Originally Posted by radind

Unfortunately, you are correct. At one point we could not do it because the Kaiser did it. Actually, I am in favor of keeping our total health care spending where it is and creating the world’s best health care system. Then the remaining problem would be to control cost increases so that Health care costs do not continue to increase as a percentage of GDP.

One thing to keep into consideration is that for profit insurance giants have very high overhead costs becaus ethey pay outrageous salaries to their CEOs and adminstrators. The other huge drain of dollars that does not go to direct health spending is their beholding to their stockholders.

While there willl never be a perfect system, there is a more compassionate system that embraces all citizens and not just the ones who can afford care, or fortunate enough to have a job that offers good coverage, it's an improved Medicare For All.

A healthy and just society equals a strong country.

Originally Posted by The Rani

I dunno, that "this isn't Cuba" comment was just bizarre.

FWIW, I don't think Cuba is in play. Maybe we can be French ... or Japanese. We're #22 on the list of life expectancy in good health, and we're #1 on the list of per capita expenditures on health . Feel free to emulate any of the countries above us on the first list, since they can't be above us on the second.

Originally Posted by The Rani

Uh ... what? I have read your post several times now and I still can't figure out what you're saying.
If it's that more money does not equal better care, yeah exactly, that's why "universal coverage" won't change much.

OK, less subtle then. We, as a country, have a horribly mis-configured healthcare system, because we absolutely demand things that are impossible and conflicting. We want total control of our care, but we also want low cost. We expect heroic responses when they are needed, and no personal responsibility for outcomes. The list is long, but you already know all this.

In other countries, there is an understood relationship between all of these issues. If you smoke or drink heavily, you will have life expectancy issues (though two of the worst offenders, France and Japan, still seem to do better than we do). Heroic measures are expensive and only justified in some cases ... not including keeping me alive at 95, when I'm going to die next week anyway.

Most countries honor the idea of expertise. Here, we consider it a hindrance. Since we all have health issues, we feel empowered to design the healthcare system; I'm doing that now. Experts will have other more knowledgeable opinions, but that doesn't matter in the country where everything can be put to a vote. We demonize silicone implants, when all the evidence pointed to the contrary. We're doing the same with immunizations right now. Next year, new demon. Stay tuned.

Originally Posted by Deb C

One thing to keep into consideration is that for profit insurance giants have very high overhead costs becaus ethey pay outrageous salaries to their CEOs and adminstrators. The other huge drain of dollars that does not go to direct health spending is their beholding to their stockholders.

While there willl never be a perfect system, there is a more compassionate system that embraces all citizens and not just the ones who can afford care, or fortunate enough to have a job that offers good coverage, it's an improved Medicare For All.

A healthy and just society equals a strong country.

There is no point in looking for perfection. I am still not clear on how Medicare for All does anything to control the costs from the health care providers.
I know that we are not going to agree, but my take is that the health care providers are the main cost drivers. I agree that the abuses of the insurance providers must be dealt with.
However, I do not see these abuses in the federal employee health care system (managed competition). There are several alternate national providers (Unions, Employee Associations) to keep the Insurance companies in line. This is probably a philosophical difference, but I prefer to maintain some competition and choice (for the citizens) in whatever health care system we develop. This is probably a lost cause, but in this federal system, no company could attract 'buyers' with a product that is not competitive.( It would collapse to a single payer system). A model based on expanding this concept for all citizens could also work.

Originally Posted by radind

There is no point in looking for perfection. I am still not clear on how Medicare for All does anything to control the costs from the health care providers.
.

Currently, if health care providers are caring for a vast population, those with insurance, the under-insured and those without insurance, they have to pass on the expense of non-payments. It's an expensive endeavor to recoup the overhead costs of the non-insured, under-insured and non-payments. This is why that family physician said he would move to Vermont if they passed a single payer system.

If everyone was insured, it would cut out tons of paper work, the expense to recoup payments, and remove the headache of hassles with variuos insurance corporations for qualified payments. Therefore, the physicians job would be more profitable.

Originally Posted by radind

There is no point in looking for perfection. I am still not clear on how Medicare for All does anything to control the costs from the health care providers.
I know that we are not going to agree, but my take is that the health care providers are the main cost drivers. I agree that the abuses of the insurance providers must be dealt with.

1. It costs an obscene amount of money to become a high level healthcare provider. This makes no sense at all. Well-educated professionals are as much infrastructure as bridges and highways. Maybe more. Why does it not make sense to educate everyone/anyone for free with as much education as they can stand?

2. Paying healthcare professionals, who have a back-breaking debt, by the number of procedures they perform is insanity, and is one of the BIG variables that drives the costs. Healthcare professionals need to be on SALARY. Then they can do what they could be good at, advocating for their patients.

3. The "Free Market" doesn't work in medicine. In Econ 101, the fundamental assumption with almost any of the supply-demand-pricing models is perfect information. Most people don't have a clue when it comes to any but the simplest things that go wrong with the human body, and even less of a clue when it comes to what can and cannot be done to help or fix said disorder.

4. "Evidence-based Medicine" has been around for some decades now. Why in god's name is it not practiced more? Why do many healthcare providers cling to their own artsy-fartsy view of what is best for each patient, when the evidence is very clear for many common disorders.

5. If you don't provide decent care for all of the population, you get suboptimal care for all of the population. It's like Brown vs. the Board of Education.

6. What value does an insurance company add to a healthcare transaction anyway, if their underwriters underwrite the sick people out of the system? In other words, if insurance companies don't insure, why do we need them?

Originally Posted by Marx & Lennon

OK, less subtle then. We, as a country, have a horribly mis-configured healthcare system, because we absolutely demand things that are impossible and conflicting. We want total control of our care, but we also want low cost. We expect heroic responses when they are needed, and no personal responsibility for outcomes. The list is long, but you already know all this.

In other countries, there is an understood relationship between all of these issues. If you smoke or drink heavily, you will have life expectancy issues (though two of the worst offenders, France and Japan, still seem to do better than we do). Heroic measures are expensive and only justified in some cases ... not including keeping me alive at 95, when I'm going to die next week anyway.

Most countries honor the idea of expertise. Here, we consider it a hindrance. Since we all have health issues, we feel empowered to design the healthcare system; I'm doing that now. Experts will have other more knowledgeable opinions, but that doesn't matter in the country where everything can be put to a vote. We demonize silicone implants, when all the evidence pointed to the contrary. We're doing the same with immunizations right now. Next year, new demon. Stay tuned.

IMO Americans refuse to admit that they must make a choice between rationing based on ability to pay and rationing based on waiting lists, to put it at it's simplest. You can't have cheap health care unless people lower their expectations, the fear about "government-rationed healthcare" shows that expectations people have are unrealistic.

Originally Posted by Odin

IMO Americans refuse to admit that they must make a choice between rationing based on ability to pay and rationing based on waiting lists, to put it at it's simplest. You can't have cheap health care unless people lower their expectations, the fear about "government-rationed healthcare" shows that expectations people have are unrealistic.

Rationing is going on right now. My husband has to fight for his patients everyday. He has to prove to someone at an insurance corporation that each patient fits the insurance criteria for treatment. Forget what the doctor or provider of services say, the bottom line is that the insurance corporation has the last say.

Insurance corporations want well consumers paying high premiums for their products, not actually people who need medical services. People are denied services all the time in this country by the for profit industry. After all, that's how they make the big bucks.

Originally Posted by Deb C

Currently, if health care providers are caring for a vast population, those with insurance, the under-insured and those without insurance, they have to pass on the expense of non-payments. It's an expensive endeavor to recoup the overhead costs of the non-insured, under-insured and non-payments. This is why that family physician said he would move to Vermont if they passed a single payer system.

If everyone was insured, it would cut out tons of paper work, the expense to recoup payments, and remove the headache of hassles with variuos insurance corporations for qualified payments. Therefore, the physicians job would be more profitable.

At least we agree that everyone( every citizen) should be insured. Providers either take all comers with a good plan or don't participate. Unfortunately ,we may have to wait until a few states experiment with different concepts to get some US data.

Originally Posted by TnT

1. It costs an obscene amount of money to become a high level healthcare provider. This makes no sense at all. Well-educated professionals are as much infrastructure as bridges and highways. Maybe more. Why does it not make sense to educate everyone/anyone for free with as much education as they can stand?

2. Paying healthcare professionals, who have a back-breaking debt, by the number of procedures they perform is insanity, and is one of the BIG variables that drives the costs. Healthcare professionals need to be on SALARY. Then they can do what they could be good at, advocating for their patients.

3. The "Free Market" doesn't work in medicine. In Econ 101, the fundamental assumption with almost any of the supply-demand-pricing models is perfect information. Most people don't have a clue when it comes to any but the simplest things that go wrong with the human body, and even less of a clue when it comes to what can and cannot be done to help or fix said disorder.

4. "Evidence-based Medicine" has been around for some decades now. Why in god's name is it not practiced more? Why do many healthcare providers cling to their own artsy-fartsy view of what is best for each patient, when the evidence is very clear for many common disorders.

5. If you don't provide decent care for all of the population, you get suboptimal care for all of the population. It's like Brown vs. the Board of Education.

6. What value does an insurance company add to a healthcare transaction anyway, if their underwriters underwrite the sick people out of the system? In other words, if insurance companies don't insure, why do we need them?

I agree with most of your comments. There is an in balance in power between the health care providers and the individuals needing health care. And no parent with a sick child says 'take me to the low bidder'.

I do like the way the federal health care system works. There are multiple insurance providers, under Government oversight, that provide many good choices (with annual open season) for the employees. It is clear that you don’t want any companies involved, but this has worked well for decades for the government employees.


As I see it, there are 3 key elements to implement a new health care system:
1. Define a clear system to provide good health care insurance for all citizens. (This is the ‘easy’ part and should be straightforward.)
2. Design an approach to control the costs from the health care providers. (This is harder. I don’t have a neat solution, and haven’t seen one.)
3. Develop a viable plan to pay for this. (This is the hardest part. However, we should be able to do this without increasing the current funding on health care.)


Even though I prefer a managed competition for the insurance providers, I could support a single payer plan, provided that this was clearly defined and the issue of lack of competition among the health care providers was also addressed.

Finally, we do need to reach a national consensus to implement a new plan that will have long-term support by the public. I know that there are many Republicans who dismiss any attempt to fix health care as ‘socialism’. However, I hope that enough independents and conservatives can be convinced to be part of a national consensus to support a decent system. I also suggest that leaving some element of competition among the insurance providers would help in this effort.
-In any case, if the companies involved in providing insurance on a national level remain as bad as you seem to think, they would not attract any customers anyway and would just go away.

Originally Posted by radind

At least we agree that everyone( every citizen) should be insured. Providers either take all comers with a good plan or don't participate. Unfortunately ,we may have to wait until a few states experiment with different concepts to get some US data.

I just knew that we could find some things in common. You ask some very good questions.

I have been looking for something that explains FEHPB better than I have done. Note that FEHBP includes several Unions and employee associations in addition to insurance companies.

Austin Frakt on Medicare Advantage and Walton Francis on the FEHBP - By Reihan Salam - The Agenda - National Review Online
http://www.nationalreview.com/agenda...p-reihan-salam
..."Yet Francis suggests that the original FEHBP was able to resist these pressures:

* The FEHBP offers federal employees the opportunity to choose among different private insurance plans through market-based competition. Medicare, in contrast, relies on thousands of pages of statutory and regulatory requirements that dictate almost every design and operational detail. Over 4,000 civil servants run Medicare, while fewer than 200 are needed to administer the FEHBP, a $40 billion program that spends more money than some cabinet departments.

* In contrast to original Medicare, fraud is almost nonexistent in the FEHBP and the new competitive Medicare programs because private plans are far more effective than bureaucracy at preventing and eliminating fraud. Preventing fraud benefits private plans directly, an incentive absent from publically administered programs."...

Originally Posted by radind

I have been looking for something that explains FEHPB better than I have done. Note that FEHBP includes several Unions and employee associations in addition to insurance companies.

Here's a little something that might help us understand how the FEHPB has quite a few flaws.

Federal Employees Health Benefits Program (FEHBP)
AmericanFederation of Government Employees
February 9, 2009

FEHBP has both structural and political flaws.

Those who must rely upon FEHBP for health insurance know its flaws well, and consider it anything but a model.

An estimated quarter of a million federal workers and their families are uninsured because FEHBP premiums are unaffordable to them on their modest federal salaries. The continued cost-shifting only increases the ranks of uninsured and underinsured Americans.

http://www.afge.org/index.cfm?page=2...ContentID=1742

Originally Posted by Deb C

Here's a little something that might help us understand how the FEHPB has quite a few flaws.

Good review of FEHBP. I like the conclusion:

..."AFGE strongly supports legislation like that introduced by Majority Leader Hoyer in the last two Congresses which improves the financing formula to make group health insurance—the most efficient means of delivering health care coverage—more affordable and more accessible for federal employees and their families. Likewise, AFGE will work to pass legislation that extends FEHBP family coverage to dependents up to age 25. AFGE will also work with Congress and the Obama administration to ensure that federal employees and retirees have a seat at the table when OPM negotiates benefits and premiums with FEHBP’s insurance carriers, so the interests of those who pay a third of the program’s costs will be considered. AFGE also believes that the Obama administration should take aim at one of the major causes of premium inflation—prescription drug prices."...

In addtion to high prescription costs, we also must address some way to control the underlying costs of the other health care providers.
If we adoped the FEHBP as a starting point, more power could be given to AFGE and the insurance providers in the design of the system. Although I prefer the options available with an 'FEHBP' type approach ( vs "Single Payer"), the key issue that must be addressed in any national , insurance for all, system is the cost of health care delivery.
Then we can try to deal with the question of how to pay for a national health care system. I would like to free us from employer provided health insurance, but this is highly unlikely to get any political traction.

Originally Posted by The Rani

I'm not familiar with the program, but it sounds a lot like what they did with Medicaid a few years ago, allowed patients the choice of switching to private insurance through the program.
Most people who tried it hated it, and went right back to straight Medicaid at their next enrollment period.

I have little information on the Medicaid program, but the people I know on the FEHPB program are happy with this program. I am sure that there are exceptions, but I have not encountered them.

Originally Posted by The Rani

This is what happens when you forget that no matter what kind of health care reform laws you pass, it won't work if doctors aren't willing (or able, due to excessive debt) to practice that way.

Yah. Like I've been saying the past couple years -- the woes of american health care can be mainly traced back to the cartelization of the industry. High costs of insurance are like third-order (if not even more remote) consequences of that fact. If the main issue doesn't get fixed, no amount of bandaids will help.

But by all means, ignore the problem and instead institutionalize the "insurance" bandaid! Make sure it has pictures of batman on it -- you know how kids love those. Feel like you're Doing Something!

Originally Posted by The Rani

This is what happens when you forget that no matter what kind of health care reform laws you pass, it won't work if doctors aren't willing (or able, due to excessive debt) to practice that way.

I think it's also why some proponents of universal single-payer want to ban the practice of the "rich" buying additional care out of the system. The problem is that the only way to do that is to effectively make workers in the health care field little more than indentured servants who, if they want to practice their trade, have no choice but to accept the government's terms.

Originally Posted by The Rani

High-end medical option prompts Medicare worries


This is what happens when you forget that no matter what kind of health care reform laws you pass, it won't work if doctors aren't willing (or able, due to excessive debt) to practice that way.

I have seen this happen for Medicare patients. I know of one physician who no longer accepts Medicare payments( patients have to pay a monthly fee remain a patient). This doctor still accepts private insurance. If we go to single payer, there would have to be some mandate for the doctors to paticipate. This is already a problem and must be dealt with for a viable national plan .

Originally Posted by The Rani

I'm tired of saying it, too. People will have to learn the hard way.
And I love that you put "insurance" in quotes. Asking health "insurance" companies to take on pre-existing conditions is like trying to sign up for State Farm the day after your accident. Duh!

That is why I am in favor of a single insurance pool for all citizens. Then make a simple rule than all health care insurance providers must take any and all who apply for insurance. (expanded version of the FEHBP). I am sure that many companies would just drop out. We actually would not need 100's or 1000's of providers and I would expect that more than 10 organizations would remain as providers.

Originally Posted by radind

I have seen this happen for Medicare patients. I know of one physician who no longer accepts Medicare payments( patients have to pay a monthly fee remain a patient). This doctor still accepts private insurance. If we go to single payer, there would have to be some mandate for the doctors to paticipate. This is already a problem and must be dealt with for a viable national plan .

Except that enserfing doctors (and that'd have to trickle down throughout the field) isn't The Solution. It's hardly even a solution, if your goal is to make medicine in the USA be no longer crap.

You don't break up a cartel by putting it all under even yet one more restricted-movement organization. Really, that just makes things worse.

Originally Posted by The Rani

Any health care system in America will only work if enough doctors are willing to participate.

Heh. That dovetails very nicely with an obvious solution: stop restricting the supply of doctors. The end result is more doctors, which necessarily means more who would be willing to participate (since at least some of the additional ones would be on-board).

Originally Posted by Justin '77

Heh. That dovetails very nicely with an obvious solution: stop restricting the supply of doctors. The end result is more doctors, which necessarily means more who would be willing to participate (since at least some of the additional ones would be on-board).

And make the education of docs less expensive so they don't need super-high salaries to pay off student loans. Canadian and European doctors make a lot less than American doctors do.

Originally Posted by Odin

And make the education of docs less expensive so they don't need super-high salaries to pay off student loans.

That's a second-order step -- but an important part of the whole thing. What Rani said is important, too. "Health" isn't a commodity in the sense that our society wants to pretend it is; we do ourselves a great disservice in trying to shoehorn it into that box.

Originally Posted by Odin

And make the education of docs less expensive so they don't need super-high salaries to pay off student loans. Canadian and European doctors make a lot less than American doctors do.

The Nordic Nations understand your suggestion. Everyone is on a fair playing field and education is provided. They seem to grasp the concept that education, health care, and supportive services for all, makes for a strong society.

Originally Posted by The Rani

We can also decrease our reliance on doctors and take more steps to improve our own health:
Community Capacities and Community Necessities: A Call to Action by John McKnight


EDIT to add practical examples:

Great ideas