Democrats & Liberals Archives

Bi-partisan Healthcare

It appears that everyone wants a good healthcare system that serves all our needs. The big difference between Republicans and Democrats is that Republicans prefer relying on the private sector and Democrats prefer relying on the public sector. The result is a clash that makes nobody happy. Why can’t we have a healthcare system that is a mixture of the private and public?

The major requirements of a good healthcare system that most of us can agree on are:

  • Universality - Everyone is included
  • Choice - Each person has a choice of provider
  • Quality - As excellent a service as can be achieved
  • Reduced Cost - At least as inexpensive as systems of other industrialized nations
We do not have universality. About 47 million are uninsured. The poor are not covered. Self-employed have a tough time getting insurance. Many workers losing their jobs lose their health insurance as well.

I'm sure that both Republicans and Democrats agree that we must correct this unfortunate situation. Naturally they have different approaches. Republicans prefer to keep the current private system as is and add a few modifications. Democrats prefer a government-run single-payer system, such as they have in Canada.

Republicans talk a lot about choice. In the current system, a patient may go to any doctor, hospital or other medical provider. Yes, indeed, if you have the money you can buy whatever healthcare you need. What about the indigent? Do they have a choice? What about the permanently disabled and chronically ill? What's their choice? What about those terribly sick people for whom insurance companies do not offer any kind of insurance?

The Democratic answer is that though we prefer a single-payer system we can settle for at least having a public-sector component to which any individual may apply. Let's keep the Republican-approved private-sector insurance system - with appropriate laws assuring that all who apply are insured. But the public sector is needed for those dissatisfied with available insurance policies.

Republicans claim that a public sector would compete unfairly with the private sector. I don't understand. I thought the Republican mantra is that the government cannot do anything well. If so, why be afraid of government competition? Democrats insist that without a public choice the system will essentially be the same as it is. As Howard Dean says:

Give America a choice. We support health care reform that allows individual Americans to choose either a universally available public health care option like Medicare or for-profit private insurance. A public option is the only way to guarantee health care for all Americans and its inclusion is non-negotiable.

Any legislation without the choice of a public option is only insurance reform and not the health care reform America needs.

The other 2 requirements are quality and cost reduction. Currently, U.S. spends about twice as much on healthcare as do other industrialized countries. According to Richard Kirch, "health insurance premiums have gone up six times faster than wages in the past nine years." And what do we get for it? Very little compared to other countries, such as Sweden, where citizens live longer, are healthier and receive superior care when ill than we do in the U.S.

Both gaining quality and reducing cost may be achieved through a properly designed medical information system. Among the many quality problems are choosing the best provider, making sure prescriptions are correct, establishing medical standards, gaining immediate access to files, learning about new research and inventions and much more. All of these quality problems may be solved to a great degree with a comprehensive medical information system.

If you have visited a doctor's office lately, I'm sure you have seen rows and rows of bins and bins storing files. After you sign in, the receptionist searches and locates your file and then brings it to a desk in the examination room. My heart doctor has a file on me that is about 5 inches thick. Before he comes in to the room, the nurse makes sure that all the data in the file is in order. This is a terrible waste of space, energy and time when we know that a broad medical information system could do away with this inefficient system. Imagine the smaller office with less storage space and with less manpower. This gives you a small inkling of the possible cost savings an information system would bring.

A medical information system need not be centralized and need not change how different parts of the medical system function. Doctors, surgeons, doctor groups, hmos, hospitals, researchers, universities, pharmacists, insurance companies, Medicare and other entities may work as before. The big difference will be that people in one group may talk to those in another group.

The good news is that Congress already voted for a downpayment on the medical information system. We must now work to make sure there is a public sector to whatever is proposed in a future healthcare system.

Posted by Paul Siegel at April 28, 2009 6:09 PM
Comments
Comment #281095

Paul
I regard keeping insurance carriers in the picture like inviting the local burgler over to discuss home security. He may know a lot about it but do you really want him in on it?They are the problem and will make any solution more difficult.
That being said, politically it is a good move and likely the only way forward. Sooner or later that industry will shrink to something like Canada has. The government provides basic care while insurance is available to provide things like braces and liposuction. The Trojan Horse here is quality. It the private carriers pay the providers much more than the public sector there is a possibility that they may attract the best doctors etc. They can’t do that under the Canadian system.
That’s it for compromise. What the right refuses to see it that single payer IS a compromise already and not socialized medicine. The facilities and providers would not be part of the government as in a socialized system and would be left to compete on service and efficiency.

Posted by: bills at April 29, 2009 1:06 AM
Comment #281111

The greatest problem with merging the two systems (public & private), is those who can pay their own way do not want their tax monies going to those who cannot pay their own way. It is difficult for some to grasp that the best of us is no better than the least of us.

Posted by: Marysdude at April 29, 2009 1:36 PM
Comment #281114

I recall listening to Hillary speak on TV when she was running for president she said that already a few payments a year that i pay you pay and everyone else pays for insurance go towards the one’s who can’t afford it and I’m not complaining but something new must be done it’s a national disgrace.

Posted by: Rodney Brown at April 29, 2009 2:43 PM
Comment #281118

Paul excellent article. The two things we need to get out of the healthcare system is insurance companies and employer provided insurance policies. The reason our system is so high cost has less to do with medical records and more to do with profit taking. When is the last time insurance companies cut rates for an insurance plan even as they have reduced costs and liability? For profit hospitals need to compete with widget makers and financial institutions to attract the wall street speculators so profit has priority over healthcare, how foolish is that?
It is no wonder costs are so high when both insurance companies and hospitals need to keep increasing profits to compete on wall street.With the boomer generation coming into the age where one would expect cost reductions because of economies of scale we find costs increasing dramatically instead. As insurance companies are not productive in creating better health care one would think the free market would correct this mistake instead of protect it.
The back bone of job creation in this country, small business, is at a competitive disadvantage due to the high costs of health insurance for small business. The system as it is doesn’t work and needs to be replaced.

Posted by: j2t2 at April 29, 2009 3:21 PM
Comment #281146

J2t2,
Large international companies are disadvantaged, too, in a global market, where other leading economies provide healthcare without burdens on employers.

Posted by: gergle at April 30, 2009 12:01 PM
Comment #281151

So wouldn’t a bipartisan solution be to make all insurance premiums tax deductible? Then insurance companies could start offering competitive products to the employer based products and over time the employers could get out of the insurance business.

I know I would love to buy a 20 year individual contract that coverts to a Medicare supplement. And I’m sure I could do better in determining my insurance needs than the guy 500 miles away that never answers his phone.

That’s not as sexy as a whole new system though…..

Posted by: George at April 30, 2009 12:31 PM
Comment #281158

George,

I think that would be like the government paying for all insurance premiums, without the controls or say-so over coverages or costs. Sounds like a lose-lose situation to me?!?!?

Posted by: Marysdude at April 30, 2009 3:10 PM
Comment #281200

Mary’s,

It’s not that the government is paying for all in George’s case, it is just offering private citizens the same tax incentive to get insurance that it offers businesses to provide it now since the cost of benefits can be written down against profits to lower the overall corporate tax burden.

That said, I agree with Gergle and j2t2, the time of employer based coverages has come and gone. The benefit is so now expensive that it has completely consumed nearly all wage increases for the middle class over the past 15 years. When we talk about the fact that take home pay has not held pace for the middle class over the past 15 years it is due primarily to the hyperinflation in health care premiums that have driven all of those increases away from our pockets and into the benefits side of the equation.

It is also true that our overall workforce costs are much higher because of this benefit than most other industrialized and proto-industrialized nations. As a die-hard conservative, I hate to admit, but government health care is now a necessity.

Since we can not tear down the expensive infrastructure that is in private hands at this point and solely replace it with a public enterprise in a reasonable time period, we have no choice but to make it a public/ private joint venture.

Posted by: Rob at May 1, 2009 7:46 PM
Comment #281205

I had an interesting experience with my insurance company the other day.

They denied my office visit to the doctor. They sent me a copy of the denial which included a vague phrase about a one year pre-existing condition exclusion, which does not include(or exclude,actually) out patient medications.

I went to the doctor to renew some presriptions. Both were for pre-existing conditions, but since these are not excluded, there shouldn’t have been a problem.

My doctor had retired and a new staff had taken over his practice.

I sent them a couple of e-mails asking why my office visit wasn’t paid. I received a couple of letters repeating the same legal mumbo-jumbo.

Suddenly the office visit was approved.

I called to ask why. More mumbo-jumbo. The person said I was yelling. I wasn’t, just interupting her from repeating the same mumbo jumbo lines over and over. I asked to speak to someone who could answer my question. She finally said I was denied because the doctor hadn’t placed a date for the first treatment of the condition. The doctor then submitted the date of the office visit as the first date of treatment.

The condition was arteriosclerosis. I’ve had a heart attack. I have arteriosclerosis. I do not take medication for it (except an aspirin). The doctor did not treat me for arteriosclerosis. We discussed it, since she was a new doctor to me. The prescriptions were for other conditions.

I get the feeling that this is bizzaro world where everyone lies to each other, speaking in the dialect of babel, to make the money flow. Get me out of here. Someone bring some sanity to this nightmare.

Posted by: gergle at May 2, 2009 12:55 AM
Comment #281208

gergle

That happened because insurance companies treat their clams adjustment departments as profit centers. Their function is to deny,obsfucate and delay payments under the legal guise of makeing sure they only pay for what they are contractually liable for. People die. People get better on their own. The longer they can delay a claim, the more interest they make on the money. Its just business. Its also why they should have no place in a basic heath care delivery system.
To conter this health care providers also have to have their own large departments just to deal with the carriers. Even the local doctor probably has two or three secretaries just to manage claims. This amounts to a huge drain on the system that in reality provides absolutly zero health care. There are estimates that just by simplifying the paperwork, enough savings can be achieved to cover the uninsured. That is a big potential plus for a well designed ,single payer system that should also include severe financial and criminal sanctions for false claims as well as enforcement.

Posted by: bills at May 2, 2009 3:41 AM
Comment #281209

Rob

Thats right. Its high time for a government run payments system coupled with a private/public provider network. If we do it right, we will get the best of both worlds.
Another reason to do that is as part a wider improvement in the social safety net. We have to do this as a response to globalization. The alternative is for American workers to decend to third world levels and that is not likely in a democracy. Things like free college,health care, increased unemployment compensations are the way forward if we want to remain competitive.

While on the subject,we might as well dive into what I am sure will be a contentious debate. Should we also cover undocumented residents?Besides the moral aspects, should we refuse treatment to a sick five year old,etc,there is good reason IMO to treat everyone who is here,including tourist. Illnesses spread. We are witnessing a frightening example of that right now.

Posted by: bills at May 2, 2009 4:14 AM
Comment #281214

Rob,

It’s not that the government is paying for all in George’s case, it is just offering private citizens the same tax incentive to get insurance that it offers businesses to provide it now since the cost of benefits can be written down against profits to lower the overall corporate tax burden.

I won’t argue the case, but when I re-read his entry (below), it looks like he’s saying taxpayers pay all insurance premiums for all citizens. If that is what he’s saying, then I stand by my statement. If he is saying something different, I can’t pick it out. My view: If the government buys the insurance, taxpayers have a say in costs and benefits, but if there is only a tax break for premiums, it leaves out those who can’t afford the premiums in the first place, and loses taxpayer control over costs and benefits…???

So wouldn’t a bipartisan solution be to make all insurance premiums tax deductible? Then insurance companies could start offering competitive products to the employer based products and over time the employers could get out of the insurance business.
Posted by: George at April 30, 2009 12:31 PM Posted by: Marysdude at May 2, 2009 10:36 AM
Comment #281233

Hey Dude-

Sorry I didn’t get back to you but I was over in France checking out there healthcare (well just working).

Rob’s definition of my statement is much more accurate. Any solution to healthcare, IMO, will involve getting away from the employer based system. Because me and my wife are both working, I end up spending a lot more in healthcare premiums then I would if I could buy an individual contract just for my family. The biggest roadblock to moving away from the employer provided insurance is its greatest advantage; the ability to obtain the insurance tax free. If we just level that playing field the system, which should have died a long time ago, will surely die. What replaces it nobody knows, but whatever does will be better.

As to your statement that tax payers should have a say in costs and benefits, the government now provides 1 in 3 with medical coverage (Medicare, Medicaid, and employees). Yet we still have a crisis (it’s been a crisis since I can remember).

The problem is my simple “first step” was proposed back in the early 90’s and it wouldn’t cost much (only the revenue of people who have done the right thing by buying their insurance regardless of the taxes). Bush proposed it again a few years ago, But the Republicans package it with other reforms and the Democrats hold out for a new system all together. You and me end up with nothing.

Posted by: George at May 3, 2009 8:49 AM
Comment #281288

George,

Yeah, I read you wrong…I thought you wanted taxpayers to foot the bill for premiums, but you merely want the premiums to be untaxed. I don’t know if I agree with you or not, because I havn’t enough background to form an opinion on it, but what you say makes sense…mea culpa for not reading your post more carefully.

Posted by: Marysdude at May 4, 2009 8:49 AM
Comment #281352

Insurance based on a illness system is going to maximize costs. Insurance based on a wellness system will avoid a lot of high dollar illness and injury which will never occur due to well-care insurance. This is one way in which a national health care system can lower per capita costs.

Another way is based on the fundamentals of insurance. Broaden the premium paying base, and the cost for all goes down.

The issue going forward is not reform, not socialized vs. private health care systems philosophically, not single payer vs. hodge podge payer systems. The issue going forward is lowering the overall cost of health care which currently leaves 47 million without insurance and growing, as well as leaving Medicare and Medicaid grinding the gears of our future economic engine to nubs and finally a grinding halt and bankruptcy.

The issue is how to lower over all health care costs while preserving or increasing the health level of Americans going forward. As far as I can tell, Obama does NOT favor a single payer system.

But, he does want to bring the entire population into the premium paying pool of health insurance and he wants the emphasis of the health care professions to shift a bit away from profiting from illness and injury, to profiting from wellness and preventive care lifestyles which avoid illness and injury.

And both of these measures logically, result in lower health care costs per capita being spent in this country.

Posted by: David R. Remer at May 5, 2009 7:35 PM
Comment #292615

My husband & I do not want government run health care. We want the insurance we have now . We dont want rationing of care.

Posted by: Jeanne Streeter at December 13, 2009 7:34 PM
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