Curiosity Over Pride (FYI: To comment, send an e-mail to

Saturday, June 6, 2009


The more I listen to the debate the more convinced I become that single payer is the only option which will reduce costs and provide better medical care. We could easily see the option voted down in the Congress but in the long run as the private insurance system has become totally unserviceable and unwieldy we should stake this out as our position instead of, for ostensibly political purposes, ceding to our adversaries 90% of what they want at the end of the process.

It was nice of insurers to join with others in pledging to reduce costs, unfortunately we instantaneously saw how flimsy this pledge was. They will not digitize and especially not harmonize medical records - they consider patients they acquire at cost their property - nor are they able to negotiate effectively for lower prices a situation which could become worse with interlocking ownership.

If, as we well might, we lose the fight for single payer we should not accept a dubious compromise but come back to the public with an explanation of how they are being sold out by the current system. While it probably won't resonate at first given the marketing dollars of the health industry as time goes by and the situation continues to degrade, the public will begin to understand the reasons of a political approach which has been consistent and forthright.

Single payer will necessitate addressing the problems of unemployment in the medical insurance and administrative sectors. While I have seen estimates of savings here of up to 1/3 of total medical costs, in the short term, with the economy in shambles, the problem of unemployment in the insurance and administrative sectors created by single payer will have to be addressed.

A two pronged attack can help to this end. Phase in the single payer system over several years and provide retraining for insurance and administrative personal who want to work in an expanded National Health Service. This service could have as one of its core goals in addition to administration of a single payer system, expanded out reach to communities and preventive care. If even a small dent is made in problems like obesity and diabetes as a result of the outreach program National Health Service will have done much good.

The problem of medical school costs will also need to be addressed. Partnership with the Medical Schools and the public health system would need to be implemented to address this problem.

For those who prefer the current system to one whose focus is the patient rather than the money, I would suggest having your sanity checked but be prepared, it might cost more than you are able to pay as the extent of coverage for mental illness in most insurance schemes is very low.



Thai said...

@Dink, I sent your email my first post. Can you "hook me up to post?"

@SS, I am completely agnostic in the single payor debate as 30% of my patients pay me about 80% of all the money I collect. AND I completely agree that one cannot trust the insurance companies at times (the games they play make my blood boil).

I certainly understand lowering fees on the ones who pay the most while raising the amount the other 70% pay means a physician/hospital will collect the same amount in the end and the whole thing is a wash.

Or as a friend of mine explains to people who don't understand: Since 1/2 of my patients pay me everything and 1/2 pay me nothing, if EVERYONE pays 1/2 as much as the ones who do pay, then the doctor is no worse (or better) off.

BUT unless I misunderstanding you, a number of statements in this post suggest you do not understand the health care issues all that well.

To help we with where your head is, can you:

1. Clarify how much savings you think can be achieved in the efficiency of going to a single payer system and eliminating all the "excess" paperwork and excess high salaries and profit distributions that insurance companies pay?

What % of all health care is this?

You have said "I have seen estimates of savings here of up to 1/3 of total medical costs."

You may have seen these estimates, but they are clearly wrong and NO SERIOUS student of medical economics would respect you if you continue to promote them. If have given the numbers before, but I think uber liberal Maggie Mahar has done as very good job in this link of any of telling everyone in liberal fantasy land "sorry", AT most we can save 2% of US health care costs.

2. Clarify what % savings can be achieved BEST CASE SCENARIO from computerizing medical records?

I will give you a hint, most studies show computerizing medical records dramatically lowers productivity- studies in Emergency Medicine show an average productivity loss of 25%- meaning if a physician and nurse could see 4 patients in 2 hours, now they can only see 3 and therefore you need to increase staffing by 25% (because doctors and nurses are now sitting typing at computers as opposed to seeing patients).

This is why computerized records failed in the UK recently FYI.

3. How does SHIFTING the cost of medical education save the system ANY money at all?

FYI, in my experience cost shifting tends to INCREASE costs since they are harder to now understand.

None of this is t say I prefer our system over others, but call a spade a spade.

You will kill people with this kind of approach to policy, of that I am sure.

Thai said...

Again, I really recommend you download the following link if you want to see how America does and does not perform well in various cost areas.

Thai said...

I have been trying to figure out where you would have come up with the idea of "1/3"???

I think you may be confusing the idea of saving 1/3 of health insurance administrative costs with the idea of saving the entire health system 1/3.

There is obviously a VERY big difference.

In fact, the latest iteration of the endless Krugman-Mankiw debate is on just this issue.

Mankiw is absolutely correct to point this out.

Be careful you don't confuse the idea of cost savings with the idea of cost shifting as one is a very real savings to the system and one is nothing but am illusion.

Most proposals you read about in health care are nothing more than cost shifting.

In fact, there are only a few proposals that are truly cost savings and sadly these are the toughest to implement in a highly regulated environment.

yoyomo said...

Oh, goodie-goodie; Thai & SS aren't lined up on the same side of the barricade against me this time.

SS said...

@ Thai

An estimate of single payer in Colorado os for savings of 26% of costs for health care providers by reducing insurance administration; estimates for other modules in the system, e.g. hospitals, et al are also there and can be found at:

Unfortunately the other estimates are in dollars not percents but all show large savings.


SS said...

NOTE * Single payer saves $350 billion a year because it has administrative costs of 3%, unlike the 30% that the health insurance parasites siphon off.


yoyomo said...

Sorry Thai, but your Maggie Mahar link says nothing about the cost savings of switching over to single-payer; and a long link it was!

Debra said...

Yoyo, I think that you and I should go off into the Internet bushes and have a little fun on our little lonesomes while SS and Thai hash this one out together.
Thai, and SS, as the daughter, wife, and mother of a (future) doctor, I find this subject incredibly BORING !!!!!!!!!!!!
For my comments on this subject, please go to Cotton's ten page link on the agro industry, and substitute health care for food.
Indeed, the culprit is once again, the industrialization of yet another sector of our lives.
But, in one of those scenarios that Joe is familiar with, I think that it is safe to say that when oil definitively heads out the window, industrialized medicine will come to a grinding halt.
At that time, the people who have managed to develop good clinical diagnostic skills, good common sense, and know how to think AND remain compassionate will also be good doctors.
Without computerized records, IRMs, and the whole sheboodle.

Thai said...

Yo, sorry. I did give the wrong link. I saw it had graphs showing the % of total heath care going to insurance administrative and thought I had the right link. This is the link I intended. You should read it as well SS.

Anyway, sorry

@SS, your numbers make no sense at all. Just think about them a little, they pass no sniff test whatsoever. I recommend the Maggie Mahar link about.

Be that as it may, I followed your links as far as they could go.

FWIW, I would personally be a little embarrassed to forward such nonsense links.

If you extrapolate The Health Blog's proposed Colorado savings numbers to the entire US, the most it would save (again, this is a highly partisan link) is $80 billion/year.

The other link, Health Care reform Kabuki, is simply embarrassing. By comparison, Yo's Counterpunch is like the New York Times with editors doing additional quintuple fact checking.

I did followed their numbers to their claimed source- a New England Journal of Medicine (NEJM) article by Woolhandler from 2003. It was very interesting so I do thank you for the opportunity to read it. I was aware of its general claims but had never read them in such detail before.

Anyway, here is the embarrassing part. Your authors, using a wonderful NEJM source article, are mixing issues up.

One senses they read the word administration and thought this must be "health insurance" administration, they forgot there are lots and lots of types of administration.

While the the NEJM article does include health insurance administration costs, the article is talking about ALL health care administrative costs, not just health insurance administrative costs.

America does indeed have very much higher administrative costs than any other country on this planet. But don't confuse one type of administrative cost with another.

There are MASSIVE administrative costs in America associated with quality oversight, disease management, regulatory compliance, etc... and these are completely different than administrative costs for insurers/payors.

Every time a new regulatory issue is required (say certain things must be done, such as whether a patient had smoking cessation education when they were admitted to a hospital), we increase administrative oversight costs even more.

but these costs are completely different than administrative costs born by payors. And none of these costs would be changed by moving to a single payer system from a multi payor system.

To get rid of these, we need to completely relax a ton of other regulations, requirements.

SS said...

@ Thai,

One problem with this estimate compared with those I showed you is that it does not include administrative staff in the Doctor's Office who spend their entire time processing the patients claims before sending them out, idem. the hospital.


Thai said...

True, but that is part of admin costs in general and would still be part of the costs of medical practice in any single payor system.

This % would not go down much (if any at all) under single payor, of that I am sure.

Someone would still needs to fill out the bills, even if these bills were in the form of a new universal simplified document.

There might be a little savings on my end, but not much.

Thai said...

Saw this and smiled.

Dink said...

Cotton and Thai,
Check your gmail accounts; you should be on your way to posting!

One aspect of nationalized health care that used to bother me was privacy. But I'm pretty much over that as privacy becomes more and more of an impossibility. In a big picture way it seems odd that the gov would spend billions to treat lung cancer instead of just making smoking illegal. Could the non-smokers get together and vote to make smoking illegal because they don't want to pay for it via taxes?


You're killing me. Stop being so aggressive and accusatory in your comments. We all come to the saloon to play, not to be abused. And don't sulk away all pissed off at me. I want you to come here and play, just play nice. Have you seen "The Big Lebowski" yet? "Anchorman: The Legend of Ron Burgundy" is also funny as hell.

Debra said...

As an extremely negative, contestatory person, I feel like coming to yoyo's defense, particularly as I can sincerely understand why he is so upset about these issues.
And I have a LOT in common with yoyo. He may not know it, or acknowledge it, but I feel it to be true.
Once you have started to realize the tremendous import of the subjects that Yoyo is putting in front of us, it is difficult to minimize them, as I feel that too many people do, including the people on this blog.

On another, lighter note, I wonder if you looked at the election results in the European Union (parliament elections), SS.
Once you recover from the crushing blow of 60 % abstention (no surprise, people don't believe in POLITICS period, why should they bother to vote ?) you will notice that what "passes" for the Socialist Party in all Western European countries is in free fall.
And YOU think that socialism is the answer to our problems ?
Personally, I happen to feel that DEMOCRACY is the answer to most of our problems. The major problem being that we have never HAD an honest to God democracy in our countries.
Oligarchy doesn't count...

Thai said...

You guys can just make up more imaginary email addresses (say yahoo) and share these.

Thai said...

Dink, you do bring up a very good point.

The reality is that there are a lot of people that really see nationalized health care as "cost shifting" where they want others to pick up their costs in a way they are not picked up today.

In particular re: smokers, they are one of the groups who are probably already paying their fare share in sin taxes, though alcohol taxes are probably too low.

It is behavioral issues that are much larger (gun users, etc...) and mental health issues in combination with multiple medical problems.

This kind of issue is typical.

Now think if these patients also had diabetes, etc...

Those are the ones who are killing the system.

Remember, EVERYTHING is non-linear.

Dink said...

@ Debra,
"As an extremely negative, contestatory person"

I believe the term you're looking for is "ornery" ;) And its good that you and Yo are feisty, but we must maintain goodwill.

@ Thai,
"It is behavioral issues that are much larger (gun users, etc...) and mental health issues in combination with multiple medical problems"

Those links are ...... sigh. They can't take care of themselves, but if another person tries to take care of them its taking their freedom away. The only solutions seem to head to Huxley-esque visions of levels of citizenship based on ability.

yoyomo said...

You've been patient with me and I do appreciate it but I would like you to answer these two questions as frankly as you can. Up to recently you may have actually liked me somewhat but how would you feel if a PREDATOR (since you're into sci-fi) was on his way to kill you and your family and not only did I know about it but instead of helping you get away, I nailed all your windows and doors shut so you couldn't escape? Let's say you managed to get away but your family didn't, how would you feel toward the people who insist on shielding me from criticism because I was such a respected pillar of the community and told you to focus all your anger solely on the PREDATOR instead?

That is the analogy we have here and your kumbia-centric approach is not the least bit adequate to the topic matter. The only honest alternative is to admit that some topics are too hot to handle.

Your approach reminds me of a beautiful, happy, boundlessly optimistic child who just found out that his absolutely favorite uncle in the whole wide world (the one that always takes him to the beach, amusement park, ball game when mom and dad were too busy) has been accused of molestation. You know that's a very bad thing but you still love your uncle because he never did anything like that to you and you can't help resenting and being angry at the accuser. The BIG difference, of course, is that if it HAD happened to you, then and only then, you would have known how the accuser felt.

I would like you to keep two things in mind:

#1 You may be young at heart (and I love that about you) but you're no longer a child.

#2 The people who worked tirelessly to keep the Jews trapped in Europe unless, and ONLY if, they could further the establishment of Israel were not squirrels, they were zionists. They had more than adequate mental capacity to understand both their actions and the certain, inevitable, unavoidable consequences of their actions. This was not some horrible tragedy that no one could forsee before it happened. There were people working day and night to lower the ladder into the pit so the victims could escape but they were overwhelmed by those who had other priorities.

Read the Ten Questions asked by Rabbi Dov Weissmandl who worked to try and evacuate Jews to anywhere that would take them but couldn't overcome the opposition of the zionists. Honestly please, do you think maintaining a pleasant atmosphere was topmost in his mind when he found out about what was done to frustrate his efforts to save lives?

In any case, I'll continue an adult conversation with Debra on her post.

Thai said...

For those who have read my post on my own blog (when you click on my name), it appears the politicians are starting to catch on to the issue.

The political alliances on this issue are simply too delicious to ignore.

Will Obama abandon his voters?

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  • Hitchhiker's Guide To The Universe trilogy
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