Why women need universal single payer health care
March 28, 2009
by Liz of The Liz Library
|Editor’s note: We’re pleased to present this guest post by Liz of The Liz Library, an online compendium of information on law, women’s issues, and women’s history.
What is single payer health care?
“Medicare” for all Americans. No medical insurance industry, period. No middleman profiting from sickness. The government already pays for medical care for this country’s sick, disabled, poor and elderly. We need to add the healthy work force.
What makes it specifically a women’s issue?
- Medical insurance has a big impact on whether women can work part time at several jobs, be self-employed, or more easily become entrepreneurs, in order to keep their time flexible to care for children or other family members or attend school, rather than being tied to full-time wage-based employment.
- Medical care needs are the #1 reason young pregnant women require welfare, which in turn is the primary reason for various intrusive paternity establishment laws, which in turn have child custody repercussions, which in turn cripple women’s lives and options.
- Medical insurance is an issue that ties women to marriages to abusive men, keeps women dependent on traditionally-employed breadwinners, and permits abusive ex-spouses access to revealing records in connection with child support orders.
- Child support issues in turn breed child custody and post-decree relocation backlash issues, which in turn affect women’s employment and educational opportunities.
- The need to be employed merely to obtain these employment benefits hampers women’s options, depresses their wages, creates employment discrimination against young women and perceived maternity costs, and has created pink collar ghettos of less than full-time jobs wherever smaller employers cannot afford to put on another covered full-time employee.
- The need for medical insurance, especially for women and children who cannot get or easily afford private insurance, keeps women tied to jobs in which they are harassed, underpaid, and discriminated against.
Finally, universal single payer health care would eliminate some of the rather idiotic issues that emerge from basing access to health care on the sanctioned or registered sexual relationships of people, such as marriages and domestic partnerships which do not necessarily correlate with dependents or even co-resident “family.”
Sounds good to me. Of course we all have a wish list, but as someone who relies almost solely on holistic care, I would like to see something like an IRA only an IMA (Individual Medical Account). Something we could put some pre-tax dollars into to be used for personal health choices.
Excellent, Liz! In all the discussion that goes on about health insurance, I’ve heard/seen nothing about the huge difference that single payer would make in women’s lives, and how the lack of it has so many damaging consequences for women. Thanks for spelling out several of them so we can see the links among them.
It is so important to develop a feminist perspective on health care—and on Social Security, Medicare, long-term care, and end-of-life care. All of these differentially affect women.
Single payer is off the table—unless we get it on there. I understand that not one advocate for single payer was invited to the white house meeting a week or two ago–until some arm-twisting got two people, two out of 120 or so, into the room. John Conyers of Michigan is building support for single payer and urging everyone to get their Reps on board. The public is way ahead of the Congress.
I need to check my numbers but my recall is that the overhead costs (which includes profit??) of private insurers runs 25-30% while Medicare’s overhead is 1.5%-3.0%. If you want to get health care costs under control, you have to go single payer. So the new administration is pushing a total contradiction: carrying on about reducing costs while leaving the insurers in charge.
So is single payer like Canada’s system?
Thanks for this excellent list. Many women I know relate with the specifics you outline here.
And Carolyn, I like your idea, too! I rarely see a Western doctor so I’d love a little help with those acupuncture bills.
I am probably showing ignorance here, but what is the proposal for the funding on this? Would it be in the form of an income tax? How would employers fit in? Seems like it would be a big savings to an employer providing any health care dollars to employees. Maybe someone could direct me to a site that would help answer some of these questions.
A socialized medicine program (that’s what a single payer system is – Medicare) would only work so far in the US. Maybe a Medicare Part A (hospital), but we American’s like our choices in health care coverage as well as what types of care is used. Homeopathic and other alternative programs may not be covered for everyone. One interesting development is that the insurance companies have now proposed that they would cover pre-exisiting conditions if everyone was required to purchase health care coverage. I lean towards this approach because it keeps government’s role reduced (and our tax money) and allows competition between levels of coverage, types of coverage, and how employers can offer additional coverage to attract employees.
Keep in mind, Medicare Part A (hospital) is paid for by taxes, Part B (Dr) is subsidized by taxpayer dollars depending on income levels, and all Medigap coverage is paid for individually. If all of this becomes paid for by the government, our tax rates will increase across the board. For many – between federal and state it is approaching 50% (then add payroll tax so it’s almost 57% or 65% for self employed). Can we really expect people to pay 60+% taxes?
“Seems like it would be a big savings to an employer providing any health care dollars to employees.”
It is a big savings to employers. It helps entrepreneurs start businesses and it’s one reason that American companies (like auto companies) close — they can’t compete with all the companies that don’t have to pay health insurance for their workers in the rest of the industrialized world.
Also, you have to remember the individual ends up with more money in the end despite possibly raising taxes because they aren’t paying HMO’s. And, in many systems, you can choose to buy “extras”.
Here are some good sites for more info:
http://www.pnhp.org/
http://www.grahamazon.com/sp/index.php (this might take you to an animated page, just click on “single payer” at the bottom to skip)
“Single-payer eliminates the bulk of paperwork duplication, and in the process, could potentially save hundreds of BILLIONS (that’s 100,000 million) of dollars. As it is right now, American businesses are at an economic disadvantage, because their health costs are so much higher than in other countries. The Canadian branches of Ford, GM, and Daimler-Chrysler all publicly support Canada’s health care system, because it saves them an enormous amount of money, compared to their counterparts in the US.”
http://cthealth.server101.com/.....states.htm (this is from 1999)
http://www.amsa.org/uhc/CaseForUHC.pdf (PDF!) (AMSA is the American Medical Student Association)
Does any country require everyone to purchase health care coverage? I was just wondering how it is enforced and what the penalties are if someone doesn’t purchase the coverage.
a single payer system does not look like a good idea. takes out all competition. now we have no public insurance program for people under 65 and the private insurance can berry pick the healthy ones and exclude people who need care. I think it is a giant step forward that the private insurance companies voiced their intent to do away with pre-existing clauses. I am favoring having a public payer system in the pool of competition. As physician, cancer survivor and having lived and dealt with health care systems in the US and Germany I have some experience in the field. The notion that single payer health care system would solve all the very valid points Liz raised seems unlikely to me. public health insurance systems have the general physician as gate keeper to specialized care, which may result in adequate or inadequate restrictions depending where you live. if you have a rare condition or disease with grave outcome, you want to be able to talk to the doctor who has seen more than one patient like you. If you have additional insurance plans which allow you free access to doctors you are usually better off. The notion that a single payer health care plan would lessen burocracy seems to me awfully optimistic and cannot be backed up when comparing with existing single payer systems.
most important of all, a single payer system takes away any competition. if the government chooses any change in coverage or doctor access, there would be no other option. I am not defending the current US insurance systems. they should compete with a public plan. in the socialist countries patients were on long wait lists, and not only for rare and difficult conditions. In some communist countries such as Russia the doctors were mostly female, with low pay and low social status.
I understand that the current US health insurance system offers little acceptable options. But better check out for what you are wishing for before advertising a monopolist single payer system.
to OK
medical records will be electronic which will reduce paperwork duplication with either payer system. By the way the thought of having medical records available on electronic systems allows for a on the privacy of physician patient
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Thank you, Marille. Physicians bring to the table a very important and valid perspective. I would like to hear more from physicians from various countries, their perspectives of the health care systems in which they work. I know a physician in Canada who is not happy with the system and has told me horror stories. Yet we have our own horror stories right here in the U.S. I don’t know what the answer is. I’m definitely for some sort of socialized medicine. I am glad the United States is finally talking about this. But how to enact this? This definitely deserves a thorough discussion. In the United States this is a very new topic for us and I don’t know if we have fully considered what is the best approach. Let’s talk!
This was news to me so I thought I’d share:
“How much of the health care dollar is publicly financed?
Over sixty percent (60.5 percent) of health spending in the U.S. is funded by government. Official figures for 2005 peg government’s share of total health expenditure at 45.4 percent, but this excludes two items:
1. Tax subsidies for private insurance, which cost the federal treasury $188.6 billion in 2004. These predominantly benefit wealthy taxpayers.
2. Government purchases of private health insurance for public employees such as police officers and teachers. Government paid private insurers $120.2 billion for such coverage in 2005: 24.7 percent of the total spending by U.S. employers for private insurance.
So, government’s true share amounted to 9.7 percent of gross domestic product in 2005, 60.5 percent of total health spending, or $4,048 per capita (out of total expenditure of $6,697).
By contrast, government health spending in Canada and the U.K. was 6.9 percent and 7.2 percent of gross domestic product respectively (or $2,337 and $2,371 per capita). Government health spending per capita in the U.S. exceeds total (public plus private) per capita health spending in every country except Norway, Switzerland and Luxembourg.
(Source: Himmelstein and Woolhandler, “Competition in a publicly funded healthcare system” BMJ 2007; 335:1126-1129 [1 December] and Woolhandler and Himmelstein, Health Affairs, 2002, 21(4), 88, “Paying for National Health Insurance – And Not Getting It.”)”
If you go to http://www.pnhp.org (which is Physicians for a National Healthcare Program) you can find a huge FAQ section that might be of interest for some here. (http://www.pnhp.org/facts/singlepayer_faq.php)
Here are some answers they give in the FAQ’s for questions asked in this thread:
Won’t competition be impeded by a universal health care system?
Advocates of the “free market” approach to health care claim that competition will streamline the costs of health care and make it more efficient. What is overlooked is that past competitive activities in health care under a free market system have been wasteful and expensive, and are the major cause of rising costs.
There are two main areas where competition exists in health care: among the providers and among the payers. When, for example, hospitals compete they often duplicate expensive equipment in order to corner more of the market for lucrative procedure-oriented care. This drives up overall medical costs to pay for the equipment and encourages overtreatment. They also waste money on advertising and marketing. The preferred scenario has hospitals coordinating services and cooperating to meet the needs of their communities.
Competition among insurers (the payers) is not effective in containing costs either. Rather, it results in competitive practices such as avoiding the sick, cherry-picking, denial of payment for expensive procedures, etc. An insurance firm that engages in these practices may reduce its own outlays, but at the expense of other payers and patients.
How much could the states save on administrative waste by adopting a statewide single-payer program? (keep in mind that administrative costs are not just about paperwork, they include paying people to decide who does or does not get care, cherry-picking to only cover the healthy, and finding ways to deny care to keep their profits up)
Data on total health expenditures by state (excluding administrative spending) is available at: http://www.cms.hhs.gov/Nationa.....counts.asp
Estimates of state administrative costs (a few years old, but the best available) are in an article by Drs. David Himmelstein and Steffie Woolhandler from 2003.
Should PNHP support a public Medicare-like option in a market of private plans?
Response by Drs. David Himmelstein and Steffie Woolhandler:
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.
4-Waits for care compromise access in Canada, and these access problems are worse than those in the U.S.
The O’Neill analysis admits that fewer Canadians than Americans report an unmet health need (11.3% vs. 14.4%). In the U.S., cost is the big problem, while waits for care are more prominent in Canada. They try to obfuscate the Canadian advantage on access measures by presenting a complex sub-group analysis of pain suffered by those unable to get care. But when you cut through their obfuscation, even this measure favors Canada; about 12% more Americans who say they’re unable to get care report being in pain.
What does PNHP have to say about the primary care workforce shortage?
Countries with strong health care systems have at least half of their physicians in generalist primare care practice 50 percent in Canada, 70 percent in the United Kingdom (Starfield, B, Is primary care essential? Lancet 344: 1129, 1994)
In 2008, less than 8 percent of U. S. seniors chose family medicine, a 50 percent decline since 1997; only 199 U. S, seniors matched into primary care internal medicine, 248 into IM/Peds, and 53 into primary Peds. The percentage of international medical graduates (IMG’s) in our 3 primary care specialties is now 73 percent for IM, 68 percent for Peds, and 55 percent for Fam. Med. (Pugno, P , et al Fam Med 40 (8): 563, 2008) I don’t believe that we have more than about 30 percent of our physicians in primary care. Only 20 percent of internal medicine graduates become general internists, and most pediatric graduates go into sub-specialties. (Bodenheimer, T. Primary care—Will it survive? N Engl J Med 355 (9):861, 2006).
Primary care has been declining in this country for many years, as a result of multiple factors, including more attractive lifestyles and reimbursement on the non-primary care fields;student perceptions of the demands, rewards, and prestige of generalist practice; and uncertainty of the health care environment. The American College of Physicians in 2007 declared that: “Our primary care infrastructure is at grave risk of collapse”.
Single-payer national health insurance will provide an opportunity to restructure the U.S. physician workforce, strenghten and rebuild primary care. We should have at least 50 percent of our physicians in primary care fields. Useful approaches include reimbursement reform, loan forgiveness programs for graduating medical students entering primary care residencies, increased funding for graduate medical education (GME) teaching programs in primary care, and reallocation of GME training slots by specialty.
Won’t this just be another bureaucracy?
The United States has the most bureaucratic health care system in the world. Over 31% of every health care dollar goes to paperwork, overhead, CEO salaries, profits, etc. Because the U.S. does not have a unified system that serves everyone, and instead has thousands of different insurance plans, each with its own marketing, paperwork, enrollment, premiums, and rules and regulations, our insurance system is both extremely complex and fragmented.
The Medicare program operates with just 3% overhead, compared to 15% to 25% overhead at a typical HMO. Provincial single-payer plans in Canada have an overhead of about 1%.
It is not necessary to have a huge bureaucracy to decide who gets care and who doesn’t when everyone is covered and has the same comprehensive benefits. With a universal health care system we would be able to cut our bureaucratic burden in half and save over $300 billion annually.
What about alternative care, will it be covered?
Alternative care that is proven in clinical trials to be effective will be covered. For example, spinal manipulation for some lower back conditions would be covered, but not chiropractic care of the neck (which is unproven and possibly dangerous). Antioxidant vitamins would be covered for people with macular degeneration, but not for the general population (where they appear to be harmful). In general, coverage decisions will be made by the health care planning board or another public body. New kinds of treatments will be added to the benefits package over time as they are shown to be effective, including “alternative” treatments. Similarly, ineffective or harmful care can be removed from the benefits package, such as high dose epo for cancer.
(This is the way it is now with my healthcare plan. I don’t know if it’s common to find healthcare coverage of alternative treatments.)
The facts:
1. Americans are paying more for health insurance and receiving fewer and fewer benefits
2. Health insurance companies continue to raise their premiums while decreasing and denying coverage
3. Healthcare insurance companies deny healthcare claims on a regular basis, and change their coding schemas frequently to avoid paying legitimate claims
4. Physicians are forced to pay huge administrative costs and employ large staffs to deal with health insurance companies
5. The severe shortage of primary care physicians—due in part to declining reimbursements and impossible administrative hassles from third-party payers — seriously threatens the quality of healthcare US citizens receive now and in the future.
6. Millions of Americans cannot afford or have no health insurance—50 million have no health insurance and 87 million have been without health insurance at some time in the past 2 years.
The health insurance companies have played a major role in our current healthcare crisis. They make huge profits and their CEOs make millions, while the rest of us are denied care.
ANNUAL COMPENSATION OF HEALTH INSURANCE COMPANY EXECUTIVES (2006 and 2007 figures):
• Ronald A. Williams, Chair/ CEO, Aetna Inc., $23,045,834
• H. Edward Hanway, Chair/ CEO, Cigna Corp, $30.16 million
• David B. Snow, Jr, Chair/ CEO, Medco Health, $21.76 million
• Michael B. MCallister, CEO, Humana Inc, $20.06 million
• Stephen J. Hemsley, CEO, UnitedHealth Group, $13,164,529
• Angela F. Braly, President/ CEO, Wellpoint, $9,094,771
• Dale B. Wolf, CEO, Coventry Health Care, $20.86 million
• Jay M. Gellert, President/ CEO, Health Net, $16.65 million
• William C. Van Faasen, Chairman, Blue Cross Blue Shield of Massachusetts, $3 million plus $16.4 million in retirement benefits
• Charlie Baker, President/ CEO, Harvard Pilgrim Health Care, $1.5 million
• James Roosevelt, Jr., CEO, Tufts Associated Health Plans, $1.3 million
• Cleve L. Killingsworth, President/CEO Blue Cross Blue Shield of Massachusetts, $3.6 million
• Raymond McCaskey, CEO, Health Care Service Corp (Blue Cross Blue Shield), $10.3 million
• Daniel P. McCartney, CEO, Healthcare Services Group, Inc, $ 1,061,513
• Daniel Loepp, CEO, Blue Cross Blue Shield of Michigan, $1,657,555
• Todd S. Farha, CEO, WellCare Health Plans, $5,270,825
• Michael F. Neidorff, CEO, Centene Corp, $8,750,751
• Daniel Loepp, CEO, Blue Cross Blue Shield of Michigan, $1,657,555
• Todd S. Farha, CEO, WellCare Health Plans, $5,270,825
• Michael F. Neidorff, CEO, Centene Corp, $8,750,751
This executive compensation could be used to provide quality healthcare for thousands of Americans! We must get the insurance companies OUT of healthcare, and end the inhumanity of our failed healthcare insurance system where profits are more important than patients’ health.
HEALTHCARE SHOULD BE A RIGHT, NOT A BUSINESS.
ER thanks for the impressive list of incomes. looks like a huge overhead and waisteful spending.
another big component of waisteful spending is the incredible use of lawsuits. anybody watch TV after midnight. thatis when you see the adds: you had trauma, you had cancer, you had what not … we help you get money. I don’t know of any country in the world where doctors spend comparable amounts of money on liability insurance, order work ups, duplicate tests with the prospects of lawsuits, to be safe in case of lawsuits. In Germany people sue if they are unhappy with their doctor, here people sue because there might be money. there are states where you can’t find some specialty doctors like obstetrics because nobody gives you liability insurance. in my experience most doctors incomes are under often way under the 200k annual. but in the media doctors are the rich guys, not the lawyers. working on a cap for awards and changing mentality about when to file a law suit would go a long way in waisteful spending.
back to private insurance. expanding medicare is definitely to come and will be a big player putting private insurers in place. they have already offered to give up the th pre-existing conditions clause. they will be no berry picking and dumping ill patients on public insurance. The idea to be as patient dependent on what the government sees acceptable for financing of your healthcare is scary to me. the insurances (public and private) will not have a bureaucracy cherry picking whom to take but what tests they pay and what choice you have in choosing your doctors.
that is where the difference in chosing between public and private insurers lie in Germany.
Remember the scandals in Walter Reed Hospital. and how long it took to expose them (surely no accident that the exposure came in a campaign year). As resident I saw the differences between VAs, and places with private insurance. anyone remember the story from the ABC new anchor who got back from Irak with major brain injury. he got treated in a university hospital (private insurance) and took it on himself to do something for the military men and women coming back with injuries and getting inferior care. to be dependent on a single payer healthcare system can’t be the solution. there have to be other ways to control excessive overhead costs.
there is fake competition and there is true competition which brings price down. but if you have only a private market place with attempts to trick the system this healthy competition is gone. praising the government as single savior appears extremely short sighted to me.
by the way ER I usually agree with your comments a lot.
Health care, not stockholders share.
Thanks marille. I agree tort reform is essential. That way, we wouldn’t have to practice defensive medicine to the degree required now, but could focus much more exclusively on patient-centered care.
Healthcare reform is complex. The system is badly broken, where profits are much more important than patients’ health. The values and behavior of the health insurance companies, which control healthcare at present, reminds me of Wall Street and the greed, corruption, and ultimate collapse we have seen there.
I believe we must end the current disgraceful practice of insurance companies refusing to pay for medical treatment, denying claims, and engaging in rampant price gouging that discourages patients from going to the doctor and has resulted in 50 million Americans without healthcare and 87 million Americans without health insurance at some point in the past 2 years.
Here is additional data that I think all should be aware of:
Health insurance companies play a major role in our current healthcare crisis. These companies make huge profits and their CEOs make millions, while the rest of us face skyrocketing healthcare costs, impossible bureaucracy, and life-threatening insurance denials.
HEALTH INSURANCE COMPANY PROFITS IN 2007:
1. UnitedHealth Group — $ 4.654 BILLION. UnitedHealth Group owns Oxford, PacifiCare, IBA, AmeriChoice, Evercare, Ovations, MAMSI and Ingenix, a healthcare data company
2. WellPoint — $ 3.345 BILLION. Wellpoint owns BLUES across the US, including Anthem Blue Cross Blue Shield, Blue Cross Blue Shield of Georgia, Blue Cross Blue Shield of Wisconsin, Empire HealthChoice Assurance, Healthy Alliance, and many others
3. Aetna Inc. — $ 1.831 BILLION
4. CIGNA Corp — $ 1.115 BILLION
5. Humana Inc. — $ 834 million
6. Coventry Health Care — $626 million. Coventry owns Altius, Carelink, Group Health Plan, HealthAmerica, OmniCare, WellPath, others
7. Health Net — $ 194 million
The huge insurance company profits—BILLIONS EACH YEAR—could be used to provide quality healthcare for millions of people, and to pay physicians adequately for their work.
The solution, to me, is yet unclear. But I do know that we must GET RID OF THE INSURANCE COMPANIES AS PROFIT CENTERS. We must have a large PUBLIC option for coverage, and the insurance companies should be NON-profit if they remain in healthcare. I’d also suggest that all of their CEOs and staff take intensive business ethics and values courses where they can come to understand how their business decisions have led to loss of life, morbidity, and poor quality care on an enormous scale.
If you want to learn more, go to:
http://www.insurancecompanyrul.....he_roster/
I don’t see how “requiring” people to have health care insurance is better than what we are doing now. The main reason people don’t have it now is because they can’t afford it. And it seems like it would take money and people power somewhere to enforce, penalize, etc.
“Requiring” people to have healthcare is a crafty ploy recommended and pushed by the health insurance companies. They can then use the money from all Americans who ‘must’ buy in, spread the costs some, and make more PROFITS for themselves.
In addition, the insurance companies are now saying they will charge healthy people (rather than sick, chronically ill people) more for healthcare, IF all Americans are ‘required’ to buy health care. Sneaky cost shifting to make them look good and stave off he public plan option.
More info here: http://news.yahoo.com/s/ap/200.....Kn8p_VJRIF
Here’s how women are affected by the current state of affairs in healthcare and by the healthcare insurance companies:
See the NY Times article, “Women Buying Health Policies Pay a Penalty” You can read it here: http://www.nytimes.com/2008/10.....=1&em
Additional issues:
The individual healthcare insurance market fails women.
1. It is difficult for women to get approved for coverage. Insurance companies can deny women for coverage for a variety of reasons that are particularly relevant to women, such as having had a Caesarean section or being a survivor of domestic violence.
?2. If they do get coverage – women often face higher premiums than men for the same coverage. In 40 states and the District of Columbia, insurance companies are permitted to charge women higher insurance premiums than men under a common insurance industry practice known as “gender rating.”
?3. And if a woman does find coverage she can afford it may not be comprehensive enough to meet her needs. The vast majority of the more than 3500 individual market health insurance policies examined do not cover maternity care at all. ?
Many healthcare reform proposals would expand the individual insurance market. Leaving women to fend for themselves in the individual insurance market would be disastrous for women’s health.
For more information, see the National Women’s Law Center website: http://action.nwlc.org/site/Pa.....urn_Report
Liz and others have correctly identified profit as that which motivates insurance companies. But the notion that they are “profiting from sickness” has it exactly backwards. Insurance companies profit from health, not sickness, for the obvious reason that when you’re healthy they have no claims to pay. So the profit motive at least partially lines up with women’s primary objective, which is to be healthy. Of course there are plenty of ways in which profits are contrary to women’s objectives—insurance companies would make more money by raising premiums and reduce benefits, at least up to a point.
The profit motive may be distasteful to many, but it has at least the virtue of being predictable. A company will act to increase its profits and decrease its losses. And with predictability comes the opportunity for some control. For example, if we want a company to invent, develop, and manufacture new treatments for breast cancer, make it profitable to do so and they’ll get right on it. Make it very profitable and they’ll take considerable risk, with their own money, to give it a try.
So the profit motive is a mixed bag at best. Fair enough. But if we are proposing to grant to the state a monopoly on health insurance, it is fair to inquire about the state’s motives. Is the state likely to be motivated by the best interests of women? Or is it more likely to be motivated by partisan politics and the agenda of whatever majority happens to be in charge? By the welfare of those of limited means, or by backroom dealing, corruption, and the desire to hold power?
History suggests that the state is not overly motivated by a desire to look out for women’s interests. State motives are far more complex and less predictable than profit motives, and it is not unreasonable to prefer the latter. I am not prepared to grant the state a monopoly on health insurance.
What great work. I’m lifting it off and sending it to Canadian sources as fast as you’re laying it down.
Would you believe there are Canadians who want U.S. style health care because they don’t think they should have to wait at all in our triage system.
What they don’t get is that there are 50 million Americans who can’t even get on a wait list, and that many of those are the formerly healthy who became uninsurable as soon as they became ill.
Our system isn’t perfect, but to the extent that it is not, that’s where it’s aping the U.S. system.
Errr Bill? State (provincial/federal) motives ARE profit motives, because the pharma lobbyists are out golfing with your elected reps as we speak. They spent millions courting both Republicans and Democrates in your recent election. At least elected governments are (somewhat) subject to democracy.
Seems like the drug companies are truly the ones who profit from illness — but that’s opening up a new can of worms.
I believe, if done correctly, state could handle it. But, as you say, Bill, we know what happens when motives become political. How would it be handled differently from, say, Social Security, which isn’t working. And even health insurance companies never “reward” anyone for good health. I see people all around me making such obviously poor health choices — and running up their medical bills — while I take my “health” very seriously and have not had a claim in 12 years.
there are many diseases for which we don’t have any ideas for prevention. look at MS or other debilitating diseases. and despite all the cancer research for many we don’t know how to prevent just how to diagnose earlier.
government agencies are not usually known for cutting bureaucratic overhead waste.
look into the VA system, that is the closest we have as single payer healthcare and see how happy people are. cutting out all alternative options never seems to be a good option to me.
Tip o’ my hat to you, ER, for the many facts and links to share.
WRT women paying higher premiums due to “gender rating” discrimination… I recently went through some old insurance & business papers plenty old enough to shred. I found one of my policy statements for Disability Benefits, listing the premium that I, the small-business owner, had to pay for my 2 part-time female employees.
The insurance co. used a boilerplate page so it referenced the std premium for male employees though I hadn’t any at the time. The male premium was less than half of what I was charged for female workers. The English and the numbers were quite plain.
I recall, I had phoned my agent and he gave me his usual accurate, honest explanation: I had to pay more because pregnancy means higher costs and is always a risk with female employees. Ugh. Pregnancy– defined as a disability in this country– was the “reason” and btw, both women would have informed the insurance company of being well past, thankfully past, their “childbearing years” and glad to be nearing retirement age in fact. They could have been 105 but the insurance company wouldn’t have cared, nor did state and federal officials.
I don’t know if that type of “gender rating” still applies to Disability Benefits insurance premiums. It’s a monster waiting to be slain.
Marille, I know what you mean. It would be wonderful if we could have single pay, and it does seem as if cutting out all insurance company waste would take up the slack — it should — but I guess until someone shows me a successfully run government program I am not ready to jump on the band wagon. I agree — I do like to have a choice.
Tuesday night (March 31st), PBS will be showing a Frontline investigation of “the failures of America’s health care system.”
Sick Around America
http://www.pbs.org/frontline/sickaroundamerica
As the worsening economy leads to massive job losses– potentially forcing millions more Americans to go without health insurance– Frontline travels the country examining the nation’s broken health care system and explores the need for a fundamental overhaul. Veteran Frontline producer Jon Palfreman dissects the private insurance system, a system that not only fails to cover 46 million Americans but also leaves millions more underinsured and at risk of bankruptcy.
Thanks T.I. for reminding us about the Frontline showing of Sick Around America tonight!
Here are more facts:
From The CIA Website — 2008 LIFE EXPECTANCIES in countries with socialized / nationalized healthcare:
Canada: males:78.65 females:83.81?
France: males:77.68 females:84.23?
Germany: males:76.11 females:82.26?
Japan: male:78.73 females:85.59?
Luxembourg: males:75.91 females:82.67?
United Kingdom: males:76.37 females:81.46?
Ireland: males:75.44 females:80.88?
Lichtenstein: males:76.38 females:83.52?
Netherlands: male:76.66 females: 81.98?
Belgium: males:75.9 females:82.38?
Spain: males:76.6 females:83.45?
Norway: males:77.16 females:82.6?
Sweden: males:78.49 female:83.13?
Finland: males:75.31 females:82.46?
Italy: males:77.13 female:83.2?
Austria: male:76.46 female:82.41?
Switzerland: males:77.91 female:83.71
–>The United States: males:75.29 females:81.13
In addition to the above, a recent study found that single-payer healthcare reform would be a major stimulus for the US economy and would provide:
** 2.6 Million New Jobs,
** $317 Billion in Business Revenue,
** $100 Billion in Wages, and
** $44 Billion New Tax Revenues
You can find out more about this study here: http://www.CalNurses.org/
The press release is here: http://www.calnurses.org/media.....y-net.html
Hello there to Carolyn and Marille. You’ve raised good points and concerns. ER, thanks again for thought-provoking figures from the Calnurses.org site.
Today I had more time to gather the following info on a previous Frontline program, which compared U.S. health care with the universal systems in several other countries.
This same time last year (April 2008) PBS ran Sick Around the World. An anniversary re-broadcast of it might be on some PBS channels, either directly before or after Jon Palfreman’s new program. It’s well worth a check in your local TV listings.
T.R. Reid’s Sick Around the World
links to on-site interviews & statistics on synopsis page:
“FRONTLINE teams up with veteran Washington Post foreign correspondent T.R. Reid to find out how five other capitalist democracies– the United Kingdom, Japan, Germany, Taiwan and Switzerland– deliver health care, and what the United States might learn from their successes and their failures.”
ER
Would these figures on new jobs be “net” figures. I would assume that under single pay insurance the private companies would be cutting a lot of jobs.
As for life expectancies, in comparison to the others on the list I would wager the U.S. has, by far, the worst eating/health habits. It is also my understanding that a lot of these other countries train their doctors in the use of herbal remedies, which they also use. I believe perscription drugs are a large part of our health problems. I would think to have an accurate comparison we would need to line up with them in this way as well.
I would like to see this work, but Social Security was supposed to be all that and more and look where that is now. It is a huge step and one which, when taken, can never be reversed.
Medicare is designed for people over 65 and is funded by premiums. Has anyone ever put numbers to offering a reasonably priced policy to people falling under a certain income level?
Carolyn, the full report of the recent study that found that single-payer healthcare reform would be a major stimulus for the US economy is here: http://www.calnurses.org/resea.....y_2009.pdf
and some useful charts are here: http://www.calnurses.org/resea.....011509.pdf
Scroll down to the last chart – it’s really telling!
Carolyn, I’d like to see this work as well. Here is a response from Dr. Marcia Angell:
Please see the wonderful article, “A Singular Solution for Healthcare” by Judy Norsigian and Jennifer Potter just published in the Boston Globe.
It includes some excellent material about why single payer healthcare reform would especially benefit women.
The article is here: http://www.boston.com/bostongl.....ealthcare/
Health care reform is controlled by special interests (the insurance and pharmaceutical companies) so they can maintain their profits. http://thenewagenda.net/2009/0.....imination/
Only a single-payer approach to healthcare reform will end the inhumanity of our failed healthcare insurance system, where profits are more important than patients’ health, and where people die because of it.
HR 676, The United States National Health Insurance Act (in the House), and S 703, The American Health Security Act (in the Senate) would ensure that every American, regardless of gender,, income, employment status, or race, has access to quality, affordable health care services.
Healthcare reform legislation is being written right NOW.
We need to bombard the White House, Senator Kennedy’s office, and our Senators and Representatives with CALLS, Faxes and Emails for SINGLE PAYER.
TAKE ACTION:
1. ASK Obama to support Single Payer reform. Tell him it’s what the country wants and needs. 45 million are uninsured. People are dying because of our current healhcare system. We can’t afford not to have single-payer reform!
COMMENT HERE: http://www.healthreform.gov/contact/index.html
AND HERE: http://www.whitehouse.gov/contact/
CALL AND FAX: Phone: Comments: 202-456-1111;?Switchboard: 202-456-1414; FAX: 202-456-2461
2. Call, Fax and Email Senator Kennedy’s office and insist that he put SINGLE-PAYER healthcare reform on the table. Object to forcing all Americans to buy health insurance.
You can email Senator Kennedy’s office here: http://kennedy.senate.gov/senator/contact.cfm
Fax him here:
FAX Senator Kennedy’s Washington office: 202-224-2417
FAX Senator Kennedy’s Massachusetts office: 617-565-3183
3. ASK your Senators to co-sponsor S 703, The American Health Security Act.
ASK your Representative to co-sponsor HR 676, The United States National Health Insurance Act. (78 Representatives have signed on as co-sponsors so far).
You can find your legislators’ contact information here: http://www.usa.gov/Contact/Elected.shtml
For more information on both bills:
http://www.healthcare-now.org/.....urity-act/
http://www.healthcare-now.org/hr-676/
Please see the wonderful article, “A Singular Solution for Healthcare” by Judy Norsigian and Jennifer Potter just published in the Boston Globe.
It includes some excellent material about why single payer healthcare reform would especially benefit women.
The article is here: http://www.boston.com/bostongl.....ealthcare/
Health care reform is controlled by special interests (the insurance and pharmaceutical companies) so they can maintain their profits. http://thenewagenda.net/2009/0.....imination/
Only a single-payer approach to healthcare reform will end the inhumanity of our failed healthcare insurance system, where profits are more important than patients’ health, and where people die because of it.
HR 676, The United States National Health Insurance Act (in the House), and S 703, The American Health Security Act (in the Senate) would ensure that every American, regardless of gender,, income, employment status, or race, has access to quality, affordable health care services.
Healthcare reform legislation is being written right NOW.
We need to bombard the White House, Senator Kennedy’s office, and our Senators and Representatives with CALLS, Faxes and Emails for SINGLE PAYER.
TAKE ACTION:
1. ASK Obama to support Single Payer reform. Tell him it’s what the country wants and needs. 45 million are uninsured. People are dying because of our current healhcare system. We can’t afford not to have single-payer reform!
COMMENT HERE: http://www.healthreform.gov/contact/index.html
AND HERE: http://www.whitehouse.gov/contact/
CALL AND FAX: Phone: Comments: 202-456-1111;?Switchboard: 202-456-1414; FAX: 202-456-2461
2. Call, Fax and Email Senator Kennedy’s office and insist that he put SINGLE-PAYER healthcare reform on the table. Object to forcing all Americans to buy health insurance.
You can email Senator Kennedy’s office here: http://kennedy.senate.gov/senator/contact.cfm
Fax him here:
FAX Senator Kennedy’s Washington office: 202-224-2417
FAX Senator Kennedy’s Massachusetts office: 617-565-3183
3. ASK your Senators to co-sponsor S 703, The American Health Security Act.
ASK your Representative to co-sponsor HR 676, The United States National Health Insurance Act. (78 Representatives have signed on as co-sponsors so far).
You can find your legislators’ contact information here: http://www.usa.gov/Contact/Elected.shtml
For more information on both bills:
http://www.healthcare-now.org/.....urity-act/
http://www.healthcare-now.org/hr-676/
Why are the principles of free enterprise lost when it comes to healthcare. If the single payer model is applied to any other provider of goods and services history shows those same goods and services will increase in cost, decrease in quality and prohibits innovation. Deregulation of the telecom industry is a good example of how healthy competition increases value, drives innovation while decreasing cost. Healthcare is a business, insurance is a business, doctors are businessmen and a profit is the reward. Only 4% of the new medications to hit the market were developed by the feds, while 96% of the new medications come from American “big” business driven by the expectation of profits for shareholders. The consumer makes the decision on buy or not to buy. Profit is not a four letter word.
Steve, I am not supporting Obama’s plan, I am not for a single payer plan, but healthcare is not just a business. As doctor you may see very sick people, you do whatever possible to have them survive. I spend decades in healthcare and my experience does not tell me that healthcare is about profits in the first place.
we need competition not for profits but for advancing medicine, and staying at the top level of services.
the overhead cost of private insurers are outrageous. but the answer is not government. not because government does everything bad, they don’t. but they do not provide top services and their expertise is limited. our constitution limits what government does for a good reason. we don’t want our sensitive healthcare data in government hands.
and did not obama promise to let everybody get in the public healthcare plan our political representatives use. that has fallen off and the discussions are about a public option and medicare cutting services. we have a huge deficit and medicare is bancrupt in a few years. so the healthcare discussion is sold as saving medicare and getting everybody insured, when in reality the discussion is about rationing services for seniors and getting younger mostly healthy people into insurance, who would pay and use the services very little.
recently proposals for non-profit insurers one of them called “we the people” have sprung up. I find this very interesting. if these new pools of non-profits with their low overhead costs are large enough they can compete. and we don’t need the government control our healthcare data. if these groups can bring the prices down and deal directly with providers like PPOs (prefered provider) they may significantly drop costs and make healthcare affordable. they can offer a variety of plans to choose from.
to increase non-profit organizations in healthcare together with tort reform could solve a lot of our problems. instead of penalties from the government for people not insured I favor tax incentives to get people insured.
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