Friday, June 19

Why we need a single-payer system

**Blogger's note: This is a bit less concise and well-organized than most of my posts, I think. This is, at least partially, because I (appropriately enough) have been fighting a cold all week. Makes me less patient about editing and more interested in spewing rants onto the page. Still, I feel strongly about health care. Probably because it consumes so much of my and Tim's life. I hope you'll find some of my points interesting. I hope you'll be polite about the ones you disagree with. Either way, I hope you leave a comment.

Picture by dubble.think

Okay, I know I've groused before about Medicare. It has its problems, to be sure. But, of all the options out there, right now, I firmly believe a single-payer system is the best chance we have.

I will probably get some people who violently disagree with me. Heck, one guy on Twitter blocked me because I disputed that we have "the best health care system in the world."

What was funny about the whole exchange, really, is that I tried to explain to him why his statement was so patently false. My first line of attack was that we have people dying from staph infections. It takes one small antibiotic. Very common, very easy. And yet people wait. Because they can't afford to see a doctor.

He pointed out that any emergency room would have to treat them. (Actually, not true. Any public hospital's emergency room has to take you. But I didn't want to argue semantics.) So I told him that, while that's true, if you wait to go the ER, you have two more problems: the bills are even bigger, and your conditions has worsened considerably.

He didn't reply to that. So I mentioned Tim's $502/month insurance, or 18% of our post-tax income. And that's not even touching on the $500 deductible, the co-pays, etc. At his dermatologist -- the doctor Tim sees the most -- we have already racked up nearly $500 in the past 6 months.

I also mentioned that I'm on Medicare, myself. But he apparently was done with the subject. He told me I didn't know what I was talking about, and he didn't want this stuff on his twitter.

His right to not listen, of course. Still, given that I've traversed the bureaucracy of Medicare, Medicaid, private insurance and hospital financial aid, I find it funny that he could accuse me of ignorance.

So, taking all that into account, I will admit a couple of things: I don't know anything about the budget or about where, exactly, all the money will come from. But I felt the need to blog about this because I do know quite a bit about being broke in America -- just barely getting by or, in some cases, sinking deeper into debt just trying to survive -- while also dealing with health issues.

And all that experience tells me that we need a single-payer system.

Just to be sure we're all on the same page, that means a system similar to Medicare. And just to be sure we're all talking about reality -- not what some talking heads are telling you will happen -- let's review Medicare briefly.

  • Part A: Hospital Insurance. This is generally free of charge. (For exceptions, go here.) Part A covers inpatient care, skilled nurse facilities, etc.
  • Part B: Health Insurance. The monthly charge is $96.40. People with low income can qualify for help with premiums.
  • Medicare Advantage Plan. This allows you to buy better health care plans. You have the choice of managed care, PPO or fee-for-service. Depending on the quality of the plan, the price varies. This cost is on top of your Part B premiums.
  • Medicare Prescription Plan. This provides more thorough prescription-cost coverage.

So, this plan isn't perfect. It needs some tweaking, especially when you start to consider the donut hole. But it's still better than letting 1 of every 6 Americans go uninsured. (And plenty of the other 5 have things like high-deductible insurance, which discourages getting routine care.)

Here are my arguments:

  • We would have a lower mortality rate. By the time some people get diagnosed, their diseases are out of control. My mom was on a bus and overheard two fast food employees chatting. One of their coworkers died from MRSA. That's the same thing that Tim's had more than 20 times in the past two years. The only difference: Tim had insurance and a wife who knew how to get financial help for medical bills.
  • A healthier America. If people got more routine care, we would arguably have a better shot at staying healthy. Obviously, some disabilities cannot be helped. Mine certainly wasn't avoided by having insurance. But many health conditions that keep people from working full-time are also ones that could be avoided -- or at least ameliorated -- by having medical care.
  • Less welfare. The better people are, the more likely that they can work and earn a living. I don't care what kind of things you believe about homeless people and people on welfare. Yes, there are some people who are playing the system or otherwise have choices. Most of us don't. Most of us would love nothing more than to be able to work and support ourselves.
  • Less money for Medicaid. I actually started paying more out of pocket once I was accepted to Medicare than on Medicaid. The state of Washington gave me no deductibles, no co-pays, no anything. Currently, Medicaid provides low-income folks with coverage, but it also covers premiums and lowers co-pays for low-income Medicare users. Under a single-payer system, the state would no longer have to cover 100% of some residents' care.
  • More money for hospitals. Right now, there are tons of hospital bills that won't get paid. Either the patient applies for financial assistance, and most of the charges are waived, or people simply default because the amounts are just too high. With more folks insured, this would reduce the pressure on already limited hospital funds. This would probably mean fewer funds coming from state and federal programs, as well.
  • Potentially lower medical bills. If hospitals don't have to make up for non-payments, they could probably bill for less. If they know they'll always get at least something for services, actual charges could be less. Probably naive, but at least at community hospitals, they do have an interest in helping everyone. (Of course, I also believe that if we subsidized medical school -- requiring a certain period of work at free clinics in exchange -- we could help lower medical costs. If doctors had less debt to erase, they could afford to charge more reasonable amounts.)
  • More reasonable ER wait times. Right now, across the country, ERs are clogged full of patients. It's stressful, noisy and very, very tedious. ERs tend to be uninsured Americans' general practitioner. One friend of mine ended up in the hospital for three days because of a spider bite. It got infected and, by the time he finally saw a doctor, the infection was spreading into his bloodstream. I'm sure a lot of people could have used his bed. And I know he and the hospital would have loved to save the money for something less preventable.
  • Economic stimulus. If employers no longer shoulder the burden of health care costs, businesses would be hurting a lot less. The average individual plan is close to $500. So even if you pay $200 a month, your company is still paying $300 per employee. Every month. With that money, the business could give raises, hire more people or, at the very least, not fire more people. This could help staunch the rising unemployment rate.

Of course, for me, the best argument remains the most human one: Everyone deserves health care. Not last-minute care that threatens your financial future. Not care only once you've put your life in danger by trying to take care of it yourself. We deserve help when we need and preventative care so that, hopefully, we won't.

Yes, a lot of details need to be worked out. The donut hole, for one. Though, of course, if you're not on disability or retirement, the donut hole will be far less financially devastating. And some of the co-pays for in-patient care need to be fine-tuned.

But I'm sick of hearing that we have to keep competition to keep insurance companies competitive. There is competition already, in the market. There are plenty of insurance companies, and health care costs only continue to rise. Meanwhile, the bureaucrats at the companies try to find reasons not to pay out, or ways to kick people off their policies. But because they have so many customers, they can negotiate lower rates. Often, they pay less than 75% of the billed amount. Yet people without coverage, people who really need the help, can only get a few percent off for paying in cash.

In short, this system isn't working. And I'm sick of listening to healthy, middle-class Americans preach that "socialism" isn't the way to go. One out of three American families is already on some form of government help. So clearly capitalism isn't exactly working out that well, either.

How about we try something new? Something that, say, other governments rely on all the time. I'm tired of quibbling about inherent problems. Any idea will have flaws and drawbacks. The point is to find the one that benefits the most people. Install that and then do your best to make it better over time.

And if you disagree, take a notebook and a pen and go spend some time down in an ER. Talk to the people there. But wear a mask. You wouldn't want to get sick, now, would you?

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Blogger Alane said...

While I will agree that all people should have access to affordable healthcare I don't believe government sponsored insurance is the way to go.
It is my understanding that medicare and medicaid pay even less then other insurances. The company my husband works for is self insured. It is a huge tax write off for them every year.
What happens to all the insurance companies and their employees if we suddenly go to a single system?
I have also been on Medicaid and it stunk. I couldn't find a single practioner who would take it and so would spend hours sitting in clinics just waiting to get my kids their routine checkups.
I am also curious where did you get the stat that says 1in 3 families receive some kind of assistance?

June 20, 2009 at 5:50 AM

Blogger Meg said...

I've been on state-funded insurance (as a kid) and it stunk -- but it was better than nothing, which was the alternative.

We have people dying because they don't have health insurance -- or they have bad health insurance. Far more people than died on 9/11. And if you don't die, you go bankrupt. But why aren't more people up in arms about THAT? Why? Because the problems of the poor are all to often ignored by people who think -- and wrongly -- that it can never happen to them.

We cannot afford this loss of life. That SHOULD be obvious. But if that's not enough, then let's talk about the financial cost! I've seen firsthand how ERs fill up with people who have either minor cases that should be treated at a clinic or major cases that could have been avoided by seeing a doc before things get that bad. But they go to the ER because -- even though they can't afford the higher costs there -- they know that they can't be turned away. So, we STILL end up paying for their healthcare, but now it is outrageously more expensive! Bravo, people!

And people complain and wonder why it takes 6 hours to be seen! They should do a new E.R. show that's more like reality -- you show up dying and sit there (even with great insurance!) because there are no free rooms or docs because they're treating people for diabetes complications that should have been avoided in the first place.

Anyhow... I believe that the government HAS to step in somehow. I don't think they'll get it perfect, but it's necessary at this point. We can't afford our current system. And capitalism is failing us because capitalism relies on us being able to make informed choices. Well, what choice do we have when a basic insurance plan costs more than your entire monthly income? What choice is there when the only real insurance option you have -- IF YOU HAVE ONE -- is the company that your company chooses based on what they are willing to pay for? And if you somehow had the choice of two insurance companies, who can read all the fine print and figure out which is the best for them based on what conditions they might someday have and try to guess what loopholes the companies will find to not pay? It's not like they say "Sorry, we won't pay for your cancer treatments!" and you say, "Well, I'll just take my business elsewhere! Take that!"

June 20, 2009 at 9:20 AM

Blogger Alane said...

I have not done a lot of research on this so I won't make statements without facts to back them up though I might reference personal experiences I have had.
Are there statistics on how many people die everyday in our country due to lack of preventive care?
While you can't be turned away from a public hospital ER when ill what is the real expense of a yearly check up and full blood panel every two years as suggested by I think it is the FDA ( or whatever government agency that sets those guideline)
I spent several years with no insurance when my children were young I had a great GP who saw my kids as a 2 for 1 when I brought them in and took them to the free immunization clinic our county ran.
The system we have now isn't perfect but I don't want the government stepping in and telling me how to live my life or what kind of care I should have either. In my house three of us have preexisting medical conditions and that is probably the single biggest reason my husband works for who he works for and will do whatever he has to to stay employed by them forever.
It may sound uncaring because we have what we have and others don't but we were poor a long time and made many sacrifices to get where we are today and I know that a single bout of cancer could bankrupt us I sometimes wonder if all of our great medical advances are part of the problem Less than 75 years ago if you got cancer you just died. Now we have all of these treatment options could extend your life quite considerably even if you are miserable the whole time.

June 20, 2009 at 10:24 AM

Blogger Alissa Grosso said...

Actually that guy on Twitter is way wrong. I think we rank somewhere like 37 or 38 on the list of countries in terms of our healthcare system. That's a long way from being "the best".

I think right now the big problem is insurance companies. They have driven up the cost of healthcare so that everything is now way beyond the means of any ordinary person. So, that everyone needs health insurance just to get by, but of course the insurance is expensive and very, very far from perfect.

I know that we are in a bit of a financial mess and shutting down a bunch of health insurance companies will likely make things worse, but it might be the only way to fix healthcare in this country. Sometimes things need to get worse before they get better.

Other countries have figured this out, and are doing quite well. Maybe she would actually try to learn from what they are doing right.

I think a single-payer system is the only way to go. If we do this right it wouldn't be the government telling us what treatment we could and couldn't have (which isn't really any better than insurance companies telling us what treatment we could and couldn't have) but actual members of the medical profession. What a concept.

The biggest complaint I have heard from people is that there would be a wait for elective surgery. This would be surgery that isn't a matter of life and death. If the surgeons were performing necessary surgery before unnecessary surgery would this be a bad thing? Besides, I'm sure there will be enterprising types out there would would charge a premium for this elective surgery and people who elected to could pay extra to not have to wait. Seems like it would make sense to me.

June 20, 2009 at 12:27 PM

Blogger Meg said...


"The biggest complaint I have heard from people is that there would be a wait for elective surgery."

I've heard that, too -- and it seems ridiculous! They might as well say "But all those poor people will delay my nose job!" O.k., maybe not that bad. And I do feel for people who are waiting for "elective" surgeries. I've had some myself (none purely cosmetic, though I don't really have anything against them). But people are already waiting for MUCH NEEDED surgery because they can't afford it! And too often, they don't get it in time.


According to one study, the number is 18,000 a year in the U.S. Here's a report on it: Note that that's from 2002. It may be different now, but I doubt it is any better. And of course, that doesn't count the many (probably many more) people who don't die but still suffer from treatable or preventable diseases.

June 20, 2009 at 1:00 PM

Blogger Alane said...

You may be right. I only have anecdotal evidence of other countries insurance programs so I know it colors my decisions.
I live just outside Camden City,NJ one of the poorest most violent cities in our nation and my personal experience with people using/misusing the Er's alway revolved around poor healthcare decisions not necessarily a lack of health insurance. A few examples:
A man who came in because he had a headache for 3 days and during the intake process it was discovered he had never even bothered trying advil or tylenol to treat the problem.
Another time was a worried mom whose baby had a stomach bug and despite the fact she took the baby to a clinic three times in less than a week and did not follow the advice of the docs the babies symptoms had not gotten better.
Drug addicts overdosing in August and passing out on the streets with internal body temps of 110 ( no exagerating).
These things have held up the treatment of other people who were there insured or not who had genuine issues.
Like I have said before I would love to see some kind of discount or voucher program so everyone can at least get the basics. All women should be able to get affordable PAP tests and Mamos. Everyone 50 and older should get affordable colonoscopies. All children should get immunizations at no cost at all. Outside of that people should still be held responsible for there own basic health. Look I smoke and drink I don't think anyone outside my insurance company which I pay into should pay for my behavior.

June 20, 2009 at 1:17 PM

Blogger Abigail said...

To Alane & Meg,

I'm sorry that you had such bad dealings with Medicaid. Staying ON Medicaid is definitely a trial. Random updates to remember, etc. But the clinics around here make it easy to find doctors. And my doctor is pretty good, despite being at a free clinic.

Also, Alane, don't forget that if everyone is on a single-payer system, it will be easier to find doctors that take your plan. You will also still be able to call your plans and find doctors in your area, just like you do with your current insurance plan.

As for current insurance company employees... Yes, there will be some unemployment. But there will be plenty of people needing to help administrate so many new clients, through the single-payer program. So many of them can transition there.

Also, with the extra coverage you can buy, the insurance companies will still exist and need employees.

As for the discount/voucher program, all women can get affordable OB-GYN care through Planned Parenthood. Depending on your income, your costs will vary. I get free care in that arena. Most kids, no matter income, can get immunizations and basic care. It's the not-working-poor who will get hit with bills. But most doctors will find a way to work with you in some way.

June 20, 2009 at 8:46 PM

Blogger Abigail said...


I couldn't find the article I was referring to, but I found another one that -- as of 2007 -- it was actually one in TWO. (

Also beware of making generalizations. Of course, there are plenty of silly, unnecessary trips to the ER. But I don't think they're the main population in any place.

First off, most moms can overreact about their kids. I think it’s frustrating that the mom jams up the system, but that’s also why they invented triage. If you’re having trouble breathing, her kid with a stomach bug isn’t going to get seen first.

The guy who didn't take a friggin Tylenol though. Him I would have probably thrown a chair at. At least then he would have had a valid complaint. And probably been seen more quickly.

But I'm not really sure how some guy being an addict and OD-ing on the street is really a poor healthcare decision. I mean, obviously it's a bad idea to start using drugs. But I don't think anyone chooses to be an addict. So blaming an addict for being an addict and the trouble it creates is sort of... a waste of time.

Also, I think having coverage could help addicts. No, it won’t make them realize they have a problem. But they’d have access to medical care. And, if and when they wanted it, rehab. Right now, you can wait several months to get a bed through the state. So you can either spend it in jail or out in the world, getting back into old habits.

And, Alane, one day you'll be on Medicare and the lifetime of smoking will probably have created all sorts of health problems. Depending on how much you drink, that might too. At that point, people besides you will be paying for your health choices. And if you don’t have insurance and develop cancer before then, a hospital won’t refuse you care. But the money has to come from somewhere. So don’t think for a minute that you and you alone are paying for your own life choices. (Not to mention the fact that your employer, I assume, pays at least part of your premium.)

Yes, in a perfect world, we could simply get insurance companies for all. But we can't. Hell, Tim can't get individual insurance because he's too big a risk. Luckily, we’re in WA, where there’s a health insurance pool. Not all states have one. Like Arizona, for example.

If he wanted health care down there, we could either choose to make under $1215 a month (and get government help) or he’d be uncovered. Then, when he did get a job with benefits, he’d have to wait for the “pre-existing conditions” clause to fall off. So for every month without insurance, his eczema/asthma/ADD wouldn’t be covered. That turns three months without insurance into a half year without coverage for his basic problems.

You said we should be responsible for our own health. But that’s even harder if you aren’t covered. In the past, Tim didn’t have coverage. So he’d wait until his skinw as unbearable. By which time he often had a severe staph infection and could barely move. (Eczema involves skin growing too quickly, so he can heal with arms bent and be unable to straighten them. Other times, he can’t move his neck. It’s locked in place, essentially.) Then he’d finally go to a clinic or an ER and get steroids. About all they could do other than advise him to get follow-up care he couldn’t afford. So then he’d just hope his skin would behave for awhile.

So if people don’t have insurance, how are they supposed to be responsible about their health conditions? Yes, we should eat better to avoid diabetes type II. We should drink less, smoke less and exercise more. But what about the health conditions that aren’t a result of any of that? How do we be responsible without insurance? Especially if the conditions keep us from working jobs long enough to get insurance – or only able to work part-time so that most employers won’t cover us?

June 20, 2009 at 8:48 PM

Anonymous Anonymous said...

My husband and I are living abroad with our two small children, partly because we cannot afford health care in the United States. Sad. I have never been a "rah rah America is #1" kinda gal; I prefer to consider myself a world citizen. . . so it is beyond my ability to understand why Americans are so determined NOT to look at what other countries do--like Canada, Finland, Sweden, France (heck, nearly ALL industrialized and some third-world countries!!!) Why are we wasting so much time trying to reinvent the wheel? How long would it really take an educated group of individuals to study the single-payer health care systems THAT WORK and model a plan after them? Nothing is perfect and we can tweak as we go (that's what's happening now with government run programs). Why why WHY do Americans feel we have to do something NEW for it to be better? good enough? Or is it just a stalling tactic? I would really like to come "home," but until the United States decides that ALL Americans have the basic right to decent affordable health care, it looks like I will remain an expat.

June 21, 2009 at 12:37 AM

Blogger Helene said...

All Americans should fight for a single payer health care system. Our present employer/insurance company sponsosred system is a miserable failure. Thanks for your contribution to Take Charge of Your Health Care Carnival.

July 28, 2009 at 2:35 AM


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