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.

What’s Wrong With a Single-Payer System?

HSAs and Choice


For the first time in my life, I don’t have Dental Insurance.

I do, however, have an HSA which can be used for all dental-related expenses.

Today, I went to my 6 month dentist appointment. At the start, they wanted to give me my yearly x-ray, and so — now that I’m in control of my medical expenses — I questioned the necessity of them.

In the end I decided to spring for the extra $50 and get the x-rays done. But it was my choice, since it was my expense (I wouldn’t have questioned it if I knew my insurance was paying for them regardless).

As it turned out, I have a cavity on one of my back teeth (floss, people!) which they wouldn’t have found without the x-ray. If they wouldn’t have found it, over the next months it would have gotten worse, and then my problems — and personal expenses — would have gotten much worse.

I don’t know what it means — and I certainly don’t know if there are any implications for the current Health Care debate — but this experience was very empowering for me. I got to make a decision about my health expenses and in the end, I win.

This is the goal. However, this will not happen with Obama’s healthcare reforms. If everyone is “covered” and HSAs are essentially banned, you will be spending other people’s money and won’t care how you spend it. Therefore, healthcare spending will continue to skyrocket because the health insurance industry will be mandated to cover the equivalent of your oil changes. We have to get the insurance industry out of micromanaging healthcare. The cost of micromanagement far outweighs the supposed benefit of having expensive “easy” access. Enjoy this while it lasts. It is the ideal and what we’ll be providing with Hello Health, but essentially made useless under healthcare “reform.”

Obama’s Eight Points



from Ezra Klein/The Washington Post

Barack Obama is going on the road today with a retooled pitch for health-care reform. In particular, he’s emphasizing how reform will help the rest of us. To dramatize this, the White House has come up with the eight guarantees that will be written into health care bill:

  1. No Discrimination for Pre-Existing Conditions: Insurance companies will be prohibited from refusing you coverage because of your medical history.

  2. No Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays: Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.

  3. No Cost-Sharing for Preventive Care: Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.

  4. No Dropping of Coverage for Seriously Ill: Insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.

  5. No Gender Discrimination: Insurance companies will be prohibited from charging you more because of your gender.

  6. No Annual or Lifetime Caps on Coverage: Insurance companies will be prevented from placing annual or lifetime caps on the coverage you receive.

  7. Extended Coverage for Young Adults: Children would continue to be eligible for family coverage through the age of 26.

  8. Guaranteed Insurance Renewal: Insurance companies will be required to renew any policy as long as the policyholder pays their premium in full. Insurance companies won’t be allowed to refuse renewal because someone became sick.

These protections would help a lot of people. Or, to be more precise about it, these protections will keep a lot of people from receiving a terrible blow when they’re most vulnerable.

These are all important inclusions, and there’s an interesting segment on last week’s This American Life about point four — recission of coverage when one becomes seriously (read: expensively) ill, but where’s the public option?

I’m sorry but these are simply not possible without a marked increase in monthly premiums. New York has what’s called “community ratings” meaning everyone pays the same premium and, in exchange, insurance companies cannot discriminate based on pre-existing condition. New York has the third highest average premiums in America because you simply cannot receive a lower premium because you are young and healthy. The argument is that if a population enrolls a larger amount of the previously uninsured and increases its pool, premiums will decrease. However, insurance premiums have not decreased (as promised by the insurance companies).

Again…the fundamental problem of healthcare is the process of healthcare delivery:

Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coördination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later? Getting the country’s best electrician on the job (he trained at Harvard, somebody tells you) isn’t going to solve this problem. Nor will changing the person who writes him the check.

Obama’s Eight Points

Best. Comment. Ever.

This is, without a doubt, the best comment ever on TechCrunch. Left by “J” on MG’s latest iPhone rant about the Google Voice debacle. Beautiful.

AT&T: You want answers?

TechCrunch: We think we’re entitled to them.

AT&T: You want answers?!

TechCrunch: We want Google Voice on our iPhones.

AT&T: You can’t handle the iPhone with Google Voice! Son, we operate on network that has walls. And those walls have to be guarded by carriers with restrictions. Who’s gonna do it? You? You, Verizon Wireless? We have a greater responsibility than you can possibly fathom. You weep for Google Voice and you curse AT&T. You have that luxury. You have the luxury of not knowing what we know: That pulling Google Voice, while tragic, probably saved the network. And our existence, while grotesque and incomprehensible to you, saves the network. You don’t want the Google Voice on your iPhone. Because deep down, in places you don’t talk about at TechCrunch50, you want us protecting the network. You need us protecting that network. We use words like rate limiting, application approval and restrictions…we use these words as the backbone to a life spent defending something. You use them as a punchline. We have neither the time nor the inclination to explain ourselves to a blog who writes and profits under the blanket of the very network that we provide, then questions the manner in which we provide it. We’d prefer you just said thank you and went on your way. Otherwise, we suggest you pick up a router and build your own network. Either way, We don’t give a damn what you think you’re entitled to.

TechCrunch: Did you order Google Voice taken down?

AT&T: We did the job you sent us to do.

TechCrunch: Did you order Google Voice taken down?

AT&T: You’re goddamn right we did.

I got to spend a day with David Iglesias a few weeks ago. He’s the real-life lawyer that inspired the movie, “A Few Good Men” and was played by Tom Cruise. He’s also one of the 8 Attorney Generals fired by Bush for not playing politics. And now he is in charge of the legal team figuring out what to do with the “terrorists” at Gitmo under President Obama. He is one of my new heros. He’s never been known to back down from a challenge and to simply do what’s right. I wish him the best.

Best. Comment. Ever.

Recalcitrant Blue Dogs Raked In Health Industry Cash

The seven Blue Dog Democrats holding up health care reform legislation in the House Energy and Commerce Committee have received tens of thousands more dollars from health and insurance interests than other Democrats on the same committee, a new report finds.

An analysis of campaign finance data by the Public Campaign Action Fund finds a fairly strong correlation between private industry donations and opposition to health care reform. Lawmakers in both the House and Senate who voted against proposed legislation this congressional cycle, the report found, received roughly 65 percent more money from health and insurance interests than those who supported the bills.

When it came to the Blue Dogs in particular, that data showed that the seven members who sit on the Energy and Commerce Committee – Reps. Mike Ross (Ala.), Baron Hill (Ind.), Charlie Melancon (La.), Jim Matheson (Utah), John Barrow (Ga.), Bart Gordon (Tenn.) and Zach Space (Ohio) – have received, on average, $711,828 from the health and insurance sectors. Other Democrats on the committee, by contrast, have received an average of $628,023.

$628K vs. $711K? HUGE difference! Of course, damn near all of our “leaders” are feeding at the industry trough.

I want leaders that lead. I don’t want leaders that follow the money.

If this doesn’t make you lose hope in the ability for a centralized top-down “revolution” in healthcare to actually benefit the citizens, I don’t know what will.

Can anyone tell me the benefits of buying a vote or an opinion with money from the oligopolies? What good does it do for the citizens being crushed by the cost of basic healthcare and the fear of personal bankruptcy?

Recalcitrant Blue Dogs Raked In Health Industry Cash