August to-do list: Medicare for All

Monday, August 3rd, 2009 · 115 Comments »


Before breaking for the August recess, Nancy Pelosi promised that when Congress gets back, she’ll allow an up-or-down floor vote on single-payer. Reaction in the progressive tubes has been divided, with most bloggers choosing to respond to the announcement in one of four ways:

  1. Ignore it, because it’s not nearly as important as ridiculing Sarah Palin.
  2. Dismiss it, with a certain Villagey smugness, as a “symbolic gesture” that of course won’t pass and is being offered up purely so Democrats can say they tried.
  3. Take the myiq2xu approach, and say that since it so obviously is just a piece of kabuki theatre (see #2), to hell with it and the horse it rode in on.
  4. Argue, as lambert and donna darko and others do, that while it may be intended as theatre, at least it’s an opening.

I tend to go with #4 on this, mostly because I’m desperate for some kind of crack in the door. Healthcare is too important not to at least try.

My own view on this whole thing is simple: Medicare for All. It’s the obvious solution. It makes sense, solves our problems, and will probably even save money.

Yes: we can apply the Medicare model to the entire population and cover everybody, and it will cost the same or less than we are currently spending for the crazy patchwork of private health insurance and various government-funded plans that still leaves 47 million Americans uninsured.

If you don’t believe me, look at the numbers. As a nation, we are spending about $2.5 trillion every year on health care:

  • About $1 trillion of that is government spending — mostly Medicare/Medicaid, a relatively small amount for Tricare/Champus (the military system), plus the outlay from local governments and hospitals for uninsured poor people who show up in the emergency room. All together, this accounts for about half of the healthcare population. Medicare has its issues and could stand some improvement, but overall it is fantastically efficient compared to the private insurance industry, as we’ll see. It covers the oldest, sickest people in the country, and it does so with a minimal administrative overhead of only 3%.
  • The other $1.5 trillion is through private health insurance — the health insurance people have through their employers or on their own, plus out-of-pocket expenditures. This also accounts for about half of the healthcare population, but notice that the cost is one-and-a-half times as much. Why? Mostly because private health insurance carries enormous overhead — 30% or more. That’s partly profit, of course, but it’s also the huge administrative costs involved in denying all those claims and meddling endlessly with doctors and patients. Private insurance is vastly inefficient and larded with profits — profits we as a nation can’t afford.

So what we need to do is allocate that $2.5 trillion differently. We’re already spending enough money; we just need to slice up the pie in a smarter way. Instead of funneling $1.5 trillion through the private insurance sector — with its 30% markup — we can instead direct that money to bankrolling Medicare. Just eliminate the private insurance middleman altogether. That would save almost half a trillion dollars right there! Everybody now on private insurance would instead be on Medicare, for half a trillion dollars less. And the savings would be just what we need to expand coverage to those 47 million people who currently have no insurance at all.

See? Same amount of money, just allocated differently. And everybody gets covered.


How would we do it? Through payroll taxes and income taxes, the same way Medicare is funded now. And we would all stop paying private health insurance premiums. For almost all of us, that would mean a net savings.

The Physicians for a National Health Program explain how it might work:

A universal public system would be financed in the following way: The public funds already funneled to Medicare and Medicaid would be retained. The difference, or the gap between current public funding and what we would need for a universal health care system, would be financed by a payroll tax on employers (about 7%) and an income tax on individuals (about 2%). The payroll tax would replace all other employer expenses for employees’ health care, which would be eliminated. The income tax would take the place of all current insurance premiums, co-pays, deductibles, and other out-of-pocket payments. For the vast majority of people, a 2% income tax is less than what they now pay for insurance premiums and out-of-pocket payments such as co-pays and deductibles, particularly if a family member has a serious illness. It is also a fair and sustainable contribution.

(Note that the taxes in that example are slightly different from the proposal in Rep. Conyers’ H.R. 676 — the United States National Health Care Act — which is the current version of a Medicare for All bill in Congress.)

Some people believe that the total cost of Medicare for All would actually be less than what our current crazy system costs, owing to economies of scale and so forth, but that may be optimistic. Either way, we’d still come out a winner:

  • Healthcare coverage for all Americans
  • An overall national price tag that is, at worst, no higher than what we’ve got now

What’s not to like? It’s a no-brainer.

So, the burning question: why aren’t we doing this?

As far as I can tell, the reason we’re not doing this is because our lawmakers are intent on propping up the private insurance industry. The insurance industry doesn’t add value, doesn’t contribute to the public good; it’s just a drain. It’s just sitting there, like a Mafia overlord, taking a 30% cut. But this wealthy, lucrative industry has lobbyists, and millions of dollars to spend in political contributions, and you know how that works.

The pharmaceutical industry, too, is in on the lobbying, because the current patchwork insurance system allows them to charge higher prices for their drugs. If we had Medicare for All, the government would be able to insist on lower prices, and Big Pharma doesn’t want that.


The political rhetoric that’s floated as a smokescreen for all this is filled with references to “free markets” and “competition,” but that’s absurd. We’ve had plenty of time to see how the market works in the health insurance biz. What happens is that premiums spiral up endlessly and more and more folks are denied coverage as insurance companies seek to maximize profit. This is not surprising, since the driving goal of insurance companies is not to pay for people’s healthcare, but to collect premiums and avoid paying claims. Applying simple-minded Adam Smith models to health insurance, like it’s the market for widgets from your Econ 101 textbook, doesn’t wash. Health insurance simply doesn’t work that way.

It’s true that people in the private health insurance industry would lose their jobs with the switch to Medicare for All, but many other jobs would open up in healthcare itself. As the Physicians for a National Health Program note, “Many people now working in the insurance industry are, in fact, already health professionals (e.g. nurses) who will be able to find work in the health care field again.” Not all of them, though, so some retraining and job placement will be necessary. But the cost of that will be minuscule compared to the vast savings to be gained.

So, my second burning question is: what can we do for the next month to make that floor vote on single payer something more than just a “symbolic gesture”?

Filed under: Healthcare Reform · Tags:

115 Responses to “August to-do list: Medicare for All”

  1. Alison says:

    Is it that easy, Violet?

    Here are some things I’m thinking about.

    1. Absolute horror stories I have heard from friends and family in Canada. We all know them. And of course I am aware that we have our horror stories here. But I’d like to come up with a plan where there are very, very few horror stories due to systematic crap.

    2. Does single payer mean that there is no longer any private medical practices and private insurance? I do not like this. If the government is giving me some crap doctor or if I have a condition that I DO NOT want the government to know about I’d like the option to go private.

    3. What happens to the doctors? Do they get the same salaries? Will it be the government that pays the huge cost of malpractice insurance?

    4. Will care be rationed? As in, oh, you are probably going to die in 5 years anyways, so you really don’t need that hip replacement…

    5. Will it cover the cost of abortions? Morning after pills? How will single payer look after women?

    Disclaimer: I am for some sort of expansion of socialized medicine but I am unclear about how to go about it. No, I do not think our present system is ideal.

  2. Violet says:

    1. But what stories? All systems have some horror stories. And obviously it’s important to minimize those. Medicare for All wouldn’t be identical to the Canada system, which has its own history, peculiarities, and medical communities. So I don’t know how to answer you without knowing what horror stories you mean and if there would be an analog in the States.

    2. The government doesn’t give you a doctor. Medicare doesn’t assign doctors; it just pays the bills. Of course you could always seek medical care on your own and pay for it yourself. And there would almost certainly be supplemental policies available, though ideally Medicare for All should be expansive enough that supplemental policies have little appeal.

    3. The doctors remain pretty much the same: The Physicians for a National Health Program predict malpractice costs would drop significantly:

    4. Right now we have rationed medical care: it’s rationed by wealth. The richer you are, the better/quicker care you get.

    5. It would have to. Anything less would be grossly discriminatory.

  3. Three Wickets says:

    Single payer is the only truly democratic and financially sensible answer. Difficulty is the transition. The entrenched interests and their govt allies make any change very difficult. However, there is also a jobs reality to overcome beyond the profit incentives of corporations. Healthcare administration at the providers and insurers account for around 5 million jobs across the country. If you include health insurance administrators at the employers and healthcare regulators in and out of government, that’s roughly another 5 million jobs. Some of those total 10 million jobs would of course migrate in a single payer world, but most would go away. For perspective, the total number of Americans drawing unemployment checks today is already around 10 million. Some of these millions of jobs in healthcare administration could and should transition to jobs in the actual providing of healthcare services to patients. That may take more time for training and schooling.

  4. myiq2xu says:

    If the government is giving me some crap doctor or if I have a condition that I DO NOT want the government to know about I’d like the option to go private.

    Right now virtually everyone is given a doctor by a private bureaucracy – the insurance companies let you choose from a limited list. If you have no insurance you get whoever is on duty when you go into the emergency room. In fact, during ANY emergency you’re unlikely to see your regular doctor.

    How do you know if your doctor is any good until he almost kills you? He could be a highly-competent jerk like Dr. House or a smooth-talking quack. He could also be an addiction facilitator like Michael Jackson’s doctor. The issue of competency is separate from availability.

    Right now private agencies have access to your medical records, you don’t know who has access to them (including the government) and if they go electronic they can be hacked.

    IOW – all the problems we might have we already have.

  5. yttik says:

    I’ve lost all hope of congress and the president ever doing anything the least bit reasonable. When Pelosi said we’ll allow a floor vote, it did immediately remind me of the floor vote “allowed” at the DNC for Hillary.

    The 1000 page bill they are considering now has some atrocious things in it. It cuts back on medicare and SCHIP, it forces people to buy insurance and it fines those who can’t.

    As to Violet’s payroll tax, we’re loosing jobs right and left at the moment. If you expect employers to pay another 7% payroll tax, you’re adding that on top of labor and industries, soc sec, medi that we already have to pay. We already pay 6.2 in soc sec, 1.45 in medi, and depending what state you’re in, as much as five bucks an hour for L&I. L&I is an incredibly expensive Gov run insurance program that people have to fight like crazy to get any benefit from if they are injured. Being in construction, I pay 40 bucks a day per person so people can get medical care if they are injured on the job. That should be enough money to provide them full medical benefits on and off the job.

  6. Violet says:

    If you expect employers to pay another 7% payroll tax, you’re adding that on top of labor and industries, soc sec, medi that we already have to pay.

    The 7% payroll tax would be instead of the current health insurance premiums for employees, which is a huge chunk of employer costs.

  7. yttik says:

    True violet, but what are you going to do with all the self employed? The unemployed? The poor? Those who work minimum wage and have no insurance at all?

    Big corporations would love it, but small businesses are hanging on by a shoestring and many of them don’t provide health insurance because they can’t afford it.

    There is money already being spent for healthcare, more than any other country that actually provides their citizens with medical care. We’re already paying for universal care in this country, what we have is a delivery system failure. The solution should not be to raise taxes, especially on those who are driving the economy and are already burdened. What we need to do is to take the money we already spend and redirect it so it actually benefits people. The Gov will pick up an uncompensated care ER bill of a couple grand, why won’t they pay 60 bucks for a doctors visit instead?

  8. lambert strether says:

    On the cost savings: Some of the people who believe that Medicare for All will save $350 billion a year include the New England Journal of Medicine.

    On Canadian and other horror stories: A reality based community should be able to recognize that we’re spending twice as much money as the next country (France — a fact that for some reason goes unreported) and for worse outcomes. Also, you should consider that many of the Canadian horror stories are spread by their equivalent of the right wing think tanks down here who are seeking wedge issues; the funding sources, IIRC, overlap.

    On funding mechanisms: HR676, the Medicare for All (single payer) bill in the House (FAQ) is funded with a variety of mechanisms, not just payroll, including a transaction tax which I, for one, would be happy to increase. Also, consider the net: You won’t have to pay the health insurance companies a dime!

    On doctors: HR676 does not assign doctors (unlike the insurance company call centers). HR676 is a funding mechanism (single payer), not a delivery mechanism (unlike the UK’s National Health Service, say).

    On private care: Both Canada and France allow private systems to supplement the public ones. This has to be managed, of course, to make sure that rapacious insurance companies don’t game their way back into control of the system.

    As far as the promise of a floor vote reminding people of the Denver convention: I understand that completely. I would also remind everybody who fought for that floor vote that it was the right thing to do, no matter what the prospects of success. But as one of the Ragin Grannies told me at a single payer rally: “If it’s theatre, learn your lines and get on the stage!” I think it’s important to learn lessons from the events of 2008, but one lesson to learn is that although two situations may resemble each other, that doesn’t mean they will have the same outcomes.

    I’m with Violet in that I think there’s a chance to do some good. That’s all, but that’s not nothing, and demanding the system that Nancy Pelosi admits is the best can only do good for us now and in the future.

    NOTE There’s also an additional argument that Medicare for All (single payer) lets you leave your job without losing your insurance. I don’t know if that’s a big factor for woman specifically, but somebody might want to look into that.

  9. Violet says:

    True violet, but what are you going to do with all the self employed? The unemployed? The poor? Those who work minimum wage and have no insurance at all?

    Medicare for All is Medicare for All. Everybody. The whole country.

    We’re already paying for universal care in this country, what we have is a delivery system failure.

    No, we’re not. Not at all. I wonder why you think that. There is no mechanism in this country for universal coverage. No attempt at that.

    The solution should not be to raise taxes, especially on those who are driving the economy and are already burdened. What we need to do is to take the money we already spend and redirect it so it actually benefits people.

    I have a sneaking suspicion you didn’t actually read the post. Or if you did, you got confused. The whole point of the post is that all we need to do is redirect the money we’re already spending. Instead of paying for expensive insurance with 30% overhead, we should spend it on Medicare with only 3% overhead.

    Think of it this way: you have 6 kids to feed. You can feed them all if you go to the cheap grocery store. But if you go to the expensive grocery store with huge markups in the prices, you can only feed 5 kids. So why would you go to the expensive store?

  10. myiq2xu says:

    Dennis Kucinich came today to Aurora I helped organize the talk. My main message is he was not pleased about HR 676 coming to the floor, he thought it was basically a trap where they were going to kill it and declare it dead ASAP.

    I told you so!

  11. yttik says:

    “No, we’re not. Not at all. I wonder why you think that. There is no mechanism in this country for universal coverage. No attempt at that.”

    We already spend more on healthcare than any other country. The money is already there. People without insurance go to emergency rooms, they go broke and wind up with medicaid. They become disabled and wind up on disability. We are currently funding health care, it’s just an inhumane system that doesn’t trickle down to the people very well. It’s not the cost that is causing us problems, it’s the lack of will.

  12. Alison says:

    1. Violet, in regard to “What stories?” I am thinking of stories that I have heard on shows like 60 minutes (in Canada, delaying testing due to waiting lists until unidentified tumor becomes untreatable or delaying treatment so that sick person is in pain for an extended period of time). And then stories that I have heard from friends and family who live in Canada and Britain. A Brit friend of mine recently went to the UK for surgery. There were complications but she could not see her doctor afterward because he went on vacay. And then, through their system, she was unable to schedule an appointment with another doctor. So she suffered in agony. And then rationing care for the elderly. I know many first world socialized health care programs do this, and from what I know Obama’s plan would do this as well.

    I’m not saying this is what single payer would be in the United States. I really don’t know. But I am wondering if there is a program in some other country that would be comparable to what single payer would be here?

    I just want to repeat that I don’t think we have an effective system now. But before I sign up and get with any program I want to know the benefits and the risks with any and all proposed programs, including the one we have now.

    2. Myiq2 – You misunderstand the point of my question. I really do not like the Canadian system where there is no other option besides government care. If single payer in the US allows for seeing doctors outside of the government system, I am happy about that.

  13. Violet says:

    NOTE There’s also an additional argument that Medicare for All (single payer) lets you leave your job without losing your insurance. I don’t know if that’s a big factor for woman specifically, but somebody might want to look into that.

    I think it is, and I think another factor for women is that employer health insurance is one thing that can keep women in abusive marriages. This whole system of health insurance for the family of a wage-earner is patriarchal in origin. And as long as men are still higher wage earners on average with greater health benefits, then women are far more dependent on their husbands for income/health benefits than vice versa.

    Health coverage should be for each person, and should not be tied to spouses. Women shouldn’t feel compelled to stay with a bad or abusive husband because they can’t afford to lose their benefits from his health insurance plan.

  14. Violet says:

    Alison, the British system is not an appropriate comparison. They have socialized medicine, with doctors and hospitals under government control.

    Medicare for All wouldn’t be socialized medicine. It would be an expansion of Medicare, which is just a payment system. (You might call it socialized insurance coverage.) Medicare doesn’t own hospitals or employ doctors. It’s just about who pays.

    The value of the system is that it creates the maximum risk pool — everybody — which is key to keeping costs low. And the administrative overhead is minimal because there are no profit-driven private insurance companies trying to make a buck.

    By the way, I want to point out that true socialized medicine, such as in Britain, doesn’t have to be bad. We have just such a socialized system in this country — the military system — and it’s great. In fact, the level of care is much higher than in the private sector.

  15. myiq2xu says:

    Whenever healthcare reform is discussed we start hearing horror stories about healthcare in other industrialized countries.

    But all those countries:

    1. Spend less per person

    2. Cover all of their people

    3. Provide equal or better care (based on statistics rather than anecdotes)

    If their systems are so bad, why aren’t they switching to ours?

  16. Alison says:

    Thanks, Violet.

    So under single payer one could pick and choose their doctors?

  17. DancingOpossum says:

    I know people who have all kinds of offbeat arrangements with ex-husbands, ex-employers, and so on, just to hold onto their healthcare coverage. Fear of losing insurance is a drag on anybody’s freedom and mobility, and incidentally it’s also a very good way to keep workers cowed and unwilling to fight against–or leave–lousy employment situations (or marriages).

    It can’t be said enough: The single greatest reason for bankruptcy filings in this country is medical bills–and the majority of those filing are people who have health insurance!!

    Oh, and a final note to those who worry about the government choosing your healthcare…Right now it’s those warm, tender, goodhearted people at your insurance company who get to decide who your doctor is, what you’ll get covered for, and whether it’s worth it to them to keep you or your family member alive. How is this better?

  18. Violet says:

    We already spend more on healthcare than any other country.

    Yes, we do. But hundreds of billions of dollars of that money is going towards profits for private insurance companies, administrative overhead at private insurance companies, and the byzantine billing systems that doctors and hospitals are required to maintain in order to comply with those private insurance companies.

    The money is already there.

    Yep, it sure is. We just need to spend it on Medicare instead of private insurer profits and overhead.

    We are currently funding health care, it’s just an inhumane system that doesn’t trickle down to the people very well.

    There are 47 million uninsured people. There is no trickle-down about it.

  19. Violet says:

    So under single payer one could pick and choose their doctors?

    Absolutely. And you would have a much wider choice than most people do now under private health insurance. Most private insurers have networks with participating physicians, and you have to pick someone in the network to get full coverage.

    If everybody in the country was covered by a single-payer system, then 99.99% of doctors and hospitals would participate. They’d have to if they wanted any patients. Unless they were catering to a very rich clientele.

  20. yttik says:

    Both the VA and medicare should not be held up as paragons of virtue, as examples of the kind of health care we all want. You can go visit a medicare funded nursing home or Walter Reed Army Medical Center for examples of how bad things can get when you are dependent on the Gov for your care. We have to provide standards to force the gov to actually care about the people they are serving or we really do become just like cattle who are herded thru a Gov run program with a bunch of politicians who constantly want to keep costs down and who whine about entitlements.

  21. Violet says:

    I grew up as a military dependent, and the health care was outstanding.

    My parents are still covered by Tricare, and it’s outstanding. They wouldn’t trade it for the world.

    Abuses are possible with any system, of course. But actually, a big part of the current problems with Medicare is that the Republicans have been trying to destroy it for decades. The creeping privatization of Medicare has placed more and more of the system in the hands of private supplemental insurers, which is just what Republicans want.

    The way to have a strong single-payer system is to keep everybody in the system and provide maximum coverage for all. If you let it become just a system for poor people, then it will degrade. If it’s a system for everybody, then it will be flush with funding and the rich/powerful will make damn sure it offers the coverage and service they demand.

  22. myiq2xu says:

    Republicans have been trying to destroy it for decades

    Not just Medicare – pretty much the whole government (except the military and law enforcement/prisons.)

    The GOPers try to cut funding, impose restrictions and appoint managers that oppose the existence of the agencies/bureaus they will run.

    They make government fail and then point to that failure as proof that government doesn’t work.

    Under Clinton FEMA was a shining example of the potential of government, under Bush we got Katrina and “Heckuva job, Brownie!”

  23. DancingOpossum says:

    yttk, the VA and the Army hospitals like Walter Reed are two different animals entirely — although confusing them is natural because our illustrious media never bothers to explain this simple fact. In simple terms, the government runs the VA hospital system and the DOD runs the army hospital system.

    Quality of care at army hospitals can vary, and these are the hospitals that gave rise to the Walter Reed Scandal and the horrific scenes in Oliver Stone’s “Born on the Fourth of July.” (No, not a big Stone fan myself but he was in the service at the time.) Still, most people are pretty happy with it (the one complaint I’ve heard from folks in the service is that doctors at army hospitals tend to have expertise but no–or awful–bedside manner).

    The VA system, OTOH is one of the best hospital systems in the country if not the world.

  24. Toonces says:

    I can’t believe people still haven’t watched Sicko. And if we’re trading anecdotes, my friends in Canada, England (yup), Australia and Japan (especially), wouldn’t trade their healthcare for ours if we paid them our insurance premiums.

    How can anyone be scared of the healthcare they have in France? It’s effing glorious compared to ours. It’s an absolute dream come true compared to our sick, barbaric system. If I had the means, I would have been out of here years ago, specifically for the healthcare.

    And I say all this as someone who has been on Medicare and didn’t find it the least bit different from an HMO, except there was noticeably less paperwork, and easier access to doctors.

  25. Gayle says:

    I’m amazed people are still scared off by propaganda about long waits for service.

    Haven’t these people been to emergency rooms here in the States? They’re horror shows with 8-10-12 hour waits. I called my doc’s office this week to find there’s a 6-8 month waiting period to book my yearly physical.

    The talking point that really cracks me up however is the one about bureaucrats running our health care system. Dear God, who do you think is running things now? Bureaucrats whose sole purpose isn’t to ensure quality care but maximum profits.

  26. RKMK says:

    I can’t believe people still haven’t watched Sicko. And if we’re trading anecdotes, my friends in Canada, England (yup), Australia and Japan (especially), wouldn’t trade their healthcare for ours if we paid them our insurance premiums.

    *raises hand* Like me!

    I remember watching ER as a young pup of 13 or 14, and it was this episode where this construction worker with a wife and four kids got lung cancer and had no insurance. He’d put off coming in as long as possible, to the point that fighting and winning was slim to nil – and he basically ignored Carole and refused treatment, walked out because he chose to die than bankrupt his family on treatment that probably wouldn’t work. My own grandfather was being treated for lung cancer at the time, and I was absolutely horrified. I couldn’t (/can’t) understand how such a barbaric and inhumane system is allowed to continue.

  27. Alice Paul says:

    Regarding the “horror” stories. I am an American living in Canada and guess what? Their television programs here regularly run “horror stories” too, about the U.S. system!

    My family are nearly all in the medical field in the U.S. Doctors, nurses and medical social workers. I hear direct horror stories from them about HMO’s who DO decide people’s care or lack thereof.

    When I first came to Canada having grown up on a steady diet of right wing b.s. about Canada’s health care system I am ashamed to admit it but, I was scared! I’d had stellar care in the U.S. *before HMO’s mostly” and I also admit that having family in the medical field did not hurt me at all..I always got the best of the best in specialist referrals etc.

    However, I have to say as someone who has chronic health issues and who has a son with the same that the Canadian system is far superior. Most Canadians would never dream of trading their system for what the U.S. has. No one goes bankrupt here paying for care. The wait lists are totally and utterly exaggerated south of the border. You know you hear all this stuff about Canadians going south of the border for care. Well, the truth is that for some things some people want care that they will need to jump the SHORT lines for..if so the Canadian government will PAY for them to go south of the border for care if they want it. Yes, that’s right..these people who chose to go for care in the U.S. for something are having that U.S. care paid for by our medical system here in Canada.

    Also, MANY Americans come up here for care too. In fact there is a bit of resentment here because Canadians see this at times as a drain on their system. But in the U.S. you won’t hear much about those stories..we do hear them here. I have seen several people on the net saying “If the care is so good up there why do Canadians come here for care?” but, nothing about the thousands of Americans who come up here. Many of them including myself are now living here as landed immigrants…I would rather be home but, that would mean choosing between insurance *sky high for someone like me* or living in a cardboard box.

    Obama’s plan is not single payer and I am NOT for it as it will ruin any future chances for something like HR676 to pass at all.

    One final thing, in Canada the government does NOT choose your doctor or decide what treatment you will get. It is a publicly funded private system. The system is paid for by the citizens, all of them, through taxes, and the doctors, hospitals and you are the only ones to decide who your doctor will and the direction of your care.

    The only big difference I see in the systems is that the hospitals for the most part are not works of modern art. If you want t.v. in your room you pay extra, if you want a private room you pay for that too. It’s no frills and that’s fine with me. The money goes to health care not add ons. You can have those ad ons for very, very little extra but, it’s still extra.

    I’ve gotten excellent care here. I would almost laugh now at some of the scare stories out there about the health care system except those stories are the very thing keeping Americans from understanding that universal health care is not some boogie man to be afraid of.

    I’m deeply disappointed that Obama has put forth such a mish mash of a plan. HR676 will work, it’s cheaper and it cuts out those insurance companies…oh wait..maybe that’s why he didn’t want it.

    Keep fighting for universal health care! It’s worth the fight!

  28. Jackie says:

    Violet, I love your blog, love your writing and think that you consistently offer valuable insight into very complex and contentious issues. I say this because first, I want to offer you a long overdue compliment, and second, I hope you will allow me to keep commenting here after this comment. I was banned from commenting on another blog for describing my family and friends’ experience with the Canadian healthcare system.

    I know that many people in the United States who are of a certain political bent like to hold up Canada and single payer as a panacea for what ails the system here. I know that many people here suffer because they lack insurance or their insurance is crap. I am still very much against single payer, especially if it is going to be modeled on the Canadian system. The system here is broken, but the Canadian system is not much better.

    For example, my step-daughter waited about 4 times longer in a Canadian ER when she broke a bone than my daughter did here in the U.S. Remember when Tipper Gore had a thyroid nodule and within days she had had it removed even though it turned out it was not cancerous? My mother waited over six months for thyroid cancer surgery in Canada. The wait for an MRI in Winnipeg is over 12 months. My father waited nearly 18 months to have tendons surgically reattached after he injured his arm.

    The father of a family friend was diagnosed with a brain tumor and was sent home to die. He was in his late 50′s or early 60′s at the time. His family sought treatment at the Mayo Clinic and he lived for another seven years, although it cost them over 200K. He was also often forced to fly from Manitoba to private clinics in Vancouver, BC for CAT scans because the wait was so long in Manitoba and the surrounding provinces. Three Canadian provinces currently allow private for-pay clinics to operate because waiting lists are so long and there is so much demand. Health insurance is illegal so only the rich can afford these clinics, or those willing to bankrupt themselves for care.

    I was born in Canada in 1966. As a child, I remember that my parents had to pay for some medical services. During my teens and early twenties, the medical system was completely free and and seemed to me to be good quality but it has degraded over time. There is rarely the political will to adequately fund healthcare and it continues to deteriorate. Wealthy Canadians, including politicians, seek care in other countries.

    Is single payer better than what we have now? I don’t know. Probably the only thing it offers is a kind of safety net for the middle class and working poor, as opposed to just the very poor and the elderly. I can definitely say that the quality of care those with good insurance receive here is much better than what the average Canadian receives, however. Having seen both sides, I would much rather everyone receive the kind of care I receive here with good insurance than go back to living under a system like Canada’s. If we are going to go single payer we will need to do a much better job of making sure that the quality of care is what it ought to be for all Americans and to ensure it will remain adequately funded. I haven’t yet heard how those two things would be addressed.

    I fully expect that commenters here will jump down my throat for saying what I have said. I have been accused of being a concern troll. Far from it. I don’t have much time to spend on blogs lately, even ones like this that I greatly enjoy, and I can’t stay online today to defend myself. I only hope people will read what I have written, and then take the time to learn about the Canadian system, warts and all. Read what Canadian news outlets have reported about emergency room deaths, doctor shortages, waiting lists, hospital and clinic closures and funding shortfalls. Maybe they’ll still be in favor of single payer, but at least they’ll have a more realistic idea of what they’d be getting.

  29. Hammer of the Dyke says:

    The scandals at Walter Reed were due, in large part, to privatization of certain functions (you know, all those no-bid contracts? It doesn’t take long at all for the extreme inefficiencies of capitalism to fuck something up completely). There is no human endeavor that has no failings, but VA and military healthcare is some of the best available in the USA, in terms of access and treatment. Why do I say this? Because I am an ER physician who has worked for the military and now works for a not-for-profit hospital (but in the USA, not-for-profits must compete with for-profits, so there really is no difference between them).

    Americans seem to believe their own propaganda to an impressive degree. I have patients tell me, “We have the best healthcare in the world.” No, actually, you don’t. You’re down there with Romania for health outcomes. Sorry. The so-called horror stories from other countries are then trotted out. Oooohhhh…waiting lists, blah, blah. People, there are waiting lists here, too. I routinely send people out of the ER for various issues, say broken bones or gallbladder flare-ups. They are directed to schedule an appointment with a surgeon, who will perform their surgeries at her/his convenience, i.e., put them on a waiting list. I routinely have patients and their families in my face because they want their issue taken care of now, goddammit, but they don’t understand – their insurance carrier has decreed that gallbladder surgery is now an outpatient procedure, so they have to wait. (As an aside, sometimes waiting is a good thing, especially in orthopedic cases – something learned from the injured soldiers in Iraq, who were stabilized and then flown out, giving swelling time to go down, and thus, to decrease long-term complications. That rotten military healthcare actually does much research to benefit the public). Anyway, my practice is totally dictated by insurance company requirements. I can’t treat or prescribe what I think is best for the patient. Humana, Aetna, Cigna, etc., tell me what I may do – and then, they fail to pay their claims. Humana owes my physician group over $600,000. The only time I don’t have to negotiate is with TriCare or other publicly funded healthcare. Hmm.

    What really irks me is the claim that poor people get “free” ER treatment, and such is adequate to their needs. Utter crap! First, sick people are turned away every day from my ER because they do not have insurance. Again, I do not determine whether a patient is admitted, hospital administration does. I send patients with cellulitis out with a prescription for antibiotics, praying that they can afford the medication. If they can’t, it amounts to no treatment and a big, fat ER bill. There are many such cases I would prefer to admit for IV antibiotic therapy with, say, Vancomycin, particularly older patients with co-morbidities, but I am told “No!” The poor and uninsured come to my ER in droves, out of desperation, but we do little to nothing for them (as little as we can get away with!), and that, my dear Americans is the raw, ugly truth. (“Yeah, but I know a teenage, immigrant, welfare mother on drugs that got free plastic surgery…whatever).

    When you have profit-motives attached to healthcare, you have profiteering (as well as profound immorality), an ongoing horror story. Medical procedures and medications cost 3 times as much here as they do anywhere else. I routinely send uninsured patients to Canadian or Mexican sources to obtain drugs at up to 75% off of what they would pay here. Americans, propagandized to the end, always ask, “Well, isn’t that dangerous? Who knows what’s in their drugs?” Um, actually, both Canada and Mexico have health regulatory agencies with teeth. They don’t allow what amounts to factory seconds to be sold there as they do in the US market. Profit comes first, people. Doesn’t the Creator support capitalism? My patients often tell me that the drugs they buy from Canada or Mexico seem to work better than the same products purchased in American pharmacies. But, someone needs to support Big Pharma, so they can do all that important research, right? Wrong, oh propagandized one! You, the taxpayer, fund the research through NIH and university research grants, then the FDA, after approval (second-rate studies are A-OK), licenses a company to manufacture said drug for a period with an exclusive patent – everybody wins (except the people who need the drug, but hey, there is money to be made)! These companies run so many shenanigans one cannot keep up with them all. For example, insulin used to be a fairly reasonably priced medication back in the day. Then, through the marvels of genetic engineering, the costs of producing insulin went down, but the price went up. Further, new insulins were developed that helped diabetics better control their blood sugars. These insulins were initially released as OTC items at the same price as other insulins. However, once it became apparent that these new insulins were a big hit among insulin-dependent diabetics, Eli Lilly and Novo-Nordisk switched their new insulin lines to prescription only and raised the prices over 100%. In Canada and Mexico, the prices of the new insulins remain on par with the others and they are OTC items. Hmm. Of course, Big Pharma will tell you that they had to do it. There’s a Klaus von Bulow hiding in every closet, don’cha know?

    Of course, I could go on and on, but don’t trust me – I actually know what I’m talking about. Let me add up the cases I’ve felt guilty about this week, but my hands were tied because of the way medicine is run in this country. What really weirds me out is that people have been propagandized to worry about doctors going broke. Oooohhhh, if doctors don’t get paid enough they’ll refuse to help anyone. Well, if that’s true, fuck them! These are not the kind of people you want practicing medicine, anyway. Usually, when I call another doc to admit or to consult on a patient, the first words out of her/his mouth are “Does the patient have insurance?” Yes, people, sometimes it’s other doctors who force me to cut patients loose. These are the people about whose incomes you are terribly worried? I’ll tell you another insider no-no: most of the malpractice claims that are filed have some merit (there are a lot of fuck-ups in the best medical system in the world, after all), but it was insurance companies that funded legislation to cap judgments awarded to plaintiffs. Yep.

    Help me to help you. Tell your Congress to offer a single-payer, public option. End this greedy madness that is eating me, and every other medical practitioner with a conscience, alive.

  30. votermom says:

    RKMK, I think I would refuse treatment that would bankrupt my family. It’s emotional blackmail what hospitals do to patients now.

  31. RKMK says:

    For example, my step-daughter waited about 4 times longer in a Canadian ER when she broke a bone than my daughter did here in the U.S. Remember when Tipper Gore had a thyroid nodule and within days she had had it removed even though it turned out it was not cancerous? My mother waited over six months for thyroid cancer surgery in Canada. The wait for an MRI in Winnipeg is over 12 months. My father waited nearly 18 months to have tendons surgically reattached after he injured his arm.

    And when I broke my nose in gym class, my ER doctor warned it could take weeks to get an appointment with a plastic surgeon. We got one in three days. My mother’s cataract surgery was initially scheduled five months away, and was moved up by three months. My father’s surgery for his carpal tunnel tendonitis? One month wait. He was offered to get bumped up, but he’d already scheduled his work schedule to accommodate the surgery, so he encouraged them to give the spot to someone else. For every horror anecdote you’ve got, I’ve got a counterstory on our system working better than we expected.

    We do have a problem with doctor shortages, especially in rural area… because many graduates migrate south so they can bill extortionately high for services. My parents were dependent on their local hospital/clinic when our GP retired, and they couldn’t get a new family doctor. I believe we’ve made it a bit easier for foreign-trained doctors to get certified here now, though, and in the last few months a couple of doctors have moved to town – one Russian, one Japanese – and now they’re just happy as clams.

  32. Huan says:

    Since when has the US government did anything better and cheaper? anything? Many doctors currently do not take new medicare or medicaid patients because of onerous regulatons and poor reimbursement. We all know that we get what we pay for and do not get what we do not pay for. The current problem with health care in the US is not quality. Our quality is better than Europe. Our cancer survival is better stage for stage for instance. This was published in lay press 1 or 2 years ago. Inevitably someone will drag out infant mortality data. What they do not know is that we record any live births as infants and will do whatever it takes to keep that infant alive. Many country will not do so and record this as aborted births and thus these deaths will not show up as infant mortality. We also spend a tremendous amount of resources in the last 30 days of patient’s life. To try to keep them alive longer as well as more comfortable. Thus when we use mortality as a calculus we disregard quality of life as well. In medicine there has been a tremendous effort in the past 30-50 years to move beyond just saving lives but to also preserve quality life. Yes there has been tremendous cost associated with this duality of life and quality of life. But the result has also been a tremendous amount of medical innovation. We are the world leader in healthcare. Would we still be without competition and cost?

    The real healthcare issue has always been about cost rather than coverage. Uninsured people gets the care they need when they need it. Yes they will get a bill but many hospital also write off the bills for tax advantages. And no, without coverage you might not get preventative care, but other than mammography (of which there are a tremendous amount of free services available), there has been little evidence to suggest that they increase or improve lives. Interesting enough, the same calculus will be used by the government to decide which care is appropriate to spend on.

    So again the issue with healthcare is one of cost. And lets be serious about this, there are only two ways to control healthcare cost: for patient to ask for less or the provider to give less. That is just basic of any budget. Yes there is some fat to be trimmed from greater efficiency. But these cost savings only occur for 2-4 years after the new program. This was seen again and again in any healthcare system adopting a new model, whether it be paid for service or HMO or whatever model that has been used to control cost. The same with government healthcare. The rate of increase in healthcare cost is similar in socialized medicine as it is with the US system. Cost savings is limited, and when it rises again, either we will still have to pay more and or we will get less if there is only one payor.

    personally i would rather have a choice, to be insured or not to be insured, to go with plan A with a $1000 rather than $5000, to go with Aethna rather than HCA, etc. More importantly, I rather be the one choosing not to havve chemotherapy for terminal cancer rather than have bureacrats tell me i cannot get it. We all know that we get what we pay for and do not get what we do not pay for.

    One last thought. Doctors remain professionals. They do not take out tonsils just to make money. And as a patient, don’t you think a surgeon taking out your appendix should be paid more than a doctor prescribing antihypertensives? And which would you want to be the best in the field. Among our best and brightest. Would doctors be our best and brightest if there is no rewards to be thus?

    sorry for the typos and grammar, trying to get home before too long.

    i enjoy your blog and hope you keep blogging.

  33. Huan says:

    one last last thought.

    our over all mortality maybe comparable to Europe, but we have a whole lot more violent crimes related deaths as well. thus our results are much better than the stats may suggest.

    beware of stats.

  34. Jackie says:


    How wonderful that you and your family had a different experience. I would bet that quality of care depends a lot on what province you live in and how close you are to an urban area. My family mostly lives in Manitoba and are three hours away from a major metropolitan area, although my stepdaughter does live in a city. Does location excuse the poor care and long waits they experience? My husband’s grandmother lost a leg to a bacteria similar to flesh eating disease due to a lack of prompt follow up care of a foot injury. She also lives in the same rural area. Does that make it okay?

    The point I would like to make is that if the US adopts a similar system we need to be much, much better at ensuring that all Americans receive excellent care, not just those who live in populous, wealthy states. The man who died in the waiting room of a Winnipeg ER recently is no less dead than the people who die waiting for care in American emergency rooms. It worries me that I haven’t heard quality of care issues under a single payer system adequately addressed, and it worries me that there is currenlty no real way to ensure adequate funding going forward.

  35. Violet says:

    Huan, with all due respect: almost nothing you say is true. As Chris Clarke would say, wrong wrong wrongity wrong!

  36. Toonces says:

    Jackie, are you under the impression that Americans in rural areas have access to the same medical care that Americans in urban areas do?

  37. Jackie says:

    Toonces, of course not, but if the aim is to improve healthcare for Americans then shouldn’t rural areas and poorer states expect the same quality of care as anyone else, especially under a single payer system? It’s an example of how things are not necessarily better under single payer.

  38. Toonces says:

    Right, not necessarily better, but certainly not worse.

  39. Jackie says:

    Well then, if it’s not better then what’s the point?

  40. Toonces says:

    Well, I take that back. I think all Americans receiving health care is necessarily better.

  41. Toonces says:

    Jackie, I have good private health care. I don’t need the system to change at this point. The thing is, I care about people who are going into bankruptcy and/or dying because of greedy CEO’s. I feel that’s barbaric and sociopathic and not conducive to a healthy society. I can’t make anyone else feel the same way.

    But you’re arguing that socialize medicine is automatically dangerous and worse than what America has and that’s simply not true, not by a longshot.

  42. Violet says:

    Of course it’s better! Jesus.

    Jackie, please understand that the American health care system is currently just about the worst in the industrialized world. We pay twice as much per capita as anybody. And 47 million Americans are still uninsured!

    And the coverage people do have is largely inadequate. Medical costs are the leading cause of bankruptcy, even for people who have health insurance.

    Our system is fucked.

  43. Alice Paul says:

    There was a doctor shortage here for a while but, it has vastly improved. It lasted about five years. Also, the person above with the “horror” stories ..these prove nothing! We can go back and forth all day about this individual story in Canada or that one in the U.S. and it’s the same ..I have not found wait times in my city *or any other here as I’ve lived in three major Canadian cities* to be bad at all IF there even was a wait time!

    New clinics are being opened and Canada has made efforts to bring in new doctors. For instance if you agree to go into family practice *that was the issue as most doctors here were becoming specialists!* then the Canadian government will pay for part of your medical school training if not all! You have to agree to stay in family practice for at least five years. Well, it’s working.

    And who up there thinks specialists are not paid more here? I am agog! I tell ya agog! Some of the information Americans believe about the CURRENT system up here is amazing.

    So many Americans were coming here using the health care cards of friends and family here that Canada had to change it’s health care cards to having photos on them. Before *and my sister did this* Someone could visit you, take your card that only had your name and number on it and go to a doctor and get it paid for here! Now you have to had a holographic i.d. with a photo so no more urgent out of country care that is under the radar and saps the system up here.

    Yes, for a while some rural areas had fewer doctors. Canada is working hard to address this and I frankly have seen a huge improvement in the last few years especially.

    I would urge you to write to a Canadian or visit here and randomly ask ANY person in this country if they want to switch to the U.S. system…I will fall over if you get one person who says yes.

    Now have some people as evidenced here had something bad happen, or maybe two somethings and things here? Probably. I’ve had one or two myself but, I realize those things can and DO happen in the U.S. and then I would have to PAY for someone who gave me fucked up treatment, and then have the insurance company tell me I have to keep going to X bad doctor because he’s one of the only specialists covered under my expensive HMO insurance.

    Thanks but, no thanks.

    And Huan, the Canadian government does NOT “run healthcare here” doctors and patients DO..the government just funds it, they do not make healthcare decisions!

  44. Violet says:

    if the aim is to improve healthcare for Americans then shouldn’t rural areas and poorer states expect the same quality of care as anyone else, especially under a single payer system?

    We’re talking about giving everybody health insurance, not disrupting the space-time continuum. Rural areas are rural areas: you’re lucky if you have a Wal-Mart and a doctor within driving distance. This will not change with the advent of universal health coverage.

    Of course rural people should have adequate care — no dying in waiting rooms, etc. But providing health insurance will not change the fact that urban people have access to nearby, varied care providers, while rural people have more limited options. That’s true regardless.

  45. Jackie says:

    I think that all Americans receiving excellent healthcare would be better. I firmly believe that what we would get is all Americans having access to mediocre care, and wealthier Americans paying for better care. Then, if we outlawed private medical practices that industry would move to other countries. The type of care regularily available now to those with cash or good insurance here would eventually cease to exist.

    Unless, of course, we have airtight legislation mandating a certain level of care and a rock solid commitment to adequate future funding. It almost seems like a constitutional amendment would be necessary, really. I think we are far from having anywhere near the political will to do what would be required to make single payer work here in any meaningful way.

  46. Toonces says:

    Sorry, above I meant socialized insurance I guess (single payer), not medicine.

    And there’s a shortage of PCP’s in the US with doctors going into specialization here, too. It’s one of the reasons we get about 10 minutes with them (the other reason being all the paperwork).

  47. Violet says:

    Jackie, if you think single-payer involves outlawing private medical practice, I think you have some misconceptions about what’s under discussion.

    As for your belief that Americans get good care now that will inevitably degrade under universal coverage, that just isn’t backed up by any study or national comparison I’m aware of. Instead, every study — including from doctors and medical professionals — points to the gross inefficiencies, excessive costs, and lack of adequate care in our system.

  48. Toonces says:

    Jackie, what we have now is most Americans receiving mediocre care, regardless of ability to pay, and many Americans going without care at all. And many of those paying for “excellent” care here never actually receive it because insurance companies find a way to deny their claims.

    Also, as has been said above, many countries that have UHC or single-payer also have supplemental insurance options and private clinics. Why would that be a unique impossibility in America?

    I’m not sure how to respond to the rest of your comment (constitutional amendments? why?), except that 73% of Americans support a single-payer option so the political will is there.

  49. Violet says:


    I firmly believe that what we would get is all Americans having access to mediocre care, and wealthier Americans paying for better care.

    Even if that’s what happens, wouldn’t that still be an improvement? As it is, most Americans with private insurance have mediocre care with inadequate coverage and very high costs, massive restrictions, and anxieties. Wealthier Americans have excellent care. One-sixth of Americans have nothing at all.

    Even mediocre for everybody would be better than that.

  50. Jackie says:

    Violet, perhaps I am not expressing myself very well. My intent was to compare the Canadian and US systems. Private medical practices are against the law in Canada in most provinces. Yes, single payer does not necessarily mean that would happen here but with prices for care set by the government, it does not seem like it would be out of the realm of possibility that medical professionals who wanted to be paid more than what was offered by the government would leave the country.

    All I can say is I related my own experiences and those of my family, and expressed my own opinion. Perhaps I’ve only seen the worst of the Canadian system and the best of the US system. In any event, my own experiences are all I have to go by.

    Please don’t think I feel that nothing needs to change here. Our system is difficult, wasteful and even cruel. Of course everyone ought to have a right to medical care, but anyone who takes the time to really learn about the Canadian system will see that it is not the utopia it is made out to be. Perhaps single payer the way you have envisioned it will be better.

  51. Toonces says:

    Warren Buffet gets great healthcare so let’s not do anything to improve our system or save “poor” peoples’ lives.


  52. Toonces says:

    Yes, single payer does not necessarily mean that would happen here but with prices for care set by the government, it does not seem like it would be out of the realm of possibility that medical professionals who wanted to be paid more than what was offered by the government would leave the country.

    Where would they go? That’s a serious question. America’s the holdout in the industrialized world and I doubt they’d be making more in developing countries so…??

    Also, as I understand it, there are many incentives for doctors in other countries to make more money if they want to, by improving their quality of practice…sort of like most other jobs.

  53. sister of ye says:

    I firmly believe that what we would get is all Americans having access to mediocre care, and wealthier Americans paying for better care.

    Uh, darlin’, barking up the wrong tree with that argument. That’s exactly what we have now. For those who can get care.

    I live on the U.S.-Canadian border and work with a number of Canadians. The worst complaint I’ve heard was about wait times for specialists. But the wait times quoted were no longer than what I wait, and I have what has actually proved so far to be a decent HMO.

    My niece’s dad had to wait more than a year for a kidney transplant at a local premier university hospital. He wasn’t awaiting a donor, since his brother was providing one. He looked at death’s door when they finally gave the go-ahead. I never did get the story on why they waited so damn long, but I’d bet insurance or some other profit motive was behind it.

    That doesn’t even get into the drug company that decided to no longer market my effective asthma inhaler, replacing it with one for which I had to pay the “name-brand” co-pay, four times higher than the generic. That’s my acute attack inhaler, the one I keep with me constantly, as in potentially a matter of life and death.

    Sometimes I’m tempted to go down the riverfront with a big sign inviting: Canada, please invade! Don’t forget to bring your health care with you. (We already have hockey and Tim Horton’s donuts.)

  54. Aspen says:

    I very strongly urge those of you with reservations or questions about Single Payer to read the FAQ at the PNHP (Physicians for a National Health Care Plan) website. It answers many of the questions that have been asked to Violet on this thread. She has done an excellent job explaining them, but reading the FAQ will really help, I think.

    The FAQ is here:

    Speaking as a single-payer advocate myself, I in no way think medicare is a “panacea”; but I can’t understand why anyone thinks that longer waits for care, even if that were true, would not still be better than NO covered care, which is what millions of people in the US already get (and it’s just going to continue to get worse and worse, as fewer and fewer employers can afford to offer private health insurance). I don’t get it.

  55. Jackie says:

    Toonces, it’s my understanding that the US and the UK have far more doctors per capita than anywhere else in the world. I would imagine that is likely because they can earn the most money in those two countries as well as enjoying a good quality of life generally. I also understand from talking to my ex-pat friends from Ireland that the care under the public system is terrible there. They are all techies who have great insurance and talk about how wonderful the medical care (with insurance) is here in comparison.

    I suppose if all the relatively wealthy countries in the world put a cap on earnings for medical professionals then indeed doctors would have nowhere to go. I don’t think that is likely to happen.

  56. Violet says:


    We do have a problem with doctor shortages, especially in rural area… because many graduates migrate south so they can bill extortionately high for services.

    Yeah. I didn’t go into this in the post, because I was trying to keep it simple and just focus on the resource re-allocation issue. But the profit issue is not just with insurers; it’s with the whole for-profit system, including doctors. Bonus points to anyone who has the link to that New Yorker article dissecting the health costs in that little Texas town, where the doctors and clinics went bananas with ultra-high-tech uber-expensive totally unnecessary tests and so forth. Because the insurance would pay, and because it was fantastically lucrative.

    Yep, a single-payer system, properly administered, would put an end to that. As it should. A huge contributor to our spiraling health costs is the profit-driven market — contrary to what Republicans like to say.

    Medicare for All would be not just an expanded Medicare but an improved Medicare, with adequate payout rates. This would be possible because it would be a universal system — not just a system for your grandmother — and because THE GODDAMN PRIVATE INSURANCE MONKEY would be off our lawmakers’ backs.

  57. Toonces says:

    Right, they’ll run screaming from our single-payer system… to another single-payer system. Because America, left-leaning country that it is (*SNORT*) will make sure there are no private insurance options or clinics, even though other countries have managed it. Ookay…


    Canada may not be a healthcare utopia, but Japan and France come pretty damn close, IMO, at least compared to what we in the US have. The thing is, every time someone brings up the prospect of single-payer, people start acting as if it’s going to kill us all (no, it’s not a plot to exterminate old people), so we can’t get there.

    I’ll settle for Medicare for all instead for now, and hope that after that system is implemented, doctors will be better able to concentrate on the needs of their patients and focus on things like preventative medicine and having good relationships with the people they’re treating (which seem to be two of the hallmarks of what makes Japan and France’s systems work better). Of course, I’m not holding my breath and one of my long-term goals is to move before the 2012 election.

  58. Violet says:

    I also understand from talking to my ex-pat friends from Ireland that the care under the public system is terrible there.

    I note that this would be more relevant if anybody were proposing that we implement the Irish system here.

  59. Violet says:

    Off topic: Toonces, I need you to use a better email address. What you’re doing is throwing all of your comments into spam, and I have to manually fish them out of the filter.

  60. paper doll says:

    It cracks me up to hear of horror stories associated with UHC….well hell we have horror stories up the wing wham here , but we have to pay though the nose for them. It would be nice to wait for okay care and not be personally billed thought the roof for it. Somehow that’s forgotten in the back and forth

  61. Toonces says:

    Woops, sorry Violet. It should be fixed now.

  62. myiq2xu says:

    If you haven’t seen “Sicko” you should. It’s not about people with no medical insurance. The movie is about people who thought they had good medical insurance until they really needed it.

    If you get so sick you can’t work will you be able to afford premiums? What treatments does your insurance consider “experimental” and therefore not covered?

    Is there a maximum level of benefits in your plan (hint: there is)and how much is it? If you need $100,000 of care and your plan maxes out at $50,000 can you afford to pay out of pocket for the rest?

  63. janicen says:

    Some excellent points were made above about employees being less mobile and employers having more control over their employees in our current system of employer provided health insurance. I’ve often asked myself why employers wouldn’t jump at the chance at passing such an enormous expense off to their employees and the government? The only answer I can come up with is that, with a single payer system, employees would not be tethered to their employers because they need their health insurance, and would therefore have the mobility to shop around for another job if they find their working conditions unacceptable.

    People have been frightened (and deliberately so) into believing that healthcare will change. Healthcare will not change, the payer will change.

  64. Violet says:

    Thanks, Toonces. I hope it works now.

    janicen, all the single-payer proposals I’ve seen involve payroll taxes of some kind instead of the existing premiums employers pay. So there would be a net savings for employers, but it wouldn’t be a free ride.

    As for employers’ attitudes: who’s to say they wouldn’t jump at the chance? I think a lot of employers would welcome a fixed payroll tax in lieu of the ever-increasing cost (and nightmare) of private insurance plans.

  65. Alison says:

    Violet, thanks for the info. That was interesting and it is making me think twice about single payer.

    But I find some comments in this thread as one sided as the typical capitalist who loves the competition of the US health care system and doesn’t want to hear a single bad thing. I’ve noticed some people just don’t want to hear any sort of analysis over British and Canadian systems unless it is a glowing review. There are indeed horror stories in these countries and the anecdotes that I presented are just as relevant as the anecdotes we can go over regarding the fucked up US system. Anecdotes do have a level of relevancy but of course do not present the whole picture. Statistics can complete that picture. Throw’em at me if you like. I’m just in a learning stage, as I think most Americans are at this point with the topic of health care.

    But from what I already know I can say two things: I do not want to keep our present fucked up private system. And I do not want the Canadian system. Since Canada is single payer this is what I thought single payer would look like here but I’ve learned today that it can be different.

    BTW, I do have relatives in Canada and one is a doctor who is an activist involved in reforming care in Canada.

  66. Violet says:

    I’ve noticed some people just don’t want to hear any sort of analysis over British and Canadian systems unless it is a glowing review.

    Not to beat a dead alpaca, but the British system is irrelevant. As is the Irish. We’re not talking about implementing national health care. So those comparisons don’t make sense.

    As for the Canadian system, there are differences between their system and what we would have, which it seems important to point out if we’re going to guess what single-payer would look like here. This is what people are trying to accomplish with their comments. As for the anecdotes, it’s frustrating to hear anecdotes when we have the same kind of thing already happening but a thousand times over.

    When people come in and say, “My uncle didn’t get treated in Canada and I hear health care is terrible in Ireland,” yes, you’re going to get push-back from people who are trying to keep the discussion relevant and the comparisons measurable.

  67. Sandra S. says:

    Is this it?

  68. Hammer of the Dyke says:

    ” Many doctors currently do not take new medicare or medicaid patients because of onerous regulatons and poor reimbursement.”

    Really, is that what the Libertarian Weekly is saying? I loves me some Medicare patients. I get reimbursed within a reasonable time and I don’t have to argue about treatment. The doctors who are not taking Medicare/Medicaid patients are just greedy, pure and simple. Not palatable, but true. There are certainly regulations associated with CMS but these are “Core Measures,” established by research to improve patient outcomes (anyway, it only takes a small amount of documentation to countermand core measures, if they are not applicable). You sure you want some out-of-date dope (that would be most doctors) to decide that what they learned in 1974 is sufficient? By the way, cancer outcomes have improved because of publicly funded screening programs which detect cancer earlier (oh yeah, CMS requires these screenings). This is not a great achievement of cancer research, but of public funding, as usual.

    Speaking of research, the USA is not the center of medical research in the world, either. Most of the protocols that I use in patient care were developed in countries with socialized healthcare. ACLS protocols come from Ireland and many trauma protocols come from Israel. The EU is actually at the forefront of medical research in many areas. One of their most impressive contributions has come in the area of blood conservation. Blood transfusions are sometimes necessary, but are associated with a host of potentially expensive complications, especially TRALI. Many surgical procedures that required a lot of blood, like hip replacements, have been redesigned to require no blood. Nope, none. The USA is only now starting to pick up on this established practice in Europe. You see, socialized medicine often incentivizes practices that benefit patients and decrease costs, unlike the USA, which incentivizes profit.

    “The real healthcare issue has always been about cost rather than coverage. Uninsured people gets the care they need when they need it. Yes they will get a bill but many hospital also write off the bills for tax advantages.”

    I think I made it pretty clear in my prior post that the uninsured do not get care when they need it. I turn people out of my ER with as little treatment as possible, not because I want to do this, but because the hospital refuses to cover my proposed plan of treatment. They get a prescription and discharge instructions to see their PMD. Yeah, right. And if you think the hospital just writes off these bills while singing la, la, la, you are seriously deluded. Hospitals pursue non-payers rabidly, hiring the vilest collection agencies or lawyers to go after the sick and poor.

    “One last thought. Doctors remain professionals. They do not take out tonsils just to make money”

    Really, you don’t know many doctors, do you? Healthy tonsils and appendixes are removed galore – called an incidental removal – and then the patient is billed for an exploratory lap. This idea that doctors stand at the apex of scientific reasoning really needs to go. Doctors have minimal preparation in the hard sciences. The requirements are all at 101 levels, and most major in biology, not chemistry, physics or mathematics. All it takes to succeed in medical school is a good memory. I’m not saying that doctors are complete idiots (some are) but that their intellectual prowess is vastly overrated (I admit this, but my colleagues will not). Anyway, they are compromised by profiteering, so you must always consider very carefully the advice given to you by a physician. I have seen so many patients bullied into procedures by specialists coming to see insured patients in the ER. “I came all the way down here to see you and give you my advice, and you aren’t sure? Well, I’m sure and I went to medical school – you didn’t.” Yep, that’s verbatim.

    “And as a patient, don’t you think a surgeon taking out your appendix should be paid more than a doctor prescribing antihypertensives?”

    No, I don’t. Appendix removal is, usually, an easy procedure, largely devoid of the presence of the surgeon. Control of hypertension is an ongoing nightmare that requires substantive monitoring. In socialized systems, this monitoring is incentivized – meaning that the physician is paid more when her patients have good BP control. In the US, you’ll get a prescription for the newest, latest-and-greatest, most expensive BP med, and you’ll be lucky to see the doc again in 3 months. “Bye! Hope you don’t stroke out!” I see patients every day who have run out of BP medication and couldn’t get in to see their primary doctors. Yes, every day.

    “And which would you want to be the best in the field. Among our best and brightest. Would doctors be our best and brightest if there is no rewards to be thus?”

    Are you seriously under the impression that the best and brightest are here? Oh, dear. Most physicians simply do not keep up with the latest developments in their fields. They are too busy because they must work everyday, not to pay malpractice insurance, but to make payments on a style of living that befits their own narcissistic judgment of themselves (college tuition for the 3rd set of kids you had with the 3rd trophy wife can really wear a guy down). Fairly recently, I had a dickhead surgeon scream at me because I did not use heparin, but saline, to maintain patency of an arterial line. I told him that heparin wasn’t commonly used since, oh, the early nineties (and he did not thank me for putting the line in, either). Some of the “best and brightest” are affiliated with my institution, but when I call them to admit patients, they whine for half an hour before we can get down to business: “Why don’t you admit this loser? Why did you call me?” When I tell them, “Because you’re on call. You have to admit him,” they respond with, “You’re a nasty bitch. You’re gonna EMTALA me, I’ll kick your fucking ass!” Then, they punish the patient by not showing up until 5 minutes before the deadline and refusing to give orders to the nurses to care for the patient, “I can’t give orders, I haven’t seen the patient. Get the ER doc to give the orders.” They don’t thank me for doing all of the work for them, either. This, Huan is the actual sound of the system that you seem to believe is a boon to producing the best and brightest. Seriously, get a clue.

  69. Toonces says:

    A nurse here in CO exposed some 5,000 people to hepatitis C because she was stealing drugs by replacing clean needles with her used ones. It’s a horrifying anecdote, and now a lot of people are facing illness because of her carelessness, but no one is claiming that it happened specifically because our system is privatized, as it could happen in other systems where there isn’t enough oversight.

    Universal access to care is objectively better, glowingly even.

  70. Violet says:

    Yes, Sandra, that’s it! You get the prize. What do you want?

    Alison, I didn’t mean to sound short — I hope I didn’t. I fully realize that there are horror stories everywhere and I don’t imagine that single-payer will be perfect. But I think people here are just trying to keep the comparison relevant and on point. It’s easy to get bogged down in dueling anecdotes.

  71. Sandra S. says:

    Uh, I don’t know. Maybe one day you could make a post about the intersection of an authentic personal sexuality and the learned expression of sexuality within a patriarchy… or a sticker?

  72. masslib says:

    Violet, for the Canadian naysayers, apparently we already have those problems and they are not related to health care finance:

  73. Violet says:

    Hammer of the Dyke, I thank you profusely for the detailed reply to Huan. It was much more useful than my “wrong wrong wrongity wrong.”

    Sandra: I’ll do the sticker.

  74. Violet says:

    Actually I would do the sex post, but it would attract leering men and the ALL PORN ALL THE TIME crowd and I would have to take more Xanax. Which would involve a trip to my doctor for a bigger prescription and I can’t hack that.

  75. Tabby Lavalamp says:

    As a Canadian I can say I’d keep our clunky system any day. As an Alberta I can say the biggest problem with our health care system is our provincial government. Our conservative provincial government who keeps telling us the system is broken, makes deep cuts, tells us the system is really broken, makes more cuts, then tell us at the rate we’re going the system isn’t going to be able to afford to cover everyone in the near future so we’d better start privatizing.
    The only problem with a single-payer, government-funded system is when the government is filled with right-wing ideologues who put their “government bad/free market good” fetishes ahead of the welfare of the people.

  76. Violet says:

    “government bad/free market good” fetishes

    You know, I remember when people thought Milton Friedman was a lunatic.

    I remember being in college during Reagan’s first term, and my econ professor treating “supply-side economics” like some kind of jokey cult belief (which it was).

    Astonishing how much damage the right wing has done with their batshit propaganda.

  77. Hammer of the Dyke says:

    Oh no, I think wrong, wrong, wrongity wrong sums it up very nicely, but I’d love to see a post on Sandra’s suggestion. I’d even renew your Xanax prescription.

  78. Huan says:


    I have no problem linking my assertions.
    1. US cancer survival is better than Europe:
    2. US infant mortality:
    from Dr. Bernadine Healy, Former Director of the National Institutes of Health:
    3. 27% of Medicare budget is spent in the last year of a patient’s life.

    everything i have posted is true. while you and i may disagree on their significance, the facts as i have reported are independent of our personal bias.

    and yes, we all get what we pay for, and we will not get what we will not pay for. there is very little fraud in health care. what we pay for is direct personal care as we want them, as we want them, and a significant part of what we pay for also go to fund medical research as well as indigent care.

  79. Huan says:

    @ hammer of Dyke

    i assume you are an ER physician. amusing that you do not pick up your own sampling errors.

    1. yes many doctors do not take medicare patients. you can call them greedy if you want. but that does not negate the fact that many doctors do not take medicare.

    2. that cancer mortality rate has fallen has very little to do with screening with the sole exception of breast cancer. the rate has been falling for decades. but this was not my argument was it? my argument is that US is better than EU. and in my previous post i put up links that supports my assertions.

    3. medical research is not the same as medical innovation. many drugs and treatments are tested in europe. this is partly because their equivalent of the FDA is less stringent there. in fact, the FDA has been criticized for not approving drugs. why? because they do not meet the US FDA patient benefit to safety analysis. But seriously, beyond clinical protocols, which are translational in nature, innovative research is superior in the US. the amount of resources, the patents, the drugs developed, and the scientific publications from the US over welm that of the EU.

    3. the fact that patient are non compliant on the BP meds do not make you a better doctor than a surgeon able to take out an appendix, or a tonsil. or more worthy of better reimbursement. or are actually valued more. and yes, an appendectomy still require a surgeon. prescribing antihypertensive can be done by a PA or a NP. no?

    4. just why couldn’t they get in to see the PCP anyway? because they had to keep their schedule full in order to keep up with cost? so instead of 15 minutes per patient they see 10? so yeah, lets cut reimbursement for them as well!

    5. yes, heparin still has a role. low molecular weight heparin has equivalent, note equivalent not superior, anticoagulative efficacy but comes at a higher cost, substantially higher cost. yes it also has equivalent safety profile, and yes still preffered in pregnancy. sure it is a better quality of life drug as once a day injection is better than twice a day. half the shots, worth the cost? i thought you would be more interested in controlling cost for same gains?

    6. have you ever turned away a patient because he/she could not pay? was uninsured? it is illegal. i know you said the hospital told you so but does this make you an accomplice? a facilitator? or a doctor? I know you said you gave them less treatment. did they have an adverse outcome because of it? I am sure you are aware that in a lawsuit the hospital would leave you hanging on your own.
    i know many doctors who would push their hospitals to provide necessary care. too bad you let the hospital dictate your practice rather than the oath. why would you think the government would dictate better care than the hospital? or you?
    so no, uninsured does not mean untreated.

    7. maybe if you were more pleasant to your consultants, they might be nicer to you as well? and interesting enough, why did you have to call a surgeon at all? aren’t you the superior doctor? unprofessional behavior does not condone more unprofessional behavior.

    8. as a doc in a box, i assume you are on contract. so what leads you to such wealth of knowledge on medical economic? just curious.


    sampling errors, some understand it, others do not.

  80. Adrienne in CA says:

    Toonces, it’s my understanding that the US and the UK have far more doctors per capita than anywhere else in the world. I would imagine that is likely because they can earn the most money in those two countries as well as enjoying a good quality of life generally.

    Well if that’s true, I’m not sure what it would prove, since US and UK health care systems couldn’t be more different. The UK not only has single-payer universal care funded through taxation, the government National Health Service also runs the hospitals. Most UK docs either work directly for NHS or subcontract to it. And you’re right — they make a comfortable living doing it.


  81. octogalore says:

    Hopefully your proposed system would look beyond the traditional decisions as to what to cover?

  82. Hammer of the Dyke says:

    Huan, you don’t know what you are talking about.

    1, I don’t think greed is a good thing in a physician, but we can differ there. The doctors who don’t take Medicare want to earn more per patient. Then, of course, the patients come to me.

    2. You know, I can cite an equal number of studies that show screening for cancer has dramatically improved treatment outcomes across the board, not just for breast cancer, because the disease was caught earlier.

    3, You seem to think that better medical treatments are just bursting out all over, but that is crap. Sure, the USA is full of grossly expensive innovation, like LVAD, but really, quality of life is not necessarily improved nor prolonged. Even after cardiac by-pass, life expectancy is approximately 5 years, about what it would be if there were no surgery. The FDA is criticized by US citizens for not approving drugs, not because they are unsafe, but because the FDA, a captured agency, does not approve medications that cut into the profit margins of Big Pharma. There has been a potential cure for Type I diabetes in the pipeline for over 25 years, but the cure is cheap, so it is not developed.

    3. (You repeated it for some reason) Non-compliant is a rude and foolish way to refer to patients. I do not presume to know their situations and I do not tell people, with whom I am trying to establish a therapeutic relationship, that they are non-compliant. Instead, I ask them why they are unable to obtain their medications. You wouldn’t like the answers; they are not entirely to blame. Anyway, surgeons do minimal work – a snip or two – to remove appendixes. The first assistant, not a surgeon, makes the opening incision and usually closes after the snip. It’s really quite elementary. NPs and PAs certainly have prescriptive authority and the same difficulties managing patients with high blood pressure. I simply do not accept that surgery is magical and, therefore, requires vastly greater reward. If you’re in it for the money only, you’re in medicine for the wrong reasons. I made no claims to be a better doctor, but I think you’re personalizing this either a) because you don’t really understand what I’m saying or b) because you have some issues.

    5. “Just why couldn’t they get in to see the PCP?” I already told you that many doctors overbook their schedules to rake in as much money as possible. There are business management firms that have presentations for docs on “How to have a $10,000 day,” and many strive for this. This is why, when I call them, they can barely be civil to me.

    5. You are talking about the use of heparin for anti-coagulation in general. If you knew what you were talking about, you would realize that anti-coagulation in arterial lines can be handled effectively with NS and a pressure bag – and that is the standard of care. There is no reason to introduce heparin into someone’s blood stream when it is not required. Indeed, heparinization of art lines is not very controlled. If you want anti-coagulation, then of course, LMWH is worth considering in some clinical cases, but it has nothing to do with art lines. You don’t work for Aventis, do you? (My apologies to other readers for delving into a heavily jargon-laden topic).

    6. Thank-you for your advice, but you are profoundly ignorant. People who have no other recourse to healthcare except an ER are routinely screened out by mid-level practitioners before they even get to a doctor. If they are deemed not to have an “emergency medical condition,” they are asked to pay upfront or leave. No, this is not illegal. As it happens, my facility does not do this, but yes, Virginia, the American healthcare system rations care. No matter how hard I push, I cannot admit patients against the will of the hospital or the insurance companies. You are right: there are doctors of good conscience, like me, who try to buck the system, but I don’t always win. You seem to think doctors have much more power than we do, and sadly, most of my colleagues are so beaten down, they don’t try anymore. You haven’t the slightest idea, and I don’t like your tone.

    7. I must presume that your English is not sufficient to allow you to appreciate that what I was describing was consultants being rude to me, not me to them. Dealing with admitting physicians is one of the greatest stresses of Emergency medicine. Much of our time is spent trying to get on-call physicians to assume their responsibilities and to care for their patients, especially if they are poorly insured. Again, you personalize, but don’t know what you are talking about.

    8. I’m not a doc in a box, but hell, I think I’d like to be. Those urgent care centers offer a nice, cozy 9-5 without most of the headaches. My physicians’ group is contracted to provide EM services to the hospital system for whom I work. I do not claim to be an expert in economics, a pseudo-science if ever there were one, but I am not at all mystified by sampling errors. They are not arcane in the least, but again, your tone is rude. Tell me you don’t think I know what I’m talking about and why – don’t meander around making rude comments about lawsuits or your estimation of my economic mastery or my abilities as a physician. I get that you do not want the scales ripped from your eyes, but it is not necessary to be a troll.

  83. jz says:

    @Hammer of the Dyke,
    from one ER doc to another, I simply will suggest that part of the animus you receive is generated by your own attitudes. Yes, the job is tough, but a bit of humor, finesse, and compassion for your peers will go a long way.

    –your med staff is greedy? Do you work for free?
    –you didn’t mention your own contributions to the mess, ie. all that defensive testing.

  84. Jackie says:


    The UK allows private health insurance. They have a two tier system, like many of the other countries, including Canada, who are currently moving away from single payer systems.

  85. donna darko says:

    No time to read all 82 comments yet but Hamsher blamed the CPC for the “symbolic” vote even though her post is also about Blue Dogs. OpenLeft said they will fold on HCR before Blue Dogs but I think the article is about folding on inadequate HCR, one without an adequate public option. They’re blaming the victim. Ridiculous.

    If Obama hadn’t gone “bipartian” we wouldn’t be worried about Republicans any more. He enabled them along with the so-called “left.” If they had pushed Obama left from January 20 on, we’d have none of these problems with the re-emerging Republican party, right-wing talk show hosts and smears. They’d be irrelevant by now. But they had to have Mr. Post-partisian, Post-racial end of the Democratic Party.

  86. donna darko says:

    I just saw this hilarious (and true) exchange between SUGAR and Patsy via SUGAR’s twitter feed.

    PATSY: They spend so much time calling everyone racist, they don’t recognize the true racists in the room

    This is, without a doubt, the dumbest comment I ever read: “Until the racism, hatred and ignorance ends, we need to be bashed.”

    What the fuck is wrong with liberals? You give dems a bad name. Glad I affiliate myself with the clinton branch of the party.

    Why is everything “Racist” with the writers on Daily Kos? Every time you turn around there explanation? “It’s racist”. Ugh

    I have a serious problem with this because they are intentionally stirring up hate and race issues which will cause problems

    Anyone supporting that kind of racial divide did not truly understand the message of MLK. This is disgusting.

    Why are we going to allow people to ruin what some fought so hard for with civil rights by using the black community back to play the race

    SUGAR: where was all of that love for black folks PRE Obama? They make me sick at Daily Kooks. Stop torturing yourself.

  87. donna darko says:

    Exactly, SUGAR. The fake anti-racism conveniently began RIGHT AFTER EDWARDS DROPPED OUT January 30, 2008. As a cover/excuse for misogyny which was a tactic of the Obama campaign. It’s still a tactic for the Obama ADMINISTRATION not to mention 2012.

  88. LV says:

    I am British. For anyone wondering about the UK NHS, the following might be informative.

    On the plus side, the system works brilliantly for acute or life-threatening conditions, emergencies, and the like. If you need surgery, emergency attention, access to a specialist, you get it, and you get it quickly. If you have a major accident or are diagnosed with cancer, you don’t have to add fear of bankruptcy to your worries, and having grown up with that security, I can only imagine what a mental burden that must be to most Americans.

    Despite the NHS being pretty ‘socialized’ compared to most countries, private insurance and private doctors do exist and some people use them. Often (though not always) this is a status, aspirational, or vanity thing – ‘I can afford to go private’.

    Like any system, it has its problems. These are probably the same problems that would dog a private healthcare system – lobbying by big pharma – whether to government or private insurers – can affect policy; mechanisms intended to ensure standards of care inevitably lead to a one size fits all approach, which does lead some patients to pay out of pocket for private care if they want or need a non-standard treatment. But again, this is equally the case when private medical insurers dictate which doctors and procedures they will and won’t pay for.

    Not surprisingly, public opinion is overwhelmingly supportive of the principle of the NHS. Right-wing tabloids print horror stories – waiting lists, negligence, etc – which nearly always turn out to be unfounded or unrepresentative, but which nevertheless colour people’s perception of the NHS as an institution, despite the fact that opinion surveys always reveal that most people’s personal experiences of the service are positive.

  89. Huan says:

    @Hammer of Dyke

    1. i agree that greed is not a good trait for doctors. but wanting to earn more per patient does not directly translate to being greedy. if re-imbursement does not meet or exceed cost, then they are just trying to keep up.

    2. actually most pre-cancers are treated the same as cancers, whether it be lumpectomy for DCIS or breast cancer, or colectomy for severe dysplasia or cancer.

    3. if the FDA is in cahoot with big pharma, why would anyone want a government controlled single payor? regarding innovation and research, the vast majority is basic science and never pans out clinically. but what is learned do expand our basic understanding of human biology.

    4. yes non-compliance has many issues, from cost of care, to lack of understanding by patients, to lack of desire by patient. non-compliance is a nonjudgmental term.
    regarding surgeons vs pcps, your previous post minimalized the value of their work. you seem to be under the misconception that surgery and operation are synonymous. they are not. there are substantial thought process to deciding who, when, and what when (similar to non surgeons diagnostic assesment and clinical judgment on therapy) it comes to it. not to minimize the deed itself (which non-surgeons do not do). suggesting that surgery is magical is a strawman.

    5. do doctors overbook because they are greedy? or to make ends meet? I will suggest to you that any doctor that seek to be rich from clinical practice is a fool. most rich doctors are rich because they invest their earnings well.

    6. you railed against heparin in general. now you limit it to a-line. two comments. one, a-lines are largely to treat doctors and make it easier for nurses to draw blood. very little impact on overall patient outcome. they also carry significant risk of hand/finger loss. two, no, i do not work for any pharma.

    7. i am sorry you do not like my tone. and i will here apologize for that.
    maybe it is the particulars of your hospital. most indigent patients do get healthcare. there are already federal, state, and local resources for them to do so. there are also many non-proffit programs available to them. this is in part what i mean by sampling error. just because they do not get care at your hospital does not mean they do not get care anywhere else.

    8. did i suggest you initiated hostility with your consultants? but you did exhibit hostility in reference to how they treat you. it starts somewhere doesn’t it.

    9. i do not find arguments predicated on “you are wrong” or “you are ignorant” to be convincing in the absence of data of support. and feelings and anecdotes do not constitute data. it is erroneous to think that even if i am wrong you are right. ad hominem and threats to rip scales from my eyes certainly don’t make you a winner either.

    10. you might have leveled arguments as to what is wrong with the current system. we all know that it is imperfect. no one will tell argue otherwise. but this is not the same as an argument that single payor universal coverage under medicare would be better. as previously posted comparison of our current health care system with that of the EU, we do better in some ways. yes we spend more, but we also spend more on cars, TV, and other things as well.

    11. i am certain you understand that the enemy of good is perfect. that we can take a “broken” system and make it worse. some morbidity and mortality are not from patient disease but from doctors trying to make them better.

  90. Hammer of the Dyke says:

    I have never commented on my own comment before, but my exchange with Huan bothers me. Aside from the boring, point-to-point disquisition that few will want to read, I think what I really meant to say was this: life is not a controlled, double-blind study. I do not view my colleagues or my patients as sampling errors. The experiences I describe happen to real human beings. I feel great disquiet at some of the actions I am forced to take because of hospital or insurance regulations. That is a fact that needs no quantification. The medical system, for all of its successes (I don’t deny that it can be good for the well-insured), fails the majority of Americans. Access to care is very difficult, even for the well-to-do, but for the poor, it is next to impossible. The poor are not just a bunch of “non-compliant,” ne’er-do-well statistics. It is easy to look down on them in judgment, citing your plethora of teenage, immigrant, welfare-mother on drugs stats, but what kind of society views people in this manner? Until you’ve walked a mile in their shoes, what can you say about the issue? My patients, who, in and of themselves, might comprise a sampling error, tell me that they have problems accessing and affording healthcare. When they tell me this, it is a cri du coeur. Should I tell them that they should feel better because they comprise only a small percentage of individuals who are in such a situation? That doesn’t work for me. I hear these cries from the heart daily and I am often powerless to help as I would like. This eats at me, and it eats at every other physician I know who has a conscience. Again, this needs no quantification. People like Huan mystify me; it is like they believe they do not share in the human condition or that complex issues are easily reduced to mere tabulation and iteration. I do not know if he meant to be as offensive as he came across, but he reminds me of the bureaucrats spoken of in Christy Moore’s brilliant song, “No Time for Love:”

    Come all you people who give to your sisters and brothers the will to fight on

    They say you can get used to a war but that doesn’t mean the war isn’t on

    The fish need the sea to survive, just like your people need you

    And the death squad can only get through to them, if first they can get through to you.

  91. Covered Care says:

    Health care in America is great. If you are rich. And live in an area with abundant medical choices.

    I pay $950 per month for my PPO. I have access to hundreds of physicians and other medical professionals, my wait times are almost nil (exc. 4 weeks for a mammogram), and I live within 5 minutes of a Level I trauma center. There are 4-5 other stellar hospitals I can go to if it’s likely the big ER will be too crowded and my injury or illness is slight.

    So why is this only available to me and my “ilk”? Why isn’t this the standard for all? I realize people in less populated areas won’t have the option to go to as many places for treatment, but why isn’t everyone’s health care as hassle-free and competent as mine?

    Because I can afford it, that’s why. For now, I can afford the hugely expensive premiums and $500 in-plan deductible and 80/20 major medical and $25 co-pays.

    And when/if I can no longer pay? Tough s**t, right?

    Health care in America is all about privilege. There’s a huge divide between rich and poor. I don’t believe we “can’t” give great care to all. I believe we don’t want to because there’s no profit in doing so. And because those damn poor people shoulda been pulling themselves up by their bootstraps, ya know?

  92. jenjen1352 says:

    Speaking as a Brit, the sooner you lot get a system like ours the better. All treatment is free, all contraception is free, abortions are readily available and free, medicine is price-capped (£7 odd per item) or free, doctors are free. Everyone not on State Benefits pays National Insurance. Everyone gets the same quality care whether you have paid your contribution or not.

    Yes, there are waiting lists, and various other problems, but none of us have to worry that we can’t even afford to visit our own doctor with a bad back. We also get free treatment from other medical professionals, like physiotherapists.

    You can pay extra for private health care, but if you’re really sick you’ll be better cared for under the National Health Service in a nice NHS hospital.

    The NHS is friendly and informative, and has a centralised computer records system. Obviously a dangerously socialist organisation to be avoided at all costs! Oh, and should you need medical treatment while visiting the UK, you won’t have to pay for it either!!

  93. donna darko says:

    Read all the comments now. Who can forget Pelosi’s “symbolic roll call vote”? It is still useful to everybody to seriously push to the left like The Nation’s article said today.

    Something disturbing I noticed today is the lack of fight for HCR or even worry about its failure/Dems losing in 2012. It would mean Dems will not be in charge post-2012 but mainly that Hillary Clinton will never be President. They took her out of commission last year and Repubs taking over again in 2012 would mean she will never be President. Now that they sexually harrassed Palin off the stage, thry are focusing on Bachmann. Via BTD’s post about Obama’s lack of fight today is a new book about how Obama won the Presidency. In it, he says his biggest fear was Clinton not McCain but he demurs and said it was because McCain’s organization wasn’t as strong. Of course, we know the mentality of the “left”. He goes on to sat his election should not have been so easy and it made it harder for him to fight upcoming battles. We saw EVERYTHING all along. Clinton was a fighter readt on day one. She had experience and knew how to fight Republicans.The health care fight and downfall of Dwmocrats made me very sad lately. About a week ago, Taibbi wrote health care was dead, then C-listers pushed hard from the left, shook things up and got it moving again. The “left” has to continue this or we will lose to grassroots Republicans. What better message than the 10-page Conyers 676 bill?

  94. donna darko says:

    In the deep recesses of their minds, or more accurately, their brainstems, they fear a woman President more than anything. Romney, Huckabee, Gingrich, FREAKING BILL Kristol who took down HCR the first time, ELICIT NO RESPONSE.

  95. Hammer of the Dyke says:

    #83 JZ

    Sorry, but you don’t know me or anything about my modes of expression. Needless to say, what I might write anonymously, on an internet forum, is not what I say at work. I can’t imagine why you think that I would. Certainly, if you think I have no humor, compassion or finesse, you are seriously mistaken – I was a military doc for 25 years.

    Yes, I think my med staff is greedy, and I’m entitled to that opinion. I do work for free, actually. I only work for the hospital 2-3 days a week, for a total of about 24 hours. I do not make even a six figure income, but I have enough. The rest of my time I spend working in a free clinic sponsored by a charitable organization. I’m sure you’re sorry you asked.

    Oh, JZ, I am more than ready to cry mea culpa. You are absolutely right that we do a tremendous amount of defensive testing, practicing medicine for the courtroom. I know that I am not the only ER doc who fears rich, well-connected patients. I hate it when I go home worrying about the minute pebble I left unturned – I think I got all the stones (I hope, I hope). You know the feeling.

    Down to brass tacks, though, I think a goodly percentage of my physician colleagues is impaired, too emotionally immature to be effective. Narcissism, arrogance and endless pissing contests kill people. You know, you have to shudder when studies report that physicians spend the majority of their very limited time with patients talking about themselves. You know that we do not call out our colleagues for shitty practice (sometimes even the most egregious), though we might grumble about it amongst ourselves – that doc who screams at and intimidates your nurses, bullies you and your patients and then smiles in your face as he delivers a loud and stentorian lecture to you. Ain’t that grand? Again, mea culpa. In the military, I had redress for these sorts of behaviors, but in civilian world, well… Of course, sexism is rampant in medicine and hampers patient care. If you are female, you just might be better off never seeing a male doctor. You know very well what I’m talking about. I do believe that most doctors are in medicine for the status – many that I meet don’t even seem to like people. Sad.

    What you don’t know is that I love what I do. I like people and I like helping people. I am trained in emergency and environmental medicine and as a medical paratrooper. I am a military creation all the way; in fact, I came to the USA to train your military to do what we do back home. I will return there once my goddess of love finishes her degree. I hope I have sufficiently smashed your stereotypical notions of me, but if not, so be it.

  96. Kiuku says:

    “If the government is giving me some crap doctor or if I have a condition that I DO NOT want the government to know about I’d like the option to go private.”

    Well, private insurance companies now want, and they have the power and influence to make happen, your medical history to have a credit score. They want a centralized database, that all doctors can access, as well as your current credit score.

  97. Kiuku says:

    I will always feel ripped off paying $1000 or my company paying $1000 for shitty healthcare when I got emergency healthcare by some of the best doctors in the world, in Jordan, for about or less than $50.

    I just can’t do it. I don’t believe in insurance. I think it rips people off. If you are paying $950 a month because you might get sick, you are being ripped off. That is a lot of money.

  98. Toonces says:

    I have a question:

    What do other industrialized nations do when it comes to long-term care/nursing home facilities? Are they paying $6,000+ a month, like us?

  99. alwaysfiredup says:

    Here’s my issue: I totally agree that the poor in this country get shafted on healthcare. However, they have Medicaid. And yet they STILL get shafted. Why? Because far too many doctors & hospitals refuse to take Medicaid patients. Medicaid for all isn’t going to fix that, in fact it will probably make it worse. We need more doctors in the worst way before we can realistically expand coverage. The way the system is set up now, whoever has to pay will go broke, whether it’s the gov’t, the insurers or the patients.

    I would like people to be more exercised about forcing med schools to take more students. They deliberately restrict class size to keep salaries high. If we’re okay with being treated by nurse practitioners because they are cheaper and easier to get, then why continue making med students spend 8 years getting a degree? If what they learn in 8 years is essential, then I’m not okay putting my life in the hands of an NP. Something is very wrong here.

    We have to fix the current models of public health insurance before a majority of Americans will agree to extend it to everyone. The VA is terrible. Medicaid is terrible. Medicare is popular because everything is free, but broke…because everything is free. And it’s a lie that Medicare spends less per-patient per-year than private insurance. They just spend less on administrative costs. Overall the spending per insured is about the same. We have to find ways to reform Medicare first and expand public health insurance afterwards. Otherwise it will be an enormous fiscal disaster.

  100. RKMK says:

    Toonces, any stay in a hospital is covered by provincial healthcare, but nursing homes are not. Those nursing homes are not $6000 a month, though – my grandmother had to spend her winters in one in the last years before she died, and she certainly didn’t have that kind of money. I would theorize she paid more along the lines of $1500-2000, max. If that. (I’ll try to look into it; the website of the place she stayed doesn’t have publicly posted rates.)

  101. Violet says:

    Because far too many doctors & hospitals refuse to take Medicaid patients. Medicaid for all isn’t going to fix that, in fact it will probably make it worse.

    That is exactly what Medicare for All will fix.

    If everyone in the country is using Medicare, how many doctors do you think will opt out? How many hospitals?

    Virtually none.

  102. Violet says:

    most indigent patients do get healthcare. there are already federal, state, and local resources for them to do so. there are also many non-proffit programs available to them. this is in part what i mean by sampling error. just because they do not get care at your hospital does not mean they do not get care anywhere else.

    Huan, this is a lie. I’m not going to keep approving comments from you if you keep spreading disinformation.

    No, healthcare is not available to everyone. I can’t just go and demand that I get treated.

    I personally do not have the coverage I need to get care for my own health situation. Nor can I afford to pay for the care out of pocket. There are no magic programs for me, no magic way I’ll get the care I need. I’m frankly sick of people like you just blathering on and on about how “everyone gets the care they need” when it’s NOT TRUE.

  103. Kiuku says:

    Yes I agree with Violet. I don’t think these people have ever been sick. They either work in healthcare and think it really is magical, or they have never been unemployed or out of family in America.

    I was in the military, and even then I couldn’t get the care I needed.

  104. HeroesGetMade says:

    Great discussion of single-payer and I really appreciated Hammer of the Dyke sharing her experiences as a practitioner in this broken system we have. But hey, it’s uniquely American, no? So much so, that I think the foreigners are starting to entertain themselves with our stupidity:

    On the jobs that would be lost to single-payer, mostly jobs dealing with the greedy bloodsuckers who deny people healthcare, I think there’s a net gain in jobs. When 47 million people who previously had no access to regular healthcare can now get it, that creates many, many good jobs that cannot be outsourced. It would automatically stimulate the economy by creating jobs more rewarding than dealing with for-profit health insurance parasites. Many more general practitioners will be needed, and yes, nurse practitioners who have the experience to fill that role should be afforded opportunities to fill the resource gap. Also, I would like to see alternative health care practitioners get single-payer coverage – if your chosen health care practitioner keeps you healthy, they should get paid in a single-payer system.

  105. cellocat says:

    HeroesGetMade said: “Also, I would like to see alternative health care practitioners get single-payer coverage – if your chosen health care practitioner keeps you healthy, they should get paid in a single-payer system.”

    YES!! I rarely use traditional health care, but had to pay out-of-pocket for the things that helped me the most during my pregnancy – acupuncture, etc. I would love to see more of an acceptance by both the naturopathic and alopathic communities of each other’s worth and necessity. Single payer might help this along, because if both were covered, and you didn’t have to get permission from an MD to see an ND or an acupuncturist, but could self-refer, patient demand could aid in creating a better balance between those two paths.

  106. LV says:

    “What do other industrialized nations do when it comes to long-term care/nursing home facilities? Are they paying $6,000+ a month, like us?”

    In the UK, nursing home care is technically paid for by the patient. Establishments charge fees which range from hundreds to thousands of pounds a month. However, patients are means-tested; those who can’t afford the fees get an allowance from the government. This allowance pays for the fees of cheaper nursing homes either outright, or wealthier families may top up the allowance to pay for a more expensive one for their elderly parents/grandparents.

    The issue is actually a contentious one in the UK because the means assessment takes into account assets (both property and capital) as well as income. One patient could have the same or lower income than another, but because they own their home rather than renting it they will be deemed liable for their own fees and so are obliged to sell their homes to pay for their care. This means that a lot of older people fear having to go into a nursing home because they think they’ll have nothing to leave to their children. Liberal opinion tends to be divided on this – some view it as fair because it’s means-tested, others as essentially a tax that falls disproportionately on lower-middle class working people, as it often consumes the whole estate, whereas for wealthier individuals with capital and more than one property it will only be a proportion, possibly a small one, of their estate.

    This is the situation for nursing home care for the elderly – I don’t know if it’s different for those needing care for other reasons.

  107. Branjor says:

    LV, thanks for the answer. I was interested in that question too. Now, I wonder how France handles long term care and nursing home facilities for the elderly?

  108. alwaysfiredup says:

    Violet says:
    If everyone in the country is using Medicare, how many doctors do you think will opt out? How many hospitals? Virtually none.

    Even if all doctors opt-in (which I still doubt bc ObamaCare isn’t going to prevent people from “going private” and docs can make a lot more money that way), there just plain aren’t enough doctors. It’s exactly what Massachusetts discovered with its health program.

    And I still think that applying the proposed cost-saving measures to Medicare and working out the bugs so that we can prove we can spend a lot less on single-payer for equal or better results is a prudent and necessary precursor to getting medicare-for-all. Too much change too fast makes the wheels go off the track, and slowing down a little now can get you further in the end.

  109. Toonces says:

    Thanks for the responses, RKMK and LV. To be honest, I don’t even know all the ins and outs of how long-term care works here in the US. I know Medicare helps with the payment under certain circumstances, but I think maybe it costs more here because of medical care costing more here in general. Don’t quote me on that, though.

  110. Violet says:

    Even if all doctors opt-in (which I still doubt bc ObamaCare isn’t going to prevent people from “going private” and docs can make a lot more money that way), there just plain aren’t enough doctors.

    ObamaCare, as it stands, isn’t single-payer. It isn’t Medicare for All. Unfortunately. What Obama seems to want is a “public option” which would be like Medicaid or something. And yes, doctors might certainly opt out of that.

    That’s one of many reasons a half-assed plan like ObamaCare is a mistake.

    And I still think that applying the proposed cost-saving measures to Medicare and working out the bugs so that we can prove we can spend a lot less on single-payer for equal or better results is a prudent and necessary precursor to getting medicare-for-all.

    Medicare is already ten times more cost-effective than private insurance. Literally: Medicare’s overhead is 3%. Private insurance? 30%. What do you hope to prove?

  111. Toonces says:

    ObamaCare also only allows a low enough percentage of people to opt-in to a public option that it can’t really compete with the private insurance companies (by lowering costs because there’s a large enough pool to bargain prices down, like a big box store buying in bulk), thereby proving that a public option could never, ever, ever, ever work and socialism iz so bad, bad bad.

  112. Swannie says:

    Not only are there not enough doctors , there are not enough nurse practitioners ( and you still have that feud going on with the MDS and the NPS, what you didnt know ?? ) not enough Nurses ( the average age of RNs five years ago was 45 ) , not enough Physical Therapists Xray and Lab techs etc etc etc …
    I say….. insure ALL the children right away ages 0 to 18 ; with an extra incentive if they are in school; or somekind of mild penalty if they are not in school when they are school age of course
    … with a system like medicare for kids… that would bring 8 million people into the system instead of 48 million…and give us time to adjust …THEN perhaps if the kids were all covered the parents might even have enough to pay for themselves ..and we wuold have a great beginning for preventive care
    But what do I know , having been an RN for the past 20 or so years…; it is highly unlikely anyone will ask me ..

  113. Hammer of the Dyke says:

    #102 Violet
    Blogs that embrace a pro healthcare reform position always attract posters like Huan, etc. Nothing else seems to explain their willful inability to comprehend what is actually being said. I must laugh when I am told that my actual experiences have no statistical validity, and since I had those experiences, I must be an asshole. Right-wing sites have guidelines for disrupting intelligent discussion of reform of all kinds, as per the suppression of the left discussion. Huan follows these guidelines to a tee, even complimenting the blog in his first post. Somehow, I doubt Huan is a feminist, let alone a leftist. I think he is a completely fake obfuscation-bot. I suppose doctors who jump off the bandwagon are perceived as very threatening.

    It’s funny, but the only reason that I have taken a job with a hospital is to obtain medical insurance for me and my partner, who is a full-time student. If I actually became ill, and required ongoing treatment, I’d simply go home – where I am covered with a superior plan, to what I have here, for about $29 bucks a month. Still, I don’t want to go bankrupt if my partner or I is in an accident and must be treated here. I work the minimum number of hours to qualify for insurance coverage. It is all I can stand.

    #111 Swannie
    I can’t say enough good things about nurses. There is no feud with NPs from my end, but in the military, medical skills (yes, even surgical skills, Huan – that’s why the military was able to achieve a 99% live rescue rate from the battlefield) are possessed by medics and nurses, so I am used to working with all levels of practitioners. There is no substitute for the hands on, ongoing evaluation that nurses do. People do not go to hospitals because they need a doc’s care (they can go to the office for that). People are hospitalized so they can receive nursing care. What amazes me is how few people really understand what it is that nurses do, or how critical it is. I will say it again, nurses have saved my ass on many occasions. Nurses have been at the forefront of promoting a single-payer plan; the California Nurses’ Organization has been particularly effective. They have a national organization, called the NNOC, which maintains a mailing list to notify subscribers of upcoming legislation, with names and numbers of your representatives. I don’t think you have to be a nurse to subscribe.

  114. Alice Paul says:

    A few actual facts about the Canadian system as opposed to Obamacare and the conservative scare. Obamacare is nothing but, the failed plan in Mass. many middle income people cannot afford it. They make “just” too much to qualify for the public option but, have too many bills to be able to pay for the private one. I am going to focus on the conservative so called “points’ though because well…they are simply false and the same baloney that went round in the the nineties. We really need HR676 or at LEAST something as comprehensive as Hillary’s plan was or it is NOT going to work!

    I mean just to try and balance these wild crazy stories going around about *gasp!* that gommunit health care.

    Conservative argument number one, “Ask a Canadian”- well, CTV News did that. They found that 91% of Canadians feel their system is superior to the United States’ system. Quality of Care in Canada is ranked 30th by the WHO and the US is ranked 37th. Canadians feel that the “evil mastermind” who “devised” single payer health care is so “vile” (a Mr. Tommy Douglas) that they voted him the “Greatest Canadian” in history in 2004. And so reviled were they at their “government run and failed” system that when the Conservative Party offered making the health care system more privately run, public backlash (by conservatives!)led them to take back the suggestion. Besides, Canadians live longer, have lower infant and maternal mortality rates, and have lower cancer occurrence and mortality rates, and less of every disease comparatively than the United States. 70% to 80% of Canadians approve of the waiting times. Only 3% of Medical procedures in Canada, France and Britain are delayed.

    Conservative argument number two, “It will cost too much”- It has never ceased to amaze me that we can always find more money to invade and kill people in other countries, whether Afghanistan, Iraq, Somalia, or elsewhere, and we can always find money to bail out banks who got their money from cheating Americans but we can never find money for something worth it. By switching to single payer, Americans would actually SAVE $400 billion annually, due to cuts in administrative spending, bloated CEO salaries, bonuses, shareholder paybacks, etc.

    Conservative argument number three, “Socialized Medicine puts a bureaucrat between you and your doctor”- Actually, socialized medicine REMOVES the bureaucrat. Right now, if anyone on this page got seriously ill, it is very likely your insurance company (assuming you’re insured with all the redlining) would dump you like a celibate prom date because they need to maximize profits, and in order to do that, must cut costs. Guess what guys? We are all “costs”! Yay! A single payer system (read this SLOWLY conservatives) publicly funds INSURANCE (stay with me) but leaves delivery to privately operated not-for-profit facilities. Ask anyone with Medicare how their experience has been, then ask anyone with a private insurer or HMO. The Commonwealth Fund found that Medicare recipients are far more satisfied with their experience.

    Conservative argument number four, “SOCIALISM, SOCIALISM, SOCIALISM!!!!!”- Don’t worry guys, the reds will be easy on ya, just like they have been with the libraries, fire departments, military and police stations. Just think conservatives, you guys are the ones always talking about how great our police are.

    Also, most of the uninsured are not poor. According to an ASPE Issue Brief released by the United States Department of Health and Human Services, only 25% of the uninsured are below the poverty line and not even all of them qualify for Medicaid/Medicare (those programs are not based on income alone but also other factors). Everyone may use a doctor at different amounts, that is precisely why we need universal coverage, what if middle or lower income people need MORE use due to serious illness, etc. and can’t pay for it? Health care is a human right, not a privilege for a few. If capitalism is so efficient, what the hell happened? Why is somebody filing for bankruptcy every 30 seconds due to medical bills? Why can’t 50 million people get insurance? Most of it is redlining and cost cutting for maximized profits Ann, why don’t they pay 15% of GDP for care in other nations? Why don’t they have huge scales of bankruptcies due to medical bills? It’s because they get what they need and get out for free.

  115. How bad is the healthcare reform bill? | Reclusive Leftist says:

    [...] activists have been trying to make this calculus all year. Anything less than single-payer (Medicare for All) is bound to be some flavor of dog’s breakfast; the issue is whether the resulting mess will [...]