Re: Why would anybody oppose single payer ?


"El Castor" <No_One@xxxxxxxx> wrote in message
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On Wed, 11 Jul 2007 15:12:13 -0500, "John Galt"
<whoisjohngalt@xxxxxxxxxxxxxx> wrote:


"El Castor" <No_One@xxxxxxxx> wrote in message
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On Tue, 10 Jul 2007 22:04:20 -0500, "John Galt"
<whoisjohngalt@xxxxxxxxxxxxxx> wrote:


"El Castor" <No_One@xxxxxxxx> wrote in message
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On Tue, 10 Jul 2007 18:25:41 -0500, "John Galt"
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"El Castor" <No_One@xxxxxxxx> wrote in message
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On Tue, 10 Jul 2007 17:39:39 -0400, Gary <nope@xxxxxxxx> wrote:



Anyhow, I'm sure you lefties will eventually win this one. It's
inevitable -- just like the fact that Jose will not be going back to
Mexico, but you WILL be paying for his medical care.

Depends what they want to win. Single payer works (such as it does) in
other
countries because the citizens give something up. You get to choose
between
giving up low cost, high quality, on-demand, and physician choice.

When the details of whatever program are presented, I tend to doubt
that
the
boomer generation, who (if insured) has enjoyed all of the above at
high
cost, and who then will comprise the largest block of regular voters
in
history, will vote to take one of the final three away from
themselves.

JG

You are probably right, but when did a politician ever present the
"details" in a fair and objective way?

True, but you can depend on the conservative opposition (be it the
majority
or the minority) to bring out these matters, can you not?

If you read Gary's piece,
Single Payer is even greater than sliced bread -- and perfect in every
respect. Present people with a promise of better care for less money,
and they just might take the bait. Once the government has it's hooks
into healthcare, going back is quite difficult -- as the Canadians are
finding out.

Quite so. We can debate the details, but the larger picture is the
question
if Americans are comfortable with (my estimate) the size of US social
spending doubling in one fell swoop.

That's not the way it works. It's much easier to nibble away at the
problem one little bite at a time. Medicare was a first step. Bush's
prescription drug plan. Something for "the children" is probably
next.

Commentators from both sides of the
political spectrum have pointed out that the entire notion of single
payer
is so antithetical to the American ethos that, once presented to the
American people, it's DOA. If the next President is wise, he/she will
focus
on Massachusetts-style plans that bring the strength of the free market
to
bear on the problem.

You are obviously more knowledgeable than I am. Can you point to a
country that has a system that in your opinion works well and could be
translated to work in the United States?

I'm not knowledgeable about specific plans enough to comment, although I
suspect that a more appropriate fix includes elements of the Massachusetts
plan. There are a few things that have to be recognized:

1) Insurance works because low risk coverees offset the cost of high risk
coverees. We have to recognize that a core fault of our private health
insurance system is that low risk coverees are permitted to opt out of
care.
(We don't let good drivers opt out of auto insurance; it may be
"fascistic"
to pass a law requiring all to own coverage under penalty of law, but you
can't fix the system without it.)

I don't want to argue against what you propose, but right off the bat
I shudder at this one. I understand the need, but frankly getting
people to pay taxes is tough enough. Requiring them to pay for health
insurance as an out of pocket expense (#2) would be a very tough sell,
and difficult to enforce. As you know, employers currently pick up
part of the tab -- a payment which is in effect a pre-tax salary
deduction. Converting that to an after tax salary payment would cause
all sorts of controversy. Yee Gods, enforcement could turn into a
bureaucratic nightmare. And asking every age class, but particularly
the young, to subsidize the elderly (#3) would be equally problematic.
Then there is the issue of the unemployed, under employed, illegal
aliens, the under the radar cash economy, and the poor -- or
apparently poor, etc.

What you propose might make sense, but I believe it would be very
complicated, and an extremely hard sell.

I don;t toss it out to argue about the details. The point is that everyone
has to be insured. Period. Now, whether that's a payroll deduction that gets
transferred to an insurer automatically, or whatever, it doesn't matter. If
you can be forced to have auto insurance, you can be forced to have health
insurance.

2) Although we have multiple health care insurers, they don't compete with
each other as efficiently as they should because they are are
"wholesalers"
that sell packages to "distributors" (corporations) who (supposedly) pass
those packages along to their employees at cost. Recognizing that there
are
devils in the details, insurance companies should be required to sell
retail
only, and to all customers, taking one's employer out of the loop.

3) Although this *should* increase competition significantly, it *may*
(unfortuantely) be necessary for the goverment to set maximum and minimum
prices for each age group to insure that the benefits of competition don't
flow to the young at the expense of the elderly. Alternatively, you're
going
to need some help for the lower income brackets to afford policies anyway;
you may also have to extend such help to the elderly to insure the
companies
compete for business throughout all age brackets.

The net effect of all this should be to drive down the cost of policies
through more creative packaging for the end user. For example, your
current
premium includes coverage should you become pregnant. Much chance of that
happening? And there's more. If I want to waive any and all Patient Bill
of
RIghts provisions to obtain a lower premium, shouldn't that be my right to
do so? By law, the providers currently can't package that way. If a person
chooses a hard gatekeeper plan to lower premiums, oughtn't that be their
right?

Now, here's another issue that must be addressed, and is much less talked
about, because it strikes us in an area we don't like to think about:

5) The US has about 2.4 practicing physicians per 1000 of population. Take
a
look at this chart:

http://www.nationmaster.com/graph/hea_pra_phy-health-practising-physicians

....and tell me that the AMA, who control certification of both physicians
and medical colleges, isn't holding back the number of practicing
physicians
in order to drive up wages? It's well known how difficult it is to get
into
medical school, and everyone knows some students (often family members)
who
are superb students who were unable to obtain admission. Part of this
national transition OUGHT to include a plan by the AMA to AT LEAST get us
to
the OECD average of 3.0 physicians per 1000 within a reasonable number of
years. If they do not, we move certification of medical schools from the
AMA
to the goverment. They simply cannot give us the exuse that there is a
lack
of qualified candidates. We know better.

On a related note, here's an interesting article:

The free market at work. :-)

JG



"Doctors clamoring to come to Texas, creating backlog of applicants
More than 2,000 doctors awaiting Texas licenses, as patients wait to
see certain specialists

By Mary Ann Roser
AMERICAN-STATESMAN STAFF
Monday, July 09, 2007

An influx of doctors into Texas has caused long waits for medical
licenses, inconveniences for patients wanting to see certain
specialists and anxiety for physicians awaiting new colleagues to help
with high caseloads.

People in the medical field say the state's limits on malpractice
lawsuits have generated a surge of doctors, including specialists, who
want to practice in Texas, which is helping bring more doctors to
areas of the state that don't have enough."
http://www.statesman.com/news/content/news/stories/local/07/09/0709backlog.html

(As an aside, I'm not sure why this statistic is rarely, if ever, talked
about. Obviously, patient outcomes are better if doctors are more
accessible -- people who have insurance still often avoid doctors, for the
reason that a doctor's appointment usually involves a two week wait
(minimum) followed by chilling one's heels in a palatially appointed
waiting
room when one is supposed to be working. Our French friends have .9 more
doctors per 1000 than we do, which, if nothing else, translates to better
accessibility.)

I can go on, but the short of it is that we have 1) a cost and coverage
problem in health care, 2) there are ways to address coverage without
increasing (substantially) the size of the federal bureacracy, and 3)
there
are other factors extant in our current system that seem to artifically
kick
up costs without providing any benefit to the patient.

Let's address coverage first, THEN reform the system to insure that market
forces are acting at all levels to control price, and THEN, **IF** the
result of all that is unsatisfactory, talk about far-reaching
alternatives.
Seems prudent to approach this matter in an incremental fashion,
especially
from the provider POV.

JG




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Relevant Pages

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  • Re: Why would anybody oppose single payer ?
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    (soc.retirement)
  • Re: Why would anybody oppose single payer ?
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    (soc.retirement)
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