A Question of Healthcare – Part 1
Is It Funny or Is It Ageism?

A Question of Healthcare – Part 2

[EDITOR'S NOTE: A new story about the other important book Betty Friedan wrote has been posted at BlogHer today.]

category_bug_politics.gif When I got sick when I was a little girl and if my mother thought I was too ill to travel or it appeared I had something contagious like chickenpox, the doctor came to our house. When I needed immunization boosters or a routine visit with the pediatrician, we went to the doctor’s office.

At the end of the visit at home or the office, my mother paid the doctor in cash or by check. Credit cards did not exist in the late 1940s (or were barely known) and employers did not widely offer health insurance as a benefit yet.

Medical needs were generally affordable. Doctors, even in cities, did not drive Mercedes and they often reduced their fee or did not charge at all when they knew a family’s budget was stretched thin.

Life is not so simple anymore. Healthcare has become more sophisticated and complex involving million-dollar machines and procedures. Physicians have been divided up into specialists so that the person we see for an ailment is often a stranger. And healthcare has become big business operated from the top down by the insurance industry and giant HMOs.

Aside from the insurance industry which reaps billions of dollars in annual profits, no one is happy with healthcare we have, and there is no doubt that the system in the U.S. is at crisis level, ready to implode.

Yesterday, we covered some of the myths of American healthcare. Contrary to what our leaders repeat to us, our system is just about the least effective among nations in the developed world and costs twice as much as other governments spend.

So far among announced presidential candidates, only John Edwards has laid out a definitive healthcare plan. His would cover everyone by 2012 and to pay for it, he would abolish the tax cuts President Bush rammed through for people who earn more than $200,000 a year.

The plan would require that all employers cover every worker or contribute six percent of each worker’s salary toward coverage the worker would then purchase. Government-funded insurance would be supplied to low-income adults and children.

The difficulty I see with this plan is that is leaves most insurance still in the hands of employers which was a poor idea when it was first introduced in the 1940s. Additionally and more important, it is not a single-payer system. The for-profit insurance companies remain in control extracting billions of dollars for themselves that would otherwise go to healthcare.

Senator Hillary Clinton has a history with healthcare, having chaired a committee to develop a new system in 1993 and 1994 when she was first lady. But do not think that was a single-payer plan anymore than John Edwards' is today. When Senator Clinton was in Iowa recently,

“One voter asked her bluntly what happened when she and her husband, former president Bill Clinton, tried to expand coverage in 1993-1994 and what she intended to do now to reach that goal.

"’It's a fair question,’ Clinton replied, ‘because everybody who cares about this issue - which is nearly everybody in the country - knows that we tried very hard in '93-'94 and we could not put together the political consensus that we needed to make changes.'

“What followed was a 10-minute explanation of why the Clintons had failed then, how the problem has grown worse in the subsequent years and why she is not ready to outline in any detail her plan for the future. (‘I'm not ready to be specific until I hear from people,’ she said.)”

- Washington Post, 29 January 2007

There is no reason to hear from “people,” whoever she may be referring to. And, there are literally dozens of single-payer plans gathering dust on shelves of public policy organizations around the U.S. Pick one.

Many polls show that a majority of Americans want a single-payer system and there is already a decent plan that was re-introduced in Congress in January by its original 2005 author, Rep. John Conyers of Michigan. The bill, named HR676, The National Health Insurance Act, which now has 78 additional sponsors, would expand Medicare to cover every American.

On the other side of the Capitol, at least two senators, Ted Kennedy and Barney Frank – both of Massachusetts – are on record supporting an expanded Medicare system. A virtue of expanding Medicare to everyone is that the bureaucracy is already in place, the kinks have long been worked out and it needs only to be enlarged while keeping tried and true procedures in place.

A difficulty in getting this or any such bill through either house of Congress is the huge donations insurance companies lavish on the campaigns of candidates for national office – a giveaway that voters cannot possibly match. So unless we all speak up and do so loudly and repeatedly, even the dissatisfaction of a majority of Americans can be drowned out by corporate money. Keep that in mind as this long, presidential campaign continues for two years.

No healthcare plan is perfect, but Medicare works quite well for elder Americans and a single-payer system works just as effectively for all citizens of every other developed nation in the world. Without hundreds of insurance companies and managed care behemoths controlling who gets what care, costs can be controlled; everyone would be covered; doctors, nurses and hospitals would be relieved of excessive paperwork to do the work they trained for, for so long.

Even so, many people oppose this bill and single-payer systems altogether. Certainly the insurance companies do and a large body of conservative voters oppose universal healthcare with that old bugaboo, “socialized medicine” - which is not what this is, so don't let the phrase scare you.

So – as CNN’s Jack Cafferty says every day, here’s the question [if you have some alternative ideas, please leave them in the comments section. Americans need all the help we can get on this issue]:


ronni, your readers seem to be voting while not commenting on this clear presentation of an issue that has to be at the top of everyone's list. are we so overwhelmed by the power of the insurance lobby. think so.

have you heard any politician suggesting that we need to limit the reach of these companies? no one is that courageous--certainly not the doctors who have been handmaidens to all this for many, many years.

I would much prefer a system which bypasses the insurance companies, which would be more efficient in the long run. But I give Edwards credit for proposing a system that might be the first step on a path from where we are to where we want to be.

My understanding is that he also has a provision that each area should offer a government-sponsored plan like Medicare along with the private insurance plans. So if that plan turns out to be better, and more people select it, it could over time become more dominant.

Also, in regard to the question of removing the connection of health care coverage from employment, this plan takes one big step in that direction. Currently, if you self-employed or unemployed, you must buy health insurance from a different pool with much high rates, which get even higher (or sometimes even are totally unavailable) for people with pre-existing conditions. Under the Edwards plan, everyone would be in the same pool with the same pricing structures, whether employed, unemployed, or self-employed. This is a big step forward.

It is no secret that I am a supporter of John Edwards for President, but I think he's on the wrong track with UHC.
Universal Healthcare is about a healthcare delivery system, and insurance companies are in the business of financial investment; they simply raise capital by selling insurance services including health insurance.
Extending Medicare to the general population should include optional benefits such as Medicare Advantage Plans; but everyone in the U.S. should have access to necessary health care and letting BCBS set the price we pay is nuts.

The devil is in the details. I am "for" a lot of things; but, by the time they become law, there is little to identify them with the idea that I thought I was supporting. I fear that healthcare is no exception. The options provided (by this blog and by the presidential hopefuls) lack enough definition to be meaningful choices.

I am enjoying reading your posting on your health system and the comments from your readers.

As a Canadian living in Germany (both with social medical systems), I usually can only read what the media decides to deliver. So, reading your thoughts has been very interesting.

Just thought that I'd like to tell your readers that in the city I live, we've been going to same general practitioner for the last fifteen years. She knows us well, knows our past medical history, can judge well when we need medical intervention or when we risk waiting another day before starting the antibiotics. She makes home visits if my children or my husband and I are too ill to get out of bed or possibly have something contagious. There is also a clinic we can call, whose doctors make home visit 24 hours a day; if we are seriously sick when the doctor is not in her practice. Why do all children get sick late Friday evening? All of these (luxuries) services are available on our social medical insurance.

That is not to say our social medical system is not costly or without severe problems. But, most of the time it does work well and, as far as I can discern, it is less costly and simpler than your present system.

What sometimes puzzles me when reading newspaper articles about the costs and logistics of switching from a private to a social system, is how much of the discussion is what type of system would work or how would your government do it. Why don’t your politicians just consider (relatively) using one of the successful models from other industrial countries? There is a wide selection, as well as decades of experience to build upon. There is no reason to reinvent the wheel.

I'm a supporter of John Edwards for a lot of reasons, not the least of which is his profound sense of responsibility to the working class. Having said that, here are a few observations. First, one of the major problems with our health care system is that technology's ability to diagnose (and treat) illness has outpaced our capacity to pay. That reality is one of the developments that's crippling our health care system .. which leads to the second dilemma: Just because we know how to diagnose and treat every disorder-- from the simple to the complicated -- does that, then, create a moral obligation to do so for every person in every situation ... and if not, who is entitled to the Cadillac treatment -- everybody? the rich? the poor? the insured? Are we ALL entitled to Cadillac health care, ALL the time? Part of the time? When? For whom? Should people who *choose* to go to doctors less often be rewarded in any way? If so, how? Why aren't there -- at the very least -- free clinics for everybody that treat the common stuff-- colds, flu, broken bones, ear aches, fever, migraines, depression? Why does it have to be all or nothing? Why aren't there more tiers of choice? If we let our sense of entitlement drive our every action, how can we complain when there's not enough to go around? What role do law suits and our litigious behavior play in what we've wrought? Are we willing to give up at least SOME of our demands for perfect care from perfect physicians ALL the time? In effect, our medical resources aren't much different than our natural resources, are they .. so where's the conservation? Shouldn't we at least TRY to grapple with these fundamental ethical questions in devising national health care policy? I'll be very interested in others' thoughts..

Leah posted what follows on A Question of Healthcare - Part 1. I'm adding it here because it references HR676 mentioned in this post and not yesterday's:

Thank you so much for calling attention to John Conyers' bill. I just quickly read through it, then compared it with John Edwards' health care proposal, which is on Edwards' web site. I find the Conyers bill far superior. I'll do everything I can to call attention to HR 676. (I can just see it: the Republicans are going to bring up their old scare tactic about "socialized medicine." Think of something clever to refute that.)

I think we have to consider the insurance companies, which employ hundreds of thousands of people, in this equation. Edwards plan acknowledges that, and realistically, this is the only way it's going to go forward. We can first cover those without insurance of any sort in a national plan, then phase into the overall coverage as people age into medicare, and as children who have been covered by the new national plan age and don't require insurance.

Those who can afford to should still be able to buy their own coverage and companies that can afford to can still cover their employees. Smaller companies can be subsidized into a corporate plan.

Honestly, there's no other way for this to be settled. It would be great to move instantaneously to a national plan, but it's not going to happen.

Nancy has good input (as do others, but hers is what triggered my thoughts). One of our big issues is that--if we can do something, many people think it should be done. I know a guy who, because insurance would cover it, went in for a full-body MRI. He had no symptoms, had no problems, he just thought he needed to know everything that he could know about his body. The MRI showed nothing. It was a terrible waste of our resources, and raised our insurance rates, no doubt.

I, myself, turn down any sort of testing for stuff that is "nice to know". If the result of testing isn't going to cause me/my physician to do anything differently, it's a waste of time and resources. I would also, in future, turn down any suggestion of testing that is beyond "nice to know" but isn't very reliable--such as any sort of treadmill testing for women.

Good gravy, folks.

Basic universal healthcare for everyone does not have to be a pie-in-the-sky fairytale, nor does it need to be the chicken-little bugaboo as told by the well-paid, well-insured fearers of anything that hints of a social program.

Social = society = people. REAL people.

I am not against paying something reasonable for my family's healthcare. But, we cannot afford a bare bones health insurance plan that takes one-fourth of our wages a month to purchase. And forget about paying even that if either myself or my husband become unemployed, or have to take a job that pays less.

That insurance premium doesn't care which artery we take the blood money from, it only wants its shareholders to be happy.

A big chunk of our tax dollars go to so much idiotic waste (like the drug education "Just Say No" program which has not made one speck of difference in the addict rates).

Using wise fiscal policy (Aha! What a novel idea!), these same dollars could make a life or death difference in many many many families - including my own, or my young neighbor's, who is most likely going to die because her insurance company refused to pay for some of those "nice to know" tests which, in turn, might have made a difference early on in her ultimate cancer prognosis of "too bad, no money, no treatment, so go home and die".

I'm pissed.

If your survey is any barometer of the National average (and I am sure it is),I suggest that everyone of you start writing letters to your editor and writing, or calling, your Representatives. Only by raising such clamor can the Insurance companies lose their power with your Senator or Congressman. Only the fear of not being re-elected is stronger than the purse strings of the insurance industry. Be sure to mention the Conyer's bill HR676.

Trying to keep the insurance companies making their huge profits and keeping a lot of people employed who aren't really needed comes under the category of transition. Change hurts but sometimes you have to be realistic. A lot of industries have proven to no longer serve a purpose and gone under.

As it is now, health insurance inflates the cost of receiving life-saving medical care. There will be screaming if you stop insurance companies from making money on health policies; but to me our system is not working and paying people for a job that is not needed doesn't make sense. There is a simpler way to do this- medicare proves it. Yes, higher taxes but then everyone gets care, not just the fortunate ones.

Upheaval is never fun but with the global climate change coming, we should all get used to it.

Good thoughts all. As a physician who has worked in 2 different "universal" systems as well as in the market place, I can tell you the best has been a universal system.

I have experienced the care I can provide within the Indian Health Service, which can range from pretty good in some geographical areas to abysmal in others. It is no fun deciding from week to week if you can pay for the life threatening heart attack, motor vehicle accident, cancer treatment, etc. based on the $$ available at that point in time. Having to cobble together a series of different meds to equal one med available to the general public is also loads of fun. But through the Indian Health Service, Native Americans have access to health care, and the preventive health services are generally good too, when they are taken advantage of.

My next "favorite" is private practice. For many, the decision process is not dissimilar to that experienced by the physicians and patients in Indian Health. Many patients have no insurance or poor insurance. Medicines are available, but can they be afforded? How many times have I written a prescription I suspect will never be filled? I must listen to the pitches of multiple drug reps each week so that there are samples available for the needy. I see many who came in late for a condition that might have had a straight forward treatment, if it had been seen early on. I spend many hours dealing with admin issues vs. taking care of patients. How many different systems and "tiers" can one keep in their head? Cadillac care is available and is easy to deal with, but it's rare. Mostly, the well to do have this. In a former time, many workers had good insurance. No more. Employers, for the most part, are no longer part of the social contract.

The best healthcare system was the military. The first question asked at the front desk was "How may we help you?" not "How will you be paying for this today?" We had a rational formulary, one that had negotiated prices and that met the needs of most patients. Inside the system, we could care for patients well. Sending a patient to the economy was much more a mixed bag, as the pay to the outside providers was poor and many civilian physicians would not consider taking that pay, thereby limiting access to care for the Active Duty folks.

A few thoughts on how to fix the current system:

1. Some kind of single payer that provides a baseline for everyone must be established. Everyone must participate at this level - no cherry picking by the insurance companies to attract the least ill and leave the sickest to society. A rational process to choose a formulary of drugs that is adequate to the needs of most patients is necessary to this baseline. Would this look like Oregon or Massachusetts? I'm not sure.

2. There needs to be direct negotiation of prices for services and meds with those who provide them. Note I said negotiation. Not dictation.

3. Tort must be addressed. "Malpractice" is a rare occurance. A physician does not set out to harm a patient. There are poor outcomes. These don't need to be in court with the large $$ going to the system and not to the patient. When compensation is deserved, it should be an adminstrative action and not a lottery. The money being spent for defensive medicine is grossly underestimated and should be used to provide more care.

4. Even though I like the military system, one weakness is that it is "free". The patient can access all the care they want without thought. Therefore, there should be no "first dollar" coverage. Everyone should have a co-pay, even if just a dollar. People value and think about what they have to pay for.

5. The patient must have a say in the system and the care. I'd like to have a system that provides the same care for all; that won't happen here in this country. There will always be disparities between Bill Gates, the Congress (who have a great system), the employed, and the needy. But we can give everyone a say in who they see and how they are taken care of within a framework that provides evidence-based care, preventive care, rescue care for common conditions and the option for the "do everything" care for those that can afford it. It's long past time for this country to provide decent basic health care for all of its citizens.

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