Why is a single payer system better than a hybrid system of public and private plans?

[NJmaverick]

I have seen strong support for single payer system here at DU. I am trying to get a handle on this issue (as it's not an issue I have been following all that closely). If you are able to basically able to get a medicare type plan, what difference does it make if people can also purchase private insurance. Wouldn't the public and private plans compete to keep each other's costs down (at least in theory)? Please this is not a post looking to start angry responses. I don't have a problem with either plan, I am just trying to figure out why I would want to support only the single payer option.

[depakid]

1. Because it's more efficient and equitable

Unfortunately, it's not able to be accopmlished in one fell swoop, given the dysfunctional nature of the US political system.

[JuniperLea]

2. Private insurance is very expensive...

Why pay 30% more to make some CEO rich?

:shrug:

Same doctor, same hospital, same service, less money.

[pnwmom]

7. Right. Which is why most people will eventually end up on the public option.

But I think the poster is asking -- what's wrong with offering both, and letting people make up their minds? It will either cause the private companies to improve themselves so they can compete, or it will cause them to wither away.

[JuniperLea]

13. Did you watch Obama the other night?

He said that about six times... he wants both offered so we have a choice.

I am a little perplexed by DU these days... we used to be so well informed.

[Jakes Progress]

15. Yes he did. And

then he indicated that offering both wasn't a deal breaker. Then one WH office said he didn't say that. Then another said they weren't sure.

I believe he wants a public option. But as far as being informed, we have a plethora of sources and opinions. So it often comes down to belief. I choose to believe, but I often read reliable information that contradicts easy belief.

These are very scary times for this administration. They need health care reform, but if they compromise the hell out of it so that it won't work, we won't get another shot at it for another sixteen years. And I fear that he will go into the next election with a failure on his back.

I favor single payer since it is the sanest. But if we have to have the devil in our insurance, at least don't let him write the bill. What we will get if big insurance participates in the drafting will be some form of the Senior Drug Plan, a nightmare of obfuscation and greed.

[JuniperLea]

18. I choose to believe what the president said, over and over again...

And anything in print, or on TV, to the contrary, I consider to be suspect. He seemed very adamant, repeating the choice over and over again.

[Jakes Progress]

101. How nice.

Naive and myopic, but nice and a nice way to get to contentment.

[pnwmom]

17. Yes, I think the was very persuasive, as usual. If enough people were listening . . .

[JuniperLea]

19. And not believing news reports to the contrary...

I think that is key.

[Jakes Progress]

100. The key to what?

You choose to believe only what you heard. You choose not to believe anything that would diminish your view or contradict it. I don't find that a way to be the kind of fully informed DUer that you wished for.

This is not a simple life. It can seem simple if you only see things the way you want to see them and ignore all information or reports that might blur that vision.

As I said. I believe that our president wants a form of public option. I won't be so naive or ignorant that I cannot conceive of a world where that might not be the case. I am unhappy with compromises and concessions that the administration has made on other vital issues, so I also won't be so naive as to believe that just because he said something, that is the way it will happen.

[Warpy]

3. Given any sort of a two tier system

conservatives will always seek to underfund the public tier, the one which concentrates the poor, the old and the sick.

The best we can hope for out of any two tier system is enough regulation to make the top for profit tier unprofitable. We can do this by ending all the abuses of refusing people with health conditions, refusing the old, rescinding policies due to technicalities, creating artificial "insurance pools" and jacking up rates as people within them become ill, and simply delaying or denying care in the hope that a client dies and saves them the bother of paying for treatment.

If we make for profit insurance unprofitable enough, the vultures will exit and look for another industry to strip and what's left won't be particularly motivated to continue.

[ieoeja]

4. Every major company in the US (except for Wal-Mart and the Insurers) would save tons.

Taxpayer funded healthcare would make all these companies more competitive with their overseas counterparts that do not have provide their employers healthcare.

It would hurt the insurance industry. But help everyone else. Except Wal-Mart who uses taxpayer funded healthcare already by (1) paying their employees little enough that they qualify for Medicaid, (2) providing their employees assistance in applying for Medicaid and (3) not providing their employees any healthcare.

We do not have to actually change any laws to have single-payer health care. We just need all of our corporations to lower salaries to the Wal-Mart standard. Then everybody would be on Medicaid.

[rocktivity]

5. Try this web site for some real answers

http://www.pnhp.org/facts/single_payer_resources.php
http://www.pnhp.org/facts/singlepayer_faq.php

:headbang:
rocktivity

[NJmaverick]

6. Thanks, that was helpful

:hi:

[rocktivity]

11. Here's some FAQs

http://www.pnhp.org/facts/singlepayer_faq.php

And here's some stuff I posted yesterday.

:headbang:
rocktivity

[JuniperLea]

21. Great links!

Thanks for spreading the truth!

[rocktivity]

39. If you have a Twitter account

http://tinyurl.com/ys4w67+%231payer">Clicking on this will take you to the web site and automatically post a link to http://www.pnhp.org/facts/singlepayer_faq.php after you log in.

:headbang:
rocktivity

[rucky]

8. Shared risk pool makes a stronger system.

Plus we as consumers of healthcare and prescription drugs would have a reverse monopoly.

[TransitJohn]

9. It gets rid of

the profit motive of the middle man. An insurance company is a middle man looking to skim off of the transaction between patient and provider. If the gov't were the only insurance company (a single payer), and it wasn't looking to make a profit but break even, then costs for health care delivery go down.

[rampart]

25. cherry picking

the for profit insurer will be the best choice as long as you have no claims.

at that point they drop you, the gov't plan pays the bills, and you can never have the private insurance again due to the claim.

[TransitJohn]

44. uh....what???

the for profit is the WORST choice if you have no claims....why pay the most money for no return? Plus, what does this have to do with my reply?

[Selatius]

10. Single-payer means that one entity represents all. It achieves economies of scale as a result.

One entity representing all means that it has tremendous bargaining power in terms of keeping down costs as far as medical procedures, the cost of prescription drugs, etc. It can do this a lot better than 300 insurance companies can. This saves the taxpayers money in the long-run.

Also, single-payer means the organization is not run specifically to generate profits but to serve the public. Medicare is a good example. Private health insurance entities exist, first and foremost, to generate profits for shareholders and to increase stockholder value. Services rendered are secondary to that goal. If it is more profitable to drop people from coverage or to prevent people from even enrolling, then it will be done.

[spin]

12. Because it WORKS...

I've talked to people in Great Britain and Canada.

They love their health care system and wouldn't trade it for ours.

But we will never get a fair health care system, our politicians are bought and paid for by the medical establishment.

We'll get change, it will probably cost more, be inferior to what we have now and will serve only to benefit those who contribute large amounts of money to reelect the people who are supposed to serve the average people of our country.

We could change this, but the mainstream media and the commercials on their controlled networks will convince the vast majority that we need to preserve a system that discriminates against the average citizen to the benefit of the big corporations.

The rich will get richer and be able to afford the best health care, the average feudal serf will merely have to expect inferior care and die younger. That why the rich call us peons. They really don't give a shit about us, or how long we live. As long as we slave for them they're happy. And like mushroom farmers, they keep us in the dark and feed us bullshit.

[TahitiNut]

14. Part of the inflated COST of health care in the US is the DOCTOR'S billing/admin overhead ...

... as seen in the large, complex billing and accounts receivable departments in hospitals and clinics and personnel COMPLETELY dedicated to negotiating the myriad of insurance interfaces. There is little standardization in reporting or coverage and the delays and degrees of coverage vary greatly. That's an overhead that does NOTHING to serve the HEALTH of the patient.

This is separate and distinct from the accounts payable and green-eye-shade clericals on the insurance side ... and create this warring/adversarial bureaucracy overhead dedicated to the perpetuation of their own functions.

[lindisfarne]

16. Fundamentally, the concept of single payer is not inherently better than a public option (not co-op)

There are many ways to set up single payer - not everyone has to be covered, premiums can be assessed, subsidies may or may not be provided to help the poor, access to physician/hospital of choice may or may not be restricted.

Howard Dean doesn't see much difference.
"Dean also said that single-payer is pretty tough to differentiate from the public option. "Public option is like single payer. It gives consumers the choice. There's no such thing as a pure single-payer plan anywhere." Dean went on to say that there's absolutely no reason for a wedge between single payer advocates and those who support the public option. In fact, Dean said he believes that it's a recipe for disaster. "It's a mistake to drive that wedge. It's how reform has been killed in the past.", Dean said."
http://www.democraticunderground.com/discuss/duboard.php?az=show_topic&forum=389&topic_id=5864814

[NJmaverick]

20. Interesting and now I am even further confused

as it seems I am getting all sorts of conflicting views

[Cleita]

23. We already have a single payer plan here in the USA. It's called Medicare.

Ask your grandparents about how it works.

[MajorChode]

105. Not exactly

For about a decade now there's been Part C and about 20% of those enrolled in Medicare have it.

I kinda like the French system. They have a basic government plan and everyone can purchase supplemental coverage from private providers (about 90% of the population does). Of course if you just mention the French, wingnut heads explode.

[lindisfarne]

27. Practically, you could factor in whether it has a political chance in hell to pass.

The public supports the public option with private insurance more than they support single payer (see #7 in my previous response for data; NY Times had a poll with similar results more recently).

If you believe "it's my way or nothing", then you might support a different option.

There are enough people who are apprehensive about losing private insurance that single payer doesn't have a chance. Single payer folks will say "with education they will change their mind". The Bush era proved that some folks can't be educated, and never will change their mind.

People want improvement in the health care system (e.g., to get most insured, cut costs), but enough have private insurance that they think will be better than a medicare-like program and they don't want single-payer. Those people are why single-payer is not politically possible right now. I personally am not a single-payer advocate; I don't see it as our salvation like some.

[lindisfarne]

29. France's system has been ranked the best in the world, but it's not single-payer. Ezra Klein has a

good article on various systems in a few countries here:
http://www.prospect.org/cs/articles?articleId=12683

(In France, gov provides basic level of insurance but encourages people to buy private insurance for additional coverage & 86% of people do. Some still consider this "single payer" - I wouldn't because of the prevalence of private insurance (and government encouragement of it).

See how complex it gets? France's system is not so different from Obama's public option with private insurance alongside. No, the government wouldn't provide a basic level of insurance to all (those who chose private insurance wouldn't have any gov't provided insurance). But, if the US made insurance mandatory, with subsidies for the poor to cover premiums, there would always some option to obtain affordable insurance. People could always turn to the public option for insurance. Not identical to France, but not so different, either.

[Cleita]

31. It is single payer. Read this part of your own article.

It's a common lament among health-policy wonks that the world's best health-care system resides in a country Americans are particularly loath to learn from. Yet France's system is hard to beat. Where Canada's system has a high floor and a low ceiling, France's has a high floor and no ceiling. The government provides basic insurance for all citizens, albeit with relatively robust co-pays, and then encourages the population to also purchase supplementary insurance -- which 86 percent do, most of them through employers, with the poor being subsidized by the state. This allows for as high a level of care as an individual is willing to pay for, and may help explain why waiting lines are nearly unknown in France.

People mistakenly think the insurance companies can compete with the government plan. It can't. It can only supplement the basic plan. It's how our Medicare works. Also they provide a supplemental government plan for those who can't afford to buy insurance. We could do this here but the insurance companies won't even compromise on this. Personally, I would prefer Canada's plan because I'm fed up with the greedy insurers and don't feel they need any help from us to maintain their profit margin.

[lindisfarne]

33. Uhh-you failed to read MY post. 86% of the French have private insurance to subsidize the gov't plan

Not everyone considers France a single-payer and although Ezra Klein may, he's not the definitive expert.

This only points to the complexity of what single payer plans can look like - which is a point I've made over and over (and did in my first reply as well). If, in fact, 86% of people have private insurance in France, the government is not the only payer for health care expenses - as I already said:

"In France, gov provides basic level of insurance but encourages people to buy private insurance for additional coverage & 86% of people do. Some still consider this "single payer" - I wouldn't because of the prevalence of private insurance (and government encouragement of it."

Also, private insurance coexists with a government plan in Germany. So insurance companies CAN compete with government plans.

Also - single payer is NOT necessarily UNIVERSAL health care. It can be set up that way, but does not have to be.

[Cleita]

35. The basic government plan is single payer and no insurance can duplicate it.

That's what single payer is. People think that what congress is doing in this choice thing is like France's but it's not. Everyone has to be covered by the government plan and then they buy insurance to supplement it. This is how Medicare works. Medicare the basic plan sets the fee schedule and pays 80%. Most of us have supplemental insurance for the other 20%. The only difference I believe in the French plan is that they don't set a fee schedule so you can buy insurance that will cover what the basic plan doesn't. It can be as basic or as fancy as you can afford.

[lindisfarne]

37. The PNHP definition of "single payer" doesn't agree with you. And if you're correct,

then how are all possible single-payer systems better?
What if the gov't provided a ridiculously low level of "single-payer" care that couldn't be "duplicated"? So low as to make private insurance necessary to have any real level of coverage at all?

And again, can it really be considered "single-payer" when 86% of the people feel they need supplemental insurance?

Single payer folks keep arguing that single payer IS the best option. Of course it's not. Some single-payer plans can probably be quite good but others could be horrible. The details are what make it better or worse.

According to PNHP's definition, France would not be a "single-payer" system - the French gov't does not "collect all healthcare fees" nor "pay out all healthcare costs".
http://www.pnhp.org/facts/what_is_single_payer.php
Single-payer is a term used to describe a type of financing system. It refers to one entity acting as administrator, or “payer.” In the case of healthcare, a single-payer system would be setup such that one entity—a government run organization—would collect all healthcare fees, and pay out all healthcare costs.

In a single-payer system, all hospitals, doctors, and other healthcare providers would bill one entity for their services. This alone reduces administrative waste greatly, and saves money, which can be used to provide care and insurance to those who currently don’t have it.

[Cleita]

40. Yes, but actually even in Canada some provinces have co-pays or may not

pay for drugs and you can buy insurance for it, but it's still regarded as single payer. I know PNHP have narrowed the definition for their purposes. Truman referred to it as a national health insurance fund, but it's still the same thing.

The most controversial aspect of the plan was the proposed national health insurance plan. In the November 19th address, President Truman called for the creation of a national health insurance fund, to be run by the federal government. This fund would be open to all Americans, but would remain optional. Participants would pay monthly fees into the plan, which would cover the cost of any and all medical expenses that arose in a time of need. The government would pay for the cost of services rendered by any doctor who chose to join the program. In addition, the insurance plan would give a cash balance to the policy holder to replace wages lost due to illness or injury.

http://www.leftinalabama.com/diary/901/

[lindisfarne]

43. So single-payer can be many things. It doesn't require a single-entity to pay (although PNHP defines

it as such) and can have private insurance supplementing it (in France, 86% have private insurance supplementing the government plan).

Many DU single-payer enthusiasts have argued against the public option because they say the private insurance alongside of the government plan(s) makes health care overall more expensive.

Some points:
1. Single payer (at least according to some) does not exclude people having/needing private insurance. 86% of the French population purchasing private insurance suggests there is considerable need for the supplemental insurance. The French combination government/private system (with significant co-pays for the government-provided coverage) seems to work - they were rated first in the world.

2. Single payer is not necessarily universal health care, nor necessarily free. Nor does it necessarily guarantee you choice. It's all in how it's set up - same with public option.

3. The private insurance industry can be regulated to a greater or lesser degree. In Germany, they have a public plan, but some can also choose to opt out and buy private insurance (insurance -either public or private- is now mandatory in Germany). Both France and Germany spend a much lower % of GDP on health care - so having private insurance alongside of some kind of gov't option does not necessarily make health care exorbitantly expensive.

4. In practice, looking at developed countries, single-payer does not mean only one single entity pays for health care. In France, 86% have supplemental private insurance. In Canada, apparently, some do as well, at least for certain things.

5. In the US, the political feasibility of single-payer is pretty questionable. The public option with private insurance alongside is a system used in Germany & it seems to work well for them. Inherently, there is nothing fundamentally flawed about this option.

[Cleita]

45. It does require a single entity to pay for what it covers. Anything else is

extra and can be paid for any number of ways as France's system is. But I get upset when people don't make the distinction of what constitutes the government covered part of France's health care. It gives the RW corporatists a chance to claim that private marketplace works in France so it should work here. The reason that it doesn't work here is that insurers are allowed to cover basic care so there are any number of payers in our system and that isn't the truth in France. There is only one payer for their system and everybody has to be enrolled in it. Anything that is extra is what is offered in the private insurance sector and you can shop around for what you want or can afford. If you are poor then the government will pay the extra with a plan like our Medicaid, just like we do here for Medicare recipients who can't afford the copays or the Medigap insurance.

[lindisfarne]

47. But 86% of France's population buy private insurance. Clearly a non-government entity pays for a lot

of their health care, thus, not a "single-payer". You are arguing the government provides a basic level of health care and pays for that (true) - and 86% of the population feels feels it needs to be supplemented.

The facts are the facts.
I don't care what the RW corporatists manipulate things to be. That doesn't mean we should manipulate things to look better than they are.

[Cleita]

49. You don't get it do you. They buy insurance for what the government doesn't

cover. The insurers do not pay for the basic coverage like our insurers do. France had to do it that way because their insurance companies weren't getting out of the way either so they had to throw a bone to them in order to get a national health plan with everyone covered. People who can afford to buy insurance for the co-pays have to shell out that extra, just like I do with my Medigap policy for my Medicare, but it gives me security because Medicare dictates the terms. I will not be denied for pre-existing conditions nor dropped because I have too many medical problems. With both options I have 100% coverage and I can go to any doctor or clinic that accepts Medicare and I haven't been turned down yet. I can travel anywhere or work anywhere and my coverage goes with me. If my insurance gets too expensive and I'm poor enough then Medicaid will take over the gap.

[lindisfarne]

52. I do get it. I just don't agree that single-payer is the only - or best- answer. It can be set up in

many ways.

A government could set up a "single payer" plan which covered only the first 10% of costs, and say, if you want more, buy private insurance. Under your definition, that would be single payer - even though the coverage is so minuscule that most would purchase private insurance.

The French government could provide a higher level of coverage so only 10% of of people wanted to buy supplemental insurance. That, too, would be single-payer.

My argument is that single-payer is not one thing. It can be better-and it can be worse. Single-payer is not inherently better than a public option with private insurance alongside. Germany has this - it works really well for Germans and keeps costs low - in large part due to heavy regulation of the private insurance industry.

[Cleita]

53. Heavy regulation would work for awhile but they will figure out a way to

erode it just like is happening in Germany. Yes, they are having problems with coverage being chipped away so the insurers have to pay less. The best way is to make health care a human right in our Constitution like it is in other countries and then make it non-profit. Single payer works best under those conditions.

[lindisfarne]

55. In Germany, the public plan is cutting coverage. It has nothing to do with the insurers - 88% of

Germans have the public plan. The issue in Germany is taxation - people (and corporations) want taxes cut - which means government programs have to get cut (Merkel is big on cutting government programs).

Corporations in general (plus some of the population) are eating away at the public insurance plan - and all government programs. It's not just the health insurance companies.

[Cleita]

58. Yes, because the same conservative forces are at work, but it won't

last because the people will rebel, just like the Canadians do everytime the conservatives mess with their health care. Anyway having this conversation with you is leading me to believe that you like things just like they are and once the insurance industry takes over Medicaid and the VA and any number of our govt. health plans, you will be ecstatic. Do you work for health insurance lobbyists? I'm asking you directly if you do because it makes it easier for the rest of us not to bother to explain things to you because your mind is already made up.

[lindisfarne]

64. Yes. So now you progress to personal attacks. Howard Dean has said there is no difference between

single payer and a public option with private health insurance alongside.

Are you going to accuse him of working for the health insurance lobbyists too?

[Cleita]

85. It's no attack. It's an honest question which you haven't answered. Health

care shouldn't be a Republican or Democratic issue, but a human rights one that both parties should come together to work on. Instead it has been politicized because of insurance lobbyists in Washington. So I thought I would ask. You seem to be on the side of privatization. Howard Dean has nothing to do with this conversation.

[lindisfarne]

89. It's a stupid question. Do you believe everyone who supports Obama works for the insurance lobbyists

I refuse to answer stupid questions.
It's a personal attack, made because I (a) disagree with you and (b) have made very good points.

[Cleita]

92. If you think your points were good, so be it. n/t

[lindisfarne]

56. Government program, including health program, have been cut in France & Canada,too. Single payer

doesn't ensure cuts won't happen. It doesn't ensure a lower % of GDP will be spent on health care, either. Nor does it ensure that the same level of health care will be cheaper.

In the US, a government plan (with private insurance alongside) could provide a certain level of health care cheaper than is the case in Canada or France. It all depends on what the overhead is, how well unnecessary tests are controlled, and so on. The US government plan could certainly have different costs than the private health insurance companies (just as medicare does now). If individuals choose to have private health insurance in the US and those insurance companies have higher overhead, then the costs to the individuals will be higher. It's the choice of the individual.

There are more people currently on federally-provided insurance in the US (83 million) than the entire German population (80 million). A public program can work quite well in the US alongside a private option.

[Cleita]

57. The same forces that are trying to privatize our Medicare are also at

work in those countries but they won't get away with it because the people like their health plans too much.

[lindisfarne]

61. Do you verify the truth of your statements? The people have to be willing to pay the taxes to keep

the coverage. That is true for ANY government program in ANY country. I'm all for government programs, but single-payer won't prevent these pressures. If the public decides they don't want to pay taxes, government programs have to be cut.

Canada certainly has a decent health care system, but that doesn't mean Canada isn't facing tough choices about health coverage costs. The money has to come from somewhere - and the system is only as good as the money people are willing to pay.

In France, cuts ARE being made to government-provided health care benefits. Single-payer (as you define France's system) has not prevented this.
https://www.npr.org/templates/story/story.php?storyId=92419273
To fund universal health care in France, workers are required to pay about 21 percent of their income into the national health care system. Employers pick up a little more than half of that. (French employers say these high taxes constrain their ability to hire more people.)
...
France, like all countries, faces rising costs for health care. In a country that's so generous, it's even harder to get those expenses under control. Last year, the national health system ran nearly $9 billion in debt. Although it is a smaller deficit than in previous years, it forced the government of President Nicolas Sarkozy to start charging patients more for some drugs, ambulance costs and other services. Debates over cost-cutting have become an expected part of the national dialogue on health care.

See also #62 for more issues with the French system.

[Cleita]

83. Yes, I do. I was wondering about you. Only conservatives don't like to pay

taxes. Liberals realize taxes are necessary to pay for things that we use in common like roads, fire departments, police departments, government and we should have health care in there too. I thought you were all for the French system and now you are dissing them. I'm not in favor of it as you know because I would like private insurance entirely out the picture in delivering health care with the exception of frills like private suites at the hospital as long as they don't interject themselves in the mainstream delivery of health care. Yes, governments sometimes have to fix things when the conservatives start tapering with things that don't need to be fixed. Employers always bitch about taxes and maybe there could be some shift of tax bases to those who don't pay their fair share and that is something governments have to fix.

[lindisfarne]

88. I didn't "diss" the French system. I provided real facts about it. Facts are relevant - even if they

don't support one's position. Every government program has its strengths and its weaknesses, and it's important to assess them honestly when deciding where US health care should go. Acknowledging a weakness is not "dissing" (I hate that word, but since you used it, I will stick to your choice of word).

"Only conservatives don't like to pay taxes." Of course, that's not true. Progressives are more willing to pay taxes, on average, but even they have limits. And most progressives in the US would not vote to pay the taxes that are assessed, for example, in Norway.

Think about this:
Do you pay your state taxes for things you order over the internet? Most states have laws which require residents to pay those taxes on their income tax if you weren't assessed it when you ordered your product online (sometimes if you buy things out of state when you physically go to another state). If you don't, does that make you a conservative, because you "don't like to pay taxes"?

[bobbolink]

99. PNHP would beg to differ. "Public Option" is a set-up to fail.

The so-called "Public Option" (I'm so tired of these silly phrases)wouldn't have the large pool that is required to really lower prices, and provide adequate care for all.

It would mostly attract the sickest and poorest, and therefore likely go down the drain.

Do we have to keep learning the hard way?

[Jakes Progress]

102. You don't mean fundamentally,

you mean idealistically. In the ideal world - one where congressmen and corporations had the best interests of their constituents and customers at heart - they could be equal.

For an example of what happens when you let corporate pigs "help" with health care, look at the Senior Drug Plan. Corporate pharma and the neocons sold that one to seniors as the answer to their problems. Instead of letting Medicare handle the plan and allowing them to bargain for price, seniors got a million "options" that were pure obfuscation and greed-driven.

Medicare is single payer. The Senior Drug Plan is what you get when the corporations and their purchased legislators sell the public on choice and options.

Now whether our corrupt congress will pass single payer, that is another question. The OP asked why single payer would be better. It would be better because it puts it out of the reach of corporations. Another question is whether a determined and eloquent leader could have convinced the public that the single payer plan was better. We will never know.

[Cleita]

22. Because it's more cost effective and health care shouldn't be profit driven.

Most countries that have national health care and insurance, deliver basic health care to everyone through a government plan. Insurers can insure for bells and whistles but they can't duplicate the basic coverage. This keeps the quality high and cost low. When you let the private sector in like they have been allowed in Medicare, it starts to deteriorate the system and makes it more costly.

[surrealAmerican]

24. A big part of it is what TahitiNut said: multiple options ...

... means more work for doctors and hospital billing offices, and that increases costs.

Another important point is that, with both options available, the private insurers are going to try to "skim off" the healthiest "consumers", leaving the public option with the people who cost the system more, and contribute less in premiums. This could cause the public option to cost so much that it would fail.

[Greyhound]

26. Nothing as you've laid it out.

The problem lies in the so-called compromise where the public option is designed to not be competitive with the profit driven insurance programs, IOW we would be required to spend even more $$ than is currently being wasted into a plan specifically designed to fail by retaining bribes campaign contributions from the health care denial industry.

[NorthCarolina]

28. Because Single Payer takes the "For Profit" profits out of health care nt

[slipslidingaway]

30. Recommended, also see this link....

http://www.youtube.com/watch?v=HQNphM6xUsE

[Demoiselle]

32. An overall single payer system has enough clout to control costs...

A well designed public/private system (Medicare for all) would naturally tilt toward the most efficient, least expensive coverage for the most people., which would force prices down in the "private" sector as well. It would take longer to adjust....I'm so impatient at this point I'd rather see the single payer go in right away...but I understand those who don't agree.
And remember, people can, still, in fact, purchase private insurance in England. So even in that socialist bastion, so reviled by the right, there are choices available. We have a friend there who is rather wealthy and rather snobbish and
has always purchased his own private health insurance...but he has admitted to us that when he needed to go into the the public system for emergency treatment, he was wonderfully cared for. HAH!

[Hannah Bell]

34. because the richest 1% have more money than the poorest 95%.

[Just Saying]

36. Check out this NPR site

It compares different types of systems around the world, the cost, pros and cons, if there is a private option, etc.

http://www.npr.org/news/specials/healthcare/healthcare_profiles.html

[NJmaverick]

50. Thanks, that is a very nice site

[marmar]

38. Insurance companies MUST be shown the door.....

..... As long as they are so intimately involved in the health care system, we're going to get mediocrity.

[OETKB]

41. Several reasons

Adding a public option to the payer mix adds another insurance plan to be billed by hospitals, doctors, and other medical services. This is a major cost saver when there is a single payer but not so with multiple payers.

The cost saving loss tarnishes a National Health Plan and will be used politically to push it off the national agenda for years to come.

It removes 400 billion in savings that will be used to remove all deductibles, co-payments, and supplements. All of which at their current levels are barriers to care.

A single payer is a great equalizer in terms of doctor-patient relationships. With one National Health Card the medical world does not react to what insurance a patient has. Some doctors even refuse to serve patients on Medicaid or Medicare or Workman's Comp, etc.

It allows workers to choose the jobs to which they are most suited and allows employers to choose employees that will best fit their companies.

This social insurance, not Socialism, changes the mind set to a collective need rather than an individual responsibility. The health care system is the same no matter what insurance is purchased but under multiple plans it is rationed on an ability to pay or a preferrable payer basis. We do not privatize the payment for fire protection. It should not be done for our health care either.

[Warren Stupidity]

42. Because the kleptocracy will castrate the public plan

in order to keep their 30% baked in overhead shafting of us peasants in their coveted 'private plans'.

Private general health insurance cannot compete with a non-profit public insurance program unless the public program is crippled. We have seen this fact proven through the maneuvering by the kleptocracy in the senate to cripple any and all public options.

Single payer eliminates this maneuver.

[lindisfarne]

48. In Germany private general health insurance competes with a nonprofit public insurance plan.

As I said above:

Many DU single-payer enthusiasts have argued against the public option because they say the private insurance alongside of the government plan(s) makes health care overall more expensive.

Some points:
1. Single payer (at least according to some) does not exclude people having/needing private insurance. 86% of the French population purchasing private insurance suggests there is considerable need for the supplemental insurance. The French combination government/private system (with significant co-pays for the government-provided coverage) seems to work - they were rated first in the world.

2. Single payer is not necessarily universal health care, nor necessarily free. Nor does it necessarily guarantee you choice. It's all in how it's set up - same with public option.

3. The private insurance industry can be regulated to a greater or lesser degree. In Germany, they have a public plan, but some can also choose to opt out and buy private insurance (insurance -either public or private- is now mandatory in Germany). Both France and Germany spend a much lower % of GDP on health care - so having private insurance alongside of some kind of gov't option does not necessarily make health care exorbitantly expensive.

4. In practice, looking at developed countries, single-payer does not mean only one single entity pays for health care. In France, 86% have supplemental private insurance. In Canada, apparently, some do as well, at least for certain things.

5. In the US, the political feasibility of single-payer is pretty questionable. The public option with private insurance alongside is a system used in Germany & it seems to work well for them. Inherently, there is nothing fundamentally flawed about this option.

[Lydia Leftcoast]

67. But I bet the German private insurance is regulated in ways that

American insurance companies wouldn't tolerate.

Germany is a much-less corporation-coddling society than America is.

[lindisfarne]

71. Am. Insurance companies don't want to tolerate any reform. Are we going to allow that? n/t

[Lydia Leftcoast]

77. I'm afraid the Democrats will tolerate it, given their track record so far

:grr:

[lindisfarne]

91. Then single-payer is pointless to fight for, unless you want single-payer or nothing.

Even if I felt single-payer was inherently better, if I believed it didn't have a chance (and I don't think it does), I'd be fighting for Obama's plan.

I think both single-payer and public option with private insurance alongside can be equally effective. The real issues come in how they get set up. If there was the public will for single-payer and not for public option, I'd be fighting for single-payer.

I'm not a purist. I want the best system we can get, given the political considerations, which depend on the American people, which unfortunately, include many who fear government involvement in health care, however stupid that may be.

It's not just the Democrats. It's the American people. Many of whom will not change their mind.

[Lydia Leftcoast]

103. And how many Americans know about single payer other than

what they hear on KTLK?

When the Republicans want something, they speak with one voice and start an all-out PR offensive.

When the Democrats want something, they check with the Republicans to see if it's all right, and then the DLCers go on Fox News and speak against it. Then the Dems say, "See, the public didn't want it."

[Warren Stupidity]

108. Germany has a strong social democratic political party

and a long tradition of socialist political activism that prevents the complete abject corruption by the corporate elites that is the defining characteristic of our political system.

The German system has been in place, and has evolved, over more than 100 years. It is quite complicated. However "Currently 85% of the population is covered by a basic 'Statutory Health Insurance' plan, which provides the standard level of coverage."

That is essentially a single payer system except for the 15% of the population who are outside the public system.

"Public insurance
All salaried employees must have a public health insurance. Only public officers, self-employed people and employees with a gross income above ca. 50000 EU (adjusted yearly) may join the private system."

http://en.wikipedia.org/wiki/Health_care_in_Germany

Perhaps I wasn't clear. Given the level of corruption in our federal government, it would be nearly impossible for a public/private mixed system to be anything other than a farce, with the public option crippled to be non-competitive, for example by being saddled with all the adverse selection fallout, or by being prohibited from negotiating prices as in the Medicare prescription plan, or as has been floated - by being prohibited altogether for an absurd 10 year time frame.

Could such a system theoretically work? Yes, just not in practice here inside the bowels of the global kleptocracy.

[lindisfarne]

59. There are more people currently on federally-provided insurance in the US (83 million) than the enti

entire German population (80 million). A public program can work quite well in the US alongside a private option. (46 million with Medicare, 11 million military, 8 million SCHIP, rest federal employees & minor other programs)

[Warren Stupidity]

109. theoretically it could work. Just not in practice. nt.

[SoCalDem]

46. Gap insurance yes.. "Instead-of" insurance NO

Imagine how pricey car insurance would be if people who had never had a wreck, were not required to buy it?

older , safe drivers would opt out, and prices would skyrocket.

The more "competing" plans out there, the more gaps , and the harder it will be for people to "choose the right plan". That's how the 401-ks were supposed to operate too.. "let the people choose".. they did, and most lost almost everything.

"Choosing" a plan when you are not sick is easy. getting that "choice" to pay up when you ARE sick, is almost impossible...and then it's too late.

[ZombieHorde]

51. I support single payer but FrenchieCat pointed out the French system is not single payer and is

considered to be the best in the World.

[lindisfarne]

54. See #29 for more details on France.n/t

[Cleita]

60. Oh boy here we go again.

In France everyone is covered for basic care under their national health care plan. Insurance is bought for co-pays and bells and whistles coverage. This is how they cover everyone. It is not what is being proposed by our corporate whore politicians giving us a choice of plans that would cover basic care or no care as it happens to be today. There is one basic health plan, covering everyone and paid for by the government. Everything else is frills.

[FrenchieCat]

62. Well.....

Private Insurance. “More than 92% of French residents have complementary private insurance.” This insurance pays for additional fees in order to access higher quality providers. Private health insurances makes up 12.7% of French health care spending. These complementary private insurance funds are very loosely regulated (less than in the U.S.) and the only stringent requirement is guaranteed renewability. Private insurance benefits are not equally distributed so there is, in essence, a two-tier system.

Physician Compensation. French doctors are paid by the national health insurance system based on a centrally planned fee schedule, but doctors can charge whatever price they want. The fees are based on an up front treatment lump sum, which is similar to DRGs in the U.S. The patient–or their private insurance–must make up the difference between the fee charged by the doctor and the amount paid for by the universal health care system. The average French doctor earns only €40,000, although medical school is free for them and the French legal system is fairly tort-averse.

Physician Choice. The French have a fair amount of choice in which doctors they choose. However, recently the French have moved towards a more “managed care” practice style where patients have a “preferred doctors” who acts as a gatekeeper for specialists.

Copayment/Deductibles. 10% to 40% copayments.

Technology. The government does not reimburse new technologies very generously and because of global budgets and fee restrictions, there is little incentive to make capital investments in medical technology.

Waiting Times. France has generally avoided waiting lists, likely due to the fairly high coinsurance charges. Recent trends towards Increased restrictions, reduced reimbursement rates, and rationing has increased wait times however.

Tanner’s summary. “To sum up: the French health care system clearly works better than most national health care systems. Despite some problems, France has generally avoided the rationing inherent in other systems. However, the program is threatened by increasing costs and may be forced to resort to rationing in the future.”
http://healthcare-economist.com/2008/04/14/health-care-around-the-world-france/

[Cleita]

86. Too bad you can't get rid of the insurers. Your system would streamline

down much better once you cut out the middle men. Then that money that people have to spend to get co-insurance would be easier on the pocket book of the French people even if there was a slight boost in taxes to make up for it. It would still be less out of pocket than the insurance premiums. But I know you can't have your basic care without greasing the insurers wheels as well. Too bad.

[lindisfarne]

63. France is cutting government coverage(#61). Single-payer is not necessarily more effective

than a public government plan with private health insurance alongside. It can be effective (many cite France & Canada as examples) but Germany's system works well, so do the systems in many other European countries which aren't single-payer.

Single payer doesn't ensure cuts won't happen. It doesn't ensure a lower % of GDP will be spent on health care, either. Nor does it ensure that the same level of health care will be cheaper.

In the US, a government plan (with private insurance alongside) could provide a certain level of health care cheaper than is the case in Canada or France. It all depends on what the overhead is, how well unnecessary tests are controlled, and so on. The US government plan could certainly have different costs than the private health insurance companies (just as medicare does now). If individuals choose to have private health insurance in the US and those insurance companies have higher overhead, then the costs to the individuals will be higher. It's the choice of the individual.

There are more people currently on federally-provided insurance in the US (83 million) than the entire German population (80 million). A public program can work quite well in the US alongside a private option.

[lindisfarne]

68. There are many good health care systems in Europe- many are not single-payer. There is more than one

way to achieve a good health care system.

In the US, single-payer does not have the support of the American people that a public option with private health insurance alongside has - see #16 for link. (Germany has a system like this and it works. However, what really matters is the details of how ANY system is set up.)

[Lydia Leftcoast]

65. Because it doesn't leave anybody out

Young, old, rich, poor. If you're a legal resident you're in (and in some countries, even non-residents can get life-saving emergency care, such as stabilizing treatment after an accident or heart attack).

In a privatized system or a mixed system, there's always the question of who's covered and who's not and for what conditions.

In a Massachusetts-style system, where they just require you to buy private insurance or pay a fine, there are two problems: 1) A lot of people are technically too "rich" for Medicaid but still don't make enough to afford private insurance, 2) The type of private insurance they can qualify is virtually useless, since it has such high deductibles and may have a whole list of exclusions.

A privatized system would work only if the insurance companies were regulated in the same way that airlines were regulated before 1979: They'd be told what services they had to provide and what they could charge, period, no wiggle room.

[lindisfarne]

66. Single-payer is not necessarily universal health care. It can be set up that way, but doesn't have

to be.

[Lydia Leftcoast]

69. In most cases it is universal

In which countries is it not universal?

[lindisfarne]

70. The point is that single payer does not imply Univ coverage. Germany has universal coverage but not

single payer.
Health care systems are bad - or good - based on how they are set up.
There are many systems in Europe - many not single-payer - that work very well.
Germany covers everyone (mandatory health insurance), yet only about 88% have the government option - 12% have private insurance. So in fact, you don't need single-payer to cover everyone.

[Lydia Leftcoast]

75. As I said upthread, I bet German insurance companies are so regulated

that they can't pull the kind of crap that American insurance companies think of as "sound business practices."

[lindisfarne]

79. Did you read my reply? I said the Ins. companies don't want any reform - will the public allow this?

[lindisfarne]

72. Also, are you willing to say "single-payer" or nothing? Do you think there's the political will

for single payer?
See #27 for details.

[Lydia Leftcoast]

74. Yes, if the Dems actually unite behind it

and explain it properly, as opposed to listening to naysayers who are PR flacks for insurance companies.

[lindisfarne]

81. We'll see if that happens. The American public are not good at being educated, esp. the RT half of

it.

[MasonJar]

73. PRIVATE INSURANCE IS PROFIT DRIVEN AND DOES NOT SERVE

ITS CUSTOMERS. It eats up giant amounts of money in administration of techniques to disallow its own customers reimbursement for medical procedures. The less it pays out the higher its stock value on Wall Street, and so many billions are spent excluding benefits, advertising and lobbying.

[Lydia Leftcoast]

76. Yeah, what MasonJar said

Do the insurance company apologists and shills and privatization freaks not realize what bloodsucking leeches even the allegedly nonprofit insurance companies are?

[lindisfarne]

80. Personal attacks are unnecessary. Do you consider Howard Dean and Obama apologists and shills?

[Lydia Leftcoast]

82. If the shoe fits, wear it

Was I talking about you?

[lindisfarne]

84. It seems that anyone who doesn't agree with you on single-payer is labeled a shill or apologist.n/t

[Lydia Leftcoast]

90. As I said, if the shoe fits, wear it

And I don't consider Obama and Dean to be shills for single payer, since they're not paid to endorse it.

If you're paid to endorse private insurance, then you're a shill. If you're not, then you're getting insulted for nothing.

[lindisfarne]

93. Implying that anyone who disagrees with you is a shill is a rather stupid position to take.

You've implied a stupid question that deserves no answer whatsoever. You've also rather selectively read what I've written; in this thread alone, you'd find the answer in what I've said.

But I'll let you think whatever you choose. You're intent on doing that because I have expressed an opinion that differs from yours.

[Lydia Leftcoast]

94. Huh?

No, I said that if you get PAID to endorse something, you're a shill.

Are you paid to argue for private insurance? No? Then you're not a shill.

[HughMoran]

95. You're catching on to the game

It's called "How to influence people to people (into hating you and your intransigence)"

[lindisfarne]

96. Ludicrous, really. But not uncommon, even on DU, unfortunately. n/t

[lindisfarne]

78. That's true in the US. A public option would not be subject to the profit motive, even with private

insurance alongside. Several polls have shown consistently stronger support for the public option with private insurance alongside.
Read #43: single-payer can be set up in MANY ways. It does not inherently guarantee what many think it does, and a public option (with private health insurance alongside) can be set up to guarantee the same things. The public option can be very cost effective (as medicare is now) even with private health insurance alongside.

If some Americans choose a more expensive option, that's their choice. As Obama said, if insurance companies don't cut their overhead so they can compete with a public option, the public will cease to choose them.

[bread_and_roses]

87. No....I think you should explain how profit adds to health care

Look. The for-profit health insurance industy has had - what? - about thirty unfettered years? A good long time, at any rate, to do its thing. We see the outcome. We can look at other systems around the world, and we have reams of data on both the savings and the health care benefits of a single payer system (and I refer to single payer as covering ALL preventive and disease-care health needs, including dental, vision, and mental health; if people want to buy some extraeneous "extras" from a for-profit system, go for it. I don't care how people pay for elective plastic surgury, for example).

Since we have these reams of data, I think it's up to anyone who wants to argue for a "for-profit" system to make their case. The case for single-payor, or at worst case, a comprehensive available to all public option with paid for by the usual method - progressive taxation, is already well-made. And the actual outcomes of a for-profit system are equally well-documented.

[slipslidingaway]

98. +1000 n/t

[Warren Stupidity]

111. [phone]

[lumberjack_jeff]

97. In a single payer system, medical office staff is minimized...

... because of a standardized billing procedure.

[eridani]

104. Because even if half of all adults chose the public option--

--we would only save 9% on our total health care costs. With single payer, private insurers are forbidden to offer the same basic package for comprehensive care, thus eliminating the waste of 30 cents on the dollar. They would be allowed to offer coverage for anything NOT covered by single payer. In all countries with universal health care, that is exactly what they do.

Congressional Testimony of April 2009 by Dr. David Himmelstein

Official Transcript: http://edlabor.house.gov/documents/111/pdf/testimony/20090423DavidHimmelsteinTestimony.pdf
Video of testimony: http://www.youtube.com/watch?v=p-mpadKoFB4&feature=channel_page

Mr. Chairman, members of the Committee. My name is David Himmelstein. I am a primary care doctor in Cambridge, Massachusetts and Associate Professor of Medicine at Harvard. I also serve as National Spokesperson for Physicians for a National Health Program. Our 15,000 physician members support non-profit, single payer national health insurance because of overwhelming evidence that lesser reforms will fail.

Health reform must address the cost crisis for insured as well as uninsured Americans. My research group found that illness and medical bills caused about half of all personal bankruptcies in 2001, and even more than that in 2007. Strikingly, three quarters of the medically bankrupt were insured. But their coverage was too skimpy to protect them from financial collapse.

A single payer reform would make care affordable through vast savings on bureaucracy and profits. As my colleagues and I have shown in research published in the New England Journal of Medicine, administration consumes 31% of health spending in the U.S., nearly double what Canada spends. In other words, if we cut our bureaucratic costs to Canadian levels, we’d save nearly $400 billion annually - more than enough to cover the uninsured and to eliminate copayments and deductibles for all Americans. By simplifying its payment system Canada has cut insurance overhead to 1% of premiums—one twentieth of Aetna’s overhead--and eliminated mounds of expensive paperwork for doctors and hospitals. In fact, while cutting insurance overhead could save us $131 billion annually, our insurers waste much more than that because of the useless paperwork they inflict on doctors and hospitals.

A Canadian hospital gets paid like a fire department does in the U.S. It negotiates a global budget with the single insurance plan in its province, and gets one check each month that covers virtually all costs. They don’t have to bill for each bandaid and aspirin tablet. At my hospital, we know our budget on January 1, but we collect it piecemeal in fights with hundreds of insurers over thousands of bills each day. The result is that hundreds of people work for Mass General’s billing department, while Toronto General employs only a handful - mostly to send bills to Americans who wander across the border. Altogether, U.S. hospitals could save about $120 billion annually on bureaucracy under a single payer system.

And doctors in the U.S. waste about $95 billion each year fighting with insurance companies and filling out useless paperwork.

Unfortunately, these massive potential savings on bureaucracy can only be achieved through a single payer reform. A health reform plan that includes a public plan option might realize some savings on insurance overhead. However, as long as multiple private plans coexist with the public plan, hospitals and doctors would have to maintain their costly billing and internal cost tracking apparatus. Indeed, my colleagues and I estimate that even if half of all privately insured Americans switched to a public plan with overhead at Medicare’s level, the administrative savings would amount to only 9% of the savings under single payer.

While administrative savings from a reform that includes a Medicare-like public plan option are modest, at least they’re real. In contrast, other widely touted cost control measures are completely illusory. A raft of studies shows that prevention saves lives, but usually costs money. The recently-completed Medicare demonstration project found no cost savings from chronic disease management programs. And the claim that computers will save money is based on pure conjecture. Indeed, in a study of 3000 U.S. hospitals that my colleagues and I have recently completed, the most computerized hospitals had, if anything, slightly higher costs.

My home state of Massachusetts recent experience with health reform illustrates the dangers of believing overly optimistic cost control claims. Before its passage, the reform’s backers made many of the same claims for savings that we’re hearing today in Washington. Prevention, disease management, computers, and a health insurance exchange were supposed to make reform affordable. Instead, costs have skyrocketed, rising 23% between 2005 and 2007, and the insurance exchange adds 4% for its own administrative costs on top of the already high overhead charged by private insurers. As a result, one in five Massachusetts residents went without care last year because they couldn’t afford it. Hundreds of thousands remain uninsured, and the state has drained money from safety net hospitals and clinics to keep the reform afloat.

In sum, a single payer reform would make universal, comprehensive coverage affordable by diverting hundreds of billions of dollars from bureaucracy to patient care. Lesser reforms—even those that include a public plan option—cannot realize such savings. While reforms that maintain a major role for private insurers may be politically attractive, they are economically and medically nonsensical.

[Greyhound]

106. Also please look into these "private insurance" companies in other countries. There is a terminology

gap that our parasites are exploiting. In Japan for instance, their private insurance companies are what we would call non-profit organizations, any excess in collected premiums are expended the following year to reduce payments.

You will find the same thing over and over wherever you look. The bottom line is we are paying for huge profits and unbelievable salaries not seen anywhere else, and getting worse care for those that have coverage.

Another unmentioned problem is that so many people only believe they are covered because they pay their premiums and can get basic check-ups, if they actually need their coverage they enter the morass of the company refusing to pay the providers and they find themselves wiped out, bankrupt, and uninsurable because they now have a "pre-existing condition".

[western mass]

107. False dichotomy

This makes it sound like a single-payer system will abolish all private health insurance.

In the UK, there's the NHS. AND people are free to get private insurance as a supplement, if they wish (and many do).

[DireStrike]

110. A private system has a HUGE handicap. The private one has to profit.

In some cases, the greed of the people running a private institution can be a motivational factor that will cause it to be better run.

In a corporate setting, the job of the executives is to make sure the company does well enough to keep their pay levels the same, or allow them to increase. The company does not actually have to do better to accomplish this. It seems the norm to continually reduce the quality of product and service and ruthlessly cut the "costs" which contribute to a better product, and simply comtinue to funnel the money to those at the top.


Mixing public and private is like mixing shit and ice cream.

[Juche]

112. Lower administration and bulk purchasing power

The savings from single payer run about $400 billion a year. $300 billion in lower overhead, and $100 billion in bulk purchasin power and the ability to negotiate lower prices for medical supplies. I believe the savings from having a public plan compete with private plans would be about $2 trillion over the next decade in slower medical growth. ie, with competing public vs private plans you'd only grow medical costs by about 5% a year rather than 6%, which adds up to 2 trillion. However with single payer you are saving 4 trillion in that same period. Not only that but single payer will keep cost growths down too, so you may end up saving 7 trillion or more over the next decade. So a single payer system could save up 6+ trillion over the next decade, a public/private hybrid would save us 2 trillion.

With a public plan I don't know if it will be allowed to negotiate prices. The administration will be lower though, and that is one reason why tens of millions will likely join a real public plan, since it is cheaper.

Basically single payer is like the public plan, except stronger, with bigger savings and with more teeth.