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POLICY: Healthcare by Lobbyist By Eric Novack

Das Kapital
Place this in the ‘toot my own horn’ category. And in the ‘you really ought to listen to The Eric Novack Show’ at www.ericnovack.com‘ category.

From the Wall Street Journal October 10, 2006 edition:

Competition is an issue that many patient-advocacy groups wrestle with as they struggle to raise funds for research, attract greater interest in their diseases, and speed up the search for a cure.

The article ostensibly discusses how there are over 140 advocacy groups for brain tumors alone— and how they actively compete against each other for members, funding, and the ear (and hopefully pocketbooks) of elected officials.

As we give more and more power over the administration, funding and regulation over to unelected bureaucrats appointed by our ever campaigning politicians, we head toward the only guaranteed outcome of ‘single payer’, ‘single pool’, ‘national’ healthcare:  the protected by law, expanded by lawsuit, and guarded by lobbyists development of healthcare-by-lobbying.

In the world of healthcare-by-lobbying, heart disease advocates fight against Alzheimer’s groups, child advocates fight against the AARP, hip replacement makers fight against pacemaker manufacturers.

There is no free market-no free market of ideas, no free market for patients, no free market for doctors. And busy legislators find themselves uncertain about what the greatest need is for patients because each group emphasizes different issues or aspects of the disease.

There is also recognition that as cancer research increasingly focuses on using costly, cutting-edge technology to identify genes and cellular changes as an avenue to new treatments, progress is going to take huge sums of money that small patient-advocacy groups are unlikely to be able to raise on their own.

I have yet to ever hear an argument from the single payer advocates how this can be prevented.  Rather, it appears as if this is an essential part of their plan.

Proof- spend 10 minutes reading the single payer bill vetoed by Governor Schwarzenegger in California last month.  80+ pages of committees and  bureaucracy.

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35 replies »

  1. My husband and I are former active duty USAF. He just returned from Afghanistan on active duty status while flying with the air national guard. Our family now qualifies for six months of “free” medical coverage from the military–it’s called tricare prime. We can’t get an appointment for ourselves or our children. Today they told me to call back every day to check and see if I could get an appointment before March. Congress isn’t even this inefficient! Government sactioned health care couldn’t be this bad. We’re just lucky that nothing is wrong with any of our children and that the appointments we need are simply standard. My husband risked his life every day for five months and his family members can’t get a flu shot? What a bunch of b.s.!

  2. “pgbMD, you failed to detect my sarcasim.”
    I think you meant ‘satire’, the term librules typically use to avoid criticism.
    “would not be sacrificed because Karl Rove needed an issue to win elections and Cheney’s Haliburton and the other war contractors wanted more cash for blood.”
    Jeez, straight out of the Soros playbook? That may work in the great white north but that trash don’t play down here.
    I really think that when we hand out these citizenship cards we should require 18 months of military service.

  3. Eric, we already have public funding of elections. Its just through the back door and it is costing us hundreds of times more than if we just paid for the elections up front (at a total cost of about $15 per taxpayer per year). Instead it is costing an average of $4000 per taxpayer per year in all of the tax breaks, subsidies, no-bid contracks, roads to nowhere and etc. I’d prefer eliminating the middleman and paying my $15, thank you.
    But I’d prefer that in the health care system as well.
    But Peter’s point is right on target. Were it not for the $100 million per year passing hands between the health care industry and our trusted politicians, we’d have solved the “health care crisis” years ago.
    It always amazes me that business leaders (and physicians) who would fire an employee or have him jailed for taking money from favored vendors on the side. But they tolerate it when done by their favorite politician.

  4. Eric, your attempt to characterize my broad comments into one simplistic personal analysis for the use of self serving ridicule is quite blantant. You asked for my suggestions on reforming our present state of political corruption, I gave some. How much monopolizing of blog space do you want me to take? I suggest you review my prior comments on the complex issues of healthcare reform to better and more accurately understand my viewpoint. But make no mistake, healthcare reform will not happen without political reform – something I think you are aware of and covet as your ace in the hole against change.

  5. “I don’t think it is appropriate here to start questioning someones patriotism on this blog, but if you are interested I know a couple of recruiters I can send your way to sign-up you or your kids!”
    pgbMD, you failed to detect my sarcasim. Although we do consider those that serve to be “more patriotic” than those that don’t. Certainely “patriotism” has been used more widely by these Republicans than anyone else. Oppose the war, can’t be patriotic. But I wouldn’t give this political Iraq war two weeks if rich families had to send their kids as well. Maybe 1 week if politicians had to send their’s. It also seems that DOD was playing the “patriotism” card on Eric before I did. As for the recuiter, no thanks, my kids, if I had any, would not be sacrificed because Karl Rove needed an issue to win elections and Cheney’s Haliburton and the other war contractors wanted more cash for blood.
    “All renal transplants are 100% covered by medicare..”
    That’s it? your answer is one example? Here’s more,
    http://abcnews.go.com/Health/story?id=1514702
    Eric, my anger is directed at no risk “patriots” who have nothing to loose with support of the Iraq war. Your post entered the patriot comment. But $2 billion per week for the war could be better spent on healthcare, maybe even better Tricare payments to you.
    “As soon as you devolve into an anti-Bush/ republican rant, serious health policy discussion ceases.”
    Serious health policy issues cannot be separated from politics, especially the ones practiced by this administration. If the Dems take over Nov 8th, (I’m doubtful) I’ll expect some more “rants” from you. I think your “serious health policy discussion” always starts from a Republican agenda. “I want to keep what I have.” I am on record as not any more supportive of Democrats, and not supportive of a system that excludes any more parties or ideas.
    As to some solutions to bribery/corruption/money politics, first stop considering corporations as people, with the same rights. Ban all corporate/corporate lobbyist political donations. Only allow donations from individuals that are capped and publicly finance elections, we’re paying for it anyway through tax deductions. The system that allows anyone to shout louder over the other because they have more money is not a democratic one. But the argument that the Dems do it too, plays into the corporate/Repubican game plan. “Might as well vote for me cause they’re just as bad.” Now there’s a slogan to build a country on.

  6. I believe the answer is to dis-empower government and lobbyists by putting more value and responsibility in the hands of people.
    This formulation always makes me chuckle. Lobbyists and government employees are not “people”, I guess. Only the profiteers in our hopelessly screwed-up private system count as “people”.

  7. Barry, it is indeed a sad situation when we must rely on bribery and payola to protect the rich from the poor, but since political bribery has already facilitated the Bush tax cuts to the detriment of middle and lower income wage earners, I guess your concern is justified. The reverse could certainly occur, and turnabout is certainly not fair when it happens to the rich. Perhaps we should decide how the tax burden should be shared and then adjust the political bribery to accommodate that number.
    Or alternatively, we could have politicians passing laws that are in the best interest of the public and society as a whole, and let the chips fall where they may. That’s my preference, and I can assure you that without $100 million passing into the hands of politicians we’d have had universal health care long ago.

  8. “While I’ve paid far more taxes than the average taxpayer, Barry, I nonetheless have that attitude. Galling as it may be. I am not altruistic, but I am a strong believer in the progressive tax system. It is not unfair; it is necessary if we are to protect the longevity of our democracy.”
    Jack, with all due respect, if you carried this argument to its logical extreme, you would have politicians elected with taxpayer financing (no special interests) deciding how much high income people “need” or “should have” to finance a “comfortable” lifestyle and then tax the rest at 100% to finance services for the poor and middle class. Is that what you are suggesting?
    I believe in paying a “fair share,” the definition of which is subject to debate and difference of opinion. My own definition, which many people think is too high, is a total federal tax burden (federal, state and local) of between about 33% of gross income and 40%. If liberals want to argue for a higher percentage like 50% or 60% or more, they should have the courage, honesty and decency to articulate their view in those terms, and let voters factor that in, along with their views on other issues, in deciding whether to vote for them or not. To dodge the issue by not offering a number or a range for the tax burden is disingenuous at best and dishonest at worst.

  9. Barry, if you give the people only half the story — that is, that the cost will be $1000 per year — without giving them the whole story and that it would reduce consumer prices by an equal amount, I guarantee that you’ll get those results. It’s called stacking the deck to get the answer you want. But the majority of US citizens support a single-payer plan.
    >>> “The attitude that high income people are always ripe for further soaking no matter how much they are already paying is galling.”
    While I’ve paid far more taxes than the average taxpayer, Barry, I nonetheless have that attitude. Galling as it may be. I am not altruistic, but I am a strong believer in the progressive tax system. It is not unfair; it is necessary if we are to protect the longevity of our democracy.

  10. “But I disagree that the (lower wage) public will resist increased taxes if it resolves the health care problems. (I don’t have that same confidence with higher-waged earners who have a tendency to be a bit more, shall I say, “conservative.”)”
    According to the recent report by the Citizens Health Task Force, only 12% of people surveyed said they would be willing to pay an extra $1,000 per year or more to get us to a healthcare system that covers everyone. An additional 17% would pony up an additional $300-$999 while 71% would contribute 0-$299.
    I don’t think this will cut the mustard by a long shot. I suspect that if you really pressed most people about how such a system should be paid for, they would respond like my late father in law used to on similar issues. He would shrug and say “Let the rich pay.”
    The attitude that high income people are always ripe for further soaking no matter how much they are already paying is galling.
    To read the full report by the Citizens Health Task Force, see http://www.citizenshealthcare.gov.

  11. Barry, with a “fair” single-payer system BIDMC and all others will indeed be able to provide good care, just as they do in all other s-p countries. If you don’t want to consider Canada as the model, look at Japan or France.
    But the emphasis is on “fair,” and that’s the last thing in the world the for-profit health care interests want to see. They want to retain our current free-for-all system, and “fair” is not good enough.
    >> “doctors are generally not profiting personally from the tests they order for hospital inpatients”

    Very frequently the doctors do indeed profit from in-patient tests because they have a contract with the hospital to provide medical interpretations of these tests. While they do not share in the technical component, they walk away with 100% of the professional component. You are correct, however, with regard to those who are not “on contract.” You can be assured that the order is either needed, may help in excluding a potential disease, or simply done to cover their ass (which also draws us to the issue of malpractice reform, and I agree with Eric on that issue).

    >>> “With respect to your assertion that wait times under a single payer system could be avoided if it were “properly funded,” the problem is that demand is potentially infinite, especially if there are no co-pays or deductibles and nobody ever receives a bill.”

    I don’t know of a lot of patients who like to needlessly sit in doctor’s waiting rooms, but “infinite demand” is not a likely scenario. I don’t have a problem with reasonable co-pays, but as I have mentioned before they could backfire and keep people away until disease is more costly to treat.

    >>> “Even if it wanted to, Congress cannot just keep raising taxes to the extent necessary to keep the system “properly funded.”

    We need proper regulation to control over-utilization, unless we adopt a salaried system like the VA.
    But I disagree that the (lower wage) public will resist increased taxes if it resolves the health care problems. (I don’t have that same confidence with higher-waged earners who have a tendency to be a bit more, shall I say, “conservative.”)
    A single-payer plan that is 100% funded by taxpayers will reduce consumer costs for products that currently have health care built into the product price. Fewer jobs will be outsourced to other countries because manufacturers will be able to better compete.

    >>> “Finally, regarding your comment about finding Medicare payments to be fair compensation in your business, my perception is that cardiac care is one area of healthcare where Medicare pays comparatively well. It tends to reward tests and procedures much more generously than it rewards time based counseling and consulting.”

    I was at the bottom of the food chain, but even if cardiac is better reimbursed is no reason to throw the baby out with the bathwater. A fairly reimbursed system is better than a free-for-all system.
    We cannot solve the tax issue here, but I’d refer you to my page at http://www.throwtherascalsout.org/taxes.htm.

  12. Jack,
    I’m glad to see we have some common ground regarding the end of life care issue.
    Regarding my comment about BIDMC not being able to afford to provide its current level of care if it had to accept Medicare rates from all patients, doctors are generally not profiting personally from the tests they order for hospital inpatients. They are probably more interested in exercising what they consider to be sound medical judgment and protecting themselves from lawsuits (defensive medicine) than worrying about whether the hospital is making money or not on the tests they order and drugs they prescribe.
    With respect to your assertion that wait times under a single payer system could be avoided if it were “properly funded,” the problem is that demand is potentially infinite, especially if there are no co-pays or deductibles and nobody ever receives a bill.
    In the U.S., since World War II, federal revenues (taxes) averaged approximately 18% of GDP. They will be 18.4% for the year just ended and peaked at a bit above 20% in 2000. Given that long history, there is an implicit consensus in the country, at least so far, that we will not tolerate a federal tax burden much above this range, no matter how much money is given to politicians by special interest groups. Even if it wanted to, Congress cannot just keep raising taxes to the extent necessary to keep the system “properly funded.” That inevitably means that provider payments will be squeezed and/or benefits will be reduced.
    I also think you may be overestimating how much money can be squeezed from a small sliver of high income people via progressive taxation. While I would support raising the capital gains tax (and now the tax on qualified dividends) back to 28% that prevailed after the Tax Reform Act of 1986, the top individual tax rate on ordinary income is 35% at the federal level and between 7% and 10% in many of our most populated states — NY, NJ, CA, etc. Furthermore, there is a combined employer/employee tax of 12.4% on the first $94,000 of wages for Social Security and another 2.9% on ALL WAGES for Medicare. Throw in property taxes, sales taxes, etc., and many of us in high tax states are already paying more than 40% of gross income in federal, state, and local taxes excluding the employer share of Social Security and Medicare which most economists say we are also paying in the form of lower wages than we would otherwise be paid if the tax didn’t exist. There are people in finance, law, medicine, etc. who earn high incomes but who have not yet acquired a lot of wealth. Most of these people do not want the government as the senior partner in their lives — taking more than 50% of their income in taxes.
    Finally, regarding your comment about finding Medicare payments to be fair compensation in your business, my perception is that cardiac care is one area of healthcare where Medicare pays comparatively well. It tends to reward tests and procedures much more generously than it rewards time based counseling and consulting.

  13. We have a guy like Bloomberg; he’s named Kohl. I don’t like him, but even when he votes for stupid things I know its his own stupidity and not dictated by moneyed interests. I can live with that.
    I recognize that this is not a political blog, but it is the moneyed health care interests that I believe are driving the medical community in a direction it cannot win. I will put my money on the corporations that control the gold.

  14. “I am sick of the corruption too but it crosses party lines. Maybe we are nearing a time in this country’s history when a legit 3rd party can actual have a shot at power. Unlikely though.”
    You might want to keep an eye on New York City Mayor Michael Bloomberg. If he decides to run for President in 2008, he could easily self-fund his campaign to the tune of $500 million or even more, if necessary!
    He already self-funded both campaigns for Mayor (this is is 2nd and last term), and most of us think he’s done a very good job. Self-funding allowed him to maintain independence from the powerful public employee unions, and he won both times despite their opposition.

  15. Peter– I was worried that angry, angry comments were not forthcoming, so I am glad I have you ‘back on board’.
    As soon as you devolve into an anti-Bush/ republican rant, serious health policy discussion ceases.
    Corruption is a big problem. For both sides of the aisle (Rep. Jefferson, Sen. Menendez, Sen. Reid, Rep. Mollohan, just off the top of my head on the Dem side). Reps Ney and Cunningham are a disgrace to the country.
    Rep. Foley very well may be a criminal.
    But that is both the point and beside the point.
    You want to reduce the impact of big money lobbying Congress? Reduce the ability of Congress to spend your money.
    If I may, please answer me this question:
    You want to get money out of politics (get rid of policy-for-hire politicians and corporatee America); 1 out of 6 dollars of the economy is spent on healthcare; how would you propose to change things to remedy these problems?

  16. pgbMD, a legit 3rd party is at least something we can agree on. I’m pissed at both parties because both parties are crooked as hell and blocking the fixes we need not just in health care, but in many facets of society.
    But I agree with Peter that Tricare is not the standard we should be using for a single-payer plan. Prior to becoming a Medicare patient I dealt with Medicare for years and always found them fair. They never made me rich but I also never lost money with them.
    But all I am hearing from physicians is that only a free market approach (I prefer calling it a free-for-all approach) is the only thing that will work. The VA and armed forces systems proves this theory wrong. A properly funded single-payer plan will protect both patients and physicians from our current direction, which is an HMO-for-all system.

  17. “or the wait times of those unisured who need many other types of medical care, like transplants, who can’t afford the $100K upfront fee”
    All renal transplants are 100% covered by medicare so if you are rich or poor in this country you wait in the same line unless of course you are some hollywood type that killed his liver with etoh and gets to jump the line.
    “Where is your patriotism? We have brave men and women fighting and sacrificing to protect YOUR freedoms here.”
    I don’t think it is appropriate here to start questioning someones patriotism on this blog, but if you are interested I know a couple of recruiters I can send your way to sign-up you or your kids!
    “if the military families can’t get Ticare to look after them why don’t they just opt-out and go with their own plan?”
    No opt out option for active duty and most family member dependents can’t afford to opt out b/c of the huge out of pocket expenses they tag on.
    “As an “old Republican,” I’ve become very disappointed with the Neocons. If they had “values, honesty and integrity,” we’d not have the corruption in government that we have today.”
    I am sick of the corruption too but it crosses party lines. Maybe we are nearing a time in this country’s history when a legit 3rd party can actual have a shot at power. Unlikely though.

  18. pgbMD, if the military families can’t get Ticare to look after them why don’t they just opt-out and go with their own plan? Could it be the same reason that many military families need food stamps?
    Barry, you keep pointing out wait times as a fault of government run systems. But you don’t point to the wait times for the uninsured who can’t afford treatment. Or the wait times for those people who have had their homes confiscated for non-payment of healthcare bills, or the wait times of those unisured who need many other types of medical care, like transplants, who can’t afford the $100K upfront fee. Or the wait times in many of our overloaded ER’s where the system is collapsing. Or the wait times for the families devastated financially by a sick member, whether with or without insurance, by this money sucking machine called “The U.S. Healthcare System”. What you really mean is “MY” wait time will suffer, but all you other slobs, you can wait.
    Quote by Eric,
    “We called and asked how they could justify the pay cuts when government continued to pay TRICARE at above medicare rates— the answer, and I quote– “be patriotic”, and take the pay cut.”
    Eric, Where is your patriotism? We have brave men and women fighting and sacrificing to protect YOUR freedoms here. The least you can do is “SUPPORT OUR TROOPS” by giving a little on the home front. But hey, what good is a war if we all can’t profit by it while OTHER peoples kids are dying.

  19. >>> “CMS ….. have not been able to control their costs, and …. academic medical centers …. say they could not sustain their current level of care at Medicare rates.”

    Barry, that’s because physicians over-order on Medicare patients too, because they are also profitable (though not as much so). If they were losing money on Medicare that surely wouldn’t be a problem. Testing would go down.

    >>> “everyone else would be worse off as quality deteriorates, wait times expand and explicit rationing sets in.”

    It wouldn’t have to be that way if it were properly funded. But as in Canada, the for-profit health care interests will lobby to block funding so it encourages pressure to move back to a free-market system that they can profit under. We can’t even surmise what the politicians would do, except without political money they would follow the desires of the public.

    >>> “As for companies becoming more competitive if they no longer had to pay for health insurance, I think, as a former business owner, you know better. If the current system were replaced with, say, a 15% payroll tax (similar to the German system), even if the employee paid the whole thing, employers would likely have to raise wages so employees could cover the tax and still have comparable income to what they had before to pay for all of their other living costs. Thus, net costs for employers would not go down. In fact, they would rise for employers who previously did not provide health coverage.”

    You are suggesting an employee tax and I am not. This should be a government expenditure that is progressively paid by the taxpayers. Not employers. But even if it were, the employee tax in Canada is only $800 compared to the $6500 it now costs US employers.
    You are right that health care is not the only problem GM has; it is the other issues as well. The $6500 vs $800 is nonetheless the greatest factor.

    >>> “The Europeans are also paying for their expansive social safety net, not only in the form of very high taxes, but also stagnant economies and way too few economic opportunities for their young people resulting in much higher unemployment than here. Canada and Australia are doing relatively well now because of high prices for energy and other commodities, but those industries are extremely cyclical.

    So in the end, if we want a vibrant economy, we have to accept healthg care and energy rip-offs?

    >>> “longer wait times, explicit rationing, and a more restrictive approach to providing care at the end of life”

    I don’t believe that longer wait times are necessary, but I would accept restrictions at end of life unless the family were willing and able to pay for extraordinary care.

  20. Jack,
    CMS, along with state governments, currently spend approximately $800 billion per year to provide healthcare to over 85 million elderly and indigent people or slightly more than the population of Germany. Depsite reimbursement rates lower than everyone else’s, they have not been able to control their costs, and costs are increasing just as rapidly in the countries with national health insurance as well. Large acamdemic medical centers like Beth Israel Deaconess in Boston say they could not sustain their current level of care at Medicare rates.
    While the currently uninsured might be net better off than they are now under a national health insurance scheme, I suspect everyone else would be worse off as quality deterioriates, wait times expand and explicit rationing sets in. Even if we went to complete taxpayer financing for political campaigns, politicians would quickly run into budget constraints in trying to finance growing healthcare costs and would react initially by trying to squeeze provider payments even more.
    As for companies becoming more competitive if they no longer had to pay for health insurance, I think, as a former business owner, you know better. If the current system were replaced with, say, a 15% payroll tax (similar to the German system), even if the employee paid the whole thing, employers would likely have to raise wages so employees could cover the tax and still have comparable income to what they had before to pay for all of their other living costs. Thus, net costs for employers would not go down. In fact, they would rise for employers who previously did not provide health coverage.
    Regarding the automotive industry example you like to cite about costs being cheaper in Canada, GM’s problems relate to retiree healthcare costs and not making enough cars that people want to buy. Foreign transplants keep building non-union plants in the South where they higher plenty of workers at competitive wages and provide good health insurance.
    The Europeans are also paying for their expansive social safety net, not only in the form of very high taxes, but also stagnant economies and way too few economic opportunities for their young people resulting in much higher unemployment than here. Canada and Australia are doing relatively well now because of high prices for energy and other commodities, but those industries are extremely cyclical.
    I think single payer advocates might have more credibility if they suggested that longer wait times, explicit rationing, and a more restrictive approach to providing care at the end of life, while not ideal, are probably part of the equation if we expect to provide healthcare for all at a price the society can afford and sustain.

  21. >>> Eric: “I believe the answer is to dis-empower government and lobbyists by putting more value and responsibility in the hands of people. That simply cannot happen under a single payer system.”
    Eric, the answer is to get special interest money out of our corrupt political system. If politicians were not receiving $100 million per year from the health care industry we’d have this system fixed overnight. And we’d also not have $300 billion per year going to tax breaks, subsidies and other corporate welfare, thus the resulting government deficits wouldn’t force the cuts in health care (including the TRICARE that you and pgbMD dislike so much).
    >>> Peter described well the problems Canada has and nailed it on the head: “I think for a single pay system to work here we would need to get rid of the policy-for-hire politicians who along with corporate America have the system gamed to operate on bribery and not on good policy.”
    OF COURSE the health care apologists don’t want the system fixed. They are benefiting from it. But they are, indeed, going to lose control to the corporations over time. As we discuss this here today, corporations are planning health care consortiums to control their costs (and the profits currently being taken from the system). It’s called HMOs-for-all. Get used to it.
    >>> Peter: “We (not me, I wasn’t stupid enough) were sold the idea that Republicans had family values, ethics, honesty, integrity over the evil Democrats and Clinton.”
    Right on, Peter. As an “old Republican,” I’ve become very disappointed with the Neocons. If they had “values, honesty and integrity,” we’d not have the corruption in government that we have today.

  22. Just a quick personal note on TRICARE. We ‘dropped’ TRICARE a couple of years ago when they summarily told us that our reimbursement was dropping to 83% of the medicare fee schedule. Remember that TRICARE gets paid by the federal government at above medicare rates to administer health insurance for military- active and retired, in many cases- and their families.
    We called and asked how they could justify the pay cuts when government continued to pay TRICARE at above medicare rates— the answer, and I quote– “be patriotic”, and take the pay cut.
    We no longer participate in TRICARE.

  23. I can give you more examples that are not just personal. While my wife was pregnant with twin girls we went to a multiples meeting with about 20 pregnant women some of whom were trapped in the TRISCARE system. They all had horror stories. I was embarrassed to identify myself as a doctor in the TRISCARE system. I thought they were going to flog me, but instead I gave them my cell phone number and told them to call me if they are having trouble getting in through “the gate”. I never did receive a call, but they did appreciate having my number just in case. I can go on and on. We don’t have a robot at the hospital, but at the same time we won’t cover patients who want to go to a civilian hospital to get a robotic prostatectomy. Just not right.
    Bottom-line, from my long experience in a single-pay system, it puts way too much power into the hands of the beaurocrats and politicians.

  24. I suggest that the single payer advocates check out a blog started a couple of months ago by Paul Levy, CEO of Boston’s Beth Israel Deaconess Medical Center called Running A Hospital. It can be found at http://www.runningahospital.blogspot.com. Scroll down to a post of 8/11/06 about the single payer concept, along with the six comments. It’s a very interesting and informative perspective indeed.

  25. pgbMD,
    You gave one example, TRICARE, with your own personal (subjective) experience as evidence. There is also the VA system as an example of government as the payer in the US. There is also Medicare and Medicaid. Why not look at these as models instead? And while personal experience is one of the reasons I come to a blog like this, it is no substitute for large scale data on system performance. TRICARE may be a program in disarray. I’d welcome a larger analysis.
    I tell you what, I’ll wake up if you’ll open your eyes.

  26. pgbMD, that who-you-know line jumping happens in the Canadian system as well, but my experience there has been all good. My experience here all bad. It depends how it’s managed, who controls the budgets, and who sets the priorities. In Canada every election has healthcare as an issue. But at least Canadians have a chance through the democratic process to change the system, what chance do voters have here, unless they can hire a carpet-bagger lobbyist. Usually I have found these government systems get underfunded, not because of necessity, but because of ideology. The private pay people want the system to fail so they can move in to pocket the profits. But there is no excuse for poor and incompetent management. I think for a single pay system to work here we would need to get rid of the policy-for-hire politicians who along with corporate America have the system gamed to operate on bribery and not on good policy. If Americans don’t like the system they may have to actually pay attention and participate in the political system. Maybe your wife has to wait because we are spending $2 billion per week on Iraq and corrupt contractors. Why couldn’t our troops get body armour and bomb/bullet proof humvees? Maybe the same reason your wife couldn’t get an appointment.

  27. You single pay people need to wake up. I work in the TRISCARE system in the military and it sucks. My wife has to call for months to get an appointment for our kids to see a pediatrician and when she gives up I end up calling the head of the peds clinic and force my way in b/c I am an MD in the system. Horrible. Lived in the UK for a while and that system is the pits. Americans would not like it.

  28. “I am GENERALLY not in favor oof the unholy alliance between overly powerful, myopic companies and trade organizations…”
    Eric, when would you be SPECIFICALLY in favor of an unholy alliance? The AMA one maybe?
    “Not the least of which is that the proponents have no plan to reduce spending, reduce benefits, reduce access, change education funding, enact substantive liability reform, scale a system to a country the size of the US, and on and on and on.”
    So what “plan” of yours shows us the way to the promised land? All I’ve seen from you and your supporters Eric is self serving, “how to tweek the present system” so we keep what we have. We have worldwide examples of how to structure such single pay plans and systems as well as ways to improve them for this country. Those that support those plans have all presented the ways to do everything on your list. But what keeps this “system” going is the “UNHOLY ALLIANCE” you claim to dislike. Read this to get one more way the system is rigged.
    “By James V. Grimaldi and Susan Schmidt
    Washington Post(Today) – Five conservative nonprofit organizations, including one run by prominent Republican Grover Norquist, “appear to have perpetrated a fraud” on taxpayers by selling their clout to lobbyist Jack Abramoff, Senate investigators said in a report issued yesterday.”
    We (not me, I wasn’t stupid enough) were sold the idea that Republicans had family values, ethics, honesty, integrity over the evil Democrats and Clinton. They would bring back dignity to the White House. And right in the thick of this fraud is/was Tom Delay and the rest of the junta that has convinced the electorate that the Christian bible is all we need to govern.

  29. To all- I am generally not in favor oof the unholy alliance between overly powerful, myopic companies and trade organizations who spend freely in Washington and state capitols to create carve out after carve out, and loophole after loophole with no regard for anything but their own organization.
    I believe the answer is to dis-empower government and lobbyists by putting more value and responsibility in the hands of people. That simply cannot happen under a single payer system.
    There are many reasons that it is difficult to look to other countries when designing a US – single payer system. Not the least of which is that the proponents have no plan to reduce spending, reduce benefits, reduce access, change education funding, enact substantive liability reform, scale a system to a country the size of the US, and on and on and on.

  30. Eric, I take it you don’t approve of this example of Healthcare by lobbyist. Wasteful, corrupt, overly expensive. Sounds like you are also against the rest of our rigged healthcare system – Healthcare Policy by Lobbyist. Wasteful, corrupt, overly expensive with politicians, not researchers, chasing dollars.

  31. Eric, I’m not sure I see your point. Are you saying that universal payer is bad because there will be lots of healthcare lobbying? Do you mean to suggest this is different from what we have now?
    Please explain why there will *necessarily* be any more lobbying in a system in which there is universal, single-payer healthcare. As you point out, there is an enormous amount of it in the current system. This is for two reasons: 1) There is an enormous amount of money made and spent in healthcare and lobbyists follow the money; 2) lots of people care deeply about healthcare issues because they care about specific diseases and making sure people don’t get them, or don’t suffer too much from them. Reason #2 stays the same whether we have universal healthcare or not. Reason #1 would actually suggest that in the long run healthcare lobbying would decline if we have real reform that moves healthcare from being 16% of the economy to something closer to 10%.
    Whenever people try to scare us about universal healthcare or single payer, my first thought is always: does this scary scenario exist in Europe or Japan? If it doesn’t, that is proof positive that the feared outcome can be avoided. Is lobbying worse in Europe than it is here? I have seen no evidence of it. Please show me if you know otherwise.

  32. “The article ostensibly discusses how there are over 140 advocacy groups for brain tumors alone— and how they actively compete against each other for members, funding, and the ear (and hopefully pocketbooks) of elected officials.”
    And their jobs. They are competing for their jobs.
    As someone involved in research I daily see and talk to people who are ‘chasing the dollar.’ Looking for the next fundable research project. These people are less interested in scientific advancement and more interested in career and financial advancement.
    And I’m not talking about pharma projects. These are doctors trying to get on the blood pressure/obesity/diabetes/insertcurrentissuehere.
    Sadly, a lot of doctors don’t like being doctors. So, they do research. If their funding runs out they are back to sitting in clinic looking at sick people.
    The reserach system is flawed at its very core. We keep throwing more money at the problems.

  33. All of these musings about the single payor system make me chuckle… Legislators can sit around and create bills out the wazoo and spend our tax dollars doing it. The truth of the matter is that healthcare providers which are in insurance networks will always be slaves to which services insurers decide to cover. By the time an insurer decides to cover a service or immunization which is cutting edge, it is five years later. Consider a growing niche of pediatrics which first and foremost puts customers FIRST and makes the current competition in pediatrics healthcare IRRELEVANT. Our patented system of software and hardware enables pediatricians to return to a simpler for of pediatric care which every parent in America wants!! Take a look at my blog at http://Personalpediatrics.blogspot.com and http://www.personalpediatrics.com to see the future of healthcare. You can sit and wait for politicians to save you, but I fear that you will be waiting a LONG time! Natalie Hodge MD

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