- Politics and Social Issues
Obamacare Facts: The Devil is in the Details
A Single-Payer Healthcare Plan - Boon or Bust
from the Curmudgeon's desk: GA Anderson - A discussion of Obamacare and Single-player healthcare plan proposals
Understand that this is an opinion piece on the real Obamacare facts and details. What else would you expect from a curmudgeon? I first discarded the idea doing an Obamacare piece. I knew enough to have an opinion about it, but the political fight to pass it left me so disgusted with the subject, I just left it alone. Plus, because of the massive TV face-time both sides blasted the media outlets with, almost any discussion will sound like it's being read from a "talking points" hand-out, and I hate "talking points" discussions.
But, a recent discussion has changed my mind. To intelligently continue that discussion I went looking for some single-payer healthcare plan information, and what I found truly frightened me.
I understand that, speaking from the heart, free national healthcare for all is an admirable goal. But when you examine the nuts and bolts of what it will take to get there - with rational, rather than emotional, thought. A single-payer plan is not the way America works.
The Demons are called Saints
What frightened me was what I found on a prominent pro and apparently credible, (note the apparently qualifier), single-payer website that was dominating the first page of Google search results. Anybody that was looking for national single-payer healthcare plan information was going to find this information first.
Remember the battle to get Obamacare passed? It was a time when the Democrats controlled the game. They had the Presidency, and they controlled both houses of the Congress, and it still took billions of dollars of Federal trough money to bribe enough votes to pass it.
Sure you can take issue with that last statement, but another time. The point is - it was a Battle!
The Republicans were screaming about the demons in the bill. Death panels, healthcare decision panels, the end of the private healthcare industry, socialized medicine, etc. etc. etc. You remember.
The Democrats were praising it as the savior of our citizens, free guaranteed healthcare, long life, love and hosanna for all, etc. etc. etc. I'm sure you remember that too.
But for me, it was the combination of the Federal bribery it took to get the passing votes, and Nancy Pelosi's declaration - "You have to pass the bill to see what's in it!", or something close to that, that made me the most skeptical of the greatness of its beneficial claims.
I didn't like Obamacare. I don't like Obamacare. And I don't trust the claims made of it as a great step forward. (I almost said Great Leap Forward)
Sorry, I'll get back to the point. That stuff was just to lay the groundwork.
As I was about to say. What I found at that prominent website was that, they were touting as benefits, all the demons that the Republicans were claiming would be the downfall of American healthcare. I really was frightened by what I read. Could intelligent people read this stuff and not see it for the propaganda that it was?
Well, now that my position is established, let's move to the content.
For the full text - here is the website
This is a nationally sponsored website of doctors - which means they have credibility and know what they're talking about right? Once more, what frightened me was that if a reader doesn't look beyond the cheese, they won't see the trap.
*note: the page referenced includes data and projections referring to years as far back as 2002, and 2004. This does not mean the rest of the site isn't current and up-to-date - just that the format of this page was the best vehicle for this comparison.
The doctor's explanation of a single-payer national healthcare plan.
1. What is a single-payer healthcare plan
Single-payer is a term used to describe a type of financing system. It refers to one entity acting as administrator, or “payer.” In the case of health care, a single-payer system would be setup such that one entity—a government run organization—would collect all health care fees, and pay out all health care costs.
True, but misleading. It implies it's just an administrative mechanism. But it is much more, it involves treatment decisions, technology decisions, payment and practice systems. The scary part? They actually tell you this, but with phraseology that hides it - one entity—a government run organization... but they say it in the context of finances and administration. It may appear that I am misstating its context, but my point will be more clear further on - about what that phrase really means.
2. Single-payer healthcare access and benefits
All Americans would receive comprehensive medical benefits... all medically necessary services, including rehabilitative, long-term, and home care; mental health care, prescription drugs, and medical supplies; and preventive and public health measures...based on need, not on ability to pay.
Sounds great, get the medical healthcare you need, all in a single-payer system. But three things to note. 1) their list of covered services appears to be just an illustrative example, but again, as you will see further on, it is almost the entire menu, wait until you see how they hint at the services you won't be able to get under this system. 2.) Did you skip right over ...medically necessary services? It doesn't say all available medical services, or medical services you want, it says necessary services, and guess who is going to decide what is necessary? 3.) and another phrase that appears to mean one thing in the context of its use... based on need. Further on it will be clear who they have in mind to decide your need.
I know, that sounds like the Republican talking-points "Death Panel" mantra we all heard and dismissed as rhetoric, but bear with me... my points will be more clear as we get into the real meat of their explanations.
3. Single-payer healthcare payment mechanism
...hospitals would receive an annual lump-sum payment from the government to cover operating expenses... separate budget would cover such expenses as hospital expansion, the purchase of technology, marketing, etc... they list these options for doctor's fees... fee-for-service, salaried positions in hospitals, and salaried positions within group practices
Now follow their next sentence closely - ...Fees would be negotiated between a representative of the fee-for-service practitioners (such as the state medical society) and a state payment board. In most cases, government would serve as administrator
Notice that they say lump-sum payment for operating expenses. What happens if operating expenses go up, through no fault of the hospital's operating management? The hospital has to absorb the extra costs. How? Reduce staffing? Reduce quality of care? New catheter every three days, instead of daily? Think I'm be overly dramatic? Give it some thought.
... and a separate budget for expansion and new technology? What about some newly developed operating room devices that are saving more lives due to their innovations? Maybe the budget can handle it, or maybe the "plan" says nope, not enough in the budget for new equipment this year. Sound okay to you? Probably won't affect your 82 year-old mother's heart surgery next month anyway. As long as she has the top surgeon on the job.
They come right out and tell you that the government will control doctor's fees! If you don't think that sounds like a bad thing... consider that they are not just talking about office visit charges. They mean all doctors fees. Medical test charges? What about an MRI? Those are multi-million dollar pieces of equipment. What if, (and I'm just picking an illustrative number), a doctor needs to charge $100 per test to be able to pay for the machine based on its planned life expectancy usage, and the government says, "No! You can only charge $25 for that test because that's all the plan can afford to pay."
Don't you suppose that would influence a doctor's decision whether or not to invest in the purchase of an MRI, when he knows he will not be able to recoup his investment based on the life expectancy of the equipment?
Can you not see the potential for a reduced availability of MRI's? Which in turn could mean waiting lists for the tests? That is exactly what happened in Britain. Canada also, except that Canada does have a secondary private-medicine industry... if you have the money.
What about surgeons? The government will now value the skills of a surgeon? The tops in the field feel they are worth $200, but the government says, Nope, the single-payer plan can only afford to pay $100, so guess what - you get the 2nd or 3rd best surgeon operating on you.
Is that okay with you? 2nd or 3rd best should be okay for your neurosurgery, right?
You will hear this again and again, but a government single-payer system is not going to provide the same healthcare as a private-economy system. That might not be the most terrible choice in the world, if there were still other options if you needed them, but as we go further, you will see two things; a single-payer plan will only work if private medicine IS NOT allowed to be available, (they actually state this), and the very construct of this system will destroy private healthcare companies. They will go out of business because the government will not allow them to make a profit.
4. How will the government pay for this single-payer plan.
...Employers would pay a 7.0 percent payroll tax and employees would pay 2.0 percent, essentially converting premium payments to a health care payroll tax.
Great no more healthcare premiums. Life is good.Just another payroll tax burden on employers. That won't affect their hiring and staffing decisions will it?
This is the least worrisome of the details. It could be conceded that this is just the cost of having national coverage, which if single-payer were something I could accept - I wouldn't be complaining about a funding mechanism like this.
And the 2% additional income tax charge? Peanuts for you right?
Oh, there was one other line...
includes a $2 per pack cigarette tax.
But you're not a smoker so no problem right? Well, maybe not. If they have that figure nailed to a specific amount, it must mean they are basing it on "x" number of smokers right? What happens when that new tax burden reduces the number of smokers, thus reducing the tax income? Just raise the cigarette tax to $3, $4, $5...? Guess where they will look for the money they planned to get from smokers - but didn't?
5. Administrative Savings through a single-payer healthcare plan
Finally, one I can agree with
GAO projects administrative savings of 10 percent through the elimination of private insurance bills and administrative waste, or $150 billion in 2002...
The medical billing procedures a doctor's office has to comply with are so onerous and complicated that it requires a staffing position solely for insurance company billing. The industry is somewhat standardized, in that doctor's offices use something called, a super bill, which is a page full of small-type coded services listings that must be checked off.
It's really enough just to understand that the billing/payment relationship between provider and payer is a burdensome process that works in the favor of the insurance companies.
But, this is something that could be corrected with system reformation, it doesn't require switching to a single-payer system to fix it. Also, doesn't it seem curious that administrative costs savings should be touted as a major reason for a single-payer system? Implying that that is the only way to rectify an admitted imperfection.
6. Cost containment benefits of a single-payer system
GAO ...projects that single payer would reduce overall health costs by $225 billion by 2004 despite the expansion of comprehensive care to all Americans...
This is in addition to the 10% administrative savings. Sounds great to toss out $225 billion - but where is it coming from? Going to provide more, but it will cost less - how? And don't quote the economy of scale logic, because it's apples and oranges. That applies to reducing the overall costs of the plan. This contention seems to be related to healthcare costs, not plan costs.
I only question this one because of it's lack of clarity, and my already high level of suspicion fueled by what has come before it.
Different Perspectives on the Benefits of Single-Payer
At this point, the segments switch to their, (PNHP), perspectives of the general benefits of switching to a single-payer national healthcare system.
Patient's single-payer plan benefits
...regardless of ability to pay would receive high-quality, comprehensive medical care ...free choice of doctors and hospitals ... receive no bills, and co-payment and deductibles would be eliminated ... would pay less overall for health care than they pay now.
The most contentious issue here is about retaining free choice of doctors and hospitals. In recent discussions, explanations, and admissions, by the political proponents of this plan, they have admitted, under questioning, that by the very nature of the changes required to implement a single-payer plan - this may not be the case.
Regarding his previous explanation, and pledge, President Obama himself, has had to back-track and admit that with these changes, you may not be able to keep those choices.
Also, as more of the details emerged after the passage of the bill; healthcare choice decision-making state panels, mandated conversion of hospitals and major healthcare facilities from privately owned for-profit entities to plan owned, (truthfully just a different way of saying nationalization of privately institutions), that statement has become harder to defend as correct and truthful.
Doctor's single-payer plan benefits
Doctors’ incomes would change little, though the disparity in income between specialties would shrink. The need for a “wallet biopsy” before treatment would be eliminated; time currently wasted on administrative duties could be channeled into providing care; and clinical decisions would no longer be dictated by insurance company policy.
*this segment also included a large text block listing medical-related association's endorsements that although pertinent to showing support, were not pertinent to this explanation - following the above provided link will allow you to see what has been omitted here.
Except to note this statement; disparity in income between specialties would shrink, which was noted earlier, seems to indicate fields of medical specialization development will possibly atrophy due to lack of motivating factors. Whether you want to admit it or not, the opportunity for profit motivates more doctors to delve into medical specialties, than the motive of altruism.
The combination of both of those motives has probably been the driving force that has produced most of the "best and brightest" medical professionals we have today. Of course this is something that can only be surmised... but is it hard to consider that if you remove half of something, you will not alter the result?
To respond to the rest of these general statements would only amount to a he said - she said discussion - which would be more properly addressed in an article devoted to just those points.
Hospital's benefits from a single-payer plan
...administrative personnel needed to handle itemized billing to 1,500 private insurance companies would no longer be needed ...negotiated “global budget” would cover operating expenses ...budgets for capital would be allocated separately based on health care priorities ...hospitals would no longer close because of unpaid bills.
yes, burdensome administrative costs would be reduced under a single-payer national healthcare plan, so it would seem to be hard to argue these points.
Except, as noted above; the potential repercussions of a ...negotiated “global budget, and ...allocated separately based on health care priorities. Also, the closing statement, ...hospitals would no longer close because of unpaid bills, is a deceptive strawman argument. Successfully managed hospitals don't close due to unpaid bills, marginally proficient ones do. The real reason some hospitals will close will be due to choices made by some of the plan's newly created "decisions panels" regarding necessary medical needs for different population areas, and global budget allowances.
Additionally, they address this question:
What happens to investor-owned hospitals under national health insurance?
“The NHI program would compensate owners of investor-owned hospitals, group/staff model HMOs, nursing homes and clinics for the loss of their clinical facilities, as well as any computers and administrative facilities needed to manage NHI. They would not be reimbursed for loss of business opportunities or for administrative capacity not used by NHI. Investor-owned providers would be converted to nonprofit status.
Sounds like they are saying we will pay you a worth, (that they determine), for your physical properties, and, we will pay you for the other assets we determine will be needed, (again a value they will determine), but for the rest... too bad, so sad.
Just imagine the contortions needed to avoid viewing this as nationalization of private property and assets.
Insurance Industry benefits from a single-payer plan
The need for private insurance would be eliminated. One single payer bill currently in the House (H.R. 1200) would provide one percent of funding for retraining displaced insurance workers during its first few years of implementation.
They aren't mincing words here, they come right out and tell us that the private healthcare industry will go away, (hmmm.. how then will you be able to keep your choice of doctors and hospitals?), and the plan has determined the amount needed to retrain healthcare industry workers. Okay, so what if you trained to be a nurse, sorry, but we just don't need as many buggy whips anymore. But no worries, we have a grant to help you retrain to be a .... butcher or baker or candlestick maker.
Also, this is just a snippet taken from within a larger explanation that uses "the wealthy" as the bogey-man for justification - with phrases like; "...if we allow the wealthy, or ... if the wealthy are forced",
Studies in New Zealand and Canada show that the growth of private care in parallel to the public system results in lengthening waits. Additionally, allowing the development of a parallel, private system...
Even further yet, they stipulate, (in other statements available through the link already provided), that a single-payer plan can not succeed if private healthcare services remain available. Implementation will require outlawing those private healthcare services.
Doesn't that prospect at least cause a few alarm bells to ring for you?
That's pretty much the gist of a national single-payer healthcare plan
A couple caveats:
- Granted this article, as lengthy as it turned out to be, only addresses a very complex issue in a very simplistic form
- Granted, most of the PNHP explanations were "cherry-picked", and not presented in their totality - BUT... that was due to the need for brevity, and to avoid publication restrictions due to "duplicate content" filters. NONE of the "cherry-picked" segments were chosen to distort the context of PNHP's full explanations, and a link to the full explanations was provided to ensure you had access to verify the context was as stated
- Granted that much of the criticism of the described single-payer plan features are assumptive and position-biased - but isn't that true for all debated issues that aren't purely mathematically provable facts? This is not a case of 2+2=4!
Eureka - I have the answer!
It's amazing, I know the answer to how to fix our nations healthcare industry!
I didn't know it when I started this article, but somewhere near the halfway point, I started to feel the glow of an inkling of a solution. And just as I was finishing the segment about the hospital issues involved - it burst upon me, fully developed, just as obviously true as the old adage about "spitting in the wind..."
It's the same answer a wise old farmer once gave when a carload of city-slickers pulled up to ask directions....
"... ya can't get there from here!"
There will be no solution to our healthcare problems, or any of the many other large problems we face... until we fix our corrupt political problems first. No matter what solution we try for any problem our government or society face -
...as long as somebody with money can buy somebody with influence,
no matter if it is healthcare or widgets, the moneyed interests will be advantaged, and the rest of us will have to live with the results. That's not a criticism of Big Money, I wish I had some of it. It is a criticism of what we allow crooked politicians to do to us.
If we had honest politicians that had the integrity to resist the bribes, it wouldn't matter how much money Big Money had.
If you want a fair and level playing field - vote intelligently!
If you vote for Obamacare...
See more GA Anderson Political articles
About the Author
Writing for the Daily Constitutional, and commentary from the Curmudgeon's desk - GA Anderson
"Seeing it does not make it real, and reading it does not make it true. Use a little common-sense and trust your instincts." - GAA
*Composite image component source citations: Creative Commons images from:commons.wikimedia.org, flickr.com/creativecommons, search.creativecommons.org, http://googlesystem.blogspot.com/2009/06/find-creative-commons-images-in-google.html. *photo and image source credits: divider and separation images - http://gaanderson.hubpages.com