There is a cognitive bridge that must be crossed in order to embrace single payer and I’ve not figured out how to explain it. Jon, your persistence in expressing the single payer mindset is admirable. Please keep it up. It’s like you’re throwing darts. Maybe a universally understandable/persuasive argument (bullseye) will emerge.

Those opposed SEEM to ignore the fact that the huge monetary inflow (INTO the insco’s) is reduced by approximately 25% before it is distributed to the providers of health care. Doesn’t that actually inflate the cost by at least 15%? From what I’ve gathered, the overhead expense of Medicare is less than 10%. IF that is so (and I’ve used conservative percentages) isn’t that pretty easy math? A savings of 15% of all the monies currently spent on for-profit premiums is not exactly chump-change. And wouldn’t the lion’s share of THAT go into the single payer reserves? Furthermore, isn’t the current non-Medicare-age crowd actuarially LESS at risk? Aren’t the private insurers ‘cherry picking” comparatively speaking? I don’t have ready access to all the data to back up my suppositions. Does anyone? This cognitive bridge must be crossed in order to gain support from all but the most selfishly invested in the controversy. Those whose oppositional stance is entirely self-serving are certainly in the minority.

Thanks again Jon for keeping on this issue.

Washington is making it’s own reality.
I wonder if they will even notice when American cities start to burn.

The “concern” about the deficit is not about the deficit at all. It’s about accelerating class warfare.

When you are the puppet of the plutocrats, your policies benefit their interests rather than those that would benefit the majority of the people and the health of the nation. It’s really that simple.

Single-payer advocacy groups such as PNHP and HC-N!, have honed the cost savings data and arguments you cite into succinct and cogent talk points and have been on the case for years. The cognitive bridge consists not in getting people to understand these truths but to face them.

And yes, the reason Medicare has been allowed to exist at all in this country relates to the inverse cherry-picking you cite. That’s also why end-stage renal disease patients were folded into Medicare decades ago.

Cripes! Where were they two years ago?

Better late than never I guess

Thanks for the links!!!

ACA has already come under enough duress to make single payer look like a far better alternative, and somewhat likely going forward. It’s too bad we’ve been on such a detour so far.

The demise of the individual mandate in ACA could make it happen. Kucinich has seemed to think so.

Amen! If we developed an effective healthcare system like many other countries we wouldn’t have a deficit problem.

I read where health insurance costs are only 4% or 5% of total US health care costs.

The second way for government to address its health costs is not to shift them but to reduce them

Doesn’t that mean shifting them onto the backs of doctors?

Jon,

The administrative expenses for Medicare are indeed much lower than that for private insurance–I seem to recall 3% versus 30% or more.

But Medicare costs are still escalating at a rate higher than inflation–not as rapidly as for private insurance, but still at an unsustainable rate.

Some the measures built into PPACA were designed to “bend the cost curve”, such as the Independent Payment Advisory Board, and making Medpac recommendations binding unless vetoed by COngress within a 30 day window (or something like that).

Of course, eliminating Medicare Advantage, reforming Medicare Part D so that the govt can negotiate fees with Phrma, and reforming the way Medicare pays for medical devices are essential to making Medicare a sustainable program.

What’s sobering,however, is to look at the programs that have tried, and failed, to control costs. The “Patient Center Medical Home” being the latest example. And I think that adaptation of electronic records will in the end be a wash (but that’s just my opinion).

The private option was originally designed as a way to introduce competition and cost effectiveness into the health care market. Too bad President “I’m not wasting my political capital on anyone or anything” couldn’t get his act together to endorse it. He probably never really understood the concept, anyway.

These millionaires (Obama, Baucus, and the rest of both houses of Congress) have zero skin in the Medicaid, Medicare, or Social Security issues. They will never have to depend on any of them.

It seems they have zero empathy for those of us who do depend on these programs to keep us out of subsistence-level existence (again!).

They’re protecting their contributors, and doing a damn fine job of it and screwing the regular people. The benefits flow upward, rather than to regular people.

Neither radically increasing medicare coverage nor radically reducing medicare coverage (by itself) will bring about the needed savings, though either may lead to the real changes that will force changes. The ONLY thing that will reduce health care spending – which will ultimately eat up the savings associated with any scheme suggested – is to reduce the rate of new health care innovations (or at the very least, cost-testing new innovations).

Cold turkey will do it. So will letting the bank go broke.

So long as we keep demanding new miracles each year and finding some way to pay for it, health care spending will continue its road to domination of all else – whether its through Medicare or not.

I’m paranoid enough to believe that ACA was constructed as not to work effectively to the point where the only option is single payer. It’s an unsuccessful evolutionary step to single payer.

The biggest obstacle is the power and influence of the insurance and pharma lobby. Every health insurance company ought to be cast to the winds. They are all bandits, but as long as you have pols who are bought and paid for by pharma and insurance nothing, absolutely NOTHING, will change.

Easy to understand 4 min video

http://www.youtube.com/watch?v=RAvy9jew9dM

The next steps to reducing the deficit are cutting the “defense” budget and letting the Bush tax cuts lapse!

@alan1tx,

No, not shifting to doctors, it means eliminating the profit that goes to advertising, marketing, CEO compensation etc etc etc.

Shifting onto the backs of doctors will transpire when the Super Congress fails to make a bargain in November and the “trigger” is pulled. My understanding is that there will be an automatic paycut of 29.5% anyway with out the trigger as of Jan 2012; then the “debt deal” adds another 2%.

total nonsense. Germany, Japan, France they all provide a similar level of care for a fraction of the cost. You could remove huge amounts of administrative overhead and importantly overcharging with all-payer or single payer

eliminating the profit that goes to advertising, marketing, CEO compensation etc etc etc.

As I said, that’s about 4% of US health care costs. A big number, but a small percent. In 2008 about $92B.

BTW, in 2008 the US deficit was $407B, so it doesn’t look like eliminating health insurance will eliminate the deficit.

Conservatives don’t like Single Payer because undeserving Black People will get FREE HEALTH CARE, that’s it. VERY SIMPLE.

Doctors should not take the hit for the mismanagement and dishonesty of the gov’t. It’s my understanding that many people already have difficulty finding a doctor who will take Medicare patients. I was lucky and found one I like and trust. Why have Medicare if you can’t even find a doctor? The whole thing is crazy.

I agree that we will have no choice but to move to single payer. We cannot afford to implement Obama Care which has no price controls and is nothing more than subsidizing immense profits for corporation. What Medicare is in a big part also operating by subsidizing private profit makers) is spending.

A couple of frames that come to mind are to direct attention to the fact that insurance is not medical care and whatever plans emerge the specifics of coverage and the cost of premiums and co-pays be in the discussion. Cost to the patient is important but most important is reliability and predictability of kind of care is the biggest concern of ordinary people.

Germany, Japan, France (and virtually every country not named the United States) benefits from the United States paying market prices for health care advances (health care technology firms benefit by collecting anything above marginal cost from other nations so long as the U.S. will meet their fixed cost needs). Even the relatively small amount of R&D from other countries (the United States spends as much as 75% of the world total) is spent with the U.S. market in mind. Now, if some NEW country shows up that’s willing to take on the U.S. role, then you may have a solution. Barring that, once the American health care market-based approach ends, the Law of One Price means that one of three things happens:

1. The countries you name pay more while we pay less
2. The countries you name stop offering the same level of care
3. Healthcare technology companies stop receiving revenues at the same rate resulting in a slow down of technology development.

The CBO issued two excellent reports on precisely these issues (in 2006 and 2008). Linear advantages (like reducing administrative overhead or the inclusion of an insurance profit-taker) are dominated in the long-run by exponential disadvantages (like R&D).

France makes us look completely stupid that’s why Conservatives always want to make them villains and remember World War II, painting them as ungrateful.

Remember Freedom Fries?

Germany has a problem, during the last retooling of their health care system they allowed the Rich to opt out. That is costing them. Doctors complain about wages and they have other problems. Eventually they will have to ask the rich to pay their fair share.

Japan has issues too.

The model we should be looking at is Singapore.

No, not the doctors, “shifting expenses” in Republican means “shifting expenses to the beneficiaries” i.e. the ill and the elderly — which is exacty what Paul Ryan is trying to accomplish with his so-called budget.

In the case of “Medicare for All” the “shifting expenses” means taking the Ghodsforsaken Insurance companies out of the money loop completely. What most people don’t seem to get is that the damned insurance companies do not provide any health care services whatsoever. So Medicare, whose administrative overhead is 3% of the program costs, is, and will continue to be, the most efficient way of seeing that the true providers of care get compensated — something the insurance companies fight tooth and nail against doing.

I have a radical idea. Repeal Obama care. Make employer mandates illegal. ie take the employer out of the role of providing for medical care. Set up a real universal single payer system that begins coverage at the instant of birth.

As another sweetner for the corporates, eliminate all federal corporate taxes. Increase individual income taxes on the wealthy in an amount sufficient to compensate for loss by repeal of corporate taxes. Account for and deal with lots of ramifications. But one would be the elimination of a whole layer of hidden putrid corruption.

I posted this the other day. S & P’s list of AAA rated countries all had something in common: higher taxes and public health for all.

It is a simple answer.

2008 Health Care Costs:

Hospitals are 30.7%.
Doctors and nurses are 31.3%.
Drugs are 12.8%.

Health insurance costs are 4%. That seems to stack up comparably with Medicare.

France reimburses its doctors at a far lower rate than U.S. physicians would accept. However, French doctors don’t have to pay back their crushing student loans because medical school is paid for by the state, and malpractice insurance premiums are a tiny fraction of the $55,000 a year and up that many U.S. doctors pay. That $55,000 equals the average yearly net income for French doctors, a third of what their American counterparts earn.

Total administrative costs were around 31% in 2003 (have costs not increased since then?) according to the New England Journal of Medicine.

http://www.nejm.org/doi/full/10.1056/NEJMsa022033

Total overhead … insurance + doctors offices + hospitals + nursing homes + … = 31%

Versus 3% overhead for medicare

Doctors are making far more money than a few decades ago but they have less power in the treatment of their patients. Hush money? I know I sound cynical, but it is based on tons of experience as a patient, care giver and doctor’s wife. The system needs to be flipped back into care for humans rather than profits for asshole corporations. (excuse the use of a biological adjective for NONperson corporations, please)

Interesting. Business should LOVE it and become more globally competitive. How would you fund it? Assuming the Medicare Tax would be increased, it would be interesting to compute what percentage would be needed. It would HAVE to be levied in an equitable manner and “equitable” would have to be defined. I can see knee-jerk rejection no matter how much sense it may make. Too many people want it to be “free”. Medical providers can’t be made to be indentured servants. But, again, “business” should love it. Now, how do you present it as a “win-win”?

Germany, Japan, France (and virtually every country not named the United States) benefits from the United States paying market prices for health care advances (health care technology firms benefit by collecting anything above marginal cost from other nations so long as the U.S. will meet their fixed cost needs). Even the relatively small amount of R&D from other countries (the United States spends as much as 75% of the world total) is spent with the U.S. market in mind. Now, if some NEW country shows up that’s willing to take on the U.S. role, then you may have a solution.

The ridiculous assumption here is that pharmaceutical companies bear the cost of their own R&D. They don’t. The NIH bears huge chunks of it, then transfers the exclusive rights to pharmaceutical companies. And then groups like Susan G. Komen, or foundations, come along and pick up the tab for clinical tests to bring many of them to market.

We’ve let you be here for a very long time but you just broke the hard and fast Pro-troll rule, PhRma boy. You’re not allowed to come in here and deliberately spread your industry’s disinformation.

Are you saying that for-profit health insurance administrative costs are only 4% of health care spending?

The fact is, this is not as difficult a problemn as we have made it. But as our two political parties are so far apart in their approaches and goals, I don’t know what we will do.

I don’t necessarily want to throw everybody in the insurance industry out of a job, but our healthcare costs are just WAAAY too high compared to everybody else’s.

and certainly the a holes that crafted the piece of shit posing as health care reform could never have predicted that a single payer system could actually reduce the deficit. What unmitigated bastards.

One could argue that the entire circus clown car demolition derby of the debt ceiling debate, S&P’s downgrade of the nation’s credit rating, the creation of the Super Congress!! Son of Catfood, and all the other missed opportunities and self-inflicted wounds that Obama has gifted to this great country of ours were simply his brilliant attempt to move the nation’s discourse in such a way that Medicare for All not only becomes the new narrative, but also inevitable. If that’s the case, he’s playing eleventy dimensional chess at the Grand Master level.

But one would be wrong.

troll boy, you need a laxative because you’re full of it.

There’s more to it than this. Support research grants into cutting the cost of medical devices and their use. Support funding into re-training and changing certifications so that a wider range of medical professionals can use a wider range of medical diagnostic and test devices, and change the emphasis on devices to lab-on-a-chip and non-invasive test devices (e.g. blood sugar bracelets).

Re-purpose the biotech industry into climate change initiatives.

Unless you do these things too, the costs will continue spiralling because there will be no place to retrain skilled workers during a time when you need to put people into jobs, so you have the need to create jobs positioned antithetically with the need to contain health care costs.

Save your sobs for the employees of the insurance companies — if we ever actually get Medicare for All — the insurance companies will sell supplemental plans to those who believe they’ll get superior care thereby…

(All they’ll really be is lighter in the pocketbook, because the insurance privateers will get their 30% from the marks.)

Jon, Medicare for all or Public Option would have got more subscribers to medical industry, would have been in-line with our constitution, with American spirit, absolutely palatable for all and Democrats would have been in power in congress now.

They attend minimum $15K a plate dinners and how can we be naive that a right thing will be done when we saw the free-spirit quelling individual mandates for private entities using a classic bait and switch which destroys our whole economic system long term was added.

How do we think everything is going to change and I have seen talk but not one iota of real action to show there is any step on the right path.

BTW all that I see is news of those minimum $15K a plate dinners so do not expect any thing different because promises will be made and they need to be kept so that bigger maybe $50K dinners can be attended in future.

How would you fund it?

Individual income taxes on the wealthy. Calculate rates to compensate for loss of corporate taxes.

Seems to me you should try your luck arguing those numbers with the folks over at the links ralphbon provided @5 then c’mon back over here and let us know how you did. We are not going to reargue the case with you here. You are essentially making stealth anti-single payer or anti-public option arguments, of which we have seen & rebutted several dozen variations.

It may be a requirement to be a physician or health-care professional to become a “member” of PNHP, so I can’t vouch for how or whether they offer blogging for members, but I can show you this web page titled “Single-Payer National Health Insurance. PNHP are “Physicians for a National Health Program.” Physicians who possibly don’t crave or need the massive personal incomes built into our current for-profit healthcare industry.

Alan,

what’s the source for that breakdown?

Jon,

It’s a one time cost savings. The way medicine works in America, spending still increases at twice the rate of inflation. France, England, Germany and all the other countries struggle to keep costs under control.

This is not to say single payor isn’t preferable to the awful system we have now. But it’s not realistic to think that if we just shift everyone over to single payer we’ve solved all the problems.

Of course, the whole discussion of dying and limiting care is toxic in America. Too bad.

I can guarantee you that every single last one of them is a primary care physician (internist, family practitioner or pediatrician).

They feel they have nothing left to lose.

Excellent link. Too bad we’re preaching to our own choir.

Hat tip to ralphbon @5 for the link to PNHP, like I said @43.

Gotta run before the stores get too crowded. I’m out.

Blast. You get there first :-(.

“The demise of the individual mandate” is a tall order. I very seriously doubt that the US Supreme Court will strike it down. The individual mandate is something that can only help big businesses, especially the health insurance industry. Kowtowing to big money interests is all the US Supreme Court has been doing in modern times, whether it be via Kelo v. City of New London, or by Citizens United v. Federal Election Commission.

I think the only way we’ll ever see the demise of the individual mandate is through massive civil disobedience.

Don’t you know that any government program that serves the common good is socialism and socialism is bad? That’s what the Republicans have taught us.