What to Say to Those Who Think Single Payer Advocates Are Wacko

[slipslidingaway]

http://www.commondreams.org/view/2010/02/08-6

by Paul Hochfeld M.D.

"What do we say to our more conservative friends, who genuinely think that the Single Payer solution to our health care crisis would be a disaster? Try what follows. In the end, you may simply agree to disagree. That's O.K., but what follows may give them pause to think.

Already, 60% of all our health care dollars come directly or indirectly (because employers insurance premiums are tax deductible) from the taxpayer. The care of our oldest neighbors are financed by Medicare, i.e. the taxpayers. The care of our disabled neighbors is financed by Medicaid. Ditto the care of our poorest neighbors who, because health follows wealth, are also at greater risk of high expense. Fourteen hundred insurance companies, at significant expense, stratify the rest of the population by "risk". Their top-secret formula results in them covering the employed people, small groups, and individuals who can prove that they are at low risk. What about the others? When those who can't afford the premiums get sick, go bankrupt, and can't pay their bills, "we" all pay for it in higher charges. Furthermore, employer-paid premiums are tax deductible which means insurance company profits are subsidized by the taxpayer.

As near as I can tell, this is a big taxpayer rip-off. Additionally, our non-system is fraught with numerous perverse incentives that result in more care, but not necessarily better care. Physicians must share a significant part of the blame here, but that's a different, though important, discussion. Addressing these perversities is problematic because we don't have a Health Care System we have For-Profit Sick Care Non-System that, to extent that it has any design at all, is designed to serve the for-profit insurance and the pharmaceutical industries. Perverse incentives work for those who profit from them. They don't work for patients or those who pay the bills, i.e., taxpayers.

Single payer means one risk pool. You've heard the slogan. Everyone in. Nobody out. We gather all the money that employers and individuals are currently paying for health care. It's not more money. It's the same money, already being spent on health care, but by pooling it, we can save 20% right off the top. Providers won't have negotiate fee schedules with all the different payers. Providers will only have to send bills, electronically, to one place. Furthermore, substantial savings accrue as the system matures. When an ER Doctor in Oregon sees a patient passing through town, he will access her electronic medical record in Iowa, resulting in, not just less expensive care, but better care. None of this is going to be accomplished until we have Public Health Authorities administering a health care system with the goal of health, financed publicly and delivered privately...


Is access to appropriate health care a human right? If not, we can agree to disagree. If so, it is a legitimate function of our government to make sure that nobody falls through the cracks. Also, doesn't the government have a fiduciary responsibility to make sure the taxpayer is getting value for its health care dollars? Insurance company CEO's have a fiduciary responsibility to maximize profits even if it means investing large sums of money in manipulating public policy... and that's exactly what they've been doing. It's unfathomable to me that some people distrust "The United States" more than United Health Care. That may be where we end up agreeing to disagree.

In any case, the taxpayer is being ripped off, big time."


Dr. Paul Hochfeld is an ER Doctor, producer of Health Money and Fear, and one of the Mad As Hell Doctors who traveled to DC last September. MadAsHellDoctors.com

[rgbecker]

1. I like it, but it won't fit on my hand in larger than font #1!

I'm going to try and get it up on my TelePrompTer.

Very good points all.

[slipslidingaway]

2. Does this fit :) .....

http://pnhp.org/blog/2010/02/08/canadian-medical-travel-executive-on-premier-williams-care-in-the-u-s/

"...I have dual citizenship in the US and Canada and have practiced medicine in both countries, and, were I pushed to choose, I would definitely opt for the Canadian system..."

;-)


"...It is a relief to know that Premier Danny Williams (Newfoundland and Labrador) is doing well after his heart surgery here in the United States. This news is a refreshing and reassuring breather after having been inundated with the callous releases from right-wing extremists celebrating Premier Williams’ medical misfortune, used to both denigrate the Canadian health care system, and tout the quality of the U.S. system (for some).

The North Star National article by Mark Watson is but one of those insensitive and distorted reports and certainly would not be worth including as a Quote of the Day, except that it provoked the response of an executive of a Canadian medical travel firm who also happens to be a physician who has practiced in both the United States and Canada.

We do not agree with Dr. T. Rand Collins that Canada needs a “private option.” That would create a two-tiered system with even longer queues in the public sector. They simply need to continue moving forward with their ongoing efforts in queue management.

Considering that Dr. Collins’ firm is in the business of bypassing Canadian queues by arranging for care in the United States, his fundamental assessment of the systems of both nations is certainly noteworthy. As he says, “… were I pushed to choose, I would definitely opt for the Canadian system.”

[spin]

3. The graph tells the entire story ...

Some people complain that other countries have problems with their healthcare system. We could take the best heathcare system currently existing and adopt it. We could than fix the difficulties with this heathcare system for the difference in what we currently pay for our crappy system.

The World Heath Organization lists France as having the best heathcare program and the U.S. is rated at #37
http://www.photius.com/rankings/healthranks.html

Japan has the longest life expectancy, France holds #3 while the U.S. drags in at #24.
http://www.photius.com/rankings/healthy_life_table2.html

Why is France's heathcare so good and could we adapt it?

In Sicko, Moore lumps France in with the socialized systems of Britain, Canada, and Cuba. In fact, the French system is similar enough to the U.S. model that reforms based on France's experience might work in America. The French can choose their doctors and see any specialist they want. Doctors in France, many of whom are self- employed, are free to prescribe any care they deem medically necessary. "The French approach suggests it is possible to solve the problem of financing universal coverage... reorganizing the entire system," says Victor G. Rodwin, professor of health policy and management at New York University.

France also demonstrates that you can deliver stellar results with this mix of public and private financing. In a recent World Health Organization health-care ranking, France came in first, while the U.S. scored 37th, slightly better than Cuba and one notch above Slovenia. France's infant death rate is 3.9 per 1,000 live births, compared with 7 in the U.S., and average life expectancy is 79.4 years, two years more than in the U.S. The country has far more hospital beds and doctors per capita than America, and far lower rates of death from diabetes and heart disease. The difference in deaths from respiratory disease, an often preventable form of mortality, is particularly striking: 31.2 per 100,000 people in France, vs. 61.5 per 100,000 in the U.S.

That's not to say the French have solved all health-care riddles. Like every other nation, France is wrestling with runaway health-care inflation. That has led to some hefty tax hikes, and France is now considering U.S.-style health-maintenance organization tactics to rein in costs. Still, some 65% of French citizens express satisfaction with their system, compared with 40% of U.S. residents. And France spends just 10.7% of its gross domestic product on health care, while the U.S. lays out 16%, more than any other nation.
http://www.businessweek.com/magazine/content/07_28/b4042070.htm

But until our politicians are no longer owned by the "for profit" insurance industry, we can expect to continue to get screwed royally. Wake up and realize that those we elect, both Republican and Democrat, are not interested in our getting the best healthcare system in the world.

"For profit" heathcare always has been and will continue to be a recipe for inferior and very expensive heathcare.

[slipslidingaway]

4. Agreed - There was a great opportunity for the US to have a real discussion...

about HC systems, instead we silenced other ideas and were told to rally behind a system that would further entrench the for profit companies in our HC delivery system, same thing happened under Cinton.

Thanks for the links.

:)

[Mumblefratz]

5. This is both a reasonable and a reasoned argument ...

too bad logic and reason count for so little when talking to most conservatives.

I've never had a problem with agreeing to disagree however in general I've found it difficult to get conservatives to even agree to this much. The thing is that to agree to disagree you must at least acknowledge that the other person's point of view is a reasonable one to hold even though you don't happen to agree with it.

In my experience it's a very rare conservative that will grant even that much. Usually they act as if their opinions are not merely opinions but proven fact and that your opinions are not only opinions but are both wrong and unreasonable to hold.

They then proceed to "prove" to you how your every premise is wrong and that only an asshole could hold such an opinion. In this case there is certainly no possibility of logical discussion and therefore no point in arguing with them in the first place.

In general if someone is reasonable enough to listen to a logical argument with an open mind and come to a logical conclusion based on a reasonable premise then they probably aren't conservative to begin with. Of course I'm sure there are some conservatives that have an open mind and are willing to grant a logical point and hopefully some day I'll meet one.

[slipslidingaway]

6. At this point I believe we have to try and convince the Democrats...

that a SP system is the best course.

Welcome to DU

:)