"All candidates' flaw is they support private health insurance, an obsolete model"

Don McCanne writes the Quote of the Day over at PHNP, which one of the best quick reads on single-payer and its opponents. It is sent as a almost-daily email update if you are interested. This short video features Dr. McCanne talking about what is wrong with the Presidential Candidates' health care plans, and a Harvard business school professor talking about why she likes them (choice). Dr. McCanne's written comment is available after the break.



Comment: Anyone following the national dialogue on reform is certainly aware of the rhetoric over "choice." Those supporting reform that builds on private health plans use "choice" to mean choice of health plans. Those supporting a publicly financed and publicly administered national health program use "choice" to mean choice of physicians and hospitals and other health care professionals and institutions.

People do like to have choice. The three remaining presidential candidates understand that and tout the choice that their health care proposals offer. Of course, that is only the choice of health plans, a choice that usually takes away your freedom to choose your health care professionals. But they never mention this latter point since they would be admitting to a serious flaw in their proposals. Even libertarians should be concerned about loss of freedom to choose your own health care.

One irony here is that Regina Herzlinger, who has been referred to as the Godmother of consumer-driven health care and who is an outspoken opponent of single payer, states that she likes "all three platforms that the presidential candidates are offering." You would think that the Democratic candidates would support a progressive model of reform. Instead, they are supporting a neoliberal model based on the conservative framing of private market health plans.

When you fully understand Herzlinger's concepts of reform, you recognize what a disaster they would be for access, equity and affordability. You really must ask yourself why she likes the proposals of Senators Obama and Clinton. When you figure that out, speak up!

Comments

How much do you want to pay for false choices?

I've "chosen" my health care plan, from the limited number available by the only provider in my area. From that, I have chosen my doctor and my children's doctors, from those available in the immediate area. Of course, it was not until after I read the fine print that I realized that many/most OT/PT/ST were not taking this plan because its payout was so low. But, we have the choice of not providing our children with those services, or driving to Cary. So, who am I to complain? Sure, there are great providers within walking distance of my house who are covered by Medicaid and Medicare and who would see my children in a public health care system. But, why would I deserve that choice?

Jesus Swept ticked me off. Too short. I loved the characters and then POOF it was over.
-me

Choice is overrated, as far as I'm concerned

The main reason is the average person doesn't even know how to gauge the qualifications of doctors or the quality of a facility's service. They often use subjective reasoning (doctor seems "trustworthy") or anecdotal evidence (friend says doctor is "trustworthy"), so their choice(s) might actually be resulting in poorer care.

The second reason is because patients' choices have actually helped to drive up health care costs anyway. They often skip the primary care physician and (unecessarily) run straight to a specialist, and they also tend to gravitate towards physicians who are prolific prescription-writers.

You make an interesting point.

There isn't a good way of measuring the quality of a physician until it is too late. I had a "great" Pediatrician at Duke for our first child. It wasn't until we moved away that I realized that while our Pediatrician was well-educated, kept up on the latest news, etc - the practice stunk. We always waited 1.5 hours to see a doctor, then as soon as they hit the door he was turned sideways trying to get to the next patient.

Your second point is really tied up in the idea that pharma companies can do advertising. They spend more on advertising than on R&D. Shouldn't the choice of medication be made by a team of health care professionals with input from the patient ("Actually, I get sick on Tylenol 3 so maybe that isn't a good idea").

Jesus Swept ticked me off. Too short. I loved the characters and then POOF it was over.
-me

I really do like this:

Shouldn't the choice of medication be made by a team of health care professionals with input from the patient

especially considering that many (older) patients receive ongoing treatment (and medications) from multiple physicians for a variety of ailments. I've always believed that a patient's treatment "team" should include any and all providers, be they MDs, PAs, mental/physical therapists, etc. In this day and age, there is no reason for a doctor to ask the patient, "Why were you prescribed this medication?", but that happens quite a bit.

Of course, with this level of communication comes additional costs and delays associated with "time spent". But what I've heard and read about the need for an increase in the ranks and utilization of Primary Care physicians, they could not only better ascertain the needs of the patient, they could also serve as an information nexus, keeping all parties informed.

Integrated, team medicine

Is the new buzz word, or some variation of it. Look for it in a health care plan near you if plans have to compete on care and not cost-cuts.

Jesus Swept ticked me off. Too short. I loved the characters and then POOF it was over.
-me

Edward's plan?

Robert,

I'm confused. I remember John Edwards saying that his program would allow competition between private insurance companies and a government program (like Medicare?). Then people could choose (I would chose the gov't program since I greatly dislike the insurance companies I've had to deal with and have found that Medicare simply pays my doctors - private insurance pays the difference).

So here's my confusion: I was under the impression that Hillary Clinton had pretty much adopted Edward's plan. Is her plan missing the gov't program part? Does Obama's plan have anything like it?

Or have I misunderstood the whole dang thing!?

Thanks,
ge

Besta é tu se você não viver nesse mundo
http://george.entenman.name

Besta é tu se você não viver nesse mundo
https://george.entenman.name

The Health Plans

First of all, forget McCain's claim that he has a healthcare plan. If he wins, it will be a non-starter with the Republicans in Congress. In other words, more of the same.

Hillary's plan mandates coverage for all Americans -- but by whom? Employers? Individuals? Which way will this political fight go? I can only see it moving in the direction of single-payer or nothing at all.

Barack's plan subsidizes folks who can't afford health insurance. What will employers do when they see the government subsidizing the uninsured? Yep, create more uninsured. Assuming that the plan is passed, it seems to be a slick slide to single-payer.

Of course all of this ignores some of the real issues in healthcare finance even though it addresses the issue of moving to a single risk pool for all Americans.

It ignores the massive waste in the micromanaged fee-for-service system which disproportionately advantages expensive healthcare "systems" over independent providers.

It ignores the fact that many health supply and pharmaceutical costs are the result of non-competitive market practices, which should be subject to anti-trust.

It ignores the fact that healthcare professionals, especially doctors and nurses, are becoming indentured servants of healthcare systems in exchange for payment of their medical school or nursing school costs.

It ignores the fact that there are no competitive incentives for health equipment manufacturers to create units suitable for the budgets and service areas of small rural hospitals.

When will we start to have a debate about the real issues, instead of the phony issues of choice of providers? Does the phrase "out-of-network" ring a bell?

50 states, 210 media market, 435 Congressional Districts, 3080 counties, 192,480 precincts

50 states, 210 media market, 435 Congressional Districts, 3080 counties, 192,480 precincts

Hillary has a public option

I think her health care plan is probably better, but it comes with her attached.

If I could design a plan from scratch and put it in place, I would do single payer, but even a Harvard professor has to realize that many many tens of thousands of Americans are employed by our current system. Yes, that means there are ineffeciencies throughout the system, and, let's face it, the delivery system flat out sucks. But you can't just say "ok, all these insurance companies and HMOs are out of business. Sorry about those jobs, by the way."

Gotta be a way to phase it in. And that is why JRE's plan was the best, and why Hillary stole it.

"Hampton Dellinger WILL be a great Lieutenant Governor." - Al Gore.

"Man is free at the moment he wishes to be." -Voltaire

One man's wasteful spending

...is another's employment.

Any plan must have some way of providing transition for workers who have been doing the busy work.

50 states, 210 media market, 435 Congressional Districts, 3080 counties, 192,480 precincts

50 states, 210 media market, 435 Congressional Districts, 3080 counties, 192,480 precincts

Phase-outs

Agreed.

You can be sure the executives will have seen to their own golden parachutes.

A sudden, drastic change will just hurt the folks who work for a living.

--
relocating from Indianapolis, IN to RTP, NC soon; got any advice for me?

I wouldn't recommend drugs, alcohol, violence, or insanity for everyone, but they've always worked for me. -- Hunter S. Thompson

--
Garner, NC

I wouldn't recommend drugs, alcohol, violence, or insanity for everyone, but they've always worked for me. -- Hunter S. Thompson