An intellectual freedom blog with an emphasis on libraries and technology

Friday, August 14, 2009

Single-payer vs. two-tier healthcare

I wrote a lengthy reply to a friend's message containing an idea about providing greater efficiency to the health care system in the coming years. My reply took on a life of its own and turned into an editorial on the current state of the "reform effort."

Keep in mind I reproduce below mostly as I originally wrote it a message to a friend. This provides the context: I replied to an idea that promises to streamline the presently bureaucratic process we all must suffer when we need to go to the hospital.

Well if the right-wing is going to combat healthcare reform with "Obama wants to kill your grandmother" then what do you expect them to do with this? There exist some privacy, security and fraud "holes" that I see no iron-clad air-tight way to fix. You know how Republicans/Conservatives combat reform: they point to the problems and ignore the benefits thus making it impossible to defend a change unless it's a 100% solution. Anyone can nit-pick a plan to death. Given the viciousness we have seen already I am reluctant to invest any money and (no offense) even much time in a technological element that has such obvious vulnerabilities to political attack.

Now to the other political/social consideration. You know I respect you and realize you have knowledge, expertise and experience in this field that goes way beyond my meager collection of information. I will venture an opinion/argument anyway. When Cindy and Alex visited Canada a few years ago Cindy sustained a minor injury and needed to go to the hospital for outpatient care. When they asked about payment or insurance the Canadians laughed and told them there was nothing for them to sign, no forms to fill out, no idiocy with which they had to deal. They walked out of the hospital without so much as a co-payment. If you want efficiency, single-payer makes any sort of plan such as you envision totally unnecessary.

Single-payer also obtains greater cost-effectiveness than any private insurance. It's a myth and a lie that government is intrinsically incapable of accomplishing anything. The overhead expressed in dollars per $100 of reimbursement for most HMOs is $15. The most efficient is Kaiser which has about $12 per $100. What about Medicare and Medicaid? Try $3 each. This from the GAO and also reported (twice) in Consumer Reports (non-partisan and accepts no advertising). Recall also that back on April or May the Health Insurance industry offered Obama a trillion dollars in savings over 5 years. Think about it - that's how much they planned to over-charge us.

You understand the insurance business better than I do. You understand then, why when Canada changed the rules to allow private insurance to operate the one most important rule they enforce is that the private insurance can not underprice the government. In other words, there's no poaching the good risks. If you only insure the people who have a very low incidence of serious illness or injury, and who recover from injuries quickly, you rake in money. Freed from the expense of actually providing healthcare, you can spend the profits on bonuses so your executives can afford yachts and summer homes. The money is not spent on healthcare. Then, when the "good risks" age and become "bad risks" you either cancel their policies or price them so astronomically high that the "customer" must opt into the government-run system.

This is what I foresee happening: a two-tiered system in which the very wealthy have the very best healthcare but the private insurance companies otherwise will insure only the good risks, then dump them into the government-run half of the "system" when they actually need expensive treatments. Essentially what, according to documented cases, the private insurance companies do now. And I'm not just talking about "Sicko." I have also read numerous cases of policy cancellations and/or denial of treatment outside of Moore and his grandstanding silliness. The difference between $3 per $100 vs. $15 is not better health care (at least not in most cases). It's yachts and summer houses. A single-payer system will give us greatly reduced costs just by spending the money on healthcare.

In England the doctors have incentives to encourage their patients to lose weight and to quit smoking. With more time spent with patients the doctor can spend more time on educating patients and that can translate to more effectiveness in changing diet and behaviors that lead to obesity and other maladies. The present system of pressuring the doctors to see patients for as little time as possible does not serve me. I find it ultimately a self-fulfilling prophecy the argument that there are some who ruin their own health and drive costs up for everybody but then we do not let doctors have the time necessary with their patients to help them change. There are also some "cross purposes" with other industries, in particular the agribusiness industry which does research to design foods that lead to over-eating (especially snack foods are specifically designed to encourage the consumer to eat the whole package and still feel hungry). We have lots of people trying to gouge as much money from us as possible without regard to any sort of "greater good."

The English and Canadian systems are not perfect. But they are well liked by the majority of the populations of those countries. This morning on my clock radio NPR reported that some U.S. anti-healthcare liars duped some English people into complaining about their National Health Service on camera for what the English thought was a documentary. The two dupes have stated publicly that they have complaints but would never dream of replacing the NHS with an "American style" system. Likewise, when Canadian journalists at a press conference chided Michael Moore about "Sicko" pointing out that they thought he painted an unrealistically rosy picture of the Canadian healthcare system he asked them if they would prefer to switch to the American one instead. The Canadian journalists did the equivalent of crossing themselves a dozen times and said absolutely not.

In the present farce of a debate taking place you have a Senate full of millionaires (no exaggeration, I think that Al Franken is one too, given his successful show business career) all of whom enjoy government-provided healthcare, many of them telling us how evil, inefficient, bad and (gasp!) socialist a government-run system would be. I don't see any of these jackals signing up for Kaiser. I want what they're having.

Related links:

Joan Walsh in has a great post of the "liberal" media covering the "town hells" astroturfing while ignoring a three-day long effort by Remote Area Medical group to provide free healthcare in Los Angeles, mostly to employed people without insurance. It's worth reading in its entirety. My favorite part: Katy Abram, the supposedly "just folks" shouter at Arlen Specter's town hall is a leader of the "9/12" group as shown by her own words on her own networking web site. Oh, and she compares herself to Martin Luther King.