Medicare for all

Medicare as it now exists is an impending financial disaster, but a great deal for today’s seniors.

Creating universal single-payer health care is not the same thing as expanding Medicare coverage. Universal single-payer health care can be much more cost-efficient than the current health care system; however, such coverage cannot be paid for by another Ponzi scheme.

We already have a good example of the quality of care we get when we let the government run a health care system via a single-payer scheme. It's the VA.

You might want to peruse some of the recent articles on the care the soldiers recently back from Iraq are getting from the VA. If the government can't or won't take care of our wounded soldiers, what makes anyone think they'll take better care of the rest of us?!

The current administration is made up of people who hate government and not surprisingly, don't administer effective government programs. FEMA used to be a great agency. The Bush administration gutted it, hence the disastrous response after Katrina.

When you say we have a good example "of the quality of care we get when we let the government run a health care system via a single-payer scheme. It's the VA." do you mean to say that countries like Australia, Austria, Switzerland, Sweden, Japan, Korea, (should I get out a map and start listing), where they have government run health care systems that provide quality care for everyone -- and often now, better care than we can get here -- for reasonable amounts of money, do you mean to say that there is something inherently inferior about Americans that we would never be able to do better than that? Because I take issue with that.

Are you saying that our armed forces are doomed to always be a disaster because anything "government run" must by definition be second-rate? Because again, I take issue with that, I think we have the finest soldiers and military in the world.

Government programs can be run poorly and they can be run well. I think it's obvious that they aren't run well by people who inherently believe they can't be.

Walter Reed is not run by the VA.
See the following link for a brief explanation.

Web Link

During the 1990's the VA had been greatly overhauled for the better.

citizen, you're much too glib about the success of nationalized health schemes in other countries.

Take Australia, the first country on your list. Actually Australia has a hybrid system with parallel public and private insurance. If you are in the public (government) system, your choice of doctors is severely limited and you face much longer waits for elective service.

Take Canada, perhaps our closest cultural equal. There, the nationalized health service rations treatment severly and waits for simple procedures like MRI's and even cancer treatment can be many weeks or even months. We all have seen stories about Canadians coming over the border for treatment because they can't get it in a timely way in Canada.

In Great Britain, if you're past 55 and need dialysis...tough. They ration it in part by age and if you are too old you're out of luck.

Americans never would accept this kind of treatment. Our expectations and standards are too high.

THe invocation of government run military is inapt. The government runs the military because (obviously), even if it were theoretically possible, we don't want private military forces.

There may be better run and more poorly run government programs, but generally, when something can be provided by both government and the private sector, the private sector does it more efficiently.

Frenchie,

Generally where there is no meaningful avenue for competition and the customer can be held hostage -- such as with utilities, an example close to home since we have for 100 years had better utilities here in PA run by government -- generally under those circumstances, public is cheaper and more efficient than private. There are many studies of how non-profit health care providers have provided lower-cost care of equal or better quality to for-profit here in this country.

I have friends in Australia who consistently get better care than we do here. And I don't mean in small measures, I mean out-of-this-world better care. I have friends who have had care in both countries and hands down say it's better in Australia, for a tiny fraction of the cost we pay here. I have some wealthy friends who tell me that in diplomatic negotiations, the US is always pressuring Australia to dump its socialized medicine, but it's so popular there, politicians would be committing political suicide if they caved.

I have family in Europe, so I'm sorry I cannot agree with your typical scare tactics, I know how consistently better their care is in most countries there, and how they don't have to deal with the hugely hugely burdensome paperwork that we have here. I usually end up spending from 10 to 1000 times as much time on the paperwork as I do on the actual care. I personally would not want a system like they have in Great Britain either, but why shoot for that when there are better-run systems we can look to? ALL provide low-cost care to everyone, without the crushing bureaucracy.

And the waits? I need surgery and can't afford it even though I have health insurance, how does that make me any different? We have a friend who needed strong medicine for an infected limb and had to be put on a waiting list at his HMO's hospital HERE! I think the estimates are that we have 80,000 people in this country who suffer unnecessary death or disability every year because they cannot afford the care they need. (I just heard Ralph Nader give the number of the Commonwealth Club today.)

Generally, monopolies and rackets cost more and don't deliver, and that's what we have in health care here, and why we are getting less yet spending more and more every year. The Public vs. private argument is a red herring, it's just not what we've got.

citizen,

The issue with respect to health care is not non-profit vs profit. It's government run vs privately run systems. I await (if you have them) some specific examples of government run care that is lower cost and equal or better care. Give cites and numbers please.

Anecdotal care of friends in Australia or family in Europe bear little weight in a discussion of this kind.

Here's what one oft-cited source says about Australia's system:

"Approximately 30% of Australians also retain private health insurance, even though they are already entitled to free treatment in public hospitals. The major reasons for taking up health insurance despite the free public system are:

* Shorter waiting lists in private hospitals (especially for procedures such as joint reconstructions or heart bypass surgery, for which there are often long waiting times in public hospitals).
* Choice of hospital/physician in the private system;
* Improved accommodation facilities such as private rooms (although medical facilities are usually more extensive in the public system);
* The coverage of a broader range of services (e.g. chiropractic, dental, optical, etc)." Web Link

You don't mention the countries in Europe you say are so much better than ours, so it's impossible to say much about your unsupported assertions.

Similarly, an unsupported assertion of wait differences between other countries and the US, that contradicts almost every reported press story on the topic is difficult to respond to. Web Link

Finally, I actually agree with your assertions about monopolies: monopolies don't deliver as well as competitive industries. There is way too little competition among health care providers in the US. Much of this is due to government intervention. But regardless of its cause, why in the world would you want to turn a less than ideally competitive system into a legal monopoly via single payer government health care?

People seem to have no trouble using an occasional scare anecdote about other systems, but try to rattle off the vast majority who have great experiences, and suddenly the anecdotes don't count.

If you want to get educated about how much better and cheaper many healthcare systems are around the world now than ours, use Google, it's not hard. Anecdotes do have bearing, because statistics are one thing, but if you want to really get a sense of how far we have slipped, try talking to people from other countries about what kind of care they get and for how much, and you'll really wish we'd fix our system. People from other countries can't believe what is going on here.

The World Health Organization rankings in 2000 put the US at number 37, behind Norway, Austria, Japan, Singapore, Italy, France, etc., though not behind Australia interestingly (though I wonder if that would change now, seven years is a long time in the downward spiral we are on; probably their ranking also is affected by their not dealing so well with Aboriginal populations). We are #37 on that list in care, but we spend by far the most on healthcare. Web Link

As far as other people coming to this country for care, an article in Reader's Digest recently pointed out that our country USED to be the leader in "medical tourism" -- which USED to mean people coming from other countries for our better care. The article pointed out that we have all but lost that business to other countries like Singapore and Switzerland, where the care is just as or more advanced and cheaper. Now "medical tourism" means Americans going to other countries where they can afford the care.

There's a far more serious problem looming, and that is when we have lost our reputation as a leader in the rest of the world (and that is coming), we will suffer far more serious economic hits (in various medical product arenas, e.g.) that will be hard to regain. We have all but taken our reputation for granted, but the rest of the world does not see us through the same rose-colored glasses. At what point do we wake up and smell the roses?

Even by your statistics, 70% of Australians don't bother carrying any supplemental insurance, the vast majority. Your point says nothing about how many of the small percentage who do carry insurance actually use it. PLUS (more importantly), private insurance in Oz is not the same thing as private insurance here. They have tight regulation and insurance actually has to live up to its contract. In this country, insurance was deregulated on the federal level, oh, just coincidentally right before our system started going to the birds.

A Public Citizen study in 2003 pegged annual administrative waste in our system at around $300 billion annually, most of it because of private insurance. It's "waste" from the public's perspective, but insurers don't spend a dime they don't benefit from. They get a windfall from delaying and denying care, which they accomplish through the paperwork, so the efficiencies of the private sector are feeding the paperwork nightmare because there is no realistic competition when it comes to DELIVERY of insurance. The incentives are all wrong. It's an insane way to finance and administer healthcare. More frightening still, if they are spending $300 billion annually on administrative shenanigans for that windfall, how much more is that windfall costing us?

Meanwhile, we have half of all personal bankruptcies caused by health costs, the majority of those people had insurance at the start of the bankrupting health condition, yada yada.

That said, I'm not sure I'd like to see a single payer system. However, transitioning to a single-payer system has an advantage I think most people don't realize -- that is, once the racket (mainly private insurance) is gone from the health care system, the system will be far more amenable to change, gradual improvement efforts, and adjustment. Right now, every attempt to improve things for the public threatens the extreme profits of the racket. It's all but impossible to make improvements, because what is in our interests is at odds with those who are making the most money (by not providing care). If we had a single-payer system that needed tweeking to improve it for the benefit of the public, there's nothing stopping the private sector from bringing those improvements. Then the incentives would be to improve the system for the benefit of those is serves.

But, I think the odds of the above happening are about zero. Things will probably have to just continue to get so bad in this country that there finally is a "revolution." Those benefitting most from the conditions that spur a revolution almost never believe it's coming.

I have family in the UK all of whom carry private medical insurance because the National Health system in Britain is underfunded and swamped. If you need treatment, even for cancer, you must wait in line. I know because my Brother received chemo and immediate hospitalization only because he had private insurance. If the U.S. had a similar system of health care, our system would be on overload too. We would sacrifice quality for quantity and those who could afford it would still carry private insurance. It would very quickly become a two tier system.

Much of the National Health in Britain is financed through huge gasoline taxes; that's why gas is so expensive in Europe. Would the U.S. be willing to pay more than double for their gas to finance a national health care system - I don't think so?

Neighbor is on-track.

Government provided services are almost always underfunded and poorly run. They ration what they provide either explicitly, or through lines and waiting lists.

Think about where you stand in line anymore. The DMV, the Social Security administration, the post office, for passports, food stamps, .... you get the idea.

Sure some banks, for example, have lines. But when my bank has lines too often, I have plenty of alternatives.

WHen the government runs medical care, what do we do for alternatives? Go to Canada?

Um, "A neighbor", do you understand that our system here NOW is hugely more expensive than the one in Britain? That our system is vastly more expensive than any system in the world, yet we are providing lower and lower quality care as time passes to fewer or our citizens, and that millions of our citizens have NO recourse, forget a two-tiered one. Are you saying that if we tried to change, we would never be able to do better than the British?

And if you get beyond the few anecdotes that Frenchie wouldn't allow for, generally even the British system does better than ours by objective measures (according, for example, to the World Health Organization study). As I said, we could look to better examples.

Here's an article from the BBC about France about the World Health Organization study into the best health care systems. Web Link

"The study echoes the findings of opinion polls carried out in France, where people consistently register a high degree of satisfaction with their level of health care.

By and large, hospitals are clean and efficient, waiting lists are short, general and specialist doctors are in plentiful supply and, above all, in a country that prizes its spirit of solidarity, the benefits are universally available."

Everyone pays into a government-run insurance plan. The government doesn't run their health care system, it just takes the graft out of insurance.

Maybe there are medical consumers out there like Donnie who will never wake up to the realities, but this burden is sinking American business. I find it really interesting that the top countries on that WHO list are now producing some of the best medical research in the world.

Think of all the unintended economic and health benefits of intantaneously giving our many thousands of doctors back the considerable fraction of their time now spent dealing with the paperwork in our system. (And to the patients, too.)

If you extend medicare for all, you will created a multi-tiered system. There are many doctors today that will not accept medicare patients or even medical insurance; they will only accept their own private patients.

If medicare was extended to all, many more doctors would go independent. There would be Doctors who will only accept private patients, doctors who will accept private patients and those insuranced privately, and a few doctors who may accept universal Medicare patients. The same would go for hospitals and all other health care workers.

You can't do everything for everybody. When you give heart lung transplants to death row inmates and sex change operations to Frisco workers and 6K detox sessions the money runs down quick. Triage either has to be built into the system or it will creep in bureaucraticly. In my lifetime we have always had emergency level care in this country. Add incremental until you reach a sustainable level then let those who want more pay for it, and let us all carry catastrofic coverage.