"""restricting provider payment increases, negotiating deeper drug discounts, and simplified administration""

What a great idea, will the Feds also pay my doctors education loans? He owes about 100,00 dollars, so why don't the Feds just step in and tell the medical schools to forget about being paid?

Why don't we negoitiate lower proffessor salaries, lower education costs and get at the heart of problem?

And can we finally tell the drug companies to quit spending huge sums of money onresearching future treatments and drugs? I mean if were going to pay them less, we can simply forgo new drugs and new studies on new treatments. What we have is fine, it simply costs too much money to do this basic research which can be done much cheaper by China, or Eastern Europe.

And simplified adminstration just sounds so gooood and delicious, it just rolls off the tongue like Hope and Change.
But did we throw in any money toward enforcement?

What about jails for doctors that perform work outside of the governments plan?

We've always said if you outlaw abortions, you'll make women criminals, but what if a women wants to use an abortionists not approved by the government plan? What if the abortionist wants more money then you or the government in this case is willing to pay?

Are we going to deny women abortions to save a few bucks? And just who will decide what the cost of each medical procedure will be?

Ohh what am I saying, I have hope, I really do....

There are different issues of costs... costs to the system (e.g., % of GNP spend on health care), costs to government (Medicare, Medicaid, DoD care, VAMC, state and local public facilities, etc.).

And there are costs to individuals... taxes that go to the above, but also additional out of pocket for premiums, deductibles, co-pays, out-of-service, denies coverage, etc.

When there is discussion of "costs" way too often the issue of "whose" costs is glossed over.

Per the Lewin analysis of the Hacker plan: How would the proposal make reasonably comprehensive health insurance affordable for average income families?

Regarding benefits covered: “Covered services under Health Care for America would include the services under the current Medicare program as well as comprehensive mental health, maternal and child health services and comprehensive prescription drug coverage, subject to a formulary.” So the benefits are better than Medicare.

From Don McCanne's analysis:

http://www.pnhp.org/news/quote_of_the_day.php

For a two-parent family at 300 percent of the federal poverty level or $63,600 (the income level at which the premium is fully phased in). A family that used no medical care would be directly responsible for the $2400 premium plus indirectly responsible for $3816 in payroll taxes, or a total of $6216. That is 9.2 percent of their total income of $67,416 ($63,600 plus the employer payment of $3816 on the employee’s behalf). If they also had out-of-pocket expenses of $4770 (capped at 7.5 percent of $63,600 in direct income) that would be 16.3 percent of their total income of $67,416.

For non-workers, premiums are fully phased in at 400 percent of the federal poverty level or $84,800. For a two-parent family the annual premium would be $8040 or 9.5 percent of their income. If they too had out-of-pocket expenses of $5000 (plan cap on cost sharing) that would total 15.4 percent of their income.

When the average premium for employer-sponsored coverage is already over $12,000 per year, these family payments of $6216 and $8040 seem low. In fact, for an individual, the report states, “We estimate average enrollee costs in Health Care for America would be about $3250 compared to $4230 under a private insurance product in 2007.”

Does that seem reasonable? They state, “Health Care for America premiums would be lower than comparable private insurance due to lower provider payment rates, administrative costs and low-income subsidies.” The low-income subsidies do not apply to the two examples above, both middle-income families. Although they do discuss administrative savings in the report, it is likely that the amount is much smaller than they suggest because they fail to recover much of the waste inherent in a multi-payer system. And the lower provider payment rates? I’ll let you think about that one.

It reminds me of the mathematician, the accountant and the economist who were each asked to solve the problem of two plus two. The mathematician said four, the accountant said four, plus or minus ten percent, and the economist asked, “What do you want it to be?”

Rather than crafting health care financing based on individual plans, whether public or private, it would be far more efficient and equitable to totally separate health care financing from the delivery of health care services. Establish a single, universal risk pool, funded equitably through the tax system, and then use that common pool to fund health care.

Then we would no longer have to tell the economists that we want a plan that provides comprehensive benefits, but it has to have a premium that’s affordable. That may be what we want the plan to be, but we can’t ignore the simple math behind the program.

Finally, I wish to express my profound admiration and respect for the individuals supporting the “Health Care for America” proposal. They share precisely the same goal as ours - comprehensive, high-quality, affordable health care for everyone. With the most noble of intentions, they have crafted a proposal that they believe meets the test of political feasibility while accepting what they would hope to be only temporary, modest compromises on the path to reform.

Our only substantial difference is that we believe that we should not begin from a position of compromise. The private insurance industry has to go.

I'll debunk the rest of this when I am done working, actually setting up and running health plans versus just blogging about them, but to wipe out any creditability to the post let me comment on this;

"Lewin Group -- probably the most highly respected health care consultancy firm around "

Um who? I have around 17 years in the business and have never heard of them. The companies I work for have been around since 1980 and no one has heard of them. If you had said Marsh, Buck, Towers Perrin, Deliotte, or any of a couple others you would have an argument. Lewin is a bunch of nobodys, they might have the respect of politicians but that means nothing in the real world.

The question is why would you claim they where so well respected? Maybe your trying to build their bonofides a bit to support some prety outlandish claims? Reading their website I don't see anyone outside of themselves and politicians who have anything great to say about them. Persoanlly if they are highly recommended by the politicos then I know to stay away from their analysis.

I'll tear the rest of it apart after work, won't take long as these are some pretty flimsy claim and unsupported assumptions. For example what happened to Medicare's 10% fraud rate, seems to have vanished along with the billions spent on prevention and enforcement.

Well Ezra it may be true that reform is not "only a matter of justice and decency, it's also a matter of economics" but what about ideology? I mean, if I was transferring an intense and tragic emotional illness into a right wing ideology that would make me against reform regardless of how good it is, would this reform cover my (very sorely needed) mental health treatment?

Well Nate, the state of Colorado hired The Lewin Group to analyze the 5 health care proposals we are currently debating. Perhaps you've never heard of Colorado either?

In addition the 4,000+ member trade association I worked for used the Lewin Group as well.

"- Nearly 48 million U.S. residents went without health insurance last year."

For a portion of the year most had coverage for part of the year.

"Administrative costs are much lower in Medicare than in private insurance."

No they aren't and this has been proven on this blog at least 3-4 times. Some private insurance plan's spend 1/3 of what Medicare does.

The biggest problem driving inflation now is utilization/consumtion and they propose to cap OOP lower then it is now for most people. And this is calcualted to save cost? Every study and bit of common sinse says once people hit 100% reimbursement consumption skyrockets.

Like Medicare and politicians they are pushing HMOs, HMOs are a major reason things are as F'ed up as they are now. HMOs have been a failure, the special laws created to allow for them need repealed. It's a failed concept.

More to come but in summation this is a joke, anyone that would fall for this doesn't know the first thing about healthcare.

Ezra,

Some of these assumptions are really questionable, bordering on dishonest.

They have four big buckets of cost-savings:

-prescription drugs
-restricted provider payments
-cost synergies from "medical homes"
-lower admin costs

I think the drugs and admin costs savings are reasonable models (with some minor quibbles), the other two definitely are not. Provider payments assumed that physicians would take a 17% cut and hospitals a 26% cut. Beyond being completely politically tone-deaf (can you imagine the commercials on the "lower-quality public health care" put out by providers? the next-gen Harry and Louise ads are practically writing themselves already) they are assuming the provider reimbursements are cut to Medicare levels, which are widely disparaged by providers as being below their costs of care. There is absolutely zero chance of Lewin's assumed reimbursement levels being the reality. Zero. And they know that, or at least should. It does really make me question the neutrality of the rest of the analysis. It is hard to see this as anything except trying to find dollars, when we know the reality is far different.

On medical homes, its a great concept, but like many similar improvements in health care (e.g. health IT, greater use of evidence-based medicine, etc.) the experts in the trenches will consistently tell you that assuming cost-savings here are foolish. These improvements very likely increase quality, but with a concomitant increase in utilization generally. If they have a zero-sum cost effect with increased quality, its great value, but there are no real cost-savings. Consultants can get ahead of themselves with their modeling.

There are also some broader assumptions that completely ignore viable criticisms of public health plans. Few utilization controls are in place in Medicare, yet the assumption of Medicare-style administration is not met with any differences in assumed utilization. This is a huge oversight. Similarly, they assume that the uninsured will utilize health care at the same rates as the current insured, when there are real questions about whether that population is more likely to have greater health issues at the start, requiring higher levels of utilization.

There are other more minor assumptions that add questions, but at minimum, 40% of their targeted cost-savings are either extremely questionable or not based in reality. Couple that with likely underestimates on the costs of the program (i.e. utilization), and all of the sudden that 1 trillion in savings can shrivel close to zero.

This all was much better when we acknowledged that were no real cost controls in these plans. Pretending there is $1 trillion in savings will just cause credibility questions about other claims made on the plan benefits.

Attention, Ezra!
McMegan actually made a ggod point this time:
"There is [] substantial evidence — good, solid research, not awful surveys — that easy bankruptcy is one of the hidden strengths of the American economy. American bankruptcy law offers an interesting natural experiment; the code, meaning the rules under which debts are discharged, is national, but the details of what is exempt from bankruptcy are done at the state level. Researchers consistently find that the more generous the exemptions are, the higher a state's rate of entrepreneurship. When failing is less risky, people are more willing to try."
http://www.washingtonmonthly.com/archives/individual/2008_02/013165.php

If anyone is watching news right now, Woot!

Bye Bye mr Honor and integrity.

What was that he was saying about public financing?

...and single-payer saves lives (including letting overworked doctors live longer) by freeing doctors from dealing with 100+ sets of rules and fees and dueling with 100+ care deniers: to do the number one thing they need to do off-office hours: stay current with all the never expanding wealth of medical knowledge.

It's the staying current, smarty!

I don't want to be too nagging, but I would like to stress a bit more a point that Ezra only briefly alluded to in his report on the Lewin review of the Hacker plan. Though noting correctly that the Hacker plan is the "ur-Democratic plan" for the subsequent Edwards, Clinton, and Obama plans, it is somewhat discomfiting to see the Bloggingheads Ezra, the who recently administered a facial to Christopher Hayes on this particular matter, relegate to a mere parenthetical the crucial difference between the Clinton/Edwards take on Hacker and the Obama take: "(and for the record, it [Hacker] includes an individual mandate)".

Though I haven't personally checked the details in the Lewin review of Hacker yet – by the time I do this thoroughly, Ezra will have (rightly!) closed this post for comments – I'll take his report as accurate that the Hacker plan would result in "the broad expansion of coverage to 46 million (or so) [more] Americans."

That figure is remarkably close to the 45 million net new insureds that Jonathan Gruber calculated for a Hillarycare-type plan with individual mandates as opposed to an Obamacare-type plan without mandates (23 million net new insureds). And both the Lewin and Gruber numbers are broadly in line with what has been argued on this matter by the Linda J. Blumberg and John Holohan, "Do Individual Mandates Matter?," Urban Institute, January 2008.

So it seems the wonks are once again in agreement: mandates really do make a difference.

I realize why it is tempting in the face of an impending Obama victory in the Democratic primary process to start to paper over the very real differences between the Clinton and Obama healthcare plans. But it would seem that it is, intellectually at least, not at all useful to provide oxygen for the suggestion that the Obama plan, if implemented, would end up in the same place (though perhaps only a tad later) as the Hacker and Clinton plans – with all of those additional people covered and all of that money left over for more iPhones.

In addition, there is considerable logic to suggest that the main ones who will get the iPhones if the Obama plan even gets off the ground – especially under the bright lights of the C-Span cameras -- will be the insurance executives and their lobbyists, who will arguably be able to unravel it until it is just about as toothless as the tax dollars spigot they successfully set up for themselves back in 2003 with Medicare Part D.

And if that happens, will the cost savings for Obamacare be materially less than the $1.04 trillion projected by Lewin? Ezra implies no, and says the $1.04 trillion "applies with pretty fair specificity to the plans offered by both Clinton and Obama." I don't see how that can be the case if the Obama plan has considerably fewer net new uninsureds. And I am not really willing to take Ezra word for it on this one. Note, in particular, the proleptic exonerative of the intensified "pretty fair." But that puts me under an obligation to start noodling the Lewin review. Which I will do.

Of course DrSteveB thinks that Hackercare and Hillarycare are doomed to come unraveled as well, and that, therefore, the only way to go is to stay pure from the start and try to ram through single payer.

I hope he is wrong, if only because I don't think there is any political shot at getting single payer in one pass. In short, we do, in my opinion, have to reject DrSteveB's implicit argument that, at least in this case, "the better is the enemy of the best."

The conclusion?

It would seem, to repeat, that the science of the matter has given the nod to Clintoncare over Obamacare.

The politics?

Much iffier to be sure.

But the fact that, in the post implementation stage, if we ever get there, Obamacare could completely unravel without mandates in a way that Hillarycare would arguably not, and thus set back the cause of single payer for another generation – or at least an "ordinary" presidential cycle of 8 years – suggests that we should place not just our scientific, but also our political, bets on Hillarycare.

And the fact that this particular judgment of mine is – almost already – a counterfactual argument, does not change the fact that it has a better claim on being true than the opposite argument.

But thanks for letting us continue to beat this horse, Ezra -- until it is officially pronounced dead.

OOP is tied to income, wow that is a catchy sound bite. As with all other Progressives reform proposals short on details though. From the material referenced employers will pay 6% payroll tax and employees will be capped at a percentage of their revenue. How exactly do you handle a trust fund baby? They have no job so it would appear they would not be contributing to the cost of their insurance. Not very progressive giving the super rich free insurance like that. If you have no income besides what is given to you by rich relatives how low would your OOP be exactly? I guess that is the motivation to get rich, become a multi millionaire and your family gets free insurance for life.

http://www.irs.gov/newsroom/article/0,,id=129379,00.html

The link above is to a TIP compliance program. Basically if you agree to pay taxes on a small portion of your tips they won’t audit you. In the service industry you’re talking 100,000s of participants who will have their OOP capped at artificially low levels. They already avoid paying taxes on 50%+ of their income now you’re going to subsidize their insurance?

In Vegas, might not be like this in other cities, we have tens of thousands of “dancers” who are independent contractors. They have no paycheck and thus would appear to avoid the 6% employer contribution. For the entire self employed classification, which is millions of people, how are you honestly going to collect their 6% employer contribution? They are already notorious for hiding income and shucking taxes.

I could go on like this all day but the truth should be self evident by now. This plan was written by idiots and only believed by idiots. None of the assumptions even hold up to common sense. The fact that certain college educated people couldn’t see these glaring gaps in logic proves we are overpaying for college.

Nate, your point is that trust fund babies, waiters & waitresses, and strippers might get cheap health care?

That's a pretty tiny problem compared to 47 million uninsured (and I don't much care that some of them were only uninsured for part of the year -- that still shouldn't happen).

Of course if we had a "medicare for all" system on the table (instead of a "mandatory insurance for all" system), we could save the money that currently goes to insurance company profits -- money that is paid in premiums but does not pay for any care, and does not even pay the employees at the health insurance company.

Not to discount the value of rethinking how medical school is paid for or how new drug research is financed, but talk about an elephant in the room.

Tom,

Their analysis falsely claims 1.04 trillion in savings. Those where a couple of numerous examples of how their math doesn't add up and fundenmental problems with their proposal. Their system of funding HC with a 6% payroll tax would never work, it misses to many people. If thge people aren't paying or have a method to avoid the mandate, i.e. be self employed, then they would not be in the system and it would not be UHC. You need to think of the ramifications 5 levels away not just what is layed outin front of you. Like all progressive reform you must account for the consiquences and reality not just what you propose to happen. I'll further assure you if people making 301% of poverty are forced to purchase insurance they don't want and find out trust fund babies are getting it for free or cheap they will revolt.

Shortwoman,

If we implemented Medicare for all the additional fruad would cost more then what insurance companies make in profit. The exact numbers in case your curious are;

Average insurance company profit 6-7%

Medicare Fraud rate 10%.

Not to mention you will piss off a lot of retirees that live off those profits. Look at the largest stock holders of any major insurance companies and you will see all sorts of retirement trust, mutual funds, and public investment pools.

Yeah.. my doctor drives a porche and lives in a mansion in the best part of the metro area cause of high tuition rates. I get it.. after paying off his school debt he HAS to do something with the money.

..its all so unfair that we offload so much cash on them like that.

..and all the rest of us graduating with a mere $50k (roughly 1/2 their burden) in college debt have to make due with 1/4 the avg pay why?

Physicians and/or the systems that they are a part of have abused their uniquely scarce and required product to the detriment of the public. Other utility providers in other industries all had their prices monitored and restricted when this was done, to quell such abuses. They were only 'deregulated' when it was 'proven' that they would provide enough value to the consumer that the public interest was served.

Theres no reason that a Tylenol should end up billed at 2400% retail price because it was served to you in a hospital bed. Theres no reason that a tonsilectomy should be 600% more expensive today then it was 30 years ago, other then price fixing and collusion with the insurance industry.

billyblog,
Will you -- or somebody -- please explain to me what is so difficult about passing the health care plan that everybody (except the industry) loves the best: Medicare for All?

In my lifetime I watched LBJ ram through Medicare, Medicaid, a $10/hr minimum wage, etc., and yes, he could very likely have passed the Civil Rights legislation all on his own. Okay, that was on his own blackmail, bribery, cajolery or even reasoning together; LBJ the near tyrant -- but LBJ was working in a complacent period where he had to do it all on his own, unlike FDR who had vast public support for change.

There IS vast public support for universal health in this (Obama?) era and the broad preference is Medicare for All -- which Medicare happens to have much built-in flame proofing against the usual Republican flaming because it is already in place for our most vulnerable (the old who love it) and everyone understands exactly what it is.

Lets go over that: great groundswell, everybody's first choice and fire proof. Sounds like the path of least resistance to me -- but I've only been following American politics intensively since 1961 (age 17).

We need an National Medical Service that treats anyone on the tax payer and that is funded with 5% or 6% of GDP. IMO anything else will not help.

BTW the goal should be to save money for teh median income, medican health American.

Yes, national health care can save a hell of a lot of money as well as improving our health and overall sense of well-being -- all very good things. But we've gotta keep in mind, there's the policy and then there's the politics of health reform. And then there's the money - BIG MONEY - that directly influences both the policy work and the politics.

I see these dynamics play out in excruciating detail from my perspective as a nurse and a long-time health system reform activist in Massachusetts. For this reason I want to speak to the individual mandate piece (a hell we are currently living through here in MA).

As a component of health policy, the Gruber mandate and the Lewin version are simply theoretical models on paper. And already the MA mandate experiment is proving this model to be seriously flawed when it comes to being implemented in the real world (the place where most of us live). Gruber's individual mandate policy model is FAILING miserabley here in MA. The public backlash has begun.

Don't take my word for it; look at today's post on the MA NPR/wbur CommonHealth blog for a taste of Gurber mandate failure - and to see who's paying the steep price for that failure.

Moving on to the politics of reform. An individual mandate is just a stupid element to include at the outset fo the reform process. Much of the left hates it (for good reason, imho) as well as much of the right. The Hackerites would be wise to remove the individual mandate provision if they want to get any traction for that plan, and by association, traction for any plan that includes a individual mandate as we advance reform toward the goal of a nonprofit national health care program.

So, on the policy side of Hacker we have, among its many elements, a individual mandate policy that is tested and is proven to be unable to transfer from the MIT ivory tower paper it was conceived on to being successfully implemented in real life. And on the politics side of Hackerplan the individual mandate serves as a serious non-starter, an obstacle to building widespread support for the plan. Somebody try to convince me why that's not true and I'll listen but for now these conclusions stand firm.

Excise the individual mandate piece then maybe the Hackerplan holds some promise to move the ball down the field. It also makes sense - is an imperative, really - to keep building the grassroots public demand for far-reaching reform of the type that a previous commentor stated so well. Ditto for me:

"Of course if we had a medicare for all system on the table (instead of a "mandatory insurance for all" system), we could save the money that currently goes to insurance company profits -- money that is paid in premiums but does not pay for any care, and does not even pay the employees at the health insurance company.

Not to discount the value of rethinking how medical school [and, I'll add, nursing school including for nurse practitioners,] is paid for or how new drug research is financed, but talk about an elephant in the room."

You can easily sign up to endorse and to be a part of these reforms at www dot healthcare-now dot org

While I am an idealist whose views fall perfectly in line with the free market perspective for a capitalistic economy/society. I have come to realize that there are some issues the free market leaves unresolved. When it really comes down to it the free market can NOT be expected to provide necessities.
I will explain in further detail in a second, but first let me state again that I hold my preference for socialized healthcare grudgingly, for I strongly believe that bureaucratic lawmakers can never be expected to efficiently run anything on a national level. Think about if, when cell phones were first coming out, that the government come forward and said “We have decided to make sure every man, woman, and child has a cell phone within the next few years!”… We would still have those 1980’s block phones with the 15min batteries that the size of Shaq’s shoe, and there’s no way they would be as plentiful. The free market worked wonderfully with cell phones! Every man woman and child really does have one now.
But here’s the major difference between cell phones and health care: Healthcare is a necessity. It is the same as some of the other necessities we have such as a fire department or police. Back when the country started, our fire departments were privatized and only the wealthy could afford their services, but the need for socialization was quickly realized as a necessity when the fires spread and the wealthy suffered losses to their property.
Healthcare is a necessity. And when for profit companies are in charge of providing it then there will always be horribly tragic stories of people being unjustly denied care and old ladies being booted out of taxi cabs still wearing their gowns and an IV still in their arm. What happens with for profit companies is that they attempt to cut costs to increase profit, and so insurance companies deny coverage in order to maximize profit. The entire pay structures of high level execs are based upon the denial of coverage… There’s something very inherently wrong with this situation.

Nate, Tom, everybody else who thinks self-employed people don't pay employment taxes: We do. We pay the employee half and the employer half, double what you pay.

And no one wants single-payer more than independent contractors with a pre-existing condition! (Except maybe employees who want to quit and work on their own, if only they could get health insurance.)

Joyful Alternative,

How many self-employed claim 100% of their income? I have never meet a single self employed person that didn't pocket cash transactions and not ring them up or write off phony expenses. The level of compliance by self employed individuals in reporting income is far less then those that are W2ed. No one is claiming you don't pay any taxes I'm saying you claim far less then you should. Tack on another 6% tax and I'll assure you claimed wages will drop even further. The higher the tax the more motivation to subvert it.

PessimisticIdealismIsOptimisticRealism,

Do a search for King Drew Hospital aka killa Drew. One of many examples of how government run healthcare is worse then for profit. A for profit company does you wrong or kills you at least you can file a court case. Government kills you your kin can't even do that. Recently Las Vegas' public hospital, UMC, went through a mess and just indicted the administrator on fraud and enrichment at public expense or something. Government has a far worse track record in Healthcare then private business.

"When it really comes down to it the free market can NOT be expected to provide necessities."

Where do you get your food? Your clothes? Housing? Far more necessities are provided by the free market then are provided by the government. HC has not been a free market since late 1960s it's more akin to Power, water, cable and other heavily regualted indistries. Have you ever stopped to question if maybe the regualtion is the problem instead of the system?????

Nate: I happen to have been brought up to be honest, not frightened of paying taxes, and I do claim ALL my income as a self-employed person. Contrary to your pessimism, most of the working class pay taxes while the rich you so highly regard pay at a much lower rate, if they can't find someone smart enough to get them out of paying any. The solution is to finance HC as a percent of GDP, thereby avoiding the individual mandate.
You are obsessed with the issue of fraud and others "getting away with something" or "getting over on you". If ALL people were entitled to medical care, then anyone getting medical care would be legal, and thus there would be no fraud. PERIOD. There is no fraud when people breathe, because all are entitled to air.
Like the fire department analogy, medical care for all is a social necessity. Why should one house be entitled to fire insurance and another not? (BTW, the great Boston fire was directly attributable to the free market capitalists who controlled the Water Board and refused to spend the money on larger pipes. After all their parsimony, these capitalists were the greatest losers in the fire. So much for the intelligence of "market forces".)
As a parallel thought, in a society where all have access to HC, anyone sick will go to the doctor, and as recently happened in Canada with SARS, a pandemic is much more easily contained in a short time. If SARS struck an uninsured person, how many people would be infected before that person was finally taken to the emergency room?
And finally, there is no point in cutting the wages of providers if the study finds trillions of savings. Some of those savings could go to decent wages for all docs, nurses, medical schools, and even some for basic research.
A laissez faire capitalist mindset may be fine for iPods, but for issues of national security - police, fire, HC, etc. - like roads, the people must decide what level of expenditure they are willing to endure. If they don't like to have roads with potholes, then they will pay to have them fixed. I see that in every town meeting I attend in my small town.

Gomer, you can't institute results. Your half brained ideas are meaningless unless you have a way to achieve them. Start with your idea to finance HC as a percent of GDP. How exactly do you propose to achieve that? Every service performed earns points then at the end of the year divide GDP by the total number of points and that’s how much money the provides get paid? Your problem is you have desired end results but no way of getting there. Yes if we could wave our magic wand and spend exactly 10% of GDP on HC that would be great, until you give a detailed description of how to accomplish that your just another blabbering progressive without a clue.

Your claim that there would be no fraud is laughable. What you mention wouldn't in any way stop provider fraud unless your proposing to make every provider an employee of the federal government, give them a salary and there is no billing or tracking of services rendered.

There is no fraud with air because it is an almost unlimited resource that is regenerated when consumed. HC is financed by finite dollars which can be exhausted, it's the pursuit of this limited resource that leads to fraud.

Like your fire insurance analogy why is it not universal? Why do some people have better fire protection then others. Oops Gomer you just made the conservative point. If you live in BFE on top of a Mt. you have no fire insurance. If you live in a small town with volunteer fire fighters your fire protection isn't as good as living in a city with full time employed fire fighters. Analogies don’t work when you pick and choose the characteristics you like.

I wonder what information is being used to determine that private healthcare is less expensive?

Are we counting the part where doctors get paid to deny treatment to people?

Throwing out the uninsured onto the streets instead of spending the millions in medical assistance they need?

Yeah doing stuff like that you can become very cost effective. It's especially convenient when you're just a business and have no moral obligation with patients.

It doesn't matter to me if healthcare is privatized or not, it's the people dieing so that corporations can save a penny that makes the world sick.