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Letter: Single payer system should be on the table

Single payer (Medicare for All, HR 676) is favored by 59 percent of physicians and 62 percent of Americans, according to the Physicians for National Health Program. Single payer would be far simpler, cover everybody and be much cheaper than the current mess involving hundreds of private insurance companies. Congressman Conyers’ Web site says an average family of four with an employer-provided health plan now spends about $4,225 on health care annually. The employer pays about $8,510 as their share, or 8.5 percent of payroll, for a total of about $12,735.

Under single payer, a family of four with the median income of $56,200 would pay about $2,700 through payroll taxes; the employer would pay a 4.75 percent payroll tax or about $2,700, for a total of about $5,400. All Americans would be insured by the federal government: no more deductibles, co-pays, insurance premiums, worry about pre-existing conditions, catastrophic illness, or losing coverage because of job changes. All necessary medical procedures, including dental, eye care, drugs, mental health and long term care would be covered. Ninety-five percent of families would pay less for health care.

By eliminating private insurers, huge savings would result. In the first year, single payer would save $150 billion in administrative costs and $50 billion through competitive drug purchases. Yet single payer may not happen. Why? Because Sen. Max Baucus will not give single payer a hearing. He continues to push the private insurance approach, possibly due to over $1 million in “contributions” he received from insurance and pharmaceutical companies. Want to guess who Baucus really works for?

Thank you very much. May you have a happy and prosperous New Year.

Auzie Blevins, Billings


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Brian wrote on Jan 6, 2009 9:38 AM:

" This sounds great, can I opt out and take care of my medical needs on my own or do you suggest we should all be forced to pay for this program? "

Jeff wrote on Jan 6, 2009 6:16 PM:

" I will leave medicine if we nationalize healthcare. The current government programs, VA, Medicaid, Medicare, are shining examples of how the government makes medicine more inefficient. Why do we expect giving them everyone's healthcare will be better?

Jeffrey K. Lindley, MD "

David wrote on Jan 6, 2009 9:55 PM:

" Jeff must be a specialist, making 2-3 times what a generalist makes. This country needs more generalists and fewer specialists. I say, increase the incomes of generalists and lower those of specialists, and this will be done through a single-payer system. The so-called system we now have is bankrupt, just a profit-driven enterprise that puts money ahead of patients. Adios, Jeff. "

Vrede wrote on Jan 7, 2009 6:59 AM:

" Huh? In the government programs, around 5-7% of the money goes to overhead whereas private insurers reap 25-30% for overhead and profit. I suspect Dr. Lindley's definition of "inefficient" is less money in his pocket. "

Erick Prather wrote on Jan 7, 2009 10:43 AM:

" Does any W-2 employee have the option to opt out from paying Unemployment Insurance or payroll taxes, no. But I would be willing to bet one would file unemployment if needed and my guess is they wouldn't complain. How is this any different than health care? I know quite a few people who have been laid off, can't afford COBRA and can't afford an $1100 a month health insurance premium for their family. I too know many who gamble and go without health care simply because they can't work a 3rd job to pay the premiums.
The Dr. is assuming that a single payer system would be a mirror image of our current entittlements. Dr, what if it is not? What if this system actually worked? What if this system gave great health care and HOPE to all citizens of this great nation? What if another U.S. citizen didn't have to suffer at home because he or she was able to receive great medical care from a great Physician like yourself, nevermind, that's right, you are going to quit. Thanks for quitting on us Dr Lindley, I'm sure that's what was taught to you in medical school! I hope for the health of this country that not all doctors have the naïve outlook that you posses.

p.s. Vrede, for once you and I agree on something. "

Brian wrote on Jan 7, 2009 12:18 PM:

" Trust me, I would opt out of unemployment if I could, that system is abused and corrupt just as I suspect socialized medicine would be one day too. I tried for years to opt out of employer paid health insurance, I certainly could have spent the money more wisely given the chance. Now that I can, I have gone to a health savings plan with a much lower insurance premium. Why should I pay the same premium for health insurance as someone who is diabetic or has cancer? I shouldn't. That would be like a safe driver paying the same premiums as someone who is a high risk driver.
Do any of you who disagree with Dr. Lindley think he should be forced to practice medicine in a manner he doesn't want to? Really? I don't care what kind of doctor he is, I certainly don't advocate forcing a career on anyone.
Entitlement programs are not the answer. "

Jeff wrote on Jan 7, 2009 12:42 PM:

" Actually, I am a generalist. My salary has decreased 4% each year since I started nearly 10 years ago. This has been driven by the declining reimbursement by Medicare, and insurance companies following suit. The current Medicare payment for a $100 doctor bill is about $40. Those that have insurance are subsidising those that don't. The cash paying patient (without insurance) is responsible for the $100, but the person with Medicare or Medicaid isn't required to pay the rest of the bill. Some docs quit seeing Medicare patients, to keep their business solvent. I continue to see Medicare patients. I agree that insurance companies take more money and provide less coverage, but the answer isn't to nationalize care. Removing the extra costs of medical care will help. Stopping the overuse of emergency rooms for non-emergent care, filing your own insurance claim instead of paying my staff to do it, using electronic medical records, and medical lawsuit reform are just some examples of how to reduce the costs of medical care. Giving up the system to the government has led to the rationing of care in countries that have tried it. This won't maintain the quality of care that currently exists. I'm afraid most doctors ARE against the knee-jerk reaction to have the government "Save Us." I can't speak for all physicians, but believe most docs are very hopeful that through private markets, these problems can be solved. "

Erick Prather wrote on Jan 7, 2009 1:06 PM:

" Brian, I think you'll agree with me that this is awful! If you or your employer offers health insurance I believe you should keep it, you know whats best for you. For folks that can't afford it or aren't offered it thru their employer should be given an opportunity to purchase on a sliding scale upto and including no cost. I don't want big brother dictating how many pills I take and when. I want big brother to step forward and help those who are worthy and could benefit and prosper from health insurance they ultimately can not afford. "

Erick Prather wrote on Jan 7, 2009 5:48 PM:

" Brian, I couldn't agree with you more on the abuse of entitlements and trust me I'd rather keep more of my paycheck as well. However, many folks will never be able to afford health care, never! I don't see any other way around helping those that can't afford it. Many have assets and jobs that keep then from qualifying for assistance and therefore go without or when in a time of need are unable to satisfy their invoice and eventually get sent to collections, litigation or worse, file for bankruptcy. I've quickly researched bankruptcies in '07. Over 1 million BK's filed, more than 95% were personal. Out of the 95% it's estimated that upwards of 65% were medical related. Brian, I think you'll agree with me that this is awful! If you or your employer offers health insurance I believe you should keep it, you know whats best for you. For folks that can't afford it or aren't offered it thru their employer should be given an opportunity to purchase on a sliding scale upto and including no cost. I don't want big brother dictating how many pills I take and when. I want big brother to step forward and help those who are worthy and could benefit and prosper from health insurance they ultimately can not afford. "

Erick Prather wrote on Jan 7, 2009 6:06 PM:

" Jeff- How do you propose this be fixed? How do we get everyone insured? I have been on both sides of the table and I can tell you that neither side has a good feeling. Up until late, I had a $1087 per month Blue Cross Blue Shield payment. There are some folks that don't make that in a month. I too have been faced with paying $60,000 in medical bills. I'm grateful for the efforts that were put forth to help my wife, but without insurance I was forced to negotiate and obtain a line of credit. Sure, I consulted my attorney. He recommended the following- 1- divorce my wife and let her take the hit. 2- file for medical bankruptcy. 3- negotiate and pay the bills. Let me tell you Jeff, it's not a great feeling. On the other had, I definitely understand your concerns and it sounds like a Medicare patient may even cost you money, which is sad that the Medicare program puts you in that situation. Our health care system must be repaired. I'm sure toes are going to have to be stepped on and friendships maybe lost, but this has got to be fixed. "

Jeff wrote on Jan 8, 2009 7:19 AM:

" Erick- Your idealism is admirable and shared. I wonder how long you have been paying taxes, and how you've maintained your idealism as you throw so much money down the drain. I direct you to the following website that takes a more in-depth look at the upcoming confirmation of former Senator Daschle as HHS secretary. It addresses the inequities that make this debate so emotional. Yes we want people to be safe, but why should the hard-working taxpayers always carry the load? As a primary care doctor, I feel personal responsibility is part of one's health and well-being. Self-sufficiency is the key to not being left behind. We need to improve access by driving down costs, not by creating another agency.

http://www.heritage.org/Research/HealthCare/wm2192.cfm "

Vrede RN wrote on Jan 8, 2009 9:07 AM:

" Jeffrey K. Lindley,

If you want your case to be taken seriously, you'll have to come up with a less biased, more credible source than the Heritage Foundation. Should we also look to Rush Limbaugh for scientific information on substance abuse?

Personal responsibility and self-sufficiency are fine things. Please let us know when communicable diseases start checking with potential hosts to see if they are practitioners of these attributes or not. Until then, healthy individuals make for a healthier society, however it is achieved. "

J. Lund wrote on Jan 8, 2009 5:35 PM:

" Where in the constitution does it say government even has the right to take over the medical industry or any other industry for that matter? "

Erick Prather wrote on Jan 8, 2009 6:32 PM:

" Jeff- I've been a taxpayer for 19 years, a small business owner for almost 10 of those years. To answer your question, I have a great accountant and I've been extremely lucky, haha just kidding. We (tax payers) are already paying for a broken Medicare, Medicaid, Medi-cal (hope the Medi-cal didn't give away my state of origin). I'm not suggesting the addition of another agency. I'm suggesting the "re-tooling" of available health care entitlements. Trust me, drives me nuts to see lazy people milking the system. However, there are some folks that could truly use the help. You know as well as I do, costs for everything have risen, yet our salaries haven't. I believe a lot of our health care costs have risen because of the uninsured who are unable to settle their debt with the health care community, therefore, costs are passed down to the insured. In the interim, you take the hit with 60% discounts on your Medicare invoices. Somethings' got to happen. I'd rather pay less for my health insurance and I'm sure you'd rather have your invoices paid in full. "

Jeff wrote on Jan 8, 2009 8:06 PM:

" Since you seem to be an expert on this, Vrede, please direct me to a more scientific reference.

The point is, we all want to have healthy neighbors. But we are not all paying for it. Everyone in this country has the opportunity to improve their lot. The government shouldn't be a means to just provide everything. It should be there to protect and provide the OPPORTUNITY to improve yourself. The letter to editor implied most docs favor a national health care system. The statistics quoted are from a lobbyist group for national health care. My source is biased? The face of medicine will change if it is run by the government. We are a stronger, more entrepreneurial, more innovative, more inventive society than that. Get the panic-mongers out of the way and use American innovation to improve health care and health care access. Don't just give it up and become another half-baked entitlement program.

If half of the presidential campaign funds were put into buying insurance for the uninsured, we would nearly have every child covered. Why not raffle off tickets to the inauguration and put the proceeds toward CHIP? or AIDS? or cancer research?

I already work in a system where paperwork is magnified by insurance companies trying to ration care. Who would stop the government from rationing needed surgery or medications, or prevention services? "

Vrede RN wrote on Jan 9, 2009 4:09 AM:

" J. Lund,

"We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, PROMOTE THE GENERAL WELFARE, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America."

Hence fire fighting, police, schools, road building, etc. "

Vrede RN wrote on Jan 9, 2009 8:57 AM:

" Jeffrey K. Lindley: "I already work in a system where paperwork is magnified by insurance companies trying to ration care. Who would stop the government from rationing needed surgery or medications, or prevention services?"

Well, democracy would have the opportunity to, something not available with our insurance company run system. BTW, it already is horribly rationed for the 50 million uninsured Americans.

I agree that election spending is obscene. It's a shame that the GOP, with the exception of McCain, has been such an impediment to radical campaign finance reform. "

Pablomontoya wrote on Jan 9, 2009 10:08 AM:

" Anybody who thinks single-payer would not be successful and popular should try and convince a senior to give up their Medicare.

Dr. Lindley sounds convincing, but if he was relieved of the hassle of multiple payers and the burden that causes, he would have more time for patient care. All the technical solutions he proposes would be easier to administer with a single payer.

Don't give up, Dr. Lindley. "

J. Lund wrote on Jan 9, 2009 5:42 PM:

" Vrede RN-
Oh yes, of course. The general welfare clause. Commonly used by every politician to fund their pet project at the expense of the rest of us in order to mine votes. Article 1 section 8 of the constitution specifically enumerates powers delegated to congress, I cannot find the clause, “take over any industry at will because we egalitarian, public minded folk simply know better how to plan it than you selfish entrepreneurs.” If the founders would have known how this clause would later be exploited I’m certain it would have been omitted. I also know that competition always and in every case breeds a better product at a cheaper price and the system you advocate destroy that. I would also argue that your examples of police, road building, firefighting, etc. could all be provided on the private market thru mutually beneficial, voluntary exchange at a far cheaper cost and a much higher quality product. I find your lack of economic imagination vapid. "

Vrede RN wrote on Jan 10, 2009 10:51 AM:

" J. Lund,

On the other hand, I find your fantastic "economic imagination" of a libertarian nirvana where all essential government services are privatized to be extraordinary. I, too, can wish for the libertarian goals of drug and prostitution legalization, a non-interventionist foreign policy, and unfettered abortion.

However, while it makes for engaging bar conversation, I also live and work in the real world of overflowing ERs, the expansion of treatable, eradicable diseases, 25-30% of our health care dollars going instead into insurance company pockets, declining longevity, lousy U.S. infant survival, and 50 million uninsured Americans left out of the process. The only "competition" in our system is for those lucky few that can travel to other, often socialized, countries for their delayable or elective procedures.

My interest is in implementing the fixes that can possibly be achieved now, rather than a dogmatic desire for what will never be. Of course, I wouldn't expect someone that claims the ability to read the minds of the Constitution's authors to understand something so unimaginatively realistic. "

Tom wrote on Jan 10, 2009 3:03 PM:

" Jeff-
Hang in there Doc! take every comment from Vrede with a grain of salt. Vrede knows all and sees all...your time will be better spent talking with a brick than Vrede..( the brick is more flexible and human) "

James L. wrote on Jan 10, 2009 3:25 PM:

" Vede RN-
The “fixes” you advocate would only amplify the problems you just sited. It is precisely because of government meddling that the troubles in the health care industry are exacerbated. We need only look at the fully socialized VA. The cost per patient is far above that of the private sector and the quality is shameful.
Also I do not pretend to read them minds of the framers of the constitution. There was a tremendous amount of debate leading up to the ratification of the constitution on the very issue of the “general welfare” clause and how it could be interpreted for an all-encompassing grant of power in the future. It turns out the anti-federalists were correct in opposing it since we are having this argument today.
It should also be noted that you are correct, the libertarian position on personal issues like the use of drugs, sexual habits and abortion is one of liberty, that is, they should be free of government interference. So why shouldn’t economic liberty be included into the debate? My property rights should not be infringed upon to finance a system that proclaims to be the most “equitable.” Equal in what way I might ask. The healthy should pay for the sick? The responsible for the negligent? Please, if anybody’s position is dogmatic, it surly is yours. "

trythis wrote on Jan 11, 2009 2:27 PM:

" insurance companies take the money you give them and don't put it in a box, it goes to wall st, buying up stocks, bonds, etc. So there is a GREAT insentive by lots of people, politicians include to get everyone insurance even if it has to be bought with tax payer's money and to cover 'The Children', It's not about your health, it's about trillions of dollars of insurance premiums getting funneled to wall st.
Second, is it your employer's duty to buy you car insurance, then why heatlh insurance. Plus you'd have to search for car insurance everytime you change jobs....Insurance companies know that you would never pay those outragous premiums if let to your own devices, so have the employer do it for you, out of you salary though. The employer will pay more because it's not his money, it's just coming out of your salary.
If someone else is paying less because they are in a group plan, that difference has to be made up by the single payers.
Make it illegal for employers to supply health insurance, give that money to the employee, he can buy his own, and take it with him when he leaves the job. Once an indivudual has to pay for it himself, they'll find better things to do with his money - then watch the price come down to get him to buy the insurance. "

depot wrote on Jan 11, 2009 7:18 PM:

" I've been following the universal health care debate for a very long time. I think it is high time we got honest and stop sugar coating the message. People who can't afford health insurance and have few assets to pay for treatment have a moral obligation to die. Let's stop pretending the less fortunate among us are in anyway worthy of our concern. If they were better people, they would improve their own lot in life. We all know only the profligate and reprobate get sick. The rest of us will never face a medical emergency beyond our control. So, if you don't have health insurance or lots of money, cancel those yearly screenings because if they find something you won't be able to pay for a cure. That should free up some time for Dr. Jeff to do his paperwork. "

David wrote on Jan 12, 2009 10:20 PM:

" All Americans should have access to the provisions of Medicare and whatever care the VA provides for veterans and whatever care is provided for employees of the Federal government, which includes members of the White House and the Congress.

Health insurance cannot be a province of the private sector. Insuring against disease, etc., cannot result in people making a profit on other peoples' misfortunes, due to no fault of their own. This is a misunderstood economic issue, because most bankruptcies are due to medical expenses.

Private sector insurance has other fields to plow & cultivate. Unlike claims to the contrary, America will not become a socialistic contry any more than it is now if it universalizes health care.

Unlike Jeff, I imagine most doctors will be glad to get the paperwork & resulting expense off their backs so they can have more time to practice medicine. "

J. Lund wrote on Jan 13, 2009 5:07 PM:

" Well if David’s argument that misfortunate events need to be under the control of government intervention, then the misfortune of hunger too should be “universalized.” All food production in this country should be taken over by the government. Also, given the argument, clothing and housing should be under the control of government. Every essential service should be under the domain of one producer, namely, our egalitarian, public minded rulers. If that’s not socialism David, we are looking at two definitions of the word. "

David wrote on Jan 13, 2009 7:45 PM:

" Well, J. Lund, I was talking about health insurance, not about food, clothing, housing, etc. Speaking of food, we already have government-run food stamp programs and assistance to food banks. And, of housing, we have the Dept. of Housing & Urban Development. Maybe this should be enough for you to leave this "socialized" country.

As to two definitions, I agree with you. You, I believe, identify "socialism" with the Russian brand, Communism. Big difference between that & how I define socialism as American government assisting the less "lucky." See the Preamble to the U.S. Constitution, a mission statement for this country: ...."promote the general Welfare...." Does that make the Constitution a socialist document?

I'm addressing the health care issue from the standpoint that there's plenty of other fields for the insurance co.'s & health care should not be one of them.
There's a great deal of room in this country for private enterprise, altho it's looking like the private sector has let this country down, big time. "

J. Lund wrote on Jan 14, 2009 8:54 AM:

" Of course, if you disagree, you should leave.

The preamble to the constitution is merely, as you well know, is a statement of intent, it does not and should not set policy. Article 1 section 8 clearly defines the role of the congress there in, and there is no mention of government providing for the misfortunes or “misluck” of anybody.

As to the definition of socialism, I make no distinction between whatever state spin is put onto it. When means of production are no longer in private hands but instead owned by the public as a whole, that is socialism regardless of what government implements it.

If you honestly think the private sector is somehow failing the country then perhaps you should take a look around. Every bit of wealth, the fact that our standard of living is better than every pharaoh and emperor that ever lived, is due to free people acting to better their position through the free market. Government only gets in the way and furthermore the programs you site only distort that free market.

Why cannot people see the benefits gained from liberty? "

David wrote on Jan 14, 2009 11:49 AM:

" J. Lund: Making affordable, competent health care to all is as essential to this country as national defense. Health care is separated from issues of the economy, but it really affects the economy.

All I'm saying is, national health care, whatever label you want to put on it, is essential for providing some kind of financial stability for people, regardless of whether they can pay, their employers can pay, etc.

Yes, all will pay through their taxes, but those taxes will be less than the costs of what people now pay with private health insurance.

You are fearful of a "slippery slope." No way. This is America, after all, not the Soviet Union. As I've said before, there are plenty of fields for private enterprise. Health insurance is not one of them. "

J. Lund wrote on Jan 14, 2009 6:36 PM:

" Sorry David but the economy is all encompassing. Everything in some way affects it, these includes factors of production, distribution, division of labor, consumer habits, taxes, regulations and so on. It is impossible to separate healthcare from the economy as a whole.
To your second point that we could the secure financial security of the people through socialized medicine is laughable. Redistributing wealth makes everyone poorer. Plus, if you think for a second that getting something for free insures financial stability you need only look at empirical evidence to the contrary. i.e. the welfare state.
There is no way taxes would be less than the current system. How would you expect this massive program to be paid for? There is always a ratchet effect when it comes to government taxes and spending.
You are right in that this is the US not the former Soviet Union. However, the major difference is geographical. They too ignorantly believed the notion of economic equality. They too had an oppressive government who would stop at nothing to impose their will on the people. We too, if we don’t change course in the near future, will suffer the disintegration of our union. "

David wrote on Jan 15, 2009 11:47 AM:

" J. Lund: You're an idealogue; I suppose I am too. Let's just leave it at that. "

ERICK PRATHER wrote on Jan 16, 2009 8:37 PM:

" Jeff- What is your take on the "AMA,voice for the uninsured" proposal? Do you believe if heath insurance company's were considered not-for-profit we could see lower premiums? Do you believe that patients who enroll in a wellness program and improve the state of their health receive a reduced premium? I sympathize with you on the paperwork end of the business. I recently went to the Dr. I received a preliminary invoice with the charges, an explanation of benefits from my insurance company, an revised invoice from Community and then a separate invoice from a medical billing service! I definitely support minimizing paperwork. "

ERICK PRATHER wrote on Jan 16, 2009 8:56 PM:

" Jeff- I agree wholeheartedly on the campaign contributions. It truly makes me ill to see the amount of money ALL of the candidates raised and blew on commercials that attack each other, what a waste! Campaign reform should be reformed again. I'm sure there are plenty of other charitable avenues to dispense this money. "

trythis wrote on Jan 17, 2009 2:40 PM:

" I told you clowns - prevent employers from buying insurance with employee money, give that portion of their salary back to do with as they please....This will go a loooooooooooooooooooong way in improving insurance costs.

Second, its a free country, that doesn't mean free insurance. For anyone that is sympathetic to the needs of other's health just start forking over your money to them, the state can even set up a state fund, and you can donate to it, or have it deducted from you salary or auto-pay every month from your bank account....And for all the others that don't beleive in giving away money to other people for whatever reason, well they don't...Problem solved.
You are making this much more difficult than it is. But I understand the more confusing we make the problem the more money there is to be made.
Perhaps you all could get together and write a book about how 1000 generations preceeding this one managed to live their lives and be happy without health insurance.
This whole issue has nothing to do with peoples health, it's all about money, who gets it and how much, politicians love this kind of stuff, it gives them an excuse to rub elbows with the real wealth in the insurance industry, hoping some will rub off on them. "


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