Single payer health care system?

[lessthanjake]

Ok i have a question. In a single payer health care system the government pays for all medical services right? I mean if it were implemented would we pay anything for medical services?

[DaveinMD]

1. maybe a copay

I agree with Howard Dean on this issue. We need to insure everyone. Then we can reform the system.

[no name no slogan]

8. But how can we insure everyone, if everyone is NOT covered?

It's a catch-22: we can't actually insure EVERYONE until we make everyone covered-- and the only way to do that is through a single-payer, universal healthcare system.

I live in a state with a very high insurance rate, due in part to a state-sponsored insurance program that is available to low-income working people. The system, MinnesotaCare, is administered by the state, and delivered by various not-for-profit HMOs. IOW, it's very similar to the Vermont system, if not exactly the same.

However, we STILL have 3-5% of the population who, at any given time, are not covered by any medical insurance whatsoever. These are people that have either been turned down by commercial insurers/HMOs, or who do not qualify for MinnesotaCare, or simply can't afford MNCare's premiums, which have gone up during the Repub administration.

These are people who will ALWAYS be uninsured by any sort of public/private plan, or any other plan that relies on 'insurance'.

A single-payer plan solves the insurance problem easily: everybody is a member, and everybody is covered. There's no messy insurance bureaucracy to go through, because everyone has the same 'insurance': i.e., none in the traditional sense.

With a universal, single-payer plan, if you're sick, you are covered. No 'unreimbursed' procedures, no 'networks', none of that. Why? Because every doctor, every hospital, every clinic is part of the plan. It's that simple.

We don't need any more insurance plans in America. What we need is COVERAGE.

[DaveinMD]

12. There are ways to do it

First mandate that everyone get coverage. Give subsidies to people that can't afford care. Create purchasing pools to help small businesses provide coverage. The single payer system will never happen in the US. Dr. Dean was right about this. So was Bill Bradley in the previous campaign. The way Gore scared voters about the Bradley plan was ludicrous.

[eridani]

15. Copays are worthless.

The intent is to reduce unneccessary use of the system, but all it does is reduce both necessary and unneccessary use. Copays that are low enough not to deny care to low income people are too low to cover the costs of their own processing.

[barackmyworld]

2. the system has advantages and disadvantages

Saves the administrative burden, gives insurance to everyone, it's the ultimate risk-sharing pool, but in practice, it has negatively impacted quality. In Canada, people wait weeks or months to see a specialist, there aren't enough MRI machines, etc. Rich Canadians come to the US for more advanced services.

[Cheswick2.0]

4. If canadians were unhappy with the system they would get rid

of it. We wait months to see a specialist and poor americans have no healthcare at all.

[xray s]

10. The myth of the rich Canadian coming to America for health care

http://matthewholt.net/2003/11/policy-oh-canada.html

While the argument about Canadians flooding south to get medical care withheld from them up north is widely heard, it's bullshit. Yup, lots of Canadians get care in the US, but that's because, due to the better weather, the higher incomes, going to college or that NAFTA thing, they eitherlive here, or are on vacation in Florida to escape that terrible winter. Work done by a team led by Steve Katz at University of Michigan with the Evans/Barer/Cardiff team at UBC which looked into this in obsessive detail found essentially no evidence of Canadians crossing the border to get care. (Incidentally plenty of Americans are still going up there for non-covered surgery like laser corrective eye surgery, which is cheaper and just as good up north). In fact according to Canadian insurers there appears to be no interest amongst Canadian consumers in commercial insurance products to cover care abroad, other than standard holiday cover. Note that this is not the case in the UK, where private insurance allows about 10% of Brits to jump the queue to get surgery in a private hospital. So it looks like the Canadians accept the fact that they have to wait for surgery, and not surprisingly don't want to come down here to pay for it out of pocket

[FlaGranny]

49. Living in Florida, I have lots of

Canadian neighbors who are snowbirds. Every time I meet a Canadian for the first time, I ask him or her about health care in Canada. I have yet to find the first person to complain about it. Every single one of them, so far, has told me it is better than here. Canadians buy a special policy to cover them while they're in the US.

[Telly Savalas]

17. However...

In the U.S. many people never see specialists, or if they do it devastates their finances. Furthermore, the U.S. spends a much higher percentage of their GDP on health care. If Canada had the same funding levels as the United States, the waiting lists would be much shorter. Finally, dickheads from the CATO institute love to exagerrate the waiting lists. My family has lived in Canada for 3 years, and we've had nothing but good experiences with the health care system.

[lessthanjake]

3. I ask this since it seems too good to be true

I mean think about it.

Single payer health care costs 2.2 trillion dollars a year for the government. Seems like a lot right?

Well its not really. We already are spending 1 trillion for stuff that would be gone with single payer health care. Then when you put a 7.7% payroll tax on businesses you get another 1 trillion. And this 7.7% actually leaves businesses ahead. The average business spends 8.5% on health insurance for their workers. Theyd no longer be paying that so theyd actually be 0.8% ahead. This would be even moreso for small businesses. And then theres savings in paperwork. WIthout all the crap with different health care plans and everything the government, according to a harvard study, would save 286 billion in lowered paperwork costs.

So we have more than that 2.2 trillion already. We have 2.286 trillion.

And not only do businesses save but all americans save. The average american spends 8,000 dollars on health care premiums. They would not be paying that any longer. It would be like an 8000 dollar tax cut for all.

ALso prescription drugs would be paid for. THe average american spend 1% of his or her income on prescription drugs. There a 1% tax cut right there.

And all the stuff about no choice of doctors and long waits wouldnt be right. Youd have more choice since you wouldnt be limited to any plan. You could go wherever you wanted to. ANd there would be less waits. Think about this. With all the different forms and stuff doctors spend more time filling out paperwork than actually doing stuff for patients. With one simple government form theyd cut down on that time by a HUGE amount and theyd have more than enough time to look at the new patients theyd have.

The only people who would lose are the 11 million americans working in the health insurance industry. However that big 8000 dollar thing for all americans would help the economy which would help them find jobs. We could also spend the couple billion left (2.286 trillion saved compared to the needed 2.2 trillion) on job training programs for them.

Everyone else would win. Uninsured would be insured. All other americans would effectively get a tax cut. Seniors wouldnt have to pay for prescription drugs. Businesses would get a 0.8% tax cut.

Its amazing and i thought it was too good to be true.

[Cheswick2.0]

5. it is not to good to be true

the reason we don't do it is because the insurance industry gives so much money to key people in both parties.

[lessthanjake]

6. Yeah i know thats the problem

But i am talking from a purely hypothetical standpoint.

Its funny that oddly enough the only health care plan proposed by a democratic candidate this time around that actually payed for itself was dennis kucinich and his plan that covered everyone.

[no name no slogan]

9. That was a big reason I supported him

We don't need any more government-sponsored, overly-complicated 'insurance' plans any more than we need more nuclear weapons.

What people need is COVERAGE, not more insurance. Another public/private insurance plan will not solve the problems we have with this system. They'll only prolong them-- and keep sending our tax $$ to the insurance companies and HMOs.

[dorktv]

14. Democratic Presidential Candidate thank you.

I had a Single payer system with the government only talking to the hospitals, doctors and other providers of health care. You pay through the payroll tax with the cap lifted (so you make $500,000 you pay the percentage on all of it), and you can go anywhere you want to. Your choice, the government has no control over who you see, what care you get or anything. AND it had a provision for hospital improvements. Check my webpage out. http://www.er2004.com I was a Democratic Congressional Candidate.

[Blue Topaz]

7. The Canadians and Brits I know LOVE their universal health care

They wouldn't give it up for anything. They can't imagine living with the healthcare system we have (or rather don't have, for how many millions?). The notion that we are only deserving of healthcare if we have the right job or are wealthy enough to just purchase our own is cruel - class warfare at its worst.

From talking to Canadians, the reports of long lines and substandard care are either myths or vastly overstated. In fact, one woman told me that if their system doesn't have a particular treatment you need in Canada, they will pay to have you treated in the US. Sigh... I am so ready for universal healthcare.

[From the south]

20. Maybe we know people in different income brackets

but every canadian and brit i know hates their healthcare system... for what is costs them its sucks. All the brits I know have additional healthcare insurance so they can go to private doctors, every single one.

[Bridget Burke]

21. I know a Scottish lady with UK & Canadian citizenship.

She's given me detailed reviews of what's offered in both countries. The only reason she's not become a US citizen is that she & her husband are aging & already have some health problems. Therefore, they may have to retire in Canada or the UK--mostly for the medical care.

And she does feel a bit guilty because she would have loved to vote against Bush.

By the way--I live in Houston, Texas. Where in the South do you live?

[lessthanjake]

23. The thing is that we are already paying for universal healthcare

We spend way more per capita on health care than canada or the UK already. So it wont cost us any extra to fix it and make it work to cover everyone.

[blondeatlast]

27. Know any US citizens with chronic health problems?

They pretty much loathe the system we have.

BTW, in answer to my SL question, you do. ME.

Right now, I am praying that my husband gets another job because his employer is looking for ANY excuse to drop the health insurance benefit.

and the excuse is just around the corner, as Bush has set out to dismantle the tax deduction offered to businesses for providing health insurance for employees.

[FlaGranny]

50. On the other hand,

EVERY American who doesn't have a generous employer hates the American health care system. The only Americans who are happy with our system are either relatively wealthy or have employers who pay the biggest share of their premium and who can afford to buy them the best plan.

I don't hate my health insurance because I don't have any - can't afford the $1000 a month (just for me - my husband is on Medicare). I don't have access to the "best care in the world." There are another 50 million like me, and hundreds of millions who have insurance but still can't afford to see a doctor. Then there are the "elite" - the one's I mentioned above, who have the best of all worlds, want to keep it that way for themselves, and don't care about the rest of us.

[greenohio]

53. I've heard the same thing.

In fact I asked several when I was in the UK recently. They hate their healthcare system. They did complain about the wait and the quality of care. Grass is always greener I guess. I am sure the answer is somewhere inbetween.

[xray s]

11. If you want to learn about the Canadian systems + & -'s read this

http://matthewholt.net/2003/11/policy-oh-canada.html

[davsand]

13. You are paying for it NOW.

I hate to break the news, but you ARE paying for health care for the medically indigent right now. You and every other person who pays rent or medical bills or has any insurance at all.

Close to 80% of the hospitals in the US are incorporated as Non-profits. They are granted exemption from federal taxes as well as (usually) state sales and income taxes as well as local property taxes.

In return for that support, the hospitals charge the uninsured MORE for the same treatments, sue those poor people to collect the higher fees, then write it all off as a "community benefit" in the form of bad debt. While they do all that they pay out huge salaries to the CEOs who run the hospitals along with performance bonuses that are based on cash brought in.

YOU subsidize that behavior. We ALL do.

The thing that REALLY gripes my ass is the fact that while the CEO's get rich, and the hospitals we subsidize are raping poor people, people in this country are DYING every FREAKING day because they don't have insurance and are afraid to go to the ER with life threatening illnesses.

THAT is the reality of the health care crisis in this nation as far as the people are concerned.

Now, let's talk about the reality for hospitals. They are obligated to treat any person who is in a life threatening condition and turns up at the ER. What a lot of hospitals are doing is eliminating the ER completely. They no longer have ERs. That way, they can control admissions.

Hospitals are obligated to provide Charity Care for the medically indigent (usually at the level of 125% of poverty level) as a part of the federal tax exemption they enjoy. The IRS doesn't REALLY enforce that much--I think the last report I saw said maybe a dozen have been investigated by the IRS in the last twenty years...

Local laws regarding provision of charity care are muddled and pretty much a scattered thing. Enforcement at a local level is really not all that common--or at least it wasn't until a couple of years ago.

If you want an extended look at the issue, do a Google search on the key words of "Charity Care + Provena." I worked on that case, and I was one of that board that laid the groundwork to strip that property tax exemption from that hospital. (I am speaking in Chicago tomorrow to a group of Illinois taxing officials on this case, in fact...)

Our local hospital was a bunch of arrogant rat bastards who were raping poor people and we took them to account for it. It CAN be done, and needs to happen all over the US. It better happen--we have got people DYING because of a lack of health care.

The ultimate solution will be single payer. Until that time, however, local oversight is going to have to fill in part of the way.

Just my 2 cents.

Laura

[LimpingLib]

16. Unless we get rid of the insurance companys then no plan is credible.

All plans that dont reduce that massive layer of costs (like 30%+) caused by insurance companys are just elite garbage.

The plans are worth nothing more than reducing the uninsured to "insignificant levels" of say 30 million or less. Heck what is 10% ? To hell with em.


Single payer reduces costs and covers more people.

Anything that doesnt end the insurance company scheme is pure crap IMO.

Also the government funds almost all research , so we can "socalize" that and not hurt research. Just stop some crook from leaching us all for research then charging us like 10 times the needed amount to use the technology.Talented people will stil get paid to develope drugs and technology.

Waste ,fraud , and abuse need to be reduced.

WE need to consider reforms to policy on the elderly who consume nearly half of all health care costs in their final year of life.

With everybody getting check-ups we will prevent far more expensive late detection care.

I think we should distribute vitamins to everybody.85% of Cubans get too little vitamin C despite being a citrus island. WE are the same way.

WE can reduce health care costs at least 50% with reforms.

Take all the government and business money now spent and we can cover alot of people for a very low cost.

[lessthanjake]

18. I totally agree

Anything other than that is just trying to put a band aid on the system instead of actually fixing it.

[Blue Wally]

19. Medicare

We already have the medicare system in place, just expand it to cover all Americans. All of the procedures, paperwork, and protocols have been time-tested, you just need to enlarge the scale. Pay for it with a Federal Value-Added Tax and use the current medicare tax to help fix social security.

[Quill Pen]

36. We wouldn't even need the VAT.

Close idiotic loopholes that allow business owners to deduct luxury car, SUV and boat purchases when they're not required for business. End corporate welfare. Slash worthless initiatives like the embarrassingly ineffective color-coded terror alert system. And, of course, end this goddamn war, saving us billions. Just ending the no-bid, pork-stuffed reconstruction contracts alone would save significant amounts.

Eliminate discriminatory child tax refunds and credits (having children is a personal choice, and certainly not all the beneficiaries of these are poor parents; rich parents get them too), and force the 60% of corporations who pay no income taxes to pay up.

In every election, the candidates pander to families by promising increased child tax credits and rebates (Bush promised some nice fat ones, as I recall) and none of these have improved the quality of life in America, that I can tell, for anyone: man, woman, or child. In fact, as this thread alone testifies, America's long-term livability is declining.

With all that cash, not only would we be able to fund a high-quality single-payer healthcare system, we'd be able to fully fund education as well.

[Blue Wally]

37. No

Keep the Medical system Off-Budget with its own stand-alone tax. That is the weakness of the Canadian system. It competes with everything else in the budget and they have many unmet needs gobbled up with the health program. We should have several separate budgets each with their own tax structure:

1. General government operations

2. National defense

3. Social security/government retirement/military retirement

4. National health system

5. Welfare/education/housing

6. Transportation and energy

Then we can see where the real deficits are.

[dorktv]

44. HR 696 I believe is the bill that would do that very thing.

[Princess Turandot]

22. Bingo!..and I fear no one will take the insurance companies on..

one of the most disappointing things abt Clinton's presidency was the Hillary healthplan, which even to people who have worked in healthcare finance for a long time (like me) was fairly incomprehensible and did little to reduce the impact of insurance companies in the game. If I recall correctly, it even would have provided them with more business in the long run. I think its incoherency put the idea of a national health plan even further in its grave.

The US already has a national program which could be expanded to all citizens: Medicare. Issues which people have with it relate mostly to benefit coverage and in some states, physician participation due to fees compared to private insurers. But as a mechanism, it works pretty well. Its issues are really ones of funding. They could expand the program by having employers who currently buy their insurance from private companies buy it instead from the national health plan. Healthcare providers would get paid for services, instead of being jerked around by HMOs whose mission is to deny coverage for services. ("What, you broke your leg at 3AM? Why did you go to an ER, and not your primary care doctor??")

That's not going to happen though, I fear. No politician wants to take on the insurance companies, between their contributions and I assume, some concerns abt what that might do to the financial markets if some of the huge insurers lose this line of business.

I also think that people have to come to terms with the fact that healthcare is an expensive service. Costs can of course be cut out of the process, with pharmaceuticals leading the way. (As has already been said, a huge amount of R & D is funded by the federal government and is performed in federal labs.) If price controls were implemented, the FDA could for example, keep needed research going by limiting the number of patents it approves for new drugs which are not significantly different from existing ones, but have been developed by competing companies. (Viagra and its uhm offspings are one example.) Perhaps then, more drug R & D money would go towards cures/treatment for illnesses.

But as I said, if you want a level of healthcare service comparable to that which is available to people with insurance in places with adequate medical facilities, it is not going to be cheap. Prior to the late 1980's, nurses were paid practically coolie wages, yet they are the caregivers who spend the most time with hospitalized patients.In the 1990's because of nurse shortages, salaries and benefits took off in a major way, which significantly drove up hospital costs since nurses are the largest category of employees in any hospital. But do people want nurses caring for them who earn salaries that are the same or less than secretaries (with no disrespect to the secretarial workforce intended)? Do you want two of them on duty at night on a unit which requires four for optimal coverage? Do you want that scan of your brain looking for a possible tumor to be done by a 10 year old CAT Scan, or a state of the art MRI machine, with a price tag well over $2 million more than even a new CAT Scan?

The US needs serious review of its healthcare economics not by policy wonks and academics but rather people who work in the industry for a living, and who are willing to be honest brokers. Money can be saved in various ways, including preventative care, but putting money into healthcare makes a lot more sense to me than using it to produce 100's of new fighter planes which no one seems to know if we need, or the Reagan-concocted Star Wars defense. (I believe in strong national defense, but if we aren't also defending the health of our citizens, what are we striving for?)

The issue of elder-care is obviously a very complicated one. You are of course right in saying that it consumes much of the US healthcare spending, since the aged will always be sicker than 20 to 40 year olds. People are surprised to learn that in NYS, much of the Medicaid spending goes towards nursing home care, not 'cheating welfare queens'.<Sarcasm, if not obvious.> However, when the question becomes one of deciding that the 80 y.o. Mary Jones should no longer receive life prolonging care that she wants (dialysis for example, which Medicare pays for), whose call is it that she gets to die a little quicker?

Just some random thoughts on the topic..

[BurgherHoldtheLies]

24. Single PRAYER health system...

Do the born-again, literal Bible interpreting, right-wing radicals need healthcare????...couldn't they unburden the US healthcare system by simply praying away illness?!?!?

Oh ya, and why do they seek out science/medicine for infertility treatment...isn't this going against God's plan??

[otohara]

38. But Only "One Prayer" Allowed Per Week

so God isn't over burdened w/ prayer overload syndrome

[sandnsea]

25. Through your taxes

Yes, of course you'll pay. The #1 health care system in the world is France, and they have a public/private system. With insurance. We have to fix our system, and single payer may well be part of it, but it's not a magic bullet either and it is NOT free.

[rhino47]

26. With medical care eating up more of our economy

There is really no choice but to have national health care.
EU just signed its constitution.This is really relevant to health care issues in this country.Every us made car has 1200.00 more in health care costs then eu cars.I will get back with link.
If we are too compete even with europe we have to take the health care burden off our industry.To say nothing that our rationed health care in this country is immoral.If you can pay for it.. you can live,if not oh well you got a death sentence. you arent fit to live mentality.

[lessthanjake]

28. Yeah Ford car company

spends more on its workers health insurance than it does on steel for its cars.

Unfortunately this cost cant be averted mostly since the payroll tax on companies is needed to pay for universal health care. We can benifit then by 1% and that is about it.

[sandnsea]

29. Which system?

That's all I'm saying. Every country in Europe does their health care differently.

And it's not free. I get so sick of people saying they want free health care. Nothing is free, we pay for it one way or the other.

We need to make the best choice based on through study and reality, not fanciful notions of health care systems that may not even exist. Which shouldn't lead anybody to the conlusion I support the monstrosity we have today. On the other hand, I live with one choice for health care. One clinic. Thanks to the streamlining they did when they put in the Oregon Health Plan. But since I don't have insurance, I STILL get to pay more than everybody else!! Wohoo! The local clinic/hospital is better than dying, barely. And if you've never experienced cattle call pre-natal care at a military hospital; well you just haven't lived.

[lessthanjake]

30. You are paying for it two times over

You are paying for universal health care through taxes (the US has a greater per capita spending on universal health care than canada by a HUGE margin) and you paying through premiums.

This would make you only pay for it through taxes.

[sandnsea]

43. that's not an answer

Which system do we want to replace what we've got. There's more than one choice. What if there's better choices than just single payer?

[lessthanjake]

55. There arent better choices

This is the only one that isnt completely socialized and leaves choice to the consumer.

[Jackpine Radical]

31. Are there any good, recent consumer satisfaction studies

available on Canadian health care?

I recall Consumer Reports did one in about 1995 that reported the long line stories were mostly myth, Canadians were pretty happy, etc.

I gather that since that time, conservative politicians & other forces have cut the funding going into the system so some problems were developing.

Anyway, the amazing thing is that the Canadians provide what they do for about 7.5 or 8% of GDP, while we spend 15% & STILL don't insure 44 million people.

[tired of bush]

32. here is my two cents

All you need to do to figure out which country has the best health care system is look at the average life expactancies by country...I'll see if I can find the chart, but if I remember, the US was about 9th or 10th on the list..ALL of the countries that had some sort of universal health care had a higher (by 1-4 years) life expectancy for their population. If the US has the best health care system in the world, why do we on average die younger than those countries with those evil government controlled health care systems?

[tired of bush]

33. the other point

The other point I meant to make was, I do beleive we will get national health care w/in a decade or less. Unfortunately, it won't be because of any altruistic, noble motivation on part of those that currently oppose it...why it will happen is because big companies like GE, Ford, GM, SBC etc are suddenly realizing that they need to compete with companies across the globle that are not "burdened" with the cost of providing health care to their employees and retiree's..and all of a sudden the cost is becoming huge and threatneing the livelihood of those companies...so, those companies will start buying themselves some politicians of both parties and slowly but surely they will offload the entire cost of health onto the government. Mark my words, this is the way it will happen...

It won't be for the right reasons, but at least it will happen....and the CEO's will get a bigger bonus to boot.

[Jackpine Radical]

35. The alternative would just be to dump it on us.

I'm not even sure there's a requirement that big businesses provide health care for their employees. I know there's no such requirement for small companies. If there is any such requirement, it will be cheaper to get the laws rewritten than to continue paying it. Prepare to have half your salary go to health inurance.

[hughee99]

34. I think part of our shorter life span is due to "culture"

not health care. The "American" diet is considerably less healthy that that of most other developed nations. All the health care in the world isn't going to fix this, it's a matter of culture.

I would like to everyone to have health coverage, but I do not believe that forcing a single payer system on everyone is the way to go about it. I think the government needs to expand Medicare and allow it as an option to anyone who wants it. If it is a good system, people will opt into it. If it doesn't work for some, they don't have to use it. It seems like Americans will always fight any system that looks to monopolize some aspect of our life. I think that this is partly out of fear of the government. Some believe any "all-encompassing" system that people are forced into could become an instrument of control by the government in the wrong hands. And as we've seen recently, the "wrong hands" do get elected sometimes.

[eridani]

42. Except for the genetically unlucky, diet has very little effect --

--on life expectancy.

You pretty much have to force everyone to pay for health care for the same reason you force everyone to pay property taxes for fire protection, namely because comparatively small percentages of people account for most of the expenses, but anyone at all could be in that percent. Health care is infrastructure, and not paying for infrastructure isn't an option.

[hughee99]

45. I don't agree

If diet had little effect on life expectancy why would it matter what someone ate at all? Why do we need food labels, why are people concerned about genetically modified food, and what was the movie "Super Size Me" all about? Yes genetics plays a big roll but diet does as well, and I think most doctors would agree with me on that.

I also don't see health care as being necessarily the same as infrastructure although I can see many areas where where there are similarities. The fire protection was a particularly good example, but I see it more like security. Property taxes also pay for police, whose job it is to provide security. People can depend on the police to protect them, but they also have the option to hire private security if they don't feel that the police force can adequately meet their needs. If the police force were better funded, staffed and trained they may feel differently. They also may prefer to have more control over the security they have, so even if the police may adequately be able to do the job, they may prefer to hire their own security people, because the police are not answerable to them. They still pay property taxes, but the prefer not to fully utilize the service they pay for, because they don't feel it is adequate.

Relating this to health care, I don't have any issues with a national health care system, or paying for it, but I think we should have the option of spending my own money for something else. The government has yet to prove, to me anyway, that it can effectively manage a health care system, and I don't want to be forced into a system until I'm convinced it's better than the one I have now.

[eridani]

46. Every other developed country in the world has universal health care--

--so it can be done. If no one in our government can do it, we can hire foreigners to train us. I don't think anyone should be allowed out of paying, just as you can't opt out of paying for public schools just because you don't have kids. You'd be free to buy all the extra bells and whistles you wanted, though. There should be no difference in how people are treated when using the full panoply of basic services, just as the same firetruck and crew go to a house worth $100,000 as readily as they do a million dollar house. If you want private rooms, gourmet meals, experimental treatment that haven't been validated on top of that, fine--your dime. I don't care that Bill Gates has a state of the art fire alarm system that I can't afford either. Hire all the extra security you want--you still have to pay the regular cops. (BTW, Medicare overhead is way lower than private insurance even now. The main problem with it is that their cost control method is the same as that of private insurers--case by case payments and case by case review. If we had global budgeting like Canada, practictioners in local regions would quickly catch on to bad apples taking money out of every one else's pockets. It's analogous to controlling the movements of a herd of cattle--do it the stupid way by hiring a lot of cowpokes with individual reins for each cow, or do it the smart way by just building a fence around them.)

Cite me a single study controlled study that shows lifestyle extension of life expectancy by more that 6 months in the general population and I'll eat my hat. Granted, if you are genetically prone toward heart disease or diabetes, being careful about your diet can add more than that (sometimes significantly), but if you aren't there is zero effect. It's like saying that a diet low in phenylalanine can raise your intelligence. It can't if you are genetically normal, but if you have phenylketonuria (PKU), such a diet can insure that you have a normal or above IQ instead of being brain damaged. Add a minority that benefits a lot from lifestyle modifications to the majority that doesn't and divide by the total number--what you get is only a slight increase in life expectancy or intelligence.

And, BTW, healthier lifestyles will serve to dramatically raise lifetime health care expenses by allowing the genetically disadvantaged to live long enough to join the demographic that has the most health care expenses. Me for instance--when my grandmother was my age she had been dead for five years of diabetic complications. I exercise, watch my intake of high glycemic foods and am on metformin. Still have HbA1c values in the high normal range, which means that I will have quite a few more years in the most expensive age group than my grandma did--she quit costing society money by dropping dead early.

Same for smoking. Some tobacco company raised a real shitstorm a few years back by recommending that the Czech Republic promote smoking to reduce its health care expenses. That they were amoral assholes didn't stop them from being right--kill people off after they have already raised their kids and had their most productive work years and you eliminate lots of age-related health expenditures.

[FlaGranny]

51. I don't think food has as much

effect as you might think - at least not pure foods. Some of the additives we've started using in the last 50 years might, though.

My parents are a good example. Father died at 90, mother at 94. Both of them, in their earlier years and most of their lives, ate a country-type diet, eggs, bacon, butter, steak, potatoes, gravy, and fresh fruits and vegetables in season and canned out of season. Neither of them was ever obese, and both of them stayed healthy until very near the end. I say genetics is the most important factor in a person's health.

[CAN_for_Kerry]

39. This link will give you data on the US...

For example life expentency, infant mortality rates, etc. for the US and all countries.
http://hdr.undp.org/statistics/data/cty/cty_f_USA.html

[canuckforpeace]

40. Welcome fellow Canucknucklhead!

:hi:

[CAN_for_Kerry]

41. Hi canuck head

where are you located in our great nation?

[TeddyKGB]

47. Never happen in America. Never.

Unless you can eliminate the insurance lobby and make Americans enjoy paying high taxes.

[Telly Savalas]

48. It could happen if...

one of the two parties would quit kissing the insurance lobby's ass. (If I didn't feel this was possible at some point, I'd quit calling myself a Democrat.)

and

if Americans realize if higher taxes are accompanied by lower insurance premiums (or the abolition of premiums), then the impact on their pocketbook can be positive. As has been mentioned several times in this thread, the U.S. pays more per capita than any other nation in the world for health care. Replacing our current monstrosity with a system that's efficient would save Americans money.

[many a good man]

52. Its inevitable -- and so are the consequences

Businesses are already beginning to cry out for de-coupling health insurance and employment. It really doesn't make much sense in today's job market and its killing their bottom line. Look for their cries to get louder as the years pass.

If government doesn't step in the numbers of uninsured will skyrocket.

There are two major models for universal health care: 1) govt runs both the insurance side AND the medical services side; and 2) govt only runs the insurance side (like Canada). The single payer plan will appeal much more to Americans.

But it will force govt to crack down with price controls on corporations that deliver health care and pharmaceuticals. bush* says it will lead to "rationing" and he's right. But it will be the taxpayers/voters that make decision on how to ration. Right now we have little or no input.

The Health industry knows it is inevitable so they are making a mad grab and stuffing the cash into their pockets before the honey pot gets taken away from them...

[Lydia Leftcoast]

54. Here's how I'd do it--if we MUST have insurance companies

Gradually move the age of eligibility for Medicare downward by allowing people to buy into it at a price signficantly lower than what insurance companies charge. Make it a manageable percentage of a person's income, as the Japanese system does.

My ideal system would have a small co-pay, waived for people below some set income level, but no deductible. I know from experience that deductibles on top of insurance premiums serve perhaps their intended function of "keeping costs down" by discouraging people from seeking care.

People then have a choice: pay the inflated premiums levied by the insurance companies or the more reasonable premiums offered by Medicare. There's a no brainer.

Given some real competition, the insurance companies would then be forced to lower their rates. They might even decide to get out of the medical insurance business entirely.