Vic Socotra

20 August 2009

Single Payer

(The Single Payer System I know and Love)

You know I have tried to avoid this as long as I could. I have kept my voice down, and tried to be as polite as possible. But the time has come.

President Obama apparently had an afternoon chat vie teleconference with religious leaders yesterday, breaking his brief silence on the subject as his team tries to figure out a means to get a Health Care Reform bill that he can sign by mid-September.

When all else fails in politics, you can always appeal to our higher instincts; in this case, Mr. Obama sought to color the debate as something on a loftier plane, larger than something with an event horizon of a single Presidency.

He compared health care reform with the great social entitlement programs that we have come to know and love, even if both are in really deep trouble: Social Security http://topics.nytimes.com/top/reference/timestopics/subjects/s/social_security_us/index.html?inline=nyt-classifier and Medicare http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/medicare/index.html?inline=nyt-classifier.

I cannot better state the argument than the way the charming man from Chicago did. “These struggles always boil down to a contest between hope and fear…That was true in the debate over Social Security, when F.D.R. was accused of being a socialist. That was true when J.F.K. and Lyndon Johnson tried to pass Medicare. And it’s true in this debate today.”

There is so much contained in those compelling words that one is tempted to puzzle over each of them.

For example, one can legitimately argue that Mr. Roosevelt was a socialist, if not something much more authoritarian; his rigid regulation of the economy also arguably made the Depression longer, and more intense; and his cap on wages laid the foundation for the intricate system of employer-provided health care on which most of us depend, and which now is so broken that we have a crisis.

The major lessons-learned from the FDR administration was that is was preferable to gulp, write a big check, and move on. Now that worst appears to be over, we are free to move on and make all the other mistakes again.

The election of the charming John Kennedy from Boston was arguably delivered, not by the popular vote, but by the Mayor of Chicago, who manipulated the ballots; his untimely death, at the hands of person-or-persons unknown in Lyndon Johnson’s home state is still a mystery.

That is before we get to the part about Social Security and Medicare, which along with Medicaid, are unsustainable in their current forms and will, if not corrected, bankrupt the government.

Since these government plans are problematic but beloved, it is clear that something needs to be done.

If we are to take the higher ground, as our President recommends, we should probably just go to a single-payer government system. Hear me out: don’t start shouting. The prototype single-payer system in Massachusetts may be in trouble right now, but virtually all the citizens of that whacky state have some sort of coverage.

If the system is dumbed down just a little, and made a little more restrictive, it might actually be sustainable.

I have a perspective on government health care, since my employer-provided health plan is eternal, and provided by the government. I have been on a “single payer” plan since 1977.

My kids were born on it, had emergency surgery by its doctors, and it manages my chronic pain. It pulled my teeth, when necessary, and provided an emergency room that was not clogged with the indigent.

As an aside, that remains problematic. Everyone insists that the undocumented are not part of any solution. Fine; that would really piss off the taxpayers, the idea that we would be paying the health care tab for those who snuck into the country illegally. But since they would still be here, they will continue to make the ER like a visit to Purgatory, or the DMV, both of which started as government programs.

Anyway, as a TriCare For Life recipient, I am basically like one of the Brits who are paraded on the media these days explaining that their National Health Service is OK.

I’m OK with mine, too. But of course, I have been pretty healthy for most of my life. For all its faults, my health care works best when I don’t use it.

Being a government program, my health care has required constant vigilance since there is always the real peril that the elected buffoons will do something stupid to us.

They try all the time; this Administration is just the latest in a long line that floated a trial balloon about making combat-disabled vets use private plans to take care of routine care. They had to back off that initiative when the collective roar of outrage hit their in-baskets.

The President is just trying to get it straight. “You’ve heard that there’s a government takeover of health care. That’s not true,” he said yesterday. Then he went on to call one of the most startling assertions flying around about “death panels“ for the elderly “an extraordinary lie.”

Well, death panel, no. Something called “end of life counseling” was certainly one of the provisions of one of the bills, and it is actually sort of reasonable. My understanding is that regardless of who is running health care, the profiteers at Blue Cross, or some bureaucrat at the VA, we still have a 100% opportunity to die.

The only way to limit costs is to limit care; in the DoD/VA system it works the same way it does in nation’s with single-payer systems. A panel determines what courses of treatment will be provided, and that is the end of the matter.

For all the prim denials, this is how it really works in a popular system in Britain:

“The NHS Bowel Cancer Screening Programme offers screening every two years to all men and women aged 60 to 69. People over 70 can request a screening kit by calling a free phone helpline when the programme reaches their area.”

No testing until you’re 60 and no colonoscopies -- just blood in the stool monitoring for a condition that when it reaches this bloody-crap stage has a less than happy prognosis for a cure when compared to US practices. Brits can only access colonoscopy testing when blood is detected in the stool.

“Around 2 in 100 people will receive an abnormal result. They will be referred for further investigation and usuallyoffered a colonoscopy.” The emphasis is mine.

You can get a forecast of the system if you skim the executive summary at
http://www.cancerscreening.nhs.uk/bowel/scharr.pdf

Try not to let your head explode when you read Orwellian phrases- it is really OK and it is the only way we can take the high-ground and provide the care to those who are too helpless (or stupid) to take care of themselves.

I particularly like the term “QALY,” which is the amount society is willing to pay to save
one Quality Adjusted Life Year.

That isn’t a “death panel.” The President is quite correct. That would be foolish. It is just a panel of government experts that will tell you whether or not you can live.

Don’t fear the future, and don’t fear change. I have government health care and it is just fine. I don’t recommend getting sick, though.

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