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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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RoziThomas BrooksRonJohn A. Day, Jr.MD as HELL Recent comment authors
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Rozi
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I find this medical health information blog is useful and valuable. I like these information.

Thomas Brooks
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Thomas Brooks

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

John A. Day, Jr.
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John A. Day, Jr.

Yep.

Ron
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Ron

Dr. Day,
I think you have your answer.

John A. Day, Jr.
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John A. Day, Jr.

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?

John A. Day, Jr.
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John A. Day, Jr.

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?

David
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David

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.

John A. Day, Jr.
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John A. Day, Jr.

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.

MD as HELL
Guest
MD as HELL

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.

Don McCanne
Guest

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… Read more »

David
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David

Given that the comments on this blog seem to have pragmatism in common, I thought this article would be appropriate:
http://www.afcm.org/besthealthcare.html

David MD
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David MD

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… Read more »

David
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David

This is an excellent article on EMTALA and its effect on physicians:
http://edwinleap.com/blog/?p=151

David
Guest
David

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… Read more »

Peter
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Peter

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… Read more »