Inkwell: Authors and Artists
Rip Van Winkle (keta) Fri 26 May 06 19:53
Or, for that matter, that the government will turn out to be hollow and collapse a la Enron... As far as political currency, just got a mailer from John Russo, Oakland City Attorney running for Assembly, and he's promising he'll fight for SP. And Dellums is running for mayor on the theme. What's with that?
Joe Flower (bbear) Sat 27 May 06 11:17
That's a reasonable scenario, Jonathan. Keta, Dellums and Russo are signs of an important ingredient here: States and localities are beginning to see that they can do smoething about this - not everything, but something. There is movement afoot in Congress to pre-empt state and local laws like those in Masachusetts. I think it would be a very interesting political test of how far the SP idea has cmoe.
Carl LaFong (mcdee) Sat 27 May 06 22:53
We certainly have the best Congress money can buy.
Joe Flower (bbear) Mon 29 May 06 09:32
So, what shape should a Single Payer system take? If you just say, "The government pays for health care out of tax revenues," you still haven't said how the government pays - and the differences make a difference. Let's look at some alternatives: o The government simply pays a flat yearly budget for each institution, and a salary and overhead costs for each practitioner. o The government pays established amounts per covered life - your institution or practice does the healthcare for X number of people (of Y ages and conditions), you get Z dollars. (In a twist on this one, people are assigned to their local institution. If someone assigned to your institution has to, or chooses to, go elsewhere for treatment, you have to pay for that treatment out of your budget - so you have lots of incentive to provide the best treatment so that your customers don't wander elsewhere. This is the Iranian system, designed for the Shah by a professor at Carnegie Mellon, and still in place.) o The government pays established amounts per medical act (i.e. extend Medicare to everyone). o The government pays insurance companies to insure people for healthcare. o The government funds medical savings accounts for people, with which they can buy private insurance, buy into high-deductible plans and leave the rest in the MSA to pay for everyday medical needs, or any combination of things, as long as it is medically related. If you are diagnosed with a condition (e.g. MS, AIDS . . .) that will require large amounts of healthcare for a long period of time, you are shifted into a Medicare-style program that pays for everything. In any of these, you could have the government program be the only one allowed (as Canada did until now), or you could allow private funding to run in parallel, for people who can afford something more - and you could have private insurance be a tax-deductible business expense, or not. The first three of these funding schemes wipe out the healthcare insurance industry, and so are less politically feasible. Each of these funding styles has different incentives for the providers and for the consumers to control use and costs. Anything that is fully covered tends to increase: the prices go up, and people use more. So what shape?
Paulina Borsook (loris) Mon 29 May 06 19:11
just curious --- where would gatekeepers/decisionmakers over who gets what kind of treatment fit into any of these schemes? have heard anecdotally about all kinds of things NOT covered by the uk and canadian systems --- stuff i would put under the category of 'care' (physical therapy; better wheelchairs; etc etc) rather than 'immediate medical intervention' (stithces for a gash in the head) rationing of healthcare? any input on oregon's attempts at rationing healthcare?
Don Mussell (dmsml) Mon 29 May 06 19:22
We would probably get a solution to the healthcare situation sooner if congress was denied the benefits that they voted for themselves, and had to sink or swim like the rest of us.
Marla Hammond (marlah) Mon 29 May 06 19:49
>>if congress was denied the benefits that they voted for themselves yep
Gail Williams (gail) Tue 30 May 06 09:59
Except of course that they generally are wealthy individuals, and we generally are not. That makes basic emapathy and equity a little tougher. The pressure of a situation where not to suipport a strong national health plan would be political suicide is what's needed, in my opinion. The hardest political task may be to get the populace to believe it's possible and to detect and reject phony decoy proposals that are sure to surface with a whole lot of dollars behind them.
Joe Flower (bbear) Tue 30 May 06 15:32
Gail speaks sooth. >gatekeepers #1-3: Government, as the CMS (Center for Medicare and Medicaid Services) does today for Medicare and Medicaid. #4 (gov pays for private insurance): Probably insurance companies #5 (gov funds MSAs): mostly the individual consumer, except the gov would decide who qualifies for the hardship stuff Most countries have the government be the gatekeeper, which is why in most countries the actual management of healthcare (not just payment) is a constant political issue, while it is not in the United States.
Paulina Borsook (loris) Tue 30 May 06 17:01
it's interesting, in that medicare -is- our sp, but - one is advised to get medigap insurance, which only makes up for what is cobvered by medicare but - there is tons of stuff not covered by medicare. and of course the stuff not covered adds up. i dont know what the other SP systems (western europe minus the uk; japan) do in these matters... .
Cynthia Dyer-Bennet (cdb) Wed 31 May 06 12:57
Joe, this has been such a rich conversation, with so much to explore. I feel like we've hardly gotten started, yet it's been two weeks since you first joined us. Thank you, Joe, for sharing your time and expertise with us, and thank you, Andrea, for being such an excellent moderator. Though our viritual spotlight has turned to a new discussion, this topic will remain open for further comments indefinitely. So if you're able to stick around, please know you're more than welcome. Thanks!
virtual community or butter? (bumbaugh) Thu 1 Jun 06 06:40
Yes, thanks, Joe and Andrea; it's been great. How great? Robin writes in e-mail to say she's joining the Well to participate. She also says: "Hello. My name is Robin Podolsky, and I work for State Senator Sheila Kuehl, who has authored legislation, SB 840, that will bring single payer healthcare to California. Under the terms of the bill, each resident of the state would be insured with comprehensive benefits (medical, dental, vision, hospitalization, etc); California would negotiate bulk rates for prescription drugs and durable medical equipment, such as wheelchairs; and we would each retain the right to choose our own doctor. The state would oversee claims and reimbursement. This would lower the percentage of the healthcare budget now spent on administrative costs from about 30% to less than 5%, while leaving doctors, hospitals and pharmacies in business for themselves as they are now. The bill passed the State Senate and Assembly Health committees last year and is making its way through the Senate again. I am very excited to see this issue taken up here and look forward to participating in the discussion."
Joe Flower (bbear) Thu 1 Jun 06 16:13
Wow. I wonder what the chances of that passing are, Imagine that you are an executive for United or Aetna. Here is a bill that proposes to take away your largest market. What would you do?
Carl LaFong (mcdee) Thu 1 Jun 06 18:00
Bribery. Failing that, murder for hire.
Joe Flower (bbear) Sun 4 Jun 06 15:46
There you go again. one thing your solutions would do is overlaod the already overloaded ERs. Here is an article from the Economist reviewing Michael Porter's new book "Redefining Healthcare," which argues that 1) competitive forces used so far in healthcare have been 'introduced piecemeal, in incoherent and counter-productive ways that lead to perverse incentives and worse outcomes: "health-care competition is not focused on delivering value for patients."' But 2) 'a redirection of competition from the level of health plans, doctors, clinics and hospitals, to competition "at the level of medical conditions, which is all but absent" could bring quality up and costs down. http://www.economist.com/business/globalexecutive/reading/ displaystory.cfm?story_id=6999160 I have not read the book yet. I have the book right here. It is one of several that I am to write an essay on for Strategy + Business over the summer. I must say that as far as I understand the book, I agree with Porter - and I also see no conflict between competition in the marketplace and a single-payer system (as I said in the article that framed this conversation). But I am less sanguine that the powerful forces looking to make money from healthcare could let the necessary reforms come through that would shape the competition around bringing true value to the customer. Those forces are having a fine time with the present system skimming off the value for themselves, and would surely strive to skew any reforms to benefit them even more, at the cost of any benefit to the individual consumer or the society as a whole.
Carl LaFong (mcdee) Sun 4 Jun 06 18:40
My solutions would only overload the morgue. Just buy another fridge or two and you're fine.
Dennis Wilen (the-voidmstr) Sun 4 Jun 06 18:58
Thanks <bbear>! Great thinking!
Robin Podolsky (podolsky) Mon 5 Jun 06 17:20
"Wow. I wonder what the chances of that passing are, Imagine that you are an executive for United or Aetna. Here is a bill that proposes to take away your largest market. What would you do?" Well, all of us are still alive and unharmed--and this bill that wasn't supposed to make it out of its first committee is alive and well also. Thing is, almost any business that now offers health benefits (most of the large ones) would save money due to this bill--corporations, like individuals would be assessed on the basis of means, not what a monopolized industry could squeeze out of them. As to small businesses--the benefits/pension crisis doesn't only threaten big corps like GM--if they fail and their workers lose jobs, every dry cleaner, hair dresser and realtor who depends on them loses income too. Further, the costs of underinsurance drain small businesses in ways that are hard to measure--lost hours, lost efficiency, low morale, etc; in addition to ways that can be measured, such as higher local fees from governments that need to pay for their own benefits packages. So, it's not even us vs. big business--it's a certain kind of big insurance vs. everyone else. Companies like Kaiser, on the other hand, would do great with our bill. They could negotiate a yearly budget that would allow them to provide healthcare efficiently without dangerous corner-cutting.
Jonathan David Haskett (jhaskett) Tue 13 Jun 06 14:33
A personal note. What a diconnect. It is hard to keep this discussion going because in open discussion the consensus comes to single payer and then what more is there to say. Meantime my housemate was sitting at the dinning room table in tears yesterday because she has no insurance and routine medical tests, yes all those recommended tests that save money in the long-run are going to cost her $500 which she is hard pressed to come up with. As an uninsured person she has had years of people implying that her lack of insurance is due to a lack of motivation, drive, will to get ahead and essentially her own fault.
Stephanie Vardavas (vard) Tue 13 Jun 06 14:45
That absolutely sucks, jhaskett. It makes me so angry.
Jonathan David Haskett (jhaskett) Wed 14 Jun 06 13:12
Meanwhile, I had to take my stepson to Kaiser yesterday evening for a cat-scratch that had gotten infected. Got through to an actual human advice nurse (as opposed to an automated AI go - to - the - Emergency Room, telephone button decision tree like at Amerigroup). She had all his records available electronically, was able to hunt me up an appointment at the nearest urgent - care facility and send them a note electronically that I couldn't find his Kaiser card (no problem). Waited 15 minutes at the urgent care facility got to see a doctor who, again, had all Sebastian's records online, got a prescription filled at the inhouse pharmacy and got home in like 1 hour and 45 minutes. Saved Kaiser a boatload of money by A) not deferring treatment until the infection was severe because of fear of costs and B) not going to the emergency room. This could be everybody.
Jonathan David Haskett (jhaskett) Wed 21 Jun 06 10:42
Time to take some of these ideas to a more political venue. Two new websites reported in today's Washington Post both of which aim at boosting progressive/democratic idea generation. www.democracyjournal.com www.thedemocraticstrategist.org/premiere/ Democracy Journal has an article illustrating how the deductability of coporate health insurance amounts to a govt. subsidy of the current broken healthcare system. These are the kinds of policy forums in which single-payer needs to presented and support for it solidified so that it becomes part of the Democratic party idea bank. For those who don't like Dems I would be happy to know where an althernative forum exists to present this idea with any viability to the Repubs, or a policy alternative that provides the potential for 100% coverage for all Americans, at equivalent high standards and low costs.
Jonathan David Haskett (jhaskett) Wed 21 Jun 06 11:32
S.F. unveils universal health care plan - Yahoo! News http://news.yahoo.com/s/ap/20060621/ap_on_he_me/san_francisco_health_care A better model than Massachussetts?
rebarebar (rebarebar) Sun 1 Oct 06 09:52
The next part of this discussion is how to get there. The recent Massachusetts legislation is flawed in many ways and may not work ultimately because its compromise was caving to the insurance and drug industries. As long as the model is to accommodate these profit making entities as they wish, no real change can happen. BUT! If the discussion in the media, in legislatures can ever get framed properly, it might include: 1--Access to health care is as important to our economy and democracy is access to education. Why do we not treat it the same way? 2--Access to health care for all will go farther to ensure our general wellbeing by better controlling communicable diseases. Think of another flu outbreak, SARS, and so on.
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