Those words, applied to health care and uttered in America, are generally enough to set off a rousing discussion.
For some, a government-run insurance program is the fairest way to provide health coverage to all. For others, it smacks of too much government intervention in the private marketplace.
Baucus spoke the words first, noting that he doesn't think a single-payer - read government - system is right for America.
“I do want universal coverage,” Baucus said, but added that coverage should result from a public-private partnership.
Then, after a panel offered some perspective on the health care problem, Pat Williams, the former Montana congressman, stood up.
He reminded Baucus and the panel that countries of the world that have adopted single-payer systems were sometimes copycats.
“Seniors already have a single-payer system,” Williams said. “It's called Medicare.”
Then he mentioned health care for veterans.
“That's where a lot of the world got their ideas for single-payer packages,” Williams said to loud applause.
Williams said he doesn't hold out much hope that Congress would actually pass a single-payer system, but he said the idea should be left on the table as a way to “inform the debate.”
Baucus said he plans to make health care reform a central part of the 2009 session, and said coming to Montana gives him a better sense of what health care problems mean for ordinary people.
He both delivered and received an earful, almost none of it good.
Baucus, along with Dr. Sara Collins of the Commonwealth Foundation, delivered a host of troubling statistics.
American health care costs increase at least 7 percent per year. From 2000 to 2007, rising health care costs outstripped wages by 5.5 times.
Two-thirds of Americans put off necessary health care because of expense.
More than 46 million Americans are uninsured and another 25 million are underinsured.
Americans spend $2 trillion a year for health care, more than $7,000 a person. For what? To rank No. 19 in a list of 19 industrial nations for the number of preventable deaths.
In Montana, 53 percent of the 160,000 uninsured are working for small businesses that can't afford to buy insurance for their workers.
Said Williams: “Our state is almost dragging bottom when it comes to appropriate health care.”
“The system is in need of reform,” Baucus said.
The problem, of course, is how. Baucus heard some frank and interesting assessments of what's wrong.
Jeff Fee, president and chief executive of St. Pat's, put one part of the problem bluntly.
As a hospital executive, seeing all the beds full of patients is a good thing, he said, at least for the hospital's bottom line. On the other hand, it likely means the community isn't doing a very good job of taking care of itself.
“We're competing for sick patients and not working on keeping people well,” Fee said.
That was a theme Tuesday, with a general consensus that Americans consume too much specialized health care while bypassing basic preventive care.
The focus on specialized medicine as part of the problem is, in part, a result of how doctors are compensated for services. And that compensation model is pushing doctors out of primary, family practice and into specialities.
“We're just not paying these guys enough to practice medicine,” Dr. Tom Roberts, who heads the Western Montana Clinic, said of primary-care doctors.
And the problem there isn't so much the pay of doctors, Roberts said.
“That's about the health of the country,” he said.
Dr. Fred Olson, chief medical officer of Blue Cross Blue Shield in Montana, said too much health care in Montana is redundant. Olson said doctors often schedule medical procedures just to cover themselves should they be sued.
Asked by Baucus about the high administrative costs of insurance companies, Olson agreed that they're too high. Olson said he understands why Americans are frustrated by their insurance companies.
In fact, as a consumer paying $14,000 for his own family's insurance, he shares some of that frustration.
“I see why people are angry,” he said. “If Americans want a single-payer system, so be it.”
Although Baucus heard from plenty of people inside the health care system, he also heard from consumers. Leif Bjelland, owner of Le Petit Outre, and Julie Foster, a Missoula cosmetologist, put very human faces on the affordability crisis.
Bjelland provides a health care program to his bakery employees, but said it's getting hard to maintain as premiums keep rising. If the price of a baguette rose like the price of health care, bread would be $5.
“I don't think any of you would want it then,” Bjelland said. “I definitely feel that reform is necessary.”
Foster spoke with the authority of someone who was forced into bankruptcy by her daughter's bout with spinal meningitis. Even now, she works full time but can't afford insurance.
“I would just be devastated by a major medical issue,” she said.
Reporter Michael Moore can be reached at 523-5252 or at mmoore@missoulian.com.
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