What Did The President Say?
I've watched President Obama's speech made to a joint session of Congress on September 9th several times. Each time I watch it I find fresh objections. President Obama is a charismatic speaker, both intelligent and articulate. He did an especially good job of dispelling the worst misrepresentations of his proposed health care reforms being made by the Republican right. He also did an excellent job of reinforcing the misrepresentations being made by Democratic centrists. The president and other centrists are counting on the support of liberals who continue to misunderstand what the proposed reforms do and do not achieve.
The "Universal Health Care" Lie
At one point in the speech he told us, "A bill for comprehensive health reform was first introduced by John Dingell Sr. in 1943. Sixty-five years later, his son continues to introduce that same bill at the beginning of each session."
What he didn't tell us was that the bill introduced in 1943 by the John D. Dingell, Sr. the earliest version of the United States National Health Insurance Act .
John D. Dingell, Jr. reintroduced H.R. 15, the United States National Health Insurance Act of 2009 earlier this year. But, while his father's dream of single-payer, publicly-financed, privately-delivered universal health care languishes in committee, Dingell is lending the family name to H.R. 3200, a compulsory purchase of private health insurance plan that was moved out of the same committee to the floor of the house.
Meanwhile a better version of his father's dream, H.R. 676, a bill to provide for comprehensive health insurance coverage for all United States residents, is getting no press coverage and the progressive and liberal elements of the Democratic party are blissfully unaware that it even exists.
The "You Pay For Uninsured People" Lie
The support for single-payer, publicly-financed, privately-delivered universal health care was apparent with the president said, "Now, there are those on the left who believe that the only way to fix the system is through a single-payer system like Canada's, where we would -- ," and small, but significant faction of the Democrats entered into spontaneous and unwelcome applause.
The president quickly moved on, dismissing the support for such a program as, "a radical shift that would disrupt the health care most people currently have."
President Obama told us that people who can afford health insurance but fail to purchase it are "irresponsible" and their unpaid "expensive emergency room visits" represented a hidden tax on those who purchased health insurance of about $1,000 each. But is that true?
About $60 billion of medical bills go unpaid each year. There is no way of knowing how many of these unpaid bills are attributable to the expensive emergency room visits made by uninsured people. Personal experience in the medical sector tells me that many of the unpaid bills are non-emergencies and are attributable to insured people. Remember, 65% of the people who go bankrupt because they can't afford medical bill are fully insured.
The Truth Is That Government is Underpaying and Private Payers Are Being Overbilled
There might be another reason that the unpaid medical bills of uninsured customers are so high. Insurance companies negotiate for rates that are about half of what uninsured patients are typically charged. A Complete Blood Count (CBC) might be billed at $36, the insurance company may have a negotiated rate of $18, Medicare may pay less than $12 and Medicaid is unlikely to pay more than $6.
Medicaid pays about $333 billion in claims and there are probably more than $1.5 trillion dollars that are billed to Medicaid but are unpaid. Medicare pays over a $1 trillion in claims and there are probably about $2 billion that are billed to Medicare but are unpaid. If even half of the uninsured patients pay their bills, clinics and hospitals are getting at least as much from them as they would get from insured patients and far more than they would get if they were billing to Medicare or Medicaid.
This explains why the medical industry is not interested in expanding Medicare or Medicaid and why they want to compel us to purchase private insurance instead. Still, they are going to miss the huge write offs they get by over billing people who are less likely to pay. Using the example of the CBC, a $36 write off only costs the clinic or hospital about $4.
If you have to tell a lie to tell the truth, it isn't the truth. And the truth is that Medicare and Medicaid patients are not profitable for private insurance companies either because they are older and tend to have big health care bills or because they are too poor to pay premiums.
It's All About Profitability
Most of the 37 million Americans who are uninsured are also unprofitable for private insurance companies but could be profitable if the government subsidized their premiums with tax dollars AND compelled the healthy young people to purchase insurance policies.
This isn't about universal health care, it is about tax subsidized profitability for the health care and health insurance sectors at the expense of individual liberty. If there was any way that our elected officials could continue to ignore the impact of overpriced medical care couples with the shameful business practices of insurance companies, they would. But since they can't, this is the next best way to keep the big corporate friends of big government happy.
Watch the complete broadcast of President Barack Obama's address to Congress.
Why We Need Government-Run Universal Socialized Health Insurance
I call it single-payer, publicly-financed, privately-delivered universal health care. One of the biggest problems is that the bill under consideration, H.R. 3200 America's Affordable Health Choices Act of 2009, doesn't provide that. Many of the arguments against H.R. 3200 are strawman arguments. It is argued that in Canada [fill in the blank], but in Canada they have single-payer, publicly-financed, privately-delivered universal health care and that isn't what H.R. 3200 provides. Then it is argued that social medicine [fill in the blank], but H.R. 3200 doesn't propose a government owned system of clinics and hospitals, the hallmark of socialized medicine. Then it is argued that the government will interfere with your choice of clinics and hospital and your treatment option, but under H.R. 3200 private insurance companies will be doing that, just as they do now.
If you agree that we need single-payer, publicly-financed, privately-delivered universal health care then you should understand that H.R. 3200 is not the bill we need, what we need is H.R. 676 the United States National Health Insurance Act of 2007. We already have socialized education, fire protection, police protection, road maintenance, water, sanitation, postal services and health care insurance for the poor and aged. Why not socialize health insurance for the middle-aged, working class, middle and upper class? The answer is ugly, it is because insurance companies are making a lot of money off those best able to pay while taxpayers take care of those lease likely to be able to buy insurance or most likely to be unprofitable for insurance companies.
The private health care system likes this arrangement too. They have always lost money caring for the poor, but some money is better than none money and Medicaid is just that. Without Medicare, the aged wouldn't be able to get insurance because they are too big a risk. And private pay (insurance and out-of-pocket) is the most profitable segment of health care.
So, why do we need a government-run universal socialized health insurance program? Enjoy this video written and animated by Andy Lubershane, I think it does a good job of answering the question.
Who Will Be the Most Famous American of All Time?
A nationally televised contest organized by the Canadian Broadcasting Corporation in 2004 voted a Scottish-born Baptist minister turned prominent Canadian social democrat, Tommy Douglas (20 October 1904 – 24 February 1986), "The Greatest Canadian" of all time.
He might have been remembered as a leader of the 
Saskatchewan Co-operative Commonwealth Federation (CCF) from 1942 and the seventh Premier of Saskatchewan from 1944 to 1961, but I don't think so. It is more likely that he was remembered as the person who introduced single-payer, publicly-financed, privately-delivered universal health care to Canada.
Who will be remember as the person who introduced single-payer, publicly-financed, privately-delivered universal health care to the United States? It might have been John Conyers or Dennis Kucinich with H.R. 676 the United States National Health Insurance Act (or the Expanded and Improved Medicare for All Act) of 2007, but it won't be Nancy Pelosi, George Miller or Charles Rangle with H.R. 3200 America's "so-called" Affordable Health Choices Act of 2009. And, it won't be Barrack Obama who will be best remembered for leading the effort that compelled millions of Americans who could not afford to buy Health Insurance from PRIVATE insurance companies to buy it anyway.
Who will be the most famous American of all time?
Democracy NOW! - Actor Kiefer Sutherland’s Grandfather Tommy Douglas Remembered for Bringing Universal Healthcare System to Canada
As premier of Saskatchewan, Tommy Douglas pioneered a number of progressive policies there, including the expansion of public utilities, unionization and public auto insurance. But his biggest achievement was the creation of universal health insurance, called Medicare. It passed in Saskatchewan in 1962, guaranteeing hospital care for all residents. The rest of Canada soon followed, province by province. After his death, Douglas earned the title of “The Greatest Canadian” in a poll by the CBC. We speak with Canadian doctor Michael Rachlis.
Single-Payer Sell-Outs!
On July 27, 2009, the House Committee on Education and Labor, the Ways and Means committee, and the Energy and Commerce Committee, passed H.R. 3200, “America’s Affordable Health Choices Act of 2009”. House Committee on Education and Labor chairman, George Miller, announced the event calling H.R. 3200 “universal health care”. House Ways and Means chairman, Charles Rangle, made his announcement calling it “national health insurance.”
In 2007, representatives George Miller and Charles Rangle cosponsored 
H.R. 676, the United States National Health Insurance Act (or the Expanded and Improved Medicare for All Act) of 2007, a bill to provide for comprehensive health insurance coverage for all United States residents.
Have these distinguished representatives and committee chairs forgotten the definitions of universal health care and national health care? Did they wake up one morning and decide that they no longer supported single-payer health care? The bills that came out of their committees are not universal health care, they are not national health insurance and they are not single-payer health care!
Will Single-Payer Be a State-By-State Battle?
Days before the passage of H.R. 3200, representative and committee member, 
Dennis Kucinich, previously a cosponsor of H.R. 676, the United States National Health Insurance Act of 2007, said of H.R. 3200, “The bill we are considering today, I regret to say, is not a single payer bill. It further entrenches the existing for-profit, insurance-based system by handing even more money over to the insurance industry.”
CBC News Video. Remote Area Medical (RAM) helps people
in Knoxville, Tennessee who could not afford health care.
How is it possible that so many Americans are so desperate for health care?
HR 3200: America's UNAffordable Health Choices Act of 2009
By Zarathustra
HR 3200, America's Affordable Health Choices Act of 2009 is so mischaracterized by both conservatives and liberals that it is worth taking time to consider what it is and what it is not and who benefits most by it. It is not universal health care, it is not social medicine, it is not national insurance, it is not even health care reform. Perhaps the one thing that it is is fascism.
Following are some highlights of what HR 3200 does:
Expand Medicaid Coverage to Families Up to 133% of Poverty
- Up to $14,404 Annual Income for Individuals
- Up to $29,327 Annual Income for a Family of Four
Reform Payment System for Medicare
Provide Health Care Tax Credits to Help Pay Premiums of Lower Middle Class
- Up to $43,000 Annual Income for Individuals
- Up to $88,000 Annual Income for a Family of Four
Compels Employers to Provide a Qualifying Health Plan (QHP) to Employees
Compels Individuals to Purchase a Qualifying Health Plan (QHP)
Play or Pay
Employers who refuse to offer their employees a QHP will be taxed an additional 8% on the employee's income. Some small employers will be exempt.
Employer's Share
- Employer pays 75% or more on Full-time Employee Individual Coverage
- Employer pays 62.5% or more on Full-time, Employee Families Coverage
- Employers have a formula for part-time employees.
Employee's and Individuals Must Play Too
Employees or Individuals who elect no coverage will be taxed an additional 2%.
Employees or Individuals who do not have an employer plan to choose from may buy from the Health Care Exchange.
Group Health Care Coverage Cost
Typical group health care coverage currently costs:
- $4,700 per year ($1, 2929 employee / $3,408 employer) for Individuals
- $12,700 per year ($4,445 employee / $8,255 employer) for a Family of Four
A full-time, minimum wage employee earns approximately $15,080. If the employee has one or more dependents, they will qualify for Medicaid if the employer does not provide them with coverage. The employer's 8% tax is 1,207 which is a lot less than the cost of insurance. Most retail employers and employees will be better off if the employer elects to pay instead of playing. That may be why WalMart endorsed HR 3200.
A family of four earning $88,000 per year with annual insurance costs of $12,700 may elect no coverage and pay $1,760. Many families in this income bracket are already close to foreclosure on their homes. Insurance could easily push them over the edge.
A Qualifying Health Plan (QHP)
- May have maximum out of pocket expenses of $5,000 per year for individuals and $10,000 for families.
- Must pay in full for a list of examination, screening procedures and vaccines.
- Must cover pregnancies and deliveries.
There are a lot more details, but a maximum of $10,000 in out of pocket expenses seems like enough to put a median income family with $50,200 into bankruptcy.
Compelling Insurance Companies to Actually Insure People
Insurance companies currently expend as much energy trying not to insure people as they do insuring them. Many people find themselves unable to acquire insurance at any price when they loose their employment.
- Insurers will be compelled to accept new customers with preexisting conditions and may not charge them more.
- They may not charge more for pregnancies and deliveries.
You can be sure that insurers will continue to do their best to deny claims. And I can almost hear the canned pitch to customers with bad health histories, explaining how they can save a few hundred dollars by choosing the Public Option.
The So-Called Public Option
- Will most likely be administered by a private, for profit company
- Will cost about the same as private insurance
This will most likely being the Fannie Mae / Freddie Mac of the insurance sector with the public taking the risks and private investor taking the profits.
What will an individual earning $88,000 per year purchasing a $12,700 insurance policy for a family of four care that they bought it from a quasi-government insurance plan or a private plan when they get stiffed for $5,000 in medical expenses and go bankrupt because they couldn't afford $17,700 in addition to their regular taxes after being compelled to purchase health care insurance?
The Public Option is the one provision in HR 3200 that may end up being cut out. It really changes nothing for the consumer.
Universal Health Care
There is no way to know what a person means when they use the phrase "universal health care". The goal of universal health care is clear enough, to ensure that every person that needs health care is able to get health care. The means of achieving universal health care are hotly disputed.
Single-Payer Health Care Models
Any health care payment model where e all health care is paid by a single payer, it is usually assumed that the government will administer single-payer. The phrase "single-payer" does not inform us as to how the payments will be funded or how health care will be delivered.
Many so-called single-payer health care models are actually hybrids. For example, Medicare in the United States is often considered to be an excellent example of a single-payer, but Medicare does not always pay in full so some of the health care is paid for by direct payment or private insurance.
Medicaid in the United States is a better example of single-payer. Health care providers must accept the Medicaid payment as payment in full. But Medicaid, like Medicare, only covers a segment of society so others must obtain health services through direct pay or private insurance. Also, Medicaid pays so poorly that many health care providers do not accept Medicaid patients.
Better examples of single-payer are found in Australia, Canada, Taiwan and the United Kingdom.
Paying for Health Care
- Private Payment (Direct or Out-Of-Pocket Payments)
- Private Health Insurance
- Government Health Insurance (Social Health Insurance, National Health Insurance)
- Taxation (General and/or Special Taxes)
- Donation (Charitable Contributions)
- Hybrid Payment Models
Delivering Health Care
- Private Ownership
- Government Ownership (Socialized medicine)
- Hybrid Delivery Model
In the United States, the majority of health care is delivered by privately owned health systems. However, the government owns and administers a portion of the health care delivery system including military and veteran health care, health care on reservations, and some county and city hospital and health care systems. There are also health care delivery systems involving private health care contracted by the government.
In the United Kingdom, most health care is delivered by government owned hospitals and health care systems, health care workers, including physicians and nurses, are generally government employees. Even with a large government owned health care delivery system, there are many privately owned clinics and hospitals
Single-Payer Universal Health Care Models
United Kingdom (UK) - National Health Care
National Health Service (NHS) provides free health care to anyone normally resident in the UK. Most hospitals and clinics are owned and operated by the government. The hospitals and clinics do not bill for services, operations are paid from the general tax base.
There are some fees for eye tests, dental care, prescriptions, and many aspects of personal care. Many dentists are private practice with NHS contracts. Most pharmacies are private with NHS contracts. Ambulance services are provided by the NHS or volunteers.
Services are slightly different in England, Scotland, Northern Ireland and Wales.
Medical advice is freely available 24-hours a day.
About 8% of health care is private, non-government care covered largely by private health insurance.
Universal health care costs taxpayers in the UK about US$2,401 per person. Health care spending is 15.8% of government revenue. The combined government and private cost of health care in the UK is US$2,760. Health in the UK was ranked 24 and health system performance was ranked 18; financial fairness was ranked 8 - 11.
Health care costs taxpayers in the US about $3,353 per person, or about 40% more than in the UK. Health care spending is 18.5% of government revenue, or 2.7% more than in the UK. The combined government and private cost of health care in the US is $7,290, or about 2.6 times what it costs in the UK. Health in the US was ranked 72 and health system performance was ranked 37; financial fairness was ranked 54-55.
Comparing the US and the UK
It can easily be said the the US and the UK represent two extremes in the socialization of health care in the modern, western nations. The US slightly socialized with government health care for the needy and the aged but most hospitals and clinics privately owned and government health care in the form of insurance. The UK heavily socialized with government health care available to everyone, most hospitals and clinics government owned and no billing.
Both government and total health care costs in the US are the highlights in the modern, western nations; in the UK they are both the lowest.
So what costs more in the US and less in the UK?
Even though there are roughly the same number of physicians per person in the US and the UK, physicians cost roughly 70% more in the US. And, even though there are roughly the same number of physicians and nurses combined in the US and the UK, health employees cost roughly 45% more. Much of the increased employment cost can be attributed to the higher cost of physicians, but higher costs for administration is also a significant factor.
The US and the UK have roughly the same cost for hospital beds and drugs. But the cost of high-tech, diagnostic procedures like CT scans and MRIs in the US is five times what it is in the UK. This is also true when comparing costs to Denmark and Sweden.
Direct employment of physicians reduces costs. Elimination of insurance billing reduces administrative costs. Treatment costs, reflected in the cost of hospital beds and drugs, remain about the same. The private health delivery model coupled with the insurance model encourage excessive diagnostic costs.
So, how does socialized health care affect the patients.
Causation and correlation are difficult to establish but here are a couple of indicators:
Poverty in the US is 21.0% while it is 16.8% in the UK. Is this 4.8% reduction in poverty at least partially the result of lower health care costs?
Life expectancy in the US and the UK is roughly the same. In the US male and female life expectancy from birth is 75 and 80; in the UK it is 76 and 81. From birth the UK seems to live, on average, one year longer. This could be due to better healthcare throughout the life of the individual.
However, for those who have survived to the age of 60, women may live one year longer in the US. Other statistics indicate that those who live to be 65, 70, 80 and 85 each have incrementally increases in longevity if they live in the US.
There may be an explanation for this phenomenon in social attitudes about life and death. Europeans expect to enjoy robust, good health throughout the first 60 or more years of their life and their health care system and government policies in general emphasis not only early detection of disease, but real prevention and good health.
The US is well known for having the worst general health in the modern, western world. In the US, people begin suffering from age-related debilitation at younger ages than in Europe. That explains why life expectancy from birth is slightly lower in the US than in the UK
In Europe, there is a social acceptance of death. Europeans don't expect to survive a long, debilitated old age. In the US, it is expected that every effort will be made to extend life no matter how debilitated that life may be. This could explain the tendency of Americans who do survive to old age, to live slightly longer than Europeans and why end of life health care costs are so high in America. According to Medicare (US), 27% of their budget is spent on patients in their last year of life.
A social unwillingness to consider costs and benefits when providing health care is probably the secondary reason why in the US over 50% of the health care costs can be traced to just 5% of patients. The primary reason for the problem is a private health care system that is highly motivated to exploit emotionally distressed patients and their loved ones for profit coupled with the defensive medicine practiced by physicians who above all things fear medical malpractice lawsuits.
Canada - National Health Insurance
About 70% of all health care is paid for by Medicare. All persons normally resident in Canada are covered. All basic health care services are fully paid. However, Medicare does not cover everything (eg. dental care is mostly private pay, eye care and drug coverage vary from province to province).
Almost all hospitals and clinics and privately owned and managed. Patients are free to choose almost any hospital, clinic or practitioner they wish.
Medicare is federally funded from general tax revenues, but it is administered by the provinces.
Most criticism of Canadian healthcare has been related to long waiting periods for specialty services. However, the referral practices if Canadian practitioners are privately managed, Medicare does not direct patients to seek specialty care from any clinic, hospital or practitioner. In response to this criticism, a new Medicare web initiative helps patients find specialty services with shorter waiting periods.
Universal health care costs taxpayers in Canada about US$2,575 per person. Health care spending is 16.7% of government revenue. The combined government and private cost of health care in the UK is US$3,678. Health in Canada was ranked 35 and health system performance was ranked 30; financial fairness was ranked 17 - 19.
Health care costs taxpayers in the US about $3,353 per person, or about 30% more than in Canada. Health care spending is 18.5% of government revenue, or 1.8% more than in Canada. The combined government and private cost of health care in the US is $7,290, or about 2 times what it costs in Canada. Health in the US was ranked 72 and health system performance was ranked 37; financial fairness was ranked 54-55.
Australia - Medicare
Universal health care costs taxpayers in Australia about US$2,009 per person. Health care spending is 17.7% of government revenue. The combined government and private cost of health care in the UK is US$2,999. Health in Australia was ranked 39 and health system performance was ranked 32; financial fairness was ranked 26 - 29.
Sweden
Universal health care costs taxpayers in Sweden about US$2,616 per person. Health care spending is 13.6% of government revenue. The combined government and private cost of health care in the UK is US$3,202. Health in Sweden was ranked 21 and health system performance was ranked 23; financial fairness was ranked 12 - 15.
France - Social Security
Universal health care costs taxpayers in France about US$2,749 per person. Health care spending is 14.2% of government revenue. The combined government and private cost of health care in the UK is US$3,449. Health in France was ranked 4 and health system performance was ranked 1; financial fairness was ranked 26 - 29.
Germany - Social Security
Universal health care costs taxpayers in Germany about US$2,595 per person. Health care spending is 17.6% of government revenue. The combined government and private cost of health care in the UK is US$3,371. Health in Germany was ranked 41 and health system performance was ranked 25; financial fairness was ranked 6 - 7.
Socialism or Fascism?
The US already has socialized education, socialized law enforcement, socialized fire protection, socialized road care, and socialized health insurance for the poorest and oldest. HR 3200 does nothing to socialize health insurance for the middle and upper class. Nor does it socialize the health care delivery system. What it does is compel employers, employees and individuals who may otherwise choose not to insure themselves or their family to purchase private health insurance. The so-called public option is nothing more than private health insurance dressed up like a social program.
HR 3200 does nothing special by extending Medicare coverage to families with up to 133% of poverty level. Medicaid should have been doing that all along.
Reforming Medicare payment models is just smoke and mirrors.
The so-called Public Option is just a private plan with government backing.
The big winners are megacorporations who underpay their employees so badly that their current biggest employment cost is health insurance.
The next biggest winners are the private insurance companies who will be insuring about 47 million more Americans. They will probably also be the owners of or contractor for the so called Public Plan. They will find ways to push their highest risk patients into the public option while holding on to their lowest risk patients.
HR 3200 is a perfect example of government serving the interests of corporations and industries ahead of the people that government is supposed to serve. When the interests of business and state become so closely linked that they serve one another at the expense of the people, that is fascism.
