Petition to expand Medicare to be the Single Payer Healthcare System for the USA

[sine]

I doubt it. Dental isn't covered in our healthcare system. Knee surgery and hip replacements are another thing altogether though. The wait times vary greatly from province to province however and I find that the message in the US media around waitlists in Canada overall is exaggerated.

Wait times vary greatly even within provinces. It can take my mom (lives 45 minutes north of Toronto) up to 9 months to see a specialists. During one health scare, delay's resulted in 2 ER visits before she could see a specialist.

Now that her husband passed…..another interesting story about Canadian health care system delay's……I would love to have my mom move to the USA. One so that she is closer to us and two, have timely access to great doctors.

I'm not sure if there is any social healthcare system that covers dental. My mom sent her brother in Berlin, Germany money so he could have a dental procedure done.

For those who have great & timely healthcare in the USA, expanding Medicare to be single payer is highly undesirable. Does it cost more-maybe but "good" things cost more. But, as noted in an earlier post (linked article), price gouging by the healthcare industry is unacceptable…..mean…..who needs to deal with that crap when dealing with a health crisis.

On the flip side, if one has limited access to healthcare, "social" healthcare is desirable.

Hopefully in the coming years there will be a better balance.

[davids]

This. Name one well run Government Program. Just one. Then sit back and ask yourself do you want a post office like entity presiding over your health? No thank you. And most single systems are not as efficient as presented. Ask some Canadians what is covered and when they actually are able to access said health care procedures...There are waiting lists for such banal items as routine dental procedures.

I'm so sick of knee jerk attacks on our government, its programs and employees. There's lots of programs that work pretty damn well. I'm not even going to credit your rhetorical demand with a list.

Of course programs could work better. That's true of private industry too. That doesn't make the core concept - programs designed not for profit but for the benefit of the citizenry - wrong.

And the idea behind a single-payer system - of healthcare delivery decoupled from employment, available to all citizens as needed for prevention and treatment - is a hell of a lot better than the multi-headed beast of doctors, HMOs, hospitals, and insurance conglomerates we have now. Obamacare was a compromise to provide universal access within this disfunctional arrangement. It's made some things better but the baseline arrangement is, to put it politely, sub-optimal.

[dogrange]

I'm so sick of knee jerk attacks on our government, its programs and employees. There's lots of programs that work pretty damn well. I'm not even going to credit your rhetorical demand with a list.

Of course programs could work better. That's true of private industry too. That doesn't make the core concept - programs designed not for profit but for the benefit of the citizenry - wrong.

I was staying out of this, but David, I just have to reinforce the point that the current system is unacceptably opaque and inefficient, to the benefit of I'm not sure whom, but certainly not the patient. What, 2 daughters went to the same emergency room 3 months apart with the same treatment and the bill is 3X for daughter #2. Call insurance company - no idea, that's what the hospital billed. BTW insurance company, you actually charged me for more than the hospital billed you Call hospital - no idea, we must have thought we did more on daughter 2. No recourse to challenge these bills. WTF other industry can get away with not publishing prices and then charging whatever they feel like after the fact with essentially no recourse for the purchaser? This is the almighty private market at work?

Just try to find out what you are going to pay for anything upfront, just try. Call Aetna for estimate for CAT scan to see if foot fracture is healing. Tell them extent of CAT scan and facility - "we can only estimate what it might cost." Try to get prescription cold sore cream (which, btw, is over the counter in Canada, Mexico, EU) that costs $4 last year. Walgreens told me straight that it would now cost $850! Called Target - their low price is $2500! WTF?!?!!? Call insurance company, person on the phone reads from script of nonresponsive nonsense. I work in healthcare, so I presume the real reason is that this medicine is no longer "on formulary," but the person on the phone doesn't even know enough to confirm that simple question. How much more Kafka-esque can this before we all agree that we are living in a healthcare billing twilight zone?

Not to mention the 4 different bills for the same visit/procedure (Dr. hospital, lab and G-d knows who else feel free to send you inscrutable bills separately). The duplicate overhead of hundreds of "insurance companies" (this ain't "insurance" in my book) is better than the supposed inefficiency of the feared government?

I don't even have any significant health problems (at least not yet), and this is my experience just from the last few months. I could go on for days about a close relative with severe Ulcerative Colitis and her problems with hospitals, pharmacies, screwed up bills, script-reading private-provider automatons, but that would make this rant actually depressing, so I'll spare everyone. In short, her care has been OK (not great), but the financial/billing/payment aspects have been, to repeat the analogy, a real-life Twilight Zone morass that is a significant distraction, and dare I say, is detrimental to the care and outcomes of someone dealing with a serious condition.

Sorry guys, rant over. I'll put my flame suit on now.

[vertical_doug]

I was staying out of this, but David, I just have to reinforce the point that the current system is unacceptably opaque and inefficient, to the benefit of I'm not sure whom, but certainly not the patient. What, 2 daughters went to the same emergency room 3 months apart with the same treatment and the bill is 3X for daughter #2. Call insurance company - no idea, that's what the hospital billed. BTW insurance company, you actually charged me for more than the hospital billed you Call hospital - no idea, we must have thought we did more on daughter 2. No recourse to challenge these bills. WTF other industry can get away with not publishing prices and then charging whatever they feel like after the fact with essentially no recourse for the purchaser? This is the almighty private market at work?

Just try to find out what you are going to pay for anything upfront, just try. Call Aetna for estimate for CAT scan to see if foot fracture is healing. Tell them extent of CAT scan and facility - "we can only estimate what it might cost." Try to get prescription cold sore cream (which, btw, is over the counter in Canada, Mexico, EU) that costs $4 last year. Walgreens told me straight that it would now cost $850! Called Target - their low price is $2500! WTF?!?!!? Call insurance company, person on the phone reads from script of nonresponsive nonsense. I work in healthcare, so I presume the real reason is that this medicine is no longer "on formulary," but the person on the phone doesn't even know enough to confirm that simple question. How much more Kafka-esque can this before we all agree that we are living in a healthcare billing twilight zone?

Not to mention the 4 different bills for the same visit/procedure (Dr. hospital, lab and G-d knows who else feel free to send you inscrutable bills separately). The duplicate overhead of hundreds of "insurance companies" (this ain't "insurance" in my book) is better than the supposed inefficiency of the feared government?

I don't even have any significant health problems (at least not yet), and this is my experience just from the last few months. I could go on for days about a close relative with severe Ulcerative Colitis and her problems with hospitals, pharmacies, screwed up bills, script-reading private-provider automatons, but that would make this rant actually depressing, so I'll spare everyone. In short, her care has been OK (not great), but the financial/billing/payment aspects have been, to repeat the analogy, a real-life Twilight Zone morass that is a significant distraction, and dare I say, is detrimental to the care and outcomes of someone dealing with a serious condition.

Sorry guys, rant over. I'll put my flame suit on now.

http://www.uta.edu/faculty/story/231...ndAndGreed.pdf
Read the link I posted earlier about Bitter Pill.

This article walks you through all your complaints in detail. The 2 components you are complaining about is 1. Why does it cost so much? 2. Who is going to pay?
The people and businesses benefiting from the current system, really try to steer the conversation to who is going to pay.

Nonprofit Hospitals
Drug Companies
Lawyers
Lobbyists

I do not think the insurance companies are actually the enemies on this. Although the hospitals and others benefiting from high prices want you think the insurers are the problem. This is the reason the argument so often turns into 'who is going to pay' and not 'why does it cost so much which is the more important question.

The enemy is the chargemaster , and the big fear should be if congress passed a single-payer model, the lobbyist would get a provision inserted preventing price negotiations.

[jclay]

This. Name one well run Government Program. Just one. Then sit back and ask yourself do you want a post office like entity presiding over your health? No thank you. And most single systems are not as efficient as presented. Ask some Canadians what is covered and when they actually are able to access said health care procedures...There are waiting lists for such banal items as routine dental procedures.

Sounds great on paper and over the internet. The solution is not in the HC provider or system. It's what others have alluded to. Living a healthy lifestyle. Just imagine if everyone gave up fast food, junk food and rode their bike to work. That's the solution, not tilting at windmills for some mythical single pay system, ATMO.

Nonsense. What utter nonsense.

[jclay]

I'm so sick of knee jerk attacks on our government, its programs and employees. There's lots of programs that work pretty damn well. I'm not even going to credit your rhetorical demand with a list.

Of course programs could work better. That's true of private industry too. That doesn't make the core concept - programs designed not for profit but for the benefit of the citizenry - wrong.

And the idea behind a single-payer system - of healthcare delivery decoupled from employment, available to all citizens as needed for prevention and treatment - is a hell of a lot better than the multi-headed beast of doctors, HMOs, hospitals, and insurance conglomerates we have now. Obamacare was a compromise to provide universal access within this disfunctional arrangement. It's made some things better but the baseline arrangement is, to put it politely, sub-optimal.

Thanks for those comments. its nice to see thoughtful, circumspect and accurate responses to ridiculous and destructive claims.

[Will Neide]

http://www.uta.edu/faculty/story/231...ndAndGreed.pdf
Read the link I posted earlier about Bitter Pill.

This article walks you through all your complaints in detail. The 2 components you are complaining about is 1. Why does it cost so much? 2. Who is going to pay?
The people and businesses benefiting from the current system, really try to steer the conversation to who is going to pay.

Nonprofit Hospitals
Drug Companies
Lawyers
Lobbyists

I do not think the insurance companies are actually the enemies on this. Although the hospitals and others benefiting from high prices want you think the insurers are the problem. This is the reason the argument so often turns into 'who is going to pay' and not 'why does it cost so much which is the more important question.

The enemy is the chargemaster , and the big fear should be if congress passed a single-payer model, the lobbyist would get a provision inserted preventing price negotiations.

Hadn't read that article before, but that author knows just enough to write an article and that's it. There is a lot of mis-information in that article and big assumptions. I'm not defending our current system, and I think I stand on the fence on what should be done. It's EXTREMELY complex, and I don't say that in a cliché way. I've had to create and evaluate some of the charges.

[vertical_doug]

Hadn't read that article before, but that author knows just enough to write an article and that's it. There is a lot of mis-information in that article and big assumptions. I'm not defending our current system, and I think I stand on the fence on what should be done. It's EXTREMELY complex, and I don't say that in a cliché way. I've had to create and evaluate some of the charges.

Point out some of the mis-info and the big assumptions. I'd love the chance to learn more and see another side to the argument.

D

[defspace]

Then sit back and ask yourself do you want a post office like entity presiding over your health?

Am I the only one who thinks the post office is sort of amazing? I send a letter and pay $0.49 and it ends up across the country the next day. I can't do that myself.

Also, they bring me things that I buy off the Vsalon classifieds. That's pretty cool.

I trust the post office to send and deliver mail all the time. Just me?

[monadnocky]

I trust the post office to send and deliver mail all the time. Just me?

Nope. Never let me down.

[Eric Siepmann]

Nonsense. What utter nonsense.

Yup, living a healthy life style isn't the solution to the problem at all. Pure nonsense in educating and motivating people and getting them to live healthy happier longer lives.

[Eric Siepmann]

Am I the only one who thinks the post office is sort of amazing? I send a letter and pay $0.49 and it ends up across the country the next day. I can't do that myself.

Also, they bring me things that I buy off the Vsalon classifieds. That's pretty cool.

I trust the post office to send and deliver mail all the time. Just me?

Well, when you take into account that the .49 cent stamp doesn't cover any operating expenses or deferred liabilities such as pensions, then yeah, it's pretty amazing....

[Eric Siepmann]

I was staying out of this, but David, I just have to reinforce the point that the current system is unacceptably opaque and inefficient, to the benefit of I'm not sure whom, but certainly not the patient. What, 2 daughters went to the same emergency room 3 months apart with the same treatment and the bill is 3X for daughter #2. Call insurance company - no idea, that's what the hospital billed. BTW insurance company, you actually charged me for more than the hospital billed you Call hospital - no idea, we must have thought we did more on daughter 2. No recourse to challenge these bills. WTF other industry can get away with not publishing prices and then charging whatever they feel like after the fact with essentially no recourse for the purchaser? This is the almighty private market at work?

Just try to find out what you are going to pay for anything upfront, just try. Call Aetna for estimate for CAT scan to see if foot fracture is healing. Tell them extent of CAT scan and facility - "we can only estimate what it might cost." Try to get prescription cold sore cream (which, btw, is over the counter in Canada, Mexico, EU) that costs $4 last year. Walgreens told me straight that it would now cost $850! Called Target - their low price is $2500! WTF?!?!!? Call insurance company, person on the phone reads from script of nonresponsive nonsense. I work in healthcare, so I presume the real reason is that this medicine is no longer "on formulary," but the person on the phone doesn't even know enough to confirm that simple question. How much more Kafka-esque can this before we all agree that we are living in a healthcare billing twilight zone?

Not to mention the 4 different bills for the same visit/procedure (Dr. hospital, lab and G-d knows who else feel free to send you inscrutable bills separately). The duplicate overhead of hundreds of "insurance companies" (this ain't "insurance" in my book) is better than the supposed inefficiency of the feared government?

I don't even have any significant health problems (at least not yet), and this is my experience just from the last few months. I could go on for days about a close relative with severe Ulcerative Colitis and her problems with hospitals, pharmacies, screwed up bills, script-reading private-provider automatons, but that would make this rant actually depressing, so I'll spare everyone. In short, her care has been OK (not great), but the financial/billing/payment aspects have been, to repeat the analogy, a real-life Twilight Zone morass that is a significant distraction, and dare I say, is detrimental to the care and outcomes of someone dealing with a serious condition.

Sorry guys, rant over. I'll put my flame suit on now.

My wife had an ACL re-done last week. We could not get the insurance company to tell us why the deductible was not even met. Nor could the nurse. We just threw it on the credit card for miles, but damn, 2k to even get in the door. Still getting random bills for my son's birth. Still can not get any intelligent answers as to why either. It's a mess all over. I can't imagine dealing with this on a regular basis. Hope things sort themselves out for you though.

[davids]

Yup, living a healthy life style isn't the solution to the problem at all. Pure nonsense in educating and motivating people and getting them to live healthy happier longer lives.

I think you're being sarcastic/ironic here. Please correct me if I'm wrong.

So... Yeah, of course people should be encouraged to live healthier lives - eating better, exercising, reducing stress, etc. Of course. But really? Healthcare is something almost every last one of us has needed, needs, and will need. No matter how healthy your behavior. People need everything from flu shots to wound care to chemotherapy to palliative care, and that has nothing to do with the amount of green leafy veggies they eat.

And then there's preventative care - I just read my good friend Jonathan's happy Friday post about his colonoscopy. A healthy life style doesn't replace the importance of a colonoscopy, or a skincheck for those of us with a predispostion to melenoma, or a simple blood pressure check, or or or or or...

Illness and death comes for each of us, inevitably. Each of us deserves health care, the best health care possible, when those things happen.

[jclay]

I think you're being sarcastic/ironic here. Please correct me if I'm wrong.

So... Yeah, of course people should be encouraged to live healthier lives - eating better, exercising, reducing stress, etc. Of course. But really? Healthcare is something almost every last one of us has needed, needs, and will need. No matter how healthy your behavior. People need everything from flu shots to wound care to chemotherapy to palliative care, and that has nothing to do with the amount of green leafy veggies they eat.

And then there's preventative care - I just read my good friend Jonathan's happy Friday post about his colonoscopy. A healthy life style doesn't replace the importance of a colonoscopy, or a skincheck for those of us with a predispostion to melenoma, or a simple blood pressure check, or or or or or...

Illness and death comes for each of us, inevitably. Each of us deserves health care, the best health care possible, when those things happen.

Perfectly articulated. How otherwise sensible, reasonably well educated people can fail to grasp this message, and continue to make decisions not in their best interest (or that of our population) is beyond me.

[Christian Fox]

What's the proposed mechanism to pay for a single payer system?

[monadnocky]

What's the proposed mechanism to pay for a single payer system?

[me: puts finger alongside nose, looks around nervously]....

[jclay]

What's the proposed mechanism to pay for a single payer system?

Taxes.

The line on my pay stub that currently is labeled "Cigna Health Insurance" would be relabeled something like "National Health System" and the amount contributed would be smaller. Had we moved to a national single payer system back when Nixon suggested we needed something different than our current system (I'm being generous in calling it that) my working life contributions would have been roughly 65 to 70% of what they have been, I wouldn't lose the benefit of those contributions when I separate from service with my employer and Medicare, which would have been rolled into the same system wouldn't be under funded. That's how it's worked out for the other Western countries that have adopted national health systems.

Scale that across our entire population and pretty soon you're talking about real money, a better quality of life, improved ability of our industries to compete globally and workers that aren't tied to a particular job simply because of the "benefits".

Technically its a slam dunk.

[Christian Fox]

Taxes.

The line on my pay stub that currently is labeled "Cigna Health Insurance" would be relabeled something like "National Health System" and the amount contributed would be smaller. Had we moved to a national single payer system back when Nixon suggested we needed something different than our current system (I'm being generous in calling it that) my working life contributions would have been roughly 65 to 70% of what they have been, I wouldn't lose the benefit of those contributions when I separate from service with my employer and Medicare, which would have been rolled into the same system wouldn't be under funded. That's how it's worked out for the other Western countries that have adopted national health systems.

Scale that across our entire population and pretty soon you're talking about real money, a better quality of life, improved ability of our industries to compete globally and workers that aren't tied to a particular job simply because of the "benefits".

Technically its a slam dunk.

I agree that it's stupid to tie health care to your job. It's a vestige to when people worked at the same place for their entire career and thought of their employer as some sort of benign entity. I get that a single payer system would be funded by taxes, but would there be caps? You say your net outlay would be a fraction of what it would have been had there been a single payer system been in place all these years, but would that be the case if you were a high income earner? As it is, medicare taxes are not capped, so people earning more simply pay more. If single payer worked the same way, it certainly would not be a win/win for everyone. If you think someone who earns double your pay should pay double the "price" for healthcare via taxes, that's a very different conversation that has very little to do with "efficiency" or other touted benefits of a single payer system.

[davids]

I agree that it's stupid to tie health care to your job. It's a vestige to when people worked at the same place for their entire career and thought of their employer as some sort of benign entity. I get that a single payer system would be funded by taxes, but would there be caps? You say your net outlay would be a fraction of what it would have been had there been a single payer system been in place all these years, but would that be the case if you were a high income earner? As it is, medicare taxes are not capped, so people earning more simply pay more. If single payer worked the same way, it certainly would not be a win/win for everyone. If you think someone who earns double your pay should pay double the "price" for healthcare via taxes, that's a very different conversation that has very little to do with "efficiency" or other touted benefits of a single payer system.

I agree with you, and it could be a difficult one to have civilly.

Personally, I think it is fair for citizens with higher income & greater resources to pay a higher share of the costs of our civil society. And conversely, for citizens with lower income and fewer resources to pay a smaller (proportional) fraction of those costs. The devil, of course, is in the details.

I understand that there's an alternative point of view, that says "I earned this wealth and it is not fair that I have to give up a greater proportion of it to those who've earned less." My values skew towards the first alternative.