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May 18th, 2009
Freethought San Marcos: Single-payer health care just makes sense

Freethought San Marcos: A column
by LAMAR W. HANKINS

Sen. Max Baucus, chair of the Senate Finance Committee, conducted hearings last week into health care reform. Notably absent from the discussion were the views of a majority of Americans, as well as a majority of practicing physicians: universal health care through single-payer health insurance. Recent polling by CBS News and the Journal of the American Medical Association reveals that around 60% of both groups favor single-payer health care, similar to the Canadian system.

Large numbers of Americans support single-payer, not because it is perfect, but because it is infinitely better than the system concocted by the insurance companies that we have lived with all these years. We know single-payer works because we have the example of Medicare to prove it. Medicare is single-payer health insurance for the elderly. My experience with it over the past few years handling the health care of my parents has shown me that it is more efficient and much less of a hassle than is the private health insurance I have.

Sen. Baucus was not interested in putting a universal single-payer system–which saves nearly one-third of the cost of what we receive from the private sector’s product–on the table because he is beholden to that industry for campaign contributions. He has received nearly $4 million from those who have a vested financial interest in keeping the current health insurance system. Because of this clear conflict of interest, he should not be allowed to determine who is allowed to debate the issue before the Senate. Not allowing single-payer to be discussed is sufficient proof to me that he cannot be and has not been fair in handling this issue.

Unfortunately, our new president is not being forthright with the American people about single-payer health care either. When he was asked about the issue this past week, he said that if we were inventing a health care system from scratch, then maybe we should discuss single-payer. No country that has adopted a single-payer health care system has started from scratch, yet every industrialized country in the world except the US has managed to both discuss and adopt such a system.

The need for universal single-payer health care is obvious to all who want to live in a just society; that is, a society where families are not bankrupted by medical costs and where health care is seen not as a commodity to be bought and sold like vacuum cleaners, but a right to be enjoyed by all, based on need. What may not be so obvious is the competitive disadvantage health care creates for American businesses.

American-brand cars made in Canada cost the manufacturers about $1500 less to make than the same cars made in the US because Canada has a national health insurance system for which the companies don’t have to pay. An employment-based health care system that uses the private insurance market is an expense that makes American businesses less competitive. And it saps the budgets of such government institutions as Texas State University, as well.

A Harvard University study reported three years ago found that half of all personal bankruptcies in the United States were due to medical bills. Clearly, not having health insurance can be a catastrophic problem for a family. And it has become a major expense for employers who provide coverage. Health insurance premiums went up an average of 78% in the last six years, 119% since 1999. And these costs have not brought us top-notch health care. In 2007, the US ranked 37 among the 190 nations rated for the quality of their health care by the World Health Organization, in spite of the fact that we have the most expensive healthcare system in the world–costing twice what is spent by other industrialized countries. And 46 million Americans do not have coverage, overburdening our emergency health care system. The waste and bloated profits in the current private health insurance market would pay to cover everyone. Our current private insurance-based system is not working.

For a day or two last week, it looked as if the insurance industry was going to become a part of the solution to health care costs. President Obama told us that the industry had agreed to voluntarily reduce health care costs by $2 trillion over ten years. Then, the industry told us that the president had misspoken. The industry would work toward the $2 trillion figure as a goal, but not a promise. Whether there was a promise or merely a goal, one can only conclude that the health insurance industry must be planning to gouge American families to the tune of $200 billion a year for the next ten years, else how could the industry even contemplate savings of that magnitude and still make the profits its stockholders demand?

For those who still believe that a single-payer system is “socialized medicine,” I will explain again that the health care would be delivered by the private sector. The government, just as it does with Medicare, would be the conduit for the payments to the private health care sector, saving all the expenses now going to profits for the insurance industry, as well as saving the money that industry spends figuring out how to deny health care claims.

Almost four generations ago, President Franklin Delano Roosevelt recognized that the freedom demanded in the Declaration of Independence and promised by the United States Constitution was not just political freedom, but economic freedom, as well. Universal health care is essential to secure that economic freedom for all our citizens. If our politicians didn’t have luxurious healthcare for themselves, at taxpayer expense, perhaps they would be more aware of the needs of the rest of us to enjoy the economic freedom universal healthcare provides them.

Senator Dick Durbin told us two weeks ago that the banking industry owns the Congress. I would suggest that corporate America in its entirety – banking, insurance, finance, manufacturing, and all the rest – own the institutions of our government. It is time for all Americans who share disgust about this circumstance to let all our elected leaders know that we are tired of a government run by and for the corporations. It is time for an America run by and for the American people.

As Jim Hightower once said, we all need to become agitators–that’s the part of a washing machine that gets the dirt out.

©Lamar W. Hankins, Freethought San Marcos

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16 thoughts on “Freethought San Marcos: Single-payer health care just makes sense

  1. “For those who still believe that a single-payer system is “socialized medicine,” I will explain again that the health care would be delivered by the private sector. The government, just as it does with Medicare, would be the conduit for the payments to the private health care sector, saving all the expenses now going to profits for the insurance industry, as well as saving the money that industry spends figuring out how to deny health care claims.”

    Wow, how about not getting it.

    A: Yes, healthcare will be delivered by the private sector, but specificed by what the ‘public’ sector says they can provide, at a cost also specified by the ‘public’ sector.

    B: If you think that insurance companies deny things, just WAIT until the gov’t starts denying things. Just look at recent news by the UK. People going to the hospital and getting all of their teeth pulled is on the rise. Due to the inability of people to be able to see a dentist.

    Sounds like a good plan to me!

    Just take a look at the UK.

  2. Single payor health insurance should be explained to the public and I think Medicaer should be the reference. Many people in th USA do not know what a Singler Payor System is, even some who do medical billing don;t understand that Medicare is a Single Payor System.

  3. DS you idiot! Sure the public sector is part of the equation, but if you think the moronic system where the price is set by the f ing drug makers is sufficient, you are an idiot!

  4. The main reason other countries have undesirable results with their health care systems is because they started out with few facilities, capabilities, and public nor private wealth. Problems we don’t have. A case in point is Great Britain which started its system right after World War II. The war left Great Britain practically bankrupt and short of facilities; a high percentage of the hospitals, they did have, were built in the 1800s.

    The argument that single payer Health Care is evil because it is socialism is completely false. The Free Capitalistic Market was destroyed when the American Medical Society started practicing Birth Control by keeping the number of doctors down in the 1920s. This caused prices to go up and service to go down. After that came collusions of all kinds of groups such as hospitals controlling students to the advantage of the doctors who ran the hospitals. Those who consider socialism bad give the reason that it destroys the Free Capitalistic Market, BUT THE FREE CAPITALISTIC MARKET HAS ALREADY BEEN DESTROYED.

  5. Real Healthcare Reform:
    Changing Priorities, Incentives and the Rules of the Game; Creating an Electronic Health Record for Every Citizen Who Wants One

    If you have the financial resources of Bill Gates or Warren Buffett you needn’t pay money to a health plan each month, since if you get sick or injured – even very seriously – you have more than enough money to pay all your medical bills yourself.

    But those of us who have significantly less financial resources must find some other means of dealing with the thousands or even hundreds of thousands of dollars or more of medical expenses that we might incur should a serious illness or injury be our fate.

    Enter the concept of “health insurance”.

    Large numbers of individuals and/or their employers pay some money each month into one or another big pot called a “health plan”. Those individuals who remain essentially very healthy for many years and then suddenly die or perhaps leave a particular health plan for some other reason – if they have put more money into the pot than was taken out to pay all their medical expenses – wind up helping to pay the medical bills of those members of the health plan who become seriously ill or injured and incur a lot of medical expenses.

    Many Americans covered by some form of health insurance don’t seem to fully understand or perhaps choose to ignore the fact that if they become seriously ill or injured, for the most part their medical bills will be paid by the members of their health plan who have remained healthy. Keeping members of a health plan healthy by preventing illness and injury is critically important, but is something not currently given the high priority and attention it deserves.

    Some Americans believe that healthcare should become a “right” of every American citizen. If a nationalized single payer health plan were enacted, every American citizen who became ill or injured – for any reason whatsoever – and incurred significant medical expenses would for the most part have his or her medical bills paid by U.S. taxpayers. Many Americans oppose such a system for America recognizing that significant difficulties such as long waiting periods and rationing of care exist in such types of all inclusive government healthcare systems that currently operate in other countries such as Canada and the United Kingdom.

    For any health plan to work which has a large number of people pooling their money to essentially pay the medical bills of whichever members of the plan become seriously ill or injured, rules must be established as to when and how much money may be taken out of the pot e.g. “legitimate” doctor bills and hospital bills. Equally important is keeping track of the amount of money that is being put into the pot each month in premiums paid by health plan members or their employers. If too much is being paid out in expenses as compared with the amount being received in premiums, the pot will soon become empty and the health plan will go broke.

    As previously mentioned, the monthly premiums paid by individuals or their employers go into a health plan’s big pot from which “covered” healthcare expenses are paid. But also from this pot are paid all the health plan’s administrative expenses including what may be big salaries and golden parachutes for CEO’s and other “healthcare executives” – individuals who may be paid to find technicalities of one sort or another in the health plan’s agreements so the health plan can deny or reduce payments, raise premiums, cancel insurance, or in one way or another minimize or exclude “bad risks” from the health plan. All such questionable business practices are done to enable the health plan to make a profit and remain in business.

    Currently we are experiencing continual increases in healthcare costs that are unsustainable and which, if unchecked, will soon seriously threaten the future of the entire American economy. Healthcare costs must be controlled, but how? If a healthcare system made up of health plans is going to have a chance of both meeting the needs of health plan members and simultaneously develop the ability to keep costs under control, priorities, incentives, and the rules by which the game is played all must be changed.

    The good news is that a lot of illnesses and many injuries are actually preventable. But how will prevention ever become a top medical priority when doctors, hospitals, and other providers get paid largely for diagnosing and treating illness and injury, not for preventing it?

    Although health promotion and disease and injury prevention receive fashionable and socially acceptable lip service, the fact is that most of the participants in what should be more appropriately called our “sickness and injury care system” actually have no significant financial incentive whatsoever to spend any significant time and energy in genuinely promoting health and helping to prevent disease and injury.

    Much to the contrary. Other than the actual members of a health plan – patients and potential patients – and their employers and perhaps the employees of some health plans, most participants in our sickness and injury care system – because of the way they are paid – have an enormous (if unspoken) financial incentive for massive amounts of disease and injury – much of which is preventable – to continue to occur in America. Strictly from a financial point of view, for those whose incomes come solely from the treatment – not the prevention – of illness and injury, the more illness and injury that occurs, the better. And if the illness or injury is serious and requires perhaps many expensive tests, multiple surgical procedures, and other very complicated prolonged treatment in an intensive care unit, so much the better; just as long as those unfortunate individuals who happen to be ill or injured are “covered” by “good insurance”, i.e. health plans that are reliable bill payers.

    This is not to say that there are not some excellent very dedicated and hardworking doctors and other health professionals – although they are paid on a fee for service basis to care for illness and injury – who nevertheless attempt to essentially work themselves out of a job by making health promotion and disease and injury prevention a top priority with their patients.

    It should also be recognized that some existing health plans – e.g. Kaiser and Group Health – combine insurance, doctors, and hospitals into a single entity in such a way that provides everyone – including all the health plan’s doctors – a real incentive to spend time and effort with patients on health promotion and disease and injury prevention as well as on early diagnosis and treatment. But unfortunately the above examples represent only a small part of the sickness and injury care system that currently exists throughout America.

    For the most part – because of the way they are compensated – the majority of doctors and other professional providers, acute care hospitals and long term care facilities, pharmaceutical manufactures and pharmacists, medical and surgical equipment manufacturers and personal injury and malpractice attorneys – among others – depend mightily on massive amounts of disease and injury occurring in America; and these participants in our sickness and injury care system would be significantly negatively impacted if a lot of the preventable illnesses and injuries were actually prevented. This must be changed.

    Unless the incentives and rules are changed to give as many participants as possible a real financial stake in health promotion and disease and injury prevention, in early diagnosis and treatment, and in maximizing health and minimizing disease and injury, healthcare costs in America will never be brought under control. Making appropriate changes in the incentives and the rules of the game is the real task and challenge of “healthcare reform”.

    What about financial incentives for individual health plan members? Should individuals receive a financial incentive to be healthy? It is well recognized that engaging in regular exercise, abstaining from tobacco, and eating moderately so as to maintain a reasonably normal body weight are all significant factors in helping to promote an individual’s health and wellness. These healthy behaviors can all be confirmed by simple tests performed or ordered in a doctor’s office. Why shouldn’t those individuals who practice these health promoting behaviors and comply with recommended immunization schedules and appropriate preventive screening examinations such as for colon cancer and breast cancer pay significantly less in premiums to their health plan each month than those who don’t?

    To really reform healthcare we must find ways – through changes in incentives and the rules of the game – to actually prevent what is preventable, to maximize early diagnosis and treatment, and minimize disease and injury with all its associated cost. We must find ways for participants to be part of our “healthcare system” and not just a part of our “sickness and injury care system”.

    Significant changes in the rules of the game for our legal system – tort reform – is also critically important so that the gaming of the system now being done by personal injury and malpractice attorneys and their clients can be ended and so that the exorbitant costs to physicians and other professionals for malpractice insurance can be dramatically reduced.

    Truly transforming our “sickness and injury care system” into a “healthcare system” by making significant changes in the incentives and the rules of the game may seem to be a formidable task and one that probably has never really been done before on a large scale anywhere in the world. But it is a worthy task and a critically important task for the future of America and its people.

    One significant part of this process is developing the capability of creating an electronic health record for every American citizen who wants one. We need a standardized framework that will allow every American citizen to have an individual electronic health record – a computerized medical record – that can be accessed by all the doctors who care for a particular individual, regardless of wherever on the planet the doctors or the patients happen to be. It would be like having your own personal online banking account that only you have the password to, but which you can share with the doctors who are caring for you, wherever you or they may be.

    I applaud those who are using their energy and expertise to upgrade our deplorable current paper medical records system and bring medical records in America into the 21st century. Developing a standardized framework for an electronic health record – for every citizen who wants one – created by your doctor with your assistance, with proper security and safeguards – is something that our national government can and should do as a part of healthcare reform.

    If done well, electronic health records will be transformational in helping doctors efficiently and effectively care for patients and will save an enormous amount of time, effort, and money which is currently wasted on needless and frequently inaccurate duplication. And having an accurate electronic health record for an individual will also facilitate appropriate health promotion and disease and injury prevention for that individual. Like the telephone and the computer, someday we will all wonder how we ever got along without individual electronic health records.

    But all this requires action, not just words. Now is the time for Americans and their leaders and doctors and other health professionals to step up to the plate and begin the process of transforming our “American Sickness and Injury Care System” into an “American Healthcare System” that is worthy of our great country.

    Robert Westafer M.D.

  6. Until we get rid of the Cigna’s, Humana’s, BluCross/BlueShield’s, etc. that eat up our healthcare dollars we will continue on the road to healthcare bankruptcy. A single payer system is the only system that can keep us afloat. Our legislators are owned by those companies that pay to get them re-elected. I feel really helpless to do anything that would force smart change. In the last 2-3 decades, the power of the vote has become no power at all. Presidents cannot force congressmen to do the right thing.
    Why does no one talk about the Taiwan healthcare model?? It seems to me the Taiwan model was created to avoid problems that plague some of the other healthcare models. The critics always focus on the Canadian or UK models as healthcare systems that have problems. I have a few Canadian friends and they are quite happy with their healthcare system. Maybe no healthcare system can be perfect, but ours is worse than a failure – it’s obscene.

  7. I’m not sure that a few Canadian friends constitue an accurate representation of the system in Canada. I’ve never had any problems getting healthcare in the US, nor have my friends and family. If you surveyed us, you would have to conclude that our system is fine, too.

  8. I appreciate Dr. Westafer’s thoughtful response. He gives us a lot of places to tackle the problem at the margins and tweak a very salvagable free-market system.

    Fifteen percent (46 million) of Americans are uninsured. Of that, 5 million entered that pool within the last 30 days and 5 million found insurance. So the vast majority of Americans have insurance and probably aren’t interested in paying for those that don’t. The problem is we have too many miracle cures to treat conditions we behaved our way into (heart disease). On top of that, we accrue most of our medical expenses late in life as doctors do everything in their power to keep us alive. There was a great article in a recent New Yorker detailing how each country adopted the government health care system they have. Not one made the wholesale change from private sector over to state run. There is no silver bullet solution to health care issues. We need to fix it incrementally, the way it got damaged.

  9. I have a question about electronic health records. Will these be accessible to insurance companies? And will insurance companies use this information to deny insurance to individuals ? You know – kind of like credit scoring – only now, it will probably be called health scoring. If you are able to knock out the people who might in the future require expensive medical care, you can bring down health costs – right?
    Just curious if anyone knows anything about this or not. I’ve never seen much in the way of details on this subject.

  10. Reply to “Been Around the Block”
    If you have good health care (as a not “older person”), then you either have personal wealth that allows you to self-insure or possibly you get it thru your employer – which I did prior to retirement last year. I was happy with my employer supported healthcare – but each year my deductible went up as did the co-pays.
    Even with the additional out-of-pocket costs each year, I was reasonably happy because my income was high enough to handle the cost and because my wife and I did have health insurance, while millions of Americans didn’t. In 2003 when I had a heart attack (immediately following a cardiac stress test) I was covered.
    But in the emergency room of that Plano hospital there were so many people waiting for treatment that obviously were using the ER as their primary care facility. They are the uninsured that have no doctor. They have no healthcare thru their employers and they have no wealth to buy private insurance. You and I pay for their healthcare now – but we are paying HUGE when the ER treats their athsma and so many other illnesses that should be treated by a primary care doc or even a PA. There are millions of Americans who cannot get health insurance at anything close to an affordable price. I now pay nearly $400/month for my wife’s health insurance (Texas BlueCross/BlueShield) – and she is a healthy person. I don’t have private health insurance. My former company (EDS) did not offer paid retirement healthcare. Just think of the thousands of Americans who have lost their jobs and health insurance in just the last few months of this economic downturn.

    As to your comment about my Canadian friends. They have had to access the healthcare offered by the Canadian system, and they have had friends and family members that had major health problems that were well handled by Canadian healthcare. I did not say that my friends are a representation of the experience of all Canadians under their healthcare system. But consider that almost all Canadians do have healthcare – while SO many millions of Americans do not. Of all the world’s advanced countries, our healthcare system is probably the worst. The statistics prove it. If your family was one of the uninsured, your attitude might not be the same as it is now.

  11. Bill Moyers’ Journal on Friday night dealt almost entirely with the healthcare crisis in this country. You can access the transcript of his interviews, including those with Dr. David Himmelstein and Dr. Sidney Wolfe at .

    You can watch the broadcast on your computer at or it may be re-broadcast sometime during the next few days on Grande’s or Time Warner’s alternate PBS channels.

  12. Sorry, the automatic posting feature deleted the URL to Moyers’ program. You can find it with a Google search or by going to PBS.

  13. I watched the Bill Moyers piece and I’m more skeptical of single payer than I was before. It looks like the government would come in and assume the role of all the insurance companies. I just don’t have any confidence in their ability to do a good job with that enormous task. Then all the insurance companies would be out of business. How may people is that? Certainly some would go to work for the fed but you would still have a lot of folks out of work. I’m sure there are some reading that and saying “hurray” but in truth the insurance company is providing a valuable service.

    Currently my insurance company reviews the bill for my kid’s appendectomy and compares the charges to other appendectomies around the country and determines if those charges are fair. If the insurance company is too obstinate too many times the insurance review board gets in the game and ultimately the insurance company adjusts their policy or suffers business loss. If an insurance co is denying benefits or otherwise causing too many problems, the customer (usually an employer) will look for another provider. In single payer there is no other provider. Like it or not, you’re stuck with the fed.

    It also opens the door to the fed setting the price for any procedure. If the fed says they won’t pay more than $2,000 for procedure, who does the health care provider have to appeal to? And what if the government, in its infinite wisdom, says you don’t need a procedure? How long is it before they’re dictating when you can have the health care you want?

    I, personally, want doctors to be rich. I want rich doctors out there to act as an incentive to the best and brightest to enter the health care profession.

    Yes, there are problems with American health care but I think it’s alarmist to call it a crisis or to abandon it entirely. There are lots of places where we can make incremental improvements; timely billing for example. As a customer it’s frustrating to not be able to budget what your portion of the expenses is going to be. Centralized billing so that all the professionals involved billed through one entity would be tremendously convenient. An up-front estimate would be nice.

    Of course all these thoughts are suspect since they come from someone who doesn’t believe healthcare is right and furthermore that nationalized, universally available healthcare will be just one more disincentive to work in the ever expanding nanny-state.

  14. Just to be clear, I would not want to live in a socialized system, which is mainly what you describe. That said, I find that medicare is not socialized medicine. It is merely single-payer for seniors. If you were one of the 47 million uninsured, your views on single-payer might be different. Certainly, our personal experiences influence our views.

    The system that Moyers’ doctors described was a way to cover all Americans for the same amount of money now being spent. There is a lot of money that can be saved by moving from a bill-per-procedure system to a lump-sum payment system. While the details of how the lump-sum is determined each month is not clear to me, I can imagine some ways to do that and I will look forward to learning more about this subject.

    And I would like for the Congress to study single-payer along with figuring how it can keep the health insurance companies on the gravy train they now have. If we had single-payer, it would be only the health insurance providers that would be reduced to serving only the wealthy. Insurance for auto, home, life, etc. would continue unaffected. So, single-payer will not destroy the insurance industry, only part of it. Bookstores and newstands continue to thrive even though we have city, state, and federal-run libraries.

  15. I don’t wish this on Mr. Hutchinson, but if god forbid someday him or a member of his family loses their job and has a debilitating disease which leaves them un-insurable and they are devastated financially like so many Americans, he would feel different. Not by any fault of his own, just a genetic disease or a one in a million condition that strike him or his family. Then maybe health care would seem like a right and not a privilege of those with great jobs. I say great jobs because so many workers are un-insured or under-insured and those of us who are self employed are really charged ridiculous premiums if we can afford them at all. I don’t want a free handout but a chance to PAY for a policy like Medicare, that offers real health care coverage and can be used for things like check-ups and preventative care and not just catastrophic cancer insurance. Ever notice how politicians who seemingly could care less about this change their tune and become huge advocates when it happens to their loved ones?

  16. I’d rather have insurance for only the major stuff ($10,000+) myself. I know everyone’s situation is different, but I wonder how much the premiums would come down if the insurance didn’t cover every prescription and exam.

    I had to pay for my own insurance not too long ago and I got an HDHP with 100% coverage for anything beyond a $10,000 deductible and 0% coverage before that.

    Every year we were allowed to contribute pre-tax $$ to a savings account, which we used to pay expenses before the deductible was hit and anything that was left over, rolled over to the next year. When we hit retirement age, we would be able to pull the money out, tax-free, for whatever.

    It worked great for us and it was very helpful to see what things actually cost when paid out of pocket. Often times the savings offered by insurance coverage are minimal.

    Of course, if we had more careers in San Marcos, we’d probably have more citizens with decent coverage.

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