I generally find discussions about health care to be endless and unenlightening. So why am I live-blogging today's Midmorning discussion about the future of a single-payer health plan proposals? Because today the game changes for health care when thousands of Minnesotans are thrown under the bus through Gov. Pawlenty's unallotment plan for balancing the state budget. And thousands more will lose their health care as they continue to lose their jobs. Health care in tough times is a different beast than health care when times are good.
You can listen to today's show here. I hope you'll share your stories.
Guests: David Himmelstein, primary care doctor and co-founder of Physicians for a National Health Program. He's also associate professor of medicine at Harvard University.
Thomas Miller, resident fellow at the American Enterprise Institute. He was former senior health economist for Congress' Joint Economic Committee.
9:09 a.m. - Kerri just promoted a July 9 event in the UBS Forum on health care. However her instructions won't work. It's not listed on the MPR page. I'll try to get that fixed.
9:11 a.m. - Hillmelstein says the Canadian system has only a few people in a hospital for sending out bills. Back in Boston, a local hospital had 350 people doing the same task. "Each doctors office has to have the clinical staff to fight with the insurance companies," he said. He says $400 billion could be saved with single-payer.
9:13 a.m. - Miller says "going down a different trail doesn't deliver all those things that are promised." He says it'll just create a different bureaucracy. "Most of the problem is in how health care is delivered.... choices we make." We hear the choice thing all the time. What does that mean? Getting you to understand the cost more. If you had chest pains and the ambulance costs $900, would you be less likely to pay attention to the chest pains?
9:16 a.m. - Thirty-one cents of every health care dollar goes to bureaucracy, Himmelstein claims. Miller disagrees and cites this data. There, by the way, you'll find a list of how fast health care costs are growing (thru 2004). In Minnesota -- 7.6%.
"He's absolutely lying" Himmelstein counters. Oh dear. This has potential to be YouTube comments section.
9:21 a.m. -- Caller: Sheila in St. Croix Falls. Would there be an option so that insurance are run as non-profits?
Miller: There've been different ways to propose that. Sen. Conrad of North Dakota reflected uneasiness among moderate Democrats who want to have a cooperative insurance plan through the government w/o heavy hands. Howard Dean rejected this idea.
Miller says we're not going to take profit out of the health-care system in this country. Himmelstein says the idea would help, but not that much.
9:25 a.m. - "Why is single payer a non-starter on Capitol Hill," Kerri Miller asks.
"Most doctors aren't going to be activists," Himmelstein says. "The majority of doctors are with us, but I think the reason it's not on the agenda in Washington is clear. There's an industry here that does nothing useful and is taking money from the American people -- the health insurance industry." The industry is a big campaign contributor, he says.
9:27 a.m. - OpenSecrets.org: Health Insurers Owe Policyholders, But Pay Congress Instead
9:29 a.m. - Obama referred to a 'public plan option' yesterday. Is that single-payer? "Same railroad track, different speeds, reflecting political realities," Miller says. "We've already overloaded the government with massive amounts of debt; You just can't absorb that much."
9:30 a.m. - Caller Tim from Duluth says Canadians come to the U.S. for their health care needs. "The Canadian insurance industry wants to portray that as true," Himmelstein says, "but it's not true." He says surveys of hospitals along the border -- including the Mayo Clinic -- and they found a few Canadians come across the border for care, but not many. The Mayo Clinic, by the way, actively recruits Canadian patients.
9:33 a.m. -- Here are the details of the July 9 event in the UBS Forum on health care. (h/t: Michael Wells)
9:35 a.m. - Recommended reading during the news break:
9:38 a.m. - Caller John from Minneapolis. "The paperwork has gotten out of hand. We do less paperwork than the nursing staff but it increases all the time. I've yet to take care of a disgruntled Canadian patient." (He works for HealthEast)
Tom Miller says "I don't want to make up numbers." He gives his email address: email@example.com and says he'll email information comparing the two systems. "There's not a gigantic pile of money (through cutting waste) that's going to solve all of our problems."
9:41 a.m. - An online commenter says he/she worries that a single-payer plan would operate "like the DMV," slow and inefficient with poor service. "That's what we have now," Himmelstein counters.
9:42 a.m. - Doctors weigh in on health care plan as outlined by President Obama.
9:47 a.m. Caller Henry in Owatonna: "I lived and practiced in Canada and I now practice in the U.S. When it (Canadian system) first started, I thought I'd gone to heaven. 100% were insured and it made no difference to how I related to patients. After about 15 years, the government found the plan was too expensive for them and the government started budgeting hospitals the way you do school districts... They would give a hospital administrator $100 million to run the hospital for a year. To get the cost down, the administrator finds things that don't cost much -- my mother had a stroke and spent 9 months in the hospital. Here in Owatonna, they'd have spent a week."
9:48 a.m. - "We spend $8,000 per person, they spend $4,000 per person and they deliver better care," Himmelstein says. He says for whatever money is spent, a Canadian-style plan gets you better care.
9:52 a.m. - Would it make sense to try it on a state level? No, says Miller. There are three barriers: "Politics, economics, compulsion," he says.
Himmelstein says there should be an option to buy supplemental coverage over a state or federal single-payer plan. "You can't make the system run with private insurers in the middle of it," he says.
9:55 a.m. - Online comment from Eagan:
I keep excellent health and pay $600 a month premium and my employer pays atleast that much towards my health care. Literally I dread the occassions to visit a doctor. As much as I can, I keep fit by good eating habits and exercise routine.
I feel sorry for those people who donot have health insurance and my heart goes out to those who file for bankruptcy because of health care costs.
Medicine in USA is treated as money making machine for business and not as keeping healthy citizens and treating deceases. Now the entities who fear loss of their profits are fighting tooth and nail to protect, all the in the name of free choice. Only people waking upto this reality and actively participating in the debate will make a difference.
9:56 a.m. - Miller and Himmelstein debate whether one of them is lying. Welcome to TV cable talk show.
9:58 a.m. - I'm not sure anything much has been accomplished. This remains a hot-button issue, of course. BTW, here's an interesting blog post on NPR Check on how the issue was covered recently.
// end of live blog
==> An additional blog post with more information can be found here.
Having lived in Canada for 20 years, having excellent care promptly all those years, I was appalled when I returned to this country to find how insurance companies had inserted themselves into the mix. I have been covered by several different insurers over the past 18 years here and have not had positive experience. I've spent hours on the phone just trying to get my address changed!
Now I don't have insurance, partly because I simply refuse to be part of a useless system. I paid cash to the University of Minnesota Physicians group for some testing a while back, received 20% cash discount and an additional expected bill for lab work. Imagine my surprise to receive two different refund checks for overpayment both for the physician and the facility. What a complete waste of someone's time. Why on earth don't these people know what their fees are? Stupid, stupid, stupid. Not something I expected to say about the University of Minnesota.
Several years of experience in the claims and customer service end of managed health care inform my opinions on the subject of health care reform. I am strongly in favor of a single payer system because I think it is essential to remove the profit motive from the business of health care reimbursement.
The argument that no reasonable person wants the government involved in their health care is bogus and must have been manufactured by the insurance industry and promoted as popular opinion without ever finding out whether properly informed citizens would, in fact, think governmental involvement is any more troublesome than insurance company cost control measures. I personally have no more fear of government involvement than I do of having insurance companies participate in health care delivery. In either case, the goal is to manage the cost of care (which is obviously necessary), but in the case of insurance companies the motive is profits and in the case of the government the motive would hopefully be appropriate and equitable distribution of available resources to all covered persons. This translates to “rationing” which makes everyone nervous but which is a stark reality that we need to face. Answers will not be easily determined and are guaranteed to be controversial but need to be sought, nonetheless.
I recently heard Howard Dean express a similar point of view and I truly hope he is in a position to influence the healthcare reform discussion in Washington.
but in the case of insurance companies the motive is profits and in the case of the government the motive would hopefully be appropriate and equitable distribution of available resources to all covered persons.Which explains why Michelle Obama's salary shot to 300K after her husband won a senate seat, a seat that was later sold to the highest bidder.
I was in Canada caring for a sister who resides there who had cancer. She lived and died in that system. During the time I was there, I saw primarily Americans coming into Canada trying to get healthcare. This was so prevalent that there were actually tours and caravans being advertised and organized at that time carting Americans back and forth. I myself found need to see an MD there and get a refill of an Rx.
I was seen immediately, by the way (and didn't even have anything emergent really) - contrary to all of the scare tactics about long wait times, etc. etc. - and the MD told me that he and his fellows were really pissed off at the NUMBER of Americans coming to Canada for healthcare, expecting to be able to get it or cheaper Rx's without paying into the system that sustains such a system. I left WITHOUT a refill because new rules prevented American medical "tourists" from pillaging the Canadian system as a result of all of this.
Having cared for a father, mother, and fiance in the US's private system (with good insurance) - and gone through their end of life care and cancer treatment, I can tell you HANDS DOWN, the care my sister received (and she was what would be described as the barely working poor) phenomenally good treatment - MUCH better than what my father, fiance, and mother received in the US.
I'm for NOTHING LESS than a single payer publicly financed system. Private industry has had a long ride to proove single payer wrong and has simply brought us to where we are today - quickly going bankrupt for the sake of exorbitant salaries, profit margins, and the usual greed. If we can get rid of AIG and GM and see the waste w/these guys, why can't we do the same with the private health insurance monopoly? Every other industrialized nation is laughing at this American fuss over whether or not to retain healthcare's ability to continue to siphon a big part of its economy into executive pockets. Time for a change.
Because today the game changes for health care when thousands of Minnesotans are thrown under the bus through Gov. Pawlenty's unallotment plan for balancing the state budget.
And of course the DFL had nothing to do with this..... other than placing Education (like High School sports) higher on the hierarchy of children's needs than health care.
Might be nice to hear public radio hold Education Minnesota, the 800 lbs gorilla of Minnesota politics, accountable from time to time.
I try not to get into the political gamesmanship -- the "you stink, no YOU stink" debate that passes as intelligent discourse.
Rather, I'd like to go back to the basics: Should a poor kid have access to health care? Should health care be tied to employment? Are you poor because you want to be?
I realize that doesn't play to people's religious affiliation -- that is Republican or DFLer -- but it might be more productive.
There are basics to the health care debate that simply can't get past politics. What is the RIGHT thing to do?
That, I think would be the FIRST question to be asked in many of the issues facing the state -- what's the RIGHT thing to do? And then move toward that from there. That would be better than "how can I get elected/re-elected"?
I asked a young physician in Alberta about how it would work if a non-resident was to have emergency treatment in Canada, or if someone with an address in Alberta was travelling and has to get treated in another province.
"For people who don't have an Alberta Health Care number, but have a health care number from another province, officially Canada's health care policy is 'universal' coverage regardless of which province you live in. But every physician I see having to bill out-of-province patients always talk as is they're not going to get paid.
If you're not a resident of Canada, then there isn't any place the physician can 'bill' and so it's basically unpaid work. In the hospital, I always see physicians take on these patients reluctantly (for obvious reasons). I really couldn't say what happens in an outpatient setting."
Bob, I share your general disgust with "you stink, no you stink" sorts of debates, but it also drives me nuts how so much of the media refuse to point out factual errors, let alone state the obvious when someone lies. Frankly, anytime I hear from someone associated with AEI, I presume they're lying. It amazes me when they get on programs like this as "experts". Rather than having the lies ignored, it seems some fact-checking would be in order, and if the accused really is lying, so say, and if the charge is false, say that too. But please stop this nonsense of one side says this, one side says that, end of story. Correct the facts, call the liar on his lies, call the false accuser.
I try not to get into the political gamesmanship -- the "you stink, no YOU stink" debate that passes as intelligent discourse.I applaud that Bob, but you did write "Because today the game changes for health care when thousands of Minnesotans are thrown under the bus through Gov. Pawlenty's unallotment plan for balancing the state budget." without including a nuanced wink toward the DFL who controls both the House and Senate.
I've written in the past about the games that were played by all sides at the Capitol this year. However, the unallotment is Gov. Pawlenty and Gov. Pawlenty alone.
This is a day of poor government on the part of all sides, however.
At the current level of engagement, there's no reason to have a five-month legislative session.
However, the kneejerk tendency to lob political grenades from the Democrats to the Republicans (and back and forth) is of little interest to the poor person who is sick or mentally ill and would just like to get better.
It would be interesting to see what the debate would look like if either side wasn't spending much of it trying to score political points but could agree on a desired end result.
That's the "vision" thing which, as you know from years here, is not Minnesota's strong suit.
Right on, Eric. It is analysis and fact-checking that make a journalist a journalist, not just a broadcaster. If, in a live conversation, there is no time to fact-check, please post updates -- that is the value add of the Internet.
Eric: Thank you for your note and, karina, thank you for yours. But neither of you pointed out a lie. What is it that you heard that doesn't survive a fact check? Both sides were pretty clear about the data they were using, both cited it, and I provided -- where possible -- the link to that data, and each was coming up with a different conclusion because they were using different data.
So is the "right" data that which leads to the conclusion people want to hear? Or is there a general agreement outside of the discussion that I'm not familiar with that is universally accepted as THE data to use?
I'm not above being lectured to, but if either of you have some substance to bring to the table, bring it. But, no, I'm not going to say someone is lying because they said something with which you disagreed.
// So is the "right" data that which leads to the conclusion people want to hear? //
We could all benefit from having data that supports our preconceived conclusions questioned, if that questioning is appropriate.
Eric makes a great point. Surveys can easily be manipulated to produce desired data. When conflicting data is cited, I assume one or both sides have “produced” the data they cite. The thing that frustrates me is that data which seems intuitively false, or in conflict with other data, is seldom questioned or investigated. That data quickly becomes “fact” within the discussion.
The link provided as a source of Miller's data on bureaucracy costs contains no data on bureaucracy costs that I can see.
I have sent an email to Miller asking for the data he cited. You may recall he offered to send it to anyone who emailed, but some of you probably already have it. Would you share what you found when looking at it?
What's wrong with the DMV anyways? I think the service is excellent.
I wouldn't expect too much from Miller on the data front. The opposition to single payer is ideology based, not data based. The data all show the we deliver less health care to fewer people for more money than any other country in the world. We will have to decide at some point what we want in this country, a health care market that generates revenue for executives and shareholders or a health care system that provides affordable health care to everyone. Polls and common sense dictate that the people want a health care system. Unfortunately the health care industry still wields more influence in congress than the people do and they're fighting to maintain the status quo because they're making so much money off it. They'd just as soon move the deck chairs and call it a day- what they've been doing a couple decades.
Sorry Bob, I tried the live link thing.
It is nice to see MPR do an hour in single payer, thank you. This option has been pretty much shut out of the discussion.
I have the data from Mr. Miller now and will try to post it in a separate post at some point today.