Do You Want That With or Without Profit Motive?

In their never ending quest to prevent a government takeover of healthcare, except if you are under 18, or over 65, or a veteran or are indigent, the right wing has flogged this old horse repeatedly, and it goes something like this:

"I don't want the government, (or a government bureaucrat, or now a death panel), making decisions and getting in between me and my doctor! And universal [socialized] healthcare will result in rationing! And the USA will become the USSR!"

Well, if one is lucky enough to possess really good health insurance, who do you think makes these decisions? Corporate insurance adjusters who are driven by the bottom line. Bureaucrats. Their job, as in all cases where an insurance company is involved, is to find out ways their company does not have to pay out on their policies, or, to find out how to pay as little as possible. So a patient might not end up with the drug or the procedure that they were expecting to get, and that their doctor had, in his judgment, decided that patient should have.

And it should be patently obvious that by limiting the amount of healthcare doled out in the country to the above groups plus those who can afford their own insurance and those who are fortunate enough to have health insurance through their job, and thusly leaving out 40 or 50 million American citizens, is rationing healthcare.

Looking at certain situations where there is a government mandate to provide health insurance can be instructive. In one case there is the workmens' compensation situation, and on the other hand there is the no-fault automobile insurance. While both are mandatory within their respective spheres, one is administered to via a government bureaucracy and the other not.

Workmens' compensation is an imperfect system, but injured workers get healthcare they need for as long as they need, and a bureaucracy of government adminstrative judges oversee each case to prevent fraud and abuse. On the down side, workmens' compensation can be slow, often taking a long time to approve a given course of treatment. And while the insurance industry uses their own doctors to perform independent medical examinations of claimants, a claimants physician's medical opinion is given a lot of weight.

Then there is no-fault, which applies to those injured in automobile accidents. In the no-fault context there is little to no government administration. After approximately one month of treatment, a claimant is sent to see an insurance company doctor, and once a claimant is examined by that doctor there is a 95% chance any further treatment claims will be denied, no matter the actual condition of the claimant or how much pain they are in or how much therapy they really require. And the opinion of the claimant's doctor does not matter for a hill of beans. That's a private insurer directly affecting patient treatment and rationing care in order to protect their bottom line.

Then there is single payer healthcare, like Medicare. A claimant goes to her doctor, a treatment is prescribed, and the doctor is paid, though perhaps not as much as he would like [but who is?]. And patient satisfaction with Medicare is through the roof. And it is socialized. And patients get all the care they require. The same goes for the Veterans' Administration. And so far the USA hasn't become the USSR. Hmmm....

So, we are at the crossroads of healthcare reform. And the arguments of evil government bureaucracy and rationed care are revealed to be empty arguments, mere chimeras without real substance. And went you get to the bottom line do you want medical decisions made by a corporate bureaucrat worried about the bottom line, or by a bureaucrat who is only seeking to avoid fraud and abuse?

Some Thoughts on Single Payer Health Care

Just a few thoughts on the advantages of a single payer system, which seems to be the intellectual version of kryptonite to many left of center thinkers these days. In the interests of full disclosure, I am in favor of a single payer, government run health care system and not afraid to say it.

To come out swinging, I would just like to immediately dismiss any thoughts that "the government" can't do anything. For perpetuating this myth I would like to thank Ronald Reagan, and state he has done his fellow Americans a terrible disservice with his quip that the most terrifying thing is to hear "I'm from the government and I'm here to help." What a champ.

Anyway, if the government can't do anything, I guess landing on the Moon's surface was a fluke. And defeating those nasty fascists in the 40's. And staving off national collapse during the Great Depression. By the way, the Second World War was an enormous socialist undertaking, with everyone pitching in, saving, being paid by and resources rationed through the government. Who paid for all those refrigerator factories to produce propeller heads? Government bonds, that's who. Maybe private enterprise could have done it quicker. Or maybe we'd be speaking a mishmash of Japanese and German.

Can anyone seriously argue with a straight face that capitalism was responsible for the Normandy D-Day landings or the manufacturing of the atom bomb? Please. In fact, some might argue that the Second World War was a fight between national socialism, aka fascism, international socialism, aka soviet style communism, and democratic socialism, aka the U.S.A., U.K. and Canada.

Anyway, consider these advantages to a single payer system that no one is speaking about: first, there would be no need to purchase certain types of mandated insurance, like we have these days. If you want to drive a car, you have to have no-fault insurance in case someone gets hurt in connection with the operation of that automobile. In a single payer system, no-fault insurance is wholly obviated, at least when it comes to providing medical care [I suppose it would not cover lost earnings as a result of an accident]. Inasmuch as there are tens of millions of cars on the road, all of which are supposed to have no-fault insurance, this would save Americans somewhere in the hundreds of millions if not billions of dollars. This is one way to offset any increased taxes needed to pay for a single payer system.

The same could be said for mandatory workmen's compensation insurance. In most locales companies with more than a certain number of non-owner employees are mandated to carry workmen's compensation to cover work related accidents. To the extent that a single payer system would cover the medical costs of workers injured on the job, again mandated workmen's compensation would be obviated. Though I do not know the hard numbers, I am guessing that would be a savings of many billions of dollars a year, and would especially help small businesses whose bottom lines are tighter.

The same would be true for big businesses, like General Motors, especially in the union retirement packages which cover retired employees until they are dead. In fact, it has been this kind of massive overhead which has destroyed much of the financial strength of GM, as well as the other Detroit Big Three.

In fact, all union health plans would be obviated.

And here's one for the right wing: inasmuch as any lawsuit for medical malpractice or personal injury would no longer have to include the costs of passed and future medical expenses, the single payer system is de facto tort reform. Bam! Suddenly, those liability insurance premiums for Ob-Gyns plummet, all because of a single payer system.

So there we have it: the single payer system would give us many advantages that are not being spoken out loud.