Colin Powell Endorses Single Payer

[kalm]

Medicare already does this, for good reason.

There are many, many unnecessary tests, treatments that do nothing other than make doctors and the owners of the equipment rich.
No needed treatment is denied. No needed drug is denied.
But a whole lot of unneeded treatments are not paid for by Medicare.
Many Doctors make a lot of decisions based on personal financial gain - not what is best for the patient

But you're talking about a Medicare system that works in the same arena where non-Medicare healthcare is readily available. Sure, Medicare does decide what is necessary and what isn't necessary treatment, but for many people that's why they also have supplemental health insurance to cover what Medicare doesn't cover. So for many that have Medicare, they are happy to have it because they still have the safety net of some other system in place to get them the medication or surgery they think they need and they know thety want that they aren't too concerned when Medicare doesn't cover it.

However, if you go to a truly single-payer system without the safety net of the private market to get healthcare, then you will start to see many people become dissatisfied with the rationing that is the key to Medicare. Single payer means that a single entity decides what is covered, who it's covered for, and how much will be paid to cover it. There will be many, many things not covered that people have found ways to have covered today, and those "extra" services will become more expensive. Single payer is not some oasis in the desert nirvana that will mean quality care for all. It's just another way of doing pretty much what we do know. Someone will have to say no more testst or no more operations or so on to someone who wants those things in order to rein in costs and I'm not sure we're really ready for that sort of system.

How about single payer for basic health/catastrophic care are and supplemental insurance for luxury care the extras? Some experimental and alt medicine services are vastly over-priced and this would probably drive those costs down making them more affordable as out of pocket procedures. I think you can find this is in other countries like Switzerland... maybe Mexico.

[LeadBolt]

I don't know the answer to this, but I'll ask anyway.

Who should we trust to make those decisions on what is necessary - the docs who are trying to keep a $5MM MRI machine at near capacity, or a bureaucracy that will determine that your suspected brain tumor can be checked out in 30 days after it has been approved by some government methodology?

Not sure there is a good answer to that.
But my experience with Medicare (17+ years) is that Medicare generally allows new technology to be used/tested, then gathers data on efficiency of said tests, then sets reimbursements/approvals on the test itself, not individual cases.
For example, we give a drug called EPO. The standards (blood-iron level) are set by a medical panel as to whether or not it should be given, how much, etc. If your blood-iron level is above a certain level (ie. not anemic), then Medicare won't pay for it. You can still get it, but you pay for it yourself.
In another example, when I first started, there was a nerve testing that we performed. Patients hated it (painful), but the doctors at my old place loved it, because they made lots of money off of it. Turned out to be a mostly worthless test. Medicare stopped paying for it, most insurers quickly followed suit, and now it is never performed.

Having the Fed. government purchase some of the expensive machinery and lease it to providers on a per use basis is one way to subsidize the costs of these machines without having to run unnecessary procedures. The purchasing power of the the Feds should also push down the costs.

Tort reform is also a needed area the government can play in to reduce costs. Publishing of costs of service and care metrics for consumers to make better informed choose is another way the government can help.

Reducing the ridiculous amount of red tape in the approval of new drugs from the FDA would also help. I'm told it costs 3 times as much and takes much longer to get a drug approved here than in parts of Europe.

Subsidizing research and development for drugs and medical devices and licensing the discoveries to private industry to repay the expenditure is another way the Feds. can help.

By lowering costs and improving efficiency healthcare will be more affordable and available to all. By going to single payer and rationing healthcare and ruling it with a Federal bureaucracy will make it less available to all.

[dbackjon]

Not sure there is a good answer to that.
But my experience with Medicare (17+ years) is that Medicare generally allows new technology to be used/tested, then gathers data on efficiency of said tests, then sets reimbursements/approvals on the test itself, not individual cases.
For example, we give a drug called EPO. The standards (blood-iron level) are set by a medical panel as to whether or not it should be given, how much, etc. If your blood-iron level is above a certain level (ie. not anemic), then Medicare won't pay for it. You can still get it, but you pay for it yourself.
In another example, when I first started, there was a nerve testing that we performed. Patients hated it (painful), but the doctors at my old place loved it, because they made lots of money off of it. Turned out to be a mostly worthless test. Medicare stopped paying for it, most insurers quickly followed suit, and now it is never performed.

Having the Fed. government purchase some of the expensive machinery and lease it to providers on a per use basis is one way to subsidize the costs of these machines without having to run unnecessary procedures. The purchasing power of the the Feds should also push down the costs.

Tort reform is also a needed area the government can play in to reduce costs. Publishing of costs of service and care metrics for consumers to make better informed choose is another way the government can help.

Reducing the ridiculous amount of red tape in the approval of new drugs from the FDA would also help. I'm told it costs 3 times as much and takes much longer to get a drug approved here than in parts of Europe.

Subsidizing research and development for drugs and medical devices and licensing the discoveries to private industry to repay the expenditure is another way the Feds. can help.

By lowering costs and improving efficiency healthcare will be more affordable and available to all. By going to single payer and rationing healthcare and ruling it with a Federal bureaucracy will make it less available to all.

1) Interesting idea.
2) Some tort reform is needed, but providers still need to be held accountable for decisions. What needs to be eliminated is the "Well, this 10K test was available that might have detected my client's condition - why didn't you offer it?" type of cases
3) The US pays more for drugs because of one reason - we don't cap prices. Other countries do - and the drug cartels make their money here. We also have the most stringent requirements regarding drug safety, which is a good thing.
4) See above
5) Get the "single payor = rationing healthcare" meme out of your vocabulary. It is not accurate. Experience with Medicare has shown the opposite to be true

[LeadBolt]

Having the Fed. government purchase some of the expensive machinery and lease it to providers on a per use basis is one way to subsidize the costs of these machines without having to run unnecessary procedures. The purchasing power of the the Feds should also push down the costs.

Tort reform is also a needed area the government can play in to reduce costs. Publishing of costs of service and care metrics for consumers to make better informed choose is another way the government can help.

Reducing the ridiculous amount of red tape in the approval of new drugs from the FDA would also help. I'm told it costs 3 times as much and takes much longer to get a drug approved here than in parts of Europe.

Subsidizing research and development for drugs and medical devices and licensing the discoveries to private industry to repay the expenditure is another way the Feds. can help.

By lowering costs and improving efficiency healthcare will be more affordable and available to all. By going to single payer and rationing healthcare and ruling it with a Federal bureaucracy will make it less available to all.

1) Interesting idea.
2) Some tort reform is needed, but providers still need to be held accountable for decisions. What needs to be eliminated is the "Well, this 10K test was available that might have detected my client's condition - why didn't you offer it?" type of cases. Agreed.
3) The US pays more for drugs because of one reason - we don't cap prices. Other countries do - and the drug cartels make their money here. We also have the most stringent requirements regarding drug safety, which is a good thing. Partially true. We don't cap our prices, but we also make it more expensive to develop and get approval.
4) See above - Ditto
5) Get the "single payor = rationing healthcare" meme out of your vocabulary. It is not accurate. Experience with Medicare has shown the opposite to be true. Not true. See Gannon Fan above.

[AZGrizFan]

Having the Fed. government purchase some of the expensive machinery and lease it to providers on a per use basis is one way to subsidize the costs of these machines without having to run unnecessary procedures. The purchasing power of the the Feds should also push down the costs.

Yeah, because that "purchasing power" is put to such good use by the Feds in so many OTHER areas....dude, providers see the Federal Government as one big trough, in which they want to get their snouts as firmly planted as deeply as possible. Expensive machinery purchased by the Feds would suddenly cost 3 times as much for them as they do on the street. At a minimum....

[CID1990]

Having the Fed. government purchase some of the expensive machinery and lease it to providers on a per use basis is one way to subsidize the costs of these machines without having to run unnecessary procedures. The purchasing power of the the Feds should also push down the costs.

Tort reform is also a needed area the government can play in to reduce costs. Publishing of costs of service and care metrics for consumers to make better informed choose is another way the government can help.

Reducing the ridiculous amount of red tape in the approval of new drugs from the FDA would also help. I'm told it costs 3 times as much and takes much longer to get a drug approved here than in parts of Europe.

Subsidizing research and development for drugs and medical devices and licensing the discoveries to private industry to repay the expenditure is another way the Feds. can help.

By lowering costs and improving efficiency healthcare will be more affordable and available to all. By going to single payer and rationing healthcare and ruling it with a Federal bureaucracy will make it less available to all.

1) Interesting idea.
2) Some tort reform is needed, but providers still need to be held accountable for decisions. What needs to be eliminated is the "Well, this 10K test was available that might have detected my client's condition - why didn't you offer it?" type of cases
3) The US pays more for drugs because of one reason - we don't cap prices. Other countries do - and the drug cartels make their money here. We also have the most stringent requirements regarding drug safety, which is a good thing.
4) See above
5) Get the "single payor = rationing healthcare" meme out of your vocabulary. It is not accurate. Experience with Medicare has shown the opposite to be true

Your #2 is too narrow. 95% of lawsuits are precisely of the kind you are talking about, and they are all frivolous. John Edwards made a large fortune off these lawsuits, and then had the unmitigated gall to campaign on the high cost of healthcare.

[Skjellyfetti]

95% of lawsuits are precisely of the kind you are talking about, and they are all frivolous.

I find that extremely hard to believe.......

link to something that says it's even remotely close to 95%?

[kalm]

Kalm, I have to admit that I don't follow any of this as closely as I should but isn't single payer basically a system where the government makes all the decisions on contracts for health care? It would seem to me that it would be the ultimate breeding ground for cronyism. It would make your favorite whipping boy, Wall Street, seem like a bastion of sound morals and ethics.

Good point. Corruption is tough to avoid. But simplifying the billing process alone would save a significant amount of overhead as part of the 25% the insurance companies are taking out of the system.

[YoUDeeMan]

Kalm, I have to admit that I don't follow any of this as closely as I should but isn't single payer basically a system where the government makes all the decisions on contracts for health care? It would seem to me that it would be the ultimate breeding ground for cronyism. It would make your favorite whipping boy, Wall Street, seem like a bastion of sound morals and ethics.

Good point. Corruption is tough to avoid. But simplifying the billing process alone would save a significant amount of overhead as part of the 25% the insurance companies are taking out of the system.

Why are you against job creation in the insurance industry?

klam, the government spent how much on a computer system that didn't work? And how much paperwork is being generated from, and how much time is being devoted to, this abomination of a health care plan? The government, and its associated costs, doesn't stop growing, and the government contracts/lobbyists will continue to erode everyone's dollars.

[kalm]

Good point. Corruption is tough to avoid. But simplifying the billing process alone would save a significant amount of overhead as part of the 25% the insurance companies are taking out of the system.

Why are you against job creation in the insurance industry?

klam, the government spent how much on a computer system that didn't work? And how much paperwork is being generated from, and how much time is being devoted to, this abomination of a health care plan? The government, and its associated costs, doesn't stop growing, and the government contracts/lobbyists will continue to erode everyone's dollars.

And the industries that thrive off government spending grow right along with it...

[GannonFan]

But you're talking about a Medicare system that works in the same arena where non-Medicare healthcare is readily available. Sure, Medicare does decide what is necessary and what isn't necessary treatment, but for many people that's why they also have supplemental health insurance to cover what Medicare doesn't cover. So for many that have Medicare, they are happy to have it because they still have the safety net of some other system in place to get them the medication or surgery they think they need and they know thety want that they aren't too concerned when Medicare doesn't cover it.

However, if you go to a truly single-payer system without the safety net of the private market to get healthcare, then you will start to see many people become dissatisfied with the rationing that is the key to Medicare. Single payer means that a single entity decides what is covered, who it's covered for, and how much will be paid to cover it. There will be many, many things not covered that people have found ways to have covered today, and those "extra" services will become more expensive. Single payer is not some oasis in the desert nirvana that will mean quality care for all. It's just another way of doing pretty much what we do know. Someone will have to say no more testst or no more operations or so on to someone who wants those things in order to rein in costs and I'm not sure we're really ready for that sort of system.

How about single payer for basic health/catastrophic care are and supplemental insurance for luxury care the extras? Some experimental and alt medicine services are vastly over-priced and this would probably drive those costs down making them more affordable as out of pocket procedures. I think you can find this is in other countries like Switzerland... maybe Mexico.

That's what we basically have now for the healthcare of people over 65. Many people of that age use Medicare to the point of which it covers, and then they have supplemental insurance to make sure they can pick their doctors and hospitals so that say, if they need heart surgery, they can go to the hospital that specializes in that rather than going to the cost-conscious Medicare one. But I would assume you'd be against that kind of a system in that people of unequal inconces end up getting unequal care.

[GrizFanStuckInUtah]

I used to say I would have gladly voted for Powell. Now I would have to say I wouldn't.