MULKA: Single-payer health system preserves choice
By Linda Mulka, MD
Published January 5, 2009 at 12:01 a.m.
I am a board-certified family physician unable to actively practice because of effects of bilateral breast cancer radiation on my immune system. When dealing with Los Alamos National Lab’s self-insured United Healthcare administered program, I was evaded throughout the appeal process until arbitration to pay for services that Medicare would have covered to determine the appropriate treatment for my breast cancer. These tests incidentally saved more than $30,000 for my treatment while allowing me to avoid cytotoxic chemotherapy. Considering what happened to me as a physician in their system, I can only imagine what would have happened to a nonphysician.
When my sister lost her job last spring, she was turned down by Kaiser to continue her policy because her husband had controlled hypertension and elevated cholesterol. She now has a $10,000-deductible plan. We save money now that my parents' Blue Cross plan was canceled.
Fifty-nine percent of physicians now would support a single-payer system. Administration and profits make up about 30 percent of private insurance costs. Insurance companies do not provide or coordinate care; they just deny care, making choice in plans irrelevant. Plans do not encourage preventive care because the average insured person changes plans every two years.
Health spending per enrollee for comparable benefits grew at a rate of 7.3 percent a year under private insurance, compared to 4.6 percent under Medicare. Medicare’s administrative costs at 3 percent are well below the overhead of private insurers. This may change as the privately operated Medicare plans get bigger subsidies from the taxpayers than traditional government-run Medicare, about 17 percent more for fee-for-service plans often with less coverage.
HR 676 was introduced to implement a single-payer health care system that covers all Americans regardless of pre-existing condition or employment status and preserves choice by including all licensed providers. Financing is through sliding-scale taxation rather than employer mandates. The cost of this plan would be less than what we are currently paying with many uninsured now and worse health outcomes than most developed countries. It has gained the support of 94 U.S. representatives, many unions, state legislative bodies, cities, counties, faith groups and other organizations that believe that basic health care should be a right.
Sen. Tom Daschle does not feel that it is politically feasible to push the single-payer system despite its advantages, as I found out at the recent Health Care Reform Summit in Denver. The public option must be maintained to cut costs and insure the uninsured. Massachusetts has found it too costly to extend insurance significantly with its employer mandates.
If Republicans in Congress are stopping any health care reform if it contains a public option, they should do the right thing and drop their own public plan and get their own private insurance.
Health Care for All Colorado has a very detailed single-payer plan for Colorado that may be introduced in the next legislature.
Health care reform comments can be sent to the Obama transition team at Change.gov.
Linda Mulka, MD, is a resident of Buena Vista.
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January 5, 2009
5:57 a.m.
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SheikYurBooty writes:
Although I am sympathic to the good doctor's views, this is one poorly written letter.
Nonetheless, this thought really hits at the heart of the matter:
"If Republicans in Congress are stopping any health care reform if it contains a public option, they should do the right thing and drop their own public plan and get their own private insurance."
I will believe any politician who says he hates single payer and believes in market soolutions when they opt out of their platinum-plated taxpayer-funded plans and spend their own after-tax dollars in the "free" market for health insurance.
January 5, 2009
6:43 a.m.
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mrfxx writes:
Absolutely SYB - if members of Congress had to deal with the same health insurance and the same retirement plans that the AVERAGE taxpayer does (note - average is in caps since upper management often gets platinum plans for both - for life) both would be fixed in a heartbeat - or members wouldn't be members for life (they'd have to get other jobs to cover their retirement).
January 5, 2009
7:21 a.m.
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Mike_In_Hartsel writes:
I have long espoused mandatory rules for Congress and legislatures that would prohibit them from passing any legislation from which they solely benefit (retirement, medical, etc) or legislation from which they exempt themselves (Congress is exempt from equal employments laws, etc).
Just say no to government run retirement, medicine, housing, etc. I don't want government telling me what to use.
January 5, 2009
7:42 a.m.
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Liberalsrising writes:
Off subject but would appreciate your knowledge:
If I get cancer and tell my doctor to simply manage my pain while I die, so as to avoid a scenario where my wife will become impoverished because of medical bills, will my life insurance company (or could my life insurance company) refuse to pay my death benefits because I had refused the latest in medical care, i.e., essentially committed suicide? (I'd argue that medical care only postpones death, not eliminates death and why should I be forced by the political and medical establishment to take treatment I don't want, under threat of not paying my death benefit).
January 5, 2009
8:17 a.m.
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SheikYurBooty writes:
LR - interesting theory, but doubt it would fly. People would not accept the theory and furthermore it would pit insurance companies against one another in court. Won't happen. But sad scenarios like that will crop up. I am sure many terminal patients do activly commit suicide to avoid financial catastrophe for their loved ones. USA!!! USA!!! USA!!!
January 5, 2009
10:45 a.m.
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KelcyCo writes:
If the survival rate for your disease is low then it is not committing suicide to accept fate gracefully and attempt to have the least unpleasant death possible. Too often these days we fight, fight, fight when in reality the chances that it will succeed are slim to none. Rather we end up with the least pleasant death and our final months/years are devastating to us physically, mentally and emotionally, as well as to our family and loved ones. We are willing to have someone (rarely ourselves) spend any amount of money on the slimmest chance that we might be in that 5 percent that live one year. If it had been our own hard earned cash doing the paying then it is likely we would have looked a bit harder at the cost. If it`s "someone elses" money then it is any and all treatments no matter what the cost, and how dare you not pay it.
What I find particularly galling is that "medicine" promulgates the notion that we must fight, fight, fight. Recently I lost a dear friend to lung cancer. When it was found it was already advanced stage four. The doctor never offered a cure but did offer chemo and radiation anyway. It was all couched in terms of palliative care. Only when she turned it all down did he acknowledge it would have done nothing much and would have had many negative side effects. How silly is that? I`ve read doctors saying things like we have to try as we won`t even know what works if we don`t continue to try. Well, if we are being experimented on for the good of all mankind then there should be no charge to anyone for the experiments. If anything they should be paying us for using our bodies. When they have a 100 percent or even 90 percent survival from the disease then you can start charging for it. Otherwise, it only benefits you, the medical community, by extending your knowledge base.
January 5, 2009
11:11 a.m.
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INC writes:
Liberalsrising, SheikYurBooty,
If the Us were to allow for the terminally Ill to end their own lives. then the system would in fact save the costs of fighting a loosing battle.
I can attest that my fathers terminal prostate cancer has rendered me unable to afford health care insurance for myself and my kids.
thus I am deeper in the financial hole as my appendix burst last spring. adding another $30,000 to the $175,000 debt thrust upon me for dads long term care, imposed by weld county court. As Dad tried and failed to save me the anguish to begin with.
January 5, 2009
3:46 p.m.
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paulhsiehmd writes:
I sympathize with my colleague's personal situation. But the "single-payer" solution she supports is the wrong prescription for America.
Socialized medical systems lead to rationed medical care. The reason is simple. Whenever government attempts to guarantee health care, it must also control its costs. The inevitable result is rationing and waiting lists.
Canadian patients typically endure long waits for tests and treatments unless it is an emergency -- with the government deciding what constitutes an emergency. A Canadian woman with breast cancer may wait months until the government approves her surgery and chemotherapy. Bureaucrats ultimately decide who gets what care and when -- not doctors and patients. In socialized systems, health care is never truly a "right" but just another privilege dispensed at the discretion of the government.
The fundamental problem with all forms of "universal health care" is the premise that health care is a "right" that must be guaranteed by the government. Health care is a need, not a right. Rights are freedoms of action, not automatic claims on goods and services that must be produced by another. Attempting to guarantee an alleged "right" to health care must necessarily violate actual individual rights and will destroy the American economy in the process.
For more information on the problems with "universal health care" as well as alternative free market reforms, please see the following article:
"Moral Health Care vs. 'Universal Health Care'"
The Objective Standard, Winter 2007-2008
http://www.theobjectivestandard.com/i...
Paul Hsieh, MD
Sedalia, CO
Freedom and Individual Rights in Medicine (FIRM):
www.WeStandFIRM.org
January 5, 2009
4:16 p.m.
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The_Punnisher writes:
Delay is the deadliest form of DENIAL.
Most chairwarmers in ALL FORMS ( Govt. and Private ) know this and practice it as much as possible..
Some ONCOLOGISTS are guilty of this as well.
These people LOVE their god called MAMMON....
Because when you get down to it, MAMMON rules the decision making process.
January 5, 2009
6:26 p.m.
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SheikYurBooty writes:
Mr MD:
"Socialized medical systems lead to rationed medical care."
ALL systems that have finite resources "lead to rationed medical care." You belabor the obvious.
How do you define "socialized medical systems" since you use that term? I define it as: the same health care ***I fund*** for the POTUS, SCOTUS, every Congressman, Senator, and government employee and the military, but which I am denied access to.
"Health care is a need, not a right."
Correction: health care is a common good, like national security, good infrastructure, law and order, good schools, clear air, etc. You can call those "needs" if you wish, but "common good" is a more complete and accurate descriptor. Your whoel rant on rights is therefore misguided at best.
Few if any of the prerequisites of maket economics apply to health care, esp for emergency, catastrophic, or chronic situations. A market for routine checkups, eye exams and dental care could exist, where one could shop around, but that's it. Until we can bid out our diagnoses and surguries on eBay, there cannot be said to be a market for health care.
January 5, 2009
6:55 p.m.
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BrianSchwartz writes:
SheikYurBooty writes:
"Health care is a common good, like national security, good infrastructure, law and order, good schools, clear air, etc. You can call those "needs" if you wish, but "common good" is a more complete and accurate descriptor."
Can you define "common good," please? Might you be referring to a "public good"? Wikipedia defines it as follows:
"In economics, a public good is a good that is non-rivaled and non-excludable. This means, respectively, that consumption of the good by one individual does not reduce availability of the good for consumption by others; and that no one can be effectively excluded from using the good."
By this definition, education and health care are not public goods. If you become educated in a subject, I learn nothing. I can exclude myself from being educated in that subject by not taking the class, reading the book, etc.
If you get your annual physical, I learn nothing about my own health. I can exclude myself from the benefits of a physical -- by not getting one.
I also fail to see why Dr. Hsieh's comments on rights are a "rant."
You write: "Until we can bid out our diagnoses and surgeries on eBay, there cannot be said to be a market for health care." You may not be able to bid, but you can shop for surgery. in 2006, CBS News reported:
Like millions of Americans, Gary Garcia is shopping online, CBS News correspondent Wyatt Andrews reports. But he’s not on eBay or Amazon.com. Garcia needs a new heart valve, and he’s shopping for surgery.
Using a Web site called Health Grades.com, Garcia learns which nearby hospital is the best at heart surgery — and then, to his amazement, he gets an estimated breakdown of the costs. He gets the list price for his operation, the discounted price his insurance will pay and his estimated co-payment.
http://www.patientpowernow.org/2008/0...
January 5, 2009
7:18 p.m.
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mmannino writes:
There is no free lunch in the health care debate. In our current system, there is anxiety about the affordability of insurance. However, health care is available even if you cannot pay. Health care services are generally available without excessive waiting. In a single payer system, rationing and price controls control demand. Demand increases because health care is perceived as a right. Anxiety about insurance affordability is replaced with anxiety about quality health care. Long waits and low availability of high tech treatments are common in single payer health care systems.
The wildcard in the debate here is the medical malpractice. Every country with single payer health has substantial restrictions on malpractice awards. Single payer health care will sink with the current litigation environment. Health care quality will decline if price controls and rationing are imposed in a single payer system.
January 5, 2009
7:46 p.m.
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SheikYurBooty writes:
Brian - you CAN shop highly leisurely or elective surguries around somewhat, in theory. For anything that is not routine almost to the point of trivial, the best you can hope for is an average or estimate, never a firm price. As for cancer and trauma treatments, it's all but ludicrous to think you can shop those.
True story - I called the 2 closest ERs to me about 2 years ago and asked to know what was the absolute MINIMUM charge that I could get in and out of there with, like a kiss on a boo-boo or an aspirin or some such - I could not get a straight answer, no way, no how. Good luck shopping that case of Crohn's Disease or gunshot wound.... Internet ratings are fine for hotels and restaurants, but cannot possibly cover the base for health issues.
AndI stick by my assertion that health care is a "public" or "common" good, just like secure borders and a strong defense.
January 5, 2009
10:56 p.m.
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BetterEducated writes:
Nobody can get health insurance unless they can prove they are healthy first.
I used to be so proud of being an American, now I'm reduced to screaming: PLEASE HELP US!!!!!!
Sure, I understand nobody will hear me or care, but I had to say it anyway.
January 5, 2009
11:02 p.m.
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mmannino writes:
SheikYurBooty,
I agree with you about choices on most procedures covered by health insurance. The problem is the employer-oriented health care system. If health insurance was true insurance with coverage for major items instead of routine care, consumers would have more choices and more information about choices. For major items covered by insurance, consumers would still not have many choices.
Health care cannot be a right no matter how it is legislated. Health care cannot be a right because it is a scarce resource subject to economic laws. Making it a right means price controls and rationing will be used to control the burgeoning demand. Price controls will limit supply not increase supply. Unless the government finds a way to force others to provide health care, the supply of health care will not meet the demand under a single payer system. A single payer system will not reduce health care costs. It will just impose artificial price controls and rationing that will reduce the supply of health care, especially expensive health care on innovative procedures and care for the elderly. This result is common to every country with a single payer health care system. Most countries with single payer system now have a parallel private health care system for unmet demand.
January 6, 2009
10:06 a.m.
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gary writes:
I am sick and tired of you people that think you have the "right" to everything. OH, but it is for the "common/public" good!!
Yea right, you idiots...get a job and a life. Pay your own way in this country.
I want to be "free" to choose my life and my medical doctors. Your "public good" is not for me.
If I were to take this "public/common good" thing to be true...then it is a "public/common good" thing for me and everyone else to be rich.
So give us all the money to be millionairs...for the "public/common good".
All of you socialists need to move to Russia and let the free Americans take care of themselves.
No government controlled health care for me....EVER!
Nuff Said!
January 6, 2009
10:44 a.m.
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SheikYurBooty writes:
gary:
"Your "public good" is not for me."
Then please stop using our roads or anything that comes to you via our roads. Ditto our police, fire and national defense.
Nuff said!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
January 6, 2009
10:52 a.m.
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pslwd writes:
You want the government to run health care? Look what they did to finance. People, in this country, would be appalled to get the level of health care that is given in Canada. Why do so many Canadians come to this country for their health care needs? There are a lot of abuses of our system that need to be fixed, but a single payer system would cause health care to be rationed.
January 6, 2009
12:13 p.m.
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p_myers661 writes:
SYB
The problem with the common good is that there is no authority in our society to define that good. Each definition that is imposed on the public presses on individual freedoms guaranteed to us by our laws and customs.
People want to have shelter. We agree it is a common good. We do not define shelter except in the most general terms. Were we to do so it would cause controversy and confusion. If we made the definition one that was to cover all of us, there would be a great protest both from those who would require more than the minimum as well as from those who have less yet would resist having their situation redefined by government.
Health care is a common good. That we all presently, or at some time, require medical treatment is a given. More than that threatens our independence and freedom in the name of that same common good.
People require shelter at all times. We don't interfere with their freedom to either provide this or not do so. The time to make changes in our system is now. Those changes will require government to get its hands out of the picture in most areas.
Medicaid and Medicare are the source of our main medical problem. Want to prove what that problem is?
How much does your doctor charge for a basic office visit?
How much does it cost to do a basic blood test including white and red cell counts with chem panel (checks on your glucose and other levels in your blood.)?
Few people can answer this question. The author of this letter is a doctor who has had difficulties with an insurance company. The problem is real. The solution is not in more government interference. The solution is in more individual freedom, responsibility and knowledge.
Government created the programs that pay the bills without the patient/customer seeing what the costs are. Neither does the system encourage people to know what the costs are.
Health care providers and insurance companies changed the system where insurance was for serious illnesses or injuries into one where all is covered, all is paid for and the only money the patient thinks about is the co-payments. It used to be that people were covered by company health care policies from day one. I worked for six different companies when I was in college. I was insured in all of them and never used a day's worth of coverage.
In the parts of health care that are not covered by a majority of insurance policies, costs have come down and these services have improved. Plastic surgery is one prime example. Lasix surgery is another.
See my next post.
January 6, 2009
12:27 p.m.
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p_myers661 writes:
The reforms we need can be simple and I'll list them without explanations.
More HSA policies must be created. People must have the freedom to use these without the blocks set in place by insurance companies.
Government programs, specifically Medicare and Medicaid, must convert to HSA systems.
Government can construct clinics or it can make use of those in place in places like Walgreens and Wal-Mart. Those clinics must have extended and weekend hours.
Government must remove the tax provisions that punish individuals and reward companies for insurance purchases. Allow a business to provide a flat contribution to employees' insurance but the actual policy and coverage is purchased by the individual who can take a policy to other jobs.
Government mandates that prohibit the sale of catastrophic coverage policies and require coverage for conditions and mandate payments to alternate care providers must be eliminated. If you want coverage that pays for a chiropractor, you pay the extra costs.
There can be a system that fairly deals with denials and delays but it will require more intelligence than I have seen to make it work. I can't speak of a denial because although I was, and am again, covered by Kaiser, in the past two years I have been hospitalized over 40 times. No treatment, surgery or medication has ever been denied or delayed. That includes approval of ten extra days of hospitalization in a cardiac unit while I healed enough from a heart attack to be strong enough to survive surgery to insert a defibrillator/pacemaker.
I'd merely require that an insurer provide a detailed list of what will require approval or be forbidden. Remember that it will be individuals that the insurance companies have to sell to, not corporations. (Look at all the different plans for Medigap insurance. We'd have as many TV ads for healthcare as we have for auto insurance. And as many choices. Unfortunately it will include some as annoying as those with the perky females)
Lastly, I suggest that those in government who think they can provide health care to all better than the current system create a health care program that provides free immunizations to all. Nothing more. The result of that program will show what would happen in government managed health care.
The biggest obstacle to universal health care, no matter who pays for it, is our American attitudes that include skipping regular physicals, not taking medication as directed and demanding more treatments, whether they are possible or practical, because we can.
January 6, 2009
8:45 p.m.
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Phineas_T_Bluster writes:
Insurance policies typically have suicide clauses that expire after two years Liberalsrising. Plan accordingly.
January 6, 2009
9:10 p.m.
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Phineas_T_Bluster writes:
The Canada/UK argument is a red herring. There are other national health insurance schemes that are more market based, like the Swiss and German systems. There's also the Healthy Americans Act, proposed by Senators Bob Bennett and Ron Wyden (hardly ideological bedfellows), which is very similar to the Swiss system. However, I've discussed this issue with quite a few Canadians, and they were as disparaging of our system as we are of theirs. We already have health care rationing in this country that's based on the size of your wallet or your eligibility for entitlement programs. (Read INC, above.) I find that unacceptable, even though my wallet is adequate. Let's face it, medical care is controlled by very powerful lobbies that take care of themselves first an foremost. No disrespect intended for the many fine docs out there.
January 7, 2009
8:47 a.m.
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glowrock writes:
Anyone who doesn't think American healthcare is rationed is insane. It may not be rationed in the traditional means, but it's rationed solely based upon the highest bidder!
January 7, 2009
10:22 p.m.
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splashy writes:
It's amazing that so many think that health care is not rationed here, and that there is no waiting for anyone. Both of those are done by not being able to pay. Many don't get ANY care at all, or wait a very long time until it's too late to do anything because no one will treat them without payment first.
Those that don't realize that are living in a fool's paradise, from which they may find themselves cast if they ever fall on hard times and have to deal with our system without the safety net of decent insurance.