The great advantages of the single payer universal systems are : i) greatly reduced administrative costs ii) universal coverage of everyone and virtually every significant medical condition iii) choice of doctors (at least in Canada) as contrasted with restrictions in HMOs. These systems are not socialised medicine since the inputs to the system are primarily from capitalist manufacturers of drugs, equipment, contractors etc. But in Canada at least, hospitals are public or at least non-profit. Other services such as ambulances are mixed. Providers are forbidden to charge extra fees and collect only the amount agreed under the plan with the single-payer. The single-payer in Canada is not usually the Federal Government but one of the different provincial plan entities. In Manitoba for example it is the Manitoba Health Service. The process is simple. You have a card and present it when you go to the hospital or the number will be entered when you first go to a doctor. The beauty from the hospital or doctors point of view is that they have absolutely no worry about collecting!
The system in Canada has been under stress for some time. The federal government has cut back its share of funding placing a greater burden on provinces. Provinces in turn have cut back. With budget surpluses federally and a huge public reaction against the deterioration in care some positive changes are being made and some funds restored but at the same time governments such as Alberta are trying to introduce private hospitals and further privatise the system. There has been a very negative reaction even with Alberta to premier Klein's plans. Alberta by the way is often though of as a mirror image of Texas within Canada. It has oil and ranching and tends to be right-wing and individualist at times. It is by far the most well off of the Prairie Provinces and sit right next door to what historically has often been the most leftist province Saskatchewan. Saskatchewan was the first place in North America to introduce the single-payer system. THe plan was not perfection. In fact it was a compromise worked out with doctors after they went on strike. Instead of being put on salary doctors worked on the fee-for-service system. This does not limit their income but the single payer system guarantees payment. Probably many doctors who work for HMO's would like this system.
Cheers, Ken Hanly
Nathan Newman wrote:
> > -----Original Message-----
> > From: owner-lbo-talk at lists.panix.com
> > [mailto:owner-lbo-talk at lists.panix.com]On Behalf Of Chuck Grimes
> >
> > Okay so Nathan Newman is pushing this Bradley Medi-turd give away to
> > the insurance industry and is completely immune to arguments against
> > the idea. So, it is pointless to argue.
>
> Chuck, don't talk about being immune to arguments. You seem to be immune to
> facts, since the article Doug was responding to noted that the insurance
> industry opposed Bradley-style individual credits. It is the HMO industry - at
> loggerheads with the insurance folks - who might support it. And it is direct
> providers like Beverly enterprises and other folks who happily bilk Medicaid and
> Medicare who love those systems.
>
> For all the talk on the list about our system being hopelessly capitalist, most
> of the so-called leftists are reactionary defenders of the status quo,
> pretending that programs like Medicaid and Medicare are incipient socialism that
> need to be righteously defended against any suggested alternative.
>
> The reason I can favor Bradley's reform is that I am not so deluded as to think
> the present system is socialist, so I have no knee-jerk need to righteously
> defend it. Unlike some who see this as nasty capitalism out to oust socialism
> from our system, I recognize it is one capitalist reform as an alternative to a
> previous capitalist reform. Medicaid and Medicare passed because certain
> capitalist interests benefitted-- folks like Ross Perot became billionaires off
> those programs and others continue to bilk it for billions of dollars each year.
>
> The reactionary "just say no" response to every reform is sort of sad and
> pathetic. Marta raised some serious issues on the treatment of the disabled
> under the Medicaid plan, but most other comments like the above are the lamest
> defense of the status quo I can imagine.
>
> How about some real analysis here, tracing the conflicting capitalist interests
> between insurance providers, HMO managers, and direct for-profit service
> providers?
>
> The whole "public money" being transferred to "private" hands is the most
> simplistic (and silly) analysis I can imagine. Folks should be embarrassed
> since it's the exact same argument Al Gore has made against the Bradley plan.
> It's a sound bite that means nothing. Every health care proposal out there,
> even single-payer, is public money going to private hands.
>
> A lot of the Left really has become just knee-jerk defenders of the capitalist
> status quo.
>
> Attached is an article from today's Washington Post about the billions of
> dollars bilked from Medicare by capitalist medical providers each year.
>
> -- Nathan Newman
>
> Firm Settles Health Care Fraud Case for $500 Million
> By David A. Vise and Lorraine Adams
> Washington Post Staff Writers
> Wednesday, January 19, 2000; Page A16
>
> The Justice Department plans to announce today that it has settled a health care
> fraud case involving a national chain of kidney dialysis centers for nearly $500
> million, the largest health care settlement in the department's history.
> The settlement includes a criminal fine of $101 million for wide-ranging
> wrongdoing by National Medical Care Inc., people familiar with the matter said
> yesterday. The Massachusetts-based firm is owned by a German company that is the
> world's largest provider of dialysis products and services. The settlement also
> includes civil fines, restitution and penalties for wrongdoing related to a
> variety of government health care programs, including Medicare, the federal
> health care program for the elderly.
>
> The agreement includes allegations that company officials caused Medicare to pay
> for hundreds of thousands of needless tests for patients suffering from renal
> disease, a condition that frequently requires patients to receive kidney
> dialysis, people familiar with the case said. In addition, the company
> executives allegedly paid kickbacks to obtain referrals of lab business, a
> violation of anti-kickback statutes.
>
> The case is part of a larger effort by the Clinton administration to go after
> companies and individuals engaging in health care fraud. That effort has been
> underway since 1993, with a heavy emphasis on wrongdoing in the Medicare
> program. Unnecessary Medicare expenditures were estimated in 1998 at $12.6
> billion, a decline from the $23.2 billion in estimated overpayments in 1996, a
> sign that increased enforcement is paying off, a Justice report concludes.
>
> The German parent company, Fresenius Medicare Care AG, bought National Medical
> Care from W.R. Grace & Co. in the mid-1990s. The German company and its top
> executive said recently that under the terms of a preliminary settlement
> agreement Fresenius was negotiating, it may be forced to pay civil and criminal
> payments of about $485 million.
>
> "Fresenius Medicare Care has achieved an important step toward putting these
> issues behind us and allowing us to focus all our resources on what really
> matters: the health of our patients," Ben Lipps, chief executive officer of
> Fresenius, said recently. "The settlement means that we can concentrate on our
> position as the world's leader in dialysis and provides us a clear platform
> going forward.
>
> "None of the conduct involved in this agreement relates to the quality of care
> provided to our patients. At no time did the company compromise its goal of
> providing the very best care available to . . . patients with chronic kidney
> failure."
>
> According to industry records, the company operates kidney dialysis centers in
> the Washington area.
>
> "Health care fraud in the United States remains a serious problem that has an
> impact on all health care payers and affects every person in this country," the
> Justice Department said. "Health care fraud cheats taxpayers out of billions of
> dollars every year."
>
> The settlement and the complex schemes of which the company was accused are
> scheduled to be disclosed in Boston this morning, with Deputy Attorney General
> Eric H. Holder Jr., David W. Ogden, acting head of the civil division, and other
> officials from Washington appearing at a news briefing along with lawyers from
> the U.S. attorney's office in Boston, which has been working on the case for
> years. During that time, company officials have pleaded guilty to conspiring to
> defraud the Medicare program and other violations.
>
> Before the record settlement with National Medical Care--a company with hundreds
> of kidney dialysis and treatment centers around the country--the Justice
> Department's largest health care fraud settlement was in 1994 with National
> Medical Enterprises, a California-based hospital chain, for $379 million.
> Ironically, that case also involved the payment of kickbacks and bribes so that
> doctors and others would refer patients to the company's hospitals. It also
> included fraudulent billing of Medicare and other federal health care programs.
>
> Attorney General Janet Reno warned at the time that Justice had "made health
> care fraud a major law enforcement priority, and we're going to pursue it as
> vigorously as we possibly can."
>
> Some doctors and medical industry executives have complained that the
> government, in its zeal to halt fraud, has criminalized honest mistakes,
> misunderstandings and standard industry billing practices.
>
> Staff writer David Hilzenrath and staff researcher Lynn Davis contributed to
> this report.