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Obama's Health Care Push
President Barack Obama addresses the American Medical Association during their annual meeting on Monday. (AP)

President Barack Obama addresses the American Medical Association during their annual meeting in Chicago on Monday, June 15, 2009. (AP)

President Obama took his health care road show to Chicago yesterday, and spelled out his case for sweeping reform before the American Medical Association.

He drew some cheers from the skeptical audience of doctors, and a few boos. But back in Washington, the real fight is about to begin. The president has said that reform “will not wait another year,” and he wants a bill on his desk by October.

So, what will it look like? Does it stand a chance? And as the president picks his battles, what options, and political allies, are left behind?

This hour, On Point: Obama’s big push on health care.

You can join the conversation. Tell us what you think — here on this page, on Twitter, and on Facebook.

Guests:

Joining us from Washington is Julie Rovner, health policy correspondent for National Public Radio. (Read her liveblog of President Obama’s speech to the AMA.)

From Waltham, Mass., we’re joined by Stuart Altman, professor of national health policy at the Heller School for Social Policy and Management at Brandeis University and former advisor on health care to Barack Obama’s presidential campaign.

And joining us in our studio is Arnold Relman, emeritus professor of Medicine and Social Medicine at the Harvard Medical School and former editor-in-chief of the New England Journal of Medicine. He’s author of “A Second Opinion: Rescuing America’s Health Care.”  His article in the current New York Review of Books is “The Health Reform We Need & Are Not Getting.”

More links:

Listen to On Point’s recent interview with surgeon and writer Atul Gawande, in which he talks about his latest piece for The New Yorker, “The Cost Conundrum: What a Texas town can teach us about health care.”

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  • http://wbur.org Peter from Newton MA

    I’d like to ask the panelists, esp Prof Altman, to comment on:
    1) How single-payer would deal with politically sensitive issues, in particular abortion coverage. How does Medicaid deal with it?

    2) To get doctors, hospitals, drug companies to particpate in govt cost-control, could we not provide direct subsidies as is done for farmers (but with more oversight & better targeting)? Examples: offer income guarantees/tax credits for new doctors paying off med school loans, hospital reimbursement which awards efficiency, & drug-development cost underwriting in return for price caps and some percentage of profit return.
    Thanks.

  • david jenson

    The public health clinics could take care of alot of the medical needs for people that don’t want to buy medical insurance or can’t afford it. The one in our town works pretty well except it’s overrun with illegals that won’t pay the few dollars they are charged for services they receive. Other than that, it’s a good government run center.

  • aj
  • aj

    Anything else is less than civilized.

    But who needs Republicans with Democrats like these. Except for Pelosi ( she’s not perfect, but she is not like the other gutless Democrat backstabbing fake beholden-to-corporation two-face cowards ) Obama will talk, talk, talk, and then sell out the people to corporate interests. Guaranteed.

    Milton Friedman said you can’t have a welfare state with open borders. So to the above point, it is in the Corporate interest to have open borders, plus we will never get tough with Mexico City to do for their own people.

    What the corporate interests want, the Corporate interests get.

  • Elizabeth Michaud

    I’ve read that the United States spends something like 31 percent of every healthcare dollar on the overhead of administration, essentially supporting the bureaucracy, forms handling, and profits of all the private insurance companies. I’ve also read that countries with single-payer systems spend a far smaller percentage of their healthcare funds on administration, a far greater percentage directly on healthcare, and get far better outcomes.

    My question is: How can anyone defend spending 31% of our healthcare dollars on overhead and administration? Why is no one framing the debate in these terms?

    Thanks if you have time to address my question, and thanks for On Point, which I love.

    Elizabeth Michaud,
    Westford, Mass.

  • Putney Swope

    If you take a look at the stock portfolios of the major players in the Senate you will find that they have a vested interest in the pharmaceutical and insurance corporations doing well. Harry Reid is one example.

    As with the banks, pharmaceutical and insurance corporations run the government by way of lobbyist.

    This thing is dead in the water, what we will get here is more of the same dressed up in new clothes.

  • jack mahoney

    How can reforming the U.S. health-care system be so difficult? There are 19 other industrialized countries to use as templates. Just copy the system of our northern neighbor, Canada. (Btw, I’ve never heard them clamoring for a U.S.-style system.)

  • Rev. Paul Ricard

    Pres. Obama needs to push through health care reform, with NO cave-in on the public option. If the republicans are against it, the democrats need to push it through anyways. The fact the the United States of America cares more about the profits of doctors and insurance companies than the health of it’s people is immoral!

  • http://www.government-reform.info Bob Knisely

    EVERY conversation about reforming health care should begin by describing the health care provided to Congressmen and Senators!

    THAT is BY DEFINITION the “gold standard.”

    And if it’s good enough for them, it’s good enough for the rest of us!

    We need to widen the “Overton Window” so that SERIOUS solutions are on the table. This is part of NPR’s JOB!!

    (Check out “Overton Window” if you don’t know what that is!

  • Pete Caruso

    Why is there so little mention of one obvious payment source, which is to tax all income earners the same percentage of their income?

  • Bob Knisely

    You might consider setting your clock for Daylight time! I just posted at 1025 and it came up 0925.

    Is NPR that far behind?

  • Joe B.

    The best and most cost effective way to insure every American has affordable health care is to do what the world’s number two economy (Japan) does, PRICE CONTROLS, setting prescribed fees as to what doctors and hospitals can charge for medical services.

  • Elizabeth Michaud

    Ms. Rovner just commented that so many of the interests are in direct conflict with one another. Are people looking for win-win? It seems to me that the doctors who don’t want their costs pressed down are really saying “I spend many years in a grueling medical education, and I deserve to make a decent income.” There should be other ways to control costs besides depriving doctors of a good income.

    For example, we spend a disproportionate share of healthcare dollars on heroic measures delivered to provide the patient with a few more days or weeks, at the end of life. Can’t we look at ways to provide excellent care, and still give every patient who realistically might recover the chance to do so, but shift the incentives so that doctors, patients, and families allow people who are obviously dying to die in comfort, rather than throwing huge amounts of money at what is essentially, the attempt to forestall an inevitable death? The system can’t legislate the details, but it might be able to empower everyone to make decisions that are both more compassionate and more cost-effective, with respect to end-of-life care.

    Thanks!

  • Putney Swope

    With all due respect the Canadian system is one of the worse of these national systems. Switzerland’s is the best model. They had the same problems that we have and put together a pretty good system that uses the private insurance companies and the pharmaceutical corporations with the government mandating cost caps and negotiating for the population. Also they changed the law so that these companies can not make profits from health care.

    The insurance companies and the pharmaceutical corporations still make money, in other ways, life insurance and so on.

  • Cathy Rec

    The costs of medicine is not the price of physicians … it is the costs of administrating the physician. Once we had a nurse and an someone to make appointments and keep the files, now we have a nurse (or two) an office manager, a billing specialist and/or a coding specialist. These last two are necessary to fill out the insurance paper work. Patients no longer pay only the doctor. Doctors need to be taken off the scape-goat list.

  • Mary Horowitz

    Why we need single payer. You will notice that those evil “socialized” countries are at the top.

    The World Health Organization’s ranking of the
    world’s health systems as of the year 2000

    USA is #37, just behind Costa Rica

    The World Health Organization’s ranking of the world’s health systems
    http://www.photius.com/rankings/healthranks.html

    “The world health report 2007 − A safer future: global public health security in the 21st century”
    Full report download as a .pdf file:
    http://www.who.int/entity/whr/2007/whr07_en.pdf (4.15MB)

    1 France
    2 Italy
    3 San Marino
    4 Andorra
    5 Malta
    6 Singapore
    7 Spain
    8 Oman
    9 Austria
    10 Japan
    11 Norway
    12 Portugal
    13 Monaco
    14 Greece
    15 Iceland
    16 Luxembourg
    17 Netherlands
    18 United Kingdom
    19 Ireland
    20 Switzerland
    21 Belgium
    22 Colombia
    23 Sweden
    24 Cyprus
    25 Germany
    26 Saudi Arabia
    27 United Arab Emirates
    28 Israel
    The World Health Organization’s ranking,of the world’s health systems
    The World Health Organization’s ranking,of the world’s health systems 1
    29 Morocco
    30 Canada
    31 Finland
    32 Australia
    33 Chile
    34 Denmark
    35 Dominica
    36 Costa Rica
    37 United States of America
    38 Slovenia
    39 Cuba
    40 Brunei
    etc. etc.

  • Doshi

    Why are people fine with having public schools (along with private) but not OK with having public insurance (along with private)?

    Companies are opposed to this because they know once the gov’t gets in the health insurance business, they won’t be able to compete. They’re only for “free market” when it benefits them.

    The fact is, having public insurance will inherently decrease cost of medical care because it spreads risk and cost across more people. It is the most objectively efficient means of provided what should be a right (like education) and not a privilege.

    Insurance companies can only control cost by limiting coverage (denying claims) and cherry-picking only the healthiest people. By the way, they raise premiums at the drop of a hat. Employers just pass it on to us.

    Having insurance not tied to one’s employer would be a great step in the direction of letting the best employees move to better jobs or start their own business instead of letting health care dictate decisions.

    All the people shouting about single-payer socialism are being duped by these big companies and lobbyist. It’s a shame.

    People, read “The Great Risk Shift.”

  • Putney Swope

    Follow the money! Don’t these people get it? Between the campaign contributions and the vested interest in stock portfolios of the very politicians who are calling the shots nothing is going to get done.

    For example Senator Kennedy has a blind trust for his investments, Senator Reid is heavily invested in insurance companies and the pharmaceutical corporations. Reid will never vote for this and will doing everything in his power to kill it, why? Because he will lose money.

  • Violet

    Bottom line: doctors are tremendously afraid of losing their exorbitant paychecks.

  • John

    I’d like to thank WBUR for cutting off the doctor’s response so they could expand their pledge break.

  • Don

    What are the salary ranges in the medical field?

  • Jack Mahoney

    It’s not an exaggeration to conclude that NOTHING can be done by this country anymore. Our products are made in China, the U.S. auto industry is bankrupt, the banks and WS are corrupt, and, now, the health-care system is collapsing and people are dying because of it. Because $$$ is SO important to all parties involved, NOTHING worthwhile will come out of this debate. U.S. = Failure.

  • http://npr Jeff

    Maybe now you will understand why there is no illegal immigration problem coming from the Canadian border.

  • Bernard

    I wanted to address the issue of rationing. What puzzles me is why health care reformers and Democrats in particular don’t point out that we *already* have health care rationing in our privatized system. Private health insurance companies ration health care in order to make a profit; The more health care they provide the less money they make. They have a direct incentive to *not* provide care or at least to provide as little as possible.

    I was wondering what professors Altman and Relman think about this and why they think this isn’t brought up by politicians and health reform advocates? It seems such an obvious rebuttal to the rationing argument.

    Thank you.

    Bernard C, Maynard, MA

  • Marie Ugorek

    Here are the issues I am not hearing in this debate:

    1) If there is no public option, how do you require private insurance companies to cover people with existing conditions at an affordable price, when most private insurers have investers’ dividends to consider.

    2) How can people maintain that capitalist market forces must be applied to health care? Capatilism works well when a balance between supply and demand results in appropriate cost. This cannot be applied to the health care system, because people can not choose to put off the purchase of health care while they save up, as you can with a house, television, or new carpet. When people put off seeing a health care provider for financial reasons, the cost to everyone is usually more than it would have been otherwise.

    My conclusion, as a 32-year old who has been unable to purchase an individual plan since age 25 (and that was before I broke a bone and incurred $10,000 in medical bills), which would require 1/3 of our household income each month. A public option MUST be instituted, if only to buy time until we can decide how to solve the problem long-term.

  • Don Smith

    The health care industry is going away without reform. Insurance costs are expected to double in the next ten years and more people will drop out due to the costs. Eventually, the pool will get so small, insurance companies will have to merge or die. When this happens costs will increase even more dramatically.

  • Dr. S. lakshminarayanan

    I am very passionate about health care and education of the next generation of physicians which is tied into health care for future generations.

    The pink elephant in the room at any discussion on health care is the fact that health care in the US has become a profit oriented industry. The simple reason for this is redundant layers of administrators, complex coding and billing rules and regulations (by design), insurance companies, pharmaceutical industry interests and last but not least the physicians. All groups have heavy lobbyists and interest groups who honestly do not want reform because it would make their existence meaningless.

    We the physicians and healthcare/hospital administrators have become more focused on reimbursement and malpractice issues and have often voiced our opinions on this collectively and loudly. Our silence on the erosion of the physician patient interaction has been deafening. Our health system has been structured to favor very brief doctor visits and very busy schedules to generate more revenue. Patients are beginning to feel short changed (and rightly so) with the push for shorter visit times and double bookings. This not only sets the stage for bad Medicine and poor supervision and teaching of medical students, residents and fellows but also opens us up for litigation issues. The driver in litigations is I believe often the level of dissatisfaction a patient experiences more than the medical outcome per se.

    If we are to be true to our mission, we need to pull back from the push for shorter visit times and fix what is broken- the doctor patient relationship.

    We have to do this urgently if we and our patients are to truly know better health care.

    By complying with rules set by non physicians and administrators at insurance companies, to ensure short term survival and profitability all we are doing is making sure that the emboldened regulators/payors will impose more rules. History has clearly shown us that. That battle we will lose. The need is for us to take a stand and not pass the squeeze down stream to patients. That battle we can win if we all stand together.

    This may sound simplistic but to me seems clear without any clutter.

    At what point do the economics of care conflict with the ethics of care?

    If we are to truly realize health care reform we should be looking at universal healthcare and take profit out of the equation. What would be the cost savings if one completely did away with health care insurance companies and hence their operating expenses, CEO salaries and bonuses? I am sure it will not be small change.

    There are not many things I feel as strongly about as this set of issues.

  • Martin Bur, M.D.

    As a practicing physician in Massachusetts I find it interesting to hear opinions about how doctors are concerned primarily with their finances. After four years of Medical School and 8 years of specialty training and late and long working hours during and after training, why should a doctor make the same income as a merchant who is not regulated in anyway?. What about the free care that we provide to the poor and uninsured? Very few professions are influenced by ethics the way we are. Obama must deal with the malpractice epidemic that lead to a decrease of practicing Obstetrician and regulate lawyers as well!

  • David Nocella

    My question is that if most healthcare cost are are incurred by individuals during the later years of life and most individuals are covered by Medicare during their later years, isn’t the current state of affairs that a) we already have socialized medicine and b) that private insurers by-in-large don’t absorb most of the risk?

  • Violet

    There’s the fear right there.

  • http://wdet.org Kevin

    We should cut out these machanations and go right to a national health care system

  • Susan walters

    To those who believe the government will be making your health care decisions: who do you think makes those decisions now? CEOs and number crunchers.

  • JD

    Given what I’ve learned today myself, I think that it’s very important that people have a better understanding about the various types of government involvement in health care – single payer programs, etc. You gave some examples of the difference in the systems in Canada and England and the VA. We all need more education about the different forms so that we can better understand what Obama is actually proposing.

  • R.M

    Its inhuman . We are the disgrace to the world when it comes to health care .We need to cut off the middle men or we will continue to become a third rate third world country …Politicians who have a “financial interest” should not able to vote.

  • Putney Swope

    For those who want more information on the financial ties in both houses the Huffington Post has this article from AP: http://www.huffingtonpost.com/2009/06/12/key-senators-involved-wit_n_215082.html

  • Paul

    US patients also subsidize the rest of the world by paying far more in prescription drug than anyone else. Next time you’re in Europe check into the local prices for your top cholesterol and blood pressure pills.

  • Elizabeth Michaud

    To Dr. S. lakshminarayanan – Thank you for your wonderfully clear statement of how the centrality of the for-profit insurance companies in our system is costing us a fortune and at the same time destroying the quality of care that patients receive. Your explanation is very clear and understandable for any intelligent reader. I hope you will take your remarks, expand them, and submit them to a publication more widely read than this blog for comments to On Point.

    To Dr. Martin Bur – As a patient and not a medical professional, I’ve experienced most doctors as very skilled, and also very caring and motivated largely by very high ethics, just as you describe. But I’ve also seen a grandparent and also a friend (two separate cases) subjected to what I believe was at best very lackadaisical care, which verged in each of those cases on negligence if not malpractice. It’s important for doctors to begin to regulate their admittedly rare, less competent and careful “bad apples” effectively, so that patients are realistically protected against isolated incompetent physicians, instead of just characterizing all malpractice suits as frivolous or vindictive and requiring arbitrary limits on patients’ ability to sue. My own experience is that even most families who lose a member due to medical incompetence do not bother to sue, because of the time and effort and additional pain it would involve, on top of the bereavement. My family did not sue, and neither did my friend’s family.

  • http://tombstone001.blogspot.com MIOHAMMED N. RAZAVI, DALEVILLE, AL

    So that I know that I get this right, you want people in the third world to support your American life style right. Of course that is what globalization means right? You want Chinese and the Indians and the Arabs to pay for our health care, and that is just for starters.
    Isn’t this true that the International Brotherhood of Morons (IBM) wants to create a smarter planet so they sold their manufacturing to a Chinese Government owned company. And why not, surely it will not be ALL Americans living in that smarter planet. Isn’t it also true that the Unemployed Auto Workers (UAW) were sold out to the point that they accepted lower wages, reduced benefits and jobs cuts to the bare bones.

    Do we really expect those Chinese who work fourteen hour days for four and half dollars per day to not only support our welfare system, but while they being forced to abort a second fetus, to loan us monies to take care of the likes of Nadya Suleman and the Tennessee guy with the twenty one kids.

    And expect the people of the Indian and the African slums to pay us to keep our air conditioners going and have free health care?

    Or the Arabs to give us oil for cheap while they buy billion dollar aircraft and pay for our high dollar prostitutes.

    Or may be the Japanese and the Koreans who send their kids to ten hour school days followed by four hour home work to support our video game addicts and slackers?

    MEDICARE should only pay for birth control or an abortion. You will see the savings.

  • Bryan

    Few things illustrate more pointedly the accuracy of the Marxist dictum that “government is the executive committee of the ruling class” than the Congress’s decades-long inability to institute a rational system of health care delivery. The debate among the commentators in today’s On Point did not really do justice to a single-payer plan – the only plan that deals directly with the main problem: the existence of a wasteful, crazy-quilt plethora of private insurers, whose interest is to limit rather than expand care, and who act as totally unnecessary middlemen in siphoning off billions of dollars that could instead be spent directly on care. When Jane Clayson said that most Americans want complete coverage, she ignored this central issue: there is a difference between coverage and care. We need care, not coverage. We don’t need mandatory insurance, a la the Massachusetts model. We don’t need yet another permutation of our private insurance system. Instead, we need to eliminate that very industry. Anything less is simply tinkering around the edges of a fundamentally flawed system. But that is exactly what we stand to get in a country where people most affected by decisions in corporate board rooms or in Washington remain disorganized and unable to voice their opposition, unable to vote their economic interests.

    When it comes to health care reform, Obama is a huge disappointment, having years ago forthrightly stated that single-payer was the way to go. His supposed reform effort is merely the latest in a long line of lukewarm attempts to prop up a failing system, amounting to a minuscule band-aid stretched across a gaping wound. We shouldn’t be surprised, given his similarly timid approach to the Wall Street financial crisis, that Obama has abandoned his previous commitment to a rational single-payer system. What is galling is his explanation, in which he invokes our country’s “tradition” of private, employer-based insurance, a system inimical to providing full care for all at lower costs. He essentially is saying we can’t rock this leaky old boat. The man who strode to victory intoning the mantra of “Change” has had a golden opportunity to strike for real change, but apparently because of his own notions about political expediency, he refuses to do so.

    We are left with a debate about health care “reform” that turns on such straw-man issues as whether Obama’s plan is a “Trojan horse” for “socialized medicine,” that irksomely tiresome refrain regularly trotted out by right-wing apologists for rampant greed, which they prefer to call “free enterprise.” For over seventy years, reactionary forces in the government and corporate media have prevented a national, single-payer health plan from being created. If you want to know why, simply “follow the money,” to use an old phrase from the Watergate era. When one senator from the sparsely-populated state of Montana, Max Baucus, can set the legislative agenda and dictate to the rest of the country what we can and can’t tolerate in the name of real reform, then one has to ask why and how he wields such power. One only has to look at the extent of his campaign contributions from the insurance industry to begin to understand how the government in our vaunted democracy actually works, and for whom.

  • BHA

    It should be pretty simple – start by following the basic Medicare model:

    Base coverage (I’m sure there would be a HUGE fight over what is covered) for ALL legal residents, cooperative coverage with other countries for visitors, supplemental private insurance for those who want and can afford it.

    There is no way we can pay for a partly private (through employers), and a partly public (for those not insured by employers and not able to pay the rate private insurance companies charge) and Medicare/medicaid.

    1) FREE medical school (base MD, not specialization) for those with the aptitude and desire to get into medical school. No 6 figure loans, no need to repay them. No need for ‘extra’ income to cover the loans.
    2) No more ‘in network/out of network’ with separate deductibles and pay ratio bull. Since all medical services are payed from a single source, EVERY medical provider is ‘in network’.
    3) No more ‘can we get some other insurance company to pay this charge’ questionnaires when you make a claim.
    4) No more lack of insurance for ‘pre-existing conditions’.
    5) No more loss of insurance when you get laid off.
    6) Computerized records so ANY doctor can see the history of any ailment you might come in with. No repeated tests simply because the data is not available. And no getting multiple prescriptions for controlled drugs from many doctors. PLENTY of pluses.

    How do you pay for it? The same way every other single payer system pays for it. Everyone pays in some fashion. Business tax, Value Added (sales) tax, income tax. A mix of the 3 I’m sure. It would cost LESS than we pay now.

  • Mike

    one of your guess refers to what happen in mass as a good thing. its not since all people in mass has been required to have health insurances the cost are still going up.

    and as myself and others have to pay additional money for a health care account on top on what i pay for my health insurances. (get this) i need that account to pay for anything that could happen to me. (since my insurance doesnt cover zip) and nickle and dime me with co-pays luckly im in good shape and rarly get sick, but for some of my friends its killing them and others prefer to pay the fine(that goes up the more the make) since both ways u really dont get any coverage.

    Mass with the work of those econ democrats and former Gov Romeny(toolbag) design a system that requires the state to be beholding to the private insurance companies and CEO’s making millions who contribute zip to our health.

    if obama took the mass way of health care will not vote for him and work to get others not too since hes not big enough leader to stand up to the lobbist.

    Because of mass. and the massive amount of money being made for the private insurances they agreed to help obama only if the public option doesnt make them lower cost, increase care, but have everyone be in the servitude to them.

    I agree with the other guest who avocates for single-payers( which medical/health care should be a right not a luxury )i would hope those care about unborn babies also care about the born ones and vote out those republicans,and dems as well whose all beholded to these blood sucking insurance co.

  • loninappleton

    I support the single payer system. A majority of Americans say they do. There will be apologists on the side of insurance companies forever.

    And so long as they can talk about “health care reform” without being stopped in their tracks, they will control the message.

    Change the message to universal single payer health care all the time and every time and that message control is defeated.

    Message control was used by political speech writers like Frank Luntz to brand the estate tax as “the death tax”. Health Care Reform is the same sort of spin.

    NPR print media and Democrats and Republicans have allowed this trope to be used against the American people in defense of insurance companies. Insurance companies provide NO health care.

    Get it?

  • millard-fillmore

    Because the issue of health-care for all was important to me, I voted for Ralph Nader in 2008 who was a vocal advocate of single-payer health-care right from the get-go (it was part of his election platform), and I support the Green Party which has the same stance on the issue. I chose to vote for Nader because for so many issues that I care for, his stance on issues matched mine a lot more than Obama’s, who was a very distant third. So, there was no disconnect for me in terms of theory (stance on issues) and practice (who deserved and got my vote based on my stance on issues).

    I guess those voters, who support single-payer health-care but voted for Obama/McCain when neither of them supported single-payer health-care as part of his election campaign, need to do some soul-searching regarding their stance and whom they supported/voted for and why, and how to bridge that disconnect.

    I also can’t begin to tell you the grief I got from my Democrat apologists friends for supporting Nader – but I had done my research while they were living in 2000 (and had swallowed the media demonization of Nader hook-line-and-sinker without their own independent analysis), so I was confident in my choice. I sleep with a clear conscience because I believed in my ideals and voted for someone based on those ideals, instead of compromising.

    And we need to question the media (including On Point/WBUR) as to why didn’t they highlight Nader and Green Party’s stance on single-payer health care when they were covering the elections in the Fall of 2008 and why do they narrow down the choices given to readers/listeners to just Democrats/Republicans when both of those parties are corrupt. And why was single-payer health-care not important enough to discuss in Sept 2008 before the elections. Let’s talk about democracy and freedom here in the US first instead of (or in addition to) being concerned about what’s happening in Iran – there’s plenty to correct right here in our country when it comes to free press, media and democracy.

    Of course, I’m glad that the Democrats are thinking about single-payer health-care now, but it remains to be seen whether they will implement it. Let’s give credit to Nader/Green Party who championed it long before the Democrats. And of course, please consider supporting the Green Party in the next elections instead of maintaining the status quo of the corrupt duopoly.

  • r malkki

    Two things I’ve noticed in the several fora I’ve listened to recently on this topic which have now been mentioned are: 1) No one so far has discussed the cost of malpractice litigation that also hikes up healthcare costs rather dramatically; and B) the fact that the vast majority of money spent on an individual’s health care occur during the last few months of life. I work in hospice and palliative care and see the outrageous costs both in money and quality of life that burden patients and families at this time in life, and our society needs a real overhaul in its thinking on these points. Europe has some good examples in this area.

  • Isernia

    While health insurers and pharmaceuticals have long been blamed for the high cost of medicine, the doctors are also at fault. As a group physicians grow more cynical and rapacious the longer they are in practice. The Hypocratic Oath turns into the hypocritical oath. Doctors order unnecessary medical tests not just to protect themselves against malpractice suits, but also to fill their pockets with profits from the labs, hospitals, imaging places that they OWN! Read about this in the June lst issue of the New Yorker, and listen log on to the podcast of ON POINT on the subject.

  • Stewart Marshall

    Your one speaker misspoke yesterday. I have lived in Canada and loved their medical system. I even had a child that had terminal health problems treated up there, but he got the best mmedical care possible. However your one speaker misspoke yesterday.
    The hospitls in Canada especially in the province of Ontario are not private. They are all public. Hospitals are funded differently than they are here in the states and they are limited on what technology they have. But they are unlike hospitals in the US and more like VA hospitals.
    One of the real issues we are needing to look at is that we must be honest in that we are all ready rationing our health care based on money and level of insurance coverage. If we would be honest in that respect it might make the whole converstaion down here easier to discuss. Whatis being proposed is to level the playing field for all in the way of access for mecical care.

  • BHA

    millard-fillmore >>
    “I guess those voters, who support single-payer health-care but voted for Obama/McCain when neither of them supported single-payer health-care as part of his election campaign, need to do some soul-searching regarding their stance and whom they supported/voted for and why, and how to bridge that disconnect.”

    There are more issues to deal with than just health care. You voted for the person who most represented your stand on them and so did the rest of us.

    The reality is that there are too many power players to go directly to single payer, much as I would prefer it. I find it odd that people say offering a ‘public’ option will drive the private insurers out of business. Isn’t that what the capitalistic system they espouse SUPPOSED to do? Let the buyer choose and if some entity can’t “compete” they go out of business? Won’t it be “funny” if there is a “choose what you have now or choose the public option” and all of a sudden, the private insurance companies find a way to cut costs and be competitive.

    The cost of interim systems will be higher than going directly to single payer but as we live in a democracy, there is no dictator at the top that will decide what is best for us all.

  • millard-fillmore

    BHA,

    Yes, I’m aware that people in general, don’t vote based on a single issue. Why don’t you list your top 5 priorities/issues as a voter and then compare Obama’s stance to those of the Green Party and Nader’s stance on those issues that you care for, and see who comes out in front? That would be the rational and logical way to choose whom to vote for.

    The elections are not about issues, though we like to pretend that they are – most people vote along straight party lines and simply rationalize their decision.

  • Don A.

    Several things have been said or written that need some clarification:
    1. I don’t know about everywhere but here in Western New York, three NON-PROFIT HMOs have the vast majority of the insurance business. They are non-profit so all the talk about insurance company profits ruining everything is just not true– They don’t have ANY profit!
    2. Talk about not having rationing is not genuine. There has to be rationing. If a procedure costs $1 million and has a 1% chance of success, it’s use can not be justified and it must be rationed. How do we determine who gets to most coverage? It should be those that can afford it either through insurance or their own funds.
    3. Saying that the public option will provide competition is not true. The government has a bottomless pit of funding. It’s unfair competition. They don’t have to make money; they don’t even have to break even.
    4. Medicare isn’t a well functioning government run system. It is going broke and is costing huge amounts. Where is the control of costs–only in the arbitrary reduction in payment rates for which the private insurers have to make up the difference.
    5. Allowing everyone to choose their doctor is not realistic. Not everyone can choose the best doctor. Some must take a doctor of lesser quality. Same with hospitals.

  • millard-fillmore

    FYI.

    Grand Illusion
    by Ralph Nader

    In 2003, Barack Obama said he was for single payer.

    What would it take to get single payer enacted?

    “First, we have to take back the White House, the Senate and the House,” Obama said at the time.

    Fast forward six years.

    The Democrats have taken the White House.

    The Senate and the House.

    And now what’s Obama’s position?

    In a speech this week in Chicago before the American Medical Association, Obama made clear he was now opposed to single payer.

    And his lieutenants suggested that Obama would support legislation to make sure that single payer does not become a reality in America.

    There’s only one explanation for Obama’s flip-flop on single payer.

    The health insurance and drug corporations have a hammerlock on Washington.

    And Obama is going along to get along.

    What’s the net result?

    Sixty Americans are dying every day due to lack of health insurance. (Institute of Medicine report.)

    Instead of getting behind single payer, Obama and the Democrats are engaged in the what Dr. Marcia Angell, former editor-in-chief at the highly regarded New England Journal of Medicine calls “the futility of piecemeal tinkering.”

    Earlier this week, the Congressional Budget Office (CBO) estimated that the most liberal of the Democrats’ tinkering plans would cost $1 trillion over ten years and still leave 37 million Americans uninsured.

    Single payer on the other hand would cost less than we are overpaying now — and cover everyone.

    Zero uninsured.

    As Dr. Angell puts it — single payer is not only the best option.

    It’s the only option that will both control costs and cover everyone.

    Replace 1,300 insurance industry payers with one payer.

    Save $400 billion a year in bloated corporate administrative and executive compensation costs.

    Free choice of doctor and hospital.

    Use that money to insure everyone.

    No bills, no co-pays, no deductibles.

    No exclusions for pre-existing conditions — because under single payer, you are insured from the day you are born.

    No bankruptcies due to medical bills.

    No deaths due to lack of health insurance.

    Cheaper. Simpler. More affordable.

    Everybody in. Nobody out.

    According to recent polls, the majority of Americans, the majority of doctors, the majority of nurses, even the majority of health economists want single payer.

    That’s why almost every health care town hall event I hear about is dominated by citizens speaking out for single payer.

    Last month, we asked that you help fund a new non-profit organization – Single Payer Action – to focus this citizen energy, break through the corporate logjam in Washington and make single payer a reality.

    You came through with flying colors — and blew past our initial fundraising goal.

    The foundation was set for action.

    Out of the blocks, Single Payer Action led a stand up protest before Senator Max Baucus’ Senate Finance Committee.

    Thirteen doctors, nurses, lawyers and other single payer advocates were summarily arrested and charged with “disruption of Congress.”

    (Baucus later told single payer advocates that he regretted not inviting them to testify before his committee.)

    The arrests of the Baucus 13, their upcoming trial, and other similar single payer actions around the country have galvanized a nationwide movement.

    Single Payer Action now wants to supercharge the grassroots movement for single payer.

    Confront members of Congress back home all around the country.

    And lay the groundwork for a national citizen’s organization that will refuse to compromise with corporate power — inside the beltway and out.

    Many progressives are now confused.

    They took Obama at his word.

    They thought once Obama was elected President, he would do the right thing.

    My colleague, Theresa Amato, is not confused.

    She saw clearly through the Democratic Party’s duplicity and shenanigans — and has written a new book, titled Grand Illusion: The Myth of Voter Choice in a Two Party Tyranny (New Press, June 2009)

    The book documents how the corporate two-party system thwarts citizen activism and blocks challenging candidates in the electoral system and beyond.

    Phil Donahue said this about Grand Illusion: “Theresa Amato takes the biggest swing — not a jab, but a roundhouse punch — at America’s corrupt electoral system.”

    Single Payer Action needs to raise $50,000 over the next month to fund its actions around the country this summer.

  • millard-fillmore
  • http://www.anicetti.com Mark Anicetti

    Obama and the Senate should maintain the role of Licensed Health Insurance Agents in the distribution and information dissemination channels.

  • http://www.pricewiki.com/ William Price

    I agree to Mark that Obama and the Senate should maintain the role of Licensed Health Insurance Agents in the distribution and information dissemination channels. I think in that case many people will be satisfied for that.

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