Thursday, June 08, 2006

Single Payer Now

Steven Benen of The Carpetbagger Report fame is filling in for Kevin Drum on Political Animal this week. He's posted a number of good items, but this one is very good:
Whenever the issue universal health care comes up, near the top of the list of conservative talking points is concern about government "interfering" with health care. As it turns out, it may not be such a scary concept after all.

The federal government should guarantee that all Americans have basic health insurance coverage, says a committee set up by Congress to find out what people want when it comes to health care.

"Assuring health care is a shared social responsibility," says the interim report of the Citizens' Health Care Working Group, a 14-member committee that went to 50 communities and heard from 23,000 people.

Sens. Ron Wyden (D-Ore) and Orrin Hatch (R-Utah) agreed in 2003 to create a congressionally-backed panel to work outside DC to find out what Americans actually want from the health care system. Apparently, people said they want universal coverage, guaranteed by the federal government.

To which I respond: of course they do. The existing system costs too much and offers too little to too few people. Since the Clinton plan fell apart in 1994, the country has seen no practical changes, except services cost more and there are more uninsured Americans. A single-payer, universal system -- services are provided by a private healthcare system, but financed by the government -- has to be more appealing than the status quo.

This gets back to something Kevin and I were discussing a few months ago: when it comes to the broader political debate over healthcare, those on the left who support a single-payer system don't have to worry about changing the public's mind -- they're already there. The vast majority of the country actually wants the federal government to spend more money on health care.

As for this specific Wyden/Hatch committee, the next step in the process is a 90-day public comment period, followed by a response from the Bush White House, and then five congressional committee hearings. I'm not optimistic -- "socialized medicine" still strikes some people as scary, for reasons I don't understand -- but it should be interesting.


My father-in-law passed away on March 1st, having been killed by a fast-growing but treatable brain tumor. He did not receive treatment for two reasons - one, the system for providing medical care is severley fragmented as primary care physicians and their offices fail to coordinate provision of medical services by specialists; two, the insurance industry drags its heels approving diagnostic tests and procedures. The combination leaves the burden of tracking down the responsible parties to the patient or the patient's family.

How is an ill, often elderly, possibly non-English speaking person supposed to knowledgably and aggressive coordinate their own critical treatment? How the hell was my father-in-law or his wife, neither of whom speak English as a first language, supposed to negotiate a system designed to prevent contact and postpone provision of services? They had good insurance, too!

I almost died of an easily treatable birth defect which required straight-foward but significant surgery. I needed 1/3 of my right lung removed. I had to wait two years for an exclusionary period to pass before the insurance company would approve the surgery. I walked around with a shunt in my chest for the IV antibiotics necessary to keep me from dying of a blood infection. They would treat each infection at who knows how much expense, but not approve the surgery that permanently removed the condition. I had family willing to front the money for the surgery, but no one would take on my case unless I had insurance to cover it. Now, is that fucking stupid (not to mention playing roulette with my life!) or is that fucking stupid?

When I worked at the hospital, my boss could hold forth for hours on the profoundly broken nature of the health care system, how the voracious insurance industry does its damndest to lock providers into using their system and not their competitors, the damage they were doing to providing medical service because of the insane coding requirements to be able to bill things out, and the way in which the insurance industry scam turned providing medicine into a shell game of avoiding procedures that might not get paid for. In a recent visit to my doctor, she told me how she was miscoding my visit in order to avoid charging me some hideous fee that is levied against the uninsured (as I am now) to try to discourage them from visiting. It was the difference between a $100 visit (out of my own pocket) and a $575 visit. And we aren't even getting into medication yet.

Get employers out of the business of shopping for health insurance. I was HR at a start-up, and the insurance was always a huge expense and a pain in the butt to figure out. I keep hearing how large manufacturing interests can't be competitive in large part because of health insurance costs. Well, why don't we make them more competitive and provide more coverage to more people with better results? Seems like a no brainer to me.

Insurance spreads risk around. If you are not trying to make a profit at it and you do it on a large enough scale, you see enormous drops in overhead and increased efficiencies in handling paperwork. It's why Social Security is the most cost-effective old-age insurance system around.

Single Payer Now.


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