California's single payer bill - a cure for the healthcare and economic crisis
California's landmark single-payer bill, SB 840, is moving forward in the state legislature. It's not only critical for fixing our broken healthcare system, but also needed for the millions of families struggling with the escalating economic crisis -- as evidenced by a new survey out Wednesday.
California moved one step closer to enactment of a single-payer healthcare system Wednesday as Sen. Sheila Kuehl's landmark bill SB 840 passed its first legislative hurdle of 2008.
With broad support from a wide spectrum of nurses, doctors, labor, healthcare activist, and consumer groups, the bill advanced in the Assembly Appropriations Committee and now goes into the Assembly's legislative suspense process where other bills are also lodged pending resolution of the state budget.
Main speakers on behalf of the bill were the California Nurses Association/National Nurses Organizing Committee, the principle sponsor of the bill, and the California Physicians Alliance.
Many other organizations also lined up in support including the California School Employees Association, League of Women Voters, Health Care for All-California, California Labor Federation, California Church IMPACT, and leading seniors' organizations including the AARP, California Congress of Seniors, and California Association of Retired Americans.
The insurance industry, California Chamber of Commerce, and California Taxpayers Association opposed the bill.
Nurses are confident the bill will again pass the legislature, setting up another showdown with Gov. Arnold Schwarzenegger who vetoed it in 2006. If anything, the need for single-payer reform, the only effective cure for the state and national healthcare crisis, has grown since then.
Wednesday's hearing coincided with the release of a new poll on healthcare and the economy by NPR, the Kaiser Family Foundation, and the Harvard School of Public Health in two national battleground states, Florida and Ohio, reinforcing the extent of the emergency and the convergence of the economic and healthcare disaster.
Nearly one-fourth of Floridians and one-fifth of Ohioans say that they or someone in their household has lost a job in the past year. Concurrently, a quarter of the Ohioans and 28 percent of the Floridians say they or someone in their family has had trouble paying medical bills.
Further, more than half in each state said they or a family member have self-rationed needed medial care in the past year, either postponing dental care, medical treatment, not filling a prescription, cutting pills in half, or skipping dosages.
And, like other Americans, more than half of Florida and Ohio residents say the government should guarantee health insurance for everyone, even if their own health insurance costs would increase.
In testimony on Wednesday, CNA/NNOC emphasized the linkage between solving the healthcare emergency and the financial distress faced by Californians and other American families.
The two main components of the healthcare crisis are insurance companies' denials of needed medical care, including dropping people when they are sick or refusing to sell policies to people with preexisting conditions, and the financial plight due to soaring medical bills.
Addressing the committee, CNA/NNOC legislative director Donna Gerber noted that SB 840 is the only reform that will rein in the insurance industry It's an industry "that can not be regulated."
Gerber cited the recent Los Angeles Times report that Anthem Blue Cross is refusing to pay $1 million in fines for illegal rescissions of insurance policies -- dropping coverage for patients when they get sick, and "we will soon see the same story for Blue Shield and Health Net."
“All Californians, insured, under-insured, and uninsured; are waiting. More delay means Californians will die while waiting for help. It also means costs will continue to skyrocket. "There is no greater policy or fiscal decision in the legislature than this one," Gerber said, adding CNA/NNOC's thanks to Sen. Kuehl for her unstinting leadership for real healthcare reform.
Enactment of a single payer system would provide desperately needed relief for families. As CNA/NNOC co-president Malinda Markowitz said this week, "Everyone would have one standard of coverage and not be discouraged from seeking check-ups when well because of high deductibles and co-pays or denied care when they were sick just because it cost their insurer money."
"The result will be a healthier population and workforce in California. For businesses, that would mean higher productivity and less absenteeism, fewer workplace accidents, injuries, and worker’s comp claims.
"It means more Californians earning, putting money back into the economy, able to pay mortgages, and contributing to reducing the state budget deficit. Overall, the impact will be both guaranteed healthcare and a healthier California," Markowitz said.
Activist Diaries
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Will 2009 be the year for Medicare for all? HR 676 backers define the challenge
By Chuck Idelson
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Healthcare justice - part of the unfinished business of the civil rights movement
By Chuck Idelson
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Emergency Room
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THERE IS A SOLUTION to America's healthcare crisis but we need your help! After you TAKE ACTION in our "Emergency Room," please download and share our informative flyers with friends, family and neighbors. Together we can make a difference.
HR 676 (Conyers) The United States National Health Insurance Act
SB 840 (Kuehl) California Universal Healthcare Act
Gift Shop
Shop the all new CNA/NNOC online Gift Shop and save yourself the hassle of fighting traffic, bad weather, and crowds. Below is a sample of what you'll find online now, with more coming soon!
Waiting Room
- Top McCain Advisor: There are no uninsured Americans
- Seattle PI & John Conyers Challenge Us to Rock the Healthcare Boat
- Will 2009 be the year for Medicare for all? HR 676 backers define the challenge
- Teddy calls out 99 members of the U.S. Senate over their taxpayer subsidized health benefits
- Denver and the Landscape of Healthcare Politics
- Healthcare justice - part of the unfinished business of the civil rights movement
- Why We Fight
- Joe Biden's "reality" based healthcare
- THE DNC ROAD TO HEALTH CARE FOR ALL: From Illinois to Denver
- Oh God, they're back, and shame on the American Cancer Society for promoting this nonsense
Contact CNA/NNOC
California Nurses Association
National Nurses Organizing Committee
California Office:
2000 Franklin St.
Oakland, CA 94612
Tel: 510-273-2200
DC Office:
888 16th Street, NW
Washington, DC 20006
Fighting for single-payer is fighting for the survival of...
our business community. Healthy workers are more productive. It just doesn't make ANY sense for the California Chamber of Commerce to oppose SB 840. What are they thinking?
Big business' motivation is to earn as much profit as possible. The lower their costs, the more money they make, and the more successful they will be in the global economy. As of now, we're not doing so well competing in the world; US companies are at a disadvantage because of health care costs that range from two to five times higher than the competition.
Without a single-payer, universal health care plan, California businesses will be encumbered by ever-escalating health-care costs; inadequate insurance coverage; high insurance-company sales, marketing and executive spending; costly ER visits by the uninsured. Many businesses have been relocating to countries with national health systems.
The Chamber's current ideology hurts small business growth as well. My neighbors are small business owners, and they are having a hard time making ends meet. Like many small businesses, they find their growth stifled, because they can't afford to offer health insurance to their employees at a reasonable cost. SB 840 would take health care costs off the table and allow such businesses to grow and compete for workers based on the quality of their services and work environment.
The Chamber of Commerce should be leading the demand for passage of SB 840; it's in the best interest of a healthy, thriving California business community.
"We commit ourselves to any wrong or degradation or injury when we do not protest against it." Lillian Wald,(1867-1940), American Social Reformer/Founder Public Health Nursing
here's why
Chamber of Commerce opposes because 1) it's fiscally a bad plan 2) business and consumer get hammered with additional taxes
The LAO report on this legislation is very sobering - I highly suggest reading it.
The shortfalls projected are insanely large, even despite some *highly* favorable assumptions like the projected 5.5% increase in expected healthcare costs, which is a pipe dream.
Don't get me wrong - it would certainly result in more people getting more care, but they only way the current projection operates without losing money is if additional double digit tax rates were established.. and that doesn't have a good chance to pass... most tax payers would say they are getting better value for the tax money right now, rather than pay a large amount more for a state run plan.
Plus the benefits that are offered are *extremely* generous, mandating that overall cost share levels are extremely low for the first few years. This might win approval from lower income people, but there is a very real effect on utilization when cost share is so low. There is *no way* they could achieve a long term 5.5% growth rate with those kinds of benefits. Look at the situation Medicare is in right now. Expenses exceed available budget, so by law they balance with reductions in doctor's reimbursement growth, but congress, unwilling to actually abide by the laws they created take from the Medicare Advantage plans over the next five years, just to avoid the doctors rate cuts for the next 18 months. What happens in 2010? Are they just going to take from Medicare Advantage 5-10 years out? It's a financial sinkhole. And of course, the trust fund is projected to be completely bankrupt within one generation.
We all be a lot better off if our legislature for both State and Federal would actually excercise some discipline so when times are bad they have reserves. maybe then we could actually afford some modest proposals... but certainly not SB840
SB840 Best bargain for care and quality
As a direct care provider working in the public sector, I once again laud Sheila Kuehl for her work on the State Senate Health committee and her determination to help put SB 840 on the Governor's desk. According to the Lewin group, SB 840, would be the best for quality care for all patients and provide a better bargain for both the consumer, tax-payer and business unable to afford insurance for their workers. Our legislative budget analyst in January 08 made a prediction that mandating a patchwork system of private insurance plans mixed in with public programs as proposed by the Governor and Speaker Nunez would have run out of money as well. It would not have covered all patients and those patients unable to afford, let alone qualify for private plans would have been severly penalized by the state.
We have a segregated system of care where some have access due to their jobs. Employee based insurance plans, especially for small businesses, are not providing this as a benefit to many younger workers I see on a daily basis in public health. Many younger workers rely on the public health system for their care. The days of employer based health insurance are in my opinion, numbered, replaced by mandated private insurance plans and eventually, the privitization of Medicare for the elderly unless we enact a single-payer system for all.
The state has CHDP, has family pact services for gyn/contraceptive care and other programs that provide services at minimal cost to tax payers. These are the safety net programs that has kept infectious diseases at bay and will provide first line disaster care in the state. SB 840 would eliminate our dependence on private insurance and provide a portable state-wide plan that would cover our choice of doctors and hospitals. The physicians at PHNP know as well as the nurses of CNA/NNOC a plan that ends segregation in health care delivery under a single-payer, with everybody in and nobody out, is the best answer to our current problems in health care financing.
Nancy Lewis, RN FNP
read the LAO report; it confirms the feasibility, savings, and
soundness of implementing a single-payer system. SB 840 is on the right track. According to Dr. Don McCanne, Senior Health Policy Fellow of Physicians for a National Health Plan, "What will not be reported by those who wish to demonize single payer is that the Legislative Analyst confirmed that the features of single payer would perform as previously modeled. Truly comprehensive benefits would be provided for absolutely everyone, while the rate of cost escalation would slow. Although she made relatively minor adjustments in the assumptions, she did not report any previously unrecognized significant flaws in the single payer model.
So what is this $42 billion shortfall that did not show up in the previous Lewin analysis?
Over half is due to the fact that California has faced another five years of outrageous health care inflation, and that alone has raised the baseline by over $20 billion.
Almost half (40 percent) is due to use of more recent wage data indicating that payroll tax revenue would be less because wages are comparatively lower than previously modeled.
Different assumptions used by the Legislative Analyst account for most of the remaining shortfall - a very modest amount.
This $42 billion shortfall is not a reason to turn away from single payer, but rather it confirms that single payer reform is even more urgent. Health care inflation is killing us, and it must be harnessed immediately. The financial burdens of wage earners are killing them (sometimes literally), and they must have immediate relief from the financial hardships caused by their health care needs."
And, a careful analysis and critique of the LAO report was done by the author of SB 840, State Senator Sheila Kuehl. In the essay posted on her website, she writes, "Unsurprisingly, the LAO found that a funding model set up for health care spending in 2006 would not be enough, as is, in 2011 (in addition to adding in a large reserve in the first year, rather than phasing it in). In fact, the deficit projected by the LAO can largely be looked at as the cost to the state created by the Governor’s veto of SB 840 in 2006. Failing implementation that year, costs have ballooned, and, because the state is an employer, as well as the safety net for so many residents, those costs have fed into the current unprecedented budget crisis.
In fact, many of our budget problems are linked to our failure to address the ruinous growth in health care spending over the last decade. California buys a lot of health care – we pay for it directly though social programs and we also purchase a great deal of insurance as employers. If health care costs grow 2-3 times faster than wages, and the taxes which pay for that health care are a function of wages, then it’s pretty easy to understand that we are standing in a hole and proceeding to dig ourselves deeper each year."
LAO report does not confirm feasibility
I did read it and it confirms that the planned expenditures would not be covered by the original plan for a 12% combined payroll tax. That incremental tax hit would still leave the plan operating in the red from day one and getting worse from there. The LAO projects that a combined payroll tax of 16% would be necessary to cover expenses.
It does project a 5.5% cost increase each year, and alludes to what would be necesssary to achieve kind of miraculous trend. Namely, fixing prices for providers and limiting utilization increases, gradually increasing cost share. It also notes that cost overruns would need to be covered by the state general fund, which could be 'significant'. (Massachusetts anyone?)
A single payer system can work, of course, but people need to understand what is given up to achieve it. Those kinds of picky details are only alluded to in the LAO report, but at least they are acknowledged.
I submit that SB840 as designed is unaffordable, especially right now. 16% of payroll sucked out of those who earn it, right into a fund that will struggle to keep up with costs. And of course we still have a $15B hole in the state budget right now that the state assembly can't seem to agree on how to close. The democratic answer calls for increasing taxes... and that is totally seperate from the massive amount of tax revenue needed to sustain SB840. how about we try to get our of the state's massive financial hole first before trying to re-engineer a whole industry.
Appropriations committee confirms shortfall
Here's most important points from the Appropriations committee summary of SB840.
"The LAO forecast of costs and revenues over the 2011-2015 period shows an estimated annual shortfall, with costs outpacing revenues, of $42 billion in 2011 and $46 billion in 2015."
"According to the LAO, payroll taxes for employer and employees would need to be 16%, combined, for the single payer costs and revenues to balance at the start of the forecast period. These taxes are higher than the 12%, combined, taxation rate proposed in SB 1040."
"Potential General Fund Impacts . There are numerous GF impacts possible under a single payer system. The most significant impact would be if major shortfalls, such as those outlined by the LAO, were to occur. Because a single payer system, established by this bill, is a state-run system, the state GF would be obligated in both short- and long-term scenarios to bolster a system with GF augmentations or loans. Any cost overruns or unpredicted expenses would generate major GF pressures."
"In addition to the cost and revenue estimates referenced above, research, including both the Lewin and LAO analysis, indicates major reductions in particular types of health spending are likely under a single payer system. Savings include a major reduction in administrative overhead, which is a significant portion of expenditures in the current system. For example, Lewin estimated a $20 billion reduction in overhead related to insurers, hospitals, and physicians. In addition, a single payer system, if implemented effectively with respect to cost control, may provide greater opportunity to stabilize medical inflation compared to our current rate of health care spending growth.
This last paragraph is the most juicy. People will either say 'Great!' or 'Oh no!'. Those who know better will say 'Oh no!' because the one time save of $20B means lost income to others/lost jobs, and the 'implemented effectively with respect to cost control' means making sure providers don't earn more than 2-3% more than they did last year and limiting what will be covered even more than what Medicare and insurers do today. If everyone is on board with that, then great... but it costs 16% of payroll.
The Brits did it after a war and so can we
If Great Britian was able to offer free health care to each and every citizen after 4 years of economic devastation including aerial bombardment of its major industrial cities, then the United States of America can find the will, the money and the heart and soul to achieve universal, national health care for every person. The state of California already provides public health care programs for children, low-income pregnant women, disabled adults/older adults and gynecological/contraceptive care for women for many years and has stopped the ravages of infectious diseases and good preventative care services. Like public education, public health has been a life-line to the sick and needy.
It is merely the budget priorities of our Republican Govenor who prefers prison projects and investments in casinos and our Republican President whose spending priorities are war and allowing war profiteers like KBR, Blackwater and the oil corporations to run the country into our present deficit ditch that can explain our present economic crunch. Bush never met a war or an oil derrick he didn't trust and his corporate lobby golf buddies including big pharma have had a field day at the public's expense for far too long. Bush's fiscal mismanagement makes the "Teapot Dome" scandal of the 1920's under a similarly greedy Republican administration in collusion with oil companies appear small in comparison. Public lands and public money was riped off by the same mentality that private hands were better at managing our national treasury than the public sector. The only thing the private sector did was exploit the public's land and launder money for profit.
If we can dig our way out of a depression in the 1930's by investing in things that matter to most taxpayers like health care, education, infrastructure and a green energy policy that doesn't depend on oil and more wars to extract oil, then I have no doubt we can fully fund a truly universal single-payer system that Americans would be proud to be taxed for.
Leadership
Bush is a reckless spender - that's for sure. Broad wars, Medicare Part D, unprecedented levels of foreign aid... it's crazy. The governor of California at least tried to reduce spending growth, but couldn't get the State assembly to agree and so failed. But then the real estate boom came, money came pouring in, and everyone forgot about the horrible spending problem the state has... until now, after the economy falters and they can't meet a budget again because they've increased spending by more than 40% over 4 years, and they've borrowed to the hilt. But I digress....
Of course we CAN do it... nobody's arguing that. just be honest and tell people it's going to cost a boatload and will come with lots of restrictions.
I just don't have a large appetite for the rah-rah cheerleading. I'm more concerned with the details that make or break things.
For example, retro-active medical necessity review. As I'm sure you know, that means the doctor gets stuck with no reimbursement for something the state agency decides wasn't medically necessary, *after the fact*. This will be a major way that the agency would control utilization increases. These are the specifics that should be debated. Are you okay with a bureaucrat deciding that they will control utilization by just pretending a service never happened, leaving the doctor empty handed?
Utilization after the fact denials?
Paul, you are confusing a Health Care for All plan with your beloved for profit private insurance companies. They for sure do that. Private insurance companies practice apartheid care segregating out the sick from the well and well-heeled. And when they find their cherry-picked enrollee had the audacity to get ill and file a claim they rescind the policy or deny coverage or take back approvals as Aetna did in the case of a young Florida girl, Caitlin Jackson, who required brain surgery, was finally approved---15 minutes too late for the planned surgery and then whose policy was canceled by Aetna who claimed that she had maxed out. http://www.tampabays10.com/news/local/story.aspx?storyid=84930&catid=8
Nice company you keep and defend.
Can you cite numbers about after the fact denial instances that happen in other National Health Care programs like inFrance? Canada? Australia?
Controlling Utilization - Public Systems do it, too....
how about I just quote the LAO's assessment of SB840: "Other Plan Provisions Could Increase Utilization. Our review indicates that some of the SPP’s provisions would likely encourage higher utilization of services. For example,the SPP would permit physicians to choose to receive payment on a fee-for-service
basis rather than a fixed monthly capitation, which may encourage doctors to prescribe additional procedures. Secondly, the system would rely primarily on after-the-fact review of physician practices to control inappropriately high use of services. This practice is less likely to limit use of services than current practices utilized by health insurance companies, HMOs, and Medi-Cal, which require prior authorization for certain health
services before they can be provided. For example, the Medi-Cal Program currently employs prior authorization for various hospital, pharmacy, and other services. Medi-Cal reports that 13 percent of pharmacy prior authorization requests are denied. Additionally, the existence of the prior authorization requirement likely deters providers from recommending certain services and submitting requests that they know would not be approved."
Ie don't be fooled into thinking that a single payer sytem won't restrict utilization growth through medical necessity review, or delaying coverage for new technologies.
No real world examples for after the fact denials
in single payer/National Health systems, then? Clearly it's best to set that falsehood aside, then. And stop trying to pander it to us.
Health care for all. No excuses.
www.nurseconscience.blogspot.com
I hope our governor stops fighting it and just passes it.
I'm sure with a lot of pressure on him right now, he will.
I don't know if you guys saw an interview where he was trying to push elected officials to act, with frustration in his voice.
I would assume that he's really feeling the heat now that elected officials aren't willing to act on things.
National health insurance is the best.
I am less concerned about a "public bureaucrat" as you put it than a for-profit corporate private insurance one who makes the medical decision for the patient and their provider based on profitability and their bottom lines. You might want to read about Nataline Sarkisyan for starters as a primer as to all that is wrong with our present system. In addition, when you slowly privitize our Medicare system by inserting HMO style insurance corporations as we are seeing, you see a rise in fees to the system and a decline in re-imbursement for the providers. Many decent providers in low-income neighborhoods have been driven from practice trying to take care of those who do not have health insurance because health insurance companies reject them up front with the "pre-existing" condition limitation or patients cannot afford to buy it on their own. That is why many providers work in larger public systems that take state programs and are salaried like me.
As a nurse practitioner, I regularly get re-imburesed and am quite satisfied as a public health employee that has little restrictions on what I order. For example, simple birth control pills are free to my patients under the state's Family Planning rules along with Paps, pelvic exams, breast exams and anemia screening. Many patients who have for example Blue Cross/Blue Shield find themselves paying 30$ to 40$ a month for the same pills. The only thing that I am concerned about is the budget and the spending priorities of our state and federal government. When you focus on cutting spending in the state like social programs for health care and won't raise fees to raise revenues, then you have a definite problem in keeping the public system healthy. You forget that we don't have polio, measles, mumps, TB and lastly, influenza epidemics or Hepatitis outbreaks due to public health and agressive free immunization programs for kids and young adults. In a disaster, I and my colleagues will be disaster workers in the city when we get hit with the next earthquake not to mention the concern over future epidemics like avian flu or simple influenza that killed over 1 million Americans in the 1918. The Spanish flu hit the young and killed over 200 nurses, including student nurses serving at a very new San Francisco General Hospital. Since our National Guard has been tied up elseware, public health workers will be the back-bone of disaster relief and early response.
Locally, we regularly fight with our mayor here in San Francisco but usually win to continue our services to balance our city budget every year. We have a "Rainy Day Fund" to continue funding schools and other public programs when our budget is bad as money is banked during good budget years. But one of the dangers we are seeing more and more is creeping privitization of city DPH worker's jobs and contracting out of services to the private for profit sector. Our security guards were almost contracted out by the mayor. Multiple calls and citizen activism prevented this first step at privitization of our public health system. I'm not blaming our Mayor because we do live down-stream of a Republican Govenor and a Republican President who has different priorities than the public's health.
A publically administered base-line package of national health care for all is the best solution to the rising costs of insurance driven, for profit care in the the United States in my humble opinion. Whether it begins in a state under SB 840 or federally under HR 676 it will stop the segregated care we have now. Those adults presently without health insurance would be covered and those with health insurance would see a seemless system that is portable where the burdens and concerns about rising premiums, co-pays and denials based on profit margins would disappear.
You should spend sometime with Canadian and British nurses who serve under the Canadian Medicare system and the National Health Service. Is is perfect? No system every is. But no one is denied care because they don't have private health insurance. Nor is there the heavy burden of going bankrupt paying for care because it is provided to every Canadian and Brit. One nurse from England could not believe after spending time in an American hospital in Nevada how much of a nurse's time is spent on charging patients for not only nursing services but items used during the day. How frightening to see nurses spending less and less time doing real nursing care and spending time with patients and more time in the "charge room" where each and every medication and item was charged to the room. When she saw the bill at the end of a patient's stay she thought how awful it was to be a patient and a family in an American hospital. And just as bad, how awful to be a nurse under the American system where the care is secondary to the payment.
Better yet, spend some time with some nurses at CNA/NNOC. I would rather take my chance with under a national health care service plan than the private sector. I've been there done that as a former gate-keeper working with private sector re-imbursement I almost quit the profession of nursing that I worked so hard to get into on the conflict between my ethics as a nurse practitioner and a patient advocate and what managed care wanted me to do when a patient couldn't pay or my service. As to the doctors, when the President of the AMA has publically criticized the health insurance corporations for their denial and delays of care, then you know that many doctors within the AMA have sifted their opinions too on the merits of national health care re-imbursement vs. corporate private insurance.
Respectfully,
Nancy E. Lewis, RN MSN FNP
Joint Nursing Practice, Public Health
CNA/NNOC
Associate Professor of Nursing, Clinical Faculty
UCSF
Respectfully,
I appreciate the challenges and difficulties in your profession, and nursing is a very noble and important profession.
To blame private medicare HMOs for causing less reimbursement to providers I think it wrong, though. Federal programs reimburse less than the private sector because they set the prices wheras private industry has to negotiate. Providers make up their own shortfalls from government reimbursement in the private sector. just look at the Medicare problem right now... the budget is busted and so doctors, by law, were scheduled to recieve 5% cuts. Congress avoided the issue and postponed. Now it's a 10% but again they said they will circumvent the law and instead delay the decrease, balancing the budget by taking it away from the private insurers. The silly things is that they took it away from 5 years of private reimbursement only to make the Medicare contracted doctors whole for 18 months. So they've just delayed the issue. And worse, they are now forcing the private insurers in the Medicare Advantage program to set up their own networks rather than rely on all Medicare contracted doctors. That means the smaller private firms will close shop, leaving the market, stranding seniors who will have to look for new coverage. its the same old story all over again. Poor management from congress.
Case by case denials are determined through evidence based medicine - not how much that doctor decided to charge, so it's misleading to say that denials are directly based on profits. Allthough certainly there is an indirect link in that unfettered access would ultimately drive an insurer out of business because costs would escalate beyond what the market would bear to pay them for taking on the risk. At any rate a public system would still need to issue denials to keep the bottom line in check. Otherwise, the cost inflation issue would not be addressed and costs would outpace tax revenues.
I'm familiar with the liver transplant case. That one was really messy but I think it's telling that all the threat of lawsuits never materialized, and UCLA has kept it's mouth shut, and at the same time received a big black eye from the scandal with the mobsters from Japan recieving four liver transplants. Something is definitely fishy there, but at the very least it brought up a public debate on the reall challenges of seeking an efficient system. A public system will face the same challenges, so I'm not sure that alone is a good example.
But back to the topic of this series - the SB840 bill. I don't believe the California Medical Association is supporting it. (i could be wrong...). If so, I imagine it's because it would remove their ability to charge what they feel is appropriate for the services, despite the advantage of not having to work with several insurers. Pros and cons....
"evidence based medicine"
is just another way for insurance companies to do as they please. The real evidence shows that preventative care is what it best for the patient. But can a pre-diabetic get screened and when necessary the proper equipment and supplies to test blood sugar and pills or insulin and needles/syringes to keep the blood sugar within normal levels? NO But you will pay for an amputation.
Speaking from evidence I've seen with my own eyes.
But that's the whole point of a public system
But that's the whole point of a public system, that no one will be denied for all care, and I'll be more then happy to pay for it through higher taxes.
mandated coverage
You don't need a publicly funded and operated (single payer) system to ensure that all are covered. You can mandante coverage and provide subsidies for low income. Or you can make insurers cover anybody regardless of risk, though again you need subsidies for the poor and/or safeguards to make this sustainable. Some states have created reinsurance pools to help the private market offer this individual high risk insurance by having the state take on some of the risk if costs blow up on one company. The are a variety of approaches beyond socialism.
But mandating coverage has failed
But a mandated system will crash and burn like the governor's proposed plan.
A single-payer system is the only way to go, that way you'll have no denials of coverage, and no paperwork to do from private insurance companies for doctors and patients, and plus choice of doctors and clinics and hospitals.
But if you still have the private companies involved, they'll still be able to deny coverage and raise premiums and there's no regulating in the world that can stop that.
But with single-payer, doctors will be able to do a procedure or write a prescription without the insurance companies getting involved.
single-payer baby! yeah!
By the way, are you a republican?
Political association
I am registered independent. My values are not captured by one singular party platform. The Republican, Democratic, and Libertarian parties all embody some of my values better than others.
mandate coverage and wasteful subsidies for defective...
insurance products? It's a failed model--it's time to take these lemons off the road of highway robbery and manslaughter. "MediCare," is a publicly accountable, proven single-payer model, that should be expanded--everyone in, no one out! It's a good, socially responsible public health policy. We already acknowledge that public education, police and fire protection, clean air, and water are shared public responsibilities.
Socialism? Which cold war bomb shelter did you just crawl out of? Sorry, Paul, but you're dating yourself by tossing out the 'ol "ogre" of socialism. Socialism—defined as a centrally planned economy in which the government controls all means of production, is not what we're talking about here. Whose life would you leave by the side of the road for lack of basic, medically necessary health care? "Coverage" is not the same as getting the actual care that is medically necessary.
Let's provide for the common defense against death by spreadsheet. Since when is caring for one another a hallmark of socialism? Equitable and fair access to health care is the hallmark of a just society!
Semantics
Sorry I did not mean to get involed in a semantics discussion about communism vs. socialism vs. utilitarianism. Certainly you can agree though that we are talking about a centrally planned industry that will indirectly control the means of production by determing what doctors will get paid for and what they won't get paid for and how much.
it's difficult to argue that dismantling a private industry of insurance coverage and replacing with a single agency government as the the insurer isn't remotely socialism. And that is exactly what is happening....
The private insurance system is an industry that
"indirectly control[s] the means of production by determing [sic] what doctors will get paid for and what they won't get paid for and how much."
Or maybe it directly controls that. Doctors take what an insurer says a procedure/visit is worth. Doctors wait to do what their skills, education and expertise tell them needs to be done until insurers approve.
And again the decisions made by private insurers are done in a secretive way.
So no I don't see how private insurers are better in this regard. And given their capricious decision making behind closed corporate doors, I see them as worse.
Things we all need like police and fire protection and roads and education get paid for by a single payer-like system. I say health care belongs in that category, too. It is to society's advantage, to business' advantage and to the individual's advantage that we stay a healthy, productive populace. A National Health Plan achieves that goal. The private insurers have fallen woefully short of that goal and will ever be falling more and more behind. For over 30 years now private insurance has proven more and more each day that it is NOT what we need. It does not give us the best value for our money. We see this in World Health Organization statistics and in the Commonwealth Fund studies. We pay far too much and get far too little from our private insurers.
Health care for all. No excuses.
www.nurseconscience.blogspot.com
Why are you here?
Paul:
I am wondering...why are you here on a site that is advocating a single-payer universal system, when you clearly do not? Are you trying to play "devil's advocate"? Or are you trying to present the status-quo argument? If the latter, believe me, there are plenty of others who do that: Rush Limbaugh, John McCain, Sean Hannity, George W. Bush, etc. Most use the "socialism" canard that you tossed out; the Republican Party was very successful doing that in 1994. However, very few countries have true "socialised medicine", where the government owns all facilities and medical personnel are government employees. Canada is not like that, nor is the UK, Ireland, Germany, Australia, New Zealand or most places with universal health care.
I'm not telling you to get out; I don't have the authority to do that. But I just wonder about your motivation.
I live a stone's throw from the Canadian border. I can walk out my front door, walk a couple of blocks and look across the river into Canada. I can tell you that our hospital parking lots are not full of Canadian cars, as the Republicans would like to have us think. I have a good friend over in Canada who would be dead if not for Canadian health care. He needed triple-bypass open heart surgery, and he got it - no waiting list, excellent care by surgeons, cardiologists and GP's. The difference is that he had to go to a larger city about an hour away. If not for Canadian health care, my friend would likely be dead or bankrupt, because in this country he'd be UNINSURABLE. He said that he never would have got the level of care here that he got in Canada.
I interact with Canadians almost daily. I have not met one who would trade what they have - however imperfect - for our non-system. Most of them express utter disdain for the refusal of the Republican Party to allow universal health care.
The "waiting lists" you hear so much about are mostly for elective procedures. As far as MRI's, yes, Canada has fewer than here. They also have a much smaller population spread out over a lot more territory. They also don't have the consumerist mentality so prevalent here: "I've got to have an MRI in every little doctor's office in every little Podunk, U.S.A." For most of them, it's not an issue to travel for certain procedures, because in many cases their provincial plan reimburses their travel expenses.
And the Republicans act like Canada and the UK are the only countries with universal health care. My dad's last wish before he died in '05 was to visit Australia. They have universal care (Medicare Australia), and no-one is left out.
Also, many of the "waiting lists" have to do with funding cuts by CONSERVATIVE politicians, like Margaret Thatcher of the UK and Brian Mulroney of Canada.
Here in Michigan, General Motors announced that it was cutting off retirees from their health coverage. The auto industry in Detroit has really taken a lot of hits, largely because the cost of health care keeps going up and they can't provide it anymore. When you buy a car, keep in mind that part of what you're paying for is autoworkers' health expenses. When you pay for car insurance, it's more expensive because it has to cover medical costs in case of injury.
That is not the case with their counterparts across the Detroit River in Windsor, Ontario.
One of my in-laws is a nurse and has been for many years. She says that dealing with insurance companies is a nightmare and it grieves her to see so many going without because they can't afford it.
I am disabled and on Medicare. I thank God for that, because no way would any private insurer touch me now. I've tried. I get better coverage from Medicare now than I did from private plans while I was working. I also got better care when I was in the Air National Guard (including a stint in an Air Force hospital that would have bankrupted me on civvy street).
And remember...these Republican politicians have GOVERNMENT health care provided by TAX DOLLARS. Is it so much to call for the rest of us having what the politicians have?
It's going to take a revolution. Eventually people are going to give up trying to pay for insurance and pay for exorbitant medical costs, and the non-system will implode.
imagine that.. elected
imagine that.. elected officials voting to give themselves something really generous at taxpayer expense.
I'm here because 1) I care about healthcare policy 2) I noticed a strong lack of honest, critical consideration of the best way to improve healthcare in America 3) the blog invites comments
I found so many false arguments and misleading statements that I was compelled to act. I think these chains are a lot more interesting than the 'Yeah you go girl!' type of comments one normally sees around here.
I'm not here to defend status quo - I'm here to keep people honest. So many people describe the benefits of single payer in terms that are either insignificant or untrue.
Most people here describe the health care system
from personal experience. It is as honest as it gets. Getting screwed over time and time again causes us all to cheerlead for something better: SB 840 in California and HR 676 nationwide.
Health care for all. No excuses.
www.nurseconscience.blogspot.com
Keeping people honest?
I noticed a strong lack of honest, critical consideration of the best way to improve healthcare in America
Does this mean that the "best way" is to keep the current for-profit non-system as the building point? What is "honest" consideration in your book?
I found so many false arguments and misleading statements that I was compelled to act.
Such as? And what are your sources that they are false and misleading?
I think these chains are a lot more interesting than the 'Yeah you go girl!' type of comments one normally sees around here.
Well, I'm not a girl and assuming you aren't either...but we have a cause so naturally we're enthusiastic for it.
I'm not here to defend status quo - I'm here to keep people honest. So many people describe the benefits of single payer in terms that are either insignificant or untrue.
How do you see your function in "keeping people honest"? Is it by presenting the purported virtues of the private insurance "market", which uses peoples' lives for a profit motive?
What is being described about single-payer in terms that are "insignificant" or "untrue"? I base what I say on direct conversations with Canadians, Britons, Australians and New Zealanders who have told me about their systems as compared to our non-system.
It is time for action. We have "debated" long enough in this country, with the "debate" being controlled by the Republican Party and its allies in the insurance and pharmaceutical lobbies. The "private sector" has been given more than a chance.
It has failed.
As one of my heroes, Sir Winston Churchill, once said, "ACTION THIS DAY!"
Debate
exalmples of misleading and or false items are: claiming that the LAO report on SB840 somehow confirms it's feasibility, exagerrated claims of federal efficiency, claims that administrative costs in the private market are purely profit and do nothing to improve outcomes, and downplaying or ignoring the cost control measures that this single payer design will use that are very same thing that private industry uses.
I'm not advocating status quo. I agree there are many problems in the industry today, and the main obstacle is one of cost growth. The best solution will achieve a better rate of growth. I believe that in general, fixing prices leads to market inefficiencies, which is why I oppose that approach. That leaves us with options to control the rate of utilization increase. here, we need price transparency and greater adoption of evidence based medicine, among other things such as being proactive with managing personal health, increasing preventive measures, etc. We need to think about tradeoffs - getting rid of the nice-to-haves in favor of critical basic medical coverage for a broader set of the population. Simply adding a 16% tax burden on payroll has significant consequences that aren't being discussed.
Some costs are unavoidable, some are completely avoidable, and some are a grey area. The bias of 'do everything and anything no matter the cost' is unsustainable and a barrier to increasing access. Greater access means we have to shut down the avoidable costs and take a hard look at the grey areas. This is what private and public insurers do every day.
I would bet the farm that even with succesful bid to create a 16% payroll tax to fund SB840 that a cost growth of 5.5% will not be achieved. what is the plan to deal with this? Hope won't control the costs - the hard decisions will, and that's what people should be talking about and debating.
Paul are you a follower of Milton Friedman?
Health care for all. No excuses.
www.nurseconscience.blogspot.com
Economics
You can email me for personal questions, but since it's out there - I'm familiar with his work in general. Not sure I'd call myself a 'follower' per se. I definitely admire his contribution to economic thought. I see modern Germany, Japan, Russia, Italy, etc. as examples of why he was generally correct about economic freedom and liberty and political systems.
I'm agree that applied to healthcare, the free market bias loses some steam, primarly for two reasons: 1) assymetry of information, meaning doctors know more than patients so can anybody truly act in their own best interest since we don't know what our best interest is? 2) third party influence, meaning that, when insured, someone else pays the bills, so there is no individual motivation to balance cost and benefits
For these reasons there is a major imbalance/distortion in the healthcare free market. (note a single payer does not fix that.) To deal with these problems the industry is innovating, by creating price transparency, putting health information online, and by creating new plan designs that do align costs with choices. These things are evolutionary and will take some time.
That answer your question? Is there some other Nobel prize winning economist that you think has a better grasp of healthcare?
I am insured and still waiting
Waiting and waiting...
My cancer re-checks are suggested at certain intervals yet even with insurance I cannot come close to any of those suggested times. Even with mild -- and probably non-cancer related symptoms -- I wait months for testing and sometimes weeks for results. Yet, the appointments cannot even be scheduled without insurance verifications and promise of payment.
It is frustrating and upsetting, to say the least, to wait and wonder.
I often hear about friends and family with insurance plans who wait long periods for appointments with specialists or sometimes even for basic care. Complain? Only if you want a crabby person treating you.
Yet, miss your insurance payment by one day -- perhaps even one minute (say at 12:01 a.m., the day after your payment is due), and your policy can be cancelled. Miss your hospital or provider payment by a little more, and confront an angry clerk the next time you try to check in for care -- or here about your credit rating slipping due to slow payment.
Wait? Only the patients wait here. With little recourse. With little right to ask for better. Unless we ask collectively and loudly and at the ballot box for a system that at least puts patient care on the same level as payment options. Come on, it's time to stop waiting.
The Governator, truly had better repent of
his veto last time of SB 840. It has cost us Billions of dollars. The system that we presently have is like a wasteful run-away train. I say let it run off the track and plop into the ocean -- splat.
Health care for all. No excuses.
www.nurseconscience.blogspot.com