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The reality of single payer

Thursday, September 6 at 12:00 AM

This Speakout has not been edited.

By Cindy Sovine-Miller

The fundamental problem with the single payer system is that it doesn’t deal with the primary issue: RISING MEDICAL COSTS. Increasing income taxes to support an — all the care you can consume — system will skyrocket costs. Not decrease them. The long term viability and sustainability of such a plan has to be called into question.

The single payer plan has been receiving a lot of press around its so called pricetag coming in lower than any of the other plans. It is a disservice to the public that nobody is talking about the assumptions that the LEWIN Group is making for this to work. We will have go to Congress and demand billions of dollars with no strings attached. And if the Feds don’t approve (which they likely won’t), income taxes would have to go up a lot more than the already proposed 7% to support the system.

The single payer plan will require several acts of Congress. The changes required are controversial and are already polarizing our national leaders.

And let’s not forget that if Congress were able to act quickly and efficiently, we as a state would not be forced to grapple with health care reform on our own to begin with. Even minor tweaks to Medicaid take years to get the Feds to approve. Now we are just going to scrap Medicaid and Medicare altogether and expect to keep the Federal dollars? Do we really think Congress is going to change ERISA law for us? Seriously? It would take years to hash this out ... what happens in the meantime?

I think everyone in this debate agrees that we currently have a broken system that is failing Coloradans. The worst thing that could happen is nothing. The status quo is unacceptable. But let’s not turn the state upside down just for the sake of change. At least not without talking about what COULD and likely WOULD happen.

Whether it is the state or a health insurance company paying for it, real reform cannot be successful without dealing with the cost issue. The very first step we should take as a state is to create a strong level of meaningful transparency within insurance, hospital costs (not charge data but actual cost information) and with docs for all procedures (routine, emergency and elective). That is the only way we can get our heads around what health care is actually costing us. Second, use that information to educate consumers and empower them to take control of their health care decisions instead of letting government or health plans do it for them.

Cindy Sovine-Miller is a spokeswoman for the Colorado State Association of Health Underwriters.

READER COMMENTS

Ok let me help you, your long winded answers were well republican talking points all over again.
1)we use the VA because we cant afford any other. That’s one reason greed needs to be removed. From the equation.
2) ok you want me to admit I am anti profit. No I am not. I am anti GREED there is a difference. I asked you to not point at the Democrats and you did.
3)I have to quote you here. “we are paying only a bit more and a good part of that is because of the legal system and the failure to control frivolous malpractice lawsuits. Capping everything except actual damages and lost income, limiting lawyers to only a flat percentage of actual damages” Exactly!!! the rules should stand. Instead of now after the insurance company pays. The doc goes right back to work. The idea of huge awards is to ruin the offenders business. If the insurance company were removed from the equation along with the doctors license to practice medicine you would find more attentive doctors. Working to help people instead of covering their Mercedes payment.
4)”It also has produced NO positive results” Wrong, people who have gone to China to receive stem cell therapy, have come home and actually benefited far more than standard therapy here. Republicans would have you believe it isn’t the therapy but a miracle. I watch faux news too.

Whole lot of your book here is complaints of what Republicans have directly done to our country.
“By 1982 he had six people and a full time accountant because he had to fill out so many forms”
Ron Reagan
“If their costs go down AND the public becomes aware of costs and has an incentive to keep those costs down they, the insurance companies, will have to compete for business. They are very good at it. And annoying.” Returning to a core problem the costs will not go down. because unless it is government mandating or providing reasonable cost savings The insurance companies have no incentive to be competitive. As they have no competition in an on demand emergency endeavor.

Posted by Froward on September 15, 2007 11:07 AM

Froward wrote:

"1) If your VA health care is so crappy why do you continue to use it?"

"Our gross income is less than 30K for three people one of them a child. We have very high medical expenses for my husband's knees and shoulder which were injured in combat. He takes several medications to ease his pain and since he drives a truck they have to be DOT approved. He also needs help for his knees like braces and surgery. VA provides services for him that we can't afford the fifty and one hundred dollar co-pays for. It is crappy and if we could get the paperwork approved VA will permit him to use the Kaiser system and will make all his co-pays. Kaiser says this is possible but tries to make you pay cash for the services and then prove the co-pay has been made and, after all that, has to decide whether or not to refund your money that you paid for it. They can drag their feet better than a fifteen year old boy facing a sink full of dirty dishes.
Normally I would already have settled this permanently. I am a very hard fighter but I can't do much confined to a chair and a house most of the time I"m not in the hospital. Kaiser knows I can't get out to fight them so they get the advantage. I do advocate very high fines for insurance companies that play this game or try to "forget" that the insured person has paid their yearly maximum so the insurance company has to pay the entire bill.Right now Rocky Mountain HMO, the one that tried to slash their payments to hospitals last year, told the hospital that I owe the 3K co-pay for my hospitalization and surgery. Our yearly maximum for our family is 2.5 and for me alone is 1.5K. Every time I call them I get nothing but a telephone ping-pong match with the end being, "we'll have to check into it." The time I told them I was going to record the call they hung up.

"2) You mentioned an “anti-capitalist movement” this I have never heard of. Where are they and ill join you, in stopping them. Don’t even say Democrats as we all know, this is blatantly untrue."

While many Democrats are anti-capitalist, I was referring to you. Your constant...stop the profit, kill the insurance companies... drumbeat is classic anti-capitalism. What would you substitute for the profit incentive? Gold stars and brownie points for good intentions? Or do you think the government is capable of doing this right when they can't even get their childhood immunization program right. If you want the "free" shots you have to go to one location in the Denver area on one of two days for four hours or less on each day and stand in line. Now think how they would deal with more people and more responsibilities. This is an improvement?

"3) To correct you other countries pay LESS than we do (per taxpayer) for better care. AND everyone is entitled."

The levels of care they get are far below our average. You are comparing the lowest levels of care in the United States to the average or above average care available elsewhere. If you factor in the entire tax burden for those countries as a percentage of income and compare it to our tax burden and insurance costs combined you will see that we are paying only a bit more and a good part of that is because of the legal system and the failure to control frivolous malpractice lawsuits. Capping everything except actual damages and lost income, limiting lawyers to only a flat percentage of actual damages without the ability to charge expenses, loser pays laws where worthless claims are punished financially and changing the payment of punitive damages to the state (let them use it for health care) instead of the person suing. Remember that the threat of lawsuits also increases the tests and treatments used by doctors. This is not to better heal the patient but to cover the doctor/hospital's butt.

4) “prevent their destroying our care.” Well Stem cells are proving to be the treatment of the future. And we all know what party is currently making the United States fall behind in this research.

Embryonic stem cell research is perfectly legal in the United States. It just isn't government funded. It also has produced NO positive results. Adult and umbilical stem cells are already in use in tests and show a great deal of promise. Funding is available for research on these. You accuse the drug companies of chasing money at every opportunity and I'm not sure I disagree so you tell me why, if embryonic stem cells are going to be soooo wonderful and will perform magical feats and cures, the drug companies aren't fighting each other to fund the research since any positive results with practical uses will be like having a permit to print money. Why are they self-funding, as well as applying for government funds, dozens of researchers on the non-embryonic stem cells to the point that one expert in the field says there is more promise in umbilical cord cells than in any other type of stem cell research. According to him, the stem cells in umbilical cords are more numerous, easier to harvest, less likely to be damaged and just as neutral as embryonic stems. They also seem to be less likely to mutate in undesirable ways.

"The same old same old approach is not working. Our Health care system needs to be repaired, (and soon) before we fall behind any further."

We agree that a problem exists. You think the solution is government. I think the problem is government. I point to the beginning of the problem as being when Medicare and Medicaid put the government in the position to decide how much they would pay for which treatments and services. This was accompanied by reams of paperwork. (The family doctor who chased my naked five year old self halfway around the block one Halloween because I'd Houdini'd at the word "shot" had one woman doing his accounting since those early fifties. In the seventies the same woman was able to do the job. By 1982 he had six people and a full time accountant because he had to fill out so many forms. The insurance companies added to that too. In 1970 insurance covered you if you had a bad accident, a serious disease or something else very major. Doctor visits and prescriptions were paid for by the patient. Medicare and Medicaid provided competition and a model where more was covered. Businesses, which are the primary buyer for health insurance, began demanding more coverage and insurance complied so that the 35 dollars I paid to see my doctor in 1986 is now a 50 dollar co-payment on a two hundred dollar charge. My doctor's grandson took over the practice. Doctor D. is still around but at near 100 he is taking it easy.

You think up a system where the government provides help but the individual is responsible for his own health care. That goes for low income and seniors too. Give them a voucher card with a set amount on it and let them choose their doctors. Make sure they have a small co-pay, perhaps one dollar. Let the system encourage more insurance policies that only cover the big items and see if the costs don't come down because the health care business is a business. If their costs go down AND the public becomes aware of costs and has an incentive to keep those costs down they, the insurance companies, will have to compete for business. They are very good at it. And annoying. Esurance is the worst. I didn't know Barbie had acting credentials.

Posted by on September 13, 2007 04:06 AM

Let's see...Canada has nationalized health care. I just purchased Ridley Pearson's new book for $24.95. The price for that same book in Canada is $31.00.
Do you want to determine where your money is spent, or do you want the government to do it for you? The government is VERY GOOD at spending the tax payers’ money.
I would never consider voting for a national health plan unless every citizen including the President and members of the Senate and House are mandated to use it also. Historically speaking – they are very good at exempting themselves from “reforms” they impose upon others.

Posted by Linda on September 11, 2007 08:23 PM

Those citizens are coming here and their respective countries pay for the procedures. So what? Our citizens are going to Mexico (dental care) France (heart transplants) and China (stem cell therapy.)
My favorite quote from that article is, “in most of those countries families get added social services, such as secure pensions and health care.” The end is the best. I support the flat tax too. Thank you for the read as I found it refreshing. Obviously, Brooks, your reading comprehension is on the grade level of Michael Moore's ample butt-ox. Private school? We digress. I reiterate, the for profit insurance industry needs to be removed from Health care.

Posted by Froward on September 10, 2007 08:12 PM

Froward, pull your head out from between Michael Moore's ample glutes. See http://moneycentral.msn.com/content/Taxes/P148855.asp
For the sake of comparison, citizens in Canada and the UK both pay dramatically higher taxes then US citizens, and no one is travelling to either of those countries for the purpose of receiving health care. Their citizens are coming here for their life-saving, life-extending treatments.

Posted by Brooks Imperial on September 10, 2007 04:40 PM

1) If your VA health care is so crappy why do you continue to use it?
2) You mentioned an “anti-capitalist movement” this I have never heard of. Where are they and ill join you, in stopping them. Don’t even say Democrats as we all know, this is blatantly untrue.
3) To correct you other countries pay LESS than we do (per taxpayer) for better care. AND everyone is entitled.
4) “prevent their destroying our care.” Well Stem cells are proving to be the treatment of the future. And we all know what party is currently making the United States fall behind in this research.

The same old same old approach is not working. Our Health care system needs to be repaired, (and soon) before we fall behind any further.

Posted by Froward on September 10, 2007 01:23 PM

Froward,

The common good would be best served if the government was OUT of health care. The best way to do that might be impossible now. Too many feel it is their business to pick the workers' pockets to pay for someone else's idea of the greater good.

Insurance is a business and we have to get rid of the different roadblocks to reform. Invest the individual with both the ability and the responsibility to take care of their health care needs.

Food is a need. The government helps some people obtain food but it neither cooks it for them, gives them the recipes nor tells them what to buy. In health insurance those are the kinds of decisions the government makes everyday. The government orders certain treatments and limits others right now.

I'll repeat a tale told here before. The VA is the government version of health care. My husband was diagnosed as diabetic and it was attributed to be service related because of some medications he had been given for injuries and conditions from his service time. The doctor gave him a printed diet sheet and told him to lose weight. Since we also had a private insurance plan and a private doctor we talked to him. (I have been a diabetic for 20 years and the most important thing I learned was get on top of it right away and stay there.) The doctor put my husband on an oral medication and told him to get a glucose meter and test his blood sugar regularly. I shared my meter with him until payday then he bought one. He'd asked the VA doctor for a meter and was told the VA only gives meters to those on medication. He asked again, he'd asked when diagnosed, for the oral medication he was taking. and was told VA had only one normal medication for diabetes: insulin. Since he didn't need insulin she couldn't give him any other medication but, she could order him to use the VA meter and prescribe strips for it. When he told her that he had a meter and just needed strips, she told him that all diabetics had to have the same meter so the records could be downloaded. The meter came with enough strips for five tests a day. The refill for the strips came with only enough strips for three tests a week. Again...policy. He now gets his strips for the original monitor, at about half of the cost of the "approved" strips, through our insurance. He developed a hernia on the incision scar from surgery he had in the service. VA gave him an emergency appointment. Eight months later he finally saw the doctors. No fever, no unbearable pain? Lose 50 pounds and come back later. If he gets a high fever or is unable to move he's to go to the VA emergency room. That is what the government does because they have to make central decisions and the reality of such things is that medicine is for individuals and only individuals need to make those decisions. Insurance is about paying for the health care and the means used to do so. We spread the risk between people to make things affordable. The insurance companies are tied to a government system that denies them the right to deduct the cost of insurance from their taxes. The government supports programs like Medicare and Medicaid which were intended to help people but ended up skewing the costs because the government pays without regard to individuals.

What we need to do is to stop the anti-capitalist movement whose main agenda is to take control and punish us for our freedoms.

Other countries pay half or more of their incomes in taxes to get the same standard of health care we call neglect in free clinics here. Nothing can be done about those who refuse to claim their right to be free of government in this area. We can merely hope to prevent their destroying our care.

Posted by on September 9, 2007 09:19 PM

It’s the desperate demand of health care that drives the costs up. (the doctors and insurance companies know this and act accordingly) There is no such thing as the least expensive treatment. The treatment that works is the choice. Regardless of cost. Computerization, should reduce costs however it is also used like you pointed out to “cherry pick the profitable beneficiaries” We both agree this is the case. The private insurance had their chance. And really messed things up. I say eliminate the insurance industries’ influence altogether. And regulate the costs, yes it seems dictatorial but I know the common good would be better served. After all we are currently paying enough for all to receive health care, just not receiving it. Profit motive needs to be removed from health care, to better allocate existing resources.

Posted by Froward on September 9, 2007 08:32 AM

Price controls lead to shortages as night follows day. Nixon re-learned this economic truth the hard way with gasoline price controls. Result - gas lines, station closures, limited gas. California learned this the hard way with price controls on wholesale power. Result - brownouts.

Now comes Medicare, price controller for the entire publicly funded health care market, and standard pricing benchmark for private payors too. While some argue we have a shortage of health care, perhaps a more appropriate description is a poor allocation of available health care. The health market has been seriously screwed up bythe two edged sword of government price controls and government subsidies. That anyone ever expected an appropriately allocated health care market out of so much intervention and interference in fundamental economic mechanisms, is a mystery. That substantial numbers of people push for even more of this bad prescription, an even bigger mystery.

Add in computer technology that now enables insurers to find and isolate all their high cost beneficiaries and dump them through a variety of mechanisms, cherry picking the profitable beneficaries, and we've got a real mess.

Get government out of the health care business, and regulate insurance companies so they really operate shared-risk pools of all beneficiaries, like they used to before computerization.

The market will do the rest.

Posted by Brooks Imperial on September 8, 2007 09:21 AM

How can you control health care price? The free market system in place coupled with the BASIC NEED of health care. Along with the profit margin of those insurance companies, is what drives the costs. Making the insurance company mandatory in health care, like auto insurance? Our costs for mandatory auto insurance sure doesn’t ever come down. In my 30 plus years of driving, insurance costs have never come down. And I doubt they ever will. Unlike gas they don’t fluctuate with election cycles.
Fascism is exactly that, monopolistic companies running the show. In this case you would espouse the people to have more power? I would agree with that. but however it is the insurance companies profit margin that helps to drive up costs. At least with government control the actual cost of the particular procedure would be in check. Make the doctors immune from punitive damages (no need for malpractice insurance) Prison for gougers and actually ban bad doctors. And we are getting somewhere. It’s the cost OF insurance that has most of America uninsured. Again profit needs to be removed from health care. Or otherwise its like I said before, its lipstick on the same old pig.

Posted by Froward on September 7, 2007 11:55 PM

Once we get rid of the mandated price ignorance in health care, people will pay too much and we will have little control. If the government didn't subsidize the insurance industry with tax credits, then the individuals would be in charge.

This should read:
Once we get rid of the mandated price ignorance in health care people will no longer pay too much with little control. If the government didn't subsidize the insurance industry with business tax credits, then individuals would be the primary consumer and they would be in charge.

Posted by momma y on September 7, 2007 04:56 PM

Froward,

American style freedom is the right to make your own choices. There is no requirement for the government to pay for those choices. Individual responsibility means you pay your own way. There is nothing fascist about telling people to take care of themselves.
You have the right to do things NOT the right to force others to do them nor to require them to pay your way.

Insurance companies are businesses and we are the customers. Until we get rid of the government in the health care industry there will be a problem with insurance companies. Once we get rid of the mandated price ignorance in health care, people will pay too much and we will have little control. If the government didn't subsidize the insurance industry with tax credits, then the individuals would be in charge.

Insurance companies do not order your actions. They tell you how much they will pay and under what conditions. If we get rid of the business slanted insurance system and put the power of tax benefits with the individual there will be complete freedom.
We need to get rid of the entitlement mentality that you personify in your demand that the government pay for something you should take care of yourself. Why do you think that others should pay for your health care? I'd like you to pay my mortgage. That would be a common good. Now do you see how silly that sounds?

Posted by momma y on September 7, 2007 04:49 PM

“You don't have the right to order people to do as you say, nor to pay for it as you desire.”

The insurance company(s) does Exactly that, every day.

American style freedom would allow me to go to the doctor free of charge because. "The role of our government is to provide for the common good."

not this Fascist state as you would like to keep.

Posted by Froward on September 7, 2007 03:09 PM

Froward

You do realize that we live in a democracy, right?

It isn't a scare tactic to state the simple fact that taxes will go up and we will be paying for health care for those too lazy or too indifferent as well as those in dire need. You obviously want to have total control over the health care market as well as other things.

Forcing employers to pay for time off for workers to see doctors and all those other nice little socialistic touches have no place in our society. I am not a slave to the government and refuse to allow them to waste money. The cry that we spend too much will be a faint echo if the government is ever able to take over health care. Look at the projected costs of Medicare and Medicaid. They are more than twenty times their estimates and still growing. You are the perfect example of why the government cannot be trusted in this area.

The reason medical equipment is often donated out of country is that there are too many lawyers waiting to make excuses to sue should an older machine cause an error in diagnosis. Not only would the facility using the machine be sued but the organization donating it, the manufacturer and the night janitor would be included.

How about a bit more American style freedom and fewer iron curtain edicts?

Give tax breaks to individuals, get rid of predatory lawsuits by capping lawyer payments, allow anyone who wants to do so to join Medicaid and leave the government out of our pockets. You don't have the right to order people to do as you say, nor to pay for it as you desire.
I'm certain that France has room for you if you think their system is so superior.

Posted by momma y on September 7, 2007 01:14 PM

Again with the tax increase scare. Hello? We already pay the highest per person than the rest of the world. We simply need to come up with a plan that distributes the money evenly. Allowing for care for everybody. That’s all, simple. No need to make this about taxes when we all know that’s just a scare tactic the republicans love to roll out when faced with being wrong about an issue. Further more if the government were made up with competent persons instead of political cronies placed to bolster republican power. The system would work fine. I find it laughable how the republicans place incompetent persons in government. Then spew how incompetent government is.

I agree we should open more clinics, that’s a great first start. I would go a few steps further. like mandatory checkups, employers pay for those days employees go in. employers need not carry the whole health insurance load. Use older equipment for those clinics. More clearly when a hospital buys the newest shiny MRI machine they donate the old one to some other country. They pat themselves on the back as to how generous they are. When behind the scenes, that donation offsets the taxes on the new one. Why couldn’t the old one go to stabilize the health costs? Another step is allowing terminally ill people or inmates serving life terms, or hopelessly despondent people, to actually die. Harvesting those organs from condemned inmates curbs the cost even further. letting terminally ill people pass away with some sort of dignity, saves those long term care costs as well. How about free nursing school? My favorite would be for the pharmaceutical industry to stabilize drug costs. The same pill manufactured here sells for far less in other countries and yet is illegal to import back here? As well as get the FDA out of the drug company’s pocket. Only allow drugs for existing diseases. Only allow drugs that are safe. As the system is now it is far more profitable to issue a drug, sell it for a few years. Then settle when the drug proves unsafe. Drug companies actively pursue catchy phrases to sell their drugs. Making it cool to have some made up malady. The worst is the kickbacks given to doctors to push their product. I hate drug pushers, legal or otherwise.
The trick here is to streamline how the money is spent. To cover everyone. Not scare those more gullible with the tax man.

Posted by Froward on September 7, 2007 08:58 AM

Froward

You don't know the answers because you are looking to the government and the only thing the government does in a commercial situation is make a mess.

A survey of our health care system done without the WHO slanting would show that we have more, better health care but, because the government pays the bills without question for Medicare and Medicaid, albeit with a price cap, there is no market for the insurance companies to sell to. Investigations have shown that "creative" providers merely schedule extra tests and treatments which sometimes don't get to the patient.

We need to open some free clinics in more areas and give vouchers or some other exchange medium so that individuals can take control of their own health care. Give the workers the tax benefits the businesses have had for years and watch the progress. Doubt that an open market works for health care? Or that it works for health care for the ordinary people?

Wal-Mart has opened up clinics all over the place. Low prices, posted on the door for all to see, low priced prescriptions and open long hours and weekends. This is one place where we will see progress because Wal-Mart is a business that isn't afraid to make a profit or annoy the media. Those clinics were tested and planned long ago and they will prove that the health care industry can be a market force if people can choose for themselves. Time to make a difference is now. Usually you can test this kind of thing with a trial program but the insurance industry is set up for the present system. We can run a test program by allowing the insurance companies a year to get their policies ready the we run the test.

In Colorado we are lucky that the whole mess will require tax increases which means we have to vote and there aren't that many fools in Colorado.

Posted by momma y on September 6, 2007 10:33 PM

Kudos Mary, its worth repeating.
“I don't know the answers. but must admit I am intrigued when, I read that the US is the only industrialized country which doesn't have some sort of national health care plan, has the highest expenditure as a percent of GDP (at least double what is spent by those countries) - with the least to show for it (tied for next to last in infant mortality, and well under the average on life expectancy).”
I reiterate, WE must
Eliminate insurance companies altogether. we are already paying for health care for all in this country. We just aren’t getting it. why? because of republican mindsets like momma y. if the republicans would 1) put competent people in positions of oversight. not just, for profit or consolidation of political power, cronies. and 2)her "true competition for profits" simply doesn't work, as health care is an industry that has its clients in dire need of the services. It is the true competition for profits that has driven the costs up and up. tell me will you go in for a discount Emergency surgery? Or take the time to find the least expensive ER?

If it were mandatory under a single payer, universal health care system. To get a checkup every year, then problems could be addressed BEFORE there is a need for the ER.

Posted by Froward on September 6, 2007 08:10 PM

Mary, you need to grow up. I work in the military healthcare system, Single-payer/socialized medical care, and it dosn't work. If a person dosn't have to pay for it they abuse it. Too many of the patients don't go to their assigned clinic/PCM but instead go to the E.R., for simple/routine things. (i.e. sore throat, cold symptoms, bug bites). Many people complain that they can not get appointments or whine about the wait for ct scans, or mri's, etc. Yet, these very individuals do not have to pay one cent for their care. I have also been in the healthcare system of both Canada and Germany and their problems are even worse. So no do not let the government handle the healthcare or go to socialized medicine because the problem s will increase ten to hundred fold.

Posted by Mike on September 6, 2007 05:43 PM

It is about time someone starts point to some of the flaws going on. However, one must remember to many people like to suck at the tit of government, thus the TAXPAYER'S, instead of being responsible for themselves. Everytime the government tries to solve the problem the government makes it worse.

Posted by Chris on September 6, 2007 05:25 PM

The problem that is blocking health care reform is that no one with any authority is willing to treat health care as a commodity, a product.
Few will even admit that there is a limit on the number of doctor hours available for treatment and diagnosis. Others will ignore the absolute physical limits in the number of hospital beds, diagnostic equipment and medical personnel available to stand in support of any medical treatment.
If there is no market to control supply and demand then there will be an authority in charge of deciding who gets which commodities and how much is enough. Since in any large system such things can't be done on a case by case basis there will be guidelines and rules that will be drawn up based on the limit of the supply not the amount of demand.Such rationing usually makes an effort to be balanced. In health care this means there is always an upper limit to the care available. This isn't because the ones making the rules are evil or greedy or uncaring. They are making general rules because that is how the system works. It means that people will have a limit on how much health care they can have. Now the rich will always have every treatment they want or need because they can pay for it. The rest of us will have to live with the limits because there is no place for individual exceptions or additions in any health care monopoly. Monopolies don't have any market pretssure so they don't need to improve or change or innovate or react in any way to the market.

Perhaps it would be wise to look at another monopoly from our past.

When I grew up the telephone company had only three letters; AT&T. That monopoly was broken up and there were dire predictions of how bad the system would be without one central authority responsible for quality and other issues. At that time there was a waiting list in Denver of about 10 years to get a mobile phone.

Look at what the market has done. Hundreds of plans available, dozens of companies and more choices than we can imagine. Mobile phones? Today's kids would have to think that one over. They've grown up with phones in their pockets.
The same thing would happen in health care if we got the governments gold plated handcuffs out of the picture.
The reforming of Medicare and Medicaid would be a simple transfer of responsibility for the choice of plan from the government to the individual. We can give the poor vouchers worth a certain amount and let them use them as they see fit. Nothing is going to make everything better overnight.
It took years for the break up of the telephone monopoly to produce the I-phone. It will take similar time for reforms to fully open up the medical care field also. In the meantime we will benefit from the early changes brought about by simply getting the governmental credit card out of the picture.
One thing that can be done before any changes are made is to improve the neighborhood clinic system so that the working poor won't have to choose between going to work and getting health care. Longer hours and weekend hours will do nicely and should reduce some of the pressure on emergency rooms as well.

As for the problem of illegals taking advantage of the services it will be much more difficult to obtain a voucher than it is to get a welfare card. First of all you will need a real address and other documentation that we can do our best to make it very difficult for the services to be stolen. Other safeguards, like jail tme and immediate deportation, can be put in place as well. That is a topic for another place. See what Oklahoma has done and how it's already working.

Posted by momma y on September 6, 2007 01:32 PM

Let's see if I understand the author's perspective: the spokeswoman for the Colorado State Association of Health Underwriters (health insurance COMPANIES - plural) is opposed to a single payer system.

Many folks have been blinded by the insurance companies' argument that single payer systems don't work (swalowing whole the idea that somehow the US is NOT smart enough to compare/contrast other countries' single payer system & keep what works while throwing out what doesn't).

Many people also espouse the idea that any government intervention is bad, but blithely ignore that the whole mission of any insurance company is to collect as much money as possible while paying out as little as possibe (which I understand is the mission of every for-profit business) - and that payout side is what allows health insurance companies to override what a doctor tells a patient is in his/her best interest (for instance, the health insurance company basically declined to cover the meds Andrea Yates was on in favor of cheaper ones - with the result that she DROWNED 5 children - but heck, the insurance company saved money) - HOW IS THAT BETTER FOR THE PATIENT?

Why do the naysayers who appear to be scared to death that they will die without ever having to use whatever they contribute to in a single payer system - then whine that benefits mean the US can't compete globally - usually with countries that have single payer plans? Why do they get to have it both ways?

Yes - we need some kind of cost control, but - as we have seen so often that often only ensures that the company makes more profit, not that the savings are passed on to the consumer. But somebody needs to explain to me why (for example) a sling cost $60 - more than 15 years ago? Or a bandaid to cover a needle puncture costs at least $2? (Actually, I know the answer - insured users of medical care are already paying for the uninsured by having our bills padded.) Why, year in and year out, do health care costs increase at double or more the rate of inflation? (In 2006, employer health insurance premiums increased by 7.7 percent – two times the rate of inflation. And that doesn't factor in the patient increase in co-pays or their contribution to the health care buy-in.)

I don't know the answers, but must admit I am intrigued when I read that the US is the only industrialized country which doesn't have some sort of national health care plan, has the highest expenditure as a percent of GDP (at least double what is spent by those countries) - with the least to show for it (tied for next to last in infant mortality, and well under the average on life expectancy).

Posted by Mary on September 6, 2007 01:06 PM

"All the Care you can consume".....If I may, I will use that phrase in the future. I've not been able to articulate my main objection to most of the Health Care Fix proposals, which is that I don't see a limit...it will be all the care you can consume!

Posted by bjs on September 6, 2007 11:04 AM

The Lewin Group was asked to provide an analysis of health care reform proposals, not a definitive cost estimate. The 208 Commission specifically chose the Lewin Group because they thought the Lewin Group would explain the the inner workings of their modeling system used to come up with cost estimates more than other modeling companies would. They got what they asked for, and while the Lewin Group said the single-payer plan would save more money than the other proposals, they also explained the assumptions used in coming to this conclusion, which included some miraculous federal legislative and regulatory changes. It's refreshing to see someone actually explaining the Lewin Group's findings instead of just pointing at the final numbers.

Posted by Blair Woodbury on September 6, 2007 09:12 AM

Thanks Cindy for the view.

The only thing "broken" about our current system is that government has stepped in and has distorted the market by requiring certain minimum coverages by health care insurers.

They have essentially destroyed catastrophic care which was the only option that my parents lived under for over 20 years.

Taking the least expensive medical care away by legislative mandate and then complaining there is no "affordable" healthcare is like a man making the weather then complaining when it rains.....

Suppose you were an idiot, then suppose you were in Congress, but I repeat myself..

Mark Twain-

Posted by Father OMalley on September 6, 2007 07:42 AM