Single-Payer National Health Insurance

[Alexandre Fenelon]

At 18:40 24/08/99 -0400, you wrote:
>At 04:31 PM 8/25/99 -0500, Steve Perry wrote:
>>
>>Out here in Minnesota--whose gift to the world was the HMO system--
>>there have been quite a few interesting folks involved with the single-
>>payer question. Early in his first term, Paul Wellstone was seriously
>>interested in pushing single-payer initiatives--not that he thought it
>>was practical to attempt it nationally at that point; his notion was to
>>pursue measures that would make it easier for states to do single-payer
>>experiments and thus try for a groundswell that way. But he was 
>>seduced by Hillary Clinton during her '93 March to the Sea, and
>>he's never made a noise about it since, to my knowledge. (By the way--
>>why does everyone persist in claiming that the Clinton plan failed,
>>just because it wasn't passed into law? It's quite obvious that the
>>administration's move in the direction of HMOs touched off a merger
>>mania that made her plan--minus some of its rube goldberg 
>>convolutions--into reality.)
>
>-- snip 
>
>Two points.  First, Christopeher Hitchens argues that Hillary's "reform"
>was, in fact, a move designed by big insurance firms and received a
>relatively mild oppsotion from smaller guys in the insurance biz. So it was
>hardly a propaganda blitz that "killed" that initiative.  Au contraire, the
>whole "initiative" was a scham never intented to be implemented as advertised.
>
>
>Second, health reform involves two conceptually different issues - the
>cost-effectiveness and the universal coverage.  "Single payer" or more
>generally - public insurance schemes are designes primarily to address the
>cost-effectiveness issue by reducing transaction costs that are significant
>in this business.  It does not automatically lead to universal coverage -
>in fact the acclaimed public health care systems under state socialism were
>NOT truly universal - for example, self-employed were not covered.
>Moreover, not every procedure was covered - only those available in public
>health care facilities.
>
>Universal coverage does not require a single payer solution - it is
>possible to attain by means-tested public subsidies of insurance premiums.
>That is, you buy your insurance from a market vendor, and if you cannot
>afford one -  government subsidies will make up the difference between what
>it costs and what you can afford.
>
>So it makes a lot of sense, from the Left's point of view, to make that
>conceptual distinction clear.  As katha p. & others pointed out, changing
>the status in the insurance biz will be extremely difficult politically,
>and the left should focus their energies on issues that really matter to
>its constituents, i.e. working class.
>
>I do not think that cost-efficiency should be of primary concern to the
>Left for a number of good reasons, chief among them being that insurance
>companies can take of that.  Moreover, "government health care" has become
>one of the buzz-words that provoke a knee jerk reaction on the right - so
>fighting for a single payer system is not the best strategy for the left,
>except perhaps for scoring symbolic points in a kulturkampf.
>
>A much better strategy is to focus on universal coverage - which as I have
>argued - can be achieved by institutional arrangements that are not limited
>to a single payer public insurance scheme.  
>
>wojtek
>

Wotjek:

I think there are some troubles with your position, which is the same of
the World Bank: Private insurance for the rich and middle classes and
public health system for the poor. 
1st-It will probably not achieve universal coverage, since there are
people who are neither poor enough to be included in the public system 
not rich enough to get a good private insurance plan.
2nd-By submitting the majority of people to market logic, you will let
many persons undercovered, since coverage of private insurance is not
adjusted to the individuals necessity, but to the amount of money a
person can pay for a private insurance.
3rd-(and maybe the worst)-A public system designed to cover only the
poor will have a poor quality, since the middle class have more efficient
means to make political pressure to improve the healthcare quality. By
getting those people out from the public system, you will worse the
healthcare quality.

I'm medical oncologist and work in Brazil (whose reality is different
from the US). Here we have a one payer health system, althought it
is under heavy pressure from our right wing government, and so isn't
working well. I assure you that if this system didn't exist or if it
was restricted to the poor (who, in my country, are very poor), something
like 50% of the population wouldn't have access to cancer treatment.

                                Alexandre