Reply #65: Great about the donation, thanks!!

[Mairead]

As to the expense being reflected in your pay, I don't know. Do you have insurance from your employer now? (presuming you still have a job!) If you do, is it reflected in your pay? I had insurance at most of my jobs, and I really couldn't say whether it somehow impacted my salary. I imagine it probably varies with the industry and the position one holds...we can be sure that CEOs, for instance, never suffer, but someone on the shop floor? I'm cynical, so I'll bet 'yes', that it does now and will in future too. But maybe not!

On the 'attractive to docs', my guess would be simpler billing, a more predictable income stream, more opportunity to 'do medicine', and--I'm guessing a bit here--reduced malpractice costs. I'm presuming the reduced malpractice since a doc who does bad work won't be as easily able to dodge by changing states, hospitals, and plans. Similarly, someone who defrauds Medicare today can often continue to practice without Medicare, if they escape prison. I shouldn't think that would work when Medicare is the single payer. On the 'do medicine' part, a number of physicians have completely bailed out of the field (after all those expensive years!) because HMOs were continually rushing them, and plenty others have cheerfully taken a big income hit by going independent (my doc was one of the latter). So I think 'do medicine' will be quite important.

As far as drug companies go, I'm stumped. I can't imagine what they'd get out of it, unless it's that, with more people able to get care when they need it, the drug companies will make it up in volume as they do in Canada and the UK. They really do make out like bandits now.

I think it hasn't been done before in part because the situation has never been this bad, with so much wealth concentration, and in part (this is something I'm only partly remembering, so perhaps someone else remembers it too and better) because it's the details of Dennis's plan that make it one of those 'oh good grief why didn't I think of that' ideas. It takes a certain attitude of mind to think of this particular solution rather than some other.

I hope I've given value for your donation!