No copay, no deductible, everyone is covered.

Its actually the market that creates the low supply of health care workers (which the insurance payment rates can interact with). Another problem is how rural Canada is. When there aren't enough clinics in remote areas, well, they can have remarkably high wait times. BUT, as for their system, I can guarantee you that the single-payer will pay for all those surgeries, they just need private or public facilities to do them.

I think Canada's remote nature has put some pressure on their health care rankings that France doesn't have to deal with. The reality is that things are not like the horror stories at all

[MineralMan]

13. I know it's a good system. It gets all the bad press because

nobody mentions anything but the negative. They're trying to kill single payer here, so they dig up the mistakes and the problems and that's all we hear in the media here. Rural folks, especially as rural as it gets in Canada, have trouble everywhere, including here. It comes with the decision to live far away from things.

[Oregone]

15. Thats the real key:

"They're trying to kill single payer here, so they dig up the mistakes and the problems and that's all we hear in the media here. "

Yes, Americans could surely educate Canadians on how bad their own health care system sucks. :)

Its just a well run campaign, thats all. You only hear about how bad Canada is when US is getting ready to "reform"

[MineralMan]

9. Sure. use the tax system to get payment for this, and

make it as progressive a tax as possible. I like that. Insurance costs are withheld by employers, but don't stop if you lose your job...they just continue to be in force. Hell, that's the way it's done now, with employers paying some percentage and holding out the rest from paychecks. I don't see that that practice would change. There would be adjustments to the current plans, but there are already many such adjustments taking place right now, and to the detriment of the employee in most cases.

Apply the percentages at that level, I guess. The actual percentages, etc., are beyond my competence to even approximate.

What I'm saying is that a single pool basis would spread costs over a broader pool, including many who are now completely out of the pool. I, myself, did not buy health insurance until I was 40. I've been self-employed all my life and, until that age, could not afford it. Now that I'm almost 65, I cannot afford it once again. The next year's gonna be a tough one for my wife and I. She's uninsurable, so is stuck with what she has, and her rates are blistering.

We'll survive, but it's gonna suck hard.

[Hutzpa]

10. Bravo!

to the two of you, nothing to add but to say excellent discussion.

:thumbsup:

[MineralMan]

14. Thanks!