-
The first time he was patted down, at Newark Liberty International Airport, Mikey was 2. He cried.
Mikey Hicks, 8, Can’t Get Off U.S. Terror Watch List
And there are those that want the government to be the “single payer” for healthcare. If they can’t manage a list of 15,000 people, I don’t think they’ll even come close to managing 300 million people’s health.
-
Extending this successful program [Medicare] to those between 55 and 64, a plan I proposed in July, would be the largest expansion of Medicare in 44 years and would perhaps get us on the path to a single payer model
The proposal to extend medicare eligibility to 55 and increase medicaid in lieu of a public option really is a reasonable proposal. Some progressives are going to insist that anything that doesn’t include a robust public option is a betrayal—but in my view a medicare/medicaid expansion is significantly more progressive.
(via squashed)
“It just doesn’t matter” who writes the check for laughably inefficient processes, a 3000 page “handout to the health insurance industry” bill that doesn’t do anything about controlling costs, and insurance premiums that are rising 10% every year so that in just a few more years only the wealthy will be able to afford today’s version of healthcare. The theater happening in Washington right now “just doesn’t matter.” It’s just entertainment! And, of course, gives the media something to do.
-
a favored public plan would probably doom today’s private insurance. Although some congressional proposals limit enrollment eligibility in the public plan, pressures to liberalize would be overwhelming. Why should only some under-65 Americans enjoy lower premiums? In one study that assumed widespread eligibility, the Lewin Group estimated that 103 million people—half the number with private insurance—would switch to the public plan. Private insurance might become a specialty product.
Many would say: Whoopee! Get rid of the sinister insurers. Bring on a single-payer system. But if that’s the agenda, why not debate it directly? It’s not insurers that cause high health costs; they’re simply the middlemen. It’s the fragmented delivery system and open-ended reimbursement. Would strict regulation of doctors, hospitals and patients under a single-payer system provide control? Or would genuine competition among health plans over price and quality work better?
That’s the debate we need, but in truth, doctors, hospitals and patients don’t want to be limited, whether by government or markets. Congress reflects public opinion. Fearing a real debate, we fake it.
That’s exactly true. Who pays for healthcare is not the real issue. The real issue is the business model of healthcare. The cost of healthcare in America depends upon:
- the regular rate of increasing disease
- the rate of new diseases that can be invented
- the rate of new therapies that can be invented to treat either invented diseases or old diseases
- the rate of new tests that can be invented to treat new or old diseases
- the maximum volume of patients a doctor can see in a given year (increasing every year)
Changing who pays for this money pit will do nothing. People fighting for single payer or “The Public Option” don’t understand the root cause of our healthcare problem. It’s like trying to treat ever-increasing symptoms without curing the disease.
-
What's Wrong With a Single-Payer System?
I know the good doctor Jay Parkinson has addressed this before, but I think it’s worth taking another look.
Thanks…it’s actually very simple. It doesn’t matter who pays for healthcare if doctors are incentivized to do as much as they can and the processes of delivering healthcare are such a convoluted mess with no deliverer nor payor of healthcare responsible for your health. The government could try to streamline the process of reimbursement so doctors can get paid, but then they could also one day decide to pay half as much as they currently do to physicians. This essentially makes physicians government workers and that’s too risky to devotees to social status. I didn’t pay $250K and spend 9 years of my life working my 20’s away to become a postal worker. This simply won’t fly in America. Doctors won’t go for it and there would be a massive exodus amongst physicians out of the single-payer plan and into that cash-based second-tier. We’re already seeing that. Doctors are dropping Medicare. Why? Although Medicare always pays on time (it’s a nice little streamlined process for getting paid), they pay very little. So many physicians think that getting paid on time doesn’t outweigh the sacrifice of getting paid very little.
All of these top-down reformations don’t really matter. Even the CBO says that costs will continue to rise at 8% every year with Obama’s proposed reformations.
Specialists know they can’t continue making as much money as they do. They will have to cave to something that’s not as good as they have it now, but nowhere near being a government worker. Insurance companies know that they can’t expect the average American to pay 40% of your pre-tax income toward healthcare (which will happen in 8 years even with Obama’s proposed reformations). Hospital systems know they can’t control local doctors who independently contract with them. If they try, physicians threaten to leave them for the competition. And Big Pharma knows that they can no longer make money on blockbuster drugs with their current business model (huge investments with very little chance of return). When I speak to these groups, they know exactly what I’m saying when I say they are living in a fantasy world if they believe this can and will continue.
I now say the pressure is on. The first company who can create small scale healthcare “systems” rooted in today’s technology and careful process design along the lines of mini virtual Mayo Clinics that can deliver healthcare at half the cost with marked efficiencies will win…and they’ll win big. Healthcare will be reformed through disruptions just like many of the businesses from the 20th Century have been disrupted by smaller, much more effficient companies without the baggage of the 20th Century. It’s either disruption or literally force doctors to become government workers. And last I checked, it’s a free country bound by the pursuit of life, liberty, and happiness.
-
America’s failed attempt at a single-payer system, the Indian Health Service
Kevin, MD:
Contrary to what you may have been led to believe, the United States has already tried its hand at a pseudo-single-payer system. The VA is one example. Another, albeit less highly publicized, is the Indian Health Service. (via WhiteCoat) Based on an agreement in 1787, the government is responsible to provide free health care to Native Indians on reservations. And, as you can see from this scathing story from the Associated Press, that promise has not been kept. The numbers don’t lie: American Indians have an infant death rate that is 40 percent higher than the rate for whites. They are twice as likely to die from diabetes, 60 percent more likely to have a stroke, 30 percent more likely to have high blood pressure and 20 percent more likely to have heart disease.American Indians have disproportionately high death rates from unintentional injuries and suicide, and a high prevalence of risk factors for obesity, substance abuse, sudden infant death syndrome, teenage pregnancy, liver disease and hepatitis. And, after Haiti, where in the Western hemisphere do men have the lowest life expectancy? It’s on Indian reservations in South Dakota. The primary reason, not surprisingly, is lack of money, compounded by a difficult time recruiting physicians and other clinicians. Indeed, many Indian health clinics cannot “deal with such high rates of disease, and poor clinics do not have enough money to focus on preventive care.” So, if you’re in the camp that supports a Medicare-for-all-type solution to our health care woes, consider how that same government, whom you’re entrusting to be the single-payer, has neglected the Indian Health Service.
-
A quick overview of why healthcare is so expensive
If you read any article about our healthcare system, read this. And for any person who thinks that government run, single payer healthcare, “let’s change who writes the checks for healthcare that costs double what it should” is the answer, here’s the moneyquote:
When it comes to making care better and cheaper, changing who pays the doctor will make no more difference than changing who pays the electrician. The lesson of the high-quality, low-cost communities is that someone has to be accountable for the totality of care. Otherwise, you get a system that has no brakes.
-
Took my dog to the vet, then looked at my HSA. Noticed I paid vet 20% more for annual checkup than ins. pays pediatrician. Sad
Reminds me…I’ve started collecting photos I take of medical clinics vs. veterinary clinics in the same neighborhoods. If anyone has some good examples, send them my way…but here’s the first. Just goes to show that when people pay their own hard earned money for healthcare, providers start competing on price and quality and appearance…essentially, the consumer experience.
Make all physicians paid by a single governmental payer and where’s the incentive to provide the consumer experience in healthcare?
The quality and monetary cost of making healthcare “free” is much more expensive than mandating transparency and encouraging good old fashioned competition in healthcare - something Obama isn’t even talking about.
vs.
-
Republicans Slam Bush As "Socialist"
We can’t be a party of small government, free markets and low taxes while supporting bailouts and nationalizing industries, which lead to big government, socialism and high taxes at the expense of individual liberty and freedoms.
I couldn’t agree more. Of course, we’re in tough times right now. But prolonging the death of dinosaur industries by making taxpayers pay for inefficiencies and policies that worked in 1955 will sink our country. If a company can’t turn a profit, there are about 1000 small companies that will spring up to fill their shoes.
Next on the list for bailouts? Hospitals. This will be followed a few years later by the health insurance industry. Obviously, their hopes of becoming health care managers to turn higher profits simply hasn’t worked. So, they’ll be turning to the government for a bailout once premiums become too large for the average American to fathom (due to all the middlemen management). And therein lies the reason why the health insurance companies donated all their money to Obama rather than McCain. Because Obama will “bail them out” in the form of an even more inefficient, government single-payer bureaucracy that’s focused on pensions rather than profits.
-
Obama Presidency Could Bring Cheaper Medicines, Universal Coverage
While there’s no clear view yet of the specifics on the health front, a few ideas are pretty much off the table, the LAT writes. Those include a government-run single-payer health care system on the left and, on the right, a system rebuilt largely through tax incentives to individuals for purchasing insurance on their own.
But don’t get your hopes up, reformers. It’s easy to agree on principles of change and then see the good cheer disappear when it’s time to make something happen. “Once you get into the details, the consensus is going to vanish pretty quickly, I suspect,” Stuart Butler, VP for domestic policy at the conservative Heritage Foundation, told the LAT.
I wholeheartedly agree with all of this. Any change that decreases the revenue of the pharmaceutical industry, the hospitals, specialist physicians, and other interested players in this $2.3 trillion dollar industry will be met with the fiercest resistance that can be lobbied in the beltway. However, any change that increases the revenue of insurance companies (such as the industry’s much salivated over possibility of mandated health insurance!!!!!) will be fully supported by that industry. Unfortunately, the big players would rather see short term wild profitability at the expense of the literal sustainability of our country’s economy. Remember, the average family makes $60,000 today and health insurance costs $15,300. Insurance has gone up nearly 100% in the past 8 years. In 10 years, the average family will make $80,000 and health insurance will cost $33,000 (assuming health insurance rises at the same rate). This is 41% of your pre-tax income! It’s simply not possible for this to happen.
Just remember, no business anywhere in the world will do anything voluntarily to decrease their revenues, especially in the land we call the free.
-
Health Blog : Obama Says Single-Payer Health Care Makes Sense
If there’s anything that could destroy our health care system and make it look even more like the post office, it’s government-run health care. Why not eliminate the incentives for doctors to practice more care and do costly procedures at the expense of the consumer? That would be a step in the right direction. But government run anything is probably the worst solution to anything. Trust me, I worked at the Maryland State Department of Health. I saw all kinds of people just dying for the weekend and retirement just doing enough to get by.
Come on Obama. You’re smarter than that.
I’m a pediatrician and preventive medicine specialist with a masters in public health. Fast Company calls me The Doctor of the Future and one of The Top 10 Most Creative People in Health Care. Esquire Magazine calls me one of 2009's Best and Brightest Radicals & Rebels Who Are Changing the World.
I co-founded Hello Health and now have a creative firm, The Future Well. We design health innovations.
Read more about me here.
