Originally Posted by TnT

What difference does it make? No matter the insurance I "choose" I don't get to go to Mayo, or Cleveland Clinic, or Sloan-Kettering. If I change insurance companies, then instead of having to go to East Jesus for treatment, I have to go to West Jesus. The only thing I can hope for is that my insurance happens to contract with the healthcare providers that happen to be good at what I happen to get sick with. If I get something that my providers aren't good at ... tough s**t, I still get to go to them for its treatment.

Competition between payors merely causes dysfunction in the financing of healthcare provision.

Competition between providers will cause folks to get interested in those providers that make people well.

And how do you propose to get competition between the health care providers. This is getting to the root of the real problems, since the bulk of the costs are also with the health care providers. I have not seen any practical plan to do this.

Originally Posted by radind

And how do you propose to get competition between the health care providers. This is getting to the root of the real problems, since the bulk of the costs are also with the health care providers. I have not seen any practical plan to do this.

As I see it, America already has a national health care system. It's generally called the county clinic.
We lack not a solution, just the will to take on the for profit health care model.

Taking them on seriously means also taking on that part of the finance industry to tries to collect on medical debt.
And that of course means taking on Wall Street.

Originally Posted by herbal tee

As I see it, America already has a national health care system. It's generally called the county clinic.
We lack not a solution, just the will to take on the for profit health care model.

Taking them on seriously means also taking on that part of the finance industry to tries to collect on medical debt.
And that of course means taking on Wall Street.

And I say take them all on by forcing them to compete for real and stop supporting their monopolies.

Originally Posted by herbal tee

As I see it, America already has a national health care system. It's generally called the county clinic.
We lack not a solution, just the will to take on the for profit health care model.

Taking them on seriously means also taking on that part of the finance industry to tries to collect on medical debt.
And that of course means taking on Wall Street.

Actually, our most cost efficient medicine is performed by doctors who have never had to worry about school loans. The military is the most obvious example, though there are others ... primarily in the public health arena. We need to separate doctors form the profit motive before it becomes mandatory for their survival. Most of the European countries educate their physicians for free. Call it grades 17 - 20 in the US model. Why can't we do the same, with a transition period to the new model over some time period.

Why is medicine a profit center for the insurance and banking industries anyway? For that matter, who thought that was a good idea?

Originally Posted by Marx & Lennon

Actually, our most cost efficient medicine is performed by doctors who have never had to worry about school loans. The military is the most obvious example, though there are others ... primarily in the public health arena. We need to separate doctors form the profit motive before it becomes mandatory for their survival. Most of the European countries educate their physicians for free. Call it grades 17 - 20 in the US model. Why can't we do the same, with a transition period to the new model over some time period.

Why is medicine a profit center for the insurance and banking industries anyway? For that matter, who thought that was a good idea?

I like your comment about education for physicians.

However, we still need a real health care system vs. the badly evolved 'non-system' that we now have. After we solve the high overhead cost problem , which does invlove the multiple health insurance providers, the underlying cost drivers from the health care providers would remain. I don't like the idea of 'single payer', but could live with this provided we develop a real health care system for all US citizens.
I still maintain that using the federal health care system as a model would also bring down the administative costs because any provider with out of line costs would not attract customers. Blue Cross , for example, would have to provide a product that is competitive with products offered by Unions, Employee Associations, plus whatever group that wants to provide health insurance on a national level to all citizens.

It is not clear to me how the banking industry plays in this.

Originally Posted by radind

I like your comment about education for physicians.

However, we still need a real health care system vs. the badly evolved 'non-system' that we now have. After we solve the high overhead cost problem , which does involve the multiple health insurance providers, the underlying cost drivers from the health care providers would remain. I don't like the idea of 'single payer', but could live with this provided we develop a real health care system for all US citizens.

The payment system enforces the problem you're trying to solve. Look at the payment model. Provider A does this and that, and bills for those services. Insurer X pays the bill, because the accountants can parse the charges, apply the compensation rules and OK the payment. Nowhere in all of that is a focus on the patient, her illness or the outcome of the treatment.

Originally Posted by radind ...

I still maintain that using the federal health care system as a model would also bring down the administrative costs because any provider with out of line costs would not attract customers. Blue Cross , for example, would have to provide a product that is competitive with products offered by Unions, Employee Associations, plus whatever group that wants to provide health insurance on a national level to all citizens.

It still has the limitation of being procedure based rather than outcome based. By design, providers align their services to their best financial advantage, regardless of how frugal the payer may be with their customer's money. To do otherwise courts financial disaster. So changing that in any significant way means changing the posture of the provider community. Conservative forces (i.e. those benefiting most from the current system) will oppose that with everything they can muster.

Originally Posted by radind ...

It is not clear to me how the banking industry plays in this.

They finance education, hospital bonds, provide loans of all types to doctors and their practices, and provide the money to influence policy that favors their involvement. They have the money to buy the power.

Originally Posted by Marx & Lennon

...


It still has the limitation of being procedure based rather than outcome based. By design, providers align their services to their best financial advantage, regardless of how frugal the payer may be with their customer's money. To do otherwise courts financial disaster. So changing that in any significant way means changing the posture of the provider community. Conservative forces (i.e. those benefiting most from the current system) will oppose that with everything they can muster.


...

I agree that the current 'system' will resist mightly. Most Republicans won't even admit that we have a problem. We need to seek an approach with some chance of reaching a consensus. I would like to see the outline of a real system and followed by an understandable plan. This should not take thousands of pages to describe. Then some public dialogue could take place. I fault both parties for not seeking a viable approach. It is sad, but Congress seems unable to deal with hard problems. Maybe we need a series of "BRAC" style commisions to deal with the real problems, so Congress can sit on the sideline and just continue endless debates.

This is why we need a single payer system of health care.

Maternal Mortality in the United States: A Human Rights Failure

March 24, 2011 by Healthcare-NOW!
Filed under Single-Payer News

By Francine Coeytaux, Debra Bingham, and Nan Strauss for ARHP –

With 99% of maternal deaths occurring in developing countries, it is too often assumed that maternal mortality is not a problem in wealthier countries. Yet, statistics released in September of 2010 by the United Nations place the United States 50th in the world for maternal mortality — with maternal mortality ratios higher than almost all European countries, as well as several countries in Asia and the Middle East.1, 2

Even more troubling, the United Nations data show that between 1990 and 2008, while the vast majority of countries reduced their maternal mortality ratios for a global decrease of 34%, maternal mortality nearly doubled in the United States.1 For a country that spends more than any other country on health care and more on childbirth-related care than any other area of hospitalization — US$86 billion a year — this is a shockingly poor return on investment.3, 4

http://www.healthcare-now.org/matern...ights-failure/

Originally Posted by radind

I agree that the current 'system' will resist mightily. Most Republicans won't even admit that we have a problem. We need to seek an approach with some chance of reaching a consensus. I would like to see the outline of a real system and followed by an understandable plan. This should not take thousands of pages to describe. Then some public dialogue could take place. I fault both parties for not seeking a viable approach. It is sad, but Congress seems unable to deal with hard problems. Maybe we need a series of "BRAC" style commissions to deal with the real problems, so Congress can sit on the sideline and just continue endless debates.

Assuming that you have no problem using the experience of others, then there is a panoply of systems to use as models. The French system seems to be the best-of-the-best, but there are many others. T. R. Reid did a good cross sample study and published it in his book The Healing of America. We could do worse than starting there.

Originally Posted by Deb C

This is why we need a single payer system of health care.

Maternal Mortality in the United States: A Human Rights Failure

http://www.healthcare-now.org/matern...ights-failure/

The concern I have with single payer so far is that the plans address the administrative costs( which is necessary) , but I don't see a clear plan to develop a working health care delivery system. Right now, some doctors are dropping out of the current Medicare system and leaving the patients stranded, unless they can afford to pay these doctors up front.
I think that a good plan could be developed, but the idea of thousands of pages of law just to start makes me skeptical. To me this is a critical first step to convince a strong majority of voters to back the plan. I would not be thrilled, but I would support a clear, solid single payer plan.
This needs to be an American plan and not just another Democratic plan or a Republican plan. I don't see Congress doing this without a strong grassroots voter push. In my opinion , it would be easier to appeal to rational conservatives with a plan that retains some competition ,but still works for the individual American. Without a joint effort, we seem to have continued stalemate.

Originally Posted by Marx & Lennon

Assuming that you have no problem using the experience of others, then there is a panoply of systems to use as models. The French system seems to be the best-of-the-best, but there are many others. T. R. Reid did a good cross sample study and published it in his book The Healing of America. We could do worse than starting there.

I have no problem at all using the experience of others. I have felt for a long time that we should be able to take the current US spending on health care to provide a first class system. Some of the existing systems are underfunded. This may take a "BRAC " approach since Congress cannot even close bases without an outside group taking the lead to absorb the political heat.

Originally Posted by radind

The concern I have with single payer so far is that the plans address the administrative costs( which is necessary) , but I don't see a clear plan to develop a working health care delivery system. Right now, some doctors are dropping out of the current Medicare system and leaving the patients stranded, unless they can afford to pay these doctors up front.

The one thing that single payer does best is eliminate the substitution ploy. Saying that you won't work for the only employer in town merely guarantees starvation. Today, providers can play payers off against one another, and get better deals.

Originally Posted by radind ...

I think that a good plan could be developed, but the idea of thousands of pages of law just to start makes me skeptical. To me this is a critical first step to convince a strong majority of voters to back the plan. I would not be thrilled, but I would support a clear, solid single payer plan.
This needs to be an American plan and not just another Democratic plan or a Republican plan. I don't see Congress doing this without a strong grassroots voter push. In my opinion , it would be easier to appeal to rational conservatives with a plan that retains some competition ,but still works for the individual American. Without a joint effort, we seem to have continued stalemate.

You get thousands of pages of law and regulations when the system is complex and subtle. Multiple payers, and a vast and varied list of providers, virtually guarantees complexity.

Originally Posted by radind

... This needs to be an American plan and not just another Democratic plan or a Republican plan. I don't see Congress doing this without a strong grassroots voter push. In my opinion , it would be easier to appeal to rational conservatives with a plan that retains some competition ,but still works for the individual American. Without a joint effort, we seem to have continued stalemate.

HCA is exactly what you describe, and it got zero support from the GOP.

Originally Posted by TnT

We'd be a lot better off if the competition was between healthcare PROVIDERS. If there was a single PAYOR, then the good healthcare systems would have to compete for customers. If I had my choice of Provider, why wouldn't I go to Sloan Kettering for my cancer treatment, instead of East Jesus Memorial Cancer Money Tree in Yellowstream, Montana?

Now this just doesn't make sense. Yes, if there is single payer, there would be competition for quality, but this would only cause prices to go up. If there is only one customer (the government) that will pay pretty much any price, then there is nothing to push prices down. A provider could offer lower prices, but there is no incentive for the patient to choose the lower cost option. They will always go for the premium (the perception of premium, really, because it's easy for consumers to be manipulated by branding) if the government is the one footing the bill.

The only way that could possibly work is if the government instituted price controls, which is just bad news all around.

This is based on a quick search. I will continue to research.

T.R. Reid’s “The Healing of America” - PNHP's Official Blog
://pnhp.org/blog/2009/08/24/t-r-reids-the-healing-of-america/

..."But the biggest problem is not with the private insurers; it’s with Congress. They have decided to move forward with our patched-together system, primarily by expanding the use of U.S.-style, business-model private plans. We will be forced to use inadequate subsidies to purchase private plans that are too expensive and that provide inadequate protection in the face of medical need. This is a program that will expand expensive mediocrity – hardly the solution we seek."...

Originally Posted by Silifi

Now this just doesn't make sense. Yes, if there is single payer, there would be competition for quality, but this would only cause prices to go up. If there is only one customer (the government) that will pay pretty much any price, then there is nothing to push prices down. A provider could offer lower prices, but there is no incentive for the patient to choose the lower cost option. They will always go for the premium (the perception of premium, really, because it's easy for consumers to be manipulated by branding) if the government is the one footing the bill.

The only way that could possibly work is if the government instituted price controls, which is just bad news all around.

That's exactly the opposite of real-world experience of Medicare. For example –



I believe the differential is even greater for drug costs.

How do you explain this?

Originally Posted by The Rani

Government-funded medicine always comes with either price controls or limitations on covered treatment.

Whoops you beat me to the punch. I did have a pretty graph though.

Originally Posted by Marx & Lennon

The one thing that single payer does best is eliminate the substitution ploy. Saying that you won't work for the only employer in town merely guarantees starvation. Today, providers can play payers off against one another, and get better deals....

I agree with you about the current 'system'. This does not apply to Govt. workers in the federal health care system. Each employee can select from several national plans. This puts the power back in the hands of the consumer for the health care insurance. The issue that is not addressed is how to put the consumer in control in terms of the health care providers. This is a harder problem and it seems to me that this part gets overlooked by many in the push for 'single payer'.

Originally Posted by Marx & Lennon

HCA is exactly what you describe, and it got zero support from the GOP.

Then we need to go directly to the voters.

Originally Posted by radind

The concern I have with single payer so far is that the plans address the administrative costs( which is necessary) , but I don't see a clear plan to develop a working health care delivery system. Right now, some doctors are dropping out of the current Medicare system and leaving the patients stranded, unless they can afford to pay these doctors up front.

First, there will always be exceptional physicians who seek exceptional (that is, very rich) clients. Surely you have heard of "society doctors"; some physicians are snobs.

Second, there are also physicians who have innovative, fiendishly-expensive procedures that give hope where it is otherwise unavvailable. If we want those innovative physicians around, then maybe we need to accept that there always will be a dual-tier system of medical care. Such is freedom, and freedom doesn't always give
everyone what he wants. Could an American single-payer system afford to pay $1 million each to successfully treat a cancer that afflicts people only in extreme old age? It might have been worth it for Sam Walton even if the government paid for it, but I can think of better priorities -- like ensuring childhood nutrition and vaccinations.

Third, there are physicians on the margin of practice, most notably those on the brink of retirement or those whose competence or integrity is suspect.

I think that a good plan could be developed, but the idea of thousands of pages of law just to start makes me skeptical. To me this is a critical first step to convince a strong majority of voters to back the plan. I would not be thrilled, but I would support a clear, solid single payer plan.
This needs to be an American plan and not just another Democratic plan or a Republican plan. I don't see Congress doing this without a strong grassroots voter push. In my opinion , it would be easier to appeal to rational conservatives with a plan that retains some competition ,but still works for the individual American. Without a joint effort, we seem to have continued stalemate.

Thousands of pages? Someone who reads an average of ten pages of reading material every day reads 3652.5 pages a year. Do you know of any professional who reads that little?

Maybe you can tell me how many pages of federal law are dedicated to workplace safety, environmental laws, or the regulation of banks.

....

We are in a 4T, and rapid change of social priorities is the norm in a 4T even without cataclysmic violence -- much in contrast to the degenerate 3T in which almost all that is new is rot. We have huge social problems that have festered because of the atomization of American life. Such is unsustainable.

Originally Posted by radind

I agree with you about the current 'system'. This does not apply to Govt. workers in the federal health care system. Each employee can select from several national plans. This puts the power back in the hands of the consumer for the health care insurance. The issue that is not addressed is how to put the consumer in control in terms of the health care providers. This is a harder problem and it seems to me that this part gets overlooked by many in the push for 'single payer'.

The problem you are getting to is that the usual supply-and-demand doesn't work when it's a breast, testicle or, if not too far gone, a mind of yours or a loved one.

The current system has a way of dealing with this revolving around money - how much insurance you bought and/or how much money you have to afford a good lawyer. A single payer system makes it more a social issue - and the usual philosophical divides then ensue.

Originally Posted by pbrower2a

First, there will always be exceptional physicians who seek exceptional (that is, very rich) clients. Surely you have heard of "society doctors"; some physicians are snobs.

Second, there are also physicians who have innovative, fiendishly-expensive procedures that give hope where it is otherwise unavvailable. If we want those innovative physicians around, then maybe we need to accept that there always will be a dual-tier system of medical care. Such is freedom, and freedom doesn't always give
everyone what he wants. Could an American single-payer system afford to pay $1 million each to successfully treat a cancer that afflicts people only in extreme old age? It might have been worth it for Sam Walton even if the government paid for it, but I can think of better priorities -- like ensuring childhood nutrition and vaccinations.

Third, there are physicians on the margin of practice, most notably those on the brink of retirement or those whose competence or integrity is suspect.




Thousands of pages? Someone who reads an average of ten pages of reading material every day reads 3652.5 pages a year. Do you know of any professional who reads that little?

Maybe you can tell me how many pages of federal law are dedicated to workplace safety, environmental laws, or the regulation of banks.

....

We are in a 4T, and rapid change of social priorities is the norm in a 4T even without cataclysmic violence -- much in contrast to the degenerate 3T in which almost all that is new is rot. We have huge social problems that have festered because of the atomization of American life. Such is unsustainable.

The doctors that I am aware of are not 'society' doctors. They just got fed up with the level of Medicare payments and the extra paperwork.
I don't have any information of the vast number of pages of federal law. I just object making things overly long without a real reason. ( I have had a strong interest in a better health care system for a long time and have not spent much thought on the other topics)
On a different topic, my concern extends to the tax law which should be simplified to eliminate special interest breaks.

Originally Posted by radind

I have no problem at all using the experience of others. I have felt for a long time that we should be able to take the current US spending on health care to provide a first class system. Some of the existing systems are underfunded. This may take a "BRAC " approach since Congress cannot even close bases without an outside group taking the lead to absorb the political heat.

Some of the best analyses of health care reform that I have seen have been in The Economist.

http://www.economist.com/node/138996...id=E1_TPRJJGQS
The power of sunshine

..."A second big factor pushing up health costs is the lack of competition among operators of American hospitals. Thanks to a wave of consolidation in recent years, argues Harvard’s Ms Herzlinger, “most parts of the United States are dominated by oligopolistic hospital systems.” George Halvorson, who heads Kaiser Permanente, insists that “there is an almost total lack of price competition among providers.”"...

..."More competition and transparency would help, but the main goal of any reform plan must be to address the perverse incentives that encourage overconsumption and drive up costs. Medicare has been tinkering with “pay for performance”, a promising experiment. Mr Halvorson insists that by rejigging incentives other health providers can also create their own “virtual Kaisers”."...

radind;363939]The concern I have with single payer so far is that the plans address the administrative costs( which is necessary) , but I don't see a clear plan to develop a working health care delivery system. Right now, some doctors are dropping out of the current Medicare system and leaving the patients stranded, unless they can afford to pay these doctors up front.

Perhaps some doctors are confused and don't realize the potential benefits.

There was an article last week in regards to many doctors who indicated they would move to Vermont if it passed a single payer system.

One doctor explained it this way.

One of the out-of-state doctors who would consider relocating is Scott Graham, a family physician in Marion, Ky. “I would certainly consider moving to Vermont if it passed single payer,” he said. “The idea of having one set of rules, one form for billing, and knowing that all patients are covered – that would be wonderful.”

I think he sums up the benefits quite nicely. Not to mention that most of us who work for single payer are requesting an improved Medicare where payments to doctors are increased.

Here's the link to the article I mentioned: http://www.commondreams.org/newswire/2011/03/22-21

Originally Posted by playwrite

Whoops you beat me to the punch. I did have a pretty graph though.

If you look a the trend lines, it's the private insurers that are off-trend.

There is also the not insignificant matter of bad performance at exceedingly high cost. This has nothing to do with efficiency or generosity, it has to do with the fundamental structure of the system. I'm glad I get good health care. I wish it was better. But I also know that my plan costs far more than it should. I pay only a portion of the plan but get 100% of the care. What do you think is my primary concern?