Not to blow your hidden agenda but lets throw the cards on the table and be honest about progressive reform.

“On the one hand, there will never be the political will for single payer without effective and determined advocacy”

In truth there will never be political will for single payer unless you first destroy the current system and force it into something the public hates so much they would welcome single payer.

That is why every couple elections Congress passes some half witted legislation that drives up the cost, down the service, and makes it more difficult to deliver quality efficient and affordable care.

America will never turn the purse strings of our healthcare system over to Congress willingly. The general public aren’t idiots, they know what government care will look like.

That’s why Congress made it a Federal Law employers had to offer HMOs. That’s why COBRA with 2% response rate is structured the way it is. That’s why ERISA was weakened to allow the NY Pool Surcharge. That’s why the Government allowed 3 national insurers to gobble up the competition and eliminate choice. It’s Congress’s goal to destroy our current system so they can take control of the trillion dollar industry. Just about every major complaint about our current system was created by Congress or exasperated by them.

Has Kennedy ever answered for pushing us into HMOs? Has anyone asked him how he was so wrong back when he said they where the answer to all of our problems?

I think that single payer advocates are selling it all wrong. They need to attack the efficacy of expensive healthcare and focus on overtreatment and the medical establishment’s ability to extract rents. They should sell single payer as a way to cut medical spending to 5% of GDP with little harm to health. Instead they focus on paying for people inhalers which are cheap! They sell it with this you don't care if you do not want to pay for your countryman’s healthcare crap. Or like you have a right to expensive but ineffective healthcare.

. They need to attack the efficacy of expensive healthcare and focus on overtreatment and the medical establishment’s ability to extract rents. They should sell single payer as a way to cut medical spending to 5% of GDP with little harm to health.

But many of the single payer advocates (see nyceve at dailykos) do the opposite. They sell single payer as a way to get the treatment you demand, and denigrate insurance companies as treatment withholders. Remember the Natalia Sarkisian flap?

THE PERFECTLY GOOD FOOL:

"...we will, before this decade is out send a man halfway to the moon and return him safely to earth"

" we take this half-assed measure because it is hard, in fact, it is much harder than going all the way to the moon. It will take longer, it'll cost more, we'll burn more fuel and will be taken for the half-assed fools that we are...Now, I call on the nation to support me in this plan because something is better than nothing"

- Today's liberal

Moving to primarily single payer starts by making available a government run alternative to private insurance. Single payer will gradually become the norm. Medicare Advantage only survives because congress is willing to pay more money for people in Medicare Advantage than those in regular Medicare. Government run Medicare is less expensive and if companies and individuals are given the option of buying a less expensive policy, they will certainly do it. Every conversation I have about health care, I bring up the difference in costs in the Medicare programs and ask why private insurers are afraid of competition. If we get a government run program made available to some segment of the population (self-employed, maybe)out of the next congress, I am certain a primarily single payer system will only be a matter of time.

"""but my favored policies (think France) are a whole lot more radical than what currently seems feasible"""

You mean like the doctors going on strike and holding the country hostage....yeah that would be great.

"""French doctors go on strike """"
Paris Brad Spurgeon

Emergency services at public and university hospitals in France last week began a "general and unlimited" strike, organised by the French Association of Hospital Emergency Doctors. Joined by nurses, administrators, and ambulance drivers, the striking doctors are asking not only for more staff, better working conditions, more beds, and more money...."""

Can't wait to have a heart attack while the doctors are on strike!!

Plenty of political support -- 90%, Democrats, Republicans, liberals and most conservatives -- can be built for universal single-payer at the catastrophic level. You breathe, you're covered, forever, against catastrophic loss. We have concept models of well-run, federally-created corporations in FDIC, FEMA flood insurance, etc. This is FHIC. Supplemented with an FHIC-offered pay-as-you-go non-profit option competing with private policies beneath the catastrophic layer -- with subsidies from current Medicaid and SCHIP for low-income to buy it. No discrimination or denial for pre-existing conditions by any insurer: basic rule if you want to play in the space. Probably the insurance underneath the catastrophic will have to be mandatory for kids. From there, it's just a matter of a long-term process of deciding how far down we want to draw the umbrella.

There: that's the whole damned plan. Simple. It will sell, because it's a piece of cake to understand. It's a winner. Everybody keeps doing what they're doing, except there's a cap on private loss of any kind. That's what social insurance is all about.

TH,

Do you have any numbers or links to support you claim that Medicare is cheaper then Medicare Advantage? I hope you are aware and accounted for the considerable difference in benefits. The difference is apples and oranges, you can't directly compare the average per enrollee cost without a sizeable adjustment.

urban legend,

can you explain what cost controls your plan would have? If you took the cost of all claims over 10K or some amount that is covered by private insurers now and moved it to a governmental program the 10% fraud rate would bankrupt the system. Government ran plans can't control cost, they are nothing more then physician ATMs.

"On the other hand, barring a seismic political shift, single payer isn't passing the US Senate any time soon, and so dogmatically insisting that the only way forward is single payer is basically dogmatically insisting that there won't be health reform because you'll oppose achievable compromises."

Thank you for saying this! I am unabashedly in favor of a complete overhaul of the system - I'd love single payer, or Medicare for all, or any program that genuinely makes healthcare a right, not a privilege.

But I work in medical billing, and aside from my lofty utopian goals, I see firsthand, on a daily basis, the mess that is the current private insurance system, and all the myriad ways the system increases costs and ultimately harms both patients and doctors. So even though I'd love a massive overhaul and would welcome the elimination of insurance companies tomorrow (even though it would mean I'd be out of a job, haha), I can't stand when people demean smaller reforms and conclude that it's single payer tomorrow, or nothing.

Because believe me, if you spent a few weeks immersed in the clusterf*ck of the insurance system, appealing erroneous rejections, sending and re-sending claims and making calls and sending out medical records, just to get 50 bucks out of the insurance company, you'd see that even incremental change is needed. Every day, I spend my days poring over coding books to make sure I'm following all the rules and using the right modifiers and codes (which often differ based on what insurance company you're billing). When I'm done sending out claims, I'm spending 45 minutes on hold with some overseas call center to find out why a claim hasn't paid or to fix a problem, to make sure to get the reference # I need to appeal the rejection...only to have the claim reject as a duplicate and have to do it all again. Trust me, I want single payer, but the system is so screwed up that ANY reform is a good reform, because it removes some of the mess. Some of the costs, and some of the headaches for patients and doctors. Total reform won't happen overnight, but believe me people...some reform is better than none.

You mean like the doctors going on strike and holding the country hostage....yeah that would be great.

Last time they did that the death rate fell.

A lot of these problems go away if you tell the Feds to shove it and work at the state level. Remember Canada's single-payer system did not start in Ottawa. It started in Saskatchewan, and at first it only covered hospitals. Many other provinces imitated the program, and in '61 the Federal government made it national. This freed up a lot of Saskatchewan's budget, so they extended the program to cover everything. In '66 Ottawa made that national, too.

BTW, there was a doctor's strike in Saskatchewan in '62.

How funny jewels, I spend 45 minutes on the phone with overseas call centers to, only they work for doctor offices and are calling to ask me if someone is eligible. I never under stood why you could not ask this off your client, the patient. Of all people doesn’t the person sitting in your waiting room now best if he is still working or not? I’m not in the office with the guy how do I know if he gave notice yesterday?

I really love it when you call and ask me to process a claim over the phone; you know where you ask me 100 different ways to bill a claim so you can get the highest reimbursement. I miss the old days when you use to provide care then bill for what you did, not call to see what pays the most then bill accordingly.

Being 2008 are we any closer to doctors getting internet access? Those pushing E Records as a solution are going to be in for a huge shock when they find out how many doctors don’t have internet access. Not that I don’t love when you dial, hang up, dial, hang up till you reach someone and demand someone immediately give you eligibility and benefits because the patient is there waiting, is it my fault you waited till they showed up to call? Is it my fault you don’t have internet access where you could look it up in 2 minutes?

Speaking of medical billers, please don’t take this personal, can physician’s higher a lower form of intelligence? I mean you would think billing 50-100 bills a day you would catch on after a couple months. HCFA 1500 is pretty easy to figure out, they number the squares and tell you what to put in each one. I really love how as a group your incapable of copying the group number from the insurance card to the field that says group number. Don’t worry it only slows things down a ton to have to stop and look up every claim to see where it gets filed. And where it ask for insured’s ID, that means the employee, not 5 year old sally who doesn’t work yet.

But I’m probably being unfair, we are the might claims payers we should be able to tell what you meant to bill, just because you can’t get your codes to match the services performed or properly ID a patient and insured is no justification for us not paying you what ever amount you say it is your owed. So what if your billing 99214s all day when it should really be 99213 or even 99212, who are we to question how much money your entitled to, and those pesky books that clearly define the difference between 213 and 214 should mind their own business right, you’re the doctors office your above reproach.

Single payer isn’t more efficient they just don’t care. You can bill what ever you like to Medicare and it gets paid. Your not looking for a better functioning healthcare system your asking for an ATM. If you want improvement look at the one fact beyond debate, doctors are crappy businessmen. They are great and curing disease and treating injury but can’t run a practice to save their lives, generally speaking. What we really need to do is nationalize delivery, put them all on salary and get them dedicated to the one thing they are good for.

"Single payer isn't more efficient, they just don't care". Nate, prove it. What I can prove is that 36 industrialised nations say otherwise, with concepts as much lower (consistently) administrative cost, with no degradation in care. As a matter of fact, the care is actually generally as good as the much more expensive and inaccessible American system(s). Nate, you continously critcize the concept of Single -payer. Dogmatically, and idealogically so. But you offer nothing that would as effectively reach the objective that we supporters of single-payer know is the only thing that matters. That being the deliverance of quality, accesible health care to every American citizen, in a way that does not jeopardize the financial well-being of individual's or institution's. Tell me Nate, in what country that employs universal health-care, straight single payer or otherwise, does the excuse of overly -burdensome or high health care cost, become used as even a factor for personal bankruptcies, or businesses (Or corporations.) going under? I doubt that you can. I will also wager that at this point, you will try to change the subject, and once again engage in some personal attack on "liberals" or "progressives". I hope you do, because, A. This will just expose your ideological hackery once again. And 2. Because you know that I don't play that **it, and I'll rip your *ss a new one. Ultimately, we who advocate for single-payer do so because we believe that it does reach the objective best. We believe that it lowers the costs for everybody the most, while actually, considering where this country is, delivers the actual care the best. If the fear is a lack of public oversight, I think that this is something that can and should implemented at the beginning. And actually should be made easier with the internet. If the fear is cost, all one has to do is look at other countries and figure out what they do, and do it better. Because the whole point of single-payer is to control cost. So, to put a button on it, creating a universal system (Preferably single-payer.)will be hard not because of any structural disadvantages that the concept offers. But because of regressive ideology that does not, for what-ever warped reason, believe in the commons, and most assuredly does not believe that they, as adherants to the ideology, should have to pay into it.

Eh, I'm new here...I've been reading for awhile and I know Nate is a rightwing hack who tries to piss people off, but I'll take the bait.

"I never under stood why you could not ask this off your client, the patient. Of all people doesn’t the person sitting in your waiting room now best if he is still working or not? I’m not in the office with the guy how do I know if he gave notice yesterday?"

Well, I don't work in the office dealing with patients, so I can't ask many questions "off" my patients. Or "on" them. I work in an offsite billing company, so that's not me calling you. If I'm calling to check eligibility it's usually because I've gotten a rejection stating the member's not eligible. And I always call or check online to doublecheck those because guess what? About a third of the time those rejections are in error! Whose fault is that? Not mine, if we got the ID and group number right. Could it be - GASP - a stall tactic by the insurance companies to not pay claims? No way...not from your saintly insurance companies.

"And where it ask for insured’s ID, that means the employee, not 5 year old sally who doesn’t work yet. "

Um, with insurance ID's, it's set up one of two ways - either everyone has the same ID (so 5 year old Sally doesn't have one to use) or each member has a unique ID (so using 5 year old Sally's would be the correct one, thanks.) Any idiot who works in insurance should understand this.

"Speaking of medical billers, please don’t take this personal, can physician’s higher a lower form of intelligence? "

I don't know if they can "higher" better people. I have a masters degree, doing medical billing while finishing my Ph.D., so I think I'm pretty bright and good at my job. At least I can spell "hire."

I'll keep my thoughts to myself about what level of intelligence and education you must have to work as one of the peons who answers the phone at an insurance company, though. If you have ONE set of rules to deal with and can't even get it right the first time, that's pretty sad.

"I mean you would think billing 50-100 bills a day you would catch on after a couple months. HCFA 1500 is pretty easy to figure out, they number the squares and tell you what to put in each one."

Well sure, it should be easy, if there weren't 5000 different ways for filling out the HCFAs for each insurance company. Do you know that to bill a claim for an xray to Medicare, you need to put an ordering physician on the claim in ADDITION to the physician who performed the xray? But if you do that on a claim to any other insurance company, it will reject for an invalid provider. And do you know that an assistant surgeon claim gets billed with an 81 modifier, except to Medicare, Blue Cross, and a company called Group Health out west - in which case you need to use an AS modifier? Did you know that there is a generic code for cast supplies that you use for about 75% of companies - and specific codes for type of cast (short arm, long leg, ages 10 and under, etc.) that you need for the other 25%? It's up to me to figure out which one is right, because if I do it wrong I get told to bill the patient for "noncovered services." (Luckily I'm bright enough to know I just need to correct the code, but what if I'm not? The patient gets a bill in error.) Did you know that when billing application of a cast you need to include a modifier for the body part you're casting, but when you bill for the cast supplies themselves you can't put the body part code, but you must put a referring provider on the claim?

Yeah, those HCFAs sure are simple to figure out. The US insurance system isn't needlessly complicated or anything....

"So what if your billing 99214s all day when it should really be 99213 or even 99212, who are we to question how much money your entitled to, and those pesky books that clearly define the difference between 213 and 214 should mind their own business right, you’re the doctors office your above reproach."

Right, the doctors should totally take a backseat and let the bureaucrats in cubicles who can't spell "hire" determine what they deserve for their services.

I know you're just a hack and I shouldn't even respond, but my god man...if you're going to attack someone's comment, at least get the facts straight and spell right. If you work at an insurance company that's all the more reason to advocate for single payer, because you clearly have no concept of how the system works, and that's even scarier for patients. An uneducated or uncaring medical biller (there are quite a few of those, sadly...but they're a symptom, not the problem) plus you answering the phone at the insurance is only going to increase the costs and inefficiencies even more.

Okay, sorry for the hijack everyone, I get a little defensive about insurance, especially when I'm told "how things are" from people who've never worked inside the system...back to your regularly scheduled conversation.

Hum, how to handle this, normally I would just belittle and mock your ignorance but maybe there is something to be said for taking the high road and responding in a mature and logical manner to your arguments. The problem with that is progressive denial of fact and reality. No matter how well your arguments are refuted you will never admit you where wrong, i.e. have you ever seen a correction on this blog?

Lets play along and see what happens though.

Jewels said;

“I'd love single payer, or Medicare for all…”

Medicare is frequently and accurately used as a model for single payer in the US. If you disagree with this analogy I’m sorry but I feel it is fair and accurate. No where in her post is any reference made to 36 other countries or their systems. For reasons I might address later implementing their systems or comparing them to ours is non sequitur, no proposed single payer system in the US even begins to approach those in the other 36 nations you desire. You would have to start by drastically cutting physician salaries and rationing care to a level politicians would be dragged from office and hung. Without those “features” you can’t achieve the cost benefits your side likes to pretend are attainable. Your claiming all the benefits of these systems without any of the downside. If we cut our formularies to model the NHS our Rx cost would be significantly cheaper as well, no one is proposing we do that though. Thus your entire argument is disingenuous.

So back to my just don’t care comment, when it comes to Medicare the level of fraud is known by everyone and not even a concern. Medicare loses 10% to fraud and that’s just the way it is. There was just an article this week about millions being billed by medical supply companies using the referrals of physicians who have been dead for years. We have a legitimate model of what US single payer would look like, you can’t honestly ignore it’s failures and just look at foreign models.

No care in the world is as good as what someone with good insurance gets at Cleveland Clinic, Mayo, Scripps et al. Your asking 80% of the population to forgo the best care in the world so we can improve the care or lack there of for 20% of the population. I don’t have a problem with that philosophy if it’s what you believe. Just stand up and be honest about it. No country has better care then what most American’s receive, as nations their average care might be better. If we as a nation want to lean communist and sacrifice for the equal enjoyment of all then campaign on that, stop masking your desires in lies. Most Americans will lose care quality and be rationed under any progressive reform.

You will notice I haven’ changed the subject, I in fact challenge you to link to any post on this blog where I have done so….. I’ll gone on while we patiently await your reply on that matter.

Lol, no for you to hand me my ass….

If you’re a fraction of the savant you think you are address any of these issues;

1. Starting in 1973 Congress attempted single payer gradually by forcing us all into HMOs. American’s soundly rejected this in the 90s. If Ted Kennedy was so completely wrong in 1973 why should we trust him to have it right this time?
2. If HMOs failed specifically because they rationed care, the most critical aspect of any such system if it is to have any sustainability, how will America suddenly embrace it this time?
3. After rationing consumption, the next major factor in sustainable single payer is limiting provider reimbursement. How will you sell such drastic cuts to their reimbursement, your party caved on 10% Medicare cuts and single payer will require far greater cuts then that.
4. Fraud and waste, every single government ran health system in the US has major problems with fraud. Fraud in Gov systems run 5-8 times higher then that of private plans. America has the most ingenuitive criminals in the world, how with one piece of new legislation will single payer magically eliminate what 60 years of enforcement hasn’t even dented. Hey the war on drugs has worked so well why not start a new futile front against fraud.
5.

I could go on all day laying out 100 points no progressive could honestly answer but these 4 will suffice to show you as the intellectual charlatan you are.

Once you admit you where wrong, apologize and confess to being a healthcare idiot I will even be so gracious as to answer questions. I could give you 20 changes to the current system that would cost next to nothing, drastically cut premium and cost, and not require an overhaul of our current system. They aren’t sexy and won’t win anyone an election but if you really had even the slightest inkling to improve our current system they would be far more successful then anything on the progressive agends.

Jewels,

Couple facts, your new so you might not know;

Yes I am probably and proudly the worst speller posting on this blog. It should bother me but I was always more concerned with the content of an argument not it’s delivery. Shallow progressives tend to give more merit to the presentation then the substance, one of the main reasons I could not finish college with Healthcare Administration degree, couldn’t get along with the professors who never worked a single day in the system but had all the answers.

Sounds like doctors need to reorganize their offices so they can get accurate information where it needs to be. Hardly the fault of claim payers they are poorly structured.

Stall tactic, not likely most states have laws requiring carriers to pay claims in a set number of days, TPAs are usually exempt but it’s not their money so they have no motivation to do so. Further the median check is a fairly low amount, the extra interest earned on holding the money for 30-60 days doesn’t cover the cost of reprocessing the claim. Your argument is a progressive myth.

That’s correct sally doesn’t have an ID but that doesn’t stop 10-20% of her claims being billed with her SSN. Not having sally’s SSN that makes it very hard to identify her. Medicare has solved this problem but that’s a whole other complaint on government healthcare and inefficiency. Anyone that cares about high cost of HC read up on Medicare requiring payers to capture and report SSNs for every dependent they cover and report it to CMS or get fined.

Is spelling really the ultimate gauge of one’s intelligence? Darn all those other test that put me in the top 2% really meant nothing, who cares if your capable of complex thought as long as you can accurately spell a simple one?

“what level of intelligence and education you must have to work as one of the peons who answers the phone at an insurance company,”

Oh poor sad student of life, I own 2 TPAs in the Midwest, soon to be three. I have people that answer my phone for me. Good luck on those degrees and getting a real job eventually…

One set of rules? Boy I wish, we administer benefit plans, usually of the self funded nature. Every client has their own set of rules. I have well over 100 sets I need to live by, not counting insurance company, federal and state, thanks for having a clue though!

I totally agree you have a nightmare of a time billing some of your carriers, Odd the names you mention as being the most difficult. Medicare is a mess, why do you want to move everyone to them? We processed Medicare supplement plans for over a decade, I know full well how ridiculous their rules are, that’s why we need to get rid of them not increase their size.

1. This is 2008, not 1973. Ask the majority of Americans if they would accept a single-payer system that delivers consistently and does not jeopardize their financial well-being, as opposed to what they currently have, and I'd bet dollars to donuts the majority would choose single payer. Which the last legitimate poll that I saw indicated. 59% if I'm not mistaken (Which I'm not.). 2. Silly attempt at mis-direction, but HMO's DO ration care. It's called denial of payment for services. Rendered or proposed. All too often this happens. That's why we continue to have this conversation.3 HMO's ration reimbursement.Actually, they just create a high-bar so as to keep individuals from even seeking treatment in the first place. It's called high-deductibles (For the un-enlightened. And you KNOW who you are.). Denial of service because of high-cost to entry is no more noble than denial of service because of your hypothetical drastic rationing. Since that does'nt happen in any country with single-payer when the situation calls for immediate care.4.I don't even know what an ingenuitive criminal is, let alone do I have the capability, no matter how vast, to ascertain the ways with which private players indulge in the fraud with which you so speciously lament in regards to U.S. government RUN health care. As an aside. Considering that conceptually, a system can't defraud itself (I.E. Medicare.) you actually help my advocacy for single payer by indicting the private individuals and institutions that utilize and access the government system. 5. Oh...Screw it. You know, I wager that the 2% that you finished in, were the bottom 2.Because for all your tangential anecdotes, you sure are...daft. You talk about changes that you would propose to the current system that would make it work better, but you affer them only in hypotheticals. Where the freak do you think you are? Michelle Malkin? Why do you think we're here.If you have a better idea, or ideas than what we've offered individually or collectively, show us your tits. I doubt that you will pony up, because all you ever do is critcize other's ideas, but if you can muster your prodigous bottom 2% capabitlites, I'll await them with anticipation. But I won't hold my breath. Anyway, Nate you keep doing what you do. Like the good regressive you are, your fanatical adherence to a failed idealogy offers a...passing amusement. But understand, my hand will never touch you rear. It'll be my foot.

Onlinesavant,

1. Great job changing the subject from trusting Ted Kennedy after he force feed us HMOs to current polling for Single Payer. Who was it that accused me of, and I quote, “I will also wager that at this point, you will try to change the subject,…” Don’t they have name for this? Since you refuse to answer the questions I’ll just move on to answering yours. If you asked the majority of American’s if they would like $10 I’d bet dollars to donuts they would take it. The problem is progressive healthcare isn’t offering the $10 you asked them if they wanted or not. Your offering them Euro’s and charging them 20% more then what you give them. If you would honestly frame the question the majority of American’s have consistently said they do not want change. Ask the question the way your proposals would actually pan out, do you want to pay substantially more in taxes to join a single payer system rampant with fraud, that excludes certain high priced drugs and treatments and will ration care severely limiting the consumption you have enjoyed to date. Wow what a shock people no longer support it.

Your entire argument is if you lie to people and promise them something they can’t have they support your plans. Sorry not flying round here.

2. ? thanks for pointing out you are a clueless idiot. Yes we all know HMOs ration care, that’s why the vast majority of American’s have HMOs, that’s why Congress makes it Federal Law employers have to offer then and subsidizes them. Allow me to make the argument simpler for you. Congress already tried to ration American’s care via HMOs. Americans told them where to stick it. How will your single payer plan ration care if the HMOs failed to do it. Can you follow? Why will American’s accept rationed care under single payer if they didn’t accept HMOs?
3. LOL moron, doctors are reimbursed. Please keep your rants on topic. Again allow me to make the questions simpler for you, wish I could draw you pictures. Doctors in other countries make far less then doctors in America. For single payer to work you are going to have to give doctors a big pay cut. Doctors are reimbursed substantially higher by private insurance then they are from Medicare or Medicaid, if you eliminate private insurance they will demand a substantial increase from your single payer plan, that is not addresses in any of your arguments. You can’t match the cost effectiveness of other single payer nations paying our doctors 30% more. Our Doctors won’t work for their wages, what is your solution?
4. Again you have no clue what your talking about. Doctors and providers defraud Medicare at a rate 5-7 times higher then they do private insurance. If everyone went to single payer that means the amount of fraud would exponentially increase. Your reply makes no sense, it’s just blabbering of a confused overmatched lil kid.

Wow so after accusing me of not having honest productive debate you avoid answering even one questions and then resort to personal attacks.

Projection hath a name and it be Onlinesavant!

Content warming the tits are coming out NSFW or progressive minds

1. The Federal Reserve clears most financial transitions for a nominal fee. Have them become a clearing house for claims and payments. They already clear payments so only the claims would be an expansion of their current duties, technologically EDI is very similar to ACH. They can do it much cheaper then the private market has to date but more importantly for public health reasons the government would not have complete and total access to real time information needed to gauge and protect said public health. Increased tax investigation and such is bonus.
2. Allow Association Health Plans so small employers can group together and purchase insurance like Unions have successfully done for decades.
3. Eliminate State Insurance laws by strengthening ERISA and making it the sole source of health insurance law. A matter as national as healthcare can’t be regulated by 50 states.
4. Rewrite COBRA and HIPAA so employers aren’t put out of business by an honest clerical error.
5. Make NY Pool surcharge illegal, lock up all state legislators that voted for it and make NY pay financial restitution to every plan that filed paperwork with them.
6. Strengthen the laws allowing self funding and take down the barriers legislators have built up trying to prevent it. No one want’s to see insurance companies making more money, self funding is the most efficient delivery method and has been proven over 4 decades to be as much. Instead of trying to kill it off we should embrace it.

There are 6 legitimate ideas to get started. I’ll be shocked if even one progressive step up to debate them. Hell I would be shocked if any progressive on this blog even understood them.

silent around here…
let’s discuss pricing;
PPOs and provider contracts have outlived their time. They all need scrapped. This will require a few brilliant ideas to accomplish as the parts are inter-related to other parts.
7. Doctors are free to charge what ever they like but must charge all patients the same. Charging someone with insurance less then someone without makes no sense at all.
8. Insurers are free to reimburse what ever they like as agreed to in the insurance policy. It is up to consumers to either choose a doctor that charges the same or less then their insurance pays or to cover the difference themselves. Being told which doctor you have to go to just isn’t right.
9. Both providers and insurance plans must publish what they charge/reimburse per CPT code, online in an easy to use and search site. Providers should also have to publish their biography, any medical board actions, license problems etc.
10. CPT codes need cut in half. Office visits are coded by 5, 10, 15, 25 and 40 minutes yet hardly anyone follows the rules. They only way to audit is to read the medical records and do patient interviews hardly cost effective for a $20 reimbursement difference. It was a poorly designed system with no enforcement or audit ability. New patient visit or existing patient is all we need.
Some misc
11. Federally assigned medical identifier. People are getting sued for SSNs being stolen from them yet we have no alternative to commonly identify people. It would be a nightmare if every time you changed insurance you got a new identifier, you need one at birth that follows you forever. Get past the big brother thing and you could do some amazing things for public health with this. Just need very strong laws that history can’t be accessed by courts, police or anyone else in any way that can identify a person.
12. no more politicians determining how many doctors we should have. Some years they pay hospitals to train doctors then the following year pay them to not train them.
13. Couple years back Congress decided to give doctors in Medicare a retro active raise, this meant millions of claims needed reprocessed and checks making up the 3%? I think it was difference sent out. Payers were literally sending checks for pennies. This year Medicare payments were held up waiting to see if the cut was repelled. I would have thought this common since but apparently not for politicians. All changes in reimbursement can not take effect for minimum 90 days after the bill becomes law. Perfect example of how inefficient government ran healthcare is, they don’t care if 10 million claims need reprocessed and penny checks mailed, it’s not their money. Only a politician would come up with something that wasteful.

Well.Let's start. Firstly, sorry it took me a minute to hit you back. I do have what most contemporaries call a life.Secondly, beyond correcting your deliberate mis-interpretation of my acknowledgement of a poll, I won't try to debate your proposals as they are hypothetical and, drenched in your sad adherence to your, once again, failed ideology. I have neither the time, nor the inclination to do the research to counterpoint everyone of your, again "proposal". But I will give you credit for at least offering something beyond your usual tripe. Now, back to the Poll. The last Kaiser Family Research poll found that 54% of respondents questioned, believe that the government should play a role in making sure that every American has access to quality healthcare. The earlier poll I mentioned,( Unfortunately, at this time without notation.) found that 59% of Americans polled would be willing to pay HIGHER taxes to insure that all Americans had access to guaranteed healthcare. I don't have to lie about anything. Especially to some bushwacking, elky, scrub like you (Shout out to Elle Driver!). A bit tangential, but on to my larger point. Again, I won't debate your proposals, but what I will debate with you is ideology and intention. You see nate, I've maintained all along that what I want, and I believe the vast majority of people on this thread, hell, the vast majority of Americans, want everyone to have have access to quality health, dental, and visionary care. I believe the vast majority of Americans want everyone to have access to these things in a way that does not jeopardize the financial well-being of individuals or institutions. You dear nate, I believe, are not in the vast a majority. Reading you, it's obvious that you are on of those, YOYO's. Or, your on your owner's.Sadly, reading you, you think that there is such a thing as every man being an island unto himself, or even more delusionally, self made men. Tell me nate, did you thank the your fellow taxpayers for your clean water today? Or for the internet with which you spew your bile? Or the clean food that you ate this morning, noon, or last night? Hell, considering that you probably are some hick who lives in the boonies and thinks he's got it all figured out from afar, did you thank your fellow taxpayers for the electricity that they empowered the "guvmint" to make sure that even you have access to? I doubt that you did, or will, because reading you, I get the impression of your delusional nature. You know I could go on,but I'll truncate my further exposing of you with this. Progress is a given. The only question is speed. The only purpose that people like you serve is to try to hold it back.And in doing so, you just fall further and further into your own masochistic abyss. It's comically Sysiphean. Try, or don't try to keep up. We're moving on. Universal health-care WILL happen in this country. It's just a matter of form and time. Get right or get left. Wanker.

Thank you for clarifying that you and your kind have neither the intellectual ability to debate healthcare reform or the honest desire to improve the system. What you fail to realize, thanks for the laugh, is just about every item I listed would still need to be addressed under single payer or any other reform proposal out there.

1 would be required no matter what system we have, it’s juts a question if we continue with current private mangers or as I propose.

3 would happen under single payer

4 these would have to be rewritten in some manner under progressive reform

5. this would most likely cease to exist. Would be interesting to see if single payer passed where states would make up all the lost income.

7-9 would need addressed and 11 is sorta slowly happening.

What you have managed to do by dismissing my points is show Healthcare reform is just a general idea to you, beyond single payer sound bites you have no plan or clue how to implement it. This problem pervades your entire ideology. Single Payer is not reform, it’s the name of a path that could possibly get you there. It’s the thousands of minute details like I raise that determine the success or failure of any plan, no matter what you call the path.

Curious a number of these same proposals have come out from your side as well not that you could ever tell which ones with your limited knowledge but by your logic that makes most progressive reform plans partially born of right wing ideology, it’s almost like you had the insults but no way to use them so you just threw them out there. Classic progressive debate.

Yes the immense value of general polls, they just tell you so much. Would you pay 5% higher taxes to insure everyone? Would you pay 50%? Hum wonder of they would get the same 59% approval? That’s why your side leans so heavily on polls, easy to misrepresent and spin and don’t take any intelligence.

Well it’s time for me to go gots to unplug the power cord I steals me electricity wid be4 noones sees. You know how those billion dollar casinos hate people taking from them for free here in the desert. 1.7 million peoples or so sure be getting crowded here in dis here booney.

Thanks for the circular argument, first I don’t have ideas then they are to hard for you to understand so it’s I’m a hick and you don’t talk to hicks but I live in the city so you give up and go home. Nice to see how well thought out and mature the other ideology is.

We spend all our time fighting for or against a single payer system, which is a waste of time, money and intellectual energy. The public will not support a single payer concept. But they do support universal coverage; a prevention approach to health care over high tech; more information on trade offs for treatment options.

You can have a functioning health care system with insurance companies; choices of health plans.

What is interesting to me is in both France and Germany is that they keep insurance companies; have a basic benefit package for everyone (others can add more if they wish). Having one set of core benefits eliminates all the authorization, eligibility and referral nonsence we have now and in Germany anyway, if you are not working or are low income, the government picks up the premium, so there is no separate public system.

one claim form; one benefit package; one system.

Doctors have private practices; and government negotiates rates. Private insurance companies manage the benefits. What's so hard about this? Political will.

Cheers and more later.

Kathleen
CodeBlueNow!

Might we apply a little political ju-jitsu?

1. Ban cream-skimming: private insurance companies must accept all applicants.

2. Offer a federal health care plan.

Under such a scheme, the great majority of insurance companies would die on the vine.

Then again, having millions experience the sudden cancellation of their private health care coverage might not be pretty, so we should try to make a switch into the Federal plan straightforward. Hmmm.