If I'm dead, you're dead, too
I can think of many reasons for a single-payer health care system, but one reason in particular absolutely convinces me that anything short of universal single-payer will never deliver effective care to all or control costs.
Being on Medicaid isn't a bed of roses. It's not the bottom of the barrel, in terms of medical access--that would be NO access--but it isn't like the medical insurance the upper third of our population enjoy, either.
When an operation for Dupuytren's contracture in 2007 left my right hand even more screwed up than before (nerve damage, new involvement of all fingers, accelerated progression), I sought a few second opinions. My choices were extremely limited because Missouri's Republican-controlled legislature has seen fit in recent years to slash Medicaid and tighten the reimbursement schedule. As a result, most doctors in the state won't participate in the program.
Although I did see a couple more doctors, I never found one who could explain what went wrong in that operation or could do anything about it.
Now you might think my experience makes a good argument against a universal single-payer system, but then you would be wrong. In fact, you would be making the same idiotic leap of logic that Republicans make.
As long as Medicaid exists as an alternative single-payer system, it will always be the red-haired, bastard stepchild of health care. Same with Medicare or local federally funded clinics. Because until we are all in the same boat, Americans will always tolerate second-class health care for those considered second-class citizens.
Understanding that if I'm dead, you're dead, too, makes all the difference in demanding the highest functionality from our health care system. Health care is a basic human right. Until it's implemented with that understanding, some will always be second-class citizens. And death will be more affordable for some than for others.
Being on Medicaid isn't a bed of roses. It's not the bottom of the barrel, in terms of medical access--that would be NO access--but it isn't like the medical insurance the upper third of our population enjoy, either.
When an operation for Dupuytren's contracture in 2007 left my right hand even more screwed up than before (nerve damage, new involvement of all fingers, accelerated progression), I sought a few second opinions. My choices were extremely limited because Missouri's Republican-controlled legislature has seen fit in recent years to slash Medicaid and tighten the reimbursement schedule. As a result, most doctors in the state won't participate in the program.
Although I did see a couple more doctors, I never found one who could explain what went wrong in that operation or could do anything about it.
Now you might think my experience makes a good argument against a universal single-payer system, but then you would be wrong. In fact, you would be making the same idiotic leap of logic that Republicans make.
As long as Medicaid exists as an alternative single-payer system, it will always be the red-haired, bastard stepchild of health care. Same with Medicare or local federally funded clinics. Because until we are all in the same boat, Americans will always tolerate second-class health care for those considered second-class citizens.
Understanding that if I'm dead, you're dead, too, makes all the difference in demanding the highest functionality from our health care system. Health care is a basic human right. Until it's implemented with that understanding, some will always be second-class citizens. And death will be more affordable for some than for others.
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We will be lucky if we get even a partial public plan this time around, I think Ripper. I would be happy with that because it is a step in the right direction. It might be possible after a few years to take things further.
If they don't include any public plan at all, which is what I'm afraid we'll end up with, then there is no change at all, no reform. It will be the same old system or worse. And yeah, they can make it worse.
June 18, 2009 3:43 PM | Reply | Permalink
My concern is that:
1. The 'public option' will be limited in the number of subscribers, compared to a full-on single payer system, thus diminishing savings from an enhanced negotiating power for reduced costs.
2. Such an option will start out with all the high cost subscribers to private insurance, who were culled from the rosters of the insured through increased rates following a loss of a job/expiration of COBRA, or flat out rejection of coverage. Ad to that all the elderly that are in the medicare system, and the pool of a public option plan will start out with all the most healthcare-expensive members of our society, rather than spreading those risks across the spectrum of our population.
3. We'll see what kind of 'poison pills' the Rs and the blue dogs are able to insert into the proposal, that will restrict its' competitiveness. With Numbers 1 & 2 above, a poison pill may not even be required to kill or severly stunt the viability of a public option.
In the end, we all lose. Not just health-wise either. We lose from being unable to curtail the rising healthcare costs in the country to our maximum ability through that decreased negotiating power resulting from fragmenting our healthcare system into multiple providers. From the *smell* of what's emanating from the halls of congress, we'll be revisiting healthcare reform for years to come.
June 18, 2009 4:07 PM | Reply | Permalink
Harumph. The elderly shouldn't add anything to the cost because we are already covered, kind of. But you're right, a partial public plan would get the people who were ejected/rejected because they either got really sick while they were covered or were sick before they applied.
Ezra Klein says reform is in trouble because of the cost the CBO came up with. Baucus wants to lower the cost by reducing the amount of reform. Interestingly Klein says the less reform there is, the more it will cost whereas more reform would lower the cost. I recommend the article.
June 18, 2009 5:30 PM | Reply | Permalink
I too took away the quote:
as the most compelling idea from the article. As Nate Silver says:
June 18, 2009 8:47 PM | Reply | Permalink
RM,
Well said! Now if we could get the Democrats... Hell, A Democrat to say the same.
Until a Republican Senator or Congressmen gets denied care, much of nothing will happen. As a matter of fact you could include more than a few Democrats in that bunch.
June 18, 2009 4:29 PM | Reply | Permalink
As long as Medicaid exists as an alternative single-payer system, it will always be the red-haired, bastard stepchild of health care. Same with Medicare or local federally funded clinics. Because until we are all in the same boat, Americans will always tolerate second-class health care for those considered second-class citizens.
Are you suggesting that private purchase of health care beyond what the government covers should be banned?
June 18, 2009 6:24 PM | Reply | Permalink
Not at all. Simply stating a fact.
June 18, 2009 7:07 PM | Reply | Permalink