A prescription that makes the patient sicker: Dr. Quentin Young Physicians for a National Health

[Hannah Bell]

Program


ES: IN A recent article, Kip Sullivan, a single-payer supporter, described what the Democrats did on the public option as "bait and switch." Do you agree with that?


QY: HE'S RIGHT. Bait and switch is a good way to put it.

The administrative proposal, broadly speaking, has a mandate. The way it works is that if you don't have insurance, you must purchase it. You can purchase it from the private insurance industry, which already dominates the market. This would give them tens of millions more customers.

Or, as Obama would have it, there's a public option. He touts this as a way of creating competition with private insurance, therefore driving down their price. People would have a choice of getting a publicly administered program--presumably something close to Medicare.

In reality, the description is fallacious. Medicare works because everybody in a given group is in the program. Everyone over 65 has Medicare--it doesn't matter whether you're rich or poor, work or don't work. It's a total service to a given population.

Also, it's worth noting that when Medicare was enacted in 1965, it very quickly added all disabled people--a smaller group, but a very costly group. You'll notice what the private sector gave over to the government--people over 65 and disabled people. Common sense will tell you that these are the costliest groups medically in this society.

That's a good example of what the private sector does when it has to--it gets rid of the high-cost clients and sticks with the healthy. Well, that ain't a way to build a health system. A health system has to benefit people when they get sick and need coverage.

So we at the PNHP are, with Kip Sullivan, deeply skeptical of the public option. We think it will do very little to adjust the questions of cost, access or quality.


ES: WHAT DO you think of the behavior of the Democrats in all this? They seem to be bargaining themselves away from any substantial proposal.


QY: I THINK you're right. In their effort to get a bill passed, the concessions are all being made to the conservative elements. The kind of concessions that we read about daily can all be interpreted as maintaining market kinds of solutions--and indeed making sure that the private industry dominates the health system. That's a formula for disaster.

We're in the situation we're in now because that's precisely what has been sanctioned by government action since Medicare was passed--which was very good, but everything else that has been done hasn't been very good, and we have a bunch of costly, ineffective systems.

Number one in my book would be the Medicaid system, for which states and the federal government share costs. But Medicaid is for the poor. It's means tested, and the quality of care in that sector is bad. Not all doctors will participate, and the payment schemes are low. It's a good example of selective oppression of poor people. As long as you have these kinds of systems, you're going to have a relatively poor health program.


ES: THE CONVENTIONAL wisdom the media keep pushing about health care reform is that something is better than nothing, and that compromising is the responsible thing to do. How do you respond to this?


QY: WE DON'T buy it. We're strong, uncategorical advocates for a single-payer national health insurance.

We have many friends who agree that single payer is best. But they say, "Can't we take less than the best as a stepping stone to something better?" If that were really true, it would be a reasonable argument, and I for one would be willing to move in the direction of a better system by incremental measures.

But the really important message--and we try hard to make our critics understand this--is not that we're purists or that we don't like to compromise. That's not the case. The problem is these proposals will not work.

There have been variations of the kind of proposals being discussed now at the national level in as many as a half a dozen states over the last 10 years, and they don't work. Each of these states have more uninsured now than they did when they enacted their programs, and they've had to abandon the programs, or at least parts of them.

So we're resisting getting into a fool's gold arrangement, in which several bad things will happen. First of all, these halfway proposals won't succeed in the goal of spreading coverage to everybody. It won't happen. Second, they'll be very costly fiscally.

And perhaps most important, they fix the idea in the popular mind that the government can't do anything right. I remind you that this is a touchstone of conservative politics, and proposals like these are how they make it happen. We don't need that kind of pessimism in facing this huge social problem.

http://socialistworker.org/2009/07/30/making-the-patient-sicker

[nightrain]

1. thank you. K&R.

Excellent article. He makes great points about the criticism of single payer advocates being "purists". I have been the recipient of those unfounded criticisms on DU, which is so sad to see.

Obama is so far off on health care, it's unfortunate.

Let's make August a month of strong single payer advocacy.

[dixiegrrrrl]

2. Obama is so far off on health care, it's unfortunate.

yep

K&R

[Delphinus]

3. Thanks!

Could only scan through quickly - will read again later tonight.

[eridani]

4. I've come to the conclusion that public vs private is not the issue at all

Following is a three way comparison of a state single payer proposal (WHST), HR 3200, and the government-regulated private insurance system in the Netherlands.

Oddly enough, the tightly regulated private insurance of the Netherlands is much more like US single payer proposals than like HR 3200 or either of the much worse senate proposals. My only hope for the HR 3200 is the ERISA waiver which would allow states to establish single payer.

If Dutch private insurance costs out to individuals and employers only slightly more that the 100% public single payer proposals at state and national levels, that suggests to me a comparison between public utility companies and tightly regulated private ones. The latter are a little more expensive, but pretty much work. I'm OK with that despite my preference for public systems. The real issue here is the WILL TO BREAK THE ENRON MODEL that is the current way private insurance operates here. Private insurers bankrupt and kill people for profit by denying care and refusing to cover sick people; and I don't give a flying fuck that death and bankruptcy happen only to a very small percentage of the total population. Obama and Congress could stop this by imposing Dutch-style regulation on private insurance, by passing single payer, or by implementing within a year a public option open to anybody and run like Medicare, with no "tiers," restricted provider lists, or doubling the premium for older people. Any two out of three would be nice. I'm not seeing any of these options.

I'll support HR 3200 if the ERISA waiver for state single payer stays, or if they make the public option truly robust, which it isn't at the moment. The bottom line is that expenses to individuals, particularly people who are older or who are actually sick, are still outrageously high. Cost controls are automatic with single payer, and could be imposed on private insurance. There is no reason in hell why anyone's monthly expenses, including out of pocket, should be higher than $150 ($1800/year).

If only incremetal reform is possible on the grounds that we have to start from where we are, why not just scrap all of this and have a simple bill which will reduce Medicare age eligibility to 55? Who would dare claim that Medicare is new and untried?

Type of insurance
3200—mandated private insurance with public option available only in 2013
WHST—public insurance, with private supplementation for things not covered by WHST allowed
Netherlands—mandated government regulated private insurance, except for chronically ill and long term care

Monthly charge
3200--$416 for basic individual plan; subsidies for incomes up to 4 x poverty level
WHST--$75 per adult; subsidies available
Netherlands--100 euros per adult; subsidies available

Coverage
3200—drugs, providers, hospitalization, mental health, maternity, dental and vision for under 21
WHST—all of above plus long term care, and dental and vision for adults
Netherlands—dental not included. Chronic and long term illness care paid for by government

Benefit levels
3200—4 benefit levels above basic in the public option
WHST—only 1 comprehensive level; extras available from private insurance
Netherlands—only 1 comprehensive level; extras also available

Recission
3200—allowed for cases of fraud; reviewed by government board
WHST—not allowed at all
Netherlands—not allowed at all

Allowed rating differentials
3200—eliminates pre-existing conditions, but allows charging twice as much for older people
WHST—no differences in premiums for any condition, including age
Netherlands— no differences in premiums for any condition, including age

Preferred provider lists
3200—allowed, meaning that insurers still pick your doctors. Doctors will not be required to see people
enrolled in the public option.
WHST—free choice of any qualified practitioner or hospital
Netherlands— free choice of any qualified practitioner or hospital

Copays
3200—basic benefits cover 70% of health care expenses, with more expensive plans paying a higher
percentage. The rest is paid by the individual
WHST—small co-pays for drugs and emergency care, levels TBD
Netherlands— no co-pays or deductibles allowed

Funding from other than individual sources
3200—employers and individuals, with government subsidy, not including Medicare, Medicaid and Tricare.
Government now pays ~60%. Not possible to tell how this would change.
WHST—in addition to individual assessment, a sliding scale 10% payroll tax on employers plus Medicare , Medicaid
and Tricare
Netherlands— 50% paid by tax on employers, 5% direct government tax subsidy, 45% from individuals

http://thomas.loc.gov/cgi-bin/query/z?c111:h3200: HR 3200
http://www.healthcareforallwa.org/health-security-trust/: WA State single payer proposal
http://en.wikipedia.org/wiki/Health_care_in_the_Netherlands Insurance in the Netherlands

[global1]

5. I Met Dr. Young In 1975 While I Was Working On A MPH........

at the University of Illinois. (MPH = Masters In Public Health)

He is very charismatic and was working for the people his whole career. I'm sure that Dr.Young and Pres.Obama's paths have crossed many times in Illinois as both were deeply involved in community organizatiion.

Thank you for this post. I totally lost track of the man and actually thought he might not be of this earth anymore. I'm happy to see that he is alive and well and still working for the people. His analysis of President Obama seems spot on with respect to 'health reform'. I wish that the President would listen to Dr. Young now as this health reform is the biggest issue that we as a nation need to confront and Dr. Young is absolutely right about 'single payer'.

To learn more about Dr.Young - check this out:
http://en.wikipedia.org/wiki/Quentin_Young

[slipslidingaway]

6. knr Conyers was not allowed to bring Dr. Young to the WH Summit

on health care, he asked to bring Dr. Young and Dr. Angell but his request was denied.

Amy Goodman with Dr. Young...

Dr. Quentin Young, Longtime Obama Confidante and Physician to MLK, Criticizes Admin’s Rejection of Single-Payer Healthcare
http://www.democracynow.org/2009/3/11/dr_quentin_young_obama_confidante_and


"While the Obama administration claims “all options are on the table” for healthcare reform, it’s already rejected the solution favored by most Americans, including doctors: single-payer universal healthcare. We speak with Dr. Quentin Young, perhaps the most well-known single-payer advocate in America. He was the Rev. Martin Luther King’s doctor when he lived in Chicago and a longtime friend and ally of Barack Obama. But he was noticeably not invited to Obama’s White House healthcare summit last week. "

[slipslidingaway]

7. Link to the Bait and Switch article and thread...

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=6120089&mesg_id=6120089
http://www.pnhp.org/blog/2009/07/20/bait-and-switch-how-the-%e2%80%9cpublic-option%e2%80%9d-was-sold/


"The people who brought us the “public option” began their campaign promising one thing but now promote something entirely different. To make matters worse, they have not told the public they have backpedalled. The campaign for the “public option” resembles the classic bait-and-switch scam: tell your customers you’ve got one thing for sale when in fact you’re selling something very different.

When the “public option” campaign began, its leaders promoted a huge “Medicare-like” program that would enroll about 130 million people. Such a program would dwarf even Medicare, which, with its 45 million enrollees, is the nation’s largest health insurer, public or private. But today “public option” advocates sing the praises of tiny “public options” contained in congressional legislation sponsored by leading Democrats that bear no resemblance to the original model.

According to the Congressional Budget Office, the “public options” described in the Democrats’ legislation might enroll 10 million people and will have virtually no effect on health care costs, which means the “public options” cannot, by themselves, have any effect on the number of uninsured. But the leaders of the “public option” movement haven’t told the public they have abandoned their original vision. It’s high time they did......


The switch

Now let’s compare the “single national health insurance pool covering nearly half the population” that Hacker and other “public option” advocates enthusiastically championed with the “public option” proposed by Democrats in Congress, and then let’s inquire what Hacker and company said about it..."

[Bluerthanblue]

8. he's WRONG-

"..Medicare works because everybody in a given group is in the program. Everyone over 65 has Medicare--it doesn't matter whether you're rich or poor, work or don't work. It's a total service to a given population."-

this is a LIE- you are ONLY eligible for "MEDICARE" IF you have paid into it for a given # of 'quarters'.

"Also, it's worth noting that when Medicare was enacted in 1965, it very quickly added all disabled people--a smaller group, but a very costly group. You'll notice what the private sector gave over to the government--people over 65 and disabled people. Common sense will tell you that these are the costliest groups medically in this society."

NO "disabled person" who hasn't paid into the system for the required # of quarters, or who isn't the disabled child of a person who has or is paying into the system is covered by "MEDICARE". NONE. They may be eligible for "Medicaid"- but only if they fall withing financial guidelines, and not without far-reaching 'strings' being attached.

this may seem like 'nit-picking'- but when someone who supposedly works with this system mis-characterizes or lies like this, it makes everything they say far less convincing. Even the more accurate statements he's making lose their credibility- IMO.

I'm living with the reality of the facts he mis-states. No medical insurance at all, pre-existing condition, not enough Medicare quarters, and dependent child still at home (the only way I can be eligible for Medicaid is to have a lien placed on my home for repayment of any monies spent on my medical care, payable on my death- nice burden for my kids, who have only me). :(

This kind of mis-information really frustrates the hell out of me. sorry for the rant.