Here is a nice concise article by Krugman on why single payer is the way to go.

http://krugman.blogs.nytimes.com/2009/07/25/why-markets-cant-cure-healthcare/

By glider, July 22 at 7:51 pm #

“I hope you get this upset about the much bigger problems…”

Yes - I do.  I agree with you about most of the ones you mention, but i include immigration as one of the big ones because I think it’s a controllable issue that wastes much money (unlike some other cost issues which aren’t easily rectifiable).  I also think it has longer term socio-political ramifications beyond its short term costs.  Combine it with nationalized health care and it becomes an even bigger problem.

I’m not a “birth certificate” type republican myself and find those kinds of issues to be typical extremist distractions and spam email fodder.  Luckily I don’t think that crowd controls much true policy on the right.

I think we’re far from a mexican holocaust though - immigration is a legitimate issue faced by many benevolent countries and its not just from mexico.

Did not figure it would. At any rate we are arguing over a bill that isn’t going anywhere anyway, and a provision that would be stripped away even if it did.

I hope you get this upset about the much bigger problems of the needlessly destabilizing multi-trillion dollar wars, the multi-trillion dollar bailouts of the financial industry crooks and banksters, the runaway military industrial complex, and the crony capitalism that is threatening the country. Below subsistence level workers being allowed basic health care is not a huge problem to get upset about and there should be separate legislation to address that immigration issue anyway.

When I look at these recent mindless ranting of the republican faithful calling for examination of Obama’s birth certificate it reminds me a bit of the destabilization that led up to Hitlers ascendancy to power. If such a thing happens these hard working demonized Mexicans may have to watch out for the gas chambers as they seem to make a tempting scapegoat for that crowd.

By glider, July 21 at 10:36 pm #

You’re right that i misinterpreted the undocumented’s “percent uninsured” to be “percent of uninsured”.  But as stated in the article, the 43% uninsured of illegals is likely low because of the difficulty in surveying illegal immigrants.  Witness the difficulty in just counting their total numbers, which is why legitimate estimates vary from 12M to above 20M.  So their total representation within the ranks of the uninsured is likely greater.

But a much more important issue is that the only way an illegal can get coverage now is to pay for it - either directly or through their employer.  Which means that automatically inducting them into a universal system would have a multiplier effect on their cost to the system since citizen taxpayers would now shoulder the health care costs of ALL illegals, none of whom would be paying into the system.  So you can see the fallacy of the supposed equivalence between the current situation and that of additionally providing universal coverage to illegals.

Add to this the border-crossing incentive effect of providing free health care to Mexicans and the idea begins to seem rather ridiculous.

So no, this doesn’t do much to change my mind.

Marshall,

Well I would tend to be suspicious of the studies and want to look at the balance of them, who made them, and the methods used. As you know it is easy to manipulate numbers.

Look at your own post for example. “Here’s a PBS link which indicates that as of 2005, illegals were approx. 43% of the uninsured (citizens only 13%)”. Well, the actual quote from your link reads quite differently, “in 2005, about 13 percent of native-born citizens lacked health insurance, while 43 percent of non-citizens did”. This means that illegal immigrants are only 3.3 fold more likely to not have insurance than native born citizens, not that 43% of the uninsured are illegals. If that tracts to the 2008 numbers it suggests that roughly 5 million of the 47 million uninsured are illegal immigrants (10.6% of uninsured). So you have misread that information in a way that dramatically inflates the case you seek to make.

So does this change your mind at all?

Ooops - forgot link:

http://www.pbs.org/newshour/indepth_coverage/health/uninsured/whoaretheuninsured.html

By glider, July 21 at 6:03 pm #

“I believe we do benefit from these illegal immigrants and I am for including them in basic universal medical coverage in the USA.”

Fair enough, but how would you feel if you found that studies show a net cost, not a net benefit to the economy from immigrants?  Would this change your opinion about including them?

Here’s a PBS link which indicates that as of 2005, illegals were approx. 43% of the uninsured (citizens only 13%).  This is a very significant figure that argues that the two issues are too intertwined not to be dealt with as one.  This is one reason why I (and many) believe the US just plain can’t implement universal coverage right now and I see no red herring here.

I would also point out that much of the resistance to Obama’s plan is coming from democrats so it’s not exactly a partisan issue here.

Marshall,
I said “If the people and government truly want to stop this all they need to do is crack down hard on the employers of such immigrants”. I am not trying to have it both ways, because that is not my personal position. I believe we do benefit from these illegal immigrants and I am for including them in basic universal medical coverage in the USA. But I also say stop the hypocrisy. Illegal immigration is a separate issue that needs to be decided in the larger picture. If the government decides they don’t want them here then get rid of them and don’t have them here treated as sub-humans. This, in my opinion, is a red herring thrown in by Republicans to fight universal health care. From what I read the illegal immigration population here is 11.6 million while the uninsured population is 45 million and the underinsured population is even greater. It is a lame excuse not to deal with health care reform whose time is now.

By glider, July 21 at 4:13 pm #

Personally, i am less sensitive to the blanket stereotyping of illegal immigrants as simple minded, well meaning serfs of US elites and dupes of a hostile and predatory american system.  The answer to your question is that covering them explicitly is both a contradictory legitimization of their illegal status as well as a systemic increase in coverage costs from the current basic care they now receive for free.

Numerous studies show a net cost, not gain, to the US economy from illegal immigration because their costs - in social services, tax-free income, high crime rates, meager skills, lost citizen jobs, displacement of legal immigrants, etc… - outweigh the fast disappearing low-wage benefit. And their de-facto presence isn’t a reason to promote that presence with coverage.

But you can’t have it both ways; citing their perceived benefit as grounds to include them in universal coverage, but argue that we should crack down on businesses that hire them (I agree with the latter by the way).

I am less sensitive to the immigration issue than most. These Mexicans cross the border illegally to get better paying jobs than they get at home. They do contribute to and are part of our society (lower cost produce, affordable long term care, etc). In my region we have many who work in yard maintenance of very well to do landowner citizens. They have organized themselves with the city to get payment of $10 per hour. Much of this work is absolutely back breaking labor such as in digging ditches all day long, which takes a rather hard toll on the human body. So there is an underground economy that is the status quo in the USA which exploits these workers. If the people and government truly want to stop this all they need to do is crack down hard on the employers of such immigrants. As it stands now they are part of the system and should enjoy some basic health care as far as I am concerned.

Currently Republicans are already indignant over this and like to say this group gets free medical care by going to hospital emergency rooms. At the same time of course they will turn around and say we should not provide them coverage in any new plan because it is not affordable. So which way is it, do they already get free care or not?

By glider, July 21 at 12:45 pm #

My questions are serious, though I missed the Long Term Care information and I see there’s coverage for that in the bill.  The overall cost table appears to be a best guess but is based on incomplete data since CBO hasn’t done an analysis of the stark plan AFAICT as you note.

My question about non-citizen coverage is important because they make up such a large percentage of the uninsured and I don’t understand how a plan can entertain the idea of covering illegal immigrants.  This seems a major flaw in HR676 and it seems to me we need to address our immigration policy in tandem with any healthcare reform.  I do not believe universal coverage can be implemented in the US without restricting it to US citizens.

“Most proponents of single payer simply seem to cite the real world experiments of the lower costs and healthier populations of countries that have single payer.”

There’s a catch-22 in the WHO ratings since the majority of problems with our current system are related to the number of uninsured.  But since these statistics include millions of non-citizens, it’s an Apples to Oranges comparison.  In fact our satisfaction ratings for insured people is quite high in this country, as is their overall health.  Which is why I believe a combination of immigration reform and modifying the current system to provide universal coverage that’s not tied to employment is a better way to go.

Here is a cost analysis of various proposals (single payer is “Stark”)

http://www.dailykos.com/story/2009/7/19/754928/-House-to-Vote-on-Single-Payer-HR-676

Marshall,

I am not sure whether your questions are serious or rhetorical. The bill has a table of contents and answers to your questions are on pages 4, 5, and 17-18. I am not aware of any CBO analysis on the cost of single payer. I had thought Congress was bribed to not even consider single payer.  Do you have a source for a CBO analysis of HR676 or any other form of single payer?  Most proponents of single payer simply seem to cite the real world experiments of the lower costs and healthier populations of countries that have single payer.

You are too hung up on this “single payer” term. It only refers to the aspect of replacing the 5,000 plus existing private insurance plans with a single plan and reimbursing entity. Obviously there are many payers in the sense of the final source of funds (fed and state taxes, company subsidies, out of pocket money, etc), just as there is in the current private system, but that is not the point.

By glider, July 17 at 11:16 pm #

glider - thanks for the reference link.  I suspect that if i actually finish reading the bill, i’ll be well ahead of most in congress right now. 

Few questions that aren’t apparent off the bat: how does the bill prevent coverage of non-citizens?  I did not see language making a distinction.

Also how do you square CBO’s price tag for the bill with Obama’s desire for budget neutrality?

What kinds of things would fall under the purview of supplemental coverage vs. what’s covered under the medicare plan?

Do you know whether it covers so-called long term care?

“4. funding can be done in many ways and is somewhat independent of the concept of Single Payer”

This is what prompted my original question since it seems that “single payer” is a rather ill-defined term which really means “multiple payers paying into a single fund which then reimburses medical costs.

These corporate bloodsuckers have nearly killed their own cash cow. Fortunately for them we’ve the greediest bunch of corrupt bastards “serving” government in the world. It will take a lot of grease for them to screw us but they will, in the end ha ha!

Marshall,
I think the most widely accepted Single Payer Plan is the congressional bill HR676 (http://www.pnhp.org/nhibill/nhi_bill_final.pdf).

For me it means that government takes over the role of the multitude of private health insurance companies. Likewise it is not involved in providing medical care, which remains largely private.

For me Single Payer means;
1. fixed billing rates for services for all people, negotiated with the same power that large insurance companies currently enjoy. But no more vastly disparate charges for those in network versus out of network.

2. a single (or a few) simple understandable plan(s) of basic coverage would be provided for all, greatly simplifying administrative expenses.  People would understand what is covered and there would be no unpleasant surprises due to an insurance company needing to make its quarterly profit goal or misunderstood exploitive fine print.  Private insurance would be excluded from providing this same basic coverage but would serve an important role in providing supplemental coverage for those who desire it.

3. it would be a true insurance pool with all citizens paying the same price regardless of pre-existing conditions or other risk assessments. You wont be subject to huge rate hikes from job losses or switching insurance providers or getting older. You won’t have to worry that your medical records or DNA sequence will be used to discriminate against you. We will not have a future where everyone is paying insurance firms to do research to define individual risk and adjust their policies to profit from that analysis.

4. funding can be done in many ways and is somewhat independent of the concept of Single Payer

I believe that when we are talking about single-payer here—and from all of the advocates sites that I’ve registered with—it is Medicare for All, which is publicly financed, privately run.  There would be private insurance for those who want it, or as supplemental insurance.

To those of you advocating single-payer… do you have a definition for this term?  I think many believe that “single payer” means no private involvement, or government run which this is not necessarily the case.  Britain’s system, for example, is not single-payer; employees, employers, and taxes all pay into funds which provide healthcare.  And in most supposedly socialized systems (like France, Britain, Canada), private insurance is available (and used) by most to cover things the public system doesn’t.

“the legislation is being written so that it will not lead to single-payer in the future”

I think this is likely the key compromise from the congressional bribery resulting in the bill. It will be interesting to see the details. It is quite shrewd and expected that they will retain their existing clientele. I still feel the goal is to make the public option an expensive dumping ground for sick people the insurance companies want to avoid. At the same time they can skim off the new young healthy customers that will be forced to buy insurance, perhaps even accepting a loss there so as to make the public system look as bad as possible.  So the actuary based health insurance scam will be alive and become more profitable as they get better and better at predicting who the sick will be (real reason for the push behind computerizing everyone’s medical records?).

MB:  The news to me from this was the “public option” will not be an option for people who get coverage through their employers. As in, if an employed person wants to choose the public option and the employer offers private insurance, than there is no choice and private coverage must be selected. Unbelievable. Built-in competition squelching courtesy of the US Congress, bought and sold by the predatory healthcare industry. If not for this on the DS, I would not have picked up on that detail. It feels like a fast one, Obama’s health reform-lite plan. Very polite of Jon S to not confront Sebelius directly about why is single-payer off the table.  Unbelievable. The whole thing.

___________________________________

I’m glad you picked up on this.  It is not a good plan.  A strong public plan allows any individual or business to join without any restrictions.  Since the AMA, pharma and the insurance industry are approving of this plan, in any case, you know it’s going to be bad for the public.  They’re getting guaranteed business. 

I wish Stewart had been less polite on the point of single-payer.  It would been nice to hear Sebelius reiterate what she said on NPR, that the legislation is being written so that it will not lead to single-payer in the future.

Anybody who is still advocating the so-called “market” competition with private health insurance please listen to Bill Moyer’s excellent interview with Wendell Potter, former VP with Cigna.  That’s really all that needs to be said on this issue.  As far as driving the private companies out of business, well, they shouldn’t be in the forefront anyway.  They can operate as they do in other countries with single-payer systems. 

The point is that we should be tired of private insurers and pharma using America as their mega cash cow.  They can’t do this in other countries.

Marshall,

Your statement
“throwing out the whole system to address this isn’t the solution.  Instead, we should change the incentives for the existing system to discourage refusal of coverage while disconnecting healthcare from employment so we can achieve universal coverage”

That is a sweeping unsupported statement. Please explain to me why throwing out the health insurance system and replacing it with Single Payer is not the best solution. The 2 problems you identify are primary fixtures of the insurance industry and are best fixed by Single Payer. Single Payer would actually save money and not require increases in taxes to subsidize your precious health insurance industry.

Philosophically, I believe the free market is wonderful at building a better mousetrap and should remain the core of our system. But there are many areas where it needs to be regulated to avoid excesses. Do individuals need $50 million a year salaries to be incentivized?  No! Do we need to make the absolute cheapest mousetrap by having it built offshore under exploitive labor conditions? No! Do we need to cultivate MBAs to cleverly manipulate fine print and statistical methods to trick consumers into giving them higher profits?  No! Do we need risky exotic financial instruments produced by “too big to fail” companies?

There is a happy medium between the free market and public services and we need to correct the excesses that have have gotten us into this situation.

Marshall, I sense FREE-market bias in your post rather than a constructive proposal.

Just how absurd is your statement “healthcare cost is rising globally,..The biggest part of these costs is not the insurance, but the delivery (due to improvements in medical technology; machinery, drugs, etc…) - which doesn’t change under a public system. So rising costs is no reason to throw out the existing system because rising costs will continue.” ?

So you reason that because actual health care delivery costs are rising we should ignore the unnecessary huge 30% private insurance premium. Have you ever entertained the thought that actual health care deserves to be the most expensive part of health care?? Locking in 30% overhead for administrative billing of unnecessarily complex plans, and paying actuaries to help determine who might get sick so they can be discontinued or charged more, adds nothing of making a healthy population.

I am for single payer or at the very least a strong public health plan. The health insurance industry deserves to go out of business if they can not compete. This industry has distorted the purpose of insurance, which is to distribute individual risk and share it amongst the large population pool, to gaming the system by identifying individual risk as much as possible and charging a premium for it (i.e. optimizing their medical loss ratio). If this method of operation is allowed to continue it will become such a science that you might as well just assume your own risk.

By Hammering in the Morning…, July 16 at 9:28 pm #

I sense more of an anti free-market bias in your post than a constructive proposal.  After all, our society is full of “necessity” services (including other types of insurance) provided by private companies that are functioning well and don’t need reform.  So that’s obviously not the sole criteria for judging whether health insurance should be private.

First off, they’re not all “for profit” - Keiser, for example, is a non-profit.  And HMO is only one type of private insurance, and I’m not sure how it’s fundamentally different than any other type of health plan.  Indeed any public system will likely include an HMO plan.

You’re correct that limiting coverage is the cost cutting measure used by US insurers - but throwing out the whole system to address this isn’t the solution.  Instead, we should change the incentives for the existing system to discourage refusal of coverage while disconnecting healthcare from employment so we can achieve universal coverage (the lack of which is the main cause for all the medical bankruptcies and last ditch ER visits).  That’s the main problem here - not public vs. private.  If that were the problem, Canada’s healthcare system (among other socialized systems) wouldn’t be suffering so mightily.

A lot of people are having the same knee-jerk house cleaning reaction over health insurance that they had over the Bush administration when Obama was elected; bring in the new thing to replace the old, only to find out that the new isn’t much different but costs much much more.

I say let the health insurance companies go out of business, who cares? I certainly don’t! Health insurance companies have been blood sucking leaches on this country since HMO’s were first approved under Nixon. Health insurance is not a luxury item, it is a necessity. They figured out early on that they can charge whatever they want and people will pay it because they have to have it. Unless you have a preexisting condition in which case you can’t get insurance at any price. Meanwhile the health insurance companies build bigger and fancier office buildings every couple of years, fly around in their private jets with gold plated commodes and spend as much as they think they can get away with for overhead. Top executives take home hundreds of millions sometimes billions of dollars which all comes out of the premiums paid. Depending on which company you are with as much as 50% of your premium dollar goes into the companies pocket.

At the same time the Insurance companies actively try to deny benifits to policy holders, Whether it is by burying people in paperwork, or calling some procedure “experimental”. They will even go so far as to do a “review” and try to find some reason to drop your policy if you get seriously ill.

Meanwhile Millions of people cannot afford or can’t get health insurance so they are forced to go to the emergency room when they are sick enough that they can’t put off the trip anymore, 75% of bankruptcy’s are caused by medical bills. This adds up to Billions of dollars a year in unpaid medical bills which the doctors and hospitals build into the prices they charge.

The problem is much worse than I can articulate in three paragraphs, The bottom line is that it is long past time for us to throw off these leaches and build a low cost national plan which just pays the bills like Medicare does while keeping overhead costs to about 3%.

And if the for profit insurance companies can’t compete, well then let them go under and the sooner the better.

Stuart brings up a couple of points that, i believe, reveal the public healthcare agenda:

If private employers (his Viacom example) CAN switch to the public option simply by saying they can’t afford the private option, then they will.  Which ultimately leads to unfair competition which drives the private companies out of business.  This is the public agenda.

Sounds good to some perhaps; do away with evil corporate insurers (even though most employed people are happy with their private plans).  But taxpayer supported public systems lack accountability because they have no competition.  They can become publicly funded sink holes which get borrowed against and lose their transparency, like SS.  They become political footballs that get thrown around and modified from administration to administration.

The cost of healthcare is rising globally, not just in the US.  The biggest part of these costs is not the insurance, but the delivery (due to improvements in medical technology; machinery, drugs, etc…) - which doesn’t change under a public system.  So rising costs is no reason to throw out the existing system because rising costs will continue.

The biggest healthcare problem in this country, and the main reason other developed countries can boast higher wellness rates, is the number of uninsured.  This is the problem we need to tackle - not get hung up on public vs. private insurance.