The Health Care Crisis and What to Do About It (Krugman & Wells, NYRB)

[swag]

http://www.nybooks.com/articles/18802

brief excerpt from a long, well argued essay:

If US politicians could be persuaded of the advantages of a public health insurance system, the next step would be to convince them of the virtues, in at least some cases, of honest-to-God socialized medicine, in which government employees provide the care as well as the money. Exhibit A for the advantages of government provision is the Veterans' Administration, which runs its own hospitals and clinics, and provides some of the best-quality health care in America at far lower cost than the private sector. How does the VA do it? It turns out that there are many advantages to having a single health care organization provide individuals with what amounts to lifetime care. For example, the VA has taken the lead in introducing electronic medical records, which it can do far more easily than a private hospital chain because its patients stay with it for decades. The VA also invests heavily and systematically in preventive care, because unlike private health care providers it can expect to realize financial benefits from measures that keep its clients out of the hospital.

In summary, then, the obvious way to make the US health care system more efficient is to make it more like the systems of other advanced countries, and more like the most efficient parts of our own system. That means a shift from private insurance to public insurance, and greater government involvement in the provision of health care—if not publicly run hospitals and clinics, at least a much larger government role in creating integrated record-keeping and quality control. Such a system would probably allow individuals to purchase additional medical care, as they can in Britain (although not in Canada). But the core of the system would be government insurance—"Medicare for all," as Ted Kennedy puts it.

Unfortunately, the US political system seems unready to do what is both obvious and humane. The 2003 legislation that added drug coverage to Medicare illustrates some of the political difficulties. Although it's rarely described this way, Medicare is a single-payer system covering many of the health costs of older Americans. (Canada's universal single-payer system is, in fact, also called Medicare.) And it has some though not all the advantages of broader single-payer systems, notably low administrative costs.

But in adding a drug benefit to Medicare, the Bush administration and its allies in Congress were driven both by a desire to appease the insurance and pharmaceutical lobbies and by an ideology that insists on the superiority of the private sector even when the public sector has demonstrably lower costs. So they devised a plan that works very differently from traditional Medicare. In fact, Medicare Part D, the drug benefit, isn't a program in which the government provides drug insurance. It's a program in which private insurance companies receive subsidies to offer insurance—and seniors aren't allowed to deal directly with Medicare.

. . . much more

[xchrom]

1. if the democratic party wanted to do an end run around the a.m.a.

and the insurance and pharm corporations -- sit down and talk to g.m., ford, microsoft -- etc aand let them know how much it will relive them of some of their obligations.

i won't hold my breath.

[boobooday]

2. Exactly

Unfortunately, humanitarian arguments will probably not be as convincing as framing this as a "pro-business" move. But it is a rare issue that is pro-business, AND pro-humanity. Or at least it is pro-business for all industries except for one or two . . . and we know what they are, and how much of OUR money they have put into fighting reforms.

[rucky]

3. they like it like this, because it keeps their edge over smaller businesse

who can't afford private health insurance for their employees. This way, the "best and brightest" in the industry won't even consider anybody but the largest corporations who can afford to offer the best benefits packages. Corporations would hate the level playing field universal healthcare would create for smaller business, also because of their fear that their employees would tell them to fuck off & go somewhere else.

[xchrom]

5. that's why i advocate an end run with larger corporations

around the established opposition to medical care reform.

[happyslug]

6. While the AMA has opposed national Health in the past

Since about 1990 the AMA has adopted a more neutral position on National health insurance. This was done do to the DROP in Average Income of Doctors in the late 1980s and early 1990s. Since that time Doctor's income have stagnated (it is Hospitals and Medical Tests and procedures that have lead the advance in Medical costs from 1990 till today). Furthermore no one (Except in Britain with its severe restrictions on Medical Costs) have really capped Doctor's income as has the drop in the number of people seeing Doctors (Insurance companies have also entered restrictions on Doctor's Income, but as a general rule NOT Governments).

On the other hand big pharmacy and the Medical Insurance Companies see they profits disappearing and it is these two groups that OPPOSE National health Insurance (And they lobby the AMA headquarters to lobby with them, and this lobbying has been effective, i.e. the Head of the AMA lobby congress to oppose national health Insurance even while most of his membership today support national Health Insurance).

I bring this up is we MUST keep an eye on who the Enemy of National Health Insurance and who is really not.

[FloridaPat]

4. Anyone remember the movie "4th of July"? Didn't show the VA

as "some of the best-quality health care in America". I have not heard very much good things about VA hospitals.

[many a good man]

7. VA shows how "integrated" systems show enormous efficiencies

Read the review-- it'll be well worth your time. The VA has its problems, but this isn't one of them. In fact its a model of how to do things right!

[SharonAnn]

9. It has improved greatly. Especially under Clinton in the 90's.

[sarcasmo]

8. Great idea, but the Pharmaceutical companies have to much power

to allow Socialized medicine to happen.

[S B]

10. National Health Care

The Medicare program, underwritten by Blue Cross, has worked for Social Security beneficiaries for years. It is a good program, efficient, minor problems if any. That program could be expanded to cover everyone, and with everyone contributing the premiums would be affordable for most people and subsidies for those who can't afford it. Since taxes are where we pool our money to purchase together what we individually can't do, it makes sense to use some of our tax money to purchase what we who are not rich, all want - quality health care for all citizens. We're funding research on all kinds of medical problems - but what does it matter if people can't afford the treatments they come up with? Medicare D is a nightmare. Do away with it and include prescription coverage in Medicare B with all pharmacology covered. Could be done with contributions designated and untouchable to the overall budget (which is why Social Security is in a mess - they invested poorly and couldn't keep their hands out of it for other things).
Yes! National health care.