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Let me quote you a long and a short snippet from two excellent articles with historical perspective on the health reform debate. This one's from Jonathan Cohn at TNR:

Advocates of single-payer systems complain frequently that the mainstream political debate doesn't give their idea the attention it deserves. They are right. Public insurance programs enjoy huge economies of scale; they don't fritter away money on profits or efforts to skim healthier patients from the population. When it comes to billing, they tend to be a lot simpler than, say, a system with dozens of competing insurance plans. All insurance systems require providers to file a lot of paperwork; single-payer systems, though, require just one set. The centralized power of single-payer systems also gives them unparalleled sway over not just the amount of money they pay but how they dole it out; with that kind of leverage, they can push the medical system toward making key improvements in quality.

Conservative critics of single-payer raise the perfectly respectable question of whether a government program could really wield such power judiciously. But it's telling that, when Taiwan set out to create a universal coverage system for its newly prosperous society a few years ago, it carefully studied schemes from around the world--and settled on a single-payer system, because it seemed to deliver the best, most equitable medical care at the lowest price. Today, experts say Taiwan has one of the world's most efficient, convenient, and effective health care systems.

In an ideal world, then, single-payer would almost certainly be the best option. But is it politically feasible? Single-payer advocates like to point out that Representative John Conyers has a singlepayer bill in Congress with close to 100 co-sponsors. But many of those co-sponsors have signed on because, until now, it has been a cheap, meaningless way to win points with liberal interest groups. In the Senate, meanwhile, declared support for single-payer is virtually non-existent. Polling on the question is ambiguous, suggesting the public doesn't yet have a strong opinion about the single-payer option. But even now, as the country seems to be moving left, voters remain deeply skeptical of massive government programs.

That they are (and though it's improving year by year on the side of reform, the public still is unclear what reform looks like, and is just as concerned about cost as access), and Cohn makes an excellent political point about the many sponsors of HR 676 on a bill that can't pass the Senate. As for the shorter piece, this was from Atul Gawande in the New Yorker:

Many would-be reformers hold that "true" reform must simply override those fears. They believe that a new system will be far better for most people, and that those who would hang on to the old do so out of either lack of imagination or narrow self-interest. On the left, then, single-payer enthusiasts argue that the only coherent solution is to end private health insurance and replace it with a national insurance program. And, on the right, the free marketeers argue that the only coherent solution is to end public insurance and employer-controlled health benefits so that we can all buy our own coverage and put market forces to work.

Neither side can stand the other. But both reserve special contempt for the pragmatists, who would build around the mess we have.

Well, there's that, too. But the fact is that the reformers have the stage, and the country's attention for the first time since 1994. With an appointment at HHS near, the focus of Washington discussion will inevitably turn to health reform. That won't stop the gossip about what beltway people mean by bipartisanship but for the moment we'll accept the working definition that "bipartisan" in the Obama era means "enough votes to pass the Senate", that he gets points from the public for comity, and that he still has plenty of political capital to spend. Given that working definition, we can and should expect push-back against the New Deal-denying Republicans, and from the Democrats, historical and current perspective on the close relationship between health reform and the economy.

However, when you review polling on the topic, be sure to pay the most attention to the independents. They're the one that will decide whether the public is behind reform or not (just like they're the one's deciding that Obama is popular by siding with Democrats.) And for all practical purposes, expect the indies to act like the late, lamented New England Republicans - socially liberal and fiscally conservative, concerned about access AND cost. Health reform will have to address both (or at least explain it), or it won't be moving anywhere in the Senate. And, as always, given the irrelevance of the current batch of House Republicans (see stimulus bill)  that's where the action will be on health reform.

Update [2009-2-19 10:54:18 by DemFromCT]:: Ezra comes at this from a different angle, using Jacob Hacker (and the necessity of a public plan matched against private plans) as a discussion point:

In other words, the private plan isn't a backdoor to single payer and it's not a progressive sweetener to be traded away. It's essential to a high-performing universal health care system and should be included because it's good policy in a sector that needs more of it.

Whatever the merits or demerits, people should be aware there's more on the table to discuss than just single payer (though single payer deservers to be at the table, the Senate remains a hard sell and so does the Dem House.) For a practical example, see today's note from the Commonwealth Fund:

The Commonwealth Fund, a leading private health policy research group, unveiled a comprehensive plan for changing a U.S. health care system that is the world's most expensive yet lags many other nations in important measures of quality.

They hope the Obama administration and lawmakers consider the ideas as they move forward this year with plans for major changes in the health care system. This plan is one of many being advanced as U.S. policymakers move toward action.

The proposal favors a mix of public and private insurance options over the idea of a fully government-run health system.

Originally posted to Daily Kos on Thu Feb 19, 2009 at 04:08 AM PST.

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Comment Preferences

  •  the indies will decide who wins the spin (12+ / 0-)

    not the talking heads and pundits in the beltway

    "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

    by Greg Dworkin on Thu Feb 19, 2009 at 04:12:45 AM PST

    •  The healthcare industry will decide who wins (7+ / 0-)

      They've bought and paid for the leadership of both parties making the decision.

      Nobody knows what kind of trouble we're in / Nobody seems to think it all might happen again

      by GreenSooner on Thu Feb 19, 2009 at 04:18:02 AM PST

      [ Parent ]

      •  To put it another way... (1+ / 0-)
        Recommended by:
        axel000

        ...what the public thinks about reform is ultimately irrelevant. We don't have the scratch that the insurance and pharmaceutical companies do.  And the deciders in DC care more about money and their precious free market ideology than they do about studies or health care access for average working Americans.

        Nobody knows what kind of trouble we're in / Nobody seems to think it all might happen again

        by GreenSooner on Thu Feb 19, 2009 at 04:27:07 AM PST

        [ Parent ]

        •  that's the dumbest thing (2+ / 0-)
          Recommended by:
          DWG, Egalitare

          ...what the public thinks about reform is ultimately irrelevant.

          you ever said ;-)

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Thu Feb 19, 2009 at 04:28:12 AM PST

          [ Parent ]

          •  The New York Times published a poll last week (2+ / 0-)
            Recommended by:
            axel000, Edgewater

            ...showing 60% of the public favoring Medicare for All.

            Has that moved single payer one inch in DC? Do you honestly think that it will?

            Health care, like the Iraq War, is a big enough racket that public opinion is at best a problem to be managed. And, like the Iraq War, it helps that there's a bipartisan consensus that the public is wrong.

            Nobody knows what kind of trouble we're in / Nobody seems to think it all might happen again

            by GreenSooner on Thu Feb 19, 2009 at 04:38:40 AM PST

            [ Parent ]

            •  So your point is why bother? (0+ / 0-)

              Because the insurance company lobbyists pigs have successfully thwarted reform for decades, the situation is hopeless and we just need to cough up more money and get less medical care for it. Well, how about a complete audit of how insurance companies use premium dollars down to the last cent and making the rests public. We need to make their excesses so brutally obvious that even a thick-skulled, small-brained conservative can comprehend why we pay so much more for health care than every other country on the planet.

              An end to the Bush nightmare is only the first step in rebuilding America.

              by DWG on Thu Feb 19, 2009 at 05:57:18 AM PST

              [ Parent ]

            •  sigh (2+ / 0-)
              Recommended by:
              mayim, symptomORdisease

              health reform is not always singer payer.

              health reform should be single payer, but

              health reform does not eual single payer

              rinse and repeat.

              "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

              by Greg Dworkin on Thu Feb 19, 2009 at 06:25:19 AM PST

              [ Parent ]

          •  Americans understand the pain of change (1+ / 0-)
            Recommended by:
            axel000

            The thing about public opinion is that in the short term it can be swayed with fear and drama and all that takes is money and the right timeline.

            The ins industry is at war on all fronts attacking even the public option of the "box of bandaids" approach, as I call the package of incremental improvements.

            One big factor working for national single-payer insurance is the vast numbers of Americans who have participated in corporate redesign projects from top to bottom. We have been retooled, downsized, rightsized, outsourced, and automated and all to increase real or perceived shareholder value. US employers have pretty much all McKinsey'ed themselves down to a slim core business unit, and those non-core units, those redundant siloes eliminated, that "fat" that was pared away was us, Americans, millions of lost jobs to improve shareholder value and continuously raise efficiencies and the overall national economy. It works. We have the scars to prove it.

            We all have experienced the real threat and realities of job loss for the sake of profits. Will Americans invest some taxpayer money to transition jobs from an archaic, obsolete insurance process to one non-redundant, high performance, modern national insurance process? Really, from the worker's position, it's a piece of cake. We have done this successfully (from a corporate perspective) over and over and over for decades.

            To be given the chance to really reinvent how we deliver our health care is a one time opportunity for this generation. A mediocre plan will provide mediocre results. With our health.

            HR 676 - Health care reform we can believe in - national single-payer NOW.

            by kck on Thu Feb 19, 2009 at 05:51:55 AM PST

            [ Parent ]

        •  I'm not sure Big Insurance and Big Pharma... (3+ / 0-)
          Recommended by:
          Blutodog, pvlb, oxfdblue

          ...have the backing to do what they did to so-called "HillaryCare." Sure they are still big and powerful, but the ground has shifted. There are many more of us uninsured and underinsured. The Big Three and a growing number of large outfits are no longer fans. Small Business has never gotten any love from them.

          Just who is going actively support the expenditure of their premium payments for "Harry and Louise 2.0?"

          Single Payer...NOW!!!

          by Egalitare on Thu Feb 19, 2009 at 04:56:06 AM PST

          [ Parent ]

        •  We have something greater than "scratch"... (0+ / 0-)

          ...we have bodies, and we can put those bodies to use.

          If we workers take a notion
          we can stop all speeding trains
          Every ship upon the ocean
          we can tie with mighty chains

          Every wheel in the creation
          every mine and every mill
          fleets and armies of all nations
          will, at our command, stand still.

          That's how you get universal health coverage, or anything else that remotely resembles justice and fairness - you not only demand it, you f*cking take it.

          With our votes and our money, we'll lose every time. Maybe a small gain or two, a couple of things might improve. But nothing as radical as what we need.

          Rise like lions after slumber in unvanquishable number. Shake your chains to earth like dew, which in sleep had fallen on you. Ye are many - they are few.

          by cruz on Thu Feb 19, 2009 at 06:58:11 AM PST

          [ Parent ]

      •  interestingly (4+ / 0-)
        Recommended by:
        EeDan, kck, stonepier, Egalitare

        they don't think so.

        "You should be outraged by this process," said Joseph Gregor, president and general manager for CIGNA Healthcare. "We can no longer trust a debate in Washington. The stimulus tells us there won't be one."

        "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

        by Greg Dworkin on Thu Feb 19, 2009 at 04:27:34 AM PST

        [ Parent ]

        •  Industry reps don't get paid to be complacent. (0+ / 0-)

          Of course they're going to assume the worst and work their butts off to prevent real change.

          You're quoting from healthcare industry officials addressing the Pittsburgh Business Group.

          These statements should be read exactly the same way as John McCain's warnings last fall that electing Obama would mean adopting socialism. The statements speak volumes about how worried the speakers are. But just as McCain's fearmongering didn't make Obama a socialist, so the healthcare industry's warnings don't mean we're on the brink of real reform.

          Nobody knows what kind of trouble we're in / Nobody seems to think it all might happen again

          by GreenSooner on Thu Feb 19, 2009 at 06:00:17 AM PST

          [ Parent ]

        •  He's right (0+ / 0-)

          There are several controversial items in the stimulus plan that effectively bypass debate and the legislative process by being packaged in and they're items of a foundational nature to strategic issues.

          So, if Obama plans to get around the reliable, well-financed gridlock in Congress this way, I wish/hope/pray/plead/beg that he goes for the whole enchilada and not the vanilla Obama campaign plan.

          I worked in health care delivery and insurance and did a couple of big transformation change projects in the 1/2 billion to multi-billion dollar range. One went on a short path using the 900 pound gorilla methodology lead by a dictator. It was successful in the shortest time and still is. The other project took a collaborative polite approach consulting all along the way and building consensus. Multiply time and cost by about 9 and reduce satisfaction accordingly and that was the more expensive project.

          HR 676 - Health care reform we can believe in - national single-payer NOW.

          by kck on Thu Feb 19, 2009 at 06:04:54 AM PST

          [ Parent ]

      •  what is strange (0+ / 0-)

        is that most people, especially this week, think the incompetence and greed of the private sector, starting with Haliburton, down through every Bank and every Insurance Company are for the birds... this is the time to tie the two together and get rid of Private Insurance involved in health care issues.  They are incompetent and wasteful...much more even than the government. But people know that already ... so what is the real problem.  The problem is we are up against the media... and the political industrial complex (lobbyist, advisors,politicians who have been bought, etc.)  Those are the real villians... how do we destroy that system and replace the corporate media and political industrial complex with just plain people like us.

        ah, the grassroots has a lot of work cut out for itslef ... we can scream all we want about the health care system being in shambles and private greed winning over and over BUT unless we begin to take over the party and throw out the elected officals from botton to top who don't go along with our common sense approach about these health care matters nothing will happen that won't continue to enrich the pockets of rich people and their enablers.

        the biggest example of failure of being able to do that is Vermont... here because the grassroots is still so weak, we have a Democratic Party that can't even stand up to a horrible republican govenor standing in the way for single payer health care.  Study Vermont and help us revitalize the grassroots here... if we could do that we would have one state with single payer and then we can show how the grassroots can build.. right now our grassroots here is floundering.  We need help to figure out how to take grassroots power and develop a strategy to take over the party...a small state like Vermont would be a good place to put in efforts from top to bottem... have blogs reporting on all the failures and successes in retooling the party...concentrate on this process rather than just talking and talking... Vermont is ripe for this experiment but we need a concentrated national grassroots effort to make sure it happens.  

        Pass new laws to end media monopolization now.

        by john from vermont on Thu Feb 19, 2009 at 07:56:37 AM PST

        [ Parent ]

    •  It was called 1994 midterm elections (4+ / 1-)
      Recommended by:
      GreenSooner, ManhattanMan, oaktownadam, axel000
      Hidden by:
      pvlb

      If the Democrats want to keep a majority, and I prefer they do for foreign policy reasons,

      it's a good way to back off the idea of H.R. 676.

      Look at the disaster in Massachusetts, Mitt Romney's plan was basically the Hillary proposal. It wasn't a smashing success.

      Bring back pay go, Pelosi must go. http://www.concordcoalition.org

      by sensibledemocrat1964 on Thu Feb 19, 2009 at 04:52:07 AM PST

      [ Parent ]

    •  Time for some new polling. (3+ / 0-)
      Recommended by:
      GayHillbilly, mayim, ryan81

      I found this very interesting:

      Polling on the question is ambiguous, suggesting the public doesn't yet have a strong opinion about the single-payer option.

      I wonder why.  Most Americans are terrified of losing health coverage, esp. these days.  Maybe the questions are being asked by people who are ambivalent about it.  

      I think that a simple question would do the trick:  Do you want health coverage that is flexible, can move with you when you leave a job, and doesn't disappear when you're unemployed?  I would bet the farm (figuratively) that the answer would be a resounding YES!!!.

      Combine that with the argument about efficiency and economy of scale, and it's really a no-brainer:

      Public insurance programs enjoy huge economies of scale; they don't fritter away money on profits or efforts to skim healthier patients from the population. When it comes to billing, they tend to be a lot simpler than, say, a system with dozens of competing insurance plans. All insurance systems require providers to file a lot of paperwork; single-payer systems, though, require just one set. The centralized power of single-payer systems also gives them unparalleled sway over not just the amount of money they pay but how they dole it out; with that kind of leverage, they can push the medical system toward making key improvements in quality.

      The only astonishing thing in the entire debate is that conservative spin-meisters have managed to keep it at bay for so long.

      •  Thats not a fair question (0+ / 0-)

        Do you want health coverage that is flexible, can move with you when you leave a job, and doesn't disappear when you're unemployed?  I would bet the farm (figuratively) that the answer would be a resounding YES!!!.

        Thats a question designed to get the answer you want, aka push polling.

        You could also frame the question "Do you want the govt. to be responsible for your healthcare decisions?" And you'd get a resounding no.

        Single payer healthcare has a lot of promise, but given the govts. track record of delivering what is promised, I have a lot of reservations about it.

    •  Cohn's argument against single payer is.... (3+ / 0-)
      Recommended by:
      kck, ryan81, Edgewater
      weak and incomplete. It not just the best policy, but polls suggest that American people are way ahead of inside the beltway conventional wisdom as to what is politically acceptable:

      Here's some of the data:

      ABC News/Washington Post, Oct. 9-13, 2003:

      "Which would you prefer - the current health insurance system in the United States, in which most people get their health insurance from private employers, but some people have no insurance; or a universal health insurance program, in which everyone is covered under a program like Medicare that's run by the government and financed by taxpayers?"

      CURRENT=33%
      UNIVERSAL=62%
      NO OPINION=6%

      Four years later the same question...

      Associated Press/Yahoo News Poll, Dec. 14-20, 2007:

      Which comes closest to your view?

      "The United States should continue the current health insurance system in which most people get their health insurance from private employers, but
      some people have no insurance" = 34%

      "The United States should adopt a universal health insurance program in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers" = 65%

      Refused / Not Answered = 2%

      Interestingly, when offered essentially the same universal program is offered alone without the comparison to the current system, but with the single payer name, the numbers from the same AP/Yahoo News poll was lower but still a majority:

      "Do you consider yourself a supporter of a single-payer health care system, that is a national health plan financed by taxpayers in which all Americans would get their insurance from a single government plan, or not?"

      YES = 54%
      NO = 44%
      REFUSED/NOT ANSWERED = 2%

      See: http://www.dailykos.com/...

      And most recently CBS/NYT:

      HEALTH INSURANCE:  PRIVATE ENTERPRISE VS. GOVERNMENT?

      1979
      Private Enterprise: 48%
      Government - All Problems: 28%
      Government - Emergencies: 12%
      Don't know: 12%

      2009
      Private Enterprise: 32% (-16%)
      Government - All Problems: 49% (+21%)
      Government - Emergencies: 10% (-2%)
      Don't know: 9% (-3%)

      Also, Doctors are okay with this too:

      Reflecting a shift in thinking over the past five years among U.S. physicians, a new study shows a solid majority of doctors -- 59 percent -- now supports national health insurance.

      Such plans typically involve a single, federally administered social insurance fund that that guarantees health care coverage for everyone, much like Medicare currently does for seniors. The plans typically eliminate or substantially reduce the role of private insurance companies in the health care financing system, but still allow patients to go the doctors of their choice.

      A study published in today's Annals of Internal Medicine, a leading medical journal, reports that a survey conducted last year of 2,193 physicians across the United States showed 59 percent of them "support government legislation to establish national health insurance," while 32 percent oppose it and 9 percent are neutral.

      The findings reflect a leap of 10 percentage points in physician support for national health insurance (NHI) since 2002, when a similar survey was conducted. At that time, 49 percent of all physician respondents said they supported NHI and 40 percent opposed it.

      See:   http://www.dailykos.com/...

      Inside the beltway cowardice takes it off the table... yes; but actually politically unacceptable outside of DC... not so much.

    •  only Medicare for All controls costs & access (1+ / 0-)
      Recommended by:
      GayHillbilly

      It it is impolite to have to remind everybody, but once one is not talking to pliticians, but does the actual analysis, only Medicare for All actually does control costs and also gets to 100% access. Don't take my word for it. Commonwealth & Lewin, which are not a single a payer supporters said so in their report comparing congressional proposals:

      http://www.dailykos.com/...

      Hacker/Baucus/Obma/Clinton/Building Blocks does NOT control total costs and does not achieve 100% access.

      Wyden does NOT control total costs and does not achieve 100% access.

      Stark, as their surrogate for Medicare for All is the only one that does.

      But is is SOOOOOO important to claim that single payer advocates are nto concerned with costs (a complete lie), and to claim that mainstream proponets are (completely wrong), so as to be able to contine the pretense that they are serious and we are extremist.

      •  from commonwealth fund today (0+ / 0-)

        The Commonwealth Fund, a leading private health policy research group, unveiled a comprehensive plan for changing a U.S. health care system that is the world's most expensive yet lags many other nations in important measures of quality.

        They hope the Obama administration and lawmakers consider the ideas as they move forward this year with plans for major changes in the health care system. This plan is one of many being advanced as U.S. policymakers move toward action.

        http://uk.reuters.com/...

        "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

        by Greg Dworkin on Thu Feb 19, 2009 at 07:23:31 AM PST

        [ Parent ]

    •  as for Atul Gawande (1+ / 0-)
      Recommended by:
      kck

      Let's just say, not everyone agrees with him:

      To the New Yorker:
      Groucho Marx once asked: who are you going to believe, me or your own eyes?  The central problem with Atul Gawande's article on health reform is not that it glibly predicts the future by misstating the past, that his views serve the interests of the health insurance industry, or that those views haven't changed since he helped craft the disastrous Clinton reform plan, though all are true.  It is easy to refute his claim that health reform can only occur incrementally and smoothly. Medicare in the U.S., for example, created an entirely new public sector entitlement program. (And if "building on what we have" is truly the key to success, expanding Medicare to cover everyone would certainly be the reform of choice.) Canada, our orderly neighbor to the north, tolerated a number of bitter doctors' strikes in the 1960s in defense of its new system that covered everyone for the first time.  As they did in the Clinton era, too many policymakers are concocting exotic and complex structures that really will scare the public.  A secret Federal Reserve system to run health care?  Please.

      Dr. Gawande has blossomed into a talented and articulate commentator on health care.  But he forgets that he is writing in 2009, not 1994. In the last year we shed millions of jobs, the economy dived, and the system of employment-based health coverage became palpably and audibly shaky.  We have had more than a decade to fully internalize our experiences with for-profit health insurance plans, pre-existing condition exclusions, and medically-induced bankruptcies, and we are sore.

      Polls show the public supports a government-financed single payer system, even if some remain reserved in their trust of the government. We are starting to believe our own eyes: we get it that we need the government's clout to make health care affordable again. Of course this rattles forces with resources, and they won't go down without a fight.  But it's been a year of unexpected changes.  For the next few months, let's hear some cogent analysis of how we can really get to where we actually need to go. Back to the future is no longer acceptable.
      Ellen R. Shaffer, PhD MPH
      Co-Director, Center for Policy Analysis
      San Francisco Presidio

      and:

      Et Tu, Atul?: Test-Case for a Single-Payer Hypothesis, excerpts from Russell Mokhiber piece in CommonDreams:

      Gawande is the Boston surgeon and New Yorker writer.

      And he's being pushed by Pollack and others as a replacement for Daschle at HHS.

      In his most recent article in the January 26 New Yorker titled Getting There From Here: How Should Obama Reform Health Care? Gawande argues against single payer now.

      I started looking to find out whether Gawande had ties to the insurance industry.

      And sure enough, there it was.

      Gawande is scheduled to give the keynote speech to AHIP's annual public policy conference on March 11 in Washington, D.C.

      So, I shoot off an e-mail to the New Yorker and to Gawande and ask - is Gawande being paid by the health insurance industry for this speech?

      Aas been speaking to AHIP groups around the country since at least 2004, according to the AHIP web site.

      ...don't his New Yorker readers deserve to be told that his favorite charities -- including his church, a non-profit set up by his father, and a foundation affiliated with the hospital where he works -- are benefiting financially - and by how much -- when he speaks to the private health insurance industry ?

      As for his opposition to single payer, he remains steadfast.

      In a q/a with New Yorker readers last week, Gawande defended his opposition to single payer now.

      "Replacing the entire health-financing system with Medicare would require most working-age people to leave their current insurance plans," Gawande writes. "It would change the finances of every hospital and doctor in the country overnight. It would require replacing the premiums we pay with a tax, with massive numbers of both losers and winners. It seems simple in theory, but in practice it never is. This would be a whole new path for health care. No country has swept away their health system and simply replaced it like that. As I said in the article, one would have to be prepared for an overnight change in the way people get 3.5 billion prescriptions, 900 million office visits, 60 million operations - because how these are paid for is critical to whether and how they are provided. Doing away with private insurance coverage is no less sweeping than saying we'll do away with public insurance programs or do away with employer-paid health care. No major country has simply swept away the way so many people's care is paid for. And the reason is that people have legitimate fears about what will happen to them."

      Dr. David Himmelstein, a founder of Physicians for a National Health Program, calls this argument "bogus."

      "Patients do not care what their insurance plan is - just that it pays for the care they need. A transition from a system where virtually everyone has only partial coverage to one where they have full coverage is not a disruption for patients," Himmelstein said when we asked him to respond to Gawande. "Several nations have made abrupt changes in the financing of care. The UK instituted the National Health Service - eliminating insurance and private payment for care at a stroke. Each Canadian province went from a private insurance system very like ours to its current system virtually overnight -- though not all provinces underwent the change simultaneously. Taiwan changed to a single payer system about 10 years ago at a stroke."

      "Medicare replaced private coverage for the elderly -- who account for about 30% of all hospital patients -- about nine months after its passage. That occurred in an era before computers. The entire task of enrolling tens of millions of patients, inspecting virtually every hospital in the nation -- to certify that they were desegregated, which was mandated by the Medicare law -- and set up a new payment apparatus was carried out using paper records. Why is a shift of the other two-thirds of our system more difficult?"

      "The new payment system would be far simpler than the current one -- hospitals would receive a global budget, which initially would be based largely on their previous year's revenues. Medicare currently collects all of the financial info needed to do such budgeting at the outset. Per-patient billing for hospital care would be eliminated. For doctors, Medicare already has a fee schedule, which should be modified somewhat, but already serves as the benchmark for most private plans. Expanding this payment system to cover all fee-for-service billings would be trivial. Paying for drugs is similarly pretty simple and straightforward, with most of the needed infrastructure already in place."

      "In sum, his arguments are bogus unless you assume that we are far less competent than people in other nations, and than we used to be," Himmelstein said.

      Gawande will travel to Washington on March 11 to speak to AHIP.

      The title of his speech -- Fixing Health Care from the Inside Out: The Physician's Role in Health Care Reform.

      The majority of physicians in the United States now support a single payer system.

      Dr. Gawande does not and is coddling the private health insurance industry.

      When Daschle was driven out of office last week, a DC insider made the following observation:

      When people first come to Washington, they see it as a putrid swamp that breeds corruption.

      But after they stay awhile, they begin to see it as a hot tub.

      and from NYC PNHP:

      To the Editor:

      In "Getting there from here" Gawande suggests that the Massachusetts 2006 mandate plan is a model for national healthcare reform.  He sees his stance as pragmatic, politically feasible, rooted in the particular history of American healthcare and gifted with the common sense wisdom that we must start from where we are.  Advocates of national health insurance (single payer) are characterized as ideologically driven extremists with "contempt" for pragmatists.  I respectfully disagree.

      Most Americans, including most physicians, supported national health insurance even before the recent economic collapse, polls show.  Endorsers of the single payer bill HR676 (Expanded and Improved Medicare for All) include 93 co-sponsors in the House of Representatives, 450 union organizations in 45 states, and countless others representing a wide range of constituencies.  This is not a fringe movement.

      High costs are the root cause of Americans' health insecurity.  Gawande's analysis is flawed by use of a framework centered on insurance coverage rather than the more fundamental issue of healthcare value.  Gawande sees employer-based coverage as the "path-defining" element of our current system because most people are covered by it.  Well, it's all in how you look at it.  We need to keep our eyes on the prize, the healthcare dollar, and follow the money.   Government already dominates: tax dollars fund most health care expenditures in the US.  This is because government covers the sickest and poorest people, tax-favors employer based private insurance, and covers its own employees.  To use Gawande's metaphor, the lifeboat is already bigger than the "main boat" of American healthcare.  This is where we start.

      Gawande asserts that Massachusetts "recently became the first state to adopt a system of universal health coverage for its residents."  As Yogi Berra said, this is like déjà vu all over again.  A nearly identical assertion was made twenty years ago by then Gov. Dukakis about Massachusetts' 1988 reforms.  More breathless proclamations heralded reforms in Oregon (1988), Minnesota (1992), Tennessee (1992), Vermont (1992), Washington (1993) and Maine (2003). These plans all had common themes: public spending initiatives, new regulations and mandates, and continued dominance of private insurance in covering low risk populations.  None achieved universal coverage.  The common denominator of the ultimate failure of all these plans was the absence of effective cost control.  Two weeks ago Gov. Duval of Massachusetts warned that rising costs, "threaten to crush families and businesses and doom Massachusetts groundbreaking experiment with universal insurance."

      In the face of economic collapse and soaring unemployment, with a third of Americans forgoing medical care due to cost, "Job 1" is getting value for our healthcare dollar, not preserving employer based health insurance. The repetition of failed experiments is not pragmatic, it is part tragedy and part farce.  Electronic medical records, chronic disease management and more emphasis on prevention are all important for many reasons but we must admit that short and long term cost implications are unknown.  Some of these measures may actually increase costs.  Medicare is not perfect, but it is demonstrably more cost effective than private insurance and beloved by most Americans.  It is "shovel ready".  Single payer supporters say: everybody in, nobody out.  Burned in the fires of the failed Clinton reforms, I believe Gawande misreads the plate tectonics of political possibility at this moment in history, asserting, "No, we can't" when the opposite is true.

      Laura S. Boylan, MD

    •  more Gawande rebuttal... (0+ / 0-)

      Atul Gawande is a highly respected physician who has a well deserved reputation as a gifted writer. This commentary should not be construed as an attack on him; rather, it is an attack on his message. On his writing skills I give him an A, but on his content, a D-.

      This article represents what I believe to be a misuse of framing. Gawande uses overly simplistic framing, but then bends, breaks or even replaces his frames as he develops his theme.

      Gawande uses the linear polarity that I condemned in a recent qotd comment. In the four dimensional model that I described, he places single payer at one end of a linear polarity, free marketeers at the other end, and pragmatists in the middle.

      His stated goal is a health care system that works, a goal that most of us share. Single payer is not only a financing system, but it is an administrative system that is specifically designed to make our health care system work for all of us. It is a system designed to address our problems not only in breadth, not only in depth, but throughout the three dimensions of all parameters, and over the fourth dimension of time. It is a system that is not "on the left" as he states, but, by design, it constitutes the health care universe in its four dimensions.

      The free marketeers do not provide us with a universal system, but rather would disassemble much of what we have. They would have us each attend to our own needs, paying for whatever health care we need, or purchasing private health plans, even if the premiums alone are 16 percent of our income. No serious student of health policy would ever consider that to be a system that would work for all of us. At least Gawande is correct when he places the free marketeers out "on the right."

      What about the pragmatists? Of course, pragmatism is the theme of Gawande’s article. He cites path dependency as the natural model to achieve reform. Use what we have, and build on it to bring us closer to our goals.

      But what is it that we do have? We have an expensive, dysfunctional health care delivery system that needs extensive repair along with adoption of efficiencies so that we can pay for it. Within the health care delivery system, we need to build on what is working, and replace that which isn’t.

      But what else is it that we have? We have a health care financing system that is wasting tremendous resources, while impairing access to much needed health care, and exposing individuals to financial hardship or even financial ruin. Gawande’s major error in framing is that he conflates our health care delivery system with our health care financing, as if they were one and the same. Since we need to build on our existing delivery system, he includes as a given that building on our current fragmented financing system is an integral part of the process.

      Look at the example that he gave us: the Medicare drug benefit. By the model of path dependency that he supports, drug coverage should have been added to Medicare as yet another benefit in the program, and it would have served us very well. Instead, it followed another path dependent road - our dependency on private health plans to cover prescription drugs. As Gawande states, this decision has likely killed people. Yet he insists that building on a financing system dependent on private insurers is essential because it’s path dependent.

      He leaves us with an example of a successful application of path dependent reform - the Massachusetts "system of universal health coverage." He glosses over the point that their system is not universal, although he does concede that the plan has done nothing to control costs, even though humane cost containment is an absolute imperative of any reform program.

      But then it is hard to dispute Gawande’s perception that the Massachusetts plan is a success. After all, his surgical fees are being paid.

      The pragmatic approach to financing reform is to follow a path dependent program that works, and discard those that don’t. With improvements, Medicare would work well for all of us; private health plans would work for those of us who are relatively healthy and have good incomes, like Dr. Gawande.

      and

      His theme was that health care reform in any nation is inevitably "path dependent," building on "its own history, however imperfect, unusual, and untidy." He applies this concept to the United States stating that we must build on what we have, selecting out features of our current fragmented system of financing health care that he says should be expanded to achieve our goals. It just happens that the features he selects are those in the current leading Democratic proposal for reform.

      His article is very well written, and is quite convincing to those who have not been intensively involved in reform activities and have only a limited understanding of health policy. Since it is such a impressive article it now is being circulated widely as a statement that (superficially) seems to make sense as a guideline for reform.

      The problem is that Atul Gawande is flat out wrong. He implies that other nations merely made adjustments in their existing systems to expand coverage to everyone. In fact, these were not simple adjustments to systems that weren’t working; they were revolutionary transformations of their health care financing systems. Some residuals incorporated into their new financing systems might be called "path dependent," but a more appropriate framing would be the antithesis that the thrust of each reform effort was to eliminate the deficiencies and inadequacies of the existing financing system or non-system. This inevitably required new financing systems. The fundamentals of these new financing systems were not based on path dependency, but they were based on path trailblazing.

      Gawande dismisses single payer supporters as reformers "on the left" who "reserve special contempt for the pragmatists, who would build around the mess we have." He explains later that the path dependent, pragmatic approach that we must follow will still be "exasperating, even disappointing," while still failing to give single payer even short shrift.

      and

      Dr. David Himmelstein, a founder of Physicians for a National Health Program, calls this argument "bogus."

      "Patients do not care what their insurance plan is - just that it pays for the care they need. A transition from a system where virtually everyone has only partial coverage to one where they have full coverage is not a disruption for patients," Himmelstein said when we asked him to respond to Gawande. "Several nations have made abrupt changes in the financing of care. The UK instituted the National Health Service - eliminating insurance and private payment for care at a stroke. Each Canadian province went from a private insurance system very like ours to its current system virtually overnight — though not all provinces underwent the change simultaneously. Taiwan changed to a single payer system about 10 years ago at a stroke."

      "Medicare replaced private coverage for the elderly — who account for about 30% of all hospital patients — about nine months after its passage. That occurred in an era before computers. The entire task of enrolling tens of millions of patients, inspecting virtually every hospital in the nation — to certify that they were desegregated, which was mandated by the Medicare law — and set up a new payment apparatus was carried out using paper records. Why is a shift of the other two-thirds of our system more difficult?"

      "The new payment system would be far simpler than the current one — hospitals would receive a global budget, which initially would be based largely on their previous year’s revenues. Medicare currently collects all of the financial info needed to do such budgeting at the outset. Per-patient billing for hospital care would be eliminated. For doctors, Medicare already has a fee schedule, which should be modified somewhat, but already serves as the benchmark for most private plans. Expanding this payment system to cover all fee-for-service billings would be trivial. Paying for drugs is similarly pretty simple and straightforward, with most of the needed infrastructure already in place."

      "In sum, his arguments are bogus unless you assume that we are far less competent than people in other nations, and than we used to be," Himmelstein said.

      Mokhiber: Et Tu, Atul?: Test-Case for a Single-Payer Hypothesis
      http://www.commondreams.org/...

      Gawande: Getting There from Here: How should Obama reform health care?
      http://www.newyorker.com/...

      qotd: Gawande’s pseudo-pragmatism
      http://www.pnhp.org/...

      and from Len Rodberg NYC PNHP:

      Atul Gawande (1/26 issue) presents a convincing case that the paths that countries take into the future are strongly influenced by their history, especially their recent history. However, the path into the future is not uniquely determined but can take a number of different directions. In the case of health care reform, it is not obvious that employer-based private insurance provides the best or necessary direction that the U.S. should go. Another possible path, also drawing on our history, would expand the very successful Medicare program and the equally successful, though much-maligned, Medicaid program. Together, these two public programs account for nearly one-half of all health care expenditures today, while private insurance, which largely covers the healthy working population, accounts for barely a third of current spending.

      So we can learn a number of different lessons from the past. What we should be asking is: which approach would provide better, more cost-efficient, sustainable health care for the American people. Expanding the wasteful, costly, and increasingly dysfunctional private insurance system will not provide us with the health care we need, while building on the very successful public programs can provide cost-effective, coordinated health care for all of us. That is the path we should take.

    •  If we are to win this debate (1+ / 0-)
      Recommended by:
      HenryBurlingame

      The democrats need to directly point to the economics of this.  US firms are at a huge competitive disadvantage compared to European and some Asian firms due to the cost of healthcare they have to bear.

      Citizens are bearing all the cost of healthcare, which is going up yearly, yet wages are now flat.  Your average european makes more than your average american.

      People need to be woken up.  Corporate America, and in this instance, private healthcare, is giving you the shaft.

      Government for the people, by the people

      by axel000 on Thu Feb 19, 2009 at 07:09:06 AM PST

      [ Parent ]

  •  right wing talking points on health care are (7+ / 0-)

    easy to demolish

    1. a gov't run system will have too much bureaucracy.  Answer: it will have far less than the current nightmare
    1. a gov't run system will mean that bureaucrats rather than doctors will make medical decisions. (This one is priceless!)  Answer: today a bewildering array of competing bureaucrats make medical decisions.
    1. in a gov't run system you wont be able to choose your own doctor.

    Answer:  in the current system only the wealthiest can really choose their own doctors. The rest of us fortunate enough to have health insurance really have very few "choices".

    4)a gov't run system will lead to "rationing". This is the most priceless of all.  We obviously don't have any rationing today do we??

    •  I recently heard a GOP state lawmaker.... (1+ / 0-)
      Recommended by:
      GayHillbilly

      ....from Oklahoma make a pitch for tort reform (now rechristened "law-suit reform"...did we actually win a terminological skirmish for once?) by saying that controlling healthcare costs* is critical now because if we don't the pressure for single payer (and he used the term) will be unstoppable and our precious freedom of choice will be lost to government bureaucrats.

      Now I'm not at all sure that this guy actually believes that we're headed toward a slippery slope to single payer. And if he did, it wouldn't mean anything more than his belief in "law suit reform" and intelligent design creationism.  But I think it's interesting that "you better do what we say, or you'll get single payer" is now a talking point in my deep red state.

      ___________

      * Of course, law suits are not actually responsible for rising medical costs, but that's another story.

      Nobody knows what kind of trouble we're in / Nobody seems to think it all might happen again

      by GreenSooner on Thu Feb 19, 2009 at 04:25:00 AM PST

      [ Parent ]

      •  He's right. Thankfully we are on a course to SP. (0+ / 0-)

        Of course the only "choice" we lose is to unload the need to choose an insurance company.

        Also, the cost of law suits is trivial in the health care miasma of expenses.

        HR 676 - Health care reform we can believe in - national single-payer NOW.

        by kck on Thu Feb 19, 2009 at 06:27:34 AM PST

        [ Parent ]

    •  The one I hear from my students constantly (11+ / 0-)

      is "for serious problems or surgeries, you have to wait over a year."

      My answer (not an easy one): Please, people here wait for care just like in Canada, even worse. And, think of the 50 million people who don't even have the option of waiting because they aren't covered.

      Plus, by not approving certain procedures, insurance companies do worse than make you wait, because you're never going to get it, ever.

      My father, a public school teacher who paid into BC/BS for over 40 years, had to wait at least a year trying to get treatment for his neuropathy. The time they spent on the phone, filling out paperwork, etc., was the equivalent of a part-time job.

      I'm so goddamned sick of this debate - it is a perfect example of success of the propaganda pushed by the owners and bosses of this country, as well as their control over our joke of an electoral system. In a society with a functioning intellectual culture, we'd have had a national health program after WWII.

      Rise like lions after slumber in unvanquishable number. Shake your chains to earth like dew, which in sleep had fallen on you. Ye are many - they are few.

      by cruz on Thu Feb 19, 2009 at 04:25:11 AM PST

      [ Parent ]

      •  Amen. I'm not a policy wonk but my mom was (1+ / 0-)
        Recommended by:
        cruz

        a nice lady and now she really WAS one. She had one of those private alternatives to Medicare which was supposed to be less inflexible, but the terms of the care were such that they would tell her she had to go home the day of surgery whether she could or not and the hospital would act accordingly. She died before she had to because her plan required her to be shifted to a nursing home when she was not ready to go, and had given a DNR instruction which they flat out refused to honor. All those 'you and your physician' choices were made not by her and any doctor but by the health insurance person on the phone announcing what they would approve for payment or require as 'appropriate care' in accordance with their guidelines and pay for and what they would not. The one who decided was the "I hope it was at least a nurse' making the coverage decisions  over the phone from some other state without seeing the file or her. All that single payer would do is, at worst, change the identity of the anonymous person who is actually making the decisions from an anonymous maybe-a-nurse paid by a private entity, to a person who is in governmental employ with his or her own list of policies. Who is not the patient and not the doctor, already. If under private plans, the doctor got in fact to make the care decisions, rather than the insurance company, then there might be something to the 'socialism' argument, perhaps, but since that is not so, the socialism argument is garbage, period.

        A second problem of the Medicare alternatives, and thus of the private alternative to single payer is the practice of private insurance companies electing to offer plans in a county, and then very shortly thereafter leaving the county entirely, and leaving the patients swinging, for their private business reasons. Insurance companies are capitalists and not charities, and love pre existing condition exclusions, experimental exclusions and exclusions which supposedly conform to some policy not disclosed in the literature which is given to the patients being asked to select the plan. This is as true in Medicare alternatives as anywhere else. They are only competitive with single payer if they eliminate these, which they will not do voluntarily because of their need to make a profit.

        This private insurance practice stuff is costing lives which did not need to be lost.

  •  Admitting my ignorance (2+ / 0-)
    Recommended by:
    flumptytail, poli sigh

    As I've stated before, I'm a right brainer, a creative type, a lover.

    I don't know crap about numbers.

    I need to be educated about this stuff.  That's what will get me on the phone to Carl and Sander Levin and start the push.

    Educate me.

    I need to see all of the different options on one page so I can see them together.  And I need to know who's pushing which, and why.

    "(Our) stories are singular, but our destiny is shared, and a new dawn of American leadership is at hand."

    by Detroit Mark on Thu Feb 19, 2009 at 04:14:48 AM PST

  •  Present system = unsustainable. (4+ / 0-)
    Recommended by:
    DemFromCT, axel000, Egalitare, Actbriniel

    The push from reform will come from the fact that the present system isn't just expensive and not delivering consistent good care.  It's unsustainable.  Fewer people are insured at greater cost which leads to fewer insured at greater cost which....

    There's clearly got to be something new. The only question is what.  I don't think other countries have it so bad with the systems with government involvement.  It just seems alright.

    "The first Republican who cries "Wolverines!" on the House or Senate floor has to be considered the front-runner for the 2012 Iowa caucus." JF on TPM

    by Inland on Thu Feb 19, 2009 at 04:17:38 AM PST

  •  Progressives and the Democrats, Part 10,758 (3+ / 0-)

    Single-payer advocates like to point out that Representative John Conyers has a singlepayer bill in Congress with close to 100 co-sponsors. But many of those co-sponsors have signed on because, until now, it has been a cheap, meaningless way to win points with liberal interest groups.

    Nobody knows what kind of trouble we're in / Nobody seems to think it all might happen again

    by GreenSooner on Thu Feb 19, 2009 at 04:20:17 AM PST

    •  politics (1+ / 0-)
      Recommended by:
      stonepier

      How rude to bring up politics.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Thu Feb 19, 2009 at 04:25:55 AM PST

      [ Parent ]

      •  What's wrong with this picture. (0+ / 0-)

        Of course Lucy keeps pulling the football away. It's worked for her for decades.

        The question is why progressive Charlie Brown's keep trying to kick it expecting different results.

        Nobody knows what kind of trouble we're in / Nobody seems to think it all might happen again

        by GreenSooner on Thu Feb 19, 2009 at 04:28:48 AM PST

        [ Parent ]

        •  this year is different (0+ / 0-)

          as was 1994. just look around to what's happening.

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Thu Feb 19, 2009 at 04:29:49 AM PST

          [ Parent ]

          •  Yes, it's just like 1994. (0+ / 0-)

            There's public pressure for reform and the powers-that-be will have to work a little harder to prevent real reform.  And I don't see any signs that we've figured out a way to stop them from winning again.

            And once again, the major reform proponents (once again in the White House) are as dead-set against single payer as are the opponents.

            So opponents of real reform basically win whether the "reform" succeeds or fails.

            Nobody knows what kind of trouble we're in / Nobody seems to think it all might happen again

            by GreenSooner on Thu Feb 19, 2009 at 04:32:08 AM PST

            [ Parent ]

            •  we'll see (0+ / 0-)

              I don't think that's anything close to accurate. business and consumers both want reform, and so do the feds. very un-1994, and different in general than 10 years ago.

              "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

              by Greg Dworkin on Thu Feb 19, 2009 at 04:40:18 AM PST

              [ Parent ]

              •  Depends on what you mean by reform. (0+ / 0-)

                The moment the debate gets framed around Obama's campaign proposal on health care, real reform will be on the backburner again, millions of Americans will remain locked out of quality, affordable health care, and the various healthcare industries will be back in a heads-they-win, tails-we-lose proposition.

                Nobody knows what kind of trouble we're in / Nobody seems to think it all might happen again

                by GreenSooner on Thu Feb 19, 2009 at 04:45:12 AM PST

                [ Parent ]

  •  Conservatives jump up and down about Canada (8+ / 0-)

    But the fact is that Canada spends less of its GDP on Heath Care, covers everybody, and its citizens have longer lifespans.

    Its the economy of scale, stupid!

    Bipartisanship: what happens when an unstoppable force tries to reason with an immovable object!

    by Bobs Telecaster on Thu Feb 19, 2009 at 04:23:21 AM PST

    •  But it's CANADA! And we're USA! USA! (1+ / 0-)
      Recommended by:
      Bobs Telecaster

      Nobody knows what kind of trouble we're in / Nobody seems to think it all might happen again

      by GreenSooner on Thu Feb 19, 2009 at 04:29:47 AM PST

      [ Parent ]

    •  15% admin costs (1+ / 0-)
      Recommended by:
      mayim

      The US spends 15% of its healthcare money on admin costs.  That compares to 7% for Europe and Canada.

      If the US spends ~$2 trillion/annum on health care, then it spends $202 billion per year on paperwork.

      That means that the US would save $100 billion/year by switching to a single payer.  There would be other health efficiencies, like a single database that has your health history, so switching doctors wouldn't be going to ground zero again on your healthcare.

      The most efficient healthcare system in the US is the VA.  They are woefully underfunded, but because of economies of scale and increase information efficiencies, they achieve better care outcomes than most private plans.  

      The US already has government-run health care, it's just not comprehensive.  These "anti-socialist" sentiments run counter to the logic of our current system, which is largely run by the government, but not in a consistent, coherent manner.

      •  But you could say that about a lot of programs (0+ / 0-)

        in the US. Education is state/local, but the federal government gets involved.

        It's called federalism, and our Constitution created it. Take it up with them. Even Medicaid is a joint program.

        Bring back pay go, Pelosi must go. http://www.concordcoalition.org

        by sensibledemocrat1964 on Thu Feb 19, 2009 at 04:49:17 AM PST

        [ Parent ]

    •  Right, economies of scale are super important (2+ / 0-)
      Recommended by:
      EeDan, Bobs Telecaster

      when we're dealing with what we don't want:

      illness
      injury
      ignorance

      Economies of scale are what we hope to realize when we send the youngsters to school.  Home schooling is inefficient.  By the time the parents are good at it, the children are grown and ready to leave home.  And that's assuming the parents are actually able to teach something that will be useful later on.

      How do you tell a predator from a protector? The predator will eat you sooner rather than later.

      by hannah on Thu Feb 19, 2009 at 04:50:07 AM PST

      [ Parent ]

      •  Homeschooling: not for Most everyone (1+ / 0-)
        Recommended by:
        hannah

        I am forced to homeschool my oldest child for a variety of reasons. I'd prefer not to. My other two children are happy and triving in our public school system.

        I struggle to stay on course to place my child back into the system (I'm shooting for Fall 2010) because most of my resources are religious based people who are more interested in protecting their  children from the "evils of secularism" than my concerns of instruction in geometry, social studies, basic science,etc. Fortunately, I have friends who homeschooled their children up to age 8 with a more secular focus and I don't have reinvent all of the wheel.

        I used to joke about people being able to pass advance science courses by simply writing "The Lord works in mysterious ways" as an answer to just about every exam question posed.

        I can say for certain now that it is not a joke!!

        Single Payer...NOW!!!

        by Egalitare on Thu Feb 19, 2009 at 05:40:14 AM PST

        [ Parent ]

        •  Not to threadjack too much...but..... (0+ / 0-)

          .....you might want to look a bit more - I have many friends who homeschool for (at least partly) religious reasons. Yes, some are conservative Christians and Orthodox Jews - but just as many are UUs, liberal Quakers, atheists and Reform Jews (note that - in some cases - these categories overlap grin).

          Feel free to contact me at the email in my profile here if you want to talk about it more ;-)

    •  And there's another (1+ / 0-)
      Recommended by:
      mayim

      issue some friends in Canada pointed out that i'd never thought of, even though I've supported single payer healthcare since I lived in Europe in the 1970s.

      Malpractice suits.

      Since the government pays for all health care costs, there is not the same incentive for high judgment malpractice suits.  A patient who has an iatrogenic condition obviously will not qualify for health insurance, and basically HAS to file suit against the doctors and hospital in order to get the (possibly) life-long care they will need.
      If everybody were covered, there might still be pain and suffering suits, but damages, not so much.  This means that there will be lower costs of medical malpractice insurance, which is a huge albatross around physicians' necks.  Of course some ambulance chasing attorneys might not be terribly happy about that.

      Rationing:
      We have it here now, via huge premiums, pre-existing condition clauses, refusal of services and 'junk' policies. And NO policies. It's just a different far more costly and less humane form of rationing.

      Tiered coverage:
      People want to think they're better than the next guy.  Ok, that's cool.  In Canada, if you want more than the basic, guaranteed coverage, you can have a tiny (about $40/month) premium deducted from your paycheck to get a higher level of care/coverage.  I think there are 3 separate tiers, besides entirely private coverage.  So, people who need to, can still feel all class-superior and stuff.

      Economies of scale
      We here in the US spend a ridiculous amount for prescription medications.  I recently looked into buying into a 'prescription club' at Walgreens, which provides a 3-month supply of most of the common, generic meds I use for $12 per drug.  If I were to buy them myself, one would cost $55/month.  Now, obviously, nobody's losing money on that prescription service, or it wouldn't be offered.  If there were single payer, the Health Administration Agency would negotiate drug costs that were sustainable.  And, if big Pharma whines about R & D, who cares?  The government can fund research.

      I think these are important talking points each of us should use when talking to our friends, relatives, co-workers, and representatives as we gear up to take on this next important justice battle.

      Never get the mothers too angry.

      by pvlb on Thu Feb 19, 2009 at 06:07:04 AM PST

      [ Parent ]

  •  There's virtually no one left who isn't aware of (4+ / 0-)

    some horror story about medical care in this country. Why would anyone fight against a logical solution. I just don't get it.

    •  People are making billions of dollars... (3+ / 0-)
      Recommended by:
      Blutodog, flumptytail, OldBlueGirl

      ...of the current system. And they will fight tooth and nail to prevent their revenue stream from being seriously interrupted. In our political system, millions of horror stories pale in comparison with this fact.

      Nobody knows what kind of trouble we're in / Nobody seems to think it all might happen again

      by GreenSooner on Thu Feb 19, 2009 at 04:36:43 AM PST

      [ Parent ]

      •  Yes, you're right but all of us who aren't making (2+ / 0-)
        Recommended by:
        GayHillbilly, Egalitare

        billions outnumber them and we should all be fighting tooth and nail ourselves by now. Yes we can, by golly.

        •  So how are we going to leverage those numbers? (3+ / 0-)
          Recommended by:
          DemFromCT, flumptytail, OldBlueGirl

          That's the practical political question.

          Last year, not a single presidential candidate with a serious chance of winning favored single payer.  And that's with roughly half of the American public in favor of single payer.

          On some issues, our numbers can be expressed at the ballot box.  On health care, the majority view--if the recent poll showing 60% support for Medicare for All is to be believed--is shut out from the start.

          Republicans who oppose single payer know they have the backing of their fanatical base. Democrats who oppose single payer figure that their single-payer favoring base has nowhere else to go.  Both get millions from the health care industry.

          So how will our numbers make a difference?  A general strike?  Do you have some other idea?

          Nobody knows what kind of trouble we're in / Nobody seems to think it all might happen again

          by GreenSooner on Thu Feb 19, 2009 at 05:46:41 AM PST

          [ Parent ]

      •  Same argument can be made about other industries (5+ / 0-)

        Banking, auto industry.  Medicare for All would actually help resurrect those and other businesses.  We're in a crisis, which makes this the ideal time for radical change.

        •  That's why single payer makes sense. (1+ / 0-)
          Recommended by:
          flumptytail

          Now how do we get from A to B on it?

          The leadership of both major parties in the House and the Senate oppose single payer.

          The President opposes single payer.

          Give me a political plan of action.  "It makes sense" and/or "a majority of people support it" really don't cut it.

          Nobody knows what kind of trouble we're in / Nobody seems to think it all might happen again

          by GreenSooner on Thu Feb 19, 2009 at 05:48:35 AM PST

          [ Parent ]

      •  Vampires (0+ / 0-)

        The few making billions are human vampires in every sense of the word. They are literally feeding off of our blood. These creatures need to be brought down. We need to put a stake in the heart of this unholy business and Vampires that run and own it.

        "It's better to die on your feet then live on your knees" E. Zapata

        by Blutodog on Thu Feb 19, 2009 at 12:24:16 PM PST

        [ Parent ]

    •  because the horror stories (2+ / 0-)
      Recommended by:
      flumptytail, pvlb

      go both ways. Everyone also has a horror story about health care in Canada or England (never mind that the rest of the industrialised world ALSO uses single payer, only Canada and England seem to matter).

      After the horror story comes the "I don't want the government deciding who my doctor is!" No matter that insurance companies routinely do that very same thing here in the US. "But I can go out of network and they pay 80%." Which is fine if all you need are some tests. But when the big one hits, you are rapidly denied coverage pretty damn quick if your insurance company can't micromanage your care, which means approving your doctors and denying any care they don't want to pay for (which is pretty much everything once you get into them paying more than you've paid in).

      Then there's the "Those people" argument. "I don't want to be paying for the healthcare of deadbeats!" Obviously the people who make this argument have no idea what insurance is.

      It's a constant circular argument that is maintained by corporate interests and their toadies in government and the media.

  •  I'm one of those indies (4+ / 0-)
    Recommended by:
    DemFromCT, EeDan, kck, Egalitare

    i admit to having some serious reservations about single payer.Bu I also have a deep disdain for thinking profit in the health care "industry" is the way to go.

    I don't think the elimination of the private insurance industry in total is a good idea and frankly i know enough to know that it will never happen anyway. ever.

    i think there must be a way to provide care to everyone without it being connected to a job. it must be affordable and it must be non-discriminatory. There must be controls on costs because i don't believe the government can foot the bill for everyone who will need, say, heart surgery, if it costs 200,000 from admission to discharge.

    My husband had to take an earl retirement and he is now on medicare which by and large i think is a very good plan overall. I wish I could enroll in that, but i carry my own private coverage which has gone up ear after year even though i'm young and healthy (42).

    I've been researching most of  the plans being discussed as well as some other countries plans, like taiwan, in order to try to educate myself on what I will advocate when the time comes. I admit its overwhelming, especially when our political system is very much a part of the equation. But here's what i do know: no plan will pass that abolishes the health care industry completely. Not gonna happen.

    •  thanks for those comments ;-) (1+ / 0-)
      Recommended by:
      mdmslle

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Thu Feb 19, 2009 at 04:41:04 AM PST

      [ Parent ]

    •  The problem is (1+ / 0-)
      Recommended by:
      Egalitare

      That no one "chooses" to get sick. Health care is a system in which no one demands what is being supplied (injury and disease), so "supply and demand" metaphors simply do not apply.

      And frankly, if you think the government can't afford to pay for everyone's heart attacks, why should you think that insurance companies can do so? Or WILL do so when their incentive is entirely to maintain profits and thus deny care?

      Insurance companies make money by massive taxation -- not government taxation, mind you, but private taxation: You MUST pay their demanded fees (extortion) or risk being killed by denial of care at the hospital or risk bankruptcy when you have to sell everything you have before being killed by insurance company mandated medical neglect.

      Insurance companies provide no medical care and do not have the medical knowledge necessary to manage care. So why exactly are we paying them hundreds of billions of dollars? What do they bring to the table other than the pretence of "market dynamics?" What benefit do they provide to the so-called insured? What exactly am I paying for that I can't get with single payer health care?

      •  i'm not getting into ideological debate (0+ / 0-)

        i was just sting my own feelings and observations.

        i realize the value of single payer but i also have some trepidation about it, I just being honest.I mentioned that i think a profit-driven health care industry is a bad way to go about it but I'm not sure eliminating completely private insurance is wise either.

        as for your question

        And frankly, if you think the government can't afford to pay for everyone's heart attacks, why should you think that insurance companies can do so?

        I don;t think i suggested that insurance companies are paying for it...that's part of the problem. I acknowledge that. But let's also be honest: there are lots of people who are not currently receiving health care who will be  once a universal program in implemented. I'll use myself as an example: i have insurance but havent gone for a physical or mammography in over a year. Not because I cant afford it but i'd just rather not pay the copay right now. The cost of say, an MRI needs to be reduced because right now there are probably lots of folks who need to have one (insured or uninsured) but who  arent having one. And at 5000 a pop, if suddenly 3 million people go to get one, i think the government could be in big trouble.

        I;m just trying to have an honest discussion about this which is so hard to do because people have their ideological lines drawn and are not listening to each other. I dont have a dog in the race - i dont have a hard ideology about it.  I'd like to see health care available to every american at very very low cost and no one be denied ever. That said, there are some real  financial considerations that we need to be honest about if we're going to make a plan that works and doesnt bankrupt our system at some point. Let's have an honest discussion b/c this is not an easy issue.  We need to think about the aging population. We need to think about how we'll pay for it. We need to address the very real issue of medical costs run amok and how to contain that. We need to think about fairness and equity. We need to also deal with political realities and whether there could be a place for a private industry to fill any gaps or work around some of the challenges that may be presented the reform of the system.

        That's all i'm talking about.

    •  Yes, our health care industry is wonderful! (0+ / 0-)

      There are plenty of improvements that can be made, some quite serious and fundamental like the influence pharma has on clinical protocols and the negative incentives embedded in the typical fee-for-service compensation methodology.

      But overall very few people complain about the health care "industry", I prefer the term "practice", itself. We like our doctors. We want more ad better access to them.

      There are 3 main obstacles to access to health care:

      1. Cost - insurance cos charge too much in premiums, fees, copays, deductibles.
      1. Gatekeeping - insurance cos delays, cancellations, denials, and interference with clinical treatment.
      1. Location - rural locales insufficiently staffed ad not organized for remote medicine.

      Single payer fixes the first two.

      HR 676 - Health care reform we can believe in - national single-payer NOW.

      by kck on Thu Feb 19, 2009 at 06:49:01 AM PST

      [ Parent ]

  •  Reinventing the Wheel (3+ / 0-)
    Recommended by:
    Blutodog, EeDan, pvlb

    Why do Americans talk about universal healthcare like we are inventing the wheel?  Most countries have Universal healthcare run by the government.  The US in an anomaly.

    All we have to do is look at countries that we regularly talk to, like Japan, Canada, the UK, France, Germany, Italy, Scandinavian states and analyze what they did right and wrong.

    Canada still has private health care on top of their universal program.  Blue Cross/Blue Shield is alive and well here.  There are problems with the system, and they should be analyzed, but they are more nuisances than the premature death issues that the US system has.

    Americans also talk about their health care system like it is sustainable.  If you lose your job in the US, you lose your health insurance.  If you get sick, you go bankrupt.  With unemployment rising to 10%, we could see 20% of Americans without health insurance and another 20% or more with inadequate health insurance.  Can you call a system a success with that high of a failure rate?  It's not like it is going to get better on its own!

    •  check out the gawande article (and Cohn's) for (0+ / 0-)

      historical perspective... they're both excellent.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Thu Feb 19, 2009 at 04:41:58 AM PST

      [ Parent ]

  •  So -- economies of scale? (0+ / 0-)

    What are they?

    Insurance companies don't run factories and don't buy large machineries.

    They really don't have any large capital investments other than the assorted computer systems that make them go, and, with those,  scale doesn't provide any great economies once you reach a certain point.

    If anything, larger organizations are more prone to diseconomies of scale due to larger and more lethargic bureaucracies, and the lack of competition does not provide a fruitful environment for fighting those.

    The big advantage I can see for single payer doesn't require single payer at all -- standardized forms and processing.  Far too much money is spent on insurance processing because of differences between forms, policy provisions, and the like.

    And, of course, that's not an economy of scale.  it's an economy of standardization.

    Free speech? Yeah, I've heard of that. Have you?

    by dinotrac on Thu Feb 19, 2009 at 04:43:36 AM PST

  •  Two important notes (0+ / 0-)
    1. The oft-quoted 47 million insured is from the Census Bureau. Census Burea includes illegal immigrants. I don't think any serious person would consider giving illegal immigrants free universal health care.  So pick a new number, folk.
    1. It's constantly mentioned the US pays more for health care, something like two times other countries with single-payer. However, the federal government already spends 1 out of every 2 health care dollars in America.

     So here's my proposition: Anyone can try single-payer with no new tax increases, only money budgeted for current health care and see if it would lower costs.....
        I'll give 10:1 odds your favor.

    Bring back pay go, Pelosi must go. http://www.concordcoalition.org

    by sensibledemocrat1964 on Thu Feb 19, 2009 at 04:43:42 AM PST

    •  47 million uninsured* n/t (0+ / 0-)

      Bring back pay go, Pelosi must go. http://www.concordcoalition.org

      by sensibledemocrat1964 on Thu Feb 19, 2009 at 04:44:44 AM PST

      [ Parent ]

      •  But illegal immigrants still are injured and (3+ / 0-)
        Recommended by:
        Phil N DeBlanc, mayim, Egalitare

        become sick, and in doing so wind up in emergency rooms.  So, assuming the hospital is already paid for, should the "uninsured" rate be set to the marginal cost of service?  Rather than the exorbitant shelf price you would now face?

        I'm thinking of a friend who lead a group of volunteers to eastern Europe.  First night there, one of the group broke their ankle - this would have been either in Russia or Belarus.  Of course, no health insurance.  Went to an emergency room, had x-rays, got a nice plaster cast, hobbled out a couple of hours later.  Total cost: $25 USD.

        Now granted, this isn't apples-apples.  800-900 rubles (+/- $25) is a substantial sum for many people living there.  Here, something more like $250 would be more appropriate for similar services.  But if you walked in to any major city emergency room at 8 PM with a broken ankle, A) what time the next day would you finally leave?, and B) how many thousands of dollars would you have to pay if you were uninsured?

        That which doesn't kill me merely postpones the inevitable.

        by EeDan on Thu Feb 19, 2009 at 06:41:31 AM PST

        [ Parent ]

    •  Couple questions.... (2+ / 0-)
      Recommended by:
      GayHillbilly, Phil N DeBlanc

      Rather than just getting out the watering can to hydrate this comment, I'll ask a couple questions.

      a) What is your source for the number and who is included in #1? Asking because a quick Google pretty much brings up pretty much only right-leaning sites with other agendas making that claim. While your claim may be true, it is also one that needs support.

      a1) The best estimates I've seen claim about 10 to 12 million illegal aliens in the US. So, let's see..... Hhhhmmmm. 47 minus 12 (if the claim that the uninsured number includes illegal aliens and that all the illegal aliens are not covered are true). Digs out grade 2 arithmetic skills - rusty but still in the memory...... Still leaves 35 million US citizens uninsured.

      b) If there is, say, an epidemic like the 1918 flu outbreak, do you really expect the little bacteria/viruses to stop and ask about immigration status before infecting someone?

      •  The right-wing Wikipedia (0+ / 0-)

        About 38% of the uninsured live in households with incomes over $50,000.[4] According to the Census Bureau, nearly 36 million of the uninsured are legal US citizens. Another 9.7 million are non-citizens, but the Census Bureau does not distinguish in its estimate between legal non-citizens and illegal immigrants.[4] It has been estimated that nearly one fifth of the uninsured population is able to afford insurance, almost one quarter is eligible for public coverage,

        http://en.wikipedia.org/...

        Bring back pay go, Pelosi must go. http://www.concordcoalition.org

        by sensibledemocrat1964 on Thu Feb 19, 2009 at 06:00:15 AM PST

        [ Parent ]

        •  Still... (1+ / 0-)
          Recommended by:
          Phil N DeBlanc

          when Googling, the issue is mostly pushed one websites with very definite agendas ;-)

          And.....
          notice that that says that the Census Bureau doesn't distinguish between those here legally and those here illegally. So it is possible, yes, that every single one of those 9.7 million uninsured non-citizens are here illegally.... but it is also possible that every single one is here legally ;-) My guess is reality is somewhere in between.....which is a little murkier than what most of the people using the fact that the Census Bureau doesn't distinguish as a talking point try to claim.

          And you are still talking about 35+ million US citizens with no health insurance at all.

          •  THen your Googling isn't good (0+ / 0-)

            Because Wikipedia usually comes up first for me.

            Frankly you were misinformed about the insured, and I informed you. Don't try to smear me, and say thank you.

              Furthermore, if you read the whole article on insured, you'd see 25 percent of the uninsured are eligible for public insurance, and another 25 percent can afford it.

             

            Bring back pay go, Pelosi must go. http://www.concordcoalition.org

            by sensibledemocrat1964 on Thu Feb 19, 2009 at 07:11:55 AM PST

            [ Parent ]

            •  After this, I'm going to stop (0+ / 0-)

              feeding the troll, but I will point out that Googling the fairly sensible search string

              Census Bureau statistics illegal insurance

              does indeed mostly bring up primarily anti-immigrant sites with definite agendas in the first few pages.

              The first Census Bureau link that is found does have this interesting tidbit:

              Undocumented immigrants or illegal aliens.
                 Because all residents of the United States living in households are represented in the sample of households interviewed by the CPS, undocumented immigrants or illegal aliens are probably included in CPS data. Because the CPS makes no attempt to ascertain the legal status of any person interviwed, these individuals cannot be identified from CPS data.

              So, no, I don't think I'll bother to say thank you ;-)

  •  Duh. When you're planning to do something (2+ / 0-)
    Recommended by:
    kck, Geoff D

    you've never done before, the outcome is uncertain--i.e. risky.  

    What we should ask is when did Americans become so risk-averse?  Why should a new way of paying for necessary medical care cause so much anxiety?  If people were unwilling to explore the unknown, the Americas would never have been settled by Europeans and Asians.

    Nowadays everyone wants to have all the facts before making a decision.  This is, in effect, an excuse for not making any decision for the simple reason that there are NO facts to be had about the future.

    What we have at present are a wealth of facts about health care that's either lacking or deficient.  That should be sufficient cause for change.

    Why should we the people be in charge of who pays how much for the suppression of illness and injury?  Because, illness and injury are things we don't want and we've learned from experience that what we don't want is best addressed when we take advantage of economies of scale.

    Boutique health care is fine for face-lifts and other cosmetic procedures.

    How do you tell a predator from a protector? The predator will eat you sooner rather than later.

    by hannah on Thu Feb 19, 2009 at 04:45:10 AM PST

    •  Why is this so uncertain? (2+ / 0-)
      Recommended by:
      GayHillbilly, Geoff D

      Are Americans that damned special that the same outcomes the Europeans, Canadians and East Asians report going to be so different?

      I'll bet most Americans can't tell the difference between someone from Toronto or Columbus, so why should the health care be that different?

      If other nations had cellphones, would we fret about inventing our own, or would we adapt current technology?  Why is healthcare administration so different from other tried and proven technologies?

      •  I expect it has something to do with being (0+ / 0-)

        wedded to the profit motive.  In the search for some automatic regulator of human behavior (that isn't God), Americans have settled on the market and the presumed efficacy of people wanting to be winners/make a profit and they've tried to apply it across the board--the one size fits all mentality.

        Now, it's turned out that the market can't deal with crooks (people have to regulate each other) and the profit motive can't be applied to enterprise that's designed to decrease whatever good or service it provides.  (There are people who argued that when a community experiences no wildfires, the fire suppression force should be phased out, but not too many communities bought into it).

        Americans like for things to happen automatically, but some areas just aren't suitable for that.

        How do you tell a predator from a protector? The predator will eat you sooner rather than later.

        by hannah on Thu Feb 19, 2009 at 06:50:15 AM PST

        [ Parent ]

  •  Without National Health there is no health reform (4+ / 0-)
    Recommended by:
    GreenSooner, Blutodog, GayHillbilly, pvlb

    The current system is economically unsustainable. It eats up 16% of US GDP and fails to provide good health care. Tinkering with the current system is not health care reform.  At best it will INCREASE costs to an already debt burdened nation.

    Obama needs to set the bar high and educate the public on the facts that the rest of the world provides 100% health care for 50% less and gets 20% better results with national health care plans such HR676/Medicare for All.

    Without Obama doing that, health care reform is not going to happen.  Obama is clearly not going to do that so health care reform is not going to happen.

    We have the best opportunity for health care reform since the last recession when Clinton came into office and it looks like the US will once again miss an opportunity to salvage its economy and provide health care to its citizens.

    Baffling and sad.

    •  The Public and Reform (1+ / 0-)
      Recommended by:
      Blutodog

      Throughout this thread, DemFromCT has taken a lot more comfort than I have in the fact that a majority of the American public seem to be coming around to real reform.  

      Here's where I agree with him.

      We can't ultimately blame Obama for his failure to support single payer. He has never been in favor of single payer health care. All those who supported him knew (or should have known) that he'd work against it once elected President.

      So long as supporters of single payer are willing to vote for opponents of single payer, we shouldn't be surprised that we don't get single payer.

      Nobody knows what kind of trouble we're in / Nobody seems to think it all might happen again

      by GreenSooner on Thu Feb 19, 2009 at 05:54:14 AM PST

      [ Parent ]

      •  Yes Obama not for single payer, why he/it fails. (1+ / 0-)
        Recommended by:
        Blutodog

        in regard to health care reform.

        Western Europe, Japan, Taiwan all have basically the same national health care system that works, 50% less cost than US, 100% coverage, 20% better results.

        If Obama does not have the courage to stand up for that and tell the American people, then health care reform will fail because the system we have cannot be "reformed". It is a failed system that no other country has for the very reason it is a failed system.

        •  The Cost of Lesser Evilism (0+ / 0-)

          I voted for, worked for, and donated to Obama in the fall because he was dramatically the lesser evil than John McCain.

          But this is the cost of lesser evilism.

          Obama opposes real health care reform. This isn't a matter of "courage." It's a much more simple matter of belief. Obama believes that we should keep our private insurance system.  I think he's wrong and always have. But part of the bargain of supporting him was in all likelihood putting real healthcare reform on the backburner for another couple decades.

          If we are going to achieve real healthcare reform, Obama must be recognized for what he is: part of the problem, not part of the solution. And rather than worrying about him, we need to think about ways to build the kind of mass movement that can force politicians to abandon their beliefs.

          From opponents of single payer like Obama, we need not courage but cowardice in the face of a mass movement.

          Somehow, however, I don't think we'll see either the mass movement or the cowardice.

          Nobody knows what kind of trouble we're in / Nobody seems to think it all might happen again

          by GreenSooner on Thu Feb 19, 2009 at 06:07:49 AM PST

          [ Parent ]

          •  Obama doesn't oppose, lacks courage to support it (0+ / 0-)

            He has calculated it is not politically possible so he doesn't plan to fight for it.  In the case of health care reform he lacks the courage to tell the American people the truth.

            As he said, he's not a perfect man and this is one of his major mistakes.

            •  Evidence for this claim? (0+ / 0-)

              You cannot simply attribute to Obama whatever beliefs you'd like Obama.

              Obama said, very clearly, that if we were starting from scratch he'd favor single payer, but that we're not so he favors reforming the present system. I'm willing to assume that he meant that, and did not simply say it as a way of pandering to single payer advocates. But even that is not the statement of someone who actually supports single payer in the real world.

              No, Obama is not perfect. But his failure here is a matter of ideology and policy beliefs, not courage.

              There may well be some fearful progressives in Washington. But most of the politicians whom progressive Democrats like to imagine are fearful progressives are, like Barack Obama, "New Democratic" centrists.

              Nobody knows what kind of trouble we're in / Nobody seems to think it all might happen again

              by GreenSooner on Sat Feb 21, 2009 at 09:54:38 AM PST

              [ Parent ]

      •  This is incorrect (1+ / 0-)
        Recommended by:
        Egalitare

        Obama Obama Has Consistently Said That If We Were Starting From Scratch, He Would Support A Single Payer System

        So obviously, being a pragmatic, he's saying that even though he supports single payer, it might not be possible.

        This is where we come in.  When he made those statements, it may well not have been politically feasible.  But the economic collapse has created a whole new wellspring of sentiment against the big conglomerates who have caused the current misery.

        There hasn't been another time as ripe for militating for single payer health care in our lifetimes.

        Never get the mothers too angry.

        by pvlb on Thu Feb 19, 2009 at 06:16:06 AM PST

        [ Parent ]

        •  there's that FDR line (2+ / 0-)
          Recommended by:
          pvlb, Egalitare

          make me suoport you, 'cause you know I want to.

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Thu Feb 19, 2009 at 06:31:08 AM PST

          [ Parent ]

          •  We are on the hook to at least try (0+ / 0-)

            Hillary said the same thing, with a wink and a nod, in her primary kick-off videoconference. She said, and I paraphrase from memory, that we all know the ultimate best solution but the insurance industry backlash will be enormous so the only way for that backlash to be overpowered is by a louder, more enormous public backlash, a relentless public demand that Congress simply can't ignore.

            We have a chance, a shot.

            HR 676 - Health care reform we can believe in - national single-payer NOW.

            by kck on Thu Feb 19, 2009 at 08:07:38 AM PST

            [ Parent ]

  •  What many of us overlook is our mechanism (1+ / 0-)
    Recommended by:
    pvlb

    of defeat oin this measure. Look at the insurance industry. They ban togather and form a lobbing conglomeration. We reformers have hundreds of small little groups that stay seperate, each wanting a share of the pie in donations etc. We must mirror the practices of the insurance industry to succeed, for as we have seen (consider hold out Rethugs on stimulus bill now touting their involvement)politicians don't listen to their constituents, but the do listen to cha-ching

    I get along just fine with God. It's his fan club I have significant problems with.

    by utopia on Thu Feb 19, 2009 at 04:49:28 AM PST

    •  i dont think so necessarily (2+ / 0-)
      Recommended by:
      GayHillbilly, Egalitare

      there re some pretty big lobbying groups lining up behind reform and i think that having say 15 really big groups representing different constituencies might be more influential than one big group.

      THink of it this way: Obama won the white house and broke fundraising records by having literally millions of small donors. NOt only did this increase his power and credibility, it increased our voice and influence and made it very hard for his opponent to target their fire/opposition because we were/are a "group" pf millions instead of one big monolith.

      All the union groups, the chamber of commerce, AARP and some other pretty powerful lobbying groups are moblized with 10's of millions if not hundreds of millions of dollars to this fight. And for the first time since I can remember, we al seem to be lined up n virtually the same team (that is, against the health-care-for-profit industry).

      Its a new day and its a new game.

    •  This is exactly (0+ / 0-)

      the point I've made in letters to congresscritters who don't 'represent' me.

      "In the internet age, every elected official represents every citizen, because information is instantaneous, and small donations are very easy to make".

      Never get the mothers too angry.

      by pvlb on Thu Feb 19, 2009 at 06:18:07 AM PST

      [ Parent ]

  •  Medicare for All (1+ / 0-)
    Recommended by:
    GayHillbilly

    For those of us who want single payer, continued effort to re-brand it as Medicare for All would be good politics.  Like "death tax".
    Too bad for insurance companies and their employees, but no more of a tragedy than for steelworkers, textile workers and workers in other industries that have been deemed expendable in the USA.
    And BTW for many of us the term "insurance" is a misnomer.  Many large employers are self-insured with companies like UnitedHealth only providing administrative services.  This has come as a nasty surprise to employees of insolvent companies who find there is no money in the till for their healthcare claims.

  •  Wyden/Baucus Senate Health Care Plan best so far. (0+ / 0-)

    has some Senate support.  If, as Cohn states, Senate support is the key to what kind of reform we get then Wyden's health care plan is probably the best we can expect.

    It won't really solve the cost issue that is killing US economy but it will fix the universal access to health care and might somewhat reduce the costs by providing early preventive care.

    If we are going to let health care costs ruin US economy, at least with Wyden's plan, we go down humanely providing for everyone as the ship sinks.

  •  We can have single payer health care (4+ / 0-)
    Recommended by:
    GayHillbilly, pvlb, oxfdblue, Egalitare

    if we give up on the idea of bi-partisan support for the idea.  Let the Republicans stake their careers on fighting for the insurance industries.  Let the voters decide.

    moderation in everything ... including moderation

    by C Barr on Thu Feb 19, 2009 at 05:05:03 AM PST

  •  We are already providing (2+ / 0-)
    Recommended by:
    Egalitare, whaddaya

    the functional equivalent of Medicare to nearly every federal, state and local government worker, with our tax dollars, and it ticks me off that our elected officials say that the rest of us can't have what we are providing for them.  Medicare for All!!!

  •  ... (1+ / 0-)
    Recommended by:
    whaddaya

  •  Good article on HuffPo yesterday about national (2+ / 0-)
    Recommended by:
    Egalitare, whaddaya

    health care "Patching the Tattered Blanket"
    http://www.huffingtonpost.com/...
    It talks about how each country gets to national or universal health care its own way.  I work on Medicare/Medicaid and I am personally more comfortable with incremental solutions than others here.  People who are either not on these programs or don't have to administer them tend to underestimate some of the challenges and difficulties of "Medicare for All."  I think we are more likely to come out with a better system if we proceed a bit cautiously.  CHIPRA made a lot of expansions and does in fact cover legal immigrants. It will be interesting to see how many additional individuals get covered. To me it is very important that whatever we do maintains a safety net for the most vulnerable. But I think it is critical to move forward now.

    •  so what are the problems with medicare? (0+ / 0-)

      I don't perceive them... can you please write a diary or direct us to info.

      I know there are problems with the way it bills - i.e., by procedure - but as I understand it, all plans follow Medicare in that way.

      Details - please or a source.

      thx...

  •  My cousin in England... (3+ / 0-)
    Recommended by:
    Munibond, Egalitare, whaddaya

    The primary"argument" I always hear when trying to discuss health care is the "My cousin in England needs a life saving operation and the government is making her wait!" Everyone has a horror story about health care in England (no matter that the current relatively lousy system was set up by Margaret Thatcher's government) or Canada: people are continually pouring across our northern borders to get desperately needed healthcare that the Canadian government denies them, (presumably which twirling their long, black Canadian moustaches and chortling evilly).

    Aside from the fact that I never knew so many people in the US had cousins in England, much less that so many people in England were in dire need of life-saving surgeries...

    This is the prime argument we are facing. Everyone in America just "knows" that single payer healthcare denies life-saving care. That our system ALSO denies life-saving care, and charges us more for the privilege of being denied, never seems to make it through their heads.

    So how to we manage this problem?

  •  Americans will never get a single payer system (1+ / 0-)
    Recommended by:
    Munibond

    Until each and every congressional whore who is on the take from the insurance industry is OUTTA THERE.

    The insurance industry CREATED the so-called "medical malpractice" crisis in the 70's JUST so they could market their new invention "health insurance."  Until about 1970 almost NO ONE had health insurance and very few "required" it.  However by inflating the cost of health care by imposing higher and higher costs on doctors, health insurance became a necessity for everyone.

    Rather than make this very simple adjustment and create a single payer system, instead the private insurance industry has been permitted to run completely amuk, cherry picking insureds, denying care, coverage and benefits to the sick and those who need it;  driving the cost of health care beyond the cost of housing in many cases.

    And the cheap whores in Congress have allowed it to continue and will allow it to continue DESPITE THE FACT THAT EVERY SINGLE MEMBER OF CONGRESS HAS FULLY TAXPAYER FUNDED SINGLE PAYER HEALTH INSURANCE OF THEIR OWN.

    There is no debate about it.  Only corruption.  And that is why the United States has the most frivolously expensive, selectively extended, unfair, inequitable and fucked up health care system of any country that dares call itself civilized.

    Corporate control of the congress MUST END or the American people are absolutely positively
    D O O M E D

  •  The response to this: (0+ / 0-)

    free marketeers argue that the only coherent solution is to end public insurance and employer-controlled health benefits so that we can all buy our own coverage and put market forces to work.

    Is to note that market forces are at work in the cell phone and cable industries.  So how's that working out for ya?

    That which doesn't kill me merely postpones the inevitable.

    by EeDan on Thu Feb 19, 2009 at 05:24:38 AM PST

    •  well the cable industry (0+ / 0-)

      Is a massive government mandated corporate monopoly, so lets hope healthcare won't follow that model. Note to trollish "Free Marketers" the problem isn't the monopoly in this case, it's the government mandate of a private monopoly that's at issue. Actual free market capitalism in Europe and Asia has led to people getting far more bandwidth, services and choices than here in the US with our soviet style mandate monopolies.

      But health care is a very different beast. While most people with a job can afford to buy a cellphone plan and cable TV, no one can reasonably expect to afford a major medical problem (except the millionaires who are making our choices for us, most of whom enjoy socialised medicine provided by our tax dollars).

      When faced with tens or hundreds of thousands of dollars in medical costs, the only possible solutions are, let them spend all their money, then let them die (and note that euthanasia and suicide are always denounced and vilified by the very same people who advocate against single payer: it almost seems the primary goal is to ensure penury before the victim dies. Can't let them leave anything to the kids, can we? It's almost like the system was designed to suck as much money out of sick people as possible... but no one could be that evil could they?

      Oh yeah, the other solution is some form of group payment: we all pool together to protect each other. Each of us puts up a stake, quite frankly hoping we will never need it, but when a crisis occurs, we draw from the group fund. The only argument we are actually having is the nature of that group fund. Should it be private and profit taking or socially funded?

      Private and profit taking means that some portion of OUR money goes to profits (usually about 20-30 cents of every dollar) or whether OUR money goes to pay for our medical care. Both systems require a certain amount of overhead. Which allotment of YOUR money would you rather see? Overhead of 2% (medicare and the VA and other single payer systems) or 25% (The unsurance industry)?

      The UNSURANCE industry model of the US provides LESS CARE at HIGHER PRICES than any single payer system in the world. Americans are less healthy, have shorter life spans and higher infant mortality than single payer nations all while spending twice what other countries pay. We have LESS choice of doctor and procedure, less quality outcomes and higher mortality and morbidity. So basically, what exactly are we paying (more) for?

      We pay to maintain the IDEOLOLOGY of the right. NOTHING MORE.

      •  the cable and telecoms are oligarchies. (0+ / 0-)

        But regardless they offer contracts of adhesion - accept our terms or do without.  That is what a health care market of a few providers and millions of individual purchasers would consist of, and that is exactly what the insurers want.

        That which doesn't kill me merely postpones the inevitable.

        by EeDan on Thu Feb 19, 2009 at 06:55:29 AM PST

        [ Parent ]

  •  While I expect the end result to be disappointing (0+ / 0-)

    The one thing that does give me hope is that the current situations is so pathetic, that just about anything can be an improvement.  The link between work and health care is disastrous.  The risk of losing one's health care along with their job, and then potentially being unable to get covered by a new plan, would cause me to seriously consider paying for my own private coverage even if I received insurance through my employment.  

    While everyone seems to hate the high deductible health care plans, even if we could get something like that to cover the uninsured it would be a step in the right direction.  First of all, it would cap how much you spend in a medical catastrophe at something like $5000 per year, which is better than the tens of thousands it often adds up to now.  In addition, since the amount billed to insured patients tends to be much lower, it would also reduce the costs borne by the uninsured that way.  

    Admittedly it's not a completely ideal solution, but even something as limited as that would still be an improvement.  

    Don't like XOM and OPEC? What have YOU done to reduce your oil consumption? Hot air does NOT constitute a renewable resource!

    by Asak on Thu Feb 19, 2009 at 05:41:39 AM PST

  •  Conservative critics - meh (1+ / 0-)
    Recommended by:
    GayHillbilly

    Conservative critics of single-payer raise the perfectly respectable question of whether a government program could really wield such power judiciously.

    Conservatives have no problem with the massive waste, fraud, and injudicious use of power by the Department of Defense. In fact, they laud and cheer excess in the military budget. Their qualms are duly noted over creating a national health care system that works, provides quality care for all, and does not have 40% overhead costs that go to execs and Wall Street.

    An end to the Bush nightmare is only the first step in rebuilding America.

    by DWG on Thu Feb 19, 2009 at 05:48:25 AM PST

  •  it's UNSURANCE (1+ / 0-)
    Recommended by:
    whaddaya

    While typing another comment I managed to come up with this typo: UNsurance.

    But then it occurred to me that that IS what we have here in the US: UNsurance.

    We certainly get nothing of value from the insurance industry in health acre terms. We get denial, obstruction and higher costs and more effort to manage their denials and obstruction at the times when we can least afford it (when we're sick).

    We don't have medical insurance here in the US.

    it's Unsurance.

    (is this meme-worthy?)

  •  President Obama has taken Dr. Ezekiel Emannuel (2+ / 0-)
    Recommended by:
    Munibond, whaddaya

    ...as his new health care advisor. Rahm's brother will be giving Obama an earful no doubt of his peculiar an false take on national single-payer. Dr. Emanuel falsely claims that SP is the status quo in that it is tied to the current fee-for-service billing methodology.

    SP insurance can exist with the common fee-for-service methodology if that hastens its implementation and reduces transition costs by reusing existing technology (e.g., billing methods, transaction providers, IT). However, by eliminating the fee-for-service method and using other models in the marketplace today like salaries (e.g., the VA, HMOs, military) many more benefits and reduced costs can be gained.

    HR 676 - Health care reform we can believe in - national single-payer NOW.

    by kck on Thu Feb 19, 2009 at 06:16:51 AM PST

  •  Wow, one of best stories on the subject I (2+ / 0-)
    Recommended by:
    DemFromCT, whaddaya

    have read!  Thanks for the compilation for both views and a political take.

    Single payer supporter here, but in the end, want change so more people have a better net than they have today.

  •  Being pragmatic = defeated before you start (0+ / 0-)

    building around the mess we already have is like tossing sand over a pile of cat shit.  It doesn't do much for the potential smell or health issues but we don't have to look at it.

    We're all one heartbeat away from Forever. kasandra.us

    by KS Rose on Thu Feb 19, 2009 at 06:27:49 AM PST

  •  FYI anyone who may not know these organizations (0+ / 0-)

    http://www.healthcare-now.org/

    EXCERPT

    Pay Less, Get More

    Support National, Single-Payer Healthcare

    The majority of Americans and physicians agree: We need a national, single-payer healthcare system.

    Single-Payer healthcare is the only truly universal system that would reduce costs while providing comprehensive care for all American residents.

    The only thing missing is the political will of Congress. Here's what you can do to help: sign up for our mailing list, tell your congressperson you want single-payer healthcare (HR 676), ask us about local organizations in your area, sign our petition, or donate to Healthcare-NOW.

    http://unionsforsinglepayerhr676.org/

    Unions for Single Payer Health Care

    http://www.guaranteedhealthcare4all.org/

    THE NATIONAL SINGLE PAYER ALLIANCE

    http://www.guaranteedhealthcare.org/

    We Don't Need Insurance, We Need Guaranteed Healthcare

    http://www.pnhp.org/

    Physicans for a National Health Program

  •  Are people really attached to their insurers? (4+ / 0-)
    Recommended by:
    Blutodog, Munibond, fhcec, Egalitare

    That's the point that struck me about the Gawande article.

    I didn't think much of the overall form and rhetorical strategy of what Gawande writes, which is the TNR/Slate standard of positing two "extremist" views (even if you have to invent one as a straw man) as being dominant out there, and the conflict between them as the reason we're not making any progress, so that the reasonable author can descend like a deus ex machina to instruct us poor dumb mortals in the contrarian, but blindingly obvious now that the author points it out to us, hitherto ignored sane, centrist solution that will let us move forward.  Whatever.  And, I might add, as if it were really likely that blindingly obvious good solutions would remain unperceived even though they are lying in the middle of the road, and not in some obscure corner.  Is there really a whole lot of low-hanging fruit out there that we need contrarian centrists to harvest for us?

    In this example of the genre, Gawande has to move the conflct away from a discussion of which of his two extremes, pure private insurance vs single payer, is inherently better, because that leaves him no sane postion in the center.  The only reason for private insurance, the only function such insurance provides, is private profit.  So Gawande has to talk about the practical question of what is politically possible.  Neither of the two "extremes", single payer vs reversion to a non-system of pure private insurance, has the trust of the public because neither has been our historical path to where we are now.  Some sort of mixed system for universal care, such as MA has now, is what people are comfortable with from long expereince, therefore, is what is politically possible.

    The biggest problem with this approach, is that we don't really need horse race reporting, period, much less from someone whose field of expertise is medicine, nearly so much as we need insight into, and advocacy over, the underlying policy questions.  I don't see the virtue of "getting beyond" the "mere" question of what system of paying for health care makes the most sense, in order to go meta into the politics of the thing.  It may indeed be a necessity for the politicians to make sausage compromises down the road in their smoke-filled back rooms, but I don't see why you would have an article in the New Yorker that would see as its job anything but so educating the public on the underlying policy, so that those politicians will be forced to get a political deal as close to the best policy as possible when they do their job.

    But my particular objection to this particular example of the genre of horse-race reporting, is that Gawande has to fake the politics of it.  What is the evidence that people are emotionally attached to their insurers?  Their providers, maybe -- though Lord knows the managed care revolution has done its best to break that bond of trust -- but their insurers?  Sure, people are attached to the idea of having some insurance, are often quite anxious that the plan they have now will go away or be ripped out of their hands, but the anxiety is surely that they will find nothing, or nothing so affordable, to take its place.  Does anyone really think that people are loyal to (In)Humana to the point of sacrificing their own best interests for the interests of that company?  Really?  Which do Americans now -- not some theoretical construct Americans in some future Single Payer Paradise, but people right now who have experienced both Medicare and private insurance -- have more confidence will pay all valid medical claims, Medicare or private insurance?  People know Medicare.  It's not the millenium, it's not utopia, but people know it and know that it's not SOCIALIZED MEDICINE.  The voters would be just fine with Medicare For All.

    Look, the real political problem is that the people's representatives don't work for the people, but for whoever keeps them in campaign cash.  People may be fine with Medicare for All, but the insurance industry is not; and the folks who make the rules work for the insurance industry, not the people.  Those of us who favor single payer, favor it, not just because it's better socially and medically, but because it's much better poltically, because it will kill the health insurance industry, and we won't have to worry about the folks who make the rules working for them anymore.  

    The main effect of Gawande's article is to launder the respectability of a continued mixed non-system, that continues to let the insurance industry prey on its victims, by pretending that the political practicality that keeps us from single payer is caused by the blind inertia of the people, and not by the undue influence of the predatory insurance industry.

    The presidency must be destroyed.

    by gtomkins on Thu Feb 19, 2009 at 06:58:12 AM PST

    •  SINGLE PAYER!! (0+ / 0-)

      Health Corps. are nothing more or less then VAMPIRES and CANNIBALS. These rackets feed on us like vultures and the sooner we replace anyone in Congress taking their $$ the better off all of us will be.

      "It's better to die on your feet then live on your knees" E. Zapata

      by Blutodog on Thu Feb 19, 2009 at 12:18:20 PM PST

      [ Parent ]

  •  medicare for all (5+ / 0-)
    Recommended by:
    DemFromCT, Blutodog, Munibond, kck, Egalitare

    Last month I had an unnerving episode of a-fib, atrial fibrillation, irregular heartbeat.  Hit the ER, trouble getting it under control, had to stay in the hospital overnight.  Yesterday I got my hospital bill: $13,000.  Haven't got the doctor bills yet, they all bill separately.  Thanks to Medicare, my share so far is a bit over $1000.  that's nice since I've lost about half of my paltry retirement in the wall Street boondoggle over the past year.

    uninsured workers don't have a chance in this system.

    stay healthy...........

  •  Can anyone point to some data (0+ / 0-)

    that indicates how many of us are already in non-Private care compared to the total? Medicare + Medicaid + VA + TRICARE + the Uninsured = what...60%, 65% of the total universe?

    Single Payer...NOW!!!

    by Egalitare on Thu Feb 19, 2009 at 08:18:19 AM PST

  •  Thanks, good story. (1+ / 0-)
    Recommended by:
    DemFromCT

    HR 676 - Health care reform we can believe in - national single-payer NOW.

    by kck on Thu Feb 19, 2009 at 08:19:06 AM PST

    •  as you well know (1+ / 0-)
      Recommended by:
      kck

      this ain't easy. I want us to know as many sides of this as we can, not losing site of what's likely.

      we can talk about Howard Dean all we want for HHS, but my job is also to talk about Katherine Sebelius and Phil Bredeson.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Thu Feb 19, 2009 at 08:50:17 AM PST

      [ Parent ]

      •  Yes, and you're providing an important service. (1+ / 0-)
        Recommended by:
        DemFromCT

        You are facilitating not just education on the various possibilities but when the right time comes to compromise design short cuts and digest less than perfect plans, the most comprehensive understanding of the issues will ease everyone through what may be the most difficult and contentious phase. Thanks.  

        HR 676 - Health care reform we can believe in - national single-payer NOW.

        by kck on Thu Feb 19, 2009 at 08:59:18 AM PST

        [ Parent ]

  •  "Give me your money." (1+ / 0-)
    Recommended by:
    Blutodog

    From Ezra's post:

    "Public and private insurance each have distinct strengths," he writes. "Private insurance has been quicker to provide new benefit options and offers greater flexibility in benefit design and payment strategies, while public insurance has proved more stable and better capable of controlling costs while ensuring access, especially for the most vulnerable.

    I dispute the claim: offers greater flexibility in payment strategies. Private insurance is the opposite; it raises prices, denies claims, offers fewer benefits. In fact, private insurance gets you signed up, takes your money then puts the squeeze on like a protection racket.

    Now they say "greater flexibility" or "benefit design" just as they used to sell their privatizing gig during the Clinton-Gore years. It's all hype. It's just words at the end of a loaded gun that says, "Give me your money."

    Where is Howard Dean? And Richard Clarke, Wesley Clark, Joe Wilson, Robert Kennedy, Jr?

    by mrobinson on Thu Feb 19, 2009 at 09:29:27 AM PST

    •  It's a racket (0+ / 0-)

      I agree so called private health Ins. is just a brutal deadly racket that denies coverage where ever possible, specializes in giving you the very least service possible and then stiffs the Drs. as well. What they specialize in is screwing the public and the Drs, while enriching a few hundred CEO's. This is an industry ripe for Nationalization. The greed of everyone in this Industry is legendary and the only thing between the public and having a Nat'l single payer system is the endless amounts of graft these companies pay the pols of both parties to stop us from ever having it.

      "It's better to die on your feet then live on your knees" E. Zapata

      by Blutodog on Thu Feb 19, 2009 at 12:14:48 PM PST

      [ Parent ]

  •  Three Models (0+ / 0-)

    The terminology used in the public debate needs to be precise. "Socialized medicine" is what I got in the Army. The doctors were salaried Federal employees, just like most of the doctors at the CDC or the NIH. The Army's administrative cost was very low since no insurance forms were required of anyone. "Single-Payer" is what I have now under Medicare, but only for in-hospital care. None of the doctors are federal employees, so this is not "socialized medicine." As a Federal retiree, I also pay a federally-subsidized monthly premium to be covered by supplemental private insurance for costs not covered by Medicare. This insurance is not a "single-payer" plan, since I had several plans to choose from, and it is certainly not "socialized medicine" since I can choose my doctors. As a question of fairness, I favor extending Medicare to everyone, perhaps gradually, but I could also support federally subsidized private insurance. The question is whether the higher administrative costs of a plan based on private insurance plans are needed to convince the public that that the government will not be dictating their care.    

  •  Two dimensions to this (1+ / 0-)
    Recommended by:
    DemFromCT

    There are two dimensions to the policy choices on health care provision: 1.  How many payers? 2.  How many providers?
    Choosing a single payer does not mean that there must be a single monopolistic provider.
    Different countries have made different choices.

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