Medicare for All

I’ve been interested to see how frequently the comments to this blog end up discussing (and debating) America’s health care system–even when the ostensible subject of that day’s post is something entirely different.

(As I was typing the phrase “healthcare system,” I was reminded of a graduate student—a hospital administrator—who corrected my use of that term. “America doesn’t have a healhcare system,” he said. “We have a healthcare industry” and it’s not the same thing.)

I often share insights from my cousin, a respected cardiologist who also spent many years teaching medicine. He recently sent me a thoughtful analysis of that healthcare industry, and the prospects for fixing what everyone realizes is unsustainable. I particularly like his introduction to the issue:

When considering the best way to solve our country’s medical care woes, I am reminded of Churchill’s famous statement about democracy as a form of government, in which he stated in effect: It’s a terrible system, but everything else is worse. This same statement might apply to a single payer system in medical care, for it probably beats everything else, as I explain below.

He noted that a truly effective system will require cost controls, including tort reform, the excessively high cost of drugs, inappropriate use of expensive tests and treatments, and several others. He is convinced that these issues can be resolved, and that a single-payer system (for example, “Medicare for All”) is both inevitable and the best solution:

In an article on why a single-payer system would be our best solution, Donald Berwick, MD, former administrator of the Centers for Medicare & Medicaid Services and an architect of the Affordable Care Act (ACA), contended that although the ACA has been “a step forward for the country,” it “does not deal with the problem of waste and complexity in the system,” as he feels a single-payer system would. I can personally attest to the complexity of the system with the many headaches provided by a dizzying array of differing insurance forms pertaining to treatments, hospital admissions and a multitude of other issues.

And James Burdick, MD, a transplant surgeon at Johns Hopkins University School of Medicine and author of the forthcoming book Talking About SINGLE PAYER!, argued that a single-payer system is “a more economical way to use healthcare resources. You could reduce expenses and still improve quality. That’s a tremendous opportunity that you don’t have in many other fields.” Of course, as he pointed out, this would virtually eliminate the entire commercial insurance industry—with $730 billion in revenues and a workforce of 470,000. (Maybe these same workers could be involved in more productive work such as restoring our nation’s wobbly infrastructure!) But Dr Burdick also maintains that a single payer system would likely restore doctors’ authority. And those who favor this system say that for all practices, administrative costs would plummet because there would be only one set of payment rules and forms, with the result that prior authorizations, narrow networks, and out-of-pocket payments would be eliminated.

He also reports that there is growing physician support for a single-payer system. For example, a 2014 survey of Maine physicians conducted found that nearly 65% of respondents preferred the single-payer option over trying to fix the current system—up from 52% in a 2008 survey.

Interestingly, a majority of the population (51%) now supports Medicare for all, according to a national poll released this past year.

In reality, a government-run single-payer system is the only way to provide effective basic medical health therapy and management, but for those who desire a higher level of care—and can afford it—there should be a private-pay system, contrast with the Canadian system. This would, de facto, constitute a two-tiered system. This might be objectionable to egalitarians that wish to have a “one size fits all” system, but would be the most pragmatic approach.

Usually those against single payer system trot out the usual vague objections that we are becoming “socialistic.” But what about our current Medicare system, is that not socialistic? I might add further that I personally have worked at a VA hospital, and, despite all the current noise, found that once patients were able to access the system, the care is quite good. Its main problem seems to be gaining initial entry into an overburdened system in a timely manner. By contrast, it is highly unlikely that a random assortment of for-profit HMOs would do a better job serving the high-utilization health needs of our veterans.

His conclusion–with which I concur:

Whether we like it or not, basic healthcare is like a utility—something everyone needs, and, in the best interest of our society, everyone should receive. Although there are many variations of the general theme as I have enumerated above, we are moving inevitably toward a single payer system. When it finally arrives, I believe everyone will be relieved, if not pleased, even including the Republicans!

45 thoughts on “Medicare for All

  1. Sheila, I agree with your thoughts. I wonder, though, if it could be communicated just as well without that last phrase. For once, I’d like to read a wonderful peice that doesn’t include a “ding” at those who are different.

  2. Every health care system out there has gaping holes in it and even single payer, which I believe is the best way to distribute health care to humans, isn’t the best either. But it’s better than anything else out there.

    If you have an affliction like an auto immune disease like I do, (I have a couple because they seem to go in pairs probably because of the DNA gene mutations I suffer with), I had to go out of network and out of the insurance perimeters in order to get the diagnosis and treatment that finally worked for me because in-network doctors couldn’t see the forest for the trees and insurance strapped them with time constraints. And I had to read a few books about my afflictions and study a few cookbooks in order to understand nutrition that was based solely on my being ‘sick and tired’ of being sick and tired all of the time. Why aren’t the doctors even asking what kind of food one eats considering that I had several food allergies I couldn’t pin point until I eliminated them. Yes, Gluten and Dairy Intolerance is real.
    The sole problem in our healthcare system is it is profit – based.

  3. I’m glad to know physicians are coming around to a single payer system. The loss of commercial insurance jobs with a single payer system may not be a concern.

    The U.S. government does not process Medicare claims. Those are contracted out to private insurance companies for processing at negotiated rates. Even so, the administrative costs of Medicare are said to be about 1/8th the cost of private insurance. If millions more Americans had insurance coverage through a single payer system, tens of thousands more jobs would be created to process their claims. More health care jobs would be created to provide care to those who could not previously afford it.

    If Congress would permit Medicare to negotiate discounts for medications, those costs would decrease but pharmaceutical companies could be expected to fight that with fervor.

    There ARE answers out there. I wish I thought the single-payer system was as inevitable as your cousin. I’m on Medicare and LOVE it. I so wish everyone had it.

  4. For several decades I was on ICHIA (The Indiana Health Ins Program). It cost me 14,400 / year in premiums. Had a large deductible and then 80/20. All in all, a very expensive date. NOW I am on Medicare. AMAZING. Combined with AARP to fill the gaps, I pay nothing for health care now. It is like a got a $ 1,000.00 / month raise. YAY for Medicare. It is GREAT. It SHOULD be available to all.

  5. A friend and I discussing stuff fell into a realization the other day. Our far ranging conversation started with agriculture and how everything about our food chain is inherently and maximally competitive. Food is a commodity. My corn is just like yours. There are very natural supply and demand cycles that are reflected in the markets.

    That’s why even though it’s the most essential of what we buy what we pay for it leaves very little room for people to get rich. It’s Adam Smith’s “invisible hand” at its frugal best.

    The other end of a spectrum is our health care non system (industry as Sheila’s friend suggests). We pay whatever for whatever. Consequently what rivals food as essential is out of control cost wise. Everybody in the industry is making money hand over fist.

    We have priced what we need out of reach to a growing part of our society. And we’ve created a juggernaut of lobbying intent on it not changing.

    A country near the top of the heap in terms of wealth at the bottom of the same heap in delivering an essential, physical well being.

    And we’re stuck here.

    How pathetic.

  6. Clearly the path we are going down will continue to serve the wealthy very well and also continue to underserve a huge and growing bottom end.

    Republicans say “what’s the problem, it’s exceptional for the wealthy”.

  7. Joe; that “ding” as you call it is Sheila’s reminder of the reality of the current stalemate to reach common sense single-payer health care. She has always been direct; we know where she stands on issues, she doesn’t mince words, this is why she has had my respect, and my vote, since she ran for the state Senate in 1980. It isn’t the Democratic party that has wasted time and millions of our tax dollars voting 62 times to repeal or defund the ACA; large portions of which were authored by Republicans who are now voting against their own stand on the healthcare issue. They deserve that small “ding” as a bottom line reminder of the staus quo.

  8. Why are common sense solutions so out of reach for our form of government? It isn’t just healthcare; it is gun control, financing education, industrial and farm pollution, drug addiction, and on and on.

  9. There is one and only ONE Presidential candidate who has proposed Medicare for all and that is Bernie Sanders. Sanders has also proposed negotiated charges for drugs. Part of Bernie’s platform is, “Require Medicare to use its bargaining power to negotiate with the prescription drug companies for better prices – a practice that is currently banned by law.”
    No other candidate has been this bold on Health Care. However the McMega-Media has imposed a black out on reporting on Bernie.

    The Republicon Candidates for President are determined to eliminate ACA or Obama Care as they like to refer to it. What the ACA will be replaced with is unknown.

  10. The examples of successful single-payer health care (Canada, UK, Japan, others(?)) are sighted as successful, usually for one or two (or both) reasons. 1) costs are down or 2) 80-85% of the population is happy. Interestingly, prior to ACA implementation, 80+% of US population was satisfied with healthcare. Low cost check-ups and maintenance drugs are bound to be popular. However, the folks with more serious issues are always frustrated with the long delays to get diagnosis and treatment. Japanese system is collapsing under its own weight and virtually all medical advancement happens outside the single-payer systems.

  11. One of the things we have to deal with is deciding just how we are going to deal with death. Do we want to live as long as possible regardless of cost? Should there be different treatment options available only for those who can afford them? Who makes the decisions about when we die — family, physicians, another separate group or individual? (Yes, the old ‘death panel’ shibboleth does come into it).
    And, finally, how to sell it? Federal taxes will have to go up by at least 10%, but will that be a flat tax, or a progress one? And it will have to sold as a system in which there is actually very little or no other insurance expense.
    I used to tell my students the issue they would have to deal with is this very thing — How long do we actually want the average lifespan to be?
    I think they laughed at me, but it’s here long before any of us really thought it would.

  12. Ken, are you saying that as long as our health care non system serves the wealthy well there is no reason for an alternative?

  13. Ken, first of all I seriously question your claim that “80+% of US population was satisfied with healthcare”.

    The only people that I know who are satisfied with health care are those on Medicare (the least healthy 13%).

    The other though rapidly shrinking group who are happy are those whose health care costs are largely paid by their employers.

    Are you saying that those two groups make up 80%+ of the population?

  14. I should point out that if those whose health care is largely paid by their employers realized that it was money from their pocket and not their employers pocket they would be very unhappy.

    Not to mention that the employer provided benefit allows everybody to avoid taxes on that compensation.

  15. If tort reform were the answer, Indiana would have some of the lowest rates. But it is one of the highest. And I’m sure that has absolutely NOTHING to do with this being the home of United Health Care and Anthem…. However, tort reform comes about with single payer because there are no plaintiffs. How’s this for contrast: While I was working for a lawyer in Oakland, CA, his brother, the lawyer, a Canadian citizen was on his way to work in a cab and the cab was in a wreck. He was hospitalized, had two weeks off work. Being a Canadian citizen his health care was paid, along with the wage loss. Two weeks later, he was back (economically) to where he was before the accident. No suing, no long, drawn out fights over who has to pay what.

  16. Steve; I have copied and paste your first paragraph because I can’t help but wonder where you have been for the past few years. Your term, “Should there be different treatment options available only for those who can afford them?” is the current health care system regarding living or dying in this country. You have omitted quality of life and opted to concentrate on quantity of life depending on income status and not considered personal decisions in this matter by the concerned party.

    “One of the things we have to deal with is deciding just how we are going to deal with death. Do we want to live as long as possible regardless of cost? Should there be different treatment options available only for those who can afford them? Who makes the decisions about when we die — family, physicians, another separate group or individual? (Yes, the old ‘death panel’ shibboleth does come into it).”

    Your referral to “the old ‘death panel” makes me wonder if you aren’t a follower of Sarah Palin’s views of what she termed the Obamacare death squads. If you read that section of the original bill you would have seen that it was simply a measure to allow patients to schedule an appointment with their primary physician specifically to make arrangements for their chosen options regarding their final days – kept alive on machines or not, pull the plug or not. This appointment would be covered by your health care plan. Thanks to Sarah and her followers; that was deleted, unless you work this conversation into and share your decision with your doctor during an actual medical exam, you must pay the full amount as if you have no health care.

    My “death panel”/”death squad” consisted of conversations with family members and my attorney; making out a living will with assigned power of medical decisions to my son. I simply handed copies of all information to my physician to be included in my medical records during a regularly scheduled checkup. It is a simple matter unless one decides to complicate it…or ignore it and leave the decision up to grieving, confused family members at the end.

  17. This is such a good idea that makes such perfect sense and would save such huge amounts of money and would serve to immeasurably improve health care that it would never pass.

  18. Steve Smith is correct in asking the most important questions. If we persist in perpetuating meaningless ideas like “all lives are valuable,” we can never discuss the hard choices we have to make. Right now we allow a bent and fractured set of marketplaces to determine the values of lives. So we read a story about ditch digger who is being refused the latest cancer treatment by his insurance company due to its cost, and we are outraged at the injustice. But we simply can’t pay for the most exotic treatments for every person, and we can’t bring ourselves to admit that keeping Stephen Hawking alive is worth the lives of millions of ditch diggers. So this is really an exercise in allocation of resources and a question of efficiency/effectiveness vs. equity/equality. Currently our measuring stick for human value is wealth. Are we capable of assigning values that deliver a greater good? Are we capable of protecting that system from corruption? Will we be comfortable with the hard choices made and the, for some, tragic outcomes?

  19. “America doesn’t have a healhcare system,” he said. “We have a healthcare industry” and it’s not the same thing.

    This is an excellent analogy by your student and it sums up the bulk of the problems with access to and affordability to healthcare in our country- or the lack thereof.

    When President Obama (then Senator) was campaigning for single payer health insurance I switched to being a Democrat and voted for him. Since that time, when Republicans discuss their absolute Hatred of single payer health insurance and how it is just another way for the government to take control of us, I always ask them if they have any relatives on Medicare. Typically they have parents and/or grandparents on Medicare and I ask them if they think it is a terrible program for their relatives and the answer is always NO. When they still respond that the government “should not be able to control our healthcare” I strongly suggest that they should demand that Medicare be abolished – since it is a government controlled health insurance plan and they are strongly against that. They are never able to respond to this comment because it points out their full ignorance and bias on the issue. When I am in the presence of Medicare recipients that also hate the ACA and see no reason for it, I also suggest to them that they should not have the right to Medicare and it should be abolished in accordance with their current viewpoint. I enjoy seeing their reactions, as they never thought of themselves as being the recipients of something they are so against until it is pointed out to them. Intelligent seniors recognize the great benefits of Medicare and they believe that every citizen should have the same access to it.

    For those of you that may be thinking that people deserve Medicare because they paid into it, that is incorrect. There are millions of people on Medicare that never paid a penny into it. Paying into Medicare is not a requirement and there are also several exceptions to having to being age 65.

    As for the death panels that have been beaten into Republicans’ minds, I would like to suggest that we have had death panels for decades and single payer insurance would end them. My idea of death panels is how we have excluded access to affordable health insurance and healthcare to millions. People die every day because they cannot afford access to the care they need.

    I apologize as I am passionate about this issue and could go on and on about it. As I mentioned in other posts, I used to be in healthcare financial management and oversaw billing.

  20. I agree with everything you said, Nancy Papas. Like Sallie Mae, the student lender, health care insurers will change the focus of thei business from lenders/insurers to government contractors servicing agents. The impediment to negotiating pharmaceutical costs would disappear. I believe we will eventually get to single payer. Like nothing else could, the 2008 financial crisis convinced more people, in particular the Trump/Cruz supporters, that capitalism is not a deity. Some of us have known that for a long time.

  21. The death panel idea is a real problem being avoided because of the way a village idiot phrased it. It is essential to consider somehow how much we should invest in heroic end of life risky delays.

    Personally, if called upon, I would make the decision for myself, myself.

    When my time comes I would hope that I’d be responsible enough to say it’s been fun but it’s over. Pull the plug rather than shooting for a miracle few month extension of low life quality.

    Death panels is just a political label for something essential. Frank end of life discussions and decisions.

  22. This is a subject very near and dear to my heart given my near twenty years of working for and with Riley Hospital for Children at IU Health here in Indianapolis. It has been my good fortune, actually a major blessing, to have worked very closely in a direct support role with the many parents who have had patients, their children, treated at our hospital during that time frame. One thing that happens to, I would think, anyone who has shared my experience is that you become an advocate for them, that advocacy being continually nurtured by interacting with them and seeing the tremendous pressure they have on them because of the nature of our healthcare “industry”. That pressure permeates every area of their existence.

    While the “special needs” community is not a large demographic category in regard to the overall population of this country, they experience some of the most deleterious aspects of these systems of care and the ups and downs they face on any given day are akin to scaling the Himalayas. A lot of these parents, as a result, become advocates for others which is among the most touching aspects of human behavior that I have ever seen. Helping other parents of children with special needs cope with the impact of all this is a catharsis for them but it’s far more than that. It’s compassion and empathy, often extreme empathy. They have learned to not only navigate the very complete avenues of care that are available to them that they often have to fight those same systems of care to get but they have learned to economize their daily expenses in order to keep even with the daunting needs they have. They have stood up to educational systems that have, at times, looked at their responsibilities to their children as afterthoughts. They have stood up to bullying, both of their children and, at times their families. It’s rough road in many, many ways and definitely not something for the faint of heart. They rise to the occasion over and over and over for their children.

    There is a support group based in Kansas, if I remember correctly, called “Moms from Hell”, which is sort of sums up the level of advocacy a lot of the Moms that I have worked with have to show every day. They are their child’s chief advocate, along with their husbands, and have one shot at what they have to do, often saving their child’s in the process. That advocacy doesn’t just deal with medical issues, rather it extends across the full gamut of issues that any child’s parents regarding raising their children; school, peer relationships, puberty, adolescence, on and on. I call them “Turbo Moms” and have also met quite a few “Turbo Dads” as well. They all deserve, as do their children, far better systems of care, a more compassionate and attentive health care “industry” than they currently deal with. If that ends up being a single payer system that’s fine but they need and deserve a healthcare system that levels the playing field for them. They need a system that levels the playing field for them and gives their children the best shot possible for a successful future and grants their families the same level of success.

    Joe Brubaker, who led off all these replies, knows probably more about this than I know but as a more than interested observer I couldn’t help but comment and elude to the bravery I have seen firsthand that is exhibited every day by the parents and children that it has been my pleasure and honor to work with and to have also served.

  23. I believe that the ACA is the first step to single payer health insurance and that we will eventually get there. The insurance companies, pharmaceutical companies and every other player in the business that reaps untold wealth from our illnesses will fight it to the bitter end. They will put even larger amounts of money into the pockets of our Congress than they currently do. No matter the cost to them, the financial reward is always much greater.

    You may find the March 3, 2013 issue of Time Magazine spotlights an article that is both interesting and educational. The article spells out everything that I saw while in healthcare financial management.

    Most people don’t have access to this information and therefore are completely unaware of how they really are being taken advantage of.

  24. Tom, thank you.

    We all love to whine about mankind’s mostly self inflicted problems but then someone like you comes along and says is anybody also thinking of the heroics humans demonstrate every single day?

  25. Once again, Ken Glass is factually challenged. Japan has universal health care, but it is NOT a single-payer system. http://www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2013/Nov/1717_Thomson_intl_profiles_hlt_care_sys_2013_v2.pdf

    It is true that Japan’s aging demographics will put increasing pressures on their overburdened health care system. But in fact a change to single payer may be exactly what is needed to properly re-allocate the health care resources.

  26. Candidate Obama said no bypass for the 90 something year old. He in essence said, “Keep her comfortable and let her die!” At 95, you can make the case that she should accept death. But if it is 95 today, it is 85, or 75, or 65 later. “That hip replacement for the 70-year-old will not be worn out when he dies, so….

  27. Ken: Candidate Obama said no bypass for the 90 something year old. He in essence said, “Keep her comfortable and let her die!”

    Where do you come up with this crazy propaganda?

  28. Ken your point, that we should keep health care affordable only for the very wealthy, is falling on deaf ears.

    This is a democracy. There are no rights that are given as a function of wealth. We are all free in our pursuits of happiness. And healthcare, like food, shelter, and education, are birthrights for Americans.

    Why? That’s who a majority of us are. We’re willing to accept that some criminals will take advantage of us but all deserving people are entitled to the same rights.

  29. Regarding “but we simply can’t pay for the most exotic treatments for every person, and we can’t bring ourselves to admit that keeping Stephen Hawking alive is worth the lives of millions of ditch diggers”, I was pulled up short by that statement.
    It sounds like the value of life is based purely on what that life has to contribute to society. How do you reconcile that sentiment with the huge losses in potential of war, untreated diseases, genocide, holocausts, poor sanitation, slavery, etc., etc., etc.? Who gets to make those decisions about value?
    I disagree that we need to admit that keeping one person alive with exotic treatment is of more value that the lives of millions of presumably less valuable people. If you make that choice, you negate the loss of unrealized potential, not only in that specific generation but future generations lost because of shortened lives. That statement sounds suspiciously like negative eugenics. We’ve been there and done that both in the U.S. and abroad to our collective detriment.

  30. It’s not unusual for technology to lead to philosophical discussions because now we can do something but to what degree should we.

    Medical technology potential is virtually unlimited. Here’s the moral dilemma. There are and will be more and more treatments than only great personal wealth can afford. However the development of them is typically a cost shared by everyone.

    To me the only ethical standard is the same health care for everyone. That’s only possible with socialized medicine and that’s well beyond single payer.

  31. So Ken is proven to be wrong on one fact. Does he admit/apologize? No. His response: throw out more garbage. Sorry Ken, you once said you were interested in serious discourse, that maybe folks here could learn something from you. No one has time to time to dig through all your horse crap to find the promised jewels.

  32. And if you are really worried about treatment options for 90-year-olds under Medicare, just imagine what their options would be if controlled by for-profit insurers.

  33. The March 3, 2013 Time Magazine article that I referred to in an earlier post is titled “The Bitter Pill”. If interested, you may find it online by googling it.

  34. I agree with everything you said, but there are even more benefits that would result from everyone going on Medicare, some of which would be peace of mind not just about how to get help for a health problem, but also concern about losing one’s home or other assets and perhaps being forced into bankruptcy if that lump or persistent pain turns out to be something serious and possibly life-changing.

    A large percentage (I forget the number) of personal bankruptcies are due to uninsured medical expense. When someone takes bankruptcy because they simply cannot pay for expensive health care, they also flush their other bills as well, which results in increased cost for the rest of us.

    I’ve read interviews with celebrities who were born in Canada, and it is surprising to read that they are happy to maintain Canadian citizenship because it provides a safety net if they should become ill.

    Health care ranks beside police and fire protection and education as basic human needs that don’t belong in the for-profit sector. The huge salaries, bonuses and retirement packages paid to the CEOs of health insurers are nothing short of immoral.

  35. I get riled whenever I consider one subset of the healthcare industry, nursing homes. As a personal anecdote drawn from 4-years spanning 1999 through 2003, I observed this growing and extremely lucrative business profit from the elderly, both Medicaid patients and Medicare patients. For Indiana readers, think former Rep. Eric Turner now disgraced by his unethical dealings with his nursing home development business.

    Because my mother did not qualify for Medicaid, my father paid $85K out-of-pocket for my mother’s care in a nursing home. As a result of paying out-of-pocket, my father received a monthly line item billing for expenses above the $85K. While visiting my father, I scanned the monthly bill and noted the nursing home charged $1.00 for each Tylenol tablet (OTC medication). My mother was administered 4 Tylenol tablets per day which totaled $120.00 per month.

    Being a practical person, I calculated I could purchase this non-prescription medication from a local pharmacy for $0.9 per tablet. When I approached the nursing home director with my offer of providing my mother’s Tylenol, I was told that was not possible. Seems that all medication, including OTC, had to be in a bubble pack. When I inquired where I could purchase Tylenol in a bubble pack, I quickly learned that was impossible because the nursing home had to contract with another business whose sole purpose was to sell medications in bubble packs.

    Of course, I have no way of knowing how much these Medicaid patients were charged for their Tylenol. It may have been more than $1.00 per tablet.

  36. BSH-regarding your last post:

    You witnessed the different amounts of money patients are expected to pay if they private insurance, Medicaid or are self-pay.

    It doesn’t matter what the nursing home charged Medicaid for a Tylenol. Medicaid tells the nursing homes what they will be paid and this cannot be negotiated. The nursing home will still make a profit on Medicaid patients, but not as much as they do on private pay or Medicare patients You can rest assured that Medicaid never pays $1.00 for a tylenol pill.

  37. BSH’s illustration of outrageous costs is just one example of the lack of transparency in our health care industry. A lack of transparency keeps patients uninformed and unable to make wise financial decisions about their health care.

    Medicare for all would eliminate the current issue of people being expected to pay higher or lower amounts for the exact same service based upon their individual insurance plan or a complete lack of insurance.

  38. Always a meaty topic! Theresa, the answer to your question is, to quote Pink Floyd, “Money, money, money, mon-ey!”

    I googled “90 year old bypass” to check up on the source of Ken’s outrageous statement, supposedly from Obama, and instead of finding the expected propaganda I found a scholarly article on a discussion on how elderly patients were no longer medically defined as >65 but are now >80. No matter how we fund our healthcare there will be decisions as to what services are provided. Currently a Physician Panel meets thrice yearly to determine how the medicare money will be paid out by disease or condition. These people are subtly determining what diseases or conditions will be the focus of doctors’ care.

    The American people need to stop arguing about about individual supposed inequities of a single payer system and face the facts that currently our “system’s” successful users are determined by how much money they have, not by age, worth as a human being, or potential, but by money.

    The only group that agrees this is a good system of determination is the wealthy, which is currently about 1% of us. Not a great figure.

  39. Mary Beth, you wrote “No matter how we fund our healthcare there will be decisions as to what services are provided.” And, I recommend that all people avoid letting strangers from afar make these decisions for us by developing a Living Will where we each can have our wishes stated in a legal document. I wager that most people would prefer not to be hooked to tubes or machines or to undergo invasive procedures that offer little more than a few months w/out a promise of any measure of quality of life.

  40. Exactly right, Sheila. The economics of the current structure are the barrier to reform, namely the bloated, inefficient, profit-seeking, shareholder-owned private insurance companies. Just like the NRA, the health insurance lobby buys the outcomes it wants in congress. It is a no-value-added middle man wasting hundreds of billions per year. It needs to be legislated out of existence.

  41. Australia has a 2 tier insurance system. National Health for the many and for those who can afford it and want to step out of the masses a private insurance system. It’s very expensive but it works better than what we have

  42. Did anyone notice that those people at Republican open houses, who were telling the candidates to tell Obama to keep government out of our healthcare were nearly all old enough to be on Medicare. I kept joping someone would suggest eliminating Medicare as the only eay to accomplish that.

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