[for reference]

chart via








Obama on single payer --

The New Yorker wrote, "'If you're starting from scratch,' he [Obama] says, 'then a single-payer system'-a government-managed system like Canada's, which disconnects health insurance from employment-'would probably make sense. But we've got all these legacy systems in place, and managing the transition, as well as adjusting the culture to a different system, would be difficult to pull off. So we may need a system that's not so disruptive that people feel like suddenly what they've known for most of their lives is thrown by the wayside.'" [New Yorker, 5/7/07]

Can't manage the transition?! Canada did it, we can too.


FAQ on single payer national health insurance
HR 676, National Health Insurance bill


The Senate Finance Committee hearing is tomorrow. Send an email NOW. Tell them

WE WANT SINGLE PAYER !!!

Who was that masked man?

[ok, so the title of this post is an inside joke, and a bad one, plz to ignore that part]

Krugman's latest column, The Waiting Game [that link's broken, try this one], takes on that bugaboo of Socialized Medicine [TM], the loooooong waits for elective surgery in those other countries. You have to wait, like forevah dude, for a hip replacement in Canada, but you can get one right quick here in The Good Ol USofA.

Here's why we're quicker:

On the other hand, it’s true that Americans get hip replacements faster than Canadians. But there’s a funny thing about that example, which is used constantly as an argument for the superiority of private health insurance over a government-run system: the large majority of hip replacements in the United States are paid for by, um, Medicare.

That’s right: the hip-replacement gap is actually a comparison of two government health insurance systems. American Medicare has shorter waits than Canadian Medicare (yes, that’s what they call their system) because it has more lavish funding — end of story. The alleged virtues of private insurance have nothing to do with it.

Administrative costs, here and in Canada

from Costs of Health Care Administration in the United States and Canada by Steffie Woolhandler, M.D., M.P.H., Terry Campbell, M.H.A., and David U. Himmelstein, M.D.

In Table 1, the authors [admitting that the numbers are imprecise] attempt to break out the various administrative costs in the two health care systems. Ours costs more. No surprise there.


Table 2 is a bit more interesting. The percentage of health care employees [doctors offices, hospitals, clinics, etc] in the US who are administrative or clerical has grown over the years. This isn't proof that the insurance industry is the cause of this growth, but if you've ever had a lengthy, complicated, expensive illness, you've dealt with more than your share of these people. >Bryan has some related info.


My apologies if Table 3 is unreadable here. If you click on it, a larger version should appear.

How many insurance company employees does it take to screw you out of your hard-earned dollars, and try to deny you decent health care? In Canada, it takes about 1.5 employees to deliver Canadian Medicare to 10,000 enrollees [patients, or potential patients]. In the US, it takes 23.5 employees to deliver for-profit health insurance to the same 10,000 enrollees.

Forgetting for the moment how to calculate and compare administrative costs between two very different systems, how about if we just assume, and it's a reasonable assumption, that we could dispense with 90% of those employees? This would bring it down to about 2.5 employees per 10,000 users of health care services. Even if the salaries + benefits of those employees only add up to a paltry $20,000 per year per employee, that's roughly $3 billion per year that could be spent on doctors, nurses, orderlies, pharmacists, and other truly useful people.

What are those approximately 150,000 displaced insurance workers going to do? They can do like the rest of us who have lost jobs to re-engineering, right-sizing, down-sizing, out-sourcing, and off-shoring: get another job. I wouldn't mind paying them to mop the floors in the hospitals, or take my blood pressure at the doctor's office, but I'll be damned if they ought to get any money from me for the purposes of denying me the insurance I paid for.

Speaking of denials, I didn't stumble over this until last night, but there's a whole denial managment industry out there. That's right, if we scrap the for-profit insurance industry, we're also going to put a bunch of people out of work whose job it is now to try to get the insurance companies to pay those claims that get filed.

The lights are on, and we've all come out to play.

So, last night, after a weekend of withdrawal, I was wandering through The New Fray, some of which really is an improvement [what does this button do?], when I stumbled over JackD's question about healthcare mandates. I'd been wondering much the same thing, and in particular: How did Canada make the switch from private health insurance to universal public health care? so a-Googling I did go.

And eventually ended up somewhere deep inside this site [I don't remember where exactly]. Whichever page it was, I found some information, but not enough, so I sent an e-mail to the address that you see in the sidebar on the left there, asking for more information. I figured I'd probably eventually get some kind of form letter reply.

I came home this evening to find this in my email inbox:

Thank you for your recent email to the National Union of Public and General Employees regarding the origins of Canada's single-payer health care system. We have a pamphlet posted on our website which provides some background detail on this subject. You can find the pamphlet at this link: http://www.nupge.ca/publications/Not%20without%20a%20fight%20FINAL.pdf. In essence, we were able to establish a single-payer system for a few simple reasons: (a) In the 50's and 60's we had a social democratic Premier in the province of Saskatchewan named Tommy Douglas. He believed in the benefits of a single-payer system (specifically the notion of equality) and introduced legislation that guaranteed a single-payer system in that province. It didn't happen without a fight (as our pamphlet explains). The opposition consisted mainly of for-profit insurance companies and doctors. But Douglas stood his ground. (b) the people of Saskatchewan were fed up with the for-profit medical system that existed and wanted a public system (c) Once Saskatchewan had a single-payer system and proved it could work better than a for-profit system, then the rest of he country wanted the same thing. In the late 60's and early 70's we had a series of minority federal governments and the opposition NDP demanded that the minority Liberal government implement a national single-payer system or they would no longer keep the government in office and force an election. The liberal minority government wanted to retain power so they introduced legislation called the Canada Health Act guaranteeing a single-payer system for all Canadians. All of that's to say you need: (a) a strong political leader willing to legislate single-payer and prove to other states that it does work; (b) strong grassroots support for a single-payer system; (c) the right political circumstances nationally in order to spread the system across the whole country. I hope this information has been helpful. Again, our pamphlet has more details about the situation in Saskatchewan in the 60's and 70's.
Take care,
Mike Luff
Coordinator of Communications and Research
National Union of Public and General Employees
www.nupge.ca

Wow. That's service. Thank you, Mike.

I've browsed their site a bit this evening, especially the parts where they're trying to fight off the backers of for-profit health care. Nice karmic touch: here I am, merrily blogging about how wonderful universal health care would be and what a great example of it Canada is. Meanwhile, they're using the United States as a great example of how expensive, inefficient, and just plain awful private, for-profit health care is.

Here's their front page for the section about Canada's Medicare system.

I really do need to get back to my letter writing. This time, I think I'll start with the eight Democratic Presidential candidates, and send them all e-mails about what I want them to do about health care.