Single payer Good for Business

[HM2VikingRN, RN]

http://www.thenation.com/doc/20041115/mintz/2

business leaders worship marketplace ideology "almost like religion," says raymond werntz, who for nearly thirty years ran healthcare programs for whitman corporation, a chicago-based multinational holding company. "it's emotional." in 1999 werntz became the first president of the consumer health education council in washington, a program of the employee benefit research institute, a nonprofit, nonpartisan group. he saw it as his mission to try to persuade employers to face the "huge, huge" issue of the uninsured because, he told me, "business has to be involved with the solution." the problem that emerged was its "unwillingness to even think about a solution." last year, after funding ran out, a disappointed werntz became the council's last and only president.

publicly financed universal health insurance comes in different forms. for americans, however, none should hold more interest than single-payer. it's "one and the same thing" as medicare for everybody, werntz told me. does the corporate america that's happy with medicare understand this? i asked. "it's a dialogue that hasn't happened yet," he replied. "my life for four years was trying to get business people in a room with single-payer people. i couldn't do it." ceos of large corporations see it as something "that smacks of socialism," werntz said, and therefore as "heresy."

somehow, they don't see medicare as heresy. yet it's largely why the tax-financed share of us health spending is "the highest in the world," according to drs. steffie woolhandler and david himmelstein, associate professors at harvard medical school and founders of physicians for a national health program. writing in the july/august 2002 issue of health affairs, they put the share at 59.8 percent. no wonder: federal tax revenues pay for medicare, medicaid and the medical-care systems for the military, the veterans administration, federal employees and congress; income-, sales- and property-tax revenues buy coverage for state and local public employees. taxation also hugely subsidizes health insurance while benefiting mostly "the affluent," the authors noted.

in 1991 the gao made a stark finding regarding single-payer's benefits: "if the universal coverage and single-payer features of the canadian system [had been] applied in the united states" in that year, "the savings in administrative costs"--$66.9 billion--"would have been more than enough to finance insurance coverage for the millions of americans who are currently uninsured," the gao said in a report. the $3 billion left over "would be enough...to permit a reduction, or possibly even the elimination, of copayments and deductibles."

[lamazeteacher]

It's weird, how government "shakers and movers" think single payer system of healthcare delivery is socialist, and recipients of healthcare benefits, and others, believe that "government" is synonymous with bungling. Could it be, that both supositions are merited, and the only way to get both sides heading in the same direction, would be to define the roles of socialist programs, and impress the public that government is only the cashier, not a policy maker in healthcare. Medical managers who are expert in their fields, such as MDs, NPs, and Pharmacists (not pharmaceutical reps) should be in charge of criteria for prescriptions, a committee of internists, surgeons, anaesthetists and representatives of specidic specialties need to be in charge of guidelines for surgery, withput interference by "budgeteers". Length of hospital stays and criteria for exceptions, needs to be decided by Discharge Planners, Home Health experts in the field, family practitioners (including NPs), and Physical Therapists. If I ruled the subject........

I am happy that physicians have started to explore their options and mission with single payer plans, but acknowledging that other healthcare providers are great additions to their group would make it more credible. Their "solutions" need to be open to providers on all sides of care.

[teeituptom, BSN, RN]

Big Business only calls it socialism because it may interfere with their profit driven motives

[CRNA2007]

I don't know how with a straight face anyone could possibly think having the governemnt run anything would save any money period. Government run health care would be assaulted continually from lobbyists.

[HM2VikingRN, RN]

What would you suggest?

Under our current system patients do not have real provider choice. The private insurance companies answer to their shareholders first and regulators second with a goal of siphoning 31% of the health care dollars for administration and profit. With a single payer system health care costs are transparent and under the direct control of patients through their elected representatives.

The 350 BN dollars per year spent on health care administration is more than enough to cover all of the uninsured patients in the US.

(Lteacher-I added you to my buddy list)

[CRNA2007]

Every insurance plan I have ever paid for had an extensive list of providers. Do you really believe that government run healthcare would be transparent and under the direct control of the patients? You cannot be this naive????

What would you suggest?

Under our current system patients do not have real provider choice. The private insurance companies answer to their shareholders first and regulators second with a goal of siphoning 31% of the health care dollars for administration and profit. With a single payer system health care costs are transparent and under the direct control of patients through their elected representatives.

The 350 BN dollars per year spent on health care administration is more than enough to cover all of the uninsured patients in the US.

(Lteacher-I added you to my buddy list)

[HM2VikingRN, RN]

I am not naive but I still believe in the power of the democratic process.

See:

Who will run the health care system?

There is a myth that, with national health insurance, the government will be making the medical decisions. But in a publicly-financed, universal health care system medical decisions are left to the patient and doctor, as they should be. This is true even in the countries like the UK and Spain that have socialized medicine.

In a public system the public has a say in how it’s run. Cost containment measures are publicly managed at the state level by an elected and appointed body that represents the people of that state. This body decides on the benefit package, negotiates doctor fees and hospital budgets. It also is responsible for health planning and the distribution of expensive technology.

The benefit package people will receive will not be decided upon by the legislature, but by the appointed body that represents all state residents in consultation with medical experts in all fields of medicine.

at: http://www.pnhp.org/facts/singlepayer_faq.php#run_healthcare_system

[lamazeteacher]

It's sad that people are influenced by the need to have known demons, rather than unknown ones. I remember a story that went around several decades ago, about a prisoner who was told that freedom was beyond one of several doors, and the others might release unknown horrors - or he/she could keep his/her present status. The choice? Why the present situation, of course....the known one. All the doors led to freedom. (At least that's how I recall it.)

It's so important that we realize the truth of the present delivery of healthcare, and learn from the past methods, and their consequences. I was amazed to learn about the tiers of healthcare facilities, when I arrived in the U.S.A. There are no "County" hospitals in Canada, as happens in the USA still, where lesser medical care is offered, usually by medical students and interns, with many more physical examinations, and interns performing surgeries.

The most shocking thing, I thought, was that acceptance by many healthcare providers at Los Angeles County Hospital, of sterilization following childbirth in the mid '60s by tubal ligation. Mostly non English speakers and intimidated women whose intelligence may have been borderline (never substantiated) were the objects of that move by Godly residents. Both groups did not give informed consent. Doctors believed (really!!) that they were doing patients a favor by limiting the number of children that financially challenged women had. Finally there was revelation, negative feedback, and the hospital was forced to stop that practise.

While Americans have been quite critical of past and present class distinctions in the UK, idealists here thought that didn't happen "across the pond", yet the deprivation of the poor, of state of the art healthcare has the ring of apartheid. Their hospitals had none of the decorator touches private ones have, and often were impossible for patients and their relatives and friends to navigate. Staff gave poor instructions, and laughed when patients became confused and came back without finding the lab, radiology, clinic, or whatever they sought. Crowding was/is constant. Doctors didn't keep records/histories well, and followup care was chancey.

Referrals of Public Health Clinic patients today, who have medicaid/cal, to specialists in the private sector, often don't happen, as the patient isn't sure of what they have to do (or have), to see that doctor. No one clears with the specialist whether he/she takes medicaid/cal patients (usually not). I was the senior nurse in such a clinic wherein those referrals were followed up only when there was nothing else to do........ M.A.s made the appointments, but instructions were vague and a lot of the time the patient left immediately after seeing the doctor, without knowing the referral was offered. If by some miracle the patient arrived for the appointment, no access to their records by the specialist happens. If a report of the specialist's recommendations comes back to the referring doctor, and gets into the chart at the clinic, it is another miracle. No "thank you for referring this patient" letter arrives. Cancers spread that might have been caught early, DM remains out of control, and needed surgeries don't happen, due to the need for appropriate communication. I found this out by making follow up calls......

In Canada, before their single payer system was accomplished, patients like those above were seen at hospital clinics (everyone else went to doctors' offices). Doctors on staff of the hospitals could only remain on staff by seeing patients at their clinics one day a month, without being paid for it. If these patients became hospitalized, they went onto wards having large numbers of patients to a room. In fact at Toronto General Hospital, I worked on a ward wherein the patients' beds were lined up, 16 on each side of a long hall. It was great fun, and easier.

Obviously the less money one had, the less privacy they had. However, no sudden change in their condition went unnoticed. Another patient or their visitors reported it instantly. Sips of fluid were gladly given and received by the family or patient who noticed that a patient wasn't taking fluids. Morale was high. Ah, the "good old days" - not that anyone wants to see them return.

I believe that publically funded healthcare (single payor) would achieve greater oversight of referrals, etc. and possibly equal treatment for all might be attained. That worries the wealthy, who aren't sure they want to share a doctor's waiting room with those held in distain. So they scaremonger with unfounded accusations of "socialism". Only the naive could believe that!

[MBsGirl]

Are there not long waiting periods for care in Canada and the UK? SEems like I heard about unacceptable death rates from breast cancer and prostate cancer in Canada, but I hadn't found anything that specifically spelled it out when I did a lookup.

I can't see people in the US being unselfish enough to forgoe the 250k + end of life care so often inflicted on elderly relatives in the ICU.

[lamazeteacher]

Oh, Girl. Good for you for looking into the blather that goes on about our great country - but just because we're great.....does that mean no other country is, too?

I haven't heard that the Breast Cancer recovery rate is higher in Canada (due to increased wait for care), but I do know that in Canada the link between breast and ovarian cancer is much better known than it is here. Breast Cancer clinics are called Breast-Ovarian clinics. I also hit the web upon seeing your message, and discovered this page - which shows there is research that is funded for humanistic stuff, that doesn'y exist here. Also, to add another anecdote to the mix, I gave Breast Self Examination talks for the American Cancer Society since 1974 (pre mammography), and during those events, women have told me many times IN THIS COUNTRY,

[lamazeteacher]

Oh, Girl! The propaganda demons caught you up in the prevailing attitude that the USA is so great (and wealthy), no other country could possibly exceed our wonderful healthcare. I'm so happy to see that you have raised the question.

Well, it ("ain't necessarily so", song). I gave talks for the American Cancer Society to dozens of groups of women, on monthly Breast Self Examination since 1974. Many women told me that when they found a lump, their doctor's office appointment maker, said the doctor couldn't see them for 6 weeks! Depending on the doubling time, if that lump was malignant, that woman might lose her life, due to that wait. Our O.R. scedules are jammed, and sometimes, even after a positive biopsy, it takes more weeks to have "staging" to get more extensive surgical care.

And now the July 30 National Coverage Determination {NCD} for Medicare and Medicaid/cal patients, has a cap on ESAs which prevent cancer patients from getting drugs that increase their blood's capacity to tolerate more chemotherapy, and makes it necessary for them to have transfusions that could have been avoided, for that. The passing of resolution 22 would overturn that. Senate Joint Resolution 22, introduced by Senators Max Baucus D-MT and Mike Crapo R ID - member of the Senate Finance Committee) needs the support of your Senators and Congress. Please call your Senators today and urge them to co-sponsor SJR 22. Also call your congresspeople urging them to co-sponsor HJR 54 (Eshoo D CA-Rogers R MI). As Senator Baucus said, " ........CMS's (Centers for Medicare and Medicaid Services) decision will prevent vulnerable cancer patients from getting the care they need".

In Canada, such non medical decision making "decision making" groups don't exist! One doesn't call their "primary care provider", but makes an appointment at the nearest Breast-Ovarian cancer center, upon discovering a breast lump. They call the clinics that, to raise awareness of the connection between the 2 cancers, which the USA healthcare system has continued to keep a secret.

I can refer you to a great website I went to, when I saw your comment. It's www.bc.ca/res/researchprograms.net It comes out of British Columbia, and demonstrates the supportive aspect of breast cancer care in Canada. I'm sure they can give you stats on waiting times for appointments and treatment, and time between diagnosis and treatment. Being rather chauvanistic about the country of my birth, I suspect their stats are better than ours.

Certainly their neonatal stats (my area of expertise)are better than ours.

I had an experience this year, when I was hemorrhaging internally, due to taking prescribed, enteric coated ibuprophen, and when I called a haematologist for an apointment, at my doctor's urging, I was told that "the doctor can't see you for 6 weeks". I explained that my Hgb was very low (9.7), and gave a brief history, but the response was the same. Luckily a distant friend in the next community (50 miles away) is an oncologist/haematologist and is a very well regarded (Harvard Med school trained). He saw me the next day, and continued my care, giving me warm support I'm sure would not have been available in the city where I live. I vote with my feet, so all my healthcare is now given in the other community.

In Canada, people respect their government, which responds the favor. When the healthcare plan came out in the late 60s, it wasn't voted upon, but was announced, clearly so everyone understood how it would work for them. Doctors tried, a few years afterward, to charge above the pay given by the individual provincial programs, but that was squashed by the national government. There is resentment that their earning power is lower than American doctors, however I can say from direct observation, that doctors live as luxuriously there, as most physicians here do, but they don't make huge yearly amounts, such as my Obstetrician did, in 1973. His wife was a friend of mine, and had managed his office. She told me as she divorced him, that he cleared over $800,000 that year! They lived a few doors from me, and I often saw evidence of his alcoholism....... as others must have, when he worked inebriated. He reiterated at each of my prenatal visits, how expensive his malpractise insurance was.

I'm thinking of going back to Canada, although my children are here - one with MS, who has a copay with Blue Cross of $400./month (giving up many items she'd like, and cutting down on her daily injections when her bills are high), for her copaxone treatment. She has few symptoms now, that are hardly apparent. Her husband dares not change his work, as losing the healthcare benefit would be financially suicidal. So he puts up with circumstances that thwart the business he's in.

I heard of another woman, about my daughter's age, who has been afflicted with that disease, having had similar symptoms to those my daughter had at first, 10 years ago. She has insurance, but wasn't referred by her doctor to a neurologist, or told about Interferon or copaxone, and now she is bedbound! Anecdotal, but not far from the experience of many, here. In Canada, the system would not have allowed that to happen, and being as concerned as they are, Canadians are most insistent about doing whatever is necessary to be healthy. After all, they pay more when people don't take care of themselves. I marvelled at how quickly seatbelt laws were enacted and smoking severely restricted, after the expense of healthcare for sequelae was known.

What will it take, for Americans to care enough about their compatriots, to share their monetary benefits with those less fortunate, if only because they could fall into that group some day. Perhaps it's got something to do with the prevailing attitude that others grow older, and we won't ever be 70 or 80...... After all, we pay for public transportation without utilizing it, most places, which says something about our sharing largess with others less fortunate who don't have cars.

I could go on............

[EmmaG, RN]

Great post :)

I always laugh when I hear these scare tactics, especially those regarding long waits for appointments and treatment.

Around here (and we have lotsa docs), appointments and nonemergent treatments are often months down the road. Heck, my close friend was having syncopal episodes and couldn't get scheduled for an MRI for over 3 months.

I tried to explain all this to my Dad when he wanted to get his hip replacement done. He dallied about, not scheduling the surgery until March--- because he wanted it done in April. I tried to tell him the elective schedule was 4-6 months behind, but he wouldn't listen. Then he was mad at me because he ended up having surgery in late July. Of course, it was all my fault lol.

*sigh*

BTW, my daughter lived for 6 months in England on a tourist visa. When her little boy nearly amputated half of his finger in a door hinge (ouch!), he was treated emergently by a plastics who specialized in peds, then received daily home care visits by a nurse for a number of weeks. They did a fantastic job; no loss of function and except for a faint scar, you can't even see where he was injured.