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Tuesday, 12 February 2008
Stories that tell why we need single-payer
We continue to concentrate on the wrong thing -- getting the uninsured into the present system -- when we talk about health care reform.
Increasingly, those of us who are privileged to be in the system find that we can't afford health care, either. The whole system is rotten, wasteful, too expensive and too inefficient. We pay more money to be sicker than folks in any other advanced nation.
There are a lot of problems with our system, but the biggest is the basic premise -- employer-based health care through for-profit (and we're talking for HUGE profits) private insurance companies.
If private health care coverage weren't so expensive for all of us, the 1 in 7 who remain uncovered would be in it. But it is, and will be, expensive by definition. A profit has to be made.
A single-payer system is the logical way to go. It's time we got logical about this monster that is now consuming 16 percent of our national economy.
I wrote this column -- "‘Health care reform?’ Hush! You’ll anger the Insurance Gods!" -- back in November because it's time that people like me -- in the top income quintile -- started pointing out how unaffordable this wasteful system is for us, which means it's worse for millions of others who are also in the system. An excerpt from that column:
... I make more money than most people do here in the wealthiest country in the history of the world, and I live paycheck to paycheck, in large part because of the cost of being an extremely allergic asthmatic, and needing to do what it takes to keep enough oxygen pumping to my brain to enable me to work so I can keep paying my premiums and copays. My premiums in the coming year — we’re going to a new plan — will be $274.42 on every biweekly check, not counting dental or vision care. And I’m lucky to have it. I know that, compared to most, I’ve got a sweet deal!
I’m in the top income quintile in the U.S. population, and we can’t afford cable TV, we’ve never taken a European vacation or done anything crazy like that, we haven’t bought a new car since 1986, and aside from the 401(k) I can’t touch until I retire (if I can ever afford to retire), we have no savings.
Yet I will pay my $274.42 gladly, and I will thank the one true God in whom I actually do believe that I have that insurance, and that I am in an upper-income bracket so that I can just barely pay those premiums, and that neither my wife (a cancer survivor) nor I nor either of the two children (out of five) the gods still let me cover is nearly as unhealthy as the people I see whenever I visit a hospital...
On Jan. 6, we ran an op-ed piece from B.J. Welborn that told another middle-class story. An excerpt:
But the picture is not always rosy. A recent experience made me realize that although I have a comfortable income and a good education, pay taxes and have an insurer pick up most of my health care costs, an overburdened and undermonitored health care system can leave me vulnerable and scared. Here's my latest scare:
Last year, an out-of-state company bought my husband's firm in Columbia. We were forced to change our insurance. This change required baffling paperwork to keep my Gleevec coming, and though we tried valiantly to figure out the process, different people at the insurance company told us different things. The process dragged out; the clock was ticking for me. Soon, three weeks passed without my lifesaving drug. I wondered if anybody cared.
I checked with my pharmacy and found it couldn't order Gleevec from its supplier. I searched for Gleevec at other pharmacies. This drug, still in clinical trials, isn't like a common antibiotic kept on drugstore shelves. I couldn't find it. And even if I could find Gleevec, how would I pay for it? $3,000 this month, then $3,000 the next month?
My anxiety mounted. When I washed my face, small blemishes bled, as they do when your blood can't do its job. I was slipping through the cracks, and I was cracking up...
The "what if" game is terrible. Millions play it, and one day, you or a loved one could too. Anyone can get a chronic disease -- diabetes, stroke, mental illness, heart disease or cancer.
Let's face it: You, too, could slip through the cracks of our health care system. So, it is up to you to make our potential leaders aware of what's really going on. It's not just the poor and uninsured who are hurting, it's also millions of hard-working, middle-class Americans who foot the bill for others' health care...
Then, on Friday, Feb. 1, we had this letter to the editor:
Health coverage could make writer sick
I am absolutely disgusted by the state of our nation’s health care.
I am a college-educated woman with a bachelor’s degree, an employee of a prestigious university, but most important, a wife and a mother of young children.
I live in fear that one of my family members will become seriously ill or simply require regular preventative care that my health insurance does not cover.
For example, last year, I discovered that the health insurance for S.C. state employees does not cover routine pelvic exams, and without health insurance, that type of procedure can cost almost $200. And other medical procedures aren’t covered until after I meet the $350-per-person deductible.
With one child in daycare and the costs of my children’s health care and regular childhood illnesses, I simply can’t afford to pay $200 or $350 or $550 for my own care. So I don’t go. And I hope that I don’t get sick.MARTHA BROWN
Columbia
That letter prompted this one on today's page:
Health insurance costs leave little for care
I read the letter “Health care coverage could make writer sick” by Martha Brown with interest.
While wholly sympathetic to her concerns, I feel, by comparison to many of us, she would be embarrassed by how good she has it.
As a provider for a healthy and active family of four, I am shackled with a monthly insurance bill in excess of $800. For this, we are provided with a policy that covers only 80 percent after a $1,000 deductible per person. It would appear that our policy was written to provide for the economic health of our insurance company, rather than that of my family.
Our provider enjoys strong local recognition, and I hope it is competitive with other carriers, but my bill has become a payment for asset protection rather than health care, and I’m not sure how well it provides for that.
“Health care is expensive” is the most common explanation received when I question our agent, doctors and others about our situation, but price is irrelevant when, after insurance payments, no money is left over for health care.
Surely, mine and Ms. Brown’s situation is not unique. We live in the greatest society that has yet existed, but our current profit-driven health care system is clearly in direct conflict with what is best for its citizens.EDGAR PUTNAM
Columbia
More people should come forward with these stories. It's embarrassing -- neither of my two bosses, my employer or my wife, was particularly crazy about me going into such details -- but this stuff needs to be available as we debate these issues. And we must debate them -- the status quo is not sustainable.
Posted by Brad Warthen at 06:05 PM in 2008 Presidential, Business, Health, Marketplace of ideas, Personal, The Nation, The World, Working
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Comments
This post was to help out bud, who doesn't want to talk about the main job requirement of the president -- leading the nation globally.
This is a domestic issue worth our time and energy. So would be coming to grips with Social Security.
Single-payer would be a VERY expensive new government program. But to us, the consumer, it would be cheaper, and more effective, than what we have now.
Posted by: Brad Warthen | Feb 12, 2008 6:14:39 PM
There is no such thing as "single payer" health care. It is socialized medicine with millions of taxpayers, and millions more tax consumers.
The Myth of The Uninsured
--------------------------
We are bombarded with the propaganda message of the "47,000,000 uninsured" to
conjure up the image of millions of poor people who cannot afford insurance.
It is simply a fabrication.
Most people cannot afford the automobiles, houses or vacations they want, either.
They buy what they can afford. Most people can afford medical insurance, but
choose to spend that money on nicer cars, houses, vacations and entertainment.
Of that mythical "47,000,000 uninsured", there are actually only 43,000,000,
and 95 % of them change every year, 60% every 60 months.
* There are fewer people without medical insurance today, than there were under Clinton.
The Census Bureau in 2003 reported that the number of Americans without health insurance rose in 2002 to around 43.6 million, up from 38.7 million in 2000 but below the record 44.3 million who were uninsured in 1998.
* From 1993 to 2002 the number of uninsured people in households with annual incomes above $75,000 increased by 114 percent.
* The number of uninsured in households with annual incomes from $50,000 to $75,000 increased by 57 percent.
* By contrast, the number of uninsured people in households with incomes under $25,000 FELL by 17 percent.
* About three-quarters of the rise in the number of uninsured over the past four years has been among households earning more than $50,000 per year, and almost half of that has occurred among households earning more than $75,000 per year. In fact, almost one-third of the uninsured now live in households with annual incomes above $50,000 and one in five live in households earning more than $75,000 annually.
- Unisured by Choice. National Council for Policy Analysis, Oct 2003
* 14,000,000 are illegal aliens, mooching free treatment at our hospitals.
Pew and Kaiser studies find 57% of Hispanics have medical insurance.
* 7,000,000 can afford very good insurance policies, but refuse to buy them. Many are young people who choose to spend the money on nicer automobiles, vacations, and houses.
* Most of the rest are only TEMPORARILY without insurance while changing jobs
and insurance plans.
74.7 percent are without insurance for less than 12 months.
2.5 percent are without insurance for more than 36 months.
- Source: Blue Cross and Census Bureau 2002
* 41% of those without medical insurance are 18 to 24 years old, who were dropped from their parents' insurance when they graduated from high school. Many are in college and covered by college insurance and clinic care. Others are out working and have not purchased their own insurance. Some of those can afford it and choose not to.
- Census Bureau, 2002
* 70.4 percent of those aged 18-24 do not have a private medical insurance policy.
* 82.0 percent of those aged 25-64 do not have a private medical insurance policy.
* 99.2 percent of those over age 65 do not have private medical insurance policy.
(they drop it when they become eligible for Medicare)
- Source: The Blue Cross Blue Shield Association 2002 market study
* Those aged 18-24 spend 5 times as much on dining out and entertainment than
they spend on medical care.
Source: Bureau of Labor Statistics 2001 Consumer Expenditure Survey
Real reform would end all employer-provided insurance and put everyone on their own individual policies which would follow them from job to job, through unemployment, and into retirement.
Most people cannot afford the automobiles, houses or vacations they want, either.
Wanting doesn't entitle anyone goods and services of other people.
copyright 2008 Lee Muller. Reprinted here with permission.
Posted by: Lee Muller | Feb 12, 2008 6:20:16 PM
Correction:
82.0 percent of those aged 25-64 do HAVE a private medical insurance policy.
Among working adults aged 18-64, 92.5% have their own medical insurance.
The only uninsured among working-aged Americans are the 7.5% who can afford some insurance but choose not to buy it, and the 4% who are not working at any given moment in time.
Posted by: Lee Muller | Feb 12, 2008 6:30:57 PM
Brad is right on with this one. The only criticism the opponents of single payer have is that it is socialized medicine. Ok, it's socialized medicine. And the problem is??
Posted by: bud | Feb 12, 2008 6:42:52 PM
There are lots of problems with socialized medicine:
* It's socialist, un-American, and un-Constitutional.
* It is inefficient, so it is more expensive. Medical costs rose no faster than the general cost of living, until government got involved. The most expensive part of medical costs is in the 46% of that sector controlled by government.
* It provides inferior care. I have posted before comparisons of treatments and outcomes of various illnesses in the US vs Europe and Japan. The USA beats them all. In most of Europe, you have less than half the survival rate as in America.
* It denies care. A major means of controlling costs under socialism is to stall, delay and deny diagnostics and treatments.
* It takes away choice, because it is one big managed care system. Patients cannot choose doctors. Doctors and nurses have their incomes controlled by bureaucrats.
Since 1995, over 10,000 doctors and nurses have emigrated from Canada to the USA.
Posted by: Lee Muller | Feb 12, 2008 6:52:53 PM
Brad ... your discontent with McClatchy's health care plan is getting old and tired. Some of us have decent coverage from decent employers. It's pretty clear that your crusade for single-payer would not exist if you were happy with your choices. The State starting shoving it's health care expenses back on employees 20 years ago, and it's obviously gotten worse as your bosses look for more ways to line their pockets. So stop trying to stick us with your bill and take it up with them.
Posted by: Gordon Hirsch | Feb 12, 2008 6:59:50 PM
Gordon has hit the nail on the head.
A lot of those who can afford medical insurance are on the bandwagon for socialized medicine because they know the days of lavish benefits for employees of big corporations and big government are coming to and end.
The corporations, bureaucrats, and unions want the rest of us to pick up the tab for their benefits and bankrupt pension promises. So they package and sell it as a big reform for everyone.
Posted by: Lee Muller | Feb 12, 2008 7:05:06 PM
> And the problem is??
Simple. Nobody who is for single payer can answer simple questions like:
How will you pay for it?
How will you ensure that services are not rationed?
How will prices for services be set?
How does a single payer system encourage research and innovation when the incentive
(profit) is removed?
What impact will it have on the economy (for example for local companies that employ thousands like Blue Cross) when those industries are eliminated?
(Bud - I know you have at least taken a stab at it with your tiered approach, but that's not what Brad is endorsing. He wants a "free" healthcare system where you walk into doctors offices, get free prescriptions, get your appendix removed, and are out the door (with a lollipop) in 30 minutes).
Nobody who is for single payer can articulate any solutions, only pipedreams.
I'll give you a specific example I have repeatedly asked about when it comes to single payer - my friend (a top ortho surgeon in the country) charges what he feels is appropriate for hip replacements that get the patient up and walking far faster than the standard surgery. He's is booked out for months by people who are willing to pay out of pocket for his services. He doesn't accept Medicare patients because the reimbursements don't even cover his operating room costs. In his spare time, he invents artificial joints using state of the art materials and develops surgical processes that allow him to replace a hip with two small incisions.
There are very few surgeons capable of doing this procedure. I'm asking you single payer advocates to tell me how this doctor will fit into your system? Be specific. Who will decide what he gets paid for the surgery? How will he be compensated for his inventions? Will he be able to turn away patients who he considers risky? Will he be free from malpractice insurance in a single payer system?
If you can't answer those questions, then go back to staring at the clouds in the sky as it will have the same effect. It's pure fantasy without any analysis.
And as far as I can tell from John McCain's website, he doesn't support single payer at all. (Because if he did, he wouldn't have that issue in his bag of tricks to bash Hillary with this summer). Here's one bullet from McCain's issues page on his website:
"Build genuine national markets by permitting providers to practice nationwide."
Looks like single payer is going to depend on The State endorsing Hillary or Obama.
Posted by: Doug Ross | Feb 12, 2008 7:08:21 PM
And I'll echo what Gordon said. If McClatchy's method of cutting costs is to squeeze employees on insurance, then shame on them... but don't punish the rest of us because of their policies. I have a very acceptable insurance policy with my company. I am highly doubtful that my coverage and access would be the same under a single payer plan.
Instead of coming up with a monolithic government agency, fix the system by fixing the rules that allow companies to deny coverage or price people out of coverage.
Give every American a choice to participate in the healthcare plans our government has access to. Get rid of useless government agencies and spend the money on free preventative healthcare. Just don't come asking me to pay more for less than what I have now.
Posted by: Doug Ross | Feb 12, 2008 7:17:47 PM
Here's all of McCain's views on insurance from his website. Not a single whiff of single payer in the whole thing:
"Reform the tax code to eliminate the bias toward employer-sponsored health insurance, and provide all individuals with a $2,500 tax credit ($5,000 for families) to increase incentives for insurance coverage. Individuals owning innovative multi-year policies that cost less than the full credit can deposit remainder in expanded health savings accounts.
Families should be able to purchase health
insurance nationwide, across state lines, to maximize their choices, and heighten competition for their business that will eliminate excess overhead, administrative, and excessive compensation costs from the system.
Insurance should be innovative, moving from job to home, job to job, and providing multi-year coverage.
Require any state receiving Medicaid to develop a financial "risk adjustment" bonus to high-cost and low-income families to supplement tax credits and Medicaid funds.
Allow individuals to get insurance through any organization or association that they choose: employers, individual purchases, churches, professional association, and so forth. These policies will be available to small businesses and the self-employed, will be portable across all jobs, and will automatically bridge the time between retirement and Medicare eligibility. These plans would have to meet rigorous standards and certification. "
----
I can actually support all of that.
Posted by: Doug Ross | Feb 12, 2008 7:20:54 PM
Don't get sick.
Posted by: bill | Feb 12, 2008 7:28:37 PM
If you do get sick, try not to be outside the USA.
Posted by: Lee Muller | Feb 12, 2008 7:34:32 PM
And pray tell, what's the difference between giving everyone $5,000 dollar rebates with which to buy insurance from a private company, who's going to siphon profits off of it, or using that money directly to pay for insurance (set up a non profit agency?) Everyone already has basic health insurance--its just very,very,expensive health insurance. If you're flat broke, and get sick, the local county hospital emergency ward has to take you. You don't have to pay--everyone else does, and of course, the hospital overcharges everyone with insurance in order to make up the difference. Of course, private insurance then jacks up prices to take care of that. Unfortunately, emergency room service is very expensive, because you have all these people standing by who are really not needed to provide you with a prescription for your bronchitis. It also only takes care of you in an "emergency." Frequently, what you have wouldn't be an emergency, if you could have gone in before it got that bad, or better yet, gotten your flu shot.
Failing to address the health care needs of the poor provides another problem. These uninsured people, who can't afford to get treated everytime they get sick, create a huge pool of potential infection. This is where you will probably first see MRSA and antibiotic resistant TB first flourish (not necessarily the first place reported--others can and do go to the doctor when they get sick--but the first place these diseases and others can incubate before sweeping the nation, epidemic style). Basic affordable care can stop this sort of thing from happening. And it's much cheaper in both money and human misery and/or lives to stop it before it starts. If people who can pay for insurance are choosing not to, then they can pay piecemeal later when they need it. Others need basic, thorough health insurance that they can afford.
Posted by: Karen McLeod | Feb 12, 2008 7:49:20 PM
The World Health Organizations rankings of health care systems:
Rank Country
1 France
2 Italy
3 San Marino
4 Andorra
5 Malta
6 Singapore
7 Spain
8 Oman
9 Austria
10 Japan
11 Norway
12 Portugal
13 Monaco
14 Greece
15 Iceland
16 Luxembourg
17 Netherlands
18 UK
19 Ireland
20 Switzerland
21 Belgium
22 Colombia
23 Sweden
24 Cyprus
25 Germany
26 Saudi Arabia
27 United Arab Emirates
28 Israel
29 Morocco
30 Canada
31 Finland
32 Australia
33 Chile
34 Denmark
35 Dominica
36 Costa Rica
37 United States of America
38 Slovenia
Posted by: bill | Feb 12, 2008 7:51:07 PM
I guess if we go to a single payer system we could fall behind Slovenia. We definitely don't want to do that.
There is a similar list for life expectancy. We continue to fall further behind the rest of the world in this important area. South Carolina is well behind the average in U.S. Yet many persist is turning a blind eye to the problem. If I hadn't lived the horror of the current system I might be more amenable to the free-market fanatics. But since I've been there and done that I know just how flawed the current system is.
Whoops, look what time it is. I'm late for my second job, a necessity in these days of high medical costs, $3/gallon gasoline and stagnant wages.
Posted by: bud | Feb 12, 2008 7:57:44 PM
Those ratings are bunk, because when you look at the detailed stats on waiting times, treatments available, and success rates of surgery, and survival rates for cancers, stroke and heart attacks, the USA beats the best of Europe by 2 to 1.
Our life expectancy is the same or better than Europe when you look at the same demographics. America's statistics are skewed by the sickly 30,000,000 illegal aliens who are clogging up our hospitals and bankrupting them, and the low-weight births of illegitimate babies to unmarried African-American teen girls.
Posted by: Lee Muller | Feb 12, 2008 8:03:56 PM
The problem with having government provide care directly is that they are so wasteful.
All the excessive costs in healthcare come from averaging in the 46% controlled by government, where costs are out of control.
By comparison, costs of the least regulated and newest medicine in the private sector has risen slower than the general cost of living.
* Cosmetic surgery costs have risen at half the rate of inflation.
* LASIK and other new eye surgeries cost 20% LESS in 2008 than they did in 2003.
Posted by: Lee Muller | Feb 12, 2008 8:07:13 PM
I work two jobs, too, bud. So what. My wife works. My kids work. Life is hard. Get over it.
Posted by: Gordon Hirsch | Feb 12, 2008 8:12:27 PM
Brad,
I think you are half right. There is no good reason that we should get our health insurance through our employers.
If McClatchy is anything like most employers, they probably don't give you a whole lot of choice in what insurance plan you get. As a result that insurance can jack the price up on you.
If we had the ability to select our insurance company at will, I guarantee you that we would get a better deal.
I think the WSJ just did an article about how the current tax deduction that employers get would be better allocated to individuals. That way people who don't work for large companies would benefit too. Plus we would be at the mercy of our company's HR director in limiting our health insurance choices.
I have no love lost for insurance companies. Blue Cross has a virtual monopoly here in SC based on its huge market share. But I doubt turning the federal government into a giant health insurance monopoly would be any better.
Posted by: Sand Hill | Feb 12, 2008 9:37:17 PM
correction: we WOULDN'T be at the mercy of HR directors in limiting our health insurance choices.
Posted by: Sand Hill | Feb 12, 2008 9:39:29 PM
Brad shot himself in the foot on this issue by not giving John Edwards a chance. Imagine a trial lawyer who built his fortune going after insurance companies and drug companies in the White House...
War or healthcare? The State made its choice.
Posted by: Doug Ross | Feb 12, 2008 10:13:41 PM
Thanks, guys. You've left no gall stone unturned here. So well have you covered the subject that I have nothing else to say.
Posted by: weldon VII | Feb 13, 2008 12:59:01 AM
I have a few things to say. This is a no brainer legally. The government is suppose to promote the general welfare not mandate or provide for it. Monopolies are illegal yet the health care industry has had a death grip on medicine for the last two hundred years. The DEA has gone so far as to raid and confiscate vitamins. For years our Medical Schools have artificialy kept down the number of doctors who graduate. Why? The less fingers in the pie the more the plums. The insurance companies have been in colusion with the health care providers. See how much your policy allows for chiropractors. We have one of the finest teaching schools in the nation at MUSC but why would anyone go there if they have this wonderful government insurance.
No matter who wins the White House the single payer system simply will not work.
Posted by: Richard L. Wolfe | Feb 13, 2008 1:46:14 AM
Now you've gone and made me say something, Richard, albeit not too serious.
If the med schools graduated more doctors, enough to create a real surplus, how long would it be before we saw newspaper ads like "APPENDECTOMIES 50 PERCENT OFF!" and "BUY ONE TUMMY TUCK, GET ANOTHER AT HALF PRICE (close relatives only)"?
Two many doctors might actually be a bigger problem than too few. Quality is the prevailing issue. You really don't want doctors dropping too far on the income scale, else there might cease to be enough good doctors to provide quality care. Increasing the error rate in matters of life and death would be poor economy.
Posted by: weldon VII | Feb 13, 2008 5:26:32 AM
Surgeons actually do compete and adjust their fees up and down in the market, more than most other physicians, because a lot of them are still independent, while many other physicians are captives of some hospital, a practice owned by a hospital, or HMO.
Surgeons also differ vastly in skill, which is why socialized medicine doesn't work when it tries to pay the virtuoso the same low wage or fees as the ordinary GP.
----- Socialism fails to provide doctors -----
In the UK, half of graduates of medical schools in 2006 and 2007 found no jobs, because the National Health system didn't want to spend the money on new doctors. So they are trying to leave the UK.
Posted by: Lee Muller | Feb 13, 2008 7:57:40 AM
