That's a great flash video. I still have some questions, but I understand the issue a lot better.

The inevitable: Has this been done anywhere successfully?

Clinton,

Yes, in all the other industrialized democracies.

This is an interesting video, and single payer may end up being the way to deliver care; but it doesn't answer the question of how we'll shift to paying for health related services that are known to improve health, and stop paying for things that don't. We have to find ways to get people in the state/country engaged in that part of the health care debate. The Archimedes Movement is providing that forum (online and offline) where people are working through many tough choices.

....and for anyone who can't spell Archimedes you can now go to www.JoinAM.org

As a recent cum laude Political Science graduate and soon to be Health Administration graduate student @ PSU, I see some unexplained questions. I am going to leave politics aside because the health care crisis is a problem that affects everyone and partisan bickering over universal vs. private only agitates and divides.

First, the payment system? Are we talking fee-for-service, prospective payment system (PPS) or third party (HMOS)? Can Rogue Valley Medical Center (RVMC) in Medford charge $200,000 for a quadruple heart bypass where Providence only charges $100,000? In other words, can each individual hospital charge what they want in a completely privately run, single payer system? Will it be like Medicare where medical providers get a set amount of funds per treatment and any costs they accrue past the set amount they have to pay for? Or will the insurance companies be included somehow in this single payer system?

Second, where will the emphasis be? Preventative care or paying for the soon to be retiring Baby Boomers health problems? Do we want healthy schools that emphasize physical education, no "junk" machines, and healthy cafeteria meals? Or will all the focus be on making health care affordable for some 75 year-old with a broken hip at the expense of some child's school supplies?

Lastly, how do we address the top 5 leading causes of death? Heart disease, stroke, cancer, chronic lower respiratory diseases (CLRD), and unintentional injuries were the top 5 leading cause of death. (http://www.cdc.gov/nchs/data/hus/hus05.pdf). Since all of those are lifestyle related, then how do we as a society go about addressing those causes of death? I believe we should emphasize personal responsibility from a young age so that our children do not become overweight, stressed out, alcholic smokers.

I hope this helps the conversation. Any questions email me [email protected]. I will not respond to hate mail or anything remotely political. 4 years of political science down in Ashland and the sad state of affairs our country is in has me silent on partisan politics. I am looking to solve problems, not looking to divide people over important issues.

The prom financing analogy really doesn't remotely apply to the very complex health care situation.

Also leaving politics aside for the moment -- in the case of the prom, you charge everybody who attends an equal amount, that money is pooled, and it buys the food and entertainment for everybody in (more or less) equal measure.

Applied to health care, it would be like charging every person in the high school for a prom ticket, whether or not that person was actually going to attend the prom. Then, in addition to all the food and the DJ (which some people would never see, and others would only pop in to the prom for 15 minutes or so), you'd take that pooled money to pay for a few stretch limos for a small number of students who live far away and need a ride (yeah, it's a lame comparison... as I say, the prom concept really doesn't reflect health care at all).

The point about efficiency in handling the payment of expenses is well made, but the analogy is completely misleading as it does not address the drastically different benefits (with attendant unequal costs) that would actually be used by individuals.

I think medicare is a great model. We could just expand it to cover everyone. It would be so much more efficient to take the HMOs and insurance companies with their mandated profits out of the equation.

We also need to teach our children that they are responsible for their own health and start that at an early age.

We spend so much more on health care in this country, and we get so much less.

The prom analogy does work. You charge each person the same amount regardless of what they eat, drink or do at the prom.

For our health care, the prom committee (single payer), would be given X dollars per person per year, for every man, woman and child in the US (or Oregon). This provides the total pool of money ensuring cost control while finally bringing some rationality to the spending allocation process.

Does it make sense to pay for Viagra or breast cancer treatment? Would we have less diabities and save moeny if fitness programs were subsidized? Etc., Etc.

I have only been covered by major medical ($5,000 deductible) for the past 10 years which is essentially like being uninsurred unless I happen to get really sick. Therefore, all my medical bills are out of pocket and tragically, I often neglect getting minor, inexpensive medical treatment for this reason.

I would love to be a part of a single payer system that covers all people in our society. I pay about $95/month for my non-existent medical coverage.

Ah, thanks Brian for bringing up another way that the analogy does not work -- who pays how much?

The payment pool may be determined as X dollars per person, but do these plans actually work by charging each person X dollars? No... they are either paid for out of taxes or paid based on actuarial rates, and in both cases it's like charging different people different amounts (perhaps drastically different amounts) for tickets to the same prom.

Also, you may be right about the cost control thing -- though I'm not convinced -- but if so, that's yet another way in which the prom thing falls flat. If we do get cost control, how would we get it? One of two ways:

Since we only have a limited amount of money in the pool, if real health care costs rise faster than the pool rises, we'll have to cut back on the services we pay for in order to control our costs. This is how most businesses control costs with health insurance now, by reducing coverage.

Or, since the government is the only payer in town, we'll effectively dictate the price paid to health care providers for those services we wish to cover to fit the services we want within our limited budget.

In the case of the prom, the video explains that by eliminating overhead you can spend more on a better DJ, etc. But that assumes a market where there are DJs out there who charge different amounts for different quality of service, and that those more expensive DJs can work at other proms willing to pay more for higher quality. In this case, there's no other prom in town, so the DJ is stuck working your prom for whatever you're going to pay, or not working any prom at all. Of course, the DJ might work side jobs at private parties for rich kids in order to subsidize the prom gig, but if you're serious about the cost control thing there's likely a point at which the DJ decides not to work the prom at all any more, and specialize in rich kid parties (where the money is).

Anyhow, I'm not saying that single-payer is the wrong way to go. It might actually be the best solution, within the context of broader health care reform.

I'm just saying that trying to build support for the idea based on a terribly faulty, overly simplistic analogy that doesn't address some very important implications of the system is just plain misleading and wrong. I appreciate the desire to make a complex subject easier to understand. But the prom thing makes a complex subject easier to misunderstand. ;-)

David,

The prom analogy does work albeit in simplified form.

First, you are correct in noting that not everyone will pay the same price for their prom ticket even though everyone will get the same benefits (ticket to the prom). Under a single-payer system, their is no VIP room at the prom. Health care is allocated based on need, not ability to pay.

The funding to the "prom committee" to create the pool will probably come from a variety of sources. Before we talk about sources of funds, let's make sure we recognize the source of funds currently spent on health care in Oregon.

Oregon Health Plan Public Sector workers including state, federal, municipal Medicare Medicaid Employer provided insurance non-Employer provided insurance Out of pocket co-pays Out of pocket health care Subsidized non-profit care (tax breaks, charitable contributions, etc.)

These are the current sources of funds (Please help out if I've left any out).

Under a single payer system I offer the following as a base:

A tax on cigarettes, alcohol and junk food. Employment tax to ensure that that ALL employers pay and all impacted equally. Medicare funds Medicaid funds All current public sector health care funds including insurance premiums. Oregon Health Plan funds Progressive tax on individuals to make up balance

The analogy also works regarding price controls. With a huge pot of money and all the state's health care needs to be met, tradeoffs will have to be made. Most systems use a regional, publically elected board accountable to the citizens.

There will be winners and losers in the proposed system just as there are winners and losers in the current for-profit corporate health care system. Insurance companies and their current suppliers will lose. Doctors and practice groups designed to make huge sums and maxamize profits will lose. Pharmaceutical companies will lose. Winners should be citizens (no more worry about coverage, plans, out of pocket costs, etc.), business (healthcare costs, alternative coverage, plans, strategic concerns, etc.), health care professionals (billing, reimbursment, etc).

Since there would only be a single payer for health care services, there would be no DJ gigs outside the system. All of the drugs and medical devices used in the state would be bought by a single group (talk about buying power!).

DJ's, suppliers and other professionals would need to be fairly compensated but the days of greedy providers getting filthy rich on health care should be over. Gone from the system would be the six figure pharmecutical sales men, the lobbyists, the lawyers, etc. Those in the health care field interested in huge incomes like that would have to leave the state but that is up to them.