Why not single-payer?
Posted on July 15th, 2008 by Richard Kirsch, National Campaign Director in Solutions that Work
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I want to take a moment and address those of you who have been asking why Health Care for America Now isnot focusing on creating a single-payer health insurance system. First of all, here is HCAN's official position:
The goal of Health Care for America Now is to build a national movement to win the implementation of health care reform that meets the principles in our Statement of Common Purpose. We believe that a properly designed single-payer bill is one way of doing that but not the only way. Many of the organizations that belong to HCAN support single-payer reform and have endorsed HR-676. But in joining HCAN, they recognize that the major focus needs to be on winning quality, affordable health care for all rather than advocating for only one approach. Health Care for America Now believes that the big divide in our country on health care is between those of us who believe that there needs to be substantial government involvement in guaranteeing quality, affordable health care for all and those who think that the solution is to rely ever more on an unregulated private market.
I was a leader of the fight for single-payer reform during from 1988 to 1994. I co-wrote with Richard Gottfried - then and now the Chair of the Health Committee of the New York State Assembly - the only fully-financed single-payer billto ever pass a state legislative body in the country. I shared the responsibility with Assemblyman Gottfried for presenting single-payer at twelve debates sponsored by Governor Mario Cuomo in 1991 on healthcare reform proposals. I wrote a training manual and talking points for candidates for Congress to use in running on single-payer in 1992. I could go on, but you get the idea.
So what happened to me? Five years ago,I sat down to write a history of the struggle to win a single-payer system. (Will it be Déjà vu All Over Again? Renewing the Fight for Health Care for All Tales, Hopes and Fears of a Battle-Scarred Organizer [pdf]). Here's what I wrote in the preamble to that article:
I intended to write this piece as a cautionary tale for both the new generation of organizers for universal health care and the veterans of the last fight. To my surprise, the writing led me to a fresh understanding of the paradox of achieving universal health care in the United States: the political debate about health care reform is turned upside down once the debate turns from the problem state to the solution stage. At that point, people become more scared about what they will lose from reform than what they will gain. This conclusion led me to reframe my view of how we go about organizing for universal health care, and - to my even bigger surprise - to outlining a new proposal for comprehensive reform.
I wrote at the time: "So here's my proposal, in a nutshell: provide everyone in the country with the option, and the means of paying for, coverage through Medicare or through private insurance."
One point of this approach was not to scare people away from reform or to make it easier for the opponents of reform to panic the public. I realized we could reassure people about change by building on what people are familiar with - both private insurance and Medicare's public insurance plan.
A lot of what I wrote at the time also had to do with the need to reaffirm the positive role of government in America. To do that, we need to demonstrate that government can better people's lives in real ways. Even though it might make us feel good, stating our ideological position in the hope that people will eventually come around is not effective. We need to win real changes that show government can work in positive ways.
Our goal is to have the United States provide a guarantee of good, affordable health coverage to all its residents. That's the bottom line. A national health insurance plan (single-payer) is one way to accomplish the goal, but it's not the only way. In fact, one of the myths about health care around the world is that "everyone but us has single-payer." In fact, single-payer is the way Canadians provide a government guarantee of good health coverage. Other countries - including the European countries usually held up as models - do it differently, with all sorts of variations of public, private, and non-profit insurance and socialized medicine. But what's true in all these countries is that health care is guaranteed and regulated as a public good.
We need to keep our eye on the prize and on the real debate. It would be great - a progressive dream -if the political debate were between putting everyone into a government health insurance plan (single-payer) and having a very large public insurance plan along with regulated private insurance (which is what the HCAN principles say). But the real debate is between those of us who believe that health care is a public good where government has to guarantee quality, affordable coverage and those who think that the problem with the health care system is that the market's not working, and if we gave people a voucher to buy unregulated private insurance, it would solve everything.
That's why the focus of our grassroots campaign in 2008 is our Which Side Are You On? statement. It lays out two very different visionsfor reform: "Quality affordable health care for all" or "On your own with private insurance". That's what America has to decide.
Late last year, I wrote an article that lays out in a lot of detail the argument for Health Care for America Now's strategy: Winning Quality Affordable Health Care for All [pdf]. I hope you'll take the time to read it. For now, I want to share with you the last two paragraphs from that piece:
We have to start where the American public is today. After seven years of the George W. Bush administration and 30 years of conservative dominance the American public is fearful about their economic status. Most Americans see the government as being corrupt, ineffective and on the side of wealthy special interests. People do not trust the government and that do not think that the government is on their side. Health care reform contains the promise to turn this around, to demonstrate that government can work for all of us, which the public interest can trump corporate interests and the "you are on your own" ethos of the new gilded age. Health care reform holds the promise to create a generation of Americans that support a government that works for everyone, just as the New Deal's advances led to four decades of activist government for the public good.
Coming off more than a quarter century of conservative domination of American politics, I am reminded that Karl Rove's hero, William McKinley, was followed by Theodore Roosevelt and the Progressive Era. Our job is to build a movement for health care reform that ignites the hopes and aspirations of the American people, the American values of opportunity and fairness. Winning real health care reform will requires a clear vision, a persistent, strategic energy and a belief in the miracle of change.
(Also posted at Daily Kos and The Huffington Post)
What will prevent the for profit insurance companies from "cherry picking" the young and well and leaving the sick to the public plan - or how will adverse selection be addressed?
Part of our goals is to create rules for coverage, no matter if you are on the public or private plan, to make sure a certain level of quality coverage is there for you no matter what.
The core of Richard Kirsch
I am a retired physician and, although I have heard horror stories re: universal health care in places like England and Canada, I am a firm proponent of Universal Health Care. At the present time only some of the people that have employer subsidized insurance, or those that qualify for State Insurance (the indigent) have access to medical care. In the mean time Insurance Companies make Billions of dollars as in the case of United Health Care - obviously they made enough in 2006 to PAY THEIR CEO $1.6 BILLION dollars just for ONE YEAR'S WORK. In Arizona the head person of the State program for indigent patients got paid $1.1 million for 2006 - money that came out of tax payer's pockets. How can we justify paying so much to such few people. THERE IS NO JUSTIFICATION. I would like to know what MIRACLES did those two people worked to be worth that much money; money that came out of the pockets of their enrollees. In the mean time reimbursement to Doctors, Hospitals, and other medical care facilities keeps going down. In my practice overhead expenses kept growing while insurance reimbursement kept being reduces every so many months, and it got to the point where I had to close my practice. Like everyone else I have a mortgage, utilities, groceries, medical expenses, etc. and the income was not sufficient to provide for present and future needs. And it is not like a have a mansion and a high rolling life style. I live in a track home, drive a 10y old Honda Accord, and for my vacations I usually drive to see the children and grand children (no cruises or foreign travel). Therefore, Insurances and not the Doctors are the problem. Also, we should not forget the malpractice suit lotery and its effect on doctors income (the lowest rate in my field - Internal Medicine is $120 a year. Therefore I have to make at least twice that amount just to match an engineer's salary, and they do not work over 12 hours a day, have paid vacations and benefits, and have no liability.
Wake up America, fewer people are going into Medicine and even fewer are going for Family or Internal Medicine. You may wake up tomorrow and find out that there is no one to care for your health, except maybe "foreign graduates" that did not make the cut for a USA based Medical School. Think about it, ater all IT IS ONLY YOUR HEALTH. It is time we had a revolution.
We agree on many points, for example, we agree that the Goverment's role is to provide a guarantee of quality, affordable health care. However, we disagree that the Government necessarily needs to be that Health Care provider.
I think we need to stay focused on the real fight, as Richard puts it,"the real debate is between those of us who believe that health care is a public good where government has to guarantee quality, affordable coverage and those who think that the problem with the health care system is that the market's not working, and if we gave people a voucher to buy unregulated private insurance, it would solve everything."
If you're not for single-payer, you're still part of the problem, not the solution, to the health care crisis. The system is broken, and no amount of tinkering is going to fix it. The only real fix is to remove private insurers from the equation altogether. I will not support any group or candidate that does not call for single-payer.
Nicholas Skala, above, points out that the kind of system HCAN is supporting only works when the private insurance industry is regulated in a truly radical way that would turn them into completely different animals than they are today in America:
"Even in the most privatized system, insurers are required to be non-profit, have their benefits and premiums dictated by the government, and must make
The objection to HCAN's approach, by at least some Single Payer advocates, is the combination of appropriating the single paqyer message and then not even including us at your table.
We who are advocates for the Single Payer (aka: expanded and improved Medicare for all) approach to acheving real universal health coverage in the United States are often accused of being zealots opposing the supposedly acheivable good (pre-compromising proposals like HCAN's) for the an idealistic unacheivable best. A more balanced then most version of this argument appears under the title Single Minded by Jon Cohn in the New Republic. PNHP has a response on their blog.
But as a one of those who has supported the obvious need for some sort of "universal health care" since I was first learned about the issue as a college and medical student in the 1980s, and only came to single payer per se recently, I have a few of my own points to make:
1: Strong or Weak?
Ironically, we single payer advocates are apparently so weak that we should be dismissed out of hand and not even have a seat at the negotiating table? But then again we are also strong enough to be warned not to wreck "doable reform"?
It is the Beltway sensible moderates who have worked hard to ignore the actual presendce of single-payer grassroots and to exclude its advocates from the table, not the other way around. And frankly, it is tiresome to be dismissed upfront (and then be blamed for not participating or getting on board).
We are the ones who actually have a real grassroots movement. The single payer proposal in Congress, HR-676, has more signed-on co-sponsors then then any other "universal health reform bill." It has a higher percent of the House then the Wyden bill has in the Senate. HCAN could have included single payer advocates as part of their mix, could have included support for HR-676 "Improved and expanded Medicare for All" as one option still in the mix of possibilities to be promoted; in their language and in their "poll"; etc.). First they exclude us from the table, then they call us rejectionist zealots after the fact.
I first encountered this back in 1992 after Bill Clinton was elected with our support, and they actively kept single payer advocates from the pre-inaugural economic summit. Similarly we were kept out of participating in the closed door development of the Clinton health plan during 1992-1994. More recently there was the so called Citizens' Health Care Working Group, where the citizens part supported single payer but the establishment organizers made sure they were ignored. Similarly during the early part of the primaries, during the Clinton listening tour in 2007, citizens for single payer were a majority at many of her gatherings, but were actively ignored. Most recently, leading up to HCAN, there have been numerous conference call by the "Unity" group at which single-payer advocates are told to be quiet and
Hi DrSteveB,
In fact our outreach did include many of these organizations that you refer to. I am sorry that no one contacted you directly. However, some of these organizations that support a single payer plan joined the coaltion, some did not, and some are still thinking about it. We are also open to any organization that would like to join us here: http://healthcareforamericanow.org/page/s/organization/
I am sorry that you felt left out, but we did do a lot of outreach and it is still ongoing. If you or members of your network would like to join on we would be happy to discuss that with you.
My work history very closely resembles Richard Kirsch
I am with PNHP so that is why I guess I fel left out. Speaking just for myself, I wish we could be working together better, but that would mean that HCAN did not take single payer off the table a priori, and single payer advocates would not insist that it be the only item on the table. So far it is quite unfortunate the way it has played out.
Something interesting is happening. First, "Health Care for America Now" (HCAN) announced their $40 million K-street-based grand coalition, that had many good points to it, but tried to take Single Payer off the agenda. Then they put up a Blog on their website, and it promptly filled up with the real grassroots supporting Single Payer and calling them out on it. Then one of their coalition partners, the AFL-CIO put up a Blog supporting HCAN… five out of five commenters supported Single Payer… and then they closed comments!
While the beltway and people "who knew better" did little after 1994, it has been Single Payer advocates who continued more then anybody to do the hard work of actually building a grassroots infrastructure and support.
As Jon Cohn admitted:
Actually HR-676 now has 91 co-sponsers, having added one more just this past week.
HR-676 has been endorsed by over 417 union organizations in 48 states including 107 Central Labor Councils and Area Labor Federations and 33 state AFL-CIO
Levana's comments are so skimpy. That is because she does not have any true answer. HCAN obviously needs to change back to single payer. Let the burned out person, Richard Kirsch, retire or take a break and leave the rest to us. The reason 59% of doctors favor single payer is that we see the data which has obvious conclusions and solutions. We have seen medicine deteriorate because of the rule of the private insurance company, which is employer based.
I just commented on the Kirsch article in the Huffington Post using the screen name hr676fan. Since Mr. Kirsch's article appears here, I am taking the liberty of copying my comment here as well. I've also posted on other pro-single payer blogs, so if I'm getting into the repeats, I apologize.
HCAN has stirred up a hornet's nest–and I am afraid several members of the coalition have been stung. When they signed on as as advocates of "universal health care," I cannot imagine that labor organizations and faith groups realized the HCAN coalition was going to protect the profits of the insurers. There is no way health care coverage can be made affordable with the insurers on board. Period!
Desperate for health care reform, many organizations (and maybe some of your staffers) obviously jumped on to the HCAN bandwagon without thinking. Your message replicates AARP's "Divided we fail." And we all know about AARP's links to United Health care. You can fool some of the people . . .
Anyway, here's my Huffington Post comment:
Mr. Kirsch and his Hacker/Herndon/HCAN coalition claim to offer us a "choice" of health plans, but they leave an important option off the table. On HCAN's web site, a poll asks respondents if they would prefer an all-private plan, or a public-private combo. How about an all public, single payer plan? Oops–sorry folk! You can't check that box.
Single Payer, as detailed in HR 676, has been designed and analyzed by clinicians, health care experts and economists. It has been tested and proven to work in other free-market democracies. It would be as simple to implement and run as traditional Medicare (before the incursion of Plan D and those private dis-Advantage plans).
. . . It would be difficult to implement single payer in the smaller states. We'd need to dismantle the mixed federal-state funding for Medicaid and SCHIP. (The for-profit HMOs have their tentacles in those programs too.) I think it would take the combined clout of all states to deal with those issues.
The Lewin Group reports that a taxpayer-funded plan would save trillions and control future costs. Mr Kirsch seems to overlook those findings. I suggest he get off the "focus group, framing, feasibility" bandwagon and do some real research. Let's hope the facts will lead him back to his single-payer roots.
Call your Congressperson and ask him/her to sign on as co-sponsor of HR 676.
I am not sure why many people assume that because we are not endorsing any specific plans that would prevent others from advocating for their preferred solutions. In fact, we have taken a strong stance against the insurance industry. We believe they put profits before people, and they should be carefully regulated.
We are holding a large event in Columbus Ohio to counter the message of AHIP which is the insurance industry. We hope you will join us to fight against the real problem here which is the insurance industry's bad practices.
There are 87 U.S. Representatives supporting HR676, including John Conyers.
91—as logged by the Library of Congress, which has never been given any directives by the U.S. Congress that the lists are to be updated with changes and deletions
+ 1—John Conyers
- 1—resignation in July 2007
- 2—deaths in Dec 07 and Feb 08
- 2—U.S. Delegates who do not vote
87 - total - as provided and maintained at the following web page
http://www.ninenineohnine.org/pages/U.S._Representatives
There's much more information here at the Single-Payer Support Monitor:
http://www.ninenineohnine.org/pages/Monitor_Political_Support
Bob Haiducek, Bob the Health and Health Care Advocate
http://www.99oh9.org
Levana,
Because that is the simple reality of the situation. The growing demand for single payer has frightened many people in high places. With a strong movement already underway within trade unions, professional organizations of doctors, and grassroots groups like Healthcare Now, it is not unsurprising that people feel slighted by you drowning out their message with sound bites about reform and no substance.
To the contrary you have taken a strong stand against just single payer reform (see the title of this blog article to start). This is the absolute last thing anyone interested in real healthcare reform should be doing. Which side are you on?
I would like to add my strong support for single-payer as the solution that will actually achieve universal health care for Americans. Many of us just don't trust insurance companies to ever change their ways. It is illogical to assume that we the people "like what we have." I have health insurance, but I know I can lose it in an instant. I have in the past had to buy my own health insuarance and I resented giving money to these crooks, knowing they would probably raise my rates beyond what I could afford and then all the money I gave them is down a rat hole.
With a government-funded system, the care is always there, the money always goes through the same entity, and that entity has as its purpose providing health care (not making profits). I would like to retire, but leaving my job means losing my health insurance. I have two years to go until I'm eligible for Medicare. What a relief that will be!
Healthcare-NOW Position Paper regarding Health Care for America Now
On July 8, 2008, a coalition of organizations called Health Care for America Now (HCAN) announced a campaign for healthcare reform. A spokesperson for the group stated that they plan to run a multi-million dollar ad campaign and will promote health care reform that offers a mix of public funding and private insurance.
We share the group
Reprinted From: ‘On Call’ The Journal of the Palm Beach County Medical Society
Nov-Dec, 2007
On Line: http://www.pnhp.org/news/2008/february/what_government_does.php
What Government Does Better: Health Insurance
Howard A. Green, MD, FACP, FAAD, FACMS
You’ll listen to me because I’m your doctor. I only have your health interests in mind. I have written this article without ‘prior authorization’ from any insurance companies.
There are some intuitively obvious services that the government runs more productively and efficiently than private for-profit enterprises. For example, our armed forces and GI’s conquer and hold and protect territory more effectively and at a fraction of cost of private militias such as Blackwater USA and the Crescent Security Corporations. In addition, the government rules and regulations which our governments’ military adhere to insure an ethical cohesive fighting force compared to the unregulated for-profit corporate armies. Our GI soldiers assigned to kitchen duty prepare and cook meals at a fraction of the cost of identically prepared meals from the private for-profit logistics divisions of the Halliburton or Kellog Brown and Root Corporations. Government regulated public education in America such as the undergraduate and college systems of the City of New York and other large metropolises have for over a century produced more CEO's, doctors, lawyers, accountants, engineers, chemists, poets, philosophers and military officers than any private school system, and at a fraction of the cost compared to all the private schools in the country combined. Take away the government grants, government tax breaks, and government sponsored free overseas labor from Americas top private Colleges and their classrooms and graduate programs would most likely shut down, no matter how large their private endowments. The government run and regulated public school systems of Israel, India and China are churning out competent engineers, scientists and entrepreneurs at a quality and rate much greater than that of any collection of private schools in any country in the world. These non-American people, highly educated by their government run school systems, have formed a new collective worldwide labor arbitrage system which is fueling the productivity of intercontinental private business. The Marshall Plan, Interstate Highways, Space Program, Peace Corps, and the GI Bill all demonstrate successful government run bureaucracies of their time.
In a similar fashion, our mammoth government-run health insurance company (Medicare) operates at a fraction of the cost of private insurance corporations such as Aetna, Cigna, United, Blue Shield Blue Cross, Kaiser Permanente and Humana. Medicare, the government health insurance for the elderly uses only 1-2% of your dollar to achieve rates of morbidity (sickness) and mortality (death) among their patients which are identical to those of the private health insurance corporations. However, private insurance corporate bureaucracies inefficiently siphon $350 billion per year, or 20-25% of your hard earned dollars away from doctors, hospitals and patient care into the pockets of their executives, administrative employees, shareholders and politicians. The recent stock option fraud perpetrated by the CEO of United Health Care demonstrates the negligent disdain the private insurance corporations have for physicians, hospitals, health care workers and patients. Since their founding 40 years ago, private health maintenance insurance corporations have failed to deliver what their business plans always promise; lower rates of morbidity and mortality associated with low costs to the patients. These insurance companies are financially profitable for their shareholders and executives, but medically bankrupt for their patients. Without their own massive government subsidies, government protection from malpractice lawsuits, and a government ban on collective bargaining by physicians the private health insurance corporate bureaucracies of Aetna, Cigna, United and Humana, and hundreds of other smaller health insurance companies of the health insurance industry would undoubted fail to exist. Most elderly people who call themselves Republicans, and conservative physicians in this Country have recognized the efficacy of our government regulated Medicare health insurance corporation and have enrolled themselves and utilized this Government run health insurance company for their own medical needs (despite the shrill cries of socialized medicine from their leaders). 40 years ago we heard these same shrill cries from organized medicine and Republicans concerning the establishment of Medicare. After accepting hundreds of billions of dollars in Medicare Insurance payments over the ensuing 4 decades, one can only wonder why conservative physicians still rally like Quixote against this government run insurance product.
The following 9 steps will simply suggest how, without the inefficiencies and burden to productivity of private insurance corporations, we can deliver efficient and effective comprehensive health care with great savings and no sacrifice of jobs. In fact, we may be able to decrease morbidity and mortality in this Country with one coordinated system which cares for all Americans, and concurrently analyzes optimal diagnoses and treatment modalities through its integrated computerized billing system. The savings incurred insuring all Americans through the more efficient Medicare system will benefit all citizens of our Country.
9 Steps to Comprehensive Quality Health Care in America
1) Shut down the private health insurance corporations.
2) Enroll all Americans (including Veterans) and the 40 million uninsured citizens into the Medicare Health Insurance Corporation. Since the current functioning Medicare Insurance Company is already accepted by almost all physicians, Hospitals and clinics in the Country, hardly any infrastructure investments on the health care delivery end will be necessary. Have all private businesses pay a Medicare premium for their employees instead of private health insurance premiums. Let employees as well as businesses contribute a fixed premium amount based on their age up until 65 for their Medicare services and drugs. Freeze current premiums for all Americans over 65 and adjust in the future according to the cost of living index. These premiums paid by businesses to Medicare for their employees should be less than that paid to current private insurance companies because of the lower overhead costs of the Medicare Corporation and improved risk distribution.
3) Hire the now unemployed former private health insurance corporate bureaucrats to actually deliver and not inhibit health care by working in hospitals, doctors’ offices, clinics and nursing homes around our Country. Demographically, the percentage of elderly Americans is rapidly increasing. With every American now insured through Universal Medicare Insurance, real health care workers will be in desperate need. For the first time in the brief but bloody history of managed care, these former private insurance corporation employees will actually touch and improve care for patients by working in physical therapy, nursing, home health care and other ancillary patient care capacities.
4) Obtain by eminent domain (for the public good) the best of the intellectual property protected computer codes which the closed private insurance businesses previously used to monitor patient care and doctors utilization and performance. Private health insurance companies have used these computer programs exclusively for the purpose of strong-arming their contracted health care providers into doing less for their patients and increasing the premium costs for sicker patients in order to achieve higher corporate profits. Medicare on the other hand can use these same computer programs for the common good; to monitor, collect data and eventually improve the efficacy of diagnoses and the treatment of diseases and medical outcomes every time a doctor submits a bill. For example, wouldn't it be nice to know as a medical consumer (patient) which oncology groups in Boston, New York or Houston have the highest cure rates for stage III breast cancer or Stage II prostate cancer? All those numbers currently exist in cancer registries nation wide and just need to be collected and honestly disseminated. Currently, instead of solid medical data which delineates morbidity and mortality and performance, the medical consumer when choosing an oncologist must rely on word of mouth, physician referrals or advertisements in the local papers which show photographs of smiling doctors in white coats who claim to be the ‘best’ doctors in town. In addition to garnering invaluable instantaneous epidemiologic data on diagnoses and treatment of diseases based on severity and other variables, a strong Medicare based utilization review computer code would also allow Medicare to monitor doctors and hospitals who abuse a fee-for-service billing system. Any physician, institution or service found to abuse the Medicare fee for service billing system after proper review and appeal should be dealt with severely through stiff penalties and loss of their Universal Medicare provider contract.
5) Freeze Medicare physician, hospital and ancillary services reimbursements at current 2007-2008 levels. Adjust reimbursements for future services yearly by Cost of Living increases, or in the event of a deflationary economy a decreases in doctor and hospital payments. Ask any physician and they'll tell you they would accept current reimbursement rates with COLA over the current mysterious illogical fee adjustment system of Medicare, or the physician population density reimbursement formula used by most private insurance corporations. Two tiered medical systems separating the “haves and have not’s” of society have and will always exist. Therefore, we must allow physicians to practice medicine without enrolling in or accepting the Universal Medicare reimbursement. With private medical insurance no longer available, and no performance based evidence for improved morbidity and mortality among their private for-pay patients, these extraordinarily expensive private ‘VIP’ practices will be limited.
6) Allow Medicare, much like the current Veterans Administration System and every private health insurance company and government health care system around the world, to bid on medications from pharmaceutical corporations for its Medicare drug formulary. Every physician recognizes that we don’t need a choice of a dozen redundant drugs in each pharmaceutical category. For example, we need only 2-3 statins for cholesterol, a handful of antibiotics for infections, 2 beta blockers for hypertension, and a few pain killers. Once the Government bids on pharmaceuticals for the Medicare Corporation formulary, macro economics will force prices to massively decrease to levels identical to that which all the other people of the world outside of America are paying for the same medicines. Since it has not effectively decreased morbidity or mortality in this Country, and only wastes money, we should also prohibit pharmaceutical companies and their workers from contributing to political campaigns or buying commercials on the public airways. We need to also prohibit the current practice whereby your local pharmacy and pharmacist sells your private medical diagnoses and your doctors private prescribing drug information to pharmaceutical companies so the pharmaceutical companies in-turn can directly pressure-market physicians. Prohibit pharmaceutical companies from contributing to organized medicine societies, colleges or associations because the doctors can’t rely on soft bribes or free lunches to prescribe what’s best for their patients. Prevent pharmaceutical representatives from visiting doctors’ offices or hospital pharmacies directly. Allow delivery of Medicare formulary approved sample medications for patients to physicians’ offices via post office mail only. Allow pharmaceutical companies to market products to physicians only via peer reviewed publications delivered by email or snail mail.
7) With the savings incurred from closing the private insurance corporations and paying less for drugs, have the American government fully fund the National Institutes of Health (NIH) and the National Cancer Institute (NCI) and Small Business Innovative Research (SBIR) programs. Emphasis should be placed on basic bench research carried out at not-for-profit American Institutions which employ or utilize a majority of American Citizens in their laboratories and clinics. Too often American Universities rely on free overseas labor to conduct bench research. Clinical trials should emphasize new drugs and devices which have promise to significantly decrease morbidity and mortality for any disease, including orphan diseases. Since a large percentage of private funding for drug and device studies will originate in the expanding financial liquidity and innovations and patients of the emerging developing world, we should allow the FDA to utilize research data obtained by reproduced laboratory and clinical studies performed overseas as well as in this Country.
Corruption of honest academics should be curtailed. Force all investigators to release reproduced publicly funded scientific data for all scientists to review on the internet via the Freedom of Information act (The Senator Shelby Amendment). Prohibit rights of first refusal on scientific data for private companies performing research in non-for profit institutions which receive public funding. Any rights to profits obtained from intellectual property and patents invented with combined funding from government and private sources should be split fairly among the contributing government institutions and any other private corporations funding the research, as well as with the individual inventor. Prevent organized medicine societies, associations or colleges from contributing to political campaigns since campaign donations have no relevance for physician performance or patient morbidity or mortality.
9) The quality of current medical records software lags two decades behind business software. Therefore, we need to fund and challenge America’s best software corporations to finally develop standardized electronic medical records software for use in doctors’ offices and hospitals in order to increase the efficiency and productivity of physician charting, billing and prescribing. We should use the integrated medical records system to instantaneously and confidentially gather important epidemiologic data on physicians’ performance, patient diseases, and treatments. With new potent viruses and unsophisticated biomedical and nuclear warfare on the horizon, this system will be absolutely necessary for rapid National Security responses. Protect patient confidentiality at all costs to prevent the commercialization and abuse of patient data like that which the pharmacies trade today.
Lastly, some argue that Universal Government run health care in America will result in delays in diagnosis and treatment similar to those experienced in Britain and Canada. One can not simply compare the massive extremely functional Medicare insurance corporation based infrastructure which seamlessly delivers health care to tens of millions of people yearly in the USA to the government run westernized health care systems of Canada and Britain, France, Switzerland, Netherlands, Scandinavia, and Israel. America, for the last 40 years, thanks to the government run health insurance corporation-Medicare, has built an incredibly dense and fluid public insurance system involving almost all doctors’ offices, hospitals, clinics and ancillary services. The Medicare system dwarfs in breadth and actual practitioners and efficacy the lesser insurance systems established in all other countries. The billing and reimbursement bureaucracy for health care providers contracted with Medicare Insurance is already relatively streamlined and efficiently centralized in America thanks to 40 years of physician, hospitals and government cooperation.
We all know that the medically bankrupt private health insurance corporations and medical malpractice lawsuit threats have caused many disheartened physicians to quit practicing or downsize their practices in America. A continuation and technological upgrading of our most fair Universal Medicare based health insurance Corporation based on the concepts outlined above would undoubtedly motivate those disenfranchised physicians to return to the profession and bright younger physicians to invigorate the field. If patients, physicians and the Medicare Corporation continue to work together, without the deleterious interference of private for-profit health insurance corporations, malpractice threats and overt pharmaceutical marketing, the future for American health care will be healthy indeed.. A continuation of the status-quo mixture of a government subsidized private health maintenance insurance industry operating parallel to and within Medicare is wasteful, and will continue to provide no potential future health improvements for America.