Democrats Oppose Socialized Medicine

This title is a somewhat tongue-in-cheek (while still accurate) way to describe the views of the Democratic candidates on health care as presented at the New Leadership on Health Care 2008 Presidential Forum. Whenever Democratic health care proposals are raised, conservatives start screaming “socialized medicine” but none of the Democratic proposals fit this by any reasonable definition of the term. Many conservatives reflexively refer to any Democratic proposal as socialism, even when their proposals are more consistent with the free market than the corporate welfare policies of the GOP. If we stick to more conventional definitions of socialism, it would suggest having government own and control the health care industry as is seen in some European countries. All Democratic candidates oppose such plans.

Democrats do advocate government involvement in health care, but this is not a radical change from the status quo. A tremendous number of Americans currently receive health care through Medicare, Medicaid, veterans programs, and other government programs. Increased government involvement is even welcomed by many businesses which are struggling to afford coverage for their employees and find that such expenses place them at a competitive disadvantage internationally. Under the current system 44.8 million are left uninsured, and another 30 to 50 million are underinsured creating a need for some action.

Dennis Kucinich advocates the plan which most greatly increases government involvement in health care. He opposes socialized medicine in supporting continuation of the current system of privately delivered health care, while eliminating the private health insurance industry by advocating a single payer Medicare for all plan. Such plans create confusion among those who don’t understand the difference between Medicare and true socialized medicine.

I currently run a private medical practice and submit claims to both Medicare and private insurance plans. Under Kucinich’s plan I would still operate a private practice, but would save a considerable amount of money by only having to deal with one plan. While conservatives cry “socialized medicine” to give the impression of lack of choice, Medicare typically places less inane restrictions on individual’s health care choices than many of the other plans I deal with. Medicare wastes less on employees whose function it is to decide whether to approve the consultations or tests recommended by physicians. Medicare is also more reliable in paying the bills than many insurance plans which are basically schemes to take in premiums but avoid paying out benefits.

After Dennis Kucinich the other candidates keep much more of the private insurance system while trying to do more to make coverage affordable. The devil here is in the details. Barack Obama promises to provide details of his plan in the future but had little to say today. The Edwards plan could evolve into single payer as it offers a government plan similar to Medicare as one alternative. Hillary Clinton has never seemed to understand that her plan was rejected not simply due to the Harry and Louise ads but because it was far too regimented to be tolerated by most Americans. She also placed far too much emphasis on the HMO model, one of Richard Nixon’s ideas which should be discarded as a failure. Rather than showing that she understands the problems with her plan, Clinton believes the answer is to sell the plan better.

Bill Richardson remains the candidate who might have the most experience and ideas but is also the most unexciting, including on health care. This is not necessarily bad as a simple pragmatic solution might be preferable to those which are more exciting. Richardson’s plan is reminiscent of John Kerry’s 2004 plan in allowing individuals the option of buying into the plan which insures government employees, including Senators. He offers tax credits to enable more people to afford coverage. His plan to expand Medicare to cover those between the ages of 55 and 65, while coming far short of Medicare for all, would still offer tremendous benefits. The older people get the more likely it is that they are unable to obtain affordable insurance, especially if they have any medical problems. Richardson also advocates allowing those in the VA system to obtain care from any hospital, which should please conservatives opposed to government-provided health care.

MyDD has provided summaries of the positions presented by the candidates. The summaries are worth reading, but the discussion has little more to offer as it primarily displays the irrational exuberance for John Edwards which is common in the blogosphere and ignores the less exciting proposals from Bill Richardson which have gained more attention in the media. As a large percentage of Americans who do have coverage prefer to remain with their current coverage, plans such as those offered by Richardson do offer the advantage that they are most likely to be accepted politically.

Update: A site which is properly named (although not for the reasons intended by the blogger) Health Care BS is linking to this post claiming that the “reality based community” is out of touch with reality. The post links to another post on the same site here which gives a totally inaccurate view of Medicare. David Catron make claims such as that “in their effort to dictate every nuance of an incredibly complex system, our masters in Washington have created a labyrinthine nightmare of conflicting priorities and incentives.” The post claims that Medicare is socialized medicine, controlling the health care delivery system.

I deal with Medicare and many private plans every day and see how they operate first hand, as opposed to deciding how Medicare works based upon political philosophy. While I have other qualms about single payer plans, at present Medicare is one of the least restrictive and bureaucratic plans I deal with. For the most part I can practice medicine without having to worry about a set of bizarre rules. When there is a problem there is a fair appeals mechanism, which is rarely seen with private insurance. Medicare makes it faults, but at least their primary goal is to pay for medical care, as opposed to many insurance plans which play all sorts of games to avoid paying to increaes their profits. Before writing about who is out of touch with reality, Catron might want to actually experience the reality of practicing medicine or at last pay attention to those of us who do.

Update II: Much more in the comments following a response from David Catron.

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34 Comments

  1. 1
    mbk says:

    Nice, useful, real-life analysis of the various health care proposals as well as current realities.
    thanks, Ron.

  2. 2
    David Catron says:

    As to experience, I have been the front-line finance guy in three not-for-profit hospitals and one large (41 docs) medical practice. So, my view of Medicare is driven not by political philosphy but by day-to-day experience with its many reimbursement and regulatory caprices. And I think most of the physicians with whom I have worked would describe your positive comments about Medicare to be an example of Stockholm Syndrome.

  3. 3
    Ron Chusid says:

    mbk,

    Thanks. We could still use a lot more detail on the plans of the various candidates, and there are a lot more arguments pro and con for each approach. If at very least we could have a debate over the actual merits of the plans, as opposed to falling back on bromides like “socialized medicine” we’d be ahead. As even Dennis Kucinich, who has no chance at winning, supports a plan that falls far short of socialized medicine, and the plans of the other candidates are even more moderate, I hope the comments of those who continue to resort to such smear tactics are seen as irrelevant.

  4. 4
    Ron Chusid says:

    David,

    For someone with experience, you sure seem to have a tough time presenting meaningful facts and arguments. Resorting to bromides like “socialized medicine” or saying those who disagree with you are out of touch with reality or suffering from the Stockholm Syndrome just tells me that you have no coherent arguments to support your position.

    Your background explains your lack of understanding of the issue. Hospitals and physicians are in totally different situations. I could understand that someone dealing with the hospital DRG system would be frustrated with Medicare. I’m sure you could come up with valid arguments agaisnt Medicare for all from your perspective, but again it doesn’t help your argument to resort to such specious debating tactics.

    I’ve also found that, due to the differences in background, hospital administrators have a very poor understanding of physician issues. I would rather take someone off the street and teach them medical office billing from scratch than take someone trained in a hospital billing department and have to unteach them what they picked up there.

    Arguments such as “I think most physicians” remind me of the Fox News tactic of prefacing Republican talking points with “some believe.” The average physician today is an employee or memeber of a group who has no experience with the administration of a practice and is not necessarily in a good position to compare the plans. A growing number of physican groups are now calling for single payer plans. Physicians have found that, despite all the scare stories about government plans, they are often more benign than corporate run plans.

    For over twenty years I’ve been involved in the billing and administration of a medical practice. Every week I see what is and what is not paid, and where my staff wastes time fighting with insurers. Medicare is the least of our problems. Generally we submint a claim to Medicare electronically and in about three weeks we have a check. When there is a rejection I can usually go on line to their web site and find the pertinent rules so that I can adust the claim to get it paid. My staff often spends hours on the phone trying to fix problems with other insurers.

    I don’t have to pay employees to call Medicare to get permission to run a test or to get a consult as is the case with many private plans. The one time I had problems with Medicare refusing to pay for a couple of items (with $13,000 at stake on one and $3000 on another) I was able to simply take the matter before an administrative law judge. All I had to prove was that my charges were for items which were medically necessary for the patient and consistent with current standards of medical care and Medicare was obligated by law to pay for the denied and future services. (One time afterwards I was asked about the same item when the Medicare intermediary changed and all I had to do was show the administrative law judge’s opinion and they never questioned paying again.) In contrast, private plans can simply decide internally that they will not cover something and there isn’t a thing I can do if they don’t want to change their policy.

    From a patient’s perspective, they also do not have to worry about having coverage denied due to a preexisting condition, or losing their insurance because they become too sick. Medicare clearly explains what deductibles and copays a patient owes, while many private plans make this difficult to determine.

    There are two situations where I do have problems with receiving reimbursement from Medicare. One problem occurs when a patient has dual coverage. Sometimes it takes months to sort out who should be primary and get them to acknowledge this and pay. Under a single payer plan this would no longer be an issue as Medicare would then be primary payer for all.

    The second problem has arisen with the Medicare Advantage plans. Some are fine, but others engage in dishonest sales techniques and drag their feet on paying claims. Once again this is a case of the government plan being better than many private plans.

    This is the reality of the situation for physicians–not a case of Stockholm Syndrome.

  5. 5
    Meteor Blades says:

    A very interesting piece, at least as viewed by this non-expert in your field. Thanks for cross-posting at DKos.

  6. 6
    David Catron says:

    I would be interested in knowing your payer mix. That you have time to review the details of individual patient claims suggests that Medicare patients represent a relatively small percentage. Physicians who practice in areas with large Medicare populations are considerably less sanguine about that program than you seem to be.

    Indeed, if Medicare is so “benign,” how do you account for the recent statement by the AMA Board Chair (to Congress) that “Medicare’s physician payment system is broken—and it’s time to fix the underlying cause, the flawed formula.”? Dr. Wilson was, of course, complaining about the failure of Medicare reimbursement to keep pace with practice costs.

    By the way, you will probably be surprised to learn that I agree with you on the MA plans. In fact, I have a post on my blog that laments the lack of media coverage on that scandal.

  7. 7
    Ron Chusid says:

    Actually Medicare is by far my largest payer. Considering that Medicare covers virtually everyone over 65 along with the disabled, it isn’t so much a matter of practicing in “areas with large Medicare populations” as much as being a matter of practice type and patient mix.

    I’m not saying there are no problems with Medicare. I totally agree that the payment formula is broken. I’ve had some previous blog enties here on that. Every year Congress intevenes to change payment from what would occur under that formula limiting the harm. Thanks to the bipartisan actions of Congress at the last minute there was actually an increase in reimbursement this year for physicians in primary care.

    While the formula is a problem, it is a problem which can be fixed if Congress actually took the time to dump the formula and start over. The problems with private insurance may be much more difficult to fix than fixing this formula.

    Perhaps a change in control of Congress will lead to a reexamination of the formula. At very least this is someting which would have to be fixed if Medicare were to become the model for a single payer plan. As I noted in the original post, the devil is in the details. I’m far more concerned with such specific details of the plan than whether there is a single payer versus a more conservative plan.

    Yes, the problems with Medicare Advantage plans is something the media should be paying attention to.

  8. 8
    Ron Chusid says:

    For other views, I just stumbled upon this blog.

    A urologist gives arguments as to why solo physicians would benefit from a single payer system.

    There’s also this site from Physicians for a National Health Program

    There are many more signs of physicians backing a single payer plan. This article shows that 64% of Massechusetts physicians support a single payer plan. JAMA had this article a few years ago on physicians supporting single payer plans. Here’s another physician calling for a single payer plan, and it wouldn’t be difficult to find more.

  9. 9
    Joseph j7uy5 says:

    A few points: “Denial Management” is now a two billion dollar per year industry. That means two billion of our health care dollars are spent for nothing but arguing over what claims should get paid. This is not an issue with Medicare. Next, Just in terms of MD aggravation, I have found Medicare and Medicaid to be the easiest to deal with. The exception is the Part-D Rx coverage for Medicare, which is a nightmare.

    Now, if someone has insurance coverage for prescriptions, when i hand them a prescription, they often ask “will my insurance cover this?” Often, I have to say, “I don’t know.” It is fairly common for me to have to spend time on the phone changing prescriptions, getting authorizations, or more often, trying to get authorization and not getting them.

    The simple, telling fact is this: with private insurance, the incentive is for the plan to be inefficient. The less efficeint they are, the more money they can hold on to, and the longer they can hold onto it.

    The dirty secret about health insurance cost is this: insurance companies collect premiums, then invest the money. When their investments do poorly, they have to raise their premiums. That accounts for much of the increase seen in the early ’90’s.

  10. 10
    Ron Chusid says:

    “Just in terms of MD aggravation, I have found Medicare and Medicaid to be the easiest to deal with. The exception is the Part-D Rx coverage for Medicare, which is a nightmare.”

    For the benefit of readers who are unaware of how the Medicare prescription program is set up, the plan is run by a number of private insurance companies with multiple plans out there. The drug plan is not analgous to single payer, as it would be if there was a single drug plan run by Medicare.

    Having multiple plans creates headaches because it is difficult to know which prescriptons are covered for a particular patient since the rules for different patients varies.

    Joseph–have you tried using Epocrates? This might save a little time at least in terms of telling what might be covered. There is both a free web version as well as a version for PDA’s which does include formulary data for many plans. This still leaves the problem of getting prior authroization in cases where there is nothing available which the patient needs which doesn’t require prior authorization.

  11. 11
    Nick says:

    Ron

    Just curious about your doctor viewpoint on this. On a scale of 1-10 where one is truly awful on par with Hillarycare and 10 “pure genius idea” how did you rate Kerry’s healthcare plan? I know you would’ve preferred Kerry to have won in 2004, but did Kerry’s plan go along way in solving the health care problems we face in this country? WHy or why not?

  12. 12
    Ron Chusid says:

    Nick,

    There aren’t enough details from the other candidates to rank their plans yet. We got a lot more detail on Hillary Care as it was a proposal before Congress and not just a campaign item.

    Kerry’s proposal would have gone a long way but would have still left some gaps in coverage. Still that would have been helpful. If the number of uninsured and underinsured is decreased tremendously it puts us in a much better position to find ways to cover the rest. Kerry’s proposals would also have had a much better chance to get passed as it was primarily a voluntary system, leaving those happy with the status quo to continue as they are.

  13. 13
    David Catron says:

    Ron,

    Your arguments still depend too heavily on the fallacy of composition (“I have found Medicare … to be the easiest to deal with.”) and the argument from authority (“There are many … physicians backing a single payer plan.”). Neither rhetorical strategy addresses the basic points that I made in my original Medicare post.

    As a prototype “single-payer” system, Medicare is fraught with problems that do not recommend it as a model for a “universal health care” system. Three of these are as follows:

    (1) Its cost control strategies have created provider shortages, particularly in rural areas where virtually all of the patients are either Medicare or Medicaid.

    (2) It has increasingly had to engage in cost-shifting to patients, by steadily increasing both inpatient and outpatient deductibles and co-pays.

    (3) Its metastasizing regulatory structure has created huge administrative costs that, when combined with such things as EMTALA and HIPAA, constitute a major contributor to health care inflation.

    Moreover, if you think our friends in Washington are going to continue giving physicians a pass on all this, you definitely can’t claim a “reality-based” perspective. The broken physician payment system discussed in my previous comment will become increasingly complex and less equitable as time goes by, and pay-for-performance is a Trojan horse that WILL get inside the gates and wreak serious havoc.

    All of these problems, and many that I haven’t mentioned, will get MUCH worse if the government is given a health care monopoly, whether you call it “single-payer” or “socialized medicine” or whatever.

  14. 14
    Ron Chusid says:

    David,

    For someone who has not put forward any meaningful arguments so far, I really can’t take you very seriously when you preface your comments with specious attacks on what I have written. Experience in comparing dealing with different plans is quite pertinent to the issue. I only brought up the fact that many doctors favor Medicare for all plans when you began writing as if it was an absurdity for a doctor to supprot such plans. Part of being reality based is precisely looking at the reality of the situation and not starting with prejudices such as that Medicare is bad and all doctors either hate the program or are suffering from Stockholm Syndrome. Part of being reality based is also to see the advantages and disadvantages of various plans and not to see what you oppose as being 100% bad. There are plusses and minuses to every approach at health care reform.

    I am not advocating a single payer system but arguing that each plan be considered on its merits, rather than throwing out bromides like “socialized medicine” to oppose any solutions to the problems of the uninsured and underinsured. In response to your points today:

    1) Your argument is falacious in lumping together Medicare and Medicaid. Medicaid pays very poorly and rural areas with a high Medicaid population are going to have problems. A single payer plan would end the problem with Medicaid. Payment from commercial carriers have declined in the past and while at one point Medicare paid less than others (besides Medicaid), Medicare now pays more than many of the commercial plans I deal with.

    2) The major problem with cost shifting is the growing number of uninsured, another problem which would be resolved with a single payer plan.

    3) Regulations such as HIPPA are not relevant to Medicare. Such regulations are not part of the Medicare program and cover all patients regarless of type of medical coverage.

    Single payer plans also have many advantages such as an end to the many techniques private payers use to avoid payment (which is not seen with Medicare) and much lower administrative costs.

    Your concerns about what would happen in the future is the one valid argument you give against a single payer plan, and is one of the major reasons I prefer other approaches. However the details of any plan are important and I would consider Medicare for all over a poorly designed hybrid plan. As only Kucinich supports a single payer plan, and as I don’t think it stands much of a chance to get thru Congress even with increased Democratic votes in 2008 even if backed by other candidates, I also doubt this will be an option under serious consideration.

  15. 15
    David Catron says:

    1) You allowed the passing Medicaid reference to throw you off the scent. The contribution margin for Medicare is too low for the providers in those areas to have survived, even without the additional burden of Medicaid. The point is this: when price controls are in effect, shortages inevitably develop. In this case, a shortage of providers.

    2) Medicare cost shifting has nothing to do with the uninsured. It began during the Clinton years when the uninsured were not (a large) concern. It is caused by the inability of federal revenue to keep up with expanding services, and that problem will get worse in a single-payer system.

    3) I didn’t say HIPAA and EMTALA were part of Medicare. I merely cited them as additional unfunded mandates that exacerbate the problems created by Medicare. They are also harbingers of what is to come if the bureaucrats get their greasy little fingers on the whole system.

  16. 16
    Ron Chusid says:

    David,

    1) Nonsense. It is Medicaid and the uninsured which cause such financial problems for doctors, not Medicare. If everyone had Medicare, most doctors would have a higher income. We’d also have substantially lower overhead expenses.

    2) Wrong again. Cost shifting occurs when there is variation between what different payers pay, as well as when there are people without coverage. (While the number of uninsured went up significantly under Bush, the problem was still there previously). If there is a single payer plan there are no longer different payers to shift costs between. Maybe Medicare wouldn’t pay enough, but cost shifting would no longer exist.

    3) The argument still has nothing to do with single payer. These are issues which are present regardless of whether there is single payer, muliple plans, or even if all government programs were abolished. This in no way indicates things would be worse under a single payer. Medicare is less bureaucratic than private plans and places less nonsense restrictions upon physicians and patients than many of the private plans I deal with. Creating excessive rules isn’t simply a government problem–unfortuantely it almost seems to be human nature. I’d far rather deal with the bureaucrats at Medicare than those at United Healthcare.

  17. 17
    battlebob says:

    Ron,
    Would any of the plans change the choice or methods seniors use to select their drug plans?
    Would some of the variables disappear in a SBT plan?
    In other words…go to the drug store…get the drugs…(either generic or formulated)..send the bill to uncle sam..

  18. 18
    Ron Chusid says:

    Battlebob,

    The confusion exists now because there are so many private drug plans under Medicare. Democrats have talked in the past about having a single Medicare plan but I don’t know if they are actually going to push the issue. I would assume that if any of the candidates are elected and start pushing their plans thru they would address this problem.

  19. 19
    Fabella says:

    I’ll try again…

    Ron,
    I enjoy the repartee with David (although prefacing your comments with specious attacks on his prefacing specious comment attacks gets a little old).
    As a surgical specialist, I would love to be compensated fairly by one payor.Yes, Medicare processes claims efficiently, then pays a reimbursement that more than includes those efficiences. That is, while Medicare pays quickly and with relatively few hassles, it pays only a fraction of what I get from private payors. (If, as you say, you have contracts LESS than Medicare, I would get a new negotiator when your contracts come due).

    Medicare is a system that has not increased my reimbursement for 3 years and then only 1.1% the year before that. Yet, my electric bills are higher, my employees sure don’t expect 0% pay raises every year. And my specialty society (AAOS) was HAPPY that they got a 0% increase, because Medicare was slated to CUT some reimbursement by 17%.

    Among my private plans, I have been able to raise my reimbursement 20% over those same 4 years, which, when combined with my significant Medicare/Medicaid population at least lets me cover my increases in overhead.

    And I have zero confidence in the government caring about patients’ needs or physician needs when the next “budget crunch” arrives.

  20. 20
    Ron Chusid says:

    Fabella,

    Yes, Medicare has been decreasing payment to surgeons in recent years while increasing payment for primary care, believing that surgeons were overpaid compared to primary care physicians.

    You missed the point of the debate with David. David’s initial argument was that no doctors would say anything good about Medicare. He further claimed that I’m out of touch with reality and suffering from Stockholm Syndrome for my comments.

    While you very well might be doing worse under Medicare, many doctors, including a large percentage of primary care physicans, now do better. Also keep in mind that we are talking about everyone having Medicare. There are many plans which continue to pay surgeons well but do not pay well for primary care services. There are also many people with Medicaid and no insurance who would have Medicare.

    Even for many surgeons, income would increase under Medicare for all due to increased volume if we no longer have a growing uninsured population and no longer have to settle for Medicaid payment. Overhead would also be substantially lower for primary care physicians if we no longer had to deal with multiple insurances and have staff spend time on the phone in order for patients to even be allowed to see surgeons such as yourself.
    As noted above, even some surgeons find that they would make more money under Medicare for all, such as in this link.

    I am not arguing that we should go to a single payer Medicare system but that the arguments which David raises against it are highly specious. some of his arguments, such as cost shifting, are actually arguments in favor of Medicare for all, not arguments against it.

  21. 21
    Fabella says:

    I checked out that link… a young independent solo practice urologist… For a solo practice doc, single payor is a godsend. My overhead for Work Comp alone is unbelievable and we employ 8 billers for 13 surgeons for non-work comp. Alone, I would still need at least one if not two people on the phone all the time.
    BUT, while not getting into an argument over who is “overpaid,” the reason behind decreasing surgeons payments is not to reward PCP’s, it’s to decrease overall spending and that is easier done with higher earners. At some point that well runs dry and you either lose surgeons, or you start tapping into PCP payments… or both.

    The reasoning behind Medicare’s proposed cuts for total knees/hips was not that the surgery is easier to do, takes less training, requires less follow-up, is less expensive for the surgeons… it was SOLELY because the population is aging and therefore need more replacements.
    Because a lot of people need the service I provide, does not mean that it is therefore worth less.

  22. 22
    Ron Chusid says:

    Fabella,

    Agree we don’t want to get into the question of whether anyone is overpaid compared to others, but when the payment formulas were devised it was specifically to increase payment for primary care as well as to decrease payment for surgery. If the goal was simply to cut overall spending they wouldn’t have used the savings from decreased pay to surgeons to pay more for primary care.

    Medicare for all may very well be a poor choice for some specialties, but again the issue in my debate with David wasn’t whether it was good for everyone, but only that he was incorrect in arguing that this is something which no doctor could consider supporting. As only Kucinich supports it among the major Democratic candidates, it also argues agaisnt the common claim that “Democrats support socialized medicine” per the initial topic of the post.

  23. 23
    Fabella says:

    While this may a topic for a different post, no mention of single payor systems is complete without mentioning tort reform. A major problem I have with the Dems is not only do they ask me to pay more taxes while accepting decreasing reimbursement, but they also never mention tort reform.

    A major benefit for working in the VA system is that malpractice is capped at 250K.

    To add insult, a leading candidate for the Democratic nomination made his MILLIONS suing doctors. Already, my group pays over a half million dollars a year in insurance and our state, while not great, isn’t even one of the worst ones.

  24. 24
    Ron Chusid says:

    Fabella,

    Democrats “also never mention tort reform.”

    Some do. Back in 2004 Kerry spoke out saying that tort reform must be part of any comprehensive plan for health care. We’ll have to see what happens when the 2008 candidates lay out their whole plans. My suspicion is that we have the best chances with Obama and Richardson.

    Edwards will obviously never receive the support of physicians, but even he spoke about tort reform. He added one idea which was added to Kerry’s plan after Edwards became running mate–a mechanism to penalize attorneys who file frivilous suits.

  25. 25
    bfnelms says:

    Thank you thank you thank you. I can’t believe a practicing physician has the time to maintain such a site. It should be required reading for all voters.

    Your analysis of the current debate is the most detailed and unbiased I have read. No one else has been so blunt in requiring Senator Clinton to face the fact of her previous failure and her unwillingness to see the problems that led to that failure (more than Harry and Louise!). I look forward to hearing more from Governor Richardson.

    At the moment, for any number of reasons, I am supporting John Edwards. Let’s face it. Without his initiative this issue would NOT be receiving the attention that it is now. Yes, there are still details to be worked out, but his specificity, practicality, and candor (it seems to me) far outdistance his competitors at this point. And that is characteristic of his campaign on other issues as well.

    Again, thank you for the care that you have taken and for your patient response to readers and your persuasive rebuttal for David Catron, even when he resorts to name-calling, sarcasm, and inaccurate rhetorical analysis.

  26. 26
    Fabella says:

    Ron,
    For what its worth, if you search “tort reform” on John Edwards website, the one and only result is a quote out of the Rocky Mountain News:

    “John Edwards likes to talk about how there are two Americas – and he’s right,” Adams said.

    “There’s his America, of San Francisco values, higher taxes, frivolous lawsuits and a weaker defense; and then there’s a place like Colorado, where we stand for family values, lower taxes, tort reform and a stronger defense,” he added.

    Yes, it came from a Republican, but not exactly a high priority in that campaign.

  27. 27
    Ron Chusid says:

    Fabella,

    When Edwards came out with his health care plan this year, I did note that he didn’t include the material on tort reform which he spoke about in 2003-4. I found that a bit surprising, feeling he needs to speak about tort reform to be credible considering his background. On the other hand, he is receiving huge amounts of money so far this year from the trial lawyers. Despite the excitement surrounding Edwards in the blogosphere I think he would have trouble surviving a sustained campaign and is one of the least electable Democrats running. (On the other hand, after Bush it is possible that no Republicans will be electable in 2008.)

    The problem with most Republican rhetoric is that it might sound good but the result isn’t. Family values to Republicans too often means imposing one set of religious beliefs on others. Lower taxes means shifting the tax code to primarily benefit the ultra wealthy, and running up big deficits. Tort reform often means allowing big business to get away with anything–some balance is needed here. Stronger defense turns out to mean ignoring warnings of a major terrorist attack, failing to respond to the attack meaningfully, and weakinging the country by getting us dragged into a civil war (which was created by a bungling US policy.)

  28. 28
    Susan K. says:

    Gentlemen;

    Argue all you want over the “Single Payer” vs. “Blended” solutions to our national health care delivery crisis, and whether we should even HAVE national health care, but know this:

    Canada delivers health care to ALL its citizens for about 1/3 the cost of US delivery of health care to a PORTION of its citizens, and Canadian life expentancy is 2 years longer than that of the US. All we need to do is look to our neighbors to the North to see a model for our own national health care system.

  29. 29
    Fabella says:

    Susan,
    Canada’s population is hardly comparable to ours. I always hate comparisons to relatively homogenous “first world” countries, like those in Scandanvia, or Canada for that matter. Have you ever tasted true Southern cooking? Delicious, but the fat content is astronomical. Can you change that culture… unlikely, so obesity/heart attacks/diabetes are much more a problem regardless of who pays for healthcare.

    The Canada system is great… for Canada. In my line of work, we get Xrays on every ankle sprain. Do we need them? Well, the Ottawa Rules (from Canada) give a clear algorithm as to who really needs an Xray (and most people don’t). But here, if you don’t get an one, and God forbid there is a fracture, even if it does well, a John Edwards wanna-be is slithering up to your door almost immediately.

    And how long are you willing to wait for a total knee replacement? My patients complain when they have to wait one month, much less years in order to “get on the list.” You don’t have to simply change the payor system, you have to change our whole culture of expectations.

  30. 30
    Jerry Clark says:

    A group of concerned citizens is working on developing an alternate health care delivery system. We have been searching for a name or label for this alternate. Single payer, Medicare for all, socialized medicine and others we have tried do not work. These “labels” do not describe what we want. We do want a health care system that treats health care as a right, not a privilege that you can purchase. We also want a “label” that does not turn off the public. If the costs of collecting the “reimbursement” for services could be determined (including the cost of staff and physical space and computer support and other overhead) and eliminated, the savings would be enough to provide health care as a right. The other problem that has been identified is the Insurance company -they make decisions for which they are NOT qualified. Over 3000 physicians have surrendered their licences last year, so the supply of qualified physicians is going down. Insurance companies also take their cut off of the top. We have identified a need to free up the time of caregivers by allowing them to spend time with their patient, not filling out forms and trying to get “reimbursed” for services that they have already performed. If anyone has any ideas for a non inflammatory “label” please tell me by responding to this blog. (Our governor really loves to veto anything that he does not like, or probably that the people with the money that helped him get re-elected do not like either.) There is a method to cure the governor’s behavior – like the one used in California where Arnold got the job. Thanks.

  31. 31
    Brun says:

    Dear Sir, I think you are very loyal to your party but what is best for us has nothing to do with a party.  I do not belong to any party.  I am a moderate by definition.  I am a conservative when it comes to moral values, a liberal when it comes to environment, a conservative when it comes to gun control, a liberal when it comes to public rights.  I stand for what I believe I am force every year to pick what I consider the lesser of two evils.  Only because this country thinks, there is only two ways of thinking and a party then is attached to those ways.  I at least can deal with conservatives they are in your face frank.  They are bluntly honest in their, “I do not care” attitude.  However, I find Democrats to try to lie to my face and then expect me to believe it or they treat me as if I am an idiot because I do not buy into it.  This whole article is full of double speak.  Amounting to much of nothing other than you claiming Democrats do not what socialized medicine but they do.  Start with the title of the article and your first statement. 
     
    “Democrats Oppose Socialized Medicine “
     
    Then you go right into
     
    “This title is a somewhat tongue-in-cheek (while still accurate)”
     
    “If we stick to more conventional definitions of socialism, it would suggest having government own and control the health care industry”
     
    I find you using conventional very funny as socialism is for a society.  Our society is not the French, nor is the French the Germans, you will find not socialism exactly the same so how can you have conventional socialism?  I am certain that you will find, that if the government controls something it will be forced to OWN it eventually to maintain it?  You don’t find military posts owned by private interests do you?  Even after your statement, you then show how much government is involved already.   With this sentence:
     
    “A tremendous number of Americans currently receive health care through Medicare, Medicaid, veterans programs, and other government programs.”
     
    Then you go on to say,
     
    “Dennis Kucinich advocates the plan which most greatly increases government involvement in health care.”
     
    These very government run programs do not do what they were meant to do.  Yet, you would hope for the government to have more control?  You obviously have never been the recipient of those programs.  If you have you would know how poor they do.  Let me give you my mother in-law for example.  She has Medicare and nothing else.  She makes an appointment, which I must take her to because she owns no car.  This appointment is at 10 am but she is not seen until 2 in the afternoon.  I have to use a vacation day just to help her go see her doctor.  She has no choice of doctor but must see the one that is working that day at that clinic.  Who she my not have any familiarity with and really does not know her medical history, other than notes in a folder.  If that doctor decides she does not need some procedure or tests then, she will not get the procedure or tests.  Why, because she cant go to someone else for a second opinion.
     
    Lastly, I want to point out this other interesting statement and if this is not doublespeak, I do not know what doublespeak means.
     
    “Under Kucinich’s plan I would still operate a private practice, but would save a considerable amount of money by only having to deal with ONE plan.”
     
    Then you go to say,
     
    “While conservatives cry “socialized medicine” to give the impression of lack of CHOICE”
     
    I say sir if I only have one how is it I do not have a choice?  If you have one color to paint with how can you choose another?  If there is only one dessert, how can you choose another?  So I do not think conservatives cry of lack of choice is BS when you plainly state there is only ONE plan.
     

  32. 32
    Ron Chusid says:

    “I think you are very loyal to your party.”

    I am an independent. I have no party.

    As for your comments on health care, you are confusing payment for medical services with delivery of medical services. For example, if you are unhappy with your mother’s care this has nothing to do with the Medicare program. Medicare beneficiaries see pretty much the same doctors as anyone else. People with private insurance face the same problems as your mother if they go to the same place. Your mother is also free to see any other doctor. There is nothing preventing her from getting a second opinion.

    You do not have only one choice. You have multiple choices. Polls show that Medicare beneficiaries are more satisfied with their care than those with private insurance. In general Medicare interferes far less with my practice and the choices of patients than private insurance does.

  33. 33
    Brun says:

    My friend, how is it a liberal is an independent if you were a true independent you would vote republican sometimes and other times democrat but this whole site is dedicated to the democratic liberal agenda.  As to payment, you are correct about payment.  However, im not confusing the idea of choice verses payment.  The whole idea of this push is not choice I have that.  It is the ability to pay.  The very reason people do not have coverage is they cannot pay.  Hello?  As to choice if there is only one plan, there is not a choice.  I like that different insurers have different ways to pay implies that there is competition and competition is better for the consumer.  Look at phone service I remember when there was only one company and you even had to by the phones from them.  Heck, that 5 dollar phone you can get at Wal-Mart was 90 dollars under the one company system.  You obviously have never been in a government institution.  I have, the good old USA Army 3 years my friend.  The army bought a Craftsmen crescent wrench for 75 bucks.  The same one you can buy for 8 dollars.  How do I know this, because I lost mine and the Army took it out of my paycheck.  I would say the government really does not know how to drive prices down just knows how to borrow more money from my paycheck to pay for more.  As to choices look here my friend
     
    http://www.nytimes.com/2009/04/02/business/retirementspecial/02health.html
     
    “Her gynecologist informed her that she was opting out of Medicare. When Ms. Plumb asked her primary-care doctor to recommend another gynecologist who took Medicare, the doctor responded that she didn’t know any — and that if Ms. Plumb found one she liked, could she call and tell her the name?”
     
    Quote from article
     
    Then its not confusing as to how you are covered or if you even are here is one to help you if you live in Maryland: (oh an notice this is a Advantage Plan which would imply the regular plan is not good enough)
     
    http://www.takingcareofmomanddad.com/SpecialTopics/Medicare/MedicareAdvantage/
     
    “People must have both Medicare Part A and Part B and must live in the plan’s geographic service area to join a Medicare Advantage Plan.”
     
    Geographical service? What happens if I go on vacation?  Oh yes, it says I can go anywhere but then states:
     
    “it’s important that people review plan materials carefully for details about co-payment and coverage information.”
     
    Which in laymen terms means you may have to pay for it yourself.  Better, not get sick anywhere but home I guess.  Then:
     
    “In some plans, like Medicare Health Maintenance Organizations (HMOs), people may only be able to see certain doctors or go to certain hospitals.”
     
    Before you go into Medicare is not an HMO I would say conventionally and truthfully it is under the Medicare program.
     
    This is what my mother in-law deals with and your right she can go get a second opinion if she can come up with the money to pay for it herself.
     
    http://www.ama-assn.org/amednews/2009/08/10/gvse0811.htm
     
    “The recently proposed Medicare physician fee schedule could lead to cuts in payments for radiation cancer therapy services of nearly 20%, according to survey results from the American Society for Radiation Oncology.”
    “The survey also found:

    47% of rural practices would need to close.
    60% of community practices with multiple locations would need to consolidate.
    54% of practices would no longer accept Medicare patients.
    68% would limit the number of Medicare patients.
    43% said their cancer patients would be forced to travel more than 50 miles round-trip for radiation therapy treatments.
    81% of rural practices reported that their patients would have to travel more than 50 miles for treatment.”

    How does that give me more choices my friend?  And as a after note how does that help the economy?
    I think your focus is on helping those without and I am all for that my friend.  But as to Uncle Sam doing it no thanks I have seen what the government does as a whole and I will choose the private sector over the government any day.  You have never been in the military (I have received medical service there too.  It sucks) you do not have Medicare or Medicaid and I will also be you have never been to or participated (being the recipient of) in any government program.  Ever been to a Indian reservation?  There are hundreds of examples of government involvement that shows that the government is incapable of running something to the benefit of society.  Making laws great, im all for that!  Being a watch dog, that too.  However, telling me (as though im some child) what is best for my life, forget it!

  34. 34
    Ron Chusid says:

    Brun,

    What makes you think you know how I vote?

    I’m afraid you have many misconception regarding Medicare. You are cutting and pasting things which you clearly do not understand. For example, the government Medicare program covers you regardless of where you are in the country. Medicare Advantage programs were Bush’s attempt to privatize the system. I have many posts here on the problem with Medicare Advantage programs, which include the problem you mentioned with going out of state. You are really making an argument for, not against the government Medicare program.

    Yes, there are doctors who don’t accept Medicare. There are also doctors who don’t accept various private plans.

    You also misunderstand what you pasted in on Medicare reimbursement. This is a criticism of a flawed formula but every year Congress intervenes to prevent the formula from kicking in. The health reform measures being considered in Congress include a provision to eliminate this flawed formula. When you quote these problems you are really making a case for health care reform. Note that the AMA has endorsed the House health reform proposal, partially due to the inclusion of a provision to permanently eliminate the flawed reimbursement formula.

    The bottom line is that Medicare provides care more economically than private insurance. Medicare beneficiaries are happier than those with private insurance. Medicare beneficiaries generally have more choice than those under private insurance. Nobody is telling you what is best for your life–the point is to give you more choices. Medicare beneficiaries are never denied coverage because they become sick or lose their jobs as often happens with those under private insurance.

    Blanket statements against government are not really helpful. It is necessary to look at the specifics, and to understand the specifics rather than just pasting in things you do not understand.

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