Why is single-payer health reform not viable?

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Specializes in Critical care, tele, Medical-Surgical.

reporter's notebook: why is single-payer health reform not viable?

helena - when it comes to health care reform in america, there is a relatively simple solution that will cover everyone's basic health care, control costs and save businesses, most people and the country a lot of money.

it's called a single-payer health plan, where the government collects taxes to finance national health insurance. the government, which is the "single payer," covers all citizens and pays the bills when they visit private (or public) doctors, hospitals and other facilities for medical care.

all would have basic coverage, regardless of whether they have a job, or where they work. nobody gets billed for basic care. no-body goes broke because of medical bills....

...top democrats who will be deciding policy in america in 2009, including baucus and president-elect barack obama, say single-payer is "not politically feasible," because the public won't strongly support it.

what they really mean is that when it comes to health care reform, they don't want a political fight with some of the nation's most powerful financial interests, which have the resources and the motivation to turn public opinion against meaningful reforms.

these interests include the health insurance industry, pharmaceutical drug companies, some hospitals, highly paid medical specialists, medical suppliers and others who now profit handsomely from our current system - and who could no longer command those profits under a single-payer system or an alternative form of a national health plan....

http://www.billingsgazette.net/articles/2008/12/01/news/state/35-why.txt

Specializes in LTC, Med/Surg, Peds, ICU, Tele.

It's not feasible because of the clout of well funded, powerful insurance lobby groups that have a vested interest in keeping their well-paid, albiet useless jobs...

"We the people..." can demand a single payer system through our elected officials. (Frankly as part of saving US manufacturing jobs I think we will need a single payer system.) The inefficiencies of our market system is killing our manufacturing sector.

Specializes in Critical care, tele, Medical-Surgical.

...michael lightly, director of public policy for cna, said single-payer is "the most fiscally conservative approach" to health care, because by having one payer/insurer (usually the government), you eliminate the profits of private health insurers, you negotiate bulk purchases of drugs, you negotiate reasonable fees with health care providers and you have global budgets for hospitals and large clinics....

http://www.billingsgazette.net/articles/2008/12/01/news/state/35-why.txt

Specializes in Med Surg, Tele, PH, CM.

One of the basic principles of healthcare delivery is that someone has to pay for it. Whether it is the government or insurance plans, or private individuals, someone has to pay. This will not magically disappear in a single-payor system. The savings that will be achieved by diverting insurance company profits will be spent elsewhere. There will be so many restrictions in order to achieve the bottom line. Americans who have had private insurance will be upset that they are losing benefits. Folks who have never paid for insurance will need to be taught the rules of managed care and conservation, and I speak from experience when I tell you this is no small challenge. They will also be upset because they will be forced to pay for something they couldn't afford before - a big complaint in Mass. under their current system. If Medicare is any indication of how a new single-payor system functions, we are all in trouble. First of all, it only covers 80%, and the folks who cannot afford a Medigap policy are nickled and dimed to death. And there are a lot of things it doesn't cover. Medicaid is probably the best coverage in the country today, but the costs are split between Federal and State monies and elegibility can be very restrictive for adults. We simply cannot afford to cover everyone with the Medicaid model of care. This is going to hurt a lot of folks, and probably cause problems with reimbursement to hospitals and doctors. This will definatly impact salaries. I am a proponent of UHC, but the model I would select would force responsible consumption, and it would be a hard sell to the American Public, who are notorious conspicuous consumers of everything.

When one is thinking of doing something that has never been done before, it is reasonable to speculate about what "might" happen, or what logic tells you is likely to happen. When one is thinking of doing something that has been done many times before, it seems more reasonable to look at what "has" happened.

And what we know about healthcare is that every developed country in the world has some form of universal healthcare. We also know that none of them has a major role for private insurance and we know that all of them achieve results as good as the US or a bit better for a lot less money. I don't think that patients in the US are signifiantly different in any essential way than patients in other countries, nor do I see any reason to believe that we are less capable of running a system than other countries are, so it seems reasonable to assume that we could get similar results.

No one thinks health care will be "free" under a universal system, but it's clear that there are much more efficient ways to pay for it than we do now.

On "over consumption": the best protection against over consumption of care is that consuming healthcare is not fun. Here's a simple thought experiment: If you were told that you could go for a colonoscopy (or mammogram, or pap smear for the women or prostate exam for us guys) as often as you want at no cost - would you do it more often than your doctor recommends? Not likely. And even though none of them is fun, on the scale of healthcare unpleasantness, those are all pretty mild. How about an unnecessary bypass surgery just for kicks? Or a hip replacement you don't really need? Would you have any of those just because they were free? Me neither.

Part of the reason that the French do better than us on so many measures of health is that they don't set up barriers to stop people from seeing their doctors. In fact I understand that when you turn 50 you start getting remenders to get in for your colonsoscopy, just to give one example. And people there see their doctor about twice as often as people here, so there's no evidence that services are reduced.

By the way here is a link to a very good posting on this subject on the blog "Dalilykos"

http://www.dailykos.com:80/story/2008/12/10/16229/540/641/671590

Specializes in Med Surg, Tele, PH, CM.

And what we know about healthcare is that every developed country in the world has some form of universal healthcare. We also know that none of them has a major role for private insurance and we know that all of them achieve results as good as the US or a bit better for a lot less money. I don't think that patients in the US are signifiantly different in any essential way than patients in other countries, nor do I see any reason to believe that we are less capable of running a system than other countries are, so it seems reasonable to assume that we could get similar results.

No one thinks health care will be "free" under a universal system, but it's clear that there are much more efficient ways to pay for it than we do now.

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I lived in Europe and was a recipient of socialized medicine. The system is great, and I am a proponant of adopting a system similar to France or Italy. There is, however, a difference in the mindset between the American Healthcare consumerand the European. Europeans, in general, are more into preventive medicine, because their healthcare systems have pushed it as a matter of personal responsibility. Secondly, they tend to treat themselves for minor problems like colds, rather than seeing a doctor, who does nothing more than tell them to gargle with salt water and buy OTC cough medicine. An insurance card in the hands of a typical American consumer is viewed as a "carte blanche" to use as they please. I have patients who will call an ambulance to take them to the ER for treatment of a headache or nausea. Typical diagnosis: "Unspecified viral process with dehydration". Typically dehydrated enough to cause the headache, but not enough to warrant fluids. In order to remain solvent, any UHC system we come up with will have to be very restrictive in dealing with this kind of stuff, which will make a lot of people cry "foul".

Specializes in LTC, Med/Surg, Peds, ICU, Tele.

Europe also has litigation limitation laws in place to prevent frivolous lawsuits and to limit monetary rewards for valid lawsuits.

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