The single-payer plan: Save a child, commit a crime
Sure enough, Mike Dennison has followed with a second article that is a paean to the “even bigger government” health care option, the Single Payer Plan. Again, the gist is that there is this great single payer alternative out there, but it might be hard to adopt because of all the special interests that would fight it.
Dennison writes, “Single payer or a regimented national plan also is how nearly all other countries run health care and cover everyone – and at a lower price than we do, because it’s more efficient.”
Not hardly.
First: Pure single-payer means the government pays all the bills. If you hire a doctor on the side using your own funds because your desperately-ill child is on a waiting list and can’t otherwise get care, you are committing a crime. Few countries have such a vicious system. And countries, like Britain, that used to have purely “regimented national plans” (Mike Dennison’s phrase) are headed toward more mixed systems. (I’ll give an example in a future post.)
Second: As anyone who works in government knows, the costs as reported for government programs are nearly always understated. They often don’t include capital expenses. Or costs are kept down by deferring necessary longer-term investment (that’s why it has been so difficult to get certain kinds of procedures in Canada). And, of course, they never count the costs to the economy from the taxes necessary to pay for the system.
Third: Under “regimented national plans” the waiting lists generated in government programs are themselves a form of uncounted cost – because pain and death saves money.
Fourth: The U.S. has the most innovative health care in the world for a reason – that despite the fact that government and insurance companies dominate the system, they have not yet quite taken it over completely. More government control means, of course, less of that innovation. Another prospective cost.
Fifth: The cost in privacy and autonomy of government medicine can be staggering. (Remember the British Columbia lost health records scandal?) Are you worried about a few hundred prisoners at Guantanamo? That human rights problem pales before the prospect of several hundred million prisoners of government-controlled medicine.
If the 1990s should have taught us anything, it is that “regimented national plans” don’t do anything well except (a) conceal their failures for as long as possible and (b) offer politicians options for “constituency service.”
Well spoken for the 37th best health care system in the world! We’re 37! We’re 37!
1. All countries that offer universal care must ration and triage based on need. Less important procedures must wait. We’d be doing that here save that we ration based on money and don’t provide services to 47 million except in emergencies, and then only to stabilize, and not treat.
2. If the costs of Medicare, Medicaid, SCHIP and VA are “understated”, you’d better put up something better than “everybody know”. How about “All the Helens in the world agree”?
3. The American notion that ‘ferners ‘ are on waiting lists for vital health care needs is mostly useful domestic propaganda. Yes, tehre are waiting lists for non-life threatening illnesses. We’d be doing that here if we took care of everyone. All countries ration – our system is based on 1) money, 2) access to employer-sponsored care, 3) access to government-sponsored care, and 4) good luck.
4. Most innovation (not all) comes from government sponsorship of outfits like NIH, colleges and universities. It is already government sponsored.
5. Medical privacy is now protected not by private companies, who are dying to share information so they know who to reject for coverage, but rather by government.
Max Baucus has done what Max always does – he takes a vital national movement for improvement of our health care system (47 million uninsured – you forgot to mention that), and turns it hard right. He’s preserving the private insurance model, complete with all of its bureaucracy, profit margins, and inefficiency. That you support such a system (it is the best the free market can do, after all), is no surprise. But your reasoning is full of holse big enough to drive an MRI machine through.
Finally, you say nothing about the 65% of us (according to USA today last December, but steady for decades) who want national health care. Are you an elitist? Is what we have now not dictated top-down? Are we a functioning democracy?
<a href=”http://pieceofmind.wordpress.com/2008/12/01/max-baucus-faux-bonhomme/
“>Read more here
I’ve read every word of Max’s ‘white pages’ and it is mainly fluff, and could never be implemented without a constitutional amendment.
I’ll give you my reasons for that;
(1) The Democrats are much too beholden to the trial lawyers to allow any meaningful tort reform.
(2) There is virtualy nothing the federal government can do about costs, since the hospitals, and pharmaceutical companies are all privately owned. The government can’t just show up and take over their businesses. All the government can do is shovel money at them – taxpayer money.
(3) The government has no authority to go into the insurance business, in direct competition with private companies.
(4) If there was Constitutional Authority, which their isn’t now, the federal government would have to buy, or seize all health care facilities, pharmaceutical companies, close private insurance companies, and then employ all the doctors, chemists, nurses, janitors, etc., and then you’d have universal health care. Tort reform would not be needed, as you cannot sue the federal government for malpractice.
It’s all talk right now.
Some of the chowderheads I work with were anxious to elect Obama, so they could get the free health insurance they believe he promised them.
They’re going to be waiting a long time!
Mark T. – your posts are for an audience of one.
Eric – nice post. Universal health care in the United States, as some on the left envision it (the feds are going to run the show), is not going to happen.
Mark T. – I have read several articles in the Tribune about high risk pregnancies transferred from Calgary to Great Falls. This was done because of a lack of services in the patients home country. Imagine that a city with a purportedly superior health care system and over a million in population sending their most fragile to a little American city of less than 60K. I have yet to meet a Canadian as happy with their system as you are.
Wolfpack – that’s purely anecdotal. Surveys in Canada find the vast majority 1) are mostly satisfied with their system, though it is fraught with troubles due to rising costs, like everywhere, and they do have waiting lists for non-emergency problems, a byproduct of universal care, and 2) they don’t want our system.
Border traffic between the two countries is mostly mythological. Check out Phantoms in the Snow.
I recently went through a horrible experience with the U.S. Postal Service. Mail not being delivered on time if at all. Bills never delivered. Mail damaged.
I also receive a lot of FedExs and deliverys from UPS. I have never had a problem with the private sector’s delivery of my packages…..given my experience, why should I trust the public sector’s delivery of my health care?
Nonsense. Postal service has never let me down. Never. It gets worse -they have unionized employees who work their whole careers there, who are dedicated and who do a good job. Un-american.
Un-american? Wow.
Ok. I won’t doubt your fantastic experience with the Postal Service. Let me ask you this then……if you need to send (or receive) and absolutely critical piece of mail do you send it via regular mail with a 42 cent stamp? Or are you willing to spend extra money to send it registered…or certified. Or do you send it via FedEx or UPS, also spending more money?
Mail within state and nearby states, one day. Mail to other locations, two days. If it is critically important, I send it overnight, using either UPS or FedX or the Postal Service. They all provide that service.
I don’t know what your problem is with the postal service – that’s like a talking point from 1975 or so. How are you feeling about that President …. Carter?
I told you what my problem was with the postal service….you chose not to believe me and call me Un-American.
My point is not on whether the delivery is overnight or in one or two days (for what it’s worth, that has been an issue with my Postal Service experiences), but whether you are willing to spend more money to ensure that the job was done right (i.e., registered or certified mail, or FedEx/UPS with their tracking capability).
From that, I think that you can see what my point is in regards to the Health Care.
With that, I will not question your patriotism, or where you get your information from and what year you got it in.
I apologize for derailing the thread, and will slink back into the night.
As a physician, I have an opinion or two on this subject. I will try to respond to a few points above, without ‘taking sides’ so-to-speak.
My partners and I will see any patient who needs our service, regardless of ability to pay. If an individual is uninsured, after the visit or procedure they get a bill like everyone else. Some pay in cash, others enroll in a payment program, and many simply do not pay their debt. When I do not get paid for my intellectual training or surgical skills, I consider it a service to the community.
In addition, those of us with hospital privileges are obligated to take call for the community. On Thanksgiving eve, I admitted three patients (two of whom required surgical intervention) without insurance. In one case, the patient’s situation is a result of mental illness. The other two patients were both employed, but without employer-sponsored healthcare benefits. Both were young males below the age of thirty, and apparently did not feel compelled to purchase their own health-insurance, relying instead on the safety net of a hospital emergency department and on-call surgeons. Oh, and both have a recent history of methamphetamine use…
Unfortunately, many of the uninsured folks in this community, as well as our entire nation, make poor decisions simply due to this perceived safety-net. Obvious examples include alcohol and drug use, unintended pregnancy, smoking, driving without your seat-belt, etc.
Yet the more insidious poor decision-making involves the lack of preventative care. Say you have high blood pressure. You do not seek medical care, or do not fill your prescription, due to cost concerns. And then you suffer a devastating stroke. The $200.00 doctor visit and cost of medication was a far greater return-on-investment than the 7-figure hospitalization, surgical intervention, and rehabilitation stay. After which you will never be able to return to the work force, nor care for yourself. But after spending (2 packs/day x $3.25/pack) $2,340.00 per year on cigarettes, there just wasn’t enough money left over to pay the $50.00 per month for high blood pressure pills…
Mark T. mentions lack of access as a concern. True, to a degree. Yet every patient I see as an emergency, I treat (stabilize), then offer follow-up visits to try to prevent future emergencies. To a degree, this is for selfish reasons; I would much rather see an uninsured patient at a scheduled visit, than in the middle of the night when their chronic problem becomes that emergency. But you would be surprised how many folks do not take advantage of this ‘deal’, and the next time I hear from them, they are back in the emergency room (and I am cranky).
Now to address the “myth” of border traffic for health-care. True, when I was down south, I did not treat many foreigners. Yet in Montana, I see between 5 – 10 Canadians per year. Many will present with their diagnostic studies in hand (‘cause they’re free!), and request the necessary surgery here in the U.S. due to the long wait back home. And when I trained in California, we delivered more Mexican babies than American babies (sometimes 12-16 per day!). This was not due to long waits for access to healthcare, but due to the fact they did not HAVE access to care in Mexico.
Finally, I believe we have truly good and timely care in America. Cost-efficient no, but health-efficient yes. Admittedly, I order too many tests, many of which I know will be of little value in making a diagnosis nor changing the course of treatment. It may surprise you that I don’t (typically) order these tests in order to “C.Y.A.”, nor am I afraid I will be sued if I don’t order every available study. No, it is usually patient-driven. Patients are well-informed, and feel entitled. They more often-than-not present with a sheaf of papers off the Internet, requesting the latest-greatest CT/MRI/PET scan, or with jingles from direct-to-consumer advertising on their mind (“Viva Viagra”), requesting the most expensive drug or therapy out there. As concerns the cost of health-care in America, we are our own worst enemies. We want it all, we want it now, and to hell with the cost to society (it is expected we will spend 4.2 trillion dollars on healthcare in the U.S. by the year 2016, or 20% of the G.D.P.!).
Americans will never stand for a single-payer (Government) plan. We have been spoiled by the quality and efficiency of our current healthcare system. But I do fear the Democrat platform, where individuals (who pay taxes) and businesses will foot an even larger percentage of the healthcare costs for America’s 47 million uninsured (“Provide new tax credits to families who can’t afford health insurance, and to small businesses with a new Small Business Health Tax Credit; require all large employers to contribute towards health coverage for their employees, or towards the cost of the public plan”).
There are 45 million uninsured. About half are young and healthy and/or simply don’t feel that the health insurance expenditure has value compared to other things they want to purchase. They go to the doctors’ office or emergency rooms when they have medical problems and generally get excellent care. They may or may not pay their bills. The other half is low income. Many of these patients have Medicaid. They get both preventative and urgent care essentially free. They charge their bills to you via taxes. There is a group of people who are in significant need but do not qualify for Medicaid. Some of these patients are the working poor and some are the nonworking poor. They still get care, either in the doctor’s office or the ER. They often rack up large bills and either struggle to pay them off or just ignore them for a variety of circumstances.
The problem with the spiraling cost of health care could be contained by improving price transparency, reducing regulation, offering catastrophic coverage, allowing Medicare to negotiate to some degree with pharmaceutical companies, malpractice reform, and most importantly setting up a system in which the patient is able to individually decide for most services how they will spend their health care dollars.
Buying health care should really not be that much different than buying food. Without food, you will starve in a couple of weeks. Everyone has a right to food. Should we expand the food stamp program to cover all Americans? Doesn’t everyone deserve the same quality and quantity of food in a timely manner? Do we need to create a Universal Food Care system to more equitably allocate, ration, and distribute food?
Personally, I think it would be better to just tweak the current system and have you manage your (insert need here; i.e. food, housing, transportation, clothing, recreation, gaming, sex, technology, etc) care on your own.
In my view, phrasing the question in terms of getting more people insured misses the crux of the problem, which is too much insurance, not too little. We are not going to make medical care affordable again unless patients pay directly for most day-to-day care, in which case it will almost certainly be far cheaper than it is now.
There is a role of third-party payments in the system, but it should be the exception, not the rule — catastrophic events and care for the poor come to mind.
Rob – you’re missing some critical data – our health care system is not overburdened by over-consumptive patients – that is a talking point not borne out by data. The system is strained because of large expenditures on a small part of the population – that’s the nature of the beast. Medical emergency can happen to anyone of any income level, and quickly wipe them out. 1% of health care patients consume 22% of the costs, and the 80/20 rule doesn’t apply. Controlling small expenditures will have negligible impact on the overall system.
Rooster – your input is valued, and thank you. I note that your cross section of experience is small. For instance, studies have shown that the number of Canadians seeking care here in the states as refugees is virtually negligible. In addition, in a system where so many are uninsured and incomes are so low and costs so high, people don’t seek care until it is a emergent care situation. And it is true that public health in the US is a disaster, what with fast food and smoking among the poor. Is the private sector doing anything about that besides offering more cheap high fat high sugar food? At least the public sector is taxing cigarettes to reduce smoking.
“I am with the government” – here’s the breakdown of the makeup of the uninsured population: 47 million uninsured, 46.4 million under age 65. 2/3’s have a high school degree or less, meaning they don’t have access to employer sponsored health plans. 50% have income below $30,000, meaning they can’t afford individual policies, which are highly priced to avoid adverse selection. 9.4 million are children under 19. One-fifth are foreign born but here legally (illegals are not likely to expose themselves by presenting themselves at emergency rooms.) Income breakdown: <$10,000 (16%), $10,000-$20,000 (17%), $20,000-$30,000 (17%), $30,000-$48,200 (22%), over $48,200 (28%). Within that high income group you will find many people who can afford insurance but cannot get it because insurance companies reject them.
Mark T. – are you proposing that the government legislate good health?
Maybe making alchohol and tobacco illegal maybe?
Maybe pulling lard off of the store shelves?
Making all soda be sugar free?
Ban deep fat fryers?
I don’t see where the government has the authority to tell me what to eat, or if I should excercise regularly.
And if I eat a tub of lard every week, balloon up to 450 lbs, and develop a heart condition I should be guaranteed health insurance?
Some societies struggle to feed their citizens. We, on the other hand, lament the fact that our food is so cheap and crappy that many of our poverty-stricken are obese.
What a world!
[...] at Electric City, Rob Natelson contends that the mere existence of a third-party payer causes prices to increase because consumers [...]
Eric – I don’t know the solution to the obesity problem. It is caused by poor diets and lack of exercise. You’re right that government cannot mandate healthy eating. But the anti-smoking campaign, financed by government, was effective. Maybe a similar PR campaign on healthy eating and exercise would help.
As it is, type II diabetes is a major health cost drain.
Mark T, the only effective way to change “risky” behavior detrimental to health is for those that indulge in it to bear the downside cost. When that cost is shifted to others to fund, the behavior continues.
Isn’t Natelsen a government employee, with health care benefits paid by same? Baucus and the rest of the Montana delegation happily accept taxpayer-funded plans, but won’t extend the same opportunity to working families who can’t afford private insurance. They’ll never face personal bankruptcy due to a medical emergency like the thousands they “represent” with no safety net. What’s fair is fair.
There’s another point people are missing here. Simply “having” insurance often doesn’t mean anything. If you folks really want some entertaining reading, check out the Montana Code Annotated Annotations under our bad faith insurance statutes–all sorts of fat-cat, out of state insurance companies denying people the coverage they’re clearly entitled to.
I’m not sure what this puts into the equation. Maybe Rob’s right, and they should be taken out of the equation entirely as mere surplusage that mucks up everyone’s lives. On the other hand, maybe the government should step in. On the other hand, who do you sue if the government denies your claim? I hope they wouldn’t, but it might make it harder to get any recourse in the courts.
Ladybug: Why is the fact that Prof. Natelson might have his health insurance provided by the state as a state employee any different from anyone else who might obtain health insurance coverage from his or her employer?
Hmm: You said “If you folks really want some entertaining reading, check out the Montana Code Annotated Annotations under our bad faith insurance statutes–all sorts of fat-cat, out of state insurance companies denying people the coverage they’re clearly entitled to.” You’re not assuming that “all sorts” of things are happening because there are statutes prohibiting them, are you?
Let’s see. A government employee, as part of his or her compensation package, receives health insurance coverage. Therefore, the only “fair” solution is that everyone gets free public health insurance?
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[...] violate the underlying principles of the American government, and that national healthcare would criminalize treating a child outside of the federal system, but his winning argument was clearly that because of abortion, [...]