Recommendation for health care reform

A great proposal !!

I would add one paragraph - to make any Veteran eligible for VA care based simply on service and not on having to prove a service-related disability.

Is there rationale/argument to go along with the recommendation as to why this makes sense, we can afford it, etc.?

I love it when people talk about things they know nothing about. Fact, there is no better health care on this planet than that AVAILABLE in the USA. Socialized medicine works no better than any other "Socialism".

We do not need Medical reform, we need Insurance reform.

Interested, Are you going to reject (or have you rejected) Medicare when it's offered to you? Medicare has a much higher rate of user-satisfaction than private health care plans have among people who actually need significant medical care.

Those of us who have private health care plans rather than Medicare, and who have had to use it for significant health problems, DO NOT have access to the best health care on this planet. And, we're paying far too much for the punishingly difficult-to-access care.

Candlelighter, we can't afford NOT to do this or a comparable reform of the current system.

I'm 100 percent with you, Malcolm and Peter. But will it remain only a dream?

The VA, caring for a much sicker population, spent $5,562 per patient in 2004 versus the average spent for all Americans of $6,280. And the VA has consistently received the highest consumer satisfaction ratings of ANY public or private sector health care system according to the National Quality Research Center. And the quality of care provided by the VA ranks higher than that of any other health care system.

The VA of today is dramatically different than it was 15 years ago and it provides care for about 2/3 the cost per patient of Medicare.

Diana....You wrote:

"Those of us who have private health care plans rather than Medicare, and who have had to use it for significant health problems, DO NOT have access to the best health care on this planet."

Really...Well I welcome your advising me in what other country you can get better health care....Name one.

Perhaps you can enlighten the rest of us by stating what Country you have travelled to in search of better health care.....Name one.

I look forward to continuing this discussion when you have answered those questions, at least then we might start from some semblance of reality.

The VA, caring for a much sicker population, spent $5,562 per patient in 2004 versus the average spent for all Americans of $6,280. And the VA has consistently received the highest consumer satisfaction ratings of ANY public or private sector health care system according to the National Quality Research Center. And the quality of care provided by the VA ranks higher than that of any other health care system.

The VA of today is dramatically different than it was 15 years ago and it provides care for about 2/3 the cost per patient of Medicare.


Come on Mr. Carpenter, this is a new low for you. The VA spent less money per patient. Well how wonderful for them, and then the people who had no choice but to use the VA were asked how they rated the service compared to what they did not experience they voted it highly. Well what a surprise......

Its a bit like saying here's a free hamburger, now tell us how it compares to a steak you can't taste......Its a dumb-ass comparison.

Interested, Do some research at Kaiser Family Foundation, www.kff.org

France, Germany, several Scandanavian countries, Canada -- all and others have systems that make care available to all, at far less expense. Surveys show high satisfaction rates among citizens of those countries.

Here's the link: http://kff.org

Interested should look at the facts - the National Quality Research Center at the University of Michigan rates ALL of the U.S. health care systems using exactly the same measurement tools. And the VA consistently comes out FIRST. The VA not only has lower costs but also has higher customer satisfaction AND better outcomes. What is missing?

See: Best Care Anywhere by Phillip Longman

And please let's knock off the 'new low for you', 'dumb-ass comparison' and stick to the issues.

Interested states: comparing free care at the VA to paid care elsewhere is 'Its a bit like saying here's a free hamburger, now tell us how it compares to a steak you can't taste...'.

In fact, the surveys compare VA's 'free' (ask any Vet how much they paid to earn the right to VA care and you will find it is anything but free) care with the care provided by all other health care systems regardless of who pays and the VA still comes out on top.

So it is like ' here is a free steak, now tell us how it compares to the hamburger that you weren't forced to both pay for and to eat...'

Well Peter, why don't you, as a Vietnam Veteran, tell us the last time you walked your ass down to the VA for your medical needs if its so damn wonderful.


I would love to take bets on this

Sorry, but it seems like the jury (read: American people) has weighed in on this issue. As recently as Friday (January 22), 61% of Americans say Congress should drop health care reform efforts. Link: reform.Web Link

I know a lot of people in our area don't believe this, but it appears that most Americans (61% is quite a large percentage for a national opinion poll) are pretty satisfied with our current system. Even about a third of people without insurance (commonly referred to as "invincibles) don't want this reform because they have decided not to purchase insurance (I assume to purchase a second car or flat panel tv) and they would be forced to under the proposed legislation. Our system is far from perfect, but voters seem to think it's better than the proposals that they've seen from Washington sausage makers... I mean, law makers.

That said, I agree that insurance reforms are needed. I'd love to see Congress change regulations so insurers would have to accommodate pre-existing conditions, be prevented from cancelling insurance due to claims, allow consumers to purchase insurance across state lines, and get relief from nuisance malpractice suits, etc. Unfortunately, everyone seems to agree on these things so I suspect our Congress won't even consider these changes.

And if healthcare truly is a "moral imperative," then we shouldn't exempt large groups of citizens from having to pay for it - whether they're from Nebraska or union members.

I also suspect that this is one of those issues that we're going to have to agree to disagree... but have at it.

Interested asks, in an impolite manner, 'Well Peter, why don't you, as a Vietnam Veteran, tell us the last time you walked your ass down to the VA for your medical needs if its so damn wonderful.'

I was diagnosed with incurable leukemia, presumed to have been caused by my exposure in Vietnam to Agent Orange, in 2002. I have been receiving ALL of my medical care at the Palo Alto Va ever since then.

And that care IS wonderful - I never wait more than 5 minutes beyond my appointment time to see my physician, I have email access to him, all of my medical records are electronic, my prescriptions are filled by using my computer or phone and it is the best medical care I have ever received. As a point of source credibility, I was the Executive Director of the Stanford University Medical Center from 1973-76 so I have personal knowledge on these issues.

So, Interested, I hope you didn't take any bets on my not receiving my health care at the VA because you just lost your bet, BIG TIME.

Now, can we get back to the topic?

Actually before we get back to the topic. I owe you an apology,I wish to offer it and I hope you will accept it. period.

Interested - your apology is accepted, thank you.

Now let's just minds to figure out how to do something about access to health care in this country. I think Malcom Dudley's proposal is a wonderfully simple and potentially workable alternative to the current all things for all people, particularly the lobbyists, approach that is currently dead in the water in Washington.

One needs to be very careful when proposing rolling out Medicare to all. A few things to consider:
1)People are generally satisfied with Medicare because there aren't many restrictions, and people are at an age where they use more resources from the system (i.e. are paid out) more than they pay in. This equation is not true for younger, usually more healthy populations. Hence recipients of medicare are receiving subsidized care, of course they are happy with it.
2) Medicare pays rates determined by the government which tend to be 20% or more below what others pay. In some cases, below what it costs health care providers to provide the care. These losses are then made up by increasing prices to those who pay via private insurance (consider it an unidentified tax). The Mayo clinic actuially has a pilot program where they will stop treating Medicare patients to avoid these losses. Hence, the result of "expanding" Medicare to everyone could result in some health facilities and providing going under with the result, ironically, being decreased access.
3)I'm not familiar with the methodology of the VA study cited, but as one who has worked with patients in a variety of VA settings and also at University hospital settings, when veterans had a choice, they always opted for the university setting. I'll also add that as a rule, the veterans were very appreciative and I suspect would be much more generous in their evaluation than the typical visitor to an academic medical institution.
4)I would be wary of overbroad general comparative conclusions of different health care systems. Oftentimes, the results can reflect data for a society but may be confounded by the multiple variables involved. For example, infant mortality is a measure for which the US often gets criticized. Yet looking beyond the headlines, there are many components and differing methodologies. In the US, we have neonatal intensive care units and will often treat (at great expense), very small and high risk neonates. Similar babies in some countries are not given aggressive treatment and if they don't survive 24 hours, are considered "still born" and do not count toward infant mortality stats. Since infant mortality is generally pretty low, it doesn't take more than a few deaths to markedly change the rates and ranking. Put another way, if we want to markedly improve our outcome per dollar spent on health care, we could close all the NICUs, don't count neonates that don't survive 24 hours as live births, and we would technically decrease our infant mortality rate while saving money. I'm not really advocating this, just urging caution about top line stats.
5) I believe that reconciliation can only be used for bills that reduce costs. I don't think the CBO can take the medicare proposal this thread started out with and make it a cost reducer.

One other thing. Isn't Medicare about to become insolvent? My understanding is that drugs are about 10% of the budget so even with negotiated prices to 0, there is still a problem.

I suggest that 1) lower the Medicare eligibility age to 55
and 2) giving all honorable discharged Veterans
access to VA care

would 1) significantly increase the number of Americans with access
to health care
2) be achievable with a two paragraph bill
3) that bill would be political acceptable to a
overwhelming majority of both the House and the Senate
4) and the above would lay the groundwork for further changes
in future years

Concerned Parent -

I appreciate the time you took to write your post. I agree with each of your statements.

Your comment about closing NICUs to save money and improve infant mortality scores illustrates (however perversely!) how people may misuse statistics to make a point. And you correctly point out that Medicare is a bargain for those recipients because they receive so much care for so little cost. That's not going to be true for all of those 20, 30 and 40 year olds who will be paying a lot for relatively few benefits.

Given my profession, I am also familiar with healthcare systems in other countries and I am simply astounded that anyone could honestly believe our healthcare is second rate. It is not. Perhaps they've never visited an overcrowded ward in London or talked to a Canadian patient who has waited 6 months for an angiogram.

On the other hand, our insurance system is complex, painful, expensive and fraught with abuse by insurance companies and fraud by providers and patients. That is where we need reform.

You raised some superb points and I'm looking forward to reading other participants' comments!

Diana, my question was not rhetorical. The poster made a specific suggestion, and I would like to hear his views (or yours) of why those suggestions would solve various problems. I do have a philosophical bent of the less government intervention into private lives, the better, but I am willing to listen to the arguments before making up my mind.

The VA issue brought up by Peter Carpenter is an interesting one, and I think worthy of discussion on this particular thread; no need to create another.

The Government wants to take money out of Medicare. People who feel this way may change their minds when they reach Medicare age! What about those of us worked hard to make sure we qualified for meedicare. People on Medicare have less years than pre-Medicare persons to make money!!

It is disgusting enough that Medicare doesn't give any mon ey for hearing aids or glasses. How safe is that?!!!!

It's amazing how a well-orchestrated campaign of fear-mongering can convince so many people to act against their own best interest.

While I'd like to see universal health care in this country, I think the most important thing about the currently proposed health care bill is that it would prevent insurance companies from taking away your insurance when you get sick, prevent it from denying coverage because of pre-existing conditions, and prevent it from placing a cap on lifetime coverage.

Americans have let their health insurance companies get away with outrageous behavior for far too long.

VA expenses per person may be less than private expenditures. However, all those pretty buildings at the VA hospital are paid for by the taxpayers, not the users of the services. People who use Stanford, Palo Alto Medical Foundation, etc. are using facilities that are paid for by the users and donors.

People who use Stanford, Palo Alto Medical Foundation, etc. are using facilities that are paid for by the users and donors - AND by big government grants and BIG tax deductions for health insurance premiums.

Statistics are an art, not a science ;)
I would like to know the specifics of how per patient costs are tabulated in the medicare/VA/avg comparisons if anyone has that info. Certainly subsidized land and facilities need to be included for a fair comparison with VA care. Also (and I really have no clue here) do VA facilities have trauma units? NICUs? do they get a fair number of people using emergency rooms for primary care? Is it easy to sue the government for malpractice? (just kidding on that one. Do VA doctors pay malpractice insurance? Is the cost of malpractice insurance considered in comparing Medicare rates? If the medicare reimbursement rates are below private insurance rates (or out of pocket rates), isn't the cost of medicare being further subsidized by private insurance? What about access in small towns? Further reductions in medicare reimbursement rates might force private practitioners in rural areas to close up shop or move to the nearest city for economies of scale at a hospital. Does the VA provide care in rural communities (again, no idea here). Are these apples-to-apples comparisons?

Litigous and Uninsured,
you raise some good questions. As one who used to cover the VA ER overnights, I can offer some insights, though they may be dated. The VA has outpatient clinics with urgent care during the day, but after hours everyone goes through the ER. You do get many primary care as well as patients with psych issues after hours. Malpractice ( I think you imply this) is a non-issue as one would be suing the government. That's one interesting side effect of truly socialized medicine, no large malpractice suits. Now VA docs are salaried but don't need to pay malpractice, so I don't know how that math works out. As far as what the VA needs to be ready for.... I don't believe they are set up for real trauma (like a UCSF, Stanford, or Valley Med), but they can get ambulances. There would be little need for a NICU as the patients are mostly elderly and male (though that is changing). There is also the possibility of getting active duty emergencies (including women and children), but they are rare. In general terms, the docs are paid the same independent of the number of patients seen, so it's hard to compare the rates. VAs also typically have academic affiliations and are able to get medical students and residents who are failry cheap labor, but I'm not sure where those salaries come from. All in all, an apples-to-apples comparison is very difficult. What is clear is that the care can't be rolled out to everyone with the allotted monies budgeted, hece the cutback to patients with service-related disability (a form of rationing). I agree with a comment above, that access should be based on active service alone.

This would be great! I have private health insurance whose premiums just went up 9.2% this year during a depression left over from the previous administration because they had no accountability and handed out money freely.
My health insurance company told me they were sorry and that my surgery was cost prohibitive. I have since had one surgery I paid for on my own. I need three more procedures according to my new surgeon outstide of my health care company. I can't afford surgery so I guess I will just suffer the rest of my life because we, THE WEALTHIEST NATION ON EARTH, can't afford to take care of it's own people.
INTERESTING THAT PRESIDENT BUSH MADE HEALTH CARE A RIGHT IN IRAQ!!!!!
Guess they can afford it!!!!
Didn't our leaders just get a raise????
May God bless American!

I appreciate the many informed and thoughtful comments. I believe that health care is a public good and a sign of a civilized, advanced society, not a private good for commercial gain. This fundamental assumption, whether or not it is expressed, accounts for much of the variance in views among thoughtful advocates. A public good requires a single payer system (like Medicare) with either public (UK) or private (Canada) delivery of the care. It also leaves no place for for-profit insurance companies exploit market efficiencies to make profit. I strongly recommend, "The Healing of America" (Web Link for a thoughtful exposition of the health care systems of various countries. Bottom line: In almost all categories, we are last.

The Thistle -

The innovation of intensive care units, statins, insulin pumps, advanced imaging, open heart surgery, ultrasound, thrombolytics, chemotherapy, radiation treatments, stenting, organ transplants, less invasive surgery, hip replacements, etc. all came out of our for profit system. In many cases, the motivation to bring these treatments to the public was to make money. I suspect you do your job to make money, too and probably do so without a tinge of guilt.

So the next time you're in an MRI machine, thank Ray Damadian for that painless, harmless and miraculous image. When Lipitor reduces your cholesterol and allows you to live a longer life than your parents, you can thank Bob Roth. When you walk out of a hospital with that new hip, thank Bob Kenna. When you can breathe again with your new stent, thank Dick Schatz. All of these people contributed greatly to our society and have improved numerous lives... and all of them made some money along the way.

You say that health care is a public good (read: a right) and that is your privilege. But if that is true, then it must surely be true that food and shelter - which are far more critical "human needs" - should also be rights. So should we make our farms, supermarkets and apartments, condominiums and housing non-profit too? Most of us can live a lot longer with out seeing the doctor than we can without food or shelter.

Why not make your industry non-profit? What makes it so special?

Let's cut to the chase here. Reasons why significant healthcare reform won't happen anytime soon:
(1) Many people today see themselves in precarious economic straits and are afraid to rock a very tippy canoe. Fear always militates against change.
(2) Too many in the U.S. confuse healthcare treatment and delivery (generally good) with our system of healthcare access and payment (generally irrational and unfair). (1) and (2) are abetted and encouraged by...
(3) Powerful vested interests, and their Washington allies, who are arrayed against any reform that doesn't benefit them financially. And economical and efficient healthcare certainly does not.
(4) Perhaps we as a nation have become too inept and supercilious to put together a major program that actually works, and the sun is indeed setting on the American Empire.

BTW: The cost of the wars in Iraq and Afghanistan has officially topped $1 trillion. The eventual cost is estimated at something between $3 and $5 trillion. Those of you worried about financing healthcare don't seem too concerned about the massive national treasure that continues to pour down those rat holes. End the wars now and we effectively pocket a couple of trillion dollars--enough for some very serious healthcare measures. Another benefit: no more casualties with grievous, expensive-to-treat wounds.

This ain't rocket science, folks. But we're a lot better at rocket science than we are at social programs.

Ethan -

I agree that it's not the healthcare system that's broken, it's the payment system. That's the reason I think we need insurance reform, not healthcare reform. I think we can solve a lot of our problems with four or five key changes that most people seem to support. But that's too easy for Washington and makes far too much sense.

But you are wrong when you say that I "don't seem too concerned about the massive national treature that continues to pour down those rat holes." Are you kidding me??? I'm not only concerned about those rat holes, I'm concerned about the rat holes we have recently created (both the Bush AND Obama administrations) at our banks, car companies, insurance companies, etc. We spent about as much on TARP and stimulus as the war and have about as much to show for it.

Thanks, Diana, but how many illegal aliens do they have in Scandanavia? What percentage of the population there is paid to have babies and eat french fries?

Sorry, I meant to add, "to have babies while eating french fries and doing crack?" (Both of which really tend to run up the ICU bills, both newborn and adult.)

How much do you think it would cost to support a Canada-sized EPA, with free health care, legal services, schools, everything printed in a zillion languages, police, insurance to cover PA break-ins, camps, scholarships, clothing, substitute parenting, all of the other costs absorbed by surrounding communities, etc etc? You would need a zillion liberal-filled PA equivalents to support it. So please stop with the silly comparisons.

OK, Ethan, let's stop the wars. And should we call a halt to all of the other costs that our country bears, as the protector of the free world, blah blah blah? How about if I pledge to match, dollar for dollar, the massive amount of aid contributed to Haiti by Kuba, Hugo, Oslo, etc? (Oslo? Hmmm...anybody got an undeserved little medal that he can sell, to buy some health care?...Maybe an autographed birth certificate...?)

Thanks, POGO--that's a whole rant that I didn't have to do!

Not allowing for negotiation of drug prices? Yes, that was the most inexcusable thing that Bush ever did.

Multi-tiered health care? Sorry, that's just the way it is; money does buy stuff. For example, one should be allowed to use his or her own $50K, not mine, to purchase 2 extra months of life while battling end-stage cancer. (For those keeping score at home, that's $300K per life year, and much more per QALY.)

Let's stop mouthing inanities about "preventive care," and start giving people a financial stake in pursuing healthier lifestyles (or penalties for not doing so).

To "Interested:"

That is quite fascinating, isn't it? Everyone knows how the health care system should run, yet so few claim expertise in quantum mechanics. In reality, there are probably more people in the country who are experts in the latter than the former. What would you call that, "familiarity breeds idiocy?"

I don't think would be that harsh. I think most people are concerned about the poorest in our Country that cannot afford health care and would like to find something to do about it. I understand that completely. I just don't see the answer as socialized medicine for all.

I worry about people who declare how great Socialized Medicine is but have only ever been on the outside looking in, It is a very different picture when your on the inside looking in. I can assure you there is a vast difference in the standard of care. I can prove this to you. There are now dozens of companies that offer Private health Insurance in countries like Britain...WHY?

Where are we going with this? If you just review the degradation of this thread it parallels the degradation of the national debate. Suddenly we are not talking about the problem so much as what we think about the economy and how "knowledgeable" we all are on the subjects.

We are talking about make healthcare available to the poor. Stop using that insane analogy of socialized healthcare performance versus our great, private, brave, courageous, morally superior system of care that has created the new technologies...bla bla bla.

That is a classic case of escapism from the actual topic.

How do you create a system for the poor? Any socialized system would be a welcomed improvement from having nothing.

Get on topic and stop trying to sound like a South Carolina stooge congressman.

"I think most people are concerned about the poorest in our Country that cannot afford health care and would like to find something to do about it. I understand that completely. I just don't see the answer as socialized medicine for all."


You must have missed that part. But ok Truth, institute a national sales tax and use the money to provide health care for those that don't have it. Simple. Whats more those that spend more (and presumably have more) pay more. Happy.

Actually, this thread simply demonstrates how complex our economic system is and the factors that must be considered in healthcare reform. That's why there isn't a simple fix.

Unfortunately, other countries don't share our demographics, our immigration issues, our worldwide military defense responsibilities (like it or not), our willingness to spend money on heroic healthcare efforts, our economic values and our profit engine that drives technology innovation and advancement. It is difficult to compare America's infant mortality rates to those in Iceland and Macau or our per capital healthcare spending to Finland, St. Kitts and Estonia. We don't compare well to any of them, but if you need chemotherapy or major surgery, I suspect you'd rather find yourself at Stanford Medical Center than at East Tallinn Central Hospital in Estonia.

There is definitely a cost for changing the system. In addition to cost shifting - taxing one group to pay for another - there are other economic and social costs. They may not matter to you, but they may matter to someone who is looking for a cure for their Parkinson's Disease or pancreatic cancer. They may matter to doctors who are working longer hours for less money. Those doctors can't afford to treat new Medicare patients and are now looking at even lower payments for treating their existing Medicare patients in the future. And they may matter to those drug and device companies and entrepreneurs who spend tens of billions of dollars every year on innovation and want a return on their investment.

You ignore these impacts at your own peril.

But the one thing everyone seems to agree on is that we need to change some insurance company practices (and since you've heard them all before, I'll spare you the listing) and take care of the poorest. Unfortunately, with their currently proposed 2,000 page legislation, our Congress missed both targets by a mile and that's why they have lost the confidence of the American people (and apparently many of the majority party's own members of Congress!).

I think we could address healthcare for those 10-12 million Americans who truly cannot afford it in easier, more directed and more efficient ways. And that's where we can learn a lot from Canada, France and Finland.

pogo said in 2010:
- But the one thing everyone seems to agree on is that we need to change some insurance company practices (ed: pre-existing conditions, remove caps, etc..) and take care of the poorest.
- Unfortunately, with their currently proposed 2,000 page legislation, our Congress missed both targets by a mile...

Hindsight shows us ObamaCare did much of Pogo's insurance reform AND helped 15-20 million Americans on top of the reform.

TrumpCare, according to the White house document, will take healthcare away from 26 million Americans. While funneling $600 billion in tax breaks to the top 1%.

Once TrumpCare either fails or is approved, the GOP will lose their majorities, and the opposition party will use the GOP's own tactics displayed to make 1 simple change: lower the Medicare eligibility age to ZERO.

Medicare for All.