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Single payer vs Public option

This is all you need. Shove this in anyone’s face who starts saying, “But, but, but . . . the guvvamint!” From a comment by Mikirivi on Krugman’s blog, a graphic prepared by Dr. Klein for the Arizona League of Women Voters: (click on image for larger version)
side by side comparison of the two options

The one solitary “disadvantage” that I can see in the Single Payer column is that the insurance industry would need restructuring. I seem to remember reading somewhere that that’s over two million workers. So it’s nontrivial. But as I remember reading in the same place, most of the skills in the insurance industry are various office skills and are eminently transferable to other fields. (We could even, like, you know, help people make the switch.)

So we could have a system that costs half as much and insures everyone (“Single Payer and beyond” section in the link), or a variant on the baroque BS we have now. The choice is obvious. Baroque BS, of course.

The whole thing is eerily reminiscent of the electric car vs GM debacle. On the one hand everyone wins and GM has to be restructured, whereas on the other hand everyone loses and GM . . . .

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43 Responses

  1. I have recently read that the excess overhead caused by paper work from multiple insurance companies is $440 billion. We can talk single payer until we are blue in the face, Obama has already been bought and paid for by big insurance. Ad Sec. Sebelius said on NPR:

    “”Today, on NPR, Secretary Sebelius said that single payer is not only ‘off the table’ but that the President is considering measures to make sure it does not happen now or ever.”

    • If quality of care and doctor compensation remained unchanged, we would save at least 30% on health care just by eliminating the “for profit” insurance companies.

    • “now or ever.”

      You mean Obama really is God and News Weeks Editor Evan Thomas was right, about him being sort of God?!?

  2. Oddly enough, most people I know who yell “government is bad!” find it ain’t so bad when they’re the one who needs the benefits.

    Like my brother-in-law, who rails about having to pay workers comp for the employees at his side business — but has no qualms about collecting it at his main job when he screws up and gets hurt.

    Or my brother who rails about deadbeats who should be responsible for taking care of themselves — but has declared bankruptcy twice and cashed the FEMA check after Katrina.

    Unfortunately, the anti-healthcare forces do a good job at playing the delusions of people like this.

    BTW, about the health care industry jobs – I live in the rust belt, I’ve heard politicians nattering on for years about how people losing jobs here should just get retrained. (Implied: if you weren’t such losers, you would have had important jobs in the first place.) Don’t see why that wouldn’t apply here. Once the money can actually go for actual health care versus paperwork, we’ll need more personnel like x-ray techs and phlebotomists.

    • I’ve heard politicians nattering on for years about how people losing jobs here should just get retrained.

      Retrained to do what, flip ,burgers or work at Walmart? Damn-it! those are the only jobs left out here!

    • Exellent points!

      It makes me sick when I think we could have had a President who believed in universal health care and was willing to fight for it.

      • I think I’m still not clear on the difference between UHC and single payer. Single payer means only one “insurance company” (the government), and universal means everyone has insurance….?

        • Single payer is universal health care. Everyone in the country is issued a card/number (like Social Security) and doctors, hospitals, etc. bill medicare on a fee for service basis. You get to choose your doctor(s).
          The difference is that your health care providers deal with only one payer (medicare) and don’t have to negotiate with insurance companies on a patient-by-patient, case-by-case, illness-by-illness basis. While it’s unlikely to cover elective cosmetic surgery (nose jobs, chin tucks, breast implants and such), it will eliminate debate over whether or what treatment you will receive for medical conditions based on an insurance company’s concern for its bottom line.

          • Sounds the same as the UK. Everyone registered with the National Heath Service receives a NHS card with a unique number (helps healthcare providers link to your records). And you can also get a European Health Insurance card and get medical coverage if traveling in to EU countries. I was even able to get these EHIS cards for my kids as they have British passports.

            Having lived in the UK for 20 years and now the US for 20 years, there’s no doubt in my mind that Universal Healthcare is an absolute right. It’s not something anyone should have to go without.

      • Makes me sick and I just got the news that the health insurance for the next fiscal year is going up! 😯 No one talks about the inflation in health care, no one and now Obama wants to make sure Single Payer is off the table “now or ever”…what is that all about?

  3. Thanks for the chart quixote–very accessible. Can someone clarify Hillary’s position? I thought she was for Single Payer, but yesterday SOD(?) said she was not, but her plan included the mandate to make sure all were included. Clarification?

    • fif – during the primary Hil was pushing mandated UHC. The debate rarely, if ever, went to a discussion about single payer. The main difference during the primary was that Obama was against mandates (designed to appeal to his young healthy supporters and gin up the generational divide) and Clinton was for those mandates. On at least one occasion I heard Hillary say that mandate was the stepping stone to single payer. From that I assume she was actually for single payer but knew that we would need to get there in phases.

      Obama, of course, after January changed his mind about mandates but not because it is a step to single payer but because it puts more money in the pockets of his insurance masters. I have heard it argued that Obama’s change to mandates is a move to the left. I see it as a move to the right.

  4. What I’m concerned about is rationing of services. An administration spokesperson on TV the other day actually said that if it’s not a life or death situation, that older people may not be able to get some services (like hip replacement, etc). Certainly I’ve heard people in the public worried about that, but this was someone attached to the administration – that really bothers me. I don’t know what to make of it.

    • It is important to know who it was. Sounds like a scare tactic.

      • I wish I could remember. And I wish I had a government I could trust. I still can’t believe that the first politician I ever believed in was shafted.

        • My mum and Aunt are both currently undergoing hip replacements in the UK. There is a waiting list. But they haven’t had to wait too long. And, in the meantime, the local council (state government) installed a stair lift and remodeled my mum’s bathroom to put in a walk-in shower (was previously a tub-style shower) so that she’s still able to be mobile. I feel like she’s very well taken care of. And that’s the way it should be.

          • If that’s what you get when you have to wait a bit for a new hip, where do I sign? Here we wouldn’t get a cup of coffee while on line. Glad they got those installations!

    • The elderly have a single payer plan (mostly) with Medicare. And no one I know (parents on all sides of family) have to wait for anything.

      • I know – my parents are on it now, too. But this was someone speaking about the future, about what will have to happen if we cover everyone. That’s why it alarmed me.

        I truly believe there has to be a way to insure everyone – at the very least to insure all citizens. I really don’t trust BO, though. He always says one thing and does another, and I worry that his “reforming” the existing system rather than creating a new system may just reward the insurance companies.

        I guess because I don’t trust him at all, I’ll just have to wait to see what happens. I just can’t believe any of his words….

        • They are telling you about the Health Care BOOGIE MAN…don’t buy it, it is a lie. If everyone is in, it will even get better…Stanford and Harvard take MEDICARE.

      • AMEN! You Rock in my opinion…NAILED IT!

    • Read the fine print in the HMOs, PPO and Gate Keepers…it is being rationed NOW! Why do you think, one person went off the HMO and stayed with straight Medicare, because they actually had better services available via Medicare than through the company insurance plan (HMO).

      Medicare is accepted everywhere and the HMO limits her choice of their approved doctors…those little details they don’t tell people.

      • Actually, there are doctors who refuse to take Medicare patients, because they feel the pay is too low. In case you’re wondering, I want UHC. I just don’t trust Obama.

        • Admittedly, doctors can be under severe financial pressure, paying off med school loans and practice setup loans, which puts them in the position of having to squeeze every dime out of their practices.

          But I’m old-fashioned enough to think that plain old profit is not an honorable motive in medicine. A doctor who makes a good living and doesn’t take some patients because he/she wants more money . . . I have zero sympathy. That’s be like me refusing to teach any students who happened to be behind on their tuition payments, or something. Despicable.

          In a single-payer system, of course, the option wouldn’t arise. If a doctor refused those patients, he/she wouldn’t have any.

        • If we get a Single Payer or UHC they will take it, believe me, they will take it. I have doctors in the family under UHC and they are doing just fine. When the Single Payer Advocates, went to the senate committee and got arrested, the majority of them were doctors.

        • Very very few doctors do not take Medicare (which is pretty good). LOTS of docs refuse Medicaid (which sucks donkey d*ck). They are two very different programs, often confused.

          If a patient has both, they will often be refused because the regs require the Medicaid to be primary. Medicare alone is nigh universally accepted.

  5. Obama and his chuckleheads are not the guys to handle this.

  6. Insurers tell Congress they will continue to cancel insurance coverage of sick people. And Congress still thinks single payer is a bad idea???


    • Next they will try and give you cash and cancel Medicare. If we fall asleep they will steal the blankets and leave us stark naked, with NO coverage and NO SAFETY NET!

      Do they represent the people or BIG BUSINESS?

  7. (Sorry, folks. I don’t have the hang of it yet in terms of pushing the button to post, so I didn’t realize this was up already and the conversation had started!)

    Re single payer vs socialized medicine.

    The first is paid by one entitiy. It doesn’t have to be the government. As Ezra Klein says, if Aetna, for instance, became a monopoly that would officially be single payer too. It also doesn’t have to imply universal coverage. Only that if a bill is paid, it’s paid by one entity. That’s not usually what people mean though. The single payer is the taxpayer, and coverage is universal. The actual medical services are provided by any mix of private or public businesses that the country happens to have. Single payer is equivalent to Medicare.

    The second, socialized medicine, means the services are provided by the government. Doctors are employed by the state. Socialized medicine is equivalent to the VA system for veterans (if I understand how that works.)

    The so-called public option is just our current system with a smidgen of competition for the insurance industry thrown in. And that microscopic reality check seems to be enough to terrify them.

    It’s looking bad.

    Never forget that Obama’s the guy who, when he was in the Illinois Senate, boasted about gutting their attempt at reform: “We radically changed [the health care bill] in response to concerns that were raised by the insurance industry.” (Obama, 2004/05/19)

    • When he said he did health care for his state I went and checked him out. I was doing my research in case he was all that he said he was and found people that were left high and dry. I also found articles where the ‘Health Care’ industry praised him for gutting the bill and the people’s advocates were left in tatters.

      So, if you have the link please place it up, because I get real mad when they say we criticize because we are ‘Bitter Knitters’ and discount that we are ‘Critical Readers of Information’ and if that is Knitting well OK, then.

      • That reference above is the link to the Boston Globe article quoting him. That’s as much documentation as I have, but I figure an outfit like that would get sued if they published a direct quote that was false.

  8. Oh, I also wanted to chime in on waiting times. I have an insured relative who had nerve damage complications from a pulmonary embolism. The life-threatening embolism was stabilized. The nerve damage gets progressively worse the longer it takes to get treated. This happened back in March. The first date she could get with a neurologist in her area (3 hr drive as it is) was mid-June.

    That’s far from an isolated case. The statistics on wait times in the US are no better, often worse, than in Europe. (They used to be a lot better, but not since we all got HMO’ed.)

    If you include the uninsured, who sometimes die while waiting, the numbers for the US are downright atrocious.

    • I know someone that died, because he was laid off and got an infection, had no insurance, started a phone tree (to see if anyone could help to treat him), then went into the hospital, had the leg amputated and a couple of days later died.

      Single payer would have covered him, the cost is less, when everyone is in, and the cost containment is the better part. People will continue to die and us HMO’ed folks will be told we have choice by the likes of Newt Gingrich, who is no friend of the working folks.

  9. I got this up on my page thingie. Thanks for sharing the find. 🙂

  10. I have very mixed feelings about this. I’m from Canada. Our family has had excellent coverage since we moved to the U.S. 11 years ago. When I left Canada, healthcare wasn’t too bad, but I have to tell you, the care my family receives here with good insurance is infinitely better. The Canadian healthcare system has deteriorated since we left. My father waited over a year for elective surgery to reattach some tendons in his arm. He was in constant pain. Elderly people with advanced cancer are sent home to die, period. If they are not willing to lay down and die and have means, they spend hundreds of thousands of dollars in the United States or other countries for care.

    Many people in Canada purchase supplemental insurance so that they get perks like semi-private rooms in hospital. Sometimes if you don’t have that, you end up staying on a gurney in the hallway. There are also for-pay clinics in some provinces now because waiting lists for many procedures are so long. There is a 12 month wait to see an orthopedic surgeon in my home city for an initial consultation. Many people wait 6 weeks or more to see their primary care physician. Many people can’t find a primary care physician. You cannot see a specialist without a referral. Canadian medicine is all about wait, wait, wait, and wait some more.

    My mother-in-law, who is also Canadian and an osteopath, raised her family in Australia and New Zealand and in her opinion, the system there is even worse. I’m not entirely sure, but there seems to be a system there where you can purchase insurance to obtain better care than that provided by the government. My brother-in-law nearly died from sepsis in the hospital there. The only reason he survived was that he was a body builder. He lost nearly 100 pounds. The New Zealand surgeon told my husband that if his brother had have been treated in the U.S. he would have had a much better prognosis, saying that they just didn’t have access to the kind of equipment and resources available to American doctors.

    My father-in-law has lived in Istanbul for more than ten years and lives with a Turkish woman. They tell me it is necessary to bride the hospital staff to ensure proper care. No one would dare to leave a relative unattended. All of our relatives marvel at the quality of care that is available to us here in the U.S.

    I am very conflicted by this. Of course I want everyone to have access to the same kind of care my family has always received in this country. I honestly don’t see that happening under a single payer system. What I see happening is the quality of care for people like my family deteriorating. If that’s the price I have to pay, fine, but please don’t be under any illusions about the quality of care in most single payer systems.

    • Wow, you pretty much indicted ALL the Universal Health Coverage and claim to have lived here a mere 11 years. First, I have helped to deliver children here because they didn’t have access to care, secondly, this very year a man died because he had NO care due to lay offs.

      If you lose your job, you are screwed and some plans don’t cover maternity coverage and hospitals require a deposit of several thousands of dollars before you are accepted, if you are stable they will transfer you to the county hospital.

      I traveled to a country with Universal Health Coverage to get treatment because my insurance didn’t cover it here (so bleeping much for CHOICE) and it was affordable and I was amazed at how well I was treated.

      Also, how do you figure that Canada was able to process the samples sent from Mexico and the US still hadn’t sent the ones off from California to confirm the H1N1 flu? Some of the medical advances believe it or not have been made within systems of care that have Universal Health Care. I hope your job is secure and that you don’t find yourself in the spot that man that lost his life did, no job, no insurance and then no life.

      • Look, you don’t have to believe me. I was born in Canada in 1966 and I lived there until 1998. Most of my family still lives in Canada. I witnessed several of them wend their way through the system, and some of them are now dead, perhaps partly because of it. Compared to the care available to me and my family here, the Canadian system is simply not as good. I personally know someone whose 60 something father was sent home to die and who sought care in the U.S. with some success (at least to the point of living an extra seven years, with decent quality of life).

        Here’s a great example: recently my daughter injured her foot (she’s a junior Olympic gymnast). We went to our local urgent care. We were in and out in less than an hour. She had had an x-ray and was provided with a “boot.” Cost to us: $0. My step-daughter, who lives in Canada injured her ankle around the same time. A similar process took 6 hours, which is actually pretty speedy for where she lives. Maybe not such a big deal compared to my father’s situation, or my mother’s six month wait for cancer surgery, but still illustrative. If you still don’t believe me, go to http://www.cbc.ca and search “emergency room death.” (CBC is Canada’s public broadcasting network, by the way.)

        My point is not that the U.S. system as a whole is great, it’s obviously not. Of course the Canadian system is better than no care at all, but for people who live here and have good insurance it would be a big step down. Also, proponents of a single payor system really need to think about why so many countries who once exclusively employed such a system now allow private hospitals and health insurance.

        I personally think it’s because people who can afford better care will pay for better care. If a single payor system is implemented here, it will almost certainly eventally devolve into a two-tier system with excellent care for the rich, and substandard care for everyone else. Even so, substandard care is better than no care at all, but is that really the best solution? Shouldn’t everyone receive excellent care?

  11. In 2003, Barack Obama said he was for single payer.

    What would it take to get single payer enacted?

    Grand Illusion “First, we have to take back the White House, the Senate and the House,” Obama said at the time.

    Fast forward six years.

    The Democrats have taken the White House.

    The Senate and the House.

    And now what’s Obama’s position?

    In a speech this week in Chicago before the American Medical Association, Obama made clear he was now opposed to single payer.

    And his lieutenants suggested that Obama would support legislation to make sure that single payer does not become a reality in America.

    There’s only one explanation for Obama’s flip-flop on single payer.

    The health insurance and drug corporations have a hammerlock on Washington.

    And Obama is going along to get along.

    What’s the net result?

    Sixty Americans are dying every day due to lack of health insurance. (Institute of Medicine report.)

    Instead of getting behind single payer, Obama and the Democrats are engaged in the what Dr. Marcia Angell, former editor-in-chief at the highly regarded New England Journal of Medicine calls “the futility of piecemeal tinkering.”

    Earlier this week, the Congressional Budget Office (CBO) estimated that the most liberal of the Democrats’ tinkering plans would cost $1 trillion over ten years and still leave 37 million Americans uninsured.

    Single payer on the other hand would cost less than we are overpaying now — and cover everyone.

    Zero uninsured.

    As Dr. Angell puts it — single payer is not only the best option.

    It’s the only option that will both control costs and cover everyone.

    Replace 1,300 insurance industry payers with one payer.

    Save $400 billion a year in bloated corporate administrative and executive compensation costs.

    Free choice of doctor and hospital.

    Use that money to insure everyone.

    No bills, no co-pays, no deductibles.

    No exclusions for pre-existing conditions — because under single payer, you are insured from the day you are born.

    No bankruptcies due to medical bills.

    No deaths due to lack of health insurance.

    Cheaper. Simpler. More affordable.

    Everybody in. Nobody out.

    According to recent polls, the majority of Americans, the majority of doctors, the majority of nurses, even the majority of health economists want single payer.

    That’s why almost every health care town hall event I hear about is dominated by citizens speaking out for single payer.

    Out of the blocks, Single Payer Action led a stand up protest before Senator Max Baucus’ Senate Finance Committee.

    Thirteen doctors, nurses, lawyers and other single payer advocates were summarily arrested and charged with “disruption of Congress.”

    (Baucus later told single payer advocates that he regretted not inviting them to testify before his committee.)

    Many progressives are now confused. They took Obama at his word.

    They thought once Obama was elected President, he would do the right thing.

    Ralph Nader

    Why do they fear Single Payer (The New Boogie Man) and why do they want to KEEP THEM OUT OF TE DISCUSSIONS?

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