Doomed So be it. Lets adopt a half baked plan and let the whole system come to a screaching halt within 10 years, and then start over. Because that is exactly what will happen. One thing about it... If the government adopts it..Im totally convinced it most certainly will be a "HALF BAKED SYSTEM."

Laurent Colvin Yo, Doomed, You could have at least told people you were quoting me. So, I read that people want to talk about the possible downsides to a single payer system. I, and other, keep pointing out the really bad sides of what we already have. One does not address the other, this is true. But with the healthcare systems of many other countries as examples we should look to them and learn from what they do right as well as what they do wrong. Now then, I, and again those pesky many others, point to the World Health Organization for their professional opinion about the nature of the world?s different healthcare systems. There are some (you know WHO you are, pun intended) that seem to hold the WHO suspect, as if the WHO had some ulterior motive when they studied all those healthcare systems. I think this is unlikely. Rather, I think it is far more likely that an organization such as the WHO, that has actually studied those systems, might know more about those systems than those that question them and have not. Still, the point was valid, that being that there could be untoward, as of yet unforseen consequences that might have dire effect on our health, to say nothing of our economy. The specifics of which must take into account the inherent nature of our capitalistic system. If I was to sum up our very complex economy I have to say; Me like product, then I buy product and tell my friends about product. Me not like product then me not buy or tell friends about product. This works for products or services you can actually evaluate. Health insurance is far more opaque of a subject, and it is so because it does work quite well to a point. But the incentives are all wonky. The insurance companies have to pay share holders and they do so at the expense of those who have paid for the protection of the insurance. This is a conflict of interest which is illegal in any other business. The reason that I believe that a Single Payer System is superior to the other systems being bandied about is because it maintains the competition motif on the provider side while taking out the conflict of interest on the insurer side, namely by getting rid of the insurer all together. But that isn?t entirely true. There will still be for-profit-health-insurance companies around, but they would not be allowed to duplicate the service provided by the Single Payer System. So then, if the doctors, hospitals and manufactures are still competing, then we don?t lose out on the supply side for scanners and the like. So the next question is that of price fixing, which many people are want to point to as a reason why it could fail. Well, if you read the bill HR 676 (AKA Medicare for ALL) there are provisions within it that would set a given service fee, (which in a given region currently might be offered at several different prices), to the average of the regions fees. Why do this you might ask. For one, it reduces cost of processing if the government that is paying for a services knows what it is paying for and has standardized it across the board. Secondly the doctors are no longer competing on price, but quality. They will get more patients if they are known for providing the better care. More patients means more money. It is possible to incentivize the system further by providing bonuses to those doctors and hospitals that have better outcomes. The downside here is that this tends to come with the built in incentive to dump non-compliant patients so that those stats go up. This can be eliminated by giving negative points to those offices that have to quit a patient. Sometimes it is necessary to quit a patient because they are, in fact, non-compliant but it should be made to be incentive neutral, not favorable. Any thoughts on this?

Interested

So, I read that people want to talk about the possible downsides to a single payer system. I, and other, keep pointing out the really bad sides of what we already have. One does not address the other, this is true. But with the healthcare systems of many other countries as examples we should look to them and learn from what they do right as well as what they do wrong.

Actually you haven't. You've hypothesized on the worst possible outcome of the current system while painting a very very very best (and incredibly unrealistic) possible outcome of the proposed system.

This is a conflict of interest which is illegal in any other business.

Really? how so? The entire stock market exists due to companies trying to maximize profits for it's shareholders. Every for-profit business in the world pays someone for money received from customers.

The reason that I believe that a Single Payer System is superior to the other systems being bandied about is because it maintains the competition motif on the provider side while taking out the conflict of interest on the insurer side, namely by getting rid of the insurer all together. But that isn?t entirely true. There will still be for-profit-health-insurance companies around, but they would not be allowed to duplicate the service provided by the Single Payer System.

It's not very competitive when the gov't will mandate what you may receive and what deductions in that fee you will be forced to take when the system cannot pay for itself.

So then, if the doctors, hospitals and manufactures are still competing, then we don?t lose out on the supply side for scanners and the like. So the next question is that of price fixing, which many people are want to point to as a reason why it could fail.

Reality will be - no competition, loss of professionals, dramatic decrease in R&D.

Well, if you read the bill HR 676 (AKA Medicare for ALL) there are provisions within it that would set a given service fee, (which in a given region currently might be offered at several different prices), to the average of the regions fees. Why do this you might ask. For one, it reduces cost of processing if the government that is paying for a services knows what it is paying for and has standardized it across the board. Secondly the doctors are no longer competing on price, but quality. They will get more patients if they are known for providing the better care. More patients means more money.

Do you have any studies to show that this would be the outcome? Not possible outcome, not conjecture - actual proof of this happening in practice. It's not exactly like health care is equal to weekly grocery shopping where person X buys just milk, eggs and toilet paper (only single ply for gov't rationing).

It is possible to incentivize the system further by providing bonuses to those doctors and hospitals that have better outcomes. The downside here is that this tends to come with the built in incentive to dump non-compliant patients so that those stats go up. This can be eliminated by giving negative points to those offices that have to quit a patient. Sometimes it is necessary to quit a patient because they are, in fact, non-compliant but it should be made to be incentive neutral, not favorable.

Legislative branches vote on what is in the Bill (if they read it or not is a different matter) not what could possibly - if every star aligned in the sky - then we may be able to - happen.

Laurent Colvin Dear Interested, Do you think the system we have now is good? Do you think it is okay for an insurance company to rescind someone's policy without reason? It does in fact happen, and yes they pay fines for it. Having said that, in those instances when they have paid fines, those fines did not come close to equalling the profit made by illegaly breaching their contract with the insurance customer. Is this okay with you? The previous question points out the inherent conflict between the insured and the one providing the insurance, where the one providing the insurance is dishonest. If you were to offer a service to me for a price and a contract, and then not provide that service because you had to pay your share holders, we call this a Ponzi Scheme. Sound Familiar? This is in fact what takes place all the time. A former CEO of Cigna, Mr. Wendell Potter, has admitted as much. Please explaine to me how this is not a conflict of interest. As for insurance being different from other products sold and traded on the stock exchange, it is quite different. They are similar in that the stock you buy does come with risk, but you and the one selling the stock accept that risk. No insurance buyer is intentionally buying a product they think might not be there when they need it. They are buying it because they are depending on it to be there, and the one selling it is TELLING them that it will be there. This is called a lie when they don't live up to that contract and it is illegal. This is why they pay insufficient fines when they do so. Your retort on my missive on competition was beneath you. You could do better than that. I'll pass this one up. As for asking for proof, !-] , we already know that a single payer system is provideing healthcare in other countries with better outcome measures than we have in the United States, we know that they are providing it cheaper than our country, (in fact every country provides healthcare cheaper than we do!). As for studies that can guarantee the outcome, of course not. But I take it that this is reason enough for you for U.S. to do nothing? Come on dude! Get a cup of coffee and get back to the fight tomorrow. Your just not at your best right now.

Interested

Do you think the system we have now is good? Do you think it is okay for an insurance company to rescind someone’s policy without reason? It does in fact happen, and yes they pay fines for it. Having said that, in those instances when they have paid fines, those fines did not come close to equalling the profit made by illegaly breaching their contract with the insurance customer. Is this okay with you?

Read previous post of mine on page prior to this one.

Please explaine to me how this is not a conflict of interest.

As stated before, every business is in business to return a profit for it's owners. Explain how it is.

No insurance buyer is intentionally buying a product they think might not be there when they need it. They are buying it because they are depending on it to be there, and the one selling it is TELLING them that it will be there.

Are you now attempting to say that each and every time an insurance claim is submitted it is 100% rejected or that each time a claim is introduced that meets or exceeds premiums paid that it is rejected?

As for asking for proof, !-] , .... As for studies that can guarantee the outcome, of course not. But I take it that this is reason enough for you for U.S. to do nothing?

So you have zero ability to back up what you are attempting to say?

Your retort on my missive on competition was beneath you. You could do better than that. I’ll pass this one up.

No really, come back to it and answer it.

Come on dude! Get a cup of coffee and get back to the fight tomorrow. Your just not at your best right now.

I'm doing just fine, I read some of your cut and paste articles on another news site a few minutes ago. But if you think you can back up your rosey projections with real life statistics - go for it. Here's a dose of reality for you. The government is never efficient. Whenever they claim that they _may_ need to double fees if the situation cannot pay for itself - or that doc fees will have to be cut 20% than count on double the fees, 20% cut and still it will be insufficiently funded.

Doomed Do you think the system we have now is good? Not only yes but hell yes. Is it perfect? NO Does it need work?.......yes Cost controls....price controls would be a start. But anything is better then medicare which requires a fricking supplemental insurance to keep you from going bankrupt. Like the Democrats said...Medicare is great....ummm....not really.....ask everyone who pays from 200-400 a month for a supplemental insurance policy to keep from going broke.

Tully As for asking for proof, !-] , we already know that a single payer system is provideing healthcare in other countries with better outcome measures than we have in the United States Which single-payer systems? Which outcome measures? Trot out the proofs. Because every time I actually dig into the stats, I find that people who make such claims are using very tenuous assumptions to improperly link non-direct proxy measures of outcomes to health care quality when they don't really link. A former CEO of Cigna, Mr. Wendell Potter, has admitted as much Ignorance is bliss, I guess. Potter was NOT CEO of CIGNA, but their #2 PR flack for awhile. Before he was at CIGNA he was a PR flack for Humana, and before that PR flack for a Democratic governor. He is now the head PR flack for a leftist/socialist anti-corporatist activist group, and did not begin his anti-insuror flacking until he started taking their paychecks. Can you say ASTROTURF?

Interested

Doomed : Do you think the system we have now is good? Not only yes but hell yes. Is it perfect? NO Does it need work?…….yes Cost controls….price controls would be a start. But anything is better then medicare which requires a fricking supplemental insurance to keep you from going bankrupt. Like the Democrats said…Medicare is great….ummm….not really…..ask everyone who pays from 200-400 a month for a supplemental insurance policy to keep from going broke.

I agree VA told my Uncle to Die, Medicare told him to go bankrupt.

Cost controls….price controls would be a start.

Decent start, combine that with liability controls to dampen that. I've seen Mexican nationals bring a family member over illegally in dire need for health care (with zero US Insurance). Because it is emergent care - they receive it (from a for-profit hospital). And they know the US system well. They request consultation after consultation - restricting the Hospital's ability to move the patient out of the ICU or floor and into the community hospital. The patient is then in the very high cost care of ICU for weeks all for free. After the patient finally leaves, the family will then do the same with another hospital in the city. And when all is said and done - have an extended family member that is a US citizen sue the hospital. And the hospital will settle because it is cheaper than extended court battles. All of this cost is then passed to everyone else.

Mike Laurent, Since you have now repeatedly referred to the WHO rating in order to nullify any attempt to argue that the US system is anything other than horrible, I?d like to address the question of appealing to authority. You said: "Rather, I think it is far more likely that an organization such as the WHO, that has actually studied those systems, might know more about those systems than those that question them and have not." I agree that in some cases, we have to appeal to authority. For myself, I?ve reached that conclusion on the issue of climate change, for example. About a year ago I spent a few months of my free time trying to get to the bottom of the issue, and find out once and for all who was right and who was wrong. After reading the view of one side, I would then read the critique from the other side. The critiques sounded convincing, until I would read equally convincing counter-arguments from the other side, and so on. Through this experience I learned that, when it comes to climate science, I simply don?t have adequate knowledge of the subject to be able to read an argument and decide for myself if the argument is valid. Therefore, I determined that, for myself, the best course of action is to agree with the view of the majority of scientists who understand climate science, with the caveat that I encourage the skeptics in the scientific community to continue to try to convince the other scientists. However, I only appealed to authority in that case because I believe I don't have the ability to judge for myself the merits of either side of the issue. When looking at the WHO ratings, however, this is not the case. They?ve laid out clearly how they have rated the various countries, and if I, even with limited knowledge in the area of health care, can see obvious defects in their methodology that cannot be rebutted by those with more knowledge than I have, then their presumed wisdom regarding the status of health care in the world means nothing. So let?s look at their methodology (these criticisms come from the link that I provided above, which you haven?t responded to so I will repeat them here more explicitly): 1) The WHO rating relies heavily on life-expectancy numbers. It is self-evident that the average life-expectancy of a group of people depends on much more than just the quality of health care they receive. I don?t have to be an expert in health care to know that. I can walk into any McDonalds and predict with high certainty that the people who frequent such establishments have an average life-expectancy that is less than those who do not, and that prediction does not in any way reflect any judgment of the quality of health care received by the two groups. According to one study, changes in life style could account for differences in life expectancy of up to 12 years (see http://www.bio-medicine.org/medicine-news/Change-In-Lifestyle-Could-Increase-Life-Expectancy-9736-1/), dwarfing any difference that could be due to health care quality differences in first-world countries. Therefore, relying on life-expectancy numbers is a highly flawed measure of health care quality. In addition, it is widely accepted that Americans in general have a less healthy and more risk-prone lifestyle than people in other countries, therefore the measure of life-expectancy not only is flawed, but would clearly put the US at a lower rating than where it would be if we used more accurate measures. 2) The WHO ratings also relies on a measure of equality of health care access. While access is important, it is questionable whether it should be such a large portion of the total rating (25%). Under the WHO rating system, a country that provides poor health care to all of its citizens would receive a boost in that component of the ratings compared to a country that provides poor health care to half on its citizens and excellent quality health care to the other half. Again, this is an obviously flawed measurement, and one that biases the results toward single-payer systems, regardless of the quality of the health care that is being provided by those systems. 3) The WHO rating is adjusted for the amount of money spent on health care. Countries that spend more are adjusted downwards compared to those that spend little. Therefore, you can't say that the US provides poor care despite spending a lot of money, because the WHO rating already takes the money spent into account. According to the CATO article I linked, the US would be ranked 15th if the amount spent was not taken into consideration, even without considering the flawed measures described above. For these reason, I find the WHO rating to be suspect. Can we improve our system? Yes, but we can build on the parts of our system that work well, and there's no reason to believe that switching to single-payer would actually make our system better (although it probably would help raise the WHO rating).

Mike c3: "If an individual lies on his application to an insurance company ( i.e. doesn’t admit he was diagnosed with diabetes three years prior) What recourse should the insurance company take when it discovers this?" Firstly, I would support regulating insurance companies such that they cannot vary premiums by health status, but rather by health choices. There would be difficulties with this system, but I think it's feasible and would greatly incentivize healthy choices (incidentally, the current house health care bill would actually make this kind of incentive illegal: http://sovereignmind.wordpress.com/2009/07/24/whats-wrong-with-the-health-care-bill-what-happened-to-personal-responsibility/) . That's a topic for another day. Laying that aside, I would support regulation such that insurance companies cannot rescind a policy after some period of time after it is initiated (maybe 6 months). It is the responsible of the insurance company to verify the information before that time period ends (with the availability of health records, that shouldn't be difficult). To guard against this, the insurance companies could choose to require the patient to see a physician during that time period, and have that physician review the prior health records of that patient. There still might be some cases where a policy can be rescinded in cases of clear-cut fraud. Just one idea, but like I said I would prefer policy qualification and premiums have nothing to do with current health status anyway.

Deanna McGowan There are 10 states that need HR676 to be included in the health care reform bill. The tax law waiver is a must for these states to move forward in their single payer health care systems. Everyone needs to call congress and tell them that you support HR676 to be included in the HCR bill. Public option is not single payer public option get informed do your research it truly will save tax payers billions. Public option is a very bad idea for the public plan.

Vacant Home Insurance Interesting when people talk about the truth, or at least their version of the truth. Its like when you try to learn about the healthcare debate in America and find the search for truth has different answers on CNN vs. Fox news? It seems like the truth about any issue lies in the facts what you are willing to overlook to get your point across.

Vacant Home Insurance Woah - its a mess in here! Answer to (someone's) post: 1. If an individual lies on his health insurance application and the insurance company discovers it was a pre-existing condition, they have every right to terminate coverage. 2. Good question about British conservatives -- anyone?