A single payer healthcare system is ultimately our most efficient choice
Our current health care system will be the demise of our country unless we get a single payer system. Read these points with an open, objective, non-partisan, and non-idealistic point of view.
Insurance for anything works because a large group of random people each put a small amount of money into a fund to pay for the loss that is incurred by the unlucky few. This prevents any unlucky event that one is insured for from bankrupting them.
Most insurance companies are for profit corporations and as such have a CEO, CFO, president, board of directors, salespersons, other employees, and shareholders to which dividends must be paid. Therefore the total amount of money any insurance company can payout is the total amount of insurance premiums collected, plus any income or loss made on the investment of those premiums, minus the salary of the CEO, minus the salary of the CFO, minus the salary of the President, minus the salary of board of directors, minus the salaries and bonuses of salespersons, minus the salaries of other employees, minus the dividends paid to shareholder.
This scenario works well for insuring just about everything except health care. In order to cover those large non-healthcare expenses, insurance companies must attempt to insure only healthy people thus denying many with preexisting conditions any coverage. They must deny as many surgeries and procedures they can get away with and they must deny many medications.
We have tried PPOs, HMOs, and everything in between and they have all failed to reduce cost, increase service, or insure everyone.
A for profit market based system for creating medicines, medical procedures, and medical devices is likely the best way to ensure that we will realize innovations in medicine. That said, as a country we must decide if delivery of these health care services is more efficient with for profit insurance as opposed to a single payer nonprofit based insurance system. After careful analysis, the only solution to our healthcare problem must begin with a single payer insurance that does not restrict which doctor or hospital you use. With a single payer system:
- Duplicate staffing at doctor's offices working with multiple insurance companies and medical plans no longer exist thus reducing the doctors cost to deliver healthcare
- Exorbitant salaries to multiple managements vis-à-vis multiple CEOs, CFOs, presidents, and the like no longer exist and as such more monies to deliver healthcare
- Stock holder dividend payments no longer exist yet again more monies for healthcare
- Health Insurance salesmen's' bonuses and salaries no longer exist yet again more monies for health care
- Given that every American at some time gets sick or gets into an accident that ultimately we all pay for directly or indirectly, every working American should contribute to the single payer pool. The unemployed must be covered as well
Many argue that a single payer system would be restrictive. It is untrue. HMOs and PPOs are very restrictive. They select the pool of doctors you may choose from. They select what procedures and surgeries are allowed. They select what medicines can be prescribed. Why; because of their bloated cost structure.
Many argue falsely that it would be too expensive to include the uninsured. Every person paying for health care insurance directly or indirectly is paying for the uninsured given that they are not denied medical coverage anyway. They simply get more expensive coverage in emergency rooms.
Over the last 25 years we have allowed a very destructive thought to metastasize in our brains. We have allowed politicians and private enterprise to convince us that all government is bad, though when private enterprise has failed, they have constantly begged the government for rescue. The reality is that we must have a balance between both. Our health care system needs a competently run government. Government and competency are not mutually exclusive. We are the government and we can make it as competent as we want it to be first by electing competence instead of ideology.
We are at an impasse with health care. It is imperative that we open our minds and look at the problem objectively, factually, and by the numbers. A single payer system is ultimately our most efficient choice.
Tell me your stories at http://singlepayerhealthcarenow.com/.
You just cannot use a capitalist tier system to decide which child can be treated for breathing disorders and which child cannot.
If you have level A insurance, you get this treatment.
If you have level B insurance, you this and so on.
And 48 million can show up at St. Elsewhere at three AM. BULLSHIT.
You are right on the money. We must have one insurance policy for everyone.
And when Jughead on Mornin Joke talks about 300 million getting MRI's I say, EVERYBODY GO OUT AND GET AN MRI. I get so gd mad about this. Good post.!!1
April 6, 2009 7:44 PM | Reply | Permalink
You've got it right. We face a choice. On the one hand we can have health care for all our people and improve the health of the nation by adopting a single payer plan like all the other major nations on earth. On the other hand, we can sacrifice the nation's economic and literal health on the altar of profits for a handful of executives and shareholders who don't give a damn whether any of us live or die.
April 6, 2009 9:24 PM | Reply | Permalink
You make a good case. But I don't think the conceptual elegance is all that important. Germany doesn't do this but their system works very well. Contributions from employers and employees go into a sickness fund:
It sounds complicated and it is, but it WORKS. There is no reason we can't make a system that covers everyone by broadening and more tightly regulating our current system. It's not the system that is the problem in the US, it is the incentives and lack of regulation: Doctors, drug makers, insurance companies are all unregulated and try to maximize profit and drive up prices. In Germany, with public insurance, none of that happens. Doctors get a flat-fee for seeing so many patients per month. The "sickness funds" are not for profit, kind of a semi-public entity, so they don't try to squeeze you. And the unemployed have their insurance premiums paid out of the unemployment check.
April 6, 2009 11:05 PM | Reply | Permalink
Well, you need to consider that gov't employees will be getting a salary too, and the gov't has never been efficient in anything, so there will be massive growth on their end. In addition, the DMV is a typical gov't run agency, how would you like them and their bureaucracy running your health care? Don't just assume gov't run will be well run. It seldom is. Private comapanies have a profit incentive, but gov't also has incentives and agendas, usually involving increasing their power and budget.
April 7, 2009 7:50 AM | Reply | Permalink
"the gov't has never been efficient in anything, "
Bah! You ever hear of the VA? Their medical care is excellent and they reduce costs. We should have a VA-type system that the uninsured could opt into.
April 7, 2009 9:33 AM | Reply | Permalink
In these serious times it is imperative that we stick to the numbers. The insurance companies constantly try to blur the realities and the Right Wing inflames the issues by fomenting government distrust. The numbers simply do not add up. Congress is complicit, both Democrats and Republicans and to some extent the President for not giving the true numbers to the population at large. Last I checked Medicare overhead is 3% while private insurance overhead is 30%.
April 7, 2009 10:34 AM | Reply | Permalink
Too much attention is placed on who pays instead of addressing why care is expensive. Doctors have huge overhead, insurance, staff, etc. Drug companies face massive costs due to gov't paperwork and huge insurance costs. To reduce cost of care, shield drug companies from lawsuits over FDA approved drugs - unless there is proof of fraud in the application process FDA approval should mean the company can't be sued. Reduce the required paperwork, shorten approval process. It should not cost a billion to develop a drug (costs which must be recouped before the patent expires). That's why drugs are expensive. Force med schools to increase enrollment. Allow NP's and pharmacists to handle simple procedures and treatments. Again, reduce the paperwork. That would lower medical costs. On the insurance side, treat health insurance like life insurance - your premiums depend on when you sign up. You can't allow 20 and 30 somethings to skip the system and then expect to have cheap insurance available when they hit 40 or 50. And you can't provide coverage to people who simply choose not to pay - there must be an incentive to participate. I know people who have no insurance because they just don't want to pay, so they expect the taxpayer to foot the bill if they get sick. No system will survive if you allow that, you can't get something for free.
April 7, 2009 8:25 AM | Reply | Permalink
Drug companies are just as criminal as the insurance industry. The us subsidizes drugs for the world, many of which simply don't work or are too dangerous compared to their limited benefit. The lawsuit bullsh*t is just bullsh*t along with the paperwork claim. A little light shed on the drug companies and what they do will go along way in solving those costs.
Bottom line, costs are out of control and need to be aggressively addressed by the feds. Also, we need single payer. It's the most economically efficient and the way to go. Medicare covers the sickest group, or likely to be sick, in our society already. Just expand it to cover all and overall costs will go down dramatically and make the us more competitive in the global economy. Without it, we will keep floundering and our quality of life and wealth as a nation will continue to decline, as it has been for the last 38 years.
April 7, 2009 9:01 AM | Reply | Permalink
Single payer is the holy grail, but do we want to wait FIVE MORE DECADES to get there? After all, we've been holding our breath since Truman.
Let's regulate now, set maximum prices, and have effectiveness comparison. Expensive treatments that don't work will be discarded and we will save money. As it stands now, the drug industry revisies their med slightly, gets a fresh patent, and 7 more years of profit -- all for not really treating disease any better. Boniva is another drug scam -- easier to take, one pill for weeks, but costs tons more. That's the kind of pre-bubble luxury item the public doesn't need to fund. (And we ARE funding it -- high insurance premiums being deducted from our paychecks so that makers of Boniva get rich)
So let's take a shotgun approach -- seize every opportunity to expand health care, regulate drugs and costs, and rationalize our system.
Or to use a baseball metaphor, let's get some singles ans doubles, instead of pinning all our hopes on a home run.
April 7, 2009 9:38 AM | Reply | Permalink
Observer2
Your approach seems more practical on paper and I have been fighting that thought in my brains for some months now. I think though this is the moment for a shock. I am willing to have it in the manner of having the government expands Medicare to everyone who wants to join. That by itself would cause most insurance companies from writing basic healthcare policies because of the difference in price from savings. That is why last week the insurance companies said they would begin covering everybody including those with pre-existing conditions if the government gives up creating a government alternative.
April 7, 2009 11:06 AM | Reply | Permalink
I definitely can see your point of view. Maybe bold is better. But at this point, I am willing to try anything. I don't know enough about this issue or politics to say what will pass at this point. But I'm hoping and praying for progress, and I do expect that even if we do get progress this year, we will still need to keep pushing for years to come.
Another sports metaphor -- a marathon not a sprint.
April 7, 2009 11:58 AM | Reply | Permalink
Anyway, bravo for a great discussion.
April 7, 2009 11:59 AM | Reply | Permalink
Agreed.
April 8, 2009 2:54 AM | Reply | Permalink
The approval process is already too short. New drugs are rushed to market without any long-term studies to determine just how bad the worst case scenarios might be. We are just starting to see the long-term consequences of drugs being used in more and more secondary ways, all of it approved by the FDA.
The FDA stamp doesn't mean a thing.
More deregulation isn't going to fix things. That has been the standard republican answer for more than forty years - cut taxes and deregulate. Business will take care of the rest. Well, we have been cutting taxes and deregulating for decades and it hasn't worked.
Make drug companies stop spending billions each year on marketing to consumers when doctors should be decided which drugs to use. We are the only country in the world that allows mass-market pharmaceutical advertising. Turn the health insurance companies into the non-profit organizations and set-up consistent, enforceable regulations for their operation.
I will agree that another bloated and unaccountable government program isn't the answer. More cowbell isn't the answer either. How about some creative, common sense and traditionally conservative solutions for a change?
April 7, 2009 9:41 AM | Reply | Permalink
You have valid points but more complex than necessary.
1. If everyone is required to have insurance we do not need to worry about when someone enters and charge accordingly. We need to make it law that everyone is covered. After all we will never deny coverage to anybody in an emergency room.
2. Drug companies are simply immoral. Their profits are obscene. Take a look at their stock, dividends, and bonuses over the last 25 years. The data speaks for itself. These guys do very little real research. We the tax payers give many grants for research on drugs and we get no royalties. They release similar drugs (Claritin vs Clarinex) in order to circumvent patent duration or they bribe Congress to extend patents. They should not be saved from lawsuits. Vioxx almost killed my wife and they knew of its problems. We did not sue and most people do not sue.
3. There is no reason to have a profit motive for redistributing money. That is simply legalized theft for something as important as healthcare.
4. Having one payer makes it efficient and also much more capable of performing data analysis on general medical outcomes.
April 7, 2009 10:56 AM | Reply | Permalink
the"Clever"Bulldog's false protestations aside (Medicare and VA are far more efficient than any private insurer, and, really--last time I went to the DMV, I waited 5 minutes. I wish my private healthy capitalist doctor's office was that fast), there exists one very simple fact:
Given equality otherwise, a non-profit is always cheaper and more efficient than a for-profit.
There is nothing about capitalist enterprise that would inherently allow it to be equal, let alone better; save that it feels it has no obligation to the public at large and can therefore cut corners, deny coverage, deny claims and employ various other similarly amoral instruments.
It could falsely be argued that capitalist corporations would pay the doctors better, but even if the premise were granted, I frankly do not want to be treated by a person who wants to make a lot of money: I want to be treated by a person who wants to heal people.
So, as with most things, healthcare by the people, for the people.
April 7, 2009 12:47 PM | Reply | Permalink
I concur. What's great about the VA and the Military medical care for that matter (even better than Medicare) is the integrated care. How I would love to see a system of integrated health care - especially one incorporating mental health in every aspect of care.
April 7, 2009 4:00 PM | Reply | Permalink
I absolutely agree. So how do we assure that President O'Bama remembers his same thoughts. Why has single payer been taken out of the equation? Or has it?
May 14, 2009 12:35 AM | Reply | Permalink