Mandates requiring people to get health insurance from insurance companies does nothing to get the insurance companies out of the health care business. What is needed is a single payer plan with no insurance companies involved.

Sane, universal, healthcare systems such as the one I grew up under in England guarantee health care for all. Period. Everyone contributes to the money pool and everyone is covered. Costs of administering the program are around 3%. Administrative costs in this country range anywhere (by various estimates) from 17% to over 30%. The difference, of course, is in profit for the most unproductive section of our society. It is money ripped off the backs of the needy for the enrichment of a few.

PS. Thank yu for bringing up this issue Scarecrow and Caw!

Good morning, Scarecrow!

Good morning. Hope everyone has a wonderful Christmas Eve.

nomolos — I agree, and it’s frusturating to watch the debate about universal care get stymied in the candidates debates — we really need the debate to open up, so the public can follow the logic. We’re locked into the insurance paradigm, so the candidates’ plans dance around the core problem.

I’ve been encouraged that folks like Krugman are popularizing the discussion. And I was suprised there wasn’t more discussion of Edwards’ proposals for enforcing the mandate — he’s very close to conceding, we need to tax everyone to pay for universal care. Once we put that notion on the table, we can ask why we should tax ourselves to pay for a highly expensive administration via the insurance industry.

This whole mess is a perfect example of game theory’s “Prisoners’ Dilemma” where each actor is better off if they cooperate — if both cooperate.

Employers would benefit from universal care — not universal coverage — because (a) they could get out of the insurance business and focus on making widgets, their true calling; and (b) they would stand a better chance of having a healthy workforce and healthy customers.

But mention that scary bogeyman “raise taxes” and rationality seems to go out the window.

Unless, of course, you’re in the insurance business — or taking their political contributions in large doses.

Everybody gets a social security number almost automatically anymore. Why not just use that? As a registration anyway.

Seems to me that if you design a program that’s “tempting” then, just like not having to mandate “candy,” you’ll attract people to it.

And instead of focusing on the recipients of the program, why not focus on the obstacles - the insurance companies?

When I’m trying to help people change, I try to get them focused on clearing obstacles from the path. People need healthcare. What are the obstacles? Mostly the insurance companies, I think.

I’ve been encouraged that folks like Krugman are popularizing the discussion. And I was suprised there wasn’t more discussion of Edwards’ proposals for enforcing the mandate — he’s very close to conceding, we need to tax everyone to pay for universal care. Once we put that notion on the table, we can ask why we should tax ourselves to pay for a highly expensive administration via the insurance industry.

Edwards seems to say that once we have universal health care the insurance company problem would take care of itself in that premiums would be forced down making it unpalatable for insurance companies to continue in the business. We can only hope.

Insurance for my spouse and I is almost $10,000 a year and I would swap that for a $5,000 tax bill any day of the week.

I’ve added this op ed by two advocates of a single-payer system, to the end of the post. It has some useful history of how “mandate” proposals fared in other states.

The NYT has a good piece up on the lack of dental care, stemming in part from lack of dental insurance, and the toll it takes:

BARBOURVILLE, Ky. — In the 18 years he has been visiting nursing homes, seeing patients in his private practice and, more recently, driving his mobile dental clinic through Appalachian hills and hollows, Dr. Edwin E. Smith has seen the extremes of neglect.

He has seen the shame of a 14-year-old girl who would not lift her head because she had lost most of her teeth from malnutrition, and the do-it-yourself pride of an elderly mountain man who, unable to afford a dentist, pulled his own infected teeth with a pair of pliers and a swig of peroxide.

He has seen the brutal result of angry husbands hitting their wives and the end game of pill-poppers who crack healthy teeth, one by one, to get dentists to prescribe pain medications.

But mostly he has seen everyday people who are too busy putting food on the table to worry about oral hygiene. Many of them savor their sweets, drink well water without fluoride and long ago started ruining their teeth by chewing tobacco and smoking.

Dr. Smith has a rare window on a state with the highest proportion of adults under 65 without teeth, where about half the population does not have dental insurance. He struggles to counter the effects of the drastic shortage of dentists in rural areas and oral hygiene habits that have been slow to change.

“The level of need is hard to believe until you see it up close,” said Dr. Smith, who runs a free dental clinic at a high school in one of Kentucky’s poorest counties. He also provides free care to about half of the patients who visit his private practice in Barbourville.

There’s more. It’s painful to read, but right on target.

Thanks, Scarecrow!

Yep. Welcome to the messed up economics of the U.S. medical industry.

I identified this as a problem back in 1991, and as late as then only because I didn’t look at the issue earlier. It’s been like watching the country commit economic suicide in slow motion.

I have no idea what the actual solution might be. Just watching. No doubt about the fact that rich folks & corp interests are going to muck it up. The former get great care & don’t want to pay for the less fortunate via progressive tax. The latter (not just insurance corps, but pharma & all the other vested interests) don’t want to lose their share of the pie. None of the Ds have a magic bullet because there isn’t one, but of course Edwards at least makes noises about facing off against the corp interests.

Thanks for the article on the MA plan. Off to read the details.

Interesting story. Thanks for the link, Peterr.

Make sure you read the link I added in the last paragraph, which surveys other states with mandate plans.

Once you start to think about single payer, there’s another set of debates about the role some govt entity must play in ensuring medical services are necessary, whether there are limits on payments, salaries, etc. But we can’t even get to those discussion, because we’re stuck on this mandates debate.

I suspect that Hillary and Edwards both understand where this goes, but both have chosen not to confront the insurance industry directly for now. Dunno whether that’s smart politics or poor leadership.

Like most solutions that Americans dream up for problems it will be half-assed and ineffective. All they have to do is look at health plans that are effective and popular in G.B., France, GDR, Sweden, oh but wait, those are “socialist” solutions, never mind.

Good Morning Scarecrow! caw-CAW!

You always bring so much sense to this debate.

I can’t imagine not having health insurance. And if I lost mine, I couldn’t get it due to those ever present “pre-existing conditions” we all acquire.
It’s a racket.

Any time you force people to do anything, you automatically incur resistance. It’s like a principle of human nature, I think. People simply don’t like to be forced. Most people really don’t like to see a doctor, for example. But given a problem, like a medical condition, suddenly people need health care.

That’s why I feel certain healthcare must be universal. If people choose not to use a particular system, like Medicare, for example, or a VA for vets, that’s their choice. But it needs to be there for everyone - so they feel they can choose to use it or use something else… for example pay providers who may offer special services to independent customers.

I think healthcare should be like roads. We simply assume roads. Ok, some roads are toll roads, but you never have a toll road without there being another way to get somewhere. The poorest person can use a road or a sidewalk. Or walk on the grass or through the woods. But the roads are there in any case.

I honestly think we have to change the discourse altogether. So people see healthcare as necessary …. as “there” for the taking when it’s needed.

Why do we let the opposition choose the arguments? We need to propose our own arguments. Our own playing field, so to speak. And simply hammer that home.

I may be wrong. But something about the way we discuss healthcare has got to change. We need to tie it to whatever we assume is necessary for life. Water. Oxygen. Food. Shelter. Clothing.

Tie it to national security for goodness sake! How can the nation be “secure” if it’s not healthy? And if insurance companies lobby against it, well brand them as being against national security!

Thanks for the new link Scarecrow

The “mandate model” for reform rests on impeccable political logic: avoid challenging insurance firms’ stranglehold on health care. But it is economic nonsense. The reliance on private insurers makes universal coverage unaffordable.

One has to wonder why large corporations would not embrace the idea of getting out of the health insurance business as it costing them gazillions a year until one realizes that insurance companies are big investors in these corps. Cross directorships and the concomitant conflicts of interests are, of course, another problem. A number of corps like the idea of people having to keep their jobs because of health care insurance, enslaving the worker dontcha know.

I read that. Last paragraph was interesting. I didn’t know the individual provinces had any say in the matter. I always assumed that decision was made in Ottowa for the whole country. Learn somethin’ new everyday, eh?

Tie it to national security for goodness sake! How can the nation be “secure” if it’s not healthy? And if insurance companies lobby against it, well brand them as being against national security!

Interesting analogy. What would we think of a candidate who said, “We should have universal military security, so I’m going to mandate that every person/family purchase military insurance, so that if we are attacked, each family receives protection from the soldiers provided by the insurance company and paid for by the insurance premiums. However, we won’t cover you for pre-existing arguments that led to war.”

But this is a really tough issue for our side. the other side just falls into “the US has the best healthcare in the world” mode and as with so many things, forestall debate by simply wrapping the issue in the flag.

I commented somewhere yesterday that I had watched McLaughlin Group for the first time in a long time and it was scary because Mclaughlin was making the most sense. They were doing their end-of-year awards. McLaughlin gave his “Lie of the Year” award to : “America has the best health care system in the world.” Good one for the grouchy old man. As hard as this issue is for us, if people like John McLaughlin are saying that, we’re making some progress.

Good one.

If universal care were one of the two most important issues in the next election, and Democratic candidtates all strongly advocated a single payer system, is it likely that they would win elections at this point? I have no idea, but even though I am for a single payer system, I’m not sure that Republicans might manage to stay in power, with the support of insurance money and propaganda, on that issue alone. I would hate to see that, in that there are other issues critical to the nation.

On the other hand, would candidates be less likely to increase opposition with plans similar to either the Clinton or Edwards plan at this point. Neither would preclude future change or improvement when the time seem right. I don’t know.

Here’s the fundamental problem: it is the knowledge gap between buy & seller that gives the medical industry the power to control the economics. In addition to that, the customer, being sick, is vulnerable, and therefore the seller has even more economic power.

Economists, looking at an industry with market imperfections, will try to devise a way around them that will bring the result closer to economic efficieny (i.e., the most output for the least input). But no one is even looking at the issue of the knowledge gap. The govt could do wonders by providiing more information for patients. They know which hospitals cure and which kill (ditto docs), and they could easily provide this info. The govt could also focus more of its research dollars on outcomes, which would eliminate many treatments that are either not necessary or worse (think hormone replacement therapy). Now that alone will not “solve” the problem, but it is an essential ingredient in reducing the economic power of the industry, and thus the costs. And there is not a single pol who is even considering that.

That’s why I can’t get too much into the weeds on any particular proposal. Just looking at them & wondering what all the unintended outcomes will be, giving medical care reform a bad name.

As for universal single payer, I’m very reluctant to let someone like President Bush be in charge of what kind of medical care I’m going to get. But that may be the least bad outcome.

I have a friend whose wife is Quebecois. While my friends live in the U.S., her family lives in Montreal. There’s no opt-out in Quebec & they hate the system.

I’m for single payer, too. Somebody, someday has to call bullshit like McLaughlin did yesterday (see my #19) when a GOP candidate panders by saying “We have the best healthcare system in the world.” We don’t and more people need to understand that. It’ll take a leader to get that across because we’ve been brainwashed so much.

The U.S. does have the best medical care in the world if you’re rich. The DC folks live in that bubble which is why they don’t understand the problem.

My assigmnet to myself today is to finish reading Shock Doctrine. Less than 100 pages to go, so I’m off to do that.

Maybe I didn’t understand eCAHN, where do you come down on the whole health are issue? No single payer or are you saying you’re for that because it’s the least disagreeable?

But a good point about the knowledge gap and superior power of the providers and carriers.

I saw MacLaughlin and was pleasantly surprised at his statement. However, given what has happended to the country in the last seven years, I wouldn’t want to leave war/peace, the justice system, national economy, in the hands of the Republicans because health care became the live or die issue at this point.

Really, most Canadians I’ve heard from like it. I heard somebody say.. I forget who.. that the health care system was a source of great national pride there. Who knows?

sshoula been “Really ? “

Punctuation counts. Spelling don’t.

We only have the best for those who can afford it. For the rest we have a very sub par health delivery system.

Insurance companies are little more than accountants who were supposed to manage payments and spread risk, but their first allegiance it to profits and so they do some very bad things and people suffer and die.

The you have all the greed and profit “entitlements” of the providers, phara, docs, hospitals, equipment makers who get to charge whatever they want (it’s funny money and the insurers pay wink wink)

Capitalism is way broke and it can’t make a good health care system. It makes for good profits and poor health care.

Yes. There’s a whole set of issues about how the system contains costs, so that we get health care we need but without paying more than we should or paying for service that may not be necessary (and don’t stifle innovation, etc). Right now we let the insurance industry make a lot of those judgments, and they have a set of incentives that are not aligned with those who need care. But if they’re not allowed to do that, then they can’t afford to be the financing mechanism, because the uncontrolled costs would bury them. Someone else needs to perform that function, someone whose interests are aligned with the patients’. I think the economists’ perspective is very helpful in these discussions.

Admirably, Paul Krugman resolved to focus heavily on the large gaps in health care, delivery in the U.S. over two years ago including those for the poor. None of the candidates approaches the devil in the details of how to insure the uninsured 47-48 million Americans or the patients in the middle class who are devistated by paying for significant illnesses in addition to the morbidity and trauma of the illnesses themselves.

The NYT ran an editorial recently

The Battle Over Health Care:

The four leading Republican candidates espouse no such goal and barely mention the uninsured. The Democrats are willing to put substantial federal money into health care reform. The Republicans are not… Sadly, none of the leading candidates, in either party, has the vision or the political courage to propose radical solutions for the big underlying problem behind America’s health care crisis: the inexorably rising costs.

The NYT editorial also makes a very crucial point that none of the Democratic front runners will make out loud:

Few states have the financial resources that allowed Massachusetts to move to universal coverage, and many states lack the expertise to mount a sophisticated program.

I don’t find this point adequately addressed by any of the candidates in either party, and the Republicans choose to acknowledge that there is much of a health care problem because their base doesn’t have a funding problem and their focus is on privitization that is going to do nothing to care for the poor or to prevent the costs of not caring for their chronic diseases early on before they become catastrophic multi-organ system situations. Rudy 911 ridiculously vaguely points to tax refunds for the poor, failing to acknowledge (because he does know) that the poor don’t have an income near the amount he proposes to refund them. Tax deductions don’t help poor people or unimployed people or people whose large companies like Delta Airlines failed their health plans (released by Congress from this obligation recently) who are uninsured pay for health care. He also offers no cost estimate or mechanism to pay for it.

Many physicians who have to deliver health care, ironically and paradoxically are reflexely for Republicans their entire adult lives, and if you talk to a number of them in depth, they are very poorly informed on any national issue, and will privately give as their major reason for voting Republican that they think they are better off tax-wise when in reality most of them don’t make enough money to get the huge tax breaks that the Bushies and Republican Congress afford to the top income tiers.

Many states fail to fund the large downtown teaching hospitals in large cities adequately. This has resulted, (note that I didn’t say will result), in the drying up of trauma level 3 centers throughout large states. That means that when there is significant trauma, the transport time to tertiary cutting edge trauma care is in hours which means that as high as 40% of patients with critical injuries will die before they reach the trauma modalities they need in the hospital.

The inner city teaching hospitals are being financial devistated by cases that can occur when people from any where in the state or outside the state are burned or injured and the care of these patients can costs hundreds of thousands of dollars. The hospitals are not being funded adequately by the counties immediately surrounding them, let alone at all by outlying counties and the state’s forumulas for distributing funding fail to take this into account.

Their equipment/infrastructure is woefully antiquated, and many procedures are never performed in them and residents aren’t trained to do them as thoroughly as they should be because of this. Organization is often poor, requiring patients to visit multiple clinics over months to recive the routine care they could get if they saw a primary care physician in one 20 minute visit privately–which they can’t afford, and no current plan addresses whatsoever. Electronic organization and computer systems are woefully inadequate, but this is true of some of well-funded private hospitals who make the most profits in large cities as well currently.

I don’t come down anywhere on what “should” be done because no one is talking about the real fundamental economics problem.

So the “solution” comes down to what is least bad, and I have no idea what that is yet. We are in the infancy of making every mistake under the sun while groping toward a better outcome.

This is from the article/link in the OP’s last paragraph:

With the exception of Dennis Kucinich, the Democratic presidential hopefuls sidestep an inconvenient truth: only a single-payer system of national health care can save what we estimate is the $350 billion wasted annually on medical bureaucracy and redirect those funds to expanded coverage. Mrs. Clinton, Mr. Edwards and Mr. Obama tout cost savings through computerization and improved care management, but Congressional Budget Office studies have found no evidence for these claims.

I’ve heard folk mentioning single payer here, and that is what i’d like to see. Does Kucinich have a “plan”, or has he just espoused the idea of single-payer?

Long time lurker, first time poster. Blessings everyone!

I suspect that Hillary and Edwards both understand where this goes, but both have chosen not to confront the insurance industry directly for now. Dunno whether that’s smart politics or poor leadership.

Didn’t Hillary confront this issue with single-payer about 14 years ago? There’s gonna be a tremendous attack by the Insurance, HMO, and Pharmaceutical industries if one attempts a single-payer system. Maybe all three of the leading Democratic candidates know that they will have to end up fighting a campaign against a Republican opponent who will have the combined forced of Mordor behind them to stop any possibility of Single-Payer.

True…things have gotten a lot worse in terms of health care costs since 1993-94. But I’m sure that the same old falsehoods and phoney comparisons will be hauled out. In fact, Giuliani’s statements about his prostate cancer during the SCHIP debate seems like a shot across the bow.

Right. We’ve got to change the discourse. Seize the discourse, the language, the playing field of this.

Welcome. Comment more. It’s addictive.

You can’t contain costs because you have a rigged system and no real “competition” which is what is supposed to keep costs down.

So the rules of the free market don’t apply to health except all the players are in it for profit. That rule is inviolable. And this simply drives costs up and care down and we have a broken lousy system.

Capitalism cannot deliver health care. Can’t be saying that can you in THIS country?

You can say it. I just don’t know of any state in the country where you can win an election and actually accomplish anything if you say it that way.

The NYT editorial you cite is the first link in the post. Thanks for the observations on the cost issue. Huge issues.

Out of curiousity, I wonder how large a vote would oppose anything significantly undermining the insurance industry because of their employment, as administrative workers, salesmen, etc., rather than anything having to do with actual health care. I know of at least one major city which touts insurance as their primary industry.

More information on Dennis Kucinich’s plan for Universal, Single-payer health care for all is on his web site.

He has also co-authored HB 676 - single payer, not for profit, health care system that leaves no one behind.

OT: anyone watching Babs comstock shilling for WIllard? Shit. Wish she’d done as poor a PR-snow job for SCooter-the-traitor.

When the profit motive rules and there is no competition and you have effectively monopolist practice, you get lots of profit and little service. This is a fact and we are victims of this with the rip off health care “industry”.

How bout we do health like we do fire fighting and policing?

What bothers me about the current misplaced debate on mandates, is that the Dems are attacking each other over the details of what looks like a bad idea, instead of attacking the Republicans and the industry on forcing us to think only in terms of bad ideas.

The country is ready for universal health care and if the Dems could just say, “we’re going there, even if we have to take on the insurance industry and the whole Republican party, we’re ready for that fight” — I think that’s a campaign they can win. It would engage the public, win allies among companies that need to shed these costs to stay competitive, and galvanize us.

thanks for the link to Kucinich.

True. Republicans don’t seem to be even groping, though. ‘less you count Medical Savings Accounts.

I’m not arguing with your solution, I’m only saying that you can’t even explain the issues to the electorate when words like capitalism and socialism come to dominate the discussion.

You sure? I could swear I’ve seen that name on a comment before. Anyway, good to have you here and stick around.

You transition by taking over the insurance bureaucracies of the insurers, take away the bloated management and profit and “deputize” the workers as gov workers as phase 1.

Then you incorporate this into the Medicare system. The bloated leeches will lose their cushy jobs. And they will have to work for a living.

Too top heavy…

Many physicians who have to deliver health care, ironically and paradoxically are reflexely for Republicans their entire adult lives, and if you talk to a number of them in depth, they are very poorly informed on any national issue…

Physicians know very little about anything except their own specialty because their education and training have been so narrowly focused and they tend to work long hours with very little personal time. Those who have a broader background or who take more time for themselves - to think - often come around to viewing the need for universal care.

If you want to get M.D.’s on board, here’s how. First focus on what doctors find frustrating about practice today - most doctors are extremley unhappy with the present practice conditions. Right now physicians are feeling very hemmed in due to insurers taking away their independence. They feel forced to join networks. They feel burdened by insurers taking away their decision-making in a variety of ways. There is also little continuity in terms of being able to see patients longterm if insurances change, year by year. And they are also hugely burdened by student loans. So, I would put together a package to lure doctors into supporting universal care.

First, I would make a commitment that if all citizens are to have healthcare, then all doctors will receive incentives like partial forgiveness of student loans, a minimum standard of living (to lure doctors into primary care, where the money is less than specialization), and new doctors will be trained via partial government subsidy of tuition. In addition you need to address the high cost of malpractice insurance and ways to prevent medical errors, including primary care docs having more time with each patient.

I think if you find ways to help doctors see that you are concerned about what frustrates them with practice, you will go a long way to luring them to support a program which helps everyone in the system, not just patients.

Out here in the country, firefighting is done like health care. We pay an annual premium to Rural Metro Corp. In exchange, if our house catches fire they’ll come and put it out. No government involvement. You can take a chance on not paying the premiums, but then if your house catches fire or you need an ambulance they charge you some exorbitant amount — I think it’s $70,000 to put out a fire.

It’s the your-on-your-own society.

OT - a warning about CO2 - i have been smelling exhaust when the furnace was running and couldn’t quite place where it was coming from as the basement smelled clean. After checking outside to see if the chimney were blocked (it wasn’t), i checked the flue in the fireplace. Bits of creosote had kept the flue from closing all the way and i had been smelling blowback (would that be the correct term?) well, gas finding another way out of the chimney. i cleaned out the flue, closed it, and stuffed black canvas against it for good measure. and the damn CO2 alarm never went off. (or is it a smoke alarm?)

Oh, I live in volunteer firefighting country and they’d never charge someone. I can’t imagine that. But it’s the crummy resident who doesn’t support their volunteers, can’t imagine that either.

Imagine if we ran our police and fire departments “for profit” the way we do healthcare.

Unless you had insurance or could pay cash, you would be out of luck. when you called 911, the first question wouldn’t be “where do you live?” but would be “what is your plan number?”

While your house was burning down, the dispatcher would be waiting for approval from the home office. While you were tearing your hair out in despair because your daughter was missing, you would have some bureaucrat telling you “Your plan doesn’t cover your dependents,” or that it doesn’t cover “kidnapping by strangers, only rape and murder.”

R solution to medical care: La la la I don’t want to hear it.

The ever gracious egregious just added a great picture of a newborn to the post. Refresh.

I’ve got newborns on my mind, more that usual: new niece born last night.

I hope you opened your windows if it’s your carbon monoxide monitor, and take yourself outside.

Mazel tov, egregious!

The right counts on controlling the argument over healthcare. So, every time they attack this or that element of healthcare, I would suggest you simply change the subject. Change the discourse to our own playing field, of for example heathcare is national security or healthcare is like the fire dept, and then simply attack them back from our own playing field.

I think one of the problems we on the left have is that when someone attacks us, we feel bound to defend ourselves. And thus we are lured into pointless discussions.

So, consider attacks from the right like you consider trolls. Simply ignore their points and focus on our points! Seize the playing field.

You know, these mandates could be used as a way to sneak universal health care through the back door. Keep the penalties, at least for individuals, reasonably low, then fund the pool through taxes. Bingo. States have to be willing to raise taxes though.

Shhh. Pass it on. :)

Tov, toda!

Actually we’re protestant. I know I often feel like protesting.

Their argument usually relates to the supposed horrible circumstances prevailing in those countries with government administered health care. I always wondered why no one pointed to the fact that Britain, Canada, France, Denmark, Sweden, and Norway are all democracies and ask them which one has elected to revert to our system.

But this IS America’s main problem. We refuse to face the fact that capitalism is our undoing of our democracy.

We made the world a struggle between “good” capitalism - “free markets” NB the word FREE and “bad” communism and socialism, “state controlled” economies NB the word - controlled. All nonsense of course, but hot button words used to manipulate the sheeple.

That is the privatization of services but most places fire protection and police is offered to ALL citizens and paid for by tax dollars as health care should be.

Hooray. Another Democrat! Right?

In that branch of the family? Oh yes.

Their argument usually relates to the supposed horrible circumstances prevailing in those countries with government administered health care. I always wondered why no one pointed to the fact that Britain, Canada, France, Denmark, Sweden, and Norway are all democracies and ask them which one has elected to revert to our system.

and now there’s the example of what happens here if you don’t have insurance, they skip over you on the transplant list. Krikor Sarkisyan’s story.

Better argument. They are all democracies. How come they’ve kept their systems?

And then say…. all other democratic first world countries have universal healthcare.

No democrat who wants to live will call for the destruction of the insurance industry. Remember Caren Silkwood… she decided to speak out against the nookular industry.

I always hesitate to post this out of respect for so many fine physicians who frequent FDL. There are too many patients chasing too few physicians. The AMA controls the number of seats in US Medical schools through the Liaison Committee on Medical School Education. Artificially restricting the number of physicians also increases the cost of Medical school education, which is astronomical. I think there are a lot of things that could be done to reduce those education costs. The physician shortage also cripples quality control. Many physicians are specialists and rely on other physicians for referrals. There is very little incentive to report substandard care or over billing. A lot of physicians are in specialties where manufactures pay them a bonus for sliding patients into a diagnosis which requires their medication. That has to stop. Physicians are the gateway between the patient and whatever treatment that the system provides. Whatever changes are made, they must be sensitive to the high degree of specialization within the industry.

If we went full out as a democracy the people would act in their interest and corporations would be up shit’s creek.

Imagine a tax system where YOU selected how your tax dollars are to be spent and not the bribed concress critters?

But the “sheep” vote, and I don’t think we can overcome years of education by blunt, in your face criticism of capitalism as a system. I’m not sure that you and I would agree on the ideal system, but I think improvement is more likely by pointing to the fact that we’ve reverted to a primitive form of capitalism which destroys the middle class and any hope of reaching the middle class. I think it might be more productive to emphasize pragmatism, the degree to which mixed economies work to solve differing problems, than to preach a doctrinaire economic system. We’ve had 7 hears of trying to put the radical conservative square pegs into round holes on every front.

You see the system is rigged for profit at every corner you look.

Capitalism ruin us.

Make a list of all the public healthcare systems in the US. That would include the fact that all public employees have healthcare. And there’s a military healthcare system, a VA system, public health system, and children, the disabled and elders have healthcare. So just fold it all into one system… and give that to working age people as well.

If they say, we don’t like socialized medicine, I’d say, well I don’t like insurance company controlled medicine.

I’m giving up here! Gonna bake a cake! Something I can decide on and control!

Thank you for the offer! Ok, I’m giving up on wars. I’d rather have peace and health!

Capitalism works against the workers, the people, primitive or otherwise. Left alone it creates monopolies.

If you have a lot of regulation then it’s not the capitalism which the capitalists like because it ties their hands. They want unfettered free markets. No government regulation, nadda. END OF STORY.

To be truthful, I think I’m gonna regret my question, but it needs to be asked. If the object of getting insurance were to cut the insurance companies out completely, which I hear many advocating, how would this effect capital formation. The insurance companies are known to be large pools of money that isn’t just left sitting around. It is invested in your mortgage and mine, in Reits that finance that big new skyrise in your city, or the apartment complex next door. I’m pretty sure they also supply money for other products that need capital formation, and large pools of money to invest.

I really would like a single payer system. Under Medicare, I am currently paying nearly $100/mo, but I had to choose an insurance company, which Medicare pays, as my service provider because it was more rational than trying to pay 20% of my own medical bills. One of my trips to the hospital alone would have bankrupted me. As it is, my copays alone are a minimum of $156 for drugs alone, with $35 more for each time I see one of my two specialists. I would like a system wherein the insurance companies have more vigorous competition with a bit more supervision so they can’t just walk all over their insureds. But I think we need to carefully consider the unintended consequences of bouncing the entire insurance out of anger for their past misdeeds.

Blue Texan has a new post ready — see the link at the top and below. Happy Christmas Eve everyone.

On that note, Blue Texan has a nice new thread upstairs. And by the way, h/t to Scarecrow for this post. It was great, so caw, caw!

Capital formation to make sharehiolders richer by blighting the environment with BS development? Like underwriting Big Boxes and other nonsense?

Screw capital development. Let the tax dollars fund our infrastructure.

Happy Christmas Eve Scarecrow! and thank you

A key point is that “mandates” require penalties, and you need economic experts to design a “good” penalty system that will lead companies (or individuals) to make rational decisions that are consistent with the result you want to achieve, without adding significantly to the total cost.

Scarecrow makes this point several times, that trying to avoid the mandate is “rational”. This means, I suppose, that since the only incentive of a business is to avoid expenses and thus make more money, any step to that end is rational. Apparently it applies to individuals too, who are going to avoid the mandates as well. The only acceptable rationale for human activity is “Making Lots of Money.”

Some people say we are overrun with lawyers, but it looks to me like we have been enveloped by the economic and business theorists. We don’t even question this assumption.

The de-regulation has been fairly recent and based on a lot of propaganda. I think it would be easier to explain to the electorate,at least in a big part of the nation, that many essentials work best when regulated. I really believe a large majority of the electorate believe the terms capitalism, liberty, and democracy (or republic if you like) are synonimous and if you bandy the words capitalism, socialism, syndicalism, or communism around in this country, the word capitalism will win every time. It would take conditions similar to the Great Depression to change that; i.e., a kind of reverse shock doctrine.

No Sander, the market is not being allowed to work.

The laws of supply and demand are like gravity, it doesn’t matter whether you believe in them or not. In the middle of the desert, the price for a glass of water is very, very high. The neocons hide their rank cronyism under the veil of rhetoric about the virtues of the free market. There’s nothing virtuous about the laws of supply and demand. They just explain micro and macro economic behavior. That’s in no way an endorsement of laissez faire capitalism. Government has to be invested in sufficiently to be able to adequately monitor those who own capital in large quantities. The southern cotton plantations so dominated the 19th century economy that they felt entitled to initate the civil war.

and digg this post if you haven’t all ready. Let’s get this discussion going.

MASSACHUSETTE MANDATED HEALTHCARE AND TROGAN HORSES
On November 15th’s CNN Democratic debate in Las Vegas Senator Clinton spoke of mandated national healthcare reform. Barrack Osama spoke of the “ability to pay,” mandated healthcare insurance premiums. Listen to the exchange between Senator Clinton and Senator Osama. “Mandated vs. the ability to pay!”
http://www.youtube.com/watch?v=vBQigrJObwg
Nobody picked up on this and no further questions were asked providing facts or any real information. Massachusetts has reformed health care by the legislature “demanding” all citizens purchase health insurance. If you cannot afford it, you must still purchase it, or suffer tax consequences. Strong arguments exist for the law’s unconstitutionality. Serious ethical questions exist concerning the relationship between elected officials and healthcare interests in the state and nation. The deep pockets needed to litigate the issues do not exist for most and the ACLU who itself enjoys 501 c3 tax exempt status, will not litigate the matter on behalf of the governed.
Columnist Gene Pickham’s November 23, 2007 article, “Mandatory Health Care? Now That’s Sick,” http://www.wickedlocal.com/mal.....1944247460 states:
“One would think that the ACLU would stand up to these violations of personal liberty. But so great is the zeal of achieving socialized medicine, that even the ACLU is turning a blind eye to a hole in these violations that they could drive a truck through.”
Pinkham’s article makes good points concerning Massachusetts’s Mandated Healthcare Reform, entitled Chapter 58. This is not healthcare reform. It is a fraud perpetrated by the legislature and corporate interests on the governed. Unknown to most is the “tax exempt status” within the healthcare industry and its “insulation” from change. For instance how many people know that in almost every state, HMO’s, and insurer, BCBS, and the like, are all listed as “tax exempt not for profit “public charities.” This determination is made by the IRS and is predicated on filings and review standards of “lessening the burdens of government.” Most people perceive “not for profits” to be along the lines of; American Red Cross, Boy Scouts of America, United Way, organizations that “give” to decrease the suffering of others, with no strings attached, enabled by contributions from citizens of America; not “very profitable tax exempt health related entities,” which are bankrupting Americans, forcing foreclosures, destroying the quality of life in America.
A system that uses the tax code penalizing citizens who cannot pay costly health insurance premiums to entities who enjoy tax exempt status is unjust. Pinkham article goes on to identify and even more troubling aspect of the entire process:
“But that was before the days that Political Action Committees called the tune that our elected officials dance to. Now those PACs in the medical field can contribute to candidates, as is reflected in Tisei’s last report to the Office of Campaign and Political Finance. To be fair, Tisei is not alone in reaping such contributions, and they are legion. Can a shameless declaration from a lobbyist in the health insurance industry, trumpeting that the legislature was bought and paid for, be appearing sometime soon in the New England Journal of Medicine?
Now the sad reality, to add insult to injury, corporate lobbyist operating under tax exempt status, PACs lobby our representative to vote for laws mandating that the citizen now purchase health insurance from tax exempt not for profits like Blue Cross Blue Shield. Something is putrid here. It reeks like decomposing organic matter. Odious!!!! It is a twisted plan which will further eviscerate Americans and extracts vast sums of money out of the population, while business goes on as usual. If national healthcare reform is similar, pack it up and go home. We need some good independent journalistic reporting here. It is a Trojan horse by design where perceptions have little nexus to reality
No one can argue with the logic of preventative measures for children, as it relates to future cost. No one can argue that nothing should be done. It sure can be argued that this alleged reform in Massachusetts is a fraud, perpetrated by the legislature and health care lobby, on the citizens of Massachusetts, by simply shifting the burden of cost to the citizen, insured, taxpayer, who has been subsidizing the health care for decades. Meanwhile corporate health interests which are well represented, by lobbyist, money, enabled by the state are destroying America’s middle class. It is difficult to understand how this assault on Americans, lessens the burdens of government, when the governed are being systemically “raped.” Sounds just like the King of England and his corporate cohorts in colonial crime ripping off the colonist under the color of law except this time the taxpayers are now told we must purchase healthcare under a mandate from the legislature conspiring in a continued rip off of the taxpayer in the absence of full disclosure, even at presidential debates.
Jefferson Quote:
“I believe that banking institutions are more dangerous to our liberties than standing armies. If the American people ever allow private banks to control the issue of their currency, first by inflation, then by deflation, the banks and corporations that will grow up around [the banks] will deprive the people of all property until their children wake-up homeless on the continent their fathers conquered. The issuing power should be taken from the banks and restored to the people.

Screw capital development. Let the tax dollars fund our infrastructure.

So, your advocating adopting communism? Socialism? to replace capitalism? Do you consider private ownership of homes and business buildings and industrial complexes infrastructure?

Tax exempt not for profits in the healthcare industry have no tax liabilty.

They suck up to the legisltaure, with well paid lobbyist and tax exempt PACs then use the tax code to penalize the insured taxpayer citizen, who has been subsidizing this broken system for decades…………… WTF are people that brainwashed…………………

Because I usually post a comment too late in the thread, it’s likely no one will read this. At the time of H.Clinton’s effort to reform health care and expand coverage, I was so excited because I believed, idealistically, that this was a new beginning for the delivery of health care. Boy, was I wrong. She divided the nation into five insurance company pools and proposed to dish out the largess to these five megacompanies (as I recall…may be fuzzy, but I studied her plan quite a bit). None of it approached what I had imagined was a plan to implement PREVENTATIVE CARE, the lack of which is what is wrong with our system.

My proposal was then and is now to start with the youngest age group (birth to age five or six…also prenatal) and begin single payer system but mandate as in a program exercise, nutrition, vaccination, etc., with regular checkpoints (birthdays) for progress. Then begin with the next age group (7-12) (12-20) (21-40) (40-60) (60+)

This is just a sketch of the proposal. I even went so far as to send a fleshed out plan to Hillary - no response of course.

If we could build a base of healthy people from the beginning of their lives and continue that preventative care throughout, many elements of our present system could be controlled (costs, etc.)

As we are working intensively on this age group as they progress throughout life, we wind up with a healthier population and solutions to many of our health problems.

Bugs? you bet. But it’s outside the box. Also, it might be more palatable as a slice of the problem to attack than the full frontal assault on insurance companies. As the results become more attractive, so would the support for it.

PREVENTION, NOT CRISIS MEDICAL CARE.

Marilyn…I think that this is a brilliant intiative. For one thing, as the group that has had benefits age they will be healthier and reduce the cost of expanding the program as the reach the next cohort. Plus there should be real evidence that the program decreases health costs overall by prevention. So it would seem obvious that just continuing with the coverage would be beneficial. And as the program shows success with the younger cohorts the evidence will be so strong that it should be expanded into the older cohorts.

I think this was a little what the SCHIP program was supposed to do…although I didn’t see much preventative care involved in that, actually. But the schools need to be involved, with perhaps a real pediatrician (not just nurses) involved at schools. There should be dental, vision, auditory, nutritional and other mobile labs visiting schools and assisting these preventative programs. We also need to make sure kids are eating well and have access to nutritive foods. And exercise. Kids nowadays don’t get physical activity and we are rapidly producing a nation of obese, diabetic teenagers.

I like your idea for the most part and especially your initiative for thinking this thru. The only kink I would see at a glance is that I will be dead before you get to my age group.

Seniors need health care and they need it now; in my case, I was in good health for most of my life, so I rarely gave it a thought. As I hit fifty, I started feeling run down, but I rationalized everything…It’s just age that’s catching up with me. It’s natural for me to need a nap on weekends at my age. It’s normal for riding my horse on weekends to make me extraordinarily tired. This went on and on without my noticing any symptoms that might lead me to believe that my arteries were getting very blocked. I was having a hard time breathing, and blamed it on cigarettes, which of course were related, but it was also the copd that was developing when I didn’t realize it. So losing a job at 56, and the associated loss of insurance, took a big toll. Just when I needed insurance worse, I didn’t have it and couldn’t afford it, and had pre-existing conditions that I was unaware of. I’m pretty sure I’m not the only one.

Good post Scarecrow.

I suspect that Hillary and Edwards both understand where this goes, but both have chosen not to confront the insurance industry directly for now. Dunno whether that’s smart politics or poor leadership.

There are some major corporations which consider their health care plans to be big plusses in hiring & holding good employees and don’t want UHC taking away that advantage. Other corporations are sinking under the growing costs of health care. So, Edwards & Clinton compromise and let corps keep it if they want, but then offer government-run care for those who want that. Choice!

Whether it will work well in practice is unknown. But, we have to try because the current way is killing us. Many cities are laying off police officers because they can’t afford to pay their health care. That leads directly to very real deaths and unsolved crimes.

The country is ready for universal health care and if the Dems could just say, “we’re going there, even if we have to take on the insurance industry and the whole Republican party, we’re ready for that fight” — I think that’s a campaign they can win.

Sure, that would help us win. It helped Bill Clinton too. But, ya see, we don’t just want to win the election, we want to really get UHC. It’s a difference between “change you can believe in” and real change.

I think if you find ways to help doctors see that you are concerned about what frustrates them with practice, you will go a long way to luring them to support a program which helps everyone in the system, not just patients.

I agree completely. The problem with that kind of detailed in depth reform is it could take years and years of incremental change to get there. The more Progressive approach is to change the box our health care is delivered in and ensure that macro economic system works better. Then, you can work gradually on practical things like those you suggested.

Sure, the medical practice isn’t perfect, but it’s partly that way because of the insurance system. Fix that and quite a bit of the micro problems might disappear.

I think it might be more productive to emphasize pragmatism, the degree to which mixed economies work to solve differing problems, than to preach a doctrinaire economic system.

To me ‘pragmatism’ is often a way of avoiding conscious effort to get a certain result and just relying on what seems right or good, in hopes it will result in good outcomes.

I’d prefer to start with goals and then look at ways to get to those goals. You can be pragmatic at that point as it offers more flexibility.

Take for example the economic argument of competition or choice for the purpose of price control: in the current health care system there is choice among insurance providers, but not so much with health care delivery. So, a UHC like Edwards or Clinton would offer actually improves the economics by incorporating MORE choice and competition for dollars.

If you take competition/choice as a goal from the start, then you can see how their plans are more likely to get it done.

If the object of getting insurance were to cut the insurance companies out completely, which I hear many advocating, how would this effect capital formation. The insurance companies are known to be large pools of money that isn’t just left sitting around. It is invested in your mortgage and mine, in Reits that finance that big new skyrise in your city, or the apartment complex next door. I’m pretty sure they also supply money for other products that need capital formation, and large pools of money to invest.

That’s an excellent point. It’s also relevant when discussing the wealth imbalance issue (do we need rich individuals to create capital formation for business investment?) and when considering any banking reforms.

I think the biggest danger to pay attention to is the huge risks of changing our system too quickly. This is a powerful argument against an immediate switch to a government-only UHC. I think there are other arguments against it too, but yours is very powerful.

the word capitalism will win every time. It would take conditions similar to the Great Depression to change that

We don’t have to consider capitalism a blight. We just have to work on our system to improve it bit by bit.

A little more competition here and a little more R&D investment there and a little more infrastructure over there and a few tax policy changes and the next thing ya know the things holding back growth are put aside and things sail along more smoothly.

Thera–

Sorry I didn’t get back to this sooner.

Thera wrote in part:

If you want to get M.D.’s on board, here’s how. First focus on what doctors find frustrating about practice today - most doctors are extremley unhappy with the present practice conditions. Right now physicians are feeling very hemmed in due to insurers taking away their independence. They feel forced to join networks. They feel burdened by insurers taking away their decision-making in a variety of ways. There is also little continuity in terms of being able to see patients longterm if insurances change, year by year. And they are also hugely burdened by student loans. So, I would put together a package to lure doctors into supporting universal care.

First, I would make a commitment that if all citizens are to have healthcare, then all doctors will receive incentives like partial forgiveness of student loans, a minimum standard of living (to lure doctors into primary care, where the money is less than specialization), and new doctors will be trained via partial government subsidy of tuition. In addition you need to address the high cost of malpractice insurance and ways to prevent medical errors, including primary care docs having more time with each patient.

I think if you find ways to help doctors see that you are concerned about what frustrates them with practice, you will go a long way to luring them to support a program which helps everyone in the system, not just patients.

Thera also added:

If they say, we don’t like socialized medicine, I’d say, well I don’t like insurance company controlled medicine.

I could not agree with the points you made more, and I know that to be true of scores of physicians if not hundreds or an even greater magnitude. These are all very crucial, valid points–and there are a lot in addition.

I fully understand the time committment.

All your points are extremely valid. This is a vast topic. I know what’s in physician’s heads, believe me. Most physicians, particularly those who had training up to a few years ago, never dreamed they would have to wrestle with insurance companies, that they would be restricted in what they can often Rx by managed care. They were trained to go for the best cutting edge medications/proceedures that had the most efficacy, and the least side effects or morbidity.

Most physicians are focused on the vast complexities and energy it takes to keep a practice going; to keep up with the rapidly changing literature and developments–and it’s not always as focused in one specialty as you’ve descrived–particularly for primary care physicins whether they are Family Practice (FPs) or internists.

There is also the issue that many primary care physicians can spend a lot of time and do a lot of work on a patient who comes in with three significant diseases whereas some surgical subspeicalists can do proceedures that take considerably less time but earn exponentially more money.

In a number of places in this country, primary care physicians are scarce or lacking, and there is real concern about recruitment of future physicians due to changing trends.

Believe me, many physicians have the brain power and skills to go into a lot of other professions and make a helluva lot more money with a helluva lot less work and time. I kid you not. I’ve seen it done when people are at the peak of their careers in their mid forties due to some of the hasslesa and the grind. Of course there are profound rewards, but there is an equation where there is a point of diminished returns for everyone.

Malpractice premiums weren’t the huge burden they are for some subspecialties now. Often insurance contracts are written where the doc is forced to settle when he has made no mistake. OBGYNs have a very high chance they will be sued 3 years out of residency, and a high proportion of the suits are for maloutcome, not malpractice, and it’s not a cliche–it’s absolutely a fact.

Your point about followup is extremely important for most physicians. I don’t see how it can be otherwise. Every physician feels rewarded by being able to follow a patient’s outcome of an episodic problem or long term care benefits. They are equally highly frustrated when they can’t find out what happened to their patients or participate in ongoing care, and this is happening increasingly in the HMO/PPO setting.

Physicians also have lost control of much of what they can do for their patientsbecause of intervening third parties like insurers or HMOs, over the last twenty years despite the rapid increase in medications and modalities.

There are all kinds of situations where patients are falling through the coverage cracks, another source of great frustration for MDs.

I ran accross this earlier in NYT, and a lot of patients and physicians can relate to this:

Cancer Returns and the Bills Pile Up

I know a lot of physicians with a wide variety of interests, but I believe many of them to be politically narrow minded and a high percentage “conservatives” and many not likely to find the resonance I do with the bright and agile minds on Fire Dog Lake, EW, Tbogg, and many so-called liberal blogs out of sheer blind prejudice that has been hard wired into their psyches and made them entrenched.

And call this a bias of mine, but I firmly believe that most Republicans or so-called conservatives are not very well read or as open to ideas as you will find the bloggers and the commentors on this set of blogs, the blogs linked and often mentioned here, or someone as bright and analytical as Glenn Greenwald. Very few of them would have the interest in some of the nuances in constitutional law you are going to here from EW, Christy, LHP, or Jane and some of the other bloggers here.

I find the parsing of some of these constitutional and legally strategic questions pretty interesting, and that they are posed by people with talent, and experience, and a healthy smattering of lawyers who are good writers.