i guess the single payer argument essentially wins based on data from other countries---though i wonder if in those places doctors aren't salaried professionals (as is the case for places like Mayo clinic) as oposed to fee-for-service entrepeneurs. one apparent right wing insurance company flack named leavitt was making the case that while medicare has low overhead, one way they do this is to spend little on management or cost/benefit analyses but more or less guyarantee to pay for all health services, so that part of the ticket is huge (and this is why medicare spending is very large (almost 1T$ i think). also this breeds scams (ie lying about heaslth conditions to get a reimbursement.)
so, the 'firehouse' analogy may not be correct unless doctors are salaried employees---firefighters in general don't get paid per fire, possibly because that might be seen as a socially perverse incentive. (but maybe it would create higher quality firefighters as does fee-for-service health care.)
--- On Wed, 7/29/09, Wojtek Sokolowski <swsokolowski at yahoo.com> wrote:
> From: Wojtek Sokolowski <swsokolowski at yahoo.com>
> Subject: Re: [lbo-talk] Why Public Option Is Defective; Why Only Single-Payer Will Do
> To: lbo-talk at lbo-talk.org
> Date: Wednesday, July 29, 2009, 12:40 PM
> This seems to be right on the target. The so called
> "Obama plan" which should be more accurately dubbed
> "Democrat party apparatchik plan" is a wolf in sheep's
> skin - taxing the middle class and herding people for
> fleecing by insurance companies disguised as a "coverage
> extension." This is not much different from the old
> Clinton scheme, which failed miserably and rightfully
> so. This one should fail too, because it is a really
> bad deal for most Americans. But then, if the health
> business smells profits, it may actually market is as a
> "reform" and congressmen will claim it as a feather in their
> --- On Wed, 7/29/09, Michael Pollak <mpollak at panix.com>
> > From: Michael Pollak <mpollak at panix.com>
> > Subject: [lbo-talk] Why Public Option Is Defective;
> Why Only Single-Payer Will Do
> > To: lbo-talk at lbo-talk.org
> > Date: Wednesday, July 29, 2009, 11:49 AM
> > http://www.progressive.org/mpwool072209.html
> > July 22, 2009
> > The Progressive
> > Why Obama's Public Option Is Defective, and Why We
> > Single-Payer.
> > By Drs. Steffie Woolhandler and David Himmelstein
> > Once Congress finishes mandating that we
> > all buy private health
> > insurance, it can move on to requiring
> > Americans to purchase other
> > defective products.
> > A Ford Pinto in every garage?
> > Lead-painted toys for every child?
> > Melamine-laced chow for every puppy?
> > Private health insurance doesn't work.
> > Even middle-class families with
> > supposedly good coverage are just one
> > serious illness away from financial
> > ruin.
> > Illness and medical bills contribute to
> > 62 percent of personal
> > bankruptcies -- a 50 percent increase
> > since 2001. And three-quarters of
> > the medically bankrupt had insurance, at
> > least when they first got
> > sick.
> > Coverage that families bought in good
> > faith failed to protect them.
> > Some were bankrupted by co-payments,
> > deductibles, and loopholes. Others
> > got too sick to work, leaving them
> > unemployed and uninsured.
> > Now Congress plans to make it a federal
> > offence not to purchase such
> > faulty insurance.
> > On top of that, it's threatening to tax
> > workers' health benefits to
> > meet the costs of simultaneously covering
> > the poor and keeping private
> > insurers in business.
> > President Obama's plan would finance
> > reform by draining funds from
> > hospitals that serve the neediest
> > patients. His other funding plans
> > aren't harmful, just illusory. He's
> > gotten unenforceable pledges from
> > hospitals, insurers and the American
> > Medical Association to rein in
> > costs, a replay of promises they made
> > (and broke) to Presidents Nixon
> > and Carter. And Obama trumpets savings
> > from computerized medical
> > records and better care management,
> > savings the Congressional Budget
> > Office has dismissed as wishful
> > thinking.
> > The president's health plan can't make
> > universal, comprehensive
> > coverage affordable.
> > Only single-payer health reform --
> > Medicare for All -- can achieve that
> > goal.
> > Single-payer national health care could
> > realize about $400 billion in
> > savings annually -- enough to cover the
> > uninsured and to upgrade
> > coverage for all Americans. But the vast
> > majority of these savings
> > aren't available unless we go all the way
> > to single payer.
> > A public plan option might cut into
> > private insurers' profits. That's
> > why they hate it. But their profits --
> > roughly $10 billion annually --
> > are dwarfed by the money they waste in
> > search of profit. They spend
> > vast sums for marketing (to attract the
> > healthy); demarketing (to avoid
> > the sick); billing their ever-shifting
> > roster of enrollees; fighting
> > with providers over bills; and lobbying
> > politicians. And doctors and
> > hospitals spend billions more meeting
> > insurers' demands for
> > documentation.
> > A single-payer plan would eliminate most
> > insurance overhead, as well as
> > these other paperwork expenses. Hospitals
> > could be paid like a fire
> > department, receiving a single monthly
> > check for their entire budget.
> > Physicians' billing could be similarly
> > simplified.
> > With a public insurance option, by
> > contrast, hospitals and doctors
> > would still need elaborate billing and
> > cost-tracking systems. And
> > overhead for even the most efficient
> > competitive public option would be
> > far higher than for traditional Medicare,
> > which is efficient precisely
> > because it doesn't compete. It
> > automatically enrolls seniors at 65 and
> > deducts their premiums through the social
> > security system, contracts
> > with any willing provider, and does no
> > marketing.
> > Health insurers compete by NOT paying for
> > care: by seeking out the
> > healthy and avoiding the sick; by denying
> > payment and shifting costs
> > onto patients; and by lobbying for unfair
> > public subsidies (as under
> > the Medicare HMO program). A kinder,
> > gentler public plan that failed to
> > emulate these behaviors would soon be
> > saddled with the sickest,
> > costliest patients and the highest
> > payouts, driving premiums to
> > uncompetitive levels. To compete
> > successfully, a public plan would have
> > to copy private plans.
> > Decades of experience teach that private
> > insurers cannot control costs
> > or provide families with the coverage
> > they need. And a government-run
> > clone of private insurers cannot fix
> > these flaws.
> > Drs. Steffie Woolhandler and David
> > Himmelstein are associate professors
> > at Harvard Medical School. They
> > co-founded Physicians for a National
> > Health Program, a nonprofit research and
> > education organization of
> > 16,000 physicians, medical students, and
> > health professionals who
> > support single-payer national health
> > insurance. For more about the
> > group, go to www.pnhp.org.
> > ___________________________________
> > http://mailman.lbo-talk.org/mailman/listinfo/lbo-talk