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Jess Fiedorowicz's picture

[Dr. F. has returned! --lambert]

I'm currently online and would like to thank Lambert for contacting me to set up this live blog. I'm looking forward to talking to everyone about single payer.

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chicago dyke's picture
Submitted by chicago dyke on

thank you for coming on the blog. and please, although people here are very, very serious about health care reform, sometimes we can be a little...salty and irreverent. it's a hallmark of the blogosphere, as i'm sure you've noticed.

Jess Fiedorowicz's picture
Submitted by Jess Fiedorowicz on

Thanks. I'm serious about health care reform as well and am looking forward to any discussion.

Submitted by lambert on

Iowa obviously has a very strong organization.

Up here in Maine, not so much, although with an aging and poor population, there's such a great need for it. However, there's a strongly independent "anti-government" view in a very large part of the populace -- not so much ideological as curmudgeonly.

How would you address these cultural issues?

First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi

Jess Fiedorowicz's picture
Submitted by Jess Fiedorowicz on

Lambert,

I've certainly ran into similar sentiments here as well. I explicitly try to direct the debate away from such general sentiments and toward actual evidence.

My two key arguments for single payer involve social justice and fiscal responsibility. Most people can identify with at least one of these two areas.

It is clear that our system does not and will not cover everyone. That is an injustice. Our current system further discriminates based on a variety of sociodemographic and clinical variables. That is an injustice.

The differences in overhead between the private-insurance industry and government run programs is impressive. The difference between what we spend relative to other countries and what we get in return compared to other countries is similarly impressive.

Getting people to talk about data instead of resorting to name-calling is an important first step.

Submitted by lambert on

"Evidence-based politics," heh.

I take it you make a fiscal argument, not a "lives saved" argument. I've never understood why the latter isn't used more often, but perhaps the data does not support it?

First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi

Jess Fiedorowicz's picture
Submitted by Jess Fiedorowicz on

Lambert,

Your current Gandhi quote is quite fitting.

"First they ignore you, then they ridicule you, then they fight you, then you win." -- Mahatma Gandhi

Right now, political opponents of single payer appear to recognize they cannot successfully debate single payer with any evidence-based discussion. They are then left with either excluding us from the debate or name calling. We need to get them to fight us. As Lisa Nilles, M.D. suggested at the Iowa forum. Obama promised to develop policy based on science. We need to hold the administration to this promise and engage them in an evidence-based discussion.

Submitted by lambert on

I like that idea ;-)

First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi

Andre's picture
Submitted by Andre on

thank you for your time. Now we saw how you were 'dismissed' the other day in your attempt to put it on the table, how can we get it put on the table permanently and give it due deference?

Jess Fiedorowicz's picture
Submitted by Jess Fiedorowicz on

For those who want a little background, I first became involved in the single payer movement from frustration in trying to advocate for my patients who were struggling to access needed care in a fragmented and inefficient health care system.

Currently, I am a psychiatrist and clinician investigator at the University of Iowa. My research focus relates to the excess mortality associated with mental illness. With those with mental illness overrepresented among the uninsured and underinsured, I see access as one contributor to this problem.

Until recently, my advocacy efforts have been mostly local. This is a critical time for us to advocate for single payer as a socially just and fiscally responsible alternative to our current system. I thank you for the opportunity to take this effort to your blog.

Submitted by lambert on

What's your take on all this?

First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi

Jess Fiedorowicz's picture
Submitted by Jess Fiedorowicz on

Andre,

Despite evidence that the majority of Americans (and physicians) support single payer (that is when it is even included in the polls), I think there will have to be a public outcry to put single payer on the table.

It appears that lawmakers are interested in pushing a public-private hybrid, that will neither cover all nor address excess costs with overhead. I've heard lines frequently about how we need a "uniquely American solution" and how Americans don't want to give up their doctor or their insurance.

Clearly, politicians are trying to tell us what we want, instead of listening, to distract us from the polls and actual public opinion.

Yes, we want to chose our doctor. The reality is that single payer allows this better than our current system. Private insurance with its changing of networks, etc. makes this very difficult.

We need to remind politicians that we want everyone covered and that Americans and physicians support single payer.

There are also several "uniquely American" solutions. One is democracy -- the majority want single payer. Another is Medicare, which has worked for almost 45 years and provides health care to many disabled and senior citizens. With 3% instead of 31% overhead.

Submitted by lambert on

Why does single payer make that easier? Could you step through a concrete scenario/example?

First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi

Submitted by lambert on

Why does single payer make that easier? Could you step through a concrete scenario/example?

UPDATE And IIRC, the "uniquely American" thing is the Herndon Alliance at work. Do you have any counter to the talking point? It's one of those phrases that fits into a tiny little space in a tiny little brain, but if you've heard it a lot, it seems to be doing some damage.

First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi

Mandos's picture
Submitted by Mandos on

My family in Ottawa has one particular family doctor. When my brother moved to another part of Ontario, he got another doctor. If he wants, he can have that doctor fax over records to his original doctor in Ottawa and get treated there. And vice versa.

When I moved to the USA, I was given a choice of networks by my employer. I picked the one with an office closest to me, geographically, because I don't have a car and would like to walk to it. But if I move anywhere, then I won't be able to choose the closest doctor's office to me on that network, and I can only change networks at certain times of the year.

The only issue in Canada is that there has been, from time to time, shortages of primary care physicians in certain places due to the politics of medical education. But there are still walk-in clinics in many places that take up the slack---not optimal but acceptable.

Jess Fiedorowicz's picture
Submitted by Jess Fiedorowicz on

We struggle with shortages here as well. Here in Iowa, it can take patients several months (3-6 months is not uncommon) to get an appointment with a psychiatrist. I referred someone to our headache clinic for severe migraines and they couldn't get an appointment for more than a year. We unsuccessfully tried to get an earlier appointment and I had a not so friendly reminder this didn't work after getting a consult note 14 months after the initial referral. This patient had insurance. The 48 million or so without insurance can't even get an appointment.

Nonetheless, these stories are anecdotes not data. The truth is that U.S. residents are more likely to have an unmet health need and more likely to struggle with access to care. As a clinician, this comes as no surprise to me.

Submitted by jawbone on

to give up every single doctor I was seeing.

I couldn't give up my allergist, as I'd spent so much effort finding someone who could help me, so decided to pay out of pocket for three years, when he finally got into the network. At that time I could afford that. Then downsizing and COBRA, then transfer to NJ individual plan with same insurer. I stayed with that insurer because of my doctors. And inertia. And difficulties, later, in trying to get answers I could trust about just what was covered from other insurers. Even with my own, I try to call at least twice to make sure the first answer is the same as the second. If different, I call again--then ask for supervisor.

Then, the GP I signed up with, who had been recommended by my previous wonderful, helpful, informative, respectful GP who was not available to use thru my insurance company, became disgusted with the paperwork overload from Aetna and left. So I had to find yet another GP. I tried to do some research, got recommendations, made calls. I cannot remember any doctor's office perons who was willing to answer the few questions I was using to try to establish a baseline. And, one of my base criteria was answered incorrectly by the GP I finally chose.

I could have, I suppose, just kept changing GP's, to actually have appointments with the doctors, but I tended to try to keep al low profile, I didn't want my insurer to have some reason to drop me, (I"ve since been told that as part of the individual insurance program in NJ, they can't drop someone. But, still....)

The cost for my insurance was becoming shockingly high (little did I know how high it can go!), and I decided to finally get the sinus surgery I'd hoped I could avoid and went to an ENT to set that up. I'd already been told I needed the surgery, but put it off reasoning that what can go wrong just might go wrong. But my face was swelling increasingly from the chronic infection.

That's when I was diagnosed with what was referred to as one of the "good" cancers by my ENT. He knew the insurance game well enough to know that I had no choice for my follow up specialist, as there was only one relatively nearby who was in my HMO. This specialist's office staff made my life a living hell for almost 6 weeks--My ENT wanted me to see the specialist before my surgeyr; I had to have an appointment with the specialist before I could get a referral from my GP; the specialist's office kept throwing away my records faxed to them from my ENT (with coverletter); the staff was singularly unhelpful and the person I was "assigned" to was new and added to the mess up; finally, my ENT's office person stayed on the phone while she faxed my paperwork and made the people actually read the cover letter.

That experience was horrendous--I was shaking while dialing the phone. I knew so little about my cancer, had so many questions, and no one to ask. Thank goodness for the internet and the information and then bulletin boards, informed chat groups, resources I found there. Kept me sane, really.

My wonderful allergist had made a recommendation for two other specialists, both of whom were not available to me.

Given the newness of the idea of having cancer, my multiple calls to an unrecpetive office staff made that timeframe hell. I can't imagine what a person who was not basically feeling basically well would do in such a situation.

BTW, it was better than what happened to a friend of a friend of mine. That person was in an HMO, was diagnosed with advanced cancer, but his HMO kept putting him off for weeks in getting a referral to the most expert docs for his type of cancer. He died of this cancer within months. Could he have survived with immediate care? I don't know. I do know that he was incapable of fighting the system, and my friend in NJ, who had worked for a Blue Cross/Blue Shield claims department up here about 15 years ago, was making calls to FL on his behalf and getting nothing but runaround. We decided the insurer saw his case was very difficult, at best, and was running out the clock.

I've looked for different specialists--the one's with great recommendations have been out of network. One that was in took two hours to drive to, didn't have hospital priviledges near to where I live, and I decided that was too difficult to deal with.

Now, notice how often there were multiple calls about the same thing, in just this cursory summary. When there are referrals, I have to make the appointment, call my GP's office, give info for referral. Then, the GP's office is supposed to fax the referral to the specialist. I try to remember to call the specialist's office to make sure the referral has been sent--and received and noted. Amazingly, especially with any new doctors, I more often than not have to call the GP's office to tell them the receiving office did not have the referral; then the calls can go on for awhile. Infuriating.

Oh, and I love the lab work and test facilities who don't know the rules and demand a referral when one is not required (they're supposed to take prescriptions). So I call the CP, tell them them the situation, and sometimes they can talk to lab person, sometimes they fax over an unneeded referral as the easiest way out. And I play that game bcz I don't want to be stuck with some ungodly expensive test bill in case something's changed somewhere in the bureaucracy....

OK, I'm exhausted thinking about this hellacious health blockade system devised by Big Insurance.

Submitted by jawbone on

altho that may happen.

On my cancer bulletine board, there are people trying to manage the ongoing repeated tests required to know if the cancer has been ablated, come back, spread. They stretch out appointments, they put off tests. They hope. And are scared. I cry thinking about them.

And for all here who are living "naked."

Health Blockade System.

Why can't Obama see that we can't afford to NOT HAVE single payer?

Jess Fiedorowicz's picture
Submitted by Jess Fiedorowicz on

Jawbone,

I'm very sorry you had to go through all of that. It does well illustrate these problems in the system and why it is so ironic that opponents of single payer suggest you wouldn't be able to choose your doctor, when the opposite is, in fact, true.

Jess Fiedorowicz's picture
Submitted by Jess Fiedorowicz on

Lambert,

I agree that the lives saved argument is most compelling. I'm driven to the cause for social justice reasons.

Not everyone finds the social justice element compelling (astonishingly) and the great thing about single payer is it is socially just AND fiscally responsible.

We spend more PUBLIC money on health care than the combined public AND private spending of all nations except Switzerland. I'm fine with that investment if we are getting something from it. We are not. We lag behind in health outcomes and have 48 million uninsured. That is not even close to acceptable. It is frankly infuriating.

And yes, people are dying. It is an injustice.

chicago dyke's picture
Submitted by chicago dyke on

makers. which means addressing them with a totally different language and area of focus. personally, even though i think many people are conditioned by propaganda to hate and fear any new "big government program," even one that would improve their health care situation, i'm not convinced that the number of people who think that way is relevant, or at least not as much as it used to be. i take heart in what Michael Moore reported about the making of his film "Sicko," in which he received an overwhelming number of responses to his requests for 'horror stories' about mistreatment from insurance companies. that film focused on the insured, and was all the more powerful as a result.

as in many areas, the will of the public is far more progressive than the attitudes dominant in Washington (we call it "The Village" here in the blogosphere). i believe that we need to put very hard, very specific pressure upon a number of key lawmakers, 'forcing' them to enact meaningful health care reform. i also believe that we should follow Dr. Dean's example, and bring health care to those states in which populist action is already common and can be more easily affected. i think we also have to fight 'bad' programs, in states like MA, while making regular contrast with those that are successful, such as can be found in a limited number of example in which states provide care to targeted groups, like children.

finally, i believe that health care professionals need to do a little house cleaning in their own organizations. /more later, gotta run/

Jess Fiedorowicz's picture
Submitted by Jess Fiedorowicz on

Private insurance identifies certain physicians as in-network or out-of-network. This can change as contracts are renegotiated, if you change jobs, change insurance, or for that matter lose insurance coverage all together.

I have worked with many patients who have had to change doctors for insurance reasons.

With single payer, everyone is in and nobody is out. If you change jobs, you will remain covered and will be able to keep your physician. With a single payer system, you further don't have to worry about your doctor being in or out of network, because everyone will be in.

This also gets to some of the barriers imposed by our current system that single payer addresses, which I will get to (hopefully) in another post.

Jess Fiedorowicz's picture
Submitted by Jess Fiedorowicz on

I second the comments of chicago dyke regarding the importance of putting pressure on lawmakers. In fact, that is perhaps the best way to make our voice heard. On some level, they need to know that the status quo or some incremental change in it is not acceptable. Lawmakers need to know that this issue matters and that the right stand may garner support while the wrong stand may cost votes. Further, it is simply the right thing to do.

Submitted by lambert on

I've got to step out and go to the State legislature and buttonhole reps on another issue, as it happens.

So, I want to thank Doctor Jess for dropping by and giving us these incredibly calm, patient, and lucid answers. (I"m sure his psychiatric training will be of great help to him in the blogosphere!)

First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi

chicago dyke's picture
Submitted by chicago dyke on

(sorry, had an inspector here for a minute)

i think that health care provider's unions and professional organizations can be strongly contrasted. several nurses unions, as we regularly report here, are progressive leaders on health care reform, and use their powers effectively, pressuring and educating politians and organizing public events, as well as aiding in the crafting of health care legislation. all that is terrific. compare this to some of the major physicians organizations, which have been incredibly regressive and active in opposing progressive reform. health care providers should remove those leaders of their organization who care more about hob-knobbing with politicians in the Village, or getting high-paying lobbying jobs after serving their terms. it may even be necessary for some health care professionals to form or re-form splinter organizations, the better to provide a separate lobby with a more correct focus than some of the national organizations. patients too should regularly encourage their providers to be politically active, as you are, Dr. Fiedorowicz. to the extent that patients can choose active and progressive providers, they should.

Susie from Philly's picture
Submitted by Susie from Philly on

Are that single-payers do not have a workable and specific political plan to make it happen - i.e. We can count on x number of votes.

The other objection is that the process of setting it up will take far too long, and that people need help right now. What are your thoughts?

Jess Fiedorowicz's picture
Submitted by Jess Fiedorowicz on

The "uniquely American" phrase has indeed become another way of steering the debate away from issues of justice and evidence-based solutions.

I highlighted my two responses above. The first is that democracy is an American solution and the majority of Americans and majority of physicians support single payer.

The second is that Medicare is a uniquely American solution. It has payed the medical bills for senior citizens and the disabled for almost 45 years. It operates on only three percent overhead.

A single payer system has several advantages to Medicare given that everyone is in, everyone has a stake in making it better. Further, it reduces some of the system-wide overhead that cannot be reduced by simply adding another public system into the mix.

The current "public option" is problematic in that it doesn't reduce the overhead and even with regulation will not be on a level playing field. Therefore, it doesn't reduce costs and leads toward segregation of patients. If everyone is in, we all have a stake in making it the best system possible.

Jess Fiedorowicz's picture
Submitted by Jess Fiedorowicz on

I agree that many physician organizations have not been progressive. I refuse to join the American Medical Association because of their lobbying efforts against single payer.

PNHP and the American College of Physicians are exceptions to this.

Jess Fiedorowicz's picture
Submitted by Jess Fiedorowicz on

1) Workable Plan:

There is a workable plan. It's HR 676. Encourage your representative to support. Bernie Sanders has also introduced a bill in the Senate.

2) Implementation:

Medicare was successfully implemented in 9 months. We have better computer systems, etc. now.

I think that people need help right now is an argument not to wait for another incremental change to fail. We need single payer now. American businesses are bearing a huge burden with employer-based health care, when sadly we already spend enough government money to cover everyone had we a more efficient system. More Americans have found themselves among the unemployed and I'm sure the numbers of uninsured we quote will soon become antiquated.

We need to act now! We cannot afford to wait.

chicago dyke's picture
Submitted by chicago dyke on

and that is to stop believing what they are told in the mainstream media (we call it the So-Called Liberal Media, SCLM) and start talking to people who are actually active in health care reform. turning off the TV is a great start; too often it oversimplifies health care issues, in fiction and by omission of fact in reporting, and replaces fact with propaganda, often blatantly directed by insurance companies and those hateful enough to make political hay by extending human suffering.

providers and patients, and employees of health care concerns of all kinds, should make it a point to exchange facts with one another, and their neighbors and friends. information is power, and one way people can become more empowered to bring about the reform we all need is by arming themselves with facts. we try hard at this blog to provide that, and people should share sources of information with those who may not be familiar with some of the progressive work that is being done.

our politicians take their cues from lobbying groups, who often write the legislation for politicians, handing over pre-crafted bills that favor insurance companies and large corporations, which in turn go unread by the very politicians who vote on them. people can and should take that example and turn it on its head, slamming elected officials over the proverbial head with countering information, and demanding that they remember just who they actually work for- us. that's not going to happen so long as people blithely accept nonfactual tripe that passes for "reporting" on health care issues and legislation, on most outlets of the SCLM.

Jess Fiedorowicz's picture
Submitted by Jess Fiedorowicz on

Yes, I think the media coverage is often disappointing in its breadth and depth, especially on television. Health care reform requires a thoughtful approach.

chicago dyke's picture
Submitted by chicago dyke on

i have to take my leave from this discussion, but i'd like to thank you and remind you that blogging is free of the restrictions of time (sort of): i'll be back later to review additions to the discussion and i hope others will as well. the comments made so far will remain, and generally people stop by at all hours and add more. also, if you could, Dr., would you mind stopping in again tonight, around 9pm? if that's not possible no worries, but we have advertised your post and discussion for that time, sorry if there was a mixup. again, thank you so much for your contributions here, and in this battle for real health care reform.

Jess Fiedorowicz's picture
Submitted by Jess Fiedorowicz on

I can log on later this evening. Did you advertise for 9 p.m. Central or Eastern?

Jane Hamsher's picture
Submitted by Jane Hamsher on

Can you tell me if you or any other single payer advocate have been included in the weekly meetings Kennedy is having?

http://wonkroom.thinkprogress.org/2009/0...

Many of the parties, from big insurance companies to lobbyists for consumers, doctors, hospitals and pharmaceutical companies, are embracing the idea that comprehensive health care legislation should include a requirement that every American carry insurance.…

The 20 people who regularly attend the meetings on Capitol Hill include lobbyists for AARP, Aetna, the A.F.L.-C.I.O., the American Cancer Society, the American Medical Association, America’s Health Insurance Plans, the Business Roundtable, Easter Seals, the National Federation of Independent Business, the Pharmaceutical Research and Manufacturers of America, and the United States Chamber of Commerce… But so far Republican aides have stayed away from the sessions, saying they felt they would be relegated to a secondary role, with no opportunity to set the agenda or choose the outside participants.

I've been trying to get an answer to that question for a while, with no success.

Jess Fiedorowicz's picture
Submitted by Jess Fiedorowicz on

Jane,

I don't know the answer to your question, but I will run it by the PNHP national office to see if they know. Hopefully, I can get back to you by this evening.

Mandos's picture
Submitted by Mandos on

I guess Dr. Fiedorowicz is probably off now, but...

I remember someone around here raising the problem of the adjustment of the number of people employed in health administration, which seems to be quite large and certainly too many for a single-payer system if the Canadian experience is representative. Do we have an assessment of the economic impact of quickly adjusting those jobs away?

On another note, the "uniquely American" phrase to me represents the claim that in the USA, private profits are of intrinsic moral value, and what does not result is private profits is not "American". A surprising number of people actually believe this!

Jess Fiedorowicz's picture
Submitted by Jess Fiedorowicz on

E-mail from Mark Almberg from PNHP:

Hi, Dr. Fiedorowicz,

The answer to the question is no. No single-payer advocates have been invited to take part Kennedy's closed-door meetings.

While it's true that 500 unions, including 39 state federations of the AFL-CIO, have gone on record in support of H.R. 676, and that the national AFL-CIO executive council adopted a resolution in March 2007 endorsing the concept of Medicare for All , the AFL-CIO has not been an advocate for single payer. Instead, it has embraced the HCAN approach of a so-called private-public mix, which, as you know, we have described as unworkable.

So again, the answer is no.

Best regards, Mark

vastleft's picture
Submitted by vastleft on

Thanks so much for doing this, Dr. F.!

I love this statement you posted here:

Right now, political opponents of single payer appear to recognize they cannot successfully debate single payer with any evidence-based discussion. They are then left with either excluding us from the debate or name calling. We need to get them to fight us. As Lisa Nilles, M.D. suggested at the Iowa forum. Obama promised to develop policy based on science. We need to hold the administration to this promise and engage them in an evidence-based discussion.

Seems to me the best way to "get them to fight us" is to raise to scandal-pitch the manner in which single-payer has been deliberately excluded from these supposed "listening tours," including the Daschle house parties that were designed to keep single-payer discussions at bay.

What, besides your own comments being expurgated at the White House website (along with being glibly dismissed by Gov. Culver), are the most egregious examples you've seen of single-payer being denied fair consideration in this rush/stumble to a "Uniquely American" solution?

Jess Fiedorowicz's picture
Submitted by Jess Fiedorowicz on

Mandos,

You raise a common concern regarding jobs lost for those currently working in the private health insurance industry. HR 676 includes a provision that those jobs which are eliminated "have first priority in retraining and job placement in the new system." This will account for many, but not all jobs. Those who lose their jobs "shall be eligible to receive two years of USNHC employment transition benefits" equivalent to prior salary but not to exceed $100,000. This mitigates the economic impact of "quickly adjusting those jobs away." There are further a number of healthcare professionals working in the health insurance industry that may return to actually delivering health care if interested.

The excess jobs in the private insurance system come at great cost to our economy. It has been estimated that provision of health benefits adds $1500 to the cost of an American-made automobile, to list but one example. These excess jobs have an insidious effect on the rest of the economy and impair the ability of other American businesses to compete globally. In short, these jobs may actually cost us jobs.

You also ask whether this has been studied. While there is a lot of evidence that single payer will reduce overhead, more efficiently deliver quality care, and truly cover all; the government can and should do more to study this solution. We should insist that the Congressional Budget Office formally study cost and feasibility to put single payer on the same table as the other proposals that do little to reduce overhead and will not cover every American.

Mandos's picture
Submitted by Mandos on

...I glad, but not surprised, that this issue has been considered and policy proposals made.

Jess Fiedorowicz's picture
Submitted by Jess Fiedorowicz on

Vastleft,

One of the more blatent examples of single payer being excluded from the debate occurred with the March 5th White House Health Care Summit, wherein single payer advocates were excluded.

After much protest, Oliver Fein, M.D. and Rep. John Conyers, Jr. were finally invited. With the majority of Americans in favor of single payer, it remained grossly underrepressented even after the protest concessions.

Here are Dr. Fein's comments on the event.

vastleft's picture
Submitted by vastleft on

Creating popular awareness of, and outrage about, the way single-payer is being methodically kept out from the conversation may be our best means of forcing the administration to do the right thing. People don't like the smell of dirty pool -- it's up to us to make sure they smell that smell....

Submitted by jawbone on

Or, can only Lambert do that? Senior fellows? Keep it at the top or have something noticeable on one of the columns? And, I do have the times correct, right?

I got here late this morning, saw Dr. F had been on, and thought I'd misread the previous blurb, figured I'd missed the entire Q&A. Relieved to find tonight's still on.

Anyway to make it more visible for drop by visitors (and all, actually)?

Also, how can we get word out to other lib blogs?

OOOOOPS! Just saw the ad, under the t-shirt ad. Well, that show's how carefully I look! But, maybe something sticky in way of reminder post, whch stays at the top until the session?

My thnx to anyone who can do so.

lizpolaris's picture
Submitted by lizpolaris on

One argument against the idea that single payer is better than private insurance was posed to me by a former nurse. She said that there was/is a lot of paperwork and bureaucracy required by Medicare and Medicaid. So she feels that shifting private insurance paperwork to the government will not necessarily be a net improvement or cost savings.

How would you respond to her on this question?

Mandos's picture
Submitted by Mandos on

Comparatively little billing paperwork happens in the Ontario medical system. It's mostly electronic and mostly involves listing of services rendered via codes entered into a database. There is some (rather annoying) residency-proof bureaucracy before the Ontario Health Insurance Program covers you.

Mandos's picture
Submitted by Mandos on

Comparatively little billing paperwork happens in the Ontario medical system. It's mostly electronic and mostly involves listing of services rendered via codes entered into a database. There is some (rather annoying) residency-proof bureaucracy before the Ontario Health Insurance Program covers you.

lizpolaris's picture
Submitted by lizpolaris on

But most single-payer systems I've seen advocated are based off of the existing Medicare and Medicaid systems. So your examples from Canada won't really answer the nurse's question.

Dr. F, please could you respond?

Aeryl's picture
Submitted by Aeryl on

He who will not reason is a bigot; he who cannot is a fool; and he who dares not is a slave.
- Sir William Drummond

Jess Fiedorowicz's picture
Submitted by Jess Fiedorowicz on

lizpolaris,

The argument that your friend the nurse gave is another example of an argument not based on evidence. In the future, I hope you are able to engage her in either an evidence-based discussion of competing proposals or a discussion of the sheer injustice of not providing everyone access to necessary health care.

Our health care system is clearly the most bureaucratic in the world, with over 31% of spending going to paperwork, profits, and overhead. Medicare has 3% overhead. Canada has 1%. Single payer systems simply have less bureaucracy and overhead than our current multi-payer mess.

Even if single payer paperwork was difficult to complete, it would still be but one set of paperwork. We currently have a myriad of insurance companies, each with multiple plans, different networks, benefits, and forms. The system is so fragmented and so difficult to navigate that hospitals hire legions of billing specialists. I think Dr. Uwe Reinhardt put it best when he said, "We have 900 billing clerks at Duke (medical system, 900 bed hospital). I'm not sure we have a nurse per (each) bed, but we have a billing clerk per bed...it's obscene."

It is obscene. And unjust.

lizpolaris's picture
Submitted by lizpolaris on

The 3% vs. 31% overhead costs would clearly show a cost savings.

Her argument was based on her personal experience, rather than broader evidence. Her experience is that there's just as much paperwork for the government programs as for the private insurance. However, even if that's the case - the costs are clearly lower due to the lower overhead with the government (not for profit) plan.

I'm hopeful that if we do go to single-payer, the bureaucracy could be reduced, such as we see in other countries. But that may be too much to hope for!

Thanks again for participating in this forum!

Mandos's picture
Submitted by Mandos on

Dr. Fiedorowicz,

It's been suggested that the right political strategy may be to take this fight to a state-by-state basis instead of a federal basis. This worked historically in Canada where Saskatchewan had single-payer health care before any other province did.

If the HR676 gambit does not pan out, could you perhaps comment on the prospects and practicality of a state-by-state strategy?

Jess Fiedorowicz's picture
Submitted by Jess Fiedorowicz on

To yield the maximal benefit of single payer, it makes the most sense for this to be a national reform. If we take the view of our entire health care "system," this is clearly the most effective way to substantially reduce overhead and improve efficiency.

Some states are nonetheless making great strides toward single payer and I strongly support their efforts. In Des Moines last week, I had the honor of meeting several from the Minnesota Universal Health Care Coalition and they are doing some really impressive work.

I'd be interested in your thoughts on this as well, Mandos.

Mandos's picture
Submitted by Mandos on

You're almost certainly correct that for best effect, it should be a national reform. The only problem is that national politics are divided by complex ideological questions kind of tied up in the phrase "uniquely American", and the federal system at present doesn't yield itself easily to large scale changes, quickly.

Using the Canadian example, it is still the case that the system is managed on a province-by-province basis. Each province runs its own distinct system. Technically, coverage should be portable, but this is sometimes not respected. It is not an ideal system, but it was the only one that was politically workable, especially considering that Canada is divided on complex ethnolinguistic lines.

While I wouldn't recommend abandoning the national strategy, I think history and politics show that a technically suboptimal state-based solution would occur before wide adoption in the rest of the country the same way other social reforms are presently being carried out.

I'm going to be off for most of the rest of the evening so have fun everyone.

Submitted by jawbone on

As Katiebird notes, it's very hard to know what our Dems mean when they talk about the "public option." Check out her links, see what you think.

in this post.

~~~~
Oh, I emailed Rebecca Adleman to ask why she left out any mention of Dr. F, his comments and his question... Think I'll get an answer? Heh.

Submitted by lambert on

is 202-690-7471 (according to HHS).

First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi

Jess Fiedorowicz's picture
Submitted by Jess Fiedorowicz on

I'm back. After all the discussion of fiscal issues related to health care, I just want to start with a reminder of the most compelling argument and my primary motivation for single payer, social justice:

"Of all the forms of inequality, injustice in health care is the most shocking and inhumane." Martin Luther King, Jr.

vastleft's picture
Submitted by vastleft on

... to find the means to awaken people to -- and energize them about -- the injustice.

It took the AIG bonuses, relatively small potatoes in the scheme (as it were) of things, to galvanize public thought about the bailout.

IMHO, recognition of the sleazy way that the most just, most cost-effective solution is being muscled out of the supposedly open and transparent process has the most potential to get people to recognize that they're being railroaded.

I credit the general public for preferring a public plan, but people need to get mad. And what they can and should get mad about is the sham process by which the Corporatist solution is being fast-tracked.

I've heard credible reports that many of the people called upon at these events, mouthing administration/industry approved talking points, appear to be plants. If that proves true, proving it true could galvanize opinion.

Submitted by hipparchia on

in almost-alabama [the florida/alabama border, in more ways than one].

rush limbaugh is a demi-god, too many people here are still heavily invested in the 'personal responsibility' meme, and too many of the evangelicals have been brainwashed into believing that if you get sick and don't have insurance, or have crappy insurance, then god must have meant for it all to happen that way.

i can sometimes make headway with the latter group by trading bible quotes with them. with the others, if there's any hope at all, i walk them through the math on how much they would [likely] pay under medicare-for-all vs how much they're paying now [premiums! copays! deductibles! out-of-pocket! in-network! out-of-network!]

sometimes i just give up and tell them to ask their grandma and grandpa if they'd trade their medicare for insurance.

Jess Fiedorowicz's picture
Submitted by Jess Fiedorowicz on

The following link from PNHP summarizes savings/cost studies:
http://www.pnhp.org/facts/single_payer_s...

A study by Himmmelstein et al. in Int J Health Serv 2004; 34(1): 79-86 estimated savings of 286 billion.

I've seen varied figures on this, understandably, but certainly in the ballpark.

Jess Fiedorowicz's picture
Submitted by Jess Fiedorowicz on

I believe that two single payer supporters spoke in Vermont. Thus far, my sense is that the single payer advocates have had to work pretty hard at getting in and the tickets secured were often from lotteries, etc.

Our group received two tickets, which I understand were courtesy of Leonard Boswell (IA-D-3), who last I checked was still not a co-sponsor of HR 676. We were grateful for those seats. A few from our group scored tickets in the lottery. I asked to be put on a wait list and with the bad weather they ultimately let everyone on the wait list in.

It appears that pressure to get tickets may be effective. Regarding who to put that on, it may vary from forum to forum, depending who is hosting.

Submitted by Anne on

emphasizing the social justice aspect of single-payer almost automatically slots one into the "bleeding-heart liberal" category with some people, which, for reasons that are beyond me, makes it easier for them to dismiss the whole concept.

The more I can absorb about the economic benefits, to be able to spit them out whenever I run into the all-too familar nonsense talking points, the better.

A healthier populace means a healthier economy, so if we are truly committed to improving the economy, we simply have to make health care a given; I do not like that I live in a country where clerks in cube farms are gleefully denying coverage - being paid bonuses to do so - rescinding coverage and sending untold numbers of people into poverty, all for the sake of an insurance company's almighty bottom line.

Thank you for your advocacy; it still boggles my mind that it is such an uphill battle to get the powers-that-be to do the right thing.

Jess Fiedorowicz's picture
Submitted by Jess Fiedorowicz on

Very well put, Anne. Indeed, I've had similar experiences with the social justice angle, which is surprising since I find it more compelling. My argument tends to focus on social justice and fiscal responsibility. I also often find myself going to the fiscal responsibility argument in many discussions. The data here is strong as well. Much of it is readily available on www.pnhp.org if you are interested.

Submitted by lambert on

[grovels]

First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi

Submitted by lambert on

Welcome.

Remarkably, that is the first Corrente post with that title.

And now, back to the thread!

First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi

Submitted by lambert on

Where does he say that?

First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi

Submitted by jawbone on

I"ve seen Obama et al really define it.

Is it a Medicare for All, buying into Federal employees plan(s), or something else?

Does PNHP have a handle of that, or is it still political happy talk?

Thanks for the savings figures. Worked out over a 10 year timeframe, as Obama's costing was, it seems to almost pay for itself. If it were single payer....

Also, thnx for bringing up the MLK quote. It should not be forgotten.

Jess Fiedorowicz's picture
Submitted by Jess Fiedorowicz on

The following link provides a concise critique of the public option form Himmelstein and Woolhandler.

The key message is:
1) It does little to reduce administrative overhead.
2) It will not be on a level playing field and will create a segregation of patients. Insurance companies will find a way to "cherry pick" the healthy patients, even with regulation.

I like the rallying cry of "Everybody In, Nobody Out" for single payer. With everyone in, we all have a stake in improving the system. When the public option is relegated to a minority, especially if a disenfranchised minority, it is difficult to advocate for improvements in the system.

Submitted by lambert on

Is that were one husband has many wives, or is it the other way round?

First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi

Submitted by jawbone on

talks about Nichols plan, per AP.

Sen. Charles Schumer, who is working on the issue for the Senate Finance Committee, said Thursday one potential compromise is based on insurance plans that most states already offer their employees. Obama's health secretary nominee, Kansas Gov. Kathleen Sebelius, likes the idea.

Schumer, D-N.Y., said such a plan would avoid expanding a federal program like Medicare and that a private insurer possibly could run it. Sebelius already administers that type of plan in Kansas.

Well, that's disheartening.

At a Senate hearing, Sebelius noted that more than 30 states "have a public plan side by side with private market plans in our state employee programs." State workers, she said, "have an opportunity to take a look at which is best suited to themselves and their families. And there has been no destruction of the marketplace."

The insurance lobby fears that a federally backed plan could drive companies out of business.

"We are taking a look at the different state employee plans to get a better understanding of how they operate," said Robert Zirkelbach, a spokesman for America's Health Insurance Plans.
SNIP
The state employee plans are similar to how big companies insurer their workers. Companies budget each year for health expenses, then hire an insurer to process claims, negotiate rates with doctors and hospitals and cajole employees to follow healthier lifestyles.

In California, the state sponsors three medical network plans for employees and retirees. These plans are offered alongside traditional insurance plans. The state-sponsored plans, administered by Anthem Blue Cross, account for about one-fourth of the 1.3 million people in the state employee health program, said Karen Perkins, a spokeswoman for the California Public Employees Retirement System, known as CalPERS.

The idea of using the state employee plans as a model came last month from two policy experts, Len Nichols and John Bertko.

These guys are new to me.

"We were just trying to avoid nuclear war," said Nichols, director of health policy for the nonpartisan New America Foundation. "We saw advocates of Medicare for all pushing to put the country into Medicare. And we saw the right using that to push the moderates out of engagement in the health reform debate."

In an interview, Schumer said he is looking at Nichols' idea as a possible compromise and is beginning to sound out other Democrats. He said he has some room to maneuver because Obama and many Democrats did not spell out what they mean by a "public" insurance option.

But Schumer said other Democrats insist that option should look like Medicare, in which the government directly sets benefits and payment rates.

Huh, should look like Medicare, but not be expanded Medicare, and should be run by private insurer??? Help!

Jess Fiedorowicz's picture
Submitted by Jess Fiedorowicz on

Again, such a proposal doesn't address overhead and does not appear geared to cover all.

There is no advantage to having the private insurance industry as a middleman:
1) They add overhead and we would be subsidizing this overhead
2) They are motivated by profit and the earnings won't be passed along to the taxpayer

The insurance industry is very frightened by single payer and will be coming up with all kinds of ways to prevent this, such as the following news release the day after the Des Moines forum in which they offered to stop charging higher premiums to those who were ill on the condition that all Americans were mandated to get coverage.

Submitted by jawbone on

profit. Or it will be like the Big Banksters, who said they're going to pay back all those TARP billions right away...just as soon everything's rosy again.

I fell in love with Hillary when she said health insurance could cost no more than a set percentage of income and there would be assistance for those with low incomes. I also believed she meant what she proposed.

And, while she didn't have single payer, her plan put things on a glide path to single payer...I thought and hoped....

Submitted by jawbone on

to affect how Team Obama are approaching this. As pointed out in other comments here, keeping them in business and in big profits seems to be the objective, with some nibbling around the edges to improve efficiency...or something...add a few more insured at some level of actual coverage. Oh, and the children. Yes, insurance for the children.

There is no advantage to having the private insurance industry as a middleman:
1) They add overhead and we would be subsidizing this overhead
2) They are motivated by profit and the earnings won't be passed along to the taxpayer

Submitted by lambert on

Here. I'm not seeing any names that leap out at me as pure evil, other than Steven Rattner on the board of directors.

Oh wait, I just got to the end. Chairman of the leadership council:

John C. Whitehead - Chairman, The Goldman Sachs Foundation

Alrighty, then.

Odd, though, isn't it, that Sibelius seems to consider saving the marketplace the key concern, as opposed to saving lives.

First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi

Jess Fiedorowicz's picture
Submitted by Jess Fiedorowicz on

Indeed, saving lives is most important. And how shortsighted that saving the marketplace is focused on a myopic view of a specific industry without recognizing the effect of that on other aspects of the economy. Saving private insurance hurts other businesses. It hurts the American public. More importantly, as you correctly identify Lambert, it costs lives and jeopardizes our health.

Submitted by hipparchia on

Odd, though, isn't it, that Sibelius seems to consider saving the marketplace the key concern, as opposed to saving lives.

unfortunately, many of these people really do believe that saving the insurance companies will save lives. if we were back in the dfh days, 30 years or so ago, back when insurance companies were largely non-profit [and hospitals were too], then they'd be right. without a doubt, private insurance saved my life back then. no way could my parents have afforded everything i needed otherwise.

still more unfortunately, the insurance companies of today are not the insurance companies of yesteryear.

TreeHugger's picture
Submitted by TreeHugger on

for a physician's office accepting multiple insurance plans is a nightmare, since there is no standard claims form and no stardard criteria how docs are reimbursed for procedures. This means office staff members have to know the "secret sauce" for coding for various plans to get maximum reimbursement for the procedure.

The nurse referred to above who argued that the forms were just as onerous for government plans may be correct on that point, but that arguement misses the whole issue of staff training time and expertise and management supervision of multiple forms for multiple plans.

When viewed from this perspective, single payer is clearly more efficient and thus more cost effective on the paperwork end.

(And thanks a whole bunch for returning so that a left coaster can weigh in on this)

Jess Fiedorowicz's picture
Submitted by Jess Fiedorowicz on

Well put, TreeHugger, it indeed misses the big picture of systemic bureaucracy.

The same is true of the "public option," which does nothing to improve the fragmented, multi-payer mess. It would cover more, but not all, and in a manner less effective and efficient than single payer.

Submitted by jawbone on

be something like Medicare for All or allowing people to buy into Federal employees' plan. But, on second thought, the Feds offer many plans to their employees, so that indeed has that drawback you point out.

Hadn't seen that, and thanks for pointing it out so well.

Here in NJ the individual plans are offered by different companies and have state oversight--once every 5 years! Once every 5 years the state insurance commission reviews what they charge and, as I understand it, negotiate what will be offered at what price points. So, once every 5 years, Big Insurers have to back peddle of profit, which they then make up the next 4 years.

Submitted by lambert on

What's the best study? The figure that sticks in my mind is 17,000 which, terrible as it may sound, doesn't sound like a lot (compared to cars or diet).

And what do you think of the recent stories that just a few ER patients cause most of the costs? Seems like a power curve disribution to me, is that typical in the ER? And does it sound to you like an implicit "life that is unworthy of life" sort of argument?

First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi

Jess Fiedorowicz's picture
Submitted by Jess Fiedorowicz on

A specific figure is hard to tease out, but there plenty of data to support worse than expected mortality outcomes in the U.S. (despite us outspending everyone). The figure you cite comes from the Institute of Medicine 2002 (Care Without Coverage) and suggests 18,314. However, this is simply deaths due to un-insurance. It doesn't address under-insured or other systemic problems.

If we look at more global measures, we lag considerably behind nations providing truly universal coverage (it is upsetting to have to specify truly now that politicians use universal to mean something short of access to all) in life expectancy, potential years of life lost, infant mortality, and maternal mortality. In comparison to our neighbor to the north, life expectancy is ~3 years less, infant mortality 1.3 deaths/1000 higher and maternal mortality 2.5x higher.

I'm not sure you are referencing Emergency Room care specifically, but the sickest two deciles of the population account for more than 3/4 of health care spending. Insurance companies compete NOT to cover these individuals.

Submitted by lambert on

This, from the Dallas Morning News:

Nine people accounted for nearly 2,700 of the emergency room visits in Central Texas during the past six years at a cost of $3 million to taxpayers and others, according to a report.

The patients – eight from Austin and one from Luling – went to emergency rooms 2,678 times between 2003 and 2008, said the report from the nonprofit Integrated Care Collaboration, a group of hospitals and other health care providers that treat low-income and uninsured patients in Central Texas.

"What we're really trying to do is find out who's using our emergency rooms ... and find solutions," said Ann Kitchen, executive director of the 26-member group, which presented the report last week to the Travis County Healthcare District board.

I just had one of those "Why are we having this discussion now" moments. Seems to lead naturally to calls for a less than universal program: Either exclude them from care entirely, or devise a special program only for them, and muddle through with the rest.

First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi

Jess Fiedorowicz's picture
Submitted by Jess Fiedorowicz on

Thanks for the clarification.

The uninsured can't get clinic appointments and often resort to emergency rooms, a more costly and less effective way of delivering care. Sounds like more than that was going on here. Personally, I think those who excessively utilize services often need integrated instead of fragmented care.

Submitted by jawbone on

Of the nine patients, eight have drug abuse problems, seven were diagnosed with mental health issues and three were homeless. Five are women whose average age is 40, and four are men whose average age is 50.

Sure sounds like integrated care would be needed!

Submitted by Anne on

emphasis and focus stay on saving the private insurance industry, we will never have the kind of health care system we need - that we deserve.

I find it maddening that there is so much effort being made to avoid the workable model, with a proven track record, that is right there in front of our faces - why do we have to take the "scenic" route that is chock full of toll roads and detours and speed traps when we know how to get from Point A to Point B with a minimum of cost and a maximum of efficiency?

I think it is not so much about the money that could be saved, but the money that would not be going into private pockets at quite the same clip.

Submitted by hipparchia on

back during the last depression, glass-steagall broke up the 'financial industry' into banks, insurance companies, and stockbrokers. beginning with the reagan revolution, various repeals of the 1930s bank reforms let all these industries re-merge back into one.

so yeah, we're stuck bailing them all out, since they're now basically one giant many-headed hydra.

Jess Fiedorowicz's picture
Submitted by Jess Fiedorowicz on

Anne, you are right on here. We don't need to reinvent the wheel. We can learn from what has worked and hasn't worked here AND abroad.

Further, incremental reforms have been tried repeatedly in this country. Meanwhile, we have more uninsured and our costs continue to spiral out of control.

I am afraid our leaders are walking a path toward another incremental reform, instead of the radical reform that we need and deserve.

Submitted by lambert on

On PNHP donation page. How cool is that?

NOTE Honestly, I was looking for the Sylvia cartoon on The Woman Who Lies In Her Diary (anybody got a link?), so I could write a post on "Mark to Model" accounting, but I couldn'lt find it.

First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi

Submitted by hipparchia on

i found these [no links to the actual cartoons, alas]:

-----------------------------------------------------
The Woman Who Lies in her Personal Journal (Nov. 30, 1993)
"Go with Single Payer, Cut the Insurance Companies Out"*
(Sylvia, Nov. 30, 1993) / by Nicole Hollander. -- (The
Woman who Lies in her Personal Journal) -- Key words: Bill
Clinton, Hillary Clinton, Pat Buchanan, health care reform,
"Lie down with dogs, get up with fleas." -- Call no.:
PN6726 f.B55 "health care"
-----------------------------------------------------
The Woman Who Lies in Her Personal Journal (Oct. 7, 2000)
"The Split in the Reform Party"* (Sylvia, Oct. 7, 2000) /
Nicole Hollander. -- (The Woman Who Lies in Her Personal
Journal) -- Summary: She arranges a basketball game between
Pat Buchanan and John Hagelin. -- Call no.: PN6726 f.B55
"Buchanan"
-----------------------------------------------------
The Woman Who Lies in Her Personal Journal (July 7, 2004)
"Don't You Think It Looks Bad?"* (Sylvia, July 7, 2004) /
Nicole Hollander. -- (The Woman Who Lies in Her Personal
Journal) -- Summary: She impersonates Dick Cheney and
suggests that the President is not doing right by veterans.
-- Call no.: PN6726 f.B55 "Cheney"
-----------------------------------------------------

and this one.

Submitted by lambert on

Accept the administrative savings over time.

Is there a need to raise taxes, even at the start of the program?

First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi

Submitted by hipparchia on

need to get tax money into the system right away. but the taxes will be more than offset by the amounts you wouldn't be paying as premiums, copays, deductibles, etc.

Jess Fiedorowicz's picture
Submitted by Jess Fiedorowicz on

Yes, even though we spend more public money than the combined public and private spending of all nations except Switzerland, we would need extra money to initiate the program. A plan for this is outlined in HR 676. To compensate for these additions, the proposal suggests an income tax on the top 5% of wage earners (~2%), a modest tax on payroll and self-employment income (~7%), and a small tax on stock/bond transactions. Keep in mind that some of these costs are offset by current spending by employees/employers for health insurance, copayments, and deductables.

For more detail see the following from PNHP.

Jess Fiedorowicz's picture
Submitted by Jess Fiedorowicz on

Thanks, everyone for your thoughtful questions and commentary. Thanks also for truly caring about this issue as it relates to the health and well-being of those in our community-at-large.

I really enjoyed the opportunity to discuss single payer with you as a socially just and fiscally responsible alternative to our current unjust, fragmented, and inefficient health care "system."

Have a great night!

Submitted by jawbone on

healthcare reform. Said he believes every country builds on type of system it already has. Said Brits went to NHS bcz during WWII all the hospitals ended up being run by the government due to the war conditions, but Switzerland went with private insurance bcz that's what was there.

Oh, dear.

Now talking about woman who had thyroid cancer--once she had the surgery she needed, her insurance was cap was reached, and it wouldn't cover her radiation abalation therapy. What a grim and ugly situation. Now, she's uninsurable for her cancer.

Cruel, cruel healthcare blockade system.

Submitted by lambert on

... since every country has to start somewhere, or it's a policy prescription.

And if it's a policy prescription, then wouldn't it be better to be "uniquely American" by building our policy on evidence, rather than on whatever random point we started from?

First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi

Submitted by lambert on

For everything, not merely these patient and lucid explanations.

First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi

Submitted by hipparchia on

yes, thanks for everything.

and thank you too, lambert.

chicago dyke's picture
Submitted by chicago dyke on

for a lot of reasons, some "meta" and some health care related.

having read thru this after both sessions, i feel compelled to add a little signature Correntian doominess. Dr. Fiedorowicz, forgive me, but i'm going to slip into the blogger's vernacular here, i'll happily explain if there's anything that isn't clear.

very little on this thread has addressed the *real* reason for the blockade of health care in this country (total agreement with H: make this one viral). which is, simply put: money. not to sound too arrogant, but i have no small amount of experience with the health care professions, political circles, and even insurance companies; i used to work for one and i remember not a few corporate yeah-rah meetings teaching the employees about the joys of screwing over customers. anyway, this discussion is all well and good, and describes facts that i suppose a lot of people (most of whom will never read this blog) don't know already.

but imho, the problem is situated at a very specific point, and no amount of recitation of facts like these is going to dislodge that. frankly, it's a matter of David vs Goliath, but where G has all the power and is immune to stones on the head. those of us who want to affect change in health care policy have no choice but to swallow this disturbing and disheartening fact.

simply put, the insurance industry and lobby is the most powerful force in american politics today. corrente readers are well versed in this, via the lesson that bailout money to AIG demonstrates. it's no different when it comes to health care. insurance and Big Pharma money dwarf our efforts, and literally put the screws to those moderate or progressive Democrats with a very simple message: endorse crap like single payer, and we'll kill you during the next campaign cycle.

i love anecdotes, so i'll tell you what i've heard from more than one staffer/Hill denizen. politically, the problem is age, and rank. that is, elected officials get health care for life, a good package too, if they don't already have great care because of great personal wealth. those who work for them...not so much. as anyone who's ever worked for a campaign will tell you, it sucks to be a staffer: you starve, bleed, and generally suffer, for little material reward. i say this b/c i want people to understand: the younger people on the Hill and in state congressional offices, they are with us, they are like us, they want this reform. but they also have to please their bosses, and their bosses' masters. who are, again, bigtime campaign donors. who make *lots and lots* of money, by keeping the system exactly the way it is.

there is Great Profit in keeping the majority of americans scared, uninsured or underinsured, favoring responsive health care over preventative health care...i could spend all night detailing all the ways that keeping us sick and scared makes some powerful people more powerful and more wealthy. and that is the point. i have utter and total respect for Dr. Fiedorowicz and people like him, and their efforts. but i have to confess, i have real doubts that appealing to "social justice" and even economic common sense, are the road to success, as far as our goals go. economic common sense is just that: for the common people. the elite in the Village have no interest in what is good, economically or otherwise, for the "commonweal."

i believe that must be our starting point, as we map out strategy and approach this problem. very plainly: it's us, a huge majority, vs. them, a tiny but uberwealthy minority who essentially own our lawmakers.

i don't have all the answers, nor can i, myself, point to an especially effective track record of getting things done in various congressional halls. but i really want to stress that i believe the relatively simple equation of "great money buys legislation" as a starting point. "everyone knows" that better health care is more moral, better for the economy, what a majority wants, helps The Children, etc. what everyone doesn't know is that changing our health care situation would mean upsetting the most powerful and influential interests, that not only have a great degree of control over our government, but also our media and things like "the markets."

essentially what i am saying is that i think much more radical strategies must be developed, or meaningless incremental changes are all we're ever going to get. i would bet the vast majority of people here would agree: radical health care reform could transform our distressed economy overnight, and with the added social justice benefit, reinvigorate our economy and ability to compete in the world market. why don't our leaders understand nor agree with this position? i hope everyone reading this discussion thinks about that, dispassionately and logically.

but without being too romantic or ridiculous, i will suggest to people that the only way to change things, short of dying ourselves, is to drop the appeals to "justice" and "morality," or even "economic good sense" and to recognize that nothing short of- yes, i'm going to use that verboten word- force, will bring the change we all need and want. strategy should reflect this. as should our appreciation of how and where we spend our increasingly limited resources of time and money, as we participate in this fight.

again, this is all in the way of thanking people like Dr. Fiedorowicz, and in no way meant to undercut his observations or contributions here, for which i am grateful. all i'm trying to say is that we've been down this road before, and appeals to "what is right" and "what makes general economic sense" don't, and haven't worked. it's time, long past time, to take a more radical approach. i'm sorry if the word "radical" makes some uncomfortable. but there is it.

Submitted by lambert on

Atrios:

However this situation came about, the powers that be are most interested in preserving the institutions most responsible for it. Why that is I do not know, but that's where we are.

Well, so much for the whole Obama thing, then? That didn't take long.

As for "force"... See the 198-fold way. I don't think force means violence.

For example, like so many, I'm going naked. If that nagging pain is more than the pains of age, there's no fucking way I'm dying hooked up to tubes. My friends will oack me up in the back of a station wagon and drop me off on the National Mall so I can die there, surrounded by Freeway Blogger-style signage, on YouTube. And I bet this sort of silent resolution is filling a lot of us -- especially as more and more of us have less and less to lose. I think the uber-wealthy have spent a lot of money preparing for the last war. Let's figure out how to be smarter...

First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi

Submitted by jawbone on

Powers-that-be would whisk us, or whomever tries such a demonstration, away, far away, to die out of sight, no doubt.

But, I can see lots of stickers on those concrete barriers around Washington*, saying things like "Healthcare Barrier System" and "Healthcare Blockade System," and "We've Got Hope, so Where's the Change?"; "Obama" could be added to the last one. I'm sure even better slogans can be developed....

FreewayBlogger, love that guy.

*Or any place with those concrete barriers.

Submitted by lambert on

Great theatre, right?

First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi

vastleft's picture
Submitted by vastleft on

A scandal galvanizes interest, and creates hyper-focus on every detail imaginable. It so happens the details include human lives, social justice, and economic savings.

The way single payer -- a totally proven solution -- is being kept out of the conversation by the new administration and the moneyed interests is a scandal. But more people need to know about it and to be able to wrap their minds around it.

If only one insider or shill would step forward and blow it open....

Jess Fiedorowicz's picture
Submitted by Jess Fiedorowicz on

Money and power clearly pose the primary barrier to change. Indeed, this explains the limited effectiveness of appeals to justice or economics. I appreciate you identifying this core problem and calling for a more radical approach.

Thanks again for the opportunity to at least speak truth to power.