I am getting very afraid that the Congress is being bought off on this issue and that whatever bill comes out of this is going to make the public worse off.

They're going to undermine employer paid plans and essentially cave in to the Republican idea that we all must be ordered to go out and buy an insurance policy (health insurance bubble coming) that we can't afford with deductibles we can't afford and which doesn't cover our health care needs. Having affirmed that we are not entitled to health care but we are instead mandated to buy policies (which we can't afford) they will then come back and destroy Medicare having won the argument that health care is our responsibility and that we have no entitlement to receive health care at all.

Here we go again. Health insurance bubble. Welfare in the trillions to health insurance giants. When we're all bankrupt the bubble will collapse.

It doesn't suprise me at all that the insurance companies are buying congress people with money have been doing it for years. And if you look at what happened when they made it mandatory for auto insurance it really scares me.

"...obscene charade that is beginning in Washington where, through a system of legalized bribery, the parasites of the health insurance industry will continue feeding off the body and blood American public". Perfect characterization of the little farce being conducted in Washington for the benefit of the naive and uninformed.

This is really getting to me. I just wish to see some change. But the personal stories, the heart break. Then Dr. Aaron's report. I agree with your conclusion. I just am in despair over any good outcome. But we shall see.

OB,
Hope this doesn't sound "snitty" but I see no function for health insurance companies than one that is really parasitic. I just can't imagine any scenario that they would go along with enough regulation to make any difference.

Just a thought.

But no matter whether private or public health services you were always in a nation that provided universal health care for all it's citizens as a basic right. Undoubtedly your private, but regulated existed in tandem with a universal, free system of public healthcare. Correct? It's my understanding that every european nation has a national, single payer system and most have a private system that is in tandem or in addition to that basic system.

bb - I couldn't agree more. But if they're incompetent at regulation, I can't see how that's an argument for competence at the healthcare service itself. Like I said to Face, I don't know much, but liked Edwards' idea during the primaries, of progressive public insurer-private insurer competition...

Germany, too.
The whole health care system is a public/private mix. The insurance providers are "state regulated" but certainly not "single" payer:

How is the healthcare system funded?

A: Until they reach the retirement age of 65, people must, by law, pay into health insurance plans (and, since 1994, an additional long-term care plan). The health insurance plans are either state-regulated or private. After retirement, contribution payments for the state-regulated plans stop (although private patients continue payments), but coverage is continued until death.

Only certain groups are allowed to take out private health insurance. The vast majority of people are obliged to use state-regulated plans and, depending on their individual circumstances, choose from one of about 400 options. The government regulates the fees of state-regulated plans. Although some doctors take only private patients, normally every doctor has a sign that says s/he is accredited by all insurance providers.

There are several types of state-regulated plans. Some large companies and guilds offer their employees in-house plans. Other groups – notably people working in technical and scientific environments, employees in medium-sized and small firms, or blue-collar workers – often prefer the so-called self-governing substitute plan (Ersatzkassen). The state covers health insurance contributions for the unemployed and those with low income.

Contributions to the state-regulated health plans (currently around 14% of the employee's gross income and shouldered equally by the employee and the employer) cover up to 68% of overall healthcare costs. Income taxes, funds derived from those with private health insurance, and out-of-pocket payments (e.g., for prescriptions where the insurance covers only 90% of the charges) attempt to cover the remainder.

The government regulates the use of private insurance. There are three main types of people who use private insurance plans. Persons with a monthly income exceeding US$3,825 may legally opt out of state-regulated plans and switch to private insurance. The self-employed are excluded from the state-regulated plans and so must take private insurance. Public sector employees (e.g., police, teachers) are reimbursed for part of their health costs by the state but have to be privately insured to cover the rest. (The government is now trying to make it difficult to opt for private insurance because the state-regulated insurance loses the 14% contribution from these high-income earners.)...

continued

Their system has an excellent reputation, and high costs.

ALL the systems worldwide are of course experiencing great stress on costs with the increasing ability of medicine to save more people and extend life further, and also predict even more cost problems with the aging of the worldwide postwar baby boom.

Again it's the regulation aspect, I believe, not the "insurance" being better. In the US, I simply do NOT trust what would happen if the repubs get back in power and eviscerate regulation. That's the core of the problem, in my view - letting profits drive policy, rather than social good.

Thanks for that AA. Love this kind of article. (but the link doesn't work, i think...)

It's my understanding that every european nation has a national, single payer system and most have a private system that is in tandem or in addition to that basic system

Where did you get that idea? Have you only checked out Canada and the UK and just presumed Europe is the same? It's simply not true.

People who feel strongly about advocating for single payer need to know that there are "enemies" out there, they are the many universal coverage systems that are not single payer that are lauded as successful and which most citizens of those countries seem to be happy with. Otherwise, you'll just be blindsided by these arguments about quite happy non-single-payer universal systems too late in the process.

Check out Asia, too.
Japan for example:

....It is compulsory to be enrolled in a Japanese insurance program if you are a resident of Japan. The two main categories of health insurance are referred to as Kenkō-Hoken 健康保険 ([social] health insurance) and Kokumin-Kenkō-Hoken 国民健康保険 (national health insurance). National health insurance is generally reserved for self-employed people and students, where as social insurance is normally for corporate employees....

And Singapore is lauded as having excellent cost savings with mandatory co-pays and mandatory health savings accounts with the single payer covering only 80% of basic health care services but for catastrophic there is means testing. They obviously gain by having the government make preventive care easy and cheap to get and then leaving the extremes less covered. (Which means the rich get to have the expensive risky or controversial treatments for the rare disease or problem and the poor don't?)

For the U.S. to go to single Federal payer really would be still quite a radical move in comparative terms worldwide, realize that you are asking for a radical move. Where we are really behind the eightball is that we don't have universal with full regulation and oversight and evening of playing field, not that we don't have single payer.

Sorry about the bad code.
My first link:
http://www.medhunters.com/articles/healthcareInGermany.html
My second link:
http://www.justlanded.com/english/Germany/Germany-Guide/Health/Introduction

Right. They have a two tier system. The first tier that everyone has free access to is the single payer government health program. The second tier is additional private insurance. Even in combination it is still cheaper because the insurance companies are not in charge of the primary system there as they are here. If you didn't have the primary system in the countries where found good care, you would have found what we have here, but the europeans didn't allow this sort of malignant system to take root.

Care varies no matter where you go. Could be the doctor, could be the hospital or a million other factors. Overall, however, the verdict is in and has been for a very long time: every country in europe with single payer has a better system than we do and the same goes for Canada. That's why it is obvious that only by instituting a single payer system can the US ever hope to solve the ongoing "crisis" which is caused by our rotten system and the insurance parasites who control it and feed off of it.

They have single payer in tandem with other tiers of health care delivery and cost. It is true to say they all have single payer. They don't all have the same plan. They don't all work in the same way, but their single payer plans all provide universal coverage for all their people. Any one of those types of plan is far superior to ours.

Yes, you're right. Unless you keep your wits about you, they distract you from what are the real issues. It takes a laser intensity to see their games for what they are!

You can call it regulation or adminstering the sytstem honestly, fairly and with integrity. Whatever you call it, there's no question that we cannot do it properly if it involves profit because we always and without exception put profit first. In healthcare we have demonstrated quite clearly that doesn't work well for the human beings who need medical care though it does a bangup job for people who simply want to make a killing off the idea of it.

.

Yup to this . . . Oleeb

"...the insurance industry and how they are now suddenly and miraculously making themselves into something they are not..."

Take for example the executives from the Business Roundtable, as most here already read in my blog Have You Heard This Health Care Song & Dance Before?.

And this is their shiny new talking points bought and brought to us by our own money.

businessroundtable.org/sites/default/files/BRT_exec_sum.pdf

Make sure you at least scroll through it quickly. It's the biggest song and dance routine this side of Dancing with the Stars.

~OGD~

That's the free market concept. Public services are privatized then the corporate system places a price tag for the service and the public has no choice but to pay. It's a take-it-or-leave-it system without the government interfering on the public's behalf because it's a private concern now - not public.

Obey, I'm in Europe atm and have a private insurer thru my employer and I find it's sux. I have to pay for all services,in euro(that's a 30% to 40% increase for services due to the dollar devaluation), submit paperwork for each action, and wait a few months for a refund that may range from 50% to 70% of the total costs paid. Also, the insurer doesn't give me a clue as to the doctors and specialist in my local area who will take patients with their insurance - I have to wing it on my own. There needs to be regulations on health insurers to make them more responsible for their members. One shouldn't have to make out-of-pocket payments if they have insurance, especially if the insurance is labeled International.

Between the comment I'm about to post here and the one on AIG I'm working on, I suspect I'm not going to be making myself very popular around here today anyway, so I'll just say it: take a breath, people! Take a breath and take a look at the following interesting post at 538.com on Obama's "code" by George Lakoff, author of "The Political Mind."

I draw your attention to one quote, in particular, that I think is relevant:

Behind the Obama Code are seven crucial intellectual moves that I believe are historically, practically, and cognitively appropriate, as well as politically astute. They are not all obvious, and jointly they may seem mysterious. That is why it is worth sorting them out one-by-one.

1. Values Over Programs

The first move is to distinguish programs from the value systems they represent. Every policy has a material aspect—the nuts and bolts of how it works— plus a typically implicit cognitive aspect that represents the values and ideas behind the nuts and bolts. The President knows the difference. He understands that those who see themselves as “progressive” or “conservative” all too often define those words in terms of programs rather than values. Even the programs championed by progressives may not fit what the President sees as the fundamental values of the country. He is seeking to align the programs of his administration with those values.

The potential pushback will come not just from conservatives who do not share his values, but just as much from progressives who make the mistake of thinking that programs are values and that progressivism is defined by a list of programs. When some of those programs are cut as economically secondary or as unessential, their defenders will inevitably see this as a conservative move rather than a move within an overall moral vision they share with the President.

This separation between values and programs lies behind the president’s pledge to cut programs that don’t serve those values and support those that do — no matter whether they are proposed by Republicans or Democrats. The President’s idealistic question is, what policies serve what values? — not what political interests?

[Emphasis mine.]

I've thought of this every time I see some raging comment from the single-payer absolutists.

I want decent health coverage for everyone with premiums adjusted on the basis of means but with no adjustments on the basis of age, health or pre-existing conditions. That's the value I am for. There are other things I also want. Things like, just to name a couple, the complete computerization of medial records, comprehensive preventive care and the creation of some effective incentive mechanism(s)for making medical technologies cheaper. And my defintion of "decent" would probably take a couple of thousand words.

That's the value I am for. Single-payer is not a value, it is a program.

Maybe its the best way to deliver on the value. However, though I question whether it is possilbe, if, through regulation and legislation, someone can figure out how to deliver on my value while making a profit, I am not going work myself up into a frothing rage about it. Profit motive creates perverse incentives that can result in undesirable outcomes in health care. No question. But anyone who thinks the magic words "single payer" elminate perverse incentives that result in undesirable outcomes is being almost GOP-like in their resistance to empirical input.

Note that the German system is still heavily tied to employment (as are others--Japan?) The self-employed have to get insurance on their own. More and more, if we have to do incremental (and like it or not, I think the reality politically is that we are going to get incremental change,) I'd like what to see delinking from employment as a priority. It's just suggested by the economic situation, a seize the day sort of thing. (And if you've followed economic news past, Germany has had problems with past high unemployment and small business complaints of too many onerous government requirements.) But there's problems with that, too, though---makes my head hurt--if you take the burden of insurance off of employers, how do you make them transfer some of the money saved to higher wages, so that the wage earners can afford whatever they are required to pay towards their own insurance, whether co-pays, deductibles or premiums? There's a whole "rob peter to pay paul" situation with all these plans that's over my brain capability....

This was supposed to be a reply to ncsteve above.