What happens if the Supreme Court strikes down the "individual mandate" in the health care reform law?
Commentators ranging from former Labor Secretary Robert Reich to Forbes Magazine columnist Rick Ungar agree: Such a decision could open the door to single-payer health care -- perhaps even make it inevitable.
This may be the best news about health care in years. Because ever since Republicans convinced the Obama administration to drop the "public option" in the Affordable Care Act, health reform has been in trouble. True, most Americans favor many of the provisions of Affordable Care Act. But the overall plan rests on forcing you and me to buy insurance from the same companies that have been driving up the costs of health care all along -- the same companies that have been finding creative ways to avoid covering needed care, shifting costs on to patients, and endlessly increasing premiums and out-of-pocket expenses for all of us.
Forcing all Americans into a failed system is bad policy, and it's not just President Obama's opponents who say so.
What the Doctors Ordered
When the Supreme Court agreed to hear a challenge to the Affordable Care Act brought by 26 state attorneys general, one of the supporting briefs came from an unexpected source -- a group of 50 doctors who believe that single-payer health care is the way to cover everyone and contain costs. As a model for a revamped health care system, they point to Medicare, which covers millions of seniors while devoting just 2 percent of expenditures to overhead (compared to as much as 16 percent for private insurers).
In spite of all the fear about government involvement in health care, Medicare is enormously popular; in a recent poll, two-thirds of Americans oppose changing Medicare to something more like private insurance. In the Medicare model, as in Canada's single-payer system, health care providers are in private practice, but the government acts as insurer, covering everyone. The money for the program comes from payroll taxes.
This model is just one of a variety of ways that industrialized countries provide universal coverage; only the United States does not yet offer universal coverage at all, and the impact of our fragmented, privatized approach ripples throughout the economy and into the lives of families that face bankruptcy and exclusion from needed treatment.
While we in the United States spend far more on health care, per person, than any other nation, we're way behind other wealthy countries when it comes to our actual health. The residents of 26 other countries -- all of which spend less on health care than we do -- can expect to live longer, on average, than U.S. residents. In a recent study of 19 industrialized countries, the United States came in last when it came to averting preventable death. Researchers say that amounts to more than a 100,000 avoidable deaths each year.
We devote 17.4 percent of our economy (by GDP) to paying for health care (or $7,960 per person each year), and still leave millions without coverage. In contrast, the French spend 11.8 percent of GDP on health care (or $3,978 per person) and cover everyone; the French live two years longer, on average, than Americans, and have better health by all key measures.
Follow the Money
If we're spending so much for poor results, where is all the extra money going? Private, for-profit health insurance companies spend big on overhead: covering the paperwork and arguments about who will cover what, finding ways to avoid covering people who might require costly services, disputing charges from health care providers. They spend money on marketing and on lobbying Congress, federal regulators, and state lawmakers. They pay dividends to shareholders and they pay executives six- or seven-figure compensation packages. No wonder premiums keep rising.
None of these costs are incurred by Medicare or other national insurance programs.
Some argue that patients are better off with competing insurance companies because that gives them a choice. Perhaps this is true of a patient who spends many hours required to read the small print in competing insurance plans, producing spreadsheets to track the multiple variables, guessing what sort of coverage they and their family will need in years to come, and hoping that they made the right choice when an unexpected accident or illness means their life depends on the bet they made. On the other side, insurance companies have battalions of lawyers and adjusters making bets about coverage, co-pays, and deductibles -- coming up with ways to cover less.
Asking each of us to choose among competing plans is like playing against the house in a casino -- it might seem as though you're getting choices among slot machines, but really, the odds are stacked against you whatever choice you make.
Where choice really matters to most people is in choosing health care providers. In France, where public financing of health care is the rule, patients actually have more choices among doctors than do Americans, who must choose among health care providers preferred by their insurance company.
So the doctors who are calling on the Supreme Court to strike down the individual mandate are on to something. Instead of locking us in even more tightly to an inefficient private insurance system, which has built-in incentives to take more of our money and do less for us, they argue we should switch gears. We're spending $200 billion more per year than we would need to under a single-payer system, they say. We pay more out-of-pocket than other countries, and the Obama Affordable Care Act wouldn't fix that.
What do Americans Want?
In poll after poll, a majority of Americans have expressed support for single-payer health care or national health insurance. This is true in spite of the near media blackout on this topic, and the failure of most national politicians to even consider single-payer as an option (the Obama administration and Democratic leadership in Congress excluded single-payer advocates from the key summits and hearings leading up to the passage of the health care bill).
In Massachusetts, which has had time to try out policies very similar to those in the Affordable Care Act, over 5 percent of the population remains uninsured. And, according to the doctors' brief, local initiatives calling for single-payer health care passed by wide majorities in all the Massachusetts districts where they were on the ballot.
Vermont has adopted a single-payer health care plan, and the California Assembly twice passed single-payer, only to have it vetoed by the governor.
Single-payer health care, in short, is far more popular than the political establishment likes to admit -- while requiring individuals to purchase health coverage from private insurance companies is wildly unpopular across the political spectrum. According to a recent poll, only a third of Americans favor the individual mandate, but 70 percent favor expanding the existing Medicaid program to cover more low-income, uninsured adults.
Here's something to ask yourself: if you're on Medicare now, would you give it up to move to a private insurance plan? If you're not now covered and you could sign up for Medicare today, would you?
Medicare for All
That contrast offers a good starting point. We don't need to assume that our health care policy must be designed to maintain the health-industrial complex and their lobbyists in the manner to which they have become accustomed. Instead, we can expand Medicare to cover more and more age groups, until everyone is covered. We could all then have access to a program that keeps overhead low, is wildly popular among its clients, and is similar to programs in Europe, Canada, Japan, and elsewhere that have excellent records of cost containment, universal coverage, and great health outcomes.
So what happens if the Supreme Court overturns the individual mandate or -- as now seems possible -- rejects the entire package? Such a move could turn out to be a great boon to those who doubt the wisdom of relying on private, profit-focused insurance companies to cover us when we get sick. It could offer us the opportunity to get the sort of proven universal coverage we can count on.
Sarah van Gelder wrote this article for YES! Magazine, a national, nonprofit magazine, website, and e-newsletter that fuses powerful ideas with practical actions. Sarah is co-founder and executive editor of YES!.
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Also - great description of where the money goes in overhead!
1. Democrats took single payer and expanded medicare off the discussion table and blamed republicans and lack of support, while arresting it's supporters and blocking republican bills too.
http://pnhp.org/blog/2009/05/08/why-we-risked-arrest-for-single-payer-health-care/
2. The health care bill was drafted with lobbyists behind closed doors. When Congress dared to try to mention bringing down drug prices, PHARMA disclosed a backdoor deal with Obama to fund this PR blitz and settle for fake savings, that is, they just have to make a vague claim they would raise prices $80 billion less than they would have otherwise and call it savings.
http://www.huffingtonpost.com/2009/08/07/white-house-confirms-deal_n_254408.html
3. They used their majority to block other bills and options from even being heard, while rushing this through and using reconciliation before anyone had a chance to read it, while building up a PR blitz of supporters changing health care not even knowing what they were supporting yet. They used big money, astro-turf fake grass roots zombies to railroad any real discussion on our options.
"What is single payer?
Single-payer national health insurance is a system in which a single public or quasi-public agency organizes health financing, but delivery of care remains largely private. Under a single-payer system, all Americans would be
covered for all medically necessary services, including: doctor, hospital, preventive, long-term care, mental health, reproductive health care, dental, vision, prescription drug and medical supply costs. Patients would regain free choice of doctor and hospital, and doctors would regain autonomy over patient care.
Is national health insurance ‘socialized medicine’?
No. Socialized medicine is a system in which doctors and hospitals work for and draw salaries from the government. Doctors in the Veterans Administration and the Armed Services are paid this way. The health systems in Great Britain and Spain are other examples. But in most European countries, Canada, Australia and Japan they have socialized health insurance, not socialized medicine. The government pays for care that is delivered in the
private (mostly not-for-profit) sector. This is similar to how Medicare works in this country. Doctors are in private practice and are paid on a fee-for-service basis from government funds. The government does not own or manage medical practices or hospitals.
The term socialized medicine is often used to conjure up images of government bureaucratic interference in medical care..."
If a few million citizens marched on D.C. with pitchforks, the corporate-controlled Congress would get the hint.
o Mexico
o Turkey
o The United States
Now Mexico and Turkey have forms of universal health care.
It will take a second revolution to accomplish meaningful reforms:
o government-funded elections, WITHOUT contributions from PACs, SuperPACs, unions, corporations or individuals.
o universal health care
o prosecution of financial crimes
o restoration of clouded property titles due to illegal robo-signing and MERSCORP.
"This struggle may be a moral one, or it may be a physical one, and it may be both moral and physical, but it must be a struggle. Power concedes nothing without a demand. It never did and it never will. Find out just what any people will quietly submit to and you have found out the exact measure of injustice and wrong which will be imposed upon them."
— Frederick Douglass, 1857
Vets Loving Socialized Medicine Show Government Offers Savings - Bloomberg.com
“..The care is superb,” said Tanner, 66, a San Diego resident who visits the veterans medical center in La Jolla, California, and a clinic in nearby Mission Valley. The record- keeping, he said, is “state of the art.”
As Congress considers changing Americans’ access to health care, theveterans agency, whose projected budget this year is $45 billion, is evidence that the government can provide care favored by patients that may offer savings when compared with private insurers.
Researchers publishing in the New England Journal of Medicine, the British Medical Journal and the Annals of Internal Medicine in recent years have endorsed the system. A Canadian policy journal, Healthcare Papers, devoted an entire issue to it in 2005..."
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/models.html
Too bad, I think it would be very interesting.
Instead of enacting one-size-fits-all health care legislation--which most of the country will hate for entirely different reasons--why not establish health care regions made up of ideologically similar states. New England would be thrilled by finally getting the "Medicare for All" they so desperately want. The South might go with a premium support program and total choice of insurance carrier.
Economies of scale would be achieved by creating health care by region rather than individual states.
At the end of the first five year trial period, the results from all regions would be compared as to cost and health outcomes. Those which showed excellent results could be voluntarily adopted by other regions and those regions then combined.
Every five years the regions could be evaluated and combined until there were only two or three regional plans all getting good results and with which the residents were happy. Happy citizens insure the new health care system won't wind up in front of a judge.
So what is SC waiting for? Oh I forgot it's a political football and not about health care at all.
BTW: Buying insurance across state lines won't help at all, just like it didn't for credit card companies. All it does is usurp state law, to whatever state, the insurance co. is located in.
Let's assume you get medicare for all sort of scheme. Everyone has insurance, tomorrow. Who takes care of these people? The medical professionals are up to their eyeballs in patients as it is.
More importantly, when you make all these physicians government employees they are not going to keep working 14 hours a day to see 45 patients each day.
My wife is a physician, she works 80 hours a week. I can tell you right now that she would jump at the chance to work for the government, even if it involved a pay cut. All the sudden she would be working 40 hours a week, not a minute more, and take her 6 weeks of vacation a year.
Under single-payer systems, like Canada's, health care professionals are not government employees. They continue to practice like they are today -- with private practices, non-profits and for-profit hospitals, etc. Under the British system, like the U.S. Veterans Administration, health care providers are government employees.
So how will we have enough health care professionals to care for everyone? The same question should be asked of any system that promises universal coverage, whether it's Obama's Affordable Care Act, or Medicare for All/Single Payer, or an expanded version of the V.A. We increase training of nurses and doctors, get better at prevention of illness, etc. Increasing health and getting everyone covered is where we should be putting our efforts, I believe.
What if she got paid for making phone calls instead of only for office visits?
What if the latest information was at the touch of her finger tips?
What if by practicing "Best Medical Practices" she couldn't be sued for malpractice?
Now how many hours would she work?
My guess is that the pay would be so much lower for a phone call that it would not even be worth it, office visits generally lose you money to begin with.
She is already fully integrated with EMR for everything. Entire practice is fully integrated with latest IT. BTW, EMR is actually a time sink, not a saver.
Almost every doctor, including my wife, strictly adhere to their respective colleges best practice guidelines. It means nothing when it comes to a malpractice suit, nothing at all.
Congratulations, you have pointed out a bunch of things she is already doing and still pounding 80+hours a week.
The problem is physicians get paid jack crap for seeing a patient, no matter what they do. Their only option is to see 45-50 patients a day, spend 2-4 minutes with each patient no matter what.