Single-payer questions and answers (updated)

Posted on August 4th, 2009 by ecthompson

Thanks for stopping by C&L readers.

I posted a little something on my Facebook page which stated if we went with single-payer would you save anywhere between $3 – 4 trillion over 10 years. Some of my friends began to seize when they saw that number. So I thought that I would take some time to explain where that number came from and answer some of other questions.

Are you dreaming?

Although it is nice to dream, I don’t think I’ve ever dreamed about healthcare or healthcare reform. As a matter of fact, I’m really not looking forward to dreaming about healthcare. I like dreaming about Tyra Banks, Cindy Crawford and/or Stacy Williams. On the serious side, in 2007, we spent $2.2 trillion on health care. This averages out to be about $7200 per American. If we go to a single-payer system (government payer system) this would eliminate a price when $700 billion which currently goes to health insurance overhead and administration. We can use half of the $700 billion to cover the 46 million Americans who are currently without health care. This leaves approximately $350 billion left over. Now, it is true that the folks in Washington seem to be able to find things to do with money that is left over. That’s not the point. The point is we would end up with $350 billion. Multiply that by 10 years and you get $3.5 trillion. That’s a lot of savings.

Healthcare reform is about control?

While I will grant the critics of the America’s affordable health choices act of 2009 that there is a lot of garbage in this bill, I’m not sure that you can make the leap that healthcare reform is about control. Currently we spend of roughly 16% of our gross domestic product on health care. We’ve seen healthcare expenditures skyrocketed over the last 10-20 years. There are estimates, that are legitimate, that suggests that by the year 2025, at our current rate, would spend approximately 25% of our gross domestic product on health care. There’s no way that this is acceptable.

I’m not sure how anyone could leap to the conclusion that this is about control since you will be able to keep your same hospital and your same physician. Maybe, it is about controlling health care costs. If one of the goals of healthcare reform is to control costs and the simplest way is going with single-payer which frees up $700 billion. If, on the other hand, you want to jerryrig the current system then you need to put more money in the system in order to cover the 46 million Americans who are currently not covered.  How much money will be needed?  46 million x $7200 = $330 billion.  For those folks that don’t want single payer they will need to figure out how to raise over $300 billion per year.

Where does the number 46 million come from? How many economic refugees (illegal aliens) are in the 46 million who don’t have insurance?

The US Census Bureau published a document in August 2008 called Income, Poverty, and Health Insurance Coverage in the United States: 2007. According to this document, 45.7 million Americans do not have health insurance in 2007. (Page 19) According to the same document 9.7 million economic refugees do not have health insurance. (Table on page 22)

Update: I thought of a few more questions that I have been asked over the last several months.

Should we all invest in a hospice?

Many conservatives are trying to get seniors worked into a lather. They claim that there is provision in the bill America’s Affordable Health Choices Act of 2009 which basically kills off seniors. The ridiculousness of this claim cannot be understated. In section 1233 (page 424), the bill talks about an advance care planning consultation. The bill provides funds for Americans to sit down with a health professional and talk about end-of-life issues. It isn’t mandatory. It doesn’t stop your healthcare, nor does it tell doctors never to treat you again. As a physician, I think that Americans need to talk with their spouses and their primary care physicians about end-of-life issues. We don’t do this enough in this country. I see way too many trauma patients who have told their spouses or partners nothing about their end-of-life wishes. So, if you want to invest in a hospice, do as you wish with your money. I don’t foresee any signifiicant uptick in the death rate if this legislation passes.

Isn’t this the same thing that they have in England? Isn’t this socialized medicine?

Yesterday afternoon, I was a guest on health care forum on a local radio show called Take A Stand. I was representing both healthcare and a progressive point of view. A caller related a very long story in which a friend of his had to wait a couple months for a particular procedure. During this long time period, this friend remained in the hospital. Isn’t that the same type of medicine that we’re bringing here? No! In England, they have a socialized medicine system. The doctors, the nurses, all of the healthcare professionals are employees of the state. With a single-payer system, the government pays the bills and we pay the bills. The hospitals remain privately owned. Doctors continue to be in solo or group practices as they see fit.  Nurses would continue to be employed by the hospital or doctor or nursing home.

Many politicians have pointed out the fact that we spend twice as much on health care as other industrial countries. Some have pointed to this as a bad thing. I don’t know whether it is good or bad, but I can tell you that some of the differences in expenditures are because we, Americans, expect a certain type of service. We don’t expect to be waiting in the hospital for procedures. We expect to have access to whatever tests we need, in a timely fashion. That will not change under a single-payer system. As a matter fact, the speed may actually increase with a single-payer system because you don’t have to wait for your procedure to be certified by your insurance company.

A variation on the same theme is that a single-payer system (government payer) will turn hospitals all across the country into VAs. I’m sorry, I don’t follow this line of reasoning. A hospital that was run for profit yesterday would still be for profit under a single-payer system. If the hospital was efficient before single-payer, why would it be less efficient after the implementation of a single-payer system in which the hospitals billing apparatus could be streamlined because the hospital only has to bill the government? Hospitals wouldn’t have to bill 15 or 20 different insurance companies. Finally, I would say that the VA was designed to take care of relatively elderly men. Therefore, the VA is very good at taking care of heart attacks, strokes, diabetes, prostate cancer and colon cancer. The VA has had a hard time taking care of patients who are young, who are female or who have something out of the norm, because it wasn’t designed to take care of these patients.

Tags: Healthcare // View Comments

  • TCB
    ECT: "As far as the housing mess goes, I think it was private industry that came up with mortgage-backed derivatives and credit default swaps. They are the centerpiece of our current economic collapse. Places like Morgan Stanley, AIG, Countrywide, Merrill Lynch and Bear Stearns are just a few of the private companies that help bring Wall Street to its knees. If you’re going to point to the government, I would point to the fact that there was not enough oversight to prevent the massive abuses."

    What were the abuses of Merrill Lynch and Bear Stearns?
  • TCB
    ECT: "As far as the housing mess goes, I think it was private industry that came up with mortgage-backed derivatives and credit default swaps. They are the centerpiece of our current economic collapse. Places like Morgan Stanley, AIG, Countrywide, Merrill Lynch and Bear Stearns are just a few of the private companies that help bring Wall Street to its knees. If you’re going to point to the government, I would point to the fact that there was not enough oversight to prevent the massive abuses."

    What were the abuses of Merrill Lynch and Bear Stearns?
  • TCB
    I looked over both articles and neither seemed relevant to the question of funding national healthcare by taking the money paid to insurance companies.


    The first article mainly addressed the administrative costs to various players. Given that more health care is provided in America, one would expect some increase in administrative costs. Insurance overhead was similar in both the US and Canada. Most of the administrative cost has nothing to do with the insurance overhead.


    As for the second article, I don’t know which data is relevant to the plan that you have suggested.


    As I see it, you may get about 100B to play with by eliminating insurance assuming no administrative oversight of how funds are spent .
  • TCB
    I looked over both articles and neither seemed relevant to the question of funding national healthcare by taking the money paid to insurance companies.


    The first article mainly addressed the administrative costs to various players. Given that more health care is provided in America, one would expect some increase in administrative costs. Insurance overhead was similar in both the US and Canada. Most of the administrative cost has nothing to do with the insurance overhead.


    As for the second article, I don’t know which data is relevant to the plan that you have suggested.


    As I see it, you may get about 100B to play with by eliminating insurance assuming no administrative oversight of how funds are spent .
  • ecthompson
    Emory -

    Thank you for your comments. I've read your comment a couple times today. I wanted to give you a thoughtful answer was not off-the-cuff.

    I don't think that government involvement is really driving up the costs of healthcare. It may be but I don't have any evidence to support that. When you look at the amount of money that America spends on health care -- $7200 per American in 2007; and you look at the amount of money that a place like McAllen, Texas is spending -- $15,000 per resident. It's hard to see how the government has different involvement in McAllen, Texas than it has in Dallas, Texas than it has in Miami, Florida than it has in Springfield, Illinois. Instead, it appears that there are other drivers of healthcare costs. This includes local practice norms. There was an elegant study that was published in the New England Journal of Medicine probably 10-15 years ago which looked at the care that patients get when they were diagnosed with a myocardial infarction in New York versus Los Angeles. I can't remember whether Los Angeles or New York was more expensive but the point of the study was one of the cities ordered by far more tests thanthe other and the cost was thousands of dollars more for the same diagnosis. (I'm sorry I can't find that exact study right now.) The outcomes, as I recall, where the same.

    The best example that I can give you is a person that falls down and hits their head. The patient had no loss of consciousness and comes in to the emergency room complaining of a headache. The patient has no signs or symptoms of a concussion. The patient has absolutely no other complaints but a headache. The physician can give the patient some pain medication which includes Tylenol and send him home to rest. The physician can order a CT scan of the head. One emergency room visit would be about $450. The other emergency room visit would be close to $2500.

    As far as the government being a sinkhole for incompetence, I reject the idea. The government is run by Americans. If Americans want the government to run well, we will make it run well. For 30 years we've been hearing that the government is the problem. Therefore, the government's been underfunded (epa for example). Republicans wanted Americans to point to the government and say that it isn't working but when you put people who have no experience or people who absolutely hate the agency (James Watt), in charge, you get an incompetent government. No surprise. Critics have pointed to the VA as government run healthcare. True. They've pointed to long wait times and other problems in the VA. I would point out that the VA is doing exactly what it was designed to do. It was designed to take care of elderly veterans who were retired. These are people who have time on their hands. They're mostly male. Therefore, the VA doesn't excellent job, you can look at the studies, at taking care of male diseases like myocardial infarction, congestive heart failure, colon cancer, prostate cancer and lung cancer. They're literally hundreds of studies showing good clinical outcomes. But, I would add, those of us who are proposing a single-payer system are not proposing turning all of our hospitals into one big VA. In a single-payer system, private hospitals continue to exist and the government pays the bills through our taxes. Finally, the VA has been underfunded for over a decade.


    As far as the housing mess goes, I think it was private industry that came up with mortgage-backed derivatives and credit default swaps. They are the centerpiece of our current economic collapse. Places like Morgan Stanley, AIG, Countrywide, Merrill Lynch and Bear Stearns are just a few of the private companies that help bring Wall Street to its knees. If you're going to point to the government, I would point to the fact that there was not enough oversight to prevent the massive abuses.

    My point with unions was very simple -- small companies cannot afford the staff or the outlay of money to pay for health insurance for its employees. Therefore, a high percentage of small businesses do not carry health insurance. Large corporations that are trying to save money will try to negotiate with unions to try to get higher deductibles, decrease coverage to decrease their costs.

    It would take another thousand words or so to explain what a relatively equal society would mean. I guess, when you look back in the 1950s, 1960s and most of 1970s we enjoyed wide prosperity in this country. If you are in the middle class you were able to afford a house, a car and you are able to send your kids to college. You were even able to put money away. That is no longer true for the middle class. CEOs did not get outrageous salaries. Companies supported their towns and the towns, in turn, supported their companies with available labor. It would have been unheard of in the 1950s or 60s to ship jobs overseas. That would have never happened. In a nutshell, this is what I meant and this is what I think Paul Krugman means.

    Thank you for your comments.
  • Emory -

    Thank you for your comments. I've read your comment a couple times today. I wanted to give you a thoughtful answer was not off-the-cuff.

    I don't think that government involvement is really driving up the costs of healthcare. It may be but I don't have any evidence to support that. When you look at the amount of money that America spends on health care -- $7200 per American in 2007; and you look at the amount of money that a place like McAllen, Texas is spending -- $15,000 per resident. It's hard to see how the government has different involvement in McAllen, Texas than it has in Dallas, Texas than it has in Miami, Florida than it has in Springfield, Illinois. Instead, it appears that there are other drivers of healthcare costs. This includes local practice norms. There was an elegant study that was published in the New England Journal of Medicine probably 10-15 years ago which looked at the care that patients get when they were diagnosed with a myocardial infarction in New York versus Los Angeles. I can't remember whether Los Angeles or New York was more expensive but the point of the study was one of the cities ordered by far more tests thanthe other and the cost was thousands of dollars more for the same diagnosis. (I'm sorry I can't find that exact study right now.) The outcomes, as I recall, where the same.

    The best example that I can give you is a person that falls down and hits their head. The patient had no loss of consciousness and comes in to the emergency room complaining of a headache. The patient has no signs or symptoms of a concussion. The patient has absolutely no other complaints but a headache. The physician can give the patient some pain medication which includes Tylenol and send him home to rest. The physician can order a CT scan of the head. One emergency room visit would be about $450. The other emergency room visit would be close to $2500.

    As far as the government being a sinkhole for incompetence, I reject the idea. The government is run by Americans. If Americans want the government to run well, we will make it run well. For 30 years we've been hearing that the government is the problem. Therefore, the government's been underfunded (epa for example). Republicans wanted Americans to point to the government and say that it isn't working but when you put people who have no experience or people who absolutely hate the agency (James Watt), in charge, you get an incompetent government. No surprise. Critics have pointed to the VA as government run healthcare. True. They've pointed to long wait times and other problems in the VA. I would point out that the VA is doing exactly what it was designed to do. It was designed to take care of elderly veterans who were retired. These are people who have time on their hands. They're mostly male. Therefore, the VA doesn't excellent job, you can look at the studies, at taking care of male diseases like myocardial infarction, congestive heart failure, colon cancer, prostate cancer and lung cancer. They're literally hundreds of studies showing good clinical outcomes. But, I would add, those of us who are proposing a single-payer system are not proposing turning all of our hospitals into one big VA. In a single-payer system, private hospitals continue to exist and the government pays the bills through our taxes. Finally, the VA has been underfunded for over a decade.


    As far as the housing mess goes, I think it was private industry that came up with mortgage-backed derivatives and credit default swaps. They are the centerpiece of our current economic collapse. Places like Morgan Stanley, AIG, Countrywide, Merrill Lynch and Bear Stearns are just a few of the private companies that help bring Wall Street to its knees. If you're going to point to the government, I would point to the fact that there was not enough oversight to prevent the massive abuses.

    My point with unions was very simple -- small companies cannot afford the staff or the outlay of money to pay for health insurance for its employees. Therefore, a high percentage of small businesses do not carry health insurance. Large corporations that are trying to save money will try to negotiate with unions to try to get higher deductibles, decrease coverage to decrease their costs.

    It would take another thousand words or so to explain what a relatively equal society would mean. I guess, when you look back in the 1950s, 1960s and most of 1970s we enjoyed wide prosperity in this country. If you are in the middle class you were able to afford a house, a car and you are able to send your kids to college. You were even able to put money away. That is no longer true for the middle class. CEOs did not get outrageous salaries. Companies supported their towns and the towns, in turn, supported their companies with available labor. It would have been unheard of in the 1950s or 60s to ship jobs overseas. That would have never happened. In a nutshell, this is what I meant and this is what I think Paul Krugman means.

    Thank you for your comments.
  • Emory
    Interesting read and arguements.
    I would like to hear your opinions on HOW we got here - I do mean gov't involvement in helping drive costs up. You mentioned unions in a response, please elaborate the kind of benefits afforded them, while not to other Americans who work for smaller, less influential companies.
    Also, what do you say to folks who don't support more gov't-run programs on the basis of perfromance and history. Our housing mess is a fine example of waste, fraud, and abuse. But, at its inception, gov't backed mortgages were a great idea to benefit many Americans. Now, its costing us who really knows how much?

    I do respect others' views, so the quote you cited by Krugman should be addressed: - "I believe in a relatively equal society, supported by institutions that limit extremes of wealth and poverty." Please explain what is meant by equal society, institutions, and limiting extremes......
  • Emory
    Interesting read and arguements.
    I would like to hear your opinions on HOW we got here - I do mean gov't involvement in helping drive costs up. You mentioned unions in a response, please elaborate the kind of benefits afforded them, while not to other Americans who work for smaller, less influential companies.
    Also, what do you say to folks who don't support more gov't-run programs on the basis of perfromance and history. Our housing mess is a fine example of waste, fraud, and abuse. But, at its inception, gov't backed mortgages were a great idea to benefit many Americans. Now, its costing us who really knows how much?

    I do respect others' views, so the quote you cited by Krugman should be addressed: - "I believe in a relatively equal society, supported by institutions that limit extremes of wealth and poverty." Please explain what is meant by equal society, institutions, and limiting extremes......
  • ecthompson
    Gatherdust -

    thank you for your thoughtful comments. Just like me, you should not get discouraged. Although I do have my moments. One of the goals of those who oppose healthcare reform is to get us discouraged and disinterested. I feel pretty confident that we will get healthcare reform during the first term of this president.

    Frank Burns, from M*A*S*H, had a great line where he said, "it's okay to be different just as long as we all do it the same." :-)
  • ecthompson
    Peggy --

    I'm sorry about your loss. Yet, you do make an important point about end-of-life issues. It is something that we, as Americans, seem to want to avoid. It is almost like were all Superman and were going to live forever. All you have to do is walk through an ICU anywhere in the country and I guarantee there's somebody who is in any vegetative state and on a ventilator. The physicians have talked to the family but the family is torn because there is no direction from the patient.

    Thank you for your comment.
  • ecthompson
    Mugsy -

    I couldn't agree more. Nothing that was promised with tort reform happened. I was one of the physicians that fought for tort reform and at the last minute the bill that was targeted for the healthcare industry was widened to cover all liability. I know that many physicians were very unhappy with the final product.
  • TCB -

    I would point you - here and here. I guess I would add that studies have suggested that up to a 1/3 of our healthcare dollars aren't going to healthcare. They are going to administrative costs. I might have thrown all of those costs into insurance overhead but I'm still researching.

    Thanks as always for your thoughts.
  • ecthompson
    TCB -

    I would point you - here and here. I guess I would add that studies have suggested that up to a 1/3 of our healthcare dollars aren't going to healthcare. They are going to administrative costs. I might have thrown all of those costs into insurance overhead but I'm still researching.

    Thanks as always for your thoughts.
  • TCB
    ECT: If we go to a single-payer system (government payer system) this would eliminate a price when $700 billion which currently goes to health insurance overhead and administration. We can use half of the $700 billion to cover the 46 million Americans who are currently without health care. This leaves approximately $350 billion left over.


    I think that your calculations are off. According to the HHS stats:

    Private Insurance Premiums for 2007: 775 Billion

    Private Insurance Benefits (payouts to hospitals, physicians, etc) 680 Billion

    Net Cost (administrative cost s etc) 94.6 Billion



    So unless you are suggesting taking the benefits paying for people’s healthcare and giving to the uninsured, there is only 95 Billion for the uninsured, not 350B or 700Billion.


    http://www.cms.hhs.gov/NationalHealthExpendData/downloads/tables.pdf
  • TCB
    ECT: If we go to a single-payer system (government payer system) this would eliminate a price when $700 billion which currently goes to health insurance overhead and administration. We can use half of the $700 billion to cover the 46 million Americans who are currently without health care. This leaves approximately $350 billion left over.


    I think that your calculations are off. According to the HHS stats:

    Private Insurance Premiums for 2007: 775 Billion

    Private Insurance Benefits (payouts to hospitals, physicians, etc) 680 Billion

    Net Cost (administrative cost s etc) 94.6 Billion



    So unless you are suggesting taking the benefits paying for people’s healthcare and giving to the uninsured, there is only 95 Billion for the uninsured, not 350B or 700Billion.


    http://www.cms.hhs.gov/NationalHealthExpendData/downloads/tables.pdf
  • Just a quick note on the subject of "tort reform", especially since "Texas" was mentioned, and I'm in Texas...

    "Tort" ("lawsuit") costs account for roughly 1% of healthcare costs. You could completely wipeout malpractice liability and still not budge healthcare costs. Meanwhile, for those people who are often left with permanent life-long disabilities due to medical negligence, juries made up of people like you and me decide how much a patient should be awarded for their injuries. And I'm not too keen on some bureaucrat, aided by lobbyist, telling me how much someone deserves to be compensated for their injuries.

    On "Texas", we have the WORST healthcare coverage ratio in the country. Approximately 1 in every 4 Texans is uninsured. People were promised that "tort reform" (limited judgments) was the key to bringing down insurance costs, and despite the fact it was tried and failed in California, the people voted for the "tort ceiling" anyway. The result? Not only did rates not come down, but victims of malpractice often are not awarded enough money to cover a lifetime of medical care (note, the size of the judgment is NOT inversely proportional to age, so both a 60 year old man and a 6 month old child can be limited to a maximum $5million dollars (iirc) to cover a lifetime of care.)
  • Mugsy -

    I couldn't agree more. Nothing that was promised with tort reform happened. I was one of the physicians that fought for tort reform and at the last minute the bill that was targeted for the healthcare industry was widened to cover all liability. I know that many physicians were very unhappy with the final product.
  • Mugsy
    Just a quick note on the subject of "tort reform", especially since "Texas" was mentioned, and I'm in Texas...

    "Tort" ("lawsuit") costs account for roughly 1% of healthcare costs. You could completely wipeout malpractice liability and still not budge healthcare costs. Meanwhile, for those people who are often left with permanent life-long disabilities due to medical negligence, juries made up of people like you and me decide how much a patient should be awarded for their injuries. And I'm not too keen on some bureaucrat, aided by lobbyist, telling me how much someone deserves to be compensated for their injuries.

    On "Texas", we have the WORST healthcare coverage ratio in the country. Approximately 1 in every 4 Texans is uninsured. People were promised that "tort reform" (limited judgments) was the key to bringing down insurance costs, and despite the fact it was tried and failed in California, the people voted for the "tort ceiling" anyway. The result? Not only did rates not come down, but victims of malpractice often are not awarded enough money to cover a lifetime of medical care (note, the size of the judgment is NOT inversely proportional to age, so both a 60 year old man and a 6 month old child can be limited to a maximum $5million dollars (iirc) to cover a lifetime of care.)
  • Peggy
    When my husband was dying of melanoma cancer and very ill with COPD the hospice social worker talked to us about a living will and DNR for both of us. We worked our way thru that and felt as though a big weight had been lifted off our shoulders. The proposal in the bill is all voluntary!! And so beneficial as we all tend to put off such thoughts. I guess we think we are immortal. WE ARE NOT!!!!
  • Peggy
    When my husband was dying of melanoma cancer and very ill with COPD the hospice social worker talked to us about a living will and DNR for both of us. We worked our way thru that and felt as though a big weight had been lifted off our shoulders. The proposal in the bill is all voluntary!! And so beneficial as we all tend to put off such thoughts. I guess we think we are immortal. WE ARE NOT!!!!
  • Peggy --

    I'm sorry about your loss. Yet, you do make an important point about end-of-life issues. It is something that we, as Americans, seem to want to avoid. It is almost like were all Superman and were going to live forever. All you have to do is walk through an ICU anywhere in the country and I guarantee there's somebody who is in any vegetative state and on a ventilator. The physicians have talked to the family but the family is torn because there is no direction from the patient.

    Thank you for your comment.
  • Gatherdust
    Your post and the dialogue in the comments are really discouraging. It's whats happening all around us in a nutshell. The commenter is angry and comes across as disinterested in accuracy, doesn't so much make stuff up as he parrots the same old hyperbolic talking points of others who don't intend to discuss so much as to silence their opponents, and in the end is arguing against pretty much all that has improved life in this country over the last 50 years. You point out the factual lapses and errors and it simply provokes an "and another thing.." Tort reform is another piece of blusterbus. If the rightwing demands that the consumer-producer relationship is so sacrosanct then why not create a more effective infrastructure for consumer protection? But in the end its just another talking point.

    It's as if Archie Bunker, Ted Baxter, and Frank Byrnes have ceased to be TV caricatures and have been transformed into some toxic substance put into the drinking supply.
  • Gatherdust
    Your post and the dialogue in the comments are really discouraging. It's whats happening all around us in a nutshell. The commenter is angry and comes across as disinterested in accuracy, doesn't so much make stuff up as he parrots the same old hyperbolic talking points of others who don't intend to discuss so much as to silence their opponents, and in the end is arguing against pretty much all that has improved life in this country over the last 50 years. You point out the factual lapses and errors and it simply provokes an "and another thing.." Tort reform is another piece of blusterbus. If the rightwing demands that the consumer-producer relationship is so sacrosanct then why not create a more effective infrastructure for consumer protection? But in the end its just another talking point.

    It's as if Archie Bunker, Ted Baxter, and Frank Byrnes have ceased to be TV caricatures and have been transformed into some toxic substance put into the drinking supply.
  • Gatherdust -

    thank you for your thoughtful comments. Just like me, you should not get discouraged. Although I do have my moments. One of the goals of those who oppose healthcare reform is to get us discouraged and disinterested. I feel pretty confident that we will get healthcare reform during the first term of this president.

    Frank Burns, from M*A*S*H, had a great line where he said, "it's okay to be different just as long as we all do it the same." :-)
  • Mike’s Blog Roun
    [...] Reasic: Debunking health care misinformation [...]
  • Bud Brooks
    Glad to see you fought the fight on tort reform. Otherwise, we'll continue to "agree to disagree!"
  • Bud Brooks
    Glad to see you fought the fight on tort reform. Otherwise, we'll continue to "agree to disagree!"
  • ecthompson
    I'm not beholden to anyone except my wife, my mother and my father. No Quandary. Tort reform has to happen in order to control costs. I fought for Tort Reform in Texas. WE, doctors, took it up the tailpipe as Rick Perry and other Republicans screwed us but I will leave that discussion for another day.

    Thanks again.
  • ecthompson
    Tort reform has been missing in the national debate. I have discussed this on my radio show. I talked about the elephants in the room - tort reform and immigration reform. Thanks.
  • Bud Brooks
    Oh, and one more thing; how could I have forgotten this? I had to get out of bed to come post this:

    * Where is the tort reform in this healthcare bill? Why doesn't this include national tort reform like what Texas did a few years ago. If you want to take millions of dollars of costs out of healthcare, malpractice premiums are far lower in Texas now, and more doctors and nurses have moved to Texas to practice. Erri, you must be in a real quandry on this one: on the one hand, you are a doctor, and you pay costly malpractice insurance; on the other you are a Democrat, and Dems are beholden to the "geese that lay the golden eggs" -- the trial lawyers. How do you square up those two polar opposites?
  • I'm not beholden to anyone except my wife, my mother and my father. No Quandary. Tort reform has to happen in order to control costs. I fought for Tort Reform in Texas. WE, doctors, took it up the tailpipe as Rick Perry and other Republicans screwed us but I will leave that discussion for another day.

    Thanks again.
  • Tort reform has been missing in the national debate. I have discussed this on my radio show. I talked about the elephants in the room - tort reform and immigration reform. Thanks.
  • Bud Brooks
    Oh, and one more thing; how could I have forgotten this? I had to get out of bed to come post this:

    * Where is the tort reform in this healthcare bill? Why doesn't this include national tort reform like what Texas did a few years ago. If you want to take millions of dollars of costs out of healthcare, malpractice premiums are far lower in Texas now, and more doctors and nurses have moved to Texas to practice. Erri, you must be in a real quandry on this one: on the one hand, you are a doctor, and you pay costly malpractice insurance; on the other you are a Democrat, and Dems are beholden to the "geese that lay the golden eggs" -- the trial lawyers. How do you square up those two polar opposites?
  • Bud -

    Love you like a brother but you didn't read what I posted.

    I have clearly shown in my post where the number 46 million comes from. I also clearly state, "according to the same document 9.7 million economic refugees (illegal immigrants) do not have health insurance."

    What evidence do you have that 15 million young adults would rather not have insurance? This is a wag as we say in medicine. Wild Ass Guess. Are you saying they wouldn't want to have health insurance at any price? Or, do they believe that the price that is offered, is too much? Any data would be nice.

    No. Cost savings are exactly that. As I've clearly shown, there would be no rationing of services. There'll be no rationing of services beyond what their rationed today by your health insurance! I'm not sure where you read where bureaucrats would decide anything. This is something you dreamed up. If you have any data to support this notion of rationing I would be happy to look at it. Again, I would ask you to read what I wrote. In the plan that I am outlining, there is no increase in taxes! No additional revenue is needed. None. You can look at the government figures yourself. Look at the figures. $2.2 trillion were spent on healthcare in 2007. Just less than $700 billion was gobbled up by the insurance companies for overhead. Again, don't take my word for it, look at the documentation and the links I've provided.

    Bud, read what I've been writing. I have been advocating for single-payer plan for 3 to 4 months now. It is by far the most cost-effective way to pay for health insurance and cover all Americans. Yes, I'm talking about eliminating the one who denies coverage, the one who tells you, you can't take the drug that your doctor prescribed because it's not on the formulary. You're talking about bureaucrats and I'm talking about eliminating the real problem -- insurance companies. They're the ones that limit and ration your coverage. You do understand that you cannot walk into your doctor's office and asked to have your gallbladder out and expect that your insurance company will pay for it. You know this don't you? Your health insurance tells you when and when you can't get medical care.

    Of course the government has an incentive to be efficient. If the American taxpayer demands it, it will happen. It sounds like you don't have any faith in the American taxpayer. It sounds like you don't trust the taxpayer stay on top of the government. By the way, how the Clinton administration began to pay down the deficit if there was no incentive to be efficient? Why didn't they continue to spend us into more and more debt?

    I just don't understand this hatred you have for Americans who are working for our government. It is like our government is fulled with bottom-feeders of our society. It seems to me like you believe that American workers are the greatest as long as they're not in unions (I'm guessing you feel this way) and they don't work for the government. You and I have both seen Americans who work for private companies who are lazy and don't care. Yet, you don't berate those folks (and no all of them don't get fired at their first evaluation). The fact that I had a patient in the hospital a couple weeks ago who waited 10 days to get an answer back from her insurance company to see if she qualified for rehabilitation, this doesn't come from your mouth. Why? The inefficiencies that we continue to see in the business world seems to be tolerated by conservatives. They talk about market forces like it's some magical elixir when it is far from magical. Basically, the big get bigger and crush the small. This continues until a monopoly ensues and prices escalate, unless several companies get together and fix the prices then prices escalate.

    I'm sorry that you are so confused over liberalism. It is clear that liberals of the 50s and 60s overreached. Liberals of the 70s were complacent. Liberals of the 80s were invisible. Liberals of the 90s tried to hide their liberalism in a cloak of conservatism. To quote Paul Krugman, "I believe in a relatively equal society, supported by institutions that limit extremes of wealth and poverty. I believe in democracy, civil liberties and the rule of law. That makes me a liberal, and I'm proud of it."


    I'm glad you took the time to comment. Seriously. I appreciate it. Nope, we don't agree and we will not convince the other of our correctness but this is what America is about. Discussion. Discourse. Exchange of ideas.

    Thanks.
  • Bud Brooks
    Erri, not sure where to begin with this, but I appreciate your paying attention to my comments!

    * Of the 47 million figure that's thrown around: about 15 million are illegals. Send them back across the border and no health insurance for them. Another 15 million or so are younger adults who don't want/need health insurance, and many can afford it if they need it. The remaining 17 million +/- can use some help. No need to redo the entire system for this group. Allow for tax deductions of this group's health insurance purchase, and create additional employer incentives to provide coverage for those under/uninsured who work -- employers will do that with incentives.

    * I was being a little facetious about hospice, but the govt. had no business being in charge of end-of-life discussions. It's not even their business if it's discussed or not.

    * The "cost savings" are really about a reduction/rationing of services. Bureaucrats will decide who gets what, or vague criteria will be used. There is simply no possible way to cover all these people and improve care, yet save all these trillions of dollars. And the math of bilking the richest Americans to pay for it does not add up. If you took all the marginal income of those making over $500K, that only adds up to $1 trillion during that same time period.

    * Today I heard a quotation from Obama during 2008 that "we can't eliminate the employer health insurance immediately, but over the next 10-15 years, we will." He was talking to an SEIU group somewhere in the Midwest or East Coast -- not sure where. If that is not a blatant statement that he wants to end employer-based insurance, then nothing is. There was another similar quotation too that I can't remember its context.

    * And regarding the $350 billion left over each year, the govt. does not have an incentive to be efficient, since it would be facing no competition; that always leads to a wasteful, bloated management style that does not "save" money. The for-profits and the non-profits will still be efficient, because they have to compete, but the govt. won't because it doesn't compete. There is no "market."

    * And at the end of the day; this is absolutely about CONTROL by the liberals. That's what liberalism is all about; Control, Dependence, Feeding from the Trough, and other Cradle-to-Grave initiatives that liberals love to shower upon the great unwashed, know-nothing, mind-numbed minions in the flyover country. If this goes through (which it won't), then the U.S. government will be about 47% government-controlled, which puts it as the 3rd most Socialist country of the Western industrialized nations. If people think that they get miffed about dealing with their insurance companies, just wait until they have to start dealing with govt. bureaucrats who don't care, work 9-5, M-F, and that's it. This would be a TOTAL DISASTER.

    'Nuff said!
  • Bud Brooks
    Erri, not sure where to begin with this, but I appreciate your paying attention to my comments!

    * Of the 47 million figure that's thrown around: about 15 million are illegals. Send them back across the border and no health insurance for them. Another 15 million or so are younger adults who don't want/need health insurance, and many can afford it if they need it. The remaining 17 million +/- can use some help. No need to redo the entire system for this group. Allow for tax deductions of this group's health insurance purchase, and create additional employer incentives to provide coverage for those under/uninsured who work -- employers will do that with incentives.

    * I was being a little facetious about hospice, but the govt. had no business being in charge of end-of-life discussions. It's not even their business if it's discussed or not.

    * The "cost savings" are really about a reduction/rationing of services. Bureaucrats will decide who gets what, or vague criteria will be used. There is simply no possible way to cover all these people and improve care, yet save all these trillions of dollars. And the math of bilking the richest Americans to pay for it does not add up. If you took all the marginal income of those making over $500K, that only adds up to $1 trillion during that same time period.

    * Today I heard a quotation from Obama during 2008 that "we can't eliminate the employer health insurance immediately, but over the next 10-15 years, we will." He was talking to an SEIU group somewhere in the Midwest or East Coast -- not sure where. If that is not a blatant statement that he wants to end employer-based insurance, then nothing is. There was another similar quotation too that I can't remember its context.

    * And regarding the $350 billion left over each year, the govt. does not have an incentive to be efficient, since it would be facing no competition; that always leads to a wasteful, bloated management style that does not "save" money. The for-profits and the non-profits will still be efficient, because they have to compete, but the govt. won't because it doesn't compete. There is no "market."

    * And at the end of the day; this is absolutely about CONTROL by the liberals. That's what liberalism is all about; Control, Dependence, Feeding from the Trough, and other Cradle-to-Grave initiatives that liberals love to shower upon the great unwashed, know-nothing, mind-numbed minions in the flyover country. If this goes through (which it won't), then the U.S. government will be about 47% government-controlled, which puts it as the 3rd most Socialist country of the Western industrialized nations. If people think that they get miffed about dealing with their insurance companies, just wait until they have to start dealing with govt. bureaucrats who don't care, work 9-5, M-F, and that's it. This would be a TOTAL DISASTER.

    'Nuff said!
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