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  1. Samuel Metz MD

    Dear Sir from LaGrande,

    The Vermont Workers Center meetings were advertised in the Baker City Herald and LaGrande Observer to encourage attendance from the communities and to generate questions, both hard and otherwise. Had you attended, your questions may have been answered. Would you like to add your name to our mailing list so you won’t miss our next appearance?

    Your point about private clinic expenses is well taken. Perhaps the largest expense in any primary care clinic is the cost of collecting money from private insurance companies, roughly $80,000 per year per physician. Private insurance companies deny 30% of all first claims, and those of us who have run our own practice know that these claims are being denied not because we are trying to defraud the insurance company but because insurance companies stay in business by denying valid claims. With a single payer system, this administrative cost is converted to health care.

    Medicare costs are increasing. So are health care costs around the world. Medicare attempts to protect access to health care for seniors by considering new delivery and payment mechanisms. Private insurance companies compensate by raising premiums, cutting benefits, increasing co-pays and deductibles, excluding patients who need care, dropping healthy patients who get sick, denying payment to providers, and generally providing less care to fewer patients.. Neither is attractive, but Medicare is the better bargain.

    You are correct that not-for-profit private insurance companies are no less piratical than for-profits. Both generate a 40% loss of premium dollars to administration, roughly ten times that of Medicare and twenty times that of more efficient single payer systems. We need to eliminate all private insurance companies, for-profit or not, as the parasitical intermediaries between patients and physicians.

    We absolutely agree that familiarity with the strange and twisted economics of American health care is essential to understanding any reform proposal. Any seemingly simple and easy “solution” should be received with skepticism. Fortunately, single payer systems have demonstrated their ability to provide better care to more people for less money ever since the concept was invented in America eighty years ago. Single payer systems provide care to our armed forces, our veterans, and 26 million other Americans who get care via multi-employer health plans.

    Single payer financing is the American solution to America’s health care problems.

    Samuel Metz MD

  2. Michael HuntingtonMD

    Dear Rich from LaGrande,

    Thanks for your comment. For your one letter there are probably hundreds of people who feel the same way.

    The over-riding motivation for our two tours this year was to make sure Oregonians recognize that the US health care system (really a sick-care non-system) is causing unnecessary severe suffering here and around the nation and is collapsing under its own weight. We think there are ways to reverse this tragedy. First we must decide as a society that it’s in our best interests to keep each one of us as healthy as possible, that health care is a human right and public good, and from those concepts enact laws that do include everyone and control costs. All this would seem beyond achievable except that twenty two other nations have done it. True, they all face financial and ethical struggles, but they have figured out how to provide health care for all their people at about half the US cost per-capita, while our extravagant spending provides adequate care for only about half of our population.

    The medical bills you mention are way too high for a variety of reasons that are correctible. We currently finance our health care system by making sure we do lots of medical procedures at the highest reimbursement rate we can get by with. We depend on inflated reimbursements from CTs, MRIs, surgeries, and drugs to bring in enough revenue to keep our hospitals and clinics open, support the costs of those who cannot pay, and create generous to massive incomes for segments of our health care industry. The people who can’t pay for their care are you and me except that they have been excluded from healthcare because of cost and pre-existing conditions.

    It would be as though we financed our fire department by underfunding the fire-prevention unit and allowing other conditions that cause houses to catch fire. Then we would respond to calls from owners of the burning houses, ask the owner if he/she had paid the fire protection premium that month, if not, allow the fire to continue until serious damage had occurred, then expend much manpower, equipment, and water to douse the flaming ruins, then charge the owner thousands of dollars.

    The RVU system you mentioned is at the center of this dysfunctional health care “fire department”. The AMA owns the CPT coding system and makes $ millions on royalties from it. The secretive RUC Committee of the AMA is the determiner of RVU rates and is 85% specialist in membership. Procedures are rewarded “as the market will bear”. But of course this is not a free market; the providers control price and the demand. Primary Care is left behind and gets far less reimbursement for counseling patients in ways that would prevent illness and cost.

    Then of course our health care (non)-system pays for many unnecessary middlemen. Private health insurance is an investment business only tangentially related to health care. The motivation in this industry is to minimize costs so profits will be high. Therefore the people who might get sick are systematically excluded from coverage. Removal of this parasitic industry from health care would remove about 15% of the current costs.

    But it all gets back to what we want a health care system to do. If we want it to be an income stream for as many people as the system can fund, we will continue on our present course until the system collapses. If we view health care as a human right, a public good like fire and police protection and public education, water safety, road safety, we will all benefit as part of a much healthier society.

    Michael Huntington MD

  3. Rich, former CMPE

    Saw y’all were in Baker City Last week, never had any heads up. Maybe you didn’t want anyone asking the hard questions again. Was there anyone present who has had to pay the bills in a healthcare organization and keep it running financially? Clinics don’t run on rainbows and sunshine, after all. Have you ever figured out what the RVU rate would be in your proposed system? I asked last April in La Grande, never got an answer. Our Medicare taxes don’t seem to be keeping solvent. I just watched a bunch of tripe online from MAHD, and the bottom line is “profits are bad”. Looking to my left and right, the “non-profits” always had the highest paid folks, as they could roll that payroll into expenses, and buff up their reimbursement rates from government payers. MAHD Docs: do medicine, and come to the table to discuss reality when you get some economics ed….MHO

  4. Pat Griffin

    Dear Health Professionals,

    Thank you for caring about (& working toward), a single payer plan!

    Can you give me a name of a good general practitioner or internal medicine doctor who accepts Medicare? My husband & I have a secondary insurance policy with Blue Shield/Cross, but are having a difficult time a doctor here in Portland. Pat

  5. In the summary for H.R.676 it says:

    “The Improved Medicare For All program will negotiate reimbursement rates annually with physicians, allow for global budgets (monthly lump sums for operating expenses) for hospitals, and negotiate prices for prescription drugs, medical supplies and equipment…”

    It is clear from this that these folks do not understand risk, risk management through insurance, how insurance products are priced, how insurers manage claims, and the solvency requirements of legitimate, appropriately capitalized health insurers.

    I expect this from Republicans and conservatives, I certainly expect no more from Tea Party members, but it is really disappointing to see Democrats and liberals screw this up.

    As it turns out, after close to a decade doing insurance and reinsurance rate making, reserving, and expense reporting I think I have a glimmer about this stuff. Doesn’t hurt that I am a psych social worker, psych nurse, mathematician, and statistician.

    The bottom line is that it does not matter how large the entity collecting premiums is – it matters who is actually managing the risks. If a legitimate national health insurer manages the insurance risks for the entire population, the risk management system will be the most efficient it can be.

    But, if the “National Health Insurer: functions like a managed care organization, collecting premiums, and transferring the insurance risk management role to physicians, nurse practitioners, hospitals, long term care facilities, and home health agencies, as the Prospective Payment Systems do and as the summary suggests 676 would extend, you will not alter the single most inefficient aspect of our current health care finance system: The inefficiencies introduced when health care providers serve as small, incredibly inefficient insurers for their patients.

    There is absolutely no advantage to have a “single payment receiver system” when the barriers to effective and efficient risk management remain unchanged or increase.

    I actually work on this a good deal – here are some recent publications:

    Cox, T. (2011). Standard Errors: Statistical Consequences of Health Care Provider Insurance Risk Assumption. In JSM Proceedings, Section on Health Policy Statistics. Alexandria, VA: American Statistical Association. In press.

    Cox, T. (2011). The Impact of Size on Success of Health Insurance Companies. Nurse Leader, 9(5): 38-41.

    Cox, T. (2011). Exposing the true risks of capitation financed healthcare. Journal of Healthcare Risk Management, 30: 34–41.

    Cox, T. (2010). Legal and Ethical Implications of Health Care Provider Insurance Risk Assumption. JONA’S Healthcare Law, Ethics, and Regulation, 12(4): 106-116.

    and I am putting together a series of Working Papers on risk, risk management through insurance, and health care reform.

    If, like me, you think that health care rationing is best done dispassionately and at a great distance from the face to face interactions between caregivers and patients, please do NOT support H.R. 676!

    What we need is a real national health insurer that achieves dramatic cost reductions through efficient risk management and appropriate utilization review. We do not need to continue compelling health care providers to slash patient benefits in order to remain solvent.

  6. https://wwws.whitehouse.gov/petitions#!/petition/replace-affordable-care-act-hr-676/GzrHpdWW

    Better than a public option is H.R. 676. This would reduce our nations overall healthcare costs AND provide healthcare for every man, woman and child…no exceptions…from the womb to the tomb. We need to eliminate the profit motive from the financing of healthcare. The public option would not do that. H.R. 676 would. Please log in and sign the petiition to Replace the Affordable Care Act with H.R. 676

  7. bigbrotherbooter@comcast.net

    I just created a petition on the whitehouse petition site to support and make into law the public option, that was removed from the recently passed healthcare bill. We need a whole bunch of signatures so we can create support for a public option. here is the link http://wh.gov/28R . Idealy it would be nice if we all picked a day were we can all sign the petition and get on http://www.congress.org to write our congressman and senators on the same day. Kind of a virtual march on washington. Just an idea.

  8. admin

    Dr. Metz responds to Mr. Brazier,

    Thank you for listening critically to the NPR broadcast, “To the Point,” on October 3rd and specifically to my comments. I will do my best to respond.

    Data demonstrating our public health ranks near or at the bottom of industrialized countries come from multiple sources. They all concur regarding our dismal results. The sources (and links I found most useful) are listed below [1-6].

    Correcting our health care statistics for smoking, obesity, traffic fatalities, race, and homicides makes no perceptible difference in our relative ranking [7].

    Some of the criteria stand on their own without requiring correction for equally sick patients with comparable diseases. These include maternal mortality, foot amputations per 100,000 diabetics, and lives lost to treatable diseases.

    The clinical efficacy aspect to which you refer compares clinical outcomes for patients receiving treatment. This presumes citizens receive treatment. This is mostly true in other industrialized nations but unfortunately not in the US. A participant on the broadcast, Dr. Schoen, is co-author on one article documenting compromised access to health care in the US [8,9].

    Compromised access, not provider ineptitude, is the principal factor responsible for our poor health [10,11]. Once Americans get through the door of a hospital or physician’s office, their care compares well to other countries. Unfortunately only relatively wealthy Americans have sufficient money to get through those doors. The 44% of Americans who do not receive health care in a timely manner or, in some cases, at all, make our overall statistics poor [9].

    Some statistics show longer survival rates in the US for certain kinds of cancer. These conflict with other statistics, confounding the claim [12]. Additionally, similar mortality rates for these cancers suggest differences (if any) are attributable to earlier diagnosis rather than longer life expectancy [13,14].

    You are correct that differences in the definition of “live birth” affects statistics on infant mortality and life expectancy at birth. Here is a statement from the OECD (italics in the original):

    “Some of the international variation in infant mortality rates is due to variations in registering practices of premature infants (whether they are reported as live births or not). In the United States, Canada and the Nordic countries, very premature babies (with relatively low odds of survival) are registered as live births, which increases mortality rates compared with other countries that do not register them as live births.” [15]

    Correcting for this different definition does not improve our rank. “The United States has … the highest infant mortality rate among the eight countries that report this metric similarly.” (Canada, Denmark, Finland, Iceland, Japan, Norway, Sweden, and the United States [16,17]).

    This is presented in a graph with data from the CIA, reference [17]

    Some contend American neonatologists make humanitarian (and usually futile) efforts to save premature or underweight neonates, efforts not made in other countries. If so, we expect a lower life expectancy at birth than these other countries. This is true. However, after these desperately ill neonates die young, we expect a rise in comparative life expectancy at ages five years and above. We do not see this. The relative life expectancy ranking of the US compared to other countries does not change at any age (until age 65, suggesting an effect of Medicare on health care access).

    This is presented in graph form at following reference: [18]

    You are not alone in suggesting our health care must be better than statistics indicate. Many Congressional leaders make similar statements [19-26]. As these members of Congress are in the top 10% income bracket, it is unlikely they have encountered the access failures plaguing Americans in lower income brackets. They also have political agendas served by publicizing their unsubstantiated beliefs.

    If you have additional studies that should be included, as your last paragraph suggests, please share the citations and I will include them in future discussions.

    References

    1. Organization for Economic Cooperation and Development (OECD) http://www.oecd.org/health/healthataglance http://www.oecd.org/document/16/0,3746,en_2649_37407_2085200_1_1_1_37407,00.html http://www.oecd.org/health/healthdata http://www.oecd.org/health/healthataglance http://www.oecd.org/document/11/0,3343,en_2649_33929_16502667_1_1_1_1,00.html

    2. Preker AS. The introduction of universal access to health care in the OECD: lessons for developing countries. In: Achieving Universal Coverage of Health Care. Nitagyarumphong ES, Mills A (editors). Ministry of public health, Bangkok, 1998, p.103

    3. The Central Intelligence Agency (CIA). The World Factbook. http://www.cia.gov/library/publications/the-world-factbook

    4. The World Health Organization (WHO)

    Selected indicators of health expenditure ratios, 1999–2003.World Health Report 2006. http://www.who.int/whr/2006/annex/06_annex2_en.pdf. http://www.who.int/whr/2006/annex/06_annex2_en.pdf http://www.who.int/research/en http://www.who.int/whr/2000/annex/en/index.html http://www.who.int/whr/2000/en/annex01_en.pdf http://www.who.int/whr/000en/report.htm

    5. The Commonwealth Fund http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2011/Jul/1532_Squires_US_hlt_sys_comparison_12_nations_intl_brief_v2.pdf http://www.globalhealthfacts.org/bytopic.jsp http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2011/Jul/1532_Squires_US_hlt_sys_comparison_12_nations_intl_brief_v2.pdf

    Nolte E, McKee CM.. Measuring the health of nations: updating an earlier analysis. Health Affairs, Jan/Feb 2008, p. 71

    Schoen C, Davis K, How SKH, Schoenbaum SC. US health system performance: A national scorecard. Health Affairs Web exclusive, November/December 2006; 25(6): w457-w475,

    6. The Kaiser Family Foundation http://www.globalhealthfacts.org/bytopic.jsp

    7. Muennig PA, Sherry A. Glied SA. What changes in survival rates tell us about US health care. Health Affairs 2010;29, no.11:2105-2113. doi: 10.1377/hlthaff.2010.0073

    8. Schoen C, Doty MM, Robertson RH, Collins SR. Affordable Care Act reforms could reduce the number of underinsured US adults by 70 percent. Health Affairs, 2011;30, no.9:1762-1771. http://www.latimes.com/health/la-fi-health-insurance-20110908,0,343767.story

    9. Consumer Reports Health Insurance Survey Reveals 1 in 4 People Insured But Not Adequately Covered, ConsumerReports.org, September 2007. September 12, 2007, http://www.consumerreports.org/cro/cu-press-room/pressroom/archive/2007/09/0709_eng0709ins.htm.

    10. http://www.oecd.org/document/11/0,3343,en_2649_33929_16502667_1_1_1_1,00.html

    11. Mark Pearson, Head Health Division, OECD, Written statement to Senate Special Committee on Aging, 30 September 2009. Disparities in health expenditures across OECD countries: Why does the United States spend so much more than other countries? http://www.oecdwash.org/PDFILES/Pearson_Testimony_30Sept2009.pdf

    12. Paul Krugman. Cancer Survival. New York Times, March 24, 2011. krugman.blogs.nytimes.com/2011/03/24/cancer-survival

    13. Aaron Carroll. Senator Johnson’s odd dislike of the PPACA. The Incidental Economist. March 23, 2011

    theincidentaleconomist.com/wordpress/senator-johnsons-odd-dislike-of-the-ppaca

    14. Aaron Carroll. Survival rates are not the same as mortality rates. The Incidental Economist August 31, 2010. theincidentaleconomist.com/wordpress/survival-rates-are-not-the-same-as-mortality-rates

    15. OECD Health Data 2005. http://www.oecd.org/dataoecd/15/23/34970246.pdf

    16. http://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html

    17. Congressional Research Service, Peterson CL, Burton, R. U.S. Health Care Spending: Comparison with Other OECD Countries. 9-17-2007

    18. WHO, World Bank, UNESCO, CIA, individual country databases from 2008. http://www.worldlifeexpectancy.com

    19. http://online.wsj.com/article/SB10001424052748704662604576202203050970010.html

    “We need to recognize that the finest health-care system in the world is at risk—and repeal ObamaCare before it’s too late.” Sen. Ron Johnson (R-Wisc)

    20. http://www.washingtonpost.com/wp-dyn/content/article/2010/02/25/AR2010022504325.html

    “I do believe we have the best health care system in the world.” Sen. John Barrasso (R-Wyo)

    21. http://www.nytimes.com/2009/11/05/opinion/05kristof.html

    Sen. Richard Shelby (R-Ala). President Obama’s plans amount to “the first step in destroying the best health care system the world has ever known.”

    22. http://www.mdmagazine.com/forum/general-medicine/45

    Sen. Rand Paul (R-Ky) “The debate should start by acknowledging that we have the greatest health care in the world, and that 100% of people in the country have 100% access to emergency care. Those things are sort of lost on people when they talk about the uninsured. Everybody in our country can receive medical care.”

    23. http://www.foxnews.com/politics/2009/07/21/gop-senator-steps-war-words-obama-health-care-reform/

    Senate Minority Leader Mitch McConnell (R-Ky), “We do start with the notion, however, that we have the best health care in the world,”

    24. http://www.issues2000.org/2008/John_McCain_Health_Care.htm

    Sen. John McCain (R-Ariz) “The real question is: How are we going to keep health care costs down, because we have the highest quality of health care in the world in America today?”

    25. http://www.ontheissues.org/2008/Fred_Thompson_Health_Care.htm

    former Senator Fred Thompson (R-Tenn) “Americans have the best healthcare in the world.”

    26. http://www.minnpost.com/politicalagenda/2009/08/31/11231/rep_bachmann_thinks_us_health-care_system_is_best_in_the_world_but_the_statistics_say_otherwise

    Rep. Michele Bachmann (R-Minn) “Let’s not destroy the greatest health care system the world has ever known.”

  9. Jay Brazier

    Greetings Dr. Metz:

    I listened with interest to your commentary on “To The Point This Morning.” I was particularly intrigued by your claim that the health system in every country achieves better outcomes at lower costs than the system in the US.

    Is this based on studies that directly compare the costs and clinical efficacy of treating equally sick people with specific diseases? E.g. international comparisons of clinical efficacy. If so –
    please share them here on your site. If it is not based on studies that directly compare how effectively doctors and hospitals treat patients, then please share the data that you have based these claims upon. ‘

    Life expectancy and infant mortality statistics, while commonly cited in support of such claims, are confounded by real factors (murders, accidents, risk-factor prevalence, etc) and registration artifacts (vastly different standard for determining what constitutes a live birth and recording it as such) that vary dramatically from one country to the next. Consequently – they are very unreliable indicators of clinical efficacy.

    If either constitutes the basis for your critiques of health system performance in the US, I hope that you will, at a minimum – acquaint yourself with the literature that outlines their limitations for this purpose.

    Best Regards,

    -Jay Brazier

  10. Paul Hochfeld

    The point of the first incident above is unclear. Dr. Chirls describes a failed business venture decades ago by a dozen physicians. It is not obvious how this incident relates to single payer health care today.

    His second incident states without documentation that single payer works only because wealthy patients go outside the system. As an example, he implies the Swiss health care system succeeds only because a famous private heart hospital was established there long ago. As Switzerland does not use a single payer system and is also the second most expensive country in the world for health care (the US remains in first place), the relevance of this incident to single payer remains unclear.

    The Department of Veterans Affairs health care system has evolved in the last 65 years, as have most systems. It is not clear how the third incident describing the actions of a single VA physician in 1950 relates to any current health care system, single payer or otherwise.

    His last point, that salaried physicians are second-rate, lazy, and bureaucratic, is not true. Salaried physicians at multi-specialty clinics provide care at many of America’s leading hospitals, including most academic medical centers. If Dr. Chirls has evidence these physicians provide worse care than fee-for-service physicians, he did not present it.

    Single payer systems in the US and around the world provide better care for less money to more people than American private insurance companies. Incidents from the past century presented by Dr. Chirls do not invalidate this present reality.

    Dr. Chirls comment begs the question: how can the US provide care to all citizens (as do all other industrialized countries) without increasing costs? As his comments indicate his doubts about single payer, he is welcome to propose his own solutions.

    My impression is Dr. Chirls endured some highly unpleasant business arrangements during his career in medicine and fears a single payer system will create more. It is imperative that health care planners understand the fears of clinicians like Dr. Chirls and work hard to assure them that their fears are unfounded.

    submitted by Dr. Samuel Metz, Dr. Paul Hochfeld and Dr. Mike Huntington

  11. I. Allen Chirls, MD

    It’s interesting that Dr. Metz comes fromPortland. (1) 25 or 30 years ago the insurance companies tried capitation contracts; 12 groups of ophthalmologists came out of the woodwork in Portland and bid. Unfortunately one outlier was enough to sink the project because it ate up all the spare money. (2) He avoids the fact that one-payer works because the wealthy have an outlet elsewhere. A couple of decades ago the one major hospital in Sweden appointed a famous doctor to head it. He was a cardiac surgeon and practised his specialty.He was dismissed shortly because the costs were too great. He opened a clinic in Switzerland and all the wealthy Swedes who needed heart surgery went there. (3) After World War II a young ophthalmologist opened a practice. It failed so he became phthalmolgist at a VA hospital. We sent residents there but they complained he had 3 beds, did one surgery a week but kept them post op for 2 weeks to keep the beds filled. (4) If doctors are the best and brightest, put them on salary and you will lose them. Only second-rate people and lazy bureaucratic types will fill those positions.

  12. Joel Weddington MD

    Dr. Mohler, on Feb 11, said:
    “It sometimes seems that the “Mad as Hell doctors” are really mad as hell about the fact that they make less money than specialists.”

    After 22 years of private practice orthopedics I can assert that this is quite correct! I’ve known specialists to easily make 7-figures, yet I’ve also known primary care docs to make .5M. My observation of HOW these docs make this money ihas driven me to be an activist for reform. Stories like Sandra’s (Dec 2010) are tragic in that they show how the public at large is being traumatized by neglect from our the “system.” Trust me, operations in the back offices of rich doctors are not a pretty sight.
    As I find empathic organizations such as MAHD, I hope to get connected and gather strength as a new member with passion not only for Single Payer, but also with innovative ideas such as my presentation “Doctors as Cost-Drivers.” I’m an active member of California PNHP and have a growing network of allies.
    One of my many observations: The AMA and other national doctor’s organizations work to preserve the status quo of declining health by saying “we believe in protecting the doctor-patient relationship.” This is healthcare rationing, because there’s no protection for those who can’t afford to enter that relationship. I have an idea of how we can change that.
    joelwedd@yahoo.com

  13. Karl Rashton

    Hey, I’m mad a h too. At you guys. You are part of a criminal enterprise called Western Medicine, and you are worried about delivering MORE of this bankrupt product to consumers? Get your heads out of your butts, show some integrity.

    When it is KNOWN that you can CURE cancer, diabetes, heart disease cheaply, quit prescribing phony gateway “diseases” like high cholesterol, high blood pressure, so people can load up on side-effect giving prescriptions at astronomical prices, quit the PSA and breast cancer exams, which are really only to find new profit centers before they take care of themselves…but your system won’t allow it, and you are brainwashed into actually believing the opposite, then I say an MD is a License to Kill.
    Physicians, heal thyselves. Leave us alone. I’m getting on, don’t have “health” (aka make sure we get paid) insurance, haven’t seen a quack since I figured this out. The nutrition advice you know and give is pathetic and useless. I have figured out proper nutrition, but it is hard to find anybody in your profession that has a clue (Registered Nutritionists are a joke), and the FDA prohibits proper dissemination of the information. Dentists and psychologists are just as bad as you, so don’t feel left out.
    To hell with all of you.
    The purpose of the American Medical system is to cause as much pain, to patients and loved ones, take as much of their money before killing them. Most bankruptcies are people with Medical insurance. Shame on you.

  14. Susan Anderson

    I was at the presentation in Bend last night. Best presentation I have witnessed in a long time. You did a great job! I hope to be able to help! I think one of the biggest problems facing single payer reform is that the average person knows nothing about the system. Unfortunately for a lot of people it is like how they feel about illness ( I don’t want to know any details, just tell me what to do) they are listening to media and believing what they hear. A great job of telling us what to do. Thanks

  15. Thomas Cox PhD RN

    The one thing that seems to be missing is what I call “Professional Caregiver Insurance Risk.”

    In essence, small insurers are terribly inefficient risk managers. That means that their loss ratios vary far more than the loss ratios of large insurers.

    As it turns out that is sort of important – it is the reason insurance works at all.

    Soooo, when you transfer insurance risks to health care providers through managed care, capitation, and whatever the latest BS description is, health care providers become their patient’s insurers.

    Well, that matters too, because inefficient insurers have lower probabilities of earning profits, higher probabilities of incurring operating losses, and higher probabilities of insolvency than large, more efficient insurers.

    And gosh, they also have to reduce benefits to their policyholders/patients to cope with their inefficiencies as insurers.

    So, why do you need a single payer system?

    BECAUSE IT IS THE MOST MATHEMATICALLY EFFICIENT INSURER!

    Its about the math folks… All the rest of it is political double speak and Voodoo economics.

  16. admin

    Depends on how it is designed. That is a really tough question, grounded in reality. If there is evidence, based in studies, that alternatives are not just effective, but also cost-effective, I believe they should be covered.

  17. admin

    Craig, as an emergency physician, I am paid more like a specialist than a primary care provider. This is NOT about being self-serving. The income gap within the physician community is unconsciounable, bordering on criminal. Why does a dermatologist make twice as much as a primary care doctor? Is his/her job more difficult? Is an orthopedic doctor really worth three times as much as a PCP? We can’t have a cost effective health care system without a healthy cadre of primary care providers, whether they be physicians or physician extenders. Do doctors go into medicine for the money or to serve our communities? A little of both, I would presume. So, how much is enough? Is $300,000/year enough? I think the physcian community has completely lost sight of how much money that is to the average person… while many of our specialists make upwards of one half million dollars every year. Is the goal of the health care system to sustain absurdly high physician income… or to provide care to all our neighbors?

    Do you really think, with our current non-system, that we are providing good care for our communities or is the phsycian community making a lot of money treating illness? I suggest there is a real difference.

  18. Craig G Mohler, MD

    I am a practicing (not part time physician and full time crusader like some of the “Mad as Hell” docs). I want to make it clear that these vocal doctors represent a very small minority of providers, and that they in NO way speak for the medical community as a whole. I recogize fully the problems with our current “sick care” system. What some don’t seem to realize in this debate is that other European countries (Germany for one) are able to cover everyone using private/public insurance without resorting to single payer. As a practicing specialist, the issue is pretty clear: Primary care docs advocate for single payer medicine in large part because they will make more money than they do now (see the post on this website labeled “California Road Trip, Day 19, Davis”). As much as they want to cover everyone, it sometimes seems that the “Mad as Hell doctors” are really mad as hell about the fact that they make less money than specialists.

    One way to deal with the primary care doc shortage is to utilize physician extenders. I forsee a future where most primary care is delivered by FNPs or PAs, and specialist physicians take care of the rest.

    I doubt this will be published, but it was cathartic none the less.

  19. Martha Westbrook

    Does the proposed single payer plan cover alternative medicine?

  20. Darren and Whit
    This is a free country. We don’t need to be Drs. to share an opinion. There are good Drs. & mediocre and even bad Drs. Even the best of them are not God.

  21. Sandra Bournival

    From what I’ve read about the proposed single payer system, it sounds like a much better solution that what we have had in this country (US) since I was born (1950’s). I am not a doctor, but I do believe our health care system is seriously broken.
    My husband is disabled and I am his caretaker. He lost his job at the time he became disabled in 2006. We hung onto COBRA insurance for 18 months to the tune of $900.00 per month, with the help of my parents, but it almost bankrupted us. We would have lost our house if it weren’t for the help of family. My husband is finally on Medicare but I do not have any health insurance. I worked all my life until this tragedy befell us and I have some health issues myself but cannot afford to see a doctor. DHS has been of very little help.
    I lived in Britain for a year in the 1990’s and found National Healthcare to work quite well. At least when tragedy hits, you don’t have to worry about your health!
    When are people in this country going to wake up and see the greed in our healthcare system. We are quite happy to send billions of dollars to help other countries, but our own people are dying prematurely because of no medical attention.
    I don’t think this Darren is living in the real world.
    Vote for healthcare reform!!!

  22. Michael Molamphy, O

    I would suggest the MAH organization reach out to optometrists, my profession. We provide most of the routine eye care in America, and have expanded our role in therapeutic care in recent years. Organized optometry has notable successes in the legislative battles with some elements of the medical profession. I, for one, am convinced of the need for universal access to health care,after talking to patients for 31 years about their problems, and financial hurdles to access help. In addition, my family was denied health insurance by a BC/BS corporation, although we were all healthy. The new federal actions may give us access to insurance, but we’ll be paying outrageous premiums. ok to share.

  23. Kronick-HCA

    I was disturbed by the older doctor’s statement to Dr. Hochfeld that he was resigned to the impact of money and politics on medicine and he was looking for a non-confrontational route to retirement. His attitude, and too many of his colleague’s, is what has gotten our country into this position. Politics is the nature of human contact whether in a 3 person office, on a sports team, or in terms of the delivery and payment for products and services. Money (and not value) is the negotiation of the terms of payment. Intrinsic values and ethics must be placed higher in the equation above our lazy fallback on money as the ultimate measure of value.

  24. I am a real doctor-retired Thank God! And at least one of these doctors is real since he helped me get through medical school years ago.
    America is supposed to be a country of LAWS, not of men. Humans have fought over resources since the dawn of time. The only way to keep us in line is with
    1. a personal moral code
    2. enforcement of the laws
    in other words, it is up to us to enforce the laws, since the government doesnt/wont/cant. It’s not that difficult. Treat others with respect, Stand up or speak out against wrong doing, read history.
    Greed is a sin. Doesnt matter if in a capitalist system or socialist, except that in a socialist system it always ends in social unrest, totalitarianism & genocide. Yes! Dont read your schoolbook history. Try the original speeches. letters & documentation as sources.
    The gift of America is it’s frredom.

  25. Marcia

    @ Darren: If getting Americanized means naking so much of a profit at the expense of another persons health and life, at the expense of another persons drinking water and clean soil, at the expense of someone else fresh air, then I’ll take the little red book.

    As a captured Indian once said “if heaven is full of the “white” man (used here to signify the profiteer) then let me go to hell.”

    Anyway the constitution does not say we have to have our economy based on capitalism.

    We’re not going to kill each other any more for your profits.
    We’re not going to steal from each other any more for your profits.
    We’re not going to work ourselves to death any more for your profits.
    We’re not going to deny each other our needs anymore for your profits.

    We are on to you rich folks and we will not be divided anymore. Contrary to popular movie dialogue- “Greed is NOT good!”

  26. whit

    way to go Darren. i don’t think these are real doctors. i don’t even think they play one on T.V. no doctor i know is this stupid. it looks like the socialist get to take some of their own medicine.

  27. Maggie

    It is so inconsistent that people cry out about tax dollars going towards abortions but make no complaint about the tax dollars that support the war and then kill so many in Iraq & Afghanistan. Citizens of the US as well as those countries. I am glad the bill has passed. I hope we can someday move to a single payer system.

  28. admin

    Medicare, if allowed to, could become the real public plan option we didn’t get the first time around.

  29. Laura

    Now that the Health Insurance reform bill has just passed how do you about Congressman Alan Grayson’s calling for a vote on the Medicare buy-in. He claims that the bill (HR 4789) lets anyone buy into Medicare.

  30. darren

    I’m not a PhD. Nor have I played one on TV. But may I ask a simple question? Did Mr. Axlerod type these points out personally and distribute them to you all or do you folks really beleive that you are doctors??
    I’m disgusted at the lengths you so called enlightened ones will go to to hide from the light! Just like the sorry cockroach. Get Americanized. Read the US constitution and not the Little Red Book!!

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