1 Will property taxes be reduced under a Single Payer system?
2 I have to wait 6 months after calling for an appointment to see my internist. How is this different from what occurs in Canada?
3 Why do you use "Socialized Medicine" and "National (or Universal) Health Care" interchangeable?
4 What's the gamble about a system that has worked rather well for over half a century in most of the developed world?
5 Is there any good example of a successful universal health care system? Obviously, Canada is NOT it!
6 Why are 40% of those eligible for health insurance in NY uninsured? Is it partially because of the complicated and burdensome process of getting Medicaid? How do we fix this?
7 Paul Macielak spoke about NY State. Paul Sorum seems to talk more about the whole country. How would each speaker address the "other" issue.
8 Private health insurance industry can "select" those it will be willing to insure. Isn't the cost of providing private insurance higher than the government cost for Medicare? I trust government over big for profit health corporations.
9 Will we get the Canadian model anyway, as far as access, if we reach/approach universal coverage and can't grow the delivery systems capacity? (regarding the wait for primary and specialty care, and elective hospital procedures)
10 How do the injuries/deaths from wait delays in Canada compare to the injuries/deaths due to uninsurance/underinsurance in the US?
11 In Canada, does private insurance coverage duplicate services offered by the government plan?
12 What is the rationale to allow profit margins of 30-40% by private for profit insurance plans .... Rationing care to the .... And the seriously sick of any income?
13 How will costs be controlled by the For Profit Plans under a universal health care model?
14 How will HR 676 (single payer/Medicare for all bill now in Congress) impact people who now have good health Insurance (workers and/or retirees)? These benefits were negotiated with employers and often health benefits were taken in place of salary increases.
15 People with no children pay taxes for public schools, why should not insurance resistant people pay for the health and well being of our shared society (via progressive taxation)?
16 My husband had cancer. His chemotherapy cost $8000 every 3 weeks. He lived 6 years. With single payer, would he have died 3 years sooner due to economics?
17 You talked about the expansion of the current system (public + private) as being a possible option. How would that reduce costs but also cover the 47 million uninsured Americans.
18 In your honest opinion, can a single payer system exist in the U.S., with the existence of lobbyists and interest groups who are against this?
19 I've been told that doctors are required to serve, at no cost, any uninsured person who wanders in off the street. Is this true?
20 Does Paul Macielak believe that a Multiple payer system would work on a national basis?
21 How would a Single Payer system "sign up" or accommodate the illegal alien population? They are hesitant to registering with a government program.
22 How would you handle public resistance to expanding coverage to illegals? (Remember the driver license proposal)
23 How did you get the number of 40% of the uninsured population could be insured? I am imagining these are the people that fall between the cracks.
24 What is the most important ONE question to ask a presidential candidate if we ever have a chance for meeting one face to face.
25 Likewise, what is the most important ONE question to ask the new candidates for congress from our district?
26 What do you think about the Clinton proposal for coverage of all people?
27 Dr. Sorum - It is disingenuous to say that government just collects the money and pays the providers. The government also creates policy and it is usually poorly designed.
28 I lost my husband's Medicare coverage by signing up for CDPHP as I always had. Unfortunately, the new Medicare "choice" did not allow him to use his Regular Medicare using his ELFUN medical insurance which we still pay for each month. I cancelled his CDPHP HMO but his regular medicare has not been returned. What a nightmare!
29 Dr. Sorum - Explain the difference between National Health Care System and Universal health insurance/Single Payer System.
30 Why did the Netherlands and Germany move away from "Single Payer"
31 Tell me more of how and why the Health System in France works.
32 How do Canada's longevity and infant mortality statistics compare to ours?
33 If we can afford to pay for the health care of people running and working for our government, why not all of us? Are we second class citizens?
34 How much longer do we have to wait for good health care coverage? We've been arguing this subject for more than a decade.
35 Since you don't trust Government, do you suggest that we dismantle Medicare which operates much more efficiently than private plans?
36 How can we implement or transition to a single payer plan?
37 One factor overlooked in our system is Prevention. Why not establish more "church nurses" and special areas for minor problems + not necessarly to see doctors. We could use PSA's, Nurse a block, Nurses at senior housing facilities for a limited number of hours/day, clinics in some department stores, etc. We could reduce the need for a doctor by thinking outside the box.
38 If we continue on the current path of having so many private insurance plans, is there any way to curtail the $ amount of their advertising budgets, CEO compensation and profits to shareholders?
39 You spoke of the number of specialists in the U.S. Is there any plan for prevention medicine and more GPs? (in the multiple payer system)
40 Please explain what stability comes from the multi-payer system?
41 Why should an employer pay a lower premium for insurance than an individual does when he/she purchases it?
42 Paul Sorum + If you have health care, Paul M's argument scares you by pointing out you will pay more and wait longer for services. If you don't have health care coverage, your universal coverage provides hop. How do you sell the outcomes of universal coverage knowing overall costs will rise and wait times will increase? Americans (most with health coverage) must be sold on the method to focus our political will for this "gamble" to change.
43 How can a universal system control the growth in spending without impairing quality of care?
44 Medicare usually reduces the amount doctors and others can charge, and that they will pay for each service. What is the effect of this on the comparison between Medicare and private insurance?
45 What about the numbers of people who now have to use the emergency room because they have no primary care because they can't afford health coverage?
46 Re Single Payer- People who now pay "big Bucks" to belong to HMO's, would they then become part of Medicare and pay the Medicare premium?
47 Wouldn't opening up Medicare to all increase viability of Medicare by including younger (and therefore healthier) people?
48 Where would illegal immigrants fit into a single payer system?
49 In our current system they are cutting down or reducing beds, yet the wait and rules for admissions and services are increasing + 5 hours in an ER, and 10-18 hours for a bed.
50 Neonatologists + Canadian #'s are practicing neonatologists. US #'s are board certified (ABPs board#'s ?) by the last known address. 1/6 of these are NOT practicing neonatology. Very low birth weight babies (4500gm BW) are twice the incidence in the US vs Canada. Assisted fertility, teen pregnance and smoking are the major drivers.
In recent months, we've provided articles for this newsletter to describe the need for health care reform. This month, I've decided to talk about some of the objections. You may have heard some of these positions from friends or family... or maybe you share some of these views. Some of the common objections to reform are listed below. Others will be included in upcoming issues of the newsletter. Please let us know about your concerns (or your friends). We'll try to address them!
1. "It's not necessary, we already have the best health care in the world."
It's true that many Americans do enjoy the best health care in the world. If you can afford to purchase whatever you want; or if you work for one of the country's major corporations (or the government); you probably have access to your choice of medical plans, doctors, and hospitals. However, many other Americans are uninsured or underinsured. Our health care system is not well coordinated. The US health care has a very low rating when compared to other industrialized countries. Longevity, infant mortality, and other critical factors do not score well when you average in ALL of our citizens. Many insured person's find themselves bankrupted by catastrophic medical expenses, despite their coverage!
2. "Reform is too expensive"
All of the proposals for health care reform are required to have an accompanying price tag at some point of the discussion. And the price tags are huge. Estimates for the proposals from Senator Clinton and John Edwards are $110 billion and $120 billion, respectively. The fact that health care in America is already too expensive is one point people on both sides of the argument can probably agree on. The US is already spending about twice as much as other industrialized countries (who cover all citizens) and getting far less bang for the buck. We need to look at how we are spending those dollars. Many advocates believe we can provide basic health care for everyone without spending more money. Some of current high expenses that could be reduced include:
- Reduce administrative overhead which is presently 15-30% of the cost in the insurance industry
- Negotiate the price of medication with Pharmaceutical industry
- Reduce use of expensive emergency room care by providing everyone access to primary care
- Emphasize and reward prevention and disease management
3. "Health care reform means socialized medicine"
Actually, NO ONE has proposed "socialized medicine" for the United States. Great Britain is one of the few industrialized nations that has this type of medical care. The hospitals are owned by the government and the doctors work for the government; although there is also a private health system available for those who can pay for it. Here in the United States, reform plans vary from mandates on employers to provide health insurance, or mandates on individuals to purchase health insurance, to providing individuals with a choice of purchasing public or private insurance (with lots of variations and other important reforms included in each proposal). There is only one proposal that would institute a "single payer" plan but that proposal allows everyone to choose their own providers (doctors and hospitals). "Single payer" COULD eliminate private insurance; but it could also operate like Medicare with supplemental plans available through private companies. The NYS League of Women Voters has endorsed the single payer approach because it is that plan that addresses all of the Leagues' concerns about needed health care reforms. Many analysts believe that a single payer approach will also be the least expensive reform that guarantees universal coverage.
Next month, we'll address some of the questions about the ability of the Government to handle health care reform and other issues such as individual responsibility. You can address your questions to either:
Pat Kessler, 374-2713, patkessler@aol.com
Carol Furman, 346-2746, cfurman@earthlink.net
Excerpted from Health Affairs, February 20, 2008
The U.S. Economy And Changes In Health Insurance Coverage, 2000-2006 Americans
continued to lose their health insurance even as the economy improved.
by John Holahan and Allison Cook
Between 2000 and 2004, a period of economic recession, the number of uninsured Americans increased by 6.0 million. The number increased by 3.4 million (1.0 million children and 2.4 million adults) between 2004 and 2006, despite improving economic conditions. The dominant factor in both periods was a decline in employer-sponsored insurance coverage. Employer coverage declined most for self-employed or small-firm workers, in the South, and among non-citizens. The rate of employer coverage continued to decline even when the economy improved.
For children, the decline in employer coverage was offset by large growth in Medicaid and SCHIP in the first four years of the decade. As states experienced deteriorating fiscal conditions, they adopted policies that restricted growth in these programs. As a result, the number of uninsured children increased by 1.0 million between 2004 and 2006, after having fallen by 400,000 between 2000 and 2004.
The decline in employer coverage can be traced to greater increases in health insurance premiums and not to increases wages. As health insurance becomes more and more expensive, it adds more to the cost of a worker's total compensation package. To the extent that firms cannot shift this back to workers in the form of lower wages, they become less likely to offer coverage.
It is striking that the rate of employer coverage declined and the number of uninsured people increased even after the U.S economy rebounded from the recent recession. This erosion will likely continue, particularly for low-income workers, because the basic factors underlying it seem unlikely to change.
Comment by Don McCanne, former President of the Physicians for a National Health Program.
· The fact that the number of uninsured continues to increase is certainly not news. But there are a couple of points in this article that should alarm us.
· A rebounding economy was unable to stop the decline in coverage. In spite of favorable economic trends, employers found their health benefit programs to be less affordable, and more dropped their employees from coverage. Clearly we will not be able to rely on improvements in the economy alone to expand coverage to more individuals.
· This report demonstrates that the decline in coverage is impacting all sectors of our society, though some more than others. This indicates that targeted programs cannot eliminate the problem since some sectors inevitably will be left out. Also alarming is the fact that incremental reforms more narrowly targeting populations is not working either.
· As an example, the greatest "success" in recent years has been insuring more children through the SCHIP and Medicaid programs. Yet the gain of 400,000 insured children during 2000-2004 was more than offset by a loss of 1.0 million during 2004-2006 (years of economic recovery). That certainly cannot be classified as a health policy success, yet that is the best we can show for all of our incremental efforts.
· When you look at the leading comprehensive proposals, policies are included to target the more vulnerable populations. Yet they are very weak on policies that will help the largest vulnerable group of all:
middle-income individuals and families.
· Relying on improvements in the economy for most of us, with safety-net welfare programs for the poor, will never get us to a program that guarantees reasonably comprehensive care for all of us. It will require the adoption of a health care financing system that automatically includes all of us, for our entire lives.
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