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Massachusetts doctors say single-payer or bust

Massachusetts members of the Physicians for a National Health Program released a report today faulting the state’s experiment with health reform for failing to achieve universal coverage, being too expensive and draining funds away from safety-net providers.

The doctors’ punch line is that the reform has given private insurance companies more business and power without eliminating vast administrative waste. In fact, it says, the “Connector” in charge of administering the reform adds about 5 percent more in administrative expenses.

In summary, nothing less than single-payer national health reform will work, according to authors Drs. Rachel Nardin, David Himmelstein and Steffie Woolhandler, all professors at Harvard Medical School.

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The report criticizes the Urban Institute’s largely favorable report that found only 2.6 percent of Massachusetts’ residents 

were uninsured in mid-2008 because it failed to sufficiently reach non-English speakers in its survey.

Reports in Health Affairs this winter also found significant positive support for the reform among employers and the public. There was little evidence of crowd-out.

The PNHP doctors’ report says health plans people are forced to buy are not affordable and often skimp, making the mandate that individuals buy them regressive. And moreover, it says, peoples’ experiences have shown that insurance does not guarantee access to care. The Boston Globe chronicled the long wait for primary care last September.

A final criticism the 19-page report offers is that the reform is financially unsustainable, as it does “nothing about a major driver of high health care costs, the overuse of high-technology care such as CT scanners and surgeries, and the underdevelopment of primary care.”

Last winter, Himmelstein spoke about health reform to students at Johns Hopkins School of Public Health. I asked him if single-payer advocates would work against any national reform effort that wasn’t single-payer, as the single-payer camp did in California.

Himmelstein said that if the reform plan looked like the Massachusett’s reform he probably would prefer the status quo. He believes the reform has made most vulnerable patients in Massachusetts worse off.

It looks like health reform is going to be a battle on the Left and Right.

See Also: “Fear and Loathing over the Stimulus Bill” by Joe Flower.                 “The Stimulus Pregame” by Robert Laszewski.                 “Commentology

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43 replies »

  1. You people against single-payer are so stupid I pray to wake up and not be American anymore.

  2. C’mon. Please. Answer. Somebody must be able to think of SOMETHING that the insurance INDUSTRY (as opposed to the general concept of insurance, or risk pooling) brings to the table. Really…what are they good for?

  3. I guess I didn’t frame the question well enough. What I was asking was what is the advantage of having private insurance companies, as opposed to, say, a Medicare-for-all?

  4. Well… Insurance companies, in the main, protect patients from financial ruin in the case of catastrophes during which they must be admitted to the hospital and undergo expensive procedures such as stenting, brain hematoma evacuation, cancer treatments, etc.. I think this is a clear benefit. I also think this is their core mission and all the other third-party payments for other stuff (medications for chronic conditions, office visits, etc.) is part of the problem. To compare to another industry, auto insurance should be used for that rare time when you have an accident, not to put gas in your care.

  5. One way to look at this is to simply ask what exactly is it that insurance companies bring to the table. Curious, and worried that I was missing something, I informally polled a bunch of my colleagues (I am a Pulmonary/Critical Care doc) and asked them what good things they thought the insurance industry had brought to the American health care system. No one could think of a single thing.
    Can any of you think of anything good that the private insurance industry has done for our healthcare? I am not being facetious.

  6. The single payor should be the patient. Government has brought healthcare to the edge of ruin. Single government payor politicizing healthcare decisions is insane. Remember that the USSR had single payor healthcare, and they no longer exist.

  7. David directs us to Robert Ralston’s article claiming that the United States has the “best health care” in the world. That might satisfy Ralston’s libertarian ideology in which you have the freedom and personal choice to purchase the best health care, but that freedom doesn’t help much for those who can no longer afford health insurance or health care.
    Keep in mind that the Milliman Medical Index shows that the average health care costs for a family of four with employer-sponsored coverage is now $15,600 (average – many are paying more).
    Rather than turning to an ideologue like Ralston, we might listen to OECD economists from an organization representing “countries committed to democracy and the market economy” (not exactly a left-wing concept). In their report, “Health Care Reform in the United States,” just released this month, they state: “In spite of improvements, on various measures of health outcomes the United States appears to rank relatively poorly among OECD countries. Health expenditures, in contrast, are significantly higher than in any other OECD country.”
    That is not exactly a description of the best health care in the world, only the most expensive. We pay far more, yet most of us receive only mediocre care or worse.

  8. Peter and others:
    The way to implement a system like that put in place by Mayor Bloomberg (cited in an earlier comment of mine) is to start with liberal states like Massachusetts and California, New Jersey, etc. and pass the plan that is used in New York. Then go to other liberal states, etc. and eventually there would be a “tipping point.”
    Any attempts to “improve” health care in the US without eliminating the subsidy for poor health habits such as smoking will simply lead to a rationed health care system where those that have chosen not to lead an unhealthy life style will lose out to those who consume massive amount of health care resources caused by their lifestyle choices such as smoking.
    We have to end the subsidy and that is started by New York City and State and must be emulated across the nation starting as I said in California and Massachusetts and New Jersey.

  9. Peter,
    I guess my point was that by introducing mandates, you end up driving the private sector out of business and then there is less ‘care’ available.
    I see a larger point, though. Certainly no one can be a supporter of the status quo – since it is awful. But if you find yourself in a mixed system – half free and half controlled by government – you have to ask yourself which is most contributing to the ‘badness’ of the current system.
    My view is that the massive government interference that already exists in health care is the fundamental producer of problems. This interference exists at countless levels – federal, state, local, and local hospitals. Everyone has an opinion on health care and everyone feels they have the right to interfere in the process. They mean well, but they ultimately add one more layer of stupidity to the system.
    Some issues are: (1) A non-objective malpractice system which assumes perfect knowledge and information and which awards high amounts based on pain and suffering (2) FDA control over drugs, causing significant costs for any company that wants to develop drugs – I would modify the FDA to make it advisory, not give them control over the industry (3) state control over medical licensure, thereby limiting the number of physicians who can enter the market (4) ERs and hospitals forced to care for patients (5) Medicare – which has virtually taken over the market for an entire segment of the population, giving de facto government control over many aspects of how hospitals and physician’s practices are run (6) state laws against balance billing – which essentially eliminates physicians ability to set their own prices (7) massive control over health insurance companies – limiting what products they can offer, what prices they can charge, and disallowing buying insurance out of state (8) a tax code that allows lower prices to be offered from insurance to companies, but not to individuals – thereby tying your insurance to your job. There are many more issues, there are many, many stupid controls over the system, that ultimately serve no one and that ultimately make it that much harder to provide good products.
    But people don’t see this, because not enough people who should know better are pointing it out to them. In the drumbeat to establish (or widen) government control over healthcare, (which, you must admit, is so easy to say and doesn’t involve all of the complexities in the paragraph above) one seems to provide a simple ‘solution’ to a complex problem. By smoothing over all of these thorny issues that serve to establish how we got here, the past is ignored and, in the end, people’s control over their own health is defeated.
    So my answer, as would seem obvious, is to eliminate, as much as possible, all these government controls that are destroying an entire industry. Allow the market to work. If you have concern that there will be people left out of the system, then pursue charities, volunteer, and do your best to help out those people. Instead, by controlling the system, you will eliminate all the good products, care, and innovation that the system can provide. You will, in fact, halt the usual progress of medicine towards better and better care.

  10. David, my point was that the U.S. system is doing worse providing needed care than single-pay systems. I’m not sure what your point is other than to allow ERs the ability to deny care as the solution. People go to ERs for health needs, not social needs. I agree that ERs are the worst and most expensive places to get primary care, but people end up there when they can’t get or afford primary care. Single-pay managed systems have the capacity to manage their way out of problems, in the U.S. there is no one at the helm to address these issues – the “system” just keeps floating down river without a rudder.

  11. Dave, the countries with the highest life expectancies are Japan and Sweden, which operate single payer socialised health care. Your contention that such a system produces high mortality rates for pensioners is not supported by the evidence. The US, on the other hand, does worse than Bosnia.

  12. The PNHP report was a critique of the Massachusetts plan. Several of the comments here are directed against single payer, but don’t adequately answer the concerns expressed in PNHP’s report. Following is an incomplete list of reform goals that would be achieved by a properly designed single payer program. The reason we believe that the Massachusetts plan is not a model for the United States is that it has failed to achieve every one of these goals (with the last one added as our obligatory whack at the private insurance industry – an industry incapable of achieving these goals).
    Let’s look at some of the goals, and how Massachusetts has fared:
    * Everyone should be included – We should quit being dishonest when we say universal, and start demanding that universal means absolutely everyone. The Massachusetts model has left perhaps five percent of individuals without any coverage whatsoever, and there is little likelihood that the numbers of uninsured will be reduced further because of serious flaws in their model.
    * The growth in health care costs must be slowed – The Massachusetts model has been ineffective in addressing the primary causes of excess cost escalation.
    * Health care must be affordable for each individual – Insurance premiums and cost sharing in private plans have remained unaffordable for many in Massachusetts, impairing access to care. Insurmountable debt or personal bankruptcy from medical bills remains a very real threat in Massachusetts.
    * Under-insurance must be eliminated – Massachusetts has expanded the problem of under-insurance in an attempt to make premiums affordable, failing to achieve either goal of adequate plans or affordable premiums.
    * Administrative waste must be reduced – Massachusetts has added complexity to an already complex financing system, significantly increasing the administrative waste in their system.
    * Coverage should be automatic, portable, and permanent – Massachusetts has provided further confirmation that no model built on our dysfunctional financing system can achieve these goals.
    * Health care must be accessible – The Massachusetts model has further exacerbated the deficiencies in the state’s primary care infrastructure, resulting in increased difficulty in accessing their system. Their fragmented financing model has very little capability of realigning resource allocation to improve access.
    * Private intermediaries that waste resources and impair access must be eliminated – But isn’t this what the Massachusetts plan is all about? Their view is that we must use our public agencies and tax funds in an all-out effort to protect the private insurance industry, regardless of the harm to patients in the form of physical suffering and financial hardship.

  13. Peter,
    From your article on EDs being overloaded:
    “Emergency medical care is a legal right for all Americans. Under a law enacted in 1986, emergency rooms must evaluate and stabilize anyone who shows up.”
    A paragraph later, we learn: “From 1993 to 2003, the U.S. population grew by 12 percent but emergency room visits grew by 27 percent, from 90 million to 114 million. In that same period, however, 425 emergency departments closed, along with about 700 hospitals and nearly 200,000 beds.”
    The second is the consequence of the first. If you say someone has access to health care by right, then you invite many people to use or overuse that thing. The ultimate consequence is that the hospitals and ERs that have been forced to provide the free service shut down. There, now no one can have any service! Good job, EMTALA supporters! Your belief that medicine grows on trees and is there for the taking is being exposed.

  14. I’m not a single payer fan a la Steffi & David and Canadian system (I am fan of social insurance a la Holland, but that’s a different story)>
    However, Carlton and others who say it “couldn’t happen here” are being naive. For a start we already have a single payer system called Medicare that would be relatively easy to extend. Secondly even a Forrester analyst (ooh, cheap shot) might have noticed that radical and unexpected changes can happen to any industry if that industry goes into failure. Third, playing out the tape of our current health care story it’s easy to see a scenario in which employer based health benefits for the middle class collapses all at once as it did for the working poor mostly in the early 1990s. Finally, the current political mood towards centrist liberalism may be masking a bigger swing towards a more radical progressivism. (Remember FDR & the New Deal?) You can certainly read that into the poll numbers on people’s views. Add that into unaffordable health care for 80 million uninsured middle class Americans, and “Medicare for All” becomes a very real possibility.
    I’m not saying it will happen, but never say never!

  15. David, I agree, but there have been groups fighting for corporate accountability for pollution and food responsibility for decades with snails pace success due to lobbyists and corporate political contributions. If you watched ABC News lately there was a story about rampent tooth deacy in Appalachia mostly due to the particular ingredients in Mountain Dew and its over use. PepsiCo CEO found the story so potenially damaging that she said she would work on education and donated an additioinal mobil dental office to a doc trying to provide free care to poor people. I remain sceptical about Pepsico’s “educational” effort but welcome their donation, even though they did not say they would also cover operating expenses. We can institute the things you suggest but the public and businesses will have to accept slower sales. How do you address the illness already in the pipeline while we wait for these taxes to have an effect?

  16. Umm….how is this for an idea? Emulate New York City’s lead (thanks to Mayor Bloomberg) and help people quit their smoking habit by raising taxes so that cigarettes cost $10/pack and have the tax revenues go into health care. That way smokers are at least paying for part of the additional health care costs they incur instead of having non-smokers subsidize it (recall anti-smoking warnings have been on cigarette packs for 45 years).
    Also NY State is having an 18% Obesity tax on sugar coke (but not diet) and Massachusetts should emulate this great idea as well putting the tax revenues into health care.
    Moreover, pollution causes health care costs so pollution emitting power plants and automobiles, etc. should be charged a health service fee that goes directly into the health care system.
    You see, once society insists that those who choose to incur additional health care costs either due to lifestyle choices or polluting our air actually pay for it instead of having taxpayers and private firms (through additional health care premium costs) then the costs of health care for the rest of us will go down and besides will help smokers to quit tobacco and polluters to put in anti-pollution equipment.
    The health care system will be impossible to fix until we address these sorts of issues.

  17. No one mentioned the best-kept secret of single-payer healthcare: it reduces pension costs by eliminating pensioners. They die of chronic illnesses after waiting months for life-saving surgery. Or they spend hours in a crowded emergency waiting room and pick up SARS from a dying Chinese woman. Capitalism is unfair — under socialism, everyone has an equal right to be denied health care!

  18. Well anon, we’ll just go into the poor neighborhoods and recruit by paying all education costs. I prefer my docs not in it for the money, just like I prefer Wall Street in it not just for the greed – as you can see where that got us.

  19. Peter
    Peter,
    No other country has a medical tort system like that of the US, mostly because of the private sector for-profit nature of the “system”. If one changes the nature of the system without changing the risk of practicing it, it seems to me that one should expect a significant decrease in the # of competant providers. It goes without saying that someone else beside the provider-in-training will have to pay for educating the new practitioner to enter the system. No sane individual would give up 7 productive years and an extra 200k to boot to enter a system that would not allow him to profit in some way over his professional life, not when there are so many other opportunities in a free economy.
    I ask again, can one reasonably expect an adequate # of competant providers in a system that does not allow them to profit from risk (through encouraging productivity) or (mitigate risk through practice patterns)?
    FTR, I speak as one who sees the evidence as suggesting that a supermajority of the money spent on healthcare in our country is harmful to the health of those it is spent on.

  20. anon, your comment seems based on U.S. tort system overlayed on foreign single-pay systems. I can speak directly about Ontario Canada which pays 1/2 of docs malpractice insurance and which you may want to read this about the difficulty of winning a case there.
    http://www.lawworldwide.com/Medical%20Malpractice%20-%20Essential%20Elements%20of%20a%20Claim%20in%20Ontario.htm
    I am not aware that malpractice has crippled single-pay countries. With health care costs from malpractice off the table in universal single-pay awards the judgement need not reflect those costs.

  21. “Skeptic, forced budgets will weed out the winners and losers who will have to be innovative to survive.”
    Peter, what you don’t seem to understand is that 300M people demanding lower prices through a competitive system is orders of magnitude more effective in terms of downward pressure on costs and prices and an increased focus on innovation than any lobbyist controlled govt. parasite budget could ever be.
    The only reason that worked in Japan is that the govt. attempted what the market would’ve done anyway.
    I really can’t comprehend why people don’t believe medical care should be cheap like computers and why they believe that health insurance should even exist as an industry in the first place. I’m not saying you believe either of those things, Peter, but many people with your apparent disposition toward health care do.
    There is absolutely no fundamental difference between the advancement and application of medical technology than any other form of technology, period. It is irrational to think medical technology is special just because it’s used on us and not to build lifeless objects.

  22. Single payer limits the benefit of practicing medicine through price controls but does nothing to mitigate the risk through tort reform. Faced with the same risk and less benefit, most reasonable providers will opt out rather than participate. At the least they will limit their liability by reducing their productivity, cherry picking patients and outsourcing their risk as much as possible (this is how employed physicians approach their situation…. and why one private practice physician is as productive as three employed ones). Mandate participation and physicians retire, emigrate or quit and their replacements will be less capable and less numerous.
    I have yet to here a refutation of this simple logic from the single pay crowd other than “no it won’t”. Anyone interested in taking a crack?

  23. Skeptic, forced budgets will weed out the winners and losers who will have to be innovative to survive. Here’s how Japan does it (ya, I know we’re not the Japanese):
    http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/interviews/ikegami.html
    One excerpt on how MRI costs came down.
    “So the health ministry set a low price, the MRI makers make cheaper machines to help the doctors meet that price, and now Japan is exporting these around the world?”
    We won’t get to cheaper healthcare expecting the present players to invent competition that will cut their own throats. Single-pay advocates have a more realistic understanding of how to fix the system – anti single-pay just give up due to the political road blocks. I have said that fixing the political/lobby/donation/influence system will probably have to come first.

  24. “In summary, nothing less than single-payer national health reform will work, according to authors Drs. Rachel Nardin, David Himmelstein and Steffie Woolhandler, all professors at Harvard Medical School.”
    What makes them think that will work either? The problem is not on the demand side at all. It’s NOT a problem of not enough money to pay for this, or not enough bureaucratic review of requested services. It’s a problem of not enough doctors, nurses and other healthcare professionals to provide the service. When you’ve got a limited supply, increasing demand just drives up the cost.

  25. Peter, I will concede that government enforced global budgets have certainly achieved lower per-capita health care costs (while maintaining universal coverage and a decent level of quality of care) in Canada and much of Western Europe, but it must be noted that every country in the industrialized world which enacted global budgets did so decades before the proliferation of an over-specialized and grossly inefficient health care system (e.g., Britain started its single payer system in the late 1940s). The challenge for the U.S. is to come up with a payment system which will place greater emphasis on prevention, coordination, and evidence-based medicine. I am not aware of any single payer proposal that has been devised in THIS country which has a plausible strategy for achieving these objectives. Any credible single payer proposal must specify a strategy for dealing with recalcitrant physician specialists, redundant facilities, selfish labor unions, etc. None of these folks are likely to “disarm” unilaterally, on the contrary they will use their political clout to maintain their incomes in a single payer system. This is why sober health policy analysts like Harold Luft and Ezekiel Emanuel (see their recent books), neither of whom advocate a pure “free market” approach, have published scathing critiques of the single payer concept. If I thought it would work I would storm the barracades with you, but it just seems incredibly politically unrealistic. We need a strong dose of market competition to weed out the bad actors in our health care system, the government is simply not willing or able to pick the right winners and losers.
    Skeptic

  26. Deron, my point was not the amounts but that no one would ever have considered such interventions necessary in our perfect, forever sustainable, de-regulated free market system. Henry Paulson, a staunch free market supporter, could not have imagined in his worst nightmare that he would be the one using “socialism” to solve market problems. In fact his decision to let Lehman Brothers fail (a free market solution) helped to cause the cascading effect that brought the system down. This county’s long held myths about it’s market system are showing the cracks of unrealistic expectations. The same is going to be true of healthcare. Again, I don’t advocate single-pay to cost me more, but less, as it has been proven in all other government controlled/run/regulated single-pay (with variations) countries. The government has not intervened in the financial system because the financial system was working, it did so because the system proved it could not sustain growth without fraud through debt and that it threatened to dismantle our entire economy. Healthcare is approaching it’s own meltdown due to, not too much government control, but not enough of the right kind. If the present healthcare system is the solution, then why we are we not seeing the fix? Would it not revel itself?
    Skeptic, you are right that single-pay still requires constant assessment on coverage and technology, as well as IT suitability, to assume anything else would say the system needs no management once enacted. Single-pay still needs to address disease prevention, and funding issues, and pervse provider incentives, along with the necessary incentives to keep the system functioning. But it does all of this with enforced universal budgets and riding herd on the system. These systems are not perfect and require constant modification – but there is one related feature in all of them – they provide their citizens better healthcare at about 1/2 the cost that we now provide our citizens the same service.

  27. Those liberal folk who dream of taking over an industry always tout efficiency – but it never works like that in reality. If you just think about it for a few minutes, you will realize that without incentive, any system falls apart. Communists have long felt that a ‘planned’ economy would outperform market-based economies – and have always been wrong – there are simply too many elements for government blockheads to keep track of. For the record, there are too many elements for anyone to keep track of, no matter how bright they may be. There appears to be an ‘invisible hand’ of the free-market – which uses prices and availability of products to efficiently create and produce.
    But I have always felt that liberals have a certain glee in taking over an industry, independent of their stated reasons for doing so. To them, it is ‘natural’ that they and their brethren control people and things owned by others. In this case, the very bodies of people. Freedom, with all its implications (personal responsibility, making your own way, choosing your own health care, ambition), is anathema to them.

  28. Peter – The frightening part is, you would have to add all of the amounts that you listed to get closer to the cost of nationalizing healthcare.
    Is our goal to be a government controlled state? Banking, then healthcare, then grocery stores, etc. We will always have greedy profit seekers. If you shut them out of one industry, they will move to another. When all industries are nationalized, I suppose they have no choice but to move to government.

  29. A single payer system addresses 3 market failures associated with private, voluntary insurance: (1) It effectively eliminates the risk pooling problem; (2) It has the potential to substantially reduce certain types of administrative overhead (e.g., fewer wasted resources associated with coordination of benefits); and (3) It gives the single payer a strong incentive to invest in disease prevention programs (assuming such programs exist, which of course is debatable) since subscribers can’t switch insurance carriers. Unfortunately, single payer has no other inherent advantages. For example, there is nothing inherent in the single payer approach which would resolve the difficulties associated with coverage decisions or technology assessment. In addition, single payer would perpetuate all of the perverse provider incentives associated with government-administered pricing.
    Skeptic

  30. “When the likes of Terry McAuliffe agree that a single-payer system will NEVER happen in this country…it’s time to let it go.”
    http://online.wsj.com/article/SB122390023840728367.html
    A list of the government bailouts so far this year and dollar amount spent:
    March 16 — Bear Stearns – $29 billion
    July 11 — IndyMac Bank – $8.9 billion
    Sept. 7 — Fannie Mae – $100 billion
    Sept. 7 — Freddie Mac – $100 billion
    Sept. 16 — American International Group Inc. – $85 billion
    Sept. 25 — Washington Mutual Inc. – $1.9 billion
    http://uk.reuters.com/article/topNews/idUKTRE51H7C120090218
    Never say never.

  31. Laughable indeed. The single payer crowd needs to wake-up and start moving toward a more pragmatic and rational approach. When the likes of Terry McAuliffe agree that a single-payer system will NEVER happen in this country…it’s time to let it go. I don’t think there’s a sane democrat in Washington who would seriously try to get such a proposal passed. (“sane” being the key word here)

  32. Healthcare financing (single-payer), and HIT for that matter, should not even be on the table until we get a handle on the increasing sickness of our population. It would be a mistake to redesign the system around the population in it’s current state. We have obese children, folks! That is disgusting to say the least. Does no one else see the huge societal issues that we’re facing? Single-payer does nothing to address them.

  33. LAUGHABLE
    The handful of MDs involved with this have been fruitlessly promoting single-payer for decades. Neither major political party listens to them, because neither is that stupid.
    To those MDs, a few words: Fan nie Mae & Fred die Mac. Stupid once, shame on you; stupid twice, shame on me.

  34. Woolhandler and Himmelstein’s remorse about the U.S. not following the Canadian single payer model reminds me of the Robert Browning story of the “Pied Piper of Hamelin City.”
    Great rats, small rats, lean rats, brawny rats,
    Brown rats, black rats, gray rats, tawny rats,
    Grave old plodders, gay young friskers,
    Fathers, mothers, uncles, cousins,
    Cocking tails and pricking whiskers,
    Families by tens and dozens.
    Brothers, sisters, brothers, wives –
    Followed the Piper for their lives.
    Only in the case of U.S. health reform,
    It’s single payer and multiple payer rats,
    blue and red state rats,
    liberal and conservative and connector rats,
    private and government payer rats,
    hospital and outpatient rats,
    primary care andd specialty rats,
    Who is to be the Piper,
    Who is to call the Tune,
    Who will run the health care Saloon?
    I thought Massachusetts had the Pilot Balloon,
    But say single-payer loons, Massachusetts is not even Canadian Picayune.

  35. Let me suggest that the headline is a little misleading (though it follows the press release that PNHP put out.)
    “Massachusetts Doctors” are not calling for Single-Payer.
    A small group of Massacusetts doctors who belong to Physicians for a National Health Plan (PNHP) are calling for single-payer.
    PNHP has been dedicated to pushing for single-payer for years. This is not news.
    Yet the way the press release (and this post) presents it, it seems that things have gotten so bad under Mass.
    health reform, that physicians are rising up, statewide, to call for single-payer.
    As the Boston Globe has made clear, a major problem that is making Mass healthcare so expensive is NOT INSURERS but hospitals (specifically Partners) insisting on charging 30% more than other hospitals simply because they are a brand name. And because the public sees these hospitals as a “brand” INSURERS HAVE BEEN POWERLESS TO DO ANYTHING ABOUT IT.
    (Frank Pasquale wrote a very good guest-post about this on HealthBeat http://www.healthbeatblog.com/2009/02/partners-in-power.html (He’s a visiting law professor at Yale who specializes in healthlaw, and he has his facts straight. Maybe you could cross-post, just to balance things out?)
    Let me be clear: I am not opposed to single-payer as a concept. But at this point in time it is very, very claer that it is Not Going to Happen. The majority of the public does not want to give up the insurance it has for Single-Payer.
    So, at this point, the single-payer advocates are simply dividing progressive health care reformers at a time when we need to be united against the conservative opposition– as Flower’s post, and the many comments, demonstrates.
    Giving the single-payers a platform on THCB by spreading the idea that Insurers are the problem making Mass care so expensive and that Mass Doctors are calling for single-payer seems to me–in my humble opinion–a mistake.
    Mass health care is the most expensive care on earth because there are more hospital beds and specialists per capita than in any other place in the U.S. Jack Wennberg’s Dartmouth research has made that clear (As has THCB). This is why per-capita health care spending is so high in Massachusetts–it is supply-driven. This has nothing to do with insurers.

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