34 Comments - Lula May - Monday, Apr 30, 07 @ 9:59 am: What I find most interesting is what Rich left out of the Tribune article. Such as the increasing number of immigrants without health insurance in Illinois. In 2005, one out of every seven uninsured Chicagoans were Hispanics who weren’t citizens. In the collar counties, the figure was more than one in five. Across th U.S. immigrants accounted for 86% of the increase in people without insurance. Citizens shouldn’t be asked to pay medical bills for illegal immigrants. - Huh? - Monday, Apr 30, 07 @ 10:02 am: No single payer systems! Look at what has happened in England and Canada with the signle payer systems. People waiting for things like routine surgical procedures. People can’t get in to see doctors. Keep the private insurance systems. This allows a patient to get the medical care they need and want. A single payer system will undermine the health systems that are already shaky from low and delayed medicare payments. - so-called "Austin Mayor" - Monday, Apr 30, 07 @ 10:03 am: “Question: Do you support a single-payer system? Why or why not?” Because single-payer has worked well in other first world countries and The for-profit health care model is clearly broken. The boogie-man of long waits for care only exist in single-payer countries that spend much, much less on health care than the US currently does. – SCAM - Team Sleep - Monday, Apr 30, 07 @ 10:06 am: Yes. Although people are decrying Medicare Part D as expensive and burdensome, I believe that a single-payer system set up in the vain of a Part D program could easily succeed. If you’re not paying taxes to begin with and you receive other aid-based funds, it’s not offensive to ask recipients to help offset the cost of what could easily become a very costly and bureaucratic system. Setting up the parameters for a single-payer system would also prove to be less complex (in my opinion) than a government-backed program of the same ilk. It would also show once-and-for-all that there are people who make decent money and still choose not to buy health insurance. If a bunch of twentysomethings (or even thirtsomethings) elect not to do so, a lot of the arguments that a lack of health insurance only affects the poor could be out of the window. - Carl Nyberg - Monday, Apr 30, 07 @ 10:48 am: I support single-payer for various reasons. One’s health should not be held hostage by one’s employer. It would be easier to start and expand small business in a single-payer system. Single-payer would allow the government to control costs. Market-based health care provides an incentive for costs to increase. People with pre-existing conditions shouldn’t have their employment options limited. It’s kinda immoral to have such a haphazard health care system with people be excluded from preventive medicine because they are poor. If the federal government took over health care it would stabilize the cost of local government and drastically reduce the pressures to increase local taxes, like property taxes. - PalosParkBob - Monday, Apr 30, 07 @ 10:50 am: As someone who had a family member die of heart attack after spending six months on Canadian Public Health Plan “waiting list” because they ration life saving procedures such as bypass operations, there’s no way I’d want this kind of single payer system in the US. If my father lived in the Great White North, he would have been dead six years ago, unless I would’ve sprung to get the procedure done in the US as a “private pay”. The problem is not so technically complex as it sounds. The larger the enrollment in a health plan, the lower the unit cost should be. There are both poor and wealthy, healthy and ill uninsured in Illinois and the US. The reason it’s not “affordable” is that rates are based upon a single member rates in an independent plan. The solution isn’t tricky. You create a state managed care plan for anyone who can’t be insured through an employer. For indigent citizens and other uninsured,the amount they pay for their coverage will be based upon their ability to pay based on income and liquid assets. Illegals should not be subsidized under this , or any other plan, except as an emergency service to a legally documented “guests” to the US. Of course, no one should deny those in immediate need of medical attention, but if they’re able to be moved without substantial risk, illegals should be returned to their home nation for outpatient treatment. Another option would be to require employers of illegals to pay for the full cost of their insurance under this plan, and directly be legally responsible for these costs, even if billed retroactively. The other option would be to bill the government of the nation of origin of the illegal for health care services, as well as education and other government services. This, of course, would require some sort of treaty agreement. It would be interesting to see how our friends South of the border would justify not providing treatment to their own citizens with all those petrodollars from the US flowing through their coffers. That’s my contribution to the “Illegal Immigrant Parade Day” celebration tomorrow. - Carl Nyberg - Monday, Apr 30, 07 @ 11:59 am: Do the people who spout the “waiting list” argument acknowledge that Americans die because of the gaps in our system? - i d - Monday, Apr 30, 07 @ 12:11 pm: PPB, I agree. - Rich Miller - Monday, Apr 30, 07 @ 12:11 pm: Good point, Carl. - Leroy - Monday, Apr 30, 07 @ 12:16 pm: I’m with SCAM…as long as the single payer is not me, and is someone else, I am all for it. I get sick a lot, so someone else paying will save me much $$$. - Bridget - Monday, Apr 30, 07 @ 1:01 pm: Ezra Klein posts regularly on this and related issues at: http://ezraklein.typepad.com/ - ArchPundit - Monday, Apr 30, 07 @ 1:31 pm: ===As someone who had a family member die of heart attack after spending six months on Canadian Public Health Plan “waiting list” because they ration life saving procedures such as bypass operations, there’s no way I’d want this kind of single payer system in the US. As Carl points out, we ration here as well, but instead of it being based upon medical necessity goes first, it’s based on those who have insurance or can pay. A market is a form of rationing. That said, I am sure we’ll get to universal care, but probably not single payer in the short run. We have a large industry of health insurance in the country and the transition to a universal system would only be made harder by a quick shift to single payer. We’d have to deal with the unemployment created by places like United Health Care and other large corporations. One of the better methods might be Edwards’ plan which could evolve into a single payer over time depending upon choices made by individuals. - Brian McDaniel - Monday, Apr 30, 07 @ 2:04 pm: Crossposted from my blog, and slightly off topic so please forgive me. Just as [my son] finished fussing about his afternoon nap and falls asleep, the phone rings. What is worse is the fact that it is an automatic telemarketing computer on the other end. “Hello, the Illinois General Assembly is considering a state-wide ban on smoking.” It goes on to cite the American Lung Association on how bad smoking is, then asks me to press one if I want clean air in public places like restaurants, or press two if I don’t support the ban or don’t care. I press 2 because I don’t care. The system then hangs up. The recording never identified who sponsored the poll. - Ron - Monday, Apr 30, 07 @ 2:23 pm: What Rich Miller neglected to state about the rest of the world is the quality of this care. Why do so many people from Canada come to the United States for specialized care? They can’t get it Canada. Also, many currently insured in the United States through benefit rich plans in the government and union sector will actually see their benefits decline and cost to them go up. - Rich Miller - Monday, Apr 30, 07 @ 2:27 pm: Ron, this is all up for debate here. Instead of saying that I “failed to mention” something, why not just mention it yourself? I can’t mention everything or the post would be ten pages long. - ArchPundit - Monday, Apr 30, 07 @ 2:48 pm: The irony of using Canada as an example of where problems are is that it’s the second least modernized system after the US in the developed world. In most EU countries, electronic record keeping and other basic efficiencies are far broader than in either country and report far higher rates of patient satisfaction than in the US or Canada. The assumption that technology will suffer from universal care. First, Japan is ahead of the US and Germany is very close, both with universal care. More important than technology on the end part of life is prevention earlier in life and access to care and medications. If everyone receives care they are more likely to have potential dangers addressed early. Instead of needing bypass surgery, people can take medication to reduce their cholesterol. Instead of allowing asthma to degenerate into a life threatening condition, early treatment can manage it. It’s also very hard to see how nearly all industrialized countries with universal care are an example how it will cost more to deliver universal care when most spend about half of what we do on health care. This isn’t hard to understand given the incentives in a for profit industry. Health insurers spend significant resources denying coverage to people and most, if not all of the gap in spending between the US and other industrialized countries is due to bureaucracy–bureaucracy designed to maximize profits, not patient outcomes. - Carl Nyberg - Monday, Apr 30, 07 @ 3:10 pm: Another gripe I have with defenders of the status quo is the claim that the United States has “the best health care system in the world”. An important preliminary step in debating health care policy is to define quality health care. Once one defines quality health care (perhaps including life expectancy, infant mortality, costs, etc.) much of the developed world has health care that compares favorably to the United States. - PalosParkBob - Monday, Apr 30, 07 @ 3:37 pm: As far as “rationing” care in the US, I am not aware of a single person in need of life saving treatment who has ever been deliberately refused that service. There may be instances where incompetence resulted in someone not receiving what they needed to save their lives, but not institutionalized exclusion. I’ve had this discussion with many medical professionals, both friends and family, and I have yet to hear of a case where a person, regardless of economic status, had been refused life saving care. IF you are aware of one, please educate me. I am interested in someone in this blog group identifying which nation has a universal care model which we should be emulating. I understand that access to care in some EU nations is even more economically stratified than the US. IIRC Britain has a “private” system which only the wealthy can access, but the “poor” are stuck with the national system. Canada has the US as a “fall back” high quality health care system for the wealthy. From people I know who’ve used the national systems, I generally get the same evaluation; it works well for minor outpatient treatments, but comes up really short for major medical treatment. This is because there is no expensive free market there to ensure that the highly qualified professionals, facilities and equipment are available for treatment and surgery in a timely fashion. As far as reform of our healthcare system, I understand that the vast majority of expense occurs in the last year of life. Perhaps a more caring and moral way of solving this problem is to let the terminally ill pass with dignity when it is clear that their final time is near. My mother died about six months ago after wasting away for about a year from numerous ailments. While covered under medicare, her bills had to be at least $250,000, and all it did was prolong her agony. Were there another alternative short of euthanasia, it would have been much preferable to her. That “final year” is the real problem with bankrupting the system, and we need to find a way to deal with it. Perhaps the long “waiting lists” are the socialists’ final solution to state sponsored euthaniasia. The problem is that people who could have decades more of productive life are being killed by the neglect of the national systems, as well as those for whom treatment would do little to provide a better quality of life or extend productive years. - Ivory-billed Woodpecker - Monday, Apr 30, 07 @ 4:01 pm: Yes. A single payer system will reduce medical malpractice lawsuits. A patient who has had bad outcome, regardless of whether a doctor or nurse or hospital was negligent, may have a greatly reduced capacity to work over the remainder of his or her life. When health insurance is linked to an ability to work, the patient may come to see damages (or a settlement) from a malpractice suit as the best course for paying future medical bills, most immediately those stemming from the bad outcome. When insurance and employment are decoupled, the incentive for any kind of lawsuit drops way off. - Carl Nyberg - Monday, Apr 30, 07 @ 4:08 pm: PalosParkBob, I blogged about a 12-year old who died because he didn’t have dental coverage. See Proviso Probe. - Carl Nyberg - Monday, Apr 30, 07 @ 4:10 pm: I also suspect trial lawyers quietly work against single-payer health care b/c it will reduce the medical malpractice settlements. - ArchPundit - Monday, Apr 30, 07 @ 4:30 pm: ===As far as “rationing” care in the US, I am not aware of a single person in need of life saving treatment who has ever been deliberately refused that service. You don’t seem to have a grasp of the system. One must be treated when they show up to a hospital with a critical care situation. However, someone with high cholesterol is denied access to medication if they don’t have insurance. This is no different than in Canada or any of Western Europe except they have health care finance systems designed to lessen costs for those who have conditions. Anyone who shows up at the hospital with a life threatening condition is treated there as well so I’m unclear on what you think you are identifying as different. A person with clogged arteries doesn’t get non-emergency surgery here without insurance either. This is a fairly simple point–relying upon emergency care for conditions that are treatable and preventable both makes the eventual care far, far more expensive and decreases overall health. Relying upon the system as is where health care insurance is being more and more decoupled from employment means those of us with insurance pay more to cover the costs of those who show up in the emergency room with an infection that could have been treated with simple antibiotics three weeks ago, but didn’t have the money to see a doctor or get a prescription. It’s a hidden tax and it’s a terribly inefficient way of paying for health care. To the point of rationing, all systems ration because we live in a world of limited resources. Rationing is simply what method you choose to distribute those resources. This is econ 101. ===There may be instances where incompetence resulted in someone not receiving what they needed to save their lives, but not institutionalized exclusion. There is no exclusion if you show up at the emergency room door when it’s far too late to do anything about it. Take your example —As someone who had a family member die of heart attack after spending six months on Canadian Public Health Plan “waiting list” because they ration life saving procedures such as bypass operations, there’s no way I’d want this kind of single payer system in the US. A person without insurance would never have made it to that list and died of a heart attack as well. ===From people I know who’ve used the national systems, I generally get the same evaluation; it works well for minor outpatient treatments, but comes up really short for major medical treatment. This is because there is no expensive free market there to ensure that the highly qualified professionals, facilities and equipment are available for treatment and surgery in a timely fashion. Again, as I said above, Germany is essentially on par with us and Japan is ahead of us, both have universal care. More telling is that what the US spends on health care per person is twice that of other industrialized nations, we have about 15 percent of the population not covered, and no noticeable evidence our system provides better health outcomes. What is it that spending twice as much gets us if we are not any more healthy than those countries? The waiting lists argument is odd to say the least. There are waiting lists in the United States for many things. I have follow-ups with one specialist that takes 6 months to schedule. The US system is not efficient, fair, nor effective in comparison. ===That “final year” is the real problem with bankrupting the system, and we need to find a way to deal with it. No, that’s not true. What is bankrupting the system is an inefficient system of insurance that seeks to exclude anyone who isn’t healthy and is predicated on the notion that denying a claim is the way to profitability. In addition, the lack of preventative and regular care for those without insurance makes exacerbates the problem. Look at the German system that has private insurers and a relatively decentralized system in each state. They spend less for more coverage and have at least as good of outcomes including lower infant mortality rates. I suppose being pro-life ends at birth? - Skeeter - Monday, Apr 30, 07 @ 5:00 pm: - Carl Nyberg - Monday, Apr 30, 07 @ 11:59 am: “Do the people who spout the “waiting list” argument acknowledge that Americans die because of the gaps in our system?” Sure, Carl, but those are poor people. The poor people are the ones who lack basic health care. They are the ones who lack the basic preventive care. They are the ones who need emergency care rather than basic care and in doing so, raise the cost of medical care for everyone. Our “Pro-Life” and “Pro-Family” friends on the right don’t get too wound up about those poor people. But they sure can talk about religion. - Disgusted - Monday, Apr 30, 07 @ 5:44 pm: Why does no one ever mention the horrendous charges that hospital make for the most minor items like bandaids, aspirin, tissues, etc. Let people being their own and cut costs at the hospital levels too. The cost of care, surgery and follow-up is bad enough. People shouldn’t be gouged $5.00 for an aspirin tablet. - Huh? - Monday, Apr 30, 07 @ 6:48 pm: If anybody wants to see the universal health care system in action - take a look at the State of Illinois public aid system. If you think that a bureaucrat is better suited to determine who gets what medical treatment, go sign up for public aid. If you want to see what universal health care is like, take a look at Cook County Hospital and the associated medical system. People wait hours for emergency room care. People can’t get preventitive care because the local hospitals and clinics are being closed to balance the county budget. I will take my private insurance paid health care any day of the week. I have the liberty to go where I want and when I want. Yeah, I may have to fight with the insurance company, but the bills will be paid and my family and I will have the care that we need. - NoGiftsPlease - Monday, Apr 30, 07 @ 8:19 pm: I think the insurance industry is a big part of our problem and we should move to a single payer system. We could spend the same amount of money as we do now and get more health care for it. The insurance industry was not devised to provide health care, it was developed to be profitable — which it certainly is. Their main goal is to insure people who will not get sick and deny as many claims as possible. The insurance industry is scandalous. - Anonymous - Monday, Apr 30, 07 @ 8:22 pm: I have to agree with huh? I’ve been through the clinic’s and never want to go back.It was a nightmare. Thank God I worked my way out and I’m not dependent on government health care anymore. I know this has been said before and I can’t imagine what you people are thinking. Name one program the government does better than the private sector ? - Carl Nyberg - Monday, Apr 30, 07 @ 8:48 pm: Various other countries provide health care that is substantially less expensive and equivalent in quality to our health care system. - Middle Majority - Tuesday, May 1, 07 @ 7:30 am: There are many many things wrong with our current system including having it employer-based when the culture is changing to regular job-hopping [forced or unforced]. But if we don’t somehow force people into the risk pool [paying insurance premiums] the young, the healthy, the poor, and the irresponsible will always choose to be uncovered or uninsured. Medicare as the single-payer part of our current system is not a solution but rather part of the problem, pushing costs to other patients with insurance plans. The government could never administer healthcare as efficiently as the private insurance companies. Private insurance companies make their profits by wisely investing their premium reserves, government uses healthcare providers as an interest-free bank by not paying bills on time. The free market regulates prices by supply and demand, the government can only use price controls and rationing. While there are many changes necessary, I will never support socialized medicine. - PalosParkBob - Tuesday, May 1, 07 @ 8:09 am: Archpundit- I agree that preventive care is one of the most cost effective ways of providing medical service. The costs of an emergency coronary bypass would pay for about 90 years of cholesterol medication at full price. Since an effective preventative care system actually costs less than a emergency care system, it should be able to be provided at a lower cost. therefore no additional funding should be necessary to provide it. Here’s an idea. Why not create a “model” managed preventative care program for the low income uninsured and Medicaid recipients? If you are such an advocate of a lower cost preventative care system, then I suggest that you talk to the Guv and your legislators. Illinois is one of the few states that doesn’t have such a plan due to “myserious” political considerations. There’s been a lot of hot air on this subject claiming that Japan and Germany have “better” health care systems that are “less expensive”. Does anyone making these claims have any objective reference or study that substantiates these claims? If the state of Illinois, which IMHO is doing a lousey job of providing cost effective care to those unable to afford it, is serious about reducing cost while improving service, why aren’t Blago, Madman, and Emperor Jones providing a road map to lower cost health care reform that would actually reduce expenditures? I suspect the reason is that if they adopted a more cost effective, less corrupt and incompetent system, it would work against their attempted tax increases and money grabs to AVOID making the system more fair and efficient. Perhaps more frightening to them is that some bureaucrat may screw up and actually be successful in reducing costs while improving service, and the “reform” expectations of improved service at lower cost would expand to public education and public works projects. I’m sure that sends a shudder through the spines of every “empire builder” in state, county, and local government. - Rich Miller - Tuesday, May 1, 07 @ 8:25 am: Um, “Lula May,” please try to stick with a single gender when posting. You’ve also commented here as “Larry.” lol - Lula May - Tuesday, May 1, 07 @ 8:38 am: Rich, check again your mistaken. I’ve never posted as Larry. - Rich Miller - Tuesday, May 1, 07 @ 8:44 am: OK, whatever you say. My records show otherwise but I’ll take your word for it. - Carl Nyberg - Tuesday, May 1, 07 @ 8:56 am: PalosParkBob, I’m not sure I follow your point. Are you advocating the state prove the efficiency of single-payer by absorbing all the high-risk cases the private sector doesn’t want to take? On a per capita basis every health care system is less expensive than the U.S. system. Would you accept The Kaiser Foundation as a reference? United States $5,711 Germany $2,983 Japan $2,249 Japan has a higher life expectancy than the United States. PalosParkBob, what makes the U.S. health care system so much better than Japan and Germany that it’s worth double the cost? Sorry, comments for this post are now closed.