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June 18, 2009


You're for single payer. I'm for single payer. Only problem is that almost no one whose opinions count -- i.e., Congress persons, senators, and the president -- is for it. (If you were paying attention, Obama never even campaigned for it.)

Bottom line: in the real world, single payer is not going to happen. In the real world, sometimes you settle for second best. Stop chasing windmills and go for the public option.

I say don't stop chasing windmills. Americans somehow think they don't deserve universal health care...If enough folks started insisting on REAL health care reform, without all the political compromises, then we might actually get somewhere...So far it's just a bunch of the same ol same ol.

The "public option" parrots never address the arguments made by, e.g., Physicians for a National Health Program ( Why do you think that is?

Public Plan Option in a Market of Private Plans
By David Himmelstein, M.D. and Steffie Woolhandler, M.D., M.P.H.:

The "public plan option" won't work to fix the health care system for two reasons.

1. It forgoes at least 84 percent of the administrative savings available through single payer. The public plan option would do nothing to streamline the administrative tasks (and costs) of hospitals, physicians offices, and nursing homes, which would still contend with multiple payers, and hence still need the complex cost tracking and billing apparatus that drives administrative costs. These unnecessary provider administrative costs account for the vast majority of bureaucratic waste. Hence, even if 95 percent of Americans who are currently privately insured were to join the public plan (and it had overhead costs at current Medicare levels), the savings on insurance overhead would amount to only 16 percent of the roughly $400 billion annually achievable through single payer -- not enough to make reform affordable.

2. A quarter century of experience with public/private competition in the Medicare program demonstrates that the private plans will not allow a level playing field. Despite strict regulation, private insurers have successfully cherry picked healthier seniors, and have exploited regional health spending differences to their advantage. They have progressively undermined the public plan -- which started as the single payer for seniors and has now become a funding mechanism for HMOs -- and a place to dump the unprofitably ill. A public plan option does not lead toward single payer, but toward the segregation of patients, with profitable ones in private plans and unprofitable ones in the public plan.


Everyone knows that successful negotiations begin from a position greater than what one actually wants. Therefore, starting negotiations with "public option" instead of single payer means that the ultimate outcome will be less than even "public option":


"...Obama has endorsed an individual mandate that would expand coverage to everyone - except those who cannot afford to pay for the coverage, and those whose jobs are in small businesses that cannot afford to provide employee health benefits. That is, we'll cover everyone except most of those who are currently uninsured, nor those who will lose their health benefits as the rate of employer-sponsored coverage continues to decline, especially with a pessimistic job outlook.

"The president's letter is ...a consensus statement, meant for public consumption, on the agreement between the administration and Congress ...Reading the full letter makes you realize how low the expectations are for the final reform product."

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