Osler's Razor

Too me there are at least three things that "I" see as problems with our current healthcare system:

Insurance Companies: They are in business to make a profit. And share holder value trumpskeeping cost down.

If you move across state lines the cost of one's policy changes even though the status of the persons health did not change. If can even change within a state based on the presumed health of a county. Health insurenace is cheaper for me to purchase in FL than in Durham, NC. Insurance rates in Wake and Orange county NC are cheaper than in Durham county
because they are considered two of the healthiest counties in the state of NC. I live 1 mile from the Orange county line - am I more or less healthy because of this one mile.

Cost of care for basic procedures. Let's take a person who presents with appendicitis. In the old days they would ask a series of questions, they would press on the quadrant of one's belly to see how hard or soft (yielding to pressure under the push), ask you how the pain rediated and they would run a blood test to check your white count. Now they include ultrasounds and other tests... Does the doctor not know how to diagnose appendicitis? Has the presentation changed that all these other 'cost' producing tests are truly necessary.

I could say some things about dental care too and their insistance that a person with healthy teeth come to have them cleaned 2 times a year - but I won't.
 

sorry for my typo's - why doesn't this blog have spellcheck?
 

I am not entirely opposed to a single payer system. While I think it is going to be a disaster (in the way the DMV or, more pointedly, VA health care is a disaster), I think single payer is the disaster less disastrous than the impending disaster (if we maintain our present course).

In truth, we need to figure out how to ration care. In truth, we really do need "death panels." And single payer is a proven method to ration care and cut costs.

Single payer is also a way to level benefits, which will be wonderful for many. Unfortunately, leveling means a lower level of care for about 70 percent of us. On the other hand, our amazingly high level of care is unsustainable.

So, in reality, this is not actually a discussion of how can we maintain this unsustainable system. Rather it is a question of how to go forward with the best care possible under a sustainable system.
 

freedom man...freedom. I will not succumb to the yoke of oppression man.

I will agree with Waco Farmer though. Single Payer would be better than the middle way we have tried since the advent of Medicare and Medicaid, and which Obama seems determined to take us further down.

The problem with arguing about health care in America is that those that would defend the market are forced to defend the status quo even though the status quo isn't a true free market approach to health care given federal and state programs in health care that skew and tamper with the market. So, we have a genuine market approach to health care, which we don't have now, the middle way, which we've been actively trying since the advent of Medicare at least to disasterous results generally, and single payer, which Germans seem to like.

Then again, some Germans like David Hasselhoff and facism, so...

Smoke 'em if you got 'em...
 

RRL-- I completely agree. Part of what I was saying is that with the extent of Medicare we have right now, we are halfway to single-payer, and we can't go back to a purer market system without enraging tens of millions of elderly people who will then try to kill us with their Buicks, Rascal Scooters and (in Texas) guns.
 

WF-- I love the way you phrase the question: "...how to go forward with the best care possible under a sustainable system?"

The key is "sustainable," and that is going to require some sacrifice by people like me.
 

I could never wrap my mind around Healthcare insurance as a for profit enterprise. Probably because I have this mental image of being on the operating table and some procedures would have to be skipped because they don’t fit the insurance billing list... like getting too few stiches and having an organ plop on the floor. Yikes!
 

Speaking as cog in the American Healthcare System machine I have to say that RRL is actually understating the role of government. It is far beyond skewing and tampeering. CMS (Center for Medicare/Medicaid Services) dictates the rules for billing. They set the baseline for the kinds of things hospitals and physicians can charge for and what those charges should be. The insurance companies reimbursement schedules are linked to what the government declares as billable. The amount that the provider actually receives is another story altogether. Reimbursement is as Byzantine as the tax code.
 

"I have to say that RRL is actually understating the role of government"

HA, I'm NOT crazy. In your face Mom!
 

I too could use some spell check help. I want to add that the regulations on practice dictated by CMS, State Health Departments, etc also control the administration of healthcare, much to the benefit of the citizens of this country.
To sum up: Government already controls the provision of healthcare. The problem is who is paying and who is profiting?
 

So, is anyone here against single-payer, given our current realities? Anyone? Bueller? Bueller? Dad?
 

Single payer is inevitable. We can no longer afford the luxury of employing hundreds of thousands of unnecessary workers in our insurance, health care, and marketing corps. Although,single payer will be a boon for the pocketbooks of both individuals and corporate health consumers, the timing of removing these jobs is the one drawback. We should insist that our government be wise enough to listen to facts and not to political ideology.

I disagree with WF that a single payer would lower anyone's health care benefits, on it's own and that what we have today is a high level of care. We are last in health care delivered among industrialized nations and spend double for this care. What is unsustainable are the unnecessary tests and operations, the quagmire of paperwork needed by all medical providers , the confusion in our multiple insurance plans and the marketing costs.
Single payer can be a private or public entity. Public systems have delivered better results for less money in all the countries who have moved to SP. Rationing and mismanagement are always possible, but that is what we have now. It is simply a matter who you want to give your money to to get affordable health care.

The use of a single payer is a no brainer for medical professionals and the consumer. The only question is when and what will we do with the savings.

Already, we are benefiting from the new requirements for open data on health care. Doctors are better able to look at statistics showing overuse of both testing and operations. The Doctors I know are thrilled to have this knowledge.
All good things will come to pass.
Dad
 

I'm against government single payer in healthcare. Why does inefficient government involvement in healthcare require an expansion of government's role? Politically, opposition to full scale single payer is at least as significant as opposition to market-oriented reforms to the existing welfare state. Welfare reform worked in the 90's. Why can't it work again?
 

Kendall--

Actually, I think there is significant support for single-payer right now, and no chance that you will get rid of Medicare. None.

I understand your point on principle, but this post was about political realities. RRL and WF are right-- the realistic choice is between what we have now, a slightly altered version of what we have now (Romneycare/Obamacare), or single-payer.
 

I don't think we're going to have to worry about it. The apocalypse is clearly nigh if everyone here
 

That should say "if everyone here agrees."

I didn't get taken up in the Rapture.

As if that was a concern.
 

Actually, I was concerned that the Rapture had happened, Carrie, and you were suddenly busy taking care of all those pets you contracted to feed in case of said event and the sudden absence of the pet owners.
 

Prof.-

If single-payer was a political reality, why didn't Obama and the Dem's enact it with the super majorities they had for 2 years? The response to Obama's attempt and the Clintons' in the 90's evidences a healthy opposition. And, as far as I'm aware, only 1 state currently has single payer. I don't know how you define "significant support", but it surely does not constitute a majority or political reality.

Re: medicare, you've misconstrued what I said. I have no problem paying for those who want medicare because it's been promised. But it's certainly more likely that those who believe in financial reality will finally agree to raising the qualifying age over time. And in the process, why not give people a choice to select a better option.

Comments by WF and RRL re: single payer were qualified at best, but I won't presume to speak for them.

I will say, however, that political realities are fickle. I'm curious to see which paradigms shift.
 

I can confirm that my endorsement of single payer was qualified. I am willing to consider it as a horrible solution that is potentially less horrible than the other horrible options. But once you guys start to get all Utopian on me (everyone is going to get improved care and our biggest problem will be trying to figure out what to do with all the money we are saving), I start to get cold feet.
 

WF-- Utopian never works. Least horrible is a better description. A lot of governing is triage.

What people miss, but you emphasize correctly, is that our current path (with or without the Obama/Romney type tinkering) is not sustainable economically. There needs to be a big change one way or the other, and only one way is politically feasible.
 

Perhaps I was taught too much about futile arguments.
 

Kendall--

Touche! The question is... how do you get from here to there? It may be that Republicans would suck it up and actually make those hard choices if they had a majority. Do you think they would?
 

Prof-

First, I don't express enough that although I often disagree with your take on political mayhem, your perspectives have been significantly valuable to me.

And if Republicans don't put the country on a path to fiscal sustainability the next time they get a chance, we may end up with WF's horrible solution. They seem to recognize the urgency, but we'll see.
 

I have to say that under a single payer system my health benefits would probably increase. Why - because I wouldn't fear increases to my premiums everytime I enter a doctors office. Our premiums go up based on "GP" whether we see or don't see a doctor unlike people participating in a group plan at work. At least you are locked in to an annual corporate rate. Our rates change quarterly at the whim of the insurance company, not based on our health.

Also, Congress can try to curtail the cost of Medicaire, but the fact is Baby Boomers are now entering the system so those cost will continue to rise despite all best efforts to contain costs under any method. More people in the Medicaire system equal more cost.

p.s.: Dad ~ you are very wise...