Socialized Medicine

[Tom Joad]

Carol Miller: Why Fiscal Conservatives Should Love Medicare-for-All

Good, Old-Fashioned U.S. Socialized Medicine
Why Fiscal Conservatives Should Love Medicare-for-All
By CAROL MILLER

Call me old fashioned, but a true conservative is someone who conserves, dislikes wasting money and is offended by endless corporate bailouts by hard-working taxpayers. A fiscal conservative like me. As a public health professional, I want to see health dollars used to keep people healthy through public health and wellness programs, as well as provide medical care when it’s needed.

We have a health care crisis in the United States. Nearly 50 million people do not have health insurance, and they are our family and neighbors.

There are 500,000 medical bankruptcies every year. Most of these half million families had health insurance; at least they thought they did because every month they paid for insurance. Millions of people have learned the hard way that for-profit sickness insurance does not prevent financial ruin during a health crisis.

One of the worst lies thrown around every time Congress debates health care is that the U.S. will end up with socialized medicine. Socialized medicine is when the government owns and operates health facilities as well as pays the salaries of the doctors, nurses and the rest of the healthcare work force.

Let me say as clearly as possible — President Obama and the Congress are not discussing, introducing or enacting socialized medicine.

Good old-fashioned U.S. socialized medicine

Today, the U.S. already has socialized medical systems serving more than 20 million people. The current U.S. socialized medicine systems are very popular. The largest in terms of numbers of people is the Military Health System. The largest in terms of numbers of facilities owned and operated is the Veterans Administration health system. Two additional smaller U.S. socialized medical systems are the Indian Health Service and the federal Bureau of Prisons.

Despite being socialized medicine, the VA is ranked the highest in a national survey of patient satisfaction by the University of Michigan. U.S. taxpayers own the 155 VA hospitals and 881 clinics; we employ 289,000 people working in the VA including 16,000 doctors and 42,000 nurses.

Even the bastion of capitalism, Fortune magazine, is impressed by VA health care, stating, “The seamless integration of science, information, and compassion is the dream of modern health care. Scenes like these are not fantasies, however, but daily realities at the Veterans Health Administration.” (Fortune, May 2006.)

Let me repeat, President Obama and the Congress are not discussing, introducing, or enacting socialized medicine. Unlike the socialized system military and veterans enjoy, most health care services are provided through a private delivery system. All reforms will build on the existing private delivery system.

2009 health reform debate

So now that we all agree that the President and Congress are not expanding socialized medicine in the U.S., what are they proposing? There are two basic options and neither creates a nationalized or socialized health care system.

Medicare for all: The first choice expands Medicare eligibility beyond its current limitation to elderly (over 65) and disabled individuals of any age. This is the most conservative, least-disruptive and cost-effective way to cover more people; it only takes a simple change to an existing, very popular program. Every time the Congressional Budget Office scores the cost of Medicare-for-all type programs, they pay for themselves through two key business principles, the power of bulk purchasing and administrative savings though the elimination of waste in the system.

Mandated insurance: The second choice forces taxpayers to buy for-profit insurance despite a wasteful administrative cost of $1 billion a day. Yes, a trillion dollars every two and a half years just for paperwork, not a penny of that for health care. As a fiscal conservative, I do not want to pay a secret corporate bailout so that greedy CEOs make bonuses based on how good they are at rationing care to sick people.

In this expansion of the current failed system, the U.S. spends more than twice as much per person than any other country and the excess cost does not result in better outcomes. The U.S. is about 37th in the world for life expectancy, infant mortality, and other indicators of health status.

We have to walk away from corporate rationing to create a seamless system with the highest quality services for the best price. The easiest way to hold down costs is to have the largest purchasing group possible to get bulk prices — this is the single-risk pool.

Especially in this economic downturn it is essential to help people get access to health care. Being creative now gives us the chance to create a brand-new system, an All-American plan.

False conservatives will parrot the corporate line and continue to bail out the failed sickness insurance system. True fiscal conservatives who want to eliminate waste, hold down costs and improve outcomes will support Senate Bill 703 and House Bill 676. All the other bills transfer tax dollars first into needless paperwork and corporate profits and then dole out whatever is left for medical bills.

The choice is clear. We keep our doctors and hospitals in the current private delivery system but let one public insurance plan handle the paperwork and pay the bills.

Carol Miller is a New Mexico public and rural health expert. She has public service in Washington, D.C., in both Republican and Democratic administrations, including the Clinton White House. In 1994 she was the health reform policy adviser for the National Rural Health Association and the New Mexico Secretary of Health. Miller, a former Commissioned Officer in the US Public Health Service, has used both the uniformed services and veterans health care systems.

[Yorkist]

Mandated insurance: The second choice forces taxpayers to buy for-profit insurance despite a wasteful administrative cost of $1 billion a day. Yes, a trillion dollars every two and a half years just for paperwork, not a penny of that for health care. As a fiscal conservative, I do not want to pay a secret corporate bailout so that greedy CEOs make bonuses based on how good they are at rationing care to sick people.

Worth repeating.

[MississippiMud]

worth a closer look

Mandated insurance: The second choice forces taxpayers to buy for-profit insurance despite a wasteful administrative cost of $1 billion a day. Yes, a trillion dollars every two and a half years just for paperwork, not a penny of that for health care. As a fiscal conservative, I do not want to pay a secret corporate bailout so that greedy CEOs make bonuses based on how good they are at rationing care to sick people.

A billion bucks a day for paper pushers. Add in more government bureaucracy and you think we will have less paper to push around? Im betting the farm against that deal.

[Yorkist]

Originally Posted by MississippiMud

worth a closer look

A billion bucks a day for paper pushers. Add in more government bureaucracy and you think we will have less paper to push around? Im betting the farm against that deal.

Of course there will be less paper.

• No paper needed for billing uncovered costs
• No paper needed for co-pays
• No paper needed for checking cover/exclusions
• No paper needed for calculating treatment ceilings/limits

But most of all, reams and reams of paper will be saved by the simple expedient of providing the medical treatment people need, when they need it. I wonder how much of insurance companies' paper is about sorting out those issues, arguing about them, dealing with complaints, etc.?

[MississippiMud]

Originally Posted by Yorkist

Of course there will be less paper.

• No paper needed for billing uncovered costs
• No paper needed for co-pays
• No paper needed for checking cover/exclusions
• No paper needed for calculating treatment ceilings/limits

But most of all, reams and reams of paper will be saved by the simple expedient of providing the medical treatment people need, when they need it. I wonder how much of insurance companies' paper is about sorting out those issues, arguing about them, dealing with complaints, etc.?

Perhaps but I don’t see how changing the provider will make all of the shuffling, sorting, arguing, complaining go away.

Mrs mud worked in the medical field her entire life. Much of it has an office manager for private practice and as a unit secretary at one of the largest hospitals in Michigan. So I have some insight

And have you ever seen the paper work that goes through a medical office that the consumer never sees? Add in insurance stuff, add in more for medicare. Add in even more if the provider is now having to deal even more closely with the government. Shit damn man we will be out of trees in 10 years.

Look i am all for quality care for all... just don’t blow me the smoke telling me how much cheaper it will be if the government is pushing it.

[Leo2]

Originally Posted by MississippiMud

Perhaps but I don’t see how changing the provider will make all of the shuffling, sorting, arguing, complaining go away.

Mrs mud worked in the medical field her entire life. Much of it has an office manager for private practice and as a unit secretary at one of the largest hospitals in Michigan. So I have some insight

And have you ever seen the paper work that goes through a medical office that the consumer never sees? Add in insurance stuff, add in more for medicare. Add in even more if the provider is now having to deal even more closely with the government. Shit damn man we will be out of trees in 10 years.

Look i am all for quality care for all... just don’t blow me the smoke telling me how much cheaper it will be if the government is pushing it.

Well, maybe having just one, not-for-profit insurer (and it doesn't have to be the government of the day, it can be an independent public service,) will reduce the costs of administration. It will certainly eliminate the cost of millions of dollars in insurance company profits and executive bonuses.

[Yorkist]

Originally Posted by MississippiMud

Perhaps but I don’t see how changing the provider will make all of the shuffling, sorting, arguing, complaining go away.

Mrs mud worked in the medical field her entire life. Much of it has an office manager for private practice and as a unit secretary at one of the largest hospitals in Michigan. So I have some insight

And have you ever seen the paper work that goes through a medical office that the consumer never sees? Add in insurance stuff, add in more for medicare. Add in even more if the provider is now having to deal even more closely with the government. Shit damn man we will be out of trees in 10 years.

Look i am all for quality care for all... just don’t blow me the smoke telling me how much cheaper it will be if the government is pushing it.

I bow to your greater knowledge of the American system, of course. And all of us would admit, I think, that the NHS is a huge bureaucracy. But the paperwork here is about documenting care, sharing best practice, disseminating public health information and monitoring targets, not about who is paying for what and how.

And what Leo said.

[catswiththumbs]

Originally Posted by Yorkist

I bow to your greater knowledge of the American system, of course. And all of us would admit, I think, that the NHS is a huge bureaucracy. But the paperwork here is about documenting care, sharing best practice, disseminating public health information and monitoring targets, not about who is paying for what and how.

And what Leo said.

I beg to differ - "who is paying for what and how" must be accounted for in your system as well using the same actuarial and accounting methods - doctors, nurses, support staff, etc. all must be paid and records must be kept, patient histories must be detailed, infractions must be documented. The government is writing the checks and keeping the records in your system, private entities for the most part in ours.

There is no escaping the paper.

[Yorkist]

Originally Posted by catswiththumbs

I beg to differ - "who is paying for what and how" must be accounted for in your system as well using the same actuarial and accounting methods - doctors, nurses, support staff, etc. all must be paid and records must be kept, patient histories must be detailed, infractions must be documented. The government is writing the checks and keeping the records in your system, private entities for the most part in ours.

There is no escaping the paper.

Not quite. The difference is that each Primary Care Trust is given a budget, and it spends that budget as it sees fit. Now this is not a perfect system; it leads to what is sometimes referred to as a 'postcode lottery', where different priorities in different areas can mean greater or less availability of some treatments (IVF, for instance), but I'm sure it generates less paperwork than having to justify expenditure to a third party like an insurance company or, indeed, a patient.

[catswiththumbs]

Originally Posted by Yorkist

Not quite. The difference is that each Primary Care Trust is given a budget, and it spends that budget as it sees fit. Now this is not a perfect system; it leads to what is sometimes referred to as a 'postcode lottery', where different priorities in different areas can mean greater or less availability of some treatments (IVF, for instance), but I'm sure it generates less paperwork than having to justify expenditure to a third party like an insurance company or, indeed, a patient.

Who audits the expenditures of each Primary Care Trust? Who in the government keeps track of how each trust is allocating funds? What organs of government are tasked with writing the budgets and oversight?

Not being argumentative - curious.

[catswiththumbs]

Originally Posted by catswiththumbs

Who audits the expenditures of each Primary Care Trust? Who in the government keeps track of how each trust is allocating funds? What organs of government are tasked with writing the budgets and oversight?

Not being argumentative - curious.

*Taps foot* *Whistles cheerfully*

[Sir Digalot]

in the private sector the hospital pays the healthcare staff and have their own paperwork, the hospital bills the insurance compnay and end user for the treatment, the insurance company keeps the name and records of the doctors who are eligible to authorise healthcare for the doctors, the doctors and healthcare professionals fuill out forms to authorise the insurance compnay to pay for the treatment, then the auditors in the hospital make sure that the hospital can afford to keep running and the auditors in the insurance company ( and adjusters, and fraud investigators) all make sure the insurance company is not paying out for something uneccassary and the insurance company has it's own board of doctors to ensure the origional doctor is not perscribing somethign that cannot be replaced wit ha cheaper alterantive... all of this is documented

on the whole having a government department to take care of this on a national scale is more efficient then 100 different insurance companies doing the same, and also if the doctor can take multiple insurance companies the paperwork and audit trail is doubled or tripled for him and the goons that do the follow up.

there is less paperwork in the national system, but people have this aversion to big government.... but not big corporations who still waste money in the same way, but charge more to make up the profits

[Tom Joad]

Originally Posted by MississippiMud

just don’t blow me the smoke telling me how much cheaper it will be if the government is pushing it.

It's cheaper in every country that has "socialized medicine" than it is in the U.S.

Smoke that.

[Yorkist]

Originally Posted by catswiththumbs

*Taps foot* *Whistles cheerfully*

Sorry about that. Isn't real life annoying?

Anyway, in answer to your question, apparently it's the National Audit Office:

Health and social care

[MississippiMud]

Originally Posted by Tom Joad

It's cheaper in every country that has "socialized medicine" than it is in the U.S.

Smoke that.

Thats what I keep hearing. I don't have enough (for me) details to confirm or deny that. I do know there is a difference between what you pay and what it costs. That is true of nearly everything.

I just have a real hard time wrapping around the idea that anything the feds do that involves the kind of money that the health care industry generates will be done cheaper and more efficiently. It may even start out that way but it wont last long.

Only way I see it might work cheaper is to remove insurance completely and most of the litigation, have a single payer entity that controls the entire process as a non profit organization and perhaps then you will control costs. MAYBE big big maybe.

But I look at the bright side. If Obama care works GREAT. If it fails that to may be a blessing in disguise as it might be the straw that breaks the camels back. At least one unintended consequence that could turn positive.

We shall see

[shadou]

Mud, try imagining Social Security in private, entrepreneurial hands. And as a matter of direct experience, from the user standpoint I'll take the smoothness of Medicare to entrepreneurial health insurance any day.

[Zan de Man]

The NHS is a bureaucracy, but it's nothing to the US system. The NHS has systems that capture provider activity and also report it to the commissioners (funders), so that billing is done as a by-product of normal operational activity.

[Tom Joad]

Originally Posted by MississippiMud

Thats what I keep hearing. I don't have enough (for me) details to confirm or deny that.

The evidence is all around you.

If you can't see it, there's not a hell of a lot that I can do to convince you.

[MississippiMud]

Originally Posted by Tom Joad

The evidence is all around you.

If you can't see it, there's not a hell of a lot that I can do to convince you.

O I can see it, that's the problem, to much of that evidence pointing in different directions

[Zan de Man]

Originally Posted by catswiththumbs

Who audits the expenditures of each Primary Care Trust? Who in the government keeps track of how each trust is allocating funds? What organs of government are tasked with writing the budgets and oversight?

Not being argumentative - curious.

Every healthcare organisation is required to appoint internal auditors. External auditors are appointed by the Audit Commission.

There are 10 strategic health authorities in England. They keep track of PCT performance.