Re: OT: Wal-Mart says Vote Republican

Free Lunch <lunch@xxxxxxxxxxxxxx> writes:

If there were single payor health insurance, you can be comfortably assured
that this country's health care system would an even bigger mess. It wouldn't
be what the Capitol Hill legislators get, because it's too expensive and
because the legislators can whine, moan and pass laws to change how their
benefits work, and we can't. Much like Singapore, it works because it's small.
So Obama is, as usual, talking out his rear end.

Obama isn't supporting a single payer health system and your objection
is completely unsupported by anything but ignorant bias.

Typically, you're talking out your rear also, or you would have thought that
particular kneejerk statement through. Obama is well aware that openly
supporting single payor would pretty much kill him politically. It's too
easy; it would be the revenge of Hillarycare and easily sunk.

Obama's plan is guaranteed issue, no mandate -- which means that you can
choose not to be covered. As it happens, the only way that works is to have
single payor insurance ultimately at the helm as the catch-all, or else
those that choose not to be covered won't be.

The nice side effect to that is, as I've stated, it will make the cost of
doing business for the health insurance companies considerably higher because
the low-risk population will bail out and reasonably so, because it's the
cheaper option to pay nothing out of pocket. That's the goal. Eventually,
presto: ultimately there will be only one option left, or the options that do
remain will be so out of reach of most people that they will be practically
reduced to government-based care only. Obama's plan *is* single payor
insurance. It's the only way he can accomplish what he says, without actually
saying those words.

But, of course, you'll say that's all a distortion, so let's get it from
the horse's mouth as it were (Obama in 2003, to an AFL-CIO rally):

"I happen to be a proponent of a single-payer health care program. I see no
reason why the United States of America, the wealthiest country in the
history of the world, is spending 14 percent, 14 percent, of its gross
national product on health care, cannot provide basic health insurance to
everybody." [...] "A single-payer health care plan, a universal health care
plan. And that's what I would like to see. As all of us know, we may not get
there immediately. Because first we have to take back the White House, we
have to take back the Senate, we have to take back the House."

As I said above, Obama had taken hits on this, including from HRC herself, so
he's backing away from that statement. The Washington Post at

http://blog.washingtonpost.com/fact-checker/2008/01/obama_and_health_care.html

has that comment and another more current one from his campaign staff:

"Asked about the 2003 quote, Obama spokesman Bill Burton said that Obama
'has been consistent in saying that single payer health care is a good idea
that we cannot achieve right now.'"

Thus the subtle approach.

Instead, it would look an awful lot like Medicaid or Medicare because these
are the two systems that exist and can simply be expanded, the legislative
method of least resistance, two systems which are so pathetic in their
benefit structure that they require add-on insurance to be purchased or held
to even approach what even the suckiest HMO will offer. Their reimbursements
are pathetic, their TARs and paperwork are disastrous, and the wait time to
get service approval borders on malpractice. How do I know this? I'm an MD
who deals with them on a daily basis.

Fine, let's start with Medicare and fix it and make it available to
everyone. Sure, the surgeons making half a million a year might not like
having to cut back to $450,000, but I'm sure they'll adjust.

You know, this pretty much shows your true colours -- you're more interested
in class envy. I've got a $200,000 debt from medical school, and worked my
fanny off for 11 years to get this degree, but that doesn't really interest
you, does it? Rich people, to you, couldn't possibly be rich on their own
merits and even if they are, shouldn't *be* rich. I'll expand on this based
on your particularly ad hominem comments at the end.

By being a single payor insurance, you're also going to kill the private
insurance market by giving low-risk people -- the bread and butter of every
Kaiser and Blue Cross -- an easy out. They'll just take the government
insurance, sucky or no, because they can be confident they'll probably not
need it and it's either cheap or free. By doing so, this drives up the cost
of the private insurance market by keeping the high utilizers in their pool
and not offsetting them with relatively healthy insurance risks to the point
that even if you wanted to pay for better quality care, you simply couldn't.

The point of single payer is to move insurers to the periphery rather
than having them take their 15-20% of every health care dollar. Blue
Crosses killed themselves by turning themselves into for profit
companies whose executives are most interested in their bonuses, not in
health care coverage.

Ah, so the insurers, which are assuming the risk of taking patients on, need
to be further marginalized by saying that the 15-20% they get is too much
and they should continue to provide the same level of service on less by, as
you say, being "driven into the periphery"? They're paying for that care.
Boy, you really know how to run a business, don't you?

I'm not going to dispute that there are disreputable insurance companies,
and others that maintain legality while being grossly unethical, and I don't
care for those companies. But the companies assume the risk. That's what
insurance *is*. Increase competition and drive the scum out by increasing
consumer awareness of benefits per dollar paid and choice.

There is also the hidden implication that a for-profit insurance plan is
a priori anti-patient. Certainly for-profit insurance plans *can* be
anti-patient, but that kind of insurance plan wouldn't last very long in
a competitive market when people find other plans to go to. See my other
post where I'm not opposed to making a larger market by limiting insurers'
ability to refuse coverage.

In my own practice, when people have a choice of work plans during open
enrollment, or Medi-Cal HMOs, or Medicare supplemental plans, I'll *tell*
them which ones are better because I know which plans are easy to get TARs
and covered benefits on and which ones are more difficult. On this advice they
switch. I'm not the only doctor who does this, and my patients aren't the
only ones getting informed where their health care dollars are best spent.
And contrary to your dark-coloured worldview, most of them *do* have a
choice. I even have cash-only fee for service patients, and we work out
where to get things cheap. Ironically, WalMart has been a godsend with the
$4 drug plan, which covers a great deal of medications in a lot of categories.
It even beats some insurance formularies to the point where I have those
patients just go there and pay cash. How's that for getting back on topic?

Speaking as a practicing physician, single payor insurance -- especially run
by the government -- is the LAST thing I want. And I actually work for a
government-funded health agency.

Do you take Medicare? Would you complain if all of your patients were
covered by Medicare?

Of course I accept Medicare, and if all my patients were covered by Medicare,
I would have entirely different problems. You haven't answered anything about
Part B supplemental coverage, or Part D plans. Medicare is insufficient by
itself for all but doctor's visits and certain procedures, and even doctor's
visits are not totally free except for federally qualified centres. Even
with all that, there are still gaps in coverage. So the question makes no
sense, because it's just exchanging one set of headaches for another.

The sniveling 'well it works in europe d00d' is crap. The European political
world is tremendously different and the dynamics mean a totally different
product. Most of them are badly underfunded (such as the UK's NHS) despite
the confiscatory tax rates, which is really shoddy. And ask any of the
Canadians in the private hospitals in Minnesota if they're down here for the
weather.

The NHS isn't most. Check out France, German or Switzerland sometime.

Again, the difference is in the construction. Let's take the French as an
example, which the WHO ranked #1 in 2001 IIRC. The French system does more
with less because they have a system where tort is heavily restricted,
physician school debt is near zero because medical school is free, and thus
physicians take home more of their smaller paychecks. The French Social
Security system also was constructed with much less of the fluff that plagues
HHS/CMS billing today, so the overheads to bill are lower, *and*, there are
no pre-authorizations.

That all sounds pretty good except on the cost end -- currently it's being
paid by payroll and wage levies (does this sound familiar?) and impacts
the French job market and economy because employers don't want to take on
more burden to pay, leading to a job lock not unlike what we already have
here in the USA. So, the reformers want what you want: tax everyone instead
directly, including on unearned income. And I might add that the French
Social Security system runs at a tremendous deficit: already in 2004 it
was in the red to the tune of 10.9 billion euros (source:

http://news.bbc.co.uk/2/hi/europe/3423159.stm

). Not only that, the French government-commissioned report cited in the BBC
article complained that the system was "badly regulated and badly governed,"
and that "everyone [in the system] will need to change their behaviour."

So much for #1. It's all downhill from there.

Work in the field for any length of time and you'll be singing my tune. The
system is broken as it stands. But single payor breaks it worse.

You haven't offered any evidence to back up your claim. We do know that
Medicare, which is single-payer for those over 65 is a great improvement
over what came before. Could it be better? Sure, so what. Our private
system doesn't help patients. Sure, insurance companies, pharma
companies, health care technology companies, hospital administrators,
even poor doctors do okay with the current system, but not the poor, not
uninsured patients, not people who should be getting treatment for
chronic conditions before they become acute.

What, you don't think that my opinion of the field, working in it on a
daily basis, counts for something? Ask the patients of mine waiting months
to get an MRI approved, or those for whom a particular necessary procedure
isn't even a covered benefit, with no reasonable way to appeal because they
are on a federally funded program. At least in the current broken system
there is a prayer of getting them into some other plan or program, sometimes
with a greater dollar cost, even though in some cases that prayer is faint.
But in a single payor program, that chance is zero.

And, true to form, you aren't offering any evidence for yours. Yes, something
is better than nothing, but that's not really the correct question. The
correct question is, do patients on Medicare do better than similar patients
on private plans? If they pick up supplemental coverage, do they get the same
bang for their dollar? The problem is now that Medicare is guaranteed for 65+,
we will never be able to answer that question again because there *is* no
choice. No one insures someone over 65, they tell them to get Medicare.

A better question might be to ask about Medicaid compared to private
coverage, and the answer is right there in the national HEDIS and quality
databases, which are required by federal law for each state to complete.
Since you know so much about healthcare standards, you can do your own dirty
work and clearly see that across the board, Medicaid/Medi-Cal insured
patients have greater problems with access, coverage and time to obtain
necessary procedures.

The rich are the ones who have benefitted the most from living in this
country, why shouldn't they pay more?

If you were willing to limit this to infrastructure, public works and
services that benefit society as a whole rather than specific targeted
populations (education, law enforcement, military, civil defense,
communicable disease, business regulation, etc.), then I would agree with
you. But I know that you're also using this to imply payment for entitlements
and social programs that are specifically income-qualified, where people
don't benefit from those programs if they make more than X. Where I come
from, that's called redistribution of wealth, and that's not the government's
job.

Taxes are one big lump.

So? Once it's in the whole, you can't part it out or say, paying for X is
a bad idea and let's stop doing that?

We finally get to your last parting shot:

It's no surprise that someone on top of the economic pile would whine
about how unfair life is.
The way I've always looked at taxes and programs is to say that I'll be
paying for it. And that really changes the way I look at a lot of programs.
And since I'm a "rich doctor," boy, I sure pay a lot for those programs.
I'm sure you tell yourself every day that you deserve every bit you get.

.... and there's that green-eyed monster again.

Pretty much this boils down to your basic premise that rich people are
immoral, are not entitled to their money, and should pay for your "free
lunch" by righteously confiscating their ill-gotten gains. This only shows
you're more interested in wallowing in bemoaning your circumstances or
trashing those more successful than you. Would you feel better if I paid
even more taxes? Does that greatly improve your life, knowing you're doing
it with the money I worked hard to make?

Please enjoy the remainder of this thread from the safety of my killfile.
I used to find you entertaining and sometimes had worthwhile points to make,
but I think this eloquently demonstrates your entire emphasis is simply on
low-conceived class warfare. And there's no compromise on that.

--
Cameron Kaiser * ckaiser@xxxxxxxxxxxx * posting with a Commodore 128
personal page: http://www.cameronkaiser.com/
** Computer Workshops: games, productivity software and more for C64/128! **
** http://www.armory.com/%7Espectre/cwi/ **
.

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