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Tilting at Windmills

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March 25, 2006
By: Kevin Drum

SELLING UNIVERSAL HEALTHCARE....Steve Benen points to polling data that says 70% of Americans think the government spends too little on healthcare and concludes, "Public opinion is already leaning towards single payer, whether they're familiar with the phrase or not."

I have my doubts about how strongly the public actually believes this, but Steve's point is still well taken: we may have a long public opinion battle in front of us, but at least we're not literally trying to change people's minds. Most Americans are already receptive to the idea that the government should take on a bigger role in healthcare.

He's also right to focus on the public opinion aspect of the battle for universal healthcare, something that conservatives have long understood better than liberals. And it raises a question worth asking: what's the best way of selling single-payer healthcare to the American public? Here are my two favorite themes:

  • Hammer on the notion that it's crazy to rely on employers as the main healthcare suppliers in America. After all, why should they be? A car company should be a car company, not a healthcare supplier. Along the same lines: Why should you have to pay the price every time your HR department decides to switch to a cheaper health plan? Or lose coverage if you get laid off? Or be forced to keep a dead end job forever because it provides health coverage and you're uninsurable anywhere else?

  • Work on reducing the fear of national healthcare systems in other countries. When this subject comes up conservatives will always trot out their favorite tropes (waiting lines for hip replacements in Canada!) and to counter this we need to educate people about how good most of these systems are in real life. The vast, vast majority of Americans would be better off under a good national healthcare system than they are now, and we need to convince them of that.

These things are both the work of years, so now's the time to start. Any other ideas?

Kevin Drum 11:22 AM Permalink | Trackbacks | Comments (136)

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Comments

The noise machine can make a lot of people hate guppies, groats, or hat racks. What chance does a sensible health care program have?

Posted by: Jeffrey Davis on March 25, 2006 at 11:26 AM | PERMALINK

It's going to take a presidential candidate who can offer a reasonable vision of national health care and then run with that mandate when he's elected.

Posted by: tomeck on March 25, 2006 at 11:34 AM | PERMALINK

Back when the Harry and Louise ads were running, the big scare-the-rubes line was "I don't want some faceless bureaucrat maknig decisions about my healthcare!" I was always astounded that Clinton and the rest of those pushing for expanded healthcare did not simply point out the obvious:

You already have a faceless bureaucrat makng decision about your healthcare--and that bureacrat makes those decisions solely on how it effects his employer's bottom line.

Today, if we want to get public opinion behind single-payer, I believe we MUST remind and inform the public that the current system decides your health (and perhaps survival) based on the profit motive. Single-payer would fix that.

Posted by: Derelict on March 25, 2006 at 11:35 AM | PERMALINK

One other theme that I think people will react to very positively is that no one wants to become a health care expert themselves they just want to go to a doctor and be taken care of until they are well.

Bush and the Republicans want us all to become health care comparison shoppers and pricing experts. Who has the time for that crap? Imagine the health care knowledge needed by a family in Bush's brave new world of "ownership". How much should we put away in our special health savings account this year? How much are we going to spend on the two kids? How much do we need for regular bills? Are we going to need glasses this year? Should I finally get that shoulder surgery I need?

Let's project it all out on a spreadsheet and try to determine how much we should put of our income into health. Assuming we have any money left let's also allocate all of our retirement money into our 401k, our IRA, and our various education accounts. Better set up a database as the spreadsheet is becoming unwieldy.

Now, which stocks and which mutual funds should I pick so that I can retire in a world where Social Security has been reduced, retirement ages have been extended, and lifespans are longer.

Frankly I don't want to become experts in all these things. What I want is to belong to a community where everyone gets health care and everyone gets taken care of when they are old. I don't want to become an expert in stocks, bonds, and medicine to do that.

Neither does anyone else in America who has a million better things to do.

Posted by: Curt Matlock on March 25, 2006 at 11:41 AM | PERMALINK

How about focusing on the Republicans' alternatives? They believe the problem is people are getting too much health care already, so we need to discourage them from going to the doctor so much, as well as force them to shop around to get the best price when they're diagnosed with cancer. Doesn't that sound fun?

Posted by: KCinDC on March 25, 2006 at 11:42 AM | PERMALINK

The waiting lines for hip replacements are due to a number of things, none of which have anything to do with the single payer system in Canada.

First of all, there is a finite number of orthopedic surgeons, partly due to the fact that its the privately run medical associations who get to accredit such specialists and like to keep the competition to a minimum.

More importantly, however, hip replacements have a limited lifespan; it isn't a case of have the surgery and you're fixed for life. Having the procedure before it's absolutely necessary actually can lead to worse problems later on.

When my father had his heart attack last year he was treated immediately, at no cost to him or his family.

When my mother was diagnosed with colon cancer last year she had her surgery a week later, spent a week in a private hospital room and had daily visits from a home care nurse for a month and a half after that. Didn't cost us a penny. No one asked how we would be paying for any of this, no bills were sent, my parents don't have to worry about losing their coverage or seeing insurance premiums go up, or having to mortgage the house to pay for their health.

Yeah, it sure is hell here in socialist Canuckistan....

Posted by: A Hermit on March 25, 2006 at 11:43 AM | PERMALINK

What's needed is something that every American can readily relate to: a television special on universal health care.

The movers and shakers in the liberal/progressive media need to pony up and pool resources to produce a television documentary/series that seriously examines the issue, provides clear evidence of how universal health insurance mechanisms work in other countries, and demonstrates unambiguously how inefficient and broken our system is...

I know, I know...pipe dream.

Posted by: Wonderin on March 25, 2006 at 11:44 AM | PERMALINK

Single Payer health care!

Al Gore's time has come then - time to run for President again.

Al Gore was NOT for the Iraq war know full well it would be a big mistake - was for single payer health insurance and REAL renewable energy sources. Al should run for president again however I'm quite sure Feingold would freak out if that happened.

Al Gore held so much promise for a better American - wish he'd run again. Surely Americans are alot more dispose to take a real hard look as his policies this time around as oppose to his attire.

Posted by: Cheryl on March 25, 2006 at 11:48 AM | PERMALINK

Kevin,

Tom Brosz is a very busy person - Could you simply spare him the time of posting, by including a synopsis of his anti-universal health care with all the non-pertinent links attached? - At the bottom of your thread, you could simply say, please refer to TB's following rebuttal.

To be "fair and balanced" of course.

Posted by: thethirdPaul on March 25, 2006 at 11:48 AM | PERMALINK

I fail to understand why anyone would want either a car company or the government to be master of his medical* care. It's called the veterinary model of medicine, whereby the payer determines not only how much will be paid, but also what kind of medical care the "pet" will get. To whom is your medical care more important--you or your government (just imagine what would happen with another W in charge!) or a corporation? If you think you can't afford it, then why do you think the government can afford it? If you think it's too complicated to make medical decisions, then you deserve to be a "pet." Homeownership is more expensive & almost as complicated, but we manage to do that just fine.
*Always use the word "medical" instead of "health." Heath is much more a function of genetics & lifestyle than of medicine. Turning our "health" over to the medical mafia gives them even more power over us than they already have.

Posted by: anonymous on March 25, 2006 at 11:51 AM | PERMALINK

Incremental steps work best. Or baby steps are better words. First step should be for single payer medical-child-care (need a better name here). The rest of us can wait.

Posted by: jim58 on March 25, 2006 at 11:52 AM | PERMALINK

How about ads which make the point that all Americans deserve the same kind of healthcare that their elected US representatives receive. That seems like an easy sell.

Posted by: vah on March 25, 2006 at 11:53 AM | PERMALINK

Kevin - How about telling the public how much you want to raise their taxes?

Posted by: BigRiver on March 25, 2006 at 11:55 AM | PERMALINK

I bristle every time I read cavalier, tossed-off comments like "every time your HR department decides to switch to a cheaper health plan." Thanks, but as someone in HR, if you're company's large enough to have this dilemma, chances are this is a decision for Compensation and Benefits staff, not traditional HR (although we are all part of an administrative group, there is a difference... is all I'm saying).

But never mind the semantics, thanks for making it sound as though there's some arbitrary (although I cringed happily watching them suggest just that this week on The Office) consideration set. These decisions are complex, especially for companies doing business in several states, and have to take into account what the Insurer/Plan manager is charging the company, what kinds of benefits are included and not and how to keep costs reasonable for everyone involved. "Cheaper"? Maybe; more likely, a plan with simnilar costs to the previous year with fewer benefits and services (and probably more automation and less choice), because prices for those services are increasing faster than almost anything else in the economy.

We didn't get here exactly by accident, or by arbitrary decisions in some vacuum. It's unfair, and unwise, to make the fairly decent people who try to manage these health plans into the enemy - they're just as concerned, if not more, about how health care is administered in this country, and in a better position than most to draw some conclusions about what's realistically possible and in what time frame.

I agree, there's a massive PR job that needs to happen to educate the public, first to explain what the problems are, and then to elaborate on possible solutions, including a single payer model. I think the lefty blogosphere's biggest challenge is not rushing around trying to solve all of this by the November elections; that just ain't happening. If we're lucky, maybe a few races will have more healthcare discussions, but nationalizing it too soon is risky. I think it would be easy to try and identify some handy bad-guy bogeyman as a pinch strategy, but the truth is there are plenty of them, and at the same time none of them. The saddest part really is that everyone is trying, within these narrow, conflicted, problematic parameters to help people. And they're all part of the problem as well as part of the solution. Demonization is a cheap substitute for actually dealing with a complex issue in a thoughtful way.

Posted by: weboy on March 25, 2006 at 11:58 AM | PERMALINK

Ad campaigns:

Ad Number 1: image of a doctor talking on the phone, shuffling papers on his desk. Voice over: "do you want insurance companies telling your doctor how to treat you?" It's short, truthful and to the point.

Ad Number 2: Canadians like A Hermit above telling their story, sitting at a kitchen table with a cup of coffee.

Ad Number 3: Americans telling a story of getting cancer, losing their job, going bankrupt, and saying, "healthcare savings accounts didn't do a damn thing to help me when I had no health insurance."

Ad Number 4: a round table of talking heads discussing single payer health care. The pro single payer says, "right now, we have a system where insurance executives, hospital administrators and pharmaceutical CEO's earn millions, while we have 45 million uninsured"; camera then gives a close up of an impeccably groomed, sleek executive at the table looking shifty, then saying something like "c'mon, you can't be serious! If you have single payer healthcare what would happen to us?"

I'm sure creative minds on this blog can come up with a lot better than I can...

Posted by: ExBrit on March 25, 2006 at 12:04 PM | PERMALINK

What's needed is something that every American can readily relate to: a television special on universal health care.Posted by: Wonderin on March 25, 2006 at 11:44 AM | PERMALINK

Actually Wonderin has a good point. If we leave this subject matter to the 30 second sound byte, someone with a vested interest in keeping the status quo will come up with a killer.

What this will take is a truly informative TV special, preferrably produced by a group with established credibility. The truths about what is really going on now within the health insurance industry, within the care-giving profession, and the money and politics driving it all. Only after the blinding light of day is shining on the subject as it really is, will the general public understand that there are better choices that can be made.

Posted by: jcricket on March 25, 2006 at 12:10 PM | PERMALINK

Pick up on the theme in the recent Krugman piece: because employers cannot continue to foot the bill, because the bill is only going to grow, because including everybody in the coverage pool is so damned inefficient, single-payer is inevitable. It will come, it's the only feasible route to take. The sooner the better, why not now?
Attack the notion we have the best system in the world--tell people their experience shows otherwise. Each of the three weaknesses I list is experentially validated everyday. There's got to be a better way--and there is, it's coming, the only question is when.

Posted by: Can't-resist on March 25, 2006 at 12:11 PM | PERMALINK

Guys, we're not talking about drilling for oil on the moon-
there is a single payer health care system in this country, its called Medicare. We just want to lower the age of eligibility.

Posted by: beowulf on March 25, 2006 at 12:11 PM | PERMALINK

I am all for Universal Health Care etc., but why is it necessary for the Dems to endlessly search for new issues when the winning issues are already there in front of them?

Mendacity, incompetence, lawlessness, and immorality of the Bush administration.

If they cannot win on that, all efforts to find other strategies are doomed to utter failure, not only in November 2006 but for a generation to come.

At least this voter will never vote for democrats again.

Posted by: lib on March 25, 2006 at 12:12 PM | PERMALINK

Here is how you spin it .. more people get money out of their paychecks to pay for health insurance probably 150 to 500 a month.. since employees are shifting cost to employees.

Someone needs to do the math-- basically would the average work trade that health payment taken out of their check everymonth for a 5% tax on earnings to guarentee they ALWAYS will have healthcare whether they are at the job or not.

Another argument is that healthcare traps a worker at a job.. which stiffles people from fulfilling their potential . i am sure there are many people in this country who thought about starting own businesses but didn't do it because of losing health insurance.

I do think US would probably have to start with baby steps . Kerry had the right idea first you give health insurance to every child under 18 in US. Then you expand it to pregenant mothers etc..
as soon as people with kids realize that single payer for children is a great thing you can sell them on the rest

Posted by: smartone on March 25, 2006 at 12:13 PM | PERMALINK

I think Kevin is on to something with the public opinion polls, but, if we rely on Kingdon's conception of the policy window, then that is only one, maybe two, of the three streams that are needed to pass new, innovative policy. I think it is clear to everyone that there is a health care problem, though what kind of problem this is is unclear (thus we can't claim to have a good handle on the problem stream). With regards to the political stream, that, I think, is where we can use polling data to suggest that there is some evidence that it is moving towards universal healthcare. The biggest hurdle, and I know that many in the blogosphere don't really want to hear it, is that "universal healthcare" is not a policy alternative. Universal healthcare is a panapoly of policy alternatives out of which proponents need to coalesce around a single alternative that can be acceptible to most of the American public. This isn't a simple, or quick debate, but a long drag out debate pitting moderate Democrats against liberal Democrats and exacerbating many of the tensions that already exist in the Democratic party.

Posted by: Martin on March 25, 2006 at 12:15 PM | PERMALINK

I fail to understand why anyone would want either a car company or the government to be master of his medical* care. It's called the veterinary model of medicine, whereby the payer determines not only how much will be paid, but also what kind of medical care the "pet" will get. To whom is your medical care more important--you or your government (just imagine what would happen with another W in charge!) or a corporation? If you think you can't afford it, then why do you think the government can afford it? If you think it's too complicated to make medical decisions, then you deserve to be a "pet." Homeownership is more expensive & almost as complicated, but we manage to do that just fine.

I fail to understand why anyone would want the government to be master of his personal protection. It's called the veterinary model of security, whereby the payer determines not only how much will be paid, but also what kind of protection the "pet" will get. To whom is your personal safety more important--you or your government (just imagine what would happen with another W in charge!) or a corporation? If you think you can't afford it, then why do you think the government can afford it? If you think it's too complicated to make personal security decisions, then you deserve to be a "pet." Homeownership is more expensive & almost as complicated, but we manage to do that just fine.

We should, therefore, eliminate the police department, and the military, and simply make each individual citizen responsible for protecting themselves. After all, I don't want some faceless bureaucrat telling me how I am and am not allowed to protect my family, or that I shouldn't be allowed to buy a tank or a flame-thrower....

Or we could come to our senses and realize that, since we live in a society, there are some things that are easier and more efficient to by spreading out the risks and costs among society as a whole.

Posted by: Stefan on March 25, 2006 at 12:17 PM | PERMALINK

In Vermont, the Progressive Party started making a ruckus to have state-wide universal coverage in 2004, and the Democrats followed suit. A slogan the Dems here talk about using (though I haven't yet seen it in the press) is "Everybody pays, everybody is covered."

Posted by: Carl on March 25, 2006 at 12:18 PM | PERMALINK

How much to you want to raise everyone's taxes?

Speaking as someone who pays for his own insurance, I'd say you can jack those taxes pretty fucking high and I'd still come out better. With the plan I have right now, I'm paying more than $6,000 a year in premiums and have a $12,000 deductible. So in my case, you could hit me with an additional $5,000 in taxes and I'd still come out ahead.

If I or my wife get seriously ill, you can bump my taxes up by an additional $15,000 per year and I'm still better off.

Posted by: Derelict on March 25, 2006 at 12:19 PM | PERMALINK

We already have universal single payer government sponsered health care. It is called Medicare. Everyone age 65 and older is covered by it.

This saves employers tons of money cause this group is the group with the highest health care cost. So anything provided by them becomes mearly supplemental to Medicare.

Drop the qualifying age down to 55. Raise payroll taxes a bit but not as much as the drop in premiums and you have a constituancy that can not be beaten.

Then just keep lowering the qualifying age for Medicare, until over time, everyone is covered.

It is as simple as that.

Posted by: ken on March 25, 2006 at 12:20 PM | PERMALINK

Why wait till you are 65 to have the benefits of the best, most effecient and most popular health benefit plan in the world?

Medicare is yours right now if we just lower the qualifying age to 55, or 45, or 35, or whatever it takes to bring you in.

You will never have to worry about doing without good health coverage ever again.

Posted by: ken on March 25, 2006 at 12:27 PM | PERMALINK

Give us your poor, your tired, your huddled masses yearning to breathe free.

No seriously. We will work them to death with no benefits. It's no problem--glad to do it!

Got to get back to church.

V/R
GOP

Posted by: Sparko on March 25, 2006 at 12:34 PM | PERMALINK

Here is a fine example of Hospital care in America
Alleged Skid Row Dumping Is Captured on Videotape
A patient released from a Kaiser hospital is shown wandering outside a downtown L.A. rescue mission.
By Cara Mia DiMassa, Times Staff Writer
March 23, 2006
Authorities on Wednesday released a videotape of what they say is the dumping of a 63-year-old patient from Kaiser Permanente's Bellflower hospital in gown and slippers onto the streets of skid row, eliciting an apology from hospital officials.
The videotape, recorded Monday afternoon, shows a taxicab making a U-turn and then driving out of camera view. A few seconds later, Carol Ann Reyes appears from the direction of the cab, wandering for about three minutes in busy San Pedro Street and then on the sidewalk before a Union Rescue Mission staff member escorts her inside the nearby building.

Isn't the American system of for-profit health care wonderful? It's, like, paradise to Libertarians.

Posted by: Mike on March 25, 2006 at 12:39 PM | PERMALINK

I agree with you, Kevin. And if you took this on and became the single-issue blogger for single-payor health insurance, you would be my hero. Seriously. You can do it. As Somerby says, you are a superb wonk(er?).

I won't even close this comment with a snark.

Posted by: Libby Sosume on March 25, 2006 at 12:50 PM | PERMALINK

"A car company should be a car company, not a healthcare supplier."

Be careful what you argue, because when you convince people of this, the next sentence out of Bush's speechwriters' pens in "Our Health Savings Accounts fixes that!"

Posted by: Robert Earle on March 25, 2006 at 12:51 PM | PERMALINK

Mike: the answer to this problem is very, very clear. Prosecute the Hell out of whoever video-taped the dumping. SOBs.


Oops! Late for church. We're handing out sample ballots.

V/R
GOP

Posted by: Sparko on March 25, 2006 at 12:51 PM | PERMALINK

Kevin-
I don't agree that your suggestions would be effective marketing points. The first is, sadly, probably too wonky and won't really hit home. As for the second, I just don't think pointing out over and over that France is better than the US (in anything) will go over well with most folks.

We need to sell UH in the most traditionally American manner possible- it's all about freedom.
Freedom to choose your doctor, freedom to move and not lose coverage, freedom to change jobs and not lose coverage, freedom to start your own business and not lose coverage, freedom to work part-time in order to go back to school and get a Master's degree, etc. Personal freedom. Universal Healthcare will _Liberate_ ordinary Americans. This is attractive stuff.

Posted by: Mark on March 25, 2006 at 12:51 PM | PERMALINK

I think something needs to be done to inform the ignorant that in every industrialized nation with single-payer, the individual pays less, and gets more, healthcare services than in the US. Perhaps a series of ads featuring attractive healthy-looking people with charming accents describing how their darling aged mother's cancer was treated (with adorable grannie featured sitting in her comfy living room nodding agreeably).

Somehow the point needs to be hammered home that other countries have it better than us. We need to appeal to the competitive, 'we're better than everybody else' American instinct.

The Prairie Angel

Posted by: Arachnae on March 25, 2006 at 1:02 PM | PERMALINK

I've said it before and I'll say it again: by far the most convincing argument for single payer health care with the American public is to pound on the example of Medicare.

Medicare is, to begin with, comfortably American. Moreover, it's a great popular success. I personally don't know of anyone who is covered by it who's unhappy with it. Simply suggest that the American people ask the seniors they know whether Medicare has worked for them (prescription coverage aside -- which is of course really much more of an example of the mess induced by NON single payer).

Posted by: frankly0 on March 25, 2006 at 1:03 PM | PERMALINK

single payer, and screw all that stuff about baby steps, go for the whole enchilada. baby steps are how you fight 500 battles instead of one and get nibbled to death by ducks.

no worries about "do I qualify?", "will I lose it if I get laid off?", "will I lose it if I get fired?", "will I be able to get it at all?", "if I change jobs will I get screwed?", "I'm 50, how much will it cost me if I'm out of work and have to pay for it myself?", and so on. everybody in america either has starred in a horror story themselves or knows someone who has, why would this be a hard sell? there are only three classes of people here who don't worry about health care: the very rich, the young and healthy, and the idiots.

Posted by: supersaurus on March 25, 2006 at 1:03 PM | PERMALINK

Just to follow up a bit on my post:

The chaos of the Republican Prescription Drug Coverage plan provides a perfect opportunity to argue for single payer: that plan demonstrates very convincingly what would happen if something OTHER than single payer were to take over.

In short, the message should be:

Medicare: single payer.

Prescription Drug coverage: non-centralized "choice" plans.

Posted by: frankly0 on March 25, 2006 at 1:07 PM | PERMALINK

I think we need right wing "balancing" to counter this Jesus bible blogging stuff. You'll note that Kevin doesn't have a Lucifer "Red State" presence when he mentions health care reform, the environment, or ending the war.


Too many Americans are buying into helping thy neighbor and the sick. Without rebuttal!

Oops--thought this was the WashingtonPost.com


Posted by: Sparko on March 25, 2006 at 1:08 PM | PERMALINK

I think trying to educate the American public about the advantages of single payer (Kevin's second strategy) is going to be an uphill fight. The fear-mongers have way too long a head start. Moreover, although there are lots of Americans who find their health insurance situation increasingly dissatisfactory, there are still lots of folks who are quite content.

Far easier, unfortunately, to use fear to our advantage. LOTS of people are rightly apprehensive because of the lack of security in American life these days, and the very real possibility that they're a pink slip away from having serious difficulty paying their bills, hanging on to their house, etc.

So, the best way to get support for UHC over the top would be to keep it real simple, and use this justified fear as a tool. The stance of advocates of UHC should be something along the lines of:

Nobody should lack healthcare just because they've been laid off, or they can't afford health insurance. So, America should enact legislation making it ILLEGAL and IMPOSSIBLE for anyone to lose healthcare coverage, or to lack healthcare coverage for any reason at all.

Posted by: P.B. Almeida on March 25, 2006 at 1:12 PM | PERMALINK

Turn it into a personal responsibility issue. When an uninsured person gets ill they receive medical treatment which they can't pay; that means that the costs are passed on to all of us. Everyone - employers and employees - should help shoulder the burden of health care costs: affordable premiums, but no free rides.

The beauty of this approach is that it's a sort of political aikido; the right-wing catchwords and phrases are turned against them. Yeah, it can be rebutted, but not in any sort of brief, simple way.

Posted by: Wagster on March 25, 2006 at 1:20 PM | PERMALINK

First, I think most people don't have any idea how many of their neighbors and friends probably don't have health insurance (I just found out that one of my best friends - self employed - hasn't had it in over 15 years). I've been trying to think of a way to change that. To give people a chance to learn just how widespread and horrible the problem is.

A couple of days ago I tracked down the census reports and data on the Uninsured and where they live (by state and county). Here is the link (the data files are in the bottom half of the page). It's pretty interesting. Texas and much of the west is practically black with uninsured, while the North East has many fewer uninsured (link to the map).

My idea (and I'm willing - eager for suggestions) is to make a document that says how many people are uninsured in my state and county (In Tabloid-style shocking language). With Ask your Elected representatives what they plan to do about this problem. And contact information for each official from the Federal, State & Local levels (for that neighborhood). Also contact information for me in case they want to do this too. Oh, and links to that census page.

And just spend a couple of hours a week leafletting the neighborhoods around my house.

Senator Kennedy in his recent book said that he'd failed to convince his fellow Senators of the importance of this issue. So, I think it's time that we let his fellow Senators know how important it is to us!

(does this make sense?)

Posted by: katiebird on March 25, 2006 at 1:22 PM | PERMALINK

How 'bout the New England of Medicine that concluded that bad health care was not limited to the poor, but that all of us received about the same level of health care that was worse than we should expecialy considering that we pay twice as much for it as any other country.

Posted by: Ben Goff on March 25, 2006 at 1:23 PM | PERMALINK

should have been New England Journal of Medicine article

Posted by: Ben Goff on March 25, 2006 at 1:24 PM | PERMALINK

The perception of the 70% is a little unfair: the US government actually spends what most other countries would consider a very generous amount of money on healthcare. It's just that, at some point between the government and the 70% who demand the healthcare, that money is being siphoned off and distributed to CEOs as compensation and stockholders as dividends.

Posted by: derek on March 25, 2006 at 1:37 PM | PERMALINK

What a lame post.

Drum is talking about 'spinning' and 'selling' the idea. Nothing about facts, budgets, resources. Spin.

That is why I call Kevin Drum "The Harry Reid of the Blogosphere."

Posted by: Bark At The Moon on March 25, 2006 at 1:41 PM | PERMALINK

Some random points. 1) the "veterinary" model of care almost always ends with voluntary euthanasia; 2) medical insurance tied to employment is a huge disincentive to entrepreneurs and small business owners; the downstream impact on the economy can't be good; 3) the "support cost" differentials between private insurance and Medicare/Medicaid/VA are huge; I think it might help to know what's behind the difference. I assume (perhaps without jusification) that executive compensation is one big reason, and redundent processing meant to search for reasons to deny coverage is another, but I'm open to being educated on the subject. 4) As a single adult without dependents, currently uninsured, those baby steps look pretty sucky to me. Frankly, all the diddly little increments are just doodling in the margins. Amen to the idea of contrasting Medicare simplicity with Part D complexity.

Posted by: Jeany on March 25, 2006 at 1:49 PM | PERMALINK

This is a followup to my previous post. The article in question is, "Who Is at Greatest Risk for Receiving Poor-Quality Health Care?
Asch S. M., Kerr E. A., Keesey J., Adams J. L., Setodji C. M., Malik S., McGlynn E. A.
Abstract | FREE Full Text | PDF
N Engl J Med 2006; 354:1147-1156, Mar 16, 2006. This article makes you think that our problem with health care is worse that inadequate health insurance. The insurance part may be the easy part.

Posted by: Ben Goff on March 25, 2006 at 1:52 PM | PERMALINK

In my state, it's illegal to drive a car without insurance. Why not make health insurance mandatory?

We have Medicaid, so the poor do, or should, have health care coverage already. The rest of us would simply have to have proof of health insurance just as we have to provide proof that we have car insurance.

The nice thing is that non-poor people that do not currently pay into any health care system would be a huge source of income since they, in general, only consume a tiny fraction of health care costs.

I think another idea would be to have the federal government open up Medicare/Medicaid to all people in competition to our current system. People/businesses could then choose between competing services. Here we would really see how a government run single payer system could stand up in a environment of choice.

Other ideas would be to:

1. Eliminate the current government restrictions on the number of Doctors medical schools can graduate.
2. Open competition/borders for drugs.
3. Force doctors and hospitals to post their costs per standard medical procedures.
4. Force doctors and hospital to post there success ratios or other quality measures.
5. Open up immigration for doctors and nurses
6. Allow the Canadian government single payer system to compete in the US
7. Eliminate licensing and allow nurse to do more of the work of doctors, nursing assistants the work of RNs. (see quality measures in #4 above).

Posted by: mark on March 25, 2006 at 2:11 PM | PERMALINK
And it raises a question worth asking: what's the best way of selling single-payer healthcare to the American public?

The American public, as this and other polls that have been pointed to before on this blog, don't need to be sold on single payer.

What needs to happen is that an effective demolishing counterattack on whatever scare tactic is going to be used against the actual plan when it is presented.

Posted by: cmdicely on March 25, 2006 at 2:47 PM | PERMALINK

Hammer on the point that we already spend about as much public money on health care as many countries that do have universal coverage -- we just spend a similar amount in private funds on top of that, and don't cover everybody.

Posted by: Bob Kopp on March 25, 2006 at 2:49 PM | PERMALINK

It is a sad comment on the selfishness of Americans that you feel you cant use the argument that people die all the time because they cant afford health insurance and that is not moral, not right and (because religion is on the rise) not Christian.

I read about a Florida boy who needed kidney surgery but had no insurance. The appeals went out from the family, as they so often do in these cases. After too long a period a rich Saudi heard the appeal and donated the money, but it was too late to save the boy.

What a travesty! A foreigner had to be the one to a save the life of a kid who lived in the richest country in the world! We may be rich in money, but not in compassion or simple humanity.

Posted by: James of DC on March 25, 2006 at 3:07 PM | PERMALINK

A simple summation of the Republican policy on health care: I can afford it, F everybody who can't.

Posted by: James of DC on March 25, 2006 at 3:17 PM | PERMALINK

Point out infant mortality rates. The US has a higher rate than Cuba for heavens sake. More babies die needlessly here than any other western country with universal care. It is a national disgrace. If the right to life folks are made aware of this maybe,just maybe they would actually do something to save babies.

Posted by: BillS on March 25, 2006 at 3:19 PM | PERMALINK

re : James of DC
Right on ! I often wonder when people will realize that Mainstream Christianity and the policies of corporate politicians ("globalism", reducing the safety net in the service of "competitiveness etc) are the exact opposite of authentic religious values.

In addition to single payer being the moral or "Christ-like" thing to do, it is also the best thing that could possibly happen to the Fortune 500 or for small business. I expect this to be the rationale that eventually leads to single payer in the U.S. ... in about 2020.

Posted by: rich on March 25, 2006 at 3:19 PM | PERMALINK

I think Michael Moore is taking the first real media step: our medical system is the focus of his next movie. Check out MichaelMoore.com.

Posted by: Nat on March 25, 2006 at 3:27 PM | PERMALINK

One of the conservative fallacies to watch for: They will argue "The plan will cost X billions of dollars... ." But of course, we are already paying for healthcare ourselves anyway. The real cost is of course the difference between what the government would spend and what we would have paid otherwise. Believe it or not, they actually use arguments like the above all the time, and for all kinds of issues. What's really unbelievable is that the average red-state potatoe head actually falls for that kind of stuff (well, they've been conditioned by years of Loombowel...)

Posted by: Neil' on March 25, 2006 at 3:28 PM | PERMALINK

I'm repeating myself - and I'm with Mark ( about 2/3 in if this is end post), here's a post of repeat :

National Health Care needs to be presented as capitalist Freedom. The freedom to have your own business, to be an entrepreneur without the baggage of who you hire. The Freedom to change jobs without the mystery or mirage of the new health insurance situation. The Freedom to go out on a limb with new ventures. The Freedom to entice Toyota to build their plants in our country. The Freedom to plan ahead. The Freedom to stay home and raise a family or care for others. The Freedom to go to school, to improve yourself. The Freedom to marry someone not in perfect health. The Freedom to live with dignity when ill. The Freedom to have medical hope no matter who you are.

This will strengthen marriages, lessen the financial strains, and eliminate half the bankruptcies. It will lower auto insurance and homeowner liabilities rates, and reduce lawsuits, since well all get the care without costing each other.
It will lower public liabilities, such as schools and parks.
It will equalize the country = same basic boat = freedom to be decent
***
And, as others have noted :
Bush is out talking up shopping for health care value/deals - attack this flotsam on the capitalist seas. Is it best to shop for deals before your diagnoses for cancer, or after? Is a bargain diagnoses what anyone needs? Or trusts?

Posted by: Richard W. Crews on March 25, 2006 at 3:28 PM | PERMALINK

Universal health care is needed here; the most efficient way is to have it administered under the current public employees' health care administration (which is currently used by our president, vice president, and members of Congress as well) that had been proposed by former Democratic presidential candidate John Kerry in the 2004 presidential elections.

If it's good enough to be used by the current president, vice president, and members of Congress, it would be good enough for this country's average citizens as well--without adding another bureaucracy. I've even heard--Kevin, please confirm--that some companies such as Wal-Mart would be in favor of such a universal health care plan since it would take the burden off of companies supplying costly health care benefits to their employees.

The real question: Would our government and the citizens they are supposed to represent, be able to override the objections of the entrenched health insurance industry that is more interested in keeping its current monopoly and profits?

Posted by: Jesse A. Weissman on March 25, 2006 at 3:31 PM | PERMALINK

Some talking points:

1. Even if we do have the best healthcare in the world (which I doubt, but for the sake of argument...), that means quality of care. That is not to be confused with how efficiently it is paid for, or how costly it is etc.

2. It is actually quite unfair for people with jobs to have cheaper health insurance than those who don't (or who work for companies that don't have plans.) Don't reject arguments of freeing companies from being burdened by this mess just from reflexive anti-business sentiment.

Posted by: Neil' on March 25, 2006 at 3:33 PM | PERMALINK

Another talking point: why would having the government simply pick up the tab for the bill, have any effect on how long you have to wait for a hip replacement anyway? At the risk of sounding naive, I realize that there are interactive issues which contribute to how things go in the nations with national systems. Hence, I am just saying that the Socratic dialog should be undertaken to see how such a question shakes out, and the smoke out the fallacies from the opponents.

Posted by: Neil' on March 25, 2006 at 3:37 PM | PERMALINK

More UHC ideas:

An ad shows a $1.00 bill. THe bill is divided to show what portion goes to the doctor(s), other medical providers, the insurance company for profits, and the insurance company CEO for "compensation."

When people see that about 1/3 of their health care dollar goes for expenses other than health care, this should counteract any right-wing/libertarian arguments about waiting lines, costs, and giving the government control of your medical care.

Posted by: DCNative on March 25, 2006 at 3:39 PM | PERMALINK

A concept to help make a universal plan go down better: insurance companies are afraid of losing all their business, and I can't blame them for that. But, can't we come up with a universal system that they can participate in and still get a decent return?

Posted by: Neil' on March 25, 2006 at 3:40 PM | PERMALINK

I posed the question to a cyberpal who is a consultant in the UK, who's worked for the NHS but now does international consulting. He said this, which seems to me a good summary: "For my money, the biggest gap in the US system is primary care. Universal primary care is where risk is managed, ill-health prevented and early diagnosis made. Without it, you get a highly expensive sickness service."

The NHS recently completed an in-depth plan to upgrade and modernize the service, and the result (available in pdf) is published on the web, here in its entirety. I'm not sure how helpful this will be to us, but it's for sure it doesn't lend itself to digestion in 30 second clips.

Posted by: Jeany on March 25, 2006 at 3:45 PM | PERMALINK

The way I see it, existing employees of health insurance providers would be contracted en masse to do back office processing in any new UHS. I suspect the compensation picture for the executives of these companies would change, but the worker bees would be needed, and would keep on doing what they're doing now, pretty much.

Posted by: Jeany on March 25, 2006 at 3:53 PM | PERMALINK

Like someone above said, it's time to do the math.

Lots of people are interested. It sounds like a good deal. Now run the numbers. How much are my premiums (taxes) going to be. What's covered? What's not?

I've shopped for major medical insurance for small businesses. At this point in a discussion I would have lots of brochures and fact sheets with numbers to crunch and benefits to compare.

Why aren't there any for a single payer plan?

...

Posted by: Emma Zahn on March 25, 2006 at 3:54 PM | PERMALINK

When in doubt, look at the data...

OECD on healthcare expenditure:
http://ocde.p4.siteinternet.com/publications/doifiles/012005061T002.xls

OECD data on healthcare outcomes:
http://ocde.p4.siteinternet.com/publications/doifiles/012005061T003.xls

The US spends a lot more than any other country on earth, both as a percentage of GDP and in actual dollars, on healthcare, yet, dDespite the anecdotes that rightwingers trot out, the US also does worse than most industrialized countries on measures like lifespan and child mortality. Put another way, Americans get little bang for their healthcare buck compared to countries with a socialized medical system.

I don't really see what there is to discuss.

Posted by: cactus on March 25, 2006 at 3:57 PM | PERMALINK

I agree. We need single payer, NOW.

Push the "freedom" angle. Here's another example near and dear to my heart: people who are disabled who could work, but don't, because they'd lose their Medicaid. Ditto parents of disabled/ chronically ill children, who stay unemployed so their children can get Medicaid.

Use the Medicare example to drive home the message about "intermediate costs." (Although there would be massive job loss in the industry if less paper-pushing was required... whatever plan is developed would need to have some way to deal with displaced healthcare administrative workers...)

Some people could retire and do valuable but unpaid things for society if they didn't need health insurance. My husband and I are financially comfortable enough that I could stop working, **if** I didn't need health insurance due to several chronic conditions. I can't get insured on the open market, because my regular costs are too high. I love my job, but would happily trade it for volunteer work etc. if employment and health insurance were not tied together.

Side note about the HSA/major medical approach: it works great if you can put a reasonable amount into an HSA, and you don't experience any *chronic* health conditions. Major medical doesn't work too well once you're out of the hospital but still have a condition that will be with you for the rest of your life.

Posted by: quietann on March 25, 2006 at 4:11 PM | PERMALINK

If the right to life folks are made aware of this maybe, just maybe they would actually do something to save babies.

BillS, no they wouldn't. They don't care about babies. The "right to life" is the positive spin the Religious Right put on "we want be the instrument of God's punishment on you for having sex." Dead babies is actually a harsher punishment for having sex than live ones, so it's all good as far as they're concerned.

Posted by: derek on March 25, 2006 at 4:21 PM | PERMALINK

...the US also does worse than most industrialized countries on measures like lifespan and child mortality. Put another way, Americans get little bang for their healthcare buck compared to countries with a socialized medical system...I don't really see what there is to discuss.

Don't be so fucking naive, Cactus. People who frequent sites like Kevin's are typically knowledgeable and wonkish by nature. Joe Sixpack ain't. The key is keeping it simple, not trotting out statistics. You can be sure the pharma-healthcare industrial complex isn't going to fight this fight on statistics. They're going to focus on anecdotes and scare tactics. Sheesh!

Posted by: 99 on March 25, 2006 at 4:23 PM | PERMALINK

Annual cost of govt health care for all, $100 billion, about 6 months of spending in Iraq. For that US corporations become competitive in the global "free trade" environment and those that are actually patriotic can keep jobs in the USA instead of exporting them.

Posted by: underseige on March 25, 2006 at 4:25 PM | PERMALINK

Kevin writes: The vast, vast majority of Americans would be better off under a good national healthcare system than they are now, and we need to convince them of that.

I suspect it would actually be the case that virually all Americans, not merely the vast majority, would be better off. The reason is that under any UHC plan that could possibly get through Congress, there will be plenty of scope for private healthcare that can be purchased by the affluent. You'll still be able to buy private rooms in fancy clinics, and have botox injections and boob jobs, in other words. So, with the rich being no worse off, and everybody else having lots more security, virtually everybody should enjoy healthcare delivery at least as good as today's status quo.

Posted by: 99 on March 25, 2006 at 4:34 PM | PERMALINK

when Hils screwed up the Healh Care fight years ago there were 70, yes seventy, congressmen and women ready to co-sponsor single payer. could these new sort of moderate democrats that want to be so serious and stuffy, Kevin Drum on many occasions, get off the dime, stop talking about the work of years for single payer and join those of us old guys who remember where all this moderation gets us in terms of health care and demand that the US join the rest of the civilized world and move to single payer and actually believe that health care is a right of people from their governments and not a privilege to be bestowed on us by geo bush hilary clinton and blue cross. the moderation aout health care makes me sick.

Posted by: virginia cynic on March 25, 2006 at 4:48 PM | PERMALINK

99,

Respectfully, I disagree. Tell people - "You pay more and get less than everyone else in the world. If you switch to the same system as everyone else, you'll get more and pay less." I think that would sell. But, you need to actually put dollar figures on things and you need to tell people where they can check those figures, because the other side is just making stuff up, and made up magic cake always tastes better than real cake.

Posted by: cactus on March 25, 2006 at 4:49 PM | PERMALINK

The more "regular" people I talk to the more I am convinced THEY don't need the convincing, especially since they are the ones being hurt by higher premiums and fewer medical care options. That is, if they haven't opted to go without because they can't afford it even tho they work fulltime.

This isn't including anyone needing to declare bankruptcy (a third of all bankruptcies--google Elizabethe Warren) because of medical costs.

To me, the real tack needs to concentrate on the "middle-man" insurance companies and HMOs because they are the ones who approve and disapprove tests and procedures and drop certain high-cost medical conditions off their "approved" list.

Not to mention the practice of "shedding lives" (see-- Health insurers getting bigger cut of medical dollars) where they increase premiums on a high-risk patient until that person can no longer afford the insurance.

So, if anyone trots out the "rationing" card, the act of "shedding lives" and not covering "pre-existing" conditions is indeed rationing care based solely on the basis of money and profit.

And we are supposed to be a "civilized" nation?

Posted by: NeoLotus on March 25, 2006 at 4:50 PM | PERMALINK

How about having the government pay for "Health" blessings from www.onlineblessings.com for everyone? It is right in their price range of what they want to pay for healthcare, $10.

Posted by: Reverend on March 25, 2006 at 5:18 PM | PERMALINK

I agree with Bob Kopp. I'm at a loss to figure out how universal health care would cost more money.

INSALUD costs the Spanish government 9% of GDP. It costs us around 14%. So what do we get for the additional $600B? That's not to say that the Spanish have a better system - it is to say that for a 50% premium we should have a system that much better than they do, and it seems clear that we do not.

So the question is: where is your money going? What are you really paying for?

Posted by: Saam Barrager on March 25, 2006 at 5:20 PM | PERMALINK

Speaking of car companies providing only cars, just this week we see the GM effort to rid itself of providing health care and pensions. Those two items are said to add $2,500 to the price of each car produced.

At first I wondered why Republicans would fail to support an American industry through alternate ways to provide for health care and penisons, but then realized that they prefer to buy cheaper cars made abroad.

Posted by: Hedley Lamarr on March 25, 2006 at 5:27 PM | PERMALINK

UHC has wide support already; the main concern that the public -- particularly those with good insurance now -- still has is about waiting lists and other rationing mechanisms, and provider choice.

Aside from assuring that any plan doesn't restrict provider choice (covering any eligible service at any provide legally allowed to provide that service), I think the important thing is to find a way to provide a role for private payment -- even private insurance -- to bypass any waiting lists that need to be implemented, without the complexity of our current multi-system healthcare model.

This could take the form, e.g., of a strong universal basic healthcare model wherein services that were not covered by the main system (either generally or for particular diagnoses or with waiting lists) could be covered by third-party plans where the private insurer wrote policies to a standardized set of criteria (i.e., services covered, providers allowed, diagnoses for which particular services were allowed, etc.) and collected payments, but the main healthcare plan, once the policy was "registered", actually administered the routine claim adjudication, providing an appeal system for both parties and compensating the client for any improper denials and the holding the client harmless for any improper approvals not resulting from the client's fraud.

"Universal healthcare", sure, but also hassle-free healthcare that enhances practical freedom.

Posted by: cmdicely on March 25, 2006 at 5:33 PM | PERMALINK

We already have a single payer universal healthcare system in this country for everyone over 65 - Medicare.

I never hear anyone complaining about wait lists or inadequate care. In fact, it seems most people can't wait to qualify for Medicare because its so simple to deal with.

Instead of focusing on foreign systems, I would focus on Medicare and how well it works. Especially when virtually everyone has a family member or friend who is on Medicare.

Also Medicare's administration costs last I heard were under 2% compared to HMO and insurance company administration expenses of well over 10%.

Posted by: Peter on March 25, 2006 at 6:03 PM | PERMALINK

Neil: The GOP is fearful of rationed healthcare because so many have lived in pain or did without helpful surgery that they would clog the boutiques.
Damned poor would be walking upright, lose their coughs, and have a happier outlook. Might even leave Wal-Mart.

For the record, I'll gladly wait a bit while the truly needy and hurting among us finally get the help they deserve. That is my philosophy. I'm sorry it is so controversial.

In the future, the real growth service industry will be in taking care of each other--most manufacturing and agriculture is mechanized now. But we will always need a healing hand.

However we do it, let's help America take care of its people again. Universal care is not a goal, but our raison d'etre.

Posted by: Sparko on March 25, 2006 at 6:08 PM | PERMALINK

1. Small businesses. Local mom-n-pop businesses are put at a significant disadvantage to large companies in hiring because the large companies are able to more effectively pool money for group healthcare plans. Pull some quotes from Dubya talking about the 'death tax' for this one.

2. Big private health care is about making money, not protecting your loved ones. With a governmental program there can be public oversight. Given the choice between the cheap procedure and the one that has a better chance of saving your spouse, profit-driven health care will choose the cheaper alternative.

3. Preventative health care is a major hidden cost. Part of our reforms should include mandatory preventative care in order to maintain eligibility, which will lower the overall number of people needing expensive care on the backend. That means when you need an unexpected heart transplant you're not stuck in line behind some guy who never got regular checkups to tell him that all those Twinkies were clogging up his arteries.

4. No matter how you slice it, our system is grossly inefficient. Show people $10,000 and how much they lose out of that for US-style health care versus how much they'd lose if they lived in any other first-world nation. Hold up the remainder and point out that all that money goes to the owners of big HMOs, not to better medical care, since ours is demonstrably worse. It's institutionalized theft.

5. If we can't get over the fearmongering about "cheaters" overusing the system, we could start by limiting universal health care to non-cheatable stuff like catastrophic emergencies and chronic illnesses -- things whose costs can be distributed easily and that ruin familes' finances for generations. This would also take a burden off the current system.

People worry about money being wasted under a public system, or people taking unfair advantage of. But these problems exist in the current model and cost untold millions yearly -- by building a new system, we can design oversight in, ensuring that we're not held hostage to our most critical medical needs. Think Enron screwing over grandmothers in California when that system was privatized -- why should we think that HMOs are any different? Accountability, accountability, accountability. It ties together everything that this administration has done wrong.

Posted by: spider on March 25, 2006 at 6:16 PM | PERMALINK

It's about making insurance companies rich...insurance lobbyists rich.....and banking interests rich.

Fighting the corporate lobbies will be very tough, won't it?

Posted by: Tennessean on March 25, 2006 at 6:55 PM | PERMALINK

I always say that we have national health today in the US but only for veterans and retirees on Medicare. We just want the rest of us to have something similar We do need to change the Medicare prescitions drug laws to allow the gov't to negotiate with drug companies for lower prices on prescriptions, the model isn't such a bad place to start.

A point that generally makes conservatives go quiet is that small business would expand greatly if people weren't tied to employer based health coverage. The biggest hurdle is the funding mechanism.

Posted by: dan on March 25, 2006 at 7:50 PM | PERMALINK

Universal health cover is a winner in spite of all the horror stories. You get better outcomes straight away and real cash savings down the pike. While a repugnant fear campaign can make the smallest incremental reform sound like crazy and dangerous utiopionism there is a workaround. And that is the democratic socialist party that takes up this issue also panders to the libertarian's.

Thats the key to this issue. You sell it as an overall REDUCTION in the size of the state and taxes ( for the poor and middle classes) If you don't do that then the old ' Tax-and-spend' millstone will sink you again.

The rethugs have a winner with small government - less tax. The Dems can constest this terrain but will they?

I doubt that they can. Most are lumbering dinosaurs like Drum.

Posted by: professor rat on March 25, 2006 at 8:51 PM | PERMALINK

Spider, in your point #3 above, you should change preventive medicine to primary care. I posted this above, "Universal primary care is where risk is managed, ill-health prevented and early diagnosis made." You probably know people who play chicken with their health, married couples who've made a contest of who could be the sickest the longest before caving in and going to the doctor. I'm thinking of my parents, who grew up during the Great Depression, and my aunts and uncles, whose habit of thrift cost some of them dearly. My cohort swore we wouldn't be like that, but those of us who do without insurance don't have a choice.

Good primary care is where downstream costs are checked; people who count every penny, whose deductabile or co-pay is unmanageable do not have primary care; they only go to the doctor when they absolutely must, and the cost is inevitably much higher. The economy scales negatively; those who are very poor and have no insurance present the sickest to hospital emergency rooms, where the cost of treatment is highest. Those costs are folded back into the system and raise costs for everyone else.

I subscribe to the statement above that there's not as much resistance to a single-payer system as we've been led to believe. I certainly don't think we should settle for a crazy quilt, cobbled together system designed as a sop to the insurance industry, certainly not without putting a hard press on that common wisdom that a single payer system will never fly.

How many people have figured out that we were conned by Harry and Louise? How many have taken the "free market economics" lessons we've recently learned and now question whether something as essential as health care should properly be prey to market forces. How many are comfortable putting decisions about their care in the control of a for-profit corporation, whose model of profitability is based on exclusion: excluding people from the group they will "cover," excluding certain procedures, types of care, or medications from "coverage?"

Kevin's question was "what's the best way of selling single-payer healthcare to the American public?" Part of the answer has to be in just disenthralling ourselves with the system we have, Don't believe bullshit, and don't allow anyone within your reach to believe it.

Posted by: Jeany on March 25, 2006 at 9:49 PM | PERMALINK

One thing that should be stressed is how amazingly ineffecient the American healthcare anti-system is. We spend at least one-third more of our GDP on health care than any other developed nation, and still we have 45 million uncovered.

It would be good to a have a series of commercials that explained the various unique features of the American system that lead it to waste so much money. For instance, private health insurance coverage scants on preventative care, which leads to greater costs in the long-run. Another is the major added expenses of health insurance companies, such advertising, bureaucracies, and profits. And so on.

This is important to explain because the conservatives argue that the free market is always superior to the government. That is true in a lot of cases, but there are many, such as security where it isn't (would we be better of if everyone hired a private security firm, as opposed to our present system of having the police paid by taxes?). The public needs to be educated in the reasons why privatized health care is actually much more expensive than a single payer system.

Posted by: Les Brunswick on March 25, 2006 at 10:07 PM | PERMALINK

My "standard" answers to the two biggest canards:

The "faceless bureaucrat from the government making decisions about my healthcare" canard:

"What, you mean as opposed to a faceless bureaucrat from the insurance company whose profit depends on denying your claim?"

I actually have two answers for the "you'll have to wait for a hip-replacement like they do in Canada" cannard, depending on who I'm talking to:

"Well, how many times are you going to need a hip replacement compared to how many times you'll have to go to the doctor for the flu?"

and

"The choice you have today is not between waiting for a hip replacement or not waiting for it. The choice is between waiting for a hip replacement or having to wait until payday to take your sick child to the doctor."

The main thing though (IMHO, and as I've argued elsewhere) is that we learn a lesson from the Dreaded Republicans. They have a mantra: "Lower taxes are better. Period." They argue and debate all the time about which taxes to reduce and how to do it, but whenever they're challenged from the "other side" they go back to the mantra.

Our "mantra" should be "Everybody's covered. Period." Not that we shouldn't debate proposals about how to get there amongst ourselves but that when attacked or challenged from the other side, we go to the mantra: Everbody's covered. Period.

The majority of the American people have a short attention span and limited interest in details. They just want somebody to recognize the problem and come across as being committed to fixing it. Look how far Ross Perot went with his "get under the hood and fix it" mantra. He didn't have policy proposals, and in fact, admitted that he didn't know how to fix it, but repeatedly said that there were people who did know how, and he'd find them and get them on it.

Even Bush used the same sort of appeal with his "MBA/CEO President" image - admitting that he wasn't an expert, but that he'd be the "CEO" that hired the experts. That went a long way towards assuaging any doubts the "muddled middle" had about his intelligence.

We who actually have an interest in policy details love to debate those details. Mr & Mrs Sixpack don't have the time to think about it. They're too busy trying to keep up with inflation on two not-so-great, stagnant incomes and hoping the kids don't get sick or the car doesn't break down, or the roof doesn't spring a leak or gods forbid one or both of their employers doesn't decide to outsource their jobs.

Posted by: KarenJG on March 25, 2006 at 10:29 PM | PERMALINK

WE HAVE UNIVERSAL HEALTH CARE, REGRESSIVE-DEMOCRATS.

What we don't have is universal asset protection insurance in case of overwhelming medical costs. For those with assets above a very modest total, they could own less assets and afford their own health insurance. For those with few assets, that is what bankruptcy is for (not, contrary to what R-Ds think, to rip off the hard working people at credit card companies and frugal savers and investors who risk investment in them).

How many people with out health insurance (and outside Medicaid) have cable TV, long distance telephone service, a car valued at more than $7,500 in any given year, a house in middle-income neighborhood (or a rental in such), a house that is bigger than the need (or a rental); how many drink, smoke, dine out, buy lottery tickets, do drugs? Answer: 80% at least.

R-Ds: Stop trying to frame the American people; we were fooled once (1966) and you dragged us into the 1975-1980 gutter; never again.

TOH

Posted by: The Objective Historian on March 25, 2006 at 11:16 PM | PERMALINK

An obvious reply to the hip-replacement-waits-in-Canada meme is: People don't have to wait for hip-replacements in the U.S., do they? Virtually all American hip-replacement patients are covered by Medicare, aren't they (this is a geriatric operation, after all)? And Medicare is a SINGLE-PAYER system!

Posted by: Nancy Irving on March 26, 2006 at 1:07 AM | PERMALINK
Most Americans are already receptive to the idea that the government should take on a bigger role in healthcare.

Do none of you liberals ever bother to ask the question Which government? anymore?

I'm all for MediCal, and my local tax dollars to to help support city and county community health centers and services, but I'll be damned if I see anything in the US Constitution about a National Health System.

Posted by: J.C. on March 26, 2006 at 1:14 AM | PERMALINK

but I'll be damned if I see anything in the US Constitution about a National Health System.

Do you see anything in the US Constitution about a US Air Force? And yet we seem to have one....

Posted by: Stefan on March 26, 2006 at 1:22 AM | PERMALINK

How do you pay for it? Medicare is in much worse financila shape than Soc. Sec. We're less than 25 years to it being bankrupt and you want to extend coverage to all. Hip replacement seem sto be the term de jour about current single payer systems in other countries. But if you look at the number of Canadians coming to the U.S. for treatment, it's for much more than thier hips. There are countless anecdotal stories of people in Britain paying for private healthcare due to a variety of causes. Wait time for an appointment. The technology available between the private and public health sector is wide.
You can talk about faceless bureaucrats making decisions about your health vs a for profit corperation, but a corp. has an incentive to try and satisfy the patient.
I had to use Kaiser during the last week for a sore shoulder. I was able to make an appointment only 2 hours from the time I contacted Kaiser. I was seen at the appointed time, got an x-ray within an hour that pinpointed a problem, and had a treatment regimen set within another 30 minutes. Now compare that with the myriad stories we hear from around the world from countries with single payer care

Posted by: Meatss on March 26, 2006 at 1:26 AM | PERMALINK

It might be a political disaster to leap to a single payer system. It would probably be wiser to set up national health goals, than to be wedded to one possible method of implementation.

Posted by: Tymbrimi on March 26, 2006 at 1:31 AM | PERMALINK

A couple of suggestions for selling universal health care:

Dad at table, head in hands, Mom with hands on shoulder: Mom says: "Jim, its the job you've always dreamed of. We have to find a way for you to take it." Dad embraces Mom: "Honey, I talked to their benefits counselor, and their health insurance won't cover Timmy's because of his diabetes. I-I have to turn it down."

Mom at table, frantic look in eyes, beseeching crestfallen looking Dad: "Tom, Dr. Smith has taken care of our family for twenty years. How can we change doctors?" Dad: "Honey, I'm sorry - but the company has gone to a new plan, and Dr. Smith isn't in the new network. We're just going to have to find someone that the company has approved."

Another possible theme is pointing out how much the drug companies rip off Americans because we don't have centralized bargainning power. Maybe commericials from with testimontials from people under Medicare about how much more freedom they have in choosing health care under Medicare than they did under restrictive company plans, and how they think all Americans should have the same choices they do.

The point is to find a way to tip the gut reactions in the direction of a single payer system. Logical arguments are not going to cut it against the right wing's talent for using fear and conflict to drown out rational discourse. We will have to find a way to drown them out in order to make progress on this and the other critical problems facing us.

Posted by: agingboomer on March 26, 2006 at 2:12 AM | PERMALINK

I think this shows people's demand for better healthcare service rather than wanting it run by the government.

Posted by: aaron on March 26, 2006 at 2:50 AM | PERMALINK

Those "countless anecdotal stories" are either generations old or refer to elective surgery. And the faceless bureaucrats at the insurance company know they're in a seller's market; they don't care about my satisfaction, they care about their profitability.

I want it run by the government because they're the only ones that'll run it without looking for profit. As soon as profit enters the picture, I'm excluded. If you make a rule that they have to cover me, they find someone else to exclude, that's how they make their profit.

And Mr. TOH, my total annual cable bill is less than the cost of the MRI I need to begin a diagnostic work-up on the nerve injury to my shoulder. If I were able to qualify for insurance (I'm excluded because I have priors), the monthy cost would just about equal my total utilities: water, electric, phone, and cable. When I had an emergency appendectomy, the cost exceeded my total earnings for the year about four-fold. I was made to feel like trash, like a sponger, when I applied for the state to cover my bills, it was utterly crushing humiliation; it was meant to be.

Posted by: Jeany on March 26, 2006 at 3:56 AM | PERMALINK

In a land of social/physical/occupational mobility, why should your insurance needs tie you to this or that employer/location? Single-payer national health insurance is part of the mobility promise.

Posted by: focus on March 26, 2006 at 4:38 AM | PERMALINK

We have a national health care program in this country and it works very well, Medicare. It only got screwed up when Republicans needed to fund the drug industry. Take the age limit off Medicare.

Posted by: Mike on March 26, 2006 at 5:41 AM | PERMALINK

Of course 70% of the American people do not understand how badly single payer screws them in the long run. There is no single payer system extant that drives medical progress like a consumer-controlled system, period. The better single payer systems play catch up to progress boiling out of the last capitalist medical care engine in the world, the U.S.A.

Republicans for a long time have been willing to accept single-payer with one proviso--that it be means tested. In the short run, this screws us, because we would largely be ineligible for the free benefit. In the long run, this preserves a large, healthy, and vital body of medical providers not hamstrung or slowed down by government control (although arguably HMO's would still torment them.)

Leftists hate means testing because it exposes their socialist baby for what it is, another form of involuntary charity. The brighter leftists will argue that medical advances which come fast and furious in the private sector of medical care (including the drug industry) only slowly tend to trickle down to the masses, but any innovation in medicine has to start somewhere on a small scale and be proven first.

The point is the innovations do trickle down. Queen Victoria was the first woman in the world to receive a modern anaesthetic during childbirth. Who knows, maybe Caesar really was the first Caesarian.

Alexander Solzhenytsyn pointed out in his book CANCER WARD some major peculiarities in the Soviet single-payer system. Firstly, everything is political so everything is inevitably rationed and subject to popular prejudices (ironically, they kept using leaches because the people expected it and were convinced it worked.)

In red medicine there was some disparity between the cities and the countryside, which is probably inevitable, but under communism the bumpkins were not allowed to go to the cities to receive better care. In fact, they couldn't move to the cities at all without party permission.

Secondly, high ranking communist insiders did get better care. Magically, access to the better clinics with the newer equipment opened to party members and their families. If the illness was really serious, the nomenclatura often had the option of going to a hospital in the West.

Thirdly, the private market in Russia kept reappearing surreptitiously. If you really want the best surgeon in town to schedule your wife next week instead of in six months, you go out and help him work on his dacha or fix his car with that hard-to-get part.

Leftists don't want their socialized medicine to appear as a charity deal, but that's what it is. And I sincerely pray that is the way it stays!

Posted by: Michael L. Cook on March 26, 2006 at 6:23 AM | PERMALINK

With regard to the "waiting for a hip replacement" issue, one would expect that the vast majority of people who need hip replacements are already under Medicare.

If there's any problem with people under Medicare getting hip replacements, I certainly haven't heard about it.

In general, one would expect that the greatest users of health care would of course be seniors -- yet, again, if there's a real problem with delays, etc., why haven't we heard about it?

Posted by: frankly0 on March 26, 2006 at 7:55 AM | PERMALINK

Really, Medicare has been such a successful and popular program, and with so few glitches from the standpoint of consumers, that it's going to be difficult for opponents of universal health care to present a convincing political argument against the concept of simply extending Medicare to everyone.

They would have to somehow persuade people that, while Medicare is good when restricted to a segment of the population (the segment that is the greatest USER of health care, no less), it's going to turn bad if EVERYBODY must use it. In short, they will have to make an argument that's counterintuitive, which depends on subtleties supposedly introduced only by the SYSTEMATIC application of something that is on a smaller scale quite effective.

THAT is a very hard sort of political argument to make. Extrapolation from clear success is about as powerful a political case as one can make.

Posted by: frankly0 on March 26, 2006 at 8:05 AM | PERMALINK

Thanks Kevin for your two good points- My blog partner and I believe US Health Care System is in real time rapid meltdown. Incrementalism is a non-starter. Please visit us at http://medicalcrises.blogspot.com

Be Well all,

Dr. Rick Lippin
Southampton,Pa
ralippin@aol.com

Posted by: Dr. Rick Lippin on March 26, 2006 at 8:11 AM | PERMALINK

Here's one for the conservative voters:

If we Americans are trying to promote entrepreneurship, why are we making it harder? Lack of health care prevents people from taking a risk and starting their own business, or attempting to go it alone. This additional risk for people with families is restricting entrepreneurship to the young and healthy. Single payer would encourage someone that has a family to start that restaurant, or software company, or to get that degree or license. This is exactly what conservatives claim to want.

Posted by: smoof on March 26, 2006 at 8:16 AM | PERMALINK

franklyO,

Agree with your points - However, there has been one major problem for Medicare - Payment problems to doctors have restricted acceptance of Medicare patients - Several groups in the Portland, OR greater area will not accept new Medicare patients. - Universal health coverage will help alleviate that glitch.

Posted by: thethirdPaul on March 26, 2006 at 8:17 AM | PERMALINK

thethirdPaul,

In general, I do think you're right that there are some glitches in Medicare, but fundamentally, they are on the physician/provider side, not really on the consumer side.

As you say, most of these problems go away if it becomes a universal system, from the consumers point of view.

Of course, expect heated resistance from physicians. Unfortunately for them, they're going to look only as a greedy party in this case, not as a group interested in helping out their patients -- and THAT is going to put them in a real box when it comes to arguing their case.

Posted by: frankly0 on March 26, 2006 at 8:52 AM | PERMALINK

The first thing I would say is that any incremental or means-tested approach will generate very little enthusiasm.

Anyone who has been a client of the social service bureaucracy knows that it's the down elevator to hell. The 'incremental' part means the treatment you need isn't provided and the 'means-tested' part means you make too much money.

This is what pretty much took the Clintons out of the game- early on, it was easy to see there would be no real benefit for anyone except insurance companies on the verge of bankruptcy.

The basic demand has to be for IMPROVEMENT and any attempt to offer a substitute has to be rejected out of hand. There is no need to be nice about this, just point out that we already have a means-tested incremental system and it doesn't work.

Posted by: serial catowner on March 26, 2006 at 9:46 AM | PERMALINK

Secondly, we need to recognize that Medicare funding for primary care is too low. Many times I have looked at a Medicare statement that the doctor had been paid $20 for an office visit.

This has a corollary- as a private patient at a clinic handling mainly Medicare patients, I was billed $250 for the visit Medicare would reimburse at $25. The reason, of course, is that the private-pay patients pick up the slack.

What happens next is poor care in rural areas, or poor parts of the cities. In some places you have no care, in others the doctors come and go so fast that you might as well have no care- it might actually be safer.

We are already paying for a government run system of healthcare. There is no "free market" in healthcare- it is all regulated, and you will go to jail if you try to evade the regulations.

So we need to be relentless in condemning the overpayment we are making, and demand that Medicare improve reimbursement with savings we get from using single-payer to get a better deal for all of us.

Posted by: serial catowner on March 26, 2006 at 9:59 AM | PERMALINK

And the next time Bush suggests we should 'shop around" for healthcare bargains, we should do just that- call the local hospital or clinic, tell them Bush said you should "shop around", and ask them about a few of their prices. Also, if anything is on "special" that week, or are there any "twofers". (Careful with that last one- you don't want them removing both kidneys.)

Yeah, I know, this sounds like the kind of wacky stunt Michael Moore would pull, but hey, if the President told us to do it...

Posted by: serial catowner on March 26, 2006 at 10:04 AM | PERMALINK

Michael Cook Thanks for the laugh, I wasn't prepared for someone reaching back into history to drag out the Big Red Scare. The fact is, free markets and for profit companies exist to make money, not to provide the greatest good to the greatest number; in typical fashion, your measure of good doesn't extend much beyond your own nose. I suggest you look at how the WHO measures our system's performance in comparison with the rest of the world.

I don't think you're going to get your wish; it's a strictly pragmatic matter that in order for our corporations to compete on a global level, we're going to have to uncouple access to health care from employment. The switch to universal care would uncork the economy in all sorts of ways; creative people would be much less apprehensive about striking out on their own, and small businesses would form and grow at a much higher rate. Wake up, man! Your niggardliness is killing America. Why on earth would you fixate on supporting a couple of spongers when you could free dozens of potential entrepreneurial geniuses from the golden chains of their corporate benefit health care?

Posted by: Jeany on March 26, 2006 at 10:14 AM | PERMALINK

I think the thing that Democrats should hammer over and over again in support of single payer health care is the theme that it is time to take the profit motive out of decisions about our health care. People should not be getting rich providing health care and no one should be denied access to basic health care because they can't afford what the market is demanding. It is simple, has a populist feel, and I don't think the Republicans have a good response because this is one area where people aren't comfortable with the Republican concept of just trusting the free market.

Posted by: bummer on March 26, 2006 at 10:15 AM | PERMALINK

Jeany's posts, Derelict on March 25, 2006 at 12:19 PM, and cmdicely on March 25, 2006 at 2:47 PM

Word. Lots of good comments on this thread from PA regulars and new posters I"ve never read before. Props to all and Kevin for hosting the topic.

Everybody's covered offered by KarenJG has a nice ring to it. I like it.

Like cactus' suggestion, too, with emphasis -- "You pay more and get less than everyone else in the world. If you switch to the same system as everyone else, you'll get more and pay less."

Also like the entrepreneurship and freedom to change jobs angle -- UHC takes the burden of health care off businesses' back and keeps people from being tied to a specific job because of the loss of coverage or a pre-existing condition.

I see that the right-wing Trolletariat and the Resentful Right of Involuntary Charity finally showed up. You're in the minority, people, and I'd guess you fall into the 11% who think the government either spends Too much or the Right amount on health care, according to the Princeton poll from KD's link.

Not only do 70% of Americans think the government spends too little on healthcare but 65% also think they spend too much on health care themselves. From the Princeton survey:

Do you think the average American spends too much, too little or the right amount on health care?
Too much -- 65%
Too little -- 17% [Who are these people?!]
Right amount -- 12%
Dont know / Refused -- 6%
Source: Princeton Survey Research Associates / Pew Research Center for the People and the Press; Methodology: Telephone interviews to 1,405 American adults, conducted from Mar. 8 to Mar. 12, 2006. Margin of error is 3 per cent.
I wonder if the 17% of respondents who said, Too little, are folks who meant some Americans don't get treatment, especially preventive care, because of high health care costs. I dunno. The source doesn't say.

Posted this link on another thread but it deserves an encore. Besides the skyrocketing costs of health care -- including health care premiums -- hospitals charge uninsured people much higher rates -- two to four times more than the insured. Nutso! Only in 'Publican America. Woo hoo! Freedom is on the march with a limp!

Posted by: Apollo 13 on March 26, 2006 at 10:24 AM | PERMALINK

OT: I hope someone deconstructs what Condi Rice just spewed on NBC's Meet The Press. She trotted out the lie that we never said Saddam had anything to do with 9/11. Read point (2) of the preznit's Mar. 18, 2003, letter relating use of force to the Iraq Resolution (Public Law 107-243). What a crock!

Posted by: Apollo 13 on March 26, 2006 at 10:47 AM | PERMALINK
Do none of you liberals ever bother to ask the question Which government? anymore?

Yes, we do. And some answer "federal", and some answer "state", and some answer "whichever has the will to do what is needed."

(See California's SB840 universal healthcare proposal, for instance.)

I'm all for MediCal, and my local tax dollars to to help support city and county community health centers and services, but I'll be damned if I see anything in the US Constitution about a National Health System.

Medi-Cal is simply California's name for Medicaid, one of this country's federally-governed national health systems (the big other one being Medicare).

So, if your point is that the feds are the wrong ones to establish a healthcare system, you make it very poorly by endorsing Medi-Cal.

Posted by: cmdicely on March 26, 2006 at 11:32 AM | PERMALINK

When governments everywhere control health care it will be the death knell for the kind of progress the Western world has enjoyed for the last 150 years. Of course, "large" health care entities, be they hospitals or drug companies, are out to make a profit. How do you do that in the long run? You offer an eager public something they want so much they will pay a premium to get it, like a cure for juvenile diabetes or something.

Why do lefties always, always, always want to strangle the goose that produces the golden eggs?

As far as Medicare being such a great system, my doctor doesn't take Medicare patients. While we old farts are the sickest slice of the population, no doubt, we very rarely demand socially controversial expenditures of Medicare dollars, such as for fertility services for unmarried people, sex change operations, or wacky therapies for alleged mental health problems. Not that we seniors don't have a lot of mental issues, but I don't know anyone who insists that government spend a lot of money addressing them. We eldies tend to be resigned to the way we are, mentally. Young people basically want the government to make them happy. You can spend a mountain of money trying to do that.

I'm thrilled that all you hot young entrepreneurs out there want the government to cover your health care insurance costs so that you can get on with stuffing your pockets.

Government took over the exploration of outer space right from the get-go. For awhile it did spectacularly well, even got private industry interested and stood back and let private launchings of commercial satellites blossom. But government interest in pushing the new frontier has vanished because the political pay-off has withered.

The nationalistic Americans of the "Red Scare" days wanted the flag of the U.S.A. on all the high ground. Nowadays no one even mentions the military importance of outer space, although that value is certainly undiminished and arguably has increased. Secondly, the "Red Scare" was based on the reality that (1) Stalin exterminated more people than Hitler, probably twice as many as the German Holocaust. (2) Mao Tse-Tung forced a quiet genocide in the guise of cultural revolution that very likely killed twice as many human souls as did Stalin, and (3) Pol Pot, the little Paris-educated Marxist of Cambodia, executed pure bloody-handed Marxist philosophy in a literal way and got almost no credit for it in the West, it being more politically expedient for The New York Times to blame the Cambodian derangement on errant B-52 bomb runs. What a loathesome crock of crap that slick little bit of editorial over-reaching was.

Posted by: Michael L. Cook on March 26, 2006 at 11:35 AM | PERMALINK
Leftists hate means testing because it exposes their socialist baby for what it is, another form of involuntary charity.

I don't know what "leftists" you are referring to, but plenty of UHC proposals I've seen would have means-testing elements (copays or premiums that would be income sensitive; I think the SB840 system proposed in California has them, which is one of the few fully-formed legislative proposals out there.) In fact, every system I've seen that was an exclusive system has included means-testing.

Posted by: cmdicely on March 26, 2006 at 11:39 AM | PERMALINK

Thank you for the kind words, A13; this is a subject dear to my heart. Being educated, formerly successful, unemployed and uninsured is frankly inspiring. I'm a family values kinda gal; if not for my sister, I would be a bag lady or dead.

My Brit NHS pal says we should try countering their free market rhetoric by defining the conditions for a perfect market and pointing up the impossibility of the free market in healthcare ever meeting them. I'm not smart enough wrt economics to do that, but I do think that a decade of free trade agreements and the end of manufacturing and the associated loss of good jobs here have disenthralled an awful lot of Americans with "free markets;" a lot of ex autoworkers who now work at Wal-Mart just don't feel the love like they used to. Those FMs are never going to bring us cheap orthopedic surgery like they bring us cheap DVD players. ;-))))

Ultimately, to win this battle, we're going to have to fight on every front, we're going to need *some* money to get the *positive* message out and to expose the self-serving interests of the insurance industry for what they are.

Posted by: Jeany on March 26, 2006 at 11:43 AM | PERMALINK

Had to happen- a 'legacy' troll.

Probably fell into a BBS blackhole, trying to traverse the netscape in a 286-model ship....and emerges 20 years later....

Posted by: serial catowner on March 26, 2006 at 11:44 AM | PERMALINK

Healthcare shouldn't be tied to employment.

But people should have to pay for the costs of their own care unless they are unable to for legitimate reasons. That doesn't necessarily entail single payer.

Posted by: Chad on March 26, 2006 at 11:45 AM | PERMALINK

Michael you bet I want those "hot young entrepreneurs" out there stuffing their pockets, because they keep some to reinvest, and they pay some in taxes. When they make more, the entire country makes more. That's how it works.

Posted by: Jeany on March 26, 2006 at 11:49 AM | PERMALINK

Well, actually, what we need to do is get our non-negotiable demands ready.

You see, in a few years insurance companies will use very clever tests to tell who's going to get sick. They won't insure those people.

And when people start to hear "We know you're going to get sick- so you can't buy insurance here", well, the proverbial s*it is going to hit the fan.

Naturlly, Republicans will want to start a government program that only handles sick people, thus affording fast fast fast relief to insurance companies.

Democrats will be tempted to Lieberman the issue, giving away the bathwater with the baby in their haste to "get something done".

As the old Thurber character used to say- "Git Ready!"

Posted by: serial catowner on March 26, 2006 at 11:52 AM | PERMALINK

As far as Medicare being such a great system, my doctor doesn't take Medicare patients.

And what are they going to do if EVERYBODY is a Medicare patient? Universal single payer SOLVES this problem.

Look, the reality is that there ARE losers in the single payer proposition, namely the parties who are making large amounts of money under our currently unconstrained system. Those parties include the insurance companies and drug companies most prominently, but also physicians and other health care providers. These parties constitute the natural economic enemies of single payer.

As I said earlier, though, physicians are between a rock and hard place here. While they may detest the economic consequences of single payer, they also must put up, as they always do, a great show of how they are really concerned at bottom only with the welfare of their patients. That's going to make the argument VERY hard for them to conduct.

Posted by: frankly0 on March 26, 2006 at 1:07 PM | PERMALINK

cmdicely,

"The American public, as this and other polls that have been pointed to before on this blog, don't need to be sold on single payer."

Er, where does this poll show that the American public is sold on single payer?

Posted by: floop on March 26, 2006 at 1:36 PM | PERMALINK

We must have an honest dialogue about single payer health care in this country. As with any social welfare plan, single payer health care is a large transfer from the top income quintile to others. We need to admit that and then discuss with other Americans if this plan is what they want.

Posted by: two cents on March 26, 2006 at 4:12 PM | PERMALINK

I think the majority of the public would get behind the idea of a single payer system if they understood what it was. The public needs to be better informed of our current failing system and pressure needs to be put on our elected leaders to move towards a national healthcare system.
Public Policy Virginia is a non-profit group that has held educational conferences on healthcare to better inform the public on the benefits of a nationalized healthcare system. In order for the single payer agenda to be advanced, we need to support the political action groups that push for the policies we want.

Posted by: Jeremy Barker on March 26, 2006 at 4:33 PM | PERMALINK

Apollo 13 wrote: -- hospitals charge uninsured people much higher rates -- two to four times more than the insured.

60 minutes did a segment on hospitals grossly overcharging the uninsured, and then grinding them into the ground for payment. The hospital's response: "We charge the same rates to everybody, but we have agreements with some insurers to accept less than our full charge."

So, if you are not a big insurance company and can't negotiate your medical care charges, (and you are uninsured) you pay the full freight.

Posted by: DCNative on March 26, 2006 at 4:56 PM | PERMALINK

I had to use Kaiser during the last week for a sore shoulder. I was able to make an appointment only 2 hours from the time I contacted Kaiser. I was seen at the appointed time, got an x-ray within an hour that pinpointed a problem, and had a treatment regimen set within another 30 minutes. Now compare that with the myriad stories we hear from around the world from countries with single payer care

Uh - my mum got diagnosed with breast cancer. Operation organised that day for the next day. It turned out, through surgery, that another operation was required. It happened the next day. Chemotherapy was started as soon as she recovered.

I injured my knee playing Judo. Once I went to the doctor about it, an MRI was scheduled for the following week. The surgery was done at a clinic that treats pretty much any Olympic or professional athlete from my state.

All in Australia's combination of single-payer and private. We do pay private health insurance; however, because the majority of risk is covered by the government, my private health insurance costs US$70 a month - and that covers any treatment, any hospital stay, and gives me rebates for contact lenses and other medical equipment.

Oh, and if anyone was thinking this is difficult to manage - it's entirely computerised. My private insurance company gives me a magnetic swipe card; I swipe it through a terminal at the doctors/opticians/wherever; it automatically deducts any costs paid by the private health insurer (the government-paid costs already having been deducted) and I pay the rest. It's easier than using a credit card, and unless I forget my card, the only documentation I have to send in to the insurance company is my application form when I join. Google "HICAPS" for more info.

Posted by: Shinobi on March 26, 2006 at 5:53 PM | PERMALINK

The continuation of cover thing is a big issue. Group is really cheap an attractive but you give up continuity of cover.

One way of allowing continuation of cover is to force employers to pay some special fee on termination. That can be used for the ex-employee to buy lifetime individual cover of some defined type. Plus some system that lets employers get discounts when someone with individual cover already joins the workforce.

There is room for regulation but you guys are going about it the wrong way.

Posted by: McA on March 26, 2006 at 8:35 PM | PERMALINK

OT: I hope someone deconstructs what Condi Rice just spewed on NBC's Meet The Press. She trotted out the lie that we never said Saddam had anything to do with 9/11. Read point (2) of the preznit's Mar. 18, 2003, letter relating use of force to the Iraq Resolution (Public Law 107-243). What a crock!

Posted by: Apollo 13 on March 26, 2006 at 10:47 AM | PERMALINK


Read it properly. Consistent with action against international terrorists 'including those that were'. If it was 'which were' you'd be right.

Posted by: McA on March 26, 2006 at 8:37 PM | PERMALINK

Kevin' post was about how to sell universal healthcare (UHC), but, as ususal on such threads in the liberal blogosphere, the conversation quickly morphed into a general back and forth on the merits of single payer.

Memo to liberal blogoshphere: SINGLE PAYER IS NOT POLITICALLY POSSIBLE IN THE NEAR FUTURE.

Sorry, folks, it's ain't gonna happen anytime soon. We may eventually get there, after several evolving versions of UHC lead us there (especially in another thirty years when the shit's really starting to hit the fan with respect to boomer healthcare expenses). But, no, sorry, the right has beat us to the punch on the marketing wars, and the ambitious goal of single payer is going to have to wait.

What the right hasn't been able to do, however, is convince the public that the US status quo is peachy-keen. Lots of Americans are very discontented.

So, the question isn't how to sell single payer. The question is what's the most realistic UHC system in a non-single payer setting (taking into account the crucial question of political feasiblilty) and how do we market that.

Besides, let's face it, we've all gotten a bit sloppy in our terminology. People tend to inaccurately use the term "single payer" to describe any non-American, rich world, universal healthcare system. I think it's fair to call Canada's system "single payer", or maybe Britain's. But is it really an accurate term to describe Australia's, or Japan's, or France's? All three of these nations have more expensive systems than the UK or Canada, all get good results (probably a bit better than the UK or Canada on average), and all of them see the significant participation of non-governmental actors when it comes to paying healthcare bills. Oh, and most importantly, all three of them guarantee that ALL of their citizens have access to good, high quality healthcare.

The key goal should be government guaranteed/mandated universality, not a governmental monopoly on paying healthcare bills. If the latter truly is the most sensible way to go about doing things in an American setting, I have no doubt we'll get there eventually. But in the interim we shouldn't sacrifice the goal of universal access to the false god of NHS worship.

Posted by: Diplomat on March 26, 2006 at 11:11 PM | PERMALINK

I was sitting with a few other women and one was saying how terrible the notion of single-payer was... "And the government in charge? The government is lousy at running things!"

Then one woman broke in. She's a conservative Republican who happens to be married to an Army vet. "Actually, I am for nationalized medicine, because that's what I lived with for 10 years in the army. We had good care and never got a bill."

Then the oldest lady (another conservative) said, "Well, the government runs Medicare, and I've been happy with that. So I don't know why younger people can't have the same sort of health insurance I do-- Medicare for the essentials, and then they could buy other insurance as needed." She added, "Compared to insurance companies, Medicare is really efficient."

I think if we remind naysayers that millions of Americans are already benefiting from government-paid healthcare, they might get over their certainty that it's bad.

Posted by: a on March 26, 2006 at 11:31 PM | PERMALINK

You'll never get what you don't ask for, Dip.... lomat. Show me the head of single payer and I might believe it's dead, but until then you're just another troll testing me to see if I'll curl up in a ball and cry.

Posted by: Jeany on March 27, 2006 at 12:24 AM | PERMALINK

I've read the comments and this is a topic i'm very interested in.

My issue with Single Payer run by Government is implementation. Historically all large Gov programs, Medicare, Public Housing, Social Security etc one implemented become virtually untouchable. You cant fix it, make changes, change with the times.

Look at protestes in France over a change in gov program. Unless its allowed to specifically have built in modifications and restructing points why would anyone lock into a program. While Im for universal coverage I'm less inclined to trust my health to the political whims of either political party these days.

Posted by: amy on March 27, 2006 at 10:55 AM | PERMALINK

Veterans have decidedly mixed views about the military medical delivery system. They do succeed in keeping a lot of basically very healthy young families alive.

Posted by: Michael L. Cook on March 27, 2006 at 10:59 AM | PERMALINK

Kevin wrote: "The vast, vast majority of Americans would be better off under a good national healthcare system than they are now."

If this were true, we'd have national healthcare today. It's obviously not true. A national healthcare system would make things much better for the small minority that's not insured, but it would probably make things much more costly (think higher taxes to pay for health care for the currently uninsured) and result in lower quality (think rationing, lines, etc.) for the majority who are currently insured.

You really need to go back to the drawing board on this, Kevin.

Posted by: DBL on March 27, 2006 at 2:08 PM | PERMALINK

Two cents wrote: "[S]ingle payer health care is a large transfer from the top income quintile to others."

Truer words were never spoken.

Posted by: DBL on March 27, 2006 at 2:12 PM | PERMALINK
If this were true, we'd have national healthcare today.

No, if most people (a) believed it was true, and (b) voted on that issue alone with no other concerns, we'd have it today.

That a policy would have good results don't, either in general or in the particular case of healthcare, mean that it automatically occurs, as you seem to think.

Posted by: cmdicely on March 27, 2006 at 7:40 PM | PERMALINK

"No, if most people (a) believed it was true, and (b) voted on that issue alone with no other concerns, we'd have it today."

If a significant majority of Americans really wanted "national healthcare," we'd already have it. They don't want it, so we don't have it. The fact that neither party is pursuing "national healthcare," and that the last attempt to do so, over a decade ago, went down in flames, shows how unimportant the issue is to most voters.

By the way, I'm still waiting for you to explain how this poll shows that the American public don't need to be sold on single payer.

Posted by: jibjab on March 27, 2006 at 9:11 PM | PERMALINK




 

 

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