Time For Single Payer?

San Francisco Chronicle ^ | December 29, 2003 | Ruth Rosen

[Scenic Sounds]

DON'T BE SURPRISED if health care turns out to be the sleeper issue in the 2004 presidential campaign and if a majority of Americans eventually decide that a single-payer system is the most cost-efficient way to provide health care for everyone.

[Scenic Sounds]

Ms. Rosen obviously supports a single payer system. However, the thrust of her column here concerns the political viability of the single payer proposals.

There just is a growing dissatisfaction with the way our current health care system functions. If we want to encourage private solutions to these problems, we need to come up with some proposals which actually work.

[szweig]

Howzabout pay-for-service. You go to the Doc's office...it costs you, say, $25 for the office visit. Plus extras. All fees listed in the office. You pay as you leave, either with cash, check, or credit card. Presto! No insurance costs. No extraneous people to add costs to your doctorr visit. No 'gubmint' bureaucrats getting their noses under the tent. The way we used to do it. Cheaper all around once prices settle in.

[Taliesan]

Physicians who recently resisted a single-payer system have grown increasingly resentful of HMO bureaucrats who micromanage their medical decisions. Inadequate reimbursements are driving some out of business. They also dislike having to consult dozens of drug lists or formularies before they can prescribe medicine for their patients. They'd rather spend time caring for sick people.

And putting the federal government in charge of all health care will, of course, stop the micromanagement, increase the reimbursements, and prune out the regulations.

Alice.

[Robert A Cook PE]

Socialized medicine is the holy grail of the left, and it's used by the international socialists as their prybar into people's conscious.....

To get socialism into effect, they MUST get people feeling guilty about the poor and elderly. Women. Minorities. Children above all. And anybody else who they can foster false sympathy by exploiting - by exaggerating true problems when real problems exist. (This time, by citing heart attacks in the "wealthy.")

By lying when they don't false stories to exaggerate.

They begin their praise of Cuba, for example, by noting it's socialized medicine. And that, socialized medicine, excuses ALL other ills in communism and socialism.

They NEVER, EVER, want to point out the failure of socialized medicine in EVERY case that is forced on an unwilling citizen by the government.

[ken5050]

If the author thinks that HMO bureaucrats are bad...wait till he meets GOVERNMENT bureaucrats..

another point not raised..most of the Dems supporting a single payer system are also in bed with the trial lawyers....and ANY serious effort for a single payer system will have to include a real cap on lawsuits...

BTW...everyone forgets that the various state governments were the ones who screwed up the HMO concept, whaich, at the start, held promise of real reform....HMO's stated in responsed to the traditional reimbursement type of insurance coverage..where there was NO incentive to curtail costs, they were just passed along..in the 70's..medical premiums were going up by 30-40% every year...but as soon as HMO's started gaining traction, governments started imposing minimum requirements, and mandating all sorts of coverages..which drove costs through the roof...

[RiflemanSharpe]

As more and more people find it harder to get medical insurance at there jobs, McJobs do not usually have a good benefits package. They will start to look for it at the voting booth.

[TheBigB]

Health care is a human right, not a privilege.

Start with a silly premise, get a silly article.

[Taliesan]

These are people whose votes could be captured by any candidate who promises to reduce their anxieties about getting health care.

I expect any day now to pick up the newspaper and read some "journalist" advocate giving every person within our borders a check for a million dollars.

[governsleastgovernsbest]

Why stop with health care? Why not single-payer for all the necessities of life? Let's have government provide free housing, food and clothing. For that matter, why stop at necessities? If the rich would pay their fair share, all of us could be driving a new car every two years with a minimum of 6 weeks paid vacation!

This place could be a paradise for workers, just like, uh, the Soviet Union!

[Glenn]

The way we used to do it. Cheaper all around once prices settle in.

Great for a visit to the Doc. Not so sure many peple have $50 or $100 thousand laying around for heart problems, though.

[Alberta's Child]

If we want to encourage private solutions to these problems, we need to come up with some proposals which actually work.

There's really only one "private solution" to these problems that will work, and that is a complete separation of medical insurance from a person's employment. There's no reason why employers should have any business paying for these things, except that they were an anachronism of the U.S. economy that dates back to the price controls of the World War II era.

Businesses, which seek a level playing field, may also become supporters of a single-payer system. Consider the inequities they face. General Motors, which has a huge group of retired workers, must pay for their lifetime health costs. Newer companies, however, either don't offer health-care benefits to workers or retired workers or don't yet have any retired workers to worry about.

Correction -- Some huge, old-line companies are strong supporters of a single-payer system, which is one of the major reasons to oppose such a system. These companies are not interested in the health of their employees, or in the advantages of one type of system over another -- they are only interested in taking one of the top cost items off their books. Better yet, they want to take one of the top cost items off their books and replace it with something that will no longer be subject to a collective bargaining process.

[Alberta's Child]

That's what a catastrophic policy is for. The single best strategy for dealing with high medical insurance costs is to purchase a policy with a high annual deductible (say, $5,000 or so) -- that way, you'll only be using it for major medical costs.

[templar]

Howzabout pay-for-service.

Put way too many people out of work. You ever think about how many people are employed by the current system? Consider this: we no longer employ many people to produce things, so we have to employ increasingly large numbers in administrative, management, financial, and other make work type of jobs. (or pay very high taxes to support them on the public dole for doing nothing)

[possible]

The article says, "...our health system -- a fragmented hodgepodge of private and public-health plans -- is broken." The very fact that we have a fragmented hodgepodge of private and public-health plans shows that we do not, in fact, have a system. We have something called liberty. And liberty is worth more than any health care system you can imagine.

[Amelia]

If we want to encourage private solutions to these problems, we need to come up with some proposals which actually work.

I've always liked the medical savings account idea, but it seems to get little or no traction with Congress.

As far as the waits for emergency (and other) service the author thinks government health care would prevent, she obviously hasn't been reading any articles from the British papers.

[possible]

Yes. Socialized medicine is a failure. The stories are endless of folks denied care, dying while waiting for surgery, etc. Not in some third world country but in England and Canada.

[Uncle Hal]

Ruth Rosen is of one the Chronicle's most liberal columnists. That is really saying something because, with a couple of exceptions, they are all leftists.

[alex]

"There just is a growing dissatisfaction with the way our current health care system functions. If we want to encourage private solutions to these problems, we need to come up with some proposals which actually work."

Mandatory catastrophic health insurance, medical savings accounts for and voluntary insurance to cover issues not covered by mandatory part - this is the answer.

More information here on the current status and benefits of MSA http://moneycentral.msn.com/content/Insurance/Insureyourhealth/P35610.asp

Comparing to MSA's of today we have to raise deductible and increase insured group to whole population. Today (without savings of a really big group) the high $4, 500 deductible (not catastrophic) health insurance for a family of four will cost $377/month. Raising the deductible (to say $20,000) and increasing insured group we can get down to $100 for family of four and thriving free market of medical services and insurances covering every day medical expenses (70% of insured Americans don’t even meet or exceed a $500 deductible in one year).

We have just promote this is a health care plan not saving accounts plan - so people on the street would have a possibility to grasp the main advantage offered.

[Scenic Sounds]

I've always liked the medical savings account idea, but it seems to get little or no traction with Congress.

Medical savings accounts are an alternative. I think that the American people are becoming open to any idea which really works.

As far as the waits for emergency (and other) service the author thinks government health care would prevent, she obviously hasn't been reading any articles from the British papers.

I hear lots of criticisms about the systems in Great Britain and Canada, but are the electorates there unhappy enough to vote for change?

[Blue_Ridge_Mtn_Geek]

That's what a catastrophic policy is for. The single best strategy for dealing with high medical insurance costs is to purchase a policy with a high annual deductible (say, $5,000 or so) -- that way, you'll only be using it for major medical costs.
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Yes, a cat policy with high deductible would definitely be an improvement, though with the current "food chain" in place, it would put the otherwise un-insured population at the bottom of the cost-shifting game.

You know:
1. Medicaid and Medicare stiffs the providers as much as they can politically get away with it, with the unrecoverable costs shifted to everyone further down the food chain.

2. National private networks of HMO/PPO use their large shares of the private market to negotiate deep discounts from the providers' sticker prices. Excess costs not recovered from 1 and 2 shifted further down.

3. Costs shifted from #1 and #2 get partly absorbed by the households covered by regional insurers and "self-insured" corporations (who manage to limit their losses by low-balling the "Usual and Customary" fee schedules they use to determine what they actually cover).

4. Uninsured households with minimal income, but too much to qualify for Medicaid, use the Emergency Rooms and other Urgent Care facilities to handle their routine medical services requirements, generally blowing off the bills, which are then shifted to the final group:

5. Households with "cat cover" insurance only, whose bills are loaded with the costs shifted from 1-4 to them.

Unless major reform that eliminates or at least greatly mitigates these various cost-shifting scams, households in category 5 will simply be the "great cost absorbers" at the bottom of the medical system food chain.