I'm not marching and certainly not in line for a job there.
Your fearless correspondent is taking his family to the nation's capitol to enjoy the many pleasures of museums, monuments, the national zoo and cherry blossoms.
We hope to do some serious panda watching, monument gawking and tour the big building where all of the hot gas seems to be emanating from -- the one with the big dome.
Like travelers of yore, we are taking the overnight train (The Capitol Limited) from Union Station in Chicago to Union Station in DC. Then we'll take the Metro to our suite in Arlington, Virginia, a block from the Iwo Jima memorial.
I've wanted to take the girls on this trip for ages. I've been sneaking peeks at various attractions over the 31 years I've been traveling to Washington. Since I'm a museum nut, I can't seem to get enough of those places.
We tried to get into the White House tour, but the congressional people who were supposed to wield inordinate influence and bandy about my name said that new security protocols have shut down tours for now. Apparently they are unaware of the two times I shook the hand of the chief executive when he was campaigning!
It will be great just to go there as a citizen. Nearly every time I went there, with the exception of my college graduation trip, I was covering something or getting an award. Now I will be a tourist and I can't wait.
When I'm there, I'll see what I can do to keep the world's largest economy afloat. Perhaps I can drop by Tim Geithner's office and offer my assistance. I've seen a lot of toxic debt in my time. Don't forget I'm from the South Side of Chicago where they pile it as high as mountains. Or maybe I'll see what Ben Bernanke is doing for lunch. Perhaps over a salad at the Palm we can discuss hyperinflation once the Treasury had peddled trillions to pay for the various bailouts. If I can offer my humble insights on how to avoid a Depression, I will certainly provide this service to the country I so dearly love.
I'll also snap a few pictures of the cherry blossoms.
Thursday, March 26, 2009
Tuesday, March 17, 2009
Obama's Train Set
There's something about a train.
Our President has garnered some serious seed money to build/restore the train system in this country. It's an $8 billion bet that once people get a feel for what real train travel could be like, they will want more of it.
Having traveled throughout Europe on excellent trains -- I've gone up one side of Great Britain and down the other and from Paris to Rome -- I can tell you that most Americans have no idea how pleasant and human it can be.
You sit in comfortable chairs with plenty of legroom. It's quiet. There's no turbulence or annoying announcements telling you to sit down, turn off all electronic devices or buckle up. You don't have to hold your breath once you touch down. You can get up and sit in another car for some food and beverages. You can relax or actually sleep.
I'm a big believer in train travel, mostly because it's civilized. In two weeks, my family and I are taking trains from our home to Union Station in Chicago, then to Union Station in Washington, DC. Nobody wanted to fly or drive and the kids were half price. We've booked coach class seating, although last time we went to Washington, we booked a family sleeper.
Obama's train plan is to give just enough money to state and regional planning authorities to see how much the real deal will cost. In California, for example, a Los Angeles to San Francisco high-speed train will cost about $40 billion. Regional hubs have been on the drawing board for the Midwest (Chicago-Milwaukee-Minneapolis-St. Louis-Cincinnati-Detroit), Texas, Florida and the Northeast for years. It's time we start building the tracks and regaining the edge we once had, a technology that has since been advanced by the Germans, Japanese, French and Chinese.
Where would you put these trains? In most cases, you wouldn't even need to create a right of way or purchase land. Just go down the median of the interstates. The government already owns the property and they could stop right at major population centers.
Trains make more sense than planes for distances under 400 miles. In most areas, by the time you get to the airport, through security and checked in, you've already wasted several hours -- time you could've spent reading, eating, working or just...traveling.
When my wife Kathleen and I visited Spain the summer before last, we didn't even think about renting a car. The major cities are hundreds of miles apart and there's no reason to drive. Spain now has a first-class high-speed system that has Madrid as a hub. The trains are whisper quiet and smooth as sangria.
The best reason to build a 21st century train network in this country is that it will generate a lot of employment for many years. People will use it and it can be upgraded over time.
I can picture myself now, snoozing on the Capitol Limited to Washington, waking up in the heart of the verdant Potomac Valley, easing into the nation's nerve center with the Capitol Dome popping up over the river. Yes, indeed, there's something about a train -- it's so civilized, once we have it we'll wonder how we lived so long without it.
Our President has garnered some serious seed money to build/restore the train system in this country. It's an $8 billion bet that once people get a feel for what real train travel could be like, they will want more of it.
Having traveled throughout Europe on excellent trains -- I've gone up one side of Great Britain and down the other and from Paris to Rome -- I can tell you that most Americans have no idea how pleasant and human it can be.
You sit in comfortable chairs with plenty of legroom. It's quiet. There's no turbulence or annoying announcements telling you to sit down, turn off all electronic devices or buckle up. You don't have to hold your breath once you touch down. You can get up and sit in another car for some food and beverages. You can relax or actually sleep.
I'm a big believer in train travel, mostly because it's civilized. In two weeks, my family and I are taking trains from our home to Union Station in Chicago, then to Union Station in Washington, DC. Nobody wanted to fly or drive and the kids were half price. We've booked coach class seating, although last time we went to Washington, we booked a family sleeper.
Obama's train plan is to give just enough money to state and regional planning authorities to see how much the real deal will cost. In California, for example, a Los Angeles to San Francisco high-speed train will cost about $40 billion. Regional hubs have been on the drawing board for the Midwest (Chicago-Milwaukee-Minneapolis-St. Louis-Cincinnati-Detroit), Texas, Florida and the Northeast for years. It's time we start building the tracks and regaining the edge we once had, a technology that has since been advanced by the Germans, Japanese, French and Chinese.
Where would you put these trains? In most cases, you wouldn't even need to create a right of way or purchase land. Just go down the median of the interstates. The government already owns the property and they could stop right at major population centers.
Trains make more sense than planes for distances under 400 miles. In most areas, by the time you get to the airport, through security and checked in, you've already wasted several hours -- time you could've spent reading, eating, working or just...traveling.
When my wife Kathleen and I visited Spain the summer before last, we didn't even think about renting a car. The major cities are hundreds of miles apart and there's no reason to drive. Spain now has a first-class high-speed system that has Madrid as a hub. The trains are whisper quiet and smooth as sangria.
The best reason to build a 21st century train network in this country is that it will generate a lot of employment for many years. People will use it and it can be upgraded over time.
I can picture myself now, snoozing on the Capitol Limited to Washington, waking up in the heart of the verdant Potomac Valley, easing into the nation's nerve center with the Capitol Dome popping up over the river. Yes, indeed, there's something about a train -- it's so civilized, once we have it we'll wonder how we lived so long without it.
Friday, March 13, 2009
Single-Payer Health, The People Speak
My Wednesday Bloomberg column "No Reason to Demonize Single-Payer Health" triggered an avalanche of emails -- the most I've ever received in 8 years of writing the column.
The message was pretty consistent: President Obama and Congress should consider a single-payer health plan in its reform agenda. It may be the best solution out there, but it isn't even on the table (as far as I know).
I heard from doctors, other health professionals and ordinary folks. No one can understand why we should keep such a wasteful, inefficient and expensive system that denies more than 60 million (I include the 25 million underinsured) affordable, universal care.
In my piece, I called health care a fundamental human right. Of course, I heard from folks who thought that people don't have this right. I know it's not written in the U.S. Constitution, but I think it should be an amendment. It shouldn't be a luxury. If we can build nuclear weapons, invade countries for the flimsiest of reasons, export our dollars for oil and get the Chinese to finance tax cuts, warmaking and stimulus measures, we can certainly come up with a health-care program that covers everyone.
Single-payer makes sense for just about everybody because our system is so splintered. Doctors and other providers waste time, resources and money filling out forms for thousands of different insurers. That takes away from direct care and costs everyone. Those who can't afford policies end up in emergency rooms. That costs taxpayers money. Those who don't get preventive or chronic health management also end up costing the system more than is necessary.
Will single-payer demand some changes and sacrifices? Of course it will. Will it mean higher taxes? Possibly, but not if the waste is wrung out of the system and discounts are obtained for all services and drugs. A Wal-Mart style purchasing model makes much more sense than each company contracting with middlemen for PPOs, drug plans, etc. It makes no economic logic to force employers to dance around all of these issues, add to their cost of doing business and make them less competitive with global competitors.
At the very least, single-payer should be the model that's studied first. There's plenty to examine from Europe, Japan and Australia. While I don't think that we will end up with what the UK or Canada have, we should stop the crazy rhetoric that shuts down the debate. I don't think anyone truly believes that we will become like Europe any time soon. Let's grow up and start talking like we want to help everyone.
Here's a sampling of what I received:
Hello from Paris, where I've had direct experience with single payer health care.
The key thing to get across is that single payer is not the same as single provider. It is a tribute to the power of functional illiteracy that Americans can't get that straight despite having Medicare, which is single payer and endlessly multiple providers!
It is further incomprehensible that physicians moan about paperwork, yet a majority are against single payer. You may already know this, but I'll write in anyway. In France, a doctor's paperwork now usually consists of swiping a patient's health card, typing in treatment codes and hitting the SEND button. The doctors I know here have a receptionist or several doctors share one. They just don't have the same needs or expenses.
This one was from a doctor:
Could you please address the cost savings if defensive medicine was
stopped? How much would health care resources be freed up if health care
providers did not order tests and treatment to protect themselves from
malpractice suits. Obama never mentions how much of the health care dollar
is spent by the health care industry on malpractice insurance, defense and
payouts.
Redirect the money that is spent because of malpractice litigation towards
providing health care and you will have the resources to provide medical
care to everyone in this country. Develop a better real time system than
the malpractice lawsuits to monitor and insure quality of health care. Think
of all of the ad time on TV that would be freed up if attorneys weren't
advertising ways to sue the health care providers. Find another way other
than malpractice suits for attorneys to make money.
Give all health care providers in the private sector the same electronic
medical records system and malpractice protection that they have in the VA
system. The VA system is already a single payer system. Expand the VA
system to cover everyone in this country, not Medicare. There is too much
time and resources wasted trying to collect deductibles and co-payments from
medicare recipients. The Medicare regulations compliance is another waste
of health care resources.
This email was from a retiree:
Congratulations, Mr Wasik, on your column regarding this subject. I
agree with you wholeheartedly!
While I enjoy being covered by Medicare, I believe the Medicare
Advantage system is abused by insurance companies - this aspect of
Medicare should be abandoned. Every year I am bombarded with
brochures about signing up with one of these plans.
I have a daughter and son-in-law who are finishing up their graduate
degrees to become teachers - they have no insurance at all, though
they work part time. They do not get regular checkups. Another
daughter and her husband pay terribly expensive premiums for
"catastrophic" coverage with huge deductibles, as he is self employed.
They don't get regular checkups either, despite being in their 40s.
This is a terrible state of affairs in which the supposedly
first-class nation has far less than first-class health care.
Thanks for your column. I hope you will continue to talk about it.
What about small business? They (like myself) are generally not covered by group plans, so they pay through the nose, have high deductibles and get socked with double-digit increases every year.
I work in an office with three other men, we are all commission
salesmen. One of us is on Medicare, the rest, me included, buy health
insurance on the open market and pay high single coverage rates. A single payer
program would work best for us.
Here's another letter from a phyisician:
I am an emergency physician in Oregon who has produced 48 minute video "Health, Money and Fear" which addresses why our health care non-system costs so much, what it says about us and what we can do about it. It is available for viewing, in chapters, at www.ourailinghealthcare.com (as is a two minute trailer).
The project started as an exploration and I came around to advocating for "single payer" or "publicly financed, privately delivered" care... or whatever you want to call it. In any case, we need a system in which the focus is on health instead of maximizing profits for all of the players. Physicians could be leading the charge on health reform; however the primary care providers are buried and I am afraid the specialists have become the mercenaries of The Industry.
My intent in producing "Health, Money and Fear" is to educate the
public about the perverse incentives in our non-system.
Yet another doctor:
The most under-reported story is how strong and diverse the support is for
single payer national health care. Even though 66% of Americans and
59% of doctors want single payer, including two Nobel prize winners in
economics, Drs. Joseph Stiglitz and Paul Krugman, the media ignores it
or mischaracterizes it as government run.
Here's another good point about the trillions we're spending on bailing out the banks (many have said they don't want the money and are returning it to the Treasury):
What this nation's economy needs is a single-payer plan that eliminates the thousands of health plans and their huge administrative costs that drain 31% of our health care dollars without ever laying hands on the patient. Without single-payer healthcare this nation's economy will never recover. HR676 Medicare-for-all will not only expand health care to 100% of the people, and save $400 billion annually, but it will bail out 100% of our employers to the tune of $6000 per employee per year. It will stimulate them to keep the employees they have and add new employees for growth. What better way of keeping jobs in the US? We cannot allow the insurance industry to win this issue. I'd rather see our bailout money going every US employer, not just a choice few.
This is from a licensed psychologist:
As both a provider and consumer of health care, I have put considerable attention into sorting out the realities of this issue, and find myself--along with the majority of health care providers--strongly supporting single-payer. Unfortunately, we often feel like voices in the wilderness. It is rare to find solid pieces like yours in the mainstream media.
And this last one from another doctor who focuses on my main point: Let's let people vote with their dollars in a grace period where we offer the private and public systems side by side.
If enough others follow your lead perhaps we will be able to make a realistic comparison between what this approach has to offer and the others....
What can you do? Call, write or email your Congressional representatives and tell them you want them to support single-payer health. Rep. John Conyers has such a bill worth supporting. Then contact the White House and tell President Obama you want him to propose and back such as plan. Here's a contact: http://www.whitehouse.gov/administration/eop/opl/
The message was pretty consistent: President Obama and Congress should consider a single-payer health plan in its reform agenda. It may be the best solution out there, but it isn't even on the table (as far as I know).
I heard from doctors, other health professionals and ordinary folks. No one can understand why we should keep such a wasteful, inefficient and expensive system that denies more than 60 million (I include the 25 million underinsured) affordable, universal care.
In my piece, I called health care a fundamental human right. Of course, I heard from folks who thought that people don't have this right. I know it's not written in the U.S. Constitution, but I think it should be an amendment. It shouldn't be a luxury. If we can build nuclear weapons, invade countries for the flimsiest of reasons, export our dollars for oil and get the Chinese to finance tax cuts, warmaking and stimulus measures, we can certainly come up with a health-care program that covers everyone.
Single-payer makes sense for just about everybody because our system is so splintered. Doctors and other providers waste time, resources and money filling out forms for thousands of different insurers. That takes away from direct care and costs everyone. Those who can't afford policies end up in emergency rooms. That costs taxpayers money. Those who don't get preventive or chronic health management also end up costing the system more than is necessary.
Will single-payer demand some changes and sacrifices? Of course it will. Will it mean higher taxes? Possibly, but not if the waste is wrung out of the system and discounts are obtained for all services and drugs. A Wal-Mart style purchasing model makes much more sense than each company contracting with middlemen for PPOs, drug plans, etc. It makes no economic logic to force employers to dance around all of these issues, add to their cost of doing business and make them less competitive with global competitors.
At the very least, single-payer should be the model that's studied first. There's plenty to examine from Europe, Japan and Australia. While I don't think that we will end up with what the UK or Canada have, we should stop the crazy rhetoric that shuts down the debate. I don't think anyone truly believes that we will become like Europe any time soon. Let's grow up and start talking like we want to help everyone.
Here's a sampling of what I received:
Hello from Paris, where I've had direct experience with single payer health care.
The key thing to get across is that single payer is not the same as single provider. It is a tribute to the power of functional illiteracy that Americans can't get that straight despite having Medicare, which is single payer and endlessly multiple providers!
It is further incomprehensible that physicians moan about paperwork, yet a majority are against single payer. You may already know this, but I'll write in anyway. In France, a doctor's paperwork now usually consists of swiping a patient's health card, typing in treatment codes and hitting the SEND button. The doctors I know here have a receptionist or several doctors share one. They just don't have the same needs or expenses.
This one was from a doctor:
Could you please address the cost savings if defensive medicine was
stopped? How much would health care resources be freed up if health care
providers did not order tests and treatment to protect themselves from
malpractice suits. Obama never mentions how much of the health care dollar
is spent by the health care industry on malpractice insurance, defense and
payouts.
Redirect the money that is spent because of malpractice litigation towards
providing health care and you will have the resources to provide medical
care to everyone in this country. Develop a better real time system than
the malpractice lawsuits to monitor and insure quality of health care. Think
of all of the ad time on TV that would be freed up if attorneys weren't
advertising ways to sue the health care providers. Find another way other
than malpractice suits for attorneys to make money.
Give all health care providers in the private sector the same electronic
medical records system and malpractice protection that they have in the VA
system. The VA system is already a single payer system. Expand the VA
system to cover everyone in this country, not Medicare. There is too much
time and resources wasted trying to collect deductibles and co-payments from
medicare recipients. The Medicare regulations compliance is another waste
of health care resources.
This email was from a retiree:
Congratulations, Mr Wasik, on your column regarding this subject. I
agree with you wholeheartedly!
While I enjoy being covered by Medicare, I believe the Medicare
Advantage system is abused by insurance companies - this aspect of
Medicare should be abandoned. Every year I am bombarded with
brochures about signing up with one of these plans.
I have a daughter and son-in-law who are finishing up their graduate
degrees to become teachers - they have no insurance at all, though
they work part time. They do not get regular checkups. Another
daughter and her husband pay terribly expensive premiums for
"catastrophic" coverage with huge deductibles, as he is self employed.
They don't get regular checkups either, despite being in their 40s.
This is a terrible state of affairs in which the supposedly
first-class nation has far less than first-class health care.
Thanks for your column. I hope you will continue to talk about it.
What about small business? They (like myself) are generally not covered by group plans, so they pay through the nose, have high deductibles and get socked with double-digit increases every year.
I work in an office with three other men, we are all commission
salesmen. One of us is on Medicare, the rest, me included, buy health
insurance on the open market and pay high single coverage rates. A single payer
program would work best for us.
Here's another letter from a phyisician:
I am an emergency physician in Oregon who has produced 48 minute video "Health, Money and Fear" which addresses why our health care non-system costs so much, what it says about us and what we can do about it. It is available for viewing, in chapters, at www.ourailinghealthcare.com (as is a two minute trailer).
The project started as an exploration and I came around to advocating for "single payer" or "publicly financed, privately delivered" care... or whatever you want to call it. In any case, we need a system in which the focus is on health instead of maximizing profits for all of the players. Physicians could be leading the charge on health reform; however the primary care providers are buried and I am afraid the specialists have become the mercenaries of The Industry.
My intent in producing "Health, Money and Fear" is to educate the
public about the perverse incentives in our non-system.
Yet another doctor:
The most under-reported story is how strong and diverse the support is for
single payer national health care. Even though 66% of Americans and
59% of doctors want single payer, including two Nobel prize winners in
economics, Drs. Joseph Stiglitz and Paul Krugman, the media ignores it
or mischaracterizes it as government run.
Here's another good point about the trillions we're spending on bailing out the banks (many have said they don't want the money and are returning it to the Treasury):
What this nation's economy needs is a single-payer plan that eliminates the thousands of health plans and their huge administrative costs that drain 31% of our health care dollars without ever laying hands on the patient. Without single-payer healthcare this nation's economy will never recover. HR676 Medicare-for-all will not only expand health care to 100% of the people, and save $400 billion annually, but it will bail out 100% of our employers to the tune of $6000 per employee per year. It will stimulate them to keep the employees they have and add new employees for growth. What better way of keeping jobs in the US? We cannot allow the insurance industry to win this issue. I'd rather see our bailout money going every US employer, not just a choice few.
This is from a licensed psychologist:
As both a provider and consumer of health care, I have put considerable attention into sorting out the realities of this issue, and find myself--along with the majority of health care providers--strongly supporting single-payer. Unfortunately, we often feel like voices in the wilderness. It is rare to find solid pieces like yours in the mainstream media.
And this last one from another doctor who focuses on my main point: Let's let people vote with their dollars in a grace period where we offer the private and public systems side by side.
If enough others follow your lead perhaps we will be able to make a realistic comparison between what this approach has to offer and the others....
What can you do? Call, write or email your Congressional representatives and tell them you want them to support single-payer health. Rep. John Conyers has such a bill worth supporting. Then contact the White House and tell President Obama you want him to propose and back such as plan. Here's a contact: http://www.whitehouse.gov/administration/eop/opl/
Wednesday, March 11, 2009
Obama Can't Ignore Single-Payer Health
Lions and tigers and single-payer health, OH MY! Yes, we're trying to find the wizard who will cure us of our health-care woes -- provide it to everyone at an affordable cost. Is the man behind the curtain President Obama?
The way it stands now, probably not, since he's never mentioned single-payer health and his spokesman says he's not interested. My Bloomberg column today discussed this shut-out at length: http://www.bloomberg.com/apps/news?pid=20601039&refer=columnist_wasik&sid=ao58otXrmrPM.
The bottom line is that the insurance and pharmaceutical industry see single-payer as the anti-christ. Insurers offer no value and are making health-care decisions for us every day. Yes, folks, they are RATIONING care by simply refusing to pay for some treatments or making premiums exorbitant if we are paying through individual policies or high-deductible plans. if you are sick, suffer from a chronic disease or have had any number of (dozens) of "pre-existing" conditions, you will not get an affordable rate outside of a group plan.
So those who whine about the more than 45 million who are uninsured "choosing not to get insurance," get a grip. These folks are priced out of the market simply because their health isn't good. Insurers only want people who aren't going to cost them money, "losses" in their jargon.
Enter the single-payer concept. Doctors are not employed by the government. Hospitals will not be taken over by Homeland Security. Drugs will still be available. One buyer purchases all of these services, monitors care and gets the lowest price. The health-care combine despises this idea because it will hurt their profits and may even drive them out of business they will have to compete with this system in a free market, which is anything but open right now.
There are several versions of single-payer. One is an expanded Medicare, which is not to be confused with a pure single-payer system that simply acts as a big purchasing agent.
The single-payer system in England, which is not what I'm advocating, actually owns clinics and hospitals.
Then there are various other European models, which most single-payers decry as "socialist." Yes, they are not perfect and yes they cost taxpayers more money. But they don't have people going bankrupt or losing their homes in Europe, Canada or Australia because they are hounded by medical bill collectors.
Here's an enlightening Q&A provided by my friend Dr. Ida Hellander at Physicians for a National Health Care Plan (www.pnhp.org), one of the most vocal advocates of single-payer programs:
Q and A with PNHP co-founders Drs. David Himmelstein and Steffie Woolhandler
--------------------------------------------
*Question: Should PNHP support a public Medicare-like option in a
market of private plans? PNHP should tell the truth: The "public plan option" won't work to fix
the health care system for 2 reasons.*
1- It foregoes at least 84% of the administrative savings available
through single payer. The public plan option would do nothing to
streamline the administrative tasks (and costs) of hospitals, physicians
offices, and nursing homes, which would still contend with multiple
payers, and hence still need the complex cost tracking and billing
apparatus that drives administrative costs. These unnecessary provider
administrative costs account for the vast majority of bureaucratic
waste. Hence, even 95% of Americans who are currently privately insured
were to join the public plan (and it had overhead costs at current
Medicare levels), the savings on insurance overhead would amount to only
16% of the roughly $400 billion annually achievable through single payer
- not enough to make reform affordable.
2- A quarter century of experience with public/private competition in
the Medicare program demonstrates that the private plans will not allow
a level playing field. Despite strict regulation, private insurers have
successfully cherry picked healthier seniors, and have exploited
regional health spending differences to their advantage. They have
progressively undermined the public plan - which started as the single
payer for seniors and has now become a funding mechanism for HMOs - and
a place to dump the unprofitably ill. A public plan option does not lead
toward single payer, but toward the segregation of patients; with
profitable ones in private plans and unprofitable ones in the public plan.
*
Question: Would a public plan option stabilize the health care system,
or even be a major step forward? *
Answer: The evidence is strong that such reform would have at best a
modest and temporary positive impact - a view that seems widely shared.
Indeed, we remain concerned that a public plan option as an element of
reform might well be shaped in a manner to effectively subsidize private
insurers by requiring patients to purchase coverage while relieving them
of the highest risk individuals, stabilizing private insurers for some
time and reinforcing their control of the health care system.
*
Question: Given the above, is it advisable to spend significant effort
advocating for inclusion of such reform? No, for 2 reasons.*
1 - We are doctors, not politicians. We are obligated to tell the truth
(see above), and must answer for the veracity of our stance to our
patients and colleagues over many years - a very different time horizon
and set of responsibilities than politicians'. Falling in line with a
consensus that attempts to mislead the public may gain us a seat at the
debate table, but abdicates our ethical obligations.
2- The best way to gain a half a pie is to demand the whole thing.
*Question: Is fundamental reform possible? *
We remain optimistic that real reform is quite possible, but only if we
and our many allies continue to insist on it.
The above was submitted by doctors who want reform, so they know much more about the system and how to fix it than anyone in the insurance industry or in Washington.
Tell your elected representatives to give single-payer a chance.
If you believe, as I do, that health care is a fundamental human right (I would protect it by a constitutional amendment), then join the battle. Even with Obama in office, our odds are long and we need to be organized.
The way it stands now, probably not, since he's never mentioned single-payer health and his spokesman says he's not interested. My Bloomberg column today discussed this shut-out at length: http://www.bloomberg.com/apps/news?pid=20601039&refer=columnist_wasik&sid=ao58otXrmrPM.
The bottom line is that the insurance and pharmaceutical industry see single-payer as the anti-christ. Insurers offer no value and are making health-care decisions for us every day. Yes, folks, they are RATIONING care by simply refusing to pay for some treatments or making premiums exorbitant if we are paying through individual policies or high-deductible plans. if you are sick, suffer from a chronic disease or have had any number of (dozens) of "pre-existing" conditions, you will not get an affordable rate outside of a group plan.
So those who whine about the more than 45 million who are uninsured "choosing not to get insurance," get a grip. These folks are priced out of the market simply because their health isn't good. Insurers only want people who aren't going to cost them money, "losses" in their jargon.
Enter the single-payer concept. Doctors are not employed by the government. Hospitals will not be taken over by Homeland Security. Drugs will still be available. One buyer purchases all of these services, monitors care and gets the lowest price. The health-care combine despises this idea because it will hurt their profits and may even drive them out of business they will have to compete with this system in a free market, which is anything but open right now.
There are several versions of single-payer. One is an expanded Medicare, which is not to be confused with a pure single-payer system that simply acts as a big purchasing agent.
The single-payer system in England, which is not what I'm advocating, actually owns clinics and hospitals.
Then there are various other European models, which most single-payers decry as "socialist." Yes, they are not perfect and yes they cost taxpayers more money. But they don't have people going bankrupt or losing their homes in Europe, Canada or Australia because they are hounded by medical bill collectors.
Here's an enlightening Q&A provided by my friend Dr. Ida Hellander at Physicians for a National Health Care Plan (www.pnhp.org), one of the most vocal advocates of single-payer programs:
Q and A with PNHP co-founders Drs. David Himmelstein and Steffie Woolhandler
------------------------------
*Question: Should PNHP support a public Medicare-like option in a
market of private plans? PNHP should tell the truth: The "public plan option" won't work to fix
the health care system for 2 reasons.*
1- It foregoes at least 84% of the administrative savings available
through single payer. The public plan option would do nothing to
streamline the administrative tasks (and costs) of hospitals, physicians
offices, and nursing homes, which would still contend with multiple
payers, and hence still need the complex cost tracking and billing
apparatus that drives administrative costs. These unnecessary provider
administrative costs account for the vast majority of bureaucratic
waste. Hence, even 95% of Americans who are currently privately insured
were to join the public plan (and it had overhead costs at current
Medicare levels), the savings on insurance overhead would amount to only
16% of the roughly $400 billion annually achievable through single payer
- not enough to make reform affordable.
2- A quarter century of experience with public/private competition in
the Medicare program demonstrates that the private plans will not allow
a level playing field. Despite strict regulation, private insurers have
successfully cherry picked healthier seniors, and have exploited
regional health spending differences to their advantage. They have
progressively undermined the public plan - which started as the single
payer for seniors and has now become a funding mechanism for HMOs - and
a place to dump the unprofitably ill. A public plan option does not lead
toward single payer, but toward the segregation of patients; with
profitable ones in private plans and unprofitable ones in the public plan.
*
Question: Would a public plan option stabilize the health care system,
or even be a major step forward? *
Answer: The evidence is strong that such reform would have at best a
modest and temporary positive impact - a view that seems widely shared.
Indeed, we remain concerned that a public plan option as an element of
reform might well be shaped in a manner to effectively subsidize private
insurers by requiring patients to purchase coverage while relieving them
of the highest risk individuals, stabilizing private insurers for some
time and reinforcing their control of the health care system.
*
Question: Given the above, is it advisable to spend significant effort
advocating for inclusion of such reform? No, for 2 reasons.*
1 - We are doctors, not politicians. We are obligated to tell the truth
(see above), and must answer for the veracity of our stance to our
patients and colleagues over many years - a very different time horizon
and set of responsibilities than politicians'. Falling in line with a
consensus that attempts to mislead the public may gain us a seat at the
debate table, but abdicates our ethical obligations.
2- The best way to gain a half a pie is to demand the whole thing.
*Question: Is fundamental reform possible? *
We remain optimistic that real reform is quite possible, but only if we
and our many allies continue to insist on it.
The above was submitted by doctors who want reform, so they know much more about the system and how to fix it than anyone in the insurance industry or in Washington.
Tell your elected representatives to give single-payer a chance.
If you believe, as I do, that health care is a fundamental human right (I would protect it by a constitutional amendment), then join the battle. Even with Obama in office, our odds are long and we need to be organized.
Wednesday, March 4, 2009
books, St. Patrick's Day and taxes
I've been out of the world, so the speak, for the past three weeks proofreading one book and finishing the manuscript of another. I don't normally do this, nor do I recommend this to anyone. The first book was delayed, so it's final deadline fell smack in the middle of the newer book.
Writers are like sharks. If we don't keep moving words on the page, we die. The most recent book is entitled "The Cul-de-Sac Syndrome," in which I deconstruct the housing crisis from a cultural, economic and ecological perspective. I invented a word in this book (or at least I think I did) -- the "spurb" -- a repugnant term for a sprawling urban area unconnected to a central city. This unsustainable kind of place was overleveraged, short on resources and public transportation and now hosts the lion's share of foreclosures.
In Cul-de-Sac, I don't specifically point the finger at greedy investment bankers, brokers or real estate agents (although they are certainly at fault to some degree), I blame the culture that set us up to believe that homeownership was a rite of the American Dream. It will be published by Bloomberg Press in June.
The latest work is about the Obama economic plan entitled "The Audacity of HELP." I wanted to analyze the stimulus plan and what it will mean for you and the future of the country. Since this is an evolving story, it's like trying to catch a bird in mid-flight. It's hitting the bookstores in August and will offer some unique insights into Obama's special brand of social capitalism, which is adept at addressing short-term problems but may come up short on the monster issues of Social Security, Medicare and health care reform.
After I finished these two projects, I was as tired as a hunting dog who finally caught up with the fox.
I'm looking forward to a spring break with my family to Washington the end of the month. We're going to try to get into a White House tour and we've already booked a Capitol tour.
In the interim, we have St. Patrick's Day -- a big holiday in my house. I'll be playing with my local lads "The Prairie Fogg" some jigs, reels, slip jigs, hornpipes and a polka.
The following day my non-profit group the Citizens Action Project will release our second white paper on appealing property taxes (www.citizensactionproject.org). Let me know what you think. We will present it and hold a forum of local assessors at the Byron Colby Barn (route 45 and Jones Point Road in Grayslake, IL) on March 16 at 7pm. See you there!
Writers are like sharks. If we don't keep moving words on the page, we die. The most recent book is entitled "The Cul-de-Sac Syndrome," in which I deconstruct the housing crisis from a cultural, economic and ecological perspective. I invented a word in this book (or at least I think I did) -- the "spurb" -- a repugnant term for a sprawling urban area unconnected to a central city. This unsustainable kind of place was overleveraged, short on resources and public transportation and now hosts the lion's share of foreclosures.
In Cul-de-Sac, I don't specifically point the finger at greedy investment bankers, brokers or real estate agents (although they are certainly at fault to some degree), I blame the culture that set us up to believe that homeownership was a rite of the American Dream. It will be published by Bloomberg Press in June.
The latest work is about the Obama economic plan entitled "The Audacity of HELP." I wanted to analyze the stimulus plan and what it will mean for you and the future of the country. Since this is an evolving story, it's like trying to catch a bird in mid-flight. It's hitting the bookstores in August and will offer some unique insights into Obama's special brand of social capitalism, which is adept at addressing short-term problems but may come up short on the monster issues of Social Security, Medicare and health care reform.
After I finished these two projects, I was as tired as a hunting dog who finally caught up with the fox.
I'm looking forward to a spring break with my family to Washington the end of the month. We're going to try to get into a White House tour and we've already booked a Capitol tour.
In the interim, we have St. Patrick's Day -- a big holiday in my house. I'll be playing with my local lads "The Prairie Fogg" some jigs, reels, slip jigs, hornpipes and a polka.
The following day my non-profit group the Citizens Action Project will release our second white paper on appealing property taxes (www.citizensactionproject.org). Let me know what you think. We will present it and hold a forum of local assessors at the Byron Colby Barn (route 45 and Jones Point Road in Grayslake, IL) on March 16 at 7pm. See you there!
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