Can anyone (any viable candidate, that is) say ‘single-payer?’: Column version

Editorial Page Editor
CAN ANYONE among those with a chance of becoming president say “single-payer?” If not, forget about serious reform of the way we pay for health care.
    It doesn’t even necessarily have to be “single-payer.” Any other words will do, as long as the plan they describe is equally bold, practical, understandable, and goes as far in uprooting our current impractical, wasteful and insanely complex “system.”
    And the operative word is “bold.” Why? Because unless we start the conversation there, all we might hope for is that a few more of the one out of seven Americans who don’t have insurance will be in the “system” with the rest of us — if that, after the inevitable watering-down by Congress. And that’s not “reform.” Actual reform would rescue all of us from a “system” that neither American workers nor American employers can afford to keep propping up.
    But the operative word to describe the health care plans put forward by the major, viable candidates is “timid.”
    “Single-payer” is definitely not that — at least, not within an American context. Seen from the perspective of most advanced nations — which accept medical care as just another part of a nation’s infrastructure, like roads and post offices — it’s no big deal.
    Not here, though — not by a long shot. Here, we have too many people preprogrammed to go ballistic at the mention of “single-payer.” That’s because of the identity of that payer.
    It’s… well, it’s the government!
    This column will now take a short break while libertarians run around shrieking until they turn blue and fall over… da-da-dum-dum, hmmm… readers might want to go look at the Sunday comics until we resume… da-dee-da-dahhh… Still screaming, so let’s get another cup of coffee… Ah, that’s good stuff
    OK, we’re back, and they’re still screaming, but we’ll just have to accept that they’re going to do that, and proceed.
    “Government,” in America, is a word that we use for a free people banding together to do something that we can do far better working together than working separately. Some people don’t accept that fact. They seem to believe that “government” is some scary thing that intrudes on their lives from out there somewhere, like a spaceship full of aliens with ray guns that will turn us all into toads or something.
    Those people are one of the two big reasons why you don’t hear any presidential candidates saying “single-payer” except Dennis Kucinich. You may recall recent reports that Mr. Kucinich had a close encounter with a UFO, and it was a positive experience, so I guess he’s just not scared of the aliens any more.
    But the major candidates are. Or rather, they’re scared of being labeled as extremists. Also, they don’t want to offend the health insurance companies whose reason for being would disappear under “single-payer.”
    Last week, I got a press release from a labor union that complained “that no Republican candidate has a plan to ensure all Americans have access to health care.” That’s true. But the union, which represents blue- and pink-collar workers in health care, was missing the fact that the leading Democrats are little better.
    “Sens. Hillary Clinton and Barack Obama have been engaged in a bitter back-and-forth over whose health plan covers more people,” The Wall Street Journal reported last week. “Former Sen. John Edwards has jumped in, saying his plan is the best of all.”
    But what they’re fighting over are plans that would pull varying numbers of the uninsured into the same overly expensive, wasteful, maddening system of private health insurance that the rest of us are caught in. Conveniently, they say their plans would be paid for by repealing the “Bush tax cuts for the wealthy.”
    Maybe you could pay for a health plan that way — as long as it doesn’t provide real reform.
    Make no mistake: A single-payer national health plan would cost a lot of money, and you would pay for it in new taxes. The good news is that most of us would probably still pay less than we currently pay in premiums.
    According to the Web site of Physicians for a National Health Program, which promotes single-payer, “This is because private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar. Streamlining payment through a single nonprofit payer would save more than $350 billion per year, enough to provide comprehensive, high-quality coverage for all Americans.”
    But when not even touchy-feely liberal Democrats have the guts to say it’s worth paying a new tax to make health care affordable for all, even when that’s the hottest domestic issue among voters (which would not be the case if the insured majority were happy), we’re in trouble.
    Little wonder that Dow Jones’ MarketWatch reported last week that “Those who hope the 2008 presidential election will finally bring about drastic health-care reform may well end up finding it’s a case of politics and business as usual, experts say.” The same article noted that Hillary Clinton has received $1.8 million in contributions from accident and health insurers, followed by Barack Obama with $1.45 million, Mitt Romney with $1.09 million and Rudy Giuliani with $1.08 million.
    That, by the way, is money that you and I and the guy down the street paid for health care that didn’t go to health care.
    Given the odds against substantive reform — betw
een the government haters, the insurance industry and Big Pharma, all of whom have a demonstrated willingness to outlast the rest of us in any protracted political fight — the only way we’re going to see significant change is if a president is elected with a mandate for bold reform. Only a president is elected by the whole nation, so only a president would ever have that kind of juice.
    Unfortunately, as previously noted, none of the viable candidates will say “single-payer.”
    But I will: Single-payer. Single-payer, single-payer! Now, do you have anything better to say?

46 thoughts on “Can anyone (any viable candidate, that is) say ‘single-payer?’: Column version

  1. Sanjay Seth

    I think the question for this story really should be:
    Can people back a person, e.g. Dennis Kucinich, based on the ideas they bring to the table – or do they need the media to endorse their candidate, e.g. Edwards, Clinton, Obama – to feel as though they can participate in a democracy.
    Sometimes I wonder what country I am in, where people feel like they can’t vote for the person who actually represents them.

  2. Gordon Hirsch

    Single-payer is a pipe dream. We are a Republic, not a democracy. You can’t take capitalism out of health care, and no politician in his or her right mind would ever try. Period. End of story.

  3. Karen McLeod

    When, when, when are people going to realize that the Health Insurance folks and the Pharmacy folks (HIPH) are the ones who really win big with the health care plan we use now. And since no one (but them) gets to vote on how it’s run, it’s not going to change from the inside. Don’t they realize that however poorly “THE GOVERNMENT” is run, it’s at least ultimately accountable to us. We can change it’s management. HIPH would have us believe that THE GOVERNMENT is going to suddenly come up with a substandard plan, hire monkeys for the health care professionals and then tell you you can only go to a particular monkey. If it does that, it’s time to change the management. That doesn’t mean that some politicians aren’t in HIPH’s pocket. Witness the medicare plan Mr. Bush came up with that doesn’t even allow “THE GOVERNMENT” (in this case, medicare) to negotiate for lower prices for medicines. And this benefits whom? Certainly not the seniors that need those benefits. Certainly not the taxpayer who’s paying for that benefit. But, at least we can vote to change the the regime that thought this was just fine. Now whether we will or not, who knows? What with the libertarians screaming about the sky falling, and HIPH running their scare ads, we may end up with more of the same. But if we have a poorly run “BIG GOVERNMENT” we have no one to blame but ourselves, because ultimately we are their bosses.

  4. Hugh Campbell

    Brad probably lost most of the readers of his “single-payer” editorial when they got to the part about government control of health care resulting in “streamlining” and “less paperwork”. George Will’s column on NCLB on the opposite page more accurately describes what happens when the feds decide to take over and improve an operation.

  5. Doug Ross

    > “Government,” in America, is a word that we
    > use for a free people banding together to do
    > something that we can do far better working
    > together than working separately.
    Thanks, Brad. Best laugh I’ve had in a long while. IRS, FEMA, TSA, USPS, DOT… how many more acronyms do I need to list before I get to one that is half as efficient as a Mom and Pop grocery store? If you believe the unprovable, unlikely $350B claim regarding insurance paperwork costs, surely you would consider that the IRS alone costs our economy at least some multiple of that $350B. Fix the inefficiencies of our excessive government and you can have all the money you need to put more people on the healthcare dole.
    Again, I’ll ask you to put your proverbial money where your mouth is. If you think this is an important issue, don’t endorse candidates who don’t support single payer.
    Your man McCain doesn’t even come close to your thoughts on this issue – and if I read you column correctly, it is because you think he’s afraid to address it. Will you tell the hero Senator that he’s a chicken on healthcare? Where’s the “straight talk”???

  6. Sabra Smith

    No, Brad, I don’t have anything better to say. Bravo for coming out with such a strong and convincing piece on the need for a single-payer healthcare system. You are also exactly on target about the forces that continue to oppose this major change in the way health insurance is handled. I will continue to watch what the candidates have to say and await the comments that should come rolling in here on your blog.

  7. Doug Ross

    In other posts on the insurance topic, we have seen some of the whining about the cost of insurance preventing entrepreneurs from going out there in the big, bad marketplace with their million dollar ideas.
    That’s the difference between an entrepreneur and a guy with an idea. Successful entrepreneurs would have either:
    a) A solid business plan including cost breakdowns for insurance that would encourage investors to put up the money to support the “idea”
    b) A willingness to take a risk with the potential of a great reward that would make the concern over insurance costs a mere blip on the radar screen
    Do you think people like Bill Gates worried about the cost of insurance when they started out? Or the founder of Oracle (my company), Larry Ellison, who took an “idea” and evolved a company of a couple programmers into a multi-billion dollar enterprise employing 40,000 people?
    There are insurance plans out there available to every person with an “idea”.
    If you’re waiting on the government to protect you from any chance of failure before you even start, then you probably should stick with your safe job and your lousy insurance plan. The rewards go to those willing to either take the risk or else mitigate the risk through a combination of hard work and a good business plan.

  8. Gene Retske

    I am not a viable candidate, but I tried, as you suggest, to say “single payer,” but, unfortunately, all that came out was “socialized medicine.”
    Any suggestions?

  9. Undisclosed

    You ask for a viable candidate then malign Rep. Kucinich (through a Fox News link that references Shirley MaClain’s statements about a 1980 event). There will never be a “viable” candidate for single-payer as long as viability is determined by funding, which in turn leads to press coverage. The pharmaceutical & insurance industries and the AMA will place the big money elsewhere.

  10. Richard L. Wolfe

    This has nothing to do with the subject. I just don’t know where to put it. Your paper is the most arrogant, self serving neswpaper in the state. Rather than reporting the news and engaging in public discourse, you pick a side of any given issue, push it to the max and pretend that there is no opposion. I have written your paper many times with a Libertarian point of view. You don’t have to print my letters but you will never convince me that I am the only person in this state that feels the same way I do. My letters range from opposing the unconstitutional smoking bans, your attempt to buy a better educational system, the growing medical industrial, complex, etc. Full disclosure you did print one letter only after and called the paper, then even though I was under the 150 word limit you still cut the letter in half to take out the sting and effectiveness of the message. I use to buy your paper now I wonder if I am wasting my time by visiting your website.

  11. numa hero

    Robert Samuelson has a column  on health care in Investor’s Business Daily 12/7/07. His take is that the major obstacle to health care reform is that no one will address the issue of health care costs. Those without can’t afford the cost, those with coverage think health care costs are paid by someone else.

    My take is that health care costs need to be posted; the income tax exclusion for employer-paid insurance needs to be dropped and private health care insurance needs to be portable from job to job, state to state.
    People need to see the costs and politics need to quit hiding the costs.

  12. Lee Muller

    1 out of every 10 workers in the private sector is occupied filling out tax forms and keeping tax records. That is a 10% reduction in productivity.
    On top of that already in the health care industry are the hordes of bureaucrats clog the machinery of free enterprise with regulations.
    Medicare currently costs 200 times what it was originally projected to cost in 2007.
    The new Medicare Drug Benefit is already 700% over projected cost.
    The little backers of socialized medicine know that government managed care will be less efficient and cost more, but they don’t care about anything except what it costs themselves.
    The big backers of socialized medicine only care that it is socialist, and that it will only take a year or two of it to totally destroy the private medical insurance industry, and burn the bridges of retreat from a sure failure of socialized medicine.

  13. WP Denver

    You’re overlooking a lot of Americans who like the health-care systems they’re in. We may not be a majority, but there’s a bunch of us. Maybe Kaiser Permanente hasn’t come to SC yet, but it’s available in Atlanta, and I think if you could try it, you’d like it. (Note: It’s a nonprofit.) Maybe a workable start would be to focus on reining in the obscene profits of the insurance and pharmaceutical industries. This is the sort of thing Democrats used to be able to agree on, but apparently not any more.

  14. Al

    We already have “socialized medicine” for all members of our armed forces. Their only complaint is that there isn’t more of it. We already have “socialized” mail delivery and many other “socialized” governmental programs which work well and are relatively efficient.
    When will our congressmen vote for the same health plan for us that they have for themselves?

  15. Jordan Michaels

    Mr. Muller,
    Please do a little research before posting your comments. (It’s called Google and it takes less than 10 minutes to educate yourself.) The Medicare drug benefit’s projected cost was intentionally low-balled by the Bush Administration in order to get the measure passed. Even republicans were upset when this came to light. Also, when the bill prevents the government from negotiating lower costs (as large private sector groups are allowed to do), what do you expect?

  16. Lee Muller

    All welfare programs are intentionally given low cost estimates by their backers in order to pass the legislation.
    Government does negotiate with drug companies now, at all levels, from county clinics to the VA hospitals. What socialists really mean when they call for more “government negotiating” is government forcing pharmaceutical and medical device companies to sell to them, and a price dictated by bureaucrats.
    The military does not have “socialized medicine”. Their employer has its own hospitals, just as many textile mills, steel companies, and other large industries used to do, before the rise of private medical insurance for smaller companies, during the 1940s and 1950s. The families have private insurance, called TriCare. (I don’t need to Google it, because the Pentagon hired me to improve the payments turnaround from 10 days to 1 day, which I did, for its 465,000 families and all the physicians)

  17. slugger

    This is what was sent to me by my cardiologist friend.
    Medicare pays $1000 for a service and Aetna pays $3850( an actual example of
    a service we provide) and all others in between, and what one collects
    depends on the gall of your billing person not the quality of your physician
    or service.

  18. slugger

    By Russ Britt, MarketWatch
    Last update: 7:24 p.m. EST Dec. 7, 2007
    PrintPrint EmailE-mail Subscribe to RSSRSS DisableDisable Live Quotes
    LOS ANGELES (MarketWatch) — While health-care reform may play second fiddle
    to the war in Iraq among voters this election season, it appears that the
    domestic issue is taking on new life thanks to medical-industry
    An advertisement, due to appear Monday in Iowa newspapers ahead of upcoming
    caucuses there, calls for a single-payer, national health-insurance plan
    similar to Medicare, and cites Vice President Dick Cheney’s chronic heart
    troubles as evidence of its need. It is sponsored by the Oakland,
    Calif.-based California Nurses Association/National Nurses Organizing
    At the top of the ad, there’s a news story about a recent visit by Cheney to
    the hospital for treatment of an irregular heartbeat. Underneath, it says:
    “If he were anyone else, he’d probably be dead by now.”
    The ad goes on to note that under the government health-insurance program
    that covers Cheney, he is not turned away for preexisting conditions or
    unable to be treated for what an insurance company might label “experimental
    ‘We’re trying to produce a dialogue. We’re saying that what does not work is
    the status quo.’
    – David Kinsman, American College of Physicians
    “There’s a whole set of barriers that he has never faced,” said Michael
    Lighty, director of public policy for the nurses’ group.
    Welcome to the 2008 elections, where medical professionals are turning up
    the heat in favor of a universal, single-payer system that represents a
    radical departure from what most of the major presidential candidates are
    proposing. They know that such a system is a long shot at this point, but
    the numbers in their camp are growing.
    Other medical professional organizations are calling for similar measures to
    be enacted, or at least discussed. The American Nurses Association, which
    represents 2.9 million nurses, is pressing for a national plan, as is a
    group of 14,000 doctors called the Physicians for a National Health Program.
    Dr. Quentin Young, co-founder of the physicians’ group, called alternative
    proposals from other candidates “patch-quilt failed systems that won’t
    “What we have now is the problem, not the solution,” he said.
    Also for the first time, the American College of Physicians wants the issue
    to at least be discussed among other alternatives as the nation moves toward
    some sorts of changes in health care.
    The group, which represents 124,000 internal-medicine physicians, isn’t
    advocating a Medicare-style plan, but at least wants the subject to be
    broached — a departure from past practices.
    “We’re trying to produce a dialogue,” according to spokesman David Kinsman.
    “We’re saying that what does not work is the status quo.”
    Can these professionals succeed in their quest for a national health
    program? Medical professionals are contributing in record numbers to
    candidates’ campaigns, so they’re likely to get the ear of at least some of
    the candidates. The American Nurses Association said that it plans to sit
    down with all the candidates to discuss the idea.
    The doctors and nurses who propose a single-payer plan say that it will cut
    red tape, eliminate haggling with insurers over what procedures are
    necessary and allow them to deliver unfettered health care.
    Whether this kind of approach will resonate with voters is unclear, but
    staffers in Cheney’s office, at least, seem to have little patience for the
    nurses’ advertising strategy.
    “I think it’s outrageous and it doesn’t warrant a response,” commented Megan
    Mitchell, a spokeswoman for the vice president.
    But it appears that candidates for next year’s presidential election are
    unwilling to lean toward these views — at least for now. Currently, the
    only one that is calling for the same kind of reform is Rep. Dennis
    Kucinich, D-Ohio, a dark horse who lags far behind in the polls.
    Leading Democratic contenders Sen. Hillary Clinton of New York, Sen. Barack
    Obama of Illinois and John Edwards, a former senator from North Carolina,
    all advocate a mix of public and private coverage. Clinton and Edwards
    propose mandatory coverage for all, along with tax credits for those who
    can’t afford premiums.
    ‘People are being ripped off, and these liberal Democrats are doing nothing
    to ease their pain.’
    – Dr. Quentin Young, Physicians for a National Health Program
    Republicans stray even further from the groups’ goals. GOP candidates
    largely want to let free-market forces determine the future of health care,
    with only former New York Mayor Rudolph Giuliani calling for tax credits.
    Young, of Physicians for a National Health Program, said that of the three
    major Democratic candidates, Edwards comes the closest to his organization’s
    views. But proposals from candidates like Clinton are untenable, he added.
    “She is ultimately duplicitous,” he charged. “People are being ripped off,
    and these liberal Democrats are doing nothing to ease their pain.”
    One problem for these stakeholders, though, is that they’re missing a key
    ally: the powerful American Medical Association.
    While some say the AMA has softened its stance in recent years from the
    Republicans’ free-market approach, it still advocates a mix of public and
    private programs with tax credits thrown in — much in the vein of the
    Clinton, Obama and Edwards plans. AMA officials did not return phone calls.
    “It is imperative that individuals and families be able to choose what
    health plan to join,” says an AMA February position paper on health care,
    posted on the group’s Web site.
    Without the AMA’s backing, it will be tough to enact the kind of reform
    sought by medical professionals. Still, they insist that along with the
    noise they’re making via the Cheney ads and other efforts, they’re also
    making progress.
    “We’ve moved from being irrelevant to being an undesirable alternative,”
    according to Young. End of Story
    Russ Britt is the Los Angeles bureau chief for MarketWatch

  19. Lynn

    Well Brad–I didn’t think you had it in you to be so BOLD. This should get the dialog going. How about some coverage of this complex subject so that voters can be informed about what they are voting on. Health reform is a complicated topic with no simple answers and easily demagogued.

  20. Rally

    Just saw on NBC news that Medicare pays 60 billion a year in fake claimes for medical equipment alone.
    Thats right, $60 billion.
    I have no great dislike for a single payer system, but I can tell u the government is incapable of doing it.

  21. bud

    Lynn you’re right, health care is complicated. That’s why I think a plan to break it down into 4 parts makes it managable. In my tier 1 there simply is nothing anyone can seriously argue over. Folks who come into the emergency room with serious, often life-threatening, one-time events should be treated on the spot without any consideration about how the treatment will be financed. Tier 1 will be 100% paid by the federal government for any patient at any hospital. The only decision that is needed is to determine if the event qualifies as tier 1. In the vast majority of cases this will be very simple. No insurance cards, no forms, no quibbling over payments, every hospital charges the same rate based on the ailment. This is a start to simplifying the mess we’re in.
    Tier 2, the chronic diseases are much more difficult to deal with. Treatment options are more complex. Different patients may prefer a different group of doctors and facilities. In a country that values choices tier 2 may necessitate some form of payment by the patient and/or thier insurance company. It seems like a bridge too far at this time to construct a single-payer system to address the myriad of possibilities here. But everyone should have access to basic treatment regardless of insurance status. The idea that 1 out of 7 people is likely to go untreated for basic ailments like diabetes or high-blood pressure simply because they lack insurance is IMHO barbaric.
    So let’s start with a bill to address tier 1 issues. We can pretty much leave tier 4 (elective procedures) as is. Then we can tackle the more complex issues associated with tier 2 and 3 (preventive treatments).

  22. slugger

    insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar. This is money that the doctors have to spend to pay for the paperwork to collect a dollar from the insurer.
    Maybe we have to worry about those that would be doctors. Maybe their take home pay could be better if they chose another profession. Should we be worrying about whether or not we have enough doctors to take care of the socialized medicine patients? Doctors and those that would choose to be doctors, might decide to seek another profession. Could be blame them?

  23. Doug Ross

    Slugger – don’t you know you’re not supposed to bring facts into the discussion of the single payer system? Brad’s admitted he’s not interested in the details of the issue even when they show that the Medicare payments are 1/3 of what the real world is paying for services.
    Single payer looks great when you only have to pay 33% of the cost. Wonder how many doctors and surgeons will accept single payer patients if their income would be cut by two thirds?
    Details, details… why do we let such trivial items like facts get in the way of giving everything everybody wants for free?

  24. Lee Muller

    Socialist medical systems deal with expensive chronic diseases by denying care. Treatment delayed is treatment denied. Some doctors, not satisfied with merely letting pensioners die, have taken to killing them, out of “mercy”. England recently convicted several serial killer doctors and nurses who had murdered hundreds of their patients. Holland has the same problem, but they have just legalized it, as “involuntary euthanasia”.

  25. Keith

    Much thanks for the article. I was born in the US, but also lived 12 years in Britain. Boy is their system better! Even after Thatcher and Major harmed it. It is amazing that we cannot do something that would save us over $350 billion each and every year and at the same time cover the 47 million who have no healthcare. None of the other top 35 countries in the world have a single citizen without healthcare. Maybe changing the ways our campaigns are financed would help. Try to see “Sicko”.

  26. Lynn

    Lee and Doug: Oh please stop with the horror stories of English and Canadian healthcare. If their systems were so bad we’d have tons of Canadian and English illegal aliens sneaking across our border for healthcare.
    No country has a “perfect healthcare
    system.” All developed nations struggle to balance caring for their people with the rising costs coming from changing technology and increasing service demands from a more sophisticated educated and healthy populations. All of these countries have large complex bureaucracies. Bureaucracies are bureaucracies whether private or public. They are a fact of modern life. So all countries struggle to provide effective, efficient, personal, compassionate, high tech care. All develop nations provide a healthcare system that fits their culture.
    What is important is these other countries do it for less money than the United States. Only in the US do some folks feel a sick person must be individually responsible for his/her health care including the financing of that care. Is that cancer therapy worth your home? your car? or your child’s education or your retirement? Our individual system means we all must knit together our own healthcare and figure out how to pay for it. Truly only the strong and lucky survive.
    This Rube Goldberg system has so many counter productive perverse incentives it is beyond tinkering. Believe me no matter what form reform takes, there will always be a private healthcare system in America for those who can afford it–where you can choose you physician and hospital. Choice isn’t going away. So Doug and Lee your choices will be preserved. It just that perhaps the 1 in 7 of us who depend on the kindness of our local hospital and physician community won’t have to beg for the care we need.

  27. Brad Warthen

    Well, as I said above in the column, they WILL scream and holler. But it’s past time in this country that we go ahead and do what makes sense, and not let people who don’t want to do anything about the problem stop us with naysaying.

    I will say for Doug that he has made some specific suggestions, which I appreciate. If we can get libertarians like Doug talking solutions, there’s no telling what all we can do — provided the rest of us are willing to hold up our ends of the conversation. bud’s doing his part. So should everybody else.

  28. William Smith

    I found your column on a “single-payer” health-care system very progressive. I look forward to future columns on “single-payer” solutions for food, shelter and transportation.
    William Smith

  29. Jeff Mobley

    When evaluating proposals for a health care system, we need to try to answer two questions:
    What makes health care costs so high? and
    How does this proposed system address those drivers of high health care costs?
    There are lots of reasons that health care is expensive. Here are a few of the more obvious ones:
    (1)The education and training of doctors, nurses, and other medical professionals is expensive. These professionals are willing to take on such expense in part because they expect to be highly compensated for their work and expertise.
    (2)Research and development of medical technology and drugs is expensive. Drug companies invest in the development of many potentially useful compounds, only a few of which will reach the market. These few profitable drugs have to bring in enough revenue to cover the costs of development.
    (3)When the government (as in Medicare) tells a doctor or hospital, “We’ll pay you this much for this service, and no more,” the costs have to be made up by increasing the price for others. The same happens when services are provided for those who can’t pay.
    (4)When “health insurance” is no longer really just insurance (a mechanism for pooling and sharing financial risk), but has become a complicated trading of financial liability for even some fairly certain and forseeable costs (like prescription drugs),
    then the classic insurance problem of moral hazard (the tendency of people to engage in risky behavior when the financial (or other) consequences of such behavior are mitigated by insurance) becomes even worse. When it is difficult for a person to clearly see the personal financial implications of poor health, there is a reduced financial incentive to live a healthy lifestyle. This contributes to the unhealthiness of us as a society, which is one of the biggest reasons that health care costs are almost a fifth of GDP.
    Separating the employer from the health insurance customer, and allowing everyone to purchase coverage on their own, could put a lot of pressure on insurance companies to offer a variety of policies to satisfy the particular needs of the many different types of health care consumers out there, who would in turn have a more clear incentive to be as healthy as possible. All of this could reduce costs for everyone, even those whose diseases, conditions, or injuries aren’t preventable.
    A government-run system, which would cap compensation to medical professionals and come with all sorts of mandates, would do nothing to decrease costs, would discourage innovation, and would not increase the individual incentive to live a healthy lifestyle.

  30. Jeff Mobley

    One more thing,
    Another thing that increases costs is when people who have manageable conditions stop taking their prescription drugs, and then have episodes that must be treated with hospital or doctor visits.
    So, it is important that people do not have a dis-incentive to keep taking their drugs. That’s definitely something to take into account.

  31. Lee Muller

    We actually do have hordes of Canadians coming to America for medical care, especially the politicians. I have a file full of news stories about the ones who have been caught.
    You should go to a border city like Minneapolis or Rochester, and see how many Canadians are at the hospitals, paying out of pocket for care that doesn’t exist “for free” back in Canada.
    Just go to any shopping mall on Sunday and see the piles of old clothes left in piles in the parking lots, after Canadians bought new ones to wear back across the border, and avoid the import taxes.
    A few years ago when I last checked, Richland and Lexington Counties had more MRI, CAT, and PET scanners than all of Canada.

  32. Paul DeMarco

    It is true that the US has many more CT and MRI machines than Canada. However, that fact can be used to argue for single payer in three ways:
    1) Despite our lead in technology, Canada’s outcomes (life expectancy, etc.) are better than ours
    2) If we move to a single payer, we already have a strong medical infrastructure base. Canada did not invest enough in its infrastructure and has been playing catch up over the last decade
    3) Canada uses its MRIs much more efficiently than the US, again highlighting the waste and duplication in our system. According to a 2005 report by the Canadian Institute for Health Information,
    “At the same time, new analysis in the CIHI report shows that while Canada has fewer machines per million people, it uses its MRI scanners more intensively than the U.S. and England—the only other countries collecting comparable data. In 2004–2005, numbers of MRI exams per scanner were almost 40% higher in Canada than in the U.S. or England. At the same time, the U.S. performed more than three times the number of exams, reporting 83.2 MRI exams per 1,000 population in 2004–2005, compared to 25.5 in Canada and 19.0 in England.”
    I respect your reservations about single payer and I share some of your concerns. But there is no other viable way to cover all Americans. We have Medicare as our blueprint. It’s a 40 year-old system that has served millions well. Expanding Medicare to all Americans is a sensible proposition.

  33. Jeff Mobley

    Sure, make Medicare available to those under age 65, but charge a premium that will actually cover the costs, so there is no additional burden on the taxpayer. If that premium ends up being competitive with private insurance, great.

  34. Lee Muller

    Dr DeMarco,
    Surely you are aware the the raw measure of life expectancy for two nations of vastly different racial and socio-economics is a useless data item for assessing the quality of the medical systems.
    Most of gross statistics in medical problems, crime, illiteracy, and other social problems are skewed by residents who come from uncivilized countries, and have failed to assimilate into the European culture which is the basis of America and Canada. If you factor them out, and compare similar demographic populations, the US surpasses Canada and most of Europe in these areas.
    To focus on Canada, the dissatisfaction with its socialist system can be seen by the avoidance of free care, to the point that the government outlawed the purchase of private treatment. The result has been the flight of patients to the USA, along with the exodus of 10,000 doctors and nurses since 1996.
    I refer you to the Vancouver, British Columbia-based Fraser Institute, which has a yearly publication titled, “Waiting Your Turn.” Its 2006 edition gives waiting times, by treatments, from a person’s referral by a general practitioner to treatment by a specialist. The shortest waiting time was for oncology (4.9 weeks). The longest waiting time was for orthopedic surgery (40.3 weeks), followed by plastic surgery (35.4 weeks) and neurosurgery (31.7 weeks).
    Canadians face significant waiting times for various diagnostics such as computed tomography (CT), magnetic resonance imaging (MRI) and ultrasound scans. The median wait for a CT scan across Canada was 4.3 weeks, but in Prince Edward Island, it’s 9 weeks. A Canadian’s median wait for an MRI was 10.3 weeks, but in Newfoundland, patients waited 28 weeks. Finally, the median wait for an ultrasound was 3.8 weeks across Canada, but in Manitoba and Prince Edward Island it was 8 weeks.

  35. Doug Ross

    > We have Medicare as our blueprint. It’s
    > a 40 year-old system that has served
    > millions well. Expanding Medicare to all
    > Americans is a sensible proposition.
    Dr. DeMarco, can you please tell us what percentage Medicare patients comprise of your practice? Can you give us some more details on whether the reimbursements you receive from those patients are the same or less than private insured patients? Could you make a decent living serving only Medicare / Medicaid patients?
    How would you respond to my ortho surgeon friend who says he actually loses money on every hip replacement he does for Medicare patients? How do you convince him that he won’t be faced with a hefty pay cut under single payer? How do you convince him that he will be in complete control over who he treats and how much he charges for his services? He should have that right, shouldn’t he?

  36. Lee Muller

    Medicare is a grotesque socialist failure, 20,000 percent over its original projected cost for 2007. To any intelligent person, it offers insight into just how incapable government is at providing medical care.

  37. Sparky

    One significant clarification……….”The same article noted that Hillary Clinton has received $1.8 million in contributions from accident and health insurers, followed by Barack Obama with $1.45 million, Mitt Romney with $1.09 million and Rudy Giuliani with $1.08 million.
    That, by the way, is money that you and I and the guy down the street paid for health care that didn’t go to health care.”
    NOT SO. Federal Campaign Finance law prohibits corporations from contributing to federal candidates. The “insurance” money listed by each of these candidates comes from political action committees (PACs) sponsored by insurance companies. And, all of the PAC money is contributed voluntarily by employees who are not reimbursed by the corporation, and can’t be forced to give or or otherwise be retaliated against for refusing to participate. So, no, these campaign contributions did not come from the health insurance premiums we paid.

  38. Brad Warthen

    That’s an interesting thing to know, Sparky. And it provokes one to wonder: How “voluntary” are those contributions — compared, say, to the United Way contributions that employers cajole their employees for. More so or less so?
    In any case, none of that matters to me. Think about it: Where do those insurance company employees get their money? Unless it’s all inherited or something, my point stands.

  39. Lee Muller

    The more money goes to Washington and the state capitals, and the control politicians have over business, the more in “contributions” the politicians can extort from people in those businesses.
    Illegal corporate contributions are still made, just as individuals illegally donate too much. But it is all on the Internet reports of the FEC if the donations were reported at all. That’s how Joe Wilson was caught giving an illegal contribution to Al Gore, and his wife blew the cover of her CIA front company by giving a corporate donation (of taxpayer money) to the Gore campaign.
    By the way, John McCain proposes an end to employer-provided medical coverage, with a $2,500 tax credit to individual taxpayers to cover their premiums.

  40. jabeaudib

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