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Bill Moyers & Michael Winship: Rx and the Single Payer

In 2003, a young Illinois state senator named Barack Obama told an AFL-CIO meeting, “I am a proponent of a single-payer universal health care program.”

Single payer. Universal. That’s health coverage, like Medicare, but for everyone who wants it. Single payer eliminates insurance companies as pricey middlemen. The government pays care providers directly. It’s a system that polls consistently have shown the American people favoring by as much as two-to-one.

There was only one thing standing in the way, Obama said six years ago: “All of you know we might not get there immediately because first we have to take back the White House, we have to take back the Senate and we have to take back the House.”

Fast forward six years. President Obama has everything he said was needed – Democrats in control of the executive branch and both chambers of Congress. So what’s happened to single payer?

A woman at his town hall meeting in New Mexico last week asked him exactly that. “If I were starting a system from scratch, then I think that the idea of moving towards a single-payer system could very well make sense,” the President replied. “That's the kind of system that you have in most industrialized countries around the world.

“The only problem is that we're not starting from scratch. We have historically a tradition of employer-based health care. And although there are a lot of people who are not satisfied with their health care, the truth is, is that the vast majority of people currently get health care from their employers and you've got this system that's already in place. We don't want a huge disruption as we go into health care reform where suddenly we're trying to completely reinvent one-sixth of the economy.”

So the banks were too big to fail and now, apparently, health care is too big to fix, at least the way a majority of people indicate they would like it to be fixed, with a single payer option. President Obama favors a public health plan competing with the medical cartel that he hopes will create a real market that would bring down costs. But single payer has vanished from his radar.

Nor is single payer getting much coverage in the mainstream media. Barely a mention was given to the hundreds of doctors, nurses and other health care professionals who came to Washington last week to protest the absence of official debate over single payer.

Is it the proverbial tree falling in the forest, making a noise that journalists can’t or won’t hear? Could the indifference of the press be because both the President of the United States and Congress have been avoiding single payer like, well, like the plague? As we see so often, government officials set the agenda by what they do and don’t talk about.

Instead, President Obama is looking for consensus, seeking peace among all the parties involved. Except for single payer advocates. At that big White House powwow in Washington last week, the President asked representatives of the health care business to reason together with him. “What's brought us all together today is a recognition that we can't continue down the same dangerous road we've been traveling for so many years,” he said, “ that costs are out of control; and that reform is not a luxury that can be postponed, but a necessity that cannot wait.”

They came, listened, made nice for the photo op. and while they failed to participate in a hearty chorus of “Kumbaya,” they did promise to cut health care costs voluntarily over the next ten years. The press ate it up – and Mr. Obama was a happy man.

Meanwhile, some of us looking on – those of us who’ve been around a long time – were scratching our heads. Hadn’t we heard this before?

Way, way back in the 1970’s Americans were riled up over the rising costs of health care. As a presidential candidate, Jimmy Carter started talking about the government clamping down. When he got to the White House, drug makers, insurance companies, hospitals and doctors – the very people who only a decade earlier had done everything they could to strangle Medicare in the cradle – seemed uncharacteristically humble and cooperative. “You don’t have to make us cut costs,” they promised. “We’ll do it voluntarily.”

So Uncle Sam backed down, and you guessed it. Pretty soon medical costs were soaring higher than ever.

By the early ‘90s, the public was once again hurting in the pocketbook. Feeling our pain, Bill and Hillary Clinton tried again, coming up with a plan only slightly more complicated than the schematics for an F-18 fighter jet.

This time the health industry acted more like Tony Soprano than Mother Teresa. It bludgeoned the Clinton reforms with one of the most expensive and deceitful public relations and advertising campaigns ever conceived – paid for, of course, from the industry’s swollen profits.

As the drug and insurance companies, hospitals and doctors dumped the mangled carcass of reform into the Potomac, securely encased in concrete, once again they said don’t worry; they would cut costs voluntarily.

If you believed that, we’ve got a toll-free bridge to the Mayo Clinic we’d like to sell you.

So anyone with any memory left could be excused for raising their eyebrows at the health care industry’s latest promises. As if on cue, hardly had their pledge of volunteerism rung out across the land than Jay Gellert, chief executive of Health Net Inc. and chair of the lobbying group America’s Health Insurance Plans, assured his pals not to worry abut the voluntary reductions. “We believe that we can do it without undermining the viability of companies,” he said, “and in effect enhancing the payment to physicians and hospitals.” In other words, their so-called voluntary “reforms” will in no way interfere with maximizing profits.

Also last week, John Lechleiter, the chief executive of drug giant Eli Lilly, blasted universal health care in a speech before the U.S. Chamber of Commerce: “I do not believe that policymakers have yet arrived at a full and complete diagnosis of what’s wrong and what’s right with U.S. health care,” he declared. “And I am very concerned that some of the proposed policies—the treatments, to continue my metaphor—will have unintended side-effects that make our situation worse.”

So why bother with the charm offensive on Pennsylvania Avenue? Could it be, as some critics suggest, a Trojan horse, getting the health industry a place at the table so they can leap up at the right moment and again knife to death any real reform?

Wheelers and dealers from the health sector aren’t waiting for that moment. According to the non-partisan Center for Responsive Politics, they’ve spent more than $134 million on lobbying in the first quarter of 2009 alone. And some already are shelling out big bucks for a publicity blitz and ads attacking any health care reform that threatens to reduce the profits from sickness and disease.

THE WASHINGTON POST’s health care reform blog reported Monday that Blue Cross Blue Shield of North Carolina has hired an outside PR firm to put together a video campaign assaulting Obama’s public plan. And this month alone, the group Conservatives for Patients’ Rights is spending more than a million dollars for attack ads. They’ve hired a public relations firm called CRC – Creative Response Concepts. You remember them – the same high-minded folks who brought you the Swift Boat Veterans for Truth, the gang who savaged John Kerry’s service record in Vietnam.

The ads feature the chairman of Conservatives for Patients’ Rights, Rick Scott. Who’s he? As a former deputy inspector general from the Department of Health and Human Services told THE NEW YORK TIMES, “He hopes people don’t Google his name.”

Scott’s not a doctor; he just acts like one on TV. He’s an entrepreneur who took two hospitals in Texas and built them into the largest health care chain in the world, Columbia/HCA. In 1997, he was fired by the board of directors after Columbia/HCA was caught in a scheme that ripped off the Feds and state governments for hundreds of millions of dollars in bogus Medicare and Medicaid payments, the largest such fraud in history. The company had to cough up $1.7 billion dollars to get out of the mess.

Rick Scott got off, you should excuse the expression, scot-free. Better than, in fact. According to published reports, he waltzed away with a $10 million severance deal and $300 million worth of stock. So much for voluntarily lowering overhead.

With medical costs rising six percent per year, that’s who’s offering himself as a spokesman for the health care industry. Speaking up for single payer is Geri Jenkins, a president of the California Nurses Association and National Nurses Organizing Committee – a registered nurse with literal hands-on experience.

“We're there around the clock,” she told our colleague Jessica Wang. “So we feel a real sense of obligation to advocate for the best interests of our patients and the public. Now, you can talk about policy but when you're staring at a human face it's a whole different story.”


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Comments

THE REAL REASON....

There is one MAJOR point that is not even being discussed in relation to the Single Payer model, and that is how much a person pays for health insurance as a percentage of their income.

Right now, two friends of mine, John, an entrepreneur who's 55 years old, and Mike, a colleague, who's 56, pay nearly the same in monthly premiums: about $540 per month ($6480/year). John's enterprises do quite well and he makes about $650,000 per year, and Mike pulls in about $62,000. John's cost of care is just under 1% of his income and Mike's? - you got it: he pays 10 times more at 10.5% per year!

They are both fine and fair-minded fellows who will stand up for what's good and fair. Both are successful and highly responsible people who are working hard in their chosen field. Neither one of them is creating this huge difference in relative costs - it's the system itself that does that. And neither, by themselves, can do anything about it - but we all sure can.

In Single Payer, the amount each person would pay would be proportional (and FAIR) in relation to his/her income though the process of general income taxation - though Mike would still pay a higher percentage for deductibles and co-pays. We all accept this method of paying for our schools (mostly) and our infrastructure and military, etc., so WHY NOT FOR HEALTHCARE?

This change from a market-based system to a proportional tax-based system of paying for our individual health care costs is the real reason that certain Conservatives are all up against this, calling it "a back door to socialism", etc. If that's true, then the longstanding ways we pay for roads, bridges, schools, our police, firemen and even our heroic military are all 'socialist' as well, aren't they?

Obama, bless his somewhat liberal heart, wants us all to be covered, but only along the old 'market' lines where the richer folks continue to pay a tiny fraction of what they make, while the rest of us still struggle to - just pay.

So, let's get this point out there into the debate - it's a simple and powerful truth and one of the best arguments FOR a true Single Payer model.

And as for Canada and all those other countries with Single Payer systems - now that we have all this great information about what has worked well and what has not, we Americans, using our fabled "American ingenuity" should easily be able to come up with the best crafted, most medically effective, cost efficient and downright healthiest Health Care System in all this world.

This time, let's not do it partway, half-way or any other way that for political expediency leaves the old inequities still built right in. This time let's do it really right - all the way right - and finally get the stress and worry and burden of medical costs out of our businesses, out of our health decisions and clean out of our lives for good.

Thanks,
Stephen Hannah

When are journalists going to look into how much the hedge funds have invested in the health isurance industry? They are wringing more and more profits out of them and people are not getting healthcare. And boy, are they lobbying Congress

Thank you for providing a forum for discussion of a comprehensive health care system design. I would like to share two comments:

1.) Lowering the age for Medicare coverage to 62 could enable thousands to retire, thus freeing up jobs to help the unemployment situation.

2.) So far, in the health care reform discussions, I have not heard the military "TRICARE" program proposed as a model for coverage. The TRICARE program includes contracts with large health care networks of provider/insurers, such as Blue Cross/Blue Shield, thus keeping them inside the system (and therefore not in opposition to this option) and provides excellent, cost-effective care to approximately 5 million beneficiaries. Perhaps this program, or one like it, could be expanded. I would appreciate you and your guests to examine this alternative.

Thanks again.


I believe that costs for a single payer system would be greatly reduced and patient care and satisfaction increased if the plan recognized that there is more than one medicine practised in the USA. We need to recognize Chinese Medicine (which includes acupuncture, herbs, massage, qigong, and more), Naturopathy, Homeopathy, Chiropractic, and Native American Medicine. We consumers need a choice!

Thank you Mr Moyer for bring intelligent discourse, not only to the issue of health care but to the multitude of critical issues face society today. Why is the most intelligent on TV today broadcast at 11:00 pm on a Friday evening?

It is said to see Obama following in the footsteps of the mediocre politicians that have come before. We Americans voted for change. All we are currently getting is more or the same kissing up to Wall Street, Bankers, the Military industrial complex, and Insurance giants.

Obama knows very well from the life experiences of his mother that real health care reform is an absolute necessity. He has in the past supported a single payer solution. Now that he has the bloody pulpit and an enormous amount of influence, he has backed away from the plan.

It is sad to see that the giants of the financial world have their ways of getting to even the best and the brightest.

Discouraging to say the least.

Perhaps social medical programmes don't work perfectly but the insurance based ones don't work at all. How can they when medical decisions are made by insurance companies. My wife is over 80 years old and has to pay nearly &100 a month yet in the UK she would have free medical, assisted housing and cheap utilities. I'm British but live in the USA because I can afford to but I look around me and see thousands of trailers and other abodes worthy of darkest Africa yet the USA spends billions on failed banks and car companies. Who is paying for all this, the average Joe because the US government in its wisdom doesn't tax the rich.

The media is nothing but a propoganda machine where lies are repeated ad-finitum until they're thought to be accepted. That is changing however I don't think many people believe much of what is broadcast these days.

911 is always brought up to justify the crimes being committed in Afghanistan and Iraq but it is well known amongst the informed that flight 77 and 93 couldn't have crashed the way the media claims, it was impossible,the flight data recorder confirms that.

Obama is trying to put a different face on the war of terror but the world is soon recognising exactly what is going on, deeds speak louder than words.

I always thought nationalisation was a socialist function but it seems I was wrong since the USA claims not to be socialist, but then it claims many things.

This concerns the comment about someone in the U.K. having to wait 45 days for treatment for a skin rash.

The first point I would like to make is that many people here have waiting periods longer than that for conditions more serious. My husband has atrial fibrillation. This is currently being managed by medication, although not with 100% success. He has been told that he will probably need an ablation within 2 years, and the waiting period, once a decision to proceed with surgery is made, is typically 3 months. I usually have to make an appointment several months ahead to see a gynecologist, and I once waited 3 months to see an orthopedic doctor when I had back pain so severe that I could barely walk. A friend of mine had to wait so long to see a vascular doctor when she was having leg pain due to a suspected blood clot, the clot calcified before it was diagnosed. We have waiting periods here, even for the insured, and the uninsured and underinsured often wait until they die.

The second point I would like to make is that the U.K. pays only ~ 6% of their gross national product for health care, while Canada pays ~ 10%. Both countries cover everyone. We leave nearly 50 million uncovered and many more undercovered, but we pay ~ 16% of our gross national product for health care; this is as much (as a percentage of GNP) as Canada and the U.K. put together. There is no reason why we would have to have a problem with waiting periods when we are paying that kind of money.

How would we pay for single-payer care for everyone? We would do it by retrieving the 350 billion + in administrative waste, profit, CEO compensation, etc., that is currently being wasted due to the existence of the private health insurance system.

As Ohio Congressman Dennis Kucinich often said during the presidential campaign, before they starting banning him from the debates, "We are already paying for universal care. We are just not getting it."

I will not support anything that the President, the Congress or Bill Moyer supports. I lived with socialism and i know very well what it is, it does not work, Hey democrats leave the good people of thei great America alone and go ruin your own lives.

Sari

In 2005, the CEO of United Health Care gave himself a 1.8 BILLION dollar "package". Of course, that kind of "package" could not have been provided to him had not all the employees of UHC been coerced into saying "no" to millions of claims. Psychological profiling of employees certainly is usefull.

No matter what is done now, it will be too little, too late.

Basically, a "culture" with the kind of "political" values that thunder and cry against the limiting of how much profit can be made off the misfortune of a bout of ill health that, yes, you can "bank" on that any one inside a skin body will have in a life, is truly not interested in "universal" health care. Stop pretending.

All that is going on now is the creafting of a new scheme for another kind of elite "package".

Applying my own conclusion: That government only reflects those that it governs, and can do nothing else, allows me the license to point a finger, really, at all of the people. They should, themselves, point their fingers at themselves. In the broadest electoral sense, this Country is floundering around, with no focus or sense of collective purpose. In modern, current history, since the second world war until the late 1980's there was a blanket purpose, which became thinner as it aged, of keeping this Country in the world lead militarily, economically and socially. This was a collective assumption by all, including those who found that purpose not in what they thought was their personal best interests or that the purpose got in the way of their personal desires. Today, I see no collective assumption of purpose and collective activity on a large enough scale that another blanket purpose can be placed over society. The sheer number of "issues" being debated as exclusively and of single importance to the exclusion of all others is an illustration.
What ever issue is present, the logic is that this issue has to be resolved first and foremost. The question that should follow is: Why this issue? Hundreds and hundreds of years from now our specie of human animal has to be able to leave this planet and survive elsewhere. This planet and this solar system will, without doubt, be sucked into some black hole and recycled in some plan of a "creator" which we will never be able to understand. This is quite a spacious issue, that seems so far removed from our daily efforts, as to seem not worth thinking about. But, the issue does provide an anchor for logic in our thoughts, socially and economically.
Why is it necessary for standards of living to rise? Why is it necessary to have some collective purpose? Why can’t we all live in little villages, each it’s own small society unto itself and no others? Because the problems facing each village are larger than that village. As a specie, we either have a will to survive and continue or we don’t (have a will or survive). Each time we make decisions on any policy or action there should be an anchor purpose that has to be linked, no matter how complex and extended, to that need as a specie to survive.
When standards of living rise there is a surplus of resources available to society. From the earliest of times of deciding to build a fence around that little village too today’s need for a strong economy and social network. Rising standards of living mean better schools and the time necessary to use them. Better schools mean greater intellect to address the issues of today and the future. Economically, a rise in standards of living is seriously threatened. Economic wealth resources have become increasingly controlled by a narrower and narrower portion of society. The end result of this narrower control is a lack of capacity by all of society to challenge the total of society’s capacity to produce. Two thirds of the GNP of this Country is retail spending. Retail spending is dominated by credit, not real purchasing capacity. The reasons are many, including healthcare and energy costs that are laden with enormous profit motives and results. The tax structure is directed to favor corporate and wealthy individuals. These kinds of conditions cannot continue without a collapse of the economy of that society. For this, history can provide complete support.
Standards of living only rise with the rise in productivity. Capital, not credit, is the only sustainable means of achieving a rise in productivity. Those who constantly maintain this logic argument for government should recognize the same argument for the society that supports that government.
Thesis prolog:
(The United States is, currently/11-02-04, polarized. This has been the situation for more than, at least, four years, as illustrated by the elections of 2000 and 2004. In part, if not completely, due to a lack of clarity of goals. These goals, in our representative democracy, are clarified in our political process. On either end of this polarization are perspectives based upon opinions/definitions based in ideology, philosophy and reasoning. No agreement of any significance can be reached until these opinions/definitions can be accepted by both ends of this polarization. Creating arguments that support any point in this polarization for the sole purpose of supporting an already reached conclusion does nothing to resolve either the issue or the polarization.
It could be said that there will never be an end to some polarization of some degree. Today’s polarization is, in some instances, just the process toward the next, generally accepted conclusion. Testing ideas, theories, philosophies and ideologies with arguments/reasoning that do not guarantee any already accepted conclusions is, however, required for this to happen. To dismiss a logic for the sole reason it does not support a conclusion is not acceptable. Accepting the conclusion of a logic/argument that passes a test of equal acceptance of terms/definition, even when that conclusion refutes a currently held opinion, requires maturity, character, strength and effort in the human spirit. There are currently held ideologies, philosophies, and logic that will not survive this process of growth and evolution of the human development. The following is the presentation of a logic to the process.)
THESIS:
Standards of living only rise with rising production. That is, aggregate demand is sufficient to demand an increase in production. Production being the total sum of goods and services produced by a society. Standards of living meaning standards for the totality of society.
Technology has created a capacity to meet current aggregate demand/production demand without increasing a demand for labor. This is due in part, and, by no small part, to an insufficient aggregate demand/consumption.
Technology, coupled with, in no small part, a continuing shift of purchasing capacity to a smaller portion of society, will render common/current economic indexes, and, therefore, economic policies, inadequate. These current indexes are microeconomic data relating to economic symptoms. If standards of living are directly related to production, then, policies and indexes should relate directly to root causes of aggregate demand/consumption: Why is aggregate demand at the point that it is at any given time? A more effective look at these policies and indexes with a real macroeconomic perspective is needed.
Unless a demand for production (consumption) increases on a scale to challenge production capacity, standards of living will not improve, but, rather, deteriorate. Government is, at bottom, supported by it’s populace on faith. If standards of living deteriorate sufficiently, faith in the economic policies will be lost and faith in that government will be lost as well.
As the managers of production continue to seek to find less costly labor in underdeveloped societies of the world so as to compete in a shrinking consumption pool (more competitive in only a sense: There is more capacity for production than there is for consumption) they illustrate the global impact of the circumstances. So long as underdeveloped societies do not increase the demand for production to a level needed to raise standards of living for all of global society, the cost saving found will be limited help to the underdeveloped societies only, and short lived.
"Labor" is the single largest purchasing entity and the final point of purchase for goods and services in any economic stream. Retail spending, in the United States, comprises two thirds of GNP. Public works, in it’s final product, either domestic or military, is, also, to be consumed by it’s populace, and paid for by it’s populace, as some kind of service. Reducing the cost of labor means reducing the flow of money to that entity which is the base of economic activity. This is not a moral or political perspective. It is the completion of the whole economic equation.
As John K. Galbraith wrote, the age of uncertainty began with the control of economics moving from families/aristocracy to commerce. The uncertainty of this change will not be eliminated until the reality of the need to always challenge production is adopted. Employment, consumption and living standards cannot, simply, be the products of Adam Smith’s invisible hand. The health of an economy has to be directly reconciled with employment, consumption and standards of living.
Government was designed to solve problems first, not to live within imposed budget constraints. When the constraints block problem solving, these constraints only illuminate the importance Government places upon solving any given problem. If Government decides to solve a problem, Government, first, has to relieve the constraints. Adam Smith’s invisible hand is not pro-active. Government needs only clarity of purpose, clarity of thought, to be able to act to relieve constraints and solve problems. A clear example of such Governmental clarity for the United States is World War Two. Budget constraints were not allowed to block solving the problem! Repeat! Adam Smith’s invisible hand, though always present, is not pro-active.
Currently, healthcare is a larger economic issue than one of healthcare alone. The discrepancy between the yearly amount of cash taken out of the purchasing capacity of the US economy and the total yearly spending for health treatment/patient care is, if not the single biggest drag upon economic expansion, certainly ranks with any other single drag upon spending/consumption/demand for productivity. To solve the US healthcare crisis, the issue, the problem has to be put in this context. The Pepper Commission issued it’s findings in 1989 stating that $980 Billion was taken from M and M1 in one year and that same year the total spending in the health treatment industry was $480 Billion, a difference remaining of $500 Billion annually, and, increasing each year. This begs the question then: If $480 Billion was the entirety of medical spending for treatment, then, $480 would be the cost of insuring the Country? Probably not. But, probably not much more than $480.
This year $1.7 Trillion was taken from M and M1. How much money was spent on health treatment in this same year? If the percentage difference is anywhere close to 1989, the point above is made. Expecting any adjustment to the Social Security Tax or medical benefits to make a significant impact upon the problem is not close to realistic. The argument for a solution has to follow this logic.
Beyond the economic stimulus of keeping this difference between collected and spent health dollars in the purchasing capacity of the economy, stimulating an increase is aggregate demand, Adam Smith’s invisible hand now would provide some significantly large impact. If there were a "Single Payer" program in place, the pre-existing duty condition would apply to other significant drags upon the economy. It would no longer be possible to seek court action to recover personal injury medical expense dollars. Health benefits would no longer be a part of Labor/Management negotiations. As for saving Social Security, there would no longer be a need for Social Security medical benefits. There would no longer be a need for a budget for Veterans Administration medical benefits. Two large entitlement programs, Medicare and VA, which take from the general fund, would be gone. The ancillary cost impact of providing preventative medical treatment would, probably, provide further positive cost savings. The impact of a single payer system would have further positive impacts. The distribution of medical treatment would expand nation wide. The medical industry/doctors cluster in high income areas and compete for patients limiting service in the rural or less populated areas. They leave these less populated, and ,or, lower income areas not due to a lack of patients, but, due to a lack of paying patients. The positive impacts of such a healthcare program far out weigh the perceived, possible, negatives. As for cost control: You cannot control costs of anything until you control the funds that pay the cost. Currently, patients, as a whole, are third party beneficiaries to agreements between the insurance industry and the medical industry. Placing payments for medical treatment in a single, public entity would force debate on costs into the public domain for public approval. This would, probably, be a messy and contentious process. But, if cost control and medical treatment is to be controlled by those who pay for it, this is the only process. A Single Payer Health Insurance program keeps doctors and hospitals, the medical industry, private, but no longer treats the treated as third party beneficiaries.
The logic of the above goes beyond healthcare, and, is an eternal challenge to societies everywhere. Healthcare, however, does provide for government, men and women, the citizens, to significantly address this issue of productivity and standards of living at the same time. Society evolves and the issues that any society faces evolve also. Government, what we do for societies’ collective good, requires that our approaches evolve as well. Moral imperatives can be found in providing for healthcare, but, political practicality is best addressed with an economic perspective.
Thesis notes recommendations and questions
When the labor force falls and purchasing capacity imbalances, Government forces a bond purchase on incomes above_______. This could be a form of a TIP/Tax Based Income Policy. This could be applied only during the time of the forced bond revenue spending. It would be applied to the entirety of the economy. When the economic indexes return to an acceptable parameter these public works projects would return to a level supported by the standard tax base. Economists call this "gradulism"? This keeps tax rates stable and public works projects foreseeable? This should not provide any further impediment to individuals moving from lower income brackets to higher brackets. This would force those that have succeeded economically in our Country to re-invest in this Country.
What percentage distribution of income would be called an imbalance?
How are these imbalances and productivity to be measured so as to provide data on a timely basis?
Above what level income will this bond purchase be required?
How much of a bond purchase will be required of what income above the triggering index?
Will the growth rate/economic activity return enough tax revenue to repay the bond plus any interest?
Will this growth rate support a necessary level of consumption?
What is a necessary level of consumption?

I was really surprised to find that we are advocating for a government run health care program. If it is a good idea, why do we need to use euphemisms such as 'single payer'. The reason is we know that people are opposed to the idea and rightfully so. I have a friend who lives in Britain and recently in passing mentioned in her e-mail that she has a skin rash and was waiting for her appointment to see the doctor. Guess how long it took! 45 days!!!Hospitals in Thailand and other countries in Asia are full of European patients who go down there to get surgeries they waited interminably for in their own countries. Access to health care will be based on race and wealth. Basically the system will create an upper and lower class of citizens. The ones who can go out of the system to get private care- 'the concierge medicine class' and then the rest who will be standing in lines waiting for directives from a bureaucracy. It is not going to provide greater access to health care to people who do not have access right now. We will have triage medicine deciding who will live and who will die. Let me put it this way - creating a national health care program will be like putting a patient who needs a band-aid in hospice care- dying slowly and excruciatingly. I am fully in sympathy with people who have chronic disease and those who have lost access to health care. We definitely need to help them. We do need to monitor and lower the cost of drugs and help in reducing costs. There are many ways to do this:

1) Ensure that pharmaceuticals do not take excess profits.
2) Monitor the cost of drugs.
3) Share the cost info. with patients and ask them to exercise their judgement.
4) Take punitive action against companies and hospitals that are negligent or greedy.

All this will change the environment in which medicine will dispense. Freedom and choice in health care is very important.

In no other "western" country in the world do you have the brutal censorship of public discourse like you have here in USA. Why are the only people allowed to post on this website the ones who spew the propaganda that people are stupid. Censor medical personnel with solutions and only let the clueless critics harp from their daily political memo? On top of the observable fact of brutal censorship of the truly intelligent alive in the country, day in and day out, is the other fact - with 300 million USA citizens, a Congress and Senate of 600 "representatives" is completely off kilter and is not what is mandated in the constitution. Indeed, the rest of the world is poised to steal what is left after the USA "government" is done stealing from the "stupid" citizens. Have a nice day!

Thanks for compensating for the total blackout on the single-payer option by the Obama administration and the Baucus hearings. I get a kick out of reading posts in this thread complaining that this show was more a forum on single-payer than it is on the wider subject of health-care reform. First, where is their "principled" outrage in the case of the congressional/Obama administration blackout? And second, I am convinced, after years of scrutiny of this issue, that all roads lead to single-payer. It would be very interesting for you to have a show that features the medical industrial complex and its POV, but I'll bet you a month's health insurance premiums that they won't agree to this. The industry CAN'T support its position outside of proprietary lobbying of our public officials.

I think single-payer is a little like the famous race horse Seabiscuit. Seabiscuit was far and away an extraordinarily exceptional animal who could beat all other horses on the race track, despite his questionable pedigree and unconventional training, not to mention his status as a "left-coast" horse wanting to compete with the status quo racing industry based on the east coast. The racing establishment finally relented and "allowed" Seabiscuit to compete in races with their finest steeds, and he won race after race. He became so handicapped (legally) in order to make these contests "fair," his soundness was severely compromised, but he kept on winning. Racing history now recognizes him as the finest racing horse in our history.

Single-payer is the Seabiscuit entry in the health-care reform discussion. And we're in the phase of trying to get it accepted by the health-care status quo powers into the race. It ain't gonna happen without extraordinary effort, because the medical industrial complex knows it'd win hands-down.

And re that question of who's going to pay for it? OF COURSE when you poll citizens today in this desperate economic climate about having their taxes raised, they're going to say NO WAY. But that's a false choice. The question should be, would you be willing to have the money you currently spend on premiums and out-of-pocket expenses redirected toward a government-run program open to all citizens? According to a highly-regarded Jan. 2009 NYT/CBS poll, 59% of Americans responded favorably to that scenario.

Let's keep fighting for this one! If our legislators end up offering us a health-care reform proposal that doesn't even acknowledge the blue-ribbon winner-circle aspects of single-payer now, at this moment in our political history, then WHEN will that moment be right?!

Again, the problem with all of these plans is who is going to pay for it. In the local paper over 70% or respondents polled said they would not support tax increase to subsidize health insurance costs. Another govt run program that bleeds money like Medicare and SS is not the answer.

WIP: If the system is broke, who broke it? Who had an interest in breaking it? (Shock Doctrine) And in meta-reference, was "the system" sustainable? Or was it inevitable "the system" would run up against the physical and logical contradictions it had produced?

When do-gooders posit the "boiled frog" analogy they apply it to a theoretical future, not realizing they are already hard-boiled themselves. We didn't get to paying more than double for sub-standard medicine overnight. The collective indoctrination in our artificial culture, created to serve an elite minority, made humane health care impossible, halted scientific progress, starved and deprived billions, waged wars for business competition and profit. If anyone thinks we can get workable single payer in a vacuum without overhauling our entire consumptive lifestyle, hierarchy and and mindset, they are sadly mistaken. Why pump up the tires on an engineless vehicle, unless you're planning on "going downhill"? (Can't you hear in Obama's voice that he is a scared little man of limited imagination and over-sized respect for wealth and power, who needs our people power to make any headway, personally and governmentally? A legitimate leader doesn't hem and haw like that, doesn't flinch at incisive questioning and depend on a teleprompter. What we have here is a hostage!)Sell-outs and hostages can't deliver.

The system is broke and the politicians are NOT NO WAY going to even think about fixing it period! Those impractical,impossible,inconceivable,incompetent,inconsiderate AHOLES/IDIOTS could not find their own brains if they had a search warrant.Thats because they are sitting on them.Question do you know the slim on the sidewalk a slug/snail leaves what is under it? A politician

If the two doctors on the program are not allowed a seat at future congressional hearings on the matter, there truly is no justice in America. Recent congressional votes on Wall St, the banks, and the credit card industry seem to affirm this. No justice, sad.

It would be greatly appreciated if this blog would offer links directly to single-payer advocates' sites where the drive to recruit, educate and MOBILIZE interested folks is being undertaken. The movement is still underground and off the radar screen. That has got to change quickly!

Where is President's Obama's national television broadcast informing citizens of Single Payer as the answer to solving a hugh problem. Single Payer is the legacy of any true leader in the Senate, House, or White House to make a difference in the lives of households as well as of this entire nation.

I find it interesting that some commentators have indicated that a person is responsible to take care of oneself. This is true, but what if a person does not have the means to do so adequately? I know from personal experience that having such means (in this case read: Healthcare insurance), means not being able to adequately take care of oneself, either in a preventative manner or in a recovery manner. Universal single-payer healthcare must be provided, at the very least for the poor at the beginning.

This is a social and moral issue. We can no longer afford to be the only industrialized nation in which people can lose everything because of healthcare costs. It's untenable and morally wrong.

I saw & appreciated your Journal Friday, May 22, 2009 & thought your presentation of the problems of our present health care delivery system was excellent and your reference to the Canadian system appropriate. However, I believe reform following the system developed in the UK is a much better proposal. Some of the superiorities include: (1) UK spends 8.4% of GDP, US spends 15.3%; (2) UK infant mortality is 5.4%, US 6.9%; UK life expectancy is 79.4 yrs, US 77.8 yrs.
Obviously reform is a difficult goal. Compromises may be necessary in the process of reform but I believe we should identify and try to achieve the best plan. Sincerely, Louis B Blair, Superintendent, St Luke's Hospital, Cedar Rapids, IA 1948-1975, retired

Though I favor single-payer health care and appreciated the show, I was surprised that no attention was paid to the obvious economic dilemma that single-payer presents in this economy. Healthcare, economically speaking is one of the few sectors of the economy still performing.

Unfortunately, the current healthcare system is a bubble that has not burst and it is one of the few industries that is forging ahead, albeit to the detriment of many of us. But if suddenly government, single-payer, becomes the law, the impact of dismantling a large sector of the economy must be considered. Unemployment of large numbers of people involved in medical billing and in insurance companies must follow and these are jobs that are hard to replace. Much of this employment is low to medium skill computer in-put work and the current economy is not robust enough to absorb them. The ripple effect of that much unemployment, the emptying of office buildings, the effects even on giants like A.I.G. can't be understimated.

How we get to single-payer without deliberately deepening this recession is something that must be considered.

Dear Bill,

I believe that a plan for universal health care must and foremostly begin with the responsibility of caring for Oneself. A plan built on self-reliance in this unhealthy weak world of what will they do for me, or who will take care of me, is where I think we should begin. Self-health or taking good care of Oneself is nature's healthiest and strongest universal health care Way.

=
MJA

Single payer is the first step to take the profit motive out of medical care delivery. Every doctor and medical worker in this country has had their career and values distorted by institutional greed so that it is now only the rebels and dissenters trying to deliver good advice and treatment. The claims persons in provider offices have a job description that is the epitome of banal evil and yet their employers are not content. Denials generate a cadre of supplicants in the medical office, hospital and nursing home that would be totally unnecessary without this profit motive.

And yet to say single payer would solve our medical delivery problems would be a half-truth. This is why the predatory minded people in service to great wealth gain so much traction with their insane arguments. We have problems with endemic pharmaceutical lies and frauds perpetrated on the public using doctors as salespeople and recruiters to suspect disease categories. We have the denial of poverty and lifestyle as the primary causes of chronic bad health. We have practitioners trained better in business than in doctoring who practice as predators. We have understaffed facilities where a patient's life is in danger without a knowledgeable companion present around the clock. We have a polluted environment and unregulated products that menace our well-being. We neglect pure research in a quest for treatments that will make money by maintaining millions of patients in a chronic or deluded state. We must medicate to cope with a ruined world and a hollow culture. We are a callus and predatory people who delight in sadism.

A good and intelligent nation would have achieved equitable health care during the Depression or at latest following WWII. We missed the exit just like with alternative energy and mass transportation. We let the possibilities languish until the spark almost died and our very survival became threatened, just like with universal, free quality education. Now it may be too late not only because money is short and energy more expensive, but because we are a mis-educated bunch of over-competitive and greedy self-obsessed idiots, made that way by a deceitful corporate rationality masquerading as "liberty" and "choice in a free market."

This month's (May) Scientific American is already discussing world famine as our most eminent threat, and here we are calling some jake-leg congressperson to vote right on health care, and save us a little money. The American Empire, criminal as it was, is collapsing, and we are hopeful about our speculative investments. We are a pack of idiots if we accept some half-assed health insurance scheme with the purpose of keeping big insurance afloat.

We need to get serious if we are to survive as a nation. I suggest that as many of us who can, together drop all health care coverage immediately as a boycott against the mal-adaptive system we have and in demand for an equitable universal one. Of course, this would be only a minor step to taking control of our food and our jobs and our resources and our real solutions. (People in this country, though, still can't stop eating tons of meat, even though it is tainted, even though it uses 20 times the energy of growing grain.)

No, the elites can't afford for us to control a universal, tax financed, not-for -profit health care system because it might lead to similar solutions in other areas. But we have to do it if we want civilization to continue. And we will have to do many things that might have seemed strange and remote possibilities in the recent past. You macoutes who tout liberty and choice are threatening everyone's existence, and you will never receive the rewards from the wealthy class you might expect. (If we fail you will join us in the concentration camp, or in endless slavery.)You are not preserving freedom and democracy, but denying them. You are not opposing socialism: You are only acting anti-social. It is getting dark and time is short, and it may already be too late. Why go on paying more and more for worse and worse medicine? Our last stand must be to collectively drop our insurance and starve the beast that threatens us.

Thank you so much for your show on this issue.

I believe the reason more journalists aren't covering this issue is that they are too distract by all the navel-gazing over the dying news industry to worry about the 60 people who die every day due only to lack of health coverage. Journalists need to wake up and realize that they will be the first in line at the free clinic -- assuming there is one -- if something doesn't happen soon.

Please, everyone, write your representatives at every level, and write your newspapers and TV stations. Single-payer must be on the table.

PS-Your poll on Obama's plan was badly worded. Obama has no plan as yet. Why not do a poll to see if people support single-payer?

Your program covered some of the points for a single payer system which most of the countries in Europe use. However you should have also mentioned that the average cost per person in the U.S. per year is now $8200. The average cost per person per year in Europe is about $3500. For the priviledge of paying over twice as much as a European for health care, the U.S. is 37th on list of longevity just below Slovenia. The longevity of Europeans and Canadians is higher than the U.S. according to the World Health organization. Recently it was discovered that the drug plavix when prescibed with an acid reducer such as omeprazole had a 50% higher death rate from heart attacks.This was because the acid reducer caused the plavix to not work properly, but it took 10 years and study by in insurance co trying to reduce the number of prescriptions to discover it. If there was a single payer system this interaction and probably many more would have been discovered much earlier. Lastly a friend who is a stockbroker told me to buy a stock of a medical insurance company. I asked him why I should buy this companies stock. He replied he just came back from a presentation by the insurance company to stockbrokers detailing how they would promise to cover everything but when the claims came in they firgured out how to deny a vast majority of then thereby insuring large profits for executives and stockholders. Enough said.

Thank you Mr. Moyers and PBS for this information. Single Payer IS news! I wish the media and our politicians would get out of their lobbied world and into ours and see the tremendous value of Single Payer. Not only would everybody be able to get the medical care they needed, Single Payer would get us out of our recession/depression by giving 2.6 million people good jobs and generating over $300 billion in stimulous to the economy.

Many Thanks again!

United States health care system is like no other in the world. Simply put, regardless of its payment structure and insurance structure, the costs will continue to escalate until we change the inherent greed built within the system.

What single payer advocates fail to mention is that other single payer systems have rather severe rationing as well as limitations on the type of treatments for diseases.

The problem is not the insurance system. The problem is the incredible cost and unbelievable waste on a daily basis. I work within the system and I see the waste. Countless procedures, tests, treatments that do not need to be done.
This waste is built into the system by the providers themselves. It will not get better if we have a single payer system. And, with a single payer system, you will pay regardless, in higher and higher taxes even though your wages will not increase once your employer sponsored health care is no longer available to you.


Hmmm… Health Care for ALL Americans is Simple!

1) MERGE Medicare with Medicaide into one single "Income Based" system for poor and elderly citizens.

2) REQUIRE insurance companies to provide the same basic coverage for ALL Non-Medicare/Medicaide citizens, regardless of health status, at affordable rates.

3) ALLOW insurance companies to "Profit" by offering additional benefits and options to those who qualify and are willing to pay the difference.

As for Funding…

1) Changing from an "Emergency Treatment" to a "Preventive Care" system will save local communities billions, maybe even trillions of taxpayer dollars!

2) Small business will be able to compete globally and hire additional taxpaying employees!

3) Wealthy seniors will pay their fair share!

4) The tremendous burden on future generations will be greatly reduced!

Thank-you so much Bill Moyers. I hope you will always be there to light a candle instead of cursing the darkness.We at Democracy for America in San Mateo, CA, are having a healthcare Forum on June 6, 10-1 at the San Mateo City council chambers in City Hall. Please come if you will be in the area.

Mr. Moyers, you are indeed a national treasure. Thank you for your public service, and thank you especially for this revealing and educational broadcast. I only wish that more would see it.

Thank you so much for your wonderful show on PBS about single payer health care. I am not a tinfoil hat wearing person, but I find it very interesting that no other media outlet has put ANYTHING like this out for public debate. You are truly what television aspires to be. Thank you thank you.

Kimberly and Pete in Portland Oregon.

Fantastic show!

wonderful show!! Thanks for this and for the high standard of real journalism you have set over the years. From one of the nurses who went to Washington.

Thankyou for broadcasting these interviews that gave me a better idea of how our government works. I had some hopes for the "public plan" that is part of President Obama's reform package, thinking it would incrementally point the way forward to a more rational health care system. Now I am not so sure this will work. It infuriates me that powerful interests have (again) hijacked the agenda and Americans are going along with this. I don't know why we don't stand up and fight for a solution that will work. The overwhelming evidence is that a national health care plan is the only feasible option, as many other countries have already proven.

Bill Moyers program on single-payer health care was excellent and the advocates for a single-payer system articulate and accurate.

I am a Canadian who has lived under both systems and there is no question that the government run single-payer system is far superior to the private insurance system that preceded it.

americans spend twice as much of their GNP on health care as Canadians to support their private profit system but canada scores higher in the UN Human Development Index health care indicators than does the united states. I suffer from a progressive degenerative disease that requires 5 different precription drugs. because the government of my province negotiates drug prices with the pharmaceutical companies, i pay a very small amount for drugs compared to americans who suffer from the same disease. I also have family living on both sides of the border and i can tell you from personal experience that the canadian system is far superior. my sister had 2 miscarriages and a toxemia complicated live-birth. her insurance companies refused to pay for the miscarriages nor for the complications in the live birth. she was forced to submit to a state operated bankruptcy process and her child was 10 years old before the dead babies were paid for. I only mention this case because of the false ads on US TV that suggest there are long line ups for treatment in canada and that people are forced to leave the country for treatment in the usa. in fact more americans come to canada to get treatment or buy drugs that they can't afford in the united states under the for-profit system.

It's hard for canadians to believe that over 40 million americans have no health care coverage at all. they are forced into tax-starved public hospitals or into waiting lines in charitable facilities. many simply accept illness, death or disability as inevitable.

I was fortunate to have been a friend and colleague of TC Douglas, the founder of canada's medicare system. Tommy was not a godless socialist. he was a baptist minister and a social gospel christian. his medical care commitment should be considered within that framework. I asked tommy how he could implement medicare over the opposition of the doctors and virtually every other political party in canada and in the absence of a model elsewhere in the world. douglas told me that canadian soldiers observed that in world war 2, americans had the best field hospital system of any country in the conflict. after his election as premier in 1944, he told me that he called the US president and had one of the experts from the surgeon-general's office seconded to his cabinet to help him put together the saskatchewan provincial hospital care plan which was Canada's first step towards a single-payer health care system. The fact is that canada's first medicare system was partly based on an american military model. What could be more patriotic?

I think Barack Obama is one of the best things to happen to the United States in many decades. I believe that he would like to establish a single-payer health care system in the united states but he is enough of a realist to know that he is going to be opposed by the real power in the usa: the health-care and insurance industries - organizations that have managed to pay off enough politicians - since Ronald Regan 1948 - to deprive Americans of a comprehensive health care health care system. How many people have suffered and died as a result of the "health" industry's lavish bribery and lobbying is anyone's guess. I believe that if advocates of single-payer will support Obama's effort to set up a system that is partly single-payer, eventually, the single-payer system because of its efficiency will absorb the rest

If I become seriously ill, I will just have to die. I have no money and no family. My Living Will states "provide no care."

This after working 40 years, even employing others for 11 of those years.

Shameful. Corporatist Congress is sitting on a powder keg. If they give free health care to Americans, we will be quiet for a very long time. It will heal so much suffering.

Dying, literally, for a health care solution.

I appreciate the information provided by your coverage on single payer insurance. My husband and I are covered by an HMO as part of my retirement package from the University of California but there is no guarantee that is has to continue to be provided. California legislators and our governor want to cut all manner of coverage for children and the mental health programs. All of US Citizens should have single payer insurance and we need to demand a seat at the table of the President's discussion for coverage. We need to combine the best of the Canadian, European and US systems for the best combination of all of these. Lets start the letters going to the President, Speakers of the House an Senate and our representative in the Congress. G

Thankyou for doing a program on the single payer system, it was long overdue. I have been talking about it for 40 years hoping the US would some day wise up and take the APM - 'Almighty Profit Motive' out of health care. I was born, brought up and became a hospital nurse in the UK where national health care has been considered a 'human right' since the national health insurance was introduced after the war, as far back as 1947! Wake up America - it's the only sane way to proceed.

Great show and a topic that needs to be discussed. However the real issue is not "single payer" the real issue is "single pricing" The reembursement would be determined by the government. Several of the interviews pointed out that insurance company executives without medical backgrownds are making reembursment decisions on healthcare. I am not sure that replacing them with government employees is an improvement
I agree that there would be an immediate savings in the overall administrative costs however I do not think there was enouph discussion about how the basic drivers of increasing costs: unhealthy lifestyles, liability, increasing use of expencive tecnology would be better controlled through a single payer system in the long term (or how that would be done)
I work for a not for profit HMO, no large CEO salaries, most efficient intergrated computer system I have ever seen, very large patient population and so very efficient billing, Doctors that make less than the national average and yet it is hard to keep our costs lower than our compeditors. If there is 30% to be saved, we have not seen it in our "single payer system for over 10million patients (larger than many contries)
Ed PIno

Not-For-Profit in the Arena of Needs

Who should profit from a person’s need for medical care or disability maintenance? Should anyone profit? Why should the gross-charge for medical care include a profit above and beyond the actual cost of production-distribution-administration and prorated training, design, and development and be a part of the economic model for the provision of our essential needs? Are food, water, energy, shelter, provisions for health/safety, and transportation essential need? Are these rights or privileges? Is survival of the fittest the our operating paradigm, or is compassion?

Specifically – health, medical, pharmaceutical, and prevention - businesses and services which comprise a 15 percent of our present GDP are essential to each individual’s life. Is the idea of profit for these services exploitive, if not a form of extortion? The brokers and middlemen that are now interjected between the consuming individual and the service provider/product should become unnecessary, with the improved levels of - communication, automation, and education – available today. Could an enlightened, educated, and responsible citizenry be self responsible for maintaining accountability for the efficacy of the administration of these services, and the acceptance of risk? Do we now have a model on the internet, AngiesList, that attempts to accomplish this? Is this not the place for litigation, but instead a place for the ‘free marketplace’ to weed-out, or entrust, where individuals’ actions to purchase and use are the judge and jury? If we and our educational institutions work correctly, we can dramatically improve our own oversight of medical care, and if we are individually conscientious, we can exercise higher levels of preventative medicine as well as preliminary diagnostics and even treatment prescription. If we individually fail to assume responsibility that fault lies individually with us. What defines a non-profit business? Who or what agencies monitor those not-for-profit businesses, define the policies appropriate of non-profits, and enforce those policies? Why would anyone want to establish and run a non-profit business? Could true not-for-profit health care related products and service significantly reduce the cost of health care? Or, on the other hand, are health care and the insurance management/access industries currently mainly operating as not-for-profit, thus making this argument moot? Is this truly and issue of individual responsibility, and if so how do we foster greater individual responsibility?

Another take of the problem of health care costs was developed by the CATO institute in 1994, in which the primary premise is the over-use of medical services because of ‘ease-of-access’ to the system. You can follow the link here to the article Cato Policy Analysis No. 211. In addition, Cato argues that ‘third-party’ payments (government/medicare/medicade, and insurance companies) are paying the bills, enabling the patient, and thus encouraging higher costs. Is it a combination of these observations? Are we trying to provide for the delivery of too much health care? What is too much? Too much for whom?

Last, how do these arguments relate to the other essential needs of food, water, energy, and shelter?

I want to thank the Bill Moyer Journal for the opportunity the program on Friday night, May 22, 2009 provided for the public to be given an informed easily understood presentation on the single payer system. It was time to be able to see both sides of what needs to be considered when having health reform legislation prepared in Congress. The people responding to your blog have said it all, and more. Bill Moyer has made it possible for the voices interested in a single payer system to be heard and I hope that President Obama will rethink his concern for the problems to be addressed in the shifting from a private insurance system paid by employers to one in which the government has the responsibility to develop a universal package. I know that President Obama supports change, and change does require new ways of doing things, the need for different jobs for people moving from one system to another, etc. We see that happening with our economic meltdown and I am sure we will be able to arrange the needed supports for people moving from employment in the private insurance industry to other areas of their interests and capability. If President Obama and our elected representatives in the House and Senate will join the parade for change we will have both a single payer system and health care in which the health care dollar is used for health care and not for the profits of the health industry and the pockets of their CEOs. Thank you for the stimulus you have given to the single payer system at a time when we as a nation are considering health reform. Renee Levine

I would love to have more information about how to get single payer advocates at Obama's "table." We need to become thoroughly informed about the single payer option - and about how to make it even better by allowing more choice on the part of the consumer. We need to hear more dialogue about this coming from Washington - and from the media. Any posts on this website about pushing this forward would be most welcome. I appreciate the recent post about contacting (and re- contacting) our legislators. How can we most effectively speak directly to Obama on this?

An interesting program. I have a complaint that when you asked about some of the criticisms of the Canadian system; specifically rationing,timeliness, availibility, etc, you did not follow up after Dr. Himmelstein answered only that a Canadian can go to any doctor or hospital they wanted. That did not speak to the criticisms. I know Canadians that felt they had to wait a dangerously long time for necessary heart operation.

I think the single payer is the way to go. Insurance companies find a way to deny service. After paying premiums for 4 years, Aetna and the State of Alaska denied service and refunded the premiums I had paid.

Our family has been provided with health care coverage through my husband's employer. For the last five or more years our premiums have gone up as have deductibles, and coverage has gone down. I am appalled at the numbers of people who are no longer covered by an employer, and for other reasons have completely lost their insurance. The media blitz, advertising bludgeoning, and dominance of Congress by the health insirance industry makes me angry, because they use loaded words and images which prevent rather than promote understanding. Thank you for tonight's program which gave real information and should encourage greater outspokenness by ordinary people. Please continue to work to give Single Payer Advocates a place at the decision-making tables.

I am a great admirer of Bill Moyers - especially appreciated his comments tonight on Memorial Day and remembering the realities of war.

However, I was disappointed that even he missed the obvious problem with single payer - whoever pays gets to dictate what will be covered. It's nice to say you'll have your own doctor, but what good is that, when the care given is prescribed by the government by virtue of what they will or will not pay for. This is true now of all health insurance, including Medicare.

The other two major concerns I have are:

1. The government's way to save money, given the wildly expensive medical system we have, is through mandates - for us to pay. "Universal health care" is more likely to present me with a bill, not a gift. Medicare Part B itself requires premiums that I could not pay if my sons didn't insist on chipping in - and I mostly can't use it except every couple of years, because of the deductible and co-pays.

2. Finally, nobody wants to talk about how other countries save money and get better health results by including Complementary & Alternative Medicine (CAM) under their national plans. England, with five (covered) homeopathic hospitals, spends $2,000 per capita vs. our $7,000. And Single Payer would wipe out my only chance of coverage for this - the kind of health care I want - Washington state requires insurers there to cover ALL licensed practitioners, including naturopaths, acupuncturists,homeopaths,
etc.

I don't see ANY of the health plans with a chance of passing benefiting me at all - my earnest hope is to at least avoid the mandate. It could drive me into the street, if administered like Medicare - which requires you to spend down essentially all your savings before your premium will be covered. (This, in the form of a mandate, could drive some into the street, because many seniors are dependent on their nest egg investment income to live).

Our current health insurance system discriminates according to who you're employed by, who your parents are or who you're married to and which insurance company you're offered. Democracy is supposed to give every adult citizen the right to vote. However too many of our citizens feel left out by a society that doesn't care for them. There is too much economic disparity. A single-payer universal system would help to overcome the disparity and include everyone. It would bring a greater sense of equality and improve what is supposed to be a democracy.

As I understand it, the Obama plan simply creates another Medicare-type program instead of addressing the cost issue and so it is not really a feasible option, since the insurance cos only method of reducing costs is thru reducing coverage. This is symptomatic of the way this crisis developed in the first place, with the passage of Medicare and Medicaid. If we want to cap costs we have to return to free mkt principles backed by restrictions on govt spending and the Fed.

One of the most overlooked conditions of untempered Capitalism is that it ultimately destroys all that it creates, as it feeds the pathology of greed from within. These problems concerning the health care system, like the rest of our countless crossed purposes are not too complexed, but too complicated for the plutocracy, who are comfortable with the status quo- the "many" being at the mercy of the "few". However, like all things Man, we can apply actions but we are not the arbiter of outcomes, for all we do is subsantiated by a cosmic platform of immutable Laws, and those unequivocal Laws will always maintain universal balance! So the plutocracy has a simple choice. They can, by volition, adapt to cultural changes, and necessities manifested in Nature, or Nature will do it for them. The former may be difficult, and needs only a determined will, but the latter is easy, needing only the existing complacency followed by horrendous "effects"!

I can tell you that as things stand single-payer or a public option will never happen. I work in Congress and can tell you that there is no concerted organized effort for the people's will to be done.

As someone who certainly unlike most of my colleagues has had to struggle with and without health insurance for my family, at times spending thousands because I believed we were covered only to realize that the only people covered were the insurance companies, while at other times my wife and I had to make medical decisions for my 2 year old daughter against the advice of our doctor because of money, I sincerely pray for a single-payer system that instead of illustrating that it's "government run" my fellow citizens recognize the truth that the people would own it. And with ownership comes power and choices.

But the only way we are going to get there is if the people's representatives are bombarded with the message that health care is too important for this country not to have a publicly-owned and operated system of health. So please call your members of the House and Senate and let them know you want a single-payer alternative, in fact keep calling them until they get the message! The lobbyists for profit don't ever rest and if you want this you're going to have to work overtime to get it done.

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