Vermont's Single Payer System
Some wonderful news (Single payer healthcare: Vermont's gentle revolution | Amy Goodman) out of Vermont, the first state to ban slavery, in 1777, stimulated an online discussion about the role of government. Someone sent me an article about increased wait times in Massachusetts, which although not a single payer system, was the most vigorous, and by most accounts successful, attempt to get universal healthcare done, as well as an editorial by anti-universal healthcare activist Sally Pipes in Investors Business Daily, a fantastic paper for financial raw data, but its editorial page makes the WSJ look like a leftist rag. Usually, the editorials are not just extreme in point of view but factually incorrect and poorly written (the writer of the article uses the term "Obamacare" without quotation marks or explanation as to why she is using a Tea Party epithet).
Some wonderful news (Single payer healthcare: Vermont's gentle revolution | Amy Goodman) out of Vermont, the first state to ban slavery, in 1777, stimulated an online discussion about the role of government. Someone sent me an article about increased wait times in Massachusetts, which although not a single payer system, was the most vigorous, and by most accounts successful, attempt to get universal healthcare done, as well as an editorial by anti-universal healthcare activist Sally Pipes in Investors Business Daily, a fantastic paper for financial raw data, but its editorial page makes the WSJ look like a leftist rag. Usually, the editorials are not just extreme in point of view but factually incorrect and poorly written (the writer of the article uses the term "Obamacare" without quotation marks or explanation as to why she is using a Tea Party epithet).
This Pipes editorial is more of the same. The article is deeply flawed for a number of reasons.
First, emergency room care and uncompensated care have risen everywhere as a result of the financial crisis and the fact that millions of Americans everywhere lack health insurance. Without comparable data from other states, 9% is meaningless. What is it in New York or California or Idaho? If ER visits - a proxy for a high number of uninsured - is up 33% in those states but only 9% in Massachusetts, this might be a good thing.
Second, what is the state of residence of those seeking care in Massachusetts ER's? If someone is in a car accident while driving through the state to get home to New Jersey, how is this an indictment of Massachusetts' plan per se? What was the reason for the visit? In an aging population, all things being equal, you will get more ER visits; have there been demographic shifts that would better account for this increase than lack of health insurance per se? The author does not address any of these questions because she is trying to argue against universal healthcare. I am assuming she has healthcare herself, but does not wish to pay for the healthcare of those less fortunate or more chronically ill than herself. This is America, and we have the right to be materialistic and selfish, but we do not have the right to make bogus arguments based on incomplete or misleading data.
Ms. Pipes is a paid lobbyist against universal healthcare who makes her living writing editorials and books about the evils of the Canadian system and why we should not try anything so foolish here. Her work recently led a Senator to make an embarrassing gaffe. According to Factcheck.org,
She also failed to cite the $400 million figure for uncompensated care is down from $700 million prior to the implementation of Romney's plan and - most notably - long prior to the current economic crisis. There are problems with this solution, as will be true with all solutions, but that does not mean we should just give up. The status quo is simply not acceptable. We cannot and should not let perfection be the enemy of good enough."A spokeswoman said Barrasso made a mistake by referring to an April Forbes opinion piece about the Massachusetts health care law written by Sally Pipes, president of the Pacific Research Institute, a conservative think tank. That article referred only to one state — and had nothing to do with Medicare. It referred to Massachusetts doctors who are refusing to take any new patients, regardless of age. The author cited a statistic from Massachusetts Medical Society surveys that found "56% of physicians [not 57 percent] are not taking on new patients" in that state. But that’s not right. The 56 percent figure refers only to internal medicine doctors, in a 2009 survey."
However, the articles presented were not fairly represented. A quotation from the first one undermined an earlier point about the Massachusetts plan being a "failure:"
The medical society on Monday issued its annual Physician Workforce survey, which was conducted in February and March. More than 23,000 doctors and students are members of MMS, which publishes the New England Journal of Medicine.Coombs said that despite its problems, Massachusetts has done "an incredible job" with healthcare. Issues such as a shortage of doctors in poorer communities are not unique to the state, she noted."It's a success in terms of the number of patients who have seen a doctor in the past few years, but the physician workforce has been strained," Coombs said.Massachusetts, like much of the nation, has a severe shortage of doctors in primary care - internists and family physicians - because those fields are less lucrative."We need more doctors in primary care. There's no getting around that fact," said Coombs."- source
So the first article describes the plan as a "success" and attributes problems to a shortage of primary care physicians, a problem that will continue as long as a dermatologist doing "free market" botox injections can make $750,000 a year but a busy primary care physician actually taking care of sick people, many poor, is struggling to make a living and pay her staff.
Also, the headline of the Reuters article refers to one particular of the plan, that for the indigent; please keep in mind that many of these would not have been insured anyway, so their wait times would have been infinite before this plan, which, as I mentioned is not a single player plan (which by definition would not suffer from this problem since all physicians and healthcare providers would have to take it).
Also, the headline of the Reuters article refers to one particular of the plan, that for the indigent; please keep in mind that many of these would not have been insured anyway, so their wait times would have been infinite before this plan, which, as I mentioned is not a single player plan (which by definition would not suffer from this problem since all physicians and healthcare providers would have to take it).
Tort Reform Will Not Bring Down Healthcare Costs or Lead to Universal Coverage
Re the tort reform, I support it, but the Bush administration looked long and hard into this issue with an eye toward finding massive potential savings and the most they could find was that about 1% of medical costs might be reduced with meaningful tort reform. 1% of a big number is still a big number and I support tort reform for other reasons but massive cost savings is not one of them. And by the way, universal health insurance would go a long way toward getting rid of most law suits between individuals (the vast majority of lawsuits are between corporations) since the most common reason someone sues someone else is for medical care reimbursement, something that would go away in a universal healthcare access system.
At any rate, making it harder for doctors to be sued will do nothing, absolutely nothing, to pay for a poor child's chemotherapy.
The counterargument was that ER usage, uncompensated costs, and doctor wait times had all increased in Massachusetts, and that on most counts the plan was a failure. I pointed out that it sounded as though the person making this argument was relatively young, healthy, and employed.
Healthcare is not designed for healthy people, but for the sick (it really should be sick care). You have no idea how good your plan is until you get older and need more medical care, or have a family member who is ill or in an accident. The problem with deciding something like healthcare based on anecdotal experiences or popularity (such as your "friends in Canada" who come to the United States for healthcare) is that most of us most of the time and most of our lives do not need much healthcare. For us, we will judge a plan based on hassle factors - can we see our doctor quickly if we get the sniffles, are our copayments and premiums low, and do we have to call a 1-800 number to pre-authorize every doctor's visit.
All of those are important, to some extent, but pail in comparison to the questions that really count:
These are not theoretical events; I saw them every day in private practice, often several times a day.Will your insurance find some technical reason to drop your coverage if you develop colon cancer or a family member has a stroke and requires extensive rehab?Will your lifetime cap get burned through faster than you can keep up with your doctor's bills?Will you be left scrambling looking for a new policy with a pre-existing condition in the middle of your chemotherapy, which you put on hold because your insurance cut you off?
You may have an outstanding plan. Then again, you may not; under our current roulette system, you just won't know until it's too late.
Massachusetts Plan is Not a Failure
Those who criticize Massachusetts for covering 97% of its citizens sound like someone who, when confronted with the fact that lifeboats plucked 97% of the victims of a shipwreck from the water, is arguing about the inconvenience and cost of forcing the ship to clutter its decks with those lifeboats in the first place (an argument, by the way, that led to the fatal decision to decrease the number of lifeboats the Titanic carried).
Those who criticize government-run or refereed solutions as unworkable or imperfect seem incapable of naming a single free market system anywhere in the world that has successfully covered all of its citizens. They can't because there is no such entity.
Those who criticize government-run or refereed solutions as unworkable or imperfect seem incapable of naming a single free market system anywhere in the world that has successfully covered all of its citizens. They can't because there is no such entity.
Walmart May Make Some Drugs Cheap but Cannot Replace Concerted Public Action
You may get many commonly prescribed medications for $4 from Walmart, but try getting a rare but life-saving chemotherapeutic agent there. Try getting dialysis for $4. Or the latest drug for multiple sclerosis. Can Walmart get you a $4 liver transplant? If Walmart was such a vanguard of healthcare solutions, as you allege, why does it not provide its workforce with health insurance?
And even insisting that such a low cost drug plan could not be invented by or successfully implemented by a government bureaucrat is completely unsupported by those pesky things called facts. Decades before Walmart, our government introduced flat or low rate copayments at least in the VA system for certain veterans mail ordering medications and championed mail order pharmacies and the tremendous economies of scale they offered long before private industry hopped on board. They were leaders in electronic record-keeping and still are, with the VA Medical System now the world's largest integrated electronic medical system (whose potential for research is just starting to be tapped into).
Oh, and long before Walmart and the VA, the Canadians and the Brits had us beat: is $4 a low price? How about free? Canadians and Brits pay nothing for their medications and for most medical services and their system was invented, developed, and implemented 100% by government bureaucrats.
"NO Govt bureaucrat would have created either of those solutions!"
That is a very interesting observation considering that the majority of medications on the market today (including most of those Walmart offers for $4) were developed thanks to government bureaucrats either directly (through research done at the NIH and other places) or indirectly (by writing grants to fund university research that led to countless medical breakthrough). There is not a single medication on the market today that is not there thanks to a whole chain of government bureaucrats from the folks at the FDA who initially reviewed and granted approval to the medications in the question, the inspectors who make sure they continue to be safe and safely manufactured, to the federal bureaucrats in our court system who make sure that intellectual property rights (where applicable) are not infringed upon.
Federal employees have developed many of the medications and technological advances on the market today. The tired argument (I was guilty of making myself not too many years ago) that greed is good and more greed is better simply does not fly.
Federal employees have developed many of the medications and technological advances on the market today. The tired argument (I was guilty of making myself not too many years ago) that greed is good and more greed is better simply does not fly.
Switzerland generates far more medical patents and has won far more Nobel Prizes for medicine than the United States (adjusted for population) but has universal healthcare. Ditto for the United Kingdom. Glaxo is not going bankrupt or not innovating simply because all British citizens are covered.
Government Workers are Not All Slugs
Dr. Walter Reed was a government bureaucrat who proved Yellow Fever was transmitted by a mosquito and saved countless lives (and allowed work to proceed on the Panama Canal, lowering transportation costs and improving corporate profitability). His innovative, ground-breaking work was done while an employee of the federal government.
Government bureaucrat George Miller Sternberg was not just a scientists and innovator in his own right; he actually is credited with founding the entire field of bacteriology in the United States.
Government bureaucrat George Miller Sternberg was not just a scientists and innovator in his own right; he actually is credited with founding the entire field of bacteriology in the United States.
Not bad for a government slug. Every antibiotic created today, including the minority developed by private industry, owes its existence to this federal government bureaucrat. Perhaps a private corporation would have done this too had they enough time or felt it was profitable, but the fact is that they didn't.Brigadier General George Miller Sternberg (June 8, 1838 – November 3, 1915) was a U.S. Army physician who is considered the first U.S. bacteriologist, having written Manual of Bacteriology (1892). After he survived typhoid and yellow fever, Sternberg documented the cause of malaria (1881), discovered the cause of lobar pneumonia (1881), and confirmed the roles of the bacilli of tuberculosis and typhoid fever (1886).
Small pox was of course eradicated by those bumbling government bureaucrats you feel could not accomplish anything, although not just American but internationally through the World Health Organization. There was no massive profit motive in doing so; it was simply felt to be the right thing to do. The vaccine used had been developed not by a corporate executive trying to enrich himself, but by a physician,Edward Jenner, who published his work not for personal gain but to advance scientific knowledge and reduce suffering. His work was eventually supported by the British equivalent of a federal government grant (two relatively modest infusions of cash by the king) The work of this non-corporate, government-supported philanthropist researcher transcended the disease in question, launching an entirely new field, immunology:
The importance of his work does not stop there. His vaccine also laid the groundwork for modern-day discoveries in immunology, and the field he began may someday lead to cures for arthritis, AIDS, and many other diseases of the time.
The polio vaccine was developed by Dr. Jonas Salk who famously made no effort to profit from his life-saving invention.
He was not a direct government employee, but an employee of a university that received massive federal government research support and a philanthropic organization that was non-profit.His sole focus had been to develop a safe and effective vaccine as rapidly as possible, with no interest in personal profit. When he was asked in a televised interview who owned the patent to the vaccine, Salk replied: "There is no patent. Could you patent the sun?"
And of course outside of medicine, there was the Apollo moon shot program developed, designed, and inspired by federal bureaucrats piloted by federal employees flying government vehicles hurtling into space. Other signs of federal government incompetence was the defeat of Hitler and the ending of the Thousand Year Reich almost 2,000 years ahead of schedule. There was that taxpayer bailout of Germany proposed by and executed by government employee George Marshall that not only helped jump start an unprecedented economic revival in a country devastated by war but perhaps changed the course of history by preventing a Western economic collapse and expansion of Soviet influence and power. And speaking of cars and commerce, let's not forget that both the German autobahn system and our interstate highway system were both government-sponsored and financed deals that were stunningly successful in terms of opening up and connecting markets and increasing freedom for all of us to travel safely and rapidly across this great country of ours (and Germany too, if we choose).
Maybe private industry could have developed a means of preventing Yellow Fever, built the Panama Canal, both defeated and rehabilitated Germany, developed vaccines for small pox and polio, eradicated small pox, put several men on the moon (and brought them all back too), and built the interstate highway system, but for whatever reason, they didn't. At any rate, if these achievements represent government incompetence, then give me more of it!
After these examples, the point was yielded that government "serves a purpose. But it is not our savior. It is not my mother or father. It is my servant."
After these examples, the point was yielded that government "serves a purpose. But it is not our savior. It is not my mother or father. It is my servant."
Two things. First, these examples all refute your point made earlier in this post (and repeated elsewhere in others) that, as you worded it here, "NO Govt bureaucrat would have created either of those solutions!" You did not say that few government bureaucrats have innovated, you said "NO" government bureaucrats. A single counter-example can serve to shoot down this statement; I offered several.
Second, if you consider your freedom, both from fascism and from certain public health menaces such as polio or small pox, then the government is indeed, in these respects, your savior.
My point is not to lionize government servants, but simply to make mince meat of the arguments of those who feel compelled to disparage all government service all the time. I have worked for the federal government and I have worked for private industry and I have worked for myself and in all cases I have seen inefficiencies. There is yin and yang. I think it is silly and frankly insulting to millions of hard-working Americans, many in harm's way, to keep telling them how stupid and incompetent they are. The historical track record does not support such a blanket statement.
There is one dead Saudi right now whose body is fish food who also chose every opportunity to disparage the United States government until some of highly trained government employees put a bullet through his eye.
"Greed is a basic fact of the world. Money motivates us all. You don't want your life centered around it...but if I could make $150000 in Vermont or move a few miles down the road and make $300000...I would move immediately. 98% of Humans would do that. "Greed is one of many motivators of human behavior. I am not arguing it be abolished (indeed, that would be impossible), only that it not be held up for worship. Few successful entrepreneurs are motivated primarily by greed, and those who are often drop out in frustration during the inevitable lean years. Most do it because they love it, because they are obsessed with whatever product or service they are providing, whatever problem they are solving. For most, the money is secondary, a byproduct of doing the right thing in the right place and time. Most would do it for free if they could.
Re your $300k v. $150k example, you clearly have no idea the difference in compensation between various plans, but it's not THAT dramatic. Changing specialties could lead to that sort of difference in compensation; changing plans accepted would not. It's a straw man argument, and as I've said, most of the time I have dropped plans it's not because of money but the hassle factor. In a single payer system (such as Medicare for those over 65) we can sigh in relief, knowing that if they are a legal citizen, their bills will be paid, and there will be a uniform process of bill submission and uniform standards, etc. This exodus of physicians from Massachusetts is news to me, though, especially when you consider that Massachusetts is home to Harvard Medical School and Boston General, where many physicians gladly work at a discount to what they could earn elsewhere for the opportunity to be in an intellectually stimulating environment where exciting work can be done.
Second, if you consider your freedom, both from fascism and from certain public health menaces such as polio or small pox, then the government is indeed, in these respects, your savior.
My point is not to lionize government servants, but simply to make mince meat of the arguments of those who feel compelled to disparage all government service all the time. I have worked for the federal government and I have worked for private industry and I have worked for myself and in all cases I have seen inefficiencies. There is yin and yang. I think it is silly and frankly insulting to millions of hard-working Americans, many in harm's way, to keep telling them how stupid and incompetent they are. The historical track record does not support such a blanket statement.
There is one dead Saudi right now whose body is fish food who also chose every opportunity to disparage the United States government until some of highly trained government employees put a bullet through his eye.
"Greed is a basic fact of the world. Money motivates us all. You don't want your life centered around it...but if I could make $150000 in Vermont or move a few miles down the road and make $300000...I would move immediately. 98% of Humans would do that. "Greed is one of many motivators of human behavior. I am not arguing it be abolished (indeed, that would be impossible), only that it not be held up for worship. Few successful entrepreneurs are motivated primarily by greed, and those who are often drop out in frustration during the inevitable lean years. Most do it because they love it, because they are obsessed with whatever product or service they are providing, whatever problem they are solving. For most, the money is secondary, a byproduct of doing the right thing in the right place and time. Most would do it for free if they could.
Re your $300k v. $150k example, you clearly have no idea the difference in compensation between various plans, but it's not THAT dramatic. Changing specialties could lead to that sort of difference in compensation; changing plans accepted would not. It's a straw man argument, and as I've said, most of the time I have dropped plans it's not because of money but the hassle factor. In a single payer system (such as Medicare for those over 65) we can sigh in relief, knowing that if they are a legal citizen, their bills will be paid, and there will be a uniform process of bill submission and uniform standards, etc. This exodus of physicians from Massachusetts is news to me, though, especially when you consider that Massachusetts is home to Harvard Medical School and Boston General, where many physicians gladly work at a discount to what they could earn elsewhere for the opportunity to be in an intellectually stimulating environment where exciting work can be done.
The Best and the Brightest Do Not Always Leave Government Service
I disagree with the idea that the "best and brightest" move out of government service; if you are alleging that those working for the NIH or CDC or various and sundry government organizations are there because they are less competent or not as smart as their colleagues who take jobs offering potentially higher compensation in private industry, I would have to strongly disagree (and ask for some data to support this oft-cited urban legend). There are many reasons people choose one setting over another. If, for example, one had a strong interest in public health, the government is the only game in town. If you want to treat the poor or certain under-served populations, such as Native Americans or the prison population, the government is the route to do it . If you want to treat the elderly or the disabled, you will be working either directly or indirectly for the government, since Medicare will be reimbursing your services. If you want to serve in the military or the Coast Guard or the State Department, if you want to travel, if you don't want to worry about all the administrative details of running a practice or the risk of a lawsuit, you might feel far more at home in government service than private practice. I am aware that you have much criticism of government plans' imperfections, but if you presented evidence of a "free market solution" in healthcare, I must have blinked. The United States is alone among industrialized countries in having any of its citizens without access to healthcare. We outspend every other country on the planet, yet 59 million are uninsured. How is this a "solution"? Since none of the options in any country that does successfully provide universal health insurance at a lower cost is entirely free market, what country are you referring to?
There was no response to this question, but I was asked if I had ever seen the film Mr. Smith Goes to Washington.
Yes, I saw the film, whose lead was played by a man who later proudly served as a federal employee in World War II (unlike Ronald Reagan and John Wayne who made up for it by playing soldiers on the silver screen instead). In today's world, Mr. Smith would not get very far unless he could find a deep-pocketed corporate backer like the Koch brothers to pay for his deceptive attack ads. A far better movie starring James Stewart was It's a Wonderful Life, one of the most poignant indictments of corporate greed I have ever seen. I guess we have to ask ourselves if we want to live in Pottersville or if we want to have a community where we are all invested in each other's future and actually know and care about each other.
Yes, I saw the film, whose lead was played by a man who later proudly served as a federal employee in World War II (unlike Ronald Reagan and John Wayne who made up for it by playing soldiers on the silver screen instead). In today's world, Mr. Smith would not get very far unless he could find a deep-pocketed corporate backer like the Koch brothers to pay for his deceptive attack ads. A far better movie starring James Stewart was It's a Wonderful Life, one of the most poignant indictments of corporate greed I have ever seen. I guess we have to ask ourselves if we want to live in Pottersville or if we want to have a community where we are all invested in each other's future and actually know and care about each other.
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