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New Daily Kos resource on affordable universal health care

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Remember that fact whenever somebody says, “yes… but…” Click here for the full diary

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Comment by Don McCanne, MD, a primary care doc and health justice activist who distributed this info on his health policy listserve:

Many have suggested that we need a blog on single payer health care reform. Well, it’s here.

Steve Auerbach, MD, MPH, FAAP is a medical epidemiologist who is also a member of Physicians for a National Health Program. He has established a health care blog on Daily Kos, the largest center-left political blog in the United States.

Although you won’t be able to read it in detail now (at this posting there were 432 comments), you should glance at it and save the link for future reference. Whether or not you have an interest in blogs, it is important to be aware of DrSteveB’s efforts and be able to direct to his site others who do want to see a single payer-friendly blog.

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  1. Here’s the goal, right?

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    (1) cover every person in the U.S.,
    (2) maintain the independence and income of all doctors, healthcare worker;
    (3) convince employers and taxpayers that we won’t end up paying more than we already pay or receive less service than we current receive.

      • Now, this report is four years old, but it squares with what I continue to hear:

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        New York City, October 9, 2002-Recent debates about the future of Medicare have included a range of proposals that would restructure the program to operate more like private insurance. However, according to survey findings reported in the article, “Medicare versus Private Insurance: Rhetoric and Reality,” by Commonwealth Fund president Karen Davis and colleagues, Medicare out-performs private sector plans in terms of patients’ satisfaction with quality of care, access to care, and overall insurance ratings.

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        Is Medicare perfect? Hell no. Does it compare well with private insurance? Yup. Open that sucker up.

      • It’s called the Emergency Room.  Unfortunately, since there is no Universal preventative care, people without health insurance wait until their problems require emergency care before getting treatment, costing hospitals and the public a lot more than if they had been treated earlier. There’s a reason why Americans pay far more per capita for Health Care than any other nation.

        • There’s a reason why Americans pay far more per capita for Health Care than any other nation.

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          Maybe because the US is one of, if not the richest (per capita) nation in the world.  We probably pay more per capita for every service by comparison.

        • But, “If wishes were horses, beggars would ride.” 

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          Does anyone remember the time when you could afford health care?  With or without health insurance?  The time when anyone with the intelligence and tuition could become a doctor?  The AMA now has had control over the number of doctors turned out in this country for many years.  A government sanctioned monopoly.  While it is nice that they can guarantee a doctor member can be a multi-millionaire, now patients must wait four to six months to see a doctor.  What will be the wait with government health insurance?  Does anyone think it will be the same less?

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          What is wrong with opening up the medical profession to those who wish to practice without regard to quotas?  Supply and demand work pretty well if allowed to, better than some politians that promise solutions to the problems they cause. 

                • It’s like trying to get a chicken bone from a junkyard dog – that chicken bone only provides a wee bit of nutrition to the dog, but you may lose your hand.

                • Malpractice insurance plus claims paid is around 1-2%, which is still $16 to $32 billion per year.

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                  Malpractice risk drives behaviour too:  it causes doctors to perform CYA expensive tests as defense against litigation.  It also drives out certain high risk professions (i.e. obstetricians) and makes that profession more expensive.

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                  Malpractice insurance isn’t THE one component of cost increases, but certainly it’s a large one. 

                • Studies have not found that fear of malpractice suits change physician behavior.  However, it’s true that obstetricians are getting whacked pretty hard by premiums.  My understanding is that neurosurgeons are the other group that gets hit hard.

              • that you’ve not factored in the cost of malpractice insurance?

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                Far as I know that alone creates a baseline comp need for doctors in the hundreds of thousands…

  2. the good ole U S of A is still creating innovations in health care and pharmaceuticals for them to appropriate, universally entitle, and then create waiting lists for.

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    In a sense, the US is really the only player that matters because we have/can/will continue to for the rest of the world even if other countries stunt/kill off their domestic development by price controls, entitlements, etc.  Then again I guess their giant governments can always come back in and resubsidize what they smash the entrepreneurial life out of once it starts to die eh?  Thats socialism for ya, the govt will take over one way or the other!

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    Health care is surely broken, because both the supply side (artificially restrained) and the demand side (artificially vertical when needed) are working their magic precisely how you would predict on prices. 

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    Making the demand curve larger will help none of this.  Centralizing through government will not make it more efficient.  (Nor will it encourage more supply).

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    Comon liberals, let go of the nanny state ideal.

    • that foreign governments also scam the hell out of our pharma’s by forcing them to sell at lower prices than they’d like to.  Again the US bears the burden for those leeches..

      • when those damned indians develop generic retroviral drugs that they then sell to developing countries for pennies on the dollar!

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        how dare they take money out of the pockets of hardworking merck shareholders, just to save hundreds of thousands of lives!

      • Wow. I mean, wow. Big Pharma is just a great frickin’ business to be in.

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        Merck: 22.72% profit margin
        Pfizer: 24.17%
        Eli Lilly: 21.08%
        Bristol-Myers-Squibb: 11.85% (Hrm, why lower?)
        Novartis: 18.98%

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        demolisher, compare those profit margins to any other industry, and I think you’ll find that Big Pharma is still ludicrously profitable. I mean, if they only made 10% profit margins, drugs would still get made.

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        Does Big Pharma have a God-given right to 20% profit margins?

        • that its none of your or anyone else’s business how much profit a company makes.  If they can create something that people want bad enough to pay the prices they charge, then they earned it. 

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          I’d also note for the record that the investments they make to create new drugs are mindblowingly large and often wasted due to all sorts of factors.

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          I dont know about those profit numbers, but have you seen the stock prices?

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          Seen the layoffs?

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          Democrats will smash the pharmaceutical industry given a chance, just look at whats going on today with supposedly ideal condtions…

          • OK, a big problem – the prescribers (physicians) aren’t paying for the drugs.  They prescribe based on all kinds of nutty criteria other than, say, cost-efficacy – like which company gives them the most booty.  And who has the cutest reps.

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            Vioxx killed roughly 50,000 Americans.  Had it been shown to be either safer or more effective than ibuprofen?  Nope.  And it cost probably 50x more than ibuprofen.  So why was it prescribed like M&Ms?  Draw your own conclusions.

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            Patients in other countries get the same drugs that we do – although they are less likely to get silly stuff like Vioxx. 

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            That all being said, I do think that it’s wrong that pharmaceuticals have become the whipping-boy for overpriced healthcare – they only account for 10% or so of total cost, and they’re probably the most cost-effictive thing we do, next to proper handwashing.

            • that doctors also sometimes perscribe whatever they think is right, although in many cases there are equivalent drugs and they may be swayed by drug reps – whatever the tactics.  I’m sure there are plenty of unethical docs as well.

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              Vioxx killed 50K Americans – are you fricking completely nuts?  Where do you get such things?

              • Wow, the press reports of Vioxx numbers are indeed remarkable.  I take back the nuts question.

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                Its worth noting that while the FDA estimated Vioxx contributed to something like 28k deaths, the articles go ahead and change that verb to caused which I find a bit irresponsible.

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                Furthermore, the guy David Graham who came up with the 55K rough number – his testimony smacks of melodrama and contains what appear to be some seriously big assumptions.  You can see it here:

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                http://www.mercola.c…

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                Nevertheless, it is clear the Vioxx really has contributed to many thousands of US deaths, so thanks for educating me on that.

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                • No wonder you’re attracted to this left-wing oasis.  I look forward to wooing you to the dark side.

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                  David Graham risked quite a bit to get the news out about Vioxx.  The rest of the FDA vigorously tried to suppress him.  He saved a lot of lives by doing this – probably more lives saved than have we’ve lost in Iraq.

                • I love the tale of the brave whistleblower “risking it all” though, because so often its a self serving shmuck like Lyin’ Joe Wilson getting all the adulation for his brave truthtelling…

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                  Whats the risk, really?  With so many lined up and taking aim at the pharmas and for that matter the Bush administration or any part thereof (viz, the FDA), I don’t really buy that anyone is actaully taking any risks in coming out against them.  Its kinda trendy actually.

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                  Thanks for the kind words.

          • but maybe it depends on what values you hold.  As a nurse I believe that every human being has a right to quality health care, especially in one of the richest countries on earth.  And I know that poll after poll shows that most Americans believe that everyone should have that right protected, not just us nurses or health professionals.  It’s something related to basic decent human values, I guess.

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            But back to addressing your many holes. Let’s take this statement you made:

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            If they can create something that people want bad enough to pay the prices they charge, then they earned it.

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            First off, do you know that we taxpayers fund much of the basic research that the drug companies then use to manufacture and sell drugs?  For example AZT, the first effective AIDS drug treatment, had its chemical structure reearched and created by the National Insitutes of Health (NIH) and then Burroughs Wellcome was able to waltz in and use the data and secure and exclusive patent and yes, they did charge as high as the market would bear–this “market” being life or death for thousands of people.  In 1989 dollars AZT was about $12,000 a year.  Lots of folks wiped out their families’ entire life savings due to the pricing practice you tout as “something people want bad enough”.  Me and my values find that grotesque. 

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            There are endless false arguments/lies, scare tactics and the like put forward by the drug industry to protect their obscene profits. With their kind of dough they really can put up extremely slick, sophisticated and endless obstructionist tactics. Many of big Pharma’s false arguments/deceitful manipulations etc, are detailed and blown out of the water by the work of these researchers at the B.U. Helath Reform Program

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            Take a look, at their data and a good look in the mirror at yourself and your values, and then come back and keep talking…

            • 1.  “As a nurse” I dont think qualifies you more or less to judge people’s rights
              2.  I disagree that humans can have any rights to products and services made by other people – the existence of such rights would automatically erode more important fundamental rights of others (to be free).
              3.  polls and/or popularity do not create rights
              4.  decent human values do not include taking things from other people in order to give away;  give away your own stuff if you want to

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              5.  we taxpayers fund all sorts of things (many of which we should not) but none of that is an excuse for handing even more power to the goernment.  I seriously doubt that we fund a signficant percentage of pharmaceutical R&D with tax dollars though. 

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              6.  Aids treatments were a giant public policy push and if you recall, the goal was to invent useful treatments, not to invent cheap or free treatments. 

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              What you have to understand is that the so-called “obscene” profits that pharmas make are the only reason that new drugs are getting invented.  Pharmas spend more money than you can imagine on R&D and as a result of that, we get new medicines that make our lives better.

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              Your rhetoric about the “lies” of “big Pharma” is a classic example of leftist villanizing.  Where would you or your patients be without the medicines that big pharma has brought to the world?

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              Finally, when people talk about adding a “right to healthcare” to the constitution, that is probably the time to really think long term, think outside of the box.  Don’t think just about what is popular now or what the current prices and economic conditions are.  It is not reasonable to say that we will always be able to afford to provide for such a “right”.  (Even if you think we can now).  Think long.

                1. You’re right; I attempted to convey that it is being a human being that qualifies someone to have an opinion about human rights.  I acknowledged being a nurse somewhat as a disclaimer r/t my high level of knowledge about and interest in this issue. Obviously I am a human being first and foremeost, and that’s why I followed with saying mosst people-no matter what other details describe them-support a right to health care for everyone.

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                2. See Universal Declaration of Human Rights, Article 25 for one

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                3. See #2 above

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                4. See #2 above

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                5. See what I and many people find to be convincing data from the researchers at Health Reform Program at BU School of Public Health for pharmaceutical industry profiting from taxpayer funding of Pharma R&D

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                6. Uh, right.  And people need to be able to get those treatments in order for them to be “useful”.

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                Re your smear about my “leftist villanizing” r/t my words used when discussing big Pharma’s tactic, I prefer to describe it as just plain “villanizing”.  There’s no left or right about it; they’re acting evil and killing lots of people in the process

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                But we are thinking outside the box in amending the constitution to establish a guarantee of comprehensive affordble and equitably financed health care for all.

            • I guess I don’t quite get the healthcare as a “right”. 

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              I’m not talking about elderly or impoverished.  No question but that society ought tend to the most vunerable, and I think the Medicare and Medicaid are decent attempts, warts and all. 

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              But Medicaid and Medicare recipients notwithstanding, the real debate is the coverage for the working poor.  Can we agree on that?

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              Take the situation where Universal Health has become the law, and coverage is provided by the government. 

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              And let’s say that AnnEm wants to see Dr. so-and-so because he’s really good.  But, Dr. so-and-so is busy and can’t see you right away.  So AnnEm says, tell you what, I’ll pay extra to get in the front of the line.  Dr. so-and-so likes the financial arrangement and agrees to put AnnEm at the front of the line.

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              Who goes to jail?

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              Ann and the Dr. for this subversion of equality based on Ann’s ability to pay more?  Just Ann for making the deal? The Dr.? No one?

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              That is, does this ‘right to quality healthcare for everyone’ obligate the healthcare workers to serve the government?

              • and so I’ll refer you to the very informative FAQ on universal single-payer health care that I cross posted today from Daily Kos onto BMG.  It addresses, in great detail, many of your concerns including rationing of care.

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                mr. demolisher, you in particular might learn form the data there about the villanous behaviour of Big Pharma in the U.S.

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                and gary, if you’re not being serious, please stop wasting our time.  Thanks.

                • It’s like asking for a phone number and getting smacked with a NY phone book (memo to self:  don’t ask for AnnEm’s phone number in a bar.)

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                  I just asked a letigimate question:  What if some doctor in the UH scheme decided he wanted to give ‘extra’ service to patients who could afford to pay extra?  Is that illegal ? 

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                  I read the FAQ and couldn’t find the answer.

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                  Seems as though, absent some penalty system, that a private blackmarket in medicine would develop driven by the people who want to move to the front of the line and can afford it ($$$):

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                  Take the situation where Universal Health has become the law, and coverage is provided by the government.

                  And let’s say that AnnEm wants to see Dr. so-and-so because he’s really good.  But, Dr. so-and-so is busy and can’t see you right away.  So AnnEm says, tell you what, I’ll pay extra to get in the front of the line.  Dr. so-and-so likes the financial arrangement and agrees to put AnnEm at the front of the line.

                  Who goes to jail?

                  Ann and the Dr. for this subversion of equality based on Ann’s ability to pay more?  Just Ann for making the deal? The Dr.? No one?

        • Pfizer stock price over the past 5 years:

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          http://money.cnn.com…

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          The most recent of many rounds of layoffs:

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          http://phoenix.bizjo…

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          The average cost to bring a new drug to market is something like $800 million, not considering all the candidates that fail.  Here’s an article that I just found while looking for a reference for that:

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          http://www.hoover.or…

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          which I didnt read all of but I think may be another decent counterpoint.

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          Charley I like your posts and I find you fair and honest, and thats awesome – but you gotta seek opposing data on some of this stuff.  Otherwise you may end up lined up with the mob trying to knock Good Things out of commission.

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          • To return to the original point, a falling stock price has nothing to do with whether Pfizer is entitled to avoid negotiating with the federal government on drug prices. The feds are under no obligation to say, “gosh, Pfizer stockholders, you’ve had a rough time sustaining those nutty profit margins — on behalf of the taxpayers, we’ll cut you a break.”

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            Yeah, it’s expensive to bring new drugs to market. So what? Profit is just that — what’s left over once those admittedly massive expenses are netted out.

            • The government negotiation thing is IMO full of holes – drug companies set their price, and you can buy it or not.  The entitlement piece of this picture is that the government decided to hand out a whole load of free drugs to everyone and so now has to buy them.  This is the broken part.

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              Negotiation?  What does that mean, really?  Isn’t it ultimately some kind of price control?  What if the pharmas just say no, then what happens?  The drugs won’t be available?

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              If you want your entitlement, you have to pay for it.  You can’t go get it for a price that you invent.

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              Finally, stock prices, layoffs etc are nothing to sniff at – first of all if you don’t buy my moral argument against government intrusion then you’ve at least got to acknowledge the practical consequences of further damaging the already shaky “big” pharma industry:  you risk the end of innovation.

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              Inventing new drugs is hugely costly and hugely risky, and it takes forever.  How many biotech startups in Cambridge will survive?  People do this stuff – well yes, to make a positive difference in the world – but ultimately money gets behind this stuff because of the expectation of large profits if they succeed.  If you in your [forgive me] arrogant judgement start to decide what profit margins are acceptable (i.e. 10%) then you will ruin the free market drivers that have created, for example, the Biotech explosion in Cambridge.

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              • Let’s return to Vioxx as an example.

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                At the time that Vioxx was being prescribed, here were the facts:

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                1. It was not proven, claimed, or even suspected of being more potent in its intended use than was ibuprofen (e.g., Advil).
                2. It was something like 50x more expensive than ibuprofen.
                3. It was approved by the FDA (who blew off their own data!)as safe and effective – but, as a new drug, one of a new class of drugs, long-term safety was quite unknown.
                4. It was possible that Vioxx was safer on the GI tract than ibuprofen – but that had not been shown yet in studies.  And ibuprofen is not particularly dangerous on the GI tract, anyway.

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                Given this set of facts, the reasonable thing would be to use Vioxx sparingly, as a last resort on patients who needed an anti-inflammatory medication but for whom nothing else could be tolerated.  By-and-large, this was how it was treated by most of the rest of the developed world.  In the US, however, the stuff was dispensed like candy.

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                Part of the reason that much of the rest of the first world steered clear of Vioxx was the potential safety issues.  But the bigger reason, I believe, was cost. In other first-world countries, cost-efficacy is a big consideration in how and when drugs (and procedures) are used.  This forces manufacturers to drive down prices unless a drug or procedure is a clear advance over the status-quo.  If a price is too high, a drug will become a second- or third-line treatment.  If a surgery has not been shown to help outcomes, it will not typically be reimbursed (except as a research project).

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                Did you know that good, big studies have shown that removing a cancerous prostate does nothing to improve outcomes in men over 65, i.e. the vast bulk of men who are diagnosed with prostate cancer?  In the US, we pop out prostates as a reflex – costs a fortune, and the side effects are often very, very nasty.  The Europeans tend to not remove cancerous prostates.  Which makes more sense to you?

                • OK so given that Vioxx was a disaster, and putting prostate cancer entirely aside, it seems to me that you may be saying:

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                  High prices are inversely related to desirable drug safety and efficacy?

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                  Aside from the particulars of the Vioxx case, I can’t imagine what causal relationship you have in mind here…  I could go and invent an exceedingly hard to produce gene therapy which cures brain cancer with no side effects whatsoever and guess what – its gonna be hellishly expensive.  And even if it isnt, I’m going to want the profits that I promised the investors for the last 10 years have made this development possible.  So yea, its gonna cost ya.

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                  You lost me.

                • I don’t think that poor safety and/or efficacy CAUSE high prices – but, at first glance, there does seem to be a correlation.  (I actually never thought of it this way – thanks for pointing it out.)

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                  If there is a correlation, then I believe it’s driven by the following:

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                  1. In medicine, unless things are proven to have outomes that are better than the status quo, they almost always turn out to be worse.  Vioxx, prostatectomies, hormone replacement therapies, drug-eluting coronary stents (heck, even regular stents in 2/3rds of cases), all manner of back and knee surgeries, are testaments to this reality. People are pretty complex – guesses, even by the smartest scientists and physicians, are usually wrong.

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                  2. In medicine, new stuff tends to cost more than old stuff. 

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                  3. People tend to think if something’s new, it must be better.

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                  4. New things are protectable by patent – thus they can generate more cash.  Thus there is more money to spend on marketing and incentives to prescribers – and marketing and incentives work well, which is why pharmaceutical companies spend twice as much on marketing and sales as on R&D.

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                  That being said, there are occasionally blockbuster drugs that are worth the cost – like statins.  Probably a once-in-a-decade event.

      • Press Release WHO 21 June 2000, WORLD HEALTH ORGANIZATION ASSESSES THE WORLD’S HEALTH SYSTEMS

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        The U. S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance, the report finds. The United Kingdom, which spends just six percent of gross domestic product (GDP) on health services, ranks 18th . Several small countries – San Marino, Andorra, Malta and Singapore are rated close behind second- placed Italy.

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        I believe the U.S. now has the distinction of spending 13% GDP on health care.  This while we have 47 Million people without health insurance, with insurance coverage being the most effective way to access timely care.

  3. My, my, have all the usual right-wing suspects weighed in on this already?  There’s nothing more frightening to you guys than the sound of the pigs being shooed away from the trough, is there?

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    I work for an HMO that has fewer than 200,000 members and 600 employees — think about the mathematics of that for a second.  Medicare can’t even come close to that in bureaucratic bloat.  Big Pharma isn’t plowing more than a fraction of their obscene profits back into R&D, and accepting negotiated payments from Canada et al hasn’t exactly put them out of business.  The Big Three U.S. automakers are begging Washington to adopt the catastrophic coverage concept proposed by John Kerry, because they can’t compete with automakers in that part of the civilized world where employers don’t bear this cost (i.e., anywhere else but the U.S.).  Reducing that burden on employers and workers would be a much bigger stimulus to the U.S. economy than any of the phony ones Reaganomics, Inc. has come up with so far.

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    It’s time.  It’s going to happen in some form.  It would be nice to hear something constructive and new from the other side, after decades of nothing but phony arguments about “socialized medicine”.

    • It’s time.  It’s going to happen in some form.

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      I don’t see how.  Hillarycare crashed and burned, and like they say, when a cat gets burned from jumping on a hot stove, it won’t jump on a hot stove again … or a cold one.

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      First, we have universal care already:  Medicaid for the very poor; Medicare for the old; the middle to upper class can afford insurance mainly through they employer. Obvious, right? 

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      That leaves the ‘working poor’ without insurance. They have the emergency room to act as the insurance policy.  Obvious again.

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      Caution–callous, comment of the day to follow:

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      The voting majority don’t give enough of a damn, to address the working poor’s plight to give up your current coverage and risk (i) higher taxes or (ii) rationing of your existing coverage, or (iii) political suicide, in order to opt for to  government run UH system.

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      Would you?

      • Hillarycare was not single-payer – it was a baroque assemblage of schemes designed to cover everyone while still shoveling mountains of cash into the pockets of the Clinton’s patrons.

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        Something simple and honest, like “Medicare for everyone” will get the backing of “We the People”.

        • Be realistic. The slogan ‘medicare for everyone’ would go down in flames.

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          Look at the players:

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          1:  AARP.  It’s continuency is huge and votes.  And, has medicare.  The members of the group bitch and moan about the ‘donut hole’ which affects a small portion.  They just got a raise a couple of years back.  AARP won’t support ‘medicare for all’ because it puts existing medicare more at risk

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          2: AARP.  Medicare for all means rationing for some.

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          3: Insurance companies.  Remember who sunk Hillary?  It was mainly that commercial with the elderly couple talking back and forth about how the program puts Medicare at risk. Insurance companies funded that ad.

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          4: Conservative and middle to right.  ‘Medicare for all’ sounds a lot like socialism to me, if not in practice, then as a slogan.

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          5: Doctors hate medicare.

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          So,
          -you lose the elderly vote;
          -you lose at least half the middle class vote (the conservative half)
          -you probably lose much of the liberal half vote because most of the middle class has good insurance coverage via employer,
          -you lose the state and municiple employee vote (they have very cheap insurance),
          -the ‘working poor’ don’t vote,

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          Then add to the mix, the money clout of the insurance and healthcare sector because those 2 sectors defend, respectively, against loss of business and autonomy.

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          ‘medicare for all’? 

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          Yeah, that’ll work.

          • When “real”politik becomes overwhelmed by reality.  Only for brief periods of time, granted – but it does happen.

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            Try an experiment – ask a few people (real people, not folks that hang out on political web sites) what they think of the idea of extending Medicare to everyone. I’ve found that they have an “aha!” moment.  The only pushback that I ever get is that it will cost too much.  When I tell folks that Medicare actually lowers costs – in part because there are no CEOs at Medicare making millions of dollars a year – it’s a big, big winner.

            • Medicare efficiency has been the chat for decades. 

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              Avocates: It’s more efficient than for profit; look at the administrative cost per enrollee.

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              Opponents point out that first, Medicare lacks the same oversight function cost (i.e. there’s a lot of inappropriate payments going out and that expense isn’t reflected in the overhead numbers), and second, Medicare is going bankrupt at the current pay-in rates.

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              I have no idea who, if either, is ‘correct’. I’m not sold either way on the efficiency argument.

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              But with regards to your experient,here’s a question, would you give up your current coverage and risk and take Medicare if you (i)  it meant higher taxes in an amount equal to your current premium and (ii) recognized that rationing is possible (how can you deny that rationing is not a possibility).

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  4. Americans spend far more per capita on health care than do residents of any other country – twice as much, in general.

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    There’s no evidence that we get better care.  None.

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    There’s lots of evidence that we get worse care.  We are 48th in life expectancy: http://blueworksbett…

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    We are 43rd in infant mortality, behind Cuba(!): http://blueworksbett…

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    Why we choose to pay more, for worse outcomes, is beyond me. I guess Americans are just not very bright.

    • The cost of Massachusetts is the highest in the world,high cost does not equate high quality.  Thats why the health care reform bill included provisions for access to cost and quality data, its not the only solution, but a good start.

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      I have never jumped on the single-payer wagon. Universal access, and low-cost or no-cost for everyone sounds wonderful.  However desirable outcome that may be, can someone please address how a single-payer system will reduce the cost of health care? I am not talking about premiums, I am talking the actual cost of services, someone has to pay for them, and with those costs rapidly increasing each year. So how would a single-payer system work to reduce those costs?

      • First off, there is a tremendous savings to be had in lowered administration costs.  Medicare, which is single-payer universal health insurance, has overhead costs of roughly 5%.  Private insurers have overhead costs of 20% or so.

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        Larger entities can also negotiate better deals.  For example, Medicare can pay less than other insurers, because it’s the biggest insurer and has the most negotiating power.  Providers still make a very, very good living accepting Medicare – they just can’t make a killing.  Perhaps surgeons would make $200k-$300k a year, instead of $500k-$1 million.

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        There are other structural problems with the US healthcare system, some of which may get better with single-payer healthcare – at least they don’t happen in other first-world countries, which leads me to believe that they are related to our unique scheme for funding healthcare.  For example, healthcare in the US is based around which procedures generate the most revenue.  We do three times as many angioplasties per capita as do other countries – these procedures cost a fortune ($40k or so), take little time (an hour, give or take), and do not prolong life (nor even improve it in most cases).  However we lag behind most countries in vaccines, which are cheap and do prolong life – but don’t generate the big bucks.

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        Single-payer won’t solve all problems – but it will be a very, very substantial first step.

        • accepting the notion that the government might be more efficient than private companies at anything whatsoever so I checked for some alternative viewpoints on this, and found this very interesting related article:

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          Sorry to be lame and just post an article, but I’ve always preferred principles to statistics in any case…  🙂

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          http://www.heritage….

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          Administrative Costs

          Misleading conclusions can also result from with overlooking important factors when comparing administrative costs. Critics of Medicare reform often argue that administrative costs of Medicare (defined as administrative expenses compared with spending on enrollees) averages roughly 2 per cent, and that this is well below the administrative costs of the FEHBP or private plans – suggesting that Medicare is more efficient. Merlis makes this argument, noting that administrative costs compared with benefits averages 7-10 per cent in preferred provider organizations (PPO’s) and 15 per cent or more in health maintenance organizations (HMO’s). On the face of it, therefore, Medicare management appears to be far more efficient, with private plans spending between 3 and 7 times as much on administrative costs for the same spending on beneficiaries.

          However, this simple statistic is quite misleading. For one thing, as Merlis notes in the study, a program serving predominantly retirees will necessarily spend more on benefits per enrollee than is typical in a plan serving primarily working-age people (such as FEHBP). Hence, there will be a larger denominator in the ratio of administrative costs to benefits for Medicare than for FEHBP just because of the age of the enrollees. Merlis does draw attention to this, and notes in his text that if one were to examine the cost of administrative cost per enrollee, rather than comparing it with the expenditures for each enrollee, it would be a better indicator of comparative administrative costs. He estimates that by doing this the difference between private plans and Medicare would be more like 2 to 1, rather than as much as 7 to 1.

          But even this does not provide a real comparison of efficiency. There has been concern for many years that Medicare may actually suffer from dangerously insufficient spending on management and administration. Members of the National Academy of Social Insurances panel on Medicare Governance and Management, for example, cited an inadequate investment in Medicare administration as partly responsible for poor control of costs, including excessive waste and fraud by providers. An overhaul of management and increased funding for administration featured prominently in the panel’s recommendations.[5] In addition, the General Accounting Office (GAO) issued a report in 2001criticizing the poor performance of Medicare’s management in providing information to consumers and other services related to effective management.[6] The GAO’s survey found Medicare’s line managers to be more critical of their management structure and capacity than virtually any other agency. Thus, it appears that Medicare management is inadequately funded to carry out the tasks needed to provide quality service and careful control of expenditures.

          Paradoxically, inadequate financing of management falsely gives the impression of greater efficiency. This is because wasteful unnecessary expenditures actually serve to reduce the arithmetic ratio of administration to spending. In a similar vein, a private manufacturing company that spent nothing on inventory control, quality measures, or checking accounts receivable could boast it was clearly efficient because its ratio of overhead costs to sales was very low. But of course it would be highly inefficient. Medicare is probably also below the threshold of administrative spending needed to run an efficient program.

          Thus, the comparison of administrative cost to spending between FEHBP and Medicare may well indicate that Medicare performs far less well than the FEHBP.

  5. does exist in Dr SteveB’s Daily Kos post:

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    Why shouldn’t we let people buy better health care if they can afford it?

    …My view is that one cannot have an opt-out system which would allow the for-profit sector to continue to skim of the healthy and wealthy.  The whole point of insurance is to spread the risk. Therefore, the pool of people paying and covered has to be universal, the whole U.S.  However, this being the U.S., the freedom to purchase some sort of supplemental is probably inevitable.

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    And I tend to agree with SteveB on that one.  So gary, this means there will be no going to jail for either AnnEM nor Dr X if they were to collude on AnnEM jumping to the head of the line.  I hope this is a useful answer to your question sans phone book. (I can just hear my 6 year old saying “hey, no cutting!)

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