National Health Insurance Now, Not Later

[GaryC 7]

Here is one side of the debate. I don't know what this doctors affiliations are but what he is saying is the way I also believe. If someone comes up with a conflict of interest with this guy don't just slam and dismiss. I truly believe that these are sound arguments regarding socialized health care.

Health Care Quality: Would It Survive a

Single-Payer System?

Robert J. Cihak, MD, and Merrill Matthews, Jr., PhD

In recent years some have been promoting a government-managed, single-payer health care system at state and national levels. What would a state-run system mean to the quality of the U.S. medical services? But first, what does "quality" in medical care really means? Is it an issue of access? Or is it related to "outcomes?" Does it mean the best care available? Or do convenience and cost play a role?

In a normal market, people make quality tradeoffs, sometimes substituting less quality for lower costs or greater convenience. However, when people are insulated from the cost of health care because the government is paying the bill, the role of value declines. Patients want quality at any price --- because someone else is paying that price. Ironically, when someone else is paying the bill, the insistence upon quality declines because patients --- indeed, any type of consumer --- are willing to tolerate bad outcomes and poorer service when they are free.

Some quality factors are objective, while others are subjective; some can be measured, some cannot. We identify some factors below and explain why they should be part of any evaluation of health care quality under a single-payer system.

Access

One of the most touted benefits of a single-payer system is that it would be more efficient than the current system. People would have a family physician who they can see regularly, rather than postponing needed care until they are forced to go to the more expensive emergency room.

However, getting to see a family physician under a single-payer system may not be as easy as proponents suggest. A recent flu epidemic in Toronto expanded the waiting times to see a family physician to five to six weeks --- so far in the future that most patients either would have recovered from their illness and no longer need to see a doctor or would have become critically ill and gone to an emergency room.

Affordability

Proponents of a single-payer system contend that when the government controls the cost of health care, the profit motive is removed, which means the same money can be spread over more people, which saves even more money as well as lives.

When most people enter the single-payer system, they believe someone else - personified as "the government" --- is picking up the bill. As a result, people feel insulated from the cost of care and therefore tend to overconsume --- driving health care spending much higher than it would be if patients insisted on value for money. The irony here is that the process that makes health care affordable for the vast majority of people --- a third party paying the bill --- is the primary factor behind making the health care system unaffordable. In their effort to contain the cost escalation, single-payer systems control health care utilization from the top down with spending limits and price controls.

Scarce Funding and Rationing

As a result, there is never enough money to fund any program as much as proponents and patients would like. Moreover, the decision on which programs get funded and by how much is often determined more by which group has the most political power rather than a program's true needs and merits.

In a single-payer system, the government makes the larger decisions about funding levels, leaving bottom feeders such as the doctors, hospitals and other health care providers to make the tougher individual decisions about whose care to ration. The targets of rationing are usually the marginal cases, the very young, the very old and the very sick. The patient is often simply told, "There's nothing more we can do for you," a true statement within the confines of the limited budget.

In England, some kidney patients died while dialysis machines remained idle because hospitals said they did not have the resources to keep the machines running full time.

In Canada, 121 patients waiting for heart bypass surgery were removed from the waiting list because their condition had worsened to the point that they could no longer survive the surgery.

New Technologies

In a single-payer system health care budgets always end up tight after the politicians discover that they can't raise taxes to meet the demand for services. Middle level feeders, such as the administrators and bureaucrats, often limit adoption of new medical technology because it's too costly. They usually provide only enough funds to purchase a limited amount of the newest technology - if any at all. Decisions on what to buy and when to buy it are often arbitrary and guided more by expedient politics than good medicine.

Stories abound of Canadians going to extreme measures in order to gain access to medical technology. For example, several years ago an enterprising hospital in Guelph, Ontario, decided to allow animals needing CT scans to enter the hospital in the middle of the night --- charging pet owners C$300 apiece. There is nothing necessarily wrong with that except that thousands of people in Ontario were waiting up to three months for an appointment on the same machine.

For physicians, single-payer means single employer. Yet some proponents for a single-payer monopoly gripe about working for corporate HMOs. Yet any single-payer system will surely resemble a huge HMO, without any competing services. This would look like a U.S. Postal Service without competition from UPS, FedEx, e-mail or fax machines.

Finally, in light of the recent attacks on the American homeland, we believe that the federal government has been grievously distracted from its primary duties, such as national defense, as spelled out in the U.S. Constitution. The resources of the federal government would be best redirected to such primary duties and away from meddling with the alluring mirages, such as the single-payer medical care vision.

The best way to expand citizens' control over their own care is to adopt free-market options that allow more choices and options. If policymakers move toward a single-payer system that tries to impose universal coverage, they will find that citizens will be left with neither care nor quality.

Dr. Cihak is the President of the Association of American Physicians and Surgeons. He is a retired radiologist in Aberdeen, Washington, and a nationally-distributed columnist. This column was adapted from their Washington Policy Center study. The complete study (# 01-13) is available at http://www.wips.org/HealthCare/PBMatthewsC...areQuality.html.

Originally published in the Medical Sentinel 2001;6(4);113-114. Copyright©2001 Association of American Physicians and Surgeons (AAPS)

http://www.jpands.org/hacienda/prespage10.html

[Boiler 46,238]

That is not an article about socialised health care, it is about a single payer system, bad news whether the single payer is the Government or an Insurer whatever.

Of course the majority of those obtaining treatment in the US are in a single payer system - US Gov.

I believe that in the recent budget announced a couple of days ago by GW he had a reduction in the US Gov expenditure in health expenditure..

Any system is rationed, there are not unlimited resources, to suggest that there are as this article seems to, defys logic.

A recent flu epidemic in Toronto expanded the waiting times to see a family physician to five to six weeks --- so far in the future that most patients either would have recovered from their illness and no longer need to see a doctor or would have become critically ill and gone to an emergency room

And it would be different in the US how? We have had a lot of snow in Denver, lots of accidents lots of car repairs, free market, and guess what - waiting times.....

Here is one side of the debate. I don't know what this doctors affiliations are but what he is saying is the way I also believe. If someone comes up with a conflict of interest with this guy don't just slam and dismiss. I truly believe that these are sound arguments regarding socialized health care.

Health Care Quality: Would It Survive a

Single-Payer System?

Robert J. Cihak, MD, and Merrill Matthews, Jr., PhD

In recent years some have been promoting a government-managed, single-payer health care system at state and national levels. What would a state-run system mean to the quality of the U.S. medical services? But first, what does "quality" in medical care really means? Is it an issue of access? Or is it related to "outcomes?" Does it mean the best care available? Or do convenience and cost play a role?

In a normal market, people make quality tradeoffs, sometimes substituting less quality for lower costs or greater convenience. However, when people are insulated from the cost of health care because the government is paying the bill, the role of value declines. Patients want quality at any price --- because someone else is paying that price. Ironically, when someone else is paying the bill, the insistence upon quality declines because patients --- indeed, any type of consumer --- are willing to tolerate bad outcomes and poorer service when they are free.

Some quality factors are objective, while others are subjective; some can be measured, some cannot. We identify some factors below and explain why they should be part of any evaluation of health care quality under a single-payer system.

Access

One of the most touted benefits of a single-payer system is that it would be more efficient than the current system. People would have a family physician who they can see regularly, rather than postponing needed care until they are forced to go to the more expensive emergency room.

However, getting to see a family physician under a single-payer system may not be as easy as proponents suggest. A recent flu epidemic in Toronto expanded the waiting times to see a family physician to five to six weeks --- so far in the future that most patients either would have recovered from their illness and no longer need to see a doctor or would have become critically ill and gone to an emergency room.

Affordability

Proponents of a single-payer system contend that when the government controls the cost of health care, the profit motive is removed, which means the same money can be spread over more people, which saves even more money as well as lives.

When most people enter the single-payer system, they believe someone else - personified as "the government" --- is picking up the bill. As a result, people feel insulated from the cost of care and therefore tend to overconsume --- driving health care spending much higher than it would be if patients insisted on value for money. The irony here is that the process that makes health care affordable for the vast majority of people --- a third party paying the bill --- is the primary factor behind making the health care system unaffordable. In their effort to contain the cost escalation, single-payer systems control health care utilization from the top down with spending limits and price controls.

Scarce Funding and Rationing

As a result, there is never enough money to fund any program as much as proponents and patients would like. Moreover, the decision on which programs get funded and by how much is often determined more by which group has the most political power rather than a program's true needs and merits.

In a single-payer system, the government makes the larger decisions about funding levels, leaving bottom feeders such as the doctors, hospitals and other health care providers to make the tougher individual decisions about whose care to ration. The targets of rationing are usually the marginal cases, the very young, the very old and the very sick. The patient is often simply told, "There's nothing more we can do for you," a true statement within the confines of the limited budget.

In England, some kidney patients died while dialysis machines remained idle because hospitals said they did not have the resources to keep the machines running full time.

In Canada, 121 patients waiting for heart bypass surgery were removed from the waiting list because their condition had worsened to the point that they could no longer survive the surgery.

New Technologies

In a single-payer system health care budgets always end up tight after the politicians discover that they can't raise taxes to meet the demand for services. Middle level feeders, such as the administrators and bureaucrats, often limit adoption of new medical technology because it's too costly. They usually provide only enough funds to purchase a limited amount of the newest technology - if any at all. Decisions on what to buy and when to buy it are often arbitrary and guided more by expedient politics than good medicine.

Stories abound of Canadians going to extreme measures in order to gain access to medical technology. For example, several years ago an enterprising hospital in Guelph, Ontario, decided to allow animals needing CT scans to enter the hospital in the middle of the night --- charging pet owners C$300 apiece. There is nothing necessarily wrong with that except that thousands of people in Ontario were waiting up to three months for an appointment on the same machine.

For physicians, single-payer means single employer. Yet some proponents for a single-payer monopoly gripe about working for corporate HMOs. Yet any single-payer system will surely resemble a huge HMO, without any competing services. This would look like a U.S. Postal Service without competition from UPS, FedEx, e-mail or fax machines.

Finally, in light of the recent attacks on the American homeland, we believe that the federal government has been grievously distracted from its primary duties, such as national defense, as spelled out in the U.S. Constitution. The resources of the federal government would be best redirected to such primary duties and away from meddling with the alluring mirages, such as the single-payer medical care vision.

The best way to expand citizens' control over their own care is to adopt free-market options that allow more choices and options. If policymakers move toward a single-payer system that tries to impose universal coverage, they will find that citizens will be left with neither care nor quality.

Dr. Cihak is the President of the Association of American Physicians and Surgeons. He is a retired radiologist in Aberdeen, Washington, and a nationally-distributed columnist. This column was adapted from their Washington Policy Center study. The complete study (# 01-13) is available at http://www.wips.org/HealthCare/PBMatthewsC...areQuality.html.

Originally published in the Medical Sentinel 2001;6(4);113-114. Copyright©2001 Association of American Physicians and Surgeons (AAPS)

http://www.jpands.org/hacienda/prespage10.html

[GaryC 7]

That is not an article about socialised health care, it is about a single payer system, bad news whether the single payer is the Government or an Insurer whatever.

Of course the majority of those obtaining treatment in the US are in a single payer system - US Gov.

I believe that in the recent budget announced a couple of days ago by GW he had a reduction in the US Gov expenditure in health expenditure..

Any system is rationed, there are not unlimited resources, to suggest that there are as this article seems to, defys logic.

A recent flu epidemic in Toronto expanded the waiting times to see a family physician to five to six weeks --- so far in the future that most patients either would have recovered from their illness and no longer need to see a doctor or would have become critically ill and gone to an emergency room

And it would be different in the US how? We have had a lot of snow in Denver, lots of accidents lots of car repairs, free market, and guess what - waiting times.....

Ok, people here have been using nationalized, socialized and single payer interchangeably. Regardless, if the government takes over the health care system I believe that the quality will go down for everyone. I believe that the government will make health decisions for us. I believe that in the end it will cost vastly more than our current system. I believe that it is a power over my life that I am not willing to hand over to the government.

You pointed out one quote from the article. The rationing that Canada has is because of the monolithic nature of their nationalized health care. We would have the same problem here only multiplied because of our larger population. We are a large and diverse country. All the other countries that have a government managed health care system are much smaller and more uniform in population. A one size fits all system just would not work here.

[DeadPoolX 9]

So what are YOU going to do then?

Medicare/Mediccaid is a Socialist system so inappropriate for all the many many reason you have elequently previously stated.

It also also covers the main users of any Healtcare system, the young and the old. And has been pointed the US Gov with your taxes pays more for this subset than the majority of western countries pay for all their population.

Actually, you have it half-right. Medicaid covers those who're below the poverty line. Medicare covers those who're 65 years of age and over. Neither are manditory, but in general, they're both taken when offered as they are cheaper alternatives to "normal" healthcare provider options in the United States.

Medicare, for instance, is only $60 a month. That's astoundingly low, and for that, the patient gets near-complete coverage, including physician visits and hospital stays, and prescription medication. Is it the very best coverage available in the United States? No, it is not. On the other hand, most healthcare providers wouldn't insure someone who is 65 years old or older, so Medicare sometimes is the only option available for many people.

Medicaid is a whole different ballgame. As I said, it's for those below the poverty line. The "working poor," in other words, those who aren't below the poverty line but are either close or are living from paycheck to paycheck, do not qualify. Likewise, those who earn a decent, good or fantastic living do not qualify either, and that's understable.

The problem with Medicaid and Medicare is that both programs are inefficiently and unreliably run, and are full of "red tape." If the government expanded its reach from Medicaid/Medicare to the entire healthcare system, I can't help but see many, many problems arising. The U.S. government is not good at handling large tasks and keeping things simple; it tends to mess up whatever it does.

Now, I do have an idea how people could get more affordable health insurance. What if (and yes, this would be a government-run program, as much as I hate to see that happen) the government, upon taking our taxes, returned a set portion of that money to the people in the form of a "Medical Voucher?" This voucher would only be good for use on a health insurance provider and would provide the individual would the minimum level of coverage -- the individual would be able to add to their level of coverage by paying more; however, they wouldn't need to add any more money in if all they wanted was minimum coverage. The insurance companies would still be getting paid as the voucher would be money (it's returned money from taxation from the government), so there shouldn't be any complaints there.

So as you can see, that plan would potentially give all Americans health coverage. Sure, it'd be of varying levels, but at least everyone would have minimum coverage and that's better than no coverage. For those who're under the poverty line or elderly, Medicaid and Medicare would still exist as well.

[mawilson 2,133]

We'll all be old and grey before that happens my friend, and I suspect will have more pressing problems by then. You're still being ripped off by High Street banks who have no reason to change practices which are illegal in Europe. That whole loyalty fee thing you pay when you use another bank's ATM... costs them absolutely nothing, but they ream you for it anyway.

It used to be the case in the UK as well. How did it change? Maybe all it takes is a class action lawsuit?

[GaryC 7]

We'll all be old and grey before that happens my friend, and I suspect will have more pressing problems by then. You're still being ripped off by High Street banks who have no reason to change practices which are illegal in Europe. That whole loyalty fee thing you pay when you use another bank's ATM... costs them absolutely nothing, but they ream you for it anyway.

It used to be the case in the UK as well. How did it change? Maybe all it takes is a class action lawsuit?

I am glad you brought that up. The free market is taking care of that right now. My bank no longer charges for using some other banks ATM. I even hear that some banks are refunding the fee that some ATM's charge if your not a member of their bank. The free market will in the end fix things. Health care is no different.

[one...two...tree 2,762]

We'll all be old and grey before that happens my friend, and I suspect will have more pressing problems by then. You're still being ripped off by High Street banks who have no reason to change practices which are illegal in Europe. That whole loyalty fee thing you pay when you use another bank's ATM... costs them absolutely nothing, but they ream you for it anyway.

It used to be the case in the UK as well. How did it change? Maybe all it takes is a class action lawsuit?

I am glad you brought that up. The free market is taking care of that right now. My bank no longer charges for using some other banks ATM. I even hear that some banks are refunding the fee that some ATM's charge if your not a member of their bank. The free market will in the end fix things. Health care is no different.

Gary, oh Gary, oh Gary...sigh.

[Trompe le Monde 1,107]

I am glad you brought that up. The free market is taking care of that right now. My bank no longer charges for using some other banks ATM. I even hear that some banks are refunding the fee that some ATM's charge if your not a member of their bank. The free market will in the end fix things. Health care is no different.

What bank is this? I'm changing my checkings over to it!

[Boiler 46,238]

We'll all be old and grey before that happens my friend, and I suspect will have more pressing problems by then. You're still being ripped off by High Street banks who have no reason to change practices which are illegal in Europe. That whole loyalty fee thing you pay when you use another bank's ATM... costs them absolutely nothing, but they ream you for it anyway.

It used to be the case in the UK as well. How did it change? Maybe all it takes is a class action lawsuit?

I am glad you brought that up. The free market is taking care of that right now. My bank no longer charges for using some other banks ATM. I even hear that some banks are refunding the fee that some ATM's charge if your not a member of their bank. The free market will in the end fix things. Health care is no different.

Gary, oh Gary, oh Gary...sigh.

Wow, one of most protected business's in US, must have excellent lobbyists.

I wondered why there were so many banks, made no sense. We have 2 for a population of 1600.

Then I opened an account and saw the charges.

So I wondered why there had not been major competition, like there is in say the Grocery trade, where is the Safeway Bank, Wallyworld Bank etc. The Banks have excellent lobbyists. So much for the land of the free.

Same thing goes for the Insurance industry by the way. Most Western Countries outlaw such restrictive practices.

[one...two...tree 2,762]

We'll all be old and grey before that happens my friend, and I suspect will have more pressing problems by then. You're still being ripped off by High Street banks who have no reason to change practices which are illegal in Europe. That whole loyalty fee thing you pay when you use another bank's ATM... costs them absolutely nothing, but they ream you for it anyway.

It used to be the case in the UK as well. How did it change? Maybe all it takes is a class action lawsuit?

I am glad you brought that up. The free market is taking care of that right now. My bank no longer charges for using some other banks ATM. I even hear that some banks are refunding the fee that some ATM's charge if your not a member of their bank. The free market will in the end fix things. Health care is no different.

Gary, oh Gary, oh Gary...sigh.

Wow, one of most protected business's in US, must have excellent lobbyists.

I wondered why there were so many banks, made no sense. We have 2 for a population of 1600.

Then I opened an account and saw the charges.

So I wondered why there had not been major competition, like there is in say the Grocery trade, where is the Safeway Bank, Wallyworld Bank etc. The Banks have excellent lobbyists. So much for the land of the free.

Same thing goes for the Insurance industry by the way. Most Western Countries outlaw such restrictive practices.

The free market only works when there is true competition and regulations that ensure fairness with that competition.

[mawilson 2,133]

I am glad you brought that up. The free market is taking care of that right now. My bank no longer charges for using some other banks ATM. I even hear that some banks are refunding the fee that some ATM's charge if your not a member of their bank. The free market will in the end fix things. Health care is no different.

What bank is this? I'm changing my checkings over to it!

My bank (Commerce) doesn't charge any fees.

Commerce Bank Announces the End of ATM Fees

[GaryC 7]

My bank is USBank. They don't refund the fees charged by the other banks yet but they don't charge me if I use my card in someone else's ATM. I also get free checks and checking. The competition made this happen. One bank started it and now the others have to follow suit or die. The same goes for health care. There will be a company come up with a better way and all the other insurance companies will either follow or they will go down. Look at it this way. If we go to a single payer system then there is NO competition what so ever. There will be nothing to stop price hikes. The greedy bastards in Washington will see it as another way to line their pockets at our expense. By then it will be to late. There will be no going back. Sorry, I will never support this or vote for anyone that supports this very bad idea.

[GaryC 7]

The free market only works when there is true competition and regulations that ensure fairness with that competition.

Now your statement makes sense. And I agree. That is why the single payer system will not work. It's a government controlled monopoly.

[one...two...tree 2,762]

The free market only works when there is true competition and regulations that ensure fairness with that competition.

Now your statement makes sense. And I agree. That is why the single payer system will not work. It's a government controlled monopoly.

Gary, be consistent. On one hand you've said you accept some regulations but then you keep going on these rhetorical rants about your disdain for regulations. What do you want? No regulations?

[DelcoCouple 1]

My bank is USBank. They don't refund the fees charged by the other banks yet but they don't charge me if I use my card in someone else's ATM. I also get free checks and checking. The competition made this happen. One bank started it and now the others have to follow suit or die. The same goes for health care. There will be a company come up with a better way and all the other insurance companies will either follow or they will go down. Look at it this way. If we go to a single payer system then there is NO competition what so ever. There will be nothing to stop price hikes. The greedy bastards in Washington will see it as another way to line their pockets at our expense. By then it will be to late. There will be no going back. Sorry, I will never support this or vote for anyone that supports this very bad idea.

So the free market works in Banking and will be the saviour of Medical Care?

You may want to read exactly how the free market works for USBank and medcial care for its employees

http://www.kscourts.org/ca10/cases/2006/06/05-1146.htm

Perhaps that is why you choose to bank with them

Of course the free market heros at USBank would never be like those "greedy bastards in Washington" would they?