How to get Universal Health Care: Part 1

[Silverhair]

This is the first of a series of posts about the issue that I care most about, the issue that has had me writing congress for over 20 years. Health Care. In a sense, I will be preaching to the choir. Everyone here wants health care, but I am not seeing a plan, or even elements of a plan, and nothing of a "how to". Some years ago, I owned a small insurance agency, specializing in health insurance. After a few years I grew to hate the insurance industry. And it wasn't that the companies were crooked (Although some were.) but it was the system itself that created the dynamics. The whole system needs to be overhauled - completely.

This can be our strongest wedge issue, one that can peel off lost of swing voters. Which is the greater threat to the individuals security - terrorists or medical? It has the ability to touch home to most people. How many people stay at miserable jobs, how many new small businesses are not started - because the person has coverage and can't afford to lose it?

WE CAN WIN ON THIS ISSUE BUT WE HAVE TO DO IT RIGHT.

Americans are afraid that the any attempt at universal health care will cost more and deliver less. But we need to show that it will deliver better, (NOT more, but better) and will cost less.

Currently medical care is about 15 to 20% of the national GDP. AND AT LEAST 80% OF THE MONEY IS WASTED!!!!!!!!!! That's right, most of it is wasted. All we need to do is eleminate the waste and we will have the funds available to pay for the finest REAL health care in the world, and have lots of money left over for other stuff, like paying off the national debt. (The national debt angers me, but that is another topic.)

I am going to make a series of suggestions. One per post. Some will deal with the politics of how we can get there. Some will deal with the broad outlines that such a plan would require.

FIRST SUGGESTION:
Get rid of the health insurance companies. A typical health insurance company has to have a payout/premium ratio of less than 60%. That's right, the other 40% of the health insurance dollar premium is used by the company. A huge amount of it goes to insurance agents, & advertising. On some of the policies that I wrote I got a first year commission of 60%. On the small company group plans that I wrote, I collected 10% as long as the policy was in place and I was the active agent. If you can place a couple of donzen small businesses, and them maintain them you can have a comfortable income. It has been 15 years since I wrote my last policy, and I am still collecting small residual commissions (None on groups - I am not an active agent.), and not doing a lick of insurance work to earn them. (No, I am not going to return them. Hey, I can use the money.) So by eliminating the health insurance companies, you save 40% of the health insurance premiums immediately.

On a national scale - THAT'S A LOT OF MONEY. The savings right there would be enough to pay for the rest of the population to have benefits. By getting benefits to everybody we should improve the economic performance of the country itself, so Universal Health Care would actually make money.

That's enough for one post. I will have a number of posts on this subject, and each one will have a specific suggestion.

[Sir_Shrek]

1. Good luck

Get rid of the health insurance companies.

Think all the folks who work for health insurance companies are going to go for that?

[Snow]

2. *Loud cheers*

I agree absolutely; I'll be eager to see what your further suggestions are since IMHO the insurance companies are the biggest part of the problem. Question, though (here it comes): How?

Also, smaller question (and I think I know the answer): will you differentiate between insurance companies and combined insurance/health care provider companies, especially if the latter are non-profit? Examples of the latter are Group Health Co-op of Puget Sound and Kaiser-Permanente. My suspicion is you'll say there's some good in the non-profits, but they're part of a rotten system, so out they must go, but don't let me put words in your mouth. You'll notice I'm avoiding use of the term HMO, because the media really doesn't understand the term and so neither does the public.

[Silverhair]

3. Yes, I am painting with a very broad brush. To state an idea in

the brevity required of a readable post requires extreme simplification.

[Lydia Leftcoast]

4. Former Kaiser patient here

When I first joined in 1994, my monthly premium was $110, with $10 copay for office visits and tests, and no charge for hospitalization or surgeries.

By the time I left the Pacfic Northwest in August 2003, I was paying $272 per month, $20 copay per office visit, $25 per test, and $200 a day copay for hospitalization, which you can't get unless ordered by a doctor, so it's not as if they're charging to discourage patients from checking themselves into the hospital for the hell of it. Oh, and it became harder and harder to actually see a doctor. As of 8/2003, I hadn't seen a real MD since late 2001.

[Snow]

28. But to some degree that's the fault of the purchaser, ie your employer,

who tells Kaiser to offer a cheaper package or he'll take his business to Columbia HealthCare or someone really evil. A large part of the rising cost and lower benefits is the employers negotiating things down; it's not all the insurers. Having said that, there's a number of insurers who are really gaming the whole business, and making the market very rough for the few good guys out there.

[Lydia Leftcoast]

39. My employer

was ME. That was the price for non-group coverage. The lower pricers negotiated by employers were compensated for by gouging the individual subscribers.

[Snow]

47. Ah, yes. Excellent point.

You leave me arguement-less, and that is (yet another) major flaw with our system.

[Silverhair]

41. This is part of the system that made me hate it so much.

Most of the companies are actually trying to do the best they can, but they are trapped in a vicious circle.

Two primary things have happened to your persoanl insurance costs.

Health costs themselves have gotten higher faster than the rate of inflation. I will address part of the problems driving that in a different post.

You have gotten older, and are being charged for a different age bracket.

It is also possible that your policy may have entered a "death spiral". I will explain what that is in a post dedicated to it and other insurance issues. It will be in my next post on the topic.

[Cleita]

5. Hey Silverhair

I'm with you. This has been a number one priority for me too. I once worked briefly in the health insurance industry and I worked for doctors doing the billing for health insurance. Maybe we can join forces. After the first of the year I am looking into putting up a small website, which puts all the pertinent information in one place.

I could use your input and anyone else who can shed some light on this problem and dispell the lies spread by the for profit health insurance industry. If a Democrat gets elected to the White House, you can be sure the astroturf will be all over the place.

[Silverhair]

9. I think we can get it, even with a Rep President, but it will take

a lot of work. And we will have to work smart too.

[Cleita]

11. I want to get health care horror stories from people

hence the website idea. I have my horror stories, I have heard of other's horror stories, not to mention things you read in the paper. I want this to be a section in the website of people who have been cheated by their health plan or of those who have had relatives die or become disabled without health care because they had no insurance. I will PM you when I get something set up.

[Silverhair]

12. We lost about 3,000 people on 9-11. How many children, annually,

do we lose because of inadequate BASIC healthcare? I have no idea. Can anybody provide some RELIABLE stats on that?

Which is the greater threat to national security? Terrorists or disease/injuries?

[Kanary]

18. about children

"How many children, annually, do we lose because of inadequate BASIC healthcare?"

As I have said, I agree whole-heartedly with your basic premise, and greatly appreciate what you are doing with this issue, and the effort your are expending.

However, this selective focus on children touches one of my hot buttons, and I must speak up. In my view, this is part of the right wings efforts to separate us into ever smaller groups, so that we end up fighting each other. Of course children need basic health care... as does *any* human being. By focusing on children, elderly as somehow separate and in need of special attetnion, we allow the shameful treatment of others not in those groups. All humans, regardless of age, gender, and all the other delineations, need basic attention to their health needs. I realize that it plays on the heartstrings a bit more to focus attention on children, but I don't think, in the long run, it serves our best interests.

Kanary

[Silverhair]

25. I can see your point. Yes, I was going for the hearstrings. n/t

[Kanary]

26. I understand. Thanks for listening! n/t

[SharonAnn]

29. If you do put up a website, would you consider this?

Putting a section on it that people can use to calculate how they'll come out with the new Medicare prescription drug plan would be great.

What people want to know is "What does this mean to me?" and they can't figure it out.

I envision something like this:
User inputs the prescription drugs they take now and their price.
Website calculates what their costs would be in year 1 (2006), year 2, etc.
Costs would include Medicare monthly cost (no way at present to know what HMO costs will be), deductibles, copays, and yearly increases in the cost of medications ("x" percent).

There would need to be disclaimers, of course, but it would be a good approximation so that people could actually understand what this means to them, personally.

Then, they would understand how they're being ripped off by the Republicans and how they will be ripped off even more in the years to come.

[Kanary]

31. A good and reasonable idea, SharonAnn

However, that bill is HUGE, and I doubt that anyone has any understanding yet of exactly how it will work out in actuality.

Also, it is just the comparisons of drug prices. There are many other effects in that bill. For instance, if you pay 5.00 less for a given prescription but lose coverage in another area, ....well... it all gets complicated.

Kanary

[Cleita]

42. Read this on the new Medicare bill.

I posted it yesterday and didn't get much interest in it.

http://www.democraticunderground.com/discuss/duboard.php?az=show_topic&forum=104&topic_id=954931

It's the first analysis I have seen so far and it's not positive.

[Warpy]

6. Insurance companies have got to go

..so the first part of your post was valid. I'll be looking for your other points.

The insurance industry itself will take itself out of the equation if we don't mind suffering under the present system long enough. Right now, they are raising rates to a nearly confiscatory level for anyone over 40 to compensate for losses when the stock market took a nosedive. They have been assiduously purging their rolls of elderly and the chronically ill. Some have started to pull out of "unprofitable" markets, e.g. those places where people are too poor to pay out of pocket what those companies think they deserve. The system is already beginning to collapse, and it will eventually get to the point that even right wing talk show hosts will notice.

The insurance industry did a fair job for a long time, though, spreading the risk to a large enough pool that the rates could be kept low enough to be swallowed by employers. However, employers made the mistake of allowing the young and healthy to opt out of the system in exchange for a few cents more an hour. Deprived of these low risk people in the pool, insurance companies began to cherrypick the people they had left, and abandoning anyone who might cost them money. Add to this the profiteering by the drug industry and the fact that they have to turn a profit to please their shareholders, and you have a prescription for endlessly rising rates combined with a policy the car and homeowners' insurers have always adopted: make a claim and they'll cancel your insurance. This trend is just now starting, and it's quite likely to continue apace.

Single payer insurance is inevitable, given the inherent flaws in a for-profit insurance system that treats illness like a consumer decision. I honestly think it will start to happen sooner rather than later, but on a state by state basis.

[denverbill]

7. It's a major, major issue for me also.

I agree that insurance companies are a major part of the problem. You touch on only the adminstrative costs (40% of insurance cost) that is a result of private insurance companies, but they add other costs as well. I used to work in a hospital, and from that experience I know how difficult it is when you work with 1000 different insurers. Some require their own claim forms, some don't. Some pay for some procedures, some don't. The nightmare of trying to figure out who is paying and what they will cover is eats up a lot of money that could also be better used actually paying for treatment. It adds considerably to the cost of health care because of the administrative expense of dealing with 1000 different companies.

Then there is the 'cherry picking' problem. Insurance companies LOVE to cover healthy people, but hate to actually cover sick people. If I have health insurance for 20 years, and never use it, I'll get great rates naturally. However, in year 21, if I get cancer, the insurance company will jack my rates up so high that I'll never be able to afford it in year 22. That means that the only people who can afford private health insurance are those who really don't need it.

If Democrats actually start talking about specifics, Republicans will go right down the toilet. There is no way Republicans can justify that massive waste and basic unjustness of a system where 1/3 of the country gets inadequate healthcare and 2/3 of the country pays WAY more than they need to.

[Silverhair]

10. Absolutely correct. n/t

[davekriss]

8. Universal Health Plan is Endorsed

Silverhair, the Universal Health Plan drafted endorsed by 8,000 doctors and published in JAMA over the summer would save $200 billion by eliminating for-profit hospitals and private insurance, and reapplying these funds to provide universal coverage for the uninsured -- in other words, it would be a self-funding plan!

***

Published on Wednesday, August 13, 2003 by the Boston Globe
Universal Health Plan is Endorsed
Thousands of doctors back proposal in JAMA

by Liz Kowalczyk and Amber Mobley
http://www.commondreams.org/headlines03/0813-03.htm

<snip>

The government would pay for health care through an expanded version of traditional Medicare, the federal health insurance program for the elderly. Most hospitals and clinics would remain privately owned and operated, and the national health insurance program would pay them a monthly budget for operating costs. Investor-owned facilities would be converted to nonprofit status. Private insurance companies would be virtually eliminated. The plan is endorsed by former surgeons general Dr. David Satcher, who served under Clinton, and Dr. Julius Richmond, appointed by Jimmy Carter.

One of the doctors' arguments is that for-profit companies and multiple insurers are diverting money from clinical care for the demands of business. The physicians estimate that the country would save $200 billion annually by eliminating profits of investor-owned hospitals and insurance companies and by reducing administrative costs for hospitals and doctors who must bill dozens of different insurance companies. Private health insurers now consume 12 percent of premiums for overhead, while Medicare and the Canadian national health insurance system have overhead costs below 3.2 percent, the doctors reported.

<snip>

[Name removed]

13. Deleted message

Message removed by moderator. Click here to review the message board rules.

[Kanary]

15. GAK!

"Dental care was, to put it charitably, primitive. State dentists tended to extract decayed teeth instead of
filling them."

Well, *that's* discouraging to hear! Amazing.... They did not see that the loss of teeth creates other medical problems?

When I have engaged others in this conversation, inevitably they say "BUt, xyz country's medical care is attrocious!" It seems to be the first level of debate. So, I've been countering with "There is no reason why we have to do exactly what other countries have done. Many other countries have taken some of our ideas and changed them according to their own desires, and have also learned from our mistakes and made necessary adjustments. There is no reason why we cannot do that also."

Most recently, a rather well-to-do woman complained that some other country had, gasp, no private hospital rooms, even if you had oodles of money to pay for it. I just asked her if she thought our goverment was going to step in, if one-payer health care was approved, and destroy all the private rooms in all the hospitals. ~~shaking head~~ Sometimes it's hard just to get people to *think*.

I certainly believe that an important aspect of this whole issue is studying the systems of other countries, and finding out what works, what doesn't work, and go from there. There is a poster on this forum who is considering starting just such a dialogue here.

Kanary

[Silverhair]

16. Correct. That is why this is just the first of a long series of posts

on the subject. We can do better thant the Swedes did.

[Kanary]

21. Fully concur

You are brave to take on such an indepth discussion in the context of a forum which is limited in the amount that can be said in one "take".

I realize that you threw out a lot at once, even though you wisely limited the scope, and it will take a lot of time to cover all the bases just in what you have initially presented. I'm patient. :)

Again, I appreciate your efforts in even attempting to tackle all of this. One big chunk at a time....:)

I'll look forward to some of your ideas on how the US can do it differently.

Kanary

[Silverhair]

23. And I look forward to how other DUers can contibute to the discussion

and refine my ideas.

[dpibel]

32. Would you be so very kind

As to provide a link to any sort of support for this figure? As you note, Swedes are not known for inefficiency. So one wonders how the Canadians can have universal health care, or the Brits for that matter, without having that kind of costs. As a matter of fact, I would think that paying salary plus 48 would put a lot of businesses under. Even here in the notoriously inefficient USA, Medicare provides coverage for a lot of people at a cost well below what private insurance costs.

So you can understand, I'm sure, why I might be a little skeptical.

Your help much appreciated.

[Kanary]

14. Question: stats and figures

As coincidence would have it, I've been debating this issue with a group of (mostly uninformed) liberals and entrenched neocons.
To be honest, right now I feel so physically lousy myself that I'm just not up for a lot of work to convince them, or even to get them willing to open their minds to other possibilities. However, I'm willing to give them some basic info so that they can follow it up if they are willing to put the energy into it. (hah... like that's gonna happen....)

To this end, I would very much appreciate links to some of what you have asserted. Please be assured, it's not because *I'm* questioning you, as I have no need to be convinced of the veracity of your proposals, but simply for background for anyone who I might be able to get to do some investigation.

"And it wasn't that the companies were crooked (Although
some were.) but it was the system itself that created the dynamics"

Completely agree!! Do you have any other aspect of this in mind besides the insurance companies? I also hold conglomerate ownership of hospitals responsible, and there may be other aspects also.

"Currently medical care is about 15 to 20% of the national GDP. AND AT LEAST 80% OF THE MONEY IS
WASTED!!!!!!!!!! "
I, personally, believe you. Is there anywhere you can point me to that gives these figures in a findable way?

" A typical health insurance company has to have a
payout/premium ratio of less than 60%. That's right, the other 40% of the health insurance dollar
premium is used by the company. "

Again, I believe you, and am *very* glad that, as a former "insider", you are so forthright in "outing" this situation. However, is there somewhere I can find to present these figures on a more than personal experience basis?

I am immensely grateful to you for this *huge* undertaking! If I weren't currently fighting for my very survval, I would be very interested in working with you on this issue. I also completely agree that this is such a pivotal issue that it could be the dividing issue of the election. Obviously, I support Dennis' aims in this direction. I have seen polls that say that a rather large majority of people support a one-payer system. Don't know if that is actually accurate, but obviously a majority are quite unhappy. However, there is so much ignorance of any other possibilities, and people in general are afraid of change, so...... the willingness to actually open one's mind to other possibilities is a struggle.

Thanks again, and I'll be looking for your posts with great anticipation!

Kanary

[davekriss]

17. Some links

These don't necessarily backup silverhair's claims, but here are some facts to bite your teeth into (I encourage you to explore the site).

***

Why the US Needs a Single Payer Health System
by David U. Himmelstein, MD & Steffie Woolhandler, MD
http://www.pnhp.org/facts/why_the_us_needs_a_single_payer_health_system.php

<snip>

Private insurers take, on average, 13% of premium dollars for overhead and profit. Overhead/profits are even higher, about 30%, in big managed care plans like U.S. Healthcare. In contrast, overhead consumes less than 2% of funds in the fee-for-service Medicare program, and less than 1% in Canada’s program.

Blue Cross in Massachusetts employs more people to administer coverage for about 2.5 million New Englanders than are employed in all of Canada to administer single payer coverage for 27 million Canadians.

In Massachusetts, hospitals spend 25.5% of their revenues on billing and administration. The average Canadian hospital spends less than half as much, because the single payer system obviates the need to determine patient eligibility for services, obtain prior approval, attribute costs and charges to individual patients, and battle with insurers over care and payment.

Physicians in the U.S. face massive bureaucratic costs. The average office-based American doctor employs 1.5 clerical and managerial staff, spends 44% of gross income on overhead, and devotes 134 hours of his/her own time annually to billing2. Canadian physicians employ 0.7 clerical/administrative staff, spend 34% of their gross income for overhead, and trivial amounts of time on billing2 (there’s a single half page form for all patients, or a simple electronic system).

<snip>

[Kanary]

19. Thanks for the link!

I have stored it, to peruse when I have more time and energy.

I really appreciate it!

Kanary

[Silverhair]

43. Thank you very much for your assistance.

I think that if we at DU work on this as a project, we can cobble together a workable package, with real world solutions, that would be attactive across the political spectrum. It can't appeal only to the left or it will fail. But done right, I think we can get most moderates aboard, and even some of the right too.

[Silverhair]

27. About my stats. In this post I was going from memory.

As the discussions proceed, I will need to try and find some backup for my assertations. At the same time, I am going to need the help of other DUers in research too. My intention is to paint in broad strokes to get a package of ideas in motion, and hope that others can refine the details.

My ideas have been put together over the past two decades, (I left the insurance industry in 92.)and will include ideas from both the right, the left, and some that I don't know if they would be right or left.

I seriously think that if Americans were presented with a TOTAL package, they would accept it.

Some of my ideas are going to entail some serious "bullet biting" too. In that I think the people are ahead of the politicians too.

[wanderingbear]

20. Shoot all the Repubicans??

Just a thought..

[ShimokitaJer]

22. No... we'll just have to pay to patch them up again. nt

[Silverhair]

24. No. I will talk about that too, later. We bring them aboard. n/t

[LWolf]

30. A timely post

and an issue that should resonate with everyone who has ever needed to visit a doctor.

I'd like to emphasize the difference between health "care" and health "insurance." Having insurance doesn't guarantee care. As my son, "covered" by Kaiser, can attest. It took him 2 years of fighting to get the hernia surgery he needed; in pain the entire 2 years, and then they only took care of one, rather than both, hernias.

I'm interested in reading your posts.

[Kanary]

33. A smalltown newspaper article

This was sent to me by a friend today.... this is from a small town.

I thought some here would be interested in the viewpoint of a smalltown dr.

http://www.summitdaily.com/apps/pbcs.dll/article?AID=/20031222/LETTER/312220401

As a Kucitizen, I was impressed with Dennis' proposal of enlarging Medicare to include all. This dr
doesn't think that is a good idea... doesn't like Medicare. Since this dr clearly has some compassion,
I'm willing to listen to his viewpoint as a provider who has dealt with Medicare. However, I still
lean in that direction.

I loved the "leave no lobbyist behind" phrase. ^_^

Kanary

[Enjolras]

34. Truth time: How many are also willing to reign in trial lawyers?

Despite the copious quantities of propaganda currently being spun by the Trial Lawyers of America, the impact of excessive malpractice lawsuit judgements against physicians and medical facilities, and the correspondingly exorbitant malpractice insurance premiums paid by same, on the cost of medical care in America is undisputable. Some facilities are so afraid of lawsuits by their own doctors that they're literally afraid to sanction doctors found liable for multiple malpractice awards. Why do you think John Edwards has been largely silent on the universal health care issue compared with the other candidates? (Is anyone else surprised he hasn't tried to sue Dr. Dean for malpractice yet?)

I think the trial lawyers saw this issue coming somewhere down the road, and wedded themselves financially to the Democratic party because of it. Naturally, this led to charges that the Democrats are the party of Trial Lawyers, a profession unpopular with a large percentage of Americans. I also think there are many Democrats in congress who pay lip service to the idea of universal health care because of it.

And there's the conundrum. We talk so much about the opposition of greedy insurance and pharmaceutical companies to what we know is the right thing morally, but one of the most vehement opponents of universal health care happens to be one of our own core constituencies , and they oppose it for the very same reason -- personal financial oppostunity. The privatized system has been lucrative for them, opening doors that remain closed to their Canadian and European counterparts. Malpractice awards, many of them from clearly frivolous claims, and the insurance and legal fees that go with them, really ARE a big part of that "administrative overhead" of which doctors and and medical facilities complain.

We cannot afford a single payer system, which we all know is the right thing morally, until this cancer is removed.

[Silverhair]

36. Absolutely correct. I plan to make that the topic of one of my

series of posts on this subject.

[cap]

35. how about these numbers???

25% of WV has no health insurance. Expected to grow to 33% in 5 years.

A Republican state senator can't afford health insurance on his salary.

[Silverhair]

44. Yes, that is why I think the time has come to be able to get

univeral health care, but we have to do it right. Hillary could have succeeded, but she botched it terribly. But how to get the Reps on board will be the topic of it's own post.

[OneTwentyoNine]

37. Kick the Frist family out of medicare and gain a billion or so....

For those who don't know,the wonderful Frist family owns HCA.

Lets see..wasn't that fine they paid for SCREWING medicare about oh...$$$800 million?? Of course *cough* em...they admited to absolutly NO wrong doing. But..they happen to have $800 million laying around so they paid the fine..

Fucking crooks in three piece suits steal 100 times more from America than all the bankrobbers in the last 100 years.

David

[Silverhair]

45. I understand your anger, but if we are going to succeed in

getting this, WE MUST NOT VILLIANIZE ANYBODY. Our objective is to GAIN universal health care, NOT to punish somebody (Even if they do have it coming.)

[Snow]

38. Silverhair, have you seen Sheila Kuehl's proposed single payer

system for California?
http://www.healthcareforall.org/single_payer.html
I think it's a credible starting point.

[Silverhair]

46. Thanks, I have bookmarked it and will read it later. n/t

[Lydia Leftcoast]

40. A Christmas kick for this thread

:kick:

Remember those who are in the emergency rooms today.

[camero]

48. Thank you Silverhair

I think the first thing we have to do is to convince people that health care is not a commodity. That is an odd thing to be comparing human life to coffee and sugar but so it is right now.

Would these same people who think it is a commodity also say that property protection such as police and firefighting is also a commodity? Nope.

[economic justice]

49. Thank you!!

The whole health care issue is paramount to any other domestic issue, imo. Our system of delivering (or failing to) health care is nothing short of scandalous. Thank you for the series you are planning. We need more discussions of this type on DU.

I support a single-payer system similar to Canada with a few tweaks to make it workable for a country our size. Expensive? You bet. To NOT do it? Even more expensive.