Count me as straddling--I'm covered but my children are not. They have outgrown family coverage and are a long way from affording it solo.

Of course, even national health would see those with the dough buying services the rest wouldn't have access to, but it would be like police protection--at least there is a minimum level.

Another thing about Universal coverage would be that the medical service providers could start services immediately without concern for getting paid. If it were a single payer or if the administration procedures were standardized in some other manner, a quarter of what is presently paid by medical service providers to make sure they got reimbursed would no longer be necessary.

That's enough to cover everyone and also remove a lot of the nasty co-pays.

Our society is paying out $billions simply because of refusal to change to a half-way efficient system

It wouldn't HAVE to be that way though. Since we don't have a system in place, one could be structured that would take the best features of any plan and make it work. Some referrals and pre-authorizations make sense, however. No one should go to a neurosurgeon for an initial evaluation because of a headache. Or even to an orthopedic surgeon as a first stop for back pain. Some GateKeeping is important to make the system work well. And some co-pays will discourage people from (for example) going to the Dr. so they can skip work for the day -- when I worked at Group Health in Washington DC (my first job as a nurse practitioner)-- I saw quite a bit of that.

The reason that it CAN work is that with everyone included (healthy and sickly, old and young, risk-takers and risk-averse) the financial risk is spread out as it currently is NOT with Medicaid and Medicare.

One reason it is being fought tooth and nail (even if you leave out insurance & drug companies) is that members of Congress would then have to be included with the great unwashed. Currently they have a golden health insurance policy which is unequaled anywhere else I have seen, and they really couldn't justify keeping their current system, (even though they continue to justify staying out of Social Security). They don't want to lose it, and I don't blame them, but sometimes -- and I know this is a really tough thing to wrap their brains around -- SOMETIMES YOU JUST HAVE TO DO THE RIGHT THING!

what a concept!

Jan Knaus

The new 1.3 million [uninsureds] represents a continuing expansion of middle class people who can’t afford health insurance. [emphasis added] Elizabeth Warren

This unsupported claim is likely wrong.

In broad terms we know that last year 15.9% of Americans did not have health insurance -- private or government (Medicare, Medicaid, military, SCHIP, or individual state health plans). But who were those people and why didn't they have health coverage? That, it seems to me, we don't know.

We do know that for young, healthy workers and for families who have few assets or whose principal asset consists of an exempt homestead, choosing to purchase private health insurance is, economically, a poor choice. For them, the premiums are grossly in excess of actuarially computed benefits -- that is, they are being forced to subsidize employer and government health costs.

To the extent that these uninsureds have made an economically rational decision to go "bare," why would they want to enter and pay for a universal health care system?

But would you pay $10,000 a year for fire and casualty coverage of a $100,000 property?

Property insurance and health insurance premiums are, unfortunately, apples and oranges.  The former are, actuarily, quite rational; the latter -- not so much.

If people are making an economically sound decision to go bare, now, how do you propose to convince them that paying a premium for universal health care insurance is a good deal?

The "sound" economic decision is the simple impossibility of purchasing the insurance.

Medicare and Medicaid are something like 1/4 or so of the federal budget, I think. So I'm now paying the better part of $10,000 into a medical fund for others, and myself when I get old and broke. With a full national system, most health expenditures are in people's late years anyway so the cost should not go up hugely, overall. (Lots of old folks using Medicaid now.) So I would pay about the same as private, which I would have to do anyway, the wealthy probably spend more than I would anyway, and the poor would be covered.

Also factor in the improved protection to society in infectious disease, the reduction in clogging emergency rooms with their high expense, and the improved health of children in poor families leading to more productive and longer productive life, and I don't see a finanical argument against national health.

Mirkin, which I understand is an alternate spelling of the specialized hairpiece, the merkin.

AFAIK, he's still doing radio, or was a couple of years ago. They dropped him in the DC area. I'm not quite sure I was prepared to drop my journal summaries and Medscape page, but, especially when he was on the car radio when I commuted, he had a very good handle on new developments--if one called or wrote the office, they were happy to give you the relevant journal reference, and often copy the papers.

--
Howard

*equal opportunity offense to both extremes*

You're abso-tootly-ootly right Ellen. We don't need universal or any other kind of health care system. People go uninsured because they want to go uninsured! And if they're going to die they should just get on with it and decrease the surplus population.