Monday, March 27, 2006

Universal Health Care

Could Canadian-Style Health Care Work for Connecticut?

In 1993, President Clinton and the last Democratic-controlled Congress dropped the ball on universal health care, stranding the country with the patchwork system of employer-provided benefits and limited federal and state coverage that we have now.

It stinks. It's expensive, it's confusing, it makes life difficult for doctors and patients both and, worse, it misses people. There is a significant number of people who have no health care at all.

This health care system is also slowly choking our economy. If you ask any business owner what his/her higest costs are, you'll find that most will tell you that it's benefits, namely health care.

So what do we do? Other countries (like, for example, every other Western industrialized nation) have national health care systems which work pretty well, all things considered, but our American distrust of the federal government and the fact that even the members of Congress who might be inclined to push for universal health care are gun-shy on the issue following Clinton's incredible failure means we won't see such a system for at least a generation. Thanks, Bill.

Which is too bad. As has been said elsewhere, a single-payer system like the one Canada has would be cheaper and more efficient than what we have now.

Therefore, if we want universal health care of some sort, we're going to have to enact it at the state level. In fact, there's a bill in the general assembly right now that would do just that.

Here's some of the testimony from Dr. John Battista about that bill:
...[I]t is possible for a Connecticut single payer system to fund comprehensive health care for our entire Connecticut population while saving money for the vast majority of our residents and businesses. When a single payer system for Connecticut was studied under the Weicker administration, savings of over a billion dollars per year were predicted- a finding confirmed by the Office of Health Care Access. Every prospective state and federal study on single payer supports this conclusion, which is consistent with the experience of single payer systems throughout the industrialized world. (Battista)

This plan would both save us money and make us more economically competitive. If you run a business with high health-care costs wouldn't it make sense to relocate to a state where those costs could be reduced and you could compete more effectively?

Why aren't we doing this again?

Seriously, is there a reason why this doesn't make sense? I know that the knee-jerk reaction is that it's socialist, it's European, it's a "big government" program... but the patchwork of private and public sector that we have now is a failure, and an all-private system wouldn't cover nearly everybody. Also, systems like England's and Canada's certainly allow private health care, as well. It's like the public school system: a baseline of coverage for everybody, with the option of opting out for better/different care.

At this point, with the number of uninsured and the cost of health care for everyone both going up, it's sensible to try something else for a while.

I hope the General Assembly seriously considers this bill: I think it would be a boon to both the citizens and the economy of our state. And, let's face it, it'll be a long, long time before we see it's like at the federal level.


Battista, John. "Human Services Committee Testimony In Support Of Single Payer Bill No. 482." 7 March, 2006.


Anonymous said...

Why do you think the system is better? And just out of curosity if the US goes universal, who pays for the massive amount of drug research?

Genghis Conn said...

Well, universal coverage, for one, and economic benefit for employers, for another. I think a lot of the possible negatives of universal health care would be mitigated by those two factors.

Besides, consistency would be great.

bluecoat said...

I don't support the concept of a single payer but in reality we have on in the form of medicare and medicaid for about 40% of the population - and its not all that great.

As for who will fund all the drug research, a good much of it is for non-breakthrough entries - just an attempt to get market share such as with the lipid lowering drugs and gastro reflux drugs just to name a few.

Anonymous said...

One of the problems with single payer system is that it truly addresses only the periphery of the problem. Yes you can save some money on administrative costs, and some on treating uninsured. The 900 pound gorilla in the room is usage, which no one wants to address. I can produce a study that shows savings of any amount you want, simply change the assumption about what is or is not covered. Want more savings? Delete coverage for elective surgeries. Want less savings? Increase coverage and drop co-pays/deductibles.

As a health care consumer, I want as much 'health care' as possible for my family. The provider wants to provide as much as possible (in order to earn profits). The one in the middle, trying to balance the needs, is either the insurance company (currently) or the government (and won't they do a great job balancing needs/costs).

The Canadian provincial system is breaking down, and the aging of population in Europe is putting extreme pressures on health care and the rest of the social programs previously embraced. I don't know what the answer is, but we've got to get usage under control, otherwise we're just moving the deck chairs.

I read a study a few years back (I'm looking for a link) that said something like 85% plus of all health care dollars are spent in the first and last year's of an individual's life. Try putting the squeeze on the end of life costs, or the neo-natal costs, then you will hear some screaming.

Anonymous said...


What does it say when he won't hold a public forum and answer questions from CT Democrats?

Here's my question for Joe:
Will you die a Proud Democrat?"
If Lamont wins in August, will you endorse him? Or, IS IT ALL ABOUT YOU?

turfgrrl said...

I think Canada is a poor choice to use an example, as is Great Britain. The system to look at is France.

For one, the French system, although single payer, is structured to allow for private insurance and private medical care for things like plastic surgery and other things not considered a medical necessity.

What makes the system work is the abundance of clinics, that handle the routine stuff at regulated prices. If you walk to such a clinic, and get treated for something like a broken arm, you get billed directly (approx $200) and your paperwork is submitted to the government which then determines the coverage amount. In this simple case, it would generally be 100%. Unlike our free for all system, which if you are uninsured and go to an emergency hospital you can see a bill for approx $2000. If you are insured, and the insurer decides you don't need a referral you fill out tons of paperwork and find that your broken arm used 100 services that totalled $1000, of which your insurance company will pay 80%, or 60% if its out of network.

Germany has a similar system, and other countries run similar variations. And if you look at our VA hospital system, you see similar practices that work, so it's not a wholly new concept.

The thing is that our present system is inefficient, costly and broken. There is no incentive to provide health care, its all about treating conditions. A healthier population will ultimately cost less over time. Every study on our healthcare system shows that 80% of our healthcare costs go to the last 20% of a persons life.

Healthcare should be as important to national infrastructure as electricity.

Any changes to our system have to begin with price regulation on basic medical services.

For more details in an academic format: here.

disgruntled_republican said...

Canada is a horrible example. While we may go there for drugs, they come here for medical services because their system cannot handle the burden and is not as advanced as ours.

Malpractice Insurance reform should be priority number one. Once that is done, follow up to assure DR's lower their rates making expenses more manageable. Once that is accomplished THEN we should look at a way to pay for everyone.

Simple answer: it aint gonna be easy.

Anonymous said...

Malpractice insurance, while expensive for doctors, is only a tiny fraction of the overall cost of healthcare.

Anonymous said...

Lieberman led the charge on the Dem side to kill Hilarycare and will try to kill any Universal Healthcare proposalbecause he loves the fat checks he gets from the insurance industry.

A few Brave nutmeggers even got arrested in his Senate office trying to expose Joe for the Corperate whore he was even back then.

Anonymous said...

Every discussion of healthcare immediately goes to costs and ignores the moral issues. We have to start with the fact that it is simply not acceptable for anyone to be without health care. If somebody doesn't want it, that's their choice, but everybody who wants to participate in the system should have access. The top priority must be to supply coverage to every person.

On costs: We'll save money by providing preventative over emergency anyway. Universal healthcare is in our future at some point. If it is nationalized, Connecticut is going to end up putting in a lot more money than we would if it is a state program because we are a federal donor state.

We already have a ton of public healthcare systems. If universal healthcare is a Euro-sounding idea, then patchwork public/private/non-existant healthcare is the US system. We have Medicare, Medicaid, (Husky), (ConnPACE), VA, Military Tri-care, MEHIP, SEHIP, FEHIP, "free" clinics, gauranteed ER care... did I miss any? We've pretty much agreed that for many groups in society, market-based insurance doesn't work. Universal health care would actually be a small step forward.

Anonymous said...

Anon 303 -

Hillarycare was flawed from the get go and she even admitted herself that it was far from perfect...I tried to find the article but was not able to. I have it somewhere...when I find it I will post it for you

disgruntled_republican said...

Anon 313 -

You start your post with "Every discussion of healthcare immediately goes to costs and ignores the moral issues."

I thin morally we all agree that everyone should have access to affordable medical services, that's a no brainer.

I will not, however, support doing that at the cost of billions of dollars in start up monies to our country, nor would ANY politician in Washington. A middle ground must be found, but what is it? That is a debate that needs to happen and needs to be more than a the Health Subcommittee of the US Senate.

You cite numerous "groups" that a currently part of a public healthcare system..true, but at what cost for them add in 3/4 of the American people...what do you do now?

Anonymous said...

Your pie in the sky ideals of socialized healthcare are a joke.

It is the incentivizing of healthcare that provides for the access and quality that we enjoy in this country. Remove the monetary incentives for healtchare professionals and providers and say good-bye to high quality healtchare with access to specialization.

I might also suggest that the international community relies on the breakthroughs/research of capitalist healtchare systems to "piggy-back" this quality to there own citizens.

Brass Anon said...

I have generally been opposed to malpractice reform because I believe it can be harmful to people who suffer injuries. However, the discussion of malpractice reform always centers on caps on damages. Reform does not need to be about caps. It can include proof requirements, and damages could perhaps be adjusted depending upon the degree of culpability.

My point is that I find that doctors, at least in my experience, tend to over-prescribe medications and tests in order to ensure that a malpractice claim does not arise. That drives up costs. The cost of malpractice is not in the insurance, it is in the excessive use of medicines and procedures that are otherwise unnecessary, but become necessary as a defense against malpractice claims.

I also think that we need to make consumers responsible for a portion of the cost of health services so that they can self-ration the resources. If a pill is free for me, I'll get the prescription filled. If the pill is going to cost me $50 or $100 a prescription, maybe I'll look for alternatives.

I think Health Savings Accounts, coupled with high-deductible plans might be capable of achieving this market effect, without the downside of government-run medicine.

CGG said...

One thing I like about Ned Lamont is that he's talking about this. Every time I've heard him speak healthcare has come up. Sadly as a Senator I don't think there's much he could actually do to bring Universal care to CT or the US.

Anonymous said...

Anyone who thinks that we have a purely capitalist health care system (this means you Anonymous 4:07) should wake up and read the Bayh-Dole Act. Billions in tax dollars go to private universities and private companies to fund medical research, which is then turned into private profit. We already have a hybrid public-private in which we subsidize private industry. Yet 47 million Americans are not benefitting from this arrangement.

bluecoat said...

Medical malpractice kills between 100,000 and 200,000 Americans every year. I'm all for reforming the system and a couple places for reference for how to do that are here at the IOM and here at Healthgrades or here for the CT Center for Patient Safety.
I hope you are not going to start on blaming the lawyers there, disgruntled, because CT is by no means Madison County Illionois - in CT our system is clean. It is a states rights issue and CT does it just fine but the insurance companies are screwing the docs and one of them in CT is owned by docs who are screwing docs as you can see here

bluecoat said...

Brass anon you said The cost of malpractice is not in the insurance, it is in the excessive use of medicines and procedures that are otherwise unnecessary, but become necessary as a defense against malpractice claims. but none of that stuff has ever protected a doctor from a med mal suit. A med mal suit is about negligence or incompetence. In CT you effectively can't even file a complaint without another doc looking at a file to see if it was bad medicine - and last year the state reuired that the plaintiff's attorney even file the name of the reviewing doc with the suit to further aid the doctors in their defense of a suit. All this crap about frivilous suits is just that. The medical societies and the insurance companies their members own have spent a ton of dough in CT and around the country to confuse the issue. All you have to really do to become a doc is pass organic chemistry in your sophomore or junior year. They have no business sense and that is why they think it is the lawyeres screwing them

Anonymous said...

Instead of talking about France, Canada, or GB...why don't you all just MOVE there?

Anonymous said...

If you think a single payer system will do anything besides causes thousands of layoffs in the private insurance industry, might I interest you in a bridge in Brooklyn.

Might I suggest one acquaint oneself with TennCare before suggesting a single state try some radical health care experiment

"While intended to help people, today’s Tennessean provides another clear example of how mismanaged Tenncare was . . . The Tennessean says:

Rates charged by lawyers working to limit TennCare — as much as $350 an hour — make enrollees such as Rosalie Huff, 62, of Nashville, bitter.

“$350 an hour is ridiculous, it’s just ridiculous,” said Huff, who remains on TennCare but cannot get all the drugs she needsbecause of new prescription limits — a limit won by the attorneys in federal court.

“They’re paying the lawyers and what about people on TennCare? Lawyers should have gotten $120 per hour and given that other $200 to people on TennCare who really need it.”

Some lawmakers say they’re reserving judgment on those costs.

Are you kidding me? You start a program to manage health insurance for folks not covered under Medicaid and THEN you fail to manage the costs of the program across the board. You pay lawyers $350/hour. This is not only poor management. This is criminal. The individuals who have developed this Tenncare Leviathan should be held accountable.

But, this is a great example for - not only this state - but this nation. If you don’t have the money or a game plan, DON’T START ANOTHER GOVERNMENT PROGRAM. With no end in sight, we initiated this program in the ’90s with no game plan. We simply threw money at a problem. History has shown that throwing money at a program will NEVER work - not without clear directives and effective management.

Yesterday, Bredesen declared another band-aid solution to this problem. But, keep in mind that it is just that . . . a band-aid. Not a fix. And, until we get to the root of the problem . . . poor management and unsound fiscal practices . . . you cannot save this flawed program that is destined to be plagued with failure. "

November 10, 2004
TENNESSEE'S DEMOCRATIC GOVERNOR PHIL BREDESEN plans to scrap the state's TennCare medical program as too expensive. TennCare was a testbed for HillaryCare, and a model for Kerry's health care reform plan.

Anonymous said...

I am shocked! Aghast!

Colin is having Lamont on his show.... soon he'll have to have a disclaimer when he signs off.... "This is Ned Lamont, and I approve this message"

MikeCT said...

Go Genghis! Now there's a bold proposal that gets to the root of our health care access and cost problems! I have not kept up on single payer advocacy in several years, but (apparently catching Genghis vibes) just yesterday thought about joining Physicians for a National Health Program, which does the best and brightest work on this subject. (You can join as a non-physician.) As in the early 90's, this issue will cycle around again to a state of desperation, and I think we'll be talking soon about universal health care and fundamental reforms.

Some reasons we need single payer (stats mostly from around 2001-2003):

* Every industrialized country provides for universal health coverage for their citizens, except the U.S. This is the shame of our nation. All of them spend less than we spend.

* Canadians live longer than Americans, have lower infant mortality,free choice of doctors, report less difficulty getting care. They cover all their citizens, and pay HALF of what the U.S. pays in health care costs. Yet we leave 46 million Americans uninsured.

* Because of the massive complexity of a multipayer private system, the vast amounts of paperwork and staff needed to manage billing systems and limit the provision of health care, and the need to subsidize huge profits for health plans, the U.S. pays $1,442 per person for administrative costs vs $418 for Canadians. Eliminating this massive, wasteful overhead provides the greatest savings.

* It's good for business and would vastly expand job creation. U.S. employers pay 8% of salaries for health benefits, compared to 0.6% for Canadian employers. U.S. employers could increase pay and add new employees with the savings. 40% of small business owners in the U.S. say they would support a taxpayer financed national health plan.

* Canadians don't need to come to the U.S. for care - the problem is the opposite. In a survey of 18,000 Canadians, a total of 20 came to the U.S. to get health care. 40% of U.S. health facilities near the border treated no Canadians in 2001 and another 40% treated less than 1 per month.

* There are wait lists in the U.S. - about 1/3 report waiting more than 3 weeks for checkups, or more than a week when sick.

* Some other countries have wait lists for elective procedures because they spend much less than we do. We could afford a system with no waiting lists and better quality than anywhere else in the world (while still spending less than we do now).

* Most Americans polled would prefer a universal taxpayer financed health plan to our current one and believe the Canadian system works better than ours.

Some resources:

Physicians for a National Health Plan

PNHP Powerpoint (source of most of stats above)

Single payer myths & facts

Why the US Needs a Single Payer Health System

CT radio interview with PHNH co-founder Steffie Woolhandler

More video and audio of Woolhandler

CT Coalition for Universal Health Care

Fortunately, Chris Murphy is a single payer supporter, which has earned my respect more than anything else he said or done. You can't get to the right solution without correctly diagnosing the problem, and he understands the problem. Our health care crisis is primarily one of political leadership and courage.

SB 482, the CT single payer bill was approved by the Human Services Committee (9-4) and has gone to Appropriations Committe. If your legislator is a member, please contact them.

AB said...

Lets see.....according to the statistics, 89% of the Connecticut population has adequate health insurance. nationwide roughly 85 percent of the population has some form of health insurance. So rather than address the 10-15 percent who do not, we will scrap the whole system and screw the 85 percent who do. Okay that makes sense to me.....and you wonder why Americans are throughly fed up with the democratic party in this country? Becuase it caters to the minority and the extremes rather than the majority of the population. is there a health care problem yes....can government fix it? No.....Free industry is behind every major innovationa and initiative in this country. Who do you think deoas the billiosn of dollars in medical research? The Government? Uh no...private industry. look around the world, wherever citizens rely on Government for health care, folks are flocking in droves to the US to receive adequate healthcare. The reason is simple, single payer, state run, socialistic healthcare doesnt work....simple...end of story.

Anonymous said...

Perhaps all the dreamers out there are fogetting something.


A single state single payer will draw hordes of sick people in from acorss the country ( and you can;t keep them out...see the U.S. Constitutions "right to travel").

meanwhile, the massive tax hikes required to pay for a program which will grow exponentially
(like all other government funded health programs have) will drive productive businesses out of state.

I don't know who will pay for all of 1199's pay raises then. I do not think we will be able to send the bills to the feds for our follies

Anonymous said...

anyone know what happened to Aldon Hynes?

Anonymous said...

Last I heard, Aldon was trying to get a job with the Lamont campaign. Is it time for an update. Aldon, how many hats are you still wearing?

bluecoat said...

Tenncare was not the model for Kerry's plan to incrementally fix the current system nor was it Hillarycare but maybe Kerryguy or somebody else can stand up for Kerry.

Anonymous said...

The French system as an example? That's insane. The last time I heard about the French health care system was about 2 years ago when 15,000 patients died because all of the staff was on vacation. No thanks.

As for the bigger issue of universal health care for Connecticut, forget it. As a business owner, I wouldn't trust anything that this legislature does. If they're claiming this will save me money, then I'm certain John Rowland will be our next governor. This state is already bad enough, but the moment this happens, I move my business out of state.

bluecoat said...

G.C.:just so you know this guy Battista is a psychiatrist; probaly the kookiest branch of medicine or as Tom Cruise branded it pseudoscience. They won't own up to all the damage they have done by overmedicating the poulace in the last ten years fattening the profits of Pfizer, Lilly and the rest of the Prozac nation drug dealers.

Anonymous said...

Why is health insurance - which is what this discussion is all about - always tied to "employers?" Why shouldn't everyone - EVERYONE - pay for their health INSURANCE coverage?? If everyone did, it would be cheaper for all of us because of something called "competition." - and would allow us to help those who can't pay.

Let's grow up folks - we pay for every other kind of insurance - why can't we decide what health insurance coverage and pay for it and take it away from large, employer-type plans?? COMPETITION!

bluecoat said...

anon; you almost have it right but the AMA and AHA have a monopoly going on so that needs to be busted up to get any real competition going. Unfortunately, right now the GOP is sleeping with these people and it is a much bigger problem than the drug issue, which is 10% of the total bill. The AMA and AHA effectively control 80% of how the healthcare dollar is spent regardless of who is paying. They've managed to double their take of our GDP since LBJ was in the Whitehouse and that's despite all the innovation and technology that you would expect would lower that #.i

bluecoat said...

on the issue of frivolous med mal lawsuits, this speaks for itself here.
What he doesn't say, or doesn't understand, is that it is most often the insurance companies, not the plaintiff's attorney, that brings in everybody under the sun on a liability suit and then it takes all of the named parties time to sort it out.