Centerfield

Waxman came up with that all on his own? What a genius!

i'm back! i'm not a troll... i'm just looking for unbiased opinions here. (this is why i lurk at "CENTERFIELD" -- not a left or right site.) please, this is an honest question:

i was a nurse (been one for a LONG time) and i have seen my profession become so intolerable that i have quit and now volunteer (which i can do so because of hubby's great pension and benefits - also i don't want to take a job away from someone who needs it)
what do you all think of the "Single-Payer National Health Insurance?"
http://www.pnhp.org/facts/singlepayer_faq.php

i have spoken with doctors about this...what i found is that the doctors who got into medicine to help people, think it's a great way to go. the doctors who got into medicine for the money (plastic surgeons...actually, surgeons, in general, don't like it).

but i am just a lowly wife, a nurse, a mother, a citizen who doesn't know a lot about politics, but i am someone who isn't happy with the direction of our country.

so i would appreciate your opinions! thank you!

;-)

I think we'll end up with some form of single-payer eventually. The admin overhead in both service and finance ends is some of the obvious low-lying fruit, and they're tightly linked.

I know many doctors who would be delighted to spend more time practicing medicine and less time practicing insurance politics. I also know hospital nurses who've gotten so disgusted with staff cutting and patient overloads that they went to work as office or school nurses, and only do hospital shifts when they need extra money. (Not surprisingly, the hospitals are always short of nurses for fill-in shifts.)

That's a good FAQ at that site you listed. I love that cartoon!

know many doctors who would be delighted to spend more time practicing medicine and less time practicing insurance politics. I also know hospital nurses who've gotten so disgusted with staff cutting and patient overloads that they went to work as office or school nurses

Beg to differ, Chris. The doctors I know who have left private practice were tired of being forced by the competition, their partners, and their affiliated institutions to increase their revenues, not cut their costs. They're related but different things.

For them private practice medicine had become a corporate rat race where they spent more time forced to pursue top-dollar "richest dog" goals at the expense of efficiently maximizing patient care delivery. Corporate medicine, under the "Golden Rule" of he who generated the gold gets to ignore the rules. They weren't being harried to cut costs, but to stack up the billings. Patient care came in second to that.

Most of them have ended up as salaried staff in top-end university hospitals, where they can practice medicine regardless of the patient's ability to pay, and do research, and not spend most of their time worrying about boositing their incomes.

> Beg to differ, Chris. The doctors I know who have left private
> practice were tired of being forced by the competition, their
> partners, and their affiliated institutions to increase their
> revenues, not cut their costs. They're related but different
> things.

Yeah, I remember a doctor kvetching about this when I worked for a medical startup.

But didn't doctors that used to be unhappy with that kind of thing used to set up their own practices with on less profit-maximizing lines? He said that the administrative overhead has gotten so high that clinics that don't do that run into problems.

Isn't that a result of LACK of competition? If 95% of patients weren't under BCBS or Medicare, wouldn't insurance overhead time be under more pressure to stay reasonable?

I, for one, tried hard to avoid BCBS when I was paying myself. For one thing, they were more expensive (because they have to pay for the other side of their own high average interaction times?), for another thing, my every interaction with them was terrible.

So you want to take away the little competition there is? The rulebook and time to deal with Medicare will keep growing even faster.

PS: my preference would be a combination of giving work-based insurance plan guarantees to individual insurees to free competition, and on the other hand, try approaches like MA's as a safety net.

> i was a nurse (been one for a LONG time) and i have seen my
> profession become so intolerable that i have quit and now volunteer

I'm sorry to hear that. For those of us outside the medical profession, I'd be fascinated to hear what got worst.

ok, Jon Kay, you asked for it! ;-)

cost-cutting practices, while good in some areas, were not good in the nurse-patient ratio. the more patients i had, the less time i had to spend with each.

then people started to become members of HMO's. some HMO's had restrictions such that by the time the patients were actually allowed to go to the hospital, they were in much worse shape than they should have been. less staff, sicker patients. not a good combo.

eg, one elderly, confused patient was climbing over the bedrails while i was attending to another (2nd day post-op, a new hip, transferring to potty chair). the nearest person to help me is all the way down the hall with another patient. so i gently put the little lady on the chair and ran to catch to other (across the hall). >> notice i really didn't have time to wash my hands.

hanging a pint of blood requires double-checking with another RN (matching the patient ID with the blood ID), then checking the patient every 15 minutes during transfusion. (at least when i practiced. things may have changed since then.) it was hard to find another nurse to check the blood AND hard to get back for the checking every 15 minutes.

the older, more experienced nurses left because of the unsafe situation. these nurses were the ones new nurses went to for "resource" cuz you can't learn everything in book! they help newbies to prioritize, point out subtle signs of when a patient is getting in trouble -- if you catch it fast enough, you can avoid huge problems, etc.

a scared patient is more likely to ask for pain meds than the patient who the nurse had time to communicate with, to ease their fears. also, by talking with patients, you may be able to figure out a "missing piece" of the puzzle, of why they got into a health crisis.

i could go on....enough!

Let me be blunt for everyone here. If we want a health care system with little to no "HMO/Administrative hassle" then we all need to pay for ALL of our healthcare (i.e. eliminate the middle man). Given that the cost per day in the hospital, at present, is at least $1000 I bet few will want to do that.

Why were there no hassles with health insurance companies thirty years ago? Because the costs of health care were so much lower and so the ultimate payors (the employers and the feds) didn't care that much. Today with costs so much higher they REALLY care. And since the average consumers pays such of a small percentage of the bill he's VERY sensitive to price increases.

Who here is willing to raise your taxes to pay for your health care AND that of the uninsured? And if so how much?

Finally, if we pursue a single payor system, do we truly belief the "administrative" hassles will go away? Talk to anyone of your doctor friends about the "doctor-friendly" regulations of Medicare.

Finally, if we pursue a single payor system, do we truly belief the "administrative" hassles will go away? Talk to anyone of your doctor friends about the "doctor-friendly" regulations of Medicare.

I have. Those who deal almost strictly with Medicare patients have no trouble at all running their practices by the Medicare book, and they don't starve. They also have smaller billing & compliance staffs than those who have to deal with the full gamut of payers.

Have I ever said the administrative hassles will go away? Nope. But they would be reduced to one set of rules, not the dozens or hundreds that currently inflate the hell out of system overhead costs at both the provider and payor ends. That's why single-payer could produce some significant system-cost savings, though I doubt they'd be as great as claimed.

A few points. First, we have the finest for-profit health care system in the world. It is absolutely the best in the world at producing profits. Second, because it is a for-profit system, health care is rationed by price and ability to pay. Third, because it a for-profit system on the financing end, there is a considerable overhead load that is dedicated to nothing more nor less than avoiding service provision and payment for same. Fourth, (and this is a big one that gets ignored a lot) many of the uninsured are uninsured because they simply don't need health care at this point in their lives, and can't financially justify spending the major money involved for something they don't need. In the case of a family of four with a median national income, we're talking about 25% of their GROSS income before taxes for health insurance, NOT counting deductibles and co-pays.

If we went to single-payer, bureaucracy wouldn't go away, but the rule-set would be simpler and the admin overhead a lower share of costs. That doesn't mean an overall lower system cost, but would mean more money could be spent on actual service provision rather than on overhead. And the "rationing basis" would change.

Let's face it--we have such great technology and advances in technique because of the profit motive. But that's also a major part of what drives the price increases. The newer the techniques and technology, the more they cost, the more money to be made, the more it costs for treatment. We don't want to give up those advances. At the same time, those advances are pricing health care out of reach of a large portion of society. Live long enough to get Medicare, and the government picks up most of the tab--which means we ALL pay. Including those down the ladder who can't afford THEIR OWN health care tab. That 30-something single mother in a low-to-mid-end job is paying for the health care of seniors even when she can't afford to take herself or her kids to the doctor. That 20-something slacker who doesn't need or use much health care at all may opt out of having their own insurance, but they still pay through their taxes for senior health care.

Quandary. No simple solutions.

See, now this might be one reason why centrism fails to gain traction. We had the makings of a lengthy discussion going, and then Tully weighs in with a pretty fair summary of where we are, and the thread just stops.

So from the perspective of those who frequent talk radio and sunday morning talking heads and find partisan food fights entertaining, maybe centrists are the skunks at the entertainment garden parties, the turds in the punchbowl at the "Keep the booze and good times flowing" bash.

This one's for you, Brian. Surely you can find something to explore in terms of real-world applications there... :-)

I said no simple solutions. Here and other places we're working from the other end. Instead of moaning that nothing can be done because the whole system's screwed (I know, mea culpa, I do it too) we're working with what we have to make it better, in ways that will still be useful no matter what happens in the way of national reforms.

I encourage anyone else interested to click through as well. It's a small but promising story. And there's a valuable lesson for wonks who want to be serious problem solvers. It's about the virtue of small bottom-up solutions when the hope for quick giant top-down solutions is low.

As Tully points out, 1-payer may come, and it makes some sense, but it's not coming today or tomorrow. Crossing your arms and stamping your feet won't change that. But if you're part of one of those decent bottom-up solutions, maybe someone will listen to you when the big people with no big real answers start looking for small people with pieces of the puzzle.

If this notion strikes a chord with you, and you want to remember it as a useful real-world lesson, there's a quick slogan that gets at the gist of it: Get off the cross, we need the wood for the fire....

Tully;

I have. Those who deal almost strictly with Medicare patients have no trouble at all running their practices by the Medicare book, and they don't starve. They also have smaller billing & compliance staffs than those who have to deal with the full gamut of payers.

Reviewed you link to the Sedgewick County experiment. Interesting, the second local initiative to "recreate" the health system that I've heard of this week. A few years ago we thought the states were the "innovation lab" for healthcare. Maybe now its the county. I can't imagine doing this well in a large city though. Too much diversity. And unfortunately diversity leads to "Not my problem"

It works when it's directed at specific target populations, Chris. Sedgwick County may not be large by some standards. It's geographically about as large as Rhode Island but with half the population, half a million people, and we get 90+% participation from physicians. And check the SF link in replies for a link to the Parkland Hospital maternity system in Dallas, where similar principles are yielding some excellent results, producing far better outcomes for a totally indigent patient population than the overall insured population enjoys. It's not "recreating" the system at all, it's addressing specific problems at the local level so as to improve system performance. And as you know, I'm a big believer in fixing your own area instead of waiting for the state or feds to do it for you.

In both cases the programs are solidly grounded on coordinated routine and preventative care. With some work that can be applied anywhere, even nationwide, without chaging the current system much at all.

There are some specialties where you take Medicare or you don't practice at all. Try running a cardiology practice and not taking Medicare. I know cardiologists. They manage quite well.