September 30, 2002

6:30 PM

If you can spare a moment from histrionic rhetorical arguments about far away places you have no real experience with to involve yourself with practical ways to stop the trend toward a fundamentalist totalitarian corporate dictatorship in this country and step by small pragmatic step reclaim democracy, a good first step is to support Oregon's Measure 23, to promote comprehensive universal health care using a single payer public finance mechanism, or support healthcare for everyone in your state.
posted by semmi (37 comments total)

Great links. Thanks for the info.


Forty one million Americans currently have no health insurance. 41,000,000!!!!!!
As a nation, we should be ashamed.
posted by EmoChild at 6:44 PM on September 30, 2002

It's a nice idea, but didn't Bill Clinton try this (a guy I've agreed with 99.99999% of the time) ? Where's the $$ comin' from?

I think a plan like this is more workable.
posted by owillis at 6:50 PM on September 30, 2002

Please explain, precisely, how doubling my state income tax (I'm an Oregonian) to pay for shitty state-administered healthcare is going to "reclaim democracy." Ah, yes: the efficiency of the DMV, and the compassion of the IRS. *THAT'S* who I want deciding what medical care is funded.

Perhaps if state and federal government agencies would stop mandating what coverage people "must" be offered, people could once again afford the coverage they want. At least, that's how it worked way back when a contract was a contract . . .
posted by wdpeck at 7:18 PM on September 30, 2002

semmi: you have no real experience with

So are you just an M.D. or a PhD? Which HMO do you run?
posted by skallas at 7:18 PM on September 30, 2002

That link doesn't work for me, but this does: http://www.healthcareforalloregon.org
posted by dash_slot- at 7:21 PM on September 30, 2002

Isn't shitty state-administered healthcare better than none at all?

What percent of income is taxed by the state in Oregon? How much is this going to cost the average taxpayer versus what the state spends on public hospital and emergency room care for those currently uncovered?
posted by amberglow at 7:30 PM on September 30, 2002

Our state-run schools and universities here in the state of Missouri have all but shut down. Our governor (most people call him One-Term Bob [Holden]) did a terrible job writing out our budget. We now have new sports stadiums and other silly, unneeded things instead of sufficient money to keep our schools running.

What happens when we turn over our healthcare to these political idiots? What happens when I need my appendix removed and the state can't afford it because the Rams need a new stadium?

No, thanks. I'll continue to WORK so I can PAY FOR MY OWN INSURANCE so I can get any medical attention when I need it.
posted by mychai at 7:31 PM on September 30, 2002

I'll continue to WORK so I can PAY FOR MY OWN INSURANCE so I can get any medical attention when I need it.

Let's hope you don't suffer the kind of injury or disease that stops you from working, then. Or get laid off, ever. So I'd recommend you never leave the house again. And perhaps lock yourself in a secure and well-ventilated wardrobe. Can't be too careful, can you?
posted by riviera at 7:35 PM on September 30, 2002

Or maybe you could just vote for single-payer because it's a good idea, not because a loudmouth with little sense of proportion told you America would go Fascist if you didn't.
posted by dhartung at 7:38 PM on September 30, 2002

i'm all for single-payer health insurnace, but it seems pretty infeasible at the state level, given the limited financial resources. the feds have all the money, so why not make them shell out the cash for universal coverage?

this is such a no-brainer. health care is eating up an ever growing share of our GDP, and quality of care actually seems to be getting worse rather than better. All that money that corporations are shelling out to poorly run insurance companies with high overhead could be going towards a far more effecient gov't run plan. (it is a little known fact that Medicare is probably the most effecient health insurance plan ever created, with an overhead of about 2%, compared to 15-30% overhead for your average HMO plan) Hell, currently insured workers would probably actually get a raise out of the whole deal since the companies would probably have to pay less to the government than what they are currently paying to the HMOs. Any economist worth his salt will tell you that the money that companies pay to HMOs for employee coverage comes mostly out of what would otherwise be employees wages.

A government financed system could inject some much-needed rationality into a totally out-of-control sector of the economy.
posted by boltman at 7:41 PM on September 30, 2002

The two complaints about single payer are of course:

(1) increased taxes necessary to pay for the thing

(2) stiffled innovation and quality of care

My own responses are:

(1) How is paying the premium in your taxes to a single entity worse than paying a premium to a private company? In theory, premiums should become optimized in the largest possible risk pool (everybody).

(2) I can't see how a pure single payer system would stiffle innovation. If you had a pure single payer system -- where the single payer entity does NOT actually run any practice or health care providing services, it just manages the risk pool -- individual health care providers are still free to practice whichever sort of medicine they wish, and consumers are still free to make choice of which health care provider they use. The single payer writes checks to the providers, balances premiums and stats to keep the pool going, and people get health care. If one provider comes up with an innovative method that works better, more people will patronize them, the single payer will write them more checks, and market forces work.

Now, my understanding is that the practical reality is somewhat different... I have several friends who have given me stats about the Canadian system that aren't encouraging. Unfortunately, they weren't able to give a source beyond Rush Limbaugh, who has the credibility of processed cheese. Does anyone have links available to credible sources on Canadian health care? Does anyone know if the system is pure single payer, or if the government starts actually dealing in running health care providers?
posted by namespan at 7:50 PM on September 30, 2002

EmoChild: Forty one million Americans currently have no health insurance. 41,000,000!!!!!!

It gets worse: Half the bankruptcies in the US are due primarily to medical bills.

In a way we are socializing medicine. If your local healthcare network is short a few tens of million dollars because of these bankruptcies then the prices have to be raised or the benefits lowered to make up the difference. We would be a lot better off with a real social program or a uniform rate system which would keep people from going broke. Its really in everyone's interest to keep each other from going broke. Eventually the books must be balanced, Arthur Andersen not withstanding.
posted by skallas at 8:10 PM on September 30, 2002

to pay for shitty state-administered healthcare is going to "reclaim democracy." Ah, yes: the efficiency of the DMV, and the compassion of the IRS.

wdpeck, you may want to consider that a single payer system does not necessarily imply that the state administers health care themselves. All a single payer system really implies is in its name: there's one risk pool that's managed by a single entity. There can be any number of private health care providers doing their best to provide service. They still have to compete on quality of service to recieve dollars from you and the single payer.

So everyone, repeat after me: single payer does not imply state run healthcare. Somebody may try to tack it on, and it's probably a bad idea if they do, but don't confuse the two concepts.

And as for heartlessness and inefficiency -- don't imagine for a second that our famed and champion system of private enterprise is the paragon of care and thrift. I'm just about through with my own nightmare of trying to buy insurance independently. I spent about 8 months just trying to find an insurance policy that (a) doesn't suck and (b) has national coverage so I don't have to re-enroll when I move. More than half the people I talked to said there is no such thing. There actually are about three policies that I turned up, but two of them suck.

Now, during that time period, I bought short term health insurance from a local agent. Good thing, too, because I got pretty ill shortly thereafter. Of course, that made the insurance company highly suspicious, and so they're still conducting an investigation into my medical past with the speed of a stunned sloth, and I'm holding the bills from four doctor visits, an ultrasound, and lots of labwork. There is no "pre-existing condition" to find, so they won't find one, but they keep dragging it out, refusing to ask for all medical records at once, but requesting them piecemeal, one small period of time about once a month. And of course they get my premium.

Fortunately, I've got a permanent policy that I started underwriting on mid-August. They're just about done with the process -- I'll have a nurse come to my house and take some blood, urine, and other readings on Wednesday -- but they've informed me the policy won't start until the first of the month following the month in which they recieve all this. OK, it'll be November 1st before I'm covered. This for major medical only. I don't get subsidized doctor visits or drug benefits.

My experience with the IRS, by the way, has always been pretty good. I get my refunds back inside of 2-3 weeks of filing. When I've called their question line, I've actually recieved timely help and (sometimes) unexpected additional advice that has saved me hundreds of dollars (I kid you not). I am much more impressed with the government than with private insurance. The only positive experience I've ever had with private insurance was at university -- the system there was very, very good and so was the university underwritten health coverage. Too bad I can't get that for life.
posted by namespan at 8:13 PM on September 30, 2002

This is too rich to pass up.

" ... If you can spare a moment from histrionic rhetorical arguments about far away places you have no real experience with to involve yourself with practical ways ..."

Helluva opening salvo ... and even though I have been to the middle-east, and haven't been to Oregon, maybe I'll take a shot at responding to your histionics anyway ...

" ... to stop the trend toward a fundamentalist totalitarian corporate dictatorship in this country and step by small pragmatic step reclaim democracy ..."

Or at least to replace it with a fundamentalist totalitarian socialist dictatorship.

" ... a good first step is to support Oregon's Measure 23, to promote comprehensive universal health care using a single payer public finance mechanism, or support healthcare for everyone in your state."

Some people think this is a good idea. Others, however, do not. It is very easy to be compassionate with other people's money.

The financing is proposed as:

This plan will have three sources of financing:

Current expenditures by federal, state, and local governments will provide more than a third of what will be needed.

A progressive tax on employers’ payroll will replace current insurance premiums paid by employers. The percentage ranging from 3 to 11.5% will depend on the size of the payroll, with only the largest corporations paying the highest percentages. Self-employed individuals will be exempt.

A progressive personal income tax will replace most personal health care spending: premiums, co-pays, deductibles, and out-of-pocket expenses for such items as prescription drugs, glasses, mental health, and alternative care. The rate will be between 0 and 8% of taxable income. Families at or below 150% of the federal poverty level are exempt.

This will likely lead to:

Year 1: Warm compassion spreads throughout the land. The "rich" - both individuals and corporations - largely pay for it. This is considered "just". And they are told they are selfish if they complain. It's just their "fair share".

Year 2: Oregon discovers that some of the rich seem to be leaving, and that those large companies seem to be quietly re-entering numbers into their cost/benefit calculations. Large companies with low profit margins simply decide to leave. Which means more people are unemployed. Additionally, it will trigger those from the rest of the country who have no jobs, but have expensive health conditions, to begin migrating - i.e., fewer and fewer will be paying the health care costs of more and more.

Year 3: The nonprofit Health Care Finance Board administering the thing is supposed to "negotiate compensation with health care practitioners and facilities, and will establish quality control and cost containment programs. Costs will be controlled by establishing a global budget, capping administrative costs, and negotiating the purchase of pharmaceuticals."

Yipes! It will start doing so. All sorts of established physicians and new doctors coming out of medical school will certainly flock to Oregon, now won't they?

Canada probably will benefit however - as the Canadian doctors that left Canada (due to the same system) and are practicing in Oregon will very likely begin finding their way back ...
posted by MidasMulligan at 8:17 PM on September 30, 2002

everyone knows that as soon as america or any state gets a universal health care system, its only a matter of weeks before americans figure out how to exploit it to the point of being coutnerproductive.

posted by oog at 8:22 PM on September 30, 2002

namespan: the government in this country already regulates health care institutions like hospitals and nursing homes pretty comprehensively because large health care institutions (also where most "innovation" takes place in health care) are more addicted to Medicare and Medicaid than a crack addict is to, well, crack. Government pays, thus government largely dictates how these facilities are run.

The dirty little secret of the U.S. health care system is that over half of all health care spending in this country is paid for by none other than Uncle Sam. We already pick up the tab for most of the sickest people in our population (aka, the elderly and disabled) through Medicaid , Medicare and the VA Hospitals. We also fund a huge chunk of all the social useful health care research in this country through NIH. (Private companies usually only get involved once government-funded scientists at non-profit research hospitals and universities have already done most of the heavy lifting.) So it really wouldn't be such a dramatic change to institute universal coverage.

One final point: the US spends something like $4,000 per capita on health care. Other industrialized countries with government financed health care (like Cananda) or government administered health care (like Britian) spend roughly half that per capita and they manage to cover 100% of their population! So, assuming that a U.S. single payer system would maintain its current level of spending per capita, one would assume that the quality of care in the US would be correspondingly higher than our more stingy neighbors.
posted by boltman at 8:28 PM on September 30, 2002

More precisely, the U.S. spent $4,187 per capita on health care in 1997. That's compared to $1,303 in the UK, $1,783 in Canada, and a whopping $2 per person in Afganistan.

Source (PDF, chart is on page 50)
posted by boltman at 8:47 PM on September 30, 2002

Boltman...here's the thing with state-administered health care, Britain style:

Think of the number of people from around the world who come to the US for healthcare. It's a lot, because it's the best.

Think of the number who go to Britain.

There are certain problems with all existing healthcare systems, state-run or not. The balance just needs to be weighed to see which is 'less bad'.
posted by Kevs at 10:05 PM on September 30, 2002

Think of the number of people from around the world who come to the US for healthcare. It's a lot, because it's the best.

Think of the number who go to Britain.posted by Kevs at 10:05 PM PST on September 30

Got any links? My reading of UK papers indicates quite a few overseas patients come here. Are you running on prejudice, maybe?
And I'm not claiming the UK to be the best: many come for private - ie, self-funded - treatment. Which is fair comparison, as I doubt the number of pro-bono ops done in the US is higher proportionally than in the UK.
posted by dash_slot- at 10:09 PM on September 30, 2002

Namespan:

I'm not talking about "single-payor" systems in general; I'm addressing the Oregon initiative in particular. Per their representative, speaking live during a radio talk-show interview last week, their precise proposition is to be the sole source of medical insurance for all Oregon citizens. To "administer" is to perform administrative functions; I did not claim they wanted to be health care providers (which is an even more frightening thought...).

Basically, what they propose is a mandatory statewide system like our current Oregon Health Plan, the wildly-fraud-ridden, inefficient, and bankrupt plan to administer federal Medicaid funds. When it was first proposed about 10 years ago, it was "promised" that it would "never" increase to more than about 3% of the state budget; it's now at 9%. The Measure 23 proposal mimics most of the bad parts of OHP, while offering really nothing of value to anyone who has even the most basic individual, group, or association policy now.

I hate to bandy about such a term, but it really is simply a redistribution of wealth under the guise of providing "healthcare for all." If they *really* wanted to provide "healthcare for all," they would go about reforming the sloppy and bloated OHP system we already have. Estimates are that the dollar loss due to fraud alone is around $2 billion per year. Another way of putting that is to say that's about $5000 per uninsured Oregonian per year ($2B divided by 400,000, their estimated number of uninsured Oregonians) -- and I could buy one hell of a private policy for that kind of premium.
posted by wdpeck at 10:33 PM on September 30, 2002

wdpeck:

Single-payer health insurance offers many benefits to everyone.

Patients all have health care. They can see any doctor they want, and don't have to rely on emergency care services, which are incredibly expensive. Can you see any physician you want?

Doctors are rarely questioned about their practices, as opposed to today's system, where a non-medically trained administrator makes medical decisions for them. And doctors' practices and costs can be improved, because their billing can be analyzed and feedback can be given to them.

Employers save money, because the system saves money, so their health care costs (which are just state taxes) decrease. Kraft just recently moved its Michigan plant across the border to Canada. Why? They can pay their workers less, because Kraft doesn't have to pay for health insurance. The Canadian Auto Association (can't find a link) just came out in support of Canada's single-payer system, because it keeps their costs lower than their American counterparts'.

The Lewin Group has done several studies on single-payer national health care, (Vermont and Maryland) showing that the savings to the state (and to its residents) would be in the hundreds of MILLIONS of dollars.

HMOs spend between 10-30% of every health care dollar on administration. Paperwork. Medicare? 3%. Even with a single-payer system, which might bump the administrative costs up to 6%, you stilll save MILLIONS. Doctors bill one entity. There's one form to fill out. One. You go to your doctor, you give them your health care, that's it. You don't see a bill. Doctors don't have to employ expensive billing systems, so their costs are lower. Just fathom, just for a second, what it would be like. You don't have to wait for 30 minutes to speak with your HMO about a claim, or a change in your primary care physician. You don't have to worry about getting sick if you're one of the 40 million Americans without health care.

It works in Canada, Sweden, Denmark, and countless other places. Why, again, wouldn't it work here? Americans are too different from every other nationality?

Owillis: Clinton claimed to try something like it, but just like Cheney and energy policy, he got answers from the wrong people. The Clinton program was guided by the insurance companies in the US (who are the only losers in the single-payer system). It's no surprise the health care industry won the award for spending the most on corporate lobbying last year.

To all the non-believers: Where did you learn that the British system is terrible? Or the myth that Canadians have to come to the United States for treatments? Most of the time, it's from ads that aired during late 90s, when talk of the Clinton health program started rumbling.
posted by gramcracker at 11:29 PM on September 30, 2002

just the phrase "practical ways to stop the trend toward a fundamentalist totalitarian corporate dictatorship in this country and step by small pragmatic step reclaim democracy" is enough painfully naive pseudo-intellectual crap for me to vote against whatever the author is endorsing. heh.

but anyway, about government run health care, england is currently considering moving to a partially privatized system like the US has because their health system is going down the toilet.

canada is also in the midst of a huge health care crisis also. http://www.cbc.ca/national/magazine/health/ has more info about the problems with canada's health system.

it's really not hard to find this stuff... are any of you people claiming that canada and england's health systems are working, actually looking around and talking to people there?

sheesh.
posted by wrffr at 1:20 AM on October 1, 2002

also, suggesting that medicare is the solution, is pretty entertaining.

lots of doctors have had to refuse to accept patients using medicare, because medicare doesn't even pay enough to break even on raw costs. doctors lose money for each medicare patient they see.
posted by wrffr at 1:24 AM on October 1, 2002

Kevs: Think of the number of people from around the world who come to the US for healthcare. It's a lot, because it's the best.

Think of the number of people within the US who can't afford their own healthcare. It's a lot, because it's the most expensive, with the highest overheads, and the greatest barriers to entry.

Think of the number who go to Britain.

Think of the number within Britain who go without. It's not many. Just to show the distance by which you've missed the point is measured in light years, Kevs. It's a complete non-sequitur. It has no bearing on the argument at hand. Lots of people go to Aspen, Colorado for the skiing, but that doesn't mean that everyone in the USA gets to ski.

wrffr: england is currently considering moving to a partially privatized system like the US has because their health system is going down the toilet.

Well, that's a lie for a start. The PFI will entail private companies building hospitals, that are then sold back to the government on a lease-to-buy basis, but the system will remain entirely in public hands, and free at the point of use. So you can violently fuck the fuck off with your misleading talk of it being 'partially privatized'. Not even the Tories support that.

are any of you people claiming that canada and england's health systems are working, actually looking around and talking to people there?

You are now. And it's working fine, especially compared with the horror stories on the other side of the pond. Are you listening to people there? I have my doubts.
posted by riviera at 6:04 AM on October 1, 2002

Wow, wrffr, you really know how to assume things without understanding any of them.

The Canadian and British systems are completely different. One is socialized medicine, the other is socialized insurance. You can't compare the two.

And you obviously know NOTHING about a single-payer system. It's not US medicare. In medicare, the government dictates reimbursement prices for doctors. In single-payer, doctors negotiate with the government for reimbursement. When national health insurance was initiated in Canada, physicians' incomes increased 30% the following year.

And did you ever think that Canadians and the British might understand health care "crisis" differently than Americans? Take away those countries' health systems, and THEN there will be a similar crisis situation. Fact is, the UK and Canada both spend proportionally smaller amounts of money than the US on health care, they cover all their people, and have lower infant mortalities--an important health indicator. Do some research on the subject before you post your ignorance.
posted by gramcracker at 7:26 AM on October 1, 2002

Doctors are rarely questioned about their practices, as opposed to today's system, where a non-medically trained administrator makes medical decisions for them. And doctors' practices and costs can be improved, because their billing can be analyzed and feedback can be given to them.

gramcracker, while I appreciate your other points, I think that realistically, single payer would also have to have some sort of utilization review to to be cost effective. A big part of the argument for putting government in control of financing is so they can ensure that the care being prescribed is actually worth the money for the patient. The whole point of managed care is that doctors have no incentive to manage costs, so they are going to spend like crazy unless control by an outside force.
posted by boltman at 7:43 AM on October 1, 2002

it's really not hard to find this stuff... are any of you people claiming that canada and england's health systems are working, actually looking around and talking to people there?

Sounds like you forgot about the internet, & MeFi, being international. I am British. I'm in Britain. Im lucky, in that at my practice, if I want a non-emergency appointment, i get to see one of the 5 Drs. in 24 hours or less.

sheesh [yet another example of an american being arrogant].

Over the last few years, i have seen consultants [specialists], physiotherapists, practice nurse [she froze my warts off] and osteopaths. I didn't pay a penny up front, only in taxes. I receive healthcare free at the point of delivery.

It's just that the point of delivery can be delayed: thats tha trade off. If I want, I can buy Health Insurance on top of that [something less than 10% do, I believe], skip the queues and get treated, sometimes by the same surgeon, specialist, whatever, or take a job with that as a perk.

But like me, many folk have an ethical problem with that: why should wealth entitle me to a better health service?
posted by dash_slot- at 8:10 AM on October 1, 2002

If I ignore all the overheated rhetoric in this thread, it seems there are better arguments for universal coverage than against. One compromise that I am surprised is not talked about more is the idea of a hybrid system with the government paying for say 80% of a patient's bills, with the remaining 20% to be paid by private insurance, out of the patient's pocket, or whatever. At the public hospital I work at we collect roughly 30 cents on every dollar we bill because we are the hospital of last resort for most of the uninsured patients in our state. Because of this we are run on a shoestring budget and have to raise our prices to insured patients in order to shift costs to them; this in turn makes us less competetive compared to the private hospitals that turf their uninsured patients to us. It would be a huge change for the better if every patient who walked through our doors could pay 80% of their bill courtesy of a single payor.
posted by TedW at 8:32 AM on October 1, 2002

TedW: One reason the private/public compromise you're talking about isn't talked about much by policy wonks is because it would erode or not provide for universal health care. One central tenet of NHI is that there should be no financial barriers to health care. If you require 20% of every dollar to be paid by private insurers, there's still a good number of people who won't be able to afford care.

Boltman: That's a point I struggled with, and I'm still struggling with. The best way that I understand it is the fact that most health care costs come from hospital visits and expensive technology and procedures, not outpatient doctors' bills. In a single-payer system, all the doctors can be checked for anything out of the ordinary, which gives a great way to check for fraud or malpractice. If, of the 5,000 doctors in a particular area are requesting on average, 50 blood cultures a week, and one other doctor is requesting 150, the system can immediately see where fraud or malpractice might be taking place. It's much harder to do in a fragmented system, where people don't share numbers or data. The only data the US can use to understand its health care system is Medicare/Medicaid data, whereas other countries can evaluate data of their entire population.

Another way it has been explained to me: Doctors want to achieve a certain level of income, whatever that may be. They can, at some level, decide how busy they want to be. If a doctor's practice is going slow, he or she may tell a patient to come back for multiple followup visits--because he or she can charge the insurance company for each visit. If the practice is busy, and he or she is seeing a high volume of patients, the doctor may only request one followup appointment, or none at all. (This is of course assuming the doctor is confident in the patient's health.) In NHI, doctors can see a greater number of patients, and still achieve the same net income--especially with their lower administrative costs.

Even to me, it seems too easy to cheat the system, but I haven't seen much evidence of it being a problem in any country where single-payer health care exists.
posted by gramcracker at 9:03 AM on October 1, 2002

Or the myth that Canadians have to come to the United States for treatments? Most of the time, it's from ads that aired during late 90s, when talk of the Clinton health program started rumbling.

In my case, it came from living for awhile in Montana, and knowing some folks who worked at a hospital just across the border from Canada. close to a third of their patients were Canadians.
posted by MidasMulligan at 9:52 AM on October 1, 2002

I am one of those 41 million Americans without health insurance. I am also having surgery on Friday. My thoracic surgeon told me that I needed to have my cancerous thyroid gland removed. I believed her, and they penciled me in for surgery but told me I had to have it "validated" by the financial office at the hospital before they could ink me on the schedule. Here's the kicker.. this woman at the financial office tried to convince me that this surgery was ELECTIVE. Why? Because I wasn't having it immediately, therefore it must be elective. It took a phone call to my surgeon and me stating that I was going to have to cancel if I had to bring in this huge downpayment to get the financial woman to back down and lower my payment plan.

This is a state run hospital with an attorney general's office right in the building. Forgive me if I have little faith in any state run health plan.
posted by xyzzy at 10:12 AM on October 1, 2002

close to a third of their patients were Canadians.

Being treated for what? Not emergency care, I'll warrant. Chucking around vague anecdotes based upon your voluminous global experience is just your style, though.
posted by riviera at 10:43 AM on October 1, 2002

xyzzy: your problem was not because you were at a state run hospital; it was because you do not have insurance. With the financial pressures most state run hospitals are under they do their best to put up what barriers they can to the uninsured. Insured patients are often treated the same way by their HMO's. And could you even imagine getting your surgery at a private hospital? Without insurance you would be sent right back to that state hospital.

gramcracker: I agree that a 20% co-pay would be a hardship for some patients (it is very easy to run up a two, three, or four-hundred thousand dollar bill and 20% of that is a lot of money), but as it is now, 41 million Americans have a 100% co-pay and the financial burden of caring for them is bourne by only a small number of hospitals. Also, your model of how doctors determine their own income is true only for those small percentage of docs in a traditional fee-for-service arrangement. Some are salaried, with little or no allowance for productivity, while those that rely on HMO's have a financial incentive to see as many patients as possible and spend the least amount of time and money on each patient.
posted by TedW at 11:12 AM on October 1, 2002

TedW: You're right about that. In a single-payer system, docs typically have 3 areas in which they can work: 1) private practice, fee-for-service docs, 2) salaried positions (generally within hospitals or clinics) or 3) as part of a large health practice, similar to the Kaiser Permanente model of the 80s, where one company provides all services for a patient. (HMOs that are merely administrative corporations and don't provide any actual services would only be able to insure services not covered by national health care--ie: cosmetic surgery, etc).
posted by gramcracker at 11:38 AM on October 1, 2002

Dunno if this thread is dead or not now, but here goes. I'm an Oregonian and have several major issues with this measure.

1: according to my wife (a health care professional) and a number of others, the Oregon Health Plan is GREAT for the very poor. Unfortunately for the not-very-poor-but-poor-nonetheless, it's not so good as they have to pay considerable costs because of the income limits. But because of points 2 and 3 below, they're going to get creamed by this.

2: Oregon state income tax is already 9% and this measure would bump it up another 8%?

3: the 5% on administrative cost by government fiat is sheer fantasy. What happens if you can't do it for 5%?

It sounds like the right thing to do is work on improving the affordability of the OHP, but then again, there's less opportunity for rhetorical histrionics there.
posted by turbodog at 12:16 PM on October 1, 2002

In my case, it came from living for awhile in Montana, and knowing some folks who worked at a hospital just across the border from Canada. close to a third of their patients were Canadians.

How far was the nearest comparable facility on the Canadian side of the border? If the Montana hospital was more convenient/accessible to those patients, then your anecdote says very little about the merits of nationalized healthcare.
posted by hilker at 1:40 PM on October 1, 2002

I'm posting this almost 2 weeks after the initial post so I doubt anyone is actually reading this, but I do have some reservations from purely a fiscal point of view. I have mixed feelings about socialized medicine, but putting those feelings aside, this plan seems very unrealistic. First, the state budget is only $16 billion dollars and this plan would tack another $19 billion dollars on the budget. If anything, this price tag will only go up as the upper-middle class moves out of Oregon to avoid the higher income taxes (after all, they can afford to buy private insurance). There will also be an influx of poor/lower-class people into Oregon who only need to show intent to reside in Oregon in order to receive the health coverage. It just seems that all of a sudden more than doubling the state budget with a program that might encourage the people paying for it (businesses/upper-class workers) to leave the state isn't the most prudent idea fiscally. Perhaps a more realistic plan is to have the government take over a little bit of the healthcare system and see how that goes and either scale up or down once they see the results.
posted by gyc at 10:33 PM on October 12, 2002