Single Payer Universal Health Care

R. B. MD, Writes on February 25, 2010:
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I've worked as a doctor for over thirty years now. As well as seeing patients with every insurance to no insurance and paying for health insurance for my family and employees I have come to the conclusion that a Medicare like health coverage for all is the way to go. Ask anyone over 65 if Medicare works for them and the answer is always yes. Yes, one buys supplemental, and that could, and perhaps should continue and/or medical savings account that could also be allowed.

Medicare insures the worse population.......the older folks and most certainly the ones who will pass away while under that coverage and spend a lot of money in the process. Best way to "spread the risk"...insure the young as well as the old.

Use of money for health and illness care really should not be thought of as insurance. Insurance is something you hope you don't use and insures against risk, like getting into a car wreck, or hitting a deer or moose, or having your dog bite the meter man. Everyone uses, or should use some health dollars, for preventive care, immunizations, having babies. We should think of having health coverage (and paying for it), as well as insurance to the catastrophic unanticipated events, like hitting a moose or being the meter man who gets bitten.

So what does health insurance cost now? Well, here in Michigan I have a Blue Cross Policy for my wife and me, a reduced policy from what I had two years ago, because I couldn't afford that one anymore. Now I have $8,000 deductible, which I fund through a medical savings account (allowed in this state), and then pay $1000 a month for "catastrophic" coverage, up from about $700/month just last year.

Now, instead of paying Blue Cross $12,000/year, how would I feel about payroll deduction of about $5,000-$8,000/year for my wife and me that went for Medicare like coverage. Pretty good. I believe Medicare is better run than many private insurance companies, has less administrative costs, does not have to pay expensive executives, does not have to create reserves. I believe all should contribute through payroll deduction, amount of which can be "means" tested and dependent on factors such as age, income, and perhaps life-style (smokers should pay more). The insurance should cover certain valuable preventive care fully, and have some copays or deductibles on other care. Medical savings accounts should be allowed to build up as savings over many years and be used for supplemental care, the deductibles and copays.

Here's another problem many of the public don't understand. Doctors and hospitals bill maximum for everything in order to capture every insurance dollar. But most accept insurance as full payment. Thus there may be a $300 doctor bill but the doctor accepts $150 from insurance. Or the Hospital bill $20,000 but accepts $10,000. It is illegal to bill lower to the self pay or uninsured or underinsured. So if you don't have insurance you have to pay much more. It would be much better for all if the "billing" side was appropriate and fair, and that the full amount was paid by all. Right now if doctors or hospitals or pharmacies lower their fees, insurance is likely to pay them even less.

So who would lose out on this? The insurance companies? No..claims processing would still be needed so I think those jobs would be preserved. The highly paid execs? Probably. Okay by me.

Doctors and hospitals? No matter what, they are needed and must be paid appropriately to stay in business and keep health care the best and available. Reductions in payment on the high end would likely be compensated by receiving payment for all, whereas now there is still lots of free and underinsured care given in ER's, doctor's offices and hospitals.

I don't think a government administered plan would fail. All Americans would have a stake in it.

Lastly, there is medicare, medicaid and other insurance fraud and abuse. Some real teeth have to be put into saving those lost dollars, and such savings would benefit all.

Skog....keep up the good work. What is really needed for most of our problems is education about the problem. Too often emotion, false beliefs, politics obscure and distort reality and the correct path to solutions. If you got this far, accept my thanks for listening. R B , MD